Catching Strep: Cost-Comparison of Peri-Natal Screening Assays for Goup B Streptococcus

CATCHING STREP: COST-COMPARISON OF PERINATAL SCREENING ASSAYS FOR GROUP B STREPTOCOCCUS. BG Dempsey, L Leeman, S Phelan, and S Young, University of New Mexico School of Medicine, Albuquerque, NM Purpose: To determine how the implementation of a rapid polymerase chain reaction (PCR) —based assay for Group B Streptococcus (GBS) affects the treatment and management of women presenting to the hospital, in labor with an unknown GBS culture status. Methods: We performed a retrospective chart review of women presenting in labor with an unknown GBS culture status to a large university —based hospital. We compared two groups of women: 1. Women who presented prior to the implementation of the Rapid PCR culture who were cultured using traditional methods; 2. Women who presented after the Rapid PCR GBS culture was implemented as a standard of care. We analyzed variables such as length of hospital stay, administration of prophylactic antibiotics against GBS, GBS-associated laboratory testing, and patient demographics. Results: The implementation of the Rapid PCR GBS culture was associated with a higher median cost of hospital stay compared to the traditional GBS culture method, while resulting in less extended hospital stays due to concerns for neonatal GBS infections. Conclusion: The implementation of Rapid PCR GBS cultures for women presenting in labor with an unknown GBS status does not correlate with cost-savings or decreased length of post-partum hospital stay despite being associated with a decrease in the number of infants with a prolonged hospital stay secondary to GBS concerns. Supported in part by the University of New Mexico (UNM) School of Medicine

Respuesta inmunologica en casos de bartonelosis con y sin complicaciones durante el embarazo

Bartonellosis (Carrion's Disease) during pregnancy is associated with high rates of maternal and perinatal mortality. We report the immunological patterns in two cases of human bartonellosis during pregnancy. One patient had an uncomplicated course while the second patient developed life threatening anasarca and cardiac tamponade. The patient with a complicated course had a Th1 response with a higher elevation of IL-10. This elevation has been associated with poor outcome pregnancies during bacterial infections.Bartonelosis (Enfermedad de Carrión) durante el embarazo esta asociado a una alta tasa de mortalidad maternal y perinatal. Reportamos el perfil inmunológico de dos casos de Bartonelosis humana en el embarazo. Una paciente tuvo un curso sin complicaciones, mientras la segunda presento complicaciones severas de anasarca y tamponamiento cardiaco. La paciente con curso complicado tuvo un patrón de repuesta Th1, con una elevación de IL-10, que se ha asociado a mal pronóstico en infecciones durante embarazo

Providing Doulas as Continuous Labor Support for Pregnant Patients in Substance Use Disorder Treatment Can Help Families

A 2019 NM-based pilot research project funded by NIH (Grant # U54 MD004811 – UNM TREE Center) suggests that pregnant patients receiving substance use disorder treatment may greatly benefit from access to experienced doulas providing trauma-informed and addiction-informed support. The results from the pilot also suggest that both doulas and medical providers are eager to facilitate access to doula care for these pregnant individuals

Community Versus Out-of-Hospital Birth: What's in a Name?

The term out‐of‐hospital has long been used as a kind of shorthand to refer collectively to births that occur in birth centers or at home. However, this term has also been a persistent cause of concern among health care providers who attend births in these settings, and researchers and midwives are increasingly adopting the term community birth instead to refer to planned home and birth center births. Some who resist the term out‐of‐hospital have argued that it reifies hospital birth as normative and community birth as other, marginal, or alternative. Here we propose community birth as a preferable term because it labels the practice for what it is—instead of for what it is not. This argument is similar to those made by communities of color who have critiqued the use of nonwhite as a demographic category that elevates Euro‐Americans as the default race. Medical anthropologists have also compared the use of the term out‐of‐hospital to the tendency to call nonallopathic forms of healing complementary or alternative. Yet, many so‐called complementary and alternative medicine practitioners prefer to identify their forms of healing as holistic, integrative, or functional to indicate that modalities such as acupuncture, Ayurveda, chiropractic, and so on are autonomous approaches that may exist outside of, but are not subservient to or less than, allopathic and biomedical modalities. These health care providers, too, commonly choose to refer to their practice with terms that convey what it is, rather than what it is not, just as persons of color choose to be identified for who they are, not for who they are not

C2-O-sLeX Glycoproteins Are E-Selectin Ligands that Regulate Invasion of Human Colon and Hepatic Carcinoma Cells

