Risk Assessments of Epidural Analgesia During Labor and Delivery

2017 ◽  
Vol 27 (7) ◽  
pp. 841-852
Author(s):  
Antonio Herrera-Gómez ◽  
Elvira De Luna-Bertos ◽  
Javier Ramos-Torrecillas ◽  
Francisco M. Ocaña-Peinado ◽  
Concepción Ruiz ◽  
...  
Keyword(s):  
Health Care ◽  
Epidural Analgesia ◽  
Retrospective Cohort ◽  
Well Being ◽  
Labor Pain ◽  
Risk Assessments ◽  
Perineal Laceration ◽  
Increased Risk ◽  
Spanish Hospital ◽  
Mother And Child

Epidural analgesia (EA) is one of the methods of choice for labor pain relief, but its adverse effects on the mother and child remain controversial. The objective of this study was to determine whether there is an association between the use of EA and different aspects of labor. The author(s) analyzed the effect of EA on different aspects of labor in a retrospective cohort observational study of deliveries in a public Spanish hospital during a 3-year period. Women with EA administration were found to increase the risk of stimulated labor, reduce the percentage of spontaneous deliveries, increase the risk of instrumental labor due to stalled labor or loss of fetal well-being, and increase the percentage of episiotomies. However, women with EA were not and increased risk for perineal laceration or the condition of the membranes at the delivery or with the type of placental expulsion. Thus, the administration of EA should be assessed in each case by the health care professional.

The Effect of Epidural Analgesia Alone and in Association With Other Variables on the Risk of Cesarean Section

2017 ◽  
Vol 19 (4) ◽  
pp. 393-398 ◽  
Author(s):  
Antonio Herrera-Gómez ◽  
Elvira De Luna-Bertos ◽  
Javier Ramos-Torrecillas ◽  
Francisco Manuel Ocaña-Peinado ◽  
Olga García-Martínez ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Epidural Analgesia ◽  
Cesarean Delivery ◽  
Maternal Age ◽  
Well Being ◽  
Labor Pain ◽  
Cesarean Deliveries ◽  
Increased Risk ◽  
Newborn Weight ◽  
Fetal Position

Introduction: Epidural analgesia (EA) is the most widespread pharmacologic method of labor pain relief. There remains disagreement, however, regarding its adverse effects. The objective of this study was to determine the effect of EA administration on the risk of cesarean delivery and its causes (e.g., stalled labor, risk of loss of fetal well-being, among others) and the degree to which this effect may be modulated by mother-, newborn-, and labor-related variables. Method: A retrospective cohort observational study was conducted including all deliveries in a Spanish public hospital between March 2010 and March 2013 ( N = 2,450; EA = 562, non-EA = 1,888). Results: Risk of a cesarean section was significantly increased by EA administration (odds ratio [ OR] = 2.673; p < .0001). The percentage of cesarean deliveries due to the risk of loss of fetal well-being was significantly higher in the EA (47.8%) versus non-EA group (27.5%; OR = 1.739; p = 0.0012,). The EA-associated risk of cesarean section was not significantly modified as a function of maternal age or parity, fetal position, newborn weight, weeks of gestation, or sedation administration alone. However, these variables in combination may increase the risk. We present multivariate models for each group that account for these variables, allowing for estimation of the risk of a cesarean delivery if EA is administered. Conclusion: EA is associated with an increased risk of cesarean delivery. Other variables in combination (maternal age or parity, fetal position, newborn weight, weeks of gestation, or sedation administration) may increase this risk.

scholarly journals Assessment of knowledge on non-pharmacological methods of pain relief during labour among nurses working in maternity and children hospital, Nepal

2017 ◽  
Vol 7 (3) ◽  
pp. 25-28
Author(s):  
Amshu Dhakal ◽  
Shrooti Shah ◽  
Babita Singh
Keyword(s):  
Pain Relief ◽  
Well Being ◽  
Cross Sectional Study ◽  
Labor Pain ◽  
Labor Management ◽  
Cross Sectional ◽  
Self Confidence ◽  
Increased Risk ◽  
Women And Children ◽  
Self Administered Questionnaire

Background: Labor pain is a universal phenomenon and it is associated with the contraction of uterus. Rather than making the pain disappear with pharmacotherapy, the nurses can assist the laboring women to cope up with, build their self-confidence and maintain a sense of mastery of well-being. Thus, nurses must have knowledge to assess pain to implement pain relief strategies. Methods: A descriptive cross-sectional study was carried out among 52 nurses of Siddhartha Women and Children Hospital, Butwal, Nepal to assess Knowledge about Non-pharmacological Methods of Pain Relief during Labor using structured self-administered questionnaire. The reliability of the tool after pretesting was 0.883. Descriptive statistics was used to analyze the data. Results: Among 52 nurses, 36.5% were 18-22 years of age, 46.2% of them had qualification of Proficiency certificate level Nursing, 40.4% had experience of 3 years- 6 years. In this study, 46.2% had satisfactory knowledge about non-pharmacological methods of pain relief during labor, 32.6% had fair knowledge and remaining 21.2% had poor knowledge. Conclusion: This study concluded that less than half of the nurses had satisfactory knowledge about non-pharmacological methods of pain relief during labor. Since, there is an increased risk of complications resulting from pain and anxiety during labor, management of pain is very essential thus nurse’s knowledge on these methods is crucial. Hence, the nurses should be encouraged to enhance knowledge related to management of labor pain.

scholarly journals Senior healt-hcare fraud under investigation

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Nicole F. Stowell ◽  
Carl Pacini ◽  
Martina K. Schmidt ◽  
Nathan Wadlinger
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Well Being ◽  
Care Providers ◽  
Prevention Strategies ◽  
Effective Prevention ◽  
Content Type ◽  
Health Care Fraud ◽  
Increased Risk ◽  
The Usa

Purpose This study aims to increase awareness and educate the reader about health-care fraud targeting seniors in the USA to help stakeholders better understand, recognize and prevent this type of fraud. Design/methodology/approach This paper collects statistics on the current state of health care frauds committed against seniors, and examines related cases and laws. Findings The authors find this type of fraud is highly prevalent and expected to increase. Current laws preventing this fraud from occurring are multifold and complex. While prevention strategies through law enforcement have been somewhat successful, a reduction in resources may put seniors at an increased risk in the years to come. Research limitations/implications Without additional prevention strategies, the problem will likely escalate with a growing population of older adults. This study encourages further research into effective prevention strategies and methods to fight health-care fraud against seniors. Practical implications Health-care fraud and its associated costs pose a significant threat to the society and economy of the USA. Reducing this fraud will not only reduce the costs to the US economy but also improve the physical and mental well-being of senior victims, reduce their mortality and hospitalization rates and improve the public trust placed to health-care providers. Originality/value This study highlights how health-care fraud is committed against seniors. With the projected trend of an aging US population, educating stakeholders, increasing awareness and applying tools to protect seniors will be important to reduce the absolute scope of this problem in the future.

scholarly journals COVID-19 policies in practice and their direct and indirect impacts in Northern California jails

2022 ◽  
Author(s):  
Yiran E Liu ◽  
Christopher LeBoa ◽  
Marcela Rodriguez ◽  
Beruk Sherif ◽  
Chrisele Trinidad ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Infection Control ◽  
Well Being ◽  
Poor Mental Health ◽  
Northern California ◽  
Increased Risk ◽  
Direct And Indirect Impacts ◽  
Indirect Impacts ◽  
Survey Responses

