Articles Tagged With:
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HIV Management During Pregnancy
Human immunodeficiency virus (HIV) infection during pregnancy carries a significant burden to healthcare systems, and continues to be of significant public health concern.
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The Cost-Effectiveness of HPV Vaccination for Adults Aged 30 to 45 Years
This study evaluated the cost-effectiveness of extending the upper age limit of human papillomavirus (HPV) vaccination to age 30 to 45 years using two independent HPV microsimulation models and found that vaccinating in this age group was not cost-effective.
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Are Modern Intrauterine Devices Associated with Infertility?
In this prospective cohort study of 461 women, there was no association between intrauterine device use and time to conception (hazard ratio, 1.25; 95% confidence interval, 0.99-1.58). However, past Mycoplasma genitalium infection was found to be associated with longer times to conception and lower conception rates by 12 months (68% vs. 80%, P = 0.02).
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The Levonorgestrel IUD Is Similarly Effective as the Copper IUD for Emergency Contraception
In this randomized, noninferiority trial among patients seeking emergency contraception after at least one episode of unprotected intercourse within five days of presentation, the levonorgestrel 52-mg intrauterine device (IUD) was noninferior to the copper T30A IUD at preventing pregnancy one month after IUD insertion. Adverse events between the two groups were similar.
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Ethical Responses Needed if Clinicians Say Discharge Is Unsafe
For some patients, there are no caregivers at home. Others may be living in unsafe conditions. Ethicists can help by brainstorming scenarios, and trying to connect resources accordingly.
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Novel Program Decreases Transport to ED for Hospice Patients
Ventura County, CA, paramedics underwent 30 hours of training on crisis counseling, grief, and palliative care. When EMS responded to a 911 call and determined a patient was in hospice, they contacted trained staff. During a three-year study period, the percentage of hospice patients transported to the ED was 36% in the first year, 33% in the second year, and 24% in the third year. This was compared to 80% of hospice patients transported, on average, during the six months before project implementation.
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No Evidence of Bias on Pediatric Ethics Rounds
Researchers compared sociodemographic factors between patients admitted to an academic children’s hospital during ethics rounds in the PICU, PCTU, and NICU in 2017 and 2018 who were identified as having ethics issues and all other patients admitted to those same units during the same period. The researchers expected racial and/or socioeconomic differences between the groups, with socially vulnerable patients disproportionately identified as having ethical issues on rounds. But they did not find this to be the case.
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Some Code Status Discussions Are Rushed, Incomplete, or Misleading
Learning how to engage in code status conversations is as important as learning how to perform medical procedures. Clinicians would not ask patients in completely neutral terms whether they want a procedure that has no chance of working or would inflict serious harm. Any conversation around resuscitation status should take into account patients' goals and values, what is important to them in life, and the minimum acceptable quality of life.
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Bloodborne Pathogens
In the acute care setting, clinicians may be confronted with a child who has had a nonoccupational blood and/or body fluid exposure. Being prepared with a focused approach and the ability to identify the multiple factors that may adjust the risk of contracting bloodborne pathogens is valuable in such exposures. The authors provide a focused approach to nonoccupational blood and/or body fluid exposure, as well as a discussion of each of the bloodborne pathogens.
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Challenges with Surrogate Informed Consent
The central ethical question is whether a surrogate’s judgment for consenting or refusing a medical intervention on behalf of a patient is consistent and congruent with this patient’s preferences, interests, and values.