Sonologist's characteristics related to a higher quality in fetal nuchal translucency measured in primary antenatal care centers.

OBJECTIVE: To assess the quality of nuchal translucency (NT) measurements in primary care and the sonologist's characteristics related with a higher quality. METHODS: The median NT expressed in multiples of the median (MoM) was calculated for each sonologist of 14 participating antenatal primary care centers of the Catalan Institute of Health. A survey to the sonologists was used to establish variables related to higher-quality measurements. RESULTS: The median NT MoM obtained in 16 448 NT measurements, performed by 102 sonologists, was 0.94 MoM. NT underestimation was observed in 46% of the sonologists. Underestimation were less frequent among professionals who performed more than 230 ultrasounds per year (26% vs 53%;p = .022), those who completed the online Fetal Medicine Foundation (FMF) course (22% vs 54%; p = .021), and those who were subject to periodic audits (24% vs 56%; p = .021). Underestimation rate decreased from 60%, to 33% and 14% with the increase of the years of experience from less than 5 years, to 6 to 15 years and more than 15 years of experience, respectively (p = .029). CONCLUSIONS: Higher-quality measurements were demonstrated in sonologists who performed more ultrasounds per year, those with more years of scanning experience, those who completed the online FMF course, and those periodically audited.

Does episiotomy protect against injury of the levator ani muscle in normal vaginal delivery?

AIMS: To investigate whether episiotomy is associated with avulsion of the levator ani in its pubic insertion after normal vaginal delivery. METHODS: This is an observational study at a tertiary obstetric unit recruited 194 primiparous women who had normal vaginal delivery with or without episiotomy. All women underwent translabial 4D ultrasound scanning after delivery. Tomographic ultrasound imaging was used to diagnose levator avulsion. Lesions were recorded as unilateral or bilateral. The investigators were blinded to all clinical data. The influence of other variables associated with delivery such as maternal age, body mass index, gestational age, birth weight, fetal head circumference, and use of epidural anesthesia was recorded and their relation with avulsion was also studied. RESULTS: Avulsion was identified in eleven (10.9%) of the 101 women with episiotomy and in fourteen (15.1%) of the 93 women without. The difference was not statistically significant (P = 0.401). Other variables showed no influence on the prevalence of avulsion. CONCLUSIONS: Episiotomy does not appear to be associated with injury to the levator ani muscle in its pubic insertion in normal vaginal delivery.

Effects of a Primary Care Antimicrobial Stewardship Program on Meticillin-Resistant Staphylococcus aureus Strains across a Region of Catalunya (Spain) over 5 Years.

Primary care antimicrobial stewardship program (ASP) interventions can reduce the over-prescription of unnecessary antibiotics, but the impact on the reduction in bacterial resistance is less known, and there is a lack of available data. We implemented a prolonged educational counseling ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, which was compared to a pre-intervention period, a significant reduction in antibiotic prescriptions occurred, particularly those associated with greater harmful effects and resistance selection. There was also a decrease in methicillin-resistant Staphylococcus aureus (MRSA) strains and in their co-resistance to other antibiotics, particularly those with an ecological impact.

Impact of a Primary Care Antimicrobial Stewardship Program on Bacterial Resistance Control and Ecological Imprint in Urinary Tract Infections.

Antimicrobial stewardship programs (ASPs) are a central component in reducing the overprescription of unnecessary antibiotics, with multiple studies showing benefits in the reduction of bacterial resistance. Less commonly, ASPs have been performed in outpatient settings, but there is a lack of available data in these settings. We implemented an ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, compared to the pre-intervention period, a significant reduction in antibiotic prescription occurred, with a reduction in resistance in E. coli urinary isolates. ASP activities also were found to be cost-effective, with a reduction in medication prescription.