Objective: To determine the association between amniotic fluid index (AFI) and perinatal outcomes in preterm premature rupture of membranes (PPROM). Method: A retrospective cohort study was conducted between 2008 and 2012. 86 pregnant women were included, with a diagnosis of PPROM and gestational age from 24 to 35 weeks. Women who presented hypertensive disorders, diabetes, fetuses with birth defects and infection at admission were excluded. To determine the association between AFI and perinatal outcomes, chi-square and Fisher's exact test were used if necessary, as well as risk ratio (RR) and 95% confidence intervals (95CI). Correlation between AFI and perinatal outcomes was determined by using simple linear regression, and AFI progression during pregnancy was analyzed by Z-test. Results: When comparing newborns presenting ultrasound with AFI<5cm and AFI>5cm, there was a higher frequency of perinatal mortality when the AFI was lower than 5 cm. However, when the oligohydramnios was diagnosed as severe (AFI<3cm), there was a higher frequency of Apgar scores less than seven at 1 minute, neonatal sepsis and early neonatal mortality compared to those presenting AFI>3cm. There was a positive correlation between AFI and gestational age at delivery, birth weight and Apgar scores at minutes 1 and 5. There was also a decrease in amniotic fluid volume with increased gestational age. Conclusion:The presence of severe oligohydramnios after PPROM contributed to a higher frequency of perinatal complications and death.
Objec ve:To compare learning outcomes of postpartum hemorrhage simula on training based on either instruc onal design guidelines or best prac ce. Methods:A pretest-post-test non-equivalent groups study was conducted among obstetrics and gynecology residents in Recife, Brazil, from June 8 to August 30, 2013.The instruc onal design group included 13 teams, whereas the best prac ce group included seven teams. A standardized task checklist was used for scenario analysis and the propor on of correctly executed tasks compared (post-test minus pretest). Results:The instruc onal design group scored higher than the best prac ce group for total number of tasks completed (median difference 0.46 vs 0.17; P< 0.001; effect size[ r ]=0.72). Similar results were observed for communica on (median difference 0.56 vs 0.22; P= 0.004; r= 0.58), laboratory evalua on (median difference 0.83 vs 0.00; P< 0.001; r= 0.76), and mechanical management (median difference 0.25 vs -0.15; P= 0.048; r= 0.39). Speed of learning was also increased. The median differences were 0.20 for the instruc onal design group compared with 0.05 for the best prac ce group at 60 seconds ( P= 0.015; r= 0.49), and 0.49 versus 0.26 ( P= 0.001; r= 0.65) at 360 seconds. Conclusion:The use of simula on training for postpartum hemorrhage that was based on instruc onal design guidelines yielded be er learning outcomes than did training based on best prac ce. K E Y W O R D S Educa on ; Instruc onal design ; Postpartum hemorrhage ; Simula on training ; Situa onal awareness ; Training 1 | INTRODUCTION Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, par cularly among deaths that are considered avoidable. 1 Frequently reported assistance failures associated with preventable PPH include delay in diagnosis, poor communica on, insufficient teamwork, and lack of adequate educa on and training. 2,3 Simula on training has emerged as a widespread strategy to overcome such failures. Systema c reviews of simula on-based healthcare educa on debate the best way to deliver instruc onal features to ensure op mal effec veness of training. 4,5 Nonetheless, a growing body of evidence recommends that training formats should be based on reliable educa onal principles, par cularly instruc onal design guidelines. 6 The Four-Component Instruc onal Design model 7 and Merrill ' s First Principles of Instruc on 8 summarize the main guidelines. According to the guidelines, effec ve instruc on should contain authen c, relevant, and daily real-world problems, emphasize prac ce at 100 | DE MELO ET AL. different levels of complexity, and provide feedback and diminishing instruc onal support through training. 7When devising a PPH simula on training format based on instruconal design guidelines, the learning objec ves should be clearly idenfied and summarized in strategies that aim to overcome recurrent assistance failures. Such learning objec ves include situa onal awareness enhancement, 9 improvement of both communica on and teamwork skills and a tudes, 10 and reinforcem...
Objectives: to review the available literature on the general aspects of SARS-CoV-2 infec-tion. Methods: this is a narrative literature review carried out from March to September 2020. Results: COVID-19 caused by the new coronavirus or SARS-CoV-2, grows with devas-tating effects worldwide. The literature describes epidemiological data and mortality risk groups of the disease, which presents a high rate of transmission. Prevention is the most effective way to fight the disease, persisting the absence of strong evidence on the treatment. Vaccines are not yet available. Dexamethasone is effective in reducing mortality in severe forms. Conclusions: despite great efforts, as the number of confirmed cases increases, evidence on transmission, incidence, disease progression, lethality, effects and outcomes remain limited and without any high levels of evidence. Studies are still necessary for all aspects of the disease.
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