Well-Child Care Redesign: A Mixed Methods Analysis of Parent Experiences in the PARENT Trial.

BACKGROUND: Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), is a well-child care (WCC) model that has demonstrated effectiveness in improving the receipt of comprehensive WCC services and reducing emergency department utilization for children aged 0 to 3 in low-income communities. PARENT relies on a health educator ("parent coach") to provide WCC services; it utilizes a Web-based previsit prioritization/screening tool (Well-Visit Planner) and an automated text message reminder/education service. We sought to assess intervention feasibility and acceptability among PARENT trial intervention participants. METHODS: Intervention parents completed a survey after a 12-month study period; a 26% random sample of them were invited to participate in a qualitative interview. Interviews were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis; survey responses were analyzed using bivariate methods. RESULTS: A total of 115 intervention participants completed the 12-month survey; 30 completed a qualitative interview. Nearly all intervention participants reported meeting with the coach, found her helpful, and would recommend continuing coach-led well visits (97-99%). Parents built trusting relationships with the coach and viewed her as a distinct and important part of their WCC team. They reported that PARENT well visits more efficiently used in-clinic time and were comprehensive and family centered. Most used the Well-Visit Planner (87%), and found it easy to use (94%); a minority completed it at home before the visit (18%). Sixty-two percent reported using the text message service; most reported it as a helpful source of new information and a reinforcement of information discussed during visits. CONCLUSIONS: A parent coach-led intervention for WCC for young children is a model of WCC delivery that is both acceptable and feasible to parents in a low-income urban population.

A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial.

OBJECTIVE: The goal of this study was to examine the effects of a new model for well-child care (WCC), the Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), on WCC quality and health care utilization among low-income families. METHODS: PARENT includes 4 elements designed by using a stakeholder-engaged process: (1) a parent coach (ie, health educator) to provide anticipatory guidance, psychosocial screening and referral, and developmental/behavioral guidance and screening at each well-visit; (2) a Web-based tool for previsit screening; (3) an automated text message service to provide periodic, age-specific health messages to families; and (4) a brief, problem-focused encounter with the pediatric clinician. The Promoting Healthy Development Survey-PLUS was used to assess receipt of recommended WCC services at 12 months' postenrollment. Intervention effects were examined by using bivariate analyses. RESULTS: A total of 251 parents with a child aged ≤12 months were randomized to receive either the control (usual WCC) or the intervention (PARENT); 90% completed the 12-month assessment. Mean child age at enrollment was 4.5 months; 64% had an annual household income less than $20,000. Baseline characteristics for the intervention and control groups were similar. Intervention parents scored higher on all preventive care measures (anticipatory guidance, health information, psychosocial assessment, developmental screening, and parental developmental/behavioral concerns addressed) and experiences of care measures (family-centeredness, helpfulness, and overall rating of care). Fifty-two percent fewer intervention children had ≥2 emergency department visits over the 12-month period. There were no significant differences in WCC or sick visits/urgent care utilization. CONCLUSIONS: A parent coach-led model for WCC may improve the receipt of comprehensive WCC for low-income families, and it may potentially lead to cost savings by reducing emergency department utilization.

[Rates of caesarean sections tn two types of private hospitals: restriced-access and open-access]. / Tasa de cesáreas en dos hospitales privados con normativas diferentes: abierto y cerrado.

BACKGROUND: In recent years, rising rates of caesarean section are of concern in the medical community in many countries, especially in Latin America. OBJECTIVE: Determine if there is a difference in the rate of Caesarean sections in a restricted-access hospital (HC) and an open-access hospital (HA) using the Robson classification to explain potential differences. MATERIAL AND METHOD: A prospective cohort study was conducted. This in volved all patients that attended the obstetrics sector in the two hospitals in Buenos Aires where they gave birth between 1 June 2009 and 25h January 2010. The open-access hospital is open to doctors with varying professional training and differing clinical practice. The restricted-access hospital, on the other hand, can only be attended by specified doctors with certain professional training; their medical) conduct is based on service standards and clinical practice. RESULTS: Over the study period 762 patients who fulfilled the study criteria were included from the open-access hospital and 768 from the restricted-access hospital. The global rate of caesarean sections in the HAwas 53.5%, and 48.7% in the HC, RR 1.09 (CI 0.99-1.21) a difference that was not statistically significant (p = 0.058). The onset of spontaneous labour in the HAwas significantly more than in the HC (74.9% vs. 41.8%) RR 2.66 (CU.98-3.57). The induced labour was significantly lower in HA (9,7% vs. 28,3%); RR 0.34 (CI 0.27-0.44). Elective caesarean sections were significantly lower in the HA (15.3% vs. 29.9%) RR 0.51 (CI 0.42-0.62). CONCLUSION: This study reveals a similar rate of caesarean sections in two private hospitals with different systems of care. However, it observed that the HA has a greater tendency to operate on patients at the onset of spontaneous labour and the HC has a greater number of induced labour and elective caesarean section.

