Southern California Hospitals Research Articles

Low Rate of Perinatal Sepsis in Term Infants of Mothers with Chorioamnionitis.

The risk of infection in infants of mothers with chorioamnionitis (CAM) may be lower than previously reported. This study's objective was to determine the incidence of intrapartum fever (IPF) and culture-positive early-onset bacterial neonatal infection (CPEOI) in the late preterm and term infants of mothers with or without CAM and to assess interhospital variation in neonatal infection management. This retrospective cohort study included mothers and newborns delivered at ≥35 weeks gestation at Kaiser Permanente Southern California Hospitals in 2010 (n = 31,112). Electronic medical and laboratory records from 13 medical centers were examined for maternal temperature, intrapartum, and neonatal antibiotic treatment. Rates for IPF, CAM, and CPEOI were estimated. Rates for starting neonatal antibiotics were calculated. The incidence of IPF was 9% and CAM 4%. The overall rate for CPEOI was 0.61/1,000 (95% confidence interval [CI] 0.34, 0.89/1,000). The rate of CPEOI was 4.0/1,000 (95% CI 0.50, 7.5/1,000) in infants born to mothers with CAM. The rate of beginning antibiotics for infants born to mothers with CAM ranged from 7 to 76% between nurseries. The rate of CPEOI in infants born to mothers with CAM is lower than previously reported. There is heterogeneity in initiation of neonatal antibiotics by neonatologists.

Association of maternal diabetes with autism in offspring.

Information about the association of maternal diabetes and autism spectrum disorders (ASDs) in offspring is limited, with no report on the importance of timing of exposure during gestation. To assess ASD risk associated with intrauterine exposure to preexisting type 2 diabetes and gestational diabetes mellitus (GDM) by gestational age at GDM diagnosis. Retrospective longitudinal cohort study including 322 323 singleton children born in 1995-2009 at Kaiser Permanente Southern California (KPSC) hospitals. Children were tracked from birth until the first of the following: date of clinical diagnosis of ASD, last date of continuous KPSC health plan membership, death due to any cause, or December 31, 2012. Relative risks of ASD were estimated by hazard ratios (HRs) using Cox regression models adjusted for birth year. Maternal preexisting type 2 diabetes (n = 6496), GDM diagnosed at 26 weeks' gestation or earlier (n = 7456) or after 26 weeks' gestation (n = 17 579), or no diabetes (n = 290 792) during the index pregnancy. Clinical diagnosis of ASD in offspring. During follow-up, 3388 children were diagnosed as having ASD (115 exposed to preexisting type 2 diabetes, 130 exposed to GDM at ≤26 weeks, 180 exposed to GDM at >26 weeks, and 2963 unexposed). Unadjusted annual ASD incidences were 3.26, 3.02, 1.77, and 1.77 per 1000 among children of mothers with preexisting type 2 diabetes, GDM diagnosed at 26 weeks or earlier, GDM diagnosed after 26 weeks, and no diabetes, respectively. The birth year-adjusted HRs were 1.59 (95% CI, 1.29-1.95) for preexisting type 2 diabetes, 1.63 (95% CI, 1.35-1.97) for GDM diagnosed at 26 weeks or earlier, and 0.98 (95% CI, 0.84-1.15) for GDM diagnosed after 26 weeks relative to no exposure. After adjustment for maternal age, parity, education, household income, race/ethnicity, history of comorbidity, and sex of the child, maternal preexisting type 2 diabetes was not significantly associated with risk of ASD in offspring (HR, 1.21; 95% CI, 0.97-1.52), but GDM diagnosed at 26 weeks or earlier remained so (HR, 1.42; 95% CI, 1.15-1.74). Antidiabetic medication exposure was not independently associated with ASD risk. Adjustment for a mother or older sibling with ASD in the full cohort and for maternal smoking, prepregnancy body mass index, and gestational weight gain in the subset with available data (n = 68 512) did not affect the results. In this large, multiethnic clinical cohort of singleton children born at 28 to 44 weeks' gestation, exposure to maternal GDM diagnosed by 26 weeks' gestation was associated with risk of ASD in offspring.

