Introduction
Rates of severe perineal tears and episiotomies are indicators of obstetrical quality of care, but their use for international comparisons is complicated by difficulties with accurate ...ascertainment of tears and uncertainties regarding the optimal rate of episiotomies. We compared rates of severe perineal tears and episiotomies in European countries and analysed the association between these two indicators.
Material and methods
We used aggregate data from national routine statistics available in the Euro‐Peristat project. We compared rates of severe (third‐ and fourth‐degree) tears and episiotomies in 2010 by mode of vaginal delivery (n = 20 countries), and investigated time trends between 2004 and 2010 (n = 9 countries). Statistical associations were assessed with Spearman's ranked correlations (rho).
Results
In 2010 in all vaginal deliveries, rates of severe tears ranged from 0.1% in Romania to 4.9% in Iceland, and rates of episiotomies from 3.7% in Denmark to 75.0% in Cyprus. A negative correlation between the rates of episiotomies and severe tears was observed in all deliveries (rho = −0.66; p = 0.001), instrumental deliveries (rho = −0.67; p = 0.002) and non‐instrumental deliveries (rho = −0.72; p < 0.001). However there was no relation between time trends of these two indicators (rho = 0.43; p = 0.28).
Conclusions
The large variations in severe tears and episiotomies and the negative association between these indicators in 2010 show the importance of improving the assessment and reporting of tears in each country, and evaluating the impact of low episiotomy rates on the perineum.
Izvleček
Uvod:
Učenje in ocenjevanje profesionalnega odnosa in obnašanja sta enako pomembna kot ocenjevanje
teoretičnega znanja in veščin, vendar se malokrat izvaja.
Metode: Specializant razdeli ...ocenjevalne obrazce, ki jih ocenjevalci izpolnjene in podpisane pošljejo nacionalni
koordinatorici; ko dobi deset ocen in samooceno, povabi specializanta na pogovor s presojo.
Rezultati: V 6 ciklusih 360-stopinjskega ocenjevanja je bilo opravljenih 118 pogovorov. Večina je bila ocenjena
dobro. V manj kot 10 % je bila ocena »sem zaskrbljen« in »sem hudo zaskrbljen«.
Razprava: Večina specializantov je bila prijetno presenečena nad pohvalami, ki so jih napisali sodelavci. Osem
specializantov so opozorili na manjše pomanjkljivosti v odnosu in obnašanju, ki se jih specializanti niso zavedali. Do
naslednjega ocenjevanja so pomanjkljivosti večinoma odpravili. Specializanti, ocenjeni s »sem hudo zaskrbljen«, so
bili redki, vendar so se pri njih take ocene ponavljale; niso bili samokritični in pogovora z odzivom niso sprejemali
kot dobronamernega.
Zaključki: V specializacijo porodništva in ginekologije so uvedli ocenjevanje odnosa in obnašanja specializantov.
Hkrati z ocenjevanjem so uvedli tudi druga orodja, ki vodijo k zavedanju profesionalizma: učiteljsko tutorstvo
na Medicinski fakulteti v Ljubljani z delavnicami samorefleksije in delavnice treniranja trenerjev. Poudarek na
profesionalizmu naj bo vidnejši v izbirnem postopku za specializacijo, uvodnem intervjuju s specializantom in v
pogovorih s presojo z glavnim mentorjem v rednih presledkih, v večji komunikaciji med glavnimi in neposrednimi
mentorji ter v ocenjevanju mentorjev. Na uvedbo še čaka pogovor o profesionalizmu ob sprejemu na medicinsko
fakulteto ter predmet profesionalizem na medicinskih fakultetah in med specializacijo.
Patient-Centred Acute Care Training (PACT) is the on line, modular programme for Intensive Care medicine of the European Society of Intensive Medicine (ESICM). It has been designed as an educational ...tool to improve and harmonize the quality of critical care delivery and training.
Various linear and non-linear signal-processing techniques were applied to three-channel uterine EMG records to separate term and pre-term deliveries. The linear techniques were root mean square ...value, peak and median frequency of the signal power spectrum and autocorrelation zero crossing; while the selected non-linear techniques were estimation of the maximal Lyapunov exponent, correlation dimension and calculating sample entropy. In total, 300 records were grouped into four groups according to the time of recording (before or after the 26th week of gestation) and according to the total length of gestation (term delivery records—pregnancy duration ≥37 weeks and pre-term delivery records—pregnancy duration <37 weeks). The following preprocessing band-pass Butterworth filters were tested: 0.08–4, 0.3–4, and 0.3–3 Hz. With the 0.3–3 Hz filter, the median frequency indicated a statistical difference between those term and pre-term delivery records recorded before the 26th week (
p
= 0.03), and between all term and all pre-term delivery records (
p
= 0.012). With the same filter, the sample entropy indicated statistical differences between those term and pre-term delivery records recorded before the 26th week (
p
= 0.035), and between all term and all pre-term delivery records (
p
= 0.011). Both techniques also showed noticeable differences between term delivery records recorded before and after the 26th week (
p
≤ 0.001).
Objective: To establish the prevalence of inherited and acquired risk factors for development of venous thromboembolism (VTE) in pregnancy and the puerperium.
Study design: In a retrospective study, ...30 women with a history of objectively confirmed venous thromboembolism during pregnancy or the puerperium were studied. Fifty-six women with normal pregnancies were included as controls. Antithrombin, protein C, protein S, lupus anticoagulants, homocysteine, factor V Leiden mutation, prothrombin 20210G→A polymorphism, methylenetetrahydrofolate reductase (
MTHFR) 677C→T polymorphism and the −675 (4G/5G) polymorphism in plasminogen activator inhibitor 1 gene were analysed.
