Validation of the self-administered version of the international Restless Legs Syndrome study group severity rating scale - The sIRLS.

INTRODUCTION: The International Restless Legs Study Group (IRLSSG) has developed the IRLS (International Restless Legs Syndrome Severity Scale) and validated it as a clinician/researcher administered scale to be used when both patient and examiner are present. The IRLSSG recognized the need for a self-completing scale that can be used economically in clinical practice and in large population-based studies. In this study the validity and the reliability of the IRLS as a self-administered scale (sIRLS) is assessed. METHODS: Established RLS patients were recruited by eight centers in four countries and consented to participate in this study. The validity of the sIRLS was assessed by patients completing the sIRLS before a clinician administered the IRLS. The reliability of the sIRLS was assessed by patients completing the sIRLS again, two weeks after the first one, provided no change had occurred. RESULTS: Overall, 173 patients were recruited and 164 of them were included in the analyses. The sIRLS showed satisfactory scaling assumptions and no relevant floor or ceiling effect. One factor explained 61.3% of the variance. Cronbach's alpha was 0.93 and the item homogeneity index was 0.59. Intraclass correlation coefficient between the sIRLS and the IRLS was 0.94. The sIRLS standard error of measurement was 3.61 (½ SD at baseline = 4.11). The results mostly overlapped those of the IRLS analyzed in parallel. DISCUSSION: The sIRLS is a reliable, valid and precise instrument that showed tight association with the IRLS. These findings support the use of the sIRLS for self-evaluation of RLS severity. The responses obtained on the sIRLS and the IRLS scale varied slightly. Therefore, we recommend that either the sIRLS or the IRLS scale be used as the only scale for serial measures over time.

Increasing Accessibility to Long-Acting Reversible Contraception in a Public Health Setting.

OBJECTIVE: To increase access to long-acting reversible contraception (LARC) by developing and implementing evidence-based criteria for LARC insertions at a public health clinic. DESIGN: A quality improvement pilot project aimed at improving access to LARC for women of reproductive age and decrease associated costs. SETTING/LOCAL PROBLEM: Eligibility criteria for LARC at a public health clinic in rural Georgia required two clinic visits and unnecessary screening tests for women interested in these methods. These criteria limited eligibility of candidates who desired LARC, increased time between requests for and insertion of LARC, and increased costs. PARTICIPANTS: Fifteen women of reproductive age who were uninsured or underinsured had a LARC inserted during project implementation. INTERVENTION/MEASUREMENTS: The average number of days between visits based on the old (2007) criteria was compared with the average number of days between visits after implementation of the new (2017) criteria, with specific focus on the number of same-day LARC insertions. A secondary analysis of cost savings was calculated. RESULTS: After implementation of the 2017 criteria, a statistically significant (p < .01) decrease in the mean number of days between request for and insertion of LARC was noted. Every woman who requested a LARC received it, and more than half of LARC insertions were provided the same day. Furthermore, the clinic noted savings of nearly $1,000 on LARC insertions. CONCLUSION: The wait time for LARC insertion substantially decreased, and more than half of women had a LARC inserted the same day they requested it. By decreasing the wait time between request for and insertion of a LARC and implementing a policy to advocate for same-day insertion, use of the 2017 criteria decreased women's risk for unintended pregnancy.

Pain Management in Obstetrics.

Critical care clinicians may be called on to care for a laboring woman. Comprehension of the anatomic changes associated with pregnancy, and labor and birth, is essential. A working knowledge of the current options for pain management in labor, both pharmacologic and nonpharmacologic, is necessary to facilitate patient-centered care. Pharmacologic options include intravenous or intramuscular agents, inhalational agents, and neuraxial anesthesia. Each modality has contraindications, risks, and benefits that must be considered when choosing the most appropriate method.

Trends in Practice Patterns and Perspectives of Colorado Certified Nurse-Midwives.

