bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of COVID-19 on the Cultural Transition Towards the Use of Midwives Over Standard Doctors of Medicine [ID 2683504]
Authors: Wells Brittney , Dickey Erin , Nelson Bridgett , Currier Chase , Kleffner Alison , Halfar Matthew A. 
Published: May 2024

INTRODUCTION:
In recent times, the use of midwives as obstetrical providers has become increasingly popular within the United States. Unsurprisingly, the SARS-CoV-2 pandemic (COVID-19) had a large effect on societal trust of health care, including providers, and thus this study aimed to determine whether the pandemic further accelerated the cultural transition towards utilizing midwives as birth attendants.

METHODS:
Using the CDC Natality Database, we reviewed deliveries from 2016 to 2021 of previously healthy mothers, ages 18–35, with singleton pregnancies, measuring incidence of birth attendants including MDs, DOs, nursing midwives, and non-nursing midwives. A binomial model was used to perform logistic regressions to assess whether COVID-19 correlated with alterations in rates of transition of birthing attendants.

RESULTS:
Rates of deliveries attended by MDs declined at a greater extent, whereas births attended by DOs increased at a lesser rate, and nursing midwives and non-nursing midwives increased at a greater rate (change in rates pre-to-post COVID-19: −0.390%, −0.084%, 0.044%, and 0.204%, respectively; P<2.2×10−16). Although this rate of change was small, since the start of COVID-19 there has been an 11% increase in non-MD-attended deliveries, nearly double the rate seen prior.

CONCLUSION:
There has been a significant increase in the number of deliveries attended by DOs, nursing midwives, and non-nursing midwives over the past several decades, even more so since the start of COVID-19. With the transition in the utilization of health care professionals, further investigation needs to be conducted to assess the effects this has on health outcomes of the mother and infant.
Perceptions About Marijuana Use in Pregnancy Among Pregnant Users and Nonusers in a State Without Legalized Recreational Cannabis [ID 2683513]
Authors: Ramseyer Abigail , Kennon-McGill Stefanie , Miron Laura L. , Wells Cheryl H. , Davis Kaitlyn , Ray-Griffith Shona 
Published: May 2024

INTRODUCTION:
Cannabis use in pregnancy is rising. The objective of this study is to compare attitudes regarding marijuana use among pregnant users and nonusers.

METHODS:
This was a prospective study (IRB #262700) in which a 35-question, anonymous survey was distributed to pregnant patients at outpatient prenatal visits across gestation. Questions included topics regarding marijuana use in pregnancy, perceived risks, and provider–patient education.

RESULTS:
408/460 (88.7%) approached pregnant patients completed the survey. Self-reported rate of marijuana use during pregnancy: 11.8% (48/408). There were no ethnic differences in users and the most common age for use was 18–24 years (24/48). 79% (38/48) reported use two to three times weekly or greater. Average response score (Likert scale) for participants using marijuana compared to those who did not to the following statements were statistically significant and positive towards prenatal use: belief that pregnant patients should refrain from marijuana use: 2.31 versus 3.53 (<.001); acceptability of medical marijuana: 3.68 versus 2.82 (<.001); minimal health risk: 4.15 versus 2.96 (<.001); support for legalization of recreational marijuana: 4.58 versus 3.51 (<.001). Lack of counseling on cessation and risk of cannabis use in pregnancy were reported by 82% and 84% of participants with 74% of current users reporting lack of counseling. 54% of users desired more information regarding cannabis-related pregnancy complications.

CONCLUSION:
Higher-than-expected self-reported marijuana use during pregnancy. Lack of counseling on risks of marijuana use and importance of cessation highlight an important opportunity for counseling and intervention supporting current ACOG guidelines of SBIRT (screening, brief intervention, and treatment referral).
Assessing Patient's Feelings About Their Pregnancy: A Preliminary Qualitative Exploration of Conversations Between Obstetric Clinicians and Pregnant Patients at the First Prenatal Visit [ID 2683659]
Authors: Picciotto Andrea , Chang Judy C. 
Published: May 2024

INTRODUCTION:
During the first prenatal visit, some patients may feel overwhelmed, ambivalent, or undecided about continuing the pregnancy. Understanding a patient’s feelings about the pregnancy can allow obstetric clinicians to offer support, resources, and options. Few studies have empirically examined how obstetric providers assess patient’s feelings about their pregnancy.

