bluuebunny/crossref_metadata_2025_split huggingface dataset:
Underserved Patients' Experiences Using Telemedicine for Gynecologic Care During COVID-19 [A299]
Authors: Ahsan Muhammad Danyal , Kulkarni Amita A. , Monu Ngozi , Ma Xiaoyue , Cantillo Evelyn , Chapman-Davis Eloise 
Published: June 2022

INTRODUCTION:
The use of telemedicine has dramatically increased during the COVID-19 pandemic. We evaluated the experience of underserved women using telemedicine for gynecologic visits at an urban teaching hospital.

METHODS:
We conducted a prospective study of patient experiences using telemedicine for outpatient gynecologic visits from January 2021–September 2021. Demographic/clinical data were obtained. Participants completed a modified, previously validated Telemedicine Usability Questionnaire (TUQ), with responses on a 1-5 Likert scale. Statistical analyses used the Wilcoxon signed-rank test or t test.

RESULTS:
One hundred ninety two patients agreed to participate, of which 157 completed the surveys. A total of 87% had video visits, whereas 13% had telephone visits. The majority of patients were ethnic minorities (non-Hispanic White 16%, Hispanic 32%, Black 28%, and Asian 10%), median age 40 years (range 18–69 years), with 63% having income (44 vs.<39, P=.02). Race/ethnicity, income, education level, and prior experience with telemedicine had no effect on responses for this subscale.

CONCLUSION:
Underserved women utilizing telemedicine for outpatient gynecologic visits report largely positive experiences overall. Although telemedicine holds promise in increasing access to healthcare services, attention needs to be paid to ensure reliability among telehealth visits, particularly for older populations.
Operationalizing Aspirin to Reduce Preeclampsia Risk and Related Morbidity and Mortality [A302]
Authors: Gross Maya , Hughes Ainsley E. , Sampene Katherine 
Published: June 2022

INTRODUCTION:
Low-dose aspirin (ASA) reduces the incidence of preeclampsia and related morbidity and mortality when given to pregnant patients at moderate to high risk of disease. The United States Preventive Services Task Force (USPSTF) provides clear guidelines for identifying patients who warrant a prescription for ASA; however, complexity of the algorithm may inhibit comprehensive screening and implementation. We aimed to implement a standardized approach to ASA screening and prescription in an academic obstetrics and gynecology practice.

METHODS:
Using a quality improvement framework, we implemented universal prenatal screening according to the USPSTF recommendations for ASA to prevent preeclampsia. Pre-intervention, we analyzed prescription adherence at 201 new obstetric (NOB) visits. A multistep intervention was then implemented. Nurses utilized a checklist created from USPSTF guidelines to identify high-risk patients, defined as having 1 or more high-risk factors or 2 or more moderate-risk factors. ASA orders were signed by physicians. Three months after implementation, 199 NOB visits were reviewed. The primary outcome was the percent of patients screened (goal=90%). The secondary outcome was the percent of patients who screened positive that received the ASA recommendation (goal=90%).

RESULTS:
Pre-intervention, 47% of patients met criteria for ASA, and 28% of those patients received a recommendation for ASA. Post-intervention, 99% were screened. Half (48%) met criteria for an ASA recommendation and 78% of those patients received a recommendation for ASA.

CONCLUSION:
It is feasible to standardize screening and implementation of ASA to patients at elevated risk for preeclampsia. Providers can easily reproduce our processes to improve delivery of reliable preventative obstetric care.
Impact of CervixChat, a Text Message–Based Chatbot, on Patients Needing Colposcopy [A312]
Authors: Dayaratna Sandra D. , Slamon Rachel , Claxton Nabaala , Granda-Cameron Clara , Wen Kuang-Yi 
Published: June 2022

INTRODUCTION:
Low rates of adherence to colposcopy and follow-up recommendations, particularly among underserved women, are a barrier to providing appropriate care. We evaluated a novel education intervention to assess the effects on patient knowledge and compliance with colposcopy in an urban inner-city population.

METHODS:
Institutional review board approval was obtained. We assessed the feasibility and acceptability of a mobile health patient education and support intervention, CervixChat, guided by cognitive-behavioral theory and health communication best practices. Evidence-based intervention content was developed in English and Spanish to address the purpose of colposcopy, understanding of HPV, fatalistic beliefs about cancer, worries about necessary procedures, and progression of disease. Patients received real-time tailored counseling content via text messaging.

