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1.
Journal of Personalized Medicine ; 13(1):159, 2023.
Article in English | ProQuest Central | ID: covidwho-2208604

ABSTRACT

Sugammadex may be required or used in multiple emergency situations. Moderate and high doses of this compound can be used inside and outside the operating room setting. In this communication, recent developments in the use of sugammadex for the immediate reversal of rocuronium-induced neuromuscular blockade were assessed. In emergency surgery and other clinical situations necessitating rapid sequence intubation, the tendency to use rocuronium followed by sugammadex instead of succinylcholine has been increasing. In other emergency situations such as anaphylactic shock caused by rocuronium or if intubation or ventilation is not possible, priority should be given to resuming ventilation maintaining hemodynamic stability, in accordance with the traditional guidelines. If necessary for the purpose of resuming ventilation, reversal of neuromuscular blockade should be done in a timely fashion.

2.
ARS Medica Tomitana ; 27(4):184-188, 2021.
Article in English | EMBASE | ID: covidwho-2215105

ABSTRACT

The coronavirus pandemic influenced the way medical care was provided, in ambulatory and hospital environment. We analysed of the situation on the Obstetrics-Gynecology section of the Emergency County clinical Hospital .,Saint Andrew the Apostle"in Constanta, for a period of two years, regarding the protocol of pregnant patients, gynecopats and shoots infected with Covid-19, measurement of hospital costs, prevention and limitation measures against the infection of medical personnel with the above-mentioned virus. Copyright © 2021 Ilici Olimpia et al., published by Sciendo.

3.
International Journal of Infectious Diseases ; 2023.
Article in English | ScienceDirect | ID: covidwho-2210482

ABSTRACT

Objectives This study aimed to provide guidance for clinical treatment and increase public confidence in COVID-19 vaccines. Methods The Cochrane Library, Embase, PubMed, Web of Science, ClinicalKey, and other COVID-19 datasets were searched from December 2019 to May 2022. Case–control studies and prospective cohort studies of COVID-19 vaccine effectiveness and safety in pregnant women were included. Results From Day 11 to Day 13 after the first dose of the COVID-19 mRNA vaccine, the effectiveness was 54% (95% CI: 0.33-0.69). On Days 14 to 27, the effectiveness was 59%. There was a 14% increase in vaccine effectiveness 28 days after the first dose was given. The inactivated vaccines showed similar effectiveness. The proportions of placental abruptions, postpartum hemorrhages, miscarriages, stillbirths, premature births, and small for gestational age infants were not significantly different between vaccinated and nonvaccinated pregnant women. Fatigue and fever were also not associated with pregnancy. Conclusions Our findings affirm that the effectiveness varies for different types of vaccines and is significantly and positively correlated with time in the pregnant population. COVID-19 vaccines have also been deemed safe for pregnant women. Thus, we developed a comprehensive understanding of the role of vaccines in pregnant women.

4.
Nurs Open ; 2022 Sep 10.
Article in English | MEDLINE | ID: covidwho-2173303

ABSTRACT

AIM: The primary objective of this study was to assess the patient safety culture in a general hospital in Shanghai, China, through a modified Manchester Patient Safety Framework (MaPSaF). DESIGN: This study has a qualitative interview design. Data were collected through group interviews and analyses performed through content analysis. METHODS: The MaPSaF was translated into Chinese and used to assess the patient safety culture in a large general hospital in Shanghai, China. Group interviews using the MaPSaF were conducted with 15 nurses in the obstetric ward. Participants rated their safety practice individually on each of the nine MaPSaF safety culture dimensions. The dimensions and scores were then collectively discussed and a practice-wide consensus score for each dimension was agreed. Discussions were recorded, transcribed and analysed to assess patient safety in the obstetric ward. RESULTS: It took about 2 hr to complete the discussion focusing on patients' safety employing the MaPSaF. Most participants recognized the process as acceptable and useful. The MaPSaF directed team discussion about patient safety issues and facilitated communication, prompting some practice changes. All participants responded positively to the discussion and perceived MaPSaF as a good safety culture assessment tool, with clear, comprehensive and understandable entries. The process demonstrated that the department of obstetrics in the hospital already had a positive patient safety culture, but certain areas were highlighted as still needing improvement. Based on participants' positive experience and perception of the MaPSaF, it can be concluded that there is potential benefit in its adaptation and use in obstetrics wards of Chinese hospitals. The MaPSaF has the potential to strengthen existing safety cultures and improve general safety through collaborative measures.

