Archives

Volume 2,  Issue 2 (Summer 2015)

Volume 2,  Issue 1 (Winter 2015)

Volume 1,  Issue 2 (Summer 2014)

Volume 1, Issue 1 (Fall 2013)

 

 

Volume 2, Issue 2 (Summer 2015)

Editor’s Comments

Papers

Contraceptive Choices for Reproductive Age Women at Methadone Clinics in Western North Carolina

Ginger Poulton, MD, Anna Beth Parlier, BS, Kacey Ryan Scott, MLIS, E. Blake Fagan, MD, and Shelley L. Galvin, MA

Paper presented by Anna Beth Parlier, BS at the 20th Annual MAHEC Resident Research Day, Asheville, NC; May 17, 2013.

Winner of the 20th Annual MAHEC Research Day Audience Award

PDF | Abstract
 

Examining Postpartum Contraception Choices among Teens

Regan Gage, MD, Anna Beth Parlier, BS, Lydia Russell-Roy, BA, Mimi Konitzer, MD,

Bre Bolivar, MD, Addie Bardolph, BS, and Andrea Currens, MD

Paper presented at the 22nd Annual MAHEC Research Day, Asheville, NC; May 6, 2015.

Winner of the 22nd Annual MAHEC Research Day Audience Award

PDF | Abstract
 

Assessment of an Employee Wellness Clinic with the Clinical Pharmacist Practitioner Model

Autumn D. Carroll, PharmD and Courtenay Gilmore Wilson, PharmD, CDE, BCPS, BCACP,  CPP

Paper presented at the Southeastern Residency Conference in Athens, GA; May 1, 2014.

PDF | Abstract
 

End-of-Life Care Planning in Patients with Recurrent Gynecologic Cancers

Nathaniel L. Jones, MD, Ashley Albers, DO, and Shelley L. Galvin, MA

Poster presented at the Western Association Gynecologic Oncologists Annual Meeting, Seattle, WA; June 2013.

PDF | Abstract
 

Discussing Sexual Health with Your Doctor

Tim Plaut, MD, Pai Lui, MD, and Shelley L. Galvin, MA

Paper presented by Lillian Childress, MA at the 20th Annual MAHEC Resident Research Day, Asheville, NC; May 17, 2013.

PDF | Abstract
 

Abstracts

These papers were presented at the 22nd Annual MAHEC Research Day, Asheville, NC; May 6, 2015:
 

Birth Outcomes of Patients from Western North Carolina Enrolled in Group Prenatal Care

Jon Larabee, MD, Anna Beth Parlier, BS, Amanda Murphy, CNM, MSN, and Kiran Sigmon, MD

Winner of the 22nd Annual MAHEC Research Day Award for Best Project in Obstetrics  and Gynecology

Abstract
 

Reducing High-risk Medication Use in Older Adults: Benzodiazepines and Non-Benzodiazepine Hypnotics

Frank Laughlin, MD, Pai Liu, MD, Suzanne Landis, MD, MPH, Annette Beyea, MD, MPH, and Tasha Woodall, Pharm D

Winner of the 22nd Annual MAHEC Research Day Award for Best Project in Family Medicine

Abstract
 

The System as Frontier: A Comprehensive Strategy for Improving Health Outcomes and Reducing Costs for High-Risk Medicare Beneficiaries

Justin Mutter, MD, MSc, and Pai Liu, MD

Abstract
 

Introduction to Complementary/Alternative/Integrative Medicine (CAM/IM) for Family Medicine Residency

Meredith Soles, MD, Anna Beth Parlier, BS, Shelley Galvan, MA, and Mike Coladonato, MD

Abstract
 

Posters

Presented at state, regional or national professional meetings:
 

Perceptions of Educational Experiences across Labor & Delivery Shifts: Week Days, Week Nights, and Weekends      

Karen L. Wang, MD, Elizabeth Buys, MD, Arthur T. Ollendorff, MD, and Shelley L. Galvin, MA

Poster presented at the Annual Meeting of CREOG/APGO, San Antonio, TX; March 4-7, 2015.

