Documentation of reproductive health counseling and contraception in women with inflammatory bowel diseases

Objective

Inflammatory bowel diseases (IBD) are commonly diagnosed during women's reproductive years. Counseling is important to avoid unintended pregnancy in a disease-poor state. We sought to determine reproductive counseling documentation by gastroenterologists in women with IBD.

Methods

An electronic query identified women, age 18–45, with IBD in an academic gastroenterology practice from 2010 to 2012. A random sample (15%) chart review determined contraception documentation and content/frequency of reproductive counseling.

Results

100 patients were analyzed. Median age was 35 (range 19–45), 53% were married, and 69% had Crohn's disease. Median time since IBD diagnosis was 9 years (range 1–32) with a 5 visit median (range 1–45) over 31 months (range 1–105). A contraceptive method was identified in 24% of all patients.Nineteen patients (19%) had documentation of reproductive counseling. Only 1/100 patients had a specific reference to using contraception to avoid pregnancy. The remaining counseling included (1) medication effects on pregnancy, (2) disease control before pregnancy, or (3) mode of delivery planning.

Conclusions

Outside of listing contraception as a “current medication”, documentation of reproductive counseling at gastroenterology visits for IBD is sparse.

Practice implications

In light of the importance of reproductive planning for women with IBD, future research on incentives and barriers to counseling is warranted.     

Face shape differs in phylogenetically related populations

3D analysis of facial morphology has delineated facial phenotypes in many medical conditions and detected fine grained differences between typical and atypical patients to inform genotype–phenotype studies. Next-generation sequencing techniques have enabled extremely detailed genotype–phenotype correlative analysis. Such comparisons typically employ control groups matched for age, sex and ethnicity and the distinction between ethnic categories in genotype–phenotype studies has been widely debated. The phylogenetic tree based on genetic polymorphism studies divides the world population into nine subpopulations. Here we show statistically significant face shape differences between two European Caucasian populations of close phylogenetic and geographic proximity from the UK and The Netherlands. The average face shape differences between the Dutch and UK cohorts were visualised in dynamic morphs and signature heat maps, and quantified for their statistical significance using both conventional anthropometry and state of the art dense surface modelling techniques. Our results demonstrate significant differences between Dutch and UK face shape. Other studies have shown that genetic variants influence normal facial variation. Thus, face shape difference between populations could reflect underlying genetic difference. This should be taken into account in genotype–phenotype studies and we recommend that in those studies reference groups be established in the same population as the individuals who form the subject of the study.     

A systems science perspective and transdisciplinary models for food and nutrition security

We argue that food and nutrition security is driven by complex underlying systems and that both research and policy in this area would benefit from a systems approach. We present a framework for such an approach, examine key underlying systems, and identify transdisciplinary modeling tools that may prove especially useful.     

Outbreak of Human Trichinellosis in Northern California Caused by Trichinella murrelli

Abstract. In October of 2008, an outbreak of trichinellosis occurred in northern California that sickened 30 of 38 attendees of an event at which meat from a black bear was served. Morphologic and molecular testing of muscle from the leftover portion of bear meat revealed that the bear was infected with Trichinella murrelli, a sylvatic species of Trichinella found in temperate North America. Clinical records revealed a high attack rate for this outbreak: 78% for persons consuming any bear meat and 100% for persons consuming raw or undercooked bear meat. To our knowledge, this report is the first published report of a human trichinellosis outbreak in the United States attributed to T. murrelli, and it is the second such outbreak reported worldwide.     

First,Do No Harm: Adverse Effects and the Need for Practice Standards in Neurofeedback

Adverse and iatrogenic effects associated with psychotherapy have been substantiated in research for more than 40 years. Controlled research also exists in the field of neurofeedback (electroencephalographic biofeedback) that documents that negative effects can occur from inappropriate training. This article presents accumulating evidence, taken directly from acknowledgments by neurofeedback practitioners of the existence of both transient side effects and of more serious adverse reactions that have occurred. Unlicensed and unqualified practitioners pose a risk to the public and to the integrity and future of the profession. It is vitally important that both professionals and professional societies emphasize standards of practice and that the public be protected from individuals seeking to use neurofeedback to work with medical, psychiatric, and psychological conditions for which they are not qualified and licensed to work. Some in the field propose pursuing biofeedback or psychophysiology licensure as a means to establish standards of practice and address ethical concerns. This is a reasonable option to consider, although it may take many years to implement in various states. In the meantime it is vitally important that individuals offering neurofeedback services for clinical diagnostic conditions be licensed to lawfully provide services for such conditions.     

CLINICAL CORNER

The purpose of the Clinical Corner is to provide responses to clinically oriented questions which may not, in many cases, have been evaluated yet by research. Therefore, the personal opinions expressed in the column are exactly that, the opinions of the individual authors, often based on their clinical experience. The opinions shared belong to the authors and are not necessarily those of SNR or the Journal of Neurotherapy. Nonetheless, it is hoped that the diversity of opinion expressed in this column will stimulate thought and the further exchange of ideas. Readers are invited to send questions for consideration to: D. Corydon Hammond, PhD, University of Utah School of Medicine, PM&R, Salt Lake City, UT 84132. E-mail: D.C.Hammond@utah.edu.     

The art of gene therapy for glioma： a review of the challenging road to the bedside

Glioblastoma muhiforme （GBM） is a highly invasive brain tumour that is unvaryingly fatal in humans clesplte even aggres- sive therapeutic approaches such as surgical resection followed by chemotherapy and radiotherapy. Unconventional treatment options such as gene therapy provide an intriguing option for curbing glioma related deaths. To date, gene therapy has yielded encouraging results in preclinical animal models as well as promising safety profiles in phase I clinical trials, but has failed to demonstrate significant therapeutic efficacy in phase III clinical trials. The most widely studied antiglioma gene therapy strategies are suicide gene therapy, genetic immuno- therapy and oncolytic virotherapy, and we have attributed the challenging transition of these modalities into the clinic to four major road- blocks ： （ 1 ） anatomical features of the central nervous system, （2） the host immune system, （3） heterogeneity and invasiveness of GBM and （4） limitations in current GBM animal models. In this review, we discuss possible ways to jump these hurdles and develop new gene therapies that may be used alone or in synergy with other modalities to provide a powerful treatment option for patients with GBM.     

Access to the next wave of biologic therapies (Abatacept and Tocilizumab) for the treatment of rheumatoid arthritis in England and Wales

Patients in England and Wales with rheumatoid arthritis (RA) receive treatment from the National Health Service (NHS) with therapies approved by the European Medicines Agency (EMA), under guidance from the National Institute for Health and Clinical Excellence (NICE). This document overviews the current NICE guidelines for the treatment of RA and identifies scenarios when such guidance may not represent the optimum management strategy for individual patients. Specifically, we consider the use of tocilizumab or abatacept as the most appropriate treatments for some patients. In such scenarios, it may be possible for the clinician to secure access to the required therapy through an application procedure known as an 'individual funding request', the process of which is described in detail here. At present, it is unclear the extent to which the proposed reform of the NHS will affect the role of NICE in providing guidance and setting standards of care. Until the full impact of the proposed changes are realized, individual funding requests will remain a valuable way of securing the optimal treatment for all patients suffering from RA.