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1.
Am J Emerg Med ; 70: 90-95, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37245403

RESUMO

BACKGROUND: Most obstetric emergencies are initially managed in the emergency department (ED). The Supreme Court decision of Dobbs v. Jackson Women's Health Organization, overturning Roe v. Wade, in June 2022, eliminated constitutional protection of abortion rights, allowing states to swiftly enact laws that can greatly change reproductive medicine. In this post-Roe landscape, the ambiguity and uncertainty being imposed on clinicians regarding the legality of certain interventions may have catastrophic effects. To understand and plan for the changes that will come and attempt to mitigate adverse outcomes, the authors first assessed the current state of pregnancy-related complication care in the ED setting. This study utilized data obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to evaluate trends in pregnancy-related ED visits from 2016 to 2020 that could be impacted by restricted abortion access and trigger laws. The authors subsequently analyzed the legislative changes and translated the pertinent ones to dispel misunderstandings and provide a framework for appropriate medical practice. METHODS: The retrospective study utilized data from the NHAMCS database from 2016 to 2020, encompassing an estimated total of 4,556,778 pregnancy-related ED visits. NHAMCS is a multi-stage probabilistic sample collected by the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC) using an annual survey of EDs in the United States. All data were summarized using descriptive statistics such as proportions and 95% confidence intervals Furthermore, the supreme court decision was analyzed in addition to multiple state laws and legal texts. The findings were summarized and discussed. RESULTS: The majority (79.4%) of all studied visits were for patients between the ages of 18-34 years, capturing those in peak reproductive years. This age group also comprised of the bulk (76.4%) of visits for pathologic pregnancies, including ectopic and molar pregnancies, and 79.8% of visits for a spontaneous miscarriage or threatened miscarriage in early pregnancy. Black patients accounted for 25.7%, white patients 70.1%. Regarding ethnicity, patients were separated into Hispanic and non-Hispanic, with Hispanic patients comprising 27% of all ED visits for included diagnoses between 2016 and 2020. Most visits for complications following an induced abortion occurred in the south (70.8%) and were nearly twice as likely to occur in non-metropolitan areas. Approximately 18% patients presenting with a pathologic pregnancy required admission to the hospital and approximately 50% of those visits for pathologic pregnancies and visits for bleeding in pregnancy had a procedure in the ED (49.8% and 49.5%). There were 111,264 estimated visits in which methotrexate was administered, amounting to approximately 1 in 7 visits for ectopic or molar pregnancy. In this data set, approximately 14,000 miscarriage and early bleeding patients received misoprostol. CONCLUSION: Pregnancy-related ED visits comprise of a significant proportion of emergency care. As it relates to many of the trends previously elucidated on, the true extent of the burden cannot be predicted. It must be emphasized that contrary to popular belief, Dobbs v. Jackson does not prohibit termination of pregnancy in the setting of life-threatening conditions to the mother, including ectopic pregnancy, preeclampsia, and others, but the resultant uncertainty and ambiguity surrounding the constitutional change is leading to an over-compliance of the law, necessarily obstructing reproductive health care. The authors recommend that physicians be mindful of the rapidly-evolving laws in their particular state, and to also practice in accordance with Emergency Medical Treatment and Active Labor Act (EMTALA). Patient safety must be prioritized.


Assuntos
Aborto Induzido , Aborto Espontâneo , Complicações na Gravidez , Gravidez , Feminino , Humanos , Estados Unidos , Adolescente , Adulto Jovem , Adulto , Estudos Retrospectivos , Decisões da Suprema Corte , Serviço Hospitalar de Emergência , Complicações na Gravidez/terapia
2.
Prehosp Emerg Care ; 24(1): 77-84, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30917729