Microbial Keratitis in Los Angeles: The Doheny Eye Institute and the Los Angeles County Hospital Experience

To evaluate the spectrum and antibiotic susceptibility panel of infectious keratitis at a major tertiary care referral eye center and a major county hospital in Southern California. Retrospective case series. All cultured infectious keratitis cases from July 1, 2008, through December 31, 2012, from the Doheny Eye Institute (DEI) and the Los Angeles County + University of Southern California Medical Center (LAC+USC) were evaluated. Microbiology records were reviewed retrospectively. Microbial isolates as well as antibiotic susceptibility patterns were analyzed. One hundred eighty-four (63%) of 290 cases showed positive culture results at DEI and 152 (82%) of 186 cases showed positive culture results at LAC+USC. Gram-positive pathogens were found to be the most common at both DEI (70%) and LAC+USC (68%), with coagulase-negative Staphylococcus being the most common gram-positive organism (58% at DEI and 44% at LAC+USC). Pseudomonas aeruginosa was the most common gram-negative organism (57% at DEI and 43% at LAC+USC). Ciprofloxacin and levofloxacin susceptibility for all tested pathogens was 73% at DEI and 81% at LAC+USC (P = 0.16). Oxacillin-resistant Staphylococcus aureus (ORSA) was found in 42% of cases at DEI and in 45% of cases at LAC+USC (P = 1.00). There is no significant difference in the spectrum of pathogens or antibiotic susceptibility of pathogens at DEI versus LAC+USC, and ORSA was found in approximately half of all S. aureus samples.

Job satisfaction, burnout, and stress among pediatric nurses in various specialty units at an acute care hospital

Aims: The aims of the study were to: assess job satisfaction, burnout, compassion satisfaction, and work-related stress among pediatric nurses at surgical, medical, critical care, and hematology/oncology units in a tertiary acute care hospital; and identify the predictors of job satisfaction, burnout, compassion satisfaction, and work-related stress. Methods: A cross-sectional study was conducted at a children’s hospital in southern California from February 2013 to March 2013. A convenience sample of registered nurses working in four different units (N = 240) completed the Professional Quality of Life, Brief Index of Affective Job Satisfaction, and demographic questionnaire. One-way Analysis of Variance (ANOVA) and simultaneous multiple regression procedures were performed. Results: Nurses in the hematology/oncology unit reported the lowest level of burnout and highest levels of job satisfaction and compassion satisfaction. In contrast, nurses in the surgical unit reported the opposite. Among surgical unit nurses, those with 5-9 years of RN experience reported highest burnout as well as lowest job satisfaction and compassion satisfaction. The combination of demographic variables explained a large fraction of the variance in job satisfaction ( R 2 = 0.251) and positive predictors were white ethnicity (β = 0.33) and hematology/oncology unit (β = 0.16), whereas negative predictors were surgical unit (β = -0.32) and critical care unit (β = -0.20). Conclusions: Nurses in the hematology/oncology unit reported lowest burnout and highest job satisfaction, which may be due to the educational and mentoring support from a unit-based end-of-life care program. A focused strategy targeting a specific group of nurses in a unit may help to reduce work-related stress and burnout.

Effects of the canine rattlesnake vaccine in moderate to severe cases of canine crotalid envenomation.

This is a retrospective multicenter study (2006–2012) examining a population of dogs with moderate to severe crotalid envenomation for protective effects of the canine rattlesnake vaccine. Five nonacademic emergency and referral veterinary hospitals in Southern California were involved in the study and contributed records regarding a total of 82 client-owned dogs that were treated for naturally occurring rattlesnake envenomation. All dogs received antivenin (Crotalidae) polyvalent, with dosages ranging from one to three vials (mean: 1.3±0.6). Fourteen dogs (17%) had a history of prior vaccination against crotalid venom. In univariate logistic regression modeling, cases with lower body weight (P=0.0001) or higher snakebite severity scores (P<0.0001) were associated with greater morbidity. No statistically significant difference in morbidity or mortality between vaccinated and unvaccinated dogs was found. The findings of this study did not identify a significantly protective effect of previous vaccination in the cases of moderate to severe rattlesnake envenomation that require treatment with antivenin.

Who is satisfied with general surgery clinic visits?

