Breastfeeding Motivation Predicts Infant Feeding Intention and Outcomes: Evaluation of a Novel Adaptation of the Treatment Self-Regulation Questionnaire

Background: Identifying those at risk for suboptimal breastfeeding outcomes remains critical for improving maternal and child health. Prenatal breastfeeding motivation may be a key predictor useful for identifying those who would benefit from additional breastfeeding support. Research Aims: To (1) validate a breastfeeding-specific adaptation of the Treatment Self-Regulation Questionnaire (TSRQ-BF); and (2) determine if breastfeeding motivation predicts prenatal breastfeeding intentions and early breastfeeding outcomes. Methods: Participants in their third trimester of pregnancy ( N = 150) completed several instruments, including the TSRQ-BF and infant feeding intention, and could opt to participate in an assessment of early breastfeeding outcomes (by medical record review). TSRQ-BF subscales were derived from factor analysis, and multivariable regression was used to evaluate the association between TSRQ-BF subscale scores and breastfeeding intention and outcomes during the birth hospitalization. Results: Autonomous (related to personal values/beliefs regarding self) and Autonomous-Baby (values/benefits for the infant) subscale scores were positively associated with intended exclusivity (aOR [95% CI]: 2.22 [1.57, 3.30], 4.94 [2.49, 11.07], respectively) while higher scores on these subscales predicted longer time to planned cessation (aHR [95% CI]: 0.72 [0.61, 0.84],0.52 [0.34, 0.81]). Higher Amotivation (lack of motivation) scores were negatively associated with intended exclusivity (0.45 [0.26, 0.74]). Higher scores on Autonomous, Autonomous-Baby, and Controlled (avoidance of negative feelings/punishment or gaining reward) subscales were associated with greater odds of hospital exclusivity (aOR [95% CI]: 3.39 [1.75, 8.00], 3.44 [1.66, 9.04] and 6.05 [1.88, 29.04]) and lower odds of 2-day formula supplementation (aOR [95% CI]: 0.31 [0.14, 0.59],0.28 [0.11, 0.59], 0.19 [0.04, 0.62]). Conclusions: The TSRQ-BF predicted breastfeeding intent and outcomes, and may be helpful for identifying patients at risk for suboptimal breastfeeding outcomes before delivery.

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Identifying patients at risk of futile resuscitation: palliative care indicators in out-of-hospital cardiac arrest

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-001828 ◽

2019 ◽

pp. bmjspcare-2019-001828

Author(s):

Mia Cokljat ◽

Adam Lloyd ◽

Scott Clarke ◽

Anna Crawford ◽

Gareth Clegg

Keyword(s):

At Risk ◽

Palliative Care ◽

Cardiac Arrest ◽

High Risk ◽

Low Risk ◽

Intermediate Risk ◽

Patients At Risk ◽

Risk Patients ◽

Record Review ◽

Hospital Cardiac Arrest

ObjectivesPatients with indicators for palliative care, such as those with advanced life-limiting conditions, are at risk of futile cardiopulmonary resuscitation (CPR) if they suffer out-of-hospital cardiac arrest (OHCA). Patients at risk of futile CPR could benefit from anticipatory care planning (ACP); however, the proportion of OHCA patients with indicators for palliative care is unknown. This study quantifies the extent of palliative care indicators and risk of CPR futility in OHCA patients.MethodsA retrospective medical record review was performed on all OHCA patients presenting to an emergency department (ED) in Edinburgh, Scotland in 2015. The risk of CPR futility was stratified using the Supportive and Palliative Care Indicators Tool. Patients with 0–2 indicators had a ‘low risk’ of futile CPR; 3–4 indicators had an ‘intermediate risk’; 5+ indicators had a ‘high risk’.ResultsOf the 283 OHCA patients, 12.4% (35) had a high risk of futile CPR, while 16.3% (46) had an intermediate risk and 71.4% (202) had a low risk. 84.0% (68) of intermediate-to-high risk patients were pronounced dead in the ED or ED step-down ward; only 2.5% (2) of these patients survived to discharge.ConclusionsUp to 30% of OHCA patients are being subjected to advanced resuscitation despite having at least three indicators for palliative care. More than 80% of patients with an intermediate-to-high risk of CPR futility are dying soon after conveyance to hospital, suggesting that ACP can benefit some OHCA patients. This study recommends optimising emergency treatment planning to help reduce inappropriate CPR attempts.

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Breastfeeding Intention Versus Outcomes at Two to Three Weeks Postpartum

Clinical Lactation ◽

10.1891/2158-0782.10.1.17 ◽

2019 ◽

Vol 10 (1) ◽

pp. 17-21

Author(s):

Miranda Rouse ◽

Debi Page Ferrarello

Keyword(s):

Infant Feeding ◽

Breastfeeding Initiation ◽

Breastfeeding Support ◽

Convenience Sample ◽

Breastfeeding Intention ◽

Breastfeeding Education ◽

National Public Health ◽

Healthy People 2020 ◽

Telephone Calls ◽

Hospital Practices

Breastfeeding is the optimal nutrition for infants, offering protection from many illnesses for both infant and mother. While breastfeeding initiation rates approach or exceed Healthy People 2020 goals, increasing duration remains a national public health priority. Hospital practices play an important role. An urban, academic hospital in the northeast United States with Baby-Friendly designation initiated a quality improvement (QI) project to learn how infant feeding outcomes at 2–3 weeks postpartum compare to initial breastfeeding intention. A lactation student made telephone calls to a convenience sample of breastfeeding mothers, questioning them about their current infant feeding practices and the breastfeeding support they received. The women participating in this QI project were those deemed most likely to meet their infant feeding goals. All the women gave birth in a Baby-Friendly facility, thus all their nurses had at least 20 hours of breastfeeding education, all medical providers had had at least 3 hours of breastfeeding education, and IBCLCs were available to inpatients 7 days a week. All were encouraged to call the hospital's Breastfeeding Warmline and were provided with a list of outpatient resources. However, just2–3 weeks postpartum, one-third were not exclusively breastfeeding despite their initial intention.

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