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Clinical Outcomes Associated With a Remote Postpartum Hypertension Monitoring Program. 与远程产后高血压监测计划相关的临床结果。
IF 5.7 2区 医学
Obstetrics and gynecology Pub Date : 2024-09-01 Epub Date: 2024-07-02 DOI: 10.1097/AOG.0000000000005665
Lara S Lemon, Beth Quinn, Anna Binstock, Jacob C Larkin, Hyagriv N Simhan, Alisse Hauspurg
{"title":"Clinical Outcomes Associated With a Remote Postpartum Hypertension Monitoring Program.","authors":"Lara S Lemon, Beth Quinn, Anna Binstock, Jacob C Larkin, Hyagriv N Simhan, Alisse Hauspurg","doi":"10.1097/AOG.0000000000005665","DOIUrl":"10.1097/AOG.0000000000005665","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate differences in health care utilization and guideline adherence for postpartum individuals with hypertensive disorders of pregnancy (HDP) who are engaged in a remote monitoring program, compared with usual care.</p><p><strong>Methods: </strong>This was a retrospective cohort study of postpartum individuals with HDP who delivered between March 2019 and June 2023 at a single institution. The primary exposure was enrollment in a remote hypertension management program that relies on patient home blood pressure (BP) measurement and centralized nursing team management. Patients enrolled in the program were compared with those receiving usual care. Outcomes included postpartum readmission, office visit within 6 weeks postpartum, BP measurement within 10 days, and initiation of antihypertensive medication. We performed multivariable logistic and conditional regression in a propensity score matched cohort. Propensity scores, generated by modeling likelihood of program participation, were assessed for even distribution by group, ensuring standardized bias of less than 10% after matching.</p><p><strong>Results: </strong>Overall, 12,038 eligible individuals (6,556 participants, 5,482 in the control group) were included. Program participants were more likely to be White, commercially insured, be diagnosed with preeclampsia, and have higher prenatal and inpatient postpartum BPs. Differences in baseline factors were well-balanced after implementation of propensity score. Program enrollment was associated with lower 6-week postpartum readmission rates, demonstrating 1 fewer readmission for every 100 individuals in the program (propensity score-matched adjusted risk difference [aRD] -1.5, 95% CI, -2.6 to -0.46; adjusted risk ratio [aRR] 0.78, 95% CI, 0.65-0.93). For every 100 individuals enrolled in the program, 85 more had a BP recorded within 10 days (propensity score-matched aRD 85.4, 95% CI, 84.3-86.6), and six more had a 6-week postpartum office visit (propensity score-matched aRD 5.7, 95% CI, 3.9-7.6). Program enrollment was also associated with increased initiation of an antihypertensive medication postpartum (propensity score-matched aRR 4.44, 95% CI, 3.88-5.07).</p><p><strong>Conclusion: </strong>Participation in a postpartum remote BP monitoring program was associated with fewer postpartum hospital readmissions, higher attendance at postpartum visits, improved guideline adherence, and higher rates of antihypertensive use.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Post-Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) After Infection During Pregnancy. 孕期感染严重急性呼吸系统综合征冠状病毒 2 (SARS-CoV-2) 后的急性后遗症。
IF 5.7 2区 医学
Obstetrics and gynecology Pub Date : 2024-09-01 Epub Date: 2024-07-11 DOI: 10.1097/AOG.0000000000005670
Torri D Metz, Harrison T Reeder, Rebecca G Clifton, Valerie Flaherman, Leyna V Aragon, Leah Castro Baucom, Carmen J Beamon, Alexis Braverman, Jeanette Brown, Tingyi Cao, Ann Chang, Maged M Costantine, Jodie A Dionne, Kelly S Gibson, Rachel S Gross, Estefania Guerreros, Mounira Habli, Jennifer Hadlock, Jenny Han, Rachel Hess, Leah Hillier, M Camille Hoffman, Matthew K Hoffman, Brenna L Hughes, Xiaolin Jia, Minal Kale, Stuart D Katz, Victoria Laleau, Gail Mallett, Alem Mehari, Hector Mendez-Figueroa, Grace A McComsey, Jonathan Monteiro, Vanessa Monzon, Megumi J Okumura, Deepti Pant, Luis D Pacheco, Anna Palatnik, Kristy T S Palomares, Samuel Parry, Christian M Pettker, Beth A Plunkett, Athena Poppas, Patrick Ramsey, Uma M Reddy, Dwight J Rouse, George R Saade, Grecio J Sandoval, Frank Sciurba, Hyagriv N Simhan, Daniel W Skupski, Amber Sowles, John M Thorp, Alan T N Tita, Samantha Wiegand, Steven J Weiner, Lynn M Yee, Leora I Horwitz, Andrea S Foulkes, Vanessa Jacoby
