A comparison of praevia and non-praevia outcomes in placenta accreta spectrum cases: A single centre analysis.

BACKGROUND: Placenta accreta spectrum (PAS) causes severe maternal morbidity and mortality. Antenatal diagnosis can optimise maternal outcomes and reduce the risk of complications. PAS cases where the placenta is not low lying are suggested to be more difficult to diagnose antenatally and are potentially associated with different outcomes. AIM: The aim was to compare factors associated with births in PAS pregnancies with and without placenta praevia at a single tertiary centre over 15 years. MATERIALS AND METHODS: A retrospective review of all births complicated by PAS was conducted from a site-specific database. Cases with and without a placenta praevia were analysed to compare differences in maternal risk factors, outcomes and histological diagnosis. RESULTS: Between June 2006 and July 2020 there were 134 cases of PAS, 106 with placenta praevia. Cases without praevia were less likely to have a history of previous caesarean section and to be admitted for delivery planning or with antepartum haemorrhage. A higher proportion of cases without praevia were delivered at term, with no overall difference in emergency or elective deliveries. There was a significantly lower rate of hysterectomy in the non-praevia group. The overall estimated blood loss was significantly lower in those without praevia. CONCLUSION: Suspected PAS without placenta praevia is at lower risk of hysterectomy and massive blood loss. The management approach can be tailored accordingly, with good operative outcomes with transverse abdominal and uterine incisions. Antenatal diagnosis can be difficult to accurately predict the degree of invasion, and a higher level of suspicion is required.

The multidisciplinary management of placenta accreta spectrum (PAS) within a single tertiary centre: A ten-year experience.

INTRODUCTION: Placenta accreta spectrum (PAS) covers a spectrum of placental adherence abnormalities: placenta accreta, increta and percreta. PAS is associated with significant maternal morbidity and mortality. Studies have shown the importance of multidisciplinary teamwork in the management of PAS. AIM: This study was designed to describe the maternal and neonatal morbidity and mortality associated with PAS in our centre over a ten-year period. METHODS: A retrospective cohort study was conducted of pregnancies complicated by PAS between February 2006 and January 2016 at Flinders Medical Centre (FMC), South Australia. Electronic and medical records were examined to obtain patient demographics, antenatal and surgical, findings and postnatal outcomes. RESULTS: There were 67 PAS cases with an overall incidence of 2.3 per 1000 deliveries. Three cases were excluded due to incomplete information. Of the remaining 64 cases, 56 women were antenatally diagnosed. Sixty cases were confirmed to be invasive at delivery; 28 accreta (superficial) and 32 increta/percreta (deep) cases. The four cases with no invasion at delivery were suspected antenatally to have PAS. The median (Q1, Q3) number of caesarean sections in this cohort was 2 (1, 3). Deep invasion is significantly associated with increased bleeding, intensive care unit admission, surgical complications and an extended postpartum stay. CONCLUSION: The incidence of PAS at FMC is high as it is the state's tertiary referral centre. While PAS is associated with increased morbidity, thorough perioperative planning by a multidisciplinary team is crucial for excellent patient outcomes.

Application of a High-Resolution Quadrupole/Orbital Trapping Mass Spectrometer Coupled to a Gas Chromatograph for the Determination of Persistent Organic Pollutants in Cow's and Human Milk.

A quadrupole/orbital trapping mass spectrometer or Q-Exactive (QE) interfaced with a gas chromatograph (GC) was optimized for measuring polychlorinated dibenzo- p-dioxins, dibenzofurans (PCDD/Fs), and polychlorinated biphenyls (PCBs) in foods. Figures of merit include (1) an instrument detection limit (IDL) for 2,3,7,8-tetrachlorodibenzo- p-dioxin (TCDD) of 9 femtograms (fg), (2) quantitative mass resolution from PCDD interferences (e.g., PCBs, methoxy-PCBs DDTs, polychlorodibenzylphenyl ethers, polychloroxanthenes, methyl-polychlorodibenzofuran, and polychlorodibenzothiophenes), and (3) mass accuracy <1 ppm at the IDL. The QE measured the concentrations of PCDD/Fs and PCBs in whole cow's milk with no known source of contamination (e.g., TCDD 33 fg/g fat). A National Institute of Standards and Technology (NIST) unfortified human milk standard reference material (SRM) 1953 was measured determining 27 PCDD/F and PCB congeners with an average difference of 7.6% from the certified results. The QE-GC is a benchtop instrument, easy to service, easy to operate, and requires no lock masses, mass preselection, or chemical ionization conditions. The QE-GC demonstrated that it can be an alternative to the double focusing magnetic sector instruments (sector) for the high-resolution measurement of PCDD/Fs and PCBs in dairy products.

