bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Hogwarts House Teams and Competition on Resident Wellness, Resiliency, and Academic Participation [A65]
Authors: Chatfield Lindsay , Owens Amanda , Barbier Heather 
Published: June 2022

INTRODUCTION:
The prevalence of burnout among US physicians is estimated to be 40-60%, which is higher than in workers in other fields. Additionally, obstetricians and gynecologists have one of the lowest resiliency scores compared to other medical specialties.

METHODS:
For the 2021-2022 academic year, the Walter Reed National Military Medical Center (Walter Reed) obstetrics and gynecology residents were divided into the four Hogwarts houses to take part in a year-long competition called the House Cup, during which they participate in monthly wellness challenges to earn points for their team. Additionally, residents are awarded points by demonstrating clinical excellence and outstanding work ethic. Quantitative data and qualitative feedback will be collected throughout the year to assess for feelings of wellness, burnout, and resiliency as well as academic participation.

RESULTS:
In a preintervention 2020 survey of Walter Reed obstetrics and gynecology residents, only 66% of residents believed our program had a culture of wellness. Interim data from a recent resident survey, with a response rate of 93.3% (14 of 15), showed that 84.7% (12 of 14) of residents believed our program has a culture of wellness, notably improved from last year. Additionally, 84.7% (12 of 14) of residents believed the House Cup has improved their resiliency, and 100% (14/14) of residents believed the House Cup has a positive impact on the program.

CONCLUSION:
Initial response to the House Cup competition has been overwhelmingly positive with residents reporting increased feelings of wellness and improved resiliency. Our goal is to create a sustainable, easy-to-implement initiative to improve resident wellness and resiliency not only at our program but across the country and across specialties.
Racial Disparity in Postoperative Pain Management following Laparoscopic Salpingectomies [A68]
Authors: Tsuei Angie , Swayze Emma , Tomassi Rachel , Linares Silvia 
Published: June 2022

INTRODUCTION:
Previous literature in obstetrics has shown that racial biases influence postpartum pain management. Little is known about how these preconceptions affect opioid prescriptions in a post-operative setting. We compared the amount of morphine milligram equivalents (MME) prescribed to patients who identify as White and Black after a laparoscopic bilateral salpingectomy.

METHODS:
We conducted a retrospective chart review of 399 patients who underwent outpatient laparoscopic bilateral salpingectomies at Bronson Methodist Hospital in Kalamazoo between 2016 and 2021. Mean MMEs prescribed after surgery and maximum pain scores were compared between patients who identify as Black and White. Two-sided t-test was used to evaluate the data (significance at alpha 0.05). Maximum pain scores were calculated with the Mann-Whitney U test.

RESULTS:
25.8% (103/399) of our patient population self-identified as Black and 74.2% as White. The most commonly prescribed discharge pain medication for both groups was hydrocodone/acetaminophen, 55.6% and 51.7%, respectively. The median of max pain score (scale 0-10) of both groups was 6 (P=.63). The mean MME for White patients (n=256) was 37.6 (SD 14.7), while that of Black patients (n= 88) was 39.4 (17.4) with a P-value .3295. There was not a significant difference in pain scores by race within the first or last quartiles either.

CONCLUSION:
Our work serves as a model that clinical practices can utilize to evaluate current pain prescription practices and identify racial bias in pain management at an institutional level. Future studies with larger sample sizes are warranted to further explore this relationship.
The Influence of Care at a Large Regionalized Fetal Center on Patient Employment and Education [A70]
Authors: Gregory Emily , Abbasi Aleeza , Markham Kara B. 
Published: June 2022

INTRODUCTION:
The Fetal Center (FC) at the University of Cincinnati Medical Center provides comprehensive fetal care for pregnancies complicated by fetal anomalies and genetic abnormalities. Many diagnoses require families to relocate to receive care. To date, no study has assessed the effect of fetal care on patient employment and education.

METHODS:
An anonymous survey was sent via email to patients who received care at our FC from 2015-2021. The survey included questions regarding demographics such as education and employment.

