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Aguilera MN, Hoffman S, Wunderlich W, Watson D, Vacquier M, Sidebottom A. Association of Peripartum Lactate Levels With Infection Outcomes. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(23)00318-0. [PMID: 38281725 DOI: 10.1016/j.jogn.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/19/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE To determine whether lactate levels were associated with maternal infection and infection-related outcomes in the antepartum, intrapartum, and early postpartum periods. DESIGN Retrospective, observational cohort. SETTING Eleven hospitals from a single health system. PARTICIPANTS Women (N = 783) with at least one lactate and blood culture test for obstetric sepsis screening in the antepartum period (n = 154), intrapartum period (n = 348), and early postpartum period (n = 281) from January 2, 2018, to October 21, 2020. METHODS We reported the proportion of participants with adverse outcomes by lactate cut points (≤2.0 and >2.0 mmol/L). We used logistic regression to model the association of infection-related outcomes with lactate levels and calculated receiver operating characteristic curves. RESULTS Lactate was associated with bacteremia among participants in the antepartum period (odds ratio [OR] = 1.60, 95% confidence interval [CI] [1.00, 2.56]) but not among participants in the intrapartum and early postpartum periods. Higher lactate levels were significantly associated with a composite measure of infection-related outcomes (OR = 1.41, 95% CI [1.14, 1.81]), with no differential association by antepartum, intrapartum, or early postpartum periods. Lactate levels were positively associated with intraamniotic infection in the antepartum period (OR = 1.57, 95% CI [1.06, 1.81]) but not in the intrapartum period. The receiver operating characteristic curve indicated that the lactate threshold of 2.0 mmol/L has poor sensitivity. Overall, participants in the antepartum period had lower lactate values than participants in the intrapartum and early postpartum periods. CONCLUSION Lactate levels were not consistently associated with infection-related measures across all periods. We suggest caution when interpreting lactate levels when sepsis is suspected.
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Boley S, Sidebottom A, Vacquier M, Watson D. Investigating Racial Disparities in Chemical and Physical Restraint of Mental Health Patients in the Emergency Department. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01863-4. [PMID: 38010483 DOI: 10.1007/s40615-023-01863-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
The primary aim of this study is to examine whether racial disparities exist in the use of physical or chemical restraints in the emergency department (ED). The secondary aim is to explore if there are disparities in type or intensity of restraint. We examined ED encounters for acute mental health crises from a single health system over a 3-year period. Univariate and multivariate logistic regression models were used to examine associations of race/ethnicity with primary outcomes of physical and/or chemical restraint and a measure of restraint intensity among patients physically restrained. The study sample included 18,938 ED encounters with completed psychiatric consultations representing 13,316 unique patients. Restraint use was experienced by one-third of the sample (32.6%): 27.9% chemical restraint, 0.8% physical restraint, 3.9% both physical and chemical. In adjusted logistic regression models, odds of chemical restraint were lower for non-Hispanic (NH) Black (OR 0.83, 95% CI: 0.74, 0.93), NH Asian (OR 0.63, 95% CI: 0.47, 0.83), and Hispanic (OR 0.79, 95% CI: 0.65, 0.95) patients relative to NH White, with no difference for NH American Indian and multiracial. In the models assessing physical restraint use, there were no statistically significant differences by race/ethnicity. Among patients who were physically restrained, there were no differences in the adjusted models of high versus low intensity of the restraint type used. Among ED patients at high risk for restraint, patients of minority race/ethnicity were not found to have increased likelihood of restraint or intensity of restraint.
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Affiliation(s)
- Sean Boley
- Emergency Care Consultants, Minneapolis, MN, USA.
