Evaluation of effect of pospartum intrauterine contraceptive device

Background: This study was done to compare and evaluate safety, efficacy and complications of PPIUCD and interval IUCD insertion and to generate evidence on the safety and effectiveness of these two types of IUCD insertions.Methods: This prospective study was carried out at tertiary care center and Teaching Institute in the Department of obstetrics and gynecology. All enrolled patients in obstetrics and gynecology from 1/2/16 to 31/7/16 were included in this study. Women fulfilling inclusion criteria were included in the study after informed consent. Study protocol was approved by ethics committee.Results: A total of 44 women fulfilling WHO standard medical criteria for PPIUCD insertion and willing to comply with study protocol had PPIUCD insertion.  Cause of removal was mainly bleeding (2 cases, 50%) in interval IUCD group. 4 cases of spontaneous expulsion noted in vaginal delivery group prior to 6 weeks. The cumulative rate of complications were higher in PPIUCD group in our study (12 out of 44 i.e. 27.27% and 4 out of 20% in PPIUCD group and interval IUCD group respectively). Compliance of patient was highest in trans cesarean group 87.5%.Conclusions: Postpartum insertion of PPIUCD is safe effective, feasible and reversible method of contraception

Study of impact of COVID-19 infection on ectopic pregnancy in a tertiary care center

Background: COVID-19 is an infectious disease caused by a recently discovered coronavirus (SARS-CoV-2). Most of the people infected with the coronavirus experience mild to moderate respiratory illness and recover without requiring any special treatment. In current study we have studied impact of COVID-19 pandemic on clinical outcome and management of ectopic pregnancy.Methods: Women with confirmed or suspected ectopic pregnancy admitted in emergency for further management and tested via nasopharyngeal (NP) or oropharyngeal swab for SARS-CoV-2 using reverse transcriptase polymerase chain reaction (RT-PCR) from April 1, 2020 to November 30, 2020 were included in the study.Results: In our study out of 32 case of ectopic pregnancy, 3 patients were COVID-19 positive. Total non COVID-19 patients were 29. Out of 32 ectopic pregnancies only 4 were unruptured ectopic pregnancy and rest 28 had ruptured ectopic pregnancy. Mortality among ectopic pregnancy was noted only in 1 case (3.12%).Conclusions: Timely diagnosis and initiating management at first point of care can reduce the morbidity and mortality due to ectopic pregnancy. Patient’s knowledge attitude and awareness will be achieved through health education. Women with clinical signs and physical symptoms of a ruptured ectopic pregnancy, such as hemodynamic instability or an acute abdomen, should be evaluated and treated urgently. In pandemic situation where some part of hospital facilities devoted to COVID-19 patients, so planned distribution of resources to tackle medical emergency will bear fruitful positive outcome

WRT-1006 Technical Report: Developing the Digital Engineering Competency Framework (DECF), Version 1.0

17 USC 105 interim-entered record; under review.Digital engineering is ‘‘an integrated digital approach that uses authoritative sources of systems’ data and models as a continuum across disciplines to support lifecycle activities from concept through disposal. A DE ecosystem is an interconnected infrastructure, environment, and methodology that enables the exchange of digital artifacts from an authoritative source of truth.”1 Digital transformation is fundamentally changing the way acquisition and engineering are per-formed across a wide range of government agencies, industries, and academia and is characterized by the integration of digital technology into all areas of a business, changing fundamental operations and how results are delivered in terms of new value to customers. It includes cultural change centered on alignment across leadership, strategy, customers, operations, and workforce evolution.This material is based upon work supported, in whole or in part, by the U.S. Department of Defense through the Office of the Assistant Secretary of Defense for Research and Engineering (ASD(R&E)) under Contract HQ0034-13-D-004 (Task Order 0082).This material is based upon work supported, in whole or in part, by the U.S. Department of Defense through the Office of the Assistant Secretary of Defense for Research and Engineering (ASD(R&E)) under Contract HQ0034-13-D-004 (Task Order 0082). U.S. Government affiliation is unstated in article tex

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Qualitative Interviews to Assess the Content Validity and Usability of the Electronic Raynaud Diary in Patients with Systemic Sclerosis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/176020/1/acr211522_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/176020/2/acr211522-sup-0001-Disclosureform.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/176020/3/acr211522.pd