bluuebunny/crossref_metadata_2025 huggingface dataset:
Gynecologic Cancers
Authors: Donovan Heidi S. , Thomas Teresa H.
Published: February 2021

Gynecologic cancer, which includes cancers of the ovary, endometrium, uterus, cervix, vagina, and vulva and trophoblastic disease, is the third most common cancer and the third leading cause of cancer deaths among women in the United States. Gynecologic cancer and treatment lead to a wide range of physical, psychological, and social challenges. Disparities based on race/ethnicity, socioeconomic status, and healthcare access are also prevalent for cervical cancer. Impairments in reproductive and sexual function are some of the most distressing consequences of gynecologic cancers. There is some evidence to support the use of psychological interventions, psycho-education to promote self-management of psychological and physical symptoms, sexuality counseling, and social support interventions.
Hematopoietic Dyscrasias and Stem Cell Transplantation/CAR-T Cell Therapy
Authors: Fann Jesse R. , Bates Nicole
Published: February 2021

This chapter describes the epidemiology, clinical presentation, assessment, and management of the many psychosocial issues and neuropsychiatric syndromes that may arise in patients with hematopoietic dyscrasias, including those undergoing hematopoietic stem cell transplantation (HSCT) and chimeric antigen receptor T (CAR-T) cell therapy. We focus our discussion on adults who are undergoing acute treatment and briefly discuss issues faced by long-term survivors, families, and caregivers. Although an increasing body of literature supports evidence-based management strategies, clinical recommendations for treatment continue to incorporate both empirical evidence and expert opinion. We conclude by proposing directions for future research that will lead to improved care and outcomes for this population.
HIV Infection and AIDS-Associated Neoplasms
Authors: Dognin Joanna S. , Selwyn Peter A.
Published: February 2021

Since the advent of highly active antiretroviral therapy (HAART), people living with HIV have aged and shown a growing vulnerability to a variety of comorbidities, including cancer. While the availability of HAART has led to a sharp decrease in the rates of non-AIDS-defining malignancies (non-ADMs), HIV-infected people exhibit increased risks for a range of non-AIDS-defining cancers, both at younger ages and in more aggressive forms than non-HIV-infected persons. The uncertainty of living with both HIV and cancer places significant stressors on the patient and their family and social unit. This chapter describes the prevalence of cancer in the HIV-infected population and presents behavioral risk factors for developing cancer. It discusses three patient vignettes to illustrate how the additional burden of cancer interfaces with psychological and systemic resources required for living with HIV. As HIV extends into its fifth decade, medical practices treating HIV require additional cancer education, prevention, and intervention initiatives to better serve this vulnerable population. Finally, given the tremendous mortality still exacted by HIV disease and malignancies, HIV team models must also incorporate and integrate palliative care and end-of-life care expertise into the comprehensive care of patients living with and dying from HIV.
Nausea and Vomiting
Authors: Lundi Laura J. , Ramchandran Kavitha
Published: February 2021

The etiology of nausea and vomiting, or emesis, is often multifactorial, so an emphasis is placed on patient evaluation. Antiemetics are often receptor antagonists that target the various pathways that provide input to the vomiting center of the brain. The causes of nausea and vomiting in oncology can be classified as malignancy or treatment related. Malignancy-related nausea and vomiting often results from increased pressure on an organ system and treatments focus on alleviating the underlying cause. Cancer treatment–related nausea and vomiting can occur due to disease-modifying therapy (oral/infusional), radiation, or other medications. Chemotherapy-induced nausea and vomiting can further be classified by the time between treatment and the appearance of the symptoms.
Cognitive and Behavioral Interventions
Authors: Andersen Barbara L. , Arrato Nicole A. , Dorfman Caroline S.
Published: February 2021

Cognitive and behavioral interventions are effective in treating mood and anxiety disorders in patients with cancer. Screening for disorders is more common, but referral (and uptake) of psychosocial services remains low relative to patient need. Efficacious, cognitive behavioral treatments (CBTs) are first-line treatments for adults with major depressive disorder (MDD) and generalized anxiety disorder (GAD), and there is accumulating evidence for CBT effectiveness for individuals with cancer. For those not yet diagnosed but with elevated symptoms, CBT has reduced symptoms and shown physical symptom and health-related quality-of-life improvements. Fewer studies have accrued patients diagnosed with MDD or GAD, but those studies also show CBT to be similarly effective. Thus far, CBT trials with MDD/GAD comorbidity, a common occurrence and negative prognostic factor, have not been conducted. CBT replication and extension trials are needed to confirm CBT as the treatment of choice for patients with psychiatric disorders.
Emotion-Focused Therapy
Authors: Manne Sharon
Published: February 2021