RESUMO

Objective: The purpose of this study was to examine the attitudes and behaviors of emergency medical technicians (EMTs) and Paramedics when faced with the decision to care for patients with suspected Ebola Virus Disease (EVD) and to illicit suggestions for improvement of infectious disease (ID) preparedness. Methods: A convenience sample of 22 EMT/Paramedics were recruited from an emergency department at one of the designated Ebola centers. Each provider participated in one of three on-site focus groups. Participants answered questions about how they gained their knowledge, felt about caring for EVD patients, made decisions about caring for EVD patients, and suggestions for improvement of ID preparedness. Focus groups were recorded, transcribed, and coded using inductive content analysis. Results: Analysis revealed five prominent themes: reactions to scare, education/training, danger, decision making, and suggestions for future responses. Overall, first responders were excited to be a part of the response to EVD. They were more comfortable caring for EVD patients if they received adequate education and transparency from the administration. This resulted in a decreased perceived danger of the disease and decreased hesitancy when caring for EVD patients. However, those that expressed the most hesitancy also expressed the most emotional distress. Suggestions for improvement of ID preparedness included continuing education, tiered training models, peer training models, collaboration between emergency medical services (EMS) systems, better communication between departments, and the development of an infectious disease response team. Conclusions: Although first responders were excited to be a part of the response to EVD, this did not come without hesitation and emotional distress. Some of these concerns may be mitigated by first providing a clear definition of "duty to care," followed by interventions such as the development of clear and consistent ID preparedness training and interventions that address the emotional distress experienced by these providers.


Assuntos
Atitude do Pessoal de Saúde , Doenças Transmissíveis/terapia , Serviços Médicos de Emergência , Doença pelo Vírus Ebola/prevenção & controle , Doença pelo Vírus Ebola/transmissão , Adulto , África Ocidental , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/transmissão , Serviço Hospitalar de Emergência , Feminino , Grupos Focais , Teoria Fundamentada , Doença pelo Vírus Ebola/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
5.
J Med Educ Curric Dev ; 11: 23821205241260243, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38868679

RESUMO

OBJECTIVE: A diverse physician workforce ensures equitable care. The holistic review of residency applications is one strategy to enhance physician diversity; however, little is known about current adoption and the factors that facilitate/impede the adoption of holistic recruitment practices (HRPs) by graduate medical education (GME) residency, and fellowship program directors (PDs). To describe the current state and explore, the barriers/facilitators to the adoption of HRPs at our institution. METHODS: We disseminated information about HRP within our program between 2021 and 2022. In May 2022, a survey of 73 GME PDs assessed current recruitment practices and self-reported barriers to holistic recruitment. Holistic Recruitment Scores (HRSs) reflecting the adoption of best practices were tabulated for each program and compared to identify predictors of adoption. RESULTS: 73/80 (92%) of PDs completed the survey. Programs whose PDs had higher academic rank, total number of trainees, and female trainees in the past 3 years had higher HRSs. Program size was directly correlated with HRS. Most (93%) PDs felt their current efforts were aligned to increase diversity and 58% felt there were no barriers to the adoption of holistic review. The most reported barriers were lack of time and knowledge/expertise in diversity, equity, and inclusion (DEI), both reported by 16 out of 73 PDs (22%). CONCLUSION: While most PDs implemented some HRP, institutional and departmental support of program directors through the commitment of resources (eg, staffing help and subject matter experts/coaches hiring) are crucial to overcome barriers.

6.
J Med Ethics ; 39(12): 765-71, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23355050

RESUMO

OBJECTIVE: Adolescents have had very limited access to research on biomedical prevention interventions despite high rates of HIV acquisition. One concern is that adolescents are a vulnerable population, and trials carry a possibility of harm, requiring investigators to take additional precautions. Of particular concern is preventive misconception, or the overestimation of personal protection that is afforded by enrolment in a prevention intervention trial. METHODS: As part of a larger study of preventive misconception in adolescent HIV vaccine trials, we interviewed 33 male and female 16-19-year-olds who have sex with men. Participants underwent a simulated HIV vaccine trial consent process, and then completed a semistructured interview about their understanding and opinions related to enrolment in a HIV vaccine trial. A grounded theory analysis looked for shared concepts, and focused on the content and process of adolescent participants' understanding of HIV vaccination and the components of preventive misconception, including experiment, placebo and randomisation. RESULTS: Across interviews, adolescents demonstrated active processing of information, in which they questioned the interviewer, verbally worked out their answers based upon information provided, and corrected themselves. We observed a wide variety of understanding of research concepts. While most understood experiment and placebo, fewer understood randomisation. All understood the need for safer sex even if they did not understand the more basic concepts. CONCLUSIONS: Education about basic concepts related to clinical trials, time to absorb materials and assessment of understanding may be necessary in future biomedical prevention trials.