{"title":"Post-Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) After Infection During Pregnancy.","authors":"Torri D Metz, Harrison T Reeder, Rebecca G Clifton, Valerie Flaherman, Leyna V Aragon, Leah Castro Baucom, Carmen J Beamon, Alexis Braverman, Jeanette Brown, Tingyi Cao, Ann Chang, Maged M Costantine, Jodie A Dionne, Kelly S Gibson, Rachel S Gross, Estefania Guerreros, Mounira Habli, Jennifer Hadlock, Jenny Han, Rachel Hess, Leah Hillier, M Camille Hoffman, Matthew K Hoffman, Brenna L Hughes, Xiaolin Jia, Minal Kale, Stuart D Katz, Victoria Laleau, Gail Mallett, Alem Mehari, Hector Mendez-Figueroa, Grace A McComsey, Jonathan Monteiro, Vanessa Monzon, Megumi J Okumura, Deepti Pant, Luis D Pacheco, Anna Palatnik, Kristy T S Palomares, Samuel Parry, Christian M Pettker, Beth A Plunkett, Athena Poppas, Patrick Ramsey, Uma M Reddy, Dwight J Rouse, George R Saade, Grecio J Sandoval, Frank Sciurba, Hyagriv N Simhan, Daniel W Skupski, Amber Sowles, John M Thorp, Alan T N Tita, Samantha Wiegand, Steven J Weiner, Lynn M Yee, Leora I Horwitz, Andrea S Foulkes, Vanessa Jacoby","doi":"10.1097/AOG.0000000000005670","DOIUrl":"10.1097/AOG.0000000000005670","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the prevalence of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) after infection with SARS-CoV-2 during pregnancy and to characterize associated risk factors.</p><p><strong>Methods: </strong>In a multicenter cohort study (NIH RECOVER [Researching COVID to Enhance Recovery]-Pregnancy Cohort), individuals who were pregnant during their first SARS-CoV-2 infection were enrolled across the United States from December 2021 to September 2023, either within 30 days of their infection or at differential time points thereafter. The primary outcome was PASC , defined as score of 12 or higher based on symptoms and severity as previously published by the NIH RECOVER-Adult Cohort, at the first study visit at least 6 months after the participant's first SARS-CoV-2 infection. Risk factors for PASC were evaluated, including sociodemographic characteristics, clinical characteristics before SARS-CoV-2 infection (baseline comorbidities, trimester of infection, vaccination status), and acute infection severity (classified by need for oxygen therapy). Multivariable logistic regression models were fitted to estimate associations between these characteristics and presence of PASC.</p><p><strong>Results: </strong>Of the 1,502 participants, 61.1% had their first SARS-CoV-2 infection on or after December 1, 2021 (ie, during Omicron variant dominance); 51.4% were fully vaccinated before infection; and 182 (12.1%) were enrolled within 30 days of their acute infection. The prevalence of PASC was 9.3% (95% CI, 7.9-10.9%) measured at a median of 10.3 months (interquartile range 6.1-21.5) after first infection. The most common symptoms among individuals with PASC were postexertional malaise (77.7%), fatigue (76.3%), and gastrointestinal symptoms (61.2%). In a multivariable model, the proportion PASC positive with vs without history of obesity (14.9% vs 7.5%, adjusted odds ratio [aOR] 1.65, 95% CI, 1.12-2.43), depression or anxiety disorder (14.4% vs 6.1%, aOR 2.64, 95% CI, 1.79-3.88) before first infection, economic hardship (self-reported difficulty covering expenses) (12.5% vs 6.9%, aOR 1.57, 95% CI, 1.05-2.34), and treatment with oxygen during acute SARS-CoV-2 infection (18.1% vs 8.7%, aOR 1.86, 95% CI, 1.00-3.44) were associated with increased prevalence of PASC.</p><p><strong>Conclusion: </strong>The prevalence of PASC at a median time of 10.3 months after SARS-CoV-2 infection during pregnancy was 9.3% in the NIH RECOVER-Pregnancy Cohort. The predominant symptoms were postexertional malaise, fatigue, and gastrointestinal symptoms. Several socioeconomic and clinical characteristics were associated with PASC after infection during pregnancy.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov , NCT05172024.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Optimal Timing of Delivery for Pregnant Individuals With Mild Chronic Hypertension. 轻度慢性高血压孕妇的最佳分娩时间。
