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Tavakoli A, Donovan K, Sweeney H, Uquillas K, Gordon B. Inpatient Buprenorphine Induction for Opioid Use Disorder in Pregnancy. Cureus 2023; 15:e36376. [PMID: 37090287 PMCID: PMC10113565 DOI: 10.7759/cureus.36376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/25/2023] Open
Abstract
Objective Buprenorphine is a commonly used medication to manage opioid use disorder, however there is limited data to guide induction protocols specifically during pregnancy. Similar to non-pregnant patients the Clinical Opiate Withdrawal Scale (COWS) is often used to guide induction and titration of buprenorphine in pregnancy. The objective of this retrospective descriptive study is to assess the inpatient buprenorphine induction patterns, treatment retention, and pregnancy outcomes among obstetric patients with opioid use disorder seeking treatment. Study design This was a retrospective study of obstetric patients with opioid use disorder admitted for inpatient buprenorphine induction at a large academic center between May 2015 to 2020. A descriptive analysis of the cohort, induction patterns, and dose retention after discharge were evaluated in addition to obstetric and neonatal outcomes. Results Sixty patients were admitted for inpatient buprenorphine induction at a median gestational age of 16.7 weeks. The median COWS score on presentation was 9. The starting dose for half of the patients (30 out of 60 patients) was 8 mg of buprenorphine, while 24 patients were started at 4 mg. The median duration of hospitalization was three days (range 2-12). The median buprenorphine dose upon discharge was 10 mg (range 4-20). Only 13 of the 35 patients (37%) who desired prenatal care at our institution returned to receive routine prenatal care. Of the 12 (20%) patients who delivered at our institution, nine were live births (75%). Among the live births, the median gestational age at delivery was 37.4 weeks, birth weight 3085 grams, and only one (8%) developed neonatal abstinence syndrome. Conclusion When using the Clinical Opiate Withdrawal Scale to guide inpatient buprenorphine titration for pregnant patients with opioid use disorder it takes approximately three days to establish a satisfactory maintenance dose with the median dose at discharge in this population being 10 mg. The majority of patients who followed up after hospital discharge did not need dose adjustments.
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Affiliation(s)
- Amin Tavakoli
- Obstetrics and Gynecology, Los Angeles County University of Southern California Medical Center, Los Angeles, USA
| | - Kelly Donovan
- Obstetrics and Gynecology, Los Angeles County University of Southern California Medical Center, Los Angeles, USA
| | - Heather Sweeney
- Obstetrics and Gynecology, Los Angeles County University of Southern California Medical Center, Los Angeles, USA
| | - Kristen Uquillas
- Obstetrics and Gynecology, Los Angeles County University of Southern California Medical Center, Los Angeles, USA
| | - Brian Gordon
- Obstetrics and Gynecology, Los Angeles County University of Southern California Medical Center, Los Angeles, USA
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Gordon B, Uquillas K. 877 Inpatient buprenorphine induction for opioid use disorder in pregnancy. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Szyld D, Uquillas K, Green BR, Yavner SD, Song H, Nick MW, Ng GM, Pusic MV, Riles TS, Kalet A. Improving the Clinical Skills Performance of Graduating Medical Students Using "WISE OnCall," a Multimedia Educational Module. Simul Healthc 2017; 12:385-392. [PMID: 29076970 PMCID: PMC5768220 DOI: 10.1097/sih.0000000000000254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION "Transitions to residency" programs are designed to maximize quality and safety of patient care, as medical students become residents. However, best instructional or readiness assessment practices are not yet established. We sought to study the impact of a screen-based interactive curriculum designed to prepare interns to address common clinical coverage issues (WISE OnCall) on the clinical skills demonstrated in simulation and hypothesize that performance would improve after completing the module. METHODS Senior medical students were recruited to participate in this single group prestudy/poststudy. Students responded to a call from a standardized nurse (SN) and assessed a standardized patient (SP) with low urine output, interacted with a 45-minute WISE OnCall module on the assessment and management of oliguria, and then evaluated a different SP with low urine output of a different underlying cause. Standardized patients assessed clinical skills with a 37-item, behaviorally anchored checklist measuring clinical skills (intraclass correlation coefficient [ICC], 0.55-0.81). Standardized nurses rated care quality and safety and collaboration and interprofessional communication using a 33-item literature-based, anchored checklist (ICC, 0.47-0.52). Standardized patient and SN ratings of the same student performance were correlated (r, 0.37-0.62; P < 0.01). Physicians assessed clinical reasoning quality based on the students' patient encounter note (ICC, 0.55-0.68), ratings that did not correlate with SP and SN ratings. We compared pre-post clinical skills performance and clinical reasoning. Fifty-two medical students (31%) completed this institutional review board -approved study. RESULTS Performance as measured by the SPs, SNs, and the postencounter note all showed improvement with mostly moderate to large effect sizes (range of Cohen's d, 0.30-1.88; P < 0.05) after completion of the online module. Unexpectedly, professionalism as rated by the SP was poorer after the module (Cohen's d, -0.93; P = 0.000). DISCUSSION A brief computer-based educational intervention significantly improved graduating medical students' clinical skills needed to be ready for residency.
