Enhancing Value-Based Care With a Walk-in Clinic: A Primary Care Provider Intervention to Decrease Low Acuity Emergency Department Overutilization.

Background Emergency department overutilization is a known contributor to the high per-capita healthcare cost in the United States. There is a knowledge gap regarding the substitution effect of walk-in clinic availability in primary care provider (PCP) offices and emergency department utilization (EDU). This study evaluates associations between PCP availability and EDU and analyzes the potential cost savings for health systems.

The association between the regular use of early-term labor induction and improved birth outcomes: new evidence from an Italian hospital.

Background: Associations have been recently reported between the frequent use of early-term preventive labor induction and improvements in multiple parameters of birth health. We sought to replicate these findings in an Italian hospital.

Methods: The outcomes of 120 consecutively delivered women who were exposed to the alternative method of care were compared to the outcomes of 159 women who received standard management.

US term stillbirth rates and the 39-week rule: a cause for concern?

Background: More than a decade ago an obstetric directive called "the 39-week rule" sought to limit "elective" delivery, via labor induction or cesarean delivery, before 39 weeks 0 days of gestation. In 2010 the 39-week rule became a formal quality measure in the United States. The progressive adherence to the 39-week rule throughout the United States has caused a well-documented, progressive reduction in the proportion of term deliveries occurring during the early-term period.

What is the optimal gestational age for women with gestational diabetes type A1 to deliver?

Objective: Type A1 gestational diabetes mellitus (A1GDM), also known as diet-controlled gestational diabetes, is associated with an increase in adverse perinatal outcomes such as macrosomia and Erb palsy. However, it remains unclear when to deliver these women because optimal timing of delivery requires balancing neonatal morbidities from early term delivery against the risk of intrauterine fetal demise (IUFD). We sought to determine the optimal gestational age (GA) for women with A1GDM to deliver.

Second stage of labor and epidural use: a larger effect than previously suggested.

Objective: To examine the length of second stage of labor with and without an epidural during labor.

Methods: This was a retrospective cohort study of 42,268 women who delivered vaginally with normal neonatal outcomes. Median lengths and 95th percentiles of second stage of labor were compared by epidural use with stratification by parity.

Elective induction of labor at term compared with expectant management: maternal and neonatal outcomes.

Objective: To test the association of elective induction of labor at term compared with expectant management and maternal and neonatal outcomes.

Methods: This was a retrospective cohort study of all deliveries without prior cesarean delivery in California in 2006 using linked hospital discharge and vital statistics data. We compared elective induction at each term gestational age (37-40 weeks) as defined by The Joint Commission with expectant management in vertex, nonanomalous, singleton deliveries.

Induction of labor compared to expectant management in low-risk women and associated perinatal outcomes.

Objective: We sought to examine the association of labor induction and perinatal outcomes.

Study Design: This was a retrospective cohort study of low-risk nulliparous women with term, live births. Women who had induction at a given gestational age (eg, 39 weeks) were compared to delivery at a later gestation (eg, 40, 41, or 42 weeks).

Risk of stillbirth and infant death stratified by gestational age.

Objective: To estimate the multiple dimensions of risk faced by pregnant women and their health care providers when comparing the risks of stillbirth at term with the risk of infant death after birth.

Methods: This is a retrospective cohort study that included all nonanomalous, term deliveries in the state of California from 1997 to 2006 (N=3,820,826). The study compared infant mortality rates after delivery at each week of term pregnancy with the rates of a composite fetal-infant mortality that would occur after expectant management for 1 additional week.

The risk of stillbirth and infant death stratified by gestational age in women with gestational diabetes.

Objective: We sought to compare the different mortality risks between delivery and expectant management in women with gestational diabetes mellitus (GDM).

Study Design: This is a retrospective cohort study that included singleton pregnancies of women diagnosed with GDM delivering at 36-42 weeks' gestational age in California from 1997 through 2006. A composite mortality rate was developed to estimate the risk of expectant management at each gestational age incorporating the stillbirth risk during the week of continuing pregnancy plus the infant mortality risk at the gestational age 1 week hence.

Risk adjustment in maternity care: the use of indirect standardization.

