bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Pregnancy Reasonably Excluded Guide on Pregnancy Testing in Outpatient Gynecologic Surgery [23H]
Authors: DeJong Stephanie , Holman Michelle A. , Ainsworth Alessandra , Adela Cope , Claire Flanagan , Long Margaret 
Published: May 2017

INTRODUCTION:
The Pregnancy Reasonably Excluded Guide (PREG) questionnaire is based on traditional methods of excluding pregnancy including sterilization, menopause, and the World Health Organization criteria. The PREG has been validated and shows a 99-100% negative predictive value for pregnancy (Selected practice recommendations for contraceptive use, 2013: adapted from the world health organization selected practice recommendations for contraceptive use, 2nd edition. MMWR Recomm Rep 2013; 62:1‒60.). Pregnancy testing in our outpatient surgical settings varied by provider. This study compared utilization of pregnancy tests in the outpatient gynecologic surgery setting after implementation of universal PREG administration.

METHODS:
All women undergoing outpatient gynecologic surgery were prospectively evaluated between March and September 2016. Administration of the PREG to women 18-49, excluding those undergoing procedures related to pregnancy, was implemented in July and rates of pregnancy testing pre- and post-implementation were compared using Fisher’s exact test.

RESULTS:
369 patients underwent an outpatient gynecologic procedure during the study period (excluding a two week washout period after implementation). In the pre-implementation group, 136 met inclusion criteria with 45 pregnancy tests performed (33.1%). After implementation, 80 patients met inclusion criteria and 17 pregnancy tests were performed as indicated by PREG response (21.3%), demonstrating over one third reduction in pregnancy test administration (p = 0.086). No pregnancy tests were positive and no false negative evaluations were identified. Physician and nursing staff requested continued use of the PREG after the trial.

CONCLUSION:
PREG administration on admission for outpatient gynecologic surgery consistently and effectively identifies patients in whom pregnancy testing improves the value of care.
Effect of Flibanserin on Sexual Functioning: An Analysis of Female Sexual Function Index Domains [24H]
Authors: Krychman Michael L. , Yuan James , Barbour Krista , Kissling Rob , Derogatis Leonard R. 
Published: May 2017

INTRODUCTION:
Flibanserin, a 5-HT1A agonist and 5-HT2A antagonist, is indicated for the treatment of acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. The Female Sexual Function Index (FSFI) is a validated self-report questionnaire comprising 6 domains of sexual functioning: desire, arousal, lubrication, orgasm, satisfaction, and pain. This post hoc analysis evaluated the effect of flibanserin treatment across the 6 FSFI domains.

METHODS:
Patient-level data were pooled from three 24-week, double-blind, placebo-controlled studies of flibanserin 100 mg once daily (qhs) in premenopausal women with HSDD. Between group differences in change from baseline to week 24 (last observation carried forward [LOCF]) on FSFI domain and total scores were evaluated using analysis of covariance.

RESULTS:
This analysis included 2368 women (flibanserin, n=1165; placebo, n=1204) who had at least one on-treatment efficacy assessment. The least-squares mean differences (standard error of the mean) in change scores from baseline to week 24 (LOCF) for flibanserin versus placebo were 0.3 (0.1) for the FSFI desire domain, 0.4 (0.1) for the arousal domain, 0.3 (0.1) for the lubrication domain, 0.3 (0.1) for the orgasm domain, 0.3 (0.1) for the satisfaction domain, 0.2 (0.1) for the pain domain, and 1.9 (0.3) for the total score; all P less than 0.0001 except P less than 0.01 for pain.

CONCLUSION:
Treatment with flibanserin produced significant improvement not only in the FSFI desire domain (a key outcome in clinical trials of HSDD) but also across the other domains of sexual function assessed by the FSFI.
Treatment Decision-Making Processes in the Systemic Treatment of Ovarian Cancer: Review of the Scientific Evidence [26H]
Authors: Luketina Hrvoje 
Published: May 2017

INTRODUCTION:
Background: The systemic treatment of epithelial ovarian cancer (OC) is one of the cornerstones in the multimodal management of advanced OC in both primary and recurrent stages of this disease. In most situations various treatment options are available but only few data exists about the treatment decision-making process. Therefore, we conducted a review of the current literature regarding the decision-making process concerning the systemic therapy in patients with advanced ovarian cancer.

