Mifepristone: A Safe Method of Medical Abortion and Self-Managed Medical Abortion in the Post-Roe Era.

BACKGROUND: The U.S. Supreme Court's Dobbs v. Jackson Women's Health Organization decision on June 24, 2022 effectively overturned federal constitutional protections for abortion that have existed since 1973 and returned jurisdiction to the states. Several states implemented abortion bans, some of which banned abortion after 6 weeks and others that permit abortion under limited exceptions, such as if the health or the life of the woman is in danger. Other states introduced bills that define life as beginning at fertilization. As a result of these new and proposed laws, the future availability of mifepristone, one of two drugs used for medical abortion in the United States, has become the topic of intense debate and speculation. AREAS OF UNCERTAINTY: Although its safety and effectiveness has been confirmed by many studies, the use of mifepristone has been politicized regularly since its approval. Areas of future study include mifepristone for induction termination and fetal demise in the third trimester and the management of leiomyoma. DATA SOURCES: PubMed, Society of Family Planning, American College of Obstetricians and Gynecologists, the World Health Organization. THERAPEUTIC ADVANCES: The use of no-touch medical abortion, which entails providing a medical abortion via a telehealth platform without a screening ultrasound or bloodwork, expanded during the COVID-19 pandemic, and studies have confirmed its safety. With the Dobbs decision, legal abortion will be less accessible and, consequently, self-managed abortion with mifepristone and misoprostol will become more prevalent. CONCLUSIONS: Mifepristone and misoprostol are extremely safe medications with many applications. In the current changing political climate, physicians and pregnancy-capable individuals must have access to these medications.

The Association between the Sense of Coherence and the Self-Reported Adherence to Guidelines during the First Months of the COVID-19 Pandemic in Israel.

(1) Background: Social distancing became a central strategy employed to limit the spread of the SARS-CoV-2 virus. We explore self-reported adherence (SRA) and factors associated with SRA among Israeli adults at the end of the first national lockdown in Israel. (2) Methods: We conducted a cross-sectional consumer panel survey of 820 Israeli adults aged 18 to 70 in May and June 2020. We collected data on the SRA to the social distancing measures, sociodemographic variables, perceptions of pandemic-related danger and of protection provided by the social distancing measures, as well as Sense of Coherence (SoC). (3) Results: 60% of respondents reported complying with 7 measures. Higher SoC was associated with higher SRA (p = 0.04), and was related to income, marital status, age, profession, and education. The SRA was higher among Jews than Arabs (Jews: Mean = 10.5, SD = 4.5; Arabs: Mean = 9.1, SD = 4.1, p < 0.001) and among males (Males: Mean = 10.8, SD = 4.7; Females: Mean = 9, SD = 4.1; p = 0.003). SoC, perception of protection and perception of danger were associated with higher SRA (p = 0.42, p < 0.001 and p = 0.005 respectively). Single people reported higher levels of SRA than people in relationships (Partnered: Mean = 9.7, SD = 4.2, Non-partnered: Mean = 10.9, SD = 4.7, p = 0.033). (4) Conclusions: At the time of exit from the first lockdown, compliance with social distancing measures was high, with Jewish, single and male Israelis more likely to adhere to the guidelines. We identified the populations at risk for non-adherence and associated factors, reporting for the first time the correlation between SoC and SRA. Further research is needed to assess the role of these factors in Jewish and Arab populations.

From classrooms to Zoom rooms: preserving effective communication in distance education: JITCAR

One of the immediate consequences of Covid-19 is that educational institutions all over the world had to make a rapid transition from frontal classroom learning to distance learning. The present study focuses on higher education and examines the implications of the transition from in-class learning to learning via the Zoom platform in an academic institute of engineering. Specifically, we focus on how the transition affected interpersonal communication. We examined the manifestation of the four media richness theory (MRT) dimensions as reported in the subjective evaluations of the lecturers and students. We gathered information from various formal and informal oral and textual sources and found that shifting away from in-class learning was detrimental to all four dimensions of interpersonal communication. Using Te’eni’s cognitive-affective model of communication, we examined whether successful educators used communication strategies to overcome potential harm to the learning process. We found a diverse use of six communication strategies to maintain mutual understanding and positive emotions. We recommend that educators apply these communicational strategies to compensate for the forced distance from the richest media, thus promoting a high level of effective learning in cognitive and affective terms.

