Teaching Of Obstetrics Research Articles

Roles of C-Peptide and Triglyceride as Effective Indices for Insulin Resistance Investigations in Iraqi Women with Polycystic Ovarian Syndrome

Objectives: To assess how much Insulin Resistance (IR) in both obese and non-obese PCOS women used as index of PCOS and find out a correlation between various methods used for evaluation of IR.Methods: A study included 120 participants (68 women have PCOS subdivide according to their BMI to 45 obese (BMI>=30) and 23 non-obese (BMI<30). The remaining 52 participants represent as apparently control group with normal weight and normal menstrual cycle. Patients with PCOS were selected from the Infertility Department, Gynecology and Obstetrics Teaching Hospital in Kerbala, Iraq between Nov., 2021 and June, 2022. Diagnosis of PCOS is based on 2 of 3 findings: oligo/anovulation, hyperandrogenism, polycystic ovaries in ultrasound (Rotterdam criteria). Patients were interviewed and examined for weight, height, waist and hip circumferences. Venous blood samples were collected and insulin resistance was assessed by different methods including homeostatic model assessment of insulin resistance (HOMA-IR), G/I ratio, QUICKI, McAuly, TyG index and C-peptide index.Results: The assessment of IR revealed that HOMA-IR, QUICKI, McAuley, TyG and CPI had significant difference in both PCOS groups compared with controls. G/I ratio was significantly higher in the controls than obese PCOS women. The prevalence of IR based on (HOMA-IR) was 80% in obese PCOS and 48% in non-obese PCOS women. In obese PCOS women HOMA-IR strongly and negatively correlates with G/I ratio (r= -0.81, P<0.001), QUICKI (r= -0.89, P<0.001), McAuley (r= -0.79, P<0.001) and C-peptide (r= -0.56, P<0.001). Whereas it was positively correlates with insulin (r=0.99, P<0.001), C-peptide (r=0.71, P<0.001) and TyG index (r=0.51, P<0.001). In non-obese PCOS women, HOMA-IR strongly and negatively correlates with G/I ratio (r= -0.79, P<0.001), QUICKI (r= -0.93, P<0.001) and McAuley (r= -0.77, P<0.001). Whereas it was positively correlates with insulin (r=0.99, P<0.001), C-peptide (r=0.49, P<0.05) and TyG index (r=0.47, P<0.05).Conclusion: The observed results concluded that TyG is a valuable indicator to predict IR in obese women with PCOS, partly due to its analytical and financial ease-of-access in all clinical laboratories. The use of TyG index is recommended in the assessment of IR risk among Iraqi women with PCOS.

Teaching Effect of Online Live Broadcasting with Screen Sharing and PowerPoint Recording and Broadcasting on Medical Students’ Learning of Obstetrics and Gynecology

Objective: During the prevention and control of the outbreak of the new coronavirus, an upsurge of online teaching was set off in various teaching institutions. There is a relatively new online teaching method that has stood out, namely the screen sharing method. The purpose of this study was to compare the effectiveness of live broadcasting and PowerPoint recorded lectures in terms of medical students’ mastery of knowledge. Methods: The study was carried out among medical students of class 1806 from the First Affiliated Hospital of Xi’an Medical University who were in their clinical years. The students were randomly divided into two groups, in which 15 students were enrolled in the live broadcast lecture group, while 13 were in the PowerPoint recorded lecture group. Each group underwent two weeks of teaching in obstetrics and gynecology. After the second week of the course, a knowledge post-test and satisfaction survey were carried out, and the same test paper was used again 14 days after the previous test. The knowledge post-test and satisfaction survey were carried out using the Dingding intelligent form. Results: With regard to the post-test knowledge, the scores of the students under the two teaching methods were high, indicating that the learning effects from the two methods are similar (p > 0.05). In terms of satisfaction, students showed more acceptance to screen sharing lectures (p < 0.01). Conclusion: In small-scale online teaching, live lecture with screen sharing is a better and more effective teaching method, and students are more likely to accept this teaching method.

146 Virtual role-play: A useful tool for undergraduate obstetrics and gynaecology teaching during a pandemic

Background and Aims: The Obstetrics and Gynaecology undergraduate programme at our hospital transitioned to a blended learning programme in response to the COVID-19 pandemic. Students attended for clinical assignments at the hospital two days per week and availed of online learning from home three days per week. The challenge we faced was to create opportunities for students to practice history taking and consultation skills and to create opportunities for social interaction. Methods: In order to address these concerns, weekly virtual role-play tutorials based on two clinical cases were facilitated by the clinical tutor for ten students learning from home. The cases involved role-playing a patient (played by the tutor) doctor (played by a student) interaction to obtain a history, followed by feedback, discussing investigations, interpretation of results, further management, and another role-play to counsel a patient for the indicated gynaecological procedure. After one of these tutorials, given to two groups of ten students, student feedback was obtained using a ‘one-minute paper’. Students completed the questionnaire anonymously via a Google Form. Students were asked three questions; 1) What was the most useful thing you learned? 2) What remains unclear to you? 3) Other comments/ideas for improvements? Results: The response rate was 95% (19 of 20 students). Students described the tutorials as “well-structured” and “really interactive”. The opportunity to role-play counselling a patient for a procedure was of particular value to students, with 73% of students specifying this as the most useful thing they learned. Student comments also suggest they appreciated the opportunity to receive feedback. Conclusions: Student feedback was valuable. Our findings suggest virtual role-play is a useful learning tool to support teaching in Obstetrics and Gynaecology during the COVID-19 pandemic and perhaps beyond.

Во благо здоровья женщин России (к истории научных акушерских школ императорской медико-хирургической академии и Казанского университета)

The article presents the links in the development history of two scientific schools of obstetrics and gynecology: the Imperial Medical and Surgical Academy and Kazan University. The history of training medical specialists is briefly described, starting from the 18th century and the opening of the first school of «Midwife Arts». Based on biographical data, the works of Professors A.Ya. Krassovsky, K.F. Slavyansky, V.M. Florinsky, V.S. Gruzdev and their colleagues were studied. Over the years of their medical work, a decrease in birth mortality and the number of complications during pregnancy and childbirth was achieved, and the number of successful caesarean sections increased. In addition to medical practice, their task was to develop the teaching of obstetrics and gynecology in higher educational institutions of Russia and to train highly qualified personnel. Thanks to the joint work of these scientists, the traditions and knowledge of the Saint Petersburg and Kazan schools were combined, methods of managing pregnant women, delivery and treatment of female diseases were developed, which to this day have not lost their relevance. The result of many years of their work is the preservation and enhancement of women’s health in Russia.

The Effect of Obstetric Drills Training - Jamaica Core Obstetric Teaching and Training in Emergencies (JOTTIE) on Postpartum Haemorrhage at a Jamaican Teaching Hospital.

ObjectiveTo evaluate whether the initiation of JOTTIE, a one day simulation training course focussed on the management of common obstetric emergencies, was associated with a reduction in the morbidity and mortality associated with postpartum haemorrhage (PPH) at the University Hospital of the West Indies (UHWI).Study DesignWe conducted a retrospective comparative study that evaluated the incidence of multiple outcomes related to maternal morbidity secondary to PPH, during the two year period immediately prior to the introduction of JOTTIE (pre course arm, N = 88) or the two year period, one year post introduction (post course arm, N = 103) for all women who had vaginal deliveries complicated by PPH at UHWI. A relationship was said to be statistically significant if p < 0.05. Additionally, the study examined risk factors in relation to severity of haemorrhage.ResultsGenital tract trauma represented the highest recorded cause of PPH (approximately 71%). The data revealed that patients in the pre training arm were similarly likely to have no adverse outcome in comparison to patients in the post training arm (p = 0.962). There was also no statistically significant relationship between the time period of patient exposure in relation to the JOTTIE course and severity of PPH (p > 0.05). Uterine fibroids and Crohn’s disease were the only co-morbidities found to increase the likelihood of severe PPH, at 5.154 times (p = 0.019,OR = 5.154, CI = 1.314-20.212) and 17.848 times (p = 0.085,OR = 17.848,CI = 0.672-474.365), respectively.ConclusionsThis study suggests that prior to the introduction of the JOTTIE the rate of maternal morbidity associated with PPH was relatively low at UHWI and there was no significant effect on its management or a significant reduction in maternal morbidity since introduction of the course. Future research on the morbidity related to the other obstetric emergencies addressed at JOTTIE is needed in order to assess the effect of the course as a whole.

Impact of Preeclampsia onPlatelet Count and Platelet Indices among Sudanese Pregnant Women in Gezira State

Background: Preeclampsia is considered one of the major health problems is associated with pregnancy and one of the causes of maternal mortality. The pathogenesis of preeclampsia associated with platelets activation. Objectives: The aim of this study was to evaluate the platelets parameters (platelet count and platelet indices) in pregnant women with preeclampsia. Methodology: This is a case-control laboratory-basedstudy carried out in Wad Medani Obstetrics and Gynecology Teaching Hospital, Gezira State, Sudan from January to November 2020. A total of 50 pregnant women with preeclampsia as cases (32.20 ± 3.21 years) and 50 normotensive pregnant women as controls (30.68 ± 2.85 years)participated in this study. Three ml of venous blood samples were collected from all participants in K3 EDTA containers. platelets parameters (platelet count and platelet indices) were determined using Mindray BC 3000 Automated Hematology Analyzer. Data were analyzed usingthe SPSS computer program (version 22). Results: The study results showed that the thrombocytopenia account for 56 %, all cases with low PCT (100%). Furthermore, the means of PLTs count, PCT and PDW in cases were (144.40 ± 31.80 × 109/L, 0.13 ± 0.03 % and 15.80 ± 0.45 fl respectively) versus controls (269.40 ± 72.50 × 109/L, 0.22 ± 0.05 % and 15.50 ± 0.29 fl respectively), giving statistically significant differences (P value = 0.000, 0.003 and 0.022 respectively). The mean of PCT of mild cases was lower than severe cases (P value = 0.004); but there were no significant differences in PLTs count, MPV and PDW (P value = 0.379, 0.283 and 0.075 respectively). Conclusion: The study concluded that platelet count (PLTs count) and plateletcrit (PCT) were significantly decreased in pregnant women with preeclampsia especially, so, platelets parameters especially (PLTs count and PCT) should beincluded for assessing and predictingthe risk of severe preeclampsia.

Platelet Parameters Assessment among Sudanese Pregnant Women with Preeclampsia Attending Wad Medani Obstetrics and Gynecology Teaching Hospital

Background: Preeclampsia is considered as one of the major health problems associated with pregnancy and one of the causes of maternal mortality. The pathogenesis of preeclampsia associated with platelets activation. Aims and Objectives: The aim of this study was to evaluate the platelets parameters (platelet count and platelet indices) in pregnant women with preeclampsia. Design and Methods: This is a case-control laboratory based study carried out in Wad Medani Obstetrics and Gynecology Teaching Hospital, Gezira State, Sudan from January to November 2020. A total of 50 pregnant women with preeclampsia as cases (32.20 ± 3.21 years) and 50 normotensive pregnant women as controls (30.68 ± 2.85 years) were participated in this study. Three ml of venous blood samples were collected from all participants in K3 EDTA containers. platelets parameters (platelet count and platelet indices) were determined using Mindray BC 3000 Automated Hematology Analyzer. Data were analyzed using SPSS computer program (version 22). Results: The study results showed that the thrombocytopenia account for 56 %, all cases with low PCT (100%). Furthermore the means of PLTs count, PCT and PDW in cases were (144.40 ± 31.80 × 109 /L, 0.13 ± 0.03 % and 15.80 ± 0.45 fl respectively) versus controls (269.40 ± 72.50 × 109 /L, 0.22 ± 0.05 % and 15.50 ± 0.29 fl respectively), giving statistically significant differences (P value = 0.000, 0.003 and 0.022 respectively). The mean of PCT of mild cases was lower than severe cases (P value = 0.004); but there were no significant differences in PLTs count, MPV and PDW (P value = 0.379, 0.283 and 0.075 respectively). Conclusion: The study concluded that platelet count (PLTs count) and plateletcrit (PCT) were significantly decreased in pregnant women with preeclampsia especially; so platelets parameters especially (PLTs count and PCT) should be included for assessing and predication of the risk of severe preeclampsia.

Exploration of the Methods and Practice of Clinical Teaching in Obstetrics and Gynecology

Exploration of the Methods and Practice of Clinical Teaching in Obstetrics and Gynecology

Does Simulation Training Improve the Accuracy of Vaginal Assessment of Labour Progress?