Healthcare resources are stretched perilously thin and the demand for primary healthcare services has never been greater. Despite this demand for service, relatively little is known about the practice environment of primary healthcare providers, particularly certified nurse-midwives (CNMs), where workforce surveys frequently include these specialists within the broader nurse practitioner category. A distinct professional discipline, nurse-midwives are one type of primary care provider recommended to enhance access to services. The objective of this study was to understand the nature of the nurse-midwifery practice environment in the state of Colorado. Online survey of Colorado CNMs (N = 328) found little ethnic/racial diversity and an aging workforce, with most providing care in an urban, hospital/medical center environment. Several key legislative issues were identified though respondents felt ill prepared to engage in legislative change. Overall, CNMs were optimistic about the future of midwifery and were largely satisfied with their practice.

Consensus clinical practice guidelines for the diagnosis and treatment of restless legs syndrome/Willis-Ekbom disease during pregnancy and lactation.

Restless legs syndrome (RLS)/Willis-Ekbom disease (WED) is common during pregnancy, affecting approximately one in five pregnant women in Western countries. Many report moderate or severe symptoms and negative impact on sleep. There is very little information in the medical literature for practitioners on the management of this condition during pregnancy. Accordingly, a task force was chosen by the International RLS Study Group (IRLSSG) to develop guidelines for the diagnosis and treatment of RLS/WED during pregnancy and lactation. A committee of nine experts in RLS/WED and/or obstetrics developed a set of 12 consensus questions, conducted a literature search, and extensively discussed potential guidelines. Recommendations were approved by the IRLSSG executive committee, reviewed by IRLSSG membership, and approved by the WED Foundation Medical Advisory Board. These guidelines address diagnosis, differential diagnosis, clinical course, and severity assessment of RLS/WED during pregnancy and lactation. Nonpharmacologic approaches, including reassurance, exercise and avoidance of exacerbating factors, are outlined. A rationale for iron supplementation is presented. Medications for RLS/WED are risk/benefit rated for use during pregnancy and lactation. A few are rated "may be considered" when RLS/WED is refractory to more conservative approaches. An algorithm summarizes the recommendations. These guidelines are intended to improve clinical practice and promote further research.

Metastastic choriocarcinoma in a term pregnancy: a case study.

The focus of this article is choriocarcinoma (CC), a rare and aggressive obstetric/gynecologic cancer that occurs once in every 20,000 to 40,000 pregnancies. CC is a form of gestational trophoblastic disease, which is the result of abnormal trophoblastic activity encompassing a spectrum of nonmalignant and malignant disease. Forms of gestational trophoblastic disease include complete or partial mole, invasive mole, CC, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Typically asymptomatic, the first symptom of CC in 80% of cases is shortness of breath, indicative of metastasis to the lungs. CC affects women of all ages and can occur during pregnancy, after birth, or even years remote from the antecedent pregnancy. It is highly responsive to chemotherapy, with an overall remission rate greater than 90%. This case study presents the story of a pregnant adolescent thought to have an uneventful pregnancy until metastatic CC at term was diagnosed. Available treatments, outcomes and surveillance for the disease, psychosocial aspects, and implications for nursing care are discussed.

A curious case of anti-D antibody titer.

RhD alloimmunization remains a threat to 1% of the 10% of RhD-negative women in the United States who are giving birth to RhD-positive fetuses despite routine antenatal and postpartum administration of Rh(o)D immune globulin (RhIG). This report examines the clinical course of an RhD-negative woman who developed a high anti-D antibody titer during her pregnancy while carrying an RhD-positive female fetus yet had a negative antibody screen at the time she gave birth. Although she delivered a healthy newborn unaffected by hemolytic disease, subsequent pregnancies will be treated as though she is RhD alloimmunized. The discussion below includes possible causes for the abrupt rise in this woman's anti-D antibody titer, a review of the complex Rh system and cellular anamnestic response, and current fetal surveillance for hemolytic disease of the fetus and newborn.

Leg cramps and restless legs syndrome during pregnancy.

Sleep disturbance during pregnancy can result in excessive daytime sleepiness, diminished daytime performance, inability to concentrate, irritability, and the potential for an increased length of labor and increased risk of operative birth. Sleep disturbance may be the result of a sleep disorder, such as leg cramps, a common yet benign disorder, or restless legs syndrome, a sensorimotor disorder. Both disrupt sleep, are distressing to the pregnant woman, and mimic one another and other serious disorders. During pregnancy, up to 30% of women can be affected by leg cramps, and up to 26% can be affected by restless legs syndrome.