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DeMartino J, Katsuki MY, Ansbro MR. Diversity, Equity, and Inclusion: Obstetrics and Gynecologist Hospitalists' Impact on Maternal Mortality. Obstet Gynecol Clin North Am 2024; 51:539-558. [PMID: 39098780 DOI: 10.1016/j.ogc.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Obstetrics and gynecology hospitalists play a vital role in reducing maternal morbidity and mortality by providing immediate access to obstetric care, especially in emergencies. Their presence in hospitals ensures timely interventions and expert management, contributing to better outcomes for mothers and babies. This proactive approach can extend beyond hospital walls through education, advocacy, and community outreach initiatives aimed at improving maternal health across diverse settings.
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Affiliation(s)
- Julianne DeMartino
- University Hospitals MacDonald Women's Hospital, 2101 Adelbert Road, Cleveland, OH 44106, USA.
| | - Monique Yoder Katsuki
- Cleveland Clinic Foundation, Obstetric and Gynecologic Institute, 9500 Euclid Avenue/A81, Cleveland, OH 44195, USA
| | - Megan R Ansbro
- Cleveland Clinic Foundation, Obstetric and Gynecologic Institute, 9500 Euclid Avenue/A81, Cleveland, OH 44195, USA
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Kaufman JS, Yonkers KA, Maltz C, Friedhoff CM, Londoño Tobon A, Mele A, Tessier-Kay M, Grechukhina O, Lipkind H, Byatt N, Forray A. Reporting Perinatal Substance Use to Child Protective Services: Obstetric Provider Perspectives on the Impact on Care. J Womens Health (Larchmt) 2024. [PMID: 38770764 DOI: 10.1089/jwh.2023.0822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Objective: To understand obstetric provider perspectives on child protective services (CPS)-mandated reporting requirements and how they affect care for pregnant and postpartum patients with opioid use disorder (OUD). Methods: Key informant interviews were conducted virtually with obstetricians, nurse practitioners, and social workers caring for obstetric patients (n = 12). Providers were asked about their experience as mandated reporters working with patients with OUD. Transcripts were independently coded by two staff, and content analysis was used to identify themes. Results: Our analysis resulted in six thematic areas, including CPS-mandated strengths, concerns related to CPS reporting requirements, implementation of mandates, supporting patients after CPS report, communication between stakeholders, and the impact on care. Providers noted that the fear of CPS involvement causes some patients to delay or not engage in care. Other patients are hesitant to accept medications for OUD for fear of CPS involvement. The inconsistencies in how reporting mandates are applied and how CPS handles cases make communication about the policies challenging for providers and create anxiety for patients. Conclusions: The results of this study indicate that mandated reporting requirements and the potential for CPS involvement are perceived to have minimal positive effects on perinatal individuals with OUD and may negatively affect patients and their care. Clinicaltrials.gov number: NCT04240392.
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Affiliation(s)
- Joy S Kaufman
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly A Yonkers
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Caro Maltz
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carolyn M Friedhoff
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Amalia Londoño Tobon
- Department of Psychiatry, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Amanda Mele
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Olga Grechukhina
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Heather Lipkind
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Gero A, Elliott S, Baayd J, Cohen S, Simmons RG, Gawron LM. Factors associated with a negative Patient Acceptable Symptom State (PASS) response with intrauterine device placement: A retrospective survey of HER Salt Lake participants. Contraception 2024; 133:110385. [PMID: 38307487 DOI: 10.1016/j.contraception.2024.110385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES In an established cohort of HER Salt Lake Contraceptive Initiative participants with a prior intrauterine device (IUD) placement, we sought to (1) define the proportion of participants who reported a negative Patient Acceptable Symptom State (PASS) response, (2) explore factors associated with an unacceptable PASS response, and (3) identify pain management preferences for IUD placement. STUDY DESIGN A retrospective survey was sent to 1440 HER Salt Lake IUD users. A PASS question queried IUD placement pain experience acceptability. We explored associations between an unacceptable PASS response and sociodemographic, reproductive and other individual characteristics using t-tests, chi-square tests, and multivariable logistic regression. RESULTS Of those surveyed, 620 responded (43%), and 41.6% reported an unacceptable PASS response. Those with an unacceptable PASS response reported a significantly higher experienced pain level (79.2 mm vs 51.8 mm; p < 0.01) than those with an acceptable response, were more likely to have an anxiety diagnosis (47.7% vs 37.1%; p < 0.01), and have a trauma history (33.7% vs 25.1%; p = 0.02). Most patients were not offered pain control options, but 29.4% used ibuprofen and 25.3% had a support person. Regardless of PASS response, if offered, 59.0% desired numbing medication, 56.8% ibuprofen, 51% heating pad, 33.2% support person, and 31.8% anti-anxiety medication, among others. In our multivariable logistic regression model, higher pain was associated with unacceptable PASS response (OR 1.07, 95% CI 1.05-1.08; p < 0.01). CONCLUSIONS The common finding of unacceptable pain experiences with IUD placement may cause negative perceptions of an otherwise desirable method. Incorporation of the PASS response into IUD pain management studies could expand our pain experience understanding. IMPLICATIONS IUD placement resulted in unacceptable pain experiences for 41.6% of respondents. Screening for anxiety and trauma history could identify at-risk patients to individualize pain management strategies. Incorporation of the PASS into future IUD pain management studies could result in a more comprehensive, patient-centered measure of patient experiences.
