Paediatric dermatology teleconsultations: a survey of healthcare professionals in the UK.

The COVID-19 pandemic catapulted dermatology services into a digital era, with the rapid introduction of teleconsultations. The UK National Health Service operational planning guidance recommends ≥ 25% of consultations are delivered remotely. There is a lack of data regarding the acceptability and effectiveness of paediatric dermatology teleconsultations. We surveyed UK healthcare professionals (HCPs) to explore their experiences of teleconsultations in paediatric dermatology, with a focus on follow-up consultations for paediatric eczema (PE), to inform a future clinical trial. There were 119 responses. Pre-pandemic, 37% provided some form of teleconsultation service, rising to 92% post-pandemic. In total, 41% (n = 49) now carry out > 25% of consultations remotely. We found 55% felt teleconsultations were less effective than face-to-face ones for PE follow-up. Eighty HCPs offered teleconsultations for PE. Among the HPCs who offered teleconsultations for PE, the most effective format for follow-up consultations was felt to be telephone with photographs (52/80, 65%). Our results demonstrate varying opinion on the effectiveness and optimal format of paediatric teleconsultations, supporting the need for further research.

Sexual and Reproductive Health Care Experiences and Perceptions of Women with Congenital Heart Disease.

Due to medical advances, women with congenital heart disease (CHD) are living longer, healthier lives and many are considering pregnancy. The hemodynamic changes of pregnancy present high risks of morbidity and mortality for many women with CHD. As little is known about these women's reproductive health experiences, this study explores their perceptions of pregnancy and family planning care as related to CHD. Women ages 18-45 years with a diagnosis of CHD associated with a World Health Organization (WHO) classification II-IV for pregnancy morbidity and mortality participated in individual, semi-structured interviews exploring their experiences, attitudes, and preferences toward parenthood, pregnancy, contraception and family planning care provision. Interviews were audio-recorded, transcribed verbatim. Two independent coders performed analysis using deductive and inductive coding approaches. Twenty women with CHD participated in interviews (average age 30.1 years, SD 5.85). Nine women had a prior pregnancy and 14 considered becoming a parent in the future. We identified 5 key themes among the women: (1) CHD impacted their reproductive health goals and decisions; (2) Women with CHD perceived a lack of safe contraceptive methods for their condition; (3) Women desired tailored, disease-specific sexual and reproductive health (SRH) information; (4) Women viewed their cardiologist as the primary source for SRH information and prefer provider-initiated discussions starting in adolescence; and (5) Women desire coordinated pre-pregnancy and intrapartum care between their cardiologists and women's health providers. These results provide a foundation for interventions to improve patient-centered interdisciplinary reproductive healthcare for this population.

The Science of Learning and Art of Education in Cardiology Fellowship.

The science of learning, bolstered by the foundational principles of adult learning, has evolved to allow for a more sophisticated understanding of how humans acquire knowledge. To optimize learning outcomes, cardiology educators should be familiar with these concepts and apply them routinely when teaching trainees. This paper presents an overview of the neurobiology of learning and adult learning principles and offers examples of ways in which this science can be applied in cardiology fellowships. Both fellows and educators benefit from the science of learning and its artistic application to education.

Educational Attainment, Race, and Ethnicity as Predictors for Ideal Cardiovascular Health: From the National Health and Nutrition Examination Survey.

Background Educational attainment is protective for cardiovascular health (CVH), but the benefits of education may not persist across racial and ethnic groups. Our objective was to determine whether the association between educational attainment and ideal CVH differs by race and ethnicity in a nationally representative sample. Methods and Results Using the National Health and Nutrition Examination Survey, we determined the distribution of ideal CVH, measured by Life's Simple 7, across levels of educational attainment. We used multivariable ordinal logistic regression to assess the association between educational attainment (less than high school, high school graduate, some college, college graduate) and Life's Simple 7 category (ideal, intermediate, poor), by race and ethnicity (Asian, Black, Hispanic, White). Covariates were age, sex, history of cardiovascular disease, health insurance, access to health care, and income-poverty ratio. Of 7771 National Health and Nutrition Examination Survey participants with complete data, as level of educational attainment increased, the criteria for ideal health were more often met for most metrics. After adjustment for covariates, effect of education was attenuated but remained significant (P<0.01). Those with at least a college degree had 4.12 times the odds of having an ideal Life's Simple 7 compared with less than high school (95% CI, 2.70-5.08). Among all racial and ethnic groups, as level of educational attainment increased, so did Life's Simple 7. The magnitude of the association between education and CVH varied by race and ethnicity (interaction P<0.01). Conclusions Our findings demonstrate that educational attainment has distinct associations with ideal CVH that differs by race and ethnicity. This work demonstrates the need to elucidate barriers preventing individuals from racial and ethnic minority groups from achieving equitable CVH.