Poster and Abstract
 

Presented at the 22nd Annual MAHEC Research Day, Asheville, NC; May 6, 2015

On Her Way…The Barriers to Birthing Safely in Rural Tanzania        

Bre Bolivar, MPH, MD and Reta Graham, MD

Winner of the 22nd Annual MAHEC Research Day Audience Award

Poster
 

Universal Screening for the Short Cervix: To Screen or Not to Screen?

Jennifer Bliss, MD, Shelley L. Galvin, MA, and Carol C. Coulson, MD

Poster
 

Preliminary Results from the First Year of Centering Parenting           

Helen Paulson, MD, Samantha Fawcett, MD, Joan Colburn, MLIS, and Amy Russell, MD

Poster
 

Bringing Buprenorphine Prescribing to MAHEC

Genevieve Verrastro, MD, Courtenay Wilson, Pharm D, Marina MacNamara, MD, Elizabeth Flemming, MA LPC, Joshua Schactman, LCSW, Sue Stigleman, MLS, and

E. Blake Fagan, MD

Poster
 

Tar Wars at Jones Elementary       

Mathew Swanson, MD

Poster
 

Editor’s Comments

It is with great pleasure that I take the reigns from Dr. Landis as the Editor in Chief of the MAHEC Online Journal of Research.  Since its inaugural issue in the Fall of 2013, the Journal has already demonstrated its value in disseminating the research of MAHEC learners.  My hope is that with each issue, we continue to stimulate thoughtful discussion about the scholarly activities ongoing in our community.

Let’s begin this issue with two interesting studies focusing on women’s reproductive health. 

First is the article by Gage, et al that explores the use of Long Acting Reversible Contraception (LARC) in postpartum teens.  In Western North Carolina, the rate of unintended pregnancy in teenagers remains above the national average. LARC is considered one of the most effective forms of contraception but its use in teenagers remains low (7.1% in 2013).  Dr. Gage found that 74.4% of teens in the study intended postpartum LARC, but how many actually received it?

Second is the article by Poulton, et al that considers women’s preferences for contraception and contraception counseling during opioid addiction treatment. The opioid epidemic has left few areas of the country untouched.  Many people recovering from their addiction seek treatment with medication management therapy (MMT); however, infants born to mothers on MMT may experience Neonatal Abstinence Syndrome (NAS), which is associated with significant infant morbidity. In Western North Carolina, we have seen an increase in the rates of NAS. An essential first step in addressing this alarming rise is addressing women’s contraception needs in hopes of preventing unintended pregnancies. Dr. Poulton did just that.  Let’s hope that the results of this survey are an impetus for developing contraception services within methadone treatment clinics.

Continuing on the topic of sexual health, the study conducted by Plaut, et al attempts to delve into a topic that is often considered taboo: talking about sex with older adults.  We’ve all been there: Do I bring it up?  Will she be embarrassed? Even worse…offended? Dr. Plaut has the courage to ask our patients for us: Do you want your physician to talk to you about your sexual health?  The results may surprise you!  No spoiler alerts here, but I will say this: pay close attention to the response rate.  Is that telling us more than the actual survey results?

On a more serious note, Jones, et al dissects another challenging conversation that we must have with our patients: End-of-Life Care Planning.  By assessing a cohort of patients with terminal gynecologic cancers, Dr. Jones elucidates the importance of beginning these conversations early and advocating for the involvement of our hospice and palliative care team members sooner.

Finally, is a subject dear to me.  The Asheville Project® is a nationally recognized pharmacy initiative that demonstrated that pharmacist-led employee wellness programs improve clinical outcomes and save the healthcare system money.  Carrol, et al assessed the effectiveness of MAHEC’s own employee wellness program, which was modeled after the Asheville Project®.  Did we see the same impressive results at MAHEC? 