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Affiliation(s)
- Alexandra Gero
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Sarah Elliott
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jami Baayd
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Susanna Cohen
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Rebecca G Simmons
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Lori M Gawron
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States.
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Klie KA, Nagle-Yang S, Zhao L, Fringuello ME. Integrated Care for Pregnant and Parenting People With Substance Use. Clin Obstet Gynecol 2024; 67:200-221. [PMID: 38095083 DOI: 10.1097/grf.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Caring for pregnant people with substance use requires knowledge about specific substances used, treatment options, and an integrated, trauma-informed care team. This chapter will discuss crucial information for clinicians regarding evidence-based practice for screening, intervention, and ongoing support for pregnant people and their families impacted by substance use.
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Affiliation(s)
| | | | - Lulu Zhao
- Departments of Obstetrics and Gynecology and Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Melanie E Fringuello
- Department of Obstetrics and Gynecology, Division of Academic Specialists, University of Colorado School of Medicine, Aurora, Colorado
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Gopalan P, Spada ML, Shenai N, Kratzer I, Nichols N, Kucherer S, Chou S, Hovis E, Beck S, Glance J. An Overview for the General Psychiatrist Evaluating Patients With Obstetric and Neonatal Complications and Perinatal Loss. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:35-43. [PMID: 38694157 PMCID: PMC11058915 DOI: 10.1176/appi.focus.20230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
When neonatal and obstetrical complications occur, the identification and management of mood and anxiety disorders become complex with an ever-expanding array of psychiatric needs that include the management of grief- and trauma-related disorders. With high rates of maternal morbidity and mortality in the United States and laws in many states restricting reproductive health access, psychiatrists must be proficient in managing psychiatric sequelae in this context. High-risk groups for peripartum mood and anxiety disorders, posttraumatic stress disorder, and complicated grief include those with neonatal intensive care unit (NICU) stays and those who have experienced infertility and recurrent pregnancy loss. Groups who have been historically marginalized by the medical system (e.g., Black, Indigenous, people of color) and those from LGBTQ+ communities are at similarly high risk, and more interventions are needed to support these groups. Strategies emphasizing trauma-informed care, psychotherapeutic approaches, and using patient-centered language are recommended.
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Affiliation(s)
- Priya Gopalan
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Meredith L Spada
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Neeta Shenai
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Isabella Kratzer
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Nona Nichols
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Shelly Kucherer
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Shinnyi Chou
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Elizabeth Hovis
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Stacy Beck
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Jody Glance
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
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6
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Isobel S. Trauma and the perinatal period: A review of the theory and practice of trauma-sensitive interactions for nurses and midwives. Nurs Open 2023; 10:7585-7595. [PMID: 37775971 PMCID: PMC10643851 DOI: 10.1002/nop2.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/30/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023] Open
Abstract
AIM With high rates of trauma in the population, known links between trauma and perinatal distress, and the intimate and close nature of the nursing and midwifery roles, ensuring awareness and understandings of trauma is crucial for guiding practice. This paper aims to explore the relationship of trauma to the perinatal period, based on theory and practice, to consider on how nurses and midwives can deliver trauma-sensitive interactions. DESIGN AND METHODS This discursive discussion draws on relevant research from the fields of trauma therapy, attachment theory and nursing and midwifery practice to consider elements of trauma-sensitive practice in the perinatal period. RESULTS Nurses and midwives can foster safety for people who have experienced trauma through noticing and responding to triggers, supporting awareness of attachment and its relationships to trauma, undertaking psychosocial screening with care, supporting linearity and cohesion in narratives and developing collaborative care plans that maximise safety and agency. For nurses and midwives, understandings of the relationship between trauma, pregnancy, birth, early parenting and distress is crucial for effective care delivery. Delivering perinatal nursing or midwifery care of any kind, without universal trauma precautions risks reinforcing, misinterpreting or re-enacting dynamics of trauma. To be trauma-sensitive in this period requires nurses and midwives to have awareness of the dynamics of trauma in relation to pregnancy, birth and attachment. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This paper fills a gap in the translation of theory to practice for trauma-sensitive care in the perinatal period, with a focus on the therapeutic relationship formed by nurses and midwives. The findings highlight that nurses and midwives can foster safety for people who have experienced trauma within their practice, when they hold a robust understanding of the relationship between trauma, pregnancy, birth, early parenting and distress. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Sophie Isobel
- University of SydneySydneyNew South WalesAustralia
- Perinatal Mental Health, Sydney Local Health DistrictSydneyNew South WalesAustralia
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7
