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Biomedical subjects

E Eason

Publications and source records attributed to E Eason.

15 recordsLinked to original sources
PubMed2004

Antisepsis for abdominal hysterectomy: a randomised controlled trial of povidone-iodine gel.

OBJECTIVE: To assess whether infectious morbidity after total abdominal hysterectomy is decreased by the addition of 20 cc povidone-iodine gel at the vaginal apex after the usual vaginal preparation with povidone-iodine solution. STUDY DESIGN: Randomised controlled trial. SETTING: Fifteen secondary and tertiary hospitals in Canada. SAMPLE: A total of 1570 women undergoing planned total abdominal hysterectomy. METHODS: Computer-generated randomisation using a centralised telephone service was stratified by study centre with variable block size. In the operating room, a swab for bacterial vaginosis was taken before vaginal antisepsis. Study group remained concealed until the standard surgical preparation in the operating room was complete. Then povidone-iodine gel 20 cc was placed at the vaginal apex in the intervention group only. Participants were followed for one month post-operative. MAIN OUTCOME MEASURES: The primary outcome was post-operative infectious morbidity during the 30 days after surgery, defined as: febrile morbidity with hospital stay greater than five days or antibiotic treatment, or infection requiring readmission to hospital or additional visit. Other outcomes included abdominal wound infection, pelvic abscess and other pelvic infections. RESULTS: Post-operative infectious morbidity within 30 days occurred in 128/780 (16%) women receiving povidone-iodine gel preparation and 142/790 (18%) women not receiving gel (RR 0.9, 95% CI 0.7 to 1.1). Pelvic abscess was diagnosed in 0 patients in the gel group and in seven patients in the control group (P < 0.01). No significant difference was found in pelvic cellulitis (eight in each group) or abdominal wound infection (51 in the gel group and 58 in the control group, P= 0.5). CONCLUSION: Povidone-iodine vaginal gel antisepsis led to a 9% relative decrease in overall infectious morbidity after abdominal hysterectomy, which was not statistically significant. Povidone-iodine vaginal gel decreased the risk of pelvic abscess after total abdominal hysterectomy.

Abscess↗
PubMed2002

Introducing printed postpartum orders for measles-mumps-rubella vaccination: a qualitative study.

OBJECTIVE: After introducing printed postpartum orders at our centre, we observed a large increase in measles-mumps-rubella (MMR) vaccination of susceptible women. The objective of this study was to ascertain factors responsible for the success of our approach and to identify potential obstacles so as to facilitate the implementation of similar policies at other hospitals. METHODS: For this qualitative study, taped semi-structured interviews were carried out with physicians, nurses, and a ward clerk regarding their views on postpartum MMR vaccination and on various aspects of implementing a printed postpartum order sheet that included MMR vaccination of susceptible women. Interviews were transcribed and the responses classified by theme. Thematic analysis was used to identify strengths and weaknesses of this approach. RESULTS: Following implementation of printed postpartum orders that included MMR vaccination of susceptible women, the proportion of eligible women vaccinated increased from 12.1 to 81.7% (risk ratio 6.8, 95% confidence interval [CI] 3.3, 13.7). While the physician and nursing staff broadly supported this initiative, we identified the need for changes in obstetrical care and documentation: most importantly, a comprehensive protocol with supporting information and guidelines should be provided for postpartum nurses; and a system must be in place to ensure that the completed antenatal record, including screening test results, be available in the expected hospital of delivery by the late second trimester. CONCLUSION: Previously undocumented claims that standing orders for postpartum MMR vaccination will increase the rate of vaccination of susceptible women have now been substantiated at one centre. Nevertheless, careful infrastructure and systems changes are required to ensure implementation of such orders.

Female↗
PubMed2001

Women's views on the practice of prenatal perineal massage.

OBJECTIVE: To determine how women who practised perineal massage during pregnancy assessed the technique. DESIGN: Observational study within one arm of a randomised controlled trial. SETTING: Five secondary and tertiary care hospitals in the Province of Quebec, Canada. PARTICIPANTS: Among 763 women randomised to the massage arm of a clinical trial of perineal massage during pregnancy, 684 (90%) who completed a questionnaire after delivery. MAIN OUTCOME MEASURES: A 20-item questionnaire completed a few days after birth. The first 18 questions elicited opinions using a 6-point Likert scale. Based on a factor analysis, 17 of these questions were classified into four categories: acceptability of perineal massage (8 items); preparation for birth (4 items); relationship with the partner (2 items); and effect of massage on delivery (3 items). Scores of each scale varied between 1 (highly negative assessment) to 6 (highly positive assessment). The last two questions asked whether women would perform the massage in their next pregnancy and whether they would recommend perineal massage to another pregnant woman. In addition, 262 also provided comments about their experience in the daily diary provided to record compliance during the trial. RESULTS: On average, perineal massage was felt to be quite acceptable [mean (standard deviation) 4.09 (0.93)]. Pain and technical problems reported during the first week or two of massage tended to disappear after a few weeks. Women's assessment of the effect of massage on preparation for birth [4.34 (1.08)] and on delivery [4.18 (1.37)] was positive. Women's views about the effect on their relationship with their partner were either positive or negative [3.54 (1.74)] and were proportional to the partner's participation with the massage. Most women said they would massage again if they were to have another pregnancy (79%; 95% CI, 76%-82%) and would recommend it to another pregnant woman (87%; 95% CI 84%-90%). CONCLUSION: Overall, women's assessment of prenatal perineal massage is positive.

