The COVID-19 Pandemic and Routine Prenatal Care: Use of Online Visits.

OBJECTIVE: To evaluate whether prenatal visits or screening/testing were fewer or occurred later during the initial phase of the COVID-19 pandemic in 2020 (CINT) as compared to the prior year (PreCINT). METHODS: A retrospective cohort study compared CINT (n = 2,195) to PreCINT (n = 2,395) at seven public hospitals in New York City. The primary outcome was total number of prenatal-care visits. Secondary outcomes were components of prenatal-care visits completion, timing of standard pregnancy screening tests, and adverse neonatal outcomes. RESULTS: CINT patients had more total prenatal-care visits (B = 1.30, 95% CI:1.04, 1.56, p < 0.001), lower odds for initiation of prenatal care which was inadequate according to widely used criteria (OR:0.39, 95% CI:0.34, 0.45, p < 0.001), and lower gestational age at initial visit (B=-4.51, 95% CI:-5.10, -3.93, p < 0.001) than PreCINT patients. In-person visits did not differ between the two groups. PreCINT patients had no televisits, while CINT patients had a median of one televisit (Median = 1, p < 0.001). CINT patients had increased odds for group B Streptococcus screening (OR:1.27, 95% CI: 1.10, 1.48, p = 0.001), quadrivalent screening (OR:1.30, 95% CI:1.15, 1.48, p < 0.001), and anatomy sonogram (OR:2.30, 95% CI:2.04, 2.59, p < 0.001) but decreased odds for glucose challenge test screening (OR:0.81, 95% CI:0.72, 0.91, p < 0.001). Adverse neonatal outcome did not differ between CINT and PreCINT pregnancies. CONCLUSIONS FOR PRACTICE: Despite the difficulties and perceived dangers of in-person visits during the COVID-19 pandemic, the COVID-19 pandemic had little negative impact upon the outpatient prenatal care received by patients in this hospital system.

Ability of an obstetric hemorrhage risk assessment tool to predict quantitative peripartum blood loss.

OBJECTIVES: Hemorrhage risk assessment tools have been studied using estimated blood loss. We study the association between peripartum hemorrhage risk assessment score and peripartum quantified blood loss (QBL) in term vaginal and cesarean deliveries. METHODS: This is a retrospective analysis conducted on 3,657 patients who underwent term vaginal and cesarean deliveries at a public hospital in New York City. Utilizing the risk assessment tool developed by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), patients were categorized into low-, medium-, or high-risk groups for postpartum hemorrhage. RESULTS: Medium-risk (B=0.08, SE=0.01, p<0.001) and high-risk (B=0.12, SE=0.02, p<0.001) AWHONN scores were associated with significantly higher QBL as compared to low-risk AWHONN score. Medium-risk approached significance (OR: 1.67, 95 % CI: 1.00, 2.79, p=0.050) and high-risk AWHONN score was significantly associated (OR: 1.95, 95 % CI: 1.09, 3.48, p=0.02) with increased odds for postpartum hemorrhage (≥1,000 mL). Each individual factor comprising the AWHONN score whose percentage in our sample was seen in greater than 2.7 % of patients was independently significantly associated with increased QBL (six of nine factors) and postpartum hemorrhage (four of nine factors). CONCLUSIONS: The AWHONN measure previously validated with estimated blood loss predicted obstetric blood loss with QBL. Although not on the basis of the data shown in our study, we believe that QBL should be routinely used to measure obstetric blood loss.

Utilization of Mental Health Services Within 1 Year of Delivery among Different Language Groups.

