bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reusable Menstrual Management Products: Perceptions and Use Among Hispanic Women in Puerto Rico [ID 2683545]
Authors: Castro Alexandra Alfonso , Trujillo Alejandra Alfonso , Morales-Pomalaza Bianka L. , Fernandez Molinary Karla S. , Romaguera Josefina , Schwarz Susan 
Published: May 2024

INTRODUCTION:
Reusable menstrual products offer much-needed eco-friendly and cost-effective alternatives for managing menstruation, yet disposables continue to dominate the market and public awareness. This study aims to explore women’s perceptions and knowledge of menstrual care options, revealing barriers to reusable products and the need for enhanced education.

METHODS:
A cross-sectional study was done using Survey Monkey. A 53-item questionnaire was administered covering sociodemographics, practices, and general knowledge. Recruitment primarily targeted university-aged women (21+) living in Puerto Rico via social media flyers. We employed descriptive statistics for analysis. The research was IRB-approved.

RESULTS:
Among 208 participants (85% completion rate), 20% combined reusable and disposable products. Motivations included waste reduction (31%), cost savings (26%), and friend recommendations (15%). Intriguingly, a substantial segment (30–44%) of nonusers (66%) expressed a willingness to switch, citing environmental concerns (42%) and desiring a progressive choice (18%). Hindrances to adoption encompassed perceived unhygienic aspects (29%) and lack of awareness (25%). Participants advocated for increased education, with only 12% having received information from their primary care physicians, 50% feeling their physicians lacked knowledge about available products, 81% expressing their doctors should initiate these conversations, and 87% believing menstrual management should be included in school curricula.

CONCLUSION:
Although the majority of respondents use disposable products, a noteworthy proportion is exploring reusable options or willing to switch to eco-friendly alternatives for waste reduction. Participants highlighted the need for primary care physicians and educators to incorporate menstrual management alternatives in their discussions, which could potentially result in large-scale cost savings and environmental benefits.
Fertility Preservation Knowledge and Attitudes Among Medical Students as Future Practitioners [ID 2683445]
Authors: Armstrong Austin , Schuknecht Taryn L. , Keomany Jennifer , Okut Hayrettin , Grainger David , Duncan Francesca E. 
Published: May 2024

INTRODUCTION:
Medical students are the next generation of physicians and provide a current snapshot of medical education. The objective of the study was to gain insight into the knowledge and attitudes regarding fertility preservation among medical students.

METHODS:
Medical students at The University of Kansas School of Medicine (KUSM) participated in a prospective, cross-sectional web-based survey study. Survey questions included knowledge-based questions based on the American Society for Reproductive Medicine fertility preservation guidelines, and attitudes towards fertility preservation were measured using Likert scales. This study was IRB approved.

RESULTS:
Most respondents (N=123; response rate: 14.1%) were aged 20–29 years (94.3%; n=116) and were pursuing family medicine (18.7%; n=23). In terms of training, 16.5% of respondents (n=20) reported having formal lectures on fertility preservation and 31.7% (n=38) on assisted reproduction technology. More than 45% of clinical students reported not being exposed to reproductive endocrinology and infertility or fertility preservation on clinical rotations (n=32/70). Only 1.6% of respondents (n=2) correctly answered at least 75% of knowledge questions about fertility preservation. Almost half (49.5%; 51/103) of respondents reported discomfort discussing fertility preservation with patients needing fertility preservation. Patient prognosis, finances, and age were the top factors influencing the professional decision to provide a patient with fertility preservation information.

CONCLUSION:
Students indicate poor familiarity and comfort with discussing fertility preservation, which in the future, may reduce and/or delay patient access to this option. Thus, medical student curriculum focused on reproductive endocrinology and fertility preservation represents an important educational opportunity to improve patient care and outcomes.
Navigating Intimate Partner Violence: A Comparative Analysis Between ACOG and ChatGPT on Patient Education [ID 2683552]
Authors: Cadiente Angelo , Patel Puja , Oladipo Antonia F. 
Published: May 2024

INTRODUCTION:
With the surge in artificial intelligence usage, there is an increasing need to assess its applicability in conveying public health information. We compare the readability and quality of responses between ChatGPT and the American College of Obstetricians and Gynecologists (ACOG) in answering frequently asked questions (FAQs) on intimate partner violence (IPV).