Emotion-focused therapy (EFT) is a psychological treatment that posits that exploring and understanding one’s painful emotions is necessary for adaptive functioning. EFT enhances clients’ awareness and ability to access, understand, interpret, regulate, and potentially transform their maladaptive emotional responses. This chapter describes the principles, intervention approaches, and empirical evidence evaluating EFT in both nononcology and oncology populations. There is extensive empirical evidence supporting EFT for the treatment of depression, anxiety, and traumatic life events and relationship distress among the general population. Although components of EFT, such as inner awareness and self-compassion, can be found in other psychological interventions provided to cancer patients and survivors, EFT has received little empirical attention in the psycho-oncology literature. There are only two studies that have evaluated EFT for cancer patients, and one of these studies did not support its efficacy. It may be premature to conclude whether EFT has clinical utility. Future work may benefit from a more formal test of EFT, where therapists are carefully trained and monitored to deliver EFT using the phases, steps, and approaches described in this chapter, both in the individual and couples’ context.
Dignity Therapy
Authors: Chochinov Harvey Max , Kredentser Maia S.
Published: February 2021

Maintenance and promotion of patient and family dignity is a core tenet of palliative care and has significant implications for end-of-life experience, with loss of dignity associated with increased suffering and desire for death. This chapter provides an overview of empirical research on dignity at the end of life, including the model of dignity in the terminally ill, measures to assess dignity including the Patient Dignity Inventory and the Dignity Impact Scale, and dignity therapy, an intervention aimed at bolstering dignity, meaning-making, and generativity needs to improve the end-of-life experience for patients and families. These topics are discussed in the context of a proliferation of research in the last decade across a diversity of cultures, languages, and illness groups.
Managing Cancer and Living Meaningfully (CALM) Therapy
Authors: Hales Sarah , Rodin Gary
Published: February 2021

Managing Cancer and Living Meaningfully (CALM) is a brief, semistructured individual intervention designed to alleviate distress and to promote psychological growth in individuals with advanced disease. This intervention emerged from a longitudinal program of research and from the theoretical traditions of relational, attachment, and existential theory. Through a process that supports affect regulation, attachment security, and reflective functioning, CALM focuses on four content domains: (1) symptom management and communication with health care providers; (2) changes in self and relations with close others; (3) spiritual well-being, sense of meaning, and purpose; and (4) preparing for the future, sustaining hope, and facing mortality. Caregivers are invited to one or more CALM sessions, during which communication, relational strengths and disruptions, and hopes and fears related to the present and to the future are addressed. Qualitative research has shown that the structure of CALM provides a safe place for cancer patients to explore their fears, to be seen in human terms, and to face the challenges and threats of advancing disease. Quantitative research has shown that compared to usual care, it leads to significantly greater reduction in and prevention of depressive symptoms and improvement in death preparation. Therapist skill in the delivery of CALM is developed through didactic and experiential workshops and by ongoing supervision.
Bereavement Interventions in the Setting of Cancer Care
Authors: Lichtenthal Wendy G. , Roberts Kailey E. , Prigerson Holly G. , Kissane David W.
Published: February 2021

Grieving often begins at the time of cancer diagnosis, continuing as the patient faces numerous role and functional losses, surging when death is anticipated, and typically manifesting most intensely for the relatives after the patient’s death. This chapter focuses on how providers may support those who are grieving, describing common grief reactions, risk factors for poor bereavement outcomes, and interventions that have garnered empirical support in the growing grief intervention evidence base. Supportive psychotherapy normalizes grief, educates about adaptive reactions to loss and change, explores any maladaptive coping, and assesses for complicated grief. Psycho-oncologists can continue family-centered care through bereavement by providing empirically supported grief interventions or making appropriate referrals when there is a need for more specialized grief support. The strongest intervention effects are likely to be seen when targeting high-risk or symptomatic individuals at least six months postloss. Given the substantial variability in the quality of grief intervention research, future clinical trials should utilize rigorous methods, while remaining mindful of ethical research practices with vulnerable bereft individuals. Notably, there has been limited research focusing specifically on those bereaved by cancer, who often have traumatic experiences and vulnerabilities. In addition, more resources are needed to implement evidence-based bereavement care in oncology settings.
Digital Health Interventions for Psychosocial Distress (Anxiety and Depression) in Cancer
Authors: Beatty Lisa , Dhillon Haryana
Published: February 2021

While therapist-administered psychological interventions for cancer-related distress are demonstrably effective, they have been limited by low uptake. Consequently, interest in digital health interventions for psychosocial distress in cancer has surged. This chapter outlines the current evidence base for digital health interventions for adults with cancer distress, covering (1) interventions that connect patients to one another, or to health care practitioners, and (2) patient online self-management. The chapter addresses the full treatment trajectory from diagnosis through survivorship, as well as advanced/palliative populations. While promising, this field faces notable limitations/challenges, and recommendations for future research and clinical translation are therefore discussed.
The Family Meeting
Authors: Mooney Stefanie N. , Olivares Marinel
Published: February 2021

Cancer is a challenging experience for the clinical team, the patient’s family, and especially the patient. Important medical decisions are often made without the patient completely understanding their condition and options, as well as without the clinical team fully appreciating the patient’s values that go into making healthcare choices. Family meetings are one way to address these concerns. This chapter will review the importance and benefits to holding a structured family meeting, explore appropriate timing to have a meeting, and discuss the key participants. A detailed discussion follows on how to prepare for the meeting, highlighting an exploration of patient and family values and goals, as well as a premeeting among clinical team members. The structure of the meeting itself is then described, including introductions between the medical team and family, gauging the patient and family’s understanding, providing clinical information and recommendations, giving psychosocial support, reconciling medical recommendations with values, and postmeeting debriefing. Throughout the text, specific advice is provided on how to ensure the family meeting is as successful as possible so that patient-centered care is the ultimate priority.
Sexual and Gender Minority Health in Psycho-Oncology
Authors: Kamen Charles , Tree Jennifer M. Jabson
Published: February 2021

Undergoing cancer treatment and transitioning to survivorship presents challenges for all individuals, and sexual and gender minority (SGM) individuals may face additional challenges based on the multiple identities they bring into cancer care (sexual orientation, gender identity, and gender expression, as well as race, ethnicity, socioeconomic status, and other identities). Psychosocial oncology providers are in a unique position to address these challenges and improve the experience of cancer care for SGM patients. This chapter discusses psycho-oncology care issues specific to SGM cancer patients, including general health disparities affecting SGM communities; specific disparities in cancer risk factors, incidence, and outcomes; psychosocial needs among SGM cancer patients; and recommendations for developing psycho-oncology services to address the needs of SGM patients.
Biobehavioral Psycho-Oncology Interventions
Authors: Hoyt Michael A. , Penedo Frank J.
Published: February 2021

Interventions in psycho-oncology have strong evidence for improving health-related quality of life, reducing distress, and enhancing emotional and physical well-being across the cancer trajectory. An expansion of this work has taken a biobehavioral focus. Biobehavioral interventions target the biological mechanisms and processes underlying cancer-relevant outcomes. The goals of such biobehavioral interventions have included altering physiological processes of stress and distress, relieving cancer-related symptoms by targeting common biological mechanisms, and promoting slower disease progression. This chapter provides a brief overview of this work including conceptual frameworks, an introduction to the commonly targeted intervention-sensitive biomarkers, and an examination of current evidence for biobehavioral intervention efficacy. Developing the evidence base and enhancing the clinical impact of biobehavioral interventions are discussed.
Geriatric Psycho-Oncology Assessment Issues and Interventions
Authors: Trevino Kelly M. , Saracino Rebecca M. , Roth Andrew J. , Alici Yesne , Nelson Christian J.
Published: February 2021

Older adults make up more than half of the cancer diagnoses and even a greater percentage of cancer survivors. The combined issues of aging and cancer can lead a significant number of these patients to experience emotional distress as they manage the comorbidities related to aging, the psychological impact of a cancer diagnosis, and the acute and long-term side effects of treatment. Anxiety and depression are common in older adults with cancer, and there are unique aspects when considering these constructs in this group. Many older adults experience physical and social changes that may leave them vulnerable to psychological difficulties. The assessment of anxiety and depression can be challenging as many symptoms of these constructs overlap with the comorbidities of aging and the side effects of treatment. The psychotherapy and psychopharmacologic treatments should be tailored to the unique needs of this population. More directive, structured psychotherapies such as cognitive behavioral therapy (CBT) and problem-solving therapy (PST) tend to be more effective for older adults than open-ended, explorative approaches. Psychopharmacologic treatments should be started at lower doses and titrated slowly. With the continued growth in this population, combined with the unique aspects of assessment and treatment, it is important to understand the basic psycho-oncology principles of working with older adults with cancer.
Screening and Assessment in Pediatric Psycho-Oncology
Authors: Burgers Darcy E. , Tarquini Sarah J. , Kazak Anne E. , Muriel Anna C.
Published: February 2021

This chapter provides an overview of current and recommended practices regarding systematic screening and assessment of psychosocial needs in pediatric oncology. The chapter reviews published recommendations from the Psychosocial Standards of Care Project for Childhood Cancer and provides information about validated instruments for brief screening of children and their families. It also describes guidelines for using follow-up symptom-based measures and in-person clinical assessment. It includes a summary of what is known about the current implementation of screening nationally, and possible steps to enhance implementation. There is also special consideration of screening and assessment of unique medical populations within pediatric oncology, children with developmental concerns, and families from different cultures. Future directions include using implementation science to develop models for routine screening and demonstrating the impact of screening on psychosocial outcomes for patients and families and on the system of pediatric oncology care.
Evidence-Based Psychosocial Interventions in Pediatric Psycho-Oncology
Authors: Wiener Lori , Barnett Marie , Flowers Stacy , Fair Cynthia , Thompson Amanda L.
Published: February 2021

