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Obstetrics critical care

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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
#1
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
#2
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...
April 12, 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
#3
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
#4
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
#5
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
#6
(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
https://www.readbyqxmd.com/read/29578983/acog-committee-opinion-no-732-summary-influenza-vaccination-during-pregnancy
#7
(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
https://www.readbyqxmd.com/read/29553986/a-systematic-review-of-integrated-care-interventions-addressing-perinatal-depression-care-in-ambulatory-obstetric-care-settings
#8
Tiffany A Moore Simas, Michael P Flynn, Aimee R Kroll-Desrosiers, Stephanie M Carvalho, Leonard L Levin, Kathleen Biebel, Nancy Byatt
This systematic review searched 4 databases (PubMed/MEDLINE, Scopus, CINAHL, and PsychINFO) and identified 21 articles eligible to evaluate the extent to which interventions that integrate depression care into outpatient obstetric practice are feasible, effective, acceptable, and sustainable. Despite limitations among the available studies including marked heterogeneity, there is evidence supporting feasibility, effectiveness, and acceptability. In general, this is an emerging field with promise that requires additional research...
March 16, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29540421/impact-of-violence-against-women-on-severe-acute-maternal-morbidity-in-the-intensive-care-unit-including-neonatal-outcomes-a-case-control-study-protocol-in-a-tertiary-healthcare-facility-in-lima-peru
#9
Beatriz Paulina Ayala Quintanilla, Wendy E Pollock, Susan J McDonald, Angela J Taft
INTRODUCTION: Preventing and reducing violence against women (VAW) and maternal mortality are Sustainable Development Goals. Worldwide, the maternal mortality ratio has fallen about 44% in the last 25 years, and for one maternal death there are many women affected by severe acute maternal morbidity (SAMM) requiring management in the intensive care unit (ICU). These women represent the most critically ill obstetric patients of the maternal morbidity spectrum and should be studied to complement the review of maternal mortality...
March 14, 2018: BMJ Open
https://www.readbyqxmd.com/read/29535558/aplastic-anemia-during-pregnancy-a-review-of-obstetric-and-anesthetic-considerations
#10
REVIEW
Efrain Riveros-Perez, Amy C Hermesch, Linda A Barbour, Joy L Hawkins
Aplastic anemia is a hematologic condition occasionally presenting during pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management is challenging, and treatment requires a coordinated effort by an interdisciplinary team, in order to provide safe care to these patients. In this review, we describe the current state of the literature as it applies to the complexity of aplastic anemia in pregnancy, focusing on pathophysiologic aspects of the disease in pregnancy, as well as relevant obstetric and anesthetic considerations necessary to treat this challenging problem...
2018: International Journal of Women's Health
https://www.readbyqxmd.com/read/29528929/a-unique-institutional-response-to-the-zika-virus-epidemic
#11
Jenna Dran
In 2015, Zika virus rapidly emerged as a concern for obstetric patients and health care providers as the disease spread geographically and it was discovered that Zika virus infection had the potential to cause devastating birth defects. Essentially overnight, obstetric care providers were faced with an influx of rapidly evolving information and an increased workload. New systems, workflows, and personnel were needed to effectively address the new patient care needs fueled by the burgeoning Zika virus epidemic...
April 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29521868/older-nurses-experiences-of-providing-direct-care-in-hospital-nursing-units-a-qualitative-systematic-review
#12
Karen Parsons, Alice Gaudine, Michelle Swab
BACKGROUND: Most developed countries throughout the world are experiencing an aging nursing workforce as their population ages. Older nurses often experience different challenges then their younger nurse counterparts. With the increase in older nurses relative to younger nurses potentially available to work in hospitals, it is important to understand the experience of older nurses on high paced hospital nursing units. This understanding will lend knowledge to ways of lessening the loss of these highly skilled experienced workers and improve patient outcomes...
March 2018: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29521849/implementing-statewide-severe-maternal-morbidity-review-the-illinois-experience
#13
Abigail R Koch, Pamela T Roesch, Caitlin E Garland, Stacie E Geller
CONTEXT: Severe maternal morbidity (SMM) rates in the United States more than doubled between 1998 and 2010. Advanced maternal age and chronic comorbidities do not completely explain the increase in SMM or how to effectively address it. The Centers for Disease Control and Prevention and American College of Obstetricians and Gynecologists have called for facility-level multidisciplinary review of SMM for potential preventability and have issued implementation guidelines. IMPLEMENTATION: Within Illinois, SMM was identified as any intensive or critical care unit admission and/or 4 or more units of packed red blood cells transfused at any time from conception through 42 days postpartum...
March 7, 2018: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/29497829/the-safe-use-of-surgical-energy-devices-by-surgeons-may-be-overestimated
#14
Ally Ha, Carly Richards, Erik Criman, Jillian Piaggione, Christopher Yheulon, Robert Lim
BACKGROUND: Surgical energy injuries are an underappreciated phenomenon. Improper use of surgical energy or poor attention to patient safety can result in operating room fires, tissue injuries, and interferences with other electronic devices, while rare complications can be devastatingly severe. Despite this, there is no current standard requirement for educating surgeons on the safe use of energy-based devices or evaluation of electrosurgery (ES) education in residency training, credentialing, or practice...
