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Sample records for dutch obstetric system

  1. [The first Dutch debate on anaesthesia in obstetrics].

    PubMed

    Bijker, Liselotte E

    2015-01-01

    After the publication of the Dutch medical guideline on pharmacological analgesia during childbirth in 2008, the question of whether pharmacological pain relief should be permissible during labour was hotly debated. This discussion has been going on since the second half of the 19th century when the introduction of ether and chloroform was extensively studied and described in Great Britain. This article looks back on the same debate in the Netherlands when inhalational anaesthetics were introduced into obstetrics. Study of historical journals and textbooks, originating in the Netherlands and elsewhere, and of historical medical literature on anaesthesia and obstetrics shows that the Dutch protagonists adopted more nuanced ideas on this issue than many of their foreign colleagues. This description of the first Dutch debate on anaesthesia in obstetrics shows that in fact the issues and arguments are timeless. PMID:25827148

  2. Obstetrical data management systems.

    PubMed

    1997-03-01

    Obstetrical data management systems (OBDMSs) are computer systems designed to interface with fetal and maternal monitors. This allows monitoring and charting records to be created and maintained electronically and to be viewed from centralized workstations. In theory, these systems could eliminate paper record keeping from the obstetrics department altogether, although currently at least some paper documentation, such as fetal monitoring strips, is being kept. We evaluated five OBDMSs, one of which is no longer on the market and which we did not rate. Of the remaining systems, three were rated Acceptable; the fourth was rated Acceptable-Not Recommended because it lacks several important features and functions. This Evaluation also includes a Technology Overview, in which we discuss how OBDMSs function. The Overview incorporates a supplementary article, "Obstetrical Care Monitoring and Documentation," describing the monitoring and documentation typically performed during a pregnancy. And in the Selection and Use Guide, we discuss issues involved in choosing, purchasing, and implementing an OBDMS. PMID:9067726

  3. Relevant Obstetric Factors for Cerebral Palsy: From the Nationwide Obstetric Compensation System in Japan

    PubMed Central

    Hasegawa, Junichi; Toyokawa, Satoshi; Ikenoue, Tsuyomu; Asano, Yuri; Satoh, Shoji; Ikeda, Tomoaki; Ichizuka, Kiyotake; Tamiya, Nanako; Nakai, Akihito; Fujimori, Keiya; Maeda, Tsugio; Masuzaki, Hideaki; Suzuki, Hideaki; Ueda, Shigeru

    2016-01-01

    Objective The aim of this study was to identify the relevant obstetric factors for cerebral palsy (CP) after 33 weeks’ gestation in Japan. Study design This retrospective case cohort study (1:100 cases and controls) used a Japanese national CP registry. Obstetric characteristics and clinical course were compared between CP cases in the Japan Obstetric Compensation System for Cerebral Palsy database and controls in the perinatal database of the Japan Society of Obstetrics and Gynecology born as live singleton infants between 2009 and 2011 with a birth weight ≥ 2,000 g and gestation ≥ 33 weeks. Results One hundred and seventy-five CP cases and 17,475 controls were assessed. Major relevant single factors for CP were placental abnormalities (31%), umbilical cord abnormalities (15%), maternal complications (10%), and neonatal complications (1%). A multivariate regression model demonstrated that obstetric variables associated with CP were acute delivery due to non-reassuring fetal status (relative risk [RR]: 37.182, 95% confidence interval [CI]: 20.028–69.032), uterine rupture (RR: 24.770, 95% CI: 6.006–102.160), placental abruption (RR: 20.891, 95% CI: 11.817–36.934), and preterm labor (RR: 3.153, 95% CI: 2.024–4.911), whereas protective factors were head presentation (RR: 0.199, 95% CI: 0.088–0.450) and elective cesarean section (RR: 0.236, 95% CI: 0.067–0.828). Conclusion CP after 33 weeks’ gestation in the recently reported cases in Japan was strongly associated with acute delivery due to non-reassuring fetal status, uterine rupture, and placental abruption. PMID:26821386

  4. Integrated System for Monitoring and Prevention in Obstetrics-Gynaecology.

    PubMed

    Robu, Andreea; Gauca, Bianca; Crisan-Vida, Mihaela; Stoicu-Tivadar, Lăcrămioara

    2016-01-01

    A better monitoring of pregnant women, mainly during the third trimester of pregnancy and an easy communication between physician and patients are very important for the prevention and good health of baby and mother. The paper presents an integrated system as support for the Obstetrics - Gynaecology domain consisting in two modules: a mobile application, ObGynCare, dedicated to the pregnant women and a new component of the Obstetrics-Gynaecology Department Information System dedicated to the physicians for a better monitoring of the pregnant women. The mobile application informs the pregnant women about their status, permits them to introduce glycaemia and weight values and has as option pulse and blood pressure acquisition from a smart sensor and provides results in a graphic format. It also provides support for easy patient-doctor communication related to any health problems. ObGyn Care offers nutrition recommendations and gives the pregnant women the possibility to enter a social space of common interests using social networks (Facebook) to exchange useful and practical information. Data collected from patients and from sensor are stored on the cloud and the physician may access the information and analyse it. The extended module of the Obstetrics-Gynaecology Department Information System already developed supports the physicians to visualize weekly, monthly, or on a trimester, the patient data and to discuss with her through the chat module. The mobile application is in test by pregnant women and medical personnel. PMID:27071866

  5. Haemorrhagia post partum; an implementation study on the evidence-based guideline of the Dutch Society of Obstetrics and Gynaecology (NVOG) and the MOET (Managing Obstetric Emergencies and Trauma-course) instructions; the Fluxim study

    PubMed Central

    2010-01-01

    Background One of the most important causes of maternal mortality and severe morbidity worldwide is post partum haemorrhage (PPH). Factors as substandard care are frequently reported in the international literature and there are similar reports in the Netherlands. The incidence of PPH in the Dutch population is 5% containing 10.000 women a year. The introduction of an evidence-based guideline on PPH by the Dutch society of Obstetrics and Gynaecology (NVOG) and the initiation of the MOET course (Managing Obstetrics Emergencies and Trauma) did not lead to a reduction of PPH. This implies the possibility of an incomplete implementation of both the NVOG guideline and MOET-instructions. Therefore, the aim of this study is to develop and test a tailored strategy to implement both the NVOG guideline and MOET-instructions Methods/Design One step in the development procedure is to evaluate the implementation of the guideline and MOET-instructions in the current care. Therefore measurement of the actual care will be performed in a representative sample of 20 hospitals. This will be done by prospective observation of the third stage of labour of 320 women with a high risk of PPH using quality indicators extracted from the NVOG guideline and MOET instructions. In the next step barriers and facilitators for guideline adherence will be analyzed by performance of semi structured interviews with 30 professionals and 10 patients, followed by a questionnaire study among all Dutch gynaecologists and midwives to quantify the barriers mentioned. Based on the outcomes, a tailored strategy to implement the NVOG guideline and MOET-instructions will be developed and tested in a feasibility study in 4 hospitals, including effect-, process- and cost evaluation. Discussion This study will provide insight into current Dutch practice, in particular to what extent the PPH guidelines of the NVOG and the MOET-instructions have been implemented in the actual care, and into the barriers and

  6. Perceived Health System Causes of Obstetric Fistula from Accounts of Affected Women in Rural Tanzania: A Qualitative Study.

    PubMed

    Mselle, Lilian T; Kohi, Thecla W

    2015-03-01

    Obstetric fistula is still a major problem in low income countries. While its main cause is untreated obstructed labour, misconceptions about it still persist. This study aimed at exploring and describing perceived health system causes of obstetric fistula from women affected by it in rural Tanzania. This exploratory qualitative study included twenty-eight women affected by obstetric fistula. Semi structured interviews and focus group discussions were held and thematic analysis used to analyse perceived health system causes of obstetric fistula from women's account. Perceived health system causes of obstetric fistula fundamentally reflected the poor quality of obstetric care women received at health care facilities relating to staff unaccountability, late referral, and torture by nurses. The women's perception emphasizes the importance of improving the quality of obstetric care provided by health care providers in health care facilities. PMID:26103702

  7. Applying the generic errors modeling system to obstetric hemorrhage quality improvement efforts.

    PubMed

    Bingham, Debra

    2012-01-01

    Obstetric hemorrhage is an emergency situation in which clinicians can make errors that cause women to suffer preventable maternal morbidity and mortality. Scrutinizing commonly occurring obstetric hemorrhage-related practice errors by applying the generic errors modeling system, a research-based framework, to quality improvement efforts facilitates the identification of error specific reduction strategies. The common types of errors are skill-based, rule-based, and knowledge-based active and latent errors. PMID:22548710

  8. Primary care obstetrics and perinatal health in The Netherlands.

    PubMed

    Hingstman, L

    1994-01-01

    The Netherlands is the only industrialized country in which a large percentage of obstetric care takes place at home. Almost 31% of all deliveries are home confinements under supervision of a midwife or a general practitioner, and 84% of all postnatal care is given at home by maternity care assistants. To gain a better understanding of this unique situation, the structure of Dutch obstetric care is examined with special attention to the four pillars on which the system rests: the special protected position of the midwife, a generally accepted screening system for high-risk pregnancies, a well-organized maternity home care system, and the sociocultural environment in The Netherlands in which pregnancy and childbirth are considered normal physiological processes. Description of the obstetric system shows a degree of competition between the obstetricians, midwives, and general practitioners, in which the general practitioner has lost a considerable part of the "obstetric market." PMID:7830147

  9. Productivity and quality of Dutch hospitals during system reform.

    PubMed

    van Ineveld, Martin; van Oostrum, Jeroen; Vermeulen, Rob; Steenhoek, Adri; van de Klundert, Joris

    2016-09-01

    This study addresses the productivity of Dutch hospitals since the start of the health systems reform in 2005. We consider DEA based measures, which include efficiency and quality for the complete set of Dutch hospitals and present cross-sectional and longitudinal analysis. In particular, we consider how hospital efficiency has developed. As the reform created an environment of regulated competition, we pay special attention to relative efficiency. Our results suggest that the differences in efficiency among hospitals have become larger. In the years 2009-2010, the number of hospitals identified as (close to) efficient by DEA analysis decreased. PMID:25774011

  10. Obstetric antiphospholipid syndrome.

    PubMed

    Esteve-Valverde, E; Ferrer-Oliveras, R; Alijotas-Reig, J

    2016-04-01

    Obstetric antiphospholipid syndrome is an acquired autoimmune disorder that is associated with various obstetric complications and, in the absence of prior history of thrombosis, with the presence of antiphospholipid antibodies directed against other phospholipids, proteins called cofactors or PL-cofactor complexes. Although the obstetric complications have been related to the procoagulant properties of antiphospholipid antibodies, pathological studies of human placenta have shown the proinflammatory capacity of antiphospholipid antibodies via the complement system and proinflammatory cytokines. There is no general agreement on which antiphospholipid antibodies profile (laboratory) confers the greatest obstetric risk, but the best candidates are categories I and IIa. Combined treatment with low doses of aspirin and heparin achieves good obstetric and maternal outcomes. In this study, we also review the therapeutic possibilities in refractory cases, although the likelihood of progressing to other autoimmune diseases is low. We briefly comment on incomplete obstetric antiphospholipid syndrome, also known as antiphospholipid antibody-mediated pregnancy morbidity syndrome. PMID:26603476

  11. A change of direction in the Dutch health care system?

    PubMed

    Lapré, R M

    1988-08-01

    The Dutch health care system seems to be undergoing a clear change of direction. The publication of the Report of the Committee of the Structure and Financing of the Health Care System is a prominent document which marks the emergence of a new trend. After an analysis of the characteristics of the Dutch health care system in the periods 1960-1975 and 1975-1985, an account is given of the most important proposals of the committee. The proposals clearly alter the trend towards more governmental involvement. They envisage a more market-oriented approach and freedom of operation while at the same time paying attention to aspects such as solidarity and social justice. The Committee's suggestions include the introduction of a basic insurance scheme for every citizen with a coverage determined by law, and in addition a voluntary supplementary insurance scheme in which the insured can decide what coverage he requires and that the insurer is obliged to accept him. The fact that there is a certain amount of agreement, at least over the direction that the strategy for change should take, justifies the expectation that many of the committee's proposals will be implemented. PMID:10288395

  12. Rationing and competition in the Dutch health-care system.

    PubMed

    Schut, Frederik T; Van de Ven, Wynand P M M

    2005-09-01

    In this paper we examine the goals and effects of health-care policy in the Netherlands over the period 1980--2000. During this period Dutch health-care policy is marked by a peculiar combination of increasingly stringent cost-containment policies alongside a persistent pursuit of market-oriented reforms. The main goal of cost containment was to keep labour costs down under the restriction of universal equal access to health care. Supply and price control policies were quite successful in achieving cost containment, but in due course prolonged quantity rationing began to jeopardise universal physical access to health services. The main goal of market-oriented health-care reforms is to increase the system's efficiency and its responsiveness to patient's needs, while maintaining equal access. The feasibility of the reforms crucially hinges on the realisation of adequate methods of risk adjustment, product classification and quality measurement, an appropriate consumer information system and an effective competition policy. Realising these preconditions requires a lengthy and cautious implementation process. Although considerable progress has been made in setting the appropriate stage for regulated competition in Dutch health care, the role of the market is still limited. PMID:16161190

  13. The development of an obstetric tele-monitoring system.

    PubMed

    Vermeulen-Giovagnoli, B; Peters, C; van der Hout-van der Jagt, M B; Mischi, M; van Pul, C; Cottaar, E J E; Oei, S G

    2015-01-01

    Fetal growth restriction and preterm uterine contractions can turn a normal pregnancy into a problematic one. In previous work, we have developed a system for electrophysiological measurement of fetal heart rate (fHR), fetal electrocardiogram (fECG) and (premature) uterine contractions to enable early detection of foetal problems. In this work we have expanded this system into a tele-monitoring system for measurement at home. In order to permit home monitoring, the communication chain of the data has to be designed such that home-measured signals (fHR, fECG, uterine activities) are available in the hospital in real-time. Furthermore, the data must be transferred wirelessly to any location (worldwide) for interpretation by gynaecologists. A web application helps the gynaecologist or midwife to access the signals everywhere, provided that internet access is available. We developed a webserver as the heart of the entire system; it manages the patient database, transforms the signals in a graphical representation similar to that of the cardiotocography and manages the data communication with the proper data security policy. This tele-monitoring system can be used also during home deliveries enabling prompt transfer and proper intervention in the hospital when complications occur. PMID:26736229

  14. Cost effectiveness in obstetrics and gynecology: The levonorgestrel intrauterine system.

    PubMed

    Mattson, Lisa

    2012-03-01

    Use of evidence-based practices that are both cost-effective and acceptable to patients is now a focus in health care. Considerable cost savings can be realized by reducing unintended pregnancies and improving control of menstrual-related morbidity. The levonorgestrel intrauterine system (LNG-IUS), often referred to by its brand name Mirena, has been approved by the Food and Drug Administration both for contraception and fortreating abnormal uterine bleeding. The device has been available in the United States since 2000 and has been used in Europe since 1990. Despite the fact that several evidence-based guidelines include use of the LNG-IUS, it remains underutilized in this country. This article reviews the benefits of the LNG-IUS as they pertain to women's health and to the cost of health care. PMID:22611822

  15. Urban Climate Map System for Dutch spatial planning

    NASA Astrophysics Data System (ADS)

    Ren, Chao; Spit, Tejo; Lenzholzer, Sanda; Yim, Hung Lam Steve; Heusinkveld, Bert; van Hove, Bert; Chen, Liang; Kupski, Sebastian; Burghardt, René; Katzschner, Lutz

    2012-08-01

    Facing climate change and global warming, outdoor climatic environment is an important consideration factor for planners and policy makers because improving it can greatly contribute to achieve citizen's thermal comfort and create a better urban living quality for adaptation. Thus, the climatic information must be assessed systematically and applied strategically into the planning process. This paper presents a tool named Urban Climate Map System (UCMS) that has proven capable of helping compact cities to incorporate climate effects in planning processes in a systematic way. UCMS is developed and presented in a Geographic Information System (GIS) platform in which the lessons learned and experience gained from interdisciplinary studies can be included. The methodology of UCMS of compact cities, the construction procedure, and the basic input factors - including the natural climate resources and planning data - are described. Some literatures that shed light on the applicability of UMCS are reported. The Municipality of Arnhem is one of Dutch compact urban areas and still under fast urban development and urban renewal. There is an urgent need for local planners and policy makers to protect local climate and open landscape resources and make climate change adaptation in urban construction. Thus, Arnhem is chosen to carry out a case study of UCMS. Although it is the first work of Urban Climatic Mapping in The Netherlands, it serves as a useful climatic information platform to local planners and policy makers for their daily on-going works. We attempt to use a quick method to collect available climatic and planning data and create an information platform for planning use. It relies mostly on literature and theoretical understanding that has been well practiced elsewhere. The effort here is to synergize the established understanding for a case at hand and demonstrate how useful guidance can still be made for planners and policy makers.

  16. Workplace System Factors of Obstetric Nurses in Northeastern Ontario, Canada: Using a Work Disability Prevention Approach

    PubMed Central

    Nowrouzi, Behdin; Lightfoot, Nancy; Carter, Lorraine; Larivère, Michel; Rukholm, Ellen; Belanger-Gardner, Diane

    2015-01-01

    Background The purpose of this study was to examine the relationship nursing personal and workplace system factors (work disability) and work ability index scores in Ontario, Canada. Methods A total of 111 registered nurses were randomly selected from the total number of registered nurses on staff in the labor, delivery, recovery, and postpartum areas of four northeastern Ontario hospitals. Using a stratified random design approach, 51 participants were randomly selected in four northeastern Ontario cities. Results A total of 51 (45.9% response rate) online questionnaires were returned and another 60 (54.1% response rate) were completed using the paper format. The obstetric workforce in northeastern Ontario was predominately female (94.6%) with a mean age of 41.9 (standard deviation = 10.2). In the personal systems model, three variables: marital status (p = 0.025), respondent ethnicity (p = 0.026), and mean number of patients per shift (p = 0.049) were significantly contributed to the variance in work ability scores. In the workplace system model, job and career satisfaction (p = 0.026) had a positive influence on work ability scores, while work absenteeism (p = 0.023) demonstrated an inverse relationship with work ability scores. In the combined model, all the predictors were significantly related to work ability scores. Conclusion Work ability is closely related to job and career satisfaction, and perceived control at work among obstetric nursing. In order to improve work ability, nurses need to work in environments that support them and allow them to be engaged in the decision-making processes. PMID:26929842

  17. Obstetrical Forceps

    NASA Technical Reports Server (NTRS)

    2004-01-01

    Marshall inventors Seth Lawson and Stanley Smeltzer display a pair of obstetrical forceps they designed. The forceps, made from composite space-age materials, measure the force applied during instrument-assisted delivery. The new forceps will help medical students get a feel for instrument-assisted deliveries before entering practice.

  18. MITIS: a WWW-based medical system for managing and processing gynecological-obstetrical-radiological data.

    PubMed

    Matsopoulos, George K; Kouloulias, Vassilis; Asvestas, Pantelis; Mouravliansky, Nikolaos; Delibasis, Kostantinos; Demetriades, Damianos

    2004-10-01

    In this paper a World Wide Web (WWW)-based medical system, called MITIS, is designed and developed for the management and processing of obstetrical, gynecological and radiological medical data. The system records all the necessary medical information in terms of patient data, examinations, and operations and provides the user-expert with advanced image processing tools for the manipulation, processing and storage of ultrasound and mammographic images. The system can be installed in a hospital's Local Area Network (LAN) where it can access picture archival and communication systems (PACS) servers (if available), or any other server within the radiology department, for image archiving and retrieval, based on the digital imaging and communication in medicine (DICOM) 3.0 protocol, over TCP/IP and also it is accessible to external physicians via the hospital's Internet connection. MITIS is composed as a set of independent WWW modules (ISAPI server extension dlls) and a Win32 application (COM+ server) for mammography image processing and evaluation. PMID:15313542

  19. Acquiring a New Second Language Contrast: An Analysis of the English Laryngeal System of Native Speakers of Dutch

    ERIC Educational Resources Information Center

    Simon, Ellen

    2009-01-01

    This study examines the acquisition of the English laryngeal system by native speakers of (Belgian) Dutch. Both languages have a two-way laryngeal system, but while Dutch contrasts prevoiced with short-lag stops, English has a contrast between short-lag and long-lag stops. The primary aim of the article is to test two hypotheses on the acquisition…

  20. Benefits and Costs of Privatized Public Services: Lessons from the Dutch Educational System.

    ERIC Educational Resources Information Center

    James, Estelle

    1984-01-01

    Examines the possibility of "privitizing" education (a government policy, such as a voucher or tax credit system, which combines public financing with private production of the service). Describes the Dutch system of publicly funded private education. Suggests that private organizations and local governments find themselves competing to provide…

  1. Moving Forward? Addressing the Needs of Young At-Risk Students in the Dutch Education System

    ERIC Educational Resources Information Center

    van der Aalsvoort, Geerdina M.

    2007-01-01

    Inclusive education in the Dutch education system has achieved new meaning in the last decade or so. Until 1998, the Netherlands recognized 19 types of special education. Then, two Educational Acts were passed, in 1998 and 2003, that decreased the types of special education by including measures to enhance inclusion of students with special…

  2. Pre-Conditions, Benefits and Costs of Privatized Public Services: Lessons from the Dutch Educational System.

    ERIC Educational Resources Information Center

    James, Estelle

    The system in the Netherlands of "privatization," a government policy of financially supporting private schools and encouraging people to use them, depends on conditions in Dutch society that are conducive to a large nongovernment, nonprofit sector. These include cultural heterogeneity, coupled with the lack of a single dominant culture and class…

  3. Utility of the PASS Theory and Cognitive Assessment System for Dutch Children with and without ADHD

    ERIC Educational Resources Information Center

    Van Luit, Johannes E. H.; Kroesbergen, Evelyn H.; Naglieri, Jack A.

    2005-01-01

    This study examined the utility of the Planning, Attention, Simultaneous, Successive (PASS) theory of intelligence as measured by the "Cognitive Assessment System" (CAS) for evaluation of children with attention-deficit/hyperactivity disorder (ADHD). The CAS scores of 51 Dutch children without ADHD were compared to the scores of a group of 20…

  4. Assessment of the Volunteered Geographic Information Feedback System for the Dutch Topographical Key Register

    NASA Astrophysics Data System (ADS)

    Grus, M.; te Winkel, D.

    2015-08-01

    Since Topographical Key Register has become an open data the amount of users increased enormously. The highest grow was in the private users group. The increasing number of users and their growing demand for high actuality of the topographic data sets motivates the Dutch Kadaster to innovate and improve the Topographical Key Register (BRT). One of the initiatives was to provide a voluntary geographical information project aiming at providing a user-friendly feedback system adjusted to all kinds of user groups. The feedback system is a compulsory element of the Topographical Key Register in the Netherlands. The Dutch Kadaster is obliged to deliver a feedback system and the key-users are obliged to use it. The aim of the feedback system is to improve the quality and stimulate the usage of the data. The results of the pilot shows that the user-friendly and open to everyone feedback system contributes enormously to improve the quality of the topographic dataset.

  5. What's Missing in Dutch?

    ERIC Educational Resources Information Center

    Weverink, Meike

    An often-noted contrast between child and adult language is that young children produce sentences both with and without lexical subjects even if subjects are obligatory in the adult system. However, in Dutch, there is no such structural difference between the earliest stages of Dutch child grammar and the adult stage where subjects are concerned.…

  6. Characterization of Dutch dairy farms using sensor systems for cow management.

    PubMed

    Steeneveld, W; Hogeveen, H

    2015-01-01

    To improve cow management in large dairy herds, sensors have been developed that can measure physiological, behavioral, and production indicators on individual cows. Recently, the number of dairy farms using sensor systems has increased. It is not known, however, to what extent sensor systems are used on dairy farms, and the reasons why farmers invest or not in sensor systems are unclear. The first objective of this study was to give an overview of the sensor systems currently used in the Netherlands. The second objective was to investigate the reasons for investing or not investing in sensor systems. The third objective was to characterize farms with and without sensor systems. A survey was developed to investigate first, the reasons for investing or not in sensor systems and, then, how the sensor systems are used in daily cow management. The survey was sent to 1,672 Dutch dairy farmers. The final data set consisted of 512 dairy farms (response rate of 30.6%); 202 farms indicated that they had sensor systems and 310 farms indicated that they did not have sensor systems. A wide variety of sensor systems was used on Dutch dairy farms; those for mastitis detection and estrus detection were the most-used sensor systems. The use of sensor systems was different for farms using an automatic milking system (AMS) and a conventional milking system (CMS). Reasons for investing were different for different sensor systems. For sensor systems attached to the AMS, the farmers made no conscious decision to invest: they answered that the sensors were standard in the AMS or were bought for reduced cost with the AMS. The main reasons for investing in estrus detection sensor systems were improving detection rates, gaining insights into the fertility level of the herd, improving profitability of the farm, and reducing labor. Main reasons for not investing in sensor systems were economically related. It was very difficult to characterize farms with and without sensor systems. Farms

  7. Double Dutch: A Tool for Designing Combinatorial Libraries of Biological Systems.

    PubMed

    Roehner, Nicholas; Young, Eric M; Voigt, Christopher A; Gordon, D Benjamin; Densmore, Douglas

    2016-06-17

    Recently, semirational approaches that rely on combinatorial assembly of characterized DNA components have been used to engineer biosynthetic pathways. In practice, however, it is not practical to assemble and test millions of pathway variants in order to elucidate how different DNA components affect the behavior of a pathway. To address this challenge, we apply a rigorous mathematical approach known as design of experiments (DOE) that can be used to construct empirical models of system behavior without testing all variants. To support this approach, we have developed a tool named Double Dutch, which uses a formal grammar and heuristic algorithms to automate the process of DOE library design. Compared to designing by hand, Double Dutch enables users to more efficiently and scalably design libraries of pathway variants that can be used in a DOE framework and uniquely provides a means to flexibly balance design considerations of statistical analysis, construction cost, and risk of homologous recombination, thereby demonstrating the utility of automating decision making when faced with complex design trade-offs. PMID:27110633

  8. [A proposal for introduction of Europeristat-compatible information system aiming a unified quality control of obstetrical and perinatological care in Hungary].

    PubMed

    Berkő, Péter

    2016-05-01

    It is a regrettable deficiency in the Hungarian healthcare that the culture and the system of quality control of cure have not been formed (except for a few subspecialties, units or wards). If hospital wards do not have a national, professionally unified and modern information system presenting the most important quantity and quality indicators of their medicinal activity annually, a stable basis for definition of future tasks is absent. The author puts forward a proposal for the establishment of the information systems for different professional fields. On the basis of experience of perinatological information system operating for over 3 decades in Borsod-Abaúj-Zemplén county, he also proposes introduction of a nationally unified, Europeristat-compatible information system following Tauffer-statistics which may serve as a uniform quality control of obstetrics and perinatological care, as well as introduction of its base, the dataform "TePERA" (Form of Obstetrics and Perinatological Care Risk). PMID:27106723

  9. Obstetric MRI.

    PubMed

    Levine, Deborah

    2006-07-01

    Ultrasound is the imaging modality of choice for pregnant patients. However, MRI is increasingly utilized in patients in whom the sonographic diagnosis is unclear. These include maternal conditions unique to pregnancy such as ectopic pregnancy, placenta accreta, and uterine dehiscence. MRI is also being increasingly utilized in the assessment of abdominopelvic pain in pregnancy, in particular in assessment for appendicitis. Fetal MRI is performed to assess central nervous system (CNS) abnormalities and patients who are considering fetal surgery for conditions such as neural tube defects, congenital diaphragmatic hernia, and masses that obstruct the airway. In the future, functional MRI and fetal volumetry may provide additional information that can aid in our care of complicated pregnancies. PMID:16736491

  10. Quality of DEMs derived from Kite Aerial Photogrammety System: a case study of Dutch coastal environments.

    NASA Astrophysics Data System (ADS)

    Paron, Paolo; Smith, Mike J.; Anders, Niels; Meesuk, Vorawit

    2014-05-01

    Coastal protection is one of the main challenges for the Netherlands, where a large proportion of anthropogenic activity is located below sea level (both residential and economic). The Dutch government is implementing an innovative method of coastal replenishment using natural waves and winds to relocate sand from one side to the other of the country. This requires close monitoring of the spatio-temporal evolution of beaches in order to correctly model the future direction and amount of sand movement. To do so -on the onshore beach- we tested a Kite-Aerial Photography System for monitoring the beach dynamics at Zandmotor (http://www.dezandmotor.nl/en-GB/). The equipment used for data collection were a commercial DSLR camera (Nikon D7000 with a 20mm lens), gyro-levelled rig, Sutton Flowform 16 kite and Leica GNSS Viva GS10, with GSM connection to the Dutch geodetic network. We flew using a 115 m line with an average inclination of 40 to 45°; this gave a camera vertical distance of ~80 m and pixel size of ~20 mm. The methodology follows that of Smith et al. (2009), and of Paron & Smith (2013), applied to a highly dynamic environment with low texture and small relief conditions. Here we present a comparison of the quality of the digital elevation model (DEM) generated from the same dataset using two different systems: Structure from Motion (SfM) using Agisoft Photoscan Pro and traditional photogrammetry using Leica Photograpmmetry Suite. In addition the outputs from the two data processing methods are presented, including both an image mosaic and DEM, and highlighting pros and cons of both methods. References Smith, M. J. et al. 2009. High spatial resolution data acquisition for the geosciences: kite aerial photography. ESPL, 34(1), 155-161. Paron, P., Smith, M.J. 2013. Kite aerial photogrammetry system for monitoring coastal change in the Netherlands. 8th IAG International Conference on Geomorphology, Paris, August.

