Perceptions of Rural Access to Prenatal Care in the United States by Patients, Nurses, Midwives, and Physicians: An Integrative Review.

Background: Despite substantial investments in maternity care, the United States continues to experience higher maternal mortality rates than most high-income countries. Rural regions lack adequate prenatal care services, a contributing factor to disparate maternal health outcomes.

Methods: This integrative review on patient, nurse, midwife, physician, and community perspectives on accessing prenatal care in rural areas of the United States follows Whittemore and Knafl's integrative review framework, including a systematic literature search in various databases from January 1, 2010, to May 1, 2024.

Parent-identified gaps in preparation for the postpartum period in the United States: An integrative review.

Background: In the United States, 35% of all pregnancy-related deaths occur between 24 h and 6 weeks after delivery, yet the first outpatient visit is not typically scheduled until 6 weeks postpartum. Thus, the ability to independently navigate this period is critical to maternal well-being and safety. However, previous research suggests that many women feel unprepared to manage the challenges they encounter during this time, and there is a current need to synthesize the existing evidence.

A longitudinal assessment of sex differences in the growth of the mandibular retromolar space.

Objective: To assess longitudinal variation in patterns of retromolar space growth, with regard to sex and cervical vertebrae maturation.

Design: We utilized serial lateral cephalograms from three craniofacial growth studies (Denver, Iowa, Oregon), measuring retromolar space and cervical vertebrae maturation in 99 subjects (56% male) from 8 to 18 years of age for each subject. Repeated measures ANOVA and a linear mixed effects model were used to assess retromolar space growth through time.

Key Factors to Attract More U.S. Diagnostic Radiology Residents into the Field of Nuclear Medicine and Molecular Imaging: A National Survey.

Rationale And Objectives: To understand the current state of radiology residents' exposure to nuclear medicine and molecular imaging (NM/MI), determine key factors that may attract more trainees into the field, and identify differentiating aspects between those specializing in NM/MI and those who are not.

Materials And Methods: An anonymous web-based survey was sent to contacts at all diagnostic radiology residency programs in the United States for dissemination to their residents, collecting information about trainees' NM/MI exposure during residency and factors that may attract them to NM/MI.

Results: A total of 198 trainees responded to the survey, 34 of whom plan on pursuing a career in NM/MI.

Thyroid Nodule Shape Independently Predicts Risk of Malignancy.

Context: Predictive models of thyroid nodule cancer risk are presently based upon nodule composition, echogenicity, margins, and the presence of microcalcifications. Nodule shape has shown promise to be an additive factor helping determine the need for nodule biopsy.

Objective: We sought to determine if calculation of a nodule's spherical shape independently associates with cancer risk.

Fourfold Improved Odds of a Good First Trimester Outcome Once a Yolk Sac Is Seen in Early Pregnancy.

Objectives: To compare first trimester prognosis when an early pregnancy sonogram demonstrates a gestational sac with yolk sac versus gestational sac without yolk sac.

Methods: Our study comprised 823 transvaginal sonograms without identifiable embryo performed at least 35 days from last menstrual period (LMP), in which mean sac diameter was <16 mm and first trimester outcome (live or early pregnancy loss) was known. We recorded the presence or absence of yolk sac, first trimester outcome, and several clinical features: maternal age, time since LMP, and presence or absence of vaginal bleeding.

The Virtual Homeroom: Utility and Benefits of Small Group Online Learning in the COVID-19 Era.

Objective: During COVID-19, Harvard Medical School pivoted to online learning. A large student cohort took a completely virtual Radiology clerkship with daily programming including virtual small group teaching sessions or "homerooms."

Materials And Methods: One hundred and eleven medical students were divided into 12 virtual small group sessions which emphasized foundational concepts.

Parenteral Nutrition Prescribing and Order Review Safety Study: The Need for Pharmacist Intervention.

