The association of gestational age at delivery with neonatal outcomes in prenatally diagnosed vasa previa.

OBJECTIVE: To report on the association of gestational age at delivery and neonatal outcomes in prenatally diagnosed vasa previa. METHODS: A retrospective cohort study at two academic/community hybrid hospitals, covered by the same maternal-fetal medicine group. Neonatal characteristics and outcomes were compared between cases of prenatally diagnosed vasa previa delivered at gestational age <36 weeks and ≥36 weeks. RESULTS: We identified 59 cases of vasa previa, of which 2 were excluded, one due to delivery at 28 weeks for preeclampsia, and one because it was not diagnosed prenatally, leaving 57 pregnancies in our study. There were 2 sets of twins. As such, there were 59 newborns. The mean gestational age at delivery was 35.08 (± 0.27) weeks for those delivered at <36 weeks, and 36.11 (±0.16) weeks for those delivered ≥36 weeks. All cases were delivered by cesarean. Delivery at ≥36 weeks was associated with greater mean birth weight (2774 g (±376.3 g)) compared with 2292.5 g (± 406.8 g) for those babies delivered at <36 weeks (p < 0.001). In addition, there were shorter hospital stays for the babies delivered at ≥36 weeks (median 3 days; interquartile range (IQR) 3,3) when compared with those delivered at <36 weeks (median 13 days; IQR 3,20). In addition, delivery at ≥36 weeks was associated with lower rates of intubation, jaundice and respiratory distress syndrome. Importantly, no cases of rupture of the membranes or vessel rupture occurred in either group. CONCLUSION: Our study suggests that delivery at ≥36 weeks is safe for asymptomatic patients with prenatally diagnosed vasa previa, and may be associated with improved neonatal outcomes. We suggest that stable asymptomatic patients with prenatal diagnosis of vasa previa be delivered at 36 weeks rather than at less than 36 weeks. This will reduce neonatal morbidity with no apparent increased risk to babies.

Motor Plans under Uncertainty Reflect a Trade-Off between Maximizing Reward and Success.

When faced with multiple potential movement options, individuals either reach directly to one of the options, or initiate a reach intermediate between the options. It remains unclear why people generate these two types of behaviors. Using the go-before-you-know task (commonly used to study behavior under choice uncertainty) in humans, we examined two key questions. First, do these two types of responses actually reflect distinct movement strategies? If so, the relative desirability (i.e., weighing the success likelihood vs the attainable reward) of the two target options would not need to be computed identically for direct and intermediate reaches. We showed that indeed, when reward and success likelihood differed between the two options, reach direction was preferentially biased toward different directions for direct versus intermediate reaches. Importantly, this suggests that the computation of subjective values depends on the choice of movement strategy. Second, what drives individual differences in how people respond under uncertainty? We found that risk/reward-seeking individuals tended to generate more intermediate reaches and were more responsive to changes in reward, suggesting these movements may reflect a strategy to maximize reward versus success. Together, these findings suggest that when faced with choice uncertainty, individuals adopt movement strategies consistent with their risk/reward attitude, preferentially biasing behavior toward exogenous rewards or endogenous success and consequently modulating the relative desirability of the available options.

A blended learning approach to teaching CVAD care and maintenance.

Nurses working within both acute and primary care settings are required to care for and maintain central venous access devices (CVADs). To support these nurses in practice, a higher education institution and local health board developed and delivered CVAD workshops, which were supported by a workbook and competency portfolio. Following positive evaluation of the workshops, an electronic learning (e-learning) package was also introduced to further support this clinical skill in practice. To ascertain whether this blended learning approach to teaching CVAD care and maintenance prepared nurses for practice, the learning package was evaluated through the use of electronic questionnaires. Results highlighted that the introduction of the e-learning package supported nurses' practice, and increased their confidence around correct clinical procedures.

Implementing a new teaching and learning strategy for CVAD care.

BACKGROUND: Central venous access devices (CVADs) are now a fundamental part of contemporary healthcare. Despite having many advantages, there are also complications associated with them. Evidence suggests that educating and training health professionals who maintain CVADs is essential for preventing such complications, however, the most effective approach for this training has not been evaluated. AIM: The aim of this study was to determine whether the introduction of an innovative educational intervention within a higher education institution (HEI) improved the confidence and knowledge of registered nurses dealing with CVADs. METHODS: A survey design consisting of a self-completion questionnaire and open-ended questions was used. RESULTS: This study demonstrated that nurses felt more confident following participation in the training. In addition, nurses discussed the advantages of training outside of the clinical setting as it provided them with a safe place to practise and gave them time to learn without interruption. The findings from this study suggest that the HEIs can provide an effective and safe environment for registered nurses to build confidence and knowledge in CVAD management.