A bill was introduced into the Tennessee legislature in the 2005 session that would require emergency departments to offer and dispense emergency contraception to sexual assault survivors who are at risk of pregnancy. Several advocacy groups collaborated to form the Women's Health Safety Network for the purpose of communicating as one voice. The advocacy coalition framework of policy development is applied to the political system and is used as a model to discuss issues impacting policy development for this particular bill.
As Catholic-owned hospitals merge with or take over other facilities, they impose restrictions on reproductive health services, including abortion and contraceptive services. Our interviews with US obstetrician-gynecologists working in Catholic-owned hospitals revealed that they are also restricted in managing miscarriages. Catholic-owned hospital ethics committees denied approval of uterine evacuation while fetal heart tones were still present, forcing physicians to delay care or transport miscarrying patients to non-Catholic-owned facilities.
Issues arising from the death of Savita Halappanavar in Ireland in October 2012 include the question of whether it is unethical to refuse to terminate a non-viable pregnancy when the woman's life may be at risk. In Catholic maternity services, this decision intersects with health professionals' interpretation of Catholic health policy on treatment of miscarriage as well as the law on abortion. This paper explores how these issues came together around Savita's death and the consequences for pregnant women and maternity services worldwide.
BACKGROUND: According to the Office for National Statistics, approximately a quarter of women giving birth in England and Wales are from minority ethnic groups. Previous work has indicated that these women have poorer pregnancy outcomes than White women and poorer experience of maternity care, sometimes encountering stereotyping and racism. The aims of this study were to examine service use and perceptions of care in ethnic minority women from different groups compared to White women. METHODS: Secondary analysis of data from a survey of women in 2010 was undertaken.
Almost three quarters of patients with cancer have severe pain, from invasion of the cancer itself, from effects of therapy, or from causes unrelated to the cancer (but often exacerbated by it). With the proper pain-management strategy, however, pain can be controlled in most patients. The analgesic ladder for pain control, promoted by the World Health Organization, begins with a nonnarcotic agent, progresses to a weak narcotic plus a nonnarcotic, and finally reaches a strong narcotic. Adjuvant agents, which increase the analgesic potency of the drug being used, may be added at any level.
In summary, it is common to encounter children in pain in the pediatric ED. It is often impossible to avoid inflicting pain on some children in the ED. The proper management of this pain is thus essential. This management should be accomplished with a variety of narcotic and nonnarcotic analgesics, as well as local and topical anesthetics. Other agents such as nitrous oxide, and techniques such as hypnosis and transcutaneous nerve stimulation, have a more limited role in pain management. Gentle restraint and reassurance are of paramount importance.
Five cases are presented wherein hypnosis was used by the emergency physician either as the primary mode of treatment or as an adjuvant to standard medical care. Common hypnotic phenomena (eg, anesthesia, analgesia), as well as novel effects, are reported. The technique used for trance induction and utilization is briefly outlined, and criteria are set forth for the bedside recognition of hypnotic trance.