Changing Medicine and Building Community: Maine's Adverse Childhood Experiences Momentum.

Physicians are instrumental in community education, prevention, and intervention for adverse childhood experiences. In Maine, a statewide effort is focusing on education about adverse childhood experiences and ways that communities and physicians can approach childhood adversity. This article describes how education about adversity and resilience can positively change the practice of medicine and related fields. It exemplifies the collective impact model by increasing community knowledge, affecting medical practice, and improving lives.

How is diarrhoea managed in UK care homes? A survey with implications for recognition and control of Clostridium difficile infection.

BACKGROUND: Policy and regulatory efforts to reduce Clostridium difficile infection (CDI) rates now focus increasingly on the community setting, especially residential and nursing homes for the elderly. We aimed to describe how potentially infectious diarrhoea is managed in care homes, and to explore related infection control and human waste management practices. METHODS: A questionnaire was sent to all care homes in Sussex, asking about management of diarrhoea and related infection control practices. RESULTS: Response rate was 41%. Residents with diarrhoea were reported to be isolated promptly in 36% of homes, and 78.2% of homes reported always wearing appropriate personal protective equipment. Most homes waited over 24 h before sending stool samples for testing. Human waste was disposed of by automated sluice in only 26% of care homes. Bedpans were washed in residents' sinks in 20.7% of residential homes, and in communal baths in 9.6%. CONCLUSION: This study shows that most care homes are not fully compliant with current infection prevention and control guidance, and that some unacceptable practices are occurring. In order to reduce potential for transmission of CDI and other diarrhoeal infection in care homes, infection prevention and control practices must be improved, with early diagnosis and control.

Are residential and nursing homes adequately screening overseas healthcare workers?

BACKGROUND: There has been significant growth in the number of healthcare workers born outside the UK or recruited to the UK from countries with a high prevalence of TB, Hepatitis and other blood borne infections. Government policy recognises the need for occupational health procedures to facilitate treatment for these individuals and to reduce the risk of transmission of disease to patients.The aim of this study was to undertake a survey of nursing and residential homes in South East England, to assess whether homes had occupational health screening policies for healthcare workers who have originated from overseas, and what level of occupational health screening had been undertaken on these employees. METHODS: An anonymous survey was sent to all 500 homes in West Sussex assessing occupational health practices for "overseas health care workers", defined as health care workers who had been born outside the UK. RESULTS: Only one employer (0.8%) reported they had an occupational health screening policy specific for healthcare workers who originate from overseas. Over 80% of homes who had recruited directly had no evidence of screening results for HIV, TB, Hepatitis B and C. The commonest countries of origin for staff were the UK, Philippines, Poland, South Africa, Zimbabwe, and India. CONCLUSION: This study suggests that screening of overseas healthcare workers is not routine practice for residential or nursing care homes and requires further input from Primary Care Trust's, Health Care Commission, Commission for Social Care Inspection, and Professional bodies.

A dedicated retrieval and transfer service: the QUARTS Project.

BACKGROUND: The transfer and/or retrieval of a critically patient is inherently dangerous not only for the patient but for staff as well. The quality and experience of unplanned transfers can influence patient mortality and morbidity. However, international evidence suggests that dedicated transfer/retrieval teams can improve mortality and morbidity outcomes. AIMS: The initial aim of this paper is to describe an in-house competency-based training programme, which encompasses the STaR approach to develop members of our existing nursing team to be part of the dedicated transfer/retrieval service. The paper also presents audit data findings which examined the source of referrals, number of patients actually transferred and clinical status of those being transferred. RESULTS: Audit data illustrate that the most frequent source of referrals comes from Accident and Emergency and the Surgical Directorate with the most common presenting condition being cardio-respiratory failure or arrest. Audit data reveal that the number of patients actually transferred or retrieved is relatively small (33%) compared with the overall number of requests for assistance. However, 36% of those patients transferred had a level 2 or level 3 acuity status that necessitated the admission to a critical care area. CONCLUSIONS: A number of studies have concluded that the ill-experienced and ill-equipped transfer team can place patients' at serious risk of harm. Whether planned or unplanned, dedicated critical care transfer/retrieval teams have been shown to reduce patient mortality and morbidity.