bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between ACEs and Postoperative Pain After Gynecologic Surgery [ID: 1377683]
Authors: LaPorte Amanda , Gnade Colette , Owusu Raiven , Patanwala Insiyyah 
Published: May 2023

INTRODUCTION:
Adverse childhood experiences (ACEs) are instances of abuse or household dysfunction that occur prior to 18 years of age. Numerous studies have demonstrated an increased risk of morbidity and mortality with increasing ACE scores. An association between ACEs and chronic pelvic pain has also been described; however, data for acute pain are lacking. This study evaluates the relationship between ACEs and acute postoperative pain after benign minimally invasive hysterectomies.

METHODS:
Institutional review board approval was obtained at a large academic health center. Consenting participants completed the ACEs survey prior to hysterectomy. Patient data were collected by retrospective chart review, including postoperative care unit pain scores. Descriptive statistics, Kruskal-Wallis tests, and Spearman’s correlation coefficients were utilized for analysis. Enrollment is ongoing with a recruitment goal of 112 participants.

RESULTS:
Preliminary analysis included 47 participants. Average patient age was 39.2±11.4 years. The average ACE score was 3.5±2.9 and 46.8% of participants had high ACE scores, defined as 4 or more. Although not statistically significant, patients with high ACE scores trended towards higher pain scores and morphine milligram equivalents (MME) usage. Maximum pain scores and required MME were 5.86 and 16.50 MME in the high-ACE group versus 4.88 and 7.50 MME in the low-ACE group, respectively (P=.41, P=.40).

CONCLUSION:
High ACE scores are greater than threefold more prevalent in our surgical study population compared to previously reported general population rates. Although preliminary data suggest ACE scores and postoperative pain are not associated, further data are needed.
Abortion on TikTok Versus YouTube: An Analysis of Abortion Stance and Purpose [ID: 1365895]
Authors: Bringley Johanna , Dobrowolski Ciara , Springer-Miller Ryan 
Published: May 2023

INTRODUCTION:
Social media platforms are an accessible way for individuals to consume medical information. The topic of abortion is undergoing extensive discussion, and there is increasing need to understand the information available to the public. We aimed to assess whether the social media video platform affected abortion content stance and purpose.

METHODS:
We performed a cross-sectional study of abortion content on TikTok and YouTube. We searched the term “abortion” on each platform and reviewed the first 155 videos. Videos were categorized by purpose, abortion stance, and medical misinformation. We calculated descriptive statistics and used χ2 testing to compare between groups. The Albany Medical Center IRB determined this study was exempt.

RESULTS:
Of 310 videos, 280 were included for analysis with 137 YouTube videos and 143 TikTok videos. YouTube is more likely than TikTok to have anti-abortion content (19.71% versus 7.69%, P=.003) and strongly anti-abortion content (15.33% versus 4.20%, P=.002). YouTube is more likely than TikTok to have content categorized as news (33.58% versus 0.70%, P<.001) and less likely to have personal experience content (14.6% versus 41.26%, P<.001). The platforms were similar in their content containing medical misinformation (10.14% on YouTube versus 5.44% on TikTok, P=.137).

CONCLUSION:
There are significant differences in abortion content available for public consumption on popular social media video platforms. Understanding these differences can help us recognize content biases outside the clinical setting, facilitate creation of medically accurate and patient friendly content, and spur future work on medical misinformation and changes in social media over time.
Does Proposed Anti-Abortion Legislation Affect Access to Abortion Care? A State-by-State Comparison [ID: 1371679]
Authors: Elwood Adam , Sauer Mark 
Published: May 2023

INTRODUCTION:
Concerns over unhindered access to abortion have heightened because of newly proposed state legislation designed to restrict care in the United States. This study examines the effect of such measures on abortion access within each state prior to the 2022 Dobbs v Jackson ruling.

METHODS:
Proposed anti-abortion measures from 2015 to 2019 were collected from Guttmacher Institute databases, and sorted by state and legislative progress. Rates of abortions during that period were collected from Centers for Disease Control Vital Statistics reports, and similarly sorted by state. Basic statistical analyses were used to compare data.

RESULTS:
The average ratio of introduced to enacted anti-abortion legislation in the United States was 0.176, with North Dakota having the highest ratio of 1. Average overall abortion rates did not significantly change during this time (9.70 versus 9.44 per 1,000, P=.79). However, the correlation coefficient of state data comparing enacted legislation to overall abortion rates grew in magnitude from −0.189 in 2015 to −0.350 in 2019. The overall percent change in abortion rate per enacted legislation was −0.0089%, with Washington, DC, having the largest at −0.14%.

