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Tertiary Referral Hospital (tertiary + referral_hospital)
Selected AbstractsMultidisciplinary assessment at triage: A new way forwardEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2004Joanna R Richardson Abstract Objective:, To evaluate a dual doctor and nurse triage system at a tertiary referral hospital. Methods:, Data were compared between periods of multidisciplinary triage and periods of standard triage. Data comparison was also made between rostered multidisciplinary triage shifts and non-multidisciplinary triage shifts. Staff satisfaction with the process was assessed. Results:, The percentage of patients seen within Australasian Triage Scale performance indicator thresholds increased from 75% to 81% in Category 2 patients (P = 0.12) and 56% to 78% in Category 3 patients (P < 0.0001). There was a reduction of 50% in the number of patients who left prior to being seen by a doctor (P = 0.024). Surveys showed high staff satisfaction with the process. Conclusions:, We feel that multidisciplinary triage performs a useful function in our department enabling us to reduce waiting times. The process is widely accepted amongst the staff and it ensures a senior doctor assesses most patients. It reduces the number of patients leaving prior to being seen by a doctor and it provides one way of getting around access block and a physically small department. [source] The prevalence of lipodystrophy in an ambulant HIV-infected population: it all depends on the definitionHIV MEDICINE, Issue 3 2001VM Carter Objectives This study's objective was to determine the prevalence of body shape changes and metabolic abnormalities in an ambulant population with HIV infection. Three different definitions of lipodystrophy were used to assess these changes. Patients' anthropometric measures and dual-energy X-ray absorptiometry (DEXA) scans were compared in order to estimate fat distribution in this population. We sought to evaluate potential predictors for lipodystrophy according to each of the three definitions. Methods We performed a cross-sectional study in the outpatient clinic of a tertiary referral hospital in Melbourne, Australia. We enrolled a total of 167 HIV-infected ambulatory patients over 3 months in mid-1998. Data on 159 males, 149 of whom were receiving triple combination antiretroviral therapy, were evaluated. Anthropometric measures, clinical examination, self-report of body shape changes, biochemical measures and DEXA scan were used to assess lipodystrophy and risk factors for cardiovascular disease. Patients described body shape changes in the face, trunk, arms and legs. Laboratory parameters measured included fasting triglyceride (TG), cholesterol, high-density lipoproteins (HDL), glucose, insulin, CD4 cell count and plasma HIV RNA. Current and past antiretroviral therapies were ascertained. Results According to one proposed Australian national definition of lipodystrophy (LDNC), the prevalence of lipodystrophy in this population was 65%. This definition included an objective assessment with major and minor criteria. Patient-defined lipodystrophy (LDP), which involved a subjective assessment of thinning arms and legs and central adiposity, occurred in 19%. Patient-defined lipoatrophy (LAP), which involved a subjective assessment of thinning arms and legs without central adiposity, occurred in 21.3%. No change in body habitus was noted by 37% of the cohort. Hypercholesterolaemia was recorded in 44%, hypertriglyceridaemia in 52% and elevated insulin levels in 23%. Anthropometry was predictive of the per cent total body fat recorded by DEXA scan, but produced consistently lower values. In multivariate analysis, LDP and LAP were significantly associated with stavudine (d4T) use, while LAP was also associated with zidovudine (ZDV) treatment. There were no treatment associations with LDNC. Protease inhibitor (PI) exposure was associated with metabolic changes but not patient perceived body shape changes, while d4T and ZDV exposure was associated with increased triglycerides and reduced peripheral fat stores. Conclusions The prevalence of body shape changes in a single population varied depending on the definition applied. The LDNC definition overestimated body shape abnormalities in comparison with patient perception. LAP was associated with significantly lower fat stores measured by anthropometry and DEXA scan than those identified under the LDNC definition. In contrast to LDNC, LAP was associated with d4T exposure, nucleoside reverse transcriptase inhibitor (NRTI) and ZDV duration of use, but not PI use. Until a consensus definition for lipodystrophy is developed, including agreement on objective measurement and