bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of Cytology and Histopathology Results in an Immunocompromised Population [13E]
Authors: Downer Kimberley , Gabbur Nagaraj 
Published: May 2017

INTRODUCTION:
HIV and Renal Transplant patients are in general at higher risk for cervical dysplasia and cancer due to their immunocompromised status. However, the literature is not clear if these patients are at equal risk. The objective of the study is to compare PAP smear results as well has histopathology findings in these two populations.

METHODS:
A retrospective chart review of colposcopy patients seen at SUNY Downstate Medical Center with a history of HIV or Renal Transplant was performed. Each patient’s index PAP and colposcopy results were reviewed.

RESULTS:
A total of 61 HIV patients and 11 Renal Transplant patients were included. 29.5% (18/61) of HIV patients had an initial PAP result of ASCUS and 33% (6/18) of these patients had biopsies positive for precancerous lesions ranging from CIN 1 - 3. 54% (33/61) of HIV patients had an initial PAP of LSIL and 42% (14/33) of these patients had positive biopsy results. 10% (6/61) had an initial PAP of HSIL or ASC-H and 100% of these patients had precancerous lesions (CIN 1-3) or cervical cancer (1/6). Of the 11 Renal Transplant patients, 5/11 presented with ASCUS and 6/11 had LSIL. Only 3/11 had histopathology and all had CIN 1.

CONCLUSION:
An analysis of PAP smear results in these two populations reveals that HIV patients tend to have PAP smears of a higher grade with a higher incidence of dysplasia as compared to Renal Transplant patients. The reason for this is unclear but may be due to the underlying reasons for the immunocompromised state.
Assessment of Lifestyle Counseling Offered During Pregnancy [18E]
Authors: Schneider Jason , Spiryda Lisa Beth 
Published: May 2017

INTRODUCTION:
Mild to moderate exercise, proper diet, and appropriate weight gain during pregnancy are linked to numerous maternal health benefits and improved fetal outcomes. This study was done to assess discrepancies in current patient counseling offered by outpatient clinicians, with a future goal of creating standardized patient education programs.

METHODS:
IRB exempt status was obtained. Surveys were administered before obstetric office visits. Information gathered included age, race/ethnicity, insurance type, body mass index, education level, pregnancy history, and counseling/knowledge about diet, exercise, and weight management. Statistical analysis was performed with JMP and GraphPad statistical software.

RESULTS:
73 surveys were completed with 69 subsequently analyzed. Average age of participants was 30.25 years, gestational age ranged from 7-40 weeks with a mean of 25.2, and 29.4% were primigravid. Only 48.5% of patients received exercise counseling, 64.2% diet counseling, and 58.2% weight gain counseling. White and Black women were counseled more about diet than Asian women (p=0.045 and p=0.0067); Black women received more than Hispanic women (p=00192). Obese women received more exercise and diet counseling than normal-weight women (p=0.016 and p=0.0294). Underweight women also received more diet counseling than normal-weight women (p=0.0168). There were no differences in counseling about weight gain during pregnancy according to BMI class or race.

CONCLUSION:
The number of women receiving counseling on diet, exercise, and weight management during pregnancy is suboptimal. Of the patients receiving counseling, there is a discrepancy between races and weight. Future implementation of a standardized program is recommended to adequately educate all patients.
Impact of Telephone Reminder on Attrition Rate for Reading of Tuberculin Skin Test in Prenatal Visits [19E]
Authors: Chaudhuri Aparajita , Dad Nimra , Spilsbury Alexa , Sylvestre Georges 
Published: May 2017

INTRODUCTION:
Tuberculin skin test (TST) is widely used in detection of latent tuberculosis in pregnancy. Despite being economic and easily readable, a major limitation in its use is high attrition rate and therefore, missed reading. The aim of our study was to examine the change in attrition rate associated with a telephone reminder on the day prior to reading of TST.

METHODS:
This was a case-control study involving new patients who underwent the TST at the antenatal clinic of Flushing Hospital Medical Center between June, 2016 and September, 2016 were included in the study. Women who had TST in prior visits or known positive PPD status were excluded. A reminder telephone call was made to the patient 24 hours prior to the reading date. Data on age, parity, ethnicity, insurance status and English Language Proficiency (ELP) were collected and analyzed using Microsoft Excel. P < 0.05 was defined as statistically significant.

