Pregnancy-Related Anxiety, Perceived Parental Self-Efficacy and the Influence of Parity and Age.

Pregnancy-related anxiety is contextualised by pregnancy and is a health concern for the mother and child. Perceived parental self-efficacy is associated with this anxiety and age and parity are identified as influential factors. This research, therefore, predicted that negative perceptions of parental self-efficacy would predict greater pregnancy-related anxiety, moderated by parity and age. Participants (N = 771) were recruited online and assessed for perceived parental self-efficacy, pregnancy-related anxiety, and demographics. Moderation models showed that the psychosocial and sociodemographic factors combined predicted up to 49% of the variance. Parental self-efficacy predicted anxiety in the areas of body image, worry about themselves, baby concerns, pregnancy acceptance, attitudes towards medical staff and childbirth, and avoidance. Parity predicted pregnancy-related anxiety both overall and in childbirth concerns, worry about self, baby concerns and attitudes towards childbirth. Age predicted baby concerns. There was a significant moderation effect for pregnancy acceptance indicating that primiparous women with low perceptions of parental self-efficacy are less accepting of their pregnancy. Results suggest that parity and parental self-efficacy may be risk factors for first-time mothers for pregnancy-related anxiety.

Information and Communication Technology: Design, Delivery, and Outcomes from a Nursing Informatics Boot Camp

Information and communication technology (ICT) is integral in today's healthcare as a critical piece of support to both track and improve patient and organizational outcomes. Facilitating nurses' informatics competency development through continuing education is paramount to enhance their readiness to practice safely and accurately in technologically enabled work environments. In this article, we briefly describe progress in nursing informatics (NI) and share a project exemplar that describes our experience in the design, implementation, and evaluation of a NI educational event, a one-day boot camp format that was used to provide foundational knowledge in NI targeted primarily at frontline nurses in Alberta, Canada. We also discuss the project outcomes, including lessons learned and future implications. Overall, the boot camp was successful to raise nurses' awareness about the importance of informatics in nursing practice.

Cytomegalovirus infection in patients with active inflammatory bowel disease.

BACKGROUND: The reported prevalence of cytomegalovirus (CMV) infection with active inflammatory bowel disease (IBD) is highly variable, and whether CMV negatively impacts the clinical course is controversial. AIMS: The aim of this study was to determine the prevalence of CMV in patients with active ulcerative colitis (UC) or Crohn's disease (CD) and compare the course of disease in patients with and without CMV. METHODS: Consecutive patients with acute exacerbations of active IBD colitis had immunohistochemistry staining for CMV antigen performed on archived specimens. Clinical features were retrospectively reviewed. RESULTS: Twelve (10%) of 122 UC patients had CMV, and 0/20 patients with CD had CMV. Of 12 UC patients with CMV infection, seven were not taking steroids or immunosuppressives at their index flare. UC patients with CMV were more likely to have leukocytosis (OR = 5.3, 95% CI 1.5-18.2), require hospitalization (OR = 4.9, 95% CI 1.2-19.0), and be hospitalized > or =7 days (OR = 5.0, 95% CI 1.6-21.3) compared to patients without CMV. Of 12 UC patients with CMV, ten (83%) were treated for their index flare with steroids or 6-mercaptopurine. Only one patient (8%) was treated for CMV infection which occurred 14 months after index endoscopy. Over the 6 months after the index flare, UC patients with CMV had a higher frequency of IBD-related hospitalizations compared to patients without CMV (50 vs. 24%, P = 0.021), but none required surgery or died. CONCLUSIONS: The prevalence of CMV with active UC was 10%. Although CMV infection may be a marker of disease severity, our results suggest it does not cause severe morbidity or mortality in a general population of patients with a UC flare.

Foreign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion.

BACKGROUND: Previous reports of foreign-body ingestions focused primarily on accidental ingestions. OBJECTIVE: To describe the characteristics and management of foreign-body ingestions, with predominantly intentional ingestion, in a lower socioeconomic status population. DESIGN: A retrospective case series. SETTING: An urban county hospital. PATIENTS: Patients >/=17 years old, with foreign-body ingestions between 2000 and 2006. MAIN OUTCOME MEASUREMENTS: Characteristics of ingestion cases, endoscopic extraction, need for surgery, and complications. RESULTS: Among 262 cases, 92% were intentional, 85% involved psychiatric patients, and 84% occurred in patients with prior ingestions. The time from ingestion to presentation was >48 hours in 168 cases (64%). The overall success rate for endoscopic extraction was 90% (165/183 cases). Surgery was performed in 30 cases (11%) and was more common for objects beyond the pylorus versus objects above the pylorus (16/43 [37%] vs 10/151 [7%], respectively) and in cases with a greater delay from ingestion to presentation (25/168 [15%] if >48 hours vs 4/77 [5%] if 48 hours vs 14/165 [8%] if

The utility of intraluminal impedance in patients with gastroesophageal reflux disease-like symptoms but normal endoscopy and 24-hour pH testing.

