1
|
Trent M, Perin J, Rowell J, Shah M, Anders J, Matson P, Brotman RM, Ravel J, Sharps P, Rothman R, Yusuf HE, Gaydos CA. Using Innovation to Address Adolescent and Young Adult Health Disparities in Pelvic Inflammatory Disease: Design of the Technology Enhanced Community Health Precision Nursing (TECH-PN) Trial. J Infect Dis 2021; 224:S145-S151. [PMID: 34396402 DOI: 10.1093/infdis/jiab157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
New approaches to pelvic inflammatory disease (PID) care among adolescents and young adults (AYAs) that optimize self-care and personalize treatment are warranted to address age and racial-ethnic PID-related health disparities. Here we describe the 13-month preliminary feasibility and acceptability outcomes of recruitment, retention, and intervention delivery for Technology Enhanced Community Health Precision Nursing (TECH-PN) randomized controlled trial. Urban AYAs 13-25 years assigned female sex at birth with acute mild-moderate PID provided baseline and follow-up interview data and vaginal specimens for sexually transmitted infection (STI), cytokine, and microbiota assessment. All participants received medications and text-messaging support. Participants were block randomized to either control or intervention. Control participants received 1 community nursing visit with self-management for interim care per national guidelines. Intervention participants received unlimited precision care services driven by interim STI and macrolide resistance testing results by an advanced practice provider. In the first 13 months, 75.2% patients were eligible, and 76.1% of eligible patients enrolled. Of the participants, 94% completed the intervention and 96%, 91%, and 89%, respectively, completed their 14-, 30-, and 90-day visits. Baseline laboratory results revealed infection rates that were highest for Mycoplasma genitalium (45%) followed by Chlamydia trachomatis (31%). Preliminary enrollment, STI, intervention delivery, and retention data demonstrate the feasibility and acceptability of the TECH-PN intervention and support rationale for precision care for PID among urban AYAs. ClinicalTrials.gov Identifier. NCT03828994.
Collapse
Affiliation(s)
- Maria Trent
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jamie Perin
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julia Rowell
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maunank Shah
- Department of Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer Anders
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Pamela Matson
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rebecca M Brotman
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Phyllis Sharps
- Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Richard Rothman
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hasiya E Yusuf
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Charlotte A Gaydos
- Department of Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Gutman CK, Duda E, Newton N, Alevy R, Palmer K, Wetzel M, Figueroa J, Griffiths M, Koyama A, Middlebrooks L, Simon HK, Camacho‐Gonzalez A, Morris CR. Unique Needs for the Implementation of Emergency Department Human Immunodeficiency Virus Screening in Adolescents. Acad Emerg Med 2020; 27:984-994. [PMID: 32717124 DOI: 10.1111/acem.14095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) recommend universal human immunodeficiency virus (HIV) screening starting at 13 years, which has been implemented in many general U.S. emergency departments (EDs) but infrequently in pediatric EDs. We aimed to 1) implement a pilot of routine adolescent HIV screening in a pediatric ED and 2) determine the unique barriers to CDC-recommended screening in this region of high HIV prevalence. METHODS This was a prospective 4-month implementation of a routine HIV screening pilot in a convenience sample of adolescents 13 to 18 years at a single pediatric ED, based on study personnel availability. Serum-based fourth-generation HIV testing was run through a central laboratory. Parents were allowed to remain in the room for HIV counseling and testing. Data were collected regarding patient characteristics and HIV testing quality metrics. Comparisons were made using chi-square and Fisher's exact tests. Regression analysis was performed to assess for an association between parent presence at the time of enrollment and adolescent decision to participate in HIV screening. RESULTS Over 4 months, 344 of 806 adolescents approached consented to HIV screening (57% female, mean ± SD = 15.1 ± 1.6 years). Adolescents with HIV screening were more likely to be older than those who declined (p = 0.025). Other blood tests were collected with the HIV sample for 21% of adolescents; mean time to result was 105 minutes (interquartile range = 69 to 123) and 79% were discharged before the result was available. Having a parent present for enrollment was not associated with adolescent participation (adjusted odds ratio = 1.07, 95% CI = 0.67 to 1.70). Barriers to testing included: fear of needlestick, time to results, cost, and staff availability. One of 344 tests was positive in a young adolescent with Stage 1 HIV. CONCLUSIONS Routine HIV screening in adolescents was able to be implemented in this pediatric ED and led to the identification of early infection in a young adolescent who would have otherwise been undetected at this stage of disease. Addressing the unique barriers to adolescent HIV screening is critical in high-prevalence regions and may lead to earlier diagnosis and treatment in this vulnerable population.
