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Episiotomy Rates Vary Widely Worldwide

Share this: Facebook Twitter Reddit LinkedIn WhatsApp Labour is a wondrous act of nature and unique to every childbearing women. It is a transformative and special event in a women’s life. It is the magic of creation. The very process of giving birth is the most beautiful one on earth and the mother attains unique capacities and true nobility through childbirth. The onset of motherhood present a unique set of physical, emotional and psychological challenges. Episiotomy is a common surgical procedure performed during second stage of labour. The first performance of episiotomy was done in 1742, when perineal incision was made to facilitate difficult deliveries (Grass, Dunn and stys 1986). It is made both to prevent tearing of the perineum and to release pressure on the fetal head with birth (Lawsan and Bienstock, 2007). It is the only procedure in obstetrics is performed without the patient’s specific consent. The advantage of an episiotomy is that it substitutes a clean cut for a ragged tear, minimize pressure on the fetal head, and may shorten the last portion of the second stage of labour (Incerpi,2007). Episiotomy rates vary widely worldwide, depending on whether the procedure is used restricvely / routinely. The worldwide episiotomy rate was 27%, 54% are nulliparous and 6% are multiparous women (WHO 2003).Rates vary from 8% in the Netherlands,13% in England to 25% in the USA. Among English speaking countries, the US had the highest episiotomy rate, varying greatly from region to region. One in three mothers who delivered vaginally in the U.S from 1995 to 2003 had episiotomies. In India the birth rate is very high 56% of women had an episiotomy compared to the 46% of white women. The difference between these percentage (10%) is measure of the excess frequency of episiotomy in Indian women. According to the American college of Obstetrics and Gyenaecology, approximately one in three women having a vaginal delivery also have an episiotomy. Approximately 70% of women with a vaginal birth experienced some degree of damage to the perineum due to tear (or) episiotomy and needed stitches. Like any other surgical incision, episiotomy results in some discomforts for most of postpartum patients (Hill,2000). Although relatively small in size, episiotomy sutures can cause considerable discomfort, because the perineum is an extremely tender area and the muscles of the perineum are involved in so many activities such as sitting, squatting ,bending ,urinating and defecating. Even without episiotomy women may experience bruising / tearing in the perineum. This is the most common source of infection in the days after giving birth. Various interventions are found to reduce episiotomy wound infection and enhance the healing process which include administration of antibiotics, cleanliness, topical application of ointments, infra red therapy, sitz bath, performance of kegal’s exercise and perineal care (Helen et.al 2009). In addition complementary therapy is another great aid to perineal healing. In recent years it has been seen that there has been a shift people from allopathy medicine to complementary medicine. The shift may be because people are becoming more conscious of their health and realize the need of holistic health. Quality of life is felt more important. In 2007 National health interview survey of complementary medicine use by Americans, showed that approximately 38% adults use complementary medicine. A survey by NPS medicine wise in 2008 revealed that 65% of Australians had used one (or) more complementary medicine in the previous 12 months. The term complementary medicine is primarily used to describe practices employed in conjunction with (or) to complement conventional medical treatment. Complementary medicine is sometimes called mind – body medicine because it is an approach to healing that uses the power of thought and emotions positively influence physical health ( USA Drug, 2005). Complementary therapies can help to boost the immune system, help eliminate