Women's choices in non-invasive prenatal testing for aneuploidy screening: results from a single centre prior to introduction in England.

OBJECTIVE: To evaluate patient choices and uptake of non-invasive prenatal testing (NIPT) for aneuploidy screening offered in a contingency model as part of routine care. METHOD: We retrospectively reviewed data for all women with a singleton pregnancy attending for routine first trimester screening over an 18-month period. Women with a 'high-chance' of trisomy 21, 18 or 13 (≥1:150) were offered the choice of no further testing, NIPT or invasive testing, in line with the screening pathway recommended by the UK National Screening Committee. RESULTS: Of 9342 women attending for a first trimester ultrasound scan, 7939 women were included in this study. Of these, 352 had a high-chance screening result for trisomy 21, and 291 (82.7%) opted for NIPT. The proportion of women opting for NIPT decreased as the chance of trisomy 21 increased: uptake was 93.2%, 90.0%, 77.1% and 47.2% for women with a chance of 1:100-150, 1:50-99, 1:10-49 and >1:10, respectively. 516 women (5.5%) accessed primary NIPT screening in the private sector, and 638 women (6.8%) declined any aneuploidy screening or testing. CONCLUSION: Implementation of NIPT testing in a contingency model has a high uptake in a non-research National Health Service setting; the rate of uptake is related to the combined test risk result.

A qualitative approach to understanding patients' diagnosis of Lyme disease.

OBJECTIVES: The purpose of this study was to explore the lived experience of becoming diagnosed with Lyme disease. DESIGN: A qualitative, phenomenological study was conducted to investigate the experience of becoming diagnosed with Lyme disease. SAMPLE: A purposive sample of 10 participants diagnosed with Lyme disease were interviewed and tape-recorded. Data saturation guided the size of the sample. METHODS: The interviews were transcribed verbatim. Key words or phrases were extracted and clustered; clusters were interpreted into themes. Analyzed data were confirmed with the participants for trustworthiness and reliability. RESULTS: Six themes emerged from the interviews. Participants expressed feelings of frustration during the long road to diagnosis. They endured multiple diagnostic tests and were seen by numerous health care providers. Participants voiced financial stress. They expressed the need for self-advocacy and felt validation when a diagnosis was made. Despite the chronicity of their illness, the participants voiced a sense of hopefulness for their future. CONCLUSION: A deep understanding of the lived experience of becoming diagnosed with Lyme disease allows for nurses to prioritize health care interventions and strategize ways to implement quality improvement systems as clients enter the health care environment.

Transluminal occlusion of a pseudoaneurysm arising from a thoracic aortic graft patch using catheter delivery of thrombin.

A 39-year-old man with Marfan syndrome underwent replacement of the aortic valve, root, and ascending aorta for acute type A dissection. Subsequently, he underwent infrarenal aortic replacement for aortic rupture and then graft repair of a thoracoabdominal aneurysm with patch-bearing intercostals. After the third procedure, massive intraperitoneal hemorrhage required three subsequent laparotomies. CT scan showed two thoracic aortic pseudoaneurysms at the patch-graft junction that were sequentially embolized with transcatheter delivery of thrombin.

Comparison of normal saline and heparinized saline for patency of IV locks in neonates.

In this randomized double-blind experiment of 49 neonatal intensive care unit patients, probable time to catheter failure was significantly longer (p =.0358) for catheters flushed with heparinized saline (median = 127) compared with those flushed with normal saline (median = 39). This is in contrast to the nonsignificant difference (p =.841) in mean scores for six heparin-flushed catheters (M = 41.5 hours, SD = 44.0) compared with 18 saline-flushed catheters (M = 30.4 hours, SD = 20.8) discontinued for reasons other than completion of treatment. We concluded that survival time analysis is necessary when evaluating results of time-dependent studies in which the end point may not be elective.