bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of Visual Estimation of Blood Loss in Obstetrics Using Clinical Reconstructions: An Observational Simulation Cohort Study
Authors: Athar M.W. , Abir G. , Seay R.C. , Guo N. , Butwick A. , Carvalho B. 
Published: February 2023

(Int J Obstet Anesth. 2022;50:10359)
Postpartum hemorrhage accounts for 27% of worldwide maternal deaths and is defined as blood loss ≥1000 mL or blood loss accompanied by hypovolemia after birth. Visually estimated blood loss (EBL) following delivery remains the most common method of measurement despite it being largely inaccurate. Previous studies reported that accurate and timely hemorrhage diagnosis occurred in a minority (31%) of cases. While delivery mode, distribution or location of blood loss, the patient’s cardiovascular status, or experience may impact accuracy, these have not been tested. This study investigated the relationship between these factors, EBL and actual blood loss (ABL) and contributing factors between differences in EBL and ABL.
Obstetric Analgesia and Anaesthesia in SARS-CoV-2-positive Parturients Across 10 Maternity Units in the North-west of England: A Retrospective Cohort Study
Authors: Bhatia K. 
Published: February 2023

(Anaesthesia. 2022;77:389–397)
At the onset of the COVID-19 pandemic, world health authorities recommended neuraxial (NA) over general anesthesia (GA) for infected parturients. The intent for risk reduction was 2-fold: to reduce the risks accompanying GA in parturients with acute respiratory symptoms, and to minimize SARS-CoV-2 exposure to health care teams. Initial retrospective studies have shown paradoxically both increased and decreased use of NA versus GA in different studies, but many having low numbers of participants. With no large-scale multi-center study of trends of labor analgesia in COVID-19-positive parturients, there is a need for understanding of these interventions and associated outcomes that can influence future recommendations.
COVID-19 Vaccination During Pregnancy: 2 for the Price of 1
Authors: Rasmussen S.A. , Jamieson D.J. 
Published: February 2023

(N Engl J Med. 2022;387:178–179)
Studies have shown that maternal vaccination during pregnancy propagates the transfer of antibodies across the placenta to the infant. Coronavirus disease 2019 (COVID-19) is now being studied in this context. Safety recommendations have been encouraging the vaccination of pregnancy women to protect against COVID-19 based of historical trans-placenta benefits from vaccines during pregnancy.
Sleep-Disordered Breathing in High-risk Pregnancies is Associated With Elevated Arterial Stiffness and Increased Risk for Preeclampsia
Authors: Pahn K. , Pamidi S. , Gomez Y.H. , Gorgui J. , El-Messidi A. , Gagnon R. , Kimoff R.J. , Abenhaim H.A. , Daskalopoulou S.S. 
Published: February 2023

(Am J Obstet Gynecol. 2022;226:833.e1–20)
Hormonal changes inherent in pregnancy can predispose women to sleep-disordered breathing that restrict airflow and can cause hypoxia. Snoring can be a sign of sleep-disordered breathing, and is also correlated with fetal growth restriction, gestational hypertension, and diabetes. Past studies have associated sleep-disordered breathing with preeclampsia, and arterial stiffness has been shown to be elevated in women who later develop preeclampsia, but prior studies have not studied the relationship. This study assessed the correlation between sleep-disordered breathing and arterial stiffness in women diagnosed with preeclampsia during pregnancy and investigated the association between sleep disordered breathing and preeclampsia.
Dural Puncture Epidural for Labor Analgesia: Is It Really an Improvement Over Conventional Labor Epidural Analgesia?
Authors: Segal S. , Pan P.H. 
Published: February 2023

