A systematic review of epidemiological, causal status and policy-making issues of maternal mortality in Iran

Objective Approximately one-third of maternal deaths occur postpartum. Little is known about the intersection between the postpartum period, emergency department (ED) use, and opportunities to reduce maternal mortality. The primary objectives of this systematic review are to explore the incidence of postpartum ED use, identify postpartum disease states that are evaluated in the ED, and summarize postpartum ED use by race/ethnicity and payor source. Study Design We searched PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, Cochrane CENTRAL, Social Services Abstracts, and Scopus from inception to September 19, 2019. Each identified abstract was screened by two authors; the full-text manuscripts of all studies deemed to be potential candidates were then reviewed by the same two authors and included if they were full-text, peer-reviewed articles in the English language with primary patient data reporting care of a female in the ED in the postpartum period, defined as up to 1 year after the end of pregnancy. Results A total of 620 were screened, 354 records were excluded and 266 full-text articles were reviewed. Of the 266 full-text articles, 178 were included in the systematic review; of these, 108 were case reports. Incidence of ED use by postpartum females varied from 4.8 to 12.2% in the general population. Infection was the most common reason for postpartum ED evaluation. Young females of minority race and those with public insurance were more likely than whites and those with private insurance to use the ED. Conclusion As many as 12% of postpartum women seek care in the ED. Young minority women of lower socioeconomic status are more likely to use the ED. Since approximately one-third of maternal deaths occur in the postpartum period, successful efforts to reduce maternal mortality must include ED stakeholders. Systematic Review Registration CRD42020151126. Key Points

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Should euthanasia and assisted suicide for psychiatric disorders be permitted? A systematic review of reasons

Psychological Medicine ◽

10.1017/s0033291720001543 ◽

2020 ◽

Vol 50 (8) ◽

pp. 1241-1256

Author(s):

Marie E. Nicolini ◽

Scott Y. H. Kim ◽

Madison E. Churchill ◽

Chris Gastmans

Keyword(s):

Systematic Review ◽

Policy Making ◽

Assisted Suicide ◽

Qualitative Content Analysis ◽

Self Determination ◽

Future Research ◽

Decisional Capacity ◽

Goals Of Medicine ◽

Ethical Debate ◽

Life Sustaining Treatment

AbstractBackgroundEuthanasia and assisted suicide (EAS) based on a psychiatric disorder (psychiatric EAS) continue to pose ethical and policy challenges, even in countries where the practice has been allowed for years. We conducted a systematic review of reasons, a specific type of review for bioethical questions designed to inform rational policy-making. Our aims were twofold: (1) to systematically identify all published reasons for and against the practice (2) to identify current gaps in the debate and areas for future research.MethodsFollowing the PRISMA guidelines, we performed a search across seven electronic databases to include publications focusing on psychiatric EAS and providing ethical reasons. Reasons were grouped into domains by qualitative content analysis.ResultsWe included 42 articles, most of which were written after 2013. Articles in favor and against were evenly distributed. Articles in favor were mostly full-length pieces written by non-clinicians, with articles against mostly reactive, commentary-type pieces written by clinicians. Reasons were categorized into eight domains: (1) mental and physical illness and suffering (2) decisional capacity (3) irremediability (4) goals of medicine and psychiatry (5) consequences for mental health care (6) psychiatric EAS and suicide (7) self-determination and authenticity (8) psychiatric EAS and refusal of life-sustaining treatment. Parity- (or discrimination-) based reasons were dominant across domains, mostly argued for by non-clinicians, while policy reasons were mostly pointed to by clinicians.ConclusionsThe ethical debate about psychiatric EAS is relatively young, with prominent reasons of parity. More direct engagement is needed to address ethical and policy considerations.

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Deliberation and Policy-Making: Three Ways to Think About Minipublics’ Consequences

Administration & Society ◽

10.1177/0095399720964511 ◽

2020 ◽

pp. 009539972096451

Author(s):

Vincent Jacquet ◽

Ramon van der Does

Keyword(s):

Systematic Review ◽

Structural Change ◽

Empirical Research ◽

Policy Making ◽

Future Research ◽

Review Of The Literature ◽

Policy Makers ◽

Policy Making Process

Policy-makers are increasingly experimenting with various ways to involve citizens in policy-making. Deliberative forums composed of lay citizens (minipublics) count among the most popular of such innovations. Despite their popularity, it is often unclear in what ways such minipublics could affect policy-making. This article addresses this issue of conceptual ambiguity by drawing on an original systematic review of the literature. It shows that the literature has approached these consequences in three ways: congruence with decisions, consideration in the policy-making process, and structural change. The article discusses the implications for empirical research and points out trajectories for future research on deliberative minipublics.

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