OBJECTIVES: Cultural differences can affect postpartum mental health disorders and the utilization of mental health services. We compared women speaking English, Spanish, Russian, and Urdu/Bengali/Punjabi from postpartum through 1 year after delivery. METHODS: This was a retrospective study of 3478 pregnant women from a public hospital in New York City. The primary outcome was a composite outcome of the presence of any of the following: diagnosis of depressive disorder, diagnosis of anxiety disorder, visit to a behavioral health service provider, and/or psychiatric admission. The secondary outcome was healthcare provider referral to a behavioral health service provider. RESULTS: Languages spoken were English (n = 1881), Spanish (n = 694), Russian (n = 600), and Urdu/Bengali/Punjabi (n = 303). The language groups differed significantly (P = 0.02) for the composite outcome, with English having the greatest percentage (3.5%) and Russian the lowest percentage (1.2%). The language groups significantly differed for referral to behavioral health (P = 0.04), with Spanish having the greatest percentage (1.6%) and Russian the lowest percentage (0.2%). Anxiety disorder history (odds ratio [OR] 10.43, 95% confidence interval [CI] 4.75-22.91, P < 0.001) and psychiatric disorder history (OR 5.26, 95% CI 2.13-8.49, P < 0.001) were each significantly associated with increased odds for the composite outcome. Anxiety disorder history (OR 6.42, 95% CI 1.92-21.45, P = 0.003) and elevated depressive symptoms (OR 4.92, 95% CI 2.04-11.83, P < 0.001) each were significantly associated with increased odds for referral to behavioral health. CONCLUSIONS: Russian language was associated with lower utilization of mental health services postpartum. These findings can help clinicians determine among postpartum women who will be affected with mental health concerns and who will seek treatment for mental health concerns.

Association of Socioeconomic Variables with Primary Cesarean Section.

OBJECTIVES: Socioeconomic characteristics may be associated with cesarean section (CS) rates. We probe the relationship between socioeconomic variables and primary cesarean section (PCS) by studying indicators of socioeconomic status (SES) in a population-based study in New York City. METHODS: This was a retrospective study of all 80,506 women in New York City who gave birth to a live child during 2018, and who met inclusion and exclusion criteria. Data were drawn from the New York City Department of Health and Mental Hygiene and the US Census. The main outcome measure was performance of PCS as compared with vaginal birth. RESULTS: Approximately 21% of neonates were delivered by PCS. Multivariate multilevel mixed-effects logistic regression analysis showed higher odds for PCS for women with an upper-middle class median household income of US$108,500 to $380,499 (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.07-1.76, P = 0.001), and the percentage enrolled in the Supplemental Nutrition Assistance Program (OR 1.01, 95% CI 1.001-1.012, P = 0.02). Lower odds for PCS occurred for all middle-class categories of per capita income: US$32,500 to $54,499 (OR 0.91, 95% CI 0.84-0.99, P = 0.02), US$54,500 to $108,499 (OR 0.76, 95% CI 0.66-0.88, P < 0.001), and US$108,500 to $380,499 (OR 0.80, 95% CI 0.66-0.96, P = 0.02). No significant association occurred for women receiving public assistance. CONCLUSIONS: Patient preferences in favor or against CS may be related to SES. There may be conflicts between obstetric care that is maximally beneficial and a patient's desire for delivery mode. Clinicians should be aware of the potential implications of this dilemma.

Sling and forget it? A systematic review of operative versus nonoperative outcomes for scapula fractures.

BACKGROUND: The majority of scapula fractures have historically been treated nonoperatively. The current literature describing patient outcomes following scapula fractures is limited. Our objective was to determine differences in outcomes between operatively and nonoperatively treated scapular fractures. The goal of our study was to provide an updated and comprehensive systematic review for scapula body, neck, and glenoid fractures focusing on several outcomes including union rate, return to work, pain, shoulder active range of motion, strength, functional scores, and any recorded complication. METHODS: The PRISMA methodology was followed for this systematic review. Articles were obtained from the PubMed/Medline database using the following search terms: scapula body OR scapula neck OR intra-articular glenoid AND fracture. Additional articles were obtained by searching the bibliographies of included references. Studies were included if they contained clinical data on one or more of our study objectives and contained participants with a scapular body, neck, and/or glenoid fracture who were at least 16 year old. A total of 35 papers, with 822 total cases were included. Studies chosen were assessed for level of evidence and reviewed for data pertaining to the current study objectives. All cases of scapula fractures found throughout the literature were analyzed for outcome data. Outcomes studied included union rate, return to work, pain, shoulder active range of motion, strength, functional scores, and recorded complications. RESULTS: The overwhelming majority of scapula fractures go on to union. The majority of patients will eventually return to work. Persistent postinjury pain is unfortunately common. Shoulder range of motion and strength are decreased when compared to the contralateral shoulder. Nonoperative glenoid fractures have the lowest reported functional scores. Malunion, need for additional surgeries, and post-traumatic arthritis were the most common complications. CONCLUSION: When treating scapula fractures, orthopedic surgeons must consider the specific fracture pattern, as well as patient specific goals. Risks and benefits of both operative and nonoperative management should be discussed with the patient including the exceptionally low nonunion rate regardless of treatment option and that persistent pain following injury is unfortunately common.

