Societal implications of the Dobbs v Jackson Women's Health Organization decision.

On June 24, 2022, the US Supreme Court's decision in Dobbs v Jackson Women's Health Organization marked the removal of the constitutional right to abortion in the USA, introducing a complex ethical and legal landscape for patients and providers. This shift has had immediate health and equity repercussions, but it is also crucial to examine the broader impacts on states, health-care systems, and society as a whole. Restrictions on abortion access extend beyond immediate reproductive care concerns, necessitating a comprehensive understanding of the ruling's consequences across micro and macro levels. To mitigate potential harm, it is imperative to establish a research agenda that informs policy making and ensures effective long-term monitoring and reporting, addressing both immediate and future impacts.

Health-care workforce implications of the Dobbs v Jackson Women's Health Organization decision.

The Dobbs v Jackson Women's Health Organization Supreme Court decision, which revoked the constitutional right to abortion in the USA, has impacted the national medical workforce. Impacts vary across states, but providers in states with restrictive abortion laws now must contend with evolving legal and ethical challenges that have the potential to affect workforce safety, mental health, education, and training opportunities, in addition to having serious impacts on patient health and far-reaching societal consequences. Moreover, Dobbs has consequences on almost every facet of the medical workforce, including on physicians, nurses, pharmacists, and others who work within the health-care system. Comprehensive research is urgently needed to understand the wide-ranging implications of Dobbs on the medical workforce, including legal, ethical, clinical, and psychological dimensions, to inform evidence-based policies and standards of care in abortion-restrictive settings. Lessons from the USA might also have global relevance for countries facing similar restrictions on reproductive care.

Science and Sex-A Bold Agenda for Women's Health.

This Viewpoint examines why investigators should address women's health in all biomedical and health-related research.

Clinical Assessment of Primary Hemostasis: A Review.

Primary hemostatic disorders such as thrombocytopenia and thrombocytopathia are commonly encountered in small animal practice. The key stages of primary hemostasis include platelet adhesion, activation, and aggregation. Understanding the interaction between tissues, platelets, and signaling molecules not only helps clinicians comprehend clot formation but also better recognize thrombocytopathias. Although congenital thrombocytopathia is rare, commercially available platelet function tests allow veterinarians to narrow differentials in many clinical settings. Thrombocytopenia can be easily diagnosed in any clinical setting. In this paper, we review the current understanding of primary hemostasis in veterinary medicine, including the clinical presentation and available diagnostics to identify platelet abnormalities.

Interstitial glucose monitoring has acceptable clinical accuracy in juvenile dogs.

OBJECTIVE: To compare the performance of an interstitial glucose monitor (IGM) versus a portable blood glucose monitor (PBGM) in sick juvenile dogs in a veterinary ICU. ANIMALS: 16 client-owned dogs admitted to the university teaching hospital under 1 year of age with systemic illness. PROCEDURES: Paired interstitial and blood glucose samples were collected. A third glucose measurement with a reference method was obtained when IGM and PBGM values were clinically disparate. Analytical accuracy was measured by Pearson correlation and agreement statistics, including mean absolute relative difference (MARD), bias, and 95% limits of agreement. The Parkes consensus error grid analysis was performed to assess clinical accuracy. RESULTS: 159 paired glucose measurements were available for analysis. Comparison of IGM readings to PBGM measurements resulted in an MARD of 15.4% and bias of -2.6%, with the 95% limits of agreement ranging from -42.5% to 37.4%. Positive correlation between IGM and PBGM (Pearson r = 0.65) was found. On consensus error grid analysis, 100% of the pairs fell into clinically acceptable zones (74.2% in zone A, and 25.8% in zone B). When disparate IGM and PBGM readings were compared to a laboratory reference standard (n = 13), both methods resulted in high MARD and wide limits of agreement. CLINICAL RELEVANCE: The IGM provides clinically acceptable glucose measurements compared to PBGM to monitor glucose levels in juvenile dogs in a clinical setting. Further clinical studies with a larger sample size, particularly in the hypoglycemic range, are needed to assess IGM performance in the lower glucose range.

Comparison of a commercial immunochromatographic strip crossmatch kit and standard laboratory crossmatch methods for blood transfusion compatibility in dogs.

