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Nabeel, Syed Hassan, Aamir Furqan, Aatir Fayyaz, and Rahat Akhtar. "SUBARACHNOID BLOCK;." Professional Medical Journal 24, no. 11 (November 3, 2017): 1708–12. http://dx.doi.org/10.29309/tpmj/2017.24.11.638.
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Introduction: Subarachnoid block has been in practice for below umbilicalsurgery more than 110 years.1 in recent era all over the world most of cesarean sections arebeing done under subarachnoid block because of high mortality rate associated with generalanesthesia due to failed intubation and aspiration pneumonia. Objectives: To compare theefficacy of phenylephrine versus ephedrine in the treatment of hypotension during cesareansection under subarachnoid block. Study Design: Randomized control trial. Setting:Department of Anesthesiology Nishter Hospital Multan. Period: March 2014 to August 2014.Materials and Methods: A total 80 patients included in the study and patients were divided intotwo equal groups. Phenylephrine group (P group) and Ephedrine group (E group), 40 patientsin each. Results: A total of 80 (100%) patients included in the study. As concern to the age ofpatients, mean age in group E was 30.50 and standard deviation was 5.383, similarly in groupP mean age was 30.75 and SD was 5.921. As concern to the efficacy in group E, 7 were havinggood efficacy and 33 were have poor efficacy. In group P 30 had good efficacy and 10 hadpoor efficacy. P=0.000 a significant value. Conclusion: Phenylephrine is more effective thanephedrine for the treatment of hypotension due to subarachnoid block during cesarean section.
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Boyer-Neumann, Catherine, Annie Borel-Derlon, Jenny Goudemand, Ségolène Claeyssens, Pierre-Marie Sie, Philippe Moreau, Marie-Anne Bertrand, et al. "Treatment of Von Willebrand Disease Women Undergoing Childbirth with a Von Willebrand Factor Product with a Low Content of Factor VIII: Results From 4 Multicenter Studies." Blood 120, no. 21 (November 16, 2012): 3375. http://dx.doi.org/10.1182/blood.v120.21.3375.3375.
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Abstract Abstract 3375 Introduction: Von Willebrand disease (VWD) is relative to an abnormality, either quantitative or qualitative, of von Willebrand factor (VWF). Among patients with severe VWD, pregnant women are at increased risk of bleeding especially for the peripartum period both for vaginal delivery and Caesarean section. In patients with type 3 VWD and in patients with a functional defect, the treatment with VWF is required for the prevention of bleeding during the delivery. Predisposition towards an increased risk of thrombosis in pregnant women is well establish and this predisposition to thrombosis results from the hypercoagulable state of pregnancy with increased factor VIII and VWF levels. As endogenous factor VIII production in patients with VWD is intact, the treatment with a VWF concentrate with a low factor VIII content provides hemostatic levels of factor VIII, by stabilization of endogenous factor VIII, while providing efficient primary hemostasis. We report the efficacy and safety of Wilfactin, a triple-secured VWF concentrate almost devoid of factor VIII, for the preventive treatment of bleeding during the delivery period. Methods: Data from 4 prospective multicenter studies including one fully monitored post-marketing study were pooled. As recommended in the protocols, if needed, the unscheduled childbirth was managed by VWF with the coadministration of factor VIII at the first infusion. When time permitted, two infusions of Wilfactin were administered: one at 12–24 hours and one 30 minutes-1 hour prior to childbirth. The investigators were asked to evaluate the efficacy on a 4-point scale (Excellent, Good, Moderate, None) at the end of treatment. Results: Across all studies, 22 VWD women delivered 24 children. Wilfactin was used to prevent bleeding in 9 vaginal deliveries in 9 women (3 type 1, 5 type 2 and 1 type) and 15 Cesarean deliveries in 13 women (3 type 1, 9 type 2 and 3 type 3). There were no notable differences in the evaluation of efficacy between vaginal and Caesarean deliveries. The efficacy was rated as ‘good/excellent’ in 20 of 21 (95%) evaluated deliveries and ‘moderate’ in one cesarean due to a moderate, but controlled bleeding. Blood transfusion was required for a retroplacental hematoma in one Cesarean section but the efficacy of the product was rated as excellent by the investigator. Over the total course of therapy for childbirth, the median dose per infusion was higher for vaginal delivery (42 IU/kg) than for Cesarean section (27 IU/kg). Women received more infusions for Cesarean section than for vaginal delivery (15 vs 8) and more treatment days (10 vs 6, respectively) but, the total dose per type of treatment was quite similar (374 vs 272 IU/kg). A priming dose of factor VIII at the first infusion of Wilfactin was given to ensure rapid coagulation before starting 5 Cesarean sections and 4 vaginal deliveries. For 4 other Cesarean sections, the hemostatic level of factor VIII was achieved by an initial infusion of Wilfactin 12 to 24 hours before the procedure. No special measures to increase factor VIII were required for the other 11 deliveries. The overall tolerability was very good; neither VWF inhibitor nor thrombotic complications were reported. An additional data is to note that 2 patients were treated with long-term prophylaxis regimen during pregnancy because of placental hematoma. Conclusion: Good hemostatic efficacy, absence of thrombotic or other severe complications shown in the clinical trials with Wilfactin are encouraging for its use in the management of pregnant VWD women for vaginal delivery or Cesarean section. Disclosures: No relevant conflicts of interest to declare.
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Ananthaneni, Anuradha, Srilekha Namala, Vijay Srinivas Guduru, V. V. S. Ramprasad, Sabitha Devi Ramisetty, Urmila Udayashankar, and Kiran Kumar Naik. "Efficacy of 1.5% Dish Washing Solution and 95% Lemon Water in Substituting Perilous Xylene as a Deparaffinizing Agent for Routine H and E Staining Procedure: A Short Study." Scientifica 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/707310.
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Aim. To assess the efficacy of dish washing solution and diluted lemon water in deparaffinizing sections during conventional hematoxylin and eosin staining technique.Objective. The objective is to utilize eco-friendly economical substitute for xylene.Materials and Methods. Using twenty paraffin embedded tissue blocks, three sections each were prepared. One section was stained with conventional H and E method (Group A) and the other two sections with xylene-free (XF) H and E (Groups B and C). Staining characteristics were compared with xylene and scoring was given. Total score of 3–5 was regarded as adequate for diagnosis and less than that inadequate for diagnosis.Statistical Analysis. Chi-square test, Kruskal Wallis ANOVA test, and Mann-WhitneyUtest were used.Results. Adequacy of nuclear staining, crispness, and staining for diagnosis were greater in both Groups A and C (100%) than Group B (95%). Adequacy of cytoplasmic staining was similar in all the three groups (100%). Group B showed comparatively superior uniform staining and less retention of wax.Conclusion. Dish washing solution or diluted lemon water can be replaced for xylene as deparaffinizing agent in hematoxylin and eosin procedure.
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Laohawiriyakamol, Suphawat, Puttisak Puttawibul, and Somrit Mahattanobon. "Efficacy of One-step Nucleic Acid Amplification Assay for Evaluation of Sentinel Lymph Node Metastasis of Breast Cancer in Songklanagarind Hospital." Songklanagarind Medical Journal 35, no. 1 (February 21, 2017): 17. http://dx.doi.org/10.31584/smj.2017.35.1.618.
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Objective: To compare the sensitivity, specificity and accuracy of the one-step nucleic acid amplification (OSNA) assay and frozen sections.Material and Method: One hundred and twenty patients with early breast cancer and no clinical nodal involvement underwent intraoperative sentinel lymph nodes (SLNs) evaluation and undertaken axillary lymph nodes dissection (ALND) at the Department of Surgery, Songklanagarind Hospital from March 1st, 2011-November 30th, 2014.Results: A total of 213 SLNs were evaluated (mean 1.84 nodes). The accuracy of the OSNA assay compared to histological evaluation was 95.7%. The OSNA assay performance was: sensitivity 100% (25/25); specificity 95.2% (179/188); positive predictive value (PPV) 73.5% (25/34) and negative predictive value (NPV) 100% (179/179). Turnaround time was an average 39.6 minutes. The accuracy of frozen sections compared to histological evaluation was 99.1%. The frozen sections performance was: sensitivity 92% (23/25); specificity 100% (188/188); PPV 100% (23/23) and NPV 98.9% (188/190). After discordant analysis, the PPV of the OSNA assay on nodes with macrometastases (++) was 100% (25/25), and the result on nodes with micrometastases (+) was 75% (3/4). The accuracy of OSNA after review was thus 99.5%.Conclusion: The OSNA assay is accurate and rapid for SLN evaluation and it can replace the frozen section in general practice.
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Stevens, A., A. Fischer, M. Bartels, and G. Buchkremer. "Electroconvulsive therapy: a review on indications, methods, risks and medication." European Psychiatry 11, no. 4 (1996): 165–74. http://dx.doi.org/10.1016/0924-9338(96)88386-6.
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SummaryThis paper reviews and presents data of practical impact for those administering electroconvulsive therapy (ECT). In the first section, physical and physiological aspects of the stimulus as well as methods of stimulation are discussed. The second section deals with indications for ECT, efficacy and treatment modalities such as seizure duration, treatment frequency and total number of ECT applications. The last section is devoted to side effects, risks, comedication and comorbidity.
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Yang, Xiang, Brittney R. Bullard, Ifigenia Geornaras, Shuang Hu, Dale R. Woerner, Robert J. Delmore, J. Brad Morgan, and Keith E. Belk. "Comparison of the Efficacy of a Sulfuric Acid–Sodium Sulfate Blend and Lactic Acid for the Reduction of Salmonella on Prerigor Beef Carcass Surface Tissue." Journal of Food Protection 80, no. 5 (April 3, 2017): 809–13. http://dx.doi.org/10.4315/0362-028x.jfp-16-317.
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ABSTRACT A study was conducted to compare the efficacy of a commercially available sulfuric acid–sodium sulfate blend (SSS) and lactic acid (LA) in reducing inoculated Salmonella populations on beef. Sixty pieces of prerigor beef carcass surface brisket tissue, collected directly from the processing line of a commercial beef processing plant, were cut into two sections (10 by 10 cm each) and spot inoculated (6 to 7 log CFU/cm2) on the adipose side with a six-strain mixture of Salmonella. One section per piece of brisket tissue was left untreated (control), while the second section was spray treated (5 s, 15 lb/in2, and 33 mL/s flow rate) with unheated (21°C) or heated (52°C) solutions of SSS (pH 1.1) or LA (4%). Unheated and heated SSS lowered (P < 0.05) total bacterial counts from 6.3 to 4.6 and 4.3 log CFU/cm2, respectively. Likewise, unheated and heated LA reduced (P < 0.05) total bacterial counts from 6.3 to 4.7 and 4.4 log CFU/cm2, respectively. Initial counts of inoculated Salmonella populations (6.1 to 6.2 log CFU/cm2) were reduced (P < 0.05) to 4.2 and 3.9 log CFU/cm2 following treatment with unheated and heated SSS, respectively, and to 3.7 and 3.8 log CFU/cm2 after treatment with unheated and heated LA, respectively. Overall, the temperature of the chemical solutions had a small (0.3 log CFU/cm2), but significant (P < 0.05), effect on total bacterial counts but not (P > 0.05) on Salmonella counts. Regardless of solution temperature, Salmonella counts for LA-treated samples were 0.3 log CFU/cm2 lower (P < 0.05) than those of samples treated with SSS. These results indicate that both unheated and heated solutions of SSS and LA are effective interventions for reducing Salmonella contamination on prerigor beef carcass surface tissue.