RESULTS:
Fifty eligible women with upcoming colposcopies were contacted, and 30 (60%) consented to the study. The average age of participants was 30 years old, and 53% identified as non-Hispanic White. A total of 73% completed baseline and follow-up assessments. Knowledge about cervical cancer and screening improved from 67% to 90%. Participants' beliefs about cervical cancer screening and perceived self-regulatory skills about managing their colposcopy appointment were also improved from baseline to follow-up. Colposcopy appointment adherence, extracted from the EHR, demonstrated 93% compliance.

CONCLUSION:
Participants reported high satisfaction and utility with the intervention. Overall increased knowledge about abnormal pap smears and a high level of visit compliance demonstrate the feasibility and acceptability of our CervixChat text messaging approach among a group of underserved diverse patients.
Advanced Directive Documentation in Gynecologic Oncology Inpatient Admissions [A317]
Authors: Kaufman Virginia , George Joshua S. , Corey Logan , Morris Robert 
Published: June 2022

INTRODUCTION:
Code-status documentation (CD) is an essential component to advance care planning (ACP). Our aim was to identify institutional CD compliance for admissions to gynecology oncology services (GYO) and analyze effectiveness of interventions on CD rates.

METHODS:
Retrospective chart review of inpatient GYO admissions for CD pre and post intervention in history and physical (HP) and progress notes (PN) was performed. Admissions were categorized as chemotherapy (CA), surgical (OR), or problem visit (PV). Interventions utilized Plan-Do-Study-Act (PDSA) methodology and included educational training, text reminders, and EMR reconfiguration. Chi-square test of independence was performed to examine the relationship between CD rates before/after intervention with a significance value set at 0.05.

RESULTS:
The pre-intervention group had 158 admissions with 21% of HP and 54% of PN containing CD. The post-intervention group had 150 admissions with 58% of HP and 94% of PN containing CD. X2 (1, N=306)=43.5, p For HP by admission type, 9.4% of CA, 3.7% of OR, and 39% of PV contained CD as compared to 64% of CA, 30% of OR, and 73% of PV post-intervention. In pre-intervention PN, 44% of CA, 50% of OR, and 62% of PV contained CD as compared to 92% of CA, 96% of OR, and 96% of PV post-intervention.

CONCLUSION:
Pre-intervention CD was suboptimal across note and admission types. Explanations for low CD were identified including provider discomfort discussing ACP and electronic medical record (EMR) limitations. Education and EMR interventions resulted in a statistically significant improvement in CD. Further PDSA cycles are planned to test further interventions.
Using Fine Needle Aspiration (FNA) as a Tool to Establish Cancer Burden in Resource-Limited Settings: Liberia, 2018 [A319]
Authors: Tumas Jordyn , Lieb Whitney , Beddoe Ann Marie 
Published: June 2022

INTRODUCTION:
Low- and middle-income countries (LMICs) have a disproportionate cancer burden, greater mortality, and later diagnosis compared to higher resource countries. This ultimately portends worse outcomes for patients with few survivors. Fine needle aspiration (FNA) is a well-known procedure for pathologic diagnosis that can be implemented in LMICs to diagnose malignancy with low cost, high efficiency, and minimal invasiveness. We present data from an FNA clinic established in Liberia, a LMIC, demonstrating these qualities.

METHODS:
This is a retrospective review of data from an FNA clinic in Liberia between January 2018 and December 2018 whose patients presented with palpable masses and underwent uncomplicated FNA biopsies. Institutional review board approval was waived for this study.

RESULTS:
478 FNA biopsies were performed in the study period. A total of 64% of findings were benign, 26% were malignant, and 6% were suspicious for malignancy. Four percent of samples were unsatisfactory for analysis. The most common malignancies were breast cancer (40%, N=51), metastasis from unknown primary (12%, N=16), hematogenous cancer (11%, N=14), and cervical cancer (10%, N=13). Among children's cancers, Burkitt lymphoma comprised more than half of cases (58.3%, N=7). There were no reported complications from the FNA procedures (N=0).

