Needs assessment for AAPLOG Midwinter Meeting 2010
Our target medical audience is the practicing ob/gyn who is interested or involved in life issues, specifically beginning of life issues, as well as the missionary ob/gyn physician who practices full or part time in developing situations, and the academic ob/gyn who participates in policy issues. From verbal comments to us at our booths at medical meetings, as well as informal conversations, and formal conversations, our members have asked for us to present the latest information on the most pressing issues of the year, as well as strategic upcoming issues. Members have also asked us informally about another update on embryonic stem cell research, and periconceptual information as well as to keep them updated on the rapidly evolving area of psychological impact of abortion. From numerous informal and email requests, we have been asked by our members to comment on prenatal testing, which continues to be a big issue for our members. This year’s pressing issue is the Health Care Reform1 and its impact on rights of conscience for the practicing pro-life physician. Our member’s voices are critically important in shaping the health care of this country to include the right of conscientious refusal to perform procedures forbidden by the Hippocratic Oath. We have therefore included both a legal (Frank Manion, J.D.- no CME requested) and a medical analysis (Mary Davenport, M.D. “Health Care Right of Conscience” The strategic upcoming issue which directly affects many of our members who do medical work in developing countries is the use of MDG5(Reducing Maternal Mortality) to pressure for legalization of abortion worldwide2,3,4,5,6,7. In order to equip our members to speak out on these issues in their role as health care providers for women, we have several sessions looking at the issue of maternal mortality from an international perspective, using outstanding speakers who practice medicine in development settings, and who have made significant contributions to developing models designed to reduce maternal mortality without abortion. (Jean Kagia, M.D.: Maternal Mortality Causality: A Kenyan Medical Perspective, George Mulcaire-Jones, M.D.: Safe Passages: A Model for African Maternal Health Care Development, and Steven Mosher: Reproductive Health Care, the Demographic Imperative and the Real Health Needs of Women in the Developing World.). These lectures introduce the major concepts surrounding maternal mortality causality and will allow our members, many of whom play important parts in the health care systems in the developing world, to understand the practical implications of MDG 5 and to intelligently shape the medical policy of their regions. Since research papers in the subject of psychological consequences of abortion have been multiplying rapidly, we have one talk on the newest research concerning informed consent prior to abortion. (Priscilla Coleman, PhD. “Evidence Based Informed Consent for Abortion: Toward More Systematic Qualitative and Quantitative Reviews of the Literature”) Informed consent before abortion is an issue faced by the vast majority of our membership, and prior to this paper, there was a dearth of information available on the subject. Dr. Coleman presents a new and important aspect of the informed consent, summarizing evidence based medicine psychological risks documented within the medical literature8 and the need to inform patients of these risks; a topic which is vital to the daily practice of our membership. An issue of huge numerical importance to our members current practice patterns is the vast increase in Cesarean delivery, which is currently above 30% and which some recent research estimates project may reach up to 50% of deliveries in the next decade.9 The ethical dimensions of this issue have direct bearing on the daily practice of our membership, since maternal morbidity increases significantly after the 4th repeat cesarean. Thus we have included a talk by Dr. Hoeldtke exploring the issue of Cesarean delivery and its relationship to life issues. (Nate Hoeldtke, M.D. “Cesarean Delivery in the 21st Century- Use and Abuse”) An issue in need of update is embryonic and adult stem cell research, a topic we have not covered for about 4 years, and for which policy decisions continue to be discussed. The recent research gives additional strength to the use of adult stem cells. (David Prentice, M.D. “Stem Cells”) Ob/gyn physicians are in a key position to counsel patients about cord blood banking, as well as IVF technology as infertility treatments progress.. Our members need a good understanding of the current research surrounding stem cells in order to accurately counsel patients. Further our members now are at a pivotal position to counsel the potential egg donors who supply ovum for IVF procedures. A thorough understanding of the issues involved in egg donation is important for patient care of potential donors. (Jennifer Lahl BSN. M.S.”The Healthy Non-patient Egg Donor in the U.S.”) In addition, there is fascinating new research on ovum factor and other hormonal events related to conception, concepts which will directly apply to life issues in the next decade. For this reason we have included talks on stem cell research and fetal microchimerism which will explain the new field of periconceptual hormone systems.( Ralph Miech, M.D. The Pathophysiology of Fetal Microchimerism in Postpartum and Postabortion Women) Understanding these concepts will have direct bearing on evaluation of medications for their effect on the developing human embryo. Counseling the pregnant patient who carries a genetically abnormal fetus is one of the most challenging aspects of our members’ practices. Issues of when, where and why to perform prenatal testing are paramount to prenatal care, especially in the first and second trimesters, and affect the practice of all of our members doing obstetrics. Recent literature shows the dramatic decrease in Down’s syndrome births due to perinatal testing10 and subsequent abortion. And, we as a board frequently field questions pertaining to perinatal testing and the results. So, we have included one talk exploring the aspects of counseling from a pro-life perinatologist. (Nate Hoeldtke M.D. “Stalking Down’s Syndrome”) In addition, the most rapidly growing method of abortion worldwide is misoprostol. The medical and ethical implications of self-administered abortifacients are changing the landscape of the abortion issue worldwide. (Julie Lynch McDonald, Pharm D. “Abortifacients) Physicians in the developing world especially need to be able to recognize the growing use of medical abortifacients,11 and the side effects and adverse effects associated with their use, as this will become an increasing contributor to inpatient and ER visits worldwide.
