bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing Treatment Options for Uterine Fibroids: An EHR-based Algorithm for Registry Recruitment [12H]
Authors: Hoffman Sarah , Westreich Daniel , Vines Anissa , Halladay Jacqueline , Pfaff Emily , Nicholson Wanda K. 
Published: May 2017

INTRODUCTION:
COMPARE-UF is a national registry of women with uterine fibroids (UF) that will examine the effectiveness of different fibroid treatments on patient-centered outcomes. Electronic health records (EHR) may be used for efficient identification of eligible women within healthcare systems. An EHR-based algorithm was developed to identify women with symptomatic UF for recruitment into the PCORI-supported COMPARE-UF registry.

METHODS:
An iterative process was undertaken with a goal to maximize the positive predictive value (PPV) of the final algorithm. For the first algorithm, women were required to be age 18-54, have imaging confirming UFs or a diagnosis code for UF and no history of hysterectomy. The second algorithm required both imaging and at least 2 diagnoses codes for UF. The third algorithm required at least 2 diagnosis codes for UF on separate dates, and excluded patients who had UF detected during a prenatal or emergency department visits. Randomly selected charts were reviewed for each algorithm.

RESULTS:
The first algorithm identified 4,342 patients, with a PPV of 47% (95% CI: 39-56%) after 150 charts were reviewed with ultrasound evidence of UFs in 139 (93%). The second algorithm yielded 1,174 patients, with a PPV of 65% (95% CI: 50-79%) after reviewing 51 charts. The third algorithm yielded 465 patients, with a PPV of 76% (95% CI: 71-81%) after 300 chart reviews.

CONCLUSION:
An EHR algorithm can identify patients with UFs. However symptomatic UF cases can be challenging to distinguish from asymptomatic cases and require additional steps to confirm eligibility.
Retrospective Review of Prophylactic Bilateral Salpingectomy: Evaluation of Rates & Perioperative Complications [15H]
Authors: Bell Kristin 
Published: May 2017

INTRODUCTION:
Ovarian cancer is the most lethal gynecologic malignancy. Current evidence suggests that high grade serous ovarian cancer originates in the fallopian tube. It is thought that bilateral salpingectomy (BS) will decrease the risk of ovarian cancer. Our goal is to observe the trend in rates of BS at our institution over the last three years, and evaluate operative time and complications in those patients undergoing BS.

METHODS:
A retrospective chart review was performed. Records of patients who underwent hysterectomy with and without salpingectomy for benign conditions from January 1, 2012 through December 31, 2014 were reviewed. Charts were identified using CPT codes. Exclusion criteria included malignant pathology and history of bleeding disorder. Statistical Analysis was performed, using Student's t-test for continuous variables and the Chi-square test for categorical variables.

RESULTS:
In total 921 samples were collected. A significant increase in the rate of BS was seen over the observed time period (27.8% 2012, 41.9% 2013, 46.8% 2014, P < 0.0001). Length of procedure, estimated blood loss, intraoperative/postoperative complications and unplanned readmissions were the same in the BS and no BS groups. BS was more commonly performed in abdominal and laparoscopic hysterectomies compared to vaginal and robotic hysterectomies.

CONCLUSION:
Our findings demonstrate an increase in the performance of BS in benign procedures at our institution. There were no increased operative risks associated with performing BS at the time of hysterectomy. These results are consistent with the results of other facilities and should encourage routine planning for BS at the time of benign hysterectomy.
Who Should Manage Vulvar Disorders? A National Survey of Gynecology and Dermatology Residents [16H]
Authors: Yeung Jennifer , Crisp Catrina , Mazloomdoost Donna , Kleeman Steven , Pauls Rachel 
Published: May 2017

INTRODUCTION:
Vulvar disorders are unique, and it is unclear which specialty is responsible for screening the vulva. We sought to survey behaviors, knowledge and comfort of residents in obstetrics/gynecology (OB/Gyn) and dermatology regarding vulvar disease and evaluate differences among programs.

METHODS:
This was a cross-sectional, web-based, national survey of OB/Gyn and dermatology residents. Program coordinator email addresses were obtained from FREIDA Online®. Two separate emails requested coordinators forward the author-designed survey to current residents.