METHODS:
Twelve questions from ACOG's “Intimate Partner Violence” FAQs were posed to ChatGPT-3.5 (July 19 Version). Readability and grade-level scores were determined. The quality of responses were also graded by two obstetrician–gynecologists using a 1–4 scale, where 1 represents a comprehensive response and 4 indicates an incorrect response. Statistical analysis utilized a two-tailed t-test. A weighted Cohen’s kappa coefficient evaluated interrater reliability.

RESULTS:
Mean readability favored ACOG over ChatGPT, but only the Coleman Liau Index was statistically significant (ACOG: 12.71; ChatGPT: 15.76; P=.003). Other readability measures demonstrated no significant differences. The ACOG responses were graded with an average of 1.29, alongside a Cohen’s kappa coefficient of 0.375, implying fair agreement between graders. All ChatGPT’s responses were graded a 1 with a Cohen’s kappa coefficient of 1, indicating perfect agreement. The difference in grades between ACOG and ChatGPT was statistically significant (P=.013).

CONCLUSION:
The ACOG FAQ responses are relatively equivalent in readability when compared to ChatGPT-generated responses with only one statistically significant difference across the indices. However, ChatGPT's responses were more comprehensive and accurate. Although patients can use ACOG as a source, ChatGPT provides equivalently clear and more comprehensive information on IPV.
Resident's Training in Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) [ID 2683656]
Authors: Mohr-Sasson Aya , Bhalwal Asha 
Published: May 2024

INTRODUCTION:
As the vaginal natural orifice transluminal endoscopic surgery (vNOTES) is becoming a common acceptable approach to perform benign gynecological surgeries, there is need to incorporate it in resident’s curriculum for surgical training. The aim of this study was to estimate the effect of hands-on lab simulation for vNOTES on residents’ perception and confidence in this surgical approach.

METHODS:
This is a prospective observational study conducted at a single tertiary medical center. Study population included 12 fourth-year residents that were evaluated by seven faculty attending surgeons. All residents completed didactic online training of adnexectomy, and vaginal assisted laparoscopic hysterectomy (VALH) performed by vNOTES. Three hands-on simulation labs were scheduled on a monthly base during the study period. Each resident performed both procedures on each encounter. Residents were evaluated by experienced surgeons in vNOTES approach. Survey evaluating the knowledge and confidence in the vNOTES approach was completed by the residents before and after all simulations.

RESULTS:
Forty-nine assessments were completed, of them 23 adnexectomies and 26 VALHs. Competence in VALH and adnexectomy were achieved in 5/12 and 2/12 of the residents, respectively. Feedback was completed by seven residents before and after the simulations. 33% increase in the confidence to perform anterior and posterior colpotomy was reported by the residents. 71% versus 85% reported confidence in transecting the uterosacral ligaments before and after the simulations, respectively. Confidence in transecting the uterine artery was found doubled (14% versus 28%) during vNOTES approach after the simulation. 15% increase in the confidence to perform adnexectomy was noted after the simulation; however, 14% reduction was reported by the residents in choosing vNOTES approach for hysterectomy.

CONCLUSION:
Hands-on simulation in vNOTES approach increases the knowledge and confidence of residents in the surgical steps of adnexectomy and VALH, keeping them up to date with the innovative surgical techniques.
State Abortion Policy and Provider Moral Distress Levels After Dobbs [ID 2683541]
Authors: Rivlin Katherine , Bornstein Marta , Tomu Taylor , Norris Alison H. , Howard Dana 
Published: May 2024

INTRODUCTION:
Moral distress occurs when individuals feel powerless to carry out ethically correct actions, including when prevented from providing necessary health care. We aimed to measure self-reported moral distress levels among abortion providers after the Dobbs decision and to assess differences by state-level abortion policy.

