Utilization of Mental Health Services Within 1 Year of Delivery among Different Language Groups.

OBJECTIVES: Cultural differences can affect postpartum mental health disorders and the utilization of mental health services. We compared women speaking English, Spanish, Russian, and Urdu/Bengali/Punjabi from postpartum through 1 year after delivery. METHODS: This was a retrospective study of 3478 pregnant women from a public hospital in New York City. The primary outcome was a composite outcome of the presence of any of the following: diagnosis of depressive disorder, diagnosis of anxiety disorder, visit to a behavioral health service provider, and/or psychiatric admission. The secondary outcome was healthcare provider referral to a behavioral health service provider. RESULTS: Languages spoken were English (n = 1881), Spanish (n = 694), Russian (n = 600), and Urdu/Bengali/Punjabi (n = 303). The language groups differed significantly (P = 0.02) for the composite outcome, with English having the greatest percentage (3.5%) and Russian the lowest percentage (1.2%). The language groups significantly differed for referral to behavioral health (P = 0.04), with Spanish having the greatest percentage (1.6%) and Russian the lowest percentage (0.2%). Anxiety disorder history (odds ratio [OR] 10.43, 95% confidence interval [CI] 4.75-22.91, P < 0.001) and psychiatric disorder history (OR 5.26, 95% CI 2.13-8.49, P < 0.001) were each significantly associated with increased odds for the composite outcome. Anxiety disorder history (OR 6.42, 95% CI 1.92-21.45, P = 0.003) and elevated depressive symptoms (OR 4.92, 95% CI 2.04-11.83, P < 0.001) each were significantly associated with increased odds for referral to behavioral health. CONCLUSIONS: Russian language was associated with lower utilization of mental health services postpartum. These findings can help clinicians determine among postpartum women who will be affected with mental health concerns and who will seek treatment for mental health concerns.

Improving Critical Value Read-Back Failure Rate by Modifying the Notification Procedure.

OBJECTIVES: The aim of the study was to determine whether a system process change improved successful read-back of critical values by the appropriate provider. METHODS: The study implemented a system process change of switching the "first call" physician from the admitting physician to the most recent document writer. Data were compared before (N = 301) and after the intervention (N = 201). Predictor variables included patient factors, physician factors, and environmental factors. The outcome variables measured were successful read-back within 5 and 30 minutes. RESULTS: Read-back failure within 5 minutes was significantly reduced (P < 0.001) from preintervention (49.5%) to postintervention (31.3%). Multivariate logistic regression showed reduced odds for read-back failure postintervention (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.31-0.67, P < 0.001) and increased odds for read-back failure for patients of Hispanic race/ethnicity (OR 1.77, 95% CI 1.09-2.89, P < 0.05). Read-back failure within 30 minutes did not significantly change. Multivariate logistic regression showed that an increased number of telephone calls were associated with an increased odds for read-back failure (OR 3.12, 95% CI 2.13-4.57, P < 0.001). CONCLUSIONS: We recommend the use of the physician who has most recently engaged with the patient as documented in the medical record for the daily note as the primary source of contact for reporting critical values.

The utility of systemic inflammatory response syndrome (SIRS) for diagnosing sepsis in the immediate postpartum period.

BACKGROUND: The systemic inflammatory response syndrome (SIRS) and sepsis definitions were developed to improve the ability for early detection of infection and sepsis. We studied the incidence of immediate postpartum SIRS and sepsis. We further studied immediate postpartum SIRS as a potential predictor for immediate postpartum sepsis. METHODS: This was a retrospective study of 638 immediate postpartum women who delivered either vaginally or by cesarean section. Multivariate logistic regression was used for statistical analysis. Predictor variables included demographic, labor and delivery, and SIRS variables to determine their association with acute immediate postpartum sepsis. RESULTS: We found that 72.10% of vital signs of immediate postpartum women met SIRS criteria while only 1.25% had sepsis. Both preterm gestational age of <37 weeks (OR:19.09, 95% CI:4.13, 88.36, p < 0.001) and only one of the four SIRS criteria of abnormal temperature (OR:25.90, 95% CI: 3.17, 211.52, p = 0.002) were each significantly associated with increased odds for sepsis. CONCLUSION: Our findings suggest that immediate postpartum SIRS is not useful for the identification of immediate postpartum sepsis. Furthermore, SIRS does not appear to be a useful screening tool for infection and sepsis in the immediate postpartum period.

Characteristics associated with postoperative diagnosis of adenomyosis or combined adenomyosis with fibroids.

OBJECTIVE: To identify clinical characteristics associated with combined adenomyosis and fibroids and to determine whether preoperative diagnosis by ultrasonography correlates with postoperative diagnosis by pathology. METHODS: A retrospective chart review was conducted of 206 women who attended Nassau University Medical Center, East Meadow, USA, between July 1, 2007, and June 30, 2010. The patients were stratified into 3 groups-fibroids only (n=148); adenomyosis only (n=21); or combined adenomyosis and fibroids (n=37)-according to postoperative pathology findings and variables known to be associated with adenomyosis and fibroids. Significant variables were included in a multinomial regression analysis. RESULTS: Dysmenorrhea was the only variable significantly associated with a diagnosis of adenomyosis. The odds ratio (OR) was 3.34 (95% confidence interval [CI], 1.14-9.80). Variables significantly associated with combined adenomyosis and fibroids were age (OR, 1.08; 95% CI, 1.01-1.15), black ethnicity (OR, 2.72; 95% CI, 1.11-6.68), and parity (OR, 1.44; 95% CI, 1.08-1.92). Preoperative diagnosis by ultrasonography did not correlate with the postoperative pathology report. CONCLUSION: Including the identified variables in the preoperative evaluation of patients with suspicion of fibroids might improve the counseling process and aid the choice of surgical procedure, especially among patients desiring a conservative approach.

Metformin does not improve the reproductive or metabolic profile in women with polycystic ovary syndrome (PCOS).

To determine whether metformin, when given to women with polycystic ovary syndrome (PCOS), promotes folliculogenesis by prompting a drop in free sex steroids resulting in a compensatory follicle stimulating hormone (FSH) rise, we conducted a randomized, double-blind, placebo-controlled crossover clinical trial. Eight mid-reproductive age PCOS participants with mean obese body mass index (BMI) and normal glucose tolerance received 8 weeks of metformin, given in a step-up fashion to a maximum dose of 2000 mg daily or placebo with daily urine sampling, 4-6 weeks washout, and crossover to the remaining arm for 8 weeks. To confirm the effects of metformin on glucose and other metabolic markers, a hyperinsulinemic, euglycemic 3-dose clamp (physiologic: 30 mU/m(2) per minute, high: 400 mU/m(2) per minute) followed each treatment. Urinary FSH, luteinizing hormone (LH), or pregnanediol glucuronide (Pdg) did not differ by treatment. Glucose disposal, endogenous glucose production, BMI, ovulation rates, serum sex steroids, free fatty acids, and lipids did not significantly differ by treatment, despite good evidence for compliance with the protocol. During the clamp, high-dose insulin administration was associated with an acute drop in serum LH. We conclude that short-term, high-dose metformin exerts minimal effects on both metabolic markers and reproductive hormones in a small sample of overall morbidly obese women.