Medicine and Health Sciences Commons^™

Application Of The Breastfeeding Personal Efficacy Beliefs Inventory And Acknowledgment Of Barriers For Improving Breastfeeding Initiation Rates In An Urban Population, Diwata Bose, Callie Cox Bauer, Kiley A. Bernhard, Dennis J. Baumgardner

Aurora Ob/Gyn Faculty

Introduction: Breastfeeding (BF) is recognized as the preferred method of infant nutrition by American Academy of Pediatricians, American College of Obstetricians and Gynecologists, and the World Health Organization. Despite the benefits of BF, in 1998 only 69% of new mothers in the United States initiated BF and 29% continued to breastfeed at 6 months.

Objective: To assess perceived breastfeeding confidence (BFC) and determine barriers in regards to BF in an urban population.

Methods: The Breastfeeding Personal Efficacy Beliefs Inventory (BPEBI) was used to determine perceived BFC. The survey was distributed to 271 women during prenatal appointments at an urban Milwaukee …

First-Case Operating Room Delays: Patterns Across Urban Hospitals Of A Single Health Care System, Callie M. Cox Bauer, Danielle M. Greer, Kiley B. Vander Wyst, Scott A. Kamelle

Callie Cox Bauer, DO, FACOG

Purpose

Operating room delays decrease health care system efficiency and increase costs. To improve operating room efficiency in our system, we retrospectively investigated delay frequencies, causes and costs.

Methods

We studied all first-of-the-day nonemergent surgical cases performed at three high-volume urban hospitals of a large health system from July 2012 to November 2013. Times for patient flow from arrival to procedure start and documented reasons for delay were obtained from electronic medical records. Delay was defined as patient placement in the operating room later than scheduled surgery time. Effects of patient characteristics, late patient arrival to the hospital, number of …

Application Of The Breastfeeding Personal Efficacy Beliefs Inventory And Acknowledgment Of Barriers For Improving Breastfeeding Initiation Rates In An Urban Population, Diwata Bose, Callie Cox Bauer, Kiley A. Bernhard, Dennis J. Baumgardner

Callie Cox Bauer, DO, FACOG

Introduction: Breastfeeding (BF) is recognized as the preferred method of infant nutrition by American Academy of Pediatricians, American College of Obstetricians and Gynecologists, and the World Health Organization. Despite the benefits of BF, in 1998 only 69% of new mothers in the United States initiated BF and 29% continued to breastfeed at 6 months.

Objective: To assess perceived breastfeeding confidence (BFC) and determine barriers in regards to BF in an urban population.

Methods: The Breastfeeding Personal Efficacy Beliefs Inventory (BPEBI) was used to determine perceived BFC. The survey was distributed to 271 women during prenatal appointments at an urban Milwaukee …

Cara Mengobati Penyakit Daging Tumbuh Di Kemaluan.Docx, Klinik Sentosa

Klinik Sentosa

Incorporating Home Visits In A Primary Care Residency Clinic: The Patient And Physician Experience, Mary Caitlin St. Clair, Jessica J. F. Kram, Glenda Sundberg

Jessica Kram, MPH

Purpose: Home visits, once a popular but now uncommon form of health care delivery, are on the rise. Few studies have focused on the value the experience brings to resident physicians and their patients.

Methods: A 6-month pilot was conducted with 11 residents who participated in 32 home visits with 11 patients. Patient and resident experiences were captured through a survey following the home visits.