thresholds for abnormality, careful description of the individual components of the syndrome is required to enable cohort comparisons so that predictors of the syndrome can be assessed more accurately and outcome studies made feasible. [source] Establishing an action research group to explore family-focused nursing in the intensive care unitINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 1 2007Fiona Coyer RN ENB100 PGCEA PhD This paper presents the first phase of a four-phase collaborative action research study which aimed to facilitate family-focused nursing in the intensive care environment. The purpose of phase one was to determine intensive care nurses' perceptions of family-focused critical care nursing and the appropriateness of family-focused nursing in the intensive care unit. A collaborative action research group was established with six registered nurses working in the intensive care unit of a metropolitan tertiary referral hospital. Data were collected through group discussions and analysed using open coding. Findings revealed two categories related to perceptions of family-focused intensive care nursing: partnership in care and maintaining a balance. The group unanimously agreed that family-focused nursing was appropriate in the intensive care environment. The three subsequent action research phases of this study are reported elsewhere. [source] No-Reflow Phenomenon Following Percutaneous Coronary Intervention for Acute Myocardial Infarction: Incidence, Outcome, and Effect of Pharmacologic TherapyJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2010F.A.C.C., F.A.C.P., SHEREIF H. REZKALLA M.D. Background: No-reflow (NR) phenomenon is a well-known problem, often accompanying percutaneous coronary intervention for acute ST elevation myocardial infarction (STEMI). There are little data on effects of pharmacologic therapy on the resolution, outcome, and long-term natural history of NR. Objective: Retrospectively assess incidence, management, and prognosis of NR in a tertiary referral hospital. Methods: Study included patients with STEMI, treated with percutaneous coronary intervention (PCI). Effect of pharmacologic therapy and long-term outcome were assessed. NR was defined by thrombolysis in myocardial infarction (TIMI) < 3 or myocardial blush grade (MBG) < 3. Results: Of 347 identified subjects, NR occurred in 110 (32%) by TIMI and 198 (57%) by MBG. Higher incidence was identified in men versus women (34% vs. 25% by TIMI, P = 0.08; and 60% vs. 48% by MBG, P = 0.04). Pharmacologic therapy was equally effective in restoring normal flow, increasing TIMI score from 1.62 ± 0.07 to 2.78 ± 0.06 (P < 0.0001) and MBG score from 0.43 ± 0.08 to 2.09 ± 0.11 (P < 0.0001). Twenty-three percent who did not receive pharmacologic therapy developed clinical composite of congestive heart failure, cardiogenic shock, and/or death; only 9% of patients who received pharmacologic therapy developed this composite. Patients with severe NR despite treatment had poorer prognosis. Sixty-five percent of patients who survived and had repeat angiogram about 1.5 years later had spontaneous improvement in coronary flow by MBG. Conclusion: NR is common in STEMI. Treatment with nicardipine, nitroprusside, and verapamil are equally effective in improving flow. If not treated, prognosis is poor. (J Interven Cardiol 2010;23:429,436) [source] Incidence and Treatment of Arterial Access Dissections Occurring during Cardiac CatheterizationJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2008AMIT PRASAD M.D. Background: Arterial access dissections may complicate cardiac catheterization and can often be treated percutaneously. The goal of this study was to examine the incidence, consequences, and the treatment of arterial access dissections at a tertiary referral hospital with an active training program. Methods: Patients experiencing arterial access dissection during coronary angiography or intervention at our institution between October 1, 2004, and January 31, 2007, were identified and their records were retrospectively reviewed. Results: Thirteen of the 3,062 consecutive patients (0.42%) had arterial access dissection during the study period. The location of the dissection was in the common femoral artery (CFA) (n = 6), the external iliac artery (EIA) (n = 6), or in an aortobifemoral graft (n = 1). Three of the six patients with CFA dissection were diagnosed during coronary angiography, and because of significant comorbidities were treated with self-expanding stents. After a mean follow-up of 7 months, they experienced no stent fracture or other complication. Six patients had EIA dissections. In one such patient, the dissection was not flow limiting and was treated conservatively. The