Assuntos
Vacinas contra a AIDS , Conhecimentos, Atitudes e Prática em Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto/psicologia , Sujeitos da Pesquisa/psicologia , Vacinação/psicologia , Vacinas contra a AIDS/administração & dosagem , Vacinas contra a AIDS/imunologia , Adolescente , Desenvolvimento do Adolescente , Pesquisa Biomédica , Compreensão , Tomada de Decisões , Ética em Pesquisa , Feminino , Infecções por HIV/prevenção & controle , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Comportamento Sexual/psicologia , Adulto Jovem
7.
Curr Opin Infect Dis ; 25(1): 86-91, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22143118

RESUMO

PURPOSE OF REVIEW: The present review describes the indications for vaccinating men with the quadrivalent human papillomavirus (HPV) vaccine, reports on the US rates of male vaccination, and reviews the recent research on acceptability of vaccinating men and research on the cost-effectiveness of adding men to existing female HPV immunization programs. RECENT FINDINGS: Recent evidence shows that the quadrivalent HPV vaccine prevents several HPV-related diseases in men. However, despite the licensure of the vaccine in the USA for men 9 through 26 years of age, rates of male vaccination are very low. Research on acceptability, in general, indicates strong interest in vaccination among men, parents, and healthcare providers, though female vaccination is typically seen as a higher priority. Cost-effectiveness studies indicate that in the context of modest female vaccination rates and with the specification of a broad range of disease outcomes (e.g. genital warts, anogenital cancers, and oropharyngeal cancers), male vaccination can be quite cost-effective. SUMMARY: Men are at high risk for HPV infection and can benefit from vaccination, but vaccination rates among men remain extremely low. More research needs to be done on the predictors of uptake of HPV vaccine among men and on the development of interventions to increase male vaccination.


Assuntos
Vacinação em Massa/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/uso terapêutico , Atitude do Pessoal de Saúde , Análise Custo-Benefício , Humanos , Masculino , Vacinação em Massa/economia , Vacinação em Massa/organização & administração , Infecções por Papillomavirus/economia , Vacinas contra Papillomavirus/economia , Aceitação pelo Paciente de Cuidados de Saúde , Estados Unidos
8.
BMC Pediatr ; 12: 192, 2012 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-23241217

RESUMO

BACKGROUND: Licensed for use in males in 2009, Human Papillomavirus (HPV) vaccination rates in adolescent males are extremely low. Literature on HPV vaccination focuses on females, adult males, or parents of adolescent males, without including adolescent males or the dynamics of the parent-son interaction that may influence vaccine decision-making. The purpose of this paper is to examine the decision-making process of parent-son dyads when deciding whether or not to get vaccinated against HPV. METHODS: Twenty-one adolescent males (ages 13-17), with no previous HPV vaccination, and their parents/guardians were recruited from adolescent primary care clinics serving low to middle income families in a large Midwestern city. Dyad members participated in separate semi-structured interviews assessing the relative role of the parent and son in the decision regarding HPV vaccination. Interviews were recorded, transcribed, and coded using inductive content analysis. RESULTS: Parents and sons focused on protection as a reason for vaccination; parents felt a need to protect their child, while sons wanted to protect their own health. Parents and sons commonly misinterpreted the information about the vaccine. Sons were concerned about an injection in the penis, while some parents and sons thought the vaccine would protect them against other sexually transmitted infections including Herpes, Gonorrhea, and HIV. Parents and sons recalled that the vaccine prevented genital warts rather than cancer. The vaccine decision-making process was rapid and dynamic, including an initial reaction to the recommendation for HPV vaccine, discussion between parent and son, and the final vaccine decision. Provider input was weighed in instances of initial disagreement. Many boys felt that this was the first health care decision that they had been involved in. Dyads which reported shared decision-making were more likely to openly communicate about sexual issues than those that agreed the son made the decision. CONCLUSION: Parents and sons play an active role in the decision-making process, with an individual's role being influenced by many factors. The results of this study may be used to guide the messages presented by clinicians when recommending the HPV vaccine, and future vaccine uptake interventions.


