Ambulatory Blood Pressure Trajectory and Perceived Stress in Relation to Birth Outcomes in Healthy Pregnant Adolescents.

OBJECTIVE: An early decline in resting blood pressure (BP), followed by an upward climb, is well documented and indicative of a healthy pregnancy course. Although BP is considered both an effector of stress and a clinically meaningful measurement in pregnancy, little is known about its trajectory in association with birth outcomes compared with other stress effectors. The current prospective longitudinal study examined BP trajectory and perceived stress in association with birth outcomes (gestational age (GA) at birth and birth weight (BW) percentile corrected for GA) in pregnant adolescents, a group at risk for stress-associated poor birth outcomes. METHODS: Healthy pregnant nulliparous adolescents (n = 139) were followed from early pregnancy through birth. At three time points (13-16, 24-27, and 34-37 gestational weeks ±1 week), the Perceived Stress Scale was collected along with 24-hour ambulatory BP (systolic and diastolic) and electronic diary reporting of posture. GA at birth and BW were abstracted from medical records. RESULTS: After adjustment for posture and pre-pregnancy body mass index, hierarchical mixed-model linear regression showed the expected early decline (B = -0.18, p = .023) and then increase (B = 0.01, p < .001) of diastolic BP approximating a U-shape; however, systolic BP displayed only an increase (B = 0.01, p = .010). In addition, the models indicated a stronger systolic and diastolic BP U-shape for early GA at birth and lower BW percentile and an inverted U-shape for late GA at birth and higher BW percentile. No effects of perceived stress were observed. CONCLUSIONS: These results replicate the pregnancy BP trajectory from previous studies of adults and indicate that the degree to which the trajectory emerges in adolescence may be associated with variation in birth outcomes, with a moderate U-shape indicating the healthiest outcomes.

Cardiac genetic testing: a single-center pilot study of a Dominican population.

The impact of undergoing genetic testing in a Dominican population is not well understood. The objective of this investigation was to evaluate the psychological well-being and perceived cardiac risk among Dominicans who underwent genetic testing. Participants completed a qualitative interview and the Short Form-36 (SF-36) questionnaire after cardiac genetic testing. There were 31 subjects evaluated (mean age 42 ± 11 years). Participants revealed three common themes: (a) fear of dying prematurely, (b) guilt of possibly passing on a mutation to their children, and (c) fear of having an implantable cardioverter defibrillator (ICD) shock. Physical components of the SF-36 were within normal limits (46.2 ± 6.6) but elevated for mental components (59.9 ± 5.3). The quality of life and specific themes results determined in this investigation warrant further research in the Dominican population.

Cardiac e-learning: Development of a web-based implantable cardioverter defibrillator educational system.

OBJECTIVE: The objective of this study was to design a Web-based implantable cardioverter defibrillator (ICD) module that would allow greater access to learning which could occur at an individual's convenience outside the fast-paced clinical environment. MATERIALS AND METHODS: A Web-based ICD software educational program was developed to provide general knowledge of the function of the ICD and the interpretation of the stored electrocardiograms. This learning tool could be accessed at any time via the Columbia University Internet server, using a unique, password protected login. A series of basic and advanced ICD terms were presented using actual ICD screenshots and videos that simulated scenarios the practitioner would most commonly encounter in the fast-paced clinical setting. To determine the usefulness of the site and improve the module, practitioners were asked to complete a brief (less than 5 min) online survey at the end of the module. RESULTS: Twenty-six practitioners have logged into our Web site: 20 nurses/nurse practitioners, four cardiac fellows, and two other practitioners. The majority of respondents rated the program as easy to use and useful. CONCLUSION: The success of this module has led to it becoming part of the training for student nurse practitioners before a clinical electrophysiology rotation, and the module is accessed by our cardiac entry level fellows before a rotation in the intensive care unit or electrophysiology service. Remote electronic arrhythmia learning is a successful example of the melding of technology and education to enhance clinical learning.

Training for interdisciplinary health research: defining the required competencies.

Although interdisciplinary research is becoming the dominant model for understanding complex health issues, little is known about the competencies required for successful interdisciplinary collaboration. Published research has discussed attitudes about interdisciplinary work and organizational resources but not the needed competencies. This report describes the method and results of the competency specification process for health research. Based on an established definition of interdisciplinary research, a preliminary set of competencies was developed from expert opinion of key informants and a review of the interdisciplinary research literature. A Delphi panel of interdisciplinary researchers then reached consensus on 17 competencies necessary for interdisciplinary research.

Defining interdisciplinary research: conclusions from a critical review of the literature.

