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BACKGROUND: Nurse retention is a different way of conceptualizing the employer-employee relationship when compared with turnover. Job embeddedness (JE), a construct based on retention, represents the sum of reasons why employees remain at their jobs. However, JE has not been investigated in relation to locale (urban or rural) or exclusively with a sample of registered nurses (RNs). The purpose of this study was to determine what factors (JE, age, gender, locale, and income) help predict nurse retention. METHODS: A cross-sectional mailed survey design was used with RNs in different locales (urban or rural). Job embeddedness was measured by the score on the composite, standardized instrument. Nurse retention was measured by self-report items concerning intent to stay. RESULTS: A response rate of 49.3% was obtained. The typical respondent was female (96.1%), white, non-Hispanic (87.4%), and married (74.9%). Age and JE were predictive of nurse retention and accounted for 26% of the explained variance in intent to stay. Although age was a significant predictor of intent to stay, it accounted for only 1.4% of the variance while JE accounted for 24.6% of the variance of nurse retention (as measured by intent to stay). CONCLUSIONS: Older, more 'embedded' nurses are more likely to remain employed in their current organization. Based on these findings, JE may form the basis for the development of an effective nurse retention program. [ABSTRACT FROM AUTHOR]

The purpose of this article is to provide information for health care professionals to guide the assessment of feeding and growth in breastfed infants. Tools to assist in the assessment of breastfeeding are discussed, as well as infant weight, infant test-weighing, elimination, and growth patterns. We present in detail the research surrounding the development of infant growth charts and the potential for inaccurate assessment. [ABSTRACT FROM AUTHOR]

As part of a large nonexperimental, prospective, longitudinal study, 97 breast-feeding mothers of healthy term singleton infants were queried via telephone at weeks 8-12 postpartum about their infant feeding method. At week 12, 71.1% of them provided mother's milk (MM), 16.5% provided artificial milk (AM) and MM, and 12.4% provided AM only. Logistic regression analysis identified the following predictors for risk of supplemental feedings with AM at week 12 postpartum: supplementation with AM at week 6, inadequate milk supply at week 6, frequency of breast stimulation less than 7.8 times daily at week 6. Milk output during weeks 1-6 was predictive of feeding type at week 12. Mothers who reported perceived inadequate milk supply (PIMS) at week 8 were more likely to provide AM at week 12 than mothers who did not report PIMS. Further research is needed to assist mothers of healthy term infants with sustaining their milk supply and assisting them with PIMS. [ABSTRACT FROM AUTHOR]

This article summarizes the development and psychometric properties of the first self-administered, paper-and-pencil instrument that measures maternal quality of life during the early postpartum period. The definition, domains, and conceptual model by Ferrans and Powers (QLI) were used to develop the Maternal Postpartum Quality of Life (MAPPQOL) tool. A convenience sample of 184 mothers completed the MAPP-QOL at week 1 and 3 postpartum. Component analysis revealed five domains: psychological/baby; socioeconomic; relational/spouse-partner; relational/family-friends; and health & functioning. Internal consistency reliability for the five subscales resulted in Cronbach's alpha coefficients ranging from .82 to .96. Stability reliability ranged from .66 to .76. The MAPP-QOL and a single-item measure of life satisfaction correlated (r = .69), suggesting convergent validity; discriminant validity was supported by negative correlations with the three negative mood states of the Multiple Affect Adjective Check List-Revised (MAACL-R) as well as poor sleep and fatigue scores. Acceptable reliability and construct validity suggest that the MAPP-QOL may be used in research. Further testing with larger and more diverse samples is recommended. [ABSTRACT FROM AUTHOR]