toxins, help relieve pain, improve sleep pattern, increase energy levels, induce sleep relaxation, reduce stress and tension, restore balance to body systems. Lavender oil is one of the complementary medicine. It has a light fresh aroma, is clear in color and watery in viscosity. Lavender has been use continuously for thousands of years, either in the form with lavender water of essential oil / dried flowers. In the 1800’s the yardly company in England, realizing the healing properties of lavender , began adding it to their soaps and perfumes. Lavender oil promotes rapid healing and helps to prevent scarring. These remarkable healing properties of lavender were accidently discovered by French chemist Dr. Rene Maurice Gattefosse when he burnt his hand in a laboratory experiment. He instantly plunged it into a nearby bowl of lavender oil and discovered that it stopped throbbing pain and allowed the burn to heal quickly. The therapeutic properties of lavender oil are antiseptic, analgesic,anticonvulsant,antidepressant,antirheumatic,antispasmodic,antiinflammatory,antiviral,bactericidal,sedative,carminative,soothing,hypotensive,decongestant and diuretic. The main effects of lavender are calming, soothing, balancing and normalizing. Lavender can be used to a state of mental and physical imbalances to a state balance in which healing can take place. On the skin, lavender oil tones, revitalizes and it is useful for all types of skin problems such as abscesses, acne, oily skin, boils, burns, sunburns, wound, psoriasis, insect bites, injuries and also acts as an insect repellant. Lavender oil can be used in a sitz bath and it would also have the added benefit of decreasing anxiety in the new mother which povidine iodine does not. Research carried out at Huntington’s Hinchinbrooke Hospital has found that the use of lavender oil in the sitz bath led to greater comfort and improved healing of the perineum between the third and fifth days after delivery. Adding lavender oil to a sitz bath aids in the healing of torn vaginal tissue. It also prevents the formation of excessive scar tissue, according to Margaret Fawcett of Aroma therapist and author of “Aromatherapy for pregnancy and childbirth”. It is one of the safest essential oil and can be used in full strength on the skin – also referred to as “neat”. The use of lavender oil can be effective in reducing perineal discomfort and promote wound healing following episiotomy. It is being used due to its antiseptic and healing properties. Lavender oil is found as a good choice in treating episiotomy wound healing because of its cell regenerating properties. Need for the Study The postnatal period refers to 6 weeks period after childbirth. The period is popularly termed the fourth trimester of pregnancy. It comprises an amazing variety of complex physiologic and psychological adaptations. Protecting a womená¾½s health as these changes occur is important for preserving the future childbearing function and for ensuring that she is physically well enough to incorporate her new child into her family. The physical care a women receives during the postnatal period can influence her health for the rest of her life. The nurses role is vital as she assists the mothers through these adjustments and supports them as they make a fresh start as a new family. Postnatal women are more prone for puerperal infection as a result of episiotomy which can be prevented by proper postnatal care. Approximately 33% of women with vaginal delivery had episiotomy in 2000 (American College of Obstetricians – Gynaecologist, 2008). However the prevalence of episiotomy is not the same in different countries, Asian race are presumed to have smaller and tighter perineum so, the routine episiotomy may reduce the risk of Perineal tearing during delivery (lam et.al 2008). Studies about the episiotomy rates around the world showed that this surgery ranged from 9.7% (western Europe-Sweden) to 96.2% (South Africa-Ecuador) with lowest episiotomy rates in English speaking countries (North America Canada
Mobile Web Application with Documentation – Assignment 2.

