Hemodynamic effects of slower versus faster intravenous fluid bolus rates in critically ill patients: An observational study.

Purpose: We compared the immediate and sustained effects of 500 mL of crystalloid administered at slow (333 mL/h) versus fast rates (999 mL/h) on mean arterial pressure (MAP) in critically ill patients.

Materials And Methods: Hemodynamic variables were collected immediately before and every 30 min up to 60 min after the end of the infusion. The primary outcome was the adjusted difference in MAP.

High-value care for critically ill oncohematological patients: what do we know thus far?

The number of patients with cancer requiring intensive care unit admission is increasing around the world. The improvement in the pathophysiological understanding of this group of patients, as well as the increasingly better and more targeted treatment options for their underlying disease, has led to a significant increase in their survival over the past three decades. Within the organizational concepts, it is necessary to know what adds value in the care of critical oncohematological patients.

The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon.

Background: The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Secondary bacterial infections are associated with unfavorable outcomes in respiratory viral infections. This study aimed at determining the prevalence of secondary bacterial infections in COVID-19 patients admitted at a tertiary medical center in Lebanon.

Determinants of death in critically ill COVID-19 patients during the first wave of COVID-19: a multicenter study in Brazil.

Objective: To evaluate clinical outcomes and factors associated with mortality, focusing on secondary infections, in critically ill patients with COVID-19 in three Brazilian hospitals during the first pandemic wave.

Methods: This was a retrospective observational study involving adult patients with COVID-19 admitted to one of the participating ICUs between March and August of 2020. We analyzed clinical features, comorbidities, source of SARS-CoV-2 infection, laboratory data, microbiology data, complications, and causes of death.

Removal of pregnancy categories and likelihood of prescribing: a randomized trial.

Objectives: To assess the degree to which removal of FDA' Pregnancy Categories (PC) of medications (A, B, C, and D) from labeling, affects the likelihood that providers will prescribe those medications.

Methods: Over a one-year period a convenience sample of providers was recruited into a randomized, survey-based, study. Two versions of the survey were randomly distributed; version 1 presented clinical vignettes, drug information, and PC, while version 2, presented the identical information without the PC.

Society for Maternal-Fetal Medicine Special Statement: Cognitive bias and medical error in obstetrics-challenges and opportunities.

The processes of diagnosis and management involve clinical decision-making. However, decision-making is often affected by cognitive biases that can lead to medical errors. This statement presents a framework of clinical thinking and decision-making and shows how these processes can be bias-prone.

Cesarean Birth Morbidity among Women with SARS-CoV-2.

Objective: The objective of this study was to compare maternal outcomes of women with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections who underwent cesarean births.

Study Design: This was a matched cohort study of pregnant women who had a cesarean birth between March 15, 2020, and May 20, 2020. Cases included women who tested positive for SARS-CoV-2.

Balanced Opioid-free Anesthesia with Dexmedetomidine versus Balanced Anesthesia with Remifentanil for Major or Intermediate Noncardiac Surgery.

Background: It is speculated that opioid-free anesthesia may provide adequate pain control while reducing postoperative opioid consumption. However, there is currently no evidence to support the speculation. The authors hypothesized that opioid-free balanced anesthetic with dexmedetomidine reduces postoperative opioid-related adverse events compared with balanced anesthetic with remifentanil.

Reducing Perinatal Health Disparities by Placing Equity at the Heart of Performance Improvement.

Multiple studies have demonstrated that low income and Black women in the United States are more likely to suffer from severe maternal morbidity and mortality during childbirth, even when accounting for the site of service. Structural racism, social determinants of health, and personally mediated racism are factors that may play a role. Assessing them is, therefore, critical in the attempt to deliver safe and equitable health care, which is a fundamental charge of performance-improvement committees.

Prenatally diagnosed vasa previa: association with adverse obstetrical and neonatal outcomes.

Background: Vasa previa represents a rare prenatal finding with potentially life-threatening risk to the fetus.

Objective: This study aimed to describe the natural history of prenatally diagnosed vasa previa and evaluate the association between antenatally diagnosed vasa previa and adverse obstetrical and neonatal outcomes.

Study Design: This was a multicenter descriptive and retrospective study of patients diagnosed prenatally with vasa previa on transvaginal ultrasound in the New York City Maternal-Fetal Medicine Research Consortium centers between 2012 and 2018.

Correlation of Obesity with External Cephalic Version Success among Women with One Previous Cesarean Delivery.

 Our aim was to assess the correlation of body mass index (BMI) with the success rate of external cephalic version (ECV) among women with one prior cesarean delivery.  A cross-sectional study of pregnant women with one previous cesarean delivery who underwent ECV. The relationship between BMI and success rate of ECV was assessed.

A Novel and Precise Profiling Tool to Predict Gestational Diabetes.

Background: There is a trend in healthcare for developing models for predictions of disease to enable early intervention and improve outcome.

Instrument: We present the use of artificial intelligence algorithms that were developed by Gynisus Ltd. using mathematical algorithms.

Confirmation Bias Affects Estimation of Blood Loss and Amniotic Fluid Volume: A Randomized Simulation-Based Trial.

Objective: This study was aimed to determine if confirmation bias affects diagnoses in obstetrics, specifically estimation of blood loss and amniotic fluid volume.

Study Design: We performed a randomized simulation-based trial. Participants went through the following three consecutive scenarios: (1) the first involved estimating the volume of blood (actually a blood-like substance) in a container at the simulation model's perineum.

The Relationship between Status at Presentation and Outcomes among Pregnant Women with COVID-19.

Objective: This study was aimed to compare maternal and pregnancy outcomes of symptomatic and asymptomatic pregnant women with novel coronavirus disease 2019 (COVID-19).

Study Design: This is a retrospective cohort study of pregnant women with COVID-19. Pregnant women were divided into two groups based on status at admission, symptomatic or asymptomatic.

Caring for Pregnant Patients with COVID-19: Practical Tips Getting from Policy to Practice.

Novel coronavirus disease 2019 (COVID-19) is a pandemic with most American cases in New York. As an institution residing in a high-prevalence zip code, with over 8,000 births annually, we have cared for over 80 COVID-19-infected pregnant women, and have encountered many challenges in applying new national standards for care. In this article, we review how to change outpatient and inpatient practices, develop, and disseminate new hospital protocols, and we highlight the psychosocial challenges for pregnant patients and their providers.

Antibiotic Prophylaxis Trials in Obstetrics: A Call for Pediatric Collaboration.

Surgical site infections are common complications of cesarean delivery. Many recent studies, including meta-analyses, have assessed the efficacy of antibiotic prophylaxis. Those articles have demonstrated that preincision antibiotic prophylaxis reduces the incidence of surgical site infections postcesarean, and that the use of adjunctive azithromycin further reduces infection after nonelective cesarean deliveries.

A Novel Partogram for Stages 1 and 2 of Labor Based on Fetal Head Station Measured by Ultrasound: A Prospective Multicenter Cohort Study.

Objective: This study was aimed to describe continuous labor curves, including second stage, based on fetal head station.

Study Design: We performed a prospective multicenter cohort study. The inclusion criteria were women with singleton uncomplicated cephalic term pregnancies in labor, who delivered vaginally.

Improving Healthcare Responses to Obstetric Hemorrhage: Strategies to Mitigate Risk.

Obstetric hemorrhage, with its related complications, remains a significant and often preventable cause of maternal morbidity and mortality. The medical community has made strides in beginning to address the impact of obstetric hemorrhage as a cause of maternal morbidity and mortality with standardized bundles outlining key elements for hospitals to address in order to optimize hemorrhage prevention and management. Changes in definitions, an expansion of the spectrum of causes, variation in interventions and guidelines and lack of innovation are some of the issues that pose ongoing challenges for meaningful risk reduction.

Pregnancy outcomes among women with American College of Cardiology- American Heart Association defined hypertension.

Objective: To compare the rate of adverse pregnancy outcomes of women with hypertension defined by the ACC-AHA guidelines, women with hypertension defined by ACOG guidelines, and normotensive women.

Methods: A historical cohort study of women with singleton, nonanomalous pregnancies who presented before 20 weeks for their first prenatal visit between 1 January 2014 and 31 January 2016 with (a) hypertension defined by ACC-AHA (systolic blood pressure 130 mmHg and/or diastolic blood pressure of 80 mmHg documented), (b) hypertension defined by ACOG (systolic blood pressure of 140 mmHg and/or diastolic blood pressure of 90 mmHg documented) and (c) women documented to be normotensive. Primary outcomes were preeclampsia and small for gestational age.