Human Papillomavirus, Cervical Intraepithelial Neoplasia, and Quantitative Blood Loss at Delivery.

Studies using estimated blood loss show the association of either human papillomavirus (HPV) or cervical intraepithelial neoplasia (CIN) with postpartum hemorrhage (PPH). We study the association of HPV or CIN with either blood loss or PPH as measured by the more precise measure of quantitative blood loss (QBL). We retrospectively studied 2,334 peripartum women with a documented Pap smear prior to de- livery. The main predictor variable had categories for HPV and CIN as compared to normal cytology. Covariates included demographics, medical/surgical history, and pregnancy variables. Model 1 included the whole sample. Model 2 included only those with an operative vaginal delivery or a cesarean delivery. Outcome measures were QBL and PPH measured by QBL. We found in model 1 that those HPV positive and those with CIN were each not significantly associated with QBL. In model 2, those HPV positive were significantly associated with increased QBL (B = 0.11, SE = 0.05, p = 0.047), while CIN was not significantly associated with QBL. In model 1, those HPV positive and those with CIN were each not significantly associated with PPH. In model 2, those HPV positive were significantly associated with increased odds for PPH (OR:11.03, 9% CI:1.77, 68.74, p = 0.01) while CIN was not significantly associated with PPH. In conclusion, the presence of HPV was positively associated with an increase in the QBL and PPH at time of delivery for those with operative vaginal and cesarean deliveries. We suggest that clinicians take HPV results of Pap smears into consideration when considering a patient's risk of PPH.

Xanthogranulomatous Pyelonephritis: A pooled quantitative analysis of published cases.

Xanthogranulomatous Pyelonephritis (XGP) is a serious and rare inflammatory disease of unknown etiology. This systematic review analyzes XGP cases. We performed a literature search for "Pyelonephritis, Xanthogranulomatous." The primary composite outcome was recovery with post-surgery complications, partial recovery, death, or chronic kidney disease. The secondary outcome was any presentation or treatment complication. Predictor variables consisted of demographics, history, symptoms, and diagnosis/management. Among the 251 patients, the mean age was 36.1 years, and 57.4% were female. The most common symptom and finding were fever (55.0%) and renal stones (53.8%), respectively. There were 15.5% with the composite outcome. There were 51.0% with any presentation or treatment complication. Multivariate logistic regression analysis for the composite outcome showed that kidney of both/horseshoe (OR:3.86, 95% CI:1.01, 14.73, p = 0.048), dialysis required (OR:8.64, 95% CI:2.27, 32.94, p = 0.002), and operative treatment of nephrostomy or nephrostomy followed by nephrectomy (OR:4.57, 95% CI:1.58, 13.17, p = 0.01) were each significantly associated with increased odds. Fever (OR:3.04, 95% CI:1.63, 5.67, p <0.001) and renal stones (OR:2.55, 95% CI:1.35, 4.81, p = 0.004) were each significantly associated with increased odds for any presentation/treatment complication. In conclusion, XGP patients with involvement of both or horseshoe kidneys, dialysis requirements, or treatment of nephrostomy or nephrostomy followed by nephrectomy may require aggressive treatment to mitigate poor patient outcomes.

Sharp Versus Electric Suction Curettage in Gynecologic Patients Undergoing Evaluation for Abnormal Uterine Bleeding.

