Annekathryn Goodman

Objectives: An increasing body of evidence has revealed disrespectful and abusive care in facility-based childbirth as a barrier to maternal and child health. Providers have noted subpar work environments, inadequate staffing, and negative attitudes toward marginalized groups as barriers to respectful care. What has not been studied is the impact of disaster and violence on the delivery of respectful maternity care. The purpose of this study was to evaluate the state of obstetrical care in a maternity hospital in Odessa, Ukraine during a time of military invasion. Methods: We surveyed 202 maternity care providers who have worked at Odessa City Maternity Hospital № 5 for at least one year. Measurements and topics covered in the questionnaires included respectful care practices performed; types of disrespectful behaviors witnessed; the impact of war on the provision of respectful maternity care; post-traumatic stress; and attitudes about consent in obstetric care. Results: Fifty percent of respondents believed disrespect was an issue in the field of obstetrics. A slight majority (55.0 %) reported that the frequency of disrespect and abuse remained the same before and after the invasion, while 32.2 % reported a lower frequency and 9.4 % reported a higher frequency of disrespect. There was little change in reported performance of respectful maternity care before and after the full-scale invasion. Conclusions: Reported effects of war on respectful maternity care were minimal. However, the relatively low knowledge of disrespect and the large spread of frequency of reported respectful behavior indicate an opportunity for training.

Background/Objectives: Disrespectful care of birthing persons during childbirth has been observed as a global issue and a possible factor influencing maternal morbidity and mortality. While birthing persons’ experiences of mistreatment in childbirth have been examined, perceptions from obstetrical providers of respectful maternity care have been understudied. Methods: A mixed-method cross-sectional study was conducted in Boston from April 2023 to January 2024 among 46 labor and delivery physicians, midwives, and nurses at Massachusetts General Hospital. The survey evaluated their observation of disrespectful care, the performance of respectful care, and stress and support factors influencing respectfulness of care. Results: The most reported observed disrespectful behaviors were dismissing patients’ pain (87.0%), discriminatory care based on physical characteristics (67.4%) and race (65.2%), and uncomfortable vaginal examinations (65.2%). Respondents self-reported very high levels of respectful maternity care performance. Reported barriers to respectful care included workload (76.1%) and fatigue (60.9%). Conclusions: Disrespectful care in childbirth is an issue reported by healthcare providers. Implicit bias and the working conditions of health care providers are factors in disrespectful care. This information can be used to strategize future training and other areas of intervention to improve maternity care.

Monitoring nociception, the flow of information associated with harmful stimuli through the nervous system even during unconsciousness, is critical for proper anesthesia care during surgery. Currently, this is done by tracking heart rate and blood pressure by eye. Monitoring objectively a patient’s nociceptive state remains a challenge, causing drugs to often be over- or underdosed intraoperatively. Inefficient management of surgical nociception may lead to more complex postoperative pain management and side effects such as postoperative cognitive dysfunction, particularly in elderly patients. We collected a comprehensive and multisensor prospective observational dataset focused on surgical nociception (101 surgeries, 18,582 min, and 49,878 nociceptive stimuli), including annotations of all nociceptive stimuli occurring during surgery and medications administered. Using this dataset, we developed indices of autonomic nervous system activity based on physiologically and statistically rigorous point process representations of cardiac action potentials and sweat gland activity. Next, we constructed highly interpretable supervised and unsupervised models with appropriate inductive biases that quantify surgical nociception throughout surgery. Our models track nociceptive stimuli more accurately than existing nociception monitors. We also demonstrate that the characterizing signature of nociception learned by our models resembles the known physiology of the response to pain. Our work represents an important step toward objective multisensor physiology-based markers of surgical nociception. These markers are derived from an in-depth characterization of nociception as measured during surgery itself rather than using other experimental models as surrogates for surgical nociception.

Objective Race remains a significant predictor of poor outcomes in women with gynecologic cancer and minority patients consistently report worse quality of life during cancer treatment. Disparities between patients in strength of social and emotional supports may contribute to these outcomes. This study’s objective was to describe the racial differences in patient reported outcomes of women being evaluated or treated for a gynecologic malignancy at a large tertiary cancer hospital. Methods In this prospective cohort study, all patients presenting for care at a tertiary care gynecologic oncology clinic between January 2018 and September 2019 were evaluated for inclusion. All patients were administered validated patient reported outcome measure questionnaires at serial visits. Demographic data was gathered including self-reported race. Patients were characterized as White, Black, Asian, Hispanic/Latino, or Other. Patient reported outcomes were compared between respondents of different races using linear and logistic regression. Results Between January 2018 to September 2019, 2022 patients with a known race completed questionnaires. Of these patients, 86.7% were White, 4.3% Black, and 4.9% Hispanic/Latino and 58.7% had a known cancer diagnosis. Non-White patients were significantly less likely to complete questionnaires (pConclusions Significant differences exist in patient reported outcomes between women of different racial backgrounds. Hispanic/Latino and Black women have less support during gynecologic cancer evaluation and treatment as compared with White women.