Adolescents and young adults continue to contribute to new HIV infections despite improved antiretroviral regimens and HIV preexposure and postexposure prophylaxis (PrEP and PEP). Knowledge about ...nonoccupational HIV PEP (nPEP) is relevant and important for all pediatricians as adolescents present under a variety of circumstances disclosing past sexual activity.
nPEP is effective in preventing HIV infection, and newer regimens have been shown to increase compliance amongst users, have less side effects, and lead to less HIV resistance. Yet, research on physician prescription practices shows a lack of knowledge regarding appropriate HIV nPEP medication regimens, dosing, and follow-up recommendations. Updated national guidelines are available to providers who may be unfamiliar with indications and drug regimens for nPEP. Studies also provide different strategies to increase nPEP use and compliance among patients as well as ways to increase provider awareness of appropriate nPEP prescription.
Research of HIV nPEP shows that it is effective when used correctly, but there needs to be increased education and awareness to increase provider prescription and patient use as well as institutional changes to help patients complete the full course of medication.
Sexually transmitted infections (STIs) are disproportionally prevalent in adolescents, and adolescents often present to the pediatric emergency department (PED) for STI care. Prior studies have found ...low rates of sexual history documentation and STI testing in the PED. However, these studies have had limited sample sizes because of the burden of manual chart review. We aimed to estimate the rate of sexual history documentation and identify factors associated with STI testing in a large cohort of adolescents using natural language processing (NLP).
We applied a validated NLP algorithm to all adolescent visits over a three-year period to the PED at a single large children's health care organization with a chief complaint potentially related to an STI. We utilized NLP to determine the prevalence of sexual history documentation in these patients. We applied logistic regression models to determine associations between sexual history documentation, patient demographic factors, and STI testing.
Of the 1,987 patient encounters included, only 56% had a sexual history documented, and only 40% of all patients were tested for STIs. Patients were more likely to have a sexual history documented and to be tested for STIs if they were of non-Hispanic black race/ethnicity, were >15 years of age, and had nonprivate insurance. Patients with a sexual history documented were seven times more likely to have STI testing ordered. Of patients tested (n = 728), 25% were positive for an STI.
Despite presenting to the PED with symptoms potentially related to an STI, many adolescents are not receiving recommended sexual health care. Rates of sexual history documentation and STI testing varied by demographic factors including race, age, and insurance status. Utilizing NLP technology allowed us to examine a larger sample size than previously documented in the adolescent sexual history and PED literature. This study highlights critical opportunities to improve sexual health provision and equity of care provided in the PED.
Many adolescents use the emergency department as their sole resource for primary care and sexual health care. This provides an opportunity to prevent sexually transmitted infections and unintended ...pregnancy as well as to educate teenagers about their bodies and sexual health. There is no standard curriculum on sexual health as part of pediatric emergency medicine (PEM) fellowship education. Our goal is to evaluate what is taught in PEM fellowship about adolescent sexual health.
We administered an anonymous questionnaire to both PEM fellows and program directors (PDs). The questionnaire was distributed through the PEM Program Director Survey Committee. The questionnaire was sent to 88 PDs and 305 fellows total. An introductory email explaining the purpose of the study and a link to the online questionnaire was sent. The questionnaire was created using SurveyMonkey (www.surveymonkey.com). Data were analyzed using descriptive statistics.
We achieved a 43% survey response rate from PDs (38 of 88) and a 24% survey response rate from fellows (73 of 305). The PD respondents included 61% females, and almost all (86%) are between ages 35 and 54 years. Seventy-three percent of the fellows are female, and they are all between 25 to 44 years old. There was a great deal of variability in the amount of adolescent sexual health education PDs provide their fellows in the form of lectures and bedside teaching cases. A majority of survey respondents (86% of fellows and 66% of the PDs) agreed that there should be a standard PEM curriculum to teach about adolescent sexual health. More than half (53% of PDs and 56% of fellows) are not satisfied with the number of training opportunities for adolescent sexual health.
We found variability in adolescent sexual health training during PEM fellowship, although fellows and PDs agree that there should be a standardized curriculum. We recommend that the American Board of Pediatrics form a committee to decrease variability in the training of PEM fellows on adolescent sexual health.