Assuntos
Atitude Frente a Saúde , Tomada de Decisões , Vacinas contra Papillomavirus , Relações Pais-Filho , Vacinação/psicologia , Adolescente , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
9.
Res Pract Thromb Haemost ; 6(4): e12732, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35765669

RESUMO

Background: The Pulmonary Embolism Quality of Life questionnaire (PEmb-QoL) assesses quality of life (QoL) in patients with previous pulmonary embolism (PE). Objective: Our aim was to assess the agreement between the PEmb-QoL and interviews and to explore other QoL concerns in patients diagnosed with PE. Methods: This mixed-method study included interviews with 21 patients about QoL after PE, followed by the PEmb-QoL questionnaire. In interviews, patients were asked about their lived experiences and impact of PE. Our analysis identified the frequency and severity of decreased QoL in qualitative interviews and compared with the PEmb-QoL score. Excerpts that described the effect of PE on QoL in interview transcripts were transcoded to match the answers corresponding to the 1 to 6 numeric values for each question from the PEmb-QoL using a predetermined matrix (eg, "constant" and "daily" = all of the time = value 1) and directly compared with responses on the PEmb-QoL in the areas of emotional complaints and activities of daily living/social limitations. Results: Interviews showed more functional impairment than predicted by PEmb-QoL. For fear of recurrence, 86% of participants had disagreements between PEmb-QoL scores and transcoded interview scores. We found 42% disagreement between reported descriptions of the inability to do or enjoy hobbies in interviews and the PEmb-QoL score. Conclusion: Patient interviews showed discordances compared with a validated psychometric tool. To capture a more detailed and accurate picture of the effect of PE on QoL, providers and researchers should consider the addition of qualitative methods to assess outcomes.

10.
Res Pract Thromb Haemost ; 6(1): e12647, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35071970

RESUMO

BACKGROUND: Establishing trust and effective communication can be challenging in the emergency department, where a prior relationship between patient and provider is lacking and decisions have to be made rapidly. Venous thromboembolism (VTE) represents an emergent condition that requires immediate decision making. OBJECTIVE: The aim of this paper was to document the experiences, perceptions, and the overall impact of health care provider communication on patients during the diagnosis of VTE in the emergency department. METHODS: This was a qualitative method study using semistructured interviews to increase understanding of the patient experience during the diagnosis of VTE and impact of the health care provider communication on subsequent patient perceptions. RESULTS: A total of 24 interviews were conducted. Content analysis revealed that certain aspects of health care providers' communication-namely, word choice, incomplete information, imbalance between fear over reassurance and nonverbal behavior-used to deliver and explain VTE diagnosis, treatment, and prognosis increases patients' fears. CONCLUSION: These interviews elucidate areas for improvement of communication in the emergency care setting for acute VTE.

11.
PLoS One ; 17(2): e0264539, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35213646

RESUMO

In many systems, patients with large vessel occlusion (LVO) strokes experience delays in transport to thrombectomy-capable centers. This pilot study examined use of a novel emergency medical services (EMS) protocol to expedite transfer of patients with LVOs to a comprehensive stroke center (CSC). From October 1, 2020 to February 22, 2021, Indianapolis EMS piloted a protocol, in which paramedics, after transporting a patient with a possible stroke remained at the patient's bedside until released by the emergency department or neurology physician. In patients with possible LVO, EMS providers remained at the bedside until the clinical assessment and CT angiography (CTA) were complete. If indicated, the paramedics at bedside transferred the patient, via the same ambulance, to a nearby thrombectomy-capable CSC with which an automatic transfer agreement had been arranged. This five-month mixed methods study included case-control assessment of use of the protocol, number of transfers, safety during transport, and time saved in transfer compared to emergent transfers via conventional interfacility transfer agencies. In qualitative analysis EMS providers, and ED physicians and neurologists at both sending and receiving institutions, completed e-mail surveys on the process, and offered suggestions for process improvement. Responses were coded with an inductive content analysis approach. The protocol was used 42 times during the study period; four patients were found to have LVOs and were transferred to the CSC. There were no adverse events. Median time from decision-to-transfer to arrival at the CSC was 27.5 minutes (IQR 24.5-29.0), compared to 314.5 minutes (IQR 204.0-459.3) for acute non-stroke transfers during the same period. Major themes of provider impressions included: incomplete awareness of the protocol, smooth process, challenges when a stroke alert was activated after EMS left the hospital, greater involvement of EMS in patient care, and comments on communication and efficiency. This pilot study demonstrated the feasibility, safety, and efficiency of a novel approach to expedite endovascular therapy for patients with LVOs.


