Epidemiologic factors and urogenital infections associated with preterm birth in a midwestern U.S. population.

OBJECTIVE: To correlate epidemiologic factors with urogenital infections associated with preterm birth. METHODS: Pregnant women were sequentially included from four Wisconsin cohorts: large urban, midsize urban, small city, and rural city. Demographic, clinical, and current pregnancy data were collected. Cervical and urine specimens were analyzed by microscopy, culture, and polymerase chain reaction for potential pathogens. RESULTS: Six hundred seventy-six women were evaluated. Fifty-four (8.0%) had preterm birth: 12.1% (19/157) large urban, 8.8% (15/170) midsize urban, 9.4% (16/171) small city, and 2.3% (4/178) rural city. Associated host factors and infections varied significantly among sites. Urogenital infection rates, especially Mycoplasma hominis and Ureaplasma parvum, were highest at the large urban site. Large urban site, minority ethnicity, multiple infections, and certain historical factors were associated with preterm birth by univariable analysis. By multivariable analysis, preterm birth was associated with prior preterm birth (adjusted odds ratio [aOR] 2.76, 95% confidence interval [CI] 1.27-6.02) and urinary tract infection (aOR 2.62, 95% CI 1.32-519), and negatively associated with provider-assessed good health (aOR 0.42, 95% CI 0.23-0.76) and group B streptococcal infection treatment (surrogate for health care use) (aOR 0.38, 95% CI 0.15-.99). Risk and protective factors were similar for women with birth at less than 35 weeks, and additionally associated with M hominis (aOR 3.6, 95% CI 1.4-9.7). CONCLUSION: These measured differences among sites are consistent with observations that link epidemiologic factors, both environmental and genetic, with minimally pathogenic vaginal bacteria, inducing preterm birth, especially at less than 35 weeks of gestation.

Facilitating critical thinking.

Supporting staff to think effectively is essential to improve clinical systems, decrease errors and sentinel events, and engage staff involvement to refine patient care systems in readiness for new care-delivery models that truly reflect the valued role of the RN. The authors explore practical methods, based on current research and national consulting experience, to facilitate the development of mature critical thinking skills. Assessment tools, a sample agenda for formal presentations, and teaching strategies using behavioral examples that make the important and necessary link of theory to reality are discussed in the form of a critical thinking test as well as a conceptual model for application in problem solving.

Individual and organizational accountability for development of critical thinking.

Advanced abilities to think critically are necessary to improve clinical systems, decrease errors and sentinel events, and engage staff involvement to refine patient care systems. The authors explore practical methods, based on current research, to promote mature critical-thinking skills in healthcare professionals, from patient care clinical judgment to a leadership perspective. Individual and organizational accountabilities for expanding critical thinking skills are investigated, and a problem-solving model is proposed as a coordinated strategy.

Successful restructuring: maximizing training dollars.

Data regarding the cost of staff training associated with restructuring are scarce and incomplete, with little measurement of how staff performed after training. Effectiveness of staff education efforts are hampered by staff resistance to change, dysfunctional interdisciplinary team work, and existing system "glitches." The key criteria for successful education efforts related to restructuring are: development of measurable desired outcomes of training efforts, determination of solution appropriateness and resource needs, the thoughtful timing of interventions, and a high level of ongoing organizational support. Changes in teamwork effectiveness can be measured by examining variances in quality outcomes, timely and appropriate discharge planning, and resource cost measures such as use of overtime and absenteeism. Recommendations for effective use of training dollars include acknowledging resistance and providing forums which permit time (and a process) for re-education.