BackgroundPatient satisfaction is an important patient outcome because it informs researchers and practitioners about patients' experience and identifies potential problems with their care. Patient satisfaction is typically studied through physician–patient interactions in primary care settings, and little is known about satisfaction with surgical consultations. MethodsParticipants responded to questionnaires before and after a surgical consultation. The study was conducted in a diverse outpatient clinic within a county hospital in Southern California. Participants were patients who came to the surgery clinic for their first appointment after referral from a primary care provider for a surgical consultation. ResultsPatients' ethnicity, educational attainment, and insurance status predict their satisfaction, and patients reliably differed in their satisfaction with care providers and with the hospital where they received their care. ConclusionsThese findings add to knowledge about patient care by highlighting associations between patients' demographic characteristics and patients' differential satisfaction with particular entities within the context of surgical care.

Steadily Improving Survival in Lung Cancer

BackgroundNational data demonstrate minimal improvement in survival for patients diagnosed with lung cancer despite a number of apparent advances during the past 3 decades. We wished to know how demographic characteristics, staging, therapy, and survival have changed over time for patients with lung cancer who were accessioned to the cancer registry of a large community hospital in southern California. Patients and MethodsClinical features and survival data were collected on patients diagnosed during each of the successive 6-year eras of 1986 to 1991 (n = 812), 1992 to 1997 (n = 1072), 1998 to 2003 (n = 1209), and 2004 to 2009 (n = 1365). ResultsMedian survival improved from 11 to 13 to 16 to 26 months and overall 5-year survival steadily improved from 16.5% to 19.1% to 24.0% to 31.1%. The proportion of patients with localized disease at diagnosis increased from 18.4% to 24.1% to 24.9% to 31.6%. Improvements in relative survival were much greater than have occurred nationally. Other obvious trends over time were increasing age of patients, increasing proportions with diagnoses of adenocarcinoma with concomitant decreases in squamous cell and small cell histologies, and decreases in the proportion of large cell carcinoma with reciprocal increases in neuroendocrine diagnoses. The use of chemotherapy for patients with local disease tripled in the most recent era. ConclusionSurvival has steadily improved for patients in this community who were diagnosed with lung cancer. The explanations for this improvement are multifactorial, but include earlier stage at diagnosis, decreases in histologic types associated with active smoking, and increased use of systemic therapies.

Seasonality of immune-mediated hemolytic anemia in dogs from southern California.

To determine if there is seasonal variation in the incidence of canine idiopathic immune-mediated hemolytic anemia (IMHA) at 2 specialty hospitals in southern California. Retrospective study. To determine seasonality, cases of idiopathic IMHA presenting between June 2006 and June 2012 were identified by searching medical record databases of 2 large specialty hospitals. The presence of anemia with autoagglutination, spherocytosis or a positive Coomb's test and no identifiable underlying cause were required for inclusion. Dogs with a history of recent travel (within 1 year) were excluded. One hundred and twenty-six dogs, 57 from a practice in San Diego, and 69 from a practice in Los Angeles, met the criteria. The pattern of seasonality differed with practice location (P = 0.02). More cases of idiopathic IMHA presented during spring and summer (n = 39) than winter and fall (n = 18) for the San Diego practice (P = 0.008) but not the Los Angeles practice (n = 32 and 37, respectively, P = 0.63). The incidence of idiopathic IMHA in dogs presenting to specialty hospitals located in 2 different climates of southern California was different, suggesting environmental triggers may be involved. Larger, prospective studies are needed to determine whether environmental parameters or undetected infectious disease account for some cases of idiopathic IMHA in dogs.

Healthcare Utilization and Serious Infection Prevalence Associated With Penicillin “Allergy” In Hospitalized Patients: A Cohort Study

