A new course on assisted rotational birth and complex caesarean section - Mixed methods evaluation of Art & Craft

OBJECTIVES

To assess the utility of Art & Craft - a new, hands-on course on Advanced Rotational Techniques and safe Caesarean biRth at Advanced/Full dilation Training aimed at senior Obstetrics trainees. The aims were to assess whether it improved confidence and skills in rotational vaginal birth, impacted fetal head at caesarean, and ultrasound for fetal position.

STUDY DESIGN

With ethical approval, pre- and post- course questionnaires and post- course interviews of attendees were conducted. A pre course questionnaire was emailed 1 week before the course. Attendees were asked to rate their confidence levels in performing vaginal examination and ultrasound assessment of fetal position, rotational ventouse, manual rotation, Kielland's rotational forceps, and disimpaction of the fetal head during second stage caesarean on a scale of 1 to 5. 1 = not confident at all and 5 = very confident. A post-course questionnaire with the same questions was emailed 3 days after. p values for differences in scores were calculated using the Wilcoxon signed rank test using Stata/MP 18 software.

RESULTS

32 trainees attended the course. 28 questionnaires were available for analysis. The majority 39 % were middle grade (ST3-ST5) level. Initial confidence was very low for rotational forceps (median 1/5). After attending the course and practical stations, respondents' confidence levels increased significantly (p < 0.05) across all domains; vaginal examination from 4 to 5, ultrasound for fetal position, rotational ventouse, and manual rotation from 3 to 5, disimpaction from 4 to 4.5, and Kielland's rotational forceps from 1 to 4. Nine participated in post course interviews, which were thematically analysed. Participants expressed that the course gave them the opportunity to ask specific questions from experts to improve their confidence. A barrier to learning new methods was highlighted in that it is difficult to receive practical training in Kielland's, resulting in low confidence.

CONCLUSION

A practical, hands-on course on complex operative birth significantly increases trainee confidence levels in vaginal examination, ultrasound for fetal position, disimpaction, and techniques for rotational vaginal birth. The evaluation highlights that continued education and practise is required, even when trainees are senior. Evaluation of clinical outcomes after training is needed; and planned.

Strategies to optimize the performance of Robotic-assisted laparoscopic hysterectomy

A hybrid technique of robot-assisted, laparoscopic hysterectomy using the ENSEAL(®) Tissue Sealing Device is described in a retrospective, consecutive, observational case series. Over a 45 month period, 590 robot-assisted total laparoscopic hysterectomies +/- oophorectomy for benign and malignant indications were performed by a single surgeon with a bedside assistant at a tertiary healthcare center. Patient demographics, indications for surgery, comorbidities, primary and secondary surgical procedures, total operative and surgical time, estimated blood loss (EBL), length of stay (LOS), complications, transfusions and subsequent readmissions were analyzed. The overall complication rate was 5.9% with 35 patients experiencing 69 complications. Mean (SD) surgery time, operating room (OR) time, EBL, and LOS for the entire cohort were 75.5 (39.42) minutes, 123.8 (41.15) minutes, 83.1 (71.29) millilitres, and 1.2 (0.93) days, respectively. Mean surgery time in the first year (2009) was 91.6 minutes, which declined significantly each year by 18.0, 19.0, and 24.3 minutes, respectively. EBL and LOS did not vary -significantly across the entire series. Using the cumulative sum method, an optimization curve for surgery time was evaluated, with three distinct optimization phases observed. In summary, the use of an advanced laparoscopic tissue-sealing device by a bedside surgical assistant provided an improved operative efficiency and reliable vessel sealing during robotic hysterectomy.

Influence of alcohol and drug use on AIDS risk behavior among youth in dropout prevention

Youth enrolled in dropout prevention and alternative school programs engage in a number of high risk behaviors in greater numbers than those in traditional school settings [1, 2]. However, data on alcohol and drug use influences and risky sexual behavior are often not collected or reported among these youth due to small enrollments and rapid turnover. In this study alcohol and drug use and sexual behaviors were surveyed among 212 youth in dropout prevention. A risk profile score for HIV/AIDS was developed and the contribution of alcohol and drug use to HIV/AIDS risk was determined. Results showed that use of alcohol and drugs and age of sexual initiation were significantly associated with a high risk profile score. Of sexually active youth, 28 percent reported using alcohol or drugs prior to having sexual intercourse and more than half reported not using condoms during their last sexual experience. Males were more likely than females to use alcohol and drugs before having sex, and were more likely to have had sex with two or more partners. Findings from this study suggest that among youth in dropout prevention, the association of alcohol and drug use to HIV/AIDS risk is significant and that prevention programs need to target alcohol and drug use as important influences on risky sexual behavior.

