bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of a Perinatal Mental Health Program in a Private Maternal–Fetal Medicine Practice [ID 2683639]
Authors: Ruma Michael S. 
Published: May 2024

INTRODUCTION:
The American College of Obstetricians and Gynecologists (ACOG) recommends that treatment for mental health disorders be equitably available and accessible to all pregnant women. We detail the implementation of a perinatal mental health program within a statewide maternal–fetal medicine (MFM) practice.

METHODS:
A retrospective quality improvement study was conducted among pregnant patients at a large, private MFM practice in New Mexico from October 2021 to September 2023. The primary outcome aimed to describe implementation of a perinatal mental health program and determine the demand for care of mood and anxiety disorders among pregnant patients being seen for antenatal high-risk obstetric care.

RESULTS:
In October 2021, an initial psychiatric mental health nurse practitioner (PMH-NP) employed by our MFM practice began providing care to pregnant patients. In June 2022, a second PMH-NP joined and a third was added in February 2023. No advertising of this new program was conducted to better serve existing patients. Patients are screened during each MFM visit with the Patient Health Questionnaire 9 (PHQ-9), a nine-item depression scale. Patients scoring higher than 4 were offered consultation with the PMH-NP and the patient elected to then schedule the visit. Additionally, patients with mood or anxiety disorders listed on their active problem list were queried by a clinician, offered consultation with the PMH-NP, and the patient elected to then schedule the visit. In 2021, 47 patients were seen with a total of 96 visits. In 2022, 284 patients were seen with a total of 1,046 visits. In 2023, 367 patients were seen with a total of 1,331 visits.

CONCLUSION:
Although ACOG recommends mental health treatment be available for all pregnant women, New Mexico lacks sufficient services. Implementation of a perinatal mental health program integrated within our MFM practice was successful with strong uptake by patients and year-over-year growth.
Polycystic Ovary Syndrome and Mental Health: Influence of Hyperandrogenism During Brain Plasticity Periods on Emotional Distress and Social Cognition [ID 2683671]
Authors: Del Río Juan Pablo , Dabed Francisca , Díaz Javiera P. , Ladrón de guevara Amanda , Crisosto Nicolás , Vigil Pilar 
Published: May 2024

INTRODUCTION:
Polycystic ovary syndrome (PCOS) is the most prevalent cause of endocrine disorders in teenagers. Hyperandrogenism affects brain maturation, especially in high plasticity periods (intrauterine and adolescence), potentially modulating the social-emotional status of affected adolescents (aPCOS). This study characterizes the consequences of hyperandrogenism in social-emotional status and social cognition on aPCOS.

METHODS:
This was an analytical cross-sectional study that included aPCOS between 12 and 25 years. Each patient underwent a clinical evaluation and measurements of the following: intrauterine androgen exposure markers (2D:4D, AGD), hormonal parameters, psychological questionnaires (PANAS, SDQ, EQ/SQ, RET, CAM), and Eye-Tracking (Tobii). This study was approved by Universidad de Chile's ethics commitee.

RESULTS:
Ninety participants were included: 43 cases and 47 controls. aPCOS presented more intrauterine exposure to androgens ([15/18] AGD: 9.7 versus 7.8; P=.014) and hyperandrogenemia ([15/18] FAI: 7.5 versus 4.1; P=.004). They exhibited a predominance of negative affects ([43/47] PANAS: 8.0 versus 2.0; P=.049), more socio-emotional problems ([43/47] SDQ: 2.5 versus 1.5; P=.047), less self-reported empathy ((43/47) EQ: 19.0 versus 25.1; P=.001), and differences in gaze patterns, such as longer time to first fixation in areas of interest (s) ([7/3] AOI(s): 0.35 versus 0.28; P=.037), which was associated with a worse score in emotional recognition (CAM; aR2=−0,920; f=19,48; Pr>|t|=|t|=0.049).

CONCLUSION:
aPCOS presented with predominance of negative affects, more social-emotional difficulties, and lower score on emotional recognition, associated with exposure to hyperandrogenism during the most critical neuroplasticity periods. These findings suggest that mental health should be evaluated on every PCOS patient, especially adolescents.
Effect of Financial Penalties on Appointment Nonadherence in Academic Obstetrics and Gynecology Clinics [ID 2683433]
Authors: Forbes Lauren A. , Kawakita Tetsuya , Takacs Peter 
Published: May 2024

INTRODUCTION:
The objective of this study was to examine the effect of patient financial penalties on appointment nonadherence within a single academic institution's obstetrics and gynecology outpatient clinics.