remaining five patients underwent successful implantation of self-expanding stents, and during a mean follow-up of 9.6 months, no patient had any symptoms or events related to lower extremity ischemia. Finally, one patient had an aortobifemoral graft dissection. Due to the patient's critical condition, secondary to sepsis, his family elected to withdraw care, and he subsequently expired. Conclusions: Arterial access dissections occur infrequently during cardiac catheterization. Routine femoral artery angiography may help identify vascular access complications, often allowing simultaneous endovascular treatment, with excellent short-term outcomes. [source] Therapeutic hypothermia after out-of-hospital cardiac arrest: experiences with patients treated with percutaneous coronary intervention and cardiogenic shockACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2007J. Hovdenes Background:, Therapeutic hypothermia has been shown to increase survival after out-of-hospital cardiac arrest (OHCA). The trials documenting such benefit excluded patients with cardiogenic shock and only a few patients were treated with percutaneous coronary intervention prior to admission to an intensive care unit (ICU). We use therapeutic hypothermia whenever cardiac arrest patients do not wake up immediately after return of spontaneous circulation. Methods:, This paper reports the outcome of 50 OHCA patients with ventricular fibrillation admitted to a tertiary referral hospital for immediate coronary angiography and percutaneous coronary intervention when indicated. Patients were treated with intra-aortic balloon counterpulsation (IABP) (23 of 50 patients) if indicated. All patients who were still comatose were treated with therapeutic hypothermia at 32,34 °C for 24 h before rewarming. The end-points were survival and cerebral performance category (CPC: 1, best; 5, dead) after 6 months. Results:, Forty-one patients (82%) survived until 6 months. Thirty-four patients (68%) were in CPC 1 or 2, and seven (14%) were in CPC 3. Of the 23 patients treated with IABP, 14 (61%) survived with CPC 1 or 2. In patients not treated with IABP, 20 patients (74%) survived with CPC 1 or 2. Forty patients (80%) developed myocardial infarction. Percutaneous coronary intervention was performed in 36 patients (72%). Conclusion:, In OHCA survivors who reached our hospital, the survival rate was high and the neurological outcome acceptable. Our results indicate that the use of therapeutic hypothermia is justified even in haemodynamically unstable patients and those treated with percutaneous coronary intervention. [source] Clinical features and natural history of acquired cold urticaria in a tertiary referral hospital: a 10-year prospective studyJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 12 2008A Katsarou-Katsari Abstract Background, Acquired cold urticaria (ACU) represents a heterogeneous group of disorders that share a common clinical feature: the development of urticaria or angioedema after cold exposure. We present epidemiological and clinical data of subjects with ACU, natural progression and we examine possible parameters that could correlate with disease severity. Methods, During a 10-year period in all subjects with ACU, detailed record of personal history, laboratory testing, cold stimulation testing (CST), atopy assessment and disease severity took place. In a re-evaluation visit at the end of the surveillance period, ACU progression was assessed from patients in a subjective way. Results, Four thousand one hundred fifty-seven individuals with chronic urticaria were referred, and 352 (198 males, 154 females, 8.47% of patients with chronic urticaria) presented definite symptoms of physical urticarias, while 95 individuals (49 males, 46 females, 27% of patients with physical urticarias) were detected with ACU. Sixty-two participants were included in study analysis. Thirty-two patients (51.6%) were female; the mean age was 41.5 ± 15.6 years, while the mean age at disease onset was 32.5 ± 15.6 years; half were , 30 years old at disease onset. The mean duration of surveillance was 9.0 ± 6.9 years. During this time interval, 18 patients (29.0%) showed the same or even worse symptomatology, 26 patients reported some improvement (41.9%), while in 18 patients, symptoms resolved completely (29.0%); the mean time to resolution was 5.6 ± 3.5 years. Disease severity was the only variable statistically significantly related to disease progression (P = 0.004). Conclusions, Cold urticaria is a chronic persistent disorder with occasional severe clinical manifestations. [source] Iron and vitamin deficiencies, endocrine and immune status in patients with primary Sjögren's syndromeORAL DISEASES, Issue 3 2001IMC