bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19 Pandemic Effect on Tubal Sterilization Accessibility [ID: 1376950]
Authors: Tran Khanh Hien , Hosein Safiyah , Mestad Renee 
Published: May 2023

INTRODUCTION:
The COVID-19 pandemic preferentially allocated medical resources to emergent and urgent services with postponement of “elective” procedures such as surgical sterilization. This study aims to examine effect of postponing surgical sterilization on patients’ reproductive lives.

METHODS:
This retrospective review assesses patient consultations for tubal sterilization in a hospital-based clinic in 2019 (n=75) and 2020 (n=61). An IRB waiver was obtained. The primary outcome was the rate of unintended pregnancies within 1 year of consultation. The secondary outcomes included length of time between consultation and procedure, expiration of Medicaid sterilization consent, and alternate contraceptive uptake.

RESULTS:
There was no difference between unintended pregnancies between 2019 and 2020 (8% versus 11%, P=.49). There was no difference between procedure completion rate (65% versus 59%, P=.45). The rate of expiration of Medicaid sterilization consent was statistically different (7% versus 21%, P=.012). Initial consultation to procedure completion averaged 1.8 months in 2019 and 4.0 months in 2020. Of patients who did not undergo sterilization procedure, 96% received an alternate method of contraception in 2019 compared to 88% in 2020.

CONCLUSION:
No statistical difference was found between unintended pregnancy or rate of procedure completion despite the difference in delay, suggesting that tubal sterilization may be appropriately delayed during resource shortages. The difference in expiration of Medicaid sterilization consent may pose a significant burden to the patient who needs to return to clinic and reconsent prior to the procedure.
Increasing Contraception Options Immediately After Birth: Did Immediate Postpartum Long-Acting Reversible Contraception (IPP LARC) Utilization Increase During the COVID-19 Pandemic? [ID: 1377847]
Authors: Mastronardi Alicia , Maples Jill , Shelton Zachary , Young Megan , Zite Nikki 
Published: May 2023

INTRODUCTION:
Preliminary research indicates prenatal and postpartum care decreased during the COVID-19 pandemic. Models also indicate increases in unintended pregnancies after 2020. The goal of this study was to assess whether immediate postpartum long-acting reversible contraception (IPP LARC) insertions and desire for IPP LARC increased during COVID-19 among patients insured under TennCare Medicaid (TennCare or CoverKids) with access to coverage for this type of contraception.

METHODS:
Deliveries in patients insured under TennCare Medicaid Programs (n=6,922) in one East Tennessee hospital were assessed before and during the COVID-19 pandemic (January 2019 to May 2020 and June 2020 to December 2021, respectively). Data from electronic health records were securely collected in Excel and analyzed using SPSS software. Comparisons were made using chi-square tests.

RESULTS:
During COVID, increased uptake of IPP LARC was statistically significant: 18.0% (CI 16.9–19.1%) before the COVID-19 pandemic and 22.0% (CI 20.6–23.3%) during (P<.001). In addition, desire for IPP LARC increased significantly among patients: 20.0% (CI 19.1–21.3%) before COVID-19 and 22.3% (CI 21.0–23.7%) during COVID-19 (P=.016). Significant increases in desire for IPP LARC during the pandemic occurred among adolescent patients (<20 years of age) (P=.003), those living HRSA-defined nonrural areas (P=.024), non-Hispanic women (P=.036), and White women (P=.027).

CONCLUSION:
IPP LARC is a highly effective, convenient contraception option for women, especially during times with possible increased limitations in accessing postpartum care. Perhaps because of shelter-at-home orders, limitations in “nonessential” health care being practiced, or personal preferences and desires during the pandemic, IPP LARC was more highly utilized and desired by those wishing to avoid unintended pregnancy after the pandemic began.
Online Clinical Decision Support Software Reduces Time to Diagnosis of Fertility Disorders to 8 Weeks on Average [ID: 1380156]
Authors: Chen Serena , Hecher Silvia , Van Dis Jane 
Published: May 2023

INTRODUCTION:
Time to diagnosis of fertility disorders is reported to take up to 11 years and involves five to six physicians on average. Prolonged time to diagnosis is not just an immense burden on the health care system, but also means that in vitro fertilization (IVF) becomes necessary for couples who would have been able to conceive naturally had they been diagnosed sooner, often leaving these couples childless. This observational study evaluated how a clinical decision support software based on American Society for Reproductive Medicine, American College of Obstetricians and Gynecologists, and European Society of Human Reproduction and Embryology guidelines used by patients and obstetrician–gynecologists together can reduce the time to diagnosis of up to 65 conditions affecting female fertility.