BACKGROUND & AIMS: Fifty percent of patients with gastroesophageal reflux disease-like symptoms and negative endoscopy have negative 24-hour pH testing, suggesting that symptoms are not caused by abnormal esophageal acid exposure. Multichannel intraluminal impedance (MII)-24-hour pH allows the recognition of major acid, minor acid, nonacid, and gas reflux. Recorded symptoms can be correlated with all reflux events (eg, acid, minor acid, nonacid, and gas) and a symptom score can be generated. We aimed to determine whether the Symptom Index (SI) obtained using MII-pH identified an association of symptoms with reflux events in nonclassic acid-reflux disease. METHODS: Thirty-seven patients with heartburn or regurgitation, negative endoscopy, and 24-hour pH were enlisted. Acid suppression was stopped, a 24-hour MII-pH test was performed, and an SI was calculated for major acid reflux alone and for all reflux episodes including major, minor, and nonacid. On this basis patients were divided into 4 groups: (1) standard acid reflux: positive standard pH test; (2) acid sensitive: positive SI for major acid but normal pH test; (3) general reflux: positive SI for major, minor, and nonacid combined, but not for major acid alone; and (4) no reflux: negative SI. RESULTS: Six patients (16%) had standard reflux, 10 patients (27%) had acid-sensitive esophagus, 14 patients (38%) had general reflux, and 7 patients (19%) had a negative SI. CONCLUSIONS: Fifty-seven percent of patients received a diagnosis unachievable with standard pH testing (38% had symptoms associated with general reflux and 19% had no reflux symptom associations). These findings support a potential role for MII-pH testing in this difficult group.

Comparison of renal allograft outcomes in combined liver-kidney transplantation versus subsequent kidney transplantation in liver transplant recipients: Analysis of UNOS Database.

BACKGROUND: There may be an allograft-enhancing effect by the liver on the renal allograft in the setting of simultaneous combined liver-kidney transplantation (CLKT) from the same donor. This study was performed to investigate whether an existing liver allograft could protect a kidney allograft from immunologic injury due to histoincompatibility in liver transplant recipients who received sequential kidney transplantation (KALT). METHODS: Using the United Network for Organ Sharing database covering January 1996 to December 2003, outcomes of 352 KALT were compared to 1,136 CLKT. Incidence of acute and chronic rejection and rejection-free renal graft survival was compared between two groups. RESULTS: Renal half-life of KALT allografts was shorter than CLKT group (6.6+/-0.9 vs. 11.7+/-1.3 years, P < 0.001). Incidence of chronic rejection in KALT group was higher than CLKT group (4.6 vs. 1.2%, P < 0.001). One and three-year rejection-free renal graft survival of KALT and CLKT groups were different (77% and 67% KALT vs. 85% and 78% CLKT, respectively; P < 0.001). Among human leukocyte antigen mismatched and sensitized patients, rejection-free renal graft survival of KALT group was inferior to the CLKT group (75% at 1 year and 61% 3 years vs. 86% at 1 year and 79% 3 years, P < 0.001). CONCLUSION: Liver allograft provided renal graft immunoprotection if both organs are transplanted simultaneously (immunogenetic identity), but not for kidneys transplanted subsequently.

Knowledge and skill acquisition for critical care nursing practice.

In many critical care units, extended orientation or education programs have been offered to prepare the registered nurse to work in this specialty area. Current shortages of nurses and less experienced nurses applying for critical care positions have augmented the need for educational programs. In the Edmonton region, a partnership between two public institutions led to the development and implementation of an innovative educational program. In this article, we describe challenges and strategies to prepare critical care nurses to integrate knowledge, and meet the standards and expectations of both partners. In particular, methods are described to achieve theoretical and clinical outcomes. This article contributes to the discussion and implementation to offer knowledge and skill acquisition for a novice critical care nurse.

Prophylaxis against chemotherapy-induced reactivation of hepatitis B virus infection with Lamivudine.

The results of lamivudine therapy in 4 patients with chemotherapy-induced hepatitis B virus (HBV) reactivation are reported. Cancer chemotherapy-induced reactivation is a known complication in patients with chronic HBV infection or history of HBV infection with recovery. Reactivation of HBV infection has a broad spectrum of manifestations ranging from mild elevation of aminotransferase levels to fatal fulminant hepatitis. Lamivudine is a nucleoside analogue and a potent inhibitor of HBV reverse transcription. The 4 patients treated with lamivudine included 1 woman with breast cancer and 3 men with non-Hodgkin lymphoma, ranging from 41 to 63 years of age. All 4 patients were undergoing standard, multi-agent chemotherapy when they presented with HBV reactivation manifested by sudden onset of fatigue, jaundice, and HBV serology consistent with active HBV infection (detectable serum HBV DNA) in the absence of other known causes of acute hepatitis. Lamivudine therapy (100 mg/d in 3 patients and 150 mg/d in 1 patient) was initiated from 1 to 18 days following the diagnosis of HBV reactivation. All 4 patients showed rapid decrease in aminotransferase levels within 2 weeks after initiating lamivudine therapy. Unfortunately, hepatic synthetic function failed to improve in 2 patients, who both died. The remaining 2 patients had suppression of HBV DNA to undetectable levels after 1 and 4 months of treatment and had biochemical and clinical improvement. The 2 patients who died received lamivudine therapy for 8 days and for 3 weeks. There have been no randomized clinical trials to study the role of lamivudine for prophylaxis or treatment of HBV reactivation associated with chemotherapy. However, based on our limited experience, lamivudine may be efficacious in suppressing potentially fatal HBV reactivation secondary to chemotherapy in patients with chronic HBV infection or prior infection with recovery. Patients who undergo chemotherapy should be screened for the presence of markers of chronic hepatitis B infection or previous HBV infection. We recommend that patients with chronic HBV infection (positive HBV DNA and/or positive HBsAg) or history of HBV infection with recovery (positive hepatitis B core antibody with or without HBsAb) be considered for prophylactic lamivudine use to prevent chemotherapy-induced HBV reactivation.