The breastfeeding support team for low-income, predominantly-minority women: a pilot intervention study.

This quasiexperimental pilot study explored whether a focused breastfeeding intervention had potential to improve outcomes in low-income breastfeeding women. Twenty breastfeeding women (10 in intervention and 10 in usual care) were matched on type of delivery, previous breastfeeding experience, and race. Women were low-income, young, 65% high school graduates, and 40% minority. For this intervention, the BST, a breastfeeding support team (community health nurse and peer counselor) provided hospital and home visits and telephone support. Outcomes were measured weekly for the first month, and monthly through month five. At all time periods, more women who received the intervention were breastfeeding. Further, they had less nipple discomfort in the first month; significantly less fatigue in month four and at three and five months reported less fatigue, depression, and anxiety.

Breastfeeding duration among low income women.

Breastfeeding has been identified as a possible deterrent to the development of osteoporosis and breast cancer in women. In addition, infants who are breastfed exclusively for at least 4 months reportedly have fewer incidence of SIDS, ear infection, diarrhea, and allergies. Further, low income women who breastfeed may be empowered by the experience. Increasing the frequency and duration of breastfeeding is recognized as a national priority, particularly for low income, minority women. Yet, recent national data indicate that in 1997, only 16.5% of low income mothers breastfed for at least 6 months. Short breastfeeding duration in low income women may be due to problems unique to them; thus, consistent and comprehensive breastfeeding support should be provided by midwives, nurses, lactation consultants, and peer counselors who are skilled in culturally sensitive management of lactation within the context of limited financial and social resources. This article focuses on the benefits of breastfeeding, and factors that may influence its duration. It also explores culturally relevant strategies as well as suggested interventions to increase breastfeeding duration among low-income women.

Nipple shields for preterm infants: effect on milk transfer and duration of breastfeeding.

This study reports breastfeeding outcomes for 34 preterm infants whose mothers used ultrathin silicone nipple shields to increase milk transfer. Mean milk transfer was compared for 2 consecutive breastfeedings without and with the nipple shield. Total duration of breastfeeding was calculated for a maximum of 365 days. Mean milk transfer was significantly greater for feedings with the nipple shield (18.4 ml vs. 3.9 ml), with all 34 infants consuming more milk with the nipple shield in place. Mean duration of nipple shield use was 32.5 days, and mean duration of breastfeeding was 169.4 days; no association between these variables was noted. The nipple shield was used for 24.3% of the total breastfeeding experience, with no significant association between the percentage of time the shield was used and total duration of breastfeeding. These findings are the first to indicate that nipple shield use increases milk intake without decreasing total duration of breastfeeding for preterm infants.

The development of nursing in Thailand and its relationship to childbirth practices.

The nursing profession in Thailand is 100 years young. During this brief time nursing has evolved from a hospital-based, apprentice training model taught by male physicians, to the development of doctoral programs taught by nurses who are prepared at the doctoral level. The development of professional nursing has been influenced by Western countries, in particular, by close alliances with the United States. As in the United States, obstetric nursing has been guided by the need to decrease maternal and infant mortality. The high rates of maternal and infant mortality caused the early integration of midwifery courses into the nursing curriculum.

A randomized trial of early discharge and nurse specialist transitional follow-up care of high-risk childbearing women.

In a randomized clinical trial, quality of health care as reflected in patient outcomes and cost of health care was compared between two groups of high-risk childbearing women: women diagnosed with diabetes or hypertension in pregnancy. The control group (N = 52) was discharged routinely from the hospital. The intervention group (N = 44) was discharged early using a model of clinical nurse specialist transitional follow-up care. During pregnancy, the intervention group had significantly fewer rehospitalizations than the control group. For infants of diabetic women enrolled in the study during their pregnancy, low birth weight (< or = 2,500 g) was three times more prevalent in the control group (29%) than in the intervention group (8.3%). The postpartum hospital charges for the intervention group were also significantly less than for the control group. The mean total hospital charges for the intervention group were 44% less than for the control group. The mean cost of the clinical specialist follow-up care was 2% of the total hospital charges for the control group. A net savings of $13,327 was realized for each mother-infant dyad discharged early from the hospital.

Immunonephelometric quantification of group-specific component protein in patients with acute liver failure.

Serum levels of group-specific component (Gc) protein are useful in evaluating the likelihood of survival in patients with acute liver failure (ALF) who may be candidates for liver transplant surgery. Most methods for quantifying Gc protein concentration are either isotopic, manual, technically demanding, and/or time consuming to perform, and thus are not well suited for routine clinical use in a hospital setting. We modified and evaluated a recently described nonisotopic, fully automated, immunonephelometric method for quantifying serum Gc protein concentration and compared it to our previous immunoblotting method. In addition, we evaluated the effect of G-actin on the immunonephelometric measurement of Gc protein. Serum samples from 20 patients with ALF and from 20 age- and sex-matched clinic patients without liver disease were quantified by both immunoblotting and immunonephelometry. We assessed the intra-assay precision, correlation, and diagnostic accuracy of these methods in discriminating between individuals with no preexisting liver disease and those with ALF. Actin in 1.3- to 4-fold excess of Gc protein levels demonstrated minimal to no interference in the quantification of Gc protein by immunonephelometry. Immunonephelometry was more precise than immunoblotting. Gc protein values by immunonephelometry were similar to those obtained by immunoblotting, and the diagnostic accuracy of Gc protein concentration by immunonephelometry was similar to that observed by immunoblotting. Immunonephelometry provides a nonisotopic, fully automated, rapid, precise, accurate, and cost-effective method for quantifying serum levels of total Gc protein that is well suited for routine use in a hospital-based clinical laboratory.