RESULTS:
Two hundred five surveys were completed: 67% OB/Gyn and 33% dermatology. The majority of both OB/Gyn (84%) and dermatology (77%) residents believed OB/Gyns are responsible for screening the vulva. Most OB/Gyn and dermatology residents reported thoroughly inspecting the vulvar area for lesions (62%), though 19% of dermatology residents reported never examining the vulva. Concerning comfort with managing vulvar lesions, only 2% of the total sample felt “very comfortable”. Regarding training, 53% overall reported this as “adequate”, whereas 4% believed they had “very good” training. One-fifth of OB/Gyn residents were “dissatisfied” with their vulvar disorders training. Most residents correctly identified images of vulvar melanoma (80%), squamous cell carcinoma (68%), and lichen sclerosus (98%). Ob/Gyn residents were more likely to correctly respond to items regarding vulvar melanomas (p=.032), biopsy performance (p < .001), and lichen sclerosus diagnosis (p < .001).

CONCLUSION:
Both cohorts believed OB/Gyns were the appropriate group to screen the vulva. Nevertheless, dermatologists should be able to and offer to perform this exam if not completed recently. A standardized curriculum regarding vulvar disorders could improve training in both specialties.
New Case-Complexity Score for Benign Minimally Invasive Hysterectomy- One Step Beyond the Current CPT Codes [32H]
Authors: Moawad Gaby , Tyan Paul , Marfori Cherie , Abi-Khalil Elias , Amdur Richard 
Published: May 2017

INTRODUCTION:
Evidence has shown several preoperative and intraoperative factors to clearly influence the complexity of minimally invasive hysterectomy. The only factor currently taken into consideration is uterine weight.

METHODS:
Retrospective cohort analysis of 196 consecutive patients undergoing robotic or laparoscopic hysterectomy for benign indications by fellowship-trained minimally invasive gynecologists at a single urban teaching university hospital.

RESULTS:
Our regression model predicting operative time using age, race, uterine weight, history of myomectomy, ovarian cystectomy, lysis of adhesions, ureterolysis, excision of endometriosis, and uterine artery ligation was significant (F=16.90, p < .0001) with R2 = .31. The variables that were significantly independently associated with operative time included log uterine weight (p < .0001), history of myomectomy (p=.014), ovarian cystectomy (p=.061), lysis of adhesions (p=.013), and excision of endometriosis (p=.027). Parameter estimates for each of these predictors were used to calculate a complexity score. This score was strongly correlated with operative time (Pearson r = .55, p < .0001). The association of the new complexity score with estimated blood loss (EBL) (Spearman r = .32, p < .0001), length of stay (LOS) (Spearman r = .15, p=.038), and cost decile (Spearman r = .21, p=.0035) were all significant. The Spearman r’s for the uterine weight > 250 g criterion with operative time, EBL, LOS, and cost decile were .41, .20, .07, and .15.

CONCLUSION:
In addition to uterine weight, history of myomectomy and numerous concomitant procedure variables (ovarian cystectomy, lysis of adhesions, excision of endometriosis), significantly affect case-complexity. The current model (250 g) does not adequately reflect case complexity.
Uterine Curettage Versus Presumptive Methotrexate for Non-Viable Pregnancy of Unknown Location [33H]
Authors: Parks Melissa , Barnhart Kurt , Howard David 
Published: May 2017

INTRODUCTION:
When managing a non-viable pregnancy of unknown location (PUL), it is unknown which factors influence the decision to perform a uterine curettage versus presumptive administration of methotrexate.

METHODS:
A prospective, anonymous electronic survey of PUL case scenarios was administered to physicians registered with the American Medical Association Physician Masterfile and to all Obstetrics and Gynecology residents and academic faculty located in the United States.

RESULTS:
A total of 214 physicians responded. When presented with a patient diagnosed with a PUL by transvaginal ultrasound and serial βhCG measurements demonstrating an inappropriate trend for a viable pregnancy, 78 (37.0%) would offer uterine curettage before administrating methotrexate while 67 (31.7%) would offer methotrexate presumptively. The odds of choosing uterine curettage was more than four-fold higher among academic physicians compared to resident physicians (adjusted OR 4.05, 95% CI 1.62-10.10). There was no difference between private practice physicians and resident physicians. Compared to physicians in the Northeast, physicians in the South were much more likely to select uterine curettage as their initial management strategy (adjusted OR 2.48, 95% CI 0.99-6.20).