(Anesthesiology. 2022;136:667–669)
Continued innovations of the standard epidural technique have allowed for improvement of the quality of analgesia experienced by laboring women. The introduction of conventional neuraxial analgesia offered effective and safe pain relief to parturients, with relatively infrequent adverse outcomes, and is utilized in >73% of contemporary births in the United States. Procedural refinements over time have offered improvement in analgesia quality, including continuous local anesthetic infusions, optimizations of volume and concentrations of medications delivered, the addition of opioids to the injectate, timed bolus injections, and patient-controlled epidural analgesia. As protocol variations, both combined spinal-epidural and dural puncture epidural utilize a smaller spinal needle that is passed through the epidural needle. In combined spinal-epidural, small doses of opioid and local anesthetic are injected into the intrathecal (IT) space. With dural puncture epidural, the spinal needle is used to intentionally puncture the dura, but no drugs are injected. Initial evidence suggested improved analgesia with this technique over standard epidural and combined spinal-epidural, but the literature has produced mixed results since. In the same issue of this journal, Tan et al deliver results from a randomized clinical trial of obese parturients receiving dural puncture epidural vs conventional epidural to determine if analgesia quality is enhanced by dural puncture in this population at higher risk for epidural failure.
Labor Analgesia in Obese and Morbidly Obese Parturients: A Nationwide Register Analysis in Finland From 2004 to 2018
Authors: Kuitunen I. , Kekki M. , Ponkilainen V. , Huttunen T. 
Published: February 2023

(Anaesthesia. 2022;77:351–353)
Maternal obesity rates are increasing, which is concerning for the short-term maternal and neonatal well-being during vaginal and cesarean delivery. A recent study found obese and morbidly obese parturients had increased use of neuraxial blocks compared to their nonobese counterparts (76% vs. 68%). Rates in Finland in 2018 were only 60%, so this study aimed to further analyze and report the use of labor analgesia in obese and morbidly obese parturients in Finland.
In-Hospital Opioid Consumption After the Previous Cesarean Delivery Weakly Predicts Opioid Consumption After Index Delivery: A Retrospective Cohort Study
Authors: Komatsu R. , Nash M. , Mandalia S. , Dinges E. , Kamal U. , Singh D. , El-Omrani H. , Anwar A. , Delgado C. , Ziga T.M. , Carvalho B. 
Published: February 2023

(Anesth Analg. 2022;134:1280–1287)
Opioid administration is a common form of analgesia for breakthrough pain following cesarean deliveries when nonopioid medication is not sufficient. Pain severity can differ from patient to patient, so an individualized approach to care can be challenging. Predicting in-hospital opioid consumption following a repeat cesarean delivery requires study. The primary aim was to identify if prior opioid consumption 48 hours postoperatively following cesarean delivery correlates with patient opioid consumption following index cesarean delivery. The hypothesis was that an associated prediction would exist. Secondary aims included whether pain scores correlated and if obstetric and demographic variables improved prediction accuracy.
Non–immune-mediated Anaphylaxis to Synthetic Oxytocin During Labor
Authors: Srinivasan S.P.B. , Seth I. , Bulloch G. , Mills A. , Dhupar N. 
Published: February 2023

(Int J Gynaecol Obstet. 2022;159:317–318)
Cases of non–immune-mediated anaphylaxis to synthetic oxytocin are exceedingly rare, occurring with an incidence of less than 1 in 20,000. Timely diagnosis and immediate coordinated interdisciplinary response are essential for favorable outcomes. Such a case is presented in the context of a patient with a family history of atopy undergoing vacuum-assisted birth with shoulder dystocia and postpartum hemorrhage (PPH).
Rethinking breastfeeding management
Authors: Scott Allison , Kirkland Tracie 
Published: February 2023

Abstract:
The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first 6 months of life. Nationally, however, breastfeeding rates are low, with Black infants among the least likely to be breastfed. The updated AAP breastfeeding policy guidelines emphasize an urgent need for a patient-centered approach to cultivate awareness of breastfeeding benefits and promote equitable care.
Sudden cardiac death in the young
Authors: Doucette Julianne , Rosenblum Ruth 
Published: February 2023

Abstract:
NPs can identify risk for sudden cardiac death in children during physical exams to prevent tragedy. The updated American Academy of Pediatrics 2021 policy statement on this issue provides guidance on using a combination of elements to determine and manage risk, including the organization's own 4-question screening tool, the American Heart Association 14-Element Preparticipation Cardiovascular Screening of Young Competitive Athletes, personal history, family history, physical exam, ECG, and cardiology referral as indicated.
Vaccine hesitancy in prenatal women and mothers of newborns
Authors: Hallas Donna , Altman Susan , Mandel Elizabeth , Fletcher Jason 
Published: February 2023

Abstract

Introduction:
The purpose of this study was to determine the effectiveness of a web-based, vaccine resource-directed, interactive communication intervention for vaccine-hesitant prenatal women and mothers of newborns/infants to make informed decisions based on scientific evidence about vaccinating themselves and their newborns/infants, respectively.