Collapse
Affiliation(s)
- Colleen K. Gutman
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
| | - Elizabeth Duda
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Naomi Newton
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Ryan Alevy
- Morehouse School of Medicine Atlanta GAUSA
| | - Katherine Palmer
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Martha Wetzel
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Janet Figueroa
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Mark Griffiths
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
| | - Atsuko Koyama
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
| | - Lauren Middlebrooks
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
| | - Harold K. Simon
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
| | - Andres Camacho‐Gonzalez
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Grady Infectious Disease Program Ponce Family and Youth ClinicGrady Health Systems Atlanta GAUSA
| | - Claudia R. Morris
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
| |
Collapse
|
3
|
Ha MM, Belcher HME, Butz AM, Perin J, Matson PA, Trent M. Partner Notification, Treatment, and Subsequent Condom Use After Pelvic Inflammatory Disease: Implications for Dyadic Intervention With Urban Youth. Clin Pediatr (Phila) 2019; 58:1271-1276. [PMID: 31165630 PMCID: PMC6868422 DOI: 10.1177/0009922819852979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research suggests that youth in urban communities often remain in the same sexual relationships after a pelvic inflammatory disease (PID) diagnosis. Utilizing data from the Technology Enhanced Community Health Nursing (TECH-N) study, we explored partner notification, treatment, and condom use after PID diagnosis. Outreach interviews assessed adherence to self-care behaviors, followed by interviews 3 months after diagnosis. Descriptive statistics and multivariable logistic regressions evaluated baseline condom use versus 3 months after diagnosis as it relates to group and relationship status. Ninety-one percent reported partner notification, and of those notified, 90% reported partner treatment. Reports of condom use increased in both groups compared with baseline use. TECH-N participants were more likely to report condom use at last sex at 3 months compared with baseline. Given the open communication with partners about PID and partner-associated effects on condom use, exploring dyadic intervention to promote consistent, condom use after PID for youth in high STI (sexually transmitted infection) prevalence communities is required.
Collapse
Affiliation(s)
| | | | | | - Jamie Perin
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Maria Trent
- Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
4
|
Trent M, Perin J, Gaydos CA, Anders J, Chung SE, Tabacco Saeed L, Rowell J, Huettner S, Rothman R, Butz A. Efficacy of a Technology-Enhanced Community Health Nursing Intervention vs Standard of Care for Female Adolescents and Young Adults With Pelvic Inflammatory Disease: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e198652. [PMID: 31390037 PMCID: PMC6686980 DOI: 10.1001/jamanetworkopen.2019.8652] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022] Open
Abstract
Importance Pelvic inflammatory disease (PID) is a common reproductive health disorder that disproportionately affects female adolescents and young adults. Despite data indicating poor adherence and adverse outcomes among those who experience subsequent Neisseria gonorrhoeae and Chlamydia trachomatis infection, few trials have been designed to address this public health need. Objective To examine the efficacy of a technology-enhanced community health nursing (TECH-N) intervention vs standard of care for improving PID self-management behaviors and 90-day longitudinal prevalence of N gonorrhoeae and C trachomatis infection. Design, Setting, and Participants This randomized clinical trial of the TECH-N intervention was conducted among female patients 13 to 25 years of age diagnosed with mild to moderate PID who were being discharged to outpatient treatment from September 6, 2012, to December 8, 2016, at a large academic medical center. The final analysis of data was completed in November 2018. This study compared the efficacy of the intervention with that of the standard of care using an intention-to-treat analysis. Interventions Enrolled participants completed an audio computer-assisted self-interview, provided specimens for N gonorrhoeae and C trachomatis testing, and were randomized to standard treatment (n = 137) or the TECH-N intervention (n = 149). Intervention participants received text-messaging support and a community health nurse visit within 5 days of diagnosis. Change in the prevalence of N gonorrhoeae and C trachomatis infection was estimated with logistic regression. The N gonorrhoeae and C trachomatis positivity rate over time was evaluated using generalized estimating equations. Main Outcomes and Measures The primary outcome was the prevalence of N gonorrhoeae and C trachomatis infection at 90-day follow-up. The secondary outcome was adherence to the Centers for Disease Control and Prevention recommendations for self-care. Results A total of 286 patients (mean [SD] age, 18.8 [2.5] years; 268 [93.7%] African American) participated in the study. Although the study groups were demographically similar, the intervention group had a higher baseline rate of C trachomatis infection (45 of 139 [32.4%] vs 25 of 132 [18.9%], P = .01). Although N gonorrhoeae and C trachomatis positivity was not statistically different between groups at 90-day follow-up (6 of 135 [4.4%] vs 13 of 125 [10.4%], P = .07), the differential rate of decrease was significantly higher in the intervention group (48 of 140 [34.4%] to 6 of 135 [4.4%] compared with 34 of 133 [25.6%] to 13 of 112 [10.4%], P = .02). Intervention participants were more likely to receive the Centers for Disease Control and Prevention-recommended short-term follow-up visit compared with the control group (131 of 139 [94.2%] vs 20 of 123 [16.3%], P < .001). Conclusions and Relevance Adolescent and young adults with PID in the TECH-N intervention were more likely to experience decreases in N gonorrhoeae and C trachomatis positivity compared with the control group and to receive short-term clinical assessment. These findings suggest that the TECH-N intervention should be considered as a potential enhancement of standard of care approaches for management of female adolescents and young adults with mild to moderate PID in urban communities facing significant sexually transmitted infection disparities. Trial Registration ClinicalTrials.gov identifier: NCT01640379.
