bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Prior Vertical Uterine Incision on Subsequent Cesarean Delivery Characteristics and Outcomes [A85]
Authors: Youssefzadeh Ariane , Sangara Rauvynne , Mandelbaum Rachel , Matsuzaki Shinya , Ouzounian Joseph , Matsuo Koji 
Published: June 2022

INTRODUCTION:
There is a scarcity of national-level data examining the effect of prior vertical hysterotomy on subsequent cesarean delivery characteristics. The objective of this study is to examine outcomes of cesarean delivery in women with a history of vertical hysterotomy.

METHODS:
Comparative study that retrospectively queried the National Inpatient Sample, a population-based inpatient database in the United States. Subjects were women who underwent cesarean delivery with known uterine incision type from 10/2016-12/2018 (N=1,091,524). Exposure allocation was uterine hysterotomy type in prior delivery, vertical versus low-transverse. Main outcome measures were (i) patient demographics assessed by multivariable generalized estimating equation model and (ii) perioperative outcomes assessed by propensity score inverse provability of treatment weighting.

RESULTS:
A total of 18,575 women with prior vertical uterine incision were compared to 1,072,949 women with prior low-transverse incision. In a multivariable analysis, (i) patient factors older age, decreasing incidence in recent years, low median household income, obesity, (ii) hospital factors—large bed capacity, and (iii) pregnancy characteristics—early gestational age at delivery, placenta previa, placenta accreta spectrum, and uterine rupture remained independent characteristics associated with prior vertical hysterotomy (all, P<.05). In a propensity score weighted model, prior vertical hysterotomy was associated with increased surgical morbidity in the current cesarean delivery compared to prior low-transverse hysterotomy (10.6% versus 4.8%, OR 2.02, 95%CI 1.81-2.26), including hemorrhage (OR 1.99, 95%CI 1.74-2.27) and hysterectomy (OR 3.67, 95%CI 2.97-4.53).

CONCLUSION:
Prior vertical hysterotomy was associated with increased risk of placenta accreta spectrum (particularly percreta), uterine rupture (particularly pre-labor), and other adverse outcomes in the subsequent cesarean delivery.
Screening for High Risk Human Papillomavirus Using Passively Self-Collected Menstrual Blood [A91]
Authors: Naseri Sara , Cruz Giovanna I. , Young Stephen , Blumenthal Paul D. 
Published: June 2022

INTRODUCTION:
Globally, cervical cancer is the fourth most common women’s cancer, and the second highest cause of cancer-related mortality. High risk human papillomavirus (HR-HPV) testing is a potential primary test but is conventionally clinic-performed. HR-HPV detection via self-collected samples could increase screening access, reducing opportunity costs and uncomfortable visits. A modified menstrual pad (Q-Pad, www.qvin.com/en), offers passive HR-HPV sample collection and is a potential screening approach alternative. It has a removable collection strip, with specimen-processing as dried blood spots. Objectives: 1) to assess Q-Pad vs. clinician-collected HR-HPV concordance 2) assess Q-Pad acceptability.

METHODS:
Women presenting for either cervical cancer screening or with an HPV-positive history were eligible. Three samples were requested from participants: 1) clinician-collected cervical specimens (CCS) 2) self-collected swabs (SCS), and 3) a Q-Pad which was taken home for use during the next menstruation (QPS). All conventional samples were processed using the Roche Molecular Systems’ Cobas HPV Test. Q-Pad dried blood spots were eluted, then similarly processed.

RESULTS:
A total of 153 women participated and 107 provided QPS and CCS. Among HR-HPV positive samples where the CCS to QPS interval (Q-Pad use) was CIN2, Q-Pad and CCS agreement was 100%. Thirty percent expressed discomfort with self-swabbing and refused SCS collection. Ninety-four percent recommended Q-Pad over clinician-collected sampling. Twelve percent of patients were Q-pad HPV-positive but CCS negative.

