The compliance with a patient-safety bundle for management of placenta accreta spectrum†.

OBJECTIVE: Our objective was to evaluate the compliance with a patient-safety bundle for placenta accreta spectrum (PAS) by comparing the implementation of the components of the patient-safety bundle in the pre- and post-protocol time periods as a quality improvement project. STUDY DESIGN: This is a before and after retrospective cohort study as a quality improvement report examining compliance with a multidisciplinary delivery approach for patients with suspected PAS between 2007 and 2018. This bundle involved a multidisciplinary approach with maternal-fetal medicine, gynecologic oncology, intervention radiology, obstetric anesthesia, neonatology, and blood bank. The primary outcome was incorporation of all six of the components of the bundle into a PAS procedure: (1) betamethasone, (2) gynecologic oncology intraoperative consult, (3) preoperative balloon catheters, (4) cell salvage technology in the operating room, (5) vertical skin incision, and (6) fundal or high transverse hysterotomy. Demographic, delivery, and patient outcome data were also collected. RESULTS: There were 39 patients included in the study, 17 were pre-protocol and 22 were post-protocol. Patients were more likely to have a PAS suspected in the antenatal period during post protocol period (23.5 versus 90.9%, p < .0001), as well as having a placenta previa (35.3 versus 81.8%, p = .003), and receive betamethasone prior to delivery (23.5 versus 86.3%, p < .0001). Patients were delivered at an earlier gestational age in post protocol period (36.8 ± 2.52 versus 33.87 ± 2.4, p = .001). The primary outcome, adherence to all components of the patient-safety bundle, was more likely to occur in the post protocol period (0 versus 40.9%, p < .0001). Maternal and postoperative outcomes were not significantly different between groups. CONCLUSIONS: We have successfully implemented a patient-safety bundle for PAS and have standardized the execution of multidisciplinary management for PAS at our institution.

SHORT-TERM PERCEPTUAL TUNING TO TALKER CHARACTERISTICS.

When a listener encounters an unfamiliar talker, the ensuing perceptual accommodation to the unique characteristics of the talker has two aspects: (1) the listener assesses acoustic characteristics of speech to resolve the properties of the talker's sound production; and, (2) the listener appraises the talker's idiolect, subphonemic phonetic properties that compose the finest grain of linguistic production. A new study controlled a listener's exposure to determine whether the perceptual benefit rests on specific segmental experience. Effects of sentence exposure were measured using a spoken word identification task of Easy words (likely words drawn from sparse neighborhoods of less likely words) and Hard words (less likely words drawn from dense neighborhoods of more likely words). Recognition of words was facilitated by exposure to voiced obstruent consonants. Overall, these findings indicate that talker-specific perceptual tuning might depend more on exposure to phonemically marked consonants than to exposure distributed across the phoneme inventory.

Constraints on Sensitivity to Auditory Modulation in the Perceptual Organization of Speech.

BACKGROUND/STUDY CONTEXT: The perception of speech requires the integration of sensory details from a rapidly fading trace of a time-varying spectrum. This effortful cognitive function has been difficult to assess. New tests measuring intelligibility of sine-wave replicas of speech provided an assay of this critical function in normal-hearing young adults. METHODS: Four time-varying sinusoids replicated the frequency and amplitude variation of the natural resonances of spoken sentences. The temporal tolerance of perceptual integration of speech was measured by determining the effect on intelligibility of desynchronizing a single sine-wave component in each sentence. This method was applied in tests in which the sentences were temporally compressed or expanded over a 40% range. RESULTS: Desynchrony was harmful to perceptual integration over a narrow temporal range, indicating that modulation sensitivity is keyed to a rate of 20 Hz. No effect of variation in speech rate was observed on the intelligibility measure, whether rate was accelerated or decelerated relative to the natural rate. CONCLUSION: Performance measures of desynchrony tolerance did not vary when speech rate was accelerated or decelerated, revealing constraints on integration that are arguably primitive, sensory, auditory, and fixed. Because these are not adaptable, they limit the potential for perceptual learning in this aspect of perceptual organization. Implications for describing the elderly listener are noted.