RESULTS:
Patients (N=100) were divided in two study arms: Group A (n=100, no telephone reminder) and Group B (n=100, received telephone reminders), which were comparable in terms of demography, parity and ELP. Attrition rate was 35% in Group A and 16% in Group B. Influence of parity, age, ethnicity, ELP and insurance status was also studied.

CONCLUSION:
A telephone call as a reminder to return is shown to be associated with reduced attrition rate for TST reading during prenatal care. Further studies should be directed at the cost analysis of this simple intervention.
Comparison of Breastfeeding and Exclusive Formula Feeding Rates 2-3 and 6-8 Weeks After Delivery Amongst Primiparas [21E]
Authors: Batig Alison , Carty Jenava 
Published: May 2017

INTRODUCTION:
Our study’s objective was to compare breastfeeding and exclusive formula feeding rates amongst primiparous women with an expressed intent to breastfeed during their admission for childbirth when randomized to either a 2-3 or 6-8 week follow up interval.

METHODS:
The data for this study was obtained as part of a randomized controlled trial that recruited term, primiparous women with an expressed intent to breastfeed to postpartum appointment intervals of either 2-3 or 6-8 weeks following childbirth. At the time of their postpartum encounter, their infant feeding method was categorized and compared using an odds ration with 95% CI.

RESULTS:
Of the 340 women enrolled in the study, 307 returned for a postpartum appointment where their infant feeding could be assessed. For 4 women in each group, infant feeding status was not denoted in their encounter record. Women randomized to the 2-3 week follow up interval were less likely to report exclusive formula feeding (OR 0.16, 95% CI 0.05-0.46, p < 0.01) and more likely to report breastfeeding of any degree (OR 6.41, 95% CI 2.15-19.11, p < 0.01).

CONCLUSION:
Amongst primiparous women with an expressed intent to breastfeed during their inpatient postpartum stay, our study demonstrated that women seen for earlier postpartum follow up were more likely to report breastfeeding to any degree and less likely to report exclusive formula feeding. Our findings suggest significant breastfeeding attrition may occur between 2-3 and 6-8 weeks after delivery. Understanding the timing for breastfeeding attrition may help us to target interventions to promote breastfeeding success and continuation.
Safety of Cosmetic Procedures During Pregnancy and Lactation: A Review [24E]
Authors: Trivedi Megha , Inouye Takeshi , Murase Jenny 
Published: May 2017

INTRODUCTION:
The safety of cosmetic procedures in pregnant and lactating patients is a complex clinical question surrounded by uncertainty. Our objective is to consolidate data on the safety of commonly requested cosmetic procedures in the pregnant and lactating population after systematic review of the current literature so as to guide evidence-based care in the future.

METHODS:
A systematic search of the PubMed database was conducted for articles pertaining to cosmetic procedures in pregnancy and lactation. Prior review literature was also referenced.

RESULTS:
Due to a lack of controlled trials, individual cases were also considered. Minor procedures that involve shave, punch, snip, or electrocautery or considered safe. With respect to chemical peels, glycolic and lactic acid peels are deemed safe; However, TCA and salicylic acid peels should be avoided or used with caution. Although safety data on botulinum toxin A is insufficient, is may be safe since systemic absorption and placental transfer are insignificant. Sclerotherapy can be safe in pregnancy but must be avoided in the 1st trimester and after the 36th week. Laser and light therapy have been considered generally safe for granulomatous conditions and condylomata. Epilation should be limited to waxing, shaving, and topicals instead of permanent procedures. In lactation, most therapies discussed above are safe but fat transfer, sclerotherapy, and tumescent liposuction are not recommended.

CONCLUSION:
More controlled trials are needed to make concrete recommendations on safety of cosmetic therapy during pregnancy and lactation, but preliminary evidence suggests excellent safety profiles for many commonly requested cosmetic procedures.
A Review of Laser and Light Therapy in Melasma [25E]
Authors: Trivedi Megha , Murase Jenny , Inouye Takeshi 
Published: May 2017

INTRODUCTION:
Melasma is a condition of facial hyperpigmentation and is commonly associated with pregnancy. Current treatments are unsatisfactory due to high rates of recurrence and adverse events. Laser and light therapy are often times the treatment of choice for refractory melasma. Our objective is to comment on both the efficacy and safety of the most commonly used laser and light therapies for melasma as published in the current literature.

