Implementation of trauma-informed care strategies in a comprehensive maternal-fetal care center.

Objective: To identify traumatic stress symptoms among expectant parents with a confirmed congenital anomaly and describe the ways in which a maternal-fetal care center, with an embedded multidisciplinary psychosocial support team, provides specific trauma-informed strategies to mitigate psychological distress from the first patient contact throughout prenatal care practice.

Method: Traumatic stress symptoms in response to the confirmed congenital anomaly were assessed using the Impact of Events Scale-Revised. With Institutional Review Board approval, a total of 4,391 pregnant parents and 3,570 partners were analyzed based on routine universal screening performed in a single maternal-fetal care center.

Maternal Depressive Risk in Prenatal versus Postnatal Surgical Closure of Myelomeningocele: Associations with Parenting Stress and Child Outcomes.

Introduction: Depressive risk is higher for mothers of infants with chronic medical conditions. The present study examined maternal depressive risk and associations with parent and child outcomes among mothers of young children who were randomized to either prenatal or postnatal surgical closure for myelomeningocele.

Methods: Using the Management of Myelomeningocele Study database, maternal depressive risk was examined at 3 time points as follows: prior to birth, 12 months, and 30 months post birth.

The rise of tele-mental health in perinatal settings.

We discuss the use of tele-mental health in settings serving expectant parents in fetal care centers and parents with children receiving treatment in neonatal intensive care units within a pediatric institution. Our emphasis is on the dramatic rise of tele-mental health service delivery for this population in the wake of the onset of the COVID-19 pandemic in the U.S.

The impact of our images: psychological implications in expectant parents after a prenatal diagnosis.

Parents are at heightened risk for perinatal depression, anxiety and traumatic stress after receiving a prenatal diagnosis of a congenital anomaly. Identifying patients at risk and implementing effective support is crucial to optimizing care in this vulnerable population. A multidisciplinary care team with embedded psychosocial support services can be utilized to evaluate and address the needs of pregnant women and their families, not only at the time of diagnosis, but throughout the course of the pregnancy and postpartum period.

Developing an Infrastructure for Bereavement Outreach in a Maternal-Fetal Care Center.

Although bereavement programs are a common element of palliative medicine and hospice programs, few maternal-fetal care centers offer universal bereavement outreach services following perinatal loss. In this article, we describe the implementation of a bereavement outreach program at the Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia. The four primary goals identified when developing the bereavement outreach protocol included: (1) centralize communication for patient tracking when a perinatal loss occurs, (2) provide individualized and consistent resource support for grieving patients and families, (3) identify strategic outreach points throughout the first year post-loss, and (4) instate programmatic improvements in response to feedback from patients and their families.

Utilization, financial outcomes and stakeholder perspectives of a re-organized adult sickle cell program.

In 2011 Yale New Haven Hospital, in response to high utilization of acute care services and widespread patient and health care personnel dissatisfaction, set out to improve its care of adults living with sickle cell disease. Re-organization components included recruitment of additional personnel; re-locating inpatients to a single nursing unit; reducing the number of involved providers; personalized care plans for pain management; setting limits upon access to parenteral opioids; and an emphasis upon clinic visits focused upon home management of pain as well as specialty and primary care. Outcomes included dramatic reductions in inpatient days (79%), emergency department visits (63%), and hospitalizations (53%); an increase in outpatient visits (31%); and a decrease in costs (49%).

Addressing Perinatal Mental Health Risk within a Fetal Care Center.

Diagnosis of a fetal anomaly in pregnancy increases the risk for perinatal mental health difficulties, including anxiety, depression, and traumatic stress among expectant parents. Common emotional challenges include uncertainty about the diagnosis/prognosis, anticipated neonatal course, fears of fetal or neonatal demise, loss of a typical, uncomplicated pregnancy and postpartum course, and disruption of family roles due to medical care-related activities and restrictions. Psychologists in multidisciplinary fetal care centers are uniquely positioned to assess mental health risks and address the needs of expectant parents.

A randomized controlled study of intervention to improve continuity care engagement among HIV-infected persons after release from jails.

Short-term stay, multiple jail admissions and social and financial difficulties are significant obstacles for continuity care engagement (CCE) after release among HIV-infected jail detainees. However, data existing on interventions or strategies to increase post-release CCE among this population are limited. We conducted a randomized controlled study among HIV-infected detainees at Cook County Jail during 2011-2014.

Marijuana Use in Adults Living with Sickle Cell Disease.

Legal access to marijuana, most frequently as "medical marijuana," is becoming more common in the United States, but most states do not specify sickle cell disease as a qualifying condition. We were aware that some of our patients living with sickle cell disease used illicit marijuana, and we sought more information about this. We practice at an urban, academic medical center and provide primary, secondary, and tertiary care for ∼130 adults living with sickle cell disease.

Facilitating Milk Donation in the Context of Perinatal Palliative Care.

The option to donate milk within the context of perinatal palliative care allows pregnant women to be involved in medical decision making before birth. In this article we examine how a perinatal bereavement program engages women and families in the process of milk donation when the deaths of their newborns are anticipated. We include two case examples to offer insight into the complexities within the patient experience of milk donation after perinatal loss.