| | | | - Marc Vacquier
- Care Delivery Research, Allina Health, Minneapolis, MN, USA
| | - David Watson
- Children's of Minnesota Research Institute, Children's Minnesota, Minneapolis, MN, USA
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Sidebottom AC, Vacquier M, LaRusso E, Schulte AK, Nickel A. Prenatal and postpartum depression diagnosis in a large health system: prevalence and disparities. Ann Med 2023; 55:2281507. [PMID: 37963220 PMCID: PMC10836261 DOI: 10.1080/07853890.2023.2281507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 11/04/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND/OBJECTIVES/INTRODUCTION Depression during pregnancy or postpartum carries the same risks as general depression as well as additional risks specific to pregnancy, infant health and maternal well-being. The purpose of this study is to document the prevalence of depression symptoms and diagnosis during pregnancy and in the first 3 months postpartum among a cohort of women receiving prenatal care in a large health system. Secondarily, we examine variability in screening results and diagnosis by race, ethnicity, language, economic status and other maternal characteristics during pregnancy and postpartum. PATIENTS/MATERIALS AND METHODS A retrospective study with two cohorts of patients screened for depression during pregnancy and postpartum. Out of 7807 patients with at least three prenatal care visits and a delivery in 2016, 6725 were screened for depression (87%) at least once during pregnancy or postpartum. Another 259 were excluded because of missing race data. The final sample consisted of 6523 prenatal care patients who were screened for depression; 4914 were screened for depression in pregnancy, 4619 were screened postpartum (0-3 months). There were 3010 screened during both periods who are present in both the pregnancy and postpartum cohorts. Depression screening results are from the Patient Health Questionnaire (PHQ-9) and diagnosis of depression was measured using ICD codes. For patients screened more than once during either time period, the highest score is used for analysis. RESULTS Approximately, 11% of women had a positive depression screen as indicated by an elevated PHQ-9 score (>10) during pregnancy (11.3%) or postpartum (10.7%). Prevalence of depression diagnosis was similar in the two periods: 12.6% during pregnancy and 13.0% postpartum. A diagnosis of depression during pregnancy was most prevalent among women who were age 24 and younger (19.7%), single (20.5%), publicly insured (17.8%), multiracial (24.1%) or Native American (23.8%), and among women with a history of depression in the past year (58.9%). Among women with a positive depression screen, Black women were less than half as likely as White women to receive a diagnosis in adjusted models (AOR 0.40, CI: 0.23-0.71, p = .002). This difference was not present postpartum. CONCLUSIONS Depression symptoms and diagnoses differ by maternal characteristics during pregnancy with some groups at substantially higher risk. Efforts to examine disparities in screening and diagnosis are needed to identify reasons for variability in prenatal depression diagnosis between Black and White women.Key messagesWomen who were young, single, have public insurance, and women who identify as multiracial or non-Hispanic (NH) Native American were most likely to have a positive depression screen or a diagnosis for depression.After adjustment for confounders, NH Black women with a positive depression screen were about half as likely to have a diagnosis of depression during pregnancy as NH White women.Awareness of the differing prevalence of depression risk screening results, diagnoses and potential for variation in diagnosis may identify opportunities to improve equity in the delivery of essential mental health care to all patients.
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Affiliation(s)
| | - Marc Vacquier
- Allina Health, Care Delivery Research, Minneapolis, MN, USA
| | | | - Anna K Schulte
- Allina Health, Care Delivery Research, Minneapolis, MN, USA
| | - Amanda Nickel
- Children's of Minnesota Research Institute, Minneapolis, MN, USA
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Wagner W, Loichinger M, Sidebottom AC, Wunderlich WL, Vacquier M, Jentink T, Aguilera MN, Ahanya SN, Morgan E, Parker M, Wothe DD. Implementation and Outcomes of a Model of Care for Placenta Accreta Spectrum in a Community-Based Private Practice. Am J Perinatol 2022. [PMID: 35815573 DOI: 10.1055/s-0042-1749664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of the study is to describe a model of care and outcomes for placenta accreta spectrum (PAS) implemented in the context of a community based non-academic health system. STUDY DESIGN The program for management of PAS includes a multidisciplinary team approach with protocols for ultrasound assessment, diagnosis, and surgery. The program was implemented in the two largest private hospitals in the Twin Cities, Minnesota, United States. Maternal and fetal outcomes as well as cost were compared for histopathologic confirmed PAS cases before (2007-2014, n = 41) and after (2015-2017, n = 26) implementation of the PAS program. RESULTS Implementation of the PAS program was associated with ICU admission reductions from 53.7 to 19.2%, p = 0.005; a decrease of 1,682 mL in mean estimated blood loss (EBL) (p = 0.061); a decrease in transfusion from 85.4 to 53.9% (p = 0.005). The PAS program also resulted in a (non-significant) decrease in both surgical complications from 48.8 to 38.5% (p = 0.408) and postoperative complications from 61.0 to 42.3% (p = 0.135). The total cost of care for PAS cases in the 3 years after implementation of the program decreased by 33%. CONCLUSION The implementation of a model of care for PAS led by a perinatology practice at a large regional non-academic referral center resulted in reductions of ICU admissions, operating time, transfusion, selected surgical complications, overall postoperative complications, and cost. KEY POINTS · Implementation of a PAS care model resulted in reduced ICU admissions from 53.7% to 19.2%.. · Patient safety increased by reducing blood loss, transfusions and postoperative complications.. · This model decreased operating time, as well as total cost of care by 33%..