Introduction: Errors have been reported in the literature to occur at each step of the parenteral nutrition (PN) use process, necessitating standardized processes, clinician competence, and open communication for those involved. This study was performed at Central Admixture Pharmacy Services (CAPS®) in collaboration with the American Society for Parenteral and Enteral Nutrition (ASPEN) with the purpose to study the need for and success of PN pharmacist interventions.

Methods: A survey was developed and sent to all CAPS customers for study enrollment and to identify their demographic and practice characteristics.

First-Trimester Prognosis When an Early Gestational Sac is Seen on Ultrasound Imaging: Logistic Regression Prediction Model.

Objectives: To determine the factors that jointly and independently affect first-trimester outcome of very early intrauterine pregnancies (those whose sonogram shows a gestational sac with no identifiable yolk sac or embryo) and develop a mathematical model and Web-based calculator that computes prognosis based on these factors.

Methods: Our study population included 590 very early pregnancies scanned between January 1, 2012, and June 30, 2018, with known outcomes (live or spontaneous loss) at 14 weeks. We recorded patient age, mean sac diameter (MSD), human chorionic gonadotropin (hCG) rise, and presence/absence of: vaginal bleeding, history of infertility, prior miscarriage, and pregnancy via assisted reproductive technology.

Medical Student Education Roadblock Due to COVID-19: Virtual Radiology Core Clerkship to the Rescue.

Rationale And Objectives: Medical schools were upended by the COVID-19 pandemic, resulting in suspension of all in-person educational activities, and leaving clinical clerkships on hold indefinitely. A virtual curriculum and novel teaching methods were needed to fulfill curricular requirements. We developed a comprehensive virtual radiology clerkship and evaluated the efficacy of this novel method of teaching.

"Pseudogestational Sac" and Other 1980s-Era Concepts in Early First-Trimester Ultrasound: Are They Still Relevant Today?

Objectives: To determine whether an intrauterine round or oval fluid collection ("saclike structure") can prove to be either an intrauterine pregnancy or intrauterine fluid in conjunction with an ectopic pregnancy (sometimes termed "pseudogestational sac") and whether ultrasound features, including the presence or absence of an echogenic rim, "double sac sign" (DSS), or "intradecidual sign" (IDS), are helpful for establishing the diagnosis or predicting the prognosis.

Methods: We identified all sonograms obtained from women with positive serum human chorionic gonadotropin results at our institution between January 1, 2012, and June 30, 2018, meeting the following criteria: presence of an intrauterine saclike structure without a yolk sac or embryo; no extraovarian adnexal mass; and follow-up information identifying the location of the pregnancy as intrauterine or ectopic. Study authors reviewed sonograms in all cases and recorded the following information: presence or absence of each of an echogenic rim around the collection, a DSS, and an IDS, as well as the mean sac diameter.

Interobserver Reliability of the Antenatal Consensus Classification System for Urinary Tract Dilatation.

Objectives: The consensus classification system for urinary tract dilatation (UTD) was designed to be more objective and reproducible than previously used systems. We sought to evaluate interobserver reliability of UTD components and overall scores in a prenatal population undergoing third-trimester ultrasound examinations.

Methods: We retrospectively identified patients who underwent antenatal ultrasound examinations for UTD between 28 and 40 weeks' gestation.

Factors Influencing Choice of Radiology and Relationship to Resident Job Satisfaction.

Purpose: Identify when current radiology residents initially became interested in radiology, which factors influenced their decision to pursue a career in radiology, and which factors correlate with job satisfaction.

Methods: An online survey was distributed to United States radiology residents between December 7, 2016 and March 31, 2017. Respondents identified the most appealing aspects of radiology during medical school, identified experiences most influential in choosing radiology, and scored job satisfaction on visual analog scales.

Subchorionic Hematoma: Correlation of Grading Techniques With First-Trimester Pregnancy Outcome.

Objectives: To evaluate and compare grading systems of subchorionic hematoma (SCH) on first-trimester ultrasound examinations with live embryos to assess which best correlates with early pregnancy outcome and to assess the effect of gestational age at the time of diagnosis on outcome.