Results: In all, 100% of patients and a majority of residents were very interested in being a part of and incorporating future home visits, respectively. Every patient in the survey said that the visits resulted …

Neurological Improvement Of Perineural And Leptomeningeal Spread Of Squamous Cell Carcinoma Treated With Intrathecal Chemotherapy And Systemic Egfr Inhibition., Vincent Alexander Van Vugt, Marlon Garzo Saria, Andres Javier, Navin Kesari, Tiffany Turpin, Santosh Kesari

Marlon Garzo Saria, PhD, RN, AOCNS, FAAN

Squamous cell carcinoma (SCC) is a common cancer of the skin. Risk factors include fair skin, excessive sun and ultraviolet light exposure, and history of xeroderma pigmentosa. Perineural invasion (PNI), an uncommon manifestation of SCC, involves microscopic tumor cells invading various layers of the nerve sheath. It is associated with a poorer prognosis. Standard treatment for PNI includes radiation therapy. Here, we describe a case an older gentleman with a history of SCC with PNI successfully treated with erlotinib and intrathecal chemotherapy.

Apa Penyebab Vagina Gatal Gatal Dan Sakit.Docx, Klinik Sentosa

Klinik Sentosa

Gunakan Cara Ini Untuk Mengobati Impotensi.Docx, Klinik Sentosa

Klinik Sentosa

Apakah Kondiloma Bisa Sembuh Total Dan Tak Kambuh.Docx, Klinik Sentosa

Klinik Sentosa

Proton Pump Inhibitors Increase The Severity Of Hepatic Encephalopathy In Cirrhotic Patients, Matthew J. Fasullo, Prashanth Rau, Dong-Qi Liu, Erik Holzwanger, Jomol Mathew, Yurima Guilarte-Walker, Gyongyi Szabo

Gyongyi Szabo

BACKGROUND: Liver cirrhosis is the late stage of hepatic fibrosis and is characterized by portal hypertension that can clinically lead to decompensation in the form of ascites, esophageal/gastric varices or encephalopathy. The most common sequelae associated with liver cirrhosis are neurologic and neuropsychiatric impairments labeled as hepatic encephalopathy (HE). Well established triggers for HE include infection, gastrointestinal bleeding, constipation, and medications. Alterations to the gut microbiome is one of the leading ammonia producers in the body, and therefore may make patients more susceptible to HE.

AIM: To investigate the relationship between the use of proton pump inhibitors (PPIs) and HE …

N653_Prospectus_Final_V2_Alternatives To Transfusions .Docx, Donita Rose

Donita Rose

Review Klinik Vaginitis Terbaik Di Kelapa Gading Jakarta.Docx, Klinik Sentosa

Klinik Sentosa

Pengobatan Disfungsi Ereksi Permanen.Docx, Klinik Sentosa

Klinik Sentosa

Report Of The Aacp Criminal Background Check Advisory Panel, H. Anderson, M. A. Kirkpatrick, M. Mckenzie, W. M. Moore, K. Williams, W. Wuller, E. Anagnostiadis, L. Ross

W. Mark Moore

No abstract provided.

Treating Nonalcoholic Fatty Liver Disease In Patients With Type 2 Diabetes Mellitus: A Review Of Efficacy And Safety, E. P. Mills, K. P. Brown, K. Trotta, P. W. Vang, J. D. Smith

Beth Mills

Objective:

To review current literature for the efficacy and safety of treatment for nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM).

Data sources:

A PubMed literature search from January 1990 to June 2017 was conducted using the search terms nonalcoholic fatty liver disease, diabetes mellitus, type 2, therapy, treatment, treat, therapeutics, nonalcoholic fatty liver, nonalcoholic hepatosteatosis, NASH, NAFLD, metformin, and statin. Bibliographies of chosen articles were reviewed.

Study selection and data extraction:

Relevant articles on metformin, thiazolidinediones (TZD), glucagon-like peptide-1 receptor agonists (GLP-1 RA), and statins for the treatment of NAFLD which included patients with …

Surviving Siblings’ Illnesses, Treatments/Health Services Over 13 Months After A Sibling’S Death, Dorothy Brooten, Joanne M. Youngblut, Rosa M. Roche, Carmen Caicedo, Timothy Page