Lundström OBJECTIVES: To study the prevalence of iron and vitamin deficiencies, endocrine disorders and immunological parameters in patients with primary Sjögren's syndrome (1°SS). DESIGN AND SUBJECTS: At the time of the establishment of the diagnosis of 1°SS in 43 consecutive patients, a clinical examination including haematological analyses was performed. The patients' medical records were also reviewed. SETTING: Patients referred for diagnosis to The University Hospital, Linköping, a secondary or tertiary referral hospital serving the middle part of southern Sweden. RESULTS: In total, current or previously treated iron and vitamin deficiencies were registered for 63% of the 1°SS patients (iron 51%, vitamin B12 25%, folate 9%). Current low ferritin was noted in 24%, low iron saturation in 37%, decreased vitamin B12 in 13% and folate in 9%. Thyroid disease was found in a total of 33% and 30% had had autoimmune thyroiditis. Three patients (7%) had verified diabetes mellitus. Erythrocyte sedimentation rate (ESR) was raised in 65% of the patients and 84% had a polyclonal increase of Ig. Rheumatoid factor (RF) was detected in 85%, antinuclear antibody (ANA) in 74%, anti-SS-A in 88% and anti-SS-B in 73% of the patients. CONCLUSION: Iron and vitamin deficiencies and thyroid diseases are common in patients with 1°SS. Since these disorders often are treatable and may affect the patients' distress as well as their immune and exocrine function, an active, recurrent search for deficiencies, endocrine diseases and other frequently recorded disorders is recommended. [source] A prospective evaluation of hemoptysis cases in a tertiary referral hospitalTHE CLINICAL RESPIRATORY JOURNAL, Issue 3 2010uz Uzun Abstract Background and Aims:, Hemoptysis is symptomatic of a potentially serious and life-threatening thoracic disease. The purpose of this study was to evaluate the relative frequency of the different causes of hemoptysis, the change of the frequency of diseases, the value of the evaluation process and the outcome in a tertiary referral hospital. Methods:, A prospective study was carried out on consecutive patients presented with hemoptysis. Results:, A total of 178 patients (136 male, 42 female) were included to the study. Lung cancer (51), pulmonary embolism (23) and bronchiectasis (23) constituted most of the diagnosis. The most frequent cause of hemoptysis in males was by far lung carcinoma (50). Twelve cases of bronchiectasis and 11 cases of pulmonary embolism were observed in females. While lung cancer and pulmonary embolism were associated with mild to moderate amounts of bleeding (84% and 100%, respectively), patients with active tuberculosis and pulmonary vasculitis had severe to massive hemoptysis (50% and 44%, respectively). Transthoracic and other organ biopsies, spiral computed tomography (CT) angiography (X pres/GX model TSX-002a, Toshiba, Tochigi Ken, Japan) and aortography yielded high diagnostic results in our group (100%, 67%, 59% and 100%, respectively). The most frequent final diagnosis in patients with normal chest radiograph was pulmonary embolism (seven cases). Conclusions:, Lung cancer, pulmonary embolism and bronchiectasis were the main causes of hemoptysis in this prospective cohort; however, this is the first report showing pulmonary embolism as a leading cause of hemoptysis. CT angiography with high-resolution CT should be the primary diagnostic modality if the initial investigation is inconclusive in hemoptysis cases. Please cite this paper as: Uzun O, Atasoy Y, Findik S, Atici AG and Erkan L. A prospective evaluation of hemoptysis cases in a tertiary referral hospital. The Clinical Respiratory Journal 2010; 4: 131,138. [source] No Effect of a Nasal Decongestant on Eustachian Tube Function in Children With Ventilation Tubes,THE LARYNGOSCOPE, Issue 6 2002Niels van Heerbeek MD Abstract Objective The aim of the study was to assess the effect of a topical decongestant on eustachian tube function in children with ventilation tubes because of persistent otitis media with effusion. Study Design A randomized, double-blinded, placebo-controlled study. Methods At the outpatient departments of a secondary referral hospital and a tertiary referral hospital, eustachian tube function was measured before and after intranasal administration of five drops of 0.05% xylometazoline hydrochloride or placebo in 80 randomly selected children with ventilation tubes because of otitis media with effusion. Results Xylometazoline nose drops had no effect on the ventilatory or the protective function of the eustachian tube. Conclusions Topical decongestants do not have a positive effect on eustachian tube function in children. Therefore, the use of topical decongestants to