Children with cancer and their families experience significant emotional distress throughout the cancer trajectory. Evidence-based psychosocial interventions can alleviate suffering and promote adaptation and positive coping strategies. This chapter reviews interventions frequently used within pediatric oncology settings, including evidence-based approaches and those with limited empirical data to date. Interventions utilized at initial diagnosis, during active treatment, throughout survivorship, and at end of life and bereavement are presented. Strategies such as psychoeducation, procedural support for children, mind-body interventions, play and expressive techniques, cognitive-behavioral therapy, acceptance and commitment therapy, adherence interventions, support groups, communication, and advanced care planning tools are described along with available efficacy information. Data is also presented to describe the interventions most commonly used by pediatric psychosocial providers when caring for children with cancer and their families. The development of evidence-based standards of psychosocial care highlight the significant progress made toward supporting children with cancer and their families. Gaps in interventions are addressed, particularly on developmental and culturally sensitive approaches, school re-entry support, pediatric to adult care transitions, individual bereavement interventions, and intervention format/delivery. The field of pediatric psycho-oncology would benefit from ongoing translation of science into practice and increased access to evidence-based interventions.
Couples Facing Cancer
Authors: Badr Hoda , Bitz Courtney
Published: February 2021

Cancer survivors experience significant physical, psychological, and social challenges that contribute to poor quality of life. Intimate partners provide critical care and support across the cancer continuum, but they report psychological distress, lack basic healthcare knowledge and skills, and experience increased tension and conflict in their relationships with survivors. Couple-based interventions hold great promise in cancer because they can simultaneously address survivor, partner, and relationship concerns. However, they are seldom implemented in healthcare settings as part of routine care. This chapter will therefore integrate what research has taught us about couples and cancer and what we have learned from couples in the clinical setting. We begin with an overview of challenges faced by couples across the cancer continuum, including biopsychosocial stressors. Next, we describe different perspectives that have shaped descriptive and intervention research on couples’ psychosocial adaptation to cancer. We conclude with clinical implications and directions for future research.
Adult Survivors of Childhood Cancer
Authors: Schwartz Lisa A. , Wakefield Claire E. , McLoone Jordana K. , Werba DeRosa Branlyn , Kazak Anne E.
Published: February 2021

Young adult survivors of childhood cancer have unique challenges and perspectives related to their childhood cancer experience. Like younger survivors, they are at risk for late effects, which often increase with age. However, they have greater risk of adjustment difficulties than younger survivors, do not engage in optimal levels of health behaviors to mitigate risk for future cancer and late effects, and often do not engage in appropriate adult-oriented follow-up care. Further, young adult survivors may deal with cognitive, educational, social, and vocational challenges, as well as difficulty in autonomous functioning. A variety of demographic and disease- and treatment-related variables confer risk for negative outcomes, with brain tumor survivors or those with treatment exposures to the central nervous system most often at risk. On the other hand, young adult survivors and their parents experience positive psychological benefits of the cancer experience. Emerging topics for further research include the impact of new therapies (e.g., immunotherapy, proton therapy) and genetic predisposition.
Principles of Communication Skills Training in Cancer Care across the Life Span and Illness Trajectory
Authors: Kissane David W. , Bylund Carma L.
Published: February 2021

Evidence is growing that communication skills training can help clinicians to become more empathic and use open questions in a patient-centered manner. More work is needed to see these gains translate into improved patient outcomes. A core curriculum has matured as a conventional component of training in cancer care. Strong evidence supports the use of question prompt lists, decision aids, and audio recording of important consultations for later review by the patient and family. Gains are being made with communication challenges such as discussing internet-derived information. Patient training about optimizing their communication has started to complete the reciprocal interaction.
Implementation of Clinical Practice Guidelines for Psychosocial Cancer Care
Authors: Turner Jane , Rankin Nicole
Published: February 2021

Psychosocial clinical practice guidelines (CPGs) provide evidence-based recommendations regarding clinical care in oncology, ranging from screening for distress to identification and treatment of disorders such as depression and anxiety. This chapter describes the evolution of CPGs, frameworks for evaluation of quality, and strategies for dissemination and implementation. It also describes the challenges in implementation of CPGs including the quality of supporting psychosocial research, which is dominated by descriptive studies rather than interventions; insufficient cost-benefit research to leverage practice change; and lack of research to guide recommendations in low- and middle-income countries. Strategies to increase implementation include alignment of research with implementation science, embedding psychosocial care in national cancer plans, and focus on systems design and clinician engagement. The role of patients and caregivers as advocates for access to evidence-based psychosocial care is also discussed.
Lung Isolation Procedures
Authors: Miketic Renata , Raman Vidya T.
Published: February 2021