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Prajapati, Sonali, and Nimisha Brahmbhatt. "Analgesic efficacy of ultrasound guided transversus abdominis plane (Tap) block after caesarean delivery- A prospective randomized controlled trial." Indian Journal of Clinical Anaesthesia 8, no. 2 (June 15, 2021): 185–90. http://dx.doi.org/10.18231/j.ijca.2021.038.
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Transversus abdominis plane block is facial plane block providing post-operative analgesia after lower abdominal surgeries as part of multi-modal analgesia. We evaluated analgesic efficacy of TAP block with Bupivacaine for 24hr after caesarean section done with pffannestiel incision under spinal anaesthesia, the pain being assessed with help of VAS. Total 130 parturients (ASA I OR II) posted for elective caesarean section under spinal anaesthesia were enrolled. They were allocated randomly in to two groups of 65 each. Group B patients received bilateral TAP block under USG at the end of surgery with 15ml of 0.25%Bupivacaine on each side while Group C patients did not receive TAP block. IV paracetamol 1gm was given in both groups as baseline analgesic at the end of surgery. Post-operative pain was assessed with VAS and rescue analgesia was given in form of Inj. Diclofenac Sodium Aq. at VAS score>4. Total rescue analgesia required in mg in post-operative 24 hours was noted.USG guided TAP block after caesarean section produced effective analgesia. Time for 1st rescue analgesia was delayed in group-B (mean+SD-12.25+4.54hr) than group-C (7.96+2.89hr) (P<0.001). Total analgesic requirement was reduced in group-B (107.35+50.32mg) than group-C (183+52.83mg) (P<0.001). USG-guided TAP block is easy to perform and effective as a component of multimodal analgesic regimen after caesarean section without any major complications.
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Diedhiou, Moustapha, E. B. Ba, D. Barboza, A. Diouf, M. Dieng, O. Thiam, C. A. Dia, et al. "Bupivacaine-Fentanyl vs Ropivacaine-Fentanyl: Evaluation of two Spinal Anesthesia Protocols for Emergency Cesarean Section." Journal of Drug Delivery and Therapeutics 10, no. 6-s (December 15, 2020): 3–7. http://dx.doi.org/10.22270/jddt.v10i6-s.4403.
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Objective: Evaluation of the hemodynamic, respiratory and fetal side effects of two protocols for spinal anesthesia (P1: bupivacaine-fentanyl; P2: ropivacaine-fentanyl).
Material and Method: Prospective pseudo-randomized study comparing two spinal anesthesia protocols for emergency cesarean section conducted in the operating room of the regional hospital center of Saint Louis in Senegal. Study duration was 4 months. We studied, age, indication for Caesarean section, medical and surgical history, P1 and P2 protocols, hypotension, bradycardia, Apgar scores at birth and at 5min. Univariate and bivariate analysis was performed on the R software.
Result: A total of 115 patients were collected, with a mean age of 27.1 years (E: 15 - 45) and a standard deviation of 7.6. Indications for Caesarean section were maternal and fetal dystocia for 67 patients (58%), fetal distress for 39 parturients (34%), and pre-eclampsia for 5 patients (4%). The P1-Bupi spinal protocol was used in 42 patients (36.5%) and the P2-Ropi spinal protocol was used in 73 patients (63.5%). Anesthetic complications such as low blood pressure, bradycardia and desaturation were found in a total of 30 patients, i.e. in 26% of cases. The mean Apgar score at birth for newborns from the P1-Bupi protocol was 8 (Extremes: 7, 9); the mean Apgar score at birth for newborns from the P2-Ropi protocol was 7.5 (Extremes: 2, 10). There was a significantly negative correlation between the P1-bupi protocol and the appearance of hypotension with p-value: 0.04 and a significantly positive correlation between the P2-ropi protocol and the appearance of hypotension with p-value: 0.04.
Discussion/ Conclusion: Ropivacaine certainly has a better cardiovascular and neurological tolerance and a better efficacy in terms of analgesia. However, during caesarean sections, it is important to consider the risk of hypotension and possible fetal complications related to its use.
Keywords: Ropivacaine - Bupivacaine - Spinal anesthesia - Caesarean section
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Das, Nabanita, Usha Shukla, Dheer Singh, and Urvashi Yadav. "Comparison of analgesic efficacy between TAP block and local site infiltration post operatively in caesarean section." International Journal of Research in Medical Sciences 6, no. 4 (March 28, 2018): 1407. http://dx.doi.org/10.18203/2320-6012.ijrms20181305.
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Background: Patients undergoing caesarean section need to be alert, comfortable and mobile in order to take care of their babies, for which they must be pain free in post operative period. The aim of present study is to compare the analgesic efficacy of TAP block with local anaesthetic infiltration specifically in LSCS patients in reducing patient pain postoperatively, as well as to decrease the analgesic requirements.Methods: The study population consisted of 60 patients posted for elective and emergency caesarean section. They were blindly divided into two groups of 30 patients each. Group T received 40ml 0.25% Ropivacaine in Transverses abdominis plane (TAP) block for postoperative analgesia and group I received 40ml 0.25% ropivacaine as infiltration at incision site for postoperative analgesia. Patients were observed for numeric pain score NPS, analgesic requirements, total analgesic consumption and adverse effects if any.Results: There was highly significant difference in numeric pain scores at 2nd, 6th, 12th and 24th hours (p<0.0001). Both the time for first rescue analgesic and total amount of analgesic consumed are statistically significant (p<0.0001).Conclusions: TAP block is an effective postoperative analgesic procedure for post caesarean section patients.
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Güngör, Emre Sinan, Duygu Güzel, Ali Galip Zebitay, Gülşah İlhan, and Fatma Ferda Verit. "The efficacy of onion extract in the management of subsequent abdominal hypertrophic scar formation." Journal of Wound Care 29, no. 10 (October 2, 2020): 612–16. http://dx.doi.org/10.12968/jowc.2020.29.10.612.
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Objective: Development of postoperative scars is often a problem. This study aimed to evaluate the efficacy of gel containing Allium cepa extract, allantoin and heparin (Contractubex, Merz Pharmaceuticals GmbH, Frankfurt, Germany) in reducing scarring after a caesarean section by comparing it with a control group, and also intra-individually, using the Vancouver Scar Scale (VSS). Method: A total of 120 patients who underwent a second elective caesarean delivery and who presented with hypertrophic scar development after their first caesarean section were included in the study. A scar revision was performed for all patients during the second caesarean operation. Patients in the study group (n=60) were advised to apply the topical scar gel postoperatively for a period of 6 months. The control group (n=60) received no treatment. Results: Significant reductions were observed in the vascularity, pigmentation and height subgroups of the VSS for those in the group who continued the treatment to 24 weeks. An intra-individual analysis showed that the gel effectively reduced scarring after the second caesarean section. Conclusion: The prophylactic use of the gel to reduce scar development offers better results for vascularity, pigmentation and height subscales of the VSS after surgical removal of the primary caesarean scar during the second caesarean section. The results were better both intra-individually, and also in comparison with the control group and support the use of a gel containing Allium cepa extract, allantoin and heparin to reduce scarring after a caesarean section.
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Gami, Rupesh Kumar, Kumar Jahan, and Chandra Bhushan Jha. "Efficacy and safety of intrathecal morphine for post cesarean section analgesia." Journal of Society of Anesthesiologists of Nepal 1, no. 1 (October 3, 2015): 13–17. http://dx.doi.org/10.3126/jsan.v1i1.13583.
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Background: Government of Nepal has been conducting Cesarean section under “Safe Motherhood” program all over country. The purpose of this study was to evaluate the efficacy and safety of intrathecal morphine for post cesarean analgesia under spinal anesthesia. Methods: A total of 300 parturients posted for Cesarean section under spinal anesthesia were divided into two groups of 150 each in this prospective randomized case-control study. Morphine group received 0.15 mg of intrathecal morphine mixed in 12 mg of 0.5% bupivacaine heavy while control group received 12 mg of 0.5% bupivacaine heavy alone, after proper preparation of spinal anesthesia. The parturients were assessed for first request of analgesic as per Visual Analog Scale, frequency of analgesics required within 24 hr, nausea, vomiting, pruritus, sedation and respiratory depression.Results: Postoperative analgesia was significantly greater in morphine group as compare to control group (12.1 ± 7.6 vs 3.7 ± 2.9 hr). Frequency of analgesics requirements was also significantly lower in morphine group (1.7 ± 2.0 vs 3.4 ± 8.1). Visual Analog Scale was below 4 at most of time in morphine group. The incidence of nausea, vomiting and pruritus were more in morphine group as compare to control group but without any respiratory depression. There was no significant difference in APGAR score among fetus. Conclusion: Mixing low dose of intrathecal morphine in standard dose of spinal anesthesia effectively prolongs the duration of post cesarean analgesia and decreases the frequency of analgesics requirement without any major complication in parturients or fetus.Journal of Society of Anesthesiologists 2014 1(1): 13-17
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Moradpoor, Hedaiat, Sahar Raissi, Mohammad Javad Dehnavi, and Mohsen Safaei. "Factors Affecting the Learning of Fixed Prosthodontics Course by Students at Kermanshah University of Medical Sciences." Open Access Macedonian Journal of Medical Sciences 7, no. 17 (August 30, 2019): 2868–73. http://dx.doi.org/10.3889/oamjms.2019.692.
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AIM: The objective of this study was to investigate the factors affecting the learning of fixed prosthodontics course from the viewpoint of students and faculty members of Kermanshah Dentistry School.
MATERIAL AND METHODS: This research was a descriptive-analytical study conducted using the convenient sampling method. A total of 72 students and 5 faculty members were included in the study. Data were collected using a researcher-made questionnaire containing two sections. The first section consists of demographic information, and the second section consists of 14 questions to evaluate the factors affecting the learning of the fixed prosthodontics course.
RESULTS: From the students’ point of view, there was a significant relationship between the effect of using clinical points during a teaching on the learning efficacy of the fixed prosthodontics course and gender (P = 0.028). There was a statistically significant relationship between the level of professor's knowledge regarding the modern educational methods on the learning of fixed prosthodontics course (P = 0.034). The factor of displaying and implementing practical work on the real patient was considered important by students, and having knowledge about modern educational methods was considered important by faculty members.
CONCLUSIONS: It is recommended that appropriate educational planning be implemented to enhance students’ practical work on the real patient and increase professors’ knowledge about modern educational methods.
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Vacca, Maria, Marilyn A. Mapp, Ashlee Hiester, Nikunj M. Vyas, Julia Burke, and Kenneth Covone. "899. Reduction of Surgical Site Infections Post Cesarean Section through Implementation of Novel Evidenced Based Bundle." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S483—S484. http://dx.doi.org/10.1093/ofid/ofaa439.1087.
