1 / 73

2009 Summer Student Research and Clinical Assistantship Program Research Presentations

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

sirvat
Download Presentation

2009 Summer Student Research and Clinical Assistantship Program Research Presentations

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 2009 Summer Student Research and Clinical Assistantship ProgramResearch Presentations Department of Family Medicine August 7, 2009

  2. 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”

  3. 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

  4. 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

  5. Decline In BIMR MMWR Morb Mortal Wkly Rep. 58(20):2009

  6. 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

  7. 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

  8. Study Goal • Explore whether the decrease in Dane Co. BIMR is related to increased screening, diagnosis, or treatment for GU tract infections

  9. 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

  10. 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

  11. 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)

  12. Results and Discussion • Pending

  13. 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

  14. Acknowledgements • Gloria Sarto, MD • Laura Berghahn, MD • Amanda Schmeil, MD • Murray Katcher, MD • Carley Zeal, BS • Shapiro Scholarship • MERC grant

  15. Infant Mortality Investigation Taya Schairer and Leah Haglund Mentor: Dr. Lee Dresang

  16. 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)

  17. 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

  18. 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

  19. 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

  20. 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

  21. Difficulties Encountered Forms incomplete Self-report Subjective nature of questions Infant Death Record

  22. Project Status • Currently we have collected data for 125 African American Pregnancies • 1997/1998: 52 • 2007: 73 • Analysis has not yet been conducted

  23. 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%)

  24. 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%)

  25. 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%)

  26. 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.

  27. Analyzing the Feasibility of Group Prenatal Visits at Wingra Clinic Emily Holtan, medical student Suhani Bora, MD and Beth Potter, MD

  28. 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

  29. 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

  30. 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?

  31. Study design Three aspects of information gathering:

  32. (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

  33. (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

  34. (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

  35. 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

  36. Results: (2) Survey to Patients (3) Survey to Residents Still Pending IRB Approval *application for IRB-exemption submitted July 13th

  37. 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

  38. 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

  39. 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

  40. 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

  41. Gender and Authorship of Papers in Family Medicine Journals 2006-2008 Carla J. Bouwkamp Faculty Supervisor: Sarina Schrager, MD

  42. 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!

  43. 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

  44. 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

  45. 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

  46. Percentage Breakdown by Genderduring the 2006-2008 period

  47. Percentage Breakdown by Genderfrom 2006-2008

More Related