Faith Arimoro (Funding: Bertha Dagan Berman)
(faculty mentors: Katharine Rendle [Family Medicine and Community Health])
Fellowship term, 6 months: September 2022 - March 2023

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Project: De-Implementation Strategies to Reduce Cervical Cancer Overscreening

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Up to 45% of all cervical cancer screening in the United States is overuse, despite consensus guidelines and convincing evidence of the limited benefit and potential harm of low-value screening. Overscreening can lead to increased false positives and psychosocial harms, cause unnecessary treatment of cervical abnormalities that would resolve on their own, and result in excess financial and opportunity costs. There is a critical need to develop effective strategies for ensuring de-implementation of outdated screening practices. To help fill this gap, the overall study seeks to refine and test the effect of de-implementation strategies  on cervical cancer overscreening, and 2) evaluate contextual mechanisms contributing to the success or failure of each de-implementation strategy using mixed methods approaches. My project will work to support optimization of proposed strategies prior to study launch to advance alignment with clinical workflows and to learn methods for advancing pragmatic trials in clinical practice. 

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Theresa Christensen (Funding: Bertha Dagan Berman)
(faculty mentor: Sarita Sonalkar, MD, MPH [Obstetrics and Gynecology, Division of Family Planning])
Fellowship term, 6 months: September – December 2022, February 2023, April 2023

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Project: Tradeoffs Between Immediate and Delayed Postpartum IUDs: A Survey and Choice-based Conjoint

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Repeat pregnancy less than 18 months after a delivery is associated with worse health outcomes for both parent and child and can be prevented with use of postpartum contraception including intrauterine devices (IUDs). IUDs can be placed either immediately after delivery or at postpartum follow up appointments. Delaying IUD placement until postpartum follow up may not be effective or feasible for patients who face barriers to accessing follow up care. For this reason, increasing IUD access via immediate insertion is particularly appealing, especially in populations that may have limited access to follow up care. However, IUDs placed immediately after delivery are known to have higher risk of being incorrectly positioned within the uterus or falling out of the uterus altogether. Malpositioned IUDs may require removal in the operating room under anesthesia, limiting patients’ reproductive autonomy should they desire to get pregnant again. This study will seek to analyze which attributes of immediate vs delayed postpartum IUDs are important to patients when making decisions about postpartum contraception. This will be assessed using multiple criteria decision analysis, in which patients are asked to choose between theoretical birth control options with characteristics that vary along multiple axes including overall effectiveness, expulsion risk, requirement of additional office visit for placement, or possibility of abnormal placement in the uterus. Providers can then use this data to provide evidence- and values-based counseling to patients regarding postpartum contraception options.

Taylor Streaty  (Funding: Bertha Dagan Berman)

(faculty mentor: Andrea Roe, MD, MPH [Obstetrics and Gynecology])
Fellowship term, 6 months: (8/28-9/23 (1 month), 10/24-12/23 (2 months), 1/30-2/20 (3 weeks), 2/27-4/30 (2 months, 1 week) = total of 6 weeks

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Project: Sexual Orientation and Gender Identity Data Collection in the Electronic Medical Record:  A Needs Assessment

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Sexual orientation and gender identity (SOGI) data collection in the health care field has been supported by the CDC, as well as the Joint Commission to provide more robust research on LGBTQ+ healthcare disparities as well as improve clinical care for sexual and gender minorities (SGM). Additionally, though some fear that patients will find SOGI data collection intrusive or unnecessary, previous research has shown that SOGI data collection is deemed both acceptable and important by most patients. Though the importance of SOGI data collection has been demonstrated in many specialties, the current landscape of SOGI data collection within Obstetrics and Gynecology has not been well delineated. LGBTQ+ patients face unique challenges in receiving obstetrical and gynecological health care, particularly relating to preventive care and family planning. This study will explore the current practices of SOGI data collection at OB/GYN ambulatory sites in a large health system that spans both urban and suburban locations to identify current weaknesses in SOGI data collection and identify opportunities for SOGI data collection improvement in Obstetrics and Gynecology.

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Hilary Bediako (Funding: The Edna G. Kynett Memorial Foundation)

(faculty mentors: Jennifer Lewey, MD, MPH [Medicine/Cardiovascular Medicine] 
Fellowship term, 6 months: September 2022 - March 2023

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Project : Studying the differences in the effectiveness of a remote digital intervention in improving physical activity among a diverse group of post-partum individuals with hypertensive disorders of pregnancy

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Rising rates of postpartum obesity increase risk for cardiovascular (CV) disease, especially among individuals with adverse pregnancy outcomes such as hypertensive disorders of pregnancy (HDP). In-person programs have proven successful for lifestyle changes but may not be feasible for busy new mothers who may benefit more from remote interventions. Interventions using gamification and social incentives have been shown to improve physical activity in overweight and obese low-income individuals but studies among post-partum women are limited. Additionally, there is now a growing interest in using behavioral phenotypes derived from social, economic, and behavioral factors to improve health outcomes and minimize health disparities. A recent study showed substantial variation in response to physical activity based on behavioral phenotypes, suggesting that targeting interventions to patient behavioral phenotype may be more favorable in improving physical activity. The 2022 STEP-UP MOM trial found that an intervention with a remote wearable tracker that utilized gamification, social incentives, and principles of behavioral economics improved physical activity among post-partum women compared to wearable tracker alone. This study will be a secondary analysis to the 2022 STEP-UP MOM trial to determine how demographic, clinical, and behavioral characteristics are correlated with program engagement and intervention success among post-partum women with HDP. This current study may ultimately inform how future behavioral approaches may be tailored to maximize program engagement and success in future studies and lead to sustainable changes in physical activity among post-partum individuals, which is an important aspect of cardiovascular health and prevention of heart disease in women.

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Jessica Wu  (Funding: The Edna G. Kynett Memorial Foundation)

(faculty mentor: Andrea Roe, MD [Obstetrics and Gynecology, Division of Family Planning])
Fellowship term, 6 months: October 1, 2022 – April 1, 2023

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Project:   Inflammatory Markers Across the Menstrual Cycle in Females with Sickle Cell Disease

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Sickle cell disease is a complex and understudied condition that exhibits significant sex disparities. Pain episodes that are the hallmark of this disease affect females more frequently than males, and among females present more frequently in the perimenstrual period. Sickle cell disease also affects primarily Black individuals, and both research and clinical outcomes suffer from racial inequities prevalent in the United States, prompting the need for increased research to better understand the nuances of the disease and to decrease this disparity. Inflammatory pathways underlie the pathophysiology of pain episodes in this population, but their relationship to clinical differences in sex and across the menstrual cycle has not been described. We propose an exploratory study of sex differences and menstrual cycle variation in inflammatory markers among individuals with sickle cell disease. We hypothesize that these inflammatory markers may also relate to vascular events, such as venous thromboembolism, that individuals with sickle cell disease are already predisposed to. In this study, we will use stored samples from the Penn Biobank to:

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1. Compare serum levels of inflammatory markers across female and male patients with sickle cell disease.

2. Describe associations between serum levels of inflammatory markers and female sex hormones (as a proxy for menstrual cycle stage) among female patients with sickle cell disease.