bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitudes and Self-Reported Competencies in Advocacy Among OB/GYN Residents [25I]
Authors: Hall Evelyn , Quinlan Maura , Gerber Susan 
Published: May 2017

INTRODUCTION:
The American College of Obstetricians and Gynecologists recognizes that education and training in advocacy is an important component of postgraduate education. However, there is little published literature on how to best teach advocacy to residents.

METHODS:
We administered an IRB-approved, self-reported, cross-sectional study of ob/gyn residents at Northwestern. The survey employed a 5-point Likert scale and was designed to assess residents’ experiences with advocacy training.

RESULTS:
Forty of 46 residents completed the survey. Among respondents, 95% felt that political advocacy is important to the field of ob/gyn, 92.5% believed government policies will affect their career, and 90% believed that formal training in advocacy and policy should be a part of residency training. Yet, only 38.4% felt that they had at least a basic understanding of Medicare billing and reimbursement policy, and 40% felt that their residency program encouraged advocacy. Residents did not feel that testing advocacy on national exams would improve their knowledge base in the area. While involvement in advocacy was common during medical school (90%), only 22.5% of residents were currently engaged in advocacy activities, and 27.5% were undecided if they would engage in advocacy during training. Common barriers reported were time, stress, and lack of knowledge on how to become meaningfully involved in advocacy work.

CONCLUSION:
Residents show high interest in advocacy, yet experience multiple barriers to becoming involved and report knowledge gaps on specific policy topics. Further research is needed to improve education and opportunities in advocacy for residents.
Impact of the Universal Adoption of Ring Block Anesthesia Pre-Circumcision in a Tertiary Care Center [26I]
Authors: Akinlaja Olukayode , Beck Roxanne , Josephsen Traci , Raper Mandi 
Published: May 2017

INTRODUCTION:
Neonatal circumcision causes behavioral and physiologic changes consistent with the perception of pain. Ring block anesthesia pre-circumcision leads to a smaller increase in heart rate and respiratory rate. They demonstrated less arousal during each operative interval, less crying and a smaller decrease in oxygen saturation compared to infants not receiving anesthesia. A Joint commission site visit to our institution in March 2014 prompted the adoption of pre-circumcision anesthesia preferably ring block in April 2014 with the mindset of providing our pediatric patients with the same high quality care during a painful procedure.

METHODS:
A descriptive analysis of circumcision related data pertaining to the use of ring block anesthesia during circumcisions performed at Erlanger tertiary care facilities from March 2013 through March 2015.

RESULTS:
The use of ring block anesthesia application increased to 94.1% (n= 1394) out of 1482 post adoption compared to the prior 41.1% (n=727) out of 1770). Of note is the reduction in the total number of circumcision done in the hospital from n=1770 between March 2013 and 2014 to n=1394 between April 2014 and March 2015 of the study period.

CONCLUSION:
The near perfect implementation of ring block anesthesia pre-neonatal circumcision does illustrate the importance of hospital encouraged compliance in improving the quality of medical practice.
Impact of Nightfloat on Obstetrics and Gynecology Resident Education [27I]
Authors: Fenton Alexandra , Dangel Alissa 
Published: May 2017

INTRODUCTION:
Nightfloat rotations are common in Obstetrics and Gynecology residency programs. The impact of this type of schedule on resident education in OB/Gyn has not been evaluated. This study was initiated to determine how the scheduling challenges of nightfloat rotations may impact OB/Gyn residents’ ability to participate in educational opportunities.

METHODS:
A cross-sectional study was conducted via two surveys. One survey was sent to all U.S. OB/Gyn residency program coordinators to collect information on their rotation structure and educational activities. A separate survey was sent to residents in these programs to evaluate their perspective on participation in educational activities while on nightfloat rotations.

RESULTS:
58 program directors (24.8% response rate) and 202 residents (16.1% response rate) from 54 programs responded. Of the program coordinators who responded, 98.2% reported having nightfloat rotation. Of these, only 8.8% had nightfloat specific educational activities. Attendance at regular didactic sessions was required by 33.9% of programs, however 76.9% of residents felt that they were not alert during these sessions. The survey also revealed that 66.4% of residents thought that their educational experience on nightfloat could be improved but most stated that required attendance at didactics would be ineffective. Residents’ suggestions for alternative options included ideas such as dedicated modules and recordings of regular didactic sessions.

