Splenosis and the gynecologic patient: a case report and review of literature.

A 23-year-old woman with pelvic pain and a preoperative assessment of endometriosis eventually diagnosed as splenosis is presented. Hysterectomy, removal of the ovaries and of the splenic pelvic mass resolved her complaint. The pelvic mass in this patient was clinically mistaken for endometriosis. Use of more specific diagnostic techniques can more clearly guide therapy.

Successful magnesium sulfate tocolysis: is "weaning" the drug necessary?

OBJECTIVE: Magnesium sulfate is the most commonly used tocolytic agent for preterm labor. A common clinical practice is to slowly discontinue the drug (wean) after successful tocolysis. Our objective was to determine the necessity of this practice. STUDY DESIGN: A prospective, randomized clinical trial was performed from June 1993 to July 1996. After successful magnesium sulfate tocolysis, patients with preterm labor were randomized to two groups: stopping the drug abruptly (no weaning) or gradually weaning the drug (approximately 1 gm every 4 hours). Preterm labor was defined as documented cervical change with regular uterine contractions or regular uterine contractions with a cervix of 2 cm and 75% effacement. The primary outcome variable was the necessity to reinstitute magnesium sulfate therapy within 24 hours of discontinuation of successful tocolysis. RESULTS: One hundred forty-one patients completed the study. No patient in the no-wean group required retocolysis within 24 hours of magnesium discontinuation. However, eight patients in the wean group required retocolysis within 24 hours of magnesium discontinuation (p = 0.01). Significantly more patients in the wean group had retocolysis during pregnancy (3 vs 12, p = 0.03). Patients in the wean group were also in the labor and delivery unit longer and, as would be anticipated, received magnesium sulfate significantly longer. No differences in the neonatal outcomes were noted between the two groups. Seventy-seven percent of the patients in the study were delivered prematurely. CONCLUSION: This study demonstrated an increased need for retocolysis in the group weaned from magnesium sulfate. We also found that patients in the wean group had an increased labor and delivery time and a longer administration time of magnesium sulfate. Thus weaning magnesium sulfate increases health care cost. The practice of weaning magnesium sulfate does not appear beneficial.

Predictors of Success on the NATABOC Certification Examination.

OBJECTIVE: To determine the degree to which a selected number of variables could predict success on the first attempt at the National Athletic Trainers' Association Board of Certification Examination. DESIGN AND SETTING: Data were obtained from the student records of subjects who were enrolled in the same undergraduate athletic training education program for a minimum of two years, maintained a minimum GPA of 2.5 on a 4.0 scale, and had taken the National Athletic Trainers' Association Board of Certification Examination. A telephone survey of the subjects was used to supplement these records. SUBJECTS: Fifty-two subjects (38 male, 14 female) who had been enrolled for a mean of seven semesters (+/-2.57) participated in this study. Subjects maintained a mean overall GPA of 3.27 (+/- 0.39), with an athletic training mean GPA of 3.34 (+/-0.43) and an academic minor mean GPA of 2.91 (+/-0.46). The mean ACT composite score was 18 (+/-4.02). MEASUREMENTS: Subjects sat for the National Athletic Trainers' Association Board of Certification Examination. Examination passing status, rather than subjects' scores on individual sections, was used in the analysis. RESULTS: Analysis using forward multiple linear regression indicated that no single independent variable predicted examination success. However, a strong interrelationship was present between several of the independent variables. Multiple discriminant analysis was used to determine the nature and strength of these interrelationships. A composite set of variables was formed to include overall academic GPA, athletic training GPA, academic minor GPA, ACT composite score, and number of semesters of university enrollment. This composite set explained 42% of the variance in predicting successful completion of the entire examination on the first attempt. The predictive power of the composite set greatly decreased after the first examination attempt. CONCLUSIONS: Academic variables are the strongest predictors of first-time success on the overall National Athletic Trainers' Association Board of Certification Examination and its component sections.

