Feasibility and Utility of Posttraumatic Stress Disorder Screening Among Postpartum Patients at an Urban Safety-Net Institution.

Posttraumatic stress disorder (PTSD) is underdiagnosed peripartum. We administered a primary care screening tool and a pregnancy-related PTSD screening tool to postpartum patients presenting to our urban safety-net institution within 6 months of delivery, between August 2021 and February 2022. Our primary outcome was prevalence of positive PTSD screening results.

Effective hemodynamic monitoring.

Hemodynamic monitoring is the centerpiece of patient monitoring in acute care settings. Its effectiveness in terms of improved patient outcomes is difficult to quantify. This review focused on effectiveness of monitoring-linked resuscitation strategies from: (1) process-specific monitoring that allows for non-specific prevention of new onset cardiovascular insufficiency (CVI) in perioperative care.

Effect of an Active vs Expectant Management Strategy on Successful Resolution of Pregnancy Among Patients With a Persisting Pregnancy of Unknown Location: The ACT or NOT Randomized Clinical Trial.

Importance: Women with an early nonviable pregnancy of unknown location are at high risk of ectopic pregnancy and its inherent morbidity and mortality. Successful and timely resolution of the gestation, while minimizing unscheduled interventions, are important priorities.

Objective: To determine if active management is more effective in achieving pregnancy resolution than expectant management and whether the use of empirical methotrexate is noninferior to uterine evacuation followed by methotrexate if needed.

Anesthesia Considerations of a Pregnant Woman With COVID-19 Undergoing Cesarean Delivery: A Case Report.

Physiologic changes during pregnancy may increase the risk of coronavirus disease 2019 (COVID-19) infection. Limited data show serious complications of COVID-19 infection and pregnancy. Severe adverse maternal and perinatal outcomes such as preterm delivery, intensive care unit admission, and neonatal and intrauterine death have been reported.

Evaluation of Early Pregnancy Concerns in an Early Pregnancy Unit Compared With an Emergency Department.

Objective: To assess total time for evaluation of women with first-trimester pregnancy concerns in an early pregnancy unit compared with an emergency department (ED) within a single safety net hospital system.

Methods: We performed a retrospective cohort study at Denver Health Medical Center from May 1, 2017, to April 30, 2018. All patients who presented to the early pregnancy unit and a random sample of patients who presented to the ED were identified, stratified by month.

Regulation of the Actin Cytoskeleton in Podocytes.

Podocytes are an integral part of the glomerular filtration barrier, a structure that prevents filtration of large proteins and macromolecules into the urine. Podocyte function is dependent on actin cytoskeleton regulation within the foot processes, structures that link podocytes to the glomerular basement membrane. Actin cytoskeleton dynamics in podocyte foot processes are complex and regulated by multiple proteins and other factors.

Clinical Characteristics, Major Morbidity, and Mortality in Trauma-Related Pediatric Acute Respiratory Distress Syndrome.

Objectives: To determine the presence, central characteristics, and impact on major morbidity and mortality of trauma-related pediatric acute respiratory distress syndrome.

Design: Retrospective review of a prospective trauma database.

Setting: American College of Surgeons verified level 1 trauma center in an urban setting.

Secondary Surgical Cytoreduction for Recurrent Ovarian Cancer.

Background: Secondary surgical cytoreduction in women with platinum-sensitive, recurrent epithelial ovarian, primary peritoneal, or fallopian-tube ("ovarian") cancer is widely practiced but has not been evaluated in phase 3 investigation.

Methods: We randomly assigned patients with recurrent ovarian cancer who had received one previous therapy, had an interval during which no platinum-based chemotherapy was used (platinum-free interval) of 6 months or more, and had investigator-determined resectable disease (to no macroscopic residual disease) to undergo secondary surgical cytoreduction and then receive platinum-based chemotherapy or to receive platinum-based chemotherapy alone. Adjuvant chemotherapy (paclitaxel-carboplatin or gemcitabine-carboplatin) and use of bevacizumab were at the discretion of the investigator.

Use of Nalbuphine for Treatment of Neuraxial Opioid-Induced Pruritus: A Systematic Review and Meta-Analysis.

Opioid-induced pruritus is prevalent after neuraxial administration of opioid. A number of preventive measures have been reported; however, only a few studies evaluated treatment strategies for established pruritus. The pharmacokinetics and pharmacodynamic profiles of nalbuphine make this drug ideal for the treatment of established pruritus.

Attitudes of Trainees in Obstetrics and Gynecology Regarding the Structure of Residency Training.

Objective: To measure future and current resident perspectives on obstetrics and gynecology residency training structure and possible future models.

Methods: Medical students invited for obstetrics and gynecology residency interviews and residents (postgraduate year [PGY]-1-4) at the University of Colorado, the University of Washington, the University of California San Francisco, Loyola University, Saint Joseph's Hospital, and Texas A&M in 2017-2018 received a voluntary, electronic survey regarding possible models for restructuring residency training. Student and resident responses were compared using χ test for categorical and two-sample t-test for continuous items.

Prehospital plasma in injured patients is associated with survival principally in blunt injury: Results from two randomized prehospital plasma trials.

Introduction: Recent evidence demonstrated that prehospital plasma in patients at risk of hemorrhagic shock was safe for ground transport and resulted in a 28-day survival benefit for air medical transport patients. Whether any beneficial effect of prehospital plasma varies across injury mechanism remains unknown.

Methods: We performed a secondary analysis using a harmonized data set derived from two recent prehospital plasma randomized trials.

Prepping for Prevention: An Intervention to Optimize Skin Antisepsis and Peri-Operative Antibiotic Prophylaxis.

The U.S. Centers for Disease Control and Prevention recommend bathing prior to surgery, surgical skin antisepsis, peri-operative antibiotic administration, normothermia throughout the procedure, serum glucose concentration <200 mg/dL throughout the procedure, and hyperoxygenation in the immediate post-operative period to prevent surgical site infection (SSI).

Time course and outcomes associated with transient versus persistent fibrinolytic phenotypes after injury: A nested, prospective, multicenter cohort study.

Background: Temporal changes in fibrinolytic activity after injury and their impact on outcomes remain poorly defined. We conducted a prospective, multicenter cohort study to determine the incidence of fibrinolytic phenotypes after injury and the trajectories and associated outcomes of these phenotypes over time.

Methods: We included adults that arrived within 6 hours of injury to three American Level I trauma centers.

Career Expectations of Obstetrics and Gynecology Residents and Future Residents.

Objective: To understand contemporary fourth-year medical student and resident career expectations in obstetrics and gynecology.

Methods: Students invited for obstetrics and gynecology residency interviews and residents (postgraduate years 1-4) at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, St. Joseph's Hospital, and Texas A&M in 2016-2017 received a voluntary, electronic survey regarding career expectations.

Machine learning without borders? An adaptable tool to optimize mortality prediction in diverse clinical settings.

Background: Mortality prediction aids clinical decision making and is necessary for quality improvement initiatives. Validated metrics rely on prespecified variables and often require advanced diagnostics, which are unfeasible in resource-constrained contexts. We hypothesize that machine learning will generate superior mortality prediction in both high-income and low- and middle-income country cohorts.

Pilot Randomized Controlled Trial to Reduce Readmission for Heart Failure Using Novel Tablet and Nurse Practitioner Education.

Background: Heart failure education programs are not standardized. The best form of education is unclear. We evaluated whether addition of a novel tablet application to nurse practitioner (NP) education was superior to NP education alone in reducing 30-day readmission after heart failure hospitalization.

Development and validation of immune dysfunction score to predict 28-day mortality of sepsis patients.

Background: Sepsis-induced immune dysfunction ranging from cytokines storm to immunoparalysis impacts outcomes. Monitoring immune dysfunction enables better risk stratification and mortality prediction and is mandatory before widely application of immunoadjuvant therapies. We aimed to develop and validate a scoring system according to patients' immune dysfunction status for 28-day mortality prediction.

Dimple on the shoulder after a ski injury.

Clinical Introduction: A 74-year-old woman was brought to the ski clinic shortly after a fall on her left shoulder while skiing. She did not remember the exact fall mechanism. She felt a popping sensation in her left shoulder and was unable to move her left arm due to severe pain.

Obstetricians and Gynecologists of the Future: A Survey of Medical Students Applying to Residency.

Objective: To understand the characteristics and career goals of medical students selecting a career in obstetrics and gynecology.

Methods: In 2015-2016, medical students invited for interviews for obstetrics and gynecology residency at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, and New York University received a voluntary 20-item electronic survey regarding factors influencing their choice of medical specialty.

Results: Two hundred twenty-six of 356 students responded (63%).

The role of pre-reduction MRI in the management of complex cervical spine fracture-dislocations: an ongoing controversy?

Background: Cervical spine fracture-dislocations in neurologically intact patients represent a surgical challenge due to the risk of inflicting iatrogenic spinal cord compression by closed reduction maneuvers. The use of MRI for early advanced imaging in these injuries remains controversially debated.

Case Presentation: A 54-year old man sustained a fall over the handlebars of his racing bicycle.

Implementation of a Risk-Based Heparin Protocol for Postpartum Venous Thromboembolism Prevention.

Objective: To evaluate the effect of a postpartum risk-based low-molecular-weight heparin protocol for venous thromboembolism prevention.

Methods: We conducted a retrospective cohort study of postpartum women at a safety net hospital before (2013), during (2014), and after (2015) implementation of a risk-based enoxaparin thromboembolism prevention protocol. The calculated sample size was based on a primary outcome of enoxaparin administration rate.