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Cardiac implantable electronic devices in pregnancy: A position statement.The aim of this document is to provide guidance for the management of women and birthing people with a permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD). Cardiac devices are becoming more common in obstetric practice and a reference document for contemporary evidence-based practice is required. Where evidence is limited, expert consensus has established recommendations. The purpose is to improve safety and reduce the risk of adverse events relating to implanted cardiac devices during pregnancy, birth and the postnatal period.
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The use of solar film elements on a neonate manikin surface to estimate the received output power of neonatal phototherapy lamp systemsThe work described was undertaken to develop a means to estimate the delivered power over the exposed body surface of a neonate receiving phototherapy. Previous work of the group had involved the use of discrete photodiodes distributed over a newborn manikin surface. It was considered that improved accuracy of sensing over curved surfaces would be provided with the use of flexible solar cell elements. A group of products based on amorphous silicon was identified as potentially suitable and a range of its properties investigated. These included the wavelength sensitivity, the relative sensitivity of similar elements and the cosine response of elements. It was identified that with selection of elements of matched sensitivity, specific element types were appropriate for intended use. A total of 44 discrete solar cell elements of three separate sizes was used to cover the previously used manikin surface and a dedicated interface circuit was designed and constructed. A handheld calibrated spectroradiometer provided a means to relate incident irradiance values within specific wavelength bands to corresponding optical power over the manikin surface. Initial use of the system is described together with future potential developments in relation to clinical applications and testing standards for neonatal phototherapy devices.
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Bloom's syndrome in an Indian man in the UKA 17-year-old Indian man was diagnosed with Bloom's syndrome at the age of 3 years. This is the first reported case of Bloom's in an Indian from the UK and the third case report from the British Isles. Bloom's is typically characterised by short stature, photosensitivity, telangiectatic erythema, learning difficulties, immunodeficiency and malignancy. He was born below the 0.4th centile and failed to gain weight as an infant. He presented in clinic with short stature, prominent facial features and hyperpigmented skin patches, which are all defining characteristics of Bloom's syndrome. Other case reports have documented early neoplasms, photosensitivity and learning difficulties in these patients; however, our patient is different, and currently attends a mainstream college, demonstrating little difficulty in coping with the work. To date, he has not presented with any malignancy or characteristic malar rash.
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Intrapartum care-updated summary of NICE guidance.No Abstract Exists
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Surgical outcomes of total duct excision in the diagnosis and management of nipple dischargeIntroduction Total duct excision (TDE) is performed for the diagnosis and management of nipple discharge. The Association of Breast Surgery’s recent guidelines recommend considering diagnostic surgery for single-duct, blood-stained or clear nipple discharge, and for symptomatic management. Methods We retrospectively reviewed the diagnostic and surgical outcomes of all cases of TDE between January 2013 and November 2019.
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The Neonatal and Paediatric Pharmacokinetics of Antimicrobials study (NAPPA): investigating amoxicillin, benzylpenicillin, flucloxacillin and piperacillin pharmacokinetics from birth to adolescence.Pharmacokinetic (PK) data underlying paediatric penicillin dosing remain limited, especially in critical care.
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Outcome following laser surgery of twin–twin transfusion syndrome complicated by selective fetal growth restriction: systematic review and meta‐analysisThe published literature reports mostly on the outcome of twin pregnancies complicated by twin-twin transfusion syndrome (TTTS) without considering whether the pregnancy is also complicated by another pathology, such as selective fetal growth restriction (sFGR). The aim of this systematic review was to report on the outcome of monochorionic diamniotic (MCDA) twin pregnancies undergoing laser surgery for TTTS that were complicated by sFGR and those not complicated by sFGR.
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First-trimester choroid-plexus-to-lateral-ventricle disproportion and prediction of subsequent ventriculomegaly.Ventriculomegaly can be associated with long-term neurodevelopmental impairment. Prenatal diagnosis of ventriculomegaly is most commonly made at the routine second-trimester anomaly scan. The value of first-trimester ultrasound has expanded to early diagnosis and screening of fetal abnormalities. The objective of this study was to assess the predictive accuracy of first-trimester choroid-plexus-to-lateral-ventricle-or-head ratios for development of ventriculomegaly at a later gestational age.
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Designing economic evaluations alongside clinical trials in maternal health care: A guide for clinical trial designBackground: Economic evaluations are being conducted with increasing frequency in the maternity care setting, with more randomized controlled trials containing a health economic component. Key emerging criticisms of economic evaluation in maternity care are lack of robust data collection and measurement, inconsistencies in methodology, and lack of adherence to reporting guidelines.
