Objective: To determine the amount and type of changes in the Emergency Department, in order to hasten treatment and disposition process of patients in the Emergency Department to expedite by eliminating or minimizing...Objective: To determine the amount and type of changes in the Emergency Department, in order to hasten treatment and disposition process of patients in the Emergency Department to expedite by eliminating or minimizing such changes that decreases the cost of treatment and drug resistanceMethods: In this study, 1005 patients' file admitted to emergency department of Rasool Akram Hospital were reviewed to see at least two different health services or two shifts of one service with written orders.Results: In total, the rate of drug changes studied cases was obtained as 5.47%. The largest pharmaceutical group in which the changes were developed was antibiotic (2.8% from all cases and 50% of total drug changes). Among the various health services, the internal service had imposed the most changes (67.3% of total drug changes).Conclusions: Considering that after the removal of trauma patients, the frequency of drug changes had been 11.47%, then it should be noted that the frequency was high and it was not desirable. The greatest change has been operated by internal services due to the fact that most treatments in this department was carried out by drugs.展开更多
Objective:?To describe blood transfusion practices in obstetric at the Sylvanus Olympio University Hospital in Lomé. Patients and method: Prospective, cross-sectional and descriptive study, conducted from 1 June ...Objective:?To describe blood transfusion practices in obstetric at the Sylvanus Olympio University Hospital in Lomé. Patients and method: Prospective, cross-sectional and descriptive study, conducted from 1 June 2017 to 31 May 2018 at the gynecology-obstetrics department. The study focused on transfused pregnant, parturient and delivered women. Study parameters were sociodemographic, clinical, therapeutic and prognostic. Results: 252 patients, aged 16 to 49 with an average age of 30.4 years, referred in 74% of cases. Hemorrhage was observed in 238 cases (94.4%) and anemia in 14 cases (5.6%). Blood transfusion was urgently used in 89.7% of cases and hemorrhagic abortion was the main indication. Blood group O+ (34.5%) was the most used and blood products were obtained after two hours in 81% of cases. Conclusion: Blood transfusion is often performed urgently and for bleeding. But the Gynecology-Obstetrics department does not have any blood in reserve, whereas the Sylvanus Olympio University Hospital collection and distribution station covers less than 10% of the needs.展开更多
Background: Obstetric Fistula (OF) is a breach of the birth canal due to obstructed labor. It is a major public health problem in developing countries. Objective: Study the epidemiology and treatment of obstetric fist...Background: Obstetric Fistula (OF) is a breach of the birth canal due to obstructed labor. It is a major public health problem in developing countries. Objective: Study the epidemiology and treatment of obstetric fistulas at the Departmental University Hospital Centre of Borgou and Alibori (CHUD-B/A) in Parakou, Benin. Study Method: This was a descriptive and analytical cross-sectional study with prospective data collection on women treated during OF care missions from February 2020 to April 2021 in CHUD-B/A in Parakou, Benin. The data concerned their socio-demographic characteristics, obstetric history, the clinic and therapeutic characteristics of their obstetric fistulas. Results: In total 97 patients with OF were treated during the 14-month period. The average age of the patients was 36.42 ± 11.75 years old. The patients were married (51.54%), without professional occupation (54.64%) and had no formal education (73.20%). The vesico-vaginal variety was predominating (54.64%). The fistulas were of Type I (46.39%), Type II (20.62%) and Type III (32.99%) according to the classification of Waaldjik Kees. The patients were operated on under spinal anesthesia (94.79%), and vaginally (55.67%) according to the principle of Chassar Moir (68, 60%). The associated procedures were lengthening urethroplasty (17.53%), and interposition of the Martius flap (1.03%). The overall success rate without Stress Urinary Incontinence was 71.13%. The factors associated with the failure of the fistula repair were: the nutritional status of the patients (p = 0.004), the previous repair failure (p = 0.001), the high size of the fistula (p = 0.007), the fistula severity (p and a urethral reconstruction (p Conclusion: OF is a relatively frequent pathology in Benin. Vesico-vaginal fistula is the most common form. The success rate of the surgical treatment is satisfactory, but depends on some factors.展开更多
