RESUMO
Electronic handover tools have been advocated as a potential strategy to improve the quality of handover, especially during on-call periods at night and weekends. We aimed to quantify, categorise and explore the temporal relationship of handover tasks stored on an electronic handover system (eHandover) in an acute UK hospital trust in which the day-time primary team worked only weekdays, with only the day-time and night-time on-call teams being available at weekends. Second, we evaluated whether tasks that remained in the eHandover system throughout several shifts were likely to be completed. We defined the shift gap as the number of clinical shifts that passed between the creation of the handover task and its completion. 11,071 electronic handover parcels created on eHandover between March 2010 and January 2011 were analysed. More handovers were requested for completion on weekends (70 parcels a day) than on routine weekdays (22 parcels a day; p<0.001). The receiving teams reported that 89.4% (9,900) of the handover parcels were completed. Greater amounts of handover work was requested over weekends, when tasks were often transferred across many clinical shifts. Despite this, task-completion rates on eHandover remained consistently high. The use of a well-designed electronic handover system as part of a systematic intervention, in combination with organised verbal handover meetings, can help to reduce the risk of communication failure across shifts.
RESUMO
The phenotype of an individual, including their susceptibility to disease, is governed by several factors including parental genes and intrauterine environment. Thus, the risk of developing Type 2 diabetes is modulated by the inheritance of specific genetic variants that are slowly being characterised by the techniques of linkage analysis and population association studies using either a candidate gene or genome-wide scan approach. At the same time, evidence has accrued that alterations in the nutritional status of the developing foetus also increase the risk of diabetes in later life. Restricting protein intake in pregnant dams or interfering with placental function increases the risk of diabetes in offspring and light weight babies are more likely to develop Type 2 diabetes as adults than heavier ones. The oocyte plays a key role, since it contains not only the maternal haplotype but other information such as mitochondrial DNA and factors that modulate the expression of genes in the developing foetus. Although the ovaries contain a huge number of primordial follicles, generally each month only one oocyte matures to ovulation. Little is known about the processes that control this phenomenon. Certainly, primordial follicles and oocytes are not all the same, differing especially in mitochondrial DNA content. As women age, the oocytes released are more likely to contain genetic errors, explaining the increased risk of Trisomy 21 with maternal age. It is generally assumed that primordial follicle development and the selection of a single ooctye for ovulation is a random process. This paper suggests that this may not be the case but that a carefully controlled system may allow the mother to release an oocyte that is best suited to the prevailing environment. This would represent an important mechanism for species adaptation. Many human infertility treatments involve pharmacological superovulation, egg harvesting and culture prior to in vitro fertilisation and reimplantation. These will bypass any system of controlled ovulation and therefore might alter the risk of diseases such as Type 2 diabetes mellitus in later life. Although the offspring of human infertility treatments are generally born healthy, it is important to note that the oldest "test-tube" baby is still less than 30-years old, so the risk of late-onset diseases is still unknown.