In case that’s not enough, spend some time perusing the abstracts and posters as well. Makes you long for the next MAHEC Research Day!

Courtenay Gilmore Wilson, PharmD, CDE, BCPS, BCACP, CPP

 


The MAHEC Online Journal of Research, published by the Mountain Area Health Education Center, promotes and publishes peer-reviewed, learner research and other scholarly activities that advance the understanding of our patients, evidence-based patient care, and education in obstetrics and gynecology, family medicine, hospice and palliative care, geriatrics, and general dentistry.


Editorial Team:

Editor-in-Chief: Courtenay Gilmore Wilson, PharmD, CDE, BCPS, BCACP, CPP
Managing Editor: Joan Colburn, MLIS
Associate Editor: Shelley Galvin, MA

The MAHEC Online Journal of Research publishes open access articles under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) License which permits use, distribution and reproduction in any medium, provided the original work is properly cited and the purpose is non-commercial.

 

Volume 2, Issue 1 (Winter 2015)

Editor’s Comments

Papers

Family-Centered Cesarean Delivery

Sarah B. Francis, MD, Shelley L. Galvin, MA, Kacey R. Scott, MLIS, Kiran Sigmon, MD

PDF | Abstract
 

The Joys and Challenges of Caring for Older Adults by Primary Care Physicians: Results of Focus Groups in Western North Carolina

Kate Rasche MD, Suzanne Landis MD, MPH, Sarah Thach MPH, Shelley L. Galvin MA

PDF | Abstract
 

Walking with Obese Patients: An Innovative Method of Motivational Interviewing

Yu Kwan Chan, MD, Shelley L. Galvin, MA, Sue Stigleman, MLS, Aaron Vaughan, MD

PDF | Abstract
 

Editor’s Comments

MAHEC (Mountain Area Health Education Center) is located in Asheville, NC and is part of the state and national AHEC program. MAHEC’s mission is simply to train and retain health care providers for western NC. As part of our activities we support: a regional campus of the University of North Carolina-Chapel Hill School of Medicine with 20 students in each of the third and fourth years of medical school; residency training programs in obstetrics/gynecology, family medicine, and general dentistry; fellowship programs in geriatrics, palliative care/hospice, and now sports medicine; multiple types of premedical clinical and research experiences; continuing education for health care providers; and support of scholarly activity around health care delivery. We provide over 100,000 family medicine, dental and ob-gyn patient visits each year; we provide $4.8 million in safety net health care for low-income and uninsured patients.

The purpose of the MAHEC Online Journal of Research is to disseminate local knowledge and highlight our learners’ talents. Our learners are required to be involved with scholarly activity, but much of what they choose to investigate may reflect local practice patterns or pilot programs utilizing small numbers of learners and/or patients. With this online journal, we now have a platform in which to publish these peer reviewed papers and posters.

The three articles in this episode of the MAHEC Online Journal represent a common theme: novel ways to use physician services in a more patient-centered fashion. Dr. Francis reports on a pilot of what she calls Family Centered Cesarean Delivery with patients and family members being able to better view the delivery itself and immediate skin-to-skin contact between mother and baby as compared to the more traditional cesarean section.  Patients themselves who had experienced a traditional cesarean section previously and now had a Family Centered Cesarean Delivery were uniformly more satisfied with their experiences. Patients in the Family Centered group had similar intraoperative outcomes. As a result of this study, our obstetrical office routinely offers the Family Centered Cesarean Delivery.

Dr. Rasche describes results of focus groups with primary care physicians around the joys and challenges of caring for older adults, important information as medical care moves more towards interprofessional team-based care. Family physicians in a variety of geographical locations and practice types reported that caring for older adult patients provided them with joy, in interpersonal relationships, with helping families navigate the complex medical system, and in assisting with life transitions. However, the challenges of dealing with: hostile family dynamics; patient socioeconomic limitations; limited community resources; and the fee-for-service reimbursement structure resulted in significant frustrations that often surpassed the joys. Even with the probability that team-based care could  reduce these challenges, physicians seemed wary to embrace this type of care in the future wondering if they can trust others to care for “their” patients. Team-based care is coming to WNC; this study provides helpful information for us to start educating physicians as to the beneficial roles that other health professional can play on the primary care team.