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Affiliation(s)
- William Wagner
- Minnesota Perinatal Physicians, Allina Health, Minneapolis, Minnesota
| | | | | | | | - Marc Vacquier
- Care Delivery Research, Allina Health, Minneapolis, Minnesota
| | - Theresa Jentink
- Minnesota Perinatal Physicians, Allina Health, Minneapolis, Minnesota
| | | | | | - Elizabeth Morgan
- Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota
| | - Meiling Parker
- Health Partners Maternal Fetal Medicine, St. Paul, Minnesota
| | - Donald D Wothe
- Health Partners Maternal Fetal Medicine, St. Paul, Minnesota
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Sidebottom AC, Miedema MD, Benson G, Vacquier M, VanWormer JJ, Sillah A, Lindberg R, Boucher JL, Bradley SM. The impact of a population-based prevention program on cardiovascular events: Findings from the heart of new Ulm project. Am Heart J 2021; 239:38-51. [PMID: 33957104 DOI: 10.1016/j.ahj.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and its associated risk factors are the principal drivers of mortality and healthcare costs in the United States with rural residents experiencing higher CVD death rates than their urban counterparts. METHODS The purpose of this study was to examine incidence of major CVD events over 9 years of implementation of the Heart of New Ulm (HONU) Project, a rural population-based CVD prevention initiative. HONU interventions were delivered at individual, organizational, and community levels addressing clinical risk factors, lifestyle behaviors and environmental changes. The sample included 4,056 residents of New Ulm matched with 4,056 residents from a different community served by the same health system. The primary outcome was a composite of major CVD events (myocardial infarction, ischemic stroke, percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and CVD-related death). Secondary outcomes were the individual CVD events and procedures. RESULTS The proportion of residents in New Ulm with a major CVD event (7.79%) was not significantly different than the comparison community (8.43%, P = .290). However, the total number of events did differ by community with fewer events in New Ulm than the comparison community (447 vs 530, P = .005), with 48 fewer strokes (84 vs 132, P = .001) and 42 fewer PCI procedures (147 vs 189, P = 0.019) in New Ulm. Incidence of ischemic stroke was lower in the New Ulm community (1.85 vs 2.61, P = .020) than in the comparison community. Other specific CVD events did not have significantly different incidence or frequencies between the 2 communities. CONCLUSION In HONU, the proportion of residents experiencing a CVD event was not significantly lower than a match comparison community. However, there was a significant reduction in the total number of CVD events in New Ulm, driven primarily by lower stroke, PCI, and CABG events in the intervention community.
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Sidebottom AC, Benson G, Vacquier M, Pereira R, Hayes J, Boersma P, Boucher JL, Lindberg R, Pribyl B, VanWormer JJ. Population-Level Reach of Cardiovascular Disease Prevention Interventions in a Rural Community: Findings from the Heart of New Ulm Project. Popul Health Manag 2020; 24:86-100. [PMID: 31971871 PMCID: PMC7875136 DOI: 10.1089/pop.2019.0196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study examines participation by residents of a rural community in programs implemented as part of The Heart of New Ulm (HONU) Project, a population-based cardiovascular disease (CVD) prevention initiative. The study compares participation rates for the various interventions to assess which were the most engaging in the priority community and identifies factors that differentiate participants vs. nonparticipants. Participation data were merged with electronic health record (EHR) data representing the larger community population to enable an analysis of participation in the context of the entire community. HONU individual-level interventions engaged 44% of adult residents in the community. Participation ranked as follows: (1) heart health screenings (37% of adult residents), (2) a year-long community weight loss intervention (12% of adult residents), (3) community health challenges (10% of adult residents), and (4) a phone coaching program for invited high CVD-risk residents (enrolled 6% of adult residents). Interventions that yielded the highest engagement were those that had significant staffing and recruited participants over several months, often with many opportunities to participate or register. Compared to nonparticipants, HONU participants were significantly older and a higher proportion were female, married, overweight or obese, and had high cholesterol. Participants also had a lower prevalence of smoking and diabetes than nonparticipants. Findings indicate community-based CVD prevention initiatives can be successful in engaging a high proportion of adult community members. Partnering with local health care systems can allow for use of EHR data to identify eligible participants and evaluate reach and engagement of the priority population.
