Publications by authors named "Susan Crowe"

13 Publications

  • Page 1 of 1

What's in a Name? Enhancing Communication in the Operating Room with the Use of Names and Roles on Surgical Caps.

Jt Comm J Qual Patient Saf 2020 Nov 26. Epub 2020 Nov 26.

Objective: A pilot study was conducted in a tertiary referral center to assess whether wearing caps labeled with providers' names and roles has an impact on communication in the operating room (OR).

Methods: Two obstetricians observed surgeries for name uses and missed communications. Following each case, all providers were given a short survey that queried their attitude about the use of labeled surgical caps, their ability to know the names and roles of other providers during a case, and the impact of scrub attire on identifying others. They were also asked to rate the ease of communication and their ability to recall name and roles of the personnel specific to the case. Patients were asked how they perceived the use of labeled caps by providers.

Results: Twenty scheduled cesarean deliveries were randomized to either labeled (10) or nonlabeled (10) surgical caps. A total of 129 providers participated in the study, with 117 providing responses to the survey. Providers reported knowing the names and roles of colleagues more often with labeled caps vs. nonlabeled caps (names: 77.8% vs. 55.0%, 95% confidence interval [CI] = 64.4%-88.0% vs. 41.6%-67.9%, p = 0.011; roles: 92.5% vs. 78.3%, 95% CI = 81.8%-98.0% vs. 65.8%-88.0%, p = 0.036). Name uses increased (43 vs. 34, p = 0.208), and missed communications decreased (16 vs. 20, p = 0.614) when labeled caps were worn. Providers and patients had an overwhelmingly positive response to labeled caps.

Conclusion: This pilot study demonstrated that wearing labeled caps in the OR led to more frequent name uses and less frequent missed communications. Providers and patients embraced the concept of labeled caps and perceived wearing labeled caps as improving communication in the OR.
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http://dx.doi.org/10.1016/j.jcjq.2020.11.012DOI Listing
November 2020

Epigenetic signatures of attachment insecurity and childhood adversity provide evidence for role transition in the pathogenesis of perinatal depression.

Transl Psychiatry 2020 02 3;10(1):48. Epub 2020 Feb 3.

Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA.

Early life adversity and insecure attachment style are known risk factors for perinatal depression. The biological pathways linking these experiences, however, have not yet been elucidated. We hypothesized that overlap in patterns of DNA methylation in association with each of these phenomena could identify genes and pathways of importance. Specifically, we wished to distinguish between allostatic-load and role-transition hypotheses of perinatal depression. We conducted a large-scale analysis of methylation patterns across 5 × 10 individual CG dinucleotides in 54 women participating in a longitudinal prospective study of perinatal depression, using clustering-based criteria for significance to control for multiple comparisons. We identified 1580 regions in which methylation density was associated with childhood adversity, 3 in which methylation density was associated with insecure attachment style, and 6 in which methylation density was associated with perinatal depression. Shorter telomeres were observed in association with childhood trauma but not with perinatal depression or attachment insecurity. A detailed analysis of methylation density in the oxytocin receptor gene revealed similar patterns of DNA methylation in association with perinatal depression and with insecure attachment style, while childhood trauma was associated with a distinct methylation pattern in this gene. Clinically, attachment style was strongly associated with depression only in pregnancy and the early postpartum, whereas the association of childhood adversity with depression was time-invariant. We concluded that the broad DNA methylation signature and reduced telomere length associated with childhood adversity could indicate increased allostatic load across multiple body systems, whereas perinatal depression and attachment insecurity may be narrower phenotypes with more limited DNA methylation signatures outside the CNS, and no apparent association with telomere length or, by extension, allostatic load. In contrast, the finding of matching DNA methylation patterns within the oxytocin receptor gene for perinatal depression and attachment insecurity is consistent with the theory that the perinatal period is a time of activation of existing attachment schemas for the purpose of structuring the mother-child relationship, and that such activation may occur in part through specific patterns of methylation of the oxytocin receptor gene.
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http://dx.doi.org/10.1038/s41398-020-0703-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026105PMC
February 2020

Safety and Ergonomic Challenges of Ventilating a Premature Infant During Delayed Cord Clamping.

Children (Basel) 2019 Apr 13;6(4). Epub 2019 Apr 13.

Department of Pediatrics, Stanford University, Palo Alto, CA 94304, USA.

