Randomized trial of a web-based tool for prolapse: impact on patient understanding and provider counseling

Introduction and hypothesis

Effective patient/provider communication is important to ensure patient understanding, safety, and satisfaction. Our hypothesis was that interactive patient/provider counseling using a web-based tool (iPad? application) would have a greater impact on patient satisfaction with understanding prolapse symptoms compared with standard counseling (SC).

Methods

Women with complaints of seeing/sensing a vaginal bulge were enrolled in this randomized controlled trial. Participants completed pre- and postvisit Likert scale questionnaires on satisfaction with prolapse knowledge and related anxiety. After new patient histories and physical examinations, study participants were randomized to SC or SC with iPad?. Ninety participants were required to detect a 30 % difference in satisfaction with prolapse knowledge between the two groups.

Results

Ninety women were randomized to SC (n?=?44) or SC with iPad? (n?=?46). At baseline, 47 % of women were satisfied with their understanding of bulge symptoms (50 % SC vs. 43.5 % SC with iPad?, p?=?0.5). After counseling, 97 % of women reported increased satisfaction with understanding of bulge symptoms (p?<?0.0001), with no difference between groups [42/44 (95.5 %) SC vs. 45/46 (97.8 %) SC with iPad?, p?=?0.5]. Baseline anxiety was high: 70 % (65.9 % SC vs. 73.9 % SC with iPad?, p?=?0.4). After counseling, anxiety decreased to 30 % (p?<?0.0001), with improvement in both groups (31.8 % SC vs. 28.3 % SC with iPad?, p?=?0.7). Counseling times were similar between groups (9.5 min., SC vs. 8.9 min., SC with iPad, p?=?0.4).

Conclusions

Interactive counseling was associated with increased patient satisfaction with understanding bulge symptoms and decreased anxiety whether a web-based tool was used or not.     

Development and Testing of an Innovative User-Adjustable Support Surface for Wheelchair Seating Discomfort

ABSTRACT

Beginning in 2000, a study of discomfort experienced by wheelchair users and development of technology solutions were undertaken. This research culminated with the present study of a new technology targeting sitting discomfort. Support for development of the “Butt Scooter” prototype and its testing was provided through an NIH research grant. Investigators tested a prototype device, called the “Butt Scooter,” and conducted a focus group to obtain expert clinical opinions about the potential usefulness of the prototype. Subject testing of the prototype device followed a single subject design (ABABA). Subjects self-administered the Tool for Assessing Wheelchair disComfort (TAWC) to evaluate their discomfort levels. Results from three subjects are reported. All three expert therapists participating in the focus group responded favorably to the prototype. In summary, results from subject testing were somewhat mixed with regard to discomfort management, however all subjects commented positively on the features of the device.     

Effects of a Carrot Juice Intervention on Plasma Carotenoids,Oxidative Stress,and Inflammation in Overweight Breast Cancer Survivors

Evidence suggests that higher plasma carotenoid concentrations are protective in relation to breast cancer recurrence. This simple randomized carrot juice intervention study was designed to test the hypothesis that daily intake of 8 ounces of fresh BetaSweet (anthocyanin-rich) or Balero orange carrot juice would increase plasma total carotenoid concentrations to levels previously shown to be associated with reduced breast cancer recurrence. It was hypothesized that regular carrot juice intake would be associated with reductions in oxidative stress (8-iso-PGF2α) and inflammation (thromboxane B2, prostaglandin E2 metabolites, and hsC-reactive protein). Sixty-nine overweight breast cancer survivors consumed fresh carrot juice made from study-provided carrots for 3 wk. Total plasma carotenoids increased by 1.65 and 1.38 umol/L for the BetaSweet and Balero carrot juice, respectively. Rise in total plasma carotenoids for the overall sample was inversely associated with 8-iso-PGFα (OR: 0.13; 95% CI: 0.20 to 0.75; no differences were shown by carrot variety. These results suggest daily intake of fresh carrot juice is a simple and effective approach to increasing plasma total carotenoids and in turn reducing oxidative stress, but not inflammatory markers, in women previously treated for breast cancer.     

YOUNG LATINAS AND ABORTION: THE ROLE OF CULTURAL FACTORS,REPRODUCTIVE BEHAVIOR,AND ALTERNATIVE ROLES TO MOTHERHOOD

Latina women have often been portrayed as holding strong traditional family values leading to a greater propensity for rejection of contraception and abortion. Increasingly, the literature has consistently shown that Latina women use contraception effectively when available; however, much less is known about the prevalence of abortion and the factors related to its use in this population. In this article we examine Latinas' use of abortion and identify factors affecting its use among 1,207 ever-pregnant Latina women age 14-24 recruited at two federally-funded family planning clinics in the Los Angeles metropolitan area. Only a small proportion of the young women in our sample (7.5%) had ever had an induced abortion. In multivariate analysis the variables significantly associated with past abortion included less traditional attitudes about women's roles, higher gravidity, shorter periods of sexual activity, and a higher number of lifetime sexual partners. We conclude that use of abortion among Latinas is driven by role orientation and reproductive variables.     

The Canadian Perinatal Network: A National Network Focused on Threatened Preterm Birth at 22 to 28 Weeks’ Gestation

ObjectiveThe Canadian Perinatal Network (CPN) maintains an ongoing national database focused on threatened very preterm birth. The objective of the network is to facilitate between-hospital comparisons and other research that will lead to reductions in the burden of illness associated with very preterm birthMethodsWomen were included in the database if they were admitted to a participating tertiary perinatal unit at 22+0 to 28+6 weeks' gestation with one or more conditions most commonly responsible for very preterm birth, including spontaneous preterm labour with contractions, incompetent cervix, prolapsing membranes, preterm prelabour rupture of membranes, gestational hypertension, intrauterine growth restriction, or antepartum hemorrhage. Data were collected by review of maternal and infant charts, entered directly into standardized electronic data forms and uploaded to the CPN via a secure networkResultsBetween 2005 and 2009, the CPN enrolled 2524 women from 14 hospitals including those with preterm labour and contractions (27.4%), short cervix without contractions (16.3%), prolapsing membranes (9.4%), antepartum hemorrhage (26.0%), and preterm prelabour rupture of membranes (23 0%) The mean gestational age at enrolment was 25.9 ± 1.9 weeks and the mean gestation age at delivery was 29.9 ± 5.1 weeks; 57.0% delivered at < 29 weeks and 75.4% at < 34 weeks. Complication rates were high and included serious maternal complications (26 7%), stillbirth (8.2%), neonatal death (16.3%), neonatal intensive care unit admission (60 7%), and serious neonatal morbidity (35 0%)ConclusionThis national dataset contains detailed information about women at risk of very preterm birth. It is available to clinicians and researchers who are working with one or more CPN collaborators and who are interested in studies relating processes of care to maternal or perinatal outcomes.