Lung isolation is used for many thoracic surgeries to provide exclusive ventilation of the nonoperative lung. This allows for the operative lung to be desufflated, improving surgical conditions and exposure. Additionally, in severe cases of unilateral lung infection or bleeding, ventilation of only the healthy lung can decrease the risk for contamination with blood and infected material from the diseased lung. Techniques used for achieving lung isolation include bronchial blocker placement, mainstem intubation, and use of a double-lumen tube. Although provider comfort and surgical preference often influence choice of technique, patient size and quality of lung isolation required are also guiding factors.
Pediatric Fluid Management and Infusion
Authors: Dixon Elizabeth , Attarpour Katiun
Published: February 2021

In the pediatric population, cases with significant blood loss represent a small percentage of surgeries. However, when significant blood loss does occur, management of fluids and blood products is critical. Examples of high blood loss pediatric surgeries may include trauma, burns, large tumors, scoliosis repair, craniosynostosis repair, neurosurgery, and cardiac surgery. In this chapter, fluid and blood management, as well as the setup of various types of fluid infusions and infusion pumps, are discussed. Surgical blood loss is particularly hazardous in children, given their low baseline blood volume. Crystalloid can be used initially; however, colloid (e.g., albumin), and blood products must be promptly considered for larger amounts of blood loss, based on clinical judgment and lab measurements. Blood loss and transfusion should additionally be discussed with the surgical team. Normally, mild anemia is tolerated in children when intravascular volume deficits are repleted. In addition to lab values, use clinical indicators including postoperative urinary output, heart rate, respiratory rate, and overall hemodynamic stability to guide transfusion decisions. The development of lactic acidosis is a late sign of inadequate oxygen-carrying capacity.
Peripheral Intravenous Line Access
Authors: Levey Tristan , Wuenstel Andrew , Foley Amanda
Published: February 2021

A peripheral intravenous catheter is used to access a peripheral vein. To start a peripheral intravenous line, identify the site, place a tourniquet, clean the skin, stabilize the vein, and insert the catheter. When a “flash” is obtained, thread off the catheter, connect it to the tubing, and secure. This chapter describes tips for finding common intravenous access sites in children, which are the metacarpal, saphenous, cephalic, median, and scalp veins. These veins vary in size, depth, and difficulty. Metacarpal/dorsal hand veins are on the dorsal aspect of the hand and typically arise from adjacent digital veins and form a network that usually provides several targets for access, although there is significant variation. These veins form the cephalic vein (radial side) and basilic vein (ulnar side) as they converge. The cephalic vein arises from the lateral (radial) side of the dorsal venous network before curving around the wrist to run along the anterolateral forearm, where it is frequently easily accessed. It continues on this course up the arm, but more proximally it is less superficial. The median cubital vein runs from the cephalic vein medially toward the basilic vein diagonally across the antecubital fossa and is reliably present if not always visible. The greater saphenous vein is formed on the foot from the dorsal vein of the great toe and the dorsal venous arch of the foot. It ascends anteriorly to the medial malleolus and superiorly up the medial calf.
Caudal Epidural Anesthesia
Authors: Hylton Jared R. E. , Pineda Jorge A.
Published: February 2021

Caudal epidural anesthesia in pediatric patients was first described in 1933 as a replacement for general anesthesia in 83 children undergoing transurethral surgery, and since that time it has been shown to be useful in a variety of surgeries. The popularity of this block stems from its efficacy, simplicity, speed, and relative safety. The caudal approach to the epidural space can be used for the administration of local anesthetic and adjunct medications for either surgical anesthesia or postoperative analgesia. This technique is most commonly applied to surgical procedures occurring below the umbilicus and is frequently used as a single injection technique to be performed after induction of general anesthesia and before surgical incision for augmentation of general anesthesia and postoperative pain control. For longer procedures, a catheter can be placed to facilitate repeat dosing at the conclusion of surgery. Alternatively, more cephalad dermatomes can be anesthetized with an epidural catheter threaded to the desired level. The benefits of caudal epidural anesthesia extend beyond postoperative analgesia and include decreased intraoperative anesthetic requirements and a reduction in the neuroendocrine stress response to surgery.
Pediatric Complex Regional Pain Syndrome: Stellate Ganglion and Lumbar Sympathetic Blocks
Authors: Choxi Sarah
Published: February 2021

Complex regional pain syndrome (CRPS) is a chronic, localized pain condition following an injury, typically affecting a distal extremity. Although the pathophysiology of CRPS is unclear, multiple mechanisms are implicated, including peripheral and central sensitization as well as sympathetically mediated pain. Peripheral nerve blockade can treat the somatic component of CRPS pain, while sympathetic blockade may alleviate pain that is sympathetically mediated. Signs and symptoms manifest as abnormal sensory, motor, vasomotor, and sudomotor changes that are disproportionate to the inciting event. Early recognition of the signs and symptoms, followed by rapid implementation of a multidisciplinary treatment approach—including physical therapy, psychotherapy, pharmacotherapy, and sympathetic nerve blocks, is a major factor in improving outcome and preventing treatment-resistant CRPS.
Anesthesia for Neonatal Myelomeningocele
Authors: Clebone Anna
Published: February 2021