JoAnne Youngblut

Two million children experience sibling death annually and have problems that require clinical intervention although few receive such help. Effects on surviving siblings’ mental health has been well documented, however their physical health has not. This study described surviving siblings’ illnesses, treatments/health services at 2, 4, 6, and 13 months post-sibling death. The 132 children (76 girls, 56 boys, M 10.6 years, SD 3.43); 30% Hispanic, 51% Black, 26% White were recruited via hospital ICUs and published obituaries. Using a longitudinal design, parents reported types and numbers of surviving siblings’ illnesses, treatments/health services, and dates post-sibling death. Most of the …

Women With High-Risk Pregnancies, Problems, And Apn Interventions, Dorothy Brooten, Joanne M. Youngblut, Deborah Donahue, Margaret Hamilton, Jean Hannan, Donna Felber Neff

JoAnne Youngblut

Purpose

To (a) describe women’s prenatal and postpartum problems and advanced practice nurses (APN) interventions; and (b) determine if problems and APN interventions differed by women’s medical diagnosis (diabetes, hypertension, preterm labor).

Design and Methods

Content analysis of 85 interaction logs created by APNs during a randomized clinical trial in which half of physician-provided prenatal care was substituted with APN-provided prenatal care in the women’s homes. Patients’ problems and APN interventions were classified with the Omaha Classification System.

Findings

A total of 212,835 health problems and 212,835 APN interventions were identified. The dominant antenatal problems were physiologic (59.2%) and health-related …

Use Of Spiritual Coping Strategies By Gender, Race/Ethnicity And Religion At 1 And 3 Months After Infant’S/Child’S Intensive Care Unit Death, Dawn Hawthorne, Joanne M. Youngblut, Dorothy Brooten

JoAnne Youngblut

Background and purpose

In the US, 57,000 children (newborn-18 years) die annually. Bereaved parents may rely on religious or spiritual beliefs in their grief. The study’s purpose was to examine differences in parents’ use of spiritual and religious coping practices by gender, race/ethnicity and religion at one and three months after infant/ICU death.

Methods

The sample consisted of 165 bereaved parents; 78% minority. The Spiritual Coping Strategies Scale was used to measure religious and spiritual coping practices, separately. One-way ANOVAs indicated that Black non-Hispanic mothers used significantly more religious coping practices at 3 months than White non-Hispanic mothers. Protestant and …

School Aged Children’S Experiences 7 And 13 Months Following A Sibling’S Death, Dorothy Brooten, Joanne M. Youngblut

JoAnne Youngblut

This study described 6-year to 12-year-old children's responses 7 and 13 months after siblings' NICU/PICU/ED death. Using semi-structured interviews, at 7 months, children were asked about events around their sibling's death. At both 7 and 13 months, children were asked about their thoughts and feelings about the deceased, concerns or fears, and life changes since the death. Thirty one children (58% female), recruited from four South Florida hospitals and Florida obituaries, participated. Children's mean age was 8.4 years; 64.5% were Black, 22.5% Hispanic, 13% White. Interviews were analyzed using conventional content analysis. Resulting themes: circumstances of the death, burial events, …

Preschool Children With Head Injury: Comparing Injury Severity Measures And Clinical Care, Joanne M. Youngblut, Carmen Caicedo, Dorothy Brooten

JoAnne Youngblut

The purpose of this study was to compare child, hospital course, and discharge characteristics by admitting unit, injury type, head Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS), and test congruence of AIS and GCS categories. Chart data were collected from seven hospitals on 183 preschool children with head injury (90 admitted to PICU, 93 to general care unit). Injury events included falls (n = 89, 49%), hit by car (n = 35, 19%), motor vehicle crashes (n = 26, 14%), bicycle crashes (n = 12, 7%), and blunt traumas (n = 21, 11%). Most children (68%) had head …

Weight Gain In High-Risk Pregnant Women: Comparison By Primary Diagnosis And Type Of Care, Jennifer Herrera-Perdigon, Ellen Hopkins, Martha Marcalle, Dorothy Brooten, Joanne M. Youngblut, Maria Lourdes Lizardo

