Research Department Publications 2017

Anderson, B., Peters, E., Fialkow, M., Taouk, L. (2017). Obstetrician-gynecologists’ opinions about the Affordable Care Act and their expectations about how it will affect their practice. Preventive Medicine. 7(2017):216-220.

As the primary healthcare providers for women, obstetrician-gynecologists' (OB/GYNs) experiences with and opinions about the Affordable Care Act (ACA) are important to understand. An online survey was sent to 1000 randomly selected OB/GYNs who are members of the American College of Obstetricians and Gynecologists (ACOG) in 2014. Of those, 523 opened the email and 163 responded (31% participation rate). Data were collected August 2014-October 2014 and analyzed in 2015–2016. Support for the ACA was widely distributed, with the largest subset of the sample (about 21%) in the “very supportive” category. Opinions of the ACA were more supportive than they were in a previous study conducted in 2011. When given a list of possible positive and negative impacts of the ACA on their practice, roughly 1 in 5 reported that the ACA increased work-related stress (28%), decreased total profits (22%), and lowered career satisfaction (22%), whereas 8.6% reported that the ACA increased quality of care. Around half of the providers thought that their newly insured patients would have the same level of education (42%) and numeric ability (55%) as their current patients. Almost all respondents (87%) indicated that it is at least slightly important for patients to understand their numeric likelihood of risk (such as numeric risk information from medications, treatments, and other procedures you might prescribe) —31% think it is extremely important and 44% think it is moderately important.

Dokras A., Saini S., Gibson-Helm M., Schulkin J., Cooney L., Teede H. (2017). Gaps in knowledge among physicians regarding diagnostic criteria and management of polycystic ovary syndrome. Fertility and Sterility. 2017;107(6):1380-1386.e1.

OBJECTIVE: To identify gaps in polycystic ovary syndrome (PCOS) knowledge and practice patterns among physicians in North America in response to significant dissatisfaction identified among women with PCOS regarding their diagnosis and treatment experience.

DESIGN: Online survey conducted via American College of Obstetrics and Gynecology of gynecologists (ObGyn) and American Society of Reproductive Medicine of reproductive endocrinologists (REI-ObGyn) in 2015–16.

SETTING: Not applicable.

PATIENT(S): None.

INTERVENTION(S): None.

MAIN OUTCOME MEASURE(S): Diagnostic criteria used, key features of PCOS, management practices.

RESULT(S): Of the 630 surveys completed, 70.2% were ObGyn and 64.4% were females. Overall 27.7% respondents did not know which PCOS diagnostic criteria they used. In a multivariable analysis including physician type, age, gender, and number of patients with PCOS seen annually, REI-ObGyn were less likely compared with ObGyn to report not knowing which criteria they used (adjusted odds ratio, 0.08; 95% confidence interval, 0.04, 0.16). REI-ObGyn were more likely to use the Rotterdam criteria (odds ratio, 2.26; 95% confidence interval, 1.33, 3.82). The majority of respondents recognized the clinical features associated with PCOS; however, over one-third associated ‘‘cysts on ovaries’’ with PCOS. The majority of responders (>85%) were aware of cardiometabolic comorbidities; however, fewer ObGyn were aware of associated depression, anxiety disorders, and reduced quality of life. More REI-ObGyn recommended lifestyle changes compared with ObGyn (56.4% vs. 41.6%).

CONCLUSION(S): Our large-scale PCOS survey, conducted in response to patient concerns regarding diagnosis and treatment, highlights opportunities for physician education. Focus areas include targeting knowledge of internationally accepted Rotterdam criteria and ensuring consistent care informed by evidence-based guidelines across the reproductive, metabolic, and psychological features of PCOS.

Dotters-Katz, S., Smid, M., McElwain, C., Kuller, J., Schulkin, J. (2017, Epub ahead of print). Obstetric practice patterns in pregnancies complicated by fetal trisomy 13 or 18. The Journal of Maternal-Fetal & Neonatal Medicine.

PURPOSE: Describe practice patterns among obstetrician/gynecologists (OB/GYNs) when caring for women with pregnancy complicated by fetal trisomy 13(T13) or 18(T18), and compare these between maternal-fetal-medicine (MFM) and non-MFM providers.

METHODS: We conducted an electronic survey using the American College of Obstetricians and Gynecologists database. Using simple statistics, we describe demographics and practice patterns among respondents, and compare those of MFM practitioners with non-MFM providers.

RESULTS: The survey was sent to 300 individuals, 161 individuals verified email receipt, and 105 had complete response and were included. The median age was 58 (IQR 53,62). sixty per cent were female, 69% were private practice, and 38% were MFM. All providers were more likely to offer than to recommend antenatal and intrapartum interventions. MFMs were more likely to offer growth ultrasounds and neonatal hospice consults (53 vs. 29%, p=0.02; 88 vs. 60%, p<0.01). During labor, MFMs were more likely offer no fetal heart rate monitoring, (90 vs. 52%, p<0.01),) sixty per cent of all providers offer breech vaginal delivery; 32% offer Caesarean delivery for fetal distress.

CONCLUSION: Many providers offer antepartum and intrapartum interventions for pregnancies complicated by T13/18. We recommend that providers elicit each woman’s goals for pregnancies complicated by T13/18 and tailor management options to meet these goals.

Easter, S., Taouk, L., Schulkin, J., Robinson, J. (2017). Twin Vaginal Delivery: Innovate or Abdicate.
American Journal of Obstetrics & Gynecology 216(5): 484-488.

Neonatal safety data along with national guidelines have prompted renewed interest in vaginal delivery of twins, particularly in the case of the noncephalic second twin. Yet, the rising rate of twin cesarean deliveries, coupled with the national decline in operative obstetrics, raises concerns about the availability of providers who are skilled in twin vaginal birth. Providers are key stakeholders for increasing rates of twin vaginal delivery. We surveyed a group of practicing obstetricians to explore potential barriers to the vaginal birth of twins with a focus on delivery of the noncephalic second twin. Among 107 responding providers, only 57% would deliver a noncephalic second twin by breech extraction. Providers who preferred breech extraction had a higher rate of maternal-fetal medicine subspecialty training (26.2% vs 4.3%; P<.01) and were more likely to be in an academic practice environment (36.1% vs 10.9%; P<.01) and to practice in high-volume centers that deliver >30 sets of twins annually (57.4% vs 34.8%; P=.02). Most providers (54.2%) were familiar with the findings from the recent randomized trial that demonstrated the safety of twin vaginal birth. However, knowledge of the trial was not associated statistically with a preference for breech extraction (62.3% vs 43.5%; P=.05). Providers who preferred breech extraction were more likely to agree with recent society guidelines that encourage the vaginal birth of twins (86.9% vs 63.0%; P<.01). In an adjusted analysis, the 46% of providers with a perceived need for more training were far less likely to prefer breech extraction for delivery of a noncephalic second twin (adjusted odds ratio, 0.38; 95% confidence interval, 0.16–0.95). Furthermore, 57% of providers who would not offer their patient breech extraction would be willing to consult a colleague for support with a noncephalic twin delivery. These results suggest that scientific evidence and society opinion are likely insufficient to reverse the national trends that favor cesarean delivery for twins. Instead, implementation of provider training and support programs is critical for increasing the rates of twin vaginal birth. Changing our national landscape of vaginal twin delivery may require innovation. Without novel provider-focused strategies, we may relinquish passively the requisite skills for not only our patients but also for future generations of obstetricians.

Fialkow M., Snead C., Schulkin J. (2017). New partner recruitment to rural vs. urban ob-gyn practices: A survey of practicing ob-gyns. Health Services Research & Managerial Epidemiology. 4:1-5.

PURPOSE: The purpose of this pilot study was to investigate the recruitment efforts of practicing obstetrics and gynecology (ob-gyns) from rural and urban practices.