RationalePenicillin is the most common inaccurate drug “allergy” noted at hospital admission. Determine hospital utilization and prevalence rates of Clostridium difficile, methicillin resistant Staphylococcus aureus (MRSA), and vancomycin resistant enterococcus (VRE), in patients with and without penicillin “allergy”.MethodsA retrospective, matched cohort, study of individuals admitted to Kaiser Foundation hospitals in Southern California during 2010 through 2012.ResultsIt was possible to match 51,582 (99.6% of all possible cases) unique penicillin “allergic” hospitalized individuals to 2 unique control subjects each. Penicillin “allergic” cases averaged 0.59 (9.9%) [95% CI, 0.47 to 0.71] more total hospital days during 20.1 ± 10.5 months of follow-up, compared to discharge diagnosis category-, gender-, age-, and date of admission-matched controls. Cases were treated with significantly more fluoroquinolones, clindamycin, and vancomycin, p < 0.0001, compared to controls. Cases had 23.4% [95% CI, 15.6% to 31.7%] more Clostridium difficile, 14.1% [95% CI, 7.1% to 21.6%] more MRSA, and 30.1% [95% CI, 12.5% to 50.4%] more VRE infections than expected, compared to controls. When adding matching for the number of drug “allergies”, differences between cases and controls disappeared, but a strong positive correlation was seen for all 4 outcome variables and increasing drug “allergy” number in both cases and controls.ConclusionsA drug “allergy” history though often inaccurate, is not a benign finding at hospital admission. Drug “allergies” are associated with increased hospital utilization and increased Clostridium difficile, MRSA, and VRE prevalence. RationalePenicillin is the most common inaccurate drug “allergy” noted at hospital admission. Determine hospital utilization and prevalence rates of Clostridium difficile, methicillin resistant Staphylococcus aureus (MRSA), and vancomycin resistant enterococcus (VRE), in patients with and without penicillin “allergy”. Penicillin is the most common inaccurate drug “allergy” noted at hospital admission. Determine hospital utilization and prevalence rates of Clostridium difficile, methicillin resistant Staphylococcus aureus (MRSA), and vancomycin resistant enterococcus (VRE), in patients with and without penicillin “allergy”. MethodsA retrospective, matched cohort, study of individuals admitted to Kaiser Foundation hospitals in Southern California during 2010 through 2012. A retrospective, matched cohort, study of individuals admitted to Kaiser Foundation hospitals in Southern California during 2010 through 2012. ResultsIt was possible to match 51,582 (99.6% of all possible cases) unique penicillin “allergic” hospitalized individuals to 2 unique control subjects each. Penicillin “allergic” cases averaged 0.59 (9.9%) [95% CI, 0.47 to 0.71] more total hospital days during 20.1 ± 10.5 months of follow-up, compared to discharge diagnosis category-, gender-, age-, and date of admission-matched controls. Cases were treated with significantly more fluoroquinolones, clindamycin, and vancomycin, p < 0.0001, compared to controls. Cases had 23.4% [95% CI, 15.6% to 31.7%] more Clostridium difficile, 14.1% [95% CI, 7.1% to 21.6%] more MRSA, and 30.1% [95% CI, 12.5% to 50.4%] more VRE infections than expected, compared to controls. When adding matching for the number of drug “allergies”, differences between cases and controls disappeared, but a strong positive correlation was seen for all 4 outcome variables and increasing drug “allergy” number in both cases and controls. It was possible to match 51,582 (99.6% of all possible cases) unique penicillin “allergic” hospitalized individuals to 2 unique control subjects each. Penicillin “allergic” cases averaged 0.59 (9.9%) [95% CI, 0.47 to 0.71] more total hospital days during 20.1 ± 10.5 months of follow-up, compared to discharge diagnosis category-, gender-, age-, and date of admission-matched controls. Cases were treated with significantly more fluoroquinolones, clindamycin, and vancomycin, p < 0.0001, compared to controls. Cases had 23.4% [95% CI, 15.6% to 31.7%] more Clostridium difficile, 14.1% [95% CI, 7.1% to 21.6%] more MRSA, and 30.1% [95% CI, 12.5% to 50.4%] more VRE infections than expected, compared to controls. When adding matching for the number of drug “allergies”, differences between cases and controls disappeared, but a strong positive correlation was seen for all 4 outcome variables and increasing drug “allergy” number in both cases and controls. ConclusionsA drug “allergy” history though often inaccurate, is not a benign finding at hospital admission. Drug “allergies” are associated with increased hospital utilization and increased Clostridium difficile, MRSA, and VRE prevalence. A drug “allergy” history though often inaccurate, is not a benign finding at hospital admission. Drug “allergies” are associated with increased hospital utilization and increased Clostridium difficile, MRSA, and VRE prevalence.

