Manuel C. Vallejo

Purpose: Members of the transgender community face significant health disparities within our society, especially within the state of West Virginia, which is primarily rural. We sought to examine and compare existing attitudes and knowledge of resident and faculty physician medical professionals at our institution about treating transgender individuals within a rural tertiary care center. Methods: The Medical Practitioner Attitudes Towards Transgender Patients (MP-ATTS) survey and the Medical Practitioner Beliefs and Knowledge about Treating Transgender Patients (MP-BKTTP) survey were sent to all faculty and resident physicians at West Virginia University Hospitals. Demographics included information about gender, rurality of hometown, race, and description of medical practitioner status (i.e., years out of residency, residency status). Findings: In general, there were positive attitudes and reception of the survey among residents and faculty physicians. 76.45% of providers assumed that their patients were not transgender. More than 40% of respondents believed that they would need further education about transgender patients to provide appropriate health care. Male health care providers had significantly higher negative perceptions of the transgender community ( N =85, M=4.46, standard deviation [SD]=0.55, p N =80, M=3.24, SD=0.96, p <0.0001). Conclusion: A clear need exists for increased training in transgender health care among physicians taking care of this patient population. A gender divide exists among health care providers within West Virginia over attitudes regarding the transgender community. Further studies are needed to fully understand the health care needs and barriers of the transgender population.

Aim of review: To determine the current state of pre-procedure neuraxial ultrasound in obstetric anesthesia practice. Method: The PubMed and Scopus databases were searched for the keywords “neuraxial”, or “epidural”, or “spinal” or “ultrasound”, combined with “obstetric anesthesia”. A current review of original studies, systematic reviews, and meta-analysis within the past decade were included in the analysis. Recent findings: Pre-procedure ultrasound imaging enhances successful neuraxial placement through determination of the optimal vertebral interspace, identification of the midline, location of the optimal insertion point, best angle for needle insertion, and accurate depth for needle advancement to the epidural or intrathecal space. In the experienced clinician, neuraxial ultrasound imaging can be of particular benefit in parturients with difficult anatomy and/or landmarks. Summary: Neuraxial ultrasound imaging reduces the risk of failed or traumatic lumbar punctures and epidural catheterizations, the number of insertion attempts, and needle redirections. Citation: Manuel C. Vallejo. Pre-Procedure Neuraxial Ultrasound in Obstetric Anesthesia. J Anesth Perioper Med 2017; 4 : x- xx. doi: 10.24015/ JAPM.2017.0050 This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Background We aimed to determine the incidence of surgical site infection (SSI) after cesarean delivery (CD) and identify the risk factors in a rural population. Methods We identified 218 SSI patients by International Classification of Disease codes and matched them with 3131 parturients (control) from the electronic record database in a time-matched retrospective quality assurance analysis. Results and discussion The incidence of SSI after CD was 7.0 %. Risk factors included higher body mass index (BMI) [40.30 ± 10.60 kg/m² SSI (95 % CI 38.73–41.87) vs 34.05 ± 8.24 kg/m² control (95 % CI 33.75–34.35, P < 0.001)], years of education [13.28 ± 2.44 years SSI (95 % CI 12.9–13.66) vs 14.07 ± 2.81 years control (95 % CI 13.96–14.18, P < 0.001)], number of prior births [2 (1–9) SSI vs 1 (1–11) control (P < 0.001)], tobacco use (OR 1.49; 95 % CI 1.06–2.09, P = 0.03), prior diagnosis of hypertension (OR 1.80; 95 % CI 1.34–2.42, P < 0.001), gestational diabetes (OR 1.59; 95 % CI 1.18–2.13, P = 0.003), and an emergency/STAT CD (OR 1.6; 95 % CI 1.1–2.3, P = 0.01). Conclusions Risk factors for SSI after CD included higher BMI, less years of education, higher prior births, tobacco use, prior diagnosis of hypertension, gestational diabetes, and emergency/STAT CD. The presence of ruptured membranes was protective against SSI.