Breastfeedilzg Support Services in the Neonutd Intensive-Care Unit

Objective: To describe a model for providing breastfeeding support in the neonatal intensive-care unit (NICU).
Design: Naturalistic, participant observation.
Setting: Suburban Level III NICU.
Patients: One hundred thirty-two mother-infant pairs over 1 year. Infants were hospitalized In the NICU, and mothers had initiated lactation efforts.
Interventions: Investigators provided breastfeeding interventions for the mother-infant pairs, based on identified problems, the research literature, or both.
Main Outcome Measures: Percentage of mothers who were breastfeeding at the time of discharge from the NICU.
Results: Interventions were classified into jive categories: expression and collection of mothers' milk, gavage feeding of expressed mothers' milk, in-hospital breastfeeding sessions, postdischarge breastfeeding management, and additional consultation.
Conclusions: This model was effective In preventing breastfeeding failure for this population. The model can provide the basis for NICU breastfeeding standards of care, protocols, and chart records, or for reimbursement purposes. The model also provides a framework for studying a specific category or breastfeeding intervention.     

The Diagnosis of Alcohol and Cannabis Dependence in Cocaine Dependents and Alcohol Dependence in their Families

Genetic research in alcoholism has made major advances in recent decades. Twin, adoption, high-risk and familial studies have demonstrated an inheritance factor in alcoholism. Few studies have demonstrated a genetic predisposition to cocaine and cannabis dependence. Two hundred and sixty-three inpatients were given a structured psychiatric interview retrospectively (180) and prospectively (113) to obtain DSM-III-R diagnosis of cocaine, alcohol and cannabis dependence disorders in the inpatients and of alcohol dependence in family members. Our study reveals a large number of cocaine dependents with a positive family history for alcohol dependence. Approximately 50% of cocaine addicts had at least a first or second degree relative with a diagnosis of alcohol dependence when studied by the family history and study methods. As many as 89% of cocaine dependents diagnosed by DSM-III-R criteria for cocaine dependence qualified for other alcohol and drug dependence diagnoses. Our study finds a high prevalence of alcohol (67% and 89%) and cannabis dependence (51% and 46%) in patients with cocaine dependence. Previous reports regarding alcohol and other drug dependence among cocaine dependents and their families are few and inconclusive. The diagnosis of other drug and alcohol dependence in cocaine dependence and in family members of cocaine dependents has important impact on etiology, prognosis and treatment.     

Prevalence and trends of cigarette smoking in different occupational groups: Results of the Minnesota Heart Survey 1980-1982 and 1985-1987

The association between smoking and occupational status is exploredusing data from the Minnesota Heart Survey. 7,381 currentlyemployed subjects were included in the study (2,949 from the1980–1982 survey and 4,432 from the 1985–1987 survey).In the first survey the prevalence of current smokers rangedfrom 23 (professional) to 57% (service occupations) in men andfrom 15 (artists and writers) to 59 (repair and craft occupations)in women. Educational level, age, race, and sex were importantpredictors of smoking status in a logistic regression analysisusing combined data from the two surveys; occupational statuswas significantly associated with smoking after controllingfor these covariables. Public health efforts should focus moreon preventing smoking in lower educational groups and in thoseoccupational groups that have the highest prevalence of smoking.     

Frequency of Use of Suturing and Repair Techniques Preferred by Dermatologic Surgeons

BACKGROUND: There are many closure techniques and suture types available to cutaneous surgeons. Evidence-based data are not available regarding the frequency of use of these techniques by experienced practitioners. OBJECTIVE: To quantify, by anatomic site, the frequency of use of common closure techniques and suture types by cutaneous surgeons. METHOD: A prospective survey of the members of the Association of Academic Dermatologic Surgeons that used length-calibrated visual-analog scales to elicit the frequency of use of specific suture techniques. RESULTS: A response rate of 60% (61/101) indicated reliability of the received data. Epidermal layers were closed most often, in descending order, by simple interrupted sutures (38-50%), simple running sutures (37-42%), and vertical mattress sutures (3-8%), with subcuticular sutures used more often on the trunk and extremities (28%). The most commonly used superficial sutures were nylon (51%) and polypropylene (44%), and the most common absorbable suture was polyglactin 910 (73%). Bilayered closures, undermining, and electrocoagulation were used, on average, in 90% or more sutured repairs. The median diameters (defined as longest extent along any axis) of most final wound defects were 1.1 to 2.0 cm (56%) or 2.1 to 3.0 cm (37%). Fifty-four percent of wounds were repaired by primary closure, 20% with local flaps, and 10% with skin grafting, with the remaining 15% left to heal by second intent (10%) or referred for repair (5%). Experience-related differences were detected in defect size and closure technique: defects less than 2 cm in diameter were seen by less experienced surgeons, and defects greater than 2 cm by more experienced surgeons (Wilcoxon's rank-sum test: p=.02). But more experienced surgeons were less likely to use bilayered closures (r=-0.28, p=.036) and undermining (r=-0.28, p=.035). CONCLUSIONS: There is widespread consensus among cutaneous surgeons regarding optimal suture selection and closure technique by anatomic location. More experienced surgeons tend to repair larger defects but, possibly because of their increased confidence and skill, rely on less complicated repairs.     

Providing direct care nurses research and evidence-based practice information: an essential component of nursing leadership

staffileno b.a. & carlson e. (2010) Journal of Nursing Management  18, 84–89
Providing direct care nurses research and evidence-based practice information: an essential component of nursing leadership
Aims  This commentary describes the reasons, strategies and benefits of providing direct care nurses with research and evidence-based practice (EBP) education.
Background  A component of nursing leadership is to provide nurses opportunities for professional growth and development, yet this can be challenging during a time when resources are constrained and need to be used wisely.
Evaluation  Our research and EBP education programmes have been evaluated qualitatively, as well as by the number of research/EBP projects implemented.
Key issues  Providing direct care nurses with support and additional education empowers them to seek, critically appraise and integrate research findings into their daily patient care.
Conclusions  Direct care nurses, who participated in our programme, demonstrated a strong desire to learn about research and EBP so they could practice using evidence-based care with confidence, thus transitioning from a 'tradition-based' care approach to an evidence-based way of providing care as the standard for nursing practice.
Implications for Nursing Management  Providing a dedicated time for additional education sends a clear message that research and EBP are important elements embedded in patient care. The organisation, then, is seen as an environment that emphasizes the value of research and EBP at the unit and organisational level.     

The validity of clerkship performance evaluations

The validity of narrative evaluations of clinical performance in medical school was investigated for three successive classes of medical school graduates. The criteria were ratings obtained from residency supervisors one year after entering the programme. Bivariate correlational analysis, multiple regression analysis and canonical redundancy analysis were performed to examine the associations between the evaluations by teachers of competence in medical school clerkships and the subsequent ratings by residency supervisors. The results, best summarized in the canonical analysis, showed two relationships between the two sets of measures (lambda 1 = 0.54 and lambda 2 = 0.47). The first relationship revealed an overall-competence-in-medicine dimension; the second suggested an interpersonal-skills/professional-maturity dimension. Overall, knowledge of clerkship performance accounted for 15% of the variance in residency ratings. The findings suggest the need to improve the assessment of professional maturity and behaviour during medical school.