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Biomedical subjects

D Lewin

Publications and source records attributed to D Lewin.

At least 19 recordsLinked to original sources
PubMed1991

[The treatment of obstetrical uterine inversion. Apropos of 3 cases].

Uterine inversion is exceptional and spectacular, although treatment is simple if diagnosed early. Three cases are reported with a review of possible obstetrical procedures for reduction. Manual repositioning by central pressure is emphasised. General anesthesia is generally needed because of associated state of shock. The three principal steps of manual reduction are: intra-abdominal repositioning of the uterus, removal of placenta, intramural injection of ocytocine to avoid immediate relapse. Ideally, obstetrical procedure should be carried out within one-half hour after inversion.

Adult↗
PubMed1990

[Antenatal diagnosis and management of congenital chylothorax].

A case of congenital chylothorax diagnosed with prenatal ultrasonography is described. Thoracocentesis was performed at 33 weeks of gestational age but recurrence of chylothorax, increasing hydramnios and subcutaneous oedema made cesarean section necessary at 37 weeks. Mechanisms of chylothorax during the fetal life and its management before and after delivery are discussed.

Adult↗
PubMed1989

Clinical experience in student nurse training.

This paper presents some results on the range of clinical responsibilities undertaken by three cohorts of student nurses in basic training. It concentrates on the quantity and variety of a student's clinical experience. Seventy-seven important items in nurse training, classified into three groups (general nursing, responsibility situations and interpersonal situations) are discussed.

Curriculum↗
PubMed1989

[When should peridural analgesia be started in induced labor? Result of a randomized prospective study].

Two groups of women who had labours induced were compared in a prospective randomised trial: The first group of 41 patients (group 1) in whom the epidural was started at the beginning of induction. A second group of 47 patients (group 2) in whom the epidural was only started when labour became "active" and induction had been effective. The length of labour and the obstetrical results were identically the same in both groups: at least there was no significant difference. There was no special benefit from waiting until labour started properly before injecting the epidural. This result made us look retrospectively to women whose labours had been induced and who might have benefited from the epidural being started late. The only significant difference was found apparently between primipara and multipara, and this was quite independent of the state of the cervix and the lower segment at the onset: it would appear to be better to put the epidural analgesia in once the labour has started in primiparous patients where as in multiparous ones on the other hand there seems to be a better effect if the epidural is started as soon as induction is started.

Adult↗
PubMed1989

[The value of a large obstetrical database].

The author presents his views on the advantage of a large database in obstetrics. The objectives and methods, as well as the main previously encountered difficulties, are analyzed.

Female↗
PubMed1987

[Ultrasonic images the day after voluntary termination of a pregnancy].

We have studied 75 cases of uterine echography, obtained 24 hours after an induced abortion. In 2 out of 3 cases, the uterus was not empty and, in a majority of cases, a pseudo-organized image was observed. The images displayed were a central trans-sonic zone, limited by a line of echoes and containing some echoes which are less or more organized. A few aspects were very difficult to diagnose from a persisting pregnancy.

Abortion, Induced↗
PubMed1987

[Peridural anesthesia with a bupivacaine-fentanyl combination. Effects on uterine contractility].

One hundred-and-four induced labours were monitored with extra-amniotic open-ended tocography. In every case, anaesthesia was epidural, using both Bupivacaine and Fentanyl. In most cases, uterine contractility was not changed by this type of anaesthesia. Four cases of hypertonia, nevertheless, were observed immediately after the epidural was injected with large dips in the recordings of the fetal cardiac rate. Hypertonia lasted for no longer than seven minutes and no consequences for children were observed at the time of birth.

Anesthesia, Epidural↗
PubMed1986

Elucidation and measurement of clinical learning opportunity.

Competence in nursing derives from the actual practice of the craft. The authors describe ways of assessing the variety and extent of opportunities for clinical learning available to student nurses. Cohorts of students from each of three different types of hospital (72 students in all) were followed from the beginning to the end of training. From interviews with ward sisters, observation on the wards, and examination of nursing notes the pattern of clinical conditions characteristic of each training ward is established and hence, by aggregation, the pattern for each of the three training schemes. However, it is argued that only by investigating the learning careers of individuals can one gain knowledge and insight in sufficient detail to act as a guide to reform. Information on allocation to training wards is used to construct individual profiles of clinical opportunity, one for each student. Clinical conditions are grouped into 13 categories and it is shown how, for some categories, there are large differences between the experiences of individuals within a cohort, especially in one hospital. Finally the authors explain how, with a minimum of effort, these methods and findings could be adapted to improve and facilitate training; the procedures could be used to monitor each developing profile and, by judiciously modifying the continuing process of allocation, tutors would be able to achieve equality of clinical opportunity for their students.

Clinical Competence↗
PubMed1986

Numerical measures of integration.

In a previous article the authors showed how, by following the clinical careers of individual student nurses, one could paint a coherent and illuminating picture of opportunities for clinical learning on the wards. By observing and counting, and using only the simplest methods of calculation, numerical measures of comparison were constructed. Here the authors turn to the question of the integration of classroom and ward. Indices of integration between theory and practice were devised and computed for three sets of students in three different training schools (72 students in all). The results were used to answer the following questions. Within each training school what was the degree of equality of educational opportunity? For each hospital what is the maximum level of integration which the organization of training makes possible, and what was the actual level achieved? What is the connection between the achieved levels of integration and the type of training scheme (modular, block, etc)?

Education, Nursing, Diploma Programs↗
PubMed1983

[Echographic detection of cervical incompetence. Comparison between the abdominal and perineal route].

Ultrasonographic measurements of the cervix in perineal and abdominal projections were compared in 61 women. Measured by the abdominal route the diameter of the internal os in most cases exceeded by 4 mm that measured by the perineal route, and cervical incompetence can be diagnosed when the internal os is equal or superior to 24 mm. For the abdominal measurement to be reliable the posterior vesical angle must be well marked, which means that the bladder must be moderately filled.

Abdomen↗
PubMed1978

[Echotomographic aspects of cervical incompetence during pregnancy].

During pregnancy, the opening of the cervix can be measured by perineal echotomography. Among 200 per-gravidic clinical echotomographies, 23 cervical incompetences were recognized. A "funnel-shaped" cervix is a cervix with an internal os larger than the external os; thus no clinical sign may be apparent and only a supra-vaginal Shirodkar's operation should be done.

Adult↗