METHODS: The authors surveyed practicing ob-gyns from 5 states in the Pacific Northwest in 2016 about their background, practice setting, practice profile, partner recruitment, and retention.

RESULTS: Seventy-three patients completed the study (53.2% response rate). Thirty-seven percent of respondents work in an urban practice and 43% have a rural practice, with the remainder in a suburban setting. A majority of the respondents attempted to recruit a new partner in the past 5 years. Respondents were most interested in experience and diversity in new recruits. Urban respondents, however, were more interested in hiring those with specialized skills (w2 ¼ 7.842, P ¼ .02) than rural providers who were more interested in partners familiar with their community (w2¼ 7.153, P ¼ .03). Reasons most often cited to leave their practice were reimbursement, limited social/marital options, and workload, other than rural providers who more often also cited lack of access to specialty care (w2¼ 13.256, P ¼ .001). Rural providers were more likely to cite marital and family status as an advantage to recruitment, whereas urban and suburban providers were more often neutral.

CONCLUSIONS: Reduced access to care has led to significant health disparities for women living in rural communities. Understanding which providers are most likely to be successful in these settings might help preserve access as our health-care systems evolves.

Hall, R., Anderson, B., Schulkin, J., Cantey, P., Montgomery, S., Jones, J. (2017). Survey of Obstetrician-Gynecologists in the United States about Taeniasis and Cysticercosis. American Journal of Tropical Medicine and Hygiene 96(1):233-242.

An estimated 50 million persons worldwide are infected with cysticerci, the larval forms of the Taenia solium tapeworm. Neurocysticercosis can cause seizures, epilepsy, and hydrocephalus, and fatal cases have been reported in the United States in immigrants and in travelers returning from endemic countries. Pregnant women with symptomatic neurocysticercosis present treatment challenges, whereas those with the adult tapeworm infection (i.e., taeniasis) can put their infants and other family members, as well as obstetrician-gynecologists and their staff, at risk for cysticercosis. A questionnaire developed by the American College of Obstetricians and Gynecologists was sent to a representative sample of 1,000 physicians to assess their awareness of T. solium infection and the potential for it to be encountered in an obstetrics and gynecology setting. In total, 31.4% of respondents correctly answered that taeniasis is caused by eating undercooked pork containing T. solium cysts (95% confidence interval [CI] = 26.6–36.5). While only 14.5% (95% CI = 11.0–18.6) of respondents correctly answered that cysticercosis is acquired by ingesting tapeworm eggs shed in human stools, twice that number (30.3%; 95% CI = 25.5–35.3) correctly answered that a mother with taeniasis can cause cysticercosis in her infant. Practicing in a state in which cysticercosis was reportable at the time of the survey was not significantly associated with answering any of the 12 knowledge questions correctly. Overall, knowledge of T. solium infection among U.S. obstetricians-gynecologists is limited. This may result in missed opportunities to diagnose and treat pregnant women with taeniasis, which may put family members and obstetrics clinical staff at risk for cysticercosis.  

Jones, N., Schulkin, J., Urban, R., Wright, J., Burke, W., Hou, J., McElwain, C., Tergas, A. (2017). Physicians' Perspectives and Practice Patterns Toward Opportunistic Salpingectomy in High- and Low-Risk Women.  Cancer Investigation 35(1):51-61.

BACKGROUND:  Opportunistic bilateral salpingectomy (OBS) has been proposed as an ovarian cancer risk-reducing strategy.

METHODS:  A survey was emailed to 300 members of the American College of Obstetricians and Gynecologists.

RESULTS:  125 (42%) surveys were returned: 60% female, 88% generalists, 67% private practice. Only 36% correctly identified the lifetime risk of ovarian cancer, only 23% understood the risk-reducing benefit of bilateral salpingo-oophorectomy. 75% perform salpingectomy during hysterectomy, 26-53% use for sterilization depending on approach. Concerns were increased operative time and complications. For BRCA mutations, 64% recommend BSO, 12% recommend a two-step risk-reducing strategy, and 14% refer to gynecologic oncology.