BACKGROUND Preoperative anxiety is a common emotional problem during the perioperative period and may adversely affect postoperative recovery.Emergence agitation(EA)is a common complication of general anesthesia that ...BACKGROUND Preoperative anxiety is a common emotional problem during the perioperative period and may adversely affect postoperative recovery.Emergence agitation(EA)is a common complication of general anesthesia that may increase patient discomfort and hospital stay and may be associated with the development of postoperative complications.Pre-anesthetic anxiety may be associated with the development of EA,but studies in this area are lacking.AIM To determine the relationship between pre-anesthetic anxiety and EA after radical surgery in patients with non-small cell lung cancer(NSCLC).METHODS Eighty patients with NSCLC undergoing surgical treatment between June 2020 and June 2023 were conveniently sampled.We used the Hospital Anxiety and Depression Scale’s(HADS)anxiety subscale(HADS-A)to determine patients’anxiety at four time points(T1-T4):Patients’preoperative visit,waiting period in the surgical waiting room,after entering the operating room,and before anesthesia induction,respectively.The Riker Sedation-Agitation Scale(RSAS)examined EA after surgery.Scatter plots of HADS-A and RSAS scores assessed the correlation between patients’pre-anesthesia anxiety status and EA.We performed a partial correlation analysis of HADS-A scores with RSAS scores.RESULTS NSCLC patients’HADS-A scores gradually increased at the four time points:7.33±2.03 at T1,7.99±2.22 at T2,8.05±2.81 at T3,and 8.36±4.17 at T4.The patients’postoperative RSAS score was 4.49±1.18,and 27 patients scored≥5,indicating that 33.75%patients had EA.HADS-A scores at T3 and T4 were significantly higher in patients with EA(9.67±3.02 vs 7.23±2.31,12.56±4.10 vs 6.23±2.05,P<0.001).Scatter plots showed the highest correlation between HADS-A and RSAS scores at T3 and T4.Partial correlation analysis showed a strong positive correlation between HADS-A and RSAS scores at T3 and T4(r=0.296,0.314,P<0.01).CONCLUSION Agitation during anesthesia recovery in patients undergoing radical resection for NSCLC correlated with anxiety at the time of entering the operating room and before anesthesia induction.展开更多
This paper discusses the application of infrastructure standards in pain treatment rooms.The infrastructure construction standards of pain treatment room include hardware facility standards and software facility stand...This paper discusses the application of infrastructure standards in pain treatment rooms.The infrastructure construction standards of pain treatment room include hardware facility standards and software facility standards.The hardware facilities include the area of pain treatment room,basic equipment and apparatus,basic first-aid medicine.Software facilities include system,personnel qualification and personnel training.展开更多
The research study is a new learning mode emerging in recent years, which can cultivate students＇ many aspects of ability. In the higher vocational colleges, obstetrics and gynecology department is a subject of stron...The research study is a new learning mode emerging in recent years, which can cultivate students＇ many aspects of ability. In the higher vocational colleges, obstetrics and gynecology department is a subject of strong theory and practice, which has a higher requirement for students＇ autonomous learning and ability to independently solve and analyze the problems. And it applies to the higher vocational obstetrics and gynecology subject teaching, which conforms to the refornl and development of clinical teaching in obstetrics and gynecology, and it is good for cultivating the medical talents suitable for social need with high quality and strong practice ability.展开更多
Background:Evidence suggests that there are approximately two female genital fistula cases per 1000 women of reproductive age in sub-Saharan Africa.It is estimated that more than 200,000 women are affected by fistula ...Background:Evidence suggests that there are approximately two female genital fistula cases per 1000 women of reproductive age in sub-Saharan Africa.It is estimated that more than 200,000 women are affected by fistula in Nigeria,primarily due to obstetric causes.Awareness has been indicated as a risk factor for the development of obstetric fistula.This study explored the awareness of obstetric fistula such as causes,symptoms,and availability of and access to treatment services in southeastern and northwestern Nigeria.Methods:An exploratory qualitative study design was used to conduct this research in Kano and Ebonyi states in northern and eastern Nigeria,respectively.A total of six(6)focus group discussions were conducted with three categories of participants:women who were successfully repaired and