The document summarizes the anatomy of the female pelvis. It describes the four pelvic bones - the two innominate bones, sacrum, and coccyx. It details the structures of the innominate bones including the ilium, ischium, and pubic bone. It discusses the pelvic joints and ligaments. It also describes the false pelvis, true pelvis including the brim, cavity, and outlet. It notes the diameters and landmarks of the brim. It concludes by summarizing the muscles of the pelvic floor.
Pelvis definition, pelvis parts, pelvis functions, pelvis structure, pelvis ligaments, pelvic floor, pelvic joints, effect on labour, pelvic inclination, possible injuries in birth canal during labour, ways of preventing injuries in birth canal during labour.
Pelvis definition, pelvis parts, pelvis functions, pelvis structure, pelvis ligaments, pelvic floor, pelvic joints, effect on labour, pelvic inclination, possible injuries in birth canal during labour, ways of preventing injuries in birth canal during labour.
Anatomy of the pelvis, understand the clinical relevance and key landmarks,parts and function,blood and nerve supply and disorders associated with the pelvis.
The pelvis is the lower part of the trunk of the human body between the abdomen and the thighs.
Topographically it is made up of a bony and ligamentous framework which is lined internally and externally by soft tissue and it is closed inferior by a layer of muscle and fascia which constitute the pelvic floor.
The perineum lies below the pelvic floor.
The pelvis in its broadest sense is an anatomical region bounded behind by the sacrum and coccyx, on each side and anteriorly by the innominate bones which are the hip bones, or pelvic bones.
These bones form the skeletal base for the lower limb.
Anatomy of the pelvis, understand the clinical relevance and key landmarks,parts and function,blood and nerve supply and disorders associated with the pelvis.
The pelvis is the lower part of the trunk of the human body between the abdomen and the thighs.
Topographically it is made up of a bony and ligamentous framework which is lined internally and externally by soft tissue and it is closed inferior by a layer of muscle and fascia which constitute the pelvic floor.
The perineum lies below the pelvic floor.
The pelvis in its broadest sense is an anatomical region bounded behind by the sacrum and coccyx, on each side and anteriorly by the innominate bones which are the hip bones, or pelvic bones.
These bones form the skeletal base for the lower limb.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
2. • Knowledge of the anatomy of a normal pelvis
is needed in midwifery and obstetric practice
• One of the ways to estimate the progress of
labor is by assessing relationship of the fetus
to certain pelvic landmarks.
• Be able to recognize a normal pelvis in order
to detect deviations from normal.
3. Functions:
• Allows movement of the body especially walking and
running
• Allows a person to sit and kneel
• Transmits the weight of the trunk to the legs, acting as a
bridge between the femurs
• Takes the weight of the sitting body onto the ischial
tuberosities
• Contains and protects the bladder, rectum, and the
internal reproductive organs
• The sacrum transmits nerves to various parts of the body
• Provides the skeletal framework of the birth canal
4. Pelvic bones:
• There are 4 pelvic bones:
– 2 innominate bones (nameless) or hip bones
– One sacrum
– One coccyx
5.
6. Innominate bones:
• Each innominate bone is composed of 3 parts:
– The ilium
– The ischium
– The pubic bone
7.
