"The doctor will see you now": Direct support professionals' perspectives on supporting adults with intellectual and developmental disabilities accessing health care during COVID-19.

BACKGROUND: It is critical to consider how rapid changes in health care delivery and the rise in use of virtual modalities have impacted adults with intellectual and developmental disabilities and caregivers. OBJECTIVE: The purpose of this paper is to describe direct support professionals' experiences assisting adults with intellectual and developmental disabilities in accessing virtual and in-person health care during COVID-19. METHODS: A content analysis was conducted on responses obtained from an online questionnaire distributed to 942 direct support professionals in Canada. Descriptive statistics were used to report the type of visits that occurred and open text responses describing these visits were coded. RESULTS: Twenty four percent of direct support professionals reported supporting someone at an in-person medical appointment, 22% reported attending at least one video-based virtual appointment and 58% reported supporting at least one phone based virtual appointment in the first 5 months of the pandemic. They identified several barriers and facilitators with each type of visit which suggests there is no "single way" to provide health care to this group, but that optimal care depends on maximizing the fit between the person's abilities, the skill set of direct support professionals and health care providers, and the presenting health care issue. CONCLUSIONS: Study findings provide insight into the experience of health care for this population during COVID-19 and can be used to support direct support professionals and adults with intellectual and developmental disabilities to adapt to safe, supportive and comprehensive virtual and in-person health care during the pandemic and beyond.

Anesthesia practices in the United States common to in vitro fertilization (IVF) centers.

PURPOSE: Our purpose was to characterize and describe anesthesia practice in programs performing IVF in the United States. METHODS: We used a telephone survey requiring respondents to be either the program director, a physician, or a nurse familiar with the practice. Two hundred seven (78%) Society of Assisted Reproductive Technology (SART) registered programs agreed to participate. Programs were divided by geographic region and type of practice (academic versus private). RESULTS: Ninety-one private (68%) and 41 academic (56%) programs used personnel provided by the Department of Anesthesiology. Conscious sedation was performed most commonly (95%). The remaining 5% used primarily either general, regional, or local anesthesia. Typical recovery times were 90 to 120 min. Average costs of anesthetic administration were $300- $400 and were similar among groups except for the Eastern academic programs, with a higher mean cost of $543. Programs using personnel from anesthesiology reported higher costs compared to programs utilizing their own staff ($391 +/- 15 vs $157 +/- 11; P < 0.05). Complications were infrequent (< 10%); no hospitalizations or serious life-threatening incidents were reported. CONCLUSIONS: A large number of programs safely used their own trained personnel to deliver anesthesia, and realized a significant reduction in cost.

Placental abruption after insertion of catheter tip intrauterine pressure transducers: a report of four cases.

BACKGROUND: Although intrauterine pressure transducers have proven efficacious in the management of certain laboring women, their use has been associated with small but definite risks to both mother and fetus. The introduction of catheter tip pressure transducers has facilitated the evaluation of intrauterine pressure, but there has been a paucity of data regarding complication rates with these newer devices. CASES: We report four cases of placental abruption following insertion of catheter tip intrauterine pressure transducers. Two were associated with placental lacerations. None of these patients had definite risk factors for abruption, but they developed signs and symptoms typical of it after insertion of the catheters. Perinatal outcomes were good except in one neonate, who developed shock secondary to anemia. Three of the four cases occurred when 599 patients at our institution were monitored with catheter tip pressure transducers. CONCLUSION: Although the risk of injury is small, neonatal morbidity can be severe, and an evaluation of risk versus benefit should be made prior to insertion of these devices.

A clinical and microbiological study of venous catheterization.

In a prospective study of 210 intravenous catheters and needles 31 (15%) swabs yielded 34 microbial isolates. Twenty-eight were "non-pathogenic" skin commensals and six were "pathogenic" organisms. Commensals were isolated predominantly from catheters left in situ for only a short time (up to two days) and pathogenic organisms most frequently from specimens left in situ for a longer time. Correlation was not confirmed between colonization and infection, antibiotic therapy or phlebitis. All samples of IV fluids were sterile on culture. Changing the IV catheter at least every two days is recommended.