OBJECTIVE: To evaluate agreement between 2 standard laboratory (SL) methods and an immunochromatographic strip (ICS) method to crossmatch dogs receiving RBC transfusions. A second objective was to evaluate uninterpretable SL crossmatch results as compared to ICS in the presence of autoagglutination. DESIGN: Prospective observational study (September 2018 to October 2019). SETTING: University teaching hospital. ANIMALS: Forty anemic dogs receiving RBC transfusions. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: All dogs received DEA 1-negative packed RBCs. Three crossmatch methods were evaluated against the same unit transfused to each dog: SL method performed at institutional laboratory (SL-I), SL method sent to a commercial laboratory (SL-C), and a commercially available point-of-care ICS method. Major and minor crossmatches were incompatible for 2.5%/7.5% of ICS tests, 82.5%/52.5% of SL-I tests, and 52.5%/27.5% of SL-C tests. Agreement between ICS and SL-C major (κ = 0.05) and minor (κ = 0.02) crossmatches and between ICS and SL-I major (κ = 0.009) and minor (κ = 0.03) crossmatches was slight. Agreement between SL-C and SL-I major (κ = -0.06) and minor (κ = -0.12) crossmatches was poor. Results of major and minor crossmatches were uninterpretable due to autoagglutination in 38%/38% for SL-I and 29%/18% for SL-C crossmatches. ICS method was interpretable for 93% (major) and 98% (minor) crossmatches. After exclusion of uninterpretable SL pairings, agreement still remained poor to slight between all tests. Only 1 of 40 dogs (2.5%; 95% confidence interval: <1.0%-13.2%) had an immediate immunological transfusion reaction. CONCLUSIONS: Lack of agreement between all methodologies was noted. The high level of incompatibility predicted by SL methods despite lack of clinically relevant reactions suggests a high false incompatibility rate as compared to the ICS test. ICS testing was also able to give results more frequently in the face of autoagglutination. Further work is needed to investigate the ICS method's ability to predict clinically significant transfusion reactions.

Assessment of the physical compatibility of injectable enrofloxacin with commonly used intravenous fluids and drugs during simulated Y-port administration.

OBJECTIVE: To evaluate physical compatibility of small animal (SAE) and large animal (LAE) injectable formulations of enrofloxacin with select IV fluids and drugs. SAMPLE: 162 admixtures containing SAE or LAE with saline (0.9% NaCl) solution, lactated Ringer solution (LRS), Plasma-Lyte A (PLA), 6% hydroxyethylstarch 130/0.4 (HES), metoclopramide, or ampicillin-sulbactam. PROCEDURES: In the first of 2 simultaneously conducted experiments, admixtures containing enrofloxacin (10 mg/kg) and a volume of IV fluid that would be administered over a 20-minute period when dosed at the maintenance infusion rate (40 mL/kg/d for saline solution, LRS, and PLA and 20 mL/kg/d for HES) were created. In the second experiment, enrofloxacin (10 mg/kg) was admixed with saline solution (40 mL/kg/d) and metoclopramide (2 mg/kg/d) or ampicillin-sulbactam (30 mg/kg). In both experiments, admixture components were infused into a flask over 20 minutes assuming patient weights of 5, 10, and 20 kg. Admixtures were created by use of undiluted SAE and SAE diluted 1:1 with saline solution and undiluted LAE and LAE diluted 1:1 and 1:10 with saline solution. Admixtures were assessed for physical incompatibility at 0, 15, 30, and 60 minutes after completion of mixing. Physical incompatibility was defined as gross precipitation, cloudiness, Tyndall effect, or change in turbidity. RESULTS: Admixtures containing undiluted SAE or LAE were physically incompatible with saline solution, PLA, LRS, and HES. Because saline solution was used to dilute SAE and LAE, all admixtures containing diluted SAE or LAE were also physically incompatible. Physical compatibility of enrofloxacin with metoclopramide or ampicillin-sulbactam could not be assessed because those admixtures also contained saline solution. CONCLUSIONS AND CLINICAL RELEVANCE: Enrofloxacin was physically incompatible with all tested solutions.

Research Conducted in Women Was Deemed More Impactful but Less Publishable than the Same Research Conducted in Men.

Background: Female scientists, who are more likely than their male counterparts to study women and report findings by sex/gender, fare worse in the article peer review process. It is unknown whether the gender of research participants influences the recommendation to publish an article describing the study. Materials and Methods: Reviewers were randomly assigned to evaluate one of three versions of an article abstract describing a clinical study conducted in men, women, or individuals. Reviewers assessed the study's scientific rigor, its level of contribution to medical science, and whether they would recommend publishing the full article. Responses were analyzed with logistic regression controlling for reviewer background variables, including sex and experience level. Results: There was no significant difference in perceived research rigor by abstract condition; contribution to medical science was perceived to be greater for research conducted in women than men (odds ratio = 1.7; p = 0.030). Nevertheless, reviewers were almost twice as likely to recommend publication for research conducted in men than the same research conducted in women (predicted probability 0.606 vs. 0.322; p = 0.000). Conclusions: These results are consistent with abundant data from multiple sources showing a lower societal value placed on women than men. Because female investigators are more likely than male investigators to study women, our findings suggest a previously unrecognized bias that could contribute to gender asymmetries in the publication outcomes of peer review. This pro-male publication bias could be an additional barrier to leadership attainment for women in academic medicine and the advancement of women's health.

