scholarly journals Intent to Breastfeed and Evaluation of Culturally Sensitive Education in a Migrant Pacific Islander Population

2019 ◽  
Vol 10 (1) ◽  
pp. 22-28
Author(s):  
Allison Scott ◽  
Kelly Vowell-Johnson ◽  
Cari Addington ◽  
Bentley Snider Adams ◽  
Olivia Pennington
Keyword(s):  
Exclusive Breastfeeding ◽  
Pacific Islander ◽  
Hospital Setting ◽  
The United States ◽  
Culturally Sensitive ◽  
Education Intervention ◽  
Improvement Project ◽  
Breastfeeding Rates ◽  
The Impact ◽  
Pacific Islander Population

BackgroundThe Marshallese, a Pacific Islander population, are a growing migrant population in the United States. Breastfeeding is the preferred method of infant feeding, but many cultural barriers deter exclusive breastfeeding. A culturally sensitive education intervention was implemented to meet the needs of the Marshallese population in a postpartum setting.ObjectiveThis study aimed to evaluate the impact of an education intervention, in native language, on breastfeeding rates among Marshallese mothers during hospitalization.MethodsThis quasi-experimental study was a retrospective data analysis of a quality improvement project in a hospital seeking Baby-Friendly status. Randomized record reviews of Marshallese mothers receiving the culturally targeted education (N = 40) between the ages of 18 and 45, delivering between 37 and 42 weeks gestation, were compared with mothers prior to implementation of the education (N = 40).ResultsBirthweight, discharge weight, and delivery method were not statistically different. No statistical difference existed between feeding intent and discharge feeding behavior.ConclusionExclusive breastfeeding rates among Marshallese mothers are lower than desired. Culturally appropriate breastfeeding education in a hospital setting may not affect feeding patterns, but clarification is needed on cultural definitions of exclusive breastfeeding. Further studies are needed.

scholarly journals Evaluation of the impact of breastfeeding support groups in primary health centres in Andalusia, Spain: a study protocol for a cluster randomized controlled trial (GALMA project)

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Isabel Rodríguez-Gallego ◽  
Fatima Leon-Larios ◽  
Cecilia Ruiz-Ferrón ◽  
Maria-de-las-Mercedes Lomas-Campos
Keyword(s):  
Support Groups ◽  
Exclusive Breastfeeding ◽  
Intervention Group ◽  
World Health ◽  
Control Group ◽  
Breastfeeding Initiation ◽  
Primary Health ◽  
Breastfeeding Rate ◽  
Breastfeeding Rates ◽  
The Impact

Abstract Background In 2003, the World Health Organization recommended exclusive breastfeeding (EB) during the newborn’s first 6 months of life and, if possible, during the first 2 years. However, EB rates resist these recommendations. In developed countries, only 1 out of 3 babies is breastfed during its first 6 months of life, and great differences between areas and countries can be observed. Only 35% of the newborns receive breastfeeding at 3–4 months of age. There are diverse strategies described in the literature that have proven their efficiency in improving breastfeeding rates. It has also been proven that professional support is an effective tool to extend any kind of breastfeeding; besides, it has been observed that mother-to-mother support also increases breastfeeding initiation, sustainment, and exclusive duration. The overall aim of the study is to assess the impact of the support groups on the sustainment of exclusive breastfeeding until 6 months after birth. Methods/design This study is a cluster-random multicentric clinical trial with a control group and an intervention group, without blinding because it is impossible to mask the intervention. A randomization by centres of primary health (clusters) will be carried out. The women allocated to the intervention or control group will be randomized with a simple randomization sampling. The participants’ breastfeeding rate will be followed up at the first 10 days, and at 2, 4, and 6 months of their newborn’s life. Discussion There is a need to assess the impact of mother support groups on exclusive breastfeeding. This study aims to analyse the outcomes related to the support received and to identify what should the structure of these groups be; in other words, to describe factors related to a better breastfeeding experience in order to help women increase breastfeeding rates. Trial registration The trial is prospectively recorded at the ISRCTN registry (Trial ID: ISRCTN17263529). Date recorded: 17/06/2020.

