ABSTRACT
This article describes the design, implementation, and evaluation of an interdisciplinary clinical pathway system for maternal newborn care in a perinatal regional referral institution. Core issues in the design of this system are addressed to promote outcomes management and ongoing performance improvement. A discussion of the implementation follows, illustrating the lessons learned, changes made, and associated evaluation. This clinical pathway system has improved communication and collaboration among all disciplines, enhanced the discharge coordination process, and established protocols available to all members of the health care team.
Subject(s)
Critical Pathways/organization & administration , Documentation , Maternal Health Services/organization & administration , Medical Records , Neonatal Nursing/organization & administration , Outcome and Process Assessment, Health Care/organization & administration , Adult , Benchmarking , Evidence-Based Medicine , Female , Humans , Infant, Newborn , Patient Discharge , Practice Guidelines as Topic , Pregnancy , Program Development/methods , Program Evaluation , Total Quality Management/organization & administrationABSTRACT
A 23-year-old woman was diagnosed with a 5-cm interstitial pregnancy by transvaginal ultrasound. In addition, she was positive for the human immunodeficiency virus. She underwent laparoscopic cornual excision of the ectopic gestation and was discharged home the next day.
Subject(s)
Laparoscopy , Pregnancy, Ectopic/surgery , Adult , Female , Humans , Male , Pregnancy , Pregnancy, Ectopic/diagnostic imaging , Ultrasonography, PrenatalABSTRACT
We report the case of a 77-year-old white female with adenoid cystic carcinoma of Bartholin's gland. To date only 45 cases of adenoid cystic carcinoma of Bartholin's gland have been reported in the world literature. The longest reported survival is 27 years. This patient was originally diagnosed 33 years ago and presented with her fourth recurrence. She was treated with radical surgery and did well for 6 months, but later died secondary to renal failure. Adenoid cystic carcinoma of the Bartholin's gland is a rare tumor of the vulva. When diagnosed the treatment should be tailored to the patient. When margins are found to be positive, adjuvant radiotherapy may prove to be beneficial.
Subject(s)
Bartholin's Glands , Carcinoma, Adenoid Cystic/surgery , Vulvar Neoplasms/surgery , Aged , Carcinoma, Adenoid Cystic/pathology , Female , Humans , Neoplasm Recurrence, Local , Vulvar Neoplasms/pathologyABSTRACT
In search of further "first line" alternatives for reducing premature uterine irritability and contractions, oral nifedipine, a type II dihydropyridine calcium channel blocking agent, was selected for a prospective randomized comparison trial with an established subcutaneous terbutaline protocol. Patients without primary exclusion criteria for tocolysis, with gestational ages between 20 and 35 weeks, were eligible for the study. In this report, data from 52 patients have been collated and have undergone appropriate tests of significance (28 patients receiving nifedipine and 24 patients receiving terbutaline). Both agents were found to be highly effective for tocolysis, with a success rate of 68% for nifedipine and 71% for terbutaline. Although not statistically significant, a tendency toward a decrease in side effects was noted with nifedipine when compared with terbutaline. No deleterious maternal or fetal side effects were reported. Based on these data, nifedipine, given as a one time, 30 mg oral dose, proved to be as effective as the subcutaneous terbutaline injection protocol.
Subject(s)
Nifedipine/administration & dosage , Terbutaline/administration & dosage , Tocolysis , Administration, Oral , Adult , Female , Humans , Infant, Newborn , Injections, Subcutaneous , Nifedipine/adverse effects , Nifedipine/therapeutic use , Obstetric Labor, Premature/epidemiology , Obstetric Labor, Premature/prevention & control , Pregnancy , Prospective Studies , Terbutaline/adverse effects , Terbutaline/therapeutic useABSTRACT
Ureter injury is more common with abdominal hysterectomy than vaginal hysterectomy. Complications during laparoscopy-assisted vaginal hysterectomy cases have not been thoroughly studied. Two cases are presented that highlight urologic misadventures, specifically, ureteral injury, with the endoscopic linear stapler during laparoscopy-assisted vaginal hysterectomy.