AimTo measure the utility of the Simulation training model for training purposes over and above conventional methods of training for vaginal assessment during labour.MethodsThe study group included undergraduate trainees, and the control group included postgraduate trainees and qualified personnel, i.e. senior registrars and consultants. Participants from the study group were trained for vaginal assessment on the simulation training model. Then both the groups were tested on the model for accuracy in estimating each value of cervical dilatation and fetal station. Mean cervical dilatation and station accuracy scores were noted, and comparative analysis was done between the study and control groups.ResultsA total of 150 participants were included. The overall mean dilatation and station accuracy scores of a model trained study group participants were better than subjectively trained control group participants. Study group participants showed greater accuracy for smaller dilatations, i.e. 1, 2, 3, 4cm and middle dilatation, i.e. 5cm and 6cm (p value=<0.05). In contrast, comparing the two groups for higher dilatations from 6 to 10 cm did not show any statistical significance. Study group participants also showed greater accuracy for all the fetal stations except stations 0 and +1.ConclusionsThe simulation training model can be considered an in vitro training device to improve the trainees' understanding of cervical dilatation and fetal station and can be made a part of a routine obstetric teaching program.

Implementation of competence-based teaching and examinations in gynecology and obstetrics within the framework of the new 2020 Medical Licensing Regulation

ZusammenfassungAktuell wird der Nationale Kompetenzbasierte Lernzielkatalog Medizin auf Grundlage des „Masterplan Medizinstudium 2020“ weiterentwickelt. Er soll mit Inkrafttreten der neuen Ärztlichen Approbationsordnung verpflichtend an allen medizinischen Fakultäten umgesetzt werden. Im Mittelpunkt steht die Frage, welche Kompetenzen der ärztliche Nachwuchs im Rahmen des Kerncurriculums ihres Medizinstudiums erwerben sollte. In diesem Rahmen sollen auch neue kompetenzbasierte Lehrformate in das Medizinstudium integriert werden. Ein essenzieller Bestandteil sind dabei neue Prüfungsformate, die das aktuelle Format der Multiple-Choice-Questions (MCQ) in Zukunft ablösen werden.

Cesarean sections in Brazil's teaching hospitals: an analysis using Robson Classification.

ABSTRACTObjective.To determine the distribution of cesarean sections performed in teaching hospitals participating in the Project for Improvement and Innovation in the Care and Teaching of Obstetrics and Neonatology (Apice ON) using the Robson Classification.Methods.Cross-sectional descriptive study on cesarean sections performed at Apice ON hospitals according to the Robson Classification, using secondary data from the 2017 Live Births Information System on the year prior to project implementation, hence a baseline study. Hospitals are described according to their geographic distribution and cesarean section rates, using absolute and relative frequencies.Results.The proportions of newborns by Robson groups were similar to those proposed by the World Health Organization, except for Group 5 (with previous cesarean section) and Group 10 (preterm), with regional differences. The teaching hospitals’ average cesarean section rates ranged from 24.8% to 75.1%, exceeding by far the recommended values, even in Robson groups considered low risk for cesarean section (Groups 1 to 4).Conclusions.Brazilian teaching hospitals displayed cesarean section rates higher than those recommended by the World Health Organization for all groups; a worrisome fact, as by teaching they induce attitudes in future professional practices. These results highlight the importance of a reliable information system. Monitoring and evaluation of cesarean sections using the Robson Classification can be an important tool to guide management and propose actions to reduce rates. Countries with high cesarean section rates might explore this hypothesis in their teaching hospitals in order to define policies for the reduction of their rates.

728 Preventability of strokes during pregnancy and postpartum

To assess preventability of strokes in pregnancy and postpartum. This retrospective case series at a tertiary obstetric teaching hospital identified patients with ICD-9/10 codes for stroke between 2009—2020. Patients were excluded if they were not pregnant, or not within 12 weeks postpartum. Included cases had baseline characteristics, clinical course, and outcomes described in detail. A Maternal-Fetal Medicine specialist, a Neurologist, and an Obstetric Medicine specialist then assessed each case for preventability (define as not likely preventable, possibly preventable, probably preventable, likely preventable), factors contributing to preventability (patient, provider, system, other), and degree of resulting disability (resolved, mild, moderate, severe, fatal). 2,663 patients were initially identified, of which 15 patients experienced a stroke during pregnancy or in the first 12 weeks postpartum. The average age at diagnosis was 29. 47% of strokes occurred during antepartum, 13% peri-delivery, and 40% during postpartum (range PPD0 – PPD12). 53% of cases were complicated by acute hypertension and 60% of patients presented with a headache, often severe and unrelenting. After multidisciplinary panel review, 13% of cases were thought to be possibly preventable. Contributing factors identified were delays in presentation to care and miscommunication regarding blood pressure management to a non-obstetric consulting service during its care of a critically ill patient. In our cohort, preventability of strokes in pregnancy and postpartum was deemed “not likely” in a majority of cases. Results may not be generalizable to non-tertiary obstetric hospitals and those without an established protocol for treating acute hypertension in pregnancy. Efforts to prevent maternal stroke should focus on patient education by highlighting stroke symptoms in pregnancy (such as severe headache), improving risk assessment strategies, and educating community providers regarding differences in hypertension management and stroke presentation in pregnancy as compared to the general population.

