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https://www.readbyqxmd.com/read/29760022/burnout-and-scope-of-practice-in-new-family-physicians
#1
Amanda K H Weidner, Robert L Phillips, Bo Fang, Lars E Peterson
PURPOSE: Family physicians report some of the highest levels of burnout, but no published work has considered whether burnout is correlated with the broad scope of care that family physicians may provide. We examined the associations between family physician scope of practice and self-reported burnout. METHODS: Secondary analysis of the 2016 National Family Medicine Graduate Survey respondents who provided outpatient continuity care (N = 1,617). We used bivariate analyses and logistic regression to compare self-report of burnout and measures of scope of practice including: inpatient medicine, obstetrics, pediatric ambulatory care, number of procedures and/or clinical content areas, and providing care outside the principal practice site...
May 2018: Annals of Family Medicine
https://www.readbyqxmd.com/read/29751278/pregnancy-related-acute-kidney-injury-requiring-dialysis-as-an-indicator-of-severe-adverse-maternal-morbidity-at-a-tertiary-center-in-southwest-nigeria
#2
Ibraheem O Awowole, Oluseyi S Omitinde, Fatiu A Arogundade, Sekinah B Bola-Oyebamiji, Olumide A Adeniyi
OBJECTIVE: Despite being a Critical Intervention in the WHO Near-miss concept, the indications and clinical outcomes of patients with Pregnancy-Related Acute Kidney Injury (PRAKI) requiring dialysis at the Obafemi Awolowo University Teaching Hospitals Complex, Nigeria remain unknown. This retrospective review was conducted to facilitate counselling, prognostication and introduction of preventative measures by providing contemporary data on the aetiology and clinical outcomes of women with PRAKI...
May 2, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/29750952/glucostabilizer%C3%A2-software-guided-insulin-dosing-improves-intrapartum-glycemic-management-in-women-with-diabetes
#3
Cheryl Dinglas, Jolene Muscat, Tracy Adams, Virginia Peragallo-Dittko, Anthony Vintzileos, Hye J Heo
BACKGROUND: During labor, maintenance of maternal euglycemia is critical to decrease the risk of neonatal hypoglycemia and associated morbidities. When continuous intravenous insulin infusion is needed, standardized insulin dosing charts have been used for titration of insulin to maintain glucose in target range. GlucoStabilizer™ is a software-guided insulin dosing system that calculates the dose of intravenous insulin needed based on metabolic parameters, target glucose concentration, and an individual's response to insulin...
May 8, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29747669/role-of-the-general-practitioner-in-improving-rural-healthcare-access-a-case-from-nepal
#4
Bikash Gauchan, Stephen Mehanni, Pawan Agrawal, Mandeep Pathak, Santosh Dhungana
BACKGROUND: There is a global health workforce shortage, which is considered critical in Nepal, a low-income country with a predominantly rural population. General practitioners (GPs) may play a key role improving access to essential health services in rural Nepal, though they are currently underrepresented at the district hospital level. The objective of this paper is to describe how GPs are adding value in rural Nepal by exploring clinical, leadership, and educational roles currently performed in a rural district-level hospital...
May 10, 2018: Human Resources for Health
https://www.readbyqxmd.com/read/29727829/maternal-and-perinatal-outcomes-by-planned-place-of-birth-among-women-with-low-risk-pregnancies-in-high-income-countries-a-systematic-review-and-meta-analysis
#5
REVIEW
Vanessa L Scarf, Chris Rossiter, Saraswathi Vedam, Hannah G Dahlen, David Ellwood, Della Forster, Maralyn J Foureur, Helen McLachlan, Jeremy Oats, David Sibbritt, Charlene Thornton, Caroline S E Homer
BACKGROUND: The comparative safety of different birth settings is widely debated. Comparing research across high-income countries is complex, given differences in maternity service provision, data discrepancies, and varying research techniques and quality. Studies of births planned at home or in birth centres have reported both better and poorer outcomes than planned hospital births. Previous systematic reviews have focused on outcomes from either birth centres or home births, with inconsistent attention to quality appraisal...
April 3, 2018: Midwifery
https://www.readbyqxmd.com/read/29724141/major-obstetric-haemorrhage-of-2000-ml-or-greater-a-clinical-audit
#6
J O'Sullivan, R Mansfield, R Talbot, A E Cairns
Haemorrhage remains a leading cause of maternal death. We conducted an audit to identify strategies to improve the management at our local NHS Trust. A data collection form was based on our local guideline. A coded database search was conducted for all deliveries where the estimated blood loss was ≥2000 ml (from June 1 2015 to December 31 2015), returning 68 search results (13.7/1000 births). Fifty-six records were included. Poor compliance (<75%) was seen in some key areas including the major obstetric haemorrhage (MOH) call activation (52%), the presence of an anaesthetic consultant (63%) and tranexamic acid administration (46%)...
