Factors Impacting HIV Postexposure Prophylaxis Among Sexually Assaulted Patients Presenting to Two Urban Emergency Departments.

INTRODUCTION: Sexually assaulted patients who seek care in emergency departments are often recommended for nonoccupational HIV postexposure prophylaxis treatment. HIV postexposure prophylaxis is an effective method in preventing HIV transmission if the treatment is administered promptly and if a full 28-day course is completed. However, research has shown that only a fraction of patients who start the treatment will complete a 28-day course. Research is needed to explore factors that may be associated with compliance to postexposure prophylaxis so that interventions can be designed to address the factors that put patients at risk for noncompletion. METHODS: A retrospective chart review was conducted examining 246 medical records of sexually assaulted female patients who presented to one of two urban hospitals. A number of patient and event-related factors were examined to determine whether they were associated with HIV postexposure prophylaxis adherence among patients presenting at an emergency room after a sexual assault. RESULTS: Results revealed that five factors showed significant associations with sexually assaulted female patients completing HIV postexposure prophylaxis treatment. These factors include educational level, employment, health insurance, vaginal injuries, and tongue-mouth assaults. IMPLICATIONS FOR PRACTICE: The results of this study represent a starting point from which to inform the development of targeted interventions such that those most at risk for nonadherence can receive additional support or services to improve HIV postexposure prophylaxis adherence.

Readability and health literacy level of post-exposure prophylaxis patient education materials offered after sexual assault.

BACKGROUND: The link between readability of patient education materials and patient outcomes has been well established. Patients who experience sexual assault often present to the emergency department in an acute trauma response state. Stress interferes with memory and learning. Patients routinely receive medication to prevent sexually transmitted infections after sexual assault. HIV post-exposure prophylaxis (PEP) success is dependent on completing a 28-day course. Only 24% of sexually assaulted patients complete HIV PEP. METHODS: This descriptive study used three validated tools to assess readability and evaluate the understandability of HIV PEP patient education materials following sexual assault. Patient education materials (n = 21) were collected through a variety of databases, government sources, and secondary reference review. Each researcher independently scored all materials. Inter-rater reliability was assured after robust. DISCUSSION: Final scores were used to determine readability and health literacy levels. RESULTS: All educational materials far exceeded the recommended readability level (Range = 7th grade to college). Those with the highest readability included visual cues. The Patient Education Materials Assessment Tool (PEMAT) understandability scores ranged from 38 to 94%, and actionability scores ranged from 40 to 100%. Using a cut score of 80%, approximately 57% of the educational materials were understandable, while only 14% were actionable. CONCLUSIONS: Expert agencies recommend a sixth-grade or below reading level for patient education reading materials. Our data show that post-exposure patient education materials following sexual assault are difficult to understand. This mismatch between the patient education material's readability and health literacy levels and the recommended standards will likely limit the success of post-exposure prophylaxis course of treatment following sexual assault.

Use of Dolutegravir for Antiretroviral Therapy for Women of Childbearing Age.

The purpose of this article is to offer an update on the use of antiretroviral therapy (ART) for HIV among women of childbearing age. We focus specifically on the use of dolutegravir (DTG) because of a recently identified potential safety issue related to neural tube defects in the fetuses of women who used DTG at the time of conception. Nurses and advanced practice registered nurses should engage in shared decision-making processes for reproductive life planning with women of childbearing age who are living with or are at risk for HIV. During these processes, exploration of the full range of ART regimens is essential. Consistent and reliable contraception is necessary with the use of DTG because it is not recommended in the first trimester of pregnancy.

Human Trafficking: How Nurses Can Make a Difference.

Human trafficking is a human rights violation and a global health problem. Victims of human trafficking have medical and mental health sequelae requiring specific healthcare interventions. Healthcare professionals may be the initial contact that these victims make outside the world of trafficking. Healthcare professionals are key agents in the identification of human trafficking, which is essential in eliminating this public health problem. Unfortunately, healthcare professionals are not always able to detect signs of human trafficking. Failure to detect results in missed opportunities to assist victims. This is a case report of a victim of human trafficking who presented to an emergency department with medical and mental health issues. Despite numerous encounters with different healthcare professionals, signs and symptoms of human trafficking were not identified. Skilled assessment made by a forensic nurse alerted the healthcare team to clear features of human trafficking associated with this person. Through this case report we illustrate the key role the nurse played in identifying signs of human trafficking. Improvement of human trafficking educational programs is highlighted as a key adjunct to improving detection and facilitating the proper treatment of victims.

Do EPs change their clinical behaviour in the hallway or when a companion is present? A cross-sectional survey.

