Key PointsQuestionAmong recipients of opioid agonist therapy (OAT) in Ontario, Canada, early in the COVID-19 pandemic, was there an association between dispensing of increased take-home doses and treatment retention or opioid-related harm?FindingsIn this retrospective propensity-weighted cohort study of 21 297 OAT recipients stratified by baseline dosing and type of OAT, dispensing of increased take-home doses of OAT, compared with no change in take-home doses, was significantly associated with lower rates of OAT interruption and discontinuation in most subsets, with no statistically significant increases in opioid overdoses over 6 months of follow-up.MeaningIn Ontario, Canada, during the COVID-19 pandemic, dispensing of increased take-home doses of OAT was significantly associated with lower rates of treatment interruption and discontinuation among some subsets of patients, and there were no statistically significant increases in opioid-related overdoses, although the findings may be susceptible to residual confounding and should be interpreted cautiously.
Objectives The aim was to determine the accuracy of cell‐free DNA testing (cfDNA) for detecting sex chromosome aneuploidies (SCA) in singleton pregnancies. Methods A systematic review and meta‐analysis was performed to assess cfDNA accuracy for prenatal detection of 45,X, 47,XXY, 47,XXX and 47,XYY. Inclusion was restricted to studies published between January 2010 and December 2021 reporting both cfDNA and confirmatory diagnostic test results. Results For 45,X, the sensitivity was 98.8% (95%CI 94.6%–100%), specificity 99.4% (95%CI 98.7%–99.9%) and positive predictive value (PPV) 14.5% (95%CI 7.0%–43.8%). For 47,XXY, the sensitivity was 100% (95%CI 99.6%–100%), specificity 100% (95%CI 99.9%–100%) and PPV 97.7% (95%CI 78.6%–100%). For 47,XXX, the sensitivity was 100% (95%CI 96.9%–100%), specificity 99.9% (95%CI 99.7%–100%) and PPV 61.6% (95%CI 37.6%–95.4%). For 47,XYY, the sensitivity was 100% (95%CI 91.3%–100%), specificity 100% (95% CI 100%–100%) and PPV 100% (95%CI 76.5%–100%). All four SCAs had estimated negative predictive values (NPV) exceeding 99.99%, though false negatives were reported. Conclusions This analysis suggests that cfDNA is a reliable screening test for SCA, though both false negatives and false positives were reported. These estimates of test performance are derived from pregnancies at high pretest risk for aneuploidy, limiting the generalisability to average risk pregnancies.
Background To conduct a systematic review and thematic synthesis of qualitative studies on the pregnancy and early parenting experiences of patients with inflammatory arthritis (IA). Methods We searched online databases for English-language, qualitative studies capturing the experiences of females with IA or their healthcare providers with pregnancy and/or early parenthood. We extracted findings from included studies and used thematic synthesis to develop descriptive and higher-order analytical themes. Results Of 20 included studies, our analysis identified 5 analytical themes among patients and 3 among providers. Patients’ reproductive desires, the impact of IA on their ability to experience pregnancy, and the availability of information to guide preparedness informed their pregnancy decisions. Patients’ IA management, pregnancy expectations, and access to support influenced their reproductive experiences. Patients’ experiences seeking information and care revealed substantial gaps in reproductive care provision to patients with IA. Reproductive uncertainty related to IA placed a heavy burden on patients’ emotional and psychological wellbeing. Reproductive care provision was influenced by providers’ perceived professional responsibility to address patients’ reproductive goals, fears of negative outcomes, and capacity to harness patient trust, incorporate reproductive care into rheumatology practice and facilitate multi-disciplinary care coordination. Conclusions Our review illuminated several barriers to experiencing pregnancy among patients with IA, particularly related to pregnancy planning support, availability of information, and care coordination among the patient’s healthcare team. To improve care, these barriers may be mitigated through the provision of relevant, practical, and consistent information as well as patient-centred multi-disciplinary approaches for managing pregnancy among patients with IA.
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