Cryopreservation of feline red blood cells in liquid nitrogen using glycerol and hydroxyethyl starch.

OBJECTIVES: The objective of this study was to evaluate the techniques and short-term effects of cryopreservation of feline red blood cells (RBCs) in liquid nitrogen using glycerol or hydroxyethyl starch (HES) as a cryoprotectant. METHODS: Feline RBCs were manually mixed with either 20% glycerol or 12.5% HES and frozen for 24 h in liquid nitrogen. The samples were thawed and glycerolized samples were manually washed. Success of the freeze/thaw process was determined by recovery rate of RBCs and evaluation of morphological changes using scanning electron microscopy (SEM). A unit of canine packed RBCs was also subjected to the same methodology to evaluate the cryopreservation handling technique. RESULTS: Feline RBCs preserved with 20% glycerol had a high recovery rate (94.23 ± 1.25%) immediately after thawing. However, the majority of the cells were lost during the washing process, with a final packed cell volume of <1%. A recovery rate was unable to be assessed for samples preserved with HES owing to the high viscosity of the mixture. SEM revealed significant morphological changes after glycerol was added to the feline RBCs. Although these morphological changes were partially reversed after thawing, the majority of the RBCs were lost during the washing process. Minimal morphological changes were noted in the HES sample. Similar results were noted with the canine RBCs. CONCLUSIONS AND RELEVANCE: The described manual technique for cryopreservation using glycerol was not able to successfully preserve feline or canine RBCs. In the present study, it was difficult to make conclusions about the efficacy of HES. Further studies evaluating HES as a cryoprotectant are warranted.

Ultrasound measurements of the caudal vena cava before and after blood donation in 9 greyhound dogs.

This prospective study evaluated variation in the diameter of the caudal vena cava (DCdVC) as a marker of change in intravascular volume before and after blood donation in greyhound dogs. A preliminary study determined that the DCdVC increased with body weight. Nine greyhound blood donors had ultrasonographic images acquired of the maximum and minimum DCdVCs in transverse and sagittal orientations and sagittal aortic diameter (AoD) before and after blood donation. The collapsibility index = [(maximal mean transverse DCdVC - minimal mean transverse DCdVC)/maximal mean transverse DCdVC] and transverse DCdVC:AoD ratio were calculated for each dog. In the greyhounds, the changes in mean minimal and maximal transverse DCdVC (0.69 and 0.84 mm, respectively) and sagittal mean maximal DCdVC (0.9 mm) and collapsibility index (0.018) were significantly different (P < 0.05) before and after blood donation. While statistically significant, the magnitude of DCdVC change found in this limited number of greyhound dogs with 8% intravascular volume loss during blood donation was small. This magnitude of change is likely indistinguishable in clinical patients.

Mesures par ultrason de la veine cave caudale avant et après le don de sang chez 9 chiens Greyhound. Cette étude prospective a évalué la variation du diamètre de la veine cave caudale (DCdVC) comme marqueur du changement du volume intravasculaire avant et après le don de sang chez les chiens Greyhound. Une étude préliminaire a déterminé que le DCdVC a augmenté le poids corporel. Neuf Greyhound donneurs de sang avaient des images échographiques acquises pour les DCdVC maximum et minimum dans les orientations transversales et sagittales et le diamètre aortique sagittal (AoD) avant et après le don de sang. L'indice de collapsibilité = [(DCdVC maximal transversal moyen ­ DCdVC minimal transversal moyen)/DCdVC maximal transversal moyen] et le ratio transversal DCdVC:AoD ont été calculés pour chaque chien. Chez les Greyhounds, les changements des DCdVC minimaux et maximaux transversaux moyens (0,69 et 0,84 mm, respectivement) et le DCdVC maximal sagittal moyen (0,9 mm) et l'indice de collapsibilité (0,018) étaient significativement différents (P < 0,05) avant et après le don de sang. Même si ce changement est significatif sur le plan statistique, l'ampleur du changement DCdVC constatée dans ce nombre limité de chiens Greyhound ayant 8 % de perte de volume intravasculaire durant le don de sang était faible. Cette ampleur de changement est probablement impossible à distinguer chez les patients cliniques.(Traduit par Isabelle Vallières).

Comparison of ultrasound-guided and landmark-based techniques for central venous catheterization via the external jugular vein in healthy anesthetized dogs.

