Antepartum Contraceptive Counseling in Women with Preterm Birth

Objective To compare rates of antepartum contraceptive counseling among women with preterm birth (PTB) and term birth. Study Design This is a retrospective cohort study of patients with completed delivery records in New York from January 1, 2004, to December 31, 2014. Exposure was determined based on the timing of delivery. Exposed women delivered at <37 weeks, and nonexposed women delivered at ≥37 weeks. Primary outcome was patient response to questions regarding receipt of prenatal contraceptive counseling (PCC) by a health care provider. Secondary outcome was receipt of interpregnancy interval counseling. Chi-square tests and multivariate logistic regression were used for analysis. Results Of 724,723 delivery records, PTB rate was 7.9%. Women with PTB < 37 weeks were significantly less likely to receive PCC (odds ratio [OR]: 0.9; 95% confidence interval [CI]: 0.89–0.93) or interpregnancy interval counseling (OR: 0.95; 95% CI: 0.94–0.97). The primary outcome remained significant after adjusting for confounders (adjusted OR: 0.91; 95% CI: 0.89–0.93). PTB < 34 weeks was associated with even lower odds of receiving contraceptive counseling (OR: 0.79; 95% CI: 0.76–0.83). Conclusion Postpartum contraception is an important tool for the prevention of recurrent PTB. Antepartum contraception counseling increases postpartum contraceptive uptake. Women with PTB have less exposure to antepartum contraceptive counseling. Lack of adequate counseling and decreased uptake of postpartum contraception may impact future pregnancy outcomes.

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A Cloud-Based Solution to Support Patient Outreach and Engagement for Chronic Disease and Preventative Care-A Retrospective Study (Preprint)

10.2196/preprints.29445 ◽

2021 ◽

Author(s):

Rubina Rizvi ◽

Fernando Suarez ◽

Suwei Wang ◽

Anita Preininger ◽

Karlis Draulis ◽

...

Keyword(s):

Breast Cancer ◽

New York ◽

Response Rate ◽

Diabetic Patients ◽

Medical Group ◽

Preventative Care ◽

Chi Square ◽

Patient Response ◽

Patients With Diabetes ◽

Patient Outreach

BACKGROUND Patients more actively engaged in their care have better clinical outcomes. OBJECTIVE To examine the performance of a widely adopted cloud-based patient engagement system for management of diabetes, hypertension, and preventative screenings at two large healthcare systems. METHODS We included patients with diabetes, hypertension, and those due for breast cancer screenings and/or bi-annual wellness visits and at Loudon Medical Group (LMG) in Virginia, and Basset Medical Group (BMG) in New York between 2019-2021. We examined outreach outcomes including successful contact rate (SCR), patient response rate (PRR), and adherent response rate (ARR). Associations between demographic characteristics and outcome measures were explored with Chi-square or Fisher’s exact tests. RESULTS Attempted contacts with patients with diabetes (N=2567) at LMG resulted in SCR of 87.1%, PRR of 47.2%, and ARR of 38.4%. At BMG, attempted contacts with patients with diabetes (N=3621), hypertension (N=10881), patients for breast cancer screening (N=2441), and wellness visits (N=9070) resulted in SCR values of 91.0%, 93.2%, 90.1%, and 92.1%; PRR of 57.0%, 59.8%, 50.8%, and 52.0%; and ARR of 45.2%, 39.8%, 6.8%, and 11.5% respectively. Outreach outcomes measures were significantly higher in patients with hypertension, and those carrying commercial or Medicare insurance vs. those who were self-insured or on Medicaid plans (SCR P<.0001, PRR P<.0001, and ARR P=.0013). Among diabetic patients, only SCR (P=.0008) was significantly associated with commercial or Medicare insurance. In general, rate of contact (SCR) had more favorable results as compared to the rate of follow-up visits (PRR, ARR), with higher PRR significantly associated with female sex (P<.0001), and a higher SCR seen among patients contacted by text (P<.0001). Age-stratified analysis showed that 60-69 years old diabetic patients had the highest SCR and ARR. Hypertensive patients between the ages of 70-79 had the highest SCR, PRR, and ARR. CONCLUSIONS This cloud-based patient outreach system demonstrated high rates of contact in patients with hypertension, diabetes and/or eligible for preventative screenings. Overall response rates were over 50%, with moderate adherence rates for diabetes and hypertension, but low adherence for preventative screenings. Older patients had higher adherence rates. Additional strategies are needed to translate successful patient contact into response and adherence. CLINICALTRIAL NA

