...Sangeeta Jain MD Coordinator: Brandie Davis Overview: The Galveston Obstetrics and Gynecology clerkship consists of 1 week Labor and Delivery Days, 1 week of Labor and Delivery Nights, I week of Antepartum, 1 week of Post-partum 1 week of Gynecology, and 1 week of Out-patient clinic. However, the structure of the course is often changed in response to student feedback, so please refer to your syllabus for details! The obstetrics portion focuses on labor and delivery, antepartum, and postpartum aspects of patient care. The weeks that you spend in gynecology vary widely and can range from community clinics to gynecologic surgery. This clerkship is highly dependent on how much effort you put into it, as evaluations from residents and faculty make up a significant portion of your grade. The clerkship is generally VERY organized, which you will learn to appreciate as you go through other clerkships. Didactics: There are lectures one day per week, which are mandatory. You will be excused from all clinical duties on your didactic day. Apart from the lectures, you will have quizzes over certain topics in Ob-Gyn (refer to syllabus for schedule). The course textbook (Beckman) is an excellent study guide for these quizzes, but make sure you have the latest edition! Other helpful study resources are the online APGO quizzes, Blue Prints, First Aid and Case Files. You are allowed to wear casual clothes on didactic days. Small Groups: The small group sessions are where you will...
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...and medical decision making for specific healthcare environments and patient situations. Guideline for the Use of Oxytocin December 2012 INTRODUCTION The benefits of labor induction and augmentation must be weighed against the potential maternal and fetal risks associated with this procedure (1). The induction or augmentation of labor may increase the likelihood of neonatal complications or result in unnecessary cesarean section. These risks may be necessary to assume in complicated pregnancies, in which prolongation of gestation presents further risk to the mother or fetus. Prior to initiating oxytocin, the patient should be counseled about the indications for the use of oxytocin, the methods of administration to be employed, and the risks of failure, cesarean delivery, or fetal compromise. A physician capable of performing cesarean section should be readily available during the induction or augmentation of labor (2). UNIT STRUCTURE Each hospital’s department of obstetrics should develop a standardized, single, universal written protocol for the use of oxytocin for labor induction or augmentation. Standardization of an oxytocin infusion protocol is recommended to reduce medication dosing error and improve patient assessment. Elements of a protocol should include (2): Indications for the use of oxytocin for labor induction and augmentation. Methods for preparation and administration of oxytocin. Qualifications of staff authorized to administer oxytocin and monitor patients...
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...CLINICAL PRACTICE GUIDELINES ON INTRAPARTUM AND IMMEDIATE POSTPARTUM CARE 2012 A collaboration of the Department of Health and the Philippine Obstetrical and Gynecological Society 1 The mention of specific product brands is not meant to suggest that they are endorsed or recommended by the Department of Health (DOH) and the Philippine Obstetrical and Gynecological Society (POGS) in preference to other products of a similar nature that are not mentioned. All reasonable precautions have been taken by DOH and POGS to ensure that the information contained in this publication is accurate. However, this guideline is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the guideline lies with the end user. In no event shall DOH and POGS be liable for damages arising from its use. 2 ii MESSAGE The primary aim of MDG 5 is to reduce by three quarters by between 1990 an 2015, the maternal mortality ratio,especially among less developed countries. The Philippines is among those with high maternal mortality rate (MMR). In 2006, our MMR was 162 deaths/100,000 live births, however, the Family Health Survey in 2011 showed that the MMR has increased to 221 deaths/100,000 live births. It is therefore important that we mobilize our efforts together to avert further deaths of our pregnant mothers. The Philippine Obstetrical and Gynecological Society (Foundation), Inc. (POGS) stood up to the challenge of World...
