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Pain Prophylaxis with IUD Insertion
Get PDFIntrauterine Devices (IUDs) are a form of long- acting contraceptive that are used worldwide in preventing unwanted pregnancy. Despite their high success rate, there is a lot of hesitancy in women to choose this as their form of preferred birth control. Some of this comes from lack of patient education and other social factors, but another portion is the fear of pain during insertion. Unfortunately, there is no standard of care to mitigate pain with IUD insertion, and use of different modalities continue to be a heavily debated topic. It is believed the cause of pain with IUD insertion is multifactorial which makes finding an appropriate treatment difficult. Taking oral analgesics a few hours prior to insertion is frequently recommended, however, this has not been found to have significant success. There are other, more potent analgesic options including ketorolac or tramadol that have provided some improvement mostly with post-procedure pain. Topical anesthetics and paracervical blocks have also had some success with pain during insertion but there are some disadvantages to each. Cervical primers such as misoprostol and dinoprostone have started to fall out of favor but can be still considered especially in those who have more difficult insertion. Non-pharmacologic modalities that improve patient anxiety have also provided some improvement with pain during and after IUD insertion and should always be considered an option for the provider to utilize. Ultimately, the decision of what to use should be discussed and shared between patient and provider
Post-Acute COVID-19 Sequela: Pulmonary Hypertension
No full textThe SARS-CoV-2 virus responsible for the COVID-19 pandemic has unique features, including a specific affinity for epithelial cells of pulmonary vasculature. Damage to vessels occurs by hypoxia, inflammation, and complement activation. In addition to these microvascular changes, pulmonary, cardiac, and systemic consequences increase the risk of developing pulmonary hypertension following an acute SARS-CoV-2 infection. Nonspecific signs and symptoms, multifaceted etiologies, and various diagnostic modalities for pulmonary hypertension make diagnosing the disease difficult. A mean pulmonary arterial pressure \u3e20 mmHg measured by right heart catheterization remains the gold standard for definitive diagnosis. Further research is needed to develop appropriate screening criteria and guided diagnostic approaches to identify post-COVID-19 infection pulmonary hypertension
Streamlined Approaches for Efficient IBS Diagnosis
No full textIrritable Bowel Syndrome (IBS) poses diagnostic challenges as it is a diagnosis of exclusion and shares aspects of its clinical presentation with other gastrointestinal disorders. This CME article aims to equip clinicians with practical strategies for navigating the diagnostic complexities of IBS effectively. Clinical definitions for IBS and its subcategories are provided with an emphasis on Rome IV criteria and creating a detailed differential diagnosis to guide the history and physical examination of the patient. Recommendations for laboratory studies, including fecal calprotectin and CBC in patients with chronic abdominal pain and diarrhea, are laid out for effective and efficient diagnostics. The article concludes with guidance regarding patient education
Exercise as an Alternative to SSRIs for Mild to Moderate Depression
No full textDepression is a devastating mental health condition affecting millions worldwide. Pharmaceutical treatments, such as Selective Serotonin Reuptake Inhibitors (SSRIs), have been used as first-line treatments for depression. However, there is a growing body of evidence suggesting that exercise can be a highly effective and holistic alternative. This article explores the efficacy of exercise as a treatment option compared to SSRIs. For Physician Assistants (PA), exercise can be a more holistic and patient-centered approach to depression treatment
Unraveling and Alleviating Phantom Limb Pain: A Comprehensive Analysis
No full textPhantom limb pain (PLP) is a perplexing phenomenon posing multifaceted challenges to many healthcare professionals and researchers for decades. It requires an in-depth understanding of its complex neurophysiological background, which has previously been poorly understood. Additionally, the psychosocial impact of PLP on individuals, including mental health and overall quality of life, requires in-depth analysis. As there is currently no definitive treatment for this condition, there is an urgent need to explore novel therapeutic approaches. This Continuing Medical Education poster will highlight the critical gaps in our understanding and management of PLP emphasizing the necessity for research and advancements to enhance the care and well-being of individuals living with this challenging condition
Misconception, Government Policy, and Lack of Options: Why America Lags Behind in IUD Use and Development
No full textAmerica falls behind other countries in IUD use and development despite updated safety profiles and recommendations as the gold standard in birth control from trusted medical societies. This American “lag” can be attributed to a complex culture of peer and provider bias, misconceptions among adolescents, and low accessibility. These barriers partly stem from apprehension after the monumental failure of an IUD called the Dalkon Shield in the 1970’s. This led to extensive FDA approval policy contributing to a US market that offers far less IUD options than other countries. Experts suggest that today’s lack of options may fail to address natural uterine variability leading to the exclusion of many women, most notably, the young and nulliparous. Low IUD use is most consequential for this demographic who are at the greatest risk of unplanned pregnancy and abortion. Some suggest US rates are significantly higher than in parts of Europe that offer more diverse IUD design. These are only some of the barriers unique to the US that directly hinder contraceptive R & D. This special topic review includes information from historical articles, opinions from experts in the field, literature reviews, clinical trials, and data from well known medical bulletins with the hope of launching a new era of much needed research and consideration
Treatment and management of IBD during pregnancy and lactation
No full textPregnancy is exciting, emotional, and involves immense changes to the body’s systems to accommodate and nurture a fetus. There is already considerable uncertainty and anxiety about safety during pregnancy due to new research, changing guidelines, and most importantly the risk of hurting the fetus. Adding in a chronic inflammatory bowel disease (IBD) such as Crohn\u27s Disease (CD) and ulcerative colitis (UC) during pregnancy requires specialist care with gastroenterology (GI) that may not always be accessible to patients. This CME article discusses the various therapeutic options and management of IBD during pregnancy and lactation. It is aimed towards primary care providers and obstetricians to facilitate multidisciplinary management and better support of patients during their pregnancy
Cutting Out Sleep Disturbances in the Pediatric Perioperative Setting
No full textAdequate sleep is important for children experiencing critical illnesses that require hospitalization by fostering protein synthesis and tissue repair mechanisms. Frequent disruptions to inpatient pediatric sleep are harmful to both patients and families, particularly when recovering from surgical interventions. Proposed recommendations include a joint non-pharmacologic and pharmacologic approach
Role of China’s Belt and the Road Initiative in Global Development Finance
Get PDFChina’s Belt and the Road Initiative (BRI), introduced in 2013 by China’s President Xi, has been a major milestone in global development finance. Resonating with the historical ‘Silk Road”, BRI attempts to connect many countries and continents around the world. Matching its humongous size of nearly $1 trillion, it covers about 165 countries around the world. Even as the BRI benefitted some of the recipient countries, it has built a mountain of debt among many developing countries. This paper suggests an efficient, equitable, and representative method of resolving the BRI debt-distress through the formation of a BRI Club, which should include China as well as representatives from developing countries that borrowed under the BRI
Pacific Butterflies
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