bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation Between Residency Program Characteristics and American Board of Obstetrics and Gynecology Certifying Examination Passage Rates [ID 2683567]
Authors: Holder Erik , VanArendonk Sarah H. , Creedon Douglas , Cheng CeCe , Page-Ramsey Sarah M. , Byrne John J. 
Published: May 2024

INTRODUCTION:
The correlation between obstetrics and gynecology residency program size and type with certifying examination passage rates is not previously reported. Our objective was to evaluate the relationship between residency program size and type with American Board of Obstetrics and Gynecology (ABOG) certifying examination (CE) pass rates.

METHODS:
This is a cross-sectional study of ABOG specialty CE passage rates from 2020 to 2022. The CE passage rates were obtained from the ABOG website and stratified by program size (small 3–4, medium 5–7, large >8 residents per class) and type (community-based; community-based, university-affiliated; and university-based). Military-based programs were excluded, as were programs of unknown size. Passage rates were compared among groups using chi-squared test.

RESULTS:
During the study period, 3,766 candidates sat for the CE. Small programs accounted for 730 candidates (19.4%), 1,805 (47.9%) candidates from medium programs, and 1,231 candidates (32.7%) from large programs. Passage rates were higher among medium and large programs versus small programs (small [604/730; 82.7%], medium [1,656/1,805, 91.7%], and large [1,149/1,231; 93.3%]; P<.001). Passage rates among community-based candidates (299/347; 86.2% pass rate) and community-based university-affiliated candidates (962/1,100; 87.5% pass rate) were lower versus university-based candidates (2,148/2,319; 92.6% pass rate; P<.0001).

CONCLUSION:
During the study period, university-based programs and medium or large programs had higher CE passage rates. There are a number of limiting factors to the interpretation of the results such as academic differences upon entry to residency, resources available at each program, and amount of dedicated study time. A causal effect of program size and type cannot be assumed.
Applicant Use of Residency Program Websites During Virtual Interviews [ID 2683623]
Authors: Wells Alyssa , Heath Taylor , Coonrod Dean V. , Willey Alicia S. 
Published: May 2024

INTRODUCTION:
Program websites are the most common online resource applicants use to access information about residency programs. During the COVID-19 pandemic, online resources have had to take place of site visits when interviews transitioned to the virtual setting. At this time, the Accreditation Council for Graduate Medical Education does not have a plan for a transition back to in-person interviews. The objective of this study is to assess applicant use, and information that is sought for development of high-quality residency websites.

METHODS:
A survey was shared to interviewees on their interview day with Creighton University–Phoenix obstetrics and gynecology residency during the 2022–2023 application cycle. To remove the possibility of influence or coercion, the survey was kept anonymous. This was found to be IRB exempt.

RESULTS:
Of the 88 survey respondents, 100% marked they visited the program website. Only 32 of the 88 respondents indicated they did not find the information they were looking. The most-sought information by respondents was current resident profiles (75% of respondents), hospital/training site information (68%), rotation schedule (63%), and faculty profiles (60%). Other notable categories respondents were hoping to find information about included the following: surgical training, family planning training, and benefits offered by the program.

CONCLUSION:
Program websites are highly utilized by residency applicants. Information traditionally shared on interview day is now found through online resources; most-sought information included resident and faculty profiles, rotation schedules, and training site information.
Trends and Predictors of Cost in the Obstetrics and Gynecology Residency Application Process [ID 2683644]
Authors: Manorot Amanda , White Joseph R. , Lenze Nicholas , Benjamin William J. , Mihalic Angela , Marzano David 
Published: May 2024

INTRODUCTION:
Travel restrictions from the COVID-19 pandemic required residency programs to transition from an in-person to virtual interview process. Obtaining an obstetrics and gynecology residency position is known to be competitive and places a considerable financial burden on applicants. This study aims to quantify the total costs in the application process before and after virtual interviews were implemented.

METHODS:
The Texas STAR database was queried to identify obstetrics and gynecology residency applicants from 2019 to 2023. The primary outcome was applicant-reported spending on the residency application process. Descriptive statistics and linear regression models were used to evaluate for associations with sociodemographic, temporal, and geographic factors.