Collapse
Affiliation(s)
- Maria Trent
- Section on Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jamie Perin
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charlotte A. Gaydos
- Johns Hopkins International STD Laboratory, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer Anders
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shang-en Chung
- Section on Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa Tabacco Saeed
- Section on Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia Rowell
- Section on Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven Huettner
- Section on Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard Rothman
- Department of Adult Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arlene Butz
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
5
|
Trent M, Recto M, Qian Q, Butz A, Frick KD, Ellen JM, Lehmann H. Please Be Careful with Me: Discrepancies between Adolescent Expectations and Clinician Perspectives on the Management of Pelvic Inflammatory Disease. J Pediatr Adolesc Gynecol 2019; 32:363-367. [PMID: 30974212 PMCID: PMC6742537 DOI: 10.1016/j.jpag.2019.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To compare clinician perspectives for the treatment of pelvic inflammatory disease (PID) with those of adolescent patients and parents. DESIGN Cross-sectional study. SETTING Urban academic pediatric and adolescent medicine practices and school-based health clinics in a large urban community with a high prevalence of sexually transmitted infections and a national sample of adolescent-serving clinicians. PARTICIPANTS Female patients aged 12-19 years, parents raising an adolescent older than the age of 12 years in the urban community, and clinicians who serve adolescents recruited from regional and national listservs. INTERVENTIONS None. MAIN OUTCOME MEASURES Visual analogue scale scores on a scale of 0-10 corresponding to preferences on patient disposition in 17 clinical scenarios for a hypothetical patient with PID. RESULTS Compared with adolescents, clinicians were significantly more likely to endorse hospitalizations when patients presented with severe or complicated illness (β = 0.9; standard error [SE], 0.22; P < .001), possible surgical emergency (β = 0.83; SE, 0.2; P < .001), concurrent pregnancy (β = 0.59; SE, 0.3; P = .046), or failure of outpatient treatment (β = 0.58; SE, 0.29; P = .045). Compared with clinicians, adolescents were significantly more likely to endorse hospitalizations when patients presented at a young age (β = 1.36; SE, 0.38; P < .001), were homeless (β = 0.88; SE, 0.32; P = .007), were afraid to inform a partner (β = 1.66; SE, 0.40; P < .001), or had unaware parents (β = 2.86; SE, 0.39; P < .001). CONCLUSION Clinicians were more likely to recommend hospitalization when doing so adhered to national guidelines on PID treatment. Adolescents opted for hospitalization more often than clinicians in scenarios in which patients exhibited social vulnerability. Clinicians should engage with adolescents in shared disposition planning and use a more nuanced approach to PID management for adolescents who might not be able to tolerate an outpatient regimen.
Collapse
Affiliation(s)
- Maria Trent
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Michelle Recto
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Qiang Qian
- HaoHan Technologies, LLC, Clarksville, Maryland
| | - Arlene Butz
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kevin D Frick
- Vice Dean for Education, Carey School of Business, Baltimore, Maryland
| | - Jonathan M Ellen
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Harold Lehmann
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
6
|
Abstract
OBJECTIVES Most adolescent cases of pelvic inflammatory disease (PID) are diagnosed in the emergency department (ED). An important step to prevent PID-related morbidity among this high-risk population is to quantify prevalence and microbial patterns and identify testing and treatment gaps. METHODS We performed a retrospective, cross-sectional study of all visits by adolescents to an urban children's ED with an International Classification of Diseases, Ninth Revision, diagnosis of PID in 2012. We used standard descriptive statistics to quantify PID diagnoses, sexually transmitted infections (STI) testing, and treatment. RESULTS Pelvic inflammatory disease was diagnosed in more than 9% of women with a chief complaint of abdominal/pelvic pain. Most diagnosed cases underwent some STI testing, and 40% tested positive. Seventy percent of cases received antibiotics recommended by the Centers for Disease Control and Prevention. CONCLUSIONS There is a high prevalence of PID among adolescents in the pediatric ED. Rates of STI testing and appropriate treatment reveal gaps in diagnosis and management, representing a lost opportunity for identification and treatment of PID/STIs among high-risk adolescents.