5.
Open Access Macedonian Journal of Medical Sciences ; 10(A):1668-1675, 2022.
Article in English | EMBASE | ID: covidwho-2201138

ABSTRACT

BACKGROUND: Telehealth is not new, but licensing restrictions, HIPAA compliance issues, and lack of reimbursement were significant barriers that hindered its success in the past. Enabling practices to adopt telehealth so that in-person care could be limited to urgent patients and curbed use of finite clinical resources like personal protective equipment for which there were significant shortages. This expansion allowed services including, but not limited to, home visits, therapy services, emergency consults, and nursing facilities visits to be conducted remotely. AIM: The study objectives are to describe telehealth utilization rates among gynecology (OB/GYN) patients during the first 4 months of the COVID-19 pandemic by race/ethnicity and insurance coverage and to investigate telehealth access disparities. METHOD(S): A cross-sectional analysis design was employed. Data ion was performed using the electronic medical records of UMass Memorial Medical Center (UMMMC). A convenience sample of 9370 women who received their telehealth or in-person care at the UMMMC were included in this study. RESULT(S): Between March 15, 2020, and July 30, 2020, in total, 15,362 encounters were completed. Throughout the timeframe included in this study, 81.34% of appointments were conducted in person, and 18.66% were completed using telehealth. The age of telehealth patients ranged from 17 to 97, with a mean age of 45. Most of the patients were White (n = 1202, 63.4%) and held private health insurance (n = 975, 52.4%). Hispanic and Asian patients were less likely to attend their telehealth appointment than patients of other races (p < 0.001). Patients with private health insurance were more likely to attend their telehealth appointments than patients with public health insurance (p < 0.001). CONCLUSION(S): Telehealth services have been providing patients with access to OB/GYN care during this challenging time and have enhanced health-care delivery opportunities. This study identifies a clear need to improve telehealth access and utilization rates among racial and ethnic minority groups and persons with public insurance. Copyright © 2022 Mohammad Alkawaldeh, Amanda Lee, Nabeel Al-Yateem, Jacqueline Dias, Fatma Refaat, Syed Rahman, Muhammad Arsyad Subu.

6.
BMC Pregnancy and Childbirth ; 22:1-13, 2022.
Article in English | ProQuest Central | ID: covidwho-2196104

ABSTRACT

Background: Pregnancy is often conceptualised as a ‘teachable moment' for health behaviour change. However, it is likely that different stages of pregnancy, and individual antenatal events, provide multiple distinct teachable moments to prompt behaviour change. Whilst previous quantitative research supports this argument, it is unable to provide a full understanding of the nuanced factors influencing eating behaviour. The aim of this study was to explore influences on women's eating behaviour throughout pregnancy. Methods: In-depth interviews were conducted online with 25 women who were less than six-months postpartum. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically. Results: Five themes were generated from the data that capture influences on women's eating behaviour throughout pregnancy: ‘The preconceptual self', ‘A desire for good health', ‘Retaining control', ‘Relaxing into pregnancy', and ‘The lived environment'. Conclusion: Mid-pregnancy may provide a more salient opportunity for eating behaviour change than other stages of pregnancy. Individual antenatal events, such as the glucose test, can also prompt change. In clinical practice, it will be important to consider the changing barriers and facilitators operating throughout pregnancy, and to match health advice to stages of pregnancy, where possible. Existing models of teachable moments may be improved by considering the dynamic nature of pregnancy, along with the influence of the lived environment, pregnancy symptoms, and past behaviour. These findings provide an enhanced understanding of the diverse influences on women's eating behaviour throughout pregnancy and provide a direction for how to adapt existing theories to the context of pregnancy.