IF 5.7 2区 医学
Obstetrics and gynecology Pub Date : 2024-09-01 Epub Date: 2024-07-17 DOI: 10.1097/AOG.0000000000005676
Torri D Metz, Hui-Chien Kuo, Lorie Harper, Baha Sibai, Sherri Longo, George R Saade, Lorraine Dugoff, Kjersti Aagaard, Kim Boggess, Kirsten Lawrence, Brenna L Hughes, Joseph Bell, Rodney K Edwards, Kelly S Gibson, David M Haas, Lauren Plante, Brian Casey, Sean Esplin, Matthew K Hoffman, Kara K Hoppe, Janelle Foroutan, Methodius Tuuli, Michelle Y Owens, Hyagriv N Simhan, Heather Frey, Todd Rosen, Anna Palatnik, Susan Baker, Phyllis August, Uma M Reddy, Wendy Kinzler, Emily J Su, Iris Krishna, Nguyet A Nguyen, Mary E Norton, Daniel Skupski, Yasser Y El-Sayed, Dotun Ogunyemi, Ronald Librizzi, Leonardo Pereira, Everett F Magann, Mounira Habli, Shauna Williams, Giancarlo Mari, Gabriella Pridjian, David S McKenna, Marc Parrish, Eugene Chang, Joanne Quiñones, Zorina S Galis, Namasivayam Ambalavanan, Rachel G Sinkey, Jeff M Szychowski, Alan T N Tita
{"title":"Optimal Timing of Delivery for Pregnant Individuals With Mild Chronic Hypertension.","authors":"Torri D Metz, Hui-Chien Kuo, Lorie Harper, Baha Sibai, Sherri Longo, George R Saade, Lorraine Dugoff, Kjersti Aagaard, Kim Boggess, Kirsten Lawrence, Brenna L Hughes, Joseph Bell, Rodney K Edwards, Kelly S Gibson, David M Haas, Lauren Plante, Brian Casey, Sean Esplin, Matthew K Hoffman, Kara K Hoppe, Janelle Foroutan, Methodius Tuuli, Michelle Y Owens, Hyagriv N Simhan, Heather Frey, Todd Rosen, Anna Palatnik, Susan Baker, Phyllis August, Uma M Reddy, Wendy Kinzler, Emily J Su, Iris Krishna, Nguyet A Nguyen, Mary E Norton, Daniel Skupski, Yasser Y El-Sayed, Dotun Ogunyemi, Ronald Librizzi, Leonardo Pereira, Everett F Magann, Mounira Habli, Shauna Williams, Giancarlo Mari, Gabriella Pridjian, David S McKenna, Marc Parrish, Eugene Chang, Joanne Quiñones, Zorina S Galis, Namasivayam Ambalavanan, Rachel G Sinkey, Jeff M Szychowski, Alan T N Tita","doi":"10.1097/AOG.0000000000005676","DOIUrl":"10.1097/AOG.0000000000005676","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the optimal gestational age to deliver pregnant people with chronic hypertension to improve perinatal outcomes.</p><p><strong>Methods: </strong>We conducted a planned secondary analysis of a randomized controlled trial of chronic hypertension treatment to different blood pressure goals. Participants with term, singleton gestations were included. Those with fetal anomalies and those with a diagnosis of preeclampsia before 37 weeks of gestation were excluded. The primary maternal composite outcome included death, serious morbidity (heart failure, stroke, encephalopathy, myocardial infarction, pulmonary edema, intensive care unit admission, intubation, renal failure), preeclampsia with severe features, hemorrhage requiring blood transfusion, or abruption. The primary neonatal outcome included fetal or neonatal death, respiratory support beyond oxygen mask, Apgar score less than 3 at 5 minutes, neonatal seizures, or suspected sepsis. Secondary outcomes included intrapartum cesarean birth, length of stay, neonatal intensive care unit admission, respiratory distress syndrome (RDS), transient tachypnea of the newborn, and hypoglycemia. Those with a planned delivery were compared with those expectantly managed at each gestational week. Adjusted odds ratios (aORs) with 95% CIs are reported.</p><p><strong>Results: </strong>We included 1,417 participants with mild chronic hypertension; 305 (21.5%) with a new diagnosis in pregnancy and 1,112 (78.5%) with known preexisting hypertension. Groups differed by body mass index (BMI) and preexisting diabetes. In adjusted models, there was no association between planned delivery and the primary maternal or neonatal composite outcome in any gestational age week compared with expectant management. Planned delivery at 37 weeks of gestation was associated with RDS (7.9% vs 3.0%, aOR 2.70, 95% CI, 1.40-5.22), and planned delivery at 37 and 38 weeks was associated with neonatal hypoglycemia (19.4% vs 10.7%, aOR 1.97, 95% CI, 1.27-3.08 in week 37; 14.4% vs 7.7%, aOR 1.82, 95% CI, 1.06-3.10 in week 38).</p><p><strong>Conclusion: </strong>Planned delivery in the early-term period compared with expectant management was not associated with a reduction in adverse maternal outcomes. However, it was associated with increased odds of some neonatal complications. Delivery timing for individuals with mild chronic hypertension should weigh maternal and neonatal outcomes in each gestational week but may be optimized by delivery at 39 weeks.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Readmission Rates After Expedited Postpartum Discharge. 产后快速出院后的再入院率。
