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  • 1
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    Online Resource
    How Do Home and Clinic Blood Pressure Readings Compare in Pregnancy? : A Systematic Review and Individual Patient Data Meta-Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Hypertension Vol. 72, No. 3 ( 2018-09), p. 686-694
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 72, No. 3 ( 2018-09), p. 686-694
    Abstract: Hypertensive disorders during pregnancy result in substantial maternal morbidity and are a leading cause of maternal deaths worldwide. Self-monitoring of blood pressure (BP) might improve the detection and management of hypertensive disorders of pregnancy, but few data are available, including regarding appropriate thresholds. This systematic review and individual patient data analysis aimed to assess the current evidence on differences between clinic and self-monitored BP through pregnancy. MEDLINE and 10 other electronic databases were searched for articles published up to and including July 2016 using a strategy designed to capture all the literature on self-monitoring of BP during pregnancy. Investigators of included studies were contacted requesting individual patient data: self-monitored and clinic BP and demographic data. Twenty-one studies that utilized self-monitoring of BP during pregnancy were identified. Individual patient data from self-monitored and clinic readings were available from 7 plus 1 unpublished articles (8 studies; n=758) and 2 further studies published summary data. Analysis revealed a mean self-monitoring clinic difference of ≤1.2 mm Hg systolic BP throughout pregnancy although there was significant heterogeneity (difference in means, I 2 〉 80% throughout pregnancy). Although the overall population difference was small, levels of white coat hypertension were high, particularly toward the end of pregnancy. The available literature includes no evidence of a systematic difference between self and clinic readings, suggesting that appropriate treatment and diagnostic thresholds for self-monitoring during pregnancy would be equivalent to standard clinic thresholds.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.118.10917
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2094210-2
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  • 2
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    109. Using blood pressure self-monitoring in pregnancy: A systematic review and individual patient data meta-analysis
    Elsevier BV ; 2018
    In:  Pregnancy Hypertension Vol. 13 ( 2018-10), p. S76-
    Details
    In: Pregnancy Hypertension, Elsevier BV, Vol. 13 ( 2018-10), p. S76-
    Type of Medium: Online Resource
    ISSN: 2210-7789
    URL: Article
    DOI: 10.1016/j.preghy.2018.08.226
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 2584464-7
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  • 3
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    Mobile Assessments to Improve Screening and Novel Patient Engagement to Diagnose and Manage Maternal Mental Health (MIND) Study Midpoint Analysis: Compliance Rate of Antenatal Screening [ID: 1363058]
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Obstetrics & Gynecology Vol. 141, No. 5S ( 2023-05), p. 28S-29S
    Details
    In: Obstetrics & Gynecology, Ovid Technologies (Wolters Kluwer Health), Vol. 141, No. 5S ( 2023-05), p. 28S-29S
    Abstract: One in five to seven birthing people are affected by perinatal mood disorders. While screening for gestational diabetes is well defined, the efficacy of standardized assessment of mood disorders is less understood. Between 2018 and 2020, screening at an academic center was highly variable, demonstrating need for improvement. Remote surveillance using novel integrated technology was used to improve patient participation in routine antenatal screening. METHODS: A prospective observational cohort of 81 patients from two clinical sites in the Babyscripts (BRx) Maternal Mental Health Module received digital Edinburgh Postnatal Depression Scale (EPDS) screening at 12 and 28 weeks of gestation. The control group consisted of 81 randomly selected patients who received in-person standardized screening from 2018 to 2020. In a midpoint analysis, EPDS completion was assessed at weeks 12 and 28 in the intervention group and compared to the control group using χ 2 analysis. The study was reviewed and exempted by the George Washington University IRB. RESULTS: The BRx treatment group totaled 45 patients enrolled prior to week 14 and 74 patients enrolled prior to week 30. At week 14, 38% of BRx patients (17/45) had completed an EPDS survey, compared with 10% of patients in the control group (8/81). At week 30, 36% of BRx patients (27/74) had completed an EPDS survey, compared with 21% of control (17/81). Improved EPDS response rates of the BRx cohort were statistically significant at both assessments ( P 〈 .01 and P =.03). CONCLUSION: Remote mood screening resulted in significantly higher rates of adherence in the first and second trimesters as compared to standard methods. In the next phase of analysis, we plan to assess adherence of screening through 12 months postpartum. Future analysis is planned to determine noninferiority as compared to in-office methods among a larger cohort. We hypothesize that novel telehealth mood screenings will help to sustain engagement with providers and reduce time to intervention.
