Establishment of a low birth weight registry and initial outcomes.

The study was conducted to evaluate a regional, prospective database of information on mothers of low birth weight (LBW) infants. The database informs on unidentified or under-reported modifiable risk factors from which evidence-based, targeted community intervention strategies could be designed to lower the rate of low birth weight in the region. The LBW Registry is based on informed consent, a semi-structured face-to-face (FTF) interview with the mother of the newborn LBW infant, medical record review, and birth certificate worksheet data collection. Descriptive statistics were used to summarize data from the registry. High rates of modifiable risk factors among mothers of low birth weight infants (October 2007-October 2008) include smoking (44%), alcohol consumption (16%), and drug abuse (14%). Preconception vitamin use was low (34%). The reported use of fertility drugs in FTF interviews was notably higher than information reported on the birth certificate worksheets by the same set of interviewed mothers (5.4 vs. 1.5%), as was alcohol use during pregnancy (16 vs. 1.3%). More than half (52%) of the mothers of low birth weight infants reported a vaginal or urinary tract infection during pregnancy. Additionally there were higher than average rates of unmarried mothers (62%), unintended pregnancies (67%), and Medicaid beneficiaries (57%). Mothers repeatedly expressed excessive demands in their lives, straining their coping abilities and resources. The LBW Registry provides expanded local data on potentially modifiable risk factors to aid in designing targeted prevention and intervention strategies.

Oral contraceptives and DDAVP nasal spray: patterns of use in managing vWD-associated menorrhagia: a single-institution study.

The purpose of this study was to examine patterns of use for oral contraceptive and desmopressin acetate nasal spray, both used in managing menorrhagia in adolescents with von Willebrand disease (vWD). Hospital records of adolescents with documented vWD and menorrhagia were reviewed retrospectively. Subjects with vWD type 1 (n = 36) administered either oral contraceptives (OC) or intranasal desmopressin acetate (DDAVP) and followed from 6 months to 4 years were selected for inclusion. Treatment outcomes were examined with respect to effectiveness and safety. Assessing menstrual blood loss using PBAC scores from pretreatment and treatment periods determined effectiveness. Safety was evaluated by monitoring reported adverse events. No significant differences were identified in treatment effectiveness for controlling menorrhagia in vWD adolescents in the OC and intranasal DDAVP group comparisons: 86% versus 77% (P > 0.05), respectively. When combining both treatment groups, the majority of vWD adolescents, 81% (P > 0.05), experienced alleviation of menorrhagia symptoms. Treatment failures were attributed to either the inability of a regimen to control bleeding or to adverse events, including severe headaches and flushing with DDAVP. Safety outcomes were not significantly greater in vWD patients with menorrhagia when OC were compared with intranasal DDAVP. Both medical approaches, OC and DDAVP nasal spray, used in managing menorrhagia in adolescents with documented type I vWD were well tolerated and showed equivalent effectiveness, and no serious adverse events were reported.

Organizational dimensions of hospital nursing practice: longitudinal results.

Assessment of nurses' perceptions regarding key aspects of their work environment informs nurse administrators and helps keep a finger on the organizational pulse so that they can plan effectively for staffing needs and quality care. Longitudinal assessment of nurses' perceptions of the realities of the work environment is even more critical to inform nurse administrators for decision making and planning, especially during turbulent times. The authors report on a hospital's experience in selecting, evaluating, and, at times, discarding instruments to attain the best information on their nurses' perceptions regarding their work environment. These longitudinal findings can help nurse administrators design a more positive work environment for their nurses.

Comparison of cryopreserved sperm in vaporous and liquid nitrogen.

OBJECTIVE: To evaluate the feasibility of using the vaporous phase of liquid nitrogen as a storage medium for human semen samples. STUDY DESIGN: Human semen samples were used in a 2-armed study. In the first arm, semen samples were rapidly frozen and randomly assigned to storage in either liquid nitrogen (-196 degrees C) or vapor-phase nitrogen (-189 degrees C). In the second arm, sperm specimens were frozen in a controlled, stepwise process and randomly assigned to storage in either the vaporous or liquid phase of liquid nitrogen. The samples were subsequently thawed and analyzed for sperm viability. RESULTS: The rapid freezing technique demonstrated no differences in the examined viability parameters between semen specimens stored in either liquid or vaporous nitrogen. Similarly, semen samples prepared by the slower, controlled freezing process also showed no differences in viability parameters after storage in either the liquid or vaporous phase of liquid nitrogen. The rapid freezing technique was equal to the slow, controlled freezing method in terms of preserving the integrity of the sperm when the specimens were subsequently stored in either liquid or vaporous nitrogen. CONCLUSION: Cryopreservation of human semen in the vapor phase of nitrogen is a viable alternative to storage in liquid-phase nitrogen.