Adult↗
PubMed2000

Nausea and vomiting during pregnancy: A prospective study of its frequency, intensity, and patterns of change.

OBJECTIVE: Our purpose was to provide a detailed description of patterns of nausea and vomiting of pregnancy. STUDY DESIGN: A prospective study was performed with 160 women who provided daily recordings of frequency, duration, and severity of nausea and vomiting. RESULTS: Seventy-four percent of women reported nausea lasting a mean of 34.6 days. "Morning sickness" occurred in only 1.8% of women, whereas 80% reported nausea lasting all day. Only 50% of women were relieved by 14 weeks' gestation; 90% had relief by week 22. Data based on the McGill Nausea Questionnaire indicate that the nausea experienced by pregnant women is similar in character and intensity to the nausea experienced by patients undergoing cancer chemotherapy. CONCLUSIONS: Traditional teachings about nausea and vomiting of pregnancy are contradicted by our findings. Standardized tools for measuring the distribution, duration, and intensity of nausea are applicable to the study of nausea and vomiting of pregnancy and could be used in clinical trials to assess palliative measures.

Adult↗
PubMed2000

Randomized trial of perineal massage during pregnancy: perineal symptoms three months after delivery.

OBJECTIVE: The aim of this study was to evaluate the effect of perineal massage performed during pregnancy on perineal symptoms 3 months after delivery. STUDY DESIGN: Pregnant women from 5 hospitals in the province of Quebec, Canada, participated in this single-blind, randomized, controlled trial. All participants received oral and written information on the prevention of perineal trauma. Women in the experimental group were taught the perineal massage technique and were asked to perform a 10-minute perineal massage daily from the 34th through 35th weeks of pregnancy until delivery. Participants completed a self-administered questionnaire on perineal pain, dyspareunia, sexual satisfaction, and incontinence of urine, flatus, and stool at the time of enrollment and 3 months after delivery. RESULTS: Among participants without a previous vaginal birth there were no differences between the massage (n = 283) and the control (n = 289) groups with respect to perineal pain, dyspareunia, sexual satisfaction, and incontinence of urine, gas, or stool 3 months post partum. Among women with a previous vaginal birth more women in the massage group (n = 187) than in the control group (n = 190) were free of perineal pain (93.6% vs 85.8%; P =.01) but the frequencies of dyspareunia and incontinence of urine, gas, or stool were similar in the 2 groups. CONCLUSIONS: Perineal massage during pregnancy neither impairs nor substantially protects perineal function at 3 months post partum.

Delivery, Obstetric↗
PubMed2000

Preventing perineal trauma during childbirth: a systematic review.

OBJECTIVE: To review systematically techniques proposed to prevent perineal trauma during childbirth and meta-analyze the evidence of their efficacy from randomized controlled trials. DATA SOURCES: MEDLINE (1966-1999), the Cochrane Library (1999 Issue 1), and the Cochrane Collaboration: Pregnancy and Childbirth Database (1995); and reference lists from articles identified. Search terms included childbirth or pregnancy or delivery, and perineum, episiotomy, perineal massage, obstetric forceps, vacuum extraction, labor stage-second. No language or study-type constraints were imposed. STUDY SELECTION: Randomized controlled trials (RCTs) of interventions affecting perineal trauma were reviewed. If no RCTs were available, nonrandomized research designs such as cohort studies were included. Studies were selected by examination of titles and abstracts of more than 1,500 articles, followed by analysis of the methods sections of studies that appeared to be RCTs. INTEGRATION AND RESULTS: Eligible studies used random or quasirandom allocation of an intervention of interest and reported perineal outcomes. Further exclusions were based on failure to report results by intention to treat, or incomplete or internally inconsistent reporting of perineal outcomes. Final selection of studies and data extraction was by consensus of the first two authors. Data from trials that evaluated similar interventions were combined using a random effects model to determine weighted estimate of risk difference and number needed to treat. Effects of sensitivity analysis and quality scoring were examined. Results indicated good evidence that avoiding episiotomy decreased perineal trauma (absolute risk difference -0.23, 95% confidence interval [CI] -0.35, -0.11). In nulliparas, perineal massage during the weeks before giving birth also protected against perineal trauma (risk difference -0.08, CI -0.12, -0.04). Vacuum extraction (risk difference -0.06, CI -0.10, -0.02) and spontaneous birth (-0.11, 95% CI -0.18, -0.04) caused less anal sphincter trauma than forceps delivery. The mother's position during the second stage has little influence on perineal trauma (supported upright versus recumbent: risk difference 0.02, 95% CI -0.05, 0.09). CONCLUSION: Factors shown to increase perineal integrity include avoiding episiotomy, spontaneous or vacuum-assisted rather than forceps birth, and in nulliparas, perineal massage during the weeks before childbirth. Second-stage position has little effect. Further information on techniques to protect the perineum during spontaneous delivery is sorely needed.