METHODS:
One hundred eighty women aged 20–45 who had been trying to conceive for an average of 11 months were recruited to participate. Women completed a reproductive health assessment with a dynamic online questionnaire. The output of the assessment was a lab requisition with an individualized selection of female and male sex hormones, thyroid hormones, markers for glucose metabolism, vitamin deficiencies, complete blood count, as well as markers for immunology, genetics, and thrombophilia. The clinical decision support software combined the results from the online reproductive health assessment with the lab results to render recommendations for diagnosis, further diagnostics, and treatment.

RESULTS:
An average of four previously unknown health conditions affecting fertility were diagnosed with an average time of 8 weeks to diagnosis (range, 5–16). Diagnoses included polycystic ovarian syndrome, various forms of amenorrhea, premature ovarian insufficiency, vitamin and iron deficiency, hyperthyroidism and hypothyroidism, insulin sensitivity, and prolactinoma.

CONCLUSION:
An online clinical decision support tool can significantly reduce time to diagnosis of conditions affecting female fertility. It also reduces the number of patient–physician interactions and the time physicians spend on medical history and necessary patient education.
Socioeconomic and Racial Trends in Human Papillomavirus Vaccination: A 10-Year Retrospective Review [ID: 1366482]
Authors: Bell Christina , Beltran Thomas , Penick Emily 
Published: May 2023

INTRODUCTION:
Human papillomavirus (HPV) vaccination in the United States is low, and lack of vaccination disproportionately affects minority patients and those of a lower socioeconomic status. We sought to assess the effect of race and ethnicity and socioeconomic factors on HPV vaccine adoption over the last decade.

METHODS:
An analysis was conducted on data from the National Health Nutrition Examination Survey from 2009 to 2018 of individuals aged 12–26 years. Sociodemographic and vaccination history was gathered via self-report. Logistic regression models assessed relationships between HPV vaccination and variables of interest.

RESULTS:
Data from 8,120 individuals were included in the analysis. Vaccine initiation among females rose from 30.5% (95% CI 25.7–35.8) in 2009–2010 to 55.1% (95% CI 50.0–60.0) in 2017–2018 and from 8.3% (95% CI 6.2–10.9) in 2011–2012 to 36.4% (95% CI 31.2–41.9) in 2017–2018 for males. Individuals with insurance coverage were 2.0 times more likely to report being vaccinated (95% CI 1.8–2.6). Independent of insurance coverage, having a routine place to seek health care was associated with a 1.9 times increase (95% CI 1.5–2.3) in HPV vaccination. Independent of insurance and access to care, Mexican American and non-Hispanic Black individuals were 1.7 times (95% CI 1.3–2.2) and 1.4 times (95% CI 1.1–1.9) less likely to complete the vaccine series compared to non-Hispanic White individuals.

CONCLUSION:
Human papillomavirus vaccination initiation has increased in the United States over the past 10 years; however, vaccination has plateaued among women with only half of females vaccinated and nearly a fifth initiating but not completing the series. Access to care appears to be a significant predictor of HPV vaccination.
Comparison of Postoperative Quality of Life Scores in Women Who Underwent Myomectomy Versus Hysterectomy for Uterine Fibroids [ID: 1379414]
Authors: Mitchell Jameson , Bradley Linda , Falcone Tommaso , Frisch Emily , Llarena Natalia , Omosigho Ukpebo 
Published: May 2023

INTRODUCTION:
Uterine fibroids are highly prevalent and associated with significant effect on quality of life (QOL). The current study compares QOL scores in patients that underwent myomectomy or hysterectomy for management of fibroids.

METHODS:
After obtaining approval from the Cleveland Clinic IRB, we conducted a retrospective cohort study for patients that underwent hysterectomy or myomectomy for uterine fibroids. Eligible patients were sent validated surveys: 36-Item Short Form Health Survey (SF-36) and Uterine Fibroid Symptom and QOL questionnaire (UFS-QOL). Standard bivariate analyses were used to compare differences in QOL scores between groups, adjusting for age and race.

