Visual aids for induction of labor education: a randomized controlled trial.

This study aimed to assess whether the use of visual aids to augment the consent process for pelvic floor surgeries affects patient understanding and satisfaction. We conducted a single-blind, randomized controlled trial. Adults planning robotic sacrocolpopexy or suburethral sling surgeries were eligible. All participants received standard preoperative consent counseling. Participants randomized to the intervention also viewed slides with visual aids that paralleled standard counseling; participants randomized to the control group received only standard counseling. All participants completed surveys after their preoperative visit, the day of surgery, and at their postoperative visit. Each survey contained 12 true-false questions about risks, benefits, and alternatives of surgery, and expectations during recovery. The primary outcome was the percentage of correct true-false questions. We conducted an intention-to-treat analysis. We randomized 32 participants undergoing robotic sacrocolpopexy and 32 undergoing suburethral sling surgeries, yielding 16 in the intervention group and 16 in the control group for each procedure. The intervention and control groups for both surgeries were similar in age, body mass index, race, education, and previous surgery for similar symptoms.Among participants undergoing robotic sacrocolpopexies, median knowledge scores at the preoperative visit were similar between the intervention (92% [interquartile range {IQR}, 86%-100%]) and control (86% [IQR, 75%-94%]) groups (P = 0.21). Similar results were seen for participants undergoing suburethral sling procedures in the intervention (83.3% [IQR, 71%-92%]) and control (83% [IQR, 75%-88%]) groups (P = 0.64). We found that using visual aids during the consent process for patients undergoing robotic sacrocolpopexy or suburethral sling surgeries did not improve knowledge.

A woman may need to give birth prior to the spontaneous onset of labour in situations where the fetus has died in utero (also called a stillbirth), or for the termination of pregnancy where the fetus, if born alive would not survive or would have a permanent handicap. Misoprostol is a prostaglandin medication that can be used to induce labour in these situations. To compare the benefits and harms of misoprostol to induce labour to terminate pregnancy in the second and third trimester for women with a fetal anomaly or after intrauterine fetal death when compared with other methods of induction of labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2009). Randomised controlled trials comparing misoprostol with placebo or no treatment, or any other method of induction of labour, for women undergoing induction of labour to terminate pregnancy in the second and third trimester following an intrauterine fetal death or for fetal anomalies. Both authors independently assessed trial quality and extracted data. We included 38 studies (3679 women).Nine studies included pregnancies after intrauterine deaths, five studies included termination of pregnancies because of fetal anomalies when the fetus was still alive and the rest (24) presented the pooled data for intrauterine deaths, fetal anomalies and social reasons.When compared with agents that have traditionally been used to induce labour in this setting (for example, gemeprost, prostaglandin E(2) and prostaglandin F(2alpha)), vaginal misoprostol is as effective in ensuring vaginal birth within 24 hours, with a similar induction to birth interval. Vaginal misoprostol is associated with a reduction in the occurrence of maternal gastrointestinal side effects such as nausea, vomiting and diarrhoea when compared with other prostaglandin preparations. While the different treatments involving various prostaglandin preparations appear comparable for the reported outcomes, the information available regarding rare maternal complications, such as uterine rupture, is limited. The use of vaginal misoprostol in the termination of second and third trimester of pregnancy is as effective as other prostaglandin preparations (including cervagem, prostaglandin E(2) and prostaglandin F(2alpha)), and more effective than oral administration of misoprostol. However, important information regarding maternal safety, and in particular the occurrence of rare outcomes such as uterine rupture, remains limited. Future research efforts should be directed towards determining the optimal dose and frequency of administration, with particular attention to standardised reporting of all relevant outcomes and assessment of rare adverse events. Further information is required about the use of sublingual misoprostol in this setting.

The Use of Visual Aids in Forensic Interviews with Children

An educational video's impact on the induction of labor experience: a randomized controlled trial

AimsA quality improvement project was carried out in a General Dental Practice in London. The aim was to improve understanding and motivation in periodontal patients.MethodsResearch into interventions in the medical field to improve understanding and motivation amongst patients, lead to the idea of using visual aids to help motivate periodontal patients and to improve their understanding of the disease. The results from the first Plan-Do-Study-Act cycle using visual aids are presented.ResultsAfter the use of visual aids, patients felt more motivated in maintaining good oral hygiene, felt the visual aids improved their understanding of gum disease and how to take care of their gums and teeth. One hundred percent of patients preferred their diagnosis to be explained to them with visual aids.DiscussionThe project supported the increase in motivation and understanding in periodontal patients. However further data is required to learn more about how visual aids influence patient behaviour, how effective they are in improving patients’ understanding and motivation, and other factors which play a role in this.ConclusionsThe results of this quality improvement project are promising; it has highlighted that visual aids can have a place in the management of periodontitis in general practice.