discharged(n=2),community-married men(n=2),and women(n=2).Forty-four(44)In-depth interviews were conducted three categories of participants:18 with women with fistula who were either awaiting repair or had been repaired;6 family member caregivers accompanying fistula patients,and 20 health service providers at fistula repair centers.We developed a data analysis plan based on the emerging themes.The transcripts and field notes were imported into QSR Nvivo version 11 and coded accordingly.Content and thematic analysis was run by inductively drawing themes based on the elicited information from participants.Results:There was lack of knowledge of obstetric fistula and its causes among married men and women in the community,caregivers,and some patients were unaware of what caused their fistula for years.In this study,none of the community men and women nor caregivers correctly identified the causes and symptoms of a fistula or knew where to seek treatment.Knowledge about fistula was more common among women who had undergone repairs.Some repaired women attributed the cause of fistula to the providers who attended to them during delivery.Conclusions:Findings reveal a widespread lack of awareness of obstetric fistula onset and awareness of the availability of repair services at the community level.There is an urgent need to explore multi-pronged strategies for increasing awareness of obstetric fistula and available treatment services among women and other community members.展开更多
Objectives:To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.Methods:A...Objectives:To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.Methods:A convenience sampling method was used.A total of 260 women undergoing spontaneous or induced labor,including 97 primiparas and 163 multiparas,were recruited in a large academic specialized hospital in Guangzhou,China,from February 2018 to August 2019.The clinical data of maternal and neonatal were extracted from a structured electronic medical record system.Other demographic information,such as employment and family monthly income,was collected by a questionnaire.The Numeric Rating Scale(NRS)and the Chinese version of the Childbirth Attitude Questionnaire(C-CAQ)were applied to assess maternal in-labor pain intensity and fear of childbirth.The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.Results:Eighty-two(84.5%)primiparas and ninety-nine(60.7%)multiparas received epidural analgesia(P<0.001).In the epidural subgroup,the primiparous average fear of childbirth(36.46±10.93)was higher than that of the multiparas(32.06±10.23)(P¼0.007).However,multiparas reported more intense in-labor pain[8.0(8.0,9.0)vs.8.0(7.0,8.0)],had more successful manual boluses per hour[2.68(1.65,3.85)vs.1.77(0.90,2.47)],more hourly analgesic consumption[23.00(16.00,28.25)vs.17.24(11.52,21.36)mL]and more average analgesic consumption[0.35(0.24,0.45)vs.0.26(0.19,0.35)mL/(h$kg)]than the primiparas(P<0.05).Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth(r¼0.09)(P<0.05),hourly analgesic consumption(r¼0.16)(P<0.01)and average analgesic consumption(r¼0.17)(P<0.05).No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.Conclusions:Fear of childbirth is a potential predictor of labor pain intensity.Further study is needed to explore its role and value in pain management during delivery.Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia,especially when analgesia resources are insufficient.展开更多
Introduction: the demand for urgent obstetric and gynecology care has progressively increased: in the United States approximately 1.4 million gynecologic visits are made to the emergency department (ED) annually, whil...Introduction: the demand for urgent obstetric and gynecology care has progressively increased: in the United States approximately 1.4 million gynecologic visits are made to the emergency department (ED) annually, while almost 75% of women make at least 1 unscheduled visit during pregnancy. Moreover, research has recently focused on setting standards in unscheduled care, and developing quality indicators to improve patients’ health. Therefore, we investigated the characteristics of women with acute gynecological or pregnancy complaints using quality indicators developed for emergency medicine, to better define the needs of this population and improve care. Methods: Retrospective cohort study on ED, and Obstetrics and Gynecology (ObGyn) triage visits, at a tertiary care hospital in Italy, during 2012. Data were analyzed with population-averaged logistic regression and Poisson regression. Results: When compared to the 33,557 ED visits, the 9245 ObGyntriage referrals were more frequently associated with pregnancy (≤12 weeks’ gestation, OR: 30.7, 95%CI;24.5 - 38.4;>12 weeks’ gestation, OR 81.2, 95%CI;64.8 - 101.4), vaginal bleeding (OR 156.6, 95%CI;82.7 - 294.4), diurnal (night access OR 0.87, 95% CI;0.78 - 0.96) and weekday access (holiday access OR 0.87, 95%CI;0.78 - 0.95), frequent users (recurrent ED visits IRR 0.87, 95%CI;0.83 - 0.9) and lower hospital admissions (ED admission OR 1.6, 95%CI;1.4 - 1.8). Conclusion: ObGyn triage patients differed from ED users, and were at higher risk of “crowding”. Such diversities should be considered to improve female healthcare services and allocate resources more efficiently.展开更多