Collapse
|
7
|
Miller MK, Pickett ML, Reed JL. Adolescents at Risk for Sexually Transmitted Infection Need More Than the Right Medicine. J Pediatr 2017; 189:23-25. [PMID: 28739182 DOI: 10.1016/j.jpeds.2017.06.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/29/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Melissa K Miller
- Division of Emergency Medicine Children's Mercy Hospital Kansas City, Missouri.
| | - Michelle L Pickett
- Division of Emergency Medicine Children's Hospital of Wisconsin Milwaukee, Wisconsin
| | - Jennifer L Reed
- Division of Emergency Services Cincinnati Children's Hospital and Medical Center Cincinnati, Ohio
| |
Collapse
|
8
|
Anders J, Hill A, Chung SE, Butz A, Rothman R, Gaydos C, Perin J, Trent M. Patient Satisfaction and Treatment Adherence for Urban Adolescents and Young Adults with Pelvic Inflammatory Disease. ACTA ACUST UNITED AC 2017; 3. [PMID: 29756068 DOI: 10.15761/tec.1000152] [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: 11/08/2022]
Abstract
Objectives Urban adolescents with pelvic inflammatory disease (PID) often seek care in emergency departments (ED). This study examines the effect of the ED patient experience - wait time (WT) and length of stay (LOS) - on satisfaction and medication adherence among urban adolescents with PID. Methods Adolescents with PID were enrolled in an urban teaching hospital ED. Chart data were matched with 2-week interview queries about satisfaction and medication adherence. Chi-square and logistic regression analyses evaluated the relationships between WT, LOS, provider type, satisfaction, and medication adherence. Results Of 83 participants, 96% report satisfaction with care, but only 45% report medication adherence. Mean WT was 55 minutes and mean LOS 200 minutes. Patients with higher LOS were less adherent with medication; this relationship became non-significant after adjustments. Patients seen by trainees had much longer LOS, but no differences in satisfaction or medication adherence. Conclusions Urban adolescents with PID report satisfaction with ED care despite prolonged LOS and medication adherence is poor. Optimization of ED workflows may improve outcomes in young women with PID.
Collapse
Affiliation(s)
- Jennifer Anders
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexandra Hill
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shang-En Chung
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arlene Butz
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charlotte Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jamie Perin
- Johns Hopkins University School of Public Health, Baltimore Maryland
| | - Maria Trent
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
9
|
Das BB, Ronda J, Trent M. Pelvic inflammatory disease: improving awareness, prevention, and treatment. Infect Drug Resist 2016; 9:191-7. [PMID: 27578991 PMCID: PMC4998032 DOI: 10.2147/idr.s91260] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Pelvic inflammatory disease (PID) is a common disorder of the reproductive tract that is frequently misdiagnosed and inadequately treated. PID and its complications, such as infertility, ectopic pregnancy, and chronic pelvic pain, are preventable by screening asymptomatic patients for sexually transmitted infections (STIs) and promptly treating individuals with STIs and PID. Recent findings The rates of adverse outcomes in women with PID are high and disproportionately affect young minority women. There are key opportunities for prevention including improving provider adherence with national screening guidelines for STIs and PID treatment recommendations and patient medication adherence. Nearly half of all eligible women are not screened for STIs according to national quality standards, which may increase the risk of both acute and subclinical PID. Moreover, in clinical practice, providers poorly adhere to the Centers for Disease Control and Prevention recommendations for treatment of PID. Additionally, patients with PID struggle to adhere to the current management strategies in the outpatient setting. Conclusion Novel evidence-based clinical and public health interventions to further reduce the rates of PID and to improve outcomes for affected women are warranted. We propose potential cost-effective approaches that could be employed in real-world settings.
Collapse
Affiliation(s)
- Breanne B Das
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jocelyn Ronda
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maria Trent
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
10
|
Clinician perspectives on management of adolescents with pelvic inflammatory disease using standardized patient scenarios. Sex Transm Dis 2013; 40:496-8. [PMID: 23680907 DOI: 10.1097/olq.0b013e318284e3b5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
National survey data designed to delineate clinician perspectives on the indications to hospitalize adolescents for pelvic inflammatory disease indicate that clinicians endorse care consistent with the Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines but that there is less agreement on the social factors that may impair an adolescent's ability to self-care in the outpatient setting.
