Narrow and broad phenotype BPD children have high rates of comorbid anxiety, although only in the narrow phenotype group is comorbid anxiety associated with greater functional impairment BPD plus comorbid anxiety may represent a particularly severe phenotype of pediatric BPD.
OBJECTIVE:To evaluate the feasibility, acceptability, and compliance of a remote blood pressure monitoring protocol implemented as a quality improvement measure at the hospital level for management of hypertension in postpartum women after hospital discharge. METHODS:This is an ongoing quality improvement project that included women admitted to the postpartum unit of a single tertiary care hospital. We designed nursing call center-driven blood pressure management and treatment algorithms which were initiated after hospital discharge until 6 weeks postpartum. Women are eligible to participate if they have a diagnosis of chronic hypertension, superimposed preeclampsia, gestational hypertension, preeclampsia, or postpartum hypertension and have access to a text messaging-enabled smartphone device. After identification by an obstetric care provider, women are enrolled into the program, which is automatically indicated in the electronic medical record. Maternal, obstetric, and sociodemographic data were obtained from the electronic medical record. RESULTS:Between February 2018 and January 2019, we enrolled 499 patients. Here we report on the first 409 enrolled patients. Participants include 168 (41%) with gestational hypertension, 179 (44%) with preeclampsia with no history of chronic hypertension, 49 (12%) with chronic hypertension with superimposed preeclampsia, and 13 (3%) with postpartum preeclampsia. One hundred seventy-one (42%) participants had antihypertensives initiated or titrated through the program. Three hundred forty women (83%) continued the program beyond 3 weeks postpartum, and 360 (88%) attended an in-person 6-week postpartum visit. Two hundred thirty-five out of 250 women who completed a postprogram survey (94%) reported satisfaction with the program. CONCLUSION:In this study, we detail results from an ongoing remote blood pressure monitoring program. We demonstrate high compliance, retention, and patient satisfaction with the program. This is a feasible, scalable remote monitoring program connected to the electronic medical record.
OBJECTIVE To compare the pharmacokinetics of 2g and 3g doses of cefazolin when used for peri-operative prophylaxis in obese gravidae undergoing cesarean delivery. STUDY DESIGN We performed a double-blinded randomized controlled trial from August 2013 to April 2014. Twenty-six obese women were randomized to receive either 2g or 3g IV cefazolin within 30min of skin incision. Serial maternal plasma samples were obtained at specific time points up to 8hrs after drug administration. Umbilical cord blood was obtained after placental delivery. Maternal adipose samples were obtained prior to fascial entry, after closure of the hysterotomy and subsequent to fascial closure. Pharmacokinetic parameters were determined via non-compartmental analysis. RESULTS The median area under the plasma concentration vs. time curve was significantly greater in the 3g group than in the 2g group (27204 μg/mL/min vs. 14058 μg/mL/min: p=0.001). Maternal plasma concentrations were impacted by body mass index. For every 1 kg/m2 increase in body mass index at time of cesarean delivery, there was an associated 13.77μg/mL lower plasma concentration of cefazolin across all time points (p=0.01). By the completion of cesarean delivery, cefazolin concentrations in maternal adipose were consistently above the minimal inhibitory concentration for both gram-positive and gram-negative bacteria with both the 2g and 3g doses. The median umbilical cord blood concentrations were significantly higher in the 3g vs. the 2g group (34.5 μg/mL and 21.4 μg/mL: p=.003). CONCLUSION Cefazolin concentrations in maternal adipose both at time of hysterotomy closure and fascial closure were above the minimal inhibitory concentration for both gram-positive and gram-negative bacteria when either 2g or 3g cefazolin was administered as perioperative surgical prophylaxis. Maternal cefazolin concentrations in plasma and maternal adipose tissue are related to both dose and body mass index.
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