Sameer Desale

Early Initiation of Postpartum Contraception: Does It Decrease Rapid Repeat Pregnancy in Adolescents?

STUDY OBJECTIVE Rapid repeat adolescent pregnancy is a significant public health concern. An effective and practical means of decreasing unintended second adolescent pregnancies needs to be identified. The objective of this study is to determine if early initiation of contraception, and in particular long acting reversible contraception (LARC), decreases rapid repeat pregnancy among first time adolescent mothers. DESIGN Retrospective cohort study. SETTING Urban teaching hospital. PARTICIPANTS 340 first-time adolescent mothers age ≤ 19. INTERVENTIONS None, study was retrospective. MAIN OUTCOME MEASURES Repeat pregnancy within 2 years. RESULTS 340 first time adolescent mothers with a documented follow-up time of 2 years had a repeat pregnancy rate of 35%. Average time from delivery to repeat pregnancy was 9.9 ± 6.4 months. Logistic regression analysis comparing adolescents with and without repeat pregnancy revealed that leaving the hospital postpartum without initiating any contraception was associated with significant increase risk of repeat pregnancy (OR = 2.447, 95% CI 1.326-4.515). Follow-up within 8 weeks postpartum was associated with lower chance of repeat pregnancy (OR = 0.322, 95% CI 0.172-0.603). Initiation of a LARC method (either an intrauterine device or etonogestrel subdermal implant) by 8 weeks postpartum was also associated with decreased chance of rapid repeat pregnancy (OR = 0.118, 95% CI 0.035-0.397). CONCLUSION Adolescent mothers who initiate a LARC method within 8 weeks of delivery are less likely to have a repeat pregnancy within 2 years than those who choose other methods or no method. First time adolescent mothers should be counseled about this advantage of using LARC.

The impact of solid organ injury management on the US health care system.

BACKGROUND Since the 1980s, there has been a paradigm shift toward nonoperative management of stable patients with solid organ injury. The impact of this practice change on national health care expenditure has not been well characterized. METHODS Hospital discharge data from the Healthcare Cost Utilization Project Nationwide Inpatient Sample from every other year spanning 1994 to 2010 were studied using patients with a primary diagnosis of splenic and liver injury. Cost analysis was performed using cost-to-charge ratios, where actual costs of hospitalization with current management practices were compared with theoretical costs projecting 1994 practice patterns. Length of stay (LOS) was evaluated similarly to costs. Mortality risk was established using the validated Trauma Mortality Prediction Model. RESULTS Data from 29,409 adult patients with splenic injury and 14,704 with liver injury were used for cost and LOS analysis. The proportion of patients undergoing nonoperative management increased from 38% to 67% for splenic injury and from 62% to 81% for liver injury. The mean cost for splenic injury dropped by

Validation of the osteoporosis self-assessment tool in US male veterans.

8,421 per patient, a net reduction in total costs per admission of 29.5% (p < 0.0001), resulting in a mean estimated

Is 40 the New 30?: Pregnancy Outcomes by Degree of Weight Gain Among Obesity Subclasses

12 million per year reduction in cost of care in 2008 alone. For liver injury, cost has been reduced by

Glycemic control, compliance, and satisfaction for diabetic gravidas in centering group care

8,822 per patient, a 27.7% reduction (p < 0.0001), with a net

Segmental increases in force application during colonoscope insertion: quantitative analysis using force monitoring technology

17 million per year savings. LOS has been reduced by a mean ± SE of 1.9 ± 0.7 days per splenic injury (p = 0.0001) and 2.2 ± 0.9 days for liver injury (p = 0.0001). Mortality rate of high-risk patients (Trauma Mortality Prediction Model > 0.3) treated conservatively for splenic injury fell from 30% to 20% and from 64% to 18% for liver injury. CONCLUSION The trend toward nonoperative management of solid organ injury has resulted in a substantial decrease in health care expenditure and LOS while improving mortality for high-risk patients. Advances in trauma care can have significant impact on the cost of health care. LEVEL OF EVIDENCE Economic analysis, level III.

Impact of subspecialty elective exposures on outcomes on the American board of internal medicine certification examination

The osteoporosis self-assessment tool (OST) is a screening instrument that uses age and weight as parameters to predict the risk of osteoporosis. This study was designed to evaluate OST in predicting osteoporosis in males. Male veterans aged 50yr and older with no prior diagnosis of osteoporosis and no prior bone densitometry (dual-energy X-ray absorptiometry [DXA]) testing were eligible for the study. Sociodemographic information, medical history, and risk factors for osteoporosis were recorded. Anthropometric measurements were taken and DXA testing performed. The OST index for each subject was calculated and predictive values and receiver operating characteristic (ROC) curves were evaluated for OST and osteoporosis. Five hundred eighteen subjects underwent DXA, 92 (17.8%) had osteoporosis, 281 (54.2%) had low bone mass, and 145 (28.0%) had normal bone mineral density. The OST index ranged from -8 to 23 with a mean of 4 (standard deviation ± 4.3). An OST index of 6 or lower predicted osteoporosis with a sensitivity of 82.6%, specificity of 33.6%, and an area under the curve for the ROC curve of 0.67. OST index performed better in non-Hispanic whites and males >65 yr. OST predicts osteoporosis with moderate sensitivity and poor specificity in men.