METHODS:
This retrospective policy effectiveness-implementation hybrid study included administrative data from all appointments at a single academic institution’s obstetrics and gynecology outpatient clinics from May 1, 2018, to April 30, 2022. Institutional review board approval was waived for this study. The department-wide patient financial penalty policy for appointment nonadherence was implemented on May 1, 2020. We conducted an interrupted time series analysis after stratifying by insurance (Medicaid versus all insurance). Poisson regression was used to calculate incidence risk ratios (IRRs) with 95% CIs.

RESULTS:
There were 414,006 obstetrics and gynecology outpatient clinic appointments (pre-implementation [pre]: 208,696; post-implementation [post]: 205,410). Of these, 58,473 (14.1%; pre: 29,533 [14.2%]; post: 28,940 [14.1%]) appointments were not attended. Compared to the all insurance group, Medicaid patients had a higher rate of appointment nonadherence (36,872/188,343 [19.6%]; pre: 18,070 [19.6%]; post: 18,802 [19.6%]). In the all insurance group, the implementation of financial penalties resulted in a 4% increase in nonadherence (IRR 1.04 [95% CI, 0.99–1.09]). In the Medicaid group, the implementation of financial penalties did not change nonadherence (IRR 1.00 [95% CI, 0.98–1.02]). There was no significant difference in the coefficient between Medicaid and all insurance groups (P>.05).

CONCLUSION:
Institutional implementation of patient financial penalties for appointment nonadherence did not change appointment nonadherence rates in obstetrics and gynecology outpatient clinics. The lack of change persisted after stratifying by insurance despite the inability to charge Medicaid patients a financial penalty for appointment nonadherence.
The Association Between Food Insecurity and Census Tract-Based Indexes in an Urban Academic Reproductive Clinic: Can Residence Predict Food Insecurity in Reproductive Patients? [ID 2683613]
Authors: Deshmukh Sanyukta , Pagano Rose , Lee Jessica K. 
Published: May 2024

INTRODUCTION:
Identifying food-insecure patients remains a priority in reproductive clinics given nutrition’s effect on maternal health. We sought to determine the association between self-reported food insecurity with census tract-based indexes including the Childhood Opportunity Index (COI), Social Vulnerability Index (SVI), and the U.S. Department of Agriculture (USDA) low-income and low-food access areas (LILAs), to identify which indexes can help identify at-risk patients.

METHODS:
This is a cross-sectional survey study (UMBHP-00099693) of patients presenting for reproductive care at one urban academic center. Food insecurity was scored as greater than 0 on the 6-Item USDA Food Security Module, and living within a LILA was collected from the 2019 USDA database. We categorized social vulnerability as moderate/low/very low vulnerability or high/very high vulnerability using the SVI. We categorized childhood opportunity using the COI as very low/low and moderate/high/very high.

RESULTS:
Of the 179 participants in the study, 84 (47%) reported food insecurity. The following proportions lived in a: LILA 96 (54%); high/very high vulnerability tract 138 (77%); and low/very low childhood opportunity (CO) tract 144 (86%). Living within a LILA was associated with an increased odds of experiencing food insecurity (odds ratio [OR] 1.8 [1.0, 3.4]). Living within a high/very high vulnerability tract was not significantly associated with food insecurity (OR 1.2 [0.6, 2.4]), nor was living within a low/very low CO tract (OR 1.6 [0.8, 3.5]).

CONCLUSION:
Residence within a LILA could be associated with food insecurity in patients seeking reproductive care, which can inform the development of future clinical and geographic interventions. As one in two patients were food insecure, we recommend universal screening of all patients at reproductive appointments.
Risks of Infections With Contraceptive Vaginal Rings Compared to No Hormone Use [ID 2683646]
Authors: Karam Kathleen , Arceneaux Amy , Vincent Kathleen L. , Pyles Richard 
Published: May 2024

INTRODUCTION:
Alterations in the vaginal microbiome by hormones, foreign bodies, intercourse, etc., can affect the body’s susceptibility to infection. The effect of combined contraceptive vaginal rings (CCVRs) on the vaginal microbiome needs more study. We aim to explore the outcomes of CCVRs on vaginal health and infection risk when compared to women without hormone use to better understand the effect of these devices.

