The early detection of postpartum depression: midwives and nurses trial a checklist

OBJECTIVE: To evaluate the use of a standard pen-and-paper test versus the use of a checklist for the early identification of women at risk of postpartum depression and to investigate the experiences of nurses in using the checklist. DESIGN: A prospective cohort design using repeated measures. SETTING: The booking-in prenatal clinic at a regional hospital in Victoria, Australia, and the community-based postpartum maternal and child health service. PARTICIPANTS: 107 pregnant women over 20 years of age. MAIN MEASURES: Postpartum Depression Prediction Inventory (PDPI), Postpartum Depression Screening Scale (PDSS), Edinburgh Postnatal Depression Scale (EPDS), demographic questionnaire, and data on the outcome from the midwives and nurses. RESULTS: The PDPI identified 45% of the women at risk of depression during pregnancy and 30% postpartum. The PDSS and EPDS both identified the same 8 women (10%), who scored highly for depression at the 8-week postpartum health visit. Nurses provided 80% of the women with anticipatory guidance on postpartum depression in the prenatal period and 46% of women at the 8-week postpartum health visit. Nurse counseling or anticipatory guidance was provided for 60% of the women in the prenatal period. CONCLUSION: The PDPI was found to be a valuable checklist by many nurses involved in this research, particularly as a way of initiating open discussion with women about postpartum depression. It correlated strongly with both the PDSS and the EPDS, suggesting that it is useful as an inventory to identify women at risk of postpartum depression.     

The 80-hour work week: will we have less-experienced graduating surgeons?

OBJECTIVE: Our primary concern when modifying the Mount Carmel Medical Center surgical residency to comply with the "80-hour work week" was the effect on operative experience. Our goal was to measure the impact that work-hour restrictions have on operative volumes and to evaluate the potential benefit of a night rotation to minimize the number of "lost operations." DESIGN: Categorical surgical residents (PGY I-IV) recorded missed surgical procedures on post-call days from September 1, 2002 to March 31, 2004. The data collection is split between the pre-night rotation (September 1, 2002 to March 31, 2003) and post-night rotation (April 1, 2003 to March 31, 2004) periods. The post-night rotation period is further divided to account for the end of the academic year. Previous graduate operative logs were reviewed for comparison. SETTING: Mount Carmel Health System is a tertiary referral, community-based hospital in Columbus, Ohio. PARTICIPANTS: Categorical general surgery residents (Postgraduate Years I to V). RESULTS: In the 7-month period, extending from September 1, 2002 to March 31, 2003, the average number of missed cases for successive levels was PGY I: 21, PGY II: 31, PGY III: 26, and PGY IV: 40. From April 1, 2003 to June 30, 2003, the average number of missed cases for successive levels was PGY I: 3, PGY II: 7, PGY III: 5, and PGY IV: 6. From July 1, 2003 to March 31, 2004, the average number of missed cases for successive levels was PGY I: 34, PGY II: 8, PGY III: 14, and PGY IV: 30. Before the implementation of a night rotation, residents were projected to miss an average of 202 operations over 4 years. After implementation of a night rotation, the projected loss would drop to 107 operations over 4 years. CONCLUSIONS: Work-hour restrictions result in a significant decrease in operative experience. This detriment can be partially alleviated with the institution of a night rotation to better regulate in-house call.     

Studies of mechanosensation using the fly

Mechanosensation requires the transduction of mechanical stimuli into neuronal impulses. It encompasses not only the sense of touch but also proprioception and hearing. In contrast to sight, smell and taste, relatively little is known about the molecular machinery of mechanosensation. It is already clear, however, that important aspects are conserved across phyla, from Caenorhabditis elegans to humans. Drosophila melanogaster is well placed to make a significant contribution to this field. Its advantages include a sequenced genome allied with powerful genetic techniques, and the ability to conduct electrophysiological recording from mechanoreceptor neurons. For human geneticists, it is expected that Drosophila studies will provide a source of candidate genes whose human homologues can be examined for roles in mechanosensory development, function and disease.     

Changes in body temperature and urinary cortisol after routine immunization in babies with intrauterine growth retardation

Aim : To investigate whether infants with intrauterine growth retardation (IUGR) experience different changes in temperature and cortisol excretion after routine immunization compared with normal healthy infants. Methods : Overnight deep body temperature and urinary cortisol to creatinine ratios were measured on the night after immunization and a control night in normal and IUGR infants. Results : In 60 normal infants, first vaccination at about 10 wk of age led to a significant increase in minumum overnight temperature compared to the control night, mean rise 0.25°C (95% CI, 0.12 to 0.38). In 35 IUGR infants the mean rise in temperature between immunization night and control night was 0.35°C (95% CI, 0.15 to 0.55). The increases in minimum temperature did not differ significantly between the normal and IUGR infants ( p = 0.11). Cortisol to creatinine ratios measured from overnight urine samples showed that 23 IUGR infants had consistently higher levels than 39 normal infants; control night medians 34 and 15 ( p = 0.01) and immunization night medians 56 and 26 ( p= 0.02), respectively. However, the percentage increase did not differ significantly between the IUGR infants and the normal infants. A smaller number of second immunizations were studied, but no significant differences were found.