Creation of Entrustable Professional Activities (EPAs) in obstetrics and gynecology for medical undergraduate students

Abstract: Introduction: This article features “Entrustable Professional Activities (EPAs)” in the Obstetrics and Gynecology field designed for medical undergraduates, aiming to support the teaching/learning process. Objective: The aim is for the graduate to be competent to meet the minimum requirements necessary for the student in this field. Method: In this study, EPAs were created based on an international template already in use and validated using the Delphi technique. The structuring of the EPAs was based on the international literature: “Core Entrustable Professional Activities for Entering Residency: Curriculum Developer’s Guide” from the Association of American Medical Colleges (AAMC). The content for the topics of each EPA was based on the publication “The Obstetrics and Gynecology Milestone Project” from the joint action of the Accreditation Council for Graduate Medical Education (ACGME), the American College of Obstetrics and Gynecology (ACOG) and the American Board of Obstetrics and Gynecology (ABOG). Results: Thirteen EPAs were created with topics for teaching in that field during undergraduate school. A checklist was created for each EPA, aiming to guide the evaluator and the student regarding the performance of the tasks defined in the EPAs. Conclusion: The EPAs with checklists bring an innovative proposal for Obstetrics and Gynecology teaching in medical graduation since they facilitate and operationalize the learning, the development, and the observation of the acquisition of knowledge, skills and attitudes required for the performance of each topic in the area, thus helping the training of a competent professional. At the end of the medical course, the ability to perform all EPAs identifies a competent graduate in Gynecology and Obstetrics regarding the general practitioner.

Creation of Entrustable Professional Activities (EPAs) in obstetrics and gynecology for medical undergraduate students

Abstract: Introduction: This article features “Entrustable Professional Activities (EPAs)” in the Obstetrics and Gynecology field designed for medical undergraduates, aiming to support the teaching/learning process. Objective: The aim is for the graduate to be competent to meet the minimum requirements necessary for the student in this field. Method: In this study, EPAs were created based on an international template already in use and validated using the Delphi technique. The structuring of the EPAs was based on the international literature: “Core Entrustable Professional Activities for Entering Residency: Curriculum Developer’s Guide” from the Association of American Medical Colleges (AAMC). The content for the topics of each EPA was based on the publication “The Obstetrics and Gynecology Milestone Project” from the joint action of the Accreditation Council for Graduate Medical Education (ACGME), the American College of Obstetrics and Gynecology (ACOG) and the American Board of Obstetrics and Gynecology (ABOG). Results: Thirteen EPAs were created with topics for teaching in that field during undergraduate school. A checklist was created for each EPA, aiming to guide the evaluator and the student regarding the performance of the tasks defined in the EPAs. Conclusion: The EPAs with checklists bring an innovative proposal for Obstetrics and Gynecology teaching in medical graduation since they facilitate and operationalize the learning, the development, and the observation of the acquisition of knowledge, skills and attitudes required for the performance of each topic in the area, thus helping the training of a competent professional. At the end of the medical course, the ability to perform all EPAs identifies a competent graduate in Gynecology and Obstetrics regarding the general practitioner.

