The Coping With Labor Algorithm: An Alternate Pain Assessment Tool for the Laboring Woman

The documentation of pain in the labor and delivery setting is one of the essential tasks of all health care providers who care for women in labor. The Joint Commission standards mandate regular pain assessments, but compliance with this mandate in the highly unique patient population of laboring woman is problematic when using the standard 0 to 10 Numeric Rating Scale. Labor pain is always unique given the various contributing physiologic, emotional, social, and cultural components. This article describes the work of a process improvement group to create an alternative pain assessment tool named the Coping With Labor Algorithm. The group, consisting of nurses and nurse‐midwives, used the FOCUS format and Deming's “Plan, Do, Check, and Act” cycle to create a formalized assessment tool for use with laboring women. The Coping With Labor Algorithm is currently in use in the labor unit of a large tertiary care facility, which successfully passed a Joint Commission inspection while using the coping algorithm. The value of the coping algorithm is two‐fold: it provides a mechanism for pain documentation, and it provides nursing care suggestions for the laboring woman. This article reports nurses' perceptions of the tool.     

Darstellung vitreoretinaler Adh?renzen in Partneraugen von Patienten mit durchgreifenden Makulaforamina in der optischen Koh?renztomographie

Hintergrund. Glask?rperadh?renzen spielen eine wichtige Rolle bei der Entstehung des Makulaforamens. Wir untersuchten vitreoretinale Adh?renzen mit der OCT, um die Entstehung von Makulaforamen zu analysieren.     

Handling of the MED-EL TEMPO+ ear-level speech processor by paediatric cochlear implant users and their parents

MED-EL launched the first ear-level speech processor offering a high-rate CIS+ strategy, the TEMPO+, in 1999. Studies have already demonstrated improved speech perception, sound quality and ability to enjoy music with the TEMPO+ due to the new CIS+ speech-coding strategy, when compared to the body-worn processor. In this study we evaluated responses from parents of young children about ease of handling and usage of the TEMPO+, and satisfaction with the TEMPO+ and its performance. Overall, 65 custom-designed questionnaires were analysed. The results showed that MED-EL cochlear implant users felt comfortable manipulating the dials and switches, changing the battery pack, using external sources of input and using the accessories provided. These results confirm the suitability of the TEMPO+ for infants and toddlers.     

A Longitudinal Cohort Study of Youth Mental Health and Substance use Before and During the COVID-19 Pandemic in Ontario,Canada: An Exploratory Analysis

BackgroundYouth mental health appears to have been negatively impacted by the COVID-19 pandemic. The impact on substance use is less clear, as is the impact on subgroups of youth, including those with pre-existing mental health or substance use challenges.ObjectiveThis hypothesis-generating study examines the longitudinal evolution of youth mental health and substance use from before the COVID-19 pandemic to over one year into the pandemic among youth with pre-existing mental health or substance use challenges.MethodA total of 168 youth aged 14–24 participated. Participants provided sociodemographic data, as well as internalizing disorder, externalizing disorder, and substance use data prior to the pandemic’s onset, then every two months between April 2020–2021. Linear mixed models and Generalized Estimating Equations were used to analyze the effect of time on mental health and substance use. Exploratory analyses were conducted to examine interactions with sociodemographic and clinical characteristics.ResultsThere was no change in internalizing or externalizing disorder scores from prior to the pandemic to any point throughout the first year of the pandemic. Substance use scores during the pandemic declined compared to pre-pandemic scores. Exploratory analyses suggest that students appear to have experienced more mental health repercussions than non-students; other sociodemographic and clinical characteristics did not appear to be associated with mental health or substance use trajectories.ConclusionsWhile mental health remained stable and substance use declined from before the COVID-19 pandemic to during the pandemic among youth with pre-existing mental health challenges, some youth experienced greater challenges than others. Longitudinal monitoring among various population subgroups is crucial to identifying higher risk populations. This information is needed to provide empirical evidence to inform future research directions.     

Causal role of the right temporoparietal junction in selfishness depends on the social partner

The right temporoparietal junction (rTPJ) is a hub of the mentalizing network, but its causal role in social decisions remains an area of active investigation. While prior studies using causal neurostimulation methods have confirmed the role of the rTPJ in mentalizing and strategic social interactions, most of the evidence for its role in resource-sharing decisions comes from correlational neuroimaging studies. Further, it remains unclear if the influence of the rTPJ on decisions about sharing resources depends on whether the other person is salient and identifiable. To clarify the causal role of the rTPJ in social decision making, we examined the effects of putatively inhibitory rTPJ transcranial magnetic stimulation (TMS) on Dictator Game behavior with one partner that was physically present and one that was only minimally identified. Under control conditions, participants tended to create more advantageous inequity toward the partner that was only minimally identified, selfishly keeping more resources themselves. rTPJ TMS reduced this differential treatment of the two partners. Clarifying prior mixed findings, results suggest that the rTPJ may play a role in differentiating between others when deciding how equitably to divide resources, but may not play a general role in reducing selfishness by promoting aversion to advantageous inequity.     