Results: At least one thrombophilic defect was observed in 16 (53.3%) cases and in 12 (21.4%) controls (
P=0.003); factor V Leiden in 8 (26.7%) cases and 3 (5.7%) controls (
P=0.009); prothrombin 20210G→A polymorphism in 8 (26.7%) cases and 4 (7.5%) controls (
P=0.021) and antithrombin deficiency in 4 (13.3%) cases and in 1 (1.8%) control (
P=0.029). Other inherited and acquired risk factors were similarly distributed among cases and controls.
Conclusion: Women with pregnancy-related venous thromboembolism have an increased prevalence of inheritable thrombophilic defects predisposing them to an increased risk of thrombosis.
Objective Power spectrum (PS) of uterine electromyography (EMG) can identify true labor. EMG propagation velocity (PV) to diagnose labor has not been reported. The objective was to compare uterine ...EMG against current methods to predict preterm delivery. Study Design EMG was recorded in 116 patients (preterm labor, n = 20; preterm nonlabor, n = 68; term labor, n = 22; term nonlabor, n = 6). A Student t test was used to compare EMG values for labor vs nonlabor ( P < .05, significant). Predictive values of EMG, Bishop score, contractions on tocogram, and transvaginal cervical length were calculated using receiver-operator characteristics analysis. Results PV was higher in preterm and term labor compared with nonlabor ( P < .001). Combined PV and PS peak frequency predicted preterm delivery within 7 days with area under the curve (AUC) of 0.96. Bishop score, contractions, and cervical length had an AUC of 0.72, 0.67, and 0.54. Conclusion Uterine EMG PV and PS peak frequency more accurately identify true preterm labor than clinical methods.
Uvod:Učenje in ocenjevanje profesionalnega odnosa in obnašanja sta enako pomembna kot ocenjevanje teoretičnega znanja in veščin, vendar se malokrat izvaja. Metode: Specializant razdeli ocenjevalne ...obrazce, ki jih ocenjevalci izpolnjene in podpisane pošljejo nacionalni koordinatorici; ko dobi deset ocen in samooceno, povabi specializanta na pogovor s presojo. Rezultati: V 6 ciklusih 360-stopinjskega ocenjevanja je bilo opravljenih 118 pogovorov. Večina je bila ocenjena dobro. V manj kot 10 % je bila ocena »sem zaskrbljen« in »sem hudo zaskrbljen«. Razprava: Večina specializantov je bila prijetno presenečena nad pohvalami, ki so jih napisali sodelavci. Osem specializantov so opozorili na manjše pomanjkljivosti v odnosu in obnašanju, ki se jih specializanti niso zavedali. Do naslednjega ocenjevanja so pomanjkljivosti večinoma odpravili. Specializanti, ocenjeni s »sem hudo zaskrbljen«, so bili redki, vendar so se pri njih take ocene ponavljale; niso bili samokritični in pogovora z odzivom niso sprejemali kot dobronamernega. Zaključki: V specializacijo porodništva in ginekologije so uvedli ocenjevanje odnosa in obnašanja specializantov. Hkrati z ocenjevanjem so uvedli tudi druga orodja, ki vodijo k zavedanju profesionalizma: učiteljsko tutorstvo na Medicinski fakulteti v Ljubljani z delavnicami samorefleksije in delavnice treniranja trenerjev. Poudarek na profesionalizmu naj bo vidnejši v izbirnem postopku za specializacijo, uvodnem intervjuju s specializantom in v pogovorih s presojo z glavnim mentorjem v rednih presledkih, v večji komunikaciji med glavnimi in neposrednimi mentorji ter v ocenjevanju mentorjev. Na uvedbo še čaka pogovor o profesionalizmu ob sprejemu na medicinsko fakulteto ter predmet profesionalizem na medicinskih fakultetah in med specializacijo.
Background: When teaching and assessing, professional attitude and behaviour are as important as assessing theoretical knowledge and skills and yet it is seldom done. Methods: The trainee distributes forms to assessors, who send signed forms to a national coordinator. After ten forms and the self-assessment form are received, the trainee is invited for an appraisal interview. Results: In 6 cycles of multi-source feedback, 118 interviews were carried out. Most trainees got good marks. In less than 10% of the cases, assessors commented »I am concerned« or »I am very concerned«. Discussion: Trainees were mostly pleasantly surprised at being praised by co-workers. Eight trainees were told about minor drawbacks in attitude and behaviour that they were not aware of. The trainees had usually improved these drawbacks by the next assessment. Trainees getting »I am very concerned« comments were few, but the same comments were repeated; they did not have insight and did not accept the interview with feedback as constructive. Conclusion: Multi-source feedback was introduced into obstetrics and gynaecology training. Other tools to increase professionalism awareness were also introduced: teachers/tutors in the Ljubljana Medical faculty with Self-reflection workshops and Training the Trainers workshops. An emphasis on professionalism should be more visible during the selection interview for training, introduction interview and regular appraisal interviews with the supervisor during training, stronger communication between the supervisor and trainers, and in the assessments by supervisors and trainers. Waiting to be introduced are: the medical faculty admission interview regarding professionalism, and the introduction of professionalism as a subject in the curricula of medical faculties and during training.
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