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW Pelvic inflammatory disease (PID) is a common and serious reproductive health disorder and disease rates remain unacceptably high among adolescent girls and young adult women in the United States. Despite data demonstrating that women experience major adverse health outcomes after PID, national recommendations for management of adolescents have become increasingly less cautious in an era of cost-containment. In this review, we take an alternative look at published data on adolescents with PID to frame the next steps for optimizing management for this vulnerable population. RECENT FINDINGS Several findings emerge from review of the literature. First, there is limited evidence to guide the best practice strategies for adolescents with PID due to low enrolment of early and middle adolescents in national trials. Second, adolescents and adult women in the United States receive suboptimal treatment regimens per Centers for Disease Control and Prevention (CDC) standards. Third, available evidence suggests that adolescents are at an increased risk for poor adherence to CDC recommendations for self-care, reacquisition of sexually transmitted infections (STIs) and PID, and subsequent adverse reproductive health outcomes. SUMMARY Efforts to develop and integrate adolescent-focused, evidence-based strategies for PID management and prevention of subsequent STIs and recurrent PID are warranted.
Collapse
Affiliation(s)
- Maria Trent
- Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Population, Family, & Reproductive Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
12
|
Goyal M, Hersh A, Luan X, Localio R, Trent M, Zaoutis T. National trends in pelvic inflammatory disease among adolescents in the emergency department. J Adolesc Health 2013; 53:249-52. [PMID: 23743002 PMCID: PMC3725218 DOI: 10.1016/j.jadohealth.2013.03.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 03/15/2013] [Accepted: 03/17/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE In 2002, the Centers for Disease Control and Prevention (CDC) broadened the pelvic inflammatory disease (PID) diagnostic criteria to increase detection and prevent serious sequelae of untreated PID. The impact of this change on PID detection is unknown. Our objectives were to estimate trends in PID diagnosis among adolescent emergency department (ED) patients before and after the revised CDC definition and to identify factors associated with PID diagnoses. METHODS We performed a retrospective repeated cross-sectional study using the National Hospital Ambulatory Medical Care Survey from 2000 to 2009 of ED visits by 14- to 21-year-old females. We calculated national estimates of PID rates and performed multivariable logistic regression analyses and tests of trends. RESULTS During 2000-2009, of the 77 million female adolescent ED visits, there were an estimated 704,882 (95% confidence interval [CI], 571,807-837,957) cases of PID. After the revised criteria, PID diagnosis declined from 5.4 cases per 1,000 United States adolescent females to 3.9 cases per 1,000 (p = .03). In a multivariable model, age ≥17 years (odds ratio, 2.14; 95% CI, 1.25-3.64) and black race (odds ratio, 2.04; 95% CI, 1.36-3.07) were associated with PID diagnosis. CONCLUSIONS Despite broadened CDC diagnostic criteria, PID diagnoses did not increase over time. This raises concern about awareness and incorporation of the new guidelines into clinical practice.
Collapse
Affiliation(s)
- Monika Goyal
- Children's National Medical Center, George Washington University, Washington, DC, USA.
| | | | | | | | | | | |
Collapse
|
13
|
Trent M, Ellen JM, Frick KD. Estimating the direct costs of pelvic inflammatory disease in adolescents: a within-system analysis. Sex Transm Dis 2013; 38:326-8. [PMID: 21057380 DOI: 10.1097/olq.0b013e3181fc6c65] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We used 2008-2009 physician and hospital charges to estimate the direct cost of medical care per case of pelvic inflammatory disease. The estimated average total charge per episode was $3,025 (SD: $4155). The estimated average charge for patients treated in ambulatory (outpatient clinic and emergency department) settings was $7440 lower than for those treated on inpatient units.
