Jennifer Duffy

Introduction: Cisplatin is used to treat cancers that affect women of childbearing age and those that may breastfeed. Prior literature regarding the duration of cisplatin excretion in human milk is sparse and suggests complete clearance days after initial administration.Method: We present the case of a postpartum woman who received three doses of weekly cisplatin for cervical cancer. Platinum levels were measured in expressed milk for several months after cisplatin administration.Results: Levels of the parent element platinum were detected 159 days (over 22 weeks) followingadministration. These results demonstrate persistence of detectable platinum levels for a muchlonger period than previously reported.Conclusion: This case report is the first to follow platinum levels in expressed milk after multiplepostpartum cisplatin doses. Our results demonstrate a biphasic elimination with detectionspanning several months after cessation of treatment. Women should be advised to abstainfrom breastfeeding until long after completion of cisplatin therapy.

The key objectives of this chapter are for readers to do the following: To frame discussion of future directions, we return to our rationale for ...

OBJECTIVE: To evaluate the cost-effectiveness of immediate compared with delayed (6 weeks) postpartum etonogestrel implant insertion in preventing future unintended pregnancy. METHODS: We constructed a decision-analytic model to examine a hypothetical population of women who request a contraceptive implant after giving birth. The timeframe for analysis was from the time of childbirth to 1 year postpartum. Model inputs were derived from a comprehensive literature review. We compared immediate (before discharge from the childbirth hospital stay) compared with delayed (at first postpartum office visit) postpartum placement of the contraceptive implant from a health care system's perspective. Implant insertion and removal, loss to follow-up at the postpartum visit, use of alternative contraceptive methods, and contraceptive failure were incorporated into the model. We calculated the incremental cost of immediate insertion for each pregnancy prevented during the first postpartum year and cost savings associated with pregnancies prevented. One-way sensitivity analyses were also performed. Cost estimates are reported in 2014 U.S. dollars. RESULTS: Immediate postpartum implant insertion is associated with higher expected cost than delayed insertion ($1,091/patient compared with $650/patient) but is more effective in preventing pregnancies (expected pregnancy rate: 2.4% and 21.6%, respectively). This results in an incremental cost-effectiveness ratio of $2,304 per pregnancy prevented. When taking into consideration medical costs of the resulting unintended pregnancies that could be avoided, immediate implant insertion is expected to save $1,263 per patient. CONCLUSION: Immediate postpartum provision of the contraceptive implant is cost-effective in preventing unintended pregnancies and should be provided to women requesting this form of contraception.

Getting To Outcomes (GTO), an innovative framework for planning, implementing, evaluating, and sustaining interventions has been shown to be effective in helping community‐based organizations (CBOs) introduce science‐based approaches into their prevention work. However, the Interactive Systems Framework (ISF) suggests that adopting innovations like GTO requires a significant amount of capacity building through training and technical assistance (T/TA). In this study, 11 CBOs and three schools in South Carolina entered into a 3 year program of intense and proactive T/TA based on the ISF to learn how to apply an adaptation of GTO (Promoting Science‐Based Approaches‐Getting To Outcomes, PSBA‐GTO) to their teen pregnancy prevention programs. Using semi‐structured interviews, the partnering organizations were assessed at three points in time, pre‐T/TA, 12 months, and post T/TA (30 months) for their performance of the steps of GTO in their work. The seven organizations which participated in T/TA until the end of the project received an average of 76 h of TA and 112 h of training per organization. Interview results showed increased performance of all 10 steps of PSBA‐GTO by these organizations when conducting their teen pregnancy programs. These results suggest targeted and proactive T/TA can successfully bridge the gap between research and practice by using a three part delivery system, as prescribed in the ISF, which relies on an intermediary prevention support system to ensure accurate and effective translation of research to the everyday work of community‐based practitioners.Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith