Holly Bullock

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Scholarly Contributions

Journals/Publications

• Gabra, M. G., Gonzalez, M. G., Bullock, H. N., & Hill, M. G. (2020). Cell-Free DNA as an Addition to Ultrasound for Screening of a Complete Hydatidiform Mole and Coexisting Normal Fetus Pregnancy: A Case Report. AJP reports, 10(2), e176-e178.
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   Complete hydatidiform mole and coexisting normal fetus pregnancies (CHMCF) are rare and can be life-threatening to the mother. Definitive diagnosis can be made with chorionic villus sampling or amniocentesis. However invasive procedures carry a risk of bleeding. We present the case of a twin molar pregnancy where a cell-free DNA screening test was utilized to evaluate for CHMCF pregnancy.  A patient presented at 15-week gestational age with suspected CHMCF pregnancy. Ultrasound revealed a normal-appearing pregnancy abutting a multicystic lesion concerning for a complete mole. Cell-free DNA was obtained and was suggestive of complete paternal uniparental disomy. Pathological evaluation of the products of conception confirmed the diagnosis of CHMCF.  In atypical cases, cell-free DNA may be useful in evaluation of molar pregnancy.
• Kaur, G., Fontanilla, T., Bullock, H., & Tschann, M. (2020). "The Difference between Plan b and ella®? They're Basically the Same Thing": Results from a Mystery Client Study. Pharmacy (Basel, Switzerland), 8(2).
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  Pharmacy staff can serve an important role educating patients about emergency contraceptive pills (ECP), particularly ulipristal acetate (UPA), which requires a prescription. We conducted a secondary analysis of a previously completed mystery client study, assessing accuracy of information provided by pharmacy staffers to patients inquiring by telephone about filling a prescription for UPA. From the period December 2013 to July 2014, researchers used a mystery client methodology, contacting 198 retail pharmacies in Hawai'i. Researchers posed as patients or providers attempting to fill a prescription for UPA. During the course of the call, they asked about differences between UPA and levonorgestrel ECPs. Nearly half of all pharmacy staffers were unfamiliar with UPA. The majority of responses describing differences between the medications were incorrect or misleading, such as responses implying that UPA is an abortifacient. Lack of familiarity and incorrect information provided by pharmacy staffers may act as additional barriers in patient access to UPA. Health practitioners prescribing UPA should ensure patients receive evidence-based counseling at the time of prescription, while efforts should also be made to improve pharmacy staff familiarity with emergency contraceptive options.
• Bullock, H., Galindo, E., White, K., Nguyen, B., Turok, D. K., Simmons, R. G., Sanders, J. N., & Gawron, L. M. (2018). Increasing options for vasectomy counseling and services at Planned Parenthood of Utah. Contraception, 98(4), 337-338. doi:10.1016/j.contraception.2018.07.028
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  published abstract for oral presentation
• Roth, L. P., Sanders, J. N., Simmons, R. G., Bullock, H., Jacobson, E., & Turok, D. K. (2018). Changes in uptake and cost of long-acting reversible contraceptive devices following the introduction of a new low-cost levonorgestrel IUD in Utah's Title X clinics: a retrospective review. Contraception, 98(1), 63-68.
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  The objective was to assess changes in long-acting reversible contraceptive (LARC) method uptake at Utah's Title X clinics before and after introduction of a new, low-cost levonorgestrel (LNG) 52mg IUD (Liletta®).
• Shigesato, M., Elia, J., Tschann, M., Bullock, H., Hurwitz, E., Wu, Y. Y., & Salcedo, J. (2018). Pharmacy access to Ulipristal acetate in major cities throughout the United States. Contraception, 97(3), 264-269.
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  Ulipristal acetate (UPA) is a prescription emergency contraceptive pill (ECP). Despite the potential for UPA to reduce the risk of unintended pregnancies, a recent study in Hawaii demonstrated less than 3% of pharmacies stocked UPA and less than 23% reported the ability to order it. The primary outcome of our study was to assess the availability of UPA in a sample of large cities nationwide.