Cardiovascular severe maternal morbidity in pregnant and postpartum women: development and internal validation of risk prediction models

To develop and internally validate risk prediction models identifying women at risk for cardiovascular severe maternal morbidity (CSMM). A retrospective cohort study. An obstetric teaching hospital between 2007 and 2017. A total of 89681 delivery hospitalisations. We created and evaluated two models, one predicting CSMM at delivery (delivery model) and the other predicting CSMM postpartum following discharge from delivery hospitalisation (postpartum CSMM). We assessed model discrimination and calibration and used bootstrapping for internal validation. Cardiovascular severe maternal morbidity comprised the following confirmed conditions: pulmonary oedema/acute heart failure, myocardial infarction, aneurysm, cardiac arrest/ventricular fibrillation, heart failure/arrest during surgery or procedure, cerebrovascular disorders, cardiogenic shock, conversion of cardiac rhythm and difficult-to-control severe hypertension. The delivery model contained 11 variables and 3 interaction terms. The strongest predictors were gestational hypertension, chronic hypertension, multiple gestation, cardiac lesions or valvular heart disease, maternal age ≥40years and history of poor pregnancy outcome. The postpartum model comprised eight variables. The strongest predictors were severe pre-eclampsia, non-Hispanic Black race/ethnicity, chronic hypertension, gestational hypertension, non-severe pre-eclampsia and maternal age ≥40years at delivery. The delivery and postpartum models had an area under the receiver operating characteristic curve of 0.87 (95% CI 0.85-0.89) and 0.85 (95% CI 0.80-0.90), respectively. Both models were adequately calibrated and performed well on internal validation. These tools may help providers to identify women at highest risk of CSMM and enable future prevention measures. Risk assessment tools for cardiovascular severe maternal morbidity were developed and internally validated.

Association between Anti-Müllerian Hormone and other biomarkers with ovarian function in polycystic ovarian syndrome of Iraqi women

Objectives: The current study aimed to investigate the role of of Anti-Müllerian hormone and other hormonal biomarkers and insulin resistance in pathogenesis of polycystic ovarian syndrome of Iraqi women with various ages and BMI.&#x0D; Method: The sublects include 50 cases of polycystic ovarian syndrome obtained from gynecological and obstetric teaching hospital, Kerbala health directorate / Kerbala – Iraq and another 50 apparently healthy women as a control group. with age ranged between (18-37) years during the period from Dec. 2019 to June, 2020 which was divided into two groups depending upon their age; first group with age (18-27) years and the second with age (28-37) years, also they divided into three subgroups depending upon the body mass index, normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity (30-34.9 kg/m2) and measurement of various hormonal levels were performed including LH, FSH, insulin, insulin resistance, total testosterone and anti-müllerian hormone.&#x0D; Results: A significant elevated levels of each of Anti-Müllerian hormone (AMH), insulin, LH, total testosterone, prolactin, fasting blood glucose, FBG and insulin resistance while, a non-significant differences was found in FSH levels in women with PCOS as compared with control group.&#x0D; Conclusion: A significant high levels of the all hormonal parameters including anti-müllerian hormone, LH, prolactin and total testosterone was found in women with PCOS as compared with the control, except the FSH values.

Construction and Design of Multimedia Virtual Simulation Practical Teaching System of Ultrasound Image in Obstetrics

With the non-destructive, cheap, and real-time advantages, ultrasound diagnosis is one of the indispensable imaging diagnostic techniques in modern clinical medicine. The coherent nature of ultrasound imaging results in a low signal-to-noise ratio of ultrasound images, which adversely affects quantitative analysis and diagnosis. In practical applications, ultrasound diagnosis often has disadvantages such as the varying accuracy dependent on the doctor’s experience, the image feature extraction and analysis methods lagging behind the development of imaging technology, etc. Guided by the concept of “Mix of virtual and actual reality, multivariate cooperation”, the quality of experiment teaching in obstetrics and gynecology should be improved to achieve the experimental teaching goal of obstetrics and gynecology. In this paper, the necessity and characteristics of medical virtual simulation experiments are first analyzed. Subsequently, the construction of the medical virtual simulation experiment is expounded. Finally, how to carry out the experimental teaching of gynecology and obstetrics is summarized.