CONCLUSION:
Efforts to reduce the tumor burden of LMICs like Liberia should include the funding and establishment of FNA clinics for early tumor diagnosis. Additional steps include increasing cancer awareness among the population to encourage earlier presentation, training local providers to hone their skill in performing FNA biopsies, and building a cancer registry in order to direct national funding toward further cancer screening, diagnosis, and treatment.
Human Papillomavirus (HPV) Vaccine Effect on Incidence of in Situ and Invasive Squamous Cell Cancer of the Vulva, 2001-2018 [A322]
Authors: Berenson Abbey B. , Chang Mihyun , Hawk Ernest , Ramondetta Lois M. , Hoang Thao 
Published: June 2022

INTRODUCTION:
A recent study found that the incidence of invasive squamous cell carcinoma of the vulva (VSCC) is increasing among U.S. women, but rates of VSCC in situ (VIS) have not been reported since 2000. In 2008, indications for the human papillomavirus (HPV) vaccine were extended to include prevention of vulvar cancers. To examine its impact, we compared 2001–2018 incidence trends of VIS and VSCC among different populations of U.S. women.

METHODS:
This study was a secondary analysis of 88,942 vulvar cancer cases among adults aged 20 years and older reported in the U.S. Cancer Statistics 2001-2018 databases. We stratified data by tumor behavior (in situ/invasive) and age (20-44, 45-64, 65+ years old), race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic), and U.S. census region (Northeast, South, Midwest, West). Incidence rates and annual percentage changes (APC) were calculated by group.

RESULTS:
VIS incidence significantly decreased from 2001 to 2018 (APC –4.3, 95% CI –4.7 to −3.8) among all groups. Invasive VSCC decreased among 20- to 44-year old women (APC –0.8, 95% CI –1.3 to −0.3), but increased among older women. Regardless of tumor behavior, incidence was highest among non-Hispanic White women and those living in the Midwest.

CONCLUSION:
Rates of VIS are decreasing in women of all ages over 20 years old as well as in invasive VSCC among vaccine-eligible 20- to 44-year-old women. Since the trend began before the vaccine was available, this is probably due to multiple factors. Additional time is needed to fully realize the benefit of HPV vaccination on this cancer.
The Burden of Maternal Mental Health During COVID-19: Impact Analysis Through Perinatal Mood and Anxiety Disorders Screening [A272]
Authors: Brow Katherine , Kar Ayesha , Andrews Celine Marlin , Engel Casey , Lee Grace , James Jaclyn N. 
Published: June 2022

INTRODUCTION:
The American College of Obstetrics and Gynecology (ACOG) recommends screening for depression and anxiety at least once during the perinatal period and again during postpartum checks. The delivery of validated screening tools varies amongst institutions and individual obstetricians. The objectives of this study were to assess our institution's baseline screening rates and the impact of the COVID-19 pandemic on maternal mental health.

METHODS:
Our patient population was pregnant and postpartum patients at Carilion Clinic from January 2019 to July 2020. Data collected from medical records included scores of the Edinburgh Perinatal Depression Screening (EPDS), Personal Health Questionnaire (PHQ) 2 and 9, demographics, and psychiatric history. Screening rates and incidence of mood disorders were compared between pre– and intra–COVID-19 cohorts.

RESULTS:
Of the 850 women included, 43.5% (n=370) were screened during perinatal visits and 49.8% (n=424) postpartum. Screenings were completed more frequently during postpartum checks pre–COVID-19 compared to during the pandemic with PHQ-2 (27.4% vs. 16.1%, P=.0001) and PHQ-9 (10.3% vs. 5.4%, P=.011). More women screened positive for depression at perinatal checks during the pandemic compared to pre-pandemic (13.2% vs. 4.7%, P=.0377).

CONCLUSION:
The COVID-19 pandemic has affected rates of maternal depression screening and has significant mental health impacts on this population. This study reveals baseline rates of screening in perinatal and postpartum visits at our institution, which is critical to delivery of quality care. This information will help inform strategies to increase rates of screening and ensure that mental health needs are being addressed, especially in times of emergency.
Maternal Race/Ethnicity and Mode of Delivery in Twin Gestations [A273]
Authors: Pinson Kelsey , Mims Joseph R. , Ballas Jerasimos , Pettit Kate E. , Ramos Gladys 
Published: June 2022

INTRODUCTION:
Women of color in the United States have an increased risk of maternal morbidity and a higher risk of cesarean delivery (CD) compared to White women. This study aims to determine whether maternal race/ethnicity influenced mode of delivery (MOD) of twin gestations.