• Turok, D. K., Leeman, L., Sanders, J. N., Thaxton, L., Eggebroten, J. L., Yonke, N., Bullock, H., Gawron, L. M., Espey, E., & Singh, R. H. (2018). Immediate Postpartum Levonorgestrel Intrauterine Device Insertion and Breast-Feeding Outcomes: A Noninferiority Randomized Controlled Trial. Obstetrical & Gynecological Survey, 73(1), 30-32. doi:10.1097/01.ogx.0000527869.95368.ab
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  Background Immediate postpartum levonorgestrel intrauterine device insertion is increasing in frequency in the United States, but few studies have investigated the effect of early placement on breast-feeding outcomes. Objective This study examined the effect of immediate vs delayed postpartum levonorgestrel intrauterine device insertion on breast-feeding outcomes. Study Design We conducted this noninferiority randomized controlled trial at the University of Utah and the University of New Mexico Health Sciences Centers from February 2014 through March 2016. Eligible women were pregnant and planned to breast-feed, spoke English or Spanish, were aged 18-40 years, and desired a levonorgestrel intrauterine device. Enrolled women were randomized 1:1 to immediate postpartum insertion or delayed insertion at 4-12 weeks' postpartum. Prespecified exclusion criteria included delivery Results We met the enrollment target with 319 participants, but lost 34 prior to randomization and excluded an additional 26 for medical complications prior to delivery. The final analytic sample included 132 in the immediate group and 127 in the delayed group. Report of any breast-feeding at 8 weeks in the immediate group (79%; 95% confidence interval, 70–86%) was noninferior to that of the delayed group (84%; 95% confidence interval, 76–91%). The 5% difference in breast-feeding continuation at 8 weeks between the groups fell within the noninferiority margin (95% confidence interval, –5.6 to 15%). Time to lactogenesis (mean ± SD) in the immediate group, 65.3 ± 25.7 hours, was noninferior to that of the delayed group, 63.6 ± 21.6 hours. The mean difference between groups was 1.7 hours (95% confidence interval, –4.8 to 8.2 hours), noninferior by log-rank test. A total of 24 intrauterine device expulsions occurred in the immediate group compared to 2 in the delayed group (19% vs 2%, P Conclusion Our results of noninferior breast-feeding outcomes between women with immediate and delayed postpartum levonorgestrel intrauterine device insertion suggest that immediate postpartum intrauterine device insertion is an acceptable option for women planning to breast-feed and use the levonorgestrel intrauterine device. Expulsion rates are higher with immediate postpartum levonorgestrel intrauterine device insertion compared to delayed insertion, but this disadvantage may be outweighed by the advantages of immediate initiation of contraception. Providers should offer immediate postpartum intrauterine device insertion to breast-feeding women planning to use the levonorgestrel intrauterine device.
• Benson, A., Bullock, H., Turok, D. K., & Sanders, J. N. (2017). The effects of reduced-cost vs. no-cost contraception on postabortion method mix — a prospective cohort study. Contraception, 96(4), 283. doi:10.1016/j.contraception.2017.07.081
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  published abstract
• Bullock, H., Scogin, K. N., & Gaspar-Oishi, M. (2017). DEXA for Females Aged 65+at an OBGYN Resident Clinic in Hawaii: A Chart Audit on Compliance for Osteoporosis Screening. OBSTETRICS AND GYNECOLOGY, 129, 96S-96S.
• Bullock, H., Tschann, M., Elia, J., Kaneshiro, B., & Salcedo, J. (2017). From Kaua'i to Hawai'i Island: Interisland Differences in Emergency Contraceptive Pill Availability. Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 76(7), 178-182.
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  Emergency contraceptive pills (ECPs) are medications used after unprotected intercourse, underprotected intercourse, or sexual assault to decrease the risk of pregnancy. Availability of ECPs in Hawai'i's retail pharmacies was last assessed in 2007, following over-the-counter access to levonorgestrel ECPs (LNG-ECP) for women age 18 years or older and prior to U.S. Food and Drug Administration (FDA) approval of prescription-only ulipristal acetate (UPA). We conducted a county-by-county subanalysis from a larger observational population-based study on statewide availability of ECPs in Hawai'i's pharmacies. In the original study, researchers called all 198 unique retail pharmacies in Hawai'i between December 2013 and June 2014. Only 3% of pharmacies had UPA immediately available on-site in the state, with UPA available on Kaua'i and O'ahu only. At least one form of LNG-ECPs was available in 82% of pharmacies in 2013-2014, roughly the same as 2007 (81%) (P=0.9) when Lana'i and Moloka'i lacked access. Currently, only Moloka'i lacks retail pharmacy access to ECPs. When controlling for general inflation, the 2013-2014 mean price for name brand LNG-ECP fell within the reported range of 2007 prices. Generic LNG-ECPs were substantially lower in price than name brand LNG-ECPs in 2007 and 2013-2014. Availability of UPA is limited and significantly lower compared to LNG-ECPs. Availability of LNG-ECPs statewide has remained stable and the arrival of generics has decreased prices.