And Dr. Chan discusses a local rendition of “Walk with the Doc” program to increase obese patients’ self-motivation and confidence in adopting healthier lifestyle strategies. By reading between the lines, a great deal of the logistics about the program fell on him to orchestrate. The sample size was quite small, yet the amount of time he spent in developing, implementing, and evaluating the project was quite high. I am sure this was a great learning experience for him; but some pilots may not warrant expansion, and this appears to be one of them.

Please appreciate the hard work by our learners and their faculty supporters as you read the Journal. Email us your thoughts about the quality of the articles and posters, the value to your practice, and suggestions for future format and content.

Suzanne Landis MD, MPH
 


The MAHEC Online Journal of Research, published by the Mountain Area Health Education Center, promotes and publishes peer-reviewed, learner research and other scholarly activities that advance the understanding of our patients, evidence-based patient care, and education in obstetrics and gynecology, family medicine, hospice and palliative care, geriatrics, and general dentistry.


Editorial Team:

Editor-in-Chief: Suzanne Landis, MD, MPH
Managing Editor: Joan Colburn, MLIS
Associate Editor: Shelley Galvin, MA

The MAHEC Online Journal of Research publishes open access articles under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) License which permits use, distribution and reproduction in any medium, provided the original work is properly cited and the purpose is non-commercial.

 

Volume 1, Issue 2 (Summer 2014)

Editor’s Comments

Papers

Benign GYN Surgical Outcome in an Academic Teaching Hospital: Robotic Assisted Laparoscopic Hysterectomy versus Conventional Laparoscopic Hysterectomy

Brandi Spence, MD, Anna Beth Parlier, BS, Allen H. VanDyke, MD, and Shelley L. Galvin, MA
PDF  |  Abstract

With the introduction of new technologies comes the struggle: “Just because we can, should we, and under what conditions?”  This dilemma is heartily debated at the national level with regard to the use of the surgical robot in benign gynecological surgeries.  This debate was spurred locally by Dr. Spence’s resident research project presented at the 20th Annual MAHEC Research Day in May of 2013 and published here.  Spearheaded by Dr. Beth Buys, Program Director for the MAHEC OB/GYN Residency Program, the MAHEC Division of Regional Services collaborated with local and national stakeholders to offer a half day of continuing education entitled, “Debating the Issues of Hysterectomy in the 21st Century - Robotics vs Traditional Surgery”.  We have included here, links to a featured talk and a debate by recognized experts who present the many sides or considerations of this complex dilemma.

Featured talk at the conference "Debating the Issues of Hysterectomy in the 21st Century - Robotics vs Traditional Surgery" by Dr. Barbara S. Levy, MD, FACOG, FACS:

Outpatient Vaginal Hysterectomy

Debate with Dr. Barbara S. Levy, MD, FACOG, FACS and Dr. Charles Miller, MD, FACOG at the "Debating the Issues of Hysterectomy in the 21st Century - Robotics vs Traditional Surgery" conference:

Traditional Vaginal Hysterectomy vs Use of Robotics

Comments from an Ob/Gyn resident who attended the conference
 

Pregnancy Coercion and Birth Control Sabotage in Western North Carolina

Jessica L. Versage, MD, Jennifer Warren, MD, Kiran Sigmon, MD, and Shelley L. Galvin, MA
PDF  |  Abstract
 

Gestational Weight Gain: Evaluation of an OB/GYN Office-based Intervention

Rongrong Fan, MD, Elizabeth Buys, MD, and Shelley L. Galvin, MA
Winner of a Resident Research Award at the Annual Meeting of the NC Obstetrical and Gynecological Society; 2013 April; Asheville, NC.
PDF  |  Abstract
 

Poster Presentations

Mission Hospital Women's Service Line Toolbox: a Survey of Regional Providers.