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Online, face to face and hybrid meetings. What is the new normal in the COVID-19 era? A global collaborative survey by iTRUE group and UroSoMe working group

10.21203/rs.3.rs-89959/v1 ◽

2020 ◽

Author(s):

Daniele Castellani ◽

BM Zeeshan Hameed ◽

Yiloren Tanidir ◽

Nithesh Naik ◽

Jeremy Yuen-Chun Teoh ◽

...

Keyword(s):

Delphi Method ◽

Categorical Data ◽

Primary Outcome ◽

Secondary Outcome ◽

Chi Square ◽

Face To Face ◽

Virtual Meeting ◽

The Face ◽

Chi Square Test

Abstract Background: During the COVID-19 pandemic there was a significant increase in online webinars, which were universally available and advertised via Social Media, eliminating geographic restrictions thereby achieving a broader audience.Objective: The primary outcome of our survey was to see how virtual meetings would fare vis a vis face-to-face meeting, and if there would any future role of a “hybrid" meeting concept. The secondary outcome was to find out the best webinar/ virtual meeting settings.Design, setting, and participants: An online global survey was done between 6th June, 2020 to 5th July 2020 via https://www.surveymonkey.com/r/K26B5RQ. Using Delphi method, the survey questions were designed regarding webinars, face to face meetings and hybrid meetings, and circulated.Outcome measurements and statistical analysis: Categorical data were presented with counts and percentages, and comparison was done using Chi-square test and answers to Likert-like scale questions using the Mann-Whitney U test.Results and limitations: A total of N=526 urologists from 56 countries responded to the survey, of which N=386(73.38%) completed the questionnaire. The overall experience of participants was better in the face-to-face meeting followed by a hybrid meeting and webinar. After the COVID-19 pandemic, the preference for the type of conference was that of a hybrid meeting N=199(51%) than the webinar N=95(25%), using Zoom platform N= 283(73%) on laptop/desktop as the device of choice N=267(69%) and believed that a 1-hour webinar N=196(51%) was ideal at evening time N=277(72%) with 3-5 speakers N=242(62%) for each meeting. Although urology residents rated face-to-face meetings to have better cost-effectiveness when compared to consultants.Conclusions: The current pandemic has shown a trend towards online webinars; however, they are not a substitution to face-to-face meetings. Our survey shows an increased preference towards a hybrid meeting in the coming future which would be ideal for global participation, adding value to money and time.

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The Importance of Clinical Presentation in Risk and Management of Recurrent Preterm Birth

American Journal of Perinatology ◽

10.1055/s-0040-1715116 ◽

2020 ◽

Author(s):

Devin D. Smith ◽

Matthew M. Finneran ◽

Cynthia C. Shellhaas ◽

Philip Samuels ◽

Heather A. Frey

Keyword(s):

Preterm Birth ◽

Preterm Labor ◽

Primary Outcome ◽

Clinical Presentation ◽

Subsequent Pregnancy ◽

Spontaneous Preterm Birth ◽

Chi Square ◽

Key Points ◽

Chi Square Test ◽

History Of

Objective This study aimed to compare the risk of recurrent spontaneous preterm birth (sPTB), as well as cerclage efficacy, between groups stratified by phenotype of the index sPTB. Study Design This is a retrospective cohort study of women with a history of sPTB. Included were women with a history of singleton sPTB who received progesterone in a subsequent pregnancy. Multifetal gestations and abdominal cerclage were excluded. Exposure groups were based upon the presenting symptom that preceded their first sPTB and included painless cervical dilation (PCD), preterm premature rupture of membranes (PPROM), and painful dilation (preterm labor [PTL]). Primary outcome was delivery <34 weeks in a subsequent pregnancy. Secondary outcomes included delivery <28 and <37 weeks. Rates were compared using the Chi-square test. Multivariable Poisson regression was used to adjust for confounders. Results A total of 723 women were included. A total of 114 (16%) presented with PCD, 305 (42%) with PPROM, and 304 (42%) with PTL in their first sPTB. Cerclage in subsequent pregnancy was highest in the PCD group (42%) when compared with the PPROM (16%) and PTL (12%) groups. Rates of sPTB <34 and 37 weeks were similar among the groups. After adjusting for confounders, PCD was found to significantly increase the risk of recurrent sPTB <28 weeks (incidence rate ratio: 3.46 [1.09–11.0]; p = 0.04). Of the 121 women who underwent cerclage, there were no significant differences in rates of sPTB between the clinical presentation groups. Conclusion PCD as a specific phenotype of sPTB impacts recurrence of delivery before 28 weeks, but not at later gestational ages. In contrast, there was no significant association between clinical presentation of index sPTB and gestational latency in women who also underwent cerclage placement in a subsequent pregnancy. Our data suggest that clinical presentation is important with regards to recurrence of early sPTB, but not sPTB at later gestational ages. Key Points

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Abstract 150: Small Variations in Defibrillation Electrode Placement Affect Shock Success

Circulation ◽

10.1161/circ.130.suppl_2.150 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Alexander Esibov ◽

Sharon B Melnick ◽

Fred W Chapman ◽

Joseph L Sullivan ◽

Gregory P Walcott

Keyword(s):

Cardiac Arrest ◽

Primary Outcome ◽

Electrode Placement ◽

Secondary Outcome ◽

Electrode Position ◽

Success Rates ◽

Chi Square ◽

In Series ◽

Chi Square Test ◽

Energy Dose

Background: Defibrillation is essential in treating cardiac arrest patients with ventricular fibrillation (VF). The success of the shock in terminating VF depends on many previously studied factors, including waveform and energy dose. It has been observed clinically that defibrillation electrode placement varies widely. The goal of this study was to assess the effect of small differences in defibrillation electrode placement on first shock defibrillation success rates in swine. Methods: In 10 anesthetized swine weighing 32.7 ± 2.5 kg (mean ± standard deviation), electrode pads were attached at 3 different symmetric positions: the medial edge of each electrode was placed 3% (2.1 ± 0.1 cm), 7% (4.7 ± 0.1 cm), or 11% (7.5 ± 0.2 cm) around the circumference of the chest from mid-sternum (Fig. 1). Biphasic impedance-compensated shocks were delivered through the pads with a 50-ohm resistor added in series to replicate human impedance. The order of the 3 positions was block randomized for each experiment. At each electrode position, 24 episodes were run: VF was electrically induced and up to 2 shocks were delivered. Primary outcome was defined as successful VF termination after the first shock; secondary outcome was the cumulative success of both the first and second shock. Results: Across all experiments, at the 3%, 7%, and 11% positions, first shock success was 38.3% (92/240), 48.3% (116/240), and 36.7% (88/240) (p = 0.02, Chi-square Test); cumulative 2-shock success was 59.6% (143/240), 63.8% (153/240), and 55.4% (133/240) (p = 0.18), respectively. The lowest first shock success was at the 3% position in 6 of 10 animals, at the 11% position in 4 of 10 animals, and never at the 7% position. Conclusions: Small changes in electrode pad placement can significantly affect defibrillation shock success. Although anatomic differences may prevent the existence of one optimal electrode position, one position may be more effective for VF termination than another in a given patient.

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Is the Relationship between Short Interpregnancy Interval and Preterm Birth Related to a Short Cervix?