CONCLUSION:
Prior to the overturning of Roe v Wade, most state-introduced anti-abortion bills failed to be enacted into law. However, in states legislating restriction, women were disproportionately affected by lack of access to abortion locally. Patients and physicians alike should remain vigilant to the danger posed by anti-abortion legislation that would further hinder access to the reproductive health care of women.
Advanced Cervical Neoplasia Rates in Young Service Members: Implications of Primary HPV Screening for Military Readiness [ID: 1380248]
Authors: Crum Madison , Gregg Rebecca , Keyser Erin , Miller Caela , Watkin Rachel 
Published: May 2023

INTRODUCTION:
The new American Cancer Society (ACS) cervical cancer screening guidelines dissuade cervical cancer screening in women younger than 25, and may become universal national screening guidelines. We queried the incidence of advanced cervical dysplasia and carcinoma in military service members to determine the readiness implications of these recommendations.

METHODS:
A retrospective cohort study using the Military Health System (MHS) Data Repository and Management Analysis and Reporting Tool (MDR/M2) was performed to identify active-duty patients aged 21–25 diagnosed with cervical dysplasia and cancer across all military treatment facilities (MTFs) from January 1, 2017 to December 31, 2021. Additionally, patient age, human papillomavirus (HPV) infection status, and treatment type were collected.

RESULTS:
Only active-duty patients treated in a MTF fulfilling the above criteria were captured. In the 5 years of data collection, there were 955 active-duty women who met the inclusion criteria. Moderate to severe cervical dysplasia accounted for 62.3%, while carcinoma in situ and cervical cancer accounted for 35.6%, and 2.1%, respectively. The majority of patients did not have HPV testing or vaccination status encoded; therefore, this endpoint was eliminated from analysis.

CONCLUSION:
There are a militarily significant number of cases of advanced cervical lesions among young service members. If the new ACS guidelines are adopted, service members with treatable precancerous conditions will evade or delay detection, resulting in cancers that compromise readiness, increase cost, and compromise the health of military women. Mandatory HPV vaccination should be considered if ACS guidelines are adopted.
Chance of Pregnancy Not Decreased With Increasing Time Duration Between Ultrasound and Trigger Shot in Insemination Cycles [ID: 1368364]
Authors: Ravipati Vaishnavi , Hurley Emily , Sax Megan , Starostanko Andrea 
Published: May 2023

INTRODUCTION:
Follicle growth is often estimated during intrauterine insemination (IUI) ultrasounds in order to benefit the patient financially and decrease the number of appointments. There is a paucity of research evaluating the risks of increasing time duration between last ultrasound and ovulation induction. We sought to explore this research question further using clinical pregnancy rate as the primary outcome.

METHODS:
A retrospective cohort study was performed utilizing the UCHealth Center for Reproductive Health IUI database (November 2021 to June 2022). Patient population includes women with history of polycystic ovarian syndrome and infertility. The main variable evaluated was the interval time (day[s]) between the final ultrasound of the ovulation induction cycle and the date of trigger shot. Primary outcome measured is clinical pregnancy rate (CPR). Chi-square analysis was used to determine a significant relationship between the data sets.

RESULTS:
A total of 324 cycles were included. There was a statistical difference in CPR (12.77% versus 34%, P=.000) when comparing the interval of less than 3 days versus greater than 3 days, respectively. There was also a statistical difference in CPR (10.99% versus 23.31%, P=.003) when comparing the interval of less than 2 days versus greater than 2 days, respectively.

CONCLUSION:
Increasing time between the final ultrasound date and the date of trigger shot does not decrease the rate of clinical pregnancy. Further research should be done, incorporating a larger sample size and increasing population diversity.
Evaluation of Perioperative Factors Influencing Vaginal Cuff Dehiscence After Minimally Invasive Hysterectomy [ID: 1372339]
Authors: Brescia Sara , Davitt Katlin , Galaviz Veronica , Gibbs Jennifer , Khan Sameer , Paolillo Salvatore 
Published: May 2023

INTRODUCTION:
Vaginal cuff dehiscence (VCD) is one of the few surgical complications identified more commonly in minimally invasive hysterectomies (MIHs) versus open hysterectomies. The objective of this study is to determine perioperative risk factors that contribute to the development of VCD in patients undergoing MIH.