OBJECTIVES: Our aim was to determine whether emergency physicians (EPs) felt their standard patient evaluation practice was modified by two non-private clinical encounters: hallway encounters and encounters during which a companion was present. METHODS: We administered an iteratively developed cross-sectional survey at an annual national professional meeting. We used logistic regression to compare relationships among non-private clinical encounters and predictors of interest. RESULTS: 409 EPs completed the survey. EPs deviated from standard history-taking when practising in a hallway location (78%) and when patients had a companion (84%). EPs altered their standard physical exam when practising in a hallway location (90%) and when patients had a companion (77%). EPs with at least a decade of experience were less likely to alter history-taking in the hallway (OR 0.55, 95% CI 0.31 to 0.99). Clinicians who frequently evaluated patients in the hallway reported delays or diagnostic error-related to altered history-taking (OR 2.34, 95% CI 1.33 to 4.11). The genitourinary system was the most common organ system linked to a delay or diagnostic error. Modifications in history-taking were linked to delays or failure to diagnose suicidal ideation or self-harm (25%), intimate partner violence (40%), child abuse (12%), human trafficking (8%), substance abuse (47%) and elder abuse (17%). CONCLUSIONS: Our study suggests that alterations in EP usual practice occurs when the doctor-patient dyad is disrupted by evaluation in a hallway or presence of a companion. Furthermore, these disruptions are associated with delays in care and failure to diagnosis medical, social and psychiatric conditions.

The Priority of Administering HIV Postexposure Prophylaxis in Cases of Sexual Assault in an Emergency Department.

INTRODUCTION: Contracting the human immunodeficiency virus (HIV) is a genuine concern for sexually assaulted patients. Emergency departments are a place where sexually assaulted patients seek care, including treatment to prevent HIV. Prompt administration of nonoccupational postexposure prophylaxis is essential because of the time-sensitive nature of the medications. Quality improvement measures at an urban hospital revealed delays in administration of postexposure prophylaxis to these patients. METHODS: A forensic simulation course and checklist was developed for emergency departments to improve care for sexually assaulted patients. Data used for analysis included time of administration of nonoccupational postexposure medication and length of stay before and after intervention with the simulation course and checklist. Points of measurement included student t-test to assess any significant differences and regression analysis to determine associations. RESULTS: When comparing differences between time of nonoccupational postexposure before and after intervention, there was a trend toward improving the time of administration, but it was not found to be significant. Before intervention, an association was found with sexually assaulted patients' lengths of stay and the time that nonoccupational postexposure medication was administered, with a regression equation of R2, 0.76. After intervention, this association was absent, with an R2 of 0.017. DISCUSSION: Implementing a simulation course and checklist for emergency nurses in caring for sexually assaulted patients helps to improve the timeliness of administration of nonoccupational postexposure medications and resolve the association between the length of stay and time of administration of medication.

A Meta-Analysis of HIV Postexposure Prophylaxis Among Sexually Assaulted Patients in the United States.

Sexual assault (SA) is a major public health problem that leaves patients at risk for HIV. The gold standard of medical treatment for SA patients includes prophylactic treatment to prevent HIV. A meta-analysis was conducted and examined the rates of nonoccupational postexposure prophylaxis (n-PEP) offered to, accepted, and completed by SA patients who presented to emergency departments in the United States. Four points of data were analyzed: (a) SA patients who met the criteria and were offered n-PEP, (b) SA patients who were offered n-PEP and accepted the medication, (c) SA patients who accepted n-PEP treatment and completed at least one follow-up appointment, and (d) SA patients who completed the entire course of n-PEP. Results of the meta-analysis indicated that approximately half of the patients who were offered n-PEP accepted the medication. However, only 25.7% of SA patients who accepted n-PEP completed the full course.

Infant bed-sharing: supporting parents to make an informed decision.

The practice of infant bed-sharing remains controversial in countries such as the UK and the US, despite its prevalence, and healthcare professionals are often faced with the task of advising parents on bed-sharing without the support of consistent or up-to-date guidelines. This article explores UK and US recommendations on infant bed-sharing, considering the existing evidence. The possible relationship between infant bed-sharing and sudden infant death syndrome (SIDS) is explored, alongside other factors that may be linked to SIDS. Areas where further research is required are identified and appropriate resources are provided, with a view to empowering healthcare professionals to support parents in making an informed and proactive decision about infant bed-sharing.

Centers for Disease Control and Prevention 2015 Human Papillomavirus Vaccine Recommendations for Sexually Assaulted Patients: A Review and Update.

Individuals who have been sexually assaulted are at risk for contracting human papillomavirus (HPV), the most common sexually transmitted infection. One of the best methods in protecting against contracting the HPV is to receive the HPV vaccine. To date, national sexual assault protocols and guidelines do not include information on HPV vaccination. The current 2015 Centers for Disease Control and Prevention has updated their recommendations for sexually assaulted patients to now receive the HPV vaccine. This article reviews information on HPV, HPV vaccines, and specific considerations for patients who have been sexually assaulted.

Sexual Assault Simulation Course for Healthcare Providers: Enhancing Sexual Assault Education Using Simulation.

Patients who have been sexually assaulted disproportionately experience gaps in healthcare delivery. Ensuring that healthcare providers who care for this population are adequately prepared is one way of addressing this gap. At the Brigham and Women's Hospital, a 4-hour long interprofessional Sexual Assault Simulation Course for Healthcare Providers (SASH) was developed and conducted at the hospital's Simulation, Training, Research, & Technology Utilization System Center. The SASH is offered using a variety of teaching methodologies including didactics, skill stations comprising how to collect forensic evidence, simulation experience with standardized patient, and debriefing. Using simulation as an educational method allows healthcare professionals to gain hands-on skills in a safe environment. Ultimately, the goal of the SASH is to enhance collaborative practice between healthcare professionals and to improve knowledge, with the purpose of improving care for patients who have been sexually assaulted.