METHODS:
In 2023, we surveyed abortion providers nationally through professional listervs. Institutional review board-exempt surveys queried demographics, practice characteristics, and the Moral Distress Thermometer (MDT), a validated psychometric tool that measures moral distress level from 0 (lowest) to 10 (highest). Providers reported whether their moral distress level had changed since Dobbs. We assessed overall moral distress level and differences by state restrictiveness (using Guttmacher’s classifications) using one-way ANOVA (continuous variables) and chi-squared tests (categorical variables).

RESULTS:
In total, 253 practitioners completed the MDT for one or more states where they practiced (N=285 MDTs analyzed), with 56.8% of responses for “protective” states and 43.2% for “restrictive” states. Moral distress levels ranged from 0 to 10 (mean=5.09) and were twice as high for providers in restrictive compared to protective states (mean=7.15 versus 3.52; P<.001). Change in distress post Dobbs differed by state restrictiveness: In restrictive states, 89.4% reported an increase compared to 71.6% in protective states (P<.01).

CONCLUSION:
Moral distress levels for abortion providers were high following Dobbs, and higher in restrictive states. Most providers experienced increased distress across policy contexts. Moral distress has been associated with burnout, errors in patient care, and attrition. High and increasing moral distress levels, especially in abortion restrictive states, may worsen provider shortages, and lead to poor patient outcomes.
Network Meta-analysis and Economic Evaluation of Neurostimulation Interventions for Chronic Nonsurgical Refractory Back Pain
Authors: Eldabe Sam , Nevitt Sarah , Bentley Anthony , Mekhail Nagy A. , Gilligan Christopher , Billet Bart , Staats Peter S. , Maden Michelle , Soliday Nicole , Leitner Angela , Duarte Rui V. 
Published: May 2024

Objectives:
Different types of spinal cord stimulation (SCS) have been evaluated for the management of chronic nonsurgical refractory back pain (NSRBP). A direct comparison between the different types of SCS or between closed-loop SCS with conventional medical management (CMM) for patients with NSRBP has not been previously conducted, and therefore, their relative effectiveness and cost-effectiveness remain unknown. The aim of this study was to perform a systematic review, network meta-analysis (NMA) and economic evaluation of closed-loop SCS compared with fixed-output SCS and CMM for patients with NSRBP.

Methods:
Databases were searched to September 8, 2023. Randomized controlled trials of SCS for NSRBP were included. The results of the studies were combined using fixed-effect NMA models. A cost-utility analysis was performed from the perspective of the UK National Health Service with results reported as incremental cost per quality-adjusted life-year (QALY).

Results:
Closed-loop SCS resulted in statistically and clinically significant reductions in pain intensity (mean difference [MD] 32.72 [95% CrI 15.69-49.78]) and improvements in secondary outcomes (Oswestry Disability Index [ODI] and health-related quality of life [HRQoL]) compared with fixed-output SCS at 6-month follow-up. Compared with CMM, both closed-loop and fixed-output SCS resulted in statistically and clinically significant reductions in pain intensity (closed-loop SCS vs. CMM MD 101.58 [95% CrI 83.73-119.48]; fixed-output SCS versus CMM MD 68.86 [95% CrI 63.43-74.31]) and improvements in secondary outcomes (ODI and HRQoL). Cost-utility analysis showed that closed-loop SCS dominates fixed-output SCS and CMM, and fixed-output SCS also dominates CMM.

Discussion:
Current evidence showed that closed-loop and fixed-output SCS provide more benefits and cost-savings compared with CMM for patients with NSRBP.
Relationship Between High ACE Score, HIV Risk Behavior, and Previous HIV Testing in the South Carolina BRFSS [ID 2683384]
Authors: Dutra Karley , Lazenby Gweneth B. , Moore Miyonta (Tay) 
Published: May 2024

INTRODUCTION:
The incidence of human immunodeficiency virus (HIV) in the United States is stable among women. Due to stigma, 13% of persons with HIV are unaware of their diagnosis. Adverse childhood experiences (ACEs) describe negative events during childhood using a standardized questionnaire. Limited data exist on how ACEs affect HIV screening. Utilizing state-collected data from the Behavioral Risk Factor Surveillance System (BRFSS), we assessed the relationships between high ACE, gender, HIV risk behaviors, and previous HIV testing.

