The Impact of COVID-19 on Freshwater Fisheries Fieldwork and Data Collection.

COVID-19 has affected almost every aspect of society including freshwater fisheries fieldwork. Our study quantified the effects of the pandemic on fisheries fieldwork in the United States. We administered a survey to fisheries chiefs in all 50 states to assess the pandemic's impact on fisheries fieldwork. Of the 37 participants, 91% reported the pandemic affected their fieldwork and 92% adapted their sampling methods in response to the pandemic. Common adaptation strategies included using personal protective equipment (100%), practicing social distancing (97%), using smaller crews (82%), and developing contingency plans (51%). Based on the survey results, we identified potential challenges to adaptations and offered strategies to improve them. Strategies we identified include adopting novel data collection techniques, finding new positions for temporary employees, and publicly sharing contingency plans. Ultimately, this paper offers novel guidance on how fisheries professionals can best move forward with fieldwork during a time of crisis.

Telemedicine Companies Providing Prescription-Only Medications: Pros, Cons, and Proposed Guidelines.

In the past few years, there has been a significant increase in the number of direct-to-consumer telehealth companies offering prescription medications to women. Leveraging technology, these companies have the potential to improve access to care and ensure that women have access to prescription-only medications in a convenient fashion. However, it is important to ensure that they are doing so in a safe, patient-centered way that observes evidence-based prescribing guidelines. In this article, we discuss the pros and cons of direct-to-consumer telehealth companies offering prescription medicine and suggest several guidelines to ensure that women are being cared for in an appropriate way.

Parental consent: an unnecessary barrier to adolescent obstetrical care.

When adolescents in the United States become pregnant, these young mothers experience differential access to obstetrical services, including prenatal, intrapartum, and postpartum care. As of 2018, 13 states in the United States do not afford a pregnant minor rights to prenatal care without parental consent, and 13 states do not ensure confidentiality from parental disclosure. Because of this, young mothers may avoid seeking timely and medically necessary care, not to mention counseling regarding preventive health services and monitoring of underlying chronic conditions. Lack of access during these critical months leads to missed essential opportunities for intervention and increased pregnancy-related risks to the mother and infant. It is imperative for obstetricians and gynecologists to value, support, and advocate for adolescents' emerging autonomy and personal agency to make informed decisions about their own bodies during their pregnancies, but also in making the choice to prevent future pregnancies through contraception.

Identifying and Assisting Sexually Exploited and Trafficked Patients Seeking Women's Health Care Services.

It is estimated that 21 million people are trafficked worldwide, including 11.4 million women and girls. Approximately 4.5 million are forced to do sexual labor. The exact prevalence of human trafficking is difficult to ascertain, however, given the limitations of data collection in an illegal industry. Obstetrician-gynecologists should not only be aware of the widespread nature of human trafficking, but also have the tools to assess patients for trafficking and respond to victim identifications. Patients may present with signs of physical abuse, depression, anxiety, posttraumatic stress disorder, substance use, sexually transmitted infections, pregnancy, and nonspecific somatic complaints. As with intimate partner violence, clinicians should be suspicious if the patient is accompanied by an individual who refuses to leave her side. Other potential red flags include patients with wounds in various stages of healing, patients appearing fearful or unable to answer specific questions, and patients who do not have any personal identification. Health care providers should speak with the patient privately, using professional interpreters when indicated. Although there are no validated screening questions for the health care setting, in this article, we provide sample questions such as, "Is anyone forcing you to do anything physically or sexually that you do not want to do?" The physical examination should be thorough with appropriate workup, sexually transmitted infection prophylaxis, and emergency contraception. Physicians and patients should be aware of their state's mandatory reporting requirements and careful documentation is essential. Finally, to ensure a comprehensive, interdisciplinary response to trafficked patients, practitioners should engage hospital-based and community-based services when appropriate.

Contraception: Menarche to Menopause.

Contraception services should be part of routine health care maintenance in reproductive-aged women, especially in light of the fact that approximately 50% of pregnancies in the United States remain unplanned. Barrier methods, especially condoms, may play a role in sexually transmitted disease prevention but are less efficacious for pregnancy avoidance. There are several available hormonal contraceptive options, including the combination hormonal pill, progestin-only pill, combination hormonal patches and rings, injectable progestins, implantable progestins, intrauterine devices (copper or progestin), and permanent sterilization. These methods have varying efficacy, often related to patient compliance or tolerance of side effects.