In order not to waste yours and my time and to avoid negative feedback and withdrawal of question, Kindly read the below very carefully.The tutor must have Mobile Web Apps and Website development skills. Many people are able to develop apps and websites but they are extremely poor in writing proper academic documentation for the same. You must be expert in Mobile Web app development and be able to write excellent technical reports, with proper academic references.Please check the attached assignment brief.You must use proper academic referencing. Harvard referencing has to be usedNeedless to mention, it must be original work, free of plagiarism, no grammatical errors. Please check the marking guide.
Mobile Web Application with Documentation – Assignment 2

Share this: Facebook Twitter Reddit LinkedIn WhatsApp A novel beating-heart technique for supravalvular pulmonary artery stenosis INTRODUCTION: Pulmonary artery stenosis (PAS) may be congenital or acquired and presents itself as isolated or multiple lesions. Acquired PAS generally occurs following the surgical correction of congenital cardiac malformations such as anomalous origin of the left coronary artery arising from the pulmonary artery (ALCAPA) and tetralogy of Fallot (TOF). Treatment options for critical PAS include stent implantation, balloon angioplasty, and surgery. In this report, our objective is to present a new surgical technique without the need for cardiopulmonary bypass used for a patient undergoing surgery for ALCAPA who required re-operation on the first postoperative day due to supravalvular pulmonary stenosis. CASE REPORT: In a 8-year old boy, direct re-implantation of the left coronary artery into the aortic root was accomplished through median sternotomy under cardiopulmonary bypass. The general status of patient declined with accompanying signs and symptoms of right-sided heart failure within the first six postoperative hours. Also, liver enzyme levels were elevated and renal functions deteriorated. A biochemical profile revealed serum glutamic-oxaloacetic transaminase (SGOT) 832 mU/dl, serum glutamic-pyruvic transaminase (SGPT) 789 mU/dl, serum urea 65 mg/dl, and creatinine 2.1 mg/dl. Echocardiography showed severe right ventricular dysfunction and mild pulmonary insufficiency. As well as the supravalvular gradient was 80 mmHg, there was no transvalvular pressure gradient. Since supravalvular PAS was the suspected cause of the clinical instability of the patient, an urgent surgery was planned. SURGICAL TECHNIQUE A median sternotomy was used for the surgical procedure. Pump was not used to avoid the possible adverse consequences of cardiopulmonary bypass in this patient with a poor general status and impaired renal and liver functions. Firstly, an incision line on the stenotic supravalvular pulmonary artery segment was drawn. Then the dimensions of the graft to be placed were determined visually and the graft was prepared. The oval-shaped graft was sutured on the target stenotic pulmonary artery segment using 6/0 polypropylene sutures. During this procedure, special emphasis was placed on two issues: 1. Other than the proximal edge of the graft (the right ventricular side) all other edges were sutured using continuous sutures. However, no knots were tied and both ends of the suture were left free. 2. During the placing of the grafts, a space was created to form a convex structure in-between the anterior surface of the pulmonary artery. Then, a small linear incision on the pulmonary artery was made distally on the pulmonary artery using a scalpel inserted from the proximal opening of the graft. Simultaneous pressure on the incision site was exerted digitally to prevent bleeding. The incision was propagated longitudinally using a Metzenbaum scissor. Upon exposure of the pulmonary artery, the convex structure disappeared spontaneously by eliminating the distance between the graft and the anterior surface of the pulmonary artery. Soon after the incision was made in the distal direction on the pulmonary artery according to a pre-determined length, the sutures on the proximal surface of the graft were stretched as to fix the graft on the pulmonary artery. At the end of the procedure, while a moderate level of tension was maintained on the sutures manually, the proximal end of the graft was closed using continuous sutures. Thus, at the end of the procedure the desired pulmonary artery diameter was achieved. No hemodynamic instability was observed during the procedure. Intraoperative echocardiography showed no residual gradients on the pulmonary artery. The patient was extubated at postoperative 12th hour. A quick clinical improvement of right-sided heart failure was observed during the follow-up along with restoration of normal liver enzyme levels within 48 hours and normal renal functions within one week after surgery. The patient was discharged at postoperative 8th day. Follow-up examination at 1 year after surgery showed a good general status with weight gain. No gradient was detected at the pulmonary artery by echocardiography. DISCUSSION: PAS may be congenital or acquired. Acquired pulmonary artery stenosis is generally a complication of the surgical procedures performed for the repair of complex congenital cardiac malformations (1). For instance, in patients such as ours with ALCAPA, supravalvular PAS may develop following surgery (2). In certain circumstances, both congenital and acquired types of pulmonary artery stenosis may pose significant surgical challenges. Particularly, the presence of clinical instability may severely limit the therapeutic options in newborns. Treatment options for critical PAS include stent implantation, balloon angioplasty, and surgery. In recent years, despite significant advances in the technology of stent and balloon production, surgical repair remains an important therapeutic option. The success rates with balloon dilatation in these patients are limited (3). On the other hand, intravascular stents are associated with the formation of re-stenosis in the long term due to somatic growth (4). Thus, surgical repair stands out as an important alternative to both other approaches in pulmonary stenosis. We didn’t prefer catheterization because of early period after surgery and impaired kidney function. The current surgical methods for the reconstruction of the PAS may be associated with untoward consequences due to the need for cardiopulmonary bypass. Therefore, in order to avoid possible adverse effects of cardiopulmonary bypass, we developed a novel surgical technique to be used for the repair of supravalvular pulmonary artery stenosis without pump. The surgical technique utilized in this patient is simple and safe distinguishing itself from other techniques by negating the need for pump. Particularly, it seems suitable for selected, clinically unstable cases who may be adversely affected by cardiopulmonary bypass. In previously operated patients with supravalvular pulmonary artery stenosis, this technique may be safely applied without the increased risk of bleeding or thromboembolic events. However, larger patient populations are warranted to more firmly establish its safety. Nevertheless, we believe that this technique for the pulmonary artery reconstruction may provide significant increases in the diameter of the pulmonary artery in a beating heart with minimal morbidity and mortality. According to our knowledge, there have not been reported any off-pump technique for PAS in the English literature to date. In conclusion, this newly developed method of supravalvular PAS surgery is safe and long lasting. This surgical technique may be applied on patients not only who had an isolated supravalvular PAS but also who were previously operated, developed restenosis in early period and were under risk if pump was used without disrupting the hemodynamic stability. Share this: Facebook Twitter Reddit LinkedIn WhatsApp
Need a reading response done for theater.