BackgroundMortality in end stage renal disease (ESRD) is higher than many malignancies. There is no data about the optimal way to present information about projected survival to patients with ESRD. In other areas, graphs have been shown to be more easily understood than narrative. We examined patient comprehension and perspectives on graphs in communicating projected survival in chronic kidney disease (CKD).MethodsOne hundred seventy-seven patients with CKD were shown 4 different graphs presenting post transplantation survival data. Patients were asked to interpret a Kaplan Meier curve, pie chart, histogram and pictograph and answer a multi-choice question to determine understanding.ResultsWe measured interpretation, usefulness and preference for the graphs. Most patients correctly interpreted the graphs. There was asignificant difference in the percentage of correct answers when comparing different graph types (p = 0.0439). The pictograph was correctly interpreted by 81% of participants, the histogram by 79%, pie chart by 77% and Kaplan Meier by 69%. Correct interpretation of the histogram was associated with educational level (p = 0.008) and inversely associated with age > 65 (p = 0.008). Of those who interpreted all four graphs correctly, there was an association with employment (p = 0.001) and New Zealand European ethnicity (p = 0.002).87% of patients found the graphs useful. The pie chart was the most preferred graph (p 0.002).The readability of the graphs may have been improved with an alternative colour choice, especially in the setting of visual impairment.ConclusionVisual aids, can be beneficial adjuncts to discussing survival in CKD.

This paper examines the perceptions of teachers on the use of visual aids in student learning. The qualitative case study approach was used as a research design. Five school teachers were interviewed for the study. The data were collected through the use of semi-structured interviews. The findings of this study further support the existing literature and the previous research. The study revealed that teachers had positive perception about visual aids. They perceived visual aids as one of the crucial and significant tools for teaching and learning. Evidences from this study suggest that teaching becomes more effective and easier for teachers through the use of visual aids. The study revealed some of the problems faced by the teachers in using modern visual aids. The participants in the study clearly pointed out erratic and unreliable internet connection as a barrier to the use of ICT in teaching –learning process. The study also found out heavy workload of teachers as one of the impending factors in the preparation of visual aids in their lesson.

Abstract: English is a language that is used by people around the world. Hence, it is necessary for everyone to learn it, including the students with special needs. This study aims to review the use of visual aids in teaching English for students with special needs, especially Autism Spectrum Disorder. The study is a library study that focuses on collecting theoretical and empirical studies about the use of visual aids in teaching students with ASD. Autism Spectrum Disorder is a neurological disorder that affects the function of the human brain. Visual aids are the tools or devices that are shown by the teacher in the classroom to help students understanding the learning materials. The study finds that the use of visual aids is effective for teaching English to students with Autism Spectrum Disorder. Therefore, teachers should consider using visual aids in teaching autistic students. This study is expected to give insightful information in educational fields.

Educational materials about human papillomavirus (HPV) vaccination must be easy to understand and must support recommended behaviors regardless of readers' health literacy levels. The purpose of this study was to evaluate the understandability, actionability, and comprehensiveness of HPV vaccination educational materials in Japan. From August to September 2023, we obtained HPV vaccination educational materials from the central government, local governments, and websites. We assessed the understandability and actionability of the materials using the Patient Education Materials Assessment Tool for Printed Materials (PEMAT-P), Japanese version. We also evaluated the comprehensiveness of the content. Ratings of understandability, actionability, and comprehensiveness were compared by material type and source. We evaluated 164 eligible materials. The mean understandability and actionability of all materials were 60.5% (standard deviation [SD] = 12.5) and 42.0% (SD = 20.5), respectively. Many materials lacked definitions of medical terms, clear explanations of numbers, content summaries, explicit steps of action, and the use of visual aids to improve understanding and actionability. The mean comprehensiveness score was 73.5% (SD = 14.7%). A few materials included all the necessary information content. The highest understandability score and actionability score were for local government mailings, and the highest comprehensiveness score was for academic materials. Most Japanese HPV vaccination educational materials were insufficiently understandable and actionable. Such materials need to be improved, especially regarding the use of numbers, medical terms, and visual aids. In terms of content, the importance of vaccination before sexual debut and the benefits of vaccination for men should be emphasized.

The use of manipulative materials and visual aids in teaching arithmetic is widely accepted by teachers and those concerned with the teaching of arithmetic. The Nationa Defense Education Act is an expression on the national level of a belief in the value of manipulative materials for instruction. While most modern arithmetic programs contain suggestions on the use of visual aids and manipulative materials, much remains to be done in evaluating the effectiveness of selected materials. Cost of materials varies considerably. One main concern of school systems is the cost of materials. Are inexpensive materials as effective as more expensive ones?