scholarly journals 566. Reduction of Hospital-Onset Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia in an Acute Care Hospital: Impact of Bundles and Universal Decolonization

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S268-S268
Author(s):  
Adriana Jimenez ◽  
Kathleen Sposato ◽  
Alicia de Leon-Sanchez ◽  
Regina Williams ◽  
Reynande Francois ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Acute Care ◽  
Care Facility ◽  
The United States ◽  
Adult Patients ◽  
Care Hospital ◽  
Icu Patients ◽  
Improvement Project ◽  
Contact Precautions ◽  
The Impact

Abstract Background MRSA is a major concern for hospitalized patients in the United States. Hospital-Onset (HO) MRSA bacteremia is used as a proxy measurement of MRSA healthcare acquisition, exposure, and infection burden. HO MRSA bacteremia standardized infection ratio (SIR) is used by several national agencies as a quality report metric. Our institution had more than expected HO MRSA bacteremia cases despite several interventions. We describe the impact of a bundle of interventions aimed to decrease HO MRSA bacteremia in an acute care facility. Methods This quality improvement project was implemented in a 380-bed community hospital in Miami, FL from January 2015 to March 2019. HO MRSA bacteremia was defined as non-duplicate MRSA isolated from a blood culture collected >3 days after admission. SIR was calculated dividing the number of observed events by the number of predicted events; predicted events were obtained from the NHSN report. During baseline period (Figure1 Phase 1 January 2015–August 2016) all adult patients in the intensive care unit (ICU) were screened for MRSA nasal colonization on admission and weekly thereafter, ICU patients received daily Chlorhexidine (CHG) bathing, and colonized/infected patients with MRSA were placed in contact precautions. In Phase 2 (September 2016–June 2017)daily CHG bathing was switched from 2% wipes to 4% soap foam and expanded to all adult patients; ICU patients also received nasal decolonization with mupirocin. Nasal mupirocin in ICU was replaced with alcohol-based nasal sanitizer for all adult units in July 2017 (Phase 3). In April 2017 we discontinued using contact precautions for MRSA patients; nasal surveillance cultures were discontinued in October 2017. In May 2018 (Phase 4) we introduced alcohol-based wipes for patient hand hygiene at the bedside. SIR were compared by exact binomial test. Results We observed 48 HO MRSA bacteremia cases during the study period. The SIR decreased from 3.66 to 0.97 from baseline to postintervention periods (P = 0.003). The largest decrease in cases and SIR was attained using combined hospital-wide daily CHG bathing, alcohol-based nasal sanitizer, and alcohol wipes for patient hand hygiene during Phase 4 (Table 1). Conclusion Our bundle of interventions for universal decolonization was successful in decreasing HO MRSA bacteremia. Disclosures All authors: No reported disclosures.

Effectiveness of Workplace Lactation Interventions on Breastfeeding Outcomes in the United States: An Updated Systematic Review

2018 ◽  
Vol 35 (1) ◽  
pp. 100-113 ◽  
Author(s):  
Julia H. Kim ◽  
Jong C. Shin ◽  
Sharon M. Donovan
Keyword(s):  
United States ◽  
Low Income ◽  
Exclusive Breastfeeding ◽  
Maternity Leave ◽  
The United States ◽  
Breastfeeding Duration ◽  
Breastfeeding Initiation ◽  
White Ethnicity ◽  
Observational Study Design ◽  
The Impact