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...MBA 5101 Unit 1 Case Study Gary Campbell Our text defines a tort as “a civil wrong” and negligence as “a tort, a civil or personal wrong” (Pozgar, 2012). Negligence as it is related to healthcare is an unintentional commission or omission of an act that a reasonably prudent person or organization would or would not do under normal circumstances. Not following a recognized standard of care could be considered negligence. The case I have chosen to study is one from the Circuit Court of Baltimore City Maryland and is that of Enso Martinez a minor by and through his parent (Rebecca Fielding) vs The Johns Hopkins Hospital in Baltimore Maryland July 2013. I would describe this as a landmark, “David vs Goliath” case involving medical negligence in the form of nonfeasance and malpractice. Reckless and willfulness disregard for safety is called criminal negligence and is often considered a form of gross negligence, a more serious tort (Pozgar, 2012). The question in my mind throughout the read was; “did the conduct of the provider and the hospital constitute criminal negligence”? The jury’s verdict and plaintiff’s award seemed to suggest yes. As a health professional, while I might agree with the Jury’s decision, I’m not so sure I agree with the size of the award. Did Johns Hopkins Hospital (the Hospital), negligently fail to perform a timely Caesarean section, causing Martinez to suffer from cerebral palsy, retardation, and other disorders. The following are...
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...can lead to low birth weight. If it is untreated, it may result in liver, lungs, and kidneys failure. It appears during the second or third trimester of pregnancy, and is more prevalent in first pregnancies, multiple births, teenagers, and women over 35. Background Approximately 50,000 maternal deaths occur annually due to eclampsia, with the highest percentage being in third world countries. This study discusses the use of a Criteria-based audits (CBA) to improve quality of care among eclampsia patients admitted at a University teaching hospital in Dar es Salaam Tanzania. The incidence of eclampsia is high (about 6%) with the majority of cases arriving after episodes of convulsions. The quality of health care versus maternal mortality rates average and below average income countries is diverse, whenever, the need arises to achieve the Millennium development goal (MDG) in spite of having less than desirable finances and the infrastructure. Numerous policies have been found for shrinking maternal and perinatal mortality; for example, through high quality antenatal care, delivery performed by trained health professionals and facility of both basic and comprehensive emergency obstetrical care. These 3 Controlling Pre-eclampsia and Eclampsia in Pregnancy...
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...2008 Betty W. Steadman 135 IMPLEMENTING THE ACTIVITY BASE COSTING SYSTEM: A CASE STUDY ON DAKOTA OFFICE SUPPLY By Betty W. Steadman Overview Activity Based Costing (ABC) is an accounting method that allows an organization to determine actual costs associated with each product and/or service produced by the organization without regard to the organizational structure or other extraneous function. For Dakota Office Products (DOP), its existing costing system was inadequate because it is incapable of accounting for even all of the known costs such as the desktop delivery service as well as hidden costs such as the 10% DOP paid to maintain its working capital line of credit for accounts receivable (Kaplan, 2003, p.4). Since ABC is a powerful tool for measuring performance, identifying, describing, and assigning costs to, and reporting on an organization’s operations it could solve much of DOP’s critical cost oversights (Caplan, Melumad & Ziv, 2005). Used holistically ABC can be utilized to also improve processes and identify opportunities to improve business effectiveness and efficiency by determining the true or real costs of a given product or service. ABC principles are used to focus management’s attention on the total cost to produce a product or service, and as a basis for full cost recovery of a production or service process. Situational Analysis DOP is a regional office supply company with a strong reputation for customer service and quality supplies. Additionally...
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...Black women and pregnancy: Fibroids by Kimberly Seals-Allers, author of The Mocha Manual to a Fabulous Pregnancy Reviewed by the BabyCenter Medical Advisory Board Last updated: January 2010 What are fibroids? Fibroids are noncancerous tumors that grow from muscle tissue in the uterus. Fibroids, also called uterine leiomyomas or myomas, can grow on the outside of your uterine wall, within the uterine wall, or into the uterine cavity. Women can have fibroids in one or more of these locations. The growths can be as small as a pea or as large as a basketball. But they are almost always benign, no matter how large they get. If a fibroid or cluster of fibroids is particularly large or is growing on the outside of the uterine wall, it can push the uterus into an abnormal position. It can also put pressure on the bladder or intestine, causing symptoms such as frequent urination, constipation, pelvic pain, or backache. Fibroids may also cause heavy menstrual bleeding. Fibroids can interfere with fertility, and they occasionally cause complications during pregnancy. For example, if a large fibroid blocks the opening of a woman's uterus, she may have to deliver her baby by c-section. African American women are more likely than other women to get fibroids, but any woman of any race can get them. Why is it especially important for black women to know about fibroids? In the United States, African American women have the highest rates of fibroids. They're two to three times...