METHODS:
We analyzed transcripts of audio-recorded patient–obstetric clinician first obstetric visits for discussions exploring the patient’s feelings, intentions, or desires regarding their pregnancy. These discussions were then coded for content and communication approach.

RESULTS:
We coded 100 transcribed visits. Discussions about pregnancy intent, desire, or feelings occurred in 70 visits. In 11 visits, the clinician used an open-ended neutral question (eg, “how are you feeling about this pregnancy?”). Fifteen clinicians expressed assumptions about the patient’s feelings regarding the pregnancy (eg, “congratulations!”). Fifty-seven clinicians specifically asked about intendedness (eg, “Was this a planned pregnancy?). Twenty-one addressed the topic with leading statements (eg, “but you want to keep the baby, right?”). Of the 53 patients that admitted to an unplanned pregnancy, only 42 (79%) of these conversations were further explored—29 (54%) specifically only asked about patient’s desire to continue the pregnancy; 13 (24%) provided additional options counseling, information, or support.

CONCLUSION:
Few obstetric clinicians explored the feelings and desires about the pregnancy during first obstetric visits. Further work is needed to explore improved methods of addressing how patients feel about their pregnancy.
Melanoma in Pregnancy: A Shocking Report [ID 2683420]
Authors: Dubey Shresttha , Montes Andres I. 
Published: May 2024

INTRODUCTION:
This case describes the clinical course of a 25-year-old patient presenting for her 16-week obstetric check who was emergently diagnosed with stage 4 melanoma with metastasis to the oral cavity, liver, and skin. The young age of the patient and rapid advancement of the disease make this case worthy of attention. The study of this patient is designed to provide context and data for the actively growing body of literature on the potential relationship between pregnancy and melanoma, which is not currently understood. The goal of this case report is to contribute to the current literature, which is divided on whether there is a relationship between melanoma and pregnancy and whether a potential relationship is clinically relevant.

METHODS:
The hospital course of the patient was studied and written out in case report format. Patient consent was obtained to present her hospital course at conferences.

RESULTS:
Excisional biopsy of subcutaneous flank nodule was done, which confirmed diagnosis of stage 4 melanoma. The patient was started on chemotherapy, and treatment is ongoing.

CONCLUSION:
The case of a 25-year-old pregnant patient who was found to have stage 4 melanoma with metastasis has an important role in the ongoing investigation of the potential relationship between pregnancy and melanoma. This case is noteworthy because of the young age of the patient, the aggressive spread of the disease, and the ethical questions raised when treating cancer in a pregnant patient.
Association of Low Levels of Placental Growth Factor and Fetal Growth Restriction in a Setting With a High Prevalence of Diabetes [ID 2683431]
Authors: Figueiro-Filho Ernesto A. , Vinken Jamie , Versteeg Kathryn , Orieux Alyx , Grzyb Karolina 
Published: May 2024

INTRODUCTION:
Placental growth factor (PlGF) is a glycosylated protein from the vascular endothelial growth factor (VEGF) family that is involved in placental angiogenesis. In cases of placental dysfunction, decreased maternal serum PlGF levels predict the development of pregnancy complications such as preeclampsia, fetal growth restriction (FGR), and stillbirth.

METHODS:
Datasets from 114 high-risk patients who had clinical indication for PlGF testing from 2021 to 2023 were collected retrospectively. The anonymized dataset comprises PlGF test results categorized by gestational age-specific ranges and FGR categorized by percentile. Chi-squared analysis of 114 patients was used to assess the association between PlGF levels and FGR (less than 10th percentile). This study was approved by REb-USask #Bio3702.

RESULTS:
Of the 114 patients, 21 (18.4%) with low/very low PlGF and 8 (7.1%) with borderline/normal PlGF had fetuses with FGR less than 10th percentile. There was a significant difference between groups with a low/very low PlGF and normal PlGF levels (P<.001). The negative predictive value (NPV) for development of FGR less than 10% was 97.54%.

