Motivational interviewing for maternal Immunizations: Intervention development

Background and ObjectiveVaccine uptake during pregnancy remains low. Our objectives were to describe 1) development and adaptation of a clinician communication training intervention for maternal immunizations and 2) obstetrics and gynecology (ob-gyn) clinician and staff perspectives on the intervention and fit for the prenatal care context.MethodsDesign of the Motivational Interviewing for Maternal Immunizations (MI4MI) intervention was based on similar communication training interventions for pediatric settings and included presumptive initiation of vaccine recommendations (“You’re due for two vaccines today”) combined with motivational interviewing (MI) for hesitant patients. Interviews and focus group discussions were conducted with ob-gyn clinicians and staff in five Colorado clinics including settings with obstetric physicians, certified nurse midwives (CNMs), and clinician-trainees. Participants were asked about adapting training to the ob-gyn setting and their implementation experiences. Feedback was incorporated through iterative changes to training components.ResultsInterview and focus group discussion results from participants before (n = 3), during (n = 11) and after (n = 25) implementation guided intervention development and adaptation. Three virtual, asynchronous training components were created: a video and two interactive modules. This virtual format was favored due to challenges attending group meetings; however, participants noted opportunities to practice skills through role-play were lacking. Training modules were adapted to include common challenging vaccine conversations and live-action videos. Participants liked interactive training components and use of adult learning strategies. Some participants initially resisted the presumptive approach but later found it useful after applying it in their practices. Overall, participants reported that MI4MI training fit well with the prenatal context and recommended more inclusion of non-clinician staff.ConclusionsMI4MI training was viewed as relevant and useful for ob-gyn clinicians and staff. Suggestions included making training more interactive, and including more complex scenarios and non-clinician staff.     

Surgical emergencies in pregnancy in the era of modern diagnostics and treatment

Pregnancy can be complicated with different surgical emergencies which may potentially endanger the mother as well as foetus. In the modern era of advanced diagnostics and treatments, neither of them in response to a surgical emergency in a pregnant woman should be delayed. Appropriate early intervention is essential to decrease the morbidity and mortality. Following article encompasses common surgical emergencies that can arise in a pregnant woman and tries to suggest the approach that may be taken to reduce the burden of morbidity and mortality.     

多囊卵巢综合征妊娠患者与非多囊卵巢综合征孕妇妊娠结局比较

目的比较多囊卵巢综合征(PCOS)妊娠患者与非PCOS孕妇的妊娠结局。方法选取200例PCOS妊娠患者作为研究组,并选取同期200例非PCOS孕妇作为对照组,比较两组孕妇的妊娠结局、新生儿情况及妊娠期并发症情况。结果研究组的先兆流产、早产、足月剖宫产发生率显著高于对照组(P <0.05);两组的先兆早产发生率比较无统计学差异(P>0.05)。两组的新生儿情况比较无统计学差异(P>0.05)。研究组的妊娠期高血压综合征、妊娠期糖尿病、羊水异常、胎儿窘迫发生率显著高于对照组(P <0.05)。结论与非PCOS孕妇相比,PCOS妊娠患者的早产风险增加,且妊娠期高血压综合征、妊娠期糖尿病、羊水异常、胎儿窘迫发生率显著升高。     

改良三点式重睑成形术的临床应用研究

目的:探讨改良三点式重睑术的临床应用疗效。方法:2012年6月-2019年6月,共165例单睑患者采用了改良三点式重睑术,沿术前标记线将三点处皮肤切开,剪刀将切口下唇的眼轮匝肌适当去除,同时将切口与切口在皮下层打通,剪除切口与切口之间的眼轮匝肌,6-0可吸收线挂睑板前筋膜或提上睑肌腱膜及切口下唇皮下组织缝合,三点切口各缝1针。再用6-0单丝尼龙线按照常规重睑线缝合方法挂切口下唇皮肤、睑板前筋膜或提上睑肌腱膜及切口上唇皮肤缝合打结,三点切口各缝1针。伴内眦赘皮者同时行内眦赘皮矫正术。结果:152例患者获得随访,随访患者大部分获得了比较满意的重睑,睁眼重睑流畅、自然,闭眼刀口痕迹不明显。2例患者出现内侧重睑线变浅,1例患者出现外侧重睑线变浅,所有患者均未出现重睑消失。5例患者双侧重睑线有轻度不对称。患者总体满意率为94.7%(144/152)。结论:改良三点式重睑术具有创伤小、并发症少、效果逼真、不易脱落、手术痕迹不明显等优点,值得推广应用。     

腹腔镜与开腹手术治疗老年胆囊炎患者的分析

目的观察在治疗老年急性胆囊炎患者采取开腹手术与腹腔镜手术的治疗效果并分析。方法将2017年1月—2018年9月期间医院收治的74例急性胆囊炎患者采用随机数字表法分为观察组和对照组,对照组37例采取开腹手术治疗,观察组37例采取腹腔镜治疗,对比两组治疗效果。结果观察组并发症发生率5.4%、治疗总有效率97.3%优于对照组的24.3%、78.4%,P<0.05。观察组术中出血量(15.7±3.4)mL、手术时间(40.7±4.4)min、住院时间(7.1±1.8)d、术后肠道恢复时间(3.3±1.2)d均低于对照组的(46.4±3.5)mL、(68.6±14.7)min、(12.6±2.3)d、(6.1±1.5)d,P<0.05。观察组躯体疼痛(87.3±0.5)分、总体健康(85.2±1.2)分、精神状况(86.4±1.3)分、社会活动评分(90.2±1.3)分均高于于对照组(78.3±1.2)分、(70.3±10.8)分、(71.3±0.5)分、(75.5±2.1)分,对比有统计学意义(P<0.05)。结论腹腔镜手术治疗老年急性胆囊炎患者效果良好,可有效减少患者病程,促进康复和提高生活质量,值得推广。