March 1, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29495076/empowering-members-of-a-rural-southern-community-in-nigeria-to-plan-to-take-action-to-prevent-maternal-mortality-a-participatory-action-research-project
#15
Ekpoanwan E Esienumoh, Janette Allotey, Heather Waterman
AIMS AND OBJECTIVES: To facilitate the empowerment of members of a rural community to plan to take action to prevent maternal mortality. BACKGROUND: Globally, about 300,000 maternal deaths occur yearly. Sub-Saharan Africa and Southern Asia regions account for almost all the deaths. Within those regions, India and Nigeria account for over a third of the global maternal deaths. Problem of maternal mortality in Nigeria is multifaceted. About 80% of maternal deaths are avoidable, given strategies which include skilled attendants, emergency obstetric care and community mobilization...
March 1, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29476798/prevalence-of-dyspnea-among-hospitalized-patients-at-the-time-of-admission
#16
Jennifer P Stevens, Tenzin Dechen, Richard Schwartzstein, Carl O'Donnell, Kathy Baker, Michael D Howell, Robert B Banzett
CONTEXT: Dyspnea is an uncomfortable and distressing sensation experienced by hospitalized patients. OBJECTIVES: There is no large-scale study of the prevalence and intensity of patient-reported dyspnea at the time of admission to the hospital. METHODS: Between March 2014 and September 2016, we conducted a prospective cohort study among all consecutive hospitalized patients at a single tertiary care center in Boston, MA. During the first 12 hours of admission to medical-surgical and obstetric units, nurses at our institution routinely collect a patient's (1) current level of dyspnea on a 0-10 scale with 10 anchored at "unbearable", (2) worst dyspnea in the past 24 hours prior to arrival at the hospital on the same 0-10 scale, and (3) what activities were associated with dyspnea prior to admission...
February 21, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29471845/association-of-the-client-provider-ratio-with-the-risk-of-maternal-mortality-in-referral-hospitals-a-multi-site-study-in-nigeria
#17
Friday Okonofua, Lorretta Ntoimo, Rosemary Ogu, Hadiza Galadanci, Rukiyat Abdus-Salam, Mohammed Gana, Ola Okike, Kingsley Agholor, Eghe Abe, Adetoye Durodola, Abdullahi Randawa
BACKGROUND: The paucity of human resources for health buoyed by excessive workloads has been identified as being responsible for poor quality obstetric care, which leads to high maternal mortality in Nigeria. While there is anecdotal and qualitative research to support this observation, limited quantitative studies have been conducted to test the association between the number and density of human resources and risk of maternal mortality. This study aims to investigate the association between client-provider ratios for antenatal and delivery care and the risk of maternal mortality in 8 referral hospitals in Nigeria...
February 22, 2018: Reproductive Health
https://www.readbyqxmd.com/read/29471830/beyond-coverage-improving-the-quality-of-antenatal-care-delivery-through-integrated-mentorship-and-quality-improvement-at-health-centers-in-rural-rwanda
#18
Anatole Manzi, Laetitia Nyirazinyoye, Joseph Ntaganira, Hema Magge, Evariste Bigirimana, Leoncie Mukanzabikeshimana, Lisa R Hirschhorn, Bethany Hedt-Gauthier
BACKGROUND: Inadequate antenatal care (ANC) can lead to missed diagnosis of danger signs or delayed referral to emergency obstetrical care, contributing to maternal mortality. In developing countries, ANC quality is often limited by skill and knowledge gaps of the health workforce. In 2011, the Mentorship, Enhanced Supervision for Healthcare and Quality Improvement (MESH-QI) program was implemented to strengthen providers' ANC performance at 21 rural health centers in Rwanda. We evaluated the effect of MESH-QI on the completeness of danger sign assessments...
February 23, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29470814/continuing-professional-development-in-maternal-health-care-barriers-to-applying-new-knowledge-and-skills-in-the-hospitals-of-rwanda
#19
Germaine Tuyisenge, Celestin Hategeka, Isaac Luginaah, Yolanda Babenko-Mould, David Cechetto, Stephen Rulisa
Objectives Training healthcare professionals in emergency maternal healthcare is a critical component of improving overall maternal health in developing countries like Rwanda. This paper explored the challenges that healthcare professionals who participated in a Continuing Professional Development (CPD) program on Advanced Life Support in Obstetrics® (ALSO) face in putting the learned knowledge and skills into practice in hospitals of Rwanda. Methods This study used a mixed methods approach to understand the challenges/barriers to applying new knowledge and skills in the hospitals of Rwanda...
February 22, 2018: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/29454125/management-of-skull-base-tumors-in-the-obstetric-population-a-case-series
#20
Blake H Priddy, Bradley A Otto, Ricardo L Carrau, Daniel M Prevedello
BACKGROUND: Neoplasms rarely present during pregnancy. However, increase in plasma volume, hormone release induced growth, and tumor hypervascularity, can cause rapid symptoms. These range from not requiring intervention to necessitating emergent operations. OBJECTIVE: We describe an algorithm for the management of symptomatic neoplasm in the obstetric population, and provide recommendations regarding surgical indications and timing. METHODS: Patients who presented to a skull base clinic from 2010-2016 at large tertiary care hospital were reviewed to identify patients who presented with a skull base tumor during pregnancy...
February 14, 2018: World Neurosurgery
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