Plan-do-study-act cycles as an instrument for improvement of compliance with infection control measures in care of patients after cardiothoracic surgery.

The aim of this study was to determine whether compliance with infection control measures for the care of patients during and after cardiothoracic surgery could be improved by using 'plan-do-study-act' (PDSA) improvement cycles in a 715-bed university hospital. The endpoints of these cycles were indices of correct procedure based on infection control standards. The intervention consisted of instruction and training of nursing and medical staff on the use of PDSA cycles, feedback of the baseline measurements, and the use of posters in the proximity of the operating room (OR). At follow-up, overall compliance only improved in the room used by the perfusionists and the OR. After the follow-up period, monitoring revealed a drop in compliance in the OR, but improved compliance during vascular catheter care of patients with prolonged stay in the intensive care unit (ICU), and during wound care of patients on the nursing ward. The last series of monitoring showed that compliance with general infection control measures in the OR had improved again, and that compliance had remained satisfactory on the ward and in the ICU, with the exception of patients recently transferred to the ICU from the OR. The results show that by using PDSA cycles, compliance with infection control measures can improve significantly. However, repeated monitoring is necessary to ensure continued compliance.

Karyotyping from uncultured human trophoblast in the first trimester of pregnancy.

Chorionic villi were sampled by transcervical aspiration after ultrasonic localization of the chorion frondosum. Sampling was successful in 82 of 98 women. Subsequent karyotyping of the chorionic material was done by the modified Evans method. Mitoses of reasonable quality were obtained providing an easy cytogenetic diagnosis from human cytotrophoblast. A second trimester chorionic plate biopsy and direct karyotyping in case of severe oligohydramnios and malformed fetus revealing numerical (45, XO) chromosomal abnormality is also reported.

A longitudinal study of velogenic Newcastle disease virus genotypes isolated in Italy between 1960 and 2000.

Thirty-six representative velogenic strains of Newcastle disease virus isolated in Italy since 1960 were characterized by restriction site and partial sequence analyses of the fusion protein gene. Viruses belonging to the six known genotypes of Lomniczi et al . were found. Genotype IV, which was most probably the main epizootic group in Europe before the war, was responsible for outbreaks in the 1960s and persisted until the late 1980s in Italy. An epizootic peak in 1972 to 1974 coincided with the appearance of genotype V viruses that were present for more than a decade. Outbreaks in 1992 were caused by genotype VIIa viruses and were part of a contemporaneous epizootic of Far East origin that affected Western European countries. The Newcastle disease epizootic that commenced in Italy in May 2000 was due to a genotype VIIb virus that is indistinguishable from those causing sporadic outbreaks in Great Britain and Northern Europe in the late 1990s. Isolated cases yielded a variant of genotype VI (reference epizootic: Middle East in the late 1960s) and a group VIII virus (enzootic in South Africa).

Randomized comparison of different prostaglandin analogues and laminaria tent for preoperative cervical dilatation. World Health Organization Special Programme of Research, Development and Research Training in Human Reproduction: Task Force on Prostaglandins for Fertility Regulation.

In an eleven-centre study, 627 nulliparous subjects in the 8th to 12th week of gestation admitted for termination of pregnancy were allocated to one of five treatments to induce pre-operative cervical dilatation. The treatments were: 0.5 mg PGE2 methyl sulphonylamide; 1.0 mg PGE1 methyl ester; 30 mg 9-methylene PGE2 free acid, 0.5 mg 15-methyl PGF2 alpha; a single medium-sized laminaria tent. The results indicate that the three PGE analogues are at least equally effective as one medium sized laminaria tent and more effective than 0.5 mg 15-methyl PGF2 alpha in producing adequate pre-operative cervical dilatation prior to vacuum aspiration. It is concluded that both pre-treatment with prostaglandin analogues and laminaria tent are effective methods for preoperative cervical dilatation and both types of treatment are associated with a low incidence of side effects. Prostaglandin analogue treatment can be administered by paramedical personnel but laminaria tent insertion has to be performed by medical staff.

High-risk obstetrics, medicolegal problems.

