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Background: In recent years, the Accreditation Council for Graduate Medical Education (ACGME), and the Ambulatory Pediatric Association (APA) have developed detailed resident learning objectives and competencies. Maintaining adequate documentation that residents are fulfilling these objectives and competencies is a challenge. Objectives: To develop and evaluate use of an internet based curriculum, EPIC (East Tennessee Pediatric Internet Curriculum) to facilitate teaching and evaluation of the core competencies. Methods: Goals and content for the site were developed based on literature review and input from a pediatric internet committee. Resident internet-based learning is being evaluated using pre- and post- surveys over a six month period. Results: EPIC is a central location for residents to access information, including announcements, phone lists, and scheduling information. Educational content is organized around the six core competencies for resident education. For example, “Medical Knowledge”consists of a portfolio system developed for the ambulatory clinic. Portfolios include a checklist of pertinent information to be covered during a patient encounter and a related downloadable article to enhance resident knowledge. The section also includes links to other learning resources. An interactive discussion forum exists to facilitate discourse on medical and residency-related topics. Residents also complete online pre- and post- test questions during every clinical rotation and receive instant feedback on their responses. All 11 residents completed the pre-survey. Frequent or very frequent internet use was reported by 54% of residents to answer specific clinical questions and 45% of residents for general medical learning during the work day. Conclusion: Pediatric residents already utilize the internet to access medical information. EPIC accommodates residents’varying schedules and is a useful adjunct to other teaching and evaluation methods.

Case Report: Through the Tennessee Initiative for Perinatal Quality Care (www.tipqc.org), four pilot prenatal (Family Medicine and OB-GYN) practices representing academic and private groups from across the state established primary improvement teams including relevant stakeholders. An online toolkit of evidence-based practices and published tools from the AAP, ACOG, ABM, and elsewhere was developed by an interdisciplinary team and provided to pilot practices. The toolkit included a menu of “potentially better practices” (PBPs) that could be implemented individually, or as a bundle. Success of this project relied on use of rapid Plan-Do-Study-Act (PDSA) cycles. Pilot practices were educated on basic QI procedures, data collection, toolkit content, etc. and shared experiences through monthly webinars called “Huddles”. Regional trainings were also provided at various intervals by the TIPQC staff. Before implementation of a PBP, each practice collected their baseline breastfeeding rate at the 4-8 week postpartum visit. Practices used a web-based, HIPAA-compliant data-entry system through REDCap. The project was reviewed and approved by the Institutional Review Boards (IRBs) of participating pilots, and funded under an agreement with the state of Tennessee. PBPs implemented by the pilot practices included: - Providing resident and provider education - Distributing written literature on breastfeeding benefits and advice - Providing written breastfeeding prescriptions - Having patients view educational breastfeeding videos - Creating a breastfeeding-friendly office environment Baseline pilot data revealed that at presentation for the first postpartum visit, 28.1%, 23%, and 49% of mothers were exclusively feeding breastmilk, feeding a mix of breastmilk and formula, and exclusively feeding formula, respectively (n=196). Baseline data was successfully collected, and early data following the first PDSA has been collected across the four pilot participants. For participating practices, this is the first time they have systematically looked at their 6-week breastfeeding rates. Open communication and brainstorming across the various practices has been very helpful. A numbers of challenges have been cited, including time constraints related to large volumes of patients and inability to extract data electronically, coordination of efforts among large numbers of providers and staff who may be unfamiliar with breastfeeding, and a need for more family, hospital, and community provider support for breastfeeding. Discussion: This quality improvement prenatal breastfeeding promotion pilot project provides insight into the process of team building and use of thin data sets to drive practice level improvement, and lays the groundwork for statewide spread, where challenges encountered in the pilot centers can be addressed. Participants are now looking at the reliability of their implementation, and determining whether their initial selections from the menu/toolkit were effective.

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StatPearls Publishing Review Series strives to help you learn the pearls in pediatrics. This text contains 1000 multiple-choice questions with explanations that are linked to additional online references.

Thesis M. Med.(Family Medicine))University of Limpopo (Medunsa Campus), 2010. / The experience of child birth occurs in all cultures and is important for the continuation of a community. Beliefs related to pregnancy and child birth though usually harmless may at times be detrimental to the health and well being of women that may practice them. The adherence to such beliefs depends on the socio cultural background of individuals and the importance they place on their cultural practices. Aim and objectives The study aimed to explore the health beliefs regarding pregnancy and childbirth of women attending the antenatal clinic at Chawama Health Center in Lusaka Zambia. The main study objectives were to determine the demographic characteristics of the women and ascertain their beliefs regarding diet, behaviour and belief in the use of herbs during pregnancy, delivery and the post natal period. Methods A descriptive, cross-sectional survey was conducted. A 32 item questionnaire was administered to 294 women over a four week period by two research assistants, after obtaining informed consent. Results Results indicate that traditional beliefs were wide spread among the participants though few significant associations were demonstrated. Dietary beliefs that what is eaten could ix affect the progress of labor or the unborn child’s appearance or behaviour were popular. Negative behaviour such as quarrelling or infidelity was believed could lead to difficult labour or adverse outcomes. Herbs were generally believed to be useful for certain indications such as to assist labour or for ‘cleansing’ after miscarriage. Conclusion Health beliefs regarding pregnancy and child birth are an integral part of the community and to be discussed in order to have some influence on them. Continued dialogue is recommended though current clinic health education sessions and qualitative studies to explore other beliefs and myths that are arising out of new health concerns such as HIV.