Myelomeningocele, also known as spina bifida aperta (often shortened to the nonspecific name “spina bifida”) is a congenital disorder of the spine. In infants with a myelomeningocele, the neural tube has not closed, and the vertebral arches have not fused during development, leading to spinal cord and meningeal herniation through the skin. Because of the high potential for injury and infection of the exposed spinal cord, which could lead to lifetime disability, these lesions are typically repaired within 24 to 48 hours after birth. A myelomeningocele occurs before day 28 of human fetal development and is an abnormality in which the posterior neural tube closes incompletely. The outcome is a vertebral column deformity, through which the meningeal-lined sac herniates. After the bony defect is created, the hypothesized mechanism of meningeal herniation is that the pulsations of cerebrospinal fluid act progressively to balloon out the spinal cord. If the sac is filled with spinal nerves or the spinal cord, it is known as a myelomeningocele; if the sac is empty, it is called a meningocele.
Magnesium Sulphate for Seizure Prophylaxis in Women With Preeclampsia
Authors: Lindner Peter , Deering Shad
Published: February 2021

The article “Do Women With Pre-Eclampsia, and Their Babies, Benefit From Magnesium Sulphate? The Magpie Trial: A Randomized Placebo-Controlled Trial” is the first randomized trial that objectively evaluates the utility of magnesium sulphate therapy as prophylaxis against progression to eclamptic convulsions in a high-risk cohort of women. It specifically evaluates the effect of magnesium sulphate given before and after delivery on maternal progression to eclampsia and fetal/neonatal death. It also evaluates secondary outcomes such as maternal morbidity; magnesium toxicity; side effects of magnesium sulphate; and, for those who received magnesium sulphate prior to delivery, it evaluated complications of the labor process.
Low-Dose Aspirin for the Prevention and Treatment of Preeclampsia
Authors: Panelli Danielle M. , Lyell Deirdre J.
Published: February 2021

“CLASP: A Randomized Trial of Low-Dose Aspirin for the Prevention and Treatment of Preeclampsia Among 9364 Pregnant Women” was a double-blinded, placebo-controlled trial that evaluated the impact of antenatal aspirin administration on development of preeclampsia and intrauterine growth restriction (IUGR). A total of 9364 women either at risk for preeclampsia or currently experiencing preeclampsia or IUGR were enrolled between 12 and 32 weeks and randomized to receive 60mg aspirin daily or placebo. While a nonsignificant 12% reduction in the odds of preeclampsia was found among the entire cohort, the reduction in preeclampsia with aspirin use was more pronounced for those who began prophylaxis prior to 20 weeks (22% reduction, p = 0.06). There was also a lower risk of preterm birth before 37 weeks in those who received aspirin at any time (19.7% vs. 22.2%, p = 0.003) but no difference in IUGR infants. In conclusion, 60mg aspirin daily did not significantly reduce the risk of preeclampsia or IUGR among the women included in this study.
Reduction of Maternal–Infant Transmission of HIV Type 1 With Zidovudine Treatment
Authors: McElwee Eliza Rodrigue , Mehta Pooja K.
Published: February 2021

This article summarizes the landmark results of Pediatric AIDS Clinical Trials Group Protocol 076. Pregnant women between 14 and 34 weeks with a CD4 count above 200 and no indication for antiretroviral therapy were randomized to zidovudine treatment or placebo. Zidovudine was shown to reduce HIV transmission from mother to child by 67.5%. Zidovudine treatment was not associated with neonatal death, premature birth, fetal growth or structural abnormalities. The majority of maternal adverse effects were obstetric complications that were not associated with either placebo or intervention groups. It reviews study design, findings, and limitations. This study is then situated in historical context and in reference to current guidelines.
Pelvic Scoring for Elective Induction
Authors: Ajewole C. Sola , Abbott Jodi F.
Published: February 2021

This article reviews the commonly known Bishop score and how it was derived from the Pelvic Scoring for Elective Induction study. The study observed women in spontaneous labor, their initial cervical exams, as well as the development and implementation of pelvic scoring for labor induction. It reviews the components of the original Bishop score and compares it to a Simplified Bishop score and how their applications compare when determining the likelihood of success of vaginal delivery. It demonstrates how a cervix is determined to be favorable or unfavorable. This article includes a figure that displays time to delivery and the content is intended for providers in obstetrics and gynecology.
Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes
Authors: Johnson Katherine , Young Brett C.
Published: February 2021

This article provides a summary of a landmark study in obstetrics. The article provides insight on a pivotal question; Is delivery before 39 weeks among patients undergoing elective repeat cesarean delivery associated with increased risk of adverse neonatal outcomes? The authors describe the basics of the study, including study location, study population, number of patients, study design, endpoints, results, and limitations. The article briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The article places these finding in contemporary context and highlights its impact on obstetric care. In addition, the author reference updated national guidelines developed as a result of this study.
First-Trimester or Second-Trimester Screening, or Both, for Down Syndrome
Authors: Hart Jessica M. , O’Brien Barbara M.
Published: February 2021