RESULTS:
Of the 142 survey respondents, 37 underwent myomectomy and 105 underwent hysterectomy. The median number of days between surgery and survey completion was 1,652 (1,142, 2,328) for myomectomy and 1,022 (740, 1,317) for hysterectomy. For SF-36, hysterectomy patients reported significantly less energy (P=.006) compared to myomectomy. Significant differences were not observed in postoperative physical functioning, role limitations, pain, health perceptions, vitality, social functioning, or mental health. Although there was no statistically significant difference in UFS-QOL scores, patients who underwent hysterectomy experienced significantly lower symptom severity (P=.009) and levels of concern (P<.001), and increased activity tolerance (P=.005) and sense of control (P=.029).

CONCLUSION:
While patients who underwent hysterectomy reported more fatigue, they experienced lower symptom severity, lower levels of concern, higher activity tolerance, and increased sense of control compared to myomectomy. These findings may help guide counseling for surgical fibroid treatment.
Preoperative Pain Control Discussion With EMR Documentation Prompt to Guide Opioid Prescriptions for Laparoscopic Sterilization Surgery [ID: 1377197]
Authors: Chase Gillian , Burrell Dayna , Eger Renee , Matteson Kristen 
Published: May 2023

INTRODUCTION:
Our objective was to evaluate whether implementing a standardized patient–physician counseling and documentation process about pain and opioid use after laparoscopic bilateral salpingectomy (LSC BS) decreased opioid prescribing.

METHODS:
In this study, we evaluated a quality improvement project aimed at decreasing opioid overprescribing and promoting patient–physician conversations and documentation surrounding pain control after surgery. An electronic medical record (EMR) standardized smart phrase was implemented in the Resident GYN Specialty Clinic at the Obstetrics and Gynecology Care Center in order to standardize patient–physician counseling and documentation about postoperative pain, opioid use, storage, and disposal, providing written and verbal education at the time of preoperative and postoperative appointments for Lap BS. We collected EMR data from patients who had a LSC BS preintervention (January 2019 to December 9, 2020) and postimplementation (March 2021 to October 2022). To have 90% power to detect a 25% reduction in morphine milligram equivalents (MMEs) from preimplementation to postimplementation, we needed 78 patients per group.

RESULTS:
A total of 78 patients met inclusion criteria for both groups. Patients postintervention were prescribed significantly fewer opioids (58.3 versus 31.35 MME, P<.001, or 7.8 versus 4.2 oxycodone 5 mg tablets) compared to patients preintervention. Significant differences were also seen in secondary outcomes with increased documentation of discussion surrounding the addictive properties of opioids and expected pain postoperatively postintervention compared to preintervention.

CONCLUSION:
Implementation of physician education combined with EMR prompts decreased the amount of opioids prescribed and increased documentation of patient–physician communication about safe opioid use and pain control.
The Gonadotoxic Effects of Conditioning Chemotherapy Regimens Prior to Hematopoietic Stem Cell Transplantation [ID: 1376168]
Authors: Jiang Heng , Dong Rosemary , Kim So-Youn , Luan Yi , Thonen Macy , Wadhwa Aman 
Published: May 2023

INTRODUCTION:
Primary ovarian insufficiency secondary to high-dose chemotherapy in females undergoing the conditioning regimen before hematopoietic stem cell transplantation is a challenging late complication. Limited studies have investigated the ovarian toxicity of various conditioning regimens. This study aimed to explore the gonadotoxic effects of cyclophosphamide (CY) and busulfan (BU) in CD-1 mice strain.

METHODS:
Sixteen 1-month-old female CD-1 mice (n=4/group) were subcutaneously injected with solvent, BU, CY, or BU+CY, respectively. The doses (144 mg/kg BU and 300 mg/kg CY) and injection plan were adjusted to human doses. The ovaries and female reproductive tracts were harvested 1 week after the last administration. Follicle counting was performed. The levels of serum antimüllerian hormone (AMH) and 17-beta-estradiol were measured. Animal use approval was obtained from the Institutional Animal Care and Use Committee at the University of Nebraska Medical Center.

RESULTS:
All mice survived the injections and grossly appeared normal. The average ovary weight was significantly lower in BU (P=.0007) and BU+CY (P<.0001) groups than in the control and CY groups. The primordial (P<.0001) and primary follicles (P=.01) in treatment groups were decreased compared to the control group. The serum AMH level in the BU group was also significantly lower than the control and CY group (P=.003).

