Detoxification treatment in Gynecology using a modified molded sorbent

Postpartum endometritis is a common complication of cesarean section, the progression of which often leads to the loss of the uterus and the patient's fertility. We evaluated a detoxification therapy for treating patients with postpartum endometritis using an intrauterine application of a modified molded sorbent containing polyvinylpyrrolidone. A retrospective, controlled study included 124 patients with postpartum endometritis. The study group, n = 63, was composed of puerperae with postpartum endometritis after cesarean section, receiving antibacterial therapy in combination with the intrauterine application of a molded modified sorbent containing polyvinylpyrrolidone (FSMP) for 24 h daily for 5 days. The control group, n = 61, was composed of puerperae with postpartum endometritis after cesarean section, receiving antibacterial treatment only. The uterine cavity was infected by coccal flora (Enterococcus faecalis (26.6%), Staphylococcus spp. (21.3%), E. faecium (14.3%), and Gram-negative Escherichia coli (9.6%). A combination of these microorganisms was present in 40.5% of crops. Antibiotic resistance was detected in 53.6%–68.3% of the cases. In the study group, we observed: a faster and higher decrease in neutrophils (p < 0.05); a lower uterine concentration of pro-inflammatory cytokines: interleukin-1 beta (IL-1β) and tumor necrosis factor α (TNFα) - 4.0 and 3.2 times, respectively, compared with the control group (p < 0.05); and a significant decrease in the uterus volume and cavity (M-echo). Using a newly modified sorbent associated with antibiotic treatment in patients with postpartum endometritis, compared with antibiotics alone, we showed a sharp reduction of inflammatory parameters, residual microorganism growth, and faster uterine volume involution. Moreover, the frequency of hysterectomy decreased by 14.4 times.     

Implementation of Robert's Coping with Labor Algorithm© in a large tertiary care facility

Objectiveto implement use of Roberts’ Coping with Labor Algorithm^© (CWLA) with laboring women in a large tertiary care facility.Designthis was a quality improvement project to implement an alternate approach to pain assessment during labor. It included system assessment for change readiness, implementation of the algorithm across a 6-week period, evaluation of usefulness by nursing staff, and determination of sustained change at one month. Stakeholder Theory (Friedman and Miles, 2002) and Deming's (1982) Plan-Do-Check-Act Cycle, as adapted by Roberts et al (2010), provided the framework for project implementation.Settingthe project was undertaken on a labor and delivery (L&D) unit of a large tertiary care facility in a southwestern state in the USA. The unit had 19 suites with close to 6000 laboring patients each year.Participantsfull, part-time, and per diem Registered Nurse (RN) staff (N=80), including a subset (n=18) who served as the pilot group and champions for implementing the change.Findingsa majority of RNs held a positive attitude toward use of the CWLA to assess laboring women's coping with the pain of labor as compared to a Numeric Rating Scale (NRS). RNs reported usefulness in using the CWLA with patients from a wide variety of ethnicities. A pre-existing well-developed team which advocated for evidence-based practice on the unit proved to be a significant strength which promoted rapid change in practice.Implications for practicethis work provides important knowledge supporting use of the CWLA in a large tertiary care facility and an approach for effectively implementing that change. Strengths identified in this project contributed to rapid implementation and could be emulated in other facilities. Participant reports support usefulness of the CWLA with patients of varied ethnicity. Assessment of change sustainability at 1 and 6 months demonstrated widespread use of the algorithm though long-term determination is yet needed.     

The effectiveness of breathing patterns to control maternal anxiety during the first period of labor: A randomized controlled clinical trial

ObjectiveAssess the efficacy of the breathing patterns during the active phase of the first stage of labor for maternal anxiety.DesingRandomised trial with two treatment arms and intention-to-treat analysis.ParticipantsOne Hundred and forty patient in active labour, age between 12 and 40 years old and gestational age between 37 and 41 weeks. The breathing patterns waere made depending on the dilation phase and intensity of contraction, while the control group received routine care service.ResultsThere was no difference between groups two hours after the first evaluation regarding to anxiety (MD 0.3 CI95% −4.2 to 4.8), pain (MD 0.0 CI95% −0.8 to 0.7), fatigue (MD -0.5 CI95% −1.4 to 2.5) and maternal satisfaction (MD 0.9 CI95% −0.1 to 2.0).ConclusionsThe study results showed that the use of breathing patterns during the first period of labour were not effective to control anxiety, pain, fatigue and maternal satisfaction.     

Effects of low back massage on perceived birth pain and satisfaction

AimThe aim of the study was to evaluate the effect of low back massage on perceived birth pain and delivery.MethodThis study was designed as a study-control experimental type. The study sample consisted of 62 pregnant women (massage group = 31, control group = 31).Massage was applied to the study group in three phases during intrapartum period. The massages were done at the end of latent, active and transition phases (at cervical dilatation 3–4 cm, 5–7 cm, 8–10 cm) correspondingly. The VAS scores were evaluated three times during all phases.ResultsThe first mean VAS score was 5.2 ± 0.9 and 7.3 ± 1.3 for massage and control groups, respectively. Second VAS score was found as 6.6 ± 1.6 in massage group and 8.8 ± 1.0 in control group. The third VAS score was significantly higher in the control group than massage group during third evaluation (9.2 ± 2.4 vs 6.7 ± 2.7) (p < 0.05). The mean duration of second stage was 24.6 ± 12.7 min in massage group and 31.7 ± 20.9 min in control group (p > 0.05). The mean scores of satisfaction about delivery were found as 8.8 ± 0.7 in massage group and 6.9 ± 0.8 in control group (p < 0.05).ConclusionIt was determined in the study that lower back massage has a significant impact on reducing labor pain and increasing the satisfaction with birth. Health professionals, who work in the delivery unit, can use massage intervention for decreasing pain, shortening delivery time and increasing satisfaction with birth experience.     