CONCLUSION:
Data collection is ongoing; however, in our patient population with a high prevalence of diabetes, preliminary data from 114 patients suggest that gestational age-stratified maternal serum PlGF levels have high NPV value for development of FGR less than 10th percentile. The implementation of this simple laboratory test in rural and remote communities would allow for earlier identification of pregnancies that require more intensive surveillance at a high-risk center of care.
Compliance With CDC-Recommended 7-Day Chlamydia Treatment in Nonpregnant Adult Female Patients in Low-Resource Communities: 1-Year Data [ID 2683472]
Authors: Pyle Adrienne , David Rochelle , Onukwube Sopuruchukwu I. , Plastino Kristen A. 
Published: May 2024

INTRODUCTION:
In 2021, the Centers for Disease Control and Prevention (CDC) changed treatment guidelines for chlamydia (Chlamydia trachomatis) infections in nonpregnant women, as substantial data demonstrated oral doxycycline at 100 mg twice daily for 7 days as superior to one-dose oral azithromycin at 1 g. Previously, the two antibiotic regimens were considered equivocal, allowing providers to opt for the shorter regimen course to optimize compliance and cure rate.

METHODS:
We assessed the compliance rate of patients in low-resource communities to the multidose doxycycline regimen via retrospective chart review. For a 12-month period, all nonpregnant adult female patients prescribed doxycycline for chlamydia infection at a county hospital system were included in the IRB-exempt study. Patients were called 7–10 days after initial doxycycline prescription to assess compliance, medication side effects, and adherence barriers. Noncompliant patients were offered a prescription for the azithromycin regimen. Patients were encouraged to repeat chlamydia testing in 4 weeks to assess for cure, or in 3 months for reinfection.

RESULTS:
Two hundred sixty-four patients met inclusion criteria, 193 (73.1%) of whom could be contacted. Patients were significantly compliant to multidose doxycycline despite barriers (P=.0002; 95% CI, 3.33–50.48), such as pharmacy-induced medication fill delay and medication side effects. Only 7 (58.3%) noncompliant patients desired to switch to azithromycin. Of the 105 compliant patients re-tested, most (87.6%) tested negative.

CONCLUSION:
The data demonstrated that patients in low-resource communities are significantly compliant with the CDC-recommended 7-day doxycycline regimen despite barriers to adherence. Therefore, even in low-resource communities, practitioners should prescribe multidose doxycycline for chlamydia infection in nonpregnant females.
Examining Accessibility of Freestanding Abortion Clinics for People With Disabilities [ID 2683401]
Authors: Alpern Rebecca R. , Folarin-Amode Faridat , Or Maya , Jamshidi Roxanne 
Published: May 2024

INTRODUCTION:
People with disabilities face numerous barriers to equitable health care but have a fundamental right to safe abortion care. This study reviews the accessibility of freestanding abortion clinics in the United States for those with disabilities.

METHODS:
A quantitative data analysis was performed. All freestanding abortion clinics registered with the Abortion Care Network were included except those directly affiliated with a university or general gynecology clinic and those exclusively operating online. Two independent reviewers analyzed clinic websites after an interrater reliability test. Independent variables analyzed included Flesch Reading Ease score, presence of a statement affirming dignity for all persons, online appointment scheduling, transparent pricing, and financial assistance information.

RESULTS:
Seventy-two clinics were included. No clinic explicitly stated that their facilities were accessible to individuals with disabilities. Fifty-four percent had a statement affirming dignity for all persons, most of which were in the Northeast or West Coast. 6% had an accessibility widget, and 63% had online appointment scheduling. Mean Flesch Reading Ease score was 55.37 correlating to a 10th- to 12th-grade reading level. 33% had transparent pricing information, and 71% offered information on financial assistance.

CONCLUSION:
Several accessibility barriers were identified on these websites. Freestanding abortion clinics should focus on enhancing accessibility by explicitly affirming dignity for all patients, providing clear information on facility accessibility, and implementing an accessibility widget, online scheduling, and transparent pricing. Furthermore, these websites should be written at an easily comprehensible reading level. These simple changes would make these clinics more accessible for those with disabilities.
Patient Satisfaction With Over-the-Phone Interpretation in an Outpatient Gynecology Clinic [ID 2683580]
Authors: Gomez Daniel A. 
Published: May 2024

INTRODUCTION:
In Miami, Florida, the majority of households are bilingual or non-English speaking, often necessitating use of translation services in clinical settings. Culturally competent care includes using a language that patients understand, which can lead to improved clinical outcomes. Over-the-phone translation is the only method of interpretation available in our public safety net outpatient gynecology clinic. To our knowledge, no study has explored patient satisfaction and comfort with this mode of interpretation in a gynecology clinic.