Background: Rates of labour induction are increasing. Objective: To make a list of common indications of induction. Design: Prospective observational study. Setting: Gynecology unit of D.H.Q teaching hospital, Sargodha for a period of 1 year from March 2008 - March 2009. Patients and Methods: Patients admitted in the labour room through emergency or through OPD who were planned to have induction of labour, were included in the observation. Their age, parity, duration of pregnancy and the particular condition for which she was induced labour, was recorded. All essential points of examination and required investigations for the mother and the foetus were recorded. Outcome: At the end of induction in the form of mode of delivery was recorded whether spontaneous, instrumental or operative delivery. Results: Out of 400 patients 158 were primi gravidas and rest of 242 were G 2 to G 9 . 342 had alive foetuses and 58 had I.U.F.D. (Intra uterine foetal death). Duration of pregnancy ranged from 28 to 41 wks. Indications for induction of labour were prolonged pregnancy, (36). Pre-eclampsia, (46) I.U.G.R. (16). Placental abruption (32) PROM (20) foetal anomalies (20), I.U.F.D (58), gestational diabetes (10) and non-medical indications (108). Spontaneous vaginal deliveries (242) Instru-mental deliveries (60) and C - sections - (98). Conclusion: The most common was non-medical indications for induction of labour. Key Words: Indications. Induction of labour.

Factors Associated with Failed Induction of Labor After Cesarean with an Unfavorable Cervix at Term.

Induction of labor versus expectant management for women with a prior cesarean delivery

Induction of labour is a common obstetric intervention, with between 20% and 30% of births reported to occur following induction of labour. Women with a prior caesarean delivery have an increased risk of uterine rupture, particularly when labour is induced. For women who have had a previous caesarean birth and who require induction of labour in a subsequent pregnancy, it is unclear which method of cervical ripening and labour induction is preferable. To assess the benefits and harms associated with different methods used to induce labour in women who have had a previous caesarean birth and require induction of labour in a subsequent pregnancy. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2012) and reference lists of retrieved studies. All randomised controlled trials comparing any method of third trimester cervical ripening or labour induction, with placebo/no treatment or other methods in women with prior caesarean section requiring labour induction in a subsequent pregnancy were included.Methods of cervical ripening or labour induction could include: prostaglandin medication (including oral or vaginal prostaglandin E2 (PGE2) and misoprostol); mifepristone; mechanical methods (including Foley catheters and double balloon catheters); oxytocin, or placebo. The two review authors independently assessed studies for inclusion and trial quality. Any disagreement was resolved by discussion. Both review authors independently extracted data and data were checked for accuracy. Two studies (involving a total of 80 women) were included. However, the two included studies used different methods and thus, meta-analysis was not appropriate. The two included studies compared 2.5 mg vaginal PGE2 inserts versus oxytocin (Taylor and colleagues) and misoprostol versus oxytocin (Wing and colleagues). Risk of bias in the included studies was judged 'low' and 'unclear' respectively.Vaginal PGE2 inserts versus oxytocin - Taylor and colleagues included 42 women, equally distributed over both groups. Baseline characteristics, and reasons for labour induction were comparable between the groups. There were no significant differences in any of the outcome measures reported (caesarean section, instrumental vaginal deliveries, epidural analgesia, Apgar score, perinatal death). One uterine rupture occurred in the prostaglandin group, after the use of prostaglandins and oxytocin, while no ruptures occurred in the oxytocin group (one study, 42 women; risk ratio (RR) 3.00, 95% confidence interval (CI) 0.13 to 69.70).Misoprostol versus oxytocin - the study conducted by Wing and colleagues was stopped prematurely due to safety concerns after the inclusion of 38 women. Seventeen women had been included in the misoprostol group, and 21 women in the oxytocin group. There were no significant difference in the only outcome measure reported by the authors, uterine rupture, which occurred twice in the misoprostol group, and did not occur in the oxytocin group (one study; 38 women; RR 6.11, 95% CI 0.31 to 119.33). There is insufficient information available from randomised controlled trials on which to base clinical decisions regarding the optimal method of induction of labour in women with a prior caesarean birth.

RCT evidence on methods of induction of labour for women with a prior caesarean section is inadequate, and studies are underpowered to detect clinically relevant differences for many outcomes. Several studies reported few of our prespecified outcomes and reporting of infant outcomes was especially scarce. The GRADE level for quality of evidence was moderate to very low, due to imprecision and study design limitations.High-quality, adequately-powered RCTs would be the best approach to determine the optimal method for induction of labour in women with a prior caesarean birth. However, such trials are unlikely to be undertaken due to the very large numbers needed to investigate the risk of infrequent but serious adverse outcomes (e.g. uterine rupture). Observational studies (cohort studies), including different methods of cervical ripening, may be the best alternative. Studies could compare methods believed to provide effective induction of labour with low risk of serious harm, and report the outcomes listed in this review.