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Abstract Background A frequent complication post cesarean section (C-section) is surgical site infections (SSI) which are associated with heightened maternal morbidity and mortality, decreased patient satisfaction, prolonged hospitalization, and increased costs. In Calendar Year 2019, our Infection Control Committee identified an increase in the incidence of post-operative C-section SSI rates over an 8 month period from January through August of 2019.. The purpose of this study was to develop, implement and measure the compliance and efficacy of a novel pre-operative bundle (POB) for patients undergoing C-section. Calendar Year 2019 Jan. through Aug. C-Section Infections Raw Numbers Methods In October 2019, our multidisciplinary team consisting of Infection Control, Pharmacy, Nursing, and Physicians developed and implemented POB for patients undergoing C-section. The POB included the following: 1. Mandatory interventions of vaginal cleansing using povidone iodine 2. Chlorhexidine (CHG) 2% wipes to abdomen 3. Addition of Azithromycin 500mg x 1 dose as pre-operative antibiotic. Primary endpoint of the study was to measure the overall C-section SSI incidence for 8 months period pre and 8 months post implementation of the POB. This Secondary endpoint of the study included POB compliance and efficacy of real-time prospective audit and feedback for non-compliance. Novel Preoperative Bundle Auditing Compliance Results There were total of 212 patients who received C-section in Pre-POB group and 182 in Post-POB group. Baseline characteristics between the groups were similar. Overall C-section rates Pre-POB was 3.8 % vs 0% in Post-POB group. We noted a bundle compliance of 97.9% since implementation of POB. Real time prospective audit and feedback was provided to total of 122 cases after implementation of POB. Comparison of C-Section Raw Numbers Calendar Year 2019 Pre and Post Novel Bundle Implementation Conclusion With implementation of POB, we noticed a significant drop in our C-section SSI. We observed a very high bundle compliance with implementation of prospective audit and feedback approach. This is the first study evaluating implementing a novel pre-operative bundle for patients undergoing C-section. Continued auditing and real time feed back of novel bundle will ensure continued success. Disclosures All Authors: No reported disclosures
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Ashraf, Saima, Amara Sahar, and Sohail Safdar. "INDUCING ABORTION IN 2ND TRIMESTER;." Professional Medical Journal 24, no. 06 (June 5, 2017): 839–42. http://dx.doi.org/10.29309/tpmj/2017.24.06.1120.
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Objectives: To determine the efficacy of misoprostol for inducing the abortionin 2nd trimester with previous one cesarean section. Study Design: Descriptive case series.Place and Duration of Study: Department of Obstetrics & Gynaecology, Nishtar MedicalCollege and Hospital Multan from May, 2015 to October 2015. Material and Methods: Thesample included 139 patients having pervious one cesarean section with gestational age 14-20wks assessed on ultrasound and having an indication for termination of pregnancy like IUD,fetal anomalies (neural anomaly, cardiac anomaly), medical disorder hypertension, diabetesmellitus. General physical examination was done by the researcher. Investigations includingcomplete blood count, complete urine examination, random blood sugar, liver and kidneyfunction tests, coagulation profile were carried out. The researcher placed misoprostol 200μgper vaginally every 4 hourly with overnight rest maximum for 72 hours. Efficacy of misoprostolwas judged in terms of success rate in achieving termination. Termination of pregnancy wasconsidered successfully if cervical os progressively dilated and both fetus and placenta expelledwithin 72 hours after insertion of 1st dose of misoprostol without surgical intervention. Results.A total of 139 cases fulfilling the inclusion criteria were enrolled to determine the efficacy ofmisoprostol for inducing abortion in 2nd trimester with previous one cesarean section. Amongthese patients 84.89% (n=118) were treated effectively, 15.11% (n=21) were not effectivelytreated. Conclusion: Misoprostol for inducing the abortion in 2nd trimester with previous onecesarean section is effective for expulsion of the fetus and placenta.
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Mahdizadeh-Shahri, MSc, Maryam, Manijeh Nourian, PhD, Maryam Varzeshnejad, PhD, and Maliheh Nasiri, PhD. "The Effect of Oketani Breast Massage on Successful Breastfeeding, Mothers’ Need for Breastfeeding Support, and Breastfeeding Self-Efficacy: an Experimental Study." International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice 14, no. 3 (June 8, 2021): 4–14. http://dx.doi.org/10.3822/ijtmb.v14i3.625.
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Background: The negative effects of cesarean section on breastfeeding are a major global concern.
Purpose: This study aimed to determine the effect of Oketani breast massage on the maternal need for support during breastfeeding, breastfeeding success, and breastfeeding self-efficacy.
Setting: Three hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran, from April to July 2019.
Study Design: The participants in this experimental study were 113 pregnant women who were candidates for cesarean section. The mothers were selected using convenience sampling and randomly assigned. In addition to routine care, the mothers in the intervention group received Oketani breast massages twice. However, the mothers in the control group received routine care. The data were collected using the Infant Breastfeeding Assessment Tool (IBFAT), LATCH Assessment Score, and the Breastfeeding Self-Efficacy Scale (BSES). The data were analyzed with SPSS 20 software via the independent samples t test, the Mann–Whitney U test, and the chi-square test.
Results: The results of the study suggested that the breastfeeding success rate, which was evaluated with IBFAT in both the first two breastfeeding stages and the last pre-discharge breastfeeding, was significantly higher for the mothers in the intervention group (p < .001). In addition, the mother’s need for support, which was evaluated with LATCH in the first two breastfeeding stages (p = .044) and the last pre-discharge breastfeeding (p < .001) in the intervention group, was less. The total number of breastfeeding sessions from birth to discharge was higher in the intervention group (p = .002). Furthermore, the mothers in the intervention group breastfed their infants in a significantly shorter time interval (p = .002). Breastfeeding self-efficacy, according to the BSES, was significantly higher in the mothers of the intervention group (p < .001).
Conclusion: Oketani massage can be used as a care intervention by nurses to improve breastfeeding in mothers who undergo cesarean sections.
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Singh, Grisuna, Farhat Banu, and Husneyera Haque. "Efficacy of Transversus Abdominis Plane Block After Post Caesarean Section Delivery." Journal of Nepalgunj Medical College 16, no. 1 (July 31, 2018): 2–6. http://dx.doi.org/10.3126/jngmc.v16i1.24217.
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Introduction: Post operative pain following caesarean section delivery can negatively affect early wound healing, proper breast feeding to the new born baby and therefore impair mother to child bonding. Combination of non steroidal anti inflammatory drugs (NSAIDS) and opioids has most commonly been used in pain management. The combination of regional anesthetic techniques like Transversus Abdominis Plane (TAP) block reduces pain and the dose of total analgesics consumed and therefore helps to prevent opioid related side effects.
Objective: To evaluate the analgesic efficacy of Transversus Abdominis Plane block for management of postoperative pain in the first 24 hours after caesarean section.
Methodology: It is a prospective randomized controlled single blinded study involving 60 patients of ASA II done in Nepalgunj Medical College Teaching Hospital over a period of 2 months. They are divided into two groups of 30 patients each. Group 1 received 20 ml of 0.25% isobaric bupivacaine in the triangle of Petit bilaterally. Group 2 received IV analgesics (NSAIDS and Tramadol 50 mg with Phenargan 25 mg). VAS score was taken every 6 hourly for 24 hours post operatively.
Results: The mean VAS score of the patients in group 2 at 0-6 hours, 6-12 hours, 12-18 hours and 18-24 hours was 6.73(SD±0.69), 6.63(SD±0.610), 6.40(SD±0.56) and 6.43(SD±0.57) respectively. The mean VAS score of the patients who received block is significantly less as compared to those who did not receive the block with a p value of <0.001. The mean time to first analgesic request in group 1 was 10.83(SD±2.95) and in group 2 was 4.87(SD±0.68) with a p value of <0.001. In group 1, 70% patients received single dose of analgesics, 23.3% received two doses and 6.7% received three doses of analgesics. In group 2 all the patients received four doses of analgesics.
Conclusion: Transversus Abdominis Plane Block can be used as a part of multimodal analgesic therapy for the management of post operative pain after caesarean section as it is technically less demanding, safe and economical. It reduces the side effects related with opioid analgesics and encourage early mobility, wound healing and proper mother to child bonding.
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KAUSAR, ROBINA, and LUBNA YASMEEN. "ELECTIVE CAESAREAN SECTION." Professional Medical Journal 17, no. 02 (June 10, 2010): 304–7. http://dx.doi.org/10.29309/tpmj/2010.17.02.2436.
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Objective: To compare short antibiotic prophylaxis versus prolonged antibiotic regime in terms of morbidity control of infection in patients undergoing elective caesarean section. Study Design and Settings: It was a experimental study done in Gynae/Obs unit I Holy Family Hospital Rawalpindi over a period of one year. Patients and Methods: Total of 200 patients selected randomly were admitted in antenatal ward for elective caesarean section. All these booked patients with age less then 40 years, gestational age of > 38 weeks, Hb >10g/dl, with no signs of genitourinary or respiratory tract infection were included in the study. These patients were divided in two groups with 100 patients in each group. In group I, short antibiotic prophylaxis in form of three doses of injectable antibiotic was given. In group II prolonged antibiotic regime wasgiven as 5 days course. Augmentin was chosen as it has proven efficacy and good coverage for microorganisms of urogential tract and skin. Injection Augmentin was given in dose of 1.2g (1g Amoxycillin + 200mg clavulanic acid) I/V x BD. All operation were performed by transverse lower segment caesarean section by registrars and consultants. Anaesthesia used was mostly spinal and more than 80% of the patients were having body mass index of <30. These patients were followed in postnatal ward for post operative infectious morbidity till discharge. Data collected through proformas was entered in computer and analyzed using SPSS. Result: Over all post operative infectious morbidity in group I was 29% and in group II 30% (p = 0.877). Post operative fever in group I was 09% and group II 08% (p = 0.800), while frequency of endometritiswas found to be same in both groups which was 03%. No case of chest infection was recorded in both groups. Only 5% patients in group I and 4% patients in group II were reported to have urinary tract infection (p = 0.733). The most common complication found during study was wound infection, the rate being 12% in group I and 15% in group II (p = 0.535). So the overall results showed no statistically significant differencebetween two groups. Conclusion: Short antibiotic prophylaxis is as effective as prolonged antibiotic regimen. As it is cost effective and most of our patients come from low socio economic class, so this short antibiotic prophylaxis should be recommended routinely for all elective caesarean sections.
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Almeida, Raul Frankllim de Carvalho, Antônio Altenor Bessa de Queiroz, João Carlos Belloti, José Maria Bedran de Castro Filho, Moisés Cohen, and Ricardo Dizioli Navarro. "Approach towards total knee arthroplasty in Brazil: cross-sectional study." Sao Paulo Medical Journal 127, no. 4 (July 2009): 190–97. http://dx.doi.org/10.1590/s1516-31802009000400003.