Context: Although the increased risk of COVID-19 in carceral facilities is well documented, little is known about the practical barriers to infection control and indirect impacts of pandemic policies in these settings. Evidence in jails is especially scarce. Methods: Between July 8, 2020 and April 30, 2021 we performed SARS-CoV-2 serology testing and administered a questionnaire among residents and staff in four Northern California jails. We analyzed seroprevalence in conjunction with demographic factors and survey responses of self-perceived COVID-19 risk, recent illness, COVID-19 test results, and symptom reporting behaviors. We additionally assessed COVID-19 policies in practice and evaluated their impacts on court dates, mental health, and routine health care. We engaged stakeholder representatives, including incarcerated individuals and their advocates, to guide study design, conduct, and interpretation. Findings: We enrolled 788 incarcerated individuals and 380 staff across four county jails. Most seropositive individuals had not previously tested positive for COVID-19, despite many suspecting prior infection. Among incarcerated participants, we identified deficient access to face masks and prevalent symptom underreporting associated with fears of isolation and perceptions of medical neglect in jail. Incarcerated participants also reported substantial hindrances to court cases and reductions in routine health care due to COVID-19. Incarcerated individuals and staff both cited worsened mental health due to COVID-19, which for incarcerated individuals was largely attributable to further isolation from loved ones and other pandemic restrictions on recreation and programming. Conclusions: Perceptions of inadequate protection from COVID-19 were pervasive among incarcerated individuals. Simultaneously, restrictive measures compounded poor mental health and fostered fears of isolation that undermined effective infection control. Custody officials should work to systematically improve provision of masks, understand and mitigate fears and mistrust, and take proactive steps to minimize the detrimental impacts of restrictive policies on residents' mental health and well-being.

The Divorced Family–Focused Care Model: A Nursing Model to Enhance Child and Family Mental Health and Well-Being of Doubly Bereaved Children Following Parental Divorce and Subsequent Parental Cancer and Death

2019 ◽  
Vol 25 (3) ◽  
pp. 419-446 ◽  
Author(s):  
Jette Marcussen ◽  
Lise Hounsgaard ◽  
Poul Bruun ◽  
Merete Golles Laursen ◽  
Frode Thuen ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Problems ◽  
Parental Divorce ◽  
Well Being ◽  
Care Model ◽  
Bereaved Children ◽  
Increased Risk ◽  
American Children ◽  
Divorced Family

The experience of parental death concomitant with parental divorce occurs for 46% of Danish children and 50% of American children who lose a parent to death. This experience of loss and double bereavement compounds increased risk of mental health problems. The aim of this study was to explore nursing interventions for double bereaved children that promoted their well-being. A phenomenological–hermeneutic approach was used to conduct 20 interviews with nurses in family cancer care. Ricoeur’s theoretical framework was followed with naïve reading, structural analysis, and critical interpretation, resulting in the formulation of a new model of nursing care for these children: the Divorced Family–Focused Care Model. Four themes were apparent: (a) collection of information about family structure, (b) assessment of support needs, (c) initiation of well-being support, and (d) coordination and follow-up focused on the child’s well-being. The new intervention model has implications for health care education and implementation of health care policies.

Sleep Well to Be Well: Importance of Healthy Sleep during Medical Training

2019 ◽  
Author(s):  
Ilia Kritikou ◽  
Ilene Rosen
Keyword(s):  
Health Care ◽  
Patient Outcomes ◽  
Medical Training ◽  
Well Being ◽  
Negative Consequences ◽  
Care Providers ◽  
Circadian Misalignment ◽  
Phone Calls ◽  
Resident Physicians ◽  
Increased Risk

Sleep is vital for our survival and wellness; lack of sleep is associated with significant cognitive, behavioral and physical health consequences, including increased mortality. In resident physicians and other health care providers, scheduled in-house calls, frequent pager/phone calls, and work required during nights are the norm. These phenomena along with the normal pull for work/life balance lead to acute and chronic partial sleep restriction, sleep disruption and circadian misalignment. As is true for the general population, residents are not immune to sleepiness and performance deficits associated with curtailed sleep. Residents are also at risk for metabolic dysregulation, including increased risk of obesity, cardiovascular disease, and mood disturbances that accompany disrupted sleep and circadian misalignment. Initial data suggesting worse patient outcomes when residents work >80 hours weekly, pushed Accreditation Council for Graduate Medical Education (ACGME) to limit resident duty-hours to 80 weekly, 30 per shift; newer data fail to show improved patient outcomes under the new limited work schedule. Nevertheless, recent studies suggest extended work schedules and circadian misalignment negatively affect well-being of resident physicians, increase risk of motor vehicle accidents. Long-term effects are yet to be determined.Implementing educational programs that foster programmatic, individual responsibility for fatigue management, GME programs and their leadership may mitigate negative consequences on safety and wellness. This review contains 2 figures, 3 tables, and 36 references. Keywords: sleep, sleep deprivation, sleepiness, circadian rhythms, residency, health care, patient outcomes, ACGME, wellness

