摘要:

In 1994, the National Institutes of Health Consensus Development Conference on Antenatal Steroids recommended corticosteroids between 24 and 30–32 weeks' gestation in pregnancies complicated by preterm premature rupture of membranes (PROM). Since the Consensus Conference, the use of antenatal corticosteroids has increased to approximately 60% of potential treatment candidates. Some of the remaining 40% of pregnant candidates may go untreated because of concern that corticosteroids could increase the risk of neonatal infection. Using decision-analysis techniques, we compared the potential benefit of antenatal corticosteroids in reducing the incidence of severe intraventricular hemorrhage with the potential risk of increasing the rate of neonatal sepsis. Our analysis indicates that the benefit of a small decrease in severe intraventricular hemorrhage outweighs the potential harm of a large increase in the rate of neonatal sepsis. Therefore, we support the Consensus Conference panel's recommendation that antenatal cortico-steroids be used in pregnancies complicated by preterm PROM.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the effectiveness of a gynecologic endoscopy education program in enhancing residents' proficiency in laparoscopic surgery.MethodsThe program was designed to provide residents with the knowledge and skills necessary for laparoscopic surgery, before entering the operating room, in a cost-effective manner that honored the principles of adult education. The 7-week program included didactic sessions to provide conceptual learning but focused on practical skills enhancement through practice in both pelvic trainer and animal laboratory settings. The program design included dominant, nondominant, and two-handed skills as well as models for laparoscopic dissection, hemostasis, and suturing. The evaluation of the program is based on timing of laparoscopic skills as well as resident and faculty evaluation of laparoscopic proficiency at the beginning and end of the program.ResultsPrior to the program, 48% of residents and 75% of faculty were satisfied with laparoscopic training. All residents improved operating times in pelvic trainer skills after the program, with first-year residents improving by 68%, third-year residents by 58%, and fourth-year residents by 72%. The residents self-assessment of competence in 14 laparoscopic skills revealed an increase in all skills following the program. The faculty assessment showed an upward trend in skills competence. At the conclusion of the program, 100% of residents and 92% of faculty were satisfied with the laparoscopic training.ConclusionA structured program emphasizing skills enhancement is an effective approach to improve residents' performance in laparoscopic surgery.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the effect of early postpartum discharge (less than 48 hours after vaginal birth or 96 hours after cesarean delivery) on maternal and neonatal complications, maternal concerns, patient satisfaction, and cost savings.Data SourcesWe performed a MEDLINE search of English-language journals for pertinent articles published from 1966 through January 1997. We also reviewed reference lists in all the articles retrieved in the search as well as those of major obstetric texts.Methods of Study SelectionWe included all studies describing early postpartum discharge.Tabulation, Integration, and ResultsStudies included five randomized controlled trials, ten cohort studies, one case-control study, and 12 case-series reports. We classified the data using the rating system of the U.S. Preventive Services Task Force. We calculated relative risks and 95% confidence intervals for maternal and neonatal readmission and outpatient treatment after early postpartum discharge. Most studies did not show an increase in maternal or neonatal morbidity after early discharge. The five randomized controlled studies did not meet criteria for properly designed trials. Most evidence consists of cohort studies and case-series (class II-2 and III evidence) of highly selected patients with extensive supplemental antepartum and postpartum care and education.ConclusionThe current data do not support or condemn widespread use of early postpartum discharge in the general population (class C recommendation). Early postpartum discharge appears safe for carefully selected, consenting patients. Whether these data can be extrapolated to the general population of pregnant women remains unknown.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID