“I Wasn't Alone”—A Study of Group Prenatal Care in the Military

The military has recognized that health and quality of life for service members are closely tied to the resources for their families, including how they are cared for during pregnancy and childbirth. However, there has been little examination of women's experience with different models of prenatal care (PNC) in military settings. The purpose of this article is to describe the results of a qualitative study of women's experiences with the CenteringPregnancy model of group PNC compared to individual PNC in two military health care settings. This clinical trial enrolled 322 women who were randomized into group or individual PNC at two military treatment facilities. Qualitative interviews were completed with 234 women during the postpartum period. Interpretative narrative and thematic analysis was used to identify three themes: 1) “I wasn't alone”—the experience with group PNC; 2) “I liked it but…”—recommendations to improve group PNC; and 3) “They really need to listen”—general concerns across the sample about PNC. Greatest concerns of women in individual PNC included lack of continuity and time with the provider. Our military families must be assured that their health care system meets their needs through personal and family‐centered care. Group PNC offers the potential for continuity of provider while also offering community with other women. In the process, women gain knowledge and power as a health care consumer.     

Lack of Efficacy of Bevacizumab Plus Irinotecan in Children with Recurrent Malignant Glioma and Diffuse Brainstem Glioma:A Pediatric Brain Tumor Consortium Study

PURPOSE:A phase Ⅱ study of bevacizumab(BVZ) plus irinotecan(CPT-11) was conducted in children with recurrent malignant glioma(MG) and intrinsic brainstem glioma(BSG).PATIENTS AND METHODS:Eligible patients received two doses of BVZ intravenously     

Comparison of Rx-defined morbidity groups and diagnosis- based risk adjusters for predicting healthcare costs in Taiwan

Background  

Medication claims are commonly used to calculate the risk adjustment for measuring healthcare cost. The Rx-defined Morbidity Groups (Rx-MG) which combine the use of medication to indicate morbidity have been incorporated into the Adjusted Clinical Groups (ACG) Case Mix System, developed by the Johns Hopkins University. This study aims to verify that the Rx-MG can be used for adjusting risk and for explaining the variations in the healthcare cost in Taiwan.     

A randomized controlled trial of an intervention designed to improve the care given in general practice to Type II diabetic patients: patient outcomes and professional ability to change behaviour

AIM: Our objective was to evaluate the effect of training in a patient- centred intervention for GPs and practice nurses on outcomes for patients with Type II diabetes. METHODS: We carried out a randomized controlled trial within general practices as the basis for randomization and a before-and-after design for measures of patient outcome. A parallel process study examined the use of the method by professionals. The study was carried out in 29 general practices in South Glamorgan who had participated for at least 2 years in a local scheme of audit and CME in relation to Type II diabetes care. The subjects were 252 Type II diabetic patients recruited by 15 experimental and 14 control practices. The main outcome measures were changes in glycosylated haemoglobin, patient satisfaction with care and treatment, functional health status and professional ability to apply the intervention. RESULTS: Professionals adopted the innovative method with enthusiasm, but after 2 years only 19% continued to apply the method systematically. The trial was, therefore, unable to demonstrate significant biochemical or functional improvements. This highlights the need to understand the factors associated with professional uptake and subsequent ability to sustain changes in behaviour. CONCLUSIONS: The efficacy of this behavioural intervention remains unproved, despite its acceptability to professional staff. Detailed and prolonged development and testing of behavioural interventions is an essential first step before embarking on randomized controlled trials which involve complex behavioural changes in professionals or patients.      

Validity of testing alanine aminotransferase in refrigerated whole blood

Alanine aminotransferase (ALT) was tested in the sera and plasma of in-line segments as well as the main bags of whole blood units collected from blood donors. The purpose of this study was to evaluate the stability of enzyme activity during blood storage when the analysis of ALT is postponed over weekends or holidays. In addition, when validation of a particular result is requested, an in-line segment may be convenient for confirmatory testing. While a dilutional effect was found, the anticoagulant in the main collection bag was not shown to have affected enzyme activity. During storage the mean enzyme concentration decreased. Appropriate plasma ALT cutoffs for respective time periods during storage were calculated to compensate for downward drift. This correction prevented the use of the blood units (40% of total) that would erroneously have appeared transfusable if the serum cutoff had been used. If the Day 0 plasma cutoff was used throughout the total storage time period, 14 percent of the blood would erroneously have appeared transfusable.     

Social relations and extent and severity of coronary artery disease: The Stockholm Female Coronary Risk Study

Aims Social relations have been repeatedly linked to coronary heartdisease in men, even after careful control for standard riskfactors. Women have rarely been studied and results have notbeen conclusive. We investigated the role of social supportin the severity and extent of coronary artery disease in women. Methods and Results One hundred and thirty-one women, aged 30 to 65 years, who werehospitalized for an acute coronary event and were included inthe Stockholm Female Coronary Risk Study, were examined withcom-puter assisted quantitative coronary angiography. Angio-graphicmeasures included presence of stenosis greater than 50% in atleast one coronary artery (severity) and the number of stenosesgreater than 20% within the coronary tree (extent). Social factorsincluded two measures of social support, which were previouslyshown to predict coronary disease in prospective studies ofmen. After adjustment for age, lack of social support was associatedwith both measures of coronary artery disease. With furtheradjustment for smoking, education, meno-pausal status, hypertension,high density lipoprotein and body mass index, the risk ratiofor stenosis greater than 50% in women with poor as comparedto those with strong social support was 2·5 (95% confidenceinterval 1·2 to 5·3;P=0·003). Also, womenwith poor social support had more stenoses obstructing at least20% of the coronary lumen with multivariate adjustment, butthe difference from women with strong support was only of borderlinesignificance (P=0·09). Conclusion The findings suggest that lack of social support contributesto the severity of coronary artery disease in women, independentof standard risk factors.The European Society of Cardiology