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

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.

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

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.

St. John's Wort (Hypericum Perforatum) as a Treatment for Premenstrual Dysphoric Disorder: Case Report

2003 ◽  
Vol 33 (3) ◽  
pp. 295-297 ◽  
Author(s):  
Kai-Lin Huang ◽  
Shih-Jen Tsai
Keyword(s):  
Side Effects ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Premenstrual Dysphoric Disorder ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
St John’S Wort ◽  
St John's Wort ◽  
Gastrointestinal Side Effects

Premenstrual dysphoric disorder (PMDD), a menstruous dysfunction, is characterized by profoundly depressed mood, and studies have shown that antidepressants are effective for PMDD. The authors describe a case of PMDD who was initially treated with selective serotonin reuptake inhibitors. Due to intolerable gastrointestinal side effects with selective serotonin reuptake inhibitors, St. John's wort (900 mg/day) was substituted and much improvement in PMDD symptoms was noted for at least five-month follow-up. The authors propose that St. John's wort could be an alternative medication for PMDD, especially for patients experiencing intolerable side effects with selective serotonin reuptake inhibitors.

A prospective study of mifepristone and unlimited dosing of sublingual misoprostol for termination of second-trimester pregnancy in Uzbekistan and Ukraine

2019 ◽  
Vol 45 (3) ◽  
pp. 177-182
Author(s):  
Ingrida Platais ◽  
Tamar Tsereteli ◽  
Galyna Maystruk ◽  
Dilfuza Kurbanbekova ◽  
Beverly Winikoff
Keyword(s):  
Side Effects ◽  
Medical Abortion ◽  
Second Trimester ◽  
Open Label ◽  
Link Type ◽  
Sublingual Misoprostol ◽  
Registration Number ◽  
Second Trimester Pregnancy ◽  
A Prospective Study ◽  
At Home

IntroductionWe aimed to assess the feasibility and acceptability of a second-trimester medical abortion regimen using mifepristone and sublingual misoprostol with no maximum number of misoprostol doses in Uzbekistan and Ukraine.MethodsThis prospective open-label study enrolled 306 women with pregnancies of 13–22 weeks in Uzbekistan (n=134) and Ukraine (n=172). Women took 200 mg mifepristone at a place of their choosing, and 24–48 hours later received 400 μg sublingual misoprostol every 3 hours until the expulsion of both fetus and placenta. Study staff interviewed women about the intensity of pain, side effects, and satisfaction with the procedure. The primary outcome was the rate of complete uterine evacuation without surgical intervention or oxytocin at 15 hours after the first dose of misoprostol.ResultsThe median gestational age was 18.1 weeks, and half of the women (n=149, 48.9%) chose to take mifepristone at home. The majority of women (n=266, 86.9%, 95% CI 82.6% to 90.5%) expelled by 15 hours after the start of misoprostol treatment, and by 48 hours complete uterine evacuation was achieved in 296 (96.7%) women. Most women found pain (76.1%) and side effects (89.0%) to be acceptable or very acceptable, and reported high satisfaction (89.8%) with the procedure.ConclusionMedical abortion in pregnancies of 13–22 weeks with 200 mg mifepristone followed 24–48 hours later by 400 μg sublingual misoprostol administered every 3 hours until complete expulsion is effective, safe and acceptable to women. Women can be given the option to take mifepristone at home and return to the hospital.Clinical trials registration numberClinicalTrials.gov, www.clinicaltrials.gov, NCT02415894, NCT02235155.

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

Contraception ◽  
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

scholarly journals Comparison of EBRT and I-125 seed brachytherapy concerning outcome in intermediate-risk prostate cancer

2021 ◽  
Author(s):  
Matthias Moll ◽  
Andreas Renner ◽  
Christian Kirisits ◽  
Christopher Paschen ◽  
Alexandru Zaharie ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
Cancer Patients ◽  
External Beam Radiotherapy ◽  
External Beam ◽  
Intermediate Risk ◽  
Risk Prostate Cancer ◽  
Gastrointestinal Side Effects ◽  
Over Time

