bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increasing Student-Perceived Readiness for Obstetrics and Gynecology Clerkship Using a Student-Created Curriculum [A56]
Authors: Nelms Laurel M. , Gupta Sonul , Ross-Shelton Brenda 
Published: June 2022

INTRODUCTION:
Among third-year medical students at a community-based medical school, students report feeling less prepared at the start of an obstetrics and gynecology clerkship compared to other clerkships. We sought to determine if a student-led curriculum is an effective resource for third-year clerkship preparation and how this curriculum affects student interest in obstetrics and gynecology, perceptions of the obstetrician-gynecologist attending lifestyle, comfort with obtaining a specialty-specific history and physical (H&P), and obstetric ultrasound techniques.

METHODS:
Fourth-year medical students pursuing obstetrics and gynecology designed clerkship-specific curricula and administered a lecture to third-year medical students via Zoom. This lecture focused on obtaining obstetrics and gynecology-specific H&P, interpreting tests of fetal well-being, labor and delivery (L&D) triage cases, and obstetric ultrasound techniques. An eight-question pre and postlecture survey using a Likert scale was distributed to all attendees.

RESULTS:
The pre and post lecture survey had 26 and 22 respondents, respectively. Attendees reported increased comfort with obstetrics and gynecology-specific patient presentations (P<.001), taking obstetric and gynecologic histories (P<0.001, P<.001), performing a pelvic exam (P<.001), and performing obstetric ultrasound (P<.001) after attending the lecture. Respondents overall felt more prepared for the obstetrics and gynecology clerkship relative to Family Medicine (P<.001). In terms of career guidance, students believed obstetrics and gynecology to be less demanding post-lecture (P<.03); however, student interest in the specialty did not significantly change.

CONCLUSION:
This study suggests that a single, remotely conducted, upperclassmen-led lecture centered on applied clinical knowledge in obstetrics and gynecology significantly improves third-year medical student comfort with performing specialty-specific history and physical exams, obstetric ultrasound techniques, and perception of attending lifestyle. It also confirms that student-led curriculum is an effective resource for third-year clerkship preparation.
In the Eye of the Beholder: Perspectives of Fellowship Applicants on Virtual Interviews [A66]
Authors: Tran Ann D. , Heisler Christine , Botros-Brey Sylvia , Gaigbe-Togbe Bertille , Leegant Ava , Hardart Anne 
Published: June 2022

INTRODUCTION:
The COVID-19 pandemic shifted many in-person activities to virtual settings. Given nationwide travel restrictions and recommendations from the Association of American Medical Colleges, subspecialty program directors for obstetrics and gynecology conducted interviews using a virtual platform for 2020. The impact of virtual interviews (VI) on a candidates’ ability to effectively create a rank list is unknown. The primary objective was to evaluate obstetrics and gynecology subspecialty fellowship applicants’ perspectives regarding the effectiveness of VI for creating a rank list. Secondary outcomes included perceived advantages and disadvantages of the process, including preference of interview type, cost, and time savings.

METHODS:
This was a cross-sectional electronic survey administered to a convenience sample of obstetrics and gynecology subspecialty applicants. This institutional review board-exempt survey was administered via REDCap. Descriptive statistics were used.

RESULTS:
Response rate was 158 of 330 (48%). Nearly all (99%) applicants cited cost savings as a distinct advantage of VI. Overall, 82% percent of respondents felt confident in making their rank list based on the VI, and 92% were “very satisfied” or “somewhat satisfied” with the process. Most respondents (91%) preferred Zoom to other virtual platforms. Of those who expressed an interview style preference (in-person versus VI), 44% of respondents preferred VI; 33% had no preference or were not sure.

CONCLUSION:
The majority of applicants to obstetrics and gynecology subspecialty fellowships felt confident to create a rank list based on VI. This study indicates that the virtual format is suitable for fellowship interviews and can be utilized beyond the pandemic to improve equity and diversity in the applicant pool.
Effects of COVID-19 on Cervical Cancer Screening [A74]
Authors: Patterson Taylor , Palmer Kathryn , Robinson William R. 
Published: June 2022

INTRODUCTION:
In the United States, cancer screening rates declined in spring 2020 due to the COVID-19 pandemic. Stay-at-home orders and social distancing mandates created a new barrier to health care while further exposing the pre-pandemic health care disparities.

