Early medical abortion using telemedicine – acceptability to patients

ABSTRACTIntroductionThe English government approved both stages of early medical abortion (EMA) for at-home use on 30th March 2020. MSI Reproductive Choices UK (MSUK), one of the largest service providers of abortion services in England, launched a telemedicine EMA pathway on 6th April 2020.MethodsA sample of all MSUK’s telemedicine EMA patients between April and August 2020 were invited to opt in to a follow-up call to answer clinical and satisfaction questions. 1,243 (13.7% of all telemedicine EMAs) were successfully followed-up, on average within five days post-procedure. Responses were analysed quantitatively and descriptively. The sample was compared to the total telemedicine EMA population on nine sets of background characteristics to check sample validity, and all results were tested across the same nine characteristics for variation.ResultsPatients reported high confidence in telemedicine EMA and high satisfaction with the convenience, privacy and ease of managing their abortion at home. No patient reported that they were unable to consult privately. Over 80% of patients reported preferring the telemedicine pathway, and two-thirds that they would choose telemedicine again if COVID-19 were no longer an issue.DiscussionTelemedicine EMA is a valued, private, convenient and easier option that is highly acceptable for patients seeking an abortion, especially those for whom in-clinic visits are logistically or emotionally challenging. Evidence that this pathway would be a first choice again in future for most patients supports the case to make access to telemedicine EMA permanent.Key message pointsOn 30th March 2020, the English government approved both stages of early medical abortion (EMA) for at-home use, paving the way for telemedicine EMA provision.MSUK patients receiving routine follow-up calls reported high confidence in telemedicine EMA and high satisfaction with the privacy, convenience and ease of this pathway.Two-thirds of telemedicine EMA patients reported they would choose this pathway again in future, demonstrating that it should remain available after the COVID-19 pandemic.

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Acceptability of no-test medical abortion provided via telemedicine: analysis of patient-reported outcomes

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2020-200954 ◽

2021 ◽

pp. bmjsrh-2020-200954

Author(s):

Chelsey Porter Erlank ◽

Jonathan Lord ◽

Kathryn Church

Keyword(s):

Patient Reported Outcomes ◽

Medical Abortion ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Post Procedure ◽

High Satisfaction ◽

First Choice ◽

Patient Reported ◽

At Home

IntroductionThe English government approved both stages of early medical abortion (EMA), using mifepristone and misoprostol under 10 weeks’ gestation, for at-home use on 30 March 2020. MSI Reproductive Choices UK (MSUK), one of the largest providers of abortion services in England, launched a no-test telemedicine EMA pathway on 6 April 2020. The objectives of this study were to report key patient-reported outcome measures and to assess whether our sample was representative of the whole population receiving no-test telemedicine EMA.MethodsA sample of all MSUK’s telemedicine EMA patients between April and August 2020 were invited to opt in to a follow-up call to answer clinical and satisfaction questions. A total of 1243 (13.7% of all telemedicine EMAs) were successfully followed-up, on average within 5 days post-procedure.ResultsPatients reported high confidence in telemedicine EMA and high satisfaction with the convenience, privacy and ease of managing their abortion at home. The sample responding were broadly equivalent to the whole population receiving telemedicine. No patient reported that they were unable to consult privately. The majority (1035, 83%) of patients reported preferring the telemedicine pathway, with 824 (66%) indicating that they would choose telemedicine again if COVID-19 were no longer an issue.ConclusionsTelemedicine EMA is a valued, private, convenient and more accessible option that is highly acceptable for patients seeking an abortion, especially those for whom in-clinic visits are logistically or emotionally challenging. Evidence that this pathway would be a first choice again in future for most patients supports the case to make telemedicine EMA permanent.

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The Olympia anatomic polished cemented stem is associated with a high survivorship, excellent hip-specific functional outcome, and high satisfaction levels: follow-up of 239 consecutive patients beyond 15 years

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03992-z ◽

2021 ◽

Author(s):

Gareth S. Turnbull ◽

Claire Marshall ◽

Jamie A. Nicholson ◽

Deborah J. MacDonald ◽

Nicholas D. Clement ◽

...

