Skin-to-Skin Therapy on High-Frequency Jet Ventilation: A Trauma-Informed Best Practice.

Objective: To mitigate trauma for infants on high-frequency jet ventilation by decreasing exposure to noise and facilitating skin-to-skin therapy. Design: Key drivers were identified, and we designed and implemented equipment and processes through a series of interventions. A mixed methods evaluation was used. Retrospective chart reviews assessed safety (unplanned extubation) and stability parameters. Semi-structured interviews were conducted to understand parent and staff experiences. Results: Stability parameters demonstrated safe skin-to-skin therapy. Data from the interviews showed that parents and staff experiences focused on safety, connection and healing. Conclusion: Implementing safe processes to support skin-to-skin therapy during high-frequency jet ventilation is possible. We hope other units will be encouraged to examine their current practices for infants on high-frequency jet ventilation to help mitigate trauma for infants and parents while enhancing staff satisfaction.

Patient Perception of Physician Attire in a Military Ophthalmology Clinic.

Introduction The purpose of this study is to investigate patient preferences of physician attire in an outpatient military ophthalmology clinic to determine how these preferences affect patients' perceptions of physician competence and their overall clinical experience. Materials and methods This study is a prospective survey administered to patients at the ophthalmology clinic at Brooke Army Medical Center. USA. Patients who were willing to participate in a volunteer survey were included in this study. Demographic information and survey questions were utilized in this study along with words and pictures for patients to select a preference in physician attire in the clinic setting (scrubs, military uniform, or civilian professional attire) and surgical setting (surgical cap or a surgical bouffant). The survey asks patients if physician attire impacts patient confidence in physician abilities (yes or no) and if surgeon attire impacts the likelihood of the patient taking the surgeon's advice (yes or no). Results The demographic distribution includes 57-77 years old participants (53%), females (61%), retirees (49%), and dependent spouses (40%). The racial distribution includes 46% - Caucasian, 20% - African American, 22% - Hispanic, 6 - % Asian, and 6% - other. Most patient appointment types were established follow-up (77%) with only 12% new and 11% walk-in. The survey results (N=308) indicate that most patients (64%) did not have a preference in physician clinical attire, while 22% preferred scrubs, 11% preferred military uniform, and 3% preferred civilian attire. Most patients (66%) did not have a preference for surgical headwear, while 27% preferred the surgical cap, and 7% preferred the surgical bouffant. Only 9% of the patients surveyed indicated that physician attire impacted their confidence in their physician's ability, and 12% reported that attire impacted the likelihood of taking advice. Conclusions Most patients in an outpatient military ophthalmology clinic do not have a preference for physician attire or surgical headwear when surveyed. The majority of patients did not feel physician attire impacted their perception of physician's ability or their likelihood of taking advice. When indicating a preference, patients tended to prefer scrubs to outpatient civilian attire or military attire and trended towards preferring surgical cap over surgical bouffant for headwear.

Iatrogenic Subclinical Hyperthyroidism Does Not Promote Weight Loss.

OBJECTIVES: Among patients who have undergone total thyroidectomy, do those with thyroid cancer being kept iatrogenically subclinical hyperthyroid (SCH) differ from euthyroid patients in long-term weight change? METHODS: In a retrospective study, medical records identified 291 patients who had undergone a thyroidectomy for differentiated thyroid cancer or benign thyroid disease. Weight, thyroid-stimulating hormone, and levothyroxine dose were measured presurgery and 1, 2, and 3 years postsurgery. RESULTS: Of 291 patients, 147 were in the SCH group and 144 were in the euthyroid group. At all 3 years both groups gained weight from baseline, but the two groups did not differ in weight change from baseline at any time period: year 1 (SCH mean 0.4% ± 6.2% weight gain vs euthyroid group mean 2.2% ± 6.6% weight gain; P = 0.12), year 2 (SCH mean 1.1% ± 9.1% weight gain vs euthyroid mean 2.9% ± 7.8% weight gain; P = 0.22), and year 3 (SCH mean 2.6% ± 9.2% weight gain vs euthyroid mean 3.1% ± 11.1% weight gain; P = 0.49). CONCLUSIONS: Among total thyroidectomy patients, weight change did not differ between SCH patients and euthyroid patients at years 1 through 3. As such, the use of levothyroxine to induce SCH did not lead to long-term weight change when compared with euthyroid patients.

Attitudes toward and use of complementary and alternative medicine among Hispanic and white mothers.

CONTEXT: Complementary and alternative medicine (CAM) use has become more prevalent in the United States. Little is known, however, regarding the ethnic and language differences of mothers as related to their beliefs about and use of CAM. OBJECTIVE: This study intended to examine the differences in CAM beliefs and use in English- and Spanish-speaking Hispanic and white mothers of children undergoing surgery. DESIGN: The research team employed a cross-sectional survey design. SETTING: Mothers were recruited from the Children's Hospital of Orange County (CHOC) in Southern California, and they completed the study's surveys on the day of their children's outpatient surgery. PARTICIPANTS: A total of 206 mothers participated: (1) 42 English-speaking, non-Hispanic white (ESW) women; (2) 92 English-speaking Hispanic (ESH) women; and (3) 72 Spanish-speaking Hispanic (SSH) women. OUTCOME MEASURES: Participants completed (1) the Holistic and Complementary and Alternative Medicine Questionnaire (HCAMQ), which captured beliefs about holistic health measures and about the validity of CAM; and (2) a checklist identifying past and present use of 27 different CAM therapies. RESULTS: The research team analyzed and controlled for demographic differences using linear regression, and the analysis revealed significant group differences in CAM use (P < .0001). ESW mothers and ESH mothers used more CAM than SSH mothers (P = .02). No significant differences were observed between groups for CAM related beliefs. CONCLUSIONS: After controlling for socioeconomic status, the research team found that SSH mothers used less CAM compared to ESH and ESW mothers. Employment of culturally specific measures of CAM use may be necessary to understand fully the differences in CAM use between Spanish- and English-speaking mothers as well as to understand the medical conditions that prompt CAM use.