METHODS:
A systematic literature search was done using the PubMed database. Key words included, “melasma” and “laser” in the title. A total of 442 results were obtained. Exclusion criteria were applied to the 442 search results. This systematic approach yielded 55 relevant prospective studies which were selected for review.

RESULTS:
Several types of laser and light therapy have been studied in the treatment of melasma. Of the Q-switched lasers, Qs Nd:YAG lasers have been the most effective especially with the use of sub-photothermolytic fluencies to reduce side effects. Intense pulsed light in combination with Qs Nd:YAG lasers and topical creams have shown to be effective in darker-skinned patients. Non-ablative lasers are often superior in safety to ablative lasers. However, non-ablative lasers are shown to be generally inferior to Qs Nd:YAG and should be used with caution in darker-skinned patients.

CONCLUSION:
Laser and light therapy, especially in combination with traditional therapies for melasma seem to be promising therapeutic modalities. More studies with longer term follow-up and varied patient populations are needed to further guide clinical practice.
A Survey of Obstetricians and Gynecologists Responses to Practices That Violate Female's Reproductive Rights [27E]
Authors: Shamshirsaz Alireza A. , Moaddab Amirhossein , Schulkin Jay , Stark Lauren , Raine Susan , McCullough Laurence 
Published: May 2017

INTRODUCTION:
In most Western countries there are no exact estimates of extent of health care professionals’ involvement in honor-related practices such as virginity testing, virginity restoration, and female genital mutilation/cutting (FGM). We aimed to conduct an exploratory, descriptive investigation of the experiences and attitudes of practicing OBGYNs in the U.S toward requests for these practices.

METHODS:
From June to August 2016, an anonymous online survey contained questions on physicians’ demographic and practice characteristics were sent to 1,000 fellows and junior fellows of the American College of Obstetricians and Gynecologists.

RESULTS:
Two-hundred and eighty eight OBGYNs responded to the survey for a response rate of 31.7%. During the last 12 months, 10.1%, 5.6%, and 58.6% of physicians provided care to at least one patient who requested for virginity testing, virginity restoration, or underwent FGM, respectively. Among all, 34.4% and 18.6% perform virginity testing and restoration, respectively upon requests which were not limited to the foreign nationals or immigrant generations. Only 10 (3.5%) of OBGYNs were aware of any institutional policies regarding receiving such requests. Surprisingly, three OBGYNs reported visiting patients who underwent FGM in the U.S. Only 34% of OBGYNs were aware that federal laws prohibit FGM.

CONCLUSION:
Although these practices are not ethically permissible, a significant number of OBGYNs perform the practices and are not aware of any available guideline/law in managing these patients. There is an urgent need for all obstetrician-gynecologists to act on their professional responsibility in the care of these patients.
Combined Hormone Pills: Physician Practice Patterns in Two Catholic Affiliated Community Hospitals [30E]
Authors: Pereira Stacey 
Published: May 2017

INTRODUCTION:
Our objective is to explore primary healthcare physicians prescribing patterns of oral combined hormone pills (CHP) in a community health setting specifically associated with a catholic hospital. CHP refers to any oral medication that contains both an estrogen and a progesterone.

METHODS:
Primary care physicians associated with two catholic affiliated community hospitals in Chicago, IL were identified. Physicians received an online survey via email which was resulted anonymously.

RESULTS:
A total of 45 respondents; 49% Internal Medicine, 27% OB/GYN, and 24% Family Practice. 64% had prescribed CHPs within the last year. Correct identification of contraindications to therapy as recommended per CDC was on average 73.47%. 68% of respondents routinely document discussion of VTE risk. Most commonly prescribed concentration of ethinyl estradiol is 20-25 mcg (60%) n=25. Only 54% of respondents prescribe < 7 refills. 58% of respondents continue to prescribe bi or triphasic pills. 33% of respondents require a pelvic exam for refill, 50% require an in-person appointment for refills. When prescribing for pregnancy prevention (n=23) 39% of respondents counsel a Sunday start.