The FASTER Trial by Malone et al. discusses methods of prenatal genetic screening for Down syndrome. The trial included 15 sites within the United States between 1999 and 2005. This trial was designed to compare the differences in detection rates of Down syndrome when applying screening tests from the first-trimester, second-trimester, or screening tests that combine markers from both trimesters. Screening tests evaluated in this trial include nuchal translucency, serum screen, combined screen, quadruple screen, independent sequential screen, stepwise sequential screen, serum integrated screen, and fully integrated screen. This trial compares detection rates, false positive rates, and timing of results between screening tests.
Complications of First-Trimester Abortion
Authors: Sackeim Maryl , Haider Sadia
Published: February 2021

This is a retrospective cohort study reporting on complications of 170,000 first-trimester abortions performed at 3 free-standing Planned Parenthood clinics in New York City from 1971 to 1987. There were no reported deaths. The overall rate of major complications was 0.71 per 1000 procedures, and the overall rate of minor complications was 8.46 per 1000 procedures. The complication rates were similar for patients undergoing general and local anesthesia. More recent studies on the safety of first-trimester abortion, which also included women with chronic medical conditions, have reconfirmed Hakim-Elahi and colleagues’ original findings. Given its observational design, the study findings have limitations due to bias. However, the study is unique in its scope given the large number of patients treated with a standardized protocol over an extensive period of time. The overwhelming evidence on the safety of abortion care in outpatient clinics has important access and policy implications.
Long-Acting Reversible Contraception (LARC) and Teen Pregnancy
Authors: Grentzer Jaclyn
Published: February 2021

Long-acting, reversible contraception (LARC), including intrauterine devices (IUDs) and contraceptive implants, are associated with higher contraceptive efficacy and continuation rates. Teen pregnancy rates have declined over the past 2 decades but continue to be a public health concern. Only 10% of teen girls elect to use LARC, likely due to educational, logistical, and economic barriers. The Contraceptive CHOICE Project enrolled 1404 girls aged 14 to 19. Of these teens, more than 70% chose LARC when given standardized contraceptive counseling and barriers to receiving LARC were removed. Pregnancy, live birth, and induced abortion rates in this cohort were lower than rates for the US population of sexually active teen girls. Failure rates were lower for LARC users, as compared to users of other reversible contraceptive methods.
Preoperative Urodynamics Testing in Stress Urinary Incontinence
Authors: Bradley Megan , Burkett Linda
Published: February 2021

This article outlines the scientific methods, results, and conclusions for the ValUE trial, “A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery.” The ValUE trial compared patients with stress urinary incontinence (SUI) who underwent office evaluation with or without preoperative urodynamics (UDS) testing prior to an anti-incontinence procedure. The majority of patients in the study underwent a mid-urethral sling. The study showed no difference in surgical or treatment outcomes for patients with uncomplicated SUI, signifying UDS may not be necessary in preoperative evaluation. Patient characteristics of uncomplicated SUI are discussed for translation into clinical practice. Reviews of related articles with secondary data analysis are summarized.
Prolonged GnRH Agonist and Add-Back Therapy for Symptomatic Endometriosis
Authors: Seaman Sierra J. , Hur Hye-Chun
Published: February 2021

Endometriosis patients receiving a 12-month course of GnRH agonist were randomized to receive one of three “add-back” regimens to address associated bone mineral density loss. Symptoms and pelvic examination scores improved for all patients. Mean bone mineral density was at or above baseline in patients receiving add-back therapy as compared to placebo. The authors concluded that patients who are receiving GnRH agonist should receive add-back therapy.
Reproductive Technologies and the Risk of Birth Defects
Authors: Sacha Caitlin , Petrozza John
Published: February 2021

Understanding the risks of adverse outcomes such as birth defects after the use of assisted reproductive technology (ART) is crucial for both OB/GYN physicians and patients suffering from infertility. In a South Australian population cohort study of 308,974 spontaneous and assisted pregnancies between 1986 and 2002 in women over age 20, assisted conceptions were associated with an increased risk of birth defects, including cerebral palsy, compared to spontaneous conceptions in fertile women (adjusted odds ratio 1.28, 95% confidence interval 1.16–1.41). However, when examining in vitro fertilization and intracytoplasmic sperm injection (ICSI) pregnancies, only ICSI with fresh transfer remained associated with an increased risk of birth defects compared to spontaneous conceptions in fertile women in adjusted models. These findings suggest that while patients should be counseled regarding the potential increased risk of birth defects with ART procedures such as ICSI, more research is needed regarding the impact of infertility itself and specific ART interventions on neonatal outcomes.
Application of Redefined Human Chorionic Gonadotropin Curves for the Diagnosis of Women at Risk for Ectopic Pregnancy
Authors: Tyan Paul , Schiff Lauren D.
Published: February 2021

