Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-7 (of 7 Records) |
Query Trace: Power ML[original query] |
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Patterns of preconception, prenatal and postnatal care for diabetic women by obstetrician-gynecologists
Power ML , Wilson EK , Hogan SO , Loft JD , Williams JL , Mersereau PW , Schulkin J . J Reprod Med 2013 58 7-14 OBJECTIVE: To assess barriers to and quality of care received by diabetic pregnant women from obstetrician-gynecologists. STUDY DESIGN: A questionnaire was mailed to 1,000 representative practicing Fellows of the American College of Obstetricians and Gynecologists; 74 did not treat pregnant patients and 510 (55.1%) returned completed surveys. Respondents were divided into 3 groups: maternal-fetal medicine specialists, physicians with high minority/low insurance patient populations, and physicians with low minority/ high insurance patient populations. RESULTS: Reported preconception and prenatal care was generally consistent with guidelines. Regarding gestational diabetes mellitus patients the 3 physician groups differed in assessing postpartum glycemic status, counseling about lifestyle changes, and counseling patients to consult a doctor before their next pregnancy. Patient demographics and perceived barriers to care were similar between maternal-fetal medicine specialists and physicians with high minority/low insurance patient populations. These two physician groups were more likely to agree that lack of educational materials, arranging specialist referrals, patient compliance with recommendations, and patients' ability to afford healthful food were barriers to quality care. CONCLUSION: According to physician self-report, pregnant diabetic patients with access to an obstetrician receive quality care regardless of insurance status. Postpartum care is more variable. Physicians with high minority/low insurance patient populations may lack access to resources. |
Attitudes and practices regarding late preterm birth among American obstetrician-gynecologists
Power ML , Henderson Z , Behler JE , Schulkin J . J Womens Health (Larchmt) 2013 22 (2) 167-72 BACKGROUND: Late preterm birth (LPTB) accounts for most preterm births and has been increasing, associated with increases in cesarean sections and inductions at this gestational age. METHODS: A self-administered survey, consisting of questions about opinions, knowledge, and practices regarding LPTB, was mailed to 1232 American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in Practice in May-July 2010. RESULTS: Surveys were returned by 520 practicing obstetricians. Two thirds of respondents correctly defined LPTB (34-36 weeks completed gestation). Most responding physicians (87%) were aware of the evidence regarding morbidity and mortality of infants born at 34-36 weeks; 81% considered such evidence sufficient to make a clinical judgment. Although 84% were concerned about long-term health problems in these infants, many disagreed that LPTB infants were at increased risk of long-term neurodevelopmental outcomes. Most agreed that the increase in LPTB in the United States is due to increasing rates and complications of multifetal pregnancies and maternal disorders. Almost all responding physicians agreed that certain clinical indications (e.g., severe preeclampsia, placental abruption, premature rupture of the membranes [PROM]) were appropriate reasons for early delivery, and most disagreed with delivering late preterm infants for logistical reasons or convenience. Half of responding physicians reported that concerns about malpractice risks contribute to their decision to induce labor or perform a cesarean section at 34-36 weeks. CONCLUSIONS: Many obstetricians underestimate long-term neurodevelopmental outcomes among infants born late preterm and may have a lower threshold to deliver some infants late preterm for indications that are not evidence based. Additional educational efforts regarding LPTB are needed. |
Practices of obstetrician-gynecologists regarding nonvaccine-related public health recommendations during the 2009 H1N1 influenza pandemic
Rasmussen SA , Power ML , Jamieson DJ , Williams J , Schulkin J , Kahn EB , Zhang Y , Macfarlane K , Kissin DM . Am J Obstet Gynecol 2012 207 (4) 294 e1-7 OBJECTIVE: We examined practices of obstetrician-gynecologists regarding nonvaccine-related public health recommendations during the 2009 H1N1 influenza pandemic. STUDY DESIGN: From February-May 2010, a survey was sent to a random sample of members of the American College of Obstetricians and Gynecologists involved in obstetric care. RESULTS: Obstetrician-gynecologists varied in their adherence to 2009 H1N1 influenza public health recommendations. Nearly all reported prescribing antiviral medications to pregnant women with suspected influenza. Most obstetrician-gynecologists reported using preventive practices in the outpatient setting to reduce exposure of well patients to ill ones. A wide range of responses was provided regarding postpartum infection control practices, suggesting lack of awareness of, disagreement with, or difficulty adhering to these recommendations. CONCLUSION: Obstetrician-gynecologists reported that they adhered to some recommendations related to 2009 H1N1 influenza, but not to others. These data provide insight into strategies for development and dissemination of recommendations in a future pandemic. |
Attitudes and practices of obstetrician-gynecologists regarding influenza vaccination in pregnancy
