Objective
To systematically develop evidence‐based bundles for care of postpartum hemorrhage (PPH).
Methods
An international technical consultation was conducted in 2017 to develop draft bundles of clinical interventions for PPH taken from the WHO's 2012 and 2017 PPH recommendations and based on the validated “GRADE Evidence‐to‐Decision” framework. Twenty‐three global maternal‐health experts participated in the development process, which was informed by a systematic literature search on bundle definitions, designs, and implementation experiences. Over a 6‐month period, the expert panel met online and via teleconferences, culminating in a 2‐day in‐person meeting.
Results
The consultation led to the definition of two care bundles for facility implementation. The “first response to PPH bundle” comprises uterotonics, isotonic crystalloids, tranexamic acid, and uterine massage. The “response to refractory PPH bundle” comprises compressive measures (aortic or bimanual uterine compression), the non‐pneumatic antishock garment, and intrauterine balloon tamponade (IBT). Advocacy, training, teamwork, communication, and use of best clinical practices were defined as PPH bundle supporting elements.
Conclusion
For the first response bundle, further research should assess its feasibility, acceptability, and effectiveness; and identify optimal implementation strategies. For the response to refractory bundle, further research should address pending controversies, including the operational definition of refractory PPH and effectiveness of IBT devices.
Excitation functions of the reactions 107Ag[(α, n); (α, 2n); (α, αn); (α, α2n)] and,109Ag[(α, 2n); (α, 3n); (α, 4n); (α, α3n); (α, α4n)] were investigated up to 70 MeV by the stacked foil activation technique and Ge(Li) gamma-ray spectroscopy method. Since the natural silver used as the target has two odd mass stable isotopes of abundance 51.83% (107Ag) and 48.17% (109Ag), their activation in some cases gives the same residual nucleus through different reaction channels, but with very different Q values. In such cases, the individual reaction cross sections are separated with the help of the ratio of theoretical cross sections. The experimental cross sections were compared with the predictions of a pre-equilibrium hybrid model. The (α, xn) reactions are fairly well reproduced with initial exciton number n0 = 4(4p0h), whereas (α, αxn) reactions are underestimated in magnitude by a factor of five to six.
Introduction and Objectives:In recent times, audio-video (A-V) recording of consent process for all the study subjects entering a clinical trial has been made mandatory. A-V recording of informed consent process is a big challenge due to confidentiality and the sociocultural environment in India. It is important to find out the acceptability for A-V recording of the consent process and reasons for refusal, if any to address this new challenge.Materials and Methods:A descriptive survey was done among 150 residents of a rural community of South India. Acceptability for A-V recording of consent process was assessed among those who had given the informed written consent for participation in the study. An attempt to find the factors determining the refusal was also made.Results:More than one-third (34%) of the study subjects refused to give consent for A-V recording of consent process. Not interested in recording or don’t like to be recorded (39%) were the most common reasons to refuse for A-V recording of consent process. The refusal was higher among female and younger age-group adult subjects. Socioeconomic status was not found to be significantly associated with refusal to consent for A-V recording.Conclusion:Refusal for A-V recording of consent process is high in the South Indian rural population. Before any major clinical trial, particularly a field trial, an assessment of consent for A-V recording would be helpful in recruitment of study subjects.
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