JoAnne Youngblut

Reasonable weight gain in pregnancy is essential for the health of the woman and fetus. The purpose of this secondary analysis was to examine patterns of prenatal weight gain in women with diabetes and hypertension using data from a randomized controlled trial examining physician-only (n = 29) versus APN and physician-delivered (n = 38) prenatal care. Data collection included gestational age at enrollment, delivery, diagnosis (diabetes, hypertension), prepregnancy body mass index (BMI), weight every 4 weeks during pregnancy, and total weight gain during pregnancy. Based on prepregnancy BMI, 21% of the sample was normal weight, 16% overweight, and 63% obese. …

Perinatal And Pediatric Issues In Palliative And End-Of-Life Care From The 2011 Summit On Compassionate Care, Joanne M. Youngblut, Dorothy Brooten

JoAnne Youngblut

More than 25,000 infants and children die in US hospitals annually; 86% occur in the NICU or PICU. Parents see the child’s pain and suffering and, near the point of death, must decide whether to resuscitate, limit medical treatment and/or withdraw life support. Immediately after the death parents must decide whether to see and/or hold the infant/child, donate organs, agree to an autopsy, make funeral arrangements, and somehow maintain functioning. Few children and their families receive pediatric palliative care services, especially those from minority groups. Barriers to these programs include lack of services, difficulty identifying the dying point, discomfort in …

Psychometric Evaluation Of The Spanish And English Versions Of The Spiritual Coping Strategies Scale, Dawn Hawthorne, Joanne M. Youngblut, Dorothy Brooten

JoAnne Youngblut

The Spiritual Coping Strategies (SCS) Scale measures how frequently religious and nonreligious (spiritual) coping strategies are used to cope with a stressful experience. This study’s purpose is to evaluate the psychometric properties of the newly translated Spanish version of the SCS. A total of 51 bilingual adults completed the SCS in Spanish and English, with 25 completing them again 2–3 weeks later. Internal consistency reliability for the Spanish (r = 0.83) and English (r = 0.82) versions of the SCS in the total sample were good. Test–retest reliability was .84 for the Spanish and .80 for the English …

Parents’ Reactions At 24–48 Hours After A Preschool Child’S Head Injury, Joanne M. Youngblut, Dorothy Brooten, John Kuluz

JoAnne Youngblut

Objectives

1) Compare mothers’ and fathers’ early reactions (stressors, concerns) to the preschool child’s head injury, their perceptions of the child’s injury severity, their social support and mental health; 2) compare families with a child in the pediatric intensive care unit (PICU) vs. general care unit (GCU) on these variables; 3) describe the relationships between parents’ early reactions and perceived and objective injury severity, their social support and mental health.

Design

Analysis of data collected in the hospital 24–48 hours after the child’s admission as part of a longitudinal study of parent and family functioning after a preschool child’s head …

Pediatric Head Trauma: Parent, Parent-Child, And Family Functioning 2 Weeks After Hospital Discharge, Joanne M. Youngblut, Dorothy Brooten

JoAnne Youngblut

OBJECTIVE:

To investigate effects of pediatric head trauma on parent mental health, parent-child relationship and family functioning 2 weeks after discharge.

METHODS:

Ninety-seven mothers and 37 fathers of 106 preschool children hospitalized with head injury completed Mental Health Inventory (MHI), Parenting Stress Index, Family Adaptability and Cohesion Evaluation Scales II (FACES II) and Multidimensional Scale of Perceived Social Support (MSPSS) 2 weeks after discharge, and perceived injury severity, Parental Concerns Scale (PCS), Parental Stressors Scale: Pediatric Intensive Care Unit (PSS: PICU), and MHI 24-48 h after hospital admission.

RESULTS:

Mental health after discharge was related to social support and baseline …

Patient Problems, Advanced Practice Nurse (Apn) Interventions, Time And Contacts Among Five Patient Groups, Dorothy Brooten, Joanne M. Youngblut, Janet Deatrick, Mary Naylor, Ruth York

JoAnne Youngblut

PURPOSE:

To describe patient problems and APN interventions in each of five clinical trials and to establish links among patient problems, APN interventions, APN time and number of contacts, patient outcomes, and health care costs.