    Type of Medium: Online Resource
    ISSN: 0029-7844
    URL: Article
    DOI: 10.1097/01.AOG.0000930072.37985.05
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2012791-1
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  • 4
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    Integrating Adverse Event Reporting Into a Free-Text Mobile Application Used in Daily Workflow Increases Adverse Event Reporting by Physicians
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  American Journal of Medical Quality Vol. 35, No. 5 ( 2020-09), p. 374-379
    Details
    In: American Journal of Medical Quality, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 5 ( 2020-09), p. 374-379
    Abstract: Adverse event (AE) reporting is a key component of patient safety and physicians are known to underreport. The authors hypothesized that integrating AE reporting into a mobile application used in daily physician workflow would increase physician reporting of AEs. After integrating AE reporting into a free-text mobile application used for daily workflow, the change in AE reporting by physicians was analyzed using Mann-Whitney U tests. AE reporting by physicians increased more than 37-fold (21 to 806; U = 7.5, P 〈 .0001). AE reporting by physicians as a proportion of all AE reports received increased 120-fold (from 0.1% to 12% of all reports, U = 10, P 〈 .0001). Integrating AE reporting into a free-text mobile application used in daily physician workflow markedly increased their reporting of AEs. This approach shifted time burden from physicians to quality officers. Implementation should be coupled with physician education about identifying AEs and content to include in reports.
    Type of Medium: Online Resource
    ISSN: 1062-8606 , 1555-824X
    URL: Article
    DOI: 10.1177/1062860619891995
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2181248-2
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  • 5
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    Connected Health and Mobile Apps in Obstetrics and Gynecology
    Elsevier BV ; 2020
    In:  Obstetrics and Gynecology Clinics of North America Vol. 47, No. 2 ( 2020-06), p. 317-331
    Details
    In: Obstetrics and Gynecology Clinics of North America, Elsevier BV, Vol. 47, No. 2 ( 2020-06), p. 317-331
    Type of Medium: Online Resource
    ISSN: 0889-8545
    URL: Article
    DOI: 10.1016/j.ogc.2020.02.008
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
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  • 6
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    A Novel, Web-Based Quality Improvement Platform to Address ACGME CLER Requirements
    Journal of Graduate Medical Education ; 2020
    In:  Journal of Graduate Medical Education Vol. 12, No. 1 ( 2020-02-01), p. 80-85
    Details
    In: Journal of Graduate Medical Education, Journal of Graduate Medical Education, Vol. 12, No. 1 ( 2020-02-01), p. 80-85
    Abstract: In 2014, the Accreditation Council for Graduate Medical Education (ACGME) formally mandated trainee (resident and fellow) participation in health care quality improvement (QI) projects as one of the Clinical Learning Environment Review (CLER) Pathways to Excellence. Subsequent national reviews showed large variations in how QI education is conducted, as well as a significant mismatch between educational and organizational goals. Objective We developed a web-based platform to engage trainees in QI that better aligned with best practice methodology and matched identified institutional priorities. Methods A needs assessment survey was distributed to trainees to understand the obstacles to compliance with ACGME QI requirements. Based on the results, a web-based clearinghouse, called the QI Platform, was developed and launched in July 2016, and utilization was analyzed in February 2019. Results A total of 196 of 440 needs assessment surveys (45%) were completed. Themes extracted from surveys to identify barriers in QI participation included difficulties designing projects, lack of mentorship or expert support, and difficulty engaging an interprofessional team. Over 2.5 years, 151 projects were registered on the platform. Of these, 17 (11%) were collaborative entries. At the time of analysis, 166 of 437 trainees (38%) were listed as participants in active QI projects. A total of 22 projects were archived as complete, and 68 incomplete projects were reassigned to the “Ideas” section as works in progress after lead trainee graduation. Conclusions An institutional QI Platform clearinghouse for GME QI projects was feasible to develop and maintain, and it appeared acceptable to most GME programs and trainees for recording and tracking QI projects, and linking these to hospital QI priorities.