A peer-led AIDS prevention program for students in an alternative school

School-based programs designed to measure health risk behavior and reduce the risk of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infection have not addressed adequately the needs of adolescents outside of main-stream schools. In Florida, these youth represent a sizable proportion of the population and have been shown to be at increased risk for acquiring sexually transmitted diseases and human immunodeficiency virus. This article describes a peer-led STD/HIV intervention for students in a dropout prevention program in Dade Country, Florida. Trained peer counselor/educators (PCEs) led schoolwide activities and classroom sessions covering STD/HIV information, community health resources, communication and negotiation skills, and safer sex strategies. Teachers and students rated the PCEs effective in promoting discussion and serving as sources of information about AIDS and community health resources. Pre/post intervention questionaire results demonstrated an increase in AIDS awareness and discussion among students as well as an increase in condom use. Based on this social influences approach, peer education appears to be a promising health education strategy for students in dropout prevention programs.

An emulsion formulation of amphotericin B improves the therapeutic index when treating systemic murine candidiasis

Incorporating amphotericin B into liposomes was reported to decrease amphotericin B toxicity without a concomitant loss of antifungal efficacy. We formulated an alternative emulsion-based delivery system for amphotericin B and compared it with Fungizone. The maximal tolerated dose (MTD) in mice was 1 mg of Fungizone/kg; however, the MTD was greater than 9 mg of the Intralipid emulsion formulation/kg. The emulsion formulation and Fungizone were equipotent for treating systemic candidiasis in mice. Amphotericin B nephrotoxicity, as manifested by polyuria that was resistant to antidiuretic hormone, was markedly diminished when amphotericin B was administered as an emulsion to rats. Loss of potassium from human red blood cells was also reduced by formulating this agent within emulsions. The emulsion formulation extended the survival time of mice that had established Candida albicans infections, when compared with the Fungizone treatment. The efficacy and reduced toxicity of the amphotericin B emulsion are findings suggesting that the emulsion formulation is preferable to Fungizone.

Inhibition by auranofin of pharmacologic and antigen-induced contractions of the isolated guinea pig trachea

The effects of an orally active gold complex, auranofin, were investigated on the isolated guinea pig trachea contracted pharmacologically and antigenically. Pretreatment of the tracheal tissues for 15 minutes with auranofin (10(-5) and 10(-4) mol/L) produced a significant rightward shift of a histamine dose-response curve (p less than 0.001), whereas a 30-minute pretreatment with auranofin (10(-4) mol/L) inhibited LTD4-induced (but not LTC4-induced) contraction of the tracheal spirals. In tracheas from animals actively sensitized to ovalbumin, auranofin (10(-4) mol/L) significantly inhibited contractions elicited by 0.01 micrograms/ml of this antigen. Auranofin does not appear to behave like a nonspecific suppressant of tracheal muscle contraction since it failed to antagonize a potassium chloride-induced (6 X 10(-2) mol/L) contraction. Therefore, auranofin appears to alter the in vitro response of the guinea pig trachea not only to histamine but also, more importantly, to LTD4 and specific antigen. These results characterize and extend further the pharmacology of auranofin in airway tissue.

Pleiotropic expression of Epstein--Barr virus DNA in human epithelial cells

We have attempted to establish a system that can be used to study the association of Epstein--Barr virus (EBV) with epithelial cells. Attempts were made to transfect human carcinoma cells with EBV DNA. Successful transfection was confirmed by the expression of EBV-specific early antigen (EA), virus capsid antigen, and the presence of virus DNA. The transfecting preparation contained a mixture of EBV and cellular DNA extracted from two producer cell lines, P3HR-1 and AG-876. Our data suggest that virus DNA obtained from the P3HR-1 nontransforming, EA-inducing strain of EBV was lytically expressed in the epithelial tumor cells. The DNA derived from AG-876 cells, which produce a transforming, non-EA-inducing strain of EBV, also produced a lytic infection.

Studies on the high-sulphur proteins of reduced mohair. The isolation and amino acid sequence of protein scmkb-m1.2

The complete amino acid sequence of mohair protein, SCMKB-M1.2 (97 residues), was determined. The protein was isolated from reduced and carboxymethylated mohair by chromatography on DEAE-cellulose phosphate. Peptides for sequence determination were obtained by digestion with trypsin, pepsin, chymotrypsin, thermolysin and papain, and were fractionated by DEAE-cellulose chromatography, paper chromatography and electrophoresis. The sequence of the peptides were determined by the Edman degradation method (by use of both the Beckman Sequence and a non-automatic procedure), and by partial acid hydrolysis. The protein is closely homologous to wool protein SCMKB-IIIB2, and also contains acetylated alanine as N-terminal amino acid.