Recent studies demonstrate that vasopressin is useful when treating hemorrhagic and septic shock. The effect of vasopressin on systemic anaphylaxis has not been investigated except in clinical case reports. Vasopressin increases blood pressure because of vasoconstriction through the V1 receptor. Thus, we evaluated the effect of vasopressin on circulatory depression and bronchoconstriction provoked by systemic anaphylaxis and survival rates in rabbits. In the first set of experiments, 15 nonsensitized rabbits received normal saline (control) and vasopressin at 0.8 or 0.08 U/kg. In the second set, 40 sensitized rabbits received horse serum to induce anaphylaxis, and then received the same drugs as in the first set. In the first set, mean arterial pressure (MAP) in vasopressin groups increased by 18% to 24% compared with the control. Vasopressin at 0.8 U/kg decreased MAP insignificantly before the increases of MAP occurred. In the second set, vasopressin at 0.08 U/kg improved the survival rate. At 45 min after antigen challenge, 69% of the rabbits that received vasopressin at 0.08 U/kg were alive, whereas 29% of the control rabbits and 23% of the rabbits that received vasopressin at 0.8 U/kg were alive. Vasopressin increased MAP by 36% to 109% compared with the control within 5 min, however, at 2 min, vasopressin at 0.8 U/kg had no effect on MAP. Pulmonary dynamics were similar. In conclusion, vasopressin at 0.08 U/kg improved survival rates and severe hypotension provoked by systemic anaphylaxis, suggesting that this agent may be useful in the treatment of systemic anaphylaxis.
The purpose of this study was to evaluate an e-learning program on postpartum hemorrhage (PPH) for midwives. Methods Participants were midwives who worked at an obstetrics ward at a hospital, birth clinic, or birth center in the Kanto area. The e-learning program consisted of four parts. We measured knowledge about PPH using a pre-and a posttest, and evaluated the program using questionnaires. Results We analyzed 48 midwives. Knowledge scores significantly increased from the pre-to posttest (t = 10.27, p < .001). The average total score on the knowledge pretest was 15.85 (range 11-21, SD 2.78) and posttest 20.02 (range 14-23, SD 2.21). The percentage of questions correctly answered significantly increased with respect to 12 items: "characteristics of atonic bleeding," "clotting factors and hemorrhage," "percentage decrease of circulating blood volume as a cause of hemorrhagic shock," "circulating blood volume of adults," "support for patients with hemorrhagic shock," "characteristics of dilutional coagulopathy," "configuration of extracellular fluid," "characteristics of obstetric disseminated intravascular coagulation syndrome (DIC)," "causes of increased blood volume," "circulating hemorrhage volume according to the shock index," "blood infusion," and "components of blood plasma." No significant changes were found for two items: "colloid oncotic pressure" and "crystalloid pressure." Furthermore, we analyzed the relationship of the average total score with participants' characteristics (two-way factorial analysis of variance). No significant associations were detected. The design of the e-learning program was useful because of the positive assessment by the trainees of the mode of operation, appropriateness of the program, and overall satisfaction. Conclusion An e-learning program is an effective method for improving trainees' knowledge. There are limitations with regard to the effectiveness of teaching of physiology related to fluid therapy. We are planning on modifying the program; it required longitudinal assessment of knowledge retention.
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