Pain management at home in children with cancer: A daily diary study

With the transition of care of cancer patients from the hospital to the home setting, parents are largely responsible for children's pain management. Children's cancer pain is undermanaged, yet, there is little empirical data on the occurrence and management of cancer pain in the home setting. The purpose of the present study, therefore, was to employ a daily diary protocol to examine barriers to pain management of children's cancer pain by parents at home. Parent-child dyads were recruited from the Cancer Institute at a major children's hospital in Southern California. A total of 45 patient/parent pairs completed baseline data on demographic and personality characteristics, children's quality of life, and parental beliefs regarding analgesic use for children and then completed daily diaries of pain and analgesic administration for 14 consecutive days. Most children were reported to experience chronic pain while undergoing treatment for cancer, yet overall analgesic administration at home was low. Parents who reported misconceptions regarding analgesic use for children were less likely to administer pain medication to children. Children who were less shy, more social, or had lower quality of life were more likely to receive analgesics. A significant proportion of children receiving outpatient treatment for cancer were rated as experiencing chronic pain and pain was not optimally managed in the home setting. Further understanding and addressing barriers to children's cancer pain management in the home setting will aid in alleviating unnecessary pain in this vulnerable patient population.

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Introduction: BRH is a 105-bed LTAC hospital network that serves as a regional weaning center, accepting chronically critically ill (CCI) patients transferred from the ICUs of hospitals in southern California. Herein we report updates to patient characteristics, weaning outcomes, and discharge dispo

Transforming care through leadership and research alignment

Transforming care through leadership and research alignment

Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: A cohort study

Penicillin is the most common drug "allergy" noted at hospital admission, although it is often inaccurate. We sought to determine total hospital days, antibiotic exposures, and the prevalence rates of Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) in patients with and without penicillin "allergy" at hospital admission. We performed a retrospective, matched cohort study of subjects admitted to Kaiser Foundation hospitals in Southern California during 2010 through 2012. It was possible to match 51,582 (99.6% of all possible cases) unique hospitalized subjects with penicillin "allergy" to 2 unique discharge diagnosis category-matched, sex-matched, age-matched, and date of admission-matched control subjects each. Cases with penicillin "allergy" averaged 0.59 (9.9%; 95% CI, 0.47-0.71) more total hospital days during 20.1 ± 10.5 months of follow-up compared with control subjects. Cases were treated with significantly more fluoroquinolones, clindamycin, and vancomycin (P < .0001) for each antibiotic compared with control subjects. Cases had 23.4% (95% CI, 15.6% to 31.7%) more C difficile, 14.1% (95% CI, 7.1% to 21.6%) more MRSA, and 30.1% (95% CI, 12.5% to 50.4%) more VRE infections than expected compared with control subjects. A penicillin "allergy" history, although often inaccurate, is not a benign finding at hospital admission. Subjects with a penicillin "allergy" history spend significantly more time in the hospital. Subjects with a penicillin "allergy" history are exposed to significantly more antibiotics previously associated with C difficile and VRE. Drug "allergies" in general, but most those notably to penicillin, are associated with increased hospital use and increased C difficile, MRSA, and VRE prevalence.

Acute pyelonephritis in pregnancy: an 18-year retrospective analysis

We sought to describe the incidence of acute pyelonephritis in pregnancy, and to assess its association with perinatal outcomes in an integrated health care system. A retrospective cohort study was performed using medical records on 546,092 singleton pregnancies delivered in all Kaiser Permanente Southern California hospitals from 1993 through 2010. These medical records include the perinatal service system along with inpatient and outpatient encounter files. Adjusted odd ratios (ORs) and 95% confidence intervals (CIs) were used to estimate associations. The incidence of acute antepartum pyelonephritis was 0.5% (2894/543,430). Women with pyelonephritis in pregnancy were more likely to be black or Hispanic, young, less educated, nulliparous, initiate prenatal care late, and smoke during pregnancy. Pregnancies of women with pyelonephritis compared to those without were more likely to be complicated by anemia (26.3% vs 11.4%; OR, 2.6; 95% CI, 2.4-2.9), septicemia (1.9% vs 0.03%; OR, 56.5; 95% CI, 41.3-77.4), acute pulmonary insufficiency (0.5% vs 0.04%; OR, 12.5; 95% CI, 7.2-21.6), acute renal dysfunction (0.4% vs 0.03%; OR, 16.5; 95% CI, 8.8-30.7), and spontaneous preterm birth (10.3% vs 7.9%; OR, 1.3; 95% CI, 1.2-1.5). Most of the preterm births occurred between 33-36 weeks (9.1%). We characterize the incidence of pyelonephritis in an integrated health care system where routine prenatal screening for asymptomatic bacteriuria is employed. Maternal complications are commonly encountered and the risk of preterm birth is higher than the baseline obstetric population.

