Faculty Bibliography

OBJECTIVE:To assess compliance with, and outcomes related to, the Society of Gynecologic Oncology quality measure in ovarian cancer to administer chemotherapy within 42 days of cytoreductive surgery in patients with epithelial ovarian/fallopian tube/peritoneal cancer. METHODS:Institutional ovarian cancer database was evaluated for compliance with the quality measure to administer chemotherapy within 42 days of cytoreductive surgery. The influence of chemotherapy timing on the risk of death was evaluated, and factors related to the timing of chemotherapy after surgery was assessed. RESULTS:Of 668 patients with epithelial ovarian/fallopian tube/peritoneal cancer who underwent surgical treatment for their disease (primary or interval), 635 met criteria for administration of adjuvant chemotherapy (with stages IA/IB, grade 2 or 3 disease; stage IC or more advanced stage disease). Compliance to administer chemotherapy within 42 days was 59.1%. The adjusted risk of death was not strongly associated with time to chemotherapy within 42 days (aHR: 0.80; 0.61, 1.05) and this did not differ by primary or interval debulking surgery. CONCLUSIONS:In this prospectively maintained database, 59.1% of patients received chemotherapy within 42 days of surgery. The time to chemotherapy interval of within 42 days was not strongly associated with improved survival, particularly when age, stage of disease, insurance enrollment and surgical characteristics were taken into account. Further, the relationship between time to chemotherapy interval of within 42 days and survival did not vary by patients who received primary versus interval debulking surgery or had no residual disease.

OBJECTIVES:The purpose of this study was to compare the rates of mental health diagnoses and psychotropic prescriptions pre- and posthospitalization for injury in a managed-Medicaid population. We hypothesized that children have increased rates of mental health diagnoses and psychotropic prescriptions after injury. STUDY DESIGN:We investigated children (n = 2208) ≤18 years of age treated at a pediatric trauma center from 2005 to 2015 who were enrolled in a managed-Medicaid program at hospital admission and for at least 1 healthcare visit in the preceding year. We used Poisson regression models to estimate rates of mental health diagnoses and psychotropic prescriptions that occurred in the 12 months pre- and postinjury. RESULTS:The rate of mental health diagnoses preinjury was 95.9 per 1000 person-years, which increased to 156.7 per 1000 postinjury (rate ratio [RR] 1.63, 95% CI 1.39-1.92). Children ages 0-4 years with burns were more likely to have mental health diagnoses postinjury (race and ethnicity adjusted RR [aRR] 8.56, 95% CI 3.30-22.2). Children with head injuries were also more likely to have mental health diagnoses postinjury: ages 0-4 years (aRR 3.87, 95% CI 1.31-11.5); ages 5-9 (aRR 3.11, 95% CI 1.27-7.59); ages 10-14 (aRR 2.17, 95% CI 1.27-3.73); and ages 15-18 (aRR 5.37, 95% CI 2.12-13.6). The rate of psychotropic prescriptions preinjury was 121.7 per 1000 person-years and increased to 310.9 per 1000 postinjury (RR 2.55, 95% CI 2.26-2.89). CONCLUSIONS:We identified increased mental health diagnoses and psychotropic prescriptions in children following hospitalization for injury.

The objectives of the study were to describe robotic-assisted surgery training programs currently being used by ACGME-accredited obstetrics and gynecology (OB/Gyn) residency programs and to explore residents' attitudes towards their robotic surgery training curricula to evaluate resident desire for robotics training. We conducted a cross-sectional study of OB/Gyn residents for the 2015-2016 academic year. Participants completed a 31-item online questionnaire regarding their robotic-assisted surgical training and associated perspectives. Analyses of these data were primarily descriptive. In total, 98.9% of included respondents (N = 177) reported availability of a surgical robot at their training institution, and 35.0% of participants reported not having any structured robotics training program at their institution. The most commonly used training modalities included online modules (62.2%), dual-assist console (55.1%) and virtual reality simulation (50.3%). The most commonly reported barriers to completing a robots training were a lack of personal time (56.2%) and availability of the virtual reality simulator or access to the robotic equipment (29.2%). OB/Gyn residents desire robotics training and are exposed to a wide variety of training modalities. The ACGME should consider recommending the incorporation of a standardized formal robotics training program as part of the OB/Gyn residency curriculum.