STUDY OBJECTIVE: Suction curettage is preferred over sharp curettage in obstetric settings. We compare the quality of operative tissue sampling between sharp curettage and suction curettage using electric vacuum aspiration for nonobstetric abnormal uterine bleeding in reproductive-aged women. DESIGN: A retrospective cohort study. SETTING: Community hospital in Long Island, New York. PATIENTS: Women ages 21 to 45 years (n = 257) who underwent operative curettage procedure for nonobstetric abnormal uterine bleeding. INTERVENTIONS: Independent ratings of specimens from suction curettage using electric vacuum aspiration and sharp curettage by 2 pathologists blinded to method of tissue collection. MEASUREMENTS AND MAIN RESULTS: The primary outcome was percentage of organized tissue, indicative of a higher-quality pathology specimen. Specimens obtained by electric suction curettage (p <.001) had a significantly higher percentage of organized tissue (M = 66.28, SD = 20.33) than sharp curettage (M = 55.51, SD = 24.17). There were no differences between the curettage groups for operative time, blood loss, intraoperative complications, or pathology diagnosis. CONCLUSION: Specimens obtained with suction curettage contained more organized tissue with similar pathologist satisfaction and confidence scores than sharp curettage. We suggest clinicians consider electric suction curettage in the diagnostic workup of abnormal uterine bleeding in reproductive-aged women. In addition, patient-centered benefits include no increase in operative time, blood loss, or complication rate compared with sharp curettage.

Immediate Postnatal Microbial Colonization in Sick Term Neonates Admitted to NICU: Prevalence, Microbiota, and Associated Characteristics.

OBJECTIVE: The immediate postnatal rectal (RC) and nasopharyngeal colonization (NPC), their prevalence, taxa, and associated characteristics were investigated in sick term infants admitted to the neonatal intensive care unit. STUDY DESIGN: In a retrospective cohort single center study, nasopharyngeal (NPCx) and rectal (RCx) microbial cultures were obtained within 20 minutes of birth in mild-to- moderate sick term infants. Associations between the colonization and maternal-neonatal variables, including early neonatal course, were analyzed via logistic regression analysis. RESULTS: A total of 154 term infants were admitted for respiratory distress, hypoglycemia, maternal chorioamnionitis (CHO), and suspected neonatal sepsis; out of which, 80 (52%) were NPCx-positive (+) infants. The duration of rupture of membrane (ROM) was higher (15.5 ± 10.0 vs. 11.3 ± 11.0 hours, p = 0.02), while the respiratory support requirement (16.3 vs. 29.7%, p = 0.04) and occurrence of maternal group B Streptococcus (GBS) colonization lower (15.0 vs. 35.1%, p = 0.01) in NPCx+ infants. ROM increased (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.01-1.07), and maternal GBS colonization decreased the odds of positive nasopharyngeal cultures (OR: 0.31, 95% CI: 0.14-0.72). The major microorganisms isolated were Staphylococcus epidermidis (41%), α hemolytic Streptococcus (AHS; 16%), Escherichia coli (13%), and GBS (1.06%). Among the enrolled infants, 44 (28.5%) were RCx positive. The need for (11.4 vs. 27.3%, p = 0.03) and days on respiratory support (0.2 ± 0.6 vs. 0.8 ± 2.5, p = 0.03) were lower and the occurrence of CHO higher (41.0 vs. 23.2%, p = 0.04) in the RCx positive infants. Cesarean section (CS) was performed less frequently (18.2 vs. 55.5%, p = 0.001) and decreased the odds of having positive rectal cultures (OR: 0.21, 95% CI: 0.08-0.51). In total, 80% of the RCx positive infants isolated E. coli, and 6.8% Klebsiella. CONCLUSION: In sick term neonates, early NPC is dominated by SE and RC by E. coli. NPC is supported by ROM and declines by maternal GBS colonization, whereas RC decreases with CS. NPC is more common than RC in this population. KEY POINTS: · Early neonatal nasopharyngeal microbial colonization in sick term neonates, dominated by Staphylococcus epidermidis, is enhanced by the rupture of membrane and diminishes by maternal GBS colonization.. · Cesarean section decreases the rectal colonization, which is composed of E. coli as the predominant microorganism.. · The microbiota of early postnatal colonization in sick term neonates differs from that reported in healthy term infants..