Delivery, Obstetric↗
PubMed2000

Much ado about a little cut: is episiotomy worthwhile?

Methods to prevent perineal trauma during childbirth include avoiding episiotomy and forceps delivery and slowing delivery of the head to allow the perineum time to stretch. Each intervention can lengthen the second stage of labor and change the biophysical stresses on infants and the pelvic floor. Available evidence supports the belief that the interventions are safe for infants and do not lead to significant short- or long-term maternal morbidity. We should abandon the conventional teaching that a longer second stage and perineal stretching are harmful. Routine episiotomy is no longer advisable. Forces that might inhibit physicians from practicing evidence-based techniques of obstetric delivery include time pressures, malpractice concerns, lack of experience with slow perineal stretching, and an interventionist practice pattern. Changes in practice can be effectively introduced through consumer pressures, opinion leaders, and in teaching institutions, by house staff.

Episiotomy↗
PubMed1999

Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of perineal massage during pregnancy for the prevention of perineal trauma at birth. STUDY DESIGN: Pregnant women with (n = 493) and without (n = 1034) a previous vaginal birth from 5 hospitals in the province of Québec, Canada, participated in this single-blind, randomized, controlled trial. All participants received oral and written information on the prevention of perineal trauma. Women in the experimental groups were requested to perform a 10-minute perineal massage daily from the 34th or 35th week of pregnancy until delivery. RESULTS: Among participants without a previous vaginal birth, 24.3% (100/411) from the perineal massage group and 15.1% (63/417) from the control group were delivered vaginally with an intact perineum, for a 9.2% absolute difference (95% confidence interval 3.8%-14.6%). The incidence of delivery with an intact perineum increased with compliance with regular practice of perineal massage (chi2 for trend 13.2, P = 0.0003). Among women with a previous vaginal birth, 34.9% (82/235) and 32.4% (78/241) in the massage and control groups, respectively, were delivered with an intact perineum, for an absolute difference of 2.5% (95% confidence interval -6.0% to 11.0%). There were no differences between the groups in the frequency of sutured vulvar and vaginal tears, women's sense of control, and satisfaction with the delivery experience. CONCLUSION: Perineal massage is an effective approach to increasing the chance of delivery with an intact perineum for women with a first vaginal delivery but not for women with a previous vaginal birth.

Adult↗
PubMed1997

Pelvic fluid collections by sonography and febrile morbidity after abdominal hysterectomy.

OBJECTIVE: To assess the range of normal findings at endovaginal sonography after abdominal hysterectomy and to assess the relationship these findings and febrile morbidity. METHODS: Fifty-eight women had endovaginal ultrasound at a median of 4 days after abdominal hysterectomy. The volume of fluid in the cul-de-sac and its sonographic characteristics were assessed. Ultrasound findings, which were not released to the patients' physicians, were correlated with febrile morbidity and clinical outcomes. RESULTS: The median pelvic fluid volume was 3.4 mL (interquartile range 0-16.8 mL). No pelvic fluid was detected in 22 of 58 women (37.9%). In the other 36 women, fluid volumes ranged between 0.2 and 76.3 mL. Febrile morbidity was present in 15 of 58 women (26%) overall: eight of 36 (25%) with and seven of 22 (32%) without pelvic fluid. There was no association between the presence of pelvic fluid collections and febrile morbidity (P = .54) or prolonged fever (P = 1.00). There was no difference in the median or mean fluid volumes between women with and without febrile morbidity. The study had a power of 90% with alpha = .05 to detect a difference of 20 mL. Even women with fixed, markedly echoic fluid collections larger than 35 mL did not have significantly more febrile morbidity than women with no pelvic fluid (P = .33). CONCLUSION: The volume of pelvic fluid 3-5 days after hysterectomy does not predict febrile morbidity or the need for drainage. Large or complex fluid collections may be present without adverse clinical consequences, and discovering such a collection in a patient with febrile morbidity after hysterectomy does not necessitate antibiotic therapy or surgical drainage of the fluid collection.

Adult↗
PubMedDate not supplied

Prenatal HIV screening in a tertiary care centre.

OBJECTIVE: Strategies are available to reduce maternal-fetal transmission of HIV and depend on adequate prenatal screening. At present, a significant proportion of Canadian pregnant women remain unscreened. We reviewed our screening practices before and after the implementation of a departmental policy on universal counselling for HIV screening and the distribution of a patient educational brochure developed at our centre (interventions). METHODS: Charts of all new antenatal patients seen during February-April in 1996 (n = 186) and 1998 (n = 212) were reviewed. Maternal demographics and evidence of HIV counselling and screening were collected and analyzed. RESULTS: Following our interventions, HIV counselling and screening rates increased from 13% to 72%. Patient acceptance of testing was high. The majority of missed opportunities for HIV testing were patients transferred urgently from other institutions. CONCLUSION: HIV counselling and screening can be improved by implementation of local strategies. We have demonstrated the feasibility of this approach in a tertiary care unit.

AIDS Serodiagnosis↗