Delayed cord clamping (DCC) is endorsed by multiple professional organizations for both term and preterm infants. In preterm infants, DCC has been shown to reduce intraventricular hemorrhage, lower incidence of necrotizing enterocolitis, and reduce the need for transfusions. Furthermore, in preterm animal models, ventilation during DCC leads to improved hemodynamics. While providing ventilation and continuous positive airway pressure (CPAP) during DCC may benefit infants, the logistics of performing such a maneuver can be complicated. In this simulation-based study, we sought to explore attitudes of providers along with the safety and ergonomic challenges involved with safely resuscitating a newborn infant while attached to the placenta. Multidisciplinary workshops were held simulating vaginal and Caesarean deliveries, during which providers started positive pressure ventilation and transitioned to holding CPAP on a preterm manikin. Review of videos identified 5 themes of concerns: sterility, equipment, mobility, space and workflow, and communication. In this study, simulation was a key methodology for safe identification of various safety and ergonomic issues related to implementation of ventilation during DCC. Centers interested in implementing DCC with ventilation are encouraged to form multidisciplinary work groups and utilize simulations prior to performing care on infants.
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http://dx.doi.org/10.3390/children6040059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518235PMC
April 2019

Breastfeeding Duration and the Risk of Coronary Artery Disease.

J Womens Health (Larchmt) 2019 01 5;28(1):30-36. Epub 2018 Dec 5.

1 Department of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California.

Background: Previous studies have suggested that prolonged breastfeeding has beneficial effects on the health of the mother including the reduction of long-term risk of coronary artery disease (CAD). The mechanism of this association remains unclear.

Methods: We surveyed 643 women aged 40-65 years receiving outpatient care at Stanford University Hospital on their reproductive/lactation history, including 137 women (cases) with clinically confirmed CAD. Survey data were supplemented with traditional risk factor data for CAD obtained from the participant's medical record. We then conducted logistic regression analyses to assess the relationship between breastfeeding duration and case-control status for each of the two separate definitions of duration. The first was based on the participant's single longest duration of breastfeeding considering all live births reported and the second was based on a participant's total duration of breastfeeding summed over all live births. For each of these two definitions, we ran three sequential models each with a different reference group-(1) nulliparous women, (2) parous women that never breastfed, and (3) parous women with a short duration of breastfeeding-successively excluding women in the reference group of the previous model(s).

Results: Just over one-half (51.6%) of the women surveyed reported a history of breastfeeding. We found nominally significant associations (p = 0.04-0.12) for our multivariate analyses that modeled maximum duration of breastfeeding. When compared with nulliparous women, parous women who either never breastfed or always breastfed for <5 months had approximately double the risk of CAD. Among parous women, women who breastfeed for ≥5 months at least once in their lifetime had a ∼30% decrease risk of CAD compared with those who did not initiate breastfeeding. Among parous women who breastfed ≥1 month, women who breastfed ≥5 months had ∼50% decreased risk of CAD. We found similar point estimates of effect for analogous analyses modeling maximum breastfeeding duration but p-values for these analyses were not significant. Unadjusted analyses demonstrated higher valued odds ratios and lower p-values suggesting the presence of some confounding by traditional risk factors.

Conclusions: Parous women who breastfeed ≥5 months in at least one pregnancy seem to be at decreased risk of CAD later in their life, whereas parous women who either never breastfed or discontinued breastfeeding early seem to be at increased risk. More research is needed to more reliably quantify and determine the nature of the relationship between parity, breastfeeding duration, and risk of CAD.
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http://dx.doi.org/10.1089/jwh.2018.6970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422010PMC
January 2019

Opportunities to Foster Efficient Communication in Labor and Delivery Using Simulation.

AJP Rep 2017 Jan;7(1):e44-e48

Department of Pediatrics, Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California; Department of Pediatrics, Stanford University School of Medicine, Stanford, California.