Conclusion : These results suggest that although the impact of immunization is the same for IUGR and normal infants, because IUGR infants are less mature and at greater stress before immunization, the absolute levels that they experience after immunization are higher than those for normal infants.     

Pulmonary embolism after hip or knee replacement: postoperative changes on pulmonary scintigrams in asymptomatic patients

Serial pulmonary imaging has proved to be effective in the evaluation of patients undergoing total joint arthroplasty. A clinical dilemma arises in asymptomatic patients whose postoperative pulmonary images differ from the preoperative images. The authors prospectively evaluated 403 patients with serial imaging to determine the significance of changed postoperative images in asymptomatic patients undergoing total hip or knee arthroplasty. Twenty-two (5.5%) patients had significant changes on postoperative images. Seventeen were asymptomatic; all but one underwent pulmonary angiography. Documented pulmonary emboli were demonstrated in 100% of patients whose postoperative images changed to indicate a high probability of pulmonary embolism, 71% whose images changed to a moderate probability, and 0% whose images changed to indeterminate probability. Overall, pulmonary emboli occurred in 76% of all asymptomatic patients with significantly change postoperative images. Asymptomatic pulmonary embolism is a significant occurrence after total hip or knee repair, and a changed lung scan with appropriate clinical evaluation is an accurate indicator of pulmonary emboli in asymptomatic postarthroplasty patients.     

Pharmacokinetics of the thymidylate synthase inhibitor N10-propargyl-5,8-dideazafolic acid (CB3717) in the mouse

The tissue distribution, excretion, and metabolism of the thymidylate synthase inhibitor N10-propargyl-5,8-dideazafolic acid (CB3717) have been investigated in the mouse. Following 100 mg/kg of 2-14C-CB3717 ip, levels of radioactivity in the brain, testes, muscle, heart, and lung equilibrated slowly with those in the plasma and were no longer significantly lower 5 hours (lung) and 12 hours (brain, testes, muscle, and heart) after administration. In contrast, concentrations of 14C in the liver and kidney were markedly higher than those in the plasma at all time points studied (1.3 hours-23 days). High-performance liquid chromatographic (HPLC) analysis of livers removed 5 hours after drug administration and kidneys excised 24 hours after treatment indicated that, at these time points, greater than 50% of the radioactivity was in the form of unchanged CB3717. Furthermore, HPLC analysis of plasma removed over the period 0.5-6 hours demonstrated that all of the 14C could be accounted for as CB3717. Although the accumulation and retention of radioactivity in the liver and kidney were also apparent following 20 and 200 mg/kg of 14C-CB3717, the effect was less marked at the lower dose, thereby suggesting dose-dependent pharmacokinetics. In excretion studies (0-48 hours), the major route of elimination was found to be via the feces, with 46% of the 14C recovered; 26% of the dose was recovered as unchanged CB3717. Radioactivity excreted in the urine accounted for 20% of the administered 14C, while CB3717 eliminated via this route represented 15% of the dose. In addition to CB3717, a metabolite was detected in the feces which comprised 8% of the dose administered. The metabolite was shown to be 4-(N-((2-amino-4-hydroxy-6-quinazolinyl)methyl)prop-2-ynylamino) benzoic acid (CB3751) by HPLC and mass spectrometry. The formation of CB3751 could be catalyzed in vitro by the contents of the cecum and prevented in vivo by antibiotic pretreatment and is therefore considered to be the result of bacterial metabolism. CB3717 binds extensively to plasma proteins (92%; concentration range, 25-250 microM). These studies have shown that CB3717 does not apparently undergo extensive host metabolism in vivo, and therefore the biological properties of this novel antimetabolite are probably a function of the parent compound. In addition, the accumulation of CB3717 in the liver and kidney may be related to the hepatotoxic and nephrotoxic effects of this drug.     

Paroxysmal dystonic choreoathetosis: clinical features and investigation of pathophysiology in a large family.

Paroxysmal dystonic choreoathetosis (PDC) is an unusual hyperkinetic movement disorder characterized by attacks of chorea, dystonia, and ballism with onset in childhood. We report a large British family with dominantly inherited PDC linked to chromosome 2q and describe the clinical features in 20 affected family members. Attacks were precipitated by a variety of factors, including caffeine, alcohol, or emotion, and could be relieved by short periods of sleep in most subjects. The clinical features in the family are compared with those of 11 other PDC families in the literature and a core phenotype for PDC suggested. CSF monoamine metabolites measured at baseline and during an attack in one subject were found to increase during the attack. Magnetic resonance spectroscopy of brain and basal ganglia performed both during and between attacks was normal. Positron emission tomography using the D2 receptor ligand, 11C-raclopride, showed no abnormalities.