Seminars in perinatology最新文献_第7页

Ethics, maternal-fetal interventions, and the technological imperative 伦理，母胎干预，和技术的必要性。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-05-29 DOI: 10.1016/j.semperi.2025.152095

Brian S Carter , Christy L Cummings

引用次数: 0

Perinatal decision making as a decision scientist 作为决策科学家做围产期决策

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-04-01 DOI: 10.1016/j.semperi.2025.152051

Barry Dewitt

{"title":"Perinatal decision making as a decision scientist","authors":"Barry Dewitt","doi":"10.1016/j.semperi.2025.152051","DOIUrl":"10.1016/j.semperi.2025.152051","url":null,"abstract":"<div><div>Decision science offers an opportunity to understand perspectives on perinatal decision making, from understanding risk and uncertainty, to decision-maker preferences. Here, I describe a specific instance of making perinatal medical decisions from the perspective of a decision scientist and a parent navigating clinical uncertainty. I explain how clinical encounters did and did not provide the required information needed to make choices informed by decision science methods and results. My purpose is to provide modest inspiration to those working at the intersection of decision science and perinatal/neonatal medicine about problems their disciplines could solve to improve the experience of decision-makers.Years before I would have children of my own, I read Detlof von Winterfeldt's account of his wife deciding whether to undergo a procedure to try and move her nearly-term fetus out of the breech position (1). He describes his analysis of the problem, informed by his wife's values and preferences. That analysis revealed that the best decision was unambiguously not to do the procedure, despite the opposing view of his wife's physician, who had not thought through what the evidence meant for them, nor considered von Winterfeldt's wife's preferences. The account is an illustrative description of the decision-analytic method, showing how science, beliefs, and values can be integrated into a framework to guide medical (and other) decision making.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 3","pages":"Article 152051"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medication decision making under uncertainty: Considering chronic disease and pregnancy potential 不确定条件下的用药决策：考虑慢性病和妊娠潜能

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-04-01 DOI: 10.1016/j.semperi.2025.152057

Mehret Birru Talabi , Rebekah Miller , Tamar Krishnamurti

{"title":"Medication decision making under uncertainty: Considering chronic disease and pregnancy potential","authors":"Mehret Birru Talabi , Rebekah Miller , Tamar Krishnamurti","doi":"10.1016/j.semperi.2025.152057","DOIUrl":"10.1016/j.semperi.2025.152057","url":null,"abstract":"<div><div>People with chronic illness who are (or could become) pregnant and their clinicians may face difficult decisions about the use of medications that can affect fetal health and development. In these situations, people must make the choice whether to use a drug with limited information about teratogenicity to treat their illness, putting an existing or potential pregnancy at risk. This manuscript serves as a call to action for all clinicians whose patients face such treatment choices regarding teratogenic medications or medications with unknown fetal safety. It offers an approach to guiding patient-provider conversations on medication management for individuals who are or might become pregnant, grounded in a review of the existing literature on medication decision making for drugs with known or potential teratogenic properties and informed by the current tools available for offering decision support. As a case study for highlighting current challenges and potential solutions around safe prescribing, we focus on two systemic autoimmune and rheumatic diseases, systemic lupus erythematosus and rheumatoid arthritis, which disproportionately affect females compared to males (with incidence ratios of 9:1 and 3:1, respectively). We address how recent reproductive policy changes that restrict abortion access may affect both a provider and a patient's decision calculus. Finally, we highlight several gaps that could be addressed by future research and the implementation of new data collection practices by federal bodies, while offering an approach to optimize patient-provider communication under conditions of ongoing uncertainty around the safety of drugs for those who may become pregnant while using them.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 3","pages":"Article 152057"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Conceptualizing perinatal health-related quality of life for decision making 将围产期健康相关生活质量概念化以供决策

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-04-01 DOI: 10.1016/j.semperi.2025.152049

Kim Dalziel

{"title":"Conceptualizing perinatal health-related quality of life for decision making","authors":"Kim Dalziel","doi":"10.1016/j.semperi.2025.152049","DOIUrl":"10.1016/j.semperi.2025.152049","url":null,"abstract":"<div><div>Increased health care needs during the perinatal period can significantly impact a patient's quality of life. Health-related quality of life (HRQoL) reflects the impact of a patient's health on their physical, mental and social wellbeing. Research has focused on development of tools suitable to measure HRQoL. These can be applied across the perinatal period from conception to postnatal care for use in clinical care, as an aid to shared decision making, in research and as an input to cost-effectiveness analyses used for resource allocation. HRQoL tools are a subset of Patient Reported Outcome Measures (PROMs), which help clinicians/researchers understand patient's experience of health. This essay serves as a primer to review the availability, validity and evidence of HRQoL tools for use in perinatal care. While some PROMs are routinely being implemented in pregnancy care, gaps remain regarding the specific impact of HRQoL tools on decision making and their potential use in family planning and neonatal care. Future research is needed to determine whether routine perinatal implementation of HRQoL tools will lead to stronger decision making for patients and providers. Involvement of parents in this process is essential to better understand how HRQoL tools can benefit decision making and perinatal care.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 3","pages":"Article 152049"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A tapestry of voices speaking to uncertainty 各种声音都在谈论不确定性

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-04-01 DOI: 10.1016/j.semperi.2025.152063

Tamar Krishnamurti , Marlyse Haward

引用次数: 0

Challenges in making an evidence-based prognosis 做出循证预后的挑战

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-04-01 DOI: 10.1016/j.semperi.2025.152054