This study examined potential primary mediators, such as intended length to breastfeed, maternal education, income, and infant gestation, and secondary mediators, such as early frequency of breast stimulation, early milk output, and supplementation with artificial milks that may influence milk output in mothers of preterm and term infants the first 6 weeks postpartum. Analysis suggested that for mothers of a preterm infant (n = 95), the primary mediators, income and infant gestation, and the secondary mediators, early milk output/d and early frequency/d, accounted for 53.5% of the variance in milk output/d at week 6. For mothers of a term infant (n = 98), the primary mediator, income, and secondary mediators, early milk output/d and supplementation, accounted for 48.4% of the variance in milk output/d at week 6. Further research is needed to determine what early interventions may improve milk output in mothers at risk for lactation failure. [ABSTRACT FROM AUTHOR]

This article contains two case reports that illustrate the difficulty two mothers experienced when they mechanically expressed their milk for their very preterm infants. Each of the mothers was enrolled in a separate research study and had previously undergone surgery for breast augmentation. Neither of the mothers was able to provide an adequate milk supply for her preterm infant. Preoperative counseling and informed consent for breast augmentation is vital if the mother desires to exclusively provide mother's milk for the infant. [ABSTRACT FROM AUTHOR]

This secondary data analysis examined if time of initiation of milk expression and pumping frequency influenced milk weight weeks 2-5 postpartum. Of the 39 subjects in the convenience sample, 20 were in the early initiating (EI) group, (n = 12 high frequency [HF], n = 8 low frequency [LF] ), and 19 were in the late initiating (LI) group, (n = 7 HF, n = 12 LF). The EI group initiated pumping <_ 48 hours after birth; the HF group pumped a minimum of 6.25 times daily. A two-way analysis of variance indicated that milk weight was significantly higher in the HF as compared to the LF group. While there was no significant difference in milk weight between the El and LI groups, there was a significant interaction between frequency and initiation. Milk weight for the LF/EI group appeared to be positively influenced by the initiation of mechanical expression soon after birth. [ABSTRACT FROM AUTHOR]

Background: Research about parity or breastfeeding experience and its relationship with milk production in humans is limited. The purpose of this study was to determine if any difference in milk volume occurred among mothers with and without breastfeeding experience who used either a single or double breast pumping regimen the first 5 weeks postpartum. Methods: A convenience sample of 39 mothers of nonnursing preterm infants participated from two tertian' care centers in the midwestern United States. The sequential single pumping group consisted of 20 mothers, 7 of whom had previous breastfeeding experience; the simultaneous double pumping group consisted of 19 mothers, 2 of whom had previous breastfeeding experience. Income and pumping group regimen were used as blocking variables, and average frequency of kangaroo care per week and average frequency of breast pumping per week were covariants in the repeated measures analysis of variance. Results: Mothers with previous breastfeeding experience had greater milk weights over tune, but weights were not significantly different when compared with those mothers with no previous breastfeeding experience. Additional analysis with the covariants of pumping frequency and kangaroo care, and with the independent variables of group, breastfeeding experience, and income resulted in statistically significantly greater milk yield in the women with previous breastfeeding experience. Conclusions: The findings of the two repeated analyses indicated the complexity of the milk production response, and the importance of considerations of environmental as well as physiologic factors. [ABSTRACT FROM AUTHOR]

Milk production was examined in 39 lactating mothers of non-nursing preterm infants from 2 tertiary care centers. The purposes of this study were (1) to compare milk production of those using sequential single (SEQ) or simultaneous double (SIM) breast-pumping regimen, and (2) to examine the relationship of selected variables to inadequate (< 3500 g/week) and adequate (> or = 3500 g/week) milk production. In multivariate analysis, mothers using SIM produced a similar amount of milk by weight during weeks 2 to 5 postpartum compared to those using SEQ. A logistic regression model including frequency of kangaroo care, frequency of pumping, high versus low income, and previous breastfeeding experience was predictive of mothers producing adequate versus inadequate milk volume 79% of the time. All of the mothers producing > 3500 g at week 2 produced adequate amounts of milk at weeks 4 and 5. None of the mothers producing < 1700 g at week 2 reached adequate production by weeks 4 and 5. Of the remaining mothers who produced 1700 g to 3500 g at week 2, 54% achieved adequate production during weeks 4 and 5 postpartum. [ABSTRACT FROM AUTHOR]

Sampling bias occurs in research when a large percentage of subjects who are eligible for the study refuse to participate. During Phase I of a two-phase multisite Mother-Baby Feeding Project, approximately 50% of the 235 potential participants at four of five sites declined to enter the study. This report compares subjects who fully participated with those who minimally participated and explores factors related to subjects' refusal to participate. Data regarding sociodemographic data, breast-feeding experience, and reason for refusal were collected from 92 subjects who declined to enter but agreed to minimally participate. The fully participating subjects had more education than those who participated minimally. However, the breast-feeding outcomes studied were similar for both groups. This provides support for generalizing additional study findings beyond the group of fully participating subjects when considering breast-feeding outcomes. Findings lend insight into the problem of subject recruitment that is not well-addressed in the nursing literature. [ABSTRACT FROM AUTHOR]

The objective of the study was to ascertain the nature of health professional contacts related to breastfeeding for 341 women. Subjects were prospectively queried by phone or home visit over a 20-week period regarding the number and nature of contacts with health care professionals related to breastfeeding. Lactation consultants gave significantly more positive encouragement (98%) (p = .01) than either nurses (75%) or physicians (68%) did. However, of the 233 health provider contacts that included breastfeeding advice, only 21% involved lactation consultants. Primiparae were likely to decrease their level of breastfeeding if a health professional encouraged supplemental foods (39%) or weaning (86%) during the prior week. Multiparae who were experienced at breastfeeding (3+ weeks breastfeeding the previous infant) decreased their breastfeeding slowly across the weeks with the current infant, and their level of breastfeeding in general appeared independent of health care provider advice. Multiparae who lacked previous sustained breastfeeding experience (0-3 weeks) had the most rapid decrease (65%) in their breastfeeding rates even with health care provider encouragement to continue. Thus, they too appeared to act independently of health care provider advice. [ABSTRACT FROM AUTHOR]

Mothers who must express milk for a prolonged period frequently report that milk volumes decrease. The purpose of this pilot study was to assess the feasibility of having a sample of lactating mothers of preterm infants follow a specific breast pumping protocol, express milk mechanically for six weeks, and have a subsample consent to venipuncture. This pilot study compared the effects of pumping breasts sequentially or simultaneously on milk volume and prolactin levels in mothers of preterm infants. Nine lactating mothers were randomly assigned to a sequential single or simultaneous double electric breast pumping system. Prolactin levels were examined in four mothers on days 21 and 42 postpartum. The sequential single and simultaneous double groups had mean baseline prolactin levels of 50.8 ng/ml and 40.6 ng/ml, respectively on day 21, and 26.6 ng/ml and 34.5 ng/ml, respectively, on day 42 postpartum. At 9 and 12 weeks postpartum mothers were queried about their lactational status. The results suggested that milk yield may be maintained or increased with frequent use of the simultaneous double pumping system. Further study is needed to confirm results of this pilot study. [ABSTRACT FROM AUTHOR]

For 14 days following birth, 114 breastfeeding mothers rated their level of breast engorgement twice daily, using a six-point engorgement scale. Individual engorgement ratings were plotted by intensity over time to provide a visual display of each subject's breast engorgement experience. Four distinct patterns of breast engorgement emerged; mothers experienced either a bell-shaped pattern, a multi-modal pattern, a pattern of intense engorgement, or a pattern of minimal engorgement. Characteristics of mothers and infants, and feeding frequency were similar across the four breast engorgement patterns. [ABSTRACT FROM AUTHOR]