  11. Obesity and obstetric anaesthesia.

    PubMed

    Mace, H S; Paech, M J; McDonnell, N J

    2011-07-01

    Obesity is increasing in the population as a whole, and especially in the obstetric population, among whom pregnancy-induced physiological changes impact on those already present due to obesity. In particular, changes in the cardiovascular and respiratory systems during pregnancy further alter the physiological effects and comorbidities of obesity. Obese pregnant women are at increased risk of diabetes, hypertensive disorders of pregnancy, ischaemic heart disease, congenital malformations, operative delivery postpartum infection and thromboembolism. Regional analgesia and anaesthesia is usually preferred but may be challenging. Obese pregnant women appear to have increased morbidity and mortality associated with caesarean delivery and general anaesthesia for caesarean delivery in particular, and more anaesthesia-related complications. This article summarises the physiological and pharmacological implications of obesity and pregnancy and describes the issues surrounding the management of these women for labour and delivery. PMID:21823371

  12. System theory and safety models in Swedish, UK, Dutch and Australian road safety strategies.

    PubMed

    Hughes, B P; Anund, A; Falkmer, T

    2015-01-01

    Road safety strategies represent interventions on a complex social technical system level. An understanding of a theoretical basis and description is required for strategies to be structured and developed. Road safety strategies are described as systems, but have not been related to the theory, principles and basis by which systems have been developed and analysed. Recently, road safety strategies, which have been employed for many years in different countries, have moved to a 'vision zero', or 'safe system' style. The aim of this study was to analyse the successful Swedish, United Kingdom and Dutch road safety strategies against the older, and newer, Australian road safety strategies, with respect to their foundations in system theory and safety models. Analysis of the strategies against these foundations could indicate potential improvements. The content of four modern cases of road safety strategy was compared against each other, reviewed against scientific systems theory and reviewed against types of safety model. The strategies contained substantial similarities, but were different in terms of fundamental constructs and principles, with limited theoretical basis. The results indicate that the modern strategies do not include essential aspects of systems theory that describe relationships and interdependencies between key components. The description of these strategies as systems is therefore not well founded and deserves further development. PMID:25109432

  13. Optimization of the central automatic control of a small Dutch sewer system

    NASA Astrophysics Data System (ADS)

    Kolechkina, A. G.; Hoes, O. A. C.

    2012-04-01

    A sewer control system was developed in the context of a subsidized project aiming at improvement of surface water quality by control of sewer systems and surface water systems. The project was coordinated by the local water board, "Waterschap Hollandse Delta". Other participants were Delft University of Technology, Deltares and the municipalities Strijen, Cromstrijen, Westmaas, Oud Beijerland and Piershil. As part of the project there were two pilot implementations where a central automatic controller was coupled to the existing SCADA system. For these two pilots the system is now operational. A Dutch urban area in the western part of the Netherlands is usually part of a polder, which is effectively an artificially drained catchment. The urban area itself is split into small subcatchments that manage runoff in different ways. In all cases a large fraction goes into the natural hydrological cycle, but, depending on the design of the local sewer system, a larger or smaller part finds its way into the sewer system. Proper control of this flow is necessary to control surface water quality and to avoid health risks from flow from the sewer into the streets. At each time step the controller switches pumps to distribute the remaining water in the system at the end of the time step over the different subcatchments. The distribution is created based on expert judgment of the relative vulnerability and subcatchment sewer system water quality. It is implemented in terms curves of total system stored volume versus subcatchment stored volume. We describe the process of the adaptation of a controller to two different sewer systems and the understanding of the artificial part of the catchment we gained during this process. In the process of adaptation the type of sewer system (combined foul water and storm water transport or separate foul water and storm water transport) played a major role.

  14. Costs and effects of a nursing information system in three Dutch hospitals.

    PubMed

    van Gennip, E M; Klaassen-Leil, C C; Stokman, R; van Valkenburg, R K

    1995-01-01

    VISION is an integrated nursing information system developed in the Netherlands. In mid-1992, a technology assessment of this system was started: the VISTA project. Its aim is to assess the costs and effects of VISION in three different types of hospitals: a University Hospital, a General Hospital, and a Psychiatric Hospital. The study was financially supported by the Dutch Ministry of Welfare, Health, and Culture. Each hospital selected an experimental ward at which VISION parts were installed (VISION was not yet complete during the study). Also, control wards were selected at which no VISION parts were installed. A series of two measurements were carried out at the experimental and control wards. The first experiences show that VISION can be used in various applications, in different environments. Although the second measurements were done just a few weeks after the installation of VISION parts, first effects could already be demonstrated. Nurses were enthusiastic and the quality of coordination of care increased. Time savings have not yet been demonstrated, but are expected after a longer, more extensive use of the system. Extrapolation of costs for hospital-wide implementation revealed that the costs of VISION are low compared to similar systems in the US. After reviewing the first results, each hospital decided to continue the implementation of VISION parts. More measurements are planned. PMID:8591462

  15. Obstetric ultrasound simulation.

    PubMed

    Nitsche, Joshua F; Brost, Brian C

    2013-06-01

    Obstetric ultrasound is becoming an increasingly important part of the practice of maternal-fetal medicine. Thus, it is important to develop rigorous and effective training curricula for obstetrics and gynecology residents and maternal-fetal medicine fellows. Traditionally, this training has come almost entirely from exposure to ultrasound in the clinical setting. However, with the increased complexity of modern ultrasound and advent of duty-hour restrictions, a purely clinical training model is no longer viable. With the advent of high-fidelity obstetric ultrasound simulators, a significant amount of training can occur in a non-clinical setting which allows learners to obtain significant skill prior to their first patient ultrasound encounter and obtain proficiency in a shorter period of time. In this manuscript we discuss the available obstetric ultrasound simulators and ways to construct a comprehensive ultrasound training curricula to meet the increasing demands of modern maternal-fetal medicine. PMID:23721777

  16. Medical Devices; Obstetrical and Gynecological Devices; Classification of the Intravaginal Culture System. Final order.

    PubMed

    2016-01-01

    The Food and Drug Administration (FDA) is classifying the intravaginal culture system into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the intravaginal culture system's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device. PMID:26742184

  17. Obstetric life support.

    PubMed

    Puck, Andrea Lorraine; Oakeson, Ann Marie; Morales-Clark, Ana; Druzin, Maurice

    2012-01-01

    The death of a woman during pregnancy is devastating. Although the incidence of maternal cardiac arrest is increasing, it continues to be a comparatively rare event. Obstetric healthcare providers may go through their entire career without participating in a maternal cardiac resuscitation. Concern has been raised that when an arrest does occur in the obstetric unit, providers who are trained in life support skills at 2-year intervals are ill equipped to provide the best possible care. The quality of resuscitation skills provided during cardiopulmonary arrest of inpatients often may be poor, and knowledge of critical steps to be followed during resuscitation may not be retained after life support training. The Obstetric Life Support (ObLS) training program is a method of obstetric nursing and medical staff training that is relevant, comprehensive, and cost-effective. It takes into consideration both the care needs of the obstetric patient and the adult learning needs of providers. The ObLS program brings obstetric nurses, obstetricians, and anesthesiologists together in multidisciplinary team training that is crucial to developing efficient emergency response. PMID:22551860

  18. Analgesia in Obstetrics

    PubMed Central

    Heesen, M.; Veeser, M.

    2012-01-01

    Background: An effective relief of labour pain has become an important part of obstetric medicine. Therefore regional nerve blocks, systemic analgesic and non-pharmacologic techniques are commonly used. This review article gives a summary of pathophysiology and anatomy of labour pain as well as advantages, disadvantages, risks and adverse reactions of analgesic techniques in newborns and parturients. Methods: We performed a selective literature search in Medline via PubMed using the search-terms “Analgesia” and “Obstetrics”. We also included the current guidelines of the German Society for Anesthesiology and Intensive Care Medicine. Results: PDA and CSE are safe techniques for the relief of labour pain if contraindications are excluded. The risk for instrumental delivery but not for caesarean section is increased under neuraxial analgesia. PDA and CSE should be performed in an early stage of labour using low doses of local anaesthetics if possible. It is not necessary to wait for a defined cervical dilatation before starting neuraxial analgesia. Anesthesiologists and obstetricians should inform patients as soon as possible before the situation of stress during labour. Systemic opioid analgesia is a possible alternative for neuraxial techniques. Because of possible side effects systemic remifentanil analgesia should only be performed under continuous monitoring. Several nonpharmacologic methods can also relieve labour pain, but results of studies about their effectiveness are inconsistent. PMID:25264376

  19. Medical devices; obstetrical and gynecological devices; classification of the breast lesion documentation system. Final rule.

    PubMed

    2003-07-28

    The Food and Drug Administration (FDA) is classifying the breast lesion documentation system into class II (special controls). The special controls that will apply to this device are discussed later in this document. The agency is taking this action in response to a petition submitted under the Federal Food, Drug, and Cosmetic Act (the act) as amended by the Medical Device Amendments of 1976 (the amendments), the Safe Medical Devices Act of 1990, and the Food and Drug Administration Modernization Act of 1997 (FDAMA). The agency is classifying this device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device. Elsewhere in this issue of the Federal Register, FDA is publishing a notice of availability of a guidance document that is the special control for this device. PMID:12884877

  20. Throwing the baby out with the bath water? Occupational hygienists' views on the revised dutch system for occupational exposure limits.

    PubMed

    Schenk, Linda; Palmen, Nicole Gm

    2013-06-01

    In 2007, the Dutch Working Conditions Act was revised with the goal to decrease the regulatory burden, and to open up for company-specific solutions of establishing a safe and healthy work environment. One tool geared towards company-specific solutions is the compilation of the Arbocatalogs, which are company or sector-level collections of safe working methods and guidelines developed both by employers and employees. The revision also introduced a new occupational exposure limit (OEL) system in the Netherlands. This system encompasses two kinds of OELs: private and public. Private OELs are to be derived by the industry, while public OELs are issued by the Ministry of Social Affairs and Employment. With this change, the majority of the previously set Dutch OELs were removed, as the substances in question now are falling under the private realm. The motivations, expectations, and practical impacts of these revisions have been investigated through interviews with stakeholder organizations and a questionnaire study targeted at occupational hygienists. The questionnaire results show that although the Arbocatalogs seem to be relatively well received, a majority of the Dutch occupational hygienists are still relatively negative to the changes. There is a fear that private OELs will be less scientifically robust than public OELs and that the lack of robustness will have a negative impact on the field of occupational hygiene as a whole. PMID:23253359

  1. Spoken Dutch.

    ERIC Educational Resources Information Center

    Bloomfield, Leonard

    This course in spoken Dutch is intended for use in introductory conversational classes. The book is divided into five major parts, each containing five learning units and one unit devoted to review. Each unit contains sections including (1) basic sentences, (2) word study and review of basic sentences, (3) listening comprehension, and (4)…

  2. Prevention in Obstetrics.

    ERIC Educational Resources Information Center

    Children in the Tropics, 1984

    1984-01-01

    The aim of this issue of "Children in the Tropics" is to describe work that may be done by a motivated health team having only the strict minimum of material resources. While not a handbook of obstetrics, this text serves as a reminder of basic information and procedures workers must be able to perform. Following a review of the educational and…

  3. Disseminated Intravascular Coagulation Syndromes in Obstetrics.

    PubMed

    Cunningham, F Gary; Nelson, David B

    2015-11-01

    Disseminated intravascular coagulation (DIC) is a syndrome that can be initiated by a myriad of medical, surgical, and obstetric disorders. Also known as consumptive coagulopathy, DIC is a common contributor to maternal morbidity and mortality and is associated with up to 25% of maternal deaths. The etiopathogenesis of DIC is complex and currently thought to be initiated by tissue factor or thromboplastin, which is released from trophoblastic or fetal tissue, or maternal decidua or endothelium. Tissue factor activates the coagulation sequence to cause fibrin clotting and its dissolution by the fibrinolysin system. The result of this process can range from mild, clinically insignificant laboratory derangements to marked coagulopathy with bleeding at sites of minimal trauma. Although clinical recognition varies by disease severity, several organizations have attempted to standardize the diagnosis through development of scoring systems. Several important--albeit not necessarily common--obstetric disorders associated with DIC include placental abruption, amniotic fluid embolism, sepsis syndrome, and acute fatty liver of pregnancy. More common disorders include severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and massive obstetric hemorrhage. Importantly, many of these disorders either cause or are associated with substantive obstetric hemorrhage. Treatment of DIC is centered on two principles. The first is identification and treatment of the underlying disorder. Because many women with consumptive coagulopathy also have massive hemorrhage, the second tenet of treatment is that obstetric complications such as uterine atony or lacerations must be controlled simultaneously with prompt blood and component replacement for a salutary outcome. PMID:26444122

  4. Prohemostatic interventions in obstetric hemorrhage.

    PubMed

    Bonnet, Marie-Pierre; Basso, Olga

    2012-04-01

    Obstetric hemorrhage is a major cause of maternal morbidity and mortality. Pregnancy is associated with substantial hemostatic changes, resulting in a relatively hypercoagulable state. Acquired coagulopathy can, however, develop rapidly in severe obstetric hemorrhage. Therefore, prohemostatic treatments based on high fresh frozen plasma and red blood cell (FFP:RBC) ratio transfusion and procoagulant agents (fibrinogen concentrates, recombinant activated factor VII, and tranexamic acid) are crucial aspects of management. Often, evidence from trauma patients is applied to obstetric hemorrhage management, although distinct differences exist between the two situations. Therefore, until efficacy and safety are demonstrated in obstetric hemorrhage, clinicians should be cautious about wholesale adoption of high FFP:RBC ratio products. Applications of transfusion protocols, dedicated to massive obstetric hemorrhage and multidisciplinarily developed, currently remain the best available option. Similarly, while procoagulant agents appear promising in treatment of obstetric hemorrhage, caution is nonetheless warranted as long as clear evidence in the context of obstetric hemorrhage is lacking. PMID:22510859

  5. Obstetric (nonfetal) complications.

    PubMed

    Shanbhogue, Alampady K P; Menias, Christine O; Lalwani, Neeraj; Lall, Chandana; Khandelwal, Ashish; Nagar, Arpit

    2013-11-01

    Pregnancy predisposes women to a wide array of obstetric and gynecological complications which are often complex, challenging and sometimes life-threatening. While some of these are unique to pregnancy, a few that occur in nonpregnant women are more common during pregnancy. Imaging plays a crucial role in the diagnosis and management of pregnancy-related obstetric and gynecologic complications. Ultrasonography and magnetic resonance imaging confer the least risk to the fetus and should be the preferred examinations for evaluating these complications. Multidetector computed tomography should be used after carefully weighing the risk-benefit ratio based on the clinical condition in question. Interventional radiology is emerging as a preferred, noninvasive or minimally invasive treatment option that can obviate surgery and its antecedent short term and long term complications. Knowledge of appropriateness of imaging and image guided intervention is necessary for accurate patient management. PMID:24210440

  6. Obstetric antiphospholipid syndrome.

    PubMed

    Galarza-Maldonado, Claudio; Kourilovitch, Maria R; Pérez-Fernández, Oscar M; Gaybor, Mariana; Cordero, Christian; Cabrera, Sonia; Soroka, Nikolai F

    2012-02-01

    Antiphospholipid syndrome (APS) in pregnancy has a serious impact on maternal and fetal morbidity. It causes recurrent pregnancy miscarriage and it is associated with other adverse obstetric findings like preterm delivery, intrauterine growth restriction, preeclampsia, HELLP syndrome and others. The 2006 revised criteria, which is still valid, is used for APS classification. Epidemiology of obstetric APS varies from one population group to another largely due to different inclusion criteria and lack of standardization of antibody detection methods. Treatment is still controversial. This topic should include a multidisciplinary team and should be individualized. Success here is based on strict control and monitoring throughout pregnancy and even in the preconception and postpartum periods. Further research in this field and unification of criteria are required to yield better therapeutic strategies in the future. PMID:22001418

  7. Cell Salvage in Obstetrics.

    PubMed

    Goucher, Haley; Wong, Cynthia A; Patel, Samir K; Toledo, Paloma

    2015-08-01

    Intraoperative cell salvage is a strategy to decrease the need for allogeneic blood transfusion. Traditionally, cell salvage has been avoided in the obstetric population because of the perceived risk of amniotic fluid embolism or induction of maternal alloimmunization. With advances in cell salvage technology, the risks of cell salvage in the obstetric population parallel those in the general population. Levels of fetal squamous cells in salvaged blood are comparable to those in maternal venous blood at the time of placental separation. No definite cases of amniotic fluid embolism have been reported and appear unlikely with modern equipment. Cell salvage is cost-effective in patients with predictably high rates of transfusion, such as parturients with abnormal placentation. PMID:26197375

  8. A computerized obstetric medical record.

    PubMed

    Stead, W W; Brame, R G; Hammond, W E; Jelovsek, F R; Estes, E H; Parker, R T

    1977-04-01

    Duke University has utilized computerized obstetric medical records since 1971. System evolution is described. Deficiencies in the current system appear to evolve from the computer/human interface rather than from basic system design. Critical elements in system success are physician acceptance of the appearance of data collection sheets and printed notes and continual rapid response in programing modification to allow for physician individuality and changes in medical practice. The limiting factor in the potential usefulness of such a system is the rate of incomplete data collection. It is suggested that if the physician were to enter data directly into the computer through a terminal, data collection would be more accurate and complete. PMID:854253

  9. Emergency preparedness in obstetrics.

    PubMed

    Haeri, Sina; Marcozzi, David

    2015-04-01

    During and after disasters, focus is directed toward meeting the immediate needs of the general population. As a result, the routine health care and the special needs of some vulnerable populations such as pregnant and postpartum women may be overlooked within a resource-limited setting. In the event of hazards such as natural disasters, manmade disasters, and terrorism, knowledge of emergency preparedness strategies is imperative for the pregnant woman and her family, obstetric providers, and hospitals. Individualized plans for the pregnant woman and her family should include knowledge of shelter in place, birth at home, and evacuation. Obstetric providers need to have a personal disaster plan in place that accounts for work responsibilities in case of an emergency and business continuity strategies to continue to provide care to their communities. Hospitals should have a comprehensive emergency preparedness program utilizing an "all hazards" approach to meet the needs of pregnant and postpartum women and other vulnerable populations during disasters. With lessons learned in recent tragedies such as Hurricane Katrina in mind, we hope this review will stimulate emergency preparedness discussions and actions among obstetric providers and attenuate adverse outcomes related to catastrophes in the future. PMID:25751222

  10. Blood transfusion in obstetrics.

    PubMed

    Nigam, A; Prakash, A; Saxena, P

    2013-01-01

    Transfusion of blood and blood components is a common practice in obstetric wards but it is not without risk. The incidence of transfusion reactions varies from 4 in every hundred transfusions for non-haemolytic reactions to one in every 40,000 for haemolytic transfusion reactions. The physiological basis of blood transfusion is outlined in this article. Most of the donated blood is processed into components: packed red cells (PRBCs), platelets, and fresh frozen plasma (FFP) or cryoprecipitate. Various alternatives to blood transfusion exist and include autotransfusion, pre-autologous blood storage, use of oxygen carrying blood substitutes and intraoperative cell salvage. Despite the risks associated with transfusions, obstetricians are frequently too aggressive in transfusing blood and blood products to their patients. Acute blood loss in obstetrics is usually due to placenta praevia, postpartum blood loss and surgery related. An early involvement of a consultant obstetrician, anaesthetist, haematologist and the blood bank is essential. There are no established criteria for initiating red cell transfusions and the decision is purely based on clinical and haematological parameters, which have been discussed along with the general principles of blood transfusion in obstetrics and some practical guidelines. PMID:24899337

  11. Steps toward a national disaster plan for obstetrics.

    PubMed

    Daniels, Kay; Oakeson, Ann Marie; Hilton, Gillian

    2014-07-01

    Hospitals play a central role in disasters by receiving an influx of casualties and coordinating medical efforts to manage resources. However, plans have not been fully developed in the event the hospital itself is severely damaged, either from natural disasters like earthquakes or tornados or manmade events such as a massive electrical failure or terrorist attacks. Of particular concern is the limited awareness of the obstetric units' specialized needs in the world of disaster planning. Within the same footprint of any obstetric unit, there exists a large variety of patient acuity and needs including laboring women, postoperative patients, and healthy postpartum patients with their newborns. An obstetric-specific triage method is paramount to accurately assess and rapidly triage patients during a disaster. An example is presented here called OB TRAIN (Obstetric Triage by Resource Allocation for Inpatient). To accomplish a comprehensive obstetric disaster plan, there must be 1) national adoption of a common triage and evacuation language including an effective patient tracking system to avoid maternal-neonatal separation; 2) a stratification of maternity hospital levels of care; and 3) a collaborative network of obstetric hospitals, both regionally and nationally. However, obstetric disaster planning goes beyond evacuation and must include plans for shelter-in-place and surge capacity, all uniquely designed for the obstetric patient. Disasters, manmade or natural, are neither predictable nor preventable, but we can and should prepare for them. PMID:24901273

  12. The Empathy and Systemizing Quotient: The Psychometric Properties of the Dutch Version and a Review of the Cross-Cultural Stability

    ERIC Educational Resources Information Center

    Groen, Y.; Fuermaier, A. B. M.; Den Heijer, A. E.; Tucha, O.; Althaus, M.

    2015-01-01

    The "Empathy Quotient" (EQ) and "Systemizing Quotient" (SQ) are used worldwide to measure people's empathizing and systemizing cognitive styles. This study investigates the psychometric properties of the Dutch EQ and SQ in healthy participants (n = 685), and high functioning males with autism spectrum disorder (n = 42). Factor…

  13. Shaping the System - The DRG Evaluation Project of the German Society for Gynaecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG).

    PubMed

    Fiori, W; Renner, S P; Siam, K; Babapirali, J; Roeder, N; Dausch, E; Hildebrandt, T; Hillemanns, P; Nehmzow, M; Zygmunt, M; Piroth, D; Schem, C; Schwenzer, T; Friese, K; Wallwiener, D; Beckmann, M W

    2013-08-01

    Introduction: The German DRG system is annually adapted to the changing services provided. For the further development, the self-governing body and its DRG Institute (InEK) depend on participation of the users. Methods: For one of the DRG evaluation projects initiated by DGGG, cost and performance data for the year 2011 from 16 hospitals were available. After plausibility checks and corrections, analyses for service and cost homogeneity were performed. In cases of inadequate DRG-representation attributes were sought that would make an appropriate reimbursement possible. Conspicuities and potential solutions were checked for clinical plausibility. Results: 44 concrete modification proposals for further development of the G-DRG system were formulated and submitted in due time to the InEK. In addition, 3 modification proposals were addressed to the German Institute for Medical Documentation and Information (Deutsches Institut für Medizinische Dokumentation und Information, DIMDI) for further development of the diagnosis classification ICD-10-GM. For all modification proposals care was taken to minimise misdirected incentives and to reduce the potential for disputes with the cost bearers and their auditors services in settlements. Discussion: The publication of the G-DRG system 2014 shows which modification proposals have been realised. Essentially, an appropriate redistribution of the resources among the gynaecological and obstetrics departments is to be expected. The financial pressure that is caused by the generally inadequate financing of hospitals will not be reduced by a further development of the G-DRG system. PMID:24771931

  14. Nationwide population-based cohort study of uterine rupture in Belgium: results from the Belgian Obstetric Surveillance System

    PubMed Central

    Vandenberghe, G; De Blaere, M; Van Leeuw, V; Roelens, K; Englert, Y; Hanssens, M; Verstraelen, H

    2016-01-01

    Objectives We aimed to assess the prevalence of uterine rupture in Belgium and to evaluate risk factors, management and outcomes for mother and child. Design Nationwide population-based prospective cohort study. Setting Emergency obstetric care. Participation of 97% of maternity units covering 98.6% of the deliveries in Belgium. Participants All women with uterine rupture in Belgium between January 2012 and December 2013. 8 women were excluded because data collection forms were not returned. Results Data on 90 cases of confirmed uterine rupture were obtained, of which 73 had a previous Caesarean section (CS), representing an estimated prevalence of 3.6 (95% CI 2.9 to 4.4) per 10 000 deliveries overall and of 27 (95% CI 21 to 33) and 0.7 (95% CI 0.4 to 1.2) per 10 000 deliveries in women with and without previous CS, respectively. Rupture occurred during trial of labour after caesarean section (TOLAC) in 57 women (81.4%, 95% CI 68% to 88%), with a high rate of augmented (38.5%) and induced (29.8%) labour. All patients who underwent induction of labour had an unfavourable cervix at start of induction (Bishop Score ≤7 in 100%). Other uterine surgery was reported in the history of 22 cases (24%, 95% CI 17% to 34%), including 1 case of myomectomy, 3 cases of salpingectomy and 2 cases of hysteroscopic resection of a uterine septum. 14 cases ruptured in the absence of labour (15.6%, 95% CI 9.5% to 24.7%). No mothers died; 8 required hysterectomy (8.9%, 95% CI 4.6% to 16.6%). There were 10 perinatal deaths (perinatal mortality rate 117/1000 births, 95% CI 60 to 203) and perinatal asphyxia was observed in 29 infants (34.5%, 95% CI 25.2% to 45.1%). Conclusions The prevalence of uterine rupture in Belgium is similar to that in other Western countries. There is scope for improvement through the implementation of nationally adopted guidelines on TOLAC, to prevent use of unsafe procedures, and thereby reduce avoidable morbidity and mortality. PMID:27188805

  15. An Intermediate-Advanced Level Dutch Refresher Course.

    ERIC Educational Resources Information Center

    English Language Services, Inc., Washington, DC.

    This refresher course in Dutch consists of eight volumes (Books I-IV, each in two parts). Book I, which begins on the intermediate level, presents the sound system of Dutch with accompanying drills. These provide practice in sound-to-spelling correspondence, and contrastive English-Dutch phonology. Books II and III are comprised of six units of…

  16. The Empathy and Systemizing Quotient: The Psychometric Properties of the Dutch Version and a Review of the Cross-Cultural Stability.

    PubMed

    Groen, Y; Fuermaier, A B M; Den Heijer, A E; Tucha, O; Althaus, M

    2015-09-01

    The 'Empathy Quotient' (EQ) and 'Systemizing Quotient' (SQ) are used worldwide to measure people's empathizing and systemizing cognitive styles. This study investigates the psychometric properties of the Dutch EQ and SQ in healthy participants (n = 685), and high functioning males with autism spectrum disorder (n = 42). Factor analysis provided support for three subscales of the abridged 28-item EQ: Cognitive Empathy, Emotional Empathy and Social Skills. Overall, the Dutch EQ and SQ appeared reliable and valid tools to assess empathizing and systemizing cognitive style in healthy adults and high functioning adults with autism. The literature showed good cross-cultural stability of the SQ and EQ in Western countries, but in Asian countries EQ is less stable and less sensitive to sex differences. PMID:25911303

  17. Three-dimensional obstetric ultrasound.

    PubMed

    Tache, Veronique; Tarsa, Maryam; Romine, Lorene; Pretorius, Dolores H

    2008-04-01

    Three-dimensional ultrasound has gained a significant popularity in obstetrical practice in recent years. The advantage of this modality in some cases is in question, however. This article provides a basic review of volume acquisition, mechanical positioning, and display modalities. Multiple uses of this technique in obstetrical care including first trimester applications and its utility in clarification of fetal anatomy such as brain, face, heart, and skeleton is discussed. PMID:18450140

  18. Doing obstetrics and staying alive.

    PubMed Central

    Reynolds, J. L.

