To evaluate the impact on cesarean section (CS) rate with of a program of multiple non-clinical interventions targeted at health-care professional within a hospital maternity ward.
Retrospective ...quasi-experimental pre-post intervention study with an historical control group conducted in a second-level teaching hospital. All women who gave birth in the period 2014 to 2018 were included. A series of multiple non-clinical interventions including a dedicated team of obstetricians for delivery room and antenatal counseling, monthly internal audits and physician education by local opinion leader were prospectively introduced from September 2016. The primary outcome of the study was the CS rate. The incidences of operative vaginal delivery, 3rd-/4th-degree perineal tears and further maternal and neonatal complications were considered as secondary outcomes.
The CS rate dropped from 33.05 to 26.06% after starting the interventions (p < 0.01); in particular, the cumulative rate of CS performed during labor decreased significantly from 19.46 to 14.11% (p < 0.01). CS reduction was still statistically significant after multivariate correction (OR = 0.66, CI.95 = 0.57-0.76, p < 0.01). Results further showed an increased prevalence of 3rd-degree perineal tears (0.97% versus 2.24%, p < 0.01), present also after correcting for possible confounding factors (OR = 2.36, CI.95 = 1.48-3.76, p < 0.01). No differences were found in the rate of vaginal-operative births and further maternal complications, while the composite neonatal outcome was found to be improved (OR = 0.73, CI.95 = 0.57-0.93, p = 0.010).
The introduction of multiple non-clinical interventions can significantly reduce the CS rate. However, beside an improvement in neonatal composite outcome, a potential increase in high-degree perineal tears should be taken in account.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Subjective tinnitus is a symptom in many ENT pathologies, for which there is no curative treatment. It may be poorly tolerated by some patients, who develop attention or sleep disorder or even major ...anxiety and depression, severely impairing quality of life. Pathophysiological models of the genesis and maintenance of tinnitus symptomatology highlight maladaptive cerebral plasticity induced by peripheral hearing loss. Although not fully elucidated, these changes in neuronal activity are the target of various attempts at neuromodulation, particularly using repetitive transcranial magnetic stimulation (rTMS), which has been the focus of various clinical studies and meta-analyses. A recent consensus statement (Lefaucheur, 2014) reported level-C evidence (possible efficacy) for rTMS using low frequency (1Hz) tonic stimulation targeting the left cerebral cortex. However, many questions remain concerning the use of this technique in everyday practice. The present article reports a recent literature review using the search-terms “tinnitus” and “rTMS” in the PubMed and Cochrane databases for April 2014 to December 2016.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The effects of supplementing canthaxanthin on productive and reproductive aspects of broiler breeders were examined in this study. In total, 360 female pullets and 36 roosters were placed in an ...open-sided house with 12 pens, each pen with an area of 7.0 m2 (3.5 x 2.0 m). At 42 wk of age, the breeder hens and roosters were distributed into 2 experimental groups with similar BW and uniformity. From 46 to 66 wk of age, one group received 6 mg/kg of canthaxanthin supplemented in the diet and the other group received the diet without the addition of canthaxanthin (control diet). Body weight was measured every 28 d, the laying rate was calculated weekly, and mortality was evaluated at the end of the study. Twenty-one weekly incubations were performed to evaluate fertility and incubation responses. To evaluate the antioxidant effect of canthaxanthin at different storage times and during the incubation process, eggs from each treatment were subject to thiobarbituric reactive substances analysis. Body weight, mortality, and laying rate were not affected by the inclusion of canthaxanthin in the breeder’s diets. An increase in hatchability of total and fertile eggs (P ≤ 0.0001 and P ≤ 0.0003, respectively) in breeders fed canthaxanthin during the experimental period was observed. Canthaxanthin also improved breeder fertility and reduced embryo mortality. This can be attributed to reductions in embryo mortality in the first 48 h of incubation and in the last wk of incubation. No differences were observed in BW and quality of the chicks. A reduction of thiobarbituric reactive substances was observed in yolks from stored hatching eggs produced by breeders fed diets plus canthaxanthin. The same effect was observed in yolks of eggs stored for 4 d and incubated for 7 d. The supplementation of broiler breeder diets with canthaxanthin improved the hatchability rate, fertility, and reduced the presence of thiobarbituric reactive substances in eggs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract
Purpose:
To evaluate the role of quantitative elastography of the cervix in the prediction of successful labor induction compared to the Bishop score (BS) and ultrasound cervical length ...(CL).
Materials and Methods:
A prospective pilot study was conducted between July 2010 and June 2011 in patients without preterm membrane rupture undergoing labor induction with vaginal prostaglandins. Before starting induction, the BS, functional CL and cervical tissue strain (TS) were assessed. TS assessment was performed twice using the Tissue Doppler Imaging (TDI) software. Diagnostic accuracy was evaluated for the prediction of the following endpoints: active labor achievement (success vs. failure, time interval < 24 h and < 48 h), vaginal delivery (success vs. failure, time interval < 36 h and < 72 h) and total amount of prostaglandins used for labor induction (< 6 mg and < 12 mg).
Results:
We analyzed 77 patients with a mean gestational age of 39.7 ± 1.5 weeks of gestation and a mean strain of 0.75 ± 0.17. The TS significantly predicted a failure of labor induction, which occurred in 4 cases, both in mono- and multivariate analysis, independently of the functional cervical length (TS 0.6 ± 0.1). No correlation was found between the TS and other outcomes. The Bishop score and functional cervical length were found to predict only an early response to labor induction (time to active labor < 24 h, time to vaginal delivery < 36 h and PG usage < 6 mg). The diagnostic accuracy was slightly but not significantly improved if both TS and CL were considered.
Conclusion:
Preliminary data show the possible usefulness of quantitative cervical elastography in the prediction of labor induction failure.
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