American Journal of Perinatology ◽

10.1055/s-0037-1601310 ◽

2017 ◽

Vol 34 (09) ◽

pp. 922-926

Author(s):

N. Zork ◽

A. Merriam ◽

C. Gyamfi-Bannerman ◽

S. Govindappagari

Keyword(s):

Preterm Birth ◽

Regression Model ◽

Preterm Delivery ◽

Outcome Data ◽

Secondary Outcome ◽

Interpregnancy Interval ◽

Short Cervix ◽

Group 2 ◽

The Relationship ◽

Group 1

Objective Our objective was to determine if the relationship between interpregnancy interval (IPI) and preterm delivery was related to cervical shortening. Methods This is a secondary analysis of a prospective cohort study designed to assess the relationship between cervical length (CL) and preterm delivery. Multiparous patients, who had transvaginal CLs obtained at 22 to 24 weeks and complete pregnancy outcome data available were included. The women were divided into two groups: Group 1 with an IPI of ≤ 1 year and Group 2 with an IPI of > 1 year. The primary outcome was short cervix (CL < 2.5 cm) at 24 weeks. The secondary outcome was the incidence of preterm delivery < 37 weeks. Interaction between short cervix and IPI was examined in a regression model. Results There were 155 women in Group 1 and 328 women in Group 2. There was no difference in the incidence of short cervix between groups (10.0% in Group 1 and 12.9% in Group 2, p = 0.35). In a logistic regression model, short IPI and short cervix were independently associated with preterm birth. Conclusion The relationship between short IPI and preterm birth is not explained by a short cervix. They remain independent risk factors for preterm birth.

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Rationale, baseline characteristics and methodology of the non-interventional VIVA study in postmenopausal osteoporosis

Osteologie/Osteology ◽

10.1055/s-0037-1620027 ◽

2014 ◽

Vol 23 (01) ◽

pp. 49-55

Author(s):

L. C. Hofbauer ◽

D. Felsenberg ◽

M. Amling ◽

A. Kurth ◽

P. Hadji

Keyword(s):

Quality Of Life ◽

Postmenopausal Osteoporosis ◽

Primary Outcome ◽

Osteoporosis Treatment ◽

Secondary Outcome ◽

Matched Pairs ◽

Fracture History ◽

Baseline Characteristics ◽

Study Inclusion

SummaryIt is important to understand compliance and persistence with medication use in the clinical practice of osteoporosis treatment. The purpose of this work is to describe the “intravenous ibandronate versus oral alendronate” (VIVA) study, a non-interventional trial to assess the compliance and persistence of osteopenic postmenopausal women with treatment via weekly oral alendronate or intravenous ibandronate (Bonviva®) every three months.4477 patients receiving ibandronate 3 mg i. v. quarterly and 1491 patients receiving alendronate 70 mg orally weekly were included in the study. Matched pairs of 901 subjects in each group were also generated. Matching was performed on the basis of age, body mass index, fracture history at study inclusion, prior treatment with bisphosphonates and the number of concomitant disorders. Secondary outcome measures of osteoporosis related fractures, mobility restriction and pain, analgesia, quality of life questionnaires as well as attitudes to medications were assessed. The primary outcome parameters of compliance and persistence will be tracked in these subjects.At baseline, the entire collectives differed significantly on body weight (less in ibandronate group), duration since osteo - porosis diagnosis (longer in ibandronate), and incidence of prior osteoporotic fracture (higher in ibandronate group). The matched-pairs differed only on mobility restriction and quality of life (both worse in ibandronate group).The results from the VIVA study trial will provide scientific rationale for clinical recommendations in the pharmacological treatment of postmenopausal osteoporosis.

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Patient Tolerability of Bowel Preparation is Associated with Polyp Detection Rate During Colonoscopy

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.232.ewh1 ◽

2014 ◽

Vol 23 (2) ◽

pp. 135-140 ◽

Cited By ~ 5

Author(s):

Edward W. Holt ◽

Kidist K. Yimam ◽

Hanley Ma ◽

Richard E. Shaw ◽

Richard A. Sundberg ◽

...

