Maternal and neonatal outcomes in patients with hepatitis C and intrahepatic cholestasis of pregnancy: The sum of the parts.

ObjectiveHepatitis C virus and intrahepatic cholestasis of pregnancy (ICP) are well-known independent risk factors for adverse outcomes in pregnancy. In addition, it is well-established that there is an association between Hepatitis C and ICP. This study's objective was to describe the impact of having both Hepatitis C and ICP on maternal and obstetric outcomes compared to patients having either Hepatitis C or ICP.MethodsWe conducted a retrospective cohort study of the Nationwide Readmissions Database, an all-payor sample of discharges from approximately 60% of US hospitalizations. Deliveries at 24-42+ weeks between 10/2015 and 12/2020 were included. Diagnosis of Hepatitis C and ICP, and outcomes related to severe maternal morbidity were identified using International Classification of Disease-10 codes. Patients were categorized based on Hepatitis C and ICP status. Weighted logistic and negative binomial regression analyses were used to evaluate the association between Hepatitis C and ICP status and outcomes, adjusting for patient and hospital characteristics. The primary outcome was any severe maternal morbidity; secondary outcomes included acute respiratory distress syndrome, acute kidney injury, sepsis, gestational diabetes, cesarean delivery, preterm birth, and hospital length of stay. We modeled interaction terms between ICP and Hepatitis C to assess whether there was a greater or lesser effect from having both conditions on outcomes than we would expect from additive combination of the individual components (i.e., synergy or antagonism).ResultsA total of 10,040,850 deliveries between 24-42+ weeks were identified. Of these, 45,368 had Hepatitis C only; 84,582 had ICP only; and 1,967 had both Hepatitis C and ICP. Patients with both Hepatitis C and ICP had 1.5-fold higher odds of developing severe maternal morbidity compared to having neither. There was an also an increased odds of severe maternal morbidity in patients with both Hepatitis C and ICP compared to patients with only Hepatitis C or ICP. Having both was also associated with higher odds of preterm birth and length of stay compared to having only Hepatitis C, only ICP, or neither (preterm birth: aOR 5.09, 95% CI 4.87-5.33 vs. neither; length of stay: 46% mean increase, 95% CI 35-58% vs. neither). Associations were additive-no significant interactions between hepatitis C and cholestasis were found on rates of severe maternal morbidity, acute respiratory distress syndrome, acute kidney injury, sepsis, cesarean section, or preterm birth (all p>0.05), and was minimal for gestational diabetes and length of stay.ConclusionHepatitis C and ICP are independent, additive risk factors for adverse maternal and obstetric outcomes. Despite physiologic plausibility, no evidence of a synergistic effect of these two diagnoses on outcomes was noted. These data may be useful in counseling patients regarding their increased risk of adverse outcomes when ICP presents in association with Hepatitis C versus ICP alone

A single institution, cross-sectional study on medical student preferences for collaborators in interprofessional education

Abstract Background While the importance of interprofessional education in medical training has been well-established, no specific framework has been used uniformly or shown to be most effective in the creation of interprofessional education (IPE) sessions. Further, prior studies have demonstrated that students have preferences for the design of these experiences. In this study, we sought to understand medical student preference for interprofessional teammates and motivations for this choice. Methods In this single-institution, cross-sectional analysis of the Duke IPE Clinic, participating students from September 2019–March 2020 completed a voluntary electronic survey that queried preferences for which health professions students (Doctor of Physical Therapy (DPT), Accelerated Bachelor of Science in Nursing (ABSN), Nurse Practitioner (NP), Pharmacy, and Physician’s Associate (PA)) they would want to work with, and the motivating reason. Preferences and reasons were compared between first-year medical students (MS1s) and third- and fourth-year medical students (MS3s/MS4s). Results In total, 132 students participated. We found that MS1s most preferred interprofessional teammates with a more similar area of study (PA, NP), whereas MS3s/MS4s most preferred classmates with a less similar area of study (pharmacy, DPT, ABSN). MS1 students frequently selected their first-choice preference because the profession seemed most similar, while MS3/MS4 students often selected their first-choice preference because the profession seemed most different. Conclusions Medical students earlier in training have more interest in working with professions they view as similar whereas senior students prefer to work with professions they view as more different. This information is important for designing educational IPE opportunities