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2009 Summer Student Research and Clinical Assistantship Program Research Presentations. Department of Family Medicine August 7, 2009. 2009 Presentations. Qi Zhang

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2009 summer student research and clinical assistantship program research presentations

2009 Summer Student Research and Clinical Assistantship ProgramResearch Presentations

Department of Family Medicine

August 7, 2009

2009 presentations
2009 Presentations
  • Qi Zhang

“Genitourinary tract infections during pregnancy and birth outcomes: A retrospective chart review study of African Americans in Dane County”

  • Taya Schairer, Leah Haglund

“Infant Mortality Investigation in Dane County”

  • Emily Holtan,

“Analyzing the Feasibility of Group Prenatal Visits at Wingra Clinic”

  • Carla J. Bouwkamp

“Gender and Authorship of Papers in Family Medicine Journals 2006-2008”

  • Anna Ziemer

“Survey of Nipple Shield Use Among Knowledgeable Health Professionals”

slide3

Genitourinary tract infections during pregnancy and birth outcomes:A retrospective chart review study of African Americans in Dane County

Qi Zhang

SSRCA 2009 Final Seminar

Summer Shapiro Project

background
Background
  • 2002-2004 US black infant mortality rate (BIMR) was 13.3 deaths per 1000 live births
  • Wisconsin BIMR was 17.6, higher than the national average
  • 2002-2007 Dane Co. BIMR was 6.4
    • 1990-2001 Dane Co. BIMR was 19.4
    • ~70% reduction
    • Why? And why not in the rest of the state?

MMWR Morb Mortal Wkly Rep. 58(20):2009

decline in bimr
Decline In BIMR

MMWR Morb Mortal Wkly Rep. 58(20):2009

background6
Background
  • In the last decade among African Americans in Dane Co:
    • Decrease in premature births (<37 weeks gestation)
    • Decrease in low birth-weight (<2500g)
    • Increased survival of premature and low-birth weight infants
  • This may be an important factor in the decrease of Dane Co. BIMR

MMWR Morb Mortal Wkly Rep. 58(20):2009

role of genitourinary tract infections during pregnancy
Role of Genitourinary Tract Infections During Pregnancy
  • Certain GU tract infections such as gonorrhea, trichomoniasis, bacterial vaginosis (BV) and urinary tract infections (UTI) have been associated with preterm labor
  • Correlated with other adverse outcomes such as pre-term pre-labor rupture of membranes (PPROM), low birth-weight, chorioamnionitis, and neonatal infection

Moodley P, Sturm AW. Semin Neonatol (5): 2000

study goal
Study Goal
  • Explore whether the decrease in Dane Co. BIMR is related to increased screening, diagnosis, or treatment for GU tract infections
methods
Methods
  • Labor and delivery records from Meriter and St. Mary’s Hospital
    • Currently we have ~260 charts reviewed from Meriter and ~30 from St. Mary’s
  • Comparing 1997 to 2007 records
methods10
Methods
  • Data obtained include information on:
    • Demographics, prenatal care, past OB/GYN hx, maternal health risks (GU tract infections), social hx, complications during labor
  • Data collected by 4 study staff members: 2 medical students and 2 OB/GYN MD’s
    • Charts were reviewed together initially to establish reliability
methods11
Methods
  • Outcome measures:
    • BIMR
    • Premature delivery
    • PPROM
    • Low birth-weight
    • GU tract infection diagnoses, treatment, test of cure
    • Demographic measures
  • Independent variable
    • Time (1997 vs. 2007)
study limitations
Study Limitations
  • Small N’s – very few cases of infant mortality and preterm labor in Dane Co.
  • Treatment and/or test of cure were not always documented
    • STI’s may have be treated elsewhere
  • Documentation of ethnic origin or nationality is not always clear in the case of African immigrants
  • Charts were not randomly pulled: at Meriter Hospital they were by timing of delivery
  • Missing and incomplete charts
  • Due to time constraints, we were only able to review charts at Meriter
acknowledgements
Acknowledgements
  • Gloria Sarto, MD
  • Laura Berghahn, MD
  • Amanda Schmeil, MD
  • Murray Katcher, MD
  • Carley Zeal, BS
  • Shapiro Scholarship
  • MERC grant
infant mortality investigation

Infant Mortality Investigation

Taya Schairer and Leah Haglund

Mentor: Dr. Lee Dresang

introduction
Introduction

In 2004, US infant mortality rate 6.78 per 1000 live births while the Black Infant Mortality Rate (BIMR) was 13.25 per 1000 live births

Between 2000-2004, WI infant mortality was 6.7 per 1000 live births while the BIMR was 17.6 per 1000 live births (1)