    1993-01-01

    Many family physicians have a love-hate relationship with childbirth care and struggle to balance their personal and family needs with the need to provide high-quality personal care during labour and birth. Many false assumptions undermine family practice obstetrics. Strategies are presented to simplify obstetric care for women and families while promoting reasoned self-care for physicians. Images p1948-a PMID:8219843

  19. Safety Assurance in Obstetrical Ultrasound

    PubMed Central

    Miller, Douglas L

    2008-01-01

    Safety assurance for diagnostic ultrasound in obstetrics began with a tacit assumption of safety allowed by a federal law enacted in 1976 for then-existing medical ultrasound equipment. The implementation of the 510(k) pre-market approval process for diagnostic ultrasound resulted in the establishment of guideline upper limits for several examination categories in 1985. The obstetrical category has undergone substantial evolution from initial limits (I. e., 46 mW/cm2 spatial peak temporal average (SPTA) intensity) set in 1985. Thermal and mechanical exposure indices, which are displayed on-screen according to an Output Display Standard (ODS), were developed for safety assurance with relaxed upper limits. In 1992, with the adoption of the ODS, the allowable output for obstetrical ultrasound was increased both in terms of the average exposure (e. g. to a possible 720 mW/cm2 SPTA intensity) and of the peak exposure (via the Mechanical Index). There has been little or no subsequent research with the modern obstetrical ultrasound machines to systematically assess potential risks to the fetus using either relevant animal models of obstetrical exposure or human epidemiology studies. The assurance of safety for obstetrical ultrasound therefore is supported by three ongoing means: (I) review of a substantial but uncoordinated bioeffect research literature, (ii) the theoretical evaluation of diagnostic ultrasound exposure in terms of thermal and nonthermal mechanisms for bioeffects, and (iii) the skill and knowledge of professional sonographers. At this time, there is no specific reason to suspect that there is any significant health risk to the fetus or mother from exposure to diagnostic ultrasound in obstetrics. This assurance of safety supports the prudent use of diagnostic ultrasound in obstetrics by trained professionals for any medically indicated examination. PMID:18450141

  20. Safety assurance in obstetrical ultrasound.

    PubMed

    Miller, Douglas L

    2008-04-01

    Safety assurance for diagnostic ultrasound in obstetrics began with a tacit assumption of safety allowed by a federal law enacted in 1976 for then-existing medical ultrasound equipment. The implementation of the 510(k) pre-market-approval process for diagnostic ultrasound resulted in the establishment of guideline upper limits for several examination categories in 1985. The obstetrical category has undergone substantial evolution from initial limits (ie, 46 mW/cm2 spatial peak temporal average [SPTA] intensity) set in 1985. Thermal and mechanical exposure indices, which are displayed onscreen according to an Output Display Standard, were developed for safety assurance with relaxed upper limits. In 1992, with the adoption of the Output Display Standard, the allowable output for obstetrical ultrasound was increased in terms of both the average exposure (eg, to a possible 720 mW/cm2 SPTA intensity) and the peak exposure (via the Mechanical Index). There has been little or no subsequent research with the modern obstetrical ultrasound machines to systematically assess potential risks to the fetus using either relevant animal models of obstetrical exposure or human epidemiology studies. The assurance of safety for obstetrical ultrasound therefore is supported by three ongoing means: (1) review of a substantial but uncoordinated bioeffect research literature; (2) the theoretical evaluation of diagnostic ultrasound exposure in terms of thermal and nonthermal mechanisms for bioeffects; and (3) the skill and knowledge of professional sonographers. At this time, there is no specific reason to suspect that there is any significant health risk to the fetus or mother from exposure to diagnostic ultrasound in obstetrics. This assurance of safety supports the prudent use of diagnostic ultrasound in obstetrics by trained professionals for any medically indicated examination. PMID:18450141

  1. Obstetric management of conjoined twins.

    PubMed

    Sakala, E P

    1986-03-01

    Three cases of conjoined twins are presented: two thorocopagus and one craniopagus. The diagnosis of conjoining varied from late second trimester to time of term delivery. Delivery mode was both by vaginal and cesarean routes, and occurred at both level one and level three hospitals. Antenatal diagnostic procedures and issues in obstetric management are discussed. A suggested obstetric management sequence for conjoined twins is proposed. PMID:3511423

  2. Dutch surgery in Japan.

    PubMed

    van Gulik, Thomas M; Nimura, Yuji

    2005-01-01

    An isolation policy was adopted in feudal Japan from 1639 to 1853 owing to the fear of foreign influence. During those 200 years of isolation, all foreigners were withheld from the country with the exception of the Dutch, who were permitted to establish a trading post on a small island in the Bay of Nagasaki, called Decima. Western culture and science reached the Japanese exclusively through the Dutch on Decima. Health care on Decima was provided by Dutch barber-surgeons, who introduced Western surgical practice in Japan. Official interpreters were the only Japanese allowed on Decima. It was from among these interpreters that the first Japanese surgeons arose who, having mastered the Dutch language, translated several Dutch anatomic and surgical texts. Genpaku Sugita translated a Dutch anatomy textbook into Japanese, which was completed in 1774. This book, entitled Kaitai Shinsho [New Book on Anatomy], was the first Western scientific monograph to be translated entirely into Japanese. Several Dutch surgical schools were founded through which Dutch surgery, known in Japan as "surgery of the red-haired" was propagated. According to the custom of the surgical guilds in Holland, certificates were granted to Japanese apprentices who had completed their training in Dutch surgery. About 60 Dutch surgeons had served on Decima up to 1850, providing the basis for surgery to develop in Japan. Among them, Philipp Franz von Siebold was an exceptional scholar who also had a great impact in making Japanese culture known to the Western world. PMID:15599736

  3. Biogenic amine production by Lactococcus lactis subsp. cremoris strains in the model system of Dutch-type cheese.

    PubMed

    Flasarová, Radka; Pachlová, Vendula; Buňková, Leona; Menšíková, Anna; Georgová, Nikola; Dráb, Vladimír; Buňka, František

    2016-03-01

    The aim of this study was to compare the biogenic amine production of two starter strains of Lactococcus lactis subsp. cremoris (strains from the Culture Collection of Dairy Microorganisms - CCDM 824 and CCDM 946) with decarboxylase positive activity in a model system of Dutch-type cheese during a 90-day ripening period at 10°C. During ripening, biogenic amine and free amino acid content, microbiological characteristics and proximate chemical properties were observed. By the end of the ripening period, the putrescine content in both samples with the addition of the biogenic amine producing strain almost evened out and the concentration of putrescine was >800mg/kg. The amount of tyramine in the cheeses with the addition of the strain of CCDM 824 approached the limit of 400mg/kg by the end of ripening. In the cheeses with the addition of the strain of CCDM 946 it even exceeded 500mg/kg. In the control samples, the amount of biogenic amines was insignificant. PMID:26471528

  4. Composite redesign of obstetrical forceps

    NASA Technical Reports Server (NTRS)

    Lawson, Seth W.; Smeltzer, Stan S.

    1994-01-01

    Due to the increase in the number of children being born recently, medical technology has struggled to keep pace in certain areas. In these areas, particular needs have arisen to which the subject of this paper is directed. In the area of obstetrics, the forceps design and function has remained relatively unchanged for a number of years. In an effort to advance the technology, NASA Marshall Space Flight Center has been asked by the obstetrical community to help in a redesign of the obstetric forceps. Traditionally the forceps design has been of tubular stainless steel, constructed in two halves which interlock and hinge to provide the gripping force necessary to aid in the delivery of an infant. The stainless steel material was used to provide for ease of cleaning and sterilization. However, one of the drawbacks of the non-flexible steel design is that excessive force can be placed upon an infants head which could result in damage or injury to the infant. The redesign of this particular obstetric tool involves applying NASA's knowledge of advanced materials and state of the art instrumentation to create a tool which can be used freely throughout the obstetrics community without the fear of injury to an infant being delivered.

  5. Medical Devices; Obstetrical and Gynecological Devices; Classification of the Gynecologic Laparoscopic Power Morcellation Containment System. Final order.

    PubMed

    2016-06-21

    The Food and Drug Administration (FDA) is classifying the gynecologic laparoscopic power morcellation containment system into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the gynecologic laparoscopic power morcellation containment system's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device. PMID:27328463

  6. Some pain, no gain: experiences with the no-claim rebate in the Dutch health care system.

    PubMed

    Holland, J; Van Exel, N J A; Schut, F T; Brouwer, W B F

    2009-10-01

    To contain expenditures in an increasingly demand driven health care system, in 2005 a no-claim rebate was introduced in the Dutch health insurance system. Since demand-side cost sharing is a very controversial issue, the no-claim rebate was launched as a consumer friendly bonus system to reward prudent utilization of health services. Internationally, the introduction of a mandatory no-claim rebate in a social health insurance scheme is unprecedented. Consumers were entitled to an annual rebate of 255 eruos if no claims were made. During the year, all health care expenses except for GP visits and maternity care were deducted from the rebate until the rebate became zero. In this article, we discuss the rationale of the no-claim rebate and the available evidence of its effect. Using a questionnaire in a convenience sample, we examined people's knowledge, attitudes, and sensitivity to the incentive scheme. We find that only 4% of respondents stated that they would reduce consumption because of the no-claim rebate. Respondents also indicated that they were willing to accept a high loss of rebate in order to use a medical treatment. However, during the last month of the year many respondents seemed willing to postpone consumption until the next year in order to keep the rebate of the current year intact. A small majority of respondents considered the no-claim rebate to be unfair. Finally, we briefly discuss why in 2008 the no-claim rebate was replaced by a mandatory deductible. PMID:19239729

  7. Obstetric Thromboprophylaxis: The Swedish Guidelines

    PubMed Central

    Lindqvist, Pelle G.; Hellgren, Margareta

    2011-01-01

    Obstetric thromboprophylaxis is difficult. Since 10 years Swedish obstetricians have used a combined risk estimation model and recommendations concerning to whom, at what dose, when, and for how long thromboprophylaxis is to be administrated based on a weighted risk score. In this paper we describe the background and validation of the Swedish guidelines for obstetric thromboprophylaxis in women with moderate-high risk of VTE, that is, at similar or higher risk as the antepartum risk among women with history of thrombosis. The risk score is based on major risk factors (i.e., 5-fold increased risk of thromboembolism). We present data on the efficacy of the model, the cost-effectiveness, and the lifestyle advice that is given. We believe that the Swedish guidelines for obstetric thromboprophylaxis aid clinicians in providing women at increased risk of VTE with effective and appropriate thromboprophylaxis, thus avoiding both over- and under-treatment. PMID:22162688

  8. The future of obstetrics/gynecology in 2020: a clearer vision. Transformational forces and thriving in the new system.

    PubMed

    Lagrew, David C; Jenkins, Todd R

    2015-01-01

    Revamping the delivery of women's health care to meet future demands will require a number of changes. In the first 2 articles of this series, we introduced the reasons for change, suggested the use of the 'Triple Aim' concept to (1) improve the health of a population, (2) enhance the patient experience, and (3) control costs as a guide post for changes, and reviewed the transformational forces of payment and care system reform. In the final article, we discuss the valuable use of information technology and disruptive clinical technologies. The new health care system will require a digital transformation so that there can be increased communication, availability of information, and ongoing assessment of clinical care. This will allow for more cost-effective and individualized treatments as data are securely shared between patients and providers. Scientific advances that radically change clinical practice are coming at an accelerated pace as the underlying technologies of genetics, robotics, artificial intelligence, and molecular biology are translated into tools for diagnosis and treatment. Thriving in the new system not only will require time-honored traits such as leadership and compassion but also will require the obstetrician/gynecologist to become comfortable with technology, care redesign, and quality improvement. PMID:25173190

  9. Limb preference in children with obstetric brachial plexus palsy.

    PubMed

    Yang, Lynda J-S; Anand, Praveen; Birch, Rolfe

    2005-07-01

    Brachial plexus palsy affects children differently than adults. In children with obstetric brachial plexus palsy, motor development must depend on nervous system adaptation. Previous studies report sensory plasticity in these children. This noninvasive study provides support for neural plasticity (the general ability of the brain to reorganize neural pathways based on new experiences) in children with obstetric brachial plexus palsy by considering upper limb preference. As in the general population, we expect that 90% of children would prefer their right upper limb. However, only 17% of children affected by right obstetric brachial plexus palsy prefer the right upper limb for overall movement; children with left obstetric brachial plexus palsy did not significantly differ from the general population in upper limb preference. This study also provides the first evidence of a significant correlation between actual task performance and select obstetric brachial plexus palsy outcome measurement systems, thereby justifying the routine use of these outcome measurement systems as a reflection of the practical utility of the affected limb to the patient. PMID:15876521

  10. Definitions of Obstetric and Gynecologic Hospitalists.

    PubMed

    McCue, Brigid; Fagnant, Robert; Townsend, Arthur; Morgan, Meredith; Gandhi-List, Shefali; Colegrove, Tanner; Stosur, Harriet; Olson, Rob; Meyer, Karenmarie; Lin, Andrew; Tessmer-Tuck, Jennifer

    2016-02-01

    The obstetric hospitalist and the obstetric and gynecologic hospitalist evolved in response to diverse forces in medicine, including the need for leadership on labor and delivery units, an increasing emphasis on quality and safety in obstetrics and gynecology, the changing demographics of the obstetric and gynecologic workforce, and rising liability costs. Current (although limited) research suggests that obstetric and obstetric and gynecologic hospitalists may improve the quality and safety of obstetric care, including lower cesarean delivery rates and higher vaginal birth after cesarean delivery rates as well as lower liability costs and fewer liability events. This research is currently hampered by the use of varied terminology. The leadership of the Society of Obstetric and Gynecologic Hospitalists proposes standardized definitions of an obstetric hospitalist, an obstetric and gynecologic hospitalist, and obstetric and gynecologic hospital medicine practices to standardize communication and facilitate program implementation and research. Clinical investigations regarding obstetric and gynecologic practices (including hospitalist practices) should define inpatient coverage arrangements using these standardized definitions to allow for fair conclusions and comparisons between practices. PMID:26942370

  11. Foetal Gender and Obstetric Outcome

    PubMed Central

    Schildberger, B.; Leitner, H.

    2016-01-01

    Introduction: Data on specific characteristics based on the gender of the unborn baby and their significance for obstetrics are limited. The aim of this study is to analyse selected parameters of obstetric relevance in the phases pregnancy, birth and postpartum period in dependence on the gender of the foetus. Materials and Methods: The selected study method comprised a retrospective data acquisition and evaluation from the Austrian birth register of the Department of Clinical Epidemiology of Tyrolean State Hospitals. For the analysis all inpatient singleton deliveries in Austria during the period from 2008 to 2013 were taken into account (live and stillbirths n = 444 685). The gender of the baby was correlated with previously defined, obstetrically relevant parameters. Results: In proportions, significantly more premature births and sub partu medical interventions (vaginal and abdominal surgical deliveries. episiotomies) were observed for male foetuses (p < 0.001). The neonatal outcome (5-min Apgar score, umbilical pH value less than 7.1, transfer to a neonatal special unit) is significantly poorer for boys (p < 0.001). Discussion: In view of the vulnerability of male foetuses and infants, further research is needed in order to be able to react appropriately to the differing gender-specific requirements in obstetrics. PMID:27065487

  12. Intraoperative cell salvage in obstetrics.

    PubMed

    Grainger, Hannah; Catling, Sue

    2011-08-01

    The use of Intraoperative Cell Salvage (ICS) in obstetrics has been slow to develop as a result of theoretical concerns relating to amniotic fluid embolism and fetal red cell contamination. In this article we examine the current UK position on the use of ICS in this clinical speciality and the recommendations for its safe and appropriate use. PMID:22029206

  13. Court-ordered obstetrical interventions.

    PubMed

    Kolder, V E; Gallagher, J; Parsons, M T

    1987-05-01

    In a national survey, we investigated the scope and circumstances of court-ordered obstetrical procedures in cases in which the women had refused therapy deemed necessary for the fetus. We also solicited the opinions of leading obstetricians regarding such cases. Court orders have been obtained for cesarean sections in 11 states, for hospital detentions in 2 states, and for intrauterine transfusions in 1 state. Among 21 cases in which court orders were sought, the orders were obtained in 86 percent; in 88 percent of those cases, the orders were received within six hours. Eighty-one percent of the women involved were black, Asian, or Hispanic, 44 percent were unmarried, and 24 percent did not speak English as their primary language. All the women were treated in a teaching-hospital clinic or were receiving public assistance. No important maternal morbidity or mortality was reported. Forty-six percent of the heads of fellowship programs in maternal-fetal medicine thought that women who refused medical advice and thereby endangered the life of the fetus should be detained. Forty-seven percent supported court orders for procedures such as intrauterine transfusions. We conclude from these data that court-ordered obstetrical procedures represent an important and growing problem that evokes sharply divided responses from faculty members in obstetrics. Such procedures are based on dubious legal grounds, and they may have far-reaching implications for obstetrical practice and maternal and infant health. PMID:3574370

  14. Continuum of Medical Education in Obstetrics and Gynecology.

    ERIC Educational Resources Information Center

    Dohner, Charles W.; Hunter, Charles A., Jr.

    1980-01-01

    Over the past eight years the obstetric and gynecology specialty has applied a system model of instructional planning to the continuum of medical education. The systems model of needs identification, preassessment, instructional objectives, instructional materials, learning experiences; and evaluation techniques directly related to objectives was…

  15. ADR Reporting by the General Public: Lessons Learnt from the Dutch and Swedish Systems.

    PubMed

    Härmark, Linda; van Hunsel, Florence; Grundmark, Birgitta

    2015-04-01

    Consumer reporting of adverse drug reactions (ADRs) has existed in several countries for decades, but throughout Europe the role of consumers as a source of information on ADRs has not been fully accepted until recently. In Europe, The Netherlands and Sweden were among the first countries to implement consumer reporting well before it was mandated by law throughout the EU. Consumer reporting is an integral part of the spontaneous reporting systems in both The Netherlands and Sweden, with yearly numbers of reports constantly increasing. Consumer reporting forms and handling procedures are essentially the same as for healthcare professional reporting; the message in the reports, not the type of messenger, is what is of importance. Studies have established the significant contribution of consumer reporting to ADR signal detection. Combining all reports regardless of reporter type is recommended since it yields the largest critical mass of reports for signal detection. Examples of signals where consumer reports have been of crucial importance for signal detection are electric shock-like sensations associated with the use of duloxetine, and persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors. An example of consumer reporting significantly strengthening a detected signal is Pandemrix(®) (influenza H1N1 vaccine)-induced narcolepsy. Raising public awareness of ADR reporting is important, but time- and resource-consuming. The minimum effort taken should be to passively inform consumers, e.g. via stakeholders' homepages and via drug product information leaflets. Another possibility of reaching out to this target group could be through co-operation with other (non-government) organizations. Information from consumer reports may give a new perspective on ADRs via the consumers' unfiltered experiences. Consumers' views may change the way the benefit-harm balance of drugs is perceived and assessed today, and, being the ultimate users

  16. Transitioning experienced registered nurses into an obstetrics specialty.

    PubMed

    Bell, Renee; Bossier-Bearden, Mary; Henry, Armilla A G; Kirksey, Kenn M

    2015-04-01

    Ensuring patient safety and enhancing nurse satisfaction both rank high on most hospitals' list of priorities. One of the concerns at a large, comprehensive, county health care system in the southwestern United States has been the shortage of experienced obstetrics (OB) nurses to provide patient care. To address this concern, a nursing fellowship was implemented to facilitate successful transition and retention of experienced RNs into the specialty area of obstetrics. The program provided a gateway for non-OB nurses to participate in relevant, evidence-based didactic and preceptor-facilitated clinical experiences to ensure adequate knowledge, skills, and competencies to care for patients in labor, delivery, and recovery suites. PMID:25856454

  17. Teamwork in obstetric critical care

    PubMed Central

    Guise, Jeanne-Marie; Segel, Sally

    2016-01-01

    Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well trained and competent medically, they have not traditionally been trained in how to work well as part of a team. Given the complexity and acuity of critical care medicine, which often relies on more than one medical team, teamwork skills are essential. This chapter discusses the history and importance of teamwork in high-reliability fields, reviews key concepts and skills in teamwork, and discusses approaches to training and working in teams. PMID:18701352

  18. Syntactic Persistence in Dutch.

    ERIC Educational Resources Information Center

    Hartsuiker, Robert J.; Kolk, Herman H. J.

    1998-01-01

    Three experiments are reported that showed effects of "structure priming," the tendency to repeat syntactic structure across successive sentences. These effects were demonstrated in Dutch, a previously untested language. All experiments studied spoken sentence production. (Author/JL)

  19. Obstetric Staffing in Small Hospitals

    PubMed Central

    Chance, G.W.; Campbell, M.K.

    1992-01-01

    Responses from 82 of the 100 Ontario hospitals with fewer than 750 births annually showed that a sufficient number of general practice obstetricians are replacing those who leave. However, we found a worsening shortage of general practice anesthetists and specialists required for obstetric emergencies, which could threaten care in such hospitals. Implications for training programs, physician remuneration, pregnancy risk determination, and regionalized perinatal care are briefly discussed.

  20. Barriers to formal emergency obstetric care services' utilization.

    PubMed

    Essendi, Hildah; Mills, Samuel; Fotso, Jean-Christophe

    2011-06-01

    Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be

  1. The key role of health insurance in a cost-effective health care system. Towards regulated competition in the Dutch medical market.

    PubMed

    van de Ven, W P

    1987-04-01

    The previous two sessions of this Symposium have dealt with incentives for cost-effective provider behaviour. Although incentive-reimbursement, which rewards the providers for delivery medical care in a cost-effective way, can be an important step towards a cost-effective health care system, it is not rewards the providers for delivering medical care in a cost-effective way, can be an important step towards a cost-effective health care system, it is not sufficient. As long as the insured consumers have both comprehensive health insurance coverage and freedom of choice of provider, providers will have great difficulty in resisting consumers' demand for ever more costly medical care, and politicians or other decision-makers will have great difficulty in restricting capacity and in preventing overcapacity. Fear of losing patients or voters might dominate. Therefore, in this session we shall focus on the key role of health insurance in a cost-effective health care system and on consumer incentives and insurer behaviour. If the consumers have a choice between several provider-insurer organizations. Although market forces do play an important role in a competitive health-care system, competition should not be confused with a "free market". Besides financial arrangements to protect the poor, pro-competitive regulation is needed to guarantee a "fair competition". Currently there is much consensus that the present Dutch health insurance system, in which 60% of the population is publicly insured and 40% is privately insured, should be replaced by a national health insurance scheme, which uniformly applies to the entire population. A few years ago, I made a proposal for such a scheme, which was based largely on the ideas of Ellwood, McClure, and Enthoven on competition between alternative delivery systems. The main features of this proposal will be discussed. In my opinion, the long-term prospects for regulated competition in the Dutch medical market seem rather favourable

  2. [Enigmas surrounding an obstetric forceps belonging to Albertus Titsingh (1714-1790)].

    PubMed

    Lammes, F B

    2005-12-24

    In the collections of the Society of the Dutch Journal of Medicine there is a small box containing a small obstetric forceps modelled on that of the British physician Smellie and some documents with information about its origin. The instrument belonged to the Amsterdam surgeon-obstetrician Albertus Titsingh and is claimed in the documentation to have been used during the birth of the later King William I (1772-1843) in 1772. However, historical research indicates that this is very unlikely: it is an established fact that the birth of William I was rapid and successful, while Albertus Titsingh was an authoritative obstetrician in an 'obstetric climate' of biding one's time and taking no action until the natural powers have failed. PMID:16402520

  3. An evaluation of obstetrical analgesia.

    PubMed

    FIST, H S

    1954-02-01

    Relief of pain and safety of mother and child are fundamentals in obstetrical analgesia. Elimination of those drugs which are ineffective or dangerous is the best guide to proper medication. Morphine, codeine, or similar opium derivatives should be avoided as they depress fetal respiration. Barbiturates have the same fault, despite their popularity. Demerol in small dosage is safe and effective. Scopolamine yields excellent results with safety. Magnesium sulfate potentiates and reinforces the action of scopolamine and involves no danger. This combination of drugs may be used by any competent general practitioner in the home or hospital. PMID:13126811

  4. Malpractice Burden, Rural Location, and Discontinuation of Obstetric Care: A Study of Obstetric Providers in Michigan

    PubMed Central

    Xu, Xiao; Siefert, Kristine A.; Jacobson, Peter D.; Lori, Jody R.; Gueorguieva, Iana; Ransom, Scott B.

    2011-01-01

    Context It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis. Purpose This study examined whether higher malpractice burden on obstetric providers was associated with an increased likelihood of discontinuing obstetric care and whether there were rural-urban differences in the relationship. Methods Data on 500 obstetrician-gynecologists and family physicians who had provided obstetric care at some point in their career (either currently or previously) were obtained from a statewide survey in Michigan. Statistical tests and multivariate regression analyses were performed to examine the interrelationship among malpractice burden, rural location, and discontinuation of obstetric care. Findings After adjusting for other factors that might influence a physician’s decision about whether to stop obstetric care, our results showed no significant impact of malpractice burden on physicians’ likelihood to discontinue obstetric care. Rural-urban location of the practice did not modify the nature of this relationship. However, family physicians in rural Michigan had a nearly four fold higher likelihood of withdrawing obstetric care when compared to urban family physicians. Conclusions The higher likelihood of rural family physicians to discontinue obstetric care should be carefully weighed in future interventions to preserve obstetric care supply. More research is needed to better understand the practice environment of rural family physicians and the reasons for their withdrawal from obstetric care. PMID:19166559

  5. [Shoulder dystocia: an obstetrical emergency].

    PubMed

    Marques, Joana Borges; Reynolds, Ana

    2011-01-01

    Shoulder dystocia is one of the most feared obstetric emergencies due to related maternal and neonatal complications and therefore, the growing of medico-legal litigation that it entails. Although associated with risk factors such as fetal macrossomia, gestacional diabetes and instrumented delivery, the majority of cases are unpredictable. The lack of a consensus on shoulder dystocia diagnosis causes variations on its incidence and hampers a more comprehensive analysis. Management guidelines described for its resolution include several manoeuvres but the ideal sequence of procedures is not clearly defined in more severe cases. Hands-on and team training, through simulation-based techniques applied to medicine, seems to be a promising method to learn how to deal with shoulder dystocia having in mind a reduction in related maternal or neonatal morbidity and mortality. The main goal of this paper is to provide a comprehensive revision of shoulder dystocia highlighting its relevance as an obstetric emergency. A reflection on the management is presented emphasising the importance of simulation-based training. PMID:22521019

  6. Fast MR imaging in obstetrics.

    PubMed

    Nagayama, Masako; Watanabe, Yuji; Okumura, Akira; Amoh, Yoshiki; Nakashita, Satoru; Dodo, Yoshihiro

    2002-01-01

    Ultrasonography (US) is the initial imaging modality of choice for evaluation of patients in obstetrics. However, the results of US are not always sufficient. Magnetic resonance (MR) imaging, which uses no ionizing radiation, may be an ideal method for further evaluation. Although MR imaging is not recommended during the first trimester and use of contrast material is not recommended in pregnant patients, fast MR imaging is useful in various obstetric settings and can provide more specific information with excellent tissue contrast and multiplanar views. In pregnant patients with acute conditions, various diseases (eg, red degeneration of a uterine leiomyoma) may be diagnosed. MR imaging allows characterization of pelvic masses discovered during pregnancy and diagnosis of postpartum complications (eg, abscess, hematoma, ovarian vein thrombosis). In pregnant patients with hydronephrosis, MR urography can demonstrate the site of obstruction and the cause (eg, a ureteral stone). MR pelvimetry may be beneficial in cases of breech presentation. Contrast material-enhanced dynamic MR imaging allows one to evaluate the vascularity of a placental polyp, detect the viable component of a gestational trophoblastic tumor, and diagnose a uterine arteriovenous malformation. MR imaging enables diagnosis of rare forms of ectopic pregnancy and early diagnosis of ectopic pregnancy. PMID:12006687

  7. Obstetric Provider Maldistribution: Georgia, USA, 2011.

    PubMed

    Spelke, Bridget; Zertuche, Adrienne D; Rochat, Roger

    2016-07-01

    Objectives In 2010, Georgia had the nation's highest maternal mortality rate, sixteenth highest infant mortality rate, and a waning obstetrician/gynecologist (ob/gyn) workforce. Statewide ob/gyn workforce data, however, masked obstetric-specific care shortages and regional variation in obstetric services. The Georgia Maternal and Infant Health Research Group thereby assessed each Georgia region's obstetric provider workforce to identify service-deficient areas. Methods We identified 63 birthing facilities in the 82 Primary Care Service Areas (PCSAs) outside metropolitan Atlanta and interviewed nurse managers and others to assess the age, sex, and expected departure year of each delivering professional. Using accepted annual delivery rates of 155 per obstetrician (OB), 100 per certified nurse midwife (CNM), and 70 per family medicine physician (FP) we converted obstetric providers into "OB equivalents" to standardize obstetric services available in any given area. Using facility births and computed OB equivalents (contemporary and 2020 estimates), we calculated current and projected average annual births per provider (AABP) for each PCSA, categorizing its obstetric provider workforce as "adequate" (AABP < 144), "at risk" (144 ≤ AABP ≤ 166), or "deficient" (AABP > 166). We mapped results using ArcGIS. Results Of 82 surveyed PCSAs, 52 % (43) were deficient in obstetric care; 16 % (13) had a shortage and 37 % (30) lacked obstetric providers entirely. There were no delivering FPs in 89 % (73) of PCSAs and no CNMs in 70 % (56). If Georgia fails to recruit delivering providers, 72 % (58/77) of PCSAs will have deficient or no obstetric care by 2020. Conclusions Obstetric provider shortages in Georgia hinder access to prenatal and delivery services. Care-deficient areas will expand if recruitment and retention of delivering professionals does not improve. PMID:27084367

  8. Invisible wounds: obstetric violence in the United States.

    PubMed

    Diaz-Tello, Farah

    2016-05-01

    In recent years, there has been growing public attention to a problem many US health institutions and providers disclaim: bullying and coercion of pregnant women during birth by health care personnel, known as obstetric violence. Through a series of real case studies, this article provides a legal practitioner's perspective on a systemic problem of institutionalized gender-based violence with only individual tort litigation as an avenue for redress, and even that largely out of reach for women. It provides an overview of the limitations of the civil justice system in addressing obstetric violence, and compares alternatives from Latin American jurisdictions. Finally, the article posits policy solutions for the legal system and health care systems. PMID:27578339

  9. [HYPNOSIS IN OBSTETRICS AND GYNECOLOGY].