METHODS:
From 2016 to 2022, a multicenter retrospective analysis of patients undergoing MIH was conducted. Patient characteristics, preexisting conditions, surgical history, intraoperative factors, and type of MIH were evaluated to determine factors contributing to the development of VCD.

RESULTS:
One thousand one hundred eighty-nine patients underwent MIH. Only 10 (0.8%) patients developed VCD. There was no significant difference in mean body mass index, postoperative length of stay, or estimated blood loss between those with VCD versus those without. Incidence of VCD was highest in total laparoscopic hysterectomy versus all other MIH modalities (P=.002). There were no cases of VCD in laparoscopic-assisted vaginal hysterectomy. No patients with endometriosis experienced VCD, and there was no difference in the incidence in patients with cancer versus benign conditions (1.3% versus 0.8%, P=.488, odds ratio [OR] 1.29, 95% CI 0.68–8.23). Personal history of diabetes, hypertension, cesarean delivery, prior laparoscopy, prior laparotomy, or smoking did not affect the incidence of VCD (P>.05) as well as insurance status and race (P=.728 and P=.775, respectively). Patients who developed deep surgical site infections (SSIs) had significant increase in VCD (10.0% versus 2.3%, P=.006, OR 4.79, 95% CI 0.587–33.22).

CONCLUSION:
We observed that mode of MIH and SSI were perioperative risk factors that contribute to the development of VCD. What is notable is that demographics and medical comorbidities did not affect the incidence of VCD.
Evaluation of Perioperative Factors Contributing to Organ Space Surgical Site Infection After Minimally Invasive Hysterectomy [ID: 1374862]
Authors: Davitt Katlin , Brescia Sara , Gibbs Jennifer , Khan Sameer , Krickellas Joan , Paolillo Salvatore 
Published: May 2023

INTRODUCTION:
Postoperative organ space surgical site infection (oSSI), commonly referred to as pelvic abscess, is a clinically impactful complication after hysterectomy. Although more common in open hysterectomies, oSSIs occur in minimally invasive hysterectomy (MIH), contributing to morbidity. In the current study, we evaluate perioperative factors contributing to development of oSSIs in patients undergoing MIH.

METHODS:
From 2016 to 2022, a multicenter retrospective analysis of patients undergoing MIH was conducted. Patient characteristics, preexisting conditions, surgical history, intraoperative factors, and type of MIH were evaluated to determine factors contributing to the development of oSSI.

RESULTS:
One thousand one hundred eighty-nine patients underwent MIH. 28 patient (2.4%) developed oSSI. There was no difference in age or body mass index between groups (P>.05) and no difference in the incidence of oSSI based on type of MIH (P=.832). Patients with endometriosis were more likely to develop oSSI (4.9% versus 2.0%, P=.045, odds ratio [OR] 2.49, 95% CI 1.98–6.25). A diagnosis of cancer did not affect oSSI (3.9% versus 2.1%, P=.162, OR 1.90, 95% CI 0.76–4.78). History of diabetes, hypertension, cesarean delivery, prior laparoscopy, prior laparotomy, smoking, or obesity did not affect the incidence of oSSI (P<.05). Patients developing oSSI had a greater mean intraoperative estimated blood loss (EBL) (233.55 cc versus 94.3 cc, P<.001), greater mean length of stay (LOS) (2.4 versus 0.9 days, P<.001), higher incidence of post-operative ileus (15.8% versus 0.7%, P<.001) and blood transfusion (34.6% versus 1.0%, P<.001).

CONCLUSION:
Development of oSSI is associated with preexisting endometriosis and greater intraoperative EBL. Development of oSSI was associated with greater LOS, postoperative ileus, and blood transfusions. Attention to hemostasis may reduce rates of oSSI.
In-Person Versus Virtual Instruction and Simulation for Unplanned Out-of-Hospital Births [ID: 1371433]
Authors: Stansbury Nicholas , Page-Ramsey Sarah , Schenken Claire , Schenken Robert 
Published: May 2023

INTRODUCTION:
Unplanned out-of-hospital births are uncommon and associated with serious complications. Most emergency medical services (EMS) personnel receive little or no instruction on emergent vaginal delivery. Our in-person (IP) lecture and simulation training on emergent vaginal delivery for EMS personnel previously demonstrated improvement in knowledge and confidence. With COVID-19 we adapted the same curriculum into a virtual training session (VTS). In-person simulation increases confidence and knowledge, but less is known about virtual simulation training. The purpose of this study was to assess EMS personnel’s knowledge and confidence after IP versus VTS in emergent vaginal delivery.

