Discharge is a critical time to influence 10-year use of secondary prevention therapies for stroke.

BACKGROUND AND PURPOSE: When optimally managed, patients with stroke are less likely to have further vascular events. We aimed to identify factors associated with optimal use of secondary prevention therapies in long-term survivors of stroke. METHODS: We carefully documented discharge medications at baseline and self-reported use of medications at annual follow-up in the Northeast Melbourne Stroke Incidence Study (NEMESIS). We defined optimal medication use when patients reported taking (1) antihypertensive agents and (2) statin and antithrombotic agents (ischemic stroke only). Logistic regression was used to assess factors associated with optimal medication use between 2 and 10 years after stroke. RESULTS: We recruited 1241 patients with stroke. Optimal prescription at discharge from hospital was the most important factor associated with optimal medication use at each time point: odds ratio (OR), 32.2 (95% confidence interval [CI], 13.6-76.1) at 2 years; OR, 7.86 (95% CI, 4.48-13.8) at 5 years (425 of 505 survivors); OR, 6.04 (95% CI, 3.18-11.5) at 7 years (326 of 390 survivors); and OR, 2.62 (95% CI, 1.19-5.77) at 10 years (256 of 293 survivors). Associations were similar in men and women. The association between optimal prescription at discharge and optimal medication use at each time point was greater in those who were not disadvantaged, particularly women. CONCLUSIONS: Prescription of medications at hospital discharge was the strongest predictor of ongoing medication use in survivors of stroke, even at 10 years after stroke. Ensuring that patients with stroke are discharged on optimal medications is likely to improve their long-term management, but further strategies might be required among those who are disadvantaged.

Management of HIV-positive pregnant women: a Singapore experience.

INTRODUCTION: Perinatal transmission remains one of the important causes of transmission of the human immunodeficiency virus (HIV). Over the years, with better knowledge and awareness of HIV infection, the perinatal transmission rate has been significantly reduced. We previously reported on the pregnancy outcomes of HIV-positive mothers from 1997 to 2007 in our institution. This article aimed to review the standards of care of HIV-positive pregnant women since then. METHODS: A retrospective study reviewed 84 HIV-positive women who delivered in a tertiary centre from January 2008 to December 2015. Patient demographics and antenatal, intrapartum, postnatal and immediate neonatal data were analysed. RESULTS: A total of 97 deliveries with 98 neonates were recorded; 12 women delivered more than once, and there was one set of twins. The mean maternal age at diagnosis of HIV infection was 27.8 years. Of the study population, 63.1% of women were non-Singaporeans. 56 women were known to have HIV infection on presentation and 90.7% were on antiretroviral therapy during pregnancy. 88.7% of the women received intrapartum intravenous zidovudine, and 93.1% of women with detectable and 58.7% with undetectable viral load underwent Caesarean sections. All neonates were HIV-negative. CONCLUSION: The high standards of care for HIV-positive women have successfully reduced our perinatal transmission rate to zero.

Taking Serious Games Forward in Curriculum and Assessment: Starting Infusions Right Every Time.

Technology-driven educational modalities are increasingly utilized today in a variety of forms. Different combinations of the spectrum of simulation-based learning, the use of virtual reality, augmented reality, mixed reality, and serious gaming continue to gain traction on various educational platforms. In this paper, we share the formation of our project team to plan and execute a serious game on starting infusions and the use of infusion pump for nursing and health-care staff. The incorporation of element of assessment is also discussed. The various phases we went through included: Learning needs assessment and conceptualizationAssembly of project teamTransfer of medical conceptsStoryboard and content productionLearners' experiential mappingTesting of the prototypeBeta testing and release of the final product The collaborative work and coordination between the subject-matter experts together with the technical production team is critical. Issues such as assessment and debriefing in serious gaming were also addressed, not forgetting the need to ensure that, above all, learning must take place.

Outcomes following selective fetoscopic laser ablation for twin-to-twin transfusion syndrome: a single-centre experience.

INTRODUCTION: Fetoscopic laser photocoagulation (FLP), a treatment option for twin-to-twin transfusion syndrome (TTTS) in monochorionic twin pregnancies, is currently the treatment of choice at our centre. We previously reported on our experience of FLP from June 2011 to March 2014. This paper audits our fetal surgery performance since then. METHODS: 15 consecutive patients who underwent FLP for Stage II-III TTTS before 26 weeks of gestation from June 2011 to January 2017 were retrospectively reviewed, consisting of five cases from our initial experience and ten subsequent cases. Perioperative, perinatal and neonatal outcomes were analysed. RESULTS: Of 15 pregnancies, 10 (66.7%) and 5 (33.3%) were for Stage II and III TTTS respectively, with FLP performed at an earlier Quintero stage in the later cohort. Overall mean gestational ages at presentation, laser and delivery were comparable between the cohorts at 19.7 (15.4-24.3) weeks, 20.3 (16.3-25.0) weeks and 31.2 (27.6-37.0) weeks, respectively. 2 (13.3%) cases had intra-amniotic bleeding and 1 (6.7%) had iatrogenic septostomy. 1 (6.7%) case had persistent TTTS requiring repeat FLP, and another (6.7%) had preterm premature rupture of membranes at seven weeks post procedure. The overall perinatal survival rate was 21 (75.0%) out of 28 infants. One mother underwent termination of pregnancy for social reasons at 1.4 weeks post procedure. Double survival occurred in 8 (57.1%) out of 14 pregnancies, while 13 (92.9%) had at least one survivor. CONCLUSION: FLP requires a highly specialised team and tertiary neonatal facility. Continual training improves maternal and perinatal outcomes, ensuring comparable standards with international centres.

Evaluation of the Natus ALGO 3 Newborn Hearing Screener.

OBJECTIVE: To compare the ALGO 3 Newborn Hearing Screener (Natus Medical Inc.) to the ALGO 2e Newborn Hearing Screener (Natus Medical Inc.). DESIGN: A prospective evaluation. SETTING: Three maternity hospitals. PATIENTS/PARTICIPANTS: 199 newborns enrolled; 194 completed the study. INTERVENTIONS: Patients were tested using either the ALGO 3 screener or the ALGO 2e screener first, and then screened with the alternate device. Initial screens resulting in REFER outcomes were repeated using the same device. An ALGO 2e PASS result was accepted as adequate evidence of hearing. Two sequential ALGO 2e REFER results required further diagnostic testing to determine hearing status. MAIN OUTCOME MEASURES: Average screening times and referral rates of both hearing screeners. RESULTS: The ALGO 3 screener averaged 70.8 seconds (95% confidence interval = 34.5-107.1 seconds), or was 23% faster than the ALGO 2e screener (p = .0002). There were 48% fewer REFER results after initial screening with the ALGO 3 screener (5.7%) than with the ALGO 2e screener (10.9%) (p = .06). Faster screen times and fewer referrals were noted at each hospital. CONCLUSION: The ALGO 3 screener can increase caregiver efficiency by accurately screening hearing in newborns faster and with fewer REFER results than the ALGO 2e screener.