Predictors of intention to provide abortions after OB/GYN residency training.

INTRODUCTION: Abortion is a common gynecological procedure and plays a central role in women's health and autonomy. To maintain accessibility to abortion, it is important that sufficient obstetrics and gynecology (Ob/Gyn) residents intend to provide abortion care after residency. This study identifies factors that influence a resident's intention to provide abortions (IPA) post-training. MATERIALS AND METHODS: A multiple-choice survey, addressing demographics, religious background, residency program metrics, training experience and intent to provide abortions (IPA), was answered by 409 Ob/Gyn residents. Chi-square test was performed on descriptive statistics and continuous variables were tested with ANOVA with p<0.05 considered significant. RESULTS: Residents with IPA were predominantly female (p = 0.001), training in the Northeast and West (p<0.001), identifying either as non-religious, agnostic/atheist or Jewish (p<0.01), not actively practicing their religion (p<0.001) and leaning democrats (p<0.002). Those with IPA were more likely to train at hospitals without religious affiliation (p<0.008), to train at a Ryan Program (p<0.001), to place strong emphasis on choosing a program with family planning training (p<0.001), to join programs where a significant portion of the faculty performs abortions (p<0.001) and to have completed a higher number of first trimester medical and surgical abortion procedures during the last six months of training (p<0.001). CONCLUSION: These results suggest that factors influencing a physician's intention to provide abortions are multifactorial, involving personal and program factors. A model predicting IPA is derived. To maximize IPA, residency programs can increase abortion volume, facilitate additional training and build a supportive faculty.

An educational workshop and student competency in pregnancy options counseling: a randomized controlled trial.

OBJECTIVE: We sought to determine the effect of a pregnancy options counseling workshop focusing on communication skills and ethics on medical student competency. STUDY DESIGN: This educational trial randomized 105 third-year students to performance of an objective structured clinical examination before or after participation in the workshop assessed by a blinded reviewer. The primary outcome variable was student-level global competency in options counseling; secondary outcomes included competency components of general communication. RESULTS: Global competency was achieved by 36% of students in the preworkshop group and 50% in the postworkshop group (P = .16). Students who participated in the workshop demonstrated higher communication skills. Student ratings of objective structured clinical examination quality were 96-100% positive, with 80% reporting an increase in comfort with options counseling and 88% reporting increased comfort with communication skills. CONCLUSION: Participation in a workshop focusing on conscientious refusal positively improved communication skills, but did not significantly impact students' competency in pregnancy options counseling.

A Student-Led Global Shared Medical Curriculum.

Students can be change agents in transforming medical education. The Medical Student Alliance for Global Education (MeSAGE) aims to establish a worldwide shared medical curriculum through open-access content focused on emerging global health issues. MeSAGE modules are novel tools for integration of ideas and topics important to medical students.

Long-Acting Reversible Contraception: Placement, Continuation, and Removal Rates at an Inner-City Academic Medical Center Clinic.

Long-Acting Reversible Contraception (LARCs) has the potential to decrease unintended pregnancies but only if women can easily access a requested method. Retrospective electronic chart review identified women desiring LARC placement over a one-year period ending 31 December 2016. Most of the 311 insertions were for family planning, with 220 new insertions and 60 replacements. Delays occurred in 38% (n = 118) of patients, averaged 5 ± 5 weeks, and 47% received interval contraception. Reasons included absence of qualified provider (n = 44, 37%), pending cultures (n = 31, 26%), and Mirena availability. Teenage LARC use favored Nexplanon whereas older women preferred Mirena (p < 0.01). Of the 11% choosing early LARC removal, a significant number were African Americans (p = 0.040) or teenagers (p = 0.048). Retention time varied by device type; most patients switched to other contraceptives. No patients experienced IUD expulsion. Understanding barriers, attempting to remedy them, and addressing the side effects associated with LARC use is of importance in this inner-city patient population in the United States.

Bone loss in rats with aldosteronism.