CONCLUSION:
Catholic affiliated hospital physicians do prescribe CHPs. Important knowledge gaps exist within community physicians with regards to eligibility criteria for CHPs. There has been slow adaptation of recommended standards of practice with respect to CHPs such as number of refills given, physical exam requirements and other recommendations set forth by current population based research. Patient education by community physicians is lacking with regards to benefits of CHPs.
Determination of Optimal Routine Exchange Frequency After PCN Placement for Malignant Urinary Obstruction [35E]
Authors: Acosta-Torres Stefany , McDevitt Joseph , Zhang Ning , Xi Yin , Pillai Anil , Miller David S. 
Published: May 2017

INTRODUCTION:
To determine the optimal time for routine exchange of indwelling percutaneous nephrostomies (PCNs) in patients with malignant urinary obstruction.

METHODS:
Patients with urinary obstruction due to gynecologic malignancies who underwent placement of PCN that required at least one exchange from 2011-2013 were reviewed. Exchanges were classified as routine or due to one of three complication types: mechanical (tube dislodgement), obstruction, or infection. Charges for each complication type were defined as the median value from representative cases. The distribution of exchange types under different routine exchange frequencies was estimated with an Accelerated Failure Time Model and average yearly PCN-related hospital charges were estimated with a Markov Chain Monte Carlo model.

RESULTS:
33 patients with 57 exchange encounters were included. Median representative hospital charges were $3.4k for routine exchanges, $36.5k for infection, $10.5k for obstruction, and $8.3k for mechanical. The model predicted that with a 90-day routine exchange and 50% adherence, 25% of exchanges would be routine and 35% would be due to infection, which would improve to 47% and 20%, respectively, with a 60-day routine exchange and 75% adherence. Estimated yearly PCN-related hospital charges were $160.0k without mandated routine exchanges, and were lowest when routine exchange was performed at 60 days (savings of $22.9k ± $2.0k with 75% adherence). Projected savings increased as patient adherence improved, as projected savings with 60-day exchange were reduced to $7.6k ± $0.7k if adherence fell to 25%.

CONCLUSION:
Scheduled routine PCN exchanges every 2 months is the least costly strategy for patients with malignant ureteral obstruction.
Oral Contraceptive Preference and Prescription Patterns Among Primary Care Residents in an Academic Medical Center [1F]
Authors: Zhang Shiliang , Sridhar Aparna 
Published: May 2017

INTRODUCTION:
Oral contraceptive pills (OCPs) are the most widely-used form of reversible contraception in the United States. There are a variety of formulations available with little evidence in the literature on which to recommend over another. This study analyzes OCP prescription patterns among primary care residents within the University of California Los Angeles (UCLA) Health System.

METHODS:
An IRB-approved cross-sectional survey was administered electronically to residents in three primary care specialties (family medicine, internal medicine, obstetrics and gynecology). The survey contained questions analyzing frequency of OCP prescription, as well as attitudes and practices regarding prescription of OCP formulations. Data analysis was performed using univariate statistics.

RESULTS:
Survey response rate is 34% with 52 completed surveys. 52% of respondents reported prescribing up to 5 OCPs per week. A majority of residents (85%) demonstrated understanding of the pharmacological and clinical equivalences between generic and branded OCPs. However only 35% of residents felt comfortable helping patients choose an appropriate OCP or counseling patients on choices between generic versus branded pills. More than half of the respondents (62%) did not feel comfortable managing breakthrough bleeding with the use of OCPs. When asked to choose a “preferred” formulation, residents tended to choose a monophasic (72%), combined hormonal (92%), generic (72%) oral contraceptive pill.

CONCLUSION:
There is extensive redundancy of OCP formulations on the market. Improving knowledge of OCP prescription preferences is essential to clarifying common practices among physicians. Curriculum for primary care residents should elucidate the differences between formulations of OCPs, types of progestins, and relative side effects.
Postpartum LARC Use in Low-Risk Women in Centering Pregnancy® Versus Traditional Nurse Midwifery Prenatal Care [5F]
Authors: Hoff Tara , Hahn Petra , Huntly Jaimie , Sharma Deepti , Stockdale Colleen , Hardy-Fairbanks Abbey 
Published: May 2017

INTRODUCTION:
Despite the low failure rates of long-acting reversible contraceptive devices (LARC) of 0.05-0.8%, women typically choose less effective forms of contraception. This is of particular interest in the postpartum patient population with regards to prevention of short interval pregnancies, which have increased morbidity. This study investigates rates of LARC use in women who attend Centering Pregnancy® (CP), a standardized group care, versus traditional prenatal (TP) care with Certified Nurse Midwifes (CNM).

