Objectives: Determined the effects of music on the result of non-stress test at 33 weeks of gestational ages for prenatal assessment.

Methods: The cohort design was conducted between 89 women who had regular NST (without music), and 88 women who do NST with music. These are women with a single pregnancy of 33 weeks or older who are not in the risk pregnancy group, with no signs of preterm labor.

Results: There were 178 pregnant women participating in the study. The median age of pregnant women in the study group who did not listen to music or listen to music was 30.0 ± 4.60 and 30.4 ± 4.00, respectively. The average gestational age in our study was 36.73 ± 1.64 and 36.07 ± 1.91, respectively, for with and without music group. Music increased the average number of fetal movements in the group of pregnant women listening to the music compared to the group that did not listen to music (11.13 ± 0.91 and 17.52 ± 1.63) during the NST. Music also increased the number of accelerations (5.54 ± 0.43 compared to 7.28 ± 0.47) and the resulting reactive NST in pregnant women.

Conclusion: Music increased the average number of fetal movements and the number of accelerations the group of pregnant women listening to the music compared to the group that did not listen to during the NST. Music also increased the resulting reactive NSTs in pregnant women. We can consider using music during NSTs.

Brachial plexus injury in neonates is a rare obstetrical complication, but it can cause huge anxiety to parents if occurring and sometimes leading to legal disputes in obstetrical practice. Trauma during birth delivery is mainly due to the over-stretch of fetal neck which is the main cause of brachial plexus injury in infants. However, those injuries are self-limited and most of them will self-recover. We conducted a retrospective analysis on ten cases diagnosed of post-delivery brachial plexus injury under monitoring at Tu Du Hospital from January to November 2018. Such factors as maternal obstetrical history, labor characteristics, mode of delivery, clinical symptoms and treatment approach of those cases were collected and analyzed. The risk factors of brachial plexus injury in our study included large fetus, interventional delivery, prolonged second stage of labor and shoulder dystocia. All the cases were treated with physiotherapy and recovered after 3 – 6 months. Family counseling and infants’ recovery played an important role in the management of those cases.

Objectives: to evaluate the fluid responsiveness according to fluid bolus triggers and their combination in severe sepsis and septic shock.

Design: observational study.

Patients and Methods: patients with severe sepsis and septic shock who already received fluid after rescue phase of resuscitation. Fluid bolus (FB) was prescribed upon perceived hypovolemic manifestations: low central venous pressure (CVP), low blood pressure, tachycardia, low urine output (UOP), hyperlactatemia. FB was performed by Ringer lactate 500 ml/30 min and responsiveness was defined by increasing in stroke volume (SV) ≥15%.

Results: 84 patients were enrolled, among them 30 responded to FB (35.7%). Demographic and hemodynamic profile before fluid bolus were similar between responders and non-responders, except CVP was lower in responders (7.3 ± 3.4 mmHg vs 9.2 ± 3.6 mmHg) (p 0.018). Fluid response in low CVP, low blood pressure, tachycardia, low UOP, hyperlactatemia were 48.6%, 47.4%, 38.5%, 37.0%, 36.8% making the odd ratio (OR) of these triggers were 2.81 (1.09-7.27), 1.60 (0.54-4.78), 1.89 (0.58-6.18), 1.15 (0.41-3.27) and 1.27 (0.46-3.53) respectively. Although CVP < 8 mmHg had a higher response rate, the association was not consistent at lower cut-offs. The combination of these triggers appeared to raise fluid response but did not reach statistical significance: 26.7% (1 trigger), 31.0% (2 triggers), 35.7% (3 triggers), 55.6% (4 triggers), 100% (5 triggers).

Conclusions: fluid responsiveness was low in optimization phase of resuscitation. No fluid bolus trigger was superior to the others in term of providing a higher responsiveness, their combination did not improve fluid responsiveness as well.

The issue of causation is one of the major challenges for epidemiologists who aim to understand the association between an exposure and an outcome to explain disease patterns and potentially provide a basis for intervention. Suitably designed experimental studies can offer robust evidence of the causal relationships. The experimental studies, however, are not popular, difficult or even unethical and impossible to conduct; it would be desirable if there is a methodology for reducing bias or strengthening the causal inferences drawn from observational studies. The traditional approach of estimating causal effects in such studies is to adjust for a set of variables judged to be confounders by including them in a multiple regression. However, which variables should be adjusted for as confounders in a regression model has long been a controversial issue in epidemiology. From my observation, the adjustments using only "statistical artifacts" methods such as the p-value<0.2 in univariate analysis, stepwise (forward/backward) are widely used in research and teaching in Epidemiology and Statistics but without appropriated notice on the biological or clinical relationships between exposure and outcome which may induce the bias in estimating causal effects. In this mini-review, we introduce an interesting method, namely Directed Acyclic Graphs (DAGs), which can be used to reduce the bias in estimating causal effects; it is also a good application for Epidemiology and Biostatistics teaching.

Evidence based medicine (EBM) education is a modern method for medical students in clinical training based on the reasonable use of the best evidence in making decisions about individual patient’s treatment. EBM education syllabus teaches medical student how to integrate the clinical experience and patient examination with the simplest out-there analysis data for increasing the utilization of top quality clinical analysis in clinical deciding, this methodology requires new literature looking out and proof evaluating skills. Thus, replacing the recently educated method by EBM has more challenges, the new program ought to analysis fastidiously for evaluating the behavior changes, the development of clinical skills and analysis the ultimate examination score for evaluating the effectiveness of EBM program. The result show that active teaching proves to be statistically completely different and has robust impact toward the ultimate outcome. EBM educated method might improve clinical knowledge and application of PBL/EBM brings concerning higher scores compared to recently educated method.