Restorative yoga therapy for third-year medical students in pediatrics rotation: Working to improve medical student well-being.

BACKGROUND: Stress experienced by medical students is a well-documented and widespread phenomenon that may have physical and psychological effects on their well-being. One solution is to provide students with the tools to recognize and cope with stress. The aim of this study was to incorporate restorative yoga training-a well-recognized tool for stress reduction-in the third-year medical student pediatrics clerkship and assess the intervention's impact on students' well-being. MATERIALS AND METHOD: Restorative yoga, as a prospective intervention, was offered to third-year medical students at Texas Tech University Health Sciences Center during their pediatrics rotation. The study was between March and August 2020. Each yoga session lasted 45-minutes, once a week for six weeks. Participants completed anonymous questionnaires before and after the intervention via the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). RESULT: Over the six-month study period, 25 (71%) of 35 medical students, having been given the option, chose to participate. The WEMWBS contains 14 statements on well-being, and all but one from the list showed a positive increase in average rating from pre intervention to post intervention. The statements "I've been feeling more relaxed" and "I've been thinking clearly" showed the greatest average increase. Following Chi-squared testing, two statements were found to be significantly different (P < 0.05) before intervention and after intervention: "I've been feeling more relaxed" and "I've been feeling good about myself." CONCLUSION: Students' well-being is paramount to medical schools. Restorative yoga offers hopeful outcomes for effective mitigation of the stresses of medical education and may be recommended for wider use.

The Impact of "Mom/Dad of the Day" Cards, Newborn Heart Auscultation, and Father Skin-to-Skin Care on Parent-Newborn Bonding.

Texas Tech Pediatrics at Northwest Texas Hospital System in Amarillo, Texas, currently practices giving "Mom/Dad of the Day" cards to all new parents, offering the opportunity for fathers to auscultate the newborn heart sound, and encouraging maternal and paternal skin-to-skin contact. New parents were asked to fill out 2 anonymous surveys regarding these practices. Survey results showed statistically significant positive responses by the parents for subjective improvement in fetal sleep and feeding as well as parental confidence and preparedness for taking care of their newborn. Additionally, these practices are desired by parents, with 96% fathers recommending that the hospital routinely offering opportunities for heart auscultation and 94% parents recommending "Mom/Dad of the Day" cards for all future parents in the hospital. Small, nonmedical initiatives such as these are well received and can be feasibly adopted in more hospitals to improve patient quality of care.

Why Are We Cutting? A Survey of Cultural Views on Circumcision in the Texas Panhandle.

To determine the factors that may contribute to parents' decision to circumcise their son in the Texas Panhandle region, voluntary surveys were distributed to all mothers with term male newborns during the mandatory discharge planning class. The father being circumcised (P < .0001), Caucasian (P < .05), and some graduate school of the caregiver (P < .011) were factors most correlated with newborns being circumcised. Newborns of Hispanic origin, those having Medicaid insurance, and a Catholic affiliation were less likely to be circumcised. No significant correlations were found between circumcision and other ethnic affiliations, caregiver's age, father's involvement, and medical counseling. Of note, one third of caregivers were not counseled by a medical professional about circumcision. While the American Academy of Pediatrics Circumcision Policy Statement is clear that a neutral position must be maintained, this does not preclude having a discussion of the benefits versus the risks of circumcision.

Term Neonate With Liver Laceration, Obstructive Uropathy, and Ascites-Secondary to Extravasation of Total Parenteral Nutrition: A Complication of Malpositioned Umbilical Venous Catheter.

We report a rare, but serious, complication of a malpositioned umbilical venous catheter in a term male infant who developed laceration, hematoma, and necrosis of liver, ascites, and left-sided obstructive uropathy secondary to extravasation of total parenteral nutrition. Abdominal paracentesis confirmed the presence of parenteral nutrition in the peritoneal cavity. Although, the umbilical venous catheterization is a common intravenous access used in neonatal intensive care units, judicious continued monitoring of its use should be practiced to avoid serious complications.

Microbial contamination of hospital bed handsets.

BACKGROUND: Hospital bed handsets, including nurse call equipment and television controls, have been found to contain biologic material and may be contaminated with microbes. OBJECTIVE: The aim of this study was to assess the microbial contamination of hospital bed handsets. METHODS: Hospital bed handsets were removed from 115 randomly chosen rooms in a suburban hospital. The handsets were transported to the laboratory in a sterile fashion and opened using a sterile technique, and cultures were obtained from both the anterior and posterior surfaces of the units. RESULTS: The cultures of 12 units (10.4%) revealed no microorganisms. One hundred three units (89.6%) had cultures that grew microorganisms. Of the handsets that were found to contain microorganisms, 48 units (46.6%) had only 1 microorganism, and 55 units (53.4%) had multiple organisms, including 33 units (32.0%) with 2 microorganisms, 21 units (20.4%) with 3 microorganisms, and 1 unit (1.0%) with 4 microorganisms. The microorganisms identified included 90 isolates (87.4%) of coagulase-negative staphylococcus, 51 isolates (49.5%) of bacillus species, 13 isolates (12.6%) of fungal species, 8 isolates (7.8%) of nonhemolytic streptococcus species, 7 isolates (6.8%) of alpha-hemolytic streptococcus species, 1 isolate (1.0%) of Staphylococcus aureus, and 1 isolate (1.0%) of methicillin-resistant Staphylococcus aureus. CONCLUSION: Hospital bed handsets were found to have a high incidence of contamination with bacteria and fungus and were found to contain organisms that are known to be the etiologic agents in nosocomial infections. Because of the frequency and duration of contact between hospital patients and hospital bed handsets, existing infection control measures should be studied that could reduce the level of contamination of such handsets or that could isolate the handsets from the patient.

