Evaluation of a pre-exposure prophylaxis (PrEP) program for HIV prevention in a federally qualified health center (FQHC).

BACKGROUND: Preventing new cases of the human immunodeficiency virus (HIV) is key to the Centers for Disease Control and Prevention (CDC) Ending the HIV Epidemic: A Plan for America initiative. In 2012, Truvada became the first medication approved in the United States to prevent HIV infection, yet it has not seen widespread use. AIM: This study aimed to allow for the incorporation of an HIV risk assessment into the primary care provider (PCP) visit and promote increased numbers of patients screened for pre-exposure prophylaxis of HIV (PrEP). METHODS: An educational program and an electronic HIV risk assessment tool were provided to the healthcare providers in an urban federally qualified health center to decrease barriers to providing PrEP. RESULTS: Provider likelihood to prescribe PrEP increased among the internal medicine/family medicine (p = .0001, p = .0001) and obstetrics/gynecology providers (p = .0034, p = .0034), but there was no significant change among the pediatric providers (p = .4227, p = .1965). LINKING EVIDENCE TO ACTION: Improvement among most providers demonstrated the success of this effort. Additional assessments and interventions are warranted among pediatric providers. Continued efforts are needed to progress to the incorporation of PrEP in the PCP visit.

Improving Attitudes and Beliefs of Cervical Cancer Screening Guidelines: An Evidence-Based Quality Improvement Project.

Cervical cancer, one of the most common gynecological cancers in the United States, is highly preventable due to the papanicoloau (Pap) test with human papillomavirus (HPV) co-screening. However, there is increasing evidence of low adherence to screening guidelines by health care providers (HCP). The purpose of this study was to identify and improve health care providers' attitudes, beliefs, and knowledge of the most updated screening guidelines and to provide them with an evidence-based educational intervention to increase their confidence in the updated guidelines, improve their attitudes and beliefs, and screen their patients more appropriately. Before being presented with an intervention consisting of an educational session that detailed the most recent U.S. Preventative Services Task Force (USPSTF) cervical cancer screening guidelines, the HCPs were surveyed for knowledge and at 2 months post-intervention, they were surveyed again. When the survey was scored pre- and post-intervention, two-thirds of the HCPs improved their score. An important barrier (67% post-intervention) to extending the interval included concerns about the patients losing contact with the medical system (50% at baseline). An educational intervention, including the updated screening guidelines, improved the HCPs' attitudes, beliefs, and knowledge of screening guidelines.

Improving Provider Readiness for Intimate Partner Violence Screening.

BACKGROUND: Intimate partner violence (IPV) is a significant public health issue. Healthcare providers (e.g., nurses, advanced practice nurses, physicians, social workers) have a unique opportunity to prevent and reduce IPV through screening and referral. The objective of this project was to determine the impact of education and a brief screening tool integrated into the electronic medical record (EMR) on readiness to screen for IPV. METHODS: An intervention was implemented that included the EMR integration of a screening tool, creation of an automated resource telephone system and healthcare provider IPV screening and response education. Readiness for screening was evaluated pre- and postintervention using the Domestic Violence Health Care Provider Survey Scale (DVHCPSS), which is scored cumulatively and by each of six domains. An unpaired Student's t test was performed. RESULTS: Mean age (31-40 years of age) and years of clinical practice (11-15 years) was the same for pre- (n = 96) and postintervention (n = 83) survey respondents. There was an overall significant increase in screening readiness (p = .003) with significant improvement in "professional role resistance/fear of offending the patient" (p < .0001), "blame victim items" (p = .0029), "perceived self-efficacy" (p = .0064), and "victim/provider safety" (p = .003). LINKING EVIDENCE TO ACTION: Adopting and integrating a validated IPV screening tool into the EMR combined with education was associated with an improvement in overall readiness for IPV screening. Reducing and preventing IPV through universal screening and referral can be accomplished by embedding a standardized readily accessible validated IPV screening tool in the EMR.

Perceptions to Overcoming Barriers to Prenatal Care in African American Women.

Pregnancy-related deaths affect African American women at a rate four to five times higher than White women. These deaths occur during pregnancy or up to 1 year after childbirth. Inadequate or delayed prenatal care is a factor associated with poor maternal health outcomes in African American women. Identifying factors that pose as facilitators and barriers to prenatal care is essential in developing interventions aimed at improving maternal health outcomes.