    PubMed

    Rabinerson, David; Yeoshua, Effi; Gabbay-Ben-Ziv, Rinat

    2015-05-01

    Hypnosis is an ancient method of treatment, in which an enhanced state of mind and elevated susceptibility for suggestion of the patient, are increased. Hypnosis is executed, either by a caregiver or by the person himself (after brief training). The use of hypnosis in alleviating labor pain has been studied as of the second half of the 20th century. In early studies, the use of hypnosis for this purpose has been proven quite effective. However, later studies, performed in randomized controlled trial terms, have shown controversial results. Other studies, in which the effect of hypnosis was tested in various aspects of both obstetrics and gynecology and with different levels of success, are elaborated on in this review. PMID:26168643

  10. Autologous blood storage in obstetrics.

    PubMed

    Herbert, W N; Owen, H G; Collins, M L

    1988-08-01

    Autologous transfusion, storage of one's own blood for subsequent infusion if needed, is safe and effective in a variety of scheduled operative procedures. Obstetric involvement in such programs is very limited, however. Thirty pregnant women with placenta previa or other potential complications underwent 55 phlebotomies in an autologous transfusion program. Phlebotomies were performed at an average gestational age of 32.4 weeks (range 13-40). Changes in mean diastolic blood pressure and pulse were minimal. Electronic fetal monitoring tracings were normal during the 34 procedures in which it was used. The frequency of mild donor reactions (4%) was consistent with that in nonpregnant donors. After entry into this program, 15 patients received a total of 29 U of packed red blood cells (23 autologous; six homologous). Homologous transfusion was avoided in 86.7% of patients receiving blood. Selected pregnant women can participate safely in autologous blood collection programs, minimizing the need, and therefore the risks, of homologous transfusion. PMID:3292974

  11. 21 CFR 884.4900 - Obstetric table and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Obstetric table and accessories. 884.4900 Section 884.4900 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Surgical Devices § 884.4900 Obstetric table and...

  12. 21 CFR 884.4900 - Obstetric table and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Obstetric table and accessories. 884.4900 Section 884.4900 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Surgical Devices § 884.4900 Obstetric table and...

  13. Is Personalized Medicine Achievable in Obstetrics?

    PubMed Central

    Quinney, Sara K; Flockhart, David A; Patil, Avinash S

    2014-01-01

    Personalized medicine seeks to identify the right dose of the right drug for the right patient at the right time. Typically, individualization of therapy is based on the pharmacogenomic make-up of the individual and environmental factors that alter drug disposition and response. In addition to these factors, during pregnancy a woman’s body undergoes many changes that can impact the therapeutic efficacy of medications. Yet, there is minimal research regarding personalized medicine in obstetrics. Adoption of pharmacogenetic testing into the obstetrical care is dependent on evidence of analytical validity, clinical validity, and clinical utility. Here, we briefly present information regarding the potential utility of personalized medicine for treating the obstetric patient for pain with narcotics, hypertension, and preterm labor and discuss the impediments of bringing personalized medicine to the obstetrical clinic. PMID:25282474

  14. Dutch euthanasia revisited.

    PubMed

    Fenigsen, R

    1997-01-01

    The results of a follow-up study of euthanasia by the Dutch government, five years after the first study, were published on November 26, 1996. This article provides a detailed review of the two reports comparing and contrasting the statistics cited therein. The author notes that the "rules of careful conduct" proposed by the courts and by the Royal Dutch Society of Medicine were frequently disregarded. Special topics included for the first time in the second study were the notification and non-prosecution procedure, euthanasia of newborns and infants, and assisted suicide in psychiatric practice. The authors of the follow-up report state that it would be desirable to reduce the number of "terminations of life without patients' request," but this must be the common responsibility of the doctor and the patient. They suggest that the person who does not wish to have his life terminated should declare this clearly, in advance, verbally and in writing, preferably in the form of a living will. Involuntary euthanasia was rampant in 1990 and equally rampant in 1995. The author concludes that Dutch doctors who practice euthanasia are not on the slippery slope. From the very beginning, they have been at the bottom. PMID:9479883

  15. Tocolytic Drugs for Use in Veterinary Obstetrics

    PubMed Central

    Ménard, L.

    1984-01-01

    The author presents a literature review of two tocolytic agents used in veterinary obstetrics: isoxsuprine and clenbuterol. The medical background from which these drugs emerged for human use and to which is linked their application in animal medicine is described. Each drug is reviewed according to its pharmacology, basic considerations for its clinical use and the reports on its application in the treatment and management of obstetrical disorders in veterinary medicine. PMID:17422462

  16. Dutch national rainfallradar project: a unique corporation

    NASA Astrophysics Data System (ADS)

    Schuurmans, Hanneke; Maarten Verbree, Jan; Leijnse, Hidde; van Heeringen, Klaas-Jan; Uijlenhoet, Remko; Bierkens, Mark; van de Giesen, Nick; Gooijer, Jan; van den Houten, Gert

    2013-04-01

    Since January 2013 Dutch watermanagers have access to innovative high-quality rainfall data. This product is innovative because of the following reasons. (i) The product is developed in a 'golden triangle' construction - corporation between government, business and research institutes. (ii) Second the rainfall products are developed according to the open-source GPL license. The initiative comes from a group of water boards in the Netherlands that joined their forces to fund the development of a new rainfall product. Not only data from Dutch radar stations (as is currently done by the Dutch meteorological organization KNMI) is used but also data from radars in Germany and Belgium. After a radarcomposite is made, it is adjusted according to data from raingauges (ground truth). This results in 9 different rainfall products that give for each moment the best rainfall data. This data will be used, depending on the end-user for several applications: (i) forecasts: input for flood early warning systems, (ii) water system analysis: hydrological model input, (iii) optimization: real time control and (iv) investigation of incidents: in case of flooding, who's responsible. The latter is mainly insight in the return period of heavy rainfall events. More info (in Dutch): www.nationaleregenradar.nl

  17. The laryngeal mask airway in obstetrical anaesthesia.

    PubMed

    Gataure, P S; Hughes, J A

    1995-02-01

    The laryngeal mask airway (LMA) has been used extensively to provide a safe airway in spontaneously breathing patients who are not at risk from aspiration of gastric contents. The role of the LMA in the event of a failed intubation in an obstetrical patient, and its place in a failed intubation drill remains unclear. Two hundred and fifty consultant obstetric anaesthetists in the United Kingdom were asked to complete an anonymous questionnaire regarding their views about using the laryngeal mask airway (LMA) in obstetrical anaesthesia. The LMA was available in 91.4% of obstetric units. Seventy-two per cent of anaesthetists were in favour of using the LMA to maintain oxygenation when tracheal intubation had failed and ventilation using a face mask was inadequate. Twenty-four respondents had had personal experience with the LMA in obstetrical anaesthesia, eight of whom stated that the LMA had proved to be a lifesaver. We believe that the LMA has a role in obstetrical anaesthesia when tracheal intubation has failed and ventilation using a face mask proves to be impossible, and it should be inserted before attempting cricothyroidectomy. PMID:7720155

  18. Shaping the System – The DRG Evaluation Project of the German Society for Gynaecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG)

    PubMed Central

    Fiori, W.; Renner, S. P.; Siam, K.; Babapirali, J.; Roeder, N.; Dausch, E.; Hildebrandt, T.; Hillemanns, P.; Nehmzow, M.; Zygmunt, M.; Piroth, D.; Schem, C.; Schwenzer, T.; Friese, K.; Wallwiener, D.; Beckmann, M. W.

    2013-01-01

    Introduction: The German DRG system is annually adapted to the changing services provided. For the further development, the self-governing body and its DRG Institute (InEK) depend on participation of the users. Methods: For one of the DRG evaluation projects initiated by DGGG, cost and performance data for the year 2011 from 16 hospitals were available. After plausibility checks and corrections, analyses for service and cost homogeneity were performed. In cases of inadequate DRG-representation attributes were sought that would make an appropriate reimbursement possible. Conspicuities and potential solutions were checked for clinical plausibility. Results: 44 concrete modification proposals for further development of the G-DRG system were formulated and submitted in due time to the InEK. In addition, 3 modification proposals were addressed to the German Institute for Medical Documentation and Information (Deutsches Institut für Medizinische Dokumentation und Information, DIMDI) for further development of the diagnosis classification ICD-10-GM. For all modification proposals care was taken to minimise misdirected incentives and to reduce the potential for disputes with the cost bearers and their auditors services in settlements. Discussion: The publication of the G-DRG system 2014 shows which modification proposals have been realised. Essentially, an appropriate redistribution of the resources among the gynaecological and obstetrics departments is to be expected. The financial pressure that is caused by the generally inadequate financing of hospitals will not be reduced by a further development of the G-DRG system. PMID:24771931

  19. The development of an obstetric triage acuity tool.

    PubMed

    Paisley, Kathleen S; Wallace, Ruth; DuRant, Patricia G

    2011-01-01

    The purpose of this article is to describe the journey a multicampus hospital system took to improve the obstetric triage process. A review of literature revealed no current comprehensive obstetric acuity tool, and thus our team developed a tool with a patient flow process, revised and updated triage nurse competencies, and then educated the nurses about the new tool and process. Data were collected to assess the functionality of the new process in assigning acuity upon patient arrival, conveying appropriate acuities based on patient complaints, and initiating the medical screening examination, all within prescribed time intervals. Initially data indicated that processes were still not optimal, and re-education was provided for all triage nurses. This improved all data points. The result of this QI project is that our patients are now seen based on their acuity within designated time frames. PMID:21857199

  20. Obstetric audit: the Bradford way

    PubMed Central

    Lomas, Karen; Jaworskyj, Suzanne; Thomson, Heidi

    2014-01-01

    Ultrasound is widely used as a screening tool in obstetrics with the aim of reducing maternal and foetal morbidity. However, to be effective it is recommended that scanning services follow standard protocols based on national guidelines and that scanning practice is audited to ensure consistency. Bradford has a multi-ethnic population with one of the highest rates of birth defects in the UK and it requires an effective foetal anomaly screening service. We implemented a rolling programme of audits of dating scans, foetal anomaly scans and growth scans carried out by sonographers in Bradford. All three categories of scan were audited using measurable parameters based on national guidelines. Following feedback and re-training to address issues identified, re-audits of dating and foetal anomaly scans were carried out. In both cases, sonographers being re-audited had a marked improvement in their practice. Analysis of foetal abnormality detection rates showed that as a department, we were reaching the nationally agreed detection rates for the Fetal Anomaly Screening Programme auditable conditions. Audit has been shown to be a useful and essential process in achieving consistent scanning practices and high quality images and measurements.

  1. Obstetric hemorrhage: A global review.

    PubMed

    Goffman, Dena; Nathan, Lisa; Chazotte, Cynthia

    2016-03-01

    Postpartum hemorrhage remains the number one cause of maternal death globally despite the fact that it is largely a preventable and most often a treatable condition. While the global problem is appreciated, some may not realize that in the United States postpartum hemorrhage is a leading cause of mortality and unfortunately, the incidence is on the rise. In New York, obstetric hemorrhage is the second leading cause of maternal mortality in the state. National data suggests that hemorrhage is disproportionally overrepresented as a contributor to severe maternal morbidity and we suspect as we explore further this will be true in New York State as well. Given the persistent and significant contribution to maternal mortality, it may be useful to analyze the persistence of this largely preventable cause of death within the framework of the historic "Three Delays" model of maternal mortality. The ongoing national and statewide problem with postpartum hemorrhage will be reviewed in this context of delays in an effort to inform potential solutions. PMID:26742599

  2. Will Dutch Become Flemish? Autonomous Developments in Belgian Dutch

    ERIC Educational Resources Information Center

    Van de Velde, Hans; Kissine, Mikhail; Tops, Evie; van der Harst, Sander; van Hout, Roeland

    2010-01-01

    In this paper a series of studies of standard Dutch pronunciation in Belgium and the Netherlands is presented. The research is based on two speech corpora: a diachronic corpus of radio speech (1935-1995) and a synchronic corpus of Belgian and Netherlandic standard Dutch from different regions at the turn of the millennium. It is shown that two…

  3. Natural and built environmental exposures on children's active school travel: A Dutch global positioning system-based cross-sectional study.

    PubMed

    Helbich, Marco; Emmichoven, Maarten J Zeylmans van; Dijst, Martin J; Kwan, Mei-Po; Pierik, Frank H; Vries, Sanne I de

    2016-05-01

    Physical inactivity among children is on the rise. Active transport to school (ATS), namely walking and cycling there, adds to children's activity level. Little is known about how exposures along actual routes influence children's transport behavior. This study examined how natural and built environments influence mode choice among Dutch children aged 6-11 years. 623 school trips were tracked with global positioning system. Natural and built environmental exposures were determined by means of a geographic information system and their associations with children's active/passive mode choice were analyzed using mixed models. The actual commuted distance is inversely associated with ATS when only personal, traffic safety, and weather features are considered. When the model is adjusted for urban environments, the results are reversed and distance is no longer significant, whereas well-connected streets and cycling lanes are positively associated with ATS. Neither green space nor weather is significant. As distance is not apparent as a constraining travel determinant when moving through urban landscapes, planning authorities should support children's ATS by providing well-designed cities. PMID:27010106

  4. Pennsylvania Dutch Crafts and Culture

    ERIC Educational Resources Information Center

    Turner, Dianne

    2008-01-01

    Many people hold two common misconceptions about the Pennsylvania Dutch: first, that these people live exclusively in the state of Pennsylvania; second, that their ancestors came from Holland. However, neither assumption is correct. One can find large Pennsylvania Dutch communities in Mary land, West Virginia, Virginia, the Carolinas, Ohio,…

  5. Pakistan: the Faisalabad Obstetric Flying Squad.

    PubMed

    Andina, M M; Fikree, F F

    1995-01-01

    The Faisalabad Obstetric Flying Squad was established in 1988 and provides access to emergency obstetric services for the poor women of Faisalabad. The service is highly appreciated by both women and participating dais. The latter receive training from the Mother and Child Welfare Association of Faisalabad and form an integral part of the obstetric care team. While problems in accessing communication facilities exist, the project has made a lasting impact on the provision of emergency obstetric services in the city. Improved recording and reporting mechanisms would permit a more precise assessment of the impact of the service on the reduction of maternal morbidity and mortality. It would also permit an assessment of the operating costs of the service. One of the reasons the service functions effectively is that it is fully integrated into the general operations of the Allied Hospital. If similar institutional mechanisms can be established there is good reason to think that the Faisalabad Obstetric Flying Squad could be replicated in other developing country settings. PMID:7571713

  6. Acute myocardial infarction in the obstetric patient

    PubMed Central

    Firoz, Tabassum; Magee, Laura A

    2012-01-01

    Acute myocardial infraction (AMI) in the obstetric patient is a rare event, although the incidence is rising due to advancing maternal age and pre-existing cardiac risk factors and medical co-morbidities. While atherosclerotic disease is the leading cause of AMI, coronary artery dissection is an important consideration in pregnancy and in the postpartum period. The physiological changes of pregnancy as well as pregnancy-specific risk factors can predispose the obstetric patient to AMI. Diagnosis of AMI can be challenging as symptoms may be atypical. Furthermore, diagnostic tests must be interpreted in the context of pregnancy. While the overall management of the obstetric patient with AMI is similar to that outside of pregnancy, drug therapy requires modification as some medications may be contraindicated in pregnancy and breastfeeding. There is limited information about prognosis and risk stratification but it is anticipated that future studies will address this issue.

  7. The usage of blood components in obstetrics.

    PubMed

    Adukauskienė, Dalia; Veikutienė, Audronė; Adukauskaitė, Agnė; Veikutis, Vincentas; Rimaitis, Kęstutis

    2010-01-01

    Major obstetric hemorrhage remains the leading cause of maternal morbidity and mortality worldwide. Even though blood transfusion may be a life-saving procedure, an inappropriate usage of blood products in obstetric emergencies especially in cases of massive bleeding is associated with increased morbidity and risk of death. Thorough knowledge of the etiology, pathophysiology, and optimal therapeutic options of major obstetric hemorrhage may help to avoid lethal outcomes. There are evidence-based data about some risks related with transfusion of blood components: acute or delayed hemolytic, febrile, allergic reactions, transfusion-related acute lung injury, negative immunomodulative effect, transmission of infectious diseases, dissemination of cancer. This is why the indications for allogeneic blood transfusion are restricted, and new safer methods are being discovered to decrease the requirement for it. Red cell alloimmunization may develop in pregnancy; therefore, all pregnant women should pass screening for irregular antibodies. Antierythrocytic irregular antibodies may occur due to previous pregnancies or allogeneic red blood cell transfusions, and it is important for blood cross-matching in the future. Under certain circumstances, such as complicated maternal history, severe coagulation abnormalities, severe anemia, the preparation of cross-matched blood is necessary. There is evidence of very significant variation in the use of blood products (red cells, platelets, fresh frozen plasma, or cryoprecipitate) among clinicians in various medical institutions, and sometimes indications for transfusion are not correctly motivated. The transfusion of each single blood product must be performed only in case of evaluation of expected effect. The need for blood products and for their combination is necessary to estimate for each patient individually in case of obstetric emergencies either. Indications for transfusion of blood components in obstetrics are presented in

  8. Methicillin-resistant Staphylococcus aureus in obstetrics.

    PubMed

    Sheffield, Jeanne S

    2013-02-01

    Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the major multiple antibiotic-resistant bacterial pathogens causing serious community-associated and health care-associated infections. It is now pervasive in the obstetric population associated with skin and soft tissue infections, mastitis, episiotomy, and cesarean wound infections and urinary tract infections. This review addresses the epidemiology, definitions, microbiology, and pathogenesis as well as common clinical presentations. A discussion of the 2011 Infectious Diseases Society of America MRSA treatment guidelines details available antibiotics, invasive and noninvasive MRSA management, and specific factors related to obstetrics. Finally, prevention strategies including decolonization are discussed. PMID:23292915

  9. Vasopressors in obstetric anesthesia: A current perspective

    PubMed Central

    Nag, Deb Sanjay; Samaddar, Devi Prasad; Chatterjee, Abhishek; Kumar, Himanshu; Dembla, Ankur

    2015-01-01

    Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point where phenylephrine has become the preferred vasopressor. Due to the absence of definitive evidence showing absolute clinical benefit of one over the other, especially in emergency and high-risk Cesarean sections, our choice of phenylephrine over the other vasopressors like mephentermine, metaraminol, and ephedrine is guided by indirect evidence on fetal acid-base status. This review article evaluates the present day evidence on the various vasopressors used in obstetric anesthesia today. PMID:25610851

  10. [Sexual medicine in obstetrics and gynecology].

    PubMed

    Fornage, Sandra; Bianchi-Demicheli, Francesco

    2016-03-16

    Obstetrics and gynecology specialists should be women's favoured interlocutors when talking about their sexuality. Indeed every day they assess their patient's intimacy, they manage pathologies that have a potential but well-known impact on sexuality, and they are very early aware of a more global approach like psycho-somatic. Furthermore, women are going to meet their obstetrician and gynecologist through all ages, from adolescence to post-menopause. At every step sexual problems can occur that can be searched, investigated and mostly managed by this specialist. The relationship between female sexual medicine and obstetrics and gynecology is undeniable and deserve to be favoured and consolidated. PMID:27149716

  11. The Dutch experience.

    PubMed

    Hendin, Herbert

    2002-01-01

    Euthanasia has been legally sanctioned in the Netherlands by a series of court decisions going back to the 1970s. The author discusses the cultural and historical factors that may have contributed to this development. In the past decade, studies sanctioned by the Dutch government reveal that guidelines established for the regulation of euthanasia--a voluntary, well-considered, persistent request, intolerable suffering that cannot be relieved, consultation with a colleague, and reporting of cases--are consistently violated. Of greatest concern is the number of patients who are put to death without their consent--there are more involuntary than voluntary cases. Euthanasia intended originally for the exceptional case has become an accepted way of dealing with the physical and mental distress of serious or terminal illness. In the process palliative care has become one of the casualties while hospice care lags behind that of other countries. Case examples are given. PMID:11925835

  12. The Current Status and Future of Academic Obstetrics.

    ERIC Educational Resources Information Center

    Bowers, John Z., Ed.; Purcell, Elizabeth F., Ed.

    The state of research in academic obstetrics and its relationship to research in other academic disciplines was addressed in a 1979 conference. Participants included representatives of academic obstetrics, academic pediatrics, and public health. After an introductory discussion by Howard C. Taylor, Jr. on changes in obstetrics in the last 25…

  13. 21 CFR 884.5100 - Obstetric anesthesia set.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Obstetric anesthesia set. 884.5100 Section 884... § 884.5100 Obstetric anesthesia set. (a) Identification. An obstetric anesthesia set is an assembly of... anesthetic drug. This device is used to administer regional blocks (e.g., paracervical, uterosacral,...

  14. 21 CFR 884.5100 - Obstetric anesthesia set.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Obstetric anesthesia set. 884.5100 Section 884... § 884.5100 Obstetric anesthesia set. (a) Identification. An obstetric anesthesia set is an assembly of... anesthetic drug. This device is used to administer regional blocks (e.g., paracervical, uterosacral,...

  15. 21 CFR 884.5100 - Obstetric anesthesia set.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Obstetric anesthesia set. 884.5100 Section 884... § 884.5100 Obstetric anesthesia set. (a) Identification. An obstetric anesthesia set is an assembly of... anesthetic drug. This device is used to administer regional blocks (e.g., paracervical, uterosacral,...

  16. 21 CFR 884.5100 - Obstetric anesthesia set.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Obstetric anesthesia set. 884.5100 Section 884... § 884.5100 Obstetric anesthesia set. (a) Identification. An obstetric anesthesia set is an assembly of... anesthetic drug. This device is used to administer regional blocks (e.g., paracervical, uterosacral,...

  17. 21 CFR 884.2960 - Obstetric ultrasonic transducer and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Obstetric ultrasonic transducer and accessories... Monitoring Devices § 884.2960 Obstetric ultrasonic transducer and accessories. (a) Identification. An obstetric ultrasonic transducer is a device used to apply ultrasonic energy to, and to receive...

  18. 21 CFR 884.2960 - Obstetric ultrasonic transducer and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Obstetric ultrasonic transducer and accessories... Monitoring Devices § 884.2960 Obstetric ultrasonic transducer and accessories. (a) Identification. An obstetric ultrasonic transducer is a device used to apply ultrasonic energy to, and to receive...

  19. 21 CFR 884.2960 - Obstetric ultrasonic transducer and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Obstetric ultrasonic transducer and accessories... Monitoring Devices § 884.2960 Obstetric ultrasonic transducer and accessories. (a) Identification. An obstetric ultrasonic transducer is a device used to apply ultrasonic energy to, and to receive...

  20. 21 CFR 884.2960 - Obstetric ultrasonic transducer and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric ultrasonic transducer and accessories... Monitoring Devices § 884.2960 Obstetric ultrasonic transducer and accessories. (a) Identification. An obstetric ultrasonic transducer is a device used to apply ultrasonic energy to, and to receive...

  1. 21 CFR 884.2960 - Obstetric ultrasonic transducer and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Obstetric ultrasonic transducer and accessories... Monitoring Devices § 884.2960 Obstetric ultrasonic transducer and accessories. (a) Identification. An obstetric ultrasonic transducer is a device used to apply ultrasonic energy to, and to receive...

  2. 21 CFR 884.5100 - Obstetric anesthesia set.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric anesthesia set. 884.5100 Section 884.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... § 884.5100 Obstetric anesthesia set. (a) Identification. An obstetric anesthesia set is an assembly...

  3. 21 CFR 884.4900 - Obstetric table and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Obstetric table and accessories. 884.4900 Section 884.4900 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological...

  4. 21 CFR 884.4900 - Obstetric table and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric table and accessories. 884.4900 Section 884.4900 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological...

  5. 21 CFR 884.4900 - Obstetric table and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Obstetric table and accessories. 884.4900 Section 884.4900 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological...

  6. Towards Evidence-Based, Quality-Controlled Health Promotion: The Dutch Recognition System for Health Promotion Interventions

    ERIC Educational Resources Information Center

    Brug, Johannes; van Dale, Djoeke; Lanting, Loes; Kremers, Stef; Veenhof, Cindy; Leurs, Mariken; van Yperen, Tom; Kok, Gerjo

    2010-01-01

    Registration or recognition systems for best-practice health promotion interventions may contribute to better quality assurance and control in health promotion practice. In the Netherlands, such a system has been developed and is being implemented aiming to provide policy makers and professionals with more information on the quality and…

  7. A qualitative study of the experience of obstetric fistula survivors in Addis Ababa, Ethiopia

    PubMed Central

    Gebresilase, Yenenesh Tadesse

    2014-01-01

    Research on obstetric fistula has paid limited attention to the lived experiences of survivors. This qualitative study explored the evolution of survivors’ perceptions of their social relationships and health since developing this obstetric complication. In-depth interviews were conducted with eight survivors who were selected based on purposive and snowball sampling techniques. Thematic categorization and content analysis was used to analyze the data. The resultant themes included participants’ understanding of factors predisposing to fistula, challenges they encounter, their coping responses, and the meaning of their experiences. First, the participants had a common understanding of the factors that predisposed them to obstetric fistula. They mentioned poor knowledge about pregnancy, early marriage, cultural practices, and a delay in or lack of access to emergency obstetric care. Second, the participants suffered from powerlessness experienced during their childhood and married lives. They also faced prolonged obstructed labor, physical injury, emotional breakdown, depression, erosion of social capital, and loss of healthy years. Third, to control their negative emotions, participants reported isolating themselves, having suicidal thoughts, positive interpretation about the future, and avoidance. To obtain relief from their disease, the women used their family support, sold their properties, and oriented to reality. Fourth, the participants were struggling to keep going, to accept their changed reality, and to change their perspectives on life. In conclusion, obstetric fistula has significant physical, psychosocial, and emotional consequences. The study participants were not passive victims but rather active survivors of these challenges. Adequate support was not provided by their formal or informal support systems. To prevent and manage obstetric fistula successfully, there should be family-based interventions that improve access to and provision of

  8. Vaginal versus Obstetric Infection Escherichia coli Isolates among Pregnant Women: Antimicrobial Resistance and Genetic Virulence Profile

    PubMed Central

    Sáez-López, Emma; Guiral, Elisabet; Fernández-Orth, Dietmar; Villanueva, Sonia; Goncé, Anna; López, Marta; Teixidó, Irene; Pericot, Anna; Figueras, Francesc; Palacio, Montse; Cobo, Teresa; Bosch, Jordi; Soto, Sara M.

    2016-01-01

    Vaginal Escherichia coli colonization is related to obstetric infections and the consequent development of infections in newborns. Ampicillin resistance among E. coli strains is increasing, which is the main choice for treating empirically many obstetric and neonatal infections. Vaginal E. coli strains are very similar to extraintestinal pathogenic E. coli with regards to the virulence factors and the belonging to phylogroup B2. We studied the antimicrobial resistance and the genetic virulence profile of 82 E. coli isolates from 638 vaginal samples and 63 isolated from endometrial aspirate, placental and amniotic fluid samples from pregnant women with obstetric infections. The prevalence of E. coli in the vaginal samples was 13%, which was significant among women with associated risk factors during pregnancy, especially premature preterm rupture of membranes (p<0.0001). Sixty-five percent of the strains were ampicillin-resistant. The E. coli isolates causing obstetric infections showed higher resistance levels than vaginal isolates, particularly for gentamicin (p = 0.001). The most prevalent virulence factor genes were those related to the iron uptake systems revealing clear targets for interventions. More than 50% of the isolates belonged to the virulent B2 group possessing the highest number of virulence factor genes. The ampicillin-resistant isolates had high number of virulence factors primarily related to pathogenicity islands, and the remarkable gentamicin resistance in E. coli isolates from women presenting obstetric infections, the choice of the most appropriate empiric treatment and clinical management of pregnant women and neonates should be carefully made. Taking into account host-susceptibility, the heterogeneity of E. coli due to evolution over time and the geographical area, characterization of E. coli isolates colonizing the vagina and causing obstetric infections in different regions may help to develop interventions and avoid the aetiological link

  9. The soil-water system as basis for a climate proof and healthy urban environment: opportunities identified in a Dutch case-study.