Methods:
A prospective quasi-experimental design was used to determine the effectiveness of the intervention for vaccine-hesitant prenatal women (stage 1) and for mothers of newborns (stage 2). A survey was administered to prenatal women to determine attitudes about vaccines for themselves during pregnancy. A survey on parental attitudes about vaccination for their children was administered to mothers of newborns. The surveys were administered to determine levels of vaccine acceptance. Vaccine acceptors and vaccine-hesitant individuals were included in the study as control and intervention group participants, respectively; vaccine refusers were eliminated from the study.

Results:
Among prenatal vaccine-hesitant women, 82% had full prenatal vaccination coverage after receiving the intervention (χ2 = 7.2, P = .02). The majority of mothers of newborns/infants (74%) fully immunized their infants.

Discussion:
The interventions for prenatal vaccine-hesitant women were effective in changing their status from hesitant to acceptors. The mothers of newborns/infants who were initially hesitant had vaccination rates that exceeded the comparison group comprised of vaccine acceptors.
Video-Based (Livestream) and In-Person Continuing Professional Development: Participant and Course Features Associated With Choice
Authors: Cook David A. , Pendl Aaron K. , Pankratz V. Shane 
Published: February 2023

Purpose
Information on factors influencing learner choice between in-person and video-based continuing professional development (CPD) would help course leaders with planning and implementation. This study aimed to investigate how registration patterns differ between in-person and video-based offerings for the same CPD course.

Method
The authors obtained data from 55 CPD courses offered in-person (at various U.S. locations) and via livestreamed video, January 2020 to April 2022. Participants included physicians, advanced practice providers, allied health professionals, nurses, and pharmacists. Registration rates were compared by participant and course features including professional role, age, country of residence, distance to and perceived desirability of the in-person destination, and timing of registration.

Results
Analyses included 11,072 registrations, of which 4,336 (39.2%) were for video-based learning. There was significant heterogeneity in video-based registrations across courses, ranging 14.3% to 71.4%. Multivariable analysis showed higher video-based registrations for advanced practice providers (vs physicians; adjusted odds ratio [AOR] 1.80 [99% confidence interval, 1.55–2.10]), non-U.S. residents (AOR 3.26 [1.18–9.01]), longer distance (AOR 1.19 [1.16–1.23] for each doubling of distance), and courses in July–September 2021 (vs January–April 2022; AOR 1.59 [1.24–2.02]); video-based registrations were lower for current or former employees or trainees of our institution (AOR 0.53 [0.45–0.61]), destinations of moderate or high desirability (vs low; AOR 0.42 [0.34–0.51] and 0.44 [0.33–0.58], respectively), and early registration (AOR 0.67 [0.64–0.69] for each doubling of days between registration and course start). There was no significant difference by age (AOR 0.92 [0.82–1.05] for participants > 46 years old vs younger participants). The multivariable model correctly predicted actual registration 78.5% of the time.

Conclusions
Video-based livestreamed CPD is popular (chosen by nearly 40% of participants), although choices varied widely by course. Professional role, institutional affiliation, distance traveled, location desirability, and registration timing have small but statistically significant associations with choice of video-based vs in-person CPD.
Strengthening Doctor–Patient Relationships Through Hospital-Based Violence Interventions
Authors: Cosey-Gay Franklin , Johnson Dwayne , Perez Ernestina , Milkovich Rachel , Robles Carlos , Rogers Selwyn O. 
Published: February 2023

Problem
Violence in Chicago has been persistently high in low-income communities of color. Recent attention has focused on how structural inequities weaken protective factors that help keep communities healthy and safe. Spikes in community violence seen in Chicago since the COVID-19 pandemic further expose the lack of social service, health care, economic, and political safety nets in low-income communities and the apparent dearth of faith in those systems.