prevent or treat otitis media with effusion in children is not justified and should be discouraged. [source] A prospective study of the effect of nursing home residency on mortality following hip fractureANZ JOURNAL OF SURGERY, Issue 6 2010Ian A. Harris Abstract Background:, The strength of nursing home residence as a prognostic indicator of outcome following hip fracture has not previously been examined in Australia. The aim of the study was to examine the influence of nursing home residency on mortality after sustaining an acute hip fracture. Methods:, A prospective study of all adults aged 65 years and over presenting to a single tertiary referral hospital for management of a proximal femoral fracture between July 2003 and September 2006. Residential status was obtained at admission. Patients were followed up to September 2007 (minimum 12 months). Relative risk values for mortality were calculated comparing nursing home residents with non-nursing home residents. Survival analysis was performed. Results:, Relative risk of death was higher in nursing home patients compared with non-nursing home patients. The difference was greater in the immediate period (30 days) post-injury (relative risk 1.9, 95% confidence interval 1.0,3.6, P= 0.04) than after 12 months (relative risk 1.5, 95% confidence interval 1.2,1.8, P= 0.001). Survival analysis showed that 25% of patients in the nursing home group died by 96 days post-injury, compared with 435 days in the non-nursing home group. Conclusions:, Nursing home residence confers an increased risk of death following hip fracture; this difference is greater in the immediate post-injury period. The relative risk of death decreases over time to equal previously reported comparative mortality rates between nursing home residents and community dwellers without hip fracture. [source] Cryotherapy as the treatment modality of postcoital bleeding: A randomised clinical trial of efficacy and safetyAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009Grace Wing Shan KONG Background:, Postcoital bleeding is a common gynaecological problem that impacts on a woman's quality of life and sexual function. There is little systematic research into its management. Aims:, To assess the efficacy and side-effects of cryotherapy as treatment for postcoital bleeding. Methods:, A prospective randomised controlled trial was conducted in a tertiary referral hospital in Hong Kong. A total of 85 women who presented with postcoital bleeding were recruited, and randomised to cryotherapy or no treatment. The treatment group received cryotherapy with compressed carbon dioxide through a cryoprobe placed on the cervix, and controls had cryoprobe on the cervix without compressed carbon dioxide flow. All recruited women were followed up two weeks, three months and six months to review their symptoms and response to the treatment. Results:, The treatment group had a significantly better long-term cure rate and improvement rate. At six months, the cryotherapy group reported a cure rate of 72.1% while that in the control group the cure rate was 50.0% (P = 0.04). The number needed to treat was 5. The mean improvement rate of the cryotherapy group was 82.88% ± 35.87 but was only 61.62% ± 55.30 in the control group (P = 0.04). The results were more significant in women with the defined pathological cervix. Apart from the vaginal discharge at second week follow up in the treatment group, there was no statistical significant difference in side-effects and complications among two groups. Conclusion:, Our study demonstrated that cryotherapy is a safe and an effective treatment for postcoital bleeding. [source] Medical and midwifery students: how do they view their respective roles on the labour ward?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2002Julie A Quinlivan ABSTRACT Background It has been suggested that much of the medical and midwifery student curricula on normal pregnancy and birth could be taught as a co-operative effort between obstetric and midwifery staff. One important element of a successful combined teaching strategy would involve a determination of the extent to which the students themselves identify common learning objectives. Aim The aim of the present study was to survey medical and midwifery students about how they perceived their respective learning roles on the delivery suite. Methods A descriptive cross-sectional survey study was undertaken. The study venue was an Australian teaching and tertiary referral hospital in obstetrics and gynaecology. Survey participants were medical students who had just completed a 10 week clinical attachment in obstetrics and gynaecology during the 5th year of a six year undergraduate medical curriculum and