Biomedical subjects

Adrienne Einarson

Publications and source records attributed to Adrienne Einarson.

45 records · Page 3Linked to original sources

PubMed2002

A survey of physicians knowledge regarding awareness of maternal alcohol use and the diagnosis of FAS.

BACKGROUND: Alcohol is the most widely used drug in the world that is a human teratogen whose use among women of childbearing age has been steadily increasing. It is also probable that Fetal Alcohol Syndrome is under diagnosed by physicians. The objectives of this study were twofold: 1) to evaluate the experience, knowledge and confidence of family physicians with respect to the diagnosis of FAS and 2) to evaluate physicians awareness of maternal drinking patterns. METHODS AND PARTICIPANTS: A multiple choice anonymous questionnaire was sent to a randomly selected group of family physicians in the Metropolitan Toronto area. RESULTS: There was a 73% (75/103) total response rate; Overall, 6/75 (8%) of family physicians reported that they had actually diagnosed a child with FAS. 17.9% had suspicions but did not make a diagnosis and 12.7% reported making a referral to confirm the diagnosis. Physician rated confidence in the ability to diagnosis FAS was low, with 49% feeling they had very little confidence. 75% reported counselling pregnant women and 60.8% reported counselling childbearing women in general on the use of alcohol. When asked what screening test they used to detect the use of alcohol, 75% described frequency/quantity. Not a single respondent identified using the current accepted screening method for alcohol use (TWEAK) which is recommended by The Centre for Addiction and Mental Health. CONCLUSIONS: Family physicians do not feel confident about diagnosing FAS. None of the physicians were aware of the current screening methods to accurately gage alcohol use in pregnant and childbearing women.

Alcohol Drinking↗

PubMed2002

Motherisk-PUQE (pregnancy-unique quantification of emesis and nausea) scoring system for nausea and vomiting of pregnancy.

OBJECTIVE: The morbidity of nausea and vomiting of pregnancy varies substantially. In addition to the physical symptoms, the emotional and psychosocial stress must be considered. The method available today to measure the severity of nausea and vomiting of pregnancy stems from chemotherapy-induced symptoms and is too complicated to use clinically. We sought to establish a simple and clinically relevant method for evaluation of the severity of nausea and vomiting of pregnancy that can be used for both clinical practice and research. METHODS: Women with nausea and vomiting of pregnancy were scored by use of the "gold standard" Rhodes' score, which includes 8 items. The Rhodes' score was compared with several short versions of 3 to 4 items. Patients were subsequently followed up a week later to monitor changes in scores. Changes in the Rhodes' scores were correlated with changes in the simplified scores. RESULTS: There was a very tight correlation between the Rhodes' score and the new pregnancy-unique quantification of emesis and nausea (PUQE) scoring system, which was based on the 3 items that included the number of daily vomiting episodes, the length of nausea per day in hours, and the number of retching episodes (r = 0.904; P <.0001). The distribution of severity of cases (between none, mild, moderate, and severe) did not differ between the Rhodes' and the PUQE. Comparing the changes in Rhodes' scores after a week of follow-up versus changes in the new PUQE score, there was a very high agreement (r = 0.95;P <.0001). CONCLUSION: The new PUQE score yields similar results to the gold standard, but more cumbersome, Rhode's score. Clinicians and researchers can easily use PUQE.

Female↗

PubMed2002

Nausea and vomiting of pregnancy. Evidence-based treatment algorithm.

QUESTION: One of my patients suffers from a moderate-to-severe form of morning sickness. She responded only partially to doxylamine and pyridoxine (Dicletin), and I wish to try adding another medication. What should my priority be? ANSWER: An algorithm used by Motherisk to manage thousands of patients takes a hierarchical approach to this condition. This approach is evidence based with regard to fetal safety as well as efficacy.

Adult↗

PubMed2002

Use of warfarin during pregnancy.

QUESTION: One of my patients, who has been taking warfarin for some time for treatment and prophylaxis of deep vein thrombosis, became pregnant due to failed contraception. I am unsure how to counsel her. Is there evidence that warfarin use during pregnancy is associated with fetal risk? ANSWER: If possible, warfarin therapy should be avoided during pregnancy. If warfarin therapy is essential, it should be avoided at least during the first trimester (because of teratogenicity) and from about 2 to 4 weeks before delivery to reduce risk of hemorrhagic complications. Unfractionated heparin or low molecular weight heparin could be substituted when appropriate because these agents do not cross the placenta and are considered the anticoagulant drugs of choice during pregnancy.

