A Comparison of Visual Estimate versus Calculated Estimate of Blood Loss at Vaginal Delivery.

Aims: To compare blood loss following vaginal delivery by two different methods: visually estimated blood loss (vEBL) and calculated estimate of blood loss (cEBL). Study Design: Postpartum blood loss was analyzed during 2 different time frames: 1. Traditional estimation (vEBL) of blood loss and 2. Following training, with the use of a systematic method (cEBL). Place and Duration of Study: Department of Labor and Delivery at Maricopa Medical Center in Phoenix, Arizona. Charts were reviewed from September and October 2009 and from September 2010. Methodology: This was a retrospective cohort study in which blood loss was compared using two different methods. Traditional physician estimate of blood loss at vaginal delivery, “vEBL” was compared to a more formal determination of blood loss “cEBL” - calculated blood loss. Results: The cEBL subjects (mean age 28.0+/-6.6) were significantly older than the vEBL subjects (mean age 25.4+/-5.8). The two groups were otherwise similar. Mean blood loss was compared across the two methods using Analysis of Variance. Mean blood loss was 324 for the cEBL group, and 309 for the vEBL group (F(1,192)=0.76, p=.385). Although the difference in mean blood loss was not statistically significant, the variance of the cEBL method was significantly larger (P<.0005). 2/94 (2.1%) of patients in the vEBL group were noted to have blood loss ≥500cc; 11/100 (11%) of patients in the cEBL group were noted to have blood loss ≥500cc. Conclusion: The variance for the cEBL method was significantly greater than in the vEBL group, suggesting that postpartum hemorrhage may be diagnosed sooner with this method. As calculation of blood loss postpartum is increasingly endorsed we recommend further study to determine the typical range for blood loss with measurement via this technique.

Hallazgo imagenológico de hendidura mandibular media incompleta: reporte de un caso / Imaging findings of an incomplete median mandibular cleft: a case report

La hendidura mandibular media es una rara anomalía congénita la cual ha sido descrita como hendidura Tessier 30, la misma puede estar asociada a una variedad de alteraciones de distinta severidad y por ello expresarse como una simple muesca en el bermellón del labio hasta la ausencia del manubrio esternal. El presente trabajo tuvo como propósito describir un hallazgo imagenológico de hendidura mandibular media incompleta, con énfasis en el recurso de la Tomografía Computarizada (TC) como medio para su caracterización. Paciente masculino de 11 años de edad quien es referido para estudio mediante TC, por la presencia de una imagen radiolúcida en radiografía panorámica previa. Al examen extrabucal, no presentaba herida cutánea o asimetría facial; en el examen intrabucal se observó la ausencia de elementos dentarios permanente en zona anteriosuperior e inferior. En la radiografía panorámica se verificó la retención de los dientes 12-22, 32, 42 y 41, así como una imagen radiolúcida en línea media de la mandíbula, de bordes corticalizados que se extendía desde el borde inferior sin alcanzar la cresta del reborde alveolar. Las reconstrucciones en los planos axial, sagital y coronal obtenidas por TC mostraron la extensión de la imagen hipodensa en sentido vestíbulo-lingual, la cual no ocupaba el espesor del hueso, comprobándose también la corticalización de los márgenes. El uso de la TC permitió conocer los límites y extensión de la alteración, así como confirmar la corticalización de los márgenes en la imagen, lo que permitió formular la hipótesis diagnóstica de hendidura mandibular media.

Median mandibular cleft is a rare congenital anomaly described as Tessier cleft 30, associated with a variety of disorders of different severity; it could be expressed as a notch in the lip vermillion to the absence of the sternal manubrium. The present study was aimed to describe an imaging finding of a median incomplete mandibular cleft, with emphasis on the use of computed tomography (CT) as a means of characterization. An 11 year old male patient referred for CT study, due to the presence of a radiolucent image in a previous panoramic radiograph. The extraoral examination showed no skin wound or facial asymmetry; intraoral exam demonstrated the absence of anterior superior and lower permanent tooth elements. In the panoramic radiograph the impaction of teeth 12 -22, 32, 42 and 41, as well as a midline radiolucent image in the mandible with corticalized margins extending from the inferior border without reaching the alveolar ridge crest was verified . Reconstructions in the axial, sagittal and coronal planes obtained by CT showed extension of the hypodense image in the vestibular-lingual orientation, which did not occupy the entire bone thickness, also it was ascertained margins corticalization The use of CT allowed to know the limits and extent of the alteration, and confirm margins corticalization in the image, allowing to formulate a diagnostic hypothesis of incomplete median mandibular cleft.

