A MATURITY MODEL FOR CARE PATHWAYS

Over the last recent decades, increasing the quality of healthcare services while reducing costs has been among the top concerns in the healthcare landscape. Several healthcare institutions have initiated improvement programs and invested considerably in process orientation and management. Care pathways are receiving increasing attention from clinicians, healthcare managers, and academics, as a way to standardize healthcare processes to improve the safety, quality, and efficiency of healthcare services. Despite considerable literature on the definition of care pathways, to date there is no agreement on their key process characteristics and the way they traverse from an immature to a mature state. Such a model would guide healthcare institutions to assess pathways’ level of maturity and generate a roadmap for improving towards higher levels. In this paper, we propose a maturity model for care pathways that is constructed taking a generic business process maturity model as a basis. The model was refined through a Delphi study with nine domain experts to address healthcare domain specific concerns. To evaluate its validity, we applied it in assessing the maturity of a particular care pathway taking place in 11 healthcare institutions. The results indicate the usefulness of the proposed model in assessing pathway’s maturity and its potential to provide guidance for its improvement

Can transvaginal ultrasonographic evaluation of the endocervical glandular area predict preterm labor among patients who received tocolytic therapy for threatened labor: a cross-sectional study

Objective: Increased neonatal morbidity and mortality rates resulting from preterm delivery(PTD) remain as a problem despite increasing evidence about the physiology of uterinecontractility process. More predictive signs of preterm labor detected on prenatal ultrasonographylike the presence of cervical gland area (CGA) on transvaginal ultrasonography can bea reassuring finding among patients with threatened labor risk.Methods: In this prospective study, 85 pregnant patients at 24–34 weeks of gestation whoattended to our high risk pregnancy clinic for threatened labor between March 2011 and March2012 have been examined by transvaginal ultrasonography to evaluate CGA located around theendocervical canal. Following discharge, the gestational week at birth, birth weight and birthroute of patients have been recorded.Results: Among patients with a cervical length (CL) 530mm and 30mm measuredby transvaginal ultrasonography on admission, 82.4% of the patients with a short cervixexhibiting echolucent endocervical glandular area and 42.3% of the patients with short cervixexhibiting echogen endocervical glandular area on sonography delivered at term (p¼0.013).Conclusion: The presence of CGA detected on transvaginal ultrasonography especially whencombined with the evaluation of CL during the management of patients with threatenedlabor can be a reassuring sign for actual probability of PTD

Moguća povezanost gestacijskog dijabetesa s upalom

The aim of this study was to investigate whether gestational diabetes mellitus (GDM) is associated with inflammation by comparing serum levels of human chitinase-3-like protein 1 (YKL-40), neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR). This case control study included 29 pregnant women with GDM and 29 pregnant women with normal glucose tolerance matched for age (±2 years) and pre-pregnancy body mass index (±2 kg/m2). The YKL-40/CHI3L1 levels were measured, and NLR and PLR investigated. There were no statistically significant differences in maternal age, gestational age, gravidity and parity. Higher YKL-40 levels were recorded in pregnant women with GDM compared to control subjects (203 (65-300) ng/mL vs. 159.2 (14-290) ng/mL, p=0.007). NLR and PLR were significantly higher in GDM compared with control group. In conclusion, GDM is associated with high levels of YKL-40, NLR and PLR, which indicate inflammatory status.Cilj ovoga istraživanja bio je procijeniti je li gestacijski dijabetes melitus (GDM) udružen s upalom i to usporedbom serumskih razina humanog hitinazi-3-sličnog proteina 1 (YKL-40) te omjera neutrofila/limfocita (NLR) i omjera trombocita/limfocita (PLR). U ovo istraživanje parova bilo je uključeno 29 trudnica s GDM i 29 trudnica s normalnom tolerancijom glukoze. Dob (± 2 godine) i indeks tjelesne mase prije trudnoće bili su podjednaki u obje skupine. Mjerene su razine humanog hitinazi-3-sličnog proteina 1 (YKL-40/CHI3L1) te ispitani omjeri NLR i PLR. Nije bilo statistički značajnih razlika u dobi, gestacijskoj dobi i gravidnosti. Zabilježene su više razine YKL-40 u trudnica s GDM u usporedbi s kontrolnim trudnicama (203 (65-300) ng/mL prema 159,2 (14-290) ng/mL, p=0,007). NLR i PLR bili su značajno viši u skupini s GDM nego u kontrolnoj skupini. U zaključku, GDM je udružen s visokim razinama YKL-40, NLR i PLR koji ukazuju na upalno stanje

Comparison of one hour versus 90 minute postprandial glucose measurement in women with gestational diabetes; which one is more effective?

In the present study, we aimed to compare postprandial 90 minute measurements and postprandial 1 hour (PP1-HR) measurements for prediction of foetal growth disturbances and pregnancy complications. This was a prospective study conducted in Acıbadem Mehmet Ali Aydınlar University Altunizade Hospital in Department of Perinatology. The study group consisted of patients diagnosed with gestational diabetes. In each antepartum visit, the patients fasting plasma glucose as well as PP1-HR and 90 minute measurements were made. Perinatal and neonatal data were obtained from each patient. The rate of large for gestational age infants was increased in patients when either PP1-HR measurement above 140 mg/dl or postprandial 90 minute measurement above 165 mg/dl compared to patients with normal PP1-HR or postprandial 90 minute measurement. Preterm delivery rate was increased in patients with postprandial 90 minute measurement above 165 mg/dl but not in patients with PP1-HR measurement above 140 mg/dl. The optimal cut-off for postprandial 90 minute measurement was 165 mg/dl based on receiver operating characteristics curve. Our preliminary data show that postprandial 90 minute measurements are superior to PP1-HR measurements in predicting large for gestational age infants.Impact Statement What is already known on this subject? Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset or first recognition in pregnancy. Maternal hyperglycaemia has been linked to metabolic alterations in the foetus and thus brings about foetal macrosomia as well as other pregnancy complications such as preterm delivery and preeclampsia. What the results of this study add? The findings of the present study suggest that postprandial 90 minute predicted more cases of LGA infants than postprandial 1-hour (PP1-HR) measurements. In addition, the rate of preterm deliveries was found to be increased in patients with mean postprandial 90 minute measurements above 165 mg/dl compared to patients with postprandial 90 minute measurements below 165 mg/dl. However, the rate of preterm deliveries was similar in patients with elevated PP1-HR measurements and patients with normal PP1-HR measurements. What the implications are of these findings for clinical practice and/or further research? Our study is the first to investigate the usefulness of postprandial 90 minute in a prospective design. Our preliminary data show that postprandial 90 minute measurements are superior to PP 1 measurements in predicting LGA babies. It also correlates better with preterm deliveries