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Affiliation(s)
| | - Gretchen Benson
- Population Health, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Marc Vacquier
- Care Delivery Research, Allina Health, Minneapolis, Minnesota, USA
| | - Raquel Pereira
- Population Health, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Joy Hayes
- Population Health, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Peter Boersma
- Population Health, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | | - Rebecca Lindberg
- Population Health, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | | - Jeffrey J VanWormer
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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Morgan EA, Sidebottom A, Vacquier M, Wunderlich W, Loichinger M. The effect of placental location in cases of placenta accreta spectrum. Am J Obstet Gynecol 2019; 221:357.e1-357.e5. [PMID: 31344349 DOI: 10.1016/j.ajog.2019.07.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/22/2019] [Accepted: 07/16/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Placenta accreta spectrum affects approximately 3 in 1000 pregnancies. There is a paucity of data evaluating the effect of placental location on diagnosis, risk factors, and resultant outcomes in cases of placenta accreta spectrum. OBJECTIVE We analyzed placenta accreta spectrum cases to assess whether risk factors or maternal outcomes varied based on placental location. MATERIALS AND METHODS We performed a retrospective chart review of pathology-confirmed cases of placenta accreta spectrum from patients delivering at 2 large urban hospitals in the same healthcare system from 2007 to 2017. Placental location was defined by ultrasound images and confirmed by pathology reports. Location was categorized as anterior, posterior, or anterior/posterior for those with placental location at both sites. Fisher exact tests and analysis of variance were used to examine associations with measures of diagnosis, risk factors, and maternal outcomes. RESULTS A total of 86 pathology-confirmed placenta accreta spectrum cases were reviewed. The distribution of placental location on ultrasound was as follows: 19% posterior, 59% anterior, and 22% anterior/posterior. We found that prior cesarean delivery was lower with posterior placenta accreta spectrum (63% vs 94% vs 84% in the anterior and anterior/posterior groups respectively; (P = .007); however, in vitro fertilization rates were significantly higher (38% vs 2% vs 5% in the anterior and anterior/posterior groups respectively; P = .001). There was also lower incidence of percreta with posterior placenta accreta spectrum compared to the anterior and anterior/posterior groups (19% vs 47% vs 58% respectively; P = .055). Posterior cases were less likely to have placenta accreta spectrum suspected prenatally (50%) compared to anterior (80%) and anterior/posterior (89%) cases (P = .019). Despite late diagnosis, ureteral injury was the only surgical complication that was more common in patients with posterior placenta accreta spectrum (13% vs 0% vs 5% for anterior and anterior/posterior groups respectively; P = .037). CONCLUSION Placenta accreta spectrum with posterior placental location is associated with delayed diagnosis, surgical complications, assisted reproductive technology, and lower numbers of prior cesarean deliveries relative to anterior location. These differences in outcomes and risk factors based on placental location may allow for heightened clinical awareness, and improved diagnosis and management.
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Xiao M, St Hill CA, Vacquier M, Patel L, Mink P, Fernstrom K, Kirven J, Jeruzal J, Beddow D. Retrospective Analysis of the Effect of Postdischarge Telephone Calls by Hospitalists on Improvement of Patient Satisfaction and Readmission Rates. South Med J 2019; 112:357-362. [PMID: 31282963 DOI: 10.14423/smj.0000000000000994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The influence of postdischarge telephone call interventions preventing hospital readmissions is unclear. A novel approach of the discharging hospitalist providing this intervention may improve overall patient satisfaction. Our objective was to assess the impact of postdischarge telephone calls from discharging hospitalists on readmissions and patients' ratings of hospital care and hospitalist communication. METHODS Data were retrospectively collected from patients' electronic health records at a 167-bed hospital in Fridley, Minnesota and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Patients were 18 years old or older and diagnosed as having nonpsychiatric conditions. Telephone calls were made by the discharging hospitalist to adult patients discharged to home with or without home care services between February 28, 2015 and February 29, 2016. Multivariate logistic regression models were used to evaluate associations of postdischarge telephone calls with global hospital care rating and hospitalist communication from HCAHPS, and 30-day readmission rates from electronic health records. RESULTS Of 4490 eligible patients, 1067 had completed telephone calls (23.8%). The intervention was associated with a statistically significant improvement in the responses to HCAHPS overall hospital rating and HCAHPS doctor communication questions (adjusted odds ratio 1.52, P = 0.04 and adjusted odds ratio 1.56, P = 0.021) that varied by patient age at first admission (P = 0.001 and P = 0.101). With longer inpatient lengths of stay, 30-day readmission rates improved after patients received a postdischarge telephone call, but this outcome was not statistically significant. CONCLUSIONS This study revealed that postdischarge telephone calls from discharging hospitalists increased patient satisfaction. Further research is needed to understand the causal relationships among the intervention, 30-day hospital readmission rates, and inpatient length of stay.