Kampo medicines are currently manufactured under strict quality controls. The Ministry of Health, Labour and Welfare of Japan has approved 148 Kampo formulas. There is increasing evidence for the ...efficacy of Kampo medicines, and some are used clinically for palliative care in Japan. The specific aim of this review is to evaluate the clinical use of Kampo medicines in palliative care in the treatment of cancer. The conclusions are as follows: Juzentaihoto inhibits the progression of liver tumors in a dose-dependent manner and contributes to long-term survival. Hochuekkito has clinical effects on cachexia for genitourinary cancer and improves the QOL and immunological status of weak patients, such as postoperative patients. Daikenchuto increases intestinal motility and decreases the postoperative symptoms of patients with total gastrectomy with jejunal pouch interposition, suppresses postoperative inflammation following surgery for colorectal cancer, and controls radiation-induced enteritis. Rikkunshito contributes to the amelioration of anorectic conditions in cancer cachexia-anorexia syndrome. Goshajinkigan and Shakuyakukanzoto reduce the neurotoxicity of patients with colorectal cancer who undergo oxaliplatin and FOLFOX (5-fluorouracil/folinic acid plus oxaliplatin) therapy. Hangeshashinto has the effect of preventing and alleviating diarrhea induced by CPT-11(irinotecan) and combination therapy with S-1/CPT-11. O'rengedokuto significantly improves mucositis caused by anticancer agents.
Purpose: Sexually transmitted infections (STIs) are disproportionately prevalent in the adolescent population, and these patients often present to the pediatric emergency department (PED) for care. ...Despite practice recommendations, prior studies have found low rates of sexual history documentation and STI testing in the PED. However, these studies have had limited sample sizes due to the burden of manual review. We aimed to estimate the rate of sexual history documentation and identify factors associated with STI testing in a large cohort of adolescents using natural language processing (NLP). Methods: We applied a validated NLP algorithm to all adolescent visits with a chief complaint potentially related to an STI over a three-year period to three PEDs in a large children's healthcare organization in the southeastern United States. We utilized NLP to determine the prevalence of sexual history documentation and aspects of a sexual history documented for these patients. We applied logistic regression models to determine associations between patient demographic factors, sexual history documentation, and STI testing. Results: Only 56% (1,108 of 1,987 included encounters) had a sexual history documented; of those, 61% (671 of 1,108) were identified as possibly sexually active, and 80% of those (534 of 671) had an STI test ordered. In contrast, a total of 265 patients (13% of the total sample) had STI testing ordered when either no sexual history was documented (n=115) or the provider documentation indicated the patient as not sexually active (n=150). The prevalence of CDC recommended elements of a sexual history varied widely; 5% documented sexual practices, 28.7% documented contraceptive use/nonuse, 41.2% documented condom use, and 62% documented partner gender. Patients were more likely to have a sexual history documented if they were of non-Hispanic Black race/ethnicity (adjusted odds ratio aOR 2.82; 95% confidence interval CI (2.13-3.73), >15 years of age aOR 2.33; CI (1.86-2.91), had non-private insurance aOR 2.05; CI (1.59-2.65), and had a trainee involved in their care aOR 3.38; CI (2.63-4.35). In total, 40% of all symptomatic adolescent patients were tested for STIs. Patients were more likely to be tested for STIs if they had a sexual history documented (adjusted odds ratio aOR 7.19; CI (5.64-9.17), were of non-Hispanic Black race/ethnicity aOR 1.91; CI (1.38-2.66), >15 years of age aOR 2.46; CI (1.91-3.18)), and had non-private insurance aOR 1.63; CI (1.21-2.89). Of patients tested (n=728), 25% were positive for an STI. Conclusions: Despite presenting to the PED with symptoms potentially related to an STI, adolescents are not receiving recommended sexual health care, and there are demographic differences in which patients have sexual history documentation and STI testing. Utilizing NLP technology allowed us to examine a larger sample size than previously documented in the adolescent sexual health and PED literature. This study highlights critical opportunities to improve sexual health provision and equity of care provided in the PED. Future efforts to improve guideline-recommended sexual health care could benefit from automated methods to detect sexual history documentation and STI screening to improve adolescent health.
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