IF 5.7 2区 医学
Obstetrics and gynecology Pub Date : 2024-09-01 Epub Date: 2024-07-25 DOI: 10.1097/AOG.0000000000005680
Anjali Walia, Alexander M Friedman, Nasim C Sobhani, Timothy Wen
{"title":"Readmission Rates After Expedited Postpartum Discharge.","authors":"Anjali Walia, Alexander M Friedman, Nasim C Sobhani, Timothy Wen","doi":"10.1097/AOG.0000000000005680","DOIUrl":"10.1097/AOG.0000000000005680","url":null,"abstract":"<p><strong>Objective: </strong>To characterize national trends in expedited postpartum discharge and, secondarily, to identify predictors of expedited postpartum discharge and assess whether expedited postpartum discharge was associated with postpartum readmissions within 60 days of delivery hospitalization discharge.</p><p><strong>Methods: </strong>Birth hospitalizations and subsequent 60-day postpartum readmissions were extracted from the 2016-2020 Nationwide Readmissions Database for this retrospective cohort study. Postpartum discharge was categorized as expedited (less than 2 days after vaginal birth or less than 3 days after cesarean birth), routine (2 days after vaginal birth or 3 days after cesarean birth), or prolonged (more than 2 days after vaginal birth or more than 3 days after cesarean birth). Trends in expedited discharge were assessed over the study period with joinpoint regression. Unadjusted and adjusted logistic regression models were performed to assess clinical, hospital, and demographic predictors of expedited postpartum discharge. Sixty-day postpartum readmission risk was calculated, and adjusted regression models were performed to evaluate the association between expedited postpartum discharge and readmission.</p><p><strong>Results: </strong>Of 17.9 million birth hospitalizations, 32.9% had expedited postpartum discharge. The overall 60-day postpartum readmission rate after delivery hospitalization discharge was 1.7% for all patients, 1.4% for expedited postpartum discharge, 1.6% for routine discharge, and 3.3% for prolonged discharge. Rates of expedited postpartum increased from 29.1% in 2016 to 31.4% in 2019 and to 43.8% in 2020. This trend was not significant (average annual percent change: 9.9%, 95% CI, -1.6% to 23.7%), although rates of expedited discharge were significantly higher in 2020 than in 2016-2019 ( P <.01). Younger and older age, chronic comorbid conditions, mental health conditions, and obstetric complications (eg, transfusion, chorioamnionitis or endometritis) were associated with lower likelihood of expedited postpartum discharge. Expedited postpartum discharge was associated with 14% lower adjusted odds of 60-day postpartum readmission compared with routine discharge (adjusted odds ratio 0.86, 95% CI, 0.85-0.88).</p><p><strong>Conclusion: </strong>Rates of expedited postpartum discharge increased significantly in 2020 compared with 2016-2019 and were not associated with 60-day postpartum readmission. These findings suggest that broader use of expedited postpartum discharge has not resulted in increased risk of postpartum readmissions.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
In Reply. 回复中。
IF 5.7 2区 医学
Obstetrics and gynecology Pub Date : 2024-09-01 DOI: 10.1097/AOG.0000000000005687
Michele Torosis, A Lenore Ackerman
{"title":"In Reply.","authors":"Michele Torosis, A Lenore Ackerman","doi":"10.1097/AOG.0000000000005687","DOIUrl":"10.1097/AOG.0000000000005687","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Immediate Postpartum Long-Acting Reversible Contraception for Preventing Severe Maternal Morbidity: A Cost-Effectiveness Analysis. 产后立即使用长效可逆避孕药预防严重孕产妇发病率:成本效益分析》。
IF 5.7 2区 医学
Obstetrics and gynecology Pub Date : 2024-09-01 Epub Date: 2024-07-25 DOI: 10.1097/AOG.0000000000005679
Kimberley A Bullard, Shaalini Ramanadhan, Aaron B Caughey, Maria I Rodriguez