Effects of SBAR model in nursing clinical teaching of Obstetrics and Gynecology Department

Objective To explore the effects of situation, background, assessment and recommendation (SBAR) model on communication skills and clinical practice abilities in nursing clinical teaching of Obstetrics and Gynecology Department so as to provide a basis for perfecting clinical nursing practice. Methods By convenience sampling, this study selected 31 intern nursing students in Obstetrics and Gynecology Department of Xuanwu Hospital, Capital Medical University from June 2017 to December 2017 in control group and 30 intern nursing students from June to December 2018 in observation group. Control group carried out the one-to-one teaching based on nursing intern outline of Obstetrics and Gynecology Department, especially paid attention to theoretical and skill training for intern nursing students. On the basis of that, observation group implemented clinical teaching with the SBAR model. The effects of teaching models of two groups in clinical teaching were evaluated with the score of clinical communication competence scale, inpatient satisfaction with nursing students and clinical practice performance. Results The clinical communication competence, inpatient satisfaction with nursing students and examination scores of nursing students in observation group after-department were higher than those in control group with statistical differences (P<0.05) . Conclusions SBAR model teaching is conducive to cultivating nursing students' clinical communication competence, improving their abilities to analyzing and solving problems in clinical practice. Key words: Obstetrics and gynecology department, hospital; Students, nursing; Internship; SBAR model; Clinical teaching; Communication skills

Structure and practices in hospitals of the Apice ON Project: a baseline study.

ABSTRACTOBJECTIVE To describe some characteristics of the 97 teaching hospitals participating in the Projeto de Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia (Apice ON—Project for Improvement and Innovation in Care and Teaching in Obstetrics and Neonatology).METHODS The semester prior to the beginning of the program was adopted as the baseline to evaluate the subsequent structural and processes changes of this project. Secondary data from the first half of 2017 were extracted from the National Registry of Health Establishments (NRHE), the Hospital Information System and the Sistema de Informações sobre Nascidos Vivos (SINASC—Live Birth Information System).RESULTS Before the implementation of the project, only 66% of the hospitals had a Baby-friendly Hospital Initiative, only 3% offered special accommodations for high-risk pregnant women, mothers and their newborns, and 45.4% hospitals adopted the skin-to-skin contact; 97% hospitals had separate rooms for pre-labor and vaginal delivery (93%), not following the recommendations of the Ministry of Health; nine hospitals (9%) had no rooming-in; there were few obstetrics nurses (less than 1% of professionals enrolled in the NRHE), and in only six hospitals the proportion of births assisted by this professional was above 50% of vaginal deliveries, while in eight this percentage ranged between 15% and 50%; the average cesarean section rate was 42%, ranging between 37.6% (Southeast) and 49.1% (Northeast); ten hospitals did not charge for companions according to inpatient hospital authorization.CONCLUSION The study strengthens the relevance of the Apice ON project as an inducer of change of the care model in teaching hospitals and, therefore, as a strategy for the implementation of the national public policy represented by the Stork Network.

Identifying cardiovascular severe maternal morbidity in epidemiologic studies.

Cardiovascular severe maternal morbidity (CSMM) is rising and has become the leading cause of maternal mortality. Research using administrative data sets may allow for better understanding of this critical group of diseases. To validate a composite variable of CSMM for use in epidemiologic studies. We analysed delivery hospitalisations at an obstetric teaching hospital from 2007 to 2017. We utilised a subset of indicators developed by the Centers for Disease Control and Prevention based on ICD codes to form the composite variable for CSMM. Two expert clinicians manually reviewed all qualifying events using a standardised tool to determine whether these represented true CSMM events. Additionally, we estimated the number of CSMM cases among delivery hospitalisations without qualifying ICD codes by manually reviewing all hospitalisations with severe preeclampsia, a population at high risk of CSMM, and a random sample of 1000 hospitalisations without severe preeclampsia. We estimated validity of the composite variable. Among 91355 admissions for delivery, we captured 113 potential CSMM cases using qualifying ICD codes. Of these, 65 (57.5%) were true CSMM cases. Indicators for acute myocardial infarction, cardiac arrest, and cardioversion had the highest true-positive rates (100% for all). We found an additional 70 CSMM cases in the 2102 admissions with severe preeclampsia and a single CSMM case in the random sample. Assuming a rate of 1 CSMM case per 1000 deliveries in the remaining cohort, the composite variable had a positive predictive value of 57.5% (95% CI 47,9, 66.8), a negative predictive value of 99.8% (95% CI 99.8, 99.9), a sensitivity of 29.0% (95% CI 23.2, 35.4), and a specificity of 100% (95% CI 99.9, 100.0). A novel composite variable for CSMM had reasonable PPV but limited sensitivity. This composite variable may enable epidemiologic studies geared towards reducing maternal morbidity and mortality.