ABSTRACT
Preterm labor is still has the main cause of preterm birth. The aim of this study to know the rate of this complication in our hospital, and the relation between preterm labor and some risk factors like parity ,maternal age and multiple pregnancy, and the relation between premature labor and gestational age, gestational weight and apgar`s score . This study is a case-control study was done in department of obstetrics and gynecology, Damascus. It`s involved 653 women was diagnosed as preterm labor [study group] and 100 women as [control group]. the prevalence of preterm labor in our hospital was 6.5% ,while the average age were 21-30 years [53.9%], about 56.7% of patients have children between 1-5, while the gestational age of 45% were more than 34 week, and the gestational weight was more than 1500 g in 70% of patients. our rate was accepted if we compare with other studies, but the relation with some factors like maternal age and parity were different, so we should disuse our result from pointes are going on our society and our behaviors
ABSTRACT
A clinical pathway defines the optimal care process, sequencing and timing of interventions for a particular diagnosis or procedure. Clinical pathway implementation has the potential to standardize treatment and improve outcomes. Therefore the aim of this study is to determine whether clinical pathway implementation would alter process of care, hospital stay and mortality rates for acute myocardial infarction at Alexandria Main University Hospital. The study consisted of three phases: pre-intervention phase, development and dissemination of a clinical pathway for acute myocardial infarction and post- intervention evaluation phase. Process and outcome indicators were used to assess the quality of care provided to patients with acute myocardial infarction before and after implementation of the pathway. Results revealed that 4 process indicators out of 7 showed significant improvement namely, the utilization of thrombolytic therapy [from 76.9 to 88.5%], B-blockers at admission [from 28.5% to 50.0%], ACE inhibitors at discharge [from 61.2% to 75.2%] and smoking cessation counselling [from zero to 86.7%]. There was also reduction of variation in length of ICU stay as 67.7% achieved length of stay goal of 3 days after implementation of the pathway. ICU mortality was decreased from 20.8% to 6.9% after implementation of the pathway. These data suggest that the implemented acute myocardial infarction pathway lead to improved patient care and utilization of resources by providing a structured framework and educational guide to assist in the delivery of care to patients admitted with myocardial infarction
Subject(s)
Humans , Male , Female , Clinical Protocols , Intensive Care Units/standards , Quality of Health Care , Length of Stay , Acute Disease , Critical Illness , Critical Care , Treatment Outcome , MortalityABSTRACT
To determine the prognostic value of early echocardiographic assessment in patients with acute variceal bleeding. The study was conducted on 80 patients with portal hypertension, admitted to the emergency hematemesis and tropical medicine units at the Alexandria University main Hospital. They were divided into two groups; group I: included 40 patients with acute variceal hemorrhage and group II: included 40 patients without active bleeding. Transthoracic echocardiography was used to measure and calculate left ventricular fractional shorting, left ventricular ejection fraction, stroke volume, cardiac output, total peripheral vascular resistance and the left venticular stoke work. According to the inhospital course; the bleeders [group I] were further subdivided into two subgroups: group la included 16 [40%] patients who had a poor evolution [inhospital mortality or early variceal rebleeding], and group Ib included 24 [60%] patients were discharged uneventfully. Using standard univariate analysis, the poorly evoluted patients had lower stroke volume [64.44 +/- 13.25vs. 82.33 +/- 15.88ml/beat, p=0.017], lesser cardiac index [3.10 +/- 0.66vs. 4.48 +/- 0.69L/min/[m]2, p=0.007], higher systemic vascular resistance [1387 +/- 379vs. 990 +/- 239dynes/sec/[cm]-5,p=0.010] and lower left ventricular stroke work [77.94 +/- 13.34vs. 104.18 +/- 23gram-m; p=0.007]. The prognostic value of such four variables was tested by running a stepwise logistic regression analysis. The cardiac index was the only significant predictor factor for poor evolution among our patients [chi square = 13.78, P=0.002]. The resting cardiac index is a useful predictor for inhospital mortality among patients with portal hypertension and acute variceal bleeding. Echocardiographic measurement of the cardiac index and the systemic vascular resistance may help to identify the high risk bleeders to optimise their management