Beth England, MD, Hollis Konitzer, BS, Jeannie Buckner, and Kellett Letson, MD
Poster session presented at: Meeting of the North Carolina Medical Society; 2013 October; Raleigh, NC
PDF

Patient-Centered Self-Management of Chronic Pain Improves Patent’s Self-Efficacy.

Bruce Ulrich, MD, Shelley L. Galvin, MA, Elizabeth Flemming, LPC, Courtenay Wilson, PharmD, AnnaBeth Parlier, BS, and John Rowe, MD.
Poster session presented at: Annual Winter Meeting of the North Carolina Academy of Family Physicians; 2013 December 12; Asheville, NC, and updated and presented at: 21st Annual MAHEC Research Day; 2014 May 7; Asheville, NC.
PDF

Developing Clinical Quality Measures for an Academic OB/GYN Department

Laurel Berry, MD, Kellett Letson, MD and Arthur Ollendorff, MD
Poster presented at: Annual Meeting of the NC OB/GYN Society; 2014 April; Pinehurst, NC
PDF

The MAHEC Online Journal of Research publishes open access articles under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) License which permits use, distribution and reproduction in any medium, provided the original work is properly cited and the purpose is non-commercial.

 

Editor’s Comments

Today we launch our second edition of the MAHEC Online Journal of Research. The Mountain Area Health Education Center (MAHEC) is located in Asheville, NC and is part of the state and national Area Health Education Center (AHEC) program. MAHEC’s mission is simply to train and retain health care providers for Western NC. As part of our activities we support: a regional campus of the University of North Carolina-Chapel Hill School of Medicine with 20 students in each of the third and fourth years of medical school; residency training programs in obstetrics/gynecology, family medicine, and general dentistry; fellowship programs in geriatrics and palliative care/hospice; multiple types of premedical clinical and research experiences; continuing education and library services for health care providers; and scholarly activity around health care delivery. We provide over 100,000 family medicine, dental and ob-gyn patient visits each year; we provide $4.8 million in safety net health care for low-income and uninsured patients. We are truly a community resource.

The purpose of the MAHEC Online Journal of Research is to disseminate local knowledge and highlight our learners’ talents. Our learners are required to be involved with scholarly activity, but much of what they choose to investigate may reflect local practice patterns or pilot programs utilizing small numbers of learners and/or patients. With the implementation of this twice yearly online journal, we now have a platform in which to publish these peer-reviewed papers and posters.

This issue focuses on some core issues of obstetrics/gynecology and demonstrates the breadth of topics in which our learners are interested. Don’t you just love when a resident questions the benefits of new technologies? With Dr. Spence’s study on surgical outcomes associated with robotic assisted laparoscopic hysterectomy versus conventional laparoscopic hysterectomy, she set off a cascade of events resulting in a continuing education seminar with national experts debating this issue. What a great learning experience for our residents. In addition, Dr. Spence appropriately questions how will residents learn new technologies if private community physicians who perform the majority of the robotic surgeries operate without resident assistance. This is a common concern—how to offset the needs of learners with the needs of private physicians---for which there is no easy answer.

Dr. Fan’s paper demonstrates the challenges of evaluating an intervention which is successful elsewhere and adapted for home use; is the lack of reduction in mean gestational weight gain among the normal pre-pregnancy BMI group a result of lack of effectiveness of the intervention or lack of robust implementation of the intervention? It looks as though the gestational weight gain grids were regularly used in all pregnant women for almost all of their prenatal visits. But perhaps nurses and physicians did not emphasize the importance of limiting weight gain among normal weight women as compared to overweight or obese woman?