CONCLUSION:
Among HPV-positive women, the Q-Pad showed highly concordant results (95-100%) compared to clinician-collected sampling. This collection approach shows promise for integration into cervical cancer prevention programs.
Transvaginal Myomectomy of a Large Obstructive Fibroid Performed at 10 Weeks Gestation [A95]
Authors: Alley Addison W. , Norton Taylor , Steck-Bayat Kayvahn P. , Mourad Jamal 
Published: June 2022

INTRODUCTION:
Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a minimally invasive approach for gynecologic surgery with increasing applications. We present the case of a patient at 10weeks of gestation with a desired pregnancy who developed urinary retention related to uterine fibroids leading to recurrent urinary infections and requiring indwelling catheter. Due to this, she sought termination, however this was unsuccessful due to anatomic distortion. The patient expressed her desire to continue the pregnancy if myomectomy could be performed. Magnetic resonance imaging revealed a 10.4 cm posterior lower uterine fibroid and large left fundal fibroid. The size and position of the fibroids made access via laparoscopy or laparotomy difficult. With shared decision making, we performed a diagnostic vNOTES procedure and subsequent transvaginal myomectomy.

METHODS:
We performed diagnostic laparoscopy and diagnostic vNOTES procedure through a posterior colpotomy to identify pelvic anatomy and obstructing fibroid. Vasopressin was injected and fibroid excised and morcellated vaginally. A second vNOTES and cystoscopy were performed to confirm hemostasis, restoration of normal anatomy and urine outflow. Informed consent was obtained to present the case.

RESULTS:
The patient tolerated the procedure well, was able to void spontaneously, and discharged home on post-operative day one. Final pathology confirmed leiomyoma with degenerative features. The patient carried her pregnancy to term without further urinary obstruction and delivered a healthy infant.

CONCLUSION:
Vaginal surgical approaches, such as vNOTES, can provide surgical access and visualization that may not be accessible by traditional laparoscopy or laparotomy. In certain patient scenarios, this may be considered for gynecologic surgery in pregnancy.
A Curriculum for Opioid Prescribing: What is the Effect on Postoperative Prescribing Patterns? [A97]
Authors: Harris Chelsey A. , Jin Emmy , McDaniel Katherine E. , Dancz Christina E. , Ciotti Mary C. 
Published: June 2022

INTRODUCTION:
Many patients receive an excess of opioids to treat their postoperative pain. We sought to assess the impact of a provider-based curricular intervention on postoperative prescribing patterns following benign obstetric and gynecologic procedures.

METHODS:
A provider-based opioid curriculum was developed and implemented. Cases for each of six different categories of procedure were identified (abdominal, laparoscopic, vaginal, hysteroscopic, vaginal delivery, and cesarean delivery). Morphine milligram equivalents (MMEs) prescribed were recorded before and after the curriculum. Initial analysis was to describe MMEs prescribed with a precision of 10 MMEs– requiring 72 subjects per group (80% power alpha=0.05). For the post curricular comparison, 26 subjects were required in each of the six surgical groups to detect a reduction of 10 MMEs (2:1, 80% power alpha=0.05).

RESULTS:
A total of 588 charts were reviewed. The overall median opioids prescribed decreased from 75 to 35 MMEs (P post curriculum were: abdominal (150->60, n=98, P=43.7, n=99, P 50, n=96, P=.01); hysteroscopic (0->0, n=98, P=.87); vaginal delivery (0->0, n=99, P=.22); and cesarean delivery (100->60, n=98, P<.01). The number of people who were prescribed no opioids increased from 145 of 429 (33.6%) to 65of 156 (41.7%), though this was not statistically significant (P=.08). The variation of types of opioid medications prescribed decreased from 7 to 4 (P=.027).