OBJECTIVES:The Ohio Infant Mortality Reduction Initiative (OIMRI) is a home-visiting program that aims to reduce infant mortality among infants of high-risk black women. This study examined birth outcomes among OIMRI participants and compared program participants to matched non-OIMRI women. DESIGN:Program data were linked to birth records, death records, and Medicaid claims data. Propensity score matching was used to match program participants with like women in Ohio. SAMPLE:The sample consisted of 2,837 black mothers from 14 counties in Ohio. MEASUREMENTS:Infant mortality, causes of death, and birth weight were examined. RESULTS:There were 25 deaths among 2,837 OIMRI participants from 2010 to 2015, for an infant mortality rate of 8.8 deaths per 1,000 live births (95% CI 5.4-12.2). Among those women who participated in OIMRI, three fewer deaths per 1,000 births within the first year of life were estimated compared to those not in OIMRI; however, this was not statistically significant. CONCLUSIONS:The number of infant deaths among women enrolled in the OIMRI program was not significantly different from those who did not participate in OIMRI. Programs like OIMRI cannot singlehandedly address the infant mortality disparity but may help prevent some infant mortality risks.

BACKGROUND:Multiple myeloma (MM) is a disease of aging adults resulting in osteolytic and/or osteoporotic bone disease. Primary osteoporosis is also highly prevalent in aging adults and is associated with increased mortality. It is unknown how concurrent osteoporosis is associated with outcomes in patients who develop MM. PATIENTS AND METHODS:We identified 362 women with MM of the 161,808 enrolled in the Women's Health Initiative (WHI) dataset and evaluated bone health using the Fracture Risk Assessment Tool (FRAX) to identify clinical factors that affect overall MM survival in post-menopausal women, as measured from the time of diagnosis. RESULTS:Of the 362 participants who developed incident MM, with an average 10.5 years of follow-up, 226 died, including 71 with high FRAX scores and 155 with low FRAX scores. On average, women with high FRAX scores were 8.3 years older at enrollment (95% confidence interval [CI], 7.2-9.3 years) and 8.0 years older at time of MM diagnosis (95% CI, 7.0-9.2 years) compared with those with low FRAX scores. MM mortality for women with high FRAX scores was greater (covariate-adjusted hazard ratio scores [aHR] 1.51; 95% CI, 1.01-2.25; P = .044) compared with those with low FRAX scores. CONCLUSION:Higher fracture risk, measured by FRAX, was associated with higher MM mortality in post-menopausal women, independent of many other clinical factors.

Our objective is to operationalize a novel antibiotic advisor, called the personalized weighted incidence syndromic combination antibiogram (pWISCA), intended to help physicians with initial antibiotic choice in hospitals. Clinical decision support tools are a promising technology for providing evidence-based guidance that incorporates data about patients from electronic health records. Nevertheless, congruence with policies and procedures and local experts' opinions, as well as taking into account local resistance data for the medical center's patient population, is needed when selecting and ordering the antibiotic medication options provided by pWISCA. This paper presents findings from applying a mixed methods approach to identify and prioritize antibiotic medications and associated contextual data to display in a CDS tailored to the local hospital. We discuss implications of these findings.

Background Stroke is the third leading cause of death among US Hispanic and non-Hispanic black women aged 65 and older. One factor that may protect against stroke is breastfeeding. Few studies have assessed the association between breastfeeding and stroke and whether this association differs by race and ethnicity. Methods and Results Data were taken from the Women's Health Initiative Observational Study with follow-up through 2010; adjusted hazard ratios for stroke subsequent to childbirth were estimated with Cox regression models accounting for left and right censoring, overall and stratified by race/ethnicity. Of the 80 191 parous women in the Women's Health Initiative Observational Study, 2699 (3.4%) had experienced a stroke within a follow-up period of 12.6 years. The average age was 63.7 years at baseline. Fifty-eight percent (n=46 699) reported ever breastfeeding; 83% were non-Hispanic white, 8% were non-Hispanic black, 4% were Hispanic, and 5% were of other race/ethnicity. After adjustment for nonmodifiable potential confounders, compared with women who had never breastfed, women who reported ever breastfeeding had a 23% lower risk of stroke (adjusted hazard ratio=0.77; 95% confidence interval 0.70-0.83). This association was strongest for non-Hispanic black women (adjusted hazard ratio=0.52; 95% confidence interval 0.37-0.71). Further, breastfeeding for a relatively short duration (1-6 months) was associated with a 19% lower risk of stroke (adjusted hazard ratios=0.81; 95% confidence interval 0.74-0.89). This association appeared stronger with longer breastfeeding duration and among non-Hispanic white and non-Hispanic black women (test for trend P<0.01). Conclusions Study results show an association and dose-response relationship between breastfeeding and lower risk of stroke among postmenopausal women after adjustment for multiple stroke risk factors and lifestyle variables. Further investigation is warranted.