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Provider Navigation of Cannabis Use Among Patients Who Seek Reproductive Healthcare
Get PDFBackground: Research and data show increasing trends of individuals who use cannabis in Washington state and across the US, with limited information regarding specific populations such as those who are pregnant, postpartum, or breastfeeding. Many research studies highlight the historic lack of information in healthcare professionals’ curriculums and competencies regarding cannabis use for treatment of health symptoms. Measures: This practice-based inquiry utilizes a survey method to determine how reproductive healthcare providers navigate cannabis use among pregnant, postpartum, and breastfeeding patients. Outcomes: 12 individuals participated in the online survey with the majority that practice in Washington state. Almost all healthcare providers in this study reported managing or caring for patients that disclose cannabis use in general, during pregnancy, postpartum, and while breastfeeding. They report feeling confident and comfortable discussing and managing the care of patients that use cannabis across all populations. However, they were not at all confident or comfortable educating, recommending/authorizing cannabis to patients in treatment of their health symptoms in any category. Conclusion: The findings from this study provide a glimpse into how some providers may navigate cannabis use among their patients who seek reproductive care. It is recommended that better education regarding cannabis use, and incorporation of cannabis-related evidence-based practices and guidelines can help build trusting relationships and increase shared decision-making between providers and patients while simultaneously reducing racial and gender inequities seen in medical and institutional systems and reduce harm
Collaboration with OB/GYNs: A Best Practice Midwife-led High-Risk Peripartum Care Model in a Federally Qualified Health Center
Get PDFThe maternal mortality rate has improved in the United States (U.S.) with a decreased mortality rate in 2022 of 22.3 women per 100,000 births compared to 32.9 in 2021 (Hoyert, 2024). Women and birthing individuals of color are disproportionately affected by these peripartum outcomes with the maternal mortality rate of non-Hispanic Black women being 2.6 times higher than the rate of non-Hispanic white women nationally (Hoyert, 2024). Washington State’s maternal mortality rate between 2014-2020 was 15.9 per 100,000 live births, which is lower than the national maternal mortality rate of 18.6 in this 6-year period (Washington State Department of Health [WADOH], n.d.). While peripartum-related deaths in this state remain stable compared to nationally, the mortality rate for people of color in Washington State is still 2.5 times higher than non-Hispanic White people in this state (WADOH, n.d.)
Systematic Review of Diagnostic Accuracy and Clinical Impact of Ordering Compression Ultrasonography Exams Based on a Positive D-dimer Assay Test
Get PDFPurpose: The aim of this literature review was to examine the diagnostic accuracy and clinical impact of medical providers ordering compression ultrasonography (CUS) exams for the lower extremity venous systems based on a patient’s positive D-dimer assay test.
Method: A systematic review of the current literature was conducted from September 2023-May 2024 using various search engines without language or date restrictions. From 30 sources inspected, articles were excluded from the research if they did not have statistics relating the positive or negative results of the D-dimer to the pretest clinical probability assessments and results of the following CUS exams. 20 sources met the inclusion criteria for this review.
Results: Across three of the studies with the biggest sample size, it was found that the percentage of patients who had a positive D-dimer and a positive diagnosis of PE, DVT, or VTE were below 25%. It was also found that D-dimer testing still faces ambiguity regarding age-adjusted threshold values, a lack of a universally standardized unit of measure, and differing levels of testing sensitivity and specificity across different commercial brands of D-dimer assays.
Conclusion: Throughout the research done thus far, there is still varying information regarding the effectiveness of D-dimers due to the wide variety of D-dimer assay types that are commercially available. The push for both the standardization of D-dimer threshold values as well as age-adjusted D-dimer threshold values will further optimize this test to reduce the rate of false positives. Most of the literature reflect an overlying theme that D-dimers are most useful in a setting where the test is administered alongside a clinical probability score to determine if a CUS is necessary to further evaluate for DVT, PE, and VTE. This method is most effective once a medical institution has a firm idea of the threshold values of their D-dimer tests for different age groups
Weathering Determinism
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Social Identity Matters: Lived Experiences of Latina Teachers in Predominantly White Staff Schools
Get PDFThe demographic makeup of student populations is undergoing profound shifts, with Latina/o students constituting a significant percentage. However, the representation of Latina/o educators within school systems remains disproportionately low. This incongruity between student demographics and educator representation may pose multifaceted challenges. To address this disparity, the present study delves into the lived experiences of Latina educators, illuminating the nuanced interplay of their social identities within educational contexts, particularly in relation to their interactions with White staff colleagues. Employing a phenomenological approach and supported by social identity theory and transformational leadership theory, this research endeavors to uncover the salient factors shaping the professional experiences of Latina educators, including the facilitators and impediments to the expression and integration of their social identities in professional settings. Drawing upon a purposive sample comprising six Latina educators from a designated school district in Washington State, data collection was conducted through structured interviews, with thematic data analysis serving as the primary analytical framework. The findings illuminate essential components of Latina teachers\u27 social identities and their strategic utilization within the professional sphere. Moreover, the study identifies avenues for fostering a sense of belonging among Latina educators, delineates the barriers encountered within predominantly White staff environments, and suggests the pivotal role of leadership in fostering inclusive school cultures. Finally, actionable recommendations are presented for district and school leaders to generate an inclusive and supportive environment for Latina educators, thereby enriching their professional experiences toward attracting more as teachers
