Remote Options for Medication Abortion: Improving Patient Care During and After the Covid-19 Crisis

The COVID-19 pandemic has shifted primary care and other practices towards remote care and telemedicine options to minimize viral exposure. Although in-person visits are sometimes indispensable, research shows that telemedicine can expand access to vital services without sacrificing patient-centered care. Medication abortion is an essential, time-sensitive service that is particularly well-suited to telemedicine provision, including in primary care settings. Decades of clinical research and practice guidelines from core medical societies affirm the safety and efficacy of providing medication abortion remotely. Neither FDA nor professional guidelines require sonography for medication abortion, and research shows that necessary clinical assessments can be achieved without ultrasound. New practice guidelines recommend against Rh testing for abortions under 8 weeks of pregnancy and rely on patient history for those provided from 8 to 11 weeks. As primary care providers, we can and should provide high-quality, low-risk abortion care for patients without point-of-care exams and labs. This discussion includes a detailed checklist for providing such remote-care medication abortion in a variety of settings. Such strategies will allow more clinicians to offer this essential care both during and after the Covid-19 crisis.https://deepblue.lib.umich.edu/bitstream/2027.42/155399/1/Stein main article.pd

In-Situ Thermal Image Correlation with Mechanical Properties of Nylon-12 in SLS

Selective laser sintering (SLS) of Nylon is a significant portion of the additive manufacturing market for structurally sensitive applications. Current methods of acceptance for such parts are based on the inclusion of ASTM tensile test specimens within the build volume to assess the overall build quality. Ultimate strength and elongation of these specimens oriented both in-plane and normal to the layer build direction are the primary quality metrics. This paper looks at a more complete method of certifying parts for acceptance based on examination of the build conditions in each layer of the part by comparing layer-by-layer thermal conditions during the part build to the resulting ASTM specimen tensile properties. Through such a comparison, a more complete three-dimensional assessment of part quality during the build process can be constructed. The layer-by-layer assessment used here is derived from infrared thermal imaging; mapping temperature profiles of SLS-built tensile bars with data collected before, during, and after each layer-wise laser melting sequence. Mechanical properties and fracture conditions are then quantified and correlated with the conditions where the fractures occur. Build conditions associated with poor failure conditions may then be used to assess poor SLS bonding throughout the part volume, improving overall part quality assessment and certification. As the method is matured, real time layer-by-layer assessment will be linked to SLS control, to correct for observed defects during the build and improve overall part quality and repeatability.Mechanical Engineerin

Beta2-adrenoceptor agonists for dysmenorrhoea

Background:Dysmenorrhoea is a common gynaecological complaint that can affect as many as 50% of premenopausal women, 10% of whom suffer severely enough to be rendered incapacitated for one to three days during each menstrual cycle. Primary dysmenorrhoea is where women suffer from menstrual pain but lack any pathology in their pelvic anatomy. Beta2-adrenoceptor agonists have been used in the treatment of women with primary dysmenorrhoea but their effects are unclear.Objectives:To determine the effectiveness and safety of beta2-adrenoceptor agonists in the treatment of primary dysmenorrhoea. Search methods: We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL (The Cochrane Library 2011, Issue 8), MEDLINE, EMBASE, PsycINFO and the EBM Reviews databases. The last search was on 22 August 2011.Selection criteriaRandomised controlled trials comparing beta2-adrenoceptor agonists with placebo or no treatment, each other or any other conventional treatment in women of reproductive age with primary dysmenorrhoea. Data collection and analysisTwo review authors independently assessed trial quality and extracted the data.Main results:Five trials involving 187 women with an age range of 15 to 40 years were included. Oral isoxsuprine was compared with placebo in two trials, terbutaline oral spray, ritodrine chloride and oral hydroxyphenyl-orciprenalin were compared with placebo in a further three trials. Clinical diversity in the studies in terms of the interventions being evaluated, assessments at different time points and the use of different assessment tools mitigated against pooling of outcome data across studies in order to provide a summary estimate of effect for any of the comparisons. Only one study, with unclear risk of bias, reported pain relief with a combination of isoxsuprine, acetaminophen and caffeine. None of the other studies reported any significant clinical difference in effectiveness between the intervention and placebo. Adverse effects were reported with all of these medications in up to a quarter of the total number of participants. They included nausea, vomiting, dizziness, quivering, tremor and palpitations.Authors\u27 conclusions:The evidence presented in this review was based on a few relatively small-sized studies that were categorised to have unclear to high risk of bias, which does not allow confident decision-making at present about the use of beta2-adrenoceptor agonists for dysmenorrhoea. The benefits as reported in one study should be balanced against the wide array of unacceptable side effects documented with this class of medication. We have emphasised the lack of precision and limitations in the reported data where appropriate

Medication to Manage Abortion and Miscarriage.

Abortion and miscarriage are common, affecting millions of US women each year. By age 45, one in four women in the USA will have had an abortion, and at least as many will have had a miscarriage. Most individuals seeking abortion services do so before 10 weeks gestation when medication abortions are a safe and effective option, using a regimen of oral mifepristone followed by misoprostol tablets. When a pregnancy is non-viable before 13 weeks gestation, it is referred to as an early pregnancy loss or miscarriage and can be managed using the same mifepristone and misoprostol regimen. Given their safety and efficacy, mifepristone and misoprostol can be offered in ambulatory settings without special equipment or on-site emergency services. As more patients find it difficult to access clinical care when faced with an undesired pregnancy or a miscarriage, it is important for general internists and primary care providers to become familiar with how to use medications to manage these common conditions. We summarize the most recent evidence regarding the use of mifepristone with misoprostol for early abortion and miscarriage. We discuss clinical considerations and resources for integrating mifepristone and misoprostol into clinical practice. By learning to prescribe mifepristone and misoprostol, clinicians can expand access to time-sensitive health services for vulnerable populations

The impact of the COVID-19 pandemic on economic security and pregnancy intentions among people at risk of pregnancy

ObjectiveTo understand how the COVID-19 pandemic affected women of reproductive age, specifically their economic conditions, desire for pregnancy, and access to contraceptive services during the pandemic.Study designsA total of 554 women respondents age 18 to 49 and reside in the United States were recruited using social media between May 16, 2020 and June 16, 2020. Logistic regression models assessed predictors of reporting pandemic-related changes in economic conditions, desire for pregnancy, and contraceptive access.ResultsCompared to White/Caucasian respondents, Hispanics/Latinx and Black/African Americans have 4 times the odds of experiencing inability to afford food, transportation, and/or housing (p < 0.01) during the pandemic; Hispanics/Latinx have twice the odds of experiencing food insecurity (p < 0.05). Inability to afford food, transportation, and/or housing was associated with drop in desire to be pregnant (p < 0.01). Despite the 25% of participants who reported a drop in desire for pregnancy, 1 in 6 reported difficulty accessing contraceptives, particularly those who experienced reduced income (p < 0.01).ConclusionsIn our sample, the pandemic unevenly affected people from different socioeconomic groups. Many simultaneously experienced reduced income, difficulties in accessing contraception, and a greater desire to avoid a pregnancy. This combination of factors increases the chance that people will experience unintended pregnancies.ImplicationsThe pandemic caused economic hardship and an increased desire to postpone or prevent pregnancy at the same time that it created new barriers to contraceptive services. This pattern may lead to a potential net effect of an increase in unintended pregnancy, particularly among people who had difficulty affording food, transportation, and/or housing during the pandemic