Collapse
Affiliation(s)
- Maria Trent
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | | | | |
Collapse
|
14
|
Maldonado NG, Takhar SS. Update on Emerging Infections: news from the Centers for Disease Control and Prevention. Update to the CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral cephalosporins no longer a recommended treatment for gonococcal infections . Ann Emerg Med 2013; 61:91-5. [PMID: 23260686 DOI: 10.1016/j.annemergmed.2012.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Nicholas G Maldonado
- Brigham and Women's Hospital-Massachusetts General Hospital-Harvard Affiliated Emergency Medicine Residency, Boston, MA, USA
| | | |
Collapse
|
15
|
Affiliation(s)
- Maria Trent
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
16
|
Silver BJ, Knox J, Smith KS, S Ward J, Boyle J, J Guy R, Kaldor J, Rumbold AR. Frequent occurrence of undiagnosed pelvic inflammatory disease in remote communities of central Australia. Med J Aust 2012; 197:647-51. [DOI: 10.5694/mja11.11450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 07/11/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Bronwyn J Silver
- Epidemiology and Health Systems, Menzies School of Health Research, Alice Springs, NT
| | - Janet Knox
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW
| | - Kirsty S Smith
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW
| | - James S Ward
- Preventative Health, Baker IDI Heart and Diabetes Institute, Alice Springs, NT
| | - Jacqueline Boyle
- Jean Hailes Foundation for Women's Health, Monash University, Melbourne, VIC
| | - Rebecca J Guy
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW
| | - John Kaldor
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW
| | - Alice R Rumbold
- Epidemiology and Health Systems, Menzies School of Health Research, Alice Springs, NT
- Obstetrics and Gynaecology, University of Adelaide, Adelaide, SA
| |
Collapse
|
17
|
Smith JD. Single-case experimental designs: a systematic review of published research and current standards. Psychol Methods 2012; 17:510-50. [PMID: 22845874 PMCID: PMC3652808 DOI: 10.1037/a0029312] [Citation(s) in RCA: 298] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article systematically reviews the research design and methodological characteristics of single-case experimental design (SCED) research published in peer-reviewed journals between 2000 and 2010. SCEDs provide researchers with a flexible and viable alternative to group designs with large sample sizes. However, methodological challenges have precluded widespread implementation and acceptance of the SCED as a viable complementary methodology to the predominant group design. This article includes a description of the research design, measurement, and analysis domains distinctive to the SCED; a discussion of the results within the framework of contemporary standards and guidelines in the field; and a presentation of updated benchmarks for key characteristics (e.g., baseline sampling, method of analysis), and overall, it provides researchers and reviewers with a resource for conducting and evaluating SCED research. The results of the systematic review of 409 studies suggest that recently published SCED research is largely in accordance with contemporary criteria for experimental quality. Analytic method emerged as an area of discord. Comparison of the findings of this review with historical estimates of the use of statistical analysis indicates an upward trend, but visual analysis remains the most common analytic method and also garners the most support among those entities providing SCED standards. Although consensus exists along key dimensions of single-case research design, and researchers appear to be practicing within these parameters, there remains a need for further evaluation of assessment and sampling techniques and data analytic methods.
Collapse
Affiliation(s)
- Justin D Smith
- Child and Family Center, University of Oregon, Eugene, OR 97401-3408, USA.
| |
Collapse
|
18
|
Liu B, Donovan B, Hocking JS, Knox J, Silver B, Guy R. Improving adherence to guidelines for the diagnosis and management of pelvic inflammatory disease: a systematic review. Infect Dis Obstet Gynecol 2012; 2012:325108. [PMID: 22973085 PMCID: PMC3437626 DOI: 10.1155/2012/325108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/19/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence suggests adherence to clinical guidelines for pelvic inflammatory disease (PID) diagnosis and management is suboptimal. We systematically reviewed the literature for studies describing strategies to improve the adherence to PID clinical guidelines. METHODS The databases MEDLINE and EMBASE, and reference lists of review articles were searched from January 2000 to April 2012. Only studies with a control group were included. RESULTS An interrupted time-series study and two randomised controlled trials (RCTs) were included. The interrupted time-series found that following a multifaceted patient and practitioner intervention (practice protocol, provision of antibiotics on-site, written instructions for patients, and active followup), more patients received the recommended antibiotics and attended for followup. One RCT found a patient video on PID self-care did not improve medication compliance and followup. Another RCT found an abbreviated PID treatment guideline for health-practitioners improved their management of PID in hypothetical case scenarios but not their diagnosis of PID. CONCLUSION There is limited research on what strategies can improve practitioner and patient adherence to PID diagnosis and management guidelines. Interventions that make managing PID more convenient, such as summary guidelines and provision of treatment on-site, appear to lead to better adherence but further empirical evidence is necessary.
Collapse
Affiliation(s)
- Bette Liu
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
| | | | | | | | | | | |
Collapse
|
19
|
Huppert JS, Reed JL, Munafo JK, Ekstrand R, Gillespie G, Holland C, Britto MT. Improving notification of sexually transmitted infections: a quality improvement project and planned experiment. Pediatrics 2012; 130:e415-22. [PMID: 22753557 PMCID: PMC4074614 DOI: 10.1542/peds.2011-3326] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Inadequate follow-up of positive sexually transmitted infection (STI) test results is a gap in health care quality that contributes to the epidemic of STIs in adolescent women. The goal of this study was to improve our ability to contact adolescent women with positive STI test results after an emergency department visit. METHODS We conducted an interventional quality improvement project at a pediatric emergency department. Phase 1 included plan-do-study-act cycles to test interventions such as provider education and system changes. Phase 2 was a planned experiment studying 2 interventions (study cell phone and patient activation card), using a 2 × 2 factorial design with 1 background variable and 2 replications. Outcomes were: (1) the proportion of women aged 14 to 21 years with STI testing whose confidential telephone number was documented in the electronic medical record; (2) the proportion of STI positive women successfully contacted within 7 days. RESULTS Phase 1 interventions increased the proportion of records with a confidential number from 24% to 58% and the proportion contacted from 45% to 65%, and decreased loss to follow-up from 40% to 24%. In phase 2, the proportion contacted decreased after the electronic medical record system changed and recording of the confidential number decreased. Study interventions (patient activation card and study cell phone) had a synergistic effect on successful contact, especially when confidential numbers were less reliably documented. CONCLUSIONS Feasible and sustainable interventions such as improved documentation of a confidential number worked synergistically to increase our ability to successfully contact adolescent women with their STI test results.
