Thomas Riggs

OBJECTIVE: To evaluate observational research manuscripts submitted to Obstetrics & Gynecology to determine the level of adherence to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and highlight specific areas that could be improved. METHODS: A scoring system based on the STROBE checklist was developed and validated for consistency by volunteer medical students or doctors. Using this scoring system, we performed a cross-sectional analysis on 198 observational research manuscripts submitted to Obstetrics & Gynecology from 2008 to 2016. Each manuscript was given a score based on the STROBE checklist. Comparisons were made among acceptance status, country of origin, and study type. Descriptive statistics (means, medians, and frequencies) were calculated for each manuscript category. The t test or Wilcoxon rank-sum test was used to compare differences between two groups and analysis of variance or the Kruskal-Wallis test was used to compare differences among three or more groups. RESULTS: There was a statistically significant difference between the mean score for accepted (23.2±2.7) compared with rejected (19.7±4.1) manuscripts (P<.001). This difference was not seen when comparing country of origin and study type. Poor reporting was seen among all manuscript categories for objectives, study size, missing data, study participants, and translation of risk. Additionally, rejected manuscripts had poor reporting for eligibility criteria, variables, bias and confounding, statistical methods, unadjusted and adjusted estimates, and category boundaries. CONCLUSION: Overall, accepted manuscripts show better adherence to the STROBE checklist, but there are several critical items that are poorly reported in all manuscripts.

Peer review quality differs based on obstetrics and gynecology subspecialty. Obstetrics and gynecology subspecialty and reviewer experience have implications for manuscript rejection recommendation. Reviewer assignment is pivotal to maintaining a rigorous manuscript selection process.

OBJECTIVE: To determine the prevalence of high TG levels in extremely low birth weight (ELBW) infants and what the risk factors are for high TG levels. STUDY DESIGN: We performed a prospective observational study of triglyceride concentrations in extremely low birth weight infants receiving lipid infusions. Lipid infusions were begun at 0.5 grams/kg/day at age one day and the dose advanced by 0.5 grams/kg/day. Triglyceride concentrations were drawn when the dose reached 1 and 2 grams/kg/day. We compared infants with normal triglyceride levels (≤200 mg/dl) with those with elevated triglyceride levels (>200 mg/dl) with univariate and multivariate analysis. RESULTS: There were 75 infants included in the analysis. Twenty (26.7% , 95% CI = 16.6–36.7%) had triglyceride levels >200 mg/dl. On multiple logistic regression analysis, lower birth weight was associated with the risk of an elevated triglyceride level. Triglyceride levels >200 mg/dl did not predict future mortality or morbidity. CONCLUSION: Elevated TG levels occur commonly in ELBW infants and are associated with a lower birth weight.

Sedation with propofol is gaining popularity. It is unclear whether sedation with propofol is associated with colonoscopic perforation. The purpose of this study was to compare perforation rates during colonoscopy using sedation with or without propofol. This was a retrospective case series study. Data from a tertiary center were analyzed. Demographics, method of sedation, and type of endoscopic procedure performed were collected. Patients who underwent a colonoscopy from January 2003 to October 2012 were analyzed. Perforation rate expressed per 10,000 colonoscopies was measured. A total of 118,004 colonoscopies were performed during the study period, with 48 perforations (0.041% or 4.1 per 10,000). Overall, the use of propofol was associated with a 2.5 times increased rate of perforation (6.9 vs 2.7 per 10,000; p = 0.0015). Similarly, in patients undergoing therapeutic colonoscopies, there was a 3.4-times increased risk of perforation associated with the use of propofol (8.7 vs 2.6 per 10,000; p = 0.0016). However, in patients undergoing diagnostic colonoscopies, there was no significantly increased risk of perforation with the use of propofol (4.2 vs 2.9 per 10,000; p = 0.64). In univariate and multivariate analyses, there were no differential perforation risks on the basis of sex, but each decade increase in age was associated with an increased risk of perforation. In those patients having a therapeutic colonoscopy, age (per decade) and propofol use were independently and significantly associated with an increased perforation risk, with adjusted ORs of 1.32 (p = 0.04) and 3.38 (p = 0.001). This was a retrospective study with the potential for selection bias. This study shows that propofol administration is associated with an increased risk of colonoscopic perforation among patients undergoing a therapeutic colonoscopy; however, this association was not evident in patients undergoing a diagnostic colonoscopy. Further studies, such as a prospective, randomized clinical trial, should be done to further evaluate this association.

Objective. To assess the impact of the 16-duty hour restriction on pediatric interns’ neonatal education. Method. Survey of interns clinical and educational experiences during their neonatal rotations. Results. A total of 316 respondents in 2011, who worked >16 hours, were compared with 509 respondents in 2012, who worked ≤16 hours. The average work week decreased from 67.3 ± 9.6 to 59.3 ± 8.1 hours ( P < .0001). The 2012 cohort attended fewer didactic lectures (−16%, P < .0001), grand rounds (−27%, P < .0001), and mock resuscitations (−16%, P < .005). There were no significant differences in the number of (1) patients on service, (2) deliveries attended, or (3) procedures. There was no significant difference in the median number of correct responses (4) on 10 knowledge-based multiple-choice questions. Conclusions. The decrease in duty hours was achieved without significantly affecting interns’ knowledge or clinical experience.