Background Returning to work is one of the main barriers to breastfeeding duration among working mothers in the United States. However, the impact of workplace lactation programs is unclear. Research Aim The aim of this study was to evaluate the effectiveness of workplace lactation programs in the United States on breastfeeding practices. Methods A systematic search was conducted of seven databases through September 2017. Articles ( N = 10) meeting the inclusion criteria of describing a workplace lactation intervention and evaluation in the United States and measuring initiation, exclusivity, or duration using an experimental or observational study design were critically evaluated. Two reviewers conducted quality assessments and reviewed the full-text articles during the analysis. Results Common services provided were breast pumps, social support, lactation rooms, and breastfeeding classes. Breastfeeding initiation was very high, ranging from 87% to 98%. Several factors were significantly associated with duration of exclusive breastfeeding: (a) receiving a breast pump for one year (8.3 versus 4.7 months), (b) return-to-work consultations (40% versus 17% at 6 months), and (c) telephone support (42% versus 15% at 6 months). Each additional service (except prenatal education) dose-dependently increased exclusively breastfeeding at 6 months. Sociodemographic information including older maternal age, working part-time, longer maternity leave, and white ethnicity were associated with longer breastfeeding duration. Conclusion Workplace lactation interventions increased breastfeeding initiation, duration, and exclusive breastfeeding, with greater changes observed with more available services. More evidence is needed on the impact of workplace support in low-income populations, and the cost-effectiveness of these programs in reducing health care costs.

scholarly journals The Burden of Antimicrobial Resistance among Urinary Tract Isolates of Escherichia coli in the United States in 2017

2019 ◽  
Author(s):  
Ian A Critchley ◽  
Nicole Cotroneo ◽  
Michael J Pucci ◽  
Rodrigo Mendes
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Hospital Setting ◽  
Clonal Expansion ◽  
The United States ◽  
Cross Resistance ◽  
E Coli ◽  
Oral Agents ◽  
Tract Infections ◽  
The Impact

AbstractUrinary tract infections (UTIs) caused by Escherichia coli have been historically managed with oral antibiotics including the cephalosporins, fluoroquinolones and trimethoprim-sulfamethoxazole. The use of these agents is being compromised by the increase in extended spectrum β-lactamase (ESBL)-producing organisms, mostly caused by the emergence and clonal expansion of E. coli multilocus sequence typing (ST) 131. In addition, ESBL isolates show co-resistance to many of oral agents. Management of UTIs caused by ESBL and fluoroquinolone-resistant organisms is becoming increasingly challenging to treat outside of the hospital setting with clinicians having to resort to intravenous agents. The aim of this study was to assess the prevalence of ESBL phenotypes and genotypes among UTI isolates of E. coli collected in the US during 2017 as well as the impact of co-resistance to oral agents such as the fluoroquinolones and trimethoprim-sulfamethoxazole. The national prevalence of ESBL phenotypes of E. coli was 15.7% and was geographically distributed across all nine Census regions. Levofloxacin and trimethoprim-sulfamethoxazole-resistance rates were ≥ 24% among all isolates and this co-resistance phenotype was considerably higher among isolates showing an ESBL phenotype (≥ 59.2%) and carrying blaCTX-M-15 (≥ 69.5%). The agents with the highest potency against UTI isolates of E. coli, including ESBL isolates showing cross-resistance across oral agents, were the intravenous carbapenems. The results of this study indicate that new oral options with the spectrum and potency similar to the intravenous carbapenems would address a significant unmet need for the treatment of UTIs in an era of emergence and clonal expansion of ESBL isolates resistant to several classes of antimicrobial agents, including oral options.

scholarly journals In-hospital mortality trends among patients with idiopathic pulmonary fibrosis in the United States between 2013-2017: a comparison of academic and non-academic programs.