Seeber et al. set forth the structure for objectively assessing the trend of human chorionic gonadotropin (hCG) rise or fall for the diagnosis of an ectopic pregnancy. The primary goal of their work was to improve the accuracy of the diagnosis of an ectopic pregnancy based on 2 hCG values in an effort to provide the framework for counseling patients using objective data to guide clinical practice. Their proposed cutoff values provided high specificity and sensitivity to make the correct diagnosis, saved the patients multiple visits, and shortened the time-to-diagnosis. Based on the data published in this article, clinicians should be incentivized to use other resources to aid in the diagnosis of patients who present to the emergency department with pain or bleeding in the setting of early pregnancy. The hCG trends should guide clinical decision-making; however, other modalities to aid in diagnosis should be employed.
Stanford’s Brainstorm Lab for Mental Health Innovation
Authors: Albuquerque Anjali , Chaudhary Neha P , Aragam Gowri G , Vasan Nina
Published: February 2021

Stanford Brainstorm, the world’s first lab for mental health innovation, taps into the combined potential of academia and industry—bridging medicine, technology, and entrepreneurship—to redesign the way the world views, diagnoses, and treats mental illness. Convergence science has facilitated Brainstorm’s emergence as a pivotal protagonist in the history of the mental health innovation field. In turn, Brainstorm has catalyzed innovation within mental health by applying convergent approaches to tackle the scope, immediacy, and impact of mental illness. Stanford Brainstorm’s thinking about mental health represents a shift in the discipline of psychiatry from a focus on one-to-one delivery to collaborative and sustainable solutions for millions.
Antidepressants
Authors: Roth Andrew J. , Nelson Christian J.
Published: February 2021

Although many people with cancer experience depressive moods, not all will have a major depressive episode. It is therefore important to distinguish and address subsyndromal depression from a depressive syndrome that could benefit from psychopharmacologic intervention. This chapter discusses risk factors for depression in cancer patients and provides suggestions for improving identification of depression in complicated cancer situations. The goal is to help non-prescribing clinicians more easily decide when referrals for medication are warranted and how to maintain connections and enhance communication with prescribers after medications are started. Pearls and potholes of why different medications are used for specific circumstances, and how prescribers seek to obtain more than one use out of a single medication, are described.
Medications for Sleep Disturbance
Authors: Roth Andrew J. , Nelson Christian J.
Published: February 2021

Insomnia, or sleep disturbance, manifests in many ways in people with cancer. Sleep complaints may be intermittent, often related to specific situations or medical problems. They can develop into an ongoing syndrome and can severely impair a person’s quality of life with compromised energy and risk for falls. Non-prescribers are often called upon to assist with teaching healthy nonpharmacologic sleep hygiene techniques. However, it is important to recognize when a proper medication can assist or supplement good sleep habits and make a timely referral to a prescriber. This chapter discusses the potential benefits and pitfalls of medications used to induce and maintain sleep and how patients can integrate medication use into the standard nonmedication sleep-promoting techniques. All clinicians will be able to monitor for potential side effects of hypnotics (sleep medications), including cognitive and balance abnormalities, as well as compromised daytime energy and alertness, which might discourage patients from taking these medications.
The Art and Science of Compassion, A Primer
Authors: Wong Agnes M.F.
Published: February 2021

The Art and Science of Compassion, A Primer is designed as a short, “all-in-one,” introductory text that covers the full gamut of compassion, from the evolutional, biological, behavioural, and psychological, to the social, philosophical, and spiritual. Written with busy trainees, clinicians, and educators in mind, it aims to address the following questions: What is compassion? Is it innate or a trainable skill? What do different scientific disciplines, including neuroscience, tell us about compassion? Why is “compassion fatigue” a misnomer? What are the obstacles to compassion? Why are burnout, moral suffering, and bullying so rampant in healthcare? And, finally, what does it take to cultivate compassion? Drawing on her diverse background as a clinician, scientist, educator, and chaplain, Dr. Wong presents a wealth of scientific evidence supporting that compassion is both innate and trainable. By interleaving personal experiences and reflections, she shares her insights on what it takes to cultivate compassion to support the art of medicine and caregiving. The training described draws on both contemplative and scientific disciplines to help clinicians develop cognitive, attentional, affective, and somatic skills that are critical for the cultivation of compassion. Compassion not only benefits the recipients, produces better patient care, and improves the healthcare system, but it is also a boundless source of energy, resilience, and wellness for the givers. With striking illustrations for key concepts and a concise summary for each chapter, this book provides a solid conceptual framework and practical approaches to cultivate compassion. It serves to complement the experiential component of compassion that the readers are strongly encouraged to develop and practise in their daily lives.