CONCLUSION:
Resident physicians appear to be significantly more likely to presumptively administer methotrexate compared to academic physicians in the context of a non-viable PUL. If confirmed by larger studies, this finding has direct implications for future resident education.
Can We Predict Emergent Delivery in Cases of Suspected Placenta Accreta? [36H]
Authors: Razavi Armin , Fields Jessica , Chasen Stephen 
Published: May 2017

INTRODUCTION:
To identify factors associated with emergent delivery in women with a suspected placenta accreta.

METHODS:
This was a retrospective review of pregnancies with sonographic features of placenta accreta delivering at our institution from 2006-2016. Demographic information, antepartum course and delivery information were extracted from electronic medical records. Chi square analysis, Fisher’s exact test, Mann Whitney U tests and logistic regression were used in statistical analysis.

RESULTS:
Fifty-four patients with suspected placenta accreta were included. Nineteen patients (35.2%) had an emergent delivery and 42 (77.8%) had a confirmed accreta on pathology. Those undergoing emergent delivery were more likely to have one or more bleeding episodes prior to the time of delivery than those with scheduled delivery (73.7% vs. 37.1%; p=.01), and these patients delivered at earlier gestational ages than those without bleeding (33 vs 35 weeks, p = 0.03). Regression identified antepartum bleeding as an independent risk factor for emergent delivery, OR 4.7 [1.4-16.2]. Placenta previa, history of preterm birth, short cervix and prior uterine surgery were not predictive of emergent delivery. The median number of packed red blood cell units (PRBCs) transfused was greater in the emergent delivery group (4 vs 2, p=0.007) although ICU admission and length of hospital stay did not differ.

CONCLUSION:
Women with suspected placenta accreta who experience antepartum bleeding are more likely to require emergent delivery and have hemorrhagic morbidity. In those with one or more episodes of antepartum bleeding, earlier scheduled delivery could reduce maternal morbidity by reducing the rate of emergent delivery.
Cesarean Sections for Labor Arrest Disorders: Are We Moving to Cesarean Section Too Soon? [38H]
Authors: Smrekar Lisa M. , Perlow Jordan H. , Gerkin Richard D. 
Published: May 2017

INTRODUCTION:
Contemporary studies show that active phase of labor begins later and that labor may take longer to progress than previously thought. The rising cesarean section (C-section) rate has sparked focus on preventing the first C-section to minimize morbidity.

Objective:
To determine the percentage of women given adequate time in labor prior to C-section for labor arrest.

METHODS:
Retrospective review of C-sections for labor arrest disorders at Banner University Medical Center: January 1, 2013- December 31, 2013. Descriptive analysis was performed with means ± standard deviation or percentages. Comparisons used T-tests for continuous variables, χ2 tests for categorical variables, and logistic regression models were performed. A two-tailed P value less than .05 was considered statistically significant.

RESULTS:
155 women met inclusion criteria. 43.2% were given adequate time to progress in labor prior to C-section. Teaching service patients were significantly more likely to be given adequate time to progress compared to patients of other physicians (OR 2.91). For each additional centimeter of dilation at time of C-section patients had a 27% increase in having had adequate time to progress (OR 1.27). There was no significant difference in parity, age, body mass index, ethnicity, or spontaneous labor vs labor induction in women given adequate or inadequate time to progress.

CONCLUSION:
The majority of C-sections for labor arrest disorders were performed too soon, suggesting an opportunity to reduce the overall number of C-sections through physician education. We suggest other centers consider such internal reviews, which ultimately may contribute to a reduction in cesarean deliveries and associated morbidities.
Modern Learning: How Today’s Obstetrics and Gynecology Residents Gain Knowledge [2I]
Authors: Friedman M. Alexandra , Adjei Naomi , Wenstrom Katharine 
Published: May 2017

INTRODUCTION:
Little is known about OB-GYN residents’ habits or preferences with regard to self-education. We investigated current resident learning behaviors and preferences, as well as attitudes towards podcasting as an educational tool.