METHODS:
De-identified data were collected from TriNetX. Using ICD-10 and RXNorm codes, populations were selected for women receiving etonogestrel and ethinyl estradiol CCVR without segesterone use, versus sexually active women of reproductive age on no hormonal contraceptives. Cohorts were matched for age at index, race, and ethnicity. Statistical analysis within 1 year of CCVR placement using risk ratios (RRs); P<.05 was considered significant.

RESULTS:
Cohort sizes were 274,743 each. Combined contraceptive vaginal ring usage showed an increased risk of gonorrhea (RR 1.221; P=.012), HSV-2 (RR 1.229; P<.0005), acute vaginitis (RR 1.314; P<.0005), subacute/chronic vaginitis (RR 1.708; P<.0005), acute vulvitis (RR 1.708; P<.0005), subacute/chronic vulvitis (RR 1.722; P<.0005), pelvic inflammatory disease (RR 1.184; P<.0005), anogenital warts (RR 1.314; P<.0005), and candidiasis (RR 1.402; P<.0005) when compared to women receiving no hormonal contraception. Combined contraceptive vaginal ring showed significant decreased risk of chlamydia (RR 0.786; P<.0005), syphilis (RR 0.493; P<.0005), and HIV (RR 0.434; P<.0005). Trichomoniasis was statistically insignificant.

CONCLUSION:
Women on etonogestrel and ethinyl estradiol CCVRs have an increased risk of gonorrhea, HSV-2, vaginitis, vulvitis, PID, anogenital warts, and candidiasis, with a decreased risk of chlamydia, syphilis, and HIV when compared to women receiving no hormonal contraception. Further investigation could be useful in developing multipurpose prevention technologies.
Pain Management in Outpatient Gynecologic Procedures: An Exploration of #Colposcopy on TikTok [ID 2683582]
Authors: Fulton Jessica , Chalif Julia , Morton Molly , Chambers Laura 
Published: May 2024

INTRODUCTION:
TikTok, a rapidly expanding social platform, features content on painful outpatient gynecologic procedures like colposcopy. Although pain management strategies have been studied, mainstream perceptions of this procedure remain underresearched. This study aims to describe #colposcopy content on TikTok.

METHODS:
On August 30, 2023, the first 200 videos under #colposcopy on TikTok were collected for cross-sectional content analysis. Data were collected for author demographics, intent, tones, timing, and content themes. Educational videos were rated for quality and reliability utilizing the modified DISCERN scale.

RESULTS:
As of August 2023, #colposcopy on TikTok had 65.3 million views. 183 of the first 200 posts were eligible for inclusion. On average, each video received 21,754 likes, 623 comments, and 752 shares. The majority of creators (n=133; 72.7%) were White, 14 (7.7%) were Black, 6 (3.3%) were Asian, 6 (3.3%) were Hispanic/Latino, and 24 (13.1%) were unable to determine. 109 (59.6%) of the creators were patients sharing their experiences, and 26 (14.2%) were physicians or APPs intending to educate. 33 (18.0%) TikToks were educational, with a median DISCERN score of 2. Among 13 content categories, the category most observed was “pain and pain management” (n=117; 63.9%), with 81 (75.7%) creators describing the procedure as painful and 26 (25.5%) describing it as painless. Significant differences in content were also analyzed by author demographics, intent, tone, and timing.

CONCLUSION:
Colposcopy-related content on TikTok centers on patients’ pain experiences. Specifically, users of #colposcopy discussed the providers’ lack of pain management options. Opportunities exist to improve pain expectations and management strategies with patients.
Size Matters: In-Office Hysteroscopy and Successful Removal of Endometrial Polyp [ID 2683670]
Authors: Marquez Kyara M. , Marbin Staci J. , Mouhanna Joelle N. , Rodriguez Suset , Carugno Jose 
Published: May 2024

INTRODUCTION:
Hysteroscopy serves as the gold standard for investigating intrauterine pathologies. Previous studies suggest successful in-office hysteroscopic polypectomy in younger, lower body mass index, premenopausal patients with smaller polyps and painless examinations. We share our in-office hysteroscopic polypectomy experience and aim to determine the threshold for estimated polyp size on ultrasound imaging most associated with successful in-office removal.