METHODS:
IRB approved, retrospective chart analysis was conducted for all women who participated in (1) GP care between March 2012 and May 2016 and (2) TP care during the same time period. Contraception status was recorded at discharge and at a scheduled 6-8 week postpartum visit.

RESULTS:
126 women participated in GP care and 847 women attended TP care. GP patients were more likely to be admitted to the antepartum service (33.6% vs 13.4%, P < .0001), deliver before 37 weeks (9.5% vs 3.8%, P=.004) and have a higher average of prenatal visits (14 vs 11, P < .0001). LARC use rates at discharge were similar between the two groups (27.8% vs 34.4%, P=.144). More women attended their postpartum visit in the GP group (94.4% vs 83.2%, P=0.001) and LARC use rates at the postpartum visit were not statistically different (31.9% vs 33.3%, P=0.764).

CONCLUSION:
Despite a greater number of prenatal visits among women who attended group prenatal care at our institution, there was no significant difference in LARC use rates at discharge after delivery or at the postpartum visit.
Postpartum Contraception Education: Contraceptive Choice and Use of Long-Acting Reversible Contraception (LARC) [6F]
Authors: Vaglio Meghan E. , Satterwhite Catherine , Wieneke Carrie , Fitzgerald Sharon 
Published: May 2017

INTRODUCTION:
Comprehensive contraception counseling provided in the postpartum period has the potential to increase LARC use.

METHODS:
A prospective observational study evaluating the impact of the Bedsider.org website contraception selection among consenting patients during the immediate postpartum period was conducted. After a baseline survey assessing their intended postpartum contraception method, participants were invited to use Bedsider to explore contraception methods. A follow-up survey was administered to determine participants’ contraception choice after having an opportunity to use Bedsider. The final contraception choice at the six-week postpartum visit was captured by chart review.

RESULTS:
Of the 103 participants enrolled, 65 participants completed both surveys (63.1%). The most common contraception method selected at baseline was oral contraceptives and Depo Provera (43.1%), with 16.9% indicating planned LARC use. A total of 8 participants changed their baseline method after visiting Bedsider; 5 reported intended LARC use. Among women attending a post-partum follow up visit (41/65), 24% received a LARC method at their visit. When compared to the intended method documented in the follow-up survey, one third of participants selected a different final contraception method at their postpartum follow-up visit (31.7%).

CONCLUSION:
Most patients were not influenced by the Bedsider tool. LARC education may be more effective if delivered in the prenatal period or at the postpartum visit.
Policies Restricting Medicaid Coverage for Pregnancy Termination in Women With Moderate Chronic Kidney Disease [8F]
Authors: Scrivner Karen , Clennon Emily , Savitsky Leah , Caughey Aaron B. 
Published: May 2017

INTRODUCTION:
Recent policies have attempted to restrict which reproductive health services Medicaid can cover. Under these policies, a woman seeking an abortion with renal disease requiring dialysis treatment, but not a woman with moderate (Stage 3) chronic kidney disease (CKD) can undergo a termination covered by Medicaid. Our objective was to analyze the costs and outcomes associated with a policy that does not cover a pregnancy termination in a woman with moderate CKD.

METHODS:
A decision-analytic model was constructed using TreeAge 2016 software, and all probabilities were derived from the literature. We calculated our costs and outcomes using a hypothetical cohort of 5,000 women with CKD who experience an unintended pregnancy and would be covered by Medicaid. Primary outcomes included the cost associated with this policy restriction and the cost per quality adjusted life year (QALY). A cost-effectiveness threshold was set at $100,000 per QALY.

RESULTS:
In our cohort of 5,000 women, restricting funding for abortion in cases of Stage 3 CKD results in an additional societal cost of $5 million. Our cohort also experienced a decrease of 20 QALYs, 3 more cases of progression to Stage 4 CKD and 1 to dialysis, the same number of neonatal deaths, 6 more cases of intrauterine growth restriction, 11 more preterm deliveries and 7 more instances of preeclampsia.

CONCLUSION:
Restricting Medicaid coverage for abortion results in an increased economic burden and worse maternal and neonatal outcomes. These policy bans should consider both the health care and economic impact to women when deciding to enact these policies.