Sexual violence and cardiovascular disease risk: A systematic review and meta-analysis.

BACKGROUND: Cardiovascular disease (CVD) is a leading cause of death among adults. Over 35% of women worldwide report lifetime exposure to sexual violence. While psychosocial factors broadly have been linked to CVD risk, it is unclear if a history of sexual violence is associated with increased risk for CVD. This study employed quantitative meta-analysis to investigate the association between sexual violence and CVD risk. METHODS: PubMed and PsycINFO databases were searched through March 1, 2021. Included articles had a measure of sexual violence and at least one cardiovascular outcome (i.e., clinical CVD, subclinical CVD, select CVD risk factors) in women and men aged 18 years or older. Data were expressed as odds ratios (OR) or hazard ratios (HR) with 95% confidence intervals (CI) extracted from fully-adjusted models. OR and HR effects were pooled separately, given the inability to statistically harmonize these effects and differences in interpretation, using random effects meta-analysis. Heterogeneity of effects was tested using Cochran's Q test. RESULTS: Overall, 45 articles based on 830,579 adults (77.1% women) were included (113 individual effects expressed as OR and 9 individual effects expressed as HR). Results indicated that sexual violence was related to adult CVD risk (OR [95%CI] = 1.25 [1.11-1.40]; HR [95%CI] = 1.17 [1.05-1.31]). Results varied by outcome type and measurement, and timing of violence. CONCLUSIONS: Adults with a history of sexual violence demonstrate greater CVD risk relative to those without this history. The results highlight the importance of addressing sexual violence in CVD risk reduction efforts.

The effect of the lone parent household on cardiovascular health (National Health and Nutrition Examination Survey, 2015-2016).

STUDY OBJECTIVE: Single parenthood is associated with adverse health outcomes. How cardiovascular risk differs by parenthood status has had limited study. We hypothesized that single parents would have worse cardiovascular risk profiles compared to those in partnered-parent households. DESIGN: We compared associations of parenthood status and the American Heart Association's Life Simple 7 (LS7), an established metric measuring modifiable components of cardiovascular health (smoking status, body mass index, physical activity, diet, cholesterol, glycohemoglobin, and blood pressure) in multivariable-adjusted models. PARTICIPANTS: We selected adults (age ≥ 25) from the National Health and Nutrition Examination Survey (NHANES) 2015-16 cycle. We defined single parenthood as reporting a child <18 years residing in the home and marital status other than married or living with partner. MAIN OUTCOME MEASURES: LS7, continuous (range 0-14) and categorized as poor (0-4), intermediate (5-9), or ideal (10-14). RESULTS: In total, 2180 NHANES participants identified as parents and 1782 (82%) had complete LS7 scores. Of these, 462 identified as single parents, of whom 356 (74.9%) were women. Single parents were more likely to smoke, have poor physical activity, and have high blood pressure (p < 0.01) than partnered parents. Single parents had 1.3-fold greater likelihood of poor cardiovascular health compared with partnered parents, adjusting for age, sex, race/ethnicity, health insurance, healthcare access, poverty index, educational attainment and number of children (95% confidence interval [CI] 1.01-1.71). CONCLUSIONS: We identified an association between single parenthood and adverse cardiovascular health. Our results demonstrate the importance of considering household composition in risk assessment and cardiovascular disease prevention.

Management of Cardiac Arrest in the Pregnant Patient.

PURPOSE OF REVIEW: The goal of this review is to elucidate what is known about the science of maternal resuscitation and how treatment guidelines have developed to optimize management. RECENT FINDINGS: There is limited data on maternal cardiac arrest. Case reports are providing some insight into safety and efficacy of certain mechanisms of treatment, including use of extracorporeal membranous oxygenation and thrombolysis, for example. Data increasingly supports the preventability of a significant portion of maternal cardiac arrest, which remains the most important target for intervention. maternal cardiac arrest has increased in incidence over the past several decades but remains a rare event. In recent years, guidelines have emerged in attempt to standardize treatment, although research on best practice is scarce. Ultimately, future progress in targeting the rise in rate of cardiac arrest will come from large scale collaboration in data sharing and development of mechanisms to identify at risk patients to prevent arrest.

The Effects of Gonadotropin-Releasing Hormone Agonist Combined with Add-Back Therapy on Quality of Life for Adolescents with Endometriosis: A Randomized Controlled Trial.