midwifery students undertaking a one year full-time (or two year part-time) postgraduate diploma in midwifery. Results Of 130 and 52 questionnaires distributed to medical and midwifery students, response rates of 72% and 52% were achieved respectively. The key finding was that students reported a lesser role for their professional colleagues than they identified for themselves. Some medical students lacked an understanding of the role of midwives as 8%, 10%, and 23% did not feel that student midwives should observe or perform a normal birth or neonatal assessment respectively. Of equal concern, 7%, 22%, 26% and 85% of student midwives did not identify a role for medical students to observe or perform a normal birth, neonatal assessment or provide advice on breastfeeding respectively. Summary Medical and midwifery students are placed in a competitive framework and some students may not understand the complementary role of their future colleagues. Interdisciplinary teaching may facilitate co-operation between the professions and improve working relationships. [source] Increased maternal BMI is associated with an increased risk of minor complications during pregnancy with consequent cost implicationsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2009FC Denison Objective, To investigate the effect of maternal body mass index (BMI) on minor complications, associated additional medication use during pregnancy and the consequent cost implications. Design, Retrospective analysis of case notes. Setting, Labour wards, tertiary referral hospital, Royal Infirmary Edinburgh, UK. Population, Six hundred and fifty-one women with a singleton pregnancy over four separate time periods in 2007 and 2008. Methods, Descriptive statistics, univariate and multivariate logistic regression analysis and cost analysis using standard techniques and inflation indices. Main outcome measures, Minor complications, use of medications during pregnancy and consequent incremental costs from the perspective of the National Health Service (NHS). Results, 42.4% of women were overweight or obese (BMI , 25 kg/m2). Higher BMI during the first trimester (BMI , 30 kg/m2 compared with BMI < 25 kg/m2) was associated with an increased risk of minor complications including symphysis pubis dysfunction (OR 3.97; 95% CI 2.19,7.18), heartburn (OR 2.65; 95% CI 1.42,4.94) and chest infection (OR 8.71; 95% 2.20,34.44) and with drugs used to treat these complications including Gaviscon (OR 3.52; 95% CI 1.78,6.96). The mean incremental (additional) NHS costs per woman for treating minor complications increased with maternal BMI were £15.45/woman, £17.64/woman and £48.66/woman for BMI < 25 kg/m2, BMI , 25 to <30 kg/m2 and BMI , 30 kg/m2 respectively. Conclusions, Increased maternal BMI is associated with increased risk of developing minor complications during pregnancy; use of medications associated with treating these conditions and has significant NHS costs. [source] Inter- and intra-observer agreement of intrapartum ST analysis of the fetal electrocardiogram in women monitored by STANBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2009MEMH Westerhuis Objective, The objective of this study was to quantify inter- and intra-observer agreement on classification of the intrapartum cardiotocogram (CTG) and decision to intervene following STAN guidelines. Design, A prospective, observational study. Setting, Obstetrics Department of a tertiary referral hospital. Population, STAN recordings of 73 women after 36 weeks of gestation with a high-risk pregnancy, induced or oxytocin-augmented labour, meconium-stained amniotic fluid or epidural analgesia. Methods, Six observers classified 73 STAN recordings and decided if and when they would suggest an intervention. Proportions of specific agreement (Ps) and kappa values (K) were calculated. Main outcome measures, Agreement upon classification of the intrapartum CTG and decision to perform an intervention. Results, Agreement for classification of a normal and a (pre)terminal CTG was good (Ps range 0.50,0.84), but poor for the intermediary and abnormal CTG (Ps range 0.34,0.56). Agreement on the decision to intervene was higher, especially on the decision to perform ,no intervention' (Ps range 0.76,0.94). Overall inter-observer agreement on the decision to intervene was considered moderate in five of six observer combinations according to the kappa (K range 0.42,0.73). Intra-observer agreement for CTG classification and decision to intervene was moderate (K range 0.52,0.67 and 0.61,0.75). Conclusions, Inter-observer agreement on classification of the intrapartum CTG is poor, but addition of information regarding fetal electrocardiogram, especially in case of intermediary or