Variation in Use of Prophylactic Antibiotics in Gynecologic Procedures Before and After an Educational Intervention

Objectives: Guidelines for use of prophylactic antibiotics in gynecologic procedures are outlined by the American Congress of Obstetricians and Gynecologists. There remains, however, a high rate of unindicated administration of antibiotics for surgeries. A retrospective study performed at our institution in 2012–2013 demonstrated that unindicated prophylactic antibiotics were administered over half the time. This study aimed to examine...

Improving Postoperative Efficiency: An Algorithm for Expedited Void Trials After Urogynecologic Surgery

Objectives: To evaluate the relation between voided volume and void trial “success” to create an algorithm that minimizes the need for postvoid residual volume (PVR) assessment in backfill-assisted void trials. Methods: This article is an ancillary analysis of deidentified data from a randomized trial evaluating prophylactic antibiotics after urogynecologic surgery. Void trials were routinely performed after surgery; voided volumes, PVR,...

Commentary on “Improving Postoperative Efficiency: An Algorithm for Expedited Void Trials After Urogynecologic Surgery”

For many reasons, including the general aging of the US female population, women’s awareness of surgical therapies to address pelvic floor dysfunction, and the increasing acceptance of such therapies, the incidence of pelvic floor reconstructive surgery is increasing and likely will continue to...

Trends in Abortion Incidence and Availability in North Carolina, 1980–2013

Objectives: Abortion incidence has declined nationally during the last decade. In recent years, many states, including North Carolina, have passed legislation related to the provision of abortion services. Despite the changing political environment, there is no comprehensive analysis on past and current trends related to unintended pregnancy and abortion in North Carolina. Methods: This study is a secondary analysis of vital registration data...

Chronic Kidney Disease in Pregnancy

With the increasing prevalence of chronic kidney disease (CKD) worldwide, the number of pregnant women with various degrees of renal dysfunction is expected to increase. There is a bidirectional relation between CKD and pregnancy in which renal dysfunction negatively affects pregnancy outcomes, and the pregnancy can have a deleterious impact on various aspects of kidney disease. It has been shown that even mild renal dysfunction can increase...

Management of Intrauterine Contraception in Early Pregnancy

Objectives: Women with rare intrauterine contraception (IUC) failures are advised to have their IUC removed because of the risk of poor obstetric outcomes with a retained IUC. Specifics regarding IUC removal in early pregnancy including techniques for removal, rates of success, and immediate pregnancy outcomes following removal are not well described, however. The objective of this study was to identify women with an IUC in early pregnancy...

Underdiagnosis and Lower Rates of Office Visits for Overweight/Obese Pediatric Patients in Rural Compared with Urban Areas

Objectives: This study compared the number of children enrolled in Medicaid in rural and urban areas of South Carolina with an overweight/obesity diagnosis and the mean rates of office visits with overweight/obesity diagnosed. Methods: Medicaid claims data from 2012 for children in three South Carolina counties, categorized as urban, rural high resource, and rural low resource, were used to identify those who had been diagnosed as being...

Adequately Addressing Pediatric Obesity: Challenges Faced by Primary Care Providers

Objective: To assess the challenges primary care providers encounter when providing counseling for pediatric patients identified as obese. Methods: A survey assessed the current challenges and barriers to the screening and treatment of pediatric obesity for providers in northwest Arkansas who provide care to families. The survey consisted of 15 Likert scale questions and 4 open-ended questions. Results: Time, resources, comfort, and...

Commentary on “Do Mixed-Flora Preoperative Urine Cultures Matter?”

Urogynecologic and urologic surgeons routinely diagnose and treat postoperative urinary tract infections (UTIs) in women. Often already uncomfortable from surgical pain, these patients can be frustrated upon receiving a diagnosis of a UTI. As such, it would be optimal if surgeons could identify those patients at risk for postoperative UTI and offer prophylactic therapy to prevent...

Do Mixed-Flora Preoperative Urine Cultures Matter?

Objectives: To determine whether mixed-flora preoperative urine cultures, as compared with no-growth preoperative urine cultures, are associated with a higher prevalence of postoperative urinary tract infections (UTIs). Methods: This was a retrospective cohort study. Women who underwent urogynecologic surgery were included if their preoperative clean-catch urine culture result was mixed flora or no growth. Women were excluded if they received...

