Development of an outpatient clinic to provide pertussis vaccinations to maternity patients and family members.

PURPOSE: The implementation of a hospital-based outpatient pertussis prevention program targeting maternity patients and family members is described. SUMMARY: Faced with a rising incidence of pertussis statewide, a large Ohio hospital formed a multidisciplinary team to ensure hospital compliance with current guidelines calling for administration of the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine to all maternity patients as well as previously unvaccinated family members and likely neonatal caregivers (i.e., "cocooning"). The team had regularly scheduled meetings to identify and address fiscal, logistic, and practice-related challenges throughout the implementation process. Key challenges included (1) determining the availability of insurance reimbursement for Tdap vaccination services, (2) cultivating support for the vaccination initiative among obstetrics and maternal-fetal medicine specialists, (3) coordinating development and dissemination of educational information to patients and their families at specified points of contact, and (4) establishing an efficient registration process for family members. The outpatient vaccination clinic was located adjacent to the hospital's maternity center in order to provide convenient access. Despite limited clinic hours (three hours daily on weekdays only) and ongoing reimbursement and funding challenges, the program has improved Tdap vaccination rates in the target population and is considered a successful demonstration of the cocooning concept. CONCLUSION: Implementation of an outpatient clinic for neonatal pertussis prevention was well accepted by family members of newborns, and Tdap vaccinations were administered to 329 family members during the first 11 months of clinic operations.

Novel oral contraceptive for heavy menstrual bleeding: estradiol valerate and dienogest.

Abnormal uterine bleeding (AUB) is associated with significant direct medical costs and impacts both society and the quality of life for individual women. Heavy menstrual bleeding, a subset of AUB, also referred to as menorrhagia, is defined as menstrual blood loss greater than 80 mL or the patient's perception of excessive blood loss. The newest treatment option available is a novel combination oral contraceptive product containing estradiol valerate (E2V) and dienogest (DNG). As with other combination oral contraceptives, E2V/DNG works primarily by preventing ovulation. However, in contrast with other combination oral contraceptives, it is the progestin component of E2V/DNG that is responsible for endometrial stabilization. Use of E2V/DNG for six months has led to significant reductions in heavy menstrual bleeding with an average 65% reduction in mean blood loss. Approximately half of the women with heavy menstrual bleeding who received E2V/DNG for six months demonstrated an 80% reduction in mean blood loss. Additionally, significant improvements in hematologic indicators (ie, ferritin, hemoglobin, and hematocrit) have been shown. Based on its chemical properties, E2V/DNG may have fewer adverse effects on lipid and glucose metabolism and reduced risk of thromboembolic complications compared with other combination oral contraceptives. This has not yet been shown in clinical trials and until then it should be assumed that E2V/DNG has a safety profile similar to other combination oral contraceptives containing 35 µg or less of ethinyl estradiol. E2V/DNG has been compared with another combination oral contraceptive in healthy women without heavy menstrual bleeding and demonstrated improved bleeding patterns. E2V/DNG has not been compared with the levonorgestrel intrauterine device or other treatments for heavy menstrual bleeding. When compared with some other treatment options for AUB, E2V/DNG provides the added advantage of effective contraception.