RESULTS:
74.2% of patients (95% CI 69.9-78.2) reported employment during pregnancy, with half reporting full-time employment (54.2%, CI 49.3-59). Nearly half reported missing 1-5 days of work related to their care at the FC (45.4%, CI 40.2-50.7) and more than one-third of women missed >10 days (37.4%, CI 32.4-42.7). Ninety percent of patient partners worked full time during the pregnancy (90.5%, CI 87.3-92.9), with similar work absences (44.3% missed 1-5 days, CI 39.4-49.3, and 32.6% missed >10 days, CI 28.2-37.5). Only 8% of patients (CI 5.8-10.9) were pursuing education during their pregnancies, 4/5 of whom were unable to continue (78.1%, CI 69.3-84.9). Overall, >40% of women reported a moderate to severe negative effect on their employment or education related to care at the FC (41.6%, CI 36.8-46.5).

CONCLUSION:
This study illuminates the barriers to continued employment and education that care at a tertiary FC imposes on patients and their partners. This may have significant financial implications for families who may already be contending with the costs of medical care for their child, and providers should be cognizant of the fiscal effects of their recommendations.
A Parasitic Leiomyoma of the Colon Leading to a Surgical Emergency in Pregnancy [A76]
Authors: Wilhoite Morgan N. 
Published: June 2022

INTRODUCTION:
Uterine leiomyomas are the most common benign tumor of the reproductive tract. When a subserosal fibroid becomes adherent to another structure, the tumor sequesters blood supply from that structure and the pedicle on which the fibroid was once suspended either disappears or becomes avascular. This resultant tumor is termed a parasitic leiomyoma. Cases are few in which a parasitic fibroid develops without prior uterine surgery. The purpose of this case is to illustrate the workup and management of a parasitic leiomyoma causing bowel obstruction in a gravid patient naive to uterine surgery.

METHODS:
This is a case of a 26-year-old primigravid at 19 weeks gestation who presented with nausea, vomiting, and constipation, found to have a large colonic obstruction secondary to a presumed pedunculated uterine fibroid. The patient underwent an emergent laparotomy with plan for myomectomy. Intraoperatively, the mass was found to be entirely contained in the colonic mesentery, free of surrounding structures, without attachment to pelvic anatomy. General surgery was consulted to resect what was appeared to be a gastrointestinal stromal tumor (GIST) causing her obstruction. A partial colectomy and resection of the mass with end colostomy was performed. Histopathology confirmed a leiomyoma of uterine origin. The patient progressed through her pregnancy uncomplicated and went on to deliver vaginally at term.

CONCLUSION:
Parasitic leiomyomas can present in a variety of ways, including rarely as a bowel obstruction in a pregnant patient. This unusual situation should be included in the differential diagnosis when managing bowel pathology in pregnancy.
Bleeding Patterns in Women With Uterine Fibroids Receiving Relugolix Combination Therapy Over 1 Year [A78]
Authors: Lukes Andrea S. , Venturella Roberta , Al-Hendy Ayman , Zhu Emily Y. , Wagman Rachel , Stewart Elizabeth A. 
Published: June 2022

INTRODUCTION:
In the institutional review board-approved LIBERTY 1 and 2 studies and long-term extension study, relugolix combination therapy (Relugolix-CT; once-daily relugolix 40 mg, estradiol 1 mg, norethindrone acetate 0.5 mg) improved uterine fibroid (UF)-associated heavy menstrual bleeding (HMB). We analyzed bleeding patterns and bleeding intensity reported in a daily diary through 52 weeks/end of treatment.

METHODS:
Menstrual blood loss (MBL) volume was quantified by the alkaline hematin method. Amenorrhea was defined as lack of bleeding for two consecutive visits (approximately 56 days). Bleeding pattern was defined as cyclic (3–12 days of bleeding with ≤2 consecutive non-bleeding days within the menstruation duration) or irregular (did not meet the definition of amenorrhea or cyclic bleeding). Bleeding intensity was categorized as MBL volume of ≤80mL (including spotting, light and moderate bleeding) or >80mL.

RESULTS:
In total, 163 women received relugolix combination therapy for up to 52 weeks. Of those, 70.6% reported amenorrhea. Smaller proportions of women reported cyclic or irregular patterns (9.2% and 20.2%, respectively). Of 15 patients with cyclic bleeding, nine experienced spotting or light/moderate bleeding (≤80mL) while five had >80mL and one had no data. Similar intensity was observed among 33 women with irregular bleeding (≤80mL [15 women], >80mL [10 women], and eight women had no data).

