Fertility preservation in women with cystic fibrosis pre-lung transplantation: A mixed methods study.

AIMS: Explore the knowledge, experiences, preferences, and concerns related to fertility preservation as an option for building a biological family among women with cystic fibrosis. DESIGN: Convergent mixed methods study design. METHODS: We recruited women with cystic fibrosis of childbearing age in the United States through cystic fibrosis centres, snowball sampling, and social media. Participants completed an anonymous survey about fertility and fertility preservation (n = 50). We also conducted audio-recorded, semi-structured interviews with a subset of women to gain a better understanding of their perspectives (n = 20). We transcribed the interviews verbatim and analysed them using thematic analysis. RESULTS: For the quantitative arm, 78% of women indicated that they would like to have a child in the future; however, 74% reported never having had conversations about fertility preservation with their providers. For the qualitative arm, four major themes emerged: (1) Women with cystic fibrosis have inadequate knowledge about fertility and fertility preservation; (2) fertility is a low priority area for the cystic fibrosis care team; (3) women with cystic fibrosis recommend that the cystic fibrosis care team provide specific fertility resources; and (4) providers and literature lack information on fertility and cystic fibrosis. Integrated findings identified that while the majority of women with cystic fibrosis want to become mothers in the future, including post-lung transplantation, they have not received education on fertility preservation, and there is a general lack of knowledge on the topic of fertility in cystic fibrosis. CONCLUSION: Women with cystic fibrosis desire to have children but have little knowledge about fertility preservation, and cystic fibrosis providers do not initiate family planning discussions. IMPACT: Findings from the study support that additional education is needed for women with cystic fibrosis who are considering parenthood. Clinical care models should include early, regular, and thoughtful discussions about reproductive health issues, including fertility preservation.

Retropharyngeal abscess in a post-lung transplant cystic fibrosis patient with prior cervical fusion: a case study.

BACKGROUND: Cystic fibrosis (CF) is a chronic, genetic, incurable disease that affects primarily the respiratory and gastrointestinal systems. End-stage lung disease is the leading cause of death in people with CF, and lung transplant is required to preserve life. Anti-rejection medications are necessary post-transplant; however, these medications lower immune response and increase susceptibility to bacterial infections. Complications from infections post lung-transplant account for approximately 30% of CF-related deaths. Retropharyngeal abscess (RPA) is a rare deep neck infection that occurs most commonly in children. This is the case of a 45-year-old Caucasian male with CF who developed a retropharyngeal abscess post wisdom teeth extraction that seeded into hardware from a previous cervical disc fusion. CASE PRESENTATION: The patient presented to the emergency department with severe neck and shoulder pain, limited range of motion in his arm and neck, and dysphonia. He reported feeling pain for 10 days and suspected the pain was caused by a weightlifting injury. The patient reported low-grade fever 5 days prior, which responded to acetaminophen. He was afebrile upon admission and in no respiratory distress. Diagnostic labs revealed WBC 22,000/uL and CRP 211 mg/L. The CT scan showed a large abscess in the retropharyngeal space between C2-C7. The immediate concern was airway obstruction and need for possible intubation or tracheostomy. The patient was transferred to ENT service with neurosurgery and transplant consults. The RPA was drained and lavaged. The cervical hardware was discovered to be infected and was removed. The source of the RPA infection was determined to be from the patient's wisdom teeth extraction 6 months prior to RPA. The patient received 8 weeks of intravenous ceftriaxone for Streptococcus pneumoniae bacteremia and underwent revision of his cervical fusion 3 months after hardware removal. CONCLUSIONS: Clinicians should consider prophylactic antimicrobial therapy for immunocompromised patients when they are at increased risk for transient bacteremia such as following invasive procedures (e.g., tooth extraction). Prophylactic antimicrobial therapy could prevent potentially life-threatening infections such as RPA in immunocompromised patients.

Adolescents' perceptions of sexual health education programs: An integrative review.

INTRODUCTION: Adolescents are key stakeholders in sexual health education, yet they are rarely consulted when developing sexual health programs. Their voices are integral to improving the delivery of relevant and appropriate school-based sexual health education to promote safer adolescent sexual behaviors. METHODS: An integrative review was conducted utilizing three databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete, PubMed, and Education Resources Information Center (ERIC). The PRISMA and matrix method were used to search the literature and synthesize the findings from 16 articles regarding adolescent perceptions of school-based sexual health education. RESULTS: The main themes that emerged from this review included: (a) factors influencing adolescent perceptions of sexual health education programs, (b) characteristics of good sexual health education programs, and (c) areas of improvement in sexual health education programs. CONCLUSION: Adolescents overwhelmingly requested honest, comprehensive content delivered by nonjudgmental, well-educated health professionals in a comfortable environment.

Challenge of intravascular volume assessment in acute ischemic stroke.