AIM: To investigate the treatment priority given to selfharmers presenting to a hospital emergency department(ED) in Queensland, Australia, over the period 2005-2010. METHODS: The main outcome measure of this study wa...AIM: To investigate the treatment priority given to selfharmers presenting to a hospital emergency department(ED) in Queensland, Australia, over the period 2005-2010. METHODS: The main outcome measure of this study was the treatment priority given to persons presenting with suicide ideation and communication(SIC) or self-harming behaviour. Treatment priority was measured using the Australasian Triage Scale, which ranks patients from 1(in need of immediate treatment) to 5(assessment and treatment to start within 120 min). Ordered logistic regression was used to assess the broad demographic and treatment-related factors associated with more urgent triage categories and to in-vestigate which methods of non-fatal suicidal behaviour(NFSB) were prioritised as most urgent.RESULTS: Most cases of NFSB were between 15 and 34 years. A larger proportion of persons presenting for SIC were aged 35 to 44 years. Over 50% of male presentations and 38% of female presentations were for SIC. Those cases prioritised as being more urgent had significantly greater odds of being older, presented after an act of self-harm rather than SIC, and had used multiple methods of NFSB. These individuals also had greater odds of being male and having made past presentations for SIC or NFSB. Among males, those presenting after ingestion of drugs had the greatest odds of receiving immediate attention compared to SIC. "Cutters" were considered as the least "urgent" subjects, and had a greatest risk of waiting 60 to 120 min for treatment compared to suicide ideators. Among females, those presenting with chemicals, poisons and gases had the greatest odds of receiving immediate attention compared to SIC. Females who presenting after cutting themselves had lower odds of receiving immediate treatment than those who presented with SIC. CONCLUSION: ED staff seems to judge the urgency of cases based on demographic factors such as age and gender, as well as method of NFSB.展开更多
Objective: The recto-vaginal fistula is an abnormal communication between the previous wall of the rectum and the posterior face of the vagina through the recto-vaginal septum. They are often due to the obstetric trau...Objective: The recto-vaginal fistula is an abnormal communication between the previous wall of the rectum and the posterior face of the vagina through the recto-vaginal septum. They are often due to the obstetric traumas and they can be of post-surgical origin. Methods: We report five cases of patients with obstetric recto-vaginal fistula and all of the patients have surgical intervention with a resection of the fistulous route and rectal wall. Results: The patient did not present any recidivating and the evolution is satisfactory without complications or recidivating. Conclusion: The treatment of recto-vaginal fistula is often difficult exposed to recurrence;and the therapeutic indications must be adapted to every type of fistula by taking into account its size, its location and its etiology.展开更多
文摘Objective: To determine the amount and type of changes in the Emergency Department, in order to hasten treatment and disposition process of patients in the Emergency Department to expedite by eliminating or minimizing such changes that decreases the cost of treatment and drug resistanceMethods: In this study, 1005 patients' file admitted to emergency department of Rasool Akram Hospital were reviewed to see at least two different health services or two shifts of one service with written orders.Results: In total, the rate of drug changes studied cases was obtained as 5.47%. The largest pharmaceutical group in which the changes were developed was antibiotic (2.8% from all cases and 50% of total drug changes). Among the various health services, the internal service had imposed the most changes (67.3% of total drug changes).Conclusions: Considering that after the removal of trauma patients, the frequency of drug changes had been 11.47%, then it should be noted that the frequency was high and it was not desirable. The greatest change has been operated by internal services due to the fact that most treatments in this department was carried out by drugs.
