Placental cord drainage impact on third stage of labor: A randomized controlled trial.

BACKGROUND: The third stage of labor is a pivotal phase in obstetric care. Management may be physiological or active. Although the use of prophylactic placental cord drainage has been assessed in prior data, there is still no clear-cut evidence supporting its effectiveness in improving key obstetric outcomes. OBJECTIVE: The aim of the study was to investigate the impact of placental cord drainage during the third stage of labor on the amount of maternal bleeding, duration of the third stage, and incidence of postpartum hemorrhage. STUDY DESIGN: A randomized controlled trial was conducted at a high-volume tertiary obstetric center between May 2021 and December 2022. A total of 212 pregnant women with a singleton uncomplicated pregnancy were randomly assigned to undergo placental cord drainage or standard care without drainage. The randomization was manual, using pre-marked cards drawn by the participants. The power calculation determined a sample size of 92 participants per group to achieve 80% power at a 5% significance level, aiming to detect 20% difference in bleeding amount between the groups. In practice, we included more than 100 women in each group. The primary outcome was the amount of bleeding during the third stage of labor, while secondary outcomes included the duration of the third stage and incidence of postpartum hemorrhage. After delivery, all participants received 10 units of oxytocin via intravenous drip and delayed cord clamping was performed. In the study group, the maternal umbilical cord was then unclamped. Blood was allowed to drain into a plastic bag placed under the women's buttocks. If an episiotomy or perineal tear was observed, pressure packing was applied to reduce bleeding. The collected blood was measured in milliliters after placental expulsion. RESULTS: A total of 212 women were recruited of whom 104 underwent placental cord drainage and 108 received standard care without drainage. No significant differences were observed between the intervention and control groups in mean duration of the third stage of labor (10.56±6.12 vs. 10.95±6.33 minutes, P=0.65), incidence of postpartum hemorrhage (3.84% vs. 7.41%, P=0.38), or mean amount of bleeding during the third stage of labor (292±200 vs. 300±242 ml, P=0.79). Furthermore, there were no significant between-group differences in the mean amount of bleeding on separate analysis of nulliparous women (356±246 vs. 330±240 ml, P=0.68), multiparous women (265±171 vs. 289±244 ml, P=0.50), women who were not exposed to external oxytocin during labor (287±204 vs. 317±250 ml, P=0.59), and women who were exposed to external oxytocin (296±198 vs. 289±238 ml, P=0.39). CONCLUSIONS: Placental cord drainage during the third stage of labor showed no statistically significant impact on bleeding amount, third-stage length, or postpartum hemorrhage rate. The findings suggest that placental cord drainage may not offer additional benefits in preventing postpartum hemorrhage in women with uncomplicated pregnancies.

[A CHILD IS LOST: THE PHENOMENON OF REFUSING TO BE HOSPITALIZED IN FAMILIES OF CHILDREN REFERRED TO THE DEPARTMENT OF EMERGENCY MEDICINE].

BACKGROUND: Discharge against medical advice (DAMA) in pediatrics may endanger the child, increase the rate of complications, morbidity or mortality. Despite the prevalence of this phenomenon in the world, we found only one study that examined the DAMA phenomenon in Israel. The study examined the phenomenon in one ER in general and did not distinguish between adults and children. OBJECTIVES: To describe the characteristics of children and parents who left the ER against medical advice for hospitalization and to examine the reasons given by the parents, and factors associated with this phenomenon. METHODS: A prospective study involving parents who refused to hospitalize their children despite a medical recommendation. Data was collected from medical records and telephone interviews after discharge. RESULTS: During the study, there were 16,376 visits to the pediatric ER, 3288 recommendations for hospitalization (20.07%) and 200 DAMA (6%). Reasons for parents refusing hospitalization can be categorized according to: child's health reasons, parents personal reasons and reasons related to the health system`s function. A total of 22 of the children returned to the ER for the same complaint and 12 of them were hospitalized (7.9% of the children who completed their participation in the study). DISCUSSION: Refusal of medical care for children is a disturbing phenomenon due to the negative consequences that may result from this. In order to minimize the extent of DAMA and its damage, it is very important to recognize the extent and understand the factors associated with this phenomenon.

Patients' knowledge and opinions regarding osteoporosis, osteoporosis treatment, and oral health care.