7.
BMJ open ; 12(12):e068575, 2022.
Article in English | EMBASE | ID: covidwho-2193804

ABSTRACT

OBJECTIVE: To identify independent risk factors for severe COVID-19 in pregnant women and to evaluate the impact of disease severity on preterm birth. DESIGN: A case-control study based on data from a nationwide questionnaire-based survey of maternity services in Japan. SETTING: A questionnaire was mailed to all 2135 delivery institutions in Japan between July and August 2021. A total of 1288 institutions responded (60% of all delivery institutions in Japan). 566 facilities reported having cared for pregnant women with COVID-19, and 722 facilities reported having had no such patients. PARTICIPANTS: One thousand and forty-three hospitalised and non-hospitalised pregnant women diagnosed with COVID-19 between July 2020 and 30 June 2021. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was progression to severe COVID-19. The secondary outcome was preterm birth due to COVID-19 infection. RESULT(S): 56 cases (5.4%) were severe, and 987 (94.6%) were non-severe. Multivariable logistic regression analysis showed that gestational age>=24 weeks (adjusted OR (aOR) 6.68, 95%CI 2.8 to 16.0) and maternal age>=32 years (aOR 2.40, 95%CI 1.3 to 4.3) were independently associated with severe cases. Using the Kaplan-Meier method, the probability of continued pregnancy at 14 days after diagnosis for severe cases was 0.57 between 24 and 31 weeks' gestation and 0.27 between 32 and 36 weeks' gestation. The probability for non-severe cases was 1.0 between 24 and 31 weeks' gestation and 0.8 between 32 and 36 weeks' gestation. Among the patients with COVID-19 in the preterm period, preterm birth due to infection was significantly more common in severe than non-severe cases (48% vs 6%, p< 0.0001). CONCLUSION(S): Severe COVID-19 in pregnant women was associated with gestational age>=24 weeks and maternal age>=32. The rate of preterm delivery due to the infection was significantly higher in severe COVID-19 cases. Copyright © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

8.
J Obstet Gynaecol ; : 2153654, 2022.
Article in English | Web of Science | ID: covidwho-2186850

ABSTRACT

The Covid-19 pandemic brought substantial changes in clinical practice in Obstetrics and Gynaecology (O and G). Redeployment of staff and restrictions in elective services raised training concerns. We sought to assess the impact on subspecialty training, to identify issues to help mitigate the impact. We conducted cross-sectional anonymous electronic surveys of UK subspecialty trainees at three time points: June 2020, February 2021, September 2021. Surveys were analysed by descriptive statistics and thematic analysis of free-text responses. Response rates ranged from 30% to 40%, with higher response rates from urogynaecology trainees. Up to 72% reported an impact on training, most notable in gynaecological subspecialties, and particularly urogynaecology, which persisted over time. More than a third anticipated needing extra time to complete training. This raises serious future workforce and patient care concerns. Clinical recovery should consider training needs as essential when re-establishing services. Subspecialty trainees may need additional time to achieve competencies required of future consultants.IMPACT STATEMENTWhat is already known on the subject? Covid-19 led to dramatic changes in clinical practice in Obstetrics and Gynaecology. Previous studies on training in O and G during the pandemic in the UK and internationally highlighted issues from redeployment, trainee absence, and changes in service provision, that had potential to severely impact training.What do the results of this study add? Subspecialty training in Obstetrics and Gynaecology has been affected by the pandemic. Urogynaecology was worst affected and continues to be affected over the course of the pandemic.What are the implications of these findings for clinical practice and/or further research? Covid-19 recovery plans need to incorporate training requirements. Extended training due to the pandemic may affect consultant workforce numbers and thus service provision in tertiary care.

9.
The New England Journal of Medicine ; 388(3):278-279, 2023.
Article in English | ProQuest Central | ID: covidwho-2186493

ABSTRACT

Discovery of Ectopic Pregnancy after Attempted Self-Managed AbortionAn ectopic pregnancy found after an attempted self-managed abortion highlights the need for high suspicion for the condition in the context of medical abortion without confirmation of intrauterine pregnancy.