METHODS:
We conducted a retrospective study at a single urban hospital, including all patients who underwent in-office hysteroscopy (IOH) between December 2018 and April 2023. Using standardized protocols, we employed vaginoscopy no-touch techniques with a 5-mm diagnostic hysteroscope (30-degree optic) using normal saline for distension without anesthesia. Polyps were removed using hysteroscopic instruments. Preoperative ultrasound reports provided initial polyp diameter, which was subsequently correlated with intraoperative hysteroscopic impression and postoperative pathology reports.

RESULTS:
One hundred forty patients underwent IOH. Among them, 53 (38%) were referred for suspected endometrial polyps identified on ultrasound. 10 patients were excluded from the study: 6 lacked available imaging, 2 showed no polyps on imaging, and 2 had unsuccessful entry due to cervical stenosis. Successful entry into the endometrial cavity was achieved in 95.3% of cases, with cervical stenosis and pain as limiting factors. 13.9% (6 patients) experienced failed in-office polypectomy due to large polyp size (mean estimated diameter: 2.23 cm).

CONCLUSION:
In-office hysteroscopy using the vaginoscopy no-touch technique is a highly advantageous therapeutic modality for managing patients with endometrial polyps. Polyps larger than 2 cm pose challenges, often leading to unsuccessful in-office removal.
Correlation of Medical Specialty With Malpositioned Intrauterine Devices [ID 2683518]
Authors: Hewell Kerrilyn , Wilson Teresa S. , Groesch Kathleen , Delfino Kristin , Nguyen Lynn , Zeino Mhd Yahia 
Published: May 2024

INTRODUCTION:
Intrauterine devices (IUDs) are an effective method of long-acting reversible contraception (LARC) and essential for preventing unintended pregnancies, as well as controlling abnormal uterine bleeding (AUB). Intrauterine devices are placed by both obstetrician−gynecologists and primary care providers. As an academic institution, our objective was to determine if training specialty of inserting provider correlated with the rate of malpositioned IUDs.

METHODS:
All ultrasounds from 2017 to 2020 in which an IUD was documented at SIU School of Medicine Department of Obstetrics and Gynecology, an American Institute of Ultrasound Medicine-certified center, were reviewed (IRB# 21-834). Association between specialty of inserting provider and malposition rate was assessed using chi-squared test.

RESULTS:
A total of 602 ultrasound reports documenting an IUD were reviewed; 109 malpositioned IUDs were identified (18.1%). Body mass index, age, and gravidity/parity were not significantly different in participants with malpositioned IUDs from those with a properly placed IUD. Indications for ultrasound included pelvic pain, bleeding, and lost strings. Intrauterine devices placed by primary care providers were malpositioned at a significantly higher rate than those placed by obstetrician−gynecologists, 30.0% versus 17.3%, respectively (P=.043). Obstetrician−gynecologists placed 1,961 IUDs and primary care providers placed 276 IUDs between 2017 and 2020.

CONCLUSION:
Intrauterine devices are a safe and reliable choice for LARC to prevent unwanted pregnancies and to control AUB. Training providers on proper techniques for IUD insertion is imperative for good clinical practice and patient satisfaction. Primary care providers are often seen for contraception management; therefore, the significantly higher malpositioned rate indicates the need to implement an enhanced simulation/education curriculum for IUD insertion.
Short-Term Telehealth Follow-up in Complex Gynecologic Conditions [ID 2683660]
Authors: Phillips Nancy , Rocktashel Maria 
Published: May 2024

INTRODUCTION:
Studies show up to 50% of patients leave health care appointments not understanding or remembering important information, instructions, or correct use of medications. The Rutgers Center for Vulvovaginal Health treats women referred for complex vulvovaginal or pain disorders and sexual dysfunctions. Despite receiving written instructions and diagrams at initial visit, many returned without having started or having discontinued treatment. We initiated a nurse practitioner telehealth visit 2–3 weeks after initial encounter to evaluate acceptance and benefit in this population.

METHODS:
This was a retrospective chart review of 50 telehealth visits for new patients seen at the center. Outcome measures were determined from questions presented to all women regarding understanding of condition, and adherence to medication and treatment plan.

RESULTS:
Overall, 98% of women found the telehealth visit helpful, and 46% had questions related to their first visit. Of the 43 prescribed medications, 37 initiated treatment (86%) and only 2 (4.7%) had not attempted to fill the prescription. Medication was changed in 10%, mostly because of side effects. Pelvic floor physical therapy and imaging studies were initiated in 75% and 67%, respectively.