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Affiliation(s)
- Mengli Xiao
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Catherine A St Hill
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Marc Vacquier
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Love Patel
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Pamela Mink
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Karl Fernstrom
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Justin Kirven
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Jessica Jeruzal
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - David Beddow
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
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Wagner B, Barr-Anderson DJ, Friend S, Vacquier M, Fulkerson JA. Association of Sports Participation with Intake of Fast Food for Family Meals Among Rural Children. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562051.83371.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sidebottom AC, Vacquier M, Simon K, Fontaine P, Dahlgren-Roemmich D, Hyer B, Jackson J, Steinbring S, Wunderlich W, Saul L. Who Gives Birth in the Water? A Retrospective Cohort Study of Intended versus Completed Waterbirths. J Midwifery Womens Health 2019; 64:403-409. [PMID: 30968545 DOI: 10.1111/jmwh.12961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Most waterbirth studies have been conducted outside the United States with a primary focus on birth outcomes. Studies to date provide limited information about how often women choosing waterbirth end water immersion before the birth and about the reasons for tub exit. This study examines a cohort of women intending a hospital-based waterbirth and documents the timing and reasons for tub exit. Demographic, clinical, and intrapartum care provider characteristics among women completing waterbirth were compared with those who exited the water prior to birth. METHODS This is a collaborative, multisite study from 2 health systems (8 hospitals) using retrospective electronic health records from August 2014 through December 2017. RESULTS Of 576 women who entered the waterbirth tub, 48% exited prior to the birth. The primary reasons for exit were maternal choice (50%), medical indication (32%), and provider decision (13%). Women exiting in the first stage did so primarily by choice (57%), whereas medical indication (42%) was the most common reason among women exiting in the second stage. Women who completed waterbirth did not differ from those who exited prior to birth with regard to age, race, ethnicity, country of origin, language, marital status, or intrapartum care provider specialty. Women completing waterbirth were more likely to have previously given birth (72% vs 47%) and to have a provider with more water immersion births during the study period (65% vs 55%). DISCUSSION Giving birth in the tub was associated with parity and intrapartum care provider experience. Half of the women intending waterbirth in this study exited the tub, with variation in exit reason by stage and provider type. It is important for women to understand that they or their provider may change the birth plan based on labor progress and maternal experience.
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Affiliation(s)
| | - Marc Vacquier
- Care Delivery Research, Allina Health, Minneapolis, Minnesota
| | - Kathrine Simon
- Allina Health Clinics, Allina Health, Minneapolis, Minnesota
| | | | | | - Barbara Hyer
- Health Partners Medical Clinic, St. Paul, Minnesota
| | - Jody Jackson
- Health Partners Institute, Minneapolis, Minnesota
| | | | | | - Lisa Saul
- Minnesota Perinatal Physicians and Mother Baby Clinical Service Line, Allina Health, Minneapolis, Minnesota
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Benson GA, Sidebottom A, Hayes J, Miedema MD, Boucher J, Vacquier M, Sillah A, Gamam S, VanWormer JJ. Impact of ENHANCED (diEtitiaNs Helping pAtieNts CarE for Diabetes) Telemedicine Randomized Controlled Trial on Diabetes Optimal Care Outcomes in Patients with Type 2 Diabetes. J Acad Nutr Diet 2019; 119:585-598. [DOI: 10.1016/j.jand.2018.11.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/07/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
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Morgan EA, Sidebottom A, Vacquier M, Wunderlich W, Loichinger M. 847: The effect of placental location in cases of morbidly adherent placenta. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vacquier M, Martinoli JL, Morelis P. [The effect of an anticonvulsant medication, n-dipropylacetate, on the cerebral penetration of tryptophan in mice]. C R Acad Hebd Seances Acad Sci D 1976; 282:779-81. [PMID: 817842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Riotte M, Peyrin L, Vacquier M, Cussac JP, Naud D. [Fluorimetric determination of urinary catecholamines (adrenaline, noradrenaline, dopamine)]. Rev Eur Etud Clin Biol 1970; 15:343-51. [PMID: 5447061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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