Assuntos
Protocolos Clínicos , Serviços Médicos de Emergência , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento , Idoso , Arteriopatias Oclusivas/terapia , Angiografia por Tomografia Computadorizada , Serviços Médicos de Emergência/métodos , Feminino , Humanos , AVC Isquêmico/terapia , Masculino , Pessoa de Meia-Idade , Neurologistas/psicologia , Transferência de Pacientes , Médicos/psicologia , Projetos Piloto , Inquéritos e Questionários
12.
Res Pract Thromb Haemost ; 5(6): e12593, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34532630

RESUMO

INTRODUCTION: Qualitative research has been increasingly used in health care research to allow in-depth insights and understanding of patients' lived experiences for poorly understood phenomena. The psychological stress mechanisms underlying fear, dyspnea, and pain after venous thromboembolism (VTE) remain poorly understood. However, novice VTE researchers may not be familiar with the process of undertaking qualitative research. OBJECTIVE: The aim of this article is to describe the planning, methodology and execution of qualitative methods, using the example of patients' lived experiences during and after the diagnosis of VTE. We discuss challenges and solutions in implementing qualitative research methods in health care research. METHODS: Patients were recruited from the emergency department and clinic using in-person and phone contact. We used both in-person and video format to interview 24 patients. Interviews were guided by a set of questions to be explored but conducted to elucidate unique thoughts and opinions from patients. RESULTS: For recruitment, "cold-calling" was found to be largely unsuccessful. Many patients have preexisting diagnoses of anxiety and depression. Video interviews were found to be at least as effective as in-person interviews. Interviews revealed unique post-VTE experiences from all participants, with a wide range of impact on quality of life. Themes that were most common included perceptions of physician communication, fear of recurrence, and concerns of death. CONCLUSION: A qualitative research approach can reveal individual experiences and psychosocial impact in patients diagnosed with VTE, which allow the researchers to better comprehend the complexity of this phenomenon and its impact in health care.

13.
West J Emerg Med ; 22(3): 769-774, 2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34125059

RESUMO

INTRODUCTION: Unintended pregnancy disproportionately affects marginalized populations and has significant negative health and financial impacts on women, their families, and society. The emergency department (ED) is a promising alternative setting to increase access to sexual and reproductive health (SRH) services including contraception, especially among marginalized populations. The primary objective of this study was to determine the extent to which adult women of childbearing age who present to the ED would be receptive to receiving contraception and/or information about contraception in the ED. As a secondary objective, we sought to identify the barriers faced in attempting to obtain SRH care in the past. METHODS: We conducted a quantitative, cross-sectional, assisted, in-person survey of women aged 18-50 in the ED setting at two large, urban, academic EDs between June 2018-September 2019. The survey was approved by the institutional review board. Survey items included demographics, interest in contraception initiation and/or receiving information about contraception in the ED, desire to conceive, prior SRH care utilization, and barriers to SRH. RESULTS: A total of 505 patients participated in the survey. Participants were predominantly single and Black, with a mean age of 31 years, and reporting not wanting to become pregnant in the next year. Of those participants, 55.2% (n = 279) stated they would be interested in receiving information about birth control AND receiving birth control in the ED if it were available. Of those who reported the ability to get pregnant, and not desiring pregnancy in the next year (n = 279, 55.2%), 32.6% were not currently using anything to prevent pregnancy (n = 91). Only 10.5% of participants stated they had experienced barriers to SRH care in the past (n = 53). Participants who experienced barriers to SRH reported higher interest in receiving information and birth control in the ED (74%, n = 39) compared to those who had not experienced barriers (53%, n = 240); (P = 0.004, 95% confidence interval, 1.30-4.66). CONCLUSION: The majority of women of childbearing age indicated the desire to access contraception services in the ED setting. This finding suggests favorable patient acceptability for an implementation study of contraception services in emergency care.