CONCLUSION:
We show that conditioning chemotherapy with CY and BU can reduce the ovarian reserve in CD-1 mice strain and may have a synergic effect. Future studies to investigate the mechanism of chemotherapy-related ovarian follicle death are needed to improve fertility outcomes in patients receiving conditioning chemotherapy.
Oncofertility Referral Patterns for Female Adolescent and Young Adult Cancer Survivors [ID: 1380296]
Authors: Holley-Cuthrell Jenan , Choi Alexandria , Class Quetzal A. , Gorniak Adrianna , Hussein Nada , MacLaughlan David Shannon 
Published: May 2023

INTRODUCTION:
Oncofertility counseling for adolescent and young adult (AYA) cancer survivors is standard of care, but referral rates to reproductive endocrinology and infertility (REI) are low. We examined factors associated with oncofertility referrals in a diverse urban cancer center.

METHODS:
This is a retrospective cohort study of female AYA survivors aged 15–39 years between 2015 and 2021.

RESULTS:
Female AYA survivors (n=303) had a mean age of 30.9 (±5.75), ranging 16–39 years. Only 21 (6.9%) patients had oncofertility counseling prior to starting cancer treatment. The population was 40.8% White (n=122) and 37.8% Black (n=113). Seventy-two (25.6%) were referred to REI, and 62.0% of those (n=44) underwent counseling. Black AYA survivors had three times higher odds of referral than White survivors (odds ratio [OR] 2.99, 95% CI 1.49–5.96), and parity was associated with lower odds of referral (OR 0.35, 95% CI 0.19–0.68). Eighteen of the Black survivors referred (52.9%) underwent counseling. Of the 22 White survivors referred, 81.8% (n=18) underwent counseling, more than expected compared with other races (X2=7.46, P=.05). Age (OR 0.82, 95% CI 0.71–0.94) and parity (OR 0.22, 95% CI 0.06–0.85) reduced odds of accepting referral. In a multivariable model including age, parity, race, insurance, cancer type, and treatment received, race was no longer predictive, but childbearing status remained associated with lower odds of oncofertility referral (OR 0.19, 95% CI 0.08–0.46).

CONCLUSION:
Most female AYA survivors did not receive timely oncofertility counseling. Black survivors were offered referral more than White individuals, which did not improve access to REI services. Future efforts will focus on integrating REI services into cancer center operations.
A Prospective Study to Assess for Histologic Changes on Vulvar Biopsies in Postmenopausal Women With Lichen Sclerosus Treated With Fractionated CO2 Laser Therapy [ID: 1339895]
Authors: Lee Jennifer , Cardis Michael , Dieter Alexis , Etcheverry Maria , Gonzales Melissa , Iglesia Cheryl 
Published: May 2023

INTRODUCTION:
Lichen sclerosus (LS) is a chronic skin condition affecting men and women of all ages. Fractionated carbon dioxide (FxCO2) laser therapy has been proposed as a novel treatment modality. Our objective was to investigate histologic changes after FxCO2 laser therapy for vulvar LS and assess symptomatic improvement using the Skindex-16 questionnaire.

METHODS:
This prospective single-arm study was conducted from April 2021 to August 2022 at one academic medical center. Ten English-speaking postmenopausal women with biopsy-proven LS undergoing FxCO2 laser treatment were enrolled. Exclusion criteria included prior transvaginal mesh for prolapse, recent topical corticosteroid use, prior pelvic radiation, malignancy, active genital infection, or pregnancy. Institutional review board approval and written consent from participants were obtained. The vulvovaginal SmartXide2-V2-LR laser system FxCO2 laser (DEKA, Calenzano, Italy) was used to treat visually affected areas of vulvar and perianal LS with a single pass over three treatments spaced 4–6 weeks apart. Participants completed the Skindex-16 questionnaire and underwent vulvar biopsy at baseline and 4 weeks after the third FxCO2 laser therapy. Histologic slides were blinded and then scored by a dermatopathologist (MC) on a 5-point scale to assess sclerosus, inflammation, and epidermal atrophy.