CONCLUSION:
There is a need to improve the educational experience for residents on nightfloat rotations.
Impact of After Hour Availability of Gynecological Surgical and Clinical Supplies on Resident Satisfaction [29I]
Authors: Rosa Paola , Lospinoso Joshua , Weir Larissa , Miller Caela R. 
Published: May 2017

INTRODUCTION:
We studied if changing the availability of key surgical instruments and clinical supplies improved resident experience when treating gynecologic patients after hours.

METHODS:
Eighteen surveys were distributed to San Antonio Uniformed Services Health Education Consortium Obstetric/Gynecology (OB/GYN) residents. The survey was a five point Likert scale that focused on the opinions of residents regarding the availability of needed equipment, and their ability to evaluate and manage patients outside regular clinic hours. A comprehensive kit was then developed with essential supplies and made readily accessible to residents in the OB/GYN clinic and the emergency department. The same five point Likert scale survey was redistributed a year later. Statistical analysis was conducted by modeling survey responses with a cumulative (ordinal) logistic model. Cumulative logistic regression assessed whether Gynecologic call kit availability increased resident satisfaction while controlling for respondent year level and question-level idiosyncrasy.

RESULTS:
In our model, the creation of a Gynecologic call kit had a strong, positive, and statistically significant effect on improving resident satisfaction on surveys (P= < .005). Compared to a survey response after the call kit was available, a pre-intervention response was 13.2 times as likely to be one value worse on the Likert scale after controlling for resident year group, question and survey idiosyncrasies.

CONCLUSION:
Analysis of our survey responses concluded that clinical supply accessibility after hours is essential for resident satisfaction and the provision of quality patient care. Surveys showed increased resident confidence post intervention in their ability to appropriately treat patients and handle clinical emergencies.
Towards Prevention of the Primary Cesarean Section: A Multi-Factorial Approach [31I]
Authors: Runyan Aliye , Schiwek Jacqueline , Dudick Steven , Tamakuwala Sejal , Dai Jing , Puder Karoline 
Published: May 2017

INTRODUCTION:
To determine factors that influence the rate of primary Cesarean delivery within Detroit Medical Center (DMC), and whether indications for primary cesarean delivery fall within American College of Obstetricians and Gynecologists and SMFM recommendations. The primary Cesarean delivery rate for DMC hospitals for January - July 2014 ranges from 10.3 to 15.2% at our academic medical center, and from 10.6 to 21.5% at our community hospital. We looked at factors that contribute to this variability so that our hospitals may develop strategies to decrease rates of primary Cesarean delivery.

METHODS:
Retrospective chart review of 6 months of primary Cesarean deliveries in 2014 to determine indications. Survey to assess attitudes and behaviors in regards to provider threshold for calling a primary Cesarean, as well as resident and junior attending willingness to question decisions made by their seniors.

RESULTS:
The average age of women who had primary Cesareans was 26, the prior vaginal deliveries ranged from 0 to 8 with the majority of women (65.3%) having no prior vaginal deliveries, with a mean gestational age of 38 weeks. The most listed indications for Cesarean were FHT concern (51%) and category 2 tracing (47%). Fetal malpresentation (20%) and failed induction (15%) were also found in higher proportion.

CONCLUSION:
In order to foster dialogue regarding appropriate indications for Cesarean deliveries, it is good practice for a hospital system to perform self-assessment in the form of objective review as well as CME on how provider behavior can influence rate of Cesarean deliveries. Knowing the listed indications helps to focus on methods for prevention.
Randomized Trial of Self-Paced vs. Group Introduction to Open Surgical Skills Curriculum [34I]
Authors: Chen Lucy , Fuller Tobi , Kho Kimberly A. 
Published: May 2017

INTRODUCTION:
At UT Southwestern/Parkland residency program, incoming interns are traditionally taught core open surgical skills in a group setting by viewing 12 instructional videos consecutively followed by individual pre-testing. We sought to determine if introduction to open surgical skills via self-paced viewing of video tutorials, as opposed to traditional group viewing, results in improved surgical skill acquisition in OBGYN interns as measured by higher proficiency score with decreased workload stress and anxiety.