文摘Objective:?To describe blood transfusion practices in obstetric at the Sylvanus Olympio University Hospital in Lomé. Patients and method: Prospective, cross-sectional and descriptive study, conducted from 1 June 2017 to 31 May 2018 at the gynecology-obstetrics department. The study focused on transfused pregnant, parturient and delivered women. Study parameters were sociodemographic, clinical, therapeutic and prognostic. Results: 252 patients, aged 16 to 49 with an average age of 30.4 years, referred in 74% of cases. Hemorrhage was observed in 238 cases (94.4%) and anemia in 14 cases (5.6%). Blood transfusion was urgently used in 89.7% of cases and hemorrhagic abortion was the main indication. Blood group O+ (34.5%) was the most used and blood products were obtained after two hours in 81% of cases. Conclusion: Blood transfusion is often performed urgently and for bleeding. But the Gynecology-Obstetrics department does not have any blood in reserve, whereas the Sylvanus Olympio University Hospital collection and distribution station covers less than 10% of the needs.
文摘Background: Obstetric Fistula (OF) is a breach of the birth canal due to obstructed labor. It is a major public health problem in developing countries. Objective: Study the epidemiology and treatment of obstetric fistulas at the Departmental University Hospital Centre of Borgou and Alibori (CHUD-B/A) in Parakou, Benin. Study Method: This was a descriptive and analytical cross-sectional study with prospective data collection on women treated during OF care missions from February 2020 to April 2021 in CHUD-B/A in Parakou, Benin. The data concerned their socio-demographic characteristics, obstetric history, the clinic and therapeutic characteristics of their obstetric fistulas. Results: In total 97 patients with OF were treated during the 14-month period. The average age of the patients was 36.42 ± 11.75 years old. The patients were married (51.54%), without professional occupation (54.64%) and had no formal education (73.20%). The vesico-vaginal variety was predominating (54.64%). The fistulas were of Type I (46.39%), Type II (20.62%) and Type III (32.99%) according to the classification of Waaldjik Kees. The patients were operated on under spinal anesthesia (94.79%), and vaginally (55.67%) according to the principle of Chassar Moir (68, 60%). The associated procedures were lengthening urethroplasty (17.53%), and interposition of the Martius flap (1.03%). The overall success rate without Stress Urinary Incontinence was 71.13%. The factors associated with the failure of the fistula repair were: the nutritional status of the patients (p = 0.004), the previous repair failure (p = 0.001), the high size of the fistula (p = 0.007), the fistula severity (p and a urethral reconstruction (p Conclusion: OF is a relatively frequent pathology in Benin. Vesico-vaginal fistula is the most common form. The success rate of the surgical treatment is satisfactory, but depends on some factors.
文摘BACKGROUND Preoperative anxiety is a common emotional problem during the perioperative period and may adversely affect postoperative recovery.Emergence agitation(EA)is a common complication of general anesthesia that may increase patient discomfort and hospital stay and may be associated with the development of postoperative complications.Pre-anesthetic anxiety may be associated with the development of EA,but studies in this area are lacking.AIM To determine the relationship between pre-anesthetic anxiety and EA after radical surgery in patients with non-small cell lung cancer(NSCLC).METHODS Eighty patients with NSCLC undergoing surgical treatment between June 2020 and June 2023 were conveniently sampled.We used the Hospital Anxiety and Depression Scale’s(HADS)anxiety subscale(HADS-A)to determine patients’anxiety at four time points(T1-T4):Patients’preoperative visit,waiting period in the surgical waiting room,after entering the operating room,and before anesthesia induction,respectively.The Riker Sedation-Agitation Scale(RSAS)examined EA after surgery.Scatter plots of HADS-A and RSAS scores assessed the correlation between patients’pre-anesthesia anxiety status and EA.We performed a partial correlation analysis of HADS-A scores with RSAS scores.RESULTS NSCLC patients’HADS-A scores gradually increased at the four time points:7.33±2.03 at T1,7.99±2.22 at T2,8.05±2.81 at T3,and 8.36±4.17 at T4.The patients’postoperative RSAS score was 4.49±1.18,and 27 patients scored≥5,indicating that 33.75%patients had EA.HADS-A scores at T3 and T4 were significantly higher in patients with EA(9.67±3.02 vs 7.23±2.31,12.56±4.10 vs 6.23±2.05,P<0.001).Scatter plots showed the highest correlation between HADS-A and RSAS scores at T3 and T4.Partial correlation analysis showed a strong positive correlation between HADS-A and RSAS scores at T3 and T4(r=0.296,0.314,P<0.01).CONCLUSION Agitation during anesthesia recovery in patients undergoing radical resection for NSCLC correlated with anxiety at the time of entering the operating room and before anesthesia induction.
