AUDIT OF CESAREAN SECTION IN A RURAL TEACHING HOSPITAL AS PER WHO GUIDELINES (ROBSON’S TEN GROUP CLASSIFICATION SYSTEM)

Background: Rate of cesarean section (CS) is one of the most frequently used indicators of healthcare quality at the national and international levels for clinical governance. Audit of indications of CS and to propose measures to reduce the rate of CS in our institution Methods: Prospective observational study was conducted at Department of Obstetrics and Gynaecology at Dr Rajendra Prasad Government Medical College Kangra at Tanda (HP) Results: In our study, previous CS (group 5) contributed the most (30.44%) of overall CS.Second largest contributor was nulliparous women with cephalic presentation at term (group 1 and 2).Induction of labor (group 2) was associated with higher CS (23.66%), as compare spontaneous labor (group1). Women with breech presentation (group 6 and 7) also showed high CS rate. Conclusion: In conclusion, RTGCS permits the easy identification of the leading contributing groups to CS increases. RTGCS is an internationally accepted classification that is much needed to scientifically study the effects of the rising CS rate. It identifies the contributors to differences in the CS rate but does not provide any explanation for these differences across various subgroups. Keywords: RTGCS, CS, NVD, Women.

Differences in Biometric Fetal Weight Estimation Accuracy and Doppler Examination Results in Uncomplicated Term Singleton Pregnancies between Vertex and Breech Presentation

Doppler examination of the umbilical artery and the fetal middle cerebral artery is evaluated predominantly in pregnancies with fetuses in cephalic presentation and never has been elucidated in breech presentation. Evidence on the accuracy of fetal weight estimation in dependence of the fetal presentation is controversial. Nevertheless, clinical decisions including recommendations for a cesarean section or labor induction based on these examinations are applied to pregnancies with fetuses in breech presentation. The objective of this study was to investigate the influence of the fetal presentation on fetal weight estimation accuracy, umbilical artery and middle cerebral artery resistance indices (RI) in a prospective case control study. Ultrasound examinations in 305 uncomplicated term pregnancies (153 vertex presentations, 152 breech) were investigated. Non-parametric variables were compared using Pearson’s chi2 test and Wilcoxon chi2 test, depending on variable scaling. Fetal weight estimation accuracy was not significantly different between vertex presentation group (VP) (6.97%) and breech presentation group (BP) (7.96%, p = 0.099). Fetal head circumference measurements were significantly larger in BP (350 mm vs. 341 mm in VB, p > 0.0001) while abdominal circumferences were significantly smaller (VP: 338 mm, BP: 331 mm, p = 0.0039) and weight estimation was not significantly different. Umbilical artery RIs were not significantly different between VP (54.5) and BP (55.3, p = 0.354). Fetal middle cerebral artery RIs also showed no significant differences (VP: 71.2, BP: 70.7, p = 0.335). Our study shows that fetal Doppler (RI) and weight estimation ultrasound originally calibrated in cephalic pregnancies are applicable to pregnancies with fetuses in breech presentation.

Traumatic isolated intracerebellar haematoma without any supratentorial lesion

Purpose. Pure isolated cerebellar haematoma of traumatic aetiology, without associated posterior fossa sub- or epidural haematomas and without supratentorial bleed is a rare entity. We conducted this retrospective study to analyze the management strategy of isolated traumatic intracerebellar haematoma without supratentorial lesion in our institute. Methods. We retrospectively reviewed records of more than 15000 head injury patients in our department of neurosurgery between January 2014 and November 2019. In this isolated intracerebellar hematoma patients are 60. Patients were divided into two groups assessed by the GCS score at the time of presentation – Group A (GCS>13) Group B (GCS lesser than or equal to 13). Group A treated conservatively and B surgically. Group A subdivided according to the size of hematoma into1st (>3cm ) and 2nd (<3 cm ). Group B subdivided according to GCS into 1st ( <8 ) and 2nd ( 8-13). Results. Most Group B, subgroup 1st ( GCS<8) patients found to be associated with poorer outcome ( 60 %) and subgroup 2nd ( GCS 8-13) had only 10 %. Group A subgroup 1st ( > 3 cm hematoma) has associated with poor outcome ( 28.57%) and Subgroup 2nd ( < 3 cm ) has 4.34% . GCS score at the time of admission, hematoma size, hematoma location, the timing of surgery were important factors for outcome. Conclusion. We concluded that hematoma size is > 3 cm and GCS > 8 patient should operate within 12 hr. Patient of GCS < 8 results of surgery are poor( 60%.) .If the size of hematoma < 3 cm, lateral hematoma and GCS >13 should be treated conservatively. The factors which may be associated with the poor outcome are Low GCS score at the time of admission(<8), the large size of hematoma (>3cm), median location and delay time of surgery(>12hr).