The purpose of this study was to describe the lived experience of hope for mothers of premature infants in the Neonatal Intensive Care Unit (NICU). This study was grounded in the existential-phenomenologic philosophy of Merleau-Ponty. A purposive sample of six mothers of infants born between 23 ½ and 31 weeks gestation were interviewed by the researcher 10 months to 2 ½ years after birth. Mothers were asked to think back to when their infant was in the NICU and tell about a specific time when they were aware of hope. Interviews were transcribed verbatim and analyzed following a hermeneutic process developed by Thomas & Pollio (2002). Data analysis revealed consistent themes across participants. The contextual ground was the World of the NICU—a world in which uncertainty, powerlessness, and the marking of time from admission until discharge were set against the backdrop of an unfamiliar environment perceived as negative by mothers. In this context hope emerged from within the mother-infant relationship. Three themes were figural in the mothers’ experience of hope: 1) hope and the infant, 2) hope and others, and 3) hope and the mother. Mothers took their cues to have hope directly from their infant(s). Discouraging or encouraging events dictated the extent to which mothers felt hopeful. Others had a powerful influence, either supporting or threatening mothers’ fragile hope. Sub-themes in hope and the mother were: 1) lack of knowledge/uncertainty, 2) lack of control/powerlessness, and 3) feeling like a mother. Noteworthy findings included the delayed onset of an awareness of hope—often several weeks after birth. Mothers focused solely on their infants; others became figural as they affected hope within the mother/infant dyad. They appreciated nurses who went the extra mile to encourage hope. The negative attitude or biting words of a single nurse quickly destroyed hope. Mothers rarely mentioned fathers, which suggests their lesser role in supporting hope. Mothers used the internet to reach out to others as there was limited opportunity for parent-to-parent interaction. They felt constrained to interact with other families by the emphasis on privacy related to HIPAA rules.

The relationship between parent and child is one of the most important and most studied of all human relationships. The purpose of this descriptive study was to compare first-time fathers’ attendance at an entire series of prepared childbirth classes and presence at the delivery with father-infant acquaintance/attachment at three to four months post-birth. First-time fathers living with the infant’s mother were asked to complete the How I Feel About My Baby Now scale and a demographic survey. Two groups of fathers were compared. The first group attended classes, and the other group did not attend classes. Results of a statistical analysis utilizing descriptive statistics, t-tests, and one way ANOVA indicated that fathers who attended the classes felt significantly more angry at their babies than those who did not, and that fathers in the group under 30 years of age felt more playful toward their babies than those over thirty years.

The purpose of this dissertation research was to examine the associations among racial discrimination, social support, and psychological distress among Black pregnant women. The dissertation was guided by the Ecological Systems theory which has three domains that pertain to this research: individual, interpersonal, and community. A literature review was conducted to investigate what is known about the association between racial discrimination and psychological distress among Black pregnant women. This review found that seventeen of the nineteen studies included reported a positive association between racial discrimination and psychological distress among Black pregnant or postpartum women. Limited research focused on the potential moderating effect of social support on the association between racial discrimination with psychological distress among Black pregnant women. Using a cross-sectional design, this dissertation research examined the moderating effect of social support on the association of racial discrimination with psychological distress among a sample of 599 Black pregnant women. I found that experiences of racial discrimination were related to lower levels of social support and higher levels of psychological wellbeing among these women. Social support related to lower levels of psychological wellbeing; however, social support did not moderate the association of racial discrimination with psychological distress in this sample. Finally, I found that the most frequently reported experiences of discrimination were in a store or restaurant and on the street or public setting and the least frequently reported experience was getting medical care among women in this study. Women who reported discrimination in all, but one situation reported lower levels of psychological wellbeing compared with women who did not report discrimination in these situations. This dissertation research adds to the knowledge related to the associations among racial discrimination, social support, and psychological distress among Black pregnant women.

The purpose of this dissertation research was to examine the associations among experiences of racial discrimination, perceived stress and birth satisfaction among Black women, and to examine the mediating effect of perceived stress on the association of experiences of racial discrimination with birth satisfaction among Black women. The first manuscript is an integrative literature review which evaluates prior research of the association of stress with birth satisfaction, with consideration to studies that included Black women in their samples. This review revealed a need for further research evaluating stress and birth satisfaction specific to Black women. The second manuscript examines the associations among racial discrimination, perceived stress, and birth satisfaction among a sample of 154 Black women. Experiences of racial discrimination were positively correlated with perceived stress. Perceived stress was negatively correlated with birth satisfaction. Experiences of discrimination were not related to birth satisfaction. Racial discrimination had a positive effect on perceived stress, and perceived stress had a negative effect on birth satisfaction. Racial discrimination had no direct effect on birth satisfaction; therefore, perceived stress was not applicable as a mediator in the model. The third manuscript presents challenges and successful strategies faced in the recruitment and retention of Black women in the immediate postpartum period. This dissertation adds to the current body of knowledge regarding the effects of racial discrimination on perceived stress, and the relationship between perceived stress and birth satisfaction, while also presenting successful recruiting strategies of Black postpartum women in nursing research, which is crucial to reducing racial disparities in health care.