Miotonía de Thomsen y embarazo, manejo anestésico: reporte de un caso / Myotonia of Thomsen and pregnancy, anesthetic management: a case report

La miotonía de Thomsen es una enfermedad autosómica dominante que consiste en una marcada hipertrofia muscular a predominio en miembros superiores, que se encuentra asociada a una alteración en los canales de cloruro que intervienen en el potencial de acción del músculo esquelético, dicha enfermedad ha sido vinculada con complicaciones anestésicas como episodios de hipertermia maligna. Se presenta el caso de una paciente de 20 años, IIG, IC, con embarazo de 38 semanas, y diagnóstico de miopatía de Thomsen para resolución obstétrica electiva por vía alta. Se discuten los aspectos clínicos de la enfermedad y su manejo anestésico

Thomsen myotonia is a autosomal dominant disease which consists in marked muscular hypertrophy with dominance in the upper limbs associated with disturbance in the chloride channels involved in the skeletal muscle action potential. This disease has been linked with anesthetic complications such as malignant hyperthermia episodes. Is a patient of 20 years old, IIG, IC, with 38 weeks pregnancy, and diagnosis of myopathy of Thomsen for elective obstetrical resolution by cesarean section. The clinical aspects of the disease and its anaesthetic management are discussed

Ruptura prematura de membranas / Premature rupture of membranes

Este artículo pretende destacar la importancia de las intervenciones de enfermería en pacientes que presentan Ruptura Prematura de Membranas. Se subraya la función que cumple el Líquido Amniótico en la prevención de infecciones y en la amenaza de parto prematuro. Estas acciones están dirigidas a favorecer la evolución del embarazo, conservando la salud de la paciente y la vida del feto.

Performance characterization of an insulator-based dielectrophoretic microdevice.

Dielectrophoresis (DEP), the motion of particles in nonuniform electric fields, is a nondestructive electrokinetic (EK) transport mechanism can be used to concentrate and separate bioparticles. Traditionally, DEP has been performed employing microelectrodes, an approach that is expensive due to the cost of microelectrode fabrication. An alternative is insulator-based DEP (iDEP), an inexpensive method where nonuniform electric fields are created with arrays of insulating structures. This study presents the effects of operating conditions on the dielectrophoretic behavior of polystyrene microparticles under iDEP. Experiments were performed employing microchannels containing insulating structures that worked as insulators. The parameters varied were pH (8-9) and conductivity (25-100 microS/cm) of the bulk medium, and the magnitude of the applied field (200-850 V/cm). Optimal operating conditions in terms of pH and conductivity were obtained, and the microdevice performance was characterized in terms of concentration factor and minimum electric field required (minimum energy consumption). This is the first report on improving iDEP processes when EOF is present. DEP and EOF have been studied extensively, however, this study integrates the effect of suspending medium characteristics on both EK phenomena. These findings will allow improving the performance of iDEP microdevices achieving the highest concentration fold with the lowest energy consumption.

Protein manipulation with insulator-based dielectrophoresis and direct current electric fields.

The present study demonstrates the manipulation of protein particles employing insulator-based dielectrophoresis (iDEP) and direct current (d.c.) electric fields. Fluorescently labeled bovine serum albumin (BSA) protein particles were concentrated inside a microchannel that contained an array of glass cylindrical insulating structures. d.c. electric fields were applied and the dielectrophoretic response of the particles was observed as a function of the suspending medium conductivity (25, 50 and 100 microS/cm) and pH (8 and 9). It was shown that the magnitude of the applied electric field (700-1600 V/cm) and suspending medium properties have a strong effect on the dielectrophoretic response of the protein particles. The results presented here are the first report on protein manipulation employing d.c.-iDEP.