Retrospective Analysis of Hospitalized Patients with Type 2 Diabetes Mellitus Treated with Glucagon-Like Peptide 1 Receptor Agonist Therapy.

OBJECTIVES: The use and overall benefit of glucagon-like peptide-1 (GLP-1) receptor agonist therapy for hospitalized patients with type 2 diabetes mellitus (DM) with chronic kidney disease (CKD) has limited data regarding impact and safety. We studied the impact and safety of GLP-1 receptor agonist therapy in hospitalized DM patients with CKD. METHODS: Retrospective study of 51 patients using either dulaglutide (n = 3) or liraglutide (n = 48). Glomerular filtration rate (GFR) groups of stages 3 to 5 and 1 and 2 were compared. The primary outcome was total amount of insulin within the last 24 hours in the hospital. The secondary outcomes were glucose management and safety. RESULTS: Mean insulin total amount within the last 24 hours in the hospital significantly differed (P = 0.01) between the GFR groups, with the GFR stages 3 to 5 group (mean 0.5, standard deviation 0.36) having a lower mean insulin level than the GFR stages 1 and 2 group (mean 0.8, standard deviation 0.45). Point-of-care glucose reached the target of 140 to 180 mg/dL within the last 24 hours in hospital, with increased odds for the GFR stages 3 to 5 group as compared with the GFR stages 1 and 2 group (odds ratio 4.08, 95% confidence interval 1.05-15.83, P = 0.04). For both GFR groups, there were minimal adverse events. Almost all of them continued GLP-1 receptor agonist therapy at discharge (94.1%). CONCLUSIONS: The use of GLP-1 receptor agonist therapy had better outcomes in patients with GFR stages 3 to 5 as compared with GFR stages 1 and 2. There were minimal adverse events reported for both GFR groups. This study suggests that the off-label use of GLP-1 receptor agonists for hospitalized DM patients with CKD may be useful.

Survey of COVID-19 Vaccine Attitudes in Predominately Minority Pregnant Women.

OBJECTIVES: Despite recommendations for coronavirus disease (COVID-19) vaccination during pregnancy, some pregnant women are concerned about COVID-19 vaccines and decline to be vaccinated. This study focuses on attitudes in a sample of mostly minority pregnant Hispanic and Black women that may influence vaccine hesitancy. METHODS: This was a cross-sectional survey of 400 pregnant women. Participants were provided with a one-page information sheet on pregnancy health, COVID-19 health, and COVID-19 vaccines. They were then asked to complete a survey on attitudes about these topics. RESULTS: We found that attitudes for knowing about the health topics were in the range from agree to strongly agree, whereas attitudes for knowing about topics pertaining to COVID-19 messenger RNA (mRNA) vaccines were in a lower-level range from neutral to agree. Negative vaccine attitudes were significantly associated with decreased agreement for knowing about health attitudes, but not significantly associated with COVID-19 mRNA vaccine attitudes. CONCLUSIONS: COVID-19 vaccine mRNA technology was a lesser understood topic than attitudes for knowing about other health topics. This finding suggests the need for physician intervention and that further education about COVID-19 vaccine mRNA technology may influence patient attitudes toward acceptance of the COVID-19 mRNA vaccine in pregnancy.

Direct-to-consumer prescription medication advertisements on social media: The role of social factors.

This study examines the association of social factors with the intention to seek and behavior of obtaining additional prescription medication information after direct-to-consumer prescription medication advertisement (DTCA) exposure. Data were analyzed from 667 college students who were exposed to online social media advertisements. Subjective norms and trust were both positively associated with intentions and behavior. Bridging social capital was positively associated with intentions but not with behavior. Bonding social capital was negatively associated with intentions while it was positively associated with behavior. Pharmaceutical companies should consider subjective norms and trust when advertising prescription medications on online social media.

Hypertension and Gastrointestinal Bleed in COVID-19 Patients: Associations with Mortality, Acute Kidney Injury, Vasopressor Use, and Mechanical Ventilation Use.