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Goldstein KM, Patel DB, Van Loon KA, Shapiro A, Rushton S, Lewinski AA, Lanford TJ, Cantrell S, Zullig LL, Wilson SM, Shepherd-Banigan M, Alton Dailey S, Sims C, Robinson C, Chawla N, Bosworth HB, Hamilton A, Naylor J, Gierisch JM. Optimizing the Equitable Deployment of Virtual Care for Women: Protocol for a Qualitative Evidence Synthesis Examining Patient and Provider Perspectives Supplemented with Primary Qualitative Data. Health Equity 2023; 7:570-580. [PMID: 37731781 PMCID: PMC10507937 DOI: 10.1089/heq.2023.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Women experience numerous barriers to patient-centered health care (e.g., lack of continuity). Such barriers are amplified for women from marginalized communities. Virtual care may improve equitable access. We are conducting a partner-engaged, qualitative evidence synthesis (QES) of patients' and providers' experiences with virtual health care delivery for women. Methods We use a best-fit framework approach informed by the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework and Public Health Critical Race Praxis. We will supplement published literature with qualitative interviews with women from underrepresented communities and their health care providers. We will engage patients and other contributors through multiple participatory methods. Results Our search identified 5525 articles published from 2010 to 2022. Sixty were eligible, of which 42 focused on women and 24 on provider experiences. Data abstraction and analysis are ongoing. Discussion This work offers four key innovations to advance health equity: (1) conceptual foundation rooted in an antiracist action-oriented praxis; (2) worked example of centering QES on marginalized communities; (3) supplementing QES with primary qualitative information with populations historically marginalized in the health care system; and (4) participatory approaches that foster longitudinal partnered engagement. Health Equity Implications Our approach to exploring virtual health care for women demonstrates an antiracist praxis to inform knowledge generation. In doing so, we aim to generate findings that can guide health care systems in the equitable deployment of comprehensive virtual care for women.
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Affiliation(s)
- Karen M. Goldstein
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Dhara B. Patel
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
| | - Katherine A. Van Loon
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
| | - Abigail Shapiro
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
| | - Sharron Rushton
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Allison A. Lewinski
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Tiera J. Lanford
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
| | - Sarah Cantrell
- School of Medicine, Duke University Medical Center Library, Durham, North Carolina, USA
| | - Leah L. Zullig
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Sarah M. Wilson
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Megan Shepherd-Banigan
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Margolis Center for Health Policy, Durham, North Carolina, USA
- VA VISN-6 Mid-Atlantic Mental Illness Research and Education Clinical Center, Durham, North Carolina, USA
| | - Susan Alton Dailey
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
| | - Catherine Sims
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Department of Medicine, Division of Rheumatology, Duke University, Durham, North Carolina, USA
| | - Cheryl Robinson
- Clinical Translational Sciences Institute, School of Medicine, Duke University, Durham, North Carolina, USA
- Veteran Research Engagement Panel, VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Neetu Chawla
- VA Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, California, USA
| | - Hayden B. Bosworth
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Alison Hamilton
- VA Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Jennifer Naylor
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
- VA VISN-6 Mid-Atlantic Mental Illness Research and Education Clinical Center, Durham, North Carolina, USA
| | - Jennifer M. Gierisch
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
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8
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Jagielski CH, Naftaly JP, Riehl ME. Providing Trauma Informed Care During Anorectal Evaluation. Curr Gastroenterol Rep 2023; 25:204-211. [PMID: 37470940 DOI: 10.1007/s11894-023-00879-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE OF REVIEW Patients with a history of gastrointestinal (GI) conditions report high rates of psychological trauma. This review discusses the impact of previous trauma, as well as interactions with the medical system, on a patient's physical and mental health. Trauma-informed strategies for improving patient care during gastroenterology procedures are provided. RECENT FINDINGS History of trauma increases risk of developing GI conditions and re-traumatization during sensitive anorectal procedures (i.e., anorectal manometry, balloon expulsion testing). Trauma-informed strategies include consistent trauma screening for all patients, obtaining consent before and during procedures, creating a safe environment, allowing for privacy, and post-procedure debriefing. Due to high rates of psychological trauma in the gastroenterology setting and the risk of medical trauma from the GI procedures themselves, having an established trauma-informed plan of care for all patients can reduce risk of iatrogenic harm and improve quality of care for patients with GI conditions.
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Affiliation(s)
- Christina H Jagielski
- Division of Gastroenterology and Hepatology, University of Michigan/Michigan Medicine, 1500 E. Medical Center Drive, 3912 Taubman Center, SPC 5362, Ann Arbor, MI, 48109-5362, USA.
| | - Jessica P Naftaly
- Division of Gastroenterology and Hepatology, University of Michigan/Michigan Medicine, 1500 E. Medical Center Drive, 3912 Taubman Center, SPC 5362, Ann Arbor, MI, 48109-5362, USA
| | - Megan E Riehl
- Division of Gastroenterology and Hepatology, University of Michigan/Michigan Medicine, 1500 E. Medical Center Drive, 3912 Taubman Center, SPC 5362, Ann Arbor, MI, 48109-5362, USA
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