10.
American Journal of Obstetrics and Gynecology ; 228(1 Supplement):S561, 2023.
Article in English | EMBASE | ID: covidwho-2175895

ABSTRACT

Objective: The California Maternal Quality Care Collaborative (CMQCC) proposed an algorithm to reduce maternal mortality by screening for cardiac disease in pregnancy, including use of maternal heart rates. The effect of this guideline was assessed at an outpatient obstetrics office by studying rates of heart rate screening before and after implementation. Study Design: This study reviewed 100 return in-person prenatal visits monthly from January 2019 to November 2021. Maternal heart rate, demographics, and presence of chronic hypertension or cardiac disease were noted. Rates of heart rate collection were compared pre- and post-guideline implementation. Per the CMQCC guideline, a resting heart rate of >= 110 bpm was deemed high enough to warrant further evaluation. Result(s): This retrospective cohort included 3,478 visits (100 visits per month, fewer visits in April and May 2020 due to COVID19 pandemic). Several visits (n=382, 11%) were to patients with chronic hypertension and 159 (4.6%) had underlying cardiac disease. Overall, 1798 (51.7%) visits recorded a maternal heart rate, while 1680 (48.3%) did not. More visits had heart rates recorded post- than pre-guideline (67.6% versus 21.4% of visits, respectively;p < 0.001). Maternal heart rates >= 110 bpm were recorded at 130 visits (3.7%). Pre-guideline, 29.5% of patients with heart disease and/or chronic hypertension had heart rate recorded compared to 20.1% of patients without these conditions (p=0.005). Post-guideline, patients with heart disease and/or chronic hypertension were more likely to have heart rate recorded compared to those without these conditions (78.8% versus 65.8%, p < 0.001). Elevated heart rates >= 110 were recorded at 34 of 308 (11.0%) visits to patients with known hypertension and/or cardiac disease, compared to 96 out of 1490 (6.4%) to patients without these diagnoses (p=0.005). Conclusion(s): Maternal heart rate screening significantly increased after guideline implementation. Patients with underlying cardiac disease and/or chronic hypertension were nearly twice as likely to have a heart rate >= 110 bpm when heart rate was assessed. [Formula presented] [Formula presented] Copyright © 2022

11.
American Journal of Obstetrics and Gynecology ; 228(2 Supplement):S786-S787, 2023.
Article in English | EMBASE | ID: covidwho-2175876

ABSTRACT

Objective: Studies have shown that COVID-19 affects intrapartum management, resulting in higher rates of cesarean delivery. However, it is unknown if COVID-19 infection increases rates of medically indicated deliveries. The primary objective was to determine if there are differences in medical indications for delivery in COVID-19 positive patients. Study design: This is a prospective cohort study of patients admitted for delivery at an urban obstetrical unit from April-November 2020 where patients were tested for COVID-19 following admission. Baseline demographics, labor and delivery information, and outcomes were recorded, and composite maternal and neonatal outcomes were compared between COVID-19 positive and negative patients using Fisher's exact tests and a Poisson regression analysis to adjust for confounders. Result(s): 545 deliveries were included, with 56 (10.33%) COVID-19 positive and 486 (89.67%) negative patients. There were no differences in rate of medical indications for delivery. There was a higher rate of cesarean delivery in the COVID-19 positive group (46.43% versus 31.28%, p=.034), although there was no difference in indications for cesarean delivery. Additionally, for COVID-19 positive patients, there were higher rates of preterm births (p=.014) but no increase in preterm labor. There was an increase in composite adverse neonatal outcomes (p= <0.05), but not composite adverse maternal outcomes. Conclusion(s): Despite an increase in cesarean delivery, there was no difference in medical indications for delivery in COVID-19 patients. Although there was an increase in composite adverse neonatal outcomes, this may be attributed to an increase in admission of exposed newborns to the neonatal intensive care unit. Disclosure: No [Formula presented] Copyright © 2022