Kissin DM , Power ML , Kahn EB , Williams JL , Jamieson DJ , Macfarlane K , Schulkin J , Zhang Y , Callaghan WM . Obstet Gynecol 2011 118 (5) 1074-80 OBJECTIVE: To assess knowledge, attitudes, and practices of obstetrician-gynecologists (ob-gyns) regarding vaccination of pregnant women during the 2009 H1N1 pandemic. METHODS: From February to July 2010, a self-administered mail survey was conducted among a random sample of American College of Obstetricians and Gynecologists (the College) members involved in obstetric care. To assess predictors of routinely offering influenza vaccination, adjusted prevalence ratios and 95% confidence intervals (CIs) were calculated from survey data. RESULTS: Among 3,096 survey recipients, 1,310 (42.3%) responded to the survey, of whom 873 were eligible for participation. The majority of ob-gyns reported routinely offering both seasonal and 2009 H1N1 influenza vaccination to their pregnant patients (77.6% and 85.6%, respectively) during the 2009-2010 season; 21.1% and 13.3% referred patients to other specialists. Reported reasons for not offering vaccination included inadequate reimbursement, storage limitations, or belief that vaccine should be administered by another provider. Seasonal and 2009 H1N1 influenza vaccination during the first trimester was not recommended by 10.6% and 9.6% of ob-gyns, respectively. Predictors of routinely offering 2009 H1N1 influenza vaccine included: considering primary care and preventive medicine a very important part of practice (adjusted prevalence ratio 1.2, CI 1.01-1.4); observing serious conditions attributed to influenza-like illness (adjusted prevalence ratio 1.1, CI 1.02-1.1); personally receiving 2009 H1N1 influenza vaccination (adjusted prevalence ratio 1.2, CI 1.1-1.4); and practicing in multispecialty group (adjusted prevalence ratio 1.1, CI 1.1-1.2). Physicians in solo practice were less likely to routinely offer influenza vaccine (adjusted prevalence ratio 0.8, CI 0.7-0.9). CONCLUSION: Although most ob-gyns routinely offered influenza vaccination to pregnant patients, vaccination coverage rates may be improved by addressing logistic and financial challenges of vaccine providers. LEVEL OF EVIDENCE: III. |
Prevention and management of obesity in nonpregnant women and adolescents: beliefs and practices of U.S. obstetricians and gynecologists
Cogswell ME , Power ML , Sharma AJ , Schulkin J . J Womens Health (Larchmt) 2010 19 (9) 1625-34 OBJECTIVE: To describe associations between dissemination of educational materials and U.S. obstetrician/gynecologists' prevention and management of obesity in nonpregnant patients. METHODS: Cross-sectional surveys mailed to 806 and 787 members of the American College of Obstetrician and Gynecologists (ACOG) Collaborative Ambulatory Research Network in February-April 2005 and March-May 2007, respectively, before and after dissemination of ACOG Committee Opinions. RESULTS: Compared with participants in 2005 (n = 437), the proportion of participants in 2007 (n = 433) who reported they would screen nonpregnant adult patients using body mass index (BMI), counsel patients most of the time about physical activity, and ever prescribed weight loss medications increased from 84% to 91%, 48% to 55%, and 40% to 48%, respectively (p < 0.05 for all comparisons). In contrast, reported frequencies of counseling or referring nonpregnant patients for weight control were not significantly different (p > 0.05). In 2007, 33% reported counseling most of the time, and 70% reported referral at least sometimes. A lower proportion of 2007 participants indicated it was likely or very likely that patients would follow advice about physical activity or diet or they can help patients lose weight (p < 0.01 for all comparisons). For adolescent patients, 43% and 24% of participants reported counseling most of the time about physical activity and sedentary activity, respectively. Reported frequency of counseling patients about activity, counseling adult patients about weight control, and prescribing medications was higher among obstetrician/gynecologists who reported reading the Committee Opinions. CONCLUSIONS: Despite decreased optimism about the likelihood of patients following advice, modest improvements occurred in some obstetrician/gynecologists' obesity prevention practices between 2005 and 2007. |
US obstetrician-gynaecologist's prevention and management of obesity in pregnancy
Power ML , Cogswell ME , Schulkin J . J Obstet Gynaecol 2009 29 (5) 373-7 A survey regarding management of obesity in pregnancy was mailed to 787 practising members of the American College of Obstetricians and Gynecologists (ACOG); 433 responded of whom 353 practised obstetrics. Most (79.2%) had read ACOG Committee Opinion, 'Obesity in Pregnancy,' and rated it helpful (68.6%) or very helpful (17.2%). Most responding physicians (91.2%) use BMI to assess their patients weight status; fewer (63.4%) use pre-pregnancy BMI to modify their pregnancy weight gain recommendation. Having read the Committee Opinion and being a woman were independent factors associated with using pre-pregnancy BMI. Responding physicians that had read the Committee Opinion were more knowledgeable about obesity-related pregnancy complications; but even among those physicians, only 32.2% were aware that maternal obesity is a risk factor for fetal neural tube defects. The responding physicians appeared well-versed on appropriate practice for caesarean delivery for obese patients whether they had read the Committee Opinion or not. |
Attitudes and practices regarding use of progesterone to prevent preterm births
Henderson ZT , Power ML , Berghella V , Lackritz EM , Schulkin J . Am J Perinatol 2009 26 (7) 529-36 We sought to describe current attitudes and practices of obstetrician-gynecologists regarding use of progesterone and prevention of preterm birth. A self-administered survey was mailed to American College of Obstetricians and Gynecologists Fellows and Junior Fellows in Practice in March to May 2007. The survey consisted of 36 questions, including respondents' demographic characteristics, preterm birth risk factor knowledge and screening practices, and use of progesterone for the prevention of preterm birth. The response rate was 52% ( N = 345); most respondents were general obstetrician-gynecologists (89%). Many (74%) reported recommending or offering progesterone for prevention of preterm birth. Almost all (93%) reported use for the indication of previous spontaneous preterm birth. However, many also reported use for other indications such as dilated/effaced cervix (37%), short cervix on ultrasound (34%), and cerclage (26%). These results suggest that most obstetricians recommend or offer progesterone to prevent preterm birth for women with a previous spontaneous preterm birth and many also offer it for women with other high-risk obstetric conditions. |
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