    PubMed

    Claessens, Jacqueline; Schram-Bijkerk, Dieneke; Dirven-van Breemen, Liesbet; Otte, Piet; van Wijnen, Harm

    2014-07-01

    One of the effects of climate change expected to take place in urban areas in the Netherlands is an increase in periods of extreme heat and drought. How the soil can contribute to making cities more climate proof is often neglected. Unsealed soil and green spaces increase water storage capacity and can consequently prevent flooding. The planning of public or private green spaces can have a cooling effect and, in general, have a positive effect on how people perceive their health. This paper reviews existing guidelines from Dutch policy documents regarding unsealed soil and green spaces in the Netherlands; do they support climate adaptation policies? Scientific literature was used to quantify the positive effects of green spaces on water storage capacity, cooling and public health. Finally we present a case study of a model town where different policy areas are linked together. Maps were made to provide insight into the ratio of unsealed soil and the number of green spaces in relation to existing guidelines using Geographical Information Systems (GIS). Maps marking the age and social-economic status of the population were also made. The benefits of green spaces are difficult to express in averages because they depend on many different factors such as soil properties, type of green spaces, population characteristics and spatial planning. Moreover, it is not possible to provide quantifications of the benefits of green spaces because of a lack of scientific evidence at the moment. Based on the maps, however, policy assessments can be made, for example, in which site a neighborhood will most benefit from investment in parks and public gardens. Neighborhoods where people have a low social-economic status have for example fewer green spaces than others. This offers opportunities for efficient adaptation policies linking goals of several policy fields. PMID:24656988

  10. Integrating Prevention into Obstetrics/Gynecology.

    ERIC Educational Resources Information Center

    Carey, J. Christopher

    2000-01-01

    Discusses formats to teach preventive medicine in obstetrics and gynecology (including learning objectives, lectures/seminars, and rounds/office practice) and evaluation methods (oral examinations, computerized question banks, objective structured clinical examinations). Offers examples from specific programs at American medical schools, including…

  11. [Extraclinical obstetrics in the GDR? Medicohistorical notes].

    PubMed

    Major, S; David, M; Vetter, K

    2004-02-01

    In 1946 the share of clinic deliveries in the Soviet occupation zone amounted to 27 %, 1970 the given share of clinic deliveries in the GDR come to 99 %. From the beginning of the seventies home deliveries were not listed any more in the official statistics. After that neither the home obstetrics nor the family orientated clinical obstetrics took a larger space in the scientific discussions in the specialist public of the GDR. The following will show the development of the extraclinical obstetrics on the territory of the GDR as well as describe and discuss its medical and social context from the end of the forties until 1989. Usually in the (critical) reflections of the revival of home resp. extraclinical obstetrics in the eighties and nineties only the development in the "old" Federal Republic is taken into consideration. A description of the medicohistorical development in the former GDR in order to complete the all-German way of looking at this phenomenon was still due until now. PMID:14981563

  12. Marketing the nursing practice of obstetrics.

    PubMed

    Dill, P Z

    1991-01-01

    This article offers nurses a conceptual framework for marketing their skills and discusses how that framework can be applied to obstetric nursing practice. A thorough understanding of the framework presented will provide maternity nurses with the foundation they need to participate effectively in a marketing plan. Examples of the application of the framework to specific clinical situations are examined. PMID:1941295

  13. [Development of an obstetrical pocket slide rule].

    PubMed

    Krüger, G

    1986-01-01

    We present a slide rule to value old obstetric and ultrasound findings in prenatal care day by day. We have developed the scale. Manufacturer is VEB Mantissa Dresden, sales department is Staatliches Versorgungskontor für Pharmazie und Medizintechnik. PMID:3727852

  14. Inflammatory responses to infection: the Dutch contribution.

    PubMed

    Nolte, Martijn A; van der Meer, Jos W M

    2014-12-01

    At any given moment, our body is under attack by a large variety of pathogens, which aim to enter and use our body to propagate and disseminate. The extensive cellular and molecular complexity of our immune system enables us to efficiently eliminate invading pathogens or at least develop a condition in which propagation of the microorganism is reduced to a minimum. Yet, the evolutionary pressure on pathogens to circumvent our immune defense mechanisms is immense, which continuously leads to the development of novel pathogenic strains that challenge the health of mankind. Understanding this battle between pathogen and the immune system has been a fruitful area of immunological research over the last century and will continue to do so for many years. In this review, which has been written on the occasion of the 50th anniversary of the Dutch Society for Immunology, we provide an overview of the major contributions that Dutch immunologists and infection biologists have made in the last decades on the inflammatory response to viral, bacterial, fungal or parasitic infections. We focus on those studies that have addressed both the host and the pathogen, as these are most interesting from an immunological point of view. Although it is not possible to completely cover this comprehensive research field, this review does provide an interesting overview of Dutch research on inflammatory responses to infection. PMID:25455597

  15. Beta-adrenoceptors in obstetrics and gynecology.

    PubMed

    Modzelewska, Beata

    2016-01-01

    One hundred and twenty years after the description of extracts from the adrenal medulla, the use of beta-blockers and beta-agonists evolved from antianginal drugs and tocolytics to ligand-directed signaling. Beta-blockers in the fields of obstetrics and gynecology have so far been limited to the consideration of continuing treatment of disorders of the cardiovascular system and other dysfunctions that started before pregnancy. Studies in recent years have shown that beta-adrenoceptor signaling might be crucial in carcinogenesis and metastasis, apoptosis and anoikis. On the other hand, the use of beta-adrenoceptor agonists in tocolysis is, as yet, the primary method for inhibiting premature uterine contractions. Unfortunately, the efficacy of current pharmacological treatment for the management of preterm labor is regularly questioned. Moreover, studies related to non-pregnant myometrium performed to date indicate that the rhythmic contractions of the uterus are required for menstruation and have an important role in human reproduction. In turn, abnormal uterine contractility has been linked to dysmenorrhea, a condition associated with painful uterine cramping. The benefits of the use of beta2-adrenoceptor agonists in dysmenorrhea are still unclear and should be balanced against a wide range of adverse effects recognized with this class of medication. The ideal tocolytic agent is one which is effective for the pregnant or non-pregnant woman but has no side effects on either the woman or the baby. Looking to the future with both caution and hope, the potential metamorphosis of beta3-adrenoceptor agonists from experimental tools into therapeutic drugs for tocolysis warrants attention. PMID:27442692

  16. Global obstetric medicine: Collaborating towards global progress in maternal health

    PubMed Central

    Ateka-Barrutia, Oier; Rojas-Suarez, Jose Antonio; Wijeyaratne, Chandrika; Castillo, Eliana; Lombaard, Hennie; Magee, Laura A

    2015-01-01

    Globally, the nature of maternal mortality and morbidity is shifting from direct obstetric causes to an increasing proportion of indirect causes due to chronic conditions and ageing of the maternal population. Obstetric medicine can address an important gap in the care of women by broadening its scope to include colleagues, communities and countries that do not yet have established obstetric medicine training, education and resources. We present the concept of global obstetric medicine by highlighting three low- and middle-income country experiences as well as an example of successful collaboration. The article also discusses ideas and initiatives to build future partnerships within the global obstetric medicine community. PMID:27512469

  17. Selected maternal morbidities in women with a prior caesarean delivery planning vaginal birth or elective repeat caesarean section: a retrospective cohort analysis using data from the UK Obstetric Surveillance System

    PubMed Central

    Nair, Manisha; Soffer, Kate; Noor, Nudrat; Knight, Marian; Griffiths, Malcolm

    2015-01-01

    Objective To conduct a secondary analysis of data from the UK Obstetric Surveillance System (UKOSS) to estimate the rates of specific maternal risks associated with planned vaginal birth after caesarean (VBAC) and elective repeat caesarean section (ERCS). Design A retrospective cohort analysis using UKOSS data from 4 studies conducted between 2005 and 2012. Setting All hospitals with consultant-led maternity units in the UK. Population Pregnant women who had a previous caesarean section. Method Women who had undergone a previous caesarean section were divided into 2 exposure groups: planned VBAC and ERCS. We calculated the incidence of each of the 4 outcomes of interest with 95% CIs for the 2 exposure groups using proxy denominators (total estimated VBAC and ERCS maternities in a given year). Incidences were compared between groups using χ2 test or Fisher's exact test and risk ratios with 95% CI. Main outcome measures Severe maternal morbidities: peripartum hysterectomy, severe sepsis, peripartum haemorrhage and failed tracheal intubation. Results The risks of all complications examined in both groups were low. The rates of peripartum hysterectomy, severe sepsis, peripartum haemorrhage and failed tracheal intubation were not significantly different between the 2 groups in absolute or relative terms. Conclusions While the risk of uterine rupture in the VBAC and ERCS groups is well understood, this national study did not demonstrate any other clear differences in the outcomes we examined. The absolute and relative risks of maternal complications were small in both groups. Large epidemiological studies could further help to assess whether the incidence of these rare outcomes would significantly differ between the VBAC and ERCS groups if a larger number of cases were to be examined. In the interim, this study provides important information to help pregnant women in their decision-making process. PMID:26038358

  18. Strengthening infectious disease surveillance in a Dutch-German crossborder area using a real-time information exchange system.

    PubMed

    ter Waarbeek, Henriëtte; Hoebe, Christian; Freund, Hermann; Bochat, Verena; Kara-Zaïtr, Chakib

    2011-06-01

    International outbreaks are occurring much faster than before and require rapid trans-national detection and response. Never before has there been a more urgent need for improved crossborder collaboration on harmonisation of surveillance and response systems despite varying legislations. In the Euregion Maas Rhine, the Public Health Services of South Limburg in the Netherlands and Aachen in Germany agreed to join forces to work on a collaborative tool for sharing real-time infectious disease data. Both units had already implemented an adapted version of HPZone (a web-based software suite for managing infectious diseases at the local level). The collaborative work was realised through finding solutions to five key challenges. First, Euregional disease protocols were agreed commensurate with national guidelines. Secondly, a minimal dataset for infectious disease exchange information was negotiated taking into consideration international health regulations and differences in legislation. Thirdly, a mature risk assessment model for infectious disease was augmented to account for transborder spread and Euregional impact. Fourthly, protocol alert rules were negotiated on triggers for early warning. Finally, a crossborder dashboard, as a component of HPVista and encapsulating the four previous deliverables into a secure web-based system, was developed. HPVista is the parent application to HPZone and enables wider incident command and control regionally, nationally and internationally. The dashboard has facilities for displaying what, when, where and how cases, contacts and outbreaks happen in the crossborder area. It also provides secure communications for further discussion and exchange of other key information not currently shared electronically. The collaborative work embedded in the modified HPZone and HPVista versions with real-time surveillance and geographical information system mapping readily facilitates the systematic analysis of crossborder health incidents in

  19. Prospective monitoring study: isolating Legionella pneumophila in a hospital water system located in the obstetrics and gynecology ward after eradication of Legionella anisa and reconstruction of shower units.

    PubMed

    Koide, Michio; Owan, Tomoko; Nakasone, Chikara; Yamamoto, Natsuo; Haranaga, Shusaku; Higa, Futoshi; Tateyama, Masao; Yamane, Nobuhisa; Fujita, Jiro

    2007-02-01

    We previously reported on the sporadic contamination by Legionella anisa of shower units and sink taps at Ryukyu University Hospital. Starting in July 2003, the neonatal area underwent an 8-month reconstruction, and in March 2005, the boiler system was replaced. We therefore examined shower water and tap water for the presence of Legionella just after replacement of the boiler system. In 3 of the 8 water samples collected from the remodeled area, we isolated Legionella pneumophila serogroup 1 and L. anisa. Moreover, L. pneumophila serogroup 1 was isolated in 4 of the 5 water samples gathered from the unreconstructed area of the same floor. Random amplified polymorphic DNA analysis suggested that a single clone of L. pneumophila might exist throughout the floors of the water distribution system. We replaced the shower units at the Legionella-positive site, and began flushing the sink-faucets with water heated to 55N for at least 1 h every morning. As a result, Legionella was not subsequently isolated in water samples. In this prospective study, we identified a central contamination by L. pneumophila serogroup 1 and showed that flushing with hot tap water was effective to counter this situation. PMID:17314417

  20. Obstetric near miss morbidity and maternal mortality in a Tertiary Care Centre in Western Rajasthan.

    PubMed

    Kalra, Priyanka; Kachhwaha, Chetan Prakash

    2014-01-01

    Obstetric near-miss (ONM) describes a situation of lethal complication during pregnancy, labor or puerperium in which the woman survives either because of medical care or just by chance. In a cross-sectional observational study, five factor scoring system was used to identify the near-miss cases from all the cases of severe obstetric morbidity. Assessment of the causes of maternal mortality and near-miss obstetric cases was done. The ONM rate in this study was 4.18/1000 live births. Totally 54 maternal deaths occurred during this period, resulting in a ratio of 202 maternal deaths per 100,000 live births. Hemorrhage, hypertension and sepsis were major causes of near-miss maternal morbidity and mortality, respectively in descending order. PMID:25116827

  1. CHALLENGES OF OBSTETRIC ANESTHESIA: DIFFICULT LARYNGEAL VISUALIZATION.

    PubMed

    Alanoğlu, Zekeriyya; Erkoç, Süheyla Karadağ; Güçlü, Çiğdem Yildirim; Meço, Başak Ceyda Orbey; Baytaş, Volkan; Can, Özlem Selvi; Alkiş, Neslihan

    2016-03-01

    Obstetric anesthesia is one of the high risk subspecialties of anesthesia practice. Anesthesia related complications are the sixth leading cause of maternal mortality. Difficult or failed intubation following induction of general anesthesia for CS remains the major contributory factor to anesthesia-related maternal complications. The airway management of obstetric patients is a challenging issue for several reasons. Anatomic and physiologic changes related to pregnancy may increase the difficult and failed intubation rates compared to the general surgical population. Proper evaluation of the airway anatomy and airway structures is vital to prevent airway management related catastrophes. In addition to basic airway and intubation equipment, each anesthesia department must have difficult intubation equipment cart including fiber optic laryngoscope, video laryngoscopes, and different types of laryngeal masks. It is essential that all anesthesiologists have a preconceived and well thought-out algorithm and emergency airway equipment to deal with airway emergencies during difficult or failed intubation of a parturient. PMID:27276775

  2. The history of imaging in obstetrics.

    PubMed

    Benson, Carol B; Doubilet, Peter M

    2014-11-01

    During the past century, imaging of the pregnant patient has been performed with radiography, scintigraphy, computed tomography, magnetic resonance imaging, and ultrasonography (US). US imaging has emerged as the primary imaging modality, because it provides real-time images at relatively low cost without the use of ionizing radiation. This review begins with a discussion of the history and current status of imaging modalities other than US for the pregnant patient. The discussion then turns to an in-depth description of how US technology advanced to become such a valuable diagnostic tool in the obstetric patient. Finally, the broad range of diagnostic uses of US in these patients is presented, including its uses for distinguishing an intrauterine pregnancy from a failed or ectopic pregnancy in the first trimester; assigning gestational age and assessing fetal weight; evaluating the fetus for anomalies and aneuploidy; examining the uterus, cervix, placenta, and amniotic fluid; and guiding obstetric interventional procedures. PMID:25340440

  3. Imaging modalities in obstetrics and gynecology.

    PubMed

    Harrison, Benjamin P; Crystal, Chad S

    2003-08-01

    The practicing emergency physician often encounters diagnostic dilemmas involving the choice of the most appropriate radiologic study to evaluate patients in the emergency department. In addition, the uncertainty of potentially harmful fetal effects of radiation in the pregnant patient may add unnecessary delay and concern in the workup of obstetric emergencies. An emergency physician's in-depth understanding of the strengths, limitations, and potentially harmful effects of radiologic studies allows the safest and most appropriate studies to be ordered for the gynecologic and obstetric population. With the explosion of interest and growing level of expertise in focused emergency department ultrasonography during the last decade, the practicing emergency physician should add this skill to his or her armamentarium in the future. Many emergency physicians are already comfortable in using radiologic technologies in their daily practice and have discovered how quickly vital and specific information can be obtained. PMID:12962355

  4. Obstetric management of obesity in pregnancy.

    PubMed

    Jarvie, Eleanor; Ramsay, Jane E

    2010-04-01

    Rates of obesity among the pregnant population have increased substantially and adiposity has a damaging effect on every aspect of female reproductive life. This review summarises epidemiological data concerning obesity-related complications of pregnancy. Obesity is linked to a number of adverse obstetric outcomes as well as increased maternal and neonatal morbidity and mortality. These complications include miscarriage, congenital abnormalities, pre-eclampsia, gestational diabetes mellitus, iatrogenic preterm delivery, postdates pregnancy with increased rates of induction of labour, caesarean section, postpartum haemorrhage, shoulder dystocia, infection, venous thromboembolism, and increased hospital stay. It is important to consider obese pregnant women as a high risk group with a linear increase in risk of complications associated with their degree of obesity. Their obstetric management should be consultant-led and involve a multidisciplinary team approach to improve outcome. PMID:19880362

  5. The Family Doctor in Obstetrics: Who's Looking after the Shop?

    PubMed Central

    Bain, Stanley T.; Grava-Gubins, Inese; Edney, Rachel

    1987-01-01

    This article constitutes a report on a survey of 1338 family physicians/general practitioners in Ontario. The survey, which achieved a response rate of 74%, investigated respondents' patterns of obstetrical practice and attitudes towards that practice. The detailed statistics collected show a decline in FP/GP involvement in obstetrical care. Physicians who had never practised obstetrics cited inadequate training and lack of interest as their chief reasons. Physicians who had given up obstetrical practice cited most frequently its interference with personal and family life, interruption of office schedule, rising CMPA fees, and low financial incentives as reasons for their decision. In the youngest group of respondents, no significant differences were found between males' and females' rates of choice to practise or not to practise obstetrics. Respondents who had never practised obstetrics were likely to live in larger communities, and those practising obstetrics to live in smaller communities. Various changes in patterns of practice were identified by some respondents subsequent to their giving up obstetrics. A large majority of this group expressed satisfaction with those changes. Over half the respondents stated that they would accept well-trained midwives practising under supervision in a hospital setting. A strong majority of respondents favoured the concept of family physicians with a special interest in obstetrics taking over, either alone or in association with obstetricians and/or midwives, the obstetrical cases declined by their colleagues. PMID:20469467

  6. The Obstetric Regulations 1986, 21 April 1986.

    PubMed

    1988-01-01

    These New Zealand Regulations revoke and replace the Obstetric Regulations 1975. They include provisions on the staffing of maternity hospitals (Reg. 3); the use of facilities in maternity hospitals (Reg. 4); the obligations on the part of medical practitioners to notify septic conditions, etc. (Reg. 6); the keeping of clinical records with respect to maternity patients (Reg. 9); and the maintenance, availability, and retention of registers and clinical records (Reg. 10). PMID:12289418

  7. Zertifikat Niederlaendisch: Examen en getuigschrift Nederlands als vreemde taal (Certificate in Dutch)

    ERIC Educational Resources Information Center

    Beersmans, Frans; Sudhoelter, Juergen

    1976-01-01

    An interim report on preparations for designing an examination in Dutch. The "unit-credit system" proposed by the Council of Europe is being used. The Dutch certificate will be comparable to the certificates given by the British Council and by the People's Universities. Sample portions are given. (Text is in German.) (IFS/WGA)

  8. In the Shadow of Tolerance: The Discursive Context of Dutch-Born Muslim Youth

    ERIC Educational Resources Information Center

    Zaal, Mayida

    2014-01-01

    Despite a public discourse on tolerance, anxiety about immigrants, Islam and the preservation of Dutch values has amplified fear of Muslim youth in the Netherlands. In this context, Dutch-born Muslim youth endure social and systemic discrimination that affects all aspects of their futures, including available educational opportunities and…

  9. Parent Involvement as Professionalization: Professionals' Struggle for Power in Dutch Urban Deprived Areas

    ERIC Educational Resources Information Center

    van den Berg, Marguerite; van Reekum, Rogier

    2011-01-01

    Parent involvement policies have been central in the Dutch push towards educational governance. How the implementation of these policies plays out on the ground is context-dependent. The ethnic and class cleavages impacting the Dutch educational system should be taken into account. On the basis of 50 in-depth interviews with teachers, social…

  10. Prevalence and treatment of personality disorders in Dutch forensic mental health services.

    PubMed

    de Ruiter, Corine; Trestman, Robert L

    2007-01-01

    Offenders with serious personality disorders challenge forensic systems throughout the world. In this article, the authors describe the legal system that shapes the forensic treatment of personality-disordered offenders in the Dutch psychiatric and correctional systems. The evolution of laws and regulations are addressed, as is the bifurcation of treatment between forensic hospitals and correctional settings. Prevalence data of personality disorders in the Dutch systems are presented, and comparisons between the Dutch and American systems are delineated. Current treatment modalities are described. Research initiatives and future directions for the system are presented. PMID:17389350

  11. Development of an obstetric vital sign alert to improve outcomes in acute care obstetrics.

    PubMed

    Behling, Diana J; Renaud, Michelle

    2015-01-01

    Maternal morbidity and mortality is a national health problem. Causal analysis of near-miss and actual serious patient safety events, including those resulting in maternal death, within obstetric units often highlights a failure to promptly recognize and treat women who were exhibiting signs of decompensation/deterioration. The Obstetric Vital Sign Alert (OBVSA) is an early warning tool that leverages discrete data points in the electronic health record, calculating a risk score that is displayed as a visual cue for acute care obstetric staff. When studied in a cohort of women with postpartum hemorrhage, use of the OBVSA reduced symptom-to-response time and intervention time, as well as key process and outcome measures. PMID:25900584

  12. Intelligent navigation to improve obstetrical sonography.

    PubMed

    Yeo, Lami; Romero, Roberto

    2016-04-01

    'Manual navigation' by the operator is the standard method used to obtain information from two-dimensional and volumetric sonography. Two-dimensional sonography is highly operator dependent and requires extensive training and expertise to assess fetal anatomy properly. Most of the sonographic examination time is devoted to acquisition of images, while 'retrieval' and display of diagnostic planes occurs rapidly (essentially instantaneously). In contrast, volumetric sonography has a rapid acquisition phase, but the retrieval and display of relevant diagnostic planes is often time-consuming, tedious and challenging. We propose the term 'intelligent navigation' to refer to a new method of interrogation of a volume dataset whereby identification and selection of key anatomical landmarks allow the system to: 1) generate a geometrical reconstruction of the organ of interest; and 2) automatically navigate, find, extract and display specific diagnostic planes. This is accomplished using operator-independent algorithms that are both predictable and adaptive. Virtual Intelligent Sonographer Assistance (VIS-Assistance®) is a tool that allows operator-independent sonographic navigation and exploration of the surrounding structures in previously identified diagnostic planes. The advantage of intelligent (over manual) navigation in volumetric sonography is the short time required for both acquisition and retrieval and display of diagnostic planes. Intelligent navigation technology automatically realigns the volume, and reorients and standardizes the anatomical position, so that the fetus and the diagnostic planes are consistently displayed in the same manner each time, regardless of the fetal position or the initial orientation. Automatic labeling of anatomical structures, subject orientation and each of the diagnostic planes is also possible. Intelligent navigation technology can operate on conventional computers, and is not dependent on specific ultrasound platforms or on the

  13. Obstetric Provider Trainees in Georgia: Characteristics and Attitudes About Practice in Obstetric Provider Shortage Areas.

    PubMed

    Smulian, Elizabeth A; Zahedi, Leilah; Hurvitz, Julie; Talbot, Abigail; Williams, Audra; Julian, Zoë; Zertuche, Adrienne D; Rochat, Roger

    2016-07-01

    Objectives In Georgia, 52 % of the primary care service areas outside metropolitan Atlanta have a deficit of obstetric providers. This study was designed to identify factors associated with the likelihood of Georgia's obstetric trainees (obstetrics and gynecology (OB/GYN) residents and certified nurse midwifery (CNM) students) to practice in areas of Georgia that lack obstetric providers and services, i.e. rural Georgia. Methods Pilot-tested electronic and paper surveys were distributed to all of Georgia's OB/GYN residents (N = 95) and CNM students (N = 28). Mixed-methods survey questions assessed characteristics, attitudes, and incentives that might be associated with trainee desire to practice in areas of Georgia that lack obstetric providers and services. Surveys also gathered information about concerns that may prevent trainees from practicing in shortage areas. Univariate and bivariate analyses were performed, and qualitative themes were abstracted from open-ended questions. Results The survey response rate was 87.8 % (108/123). Overall, 24.4 % (19/78) of residents and 53.6 % (15/28) of CNM students expressed interest in practicing in rural Georgia, and both residents and CNM students were more likely to desire to practice in rural Georgia with the offer of any of six financial incentives (P < 0.001). Qualitative themes highlighted trainees' strong concerns about Georgia's political environment as it relates to reproductive healthcare. Conclusions Increasing state-level, rurally-focused financial incentive programs and emphasizing the role of CNMs may alleviate obstetric provider shortages in Georgia. PMID:27072048

  14. Public Private Partnerships for Emergency Obstetric Care: Lessons from Maharashtra

    PubMed Central

    Chaturvedi, Sarika; Randive, Bharat

    2011-01-01

    Background: The National Rural Health Mission of India advocates public private partnerships (PPPs) to meet its “service guarantee” of Emergency obstetric care (EmOC) provision. The Janani Suraksha Yojana (JSY) has a provision of Rs. 1500 for contracting in obstetric specialists. Objectives: The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. Materials and Methods: A cross-sectional study using the rapid assessment approach was conducted in Ahmednagar district of Maharashtra spanning 1-year duration ending in June 2009. Primary data were obtained through interviews with women, providers, and administrators at various levels. Data were analyzed thematically. Results: The PPP scheme for EmOC is restricted to deliveries by Caesarean section.The administrators prefer subsidization of costs for services in private facilities to contracting in. There are no PPPs executed in the study district. This study identifies barriers to women in accessing the benefit and the difficulties faced by administrators in implementing the scheme. Conclusion: The PPPs for EmOC under the JSY have minimally influenced the out-of-pocket payments for EmOC. Infrastructural inadequacies and passive support of the implementers are major barriers to the implementation of contracting-in model of PPPs. Capacities in the public health system are inadequate to design and manage PPPs. PMID:21687376

  15. National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module XI. Obstetric/Gynecologic Emergencies.

    ERIC Educational Resources Information Center

    National Highway Traffic Safety Administration (DOT), Washington, DC.

    This instructor's lesson plan guide on obstetric/gynecologic emergencies is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Six units of study are presented: (1) anatomy and physiology of the female reproductive system; (2) patient assessment; (3) pathophysiology and management of gynecologic…

  16. Potential Impact of Obstetrics and Gynecology Hospitalists on Safety of Obstetric Care.

    PubMed

    Srinivas, Sindhu K

    2015-09-01

    Staffing models are critical aspects of care delivery. Provider staffing on the labor and delivery unit has recently received heightened attention. Based on the general medicine hospitalist model, the obstetrics and gynecology hospitalist or laborist model of obstetric care was introduced more than a decade ago as a plausible model-of-care delivery to improve provider satisfaction, with the goal of also improving safety and outcomes through continuous coverage by providers whose sole focus was on the labor and delivery unit without other competing clinical duties. It is plausible that this model of provider staffing and care delivery will increase safety. PMID:26333638

  17. Auditing the standard of anaesthesia care in obstetric units.

    PubMed

    Mörch-Siddall, J; Corbitt, N; Bryson, M R

    2001-04-01

    We undertook an audit of 15 obstetric units in the north of England over a 10-month period to ascertain to what extent they conformed to the Obstetric Anaesthetists' Association 'Recommended Minimum Standards for Obstetric Anaesthetic Services' using a quality assurance approach. We demonstrated that all units conformed to the majority of standards but did not conform in at least one major and minor area. PMID:15321622

  18. Increasing information accessibility for patients in obstetrics-gynecology domain.

    PubMed

    Crişan-Vida, Mihaela; Stoicu-Tivadar, Lăcrămioara

    2014-01-01

    It is important for the patient to have access to personal medical information in order to manage information for increased quality of medical care and life. The paper presents a module added to an Obstetrics-Gynaecology Department information system (OGD IS) supporting patient empowerment. The patient is accessing the system easily using laptops or mobile devices. The application accessed by the patient is web-based, implemented in Visual Studio. NET, using ASP.NET pages and C# language, and the application is published in the Windows Azure cloud. The solution is user friendly using familiar devices and is ubiquitous using the cloud solution. A module for translating medical terms in colloquial ones is integrated in the system. For certain situations the patient will get information related to life style influencing health status as how and what to eat or what type of exercise it is recommended. PMID:25160224

  19. [Clinical guideline. Obstetrical hemorrhage in the second half of pregnancy].

    PubMed

    Arce-Herrera, Rosa María; Calderón-Cisneros, Ernesto; del Rocío Cruz-Cruz, Polita; Díaz-Velázquez, Mary Flor; Medécigo-Micete, Agustina Consuelo; del Pilar Torres-Arreola, Laura

    2012-01-01

    Pregnancy at older ages and the increased frequency of caesarean births may increase the incidence of diseases associated with obstetric haemorrhage. Obstetric haemorrhage is the second leading cause of maternal mortality, preceded only by preeclampsia-eclampsia in Mexico and the Instituto Mexicano del Seguro Social. In recent years several studies have been conducted to improve the detection, diagnosis and treatment of women at risk of obstetric haemorrhage to reduce maternal and perinatal mortality. The objective of this clinical practice guideline is defining recommendations based in the best available evidence to standardize actions regarding the diagnosis and management of obstetric haemorrhage in hospital units. PMID:23331755

  20. Dutch museum marks Einstein anniversary

    NASA Astrophysics Data System (ADS)

    van Calmthout, Matijn

    2016-01-01

    A new painting of Albert Einstein's field equation from his 1915 general theory of relativity was unveiled in a ceremony in November 2015 by the Dutch physicist Robbert Dijkgraaf, who is director of the Princeton Institute for Advanced Study in the US.

  1. [Obstetric-perinatologic data collection using a personal computer].