Anticoagulants↗

PubMed2002

Bacterial vaginosis during pregnancy. Should we screen for and treat it?

QUESTION: Some of my patients have been diagnosed with bacterial vaginousis (BV) during pregnancy; some have symptoms, others do not. Should I be treating them, and if so, with what? Also, should I be screening all my pregnant patients for BV? ANSWER: There appears to be no benefit to screening or treating pregnant women with an average risk of BV. It is not even clear that treating pregnant women at high risk of BV is beneficial. If you decide to treat, the drugs of choice are oral or intravaginal gel metronidazole or oral clindamycin. Both these drugs are safe to use throughout pregnancy.

Anti-Infective Agents↗

PubMed2002

Update on motherisk updates. Seven years of questions and answers.

QUESTION: Every month I read the Motherisk Updates in your journal and find them very helpful in counseling my patients on exposures during pregnancy and breastfeeding. I was wondering: what are the most common questions you receive from family physicians? ANSWER: Since the Motherisk Update began, we have received an increasing number of inquiries from family physicians across Canada. Most questions are about drug exposures. The three classes of drugs asked about most often are antidepressants, antiepileptics, and antihistamines.

Adult↗

PubMed2002

Taking ginger for nausea and vomiting during pregnancy.

QUESTION: Many of my patients prefer to use natural or herbal medicines, such as ginger, before taking drugs to treat nausea and vomiting of pregnancy. Is there evidence that ginger is safe to use during pregnancy? Is it effective? ANSWER: Although ginger is used in many cultures to treat the symptoms of nausea and vomiting, no trials have established its safety for use during pregnancy. On the other hand, its efficacy has been documented in two randomized, blinded controlled trials.

Female↗

PubMed2002

A prospective-controlled study of pregnant veterinary staff exposed to inhaled anesthetics and x-rays.

Most veterinary staff are women of reproductive age. They are exposed to "waste" anesthetic gas and ionizing radiation in their workplace, which may endanger fetal safety. Presently, exposure of female veterinary staff to these health hazards has not been adequately addressed in the medical literature. Our primary objective was to investigate the incidence of major malformations associated with occupational exposure to inhaled anesthetics and/or radiation among pregnant veterinary staff. The secondary objective was to determine the rates of other adverse outcomes. We prospectively collected data on and followed-up women occupationally exposed to inhaled anesthetics and/or radiation in veterinary practices in Ontario, and compared them to controls matched for maternal age and gestational age at the time of call to the Motherisk Program. A total of 95 women were prospectively enrolled and followed-up. Among the participants there were 87 (93.5%) and 88 (92.8%) livebirths in the study and control groups, respectively. There were 4 (4.8%) major birth defects in the study group and 3 (3.4%) in the control group. The rates of spontaneous abortion were also similar, 6 (6.4%) cases in the study group and 7 (7.4%) cases in the control group. These results suggest that Ontario female veterinary staff exposed to inhaled anesthetics and/or radiation do not seem to be at an increased risk for major malformations above baseline risk.

Adult↗

PubMedDate not supplied

Determinants of women's decision making on whether to treat nausea and vomiting of pregnancy pharmacologically.

Nausea and vomiting of pregnancy (NVP) affects up to 80% of all women to some degree during their pregnancies. Diclectin (doxylamine and pyridoxine [vitamin B6]) has been on the Canadian market for many years and is indicated as the drug of choice for the treatment of NVP. However, some women choose not to treat NVP with pharmacologic measures, perhaps due to a persistent fear of teratogenic risk. The objective of this study was to determine the factors that influence a woman's decision not to treat NVP with pharmacologic measures. Fifty-nine women recruited from the Motherisk Nausea and Vomiting Helpline completed a questionnaire. All were informed that Diclectin was considered safe for use during pregnancy. At a follow-up telephone call, 34% were not using any pharmacologic treatment, and of those who were taking the drug, 26% were using less than the recommended dose. Reasons cited for not using the medication were insufficient safety data, preference for non-pharmacologic methods, and being made to feel uncomfortable by the physician. Of the women who did use Diclectin, the most convincing reassuring information that it was safe to use came from friends and family. Many other factors play a large role in a women's decision making.

Adult↗