电子胎心监护Ⅱ类图形反复性变异减速产妇分娩终止时限对新生儿结局的影响

目的 探讨电子胎心监护(EFM)Ⅱ类图形反复性变异减速(VD)产妇的分娩终止时限对新生儿结局的影响.方法 选择2015年1月1日至2018年12月31日在北京市通州区妇幼保健院住院分娩,并且胎儿心率出现EFMⅡ类图形反复性VD的829例产妇为研究对象.其中,胎儿心率发生轻、中、重度反复性VD的产妇分别为392、246及...     

不同浓度瑞芬太尼用于分娩镇痛的临床观察

目的：观察不同浓度的瑞芬太尼用于分娩镇痛的临床疗效,以确定最佳剂量。方法选择自然分娩的足月初产妇180例,随机分为A、B、C三组,每组60例,瑞芬太尼静脉输注的浓度分别为0.02μg/（kg·min）、0.04μg/（kg·min）和0.06μg/（kg·min）,比较各组的产程时间、宫缩疼痛视觉模拟评分（VAS）、产妇生命体征、应用催产素及器械情况、剖宫产率及新生儿Apgar评分和胎儿胎心率。结果产妇在第一、第二、第三产程持续时间、剖宫产率、催产素使用及器械使用比较差异无统计学意义;A、B两组Ramsay评分相比差异无统计学意义,但C组最高（P＜0.05）;C组出现20例低氧血症,1例出现过度镇静,表现为SpO2迅速下降、嗜睡,但停药并辅助呼吸90 s后恢复;与A、B两组相比,C组新生儿Apgar评分在出生后1 min较低（P＜0.05）,但经吸氧5 min后评分均达到10分;A、B两组药物对胎儿胎心率无显著影响,C组有一定影响。结论瑞芬太尼实施分娩镇痛,此药背景输注速度以0.04μg/（kg·min）时镇痛完善,并发症少。     

Scanning and synthesizing Canadian policies that address the school-to-work transition of youth and young adults with disabilities

BackgroundDisability faced by a young person can impact the school-to-work transition and shape health and well-being over the life course. Unique barriers to entry and advancement within the labor market that are relevant to young people with disabilities underscore the need for tailored policy-level supports.ObjectivesTo examine and describe policies that support the school-to-work transition of young people with disabilities in Canada.MethodsA scan of policies which focused on the school-to-work transition of young people with disabilities across Canada was conducted between June 2019 and January 2020. Searches were completed within federal, provincial and territorial policy portals. Each policy relating to employment participation of people with disabilities was summarized. Policies that focused on the school-to-work-specific were synthesized using Bemelmans-Vidic, Rist and Vedung's policy tool framework.ResultsA total of 36 policies were identified by our scan that focused on the employment of people with disabilities. Only five policies explicitly addressed the school-to-work transition. All existing policies were implemented at the provincial level and aimed to promote entry into employment. The synthesis of policies revealed that financial policy tools were primarily used to incentivize employment, provision of workplace accommodations, or the development and implementation of job readiness programs.ConclusionOur analysis of federal, provincial and territorial policies in Canada uncovered a limited number of policies that specifically support the school-to-work transition. Addressing these policy gaps can increase the inclusion of young people with disabilities in the labor market.     

腰麻-硬膜外联合阻滞麻醉在分娩镇痛中的应用效果观察

目的探讨腰麻-硬膜外联合阻滞在分娩镇痛中的应用效果。方法选择2010年2月~2013年2月于本院进行分娩的148例产妇为研究对象,全部产妇按照是否进行分娩镇痛分为两组,对照组产妇未给予分娩镇痛,观察组产妇则给予腰麻-硬膜外联合阻滞,观察两组产妇分娩情况及胎儿情况。结果观察组产妇第一产程较对照组明显缩短,差异有统计学意义（P〈0.05）,但观察组第二产程、第三产程以及新生儿Apgar评分与对照组差异无统计学意义（P〉0.05）;观察组产妇自然分娩率为87.06%,明显高于对照组的60.32%,差异有统计学意义（P〈0.05）。结论腰麻-硬膜外联合阻滞在分娩镇痛中的应用效果显著,且对母婴无明显影响,值得临床推广。     

地诺前列酮与缩宫素用于足月妊娠引产效果的临床观察

目的：观察分析地诺前列酮与缩宫素用于足月妊娠引产效果的临床效果和安全性。方法选取108例足月妊娠引产产妇,随机分为观察组和对照组,各54例。分别给予地诺前列酮和缩宫素引产。观察比较两组的引产效果。结果在宫颈Bishop评分、12 h临产率、24 h临产率、总有效率、阴道分娩率方面比较,观察组明显优于对照组,差异有统计学意义。在不良反应、新生儿结局方面比较,差异无统计学意义。结论地诺前列酮用于足月妊娠引产效果的临床效果较好,安全性较高,值得推广。     

城乡二元户籍制度下的我国劳动力市场分析

分析户口迁移政策改革的成本与收益 ,对我国劳动力市场跨地区流动进行了实证分析 ,认为实现劳动力的自由迁移不仅符合政府部门的利益而且可以减少城乡收入差距 ,实现政府的目标