Annual Resident Research Day 2019

Leonard H. Epstein, PhD, SUNY Distinguished Professor and Division Chief, Behavioral Medicine
Department of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo

Sarah Belliotti, MD
Mentor: Joseph De Nagy, DO, MPH

The purpose of this study is to evaluate whether a change in prescribing practices affects number of additional opioid prescriptions given in the postpartum period affects formal pain complaints to clinic in postpartum period.

This was a retrospective case control study evaluating prescribing patterns and pain complaint data from May1 2016 to January 31, 2019 via chart review.

We identified 1,527 cesarean sections for clinic based patients during our specified time period. Based on the review of charts to date, we have identified 177 patients from our control group who received on average 24 opioid tablets at time of discharge. From the time period after the prescribing practice change, we identified 71 patients from our case group who received on average 16 opioid tablets at time of discharge from the hospital. Our primary outcome is the percentage of patients who calledclinic with pain complaints. From our case data we found 2/71 (2%) who called for pain complaints vs 2/177 (1.1%) in the control group.Our secondary outcome was percentage of patients who received additional opioid prescriptions in 8 week postpartum period. From our case data we had 2/71 (2%) received additional prescriptions as documented in the EMR vs 8/177 (4.5%) in the control group.

We will await completion of chart review to comment on conclusion portion. In order to adequately power this study, we will need to collect data on 136 more cases and 237 more controls.

Elle Fisch, MD, MPH
Mentor: Joseph De Nagy, DO, MPH

Past research has shown that early clinical experiences with abortion andfamily planningcan impact medical students' knowledge, attitudes, and intentions to provide abortions and ability to counsel patients regarding contraception and pregnancy options, potentially improving women's access to comprehensive reproductive health care in the future. The purpose of this anonymous survey was to gauge whether or not medical students think that there is a difference in exposure to certain procedures between secular and religious institutions, while rotating through their Ob/Gyn clerkship in medical school. It also assessed theperceived importance of exposure to, and satisfaction with procedures during training.

This was a descriptive cross-sectional (survey) study of medical students in years one through four at a large state medical school, with approximately 600 enrolled students. The third year Ob/Gyn rotation is randomized to either a secular institution or religious institution. The survey was conducted via email sent to the medical school student list-serve, with an anonymous link embedded. The link routed the student to the survey website, hosted by google forms.

Students who are in preclinical years are more likely to think that family planning training is available at religious institutions when compared with those in their clinical years: Contraception counseling (p < 0.01), IUD insertion (p <0.001), Tubal Ligation (p < 0.05), Surgical Abortion (p <0.01), Medical Abortion (p < 0.01).  Eighty-two percent of students felt that exposure to family planning training was very important. 

Students who are in preclinical years are more likely to think that family planning training is available at religious institutions when compared with those in their clinical years

Maxwell Henricks, MD
Mentor: Faye Justicia-Linde, MD

To compare the outcomes of newborn circumcisions performed at Kaleida hospitals in 2015-2018, specifically the incidence of cosmetic abnormalities documented on newborn physical exam following circumcision. Additionally, to compare the incidence of cosmetic abnormalities utilizing Gomco versus Mogen circumcision clamps.

This was a retrospective cohort study.  Over 3,000 charts were reviewed assessing documented physical exam cosmetic abnormalities following newborn circumcisions comparing the type of circumcision clamp utilized; and comparing these two cohorts to determine the most prevalent factors for these cosmetic abnormalities (excess skin, excessive removal of skin, excessive scar tissue or adhesion). 

The circumcision related cosmentic abnormality rate was 1.6% when using a Mogen clamp and 2.4% when using a Gomco clamp, but this was not statisticallly significant (p=0.21).  Rates did not differ by age of infant nor hospital (used as proxy for training level).  Abnormailities identified were redundant foreskin (40%), adhesions (25%), both (35%).

The circumcision related cosmentic abnormality rate was within the range of previously published data and did not differ by clamp type, level of training or age of infant.