Risky Teen Driving in a Rural Southern State

Objective: Alabama is one of the five US states with the highest teen driving mortality. We recruited teen drivers to participate in a questionnaire regarding high-risk driving behaviors. Methods: Teens were recruited from a large county school system to participate in a voluntary anonymous survey. Questions were taken in part from the National Youth Risk Behavior Survey. Descriptive statistics and odds ratios with 95% confidence intervals...

Breast-feeding, Leptin:Adiponectin Ratio, and Metabolic Dysfunction in Adolescents with Obesity

Objectives: Increased adiposity increases leptin and decreases adiponectin concentrations, resulting in an increased leptin:adiponectin ratio (LAR). In adults, components of the metabolic syndrome and other cardiometabolic risk factors, what we classify here as “metabolic dysfunction,” are associated with both a high LAR and a history of being breast-fed. The relation among breast-feeding, LAR, and degree of metabolic dysfunction in obese...

Inverse Correlation of Lymphoid Leukemia Incidence and Anemia Prevalence among Preschool Children

Objective: The relation between the prevalence of anemia and incidence of childhood acute lymphoblastic leukemia was explored using international cross-sectional data as well as US time-series data. Methods: Lymphoid leukemia incidence rates for various countries from the International Agency for Research on Cancer were regressed on anemia prevalence rates from the World Health Organization in a cross-sectional analysis. Four decades of acute...

Diagnosis of Child Maltreatment: A Family Medicine Physician’s Dilemma

Objectives: Cases of child maltreatment (CM) in the United States remain high, and primary care providers lack the confidence and training to diagnose these cases. This study provides recommendations to improve family medicine physicians’ confidence in diagnosing CM. Methods: We e-mailed an electronic survey to family medicine residents and physicians practicing in the United States. Responses were collected during August and September...

Inflammation and Healthy Lifestyle Choices Influence Cardiometabolic Risks in African American Women

Objectives: Individuals of African origin in Europe and the Caribbean have a lower prevalence of coronary heart disease (CHD) than do Europeans and European Americans; however, African Americans, especially women, do not possess the same low CHD prevalence as Africans. As such, this study was designed to determine whether highly sensitive C-reactive protein (hsCRP) and fitness (V˙O2max) cluster with other cardiometabolic risks (CMRs) or whether...

Social Support and Health-Related Quality of Life Among Low-Income Women: Findings from Community-Based Participatory Research

Objectives: This study examined the association between social support and health-related quality of life (HRQoL) among low-income women in the southeastern region of the United States. Methods: Analysis was performed on data from a community needs assessment survey that was designed to explore social determinants of health and QoL indicators using a community-based participatory research approach. The study sample comprised 132 women aged 18...

Lynch Syndrome and Endometrial Cancer

In patients with Lynch syndrome, gynecologic cancer often can be the first presenting malignancy. In this review, we summarize the genetics of Lynch syndrome and review the various modalities of identifying patients at risk for this syndrome. The clinical characteristics of Lynch-associated endometrial cancer and screening and risk-reducing strategies also are...

Risk Factors for Outpatient Use of Antibiotics in Children with Acute Respiratory Illnesses

Objectives: Antibiotics for acute respiratory illness (ARI) constitute most pediatric medication use and contribute to the emergence of antimicrobial resistance. We investigated antibiotic prescription risk factors for ARI in pediatric clinics and clinical follow-up in individuals prescribed and not prescribed antibiotics. Methods: In this observational study, we enrolled children ages 2 to 17 years old presenting with ARI with fever to two...

Water Load Test in Children with Chronic Abdominal Pain or Obesity Compared with Nonobese Controls

Objective: Satiety is the perception of satisfied fullness and represents a summation of neural and hormonal influences. Satiety can be assessed by drink tests, including water load. The objective of our study was to confirm the difference in water load volume between nonobese control children and children with functional dyspepsia (FD), children with irritable bowel syndrome (IBS), and obese children. Methods: A total of 158 children ages 6...

Multidisciplinary Approach to Complicated Pregnancy

A nulliparous pregnant woman in her mid-20s and in the 32nd week of gestation presented to the emergency department with severe headache and vomiting. She had an uneventful medical history; however, the physical examination upon hospital admission revealed a hypertensive emergency, papilledema, and 2+ dipstick proteinuria. Upon establishing the diagnosis of preeclampsia, aggressive therapy with corticosteroids, antihypertensive medication, and...