Pregnancy outcomes after removal of osmotic dilators in patients who presented for second-trimester abortion.

OBJECTIVE: The objective was to report pregnancy outcomes and potentially related complications among 13 patients who had osmotic dilators placed for second-trimester dilation and evacuation (D&E) followed by subsequent removal with the intention to continue their pregnancies. STUDY DESIGN: We reviewed billing and scheduling data between 2005 and 2017 to identify the total number of women seen for D&E and to identify the individuals who had dilators placed without a subsequent scheduled dilation and evacuation. We then performed chart reviews to determine pregnancy outcomes. RESULTS: Between 2005 and 2017, we treated 2532 patients who presented for second-trimester abortions by D&E and received osmotic dilators for cervical preparation. Twenty (0.8%) of these women had cervical dilators removed with the intention of continuing their pregnancies. We could obtain outcome data for 13 of these pregnancies; one of these women ultimately elected to have an abortion. Eight of the remaining 12 women (66%) experienced complications which included premature preterm rupture of membranes, preterm delivery, maternal infection and hemorrhage. Six (50%) pregnancies ended in spontaneous abortion or fetal or neonatal death. CONCLUSION: Continuation of pregnancy after placement and removal of osmotic dilators may increase the risk of adverse pregnancy outcomes. IMPLICATIONS: Of the women who had outcome data available, 50% who had cervical dilators removed experienced spontaneous abortion or fetal or neonatal death. Conservatively assuming that all women lost to follow-up had healthy pregnancies, 30% of women experienced fetal or neonatal death and 40% had an adverse pregnancy outcome.

Association Between Appendectomy and Clostridium difficile Infection.

BACKGROUND: Recent theory proposes that the appendix functions as a reservoir for commensal bacteria, and serves to re-inoculate the colon with normal flora in the event of pathogen exposure or purging of intestinal flora. If true, we reasoned that flora from a normal appendix could provide protection against Clostridium difficile. We conducted this investigation to examine the protective effect of an intact appendix and test the hypothesis that prior appendectomy will be more common among patients with a positive test for C. difficile as compared with patients who test negative. METHODS: We contacted patients who had undergone C. difficile testing and asked them whether or not they had a prior appendectomy. Using their responses and results from Toxin A & B EIA tests, we calculated the difference in appendectomy rates between those who tested positive for C. difficile, and those who tested negative. We considered a positive 15% absolute difference to represent a significant increase in appendectomy rate. RESULTS: We enrolled 257 patients. Among the 136 who tested positive for C. difficile, 27 (19.9%) had prior appendectomies, while among 121 patients testing negative for C. difficile, 38 (31.4%) had prior appendectomies, yielding a difference in appendectomy rates of -11.6% (95% Confidence Interval: -21.6% to -0.9%). CONCLUSIONS: The rate of prior appendectomy was actually lower among patients with a positive C. difficile test as compared to those with a negative test. Conversely, patients who tested positive for C. difficile were more likely to have an intact appendix than those who tested negative. These results suggest that rather than being protective, an intact appendix appears to promote C. difficile acquisition, carriage, and disease. KEYWORDS: Clostridium difficile; Appendix; Appendectomy; Microbial reservoir; Infection.

Use of the Internet by print medical journals in 2003 to 2009: a longitudinal observational study.

STUDY OBJECTIVE: To determine how a sample of medical journals use the Internet to provide additional content and features to readers and how this has changed since 2003. METHODS: In 2005, we surveyed 2003 and 2005 issues of 138 high-impact print medical journals to determine to what extent they were using the Internet to provide online-only articles and supplementary content to print articles (sampled 28 journals), and electronic space for the postpublication critique of their articles (sampled all 138 journals). We used the same methodology to determine what kinds of Web-only supplementary material were provided with each print article in March 2007 and 2009 issues of the same 28 journals used for the 2003 to 2005 study. As before, we also determined which of the 138 journals offered rapid response pages and how those pages were being used. RESULTS: The proportion of the 28 journals providing Web-only supplementary material increased from 32% (2003) to 50% (2005) to 61% (2007) to 64% (2009), and the percentage of articles that contained supplementary material increased from 7% to 14% to 20% to 25%, respectively. We observed a marked increase in the number of video supplements. In contrast, journals offering online postpublication review decreased from 17 of 138 (12%) to 12 of 138 (9%) to 11 of 138 (8%) from 2005 to 2007 to 2009, and the percentage of articles with no responses was unchanged at 82%. CONCLUSION: The use of online-only articles and online-only supplements by print journals continues to increase. Postpublication critique of articles in online pages provided by the journal does not seem to be taking hold.

A systematic approach of tracking and reporting medication errors at a tertiary care university hospital, Karachi, Pakistan.

INTRODUCTION: Administering medication is one of the high risk areas for any health professional. It is a multidisciplinary process, which begins with the doctor's prescription, followed by review and provision by a pharmacist, and ends with preparation and administration by a nurse. Several studies have highlighted a high medication incident rate at several healthcare institutions. METHODS: Our study design was exploratory and evaluative and used methodological triangulation. Sample size was of two types. First, a convenient sample of 1000 medication dosages to estimate the medication error (95% CI). We took another sample from subjects involved in medication usage processes such as physicians, nurses, pharmacists, and patients. Two sets of instruments were designed via extensive literature review: a medication tracking error form and a focus group interview questionnaire. RESULTS: Our study findings revealed 100% compliance with a computerized physician order entry (CPOE) system by physicians, nurses, and pharmacists. The main error rate was 5.5% and pharmacists contributed an higher error rate of 2.6% followed by nurses (1.1%) and physicians (1%). Major areas for improvement in error rates were identified: delay in medication delivery, lab results reviewed electronically before prescription, dispension, and administration.

Registered nurses perception of work satisfaction at a Tertiary Care University Hospital.

Hospitals are facing serious challenges to provide high quality care with current nursing shortages. Nursing shortages are of major concern for Nursing Management, clinicians and administrators as they lead to impact on quality of care. Under-stressed, frustrated and demoralized nurses give rise to concern for hospital Nursing Management in providing quality care according to set standards. A descriptive qualitative research design was used to explore the registered nurses' perceptions regarding the high turnover rates among nurses at a Tertiary Care University Hospital. Data was collected from nurses working at various speciality areas, which were: Critical Care, Medical and Surgical Care, Ambulatory Care, Maternal/Child and Emergency departments. A convenience sample of 45 registered nurses from nine subspecialty groups was selected for a focus group interview and five focus groups were selected for a study population. Findings of exit interviews (from 1 September 2001 to 28 February 2002) were also included in the data analysis. These exit interviews of RNs were conducted by Nurse Recruiter at the time of their resignations. The data analysis showed that the most dissatisfying factors at work and within the work setting were identified as: high workload, stress associated with high workload, biased Nursing Management, lack of appreciation and monetary incentives, finally a rigid attitude of Nursing Management. However, the most satisfying factors were: working with an internationally reputable organization, patients' positive feedback and availability of required material or equipment. The study participants recommended that nursing retention could be improved at the Tertiary Care University Hospital by launching the following strategies by Nursing Management: reducing workload by adequate nurse-patient ratios according to international standards, promoting respect of nurses in front of patients and other staff, rewards and recognition of nurses, simplifying nursing documentation, increasing recreational activities for nurses and empowering nurses and Nursing Management group.