CONCLUSIONS:  We identified broad support and factors limiting willingness to perform OBS.

Lam C., Anderson B., Lopes V., Schulkin J., Matteson, K. (2017). Assessing Abnormal Uterine Bleeding: Are Physicians Taking a Meaningful Clinical History? Journal of Women’s Health. 26(7): 762-767.

INTRODUCTION: Women with abnormal uterine bleeding (AUB) report significant reductions in quality of life (QOL), which can be attributed in many cases to the fear of embarrassing episodes of bleeding. We performed this study to determine whether or not during clinical encounters physicians addressed the impact of AUB on patient-reported QOL.

MATERIALS AND METHODS: Between October 2008 and May 2009, we conducted a cross-sectional study of members of the American College of Obstetricians and Gynecologists. Surveys were distributed using a mixed method (web- and mail-based) and included questions about physician characteristics and types of questions used when obtaining a clinical history from a patient with AUB. We calculated the proportion of physicians who endorsed asking each type of clinical question with 95% confidence intervals (CIs).

RESULTS: Four hundred seventeen questionnaires were returned (52%). Ninety-nine percent (95% CI 98.4%-99.9%) reported always asking a bleeding heaviness question, 87.2% (95% CI 83.2%-90.5%) reported always asking a QOL question, and 17.5% (95% CI 13.6%-21.9%) reported always asking a mood associated with bleeding question. Seventy-eight percent specifically asked patients about bleeding through their clothes, and 55% asked about changing social plans because of bleeding. Only 18% endorsed that asking about QOL was most essential for the evaluation of women with AUB. No physician characteristics such as years since completing residency, geography, or gender were associated with how commonly providers reported asking questions regarding impact of bleeding on QOL.

CONCLUSIONS: Physicians may not be optimizing patient-provider interactions during menstrual history taking with patients with AUB by failing to assess impact of AUB on QOL in a way that is meaningful to patients.

Marcewicz, L., Anderson, B., Schulkin, J., Grant, A., Byams, V. (2017). Screening and treatment for iron deficiency anemia in women: results of a survey of obstetrician-gynecologists. Maternal and Child Health Journal. 21(8):1627-1633.

OBJECTIVE: To better understand the knowledge, attitudes and practices of obstetrician-gynecologists with respect to screening and treatment for iron deficiency anemia (IDA).

METHODS: A total of 1,200 Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists were invited to participate in a survey on blood disorders. Respondents completed a questionnaire regarding their patient population, screening and treatment practices for IDA, and general knowledge about IDA and its risk factors.

RESULTS: Overall response rate was 42.4%. Thirty-eight percent of respondents screen non-pregnant patients regularly, based on risk factors; 30.5% screen only when symptoms of anemia are present. For pregnant patients, 50.0% of respondents screen patients at their initial visit, while 46.2% screen every trimester. Sixty-one percent of respondents supplement pregnant patients when there is laboratory evidence of anemia; 31.6% supplement all pregnant patients. Forty-two percent of respondents screen post-partum patients based on their risk factors for IDA. However, when asked to identify risk factors for post-partum anemia, slightly more than half of respondents correctly identified young age and income level as risk factors for post-partum anemia; only 18.9% correctly identified pre-pregnancy obesity as a risk factor. 

CONCLUSION: There are opportunities for increased education on IDA for obstetrician-gynecologists, specifically with respect to risk factors. There also appears to be substantial practice variance regarding screening and supplementation for IDA, which may correspond to variability in professional guidelines. Increased education on IDA, especially the importance of sociodemographic factors, and further research and effort to standardize guidelines is needed.

Moaddab, A., Mccullough, L., Chervenak, F., Stark, L., Schulkin, J., Dildy, G., Raine, S., Shamshirsaz, A. (2017). A Survey of the Prevalence of Honor-Related Practices Among Obstetricians and Gynecologists. International Journal of Gynecology and Obstetrics. 139(2):164-169. 

