Diagnosis and Treatment of Sexually Transmitted Infections in the Emergency Department

Using the Electronic Health Record to Implement Expedited Partner Therapy in the Pediatric Emergency Department

OBJECTIVES

Expedited partner therapy (EPT) is a partner treatment strategy for sexually transmitted infections (STIs) including gonorrhea and chlamydia as well as trichomoniasis in some states. The process allows healthcare providers to write prescriptions for STI treatment among partners of infected patients without a previous medical evaluation. The Centers for Disease Control (CDC) has recommended EPT as a useful option to facilitate partner treatment, particularly male partners of women with chlamydia or gonorrhea infections. Our institution implemented EPT in 2016 after Ohio legislation was passed to authorize its use. We aim to describe the implementation process and descriptive outcomes of EPT adoption in a pediatric emergency department.

METHODS

This study describes use of the electronic health record for implementation of EPT in our institution. We conducted a retrospective review of EPT utilization from implementation. Electronic records from the implementation date of January 1, 2017, through December 31, 2021, were reviewed. We describe basic demographics and overall uptake of the intervention. Fisher exact tests were used for categorical variables and two-sample t -tests for continuous variables.

RESULTS

There was a total of 3275 positive test results and 739 EPT prescriptions written. Adolescent patients who received prescriptions for EPT were more likely to be female (78.7% of all EPT prescriptions, P = 0.007) and older than other patients (average age 17.7 vs 17.4 years, P = 0.004). There was no significant difference in race, insurance, or ethnicity among adolescent patients receiving and not receiving EPT. The percentage of positive STI tests associated with an EPT prescription ranged between 11.4% and 18.2%. Metronidazole was the most prescribed EPT medication.

CONCLUSIONS

The use of the electronic health record provides a platform for implementation of EPT. Our study highlights a potential strategy for increasing treatments of STIs through EPT prescribing in the emergency department setting.

The mediating effects of resilience in the relationship between social support and posttraumatic growth in patients with acute coronary syndrome in China

Background

Posttraumatic growth has a positive impact on patients diagnosed with acute coronary syndrome (ACS). Patients with acute coronary syndrome in China report low to moderate levels of posttraumatic growth. Additionally, there is a dearth of research exploring the associations between resilience, social support, and posttraumatic growth in this specific patient population.

Objective

This study examined whether resilience serves as a mediator between social support and posttraumatic growth in patients with acute coronary syndrome who had been discharged for 1 to 6 months and were being followed up in clinics.

Methods

A descriptive correlational study design was utilized. A systematic sampling technique was used to recruit 121 patients with acute coronary syndrome who had been discharged for 1 to 6 months from cardiovascular clinics of a tertiary care hospital in Jiangsu Province, China. The research instruments included the demographic characteristics questionnaire, the Connor-Davidson Resilience Scale, the Multidimensional Scale of Perceived Social Support, and the Posttraumatic Growth Inventory. The data were collected between August 2022 and November 2022 and were analyzed using descriptive statistics and regression analyses to determine the mediating effects.

Results

The level of posttraumatic growth among patients with acute coronary syndrome attending follow-up clinic visits was moderate (Mean = 60.58, SD = 14.13). Resilience had a direct and positive impact on posttraumatic growth (β = 0.361, p <0.001). Moreover, resilience fully mediated the relationship between social support and posttraumatic growth (indirect effect = 0.203, 95% CI [0.076, 0.331]; direct effect = 0.162, p = 0.101).

Conclusion

Patients with acute coronary syndrome in China experience moderate posttraumatic growth after discharge. Resilience mediates the relationship between social support and posttraumatic growth. Therefore, nursing interventions focusing on promoting social support and resilience should be developed to encourage posttraumatic growth in patients with acute coronary syndrome.

The Stigma of Sexually Transmitted Infections

Evidence-based guidelines have improved diagnosis and treatment of sexually transmitted infections (STI). Social stigma remains a barrier to STI testing and is associated with underutilization of prevention services. Alternatives for STI testing (eg, in-home testing) are convenient. However, some individuals decline follow-up treatment in fear of unintentional disclosure of their diagnosis. This article reviews STI treatment guidelines and examines the impact of stigma and ethical issues on testing, adherence, partner notification, and transmission rates. An understanding of STI-associated ethical issues and controversies is an important step toward eliminating stigma and reducing STI prevalence and morbidity.