METHODS:
A randomized control trial was conducted in which OBGYN PGY-1 residents in 2015 and 2016 (N=36) were introduced to basic open surgical skills, such as knot tying and suturing, by viewing 12 video tutorials produced at UTSW (http://www.utsouthwestern.edu/education/medical-school/departments/surgery/minimally-invasive-surgery/simulation-training/video-tutorials.html). Residents were randomized to two groups: group viewing versus self-paced viewing. Validated proficiency score was measured based on time and accuracy while workload and anxiety were measured by pre-and post-testing surveys using the NASA-TLX and STAI-6 questionnaires.

RESULTS:
There was no significant difference in proficiency score between the group versus self-paced viewing in 8 out of 12 tasks using the Wilcoxon signed rank test (P>0.10). There was no statistically significant differences in workload stress based on the NASA-TLX questionnaire (P=0.399) or self-reported anxiety based on the STAI-6 questionnaire (P=0.607).

CONCLUSION:
Contrary to recent educational data suggesting self-paced learning may improve outcomes, viewing instructional videos in a group setting continues to be a time efficient method to introduce basic open surgical skills to incoming OBGYN interns.
HybridLab Learning Method. III. Residual Value of Gynecological Clinical Skills [35I]
Authors: Nadisauskiene Ruta , Vaitkiene Daiva , Barilienė Sonata , Andriejaite Ieva , Malakauskienė Laura , Pukenyte Evelina 
Published: May 2017

INTRODUCTION:
The aim was to evaluate the retention of clinical skills over time with or without the use of a checklist reminder strategy.

METHODS:
The 5th year students in OB/GYN rotation gain gynecological patient investigation skills (gynecologic history collection, breast examination, gynecological exam, Pap smear taking) by HybridLab method. The 1st structured standardized assessment was performed during rotation. After 4-12 months, 50 students randomly took part in the 2nd control investigation without checklist reminder (group A) or with (group B) in an identical clinical task.

RESULTS:
Initial evaluation of the results between the two groups (99.34 and 99.36%) and the average time interval between assessments (7.64 ± 2.8 and 1.6 ± 9:36) did not differ in both groups (P> 0.05). The mean evaluation of practical skills of 2nd assessment was 75.6% (SD 17.0) of students in group A and 88.6% (SD 14.0) in group B (p=0,005). The total valuation change (with and without a reminder) was 17.1% (SD 16.7). Group A demonstrated reduced performance by 23.4% (16.8), group B — by 10.8% (SD 14.2) (p=0,006). The duration between assessments had no influence on the performance results. Based on ROC test, we determined that the ratio of chances OR [95%C.I] for gynecological skills evaluation change less 15% in group B (after reminding) was 6.729 [1.939-23.356]; the ratio of chances OR [95%C.I] for gynecological history taking evaluation change less 5% was 11.0 [2.587-46.779].

CONCLUSION:
HybridLab method ensures achievement of necessary clinical skills, reminder significantly boosters their retention.
Faculty and Resident Perception of a Standardized Surgical Approach and Teaching Tool for Primary Cesarean Delivery [36I]
Authors: Pallister Megan , Ballas Jerasimos , Eppes Catherine , Belfort Michael A. , Davidson Christina 
Published: May 2017

INTRODUCTION:
In 2014, our department developed a surgical site infection (SSI) care bundle in an effort to reduce the SSI rate associated with cesarean delivery (CD). A component to this bundle was to reduce operative time by developing a standardized best-practices approach to CD. The objective of this study is to evaluate faculty and resident perception of surgical preparedness and learning environment before and after implementation of this standardized approach.

METHODS:
An online questionnaire was distributed to all residents and faculty prior to implementation of the surgical guidelines. The survey assessed attitudes towards technical proficiency, surgical preparedness, resources for surgical education and evaluation of resident surgical competency. The standardized approach was introduced as a departmental guideline; a PowerPoint presentation; and a high-resolution, first-person instructional video utilizing a head-mounted Go-Pro camera. A follow-up resident survey was conducted upon completion of their rotation and after 6 months post-implementation for the faculty.