OBJECTIVE:  To assess patterns of honor-related practices—including virginity testing, virginity restoration, and female genital mutilation (FGM)—among US obstetrician–gynecologists (OBGYNs).

METHODS:  Between June 1 and August 31, 2016, 1000 members of the American College of Obstetricians and Gynecologists were invited by email to complete an anonymous online survey. The survey comprised 42 questions evaluating the demographic and practice characteristics of the respondents. 

RESULTS:  Overall, 288 of the 909 practicing US OBGYNs with functioning email addresses completed the survey (31.7% response rate). In the 12 months before the survey, 168 (58.3%) respondents had provided care to one or more patients who had previously undergone FGM. Care was also provided for patients who requested virginity testing or virginity restoration by 29 (10.1%) and 16 (5.6%) respondents, respectively. Ten (3.5%) respondents performed virginity testing on request, whereas 3 (1.0%) performed virginity restoration. 

CONCLUSIONS:  Some respondents performed honor-related practices, which indicated a need to educate all practicing US OBGYNs about their ethical and legal obligations in the care of such patients.

Mohamed S., El Andaloussi A., Al-Hendy A., Menon R., Behnia F., Schulkin J., Power M. (2017, Epub ahead of print). Vitamin D and corticotropin-releasing hormone in term and preterm birth: potential contributions to preterm labor and birth outcome. Journal of Maternal-Fetal & Neonatal Medicine. 

BACKGROUND:  Poor maternal vitamin D status and elevated circulating corticotropin-releasing hormone (CRH) are associated with preterm birth. It is not known if these risk factors are independent or interrelated. Both are associated with inflammation.

METHODS:  We measured maternal circulating 25-hydroxyvitamin D (25-OH-D) and CRH from 97 samples collected from 15 early-preterm, 31 late-preterm, 21 early-term, and 30 term births. The potential involvement of vitamin D in the regulation of inflammation was evaluated by Q-PCR in human uterine smooth muscle (UTSM) cell line.

RESULTS:  Maternal 25-OH-D was lowest in early-preterm births (22.9 ± 4.2 ng/ml versus 34.4 ± 1.4 ng/ml; p = .029). Circulating CRH was high in early-preterm births (397 ± 30 pg/ml). Late-preterm (304 ± 13 pg/ml) and early-term births (347 ± 17 pg/ml) were not different from term births (367 ± 19 pg/ml), after accounting for gestational age. Maternal circulating 25-OH-D and CRH were not associated in term births. In preterm births, 25-OH-D below 30 ng/ml was associated with higher CRH. Vitamin D treatment of UTSM significantly reduced mRNA for leptin and IL-6 receptors. Deletion of vitamin D receptor from UTSM promoted the expression of the cox2 inflammatory marker.

CONCLUSION:  Early-preterm birth showed a syndrome of high maternal CRH and low vitamin D status.

Power, M., Quaglieri, C., Schulkin, J. (2017). Reproductive Microbiomes: A New Thread in the Microbial Network. Reproductive Sciences. 24(11):1482-1492.

Almost every part of our body has a coevolved microbial community. The expressed microbial genes comprise the various microbiomes that play important roles in normal physiology and development. The various microbiomes are separate, yet often connected, with the species composition of one affecting others. The female reproductive system microbiomes (eg, vaginal, placental, and mammary/milk) remain less well explored than the gut microbiome although they comprise a large proportion of the female microbial network. This review examines the evidence for interconnectivity between the female reproductive microbiomes, other maternal microbiomes, and developing infant microbiomes and the potential roles of each in health and disease. Disruptions in maternal microbiomes may be linked to pregnancy complications and maternal, fetal, and neonatal health. The diversity of the vaginal microbiome's makeup, which appears to vary across ethnicity, has led researchers to reconsider the idea of a "healthy" or "normal" vaginal microbial community. Less is known about the possible placental microbiome, although an association between the placenta's bacterial makeup and preterm labor and other pregnancy complications is being investigated. The mammary/milk microbiome appears to be influenced by maternal characteristics and may play a role in inoculating the infant but may also be affected by the infant's oral microbiome. Probiotic therapies such as "vaginal seeding" offer potential health benefits but require more rigorous testing. Exploring the reproductive microbiomes in detail and pairing this information with an individual's detailed medical history will provide a more complete picture of the status and importance of the microbial network to health.