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...Eldora Case Study Evaluation and Recommendation By Emily-jean C. Aguocha Saint Mary’s University of Minnesota Schools of Graduate and Professional Programs PRM 600, Fundamentals of Project Management Gary Jurek, Instructor September 11, 2011 Eldora is the largest and most profitable manufacturer of mountain bicycles in the United States with the intention of going global by venturing into the Asian market. According to the case, Eldora sales seem to be going well, however, the growth of the US market had settled down to about 2% per year, while the Asian Market (for the same kind of bikes) doubled annually. Furthermore, Eldora’s competitors are moving their facilities to Asia, to take advantage of lower labor costs and distribution costs. The rest of the paper specifies Eldora’s strategic objectives, the functions of the company that might be relocated with expansion to Asia, Eldora’s core competencies, and the evaluation of Eldora’s alternatives list. For a business to venture into a new market especially in a different country, they would need to incorporate the four elements of operations objectives in their business strategy. Eldora’s strategic objectives are: quality, low-cost, delivery time, and flexibility. Quality: This should be the first priority objective for Eldora because their purpose is to satisfy their customer requirements and specifications. They would need to identify their target market in Asia, work with the selected customers to define the customers’...
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... and culture, unlike most parts of Africa. It is common for women to marry at a young age, and the ability to have many children is highly valued. It is estimated that the maternal mortality rate is 1,400 per 100,000 women, one of the highest in the world. Somalia’s lack of medical care during pregnancy and delivery contributes to their high infant and maternal mortality rates. The experience of pregnancy and the labor and delivery process in Somalia differs in many ways from that of women in the United States. It is important that health care providers in the United States are aware of these differences because 32% of the refugees in the U.S. are from Somalia, so it is likely that providers will care for a Somali female at some point in their careers. In Somalia, cesarean sections are rarely discussed and typically not performed (Ameresekere, et al., 2011). Somali women also feel that the entire labor process is rushed in the United States. In Somalia, it is common to have a baby between 9½ and 10 months, as a larger infant is preferred. They also believe that it is up to Allah to decide when the baby is to arrive. Techniques are used to facilitate progression of labor and pain management, such as position changes,...
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...tremendous changes. These changes directly affect the mother, father, siblings and extended family of the new parents. First, we can start with the changes in the newborn’s life. When the mother delivers the baby it underdoes a huge amount of stress. But until the delivery the newborn is in the mother’s uterus safe and sound. While in the mother’s womb the newborn will receive nourishment from the mother. As soon as the baby leaves the uterus there are changes that he/she goes through. The newborn will have to learn to breathe independently, adjusting to different temperatures and the difficult feeding process. Fortunately, most infants are resilient and possess many capabilities that help them adjust and embark on the growth journey. And good-quality prenatal care, a normal labor and delivery process, warm and positive interactions with parents, and good-quality medical care are critical ingredients for the newborn’s optimal adjustment. Secondly, we examine the mother, the most important figure in the early stages of the baby’s life. The mother’s adjustment to her new life can be the most difficult one. During the mother’s pregnancy the mother goes through drastic hormonal changes. Once the after the labor and delivery the body tries to go back to its state before pregnancy. This will cause hormone levels to fluctuate; in the end it will create mood swings and even depression for the mother. In addition, caring for a newborn that will need to be fed every few hours can be tiring...
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...cost savings associated with doula support during labor and delivery are significant...