Methods: First-trimester live singleton pregnancies between 6 and 11 weeks' gestational age with SCH were identified by an institutional database search. First-trimester outcome was categorized as "live" or "demise" based on ultrasound or medical record documentation.

When Is Parenteral Nutrition Appropriate?

Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur.

Standardized Competencies for Parenteral Nutrition Order Review and Parenteral Nutrition Preparation, Including Compounding: The ASPEN Model.

Parenteral nutrition (PN) is a high-alert medication with a complex drug use process. Key steps in the process include the review of each PN prescription followed by the preparation of the formulation. The preparation step includes compounding the PN or activating a standardized commercially available PN product.

The Use of an Integrated Website to Enhance the Educational Experience in a Medical School Radiology Clerkship Course.

The purpose of this study was to demonstrate the feasibility of creating an integrated website for the medical students enrolled in a core radiology clerkship and to assess the impact of this website on students' overall educational experience. An integrated website was created for the medical students and hosted on the main departmental website. The components of the website included: announcements and password-protected schedule, curriculum, student assessment, information about different radiology sections, digital resources, and fourth year opportunities.

Sonographic appearance of thyroid cancer in patients with Hashimoto thyroiditis.

Objectives: To determine whether the sonographic appearance of thyroid cancer differs in patients with and without Hashimoto thyroiditis.

Methods: Patients with histologically proven thyroid cancer who had thyroid peroxidase (TPO) antibodies measured and sonography performed preoperatively were included. We evaluated each nodule for size, echogenicity, composition, margins, halo, and vascularity and evaluated the background heterogeneity of the gland.

A.S.P.E.N. Standards for Nutrition Support: Home and Alternate Site Care.

The American Society for Parenteral and Enteral Nutrition (A.S.P.

Postnatal outcome of fetuses with the prenatal diagnosis of gastroschisis.

Objectives: The purpose of this study was to assess the postnatal outcome and complications that arise in infants with the prenatal diagnosis of gastroschisis.

Methods: Prenatal sonograms with the diagnosis of gastroschisis were identified. Maternal age, indication for sonography, gestational age at diagnosis, other sonographic abnormalities, and postnatal outcome were recorded.

Accuracy of sonography to predict estimated weight in fetuses with gastroschisis.

Objectives: The purpose of this study was to determine whether sonographic formulas for estimating fetal weight are as accurate for fetuses affected with gastroschisis as they are for healthy fetuses. We hypothesized that because the most commonly used Hadlock formulas rely on the abdominal circumference as a biometric variable, estimates of birth weight are less reliable in fetuses with gastroschisis than in healthy fetuses.

Methods: We performed a chart review of all fetuses with a prenatal diagnosis of gastroschisis at 3 tertiary care institutions from 1990 to 2008.

First-trimester cystic hygroma: relationship of nuchal translucency thickness and outcomes.

Objective: To estimate the relationship between nuchal translucency thickness and abnormal karyotype, major congenital anomaly, perinatal loss, and composite abnormal outcome in fetuses with first-trimester nuchal cystic hygroma.

Methods: We performed a retrospective cohort study of first-trimester fetuses with ultrasound-diagnosed nuchal cystic hygroma collected over a 10-year period.

Results: There were 944 first-trimester fetuses with nuchal cystic hygroma.

Pharmacist specialty certification.

Nutrition support is a pharmacy specialty in which pharmacists work with prescribers, conduct order review, and either perform or oversee compounding of these complex parenteral nutrition formulations. Pharmacists should be certified in this specialty, and the options for certification are outlined in this article.

Intraventricular hemorrhage and developmental outcomes at 24 months of age in extremely preterm infants.

Whether intraventricular hemorrhage increases the risk of adverse developmental outcome among premature infants is controversial. Using brain ultrasound, we identified intraventricular hemorrhage and white matter abnormalities among 1064 infants born before 28 weeks' gestation. We identified adverse developmental outcomes at 24 months of age using a standardized neurologic examination and the Bayley Scales of Infant Development Mental and Motor Scales.