Similar to mechanisms of recruitment of activated leukocytes to inflamed tissues, selectins mediate adhesion and extravasation of circulating cancer cells. Our objective was to determine whether sialyl Lewis X modified core 2 O-glycans (C2-O-sLeX) present on colon and hepatic carcinoma cells promote their adhesion and invasion. We examined membrane expression of C2-O-sLeX, selectin binding, invasion of human colon and hepatic carcinoma cell lines, and mRNA levels of alpha-2,3 fucosyltransferase (FucT-III) and core 2 beta-1,6 N-acetylglucosaminyltransferase (C2GnT1) genes, necessary for C2-O-sLeX synthesis, by quantitative reverse-transcriptase (RT) PCR. Synthesis of core 2 branched O-glycans decorated by sLeX is dependent on C2GnT1 function and thus we determined enzyme activity of C2GnT1. The cell lines that expressed C2GnT1 and FucT-III mRNA by quantitative RT-PCR were highly positive for C2-O-sLeX by flow cytometry, and colon carcinoma cells possessed highly active C2GnT1 enzyme. Cells bound avidly to E-selection but not to P- and L-selectin. Gene knock-down of C2GnT1 in colon and hepatic carcinoma cells using short hairpin RNAs (shRNA) resulted in a 40–90% decrease in C2-O-sLeX and a 30–50% decrease in E-selectin binding compared to control cells. Invasion of hepatic and colon carcinoma cells containing C2GnT1 shRNA was significantly reduced compared to control cells in Matrigel assays and C2GnT1 activity was down-regulated in the latter cells. The sLeX epitope was predominantly distributed on core 2 O-glycans on colon and hepatic carcinoma cells. Our findings indicate that C2GnT1 gene expression and the resulting C2-O-sLeX carbohydrates produced mediate the adhesive and invasive behaviors of human carcinomas which may influence their metastatic potential

Exploring why quality circles work in primary health care: a realist review protocol

BACKGROUND: Quality circles (QCs) are commonly used in primary health care in Europe to consider and improve standard practice over time. They represent a complex social intervention that occurs within the fast-changing system of primary health care. Numerous controlled trials, reviews, and studies have shown small but unpredictable positive effect sizes on behavior change. Although QCs seem to be effective, stakeholders have difficulty understanding how the results are achieved and in generalizing the results with confidence. They also lack understanding of the active components of QCs which result in changes in the behavior of health care professionals. This protocol for a realist synthesis will examine how configurations of components and the contextual features of QCs influence their performance. METHODS/DESIGN: Stakeholder interviews and a scoping search revealed the processes of QCs and helped to describe their core components and underlying theories. After clarifying their historical and geographical distribution, a purposive and systematic search was developed to identify relevant papers to answer the research questions, which are: understanding why, how, and when QCs work, over what time frame, and in what circumstances. After selecting and abstracting appropriate data, configurations of contexts and mechanisms which influence the outcome of QCs within each study will be identified. Studies will be grouped by similar propositional statements in order to identify patterns and validation from stakeholders sought. Finally, theories will be explored in order to explain these patterns and to help stakeholders maintain and improve QC performance. DISCUSSION: Analyzing context-mechanism-outcome (CMO) patterns will reveal how QCs work and how contextual factors interact to influence their outcome. The aim is to investigate unique configurations that enable them to improve the performance of health care professionals. Using a standardized reporting system, this realist review will allow the research questions to be answered to the satisfaction of key stakeholders and enable on-going critical examination and dissemination of the findings. STUDY REGISTRATION: PROSPERO registration number: CRD42013004826

Initiating Intrapartum Nitrous Oxide in an Academic Hospital: Considerations and Challenges.

A 50%-50% mixture of nitrous oxide and oxygen has long been used for managing pain during labor in many countries, but only recently has this intrapartum analgesic technique become popular in the United States. Nitrous oxide is considered minimal sedation and a safe pain management alternative. Many facilities are now interested in providing laboring women this analgesic option. The process of establishing use of nitrous oxide in a large institution can be complicated and may seem daunting. This brief report describes the challenges that occurred during the process of initiating nitrous oxide for pain management during childbirth at an academic medical center and discusses various committee roles. Nurses at the University of New Mexico Hospital now directly oversee the administration of nitrous oxide to women in labor in accordance to an established guideline. Despite limited available research, the guideline also allows offering nitrous oxide as a pain management technique for women with opioid dependence. Key components of the guideline and specifics related to education, cost, and safety are reviewed