Power, M., Schulkin, J. (2017). Obstetrician/gynecologists’ knowledge, attitudes, and practices regarding weight gain during pregnancy. Journal of Women’s Health. 26(11):1169-1175.

OBJECTIVE: Assess obstetrician–gynecologists’ knowledge and counseling practices regarding gestational weight gain (GWG).

MATERIALS AND METHODS: Questionnaire studies were conducted in 2012 and 2014 sent to practicing obstetrician– gynecologists.

RESULTS: Response rates were 111/236 (47%) and 206/474 (43.5%). The majority of respondents agreed (50.0%) or strongly agreed (26.6%) that excessive GWG is a major health concern, often or always calculate the body mass index (BMI) of their patients (79.1%), and use BMI to modify their weight gain recommendations (78.5%). The physicians reported that, on average, 7.8% of pregnant patients gained too little weight, 47.3% gained an appropriate amount, and 45.1% gained too much. A greater proportion of patients with private insurance was associated with physician perception of fewer gaining excessive weight (r=-0.205, n = 198, p = 0.004), whereas high proportions with Medicaid or uninsured were positively correlated with a perception of excessive GWG (r = 0.206 and 0.187, n = 198, p = 0.004 and 0.008, respectively). A majority of physicians (55.1%) were not confident in their ability to affect their patients’ prenatal weight gain. Confident physicians exhibited more appropriate practice efforts (e.g., use pre-pregnancy BMI; 83.6% vs. 74.8%, p = 0.009) and were more likely to inform their patients about the increased risk of pregnancy complications (90.8% vs. 69.7%, p = 0.001) and possible harms to their baby (76.9% vs. 61.0%, p = 0.001) from excessive GWG. 
CONCLUSIONS: Study participants perceived excessive GWG to be a significant problem, but had low confidence in their ability to address it.

Raglan, G., Margolis, B., Paulus, R., Schulkin, J. (2017). Electronic Health Record Adoption Among Obstetrician/Gynecologists in the United States: Physician Practices and Satisfaction. Journal for Healthcare Quality. 39(3):144-152.

Implementation of electronic health records (EHRs) has historically been lower among obstetrician-gynecologists (ob-gyns) than many physician groups. This study described ob-gyns' adoption and use of EHR systems in practice, as well as barriers and benefits to implementation. Surveys asking about the physicians' use of EHR, satisfaction with systems, and what features they found most or least helpful were mailed to 1,200 ob-gyns. An overall response rate of 57.4% was achieved, with 559 returning completed surveys. Over three-quarters of responders reported that they used an EHR system or planned to implement one. Physicians without EHR tended to be older, were more likely to be male, have a solo practice, and describe themselves as Asian/Pacific Islander. Over 63% of those physicians who use EHR reported being satisfied with their system, while 30.8% were not satisfied. Ob-gyns who reported satisfaction had a younger mean age (M = 52.98, SD = 8.87) than those not satisfied (M = 56.30, SD = 8.59; p = .002). Use of EHR systems among ob-gyns has increased in recent years and overall satisfaction with these systems is high. In spite of this, barriers to implementation are still present and increased outreach to certain groups of ob-gyns, including older practitioners and those in solo practices, is needed.

Smid, M., Dotters-Katz, S., McElwain, C., Stuebe, A., Volckmann, E., Schulkin, J. (2017). Pregnancy after bariatric surgery: National survey of obstetrician’s comfort, knowledge, and practice patterns. Obesity Surgery. 27(9):2354-2359.

OBJECTIVE: To survey a nationally representative sample of obstetricians regarding comfort, knowledge and practice patterns of caring for pregnant women after bariatric surgery.

