Staying Connected While Nurturing an Infant: A Challenge of New Motherhood*

Abstract: Fifteen at‐risk new mothers participating in a volunteer home‐visiting program were interviewed about their experiences with these home‐visitors and their relationships with close family and friends after their babies were born. Results of the qualitative analysis, viewed through the lens of Relational Cultural Theory (RCT), detail the social isolation and personal disconnection that they experienced. Their narratives also provide insights about the volunteers’ use of techniques—such as validation, affirmation, consistency, and emotional and instrumental aid—to enhance the mothers’ self‐confidence in caring for their babies, to reduce painful feelings, and to increase interpersonal connections. Recommendations are included for working with couples anticipating a new baby.     

The role of parenteral nutrition

Patients with acute leukemia who undergo hematopoietic stem cell transplantation (HSCT) are susceptible to malnutrition caused by several factors including intensive cytotoxic therapy. This paper discusses the significance of malnutrition in these patients and provides an overview of nutrition therapy by the oral, enteral, and parenteral routes. The goal is to investigate whether the use of parenteral nutrition (PN) produces improved clinical outcomes in patients with acute leukemia and to identify criteria for the selection of patients most likely to benefit from this therapy. Although PN may be appropriate for patients suffering from complications such as graft-versus-host disease (GVHD) and mucositis, the data available at this time do not support PN as first-line therapy for all recipients of HSCT.     

Phase II trial of bevacizumab in combination with weekly docetaxel in metastatic breast cancer patients.

PURPOSE: To evaluate the safety and efficacy of bevacizumab and weekly docetaxel as first- or second-line therapy in patients with metastatic breast cancer (MBC). PATIENTS AND METHODS: Twenty-seven MBC patients received i.v. bevacizumab at 10 mg/kg on days 1 and 15 in combination with i.v. docetaxel 35 mg/m2 on days 1, 8, and 15 of a 28-day cycle. Primary end points were to assess toxicity, overall response rate, and progression-free survival. A secondary end point was to assess the relationship between plasma endothelial and cell adhesion markers and clinical outcomes. RESULTS: One-hundred fifty-eight treatment cycles were administered with a median of six cycles (range 1-15 cycles) per patient. The most common grade 4 toxicities per patient were as follows: 2 (7%)-pulmonary embolus, 1 (4%)-febrile neutropenia, and 1 (4%)-infection; grade 3 toxicities were 4 (15%)-neutropenia, 4 (15%)-fatigue, 2 (7%)-neuropathy, 2 (7%)-athralgias, 2 (7%)-stomatitis, 1 (7%)-pleural effusion, and 1 (4%)-hypertension. The overall response rate was 52% [95% confidence interval (95% CI), 32-71%], median response duration was 6.0 months (95% CI, 4.6-6.5 months), and the median progression-free survival was 7.5 months (95% CI, 6.2-8.3 months). In hypothesis-generating univariate and limited multivariate analyses, E-selectin was statistically significantly associated with response to the combination. CONCLUSION: Bevazicumab in combination with weekly docetaxel is active with acceptable toxicities in MBC. Additional studies evaluating E-selectin as a marker of response to bevacizumab-containing chemotherapy are warranted.     

Continuous infusion of ceftazidime with a portable pump is as effective as thrice-a-day bolus in cystic fibrosis children

Continuous infusion (CI) of β-lactam antibiotics provides a stable concentration which may result in a better activity against gram-negative bacteria if exceeding the minimum inhibitory concentration (MIC). Treatment outcome after 24 h CI of ceftazidime (CAZ) in cystic fibrosis (CF) children was compared with the bolus administration regimen. Fourteen CF children with chronic Pseudomonas aeruginosa pulmonary infection were treated during 14 days with the conventional CAZ thrice-a-day bolus infusion (regimen A), and few months later with 24 h CI of CAZ (regimen B) using a portable pump. Amikacin was added to both regimens. Clinical efficacy of treatment was assessed using pulmonary, inflammatory and nutritional variables. Bacteriological analyses and CAZ concentrations in serum and sputum were also measured. All patients improved clinically with both regimens. Among the parameters used to compare both regimens, only prealbumin values improved (regimen A: +0.08 g/l versus regimen B: +0.11 g/l, P=0.015). No clinically significant side-effects were noted. In regimen A, the mean predose (trough level) CAZ concentration in serum was highly variable (range 2.2–45.4 μg/ml) with some values (32% of samples) below the MIC of P. aeruginosa isolates found in the sputum of the patients. In regimen B, the serum CAZ level achieved was 28.5 ± 8.4 μg/ml without any value below the MIC. The mean sputum levels were comparable in both regimens. No CAZ resistant strains of P. aeruginosa appeared between and directly after the treatments. Conclusion The clinical outcome of children with cystic fibrosis treated with 24 h continuous infusion of ceftazidime was no different from that achieved with the conventional bolus infusion regimen. Continuous infusion provided a sustained serum ceftazidime level well above the P. aeruginosa minimum inhibitory concentration. Continuous infusion was well tolerated and appreciated by the children and this may promote home therapy for cystic fibrosis children. Received: 12 February 2000 and in revised form: 26 May and 15 July 2000 / Accepted: 17 July 2000     

Why do preschool language abilities correlate with later reading? A twin study.

