Contraception for the HIV-Positive Woman: A Review of Interactions between Hormonal Contraception and Antiretroviral Therapy

Background. Preventing unintended pregnancy in HIV-positive women can significantly reduce maternal-to-child HIV transmission as well as improve the woman's overall health. Hormonal contraceptives are safe and effective means to avoid unintended pregnancy, but there is concern that coadministration of antiretroviral drugs may alter contraceptive efficacy. Materials and Methods. We performed a literature search of PubMed and Ovid databases of articles published between January 1980 and February 2012 to identify English-language reports of drug-drug interactions between hormonal contraceptives (HCs) and antiretroviral drugs (ARVs). We also reviewed the FDA prescribing information of contraceptive hormone preparations and antiretrovirals for additional data and recommendations. Results. Twenty peer-reviewed publications and 42 pharmaceutical package labels were reviewed. Several studies of combined oral contraceptive pills (COCs) identified decreased serum estrogen and progestin levels when coadministered with certain ARVs. The contraceptive efficacy of injectable depot medroxyprogesterone acetate (DMPA) and the levonorgestrel intrauterine system (LNG-IUS) were largely unaffected by ARVs, while data on the contraceptive patch, ring, and implant were lacking. Conclusions. HIV-positive women should be offered a full range of hormonal contraceptive options, with conscientious counseling about possible reduced efficacy of COCs and the contraceptive implant when taken with ARVs. DMPA and the LNG-IUS maintain their contraceptive efficacy when taken with ARVs

Bonytail (Gila elegans) may enhance survival of Razorback Suckers (Xyrauchen texanus) in rearing ponds by preying on exotic crayfish

This study examined the potential of bonytail (Gila elegans) to enhance survival of young razorback sucker (Xyrauchen texanus) in rearing ponds by serving as a biological control agent for young stages of Red Swamp Crayfish (Procambarus clarki). Large populations of crayfish in rearing ponds negatively affect the survival of razorback suckers, through predation and competition for food. Traps made with 6.34 mm (0.25 inch) mesh have been used in an effort to reduce crayfish populations, however crayfish less than 17 mm carapace length (CPL) are able to escape. Juvenile bonytail in experimental trials ate young crayfish ranging in size from 3 to 15 mm CPL. Crayfish consumption was not reduced in the presence of an alternative food source, but was reduced slightly by the presence of cover. These results suggest that juvenile bonytail may reduce numbers of crayfish smaller than 15 mm CPL in ponds used to rear razorback suckers. If so, integration of rearing programs for endangered razorback sucker and bonytail could have beneficial effects for both species

A Qualitative Assessment of Kansas Tracking and Reporting of Controlled Substances (K-TRACS)

Introduction. This study assessed the Kansas Tracking and Reporting of Controlled Substances system (K-TRACS), the online controlled prescription medication monitoring website in Kansas. The specific aims were to determine if and when pharmacists and physicians in Kansas were using K-TRACS and to identify any perceived benefits or barriers to using K-TRACS. Methods. A non-randomized, convenience sample of Kansas pharmacists and family physicians were interviewed face to face using a guided semi-structured questionnaire. NVivo 10 (QSR International Pty Ltd.) was used to analyze data. Results. Ten physicians and sixteen pharmacists were interviewed. All pharmacists and 70% of physicians were using K-TRACS. Usage was prompted by encounters with new patients or unease with the patient interaction. The perceived benefits included increased communication with the patient and all providers, increased provider comfort with treating chronic pain, and altered prescriber habits. Barriers to the use of K-TRACS were identified as login, password, and operating system problems. Conclusions. Among study participants, K-TRACS is used regularly, is perceived to be a benefit to providers, patients and communities, and has become a useful new tool in the treatment of chronic pain. K-TRACS is perceived to facilitate increased communication between providers and with patients

Impact of bariatric surgery on hypertensive disorders in pregnancy: retrospective analysis of insurance claims data

Objective To determine whether women who had a delivery after bariatric surgery have lower rates of hypertensive disorders in pregnancy compared with women who had a delivery before bariatric surgery

Rates of New Human Papillomavirus Detection and Loss of Detection in Middle-aged Women by Recent and Past Sexual Behavior.

BACKGROUND: Understanding the source of newly detected human papillomavirus (HPV) in middle-aged women is important to inform preventive strategies, such as screening and HPV vaccination. METHODS: We conducted a prospective cohort study in Baltimore, Maryland. Women aged 35-60 years underwent HPV testing and completed health and sexual behavior questionnaires every 6 months over a 2-year period. New detection/loss of detection rates were calculated and adjusted hazard ratios were used to identify risk factors for new detection. RESULTS: The new and loss of detection analyses included 731 women, and 104 positive for high-risk HPV. The rate of new high-risk HPV detection was 5.0 per 1000 woman-months. Reporting a new sex partner was associated with higher detection rates (adjusted hazard ratio, 8.1; 95% confidence interval, 3.5-18.6), but accounted only for 19.4% of all new detections. Among monogamous and sexually abstinent women, new detection was higher in women reporting ?5 lifetime sexual partners than in those reporting <5 (adjusted hazard ratio, 2.2; 95% confidence interval, 1.2-4.2). CONCLUSION: Although women remain at risk of HPV acquisition from new sex partners as they age, our results suggest that most new detections in middle-aged women reflect recurrence of previously acquired HPV