May 4, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/29702718/a-critical-review-on-obstetric-follow-up-of-women-affected-by-systemic-lupus-erythematosus
#7
Danilo Eduardo Abib Pastore, Maria Laura Costa, Mary Angela Parpinelli, Fernanda Garanhani Surita
OBJECTIVE:  To review the existing recommendations on the prenatal care of women with systemic lupus erythematosus (SLE), based on currently available scientific evidence. METHODS:  An integrative review was performed by two independent researchers, based on the literature available in the MEDLINE (via PubMed), EMBASE and The Cochrane Library databases, using the medical subject headings (MeSH) terms "systemic lupus erythematosus" AND "high-risk pregnancy" OR "prenatal care...
April 27, 2018: Revista Brasileira de Ginecologia e Obstetrícia
https://www.readbyqxmd.com/read/29695299/emergency-transportation-interventions-for-reducing-adverse-pregnancy-outcomes-in-low-and-middle-income-countries-a-systematic-review-protocol
#8
John Ehiri, Halimatou Alaofè, Ibitola Asaolu, Joy Chebet, Ekpereonne Esu, Martin Meremikwu
BACKGROUND: Transportation interventions seek to decrease delay in reaching a health facility for emergency obstetric care and are, thus, believed to contribute to reductions in such adverse pregnancy and childbirth outcomes as maternal deaths, stillbirths, and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited empirical evidence to support this hypothesis. The objective of the proposed review is to summarize and critically appraise evidence regarding the effect of emergency transportation interventions on outcomes of labor and delivery in LMICs...
April 25, 2018: Systematic Reviews
https://www.readbyqxmd.com/read/29694994/predicting-the-future-delivery-room-planning-of-congenital-heart-disease-diagnosed-by-fetal-echocardiography
#9
Mary T Donofrio
Advances in prenatal imaging have improved the examination of the fetal cardiovascular system. Fetal echocardiography facilitates the prenatal diagnosis of congenital heart disease (CHD) and through sequential examination, allows assessment of fetal cardiac hemodynamics, predicting the evolution of anatomical and functional cardiovascular abnormalities in utero and during the transition to a postnatal circulation at delivery. This approach allows detailed diagnosis with prenatal counseling and enables planning to define perinatal management, selecting the fetuses at a risk of postnatal hemodynamic instability who are likely to require a specialized delivery plan...
May 2018: American Journal of Perinatology
https://www.readbyqxmd.com/read/29686937/implementing-obstetric-early-warning-systems
#10
EDITORIAL
Alexander M Friedman, Mary L Campbell, Carolyn R Kline, Suzanne Wiesner, Mary E D'Alton, Laurence E Shields
Severe maternal morbidity and mortality are often preventable and obstetric early warning systems that alert care providers of potential impending critical illness may improve maternal safety. While literature on outcomes and test characteristics of maternal early warning systems is evolving, there is limited guidance on implementation. Given current interest in early warning systems and their potential role in care, the 2017 Society for Maternal-Fetal Medicine (SMFM) Annual Meeting dedicated a session to exploring early warning implementation across a wide range of hospital settings...
April 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/29683929/18f-fdg-pet-ct-in-the-evaluation-of-cancer-cervix-where-do-we-stand-today
#11
Shanmuga S Palaniswamy, Chaitanya R Borde, Padma Subramanyam
The incidence of gynecological malignancies is on the rise partly because of the availability of screening programmes, awareness, higher technological advancements, and availability of better medical care. Early diagnosis of any malignancy leads to prompt treatment. Use of 18Fluorine-Fluorodeoxyglucose (F-FDG) PET/CT in the treatment and follow-up of patients with Ca cervix considerably improves patient management. The primary diagnosis of Ca cervix is made either by biopsy of a visible tumor on the cervix or by a cone biopsy of a nonvisible malignant cervical focus...
April 20, 2018: Nuclear Medicine Communications
https://www.readbyqxmd.com/read/29683911/acog-committee-opinion-no-736-optimizing-postpartum-care
#12
(no author information available yet)
The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman's individual needs. It is recommended that all women have contact with their obstetrician-gynecologists or other obstetric care providers within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth...
May 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29683906/acog-committee-opinion-no-736-summary-optimizing-postpartum-care
#13
(no author information available yet)
The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman's individual needs. It is recommended that all women have contact with their obstetrician-gynecologists or other obstetric care providers within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth...
May 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29682497/place-of-delivery-associated-with-postnatal-care-utilization-among-childbearing-women-in-zambia
#14
Charles Chungu, Mpundu Makasa, Mumbi Chola, Choolwe Nkwemu Jacobs
Objective: Postnatal care (PNC) utilization is critical to the prevention of maternal morbidity and mortality. Despite its importance, the proportion of women utilizing this service is still low in Zambia. We investigated if place of delivery was associated with PNC utilization in the first 48 h among childbearing women in Zambia. Methods: Data from the 2013/14 Zambia Demographic and Health Survey for women, aged 15-49 years, who reported giving birth in the 2 years preceding the survey was used...