There are mixed findings on the association of hypertension or gastrointestinal bleed (GIB) with mortality in COVID-19 patients but no research on the combination of both hypertension and GIB with mortality in COVID-19 patients. We study in COVID-19 patients the association of hypertension and GIB with mortality, acute kidney injury (AKI), vasopressor use, and/or mechanical ventilation. This is a retrospective study of COVID-19 patients who were categorized into groups of no GIB/no hypertension (n = 653), yes hypertension/no GIB (n = 1,620), yes GIB/no hypertension (n = 104), or yes GIB/yes hypertension (n = 334). Covariates included demographics and medical history variables. In the multi-variate logistic regression analysis for the composite outcome of mortality, AKI, vasopressor use, and/or mechanical ventilation use, yes hypertension/no GIB (OR: 1.47, 95% CI: 1.13, 1.89, p <0.001) and yes GIB/no hypertension (OR: 1.68, 95% CI: 1.02, 2.78, p <0.001) were each significantly positively associated with the composite outcome. The yes GIB/yes hypertension group was not significantly associated with the composite outcome. In conclusion, we found that hypertension or GIB alone were each significantly associated with increased odds for the composite outcome while having both hypertension and GIB was protective and not significantly associated with the composite outcome. We recommend that clinicians be aware of such findings when treating patients with COVID-19, as those with both hypertension and GIB may not need as aggressive treatment as compared to those with either hypertension or GIB.

Implementation of a Postpartum Note Reminder and Factors Associated with Postpartum Glucose Tolerance Screening.

OBJECTIVES: Although reminder systems are used to increase provider adherence, we are not aware of any real-time reminder systems for provider adherence to postpartum glucose tolerance testing. We studied whether a reminder in the electronic medical records affects provider ordering of a postpartum glucose tolerance test. We also studied whether any demographic, medical history, prenatal, or delivery variables are associated with patient attendance to a postpartum visit and patient completion of the postpartum glucose tolerance test when ordered. METHODS: This was a retrospective study of 246 women diagnosed as having gestational diabetes mellitus who completed prenatal care and delivered at a suburban public safety-net hospital. RESULTS: Implementation of the real-time postpartum note reminder system significantly improved provider adherence to postpartum glucose screening recommendations from 58.1% to 75.0% (P = 0.01). Delivery complications were significantly associated with increased odds for postpartum visit attendance (odds ratio [OR] 3.80, 95% confidence interval [CI] 1.63-8.86, P < 0.01). Increased gestational age at first prenatal visit was significantly associated with decreased odds for postpartum visit attendance (OR 0.93, 95% CI 0.87-0.99, P < 0.05). Speaking Spanish was associated with an increased odds for completion of the postpartum glucose tolerance test when ordered (OR 2.88, 95% CI 1.24-6.70, P = 0.01). CONCLUSIONS: We recommend that hospital managers include a reminder system in the electronic medical record. Providers should focus counseling on the potential future risks to the mother, in addition to encouraging continued adherence to postpartum care. Providers also should counsel those who present later to prenatal care about the importance of obtaining postpartum glucose tolerance tests.

Chronic obstructive pulmonary disease patients' experience using Trelegy as compared with other inhalers.

Introduction: Trelegy is a combination inhaler that is often reported to offer benefits over multiple inhalers. We compared Trelegy use with multiple inhalers for adherence, symptoms, medication beliefs, and medication attitudes. Methods: This cross-sectional survey of 58 patients compared the patient's experience with Trelegy (n = 18) versus any other inhaler (n = 40). Outcome variables consisted of Test of the Adherence to Inhalers scale, the Chronic obstructive pulmonary disease Assessment Test (CAT) scale, attitude items from the St. George's Respiratory Questionnaire, the Beliefs about Medicines Questionnaire (BMQ)-necessity subscale, and the BMQ-concerns subscale. Results: We found that patients using Trelegy had greater CAT symptoms (M = 19.8, SD = 7.75) in comparison with the any other inhaler group (M = 15.7, SD = 11.10; P = 0.04). We did not find any difference between the groups for adherence or any of the medication attitudes or beliefs. CAT score was positively correlated with the number of months patients were on their current inhaler (r s = 0.29, P < 0.05) and their use of a rescue inhaler (r s = 0.42, P < 0.01). Patients with more concern about their medications were negatively correlated with the use of a rescue inhaler (r s = -0.31, P < 0.05). Discussion: We found that patients using Trelegy had greater symptoms in comparison with the any other inhaler group, but did not differ for adherence, medication attitudes, or medication beliefs. Conclusion: We recommend that clinicians should regularly re-evaluate their Trelegy recommendations, as Trelegy use may not be the best therapy for certain patients. Also, a study with a larger sample size can be beneficial to confirm these findings.