In Dane county, African American infant mortality has decreased 67% since 1990’s while other areas, like Racine County, have not seen such declines (9.4 per 1,000 live births for 1990-2001 to 6.4 for 2002-2007) (1)

reducing infant mortality disparities in wisconsin
Reducing Infant Mortality Disparities In Wisconsin
  • The goal of the larger project is to investigate improved birth outcomes in Dane County and apply what is learned to Racine county and other communities with disparities (2)
  • Aims to achieve goal:
    • Identify risk and protective factors affecting birth outcomes
    • Effects of public programs and policies
    • Impact of healthcare system
    • Compare findings between Racine and Dane County
    • Apply findings to Racine and other communities
identified risk factors of poor birth outcome 2
Identified Risk Factors of poor birth outcome (2):
  • Pre-term birth
  • Low birth weight
  • Tobacco, alcohol, and illicit drug use
  • Stressors of life events
  • Socio-demographic characteristics
clinical chart review
Clinical Chart Review
  • Our specific aim is to compare prenatal care and health determinants of African American women in 1997/1998 to 2007 at Wingra and Northeast clinics
  • Factors we recorded:
    • Maternal age, marital status, education, insurance, occupation, continuity of prenatal care, attending vs resident as primary provider, obstetric history, pre-conceptual counseling/prenatal vitamins, chronic conditions, pregnancy complications, STIs/infections, genetic disorders, substance use, postpartum characteristics
methods21
Methods

Primarily our information was obtained from ACOG sheet with supplemental information on EPIC and in previous chart records

Data recorded on Websurvey

We went through charts together and agreed on findings

difficulties encountered
Difficulties Encountered

Forms incomplete

Self-report

Subjective nature of questions

Infant Death Record

project status
Project Status
  • Currently we have collected data for 125 African American Pregnancies
    • 1997/1998: 52
    • 2007: 73
  • Analysis has not yet been conducted
preliminary results
Preliminary Results
  • Age
    • 1997/1998: Teenage (35.3%), 20+ (64.7%)
    • 2007: Teenage (29.7%), 20+ (70.3%)
  • Marital Status
    • 1997/1998: Married (8%), Single (90%), Divorced (2%)
    • 2007: Married (13.4%), Single (85.1%), Separated (1.5%)
preliminary results25
Preliminary Results
  • Chlamydia
    • 1997/1998: 12 cases (24.5%)
    • 2007: 9 cases (13.0%)
  • Gonorrhea
    • 1997/1998: 5 cases (10.4%)
    • 2007: 1 cases (1.5%)
  • Bacterial Vaginosis
    • 1997/1998: 26 cases (68.4%)
    • 2007: 27 cases (60%)
  • Trichomonas
    • 1997/1998: 11 cases (35.5%)
    • 2007: 5 cases (11.9%)
preliminary results26
Preliminary Results
  • Gestational Diabetes
    • 1997/1998: 0%
    • 2007: 4 cases (6.15%)
  • Gestational Hypertension
    • 1997/1998: 1 case (2.1%)
    • 2007: 2 cases (3.0%); 1 case of chronic HTN (1.5%)
  • Pre-eclampsia
    • 1997/1998: 0%
    • 2007: 4 cases (5.9%)
references
References
  • 1) MMWR Morb Mortal Wkly Rep. 2009 May 29;58(20):561-5. Erratum in: MMWR Morb Mortal Wkly Rep. 2009 Jul 24;58(28):781
  • 2) Sarto, Gloria E. Reducing Infant Mortality Disparities in Wisconsin.
analyzing the feasibility of group prenatal visits at wingra clinic

Analyzing the Feasibility of Group Prenatal Visits at Wingra Clinic

Emily Holtan, medical student

Suhani Bora, MD and Beth Potter, MD

what are group prenatal visits
What are group prenatal visits?
  • Two-hour group visit with doctor offers:
    • 6-8 women with similar gestational ages
    • education and counseling on topics such as:
      • labor and delivery, breastfeeding, proper nutrition, and parenting
      • access to community resources
    • social networking

* Centering Pregnancy, a non-profit organization will come to your site and implement the group visits for a large fee

what does the literature say about group prenatal visits
What does the literature say about group prenatal visits?
  • Improved birth outcomes by
    • reducing rates of preterm births
    • improving prenatal education and satisfaction with care
    • increasing rates of breastfeeding initiation
  • Research is limited regarding
    • CenteringPregnancy model versus alternative model
    • pre/post-natal depression
    • integrating group visits in a residency clinic
questions we want to answer
Questions we want to answer
  • For patients:

Is there an interest in group prenatal visits

What are the barriers for participation?

Do prenatal group provide patients with a stronger knowledge/skill set regarding prenatal care?

  • For residents:

Do prenatal group visits provide residents with better knowledge/skills for providing prenatal care?