METHODS:
This is a retrospective observational cohort study of the BRFSS from 2014–2016 and 2019–2021. High ACE score was ≥ 4. Using bivariate analyses, we compared percentages of individuals with high versus low ACE scores. We used logistic regression to determine factors associated with HIV risk behaviors and previous HIV testing.

RESULTS:
Over 54,000 individuals were surveyed; 15% had high ACE scores. 4% reported HIV risk behaviors and 35% reported previous HIV testing. The mean ACE was 1.6 (SD 2.1). High ACE demonstrated increased risk of HIV risk behaviors (adjusted odds ratio [aOR] 2.652; 95% CI, 1.987–3.538) and previous HIV testing (aOR 2.340; 95% CI, 2.031–2.696). Female respondents were less likely to report HIV risk behavior (aOR 0.442; 95% CI, 0.336–0.581) and previous HIV testing (aOR 0.822; 95% CI, 0.736–0.919).

CONCLUSION:
Persons with high ACE scores were more likely to engage in HIV risk behaviors and have a history of HIV testing. Our findings suggest ACE scores may be useful for identifying persons at risk for HIV. The stable incidence of HIV and reduced perception of risk among women demonstrate the need for tailored HIV screening for women.
Socio-Demographic and Preoperative Clinical Factors Associated With 5-Year Weight Trajectories After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy
Authors: Patel Sahil , Jiang Chen , Cowan Brandon , Yin Jie , Schaefer Catherine , Dutta Sanjoy , Mostaedi Rouzbeh , Choquet Hélène 
Published: May 2024

Objective:
To determine whether socio-demographic and preoperative clinical factors contribute to the percent total body weight loss (%TBWL) after bariatric surgery (BS).

Background:
BS is the most effective long-term treatment for medically complicated obesity. More information is needed about the factors that contribute to postoperative %TBWL in large and ethnically diverse cohorts.

Methods:
This retrospective study conducted in the Kaiser Permanente Northern California region included 7698 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between January 2009 and March 2015. Trajectory analyses were conducted from 5-year follow-up data to assign patients to “low,” “average,” or “high” postoperative %TBWL groups. We then evaluated whether age, sex, race/ethnicity, neighborhood deprivation index and preoperative body mass index (BMI)/weight loss, diabetes, hypertension, and sleep apnea contributed to postoperative %TBWL using logistic regression models.

Results:
Of 7698 patients (83.2% women), 48.6% underwent a RYGB and 51.4% underwent a SG. Postoperative %TBWL trajectories over 5 years were obtained in 6229 (81%) of 7698 eligible patients. About 27.8% and 29.3% of patients followed the “low” postoperative %TBWL trajectory, for RYGB and SG, respectively. Men, older patients, and Asian, Black, and Hispanic/Latino patients were more likely to be classified in the low postoperative %TBWL group. Patients showing lower postoperative %TBWL had a lower preoperative BMI (but lost less weight before surgery) and were more likely to have preoperative comorbidities.

Conclusions:
This study confirms and extends prior findings of the effects of several demographic and preoperative clinical factors on postoperative weight loss. Findings could improve the support of patients to achieve desired surgical outcomes.
Prevalence and Survival of Prolonged Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: An Analysis of the Extracorporeal Life Support Organization Registry
Authors: Chandel Abhimanyu , Fabyan Kimberly D. , Mendelsohn Sondra , Puri Nitin , Damuth Emily , Rackley Craig R. , Conrad Steven A. , King Christopher S. , Green Adam 
Published: May 2024

Objectives:
To examine trends in utilization and outcomes among patients with the acute respiratory distress syndrome (ARDS) requiring prolonged venovenous extracorporeal membrane oxygenation (VV ECMO) support.

Design:
Retrospective observational cohort study.

Setting:
Adult patients in the Extracorporeal Life Support Organization registry.

Patients:
Thirteen thousand six hundred eighty-one patients that required ECMO for the support of ARDS between January 2012 and December 2022.

Interventions:
None.