Approach
The authors contend that a comprehensive, collaborative approach to violence prevention that prioritizes treatment and community partnerships is needed to address social determinants of health and structural characteristics that often provide the context for interpersonal violence. One strategy to address decreasing faith in systems like hospitals is foregrounding frontline paraprofessional prevention workers who possess cultural capital based on their experiences navigating interpersonal and structural violence. Hospital-based violence intervention programs help professionalize these prevention workers by providing a framework for patient-centered crisis intervention and assertive case management. The authors describe how the Violence Recovery Program (VRP), a multidisciplinary hospital-based violence intervention model, leverages the cultural capital of credible messengers to use teachable moments to promote trauma-informed care to violently injured patients, assess their immediate risk for reinjury and retaliation, and connect them to wrap-around services to help aid comprehensive recovery.

Outcomes
Violence recovery specialists have engaged over 6,000 victims of violence since the program’s launch in 2018. Three-quarters of patients expressed social determinants of health needs. Over the past year, specialists have connected over one-third of engaged patients to mental health referrals and community-based social services.

Next Steps
High violence rates in Chicago limited case management opportunities in the emergency room. In fall 2022, the VRP began to establish collaborative agreements with community-based street outreach programs and medical–legal partnerships to address structural determinants of health.
Introducing a Sexual Wellness Clinic to an At-Risk Population Through the Emergency Department
Authors: Hazra Aniruddha , Stanford Kimberly , Schneider John , Davis Andrew 
Published: February 2023

Rates of sexually transmitted infections (STIs) in the United States have continued to increase for nearly a decade as state and local health departments across the country have divested from sexual health services. The resulting closure of municipal STI clinics has led many uninsured and underinsured patients to rely on emergency departments for their sexual health needs. The authors describe the creation of the novel Sexual Wellness Clinic at University of Chicago Medicine in February 2019.
The clinic provides comprehensive sexual health care to establish linkage to pre-exposure prophylaxis (PrEP) for HIV, primary care, and other essential services to patients presenting to the emergency department for STI care. Since operationalization, the Sexual Wellness Clinic has served 560 unique patients; 50.5% (n = 283) were cisgender male and 49.5% (n = 277) were cisgender female. The majority of patients were African American (93.4%, n = 523), non-Hispanic or Latinx (96.1%, n = 538), between 18 and 29 years old (62.3%, n = 350), and had Medicaid or were uninsured (84.3%, n = 472). New syphilis diagnoses were identified in 23.5% (132/560) of patients; gonococcal and chlamydial infections were confirmed in 14.6% (82/560) and 13.4% (75/560) of patients, respectively. Same-day PrEP was initiated for 16.1% (90/560) of patients, of which 56.7% were cisgender female.
The Sexual Wellness Clinic identified unique candidates for PrEP, notably a large proportion of Black cisgender women; however, further work is needed to support the ongoing PrEP cascade. Identifying these new populations with untreated STIs and other HIV risk factors for targeted, innovative interventions is integral to HIV elimination and STI control efforts.
Exploring the Impact of Entrustable Professional Activities on Feedback Culture: A Qualitative Study of Anesthesiology Residents and Attendings
Authors: Berger Sabine , Stalmeijer Renee E. , Marty Adrian P. , Berendonk Christoph 
Published: February 2023

Purpose
Entrustable professional activities (EPAs) were introduced as a potential way to optimize workplace-based assessments. Yet, recent studies suggest that EPAs have not yet overcome all of the challenges to implementing meaningful feedback. The aim of this study was to explore the extent to which the introduction of EPAs via mobile app impacts feedback culture as experienced by anesthesiology residents and attending physicians.

Method
Using a constructivist grounded theory approach, the authors interviewed a purposive and theoretical sample of residents (n = 11) and attendings (n = 11) at the Institute of Anaesthesiology, University Hospital of Zurich, where EPAs had recently been implemented. Interviews took place between February and December 2021. Data collection and analysis were conducted iteratively. The authors used open, axial, and selective coding to gain knowledge and understanding on the interplay of EPAs and feedback culture.