METHODS:
The electronic database MEDLINE (PubMed) was systematically reviewed for studies that evaluate the treatment decision-making processes in patients with advanced OC.

RESULTS:
The PubMed database was searched in detail for all titles and abstracts of potentially relevant studies published between 1995 and 2011. An initial search identified 15 potentially relevant studies, but only seven met all inclusion criteria. Factors that influence treatment decisions in patients with OC include not only rational arguments and medical reasons, but also individual attitudes, fears, existential questions, various projections resulting from the physician patient relationship and the social environment. The physician’s personal experience with OC treatment seems to be an important factor, followed by previous personal experience with medical issues, and the fear of side-effects and future metastases. Family and self-support organizations also seem to play a significant role in the treatment decision-making process.

CONCLUSION:
This review underlines the need for more research activities to explore the treatment decision-making process to enable the best individual support for patients in treatment decision-making. It is a challenge for clinicians to determine the individual information needs of women with OC and to involve them during the decision-making process to the extent they wish.
Preoperative Factors and Surgical Routes for Outpatient Migration of Benign Hysterectomy [27H]
Authors: Moawad Gaby , Liu Emelline , Song Chao , Fu Alex 
Published: May 2017

INTRODUCTION:
To assess the impact of patients, physicians, hospital factors and the choice of surgical routes on the likelihood of benign hysterectomy (BH) in outpatient (vs. inpatient) setting.

METHODS:
We reviewed the Premier Hospital Perspective Databases for women ≥18 years old who underwent BH from 2008-2014. Patient-, surgeon-, and hospital-level factors, and surgical routes, were included in the analysis .The impacts of preoperative factors and surgical routes were analyzed via a logistic regression model.

RESULTS:
A total of 527,964 patients who underwent BH were identified. Patient factors contributed 43.3% to the likelihood of outpatient BH, surgeon factors 22.7% and hospital factors 4.4%; surgical routes and surgeon experience of MIS in outpatient setting were the top 2 individual factors that contributed 38.0% and 20.4%, respectively. Subtotal hysterectomy (OR 1.25, 95%CI 1.23-1.28) was more likely in outpatient; older, non-white, higher CCI, obese, and insured by Medicare were less likely for outpatient BH. Surgeons with experience of outpatient minimally-invasive surgery (OR 2.90, 95%CI 2.85-2.96), obstetrics & gynecology surgeons (OR 1.71, 95%CI 1.62-1.80) and hospitals in the South region (OR 2.17, 95%CI 2.13-2.22) were more likely to perform outpatient BH. Compared to laparoscopic, robotic-assisted BH (OR 1.05, 95%C I 1.03-1.07) were more likely, whereas abdominal BH(OR 0.017, 95%CI 0.016-0.018) and vaginal BH(OR 0.45, 95%CI 0.44-0.46) were less likely to be performed in outpatient. (All P values < 0.05).

CONCLUSION:
Surgical routes and surgeon’s previous experience of MIS in outpatient setting were more impactful factors. Choice of robotic-assisted surgical route was associated with increased likelihood of outpatient BH.
Hysterectomy and Peri-operative Blood Transfusion: Identifying Modifiable Risk Factors [31H]
Authors: Zitsman Sarah , Yu Daohai , Bruce Shaina F. , Ramirez-Caban Laura , Diaz Juan 
Published: May 2017

INTRODUCTION:
Blood loss and subsequent blood transfusion is a common complication in benign gynecologic surgery that has been understudied. The purpose of this study is to identify risk factors associated with peri-operative blood transfusion and highlight those that are modifiable for abdominal and vaginal hysterectomy.

METHODS:
Using a retrospective study design between 1/1/2008 and 4/30/2014, 562 of 667 hysterectomies were included. Hysterectomies performed peripartum or for cancer were excluded. Risk factors examined include race, pre-operative hemoglobin, body mass index (BMI), surgical route, and uterine size. Comparisons between subgroups were performed using Chi-square or Wilcoxon test. Blood transfusion rate, odds ratio (OR) of transfusion and its 95% confidence interval (CI) were reported. Multiple logistic regression was used to identify potential risk factors for peri-operative blood transfusion.