Keyword(s):

Bowel Preparation ◽

Primary Outcome ◽

Secondary Outcome ◽

Polyp Detection ◽

Cross Sectional ◽

Quality Outcomes ◽

Negative Experience ◽

Polyp Detection Rate ◽

Patient Reported ◽

Bowel Prep

Background & Aims: A number of factors have been identified that influence the yield of screeningcolonoscopy. The perceived tolerability of bowel preparation has not been studied as a predictor of quality outcomes in colonoscopy. We aimed to characterize the association between patient-perceived tolerability of bowel preparation and polyp detection during colonoscopy.Methods: We performed a cross-sectional cohort study of 413 consecutive adult patients presenting foroutpatient colonoscopy at two outpatient endoscopy centers at our institution. We developed a standardized questionnaire to assess the patient's experience with bowel preparation. Bowel preparation quality was measured using the validated Ottawa scale and colonoscopic findings were recorded for each patient. The primary outcome was polyp detection and the secondary outcome was the quality of bowel preparation.Results: Patient-reported clarity of effluent during bowel preparation correlated poorly with Ottawa score during colonoscopy, k=0.15. Female gender was an independent risk factor for a poorly tolerated bowel prep (OR 3.93, 95% CI 2.30 - 6.72, p<0.001). Report of a poorly tolerated bowel prep was independently associated with the primary outcome, polyp detection (OR 0.39, 95% CI 0.18 - 0.84, p=0.02) and also with the secondary outcome, lower quality bowel preparation (OR 2.39, 95% CI 1.17 - 4.9, p=0.02).Conclusions: A patient-perceived negative experience with bowel preparation independently predicted both a lower quality bowel preparation and a lower rate of polyp of detection. Assessment of the tolerability of bowel preparation before colonoscopy may be a clinically useful predictor of quality outcomes during colonoscopy.

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57. Evaluating the Utility of a Penicillin Allergy Reconciliation Program within an Infectious Diseases Consult Population in a Community Health System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.102 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S49-S50

Author(s):

Bruce M Jones ◽

Emily Plauche ◽

Susan E Smith ◽

Christopher M Bland

Keyword(s):

Infectious Diseases ◽

Health System ◽

Community Health ◽

Intervention Program ◽

Primary Outcome ◽

Panel Member ◽

Penicillin Allergy ◽

Secondary Outcome ◽

Research Support ◽

Research Grant

Abstract Background Penicillin allergy reconciliation is an important aspect of antimicrobial stewardship with ~10% of the population reporting a penicillin allergy. Our facility utilizes a Penicillin Allergy Reconciliation Program (PARP) led by an Infectious Diseases (ID) Pharmacist and pharmacy students to identify patients with penicillin allergies to reconcile and intervene when necessary. Information is collected by interview, electronic medical record (EMR) review, prescription outpatient fill history. This study evaluated reconciliations with and without a PARP in patients in a community health system. Methods This was a retrospective study that compared reconciliations performed on adult patients admitted at least once in 2019 with a self-reported penicillin allergy and ID physician consult at a hospital with a PARP (Institution 1) and one without a formal evaluation and intervention program (Institution 2) within the same community health system with same ID physicians. The primary outcome was documented reconciliation of a patient’s penicillin allergy during an inpatient visit in 2019. Reconciliation was defined as an edit or clarification (updating the severity, reaction, or comments section, as well as deleting) to a patient’s penicillin allergy in the EMR. The secondary outcome evaluated the percentage of total and ID consult patients with a penicillin allergy. Results There were 245 patients who met criteria and were included in the study, 113 from Institution 1 and 132 from Institution 2. For the primary outcome, there were 82 (72.6%) reconciliations at Institution 1 and 15 (11.4%) reconciliations at Institution 2 (p < 0.001). Interventions at Institution 1 and 2 resulted in 74 EMR updates and 8 removals and 14 EMR updates and 1 removal, respectively. Reconciliation was performed on the same visit as the ID consult in 59/82 patients (72%) at Institution 1 and 11/15 patients (73.3%) at Institution 2. All reconciliations at Institution 2 were made by pharmacist (10) or nurses (5). For the secondary outcome, 10.9% of patients with an ID consult and 12.6% of all patients admitted in 2019 had a penicillin allergy (p=0.027). Conclusion A PARP led by an ID pharmacist and students was an effective method to perform penicillin allergy reconciliations, even in the presence of active ID consultation. Disclosures Bruce M. Jones, PharmD, BCPS, ALK-Abello (Research Grant or Support)Allergan/Abbvie (Speaker’s Bureau) Christopher M. Bland, PharMD, FCCP, FIDSA, BCPS, ALK Abello, Inc. (Grant/Research Support)Biomerieux (Consultant)Merck (Consultant, Grant/Research Support, Advisor or Review Panel member, Speaker’s Bureau)Tetraphase (Speaker’s Bureau)

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Comparative study of intracranial access in thrombectomy using next generation 0.088 inch guide catheter technology

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017341 ◽

2021 ◽

pp. neurintsurg-2021-017341

Author(s):

Devin V Bageac ◽

Blake S Gershon ◽

Jan Vargas ◽

Maxim Mokin ◽

Zeguang Ren ◽

...