Abstract Purpose This study’s objective was the comparison of external beam radiotherapy (EBRT) and I‑125 seed brachytherapy regarding clinical outcome and development of side effects. Patients and methods In all, 462 localized intermediate-risk prostate cancer patients treated between 2000 and 2019 at our department using either I‑125 seed brachytherapy or EBRT with a dose of 74 or 78 Gy were included: 297 patients were treated with EBRT and 165 with seeds. Biochemical no evidence of disease (bNED) rates according to Phoenix definition as well as late gastrointestinal and urogenital side effects (EORTC/RTOG) were assessed. Results Patients were followed up yearly with a median follow-up of 54 (3–192) months. Observed bNED rates for 74 Gy, 78 Gy and seeds were 87, 92, and 88% after 5 years and 71, 85, and 76% after 9 years, respectively. No significant differences were found comparing seeds with 74 Gy (p = 0.81) and 78 Gy (p = 0.19), as well as between 74 and 78 Gy (p = 0.32). Concerning gastrointestinal side effects, EBRT showed significantly higher rates of RTOG grade ≥ 2 toxicity compared to seeds, but at no point of the follow-up more than 10% of all patients. However, genitourinary side effects were significantly more prevalent in patients treated with seeds, with 33% RTOG grade ≥ 2 toxicity 12 months after treatment. Nevertheless, both types of side effects decreased over time. Conclusion Favorable intermediate-risk prostate cancer patients can be treated either by external beam radiotherapy (74/78 Gy) or permanent interstitial seed brachytherapy.

scholarly journals Randomized Trial of Erythromycin and Azithromycin for Treatment of Chlamydial Infection in Pregnancy

1995 ◽  
Vol 3 (6) ◽  
pp. 241-244 ◽  
Author(s):  
Marc F. Rosenn ◽  
George A. Macones ◽  
Neil S. Silverman
Keyword(s):  
Side Effects ◽  
Screening Tests ◽  
Number Of Patients ◽  
Significant Difference ◽  
Gastrointestinal Side Effects ◽  
The Cost ◽  
Cure Rates ◽  
To Receive ◽  
In Pregnancy

Objective:The purpose of this study was to compare erythromycin and azithromycin in the treatment of chlamydial cervicitis during pregnancy with regard to efficacy, side effects, and compliance.Methods:In a prospective manner, 48 pregnant patients with cervical chlamydial infections diagnosed by routine screening tests were randomly assigned to receive either erythromycin, 500 mg q.i.d. for 7 days (N = 24), or azithromycin, 1 g as a one-time dose (N = 24). All sexual partners were given prescriptions for doxycycline, 100 mg b.i.d. for 7 days. The treatment efficacy was assessed by follow-up chlamydia testing 3 weeks after the therapy was completed. The side effects, intolerance to therapy, and overall compliance were evaluated by means of a standardized posttreatment questionnaire.Results:There was no significant difference in cure rates noted between the erythromycin group and the azithromycin group (77% vs. 91%, respectively;P= 0.24). Gastrointestinal side effects were reported more frequently among patients treated with erythromycin compared with patients treated with azithromycin (45% vs. 17%, respectively;P= 0.004). The patients who received erythromycin reported intolerance to therapy secondary to side effects more frequently than patients who received azithromycin (23% vs. 4%, respectively;P= 0.07). Furthermore, the patients in the azithromycin group were more likely to complete their course of therapy as prescribed than the patients in the erythromycin group (100% vs. 61%, respectively;P= 0.002).Conclusions:Azithromycin is efficacious and well tolerated for the treatment of chlamydial cervicitis in pregnancy. Erythromycin, though efficacious, is poorly tolerated, as demonstrated by the number of patients reporting significant side effects during the course of therapy. Since the cost of azithromycin is comparable to that of generic erythromycin, the present study supports the use of azithromycin as an alternative to erythromycin for the treatment of chlamydial cervicitis in pregnancy.

scholarly journals OP0158-HPR TELEMEDICINE CONSULTATIONS IN POLYMYALGIA RHEUMATICA PATIENTS. A TWO YEARS’ EXPERIENCE REPORT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 100.2-100
Author(s):  
S. Fredslund-Andersen ◽  
P. Lage-Hansen ◽  
N. Svendsen ◽  
M. Jeppesen Rechnagel ◽  
U. Højberg ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Polymyalgia Rheumatica ◽  
Blood Analysis ◽  
Newly Diagnosed ◽  
Telephone Consultation ◽  
American College Of Rheumatology ◽  
Written Information ◽  
Telemedicine Consultation ◽  
The Mean