Taking a bite out of CRISP. Strategies on using and conducting searches in the Computer Retrieval of Information on Scientific Projects database.

A vast array of information useful to the scientific community is readily available on the internet. Currently, the National Institutes of Health (NIH) offers user access to several large databases, some of which are pertinent to nurses interested in research, health policy formation, and identifying funded research projects. One such database, the Computer Retrieval of Information on Scientific Projects (CRISP), provides information on research grants funded by the NIH from 1972 to the present. Retrieval of scientific information for each project in CRISP is made available by project title, grant number, abstract, principal investigator, eight-digit CRISP Thesaurus terms, and key words. This article introduces the reader to CRISP and provides a set of succinct strategies for conducting comprehensive searches in the database.

A model of home care for high-risk childbearing families. Women with diabetes in pregnancy.

With a national trend toward decreased hospitalizations for high-risk childbearing women, home care and follow-up services have gained increased importance. The Quality-Cost Model of Nurse Specialist Transitional Follow Up Care is presented as a method to provide home care for high-risk pregnant women, specifically those whose pregnancies are complicated by diabetes mellitus. The model offers opportunities for intensive education, assessment, intervention, and support throughout the pregnancy and postpartum period. In addition, this model can potentially decrease the burden of care on the woman and her family by providing a comprehensive program of home care, follow up, support, and education.

Controversial issues surrounding early postpartum discharge.

Throughout the world, early postpartum discharge programs are emerging as one strategy for reducing health care costs and, in some areas, relieving the shortage of hospital beds. This article summarizes the research findings to date regarding programs of early postpartum discharge. Additionally, findings from recently completed work on a program of early discharge for high-risk childbearing families is discussed.

State of the science. Breastfeeding for mothers and low birth weight infants.

There is support in the research literature for encouraging mothers of preterm and LBW to breastfeed their infants, although the numerous barriers to their successful breastfeeding have been well documented. The emerging work addressing short- and long-term health benefits for preterm infants provide's scientific rationale for allocation of resources, that is, equipment and personnel, to assist these mothers in attaining their breastfeeding goals. The literature also has linked selected, individualized interventions to breastfeeding outcomes for this population. Examples of this linkage include milk expression recommendations for maximizing milk yield, techniques for in-hospital breastfeeding, and models for providing breastfeeding services in the NICU. Clinical priorities should focus on strategies for implementing the available research into practice and for using the research to establish standards of care for mothers who breastfeed preterm and LBW infants. Research priorities should focus on practice models for providing breastfeeding services that demonstrate improved breastfeeding outcomes and cost effectiveness for this vulnerable population.

Initiation and frequency of breast expression in breastfeeding mothers of LBW and VLBW infants.

This article is a report of data derived from two investigations. In one study, the relationship between early initiation and frequency of breast stimulation to feeding pattern at 8 weeks postpartum in mothers of low-birth-weight (LBW; < or = 2500 g) infants was examined. The other study examined how selected physical, psychological, and management variables affect milk volume in mothers of very-low-birth-weight (VLBW; < or = 1500 g) infants. Initiation and frequency of breast stimulation were studied in both investigations. Mothers of LBW (N = 110) and VLBW (N = 16) infants had delayed initiation of breast stimulation after delivery and low pumping frequency. No relationship was found between early initiation and frequency of breast stimulation to feeding pattern in mothers of LBW infants.

Women with diabetes during pregnancy: sociodemographics, outcomes, and costs of care.

This study provides sociodemographic, outcome, and cost data on a population (N = 55) of predominately low-income, diabetic women who were hospitalized during pregnancy. Study findings indicated that 43 percent received no prenatal care in the first trimester, 20 percent delivered a low-birthweight infant, 47 percent had a cesarean delivery, and 63 percent reported an annual income under $12,500. Following the women's initial admission for glucose control, 19 acute care visits and 32 rehospitalizations were recorded for them. The mean hospital charges for antepartum initial hospitalization for glucose control were $4,665 (4.3 days). The mean charges for postpartum hospitalization were $7,793 (4.3 days). The mean hospital charges per infant were $12,991. Given the data presented in this study, it is imperative that monies be targeted to provide a broad spectrum of health care services that will meet the unique needs of this population. These services should address not only the needs related to superimposed disease state but also identify mechanisms to assist women to receive care prior to conception, or at the very least to begin prenatal care in the first trimester of pregnancy.

Pregnant women with diabetes: antepartum and postpartum morbidity.

Despite advances in obstetrical management, the problems that women with diabetes experience most frequently during their pregnancies and postpartum have not been clearly defined. The purpose of this study was to provide morbidity data on this patient population to assist in determining appropriate interventions.

The association between CNS direct care time and total time and very low birth weight infant outcomes.

This study examined the association between the amount of direct care time and total time (direct and administrative) spent by CNSs with families of 39 very low birth weight infants (< or = 1500 grams) and infant outcomes (rehospitalizations and acute care visits). Documentation of the CNSs' time spent with infants and families was recorded during infant hospitalization and for 18 months after infant discharge. The number of infant rehospitalizations and acute care visits was recorded from hospital and physician records. The mean total time the CNS spent per infant for the 18-month period was 27.3 hours. After discharge, there were significant relationships between the amount of CNS direct care time and the number of acute care visits (r = 0.45, p < 0.01) and infant rehospitalizations (r = 0.51, p < 0.01). Although the study findings did not demonstrate improved infant outcomes associated with the amount of time the CNS spent with this high risk population, they document the amount of CNS time spent in intervention and follow-up of these infants. This study provides data for costing home visiting by the CNS in this patient population.