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CONTEXT AND OBJECTIVE: Total knee arthroplasty (TKA) has evolved particularly since the 1970s, with improvements in implants and surgical instruments, and has thus become an effective intervention for treating knee arthrosis. Many studies have presented rates of satisfactory clinical and radiological results greater than 90%, from follow-ups of over ten years. Nevertheless, despite scientific evidence showing the efficacy of TKA, the approaches taken present controversies in certain respects. The objective of this study was to evaluate how the Brazilian orthopedists deal with TKA, with investigation of the main aspects of this procedure. DESIGN AND SETTING: Cross-sectional survey conducted during the 39th Brazilian Congress of Orthopedics and Traumatology, in São Paulo, Brazil, in November 2007. METHODS: We applied a questionnaire to orthopedists registered at the congress. The questionnaire was randomly distributed and participation was voluntary; 858 completed questionnaires were included in the analysis. RESULTS: Most of the Brazilian orthopedists were members of SBOT and worked in the southeastern region. They used imported cemented implants through an anterior access route centered on the patella, with replacement of the joint surface of the patella and preservation of the posterior cruciate ligament. They did not have experience with simultaneous bilateral TKA. Postoperatively, they used antibiotics and suction drains for 48 hours. There was no consensus regarding prophylaxis for venous thromboembolism or the frequency of the main complications. CONCLUSION: The majority of Brazilian orthopedists work in the southeastern region of the country and agree about the main aspects of the approaches towards TKA.
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Bose, Deepak, and Rasheeda Beegum. "Sublingual Misoprostol vs Intravenous Tranexamic Acid in reducing Blood Loss during Cesarean Section: A Prospective Randomized Study." Journal of South Asian Federation of Obstetrics and Gynaecology 9, no. 1 (2017): 9–13. http://dx.doi.org/10.5005/jp-journals-10006-1448.
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ABSTRACT Introduction The increasing incidence of cesarean sections in India has caused a rise in the incidence of postpartum hemorrhage (PPH). There has been expanding interest in the role of misoprostol and tranexamic acid (TXA) in preventing and managing PPH during lower (uterine) segment cesarean section (LSCS). However, the lack of a published study comparing the efficacies of these drugs prompted us to conduct this study. Aims and objectives To compare the efficacies of sublingual misoprostol (600 μg) and intravenous TXA injection (500 mg) in reducing blood loss during LSCS by assessing intraoperative blood loss, perioperative hemoglobin (Hb) fall, and need for additional uterotonic agents. Materials and methods A total of 163 pregnant patients undergoing emergency/elective LSCS during the study period from 2013 to 2014 were randomly assigned to two groups — group I (82) received sublingual misoprostol 600 μg and group II (81) intravenous TXA 500 mg at cord clamping. Visual estimation of blood loss was done and 48 hours postoperative Hb and packed cell volume were measured to compare with preoperative values. Need for added uterotonics, blood transfusion, and adverse effects of drugs was assessed. The two groups were again subgrouped based on presence or absence of risk factors for PPH. Results The TXA significantly reduced blood loss compared with misoprostol (416 vs 505 mL) in patients without high-risk factors for PPH. Misoprostol caused significantly higher minor side effects while TXA reduced operation time. Conclusion The TXA can be routinely used after cord clamping along with oxytocin in patients undergoing elective/emergency LSCS to reduce perioperative blood loss, especially in those without risk factors for PPH. How to cite this article Bose D, Beegum R. Sublingual Misoprostol vs Intravenous Tranexamic Acid in reducing Blood Loss during Cesarean Section: A Prospective Randomized Study. J South Asian Feder Obst Gynae 2017;9(1):9-13.
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Thomas, Jayakar, and Shreya Srinivasan. "Efficacy of apremilast in psoriasis: a cross sectional study." International Journal of Research in Dermatology 5, no. 1 (January 25, 2019): 187. http://dx.doi.org/10.18203/issn.2455-4529.intjresdermatol20190243.
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<p class="abstract"><strong>Background:</strong> This study was done to evaluate the efficacy of apremilast in patients with psoriasis.</p><p class="abstract"><strong>Methods:</strong> A total of 20 patients clinically diagnosed with different forms of psoriasis were prescribed apremilast 30 mg twice a day. A psoriasis area severity index (PASI) scoring was done every 4 weeks with a final score taken at the end of 12 weeks.<strong></strong></p><p class="abstract"><strong>Results:</strong> Of the 20 (eight female and 12 male) patients prescribed apremilast 30 mg, 8 patients achieved 75% and more PASI reduction, 10 patients achieved 50% and more PASI reduction at the end of 12 weeks. One patient did not show any significant PASI reduction, while another patient dropped out from the study after 3 weeks of apremilast due to intolerable vomiting and diarrhoea.</p><p class="abstract"><strong>Conclusions:</strong> Apremilast, a relatively safe drug, has no effect on the haematological, renal, hepatic systems as well as no major immunological effects like other drugs used in the treatment of psoriasis, making monitoring of laboratory parameters inconsequential. It is also well tolerated with very few side effects in comparison, making it a welcome drug in the long run.</p>
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Gandhi, Pushpal, Mahendra Agrawal, Bhavika Agrawal, and Simarn Behl. "Comparative study of clinical efficacy and safety of intrathecal isobaric ropivacaine 0.75% with fentanyl versus isobaric ropivacaine 0.75% alone for caesarean." International Journal of Scientific Reports 7, no. 1 (December 22, 2020): 1. http://dx.doi.org/10.18203/issn.2454-2156.intjscirep20205451.
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<p><strong>Background: </strong>Compare the clinical efficacy and safety of intrathecal isobaric ropivacaine 0.75% with fentanyl, 10 mcg vs isobaric ropivacaine 0.75% alone for caesarean section.</p><p><strong>Methods: </strong>Two hundred patients were considered eligible for the study of which one hundred and sixty-eight patients undergoing caesarean section under spinal anesthesia and were included in the study. Parturient to ASA physical status I-II scheduled for caesarean section were randomly selected for the study and are divided into group of 84 each.<strong></strong></p><p><strong>Results: </strong>There was significant difference in sensory block duration at T<sub>10</sub> (min) and total duration of analgesia (min) in both groups. This difference between two group’s was not significant. Adverse Effects in group RF 5 (5.9%) patients had hypotension and 2 (2.3%) bradycardias in group R 3 (3.5%) patient had hypotension.<strong></strong></p><p><strong>Conclusions: </strong>Hemodynamic parameters were comparable in both the groups. Total duration of analgesia and sensory block duration at T<sub>10</sub> was significantly shorter with ropivacaine (with saline) compared to ropivacaine with fentanyl.</p>
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Dong, Ning, Wei-Ti Chen, Meijuan Bao, Yan Lu, Yuqian Qian, and Hongzhou Lu. "Self-Management Behaviors Among Patients With Liver Cirrhosis in Shanghai, China: A Cross-Sectional Study." Clinical Nursing Research 29, no. 7 (May 28, 2018): 448–59. http://dx.doi.org/10.1177/1054773818777914.
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Effective self-management of liver cirrhosis requires medication adherence and lifestyle modifications. The purpose of this study was to investigate the self-management behaviors of liver cirrhosis patients and how their knowledge of cirrhosis, psychological status, and self-efficacy contributes to self-management practices in Shanghai, China. Subjects were recruited from the hepatology units in an infectious hospital in Shanghai, China. Self-administered questionnaires were collected and medical charts were reviewed by the research staff. A total of 134 subjects were enrolled from November 2016 to March 2017. The results indicate that the self-management behaviors mean score was 2.51 out of 4 and that depression, severity of cirrhosis, and self-efficacy significantly affected self-management behaviors and explained 22.9% of the total variance. The findings also indicate that psychological stress, disease severity, and self-efficacy affected self-management behaviors in liver cirrhosis patients. Interventions focusing on decreasing depression and enhancing self-efficacy according to disease severity should improve self-management behaviors in this population.
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Auerbach, Michael, and Harold Ballard. "Clinical Use of Intravenous Iron: Administration, Efficacy, and Safety." Hematology 2010, no. 1 (December 4, 2010): 338–47. http://dx.doi.org/10.1182/asheducation-2010.1.338.
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AbstractThis section reviews the history, pharmacology, administration, efficacy, and toxicity of intravenous iron. Intravenous iron offers advantages over oral iron for the treatment of iron deficiency anemia across a wide range of disease states associated with absolute and functional iron deficiency. However, there remain concerns about the acute safety profiles of the available preparations and the potential for long-term toxicity with their repeated administration. Seven intravenous iron formulations are available. Confusion concerning the relative toxicities of the different formulations abounds. The similarities and differences are discussed. Iron repletion has been associated with adverse outcomes in infections. The relationship, if any, between intravenous iron administration and infections is reviewed. The potential advantages of total dose infusion (TDI), complete repletion in a single setting, are highlighted. A new paradigm for iron replacement therapy in iron deficiency anemia is presented.
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Zou, Ziang, Songshu Xiao, and Min Xue. "Clinical analysis of the preoperative condition and operative prognosis of post-cesarean section scar diverticulum: a case series." Journal of Perinatal Medicine 48, no. 8 (October 25, 2020): 803–10. http://dx.doi.org/10.1515/jpm-2020-0008.
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AbstractObjectivesPost-cesarean section scar diverticulum (PCSD) is a long-term sequela of cesarean section (CS). The aim of this study was to evaluate the clinical utility of PCSD scoring criteria, and also retrospectively investigate the efficacy and fertility of two different surgical methods in 304 patients with PCSD.MethodsA total of 304 PCSD patients who underwent hysteroscopy or combined hysteroscopy and laparoscopy (referred to as laparoscopy) in our hospital from 2016 to 2018 were retrospectively analyzed. Preoperative condition was analyzed by the PCSD scoring criteria and its influencing factors were explored. The efficacy, its influencing factors and pregnancy success rate of the two different surgical methods on PCSD was also analyzed after 6- and 12-months follow-up.ResultsPCSD was more severe (high score) in patients who experienced caesarean section with one of the following conditions: age >30 years old, without medical indications or retroflexed uterus. The postoperative efficacy of patients subjected to hysteroscopy or laparoscopy was 81.25 and 89.47% (after 6 months), and 79.53 and 87.50% (after 12 months), respectively. Hysteroscopic surgery was better for PCSD patients who had fewer CS and thicker residual muscle layer and worse for PCSD patients with a longer distance of incision defect to the end of the cervix. Postoperative fertilization showed that pregnancy success rate of patients subjected to hysteroscopy or laparoscopy was 56.2 and 50%, respectively.ConclusionsThe PCSD scoring is an effective method for assessing the severity of PCSD, and hysteroscopy and laparoscopy are effective modalities for PCSD. Hysteroscopy is also an option for patients with fertility needs.
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Raina, Supriya, V. Suguna, and Padmaja Prabraju. "The efficiency and efficacy of tranexamic acid in prevention of blood loss during or after caesarean delivery: a comparative study." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 4 (March 25, 2020): 1549. http://dx.doi.org/10.18203/2320-1770.ijrcog20201221.
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Background: The practice of caesarean section is increasing day by day. Delivery by caesarean section can cause more complications than normal vaginal delivery and one of the most common complications is primary or secondary postpartum hemorrhage. The aim of present study was to study the efficacy and safety of tranexamic acid in reducing blood loss during and after caesarean section.Methods: This study was conducted at Deccan College of Medical Sciences, Hyderabad. It was a prospective randomized double blind placebo controlled study. This study includes 60 pregnant women divided in to two groups. Just before the induction of anesthesia 1 gm of tranexamic acid in 20 ml of normal saline was given over 10 minutes in test group and 20 ml of normal saline was infused in control group.Results: The demographic characters of patients in two groups were comparable. There was no statistically significant difference in the heart rates, respiratory rates and blood pressures in the two groups. There was statistically significant difference in the quantity of the blood loss from during the operation and 2 hours postpartum (p=0.003). Total mean blood loss in control group was 718.80±233.1 ml and in study group was 554.28±207.8 ml. The drop in hemoglobin after caesarean section in study group was not significant where as in control group was significant. There was no significant difference in the prothrombin time and partial thromboplastin time in the groups, pre and post operatively. In this study the use of tranexamic acid reduced the dose of other uterotonics like syntocin in study group.Conclusions: Tranexamic acid significantly reduced the amount of blood loss during the caesarean section and also reduced the use of other uterotonics. Thus, tranexamic acid can be used safely and effectively in subjects undergoing caesarean section.
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Fuller, B. W., M. A. Boetel, M. J. McLeod, and J. M. Jenson. "Foliar-Applied Rescue Treatments for Army and Pale Western Cutworm Control in Winter Wheat, 1993." Arthropod Management Tests 19, no. 1 (January 1, 1994): 295–96. http://dx.doi.org/10.1093/amt/19.1.295a.
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Abstract A winter wheat field near Murdo, SD, was chosen for this experiment. Pretreatment counts indicated that the field was naturally infested with an average of 2.4 live cutworm larvae per 2 ft2. The study involved a performance comparison of 12 insecticide treatments with an untreated check. A RCBD replicated 3 times was used. Pretreatment infestation level was used as the blocking criterion. Treatment plots were 30 × 30 ft sections of winter wheat separated by 3-ft alleys on all sides. Insecticide applications were carried out (14 May) using a CO2-propelled backpack canister sprayer system and a 6-ft boom equipped with 4, TeeJet 8002 flat fan nozzles delivering 20 gpa at 30 psi. Live cutworm counts were conducted at 6 DAT (20 May) to determine insecticide efficacy. A sample consisted of randomly selecting a 2 linear ft section of wheat within a row, then sifting ca. 2 inches deep through a 6-inch wide swath of soil including, and on either side of the row. Two samples were taken from each quadrant within a plot (i.e., a total of eight 2 ft2-samples were taken randomly from each plot). Cutworm count data were analyzed via SAS’s General Linear Models (GLM) procedure and means were compared using Duncan’s Multiple Range Test.
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Golyanovskyy, O. V., О. O. Dyadyk, Y. V. Slobodian, K. S. Kozlova, and K. V. Stetsiuk. "Clinico-morphological features of the postoperative period and healing process of the uterine scar tissue after re-cesarean section." Reports of Vinnytsia National Medical University 22, no. 1 (August 8, 2018): 93–98. http://dx.doi.org/10.31393/reports-vnmedical-2018-22(1)-18.
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A high number of repeat cesarean sections increases a risk of excessive bleeding, uterine atony, hysterectomy. The aim of study was to evaluate the efficacy of medical and technical methods (argon plasma coagulation, tranexamic acid, carbetocin) to prevent complications following repeat cesarean section and to improve the myometrial wound healing, to establish morphological features of uterine scar tissue in case of using argon plasma coagulation of myometrium in the area of the suture during the previous operation. Prospective cohort study of 77 patients who had undergone repeat cesarean section. I group included 37 women who had repeat cesarean section using argon plasma coagulation. Ten minutes before the operation, 15 mg/kg of tranexamic acid was injected intravenously. 100 mcg carbetocin was administered intravenously after cutting the umbilical cord. ІІ group comprised 40 women who had traditional cesarean section using Stark's technique and Joel-Cohen incision. Pathomorphological study of scarred lower uterine segment myometrium was performed. Immunohistochemical staining against CD3, CD34, CD68, vimentin, α-SMA was performed. Results are presented as Mean±SD. Total operative time was significantly shorter in the І group (37,0±2,1 minutes) compared to ІІ (46,1±1,8 minutes) (р<0,05). Volume of blood loss in the І group was 465,7±37,5 ml, and in the ІІ — 547, 7±34,6 ml (p<0.05). Patients of the І group needed analgesic for 18-24 hours, the ІІ group — 36-48 hours after operation. The width of the uterine cavity in group І was 9,8±0,37 mm, in group ІІ — 14,6±0,54 mm (р<0,05). One patient of group І and 9 patients of group ІІ had signs of uterine subinvolution. Length of hospital stay after surgery in group I was 4,7±0,12 days, in ІІ — 6,6±0,28 days. The ultrasound thickness of myometrium in group I and group II is an average of 9,32±0,64 mm and 6,24±0,59 mm, respectively. Pathomorphological data of scarred lower uterine segment myometrium showed that in group I regenerative processes have more favorable course, a tendency to restore the structure of myometrium, while in group II there were processes of disturbed regeneration with the replacement of smooth muscle tissue varying maturity of connective tissue, moderate inflammatory process. So, the use of tranexamic acid, carbetocin and argon plasma coagulation is effective in reducing perioperative blood loss, total operative time, dosage of uterotonic and analgesic medications and postoperative hospital stay in patients giving birth by repeat cesarean section. According to the pathomorphological study, argon plasma coagulation of myometrium in the area of suture increases the value of the reparative processes and promotes the formation of a morphologically complete scar, with the predominance of smooth muscle cells over connective tissue.
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Mohammad Pour, Shabnam, Sevil Hakimi, Abbas Delazar, Yousef Javad Zadeh, and Fatemeh Mallah. "Eremostachys laciniata as effective as rectal diclofenac suppository in cesarean section pain relief: A triple-blind controlled clinical trial." Journal of Endometriosis and Pelvic Pain Disorders 12, no. 1 (February 26, 2020): 26–34. http://dx.doi.org/10.1177/2284026519899010.
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Background: Pain and distress are two common complications of cesarean section. Among complementary therapies, Eremostachys was introduced as a pain mitigator. This study aimed at investigating the effect of Eremostachys laciniata on cesarean section pain and distress. Materials and methods: This randomized clinical trial was conducted on 86 women who gave childbirth by cesarean section. The control group received 50 mg rectal diclofenac suppository every 8 h for 3 days, and the intervention group received 35 mg E. laciniata total extract suppository every 8 h up to three doses. Pain was measured with the Visual Analogue Scale at 8, 16, and 24 h after cesarean section. The Symptom Distress Scale was completed at 8 and 24 h after cesarean section. The Redness, Edema, Ecchymosis, Discharge, Approximation scale was completed 5 days after cesarean section. Findings: Pain score at 8, 16, and 24 h after surgery (15 min after intervention) was not significantly different between the intervention and control groups. The distress score 24 h after cesarean section showed a significant difference in favor of the control group according to Friedman’s test. There was a significant difference between the two groups in wound healing score, which indicated better efficacy of rectal diclofenac suppository than E. laciniata suppository. We assessed nausea, vomiting, headache, massive hemorrhage, and any type of anaphylactic reaction. No side events were observed in two groups. Conclusion: Rectal E. laciniata suppository could be introduced as a low-complication, appropriate, and effective medication in controlling pain and distress after cesarean section; more studies should be conducted on this matter.
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Price, Owen F., Andrew C. Edwards, and Jeremy Russell-Smith. "Efficacy of permanent firebreaks and aerial prescribed burning in western Arnhem Land, Northern Territory, Australia." International Journal of Wildland Fire 16, no. 3 (2007): 295. http://dx.doi.org/10.1071/wf06039.
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We investigated the efficacy of firebreaks in the prevention of wildfires in the Arnhem Land Plateau, a vast, rugged and sparsely populated region with high biodiversity value and frequent wildfires. A total of 623 events where a fire met a permanent firebreak (cliffs, stream order, tracks and roads) in different fire seasons were compiled. Cliffs were more effective than streams at stopping fires, which were more effective than roads. Larger streams were more effective than small ones. The largest streams stop 75% of early dry season fires, but there are no firebreak types with more than 50% likelihood of stopping a late dry season fire. Geographic Information System (GIS) surfaces of the relative density of the three firebreak features in the landscape were randomly sampled and compared with the total number of fires and late dry season fires using generalised linear modelling. Several of the density variables were weakly but significantly related to fire frequency, and it appears that late dry season fires are influenced by features at a larger scale (16-km radius) than total fires (4 km). The Aerial Prescribed Burning program for 2004 was studied to identify how effective it was at stopping subsequent wildfires by dividing ignition lines into 137 5-km sections. Only 20% of sections achieved a 100% burn and where gaps occurred, a subsequent fire was 88% likely to penetrate the line. Firebreaks are not certain instruments for fire management in this area.
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Medhi, Robin, Sonika Bawri, Chaitra S.K., Mansur Ahmed, and Asmita Mishra. "Efficacy and safety of pre-operative single dose parenteral tranexamic acid in moderately anaemic parturients undergoing caesarean section." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 8 (July 26, 2017): 3423. http://dx.doi.org/10.18203/2320-1770.ijrcog20173456.
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Background: Preoperative administration of Tranexamic acid (TXA) has been found to be effective in reducing the amount of blood loss following Caesarean section in low risk women. However, studies in high risk women such as women with anaemia, where blood loss needs to be minimised are scarce.Methods: An experimental case control study was conducted with a total of 174 patients with moderate anaemia undergoing CS in a teaching hospital. Study group consisting of 87 patients received pre-operative TXA 1g intravenously. Intra operative and up to 6hours postpartum blood loss was calculated in both the groups. Requirement of blood transfusions were noted. Data analysed using Graphpad Instat® 3 statistical software.Results: Present study showed statistically significant reduction in intraoperative and postoperative blood loss among patients who received TXA compared to control group. The blood loss from placental delivery till completion of the procedure was significantly lowered (304.02ml vs 393.36ml; p value <0.0001). Postoperative blood loss (from end of the procedure up to 6hrs postpartum) was 62.57ml in comparison to 85.40ml in control group (p value <0.0001). The total blood loss from the placental delivery up to 6 hours postpartum was significantly reduced in study group (366.59ml vs 478.76ml; p value <0.0001). There was significant reduction of blood transfusion in study group (RR: 0.20, 95% CI, 0.045-0.887), without immediate adverse effect on mothers and new-borns.Conclusions: Administration of TXA preoperatively causes significant decrease in blood loss and the need for blood transfusion in patients with moderate anaemia undergoing CS.
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Abd El-Hay, Ahmed Mohamed. "Effect of Amh in Patients with Polycystic Ovarian Syndrome on Pregnancy Rate in Icsi Cycle." Women Health Care and Issues 4, no. 4 (May 17, 2021): 01–05. http://dx.doi.org/10.31579/2642-9756/068.
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Background: Surgical site infections (SSIs) pose considerable morbidity and account for up to 20% of all nosocomial infections in surgical patients Aim of the Work: to determine the efficacy & safety of irrigation of subcutaneous tissue by Gentamicin for caesarean section Incision in reducing the risk of post-caesarean wound complications among obese women compared with placebo. Patients and Methods: This prospective randomized clinical trial study was conducted on total 132 obese patients who underwent elective cesarean section at Ain Shams University Maternity hospitals. This study was conducted on obese women undergoing caesarean section at Ain Shams University Maternity Hospital with the following inclusion and exclusion criteria. Patients were distributed randomly into 2 groups using a computer based program: Group (A) N = 66: CS with Irrigation of subcutaneous tissue by placebo (200 ml of saline 0.9 %). Group (B) N = 66: CS with irrigation of subcutaneous tissue by Gentamicin solution (1mg/kg gentamicin in 200 ml of saline 0.9%). Results: The results of this study revealed that the rate of SSI was less in gentamycin (3%) (n=2/66) than control group (4.5%) (n=3/66) with no statistical significance between them. Postoperative hospital stay and readmission rate due to SSI for the gentamycin group were also shorter but not statistically different in compared to the control group. Applying local gentamycin antibiotic irrigation during wound closure after cesarean section in obese patients is not recommended. NO role of local gentamycin irrigation in subcutaneous tissue in prevention of wound surgical site infection. Conclusion: as evident from the current study, in obese women undergoing elective CS, wound irrigation with Gentamicin is not superior to wound irrigation with placebo (saline 0.9) regarding efficacy & safety.