CONCLUSION:
The majority of women with UF-associated HMB who received relugolix combination therapy for up to 52 weeks achieved amenorrhea. Of the remaining women who had either cyclic or irregular bleeding, approximately half had spotting or light/moderate bleeding that was considered within the normal range for MBL (≤80mL).
Influence of Socioeconomic Factors on Surgical Wait Times for Elective Surgeries in Benign Gynecology [A81]
Authors: Kinsey Kelly Elizabeth T. , Brustman Lois , Dabney Lisa , Khalil Susan , Hardart Anne 
Published: June 2022

INTRODUCTION:
In various disciplines, an association between patient outcomes and surgical wait times has been identified. This study provides the first investigation into whether practice setting influences wait times for elective surgeries in benign gynecology.

METHODS:
This retrospective study of patients at three Manhattan hospitals from October 2019 to February 2020 compared surgical wait times among patients seen in federally qualified health centers (FQHC) and private practice settings. Emergent surgeries, oncology cases, abortions, urogynecology procedures, and cases concurrently booked with another specialty were excluded. Surgical wait time was defined as the time (days) from the decision to operate to the day of procedure. A multivariable mixed model was used to model the log of surgical wait time by setting of care, adjusting for age, body mass index (BMI), race/ethnicity, insurance, need for medical clearance, and scheduled block time.

RESULTS:
A total of 540 patients were identified with a median age of 45.6 years (range 16-87 years). Average surgical wait time was 27 days (range 1-288 days). In multivariate analysis, longer surgical wait times were associated with the FQHC setting relative to private practice (70.9% longer, P=.006), and with needing medical clearance (36.8% longer, P=.02). Insurance type and race/ethnicity did not significantly impact surgical wait times in multivariate analysis. In univariate analysis, patients with public insurance had longer wait times compared with patients with commercial insurance (25% longer, P=.03).

CONCLUSION:
These results suggest that in benign gynecology, surgical wait times are significantly influenced by practice setting. Further research should investigate the reasons behind these preoperative delays with the goal of correcting inequities inherent in the medical system.
Long-Term Safety of Elagolix With Hormonal Add-Back Therapy in Women With Endometriosis-Associated Pain: 24-Month Results [A86]
Authors: Simon James , Kim Jin Hee , Thomas James , Miller Paul , Snabes Michael 
Published: June 2022

INTRODUCTION:
Elagolix is an oral GnRH antagonist approved for the treatment of moderate to severe endometriosis-associated pain (EAP) in the US, Canada, and Israel. Hormonal add-back therapy (1 mg estradiol/0.5 mg norethindrone acetate QD) may alleviate the hypoestrogenic effects (including bone mineral density [BMD] loss) associated with elagolix. The long-term safety of elagolix 200mg BID+add-back are currently under investigation in an ongoing phase 3, 48-month (M) study for EAP; this report focuses on open label safety results to 24M.

METHODS:
Premenopausal women with moderate-to-severe EAP were initially randomized 4:1:2 to receive elagolix 200 mg BID+add-back, elagolix 200 mg BID, or placebo for 12M, followed by open-label elagolix 200 mg BID+add-back for 36M. This 24M analysis assessed long-term safety including BMD.

RESULTS:
BMD measurements remained stable during the open label treatment period. At 24M, mean percent change from baseline in BMD for patients who initially received elagolix 200 mg BID+add-back (n=123), elagolix 200 mg BID (n=29), or placebo (n=60) was −0.85%, −1.21%, and −0.43% (spine); −0.23%, −0.58%, and −0.20%, (total hip); and −1.05%, −0.98%, and 0.14% (femoral neck). During the open-label period, safety profiles were generally similar across all three original treatment groups at 24M; rates of serious adverse events were generally low (less than 5%) and balanced across groups.

