Twenty-five music students taking classes in performance were randomly assigned either to an experimental group who received a course of 15 lessons in the Alexander technique, or to a control. A variety of measures were taken on four occasions: in both high and low stress situations before and after treatment. The experimental group showed improvement relative to the control on the following measures: overall music and technical quality as judged by independent experts blind to subjects' condition assignment, heart rate variance, self-rated anxiety and positive attitude to performance. However, with the exception of heart rate variance, these effects were restricted to performance in the low stress class situations. There were no significant effects on height, peak flow or misuse as judged on the basis of videorecordings of behaviour by independent experts in the Alexander technique.

In recent years, neonatal abstinence syndrome (NAS) rates have increased rapidly across the United States, rising from 1.2 (2000) to 5.8 (2012) per 1000 hospital births annually. Because most NAS infants are treated in an intensive care setting, associated hospital charges are high and continue to escalate, rising on average from $39,400 in 2000 to $66,700 in 2012. An innovative NAS treatment program, which includes early-initiated methadone therapy, rooming-in, and combined inpatient/outpatient weaning in a low-acuity nursery, has been in place since 2003 at a large Southeastern hospital. The program has proven safe, effective and low cost for treating infants of ≥35 weeks gestational age whose mothers used long-acting opioids. Given that 81% of NAS cases in the United States are funded by Medicaid programs and that the cost burden is rising rapidly, researchers considered the potential saved charges associated with implementing the same program in other hospitals state- and nationwide. Researchers used regression models to project state and national NAS birth rates from 2015-2025 and to predict future NAS charges under current treatment protocols. Three scenarios were developed to compare the potential saved charges of implementing the innovative NAS treatment program across the state and nation with assumptions related to the percent of NAS infants eligible for the program, percent funded by Medicaid, and fluctuations in average length of stay. The potential saved charges are substantial, creating a compelling case for policy makers and hospitals in the pursuit of safe, effective, and cost-conscious NAS care.

To describe medical, safety, and health care utilization outcomes associated with an early treatment model for neonatal opioid withdrawal. This is a retrospective review of 117 opioid-exposed infants born in a large regional hospital and treated in the level I nursery with methadone initiated within 48 hours of birth. For this cohort, mean length of stay was 8.3 days. Hospital safety events were infrequent; there were no medication errors or deaths. Within 30 days of discharge, 14% of infants visited the emergency department; 7% were readmitted. Per birth, mean hospital charges were $10,946.96; mean costs were $5,908.93. This study is the first to describe an early treatment model in a low-acuity nursery to prevent severe neonatal opioid withdrawal. The described model may be safe, effective, low-cost, and feasible for replication.

The scope of practice for newborn care in nonintensive hospital settings is ever changing, with obstetric care advances, shorter length of stay (LOS), and increased family-centered care. 1 In response to the US Surgeon General' s call to support breastfeeding and Baby Friendly USA, more infants receive care in their mothers' rooms. 2,3 Newborn clinicians require skills including diagnostic expertise and critical thinking, adaptability and sensitivity, and an understanding of this critical period of infant bonding. They also require leadership skills to manage hospital policies and link families with targeted community resources. This overview is based on the experience and research of a working group of the Academic Pediatric Association Newborn Nursery Special Interest Group (NN SIG), which consists of medical directors and physicians with expertise in newborn care from across the United States. The workgroup consisted of 17 newborn physicians ranging from young faculty to full professors at urban and rural academic and community hospitals in 17 cities and

Objectives Metformin is the only oral therapy for youth with type 2 diabetes, but up to 50% require additional agents within 2 years of diagnosis. Extended‐release (XR) metformin formulations may improve adherence and tolerability–important mediators of treatment response–but data in youth is lacking. To evaluate rates of gastrointestinal (GI) symptoms in patients treated with metformin (SR and XR) and the change in GI symptoms after changes in metformin therapy. Research Design and Methods Retrospective chart review of youth with Type 2 or prediabetes seen in a multidisciplinary clinic during 2016–2019. Results Of 488 eligible patients, 41.4% and 21.1% were taking metformin SR and XR respectively, with most (58%, n = 178/305) taking a total daily dose of ≥1500 mg/day. Those not on metformin tended to be younger, leaner, and had lower HbA1cs than those taking metformin, p < 0.05. Thirty percentage of patients described GI symptoms, most commonly, abdominal pain and diarrhea. There was no difference in GI symptoms in those on SR versus XR (18.3% vs. 14.6%, p = 0.41). Among patients who initiated metformin, rates of GI symptoms increased (13%–33%, p = 0.001, n = 99), while rates tended to decrease when metformin was discontinued (28%–12%, p = 0.076, n = 50). Rates of GI symptoms were unchanged among those that switched from SR to XR metformin (17% vs. 14%, p = 0.6, n = 58). Conclusions GI symptoms are common in youth with type 2 diabetes taking metformin XR and SR. Adjuncts to mitigate GI symptoms in youth on metformin therapy are needed to improve quality of life and medication adherence.