Introduction: Parental psychological responses during their child's ' s pediatric intensive care unit (PICU) admission are often overlooked. This study aimed to identify pre-existing and peri-traumatic factors explaining parental stress and anxiety during their child's ' s PICU admission and one-month follow-up. Method: A prospective pilot study included 60 PICU parents. Parental Stressors Scale and State-trait Anxiety Inventory measured stress and anxiety during PICU admission, and the State-trait Anxiety Inventory and Perceived Stress Scale at a one-month follow-up. Results: During PICU admission, parental stress correlated with age, race, and adverse childhood experiences (ACEs), anxiety was linked to income. At one-month follow-up, anxiety related to child's ' s health worries, perceived stress was linked to parental ACEs and education. Parental ACEs predicted perceived stress (b b = 0.83, p = .028). Children's ' s diagnoses explained anxiety, particularly respiratory and cardiac diagnoses (b b = 13.44, p = .023; 10.03, p = .045). Discussion: Identifying factors helps teams understand parental vulnerability and provide appropriate support.

Research conducted in pediatric intensive care units (PICUs) with families is essential to advancing evidenced-based practice and improving patient outcomes in this unique setting. However, several ethical, logistical, and methodological challenges have been cited in the literature as having a significant effect on the development of PICU research. Investigators at a large midwestern health care center encountered several challenges during the course of a minimal-risk, survey-based study with parents of PICU patients. This manuscript aims to highlight the challenges faced by the research team, which included challenges related to the environment of the PICU, the patients' length of stay, the health status of the patient, and the etiology of the patient's admission, as well as share the actions that the research team took to address these challenges.

The Challenge of Maternal Mortality, University of Iowa Obstetrics and Gynecology Postgraduate Virtual Conference, November 20, 2020. Poster presentations.

A study that describes the development of an electronic informed consent, using the REDCap platform, and the results of a pilot study to assess participants' understanding and acceptance of that electronic informed consent for use in a research study.

Hypertension in pregnancy is a leading cause of maternal morbidity and mortality. Studies demonstrate that body positions affect the blood pressure (BP) measurements and have led to guidelines for proper positioning by the ACC and AHA. However, studies excluded pregnant women and did not include all common patient positions, such as semi-Fowlers. These studies cannot be applied to pregnant women due to dynamic cardiovascular changes in pregnancy. We measured BP in pregnant women in inpatient and outpatient settings in various positions. These BPs were compared to the published ACC/AHA guideline position: seated with arms and feet supported. Trained team members used an aneroid sphygmomanometer and stethoscope and/or a validated electronic BP machine. There is no significant difference between BP measurements using a sphygmomanometer/stethoscope vs. an electronic BP machine in the ACC/AHA guideline position (systolic p=0.60 diastolic p=0.91). There was not a significant difference in either systolic or diastolic means in the semi-Fowlers position (at 45 degrees measured by goniometer) (systolic=0.60 diastolic=0.95). Positioning did affect the diastolic BP measurement in the seated without support position (p=0.01) and both the systolic (p< 0.001) and diastolic (p<0.001) measurements in the left lateral recumbent position. Our data demonstrate that an accurate BP measurement in pregnancy is dependent upon patient position. Monitoring BP position in left lateral recumbent may mask an elevated BP. This study also suggests that it may be possible to substitute semi-Fowlers position for reliable BP measurements when chair sitting is not practical, such as labor.

Preeclampsia (PE) is a multiorgan hypertensive-disorder in pregnancy that causes significant maternal-fetal mortality and morbidity. The diagnostics and therapeutics for PE are limited due to its unclear etiology. Using the UI Maternal Fetal Tissue Bank, our lab has demonstrated that copeptin is robustly predictive of PE. To investigate copeptin further, we developed the Rule Out PreEclampsia Study (ROPE). The ROPE study recruits women admitted to Labor and Delivery for evaluation of PE. Women are admitted for PE evaluation at all hours. Research team members are not available at all times to obtain consent which limits recruitment. Our project aimed to develop an electronic informed consent (e-IC) that is compliant with the Federal Regulation for Human Research Protection and is easy to use and readily understood by study participants. After obtaining IRB approval, simulated patients were given an iPad on which to read and evaluate the e-IC using a validated questionnaire, the Quality of Informed Consent (QuIC). Based on the QuIC, the e-IC was modified and re-tested. Participants demonstrated good comprehension of the e-IC as evidence by QuIC scores ranging from 61 to 96. Based on our results, the e-IC is an effective and efficient method for the Informed Consent process.