CONCLUSION:
A provider-based curriculum was successful at decreasing the total number of opioids prescribed to gynecologic and cesarean delivery patients in addition to increasing consistency among prescribers.
Incidence of Alopecia in Treatment of Women With Uterine Fibroids: Results of Two Phase 3 Trials of Linzagolix [A104]
Authors: Al-Hendy Ayman , Taylor Hugh S. , Catherino William , Stewart Elizabeth A. , Bestel Elke , Garner Elizabeth 
Published: June 2022

INTRODUCTION:
Although hair loss (alopecia) is a benign disorder, it can negatively affect patient's self-esteem, self-image, and overall quality of life. Linzagolix is an oral GnRH antagonist being developed at full and partial suppression doses with and without hormonal add-back therapy (ABT) for treatment of uterine fibroid-related symptoms. Alopecia was previously reported with other GnRH antagonists.

METHODS:
PRIMROSE 1 and 2 are two randomized, double-blind, placebo-controlled phase 3 trials investigating the efficacy and safety of linzagolix 100 mg and 200 mg once daily, +/- ABT in the treatment of uterine fibroids for 52 weeks.

RESULTS:
Up to week 24, alopecia was reported in total of five subjects (0.5%) in the pooled safety analysis set (N=1037). There was a similar incidence in the placebo (two subjects; 1.0%), 100 mg (one subject; 0.5%), and 200 mg+ABT groups (two subjects; 1.0%), and no reports in the 100 mg+ABT or 200 mg groups. Four of the cases resolved. For one subject (200 mg+ABT group) mild alopecia had not resolved. For this subject, the study drug was continued, and no concomitant therapy was administered for the alopecia. Up to week 52, one (0.1%) subject in the 200 mg+ABT group reported alopecia, which resolved. None of the cases led to treatment discontinuation. No subjects reported alopecia during the post-treatment follow-up.

CONCLUSION:
Hair loss (alopecia) was rarely observed in the PRIMROSE trials of linzagolix in the treatment of uterine fibroids.
Incidence of Mood Disorders in Women Treated With Linzagolix: 52-week Results From Two Phase 3 Trials [A106]
Authors: Marsh Erica E. , Catherino William , Al-Hendy Ayman , Donnez Jacques , Bestel Elke , Garner Elizabeth 
Published: June 2022

INTRODUCTION:
Safety data from two Phase 3 trials of linzagolix, a GnRH receptor antagonist, for the treatment of women with uterine fibroids (UFs) for 52 weeks were reviewed for treatment emergent adverse events (TEAEs) of depression and other mood disorders. We note that the incidence of TEAEs of depression and other mood disorders, previously reported up to 24 weeks, was low and revealed no consistent drug-related pattern.

METHODS:
PRIMROSE 1 and 2 are randomized, double-blind, placebo-controlled Phase 3 trials investigating the efficacy and safety of linzagolix 100 mg and 200 mg once daily, with and without hormonal add-back therapy (ABT) in women with UFs. After 24 weeks, the placebo group in PRIMROSE2 was switched to 200 mg+ABT. The incidence of depression and other mood disorder TEAEs from week 24 to week 52 was assessed using the Standardized MedDRA Query for Depression and suicide/self-injury and adding TEAEs of anxiety.

RESULTS:
Safety data from 336 and 421 patients, in PRIMROSE1 and PRIMROSE2, respectively, were collected from week 24 to week 52. Mood swings were reported for one (1.1%) subject in PRIMROSE2, and anxiety was reported in one (1.1%) subject in PRIMROSE1, both in the placebo/200 mg+ABT group. Depression was reported in one (1.1%) subject in PRIMROSE2 in the 200 mg/200 mg+ABT group. There were no reports of suicidal ideation, affect lability, or altered mood.