Will participating in these visit affect their interest in providing obstetrical care in the future?

study design
Study design

Three aspects of information gathering:

1 survey to prenatal professionals
(1) Survey to prenatal professionals
  • Study population: members of STFM (Society of Teachers of Family Medicine)
    • Survey given electronically
    • Targeting people who have implemented group prenatal visits or were interested
    • Open-ended questions regarding:
      • Are you using the Centering model or not?
      • Money
      • Staffing
      • Recruitment
      • Resident involvement
      • Challenges
2 survey to patients
(2) Survey to Patients
  • Study population: pregnant patients at Wingra Clinic (goal= 20 responses)
    • Survey given at routine OB visit
    • Patients recruited thru prenatal educator and MAs
    • Questions regarding:
      • Logistics of Group Visits
        • Transportation, Employment, Other Children
      • Interest in Group Visits
        • yes, no, or maybe
      • Confidence/ Knowledge regarding Prenatal Care
3 survey to residents
(3) Survey to Residents
  • Study population: UW-Madison Family Medicine residents (goal= 20 responses)
    • Survey given electronically
    • Questions regarding:
      • Confidence/Knowledge regarding prenatal care
      • Quality of residency training received in prenatal care
      • Interest in providing prenatal care in future practice
results 1 survey to prenatal professionals
Results:(1) Survey to prenatal professionals

Qualitative Responses (21 responses)

  • Most people used Centering Pregnancy for staff training
    • Had those staff train other staff internally
  • Overwhelming satisfaction for patient provider, and residents
  • At least two residents per group
  • Greatest barriers were in funding, scheduling, recruitment
results 2 survey to patients 3 survey to residents
Results: (2) Survey to Patients (3) Survey to Residents

Still Pending IRB Approval

*application for IRB-exemption submitted July 13th

discussion
Discussion
  • Conclusions:

(1) Prenatal Professional Survey

    • Feedback from prenatal professionals was generally positive
    • Allowed us to formulate our pilot project design using all of their advice
    • Received guidance whether to invest in Centering Pregnancy model
    • We have no idea how many sites are doing this, our survey responses may be biased
limitations 2 patient surveys
Limitations(2) Patient Surveys
  • Specific to the Wingra patient population only
  • Did not include depression screen
  • Patients we survey are not the same patients that will be involved in pilot group visits
limitations logistics
Limitations: Logistics

Surveys:

  • Pending IRB approval
  • Recruiting patients and residents for survey
  • Cannot move forward with implementation until know views of patients, residents

Group Visit Model:

  • Scheduling
  • Funding
    • For staff training, supplies, etc.

Summer research project

  • Timing
    • Coordinating schedule with Dr. Bora
    • Project focused on study design rather than study execution
acknowledgements42
Acknowledgements
  • Dr. Suhani Bora, 3rd year resident
  • Dr. Beth Potter, Faculty
  • Dr. Mary Beth Plane, Senior researcher

Funding Support:

provided by the Department of Family Medicine for the Summer Student Research and Clinical Assistantship Program

gender and authorship of papers in family medicine journals 2006 2008

Gender and Authorship of Papers in Family Medicine Journals 2006-2008

Carla J. Bouwkamp

Faculty Supervisor: Sarina Schrager, MD

background45
Background

Despite increasing numbers of women attending medical school and completing residencies, women continue to lag behind men in academic achievement

In 2005, women comprised only 15% of all full professors and 11% of all department chairs

Studies within surgery, otolaryngology and EM show women authorship is significantly below that of males

Editorial boards of major medical journals also show that women make up the minority

However, no research has been done in Family Medicine to see if these trends hold!

methods46
Methods
  • All original articles from the five family medicine journals were reviewed between 2006 and 2008.
    • American Family Physician (AFP)
    • Family Medicine Journal (FMJ)
    • The Annals of Family Medicine
    • The Journal of Family Practice (JFP)
    • The Journal of American Board of Family Practice (JABFP)
  • Articles were classified based on type of article, journal, year, and gender of lead author
methods47
Methods

Gender of lead author was determined by name and confirmed by internet research

Data and statistics were completed in Excel

A current issue of each of the five journals was reviewed to determine make up of editorial boards.

The AAMC website was used to gather gender information on faculty positions for family medicine

results
Results

2, 126 articles were reviewed

-712 authored by females

-1414 authored by males

7 authors were thrown out because gender could not be determined

editorial boards
Editorial Boards

Family Medicine

Editor in chief—male (but changing)

Associate editors—1/2 female

Feature editors—3/7 female

Editorial board—11/22 female ( 50%)

JFP

Editor in chief—male

Associate editors—4/4 male

Assistant editors—3/17 female

Editorial board—3/11 female (27%)

American Family Physician

Editor—male

Deputy editor for EBM—male

Assistant deputy editor—female

Associate medical editors—4/5 female

Assistant medical editors—2/2 male

Contributing editors—1/3 female

Editorial advisory board—5/49 female (10%)

JABFP

Editor—female

Deputy editor—female

Associate editor—1/2 female

Executive editor—male

Editorial board—7/27 female (25.9%)

Annals of Family Medicine

Editor—male

Senior associate editor—male

Associate editors—4/6 female

Reflections editor—female

Consulting editor—male

Statistical editor—male

Editorial board—11/28 female (39.3%)

discussion55
Discussion

There is a considerable difference between males and females authoring family medicine journal articles.