METHODS:
A 28 question survey was generated to query resident self-education generally and genetics education specifically. An invitation to complete the online survey was sent to all ACGME Program Directors, asking them to forward the survey to their residents. Data was collected and analyzed using Qualtrics Software.

RESULTS:
195 residents from 51/292 (17.5%) programs participated in the study. Average age was 28.9 years (SD 2.3 years), 85% were female, 13% were male. Half of residents (51%) reported spending between three and five hours a week on self-directed learning activities, excluding lectures, with 31% spending even less time, between zero and two hours. Residents reported they most commonly used UptoDate (129, 66%), Google (121, 62%), and Guidelines/Practice Bulletins (100, 43%) for learning. Guidelines and Practice Bulletins were considered very helpful for learning by 86% (167/195) followed by UpToDate (151, 77%). Only 35% (70) found textbooks helpful. A majority of residents reported they would be very likely to complete residency curriculum podcasts lasting 10 minutes (78%) or 20 minutes (63%). Residents would listen to podcasts while commuting to work (142, 78%), doing household chores (104, 53%), or exercising (50%).

CONCLUSION:
Residents spend five hours or less on self-education per week, and prefer concise, easily accessible learning modalities. Podcasts may be a useful educational tool for the modern OB-GYN resident.
A Prospective Trial: Traditional Versus Video-Based Teaching for Minimally Invasive Gynecologic Surgery [5I]
Authors: Truong Mireille , Tobias Claire , Ratan Rini 
Published: May 2017

INTRODUCTION:
To compare traditional versus video-based education in gynecologic surgery on task-specific cognitive and surgical skills performance among millennial trainees. To evaluate the impact of learning preference on performance.

METHODS:
Prospective study in academic medical center. OBGYN residents and medical students on gynecology were assigned to traditional (TT) or video-based (VBT) training for total laparoscopic hysterectomy skills. TT included routine didactic and clinical instruction. VBT additionally included two types of videos: 1) cognitive, 2) psychomotor skills-based. Participants received pre- and post-intervention knowledge and skills assessments. The VARK© questionnaire determined learning preference. Change in assessment scores was compared. The relationship between learning preference, intervention group, and change in assessment scores was analyzed.

RESULTS:
120 students (n=59 VBT v. n=61 TT) and 24 residents (n=12 per group) participated. Mean improvement in knowledge assessment score was 8.65 for VBT v. 7.03 for TT (p=0.02) for medical students, and 4.17 for VBT v. 4.09 for TT (p=0.98) for residents. Mean skills test score was 6.22 with VBT v. 4.28 with TT (p less than 0.001) for students, and 2.45 with VBT v. 0.36 with TT (p=0.04) for residents. Among students, as visual learning preference increased, change in knowledge assessment score increased (p=0.04, CI 0.01-0.49). A similar trend was seen with auditory learning preference (p=0.04, CI 0.01-0.56). Among residents, as auditory learning preference increased, change in skills assessment score increased (p=0.03, CI 0.08-1.34).

CONCLUSION:
Video-based teaching is an effective educational tool in gynecologic surgery. Cognitive and skills-based performance may be enhanced among individuals with visual and/or auditory learning preferences.
Communication Preferences and Norms Among Medical Students Entering Obstetrics and Gynecology [6I]
Authors: Page-Ramsey Sarah M. , Purusothaman Vaishnavi , Miller Katherine , Ramsey Patrick S. 
Published: May 2017

INTRODUCTION:
Global and mobile technology has reshaped communication in our society, impacting our next generation of OBGYNs. Our objective was to determine healthcare communication preferences among medical students entering OBGYN.

METHODS:
We surveyed medical students attending the American College of Obstetricians and Gynecologists Annual Medical Student Course from 2012-2014 regarding communicating results with patients, communication with other healthcare providers, answering patient questions, and counseling patients. Modes of communication included face-to-face, telephone, physician extenders, voicemail message, e-mail, text messaging, secure messaging, postal mail, and social networking.