{"title":"Immediate Postpartum Long-Acting Reversible Contraception for Preventing Severe Maternal Morbidity: A Cost-Effectiveness Analysis.","authors":"Kimberley A Bullard, Shaalini Ramanadhan, Aaron B Caughey, Maria I Rodriguez","doi":"10.1097/AOG.0000000000005679","DOIUrl":"10.1097/AOG.0000000000005679","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the cost effectiveness of Medicaid covering immediate postpartum long-acting reversible contraception (LARC) as a strategy to reduce future short interpregnancy interval (IPI), severe maternal morbidity (SMM), and preterm birth.</p><p><strong>Methods: </strong>We built a decision analytic model using TreeAge software to compare maternal health and cost outcomes in two settings, one in which immediate postpartum LARC is a covered option and the other where it is not, among a theoretical cohort of 100,000 people with Medicaid insurance who were immediately postpartum and did not have permanent contraception. The primary outcome was the incremental cost-effectiveness ratio (ICER), which represents the incremental cost increase per an incremental quality-adjusted life-years (QALY) gained from one health intervention compared with another. Secondary outcomes included subsequent short IPI , defined as time between last delivery and conception of less than 18 months, as well as SMM, preterm birth, overall costs, and QALYs. We performed sensitivity analyses on all costs, probabilities, and utilities.</p><p><strong>Results: </strong>Use of immediate postpartum LARC was the cost-effective strategy, with an ICER of -11,880,220,102. Use of immediate postpartum LARC resulted in 299 fewer repeat births overall, 178 fewer births with short IPI, two fewer cases of SMM, and 34 fewer preterm births. Coverage of immediate postpartum LARC resulted in 25 additional QALYs and saved $2,968,796.</p><p><strong>Conclusion: </strong>Coverage of immediate postpartum LARC at the time of index delivery can improve quality of life and reduce health care costs for Medicaid programs. Expanding coverage to include immediate postpartum LARC can help to achieve optimal IPI and decrease SMM and preterm birth.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Video-Based Coaching for Laparoscopic Salpingectomy: A Randomized Controlled Trial. 腹腔镜输卵管切除术的视频指导:随机对照试验
IF 5.7 2区 医学
Obstetrics and gynecology Pub Date : 2024-09-01 Epub Date: 2024-07-25 DOI: 10.1097/AOG.0000000000005677
Teale M Muir, Jessica Pruszynski, Kimberly A Kho, Christina I Ramirez, Nicole M Donnellan, Lisa Chao
{"title":"Video-Based Coaching for Laparoscopic Salpingectomy: A Randomized Controlled Trial.","authors":"Teale M Muir, Jessica Pruszynski, Kimberly A Kho, Christina I Ramirez, Nicole M Donnellan, Lisa Chao","doi":"10.1097/AOG.0000000000005677","DOIUrl":"10.1097/AOG.0000000000005677","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of video-based coaching on the gynecology resident performance of laparoscopic salpingectomy.</p><p><strong>Methods: </strong>PGY-1 and PGY-2 residents were randomized before their gynecology rotations to standard gynecology curriculum (control group) or standard curriculum plus two video-coaching sessions by a fellowship-trained minimally invasive gynecologic surgeon (VBC group). Residents were video recorded intraoperatively performing three unilateral laparoscopic salpingectomies. Participants in the VBC group were coached between the procedures. The primary outcome was the improvement in modified GOALS (Global Operative Assessment of Laparoscopic Skills) and OSA-LS (Objective Structured Assessment of Laparoscopic Salpingectomy) scores, compared with baseline, in the VBC and control groups, with videos independently graded by three blinded minimally invasive gynecologic surgeons. A minimum sample size of 18 participants (nine per group) was needed to achieve 90% power to detect a difference of 5.0 points.</p><p><strong>Results: </strong>From October 2021 to December 2022, 28 PGY-1 and PGY-2 residents completed the study with 14 participants per group. Baseline characteristics were similar between groups. In the VBC group, modified GOALS scores significantly improved by 3.0 points from video 1 to video 2 ( P =.04) and by 3.2 points from video 1 to video 3 ( P =.02). Modified OSA-LS scores also increased significantly in the VBC group, by 6.1 points from video 1 to video 3 ( P =.02). In the control group, modified GOALS and OSA-LS scores improved from baseline but were not significant ( P =.2, P =.5). Video-based coaching also enhanced resident comfort and confidence in performing laparoscopic surgery.