Introduction - Fact Patterns from Anonymous Closed Medical Liability Cases

Introduction to the anonymous closed medical liability cases. New York Law School\u27s Patient Safety Project was granted special permission by the New York State Office of Court Administration to obtain and make available these closes cases for the purpose of stimulating diligent conversations about the fact patterns so that the discussions can positively impact the safety processes and reduce the future incidence of patient injury.https://digitalcommons.nyls.edu/patient_safety_project/1000/thumbnail.jp

Introduction - Fact Patterns from Anonymous Closed Medical Liability Cases

Introduction to the anonymous closed medical liability cases. New York Law School\u27s Patient Safety Project was granted special permission by the New York State Office of Court Administration to obtain and make available these closes cases for the purpose of stimulating diligent conversations about the fact patterns so that the discussions can positively impact the safety processes and reduce the future incidence of patient injury.https://digitalcommons.nyls.edu/patient_safety_project/1000/thumbnail.jp

First-trimester 3-dimensional power Doppler of the uteroplacental circulation space: a potential screening method for preeclampsia

ObjectiveThe objective of the study was to compare 3-dimensional power Doppler (3DPD) of the uteroplacental circulation space (UPCS) in the first trimester between women who develop preeclampsia (PEC) and those who do not and to assess the 3DPD method as a screening tool for PEC.Study DesignThis was a prospective observational study of singleton pregnancies at 10 weeks 4 days to 13 weeks 6 days. The 3DPD indices, vascularization index (VI), flow index (FI), and vascularization flow index (VFI), were determined on a UPSC sphere biopsy with the virtual organ computer-aided analysis (VOCAL) program.ResultsOf 277 women enrolled, 24 developed PEC. The 3DPD indices were lower in women who developed PEC. The area under the receiver-operating characteristics curve for the prediction of PEC was 78.9%, 77.6%, and 79.6% for VI, FI, and VFI, respectively.ConclusionPatients who develop PEC have lower 3DPD indices of their UPCS during the first trimester. Our findings suggest that this ultrasonographic tool has the potential to predict the development of PEC

Effects of a one year reusable contraceptive vaginal ring on vaginal Microflora and the risk of vaginal infection: An open-label prospective evaluation

Background A contraceptive vaginal ring (CVR) containing Nestorone® (NES) and ethinyl estradiol (EE) that is reusable for 1-year (13 cycles) is under development. This study assessed effects of this investigational CVR on the incidence of vaginal infections and change in vaginal microflora. Methods There were 120 women enrolled into a NES/EE CVR Phase III trial and a microbiology substudy for up to 1-year of cyclic product use. Gynecological examinations were conducted at baseline, the first week of cycle 6 and last week of cycle 13 (or during early discontinuation visits). Vaginal swabs were obtained for wet mount microscopy, Gram stain and culture. The CVR was removed from the vagina at the last study visit and cultured. Semi-quantitative cultures for Lactobacillus, Gardnerella vaginalis, Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, anaerobic gram negative rods (GNRs), Candida albicans and other yeasts were performed on vaginal and CVR samples. Vaginal infections were documented throughout the study. Results Over 1-year of use, 3.3% of subjects were clinically diagnosed with bacterial vaginosis, 15.0% with vulvovaginal candidiasis, and 0.8% with trichomoniasis. The detection rate of these three infections did not change significantly from baseline to either Cycle 6 or 13. Nugent scores remained stable. H2O2-positive Lactobacillus dominated vaginal flora with a non-significant prevalence increase from 76.7%at baseline to 82.7% at cycle 6 and 90.2% at cycle 13, and a median concentration of 107 colony forming units (cfu) per gram. Although anaerobic GNRs prevalence increased significantly, the median concentration decreased slightly (104 to 103cfu per gram). There were no significant changes in frequency or concentrations of other pathogens. High levels of agreement between vaginal and ring surface microbiota were observed. Conclusion Sustained use of the NES/EE CVR did not increase the risk of vaginal infection and was not disruptive to the vaginal ecosystem

Gender differences in local and systemic reactions to inactivated influenza vaccine, established by a meta-analysis of fourteen independent studies

In order to determine whether there is a difference between genders in reported adverse reactions to inactivated influenza vaccine, a computerized database of serological studies was investigated. A standardized questionnaire was used to evaluate vaccine reactogenicity. A total of 1,800 vaccinees in 14 studies were analyzed separately for two age groups ( or = 60 years of age). Females reported significantly more local reactions than males. The pooled odds ratio for the outcome measure "any local reaction" was 0.32 (95% confidence interval, 0.26-0.40, significant) and 0.54 (95% Cl, 0.41-0.70, significant) for young and elderly adults, respectively. Similar results were obtained for the outcome measure "any systemic reaction." Previous exposure to influenza or influenza vaccine had no influence on reactogenicity. There were no gender differences in sero-responses. In conclusion, gender should be regarded as a predictor of reported reactions to influenza vaccine in both young and elderly adults and should be addressed in future study designs

Analysis of sex and gender-specific research reveals a common increase in publications and marked differences between disciplines

Oertelt-Prigione S, Parol R, Krohn S, Preißner R, Regitz-Zagrosek V. Analysis of sex and gender-specific research reveals a common increase in publications and marked differences between disciplines. BMC Medicine. 2010;8(1): 70.© 2010 Oertelt-Prigione et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

The ins and outs of drug-releasing vaginal rings: A literature review of expulsions and removals

Introduction: There is considerable interest in vaginal ring technology for sustained/controlled release of pharmaceutical drugs to the human vagina. Seven drug-releasing vaginal ring products have reached market and have many other experimental devices are in preclinical/clinical development. Although most women who have use vaginal rings are satisfied and find them acceptable, involuntary ring expulsions and voluntary ring removals are known to occur and are widely reported in the scientific literature. There have been no previous efforts to review the historical data and understand the contributing factors leading to expulsions. Areas covered: This article is intended to help researchers, clinicians and product developers understand the pertinent factors and issues around ring expulsions and removals, and to inform new research aimed at optimising the design of new ring products. The review contains four sections: (i) introduction to vaginal ring technology; (ii) a discussion of the anatomical, physiological, device, and user factors potentially affecting ring expulsion; (iii) a literature review around involuntary ring expulsions; (iv) a literature review around voluntary ring removals; and (v) concluding remarks and opinions. Expert opinion: Further research is needed to better understand the factors contributing to involuntary ring expulsions and removals so that rings can be designed from the outset to minimise rates of expulsion and to reduce removals. Determination of optimum ring dimensions and stiffness for each ring product are likely key factors, alongside better counselling around ring removal and reinsertion