The effect of gynecologic algorithm pathways on emergency department visit times.

BACKGROUND: The use of multidisciplinary algorithmic pathways is one strategy to improve efficiency and quality of care in Emergency Departments (EDs). To this end, in the fall of 2005, we implemented algorithmic pathways for evaluation of ED patients with common gynecologic complaints. OBJECTIVES: The goals of this initiative were to improve length of stay as a marker for operational efficiency and to reduce health care disparities by ensuring consistent management regimens for all patients. METHODS: A retrospective observational comparison study was performed through a review of consults in the year preceding and the year after implementation of the pathways. The length of stay was calculated based on time of initial triage until discharge. The length of stay from both groups was compared using an unpaired Student's t-test analysis. RESULTS: There was an 85-min decrease in the mean visit time between the pre-intervention group (108 patients, 610 min, SD 345.4) and the post-intervention group (105 patients, 525 min, SD 251.5), p=0.04. CONCLUSIONS: Algorithmic pathways had a positive impact on patient care as measured by the average amount of time our patients spent in the ED. Gynecologic care in the ED was standardized, and length of stay for patients with gynecologic complaints decreased. The implementation of algorithms resulted in more consistent care with earlier initiation of pertinent studies, while facilitating more rapid critical decision-making by providers from both departments. Further analysis is required to examine cost-effectiveness as well as patient safety and provider satisfaction issues.

The Effect of Implementing a Standardized Enhanced Recovery After Surgery Pain Management Pathway at an Urban Medical Center in Hawaii.

Traditional use of opioids to treat postoperative pain may lead to abuse and overdose. The development of Enhanced Recovery After Surgery (ERAS) protocols has helped to shift pain management from traditional methods to evidence-based best practices involving multimodal analgesia techniques. The purpose of this quality improvement project was to implement and determine the effectiveness of a standardized, evidence-based ERAS pain management pathway for patients undergoing colorectal or gynecology procedures at a medical center in Hawaii. After the intervention, the evaluation of data associated with opioid use, patients' pain scores, time spent in the postanesthesia care unit, and inpatient length of stay showed that most results were not significant. However, the ERAS pain management pathway did reduce clinical practice variations, intraoperative opioid administration, the time that patients spent in the postanesthesia care unit, and length of stay. The ERAS pain management pathway continues to be used and updated at this facility.

Brain Science-Based Innovative Collaborative Teaching to Facilitate Nursing Education.

BACKGROUND: Innovative teaching that effectively promotes learning is a process called brain science. Chemicals released during motivation and attention lead to improved learning, and chemicals released during high-stress situations deter learning. The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented stress while providing an opportunity to create innovative strategies for facilitated learning. METHOD: To meet the pandemic challenges of a traditional undergraduate nursing program at a large state-funded university, specialty course faculty collaborated to redesign the courses using brain science concepts. RESULTS: Students demonstrated improved average course scores across courses compared with previous students (obstetrics, 2%; pediatrics, 4.34%; and critical care, 1.38%). Overall student feedback was positive. CONCLUSION: Brain science provides the foundation for advanced education that promotes optimal learning. The stress of the COVID-19 pandemic has created the opportunity for the implementation of an advanced educational model in which learning is facilitated and supported. [J Nurs Educ. 2022;61(3):162-166.].

The Role of Vitamin B6 in Women's Health.

Vitamin B6, a cofactor in many biochemical reactions in the cells of living organisms, is an essential coenzyme for various catabolic and anabolic processes. Although vitamin B6 deficiency in young healthy women with a balanced diet is thought to be unusual, it can be seen with certain medications, health conditions, and dietary deficits, as well as aging. Vitamin B6 deficiency is associated with a variety of ill health effects, and correction of deficiency is considered beneficial. Women particularly are affected by unique health issues that are part of the array of disorders potentially alleviated through vitamin B6 supplementation.

The Stigma of Sexually Transmitted Infections.

Evidence-based guidelines have improved diagnosis and treatment of sexually transmitted infections (STI). Social stigma remains a barrier to STI testing and is associated with underutilization of prevention services. Alternatives for STI testing (eg, in-home testing) are convenient. However, some individuals decline follow-up treatment in fear of unintentional disclosure of their diagnosis. This article reviews STI treatment guidelines and examines the impact of stigma and ethical issues on testing, adherence, partner notification, and transmission rates. An understanding of STI-associated ethical issues and controversies is an important step toward eliminating stigma and reducing STI prevalence and morbidity.