CONCLUSION:
Elagolix 200 mg BID+add-back therapy for 24M continues to have a favorable safety profile with minimal long-term impact on BMD. Combined with previously reported improvements in dysmenorrhea and non-menstrual pelvic pain, these safety data suggest elagolix 200 mg BID+add-back may provide a longer-term therapeutic option for women with EAP.
Successful Identification of Mixed Vaginal Infections Requires Comprehensive Testing [A93]
Authors: Peacock Jacqueline , Carpenter Brittany L. , Dubiak Kyle , Fecteau Heather , Carlson Robert 
Published: June 2022

INTRODUCTION:
Vaginitis is one of the most common gynecological complaints and carries an extremely high recurrence risk. Despite considerable symptomatic overlap, most testing and empirical treatment focus on anaerobic pathogens or Candida albicans infections. However, comprehensive testing of patients with recurrent vaginitis demonstrates a complex picture of mixed vaginitis and antimicrobial resistance.

METHODS:
Data from vaginitis cases released between April 2020 and May 2021 were reviewed. The comprehensive, PCR-based vaginosis panel includes pathogens associated with bacterial vaginosis and aerobic vaginitis, Candida spp., sexually transmitted infections (STIs), and Lactobacillus spp. While simultaneously detecting antibiotic resistance markers.

RESULTS:
A review of 9,534 cases revealed that 32.6% included pathogens unlikely to respond to empirical treatment; aerobic pathogens were detected in 26.5% of cases and STIs in 6.1%. STIs tested included Chlamydia trachomatis (2%), herpes simplex virus 1 or 2 (2%), Neisseria gonorrhoeae (0.6%), and/or Trichomonas vaginalis (1.8%). Mycoplasma genitalium, considered an emerging STI, was also detected in 0.9% of cases. Surprisingly, evidence of bacterial vaginosis was also present in 85% of STI positive cases. STI cases also represented a younger population. Evidence of antimicrobial resistance was frequent with macrolide-resistance genes detected in 40.2% of cases and fluconazole resistance detected in more than 20% of Candida positive cases.

CONCLUSION:
Mixed vaginitis cases are more common than expected and may partially explain the frequent recurrence rate of vaginitis. Clinical outcomes following comprehensive testing-guided treatment versus empirical treatment (e.g., 5-nitroimidazole agents) may warrant future study.
Laser Vaporization vs. Cystectomy in Women with Ovarian Endometrioma: A Systematic Review and Meta-analysis [A96]
Authors: Pivazyan Laura , Kasyan Victoria , Isaeva Sapiyat , Adamyan Leila 
Published: June 2022

INTRODUCTION:
There are still many controversies about managing patients with ovarian endometrioma (OE), discussing recurrence rates, pregnancy rates, and reduction of ovarian reserve (OR). The objective of this study was to compare outcomes after laparoscopic cystectomy versus laser vaporization in women with OE.

METHODS:
A systematic review and meta-analysis was registered in PROSPERO (CRD42021281781) and was done according to the PRISMA 2020 checklist. Studies (published until October 2021) were identified by searching PubMed, Cochrane Library, Google Scholar, and ClinicalTrials databases (keywords "cystectomy," "laser vaporization," and "endometrioma"). Inclusion criteria: women of reproductive age undergoing surgery for OE larger than 30 mm. Outcomes-risk ratio for recurrence, ovarian reserve, and pregnancy rates. Tools recommended by the Cochrane Society achieved risk of bias assessment.

RESULTS:
In total, 874 studies were found, and nine studies were included in qualitative synthesis (822 patients). All of the authors compared the efficacy of cystectomy or laser vaporization in reproductive-aged women with OE. Overall risk of bias for randomized trials was 80% “some concerns” and 20% “low,” for cohort studies, 50% “some concerns” and 50% “low.” The primary meta-analysis focused on recurrence rates (four studies included in a meta-analysis) with no statistically significant difference found between these interventions (RR = 0.53, 95%CI: 0.24 to 1.21, P=.13). The next meta-analysis estimated antral follicle count (three studies) which was significantly lower in the cystectomy group (RR=-2.56, 95% CI: -3.71 to -1.42, P<.0001). Pregnancy rates were analyzed in three studies with no statistically significant difference (RR=0.96, 95% CI: 0.81 to 1.14, P=.64).