RESULTS:
The overall transfusion rate was 13.3% (75/562) and differed for abdominal versus vaginal hysterectomy (18.0% vs. 6.8% P < .001). Pre-operative hemoglobin less than 10.6 g/dL versus greater than or equal to 13.1 g/dL had five times the odds of transfusion (95% CI 2.4-13.5). Uterus size greater than 470 gm versus less than or equal to 108 gm had fourfold odds of transfusion (95% CI 1.5-14.3). African Americans had twice the odds of transfusion (95% CI 1.2-4.5), despite controlling for increased uterus size and lower hemoglobin. There was no statistically significant association between BMI and transfusion.

CONCLUSION:
This study identified lower pre-operative hemoglobin, larger uterus size, and African American race as three important risk factors. Prior to hysterectomy, hemoglobin should be optimized above 13.1 g/dL, especially for patients with large uteri and African Americans.
Impact of Extremely Advanced Maternal Age on Pregnancy Outcomes [35H]
Authors: Hollenbach Stefanie , Miller Lauren A. , Olson-Chen Courtney , Li Dongmei , Dye Timothy , Thornburg Loralei 
Published: May 2017

INTRODUCTION:
The proportion of women giving birth after the age of 45 has increased significantly over the last several decades for a multitude of reasons. We set out to describe perinatal outcomes for women as pregnancy progresses from advanced (35 or older) to extremely advanced maternal age (45 or older).

METHODS:
The NYS Perinatal Data System in Upstate New York contains information on 724,802 pregnancies from 2005-2014. Pregnancy outcomes compared between women less than age 35 and those 35-39, 40-44, 45-49 and 50 and older at delivery. Chi-square testing utilized for categorical variable analysis (significance p-value less than 0.05); odds ratios (OR) calculated for significant comparisons. Significant results were controlled for the use of assistive reproductive technologies (ART) and pre-pregnancy risk factors.

RESULTS:
A total of 104,776 women were 35 or older at delivery with 1460 women 45 or older. Compared to women younger than age 35, women 45 or older had increased pre-pregnancy risks including increased pre-gestational diabetes and hypertension (HTN), as well as worse maternal and fetal pregnancy outcomes including preterm birth OR 2.45 (CI 2.15-2.78) and pregnancy-associated HTN OR 1.95 (CI 1.63-2.35). These results were ameliorated but persisted after controlling for multi-fetal gestations, with preterm birth OR 1.65 (CI 1.07-2.55) and pregnancy-associated HTN OR 2.03 (CI 1.25-3.31) remaining more prevalent.

CONCLUSION:
Maternal and fetal risks increase as maternal age progresses. Increased incidence of multi-fetal gestation contributes to—but does not appear to comprehensively explain—the difference in risk for these women. This has implications for preconception counseling, antepartum care, and delivery planning.
Medical Student Education in Abortion Care: A Survey of Exposure, Knowledge and Attitudes Among NYC Medical Students [9I]
Authors: Figueroa Melissa M. , Lunde Britt , Jacobs Adam , Chen Katherine , Dean Gillian 
Published: May 2017

INTRODUCTION:
To assess the impact of Ryan Residency Programs on New York City (NYC) medical student exposure to, knowledge of, and attitudes towards abortion services following their clerkship in OBGYN.

METHODS:
An online survey of medical student exposure to, knowledge of, and attitudes towards abortion was created. The APGO educational objectives for abortion were used to develop knowledge questions. ACGME and Ryan Residency Program websites were used to identify medical schools and presence of Ryan programs at each clerkship site. Clerkships directors distributed the survey to students at the completion of their OBGYN clerkships. Data was evaluated using χ2 tests for categorical responses and multivariate analysis to control for confounding variables.

RESULTS:
5/6 medical schools with M.D. candidacy in NYC participated. 169 students completed the survey. 9/17 have Ryan programs. 43.2% reported routinely scheduled exposure to abortion services during the clerkship, with no difference between the Ryan and non-Ryan Program groups (p=0.10). Half (51.3%) of respondents failed the knowledge exam with no difference between the groups (p=1.0). Most students (94.8%) feel abortion should be available to women as a part of women's health care services, and that abortion is an important part of the medical school curriculum (87.8%).