OBJECTIVE: To summarize findings from a systematic exploration of existing literature and views regarding interdisciplinarity, to discuss themes and components of such work, and to propose a theoretically based definition of interdisciplinary research. DATA SOURCES/STUDY SETTING: Two major data sources were used: interviews with researchers from various disciplines, and a systematic review of the education, business, and health care literature from January 1980 through January 2005. STUDY DESIGN: Systematic review of literature, one-on-one interviews, field test (survey). DATA COLLECTION/EXTRACTION METHODS: We reviewed 14 definitions of interdisciplinarity, the characteristics of 42 interdisciplinary research publications from multiple fields of study, and 14 researcher interviews to arrive at a preliminary definition of interdisciplinary research. That definition was then field tested by 12 individuals with interdisciplinary research experience, and their responses incorporated into the definition of interdisciplinary research proposed in this paper. PRINCIPAL FINDINGS: Three key definitional characteristics were identified: the qualitative mode of research (and its theoretical underpinnings), existence of a continuum of synthesis among disciplines, and the desired outcome of the interdisciplinary research. CONCLUSION: Existing literature from several fields did not provide a definition for interdisciplinary research of sufficient specificity to facilitate activities such as identification of the competencies, structure, and resources needed for health care and health policy research. This analysis led to the proposed definition, which is designed to aid decision makers in funding agencies/program committees and researchers to identify and take full advantage the interdisciplinary approach, and to serve as a basis for competency-based formalized training to provide researchers with interdisciplinary skills.

Effectiveness of barrier precautions and surveillance cultures to control transmission of multidrug-resistant organisms: a systematic review of the literature.

BACKGROUND: Despite the priority placed on preventing transmission of multidrug-resistant organisms (MDROs) in health care facilities, there is a lack of consensus among recommended infection control guidelines. We focused on control measures that have a great potential to affect patient care, patient services, and hospital cost/resources: barrier precautions/patient isolation and surveillance cultures. METHODS: We conducted a systematic review of the literature and published English-language guidelines pertaining to the use of barrier precautions/patient isolation and surveillance cultures to prevent the transmission of MDROs. The recommendations made by the published guidelines were summarized and compared. The primary research studies identified through our literature search were evaluated for study quality. We then summarized the outcomes of the studies with the highest quality scores and made recommendations for future work. RESULTS: A total of 29 studies were included in our assessment of study quality; of those, 7 studies were of high quality. CONCLUSION: This systematic review identified key gaps in the literature including a need for greater monitoring of implementation of the interventions, more cost analyses of interventions, determining the independent contribution of specific interventions, and identifying the minimum interventions needed to reduce transmission.

Physiological response properties of displaced amacrine cells of the adult ferret retina.

The ganglion cell layer (GCL) of the mammalian retina contains a large number of neurons called displaced amacrine cells (DACs) that do not project to the optic nerve. However, with the exception of the rabbit starburst amacrine cell little is known regarding the function of this large population due to the difficulty experienced in making physiological recordings from these neurons. We have overcome these difficulties and have used whole-cell patch-clamp techniques to examine the intrinsic membrane properties of DACs in the ferret retina. Our results indicate a large degree of diversity in their intrinsic membrane properties. In response to maintained depolarizing current injection, DACs responded with graded depolarization or by eliciting either transient or sustained bursts of spiking activity. At the resting membrane potential, 10% of the DACs generated spontaneous spikes in either an apparently random manner or at the peak of intrinsic waves of depolarization. The resting membrane activity of the remaining DACs recorded could be classified into three groups that were quiescent (28%), had robust uncorrelated synaptic activity (30%), or underwent slow waves of depolarization (42%). Diversity was also revealed in the membrane currents recorded in voltage-clamp where some DACs were quiescent (19%), or exhibited robust nonrhythmic synaptic events (42%). The remaining DACs exhibited waves of oscillatory activity (39%), characterized by either rhythmic bursts of synaptic events (17%) or slow inward currents (22%). Bath application of 50 microM biccuculine or 150 microM picrotoxin had no effect on the waves of activity, however, the gap junction blocker, carbenoxolone (100 microm), blocked both oscillatory patterns. By including Lucifer yellow and biocytin in the recording pipette, it was possible to determine the morphology of recorded neurons and group them based on dendritic extent as small-, medium-, or large-field DACs. There were few relationships between these morphologically defined groups and their intrinsic membrane properties. The present study provides the first in-depth examination of the intrinsic membrane properties of DACs in the ferret retina and provides new insights into the potential roles these neurons play in the processing of visual information in the mammalian retina.