RESULTS:
A total of 2,315 obstetrics and gynecology applicants were included. Applicants reported significantly less average total spending on the residency application process after the start of the COVID-19 pandemic compared to the years prior ($2,515 [SD 2,055] versus $4,909 [SD 2,869]; P<.001). Applicants who identified as underrepresented in medicine (P=.022), had a DO degree (P<.001), completed a research year (P=.030), participated in the couples match (P<.001), or were from the Western region (P<.001) reported significantly more total spending. There was a significant positive correlation between total non-interview-related spending and the number of interviews received (P<.001).

CONCLUSION:
There was a significant reduction in applicant spending after the start of the COVID-19 pandemic, likely related to transition to virtual interviews and limitations on in-person away rotations. The association of applicant spending with the number of interview offers raises concern for possible equity implications.
Assessment of Second Victim Trauma Resources for Obstetrics and Gynecology Residents [ID 2683424]
Authors: Roy Amrita , Olson-Chen Courtney 
Published: May 2024

INTRODUCTION:
Second victim trauma (SVT) encompasses psychological, cognitive, or physical symptoms experienced by health care providers after adverse events. Obstetrics and gynecology trainees may be more vulnerable to SVT given their exposure to adverse events and lack of experience. Our objective was to assess the background knowledge of SVT among obstetrics and gynecology residency program directors (PDs) and the curricula and resources available to support obstetrics and gynecology trainees.

METHODS:
An 18-question survey was developed and disseminated to all 295 obstetrics and gynecology PDs. The survey assessed baseline knowledge of SVT, psychological resources available, knowledge regarding the SVT validated screening tool, and personal experiences. Descriptive and statistical analysis was performed using STATA, Version 12.

RESULTS:
A total of 99 PDs completed the survey (34% response rate). 92% of PDs had heard of SVT, and 82% felt they could identify its signs/symptoms. 41% of programs had SVT in the curricula. 28% of programs exist in hospitals with an SVT program, and 60% have trained clinician peer supports. Program directors who have an SVT curriculum were twice as likely to be familiar with validated survey tools for SVT (P=.004), and 2.7 times more likely to identify warning signs that a resident may need additional support (P<.001). 86% of PDs would like additional education on SVT.

CONCLUSION:
The majority of obstetrics and gynecology residency PDs are aware of SVT and have an idea of how to identify this in their residents. The rates of embedded resources vary across the country. Additional education and curriculum development focused on SVT may benefit obstetrics and gynecology PDs and trainees.
Game On: Team-Based Competition to Enhance Engagement in Obstetrics and Gynecology Graduate Medical Education [ID 2683471]
Authors: Gregg Rebecca W. , Gottula Jessica , Medla Samantha A. , Chatfield Lindsay , Keyser Erin A. 
Published: May 2024

INTRODUCTION:
Surgeon General Dr. Vivek Murthy called attention to what he declares a public health crisis of loneliness, isolation, and lack of connection in our country. Three years into the COVID pandemic, the medical profession has experienced a huge increase in burnout that has only exacerbated this crisis. Consistent with national trends, lack of faculty engagement and overall well-being was noted to have suffered on our 2022 Accreditation Council for Graduate Medical Education (ACGME) Resident Survey.

METHODS:
The Brooke Army Medical Center Gynecologic Surgery and Obstetrics residency program implemented a themed team competition for the 2022–2023 academic year, “GYN of Thrones.” Residents and staff were divided into five families, modeled after Game of Thrones to compete for the “Throne of Hysteros.” Points were awarded for participating in program activities, receiving kudos for patient care, and demonstrating clinical excellence. The data from the 2021–2022 and 2022–2023 ACGME surveys were compared to evaluate the effect of this new competition.

RESULTS:
Faculty interest in resident education increased 41% (P=.002), from 59% to 100% after implementation. Similarly, only 59% felt there was an appropriate amount of teaching in clinical and didactic activities in 2021–2022, whereas this improved to 89% in 2022–2023 (P=.041). Residents were also more satisfied with faculty feedback: 53% prior to the competition improved to 84% after (P=.047).

CONCLUSION:
Resident perception of faculty engagement in academics and quality of teaching drastically improved after implementation of this program-wide competition. Faculty well-being scores improved as well, indicating this may decrease burnout in the workforce and improve morale and connection.
How Do Women Vote: What Women Post About Home Birth Compared With Hospital Birth on Reddit and TikTok [ID 2683436]
Authors: Morris Kelsey , Lane Fiona , Nelson Anita L. , Stohl Hindi 
Published: May 2024

INTRODUCTION:
Rates of home birth have been increasing as has reliance on social media as a source of medical advice and support. This is the first study that directly evaluates birthing women’s beliefs about home births in the public posts and comments on two popular social media platforms. We sought to identify major themes on perceptions, attitudes, and advice offered about home birth on Reddit and TikTok.

METHODS:
Posts were searched using the terms “home birth” and “home versus hospital birth.” Up to five themes were collected per post or comment and were categorized as supportive, opposing, or neutral. We included posts from the United States, in English, with at least 10 comments and 10 upvotes or likes. Institutional review board approval was waived.

RESULTS:
A total of 777 posts and 47,452 comments were evaluated for inclusion; 257 posts and 2,408 comments met criteria for thematic content analysis. Overall in posts, 69% supported, 20% opposed, and 11% were neutral toward home birth. In comments, 53% supported, 28% opposed, and 19% were neutral. Supportive themes included concerns about safety of hospital delivery and reassurance about home birth safety, patient control with home deliveries, and advice about preparing for home birth. Opposing themes included concerns about risks of home birth, negligence of those attempting it, reassurance that hospital birth offers women control, and that medical interventions can be lifesaving.

CONCLUSION:
These results can help physicians recognize some of women’s concerns about hospital births and what information they may find on social media guiding them in their birth decisions.
SHARP (SHort Answer, Rationale Provision): A New Item Format to Assess Clinical Reasoning
Authors: Runyon Christopher R. , Paniagua Miguel A. , Rosenthal Francine A. , Veneziano Andrea L. , McNaughton Lauren , Murray Constance T. , Harik Polina 
Published: May 2024

Abstract

Problem
Many non–workplace-based assessments do not provide good evidence of a learner’s problem representation or ability to provide a rationale for a clinical decision they have made. Exceptions include assessment formats that require resource-intensive administration and scoring. This article reports on research efforts toward building a scalable non–workplace-based assessment format that was specifically developed to capture evidence of a learner’s ability to justify a clinical decision.

Approach
The authors developed a 2-step item format called SHARP (SHort Answer, Rationale Provision), referring to the 2 tasks that comprise the item. In collaboration with physician-educators, the authors integrated short-answer questions into a patient medical record–based item starting in October 2021 and arrived at an innovative item format in December 2021. In this format, a test-taker interprets patient medical record data to make a clinical decision, types in their response, and pinpoints medical record details that justify their answers. In January 2022, a total of 177 fourth-year medical students, representing 20 U.S. medical schools, completed 35 SHARP items in a proof-of-concept study.

Outcomes
Primary outcomes were item timing, difficulty, reliability, and scoring ease. There was substantial variability in item difficulty, with the average item answered correctly by 44% of students (range, 4%–76%). The estimated reliability (Cronbach α) of the set of SHARP items was 0.76 (95% confidence interval, 0.70–0.80). Item scoring is fully automated, minimizing resource requirements.

Next Steps
A larger study is planned to gather additional validity evidence about the item format. This study will allow comparisons between performance on SHARP items and other examinations, examination of group differences in performance, and possible use cases for formative assessment. Cognitive interviews are also planned to better understand the thought processes of medical students as they work through the SHARP items.
The American Society of Addiction Medicine Clinical Practice Guideline Development Methodology
Authors: Weimer Melissa B. , Devoto Amanda , Kansagara Devan , Safarian Taleen , Brunner Emily , Stock Audra , Rastegar Darius A. , Nelson Lewis S. , Tirado Carlos F. , Korthuis P. Todd , Boyle Maureen P. 
Published: May 2024