METHODS:
An anonymous 33-item Spanish language survey, adapted from existing studies on medical translation, was used to assess the translation experience for adult patients. Surveys were collected verbally and in-person immediately after a clinic visit in which over-the-phone translation services were used. A Likert-type scale (1, very bad, to 4, very good) was used to assess satisfaction domains.

RESULTS:
Twenty-nine Spanish-speaking participants completed the survey. The median age was 47.5 years. Over 75% (n=22) were uninsured and close to 50% had not completed high school/GED (n=14). Mean satisfaction with interpretation (3.55) and medical care (4) were high. However, 14% (n=4) felt disrespect by their interpreter, 10% (n=3) expressed dissatisfaction with their understanding of treatment plans, and 10% (n=3) reported issues of privacy with the interpreter. In participants over age 40 (n=19) and with less than a high school education (n=14), there was more discomfort in discussing medical history using the interpreter compared to less than 40 and college-educated respondents. 65% (n=19) of all respondents indicated a preference for an in-person professional interpreter.

CONCLUSION:
Although further research is needed, this study highlights potential concerns, particularly in older and less-educated patients, with over-the-phone translation services in the outpatient gynecology clinical setting. In settings where patients are likely to be non-English speaking, providing optimal translation services is crucial to both patient satisfaction and culturally competent care.
Are We Screening the Wrong Person?: A Scoping Review on Screening Men for Perpetration of Intimate Partner Violence [ID 2683612]
Authors: Soliman Omnia , Charles Lolayemi , Dada Mary , Beauchemin Esther , Ades Veronica 
Published: May 2024

INTRODUCTION:
The United States Preventive Services Task Force (USPSTF) currently does not recommend screening men for perpetration of intimate partner violence (IPV) because of a lack of evidence. Screening women for victimization of IPV has demonstrated limited effectiveness; screening potential perpetrators may be a more useful strategy for the identification and prevention of IPV. The objective of this study is to determine whether there is sufficient evidence to recommend screening men for perpetration of IPV.

METHODS:
We performed a scoping review to identify studies that screen for male perpetration of IPV. We included peer-reviewed, full-text English-language studies that screened men for perpetration of IPV or evaluated an IPV screening tool. Review articles, meta-analysis papers, and studies that only screened women were excluded.

RESULTS:
Of the 834 studies reviewed, the primary objective of 12.1% of studies was determining the prevalence of male perpetration of IPV. The most commonly used screening tools for IPV were the Conflict Tactic Scale (CTS) (23.1%) or CTS-2 (29.0%). The 10th to 90th percentile of reported physical IPV perpetration ranged from 8.10% to 44.40% with a median of 21.80%.

CONCLUSION:
There is an abundance of studies examining male perpetration of IPV, and most use the CTS or CTS-2. These studies indicate that it is feasible to assess men for perpetration of IPV; however, the length of the available questionnaires is prohibitive toward use in a medical setting. We recommend a shorter version of the CTS-2 be developed and validated for use in clinical settings.
Pathogenic BRCA Variants in the Ashkenazi Jewish Population: A Retrospective Study [ID 2683559]
Authors: Barkan Samantha , Kuizon Carmelle M. , Ruiz-Pelaez Juan G. , Etkin-Kramer Elizabeth 
Published: May 2024

INTRODUCTION:
Pathogenic variants in BRCA genes (BRCA-PV) increase risk for cancers. Established guidelines for BRCA-PV risk reduction include surveillance, chemoprevention, and surgery. Ashkenazi Jews (AJ) have increased prevalence of BRCA-PVs versus the general population: 1/40 versus 1/160. Population testing of AJs, testing based on ancestry alone, identifies more BRCA-PV carriers than testing based on family history.

METHODS:
Charts of 683 AJ patients tested in a gynecology office for BRCA-PVs between January 1, 2017, and June 30, 2020, were retrospectively reviewed for BRCA-PV status, history, and clinical management. Findings were compared to 2017 National Comprehensive Cancer Network (NCCN) guidelines, current at time of testing. Patients were appropriately counseled for clinical management.

RESULTS:
Six hundred eighty-three AJs, mean age 51.0±13.5 years, were tested for BRCA-PVs: 14 tested positive (2%), mean age 41.6±14.16; 13/14 (93%) were female. Of patients with PV, 6 (43%) patients did not qualify for screening based on 2017 guidelines. Of positive female patients, 7 (54%) chose risk-reducing bilateral salpingo-oophorectomy (rrBSO), 4 (31%) chose mastectomy, 3 (21%) chose in vitro fertilization with wild-type embryos. One patient was found to have invasive serous tubal cancer at rrBSO; another with ER− breast cancer with first screening MRI.