scholarly journals Epidural Analgesia and Back Pain after Labor

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 354 ◽  
Author(s):  
Malevic ◽  
Jatuzis ◽  
Paliulyte
Keyword(s):  
Back Pain ◽  
Statistical Analysis ◽  
Epidural Analgesia ◽  
Post Partum ◽  
Labor Pain ◽  
Intravenous Anesthesia ◽  
Intravenous Drugs ◽  
Anesthesia Group ◽  
Increased Risk ◽  
The Impact

Background and Objectives: The aim of this survey was to assess the impact of epidural analgesia on post-partum back pain in post-partum women. Materials and Methods: The questionnaire was completed by post-partum women during the first days after delivery. Six months later, the women were surveyed again. The response rate was 70.66%, a total of 212 cases were included in the statistical analysis. The statistical analysis of the data was conducted using SPSS® Results. Seventy-nine (37.26%) women received epidural analgesia, 87 (41.04%) intravenous drugs, and 46 (21.7%) women gave birth without anesthesia. The prevalence of post-partum back pain was observed in 24 (30.38%) women of the epidural analgesia group, in 24 (27.58%) subjects of the intravenous anesthesia group, and in 14 (30.43%) women attributed to the group of subjects without anesthesia. The correlation between post-partum back pain and the type of anesthesia was not statistically significant (p = 0.907). Six months later, the prevalence of back pain was found in 31.65% of women belonging to the epidural analgesia group, in 28.74% of women with intravenous anesthesia, and in 23.91% of women without anesthesia. The correlation between complaints of back pain six months after delivery and the type of anesthesia applied was not statistically significant (p = 0.654). Conclusions. The labor pain relief technique did not trigger the increased risk of back pain in the early post-partum period and six months after delivery.

scholarly journals The Association between Pre-Pregnancy BMI, Gestational Weight Gain and Pregnancy Outcomes: A Retrospective Cohort Study in Ahvaz, Iran

2020 ◽  
Author(s):  
Kambiz Ahmadi Angali ◽  
Maryam Azhdari ◽  
Maria Cheraghi ◽  
parvin shahri ◽  
shokrolah salmanzadeh ◽  
...  
Keyword(s):  
Health Care ◽  
Body Mass Index ◽  
Cohort Study ◽  
Weight Gain ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Retrospective Cohort ◽  
Large For Gestational Age ◽  
Gestational Weight ◽  
Increased Risk

Abstract Background: Maternal body mass index and maternal gestational weight gain can have positive effects on birth and maternal outcomes. We aimed to identify the effect of pre-pregnancy weight and gestational weight gain on birth outcomes.Methods: Data of this retrospective cohort study were extracted using the 1457 out of 1800 pair health records belonged to the pregnant mother and infant at Ahvaz health care centers, from 2010 to 2018.Result: The 3.18-fold increased risk for large for gestational age in overweight mothers, and a 2.9 fold increased risk for small for gestational age in those mothers with gestational weight gain below the guidelines. An increased risk of large for gestational age, low birth weight, and macrosomia were observed in overweight mothers with gestational weight gain out of the guidelines. The increased association was found between the maternal pre-body mass index and fasting blood sugar (p = 0.0001). Hence, hyperglycemia is related to a 3.58-fold incidence of macrosomia. Conclusion: Therefore, conducting more educational programs of lifestyle intervention with respect to reproductive health care is required for all women in childbearing age (before and during pregnancy), with the purpose of reducing the adverse pregnancy outcome.

