Well-woman Care Barriers and Facilitators of Low-income Women Obtaining Induced Abortion after the Affordable Care Act

Objectives

This study uses the abortion visit as an opportunity to identify women lacking well-woman care (WWC) and explores factors influencing their ability to obtain WWC after implementation of the Affordable Care Act.

Role of preoperative carbohydrate loading: a systematic review

INTRODUCTION

Surgical stress in the presence of fasting worsens the catabolic state, causes insulin resistance and may delay recovery. Carbohydrate rich drinks given preoperatively may ameliorate these deleterious effects. A systematic review was undertaken to analyse the effect of preoperative carbohydrate loading on insulin resistance, gastric emptying, gastric acidity, patient wellbeing, immunity and nutrition following surgery.

METHODS

All studies identified through PubMed until September 2011 were included. References were cross-checked to ensure capture of cited pertinent articles.

RESULTS

Overall, 17 randomised controlled trials with a total of 1,445 patients who met the inclusion criteria were identified. Preoperative carbohydrate drinks significantly improved insulin resistance and indices of patient comfort following surgery, especially hunger, thirst, malaise, anxiety and nausea. No definite conclusions could be made regarding preservation of muscle mass. Following ingestion of carbohydrate drinks, no adverse events such as apparent or proven aspiration during or after surgery were reported.

CONCLUSIONS

Administration of oral carbohydrate drinks before surgery is probably safe and may have a positive influence on a wide range of perioperative markers of clinical outcome. Further studies are required to determine its cost effectiveness.     

When the patient requires observation not hospitalization

Developing alternative health care delivery systems that successfully meet the needs of multiple consumers in a cost-efficient manner is essential. Minor revisions of long-standing programs are frequently inadequate in the face of escalating demands for a more efficient health care system. The SSU Observation Area has met the primary objectives by providing a quality, cost-efficient alternative to the use of existing inpatient and emergency department services. Alternatives, such as the SSU, require three major components to succeed: A risk-taking environment. Innovative nursing leaders, especially at the department head level. Staff nurses who demonstrate flexibility, enthusiasm, and pride in expanding their professional roles. The SSU was not developed without difficulty or some conflict. As the program was developing, full-time night coverage was not warranted so an on-call system was used. Increased use of the SSU resulted in the on-call person frequently being called in rather than just occasionally being called. Staff discontent grew as this continued. Additional night staff were added and use continued to increase, which ensured financial viability. Nursing leaders are developing alternatives in every setting. As we learn from each other, the opportunities for change grows.     

Acceptability of a patient decision aid for women aged 70 and older with stage I,estrogen receptor-positive,HER2-negative breast cancer

ObjectivesA comprehensive decision aid (DA) for women ≥70 years with Stage I ER+/HER2-negative breast cancer was developed to support locoregional and systemic treatment decision-making. We aimed to test the acceptability of this novel DA in women newly-diagnosed with breast cancer.Materials and MethodsWomen ≥70 diagnosed with Stage I, ER+/HER2- breast cancer were recruited from three Boston-area hospitals. They underwent baseline interviews after initial surgical consultation, reviewed the DA, and were surveyed <2 weeks later to determine DA acceptability (e.g., was it helpful?), changes in decisional conflict, stage of decision-making, and knowledge. Participants could optionally complete a three-month follow-up. Paired t-tests and McNemar's tests were used for statistical comparisons, and thematic analyses were conducted to identify themes in participants' open-ended comments.ResultsThirty-three of 56 eligible patients approached completed the baseline and acceptability surveys, and 25 completed the three-month follow-up. Participants' mean age was 74.7 years (±3.8). Nearly all participants (n = 31, 94%) strongly agreed that the DA was helpful and felt that the DA prepared them for treatment decision-making, with a mean decision preparation score of 4.1 (out of 5.0); 6% (n = 2) found it very anxiety provoking. Knowledge improved with a mean of 9.0 out of 14 questions correct at baseline to 10.6 correct on the acceptability survey (p < 0.0001).ConclusionsA DA tailored to women ≥70 with Stage I, ER+, HER2- breast cancer increased knowledge and was perceived to be helpful by older women. A randomized controlled trial is needed to evaluate its efficacy.     

Structuring a safer donor-replacement program

BACKGROUND: Replacement donors are more likely than volunteer donors to have positive or abnormal tests for transfusion-transmissible disease. In an effort to increase the donor pool, workers sought to identify a safer replacement-donor subgroup that may be acceptable for routine donations. STUDY DESIGN AND METHODS: In a retrospective review and cohort study, the replacement-donor effect was separated from the new- donor effect. The relative effect the replacement donor has on the risk of transfusion-transmissible diseases, donor retention, and frequency of returning donations was then quantified by comparison against the effect of repeat volunteer donors. RESULTS: The replacement donor had 3.1 times the risk and 0.72 times the donor retention rate and made 0.81 times as many returning donations as the repeat volunteer donor. The figures for the new-donor effect were similar. The two risks were additive, making a new replacement donor particularly hazardous. If replacement donations only from repeat replacement donors were considered, the donor risk and the number of donations per returning donor were made comparable to those for the general (combined) volunteer donor. CONCLUSION: The negative effect of the replacement donor is similar in magnitude to that of the new volunteer donor. A replacement-donation program targeting repeat replacement donors has an acceptable risk profile and may be a valuable adjunct to the collection of blood from general volunteer donors.     

Isokinetic torque levels for high school football players.

One hundred fifteen high school football players were screened isokinetically for the knee extensor and flexor torque generating capabilities and muscle imbalances. Each player was tested on a Cybex II at speeds of 30 degrees/sec and 180 degrees/sec. The subjects were stratified by age (15, 16, 17) and by position (linemen vs receivers and backs). Significant (p less than 0.05) torque differences were observed at both the slow and fast speeds for the knee extensors and flexors across the 3 age groups. However, the flexion to extension ratios did not differ significantly. On the other hand, when considering the positions, flexor torque and flexion to extension ratio at the slow speed were greater (p less than 0.05) for the linemen than the receivers and backs. Partial correlation analyses showed that body weight had the greatest effect on the knee torque values. It was concluded that basic torque measures differed with age and by position in the sport of football. Also, speed of movement altered the force generating capabilities of the muscle and resultant ratios.