Respiratory involvement parameters in hospitalized COVID-19 patients and their association with mortality and length of stay.

Introduction/Background: Patients with Coronavirus Disease 2019 (COVID-19) present with a spectrum of respiratory symptoms. There are no studies describing respiratory system involvement adjusted for other organ systems, oxygen saturation nadir, hospitalization days until respiratory involvement, proportion of days of respiratory system involvement, and persistent respiratory involvement at discharge in COVID-19 patients. We studied these parameters in COVID-19 patients that received respiratory therapy interventions and their association with mortality and length of stay (LOS). Methods: A single-center cross-sectional retrospective study of 738 COVID-19 patients with respiratory involvement at a hospital in the New York metropolitan area. Results: COVID-19 patients with respiratory involvement had increased mortality with oxygen requirement of FiO2 >55% (OR:39.02, 95% CI:1.59-960.51, P < 0.05) and mechanical ventilation (OR:236.64, 95% CI:8.24-6798.93, P < 0.01). Respiratory system involvement adjusted for other organ system involvement was associated with increased mortality (OR:1.60, 95% CI:1.20, 2.14, P < 0.01) and LOS (B = 0.02, SE = 0.01, P < 0.01). Oxygen saturation nadir of 70%-89% was significantly associated with increased LOS (B = 0.07, SE = 0.03, P < 0.05), whereas oxygen saturation nadir of <70% was associated with increased mortality (OR:12.95, 95% CI:2.72-61.61, P < 0.01). An increased proportion of days in hospital with respiratory system involvement was associated with decreased mortality (OR:0.004, 95% CI:<0.001-0.06, P < 0.001) and increased LOS (B = 0.90, SE = 0.07, P < 0.001). Respiratory involvement on days 4-7 was associated with decreased mortality (OR:0.02, 95% CI:<0.003-0.17, P < 0.001), and respiratory involvement on day >1 was associated with increased LOS. Respiratory involvement persistent at discharge was associated with increased mortality (OR:56.82, 95%CI:18.51-174.43, P < 0.001). Conclusions: Among all respiratory parameters, high oxygen requirements and low oxygen saturation nadir are the most predictive of COVID-19 prognosis.

The association between ectopic pregnancy and inflammatory bowel disease, irritable bowel syndrome, and celiac disease: A systematic review.

AIM: Inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and celiac disease (CeD) more commonly affect women of reproductive age. The aim of our study is to evaluate the association between ectopic pregnancy (EP) in women with IBD, IBS, and CeD. METHODS: We searched MEDLINE, Web of Science, and CINAHL from the database inception date through December 31, 2020. Peer-reviewed publications and abstracts written in English, regarding the association between EP and IBD, IBS, and CeD with controls were included. Quality assessment was conducted based on GRADE criteria. Analyses included odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity between studies was presented with I2 . RESULTS: We included five population-based cohort studies. The odds of EP significantly increased in Crohn's disease (CD), but not ulcerative colitis (UC) as compared to IBD-free controls. The odds of EP significantly increased in IBS as compared to women without IBS. No significant difference was observed for odds of EP in women with and without CeD. CONCLUSIONS: Possible evidence of associations between EP and CD as well as IBS were observed; however, not with UC and CeD. Pregnant women with chronic inflammatory bowel pathologies may warrant cautious monitoring.

Patients with falls from standing height and head or neck injury may not require body CT in the absence of signs or symptoms of body injury.