Developing Leadership Skills in the Classroom

There have been calls for pre-service teachers to be equipped with leadership skills. The 21st century urges schools and colleges to prepare the next generation of teachers to have leadership skills and to foster these skills among their students in the classroom. Pre-service teachers need to be equipped with leadership skills to be capable of making real changes in society. This study was conducted to examine to what extent pre-service teachers in Bahrain Teachers College possess leadership skills and the strategies faculty ought to use to improve those skills. A validated survey consisting of eight categories of leadership skills was used to collect the data. The sample consisted of 177 students from different majors (Arabic and Islamic, English, Maths and Science, and Cycle One). The results showed that pre-service teachers possess leadership skills and confirmed developing these skills in the classroom. The pre-service teachers enhanced their leadership skills in planning, problem-solving, self, and other management/controlling, communication, teamwork, decision-making, motivating, evaluation. Furthermore, the participants identified teaching strategies such as group presentation, group work, project-based learning, and problem-based learning as the strategies used by faculty in teaching, which they said facilitates the development of leadership skills in the classroom.

Computer-Based 3D Simulation Method in Dental Occlusion Education: Student Response and Learning Effect

Occlusion is a fundamental subject in dental education, and occlusal adjustment is clinically essential in daily dental practices. This study aimed to assess the effects of computer-based 3D simulations on learner responses and learning effect on the principles of occlusal adjustment in undergraduate dental students in comparison with the traditional approach. Two teaching methods, i.e., paper-based 2D presentation and computer-based 3D simulation, were used for teaching the occlusal adjustment concepts. Sixty dental students were divided into two groups using a pair-matching randomization method. In the 2D presentation group, a textbook with 2D illustrations was used. 3D graphic dental models and computer design software were applied in the 3D simulation group. After the course, an attitudinal survey and examination were conducted to evaluate the participants’ feedback and the learning effects resulting from the teaching methods. The independent t test was used to compare the test scores between groups (with α = 0.5). Pearson’s correlation coefficient was calculated to investigate the agreement between the survey data and test scores. Most of the students’ feedback indicated that the 3D simulation method would be effective in acquiring knowledge on occlusion and jaw movement. The examination scores were significantly higher in the 3D simulation group compared with those in the 2D presentation group in the questions for centric relation (P = 0.034). Conversely, the scores were insignificant in the questions for eccentric relation (P = 0.403). There was no correlation observed between the survey data and the actual examination score. Computer-based 3D simulation could increase the participants’ expectations and learning effects in dental occlusion education. Further studies in diversified learning environments are required on the efficacy of digital educational modality.

Association of time to initial clinic visit with prolonged recovery in pediatric patients with concussion

OBJECTIVENo studies to date have investigated the role of early clinical care in time to recovery from concussion in a pediatric population. The purpose of this study was to investigate the role of clinic presentation timing (≤ 7 days [early] compared to 8–20 days [late] from injury) in concussion assessment performance and risk for prolonged recovery (> 30 days) in pediatric concussion.METHODSThis study is a retrospective cross-sectional study from a concussion clinic between April 2016 and January 2019, including 218 children and adolescents with diagnosed concussion, separated based on clinic presentation timing following injury: early (≤ 7 days) and late (8–20 days). Outcomes were recovery time, Postconcussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Vestibular/Ocular Motor Screen (VOMS), and demographics, medical history, and injury information. A general linear model and chi-square analyses were used to assess differences between early and late presentation, along with logistic regression, to predict prolonged recovery (> 30 days).RESULTSThose with early presentation reported higher symptoms on VOMS subtests (79%–85%) compared to those with late presentation (61%–78%), with the exception of near-point of convergence distance and visual motion sensitivity (VMS). The strongest predictor of prolonged recovery was number of days to first clinic visit (OR 9.8). Positive VMS (OR 5.18), history of headache/migraine (OR 4.02), and PCSS score (OR 1.04) were also predictive of prolonged recovery.CONCLUSIONSDespite patients in the early presentation group presenting with more positive VOMS scores, the early presentation group recovered sooner than patients in the late presentation group. Even after controlling for vestibular dysfunction, history of headache or migraine, and total symptom severity, days to first visit remained the most robust predictor of recovery > 30 days. These findings suggest that early, specialized medical care and intervention for children and adolescents with recent concussion is associated with normal recovery time. Clinicians should educate children and parents on the potential importance of early treatment to improve the odds of positive outcomes following concussion.