12.
BMC Pregnancy and Childbirth ; 22:1-7, 2022.
Article in English | ProQuest Central | ID: covidwho-2171259

ABSTRACT

Background Several common maternal or neonatal risk factors have been linked to meconium amniotic fluid (MAF) development;however, the results are contradictory, depending on the study. This study aimed to assess the prevalence and risk factors of MAF in singleton pregnancies. Methods This study is a retrospective cohort that assessed singleton pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas, Iran, between January 1st, 2020, and January 1st, 2022. Mothers were divided into two groups: 1) those diagnosed with meconium amniotic fluid (MAF) and 2) those diagnosed with clear amniotic fluid. Mothers with bloody amniotic fluid were excluded. Demographic factors, obstetrical factors, and maternal comorbidities were extracted from the electronic data of each mother. The Chi-square test was used to compare differences between the groups for categorical variables. Logistic regression models were used to assess meconium amniotic fluid risk factors. Results Of 8888 singleton deliveries during the study period, 1085 (12.2%) were MAF. MAF was more common in adolescents, mothers with postterm pregnancy, and primiparous mothers, and it was less common in mothers with GDM and overt diabetes. The odds of having MAF in adolescents were three times higher than those in mothers 20–34 years old (aOR: 3.07, 95% CI: 1.87–4.98). Likewise, there were significantly increased odds of MAF in mothers with late-term pregnancy (aOR: 5.12, 95% CI: 2.76–8.94), and mothers with post-term pregnancy (aOR: 7.09, 95% CI: 3.92–9.80). Primiparous women were also more likely than multiparous mothers to have MAF (aOR: 3.41, 95% CI: 2.11–4.99). Conclusions Adolescents, primiparous mothers, and mothers with post-term pregnancies had a higher risk of MAF. Maternal comorbidities resulting in early termination of pregnancy can reduce the incidence of MAF.

13.
Midwives ; 25:31-36, 2023.
Article in English | ProQuest Central | ID: covidwho-2167568

ABSTRACT

Members' needs drive the RCM's actions at every level, from local branches to the governing board, individual matters to strategic direction. There are a few RCM committees chaired by board members - for example, looking at audit and risk or the information services for members - and all of those also feed back into the board for oversight. Keelie Barrett MSW MEMBER OF THE RCM BOARD I was the first MSW member of the RCM board, elected in 2019 when MSWs became eligible. Because of this, I feel it's important for me to be a role model to show other MSWs what's possible and encourage them to put themselves forward too. Having been on a board of governors at a school I had an insight into that - but I wasn't aware of all the sub-committees board members get involved in, such as the Investment Committee that I currently chair, all of which feeds back into the whole board meetings every other month.

14.
BMJ : British Medical Journal (Online) ; 379, 2022.
Article in English | ProQuest Central | ID: covidwho-2161837

ABSTRACT

Having achieved a foothold in the community hospital she performed minor surgery, carried out x rays, and applied plaster casts. In January 2021 she became the first person in Monmouth to receive the covid vaccination, administered by Brian Harries in the surgery she set up, now a teaching practice, which includes a list of 5000 patients, three partners, and a nurse practitioner, plus attached midwives, health visitors, and counsellors In a video of the occasion, made for Monmouth County Council, she urged patients to get vaccinated, recalling her time as a medical student when she saw polio patients in iron lungs. Charlotte Jones (b 1927;q Royal Free Hospital Medical School, London, 1952;DObst RCOG), died from the frailty of old age on 27 October 2022

15.
Emergency Medicine Clinics of North America ; 2022.
Article in English | ScienceDirect | ID: covidwho-2158769
16.
Contemporary OB/GYN ; 67(12):8-9, 2022.
Article in English | CINAHL | ID: covidwho-2157111

ABSTRACT

The article addresses the issue of leadership in the post-COVID-19-pandemic climate. Topics discussed include differences in leadership styles before and after the pandemic, reasons why employees leave their jobs without another one to replace it, and the need for leaders to be decisive, communicate clearly, and leverage the crisis to create opportunities.

17.
Journal of Autoethnography ; 3(4):576-583, 2022.
Article in English | ProQuest Central | ID: covidwho-2154393

ABSTRACT

The mind of a woman in labor is unparalleled in both strength and vulnerability. In this personal essay, I recount how I harnessed my memories about my mother and grief over her recent passing to cope with the isolation and pain of my labor and delivery on June 2, 2020—what became known as Blackout Tuesday—during the COVID-19 pandemic. As a first-time mother, being dropped off at the hospital while in pre-labor and walking through the double doors alone triggered the memories of entering the intensive care unit at the hospital where my mother died—the last time I had been in a hospital. It was a reminder that some spaces have room only for one. With my memory as my companion and labor support until my husband and I were permitted to be reunited hours after both testing negative for the virus, I navigate the meaning and purpose of pain as I push closer to giving life. This essay emerged during my first year of motherhood, out of my grapple with giving life while healing from my mother’s death, to gradually unveil my long-sought proverbial bend in the road.

