Prioritizing Evidence-based Interventions for Dissemination and Implementation Investments: AHRQ's Model and Experience.

Background: The Agency for Healthcare Research and Quality (AHRQ) is mandated to implement patient-centered outcomes research (PCOR) to promote safer, higher quality care. With this goal, we developed a process to identify which evidence-based PCOR interventions merit investment in implementation. We present our process and experience to date.

Provider Adherence to Syphilis Testing Recommendations for Women Delivering a Stillbirth.

Objective: To assess overall adherence to Centers for Disease Control and Prevention and American College of Obstetrics and Gynecology recommended guidelines for syphilis testing among women who delivered a stillbirth and compare it with other tests recommended for stillbirth evaluation.

Methods: We used MarketScan claims data with 40 million commercially insured and 8 million Medicaid enrollees annually to estimate prenatal care and follow-up testing among women who had stillbirths between January 1, 2013, and December 24, 2013. Stillbirth was identified if women had any International Classification of Disease, Ninth Revision codes related to a stillbirth outcome.

Creation of a Composite Score to Predict Adnexal Torsion in Children and Adolescents.

Study Objective: To create a composite score to predict adnexal torsion in children and adolescents.

Design: A prospective cross-sectional study.

Setting: Emergency department of a tertiary care children's hospital.

Impact of Post-visit Contact on Emergency Department Utilization for Adolescent Women with a Sexually Transmitted Infection.

Study Objectives: To understand Emergency Department (ED) utilization patterns for women who received sexually transmitted infection (STI) testing and explore the impact of post-visit telephone contact on future ED visits.

Design, Setting, Participants: We performed a secondary analysis on a prospectively collected dataset of ED patients ages 14-21 years at a children's hospital.

Interventions And Main Outcome Measures: The dataset documented initial and return visits, STI results, race, age and post-visit contact success (telephone contact ≤7 days of visit).

Adolescent patient preferences surrounding partner notification and treatment for sexually transmitted infections.

Objectives: Important barriers to addressing the sexually transmitted infection (STI) epidemic among adolescents are the inadequate partner notification of positive STI results and insufficient rates of partner testing and treatment. However, adolescent attitudes regarding partner notification and treatment are not well understood. The aim was to qualitatively explore the barriers to and preferences for partner notification and treatment among adolescent males and females tested for STIs in an emergency department (ED) setting and to explore the acceptability of ED personnel notifying their sexual partners.

Improving sexually transmitted infection results notification via mobile phone technology.

Purpose: To improve adolescent notification of positive sexually transmitted infection (STI) tests using mobile phone technology and STI information cards.

Methods: A randomized intervention among 14- to 21-year olds in a pediatric emergency department (PED). A 2 × 3 factorial design with replication was used to evaluate the effectiveness of six combinations of two factors on the proportion of STI-positive adolescents notified within 7 days of testing.

Point-of-care tests for sexually transmissible infections: what do 'end users' want?

Background: Clinicians and developers identify sensitivity as an important quality in a point-of-care test (POCT) for sexually transmissible infections (STIs). Little information exists regarding what patients want for STI POCTs.

Methods: A qualitative study, encompassing five focus groups among attendees of STI and adolescent health centres in Baltimore, Maryland, and Cincinnati, Ohio, were conducted between March 2008 and April 2009.

Blind evaluation of the microwave-accelerated metal-enhanced fluorescence ultrarapid and sensitive Chlamydia trachomatis test by use of clinical samples.

Accurate point-of-care (POC) diagnostic tests for Chlamydia trachomatis infection are urgently needed for the rapid treatment of patients. In a blind comparative study, we evaluated microwave-accelerated metal-enhanced fluorescence (MAMEF) assays for ultrafast and sensitive detection of C. trachomatis DNA from vaginal swabs.

The utility of a composite index for the evaluation of ovarian torsion.

Background/purpose: Ovarian torsion (OT) is a clinical diagnosis with a variable presentation. The aim of this study was to develop a practical scoring system to predict patients with OT in the pediatric population to facilitate more accurate diagnosis.

Methods: A retrospective study evaluating menarchal pediatric patients (1998 to 2005) with surgically confirmed OT (n = 28) compared with patients with abdominal pain and surgically confirmed non-OT (n = 26).

Gynecologic knowledge is low in college men and women.

Study Objective: Although men may influence women's reproductive choices, little is known about men's knowledge regarding gynecologic matters (eg, sex, anatomy, and contraception). This study aimed to evaluate the level of gynecologic knowledge among college students, particularly to investigate the differences in knowledge between men and women.

Design, Setting, Participants: We administered a survey to assess knowledge of sex, contraception, and female anatomy to college students at a Midwestern university during the spring 2010 semester.

Point-of-care testing improves accuracy of STI care in an emergency department.