scholarly journals THE ROLE OF BIOCHEMICAL MARKERS IN THE RISK STRATIFICATION FOR DEVELOPMENT OF PREECLAMPSIA: THE CLINICIAN’S VIEW

2017 ◽  
Vol 4 (4) ◽  
pp. 181-186
Author(s):  
I. V Ignatko ◽  
Violetta S. Florova ◽  
A. C Kuznetsov ◽  
E. Yu Kuzina
Keyword(s):  
Pregnant Woman ◽  
Biochemical Markers ◽  
Well Being ◽  
Correct Interpretation ◽  
Third Trimester ◽  
The Third ◽  
Increased Risk ◽  
The World ◽  
Mother And Child

Preeclampsia is one of the main causes of maternal mortality and leads to 50-60 thousand deaths annually worldwide, its prevalence in the world is 5-8%. Moreover, this complication is associated with an increased risk of the development of cardiovascular diseases and diabetes in the mother and child. Preeclampsia is a multi-systemic syndrome including hereditary and environmental factors in its pathogenesis and pathophysiology, and the only effective method of the treatment is still delivery. Regardless of the time of debut, preeclampsia is often characterized by the relative well-being of a pregnant woman, right up to the development of severe pre-eclampsia. This review is devoted to biochemical markers of the high risk of pre-eclampsia. Of particular interest there is the balance of proangiogenic (PIGF) and anti-angiogenic (sFlt) growth factors at different gestational ages; both the correct interpretation of the sFlt/PIGF balance and the correlation with the history data already allow us to expand the criteria for the prevention of preeclampsia and open up prospects for optimizing obstetric tactics in the third trimester of pregnancy.

scholarly journals Stress, burnout and depression in women in health care during COVID-19 Pandemic: Rapid Scoping Review

2020 ◽  
Author(s):  
Abi Sriharan ◽  
Savithiri Ratnapalan ◽  
Andrea C. Tricco ◽  
Doina Lupea ◽  
Ana Patricia Ayala ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Scoping Review ◽  
English Language ◽  
Organizational Factors ◽  
Well Being ◽  
Secondary Outcome ◽  
Family Status ◽  
Increased Risk ◽  
Scoping Reviews

ABSTRACT Objectives The overall objectives of this rapid scoping review are to (a) synthesize the common triggers of stress, burnout, and depression faced by women in health care during the COVID-19 pandemic, and (b) identify individual-, organizational-, and systems-level interventions that can support the well-being of women HCWs during a pandemic. Design This scoping review is registered on Open Science Framework (OSF) and was guided by the JBI guide to scoping reviews and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension to scoping reviews. A systematic search of literature databases (Medline, EMBASE, CINAHL, PsycInfo and ERIC) was conducted from 2003 until June 12, 2020. Two reviewers independently assessed full-text articles according to predefined criteria. Interventions We included review articles and primary studies that reported on stress, burnout, and depression in HCWs; that primarily focused on women; and that included the percentage or number of women included. All English language studies from any geographical setting where COVID-19 has affected the population were reviewed. Primary and secondary outcome measures Studies reporting on mental health outcomes (e.g., stress, burnout, and depression in HCWs), interventions to support mental health well-being were included. Results Of the 2,803 papers found, 31 were included. The triggers of stress, burnout and depression are grouped under individual-, organizational-, and systems-level factors. There is a limited amount of evidence on effective interventions that prevents anxiety, stress, burnout and depression during a pandemic. Conclusions Our preliminary findings show that women HCWs are at increased risk for stress, burnout, and depression during the COVID-19 pandemic. These negative outcomes are triggered by individual level factors such as lack of social support; family status; organizational factors such as access to personal protective equipment or high workload; and systems-level factors such as prevalence of COVID-19, rapidly changing public health guidelines, and a lack of recognition at work. Keywords Coronavirus, COVID-19, women in health care, stress, burnout, depression

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