8. The ilium:
– The ilium is the large flared- out part
– When the hand is placed on the hip it rests on the iliac
crest which is the upper border
– At the front of the iliac crest, there is the bony
prominence known as the anterior superior iliac spine
– a short distance below it is the anterior inferior iliac
spine
– On the other end of the iliac crest there are 2 similar
points known as the posterior superior and the
posterior inferior iliac spines
9. The ischium:
• Is the thick lower part
• It has a large prominence known as the ischial
tuberosity on which the body rests when
sitting
• Behind and above the tuberosity is an inward
projection , the ischial spine
• In labour the station of the fetal head is
estimated in relation to the ischial spines
10. The pubic bone:
• Forms the anterior part
• It has a body and two oar-like projections- the
superior ramus and inferior ramus
• The two pubic bones meet at the symphysis
pubis and the 2 inferior rami form the pubic arch
• The space enclosed by the body of the pubic
bone , the rami and the ischium is called the
obturator foramen
11. • On the lower border of the innominate bone
are 2 curves (the greater sciatic notch and
lesser sciatic notch)
• The greater sciatic notch extends from the
posterior inferior iliac spine to ischial spine,
while the lesser sciatic notch lies between the
ischial spine and the ischial tuberosity
12. The sacrum:
• A wedge shaped bone consisting of 5 fused
vertebrae
• The upper border of the 1st sacral vertebra
juts forward and is known as sacral
promontory
• The anterior surface of the sacrum is concave
and is referred to as the hollow of the sacrum
• Laterally the sacrum extends into a wing or
ala
13. • Four pairs of holes or foramina pierce the
sacrum and through these, nerves from
cauda equina emerge to supply the pelvic
organs
• The posterior surface is rough to receive
attachments of muscles
14. Coccyx:
• the coccyx is a vestigial tail
• Consists of 4 fused vertebrae, forming a small
triangular bone
15. Pelvic joints:
• There are 4 pelvic joints:
– One symphysis pubis
– 2 sacroiliac joints
– One sacrococcygeal joint
The symphysis pubis:
• Formed at the junction of the 2 pubic bones
which are united by a pad of cartilage
16. The sacroiliac joints:
• Are the strongest joints in the body
• They join the sacrum to the ilium and thus
connect the spine to the pelvis
The sacrococcygeal joint:
• Formed where the base of the coccyx articulates
with the tip of the sacrum
• Permits the coccyx to be deflected backwards
during the birth of the fetal head.
17. Pelvic ligaments:
• The ligaments connecting the bones of the pelvis
with each other can be divided into 4 groups:
– Interpubic ligaments – between the 2 pubic bones or
at the symphysis pubis
– Sacroiliac ligaments- connects the sacrum and the
ilium
– Sacrococcygeal ligaments- unite the sacrum and the
coccyx
– Sacrotuberous and sacrospinous ligaments- pass
between the sacrum and the ischium
18. • The ligaments of importance in midwifery
practice are the sacrotuberous and
sacrospinous ligaments
• They form the posterior wall of the pelvic
outlet
19.
20. Types of pelvis:
• There are four categories of pelves:
– The gynaecoid pelvis
– The android pelvis
– Anthropoid pelvis
– Platypelloid pelvis
21. Gynaecoid pelvis:
• The best type for childbearing
– Sacral promontory is not prominent
– It has a round brim,
– Generous forepelvis
– Straight side walls
– A shallow cavity
– Well curved sacrum
– Blunt ischial spines
– Sub-pubic arch of 900
22.
23. The android pelvis:
• Resembles the male pelvis
– Heart shaped brim
– Narrow forepelvis
– Side walls converge making it funnel shaped
– Has a deep cavity
– Staight sacrum
– Ischial spines are prominent
– Narrow sciatic notch
– Sub-pubic angle is less than 90o
– Its found in short and heavily built women, who have a
tendency to be hirsute
24. The anthropoid pelvis:
• Has a long oval brim
• The sidewalls diverge
• Sacrum is long and deeply concave
• Ischial spines not prominent
• Sciatic notch and sub-pubic angle are very
wide
– Found in tall women with narrow shoulders
25. Platypelloid pelvis:
• Has kidney shaped brim
• Sacrum is flat
• Shallow cavity
• Ischial spines are blunt
• Sciatic notch and the pubic angle are both
wide
26.
27. The pelvis is divided into false pelvis and true
pelvis.
False pelvis:
• Part of the pelvis situated above the pelvic brim
• Its formed by the upper flared-out portion of the
iliac bones and protects the abdominal organs
• It has no significance in midwifery
28. THE TRUE PELVIS:
• This is the bony canal though which the fetus
must pass through during birth
• It has a brim, a cavity and an outlet
The pelvic brim:
• The brim is round except where the sacral
promontory projects into it
• The midwife needs to be familiar with the fixed
points on the pelvic brim which are referred to as
its landmarks.
29. • These are:
– sacral promontory (1)
– Sacral ala or wing (2)
– Sacroiliac joint (3)
– Iliopectineal line, which is the edge formed at the
inward aspect of the ilium (4)
– Iliopectineal eminence, which is the roughened
area formed where the superior ramus of the
pubic bone meets the ilium (5)
30. – Superior ramus of the pubic bone (6)
– Upper inner border of the body of the pubic bone
(7)
– Upper inner border of the sympysis pubis (8)
31.