CONCLUSION:
No significant difference in abortion-related knowledge, attitudes or exposure between NYC students completing clerkships at sites with and without a Ryan Residency Program. Overall, routine exposure to abortion was low, and knowledge was low. Despite this, most medical students favor including abortion education in the core medical school curriculum.
Knowledge and Perceptions of Zika Virus Among Reproductive-aged Women in Miami, Florida [11I]
Authors: Billero Victoria , Fein Lydia A. , Tse Colette , Hellerstein Leah , Messore Marisa , Curry Christine 
Published: May 2017

INTRODUCTION:
To understand the knowledge and perceptions of Zika Virus among reproductive aged women living in Miami, Florida, the first area of the United States with local transmission.

METHODS:
Participants included reproductive-aged women attending a gynecology clinic visit in Miami-Dade County during the four weeks immediately following the announcement of local Zika virus transmission. The survey evaluated knowledge and perceptions of Zika Virus in three categories: pathogenesis and transmission, sequelae of infection, and epidemiology and public health information.

RESULTS:
Fifty-nine women (age range 18-45) completed the survey. Patients who desired or were unsure about desiring pregnancy in the next year (n=15) and those who did not desire pregnancy (n=44) received most of their information about Zika virus from the media rather than their doctors. All had a high level of knowledge in all three categories; there existed no statistically significant difference between the two groups regarding knowledge of Zika virus. Concern about spread of Zika virus in the community was greater in those desiring pregnancy (n=14, 93.3%) than those not desiring pregnancy (n=21, 79.5%, p=0.24). Personal concern about becoming infected with Zika virus was significantly higher in those considering pregnancy (n=13, 86.7% vs n=21, 47.7%, p=0.01).

CONCLUSION:
In the weeks following recognized local transmission of Zika virus, reproductive aged women had a high level of knowledge about Zika virus, but it was those considering pregnancy who had the greatest concern about personal risk of infection.
DEXA for Females Aged 65+ at an OBGYN Resident Clinic in Hawaii: A Chart Audit on Compliance for Osteoporosis Screening [13I]
Authors: Bullock Holly , Scogin K. Nicole , Gaspar-Oishi Maria 
Published: May 2017

INTRODUCTION:
Osteoporosis is a skeletal disorder of aging, caused by loss of bone mass and deterioration in both bone quality and micro-architecture. The U.S. Preventive Services Task Force (USPSTF) recommends women ages 65 and older without previous known fractures or secondary causes of osteoporosis be screened using Dual-Energy X-ray Absorptiometry (DEXA).

METHODS:
This retrospective chart review assessed compliance with osteoporosis screening guidelines in a resident clinic. We reviewed all charts of female patients 65 years or older at the Women’s Health Firm of Queen Emma Clinic in Honolulu, Hawaii from July 1, 2014 through July 1, 2015. Age, ethnicity, insurance type, presence of DEXA results and ordering provider type were abstracted. Associations between patient characteristics and DEXA screening were evaluated.

RESULTS:
96 charts were reviewed with 87 meeting inclusion criteria, with mean age 69.6 (SD + 4.6) years. Of those, 92% (80/87) were offered DEXA screening with 87% (76/87) undergoing the test. Of the 11 untested, four were offered screening and refused; two refused outright and two declined while awaiting insurance coverage. Of the remaining 7 untested, four women presented for problem visits and three had no charted explanation precluding screening. There was no differences by race (P=.8) or insurance type (P=.5). OBGYNs and Primary Care Providers ordered equal numbers of scans (38/76 for both, P=1.0).

CONCLUSION:
DEXA scan is the gold-standard for diagnosing osteoporosis and recommended by USPSTF, yet screening referrals are not universal for eligible women in resident clinics. Tailored education for residents regarding this infrequently seen demographic group is needed.
Inpatient Consultation Communication: Hospital Culture and Perspectives [15I]
Authors: Heiselman Cassandra , Smelcer Philip , Shah Khooshali , Cottrell Connie , Lavin Justin 
Published: May 2017

INTRODUCTION:
Obstetrical and Gynecological consultations are a significant component of the workflow within the healthcare system. Ineffective consult-related communication can lead to poor outcomes, costly medical errors, and suboptimal medical care.

METHODS:
This was a cross sectional mixed quantitative/qualitative survey design evaluating physicians’ perception regarding the inpatient consultation process. Physicians were asked to rank inpatient services with regards to quality of communication when requesting a consultation, to indicate the importance of specific behaviors during the consultation process, to assess the need for change, and to make suggestions for improvement.