METHODS:
The IP and VTS participants received the same lecture on emergent delivery either in-person or virtually. The IP group received in-person simulation training using a birth simulator. The VTS group received simulation training via virtual demonstration on the same model. Participants completed pretraining and posttraining surveys to assess knowledge and confidence. Responses were analyzed and compared using Student’s t test.

RESULTS:
Ninety-eight participants (59 IP, 39 VTS) participated with 100% survey completion. Pretraining knowledge scores were similar (IP 45% versus VTS 37%, P=.22). Although both groups showed improvement, the IP group had significantly higher posttraining knowledge scores (IP 99% versus VTS 75%, P<.01). More IP participants reported confidence in performing emergent delivery after training (IP 100% versus VTS 51%, P<.01).

CONCLUSION:
Live in-person instruction and simulation training of emergent vaginal delivery among EMS personnel results in higher knowledge scores and confidence when compared to virtual instruction and simulation training. Further evaluation is needed to determine generalizability to other learner groups.
No Transfer of Merotocin (FE 202767) to Breast Milk in Postpartum Women: A Novel Short-Acting Oxytocin Receptor Agonist for the Induction and Support of Lactation [ID: 1370662]
Authors: Hale Thomas , Bagger Yu , Baker Teresa , Holmqvist Carina , Jonker Daniel , Urban Lorien 
Published: May 2023

INTRODUCTION:
Establishing lactation after preterm birth is challenging, and there are no approved therapies. Merotocin (FE 202767) is a potent, short-acting, selective oxytocin-receptor agonist in clinical development for induction and support of lactation. This phase 1, open-label, parallel-group study of early postpartum women and women with established lactation investigated possible transfer of merotocin from plasma to breast milk.

METHODS:
Merotocin was administered as a single 90-minute intravenous (IV) infusion mimicking the intranasal pharmacokinetic profile. In part A, 12 early postpartum women received doses of 5 micrograms (n=6) or 20 micrograms (n=6) merotocin within 4 days of delivery. In part B, 6 women with established lactation received 20 micrograms of merotocin. The total amount of merotocin excreted in breast milk was determined, as well as the presence of metabolites of merotocin in breast milk, and adverse events. The IV route was chosen to minimize the variability in bioavailability often observed with nasal sprays. Institutional review board approval was obtained for the study.

RESULTS:
In all women (mean age, 26.3 years; 83.3% Caucasian) and at all time points, merotocin in breast milk was below the limit of quantification (25 pg/mL). Merotocin metabolites were not detected in any milk samples. Sixteen treatment-emergent adverse events occurred in early postpartum women only: including seven uterine spasms, and three breast engorgements. All events were mild except one moderate.

CONCLUSION:
Merotocin is not transferred into breast milk at quantifiable amounts, and is well tolerated. This study supports the evaluation of merotocin in an ongoing phase 2 study in women with preterm delivery (NCT02545127).
Daily Versus Twice-Daily Dosing of Nifedipine for Blood Pressure Control in Pregnancy and Postpartum [ID: 1375881]
Authors: Band Isabelle , Bianco Angela , Peterson Jessica , Wang Kelly 
Published: May 2023

INTRODUCTION:
Hypertensive disorders of pregnancy (HDP) may be managed with oral antihypertensives; however, pregnancy-induced changes in the hormonal milieu and volume of distribution make it difficult to determine optimal dosing regimens. Nifedipine is a first-line therapy for treatment of HDP. The purpose of this study is to compare 60 mg daily (QD) of extended released (XR) nifedipine to 30 mg twice daily (BID) for blood pressure (BP) control antepartum and postpartum.

METHODS:
This was a retrospective chart review conducted in Mount Sinai Health System. Patients admitted from January 1, 2015 to April 30, 2021, who were diagnosed with a HDP and received nifedipine XR 30 mg BID or 60 mg QD for intrapartum or postpartum BP control were included. The primary outcome was need for dose adjustment of nifedipine or addition of another antihypertensive agent. Patients were excluded if they had preexisting renal disease or were already taking oral antihypertensives.