Keyword(s):

Primary Outcome ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Control Group ◽

Anterior Circulation ◽

Guide Catheter ◽

Catheter Failure ◽

Catheter Technology ◽

Intracranial Vasculature

BackgroundMost conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0.088 inch guide catheter designed for intracranial navigation.MethodsThis is a multicenter retrospective study, which included patients over 18 years old who underwent thrombectomy for anterior circulation large vessel occlusions. Technical outcomes for patients treated using the TracStar Large Distal Platform (TracStar LDP) or earlier generation TRX LDP were compared with a matched cohort of patients treated with other commonly used guide catheters. The primary outcome measure was device-related complications. Secondary outcome measures included guide catheter failure and time between groin puncture and clot engagement.ResultsEach study arm included 45 patients. The TracStar group was non-inferior to the control group with regard to device-related complications (6.8% vs 8.9%), and the average time to clot engagement was 8.89 min shorter (14.29 vs 23.18 min; p=0.0017). There were no statistically significant differences with regard to other technical outcomes, including time to recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2B). The TracStar was successfully advanced into the intracranial internal carotid artery in 33 cases (73.33%); in three cases (6.67%), it was swapped for an alternate catheter. Successful reperfusion (mTICI 2B-3) was achieved in 95.56% of cases. Ninety-day follow-up data were available for 86.67% of patients, among whom 46.15% had an modified Rankin Score of 0–2%, and 10.26% were deceased.ConclusionsTracstar LDP is safe for use during stroke thrombectomy and was associated with decreased time to clot engagement. Intracranial access was regularly achieved.

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Generational differences in the placement of clitic se in New York City Spanish

International Journal of Bilingualism ◽

10.1177/13670069211016546 ◽

2021 ◽

pp. 136700692110165

Author(s):

Kevin Martillo Viner

Keyword(s):

New York ◽

New York City ◽

York City ◽

Internal Variables ◽

Chi Square ◽

Ongoing Research ◽

External Variables ◽

Two Generations ◽

Finite Verb ◽

Chi Square Tests

Aims and objectives: This study analyzes the proclitic and enclitic positions of Spanish clitic se (e.g., ella se quería ir / ella quería irse ‘she wanted to go’) across two generations of Spanish speakers in New York City. In an effort to contribute to ongoing research aimed at better understanding Spanish in the US, the following questions are addressed. In syntactic environments that permit variation, does placement of Spanish se differ between the two generations? From the internal variables identified for this study (nonfinite verb type, finite verb, tense of finite verb, grammatical person, use of se, grammatical mood of finite verb, negation), which ones have a statistically significant effect on placement? From the external variables identified for this study (national origin, region, areal origins, sex, age, years in US, socioeconomic class, education, English skill, Spanish skill, general Spanish use), which ones have a statistically significant effect on placement? Design and data: This study is carried out within a variationist-sociolinguistic framework and the sample consists of 50 participants, 25 from the first generation (G1) and 25 from the second (G2). Analysis: Bivariate chi-square tests are performed in order to determine what internal and external variables constrain placement of the dependent variable (clitic se placement). Findings: Generation has a statistically significant effect on placement ( p = .016), wherein proclisis is more frequent amongst the G2 participants. These results corroborate previous research showing an overall preference for proclisis in both monolingual and bilingual/heritage speakers. Further, chi-square tests pinpoint five conditioning effects for G1 (nonfinite verb type, use of se, finite verb, years in US, and English skill), but only two for G2 (use of se and English skill). Originality and implications: The present study is the first to discover strong correlations between the proclitic position and the numerous internal and external variables quantitatively assessed. Future research is thus warranted.

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