RESULTS:
454 of 488 (93%) students from 45 states responded. Students would communicate normal results with patients by telephone (70%), physician extender (54%), secure messaging (50%), face-to-face (42%), postal mail (27%), e-mail (26%), voicemail message (19%), and text messaging (9%). For abnormal results, face-to-face communication (78%) was most common followed by telephone (32%), physician extenders (13%), and rarely voicemail messaging (2%), text messaging (< 1%), and snail-mail (3%). For general patient questions, students would use telephone (69%), face-to-face (47%) communication, secure messaging (45%), e-mail (43%), and text messaging (9%). When counseling patients, students were most likely to support face-to-face communication (80%) and very unlikely to choose text messaging (1%).

CONCLUSION:
Students planning a career in OBGYN will use multimodal communications with patients. Face-to-face, telephone, physician extenders, and secure messaging are commonly used. Postal mail and social networking are less common. Students plan to use text messaging and e-mail to communicate with patients in some situations, but not typically for abnormal results or counseling.
A Survey of Mobile App Use Among California Obstetrics and Gynecology Residents [8I]
Authors: Perry Rachel , Burns Roshan , Simon-Freeman Rebecca 
Published: May 2017

INTRODUCTION:
Mobile applications (apps) are increasingly used in the clinical setting. We aimed to describe the attitudes and practices regarding OB/GYN-related mobile apps among OB/GYN residents.

METHODS:
We sent web-based questionnaires to residents at all 17 California OB/GYN programs. Responses were analyzed using descriptive and chi-square statistics.

RESULTS:
The survey was completed by 197 residents (response rate 51%). All respondents owned mobile devices (100% smartphone, 74% tablet), and 95% used apps in the clinical setting. The most commonly used OB/GYN-related apps were pregnancy wheels (84%), cervical cancer screening algorithms (68%), and contraceptive eligibility guidelines (47%). Fewer (52%) residents recommended apps to patients, many citing not knowing of any. The majority of residents (62%) used mobile apps for their own learning, most commonly the American College of Obstetricians and Gynecologists app. Most chose apps based on recommendations from other residents. Residents viewed mobile technology as an important clinical tool (92%) that improves efficiency (89%). Mobile app use was not associated with gender, age, or year in residency (p>0.05 for each).

CONCLUSION:
Mobile technology and OB/GYN-related app use are ubiquitous among California OB/GYN residents, who feel that apps enhance their ability to care for patients. Because residents primarily choose apps based on the recommendation of other residents, leaders in resident education may consider evaluating app content and providing recommendations for app use. There is also opportunity to expand mobile app technology as a learning interface to enhance resident education.
Assessment of Fetal Ultrasound Training for Obstetrics and Gynecology Residents [24I]
Authors: Sulmers Christine , Diaz-Sylvester Paula , Cox Jill , Han Heeyoung , Delfino Kristin , Taylor Funminiyi 
Published: May 2017

INTRODUCTION:
Accreditation Council for Graduate Medical Education (ACGME) describes “the full range of commonly employed obstetrical diagnostic procedures, including ultrasonography” as one of the critical competencies required for graduation from an Obstetrics and Gynecology (Ob/Gyn) residency. However, prior studies identified a core curriculum deficit in residency programs. We explored these gaps to determine if they are worth addressing through future interventions.

METHODS:
A needs assessment survey was disseminated to all ACGME-approved Ob/Gyn residency programs in the USA.

RESULTS:
One-hundred-forty-four residents completed the survey. Of these, 73.6% had an ultrasound curriculum, of which 77.7% was accessible. Sonographers and faculty were rated as the principal educators. Almost half noted no checklist of competencies during their training, despite the fact that 63.2% were assessed via direct patient observations. Most frequent perceived knowledge deficits included: principle of as low as reasonably achievable (ALARA) and effect of frequency on resolution. Most frequent perceived performance deficits were skill in performing the anatomic survey and diagnosing chorionicity/amnionicity. The majority of respondents felt comfortable teaching/supervising basic obstetric ultrasound except anatomy ultrasounds and cervical length. Assessment of proficiency demonstrated weaknesses in the concept of ALARA, effect of frequency on image quality and identification of suitable crown rump length image. Overall, 76.3% desired more obstetric ultrasound training. Lack of first trimester ultrasounds and insufficient time were listed the most common obstacles to education.

CONCLUSION:
Additional obstetric ultrasound training for Ob/Gyn residents appears necessary. Improvements in designing an accessible curriculum and formally assessing competencies is fundamental for improving Ob/Gyn training programs.