Purpose: Annual US national rates of family physicians providing maternity care are decreasing and rates of cesarean delivery are increasing. Family physicians tend to have lower cesarean delivery rates than obstetrician specialists, but this association is usually explained by an assumed lower pre-delivery risk for cesarean delivery. This study was developed to compare the estimated risk of cesarean delivery in patients of the two specialties.

The active management of impending cephalopelvic disproportion in nulliparous women at term: a case series.

Background: The Active Management of Risk in Pregnancy at Term (AMOR-IPAT) protocol has been associated in several studies with significant reductions of group cesarean delivery rate. Present within each of these studies were nulliparous women with risk factors for cephalopelvic disproportion. Risk factors for cephalopelvic disproportion in nulliparous women are especially important because they represent the precursors for the most common indication for primary cesarean delivery.

The association between increased use of labor induction and reduced rate of cesarean delivery.

Aim: An association was recently reported between a low cesarean section delivery rate and a method of obstetrical care that involved the frequent use of risk-guided prostaglandin-assisted preventive labor induction. We sought to confirm this finding in a subsequent group of pregnant women.

Methods: A retrospective cohort study design was used to compare the outcomes of 100 consecutively delivered women, who were exposed to the alternative method of care, with the outcomes of 300 randomly chosen women who received standard management.

"One end has nothing to do with the other:" patient attitudes regarding help seeking intention for depression in gynecologic and obstetric settings.

Many women rely on their obstetrician/gynecologist (OB/GYN) as their primary contact with the health care delivery system. There have been few studies exploring patient views on getting help for depression from these providers. The purpose of this study is to assess help seeking intention for depression and identify beliefs which moderate this intention.

Tracking the cell hierarchy in the human intestine using biochemical signatures derived by mid-infrared microspectroscopy.

Markers of gastrointestinal (GI) stem cells remain elusive. We employed synchrotron Fourier-transform infrared (FTIR) microspectroscopy to derive mid-infrared (IR) spectra along the length of human GI crypts. Tissue sections (10-μm thick) were floated onto BaF2 windows and image maps were acquired of small intestine and large bowel crypts in transmission mode with an aperture of ≤10 μm×10 μm.

The active management of risk in multiparous pregnancy at term: association between a higher preventive labor induction rate and improved birth outcomes.

Objective: To determine whether exposure of multiparous women to a high rate of preventive labor induction was associated with a significantly lower cesarean delivery rate.

Study Design: Retrospective cohort study involving 123 multiparous women, who were exposed to the frequent use of preventive labor induction, and 304 multiparous women, who received standard management. Rates of cesarean delivery and other adverse birth outcomes were compared in the 2 groups.

Active management of risk in nulliparous pregnancy at term: association between a higher preventive labor induction rate and improved birth outcomes.

Objective: The objective of the study was to determine whether exposure of nulliparous women to a high rate of preventive labor induction was associated with improvement in birth health.

Study Design: A risk-scoring system was used to guide the frequent use of preventive labor induction in 100 nulliparous women. The birth outcomes of this group were compared with those of 352 nulliparous women who received usual care.

Derivation of a subtype-specific biochemical signature of endometrial carcinoma using synchrotron-based Fourier-transform infrared microspectroscopy.

Endometrial carcinoma consists of endometrioid (type I) and serous papillary (SP; type II) subtypes; a rarer form is malignant mixed müllerian tumours (MMMT; type II/mixed). We set out to determine whether one might be able to biochemically signature these subtypes using Fourier-transform infrared (FTIR) microspectroscopy and distinguish non-tamoxifen associated from tamoxifen-associated cases. Paraffin-embedded blocks were obtained from non-tamoxifen associated cases reported as endometrioid (n=7), SP (n=4) or MMMT (n=4).

Perinatal outcomes in low-risk term pregnancies: do they differ by week of gestation?

Objective: The objective of the study was to examine whether the risk of perinatal complications increases with increasing gestational age among term pregnancies.

Study Design: This is a retrospective cohort study of low-risk women with term, singleton births in 2003 in the United States. Gestational age was subgrouped into 37, 38, 39, 40, and 41 completed weeks.