Molly Roy, MD
Mentor: Martin Caliendo, MD

The pit stop model was adopted to develop a protocol and apply it to STAT cesarean delivery simulations. The primary objective of the simulations was to teach and enforce the designated roles, allocated tasks, and improve teamwork within the interdisciplinary team of Ob physicians and L&D nurses.

Required STAT team members and tasks were identified, protocol developed, and assigned roles applied to weekly simulations. Each simulation started with the decision for STAT cesarean delivery and ended with skin incision. A survey derived from trauma literature using a Likert scale was conducted to all simulation participants 2 months after implementation to assess each member’s perception of comfort in performing their roles, communication, and development of team dynamic during the exercise. The survey was again administered to all participants 6 months after initiating the simulations.

Among residents surveyed, clarity of each team members’ roles, knowledge of personal role, comfort in performing allocated tasks, and preparedness in performing a STAT C-Section increased with more participation in simulations. Statistically significant differences were identified in comfort in performing each individual’s designated role when comparing participation in any number of simulations to no simulations. Data demonstrating the effect of time on these results is pending.

Understanding each team members’ role and improved sense of preparedness demonstrated by the survey results suggest improved interdisciplinary teamwork. Voluntary participation in simulations by nursing affected survey results. Mandatory participation by nursing and anesthesia staff should be considered for future simulations. Additional conclusions are pending results of repeat survey

Michael Shu, MD
Mentor: Abeer Eddib, MD

Sacrocolpoperineopexy has become increasingly prevalent for multicompartmental pelvic organ prolapse repair,however the impact of radical pelvic dissections for mesh attachment is yet unknown. This study aims to compareperi-operative outcomes associated with robotic-assisted laparoscopic sacrocolpoperineopexy (R-ASCPP) comparedto traditional robotic-assisted sacrocolpopexy (R-ASCP).

Cases of R-ASCPP were compared to R-ASCP with concomitant anterior-posterior (A/P) compartmental repaircontrols. Primary outcomes include narcotic medication requirements as measured by morphine milligram equivalents (MME) during the entire hospital admission and percentage of patients requiring discharge home with outpatient catheterization. Secondary outcomes include total operative time and quantitative blood loss as measured by the difference in pre-and post-operative hemoglobin (delta g/dL).

A total of 126 women were identified. Cases of R-ASCPP (n=83) were compared to matched R-ASCP with A/P repair controls (n=43) in 2:1 ratio. Total operative time was 36 minutes shorter on average for cases (214 minsvs. 250 mins, P<0.05), with similar quantitative blood loss between groups (-1.8g/dL vs. -2.1g/dL, P=0.61). Both cases and controls had similar narcotic requirements during the entire hospital admission (17.30MME vs. 20.79MME, p=0.81). A larger percentageof cases required discharge home with outpatient catheterization (32.5% vs. 14.3%, p<0.05).

R-ASCPP is a well-tolerated procedure, however is associated with a statistically significant propensity for acute urinary retention. Surgeons shouldconsider counseling R-ASCPP patients about the increased incidence for bladder dysfunction requiring either intermittent or indwelling catheterization.

Jenna Studer, MD
Mentor: Krystene DiPaola, MD

To examine the relationship between pregnancy rates and endometrial thickness on the day of intrauterine insemination for women using oral ovulation induction agents.

This was a chart review study which included women undergoing intrauterine insemination using the oral ovulation induction agents clomiphene citrate or letrozole. Charts of all patients undergoing intrauterine insemination were reviewed by dateto determine whether inclusion criteria was met. Women were excluded if their partner’s semen count was less than 5 million total motile sperm, if gonadotropins were used for ovulation induction, or if endometrial abnormalities were noted on ultrasound.

A total of 160 cycles completed by 109 women were included in the study. Age range of participants was 23 to 48. Letrozole was used for ovulation induction in 102 cycles, and clomiphene citrate was used in 58 cycles. A total of 15 cycles had an endometrial thickness <7mm at the time of intrauterine insemination. Seventeen clinical pregnancies were achieved. Pregnancy rate was 11.2% in women with thick endometrium (7mm+) and 6.7% in those with thin endometrium (<7mm), but this difference was not statistically significant (p=0.92).

Endometrium thickness on IUI day was not correlated with the likelihood of pregnancy.