Biomedical subjects

M McMain-Klein

Publications and source records attributed to M McMain-Klein.

4 recordsLinked to original sources

PubMed1997

Documenting wife abuse: a guide for physicians.

An estimated 12% to 30% of women are assaulted by their male partners at least once during the relationship. Therefore, in their everyday practice, physicians are likely to encounter women who have suffered domestic abuse. The authors define wife abuse, outline epidemiologic aspects and discuss common signs and symptoms. In cases of suspected or confirmed abuse, it is very important for physicians to document the details of the injuries, the patient visit, any treatment and follow-up as well as to screen for associated conditions and ensure that any samples taken are not tampered with. When asked to disclose information by police or courts, physicians need to know when they are obliged to submit copies of their patients' medical records, when patient consent is required, what information should be divulged and how to defend this information in court. The authors present information about the necessary, relevant and appropriate evidence to be collected and documented for both medical and legal purposes. They also discuss the criminal justice system and the role of physicians in legal proceedings concerning wife abuse.

Adult↗

PubMed1996

Factors associated with immediate abortion complications.

OBJECTIVE: To identify factors associated with increased risk of immediate complications from induced abortion. DESIGN: Retrospective analysis of a provincial database. SETTING: All Ontario general hospitals in which abortions are performed and all free-standing abortion clinics in Ontario. POPULATION: Women in Ontario aged 15 to 44 years who underwent an induced abortion in the province (without concurrent sterilization) between Jan. 1, 1992, and Dec. 31, 1993. OUTCOME MEASURES: Recording of complications at the time of the procedure, gestational age, type of procedure, place of abortion (hospital or clinic), and patient's age, parity and history of previous abortion (spontaneous or induced). RESULTS: During the study period 83 469 abortions were performed that met our inclusion criteria. Immediate complications were reported in 571 cases (0.7%). Multivariate logistic regression analysis revealed that, after other variables were controlled for, the patient's age, parity and history of previous abortions (spontaneous or induced) were not significant risk factors for immediate complications; however, gestational age, method of abortion and place of abortion were significant risk factors (p < 0.001). The odds ratio (OR) for having a complication from abortion was 1.3 (95% confidence interval [CI] 1.02 to 1.63) between 9 and 12 weeks, compared with having one after abortion at 9 weeks or earlier, and increased to 3.3 (95% CI 2.23 to 5.00) after abortion between 17 and 20 weeks. Compared with surgical dilatation and curettage (D&C), instillation of saline and instillation of prostaglandins were more likely to be associated with immediate complications (OR 24.0, 95% CI 13.22 to 43.70, and OR 11.7, 95% CI 6.43 to 21.18, respectively), whereas both suction D&C and insertion of a laminaria tent were less likely to be associated with immediate complications (OR 0.4, 95% CI 0.26 to 0.67, and OR 0.3, 95% CI 0.19 to 0.52, respectively). Compared with women who had an abortion in a free-standing clinic, the risk for immediate complications was greater among those who had an abortion in a hospital, especially a teaching hospital (OR 1.9, 95% CI 1.38 to 2.58), a nonteaching hospital with 200 to 399 acute care beds (OR 3.1, 95% CI 2.27 to 4.21) and a nonteaching hospital with fewer than 200 acute care beds (OR 5.9, 95% CI 4.04 to 8.64). CONCLUSION: The risk of immediate complications from induced abortion is very low. Unlike in previous studies, the woman's age, parity and history of previous spontaneous or induced abortions were not found to be risk factors. However, advancing gestational age and procedures involving instillation of saline or prostaglandins were predictive factors of immediate complications.

Abortion, Induced↗

PubMed1995

Small-area variations in utilization of abortion services in Ontario from 1985 to 1992.

OBJECTIVE: To assess interregional differences in the utilization of abortion services in Ontario from 1985 to 1992. DESIGN: Retrospective analysis of provincial therapeutic abortion database. SETTING: All hospitals conducting abortions between 1985 and 1992 and all free-standing abortion clinics conducting abortions between 1990 and 1992. POPULATION: All women in Ontario aged 15 to 44 years who underwent a therapeutic abortion in Ontario during the study period. OUTCOME MEASURES: Utilization of abortion services by county and age-specific abortion rates by county of residence. RESULTS: From 1985 to 1989, when only hospital data were gathered, the mean therapeutic abortion rate increased by 11.2%. From 1990 to 1992, when data from hospitals and free-standing clinics were collected, the mean rate increased by 26.5%. Logistic regression analysis showed significant variation in the age-standardized abortion rates between counties in each study year (p < 0.0001). The counties with age-standardized rates below the 25th percentile had the highest proportions of women who sought abortion services outside their county of residence; in some of these counties no abortions were performed in local facilities. CONCLUSION: There are interregional variations in the utilization of abortion services in Ontario. These disparities raise questions about the accessibility of abortion services and need to be further investigated.

Abortion, Therapeutic↗

PubMedDate not supplied

Factors influencing the delivery of abortion services in Ontario: a descriptive study.

CONTEXT: Although Canadian women have had the right to obtain legal induced abortions for the past decade, access to the procedure is still limited and controversial in many areas. METHODS: Chiefs of obstetrics and gynecology, chiefs of staff, directors of nursing and other health professionals at 163 general hospitals in Ontario, Canada, were asked to provide information on issues concerning the availability of abortion services of their facility. The hospital participation rate was 97% and the individual response rate was 75%. RESULTS: Nearly one-half (48%) of hospitals perform abortions. Approximately 36% of these hospitals do so up to a maximum gestational age of 12 weeks, 23% to a maximum of 13-16 weeks, 37% to a maximum of 17-20 weeks and 4% at greater than 20 weeks. Hospital factors, including resources and policies, did not significantly influence whether abortions are provided. However, these factors did affect the number performed, whether there were gestational limitations and the choice of procedure. About 13% of provider hospitals indicated that staff training contributes to the existence of gestational age limits, and 24% said that it directly influences procedure choice. Only 18% of hospitals reported that their physicians have received additional training outside of their medical school or medical residency education to learn abortion techniques or to gain new skills. Forty-five percent of hospitals that provide abortions had experienced harassment within the past two years, and 15% reported that this harassment has directly affected their staff members' willingness to provide abortions. CONCLUSION: Based upon the provision of obstetric care, many hospitals in Ontario that are capable of offering abortion services do not. Some of the reasons for this failure are related to the procedure itself, while others may be related to resource issues that affect the delivery of other medical services as well. Variation in the availability of abortions is due to a shortage of clinicians performing the procedure, and training directly influences gestational limits and procedural choices.

Abortion, Legal↗