The Role of Social Networks, Medical-Legal Climate, and Patient Advocacy on Surgical Options: A New Era.

The dissemination of information online and resultant public discourse through social media and other online channels has influenced the practice of medicine in dramatic ways. Physicians have historically worked to develop new techniques and devices for the benefit of their patients. It is only a more recent phenomenon, however, that these tools are either removed or their use is curtailed largely driven by anecdotal reports; passionate, vocal, often media-savvy advocates; and plaintiff attorneys. The use of power morcellation, hysteroscopic tubal sterilization, and mesh in urogynecologic procedures all have been victims of these societal pressures. It is important for health care professionals to be involved in the debate to ensure that public outcry does not unduly influence what we, as clinicians, are able to safely offer our patients. By being better advocates for our field, our instruments, and our patients, we can ensure medical decision-making is driven by good science and not public fervor.

Changes in the Practice of Obstetrics and Gynecology.

A projected shortage of obstetrician-gynecologists (OB-GYNs) is a result of both the increasing US population and the relatively static number of residency graduates. In addition, generational changes have contributed to increasing subspecialization, more desiring part-time employment, and earlier retirement. This article reviews data regarding changes in the practice of obstetrics and gynecology. Residency education is focusing more on a core curriculum in general obstetrics and gynecology, while subspecialty fellowship training has grown in popularity. There are no recent data to describe whether OB-GYNs are working fewer hours, yet more are employed in larger practices at mostly metropolitan locations. A team-based care model that incorporates nonphysician clinicians and digital conversion of clinical data has been encouraged to increase accessibility, improve comprehensiveness, commit to more continuity of care, and reduce redundancy. Compared with other medical specialists, OB-GYNs retire slightly earlier, especially females who will represent the field more. The specialty is moving toward a more comprehensive women's health care practice model that is more patient-centered, efficient, cost controlling, team-based, and adaptable to the needs of a diverse population. Implications from these changes for our practices and improving patient care are currently unclear and await more reported experience.

Credentialing based on surgical volume, physician workforce challenges, and patient access.

Advances within the medical profession have resulted in an increase in available medical therapeutic options and minimally invasive surgical techniques for common gynecologic conditions. In many circumstances, this has led to a reduction in surgical volume for many common conditions in benign gynecology. There is also some evidence that a threshold number of cases may exist, below which surgical competence may be affected. Although the practice of medicine continues to evolve, there is broad recognition of a projected workforce shortage of physicians. If credentialing or privileging bodies establish criteria based solely on the number of procedures performed by an individual physician, patient access may be greatly affected. From a public health perspective, these issues cannot be considered in isolation. Thoughtful analysis of existing data and recognition of patient access issues should be carefully weighed before any dramatic changes in hospital privileging or hiring practices. Consideration for ongoing maintenance of credentialing should be carefully balanced and strategies for ongoing assurance of competency may require creative alternatives to simple numerical documentation. Differential approaches to regions with different densities of physicians may also be necessary.

Newborn care and safety: the black box of obstetric practices and residency training.

Certain causes of newborn mortality such as sudden unexpected infant death, which includes sleep-related infant death and sudden unexplained infant death syndrome, are potentially preventable. Obstetricians are uniquely positioned to counsel new parents about safe practices regarding newborn sleep, feeding, and transportation. Patients often do not develop a relationship with their pediatricians until the neonate has been discharged, and the newborn period is a time of particular vulnerability. Newborn safety should be routinely taught in obstetric curricula, and the American College/Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics (AAP) should partner to disseminate updated literature and guidelines to health care providers regarding newborn safety. Current guidelines from the Academy of Pediatrics Task Force on Sudden Infant Syndrome are summarized in this article.

Regulatory and electronic alphabet soup: practice improvements and implications for providers.

The growth of health information technology, the focus on patient safety and an increased degree of regulatory involvement in the practice of medicine have all transformed the way practitioners provide care. This paper reviews some of the recognized benefits of these advances, while outlining some of the challenges for providers at the bedside, utilizing a case study involving a hypothetical obstetric patient. The way external factors, such as information technology and regulatory requirements, influence the daily practice of medicine, should be carefully considered as the profession evolves.Integration and streamlining processes should remain a guiding principle to ensure patient safety and assist with workflow.