METHODS:
Using fully de-identified electronic health record data from the University of Mississippi Medical Center’s (UMMC) Patient Cohort Explorer, we assessed changes in cervical cancer screening before and during the COVID-19 pandemic. The number of women screened with cervical cytology and human papillomavirus (HPV) testing in the pre-COVID months of September 2019 and January 2020 were compared with the same months of the following year during the pandemic (September 2020; January 2021).

RESULTS:
Data showed a pre-pandemic baseline of 319 and 340 women screened via cervical cytology during September 2019 and January 2020, respectively. Compared to pre-pandemic baseline, cervical cytology screening remained consistent throughout the pandemic with 302 and 311 women screened in September 2020 and January 2021, respectively. Similarly, HPV testing in the pre-COVID months resulted in 229 and 226 women screened as compared to 211 and 170 women screened during the pandemic.

CONCLUSION:
Cervical cancer screening did not significantly decline during the COVID-19 pandemic in Mississippi as compared to the 80% decline in cervical screening noted in California. The lack of change could be attributed to the low number of women screened both before and during the pandemic. Low cancer screening in women demonstrates various health care disparities affecting the UMMC patient population and the need to increase patient awareness and education regarding the importance of routine cancer screening.
Preliminary Data from Clinical Trial to Survey Results of Flourish Vaginal Care System for Recurrent BV [A80]
Authors: Chidawanyika Tamutenda , Cathy Yi Chung Hwa , Kelly-Martin Rachel , Cleland Joshua , DuPriest Elizabeth 
Published: June 2022

INTRODUCTION:
Bacterial vaginosis (BV) is a vaginal dysbiosis causing pain, irritation, discharge, odor, and itching. Antibiotic treatment is standard of care, but BV recurs in up to 50% of patients in 1 year. We hypothesized that using the Flourish Vaginal Care (FVC) system (an over-the-counter kit by Good Clean Love), with iso-osmotic components to optimize vaginal pH and Lactobacillus levels would reduce BV recurrence.

METHODS:
Ten women with two or more BV episodes within the past 2 years were enrolled in the pilot study for 11 weeks. Participants were treated with metronidazole and simultaneously started on a daily external wash with pH<4.4; iso-osmolar intravaginal lactic acid-containing gel every other day, and vaginal homeopathic suppository in a probiotic base every 3 days. Outcomes were vaginal pH, BV, and yeast occurrence tested biweekly. Participants journaled associated symptoms daily. Patient satisfaction was determined via telephone interview 10-12 months post trial.

RESULTS:
During the trial, no participants had BV recurrence. Mean vaginal pH decreased from 4.54 to 4.08 at baseline to study end. Journals showed decreased frequencies of pain and irritation (∼2-fold) and itching (∼4-fold). All (100%) of subjects participating in telephone interviews were satisfied with their symptom resolution 10-12 months post trial.

CONCLUSION:
Our pilot study shows that consistent use of vaginal products that are iso-osmotic and support optimal vaginal pH with bio-matched lactic acid prevents BV recurrence and alleviates associated symptoms. This work has important implications for prevention of recurrent BV and is evidence for the importance of maintaining the vaginal microbiome.
How Surgeon Volume Predicts Rates of Minimally Invasive Myomectomy [A83]
Authors: Tierney Cassidy E. , Tutwiler Ameisha , Tucker Lue-Yen , Weintraub Miranda Ritterman , Zaritsky Eve 
Published: June 2022

INTRODUCTION:
Creating high-volume surgeons improves perioperative outcomes and encourages surgeons to perform more minimally invasive gynecological procedures. Compared to open abdominal myomectomies (AM), minimally invasive myomectomies (MIM) for benign uterine leiomyomas have lower complication rates, costs, and recovery time. Despite this, approximately 40% of myomectomies nationally are performed via an abdominal approach. In 2011, Kaiser Permanente Northern California (KPNC) introduced a quality improvement initiative to increase the proportion of MIMs by developing a streamlined high-volume surgeon pool. This study examines the interplay between surgeon volume and route for myomectomy.

METHODS:
This was an institutional review board (IRB)-approved retrospective observational data-only cohort study of patients who received an AM or MIM for benign uterine leiomyomas between 2009 and 2019 within KPNC. Surgeon volume was categorized as low (20 cases/year).

RESULTS:
Over the 11-year study period, 4,033 adult women underwent a myomectomy. The proportion of MIMs went from 6.0% to 89.5%, a 15-fold increase. The number of MIM surgeons increased over time but remained below 50, even as MIM rates increased. Medium and high volume surgeons were significantly more likely to perform MIMs compared to their low volume peers. As the MIM surgeon pool decreased in size and experience increased, the likelihood of having a MIM increased significantly.

