Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
December 7, 2007
1. Monograph Provides Insights on Implementing Cultural
and Linguistic Competence in Organizations Addressing Maternal and
Child Health
2. Special Journal Issue Offers Guidance on Promoting and
Supporting Breastfeeding in Clinical Practice
3. Authors Evaluate Effects of a Rapid-Response Team on
Mortality and Code Rates at a Children's Hospital
4. Study Examines Racial Differences in the Use of
Respiratory Medications in Premature Infants After Discharge
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1. MONOGRAPH PROVIDES INSIGHTS ON IMPLEMENTING CULTURAL AND
LINGUISTIC COMPETENCE IN ORGANIZATIONS ADDRESSING MATERNAL AND CHILD
HEALTH
And the Journey Continues: Achieving Cultural and Linguistic Competence
in Systems Serving Children and Youth with Special Health Care Needs
and Their Families highlights experiences in infusing cultural and
linguistic competence into the policies, structures, and practices of
selected state programs. The monograph, developed by the National
Center for Cultural Competence (NCCC) at Georgetown University with
support from the Maternal and Child Health Bureau, presents stories
collected from 23 Title V Children with Special Health Care Needs
programs. Also included are key lessons that NCCC faculty, staff, and
consultants have learned about providing program guidance, as well as
an analysis of the various aspects of linguistic and cultural
competence described in each state's story. A list of references and
state and territorial contacts is included. The monograph is available
at http://www.gucchdgeorgetown.net/NCCC/journey.
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2. SPECIAL JOURNAL ISSUE OFFERS GUIDANCE ON PROMOTING AND SUPPORTING
BREASTFEEDING IN CLINICAL PRACTICE
The November-December 2007 issue of the Journal of Midwifery and
Women's Health is dedicated to lactation and reflects a commitment of
the American College of Nurse-Midwives to promote breastfeeding and
improve the clinical practice of midwives and other women's health
professionals. The issue provides recent research about the science of
lactation, including new information about breast anatomy and the
physiology of lactation. Topics include new information about the best
way to bring the infant to the breast and help the infant latch, how to
assess breastfeeding and how to assist mothers with specific
breastfeeding problems, how to appropriately counsel women about the
benefits of breastfeeding, and what can be done during labor and birth
to minimize the impact of birth practices on breastfeeding. The issue
is available at http://www.sciencedirect.com/science/journal/15269523.
Information about continuing education units offered through the
special continuing education issue is available at http://www.jmwh.org/ceus.cfm.
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3. AUTHORS EVALUATE EFFECTS OF A RAPID-RESPONSE TEAM ON MORTALITY AND
CODE RATES AT A CHILDREN'S HOSPITAL
"Implementation of an RRT [rapid-response team] in our free-standing,
quaternary care academic children's hospital was associated with
statistically significant reductions in hospital-wide mortality rates
and code rates outside the ICU [intensive care unit] setting," state
the authors of an article published in the November 21, 2007, issue of
JAMA, the Journal of the American Medical Association. According to a
recent Institute of Medicine report, between 44,000 and 98,000 deaths
per year occur in hospitals in the United States as a result of errors.
Since the report was published, the Institute of Healthcare Improvement
has recommended that RRTs (ICU-trained personnel who are available 24
hours a day, 7 days a week, for evaluation of patients not in the ICU
who develop signs or symptoms of clinical deterioration) be implemented
nationwide in an effort to decrease inpatient mortality rates. The goal
of the study described in this article was to evaluate the effect of
RRT implementation on hospital-wide mortality rates and code
(respiratory and cardiopulmonary arrests) rates outside the ICU in
pediatric inpatients at an academic children's hospital.
The authors conducted a cohort study using historical controls at the
main campus of Lucile Packard Children's Hospital (LPCH), a 264-bed
quaternary care children's hospital. Participants were included if they
were admitted to LPCH between January 1, 2001, and March 31, 2007, and
spent at least 1 day on the non-obstetric, non-nursery-based, non-ICU
medical or surgical wards. A total of 22,037 patient admissions and
102,537 patient days were evaluated preintervention (before September
1, 2005), and 7,257 patient admissions and 34,420 patient days were
evaluated postintervention (on or after September 1, 2005.)