Análisis causa-raíz de los factores vinculados a la muerte de recién nacidos internados en maternidades públicas de Argentina / Root cause analysis of factors related to the death of newborns hospitalized in public maternities in Argentina

INTRODUCCIÓN: Las tasas de mortalidad infantil y neonatal en Argentina tienen tendencia decreciente y las desigualdades entre regiones son notables. El 60% de las muertes en <1 año ocurre en el periodo neonatal, 57% de esas muertes son evitables. OBJETIVO: analizar un conjunto de muertes neonatales a través de técnicas estandarizadas y Análisis de Causa-Raíz (ACR). MÉTODO: estudio multicéntrico observacional de corte transversal. Se incluyeron los recién nacidos (RN) ≥ 500 grs que fallecieron ≤ 30 días entre 06/08 y 03/09 en 6 maternidades. La recolección de datos fue prospectiva multidimensional, próxima a la muerte, a partir de todos los actores, con marcación cronológica y evaluación de dimensiones institucional, recursos humanos, equipamiento, ambiente físico y factores externos. Se caracterizó al RN fallecido y un grupo asesor clasificó la muerte como inevitable o reducible. RESULTADOS: se analizaron 369 muertes; las causas de internación fueron dificultad respiratoria (67,7%), malformaciones (16,2%), infecciones y asfixia perinatal (12%). La dimensión de recursos humanos fue la más frecuentemente relacionada con la muerte (59%), seguida por la institucional y organizacional (48%). La condición de derivación (OR 1,97; IC95% 1,01-3,83) y la presencia de complicaciones (OR 8,56; IC 95% 5,03-14,5) y edad >6 días (OR 2,04; IC95% 1,06-3,95) resultaron asociadas en forma independiente a la reducibilidad de la muerte neonatal. CONCLUSIONES: la mayor parte de las muertes neonatales fueron reducibles. Resulta fundamental establecer estrategias de capacitación y fortalecimiento del recurso humano que asiste a esta población.

BACKGROUND: The infant and neonatal mortality rate in Argentina is decreasing but disparities between regions are notable and 60 per cent of the newborn deaths (NB) are preventable. OBJECTIVE: to analyze a set of neonatal deaths through standardized techniques and root cause analysis (RCA). The RCA is a reactive tool to identify factors contributing to the occurrence of an unwanted event in search of system failures. Design: multicentric observational cross-sectional study. METHOD: NB ≥ 500grs who died ≤ 30 days in 2008–2009 in 6 maternity hospitals in Argentina were included. Data collection was multidimensional and close to the death with chronological analysis and assessment of dimension institutional, human resources, equipment, physical environment and external factors. Every NB was epidemiologically characterized and an advisory group classified death as inevitable or reducible. RESULTS: 369 deaths were analyzed; the main hospitalization causes were respiratory distress (67.7%), malformations (16.2%), infections and perinatal asphyxia (12%). The human resources dimension was the most frequently related to the death (59%), followed by the institutional and organizational (48%). 57.7% of deaths were classified as reducible. The neonatal transport condition (OR 1.97CI95% 1, 01-3, 83), the presence of complications (OR 8,56 CI95% 5,03-14,5) and age > 6 days (OR2 CI95% 1,06-3, 95) were associated with neonatal death reducibility independently. CONCLUSIONS: most of neonatal deaths were reducible. It is essential to establish strategies for training and strengthening human resources that assist this population.

Aspectos das fortalezas e fragilidades no uso das metodologias ativas de aprendizagem / Strengths and weaknesses in the use of active learning methods

A implementação de novos modelos de ensino-aprendizagem vem ocorrendo na Faculdade de Medicina de Marília (Famema) há mais de uma década. O presente estudo analisa as fortalezas e fragilidades dos métodos ativos de aprendizagem na ótica dos estudantes. Para a coleta de dados, realizaram-se entrevistas com estudantes dos cursos de Enfermagem e Medicina. Os dados foram interpretados por meio dos parâmetros da hermenêutica dialética. Os sentidos extraídos das falas dos estudantes indicam que as metodologias ativas estimulam o estudo constante, a independência e a responsabilidade, possibilitam a integração das dimensões biopsicossociais, preparam para o trabalho em equipe e aproximam os alunos dos usuários e da equipe. No entanto, nem todos estão preparados para isso; algumas vezes, sentem-se perdidos em busca de conhecimentos, além de apresentarem dificuldades quanto a sua inserção na equipe de saúde. A construção de novos modelos de aprendizagem requer constante empenho, visando ao seu aperfeiçoamento.

New teaching-learning methods have been implemented at the Marília School of Medicine (FAMEMA) in Brazil for more than a decade. The current study analyzes the strengths and weaknesses of active learning methods from the students' perspective. Data were collected through interviews with nursing and medical students. The data were interpreted using dialectical hermeneutics. The meanings extracted from the students' speech acts indicate that the active methodologies encourage constant study, independence, and responsibility, and allow the integration of biopsychosocial dimensions, prepare the students for team work, and foster closer contact between the students and users and staff. However, not all students are prepared for this experience. Some feel lost in their search for know ledge, in addition to displaying difficulties in their integration with the health team. Building and improving new learning models requires constant effort.