Successful tocolysis: does cervical change affect time to delivery?

Generally, it is preferable to tocolyze patients with idiopathic preterm labor (PTL). Little information is available about ultimate outcomes after successful tocolysis. Our objective is to evaluate the relationship between cervical change after the initiation of tocolysis and the delay in time to delivery in patients with preterm labor. A historical analysis of all patients with successful tocolysis after PTL between January 1992 and December 1993 was undertaken. The patients were then placed in one of three categories (regression, unchanged, or progression) based on cervical change after the initiation of tocolysis. Various demographic pregnancy characteristics and pregnancy outcome data were analyzed. One hundred and twenty-six patients had successful tocolysis and met the admission criteria. Patients who had cervical progression had shorter delay to delivery, delivered at an earlier gestational age (31.7 weeks compared to 34.0 and 34.1 weeks, respectively, p < 0.05), and were more likely to deliver before 35 weeks (88% compared to 50.0 and 55.0%, respectively, p < 0.05). Also, neonates remained in the hospital longer and were more likely to have respiratory distress syndrome when compared to the other two groups. Patients who had cervical progression after the initiation of tocolysis are more likely to deliver prematurely, had a shorter delay to delivery, and delivered lower birth weight infants than did patients whose cervix regressed or remained unchanged. In our population, patients who had successful tocolysis had a preterm delivery rate of 59.5% before the 35th week of gestation.

An educational intervention to increase use of the Glasgow Coma Scale by emergency department personnel.

Data from a large series of acutely injured patients revealed the Glasgow Coma Score was acquired in less than one half of those for whom it should have been documented. To improve these statistics, a five-part educational intervention based on an application of the PRECEDE-PROCEED model was developed. The study populations consisted of hospital-based nurse-managers and their emergency department nursing staff. Evaluation of the educational intervention's effectiveness suggested (1) simply conveying benefits of a particular patient care practice is insufficient to bring about immediate and permanent changes and (2) the most significant changes occurred in settings in which a formal policy and formal data collection procedures were established to accompany and reinforce the educational intervention. On-site advocacy and physician support are essential if changes in nursing practice are to occur in hospital emergency departments.

Management of traumatic injuries in the workplace.

Traumatic injuries in the workplace occur from a variety of mechanisms and may produce a wide range of injuries. Critical to the management of these injuries is the knowledge that life saving interventions for airway, breathing, and circulation must take priority. Controlling external bleeding and managing circulation is imperative in the traumatically injured worker. Inadequate control of hemorrhage leads to cellular shock from which the client may never recover. Extremities should be managed appropriate to the specific injury. Careful monitoring of neurovascular status is significant in limb preservation. Amputated parts must be meticulously cared for, with the vision of replantation in mind. Electrical burns are unique burn injuries, as the complete area of damage is not visible. Monitoring cardiac and respiratory function is essential to detect any life threatening abnormalities in all injuries, but is especially important in the electrically injured client. The occupational health nurse can make a significant difference in the outcome of a traumatically injured client in the workplace. Adequate knowledge of treatment modalities, as well as transfer to the most appropriate trauma care facility, can make the difference in obtaining the best possible outcome.

Labor in the gravida with 10 or more years between pregnancies.

It has been suggested that women who have had a pregnancy interval of 10 or more years would have prolonged labor in pregnancies after the first, as do primigravidas. In a series of 94 multiparas with 10 or more years between pregnancies and 63 age-matched, multiparous controls, there was no significant difference in the length of the latent phase of labor or of the first, second and third stages of active labor in the two groups. The concept of a "physiologic primigravida" in these cases should be abandoned.

Cephalic replacement in severe shoulder dystocia.

In cases of severe shoulder dystocia, the outcome may be improved if cephalic replacement is attempted earlier. Severe shoulder dystocia is usually unresponsive to the traditional measures. Although still controversial, this maneuver may prove to be life-saving in an undeliverable fetus.