Measuring antenatal counseling skill with a milestone-based assessment tool: a validation study.

BACKGROUND: Antenatal counseling for parents in the setting of expected preterm delivery is an important component of pediatric training. However, healthcare professionals receive a variable amount and quality of formal training. This study evaluated and discussed validity of a practical tool to assess antenatal counseling skills and provide evaluative feedback: the Antenatal Counseling Milestones Scale (ACoMS). METHODS: Experts in antenatal counseling developed an anchored milestone-based tool to evaluate observable skills. Study participants with a range of antenatal counseling skills were recruited to participate in simulation of counseling sessions in person or via video with standardized patient actors presenting with preterm labor at 23 weeks' gestation. Two faculty observers scored each session independently using the ACoMS. Participants completed an ACoMS self-assessment, demographic, and feedback survey. Validity was measured with weighted kappas for inter-rater agreement, Kruskal-Wallis and Dunn's tests for milestone levels between degrees of expertise in counseling, and cronbach's alpha for item consistency. RESULTS: Forty-two participants completed observed counseling sessions. Of the 17 items included in the tool, 15 items were statistically significant with scores scaling with level of training. A majority of elements had fair-moderate agreement between raters, and there was high internal consistency amongst all items. CONCLUSION: This study demonstrates that the internal structure of the ACoMS rubric has greater than fair inter-rater reliability and high internal consistency amongst items. Content validity is supported by the scale's ability to discern level of training. Application of the ACoMS to clinical encounters is needed to determine utility in clinical practice.

Adverse outcomes after preterm labor are associated with tumor necrosis factor-alpha polymorphism -863, but not -308, in mother-infant pairs.

OBJECTIVE: Two single-base polymorphisms of the tumor necrosis factor-alpha gene (TNF-alpha) at positions -863 and -308 are associated with variation in production of TNF-alpha (TNF-alpha). TNF-alpha genotypes were tested for association with adverse outcomes in mother-infant pairs with preterm labor. STUDY DESIGN: We analyzed a cohort of 118 mother-infant pairs with preterm labor before 34 weeks' gestation. Polymerase chain reaction was used on extracted deoxyribonucleic acid for polymorphism assay. Outcomes included amniotic fluid TNF-alpha concentration, histologic chorioamnionitis, delivery gestational age, and composite neonatal morbidity. Statistical significance was determined by chi 2 and Kruskal-Wallis analysis of variance. RESULTS: Mothers homozygous for the -863 polymorphism (AA) had significantly earlier deliveries ( P = .02), more chorioamnionitis ( P = .03), and greater composite neonatal morbidity ( P = .03). Neither maternal nor fetal carriage of the -308 polymorphism was associated with adverse outcome. CONCLUSION: In women with preterm labor before 34 weeks' gestation, maternal homozygous carriage of the -863 polymorphism may be associated with preterm delivery and adverse neonatal outcome.

Increased tumor necrosis factor-alpha in whole blood during the luteal phase of ovulatory cycles.

OBJECTIVE: To evaluate whether the fact that blood from premenopausal, ovulatory women shows a significant fluctuation in tumor necrosis factor-alpha (TNF-alpha) levels when tested randomly over time is related to the hormonal cycle. STUDY DESIGN: In this pilot study, whole blood was collected from 8 women during the follicular, ovulatory and midluteal phases of the menstrual cycle. Ovulation was confirmed by luteinizing hormone surge and mid-luteal progesterone levels. For each subject at each phase of the menstrual cycle, TNF-alpha levels were measured at baseline and after stimulation of whole blood with 10 microg/mL of lipopolysaccharide (LPS). Supernatant was collected and assayed by enzyme-linked immunosorbent assay. TNF-alpha levels were compared with the Wilcoxon matched pairs signed rank sum test. RESULTS: Whole blood unstimulated by LPS showed increasing TNF-alpha levels over the hormonal cycle, with significantly increased median levels during the luteal phase (903 pg/mL; range, 0-3707) as compared with the follicular phase (162 pg/mL; range, 0-656) (P = .03). Blood stimulated with LPS showed increased TNF-alpha levels overall but no association with cycle timing. CONCLUSION: TNF-alpha levels in unstimulated whole blood appear to be associated with menstrual cycle timing, with highest levels during the luteal phase. However, the lack of variation in TNF-alpha production after LPS stimulation suggests that experiments do not need to be timed with the menstrual cycle.