Outcome of Abdominal Wall Hernia Repair with Permacol™ Biologic Mesh

The use of biologic mesh in abdominal wall operations has gained popularity despite a paucity of outcome data. We aimed to review the experience of a large healthcare organization with Permacol™. A retrospective study was conducted of patients who underwent abdominal hernia repair with Permacol™ in 14 Southern California hospitals. One hundred ninety-five patients were analyzed over a 4-year period. Operations included ventral/incisional hernia repairs, ostomy closures, parastomal hernia repairs, and inguinal hernia repairs. In 50 per cent of the patients, Permacol™ was used to reinforce a primary fascial repair and in 50 per cent as a fascial bridge. The overall complication rate was 39.5 per cent. The complication rate was higher in patients with infected versus clean wounds, body mass index (BMI) 40 kg/m(2) or greater versus BMI less than 40 kg/m(2), in patients with prior mesh repair, and when mesh was used as a fascial bridge. With a mean follow-up of 2.1 years, morbid obesity was associated with a higher recurrence. To date this is the largest study on the use of Permacol™ in abdominal wall hernia repair. In our patient population undergoing heterogeneous operations with a majority of wounds as Class II or higher, use of Permacol™ did not eliminate wound morbidity or prevent recurrence, especially in morbidly obese patients.

Consumer Nutrition Environments of Hospitals: An Exploratory Analysis Using the Hospital Nutrition Environment Scan for Cafeterias, Vending Machines, and Gift Shops, 2012

IntroductionHospitals are the primary worksite of over 5 million adults in the United States, and millions of meals are procured and consumed in this setting. Because many worksite nutrition initiatives use an ecological framework to improve the dietary habits of employees, the nutrition values of foods served in hospitals is receiving attention.MethodsThis study used the Hospital Nutrition Environment Scan for Cafeterias, Vending Machines, and Gift Shops to quantitatively describe the consumer nutrition environments of 39 hospitals in Southern California. Data were collected by visiting each facility once from February 2012 through May 2012.ResultsOn average, hospitals achieved only 29%, 33%, and less than 1% of the total possible points for their cafeteria, vending machines, and gift shops sections, respectively; overall, hospitals scored 25% of the total possible points. Large facility size and contracted food service operations were associated with some healthy practices in hospital cafeterias, but we found no association between these variables and the sectional or overall nutrition composite scores.ConclusionThe average consumer nutrition environment of hospitals in this sample was minimally conducive to healthful eating. Nutrition-related interventions are warranted in hospital settings.

Reliability of the Hospital Nutrition Environment Scan for Cafeterias, Vending Machines, and Gift Shops

According to ecological models, the physical environment plays a major role in determining individual health behaviors. As such, researchers have started targeting the consumer nutrition environment of large-scale foodservice operations when implementing obesity-prevention programs. In 2010, the American Hospital Association released a call-to-action encouraging health care facilities to join in this movement and improve their facilities' consumer nutrition environments. The Hospital Nutrition Environment Scan (HNES) for Cafeterias, Vending Machines, and Gift Shops was developed in 2011, and the present study evaluated the inter-rater reliability of this instrument. Two trained raters visited 39 hospitals in southern California and completed the HNES. Percent agreement, kappa statistics, and intraclass correlation coefficients were calculated. Percent agreement between raters ranged from 74.4% to 100% and kappa statistics ranged from 0.458 to 1.0. The intraclass correlation coefficient for the overall nutrition composite scores was 0.961. Given these results, the HNES demonstrated acceptable reliability metrics and can now be disseminated to assess the current state of hospital consumer nutrition environments.

