HELLP syndrome, associated with eclampsia, preeclampsia, in one hundred cases, the complications, maternal morbidity and mortality: the near miss and missed obstetric scenarios

Background: The investigations done, complications observed, mode of delivery, management of complications, the perinatal outcome, the maternal mortality, the lessons learnt have been outlined. The referral to higher tertiary care Institutes has been analysed. The goals of management were, control of hypertension, prevention of convulsions, assessment of the severity of HELLP syndrome, identification of associated complications and chances of fetal salvage, a decision to be made regarding the mode of delivery, keeping the blood products ready, anaesthetist and paediatrician to be informed, consultation of nephrologist, cardiologist, neurophysician, ophthalmologist, gastroenterologist, surgeon as required in the particular case and continued vigilance in the postpartum period. Methods: This is a prospective observational study of one hundred cases of HELLP syndrome managed at two tertiary care Institutes. Twenty-five cases, managed at CARE Institute of Medical sciences, during the years 2011 to 2013 and 75 cases from the Institute of Obstetrics and Gynaecology at Modern Government Maternity Hospital, MGMH, Osmania Medical College, OMC, between 2021 to 2023, were included in the study. Results: Labour was induced, in 47.29%, vaginal delivery in 28 cases, 37.83% and lower segment caesarean section (LSCS) was needed in 46, 62.16% in the study. A total of 90.66% of HELLP have occurred in the third trimester of pregnancy. Eclampsia was associated with HELLP syndrome in 39/100=39%. The remaining 61 cases had preeclampsia associated HELLP syndrome. PRAKI in 31/100=31%, DIC in 19%, PRES in 7/100, PPCM 2%, PPH in 18=24%, maternal mortality in 17/100=17%. Conclusions: Delivery by 37 weeks would have clearly prevented 36% of cases. Delivery by 35 weeks would have prevented 61% of cases of HELLP syndrome

Democrats and Republicans Don't Just Disagree - They Hate Each Other

This event took place as a Zoom webinar. Video can be found at: https://www.youtube.com/watch?v=8j4M7mqaeSE&t=1290s Members of Congress and state legislators routinely disagree along party lines over the size of government and individual responsibility. But the sharp divide is not only over policy issues; it has snowballed into an emotional hostility toward members of the other party. Democrats and Republicans see each other as members of disliked - even reviled - outgroups. How did the "Hatfield versus McCoy" mindset set in? Will it persist as Americans struggle to survive the shared threat of the novel Coronavirus? What is the place for principled debate in today's toxic political environment?Center for the Study of Politics and Governanc

The mystery of Japanese growth

SIGLEGBUnited Kingdo

Filling the Gap: Simulation-based Crisis Resource Management Training for Emergency Medicine Residents

Introduction: In today’s team-oriented healthcare environment, high-quality patient care requires physicians to possess not only medical knowledge and technical skills but also crisis resource management (CRM) skills. In emergency medicine (EM), the high acuity and dynamic environment makes CRM skills of physicians particularly critical to healthcare team success. The Accreditation Council of Graduate Medicine Education Core Competencies that guide residency program curriculums include CRM skills; however, EM residency programs are not given specific instructions as to how to teach these skills to their trainees. This article describes a simulation-based CRM course designed specifically for novice EM residents.  Methods: The CRM course includes an introductory didactic presentation followed by a series of simulation scenarios and structured debriefs. The course is designed to use observational learning within simulation education to decrease the time and resources required for implementation. To assess the effectiveness in improving team CRM skills, two independent raters use a validated CRM global rating scale to measure the CRM skills displayed by teams of EM interns in a pretest and posttest during the course.  Results: The CRM course improved leadership, problem solving, communication, situational awareness, teamwork, resource utilization and overall CRM skills displayed by teams of EM interns. While the improvement from pretest to posttest did not reach statistical significance for this pilot study, the large effect sizes suggest that statistical significance may be achieved with a larger sample size. Conclusion: This course can feasibly be incorporated into existing EM residency curriculums to provide EM trainees with basic CRM skills required of successful emergency physicians. We believe integrating CRM training early into existing EM education encourages continued deliberate practice, discussion, and improvement of essential CRM skills.

Filling the Gap: Simulation-based Crisis Resource Management Training for Emergency Medicine Residents

Introduction: In today’s team-oriented healthcare environment, high-quality patient care requires physicians to possess not only medical knowledge and technical skills but also crisis resource management (CRM) skills. In emergency medicine (EM), the high acuity and dynamic environment makes CRM skills of physicians particularly critical to healthcare team success. The Accreditation Council of Graduate Medicine Education Core Competencies that guide residency program curriculums include CRM skills; however, EM residency programs are not given specific instructions as to how to teach these skills to their trainees. This article describes a simulation-based CRM course designed specifically for novice EM residents.  Methods: The CRM course includes an introductory didactic presentation followed by a series of simulation scenarios and structured debriefs. The course is designed to use observational learning within simulation education to decrease the time and resources required for implementation. To assess the effectiveness in improving team CRM skills, two independent raters use a validated CRM global rating scale to measure the CRM skills displayed by teams of EM interns in a pretest and posttest during the course.  Results: The CRM course improved leadership, problem solving, communication, situational awareness, teamwork, resource utilization and overall CRM skills displayed by teams of EM interns. While the improvement from pretest to posttest did not reach statistical significance for this pilot study, the large effect sizes suggest that statistical significance may be achieved with a larger sample size. Conclusion: This course can feasibly be incorporated into existing EM residency curriculums to provide EM trainees with basic CRM skills required of successful emergency physicians. We believe integrating CRM training early into existing EM education encourages continued deliberate practice, discussion, and improvement of essential CRM skills.