Keyword(s):

Outcome Measures ◽

Femoral Stem ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

High Satisfaction ◽

Age At Surgery ◽

Patient Reported ◽

Cemented Stem ◽

Oxford Hip Score

Abstract Introduction The Olympia femoral stem is a stainless steel, anatomically shaped, polished and three-dimensionally tapered implant designed for use in cemented total hip arthroplasty (THA). The primary aim of this study was to determine the long-term survivorship, radiographic outcome, and patient-reported outcome measures (PROMs) of the Olympia stem. Patients and methods Between May 2003 and December 2005, 239 patients (264 THAs) underwent a THA with an Olympia stem in our institution. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS), EuroQol-5 dimensions (EQ-5D) score, and patient satisfaction at mean 10 years following THA. Patient records and radiographs were then reviewed at a mean of 16.5 years (SD 0.7, 15.3–17.8) following THA to identify occurrence of complications or revision surgery for any cause following surgery. Radiographs were assessed for lucent lines and lysis according to Gruen’s zones Results Mean patient age at surgery was 68.0 years (SD 10.9, 31–93 years). There were 156 women (65%, 176 THAs). Osteoarthritis was the indication for THA in 204 patients (85%). All cause stem survivorship at 10 years was 99.2% (95% confidence interval [CI], 97.9%–100%) and at 15 years was 97.5% (94.6%–100%). The 15-year stem survival for aseptic loosening was 100%. Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (96.3%–100%) at 10 years and 95.9% (92.4%–99.4%) at 15 years. There were 9 THAs with non-progressive lucent lines in a single Gruen zone and 3 had lines in two zones, and no patient demonstrated signs for lysis. At a mean of 10-year (SD 0.8, 8.7–11.3) follow-up, mean OHS was 39 (SD 10.3, range 7–48) and 94% of patients reported being very satisfied or satisfied with their THA. Conclusions The Olympia stem demonstrated excellent 10-year PROMs and very high rates of stem survivorship at final follow-up beyond 15 years.

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Use of an at-home multilevel pregnancy test and an automated telephone system to simplify medical abortion follow-up

Contraception ◽

10.1016/j.contraception.2017.02.013 ◽

2017 ◽

Vol 95 (5) ◽

pp. 518

Author(s):

H. Anger ◽

R. Dabash ◽

M. Peña ◽

D. Coutiño ◽

M. Bousiéguez ◽

...

Keyword(s):

Medical Abortion ◽

Pregnancy Test ◽

Telephone System ◽

At Home

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Self-Assessment at Home Is Feasible for Follow-up Of Medical Abortion

International Perspectives on Sexual and Reproductive Health ◽

10.1363/intsexrephea.41.3.168 ◽

2015 ◽

Vol 41 (3) ◽

pp. 168

Keyword(s):

Medical Abortion ◽

Self Assessment ◽

At Home

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Why Women Choose At-Home Abortion via Teleconsultation in France?: A Mixed-Method Study on Drivers of Telemedicine Abortion

10.1101/2021.04.19.21255757 ◽

2021 ◽

Author(s):

Hazal Atay ◽

Helene Perivier ◽

Kristina Gemzell-Danielson ◽

Jean Guilleminot ◽

Danielle Hassoun ◽

...

Keyword(s):

Mixed Method ◽

Public Involvement ◽

Medical Abortion ◽

Patient And Public Involvement ◽

Mixed Method Study ◽

List Type ◽

Cross Sectional ◽

Safe Abortion ◽

Abortion Care ◽

At Home

AbstractObjectivesIn face of the COVID-19 health emergency, France has allowed medical abortions to be performed by teleconsultation until 9 weeks of gestation. In an attempt to understand the demand and main drivers of telemedicine abortion, we analysed the requests that Women on Web (WoW), an online telemedicine abortion service operating worldwide, received from France throughout 2020.MethodsWe conducted a parallel convergent mixed-method study among 809 consultations received from France at WoW between 1 January and 31 December 2020. We performed a cross-sectional study of data obtained from the WoW consultation survey and a manifest content analysis of anonymised email correspondence of 140 women consulting with WoW helpdesk from France.ResultsWe found that women encounter macro-level, individual-level, and provider-level constraints while trying to access abortion in France. The preferences and needs over secrecy (46.2%), privacy (38.3%), and comfort (34.9%) are among the most frequent reasons for women from France to choose telemedicine abortion through WoW. The COVID-19 pandemic seems to be an important driver for resorting to telemedicine (30.6%). The lockdowns seem to have had an impact on the number of consultations received at WoW from France, increasing from 60 in March to 128 in April during the first lockdown and from 54 in October to 80 in November during the second lockdown.ConclusionsThe demand for at-home medical abortion via teleconsultation increased in France during the lockdowns. However, drivers of telemedicine abortion are multi-dimensional and go beyond the conditions unique to the pandemic. Given the various constraints women continue to encounter in accessing safe abortion, telemedicine can help meet women’s preferences and needs for secrecy, privacy and comfort, while facilitating improved access to and enabling more person-centred abortion care.Tweetable AbstractAt-home abortion via teleconsultation can help meet women’s needs and preferences for privacy, secrecy, and comfort, while facilitating improved access to abortion care in France.Key MessagesThe lockdowns seem to have had an impact on the number of consultations received at WoW from France, increasing from 60 in March to 128 in April during the first lockdown and from 54 in October to 80 in November during the second lockdown.While the COVID-19 pandemic was an important push factor for women to choose telemedicine, the drivers of telemedicine are multidimensional and go beyond conditions unique to the pandemic.Telemedicine can help meet women’s needs and preferences for privacy, secrecy, and comfort, while facilitating access to and enabling more person-centred abortion care in France.Funding InformationThis research was funded by a public grant overseen by the French National Research Agency (ANR) as part of the “Investissements d’Avenir” program LIEPP (ANR-11-LABX-0091, ANR-11-IDEX-0005-02) and the Université de Paris IdEx (ANR-18-IDEX-0001).Patient and public involvement statementThis public policy analysis does not involve patients or the public in the design, or conduct, or reporting, or dissemination plans of this work. However, the service that WoW provides is designed to address the priorities and experiences of people who access the service. Thus, the research questions were informed by the needs of people who rely on WoW to access abortion.Ethics approvalThe study was approved by the Regional Ethics Committee, Karolinska Institutet, Dnr 2009/2072-31/2 and Dnr 2020/05406.