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Xu, Zifeng. "Impact of Ketamine on Pain Management in Cesarean Section: A Systematic Review and Meta-Analysis." Pain Physician 2;23, no. 4;2 (April 14, 2020): 135–48. http://dx.doi.org/10.36076/ppj.2020/23/135.
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Background: The pain control effect of ketamine versus control in women during cesarean operation is not well determined. Objectives: The present meta-analysis aimed to evaluate the clinical efficacy of ketamine versus control in cesarean section anesthesia for reducing the postoperative pain and analgesia. Study Design: We used meta-analysis to address this concern. Setting: Meta-analysis-based study. Methods: The databases PubMed, Embase, and the Cochrane Library were systematically searched to identify the relevant randomized controlled trials (RCTs) of ketamine versus control in controlling pain after cesarean section from inception to August 2018. Based on the Cochrane Handbook, the combined analysis was performed using Revman 5.3 software. Results: A total of 20 RCTs with 1,737 patients who underwent cesarean section were included. Meta-analysis showed that the pain score in the ketamine group was less than that of the control group (mean difference [MD], –1.10; 95% confidence interval [CI], –1.61, –0.59; P < 0.0001). Application of ketamine during cesarean section also resulted in decreased consumption of morphine when compared with the control group (MD, –6.11 mg; 95% CI, –9.93, –2.29; P = 0.002). In addition, the first time required for analgesia was significantly longer in the ketamine group than that of the control group (MD, 72.48 minutes; 95% CI, 50.85, 94.11; P < 0.00001). Limitations: Limited patients were included with moderate strength. Conclusions: Ketamine supplementation during cesarean section reduces pain and morphine consumption and prolongs the postoperative analgesia. Key words: Ketamine, cesarean section, randomized controlled trials, meta-analysis
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Abbas, Sana, Bilal Yasin, Basit Mehmood Khan, Umer Hayat, Beenish Abbas, and Mohsin Fayyaz. "TO DETERMINE EFFICACY OF GRANISETRON VERSUS PLACEBO FOR REDUCING SHIVERING IN PATIENTS UNDERGOING LOWER SEGMENT CAESAREAN SECTION UNDER SPINAL ANAESTHESIA." PAFMJ 71, no. 2 (April 29, 2021): 530–34. http://dx.doi.org/10.51253/pafmj.v71i2.3577.
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Objective: To determine the efficacy of granisetron versus placebo (saline) for reducing shivering in patients undergoing lower segment caeserian section under spinal anaesthesia.
Study Design: Comparative cross - sectional study.
Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital Rawalpindi, from Apr to Sep 2019.
Methodology: Total 178 patients undergoing lower segment ceaserian section under spinal anaesthesia with age ranges from 18-40 years of American Society of Anaesthesiologists status I & II with full term pregnancy scheduled for elective caesarean section under spinal anaesthesia. Group A (n=92) received an intravenous bolus of 1 mg granisetron in a 10ml syringe and Group B (n=86) received intravenous bolus of normal saline in a 10ml syringe, drugs were administered immediately before spinal anaesthesia by anaesthetist as coded syringes. Heart rate, blood pressure, core body temperature and shivering scores were measured at 0 minutes, 30 minutes and 60 minutes, average surgery time recorded to be 60 minutes.
Results: None of the patients in group A (drug group) exhibited appreciable post spinal shivering whereas 25 (29%) in group B (placebo) had clinically significant shivering necessitated administration of other established pharmacological agents to abort shivering in order to ensure patient comfort and satisfaction with statistically significant p-value of <0.05.
Conclusion: Prophylactic injection granisetron was efficacious against post spinal shivering, moreover provides worth while relief of nausea and vomiting which is dilemma with most of the drugs employed for control of post spinal shivering.
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Berhanu, Robera Demissie, Abebe Abera Tesema, Mesfin Beharu Deme, and Shuma Gosha Kanfe. "Perceived transcultural self-efficacy and its associated factors among nurses in Ethiopia: A cross-sectional study." PLOS ONE 16, no. 7 (July 22, 2021): e0254643. http://dx.doi.org/10.1371/journal.pone.0254643.
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Background Transcultural self-efficacy is a nurse’s perception of his or her own ability to accomplish activities effectively for culturally diverse clients. This self-efficacy may be affected by different factors, either positively or negatively. Quality care can be improved significantly when nurses provide patient-centered care that considers cultural background of the patients. Thus, this study aimed to assess perceived transcultural self-efficacy and its associated factors among nurses working at Jimma Medical Center. Methods Facility-based cross-sectional study with both quantitative and qualitative methods of data collection was conducted among 244 nurses and 10 key informants from 20 May to 20 June 2020. Bivariate and multivariable linear regression analyses were used to identify factors associated with transcultural self-efficacy. Qualitative data were coded and analyzed thematically. Quantitative results were integrated with qualitative results. Results A total of 236 nurses participated in the study making the response rate 96.7%. The mean transcultural self-efficacy score was 2.89 ± 0.59. Sex, work experience, intercultural communication, cultural sensitivity, interpersonal communication, and cultural motivation were significantly associated with transcultural self-efficacy. Ten in-depth interviews were conducted and the findings of qualitative data yielded four major themes. Conclusion The level of perceived transcultural self-efficacy was moderate among nurses. Transcultural self-efficacy of nurses varies with several factors including sex, experience, intercultural communication, cultural sensitivity, interpersonal communication, and cultural motivation. This calls for the need to offer transcultural nursing training for nurses.
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Ho, Mei-ching. "Exploring Writing Anxiety and Self-Efficacy among EFL Graduate Students in Taiwan." Higher Education Studies 6, no. 1 (December 7, 2015): 24. http://dx.doi.org/10.5539/hes.v6n1p24.
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This study investigates research writing anxiety and self-efficacy beliefs among English-as-a-Foreign-Language (EFL) graduate students in engineering-related fields. The relationship between the two writing affective constructs was examined and students’ perspectives on research writing anxiety were also explored. A total of 218 survey responses from engineering graduate students at Taiwanese universities were analyzed, along with qualitative data from open-ended questions and semi-structured interviews. The findings show that while master’s and doctoral students felt a similar moderate level of writing anxiety, senior doctoral students were more self-efficacious about writing research papers in English than their junior counterparts. Overall, students with higher writing self-efficacy felt less apprehensive. Additionally, among the individual variables, experience in writing for publication better predicted writing anxiety and self-efficacy than students’ self-reported English proficiency and the number of writing courses taken. The qualitative findings indicated various sources of graduate-level writing anxiety, including insufficient writing skills in English, time constraints, and fear of negative comments. Furthermore, composing different sections of a research paper provoked different levels of anxiety due to the variations in the rhetorical purposes and discourse structures of particular sections. Implications on dealing with research writing anxiety are also discussed.
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Canakci, Ebru, Ahmet Gultekin, Zubeyir Cebeci, Bulent Hanedan, and Anil Kilinc. "The Analgesic Efficacy of Transverse Abdominis Plane Block versus Epidural Block after Caesarean Delivery: Which One Is Effective? TAP Block? Epidural Block?" Pain Research and Management 2018 (October 17, 2018): 1–7. http://dx.doi.org/10.1155/2018/3562701.
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Introduction and Objective. TAP block has gained popularity to provide postoperative analgesia after abdominal surgery but its advantage over epidural analgesia is disputed. For lower abdominal surgeries, epidural analgesia has been the gold standard and time-tested technique for providing postoperative analgesia, but contraindications for the same would warrant need for other equally good analgesic techniques. The objective of this study is to compare the analgesic efficacy of both the techniques. Materials and Methods. Eighty patients in the ASA I-II risk group, undergone an elective C-section, were randomly assigned to the study. In the TAP group, before the C-section, a single-dose spinal anaesthesia was performed by administering 3 ml of 0.5% hyperbaric bupivacaine to the patients when they were in the sitting position. After the C-section, an ultrasound-guided bilateral TAP block was performed in these patients in the recovery room for postoperative analgesia. In the single-dose EPI group, the patients received 16 cc of isobaric bupivacaine, 3 mg of morphine, and 50 mcg of fentanyl, making a total volume of 20 cc and being administered to the epidural space. Results. A higher level of patient satisfaction was observed in the EPI group (p=0.003). The amount (mg) of total analgesics received by the patients in the first 24 hours of the postoperative period was statistically significantly higher (p=0.021) in the TAP group compared to the EPI group. The visual analogue scale (VAS) scores of the EPI group were significantly lower compared to that of the TAP group (p<0.001). Conclusion. The epidural anaesthesia is still the golden standard to achieve a postcaesarean analgesia. Epidural anaesthesia is a considerably effective method in controlling the postoperative pain. We are of the opinion that epidural anaesthesia should be preferred in the first place to achieve a successful postcaesarean analgesia as it provides more effective pain control.
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McKeown, Andrew, Vyacheslav Seppi, and Raymond Hodgson. "Intravenous Magnesium Sulphate for Analgesia after Caesarean Section: A Systematic Review." Anesthesiology Research and Practice 2017 (2017): 1–9. http://dx.doi.org/10.1155/2017/9186374.
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Objective. To summarise the evidence for use of intravenous magnesium for analgesic effect in caesarean section patients. Background. Postcaesarean pain requires effective analgesia. Magnesium, an N-methyl-D-aspartate receptor antagonist and calcium-channel blocker, has previously been investigated for its analgesic properties. Methods. A systematic search was conducted of PubMed, Scopus, MEDLINE, Cochrane Library, and Google Scholar databases for randomised-control trials comparing intravenous magnesium to placebo with analgesic outcomes in caesarean patients. Results. Ten trials met inclusion criteria. Seven were qualitatively compared after exclusion of three for unclear bias risk. Four trials were conducted with general anaesthesia, while three utilised neuraxial anaesthesia. Five of seven trials resulted in decreased analgesic requirement postoperatively and four of seven resulted in lower serial visual analogue scale scores. Conclusions. Adjunct analgesic agents are utilised to improve analgesic outcomes and minimise opioid side effects. Preoperative intravenous magnesium may decrease total postcaesarean rescue analgesia consumption with few side effects; however, small sample size and heterogeneity of methodology in included trials restricts the ability to draw strong conclusions. Therefore, given the apparent safety and efficacy of magnesium, its role as an adjunct analgesic in caesarean section patients should be further investigated with the most current anaesthetic techniques.
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Liu, Yi, Weina Li, Changhong Tan, Xi Liu, Xin Wang, Yuejiang Gui, Lu Qin, Fen Deng, Changlin Hu, and Lifen Chen. "Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease." Journal of Neurosurgery 121, no. 3 (September 2014): 709–18. http://dx.doi.org/10.3171/2014.4.jns131711.