Background:Polymyalgia rheumatica (PMR) is the most common inflammatory rheumatic disease of people over 50 years in Scandinavian countries and people of northern European descent, characterized by proximal pain, stiffness, raised inflammatory markers and prompt response to steroids(1). Relapse free during tapering off prednisone, are common in approximately 50% of patients. Studies reported that up to 70% of PMR patients are successfully tapered of prednisone due to remission, within 1-2 years from treatment initiation (1). Telemedicine has found a wider application in a number of chronic diseases resulting in a decreased number of hospital visits; however, no telemedicine studies on PMR patients have been performed before (2).Objectives:To evaluate the use of telemedicine consultation in newly diagnosed PMR patients.Methods:Telemedicine consultations managed by rheumatic nurses for newly diagnosed PMR patients was established in 2017 at our department. Patients diagnosed with PMR by a rheumatologist received written information concerning the nature of the disease, a “follow-up” schedule and a prednisone treatment/tapering plan. Telephone consultations (TC) including relevant blood analysis was planned after 4, 16, 52 and 78 weeks from the time of diagnosis. TC was managed by 4 nurses specialized in rheumatic diseases, who received appropriate education of PMR prior to the establishment. A predefined questionnaire was used for every telephone consultation.All PMR patients were initially treated with 15 mg of prednisone daily, with slowly tapering to 5 mg daily at week 16 and reduced to zero at week 48. In the case of relapse symptoms, patients were instructed to contact the treating nurses. In that case, relevant biomarkers were taken and a rheumatologist evaluated the need for a physical consultation and potential treatment adjustment.Only patients with minimum disease duration of 3 months were included in the study.Results:In a period of two years, 76 patients were evaluated. The mean age was 73 years and the mean follow up period was 10, 67 ± standard deviation (SD) 5,2 months. At the time of diagnosis, all patients fulfilled the 2012 Classifications criteria for PMR (3). The Mean number of TC was 4.27(± SD 2, 3).In 45 cases (60%) no additional physical consultation was necessary. In patients examined physically due to relapse suspicion, the most common findings were PMR relapses (66%), followed by non-inflammatory muscle and joint pain (18,5%), arthritis (14%), while one patient was diagnosed with giant cell arteritis.Successfully prednisone tapering was achieved in 23 cases (30%) while 27 patients (35,5%) at the time of data evaluation were treated with only 2,5 mg of prednisone daily. The mean current daily prednisolone dosage was 3.95 mg (± SD 3.25) while disease-modifying-anti-rheumatic-drugs had been initiated in 6 patients.Conclusion:Telemedicine consultations in PMR diminish the need for physical consultations in this patient cohort. More than half of all patients were either out of- or received only a very low dose of prednisone at the time of evaluation of data.References:[1]Kermani TA, Warrington KJ. Polymyalgia rheumatica. Lancet. 2013 Jan 5;381(9860):63-72. doi: 10.1016/S0140-6736(12)60680-1.[2]Matteo Piga et al. Telemedicine for patients with rheumatic diseases: Systematic review and proposal for research agenda. Semin Arthritis Rheum. 2017 Aug;47(1):121-128. doi: 10.1016/j.semarthrit.2017.03.014. Epub 2017 Mar 22.[3]Dasgupta B, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: A European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2012; 64: 943-54.Disclosure of Interests:None declared

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

2018 ◽  
Vol 144 (1) ◽  
pp. 97-102 ◽  
Author(s):  
Holly Anger ◽  
Rasha Dabash ◽  
Melanie Peña ◽  
Dolores Coutiño ◽  
Manuel Bousiéguez ◽  
...  
Keyword(s):  
Medical Abortion ◽  
Pregnancy Test ◽  
At Home

scholarly journals Early medical abortion using telemedicine – acceptability to patients

2020 ◽  
Author(s):  
Chelsey Porter Erlank ◽  
Jonathan Lord ◽  
Kathryn Church
Keyword(s):  
Service Providers ◽  
Medical Abortion ◽  
List Type ◽  
Check Sample ◽  
High Confidence ◽  
High Satisfaction ◽  
First Choice ◽  
Patient Reported ◽  
At Home

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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