INTRODUCTION: Retrospective data indicates that dehydration in acute ischemic stroke patients may be common, even though these patients frequently have elevated blood pressure. We sought to evaluate clinical and laboratory measures of intravascular volume status compared to more objective measures using ultrasound measurements of the inferior vena cava (IVC). METHODS: This was a prospective observation study of acute ischemic stroke patients in the emergency department. Patients with NIH stroke scale ≥4 within 12 h of symptom onset were included. A trained ultrasonographer performed bi-dimensional imaging of the IVC with passive respiration to determine the percent inspiratory collapse and maximum diameter. We defined low intravascular volume as >50% IVC collapse and a maximal diameter < 2.1 cm. Analysis was limited to patients with confirmed ischemic stroke. RESULTS: There were 42 patients, of whom 31 had confirmed acute ischemic stroke. The mean age was 65 ±â€¯15 years, 52% were female, and 71% were hypertensive. The median NIH stroke scale score was 7 (IQR 5-15). Based on IVC ultrasound, low intravascular volume was present in 63% (95% CI 44-80%) of patients. A higher proportion of hypertensive patients had low intrasvascular volume (72% vs. 33%). There was poor correlation between IVC assessment of intrasvascular volume and blinded clinician assessment or laboratory markers of dehydration. CONCLUSION: The majority of ED acute ischemic stroke patients in this sample were hypertensive and demonstrated low intravascular volume based on IVC ultrasound.

HIV PrEP Coverage Among Black Adults: A Concept Analysis of the Inequities, Disparities, and Implications.

Background: Significant racial disparities exist in HIV pre-exposure prophylaxis (PrEP) coverage in the United States (U.S), with Black individuals experiencing seven times higher new HIV infection rates compared to their White counterparts. Despite being the highest priority population at risk for HIV, Black adults have the lowest PrEP coverage, impacting the overall progress toward meeting the ending the HIV epidemic (EHE) goals in the U.S. Methods: Utilizing the Walker and Avant method, this concept analysis examined existing literature and U.S. Centers for Disease Control and Prevention resources to explore HIV PrEP coverage. Results: Findings highlighted a lack of clarity in the concept, resulting in four operational definitions. To address this ambiguity, a conceptual definition of HIV PrEP coverage was proposed, focusing on equitable access to PrEP medication among sexually active individuals aged 18-64 years, particularly those traditionally underserved and would benefit from PrEP. This inclusive definition aims to align with the dynamics of sexual behavior in racial minority groups. Key attributes of this conceptual definition include estimates of PrEP use, access, need, cost, side effects, frequency of HIV testing, and self-efficacy. Antecedents entail HIV status, testing behaviors, transmission risks, and communication with health care providers. Consequences involve perceptions of risk, screening routines, provider biases, stigma, and potential HIV transmission reduction. Conclusion: Analyzing HIV PrEP coverage offers useful insights into social and structural factors exacerbating health inequities in the field of HIV prevention and control. This concept analysis underscores the importance of unified sexual health communication, diverse approaches to PrEP access for racial minorities, and improved sexual health policies for Black adults. Moreover, understanding and advocating for equity in HIV PrEP coverage is crucial for addressing the existing racial disparities and achieving the EHE objectives in the U.S.

Provider Perspectives on Fertility and Fertility Preservation Discussions Among Women With Cystic Fibrosis.

Cystic Fibrosis (CF) is a genetic disorder that primarily impacts the respiratory and gastrointestinal systems. With advances in treatment and medications, the life expectancy of people with CF is continuing to increase with current life expectancy at 47 years of age. Given the increased life expectancy, people with CF are interested in childbearing but may have CF specific fertility issues that should be addressed by their CF healthcare provider. Currently, these conversations are not occurring or are suboptimal. This study aimed to investigate the practices of cystic fibrosis (CF) healthcare providers regarding fertility and fertility preservation (FP) discussions among women with CF. This was a qualitative, descriptive study. Twenty CF healthcare providers were interviewed including nurses, nurse practitioners, social workers, and dieticians among other disciplines. The semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Four themes emerged from the provider interviews about their fertility and FP discussion practices: (1) Change over Time; (2) CF Team Provides Primary Care including Reproductive Health Care; (3) Patient Support and Advocacy; and (4) Barriers and Facilitators to FP Discussions. The results of this study demonstrate an opportunity for CF healthcare providers to deliver patient-centered care. However, CF providers need to be educated on fertility and FP options. Additionally, there is a need for a more standardized structure of care to address the reproductive health of women with CF. The findings from this study may also be useful to non-CF providers who deliver care to women whose chronic illnesses impact their reproductive health.

Transitioning to telehealth during the coronavirus disease 2019 pandemic: Perspectives from partners of women with cystic fibrosis and healthcare providers.