AbstractThe American Society of Addiction Medicine (ASAM) has published clinical practice guidelines (CPGs) since 2015. As ASAM's CPG work continues to develop, it maintains an organizational priority to establish rigorous standards for the trustworthy production of these important documents. In keeping with ASAM's mission to define and promote evidence-based best practices in addiction prevention, treatment, and recovery, ASAM has rigorously updated its CPG methodology to be in line with evolving international standards. The CPG Methodology and Oversight Subcommittee was formed to establish and publish a methodology for the development of ASAM CPGs and to develop an ASAM CPG strategic plan. This article provides a focused overview of the ASAM CPG methodology.
Gastric Pressure Monitoring Unveils Abnormal Patient–Ventilator Interaction Related to Active Expiration: A Retrospective Observational Study
Authors: Akoumianaki Evangelia , Vaporidi Katerina , Stamatopoulou Vaia , Soundoulounaki Stella , Panagiotarakou Meropi , Kondili Eumorfia , Georgopoulos Dimitris 
Published: May 2024

Background
Patient–ventilator dyssynchrony is frequently observed during assisted mechanical ventilation. However, the effects of expiratory muscle contraction on patient–ventilator interaction are underexplored. The authors hypothesized that active expiration would affect patient–ventilator interaction and they tested their hypothesis in a mixed cohort of invasively ventilated patients with spontaneous breathing activity.

Methods
This is a retrospective observational study involving patients on assisted mechanical ventilation who had their esophageal pressure (Peso) and gastric pressure monitored for clinical purposes. Active expiration was defined as gastric pressure rise (ΔPgas) greater than or equal to 1.0 cm H2O during expiratory flow without a corresponding change in diaphragmatic pressure. Waveforms of Peso, gastric pressure, diaphragmatic pressure, flow, and airway pressure (Paw) were analyzed to identify and characterize abnormal patient–ventilator interaction.

Results
76 patients were identified with Peso and gastric pressure recordings, of whom 58 demonstrated active expiration with a median ΔPgas of 3.4 cm H2O (interquartile range = 2.4 to 5.3) observed in this subgroup. Among these 58 patients, 23 presented the following events associated with expiratory muscle activity: (1) distortions in Paw and flow that resembled ineffective efforts, (2) distortions similar to autotriggering, (3) multiple triggering, (4) prolonged ventilatory cycles with biphasic inspiratory flow, with a median percentage (interquartile range) increase in mechanical inflation time and tidal volume of 54% (44 to 70%) and 25% (8 to 35%), respectively and (5) breathing exclusively by expiratory muscle relaxation. Gastric pressure monitoring was required to identify the association of active expiration with these events. Respiratory drive, assessed by the rate of inspiratory Peso decrease, was significantly higher in patients with active expiration (median [interquartile range] dPeso/dt: 12.7 [9.0 to 18.5] vs 9.2 [6.8 to 14.2] cmH2O/sec; P < 0.05).

Conclusions
Active expiration can impair patient–ventilator interaction in critically ill patients. Without documenting gastric pressure, abnormal patient–ventilator interaction associated with expiratory muscle contraction may be mistakenly attributed to a mismatch between the patient’s inspiratory effort and mechanical inflation. This misinterpretation could potentially influence decisions regarding clinical management.

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Hospital Variation in Epinephrine Administration Before Defibrillation for Cardiac Arrest Due to Shockable Rhythm
Authors: Stewart Colten , Chan Paul S. , Kennedy Kevin , Swanson Morgan B. , Girotra Saket ,   for the American Heart Association’s Get With The Guidelines (GWTG) Resuscitation Investigators.
Published: May 2024

Objectives:
Contrary to advanced cardiac life support guidelines that recommend immediate defibrillation for shockable in-hospital cardiac arrest (IHCA), epinephrine administration before first defibrillation is common and associated with lower survival at a “patient-level.” Whether this practice varies across hospitals and its association with “hospital-level” IHCA survival remains unknown. The purpose of this study was to determine hospital variation in rates of epinephrine administration before defibrillation for shockable IHCA and its association with IHCA survival.

Design:
Observational cohort study.

Setting:
Five hundred thirteen hospitals participating in the Get With The Guidelines Resuscitation Registry.

Patients:
A total of 37,668 adult patients with IHCA due to an initial shockable rhythm from 2000 to 2019.

Interventions:
Epinephrine before first defibrillation.