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Carbon dioxide monitoring during neonatal stabilisation at delivery (COSTA-Neo)-multi centre observational studyThe data is evolving on exhaled carbon dioxide (ECO2) levels for preterm infants requiring stabilisation.
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Robotic and laparoscopic gynaecological surgery: a prospective multicentre observational cohort study and economic evaluation in England.Objective: To compare the health-related quality of life and cost-effectiveness of robot-assisted laparoscopic surgery (RALS) versus conventional 'straight stick' laparoscopic surgery (CLS) in women undergoing hysterectomy as part of their treatment for either suspected or proven gynaecological malignancy.
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Do you know when the inhaler is empty?Background: Medication review is recommended at asthma appointments. The presence of propellant in the metered dose inhalers (MDIs) makes it challenging to identify when the inhaler is empty. The COVID-19 pandemic has resulted in move towards more virtual monitoring of care. We aimed to evaluate if patients identify when the inhaler is empty and the method of inhaler disposal. Methods: Prospective, multicentre quality improvement project. Data collected from children with asthma and other respiratory conditions. Outcome measures: Children/carers attending hospital were asked how they identify an empty salbutamol inhaler; dose counters in the preventer inhalers and disposal practices were reviewed. Results: 157 patients recruited. 125 (73.5%) patients deemed an empty inhaler as either full/partially full. 12 of 66 (18.2%) preventer inhalers with a dose counter were empty. 83% disposed their inhalers in a dustbin. Conclusions: Patients cannot reliably identify when their MDI is empty. There is an urgent need for improving inhaler technology and providing appropriate guidance on how to identify when an MDI is empty.
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Comparison of ductus venosus Doppler and cerebroplacental ratio for the prediction of adverse perinatal outcome in high-risk pregnancies before and after 34 weeks.The objective of the study was to compare the accuracy of the ductus venosus pulsatility index (DV PI) with that of the cerebroplacental ratio (CPR) for the prediction of adverse perinatal outcome at two gestational ages: <34 and ≥34 weeks' gestation.
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Low-grade Serous Carcinoma Arising in Inguinal Nodal Endosalpingiosis: Report of 2 Cases and Literature Review.We report 2 cases of low-grade serous carcinoma probably arising from endosalpingiosis within inguinal lymph nodes. The neoplasms occurred in 51- and 58-yr old women in the absence of tumor within the adnexa, peritoneum or elsewhere. These represent the first reported examples of low-grade serous carcinoma arising within and confined to inguinal nodes. We review the pertinent literature regarding primary nodal low-grade serous carcinoma.
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Predictors of patient preference for mode of delivery following an obstetric anal sphincter injury.Patients who sustain an Obstetric Anal Sphincter Injury (OASI) have the opportunity to select an elective caesarean section over a vaginal delivery in subsequent pregnancies. It remains unclear whether there are identifiable factors which predict expectant mothers' choices. The primary aim of our study was to explore this issue further in a consecutive group of patients who had suffered OASI.
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Levothyroxine in Women with Thyroid Peroxidase Antibodies before Conception.Thyroid peroxidase antibodies are associated with an increased risk of miscarriage and preterm birth, even when thyroid function is normal. Small trials indicate that the use of levothyroxine could reduce the incidence of such adverse outcomes.
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The use of Episcissors-60 to reduce the rate of Obstetric Anal Sphincter Injuries: A systematic review.The aim of this systematic review is to evaluate the effect of Episcissors-60, which were designed to improve the accuracy of episiotomies, on the rate of Obstetric Anal Sphincter Injuries.
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Data re-entry overload: time for a paradigm shift in maternity IT?This paper provides an overview of maternity information technology (IT) in Britain, questioning the usability, effectiveness and cost efficiency of the current models of implementation of electronic maternity records. UK experience of hand-held paper obstetric notes and computerized records reveals fundamental problems in the relationship between the two complementary methods of recording maternity data. The assumption that paper records would inevitably be replaced by electronic substitutes has proven false; the rigidity of analysable electronic records has led to immense incompatibility problems. The flexibility of paper records has distinct advantages that have so far not been sufficiently acknowledged. It is suggested that continuing work is needed to encourage the standardization of electronic maternity records, via a new co-creative, co-development approach and continuing international electronic community debate.