Medication to Manage Abortion and Miscarriage Beaman, Jessica; Prifti, Christine; Schwarz, Eleanor Bimla ...
Journal of general internal medicine : JGIM,
08/2020, Volume:
35, Issue:
8
Journal Article
Peer reviewed
Open access
Abortion and miscarriage are common, affecting millions of US women each year. By age 45, one in four women in the USA will have had an abortion, and at least as many will have had a miscarriage. ...Most individuals seeking abortion services do so before 10 weeks’ gestation when medication abortions are a safe and effective option, using a regimen of oral mifepristone followed by misoprostol tablets. When a pregnancy is non-viable before 13 weeks’ gestation, it is referred to as an early pregnancy loss or miscarriage and can be managed using the same mifepristone and misoprostol regimen. Given their safety and efficacy, mifepristone and misoprostol can be offered in ambulatory settings without special equipment or on-site emergency services. As more patients find it difficult to access clinical care when faced with an undesired pregnancy or a miscarriage, it is important for general internists and primary care providers to become familiar with how to use medications to manage these common conditions. We summarize the most recent evidence regarding the use of mifepristone with misoprostol for early abortion and miscarriage. We discuss clinical considerations and resources for integrating mifepristone and misoprostol into clinical practice. By learning to prescribe mifepristone and misoprostol, clinicians can expand access to time-sensitive health services for vulnerable populations.
Background
Long-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs) and implants are highly effective and increasingly popular. Internal Medicine (IM) clinics and residency ...curricula do not routinely include LARCs, which can limit patient access to these methods. In response, internists are integrating LARCs into IM practices and residency training.
Objective
This study examines the approaches, facilitators, and barriers reported by IM faculty to incorporating LARCs into IM clinics and resident education.
Design
We interviewed faculty who were prior or current LARC providers and/or teachers in 15 IM departments nationally. Each had implemented or attempted to implement LARC training for residents in their IM practice. Semi-structured interviews were used.
Participants
Eligible participants were a convenience sample of clinicians identified as key informants at each institution.
Approach
We used inductive thematic coding analysis to identify themes in the transcribed interviews.
Key Results
Fourteen respondents currently offered LARCs in their clinic and 12 were teaching these procedures to residents. LARC integration into IM clinics occurred in 3 models: (1) a dedicated procedure or women’s health clinic, (2) integration into existing IM clinical sessions, or (3) an interdisciplinary IM and family medicine or gynecology clinic. Balancing clinical and educational priorities was a common theme, with chosen LARC model(s) reflecting the desired priority balance at a given institution. Most programs incorporated a mix of educational modalities, with opportunities based upon resident interest and desired educational goals. Facilitators and barriers related to clinical (equipment, workflow), educational (curriculum, outcomes), or process considerations (procedural volume, credentialing). Participants reported that support from multiple stakeholders including patients, residents, leadership, and other departments was necessary for success.
Conclusion
The model for integration of LARCs into IM clinics and resident education depends upon the clinical resources, patient needs, stakeholder support, and educational goals of the program.
Over recent decades, numerous medical procedures have migrated out of hospitals and into freestanding ambulatory surgery centers (ASCs) and physician offices, with possible implications for patient ...outcomes. In response, states have passed regulations for office-based surgeries, private organizations have established standards for facility accreditation, and professional associations have developed clinical guidelines. While abortions have been performed in office setting for decades, states have also enacted laws requiring that facilities that perform abortions meet specific requirements. The extent to which facility requirements have an impact on patient outcomes-for any procedure-is unclear.
We conducted a systematic review to examine the effect of outpatient facility type (ASC vs. office) and specific facility characteristics (e.g., facility accreditation, emergency response protocols, clinician qualifications, physical plant characteristics, other policies) on patient safety, patient experience and service availability in non-hospital-affiliated outpatient settings. To identify relevant research, we searched databases of the published academic literature (PubMed, EMBASE, Web of Science) and websites of governmental and non-governmental organizations. Two investigators reviewed 3049 abstracts and full-text articles against inclusion/exclusion criteria and assessed the quality of 22 identified articles. Most studies were hampered by methodological challenges, with 12 of 22 not meeting minimum quality criteria. Of 10 studies included in the review, most (6) examined the effect of facility type on patient safety. Existing research appears to indicate no difference in patient safety for outpatient procedures performed in ASCs vs. physician offices. Research about specific facility characteristics is insufficient to draw conclusions.
More and higher quality research is needed to determine if there is a public health problem to be addressed through facility regulation and, if so, which facility characteristics may result in consistent improvements to patient safety while not adversely affecting patient experience or service availability.
A good curriculum vitae (CV) highlights medical educators' academic achievements and supports their professional goals. Many faculty struggle with timely updates and strategic formatting. These ...twelve tips will help medical educators optimize their CV to best showcase their strengths and accomplishments. The first three tips outline a process: identify a system to collect potential entries and schedule regular time for updates. Tips four and five detail how to tailor traditional CV formatting to best describe the work of medical educators. The next few tips offer concrete strategies and examples of CV entries to consider for inclusion. The remaining tips remind faculty to ask for help from colleagues, who can share a sample CV and identify overlooked activities. Our intention is to transform a task that can be burdensome into a process that seamlessly captures the breadth of our work as medical educators and allows for introspection and growth.
Computerized Counseling for Folate Knowledge and Use Schwarz, Eleanor Bimla, MD, MS; Sobota, Mindy, MD; Gonzales, Ralph, MD, MSPH ...
American journal of preventive medicine,
2008, Volume:
35, Issue:
6
Journal Article
Peer reviewed
Open access
Background Periconception folate supplementation significantly reduces the risk of neural-tube defects, but few U.S. women start folate supplementation before pregnancy, and the amount of clinician ...time available to counsel patients about folate is limited. This study evaluated whether computer-assisted counseling and the provision of free folate tablets increases women's knowledge and use of folate supplements. Design Randomized controlled trial; follow-up began 6 months after enrollment and was completed on average 7 months after enrollment. Setting/participants A total of 446 women, aged 18–45 years, were recruited from two urgent care clinics in San Francisco from March to July 2005 (data collection was completed in 2006; data were analyzed in 2007). Intervention Participants received a 15-minute computerized educational session and 200 folate tablets. Main outcome measures The primary outcome was the knowledge that folate can prevent birth defects; secondary outcomes included the self-reported use of a folate supplement at follow-up. Results At follow-up, women in the intervention group were more likely to know that folate prevents birth defects (46% vs 27%, relative risk RR=1.72, 95% CI=1.32, 2.23); to know that folate is most important in early pregnancy (36% vs 17%, RR=2.11, 95% CI=1.50, 2.97); and to report the recent use of a folate supplement (32% vs 21%, RR=1.54, 95% CI=1.12, 2.13). Conclusions A one-time, brief, computerized counseling session about folate with the provision of free folate tablets increased the knowledge and use of folate supplements among women ≥6 months later. Trial registration NCT00177515.
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