CONCLUSION:
The low incidence of depression and other mood disorder TEAEs was maintained up to 52 weeks of treatment with linzagolix. Linzagolix appears to be well tolerated in women with symptomatic UFs.
Quality of Life Improvements in Women with Uterine Fibroids: Results of Two Phase 3 Trials with Linzagolix [A107]
Authors: Al-Hendy Ayman , Bradley Linda D. , Taylor Hugh S. , Catherino William , Humberstone Andrew , Garner Elizabeth 
Published: June 2022

INTRODUCTION:
Uterine fibroids (UFs) are a frequent cause of long-term impairment in health-related quality of life (HRQL), including self-image, interpersonal relationships, and sexual function. Linzagolix is an oral GnRH antagonist being developed for treatment of fibroid-related symptoms at doses that result in full or partial estradiol suppression, both with and without add-back therapy (ABT).

METHODS:
PRIMROSE 1 and 2 are randomized, double-blind, placebo-controlled Phase 3 trials investigating the efficacy and safety of linzagolix 100 mg and 200 mg once daily, +/- ABT in the treatment of UFs for 52 weeks. Health-related qualify of life was assessed using the 3-month recall version of the Uterine Fibroid Symptom Health-Related Quality of Life (UFS QOL) questionnaire (score range: 0-100, a higher score indicating a better HRQL).

RESULTS:
After 24 weeks, in the pooled population (n=1012), the HRQL total score estimated mean (95% CI) change from baseline was 21.8 (25.6; 18.1), 28.2 (31.8; 24.5), 32.1 (35.6; 28.5), 31.5 (35.2; 27.8) and 12.7 (16.2; 9.1) in the 100 mg, 100 mg+ABT, 200 mg, 200 mg+ABT and placebo groups, respectively. All differences from placebo were significant (P<.001). The positive changes in HRQL were maintained at 52 weeks. At week 64, 12 weeks after the end of treatment, the improvements decreased in all treatment groups but did not return to baseline, ranging from a mean (SD) of 12.83 (SD 23.64) to 19.45 (SD 23.83) in the linzagolix arms.

CONCLUSION:
Linzagolix treatment had substantial beneficial effects on HRQL in women with UFs. The benefits persisted, with improvements not fully returning to baseline 12 weeks after treatment termination.
Predictors of Intraoperative Conversion to Open Hysterectomy During Minimally Invasive Approaches [A109]
Authors: Pfeuti Courtney K. , Krewson Briana 
Published: June 2022

INTRODUCTION:
Conversion from a minimally invasive approach to hysterectomy (MIH) to an open approach represents a significant complication. We therefore sought to determine risk factors for conversion.

METHODS:
We performed an institutional review board (IRB)-approved retrospective cohort study of women who underwent MIH in an academic hospital system from 2014-2021 via current procedural terminology (CPT) codes for MIH: vaginal (VH), laparoscopic-assisted vaginal (LA-VH), and laparoscopic or robotic (Lsc-H). Gynecologic cancer cases were excluded. MIH cases converted to open hysterectomies were compared to successful MIH to determine factors associated with the primary outcome: intraoperative conversion. Univariable and multivariable regression were used to determine predictors of conversion using STATA v15.0 (College Station, TX).

RESULTS:
A total of 2,231 patients were identified; conversion occurred in 23 of 228 LA-VH (10%), 48 of 1618 Lsc-H (9%), and 8 of 468 VH (2%). Age (46.3±0.95 vs. 50.9±0.25, P<.001), tobacco use (19% vs. 13%, P=.01), and preoperative hemoglobin (11.7±0.21 vs. 12.7±0.04, P<.001) were lower in converted cases. Black women underwent conversion more frequently (6%) than White women (2%), P<.001. Conversion frequency between gynecologic subspecialties significantly differed: generalists (6%), minimally invasive gynecologic surgeons (4%), urogynecologists (0.3%), and oncologists (1%), P<.001. Converted cases had larger uterine weights (459.2g±43.8 vs. 167.7g±3.5, P<.001). Adhesiolysis and postoperative transfusion frequency were higher in converted cases (27% vs. 8%, P<.001) and (14% vs. 1%, P<.001), respectively. In multivariable modeling, predictors of conversion included uterine weight (OR 1.003; 95% CI 1.002–1.004) and adhesiolysis (OR 4.11; 95% CI 2.35–7.21), P< .001.