Macrophage activation syndrome as a complication of rheumatologic disorders, a report from Iran

The objective was to evaluate the clinical and laboratory manifestations and outcomes of the MAS cases in the context of systemic juvenile idiopathic arthritis (SJIA), systemic lupus erythematosus (SLE), Kawasaki disease, poly-articular juvenile idiopathic arthritis (PJIA). Twenty consecutive patients diagnosed with MAS between 2005 and 2016 entered the study. The cases were divided into two groups: in the first, MAS emerged in the context of a previously diagnosed rheumatologic disease, while in the second, MAS was the first presentation of a rheumatologic disease. In the other classification, the cases were divided into recurrent and non-recurrent cases. Laboratory data were recorded at three times: before MAS attack, during MAS attack, and 1 month after discharge from hospital. Nineteen cases with the median age of 5.9 (3.6-10) years entered the study. Four cases (21.1%) showed recurrent attacks of MAS. MAS was the first presentation of disease in 10 cases. The median age of the patients in the underlying disease group (10 years) was significantly higher than in the first presentation group [4.5(1.7-6.1) years, p=0.003]. The median fibrinogen value during MAS attack in the underlying disease group (601 mg/ dL) was also significantly higher than in the first presentation group (174 mg/dL, p=0.038). The platelet count during MAS attack in the recurrent group (30,500/microliter) was significantly lower than in the non-recurrent group (135,000/microliter, p=0.042). Our series of MAS cases demonstrated an overview of the symptoms, signs, laboratory manifestations, treatment, and prognosis of these cases. The higher median fibrinogen in MAS in the underlying disease group revealed that a decreasing level of fibrinogen in chronic disease is more significant than a single cut off value. Indeed, the lower platelet count in the recurrent MAS group may indicate greater platelet consumption due to organomegaly. Early diagnosis and treatment may save the patients’ lives.

Innovation of Learning Device and Learning Media of Web-Based Nias Dance Techniques in Students of Dance Education Program of Art and Language Faculty in State University Of Medan (UNIMED)

Nias Dance Technique is one of the subjects included in the Presentation group, but the learning belongs to the education group. The aim is to innovate learning tools and web-based instructional media on Nias dance technique for students of Dance Program of Art and Language Faculty in State University of Medan. The type of research used is research and development (R&D). R&D is a research method used to produce certain products, and test the effectiveness of these products. The results of this study are that the Learning Tools and instructional media are to facilitate students in learning Nias Dance through web schology in the Department of Sendratasik. Learning device innovation consists of KKNI curriculum starting from RPS, LK, Assessment Rubric, Teaching Materials, VCD with dance material No Tatema Mbola.

INTRA-SENTENTIAL SWITCHING USE IN CLASSROOM ACTIVITY

The research focused in the intra-sentential code switching used by the students in English Department of IKIP Siliwangi Bandung. The research was conducted to find out the intra-sentential switching that used by the students, why the students switch code, and the function of intra-sentential switching in classroom activity. The research employed a qualitative descriptive study involing field research. The samples are 3 groups presentation from class A2 English Education 2015 IKIP Siliwangi Bandung. This study explored pattern of intra-sentential code-switching (CS) that are manifest in classroom activity of English-Indonesia-Sunda in class A2 English Education 2015 IKIP Siliwangi Bandung, the reason why students switch thier code and in what situation students switch their code or language. The result of this research are 3 groups presentation were switching their language in type of intra-sentential switching, the reasons they switch their langugae are less vocabulary, to make they easier to express their mind, to make listener or audience easier to understand, and nervous. In presentation, group discussion, speech & daily conversation are situations they switch their code or language.Keywords: Code switching, Intra-sentential switching, classroom activity.

Meningkatkan Hasil Belajar Bahasa Indonesia melalui Model Kooperatif STAD untuk Siswa Kelas XI MIA4 SMA Negeri 2 Bangkinang Kota Tahun Pelajaran 2016/2017

Classroom action research has been done in SMA Negeri 2 Bangkinang Kota on Indonesian Language subjects with research object of class XI MIA 4 in odd semester 2016/2017. This study was conducted as an effort to improve the learning ability of Indonesian for students of class XI MIA 4. STAD type was chosen to be applied after through observation and reflection conducted by the researcher. Researchers plan actions based on observations and reflections that have been done through the preparation of STAD type learning based learning tools consisting of Cycle I / test questions, and Cycle II test/test, observation sheet and lesson plan and other supporting learning tools. The implementation of STAD type cooperative learning in the learning process through the preparation stage, class presentation, group activities, carry out evaluation, group awards and recalculate basic scores and group changes. This study can be completed in 2 cycles 6 meetings, at meeting 3 and 6 meeting conducted test / repeat and complete recapitulation of learning showed that there has been an increase of positive student learning activity in class and increasing of test mean (repetition) and also increase of classical completeness from cycle I with cycle II. Student activity during the learning process is observed by the observer as data for evaluation and reflection. Average recapitulation of test (repetition) and learning completeness obtained from the value of the test in cycle 1 and the value of tests in cycle 2. Based on the results of research can be concluded that the application of learning with STAD type in class XI MIA 4 SMA Negeri 2 Bangkinang City able to improve learning outcomes subjects Indonesian language is indicated by the average test (repetition) and classical completeness in every cycle.