Clinicas Obstetricas Y Ginecologicas De Norteamerica, 2007
de las principales causas de muerte en la poblacion obstetrica [1]. Ello muestra la importancia d... more de las principales causas de muerte en la poblacion obstetrica [1]. Ello muestra la importancia de un conocimiento completo de las indicaciones y complicaciones asociadas con la reposicion de hemoderivados en la practica obstetrica. Este articulo proporciona la informacion disponible en la actualidad respecto a la preparacion y administracion de los hemoderivados, expone las alternativas a la sangre de banco en la poblacion obstetrica e introduce las estrategias farmacologicas para el tratamiento de la hemorragia.
Introduction. Widespread use of antibiotics has led to drug-resistant bacteria and reports of dru... more Introduction. Widespread use of antibiotics has led to drug-resistant bacteria and reports of drug-resistant infections. A continuing medical education (CME) campaign was used to improve antibiotic use among primary care providers. Methods. The Office of CME and Professional Development at the University of Colorado School of Medicine produces a semiannual, week-long course for primary care providers. A 2-year multifaceted CME campaign consisted of course content on antibiotic use, a practice audit, and two surveys to measure perceptions of the problem of antibiotic overuse, potential barriers to achieving appropriate use, and strategies to overcome barriers. Results. The overall response rate in the 2nd part of the campaign was 68.4%. Sixty-six percent of respondents had implemented at least one strategy to reduce antibiotic overuse. The rate was significantly higher among those who had attended previous reviews (81.0%) compared with those who had attended neither (54%, p=0.0002). ...
The study objectives are to (1) assess prevalence of congenital heart disease (CHD), (2) describe... more The study objectives are to (1) assess prevalence of congenital heart disease (CHD), (2) describe outcomes of pregnancies in women with CHD, (3) compare outcomes in women with and without CHD, and (4) characterize neonatal outcomes in pregnancies complicated by CHD. This was a retrospective cohort study of women who delivered at the University of Colorado Hospital. Diagnosis of CHD was identified based on history of cardiac disease, pulmonary disease, or subacute bacterial endocarditis prophylaxis during labor and confirmed with echocardiogram when available. Comprehensive retrospective review of anesthetic, obstetric, and neonatal outcomes was performed. University of Colorado Hospital. 18,226 women. Medical record review. Valvular abnormalities, New York Heart Failure Association classification scores, types of CHD, maternal age, race, gravidity, parity, maternal prepregnancy body mass index, cigarette use, type of delivery, type of analgesia used, early initiation of neuraxial analgesia, arrhythmias, need for peripartum diuretics, prolonged maternal hospital stay, preterm birth, small for gestational age, neonatal CHD, neonatal or maternal intensive care unit (ICU) admissions, and maternal or neonatal death. We identified 117 pregnancies in 110 women with CHD. Parturients with CHD were more likely to have operative vaginal delivery (P < .0001), neonatal ICU admissions (P = .003), and had prolonged hospital stays. Occurrence of CHD in neonates was 6%. Moderate-to-severe valvular disease was associated with increased rates of operative vaginal delivery, early initiation of neuraxial labor analgesia, cardiac complications (including arrhythmia and use of diuretics), prolonged hospital stay, and maternal ICU admission. However, most deliveries and births were uncomplicated; and there were one case each of maternal mortality and fetal death after birth. Operative abdominal deliveries and neonatal ICU admissions are more common in women with CHD, but these pregnancies are generally well tolerated with low mortality rates.
Nitrous oxide (N2O) administration with nasal mask produces variable outcomes in dental patients.... more Nitrous oxide (N2O) administration with nasal mask produces variable outcomes in dental patients. This study describes a novel sampling method to measure actual inspired/expired N2O concentrations ([N2O]). Fifteen adult volunteers (32.5 +/- 8.5 years) underwent placement of a nasopharyngeal probe. With a nasal mask, 100% oxygen (O2) was administered for 2 minutes. N2O was introduced incrementally every 2 minutes for a final flowmeter [N2O] of 50% and subsequently decreased in the same manner. Anesthesia gas monitors analyzed inspired/expired [N2O], [O2], and PETCO2 from the nasopharynx and end-inspired/expired [N2O] in the mask. Data were measured every 20 seconds and analyzed. Inspired/expired nasopharyngeal and nasal mask [N2O] and [O2] were expressed as the median value at each time point for all subjects and plotted against flowmeter settings. Average inspired nasal mask [N2O] was 31% lower than flowmeter settings and decreased by another 19% on the way to the nasopharyngeal sam...