This study describes breast engorgement during days 1-14 postpartum of 114 first and second time vaginal- and cesarean-delivery breastfeeding mothers. Most mothers reported experiencing their most intense engorgement after hospital discharge. Previous breastfeeding experience of the mother is a more critical variable than parity in predicting engorgement. Second time breastfeeding mothers experienced engorgement sooner and more severely than did first time breastfeeding mothers, regardless of delivery method. Anticipatory guidance by the care provider is discussed in an effort to enhance the experience of the breastfeeding dyad. [ABSTRACT FROM AUTHOR]

Sixty-four women of low socioeconomic status were interviewed in their third trimester and again six weeks postpartum. They were questioned about their infant feeding plans, general attitudes about breastfeeding, time of feeding decision, persons who influenced the infant feeding choice, and number of breastfeeding classes attended. Their knowledge of breastfeeding was measured by a questionnaire designed for this purpose. The choice of infant feeding method was influenced most by the mother itself. However, the subject's mother and the male partner were important influences. Mothers who breastfed were more likely to make their feeding decision before or very early in pregnancy than were mothers who bottle-fed. Maternal attitudes about breastfeeding also were more positive among breastfeeding women than among bottle-feeding women, and breastfeeding women attended more classes on this subject than their counterparts who bottle-fed. The role of education and follow-up by nurses is discussed. [ABSTRACT FROM AUTHOR]

QUESTION: In infants with a familial history of atopy, does dietary avoidance of cows' milk protein prevent asthma and wheeze during the first year of life?Data sources:Studies were identified by searching Medline (1966 to Feb 2002), CINAHL (1982 to Feb 2002), EMBASE/ Excerpta Medica (1980 to Feb 2002), UK National Research Register of Trials (up to Feb 2002), the Cochrane Controlled Trials Register (1966 to Feb 2002), bibliographies of identified articles, and by contacting colleagues and experts in the field.Study selection:Randomised controlled trials (RCTs) involving children with a familial history of atopy in >/= 1 first degree relative were selected if they compared hydrolysed cows' milk formula or soya based formula with feeding with standard cows' milk based formula during the first 4 months of life or longer. In the hydrolysed formula, the protein source from cows' milk was enzymatically hydrolysed and heat denatured resulting in smaller protein molecules with increased digestibility and reduced allergic potential.Data extraction:2 reviewers independently extracted data on study quality, patient characteristics, types of feeds and duration, dietary restrictions, and outcome measures, including asthma or wheeze.Main results:10 studies met the selection criteria; study duration ranged from 4-12 months. 7 trials evaluated hydrolysed formula for >/= 4 months in addition to dietary restrictions and in some cases dust mite reduction measures. Combining data from 3 of these trials showed a reduction in newly diagnosed and ongoing asthma and wheeze during the first year of life in infants receiving hydrolysed formula (table). There was insufficient evidence to suggest that soya based formula reduced the risk of developing asthma or wheeze at any age.Conclusions:In infants with >/= 1 first degree relative with atopy, hydrolysed milk formula, in combination with dietary restriction and house mite reduction measures, reduces the risk of developing asthma or wheeze during the first year of life. There is insufficient evidence to show that soya based milk formula has any benefit. [ABSTRACT FROM AUTHOR]

The anti-inflammatory, antifibrotic, and antiproteinuric properties of vitamin D have been defined in studies using active vitamin D analogs. In this prospective observational study we determined whether nutritional vitamin D repletion can have additional beneficial effects in patients with type 2 diabetic nephropathy already established on renin-angiotensin-aldosterone system inhibition. During a 7-month period, 63 patients were enrolled and those with low levels of 25(OH)D were treated with oral cholecalciferol for 4 months. Baseline serum 25(OH)D and 1,25(OH)(2)D showed no significant correlation with baseline urinary MCP-1, TGF-β1, or albuminuria measured as the urinary albumin-to-creatinine ratio. Of the 63 patients, 54 had insufficient or deficient levels of serum 25(OH)D and 49 complied with cholecalciferol therapy and follow-up. Both 25(OH)D and 1,25(OH)(2)D were significantly increased at 2 and 4 months of treatment. Albuminuria and urinary TGF-β1 decreased significantly at both time points compared to their baseline values, while urinary MCP-1 did not change. Thus, in the short term, dietary vitamin D repletion with cholecalciferol had a beneficial effect in delaying the progression of diabetic nephropathy above that due to established renin-angiotensin-aldosterone system inhibition. [ABSTRACT FROM AUTHOR]

