Preconception Care for Improving Perinatal Outcomes: The Time to Act

Maternal and Child Health Journal -     

Balanced analgesia after hysterectomy: the effect on outcomes.

Balanced analgesia (an opioid and a nonsteroidal anti-inflammatory agent) after hysterectomy often leads to better postoperative pain outcomes. Researchers compared post-hysterectomy patients who received balanced analgesia with those who received only morphine patient-controlled analgesia, and their relationship with pain scores, ambulation, and hospital length of stay.     

Pharynx and oesophagus evaluation during the swallow using helical computerized tomography.

PURPOSE: Videofluorography (VF) and endoscopy are commonly used for dynamic imaging (DI) of pharyngeal swallowing but do not offer transverse plane (TP) information. The aim of the present study was to evaluate helical computerized tomography (HCT) to measure the DI capability pharyngeal swallowing in the TP. METHODS: The HCT scan technique used was a single-slice cine mode with scan times of 100 ms. All 15 subjects were studied supine during dry swallow, swallowing of barium sulphate jelly and 3, 10, 15 or 20 ml of a 40% barium sulphate solution. Nine subjects repeated the test twice at more than 1 week's interval to determine the test-retest reliability. RESULTS: Swallowing leads to closure of the vocal folds, pharyngeal constriction and narrowing of the piriform sinuses allowing jelly passage between the sinuses. Laryngeal elevation then occurs with the opening of the pharyngoesophageal segment (PES). Swallowing a bolus of 20 ml produced the maximum anteroposterior and transverse diameters as well as the maximum opening area of the PES. The test-retest intraclass correlation coefficients with liquid deglutition ranged from 0.86 to 0.98. CONCLUSIONS: This study shows that HCT enables visualization of TP of PES complementing VF or endoscopic swallowing studies.     

An Interdisciplinary Clinical Advancement Program Within a Patient-Centered Care Model

Restructuring in health care does not have to compromise the pursuit of clinical excellence and quality patient care. The clinical advancement program (CAP) at the Hospital for Special Care is a newly developed multidisciplinary reward and recognition program for clinical staff. The program is integrated into the hospital's structure of service line management and, unlike traditional advancement programs, is open to all levels of care providers: professional personnel, technical staff, and aides. This article describes the basic features of the CAP model and how it was developed by a multidisciplinary task force.