PURPOSE: Language acquisition is predictive of successful reading development, but the nature of this link is poorly understood. METHOD: A sample of 7,179 twin pairs was assessed on parent-report measures of syntax and vocabulary at ages 2, 3, and 4 years and on teacher assessments of reading achievement (RA) at ages 7, 9, and 10 years. These measures were used to construct latent factors of early language ability (LA) and RA in structural equation model-fitting analyses. RESULTS: The phenotypic correlation between LA and RA (r = .40) was primarily due to shared environmental influences that contribute to familial resemblance. These environmental influences on LA and RA overlapped substantially (rC = .62). Genetic influences made a significant but smaller contribution to the phenotypic correlation between LA and RA, and showed moderate overlap (rA = .36). There was also evidence for a direct causal influence of LA on RA. CONCLUSIONS: The association between early language and later reading is underpinned by common environmental and genetic influences. The effects of some risk factors on RA may be mediated by language. The results provide a foundation for more fine-grained studies that examine links between specific measures of language, reading, genes, and environments.     

Congenital thiopurine methyltransferase deficiency and 6-mercaptopurine toxicity during treatment for acute lymphoblastic leukaemia

Two children with acute lymphoblastic leukaemia (ALL) taking daily 6-mercaptopurine as part of a national UK therapeutic trial repeatedly developed profound myelosuppression on 25% of the standard protocol dose. Both were found to have undetectable intracellular activity of thiopurine methyltransferase (TPMT), an enzyme controlling one of the major alternative catabolic pathways of 6-mercaptopurine, and both produced higher concentrations of cytotoxic drug metabolites at 10-25% of the protocol dose than other patients taking 100%. It is supposed that these patients represent the 0.33% of the normal population constitutionally lacking TPMT. It is important to recognise such individuals both to avoid fatal bone marrow failure through inadvertent overdosage, and to be reassured that an adequate drug effect can be achieved at around 10% of the standard dose.     

Endometrial secretory proteins enhance early embryo development

Purpose To evaluate the role of endometrial stromal cells and their secretory proteins in early embryo development, two-celled CB6F1 mouse embryos were cultured alone or cocultured with human endometrial stromal cells in various culture conditions.Results The percentage of embryo blastocyst formation, hatching, and outgrowth was significantly greater in (1) coculture with endometrial stromal cells than in a cell-free control when both coculture and control were carried out in protein-free medium or in RPMI 1640 plus 10% fetal calf serum; (2) coculture with hormone (i.e., progesterone plus relaxin)-treated cells than in coculture with hormone-nontreated cells; and (3) media supplemented with isolated endometrial secretory proteins than in media supplemented with BSA (0.35%). Embryo development was not found to be significantly different in coculture and in media supplemented with endometrial secretory protein.Conclusion Our data provides credence to the theory that endometrial stromal cells enhance embryo development by secreting specific proteins that are beneficial to embryo growth in vitro.Presented at the 48th Annual Meeting of the American Fertility Society, New Orleans, Louisiana, October 31–November 5, 1992.     

Retrieval, Maturation, and Fertilization of Immature Oocytes Obtained from Unstimulated Patients with Polycystic Ovary Syndrome

Purpose: Our purpose was to determine whether immature oocytes could be retrieved under local anesthesia, whether these oocytes would mature and fertilize in vitro, and whether adequate endometrium development could be obtained after hormonal supplementation. Methods: Ovum pick-up was performed under local anesthesia. Immature oocytes were cultured and inseminated. To prepare the endometrium, estradiolvalerate was administered in combination with micronized progesterone. Results: Immature oocytes were obtained in all cases. Fifty-six percent (n = 30) of the oocytes developed into metaphase II (MII) after 48 hr of culture, and another 20% reached the MII stage by 72 hr. Normal fertilization was observed in only 10% of oocytes inseminated. No embryonic development occurred, and therefore embryo transfer was not performed in any of the patients. Endometrial microbiopsy was performed in all subjects and endometrial development was considered sufficient in eight patients. Conclusions: We collected immature oocytes from patients with polycystic ovary syndrome without general anesthesia. In vitro maturation of these oocytes seemed adequate but fertilization rates were poor. Sufficient endometrial quality was obtained after hormonal substitution.     

What makes a chronic pelvic pain patient satisfied?

Purpose: Caring for women with chronic pelvic pain (CPP) is challenging. There have been few studies on what factors patients consider to be important when being treated for their pelvic pain. This study sought to identify the key factors of the health care visit that contribute to patient’s overall satisfaction with their care in a CPP clinic.

Materials and methods: Between January 2015 and December 2016, new patients visiting a tertiary care CPP clinic were recruited to complete a patient satisfaction survey. Inductive thematic analysis was performed on response data regarding important factors that impact patient satisfaction with their visit/care.

Results: Five themes of patient satisfaction identified included: providers with a compassionate and caring attitude, being listened to, clear communication with collaboration when needed, quality time spent with patient, and having a plan of care with recommendations. The theme regarding provider’s compassion and listening skills was the most frequently identified. Pain relief was seldom mentioned as a source of patient satisfaction.

Conclusions: The data suggest that a focus on empathic communication may make a meaningful difference in meeting the needs of women with CPP as well as strengthening the provider/patient relationship.