Streptococcus oralis meningitis in pregnancy.

While pregnancy is a time of relative immunosuppression, infective endocarditis and bacterial meningitis remain rare. We present a case of a pregnant woman with Streptococcus oralis endocarditis and meningitis. This is the first reported case of Streptococcus oralis meningitis in a patient without predisposing risk factors. This case highlights the importance of collecting blood cultures in febrile illness during pregnancy and illustrates that effective management plans can be formulated without performing invasive diagnostic tests such as transesophageal echocardiography.

Metabolic emergencies in pregnancy.

In pregnancy, women are more likely to develop certain metabolic disturbances as a result of the physiological changes that occur. Diabetic ketoacidosis and hypoglycaemia occur at increased frequency in women with pre-existing and gestational diabetes, and starvation ketoacidosis can present towards the end of pregnancy and can cause severe illness. Peripartum hyponatraemia is increasingly recognised and can be associated with maternal and neonatal morbidity. This review describes these conditions in detail as well as treatment priorities and the impact on both mother and baby.

A Considerative Checklist to ensure safe daily patient review.

BACKGROUND: Ward rounds are complex clinical activities, and are an integral part of hospital life. Failures in care can have a direct consequence on patient safety. Recently, simulation ward rounds have allowed medical students and junior doctors to practise their skills in a safe environment, yet there is no commonly accepted and taught framework on how to conduct a ward round. CONTEXT: After the success of the WHO Surgical Safety checklist in reducing patient morbidity and mortality, Dr Gordon Caldwell designed a Considerative Checklist for his ward rounds to ensure a comprehensive patient review. Although it does not ensure that the clinical decision-making is adequate, it does ensure that various hospital protocols have been adhered to, for example assessing patient venous thromboembolism (VTE) risk and prescribing prophylaxis. I spent 8 weeks as a part of Dr Caldwell's medical team, and during this time I was assigned the role of 'checker'. This role allowed me to actively participate in the ward rounds, and gave me a framework for the ward round that was easy to learn and follow. IMPLICATIONS: Clinical checklists have become integral to improving patient outcomes, and Dr Caldwell's checklist could be used to improve patient safety while they are in-patients. The Considerative Checklist could be a vital tool in teaching this skill to students and junior doctors, but further qualitative and quantitative research is required to investigate whether using the checklist improves student performance, learning and engagement on the wards, and whether this improves patient outcomes.