OBJECTIVE To compare time to achieve vascular access (TTVA) between an ultrasound-guided technique (UST) and landmark-based technique (LMT) for central venous catheter (CVC) placement in healthy anesthetized dogs. ANIMALS 39 purpose-bred hounds. PROCEDURES Anesthetized dogs that were hemodynamically stable following completion of a terminal surgical exercise were enrolled in the study during 2 phases, with a 45-day intermission between phases. For each dog, a UST and LMT were used for CVC placement via each external jugular vein by 2 operators (criticalist and resident). The TTVA and number of venipuncture attempts and catheter redirections were recorded for each catheterization. Placement of the CVC was confirmed by contrast fluoroscopy. After euthanasia, a gross dissection was performed during which a hematoma score was assigned to the catheter insertion site. For each phase, nonlinear least squares estimation was used for learning curve analysis of the UST. RESULTS Median TTVA, number of venipuncture attempts and catheter redirections, and hematoma score did not differ significantly between the 2 operators for either technique. Median TTVA for the UST (45 seconds) was significantly longer than that for the LMT (7 seconds). Learning curve analysis indicated that 8 and 7 UST catheterizations were required to achieve performance stability in phases 1 and 2, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that the UST was comparable to the LMT for CVC placement in healthy dogs. The extra time required to perform the UST was not clinically relevant. Additional studies evaluating the UST for CVC placement in clinically ill dogs are warranted.

Suicidal behavior-related hospitalizations among pregnant women in the USA, 2006-2012.

Suicide is one of the leading causes of maternal mortality in many countries, but little is known about the epidemiology of suicide and suicidal behavior among pregnant women in the USA. We sought to examine trends and provide nationally representative estimates for suicidal behavior (including suicidal ideation and suicide and self-inflicted injury) among pregnant women from 2006 to 2012 in the USA. Pregnant women aged 12-55 years were identified through pregnancy- and delivery-related hospitalization records from the National (Nationwide) Inpatient Sample. Suicidal behavior was identified by the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Annual, nationwide estimates and trends were determined using discharge and hospital weights. The prevalence of suicidal ideation more than doubled from 2006 to 2012 (47.5 to 115.0 per 100,000 pregnancy- and delivery-related hospitalizations), whereas the prevalence of suicide and self-inflicted injury remained stable. Nearly 10 % of suicidal behavior occurred in the 12-18-year group, showing the highest prevalence per 100,000 pregnancy- and delivery-related hospitalizations (158.8 in 2006 and 308.7 in 2012) over the study period. For suicidal ideation, blacks had higher prevalence than whites; women in the lowest income quartile had the highest prevalence. Although the prevalence of suicidal behavior was higher among hospitalizations with depression diagnoses, more than 30 % of hospitalizations were for suicidal behavior without depression diagnoses. Our findings highlight the increasing burden and racial differences in suicidal ideation among US pregnant women. Targeted suicide prevention efforts are needed for high-risk pregnant women including teens, blacks, and low-income women.

Relationship between intracranial pressure as measured by an epidural intracranial pressure monitoring system and optic nerve sheath diameter in healthy dogs.

OBJECTIVE: To evaluate the association between ultrasonographically measured optic nerve sheath diameter (ONSD) and acute increases in intracranial pressure (ICP) as measured by an epidural intracranial pressure monitoring system (EICPMS) in healthy dogs. ANIMALS: 6 young healthy dogs. PROCEDURES: An EICPMS connected to a pressure monitor was used to generate a continuous pressure waveform in each anesthetized dog. A 22-gauge IV catheter was inserted into the brain parenchyma through the contralateral parietal bone, and 0.5 to 2.0 mL of anticoagulated autologous blood was injected at predetermined intervals. At baseline (immediately after EICPMS placement) and following each injection, the ICP as indicated by EICPMS was recorded, and 3 ultrasonographic images of the optic nerve sheath of each eye were obtained. The ONSD was measured at maximum diameter and at 5 mm caudal to the optic disk. RESULTS: In linear models, the maximum ONSD was positively associated with increasing ICP. Specifically, the rate of maximum ONSD increase was greater for pressures ≤ 20 mm Hg above baseline (0.0534 mm/1 mm Hg ICP increase) than for pressures > 40 mm Hg above baseline (0.0087 mm/1 mm Hg ICP increase). The relationship of ICP to maximum ONSD was slightly nonlinear and best explained by comparison of fractional polynomial regression models. CONCLUSIONS AND CLINICAL RELEVANCE: ICP was positively and nonlinearly associated with increasing maximum ONSD, especially when ICP was ≤ 20 mm Hg above baseline, supporting the conclusion that ultrasonographic measurement of maximum ONSD may provide a noninvasive monitoring tool for evaluation of ICP in dogs. Further research is needed to assess the utility of these measurements in clinical patients.