Women's Evaluations of Their Experience in a Multicenter Randomized Controlled Trial of Intrapartum Fetal Pulse Oximetry (The FOREMOST Trial)

Abstract: Background: Fetal pulse oximetry improves the assessment of fetal well‐being during labor. The objective of this study was to evaluate women's satisfaction with their experience with this additional technology. Methods: We surveyed women participating in the FOREMOST trial, a randomized controlled trial comparing the addition of fetal pulse oximetry (FPO) to conventional cardiotocograph (CTG) monitoring (intervention group), versus CTG‐only (control group), in the presence of nonreassuring fetal status during labor. Our survey evaluated 3 aspects of women's experience: labor, fetal monitoring, and participation in the research. The survey was administered within a few days of giving birth and repeated 3 months later. Results: No differences were found between the intervention and control groups for women's evaluations of their labor, fetal monitoring, research, or overall experiences when surveyed on both occasions. Within each study group, a small but statistically significant decline occurred in women's scores for their experience of labor and overall experience from the initial survey close to the time of giving birth, to 3 months later. The magnitude of differences in responses over time was similar for the both groups. Women were more satisfied after a spontaneous or assisted vaginal birth than after cesarean section. Length of time the research midwife was present had a significant positive effect on women's ratings of their experience several days after giving birth (p = 0.006), but no effect at 3 months. Conclusions: The addition of fetal pulse oximetry for the assessment of fetal well‐being during labor did not affect childbearing women's perceptions of fetal monitoring or their labor. Women evaluated their experience in the research process positively overall. Small changes occurred in women's perception of their satisfaction over time. (BIRTH 33:2 June 2006)     

聚环氧氯丙烷／液晶复合富氧膜的研究

研究了聚环氧氯丙烷(PECHCH)/N(4-乙氧基苄叉)4-丁基苯胺(EBBA)复合膜对氧气和氮气的透过性和选择性。用示差扫描量热计(DSC)、解偏振光强仪(DLI和偏光显微镜考察了复合膜的形态结构。结果表明,当PECH/EBBA复合膜处于液晶的向列相转变温度时,有较高的气体透过性和选择性。发现只有复合膜中EBBA含量在30wt％以上,PECH和EBBA呈非均相混合时,才有较明显的富氧效果。当EBBA含量达50wt%时,氧氮分离系数α=3.78。     

丁胱亚磺酰亚胺排空组织谷胱甘肽对大鼠心肌谷胱甘肽系统的影响

目的:观察采用谷氨酰半胱氨酸合成酶抑制剂--丁胱亚磺酰亚胺(BSO)排空大鼠心肌谷胱甘肽(GSH)是否影响大鼠心肌组织GSH的稳态,以及是否对GSH代谢相关酶活性及mRNA表达产生影响.方法:采用长时间力竭运动、注射BSO排空GSH两种实验模型,比较对照组与注射BSO组SD大鼠心肌在静息状态和长时间力竭运动后GSH状态及其代谢变化.结果:注射BSO 8天后,大鼠心脏GSH含量分别为对照组?%,且GSH的下降伴随着氧化型谷胱甘肽(GSSG)的下降,GSH/GSSG的比值无显著变化.GSH排空导致GSH代谢酶活性发生适应性变化,注射BSO后心肌中谷胱甘肽过氧化物酶(GPX)活性与对照组相比显著下降(P < 0.001).注射BSO组与对照组相比,心肌谷氨酰转肽酶(GGT)活性显著增加(P < 0.05).注射BSO力竭组与注射BSO组相比,心肌GGT活性显著增加(P < 0.001),心肌注射BSO抑制γ-谷氨酰半胱酸合成酶(GCS)活性,注射BSO力竭组大鼠心肌GCS mRNA表达量高于注射BSO组,表明极度排空谷胱甘肽后,GCS mRNA表达量的增加可能是机体产生的应激反应.     

Midazolam: kinetics and effects on memory, sensorium, and haemodynamics.

This study aimed not only to compare the pharmacokinetics of oral and intravenous doses of the new water-soluble benzodiazepine, midazolam, but also to study the effects on haemodynamics, sensorium, and memory performance. Eight normal human volunteers each received a single 15 mg dose of midazolam base orally and intravenously in randomized sequence 2 weeks apart. Serial venous samples were obtained for 12 h after dosing. Vital signs, sensorium testing and memory testing using word lists were also performed. Computerized non-linear least squares curve-fitting of the two-compartment open model to the oral and intravenous data simultaneously yielded the following estimates: V1, 0.33 1 kg-1, VdSS, 1.08 1 kg-1, t1/2,lambda, 0.10 h, t1/2,Z, 1.89 h, ka 1.17 h-1 and bioavailability, 49%. The intravenous dose decreased the systolic pressure 22 mm Hg during the first half-hour and the oral dose had 50% less effect. Most subjects became drowsy halfway through the infusion and were only rousable to voice by its end. The sensorium was clear by 2-3 h. After oral dosing the peak sensorium effects of ataxia-dysarthria were seen at 30 min and had cleared by 2 h. Memory testing showed that memory acquisition was markedly impaired for at least 90 min after the intravenous dose and slight recovery was apparent at this time after the oral dose. Memory performance was proportionately more impaired than the sensorium score. We conclude that: midazolam kinetics are characterized by rapid absorption, but incomplete bioavailability and rapid elimination, midazolam intravenously may lower blood pressure significantly, and the level of consciousness correlates poorly with the degree of memory impairment.     

Computers in the ICU: panacea or plague?

The introduction of the intensive care unit (ICU) in the 1960s with its demands for management of large volumes of patient data drove the initial introduction of computers into the ICU. Since the mid-1960s computer systems for the ICU have evolved into the highly sophisticated bedside workstations commercially available today. Despite all of the technologic advances in computers, their application in ICUs in the United States continues to spread very slowly. One of the largest problems is justifying the cost of systems primarily designed to automate data charting and generation of care plans. Although the existing commercial systems do an excellent job, few conclusive studies prove that these systems have a favorable cost-to-benefit ratio. Research systems have demonstrated that if one extends these systems to incorporate a fully integrated database, decision-support tools, automation of data acquisition, and more sophisticated display and user-interface technology, then these ICU computer systems can have a significant impact on improving the quality and reducing the costs of patient care. For computers to be embraced in the ICU environment, commercial systems of the future must move beyond merely gathering and displaying information. They must help the clinician at the bedside assimilate the vast array of ICU data and help him to make more effective decisions.