18.
Obstetric Medicine ; 15(4):233-237, 2022.
Article in English | ProQuest Central | ID: covidwho-2153265

ABSTRACT

The number of pregnant women being admitted with severe COVID-19 infection and dying has increased with each wave of the pandemic. These women often present unique challenges to the medical and obstetric teams given the changes in physiology that occur in pregnancy, affecting assessment and management, as well as the practical difficulties such as the ideal location of care. Whilst the basis of treatment remains the same, there are nuances to caring for pregnant women that need considerable thought and multidisciplinary collaboration. Obstetricians, neonatologists, midwives, intensivists, anaesthetists and physicians may all be involved at some point, depending on the gestation and severity of illness. Implementing a COVID-19 in pregnancy guideline or checklist for your hospital will help ensure pregnant women are managed in a safe and timely manner. Here described are some key recommendations to help in the management of pregnant women admitted with COVID-19.

19.
Obstetric Medicine ; 15(4):220-224, 2022.
Article in English | ProQuest Central | ID: covidwho-2153262

ABSTRACT

Although the pregnant population was affected by early waves of the COVID-19 pandemic, increasing transmission and severity due to new viral variants has resulted in an increased incidence of severe illness during pregnancy in many regions. Critical illness and respiratory failure are relatively uncommon occurrences during pregnancy, and there are limited high-quality data to direct management. This paper reviews the current literature on COVID-19 management as it relates to pregnancy, and provides an overview of critical care support in these patients. COVID-19 drug therapy is similar to that used in the non-pregnant patient, including anti-inflammatory therapy with steroids and IL-6 inhibitors, although safety data are limited for antiviral drugs such as remdesivir and monoclonal antibodies. As both pregnancy and COVID-19 are thrombogenic, thromboprophylaxis is essential. Endotracheal intubation is a higher risk during pregnancy, but mechanical ventilation should follow usual principles. ICU management should be directed at optimizing maternal well-being, which in turn will benefit the fetus.

20.
BMC Med Educ ; 22(1): 800, 2022 Nov 17.
Article in English | MEDLINE | ID: covidwho-2139259

ABSTRACT

OBJECTIVE: To explore the application effect of the clinical basic integration teaching mode constructed by case studies and the MOOC platform in obstetrics and gynecology internship teaching in the face of public health emergencies. METHODS: One hundred ten clinical medical students of grade 2020 were selected as the experimental group, and 110 clinical medical students of grade 2021 were selected as the control group. The experimental group adopted the online teaching mode combined with case studies and the MOOC platform, while the control group adopted the offline traditional probation teaching method. Comprehensive test and questionnaire were used to evaluate and compare the teaching effect of the two groups of students. RESULTS: The experimental group was found to be superior to the control group in the quality assessment of complete medical record writing and the ability assessment of diagnosis and analysis of typical obstetrics and gynecology cases (P < 0. 05). However, the score of professional knowledge was lower than that of the control group (P < 0. 05). The results of questionnaire survey showed that the satisfaction of the experimental group in stimulating learning interest, enhancing problem solving ability, enhancing communication and clinical thinking ability, enhancing team cooperation awareness and independent innovation ability was higher than that of the control group (P < 0.01). The satisfaction of teacher-student interaction was also better (P < 0.05). However, in terms of strengthening theoretical understanding, the satisfaction of the experimental group was lower than that of the control group, but with no significant difference (P > 0.05). CONCLUSION: During the epidemic period, we designed a new online teaching mode, which can be applied to the probation teaching of obstetrics and gynecology. In our study, compared with traditional offline teaching, the new online teaching mode could improve students' ability of case writing and case analysis. However, more teaching practice is needed to complete this online teaching mode.


Subject(s)
Education, Distance , Gynecology , Internship and Residency , Obstetrics , Students, Medical , Humans , Gynecology/education , Learning , Obstetrics/education
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