2020 ◽  
Author(s):  
Shehabaldin Alqalyoobi ◽  
MD Evans R. Fernández Pérez ◽  
MD Justin M. Oldham
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Pulmonary Fibrosis ◽  
Hospital Mortality ◽  
Treatment Guidelines ◽  
Hospital Setting ◽  
The United States ◽  
Academic Hospital ◽  
Mortality Trends ◽  
The Impact

Abstract BackgroundIdiopathic pulmonary fibrosis (IPF) is a devastating condition characterized by progressive lung function decline and early mortality. While early accurate diagnosis is essential for IPF treatment, data evaluating the impact of hospital academic status on IPF-related mortality remains limited. Here we examined in-hospital mortality trends for patients with IPF from 2013-2017. We hypothesized that in-hospital IPF mortality would be influenced by hospital academic setting.MethodsHospitalization data was extracted from the National Inpatient Sample (NIS) for subjects with an international classification of disease code for IPF. In-hospital mortality stratified by hospital setting (academic versus non-academic) was the primary outcome of interest, with secondary analyses performed for subgroups with and without respiratory failure and requiring mechanical ventilation. Predictors of mortality were then assessed.ResultsAmong 93,680 patients with IPF requiring hospitalization, 58,450 (62.4%) were admitted to academic institutions. In-hospital mortality decreased significantly in those admitted to an academic hospital (p<0.001) but remained unchanged in patients admitted to a non-academic hospital. A plateau in-hospital mortality was observed among all hospitalized patients (p=0.12), with a significant decrease observed for patients with admitted respiratory failure (p<0.001) and those placed on mechanic ventilation (p<0.001).ConclusionIn-hospital mortality decreased significantly for patients with IPF admitted to an academic hospital, suggesting that management strategies may differ by hospital setting. Mortality among those with respiratory failure and those requiring mechanical ventilation has dropped significantly. Our findings underscore the importance of promoting early referral to an academic institution and adherence to international treatment guidelines.

Abstract 16538: The Impact of Institutional Design on Transcatheter Aortic Valve Replacement Complication Rates in the United States

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Sadip Pant ◽  
Samir Patel ◽  
Harsh Golwala ◽  
Nilesh Patel ◽  
Apurva Badheka ◽  
...  
Keyword(s):  
United States ◽  
Heart Surgery ◽  
Institutional Design ◽  
Open Heart Surgery ◽  
Hospital Setting ◽  
The United States ◽  
Hospital Inpatient ◽  
Complication Rates ◽  
Hospital Size ◽  
The Impact

Introduction: With the technical advancements and expanding indications, utilization of TAVR is on the rise among various institutions in the United States .While appropriate patient selection and better techniques are essential to improving outcomes, the impact of institutional design (or hospital setting) on outcomes with TAVR has yet to be examined. Objective: The objective of our study is to compare TAVR complication rates among teaching vs non-teaching centers in the United States Methods: We used Healthcare Cost and Utilization Project - National Inpatient Sample (NIS) data , the largest all payer database of hospital inpatient stay available in United States, to identify patients (age ≥18 years) who underwent TAVR from Jan-Dec 2012. We constructed multivariable models to determine independent predictors (age, sex, race, Charlson’s comorbidity index, hospital size, hospital location and TAVR approach) of TAVR-associated complications. Statistical analysis was performed using Stata IC 11.0 (Stata-Corp, College Station, TX). Results: We identified 7,405 TAVR procedures performed in the United States in 2012. 88% of TAVR were performed in teaching centers. There was no difference in mortality following TAVR between teaching and non-teaching centers. The occurrence of any in-hospital complication was lower in teaching centers as compared to non-teaching centers (42% vs. 50%, p<0.001). Rates of individual complications in teaching vs. non-teaching centers are illustrated in the figure. In adjusted analysis, hemorrhage requiring transfusion (13.2% vs. 20.8%, p<0.001), renal complications requiring dialysis (1.2% vs. 2.3%, p=0.009), respiratory complications (7.5% vs. 11%, p<0.001) and complications requiring open-heart surgery (2% vs. 4.6%, p<0.001) were lower in teaching centers as compared to non-teaching centers. Vascular access site complications, pacemaker insertion, pericardial and neurological complications were similar between teaching and non-teaching centers (Figure). Conclusion: Institutional design impacts TAVR complication rates albeit no difference in mortality. In general, complication rates are lower in teaching centers compared to non-teaching centers.