• Shigesato, M., Elia, J., Tschann, M., Bullock, H., & Salcedo, J. (2017). Pharmacy Access to the Emergency Contraceptive Ulipristal Acetate in Major Cities Throughout the United States. Journal of Pediatric and Adolescent Gynecology, 30(2), 2-3. doi:10.1016/j.jpag.2017.03.036
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  published manuscript
• Turok, D. K., Leeman, L., Sanders, J. N., Thaxton, L., Eggebroten, J. L., Yonke, N., Bullock, H., Singh, R., Gawron, L. M., & Espey, E. (2017). Immediate postpartum levonorgestrel intrauterine device insertion and breast-feeding outcomes: a noninferiority randomized controlled trial. American journal of obstetrics and gynecology, 217(6), 665.e1-665.e8.
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  Immediate postpartum levonorgestrel intrauterine device insertion is increasing in frequency in the United States, but few studies have investigated the effect of early placement on breast-feeding outcomes.
• Bullock, H., & , . (2016). Informed or Misinformed Consent? Abortion Policy in the United States. OBSTETRICS AND GYNECOLOGY, 128(4), 907-907.
• Bullock, H., Steele, S., Kurata, N., Tschann, M., Elia, J., Kaneshiro, B., & Salcedo, J. (2016). Pharmacy access to ulipristal acetate in Hawaii: is a prescription enough?. Contraception, 93(5), 452-4.
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  To determine pharmacy availability of ulipristal acetate (UPA) and compare to availability of levonorgestrel-containing emergency contraceptive pills (LNG-ECPs).
• Espey, E., Eggebrotten, J., Bullock, H., Turok, D. K., Sanders, J. N., & Gawron, L. M. (2016). The effect of postplacental versus interval postpartum IUD insertion on lactogenesis: the breastfeeding levonorgestrel IUD study (BLIS): a randomized controlled trial. Contraception, 94(4), 390. doi:10.1016/j.contraception.2016.07.032
• Jacobson, E., Roth, L., Bullock, H., Turok, D. K., & Sanders, J. N. (2016). Changes in IUD uptake with the availability of a low-cost levonorgestrel IUD — a retrospective review of Title X clinics. Contraception, 94(4), 410. doi:10.1016/j.contraception.2016.07.104
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  published manuscript
• Steele, K., Storck, K., Bullock, H., Turok, D. K., Sanders, J. N., & Gawron, L. M. (2016). Tracking IUD bleeding experiences (tribe): a prospective evaluation of bleeding profiles among new IUD users. Contraception, 94(4), 407. doi:10.1016/j.contraception.2016.07.093
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  published abstract
• Bullock, H., & Salcedo, J. (2015). Emergency Contraception: Do Your Patients Have a Plan B?. Obstetrics and gynecology clinics of North America, 42(4), 699-712.
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  Emergency contraception is used after unprotected sex, inadequately protected sex, or sexual assault to reduce the risk of pregnancy. Of emergency contraceptive methods available in the United States, the copper intrauterine device has the highest efficacy, followed by ulipristal acetate, levonorgestrel-containing emergency contraceptive pills, and the Yuzpe method. However, access to the most effective methods is limited. Although advanced prescription of emergency contraceptive pills and counseling on emergency contraception to all reproductive-aged women is recommended, women should be advised to contact their health care providers after taking emergency contraceptive pills to discuss possible copper intrauterine device placement and other follow-up.
• Bullock, H., Steele, S., Kurata, N., Tschann, M., Elia, J., Kaneshiro, B., & Salcedo, J. (2015). “I Need to Look That Up. I’ve Never Filled It before”: information from pharmacy staff regarding ulipristal acetate. Contraception, 92(4), 389. doi:10.1016/j.contraception.2015.06.140
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  published abstract
• Bullock, H., Steele, S., Kurata, N., Tschann, M., Elia, J., Kaneshiro, B., & Salcedo, J. (2015). Access to ulipristal acetate in Hawaii: is a prescription enough?. Contraception, 92(4), 388-389. doi:10.1016/j.contraception.2015.06.139
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  published manuscript
• Fernandez, W. G., Winter, M. R., Mitchell, P. M., Bullock, H., Donovan, J., St George, J., Feldman, J. A., Gallagher, S. S., McKay, M. P., Bernstein, E., & Colton, T. (2009). Six-month follow-up of a brief intervention on self-reported safety belt use among emergency department patients. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 16(11), 1221-4.
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  Safety belt use (SBU) reduces motor vehicle deaths by 45%. We previously reported that a brief intervention improved self-reported SBU among emergency department (ED) patients at 3 months. We sought to determine if these effects were sustained at 6 months postenrollment.
• Fernandez, W. G., Mitchell, P. M., Jamanka, A. S., Winter, M. R., Bullock, H., Donovan, J., George, J. S., Feldman, J. A., Gallagher, S. S., McKay, M. P., Bernstein, E., & Colton, T. (2008). Brief motivational intervention to increase self-reported safety belt use among emergency department patients. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 15(5), 419-25.
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  Brief motivational interventions have shown promise in reducing harmful behaviors. The authors tested an intervention to increase safety belt use (SBU) among emergency department (ED) patients.