BACKGROUND: In this study, the authors assessed the knowledge and opinions of patients regarding osteoporosis and the associations among osteoporosis, osteoporosis treatments, and oral health care use. METHODS: Outpatients with osteopenia or osteoporosis completed a questionnaire, including sociodemographic data, internet use, osteoporosis status, oral health care use status, and knowledge regarding the effect of osteoporosis pharmacotherapy on dental procedures. RESULTS: Among 258 patients (mean [standard deviation] age, 68.5 [9.3] years; 93% female), 83.9% had osteoporosis, one-third had previous osteoporotic fracture, and 74.4% took osteoporosis medication, mostly antiresorptive agents. In addition, 66.3% had more than 12 years of education, and 53.9% used the internet daily. A total of 79.9% visited a dentist during the past year, and 29.0% had undergone an invasive procedure. Yet 46.5% estimated that their dentist did not know that they had osteoporosis. Approximately one-half of the participants responded that they did not know the answers to knowledge questions regarding associations between osteoporosis, its pharmacotherapy, and oral health care. Of the patients who answered questions about associations between osteoporosis and oral health care, 70% incorrectly believed osteoporosis increased gingival disease, and 30% incorrectly thought medications should be discontinued before caries restoration. CONCLUSIONS: Outpatients with osteoporosis or osteopenia who responded to a questionnaire had limited knowledge about associations among osteoporosis, osteoporotic treatment, and oral health care. PRACTICE IMPLICATIONS: Dentists should review previous and current medical treatments with their patients, including osteoporosis diagnoses. The medical community should make more efforts to provide balanced, accurate information to help patients prioritize health care treatment and avoid unnecessary interruptions in osteoporosis treatment.

Towards a measure of accountability in nursing: A three-stage validation study.

AIMS: The aim of this study was to develop and psychometrically evaluate a three-dimensional questionnaire suitable for evaluating personal and organizational accountability in nurses. BACKGROUND: Accountability is defined as a three-dimensional value, directing professionals to take responsibility for their decisions and actions, to be willing to explain them (transparency), and to be judged according to society's accepted values (answerability). Despite the relatively clear definition, measurement of accountability lags well behind. Existing self-report questionnaires do not fully capture the complexity of the concept nor do they capture the different sources of accountability (e.g., personal accountability, organizational accountability). DESIGN: A three-stage measure development. METHODS: Data were collected during 2015-2016. In Phase 1, an initial database of items (N = 74) was developed, based on literature review and qualitative study, establishing face and content validity. In Phase 2, the face, content, construct, and criterion-related validity of the initial questionnaires (19 items for personal and organizational accountability questionnaire) were established with a sample of 229 nurses. In Phase 3, the final questionnaires (19 items each) were validated with a new sample of 329 nurses and established construct validity. RESULTS: The final version of the instruments comprised 19 items, suitable for assessing personal and organizational accountability. The questionnaire referred to the dimensions of responsibility, transparency, and answerability. The findings established the instrument's content, construct, and criterion-related validity as well as good internal reliability. CONCLUSION: The questionnaire portrays accountability in nursing, by capturing nurses' subjective perceptions of accountability dimensions (responsibility, transparency, answerability), as demonstrated by personal and organizational values.

"You are either out on the court, or sitting on the bench": understanding accountability from the perspectives of nurses and nursing managers.

AIMS: The aims of this study were: (1) to understand the implicit and explicit perceptions of accountability from the perspective of bedside nurses and their managers; (2) to identify the factors that facilitate accountability behaviours. BACKGROUND: Despite the importance attributed to accountability in nursing education and practice, empirical research lacks clarity regarding how nurses perceive accountability and decide whether or not to act accountably. DESIGN: Qualitative study. METHOD: Data of a purposeful sample of 23 nurses were collected through in-depth semi-structured interviews during 2015. They were tape-recorded, transcribed verbatim and content analysed. RESULTS: Nurses agreed that accountability, more particularly responsibility, was crucial to nursing professionalism. However, they perceived the demands for transparency and answerability as unjustified. Bedside nurses held this view more than nursing managers. Still, accountability was not considered an integral organizational norm but the choice of each nurse and his or her assessment of risks or benefits of acting accountably. CONCLUSIONS: Nurses' individual accountability was insufficient to generate accountability behaviours. They tended to weigh up the unit's accountability level in gauging risks and benefits before acting accountably. Risks of accountability behaviour included isolation, resistance and bullying, while benefits included professionalism, empowerment and pride.