Objectives: We aimed to examine the impact of a point-of-care (POC) test on overtreatment and undertreatment of sexually transmitted infections (STIs) by comparing treatment patterns for gonorrhoea (detected with nucleic acid amplification testing (NAAT)) with trichomoniasis (detected by POC test) for young women seen in an emergency department (ED).

Methods: We reviewed the database of a quality improvement (QI) project that aims to improve follow-up care for STIs in the ED. Data included the test result and antibiotic given (if any) during visits by women age 14-21 for whom an STI test was ordered.

Pediatric emergency department provider perceptions of universal sexually transmitted infection screening.

The purpose of this study was to describe the perceptions of pediatric emergency care providers in relation to implementing a universal sexually transmitted infection screening process for adolescent female patients in a pediatric emergency department. A descriptive qualitative design was used with a convenience sample of pediatric emergency physicians and nurses working in a large urban, pediatric teaching hospital. Participants were individually interviewed using a standard interview guide.

Clinical evidence for the role of Trichomonas vaginalis in regulation of secretory leukocyte protease inhibitor in the female genital tract.

Background: Secretory leukocyte protease inhibitor (SLPI) is responsible for regulating inflammatory damage to and innate and adaptive immune responses in the vaginal mucosa. Depressed cervicovaginal SLPI levels have been correlated with both Trichomonas vaginalis infection and poor reproductive health outcomes.

Methods: We measured levels of SLPI in 215 vaginal specimens collected from adolescent and young adult females aged 14-22 years.

Abnormal vaginal pH and Mycoplasma genitalium infection.

Study Objective: Mycoplasma genitalium (MG) is a sexually transmitted pathogen linked to female morbidity, but testing for MG is not standardized. We aimed to determine which point-of-care (POC) vaginal tests could predict MG infection.

Design, Setting, Participants: A cross sectional study recruited sexually active adolescent women, aged 14-22 y (n = 217) from an urban medical center.

Minding the Gap: An approach to determine critical drivers in the development of Point of Care diagnostics.

INTRODUCTION: A point of care test (POCT) for Chlamydia trachomatis detection is an urgent public health need. Technology advances in diagnostics have made solutions possible. Yet no reliable POCT exist.

Clinical variability in approaches to polycystic ovary syndrome.

Study Objective: The objective of this study was to evaluate methods of initial diagnosis and management of polycystic ovary syndrome (PCOS) among members of the North American Society for Pediatric and Adolescent Gynecology (NASPAG) to assess the degree of practice heterogeneity among specialist providers of adolescent care.

Design: Cross-sectional, anonymous, internet survey

Participants: NASPAG membership (N = 326; Respondents = 127 (39%))

Results: Percentage of respondents who incorporated specific tests at initial diagnosis was highly variable ranging from 87% (thyroid stimulating hormone) to 17% (sex hormone binding globulin). Oral contraceptives and diet modification/exercise were the most common therapies recommended by 98% and 90% of respondents respectively.

Improving notification of sexually transmitted infections: a quality improvement project and planned experiment.

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.

Low prevalence of Chlamydia trachomatis infection in non-urban pregnant women in Vellore, S. India.

Objective: To determine the prevalence and risk factors for Chlamydia trachomatis (CT) infection in pregnant women and the rate of transmission of CT to infants.

Methods: Pregnant women (≥28 weeks gestation) in Vellore, South India were approached for enrollment from April 2009 to January 2010. After informed consent was obtained, women completed a socio-demographic, prenatal, and sexual history questionnaire.

MRSA: rare in the vagina.

Study Objective: To determine the prevalence of vaginal Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) in sexually active adolescent women.

Design: A prospective surveillance study.

Acceptability of self-testing for trichomoniasis increases with experience.

Objectives: Self-testing and point-of-care (POC) tests could improve the detection of sexually transmitted infections (STIs) in adolescents. This study aimed to (1) validate a scale measuring acceptability of self-testing for trichomoniasis, (2) compare acceptability of self versus clinician testing using a POC test for trichomoniasis, (3) examine changes in acceptability after experience and review of results, and (4) examine predictors of acceptability.

Methods: Women (14-22 years old) performed the POC test and completed surveys assessing acceptability of self and clinician testing at baseline, after testing, and after discussion of results.

Biomarkers to distinguish surgical etiologies in females with lower quadrant abdominal pain.

Objectives: Lower abdominal pain is a common complaint in girls and young women presenting to a pediatric emergency department (PED). An extensive evaluation may be required to exclude surgical emergencies such as appendicitis and ovarian torsion. However, clinicians and families prefer to limit invasive procedures and radiation exposure.

Adolescent Sexually Transmitted Infections: A Community Epidemic.

Women under 25 years of age have higher rates of sexually transmitted infections (STIs) than other populations. Providing follow-up for adolescents with an STI is especially challenging in emergency departments (EDs). In our ED, we discovered that a significant number of adolescents with an STI did not receive adequate treatment, and 25% of those with an STI who were treated remained unaware of their infection.