OBJECTIVE: We hypothesized that aldosteronism is accompanied by hypercalciuria and hypermagnesuria that lead to bone loss, which could be rescued by hydrochlorothiazide and spironolactone. METHODS: We monitored 24-hour urinary Ca and Mg excretion; plasma ionized [Ca]o and [Mg]o and plasma K; and bone mineral density of the femur. The following groups (n=5 in each group) were studied: age- and gender-matched, untreated controls; controls + 4 weeks hydrochlorothiazide; 4 weeks aldosterone/salt treatment (ALDOST, 0.75 mug/h and dietary 1% NaCl/0.4% KCl); 4 weeks ALDOST+hydrochlorothiazide (50 mg/kg in prepared food); and 4 weeks ALDOST+hydrochlorothiazide+spironolactone (200 mg/kg day in divided doses by twice-daily gavage). RESULTS: ALDOST increased (P<0.05) urinary Ca and Mg excretion four- and twofold, respectively; hydrochlorothiazide co-treatment attenuated (P<0.05) Ca excretion in controls and during ALDOST without affecting augmented Mg excretion whereas hydrochlorothiazide+spironolactone normalized Ca and reduced Mg excretion (P<0.05). Compared with controls, plasma [Ca]o at 4 weeks of ALDOST was reduced (0.89+/-0.02 versus 0.83+/-0.03 mmol/L; P<0.05) but remained no different from levels in controls with hydrochlorothiazide and hydrochlorothiazide+spironolactone (0.88+/-0.04 and 0.97+/-0.03 mmol/L, respectively). Plasma [Mg]o fell (P<0.05) with ALDOST+hydrochlorothiazide (0.23+/-0.01 versus 0.34+/-0.01 mmol/L) and was prevented with spironolactone co-treatment (0.33+/-0.01 mmol/ dL). Hypokalemia (2.9+/-0.2 mmol/L) occurred in rats with ALDOST+hydrochlorothiazide but not with spironolactone co-treatment. At 4 weeks of ALDOST, plasma parathyroid hormone was increased (30+/-4 versus 11+/-3 pg/mL; P<0.05) and bone mineral density was reduced (0.153+/-0.006 versus 0.170+/-0.002 g/cm; P<0.05). Co-treatments with either hydrochlorothiazide or hydrochlorothiazide+spironolactone each prevented bone loss. CONCLUSIONS: Hypercalciuria and hypermagnesuria accompany aldosteronism and account for a decline in their plasma ionized concentrations and secondary hyperparathyroidism with bone resorption. Attenuation of bone loss in aldosteronism can be achieved with hydrochlorothiazide; however, mono- and divalent cation homeostasis, together with bone integrity, are each preserved with the combination hydrochlorothiazide+spironolactone.

A compelling practice: empowering future leaders in the medical humanities.

Medical students and faculty explore the medical humanities for diverse reasons: as a medium for self-reflection, a means to cultivate professionalism and humanism, and a way to gain an appreciation for the broader contexts in which illness and health occur. One important area for development is increasing the exposure of learners and clinicians of various levels of training to the medical humanities and to role models in the field. Student-led programs in the medical humanities at the American Medical Student Association (AMSA) address these needs by offering unique opportunities for learning and sharing experiences. AMSA programs connect physicians-in-training using technology to create virtual communication and learning opportunities. These include monthly book discussion webinars, the Writers' Institute and the Medical Humanities Scholars Program (MHSP).

Responses in extracellular and intracellular calcium and magnesium in aldosteronism.

We hypothesized the hypercalciuria and hypermagnesuria that accompany aldosteronism could be pharmacologically attenuated to prevent shifts in extracellular and intracellular levels of these divalent cations and the adverse outcomes associated with them. Accordingly, rats administered aldosterone/salt treatment (ALDOST) were cotreated with either hydrochlorothiazide (Hctz), to selectively reabsorb urinary Ca2+, or with Hctz plus spironolactone (Hctz+Spi), where Spi retards the excretion of these cations in both urine and feces. We monitored urinary excretion and responses in extracellular and intracellular Ca2+ and Mg2+, together with indices of oxi/nitrosative stress in plasma and ventricular tissue. At 4 weeks ALDOST we found the following: (1) hypercalciuria was reduced by Hctz and normalized by Hctz+Spi, and this combination, unlike Hctz alone, also rescued hypermagnesuria; (2) the decrease in plasma-ionized [Ca2+]o was not seen with Hctz or Hctz+Spi, whereas Spi cotreatment protected against a decline in [Mg2+]o; (3) the Ca2+ loading of peripheral blood mononuclear cells and cardiac tissue was not seen with Hctz+Spi; and (4) the induction of oxi/nitrosative stress, expressed as reduced plasma alpha1-antiproteinase activity and activation of gp91(phox) subunit of NADPH oxidase in inflammatory cells invading intramural coronary arteries of the right and left ventricles, together with vascular fibrosis, was completely prevented by Spi cotreatment. In rats with aldosteronism, cotreatment with Hctz+Spi more effectively (vis-à-vis Hctz alone) protects against adverse iterations in extracellular and intracellular concentrations of Ca2+ and Mg2+, as well as the appearance of oxi/nitrosative stress to prevent the proinflammatory vascular phenotype.