There is a considerable difference between males and females comprising family medicine editorial boards.

There is a considerable difference between males and females holding faculty and tenured positions.

discussion56
Discussion

Whether there is a correlation between females authoring less articles and having fewer faculty and tenured positions is still unable to be determined.

The reason why females author less journal articles or why they have fewer faculty and tenured positions is still unable to be determined.

Therefore, more research is needed to find out these answers and hopefully improve these trends.

acknowledgments
Acknowledgments

Thank you to Dr. Sarina Schrager for all your guidance and help!

Thank you to the Department of Family Medicine and Dr. Temte for providing the SSCRA program.

literature cited
Literature Cited

Battacharyya N, Shapiro NL. Increased female authorship in ototlaryngology over the past three decades. Laryngoscope 2000;110(3):358-61.

Hamel MB, Ingelfinger JR, Phimister E, Solomon CG. Women in academic medicine--progress and challenges.N Engl J Med. 2006 Jul 20;355(3):310-2

Jagsi R, Tarbell NJ, Henault LE, Chang Y, Hylek EM. The representation of women on the editorial boards of major medical journals: a 35-year perspective.Arch Intern Med. 2008 Mar 10;168(5):544-8.

Jagsi R, et al. The “gender gap” in authorship of academic medical literature—a 35 year perspective. NEJM 2006;355:281-7.

Kurichi JE, et al. Women authors of surgical research. Arch Surg 2005;140:1074-77. 

Li SF, et al. Gender trends in emergency medicine publications. Acad Emerg Med .2007;14(12):1194-6.

American Academy of Family Physicians. www.aafp.org/afp/. 2006-2008

Journal of the American Board of Family Practice. www.jabfm.org/. 2006-2008

The Annals of Family Medicine. www.annfammed.org/. 2006-2008

Family Medicine Journal. stfm.org/fmhub/fmhub.html. 2006-2008

American Family Physician. www.aafp.org/afp/. 2006-2008

AAMC. http://aamc.org/members/wim/statistics/stats08/start.htm

nipple shield use among knowledgeable health professionals

Nipple Shield Use Among Knowledgeable Health Professionals

Presented by Anna Ziemer

Mentor: Dr. Anne Eglash

August 7, 2009

background61
Background

Nipple shields are a tool used to help breastfeeding women

No guidelines exist to direct shield use

Some health professionals have concerns about shield use

Images from www.medelabreastfeedingus.com

goals of the survey
Goals of the survey:

identify the most common reasons health professionals recommend nipple shields

determine health care professionals’ most common concerns about shield use

identify most common maternal responses to nipple shields

demographics of survey respondents
Demographics of survey respondents:

Survey was completed by 490 health professionals

99% female

79% board certified in lactation

84% from the United States

nipple shield use
Nipple Shield Use

94% of respondents used nipple shields in their practice

top reasons respondents recommend nipple shield use
Top Reasons Respondents Recommend Nipple Shield Use

To help latch infants born less than 35 weeks gestation

To help latch babies born greater than 35 weeks gestation when 3-7 days old

To decrease the work of breastfeeding for infants regardless of age or size

nipple shield use for term and near term infants
Nipple Shield Use for Term and Near-Term Infants

38% recommend nipple shields for these infants when less than 3 days old

45% recommend the shield for these infants when 3-7 days old

No differences between board certified and non-board certified respondents

nipple shield use with pre term and term near term infants
Nipple Shield Use with Pre-Term and Term/Near-Term Infants

Current research shows that the shield can be beneficial for pre-term infants

No studies have been done to show that the shield is helpful for term and near-term infants

Nipple shields may be recommended too often as a ‘quick fix’

respondents top concerns about nipple shield use
Respondents’ Top Concerns About Nipple Shield Use

Lack of follow-up by those handing out the shield

Inappropriate reason for using the shield

Maternal inconvenience of using the shield

top maternal responses to nipple shields as reported by respondents
Top Maternal Responses to Nipple Shields as Reported by Respondents

The shield is helpful

I cannot wait to get rid of the shield

I find the shield convenient

The shield is inconvenient

recommendations
Recommendations

Further study is necessary to determine if nipple shield use is safe and effective for term and near-term infants

Clinicians should attempt other techniques to help infants latch before using the shield

Shield packaging should inform mothers about the need for follow-up with a knowledgeable clinician

thank you

Thank You

2009 UW-DFM SSRCA