Effects of proof-of-concept training on reducing work stress and anxiety of junior medical staff: a randomized controlled trial proof-of-concept.

BACKGROUND: Psychological stress and anxiety have seriously affected the ability of new clinicians to adapt and coordinate their clinical work. Traditional pre-job training is often not very good at assisting new recruits to regulate their emotional problems. METHODS: This study is a randomized controlled study. A total of 435 newly recruited clinicians participated in the study. 428 clinicians were randomized into a control group (n = 214) and an intervention group (n = 214). The control group conducted regular pre-job training. Doctors of the intervention group attend a themed course every two weeks on the basis of regular induction training. Their physiological status was evaluated by Perceived Stress Scale (PPS-10), Generalized Anxiety Scale (GAD-7) and Psychological Resilience Scale (CD-RISC-10) 3 months later. Participants in the intervention group received a training satisfaction questionnaire. RESULTS: After entering the clinic for 3 months, the PSS-10 and GAD-7 scores of the intervention group were significantly lower than that of the control group. Consistently, the CD-RISC-10 score of new clinicians who received proof-of-concept pre-job training was significantly higher than that of new doctors in the control group. CONCLUSION: New doctors received the proof-of-concept group experienced alleviation in stress and anxiety.

Comparison of Spontaneous Pushing and Directed Pushing During the Second Stage of Labor Among Chinese Women Without Epidural Analgesia: Protocol for a Noninferior Feasibility Study.

BACKGROUND: Maternal pushing during the second stage of labor could influence labor progress and maternal-neonatal outcomes. Although the image of health care providers directing the laboring women to push during the second stage of labor could be commonly observed globally, this practice is not sufficiently researched and is questioned regarding its effectiveness and outcomes on the mother and baby. Meanwhile, a strategy referred to as "spontaneous pushing," which supports women to push by following their bodily urges, has been evaluated in several trials. However, in China, spontaneous pushing is not common practice. Notwithstanding the evaluation of spontaneous pushing, there is a lack of high-quality evidence to support either strategies of directed pushing or spontaneous pushing. OBJECTIVE: This study aims to test the feasibility of a future randomized controlled trial to compare the effects of spontaneous pushing and directed pushing during the second stage of labor for maternal and neonatal outcomes in China. METHODS: A nonrandomized, single-group, noninferiority feasibility study will be conducted in a public hospital in Hebei Province, China. In total, 105 women meeting the selection criteria will be recruited to receive the intervention (spontaneous pushing), while 105 sets of medical notes from women who received routine care (directed pushing) will be identified and reviewed to compare outcomes for both cohorts. A mixed methods approach will be used to assess primary outcomes (feasibility and acceptability) and secondary outcomes (effectiveness). RESULTS: Data collection took place between May and October 2023. A total of 110 women were invited to participate in the intervention of spontaneous pushing. Midwives' interviews were conducted and will be transcribed for analysis in March 2024. The data analysis is planned to be completed by May 2024. CONCLUSIONS: This feasibility study will provide important information by conducting a full-scale clinical trial in the future as well as the potential facilitators and barriers of it. A future randomized controlled trial is likely to have considerable policy and funding impacts regarding pushing management during the second stage of labor and improvement in women's childbirth experience. TRIAL REGISTRATION: Chinese Clinical Trial Register ChiCTR2300071178; https://tinyurl.com/mudtnbft. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55701.

The correlation between serum total bile acid and alanine aminotransferase of pregnant women and the disorders of neonatal hyperbilirubinemia-related amino acid metabolism.