    Type of Medium: Online Resource
    ISSN: 1949-8349 , 1949-8357
    URL: Article
    DOI: 10.4300/JGME-D-19-00339.1
    Language: English
    Publisher: Journal of Graduate Medical Education
    Publication Date: 2020
    detail.hit.zdb_id: 2578612-X
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  • 7
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    Asynchronous Learning Module for Pediatric Emergency Medicine Physicians on How to Manage Vaginal Birth and Neonatal Resuscitation in the Emergency Department
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Pediatric Emergency Care Vol. 39, No. 6 ( 2023-6), p. 397-401
    Details
    In: Pediatric Emergency Care, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. 6 ( 2023-6), p. 397-401
    Abstract: Newborn deliveries and neonatal resuscitation events are rare but essential skills for pediatric emergency medicine (PEM) physicians. We sought to evaluate the effect of an online module on PEM physicians' knowledge and confidence in managing newborn deliveries and neonatal resuscitation. Methods A team of experts in PEM, obstetrics, neonatology, and medical education developed a self-directed, 1-hour online module on managing newborn deliveries with neonatal resuscitation. The module was designed to address the learning needs of the targeted group. The module was piloted before dissemination to PEM faculty. A 10-question multiple choice test was given to assess knowledge of the material covered. A 10-point Likert scale questions survey was used to evaluate confidence. Measures were administered before initiation, after module completion, and 6 months after completion. Paired t tests were used to compare mean knowledge scores, and rank sum tests were used to compare median confidence levels. Results Most (n = 47, 89%) of the PEM faculty members completed the module. The majority (n = 43, 91%) thought the information was relevant to their practice. After completing the module, physicians' overall knowledge scores improved by 18% (mean [SD]: 74% [14.7] vs 92% [8.0], P 〈 0.01). Self-assessed confidence improved after the module in terms of managing uncomplicated vaginal deliveries (median 5 vs 7, P 〈 0.01), care of patients with complicated vaginal deliveries (2 vs 5, P 〈 0.01), and managing neonatal resuscitation (7 vs 8, P 〈 0.01). During the 6-month follow-up, there was sustained improvement in physicians' overall knowledge score (82% [16.9], P = 0.007) and self-assessed confidence in managing complicated vaginal deliveries (median 2 vs 4, P = 0.0012); however, other measures were not statistically significant. Conclusions An online module is an appropriate method for training PEM providers about rarely used but essential skills such as managing vaginal deliveries and neonatal resuscitation.
    Type of Medium: Online Resource
    ISSN: 1535-1815 , 0749-5161
    URL: Article
    DOI: 10.1097/PEC.0000000000002959
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2053985-X
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  • 8
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    Telehealth Interventions to Improve Obstetric and Gynecologic Health Outcomes : A Systematic Review
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Obstetrics & Gynecology Vol. 135, No. 2 ( 2020-02), p. 371-382
    Details
    In: Obstetrics & Gynecology, Ovid Technologies (Wolters Kluwer Health), Vol. 135, No. 2 ( 2020-02), p. 371-382
    Abstract: To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes. DATA SOURCES: We conducted a comprehensive search for primary literature in ClinicalTrials.gov, Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. METHODS OF STUDY SELECTION: Qualifying primary studies had a comparison group, were conducted in countries ranked very high on the United Nations Human Development Index, published in English, and evaluated obstetric and gynecologic health outcomes. Cochrane Collaboration's tool and ROBINS-I tool were used for assessing risk of bias. Summary of evidence tables were created using the United States Preventive Services Task Force Summary of Evidence Table for Evidence Reviews. TABULATION, INTEGRATION, RESULTS: Of the 3,926 published abstracts identified, 47 met criteria for inclusion and included 31,967 participants. Telehealth interventions overall improved obstetric outcomes related to smoking cessation and breastfeeding. Telehealth interventions decreased the need for high-risk obstetric monitoring office visits while maintaining maternal and fetal outcomes. One study found reductions in diagnosed preeclampsia among women with gestational hypertension. Telehealth interventions were effective for continuation of oral and injectable contraception; one text-based study found increased oral contraception rates at 6 months. Telehealth provision of medication abortion services had similar clinical outcomes compared with in-person care and improved access to early abortion. Few studies suggested utility for telehealth to improve notification of sexually transmitted infection test results and app-based intervention to improve urinary incontinence symptoms. CONCLUSION: Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. Further well-designed studies are needed to examine these interventions and others to generate evidence that can inform decisions about implementation of newer telehealth technologies into obstetrics and gynecology practice.