Conversion to Chlorhexidine Gluconate for Perioperative Vaginal Preparation: An Evidence-Based Process Improvement Project.

Surgical site infections (SSIs) occur during the postoperative period and involve the operative site. To lower the occurrence of SSIs in their patient population, the gynecology SSI prevention committee at a large academic medical institution initiated a process improvement project examining vaginal antiseptic skin prep solutions. Some studies indicate that chlorhexidine gluconate (CHG) is superior to povidone-iodine in the reduction of microbial skin counts and SSIs. After reviewing the available literature, the committee members determined there was an opportunity to make an evidence-based practice change and realize significant cost savings by converting povidone-iodine prepping kits to CHG prepping kits for vaginal procedures. The committee members worked with perioperative and facility leaders to revise the vaginal preparation policy, provide staff member education, and convert to CHG prepping kits. Facility leaders supported this cost-saving conversion for all perioperative units, and the project led to a successful, large-scale, evidence-based process improvement.

Integration of a Comprehensive Contraception Education Program Into Clinical Practice in a Family Planning Clinic.

OBJECTIVE: To improve rates of contraception adherence by implementing a comprehensive contraception educational program for women receiving care at a family planning clinic. DESIGN: Quasi-experimental cohort study in which we evaluated women presenting before (control group) and after program implementation (intervention group) and compared the proportion of women returning for contraceptive method change and/or for unintended pregnancy. SETTING: Family planning clinic of a large academic medical center. PARTICIPANTS: English-speaking women ages 12 to 50 years who presented to the clinic for pregnancy termination or initiation of a new contraceptive method from May 2012 to May 2014. INTERVENTION: A provider-facilitated, patient-centered educational intervention was implemented to foster patient knowledge and choice about contraception. RESULTS: We conducted chart review to identify any clinic visit that occurred in the 12 months after the index visit. Pearson's chi-square test was used to compare results for women in both groups. The intervention group included 201 women, and the control group included 162 women. In the control group, 28% (n = 46/162) returned within the year for unintended pregnancy and/or contraceptive method change, whereas only 17% (n = 35/201) returned in the study group. This difference was statistically significant (p < .05). CONCLUSION: Initiation of a comprehensive contraception educational program was associated with a decrease in rates of return visits for unintended pregnancy and contraceptive method changes. This implies an improvement in adherence to the initially chosen contraceptive method. Such interventions hold promise for improving contraceptive adherence and decreasing unintended pregnancy. Improving contraceptive adherence is a critical first step to decreasing unintended pregnancies.

Management of first-trimester complications in the emergency department.

PURPOSE: The pharmacologic management and the nonpharmacologic management of first-trimester complications in the emergency department are reviewed. SUMMARY: The obstetric complications most commonly seen in early pregnancy (less than 20 weeks' gestation) include ectopic pregnancy, threatened and inevitable abortions, and incomplete, complete, and missed abortions. The treatment options for ectopic pregnancy include expectant management, medical management with methotrexate, and surgery. If patients have signs and symptoms of tubal rupture, surgery must be performed immediately. In other cases, the choice of management technique is based on the patient's clinical condition, factors related to the ectopic pregnancy, and the patient's preferences. Pharmacologic therapies for women with confirmed threatened abortion include human chorionic gonadotropin, progesterone, uterine muscle relaxants, and Rh immune globulin prophylaxis. Treatment goals for women whose condition has advanced to inevitable abortion include evacuating any retained products of conception, either with expectant (conservative) management or pharmacologic or surgical intervention. The best treatment option is often determined by the mother's clinical status at the time of presentation and her preference of management strategy. Management of complete abortion may not require any further intervention; however, it is often difficult to identify a complete versus incomplete abortion. Treatment options for complete, incomplete, and missed abortions include expectant, surgical, and medical management. CONCLUSION: Ectopic pregnancy, threatened and inevitable abortions, and incomplete, complete, and missed abortions are common complications during early pregnancy. Various medical and surgical treatment options are available for managing these complications, including expectant management, medical management, and surgery.