 Communication errors are an important contributing factor in adverse outcomes in labor and delivery (L&D) units. The objective of this study was to identify common lapses in verbal communication using simulated obstetrical scenarios and propose alternative formats for communication.  Health care professionals in L&D participated in three simulated clinical scenarios. Scenarios were recorded and reviewed to identify questions repeated within and across scenarios. Questions that were repeated more than once due to ineffective communication were identified. The frequency with which the questions were asked across simulations was identified.  Questions were commonly repeated both within and across 27 simulated scenarios. The median number of questions asked was 27 per simulated scenario. Commonly repeated questions focused on three general topics: (1) historical data/information (i.e., estimated gestational age), (2) maternal clinical status (i.e., estimated blood loss), and (3) personnel (i.e., "Has anesthesiologist been called?").  Inefficient verbal communication exists in the process of transferring information during obstetric emergencies. These findings can inform improved training and development of information displays to improve teamwork and communication. A visual display that can report static historical information and specific dynamic clinical data may facilitate optimal human performance.
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http://dx.doi.org/10.1055/s-0037-1599123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330795PMC
January 2017

Obesity and Tobacco Cessation Toolkits: Practical Tips and Tools to Save Lives.

Obstet Gynecol 2016 12;128(6):1314-1319

Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California.

Both obesity and smoking are public health burdens that together contribute to approximately one third of the deaths annually in the United States. In 2015, under the direction of Dr. Mark DeFrancesco, the American College of Obstetricians and Gynecologists convened two workgroups with the purpose of creating toolkits that bring together information that the obstetrician-gynecologist can use to address these preventable health problems. An Obesity Prevention and Treatment Workgroup and a Tobacco and Nicotine Cessation Workgroup developed toolkits on Obesity Prevention and Treatment (www.acog.org/ObesityToolkit)andTobaccoandNicotineCessation(www.acog.org/TobaccoToolkit). The toolkits contain specific talking points, counseling methods, and algorithms to address these health concerns in a supportive, efficient, and effective manner. By including these methods in practice, clinicians can help prevent the tragedy of early deaths caused by obesity, tobacco, and nicotine use.
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http://dx.doi.org/10.1097/AOG.0000000000001752DOI Listing
December 2016

Maternal attachment insecurity is a potent predictor of depressive symptoms in the early postnatal period.

J Affect Disord 2016 Jan 24;190:623-631. Epub 2015 Oct 24.

Stanford University Medical Center, Department of Psychiatry and Behavioral Science, United States; Stanford University Medical Center, Department of Obstetrics and Gynecology, United States.

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http://dx.doi.org/10.1016/j.jad.2015.09.067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4897028PMC
January 2016

Optimistic outlook regarding maternity protects against depressive symptoms postpartum.

Arch Womens Ment Health 2015 Apr 5;18(2):197-208. Epub 2014 Aug 5.

Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, 401 Quarry Road, MC 5723, Stanford, CA, 94305, USA.

The transition to motherhood is a time of elevated risk for clinical depression. Dispositional optimism may be protective against depressive symptoms; however, the arrival of a newborn presents numerous challenges that may be at odds with initially positive expectations, and which may contribute to depressed mood. We have explored the relative contributions of antenatal and postnatal optimism regarding maternity to depressive symptoms in the postnatal period. Ninety-eight pregnant women underwent clinician interview in the third trimester to record psychiatric history, antenatal depressive symptoms, and administer a novel measure of optimism towards maternity. Measures of depressive symptoms, attitudes to maternity, and mother-to-infant bonding were obtained from 97 study completers at monthly intervals through 3 months postpartum. We found a positive effect of antenatal optimism, and a negative effect of postnatal disconfirmation of expectations, on depressive mood postnatally. Postnatal disconfirmation, but not antenatal optimism, was associated with more negative attitudes toward maternity postnatally. Antenatal optimism, but not postnatal disconfirmation, was associated with reduced scores on a mother-to-infant bonding measure. The relationships between antenatal optimism, postnatal disconfirmation of expectations, and postnatal depression held true among primigravidas and multigravidas, as well as among women with prior histories of mood disorders, although antenatal optimism tended to be lower among women with mental health histories. We conclude that cautious antenatal optimism, rather than immoderate optimism or frank pessimism, is the approach that is most protective against postnatal depressive symptoms, and that this is true irrespective of either mood disorder history or parity. Factors predisposing to negative cognitive assessments and impaired mother-to-infant bonding may be substantially different than those associated with depressive symptoms, a finding that merits further study.
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http://dx.doi.org/10.1007/s00737-014-0446-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869708PMC
April 2015

Identification of three ABCA4 sequence variations exclusive to African American patients in a cohort of patients with Stargardt disease.

Am J Ophthalmol 2013 Dec 4;156(6):1220-1227.e2. Epub 2013 Sep 4.

Cole Eye Institute, Cleveland, Ohio.