CONCLUSION:
Women with complicated gynecologic problems viewed a short-term follow-up telehealth visit positively. This communication presents an opportunity for another point of contact that can be incorporated into a busy practitioner schedule without the requirement of an in-person visit, and allow convenience and reinforcement for women, as well as necessary treatment alterations. Further studies are needed to see if this short-term follow-up enhances long-term compliance or outcomes.
Assessing the Performance of ChatGPT in Correctly Evaluating Preventive Screening Clinical Vignettes Commonly Seen in Obstetrics and Gynecology Practice [ID 2683617]
Authors: Daram Naveena 
Published: May 2024

INTRODUCTION:
Preventive screening is vital in obstetrics and gynecology practice, where the accurate assessment of clinical vignettes is pivotal for delivering optimal care. This research delves into ChatGPT’s performance, an advanced language model, in evaluating common obstetrics and gynecology preventive screening scenarios.

METHODS:
We compiled a diverse dataset of obstetrics and gynecology clinical vignettes, covering areas like cervical and breast cancer screening, sexually transmitted infection testing, and prenatal care. Using 20 vignettes initially generated by ChatGPT and enriched with specific details, we rigorously assessed ChatGPT’s responses for clinical accuracy and relevance. Our evaluation was guided by quantitative metrics, aligning ChatGPT’s performance with recognized guidelines such as United States Preventive Services Task Force, American Society for Colposcopy and Cervical Pathology, American College of Obstetricians and Gynecologists, and more.

RESULTS:
ChatGPT displayed promise in comprehending obstetrics and gynecology clinical information. Out of 20 vignettes, only 2 (10%) fell short of evaluating the clinical vignette adequately. Among the remaining 18 vignettes, an impressive 15 (83%) adhered to the latest clinical guidelines, whereas 3 (17%) evaluations proved inaccurate. Notably, in 19 out of 20 vignettes (95%), ChatGPT deferred to the provider’s clinical judgment.

CONCLUSION:
This study underscores ChatGPT’s potential to assist obstetrics and gynecology practitioners in preventive screening decision-making. While promising, ChatGPT should complement, not replace, human expertise. Limitations include a focus on quantitative metrics; future research should delve into qualitative aspects of ChatGPT’s performance. Integrating ChatGPT into obstetrics and gynecology practice could enhance preventive screening quality and efficiency, potentially improving women’s health care outcomes. This research contributes to the broader discourse on AI integration in health care, particularly in women’s preventive health care, paving the way for further AI-driven solutions.
#Infertility: Evaluation of Quality and Accuracy of TikTok Videos [ID 2683621]
Authors: Brogan Cailey , Dillon Kayla , Hare Maia , Peyser Alexandra 
Published: May 2024

INTRODUCTION:
The objective of this study was to determine the quality and accuracy of infertility content on TikTok using the validated DISCERN scoring system.

METHODS:
The top 100 TikTok videos tagged “#Infertility” were assessed across 15 DISCERN categories by three reviewers. Videos were classified by type (educational, lifestyle, entertainment) and creator (patient, obstetrician–gynecologist, non-physician health care professionals, non-health care professionals, unknown). Multiple linear regression explored the creator-DISCERN score correlation, adjusting for video type, with significance at P<.05.

RESULTS:
One hundred videos were assessed: 59 lifestyle, 24 entertainment, and 17 educational, with a mean DISCERN score of 23.64±0.636. The majority of videos scored less than 39, indicating “poor”/“very poor” quality, while five scored “fair” with 39+. Most videos were patient-created (68%), followed by obstetrician–gynecologist-created (14%). There was significant association between creator and DISCERN score with patient-created videos (mean, 21.71±0.545) scoring lower than obstetrician–gynecologist-created videos (mean, 29.41±2.142; P<.001). Chi-squared independence test showed significance in video type distribution among creators with 82% of patient videos falling in the lifestyle category and 71% of obstetrician–gynecologist videos falling in the educational category (X2=67.537; df=8; P<.001). After adjusting for video type, linear regression showed no significant difference among scores of patient and obstetrician–gynecologist videos (P=.184).

CONCLUSION:
Fertility-related TikTok videos created by patients had lower DISCERN scores than those created by obstetrician–gynecologists. These results demonstrate that TikTok does not provide appropriate knowledge to educate patients. There is an increased need for unbiased fertility-related content on TikTok.