An Educational Intervention to Improve Patient Outcomes for Colonoscopy.

Bowel prep for inpatient cases are for the most part inadequate. Gastroenterology nurses are ideally situated to recognize the importance of bowel preparation for patients who require a colonoscopy. Unique challenges exist for inpatients who require a colonoscopy preparation as part of their hospitalization. We identified that inpatients scheduled for colonoscopies during their hospitalization were not appropriately prepped, leading to unsuccessful and repeat procedures. We conducted this research study to determine whether an educational intervention would optimize inpatients, bowel preparation and improve the quality of bowel preparation, patient satisfaction, and understanding of bowel preparation. Three months prior to an educational intervention, inpatients who required a colonoscopy completed surveys about their colonoscopy preparation. Then, educational in-services on how to administer bowel preparation were presented to multidisciplinary staff, which included 70% of all registered nurses (RNs). Following the education phase, 40 inpatients were surveyed. We found that patients' perception of education differed if they verbalized a past experience and the highest prep scores were obtained in patients educated by a physician and RN. Our results indicated that an educational intervention targeting inpatient staff improved patient satisfaction, decreased aborted colonoscopies by 22%, and increased Boston Bowel Preparation Scale utilization in 100% of cases. Educating inpatient providers on the necessary preparation protocol improved inpatient care outcomes by decreasing the amount of incomplete and repeat inpatient colonoscopies and therefore may reduce healthcare costs.

Relationship between intimate partner violence and antiretroviral adherence and viral suppression in pregnancy.

OBJECTIVE: To determine whether intimate partner violence (IPV) during pregnancy is associated with increased risk of clinical factors that influence maternal to child transmission (MTCT) of HIV. STUDY DESIGN: Retrospective cohort study of pregnant women living with HIV (WLHIV) who received prenatal care in a multidisciplinary perinatal HIV clinic (2007-2014). All women were assessed for IPV status during pregnancy by a social worker and/or health psychologist. Records were abstracted for obstetric information and factors associated with MTCT of HIV, including antenatal visit attendance, adherence to antiretroviral regimen, time until viral suppression after initiation of antiretroviral medications, HIV RNA at 36 weeks and at delivery, and preterm birth. Women who reported IPV were compared to those who did not using bivariable and multivariable logistic and linear regression analyses. RESULTS: Of 215 women receiving care during the study period, 91.6% (N = 197) had documentation of IPV history. Of these women, 13.7% (N = 27) reported experiencing IPV during pregnancy. Women who reported IPV were less likely to be completely adherent to antiretroviral doses (38.5% vs. 62.0%, p = 0.039) and required significantly more time to achieve stable virologic suppression (16.0 vs. 8.5 weeks, p = 0.010). Time to achieve suppression remained significant in multivariable models (ß 4.68, 95% CI 0.03-9.32). CONCLUSION: IPV during a pregnancy complicated by HIV appears to be associated with decreased antiretroviral adherence. Pregnant WLHIV who reported IPV exhibited delays in achieving virologic suppression. These women represent a vulnerable population who may require additional support and interventions to reduce the risk of MTCT of HIV.

Patterns and Predictors of Sensorineural Hearing Loss in Children With Congenital Diaphragmatic Hernia.

Importance: Although congenital diaphragmatic hernia (CDH) may be associated with sensorineural hearing loss (SNHL), to our knowledge, no studies have yet identified the pattern of this hearing loss or definitive independent risk factors that may place this population at higher risk. Objective: To characterize the type and degree or SNHL in CDH survivors and better characterize perinatal risk factors. Design, Setting, and Participants: This was a retrospective cohort study of CDH survivors who had a pure-tone audiogram available for review followed at a multidisciplinary clinic. Interventions: Treatment for CDH at birth. Main Outcomes and Measures: Audiograms were used to calculate pure-tone average (PTA) for the most severely affected side and classify SNHL as normal (<20 dB), mild (20-39 dB), moderate (>40-59 dB), severe (≥60 dB), or profound (≥80 dB). Clinically significant SNHL was defined as a PTA of at least 40 dB. Perinatal data evaluated included demographics, characteristics of CDH and neonatal respiratory course, peak total and direct bilirubin levels, exposure to ototoxic drugs, need for supplemental oxygen at discharge, and results of newborn hearing screen. Univariate analysis was conducted to examine the relationship between these variables and (1) any SNHL or (2) significant SNHL. Results: Fifty patients were included. Audiograms were performed at age 2.7 ± 2.3 years (range, 0.5-10.7 years). Of the 50 patients, 28 (56%) had any SNHL and 9 of the 28 (32%) had significant SNHL (PTA ≥ 40 dB). Any SNHL was not significantly different (P = .42) by newborn hearing screen results: 5 of 7 children (71%) who failed the screening were classified as having any SNHL, and 20 of 40 children (50%) who passed were classified as having any SNHL. While no variables were significantly associated with any SNHL, multiple significant associations were found with significant SNHL: extracorporeal membrane oxygenation support (P = .02), nonprimary CDH repair (P = .01), prolonged ventilation (≥14 days) (P = .001), and high neonatal furosemide exposure (P = .03). Conclusions and Relevance: Sensorineural hearing loss is prevalent among children with CDH. As would be expected, significant SNHL (PTA ≥ 40 dB) in this cohort was associated with markers of more severe CDH with a more complicated neonatal hospital course. Overall close follow-up for hearing and speech development, including routine audiology testing, is indicated in children with CDH.

Maternal diagnosis of obesity and risk of cerebral palsy in the child.

OBJECTIVE: To examine the association between maternal hospital diagnoses of obesity and risk of cerebral palsy (CP) in the child. STUDY DESIGN: For all California hospital births from 1991-2001, we linked infant and maternal hospitalization discharge abstracts to California Department of Developmental Services records of children receiving services for CP. We identified maternal hospital discharge diagnoses of obesity (International Classification of Diseases, 9th edition 646.1, 278.00, or 278.01) and morbid obesity (International Classification of Diseases, 9th edition 278.01), and performed logistic regression to explore the relationship between maternal obesity diagnoses and CP. RESULTS: Among 6.2 million births, 67 200 (1.1%) mothers were diagnosed with obesity, and 7878 (0.1%) with morbid obesity; 8798 (0.14%) children had CP. A maternal diagnosis of obesity (relative risk [RR] 1.30, 95% CI 1.09-1.55) or morbid obesity (RR 2.70, 95% CI 1.89-3.86) was associated with increased risk of CP. In multivariable analysis adjusting for maternal race, age, education, prenatal care, insurance status, and infant sex, both obesity (OR 1.27, 95% CI 1.06-1.52) and morbid obesity (OR 2.56, 95% CI 1.79-3.66) remained independently associated with CP. On stratified analyses, the association of obesity (RR 1.72, 95% CI 1.25-2.35) or morbid obesity (RR 3.79, 95% CI 2.35-6.10) with CP was only significant among women who were hospitalized prior to the birth admission. Adjusting for potential comorbidities and complications of obesity did not eliminate this association. CONCLUSIONS: Maternal obesity may confer an increased risk of CP in some cases. Further studies are needed to confirm this finding.