    PubMed

    Baumann, H; Huch, R; Huch, A

    1987-06-01

    A concept covering the collecting and processing of obstetrical and perinatological data is described. Collecting of patient data is effected on the basis of a case history that has been drawn up in an EDP-adequate manner, which, however, can also be used in the conventional way. This procedure was chosen because for some time to come one cannot do without a document for handwritten notes to avoid duplication of work by "double tracking" and to eliminate transmission errors, and also to continue the present procedure of dealing with the patient. A commercial data base system was chosen for data collection and storage (dBase III by Ashton Tate). This relational data base has its own programming language with very powerful macro calls. Data input is effected by means of programme masks which the user can solicit via menu monitoring. The requisite hardware configuration consists of a computer with a main storage comprising 640 KB, system MS-DOS, and a hard disk of at least 20 MB. This data collection system operates in an obstetric hospital with annually more than 1,600 births and more than 1,200 entries during early pregnancy, to the satisfaction of the users. Besides compiling the usual statistical analyses and formulating research problems, the system automatically prepares the discharge reports. This rationalisation procedure compels the user to collect the data with care and also completely. On the whole, such a data collection system offers to hospitals of any size quick and easy access to data at any time, as well as optimised patient care, without additional effort and at a reasonable cost level. PMID:3623043

  2. Malpractice Burden, Rural Location, and Discontinuation of Obstetric Care: A Study of Obstetric Providers in Michigan

    ERIC Educational Resources Information Center

    Xu, Xiao; Siefert, Kristine A.; Jacobson, Peter D.; Lori, Jody R.; Gueorguieva, Iana; Ransom, Scott B.

    2009-01-01

    Context: It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis. Purpose: This study examined whether higher malpractice…

  3. ‘Essential but not always available when needed’ – an interview study of physicians’ experiences and views regarding use of obstetric ultrasound in Tanzania

    PubMed Central

    Åhman, Annika; Kidanto, Hussein Lesio; Ngarina, Matilda; Edvardsson, Kristina; Small, Rhonda; Mogren, Ingrid

    2016-01-01

    Background The value of obstetric ultrasound in high-income countries has been extensively explored but evidence is still lacking regarding the role of obstetric ultrasound in low-income countries. Objective We aimed to explore experiences and views among physicians working in obstetric care in Tanzania, on the role of obstetric ultrasound in relation to clinical management. Design A qualitative study design was applied. Data were collected in 2015, through 16 individual interviews with physicians practicing in obstetric care at hospitals in an urban setting in Tanzania. Data were analyzed using qualitative content analysis. Results Use of obstetric ultrasound in the management of complicated pregnancy was much appreciated by participating physicians, although they expressed considerable concern about the lack of ultrasound equipment and staff able to conduct the examinations. These limitations were recognized as restricting physicians’ ability to manage complications adequately during pregnancy and birth. Better availability of ultrasound was requested to improve obstetric management. Concerns were also raised regarding pregnant women's lack of knowledge and understanding of medical issues which could make counseling in relation to obstetric ultrasound difficult. Although the physicians perceived a positive attitude toward ultrasound among most pregnant women, occasionally they came across women who feared that ultrasound might harm the fetus. Conclusions There seems to be a need to provide more physicians in antenatal care in Tanzania with ultrasound training to enable them to conduct obstetric ultrasound examinations and interpret the results themselves. Physicians also need to acquire adequate counseling skills as counseling can be especially challenging in this setting where many expectant parents have low levels of education. Providers of obstetric care and policy makers in Tanzania will need to take measures to ensure appropriate use of the scarce

  4. Drug Resistant Fetal Arrhythmia in Obstetric Cholestasis

    PubMed Central

    Altug, Nahide; Kirbas, Ayse; Daglar, Korkut; Biberoglu, Ebru; Uygur, Dilek; Danisman, Nuri

    2015-01-01

    Obstetric cholestasis (OC) is a pregnancy specific liver disease characterized by increased levels of bile acid (BA) and pruritus. Raised maternal BA levels could be associated with intrauterine death, fetal distress, and preterm labor and also alter the rate and rhythm of cardiomyocyte contraction and may cause fetal arrhythmic events. We report a case of drug resistant fetal supraventricular tachycardia and concomitant OC. Conclusion. If there are maternal OC and concomitant fetal arrhythmia, possibility of the resistance to antiarrhythmic treatment should be kept in mind. PMID:25821617

  5. [Prostaglandins in gynecology and obstetrics].

    PubMed

    Klausch, B; Kyank, H

    1972-06-01

    A review of early research (up through 1970) on prostaglandins (PGs) is presented. Their chemical structure and classification based on their ring-structure is detailed as well as various analytic methods of mammalian tissues and body fluids. For clinical use PGE1 and 2, PGF2alpha and PGA1 are the most significant ones because of their properties. PGs have many physiological activities encompassing many organ systems. Their pharmacological actions include: 1) stimulation of nonvascular smooth muscle; 2) peripheral vasodilation (excluding PGFs which cause vasoconstriction); 3) inhibition of lipolysis; 4) inhibition of platelet aggregation; 5) inhibition of gastric peristalsis and gastric juice secretion; 6) bronchodilation; and 7) inhibition of spontaneous CNS activity. The level of PGEs in semen is closely related to the degree of fertility; normally fertile men have 55 mcg PGE/ml and never less than 11 mcg/ml. Current studies are under way on the effect of PGE in artificial insemination of sperm of subfertile men. PGF2alpha and PGE2 stimulate menstruation and uterine contraction; other PGs inhibit uterine contraction. PGs from semen have a role in sperm transport and possibly act on fallopian tube motility aiding sperm capacitation, and ovum retention and transport. Early trials with PGs point to a possible action as an abortifacient, as a once-a-month contraceptive, or a postconception contraceptive agent. PGF2alpha is found in variable concentrations in maternal blood during contraction of the pregnant uterus; levels increase as labor progresses. PGs have been used for labor induction, for induction of abortion and in mole pregnancy. Given as a constant intravenous infusion they produce regular contractions leading to natural expulsion of the fetus and causing very few side effects in the woman with no adverse effects on the fetus. PGs' action compares favorably with that of oxytocin and is preferable for labor induction in certain pregnancy complications. PGE1

  6. Historical Notes on the Dutch and American-Dutch "schools" in Astronomy and Their Relations with Physics

    NASA Astrophysics Data System (ADS)

    van den Heuvel, Ed

    2006-04-01

    Dutch astronomy and physics experienced two "golden ages". The firstone covered the 17th century, culminating with Christiaan Huygens,inventor of the pendulum clock and the wave theory of light, anddiscoverer of Saturn's rings and largest satellite Titan. The secondone, which lasts till the present, started around 1880 withphysicists Lorentz, van der Waals, Zeeman and Kamerlingh Onnes andastronomer Kapteijn and his pupils De Sitter, van Rhijn, Oort andSchilt. Kapteijn, through his friendship with George Ellery Hale,initiated the strong connection between American and Dutch astronomy,which led to the rise of many Dutch-born astronomers to prominentpositions in the US, from Luyten, Bok, Brouwer, Schilt and Kuiperto Woltjer, Gehrels, and Beckers. The rise of the second "goldenage" appears to be closely related to drastic reforms in the Dutchhigh school and university systems in the last decades of the 19thcentury.

  7. Semi-automatic coding with ICPC: the Thesaurus, the algorithm and the Dutch subtitles.

    PubMed

    Gebel, R S

    1997-01-01

    In the ICPC Thesaurus Project, which ran from 1990 to 1992, the Dutch translation of the English version of the ICPC-components 1 and 7 was made available for automated coding by structuring and improving the thesaurus and by developing an algorithm for selecting possible ICPC-codes from a set of medical terms given as input to the program. The thesaurus and algorithm are available to the developers of GP information systems and are at present incorporated in all Dutch GP-systems. This paper brings you up to date with the semi-automatic coding system and the so called Dutch subtitles, an extension to the ICPC. PMID:10179584

  8. Acquisition of Publications from Asiatic Countries: Dutch Problems.

    ERIC Educational Resources Information Center

    Schiltman, Maria J.

    This presentation of the Dutch experience with the international exchange of publications focuses on the acquisition of publications from China and Indonesia to illustrate problems of availability. Lack of depository systems, restrictive export policies, inadequate national bibliographies, exorbitant commercial prices, and time consuming delivery…

  9. Development of a Test of Spoken Dutch for Prospective Immigrants

    ERIC Educational Resources Information Center

    De Jong, John H. A. L.; Lennig, Matthew; Kerkhoff, Anne; Poelmans, Petra

    2009-01-01

    Based on a parliamentary vote with broad support, the Ministry of Justice of the Netherlands in December 2003 commissioned the development of an examination system to test the Dutch oral language skills of foreigners who want to immigrate permanently to the Netherlands for economic or family reasons. This assessment would take place in the country…

  10. Obstetrical Complications and Violent Delinquency: Testing Two Developmental Pathways.

    ERIC Educational Resources Information Center

    Arseneault, Louise; Tremblay, Richard E.; Boulerice, Bernard; Saucier, Jean-Francois

    2002-01-01

    Assessed interaction between obstetrical complications and early family adversity in predicting violent behavior during childhood and adolescence among 849 boys from low SES areas. Found that elevated scores on scale of obstetrical complications (preeclampsia, umbilical cord prolapse, induced labor) increased risk of being violent at 6 and 17…

  11. Experience with a Family-Practice-Resident-Directed Obstetrical Clinic.

    ERIC Educational Resources Information Center

    Hunter, Jerry L.; Snyder, Frank

    1980-01-01

    At Toledo Hospital, family practice residents have assumed responsibility for the normal obstetrics clinic. Specialty consultations are provided by the hospital's obstetrics residency program. A medical audit of the clinic indicates that the family practice residents obtained consultations and made referrals at the appropriate times. (JMD)

  12. [Autologous transfusion in obstetrics and fetal safety].

    PubMed

    Rech, F; Patella, A; Cecchi, A; Ippolito, M; Indraccolo, S R

    1994-06-01

    It is common knowledge that for modern medicine transfusion therapy represents a precious resource and an often mandatory option. It is equally known that autohemotransfusion (or autologous transfusion) provides further advantages: certainty of blood availability when necessary, absence of transfusion reactions, elimination of the risk of infections that is still associated with the traditional homologous transfusions. In its most widespread application, autotransfusion provides for the donation of one or more units of autologous blood, mostly before elective surgery. Even in obstetrics the practice of autologous blood donation with the aim of autotransfusion is finding increasing employment. However, there are still controversial aspects and the need is pointed out for more authoritative verifications as refers to the alleged innocuity to the fetus of acute maternal blood loss. The present study was performed to contribute personal experience to a better definition of the possible interactions between autologous blood donation during pregnancy and unborn child welfare. To this end, 80 term pregnant women underwent fetal heart rate electronic monitoring before, during and after the donation of one unit of autologous blood. Both during and after the phlebotomy there were no cardiotocographic signs of fetal hypo-oxygenation. Even the non stress tests performed at a distance of 24 hours and those that were periodically repeated afterwards were normal, confirming the safety of autologous predonation during pregnancy. However, the authors think that in obstetrics it is still premature to consider the experimental phase of autotransfusion as definitively exhausted. PMID:7936387

  13. Reducing maternal mortality on a countrywide scale: The role of emergency obstetric training.

    PubMed

    Moran, Neil F; Naidoo, Mergan; Moodley, Jagidesa

    2015-11-01

    Training programmes to improve health worker skills in managing obstetric emergencies have been introduced in various countries with the aim of reducing maternal mortality through these interventions. In South Africa, based on an ongoing confidential enquiry system started in 1997, detailed information about maternal deaths is published in the form of regular 'Saving Mothers' reports. This article tracks the recommendations made in successive Saving Mothers reports with regard to emergency obstetric training, and it assesses the impact of these recommendations on reducing maternal mortality. Since 2009, South Africa has had its own training package, Essential Steps in the Management of Obstetric Emergencies (ESMOE), which the last three Saving Mothers reports have specifically recommended for all doctors and midwives working in maternity units. A special emphasis has been placed on the need for the simulation training component of ESMOE, also called obstetric 'fire drills', to be integrated into the clinical routines of all maternity units. The latest Saving Mothers report (2011-2013) suggests there has been little progress so far in improving emergency obstetric skills, indicating a need for further scale-up of ESMOE training in the country. The example of the KwaZulu-Natal province of South Africa is used to illustrate the process of scale-up and factors likely to facilitate that scale-up, including the introduction of ESMOE into the undergraduate medical training curriculum. Additional factors in the health system that are required to convert improved skills levels into improved quality of care and a reduction in maternal mortality are discussed. These include intelligent government health policies, formulated with input from clinical experts; strong clinical leadership to ensure that doctors and nurses apply the skills they have learnt appropriately, and work professionally and ethically; and a culture of clinical governance. PMID:26363737

  14. What's new in obstetric anesthesia? Focus on preeclampsia.

    PubMed

    Leffert, L R

    2015-08-01

    Recent advances in the diagnosis, pathogenesis, and understanding of preeclampsia-related morbidity provide opportunities to optimize clinical management of the mother and fetus. These discoveries are timely, as contemporary data suggest that the prevalence of preeclampsia, affecting 7.5% of pregnancies globally and 2-5% in the USA, has increased by up to 30% over the last decade. Managing pregnant patients with preeclampsia can be challenging for all members of the obstetric care team due to the disease's multi-organ system maternal and fetal effects. This review presents recent updates in the definition of preeclampsia, etiology, comorbidities and therapeutic interventions and discusses how they impact the care of these high-risk patients. PMID:25936785

  15. Medication error report: Intrathecal administration of labetalol during obstetric anesthesia

    PubMed Central

    Laha, Baisakhi; Hazra, Avijit

    2015-01-01

    Labetalol, a combined alfa and beta-adrenergic receptor antagonist, is used as an antihypertensive drug. We report a case of an acute rise in blood pressure and lower limb pain due to the inadvertent intrathecal administration of labetalol, mistaking it for bupivacaine, during obstetric anesthesia. The situation was rescued by converting to general anesthesia. The cesarean delivery was uneventful, and mother as well as newborn child showed no ill-effect. This particular medication error was attributable to a failure on the part of the doctors administering the injection to read and cross-check medication labels and the practice of keeping multiple injections together. In the absence of an organized medication error reporting system and action on that basis, such events may recur in future. PMID:26288484

  16. General-practitioner obstetrics: two styles of care.

    PubMed Central

    Roseveare, M P; Bull, M J

    1982-01-01

    Two systems of general-practitioner obstetric care currently in use in England are compared. In one (Oxford) a large number of doctors, working with community midwives, have autonomous responsibility for the management of patients whose condition conforms with defined booking criteria. In the other (Dulwich) two practitioners, working with hospital midwives, operate a minimal selection policy, but all their patients are reviewed at 36 weeks' gestation by a specialist obstetrician. Despite the differing selection policies which created incongruities in the groups in respect of age, social class, and birthweight distribution, the outcomes in terms of mode of delivery showed no significant differences. The perinatal mortality rates were also similar and appeared to be better than those achieved nationally. PMID:6802369

  17. Obstetrics anyone? How family medicine residents' interests changed.

    PubMed Central

    Ruderman, J.; Holzapfel, S. G.; Carroll, J. C.; Cummings, S.

    1999-01-01

    OBJECTIVE: To determine family medicine residents' attitudes and plans about practising obstetrics when they enter and when they graduate from their residency programs. DESIGN: Residents in each of 4 consecutive years, starting July 1991, were surveyed by questionnaire when they entered the program and again when they graduated (ending in June 1996). Only paired questionnaires were used for analysis. SETTING: Family medicine residency programs at the University of Toronto in Ontario. PARTICIPANTS: Of 358 family medicine residents who completed the University of Toronto program, 215 (60%) completed questionnaires at entry and exit. MAIN OUTCOME MEASURES: Changes in attitudes and plans during the residency program as ascertained from responses to entry and exit questionnaires. RESULTS: Analysis was based on 215 paired questionnaires. Women residents had more interest in obstetric practice at entry: 58% of women, but only 31% of men were interested. At graduation, fewer women (49%) and men (22%) were interested in practising obstetrics. The intent to undertake rural practice was strongly associated with the intent to practise obstetrics. By graduation, residents perceived lifestyle factors and compensation as very important negative factors in relation to obstetric practice. Initial interest and the eventual decision to practise obstetrics were strongly associated. CONCLUSIONS: Intent to practise obstetrics after graduation was most closely linked to being a woman, intending to practise in a rural area, and having an interest in obstetrics prior to residency. Building on the interest in obstetrics that residents already have could be a better strategy for producing more physicians willing to practise obstetrics than trying to change the minds of those uninterested in such practice. PMID:10099803

  18. Multidisciplinary Obstetric Simulated Emergency Scenarios (MOSES): Promoting Patient Safety in Obstetrics with Teamwork-Focused Interprofessional Simulations

    ERIC Educational Resources Information Center

    Freeth, Della; Ayida, Gubby; Berridge, Emma Jane; Mackintosh, Nicola; Norris, Beverley; Sadler, Chris; Strachan, Alasdair

    2009-01-01

    Introduction: We describe an example of simulation-based interprofessional continuing education, the multidisciplinary obstetric simulated emergency scenarios (MOSES) course, which was designed to enhance nontechnical skills among obstetric teams and, hence, improve patient safety. Participants' perceptions of MOSES courses, their learning, and…

  19. Implementing prospective budgeting for Dutch sickness funds.

    PubMed

    Okma, K G; Poelert, J D

    2001-06-01

    Most if not all social policies entail redistribution of scarce public resources from central government to regional and local authorities, to individual citizens or non-government agencies. Governments use a wide variety of instruments to allocate public funds, including direct state provision of subsidies and goods and services, setting budgets at different levels, and regulation of social insurance schemes. Most industrialised countries have developed budget models based on implicit or explicit allocation criteria. Governments usually start by determining global budgets for an entire category of public spending and then specifying the amounts allocated for categories of spending, and next, the budgets for individual agencies. Within such a 'cascading' model, the lower level budgets may be more controversial than the global budgets, as they directly affect the amounts available to individual actors in the system, e.g. hospitals or health insurance agencies. Setting budgets not only shifts decision-making authority but also financial risks from the central government to decentralised actors. The introduction of the prospective budgeting model for the Dutch sickness funds illustrates why determining budgets is not merely a matter of choosing objective allocation criteria, but also, of interaction between state and stakeholders. In the typical Dutch neocorporatist policy arena, where organised interests share responsibilities with government for the shaping and implementation of social policies, the health insurance agencies actively participated in the development of the budget model. PMID:11420806

  20. Reclassifying causes of obstetric death in Mexico: a repeated cross-sectional study

    PubMed Central

    Hogan, Margaret C; Saavedra-Avendano, Biani; Darney, Blair G; Torres-Palacios, Luis M; Rhenals-Osorio, Ana L; Sierra, Bertha L Vázquez; Soliz-Sánchez, Patricia N; Gakidou, Emmanuela

    2016-01-01

    Abstract Objective To describe causes of maternal mortality in Mexico over eight years, with particular attention to indirect obstetric deaths and socioeconomic disparities. Methods We conducted a repeated cross-sectional study using the 2006–2013 Búsqueda intencionada y reclasificación de muertes maternas (BIRMM) data set. We used frequencies to describe new cases, cause distributions and the reclassification of maternal mortality cases by the BIRMM process. We used statistical tests to analyse differences in sociodemographic characteristics between direct and indirect deaths and differences in the proportion of overall direct and indirect deaths, by year and by municipality poverty level. Findings A total of 9043 maternal deaths were subjected to the review process. There was a 13% increase (from 7829 to 9043) in overall identified maternal deaths and a threefold increase in the proportion of maternal deaths classified as late maternal deaths (from 2.1% to 6.9%). Over the study period direct obstetric deaths declined, while there was no change in deaths from indirect obstetric causes. Direct deaths were concentrated in women who lived in the poorest municipalities. When compared to those dying of direct causes, women dying of indirect causes had fewer pregnancies and were slightly younger, better educated and more likely to live in wealthier municipalities. Conclusion The BIRMM is one approach to correct maternal death statistics in settings with poor resources. The approach could help the health system to rethink its strategy to reduce maternal deaths from indirect obstetric causes, including prevention of unwanted pregnancies and improvement of antenatal and post-obstetric care. PMID:27147766

  1. Court ordered obstetric intervention: a commentary.

    PubMed

    Brenner, B; Burnet, P

    1995-10-27

    A case is presented where the Courts have authorised an obstetric intervention deemed necessary for the well-being of both mother and child. Although the case is one of maternal psychosis, there are legal and ethical concerns whenever court-ordered intervention is deemed necessary. Approaches to this difficult medical decision making problem in the form of utilitarian "burdens v benefit" ratio analysis or the recognised traditional ethical principles of beneficence, nonmaleficence, justice and acting in the patient's best interest are considered. The Royal College of Obstetricians and Gynaecologists guidelines suggesting "that it is inappropriate ... to invoke judicial intervention to overrule an informed and competent woman's refusal of a proposed medical treatment, even though her refusal might place her life and that of her fetus at risk" are questioned. PMID:7478347

  2. Improving medical induction in obstetrics and gynaecology

    PubMed Central

    Allen, Eve; Palmer, Edward; Lloyd, Jilly

    2014-01-01

    We present a year long quality improvement project to bring a new induction programme to the obstetrics and gynaecology (O&G) department of University Hospital Lewisham (UHL). Aimed at non-speciality junior doctors, including general practice and foundation trainees, the induction programme has sought to improve the quality of care delivered and experience of these transiting junior doctors. We have demonstrated a readily implementable and sustainable programme that requires only modest input of time from senior trainees (ST3+) periodically throughout the year. We have highlighted the specific need for senior consultant investment in the success and sustainability of such a project. We have demonstrated improvement of learning outcomes (p=0.01) in junior doctors undertaking the induction programme at Kirkpatrick's hierarchy level 2.

  3. Contracting for Trust in Family Practice Obstetrics

    PubMed Central

    Klein, Michael

    1983-01-01

    A case is presented, illustrating a problem faced by family physicians who practice obstetrics; women who present with lists of inflexible requirements for labor and delivery may be attempting to control a situation in which they feel a great deal of fear, and little trust for the physician. The physician who tries to deal with every item on the list, rather than to explore the meaning of the total presentation, risks establishing a contract that cannot be met—and attracting more demanding patients. It is better to offer to discuss the patient's fear and distrust; this is described as `contracting for trust', and is a way to promote patient and doctor flexibility. PMID:21283484

  4. The obstetrics and gynaecology resident as teacher.

    PubMed

    Cullimore, Amie J; Dalrymple, John L; Dugoff, Lorraine; Hueppchen, Nancy A; Casey, Petra M; Chuang, Alice W; Espey, Eve L; Hammoud, Maya M; Kaczmarczyk, Joseph M; Katz, Nadine T; Nuthalapaty, Francis S; Peskin, Edward G

    2010-12-01

    In this article we discuss the role residents play in the clinical training and evaluation of medical students. A literature search was performed to identify articles dealing with research, curriculum, and the evaluation of residents as teachers. We summarize the importance of resident educators and the need to provide appropriate resources for house staff in this role, and we review evidence-based literature in the area of residents as teachers. Specific attention is given to the unique circumstances of the obstetrics and gynaecology resident, who is often faced with teaching in an emotionally charged and stress-filled environment. We present examples of curricula for residents as teachers and describe barriers to their implementation and evaluation. PMID:21176331

  5. [Simulation in obstetrics and gynecology - a new method to improve the management of acute obstetric emergencies].

    PubMed

    Blum, Ronja; Gairing Bürglin, Anja; Gisin, Stefan

    2008-11-01

    In medical specialties, such as anaesthesia, the use of simulation has increased over the past 15 years. Medical simulation attempts to reproduce important clinical situations to practise team training or individual skills in a risk free environment. For a long time simulators have only been used by the airline industry and the military. Simulation as a training tool for practicing critical situations in obstetrics is not very common yet. Experience and routine are crucial to evaluate a medical emergency correctly and to take the appropriate measures. Nowadays the obstetrician requires a combination of manual and communication skills, fast emergency management and decision-making skills. Therefore simulation may help to attain these skills. This may not only satisfy the high expectations and demands of the patients towards doctors and midwives but would also help to keep calm in difficult situations and avoid mistakes. The goal is a risk free delivery for mother and child. Therefore we developed a simulation- based curricular unit for hands-on training of four different obstetric emergency scenarios. In this paper we describe our results about the feedback of doctors and midwives on their personal experiences due to this simulation-based curricular unit. The results indicate that simulation seems to be an accepted method for team training in emergency situations in obstetrics. Whether patient security increases after the regularly use of drill training needs to be investigated in further studies. PMID:18979433

  6. Increasing Liability Premiums in Obstetrics – Analysis, Effects and Options

    PubMed Central

    Soergel, P.; Schöffski, O.; Hillemanns, P.; Hille-Betz, U.; Kundu, S.

    2015-01-01

    study data more closely. Among the many solutions which have been proposed, such as the development of quality management, risk management and prevention, better remuneration, a waiver on recourse claims by social insurance underwriters, a cap on damage costs of liability insurers, state liability, an indemnity fund, a system change to Medical Treatment Risk Insurance, as well as a discussion on whether or not it makes sense to use non-clinical obstetrics for the prevention of a further increase in premiums, not one stands out as being especially convincing. On the contrary, a meaningful coordination of various concepts should follow. What seems sensible is a higher remuneration per birth, taking into account the liability premiums as well as, in the medium term, the establishment of a liability fund which, from a certain limit upwards, steps in as liable third party. PMID:26028694

  7. Obstetric admissions to ICUs in Finland: A multicentre study.

    PubMed

    Seppänen, Pia; Sund, Reijo; Roos, Mervi; Unkila, Riitta; Meriläinen, Merja; Helminen, Mika; Ala-Kokko, Tero; Suominen, Tarja

    2016-08-01

    In this study, the objective was to describe and analyse reasons for obstetric admissions to the ICU, severity of illness, level and types of interventions, adverse events and patient outcomes. In a retrospective database study, we identified 291 obstetric patients during pregnancy and puerperium from four Finnish university hospitals. Most were admitted in the post-partum period and hypertensive disorders were the main indications for admissions, followed by obstetric haemorrhage. The median length of stay was 21hours. The most common intervention was blood transfusion and mechanical ventilation was required in nearly one fifth of the patients. Three patients had a prolonged stay and nine had re-admissions. One maternal death was recorded. This study found that severity of illness and organ failure scores describe the obstetric patient as having a good probability of recovery and a short length of stay. However, the obstetric patients reason for admission and their type of delivery were associated with both the severity of illness scores and level of intervention required. Those admitted for non-obstetric reasons and having had a vaginal delivery demonstrated higher severity of illness scores, organ failure scores, and levels of intervention when compared to those admitted for obstetric reasons or those who had delivered by caesarean section. In conclusion, care of these patients can be improved by understanding the severity of illness scores, common ICU interventions and patient outcomes. PMID:27209560

  8. The art of governance of Dutch hospitals.

    PubMed

    Hoek, H

    1999-01-01

    Hospitals in The Netherlands are governed by two boards: The Board of Directors, the legal representative of the hospital, responsible for strategic and operational business activities; and the Supervisory Board, made up of co-opted volunteers and responsible for checking and approving of the major decisions of the Board of Directors. The question which arises is whether the system of governance is able to function appropriately and guarantee enough concern about general health problems, moral and ethical questions and the interest of the patients. This paper investigate the successes and shortfalls of such a system of governance in Dutch hospitals. The results and conclusions determine that although copied from the corporate governance model, it does not function well in an environment where the influence of patients and the inhabitants of the region are of great importance and shareholders do not exist. PMID:10977190

  9. Obstetric training in Emergency Medicine: a needs assessment

    PubMed Central

    Janicki, Adam James; MacKuen, Courteney; Hauspurg, Alisse; Cohn, Jamieson

    2016-01-01

    Background Identification and management of obstetric emergencies is essential in emergency medicine (EM), but exposure to pregnant patients during EM residency training is frequently limited. To date, there is little data describing effective ways to teach residents this material. Current guidelines require completion of 2 weeks of obstetrics or 10 vaginal deliveries, but it is unclear whether this instills competency. Methods We created a 15-item survey evaluating resident confidence and knowledge related to obstetric emergencies. To assess confidence, we asked residents about their exposure and comfort level regarding obstetric emergencies and eight common presentations and procedures. We assessed knowledge via multiple-choice questions addressing common obstetric presentations, pelvic ultrasound image, and cardiotocography interpretation. The survey was distributed to residency programs utilizing the Council of Emergency Medicine Residency Directors (CORD) listserv. Results The survey was completed by 212 residents, representing 55 of 204 (27%) programs belonging to CORD and 11.2% of 1,896 eligible residents. Fifty-six percent felt they had adequate exposure to obstetric emergencies. The overall comfort level was 2.99 (1–5 scale) and comfort levels of specific presentations and procedures ranged from 2.58 to 3.97; all increased moderately with postgraduate year (PGY) level. Mean overall percentage of items answered correctly on the multiple-choice questions was 58% with no statistical difference by PGY level. Performance on individual questions did not differ by PGY level. Conclusions The identification and management of obstetric emergencies is the cornerstone of EM. We found preliminary evidence of a concerning lack of resident comfort regarding obstetric conditions and knowledge deficits on core obstetrics topics. EM residents may benefit from educational interventions to increase exposure to these topics. PMID:27357908

  10. Tensions in water management: Dutch tradition and European policy.

    PubMed

    Ravesteijn, W; Kroesen, O

    2007-01-01

    Present-day worldwide water problems require new management tools and sustainable system innovations. At Delft University of Technology research is being carried out into water resources and management development aimed at forming such tools and innovations, focused on Integrated River Basin Management (IRBM). One of the case-studies deals with Dutch water management and technology in the context of European IRBM in the form of the 2000 Water Frame Directive. The Netherlands experience many water problems and European IRBM could bring help by offering a framework for both international cooperation and technological innovations. To work as an adequate management tool European IRBM should be tailored to the Dutch water tradition, which recently culminated in Integrated Water Management. Both approaches are in some respects contradicting. Europe pursues, for example, centralized control; while the Dutch have their strongly water boards based decentralized administration. The tensions between both approaches require mutual adaptation, for which the concept of subsidiarity might offer points of departure. This paper describes the first results of the case-research into Dutch water management and technology in the context of Europe as well as the backgrounds and the set-up of the research as a whole. PMID:17851211

  11. Using Web-Based Questionnaires and Obstetric Records to Assess General Health Characteristics Among Pregnant Women: A Validation Study

    PubMed Central

    Schouten, Naomi PE; Merkus, Peter JFM; Verhaak, Chris M; Roeleveld, Nel; Roukema, Jolt

    2015-01-01

    Background Self-reported medical history information is included in many studies. However, data on the validity of Web-based questionnaires assessing medical history are scarce. If proven to be valid, Web-based questionnaires may provide researchers with an efficient means to collect data on this parameter in large populations. Objective The aim of this study was to assess the validity of a Web-based questionnaire on chronic medical conditions, allergies, and blood pressure readings against obstetric records and data from general practitioners. Methods Self-reported questionnaire data were compared with obstetric records for 519 pregnant women participating in the Dutch PRegnancy and Infant DEvelopment (PRIDE) Study from July 2011 through November 2012. These women completed Web-based questionnaires around their first prenatal care visit and in gestational weeks 17 and 34. We calculated kappa statistics (κ) and the observed proportions of positive and negative agreement between the baseline questionnaire and obstetric records for chronic conditions and allergies. In case of inconsistencies between these 2 data sources, medical records from the woman’s general practitioner were consulted as the reference standard. For systolic and diastolic blood pressure, intraclass correlation coefficients (ICCs) were calculated for multiple data points. Results Agreement between the baseline questionnaire and the obstetric record was substantial (κ=.61) for any chronic condition and moderate for any allergy (κ=.51). For specific conditions, we found high observed proportions of negative agreement (range 0.88-1.00) and on average moderate observed proportions of positive agreement with a wide range (range 0.19-0.90). Using the reference standard, the sensitivity of the Web-based questionnaire for chronic conditions and allergies was comparable to or even better than the sensitivity of the obstetric records, in particular for migraine (0.90 vs 0.40, P=.02), asthma (0.86 vs 0

  12. Government, School Autonomy, and Legitimacy: Why the Dutch Government Is Adopting an Unprecedented Level of Interference with Independent Schools

    ERIC Educational Resources Information Center

    Waslander, Sietske

    2010-01-01

    When looking at independent schools, the Netherlands is often mentioned as a prime example of school autonomy. Rooted in the constitution, the Dutch education system is build upon a combination of public funding and private operation. After almost a century of independent schools, the Dutch Government adopted a law recently which enables…

  13. [Dutch parliament legitimizes harmful quackery].