Results
Participants reflected on a number of changes in their day-to-day experience of feedback culture with the implementation of EPAs. Three main mechanisms were instrumental in this process: lowering the feedback threshold, change in feedback focus, and gamification. Participants felt a lower threshold to feedback seeking and giving and that the frequency of feedback conversations increased and tended to be more focused on a specific topic and shorter, while feedback content tended to focus more on technical skills and more attention was given to average performances. Residents indicated that the app-based approach fostered a game-like motivation to “climb levels,” while attendings did not perceive a game-like experience.

Conclusions
EPAs may offer a solution to problems of infrequent occurrence of feedback and invite attention to average performances and technical competencies, but may come at the expense of feedback on nontechnical skills. This study suggests that feedback culture and feedback instruments have a mutually interacting influence on each other.
Does the Doctor–Patient Relationship Affect Enrollment in Clinical Research?
Authors: Soo Jackie , Jameson Jacob , Flores Andrea , Dubin Lisa , Perish Emily , Afzal Azka , Berry Grace , DiMaggio Vinny , Krishnamoorthi V. Ram , Porter Justin , Tang Joyce , Meltzer David 
Published: February 2023

Purpose
Recruiting patients for clinical research is challenging, especially for underrepresented populations, and may be influenced by patients’ relationships with their physicians, care experiences, and engagement with care. This study sought to understand predictors of enrollment in a research study among socioeconomically diverse participants in studies of care models that promote continuity in the doctor–patient relationship.

Method
A study of the effects of vitamin D levels and supplementation on COVID-19 risk and outcomes was implemented from 2020 to 2022 within 2 studies of care models at the University of Chicago that promoted continuity of inpatient and outpatient care from the same physician. Hypothesized predictors of vitamin D study enrollment included patient-reported measures of the care experience (quality of relationship with the doctor and their staff, timely receipt of care), engagement in care (scheduling and completing outpatient visits), and engagement with these “parent” studies (follow-up survey completion). The authors used univariate tests and multivariable logistic regression to examine the association of these predictors with enrollment in the vitamin D study among participants in the parent study intervention arms.

Results
Among 773 eligible participants, 351/561 (63%) in the parent study intervention arms enrolled in the vitamin D study, versus 35/212 (17%) in the control arms. Among intervention arm participants, vitamin D study enrollment was not associated with reported quality of communication with or trust in the doctor, or helpful/respectful office staff, but was associated with report of receiving timely care, more completed clinic visits, and higher parent study follow-up survey completion.

Conclusions
Study enrollment may be high in care models with high levels of continuity in the doctor–patient relationship. Rates of clinic involvement, parent study engagement, and experience of receiving timely access to care may better predict enrollment than quality of the doctor–patient relationship.
BREAST-Q Patient-reported Outcomes in Different Types of Breast Reconstruction after Fat Grafting
Authors: Retchkiman Meir , Elkhatib Arij , Efanov Johnny I. , Gagnon Alain , Bou-Merhi Joseph , Danino Michel Alain , Bernier Christina 
Published: February 2023

Background:
Breast reconstruction after mastectomy improves patient quality of life. Independently of the type of reconstruction, ancillary procedures are sometimes necessary to improve results. Fat grafting to the breast is a safe procedure with excellent results. We report patient-reported outcomes using the BREAST-Q questionnaire after autologous fat grafting in different types of reconstructed breasts.

Methods:
We performed a single-center, prospective, comparative study that compared patient-reported outcomes using the BREAST-Q in patients after different types of breast reconstruction (autologous, alloplastic, or after breast conserving) who subsequently had fat grafting.

Results:
In total, 254 patients were eligible for the study, but only 54 (68 breasts) completed all the stages needed for inclusion. Patient demographic and breast characteristics are described. Median age was 52 years. The mean body mass index was 26.1 ± 3.9. The mean postoperative period at the administration of BREAST-Q questionnaires was 17.6 months. The mean preoperative BREAST-Q was 59.92 ± 17.37, and the mean postoperative score was 74.84 ± 12.48 (P < 0.0001). There was no significant difference when divided by the type of reconstruction.

Conclusion:
Fat grafting is an ancillary procedure that improves the outcomes in breast reconstruction independently of the reconstruction type and heightens patient satisfaction, and it should be considered an integral part of any reconstruction algorithm.