Archive for February, 2011
Water Birth
Water birth is the process of giving birth in a tub of warm water. Some women choose to labor in the water and get out for delivery. Other women decide to stay in the water for the delivery as well. The theory behind water birth is that the baby has been in the amniotic sac for 9 months and birthing into a similar environment is gentler for the baby and less stressful for the mother.
It is the belief of midwives, birthing centers and a growing number of obstetricians, that reducing the stress during labor and delivery also reduces fetal complications. Water birth should always occur under the supervision of a health care provider.
The Potential benefits of water birth?
Benefits for Mother:
- Water is soothing, comforting, relaxing.
- In the later stages of labor, the water seems to increase the woman’s energy.
- The buoyancy lessens her body weight, allows free movement and new positioning.
- Buoyancy promotes more efficient uterine contractions and better blood circulation, resulting in better oxygenation of the uterine muscles, less pain for the mother, and more oxygen for the baby.
- Immersion in water often helps lower high blood pressure caused by anxiety.
- Water seems to alleviate stress-related hormones, allowing the mother’s body to produce endorphins, which are pain-inhibitors.
- Water causes the perineum to become more elastic and relaxed, which reduces the incidence and severity of tearing and the need for an episiotomy and stitches.
- As the laboring women relaxes physically she is able to relax mentally, concentrating her efforts inward on the birth process.
- The water provides a sense of privacy, which releases inhibitions, anxiety, and fears.
Benefits for Baby:
HOSPITAL PULMONARY AND CRITICAL CARE MEDICINE
Neuromuscular blockade in patients with acute respiratory distress syndrome (ARDS) has both desirable effects (improves oxygenation) and undesirable effects (prolonged neuromuscular weakness). A trial randomly assigned 340 patients with ARDS to receive cisatracurium besylate or placebo by continuous infusion for 48 hours. The cisatracurium besylate group had lower 90-day mortality after adjustment for baseline risk and there was no difference in the frequency of prolonged neuromuscular weakness.
The potential for long-term psychological sequelae (eg, posttraumatic stress disorder [PTSD]) has slowed the incorporation of daily interruption of sedation into routine clinical practice for management of patients requiring mechanical ventilation. However, a randomized trial found that patients who underwent daily interruption of sedation had less cognitive impairment at three months and no increase in the frequency of PTSD at 3 or 12 months, compared to patients who did not undergo daily interruption of sedation.
HIV INFECTION
Screening — In a large prospective study conducted within an urban emergency department, non-targeted opt-out HIV screening was compared with physician-directed HIV testing (based on individual risk factors or symptoms). Opt-out testing was associated with only modest gains in HIV diagnoses compared with physician-directed testing.
Diagnostic testing — In an analysis of 2176 participants who had received one of 25 HIV vaccine products, 42 percent were seropositive by HIV enzyme immunoassay testing, although they did not have HIV infection. These data have implications for HIV diagnostic testing among those with a history of HIV vaccine trial participation.
When to start antiretroviral therapy: US guidelines — A revised version of the HIV treatment guidelines from the International AIDS Society-USA panel has several major changes: a) antiretroviral therapy (ART) is now recommended for patients with a CD4 count less than 500 cells b) ART is also recommended for HIV-infected patients with certain comorbidities, regardless of CD4 cell count c) raltegravir is now considered an option for use within combination antiretroviral regimens for treatment-naive patients. These recommendations are largely in agreement with the treatment guidelines from the Department of Health and Human Services (DHHS), which were released in December 2009.
ANTIBIOTICS AND ANTIMICROBIAL RESISTANCE
Tigecycline — In September 2010, the US Food and Drug Administration (FDA) issued a safety announcement regarding increased mortality risk associated with the use of tigecycline compared with other drugs. The increased risk was seen most clearly in patients treated for hospital-acquired pneumonia, but was also seen in patients with complicated skin and skin structure infections, complicated intraabdominal infections, and diabetic foot infections.
Cefepime — An FDA review of cefepime safety data was initiated in 2007 following findings of a meta-analysis that
raised concern regarding increased all-cause mortality associated with cefepime use. The FDA reviewed these study data, conducted additional analyses based on other data, and determined that the data do not indicate a higher rate of death in cefepime-treated patients. Cefepime remains an appropriate therapy for its approved indications.
Ceftaroline — Ceftaroline is a fifth generation cephalosporin that exhibits bactericidal activity against gram-positive organisms (including MRSA,vancomycin-intermediate S. aureus, and macrolide-resistant S. pyogenes) as well as gram-negative pathogens (including Enterobacteriaceae, but not Pseudomonas species or extended-spectrum beta-lactamase producers). In phase 3 trials including 1378 patients with complicated skin and skin structure infection who were randomly assigned to receive ceftaroline alone or vancomycin plus aztreonam, clinical cure rates and rates of adverse events were similar.
too small to be used alone in making the diagnosis of ADHD in a particular person. Also, there appears to be a link between a person’s ability to pay continued attention and the amount of their brain activity. In people with ADHD, the brain areas that control attention show to be less active. This suggests that lower levels of activity in some parts of the brain may be related to problems in sustaining attention.