    PubMed

    van Dam, Frits S A M; Renckens, Cees N M

    2010-01-01

    The Dutch parliament has recently accepted a tax law in which certain groups of alternative therapists can be exempt from VAT. To be eligible for this VAT exemption, the disciplines to which the therapists belong have to meet certain training requirements. In this article it is contended, in agreement with the Royal College of Physicians in the UK, that statutory regulation is inappropriate for disciplines whose therapies are neither of proved benefit nor appropriately tested. It legitimizes harmful therapies. This is illustrated by two serious accidents, previously described in this journal, caused by a chiropractor and a craniosacral therapist. PMID:20298623

  14. [110 years--University Obstetrics and Gynecology Hospital "Maichin dom"].

    PubMed

    Zlatkov, V

    2014-01-01

    The first specialized Obstetrics and Gynecology Hospital in Bulgaria was founded based on the idea of Queen Maria Luisa (1883). Construction began in 1896 and the official opening of the hospital took place on November 19, 1903. What is unique about the University Obstetrics and Gynecology Hospital "Maichin dom" is above all the fact that the Bulgarian school of obstetrics and gynecology was founded within its institution. Currently, the hospital has nearly 400 beds and 600 employees who work at nine clinics and six laboratories, covering the entire spectrum of obstetric and gynecological activities. Its leading specialists still continue to embody the highest level of professionalism and dedication. The future development of the hospital is chiefly associated with the renovation of facilities, resources and equipment and with the enhancement of the professional competence of the staff and of the quality of hospital products to improve the health and satisfaction of the patients. PMID:24919335

  15. Intrinsic Obstetric Palsy: Case Report and Literature Review

    PubMed Central

    Neppe, Cliff

    2016-01-01

    Maternal neurological injuries may be intrinsic to the labour and delivery process or may result directly or indirectly from obstetric or anaesthetic intervention. This intrinsic obstetric palsy is a rare complication of labour but can have devastating impact on a previously healthy mother. A 23-year-old gravida1, para0 who had epidural for labour analgesia, was augmented for slow progress and had a normal vaginal delivery. She was diagnosed post delivery with intrinsic obstetric palsy involving several peripheral nerves and lumbosacral nerve roots with a guarded prognosis. In this article we have discussed the risk factors and mechanisms of intrinsic obstetric palsy and proposed further investigation into the potential protective role of ambulatory analgesia i.e. CSE (Combined Spinal Epidural) or LDI (Low Dose Infusion). PMID:27190901

  16. The Challenge of Teaching Obstetrics to Family Practice Residents

    PubMed Central

    Carroll, June C.

    1986-01-01

    Physicians who incorporate maternity care into family practice experience an increase in job satisfaction and enjoy a more favourable practice profile. Yet many family physicians are opting out of the obstetrical care of their patients. This development presents a major challenge to the teachers of family medicine. In many teaching programs the response of staff has been to move significant portions of residency training in obstetrics to smaller community hospitals. At Mount Sinai Hospital in Toronto, we believe that an integrated program in the tertiary care centre offers definite advantages. Our obstetrical training program integrates four elements: the community, the hospital, the Department of Family and Community Medicine, and the training program offered by that Department. We expect that family practice residents, by participating in this multifaceted, integrated program, will make a better-informed choice about practising obstetrics. PMID:21267328

  17. Intrinsic Obstetric Palsy: Case Report and Literature Review.

    PubMed

    Hakeem, Rashida; Neppe, Cliff

    2016-04-01

    Maternal neurological injuries may be intrinsic to the labour and delivery process or may result directly or indirectly from obstetric or anaesthetic intervention. This intrinsic obstetric palsy is a rare complication of labour but can have devastating impact on a previously healthy mother. A 23-year-old gravida1, para0 who had epidural for labour analgesia, was augmented for slow progress and had a normal vaginal delivery. She was diagnosed post delivery with intrinsic obstetric palsy involving several peripheral nerves and lumbosacral nerve roots with a guarded prognosis. In this article we have discussed the risk factors and mechanisms of intrinsic obstetric palsy and proposed further investigation into the potential protective role of ambulatory analgesia i.e. CSE (Combined Spinal Epidural) or LDI (Low Dose Infusion). PMID:27190901

  18. What Role Does Obstetrical Care Play in Childbirth?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications What role does obstetrical care play in childbirth? Skip sharing on ... has ruptured (the woman’s water breaks), but labor does not start within 24 to 48 hours When ...

  19. The Dutch school of malaria research.

    PubMed

    Verhave, J P

    1987-01-01

    An epidemic of tertian malaria in some coastal areas of The Netherlands resulted in the setting up of official measures in 1920. A scientific and a propaganda commission were charged with control. Efforts were made to reduce mosquito populations by adult and larval spraying. After the discovery that infected mosquitoes were to be found only inside houses, control operations were focussed against adult mosquitoes. Some later discoveries resulted in a more effective control. a) Spraying ditches with Paris green did not prevent adult mosquitoes from entering the control area. b) Anopheles maculipennis turned out to be a complex of species, with A. atroparvus as the vector. The latter preferred brackish water and did not go into full hibernation. The closing of the Zuyder Sea and the expected desalinization gave hope for less suitable conditions for the vector. c) Plasmodium vivax normally had an incubation period of 8 months. d) Pyrethrum was an effective but short-lasting insecticide. e) Healthy parasite carriers could infect mosquitoes. This knowledge was applied through an extensive system of investigation, including spleen examination of schoolchildren. Suspected houses were sprayed bimonthly from August to November, during which period infected mosquitoes were likely to be present. This system worked extremely well, and during the next epidemic from 1943 to 1947 the thus treated towns remained virtually free of malaria! DDT became available and was either sprayed in suspected houses as before, or through wide-spread coverage of all houses. The epidemic subsided whatever method employed and not only due to the use of DDT. The number of cases even went down to the point of no return and the last case of Dutch malaria was recorded in 1959. The wealth of experience on house-spray control, parasite and mosquito biology and experimental malaria of the Dutch malariologists has had its impact on the international bodies engaged in the battle against malaria. PMID:3334084

  20. [Obstetric vesicovaginal fistula: reporting two cases in France].

    PubMed

    Labarrère, A; Gueye, A; Ouaki, F; Pires, C; Pierre, F; Fritel, X

    2011-05-01

    Obstetric vesicovaginal fistula is nowadays rare in developed countries. We are reporting two cases of patients with obstetric vesicovaginal fistula that occurred after operative vaginal deliveries performed in a French hospital. Early postpartum symptoms were vaginal urine leakage and infectious syndrome. The fistula has been cured by vaginal surgery one case and combined (laparotomy and vagina surgery) in the other case. Patients were totally healed a few months following the surgery. PMID:21514873

  1. The principles and practice of ultrasonography in obstetrics and gynecology

    SciTech Connect

    Sanders, R.C.; James, A.E.

    1985-01-01

    This is the latest edition of a reference on diagnostic ultrasound in obstetrics and gynecology. Chapters have been added on infertility, legal aspects of ultrasound, and interventional techniques. Descriptions of instrumentation, physics and bioeffects, measurement data and normal anatomy in the fetus are given. There is a section on fetal anomalies and the investigation and management of various obstetrical problems, such as multiple pregnancy and hydatidiform mole. Coverage of gynecological ultrasound includes normal pelvic anatomy, pelvic masses, pelvic inflammatory disease, and breast evaluation.

  2. Successful Embolization of an Ovarian Artery Pseudoaneurysm Complicating Obstetric Hysterectomy

    SciTech Connect

    Rathod, Krantikumar R Deshmukh, Hemant L; Asrani, Ashwin; Salvi, Vinita S; Prabhu, Santoshi

    2005-01-15

    Transcatheter arterial embolization is becoming the therapy of choice for controlling obstetric hemorrhage, affording the ability to control persistent bleeding from pelvic vessels while avoiding the morbidity of surgical exploration. The clinicians are left with little choice if pelvic hemorrhage continues after hysterectomy and ligation of anterior division of both internal iliac arteries. We present one such case of intractable post-obstetric hysterectomy hemorrhage in which an ovarian artery pseudoaneurysm was diagnosed angiographically and successfully embolized, highlighting the role of transcatheter embolization.

  3. Obstetrics and gynecology between clinics and research.

    PubMed

    Eskes, T

    2003-01-01

    An evaluation of a 25-year chairmanship at the University of Nijmegen is given. The main tasks were patient care, teaching and research. Patient care was influenced by new techniques later introduced into the various subdisciplines of Obstetrics and Gynecology. Evaluation of patient care was guaranteed by annual reports focussing on avoidable factors for morbidity or mortality. Furthermore the department was visited every five years by a hospital recognition committee for specialist training. There were just two juridical complaints that finally were denied. Clinical teaching involved medical students, interns and residents. The changes in teaching followed an international change from one-person lectures to student study groups. Efficacy of teaching was evaluated by an inter-university comparison of study duration. Nijmegen scored high. The evaluation of teaching for residents was done by the yearly one-day participation in the American CREOG (Council Resident Examination Obstetrics and Gynecology) multiple choice examination. The level of final positions of trained residents can also be seen as a partial result of the quality of training. Twenty out of 128 (15.6%) were nominated as professors. The Ph.D. residents were all working in major teaching hospitals. Research efforts were evaluated by the number of Ph.D.'s acquired by residents. Fifty-three percent of the residents accomplished a Ph.D. thesis. This was ten times the mean of the country. Several new techniques were introduced by the department in the Netherlands: amniotic fluid analysis, chromosomal investigations, fetal monitoring, animal studies, laparoscopy, ultrasound, radio-immuno-assay, gasanalysis of cord blood, genetic counseling, monoclonal antibodies and prolactin-agonists. Four research lines could be considered as an international breakthrough: the silent fetal heart rate pattern, dopamine-agonists, fetal behavioural states and homocysteine metabolism associated with neural tube defects. The

  4. What is needed for taking emergency obstetric and neonatal programmes to scale?

    PubMed

    Bergh, Anne-Marie; Allanson, Emma; Pattinson, Robert C

    2015-11-01

    Scaling up an emergency obstetric and neonatal care (EmONC) programme entails reaching a larger number of people in a potentially broader geographical area. Multiple strategies requiring simultaneous attention should be deployed. This paper provides a framework for understanding the implementation, scale-up and sustainability of such programmes. We reviewed the existing literature and drew on our experience in scaling up the Essential Steps in the Management of Obstetric Emergencies (ESMOE) programme in South Africa. We explore the non-linear change process and conditions to be met for taking an existing EmONC programme to scale. Important concepts cutting across all components of a programme are equity, quality and leadership. Conditions to be met include appropriate awareness across the board and a policy environment that leads to the following: commitment, health systems-strengthening actions, allocation of resources (human, financial and capital/material), dissemination and training, supportive supervision and monitoring and evaluation. PMID:25921973

  5. Obstetric management of adolescents with bleeding disorders.

    PubMed

    James, Andra H

    2010-12-01

    Adolescents with bleeding disorders who become pregnant must contend with the dual challenges of their bleeding disorder and their pregnancy. Adolescents are more likely to terminate a pregnancy than adult women, and when they do carry a pregnancy, they are more likely to deliver prematurely. Otherwise, they are at risk for the same complications that adult women with bleeding disorders experience, particularly bleeding complications postpartum. Since one half to two thirds of adolescent pregnancies are unplanned, issues related to reproduction should be addressed during routine visits with the pediatrician, hematologist or gynecologist. Girls who are at risk of being carriers for hemophilia A and B, severe von Willebrand disease, and other severe bleeding disorders should have their bleeding disorder status determined before they become pregnant. During pregnancy, a plan should be established to ensure that both mother and fetus deliver safely. Young women at risk for severe bleeding or at risk of having a severely affected infant should be referred for prenatal care and delivery to a center where, in addition to specialists in high-risk obstetrics, there is a hemophilia treatment center or a hematologist with expertise in hemostasis. Prior to delivery or any invasive procedures, young women at risk for severe bleeding should receive prophylaxis. Since administration of desmopressin may result in hyponatremia, whenever available, virally inactivated or recombinant clotting factor concentrates should be used for replacement as opposed to fresh frozen plasma or cryoprecipitate. PMID:20934895

  6. Obstetric management of intrauterine growth restriction.

    PubMed

    Marsál, Karel

    2009-12-01

    The aim of obstetric management is to identify growth-restricted foetuses at risk of severe intrauterine hypoxia, to monitor their health and to deliver when the adverse outcome is imminent. After 30-32 gestational weeks, a Doppler finding of absent or reverse end-diastolic flow in the umbilical artery of a small-for-gestational age foetus is in itself an indication for delivery. In very preterm foetuses, the intrauterine risks have to be balanced against the risk of prematurity. All available diagnostic information (e.g., Doppler velocimetry of umbilical artery, foetal central arteries and veins and of maternal uterine arteries; foetal heart rate with computerised analysis of short-term variability; amniotic fluid amount; and foetal gestational age-related weight) should be collected to support the timing of delivery. If possible, the delivery should optimally take place before the onset of late signs of foetal hypoxia (pathological foetal heart rate pattern, severely abnormal ductus venosus blood velocity waveform, pulsations in the umbilical vein). PMID:19854682

  7. Nerve injuries due to obstetric trauma.

    PubMed

    Bhat, V; Ravikumara; Oumachigui, A

    1995-01-01

    The incidence of nerve injuries among 32,637 deliveries over a period of ten years was 1.81/1000. Brachial plexus injury (1/1000) and facial nerve injury (0.74/1000) accounted for 98% of nerve injuries. Both the right and left side were involved equally. Bilateral nerve injury was not seen. Lack of antenatal care, macrosomia, abnormal presentations, and operative vaginal deliveries significantly increased the risk of nerve injuries. These babies had significantly higher incidence of meconium stained liquor and intrapartum asphyxia. Parity of the mother, gestational age and sex of the baby did not have significant role in the causation of nerve injuries. Injuries to brachial plexus and facial nerve were seen even in babies born by caesarean section, when it was performed for obstructed labour caused by cephalo-pelvic disproportion and abnormal presentations. Three babies with injuries expired and forty-three could be followed up for varying periods. None of the babies had residual defects. Detection of cephalopelvic disproportion and abnormal lie in the third trimester and their appropriate management would decrease the incidence of obstetric palsies to a significant extent. PMID:10829869

  8. [Estimation of need for obstetrical interventions in Morocco. An approach based on the spatial analysis of deficits].

    PubMed

    De Brouwere, V; Laabid, A; Van Lerberghe, W

    1996-04-01

    One of the indicators of health system effectiveness with regard to maternal health is the maternal mortality ratio. Measuring this ratio in developing countries is, however, not an easy task since reliable information on mortality is rarely available. An alternative to the maternal mortality ratio measurement, as an indicator of effectiveness, is the assessment of the coverage of obstetrical intervention needs. The authors chose to restrict the notion of "needs" to the obstetrical interventions carried out in order to save a mother's life. Using data from a survey by the Ministry of Health of the Moroccan Kingdom on all the obstetrical interventions carried out in 1989, obstetrical intervention rates for "absolute maternal indications" are analysed according to the mother's origin, by province and urban/rural environment. The spatial analysis of these rates showed large variations in each of the environments (0 to 2.14 % of the expected births in urban areas and 0 to 1.25 % in rural areas) and a significative difference between the rural and urban distributions (median 0.80 % in urban areas versus 0.30 % in rural areas). Applying a reference rate of 1 %, deficits between the expected numbers of needed obstetrical interventions and the observed numbers were calculated for every province in both urban and rural areas. In the whole of Morocco, intervention rates are markedly below what is expected. The spatial analysis of the deficits helps to identify the provinces where the problem is the most prominent in terms of numbers of women whose intervention needs have to be covered. The authors discuss the validity of the reference rate and suggest several strategies to solve the problem. They conclude that the deficits map is a useful tool to decide on priorities for planning and monitoring of strategies to be implemented. The spatial analysis of obstetrical intervention deficits seems to be an instrument both cheaper and more relevant than a maternal mortality estimates

  9. Rural-Urban Inequity in Unmet Obstetric Needs and Functionality of Emergency Obstetric Care Services in a Zambian District

    PubMed Central

    Ng’anjo Phiri, Selia; Fylkesnes, Knut; Moland, Karen Marie; Byskov, Jens; Kiserud, Torvid

    2016-01-01

    Background Zambia has a high maternal mortality ratio, 398/100,000 live births. Few pregnant women access emergency obstetric care services to handle complications at childbirth. We aimed to assess the deficit in life-saving obstetric services in the rural and urban areas of Kapiri Mposhi district. Method A cross-sectional survey was conducted in 2011 as part of the ‘Response to Accountable priority setting for Trust in health systems’ (REACT) project. Data on all childbirths that occurred in emergency obstetric care facilities in 2010 were obtained retrospectively. Sources of information included registers from maternity ward admission, delivery and operation theatre, and case records. Data included age, parity, mode of delivery, obstetric complications, and outcome of mother and the newborn. An approach using estimated major obstetric interventions expected but not done in health facilities was used to assess deficit of life-saving interventions in urban and rural areas. Results A total of 2114 urban and 1226 rural childbirths occurring in emergency obstetric care facilities (excluding abortions) were analysed. Facility childbirth constituted 81% of expected births in urban and 16% in rural areas. Based on the reference estimate that 1.4% of childbearing women were expected to need major obstetric intervention, unmet obstetric need was 77 of 106 women, thus 73% (95% CI 71–75%) in rural areas whereas urban areas had no deficit. Major obstetric interventions for absolute maternal indications were higher in urban 2.1% (95% CI 1.60–2.71%) than in rural areas 0.4% (95% CI 0.27–0.55%), with an urban to rural rate ratio of 5.5 (95% CI 3.55–8.76). Conclusions Women in rural areas had deficient obstetric care. The likelihood of under-going a life-saving intervention was 5.5 times higher for women in urban than rural areas. Targeting rural women with life-saving services could substantially reduce this inequity and preventable deaths. PMID:26824599

  10. The Critical Role of Supervision in Retaining Staff in Obstetric Services: A Three Country Study

    PubMed Central

    McAuliffe, Eilish; Daly, Michael; Kamwendo, Francis; Masanja, Honorati; Sidat, Mohsin; de Pinho, Helen

    2013-01-01

    Millennium Development Goal (MDG) 5 commits us to reducing maternal mortality rates by three quarters and MDG 4 commits us to reducing child mortality by two-thirds between 1990 and 2015. In order to reach these goals, greater access to basic emergency obstetric care (EmOC) as well as comprehensive EmOC which includes safe Caesarean section, is needed.. The limited capacity of health systems to meet demand for obstetric services has led several countries to utilize mid-level cadres as a substitute to more extensively trained and more internationally mobile healthcare workers. Although this does provide greater capacity for service delivery, concern about the performance and motivation of these workers is emerging. We propose that poor leadership characterized by inadequate and unstructured supervision underlies much of the dissatisfaction and turnover that has been shown to exist amongst these mid-level healthcare workers and indeed health workers more generally. To investigate this, we conducted a large-scale survey of 1,561 mid-level cadre healthcare workers (health workers trained for shorter periods to perform specific tasks e.g. clinical officers) delivering obstetric care in Malawi, Tanzania, and Mozambique. Participants indicated the primary supervision method used in their facility and we assessed their job satisfaction and intentions to leave their current workplace. In all three countries we found robust evidence indicating that a formal supervision process predicted high levels of job satisfaction and low intentions to leave. We find no evidence that facility level factors modify the link between supervisory methods and key outcomes. We interpret this evidence as strongly supporting the need to strengthen leadership and implement a framework and mechanism for systematic supportive supervision. This will promote better job satisfaction and improve the retention and performance of obstetric care workers, something which has the potential to improve

  11. The critical role of supervision in retaining staff in obstetric services: a three country study.

    PubMed

    McAuliffe, Eilish; Daly, Michael; Kamwendo, Francis; Masanja, Honorati; Sidat, Mohsin; de Pinho, Helen

    2013-01-01

    Millennium Development Goal (MDG) 5 commits us to reducing maternal mortality rates by three quarters and MDG 4 commits us to reducing child mortality by two-thirds between 1990 and 2015. In order to reach these goals, greater access to basic emergency obstetric care (EmOC) as well as comprehensive EmOC which includes safe Caesarean section, is needed.. The limited capacity of health systems to meet demand for obstetric services has led several countries to utilize mid-level cadres as a substitute to more extensively trained and more internationally mobile healthcare workers. Although this does provide greater capacity for service delivery, concern about the performance and motivation of these workers is emerging. We propose that poor leadership characterized by inadequate and unstructured supervision underlies much of the dissatisfaction and turnover that has been shown to exist amongst these mid-level healthcare workers and indeed health workers more generally. To investigate this, we conducted a large-scale survey of 1,561 mid-level cadre healthcare workers (health workers trained for shorter periods to perform specific tasks e.g. clinical officers) delivering obstetric care in Malawi, Tanzania, and Mozambique. Participants indicated the primary supervision method used in their facility and we assessed their job satisfaction and intentions to leave their current workplace. In all three countries we found robust evidence indicating that a formal supervision process predicted high levels of job satisfaction and low intentions to leave. We find no evidence that facility level factors modify the link between supervisory methods and key outcomes. We interpret this evidence as strongly supporting the need to strengthen leadership and implement a framework and mechanism for systematic supportive supervision. This will promote better job satisfaction and improve the retention and performance of obstetric care workers, something which has the potential to improve

  12. [Apple-Macintosh compatible software for documentation, management and evaluation of ultrasound findings in obstetrics].

    PubMed

    Kurmanavicius, J; Huch, R; Huch, A

    1993-02-01

    The advantage of using a computer to automate routine calculations and print out charts of the obstetrical ultrasound examination is obvious. This report describes a software designed to simplify the documentation and analysis of ultrasound data in obstetrics. The system is easy to use, even for persons with little computer knowledge. The programme was written in FoxBase+/Mac (Fox Software, Inc., USA). FoxBase+/Mac takes full advantage of the easy-to-learn, easy-to-use Macintosh interface and is also very fast. Another advantage of this software is that it can be used in teaching. Non-experienced examinators can double-check the correctness of their scanning planes by observing the ultrasound pictures with the markers indicating the right measurement sites and the lists of standard values of biometrical parameters for the corresponding gestational age on the screen. In routine obstetrical ultrasound examinations it takes less than 5 min to enter the foetal biometry data and print out reports. These reports are informative and easy to interpret. PMID:8465182

  13. A case against Dutch euthanasia.

    PubMed

    Fenigsen, Richard

    1989-01-01

    The growing acceptance of voluntary active euthanasia by the Dutch is examined in relation to the plastic cards requesting active euthanasia carried by many people in The Netherlands, public opinion polls, and support by leading medical figures of the movement to legalize euthanasia. The author draws upon his experience as a hospital doctor to condemn the practice of active euthanasia, arguing that its voluntariness is often counterfeit and always questionable, that it is inseparable from overtly involuntary forms of euthanasia, and that its promise of sparing the sick person agony is false. "Voluntary" euthanasia also brings an ominous change in society because of the message it sends to the elderly and sick, the weak and the dependent; because the fallibility of medical judgments are inconsistent with the irreversibility of the act; and because the fallacious reasoning of the philosophy threatens to cause irreparable damage to the medical profession. PMID:11650123

  14. [Teledermatology within Dutch nursing homes].