Effect of the Washington Special Supplemental Nutrition Program for Women,Infants and Children (WIC) on Pregnancy Outcomes

Objectives We determined the effect of the Washington State Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on adverse pregnancy outcomes. Methods We used a record-linkage retrospective cohort design. We matched records of eligible women who enrolled in Washington WIC from 9/1/1999-12/31/2000 to records of their subsequent birth/fetal death from the Washington State Department of Health to determine their pregnancy outcome between 9/1/1999-10/15/2001 (N = 42,495). We selected comparison women from birth/fetal death records who were WIC-eligible but not on WIC (N = 30,751). We used unconditional logistic regression for analysis. Results WIC was protective for preterm delivery depending on history of abortion and adequacy of prenatal care, being most protective for women with abortion and inadequate prenatal care (Odds ratio (OR) = 0.4; 95% confidence interval (CI) = 0.3–0.5). WIC was protective for low birth weight depending on women’s cervical health, with most protection conferred to those with incompetent cervix (OR = 0.2; 95% CI = 0.1–0.6). WIC was protective for fetal death depending on women’s education, being most protective to those with <12 years of education (OR = 0.2; 95% CI = 0.1–0.3). Conclusions WIC is protective for adverse pregnancy outcomes especially for high risk women.     

Development of ventilatory response to transient hypercapnia and hypercapnic hypoxia in term infants

Whereas peripheral chemoreceptor oxygen sensitivity increases markedly after birth, previous studies of ventilatory responses to CO(2) in term infants have shown no postnatal development. However, the hypercapnic challenges applied have usually been long-term, which meant that the effect of central chemoreceptors dominated. Oscillatory breathing, apneas, and sighs cause transient Pco(2) changes, probably primarily stimulating peripheral chemoreceptors. We wanted to assess whether the immediate ventilatory responses to step changes in inspired CO(2) and O(2) in term infants undergo postnatal developmental changes. Twenty-six healthy term infants were studied during natural sleep 2 d and 8 wk postnatally. Ventilatory responses to a randomized sequence of 15 s hypercapnia (3% CO(2)), hypoxia (15% O(2)), and hypercapnic hypoxia (3% CO(2) + 15% O(2)) were recorded breath-by-breath using a pneumotachometer. Response rate, stimulus-response time, and response magnitude were analyzed with ANOVA after coherent averaging. Response rate increased with age by 30% (hypercapnia), 318% (hypoxia), and 302% (hypercapnic hypoxia). Response rate during hypercapnic hypoxia exceeded rate during hypercapnia plus rate during hypoxia in wk 8, but not on d 2. Time to half-maximum response decreased by 3.4 s with age for the two hypercapnic stimuli but was unchanged for hypoxia. Response magnitude was unchanged for hypercapnia, but increased for the two hypoxic stimuli. In conclusion, an interaction between the effects of hypercapnia and hypoxia on ventilatory response rate emerged between postnatal d 2 and wk 8 in term infants. Concomitantly, stimulus-response time to hypercapnic stimuli declined markedly. The development of a prompt response to transient hypercapnia may be important for infant respiratory stability.     

Subsyndromal depression is associated with functional impairment in patients with bipolar disorder

BACKGROUND: The purpose of this study was to assess whether a relationship exists between mild depressive symptoms and overall functioning in subjects with bipolar disorder. METHOD: Twenty-five male subjects with bipolar I disorder (DSM-III-R criteria), who had not experienced a DSM-III-R episode of mania, hypomania, or major depression for 3 months as determined using the Structured Clinical Interview for DSM-III-R, were evaluated for degree of depressive symptoms using the Hamilton Rating Scale for Depression (HAM-D) and for overall functional status using the Global Assessment of Functioning (GAF, DSM-IV Axis V). RESULTS: GAF scores were significantly negatively correlated with HAM-D scores (r = -0.61, df = 23, p = .001), despite the fact that no patient had a HAM-D score high enough to be considered clinically depressed. CONCLUSION: The results of this study support a relationship between subsyndromal depressive symptoms and functional impairment in bipolar subjects, despite their not meeting threshold criteria for a major depressive episode. These findings raise the possibility that in some patients with bipolar disorder subsyndromal depressive symptoms might contribute to ongoing functional impairment.     

Nerve conduction abnormalities in patients with MELAS and the A3243G mutation

BACKGROUND: Mitochondrial DNA point mutations are especially deleterious to tissues with high energy demand, including the peripheral nervous system. Neuropathy has been associated with several mitochondrial diseases, including MELAS (mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes). OBJECTIVE: To evaluate nerve conduction in a genotypically and phenotypically homogeneous group of patients with MELAS and the A3243G mutation. DESIGN: We studied 30 patients with MELAS and the A3243G mutation using neurophysiological techniques, medical history questionnaires, laboratory tests, and a standardized neurological examination. RESULTS: Twenty-three subjects (77%) had abnormal nerve conduction measures. Symptoms suggestive of neuropathy were present in only half of the patients, but almost all had decreased reflexes or distal sensory findings on examination. Nerve conduction abnormalities were predominantly axonal and sensory and mainly present in the legs. Patients with nerve conduction abnormalities tended to be older and were more likely male. CONCLUSIONS: Peripheral nerve impairment is common in those with MELAS and the A3243G mutation, and may be subclinical. Male sex and older age may add to the genetic disposition to develop neuropathy.