2010 AAPLOG Educational Objectives, Summarized
Reproductive Health Care, the Demographic Imperative, and the Real Health Needs of Women in the Developing World
Steven Mosher PhD
Abstract
This talk will enable medical practitioners to better recognize both the motivations and the specific programs proposed by proponents of “reproductive health care” and to better enable them to meet the real health needs of women. Review of the worldview shift in population programs preceding and following the Cairo conference will allow participants to understand the current vocabulary of “unmet need” and “latent demand”, and allow for practitioners here and in resource poor countries accurately discern the needs of their patient populations, and direct limited health resources to areas which better meet the real needs of their female patients.
Educational Objectives
Lecture participants will be able to:
- Identify the goals of population control programs prior to and following the 1994 Cairo conference, and their methods of implementing population control.
- List the most imperative health needs of women in developing countries, and the impact of population control methods on those needs.
- List the most effective use of limited health resources to improve both basic and obstetrical care in a clinical setting.
Maternal Mortality and Morbidity in Low Resource Countries with Emphasis on Kenya
Jean Kagia M.D.
Abstract
The issue of maternal mortality causality is vitally important to ob/gyns who work in low resource areas of the world. This lecture will explore the global incidence of maternal mortality, and causes comparing the global data to data from resource poor countries, with Kenya as a major example. The lecture will cover causes, influencing factors and challenges to reducing maternal mortality, as well as outlining a strategy for resource poor nations.
Educational Objectives
Participants will be able to:
- Identify the major causes of maternal mortality in Kenya.
- Identify the generalizable causes of maternal mortality in other low resource countries in Africa
- Outline culturally acceptable methods for decreasing maternal mortality.
- Identify challenges faced in low resource countries and factors which influence those challenges.
Safe Passages: A Model for African Maternal Health Care Development
George Mulcaire-Jones, M.D.
Abstract
This presentation will review major causes of maternal and perinatal mortality in Africa and the range of strategic responses. The experience of the “Safe Passages” training program and its emphasis on a holistic approach incorporating ethics, technology and infrastructure development will be presented. Lessons learned from Safe Passages program will be analyzed and applied to future obstetrical training initiatives in Africa.
Educational Objectives
pon completion of this activity, participants will be able to:
- Cite, in order of magnitude, the major causes of maternal and perinatal mortality in Africa and the specific obstetrical and newborn interventions necessary to address them.
- Define the following key terms: traditional birth attendance, skilled birth attendance, basic emergency obstetrical care and comprehensive emergency obstetrical care and apply them to strategies for improving maternal and newborn health.
- Apply lessons learned from the “Safe Passages” maternal health care training model and its integration of ethics, technology and infrastructure development.
The healthy non-patient egg donor in the U.S. A survey of egg donation policies and practices in America
Jennifer Lahl BSN. M.S.
Abstract
This presentation will educate conference participants on the current practice of egg donation in the U.S. as well as the recruitment of egg donors through advertisements. Changing trends in ovarian stimulation practices will be presented as it distinguishes the infertile woman vs. the non-patient healthy egg donor. A survey of policies will be presented as a means to compare the differences within international practice surrounding egg donation
Educational Objectives
Upon completion of this program, participants will be able to:
- Understand the current practice of egg donation in the U.S.
- Identify three differences with U.S. practice and international practice
- List short-term and long-term risks of egg donation
Stem Cells: Clinical Update
David Prentice, PhD.
Abstract
The controversial topic of stem cells is confusing both to the public and to professionals. This talk will clearly explain the different sources of stem cells, including the advantages and disadvantages of each source from clinical, ethical, and policy standpoints. Current and potential clinical applications of stem cells will be discussed including peer-reviewed examples.
Educational Objectives
Upon completion of this program, participants will be able to:
- Enumerate the different sources of stem cells, including clinical advantages & disadvantages
- List some current and potential clinical uses for stem cells, including concrete examples
- Discuss with other professionals and patients the practical and ethical use of stem cells
Medication Abortions: Revealing the Facts
Julie Lynch McDonald, Pharm D.
Abstract
This presentation will educate conference participants on the key chemical entities used as abortifacients, including the history of their use, mechanism of action, and common dosing regimens. The presentation will focus on the mifepristone and misoprostol abortifacient combination (RU-486), including in-depth review of clinical trials and discussion of the associated complications. Foremost controversies surrounding RU486 will be presented and current trends in use will be addressed.
Educational Objectives
Upon completion of this program, participants will be able to:
- Describe the mechanism of action, history, and dosing regimens for abortifacient medications.