PURPOSE: To determine the rate of clinically impactful body injury among patients who had a fall from standing height with an associated head/neck injury, but without evidence of body injury on physical exam or plain radiographs. We also examine surgical/endovascular intervention related to body injury and mortality rates for head/neck and body injury. METHODS: Retrospective study of 288 patients with CT evidence of acute head/neck injury that underwent body CT despite the absence of clinical or radiographic evidence of body injury. Predictor variables were age, sex, race/ethnicity, and body mass index (BMI). RESULTS: There were 11.5% (n = 33) with body injury on CT (n = 33). There were 3.1% (n = 9) with clinically impactful body injury. No patient had either surgical/endovascular intervention or mortality related to body injury. Additionally, 8.7% (n = 25) had mortality from head/neck injury. Increased age (OR = 1.05, 95% CI: 1.01, 1.08, p = 0.01) and overweight BMI (25-29.99 kg/m2) (OR = 2.85, 95% CI: 1.07, 7.62, p = 0.04) were each significantly associated with increased odds for mortality from head/neck injury. CONCLUSION: Patients with falls from standing height and known head/neck injury had a low rate of clinically impactful body injury. None of the studied variables were associated with increased risk of body injury in this patient population. The low rate of clinically impactful body injury and the lack of any mortality, procedure, or transfusion resulting from body injury suggest that body CT may not be necessary in patients with head/neck injury in the absence of clinical or radiographic evidence of body injury.

Postpartum Note Template Implementation Demonstrates Adherence to Recommended Counseling Guidelines.

Postpartum visits may provide patients with an inadequate amount of counseling on postpartum depression, birth spacing, healthy eating, exercise, or changes in sexual response and emotions. We created a template in our electronic health record (EHR) with the aid of our clinical informatics department to increased adherence with recommended counseling guidelines. We retrospectively reviewed the postpartum visits of 200 patients who had a delivery and received postpartum care. Patients were seen in a resident-run clinic: 100 visits occurred prior to implementation of the template, while 100 visits occurred post-implementation with use of the template. We observed for documentation of counseling on Pap smear, birth spacing, breastfeeding, contraception, depression, gestational diabetes mellitus, pre-eclampsia, and sleep/fatigue. Descriptive statistics of mean and standard deviation were used to describe the continuous variables. Frequency and percentage were used to describe the continuous variables. Analysis of variance compared the continuous variables. The Pearson chi-square test compared the categorical variables. In visits that occurred without use of the template, counseling was charted as low as 1.0% for birth spacing to as high as 86.0% for contraception. With use of the template, counseling was charted as 100% in all visits for each of the recommended counseling guidelines (all p < 0.001). In conclusion, an EHR template for documentation of postpartum visits is associated with resident adherence with recommended postpartum counseling guidelines. Managers in hospitals and clinical practices should consider incorporating OBGYN-specific EHR note templates to improve quality and increase adherence with recommended guidelines during postpartum visits.

Improving Critical Value Read-Back Failure Rate by Modifying the Notification Procedure.

OBJECTIVES: The aim of the study was to determine whether a system process change improved successful read-back of critical values by the appropriate provider. METHODS: The study implemented a system process change of switching the "first call" physician from the admitting physician to the most recent document writer. Data were compared before (N = 301) and after the intervention (N = 201). Predictor variables included patient factors, physician factors, and environmental factors. The outcome variables measured were successful read-back within 5 and 30 minutes. RESULTS: Read-back failure within 5 minutes was significantly reduced (P < 0.001) from preintervention (49.5%) to postintervention (31.3%). Multivariate logistic regression showed reduced odds for read-back failure postintervention (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.31-0.67, P < 0.001) and increased odds for read-back failure for patients of Hispanic race/ethnicity (OR 1.77, 95% CI 1.09-2.89, P < 0.05). Read-back failure within 30 minutes did not significantly change. Multivariate logistic regression showed that an increased number of telephone calls were associated with an increased odds for read-back failure (OR 3.12, 95% CI 2.13-4.57, P < 0.001). CONCLUSIONS: We recommend the use of the physician who has most recently engaged with the patient as documented in the medical record for the daily note as the primary source of contact for reporting critical values.