CONCLUSION:
Decreasing the number of obstetricians/gynecologists performing surgery by limiting the number of MIM-privileged surgeons effectively increased individual surgeon case volume and increased the rate of MIM over an 11-year period, even with a rise in overall myomectomy incidence.
Risk-Adapted Approach to Levonorgestrel-Containing Intrauterine Devices Placement for Heavy Menstrual Bleeding in Adolescents with Bleeding Disorders [A92]
Authors: Fiorillo Megan H. , Cygan Peter H. , Wright Tonya 
Published: June 2022

INTRODUCTION:
Females with inherited bleeding disorders (IBD) are disproportionately affected by reproductive tract bleeding, and can suffer adverse physical, social, and emotional outcomes. Recent guidelines advise development of perioperative management protocols for women undergoing invasive procedures, but do not provide specific guidance and rely on provider-level expertise. Optimizing the care of these patients requires a multidisciplinary approach.

METHODS:
Patients with known/suspected bleeding disorders present to the women and girls’ bleeding disorder clinic for evaluation and counseling. A collaborative protocol is generated by hematologists and gynecologists for the patients who desire levonorgestrel-containing intrauterine devices (LNG-IUD). A periprocedural hemostatic treatment protocol is tailored to the patient’s bleeding disorder. Ultrasound is performed in advance for uterine size and device selection. Placement is performed under ultrasound guidance in an operative setting without the use of a tenaculum. In instances where patients have severe bleeding histories or ongoing vaginal bleeding at the time of LNG-IUD placement, they may elect to use anti-fibrinolytics or continue an additional form of menstrual management such as combined oral contraceptive pills (OCPs) for one to three menstrual cycles to decrease the risk of heavy bleeding and expulsion. Patients then have a short-interval follow-up for monitoring.

RESULTS:
Eighteen patients, ages 10-19 years, underwent LNG-IUD placement in the operating room without complications such as hemorrhage or uterine perforation. None of the patients required any further hematologic interventions that were outside the protocols as outlined preoperatively.

CONCLUSION:
Highly efficacious heavy menstrual bleeding (HMB) treatment can be offered to persons with IBD via a multidisciplinary approach to assure patient safety and satisfaction.
Endometriosis Management Patterns Among Women in the National Survey of Family Growth (2017-2019) [A98]
Authors: Cox Kaily , Sriprasert Intira , Nguyen Brian 
Published: June 2022

INTRODUCTION:
Endometriosis is a common gynecologic condition among women of reproductive age. Optimal treatment should be utilized, especially among those who have not completed childbearing.

METHODS:
We described the prevalence of endometriosis and treatment patterns among reproductive-aged women from the National Survey of Family Growth (NSFG, 2017-2019), focusing on treatments received by individuals reporting a desire for future childbearing. We conducted weighted bivariate analyses using t-tests and chi-square tests as appropriate.

RESULTS:
Endometriosis was diagnosed in 5.7% (n=314/6,141) of reproductive-aged women, of whom 43.6% reported a current diagnosis. Women with endometriosis were aged 38 years, commonly identified as non-Hispanic White (7.3%), and nearly all (92.7%) had health insurance (65% from private insurance). Reported treatments included: non-narcotic medicines (58.5%), hormonal medicines (47.7%), narcotics (34.6%), hysterectomy (30.1%), and progesterone-releasing intrauterine devices (IUDs) (12.2%); 11.2% never received any treatment. Treatments received did not vary by race and ethnicity, education, income, marital status, or insurance coverage. Prior to hysterectomy among 74 women, 56.7% received non-narcotic medicines, 54.7% hormonal medicines, 47.0% narcotics, and 26.1% progesterone-releasing IUDs. Twenty women (15.5%) who underwent hysterectomy reported a desire for future childbearing. Among these, 81.8% received narcotics, 76.2% received hormonal medicines, 73.0% received non-narcotic medicines, and 23.1% received a progesterone-releasing IUD prior to hysterectomy.