Measurements and Main Results:
Using multivariable hierarchical regression, we examined hospital variation in epinephrine administration before first defibrillation and its association with hospital-level rates of risk-adjusted survival. The median hospital rate of epinephrine administration before defibrillation was 18.8%, with large variation across sites (range, 0–68.8%; median odds ratio: 1.54; 95% CI, 1.47–1.61). Major teaching status and annual IHCA volume were associated with hospital rate of epinephrine administration before defibrillation. Compared with hospitals with the lowest rate of epinephrine administration before defibrillation (Q1), there was a stepwise decline in risk-adjusted survival at hospitals with higher rates of epinephrine administration before defibrillation (Q1: 44.3%, Q2: 43.4%; Q3: 41.9%; Q4: 40.3%; p for trend < 0.001).

Conclusions:
Administration of epinephrine before defibrillation in shockable IHCA is common and varies markedly across U.S. hospitals. Hospital rates of epinephrine administration before defibrillation were associated with a significant stepwise decrease in hospital rates of risk-adjusted survival. Efforts to prioritize immediate defibrillation for patients with shockable IHCA and avoid early epinephrine administration are urgently needed.
High-Intensity, High-Frequency, Parallel Ultrasound Beams for Cellulite of the Buttocks and Thighs
Authors: Wang Jordan V. , Ugonabo Nkem , Bajaj Shirin , Jairath Neil , Munavalli Girish , Chapas Anne , Geronemus Roy G. , Kilmer Suzanne 
Published: May 2024

BACKGROUNDUltrasound energy can successfully treat fine lines and wrinkles, as well as lift the eyebrow and submentum. Ultrasound waves of high intensity induce thermal injury in the dermis with subsequent tissue remodeling.OBJECTIVETo examine the utility of a novel ultrasound device that utilizes high-intensity, high-frequency, parallel ultrasound beams to improve the clinical appearance of cellulite on the thighs and buttocks.MATERIALS AND METHODSA prospective, multicenter, clinical study investigated this novel ultrasound device using 2 treatments.RESULTSSixty-five subjects completed both treatments. The mean age was 46 years, and 100% were women. Fitzpatrick skin types I to VI were represented. Assessments compared 3-month follow-up with baseline. Two blinded reviewers agreed in identifying pretreatment and post-treatment photographs for 89.2%. For Cellulite Severity Scale rating, there was significant improvement of 1.61 units (p< .001). For cellulite Global Aesthetic Improvement Scale (GAIS), 89.2% had improvement, with a mean of 0.87 units (p< .001). For Laxity Scale rating, there was significant improvement of 0.70 units (p< .001). For skin laxity GAIS, 89.2% had improvement, with a mean of 0.76 units (p< .001). No device-related adverse events occurred.CONCLUSIONA novel ultrasound device that utilizes high-intensity, high-frequency, parallel ultrasound beams can safely and effectively improve the clinical appearance of cellulite on the thighs and buttocks.
Lower Third Leg Trauma Management Algorithm; Kasr Alainy Protocol
Authors: Elkholy Yusuf A. , Mahboub Tarek , Zaki Amr A. , ElSharkawy Omar A. , Noaman Ayman 
Published: May 2024

Background:
Soft tissue defects in the lower third of the leg present significant challenges for surgeons. Despite various options available for soft tissue coverage, selecting the most suitable option is limited by potential complications. In response to this challenge, some surgeons have sought to develop algorithms to guide decision-making in the management of lower leg trauma.

Methods:
This prospective observational cross-sectional study included 53 patients with traumatic injuries to the lower third leg and ankle regions. Each patient underwent a management plan based on our proposed algorithm, which incorporated the utilization of negative pressure wound therapy and dermal substitutes. Outcomes were assessed in terms of the ability to achieve complete coverage, complication rates, duration of hospital stay, and return to normal daily activity.

Results:
The proposed algorithm proved to be comprehensive and easily applicable, achieving complete coverage in 98.1% of cases. The mean duration for definitive coverage was 21.89 ± 12.84 days, and the majority of cases (81.1%) returned to normal daily activity within a mean duration of 60.69 ± 56.7 days. The use of dermal substitutes resulted in achieving coverage in wounds with exposed structures, with favorable outcomes in cases with a mean size of 11.39 ± 10.05 cm².

Conclusions:
Our algorithm provides a safe and effective approach to manage traumatic defects of the lower third leg and ankle, considering the patient’s general condition and the complexity of the wound. Proper utilization of dermal substitutes and negative pressure wound therapy is emphasized in the algorithm.