18F-FDG-PET SUV AS A PROGNOSTIC MARKER OF INCREASING SIZE IN THYROID CANCER TUMORS

INTRODUCTION: The objective of this study was to evaluate pregnancy outcomes by obesity classification using the 2009 Institute of Medicine weight gain guidelines. METHODS: We conducted a retrospective cohort analysis of 1,886 obese women who delivered a singleton pregnancy at our institution from 2009 to 2012. Women were stratified based on prepregnancy body mass index (BMI) into subclasses of obesity: class I (BMI 30.0–34.9 kg/m2), class II (BMI 35.0–39.9 kg/m2), and class III (BMI 40.0 kg/m2 or greater). The primary outcome was cesarean delivery. Secondary outcomes included hypertensive disorders of, gestational diabetes, preterm delivery, small for gestational age, and large for gestational age. Odds ratios and 95% confidence intervals were calculated based on weight gain less than or greater than the recommended 11–20 pounds. Weight gain within guidelines was the referent for each class. RESULTS: Before pregnancy, 957 women were obese class I, 508 women were obese class II, and 421 women were obese class III. During pregnancy, 60.1% of women gained more than the recommended amount of weight; only 18.7% of women gained the recommended 11–20 pounds. Women with class I obesity increased their risk of hypertensive disorders and large for gestational age with excessive weight gain. Women with class II obesity increased their risk of cesarean delivery with excessive weight gain. Women with class III obesity increased their risk of cesarean delivery and hypertensive disorders with excessive weight gain. Less than recommended weight gain had no clear associations. CONCLUSION: Weight gain above the guideline was common and associated with adverse pregnancy outcomes among all subclasses of obesity.

Maternal outcomes associated with early preterm cesarean delivery.

Abstract Purpose: To determine if diabetic gravidas enrolled in Centering® group care have improved glycemic control compared to those attending standard prenatal care. To compare compliance and patient satisfaction between the groups. Materials and methods: We conducted a prospective cohort study of diabetics enrolled in centering group care from October 2013 to December 2015. Glycemic control, compliance and patient satisfaction (five-point Likert scale) were evaluated. Student’s t-test, Chi-Square and mixed effects model were used to compare outcomes. Results: We compared 20 patients in centering to 28 standard prenatal care controls. Mean fasting blood sugar was lower with centering group care (91.0 versus 105.5 mg/dL, p =0.017). There was no difference in change in fasting blood sugar over time between the two groups (p = 0.458). The percentage of time patients brought their blood glucose logs did not differ between the centering group and standard prenatal care (70.7 versus 73.9%, p = 0.973). Women in centering group care had better patient satisfaction scores for “ability to be seen by a physician” (5 versus 4, p = 0.041) and “time in waiting room” (5 versus 4, p =0.001). Conclusion: Fasting blood sugar was lower for patients in centering group care. Change in blood sugar over time did not differ between groups. Diabetic gravidas enrolled in centering group care report improved patient satisfaction.

Does Pelvic Organ Prolapse Quantification Examination D Point Predict Uterosacral Ligament Suspension Outcomes

BACKGROUND Colonoscopy is a frequently performed procedure that requires extensive training and a high skill level. OBJECTIVE Quantification of forces applied to the external portion of the colonoscope insertion tube during the insertion phase of colonoscopy. DESIGN Observational cohort study of 7 expert and 9 trainee endoscopists for analysis of colonic segment force application in 49 patients. Forces were measured by using the colonoscopy force monitor, which is a wireless, handheld device that attaches to the insertion tube of the colonoscope. SETTING Academic gastroenterology training programs. PATIENTS Patients undergoing routine screening or diagnostic colonoscopy with complete segment force recordings. MAIN OUTCOME MEASUREMENTS Axial and radial force and examination time. RESULTS Both axial and radial force increased significantly as the colonoscope was advanced from the rectum to the cecum. Analysis of variance demonstrated highly significant operator-independent differences between segments of the colon (zones) in all axial and radial forces except average torque. Expert and trainee endoscopists differed only in the magnitude of counterclockwise force, average push/pull force rate used, and examination time. LIMITATIONS Small study, observational design, effect of prototype device on insertion tube manipulation. CONCLUSION Axial and radial forces used to advance the colonoscope increase through the segments of the colon and are operator independent.