Measurements and Main Results:
Mortality while supported with VV ECMO and survival to hospital discharge based on ECMO duration were examined utilizing multivariable logistic regression. Among the 13,681 patients supported with VV ECMO, 4,040 (29.5%) were supported for greater than or equal to 21 days and 975 (7.1%) for greater than or equal to 50 days. Patients supported with prolonged VV ECMO were less likely to be discharged alive from the hospital compared with those with short duration of support (46.5% vs. 59.7%; p < 0.001). However, among patients supported with VV ECMO greater than or equal to 21 days, duration of extracorporeal life support was not significantly associated with mortality (odds ratio [OR], 0.99; 95% CI, 0.98–1.01; p = 0.87 and adjusted OR, 0.99; 95% CI, 0.97–1.02; p = 0.48). Even in those supported with VV ECMO for at least 120 days (n = 113), 52 (46.0%) of these patients were ultimately discharged alive from the hospital.

Conclusions:
Prolonged VV ECMO support of ARDS has increased and accounts for a substantial portion of cases. Among patients that survive for greater than or equal to 21 days while receiving VV ECMO support, duration is not predictive of survival to hospital discharge and clinical recovery may occur even after very prolonged VV ECMO support.
Manzaneda’s Tool: Adaptation of the Piezotome for Rib Remodeling Surgery without Incisions
Authors: Manzaneda Cipriani Raúl 
Published: May 2024

Summary:
For rib remodeling surgery without incisions (RibXcar), a piezotome is used, which is a piezoelectric device that allows for selective and delicate manipulation of the bone, thanks to microvibrations that facilitate precise and smooth cuts. The piezotome, in its original form, requires the adaptation of the tip shape to perform costal surgery; therefore, Manzaneda’s tool was created, which is composed of three parts: first, modification of the shape of the tip of the piezotome; second, the experimentation with materials for coating the tip of the piezotome; and third, the sterilization of the piece. We found that the material that best adheres and protects the adapted tip of the piezotome is the Rust-Oleum High Heat. After applying the tip coating, the piece was sterilized, and finally, Manzaneda’s tool was obtained, which is specifically for use in RibXcar rib remodeling surgery. Manzaneda’s tool is a safe and customizable tool for RibXcar surgery.
Clinical Characteristics and Management of Children and Adolescents Hospitalized With Pyomyositis
Authors: Weber Sebastian , Schlaeppi Chloé , Barbey Florence , Buettcher Michael , Deubzer Beate , Duppenthaler Andrea , Jaboyedoff Manon , Kahlert Christian , Kottanattu Lisa , Relly Christa , Wagner Noemie , Zimmermann Petra , Heininger Ulrich 
Published: May 2024

Background:
Pyomyositis, a bacterial muscle infection, is an important differential diagnosis in children and adolescents with musculoskeletal pain. In contrast to tropical regions, it is rarely recognized in temperate countries, but incidence is increasing and major studies are missing.

Methods:
This retrospective multicenter study included patients <18 years of age hospitalized with pyomyositis in 11 Swiss children’s hospitals between January 2010 and December 2022. Cases were identified by ICD-10 code (Myositis; M60–M60.9), and data was extracted from electronic hospital records.

Results:
Of 331 patients identified, 102 fulfilled the case definition. Patient age at presentation ranged from 2 weeks to 17 years (median 8 years). The majority had no underlying illness and all presented with fever and localized pain. At the respective site of pyomyositis, 100 (98%) had impaired movement and 39 (38%) presented with local swelling. Pelvic (57%) and leg (28%) muscles were mostly affected. Blood or tissue cultures were obtained in 94 (92%) and 59 (57%) patients, respectively. Of those, 55 (58%) blood and 52 (88%) tissue cultures were positive, mainly for Staphylococcus aureus (35 and 19, respectively) and Streptococcus pyogenes (12 and 15, respectively). All patients received antibiotic treatment during hospitalization for a median of 10 days (interquartile range: 7–17), followed by outpatient treatment for a further median of 16 days (interquartile range: 11–22) in 95 (93%) patients. Fifty-nine (57%) patients required surgery.

Conclusions:
Pyomyositis is a challenging diagnosis that requires a high level of awareness. Blood and/or tissue cultures revealed S. aureus and S. pyogenes as the predominant causative agents.