    PubMed

    Lubeek, Satish F K; Mommers, Roland J M; van der Geer, Eric R; van de Kerkhof, Peter C M; Gerritsen, Marie-Jeanne Rianne P

    2016-06-01

    Skin problems are common within the nursing home population and could have a significant impact on quality of life. As a form of long-distance consultation teledermatology offers several potential benefits within this frail population. In this review we discuss several aspects of teledermatology, especially in relation to the nursing home population. Several studies demonstrated that teledermatology is a cost-effective and easy-to-use consultation method, which could significantly reduce the amount of hospital visits. However, teledermatology is only used in a limited number of Dutch nursing homes in daily practice due to several factors. For the optimal implementation of teledermatological consultation there are some important logistical, legal and financial framework conditions. In conclusion, teledermatology has a lot to offer within the nursing home population and therefore teledermatology will hopefully be increasingly used in daily practice within the near future. PMID:27098424

  15. Summary of the Dutch S3-guidelines on the treatment of psoriasis 2011. Dutch Society of Dermatology and Venereology.

    PubMed

    Zweegers, J; de Jong, E M G J; Nijsten, T E C; de Bes, J; te Booij, M; Borgonjen, R J; van Cranenburgh, O D; van Deutekom, H; van Everdingen, J J E; de Groot, M; Van Hees, C L M; Hulshuizen, H; Koek, M B G; de Korte, W J A; de Korte, J; Lecluse, L L A; Pasch, M C; Poblete-Gutiérrez, P A; Prens, E P; Seyger, M M B; Thio, H B; Torcque, L A; de Vries, A C Q; van de Kerkhof, P C M; Spuls, Ph I

    2014-03-01

    This document provides a summary of the Dutch S3-guidelines on the treatment of psoriasis. These guidelines were finalized in December 2011 and contain unique chapters on the treatment of psoriasis of the face and flexures, childhood psoriasis as well as the patient's perspective on treatment. They also cover the topical treatment of psoriasis, photo(chemo)therapy, conventional systemic therapy and biological therapy. PMID:24656281

  16. Accounts of severe acute obstetric complications in Rural Bangladesh

    PubMed Central

    2011-01-01

    Background As maternal deaths have decreased worldwide, increasing attention has been placed on the study of severe obstetric complications, such as hemorrhage, eclampsia, and obstructed labor, to identify where improvements can be made in maternal health. Though access to medical care is considered to be life-saving during obstetric emergencies, data on the factors associated with health care decision-making during obstetric emergencies are lacking. We aim to describe the health care decision-making process during severe acute obstetric complications among women and their families in rural Bangladesh. Methods Using the pregnancy surveillance infrastructure from a large community trial in northwest rural Bangladesh, we nested a qualitative study to document barriers to timely receipt of medical care for severe obstetric complications. We conducted 40 semi-structured, in-depth interviews with women reporting severe acute obstetric complications and purposively selected for conditions representing the top five most common obstetric complications. The interviews were transcribed and coded to highlight common themes and to develop an overall conceptual model. Results Women attributed their life-threatening experiences to societal and socioeconomic factors that led to delays in seeking timely medical care by decision makers, usually husbands or other male relatives. Despite the dominance of male relatives and husbands in the decision-making process, women who underwent induced abortions made their own decisions about their health care and relied on female relatives for advice. The study shows that non-certified providers such as village doctors and untrained birth attendants were the first-line providers for women in all categories of severe complications. Coordination of transportation and finances was often arranged through mobile phones, and referrals were likely to be provided by village doctors. Conclusions Strategies to increase timely and appropriate care seeking

  17. How Has the Free Obstetric Care Policy Impacted Unmet Obstetric Need in a Rural Health District in Guinea?

    PubMed Central

    Delamou, Alexandre; Dubourg, Dominique; Beavogui, Abdoul Habib; Delvaux, Thérèse; Kolié, Jacques Seraphin; Barry, Thierno Hamidou; Camara, Bienvenu Salim; Edginton, Mary; Hinderaker, Sven; De Brouwere, Vincent

    2015-01-01

    Introduction In 2010, the Ministry of Health (MoH) of Guinea introduced a free emergency obstetric care policy in all the public health facilities of the country. This included antenatal checks, normal delivery and Caesarean section. Objective This study aims at assessing the changes in coverage of obstetric care according to the Unmet Obstetric Need concept before (2008) and after (2012) the implementation of the free emergency obstetric care policy in a rural health district in Guinea. Methods We carried out a descriptive cross-sectional study involving the retrospective review of routine programme data during the period April to June 2014. Results No statistical difference was observed in women’s sociodemographic characteristics and indications (absolute maternal indications versus non-absolute maternal indications) before and after the implementation of the policy. Compared to referrals from health centers of patients, direct admissions at hospital significantly increased from 49% to 66% between 2008 and 2012 (p = 0.001). In rural areas, this increase concerned all maternal complications regardless of their severity, while in urban areas it mainly affected very severe complications. Compared to 2008, there were significantly more Major Obstetric Interventions for Maternal Absolute Indications in 2012 (p<0.001). Maternal deaths decreased between 2008 and 2012 from 1.5% to 1.1% while neonatal death increased from 12% in 2008 to 15% in 2012. Conclusion The implementation of the free obstetric care policy led to a significant decrease in unmet obstetric need between 2008 and 2012 in the health district of Kissidougou. However, more research is needed to allow comparisons with other health districts in the country and to analyse the trends. PMID:26047472

  18. Training of midwives in advanced obstetrics in Liberia

    PubMed Central

    Dolo, Obed; Clack, Alice; Gibson, Hannah; Lewis, Naomi

    2016-01-01

    Abstract Problem The shortage of doctors in Liberia limits the provision of comprehensive emergency obstetric and neonatal care. Approach In a pilot project, two midwives were trained in advanced obstetric procedures and in the team approach to the in-hospital provision of advanced maternity care. The training took two years and was led by a Liberian consultant obstetrician with support from international experts. Local setting The training took place in CB Dunbar Maternity Hospital. This rural hospital deals with approximately 2000 deliveries annually, many of which present complications. In February 2015 there were just 117 doctors available in Liberia. Relevant changes In the first 18 months of training, the trainees were involved with 236 caesarean sections, 35 manual evacuations of products of conception, 25 manual removals of placentas, 21 vaginal breech deliveries, 14 vacuum deliveries, four repairs of ruptured uteri, the management of four cases of shoulder dystocia, three hysterectomies, two laparotomies for ruptured ectopic pregnancies and numerous obstetric ultrasound examinations. The trainees also managed 41 cases of eclampsia or severe pre-eclampsia, 25 of major postpartum haemorrhage and 21 of shock. Although, initially they only assisted senior doctors, the trainees subsequently progressed from direct to indirect supervision and then to independent management. Lessons learnt To compensate for a shortage of doctors able to undertake comprehensive emergency obstetric and neonatal care, experienced midwives can be taught to undertake advanced obstetric care and procedures. Their team work with doctors can be particularly valuable in rural hospitals in resource-poor countries. PMID:27147768

  19. Simulation laboratories for training in obstetrics and gynecology.

    PubMed

    Macedonia, Christian R; Gherman, Robert B; Satin, Andrew J

    2003-08-01

    Simulations have been used by the military, airline industry, and our colleagues in other medical specialties to educate, evaluate, and prepare for rare but life-threatening scenarios. Work hour limits for residents in obstetrics and gynecology and decreased patient availability for teaching of students and residents require us to think creatively and practically on how to optimize their education. Medical simulations may address scenarios in clinical practice that are considered important to know or understand. Simulations can take many forms, including computer programs, models or mannequins, virtual reality data immersion caves, and a combination of formats. The purpose of this commentary is to call attention to a potential role for medical simulation in obstetrics and gynecology. We briefly describe an example of how simulation may be incorporated into obstetric and gynecologic residency training. It is our contention that educators in obstetrics and gynecology should be aware of the potential for simulation in education. We hope this commentary will stimulate interest in the field, lead to validation studies, and improve training in and the practice of obstetrics and gynecology. PMID:12907117

  20. Transfusion and coagulation management in major obstetric hemorrhage

    PubMed Central

    Butwick, A.J.; Goodnough, L.T.

    2015-01-01

    Purpose of Review Major obstetric hemorrhage is a leading cause of maternal morbidity and mortality. We will review transfusion strategies and the value of monitoring the maternal coagulation profile during severe obstetric hemorrhage. Recent Findings Epidemiologic studies indicate that rates of severe postpartum hemorrhage (PPH) in well-resourced countries are increasing. Despite these increases, rates of transfusion in obstetrics are low (0.9% - 2.3%), and investigators have questioned whether a pre-delivery ‘type and screen’ is cost-effective for all obstetric patients. Instead, blood ordering protocols specific to obstetric patients can reduce unnecessary antibody testing. When severe PPH occurs, a massive transfusion protocol (MTP) has attracted interest as a key therapeutic resource by ensuring sustained availability of blood products to the labor and delivery unit. During early postpartum bleeding, recent studies have shown that hypofibrinogenemia is an important predictor for the later development of severe PPH. Point-of-care technologies, such as thromboelastography and rotational thromboelastometry, can identify decreased fibrin-clot quality during PPH, which correlate with low fibrinogen levels. Summary A MTP provides a key resource in the management of severe PPH. However, future studies are needed to assess whether formula driven vs. goal-directed transfusion therapy improves maternal outcomes in women with severe PPH. PMID:25812005

  1. Impact of maternal under nutrition on obstetric outcomes.

    PubMed

    Triunfo, S; Lanzone, A

    2015-01-01

    Maternal malnutrition, ranging from under nutrition to over dietary intake before and in the pregnant state, is worldwide problem with significant consequences, not only for survival and increased risk for acute and chronic diseases both in mother and child, but also for economic productivity of individuals in the societies and additional costs on health system. Inter alia, pre-pregnancy underweight and insufficient gestational weight gain are considered as individual risk factors for the occurrence of spontaneous interruption, preterm birth, fetal growth restriction, and hypertensive disorders, strongly associated with poorer perinatal outcome. In a portion of this population, major eating disorders (anorexia and bulimia nervosa), once thought to be rare, but nowadays enlarged due to cultural pressure on the drive for thinness, have been identified as the etiology of an abnormal nutritional condition in developed countries, in contrast to long standing food deprivation in developing countries. Actually, even if without a complete weight management guidance for these selected pregnant women, an appropriate weight gain is recommended during pregnancy. Mainly, therapeutic approach is prevention using specific programs of improving weight before pregnant status. In this article, a review of the literature on selected obstetrical risks associated with maternal underweight has been performed and both the target prevention and management strategies have been described. PMID:25194427

  2. Dutch research reforms cause a stir

    NASA Astrophysics Data System (ADS)

    van Calmthout, Martijn

    2015-02-01

    All 69 winners of the Spinoza prize - the highest award in Dutch science - have signed a petition against proposed reforms to the country's leading funding agency, the Netherlands Organisation for Scientific Research (NWO).

  3. Persistent Identifiers for Dutch cultural heritage institutions

    NASA Astrophysics Data System (ADS)

    Ras, Marcel; Kruithof, Gijsbert

    2016-04-01

    subject of persistent identifiers, (2) develop a business model for a persistent identifier service especially for smaller CH organisations, and (3) set up some show cases. Some of the products delivered by the project in 2016 will be: (1) a business model for a persistent identifier service based on an affordable co-financing model (2) a technical implementation of a persistent identifier service based on one of the existing PI models (3) a general agreement with suppliers of collection management systems and record management systems used by cultural heritage institutions in The Netherlands (4) a decision tree for cultural heritage organisations which can guide them through the process of selecting a particular type of Persistent Identifier (Handle, DOI, ARK or NBN:URN) (5) a technical implementation help function In the presentation we will explain the collaborative work carried out in The Netherlands within the framework of the NDE Network, focusing on the Persistent Identifiers project. We will present our preliminary results on communication strategy, business model and decision tree. And we will speak about the discussions we have with the commercial vendors of record management systems in order to built-in facilities for persistent identifiers in the systems used by the Dutch cultural heritage organisations.

  4. [Dutch government invests in existing biobanks].

    PubMed

    Brandsma, Margreet; van Ommen, Gert-Jan B; Wijmenga, Cisca; Kiemeney, Lambertus A

    2010-01-01

    Modern research, aimed at discovering factors that influence health and disease, requires large collections of data and samples. Collaboration between biobanks is therefore essential. The Dutch hub in the network of biobanks, the Biobanking and Biomolecular Resources Research Infrastructure (BBMRI-NL), is one of the major Dutch biobanking initiatives. It is sponsored by the Dutch government through the Netherlands Organization for Scientific Research (NWO). BBMRI-NL sets up collaboration between approximately 150 existing clinical and population biobanks in the Netherlands, and forms the link with the European BBMRI initiative. BBMRI-NL aims at enrichment and harmonization of existing Dutch biobanks, at data management and analysis, and at laying the legal, social and ethical foundations, in order to improve access and inter-operability, and to render the information and organization up to date. Other major Dutch initiatives are String of Pearls and LifeLines. Together these will create the conditions needed for Dutch researchers to further develop their strong position in the international biobanking field. PMID:21029488

  5. The Role of Interventional Radiology in Obstetric Hemorrhage

    SciTech Connect

    Gonsalves, M. Belli, A.

    2010-10-15

    Obstetric hemorrhage remains a major cause of maternal morbidity and mortality worldwide. Traditionally, in cases of obstetric hemorrhage refractory to conservative treatment, obstetricians have resorted to major surgery with the associated risks of general anesthesia, laparotomy, and, in the case of hysterectomy, loss of fertility. Over the past two decades, the role of pelvic arterial embolization has evolved from a novel treatment option to playing a key role in the management of obstetric hemorrhage. To date, interventional radiology offers a minimally invasive, fertility-preserving alternative to conventional surgical treatment. We review current literature regarding the role of interventional radiology in postpartum hemorrhage, abnormal placentation, abortion, and cervical ectopic pregnancy. We discuss techniques, success rates, and complications.

  6. Effects of changes in copayment for obstetric emergency room visits on the utilization of obstetric emergency rooms.

    PubMed

    Raz, Iris; Novack, Lena; Yitshak-Sade, Maayan; Shahar, Yemima; Wiznitzer, Arnon; Sergienko, Ruslan; Warshawsky-Livne, Lora

    2015-10-01

    In view of the growing proportion of "non-urgent" admissions to obstetric emergency rooms (OERs) and recent changes in copayment policies for OER visits in Israel, we assessed factors contributing to OER overcrowding. The changes investigated were (a) exemption from copayment for women with birth contractions, (b) allowing phone referrals to the OER and (c) exemption from copayment during primary care clinic closing hours. We analyzed data of a large tertiary hospital with 37 deliveries per day. Counts of women discharged to home from the OER were an indicator of "non-urgent" visits. The annual number of non-urgent visits increased at a higher rate (3.4%) than the natural increase in deliveries (2.1%). Exemption from copayment for visits during non-working hours of primary care clinics was associated with increases in OER admissions (IRR=1.22) and in non-urgent OER visits (IRR=1.54). Younger and first-time mothers with medically unjustified complaints were more likely to be discharged to home. We showed that the changes in the policy for OER copayment meant to attract new clients to the HMO had an independent impact on OER utilization, and hence, added to the workload of medical personnel. The change in HMO policy regulating OER availability requires rigorous assessment of possible health system implications. PMID:26341842

  7. [Indications and risk factors for emergency obstetric hysterectomy].

    PubMed

    Nava Flores, Jorge; Paez Angulo, José Antonio; Veloz Martínez, Guadalupe; Sánchez Valle, Verónica; Hernández-Valencia, Marcelino

    2002-06-01

    Emergency obstetric hysterectomy is a procedure that potentially preserves the life and the postpartum bleeding is the direct cause of its indication, the hemorrhage postpartum happens in 1% of obstetric patients. This study was carried out to identify women with potential risk for this event and to prevent this obstetric problem. The most frequent indications for hysterectomy were identified, as well as the sociodemographic characteristic of the patients. The surgical procedure carried out was extra-fascial technique with type Richardson hysterectomy modified; the surgical pieces went to the pathology service, to obtain the histopathological diagnosis. 43 cases of obstetric hysterectomy, were analyzed; the characteristics of this group showed that bigger percentage of this event was more frequent in 31 to 35 years (39.5%), with pregnancies at term (51.1%) in third pregnancies(27.9%), nulliparas (60.4%), with first cesarean section (39.5%), without previous abortions (79.0%). The most frequent obstetric complications were uterine atony and placenta accreta. The cause for uterine atony could be interstitial edema, as well as myometrial hypertrophy, because such histopathological diagnoses were the most common. Odds ratio showed that a patient with cesarean section has 1.16 more probabilities of suffering hysterectomy than a woman with childbirth. This study describes the histological presence of interstitial edema and myometrial hypertrophy as possible causes of uterine atony in the histological study of surgical specimen. This could be related to no response of myometrial to the uterus-tonic effect of oxytocin. Obstetric uterine dysfunction has multifactorial cause. Patients with the characteristics described in this study should be considered as high risk. PMID:12148472

  8. Dutch translation and cross-cultural adaptation of the PROMIS® physical function item bank and cognitive pre-test in Dutch arthritis patients

    PubMed Central

    2012-01-01

    Introduction Patient-reported physical function is an established outcome domain in clinical studies in rheumatology. To overcome the limitations of the current generation of questionnaires, the Patient-Reported Outcomes Measurement Information System (PROMIS®) project in the USA has developed calibrated item banks for measuring several domains of health status in people with a wide range of chronic diseases. The aim of this study was to translate and cross-culturally adapt the PROMIS physical function item bank to the Dutch language and to pretest it in a sample of patients with arthritis. Methods The items of the PROMIS physical function item bank were translated using rigorous forward-backward protocols and the translated version was subsequently cognitively pretested in a sample of Dutch patients with rheumatoid arthritis. Results Few issues were encountered in the forward-backward translation. Only 5 of the 124 items to be translated had to be rewritten because of culturally inappropriate content. Subsequent pretesting showed that overall, questions of the Dutch version were understood as they were intended, while only one item required rewriting. Conclusions Results suggest that the translated version of the PROMIS physical function item bank is semantically and conceptually equivalent to the original. Future work will be directed at creating a Dutch-Flemish final version of the item bank to be used in research with Dutch speaking populations. PMID:22390734

  9. Ethnic Identity, Externalizing Problem Behaviour and the Mediating Role of Self-Esteem among Dutch, Turkish-Dutch and Moroccan-Dutch Adolescents

    ERIC Educational Resources Information Center

    Wissink, Inge B.; Dekovic, Maja; Yagmur, Sengul; Stams, Geert Jan; de Haan, Mariette

    2008-01-01

    The present study examined whether self-esteem mediates the relationship between two aspects of ethnic identity (i.e. ethnic identity exploration and ethnic identity commitment-affirmation) and externalizing problem behaviour in Dutch, Turkish-Dutch and Moroccan-Dutch adolescents living in the Netherlands. A total number of 345 adolescents (115…

  10. Isolation guidelines for obstetric patients and newborn infants.

    PubMed

    Weinstein, R A; Boyer, K M; Linn, E S

    1983-06-15

    Available isolation guidelines for use in hospitals have often overlooked the infectious diseases and unique interactions of obstetric patients and their newborn infants. To help fill this void, we present our hospital's isolation policies for obstetric and neonatal patients and guidelines for maternal-infant contact and breast-feeding. These policies represent a multidisciplinary consensus of opinion and available epidemiologic data and have been found useful and practical in a single large teaching hospital. Other institutions should be able to adapt these guidelines to their own patient populations, personnel, and physical facilities. PMID:6859157

  11. 21 CFR 884.4520 - Obstetric-gynecologic general manual instrument.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric-gynecologic general manual instrument... Surgical Devices § 884.4520 Obstetric-gynecologic general manual instrument. (a) Identification. An obstetric-gynecologic general manual instrument is one of a group of devices used to perform...

  12. 21 CFR 884.4530 - Obstetric-gynecologic specialized manual instrument.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric-gynecologic specialized manual... Gynecological Surgical Devices § 884.4530 Obstetric-gynecologic specialized manual instrument. (a) Identification. An obstetric-gynecologic specialized manual instrument is one of a group of devices used...

  13. Overcoming phase 1 delays: the critical component of obstetric fistula prevention programs in resource-poor countries

    PubMed Central

    2012-01-01

    care. Summary Women in resource-poor countries will use institutional obstetric care when the services provided are valued more than the competing choices offered by a pluralistic medical system. The key to obstetric fistula prevention is competent obstetrical care delivered respectfully, promptly, and at affordable cost. The utilization of these services is driven largely by trust. PMID:22809234

  14. Obstetrics Patients' Assessment of Medical Students' Role in Their Care.

    ERIC Educational Resources Information Center

    Magrane, Diane

    1988-01-01

    Obstetric patients rated the skills and assessed the roles of students caring for them during a clinical clerkship. They rated skills and attitudes high, generally, with lower ratings for their ability to answer questions and preparation to participate in care. Most felt students improved their care, primarily in supportive ways. (Author/MSE)

  15. Clearinghouse: Diagnostic Categories and Obstetric Complication Histories in Disturbed Children

    ERIC Educational Resources Information Center

    McNeil, Thomas F.; Wiegerink, Ronald

    1971-01-01

    No significant differences in the obstetric complication measures were found among the various diagnostic groupings of 61 psychologically or behaviorally disturbed children, nor between any complication measures and any of the three disturbed behavior patterns identified (psychotic withdrawal, acting-out aggression, organic signs). (KW)

  16. A National Survey of Undergraduate Teaching in Obstetrics and Gynecology.

    ERIC Educational Resources Information Center

    And Others; Stenchever, Morton A.

    1979-01-01

    A survey of academic departments of obstetrics and gynecology was designed to assess undergraduate educational programs and the impact of efforts made to improve teaching in the specialty. It focuses on instructional patterns, the clinical clerkship, student evaluation, and program administration and evaluation. Prior surveys are noted.…

  17. Obstetric Outcomes in Non-Gynecologic Cancer Patients in Remission

    PubMed Central

    Timur, Hakan; Tokmak, Aytekin; Iskender, Cantekin; Yildiz, Elif Sumer; Inal, Hasan Ali; Uygur, Dilek; Danisman, Nuri

    2016-01-01

    Objective: The aim of the present study was to evaluate the obstetric and perinatal outcomes in treated women who were diagnosed with non-gynecologic cancer and to compare these findings with pregnant women with no history of cancer. Materials and Methods: This retrospective study was conducted on 21 pregnant women with non-gynecologic cancer who were in remission (study group) and 63 pregnant women with no history of cancer (control group). The women were admitted to the high-risk pregnancy clinic of Zekai Tahir Burak Women’s Health Training and Research Hospital with a diagnosis of pregnancy and cancer between January 2010 and January 2015. Obstetric outcomes and demographic characteristics of the patients were recorded. Age, gravida, parity, abortus, body mass index (BMI), gestational week, smoking, mode of delivery, gestational weight, and perinatal outcomes were examined for each woman. Results: The most common cancer types were thyroid (28.5%) and breast cancers (23.8%), which constituted just over half of the non-gynecologic cancer cases during pregnancy. The time elapsed after the diagnosis was 3.8±2.2 (1–9) years. No statistically significant differences were found between the two groups with regard to age, obstetric history, BMI, gestational week, smoking, and obstetric and perinatal outcomes (p>0.05). Conclusion: Negative perinatal outcomes in non-gynecologic cancer patients in remission were found to be within acceptable levels. PMID:27551177

  18. Anxiety, Stress and Social Support: Prenatal Predictors of Obstetrical Outcomes.

    ERIC Educational Resources Information Center

    Nethercut, Gail; Adler, Nancy

    The role of anxiety, stress, and social support in predicting negative obstetrical outcomes was examined in a high-risk group of pregnant women. The predictor variables were assessed with separate self-report scales, including The Sarason Life Experience Survey, the Spielberger State/Trait Inventory, and a modified version of the Lazarus and Cohen…

  19. Recruitment and retention in obstetrics and gynaecology in the UK.

    PubMed

    Ogbonmwan, S E O; Ogbonmwan, D E

    2010-02-01

    The problem of recruitment and retention into obstetrics and gynaecology could translate into serious manpower problems if not addressed now by making the experience of trainees and medical students rotating through the speciality memorable and improving trainees' work-life balance. PMID:20220700

  20. 21 CFR 884.4500 - Obstetric fetal destructive instrument.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Obstetric fetal destructive instrument. 884.4500 Section 884.4500 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... dead or anomalous (abnormal) fetus. This generic type of device includes the cleidoclast,...

  1. 21 CFR 884.4500 - Obstetric fetal destructive instrument.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Obstetric fetal destructive instrument. 884.4500 Section 884.4500 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... dead or anomalous (abnormal) fetus. This generic type of device includes the cleidoclast,...

  2. 21 CFR 884.4500 - Obstetric fetal destructive instrument.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Obstetric fetal destructive instrument. 884.4500 Section 884.4500 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... dead or anomalous (abnormal) fetus. This generic type of device includes the cleidoclast,...

  3. 21 CFR 884.4500 - Obstetric fetal destructive instrument.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric fetal destructive instrument. 884.4500 Section 884.4500 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... dead or anomalous (abnormal) fetus. This generic type of device includes the cleidoclast,...

  4. 21 CFR 884.4500 - Obstetric fetal destructive instrument.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Obstetric fetal destructive instrument. 884.4500 Section 884.4500 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... dead or anomalous (abnormal) fetus. This generic type of device includes the cleidoclast,...

  5. Measuring and communicating blood loss during obstetric hemorrhage.

    PubMed

    Gabel, Kristi T; Weeber, Tracy A

    2012-01-01

    Accurate quantification of blood loss is an essential skill necessary to prevent maternal morbidity and mortality associated with obstetric hemorrhage. Visual estimation of blood has been consistently shown to be extremely inaccurate. The nurse plays a pivotal role in quantifying blood loss after birth, recognizing triggers, mobilizing needed interventions, and providing essential communication. PMID:22548283

  6. [Metabolic therapy and pulmonary disfunction in patients with obstetric sepsis].

    PubMed

    Iakovlev, A Iu; Zaĭtsev, P M; Zubeev, P S; Mokrov, K B; Balandina, A V; Gushchina, N N; Kucherenko, V E

    2011-01-01

    The role of reamberin, a succinate-containing infusion preparation in correlation of pulmonary metabolic and respiratory disturbances in patients with obstetric puerperal sepsis was estimated. The prospective randomized study enrolled 43 patients with puerperal obstetric sepsis complicated by polyorganic deficiency (SOFA 8-10). Nineteen patients of the 1st group and 24 patients of the 2nd group were additionally treated with reamberin in a dose of 800 ml/day for 8 days. The venous and arterial difference by glucose, lactate, pyruvate, diene conjugates, malondialdehyde and ceruloplasmin was investigated. The blood gases were determined with the Ciba Corning 45 apparatus. Lower metabolic activity of the lungs with prevalence of the glucose anaerobic metabolism and lower activity of the intrapulmonary antioxidant protection were observed in the patients with obstetric sepsis. The use of reamberin in the complex therapy of obstetric sepsis promoted maintenance of the initial balance and anaeroibic and aerobic pulmonary metabolism, thus providing shorter terms of the decompensation and recovery of the lungs respiratory function. PMID:21913408

  7. Do obstetrical providers counsel women about postpartum pelvic floor dysfunction?

    PubMed Central

    Dessie, Sybil G.; Hacker, Michele R.; Dodge, Laura E.; Elkadry, Eman A.

    2016-01-01

    Objective To assess prenatal counseling practices of obstetrical providers related to postpartum pelvic floor dysfunction at centers with integrated urogynecology services. Study Design A cross-sectional survey was distributed to obstetrical providers through urogynecology colleagues. The survey included questions about level of training as well as counseling practices related to common postpartum pelvic floor symptoms. All statistical tests were two sided, and P values <0.05 were considered statistically significant. Results One hundred ninety-two surveys were received; 19 respondents did not perform their own prenatal counseling and were excluded. Among the remaining 173 respondents, 94 (56.3%) of those who answered the question reported never discussing postpartum urinary incontinence, and 73.7% reported never discussing postpartum fecal incontinence during prenatal counseling. Obstetrics and gynecology residents were significantly less likely than attending physicians to report discussing various pelvic floor dysfunction topics in prenatal counseling. Among those who reported not counseling women regarding pelvic floor dysfunction, the most common reason cited was lack of time (39.9%) followed by lack of sufficient information (30.1%). Conclusion Prenatal counseling of pelvic floor dysfunction risk is lacking at all levels of obstetrical training. Limitations of time and information are the obstacles most often cited by providers. PMID:26126305

  8. Moral implications of obstetric technologies for pregnancy and motherhood.

    PubMed

    Brauer, Susanne

    2016-03-01

    Drawing on sociological and anthropological studies, the aim of this article is to reconstruct how obstetric technologies contribute to a moral conception of pregnancy and motherhood, and to evaluate that conception from a normative point of view. Obstetrics and midwifery, so the assumption, are value-laden, value-producing and value-reproducing practices, values that shape the social perception of what it means to be a "good" pregnant woman and to be a "good" (future) mother. Activities in the medical field of reproduction contribute to "kinning", that is the making of particular social relationships marked by closeness and special moral obligations. Three technologies, which belong to standard procedures in prenatal care in postmodern societies, are presently investigated: (1) informed consent in prenatal care, (2) obstetric sonogram, and (3) birth plan. Their widespread application is supposed to serve the moral (and legal) goal of effecting patient autonomy (and patient right). A reconstruction of the actual moral implications of these technologies, however, reveals that this goal is missed in multiple ways. Informed consent situations are marked by involuntariness and blindness to social dimensions of decision-making; obstetric sonograms construct moral subjectivity and agency in a way that attribute inconsistent and unreasonable moral responsibilities to the pregnant woman; and birth plans obscure the need for a healthcare environment that reflects a shared-decision-making model, rather than a rational-choice-framework. PMID:25837233

  9. Shaping Collective Functions in Privatized Agricultural Knowledge and Information Systems: The Positioning and Embedding of a Network Broker in the Dutch Dairy Sector

    ERIC Educational Resources Information Center

    Klerkx, Laurens; Leeuwis, Cees

    2009-01-01

    This paper examines new organizational arrangements that have emerged in the context of a privatized extension system. It investigates the positioning and embedding of a network broker aimed at enhancing interaction in the privatized agricultural knowledge and information system (AKIS), to assess whether tensions reported in other sectors also…

  10. DNA barcoding of Dutch birds

    PubMed Central

    Aliabadian, Mansour; Beentjes, Kevin K.; Roselaar, C.S. (Kees); van Brandwijk, Hans; Nijman, Vincent; Vonk, Ronald

    2013-01-01

    Abstract The mitochondrial cytochrome c oxidase subunit I (COI) can serve as a fast and accurate marker for the identification of animal species, and has been applied in a number of studies on birds. We here sequenced the COI gene for 387 individuals of 147 species of birds from the Netherlands, with 83 species being represented by > 2 sequences. The Netherlands occupies a small geographic area and 95% of all samples were collected within a 50 km radius from one another. The intraspecific divergences averaged 0.29% among this assemblage, but most values were lower; the interspecific divergences averaged 9.54%. In all, 95% of species were represented by a unique barcode, with 6 species of gulls and skua (Larus and Stercorarius) having at least one shared barcode. This is best explained by these species representing recent radiations with ongoing hybridization. In contrast, one species, the Lesser Whitethroat Sylvia curruca showed deep divergences, averaging 5.76% and up to 8.68% between individuals. These possibly represent two distinct taxa, S. curruca and S. blythi, both clearly separated in a haplotype network analysis. Our study adds to a growing body of DNA barcodes that have become available for birds, and shows that a DNA barcoding approach enables to identify known Dutch bird species with a very high resolution. In addition some species were flagged up for further detailed taxonomic investigation, illustrating that even in ornithologically well-known areas such as the Netherlands, more is to be learned about the birds that are present. PMID:24453549