From your reading, answer both sections using bullet point paragraphs REMEMBER, STATE THE QUESTION AND THEN PUT YOUR ANSWER FOR EACH BELOW IT. A. PLAY SCRIPT1. List and describe each of the three components of a play script?2. How does your course pack describe the difference between a book, a play or a film?B. WRITE A ONE PAGE SCENEUsing the three components or parts of a play script and format described in the module, create an opening scene of a musical or spoken play and if it is a musical, the lyrics of a song in that scene. You don’t have to write the song, just create the lyrics. You can set it to a popular song if it is easier for you to do. Use the following template and your imagination:
Need a reading response done for theater

Coalition Politics after the Civil Rights Movement Essay (Critical Writing)

Coalition Politics after the Civil Rights Movement Essay (Critical Writing). Many American cities encountered numerous challenges and obstacles after the Civil Rights Movement. Some of these challenges included “poverty, lack of proper houses, and inappropriate surroundings” (Gioielli 432). Many people in different urban regions died due to poor living conditions. Lead poisoning also became a major challenge after the Civil Rights Movement. This situation encouraged more people to form new political coalitions. The people wanted the government to address their pathetic living conditions. Many people in different American cities were unable to achieve their potentials. Such coalitions managed to deal with the problem of lead paint. These political coalitions also reshaped the country’s health policy. Many doctors and physicians “began to take care of every citizen affected by lead poison in St. Louis” (Gioielli 430). Such coalitions also forced the American government to address the challenges affecting different cities. The people focused on “specific challenges in order to make such coalitions successful” (Whitaker 209). The people also identified the major issues affecting different cities after the Civil Rights Movement. New policies and laws emerged in order to promote the rights of many American citizens. However, such coalitions encountered new challenges and limitations. For instance, a new disparity “emerged between the minorities and the majorities in these cities” (Whitaker 209). Several minority groups were unable to work together. Some Mexican Americans and Latinos “also identified themselves as superior against the African Americans” (Whitaker 208). This development created a new wave of animosity. Such political coalitions were therefore unable to achieve most of their goals. Although such “coalition politics managed to produce some goals during the time, the agreeable fact is that a new form of enmity emerged thus affecting different racial groups” (Whitaker 209). Works Cited Gioielli, Robert. “Get the Lead Out: Environmental Politics in 1970s St. Louis.” Journal of Urban History 36.4 (2010): 429-446. Print. Whitaker, Matthew. “Black and Chicano Leadership and the Struggle for Access and Opportunity.” Race Work: The Rise of Civil Rights in the Urban West. Ed. Matthew Whitaker. Lincoln: University of Nebraska Press, 2005. 199-221. Print. Coalition Politics after the Civil Rights Movement Essay (Critical Writing)

‘Enclosed Field Behind Saint-Paul Hospital’ by Vincent Van Gogh Paintings Essay

best essay writers ‘Enclosed Field Behind Saint-Paul Hospital’ by Vincent Van Gogh Paintings Essay. Shape and background The artwork employed in the ‘Enclosed Field Behind Saint-Paul Hospital’ comprises of vertically arranged objects. On the right side is the structure that represents the hospital, at the left side is a plantation, both of them are line drawings paint in black. The fore front is overlapped with an artwork which represents a large rectangle which seems to be a field with a greyish background. In the middle of the drawing, there is a tree-like structure that has grayish background which seems to make the entire structure remain outstandingly attractive. In the field composition, Vincent van Gogh used bright colors and an intense black line which outlines the field and the hospital. It is quite possible that this prevalent use of colors in the line is intended to push the object on the two-dimensional space, making it well illustrated (van Gogh). The lines have been made with a pastel medium, with its less than solid appearance. The overall use of color and shape is simplistic, yet appropriate to the nature of the surrounding. Clarity and precision Although the background of the artwork has more geometric shapes and the foreground has single shape indicating variety, Vincent has achieved a sense of unity with his use of illustrations. The use of bold vertical lines here appears to be more carefully planned, showing the precision of the artist and the background is carefully applied. On the foreground, the lines are vertical, but not straight and present a zigzag shape. The background lines are curved to clearly illustrate the shape of the clouds. At the far right background, Vincent used short lines vertically arranged on the top of each other in order to describe a valley-like background. Vincent also used horizontal straight lines to represent what seems to be a fence separating the field from the hospital ground. Thin short lines are used in this artwork to show the distance in between the fore and background (van Gogh). Precision The grey circles horizontally drawn at the background across the tops of the painting are also painted as if they are left unfinished; this shows Vincent’s accuracy in drawing, and truthfully creates the likeness of a nature. He tightly lined the foreground, and expansively lined the interior part of the drawing. Lines were clearly used to explain and illustrate the contour of the field as it was seen. He used black ink to draw tight lines which represented concentration of content in the artwork. Use of expansive lines in the drawing gives the work a feeling of action and enthusiasm, unlike the feeling of easiness in carefully drawn lines. His technique to place the lines varies in this artwork. At times, the lines are carefully placed on the top of each other creating a higher ground (van Gogh). Movement In other cases, Vincent van Gogh application of the lines seems more erratic and quick such as the grey background. The lines are not placed in a constant manner, they changes from one aspect to another. They are dynamic all through the artwork where changes in size, length, and even thickness. It’s not possible to predict the direction of the line with, and where it will face, as he (Vincent) chose the position of the line objectively in order to illustrate the meaning of his subject. He used implied lines to illustrate a building structure placed at the far right end of the artwork. The contours are used to articulate the overview of the field in the drawing and portray the intended message meant. The rhythm of the drawing has been illustrated by the use of texture and patterns in the work which associate the surrounding of the work. Work Cited Van Gogh, Vincent. Enclosed Field Behind Saint-Paul Hospital. 1889. Staatliche Graphische Sammlung Munich, Germany, Europe. ‘Enclosed Field Behind Saint-Paul Hospital’ by Vincent Van Gogh Paintings Essay