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Adherence to treatment and prevalence of side effects when medical abortion is delivered via telemedicine

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2021-201263 ◽

2021 ◽

pp. bmjsrh-2021-201263

Author(s):

John Joseph Reynolds-Wright ◽

Anne Johnstone ◽

Karen McCabe ◽

Emily Evans ◽

Sharon Cameron

Keyword(s):

Side Effects ◽

Medical Abortion ◽

Drug Regimen ◽

Telephone Consultation ◽

Pain Scores ◽

Telemedicine Consultation ◽

Gastrointestinal Side Effects ◽

Scottish Government ◽

At Home

BackgroundThe Scottish government introduced legislation during the COVID-19 outbreak to permit medical abortion at home with telemedicine. All women received an initial telephone consultation. For those choosing medical abortion, we provided self-administered medications to eligible women with pregnancies under 12 weeks’ gestation.AimsTo assess adherence to the recommended abortion drug regimen, with particular focus on the number of misoprostol doses used and the interval between mifepristone and misoprostol administration and the induction–expulsion interval. Additionally, to evaluate use of analgesia, antiemetics and antibiotics, and the side effects, pain and bleeding profile of medical abortion at home.MethodsWe conducted a prospective cohort study of 663 women choosing medical abortion at home via telemedicine at an NHS abortion service in Edinburgh, Scotland between 1 April and 9 July 2020. Interviewer-administered questionnaires were completed at telephone follow-up 4 and 14 days following treatment. Outcome measures were self-reported and included use of mifepristone and misoprostol, induction–expulsion interval (time from misoprostol administration until expulsion of pregnancy), antiemetics, antibiotics, analgesia use, pain scores, rates of side effects, bleeding and preparedness for treatment.ResultsAmong the respondents, 652/663 women (98%) answered at least one questionnaire, and 594/663 (89.6%) used both abortion medications as directed (24–72 hours between medications). The mean (SD) induction–expulsion interval was 4.3 (4.3) hours. Antiemetics were used by 611/663 (92%), 383/599 (64%) completed the course of prophylactic antibiotics, and 616/663 (93%) used analgesia, with mean (SD) worst-pain scores of 6.7 (2.2) out of 10. Regarding side effects, 510/663 (77%) experienced either nausea, vomiting, diarrhoea or headache, 101/663 (15%) experienced headache and 510/663 (77%) experienced bleeding that was heavier than a period; 554/663, (84%) felt prepared for their treatment by teleconsultation.ConclusionPatients are able to correctly self-administer abortion medications following a telemedicine consultation. Further research is required to optimise pain management and gastrointestinal side effects during medical abortion.

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Use of an at-home multilevel pregnancy test and an automated call-in system to follow-up the outcome of medical abortion

International Journal of Gynecology & Obstetrics ◽

10.1002/ijgo.12679 ◽

2018 ◽

Vol 144 (1) ◽

pp. 97-102 ◽

Cited By ~ 3

Author(s):

Holly Anger ◽

Rasha Dabash ◽

Melanie Peña ◽

Dolores Coutiño ◽

Manuel Bousiéguez ◽

...