BACKGROUND: To explore the association between liver metabolism-related indicators in maternal serum and neonatal hyperbilirubinemia (NHB), and further investigate the predictive value of these indicators in NHB-related amino acid metabolism disorders. METHODS: 51 NHB and 182 No-NHB newborns and their mothers who treated in the Fourth Hospital of Shijiazhuang from 2018 to 2022 were participated in the study. The differences in clinical data were compared by the Mann-Whitney U test and Chi-square test. Multivariate logistic regression was used to analyze the relationship between maternal serum indicators and the occurrence of NHB. The correlation analysis and risk factor assessment of maternal serum indicators with NHB-related amino acid metabolic disorders were performed using Spearman correlation analysis and multivariate logistic regression. RESULTS: Compared to the non NHB group, the NHB group had higher maternal serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), ALT/AST, and total bile acid (TBA), while lower levels of serum albumin (ALB), total cholesterol (TC) and high-density lipoprotein (HDL). The levels of alanine (ALA), valine (VAL), ornithine (ORN), and proline (PRO) in the newborns were reduced in NHB group, while arginine (ARG) showed a tendency to be elevated. Multiple logistic regression analysis showed that maternal ALT, AST, ALT/AST, and TBA levels were all at higher risk with the development of NHB, whereas ALB, TC, and HDL levels were negatively associated with NHB development. Increasing maternal TBA level was associated with lower ALA (r=-0.167, p = 0.011), VAL (r=-0.214, p = 0.001), ORN (r=-0.196, p = 0.003), and PRO in the newborns (r=-0.131, p = 0.045). Maternal ALT level was negatively associated with ALA (r=-0.135, p = 0.039), VAL (r=-0.177, p = 0.007), ORN (r=-0.257, p < 0.001), while ALT/AST was positively correlated with ARG (r = 0.133, p = 0.013). After adjustment for confounding factors, maternal serum TBA and ALT were the independent risk factor for neonatal ORN metabolic disorders [(adjusted odds ratio (AOR) = 0.379, 95%CI = 0.188-0.762, p = 0.006), (AOR = 0.441, 95%CI = 0.211-0.922, p = 0.030)]. Maternal ALT level was an independent risk factor for neonatal VAL metabolic disorders (AOR = 0.454, 95%CI = 0.218-0.949, p = 0.036). CONCLUSIONS: The levels of high TBA, ALT, AST, and low HDL, TC of maternal were associated with the risk of NHB. Maternal TBA and ALT levels were independent risk factors for NHB-related amino acid disturbances which have value as predictive makers.

Impact of the introduction of neuraxial labor analgesia on mode of delivery at an urban maternity hospital in China.

OBJECTIVE: To evaluate the association between the introduction of neuraxial (epidural) labor analgesia and mode of delivery in a large urban maternity hospital in China. METHODS: A single-intervention impact study was conducted at Shijiazhuang Obstetrics and Gynecology Hospital in Shijiazhuang. Baseline data collection occurred between August 1 and December 31, 2009, when no analgesic method was routinely employed during labor. An intervention was then implemented, consisting of a neuraxial labor analgesia service. The service was fully operational from September 1, 2010, and data were collected to August 31, 2011. The mode of delivery was compared between the different periods. RESULTS: Neuraxial analgesia rate was used in none of the 3787 deliveries during the baseline period and 3429 (33.5%) of 10 230 in the implementation period. Cesareans were performed in 1533 (40.5%) deliveries in the baseline period and 3441 (33.6%) in the implementation period (difference -6.8%, 99.8% confidence interval [CI] -9.7% to -3.9%; P<0.0017). The proportion of vaginal deliveries in which forceps were used was unchanged (difference -0.8%, 99.8% CI -0.7% to 2.2%; P=0.92). CONCLUSION: The introduction of epidural analgesia reduced the frequency of cesarean delivery, which improved obstetric and neonatal outcomes.

Effects of recombinant human growth hormone therapy on carbohydrate, lipid and protein metabolisms of children with Turner syndrome.

OBJECTIVE: To study the effect of recombinant human growth hormone (rhGH) therapy on carbohydrate, lipid and protein metabolisms of Turner syndrome (TS). Metho d s: Total 45 patients with TS admitted between Jul. 2008 and Jun. 2011 were involved in this study. All patients received the clinical evaluation of body fat, plasma lipids, proteins and oral glucose tolerance test (OGTT) before and after rhGH therapy. Results : Our results indicated a significant decrease of body fat (FAT%) from 23.56±4.21 to 18.71±2.23 but no obvious change on the level of fat mass (FM) (p>0.05) was observed after rhGH therapy. We also detected significant changes on plasma high-density lipoprotein cholesterol (HDL-C) from (1.65±0.58 mmol/L) to (2.20±0.65 mmol/L) and low-density lipoprotein cholesterol (LDH-C) from (2.55±0.55 mmol/L) to (2.10±0.54 mmol/L) after rhGH exposure. However, no statistical significance was detected on the level of plasma triglyceride (TG), cholesterol (CHO). Interestingly, the levels of plasma retinol binding protein (RbP) (32.55±4.28mg/L), transferrin (TRF) (2.95±0.40 mg/L), serum albumin (PRE) (250.00±45.50 mg/L) and albumin (propagated) (33.58±4.25 mg/L) were significantly increased. When it goes to the oral glucose tolerance test (OGTT) test, there were 10 impaired glucose tolerance (IGT) cases among all patients before and after rhGH therapy. No significant change was observed on homeostasis model assessment- insulin resistance (HOMA-IR) level during rhGH intervention. Conclusion : Abnormal lipid and protein metabolisms of the children with TS can be improved with rhGH therapy for 6 months.