0 ± 0.60 (range 0-2.6) cm; p = 0.0001). Overall, 131/164 (80%) of the cases had at least one of the described features (slanted posterior ilium (angle > 30°), 30%; rounded posterior ilium, 20%; thick posterior ilium cortex, 13%; focal lesion in posterior ilium, 12%; prior procedure in posterior ilium, 5%; posterior soft tissue thickness > 3 cm, 40%). CONCLUSION CT-guided bone marrow procedures were more likely to result in both adequate aspirate smears and biopsy samples and longer core lengths when compared with blind procedures.Importance Approximately 10% to 16% of women meet diagnostic criteria for depression during pregnancy. Untreated maternal depression is associated with adverse pregnancy outcomes including premature birth, low birth weight, and fetal growth restriction. objective The aim of this study is to review the current safety data on electroconvulsive therapy (ECT) in pregnancy and provide guidance to clinicians on the role of ECT in pregnancy and the special considerations for its use in our population. Evidence Acquisition We reviewed 4 meta-analyses on the use of ECT in pregnancy as well as the source material (case series, etc) for these meta-analyses. We reviewed the official position statements on ECT in pregnancy from obstetric and psychiatric governing bodies as well as clinical best practice information from practitioners of ECT in pregnancy. Results Electroconvulsive therapy may be underutilized due to stigma and lack of access for these women. Rates of ECT use in pregnancy are difficult to determine. There are physiologic differences in pregnancy that merit additional attention during ECT, including increased risk of aspiration, concern for aortocaval compression, and the possibility of fetal heart rate changes associated with prolonged seizure activity. Serious adverse outcomes associated with ECT use in pregnancy are rare. Conclusions and Relevance Electroconvulsive therapy is a highly effective and safe treatment modality for unipolar depression, bipolar disorder, schizophrenia, and other psychiatric illnesses. Electroconvulsive therapy treatment in pregnancy requires a multidisciplinary team approach with obstetrics, maternal-fetal medicine, psychiatry, and anesthesiology, but is overall felt to be safe and effective.Importance Mechanical heart valves (MHVs) pose significant thrombogenic risks to pregnant women and their fetuses, yet the choice of anticoagulation in this clinical setting remains unclear. Various therapeutic strategies carry distinct risk profiles that must be considered when making the decision about optimal anticoagulation. selleck products Objective We sought to review existing data and offer recommendations for the anticoagulation of pregnant women with MHVs, as well as management of anticoagulation in the peripartum period. Evidence Acquisition We performed a literature review of studies examining outcomes in pregnant women receiving systemic anticoagulation for mechanical valves, and also reviewed data on the safety profiles of various anticoagulant strategies in the setting of pregnancy. Results Warfarin has been shown to increase rates of embryopathy and fetal demise, although it has traditionally been the favored anticoagulant in this setting. Low-molecular-weight heparin, when dosed appropriately with close therapeutic monitoring, has been shown to be safe for both mother and fetus. Conclusions We favor the use of low-molecular-weight heparin with appropriate dosing and monitoring for the anticoagulation of pregnant women with MHVs. Data suggest that this approach minimizes the thrombotic risk associated with the valve while also providing safe and effective anticoagulation that can be easily managed in the peripartum period.Importance Opioid use disorder is increasingly common in the United States and affects many pregnancies. Given the rise in pregnancies complicated by opioid use, providers should understand the diagnosis and management of opioid use disorder in pregnancy. Objective This article focuses on screening for opioid misuse, selecting appropriate treatment for patients, initiating medication-assisted treatment in the inpatient setting, and providing appropriate peripartum care. Evidence Acquisition A PubMed search was undertaken using the following search terms “opioid use disorder”, “pregnancy,” “medication assisted treatment,” “buprenorphine,” “methadone,” “heroin,” “addiction,” “neonatal abstinence syndrome,” and “detoxification.” The search was limited to the English language publications, with most being published after 2000. Results All women should be screened for opioid use disorder during pregnancy. Opioid use has profound effects on the mother and infant. Medication-assisted treatment is the standard of care for pregnant women with opioid use disorder. Patients will require a multidisciplinary approach to management in the intrapartum and postpartum period. Conclusions Conclusions Opioid use disorder is a common, chronic condition with significant implications during pregnancy. Recognition and appropriate treatment of this disorder can optimize maternal and fetal outcomes. Conclusions Obstetricians are increasingly being challenged to manage pregnancies complicated by opioid use disorder and should be proficient in providing safe and effective care.BACKGROUND The competence of nurses who care for patients with finger replantation is critical for positive patient outcomes. This study sought to identify the effects of standardized patient (SP)-based training on surgical ward nurses’ knowledge, clinical performance, and self-efficacy regarding finger replantation. METHOD A wait-list control group with a crossover design was used for this study. Nurses were randomly assigned to group A (n = 10) or to the wait-list control group B (n = 10). Training consisted of a lecture, task training, and SP-based training. Knowledge, clinical performance, and self-efficacy data were collected at baseline, after the first intervention, and after 1 month at group crossover and second intervention. Data were analyzed using repeated measures ANOVA. RESULTS Nurses demonstrated greater knowledge, better clinical performance, and higher self-efficacy scores after the SP-based training. Following crossover, knowledge, clinical performance, and self-efficacy scores were retained 1 month after the training in group A.