DESIGN AND METHODS:

Analysis of 333 interaction logs created by APNs during five randomized controlled trials: (a) very low birthweight infants (n = 39); (b) women with unplanned cesarean birth (n = 61), (c) high-risk pregnancy (n = 44), and (d) hysterectomy (n = 53); and (e) elders with cardiac medical and surgical diagnoses (n = 139). Logs containing recordings of all APN interactions with …

Parent’S Perceptions Of Health Care Providers Actions Around Child Icu Death: What Helped, What Did Not, Dorothy Brooten, Joanne M. Youngblut, Lynn Seagrave, Carmen Caicedo, Dawn Hawthorne, Ivette Hidalgo, Rosa M. Roche

JoAnne Youngblut

Purpose

To describe parents’ perspectives of health care provider actions that helped or did not around the time of infant/child’s intensive care unit (ICU) death. Semistructured interviews with 63 parents (Black, White, and Hispanic) 7 months post infant/child death were audio-recorded, transcribed, analyzed, and themes identified.

Findings

What helped most: compassionate, sensitive staff; understandable explanations of infant’s/child’s condition; experienced, competent nurses; providers did everything to help infant/child; and parents’ involvement in care decisions. What did not help: insensitive, nonsupportive staff; conflict between providers and parents; communication problems around the death; inexperienced nurses and doctors; parents not understanding child’s …

Parent & Child Perceptions Of Child Health After Sibling Death, Rosa M. Roche, Dorothy Brooten, Joanne M. Youngblut

JoAnne Youngblut

Background

Understanding children’s health after a sibling’s death and what factors may affect it is important for treatment and clinical care. This study compared children’s and their parents’ perceptions of children’s health and identified relationships of children’s age, gender, race/ethnicity, anxiety, and depression and sibling’s cause of death to these perceptions at 2 and 4 months after sibling death.

Methods

64 children and 48 parents rated the child’s health “now” and “now vs before” the sibling’s death in an ICU or ER or at home shortly after withdrawal of life-prolonging technology. Children completed the Child Depression Inventory and Spence Children’s …

Mother’S Mental Health, Mother-Child Relationship, And Family Functioning 3 Months After A Preschooler’S Head Injury, Joanne M. Youngblut, Dorothy Brooten

JoAnne Youngblut

Objective

Investigate mothers’ mental health, mother-child relationship, and family functioning 3 months after preschool children’s head trauma and hospital discharge.

Design

Prospective survey.

Setting

7 hospitals; families’ homes.

Participants

Eighty mothers of children (ages 3–6) with head trauma.

Measures

Perceived injury severity, Mental Health Inventory (MHI), Parental Stressor Scale: PICU 24–48 hours after admission; MHI, Parenting Stress Index, FACES II, Multidimensional Scale of Perceived Social Support 3 months post-discharge.

Results

Injury severity had negative effects on mothers’ mental health at 3 months after discharge, but not on the mother-child relationship and the family’s functioning. Mothers’ baseline mental health and ongoing …

Parenting Stress: A Comparison Of Grandmother Caretakers And Mothers, Carol M. Musil, Joanne M. Youngblut, Sukhee Ahn, Vanessa L. Curry

JoAnne Youngblut

Parenting stress in grandmother caretakers has not been directly compared with a matched sample of mothers in the caretaker role. This study examined the main and interaction effects of caretaker status, employment, and race on parenting stress and whether these factors affect parenting stress in a convenience sample of grandmothers raising grandchildren (n = 86) and a sample of mothers of preschoolers (n = 86), matched for women’s partner status, race, and employment. Grandmothers raising grandchildren reported more overall parenting stress and parental distress than mothers. Non-employed women reported more negative perceptions of their children and more difficult …