I found the paper by Dr. Versage distressing; one third of 319 contraceptive users reported pregnancy coercion including birth control sabotage. Plus more than half of the women only learned about pregnancy coercion from participation in this survey. In the past year the American College of Obstetrics and Gynecology issued a committee opinion recommending ongoing screening for reproductive and sexual coercion for women seeking gynecologic and obstetric care; this is a necessary step towards spreading the news among physicians, but will not be sufficient to educate and increase the self-efficacy of women to withstand this type of coercion.

Dr. Ulrich’s poster describing the use of a chronic pain management clinic at the MAHEC Family Health Center for adult patients with chronic pain using prescribed opiates focuses on the outcome of improved scores on the Pain Self-Efficacy Questionnaire using questions such as “I can do some form of work, despite the pain.” The cohort consisted of 112 patients with paired data (baseline and over 30 days in program) and documented a significant improvement in self-efficacy scores but no change in the average pain scores over the past week. This is an admirable venture addressing a rising problem in the US of more long term opiate use and related deaths; however, I hope that these investigators will be measuring actual opiate use over time to determine if chronic opiate users are switching to non-opiate medications, non-pharmacologic treatments, or at least lower doses of opiates.

Please appreciate the hard work by our learners and their faculty supporters as you read the Journal. Email us your thoughts about the quality of the articles and posters, the value to your practice, and suggestions for future format and content.

Suzanne Landis MD, MPH
Editor



 

Volume 1, Issue 1 (Fall 2013)

Editor’s Comments

Papers

 Risk Factors Associated with Postpartum Hemorrhage in Western North Carolina

Stephanie T. Romero, MD, Shelley L. Galvin, MA, Maggie Harper, MD
Presented at the NC OBGYN Society Meeting, Asheville, NC; April, 2011
Winner of the North Carolina Obstetrical and Gynecological Society Resident Research Award
Winner of the 2011 MAHEC Resident Research Day Audience Award
PDF  |  Abstract
 

Spot Urine Protein:Creatinine Ratio versus 24-hour Urine Total Protein to Screen for Preeclampsia

Ladson Gaddy-Dubac, MD, Shelley L. Galvin, MA, Summer Gilmer, MD,
Stephanie T. Romero, MD, Carol C. Coulson, MD
Presented at the 75th Annual Meeting of the South Atlantic Association of Obstetricians and Gynecologists; 2013 Jan 19-22; White Sulphur Springs, WV.
Winner of 2012 MAHEC OB/Gyn Faculty Best Research Paper Award
PDF  |  Abstract
 

Thongs, Flip-flops, and Unintended Pregnancy:  The Seduction of p<0.05

Ruchi P. Moore, MD, Shelley L. Galvin, MA, and Hytham M. Imseis, MD
Presented at the 2006 Annual Meeting of the North Carolina Obstetrical and Gynecological Society, Asheville, NC; May 6, 2006
Winner of the North Carolina Obstetrical and Gynecological Society Resident Research Award
PDF  |  Abstract
 

Poster Presentations

Free Pregnancy Testing as a Strategy to Increase Obstetrical Volume in a Family Medicine Residency

Julia Oat-Judge, MD, Shelley L. Galvin, MA, Daniel J. Frayne, MD
Poster Presented at The 46th Annual Society of Teachers of Family Medicine Spring Conference. Baltimore, MD: May 1-5, 2013

Subsequently published:
Oat-Judge J, Galvin SL, Frayne DJ.
Free Pregnancy Testing Increases Maternity Care Volume in Family Medicine Residencies.
Fam Med. 2015 Jun;47(6):470-3. PubMed PMID: 26039765.



End-of-Life Care Planning in Patients with Recurrent Gynecologic Cancers

Nate L. Jones, MD, Ashley S. Case MD, Ashley Albers, MD, Timothy J. Vanderkwaak, MD, David J. Hetzel, MD, C. Blair Harkness, MD, and Shelley L. Galvin, MA
Poster presented at the 2013 Western Association Gynecologic Oncologists Annual Meeting. Seattle, WA: June 2013
PDF
 

Perceptions of Behavioral Interviewing

Gregory G. Eppard, MD, Elizabeth Buys, MD, Shelley L. Galvin, MA
Poster presented at the Annual Meeting of the Association of Professors of Gynecology and Obstetrics/Council on Resident Education in Obstetrics and Gynecology, Orlando, FL; March 2012
PDF
 

A System for the Validation of Labor Induction Rate as an Obstetric Quality Indicator

Margaret H. Sullivan, MD, MPH, Shelley L. Galvin, MA, Melinda Bryant, BSN, RN, A. Kellett Letson, MD
Poster accepted for presentation at the Annual Clinical Meeting of the American College of Obstetricians and Gynecologists. San Francisco, CA; May 2010
PDF
 

Medical Student Poster Presentations

Fertility Knowledge and Awareness among Reproductive Age Women

Rachel Harper, BS, Andrea F. Currens, MD, Melissa Lord, BS, Shelley L. Galvin, MA
Poster Presented at MAHEC Research Day, May 17, 2013
PDF

The MAHEC Online Journal of Research publishes open access articles under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) License which permits use, distribution and reproduction in any medium, provided the original work is properly cited and the purpose is non-commercial.

 

Editor’s Comments

Today we launch our inaugural edition of the MAHEC Online Journal of Graduate Medical Education (GME) Research. Mountain Area Health Education Center (MAHEC) is located in Asheville, NC and is part of the state and national Area Health Education Center (AHEC) program. MAHEC’s mission is simply to train and retain health care providers for western NC. As part of our activities we support: a regional campus of the University of North Carolina-Chapel Hill School of Medicine with 10 students in each of the third and fourth years of medical school; residency training programs in obstetrics/gynecology, family medicine, and general dentistry; fellowship programs in geriatrics and palliative care/hospice; multiple types of premedical clinical and research experiences; continuing education and library services for health care providers; and support of scholarly activity around health care delivery. We provide over 100,000 family medicine, dental and ob-gyn patient visits each year; we provide $4.8 million in safety net health care for low-income and uninsured patients.

The purpose of the MAHEC Online Journal of GME Research is to disseminate local knowledge and highlight our learners’ talents. Our learners are required to be involved with scholarly activity, but much of what they choose to investigate may reflect local practice patterns or pilot programs utilizing small numbers of learners and/or patients. With the start of this twice yearly online journal, we now have a platform in which to publish these peer-reviewed papers and posters.

This issue focuses on the core issues of obstetrics/gynecology and demonstrates the breadth of topics in which our learners are interested. Dr. Romero in her study of risk factors associated with postpartum hemorrhage noted that morbid obesity is a significant risk factor with an OR of 2.158 (95%CI 1.102-4.227); with obesity levels rising in the US, we may expect that postpartum hemorrhage rates might increase. Dr. Gaddy-Dubac examined the accuracy of the spot urine protein:creatinine ratio using the 24 hour total urine protein as the gold standard among pregnant women at risk for preeclampsia; sensitivity, specificity, positive and negative predictive values all varied quite widely, and thus the spot urine did not appear to be a good screening tool. However, almost 50% of the patients either did not complete the 24 hour urine or had a long delay between ordering and completing the testing; it seems important to continue searching for an easier method than the 24 hour urine test. Dr. Moore’s somewhat irreverent title of Thongs, Flip-flops and Unintended Pregnancy: The Seduction of P<0.05 points out the hazards of multiple comparisons; she conducted 362 separate analyses to identify patients’ preferences in their routine daily experiences related to seven different obstetrical outcomes. She found 26 statistically significant associations, of which 8 would be expected to be clinically meaningful, but which 8?

Please read the Journal and email us your thoughts about the quality of the articles and posters, the value to your practice, and suggestions for format and content.

Suzanne Landis MD, MPH
Editor