Improving First-hour Breastfeeding Initiation Rate After Cesarean Deliveries: A Quality Improvement Study

Objective: To improve the rates of first hour initiation ofbreastfeeding in neonates born through cesarean section from 0to 80% over 3 months through a quality improvement (QI)process.Design: Quality improvement study.Setting: Labor Room-Operation Theatre of a tertiary carehospital.Participants: Stable newborns ?35 weeks of gestation born bycesarean section under spinal anesthesia.Procedure: A team of nurses, pediatricians, obstetricians andanesthetists analyzed possible reasons for delayed initiation ofbreastfeeding by Process flow mapping and Fish bone analysis.Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles.Outcome measure: Proportion of eligible babies breast fedwithin 1 hour of delivery.Results: The rate of first-hour initiation of breastfeeding increasedfrom 0% to 93% over the study period. The result was sustainedeven after the last PDSA cycle, without any additional resources.Conclusions: A QI approach was able to accomplish sustainedimprovement in first-hour breastfeeding rates in cesareandeliveries.

Utilisation of Maternal Health Services and its Predictors in Slum Population.

Introduction: The particularly sorry plight of disadvantaged slum population with ample scope of further research into such areas as vulnerability to health risk and access to treatment, reduced economical choice and social support besides natural disasters and emotional stress of displacement. Material & Methods: An observational (cross-sectional) study was designed on a pre designed and pre tested questionnaire to understand women’s fertility and contraceptive behavior and to study Socio behavioral Determinants of Utilization of MCH services. Results: The prevalence of <18 marriage was 78.03%.The teenage pregnancy was as high as 46.36% with 47.90% having parity of 4 or more.And of those not seeking ANC 53.42% did not feel the need for care during pregnancy. A very important finding was that 64.23% had home delivery and of these, 74% did not have any trained birth attendant. Conclusion: Levels of education in the family, caste, affordability (asset-holding) and accessibility were the factors which determined the utilization pattern. In general, those with better levels of education and those with better affordability preferred private practitioners and were willing to travel longer distances to avail health services as there was more awareness, motivation and felt need.

Anesthetic management of a patient with hypertrophic obstructive cardiomyopathy with dual-chamber pacemaker undergoing transurethral resection of the prostate.

We describe the anesthetic management of a patient with hypertrophic obstructive cardiomyopathy with dual-chamber pacemaker undergoing transurethral resection of the prostate. Anesthetic challenges included prevention and management of perioperative arrhythmias, maintenance of adequate preload, afterload and heart rate to relieve left ventricular outflow tract obstruction and considerations related to the presence of dual-chamber pacemaker and TURP. We recommend preoperative reprogramming of the DDD pacemaker, avoidance of magnet application during the procedure, application of electrosurgical unit current returning pad to the anterior aspect of the thigh, especially if monopolar cautery is used, use of central venous pressure line for estimation of preload and careful titration of anesthetic drugs to maintain stable hemodynamics.

Lipoprotein(a) as a marker of coronary artery disease and its association with dietary fat.

OBJECTIVE: The main objectives of the study were to evaluate the effect of dietary fat on plasma lipoprotein(a) [Lp(a)] levels and to study the potential of Lp(a) as a more reliable marker for CAD compared to other lipids and lipoproteins. METHODS: Twenty CAD patients and 20 healthy controls were recruited for the study. Their fasting plasma Lp(a) levels and complete lipid profile were assayed. The fat intake was calculated using 24 hours dietary recall method. The patients and controls were each divided into two subgroups: Group A consuming dietary fat > 30% and Group B consuming dietary fat < or = 30% of the total kilo-calories/day. RESULTS: Results indicated that plasma Lp(a), total serum cholesterol (TC), tryglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and LDL-C/HDL-C ratio of CAD patients were significantly higher than the controls. High fat intake was found to be associated with higher plasma Lp(a) levels (p<0.05) in patients only. No significant correlation was found between Lp(a) levels and other conventional lipoproteins. CONCLUSION: The lack of correlation between Lp(a) and other lipoproteins indicates its potential as an independent risk factor for CAD. High fat intake led to higher plasma Lp(a) levels in patients; hence it would be worthwhile to evaluate the effect of quality and quantity of fat intake on plasma Lp(a) levels in a larger sample size.