MATERIALS AND METHODS: We conducted an online survey of US obstetricians and describe obstetrician’s demographics, practice settings and practice patterns. We assessed respondent’s knowledge and recommended practices. We compared provider knowledge by years since completing residency, scope of practice (generalist or specialist), and practice setting (academic setting or other). Statistical significance was set at p < .05. 

RESULTS: A total of 106 completed the survey (response rate of 54%). Respondents had a median age of 47 and median 17 years in practice. 62% were generalists. Nearly all of the respondents (94%) had some experience with caring for pregnant women after bariatric surgery and 83% reported feeling “very comfortable” (48%) or “somewhat comfortable” (35%) providing care for this population. Most (74%) were aware of increased risk of small for gestational age after surgery. Only 13% were able to correctly identify all recommended nutritional labs and 20% reported that they “did not know” which labs are recommended. There were no differences in comfort, experience, knowledge and practice patterns by physician characteristics and practice settings.

CONCLUSION: While most obstetricians are aware of perinatal risks after bariatric surgery, a substantial percentage of obstetricians are unaware of recommended practices regarding nutrition and nutritional monitoring. As bariatric surgery becomes increasingly prevalent among reproductive age women, educational interventions to increase obstetricians’ knowledge of optimal care of pregnant women after bariatric surgery are urgently needed.

Taouk, L., Farrow, V., Schulkin, J. (2017). Amount and Quality of Sleep: Exploring the Role of Stress and Work Experience in a Sample of Obstetrician-Gynecologists. Journal of Psychosomatic Obstetrics and Gynecology 2:1-6

INTRODUCTION: Sufficient sleep is necessary for optimal performance and the delivery of safe and effective health care. To establish an empirical understanding of physician fatigue, the present study investigated the factors that contributed to the amount and the quality of sleep among obstetricians and gynecologists (ob-gyns).

METHODS: A survey of personal and work experiences was sent to 495 eligible physicians belonging to the American College of Obstetricians and Gynecologists (ACOG). Data were obtained from 287 ob-gyns for a response rate of 58.0%. Associations between sleep-related items and measures of stress and work-related factors were explored.

RESULTS: Ob-gyns in our sample reported sleeping an average of 6.5 hours a night with 29.2% indicating that they received very or fairly bad quality of sleep. Average amount and quality of sleep were found to be independently related to the hours worked weekly, colleague support for a work-home balance, practice setting, perceived work-control, physician-specific stressors and perceived stress. In summary models, hours worked and perceived stress scores consistently emerged as predictors of amount of sleep.

CONCLUSIONS: Overall, findings explained a small portion of the variance in sleep. Considering the multitude of factors that contribute to sleep, subtle associations warrant further investigation.

Wright J., Raglan G., Fialkow M., Schulkin J. (2017). Attitudes and Beliefs Regarding the Utility of Robotically Assisted Gynecologic Surgery Among Practicing Gynecologists. Journal for Healthcare Quality. 39(4):211-218.

While use of robotic-assisted surgery has increased rapidly, little is known about the attitudes and beliefs of practicing gynecologists regarding the utility of the technology. We surveyed a large sample of gynecologists to examine their attitudes and beliefs about the benefits, utility, and factors driving use of robotic-assisted gynecologic surgery. A 51-item survey was mailed to 600 fellows or junior fellows of the American College of Obstetricians and Gynecologists. The survey included questions on use of robotic surgery, decision-making, and beliefs regarding the technology. Responses were stratified based on whether the respondent used robotic surgery or not. A total of 310 responses were received including 27.8% who used robotic surgery in their practices. Hysterectomy was the most commonly performed procedure. Opinions about the use and effectiveness of robotic procedures varied based on whether an individual was a robot user. Eighty-two percentage of robot users and 21% of nonrobot users believed robotic surgery provided benefits over laparoscopic (p < .0001). Among both groups, the ability to increase access to minimally invasive surgery and marketing were believed to be the greatest drivers of use of robotic surgery. Attitudes and beliefs about the effectiveness of robotic gynecologic surgery are highly variable among clinicians.

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