RESULTS:
There was a significant increase in positive resident responses when asked if faculty spent time teaching surgical skills in the operating room. In response to whether a standardized surgical approach reduces autonomy there were significantly more “strongly disagree” and “disagree” responses POST group. Amongst faculty, there were significantly more negative responses and fewer positive responses post-implementation when asked whether a standardized approach would improve surgeons’ skills, improve team working skills or reduce the length of surgical time.

CONCLUSION:
Despite negative faculty perception of a standardized approach and teaching tool for primary CD, residents perceived greater teaching opportunities without loss of autonomy in the operating room.
Cost Utility Analysis of Methotrexate Versus Actinomycin-D in Low Risk Gestational Trophoblastic Neoplasia [2J]
Authors: Geisler John , Manahan Kelly 
Published: May 2017

INTRODUCTION:
To determine the most cost effective first line regimen for women with low risk gestational trophoblastic neoplasia (GTN) (WHO risk score 0-4 and no choriocarcinoma).

METHODS:
Markov decision model (1000 patients) was used to analyze published data GOG 174. Arm 1 was weekly methotrexate at 30 mg/m2 weekly while arm 2 was actinomycin-D 1.25 mg/m2 biweekly. Costs were based on average sale price (ASP) +6%. Utility values were determined by rating scale.

RESULTS:
The mean cost of therapy for methotrexate arm was $11,970 (95%CI $11,149-$12,791). The mean cost of the actinomycin-D arm was $26,865 ($26,780-$26,950). Weekly methotrexate dominated actinomycin-D as first line therapy.

CONCLUSION:
First line therapy of low risk GTN should be weekly methotrexate.
When to Worry About Cancer: Factors Associated With a Concurrent Carcinoma in Borderline Epithelial Ovarian Tumors [9J]
Authors: Sullivan Mackenzie , Modesitt Susan 
Published: May 2017

INTRODUCTION:
Borderline ovarian tumors are technically benign yet can actually metastasize, recur, or progress to a carcinoma (typically low grade). The objective was to assess the outcomes of epithelial ovarian borderline tumors to determine factors potentially implicated in adverse outcomes.

METHODS:
The pathology and cancer databases were searched at an academic tertiary care center to identify all borderline tumors. Clinical data were abstracted via chart review. Borderline cases with/without a concurrent carcinoma were compared using relevant statistical tests and factors for any recurrence assessed.

RESULTS:
A total of 123 borderline patients were identified. The mean age at diagnosis was 51.3 years, mean BMI was 31.5 kg/m2, 82% were white, 83.7% underwent BSO +/- hysterectomy/omentectomy, median time to recurrence was 16.8 months, and over 90% were disease free. An additional ovarian cancer diagnosis occurred in 25% (half low grade, three high grade, and 11 unknown grade). Compared to the borderline only group, the carcinoma/borderline patients did not differ significantly in age, race, BMI, parity, HRT, tobacco use, or personal/family cancer history, but were significantly more likely to be postmenopausal and have an elevated Ca-125. Additionally, the cancer patients had significantly decreased serous histology and increased mucinous or endometrioid histologies.

CONCLUSION:
Concurrent ovarian cancer is common in women with borderline tumors and is associated with postmenopausal status and elevated Ca-125 levels. While the majority of cancers were still serous, there was a higher percentage of mucinous and endometrioid histologies. These factors should alert clinicians to a potential increased likelihood of concurrent cancer.
Beta Adrenergic Blockade Is Feasible During Primary Treatment for Ovarian Cancer [10J]
Authors: Ramondetta Lois , Thaker Premal , Hu Wei , Urbauer Diana , Chisholm Gary , Sood Anil 
Published: May 2017

INTRODUCTION:
Adrenergic stimulation promotes EOC growth and metastasis. Nonselective beta-blocker (BB) women with EOC is associated with longer OS. The purpose of this study was to determine the feasibility of beta-adrenergic blockade in women with EOC during initial chemotherapy in a prospective clinical trial.

METHODS:
Women with suspected diagnosis of EOC, primary peritoneal or fallopian tube cancer with plan for tumor reductive surgery (TRS) or neoadjuvant chemotherapy were eligible. Patients (pts) began propranolol 10-20 mg BID 48 hrs prior to any treatment. QOL and serum levels of angiogenic cytokines were assessed. Random effect Tobit models were used to determine association between response and IL6, IL8 and VEGF.