STUDY OBJECTIVE: Use of gonadotropin-releasing hormone agonists (GnRHa) to treat endometriosis can cause mood and vasomotor side effects. "Add-back therapy," the combination of low-dose hormones, limits side effects but research is limited to adults. We sought to characterize quality of life (QOL) before treatment and to compare an add-back regimen of norethindrone acetate (NA) with conjugated estrogens (CEE) to NA alone for preventing side effects of GnRHa therapy in female adolescents with endometriosis. DESIGN: Twelve-month double-blind, placebo-controlled trial. SETTING: Pediatric Gynecology clinic in Boston, Massachusetts. PARTICIPANTS: Fifty female adolescents (aged 15-22 years) with surgically confirmed endometriosis initiating treatment with GnRHa. INTERVENTIONS: Subjects were randomized to: NA (5 mg/d) with CEE (0.625 mg/d) or NA (5 mg/d) with placebo. All subjects received leuprolide acetate depot every 3 months. MAIN OUTCOME MEASURES: The Short Form-36 v2 Health Survey, Beck Depression Inventory II, and Menopause Rating Scale were completed at repeated intervals. RESULTS: At baseline, subjects reported impaired physical health-related QOL compared with national norms (all P < .0001). Over 12 months, these Short Form-36 v2 scores improved (all P < .05). Subjects receiving NA with CEE showed greater improvements in the pain, vitality, and physical health subscales (Pbetween groups < .05) than those receiving NA alone, as well as better physical functioning (P < .05). There were no changes in depression or menopause-like symptoms in either group. CONCLUSION: Female adolescents with endometriosis initiating GnRHa therapy have impaired QOL. Treatment with GnRHa combined with add-back therapy led to improved QOL, with no worsening of mood or menopausal side effects. NA with CEE was superior to NA alone for improving physical health-related QOL.

Cardiopulmonary laboratory biomarkers in the evaluation of acute dyspnea.

Dyspnea is a common chief complaint in the emergency department, with over 4 million visits annually in the US. Establishing the correct diagnosis can be challenging, because the subjective sensation of dyspnea can result from a wide array of underlying pathology, including pulmonary, cardiac, neurologic, psychiatric, toxic, and metabolic disorders. Further, the presence of dyspnea is linked with increased mortality in a variety of conditions, and misdiagnosis of the cause of dyspnea leads to poor patient-level outcomes. In combination with the history and physical, efficient, and focused use of laboratory studies, the various cardiopulmonary biomarkers can be useful in establishing the correct diagnosis and guiding treatment decisions in a timely manner. Use and interpretation of such tests must be guided by the clinical context, as well as an understanding of the current evidence supporting their use. This review discusses current standards and research regarding the use of established and emerging cardiopulmonary laboratory markers in the evaluation of acute dyspnea, focusing on recent evidence assessing the diagnostic and prognostic utility of various tests. These markers include brain natriuretic peptide (BNP) and N-terminal prohormone (NT-proBNP), mid-regional peptides proatrial NP and proadrenomedullin, cardiac troponins, D-dimer, soluble ST2, and galectin 3, and included is a discussion on the use of arterial and venous blood gases.

Hormonal Add-Back Therapy for Females Treated With Gonadotropin-Releasing Hormone Agonist for Endometriosis: A Randomized Controlled Trial.

OBJECTIVE: To assess whether add-back therapy with norethindrone acetate or norethindrone acetate plus conjugated equine estrogens is superior to maintain bone health in adolescents and young women using gonadotropin-releasing hormone agonists for endometriosis. Gonadotropin-releasing hormone agonists are associated with deleterious effects on bone. Hormonal add-back may mitigate these effects. METHODS: Adolescents and young women (n=51) received a random, double-blind assignment to add-back with norethindrone acetate (5 mg/day) plus conjugated equine estrogens (0.625 mg/day) or norethindrone acetate plus placebo for 12 months. Body composition, bone mineral content, and bone mineral density (BMD) were obtained by dual-energy X-ray absorptiometry every 6 months. Quality-of-life measures were collected every 3 months. Intention-to-treat comparison of outcomes was conducted by repeated-measures analysis of variance. RESULTS: Thirty-four adolescents and young women completed the trial; dropouts did not differ from those who completed the trial. Bone mineral density was normal at baseline. At 12 months, total body bone mineral content and BMD had increased in the norethindrone acetate plus conjugated equine estrogens group (bone mineral content +37 g, P<.001 and BMD +0.012 g/cm, P=.05), but not in those receiving norethindrone acetate plus placebo (bone mineral content P=.19 and BMD P=.95). Lean mass increased only in those receiving conjugated equine estrogens (+1.4 kg, P=.001). Improvements in physical functioning domains of quality-of-life assessments were greater with norethindrone acetate plus conjugated equine estrogens (P=.005). No differences were seen at the hip or lumbar spine by dual-energy X-ray absorptiometry. No significant adverse events occurred. CONCLUSION: Hormonal add-back successfully preserved bone health and improved quality of life for adolescents and young women with endometriosis during 12 months of gonadotropin-releasing hormone agonist therapy. Combination norethindrone acetate plus conjugated equine estrogens add-back appears to be more effective for increasing total body bone mineral content, areal BMD, and lean mass than norethindrone acetate monotherapy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; www.clinicaltrials.gov, NCT00474851. LEVEL OF EVIDENCE: I.