Background and Objectives: Immune checkpoint inhibitors are increasingly used to treat various malignancies, but their application in patients with kidney transplants is complicated by high allograft rejection rates. Immune checkpoint inhibitor-associated rejection is a novel, poorly understood entity demonstrating overlapping histopathologic features with immune checkpoint inhibitor-associated acute interstitial nephritis, which poses a challenge for diagnosis and clinical management. We sought to improve the understanding of these entities through biopsy-based gene expression analysis., Design, Setting, Participants, & Measurements: NanoString was used to measure and compare the expression of 725 immune-related genes in 75 archival kidney biopsies, including a 25-sample discovery cohort comprising pure T cell-mediated rejection and immune checkpoint inhibitor-associated acute interstitial nephritis and an independent 50-sample validation cohort comprising immune checkpoint inhibitor-associated acute interstitial nephritis, immune checkpoint inhibitor-associated T cell-mediated rejection, immune checkpoint inhibitor-associated crescentic GN, drug-induced acute interstitial nephritis, BK virus nephropathy, and normal biopsies., Results: Significant molecular overlap was observed between immune checkpoint inhibitor-associated acute interstitial nephritis and T cell-mediated rejection. Nevertheless, IFI27 , an IFN- α- induced transcript, was identified and validated as a novel biomarker for differentiating immune checkpoint inhibitor-associated T cell-mediated rejection from immune checkpoint inhibitor-associated acute interstitial nephritis (validation cohort: P <0.001, area under the receiver operating characteristic curve =100%, accuracy =86%). Principal component analysis revealed heterogeneity in inflammatory gene expression patterns within sample groups; however, immune checkpoint inhibitor-associated T cell-mediated rejection and immune checkpoint inhibitor-associated acute interstitial nephritis both demonstrated relatively more molecular overlap with drug-induced acute interstitial nephritis than T cell-mediated rejection, suggesting potential dominance of hypersensitivity mechanisms in these entities., Conclusions: These results indicate that, although there is significant molecular similarity between immune checkpoint inhibitor-associated rejection and acute interstitial nephritis, biopsy-based measurement of IFI27 gene expression represents a potential biomarker for differentiating these entities., (Copyright © 2021 by the American Society of Nephrology.)

Purpose: To examine the relationships and differences in the use of intuition among three categories of practicing nurses from various clinical units at a medical center in the Midwest., Design: Descriptive, correlational, cross-sectional, prospective design., Method: Three categories of nurses were based on the clinical unit: medical/surgical nurses ( n = 42), step-down/progressive care nurses ( n = 32), and critical care nurses ( n = 24). Participants were e-mailed the Rew Intuitive Judgment Scale (RIJS) via their employee e-mail to measure intuition in clinical practice. Participants were also asked to rate themselves according to Benner's (novice to expert) proficiency levels., Findings: Nurses practicing at higher self-reported proficiency levels, as defined by Benner, scored higher on the RIJS. More years of clinical experience were associated with higher self-reported levels of nursing proficiency and higher scores on the RIJS. There were no differences in intuition scores among the three categories of nurses., Conclusion: Nurses have many options, such as the nursing process, evidence-based clinical decision-making pathways, protocols, and intuition to aid them in the clinical decision-making process. Nurse educators and development professionals have a responsibility to recognize and embrace the multiple thought processes used by the nurse to better the nursing profession and positively affect patient outcomes.