Keyword(s):

Medical Abortion ◽

Pregnancy Test ◽

At Home

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Mini-Slings: Do They Stand the Test of Time? A 10-Year Cohort

Urologia Internationalis ◽

10.1159/000511648 ◽

2020 ◽

pp. 1-5

Author(s):

Margarida Manso ◽

Francisco Botelho ◽

Carlos Silva ◽

Francisco Cruz

Keyword(s):

De Novo ◽

Treatment Success ◽

Anticholinergic Drugs ◽

Patient Global Impression ◽

High Satisfaction ◽

Patient Reported ◽

De Novo Urgency ◽

Satisfaction Rates ◽

Mini Sling

Introduction: It is known that failures after midurethral slings increase with the follow-up time. Nevertheless, data concerning mini-slings are sparse. To clarify this statement, we analyze a mini-sling cohort with a median follow-up of 10 years. Although the brand used, MiniArc®, is no longer available, an identical device, Solyx™, can still be used, which makes the analysis of the cohort clinically relevant. Material and Methods: A total of 172 women with predominant stress urinary incontinence (SUI) were consecutively treated with the mini-sling MiniArc® from 2006 until 2013. They were reevaluated in 2018. The primary outcome, treatment success, was defined as no self-reported SUI symptoms and no reintervention. Secondary outcomes included the response to patient-reported outcomes. Adverse events were assessed. Results: After a median follow-up time of 113 months, 115 (66.9%) women were available for reevaluation. Forty-four (38.3%) women self-reported SUI. Seventeen women had been reoperated, 14 (12.2%) due to the reappearance of SUI and 3 due to complications. Altogether, MiniArc® had an overall success rate of 47.0% at 10 years. Among those not reoperated, 63.3% stated that they were much better or very much better in Patient Global Impression of Improvement (PGI-I) and 71.4% affirmed that their continence problem was normal or mild in Patient Global Impression of Severity (PGI-S). Almost 85% would repeat the surgery. Reoperation due to complications was rare (2.6%). De novo urgency appeared in 30.6% of the patients and it was managed with anticholinergic drugs with favorable outcomes. Discussion/Conclusion: This report adds evidence to the long-term outcomes of mini-slings, confirming that they can cure or improve SUI and give patients high satisfaction rates, at the expense of low morbidity.

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Can at-home semi-quantitative pregnancy tests serve as a replacement for clinical follow-up of medical abortion? A US study

Contraception ◽

10.1016/j.contraception.2012.06.005 ◽

2012 ◽

Vol 86 (6) ◽

pp. 757-762 ◽

Cited By ~ 44

Author(s):

Jennifer Blum ◽

Tara Shochet ◽

Kelsey Lynd ◽

E. Steve Lichtenberg ◽

Dick Fischer ◽

...

Keyword(s):

Medical Abortion ◽

At Home

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Nonsurgical Endodontik Retreatment of Maxillary First Premolar

DENTA ◽

10.30649/denta.v11i1.133 ◽

2017 ◽

Vol 11 (1) ◽

pp. 88

Author(s):

Yongki Hadinata W ◽

Karlina Samadi

Keyword(s):

Root Canal ◽

Radiographic Examination ◽

Periapical Lesion ◽

First Choice ◽

Periapical Abscess ◽

Dental Hospital ◽

Conservative Dentistry ◽

Previously Treated ◽

Endodontic Retreatment

Background : There are some factors can cause endodontic failure such as inadequate in cleaning or shaping step, non hermetic obturation, or poor restoration, which can cause bacteria multiply. Purpose : To report the management of endodontic failure with nonsurgical treatment. Case : 46-year-old woman came to Airlangga Dental Hospital Conservative Dentistry Department to treat her upper right tooth which show symptomatic pain in the last 2 weeks. The tooth has been treated and crowned with porcelain fused to metal about 10 years ago. Clinical examination show the presence of fistula on premolar buccal gingiva, react to percussion. Radiographic examination show not hermetic obturation in one root canal and radiolucency in the periapical area. The diagnosis for maxillary first premolar is previously treated tooth with chronic periapical abscess.. Treatment : Crown and post was removed from the tooth, and endodontic retreatment was done. Follow up 6 months after the retreatment show no reaction to percussion, and radiographic examination show no enlargement periapical lesion. Conclusion : Nonsurgical endodontic retreatment always become the first choice to resolve endodontic failure for previously treated tooth.Keywords : endodontic failure, maxillary first premolar, nonsurgical endodontic retreatmentCorrespondence: Yongki Hadinata W., drg. PPDGS Ilmu Konservasi Gigi Fakultas Kedokteran Gigi Universitas Airlangga, Surabaya. Jl. Mayjen. Prof. Dr. Moestopo No. 47, Surabaya.

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