    Type of Medium: Online Resource
    ISSN: 0029-7844
    URL: Article
    DOI: 10.1097/AOG.0000000000003646
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2012791-1
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  • 9
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    Blood Pressure Trends in Pregnancy: Is There a New Normal? [29D]
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Obstetrics & Gynecology Vol. 129, No. 1 ( 2017-05), p. 49S-49S
    Details
    In: Obstetrics & Gynecology, Ovid Technologies (Wolters Kluwer Health), Vol. 129, No. 1 ( 2017-05), p. 49S-49S
    Abstract: Few studies have explored blood pressure (BP) trends in pregnancy and the postpartum period. The accepted belief is that BP in pregnancy stays close to non-pregnant values (120/80mmHg). Studies also suggest variance between clinic and home based BP measurements. In this report, we describe the use of digital health technology to gather weekly BP values and better track BP trends in pregnancy. METHODS: Retrospective analysis was conducted of pregnant patients enrolled in the first trimester from 12 university-affiliated clinics. Patients received a digital sphygmomanometer and were asked to check home-based blood pressure at least weekly. BP averages were categorized by pre-pregnancy body mass index (BMI). RESULTS: 381 patient records had complete blood pressure data for the entire pregnancy totaling 8101 data points. Mean systolic BP was 101 mmHg (±11.3) for BMI 〈 18.5, 106 mmHg (±10.8) for BMI 18.5-24.9, 112 mmHg (±10.6) for BMI 25-29.9, 117 mmHg (±11) for BMI 30+. An ANOVA analysis demonstrated significant differences between weight classes (p 〈 2.8e-34). Mean systolic BP was higher in clinic vs at home except in the obese class. CONCLUSION: Mean systolic BP may be lower in pregnancy and increases significantly with increasing BMI. BP collected at home is frequently lower than clinic measurements and may be a more accurate reflection of “normal” BP. We plan to analyze this data to identify norms for each trimester. Further study of high frequency at-home BP monitoring is needed to improve our understanding of blood pressure trends in pregnancy.
    Type of Medium: Online Resource
    ISSN: 0029-7844
    URL: Article
    DOI: 10.1097/01.AOG.0000514374.14611.16
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 10
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    Evaluating Patient Satisfaction and Experience for Technology-Enabled Prenatal Care for Low Risk Women [1L]
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Obstetrics & Gynecology Vol. 131, No. 1 ( 2018-05), p. 129S-129S
    Details
    In: Obstetrics & Gynecology, Ovid Technologies (Wolters Kluwer Health), Vol. 131, No. 1 ( 2018-05), p. 129S-129S
    Abstract: Telemedicine and connected health has the potential to remodel prenatal care by enabling more frequent contact and increased patient engagement. This study sought to measure patient satisfaction in low-risk pregnant women who used an integrated mobile platform to supplement prenatal care. METHODS: Five hundred ninety-five surveys were administered to low-risk pregnant women enrolled in the Babyscripts (BRx) program, an integrated technology platform including a mobile application and connected devices (weight scale and blood pressure cuff). A 15-question survey was administered to gauge participant satisfaction in the mobile app, pregnancy readiness, relationship to the healthcare team, patient perception of saved time in the clinic, ease of use and educational content. Metrics were analyzed as percent of the total possible score. RESULTS: Among 131 respondents (22% response rate) overall patient satisfaction measured high, ranging 85%–95% (agree/strongly agree) in remote monitoring, 82%–88% with the mobile app, 77%–85% for pregnancy readiness, and 83%–90% in their relationship with the healthcare team. Ninety-three percent of respondents agreed that BRx saved time in the clinic. The mobile app was rated as “easy to use” by 86%, with a 93% and 75% ease of use rating for the weight scale and blood pressure monitor, respectively. The educational value of the app was also highly rated at 84%. CONCLUSION: Patient satisfaction with the mobile connected health platform was high. These findings support the integration of connected health platforms in low-risk pregnancies. This study suggests potential for connected health to improve value-based clinical outcomes, which can be explored with future research.
    Type of Medium: Online Resource
    ISSN: 0029-7844
    URL: Article
    DOI: 10.1097/01.AOG.0000533541.36412.24
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2012791-1
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