32. Diameters of the pelvic brim:
There are 4 main diameters of the brim:
• The anteroposterior or conjugate diameter
• The transverse diameter
• 2 oblique diameters
33. • Anteroposterior or conjugate diameter :–
from the sacral promontory to the symphysis
pubis.
– Is termed as anatomical conjugate if measured to
the upper most point of symphysis pubis. It is
12cm.
– Is termed as obstetrical conjugate when taken to
the posterior border of the upper surface. It is
11cm.
• Obstetrical conjugate represents the available space for
passage of the fetus.
34. – The diagonal conjugate is also measured
anteroposteriorly from the lower border of the
sympysis to the sacral promontory
– It may be estimated vaginally as part of pelvic
assessment and is 12-13 cms.
35.
36. • Transverse diameter -Between the points
furthest apart on the iliopectineal lines –
13cm.
37. Cont.
• The oblique diameter- From one sacroiliac
joint to the iliopectineal eminence on the
opposite side of the pelvic – 12cm.
– There are two oblique diameters and each takes
its name from the sacroilliac joint from which it
arises
– The left oblique diameter arises from the left
sacroilliac joint while the right oblique from the
right sacroiliac joint
38.
39. The cavity:
• Extends from the brim superiorly and the
outlet inferiorly
• The anterior wall is formed by the pubic bones
and sympysis pubis and its depth is 4cm
• While the posterior wall is formed by the
curve of the sacrum which is 12 cm long
• The cavity contains the pelvic colon, rectum,
bladder, and some of the reproductive organs
40. Diameters of the cavity
• Its circular in shape and therefore all the
diameters are considered to be 12 cm.
41. The pelvic outlet:
• Two outlets are described:
– Anatomical outlet
– Obstetrical outlet
• The anatomical outlet is formed by the lower
borders of each of the bones together with
the sacrotuberous ligaments
• The obstetrical outlet is of greater significance
because it includes the narrow pelvic strait
through which the fetus must pass
42. • The narrow strait lies between the sacro-
coccygeal joint, the ischial spines and the
lower border of the sympysis pubis
• Obstetrical outlet is the space between the
narrow pelvic strait and the anatomical outlet
and is diamond in shape
43. Diameters of the pelvic outlet:
• Has 3 diameters:
– Anteroposterior diameter
– Oblique diameter
– The transverse diameter
44. • The anteroposterior diameter extends from
the lower border of the sympysis pubis to the
sacrococcygeal joint and measures 13cm
• The oblique diameter has no fixed points but
is said to be between the obturator foramen
and the sacrospinous ligament and measures
12 cm.
• The transverse diameter extends between the
two ischial spines and is 11 cm.
45.
46. THE PELVIC FLOOR:
• Formed by the soft tissues that fill the outlet of
the pelvis
Functions :
• Supports the weight of the abdominal and pelvic
organs
• Its muscles are responsible for the voluntary
control of micturition and defaecation
• Play an important part in sexual intercourse
47. • During childbirth, it influences the passive
movements of the fetus through the birth
canal and relaxes to allow its exit from the
pelvis
48. Muscle layers:
• The superficial layer is composed of 5
muscles:
– The external anal sphincter encircles the anus
and is attached behind by a few fibres to the
coccyx
– The transverse perineal muscles pass from the
ischial tuberosities to the centre of the perineum
– The bulbocavernosus muscle pass the perineum
forwards around the vagina to the corpora
cavernosa
49. – The ischiocavernosus muscles pass from the
ischial tuberosities along the pubic arch to the
corpora cavernosa
– the membranous sphincter of the urethra is
composed of muscle fibres passing above and
below the urethra- it acts to close the urethra
50.
51. The deep layers is composed three pairs of
muscles which together are known as the
levator ani
• They are so called because they lift or elevate
the anus
• Each levator ani consist of :
– The pubococcygeus muscle which passes from
the pubis to the coccyx
52. – The iliococcygeus muscle passes from the fascia
covering the obturator internus muscle to the
coccyx
– The ischiococcygeus muscle passes from the
ischial spine to the coccyx infront of the
sacrospinous ligament
53.
54. The perineal body:
• A pyramid of muscle and fibrous tissue
situated between the vagina and the rectum
• The apex which is the deepest part is formed
from the fibres of the pubococcygeus muscle
which cross over at this point
• The base is formed from the transverse
perineal muscle