Thomas Edison State University Insomnia Research Paper

Thomas Edison State University Insomnia Research Paper.

QUESTION 1:Treatment RegimenThe students will write a 3- to 4-page paper (750 to 1100 words) explaining the treatment regimen for a patient with the specific sleep-wake disorder identified in the Thesis Statement (INSOMNIA). This will become a section of the final paper.QUESTION 2: Final PaperThe student will compile an integrated final paper that includes the previously submitted sections, edited for coherence and including any mentor feedback the student considers useful.The final paper will also include a 2- to 3-page section (500 to 825 words), not previously submitted, that explains the impact the sleep technologist has on patient/family education and on follow-up and long-term care for a patient with the specific sleep-wake disorder identified in the Thesis Statement.The final paper will also include a section, not previously submitted, that identifies significant findings from the research, and a concluding section. NOTES: QUESTION 2 IS REFERRING TO PREVIOUS SUBMISSIONS WHICH YOU DID THE WORK AS WELL.FINAL PROJECT [INSTRUCTIONS/REQUIREMENTS/GUIDELINES]Research Paper (Option 1)Overview and purpose:The student will investigate a specific sleep-wake disorder, of his or her choosing, and submit a Research Paper, in APA format, based on his or her investigation.In the paper, the student will explain the diagnostic and initial evaluation process for the sleep-wake disorder, implementation of treatment, impact of patient/family education, follow-up, and long-term care for a patient with a specific sleep-wake disorder, and provide a conclusion of findings.Requirements:Week 2—Submission 1: Thesis StatementDescribe a specific sleep disorder that you would like to further investigate, and include a personal statement as to why this is of particular interest to you. Include a current piece of research that supports your thesis, and provide an APA formatted appropriate citation. The selected disorder will be the basis for all submissions throughout this project. Week 4—Submission 2: Responsibilities and TasksThe student will write a 2- to 3-page paper (500 to 825 words) thoroughly discussing the responsibilities and tasks performed by the sleep technologist and the technical equipment used for initial diagnostic procedure for the specific sleep-wake disorder identified in the Thesis Statement. This will become a section of the final paper.Week 6—Submission 3: Evaluation and Diagnostic TestingThe student will write a 3- to 4-page paper (750 to 1100 words) describing the initial evaluation, diagnostic testing procedure implemented, and PSG data for a patient with the specific sleep-wake disorder identified in the Thesis Statement. This will become a section of the final paper.Week 8—Submission 4: Patient/Family InteractionThe student will write a 2- to 3-page paper (500 to 825 words) describing the initial interaction with the patient and family during the diagnostic testing and the review of the clinical information for the specific sleep-wake disorder identified in the Thesis Statement. The student will also discuss how the findings were reported to the physician and other healthcare providers. This will become a section of the final paper.
Thomas Edison State University Insomnia Research Paper

Grand Canyon University Volunteer in a Communication Position Research Paper

Grand Canyon University Volunteer in a Communication Position Research Paper.

Research a organization where you would like to volunteer with a communications position. Write a plan that explains where you would volunteer and in which department or area. Be specific as to exactly what you would do and how it fits within the communications major. Complete a proposal which requires a journal entry. In a 250-300-word entry, relate this aspect of your volunteer experience to some specific knowledge that you have previously gained in your coursework to this point. APA format is not required, but solid academic writing is expected. You may cite outside sources. Use at least 2 sources. Include in-text citations
Grand Canyon University Volunteer in a Communication Position Research Paper

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