Purpose: To describe the clinical and molecular findings in ten unrelated African American patients with Stargardt disease.

Design: Retrospective, observational case series.

Methods: We reviewed the clinical histories, examinations, and genotypes of 85 patients with molecular diagnoses of Stargardt disease. Three ABCA4 sequence variations identified exclusively in African Americans were evaluated in 300 African American controls and by in silico analysis.

Results: ABCA4 sequence changes were identified in 85 patients from 80 families, of which 11 patients identified themselves as African American. Of these 11 patients, 10 unrelated patients shared 1 of 3 ABCA4 sequence variations: c.3602T>G (p.L1201R); c.3899G>A (p.R1300Q); or c.6320G>A (p.R2107H). The minor allele frequencies in the African American control population for each variation were 7.5%, 6.3%, and 2%, respectively. This is comparable to the allele frequency in African Americans in the Exome Variant Server. In contrast, the allele frequency of all three of these variations was less than or equal to 0.05% in European Americans. Although both c.3602T>G and c.3899G>A have been reported as likely disease-causing variations, one of our control patients was homozygous for each variant, suggesting that these are nonpathogenic. In contrast, the absence of c.6320G>A in the control population in the homozygous state, combined with the results of bioinformatics analysis, support its pathogenicity.

Conclusions: Three ABCA4 sequence variations were identified exclusively in 10 unrelated African American patients: p.L1201R and p.R1300Q likely represent nonpathogenic sequence variants, whereas the p.R2107H substitution appears to be pathogenic. Characterization of population-specific disease alleles may have important implications for the development of genetic screening algorithms.
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http://dx.doi.org/10.1016/j.ajo.2013.07.008DOI Listing
December 2013

Vision First, a program to detect and treat eye diseases in young children: the first four years.

Trans Am Ophthalmol Soc 2008 ;106:179-85; discussion 185-6

Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Purpose: The Vision First program began in the fall of 2002 as a community outreach initiative by the Cleveland Clinic Cole Eye Institute in partnership with the Cleveland Metropolitan School District. It was designed to provide free eye examinations to all prekindergarten, kindergarten, and first grade students enrolled in Cleveland City public schools in order to diagnose refractive errors, amblyopia, and strabismus, so that treatment is instituted and the best possible visual outcome attained.

Methods: Examinations are performed in 2 lanes of a specially outfitted recreational vehicle. All children undergo monocular visual acuity testing at distance and near, stereopsis testing, cover testing at distance and near, testing of versions, and external ocular inspection. If a child fails any part of this examination according to the guidelines set by the American Academy of Pediatrics, cycloplegic drops are instilled and an optometrist refracts the child on location and performs indirect ophthalmoscopy. Glasses are prescribed and follow-up with a pediatric ophthamologist is arranged.

Results: During the first 4 years of the program, 22,988 examinations were performed. Seven percent of children had errors of refraction that necessitated optical correction, about 2.1% had strabismus, and 1.7% had amblyopia. The cost per student per year was around $23 excluding glasses.

Conclusions: About 10% of 5- and 6-year-old schoolchildren have eye problems that require either glasses or treatment for strabismus or amblyopia. The Vision First model brings eye care professionals to the schools and provides effective comprehensive screening of all children, as well as detailed examination and referral of those with significant eye problems.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646440PMC
March 2009

Vardenafil treatment for erectile dysfunction.

Ann Pharmacother 2004 Jan;38(1):77-85

Department of Pharmacy Services, University of Michigan Health System, University of Michigan, Ann Arbor, MI, USA.

Objective: To review the pharmacology, pharmacokinetics, clinical trial data, and adverse effects of vardenafil in the treatment of erectile dysfunction (ED).

Data Sources: Literature searches were performed using the MEDLINE database (referenced citations through December 2002), and the references of all identified articles were scanned for additional publications of interest. Unpublished information provided by the manufacturer and proceedings of professional meetings were also evaluated.

Study Selection And Data Extraction: All available studies were utilized to obtain information regarding pharmacology. Only human studies were used to gather pharmacokinetic, drug interaction, efficacy, and safety data.

Data Synthesis: Vardenafil is a potent and selective inhibitor of the phosphodiesterase 5 (PDE5) enzyme that has been shown to improve erectile function in several populations of men with ED. Vardenafil has a rapid onset of action, is hepatically metabolized, and has a half-life of 4-6 hours. Clinical trials in otherwise healthy men with ED, men with ED and diabetes, and men with ED and a history of prostatectomy have demonstrated vardenafil's efficacy. Adverse effects appear to be relatively mild in intensity and dose dependent, with 22-61% of subjects reporting adverse effects.