2018: Frontiers in Public Health
https://www.readbyqxmd.com/read/29664956/you-pray-to-your-god-a-qualitative-analysis-of-challenges-in-the-provision-of-safe-timely-and-affordable-surgical-care-in-uganda
#15
Katherine Albutt, Rachel R Yorlets, Maria Punchak, Peter Kayima, Didacus B Namanya, Geoffrey A Anderson, Mark G Shrime
BACKGROUND: Five billion people lack access to safe, affordable, and timely surgical and anesthesia care. Significant challenges remain in the provision of surgical care in low-resource settings. Uganda is no exception. METHODS: From September to November 2016, we conducted a mixed-methods countrywide surgical capacity assessment at 17 randomly selected public hospitals in Uganda. Researchers conducted 35 semi-structured interviews with key stakeholders to understand factors related to the provision of surgical care...
2018: PloS One
https://www.readbyqxmd.com/read/29652744/clinical-pearls-part-3-anaesthetic-management-of-abnormally-invasive-placentation
#16
Vinod Patil, Gamunu Ratnayake, Galina Fastovets, D S Wijayatilake
PURPOSE OF REVIEW: Abnormal placentation is a clinical condition seen increasingly in the pregnant population. It is associated with significant morbidity and mortality, which may be mitigated through robust multidisciplinary care for these patients. The role of maternal critical care for these patients has largely been ignored in the literature. RECENT FINDINGS: Advances in pharmacological management of bleeding with recent publications of large multicentre trials in addition to new technologies in the management of massive obstetric haemorrhage (MOH) have revolutionized the management of abnormal placentation...
June 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29596431/measuring-the-preparedness-of-health-facilities-to-deliver-emergency-obstetric-care-in-a-south-african-district
#17
Siphiwe Bridget Pearl Thwala, Duane Blaauw, Freddie Ssengooba
BACKGROUND: Improving the delivery of emergency obstetric care (EmNOC) remains critical in addressing direct causes of maternal mortality. United Nations (UN) agencies have promoted standard methods for evaluating the availability of EmNOC facilities although modifications have been proposed by others. This study presents an assessment of the preparedness of public health facilities to provide EmNOC using these methods in one South African district with a persistently high maternal mortality ratio...
2018: PloS One
https://www.readbyqxmd.com/read/29580964/obstetric-patients-health-related-quality-of-life-before-and-after-intensive-care
#18
Seppänen Pia, Sund Reijo, Ala-Kokko Tero, Roos Mervi, Uotila Jukka, Helminen Mika, Suominen Tarja
BACKGROUND: Intensive care admissions during pregnancy, childbirth, and postpartum period are relatively well investigated. However, very little is known about these obstetric patients' health-related quality of life (HRQoL) before and after critical care. OBJECTIVE: The objective of this study was to assess obstetric patients' HRQoL before intensive care admission (baseline) and at 6 months after discharge (follow-up) DESIGN: This was a retrospective database study...
March 23, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29580444/medical-simulation-as-a-vital-adjunct-to-identifying-clinical-life-threatening-gaps-in-austere-environments
#19
Adaora M Chima, Rahul Koka, Benjamin Lee, Tina Tran, Onyebuchi U Ogbuagu, Howard Nelson-Williams, Michael Rosen, Michael Koroma, John B Sampson
BACKGROUND: Maternal mortality and morbidity are major causes of death in low-resource countries, especially those in Sub-Saharan Africa. Healthcare workforce scarcities present in these locations result in poor perioperative care access and quality. These scarcities also limit the capacity for progressive development and enhancement of workforce training, and skills through continuing medical education. Newly available low-cost, in-situ simulation systems make it possible for a small cadre of trainers to use simulation to identify areas needing improvement and to rehearse best practice approaches, relevant to the context of target environments...
April 2018: Journal of the National Medical Association
https://www.readbyqxmd.com/read/29578985/acog-committee-opinion-no-732-influenza-vaccination-during-pregnancy
#20
(no author information available yet)
Influenza vaccination is an essential element of prepregnancy, prenatal, and postpartum care because influenza can result in serious illness, including a higher chance of progressing to pneumonia, when it occurs during the antepartum or postpartum period. In addition to hospitalization, pregnant women with influenza are at increased risk of intensive care unit admission and adverse perinatal and neonatal outcomes. The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists recommend that all adults receive an annual influenza vaccine and that women who are or will be pregnant during influenza season receive an inactivated influenza vaccine as soon as it is available...
April 2018: Obstetrics and Gynecology
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