- Understand the United States approval process for the RU-486.
- Identify the RU-486 approved dosing regimen, contraindications, precautions, and complications.
The Pathophysiology of Fetal Microchimerism in Postpartum and Postabortion Women
Ralph Miech, M.D.
Abstract
This presentation will educate conference participants on the normal physiological mechanism of maternal immunosuppression that allows implantation of the embryo and its progression to a full term pregnancy. The presentation will describe the mechanism of how progenitor cells of the fetus’ immune system are transferred to and take up maternal life-long residence in different maternal tissues as microchimera. Activation of these fetal microchimeral cells from either a past full term pregnancy or from a past abortion can orchestrate the development of different autoimmune diseases in later years in both postpartum and postabortion women.
Educational Objectives
Upon completion of this program, participants will be able to:
- Describe the potential pathophysiology of fetal–to–maternal transplacental cell trafficking of progenitor T-cells of the fetus’s developing immune system.
- Identify the maternal autoimmune diseases that are associated with fetal microchimerism.
- Evaluate and discuss the risk of maternal development of various autoimmune diseases in postabortion women.
Stalking Down’s Syndrome
Nate Hoeldtke M.D.
Abstract
The history of Down syndrome screening and diagnosis will be reviewed along with current methods of screening and diagnosis. Pitfalls and limitations of screening, including the concept of “framing” in counseling and controversy over “non-directive” counseling, will be discussed. Common failings in patient management following prenatal diagnosis of Down syndrome will be presented.
Educational Objectives
Upon completion of this program, participants will be able to:
- Describe the history of prenatal Down syndrome screening and diagnosis
- List current options for prenatal Down syndrome screening and diagnosis
- Describe limitations and pitfalls in prenatal screening for Down syndrome
Evidence Based Informed Consent for Abortion: Toward More Systematic Qualitative and Quantitative Reviews of the Literature
Priscilla Coleman, PhD.
Abstract
In response to deficiencies in evidence-based medicine relative to pre-abortion counseling, a systematic strategy for conducting rigorous qualitative literature reviews is described, focusing on the association between abortion and suicide. The scientific literatures pertaining to abortion and anxiety, depression, and substance abuse have matured to the point wherein it would also be beneficial to conduct thorough analyses of the evidence related to these other effects using the strategy advocated. The time has likewise arrived for systematic quantitatively-based reviews of the world literature that yield easily interpretable effect sizes and Population Attributable Risk (PAR) statistics for the most commonly investigated psychological outcomes of abortion. The utility of the PAR statistic will be demonstrated in relation to abortion and suicide. Finally, the need for readily comprehended results to facilitate informed consent legislation and the development of clear informed consent protocols is addressed.
Educational Objectives
Upon completion of this program, participants will be able to:
- Participants will learn about the serious deficiencies in evidence-based medicine in the realm of pre-abortion counseling related to mental health risks and the need to produce easily interpretable synopses of the peer-reviewed literature to address the lag between research and practice.
- Participants will gain the ability to identify the features of well-designed qualitative reviews of the peer-reviewed literature. Participants will gain knowledge related to conclusions regarding associations between abortion and various mental health outcomes that can be derived from competently executed qualitative reviews.
- Participants will be able to describe the basic characteristics of strong quantitative reviews of the literature and will understand the need for more sophisticated quantitative reviews of the abortion mental health literature. Participants will learn the difference between Effect Size and Population Attributable Risk statistics and the importance of including both in quantitative reviews.
Health Care Right of Conscience
Mary Davenport, M.D.
Abstract
This presentation on conscience will focus on the foundations of Hippocratic ethics that have informed medical practice for the past two millennia. Past deviations from Hippocratic medical ethics such as eugenics and medical killing under the Nazis will be explored. Current philosophical, practical and legal challenges to Hippocratic medicine will be enumerated. Characteristics of good health care conscience protections for Hippocratic health care providers, both past and future, will be described.
Educational Objectives
Upon completion of this program, participants will be able to:
- Enumerate important features of Hippocratic medicine.
- Name three 20th century deviations from Hippocratic medicine.
- Describe three contemporary challenges to Hippocratic medicine
Cesarean Delivery in the 21st Century- Use and Abuse
Nate Hoeldtke, M.D.
Abstract
Historical trends in the use of cesarean delivery will be discussed in contrast with, and as context for, current use of cesarean delivery. The “culture” of cesarean delivery and how it is shaped by physician, patient and medico-legal factors will be described. The current evidence base will be utilized to assess current and future patient concerns related to the increased use of cesarean section.
Educational Objectives
Upon completion of this program, participants will be able to:
- Put contemporary use of cesarean delivery in context with historical trends in the use of cesarean delivery.
- Describe physician, patient and medico-legal factors affecting cesarean delivery practices and how they contribute to a specific delivery “culture.”
- Use the current evidence base to list current and future concerns related to increased use of cesarean delivery, including cesarean upon maternal request.