Assuntos
Anticoncepção/psicologia , Anticoncepcionais/administração & dosagem , Serviço Hospitalar de Emergência/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Gravidez não Planejada , Saúde Reprodutiva/educação , Inquéritos e Questionários , Adulto Jovem
14.
Clin Toxicol (Phila) ; 57(3): 175-180, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30585509

RESUMO

INTRODUCTION: Loperamide is a readily accessible nonprescription medication that is increasingly being used surreptitiously as an opioid substitute to alleviate the symptoms of acute opioid withdrawal. The objective of this study was to determine the clinical characteristics of patients with loperamide misuse and toxicity. METHODS: The ToxIC registry, a nationwide, prospectively collected cohort of patients evaluated by medical toxicologists was searched from November 2011-December 2016 for patients with loperamide exposure. Each record was reviewed to determine the circumstances, dose, clinical presentations, treatment, and outcomes associated with loperamide use. RESULTS: Twenty-six cases were identified, and both the absolute number and relative proportion of overall cases in the ToxIC registry increased annually. The median age was 27 and 54% were male. Of cases with known intent (n = 18), 12(67%) were misuse/abuse, 3(17%) were self-harm/suicide, and 3(17%) were pediatric exploratory ingestions. Circumstances for misuse included taking higher doses than labeled (n =7), avoiding withdrawal (n = 6), and gaining a pleasurable sensation (n =4). The dose was reported in nine cases and ranged from 4 mg to 400 mg. In patients seeking to avoid withdrawal doses were 160-400 mg/day; the most common reported dose was 200 mg. Reported ECG abnormalities included 10 cases of prolonged QTc (>500 ms), which consisted of misuse/abuse (n =6) and self-harm (n =1) exposures; six prolonged QRS (>120 ms); two first degree AV block; seven ventricular dysrhythmias, five of which were single-agent exposures. All but one ECG demonstrated prolonged QTc with a range of 566-749 ms. All patients with dysrhythmias in which dose were reported ingested ≥200 mg. CONCLUSIONS: The majority of patients had loperamide toxicity due to misuse/abuse, in-line with national trends. In patients avoiding withdrawal, doses >100 mg were observed. When taken in large doses (>200 mg), loperamide may cause significant cardiovascular effects, including QTc-prolongation and ventricular dysrhythmias.


Assuntos
Antidiarreicos/efeitos adversos , Loperamida/efeitos adversos , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antidiarreicos/administração & dosagem , Antidiarreicos/uso terapêutico , Arritmias Cardíacas/induzido quimicamente , Bloqueio Atrioventricular/induzido quimicamente , Criança , Pré-Escolar , Estudos de Coortes , Eletrocardiografia , Feminino , Humanos , Síndrome do QT Longo/induzido quimicamente , Loperamida/administração & dosagem , Loperamida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
15.
MedEdPORTAL ; 15: 10828, 2019 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-31259237

RESUMO

Introduction: The Institute of Medicine's 2011 report on lesbian, gay, bisexual, and transgender (LGBT) health and the legalization of same-sex marriage are just two of the numerous milestones that have hastened medical schools' efforts to prepare trainees to address the needs of LGBT community members. Early awareness of sexual diversity through self- and peer introspection and video-based education can help trainees build a foundation towards providing affirming care to LGBT patients. Methods: The Kern model was used to develop, implement, and evaluate an interactive multimodal workshop to provide first-year medical students with a formative introduction to LGBT health. Learning objectives focused on comprehending the spectrum of human sexuality, health issues for LGBT patients, and better practices for promoting affirming care. The module consisted of a PowerPoint presentation, sexuality survey, videos of provider-patient encounters, and community-based resources. Results: The workshop was implemented among 178 first-year medical students in September 2018, with 93% completing the pre-/postworkshop evaluations. Comparison of evaluations showed an increase in confidence in addressing each of the three learning objectives. Over 85% rated the PowerPoint and videos as very good or excellent. Discussion: This workshop was effective in helping first-year medical students appreciate the spectrum of sexual diversity, health issues facing LGBT individuals, and better practices to promote affirming care. The real-time sexuality survey helped trainees appreciate sexual diversity through self-reflection and near-peer sharing. The videos and accompanying discussion provided real-life encounters, along with common pitfalls in and pearls for communicating with LGBT patients.