The effects of comfort care on the pain response in preterm infants undergoing screening for retinopathy of prematurity.

OBJECTIVE: The aim of the study was to determine if pain and distress during the retinopathy of prematurity (ROP) screening examination could be ameliorated by providing comfort care. STUDY DESIGN: This study was a prospective, randomized, controlled trial of 30 stable preterm infants who underwent initial ROP screening examinations. Fourteen study infants were swaddled, held, and given 24% sucrose solution during the examination. Sixteen controls were examined while lying in their cribs. Vital signs (i.e., pulse rate, respiratory rate, and oxygen saturation), crying time, and time for the vital signs to return to baseline values were recorded at different times during the examination. RESULTS: The vital signs did not vary significantly between the two groups. The participants in the control group had a trend of longer crying time, but this trend did not reach a level of statistical significance. In addition, The time required for the vital signs to return to their baseline values did not vary significantly. CONCLUSION: ROP screening is very distressful for preterm infants. The routine use of comfort care to reduce pain during the examination could not be supported by this study.

Early surfactant for neonates with mild to moderate respiratory distress syndrome: a multicenter, randomized trial.

OBJECTIVE: We studied the efficacy and safety of electively providing surfactant to preterm infants with mild to moderate respiratory distress syndrome (RDS) not requiring mechanical ventilation. STUDY DESIGN: A 5-center, randomized clinical trial was performed on 132 infants with RDS, birth weight >or=1250 grams, gestational age or=40% for >or=1 hour, and no immediate need for intubation. Infants were randomly assigned to intubation, surfactant (Survanta, Ross Laboratories, Columbus, Ohio) administration, and expedited extubation (n=65) or expectant management (n=67) with subsequent intubation and surfactant treatment as clinically indicated. The primary outcome was duration of mechanical ventilation. RESULTS: Infants in the surfactant group had a median duration of mechanical ventilation of 2.2 hours compared with 0.0 hours for control infants, since only 29 of 67 control infants required mechanical ventilation (P=.001). Surfactant-treated infants were less likely to require subsequent mechanical ventilation for worsening respiratory disease (26% vs 43%, relative risk=0.60; 95% CI, 0.37, 0.99). There were no differences in secondary outcomes (duration of nasal continuous positive airway pressure, oxygen therapy, hospital stay, or adverse outcomes). CONCLUSIONS: Routine elective intubation for administration of surfactant to preterm infants >or=1250 grams with mild to moderate RDS is not recommended.

Systemic manifestations in response to mydriasis and physical examination during screening for retinopathy of prematurity.

OBJECTIVE: To determine whether adverse effects manifested via vital sign changes during the screening examination for retinopathy of prematurity (ROP) are due to the pharmacologic properties of the eye drops or to physical manipulation of the eyes. The authors also investigated the relationship between distress during the screening process and the severity of prematurity of the infant. DESIGN AND METHODS: A prospective observational study was designed that enrolled all infants either weighing < or =1500 g or who were < or =32 weeks gestational age at birth who were admitted to the neonatal intensive care unit (NICU) at Northwest Texas Hospital or Baptist St. Anthony's Hospital from June 2002 to February 2003. Thirty participants were enrolled in this study. Blood pressure, pulse, temperature, respiratory rate, and O2 saturation were recorded at different time intervals during the examination. Infants were excluded from the study if they were on the ventilator, considered acutely ill, born with significant birth defects, or currently taking inotropic drugs, or had received albuterol 2 hours before the examination. RESULTS: Oxygen saturation and pulse rate following physical manipulation of the eyes significantly varied from baseline values and the values obtained during the three instillations of topical mydriatics. No significant changes in blood pressure, temperature, or respiratory rate from their respective baseline values were observed throughout the ROP screening examination. Gestational age of the infant did not correlate with level of distress during the examination. CONCLUSION: Regardless of the severity of prematurity, infants seem to undergo significant distress during the eyelid speculum examination. Thus ophthalmologists should take into consideration the infant's discomfort caused by physical manipulation of the eyes and attempt to perform the examination as swiftly, yet safely, as possible using topical anesthetic.