The perinatal period is one of the most dangerous time of life. The responsibilities of the obstetricians are multifold. It is very difficult to draw a line between good and substandard care, therefore in perinatology and especially in high-risk obstetrical cases there are no absolute rules of management. The lay public is convinced through media channels, that modern reproductive research eliminated all the risks and hazards associated with childbirths, therefore only 100% healthy babies are accepted. Pregnancy is regarded as a 'success story' and if the baby is born with neurological defects (cerebral palsy) the parents and their advisors feel, that someone responsible for the defect should be found in the chain of management. This attitude starts a legal battle focusing on the events of labor and delivery. But in most cases it is very difficult to determine if a peripartal neonatal encephalopathy originated from the time period of labor and delivery, or started weeks earlier during pregnancy as an unnoticed event. Perinatal morbidity indicators are best based on neonatal clinical signs, which are predictive of later morbidity of the child. Neonatal seizures within 48 h of delivery of the baby could be a good index of later morbidity.

Premedication and pain relief with Nubain during second trimester therapeutic pregnancy terminations.

OBJECTIVE: To determine the analgesic efficacy of the opioid agonist-antagonist Nubain during midtrimester therapeutic terminations with intra-amniotic PGF2 alpha or i.m. administration of the PGE2 derivative sulprostone. METHOD: Following osmotic predilatation with laminaria tents patients were given as a premedication 10 mg Valium, 10 mg Nubain and 0.5 mg atropine i.m. prior to prostaglandin treatment, and sequential doses of Nubain during the uterine contractility period. Patients indicated their own perception of uterine pain on a differential graphic rating scale, and the attending physician also evaluated patients' discomfort on a 5-grade scale. RESULT: In 55% of the cases patients experienced only 'mild' or 'moderate' pain. The mean induction-to-abortion interval was short (11.6 +/- 1.3 h). The well known gastrointestinal side-effects of the prostaglandins were avoided. CONCLUSION: Nubain proved effective in stabilizing patients' condition during intra-amniotic instillation of prostaglandin, effectively relieved uterine pain during the myometrial contractility period, prevented the occurrence of prostaglandin-related side-effects, and provided simple and good anesthesia during instrumental removal of the already detached but retained placenta.

[The most effective dosage in the administration of PGF2-alpha for interruption of pregnancy during the 2d trimester]. / A PGF2 alpha hatásosabb adagolási sémája a terhesség megszakítására a II. trimesterben

PIP: Artificial interruption of pregnancy contains too many risks from the 12th week of pregnancy. The authors have been working at finding the most suitable and effective dosage of prostaglandin for the interruption of pregnancy during the 2nd trimester. The new dosage experimented was 25 mg of prostaglandin F2alpha, followed by another 25 mg 6 hours later. The clinical efficiency of this dosage was tested. This procedures was used in 45 cases. The efficiency of the method was compared to the efficiency of the previously used dosage, which was 25 mg of prostaglandin F2alpha, followed by 25 mg 24 hours later. The new dosage was evaluated 91% efficient, while the previous dosage was found to be 75% efficient. The side effects were rated as acceptable by the patients. There was no case of infection. Two undeniable advantages were found with this new dosage: the duration of the actual procedure is considerably reduced, and the method appears to be much safer. The authors conclude that this new procedure offers numerous clinical advantages.^ieng

[Weather front sensitivity as an influencing factor in the onset of labor]. / Frontérzékenység, mint a szülésmegindulás idejét befolyásoló tényezö.

The connection between meteorological stimuli and the onset of labor was examined on the basis of the patients' front-sensitivity. Front-sensitivity was tested by a questionary containing 60 questions. Converse relation was observed between the degree of sensitivity and the gestational age. A sudden rise of onsets of labors could be shown during frontal changes, occurred after meteorologically quiet periods. During frontal changes the ratio of onsets of labors rose significantly among those patients who were sensitive tho the given front. This effect could be observed during a longer period of frontal influence. By the authors opinion also meteorological stimuli can be regarded as one of the factors, determining the actual date of onset of labor among front-sensitive women.