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Object Deep brain stimulation (DBS) is the surgical procedure of choice for patients with advanced Parkinson disease (PD). The globus pallidus internus (GPi) and the subthalamic nucleus (STN) are commonly targeted by this procedure. The purpose of this meta-analysis was to compare the efficacy of DBS in each region. Methods MEDLINE/PubMed, EMBASE, Web of Knowledge, and the Cochrane Library were searched for English-language studies published before April 2013. Results of studies investigating the efficacy and clinical outcomes of DBS of the GPi and STN for PD were analyzed. Results Six eligible trials containing a total of 563 patients were included in the analysis. Deep brain stimulation of the GPi or STN equally improved motor function, measured by the Unified Parkinson's Disease Rating Scale Section III (UPDRSIII) (motor section, for patients in on- and off-medication phases), within 1 year postsurgery. The change score for the on-medication phase was 0.68 (95% CI – 2.12 to 3.47, p > 0.05; 5 studies, 518 patients) and for the off-medication phase was 1.83 (95% CI – 3.12 to 6.77, p > 0.05; 5 studies, 518 patients). The UPDRS Section II (activities of daily living) scores for patients on medication improved equally in both DBS groups (p = 0.97). STN DBS allowed medication dosages to be reduced more than GPi DBS (95% CI 129.27–316.64, p < 0.00001; 5 studies, 540 patients). Psychiatric symptoms, measured by Beck Depression Inventory, 2nd edition scores, showed greater improvement from baseline after GPi DBS than after STN DBS (standardized mean difference −2.28, 95% CI −3.73 to −0.84, p = 0.002; 3 studies, 382 patients). Conclusions GPi and STN DBS improve motor function and activities of daily living for PD patients. Differences in therapeutic efficacy for PD were not observed between the 2 procedures. STN DBS allowed greater reduction in medication for patients, whereas GPi DBS provided greater relief from psychiatric symptoms. An understanding of other symptomatic aspects of targeting each region and long-term observations on therapeutic effects are needed.
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Jun, Eun-Young, and Hyunjin Oh. "Gender Differences in Contraceptive Self-Efficacy: A Cross-Sectional Study of South Korean College Students." International Journal of Environmental Research and Public Health 17, no. 9 (April 30, 2020): 3142. http://dx.doi.org/10.3390/ijerph17093142.
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Purpose: Healthy sexuality is an important issue in the transition to adulthood. To maintain healthy sexuality, contraceptive self-efficacy could be the most significant predictor of safe sexuality. The purpose of this study was to explore the relationship between gender roles and the healthy sexuality of South Korean college students. Method: A cross-sectional study through self-report questionnaires was administered to college students in South Korea. In total, 499 students completed the demographic information questionnaire, the Sexual Attitudes Scale, Sexual Autonomy Scale, and Condom Self-Efficacy Scale. Results: A multiple regression analysis indicated that the contraceptive self-efficacy of male students was predicted by their junior year and sexual autonomy, while that of the females was predicted by their senior year and sexual autonomy. Conclusion: Sexual education focusing on sexual autonomy should be provided for the safe and healthy sexual expression of college students.
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Xiong, Huan, Shuanglian Yi, and Yufen Lin. "The Psychological Status and Self-Efficacy of Nurses During COVID-19 Outbreak: A Cross-Sectional Survey." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 57 (January 2020): 004695802095711. http://dx.doi.org/10.1177/0046958020957114.
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A novel coronavirus pneumonia broke out and gradually developed into a global public health problem. Health care workers, especially nurses, suffered from great occupational pressure and psychological distress during the outbreak of infectious diseases. We performed a cross-sectional survey to investigate the psychological status and self-efficacy of nurses in public hospital during COVID-19 outbreak between 16th and 25th February 2020. A total of 223 nurses participated in this study. The prevalence of anxiety and depression symptoms was 40.8% (CI 95%: 34.4%-47.2%) and 26.4% (CI 95%: 20.6%-42.2%), respectively. There was no difference in the prevalence of anxiety symptoms among demographic variables. There was significant differences in the prevalence of depression symptoms according to professional titles ( P = .020). The mean score of self-efficacy was 25.90 ± 7.55. The self-efficacy was negatively correlated with anxiety ( r = −0.161, P < .05). The psychological status of nurses in public hospital during COVID-19 outbreak needs our attention. Improving nurses’ self-efficacy in dealing with emerging infectious diseases may be helpful to their psychology.
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Novinmehr, Nasser, Marzieh Hasanpour, Mahvash Salsali, Neda Mehrdad, Mostafa Qorbani, and Farshid Shamsaei. "Older adults' self-advocacy in patient safety: a cross-sectional study." British Journal of Nursing 28, no. 16 (September 12, 2019): 1076–84. http://dx.doi.org/10.12968/bjon.2019.28.16.1076.
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Background: patient advocacy is a major nursing role, which is linked to supporting, encouraging and reinforcing self-advocacy in patients. Patient safety is an important nursing outcome, especially in older adults. Aims: older adults' self-advocacy regarding patient safety behaviour and its relationship with some demographic characteristics were assessed. Methods: a valid older adult patients' self-advocacy questionnaire, which included subscales of behaviour, self-efficacy, attitude and outcome efficacy (range of scores=0–63), was used. In this cross-sectional study, 230 patients aged over 60 years were selected using a stratified sampling method. Findings: an association was found between total self-advocacy score (mean=40.16; SD=9.6) and rural living (β=–0.168; P=0.016) using multiple linear regression analysis. Similar findings were found between questionnaire subscales and sex, rural living, occupation and age. Conclusion: older adults, especially women, those of advanced age and those in rural areas, may benefit from nursing interventions to improve their self-advocacy in patient safety.
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Kim, Mi Jin, Cheol Seung Kim, Young Sam Park, Eun Hye Choi, and Kyu Dam Han. "The Efficacy of Intraoperative Frozen Section Analysis during Breast-Conserving Surgery for Patients with Ductal Carcinoma in Situ." Breast Cancer: Basic and Clinical Research 10 (January 2016): BCBCR.S40868. http://dx.doi.org/10.4137/bcbcr.s40868.
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Introduction Recently, the incidence of ductal carcinoma in situ (DCIS), a noninvasive breast malignancy, has increased. This has resulted in an increase in the incidence of breast-conserving surgery (BCS). Numerous studies have suggested that intraoperative frozen section analysis (IFSA) could reduce the rate of additional excisions required to obtain adequate resection margins. However, DCIS is a known risk factor for positive margin status during BCS. Furthermore, some authors have concluded that IFSA may not be reliable for the detection of DCIS. Aim The aim of this study was to evaluate the safety and efficacy of IFSA in patients with DCIS. Methods The operative and pathological reports of patients with DCIS, who underwent BCS at our institute between 2006 and 2015, were retrospectively reviewed. The results of IFSA and the pathological findings of final reanalyzed frozen tissue specimens were analyzed. Results In total, 25 patients were included in our analysis. None of the patients required additional operations. The correct diagnosis rate for IFSA was 89.6%, with a sensitivity and specificity of 60.0% and 95.8%, respectively. Conclusion IFSA could be beneficial for determining safety resection margins in patients with DCIS.
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Hong, Soomin, JuHee Lee, Yeonsoo Jang, and Yoonju Lee. "A Cross-Sectional Study: What Contributes to Nursing Students’ Clinical Reasoning Competence?" International Journal of Environmental Research and Public Health 18, no. 13 (June 25, 2021): 6833. http://dx.doi.org/10.3390/ijerph18136833.
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Clinical reasoning is a vital competence for nursing students, as it is required for solving problems arising in complex clinical situations. Identifying the factors that influence nursing students’ clinical reasoning competence in the social context can help their implicit educational needs. Therefore, this study aimed to determine the factors associated with developing clinical reasoning competency among undergraduate nursing students. In total, 206 senior nursing students were included in this study. Self-reported measures were used to obtain data on participants’ clinical reasoning competence, problem-solving abilities, academic self-efficacy, and level of clinical practicum stress. Relationships among continuous variables were analyzed using Pearson’s correlation coefficients. A multiple linear regression analysis was conducted to identify factors related to clinical reasoning competence. Our findings show that participants with better problem-solving abilities and academic self-efficacy perceived themselves as having higher levels of clinical reasoning competence. Nursing students with lower clinical practicum stress reported higher clinical reasoning competence. Significant factors identified were younger age and subcategories of problem-solving ability such as problem clarification, alternative solution development, planning/implementation, and self-regulated efficacy. Our findings highlight essential factors necessary for developing a nursing curriculum that contributes to professional nurses’ clinical reasoning competence.
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Park, Soon Sik, John Williams Gillespie, Bill James, and Michael Lebowitz. "Multiplex layered immunohistochemistry to predict response of HER2-positive breast cancer patients to trastuzumab therapy." Journal of Clinical Oncology 30, no. 27_suppl (September 20, 2012): 136. http://dx.doi.org/10.1200/jco.2012.30.27_suppl.136.
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136 Background: Since only 40% of HER2-positive breast cancer patients respond to trastuzumab therapy, there is a great clinical need for a test that will better predict which patients would be responders to trastuzumab therapy. Since no single biomarker will likely improve identification of responders, this study will determine the efficacy of multiple biomarkers to predict response of patients to trastuzumab therapy. Our company has developed a protein analysis platform, layered immunohistochemistry (L-IHC), for the analysis of multiple protein biomarkers from a single FFPE tissue section while retaining the histologic orientation. L-IHC is being used to develop a companion diagnostic test in which multiple protein biomarkers are analyzed in HER2-positive breast cancer specimens to predict which patients will respond to trastuzumab therapy. Methods: In this ongoing clinical exploratory study, analysis of pretreatment archival HER2-positive FFPE breast cancer tissue sections from patients whose subsequent therapy included trastuzumab and whose response to therapy (responders and non-responders) is known was performed using L-IHC. Tissue sections were probed using a panel of 14 biomarkers along the HER2 and mTOR pathways were analyzed. In a blinded fashion to the response data, the intensity of specific biomarker signals corresponding to cancer regions on an H&E was visually scored (0,1,2,3, & 4+). The pattern of biomarker expression was correlated with the responder status of the patient. Results: A total of 24 responders and 9 non-responders were analyzed. The sum of four of the 14 biomarkers including p-mTOR, p-4EBP1, pERK, and HIF1-alpha discriminated the responders and non-responders. Using 7 as a cutoff, this test correctly identified 21/24 responders and 7/9 non-responders for a sensitivity of 87%, specificity of 78%, and an accuracy of 82%. Conclusions: Results of this study strongly suggests that analysis of p-mTOR, p-4EBP1, pERK, and HIF1-alpha using L-IHC improves twofold the prediction of patient response to trastuzumab compared to Her2 alone.
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Manam, Sravani, R. N. V. Swetha, A. S. Kameswara Rao, and S. G. K. Murthy. "A prospective study of efficacy of ultrasound guided transversus abdominis plane block for postcesarean analgesia." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 5 (April 29, 2019): 1951. http://dx.doi.org/10.18203/2320-1770.ijrcog20191949.
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Background: The ultrasound guided transversus abdominis plane (TAP) block which provides effective analgesia after lower abdominal surgeries including caesarean section. It is a simple and reliable technique. In this prospective, randomized double-blind study, we determined the efficacy of TAP block using 0.25% Bupivacaine and 0.9N Saline with respect to VAS for pain, postoperative Tramadol consumption and post-operative ondansetron usage.Methods: This study was conducted on 100 adult patients of ASA physical status I and II in the age group of 18 to 40 years undergoing elective lower segment cesarean section under spinal anaesthesia. Study group received TAP block with 0.25% Bupivacaine and control group received 10 ml of 0.9N saline on each side. Patients were analyzed for postoperative pain by pain score (at rest, on movement, on cough) using VAS was recorded at 0, ½, 1, 2, 4, 6, 12 and 24 hours postoperatively. Need for rescue analgesia was assessed by time to first dose of Tramadol requirement and total dose of Tramadol over 24 hours of postoperative period. Ondansetron (4 mg i.v.) was administered whenever nausea score was more than 2 or the patient vomited. All the data was noted using uniform performs.Results: Patients received TAP block with 0.25% Bupivacaine had better pain scores at first hour of postoperative period during rest, cough and movement which was statistically significant (p<0.0010) in comparison to group B. There was a statistically significant difference (p <0.001) in the requirement of total dose of Tramadol as a rescue analgesia in patients who received transversus abdominis block with 0.25% Bupivacaine (138.77 mg) in comparison with other group(240 mg).The mean time to first request for Tramadol was significantly longer in group A (5.8 hrs) in comparison to group B (1.93 hrs) with p value <0.001. Patients received TAP block with 0.9N saline needed more dose of Ondansetron, however, the difference was not statistically significant (p >0.001).Conclusions: TAP block using ultrasound provides substantial reduction in Tramadol consumption, time to first dose of rescue tramadol when compared with control group. This study reinforces the recommendation for TAP as a part of multimodal post-operative analgesic regimen.
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Arif, Nadia, Raja Qaseem Ahmed, Bushra Zafar, and Farrukh Shehzad. "EFFICACY OF MAGNESIUM SULPHATE ON MATERNAL MORBIDITY AND MORTALITY IN ECLAMPSIA." PAFMJ 71, no. 2 (April 29, 2021): 598–601. http://dx.doi.org/10.51253/pafmj.v71i2.4100.
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Objective: To study efficacy of Magnesium Sulphate in reducing maternal morbidity and mortality in patients presenting with eclampsia.
Study Design: Prospective observational study.
Place and Duration of Study: Gynae/Obs Department, Combined Military Hospital Bannu, from Jan 2018 Sep 2019.
Methodology: A total of 134 patients fulfilling inclusion criteria were included in the study. Patient management was multidisciplinary. Convulsions were controlled by 4gram magnesium sulphate intravenously over 20 minutes as a loading dose, followed by 1gram per hour of maintenance infusion. Blood pressure was controlled with injection Labetalol 10 milligram followed by injection Hydralazine repeated after every 20 minutes till the blood pressure was controlled.
Results: A total of 134 patients had eclampsia constituting 6.8% of obstetric admissions. Case fatality was 14 (10.4%) while 120 (89.55%) of the cases responded well to treatment and survived the event. Mean age of patients was 22 years. Thirty patients 22.4% were booked and 104 patients 77.6% were un-booked. Mostly patients 122 (91%) came from rural area and only 12 (9%) were from urban areas with booked pregnancies having regular antenatal visits. One hundred and twenty six (94%) patients with eclampsia presented in antenatal period and only 8 (6%) presented in post natal period. Mode of delivery was cesarean section in 87 (64.9%) and 47 (35.1%) delivered vaginally. Frequency of patient requiring ventilator support, acute renal failure,disseminated intravascular coagulation, adult respiratory distress syndrome, HELLP (hemolysis, elevated liver enzymes, low platelet) syndrome was 11 (8.2%), 46 (34.3%), 43 (32.1%), 35 (26.1%), 7 (5.2%) respectively..........
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Pandher, Dilpreet Kaur, Shikha Rani, and Poonam Goel. "Two years follow up study of post placental insertion of IUCD during caesarean sections: safety, efficacy and complications." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 3 (February 27, 2018): 981. http://dx.doi.org/10.18203/2320-1770.ijrcog20180877.
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Background: The present study evaluates safety, efficacy, expulsion rate and complications of PPIUCD insertion in women undergoing caesarean section in a medical college for 2 years period.Methods: This is a prospective cohort study done over a 2 year period. Total 185 patients undergoing caesarean section and fulfilling medical eligibility criteria for PPIUCD were enrolled in the study. The followup of these patients was done at 6 weeks, 6 months and 1-2 years.Results: Thirteen patients (7%) lost to follow up so final outcome analysis was done in 172 patients. The problems encountered were spontaneous expulsion in 4 patients, removal due to heavy menstrual flow in 13 patients, non-visibility of threads in 4 patients, discharge per-vaginum in 1 patient and pain lower abdomen in 1 patient. Voluntary removal was done in 3 patients by 2 years who wished to conceive. The successful continuation rate came out to be 84.9% by 2 years. There was no failure reported in terms of intra-uterine or extra-uterine pregnancy and no increased risk of infection or perforation over the 2 years follow up.Conclusions: Immediate post-placental IUCD insertion is safe and effective method of contraception with no need to wait for 6 weeks which thereby reduces unwanted pregnancy rates. Mild discomfort and the minor post procedure complaints are taken care of well in puerperium. Higher rate of expulsion can be taken care of by early follow-up with regular visits and offering other safe and effective method of contraception.
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Chen, Pei-Ti, Tsae-Jyy Wang, Ming-Hsiung Hsieh, Ju-Chi Liu, Chieh-Yu Liu, Kwua-Yun Wang, and Wen-Chun Laio. "Anticoagulation adherence and its associated factors in patients with atrial fibrillation: a cross-sectional study." BMJ Open 9, no. 9 (September 2019): e029974. http://dx.doi.org/10.1136/bmjopen-2019-029974.
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ObjectiveTo investigate anticoagulant adherence and its associated factors, including demographics, clinical variables, atrial fibrillation (AF) severity, knowledge, satisfaction with services, perceived barriers, perceived benefits, symptom severity and self-efficacy in patients with AF.DesignThis is a cross-sectional study.Participants and settingA convenient sample of patients with AF were recruited from cardiology clinics of two teaching hospitals in Taiwan.MeasuresData were collected using the study questionnaires, including the AF-related symptom subscale of the AF Severity Scale, the Knowledge of Warfarin Anticoagulation Treatment Scale, the Satisfaction Scale about Service and Warfarin Treatment, the perceived benefits subscale of the Beliefs about Anticoagulation Survey, the Concerns about Anticoagulation Therapy Scale, The Self-efficacy for Appropriate Medication Use Scale and the short-form Adherence to Refills and Medications Scale.ResultsA total of 151 patients with AF participated in the study; 53 treated with warfarin and 98 treated with novel oral anticoagulants (NOACs). The difference in adherence to warfarin (mean=8.6; SD=1.6) and NOACs (mean=8.9; SD=2.0) was statistically insignificant. Multiple linear regression analysis showed that perceived barriers (β=0.18, p=0.017) and self-efficacy (β=−0.48, p<0.001) were significant predictors of anticoagulation adherence. For every 1-unit increase in the perceived barriers, there will be a 0.18-unit increase in the adherence to anticoagulation therapy. For every 1-unit increase in the self-efficacy, there will be a 0.48-unit decrease in the adherence to anticoagulation therapy. Perceived barriers and self-efficacy collectively explained 34.0% of the variance in adherence to anticoagulation therapy (F(2,149)=38.11, p<0.001).ConclusionWe found no better adherence to NOACs compared with warfarin. Patients with greater self-efficacy and perceived fewer barriers showed better adherence to anticoagulation therapy.
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Albadr, Tamador, Sara Alfawzan, Brooj Aljarba, Rana Alshehri, and Samira Mahboub. "Use of health belief model to explain the behaviour of following safety measures during the use of household chemical products among adult females in Riyadh." International Journal of Research in Medical Sciences 9, no. 1 (December 28, 2020): 9. http://dx.doi.org/10.18203/2320-6012.ijrms20205825.
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Background: The hazards and life-threatening conditions resulting from using household chemical products can be avoided or minimized by following certain safety measures. To investigate following safety measures during use of household chemical products (HHCP) among women and to explain that behaviour using the Health belief model (HBM).Methods: This was a cross sectional study. The study was conducted among adult females in Riyadh. The total sample size was 449 by convenience Sampling. this study started in September 2019 till April 2020. the questionnaire included 3 sections which were sociodemographic characteristics, safety measures followed during use of HHCP and the last section assessed the six components of health belief model.Results: Data analysis was done using JMP version 14.2 and the cutoff point of significance was 0.05. 30.3% of the studied sample demonstrated good level of following safety measures. There was no association between the level of following safety measures during the use of HHCP and level of education among studied sample (p value>0.05). The mean of each component of HBM was higher among women with good level of following safety measures than those who follow safety measures poorly. This was significant for perceived susceptibility (1.397 vs 1.269, p=0.03), perceived barriers (8.080 vs 7.038, p=0.0001), self-efficacy (2.889 vs 2.750, p=0.0240) and motivation factors (cues to action) (14.75 vs 13.69, p=0.0001). Conclusions: Health belief model can successfully explain following safety measures behaviour during use of HHCP. Motivation factors has the greatest impact on this behaviour.
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Kesani, Vishnu Priya, Sruthi Talasila, and Sheela S. R. "Chlorhexidine-alcohol versus Povidone-Iodine-alcohol for surgical site antisepsis in caesarean section." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 4 (March 26, 2019): 1359. http://dx.doi.org/10.18203/2320-1770.ijrcog20191181.
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Background: Caesarean section is one of the most common procedures performed. Recent studies found that surgical-site infection (SSI) was the most common healthcare-associated infection. Authors hypothesized that optimization of preoperative skin antisepsis may decrease postoperative infections. The objective was to establish the efficacy of chlorhexidine-based antiseptic protocol versus povidone-iodine protocol in reducing SSI for patients undergoing caesarean deliveries.Methods: This is a randomized prospective study conducted from April 2017 to September 2017 at a tertiary care center in India. Women who underwent caesarean sections were allocated into either group. Enrolled patients were randomly assigned to have the surgical site painted with chlorhexidine-alcohol preparation or painted with a solution of 10% povidone-iodine and then with surgical spirit. The outcomes were any SSI occurring within a week or during the 30 day follow up period of the surgery including any of: superficial or deep surgical site infection, or endometritis, according to Centers for Disease Control and Prevention definitions.Results: A total of 560 subjects (273 in the chlorhexidine group and 287 in the iodine group) qualified for the study. The number of surgical-site infection was significantly lower in the chlorhexidine group than in the iodine group (6.95% vs. 14.28%; P=0.005). Chlorhexidine–alcohol was significantly more protective than iodine-alcohol against both superficial incisional infections (5.49% vs. 10.10%, P=0.03) and deep incisional infections (1.46% vs. 4.18%, P=0.04).Conclusions: This study highlighted that Chlorhexidine-alcohol provided superior skin antisepsis in comparison to povidone iodine-alcohol.