RESULTS:
Participants had a mean age of 61 and were mostly White, privately insured with college/graduate-level education. Posttreatment vulvar biopsies showed significant improvement in sclerosus and epidermal atrophy (P<.05) with no statistically significant change in inflammation or Skindex-16 scores after FxCO2 laser treatment. A statistically significant correlation was found between sclerosus and Skindex-16 symptoms score (mean change of 21.4 units in Skindex-16 symptoms score for 1 unit change in histologic sclerosus score, P=.03).

CONCLUSION:
In postmenopausal women with vulvar LS undergoing FxCO2 laser therapy, symptomatic improvements are correlated with histologic changes in sclerosus on vulvar biopsy. FxCO2 laser therapy is a promising option for treatment of LS, and further studies are needed to assess safety and efficacy.
Quantitative Blood Loss in Cesarean Delivery Is More Accurate Than Visual Estimation [ID: 1376884]
Authors: Orzolek Charlotte , Durie Danielle , Flicker Amanda , Giacobbo Alexa , Quinones Joanne , Qureshey Emma 
Published: May 2023

INTRODUCTION:
The objective of this study was to determine the difference in milliliters between calculated blood loss (CBL) and two measurement techniques: estimated blood loss (EBL) versus quantitative blood loss (QBL) for cesarean deliveries.

METHODS:
This was a retrospective cohort study at a tertiary hospital examining blood loss from singleton, term cesarean births. EBL and QBL groups contained 6 separate months of deliveries. Measurements were compared to a standard CBL: (0.75 × {[maternal height (inches)×50]+[maternal weight in pounds×25]}) by percent of blood volume lost ({predelivery HCT – postdelivery HCT}/predelivery HCT). Values of CBL − recorded blood loss=0 mL represented a more accurate measurement. Blood product transfusion was also compared.

RESULTS:
Median CBL did not differ between EBL (n=460) and QBL (n=507) groups: 836 mL (interquartile range [IQR] 566–1,135) versus 839 mL (IQR 608–1,175, P=.363). Reported blood loss was not different between EBL and QBL groups: 700 (IQR 600–800) mL and 677 (IQR 479–981, P=.501) mL, respectively. Differences between the CBL and recorded blood loss was larger in the EBL group (172 [IQR –101 to 474] mL) than the QBL group (−106 [IQR –379 to 118] mL), with P<.001. Transfusion rates did not differ between groups (P=.789).

CONCLUSION:
The positive value of 172 mL suggests that EBL is an underestimation of CBL, while the negative value of −106 mL suggests QBL is a slight overestimation, although a better approximator of CBL. These data offer insight into quantifiable value differences between EBL and QBL, which may be used in future investigation to adequately power studies that evaluate blood measurements techniques and influences on clinical decision-making.
Periviable Premature Rupture of Membranes—Maternal and Neonatal Risks: A Meta-Analysis [ID: 1363862]
Authors: Saucedo Alexander , Cahill Alison , Calvert Chase , Ghartey Kobina , Groves Alan , Harper Lorie M. 
Published: May 2023

INTRODUCTION:
Periviable rupture of membranes counseling should describe maternal and neonatal outcomes associated with both immediate delivery or expectant management; unfortunately, most published data focuses on neonatal outcomes and maternal risk estimates vary widely. We performed a meta-analysis to describe outcomes associated with expectant management compared to immediate delivery of periviable PROM.

METHODS:
We performed a systematic review of the literature including published clinical trials and observational cohorts after the year 2000. Publications were selected if they included maternal and neonatal outcomes for both expectant management and immediate delivery. Gestational age range was limited from 14 to 25 weeks. The primary outcome was maternal sepsis. Secondary outcomes included chorioamnionitis, hemorrhage, laparotomy, and neonatal survival. Pooled risk differences were calculated for each outcome using a random effects model. Publication bias was assessed using funnel plots and Harbord test.

RESULTS:
A total of 2,550 studies were initially screened, and 44 manuscripts were reviewed. Of these, 5 publications met inclusion for analysis: 4 retrospective and 1 prospective. Overall, 61.1% of women chose expectant management. Expectant management was associated with a 4% increased risk of maternal sepsis, 30% increased risk of chorioamnionitis, and 28% increased risk of any laparotomy. Neonatal survival with expectant management was 34% compared to 0% with immediate delivery.

CONCLUSION:
Women who choose to undergo expectant management experience an increased risk of sepsis, chorioamnionitis, and laparotomy with only one-third of neonates surviving to discharge. Knowledge of these risks is critical to counseling patients with this diagnosis.