RESULTS:
Two hundred thirty-seven patients were included, 139 (59%) received 30 mg BID and 98 (41%) 60 mg QD. There was no statistically significant difference in the need for increase in nifedipine dose or addition of another oral antihypertensive between those receiving 30 mg BID versus 60 mg QD (33.8% versus 35.7%, adjusted odds ratio [95% CI], 0.90 [0.50, 1.60]; P=.71). Additionally, there was no difference in need for emergency hypertensive treatment after reaching study dose (P=.19) or readmission for BP control between the two groups (P>.99).

CONCLUSION:
These findings suggest that BID versus QD dosing of nifedipine XR does not improve blood pressure control in the antepartum or postpartum periods; thus, daily dosing is reasonable and may be preferable for patient convenience and compliance.
Does the Decision to Perform Cesarean Delivery for Nonreassuring Fetal Status Vary by Time of Day? [ID: 1376814]
Authors: Huysman Bridget , Carter Ebony , Dickison Shelby , Kelly Jeannie , Raghuraman Nandini , Woolfolk Candice 
Published: May 2023

INTRODUCTION:
Nonreassuring fetal status (NRFS) is a diagnosis lacking standardized definitions, making the diagnosis susceptible to bias and systemic factors. We assessed whether the decision to proceed with intrapartum cesarean delivery (CD) was associated with time of the day and whether this relationship was influenced by the presence of in-house obstetricians.

METHODS:
This was a retrospective cohort study of term pregnancies admitted in spontaneous labor or for induction between January 2019 and June 2021. The primary outcome was decision to perform intrapartum CD for NRFS. Generalized additive models with smoothing splines were used to explore nonlinear associations between time of day and CD rates. Results were then stratified by whether the attending obstetrician was in-house or remote.

RESULTS:
Of 5,526 deliveries, 6.0% were intrapartum CD for NRFS. In the overall cohort, CD for NRFS was consistent throughout the day (P=.056). For patients with in-house obstetricians, the decision for CD for NRFS was not influenced by time of day (P=.072). For patients without in-house obstetricians, the decision to perform CD for NRFS was influenced by the time of day (P=.028), with a decreasing frequency from midnight to afternoon with nadir at 15:00 (2.5%), and a subsequent increasing frequency that peaked at 23:00 (10.3%).

CONCLUSION:
The decision to perform CD for NRFS is influenced by the time of day when the obstetrician is not in-house. This decision is not affected by time of day when the obstetrician is in-house. Systemic factors such as immediate obstetrician availability affect the diagnosis of NRFS.
Effect of Neonatal Drug Screen on Monitoring and Management of Neonatal Opiate Withdrawal Syndrome [ID: 1376913]
Authors: Witcher Kristina , Huddleson Amy , Mark Katrina , Soltanian Ayda 
Published: May 2023

INTRODUCTION:
Neonates exposed to opiates in utero are at risk for developing neonatal opiate withdrawal syndrome (NOWS), which may require pharmacologic therapy if severe. Neonatal drug screening has been proposed to identify at-risk neonates that require extended monitoring for NOWS. We hypothesized that documented maternal history of opiate use would be prevalent and better predict the need for monitoring at our institution.

METHODS:
Retrospective chart review was conducted for 342 neonates with documented NOWS scores at the University of Maryland Medical Center in Baltimore, Maryland, from January 1, 2017 to January 1, 2022. Institutional review board approval was obtained prior to initiation of the study. Maternal medical history was reviewed in addition to neonatal drug screen, NOWS scores, and need for pharmacologic treatment. The primary objective was to determine the proportion of neonates for which neonatal drug screening was the only indicator that the neonate required monitoring for NOWS.

RESULTS:
There was a maternal indication for NOWS monitoring present at time of delivery for 85.4% of neonates. Of the remaining 50 (14.6%), 13 tested positive for opiates; however, only 3 of these neonates required pharmacologic treatment for NOWS. Seven neonates required treatment after negative opiate screening. Overall, the sensitivity of neonatal drug testing for NOWS requiring pharmacologic therapy was 76.3% with a positive predictive value of 55.8%.

CONCLUSION:
Maternal history of opiate use is present for most neonates monitored for NOWS, and neonatal drug screening incompletely predicted severe NOWS. Universal neonatal drug screening may not identify additional neonates at risk of NOWS with possible unforeseen risks including unnecessary monitoring or social services involvement.