CONCLUSION:
Our study confirms increased BRCA-PV prevalence amongst AJs. Over half of individuals tested did not meet 2017 NCCN criteria, including two positive patients diagnosed with cancer—indicating that 2017 criteria did not capture at-risk individuals. Updated guidelines recommending BRCA-PV testing of AJs must be implemented to identify actionable PVs and initiate cancer prevention strategies.
Transvaginal Ultrasound Simulation/Curriculum for Third-Year Medical Students Improves Educational Experience on Obstetrics and Gynecology Clerkship [ID 2683421]
Authors: Hartup Lindsay A. , Medrano Gabriel A. , Lewis Ariana 
Published: May 2024

INTRODUCTION:
The purpose of this study was to assess the effect of transvaginal ultrasound (TVUS) curriculum with simulation on third-year medical students' obstetrics and gynecology clerkship.

METHODS:
Institutional review board approval was waived for this study. The TVUS curriculum was introduced in May 2023. A 2-hour educational session with simulation was held at the beginning of the 6-week obstetrics and gynecology clerkship. At the end of the clerkship, a survey was administered to assess students’ experience and comfort level with TVUS. Students who completed their obstetrics and gynecology clerkship prior to the curriculum (July 2022 to April 2023) or were not present for the TVUS educational session were administered the same survey. Likert scale responses were compared using ordered logistic regression.

RESULTS:
Forty-one of 69 students present for the TVUS curriculum, and 66 of 187 who were absent, completed the post-clerkship survey. Students present for the TVUS curriculum were more likely to report greater understanding of the TVUS they observed during their obstetrics and gynecology clerkship (OR 2.63 [1.25, 5.65]; P=.012). They were more likely to report increased comfort recognizing normal anatomy (OR 5.18 [2.42, 11.59]; P<.001), and gynecologic pathology (OR 8.40 [3.84, 19.24]; P<.001), on real-time TVUS. Additionally, they were more likely to report increased overall understanding on their obstetrics and gynecology clerkship because of their TVUS knowledge and experience (OR 5.47 [2.56, 12.20]; P<.001).

CONCLUSION:
Universal implementation of TVUS curriculum with simulation should be considered in undergraduate medical education given the potential to improve educational experience on the obstetrics and gynecology clerkship.
Effect of Texas Abortion Laws on Reproductive Health Attitudes Among Medical Students, Residents, and Faculty: A TTUHSC Study [ID 2683579]
Authors: Finney Caroline E. , Nanni Amber , Sauers Delaney , Mallik Avantika , Chaudhury Hannah , Chaudhury Tristin 
Published: May 2024

INTRODUCTION:
In response to Texas Senate Bill 8 and the overturning of Roe v. Wade, we investigated the effect of new abortion laws on attitudes toward reproductive health and abortion within the TTUHSC community in Lubbock, Texas. As abortion remains a vital aspect of reproductive health care, understanding current and future doctors’ sentiments is essential.

METHODS:
The Omnibus survey was sent electronically to TTUHSC School of Medicine students as well as medical residents, fellows, and faculty. The survey included 25 question sets that branched according to respondent groups and received 318 responses from the TTUHSC community. Using a single predictor model in RStudio, we analyzed gender influence on attitudes toward post-law changes. All participants provided consent for their responses to be used for research purposes. This project was approved for exempt review by the TTUHSC IRB.

RESULTS:
Of 76 responses, 63% strongly agreed that medical education should address Texas abortion law changes. Females showed more desire (73%) for education changes (P=.0059). Gender also affected opinions on counseling limitations due to new laws (P=.0167) and obstetrics and gynecology residents’ abortion training (P=.0063).

CONCLUSION:
Most participants favored educating students about law changes, perceived counseling limitations, and obstetrics and gynecology training for abortions. Females consistently aligned with these sentiments. The gender-based disparities underscore a medical education gap exacerbated by the new laws. Ambiguities in current laws may affect clinical practice. Addressing these findings is crucial and encompasses integrating ethical considerations, legal nuances, and procedures into the medical education framework to produce competent, compassionate practitioners.