</p><p><strong>Conclusion: </strong>Video-based coaching improves resident performance of laparoscopic salpingectomy and can be used as an adjunct to resident surgical training.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov , NCT05103449.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quality of Care and Quality of Life: Balancing Patient Safety and Physician Burnout. 医疗质量与生活质量:平衡患者安全与医生职业倦怠。
IF 5.7 2区 医学
Obstetrics and gynecology Pub Date : 2024-09-01 Epub Date: 2024-07-25 DOI: 10.1097/AOG.0000000000005681
Howard Minkoff, Joselle O'Brien, Richard Berkowitz
{"title":"Quality of Care and Quality of Life: Balancing Patient Safety and Physician Burnout.","authors":"Howard Minkoff, Joselle O'Brien, Richard Berkowitz","doi":"10.1097/AOG.0000000000005681","DOIUrl":"10.1097/AOG.0000000000005681","url":null,"abstract":"<p><p>Since the publication of the Institute of Medicine's landmark report on medical errors in 2000, a large number of safety programs have been implemented in American hospitals. Concurrently, there has been a dramatic increase in the rate of burnout among physicians. Although there are many unrelated causes of burnout (eg, loss of autonomy), and multiple safety programs that are applauded by physicians (eg, The Safe Motherhood Initiative), other programs created in the name of safety improvements may be contributing to physician distress. In this piece, we review several of those programs, describe their limitations and costs to physician well-being, and discuss the manner in which they might be modified to retain their benefits while mitigating the burdens they place on physicians.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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In Reply. 回复中。
IF 5.7 2区 医学
Obstetrics and gynecology Pub Date : 2024-09-01 DOI: 10.1097/AOG.0000000000005685
Anabel Starosta, Moeun Son
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引用次数: 0
Human Papillomavirus Vaccination in the Postpartum Period: A Systematic Review. 产后接种人类乳头瘤病毒疫苗:系统回顾。
IF 5.7 2区 医学
Obstetrics and gynecology Pub Date : 2024-08-29 DOI: 10.1097/AOG.0000000000005718
Sara E Brenner, Susan Modesitt, Robert A Bednarczyk, Sarah E Dilley
{"title":"Human Papillomavirus Vaccination in the Postpartum Period: A Systematic Review.","authors":"Sara E Brenner, Susan Modesitt, Robert A Bednarczyk, Sarah E Dilley","doi":"10.1097/AOG.0000000000005718","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005718","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether routine postpartum human papillomavirus (HPV) vaccination is acceptable and feasible and to identify key themes and strategies that can be used to increase postpartum HPV vaccination rates.</p><p><strong>Data sources: </strong>PubMed and ClinicalTrials.gov were queried from inception to July 2024 for postpartum and HPV vaccination. Studies were limited to human subjects and the English language.</p><p><strong>Methods of study selection: </strong>Screening was performed for studies of any method that evaluated HPV vaccination in the postpartum period (N=60). Only original research that reported either uptake or acceptability of the HPV vaccine was included. Thirty-nine studies were eliminated after abstract review because they did not meet the inclusion criteria.</p><p><strong>Tabulation, integration, and results: </strong>Nine studies were categorized according to the primary aim of the study (defining the problem, assessing patient perspectives, or testing interventions to increase vaccination) and demonstrated that postpartum HPV vaccination programs can significantly increase HPV vaccination rates and are feasible and acceptable to patients.</p><p><strong>Conclusion: </strong>Incorporating HPV vaccination into standard postpartum care provides an opportunity to reach vulnerable patient populations, reduces cost for patients, and has the ability to prevent HPV-related cancers.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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