A small for dates fetus is broadly any fetus with an estimated fetal weight below the tenth percentile. What is most important is to define and classify and segregate whether it is a constitutionally small for gestational age fetus which is normal in terms of perinatal outcome or a fetus with true fetal growth restriction which is going to show signs on ultrasound and color Doppler and also reflect a poor perinatal outcome.

This differentiation is done by meticulous search for signs on 2D ultrasound with charting of growth potential and Doppler ultrasound showing changes in cerebroplacental ratio and uterine arteries and umbilical artery. Once this is done we need to reclassify them as early or late onset fetal growth restriction. Further management strategies and decision of when and where to deliver are determined by changes in Doppler showing progressive fetal deterioration.

Which vessels to be insonated, what to infer, optimal time intervals to repeat the scan and when to deliver so as to minimize fetal injury and demise and to avoid risks of iatrogenic preterm delivery is the aim of this study.

1. Turan OM, et al: Progression of Doppler abnormalities in intrauterine growth restriction. Ultrasound Obstet Gynecol 2008;32:160-167.
2. Batalle D, Eixarch E, Figueras F, Muñoz-Moreno E, Bargallo N, Illa M, Acosta-Rojas R, Amat-Roldan I, Gratacos E (2012). "Altered small-world topology of structural brain networks in infants with intrauterine growth restriction and its association with later neurodevelopmental outcome". NeuroImage. 60 (2): 1352–66
3. Vergani P, et al: Prognostic value of uterine artery Doppler velocimetry in growth-restricted fetuses delivered near term. Am J Obstet Gynecol 2002;187:932-936.
4. Ghosh GS, Gudmundsson S: Uterine and umbilical artery Doppler are comparable in predicting perinatal outcome of growth-restricted fetuses. BJOG 2009;116:424-430.
5. Oros D, et al: Longitudinal changes in uterine, umbilical and fetal cerebral Doppler indices in late-onset small-for-gestational age fetuses. Ultrasound Obstet Gynecol 2011;37:191-195.

BACKGROUND: Patient safety adverse events (PSEs) cause harm and suffer to patients and their families (first victim). However, the involved health care providers (HCPs) can also become victims (second victim-SV). The prevalence of SV phenomenon varies from 10.4% to 43.3%.

OBJECTIVES: Measurement the prevalence of PSE exposure and risk factors, symptoms and support perception among exposed.

METHODS: A cross-sectional study, conducted at Rabin Medical Center, Israel. The data were collected by using a validated self-reporting questionnaire, based on a convenience sampling of HCPs.

RESULTS: A total of 870 HCPs responded, 630 (70%) of them reported to be involved in PSEs. There was no difference in the prevalence of PSEs by profession / education of the HCPs. The participants without any academic education and those with a BA degree perceive less substantial responses whereas physicians assessed the most severe response to PSEs (3.8, 4.02, 4.08 p <.05, respectively).

Those who reported to be involved in PSEs tended to agree that the involvement in PSEs might cause  negative responses, including feelings of guilt, anger, anxiety, shame, tiredness and sleeping difficulties. At the same time, the respondents agreed that these HCPs need an organizational support.

Participants who were involved or knew colleagues who were involved in PSEs (n = 630) assessed the risk of developing negative responses after the event higher than those who were not involved in PSEs or were not familiar with these cases (n = 151) (3.98 vs. 3.56, p <.001). These subjects also had higher need for support (4.91 vs. 4.69, p <.05). In addition, it was agreed that the existing support is insufficient, and that the hospital should invest more in supporting these HCPs.

CONCLUSIONS: SV phenomenon is widespread among all HCPs, which require centrally organized support to promote a positive safety environment.