The Canada-Guyana medical education partnership: using videoconferencing to supplement post-graduate medical education among internal medicine trainees.

Background: A Guyana-based, internal medicine (IM) post-graduate medical education program was established in 2013. However, lack of formal teaching sessions are barriers to the program's success.

Objective: To describe the partnership between the University of Calgary and the University of Guyana's internal medicine residency programs (IMRP).

Universal Postpartum Mental Health Screening for Parents of Newborns With Prenatally Diagnosed Birth Defects.

Objective: To describe the implementation of a nurse-led project to screen parents for depression and traumatic stress in the postpartum period after visiting their newborns in the NICU.

Design: A standardized universal mental health postpartum screening and referral protocol was developed for parents of high-risk neonates.

Setting/local Problem: The project occurred at the Garbose Family Special Delivery Unit, the world's first obstetrics unit housed within a pediatric hospital serving healthy women who give birth to newborns with prenatally diagnosed fetal anomalies.

Internal Medicine Residency Program in Guyana: A Collaborative Model for Sustainable Graduate Medical Education in Resource-Limited Settings.

The Georgetown Public Hospital Corporation (GPHC) started the Internal Medicine/Infectious Diseases residency program in 2013. It was a collaborative initiative between GPHC and University of Maryland. Since that time the program has gone through many trials and developed new partnerships and collaboration and emerged as a young successful program with close international links that have worked and persevered in developing the successful academic and professional careers of its residents.

A Proposed Model for Perinatal Palliative Care.

Perinatal palliative care allows for an active partnership among a pregnant woman, her family, and her multidisciplinary treatment team and addresses her specialized medical care, emotional, social, and familial needs when a life-limiting fetal diagnosis is confirmed. The purpose of this article is to highlight the multidisciplinary care model used within a perinatal palliative care program. A case study provides a unique perspective on support needed for parents who anticipate that their newborn may die before or shortly after birth.

Training Pediatric Psychologists for Perinatal Behavioral Health Services in a Pediatric Hospital.

Although pediatric hospitals specialize in providing care to children and adolescents, at The Children's Hospital of Philadelphia (CHOP), our team has been providing behavioral health services for two unique parent populations-parents with a child in the Newborn Infant Intensive Care Unit and pregnant women carrying fetuses with specific birth defects and receiving prenatal care in the Center for Fetal Diagnosis and Treatment. A new training program was developed to expand the scope of pediatric psychologists' practice to include perinatal behavioral health services, specifically for these two unique parent populations served at CHOP. The program includes direct service provision for adult mental health concerns, as well as education and support to help families cope with the existing medical conditions.

Identifying expectant parents at risk for psychological distress in response to a confirmed fetal abnormality.

The aim of the study was to determine the incidence of psychological distress among expectant women carrying fetuses with prenatal diagnosed abnormalities and their partners. A 2-year retrospective medical chart review was completed of 1032 expectant mothers carrying fetuses with a confirmed anomaly, and 788 expectant fathers, who completed the CFDT Mental Health Screening Tool. Furthermore, 19.

Opt-out screening for Chlamydia trachomatis and Neisseria gonorrhoeae in female detainees at Cook County jail in Chicago, IL.

Background: In April of 2011, the Cook County Jail initiated opt-out screening of all women for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) at the time of intake. In this retrospective review, we assess the impact of opt-out protocol on rates of testing, diagnoses, and successful treatment.

Methods: We collected the results of all CT and GC tests ordered during intake from April 2011 through December 2012 and reviewed the medical chart of every patient with a positive result for documentation of treatment.

Impact of community-associated methicillin resistant Staphylococcus aureus on HIV-infected patients.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as an increasingly important pathogen, causing infections in persons who have no significant healthcare exposures. Persons with human immunodeficiency virus (HIV) infection have been disproportionately affected by CA-MRSA, with increased colonization and infection documented. Several factors are likely involved in the increased CA-MRSA burden observed among HIV-infected patients, including immune factors as well as healthcare and community exposures.

Variability of transdermal fentanyl metabolism and excretion in pain patients.

Background: The rising popularity of the fentanyl transdermal patch and the striking number of deaths attributed to its prescribed use have brought attention to the large variability of fentanyl metabolism and the need for predictive models to prevent toxicity.

Objective: The purpose of this study was to determine the amount of both intrasubject and intersubject variability in fentanyl metabolism and excretion, using urinary excretion data from patients with chronic pain prescribed the fentanyl transdermal patch.

Methods: Liquid chromatography tandem mass spectrometry analytical technique was used to quantitate fentanyl and norfentanyl concentrations in spot urine specimens, after incubation with glucuronidase.

Early pregnancy in adolescents: diagnosis, assessment, options counseling, and referral.

Health care providers are faced with many challenges when working with adolescents. Vague symptoms, unreliable menstrual history, and adolescent reluctance to disclose sexual activity present challenges to early diagnosis. When pregnancy is suspected, clinicians need skills for accurate diagnosis, conducting comprehensive assessments, and providing options counseling.