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Affiliation(s)
- Demian Szyld
- From the Department of Emergency Medicine (D.S.), Brigham and Women's Hospital; The Center for Medical Simulation (D.S.), Boston, MA; New York Simulation Center for the Health Sciences (G.N., T.S.R., A.K.), New York; Institute for Innovations in Medical Education (M.V.P., T.S.R., A.K.), NYU School of Medicine, New York, NY; Department of Obstetrics and Gynecology (K.U.), University of Southern California, Los Angeles, CA; Department of Emergency Medicine (B.R.G.), The Ohio State University, Cleveland, OH; Program for Medical Education and Technology (M.W.N., T.S.R., A.K.), NYU School of Medicine, New York, NY; Department of Journalism (S.D.Y.), Central Connecticut State University; Department of Education (H.S.), Georgian Court University, Lakewood, NJ; Department of Surgery (T.S.R., A.K.), NYU School of Medicine, New York, NY; Department of Medicine (A.K.), Division of General Internal Medicine, Research on Medical Education Outcomes (ROMEO) Unit, and Program for Medical Education Innovation and Research (PrMEIR) (A.K.), NYU School of Medicine, New York, NY
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Goldman KN, Tiegs AW, Uquillas K, Nachtigall M, Fino ME, Winkel AF, Lerner V. Interactive case-based learning improves resident knowledge and confidence in reproductive endocrinology and infertility . Gynecol Endocrinol 2017; 33:496-499. [PMID: 28277140 DOI: 10.1080/09513590.2017.1290075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Resident physicians' scores on the REI section of the CREOG exam are traditionally low, and nearly 40% of house staff nation-wide perceive their REI knowledge to be poor. We aimed to assess whether an interactive case-based group-learning curriculum would narrow the REI knowledge gap by improving understanding and retention of core REI concepts under the time constraints affecting residents. A three-hour case-based workshop was developed to address four primary CREOG objectives. A multiple-choice test was administered immediately before and after the intervention and 7 weeks post-workshop, to evaluate both knowledge and confidence. Following the intervention, residents self-reported increased confidence with counseling and treatment of PCOS, ovulation induction cycle monitoring, counseling and treatment of POI, and breaking bad news related to infertility (p < 0.05). The multiple-choice exam was re-administered 7 weeks post-intervention, and scores remained significantly improved compared to pre-workshop scores (p < 0.05). At that time, all residents either strongly agreed (91.7%) or agreed (8.3%) that the case-based interactive format was preferable to traditional lecture-based teaching. In conclusion, a nontraditional curriculum aimed at teaching core REI concepts to residents through interactive case-based learning can be successfully integrated into a residency curriculum, and significantly improves knowledge and confidence of critical concepts in REI.