Matthew A. Rysavy

引用次数: 0

Towards better enrollment decision-making for perinatal clinical research: Reconsidering recruitment and consent processes to support family values and preferences 面向围产期临床研究更好的招生决策：重新考虑招募和同意过程，以支持家庭价值观和偏好

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-04-01 DOI: 10.1016/j.semperi.2025.152055

Elliott Mark Weiss , Benjamin S. Wilfond , Stephanie A. Kraft

{"title":"Towards better enrollment decision-making for perinatal clinical research: Reconsidering recruitment and consent processes to support family values and preferences","authors":"Elliott Mark Weiss , Benjamin S. Wilfond , Stephanie A. Kraft","doi":"10.1016/j.semperi.2025.152055","DOIUrl":"10.1016/j.semperi.2025.152055","url":null,"abstract":"<div><h3>Objective</h3><div>Whether to participate in clinical research is a special type of decision for parents with infants in the neonatal intensive care unit (NICU). Parents often report negative experiences being approached for NICU research and researchers struggle to enroll a representative sample. We consider how enrollment decision-making might be better supported by integrating learnings from clinical decision-making.</div></div><div><h3>Finding</h3><div>Approaches to supporting decision-making about clinical research, though distinct from those for clinical decision-making, share many similarities. We consider ways researchers may incorporate advances in knowledge about clinical decision-making to: (a) improve documents used for regulatory purposes (e.g., consent forms), and (b) better support relationship building between researchers and parents considering research enrollment.</div></div><div><h3>Conclusion</h3><div>Researchers may benefit from considering approaches to enrollment decision-making that draw on clinical decision-making methods. Future work should assess the impact of such approaches on parental experiences of recruitment; enrollment and retention rates; and representative inclusion of NICU populations.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 3","pages":"Article 152055"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Managing moral distress and complex ethical challenges in the NICU 处理新生儿重症监护室的道德困境和复杂的伦理挑战

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-04-01 DOI: 10.1016/j.semperi.2025.152050

Béatrice Boutillier , Audrey Larone Juneau , Martin Reichherzer , Christine Tremblay , Annie Janvier

{"title":"Managing moral distress and complex ethical challenges in the NICU","authors":"Béatrice Boutillier , Audrey Larone Juneau , Martin Reichherzer , Christine Tremblay , Annie Janvier","doi":"10.1016/j.semperi.2025.152050","DOIUrl":"10.1016/j.semperi.2025.152050","url":null,"abstract":"<div><h3>Background</h3><div>In neonatology, end-of-life and complex ethical issues are frequent. This may lead to experiences of moral distress (MoD) for members of the clinical team. Here, we identify the causes, contributing factors, and contexts of MoD in the neonatal intensive care unit (NICU) and review interventions designed to manage complex ethical issues and alleviate MoD. We give a practical example of how support clinicians can help manage MoD.</div></div><div><h3>Methods</h3><div>Systematic reviews identify the causes, contributing factors, and contexts of MoD in NICUs as well as interventions to alleviate MoD. We trained an interdisciplinary team of support clinicians to be mentors in the NICU, to support other clinicians in managing the MoD associated with challenging cases.</div></div><div><h3>Results</h3><div>Managing MoD in NICUs is complex. Support clinicians actively assisted over 400 other clinicians. All were satisfied with the training and used their skills, mainly to optimize communication between clinicians and parents and/or for palliative care cases; 60% of all cases support clinicians managed were directly related to MoD; the majority resolved with initial reflective steps.</div></div><div><h3>Conclusion</h3><div>An interdisciplinary and multifaceted approach to addressing MoD in the NICU can be operationalized through support clinicians providing interdisciplinary and multifaceted interventions.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 3","pages":"Article 152050"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Harms, risks and opportunities of uncertainty: It is not as toxic as we think 不确定性带来的危害、风险和机遇：它并不像我们想象的那么有害

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-04-01 DOI: 10.1016/j.semperi.2025.152052

Marlyse F. Haward , Chantal Angueyra , John M. Lorenz

{"title":"Harms, risks and opportunities of uncertainty: It is not as toxic as we think","authors":"Marlyse F. Haward , Chantal Angueyra , John M. Lorenz","doi":"10.1016/j.semperi.2025.152052","DOIUrl":"10.1016/j.semperi.2025.152052","url":null,"abstract":"<div><div>Uncertainty is ubiquitous in neonatal medicine often reflecting incomplete knowledge of diagnoses, prognosis and optimal treatments. It profoundly influences decision-making and the relationships between parents and clinicians. Despite its pervasiveness, uncertainty is often perceived as toxic, conflictive and something to be eliminated or minimized. However, when acknowledged and accepted, it can become a source of hope and a foundation for trust between parents and clinicians. This article explores the existing literature on uncertainty in antenatal decision-making organized around three themes: harms, opportunities and recommendations. We highlight the challenges uncertainty poses for both parents and clinicians, including its potential to create conflict, feelings of loss, regret, and bias. At the same time, we emphasize the importance for clinicians to understand and embrace uncertainty to support parents, facilitate honest and balanced communication, and build trusting relationships. We acknowledge the need for more research on effective strategies to help productively navigate uncertainty and propose an approach to supporting parents by positively leveraging the inherent uncertainty in antenatal medical decision-making.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 3","pages":"Article 152052"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Decision science in perinatal decision making 围产期决策中的决策科学

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2025-04-01 DOI: 10.1016/j.semperi.2025.152064

Baruch Fischhoff

引用次数: 0