Three is a crowd: the new doctor-patient-policymaker relationship.

A recent increase in legislative initiatives involving specific aspects of the practice of medicine is challenging traditional doctor-patient relationships. A Florida state law prohibiting physicians from asking patients about the presence of guns in the home could potentially result in real harm because of the risk of childhood injuries, domestic violence, suicide, and homicide. A number of states have specific language physicians are supposed to use when obtaining consent for pregnancy terminations. Some of these items required by law to be contained in the informed consent are not based on science, but instead on political beliefs. Other legislative initiatives involve issues as varied as hysterectomy consents, glomerular filtration rates, family planning, and palliative care. Laws that prohibit physicians from asking patients certain questions may be violating doctors' First Amendment rights. Laws mandating what information is contained in procedural consent forms and requiring certain scripts to be utilized may interfere with patients' ability to have accurate, unbiased, objective information to assist in their decision making. Physicians may be caught in the untenable position of balancing their professional and ethical obligations to their patients with their duty to obey the law as citizens. Physicians should be involved in legislative advocacy to try to prevent policy makers from legislating the practice of medicine. The American Congress of Obstetricians and Gynecologists' Committee on Ethics should consider review of this evolving issue.

Topics to ponder: Part-time practice and pay parity.

BACKGROUND: The medical profession has undergone a significant demographic change, with a dramatic increase in the number of women applying to medical school and practicing medicine. OBJECTIVES: In recognition of the changing demographics in the medical profession, the American Medical Association's Women Physicians Congress (AMA-WPC) conducted a members' survey to identify the issues affecting women physicians and to ascertain certain practice characteristics. METHODS: In 2008, an e-mail survey link was sent to a randomly selected nationwide sample of 4992 WPC members, and a second, identical survey was sent to 596 female AMA members, utilizing the Epocrates database (Epocrates, Inc., San Mateo, California). Two e-mail reminders were sent for the first survey, which had a 15% response rate. A quota of 148 physicians was received within 4 days and was utilized to interpret results from the second survey. RESULTS: Achieving work-life balance was a significant concern for 91% of the respondents (n = 884). Half of the respondents believed that pay is gender neutral, and 28% indicated that they were "somewhat or very concerned about sexual harassment". When queried regarding practice patterns, 29% of respondents indicated that they had worked part-time at some point during their careers. CONCLUSIONS: In this survey, women physicians indicated that gender pay disparity and sexual harassment remain important issues in the medical profession. Less than a third of respondents had ever worked part-time, which should be a consideration for physician workforce studies. Barriers to part-time practice may exist.

Evaluation of a formal mentoring program in an obstetrics and gynecology residency training program: resident feedback and suggestions.

OBJECTIVE: A formal mentoring program for residents was introduced at our Department of Obstetrics and Gynecology in 2004. The objective of this study was to assess residents' attitudes toward and suggestions for the mentoring program. STUDY DESIGN/METHODS: An anonymous questionnaire with Likert-scaled questions on multiple areas of the program was distributed to all residents. The responses were scored with a rating of 0, 1, and 2, and mean ratings were calculated. RESULTS/CONCLUSIONS: The response rate was 28 of 40 (70.0%). Areas of the mentoring program deemed most important were "career planning" (mean score 1.85) and "scientific research" (1.51). The most negative aspects of the program were "lack of time" of the mentees (1.57) and the mentors (1.29). When matching mentees with mentors, the most important factors were "specialty/subspecialty" (1.71), "research interests"(1.65), "personality"(1.54), and the "ability to pick one's own mentor"(1.31). The majority of respondents (9 of 14, 64.3%) welcomed e-mail reminders to set up meetings with their mentor. These data have resulted in significant changes in our mentoring program. Future directions include continued surveillance of our program and collaboration between different residency programs in order to maximize the benefit of the resident mentor program.

Prospects and problems of direct-to-public genetic tests.

Direct-to-consumer advertising of genetic tests is prevalent, poorly regulated and fraught with potential negative public-health ramifications. While some genetic tests are available through means that safeguard patient understanding of the implications of having genetic tests performed, others are available to anyone who has a credit card, without any individualized counseling, assessment of whether such tests are indicated, or interpretation of test results. While the US FDA, the Centers for Medicare and Medicaid Services and the Federal Trade Commission all have a regulatory role, most experts agree that the industry is not adequately being reigned in to best protect the public it serves.