CONCLUSION:
There was no statistical difference in recurrence rate and pregnancy rates, butt antral follicle count was higher in the laser vaporization group. Nevertheless, we need more clinical trials for stronger recommendations.
Human Papillomavirus and Cervical Dysplasia in Latinas: Evaluating the Association Between HPV Infection and Cervical Dysplasia [A99]
Authors: Fanucchi Hannah , Naresh Amber 
Published: June 2022

INTRODUCTION:
Given the elevated risk of cervical dysplasia and malignancy in the Latina population, we sought to assess the rate of high-grade cervical dysplasia in a population of Latina patients with human papillomavirus (HPV)-positive testing on screening Pap smear, relative to a non-Latina White population. We additionally assessed rates of HPV vaccination, HPV strains, and concordance of cytology/histology.

METHODS:
We conducted a retrospective chart review of all HPV-positive patients undergoing colposcopy across three clinics (January 2019 to September 2021), comparing demographic factors, medical history, cytology, HPV strains, and histology results between the groups. Logistic regression was performed to control for potential confounding factors.

RESULTS:
We identified 164 patients with positive HPV testing on Pap smear who completed histologic evaluation. No difference was seen in age, immunosuppression, prior abnormal Pap smears, or cytology between Latina and non-Latina patients. CIN2+ was identified in 57.6% of Latina patients, compared to 22.5% among non-Latina White individuals; P<.001. The significant difference persisted when controlling for tobacco use, HPV vaccination, immunosuppression and history of abnormal Pap smear. Latinas had less concordance between cytology and histology: 45.7% of Latinas had CIN2+ after initial low-grade cytology, compared to 7.7% of non-Latinas; P<.001.

CONCLUSION:
Among HPV-positive patients, Latina ethnicity was associated with increased risk of high-grade cervical dysplasia relative to non-Latina patients, despite no difference in initial cytology or other relevant medical factors. Latina ethnicity was additionally associated with lower HPV vaccination rates and decreased concordance of cytology and histology, with a higher rate of high grade histology following low-grade cytology.
Defining Limits of Postpartum Leukocytosis [A347]
Authors: Guarisco Elizabeth , Song Xuemei , Hartup Lindsay , Vargas Aleena , Barton Jordan , Belmonte Cosme , Holmes Cameron , Mattathil Shawna , Parker Brenna , Tami Claudina , Teague Jennifer , Wang Zhu , Boyd Angela 
Published: June 2022

INTRODUCTION:
This study illustrates the rise in white blood cell value that can be reasonably expected after delivery and may give the physician further insight when evaluating postpartum patients with a leukocytosis.

METHODS:
This was a retrospective cohort study that examined data from January 1, 2018, to January 1, 2020. Women who delivered a live fetus at 37 weeks and 0 days gestational age or greater were included. Primary co-outcomes included defining the mean and >95th percentile white blood cell (WBC) count after delivery. Secondary outcomes included illustration of the change in predelivery WBC, hemoglobin (Hb), and hematocrit (Hct) values in the setting of certain characteristics. Extracted data included maternal age, gestational age, gravidity, parity, BMI (kg/m2), WBC value, Hb, and Hct prior to delivery and on postpartum day one. Data were analyzed using ANOVA, Student's t test, Mann-Whitney U test, and Wilcoxon rank sum test with a P<.05 indicating statistical significance.

RESULTS:
A total of 2,245 patients met the inclusion criteria, and of those, 1,476 delivered vaginally and 769 by cesarean delivery. The average change in WBC between the entry and postpartum WBC was 3.17 x 103/mm3. A WBC count greater than 19.07 x 103/mm3 was the 95th percentile. A significant difference in the rise in WBC when comparing vaginal delivery to cesarean delivery was observed (3.44 vs 2.64 x 103/mm3, P<.001). Patients diagnosed with suspected peripartum infection had a greater postpartum day-one WBC (7.24 vs 2.98 x 103/mm3, P<.001), as did those who received additional uterotonics (P<.001). There was an increase in WBC value with worsening degree of maternal tear after vaginal delivery (P<.001). There was no significant difference in WBC when comparing hypertensive disorders of pregnancy or diabetes.

CONCLUSION:
A paucity of data exists on the ultimate effect of delivery on changes in WBC indices when considering delivery characteristics and maternal co-morbidities. A boxplot was created to illustrate these values.