Roundtable Discussion: “No One Can Condemn You to a C‐Section!”

Abstract: The stories in this Roundtable Discussion are related by two women whose babies were born recently in Canadian hospitals. Each woman had undergone a cesarean delivery for her first child, and whereas Sophia delivered her second baby by vaginal birth after a cesarean (VBAC), Marie was unable to find a practitioner or hospital that would allow her to have a VBAC for her second birth. The women describe how they feel about their choices and experiences. Their two accounts and the issues that they raise are discussed in commentaries by a family physician, midwife, doula, and obstetrician. (BIRTH 37:3 September 2010)     

Battered women: Why do they stay?

This article contains an overview of the many possible answers to the question often asked of battered women, “why do they stay?”; It explores economic, social and psychological factors which may inhibit an abused woman from leaving her abuser. At the end of the article is an interview schedule designed to extract information regarding the unique situation in which the individual woman is functioning. The counselor thereby learns which factors need to be addressed and which are irrelevant to the woman's particular situation, thus increasing the efficiency and value of future counseling sessions.     

Coaching: An essential leadership skill for the advanced practice nurse

Leadership in the 21st century requires that individuals lead in creative ways that enhance and support their employees' growth, development, and performance. Employees have reported that they need to feel respected and valued. As a member of the nursing leadership team, the advanced practice nurse (APN) is on the front line, involved with staff on a daily basis, and able to coach staff in a variety of different situations. Using coaching as a leadership skill assists the APN in making a significant contribution to the health care field and to employee growth and development. Copyright © 2001 by W.B. Saunders Company     

A Position Paper on How Cost and Quality Reforms Are Changing Healthcare in America

Healthcare spending in the United States is the highest in the world, yet quality indicators such as life expectancy and infant mortality lag other countries. U.S. reforms are under way to lower costs and raise quality of care, notably the Patient Protection and Affordable Care Act (PPACA). Value‐based purchasing (VBP) and programs for reducing the incidence of hospital‐acquired conditions (HACs) and hospital readmissions represent initial changes. With these programs, overarching themes are to coordinate care during and beyond hospitalization and to ensure that physicians and hospitals are aligned in their treatment strategies. Hospital malnutrition represents a large, hidden, and costly component of medical care; hospital administrators and caregivers alike must harness the benefits of nutrition as a vital component of healthcare. Medical, nursing, and allied health training programs must find places in their curricula to increase awareness of nutrition and promote knowledge of best‐practice nutrition interventions. Hospitals use dietitians and nutrition support teams as critical members of the patient care team, but more work needs to be done to disseminate and enforce best nutrition practices. Such training, nutrition interventions, and practice changes can help prevent and treat malnutrition and thus help avert HACs, reduce hospital readmissions, lower infection and complication rates, and shorten hospital stays. Nutrition care is an effective way to reduce costs and improve patient outcomes. This article calls hospital executives and bedside clinicians to action: recognize the value of nutrition care before, during, and after hospitalization, as well as develop training programs and policies that promote nutrition care.     

Atomoxetine for the treatment of executive dysfunction in Parkinson's disease: A pilot open‐label study

Executive dysfunction (ED) is a prominent and often disabling feature of cognitive impairment in Parkinson's disease (PD). Few studies have examined treatments. Given the role of noradrenergic pathology in ED, atomoxetine, a norepinephrine reuptake inhibitor indicated for attention deficit hyperactivity disorder (ADHD), may be a potential treatment for PD‐related ED. Twelve patients with PD and disabling ED completed an 8‐week pilot open‐label, flexible dose (25–100 mg/day) trial of atomoxetine. On primary outcome measures, atomoxetine was associated with improved ED based on the Clinical Global Impression‐Change Scale (75% positive response rate; 95% CI: 43–95%, P < 05) and behavioral measures of ED [Frontal Systems Behavior Scale (FrSBE) Executive Dysfunction and Connors Adult ADHD Rating Scale (CAARS) inattention/memory subscales]. Adverse effects included sleep and gastrointestinal disturbances and hypomania. Atomoxetine is tolerable in PD and may benefit clinical manifestations of ED, warranting further study in controlled trials. © 2008 Movement Disorder Society     

Children's health care: Book and media reviews

Germs Make Me Sick, Berger, Melvin, illustratd by Hafner, Marylin, New York, Thomas Y. Crowell Junior Books, 1985. $11.50. Hardback, 32 pp.

My CAT Scan, videotape, 10 minutes. Wilke, W. Gregory, New York, American Journal of Nursing Company, Educational Services Division, 1/2 inch only. Rental, $40.00; purchase, $200.00.