CONCLUSION:
Nearly one-third of reproductive-age women with endometriosis underwent a hysterectomy, among whom approximately 16% had not completed childbearing. Narcotics are overutilized and progesterone-releasing IUDs underutilized among individuals receiving hysterectomy prior to completion of childbearing.
Neutrophilic Dermatoses in a Clinical Practice of Wound Care Professionals
Authors: Lapa Tatiana , Sibbald R. Gary , Coutts Patricia M. , Zhao Xiu Chang 
Published: June 2022

ABSTRACT
Diagnosing and treating neutrophilic dermatoses (NDs) in clinical practice can be challenging because of various presentations and stubborn treatment responses. Establishing a diagnosis is necessary, though, because many NDs are associated with underlying conditions, including malignancy. In this article, the authors provide information about Sweet syndrome, pyoderma gangrenosum, and other NDs and describe their clinical presentation, pathophysiology, diagnostic criteria, and associated conditions. The authors also present a case report describing the coexistence of two NDs and hidradenitis suppurativa in one patient and review the treatment modalities for those conditions.
Impact of Initial Warfarin Dosing on Time in Therapeutic Range for Postoperative Left Ventricular Assist Device Patients
Authors: Olson Logan M. , Korkames Grace C. , Lyden Elizabeth R. , Ryan Timothy R. , Bowman Stephanie A. 
Published: June 2022

Abstract:
Initial warfarin dosing and time in therapeutic range (TTR) are poorly characterized for early post-operative left ventricular assist device (LVAD) patients. This study evaluated TTR after LVAD implantation compared between patients receiving low-dose (<3 mg) and high-dose (≥3 mg) warfarin. This single-center, retrospective analysis included 234 LVAD patients who received warfarin within 5 days of implantation. The primary outcome was TTR during the 5 days following first international normalized ratio (INR) ≥2 compared between low-dose and high-dose groups. Secondary outcomes were hospital and intensive care unit length of stay, time to first INR ≥2, TTR after first INR ≥2, and reinitiation of parenteral anticoagulation. No difference in TTR was detected between warfarin groups (57.2% vs. 62.7%, P = 0.13). Multivariable analysis did not detect any factors predictive of TTR during the primary outcome timeframe, but age and body mass index were associated with the warfarin dose. The low-dose group received a mean warfarin dose of 1.9 mg (±0.64 mg), and the high dose group received 4.34 mg (±1.38 mg). Cohort TTR during the primary outcome timeframe was 60.5% and 56.5% for hospitalization. The low-dose group had longer intensive care unit length of stay, shorter time to therapeutic INR, and more frequently reinitiated parenteral anticoagulation. Patients with recent LVAD implantation are complex and have diverse warfarin sensitivity factors, which did not allow for optimal warfarin dose detection, although half of all patients received doses between 2.04 mg and 4.33 mg. Individualized dosing should be used, adjusting for patient-specific factors such as age, body mass index, and drug interactions.
Active Surveillance With Seroprevalence-based Infection Rates Indicates Racial Disparities With Pediatric SARS-CoV-2 Requiring Hospitalization in Mississippi, March 2020–February 2021
Authors: Hobbs Charlotte V. , Kim Sara S. , Vemula Preeti , Inagaki Kengo , Harrison Virginia A. , Malloch Lacy , Martin Lora M. , Singh Gurbaksh , Agana Urita , Williams John M. , Patterson Kayla , Kittle Theresa , Byers Paul , Palmer April , Santos Roberto P. , Dhanrajani Anita , Stephenson Meagan , Hung Leroy , Hankins Phillip , Thornburg Nathalie , Drobeniuc Jan , Flannery Brendan ,   on behalf of the CDC COVID-19 Response Team
Published: June 2022

Background:
Racial disparities in SARS-CoV-2 infection, hospitalization, and multisystem inflammatory syndrome in children (MIS-C) have been reported. However, these reports have been based on incomplete data relying on passive reporting, unknown catchment populations, and unknown infection prevalence. We aimed to characterize population-based incidence of MIS-C and COVID-19 hospitalizations among non-Hispanic Black and White children using active surveillance based on seroprevalence-based cumulative incidence of pediatric SARS-CoV-2 infection in a defined catchment 16-county area of Mississippi.

Methods:
Active, population-based surveillance for MIS-C and acute COVID-19 hospitalizations meeting clinical and laboratory criteria was conducted by adjudicating clinicians at the major pediatric referral hospital for Mississippi, University of Mississippi Medical Center, from March 2020, to February 2021. Race-stratified SARS-CoV-2 seroprevalence was estimated using convenience samples from persons <18 years to calculate cumulative SARS-CoV-2 infections in the population.

Results:
Thirty-eight MIS-C cases and 74 pediatric acute COVID-19 hospitalizations were identified. Cumulative incidence of MIS-C was 4.7 times higher among Black compared with White children (40.7 versus 8.3 cases per 100,000 SARS-CoV-2 infections). Cumulative incidence of COVID-19 hospitalization was 62.3 among Black and 33.1 among White children per 100,000 SARS-CoV-2 infections.