文摘This paper discusses the application of infrastructure standards in pain treatment rooms.The infrastructure construction standards of pain treatment room include hardware facility standards and software facility standards.The hardware facilities include the area of pain treatment room,basic equipment and apparatus,basic first-aid medicine.Software facilities include system,personnel qualification and personnel training.
文摘The research study is a new learning mode emerging in recent years, which can cultivate students＇ many aspects of ability. In the higher vocational colleges, obstetrics and gynecology department is a subject of strong theory and practice, which has a higher requirement for students＇ autonomous learning and ability to independently solve and analyze the problems. And it applies to the higher vocational obstetrics and gynecology subject teaching, which conforms to the refornl and development of clinical teaching in obstetrics and gynecology, and it is good for cultivating the medical talents suitable for social need with high quality and strong practice ability.
文摘Background:Evidence suggests that there are approximately two female genital fistula cases per 1000 women of reproductive age in sub-Saharan Africa.It is estimated that more than 200,000 women are affected by fistula in Nigeria,primarily due to obstetric causes.Awareness has been indicated as a risk factor for the development of obstetric fistula.This study explored the awareness of obstetric fistula such as causes,symptoms,and availability of and access to treatment services in southeastern and northwestern Nigeria.Methods:An exploratory qualitative study design was used to conduct this research in Kano and Ebonyi states in northern and eastern Nigeria,respectively.A total of six(6)focus group discussions were conducted with three categories of participants:women who were successfully repaired and discharged(n=2),community-married men(n=2),and women(n=2).Forty-four(44)In-depth interviews were conducted three categories of participants:18 with women with fistula who were either awaiting repair or had been repaired;6 family member caregivers accompanying fistula patients,and 20 health service providers at fistula repair centers.We developed a data analysis plan based on the emerging themes.The transcripts and field notes were imported into QSR Nvivo version 11 and coded accordingly.Content and thematic analysis was run by inductively drawing themes based on the elicited information from participants.Results:There was lack of knowledge of obstetric fistula and its causes among married men and women in the community,caregivers,and some patients were unaware of what caused their fistula for years.In this study,none of the community men and women nor caregivers correctly identified the causes and symptoms of a fistula or knew where to seek treatment.Knowledge about fistula was more common among women who had undergone repairs.Some repaired women attributed the cause of fistula to the providers who attended to them during delivery.Conclusions:Findings reveal a widespread lack of awareness of obstetric fistula onset and awareness of the availability of repair services at the community level.There is an urgent need to explore multi-pronged strategies for increasing awareness of obstetric fistula and available treatment services among women and other community members.
文摘Objectives:To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.Methods:A convenience sampling method was used.A total of 260 women undergoing spontaneous or induced labor,including 97 primiparas and 163 multiparas,were recruited in a large academic specialized hospital in Guangzhou,China,from February 2018 to August 2019.The clinical data of maternal and neonatal were extracted from a structured electronic medical record system.Other demographic information,such as employment and family monthly income,was collected by a questionnaire.The Numeric Rating Scale(NRS)and the Chinese version of the Childbirth Attitude Questionnaire(C-CAQ)were applied to assess maternal in-labor pain intensity and fear of childbirth.The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.Results:Eighty-two(84.5%)primiparas and ninety-nine(60.7%)multiparas received epidural analgesia(P<0.001).In the epidural subgroup,the primiparous average fear of childbirth(36.46±10.93)was higher than that of the multiparas(32.06±10.23)(P¼0.007).However,multiparas reported more intense in-labor pain[8.0(8.0,9.0)vs.8.0(7.0,8.0)],had more successful manual boluses per hour[2.68(1.65,3.85)vs.1.77(0.90,2.47)],more hourly analgesic consumption[23.00(16.00,28.25)vs.17.24(11.52,21.36)mL]and more average analgesic consumption[0.35(0.24,0.45)vs.0.26(0.19,0.35)mL/(h$kg)]than the primiparas(P<0.05).Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth(r¼0.09)(P<0.05),hourly analgesic consumption(r¼0.16)(P<0.01)and average analgesic consumption(r¼0.17)(P<0.05).No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.Conclusions:Fear of childbirth is a potential predictor of labor pain intensity.Further study is needed to explore its role and value in pain management during delivery.Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia,especially when analgesia resources are insufficient.