Collapse
Affiliation(s)
| | | | - Jennifer Knopf Munafo
- Center for Professional Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | |
Collapse
|
20
|
Newman RE, Hedican EB, Herigon JC, Williams DD, Williams AR, Newland JG. Impact of a guideline on management of children hospitalized with community-acquired pneumonia. Pediatrics 2012; 129:e597-604. [PMID: 22351891 DOI: 10.1542/peds.2011-1533] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We sought to describe the impact a clinical practice guideline (CPG) had on antibiotic management of children hospitalized with community-acquired pneumonia (CAP). PATIENTS AND METHODS We conducted a retrospective study of discharged patients from a children's hospital with an ICD-9-CM code for pneumonia (480-486). Eligible patients were admitted from July 8, 2007, through July 9, 2009, 12 months before and after the CAP CPG was introduced. Three-stage least squares regression analyses were performed to examine hypothesized simultaneous relationships, including the impact of our institution\x{2019}s antimicrobial stewardship program (ASP). RESULTS The final analysis included 1033 patients: 530 (51%) before the CPG (pre-CPG) and 503 (49%) after the CPG (post-CPG). Pre-CPG, ceftriaxone (72%) was the most commonly prescribed antibiotic, followed by ampicillin (13%). Post-CPG, the most common antibiotic was ampicillin (63%). The effect of the CPG was associated with a 34% increase in ampicillin use (P < .001). Discharge antibiotics also changed post-CPG, showing a significant increase in amoxicillin use (P < .001) and a significant decrease in cefdinir and amoxicillin/clavulanate (P < .001), with the combined effect of the CPG and ASP leading to 12% (P < 0.001) and 16% (P < .001) reduction, respectively. Overall, treatment failure was infrequent (1.5% vs 1%). CONCLUSIONS A CPG and ASP led to the increase in use of ampicillin for children hospitalized with CAP. In addition, less broad-spectrum discharge antibiotics were used. Patient adverse outcomes were low, indicating that ampicillin is appropriate first-line therapy for otherwise healthy children admitted with uncomplicated CAP.
Collapse
Affiliation(s)
- Ross E Newman
- Section of General Pediatrics, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Children’s Mercy Hospitals and Clinics, Kansas City, MO 64108, USA
| | | | | | | | | | | |
Collapse
|
21
|
|
22
|
Trent M, Haggerty CL, Jennings JM, Lee S, Bass DC, Ness R. Adverse adolescent reproductive health outcomes after pelvic inflammatory disease. ACTA ACUST UNITED AC 2011; 165:49-54. [PMID: 21199980 DOI: 10.1001/archpediatrics.2010.256] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare longitudinal adolescent and adult reproductive outcomes after pelvic inflammatory disease (PID). DESIGN Secondary analysis of longitudinal data from the Pelvic Inflammatory Disease Evaluation and Clinical Health study. SETTING A large multicenter randomized clinical trial assessing PID treatment strategies in the United States. PARTICIPANTS Eight hundred thirty-one female patients aged 14 to 38 years with a diagnosis of PID. MAIN EXPOSURE Adverse longitudinal outcomes were compared in adolescents (≤19 years) and adults (>19 years). OUTCOME MEASURES Primary outcome measures included recurrent sexually transmitted infection at 30 days, recurrent PID, chronic abdominal pain, infertility, pregnancy, and times to recurrent PID and pregnancy. Cox proportional hazards modeling was used to examine the effect of young age on times to pregnancy and recurrent PID. RESULTS Adolescents were more likely than adults to have positive results of sexually transmitted infection testing at baseline and at 30 days. There were no significant group differences in chronic abdominal pain, infertility, and recurrent PID at 35 or 84 months, but adolescents were more likely to have a pregnancy at both time points. Adjusted hazard ratios (95% confidence intervals) also demonstrated that adolescents had shorter times to pregnancy (1.48 [1.18-1.87]) and recurrent pelvic inflammatory disease (1.54 [1.03-2.30]). CONCLUSION Adolescents may require a different approach to clinical care and follow-up after PID to prevent recurrent sexually transmitted infections, recurrent PID, and unwanted pregnancies.