RESULTS:
243 (32.4%) of 750 physicians completed the questionnaire. The OBGYN services ranked second for quality of communication as both the consultant and the consulter with only the Medical Subspecialties service ranking higher (p < 0.0001). Across specialties, the most important consultation elements identified were asking a clear question (91.2%) and answering the initial page in a timely fashion (84.3%). The distribution of consultation components considered essential differed across specialty groups (p < 0.0001). Direct communication by the consultant (p < 0.0001) and the consulter (p < 0.0001) were considered critical elements by OBGYN physicians. 89.5% of all physicians perceived a need for change within the consultation culture. The most frequent suggestion for improvement was direct physician-to-physician communication.

CONCLUSION:
Different specialties consider different consultation components essential, making it challenging for OBGYN physicians to effectively communicate with other services. Results suggest the need for well-designed hospital guidelines for consultations that include direct communication between providers and clear, specific clinical questions.
Patient Comprehension of Gestational Weight Gain Recommendations and Associated Pregnancy Outcomes [16I]
Authors: Niemasik Erin E. , Chasen Stephen , Taubel Debra 
Published: May 2017

INTRODUCTION:
Gestational weight gain above the Institute of Medicine guidelines is associated with obstetric and fetal complications. American College of Obstetricians and Gynecologists recommends that weight management begin before conception and continue through the postpartum period. We assessed patients' knowledge of gestational weight gain recommendations and associated outcomes.

METHODS:
One-hundred-seventy-three women completed a survey at a prenatal visit after 20 weeks gestation. After delivery, a chart review obtained the patient’s starting and ending pregnancy weight and BMI. Pearson Chi-square testing and the Related Samples Wilcoxon Signed Rank test were used.

RESULTS:
Overall 44% of our studied population were overweight or obese. When assessing physician counseling of weight category, only 39% of women recalled being told their starting BMI (p=0.24). In addition, the majority (59%) reported receiving no counseling on pregnancy outcomes associated with starting BMI or excessive gestational weight gain (p=0.004). Less than one-third of overweight and obese women gained within guidelines (p=0.001), and most gained above guidelines (p=0.001).

CONCLUSION:
The majority of women gain in excess of guidelines. Excessive weight gain is associated with childhood and maternal health complications, including obesity. Our study shows that few women receive or retain information on weight recommendations and associated risks of excess gain. Not only are women unprepared for the immediate risks posed by excess gain, they are also more likely to retain weight which is a significant contributor to ill-health. Improved patient education could significantly reduce adverse outcomes in the United States related to excessive weight gain.
A Synthetic Cannabinoid Use in Pregnancy: A Brief Educational Intervention for Obstetric Providers and Patients [19I]
Authors: Sellers Jeffrey , Nunes Vanessa 
Published: May 2017

INTRODUCTION:
Synthetic Cannabinoid (SC) use is on the rise with the Substance Abuse and Mental Health Services Administration reporting a doubling of visits to Emergency Departments between 2010 and 2011 and has continued to rise resulting in increased federal attention and regulation. An acute intoxication syndrome is characterized by sympathomimetic effects, psychosis, hallucinations, delirium, acute kidney injury and even death. This drug is not detected by routine urine drug testing and no rapid testing currently exists. There is no antidote and treatment is largely supportive. The Obstetric Provider should be familiar with the mechanism of action, presentation, workup and treatment of this drug and its particular obstetric sequelae.

METHODS:
A literature review was performed on the SC and Pregnancy on the PubMed database and found 0 studies on SC use in Pregnancy. One study was found regarding SC and potential reproductive outcomes. An extensive literature search was then performed on SC use in non-pregnant patients. This information was used to create two brief evidence-based educational pamphlet one for providers and one for patients.

RESULTS:
The synthetic cannabinoids should be avoided in pregnancy. There is a baseline danger of the acute intoxication syndrome with these substances that can put the maternal fetal unit in danger. Pregnancy specific concerns include the effects of cannabinoids on neuronal migration in early pregnancy and the impact of altered autonomic regulation on the fetoplacental unit.

CONCLUSION:
An evidence based intervention for Obstetric Providers and Patients may help provide information on this growing substance epidemic for both obstetric providers and patients.