Examining the Predictors of Postoperative Nausea and Vomiting in Women Following Cesarean Delivery

Childbearing Poster Presentation Objective To answer the following research questions: What is the incidence and severity of postoperative nausea and vomiting (PONV) for women during the 24‐hour period following surgery? What are the relationships between sociodemographics, obstetric/gynecologic (OB‐GYN) history and antiemetic received (e.g., type(s), timing, and frequency) and incidence and severity of PONV? Does the timing, type, and frequency of antiemetic use predict the incidence and severity of PONV when other known predictors are considered? Design Retrospective descriptive correlational design. Setting A 600‐bed community hospital in Southern California. Sample Sixty women: White (61.7%), African American (1.7%), Hispanic (11.7%), Asian (18.3%), and nonspecified (6.6%) who had cesarean delivery. Methods Information related to sociodemographic characteristics, medical and OB‐GYN history, treatment received during cesarean delivery, incidence and severity of PONV, and treatment measures received and outcomes were abstracted from the medical records following receipt of Institutional Review Board approval. Results Thirty women (50%) complained of PONV during the 24‐hour period after surgery. The use of antiemetic during and after surgery immediately and the use of multimodal versus single therapy were associated with decreased incidence and severity of PONV ( p p = .018, respectively). In a multivariate model, these two variables accounted for 48% of the variance in PONV while age, type of anesthesia used, history of PONV, and gravidity and parity were controlled for. Conclusion/Implications for Nursing Practice PONV is a common complaint of women who receive intrathecal morphine for analgesia during cesarean delivery. There is a paucity of evidence to support implementation of strategies to reduce PONV and minimize the negative outcomes associated with PONV following cesarean delivery. Findings show that the use of multimodal antiemetics during and after cesarean delivery immediately reduces the incidence and severity of PONV. Prospective studies examining the predictors of PONV in women after cesarean delivery are warranted to better explain this phenomenon and to guide clinical nurses into the development of policies and pathways to help reduce PONV in specified populations and to collaborate mother–infant care with other healthcare providers.

Retrospective analysis of clinical findings and outcome of cats with suspected rattlesnake envenomation inSouthernCalifornia: 18 cases (2007–2010)

To evaluate treatment and survival rates of cats with suspected rattlesnake envenomation. Retrospective study. Veterinary emergency referral hospital in Southern California. Client-owned animals. None. Eighteen cats were treated for suspected rattlesnake envenomation between January 2007 and August 2010. There were 3 fatalities and 15 cats survived (16% mortality rate). Two cases developed pelvic limb paresis 3-4 days post envenomation. There were no apparent adverse reactions to treatment with antivenom. Cats are presented infrequently for treatment of envenomation compared to dogs. Envenomation in cats should be treated according to guidelines established for people and dogs and administration of antivenom does not appear to be associated with adverse events. The mortality rate in this study was found to be 16%, which is higher than the mortality rate reported for dogs suspected of rattlesnake envenomation in a similar region (4.1%). Pelvic limb paresis may develop 3-4 days post envenomation but can resolve within 24 hours.

Responses to Mantram Repetition Program from Veterans with posttraumatic stress disorder: A qualitative analysis

This study describes ways in which a Mantram Repetition Program (MRP) was used for managing posttraumatic stress disorder (PTSD) symptoms in 65 outpatient Veterans with PTSD. The MRP consisted of six weekly group sessions (90 min/wk) on how to (1) choose and use a mantram, (2) slow down thoughts and behaviors, and (3) develop one-pointed attention for emotional self-regulation. Critical incident research technique interviews were conducted at 3 mo postintervention as part of a larger randomized clinical trial. The setting was an academic-affiliated Department of Veterans Affairs hospital in southern California. Categorization and comparison of the types and frequency of incidents (i.e., triggering events) were collected. Participants reported a total of 268 triggering events. Content analysis of the outcomes resulted in 12 discreet categories, including relaxing and calming down, letting go of negative feelings, thinking clearly and rationally, diverting attention away from triggering events, focusing attention, refining mantram skills, dealing with sleep disturbances, coming back from flashbacks, slowing down, communicating thoughts and feelings more effectively, feeling in touch spiritually, and letting go of physical pain. The study shows that the MRP was helpful in managing a wide range of emotional reactions in Veterans with PTSD.