Assuntos
Conscientização , Minorias Sexuais e de Gênero , Sexualidade/psicologia , Estudantes de Medicina/psicologia , Humanos , Faculdades de Medicina , Inquéritos e Questionários , Estados Unidos
16.
Vaccine ; 33(33): 4081-6, 2015 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-26143612

RESUMO

INTRODUCTION: In the U.S., HPV vaccination of adolescent males remains low, despite the recommendation for routine vaccination. Although research has highlighted that health care provider (HCP) recommendation is very influential in HPV vaccine uptake, research on this topic in the male population is lacking. Accordingly, we used a qualitative approach to identify HCP knowledge, attitudes, and behaviors regarding adolescent male HPV vaccination, one year, after routine vaccination of adolescent males was recommended. METHOD: A total of 20 U.S. pediatric HCPs participated in 20-30 min interviews about knowledge, attitudes, and practices regarding male HPV vaccination. Interviews were audio-recorded, transcribed and, analyzed using inductive content analysis. RESULTS: The providers had been in practice for 1-35 years, 75% were female, and 75% were White. Opinions on HPV vaccination were shaped by knowledge/perception of the risks and benefits of vaccination. Although all providers frequently offered HPV vaccine to male patients, the strength and content of the offer varied greatly. Vaccination opinions determined what issues were emphasized in the vaccine offer (e.g., stressing herd immunity, discussing prevention of genital warts), while adolescent age influenced if and how they pitched their vaccine offer (e.g., HPV as a STI). Most providers agreed with the ACIP recommendations, however, several expressed that providers' preexisting opinions might remain unchanged despite the recommendations. Consistent with the literature on determinants of HPV vaccination, providers believed that their own recommendation was a major factor in a family's decision to vaccinate. Barriers to vaccination included the "newness" and sexual nature of the vaccine, lack of insurance coverage, and the vaccine not being mandated. CONCLUSIONS: Providers' opinions about, and approaches to offering, HPV vaccination to males were highly variable. Interventions designed to improve male HPV vaccination should focus on helping providers to routinely recommend the vaccine to all of their eligible patients, both males and females.


Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Adolescente , Criança , Humanos , Entrevistas como Assunto , Masculino , Estados Unidos
17.
Vaccine ; 33(11): 1331-7, 2015 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-25645175

RESUMO

PURPOSE: The purpose of this study was to examine the process of adolescent decision-making about participation in an HIV vaccine clinical trial, comparing it to adult models of informed consent with attention to developmental differences. METHODS: As part of a larger study of preventive misconception in adolescent HIV vaccine trials, we interviewed 33 male and female 16-19-year-olds who have sex with men. Participants underwent a simulated HIV vaccine trial consent process, and then completed a semistructured interview about their decision making process when deciding whether or not to enroll in and HIV vaccine trial. An ethnographic content analysis approach was utilized. RESULTS: Twelve concepts related to adolescents' decision-making about participation in an HIV vaccine trial were identified and mapped onto Appelbaum and Grisso's four components of decision making capacity including understanding of vaccines and how they work, the purpose of the study, trial procedures, and perceived trial risks and benefits, an appreciation of their own situation, the discussion and weighing of risks and benefits, discussing the need to consult with others about participation, motivations for participation, and their choice to participate. CONCLUSION: The results of this study suggest that most adolescents at high risk for HIV demonstrate the key abilities needed to make meaningful decisions about HIV vaccine clinical trial participation.