abnormal CTG traces, results in a more standardised decision to intervene. [source] Fetal fibronectin test predicts delivery before 30 weeks of gestation in high risk women, but increases anxietyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2005Andrew Shennan Objective To assess efficacy of cervico-vaginal fetal fibronectin as a predictor of spontaneous preterm birth in a high risk antenatal population, and to evaluate the psychological impact of fetal fibronectin testing. Design An observational study. Setting The antenatal clinic at a tertiary referral hospital. Population One hundred and forty-six pregnant women with known risk factors for spontaneous preterm birth. Methods Women designated as ,at risk' for preterm delivery by clinical history were screened for fetal fibronectin at 24 and again at 27 weeks of gestation. Anxiety levels were assessed by questionnaire and compared with anxiety levels of 206 low risk women also tested for fetal fibronectin. Fetal fibronectin results were disclosed to the woman and her clinician. Main outcome measures Maternal anxiety and efficacy of the 24-week fetal fibronectin test to predict delivery before 30, 34 and 37 weeks of gestation. Results Maternal anxiety was higher pretesting in those at high risk compared with low risk women undergoing the test. Among the high risk women, anxiety was raised to clinically significant levels in those receiving a positive fetal fibronectin screening test result. In all women, 5%, 9% and 21% delivered <30, <34 or <37 weeks of gestation, respectively. Nine percent (n= 13) tested positive for fetal fibronectin at 24 weeks. Predictive power for fetal fibronectin (24 weeks) was greatest for delivery <30 weeks of gestation, with a likelihood ratio of 15 for a positive test (6/13 positive women delivered before 30 weeks). Conclusions Fetal fibronectin was most efficient as a predictor of preterm spontaneous delivery <30 weeks of gestation, but was associated with high levels of anxiety. [source] Non-invasive fetal electrocardiography in singleton and multiple pregnanciesBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2003Myles J.O. Taylor Objectives To document the duration of fetal cardiac time intervals in uncomplicated singleton pregnancies using a novel non-invasive fetal electrocardiography (fECG) system and to demonstrate this technique's ability to acquire recordings in twin and triplet pregnancies. Design Prospective cross sectional observational study. Setting Antenatal wards and clinics, day assessment unit and centre for fetal care at a tertiary referral hospital, London, UK. Population or Sample Three hundred and four singleton and multiple pregnancies, 15,41 weeks of gestation. Methods Using electrodes sited on the maternal abdomen, a fetal electrocardiography (fECG) system was developed and tested on 304 pregnant women from 15 to 41 weeks of gestation, of whom 241 were uncomplicated singletons, 58 had twin and 5 had triplet pregnancies. The composite abdominal signals were stored on a laptop computer and the fECG derived off-line using a digital signal processing technique. For singletons, linear regression was used to analyse PR, QRS, QT and QTc intervals, and construct time-specific reference ranges. Main outcome measure Duration of fECG time intervals as a function of gestational age. Success of signal seperation in singleton, twin and triplet pregnancies. Results For singletons, a total of 250 recordings was obtained from 241 individuals with a signal separation success rate of 85% (213/250). Success rates were significantly poorer between 27 and 36 weeks of gestation (2 × k ,2, P < 0.0001), with 84% (31/37) of separation failures occurring during this period. P, Q, R and S waves were seen in all cases where fetal signals were separated and were used to generate fECG time interval reference ranges. In 22% (43/199) of analysed cases, no T waves were identified, 63% (27/43) of whom were ,24 weeks of gestation. In twins and triplets, separate fetal signals were obtained in 78% (91/116) and 93% (14/15), respectively; P, Q, R and S waves were evident in all averaged fECGs, while T waves were identified in 59% (54/91) and 57% (8/14). Conclusions This study provides reference ranges with gestation for fECG intervals derived non-invasively from normal singleton pregnancies and demonstrates the feasibility of obtaining complete fECG recordings non-invasively across a wide gestational range in pregnancies of all pluralities. The fECG time intervals described will enable the identification of pathological fECG recordings from high risk pregnancies where fECG abnormalities are suspected. [source] Women's attitudes to HIV screening in pregnancy in an area of low prevalenceBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2003Swati Jha Objectives To identify factors that influence acceptance of the human immunodeficiency virus (HIV) screening test by pregnant women. Design Prospective survey using questionnaires. Setting An antenatal clinic at a tertiary referral hospital. Population 200 pregnant women of multiethic origin residing in a low prevalence area. Methods Two hundred consecutive women attending the antenatal booking clinic were interviewed. We collected data on reasons for opting in or out and factors that could influence the rate of acceptance, such as ethnicity, age, parity, level of education, first language and marital or relationship status. Main outcome measure Attitudes of pregnant women to HIV screening. Results The rate of acceptance of HIV screening was 160/200(80%). The most frequent reasons for opting in were the perceived benefits of screening (92/160, 58%) and the fact that the test is now routinely offered (87/160, 54%). The most frequent reason for refusal of screening was perceived low risk of HIV (27/40, 68%). Logistic regression analysis showed that ethnicity, age, parity and level of formal education did not play a role in influencing uptake of the test. However, women whose first language was English were more likely to opt in compared with those whose first language was not English (P= 0.016) and those who were married or in a stable relationship were more likely to opt in than those who were not (P < 0.001). Conclusion We have not reached the national target of 90% in our region. This appears to be due to a combination of factors, the main one being a perception of low risk. Greater knowledge of the ease of transmission of HIV may alter this perception, which may improve acceptance of the test. [source] Idiopathic infantile arterial calcification: Two case reports, a review of the literature and a role for cardiac transplantationPEDIATRIC TRANSPLANTATION, Issue 2 2006Andrew C. Glatz Abstract:, Idiopathic infantile arterial calcification (IIAC) is a rare, but important, cause of rapidly progressive ischemic heart disease in children. In this paper, we report two recent cases of IIAC seen at tertiary referral hospitals. Both cases presented in infancy with signs of heart failure and, ultimately, died with the diagnosis of IIAC confirmed at postmortem examination. A thorough review of the literature reveals approximately 160 reported cases of IIAC. The clinical outcomes, radiographic findings and pathologic details are summarized. Proposed etiologic mechanisms are reviewed, including promising research into the role of inorganic pyrophosphate as a regulatory factor in the development of IIAC. Because of the typically fatal outcome of IIAC and the lack of proven therapies, the potential role for cardiac transplantation is discussed. [source] Twin deliveries and place of birth in NSW 2001,2005AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009Charles S. ALGERT Background:, Twin pregnancies have an elevated risk of adverse outcomes, particularly preterm twins. Aims:, Describe the distribution of twin deliveries by hospital level, the associated perinatal and maternal morbidity, and determine predictors of perinatal morbidity and urgent transfer to a neonatal intensive care unit. Methods:, Longitudinally linked New South Wales delivery and hospital records for the years 2001,2005 were used to identify perinatal and maternal morbidity/mortality in twin pregnancies. Regression analysis was used to examine predictive factors, including birth hospital volume. Results:, At , 32 weeks, 88.1% of twins were delivered in tertiary referral hospitals. By 34,35 weeks, only 39.7% of twins were delivered in tertiary units. Gestational age was the primary predictor of perinatal morbidity/mortality. Perinatal morbidity/mortality and maternal morbidity were lowest for deliveries at 38 weeks. There was no evidence that planned caesarean section at , 38 weeks was protective against perinatal morbidity/mortality. There was an increased risk of perinatal morbidity/mortality (odds ratio (OR) = 2.22) for twins delivered at 33,35 weeks gestation at hospitals with < 500 deliveries per annum, and an increased risk of urgent neonatal transfer (OR = 2.06). Twin pairs for whom there was a , 20% discordance in birthweight had an increased risk of morbidity/mortality at 36,38 weeks (OR = 1.79). Conclusions:, Both infant and maternal morbidity increase from 39 weeks gestation. Delivery of twins before 36 weeks at smaller hospitals (< 500 deliveries per annum) should be avoided. A twin pregnancy where there is a , 20% difference in estimated fetal weights should be considered for referral to a tertiary obstetric unit. [source] | ||||||||||