CONCLUSION:
Uterine weight and adhesiolysis are predictors of intraoperative conversion during MIH and should be considered, along with age, race, tobacco use, and subspecialty, during preoperative risk stratification.
Cost Efficacy of Phenazopyridine Versus Sodium Fluorescein for Use During Cystoscopy After Hysterectomy [A114]
Authors: Ryan Kelly L. , Heisler Elise , Stumpf Luciana A. , Pham Thythy 
Published: June 2022

INTRODUCTION:
Recently, sodium fluorescein and phenazopyridine have both been used to visualize ureteral efflux during cystoscopy after hysterectomy. We compared the hysterectomies at our institution that utilized these marker dyes with those that did not and the cost-utility of using sodium fluorescein versus phenazopyridine.

METHODS:
We performed a retrospective chart review of all hysterectomies from June 2018 to March 2020. The primary outcome was the proportion of hysterectomies that used marker dye. Data were analyzed, with SPSS v26, using chi-square tests and Student’s t-tests.

RESULTS:
A total of 625 mostly laparoscopic/robotic (80%), hysterectomies were performed during the study period; two-thirds by Oncology and the rest by Benign Gynecology or Female Pelvic Medicine and Reconstructive Surgery (FPMRS). In 89% of the cases, a cystoscopy was performed. Marker dyes were used in one-third (190/553) of cases; 75% used sodium fluorescein, 20% phenazopyridine, and 3% both. There were no differences in patient or surgery characteristics between the cases that used dyes and those that did not. Eight-eight percent of the FPMRS cases used marker dye compared to 60% Benign and 13% Oncology cases (P=<.001). Dye was used in two-thirds of vaginal, half of laparoscopic, 33% of open, and 19% of robotic cases (P=<.001). Complication rates were low (12%), with no urinary tract injuries. At our institution, the cost of sodium fluorescein is 97 times greater than phenazopyridine. If all cases that utilized sodium fluorescein were to instead use phenazopyridine, the total cost incurred would be almost 1/100th of the cost calculated during this period.

CONCLUSION:
Switching to phenazopyridine in place of sodium fluorescein would result in significant cost savings.
Effect of Endometriosis on Postoperative Outcomes After Hysterectomy Performed for Benign Gynecologic Disease [A115]
Authors: Wang Emily , Bossa Deina R. , Rosero Eric B. , Kho Kimberly A. 
Published: June 2022

INTRODUCTION:
Endometriosis affects 10% of reproductive-aged women. Its impact on complications after gynecologic surgery is, however, not well known. This study aimed to investigate the effect of endometriosis on perioperative outcomes of patients undergoing hysterectomy for benign disease.

METHODS:
Institutional Review Board (IRB) approval was obtained. The 2014-2019 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases were used to select patients undergoing elective hysterectomy performed for benign indications. Propensity scores derived from logistic regression and inverse probability treatment weighting analysis were used to assemble weighted samples of patients with and without endometriosis. Primary outcomes included 30-day mortality, postoperative complications, and reoperations. Binary logistic regression was used to compare differences in the primary outcomes between patients with and without endometriosis.

RESULTS:
A total of 127,556 hysterectomy cases were identified. Of those, 19,618 (15.4%) had a diagnosis of endometriosis. Patients with endometriosis were younger, had higher incidence of pelvic inflammatory disease and prior abdominal operations but lower prevalence of chronic comorbidities. The incidence of postoperative complications was higher in patients with endometriosis (9.3% vs. 8.4%; OR[95% CI], 1.12 [1.05-1.20]; P=.001). However, the incidence of 30-day mortality (0.04% vs. 0.03%; OR [95% CI],1.16 [0.38-3.52]; P=.789) and reoperations (1.50% vs. 1.36%; OR [95% CI, 1.11 [0.92-1.33]; P=.287) were not different in patients with and without endometriosis.