“What if There's Something Wrong with Her?”‐How Biomedical Technologies Contribute to Epistemic Injustice in Healthcare

While there is a steadily growing literature on epistemic injustice in healthcare, there are few discussions of the role that biomedical technologies play in harming patients in their capacity as knowers. Through an analysis of newborn and pediatric genetic and genomic sequencing technologies (GSTs), I argue that biomedical technologies can lead to epistemic injustice through two primary pathways: epistemic capture and value partitioning. I close by discussing the larger ethical and political context of critical analyses of GSTs and their broader implications for just and equitable healthcare delivery

Path to Success: Development of the Pharmacist Through the Continuum of Pharmacy School and Beyond

Objective: To explore the processes and opportunities provided in the co-curriculum of the Wegmans School of Pharmacy (WSoP) that contribute to the development of successful pharmacy graduates. Methods: Pharmacy career preparation begins at orientation with workshops on emotional intelligence, leadership, and the APhA Career Pathway Evaluation Program. During the P1 through P4 years, the optional Student Development Workshop Series (SDW) offers seminars for students on a variety of topics including time management, exam taking strategies/anxiety management, learning styles, personal “brand” creation, CV/portfolio development, and interview soft skills. All students may participate in the annual WSoP Career Day, which offers networking and career opportunities, including post-graduate training options. During the P4 year, there is opportunity for a structured Residency/Fellowship Preparation Program (RPP). Additionally, local pharmacy residents/fellows participate in a Residency Teaching/Learning Curriculum Program (TLC) to develop academic teaching and precepting skills. Results: The SDW program has been successful and well attended with greater than 90% of students finding the topics relevant to their post-graduate success. After the RPP, ASHP residency match results in the 2016 class yielded an improvement from previous years, with 76 % of applied students and 94% of ranked students matching programs in Phase 1. Of the TLC participants, 90% documented an improvement in multiple types of teaching skills. Implications: Based on data and student/faculty input, career development is reassessed and improved continuously at WSoP. In the near future, a method for tracking graduates will be designed to further monitor the impact of programs on student success

Stroke Ready: a multi-level program that combines implementation science and community-based participatory research approaches to increase acute stroke treatment: protocol for a stepped wedge trial

Abstract Background Post-stroke disability is common, costly, and projected to increase. Acute stroke treatments can substantially reduce post-stroke disability, but few patients take advantage of these cost-effective treatments. Practical, cost-efficient, and sustainable interventions to address underutilized acute stroke treatments are currently lacking. In this context, we present the Stroke Ready project, a stepped wedge design, multi-level intervention that combines implementation science and community-based participatory research approaches to increase acute stroke treatments in the predominately African American community of Flint, Michigan, USA. Methods Guided by the Tailored Implementation of Chronic Disease (TICD) framework, we begin with optimization of acute stroke care in emergency departments, with particular attention given to our safety-net hospital partners. Then, we move to a community-wide, multi-faceted, stroke preparedness intervention, with workshops led by peer educators, over 2 years. Measures of engagement of the safety-net hospital and the feasibility and sustainability of the implementation strategy as well as community intervention reach, dose delivered, and satisfaction will be collected. The primary outcome is acute stroke treatment rates, which includes both intravenous tissue plasminogen activator, and endovascular treatment. The co-secondary outcomes are intravenous tissue plasminogen activator treatment rates and the proportion of stroke patients who arrive by ambulance. Discussion If successful, Stroke Ready will increase acute stroke treatment rates through emergency department and community level interventions. The stepped wedge design and process evaluation will provide insight into how Stroke Ready works and where it might work best. By exploring the relative effectiveness of the emergency department optimization and the community intervention, we will inform hospitals and communities as they determine how best to use their resources to optimize acute stroke care. Trial registration ClinicalTrials.gov Trial Identifier NCT03645590 .https://deepblue.lib.umich.edu/bitstream/2027.42/148211/1/13012_2019_Article_869.pd

Cannabis use and risk of psychotic or aff ective mental health outcomes: a systematic review

Summary Background Whether cannabis can cause psychotic or aff ective symptoms that persist beyond transient intoxication is unclear. We systematically reviewed the evidence pertaining to cannabis use and occurrence of psychotic or aff ective mental health outcomes

Cannabis use and risk of psychotic or aff ective mental health outcomes: a systematic review

Summary Background Whether cannabis can cause psychotic or aff ective symptoms that persist beyond transient intoxication is unclear. We systematically reviewed the evidence pertaining to cannabis use and occurrence of psychotic or aff ective mental health outcomes