• Bullock, H., Colton, T., Bernstein, E., McKay, M. P., Gallagher, S. S., Feldman, J. A., George, J. S., Donovan, J., Winter, M., Jamanka, A., Mitchell, P. M., & Fernandez, W. G. (2007). Brief Motivational Intervention to Increase Self-reported Safety Belt Use among Emergency Department Patients. Academic Emergency Medicine. doi:10.1111/j.1553-2712.2008.00096.x
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  Brief motivational interventions have shown promise in reducing harmful behaviors. The authors tested an intervention to increase safety belt use (SBU) among emergency department (ED) patients.From February 2006 to May 2006, the authors conducted a randomized trial of adult ED patients at a teaching hospital in Boston. ED patients were systematically sampled for self-reported SBU. Those with SBU other than "always" were asked to participate. At baseline, participants answered a 9-item series of situational SBU questions, each scored on a 5-point Likert scale. SBU was defined as a continuous variable (9-item average) and as a dichotomous variable (response of "always" across all items). Participants were randomized to an intervention or a control group. The intervention group received a 5- to 7-minute intervention, adapted from classic motivational interviewing techniques, by a trained interventionist. Participants completed a 3-month follow-up phone survey to determine changes from baseline SBU. Continuous and dichotomous SBU were analyzed via analysis of covariance and chi-square testing.Of 432 eligible patients, 292 enrolled (mean age 35 years, standard deviation [SD] +/-11 years; 61% male). At baseline, the intervention and control groups had similar mean (+/-SD) SBU scores (2.8 [+/-1.1] vs. 2.6 [+/-1.1], p = 0.31) and SBU prevalence (each 0%). At 3 months, 81% completed follow-up. The intervention group had significantly greater improvement in mean (+/-SD) SBU scores than controls (0.76 [+/-0.91] vs. 0.34 [+/-0.88], p < 0.001). Also, SBU prevalence of "always" was higher for the intervention group than controls (14.4% vs. 5.9%, p = 0.03).Participants receiving a brief motivational intervention reported higher SBU at follow-up compared to controls. An ED-based intervention may be useful to increase SBU.
• McGrath, M. E., Lada, P., Rebholz, C. M., Mitchell, P. M., Donovan, J. M., Bullock, H. N., & Feldman, J. A. (2007). Does introduction of a sepsis protocol reduce time to antibiotics or improve outcomes for critical septic patients? A before and after study. ANNALS OF EMERGENCY MEDICINE, 50(3), S19-S20.
• Mcgrath, M. E., Lada, P., Rebholz, C. M., Mitchell, P. M., Donovan, J. M., Bullock, H. N., & Feldman, J. A. (2007). Does Introduction of a Sepsis Protocol Reduce Time to Antibiotics or Improve Outcomes for Critical Septic Patients? A Before and After Study. Annals of Emergency Medicine, 50(3), S19-S20. doi:10.1016/j.annemergmed.2007.06.090
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  published abstract
• Rebholz, C. M., Feldman, J. A., Bernard, S. A., Mitchell, P. M., Donovan, J. M., & Bullock, H. N. (2007). The Impact of Real-Time Cardiology 12 Lead ECG Review on ED Triage and Treatment Decisions in Patients With Suspected Acute Coronary Syndrome: A Prospective Pilot Study. Annals of Emergency Medicine, 50(3), S28. doi:10.1016/j.annemergmed.2007.06.119
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  published abstract
• Rebholz, C. M., Feldman, J. A., Bernard, S. A., Mitchell, P. M., Donovan, J. M., & Bullock, H. N. (2007). The impact of real-time cardiology 12 lead ECG review on ED triage and treatment decisions in patients with suspected acute coronary syndrome: A prospective pilot study. ANNALS OF EMERGENCY MEDICINE, 50(3), S28-S28.
• Walker, E. S., Vasquez, J. E., Dula, R., Bullock, H., & Sarubbi, F. A. (2003). Mupirocin-resistant, methicillin-resistant Staphylococcus aureus: does mupirocin remain effective?. Infection control and hospital epidemiology, 24(5), 342-6.
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  To determine the efficacy of mupirocin ointment in reducing nasal colonization with mupirocin-susceptible, methicillin-resistant Staphylococcus aureus (MS MRSA) as well as mupirocin-resistant MRSA (MR MRSA).

Poster Presentations

• Bullock, H., Lee, H., Morikawa, K., & Tschann, M. (2023, Fall). That’s a tricky one: access to misoprostol for early pregnancy loss in retail pharmacies across Arizona.. Presented at Society of Family Planning Annual Meeting in Seattle, WA. Oct 2023.. Seattle, WA: Society of Family Planning.