CONCLUSION:
The rate of postoperative complications was higher in hysterectomies involving endometriosis compared to hysterectomies without endometriosis. Likely this is due to the anatomic distortion incurring increased surgical complexity. Patients and surgeons should be aware of this increased risk when planning surgery for suspected endometriosis.
A Structured Skin Care Protocol for Preventing and Treating Incontinence-associated Dermatitis in Critically Ill Patients
Authors: Zhang Xiaoxue , Wang Xinran , Zhao Xiaowei , Zhang Yu 
Published: June 2022

ABSTRACT

OBJECTIVE
To examine the effectiveness of a structured skin care protocol for preventing and treating incontinence-associated dermatitis (IAD) in critically ill patients.

METHODS
Participants were drawn from the ICUs of three teaching hospitals between January 2016 and December 2017. Patients were eligible if they were ≥18 years old, had idiopathic fecal incontinence, had diarrhea but were unable to sense it, and were expected to stay in the ICU for at least 72 hours after developing incontinence. A total of 143 patients were enrolled: 79 in the experimental group and 64 in the control group. In the first phase of the study, routine skin care measures were used; in the second phase, three ICU caregivers were trained to provide a structured skin care protocol. Trained research team members conducted the data collection and analysis. The TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) Statement Checklist was followed in reporting the study results.

RESULTS
Application of the structured skin care protocol reduced the incidence of IAD from 35.9% in the control phase to 17.7% in the intervention phase (χ
2 = 6.117, P < .05) and also decreased the severity of IAD (z = −2.023, P < .05). Further, IAD developed later (z = −2.116, P < .05) in the intervention group than in the control group. In addition, the nursing times to prevent or manage IAD did not differ significantly between the groups (t = −0.258, P > .05; t = −1.190, P > .05).

CONCLUSIONS
Use of the developed structured skin care protocol for IAD in critically ill patients lowered the incidence and severity of IAD and delayed IAD development.
Beyond Checking Boxes: Exploring Tensions With Use of a Workplace-Based Assessment Tool for Formative Assessment in Clerkships
Authors: Phinney Lauren B. , Fluet Angelina , O’Brien Bridget C. , Seligman Lee , Hauer Karen E. 
Published: June 2022

Purpose
To understand the role of a workplace-based assessment (WBA) tool in facilitating feedback for medical students, this study explored changes and tensions in a clerkship feedback activity system through the lens of cultural historical activity theory (CHAT) over 2 years of tool implementation.

Method
This qualitative study uses CHAT to explore WBA use in core clerkships by identifying feedback activity system elements (e.g., community, tools, rules, objects) and tensions among these elements. University of California, San Francisco core clerkship students were invited to participate in semistructured interviews eliciting experience with a WBA tool intended to enhance direct observation and feedback in year 1 (2019) and year 2 (2020) of implementation. In year 1, the WBA tool required supervisor completion in the school’s evaluation system on a computer. In year 2, both students and supervisors had WBA completion abilities and could access the form via a smartphone separate from the school’s evaluation system.

Results
Thirty-five students participated in interviews. The authors identified tensions that shifted with time and tool iterations. Year 1 students described tensions related to cumbersome tool design, fear of burdening supervisors, confusion over WBA purpose, WBA as checking boxes, and WBA usefulness depending on clerkship context and culture. Students perceived dissatisfaction with the year 1 tool version among peers and supervisors. The year 2 mobile-based tool and student completion capabilities helped to reduce many of the tensions noted in year 1. Students expressed wider WBA acceptance among peers and supervisors in year 2 and reported understanding WBA to be for low-stakes feedback, thereby supporting formative assessment for learning.

Conclusions
Using CHAT to explore changes in a feedback activity system with WBA tool iterations revealed elements important to WBA implementation, including designing technology for tool efficiency and affording students autonomy to document feedback with WBAs.