文摘Introduction: the demand for urgent obstetric and gynecology care has progressively increased: in the United States approximately 1.4 million gynecologic visits are made to the emergency department (ED) annually, while almost 75% of women make at least 1 unscheduled visit during pregnancy. Moreover, research has recently focused on setting standards in unscheduled care, and developing quality indicators to improve patients’ health. Therefore, we investigated the characteristics of women with acute gynecological or pregnancy complaints using quality indicators developed for emergency medicine, to better define the needs of this population and improve care. Methods: Retrospective cohort study on ED, and Obstetrics and Gynecology (ObGyn) triage visits, at a tertiary care hospital in Italy, during 2012. Data were analyzed with population-averaged logistic regression and Poisson regression. Results: When compared to the 33,557 ED visits, the 9245 ObGyntriage referrals were more frequently associated with pregnancy (≤12 weeks’ gestation, OR: 30.7, 95%CI;24.5 - 38.4;>12 weeks’ gestation, OR 81.2, 95%CI;64.8 - 101.4), vaginal bleeding (OR 156.6, 95%CI;82.7 - 294.4), diurnal (night access OR 0.87, 95% CI;0.78 - 0.96) and weekday access (holiday access OR 0.87, 95%CI;0.78 - 0.95), frequent users (recurrent ED visits IRR 0.87, 95%CI;0.83 - 0.9) and lower hospital admissions (ED admission OR 1.6, 95%CI;1.4 - 1.8). Conclusion: ObGyn triage patients differed from ED users, and were at higher risk of “crowding”. Such diversities should be considered to improve female healthcare services and allocate resources more efficiently.
文摘AIM: To investigate the treatment priority given to selfharmers presenting to a hospital emergency department(ED) in Queensland, Australia, over the period 2005-2010. METHODS: The main outcome measure of this study was the treatment priority given to persons presenting with suicide ideation and communication(SIC) or self-harming behaviour. Treatment priority was measured using the Australasian Triage Scale, which ranks patients from 1(in need of immediate treatment) to 5(assessment and treatment to start within 120 min). Ordered logistic regression was used to assess the broad demographic and treatment-related factors associated with more urgent triage categories and to in-vestigate which methods of non-fatal suicidal behaviour(NFSB) were prioritised as most urgent.RESULTS: Most cases of NFSB were between 15 and 34 years. A larger proportion of persons presenting for SIC were aged 35 to 44 years. Over 50% of male presentations and 38% of female presentations were for SIC. Those cases prioritised as being more urgent had significantly greater odds of being older, presented after an act of self-harm rather than SIC, and had used multiple methods of NFSB. These individuals also had greater odds of being male and having made past presentations for SIC or NFSB. Among males, those presenting after ingestion of drugs had the greatest odds of receiving immediate attention compared to SIC. "Cutters" were considered as the least "urgent" subjects, and had a greatest risk of waiting 60 to 120 min for treatment compared to suicide ideators. Among females, those presenting with chemicals, poisons and gases had the greatest odds of receiving immediate attention compared to SIC. Females who presenting after cutting themselves had lower odds of receiving immediate treatment than those who presented with SIC. CONCLUSION: ED staff seems to judge the urgency of cases based on demographic factors such as age and gender, as well as method of NFSB.
文摘Objective: The recto-vaginal fistula is an abnormal communication between the previous wall of the rectum and the posterior face of the vagina through the recto-vaginal septum. They are often due to the obstetric traumas and they can be of post-surgical origin. Methods: We report five cases of patients with obstetric recto-vaginal fistula and all of the patients have surgical intervention with a resection of the fistulous route and rectal wall. Results: The patient did not present any recidivating and the evolution is satisfactory without complications or recidivating. Conclusion: The treatment of recto-vaginal fistula is often difficult exposed to recurrence;and the therapeutic indications must be adapted to every type of fistula by taking into account its size, its location and its etiology.
