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The experiences and support needs of adolescent mothers who commenced breastfeeding were elicited using focus groups and in-depth semistructured interviews. The study took place in the North West of England, UK. The qualitative data were analyzed using thematic networks analysis. Five themes related to experiences emerged: feeling watched and judged, lacking confidence, tiredness, discomfort, and sharing accountability. A further 5 themes were developed to describe the adolescents' support needs: emotional support, esteem support, instrumental support, informational support, and network support. These forms of support were most effective when provided together in a synergistic way and within a trusting relationship. Key supporters identified were the mother's mother, the partner, and the midwife employed in a teenage pregnancy coordinator role. Health professionals need to further explore the ways in which relationships may be developed and sustained that provide the range of support required by adolescent mothers to enable them to continue breastfeeding.

A pragmatic, single blind, randomised, controlled trial was conducted to test the hypothesis that superficial dry needling (SDN) together with active stretching is more effective than stretching alone, or no treatment, in deactivating trigger points (TrPs) and reducing myofascial pain. Forty patients with musculoskeletal pain, referred by GPs for physiotherapy, fulfilled inclusion / exclusion criteria for active TrPs. Subjects were randomised into three groups: group 1 (n=14) received superficial dry needling (SDN) and active stretching exercises (G1); group 2 (n=13) received stretching exercises alone (G2); and group 3 (n=13) were no treatment controls (G3). During the three-week intervention period for G1 and G2, the number of treatments varied according to the severity of the condition and subject/clinician availability. Assessment was carried out pre-intervention (M1), post-intervention (M2), and at a three-week follow up (M3). Outcome measures were the Short Form McGill Pain Questionnaire (SFMPQ) and Pressure Pain Threshold (PPT) of the primary TrP, using a Fischer algometer. Ninety-one per cent of assessments were blind to grouping. At M2 there were no significant inter-group differences, but at M3, G1 demonstrated significantly improved SFMPQ versus G3 (p=0.043) and significantly improved PPT versus G2 (p=0.011). There were no differences between G2 and G3. The mean PPT and SFMPQ scores correlated significantly in G1 only, though no significant inter-group differences were demonstrated. Numbers of patients requiring further treatment following the trial were: 6 (G1); 12 (G2); 9 (G3). Conclusion: SDN followed by active stretching is more effective than stretching alone in deactivating TrPs (reducing their sensitivity to pressure), and more effective than no treatment in reducing subjective pain. Stretching without prior deactivation may increase TrP sensitivity.

Objectives: Postintubation hemodynamic instability (PIHI) is a potentially life-threatening adverse event of emergent endotracheal intubation. The objectives of this study were to determine the incidence, risk factors, and impact on patient outcomes associated with PIHI in intubations performed in emergency medicine. Methods: A structured chart audit was performed of all consecutive adult patients requiring emergent endotracheal intubations over a 16-month period at a tertiary care emergency department (ED). Data collection included medications, comorbidities, vital signs in the 30 minutes before and after intubation, hospital length of stay, and in-hospital mortality. PIHI was defined as a decrease in systolic blood pressure (SBP) to # 90 mm Hg, a decrease in SBP of $ 20% from baseline, a decrease in mean arterial pressure to # 65 mm Hg, or the initiation of any vasopressor medication at any time in the 30 minutes following intubation. Results: Overall, 218 patients intubated in the ED were identified, and 44% (96 of 218) developed PIHI. On multivariate analysis, increasing age (OR 1.03, 95% CI 1.01-1.05), chronic obstructive pulmonary disease (OR 3.00, CI 1.19-7.57), and pre-emergent endotracheal intubation hemodynamic instability (OR 2.52, 95% CI 1.27-4.99) were associated with the development of PIHI. The use of a neuromuscular blocking medication was associated with a decreased incidence of PIHI (OR 0.34, 95% CI 0.16-0.75). Conclusions: Based on our data, postintubation hypotension occurs in a significant proportion of ED patients requiring emergent airway control. Further investigation is needed to confirm the factors we found to be associated with PIHI and to determine if PIHI is associated with increased morbidity and mortality. RÉ SUMÉObjectifs: L'instabilité hé modynamique aprè s intubation (IHAI) est un effet indé sirable qui peut mettre la vie en danger lors d'une intubation traché ale d'urgence. Cette é tude visait à é tablir l'incidence, les facteurs de risque, et les ré percussions sur les ré sultats pour les patients associé s à l'IHAI lors d'une intubation en mé decine d'urgence. Mé thodes: Une vé rification structuré e des dossiers a é té effectué e pour tous les patients adultes consé cutifs ayant né cessité une intubation traché ale d'urgence sur une pé riode de 16 mois dans un service des urgences (SU)_de soins tertiaires. Les donné es recueillies portant notamment sur les mé dicaments, les comorbidité s, et les signes vitaux dans les 30 minutes pré cé dant et suivant l'intubation, la duré e de l'hospitalisation, et le taux de dé cè s à l'hô pital. L'IHAI a é té dé finie comme une diminution de la tension arté rielle systolique (TAS) à # 90 mm Hg, une diminution de la TAS de $ 20 % par rapport à la ré fé rence de base, une diminution de la tension arté rielle moyenne à # 65 mm Hg, ou l'administration de tout mé dicament vasopresseur à n'importe quel moment dans les 30 minutes suivant l'intubation. Ré sultats: Au total, 218 patients intubé s au SU ont é té identifié s et 44 % (96 sur ...

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Among adult patients with intrabiliary stents, the use of a dual-ring wound protector during PD significantly reduces the risk of incisional SSI.

Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery.