RESUMO
BACKGROUND: Antenatal cases of Bombay-phenotype (Oh ) individuals and hemolytic disease of the fetus and newborn (HDFN) are not well described in the literature. We present two case reports of high-titer anti-H in pregnant Oh individuals and their serologic investigation, clinical management, and subsequent outcomes. We describe current published cases detailing pregnancy in Oh individuals, to add to the evidence base for clinical decision making and management of pregnancy. STUDY DESIGN AND METHODS: We describe two case reports of high-titer anti-H in pregnancy in Oh individuals. We summarize published cases to date, to inform clinical decision making and antenatal management in individuals with the Bombay phenotype. RESULTS: Of the case reports described, neither were affected by HDFN due to anti-H. Antibody titers were high in both cases (immunoglobulin G titer scores, 512 and 4000, respectively) and would be expected to cause some degree of HDFN, a surprising finding. Regular mean cerebral artery Doppler ultrasound was normal. Patient blood management (PBM) techniques ensured that the patient's hemoglobin (Hb) levels were monitored and maintained. Transfusion intervention was not required, with minimal blood loss recorded at birth in both cases. CONCLUSION: High-titer anti-H in Oh pregnancies may, in rare cases, cause HDFN, but evidence suggests that this may not be the case in all pregnancies. We recommend a multidisciplinary approach, with prompt referral to a fetomaternal medicine unit, combined with PBM strategies, and a planned delivery with the provision of rare-phenotype units (if available and if indicated) on standby.
Assuntos
Sistema ABO de Grupos Sanguíneos/sangue , Eritroblastose Fetal , Isoanticorpos/sangue , Adulto , Eritroblastose Fetal/sangue , Eritroblastose Fetal/terapia , Feminino , Humanos , GravidezRESUMO
A role delineation study, or job analysis, is a necessary step in the development of a quality credentialing program. The process requires a logical approach and systematic methods to have an examination that is legally defensible. There are three main phases: initial development and evaluation, validation study, and development of test specifications. In the first phase, the content expert panel discussed performance domains that exist in pain management nursing. The six domains developed were: 1) assessment, monitoring, and evaluation of pain; 2) pharmacologic pain management; 3) nonpharmacologic pain management; 4) therapeutic communication and counseling; 5) patient and family teaching; and 6) collaborative and organizational activities. The panel then produced a list of 70 task statements to develop an online survey which was sent to independent reviewers with expertise in pain management nursing. After the panel reviewed the results of the pilot test, it was decided to clarify a few items that did not perform as expected. After the questionnaire was finalized it was distributed to 1,500 pain management nurses. The final yield was 585 usable returns, for a response rate of 39%. Thirty-three percent of the respondents reported a bachelor's degree in nursing as the highest degree awarded. Over 80% indicated that they were certified in pain management. Over 35% reported working in a staff position, 14% as a nurse practitioner, and 13% as a clinical nurse specialist. Part of the questionnaire asked the participants to rate performance expectation, consequence or the likelihood that the newly certified pain management nurse could cause harm, and the frequency of how often that nurse performs in each of the performance domains. The performance expectation was rated from 0 (the newly certified pain management nurse was not at all expected to perform the domain task) to 2 (after 6 months the newly certified pain management nurse would be expected to perform the domain task). The consequences of the degree would be the inability of the newly certified pain management nurse to perform duties or tasks in each domain was rated from 0 (no harm) to 4 (extreme harm). The first domain received the highest average frequency rating. The pharmacologic domain received the highest mean rating on consequence. The reliability of all scales was 0.95 or higher, which indicated that the questionnaire consistently measured what it was intended to measure. The quality of the questionnaire is an indicator that certification is one measure of nursing excellence.
Assuntos
Descrição de Cargo , Papel do Profissional de Enfermagem , Dor/enfermagem , Especialidades de Enfermagem/organização & administração , Atitude do Pessoal de Saúde , Certificação , Comunicação , Monitoramento de Medicamentos , Emprego/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiros Clínicos/educação , Enfermeiros Clínicos/organização & administração , Enfermeiros Clínicos/psicologia , Profissionais de Enfermagem/educação , Profissionais de Enfermagem/organização & administração , Profissionais de Enfermagem/psicologia , Avaliação em Enfermagem , Pesquisa em Avaliação de Enfermagem , Dor/diagnóstico , Dor/tratamento farmacológico , Medição da Dor , Educação de Pacientes como Assunto , Sociedades de Enfermagem/organização & administração , Especialidades de Enfermagem/educação , Inquéritos e Questionários , Estados UnidosRESUMO
In the scoring of performance assessments, when two raters assign different ratings some method must be used to resolve the discrepant ratings to form an operational score for reporting. This study investigated the differential impact of various resolution methods on the operational scores for gender and ethnic groups. The mean operational scores, and the passing rates for each group on two essay prompts were compared using three resolution methods (rater mean, tertium quid, and parity). The results indicated that for female and African American students, resolution typically resulted in greater reduction of mean operational ratings and passing rates than for those of their male or White counterparts. Differential item functioning (DIF) analyses were conducted using IRT-based logistic regression models. No apparent gender-related DIF was detected. Although uniform DIF was found for the ethnic groups, the effect was small, and there was not enough evidence to support the hypothesis that DIF could be associated with a resolution method.
Assuntos
Logro , Etnicidade/estatística & dados numéricos , Aptidão , Avaliação Educacional , Feminino , Humanos , Idioma , Masculino , Fatores Sexuais , Comportamento VerbalRESUMO
OBJECTIVES: To examine the long-term relationship between chronic pelvic pain (CPP) and quality of life and see if this is affected by a negative laparoscopy result. STUDY DESIGN: A postal questionnaire survey of CPP and quality of life in 63 women who underwent a diagnostic laparoscopy 12-18 months previously. RESULTS: Women with CPP still reported pain 12-18 months after laparoscopy and a significantly poorer quality of life than UK norms for women of a similar age. Factor analysis showed that reports of pain symptoms clustered into two dimensions: (1) pain associated with menstruation and (2) pain associated with sexual intercourse and bladder and bowel function. Most dimensions of quality of life were significantly associated with pain. However, 'role limitation due to emotional problems' and 'mental health' were only associated with pain due to sexual intercourse and bladder and bowel function. Pain and quality of life were not affected by laparoscopy result or follow-up appointment. CONCLUSIONS: Women with CPP continue to have pain and a low quality of life 12-18 months after laparoscopy. Laparoscopy results and follow-up appointments do not appear to affect either pain symptoms or quality of life in the long term, although this may be confounded by women obtaining treatment elsewhere.
Assuntos
Laparoscopia , Dor Pélvica/cirurgia , Qualidade de Vida , Adolescente , Adulto , Doença Crônica , Dismenorreia , Dispareunia , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Dor Pélvica/etiologia , Dor Pélvica/patologia , Resultado do TratamentoRESUMO
OBJECTIVE: To determine risk factors and outcomes for women with severe preeclampsia and renal failure. STUDY DESIGN: Retrospective study from 1995 to 1998 of all women with renal failure who were admitted to the obstetric intensive care unit at Groote Schuur Hospital, South Africa. A total of 89 women were identified with severe preeclampsia defined as blood pressure > or = 160/110 mm Hg and > or = 2+ proteinuria, renal failure defined as a creatinine level of > or = 1.13 mg/dL, and oliguria defined as < 100 mL urine produced in 4 hours; 72 charts were available for analysis. A comparison was made between the 3 groups, which were defined by the maximum recorded creatinine levels. RESULTS: Of the 72 women, 31 women (43%) were primiparous and 41 (57%) were multiparous. Median gestation at delivery was 32 weeks (range, 21-40 weeks). The median maximum creatinine was 3.85 mg/dL (range, 1.13-12.50 mg/dL). Twelve women (16%) had a history of chronic renal disease or hypertension, and 36 women (50%) had HELLP syndrome and 23 (32%) abruptio placentae. All women with severe renal impairment had either abruptio placentae or hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Perinatal mortality was 38% (27/72). However, in this series only 7 women (10%) required dialysis in the short term and none required long-term dialysis or kidney transplant. There were no maternal deaths. CONCLUSIONS: In women with severe preeclampsia and renal failure, major obstetric complications were common and perinatal outcome was poor. However, the need for dialysis was infrequent, with only 10% women requiring transient dialysis, and there were no cases of chronic renal failure that required dialysis or kidney transplant.
Assuntos
Injúria Renal Aguda/etiologia , Hospitalização , Unidades de Terapia Intensiva , Obstetrícia , Pré-Eclâmpsia/complicações , Pré-Eclâmpsia/fisiopatologia , Descolamento Prematuro da Placenta/complicações , Injúria Renal Aguda/terapia , Feminino , Síndrome HELLP/complicações , Humanos , Mortalidade Infantil , Recém-Nascido , Complicações do Trabalho de Parto/etiologia , Gravidez , Resultado da Gravidez , Diálise Renal , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To evaluate the efficacy of oral and vaginal misoprostol compared with the standard regimen using dinoprostone for induction of labor. METHODS: We conducted a multicenter, randomized controlled trial in Cape Town, South Africa. A total of 573 women admitted for induction of labor were randomized to receive oral misoprostol, vaginal misoprostol, or the control, dinoprostone. Misoprostol was given orally or vaginally as a 50-microg dose at 6-hour intervals to a maximum of four doses. The dinoprostone gel was given as a 1-mg dose in the posterior fornix every 6 hours (maximum two doses). RESULTS: There was no significant difference in vaginal delivery rate in 24 hours between the vaginal misoprostol and dinoprostone groups. However, significantly fewer women delivered vaginally in the oral misoprostol group compared with those in the dinoprostone group (relative risk 0.71, 99% confidence interval 0.51, 0.99). The median induction to vaginal delivery time in the vaginal misoprostol, oral misoprostol, and dinoprostone groups was 12 hours, 23 hours, and 14 hours, respectively. The cesarean rate was approximately 33% in all the groups. There were more cesareans performed for fetal distress in the vaginal misoprostol group compared with the dinoprostone group (relative risk 2.86, 99% confidence interval 1.49, 5.46). There was a higher incidence of tachysystole in the vaginal misoprostol group (5.8%) compared with the other two groups: oral misoprostol (0.8%) and dinoprostone (0.8%), but this difference was not statistically significant. There were no differences in maternal or fetal complications. CONCLUSION: Vaginal misoprostol is as effective as dinoprostone in induction of labor, but it is associated with more tachysystole and cesarean sections for fetal distress compared with dinoprostone. Oral misoprostol results in fewer vaginal deliveries in 24 hours, but it is not associated with increased tachysystole or fetal distress.