RESULTS:
32 pts enrolled, 6 ineligible leaving 26 for analysis. Of 26 pts, 8 did not complete 6 cycles on BB. Only 1 pt stopped due to fatigue after 4 days of BB. Eighteen pts (69%) completed all 6 cycles on BB; 69% were white. Mean age was 58; 80% were stage IIIC- IV, 30% were primarily debulked and 85% had optimal TRS. Serum IL 6, IL 8 and VEGF correlated with response (p < 0.0001). For 18 pts completing 6 cycles on BB, overall QOL, anxiety and depression improved significantly (p=.03).

CONCLUSION:
The impact of adrenergic stimulation on cancer growth is well documented and deserves further evaluation in a randomized setting. Use of propranolol during primary treatment of EOC, PP/FT cancer is feasible and potentially results in improved QOL.
Uterine Carcinosarcoma as a Cancer Cluster? [11J]
Authors: Williams Brittney , Ziebarth Angela , Burns James 
Published: May 2017

INTRODUCTION:
Carcinosarcoma is a rare uterine malignancy. While the risks are similar to endometrial adenocarcinoma, it is more aggressive It accounts for approximately 4% of all uterine malignancies. The CDC defines cancer clusters as a geographic area with a greater than expected number of cancer case occurrences. There is limited data on uterine carcinosarcoma as a cancer cluster. The primary purpose of this review is to determine if there is a cancer cluster of uterine carcinosarcoma.

METHODS:
A retrospective chart review was performed. All patients with a pathologic diagnosis of carcinosarcoma in the Florida panhandle between 2008 to 2015 were reviewed. Patients were further identified based on uterine carcinosarcoma. Data collected included race, city and zip code, cancer stage at diagnosis.

RESULTS:
There were 31 patients diagnosed with uterine carcinosarcoma during this seven-year period. There were two geographic areas in which most of the patients 17 patients lived in the 4 main areas while 5 patients lived another 4 main areas in this region. In regards to race the majority of patients were Caucasian (20). Of the patients who were staged the majority were Stage 1 (8).

CONCLUSION:
Within a seven-year period, 31 patients with one type of rare cancer is a high number. Our patient population had more Caucasian patients. These two areas in the Florida Panhandle could represent a potential cancer cluster for uterine carcinosarcoma that could prove to provide new epidemiological data about this cancer. Further work to examine the geographical area and determine progression and overall survival are necessary.
Risk-Reducing Salpingo-Oophorectomy for BRCA Carriers: Is There a Benefit to Combination With Breast Surgery? [17J]
Authors: Liu Cici , Sims Travis , Kehoe Siobhan 
Published: May 2017

INTRODUCTION:
Patients with BRCA mutations must decide whether and when to perform risk-reducing salpingo-oophorectomy (RRSO). The combination of RRSO with mastectomy and/or breast reconstructive surgery is an attractive option. We evaluate the postoperative complication rates of RRSO in combination with breast surgery compared to RRSO alone.

METHODS:
A retrospective chart review was performed to identify patients treated with RRSO for a BRCA mutation at our institutions from 2002 through August 2016. Statistical analysis was performed using unpaired student's t, Fisher’s exact and chi-square tests.

RESULTS:
Out of 127 patients, 44 had combined breast and RRSO surgery while 83 had RRSO alone. Median age, BMI, and comorbidities were similar for both groups. The frequency of hysterectomy was also comparable: 41% in the combined vs. 46% in the RRSO group. Patients undergoing combined surgery had significantly longer mean operative times (412 vs. 164 min), more blood loss (218 vs. 96 mL), and longer hospital stay (3 vs. 1.4 days). However, the overall postoperative complication rates were similar between the two groups. Although most gynecologic procedures were performed laparoscopically, the RRSO group had more robotic surgeries and the combined surgery group had more laparotomies.

CONCLUSION:
For women with a BRCA mutation, it is a feasible and reasonable option to undergo risk-reducing salpingo-oophorectomy at the time of breast surgery. Combined surgery is associated with longer operative time, more blood loss, and longer hospital stay, but this was not associated with worsened postoperative outcomes. Further research is warranted to evaluate patient satisfaction and the cost-effectiveness of combined surgeries.