Conclusions: Vardenafil is a safe and effective oral agent for the treatment of ED. Its greater potency and PDE5 selectivity compared with sildenafil appear to confer a lower risk of vision-related adverse effects, but other clinical consequences of these differences are currently unclear.
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http://dx.doi.org/10.1345/aph.1D019DOI Listing
January 2004

Ophthalmologic findings in patients with nonsyndromic plagiocephaly.

J Craniofac Surg 2003 Jul;14(4):529-32

Center for Genetic Eye Disease, Cole Eye Institute, Cleveland, Ohio 44195, USA.

The purpose of this article was to study the prevalence of strabismus and astigmatism in children with nonsyndromic plagiocephaly. Children with deformational plagiocephaly do not have an increased prevalence of strabismus compared with the general population but do have an increased prevalence of astigmatism, whereas children with nonsyndromic craniosynostotic plagiocephaly have an increased prevalence of strabismus and astigmatism. This observational cohort study retrospectively reviewed patients in a multidisciplinary craniofacial clinic between 1993 and 2001. Patients were referred for evaluation and management of plagiocephaly or craniosynostosis. One hundred eleven patients had deformational plagiocephaly, and 45 had synostotic plagiocephaly. Patients with lambdoid craniosynostosis, hemifacial microsomia, any syndromic form of craniosynostosis, or without a formal diagnosis were excluded. All patients underwent detailed ophthalmologic, ocular motility, and craniofacial examinations. Diagnosis was based on clinical and radiographic findings. Patients were evaluated between birth and age 14 years (mean = 13 months; SD = 22 months). Only 1 of 111 (<1%) patients with deformational plagiocephaly had an esodeviation, and none had an exodeviation. Three of 45 patients (7%) with synostotic plagiocephaly had an exodeviation, and none had an esodeviation. Eight of 93 patients (9%) with deformational plagiocephaly had unilateral astigmatism, and 14 (15%) had bilateral astigmatism (mean = 1.82 diopters). Three of 43 patients (7%) with synostotic plagiocephaly had unilateral astigmatism, and 9 (21%) had bilateral astigmatism (mean = 1.83 diopters). Patients with deformational plagiocephaly do not appear to have a higher prevalence of horizontal strabismus than the normal population. Exotropia is more common in patients with nonsyndromic craniosynostotic plagiocephaly than in the general population. The prevalence of astigmatism in patients with nonsyndromic craniosynostotic plagiocephaly appears to be greater than in the general population, but this higher prevalence requires further study.
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http://dx.doi.org/10.1097/00001665-200307000-00026DOI Listing
July 2003

Lymphedema-distichiasis syndrome and FOXC2 gene mutation.

Am J Ophthalmol 2002 Oct;134(4):592-6

Center for Genetic Eye Diseases, Cole Eye Institute, Cleveland Clinic Foundation, Ohio 44195, USA.

Purpose: To describe the clinical characteristics of a family with autosomal dominant lymphedema-distichiasis syndrome and to report the results of analysis of the FOXC2 gene

Design: Observational and experimental study.

Methods: The setting was a clinical practice. The study population was 17 members of a family with lymphedema-distichiasis. Observation procedures were complete ophthalmologic examinations and collection of blood samples. DNA was extracted. Mutation analysis of the coding region of the FOXC2 gene was performed using direct sequencing of polymerase chain reaction (PCR) product and a restriction enzyme assay. The main outcome measure was inheritance of mutation in FOXC2 gene.

Results: Nine patients had distichiasis or lymphedema or both and eight did not. Sequencing of the coding region of the only translated exon of the FOXC2 gene revealed a C to A transversion at position 939 resulting in a Tyr313Stop codon with premature termination of translation and a truncated protein product. The mutation was present in all nine affected individuals and in an asymptomatic 9-year-old boy.

Conclusions: Distichiasis-lymphedema syndrome results from mutations in FOXC2, a member of the forkhead/winged family of transcription factors. There is intrafamilial variation in the clinical expression of the mutation.
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http://dx.doi.org/10.1016/s0002-9394(02)01642-2DOI Listing
October 2002