Ultrasound is an essential tool for any obstetric practise. When it started five decades ago little did we realise that this invention is a technological marvel. One could look into the presentation and the viability of the fetus. Acrania could be excluded in the third trimester and with ultrasound machines and probes getting better we could exclude that in the second trimester so called Level II scan. With high resolution probes and high frequency transvaginal probes one can now diagnose fetal abnormalities in the late first trimester. This avoids the mental trauma the mother and the family have to go through and lethal abnormalities can be terminated much earlier. Acrania, anencephaly, gross dysraphic disorganisation of the fetal spine, anterior thoracic and abdominal wall defects and gross limb abnormalities are few structural malformations that can be detected with ease as early as 11-12 weeks. Apart from structural abnormalities the index of suspicion for chromosomal abnormalities also is there with looking at the nuchal translucency, nasal bone and flow through the tricuspid valve and in the ductus venosus. Combined testing with a dual test increases the sensitivity manifold. What is most important is the knowhow of what to look and how to look in your 11-14 weeks scan.

Nursing basically is an art of providing to the sick and instead of being worshipped has come under constant scrutiny and is being forced to face many challenges. Challenges like regional differences have penetrated through and has gradually led to the development of income inequalities. Not only this,  the nurses on a day to day basis are exposed to various diseases, pathogens as well as flu germs which affects their health adversely. Inspite of their gruelling schedules they are forced to work for longer hours and also for more shifts that to without any incentives. Often this leads to fatigue, lack of sleep and gradual development of a negative atmosphere. Societies have been very harsh on the women from the start but this problem has become more acute in the case of nurses as they have to face the violent behavior not only from their fellow workers but also from the patients. A lot of times due to shortage of staff the nurses are pressurized to work more which leads to burnout and as it is their job is extremely taxing. These challenges leave them dissatisfied with their jobs. This leads to less and less people being attracted and opting for this profession.

Objective: To describe job satisfaction of pediatric intensive care units in China, and analyze the relationship of nursing work environment between job satisfaction.

Methods: From November 2017 to May 2018, a total of 1414 nurses of pediatric intensive care units from 25 hospitals of 16 provinces and cities nationwide in China were selected using convenient sampling, and surveyed by Nurses Job Satisfaction Scale (NJSS) and Practice Environment Scale (PES). Descriptive statistics and Hierarchical multiple regression analysis were performed by SPSS 20.0.

Results:  The average score of nurse job satisfaction of pediatric nurses was 3.29 ± 0.49（score range of 1-5）, which was in the middle level in China. Hierarchical regression results show that the area where the hospital is located, monthly income can affect the nurse job satisfaction, and nursing work environment play an important role for nurses’ job satisfaction, the model explained 73.1% amount of variance.

Conclusion: The nursing work environment is the important factor influencing the nurses job satisfaction of pediatric intensive care unit, how to balance the domestic resources and reduce the regional differences, we work together to create a healthy environment in pediatric intensive care unit, further improving the nurses job satisfaction will be the important issues in the future.

Statement of the Problem: Osteopathic medicine is a form of drug-free, non-invasive manual medicine, classified as a complementary and alternative medicine. It involves manual contact of body structures with slight pressures that, in addition, produce a stimulating effect of the organism's own health resources. All this suggests that its indication in the neonatal and infant period should be high, being necessary to know its contribution during this period, especially in the most vulnerable newborns, premature infants. Many studies and cases have shown the existence of clinical and scientific evidence on the benefits of this manual therapy in some of the pathologies present in childhood. Due to the close relationship between nursing professionals and their patients, nurses play a fundamental role in providing health education to patients. For this reason, this educational project focuses on nursing professionals in the NICU of Mother-Child Hospital belonging to the Gregorio Marañón General University Hospital, with the aim of making them aware of the great benefits provided by this therapy during the neonatal and infancy periods; in addition to the pathologies which respond well to osteopathic treatment, and how to recognize and select a legally accredited osteopath. Thus, in many cases, improvements in children’s health would be seen, as well as a reduction in the costs associated with these diseases.

Methodology & Theoretical Orientation: I conducted a systematic review, aiming to answer the following clinical question: Know the scientific evidence of osteopathic manipulation in the neonatal and infant period.Findings: Searching retrieved 136 articles. After the removal of conference abstracts and those which didn´t have free access to the full abstracts, 27 articles were evaluated.

Conclusion & Significance: In this systematic review, I evaluated the efficacy of the Osteopathic Manipulative Treatment based on clinical cases that reported disorders, such as: infant colic, suction problems, plagiocephaly.

To be Announced..