METHODS:
This was an IRB-approved, retrospective cohort study of all twin deliveries at a single institution between 1/1/2001 and 12/31/2018. Pregnancies delivered<24 weeks or with intrauterine fetal demise were excluded. The primary exposure, self-reported race/ethnicity, was categorized into five groups: White, Hispanic, non-Hispanic Black, Asian/Pacific Islander (PI)/Alaska Native (AN), and Other/Mixed. The primary outcome was CD. Statistical analyses included univariate analysis via Chi-square and ANOVA and logistic regression analysis.

RESULTS:
A total of 796 pregnancies were included; 377 (47.8%) of participants identified as White, 236 (29.9%) as Hispanic, 83 (10.5%) as Asian/PI/AN, 44 (5.6%) as Black, and 50 (6.3%) as Other/Mixed. BMI, maternal age at delivery, chorionicity, and parity were different by race/ethnicity groups, but gestational age at delivery was not. The overall rate of CD was 71.1% and did not vary by race/ethnicity (P=.51). There were no differences by race/ethnicity when analysis was limited to those delivering>34 weeks and birthweights>2,500 g (P=.07) or among only nulliparous women (P=.77). In multivariable analysis, only nulliparity was associated with increased risk of CD (P<.01).

CONCLUSION:
Rate of CD for twin gestations is high but was not related to maternal race/ethnicity in this cohort. Further study is needed to evaluate the indications for cesarean deliveries across racial/ethnic groups in twin gestations as this was not examined in this cohort.
Experience, Training, and Tools: A Mixed-Methods Study of Decision-Making for Obstetric Transport in a Rural State [A279]
Authors: Yi Avalon , Miller Bailey , Sandoval-Belt Payton , Patel Juhee , Quiner Trevor 
Published: June 2022

INTRODUCTION:
New Mexico relies heavily on emergency obstetric transport due to the widely separated rural communities and limited centers for providing advanced maternal, fetal, and neonatal care. Emergency transport requires careful decision making and efficient use of resources. This study aims to evaluate perceived adequacy with respect to training, experience, and resources for obstetricians who make transport decisions.

METHODS:
An interview guide and survey questions were developed to evaluate the perception of different aspects of emergency obstetric transport in New Mexico. Interviews were performed with obstetrics and gynecology providers who participate in emergency obstetric transport, both sending and receiving, throughout the state of New Mexico in both rural and urban communities. Interviews were recorded, transcribed, and coded for qualitative analysis.

RESULTS:
The majority (75%) of participating providers had no formal training in emergency transport during their medical education, and there was a common sentiment that targeted training in obstetric transports would be beneficial. However, providers who reported being uncomfortable in making transport decisions at the beginning of their current positions reported quickly gaining the experience needed to feel comfortable. Although tools to assess preterm labor are extremely limited in some settings (transvaginal cervical length available to only 40% of interviewees), all providers felt that they had the necessary tools to make transport decisions.

CONCLUSION:
Obstetric transport is essential in rural obstetric care. Although experience is an excellent teacher, obstetric training is generally lacking in transport-focused education. Development of obstetric transport-centered training may improve the comfort level of providers in new settings.
Does Vaginal Bleeding in the Presence of a Subchorionic Hematoma Increase Adverse Pregnancy Outcomes? [A283]
Authors: Thakkar Meera , Dinglas Cheryl , Rosner Jonathan 
Published: June 2022

INTRODUCTION:
Subchorionic hematomas occur when there is bleeding between the chorionic membrane and uterine wall. The incidence is approximately 1.3–3.1%. Multiple studies have evaluated subchorionic hematomas and demonstrate inconsistent findings regarding their association with adverse pregnancy outcomes. Our aim in this project was to evaluate whether vaginal bleeding in the presence of a subchorionic hematoma increases adverse pregnancy outcomes.

METHODS:
This was a retrospective chart review of all pregnant patients who had a first trimester sonogram at our Maternal Fetal Medicine center from 8/2015 to 5/2020. Inclusion criteria included patients with diagnosis of subchorionic hematoma in the first trimester. Exclusion criteria included multiple gestation, vanishing twin, and pregnancies complicated by fetal anomalies or chromosomal abnormalities.

