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Care of the dying newborn: perinatal hospice, research, and practice
the operative procedure performed. The resident either viewed the CD-ROM or read the text model the evening before the surgery and then filled out a questionnaire afterward. Operations included TAH/BSO, TVH/BSO, cold knife conization, anterior colporrhaphy, perineorrhaphy, and Burch retropubic urethropexy. Helpfulness with indications, pelvic anatomy, understanding of techniques/methods, learning the names and uses of surgical instruments, and completing dictation were assessed in a rating system of 0 (not helpful) to 7 (extremely helpful). Results: During the study period, six residents completed questionnaires in both groups (CD-ROM, text group). The mean differences in resident evaluation of the surgical indications were 2.67 (Mann-Whitney rank sum, P ⫽ 0.0022); pelvic anatomy, 3.0 (Mann-Whitney rank sum, P ⫽ 0.0065); surgical techniques, 1.83 (Mann-Whitney rank sum, P ⫽ 0.0082); knowledge and use of instruments, 3.0 (Mann-Whitney rank sum, P ⫽ 0.0022); aid in completing surgical dictations, 3.167 (Mann-Whitney rank sum, P ⫽ 0.0022); and overall usefulness: 2.33 (Mann-Whitney rank sum, P ⫽ 0.0022). Conclusion: One of the biggest complaints from junior residents has been the lack of good photographs in traditional surgical textbooks. The residents in this study felt that the photographs shown on the CD-ROM better aided their knowledge of the indications, techniques, and surgical anatomy of the aforementioned procedures. We believe that the CD-ROM medium is underused and that it could provide better resident education, especially if combined with the traditional surgical textbook.
Care of the Dying Newborn: Perinatal Hospice, Research, and Practice Anita J. Catlin, DNSc Napa Valley College, Napa, CA
Byron C. Calhoun, MD, and Brian S. Carter, MD Purpose: To inform providers of the state of the nation in the provision of neonatal palliative care. Methods: A practicing maternal–fetal medicine specialist will describe efforts to create a hospice setting for newborns. The primary investigator of the Internet-based national Delphi study to create a neonatal end-of-life palliative care protocol will review the methodology and outcomes of the protocol developed by neonatologists, obstetricians, maternal–fetal physicians, parents, nurses, ethicists, hospice specialists, social scientists, lawyers, policy makers, and others, using sequential questionnaires. Results: Research findings will include: 1) candidates for comfort care; 2) transfer to Level III versus local community hospital care; 3) best location for provision of comfort care— eg, NICU, postpartum ward, hospice, home; 4) essential components of an optimally supported neonatal dying process, including needs of parents and needs of staff; 5) step-by-
VOL. 97, NO 4 (SUPPLEMENT), APRIL 2001
step process for ventilator withdrawal, including protocol for managing the infant who does not expire as expected when life support is withdrawn; and 6) family and staff follow-up needs. Conclusions: Physicians have reported a need for clinical and ethical guidelines for the care of the neonate with a lifelimiting condition. Nationally created guidelines are now available.
Comparison of Osteoporosis Knowledge in Menopausal Women Who View a Teaching Video Versus Those Who Don’t Martin Martino, MD UMDNJ–Robert Wood Johnson Medical School, New Brunswick, NJ
Gloria Bachmann, Jennifer Kulp, and Sarika Rane Objective: To determine the effectiveness of enhancing osteoporosis education for menopausal patients via a video. Methods: Data were collected from 194 menopausal, ambulatory patients: 98 patients observed an educational osteoporosis video before their office visit, and 96 patients did not view the video. After their gynecologic visit, all patients answered a standardized osteoporosis questionnaire. Results: No statistically significant differences were noted as to the demographics of the patients, including level of education. Test scores for the control group were 82%, versus 94% for the video group. The most notable differences: two-thirds of those who did not view the video did not know the role of hormone replacement therapy in osteoporosis treatment and prevention and did not understand the role of family history and the role of weight-bearing exercise. The video group answered these questions correctly. Conclusion: The study objectively demonstrated that the use of educational materials in addition to physician counseling improves patient understanding of osteoporosis.
Influencing Physician Practice Patterns J. Patrick Lavery, MD Bronson Hospital, Kalamazoo, MI
Mary Kindle, BSN, Linda Hutchinson, RN, and Jane Janssen, MBA, RN Objective: A program was initiated to change physician ordering patterns to reduce routine postpartum blood count (CBS) determinations and ensure cost-effective quality care.
Wednesday Posters 55S
Care of the Dying Newborn: Perinatal Hospice, Research, and Practice Anita J. Catlin, DNSc Napa Valley College, Napa, CA
Byron C. Calhoun, MD, and Brian S. Carter, MD Purpose: To inform providers of the state of the nation in the provision of neonatal palliative care. Methods: A practicing maternal–fetal medicine specialist will describe efforts to create a hospice setting for newborns. The primary investigator of the Internet-based national Delphi study to create a neonatal end-of-life palliative care protocol will review the methodology and outcomes of the protocol developed by neonatologists, obstetricians, maternal–fetal physicians, parents, nurses, ethicists, hospice specialists, social scientists, lawyers, policy makers, and others, using sequential questionnaires. Results: Research findings will include: 1) candidates for comfort care; 2) transfer to Level III versus local community hospital care; 3) best location for provision of comfort care— eg, NICU, postpartum ward, hospice, home; 4) essential components of an optimally supported neonatal dying process, including needs of parents and needs of staff; 5) step-by-
VOL. 97, NO 4 (SUPPLEMENT), APRIL 2001
step process for ventilator withdrawal, including protocol for managing the infant who does not expire as expected when life support is withdrawn; and 6) family and staff follow-up needs. Conclusions: Physicians have reported a need for clinical and ethical guidelines for the care of the neonate with a lifelimiting condition. Nationally created guidelines are now available.
Comparison of Osteoporosis Knowledge in Menopausal Women Who View a Teaching Video Versus Those Who Don’t Martin Martino, MD UMDNJ–Robert Wood Johnson Medical School, New Brunswick, NJ
Gloria Bachmann, Jennifer Kulp, and Sarika Rane Objective: To determine the effectiveness of enhancing osteoporosis education for menopausal patients via a video. Methods: Data were collected from 194 menopausal, ambulatory patients: 98 patients observed an educational osteoporosis video before their office visit, and 96 patients did not view the video. After their gynecologic visit, all patients answered a standardized osteoporosis questionnaire. Results: No statistically significant differences were noted as to the demographics of the patients, including level of education. Test scores for the control group were 82%, versus 94% for the video group. The most notable differences: two-thirds of those who did not view the video did not know the role of hormone replacement therapy in osteoporosis treatment and prevention and did not understand the role of family history and the role of weight-bearing exercise. The video group answered these questions correctly. Conclusion: The study objectively demonstrated that the use of educational materials in addition to physician counseling improves patient understanding of osteoporosis.
Influencing Physician Practice Patterns J. Patrick Lavery, MD Bronson Hospital, Kalamazoo, MI
Mary Kindle, BSN, Linda Hutchinson, RN, and Jane Janssen, MBA, RN Objective: A program was initiated to change physician ordering patterns to reduce routine postpartum blood count (CBS) determinations and ensure cost-effective quality care.
Wednesday Posters 55S