Abstract 185: Declining Subarachnoid Hemorrhage Case-Fatality Rates in a Population

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jason Mackey ◽  
Kathleen Alwell ◽  
Jane C Khoury ◽  
Charles J Moomaw ◽  
Matthew L Flaherty ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Hospital Setting ◽  
Case Fatality ◽  
The United States ◽  
Population Based ◽  
Day Case ◽  
Physician Review ◽  
Time Period ◽  
Medical Advances ◽  
The Impact

Introduction: In the last few decades there have been several medical advances in the care of patients with subarachnoid hemorrhage (SAH). But few population-based studies (and none in the United States) have examined outcomes in the same population over time. Methods: All SAHs among residents of the Greater Cincinnati/Northern Kentucky (GCNK) region at least 20 years of age were identified using ICD-9 codes 430-436 and verified via study physician review in four distinct study periods. An incidence rate for each time period was calculated. Baseline characteristics, including demographics, risk factors, and functional status, were ascertained, along with hospital discharge modified Rankin score and all-cause 30- and 90-day case-fatality. Results: We identified 78 SAHs among residents of the GCNK region in 1988, 85 from 7/1993 to 6/1994, 95 in 1999, and 91 in 2005. The incidence of SAH in the four study periods (age-, race-, and sex-adjusted to the 2000 US population) was 9.4, 9.3, 10.0, and 9.0 per 100,000, respectively. Of the 349 SAHs in the study periods, 326 were diagnosed in an ED or hospital setting, while 23 were diagnosed on autopsy alone. All-cause 30- and 90-day case-fatality rates declined significantly from 1988 to 2005 ( Table ), even when all autopsy-alone cases were excluded. Conclusions: While the incidence of SAH remained stable in this population-based region, the 30-day and 90-day case-fatality rates declined significantly. Advances in surgical and medical management, along with systems-based changes such as the emergence of neurocritical care units, have likely led to reduced case-fatality. Future studies should explore the impact of specific factors related to improved case-fatality rates.

scholarly journals Promotion of Exclusive Breastfeeding in a Clinic Setting Did Not Increase Its Rates

2015 ◽  
Vol 6 (1) ◽  
pp. 40-44
Author(s):  
Allison L. Scott ◽  
Marie-Rachelle Narcisse ◽  
Lyla Lindholm
Keyword(s):  
Quality Improvement ◽  
Exclusive Breastfeeding ◽  
Infant Health ◽  
Quality Improvement Intervention ◽  
Education Intervention ◽  
Protective Effects ◽  
Care Clinic ◽  
Beneficial Effects ◽  
Breastfeeding Education ◽  
Breastfeeding Rates

Breastfeeding is known to have many protective effects on childhood health. Breastfeeding without supplementation or complementary foods until 6 months of age is inversely related to several health problems, including childhood obesity. Because of the known beneficial effects on infant health of breastfeeding, education on breastfeeding may impact exclusive breastfeeding rates, resulting in improved infant health status. This retrospective study, using Pender’s health promotion model and the theory of planned behavior (Pender, Murdaugh, & Parsons, 2011), explored the effect of a breastfeeding education intervention for quality improvement in an ambulatory care clinic on the rate of exclusive breastfeeding during the first 4 months of infancy, or short-term exclusive breastfeeding. Exclusive breastfeeding rates were measured after the 4-month well exam, which represents the time of the existence of the quality improvement intervention for 4–5 months. The expected outcome was a minimum 15% increase in exclusive breastfeeding rates in the participants who received the educational program as compared to the individuals who did not receive the breastfeeding education intervention. Contrary to expectations, the group receiving standard care had significantly higher rates of exclusive breastfeeding than those receiving the intervention.

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