Clinicas Obstetricas Y Ginecologicas De Norteamerica, 2007
de las principales causas de muerte en la poblacion obstetrica [1]. Ello muestra la importancia d... more de las principales causas de muerte en la poblacion obstetrica [1]. Ello muestra la importancia de un conocimiento completo de las indicaciones y complicaciones asociadas con la reposicion de hemoderivados en la practica obstetrica. Este articulo proporciona la informacion disponible en la actualidad respecto a la preparacion y administracion de los hemoderivados, expone las alternativas a la sangre de banco en la poblacion obstetrica e introduce las estrategias farmacologicas para el tratamiento de la hemorragia.
Introduction. Widespread use of antibiotics has led to drug-resistant bacteria and reports of dru... more Introduction. Widespread use of antibiotics has led to drug-resistant bacteria and reports of drug-resistant infections. A continuing medical education (CME) campaign was used to improve antibiotic use among primary care providers. Methods. The Office of CME and Professional Development at the University of Colorado School of Medicine produces a semiannual, week-long course for primary care providers. A 2-year multifaceted CME campaign consisted of course content on antibiotic use, a practice audit, and two surveys to measure perceptions of the problem of antibiotic overuse, potential barriers to achieving appropriate use, and strategies to overcome barriers. Results. The overall response rate in the 2nd part of the campaign was 68.4%. Sixty-six percent of respondents had implemented at least one strategy to reduce antibiotic overuse. The rate was significantly higher among those who had attended previous reviews (81.0%) compared with those who had attended neither (54%, p=0.0002). ...
The study objectives are to (1) assess prevalence of congenital heart disease (CHD), (2) describe... more The study objectives are to (1) assess prevalence of congenital heart disease (CHD), (2) describe outcomes of pregnancies in women with CHD, (3) compare outcomes in women with and without CHD, and (4) characterize neonatal outcomes in pregnancies complicated by CHD. This was a retrospective cohort study of women who delivered at the University of Colorado Hospital. Diagnosis of CHD was identified based on history of cardiac disease, pulmonary disease, or subacute bacterial endocarditis prophylaxis during labor and confirmed with echocardiogram when available. Comprehensive retrospective review of anesthetic, obstetric, and neonatal outcomes was performed. University of Colorado Hospital. 18,226 women. Medical record review. Valvular abnormalities, New York Heart Failure Association classification scores, types of CHD, maternal age, race, gravidity, parity, maternal prepregnancy body mass index, cigarette use, type of delivery, type of analgesia used, early initiation of neuraxial analgesia, arrhythmias, need for peripartum diuretics, prolonged maternal hospital stay, preterm birth, small for gestational age, neonatal CHD, neonatal or maternal intensive care unit (ICU) admissions, and maternal or neonatal death. We identified 117 pregnancies in 110 women with CHD. Parturients with CHD were more likely to have operative vaginal delivery (P < .0001), neonatal ICU admissions (P = .003), and had prolonged hospital stays. Occurrence of CHD in neonates was 6%. Moderate-to-severe valvular disease was associated with increased rates of operative vaginal delivery, early initiation of neuraxial labor analgesia, cardiac complications (including arrhythmia and use of diuretics), prolonged hospital stay, and maternal ICU admission. However, most deliveries and births were uncomplicated; and there were one case each of maternal mortality and fetal death after birth. Operative abdominal deliveries and neonatal ICU admissions are more common in women with CHD, but these pregnancies are generally well tolerated with low mortality rates.
Nitrous oxide (N2O) administration with nasal mask produces variable outcomes in dental patients.... more Nitrous oxide (N2O) administration with nasal mask produces variable outcomes in dental patients. This study describes a novel sampling method to measure actual inspired/expired N2O concentrations ([N2O]). Fifteen adult volunteers (32.5 +/- 8.5 years) underwent placement of a nasopharyngeal probe. With a nasal mask, 100% oxygen (O2) was administered for 2 minutes. N2O was introduced incrementally every 2 minutes for a final flowmeter [N2O] of 50% and subsequently decreased in the same manner. Anesthesia gas monitors analyzed inspired/expired [N2O], [O2], and PETCO2 from the nasopharynx and end-inspired/expired [N2O] in the mask. Data were measured every 20 seconds and analyzed. Inspired/expired nasopharyngeal and nasal mask [N2O] and [O2] were expressed as the median value at each time point for all subjects and plotted against flowmeter settings. Average inspired nasal mask [N2O] was 31% lower than flowmeter settings and decreased by another 19% on the way to the nasopharyngeal sam...
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