RESULTS:
A total of 100 patients with diagnoses of first-trimester hematomas were analyzed. Approximately 37% presented with first-trimester bleeding. There was no significant difference between those who presented with vaginal bleeding and those who did not, in the following categories: spontaneous abortion (2.7% vs. 0%, P=.74), intrauterine fetal death (0% vs. 3.1%, P=.67), gestational hypertension (5.4% vs. 6.3%, P=.81), preeclampsia (10.8% vs. 7.9%, P=.79), intrauterine growth restriction (0% vs. 4.7%, P=.97), oligohydramnios (2.7% vs. 6.3%, P=.73), and preterm delivery (5.4% vs. 3.1%, P=.98).

CONCLUSION:
No significant association was found with adverse pregnancy outcomes, in patients with or without bleeding. There was a trend toward an increased rate of spontaneous abortion, pre-eclampsia, and preterm delivery in those with bleeding. Further research would investigate a broader subset of patients, including age-matched controls, and investigate the impact of hematoma size on pregnancy outcomes.
Diabetic Pregnant Patients Prefer Digital Glucose Logging To Traditional Paper Glucose Logging [A285]
Authors: Holthaus Emily , Patton Kathryn , Goodman Jean R. , Sprawka Nicole , Alrahmani Layan , Lal Ann 
Published: June 2022

INTRODUCTION:
Recent diabetes research has evaluated use of digital glucose logging and smartphone apps, and suggests improvement in glucose control with the new technology. A quality initiative was implemented in a maternal fetal medicine division at a tertiary care center which transitioned from paper glucose logging to digital glucose logging for diabetic patients. Our objective was to assess patient perspectives of logging methods before and after the change.

METHODS:
The quality initiative was started in July 2021, when all diabetic patients were instructed on digital glucose logging and communication. The digital log system involved logging glucose values in an app integrated with the electronic medical record and communicating with providers via the electronic medical record. Patients were asked to complete a questionnaire both before and after the quality initiative, assessing ease of use, real-time logging, daily compliance, communication quality, and overall satisfaction with paper logging. The scoring system was based on a Likert scale: 1 (strongly disagree) to 5 (strongly agree).

RESULTS:
From July to October 2021, 11 patients transitioned from paper to digital logging and completed both questionnaires. Of those, 88% preferred digital logging. Digital logging had higher scores for ease of use (4 vs. 3.6) and overall satisfaction (3.9 vs. 3.3). Digital logging had lower scores for real-time logging (2.8 vs. 3.1) and effective communication (3.8 vs. 4.1).

CONCLUSION:
Because of the higher ease of use and satisfaction scores, ultimately digital glucose logging could lead to improved compliance and, thus, better glycemic control during pregnancy.
Implementation and Evaluation of A Gynecology eConsult Service Within A Large Health System [A287]
Authors: Buddemeyer Katherine , Hernandez Sean , Dharod Ajay , Shalowitz David 
Published: June 2022

INTRODUCTION:
Electronic consultations (eConsults) between primary care providers (PCPs) and specialty clinicians offer specialists' input into patient care without in-person consultation. However, limited data exist on process outcomes associated with implementing systemwide eConsult services for gynecologic care.

METHODS:
We reviewed all gynecology eConsults at our institution from program start in February 2020 to September 2021. Analyzed variables included content, completion time, and provider satisfaction. The eConsult data were contextualized within systemwide data regarding in-person consultation processes.

RESULTS:
Implementation required identification of gynecologists willing to answer eConsults through the electronic medical record and development of consult template text to ensure adequate information was presented. Educational outreach was provided to PCP practices on workflow. A total of 71 gynecology eConsults were analyzed. Mean time from submission to completion was 0.73 days; 85% required less than 15 minutes of specialists' time. Most common eConsults involved cervical cancer screening (32%), abnormal uterine bleeding (14%), contraception (14%), imaging (13%), and menopause (10%). Systemwide, 85% of eConsults were perceived as appropriate by specialists; 93% of PCPs reported being satisfied or extremely satisfied. Of the PCPs, 30% reported they would have initiated in-person consultations if eConsults were unavailable; systemwide, time from referral to in-person consultation was 32.8 days.

CONCLUSION:
Implementation of a gynecology eConsult program is feasible, minimally burdensome to specialists, and associated with high satisfaction among PCPs. In our system, successful eConsults improved timeliness of access to gynecologists' recommendations by several weeks. Future work is in progress to determine whether and how expansion of eConsult utilization can further improve access to gynecologic care.