Periviable Preterm Premature Rupture of Membranes: A Retrospective Study on Determinants of Neonatal Mortality

Purpose: The present study aimed to determine the risk factors for fetal and neonatal mortality in the context of Periviable Preterm Premature Rupture of Membranes (PPROM). Patients and Methods: This was a retrospective cohort study conducted at perinatology department of Zekai Tahir Burak Research and Training Hospital. The study population consisted of patients with PPROM before completing the 23rd gestational week were opted for expectant management. Maternal and Neonatal characteristics were recorded. Multivariate Logistic Regression with backward elimination is performed to investigate the effect of certain parameters on neonatal mortality. Results: In multivariate logistic regression model, gestational age <21 weeks at onset of PPROM (Odds Ratio (95% confidence interval): 8.58 (2.41–30.5), p<0.01) and nulliparity (Odds Ratio (95% confidence interval): 4.47 (1.25–15.9), p: 0.02) were independently associated with stillbirth or delivery before 23rd weeks. According to Cox regression model, the significant determinants of survival were: completed gestational weeks at delivery, sepsis in the first neonatal week and presence of pulmonary hypoplasia. Conclusion: The present data suggest that favorable outcomes can be anticipated in periviable PPROM that has occurred after 22th gestational weeks. Completed gestational weeks at delivery and nulliparity are other important determinants of mortality

Semilobar Holoprozensefalide Yeni Bir Bulgu Olarak Bilateral Koroid Pleksusta Yarıklanması Olan 25 Haftalık Bir Fetüsün Prenatal Tanısı: Bir Olgu Sunumu

Giriş: Holoprozensefali tüm konsepsiyonların 250’de birinde, canlı do- ğumların ise 10.000’de birinde görülen ciddi bir santral sinir sistemi malformasyonudur. Ağır formları yaşamla bağdaşmaz ve prenatal dönemde kolaylıkla tespit edilebilir ancak daha hafif formları prenatal dönemde tanınmayabilir. Gebelik açısından çok katastrofik sonuçlar doğuran bu patolojik durumun zamanında tespit edilmesinin büyük önemi vardır. Farklı fenotipleri olan bu malformasyonun tip spesifik ultrasonografik tanısal yeni belirteçlerinin belirlenmesi klinisyenlere doğru tanı koyma açısından yardımcı olacaktır. Olgu: Nörolojik malformasyonun boyutuna bağlı olarak termine edilen 25 haftalık bir fetüste semilobar holoprozensefali’nin yeni bir belirgin prenatal ultrasonografik bulgusu olarak bilateral koroid pleksusta yarıklanma sunulmuştur. Sonuç: Holoprozensefalide prenatal ultrasonografik bulgular hastalığın ciddiyetine göre farklılık gösterebildiğinden doğru prenatal tanı için hastalığın farklı tiplerine has ultrasonografik belirteçlerinin tespit edilmesi bu nadir durumun klinik yönetimi ve prognozu açısından önem taşımaktadır. Bu vaka sunumunda semilobar holoprozensefalinin yeni bir belirgin ultrasonografik bulgusu olan koroid pleksusta bilateral yarıklanma ilk kez bildirilmektedir

Treatment of Non - Complicated Lower Urinary Tract Infection in Pregnancy: Single Dose Fosfomycin Tromethamine Versus Multiple Dose Nitrofurantoin

OBJECTIVE: To evaluate the efficacy of single-dose fosfomycin tromethamine (FT) treatment in pregnant women with uncomplicated lower urinary tract infection (UTI). STUDY DESIGN: In this study, 421 pregnant women with established, symptomatic, uncomplicated lower UTI were randomly allocated to receive either a single dose of FT (Monurol®, Zambon Group S.p.A, Milan-ITALY) (n=217) or a 7-day course of nitrofurantoin (n=204). The treatment was found to be effective if urine culture was negative 15 days after therapy. RESULTS: Microbiological cure was achieved in 205 (94.5%) patients treated with FT and 164 (80.4%) patients treated with nitrofurantoin (p<0.05). Pathogen microorganisms were predominantly E.coli (199 in FT and 183 in NF group) followed by Klebsiella (18 in FT and 21 in NF group). CONCLUSION: The treatment of acut lower UTI in pregnant women is essential. FT is an effective, safe, single dose treatment choice in the management of uncomplicated lower UTI in pregnant women

A Rare Complication of Abdominal Drain: Fallopian Tube Herniation Through the Drain Site

Prophylactic drainage of the peritoneal cavity after obstetrical and gynecological surgery is widely practiced. The idea of “when in doubt, drain” is accepted and applied clinically by many surgeons. However, surgically placed drains are not without risk. The present case describes herniation of fallopian tube during the removal of a surgical drain placed after a cesarean section