Conclusions:
From the same catchment area, active surveillance, and cumulative incidence of infection estimated by seroprevalence, we show strikingly higher incidence of SARS-CoV-2-hospitalization and MIS-C in non-Hispanic Black children compared with White children before COVID-19 vaccination introduction in children. These disparities in SARS-CoV-2 manifestations cannot be accounted for by differences in exposure or testing. Targeted vaccine interventions will lessen disparities observed with SARS-CoV-2 manifestations in children.
Tacrolimus suppresses itch-related response in diet-induced atopic dermatitis model mice by reducing chloroquine-sensitive sensory neurons
Authors: Fujii Masanori , Imahori Shota , Nakayama Misao , Nabe Takeshi , Ohya Susumu 
Published: June 2022

Introduction:
Itch (or pruritus) is a common symptom of atopic dermatitis (AD), which significantly decreases the patient’s quality of life. Tacrolimus ointment reduces pruritus in AD; however, the underlying mechanism is not fully understood.

Methods:
In the present study, we used a diet-induced AD mouse model to examine the antipruritic mechanism of tacrolimus. After induction of AD symptoms, the tacrolimus-containing ointment was applied once daily for 7 days. Responsiveness of isolated dorsal root ganglion (DRG) cells to various stimuli was examined by monitoring intracellular Ca2+ levels.

Results:
Repeated application of tacrolimus ointment attenuated spontaneous itch-related responses, even when skin barrier dysfunction, skin inflammation, and epidermal nerve sprouting were not ameliorated. Tacrolimus-treated mice also exhibited reduced scratching behavior induced by several pruritogens, such as histamine, SLIGRL-NH2, and chloroquine (CQ), although capsaicin-induced pain behavior was not affected. DRG cells from tacrolimus-treated mice showed significantly lower Ca2+ responses to CQ. Furthermore, a reduction in CQ-sensitive DRG neurons was observed after in vitro treatment with either tacrolimus or rapamycin.

Discussion:
CQ-sensitive (MrgprA3-expressing) DRG neurons are implicated as itch-specific sensory neurons. Therefore, topically applied tacrolimus may act directly on itch-signaling neurons, consequently suppressing various itch responses in AD mice.
Decompensated cornea with epithelial and stromal edema
Authors: Menapace Rupert , Neuhann Thomas , Schmidinger Gerald , Assia Ehud , Alió Jorge , Narang Priya , Agarwal Amar , Szurman Peter 
Published: June 2022

A 66-year-old patient underwent surgery for congenital cataract in both eyes in her first year of life without implantation of an intraocular lens (IOL). In 1994, at the age of 39 years, both eyes received secondary Kelman multiflex-style angle-fixated anterior chamber IOLs (AC IOLs). The surgeries were followed by retinal detachments in both eyes, in the left eye in the same year and in the right eye 4 years later, which were successfully repaired.
The patient presented with a decompensated cornea with epithelial and stromal edema in the left eye. The AC IOL axis was oriented from 5- to 8-o'clock position with the haptic contacting the cornea. The distal portion of the inferior–nasal haptic was deeply buried and entrapped in a broad iridocorneal synechia extending between 6- and 8-o'clock positions. The synechia also caused adjacent pupillary distortion and pigment leaf eversion (Figure 1

JOURNAL/jcrs/04.03/02158034-202205000-00021/figure1/v/2023-08-19T002632Z/r/image-tiff

). The AC IOL in the right eye was well positioned, and the cornea was clear with an endothelial cell count (ECC) of 2160 cells/mm2 and central corneal thickness (CCT) of 650 μm. No ECC was obtainable in the left eye, and CCT was 775 μm (Figure 2

JOURNAL/jcrs/04.03/02158034-202205000-00021/figure2/v/2023-08-19T002632Z/r/image-tiff

). Visual acuity was 0.8 corrected in the right eye and hand motion in the left eye. Both eyes were normotonic.
On optical coherence tomography (OCT) imaging, a broad iridocorneal synechia was visible with a canal corresponding to the deeply buried haptic end of the AC IOL (Figure 3

JOURNAL/jcrs/04.03/02158034-202205000-00021/figure3/v/2023-08-19T002632Z/r/image-tiff

). Abundant condensed cortical material (Soemmerring's ring) was found behind the iris and above the ciliary body.
What would be your surgical options to rehabilitate the patient's left eye considering corneal decompensation caused by haptic contact of an angle-fixated AC IOL and capture of 1 haptic within an iridocorneal synechia extending along 2 clock hours?