Implementing online-testing – cases in higher education in Israel: JITCAR

Due to Covid-19, the higher education system in Israel faced rapid changes. Among these was the immediate shift to online exams. In this paper, we endeavor to scrutinize the different approaches to online-testing that diverge, converge, and complement each other on varying dimensions. The main questions we would like to address are how online exams were implemented on a large scale in Israel, the pros and cons of each form of implementation, and what factors characterized these exams. Data was gathered from various sources, including both interviews with faculty and students, online exam observations, e-mails and procedures, and informal queries and discussions on various online platforms such as faculty WhatsApp groups. Our findings suggest dimensions for scaling online exams and demonstrate that each of the academic institutions we examined focused on one dimension of the solution, neglecting to address the other dimensions. The main contributions of this study are a simple guide to educators including 10 easily-applied recommendations on how to better administer on-line exams, an assessment of the implementation of the chosen procedures, and our highlighting of specific key issues that have yet to be addressed. Further research is needed, specifically to gather longitudinal data, so that our conclusions may be validated and generalized.

A Shift in Medical Education During the COVID-19 Pandemic.

The COVID-19 pandemic has abruptly affected every aspect of people's daily lives worldwide. Just like every other area, the medical field has been dramatically impacted by the need to care for a large number of patients while at the same time protecting staff, patients, and their families. Changes in the wake of the pandemic called for the prompt and extensive rechanneling and re-organization of resources. The pandemic has opened challenges and concerns for patient safety, starting with the early recognition that individuals, including medical staff, may spread the virus during the asymptomatic phase. Many healthcare facilities faced resource-limited settings, including challenges in the availability of personal protective equipment for healthcare providers. Additionally, the pandemic has disrupted medical education, both at the undergraduate and at the graduate levels, and according to many predictions, its effects may forever transform the ways medical education is delivered. In this chapter, we are exploring the history of medical education, describe changes in medical education experienced during the COVID-19 pandemic, and predict some of the considerations worth taking into account when envisioning the future of medical education.

Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patients.

The development of coronavirus disease 2019 vaccines in the current and planned clinical trials is essential for the success of a public health response. This paper focuses on how physicians should implement the results of these clinical trials when counseling patients who are pregnant, planning to become pregnant, breastfeeding or planning to breastfeed about vaccines with government authorization for clinical use. Determining the most effective approach to counsel patients about coronavirus disease 2019 vaccination is challenging. We address the professionally responsible counseling of 3 groups of patients-those who are pregnant, those planning to become pregnant, and those breastfeeding or planning to breastfeed. We begin with an evidence-based account of the following 5 major challenges: the limited evidence base, the documented increased risk for severe disease among pregnant coronavirus disease 2019-infected patients, conflicting guidance from government agencies and professional associations, false information about coronavirus disease 2019 vaccines, and maternal mistrust and vaccine hesitancy. We subsequently provide evidence-based, ethically justified, practical guidance for meeting these challenges in the professionally responsible counseling of patients about coronavirus disease 2019 vaccination. To guide the professionally responsible counseling of patients who are pregnant, planning to become pregnant, and breastfeeding or planning to breastfeed, we explain how obstetrician-gynecologists should evaluate the current clinical information, why a recommendation of coronavirus disease 2019 vaccination should be made, and how this assessment should be presented to patients during the informed consent process with the goal of empowering them to make informed decisions. We also present a proactive account of how to respond when patients refuse the recommended vaccination, including the elements of the legal obligation of informed refusal and the ethical obligation to ask patients to reconsider. During this process, the physician should be alert to vaccine hesitancy, ask patients to express their hesitation and reasons for it, and respectfully address them. In contrast to the conflicting guidance from government agencies and professional associations, evidence-based professional ethics in obstetrics and gynecology provides unequivocal and clear guidance: Physicians should recommend coronavirus disease 2019 vaccination to patients who are pregnant, planning to become pregnant, and breastfeeding or planning to breastfeed. To prevent widening of the health inequities, build trust in the health benefits of vaccination, and encourage coronavirus disease 2019 vaccine and treatment uptake, in addition to recommending coronavirus disease 2019 vaccinations, physicians should engage with communities to tailor strategies to overcome mistrust and deliver evidence-based information, robust educational campaigns, and novel approaches to immunization.

Expanding the concept of the professional integrity of obstetrics during a public health emergency.

The coronavirus disease 2019 (COVID-19) pandemic has placed great demands on many hospitals to maximize their capacity to care for affected patients. The requirement to reassign space has created challenges for obstetric services. We describe the nature of that challenge for an obstetric service in New York City. This experience raised an ethical challenge: whether it would be consistent with professional integrity to respond to a public health emergency with a plan for obstetric services that would create an increased risk of rare maternal mortality. We answered this question using the conceptual tools of professional ethics in obstetrics, especially the professional virtue of integrity. A public health emergency requires frameshifting from an individual-patient perspective to a population-based perspective. We show that an individual-patient-based, beneficence-based deliberative clinical judgment is not an adequate basis for organizational policy in response to a public health emergency. Instead, physicians, especially those in leadership positions, must frameshift to population-based clinical ethical judgment that focuses on reduction of mortality as much as possible in the entire population of patients served by a healthcare organization.