Collapse
Affiliation(s)
- Maria Trent
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | | | | | | | | | | |
Collapse
|
23
|
Results of a randomized controlled trial of a brief behavioral intervention for pelvic inflammatory disease in adolescents. J Pediatr Adolesc Gynecol 2010; 23:96-101. [PMID: 19733100 DOI: 10.1016/j.jpag.2009.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Revised: 06/26/2009] [Accepted: 06/29/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this research was to examine the effectiveness of a brief behavioral intervention, provided at the time of diagnosis of pelvic inflammatory disease, on subsequent behaviors by patients who were urban adolescents in a community in which sexually transmitted infection was prevalent. METHODS 121 adolescents aged 15 to 21 years with mild to moderate pelvic inflammatory disease were enrolled in a randomized trial. All participants received standardized care, completed baseline audio computerized self-interviews, received full courses of medication at discharge, and were interviewed after the 2-week treatment course. The intervention group also watched a 6-minute intervention video. MAIN OUTCOME MEASURES Medication completion, temporary sexual abstinence during the 14-day treatment period, partner notification, partner treatment, and return for 72-hour follow-up were studied. Data were evaluated using multivariate regression analysis. RESULTS Of the participants, 61% were located and could participate in the 2-week interview by the disease intervention specialist. The intervention participants had higher rates of 72-hour follow-up (32% vs. 16%) and partner treatment (71% vs. 53%) in bivariate analyses at a P = 0.1 level. There were no differences in medication completion (66% vs. 66%), sexual abstinence (78% vs. 89%), or partner notification (88% vs. 92%). Only the partner-treatment finding persisted in multivariate models (AOR = 3.10; 95% CI, 1.03-9.39, P = .045). CONCLUSIONS Adolescent girls randomized to a community-specific video intervention at diagnosis of pelvic inflammatory disease were three times more likely to have their partners treated than those in the control group. Given the value of partner treatment in secondary prevention of sexually transmitted diseases, this video may be an essential component of discharge programming in urgent care settings. Additional structural supports may be necessary to facilitate improved adherence to other key adherence behaviors.
Collapse
|
24
|
Mehta SD. Gonorrhea and chlamydia in emergency departments: Screening, diagnosis, and treatment. Curr Infect Dis Rep 2009; 9:134-42. [PMID: 17324351 DOI: 10.1007/s11908-007-0009-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Failure to screen sexually active adolescents and adults for gonorrhea and chlamydia at the time of acute care visits to urban emergency departments (ED) results in missed treatment opportunities for 38% to 82% of infected persons. The prevalence of gonorrhea and chlamydia infections among ED patients presenting with genitourinary or pregnancy-related complaints or providing urine specimens as part of routine medical care ranges from 4.3% to 16.4%. Notably, prevalence among general ED patients is similar (9.7%-14.3%). Due to the asymptomatic or nonspecific presentation of these infections, expanded screening is recommended to increase detection, treatment, and partner notification. A lower threshold of empiric treatment in the ED setting is recommended due to the difficulty and incompleteness of follow-up subsequent to ED discharge. Specific recommendations to improve the quality of ED care for sexually transmitted infections and to expand detection are provided.
Collapse
Affiliation(s)
- Supriya D Mehta
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, 958 SPHPI, M/C 923, 1603 West Taylor Street, Chicago, IL 60612, USA.
| |
Collapse
|
25
|
Abstract
Pelvic inflammatory disease (PID), the infection and inflammation of the female upper genital tract, is a common cause of infertility, chronic pain and ectopic pregnancy. Diagnosis and management are challenging, largely resulting from varying signs and symptoms and a polymicrobial etiology that is not fully delineated. Owing to the potential for serious sequelae, a low threshold for diagnosis and treatment is recommended. As PID has a multimicrobial etiology, including Neisseria gonorrhoeae, Chlamydial trachomatis and anaerobic and mycoplasmal bacteria, treatment of PID should consist of a broad spectrum antibiotic regimen. Recent treatment trials have focused on shorter duration regimens, such as azithromycin, and monotherapies including ofloxacin, but data are sparse. Research comparing sequelae development by differing antimicrobial regimens is extremely limited, but will ultimately shape future treatment guidelines.
Collapse
Affiliation(s)
- Catherine L Haggerty
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA 15261, USA.
| | | |
Collapse
|
26
|
Claudius I, Behar S, Ballow S, Wood R, Stevenson K, Blake N, Upperman JS. Disaster Drill Exercise Documentation and Management: Are We Drilling to Standard? J Emerg Nurs 2008; 34:504-8. [DOI: 10.1016/j.jen.2008.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Accepted: 03/24/2008] [Indexed: 10/21/2022]
|