Infertility. A clinical guide for the internist

Internal medicine residents' preparedness to care for reproductive-age and pregnant women

BACKGROUND

Research that addresses whether residents are prepared to deliver preconception care and manage medical conditions in pregnant and postpartum women has been scarce since the publication of women's health competency guidelines for internists in 1997.

PURPOSE

To investigate current attitudes, training, and perceived preparedness in these areas and to explore relationships between resident characteristics and preparedness.

METHODS

A 62-item questionnaire was given to 105 internal medicine residents and recent graduates at two affiliated residency programs.

RESULTS

Eighty-five surveys were returned. Most respondents reported that they had minimal training and were unprepared in these areas but felt that learning these topics is important. Perceived preparedness correlated strongly with relevant didactic and clinical training but was not associated with gender, residency track, or career plan.

CONCLUSIONS

In light of published competency guidelines, internal medicine training programs should consider adding or increasing curricular content to improve residents' perceived preparedness to deliver care to reproductive-age and pregnant women.

Integrated perinatal health framework. A multiple determinants model with a life span approach

BACKGROUND

Despite great strides in improving prenatal care utilization among American women, key perinatal indicators have remained stagnant or worsened in the past decade, and the United States continues to rank near the bottom compared to other developed countries. A new approach is needed if we are to achieve improvements in perinatal health.

METHODS

To propose a new framework that integrates a "life span" approach with a multiple determinants model.

RESULTS

We recognize that (1) powerful influences on outcome occur long before pregnancy begins; (2) pregnancy outcome is shaped by social, psychological, behavioral, environmental, and biological forces; and (3) the demography of pregnancy has changed dramatically in the last few decades with more women delaying their first birth. Approaches that simultaneously consider the entire life span as well as multiple determinants may need to be adopted. We propose a framework that integrates these approaches and is supported by the research literature. The life span perspective focuses attention toward the preconceptional and interconceptional periods as targets for intervention in improving perinatal health. The multiple determinants model distinguishes among concepts of disease, health and functioning, and well-being for both women and their offspring.

CONCLUSIONS

Our intent is to influence how policymakers, public health professionals, clinicians, and researchers approach perinatal health.

ACP best practice no 170. Investigation of infertility with the emphasis on laboratory testing and with reference to radiological imaging

This review will discuss the investigation of infertility, with emphasis on laboratory testing and reference to the value of other investigations, including clinical and radiological. The role of laboratory investigations is viewed within an appropriate clinically directed pathway that includes medical, surgical, and social history together with environmental factors. Because embryology and assisted reproduction techniques are developing rapidly and produce continuous changes in everyday practice, this article gives a critical review of the plethora of tests that are currently used.