Perinatal Psychopharmacology: Innovative Approaches to Care Delivery.

Perinatal mental health conditions are the most common complications of childbirth and have well-established enduring negative effects. Obstetric (Ob) clinicians care for patients with perinatal mental health conditions across a spectrum of acuity, severity, and complexity. Ob and psychiatric clinicians can collaborate to create a cohesive continuum of psychopharmacologic care for perinatal patients. This chapter provides an overall framework for Ob-psychiatric clinician collaboration with examples of innovation in care delivery.

A Descriptive Analysis of the Epidemiology and Motivations for Laser Tattoo Removal in an Underserved Population.

Tattoos of formerly gang-involved and incarcerated individuals can negatively impact their ability to reintegrate into society. Laser tattoo removal is essential to helping individuals obtain employment, re-cultivate positive relationships, and disengage from gangs. The objective of this study is to describe the demographics and motivations for laser tattoo removal at a large nonprofit clinic. This was a single center retrospective study conducted on patients presenting to Ya'stuvo Tattoo Removal between January 2016-December 2018 and had at least three laser tattoo removal sessions. Data was recorded on patient demographics, geographic location of residence (e.g. zipcode), comorbidities, probation/parole status, referral source, transportation mode, and motivations for receiving and removing tattoos. A representative sample of 862 patients was used to conduct our analysis. Average age at first visit was 30. 16% (n = 134) were on probation, 8% (n = 66) were on parole, and 63% (n = 544) did not report their probation/parole status. Reasons for receiving a tattoo included gangs (46%, n = 368), a current or ex-relationship (28%, n = 223), and decoration (20%, n = 159). The most common reasons for tattoo removal were employment (66%, n = 546), readiness to change life (47%, n = 392), maturity (47%, n = 392), family (43%, n = 356), and negative attention from tattoos (37%, n = 303). The current study highlights the importance of laser tattoo removal in reintegration and gang disengagement. Expanding cost efficient laser tattoo removal is paramount to meet the safety and socioeconomic needs of this population.

The Positive Predictive Value of Hospital Discharge Data for Identifying Severe Maternal Morbidity With and Without Blood Transfusion.

BACKGROUND: Blood transfusion is 1 of the 21 indicators for severe maternal morbidity (SMM) as defined by the Centers for Disease Control and Prevention (CDC) using administrative data. The CDC SMM definition is being prepared to measure hospital quality of care; however, transfusion coding reliability has been questioned. The authors assessed the positive predictive value (PPV) of administrative data for identifying gold standard SMM using the CDC SMM definition, with and without the transfusion indicator. METHODS: A retrospective cohort study of one hospital's childbirth admissions (2016-2019) was performed. Data were screened for CDC SMM, and subgroups were created for those with transfusion as the sole indicator for SMM (transfusion-only SMM) versus those with at least one other SMM indicator (other SMM). Medical chart review classified CDC SMM cases based on gold standard SMM criteria. Gold standard SMM was defined by validated indicators identified by internal hospital quality reviews and confirmed by expert consensus. The PPV was calculated for all CDC SMM cases and the subgroups. RESULTS: Of 4,212 eligible people, 278 (6.6%) had CDC SMM. Chart review identified 110 gold standard SMM cases among screen-positive cases, yielding an overall PPV of the CDC SMM definition for gold standard SMM of 39.6%. CDC SMM cases identified solely by administrative coding for transfusion were half as likely to meet gold standard criteria, compared to cases identified by other SMM administrative codes (25.9% vs. 49.4%). CONCLUSION: Blood transfusion, coded as an independent risk factor, had a poor PPV for gold standard SMM. Given efforts to use CDC SMM for quality comparisons, more research is needed to reliably identify cases of SMM without relying on blood transfusion codes.