Faculty Bibliography

Background Expedited Partner Therapy (EPT) is the practice of treating sexual partner(s) of patients diagnosed with STIs without examining the partner(s) and is effective in reducing reinfection. It has been permissible in Virginia since 2020. This study aimed to assess knowledge and practices surrounding prescription of EPT at an academic medical center in Virginia before and after an online learning module. Methods Data were obtained via online anonymous RedCap surveys. The first was distributed via e-mail to providers who regularly diagnose and treat STIs at an academic medical center in Virginia. The survey assessed provider knowledge and practices regarding EPT and preference of future education. On the basis of the results, an online learning module with information on EPT was created and distributed to the same population of providers. The module contained pre- and post-module surveys evaluating participant knowledge of the legal status, methods of prescription, and attitudes surrounding EPT. Results The initial survey showed that 10% of participants were aware of the new legal status of EPT. In terms of EPT prescription, 4% always prescribed EPT, 14% prescribed it sometimes, and 61% never prescribed it. In the pre-module survey, 31% of respondents correctly identified one option for prescription of EPT. Knowledge surrounding the legal status and prescription methods was significantly improved in the post-module responses, with 100% of participants able to identify one correct prescription option. Conclusion These results show knowledge gaps surrounding the Virginia EPT provision and policy change. These gaps improved with the implementation of an online learning module. Further evaluation is needed to assess the continued implementation of EPT.

OBJECTIVE:We evaluated initial cervical dilation with the addition of oral mifepristone to vaginal misoprostol as cervical preparation for same-daysecond-trimester dilation and evacuation (D&E). STUDY DESIGN:Women desiring abortion between gestational ages 14weeks 0days and 19weeks 6days were randomized to 200-mg mifepristone or identical placebo immediately followed by 400-mcg misoprostol vaginally 4-6h prior to D&E. Primary outcome was cervical dilation assessed by largest Hegar dilator passed without resistance. Secondary outcomes included total procedure time and participant and provider perceptions. We had 90% power to detect a 2-mm change in initial cervical dilation with a mean of 10mm (SD=3.0mm), requiring 48 participants in each arm. RESULTS:Of 100 women enrolled, 96 were randomized and completed the study. Age, race, gestational age (mean 17.4weeks, SD=1.3) and parity did not significantly differ. Mean initial Hegar dilation measurements were 11.7 and 10.9mm in the mifepristone and placebo groups, respectively, with difference of 0.8 [95% CI=-0.4, 2.0mm]. We found total procedure times of 11.8 and 13.0min, respectively (difference of 1.2min [95% CI=-2.4, 4.8min]. Participant and provider perceptions did not differ. All 96 procedures were completed without hemorrhage, cervical laceration or other observed complications. CONCLUSION:The addition of mifepristone to vaginal misoprostol did not provide a significant increase in cervical dilation compared to misoprostol alone as cervical preparation 4-6h prior to D&E at 14weeks through 19weeks 6days. IMPLICATIONS:Adding mifepristone for a short interval (4-6h) did not improve cervical preparation with misoprostol prior to D&E at 14-19weeks. Future studies should evaluate alternative timing intervals of medications for this purpose.

The Centers for Disease Control and Prevention and Healthy People 2020 call for improvements in meeting men's reproductive health needs but little is known about the proportion of men in need. This study describes men aged 35 to 39 in need of family planning and preconception care, demographic correlates of these needs, and contraception use among men in need of family planning. Using data from Wave 4 (2008-2010) of the National Survey of Adolescent Males, men were classified in need of family planning and preconception care if they reported sex with a female in the last year and believed that they and their partner were fecund; the former included men who were neither intentionally pregnant nor intending future children and the latter included men intending future children. Men were classified as being in need of both if they reported multiple sex partners in the past year. About 40% of men aged 35 to 39 were in need of family planning and about 33% in need of preconception care with 12% in need of both. Current partner's age, current union type, and sexually transmitted infection health risk differentiated men in need of family planning and preconception care (all ps < .01) and participants' race/ethnicity further differentiated men in need of preconception care (p < .01). More than half of men in need of family planning reported none of the time current partner hormonal use (55%) or condom use (52%) during the past year. This study identified that many men in their mid-30s are in need of family planning or preconception care.

Even though contraceptive coverage expands under the Patient Protection and Affordable Care Act, reducing disparities in contraceptive access and provision requires that all providers assess their patient's reproductive life plans and that health systems work to minimize institutional and socioeconomic barriers. In this article, the challenges of providing equal access to contraceptive care, as well as recommendations for encouraging the use of effective contraception among all reproductive age women are reviewed.

BACKGROUND:Laparoscopy has been used for the resolution of acute abdominal surgical conditions in the second trimester of pregnancy for years. There are few case reports, however, regarding its use in rare presentations of the acute abdomen later in pregnancy. CASE/METHODS:We report a case of the use of laparoscopy in the resolution of an intussusception in the 34th week, creating a smaller incision and providing the benefits of minimally invasive surgery. CONCLUSION/CONCLUSIONS:We suggest that laparoscopy be considered for further utilization as a safe and minimally invasive alternative for surgical procedures in the third trimester of pregnancy.