The authors found that
- A significant decrease in the hospital-wide mortality rate of 18%
occurred after RRT implementation. Mean monthly mortality rates
preintervention and postintervention were 1.01 and 0.83 deaths per 100
discharges, respectively.
- The rate of codes outside the ICU per 1,000 eligible patient-days
decreased by 71.2% after RRT implementation, with preintervention and
postintervention rates of 0.52 and 0.15, respectively.
- The rate of codes outside the ICU per 1,000 eligible admissions
decreased by 71.7%, with preintervention and postintervention rates of
2.45 and 0.69, respectively.
- The estimated code rate per 1,000 admissions for the
postintervention
group was 0.28 times that for the preintervention group.
The authors conclude that "the potential implications of these findings
on national mortality rates for children are dramatic."
Sharek PJ, Parast LM, Leong K, et al. 2007. Effect of a rapid response
team on hospital-wide mortality and code rates outside the ICU in a
children’s hospital. JAMA, the Journal of the American Medical
Association 298(19):2267-2274. Abstract available at http://jama.ama-assn.org/cgi/content/abstract/298/19/2267?etoc.
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4. STUDY EXAMINES RACIAL DIFFERENCES IN THE USE OF RESPIRATORY
MEDICATIONS IN PREMATURE INFANTS AFTER DISCHARGE
"Racial and ethnic status was associated with different management of
premature infants presenting with respiratory symptoms after
discharge," state the authors of an article published in the December
2007 issue of the Journal of Pediatrics. Extreme prematurity often
results in respiratory complications, and even moderate prematurity
results in the need for supplemental oxygen during the first weeks
after delivery. The article presents findings from a study to determine
whether premature infants with respiratory symptoms are treated
differently by racial or ethnic status, and to assess whether
coexisting medical or socioeconomic factors or a higher incidence of
respiratory symptoms explain these differences, if differences exist.
The study sample was drawn from a large cohort of premature infants
born between 1998 and 2001 at five Kaiser Permanente Medical Care
Program (KPMCP) hospitals located in Northern California. The final
sample included 1,436 infants born at a gestational age of 34 weeks or
less. Use of oral beta-agonists, inhaled beta-agonists, and inhaled
corticosteroids was identified from prescriptions filled during the
first year after discharge from the neonatal intensive care unit.
Outpatient and inpatient visits for respiratory symptoms were also
identified. Race and ethnicity were classified as Asian, black,
Hispanic, white, or other/unknown on the basis of maternal information
collected. Primary outpatient facility for each premature infant was
also assigned. The analysis predicted the odds that infants with
different gestational ages and neonoatal complications would receive
oral beta-agonists, inhaled beta-agonists, or inhaled corticosteroids
by the infant's outpatient facility. Separate models were used to
determine the use of a respiratory medication within targeted subgroups.
The authors found that
- After controlling for medical complications, other socioeconomic
factors, and the location of outpatient care within the KPMCP system,
black premature infants were four times more likely to receive oral
beta-agonists and twice as likely to receive inhaled beta-agonists than
infants in other racial and ethnic categories. Hispanic infants were
less likely to receive inhaled medications than white infants.
- After controlling for severity of respiratory symptoms
experienced by infants within subgroups, as well as for the same
medical and social factors included in previous models, black infants
were still more likely to receive oral beta-agonists compared with
white infants, and Hispanic infants had lower odds of receiving inhaled
beta-agonists compared with white infants.
"These data suggest that, even in a high-risk population of infants,
there are substantial racial differences in the management of
respiratory disease that cannot be explained by differences in the
severity, or prevalence, of respiratory symptoms," conclude the authors.
Lorch SA, Wade KC, Bakewell-Sachs S, et al. 2007. Racial differences in
the use of respiratory medications in premature infants after discharge
from the neonatal intensive care unit. Journal of Pediatrics
151(6):635-641. Abstract available at http://www.jpeds.com/article/PIIS0022347607003988/abstract.
Readers: More information is available from the MCH Library's resource:
- Prematurity (bibliography) at
http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_premature.html&-MaxRecords=all&-DoScript=auto_search_premature&-search
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and
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