OBJECTIVES: Cystic fibrosis is a chronic, genetic disease that primarily affects the respiratory system. The coronavirus disease 2019 pandemic has altered how people with cystic fibrosis receive healthcare. This paper explores the perceptions of cystic fibrosis healthcare providers and partners of women with cystic fibrosis regarding the use of telehealth in routine cystic fibrosis healthcare in the US. METHODS: As part of a larger study examining fertility counseling for women with cystic fibrosis, we conducted qualitative, semi-structured interviews. Participants included partners of women with cystic fibrosis (n = 20) and cystic fibrosis healthcare providers (n = 20). We completed the interviews before and during the global coronavirus disease 2019 pandemic. We analyzed the data using thematic analysis. RESULTS: When in-person healthcare could not be achieved safely, partners and healthcare providers found new value in telehealth. Three themes emerged: (1) increased connection between healthcare team and family, (2) increased efficiency of healthcare appointments, and (3) improved interdisciplinary collaboration. Partners found that telehealth allowed for more engagement in their significant others' healthcare. Providers reported enhanced efficiency and opportunities for collaboration across specialties that improved healthcare delivery and care coordination. DISCUSSION: Results from this study highlighted the positive value of telehealth. Telehealth presents as a potential alternative to delivering outpatient care for people with chronic illnesses beyond the pandemic.

Sinus Arrest in Asymptomatic COVID-19 Infection.

Coronavirus disease 2019 (COVID-19) is a viral respiratory tract syndrome capable of affecting a multitude of major organs in the human body. It is a known cause of severe vascular compromise, myocardial ischemia, myocarditis, and various cardiac dysrhythmias. Dysfunction of the sinoatrial (SA) node, the primary pacemaker of the heart, can arise from structural heart disease, medications, electrolyte abnormalities, and hypothyroidism. We report and discuss a case of a 50-year-old female with no significant past medical history (PMH) and no SA dysfunction risk factors, who experienced multiple syncopal events and an episode of sinus arrest characterized by transient asystole captured with telemetry monitoring. The patient was incidentally found to be COVID-19 positive and displayed no signs or symptoms concerning the viral illness. Despite our patient's lack of respiratory issues or other symptomatology, a significant and potentially fatal relationship exists between her viral infection and cardiac sequelae.

Measuring Knowledge of Fertility Preservation in Women With Cystic Fibrosis: Instrument Development and Psychometric Analysis.

OBJECTIVE: To describe the development, evaluation, and psychometric properties of a new instrument that measures fertility preservation (FP) knowledge in women with cystic fibrosis (CF) titled the Knowledge of FP in Women With CF Instrument (KFP-WCFI). DESIGN: The 10-item KFP-WCFI was developed and evaluated through a cross-sectional survey. SETTING: Participants were recruited nationally from CF Foundation-accredited CF clinics and via snowball sampling. PARTICIPANTS: Fifty women with CF ages 18 through 35 years completed the instrument. MEASUREMENTS: Construct validity was assessed using confirmatory factor analysis (CFA). In the CFA, the model fit was evaluated using standardized root mean square residual, root mean square error of approximation, and comparative fit index. Cronbach's alpha was used to examine internal consistency reliability. The criterion validity was assessed using inferential statistics. RESULTS: The CFA with two subscales, General Fertility Knowledge and Transplant-Related Fertility Knowledge, demonstrated good fit, with a standardized root mean square residual of 0.07, root mean square error of approximation of 0.06, and comparative fit index of 0.97, indicating good construct validity of the instrument. This instrument demonstrated internal consistency reliability with a Cronbach's alpha of .91 for the General Fertility Knowledge subscale and .64 for the Transplant-Related Fertility Knowledge subscale. Women who reported a pregnancy scored higher than women who did not report a pregnancy (p = .02), suggesting criterion validity. CONCLUSION: The newly developed KFP-WCFI appears to be a valid and reliable instrument that can be used to measure self-assessed FP knowledge in women with CF.

Adolescent Chlamydia Rates by Region, Race, and Sex: Trends From 2013 to 2017.

INTRODUCTION: Chlamydia is the most common bacterial sexually transmitted infection in the United States. Adolescents (ages 15-19 years) have the highest infection rate, second only to young adults (ages 20-24 years). The purpose of this secondary data analysis is to examine trends from 2013 to 2017 in adolescent chlamydia rates by region, race, and sex. METHOD: Adolescent chlamydia rate data were obtained from the Center for Disease Control's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention database. Descriptive statistics were used to analyze the trends. RESULTS: The overall trend in male and female adolescent chlamydia rates increased from 2013 to 2017. Specifically, the trend increased faster in males, White adolescents, and those in the Northeast and Midwest regions of the country. DISCUSSION: Health care providers are uniquely positioned to positively affect adolescent chlamydia rates through targeted sexual health discussions and increased screening for sexually transmitted infections.

Investigating Postpartum Depression in the Adolescent Mother Using 3 Potential Qualitative Approaches.

Adolescent mothers are twice as likely as their adult counterparts to have postpartum depression (PPD). Left undiagnosed and untreated, PPD can have significant consequences for the mothers, infants, families, communities, and society. Although the epidemiology has been well studied, there is a scarcity in the number of qualitative research studies being conducted to study this unique group of young women. Qualitative research is a perfect match to elicit the voices of adolescent mothers having PPD because the qualitative approach offers a way to gain insight, meaning, and understanding of a phenomenon that is still largely misunderstood and unaddressed. This article will discuss 3 major qualitative approaches (phenomenology, ethnography, and participatory action research) that may be employed to study PPD in the adolescent mother.