Assuntos
Vacinas contra a AIDS , Ensaios Clínicos como Assunto , Tomada de Decisões , Participação do Paciente , Adolescente , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Consentimento Livre e Esclarecido , Masculino , Motivação , Sujeitos da Pesquisa , Comportamento Sexual/estatística & dados numéricos , Adulto Jovem
19.
Pediatr Neurol ; 51(1): 67-70, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24814056

RESUMO

BACKGROUND: Synthetic cathinones or "bath salts" are an increasing problem in the United States. Their adverse effects are related to sympathomimetic toxicity and seizures have been listed among the side effects. This study details the seizures that occur after synthetic cathinone exposure in the pediatric population. METHODS: We used the American Association of Poison Control Centers database to capture all known synthetic cathinone exposures in children <20 years of age from January 1, 2010 through January 31, 2013. Demographic data along with signs of fever, acidosis, hallucinations and/or delusions, hypertension, tachycardia, electrolyte abnormalities, and coingested substances were collected for all synthetic cathinone users and compared with those users who experienced seizure activity. RESULTS: Over the specified time period, there were 1328 pediatric synthetic cathinone exposures. Seizures complicated 73 (5.5%) of the cases, with 37 (50.7%) of those cases experiencing a single seizure, 29 (39.7%) multiple seizures, and seven (9.6%) status epilepticus. Fever and acidosis were associated with single seizures, multiple seizures, and status epilepticus. There was no correlation found between any seizure activity and electrolyte abnormalities, hallucinations and/or delusions, tachycardia, or hypertension. Coingestants were present in 33 (45%) of the seizure cases. The most commonly coingested substances were tetrahydrocannabinol, alcohol, and opioids. CONCLUSIONS: Seizures complicated 5.5% of synthetic cathinone exposures in the pediatric population. Fever and acidosis were associated with seizure activity. The presence of fever after a synthetic cathinone exposure may warrant more aggressive monitoring and treatment.


Assuntos
Alcaloides/intoxicação , Estimulantes do Sistema Nervoso Central/intoxicação , Convulsões/induzido quimicamente , Convulsões/epidemiologia , Acidose/induzido quimicamente , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Delusões/induzido quimicamente , Exposição Ambiental , Febre/induzido quimicamente , Humanos , Centros de Controle de Intoxicações/estatística & dados numéricos , Estados Unidos , Adulto Jovem
20.
Health Psychol ; 33(5): 448-56, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24588632

RESUMO

OBJECTIVE: The purpose of this article was to identify the information parents and their adolescent sons deem important when making the decision to get vaccinated against human papillomavirus (HPV). METHOD: Twenty-one adolescent males (ages 13 to 17), with no previous HPV vaccination, and their parents were recruited from adolescent primary care clinics serving low- to middle-income families in a large Midwestern city. Dyad members participated in separate semistructured interviews eliciting the information participants felt would increase vaccine uptake and series completion via media and clinic-based sources. Interviews were recorded, transcribed, and coded using inductive content analysis. RESULTS: Overall, participants felt fear-based messages would be most effective for increasing vaccination uptake through commercials. When describing clinic messages, parents and sons felt the most important component was a recommendation for vaccination from the health care provider (HCP). Additionally, parents desired more information about the vaccine from the HCP than the sons, including cost, number of shots, and time since the approval of the vaccine for males. Compared with the clinic message, the commercial message was a vector for vaccine awareness, whereas the clinic message was a source of vaccine information. Vaccine initiation messages should provide vaccine information and come from an HCP, whereas completion messages should remind the patient why they initiated the vaccine and can come from any medical staff. CONCLUSIONS: Family/individual-focused interventions should be tailored to message source, timing, and target audience. This information can be used to guide public health professionals in the development of interventions to increase vaccine uptake.


Assuntos
Atitude Frente a Saúde , Vacinas contra Papillomavirus/administração & dosagem , Pais/psicologia , Comunicação Persuasiva , Vacinação/psicologia , Adolescente , Adulto , Informação de Saúde ao Consumidor , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Relações Médico-Paciente , Pesquisa Qualitativa
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