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...more than 1.5 million children and women have passed through its doors. It is the fourth busiest labor and delivery hospital in the United States and the largest neonatal intensive care unit in the Southeast, and APH ranks fifth out of 5,000 hospitals nationwide in patient satisfaction. “Part of the reason for APH’s success,” says Executive Director Kathy Swanson, “ is the our continuous improvement process. Our goal is 100% patient satisfaction. But getting there means constantly examing and reexaming everything we do, from patient flow, to cleanliness, to layout spaces, to colors on the walls, to speed of medication delivery from pharmacy to patient. Continuous improvements is a huge and never ending task.”. One of the tools the process flow chart. Staffer Diane Bowles, who carries the “Clinical Practice Improvement Consultant” charts scores of processes. Bowles’s flowcharts help study ways to improve the turnaround of a vacated room (especially important in a hospital that has operated at 130% of capacity for years), speed up the admission process, and deliver warm meals warm. Lately, APH has been examining the flow of maternity patients (and their paperwork) from the moment they enter the hospital until they are discharged, hopefully with their healthy baby a day or two later. The flow of maternity patients follows these steps: 1. Enter APH’s Labor and Delivery check-in desk entrance. 2. If the baby is born en route or if birth is imminent, the mother and...
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...CHAPTER I INTRODUCTION A. Background of the study According to Jordan, childbearing is universally treated as a life crisis event. In most societies birth and the immediate post partum period are considered a time of vulnerability for mother and child. It is a time of ritual danger for the entire family. Most societies tend to have certain sets of practices and beliefs in childbirth. Practices and beliefs of each society have common goals namely, the maintenance of well-being and preservation of life of a new mother and her newborn. Confinement is the period after the birth and is perceived as a critical condition for a mother. At this period, women are considered to be in a weakened state due to the loss of blood during the delivery of the baby. Because a woman is weak, she is susceptible to all sorts of all illnesses and diseases. Therefore, there are a number of cultural practices which must be observed in order to gain strength and to avoid illness.[i] The puerperium is a time of great change which spans a period of transition from the pinnacle of experience of birth to the assumption of the joys and responsibilities of family life. Well-integrated post-natal care has an important role to play in assisting this transition and launching the family in their new life together. The puerperium is a period of 6 weeks which begins as soon as the placenta has been expelled. During this time a number of physiological and psychological changes take place: ...
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...can result from a floppy, uncontracted uterus. Factors that may prevent the muscles of the uterus from contracting include the following: * prolonged labor; * the use of oxytocin (Pitocin) during labor; * general anesthesia; * twin or multiple births; * increased amounts of amniotic fluid (polyhydramnios); * delivery of a large baby; * history of more than five pregnancies; * abnormal labor (dystocia); and * infection (chorioamnionitis). In addition, fragments of placenta remaining in the uterus after delivery or benign growths within the walls of the uterus (known as fibroids) can also prevent the uterus from contracting normally. Active Management Many practitioners actively manage the third stage of labor, gently pulling the umbilical cord and administering oxytocin to help the uterus contract and promote delivery of the placenta. The uterus can also be massaged to help it contract firmly. Many studies show this technique reduces postpartum hemorrhage and the need for blood transfusions. For this reason, use of oxytocin after delivery, sometimes right after the baby is delivered and sometimes after the placenta has been delivered, is now commonplace. Oxytocin is given intravenously or injected into a muscle. If heavy bleeding from atony occurs despite the use of oxytocin after delivery, then other drugs such as...
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...good design are the essence of this world class home furnishing retailer. Challenges IKEA faced many challenges in terms of culture and business practices as well as socio-economic and political conditions in China. The biggest challenges were pricing, copycat producers and cheap labor cost for assembled furniture. Alternatives To make the price more affordable for Chinese consumers IKEA has developed manufacturing units in China and collects raw materials locally. Due to country specific environment IKEA chose franchising in China. Because of cheap labor cost of Chinese assembled furniture IKEA offers reasonable fee-based assembling services. IKEA has built its stores near public transportation lines inside cities since only 20% of customers own cars in Shanghai. Recommendations IKEA needs to find more local suppliers to keep price lower. To understand local culture and purchasing habit, the company should carry out extensive market research. To attract more middleclass consumer huge adaptation is necessary. Extensive training for the employees and better supply chain management will solve customer service and out-of-stock problems for IKEA. Introduction and summary of the case study IKEA is a famous Swedish furniture company that plays the best player in the home...
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