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Affiliation(s)
- Kara N Goldman
- a Reproductive Endocrinology and Infertility, Obstetrics and Gynecology , New York University Fertility Center , New York , NY , USA and
| | - Ashley W Tiegs
- b Obstetrics and Gynecology , New York University Langone Medical Center , New York , NY , USA
| | - Kristen Uquillas
- b Obstetrics and Gynecology , New York University Langone Medical Center , New York , NY , USA
| | - Margaret Nachtigall
- b Obstetrics and Gynecology , New York University Langone Medical Center , New York , NY , USA
| | - M Elizabeth Fino
- a Reproductive Endocrinology and Infertility, Obstetrics and Gynecology , New York University Fertility Center , New York , NY , USA and
| | - Abigail F Winkel
- b Obstetrics and Gynecology , New York University Langone Medical Center , New York , NY , USA
| | - Veronica Lerner
- b Obstetrics and Gynecology , New York University Langone Medical Center , New York , NY , USA
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Uquillas K, Chan Y, King JR, Randolph LM, Incerpi M. Chorionic villus sampling fails to confirm mosaic trisomy 21 fetus after positive cell-free DNA. Prenat Diagn 2017; 37:296-298. [PMID: 28004393 DOI: 10.1002/pd.4992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/04/2016] [Accepted: 12/19/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Kristen Uquillas
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Southern California/Keck School of Medicine, Los Angeles, CA, USA
| | - Yen Chan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Southern California/Keck School of Medicine, Los Angeles, CA, USA
| | - Jennifer R King
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Southern California/Keck School of Medicine, Los Angeles, CA, USA
| | - Linda M Randolph
- Division of Medical Genetics, Children's Hospital Los Angeles, University of Southern California/ Keck School of Medicine, Los Angeles, CA, USA
| | - Marc Incerpi
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Southern California/Keck School of Medicine, Los Angeles, CA, USA
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Uquillas K, Aboudiab MS, Korst LM, Llanes A, Grubbs BH, Chmait RH. 286: Middle cerebral artery doppler changes following fetal transfusion performed with and without fetal anesthesia. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Winkel AF, Gillespie C, Uquillas K, Zabar S, Szyld D. Assessment of Developmental Progress Using an Objective Structured Clinical Examination-Simulation Hybrid Examination for Obstetrics and Gynecology Residents. J Surg Educ 2016; 73:230-237. [PMID: 26868313 DOI: 10.1016/j.jsurg.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/10/2015] [Accepted: 10/08/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The Test of Integrated Professional Skills (TIPS) is an objective structured clinical examination-simulation hybrid examination that assesses resident integration of technical, cognitive, and affective skills in Obstetrics and Gynecology (OBGYN) residents. The aim of this study was to analyze performance patterns and reactions of residents to the test to understand how it may fit within a comprehensive assessment program. DESIGN A retrospective, mixed methods review of the design and implementation of the examination, patterns of performance of trainees at different levels of training, focus group data, and description of use of TIPS results for resident remediation and curriculum development. SETTING OBGYN residents at New York University Langone Medical Center, a tertiary-care, urban academic health center. PARTICIPANTS OBGYN residents in all years of training, postgraduate year-1 through postgraduate year, all residents completing the TIPS examination and consenting to participate in focus groups were included. RESULTS In all, 24 residents completed the TIPS examination. Performance on the examination varied widely among individuals at each stage of training, and did not follow developmental trends, except for technical skills. Cronbach α for both standardized patient and faculty ratings ranged from 0.69 to 0.84, suggesting internal consistency. Focus group results indicated that residents respond to the TIPS examination in complex ways, ranging from anxiety about performance to mixed feelings about how to use the data for their learning. CONCLUSION TIPS assesses a range of attributes, and can support both formative and summative evaluation. Lack of clear developmental differences and wide variation in performance by learners at the same level of training support the argument for individualized learning plans and competency-based education.
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Affiliation(s)
- Abigail Ford Winkel
- Department of Obstetrics & Gynecology, New York University School of Medicine.
| | - Colleen Gillespie
- Institute for Innovations in Medical Education, Department of Medicine, New York University School of Medicine, NYU-HHC Clinical and Translational Sciences Institute, New York, New York
| | - Kristen Uquillas
- Simulation and Education, New York Simulation Center for the Health Sciences, Department of Obstetrics & Gynecology, New York University School of Medicine, New York, New York
| | - Sondra Zabar
- Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, New York, New York
| | - Demian Szyld
- Department of Emergency Medicine, New York Simulation Center for the Health Sciences, New York University School of Medicine, New York, New York
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Morin S, Uquillas K, McClelland S, Song J, LaVigne K, Song J. Robotic Assisted Myomectomy Enhanced by CO2 Laser. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2014.08.761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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LaVigne K, Uquillas K, McClelland S, Song J, Morin S, Song J. Robotic Assisted Hysterectomy with Salpingectomy Enhanced by CO2 Laser. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2014.08.760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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