Audit on body mass index in pregnancy
Citation: Obesity Reviews, May 2011, vol./is. 12/(199), 1467-7881 (May 2011)
Author(s): Aumeer R.
Introduction and background: Obesity during pregnancy is a risk factor for many adverse outcomes such as stillbirth, macrosomia, and gestational diabetes, among others.
Objective: To assess the quality of care and management of obese pregnant women at Dudley Hospital, United Kingdom.
Design: A retrospective audit study.
Setting: Dudley Hospital, Birmingham, United Kingdom.
Standards and criteria: All pregnant women should have their body mass index (BMI) measured and recorded at their first prenatal visit. All pregnant women with BMI > 30 should have postprandial blood tests at 20 weeks and 26 weeks to screen for diabetes. All pregnant women should receive advice about sensible diet and exercise, which should be documented in their medical notes.
Methods: Medical records for all patients with delivery dates between December 2008 and January 2009 were audited post delivery.
Participants: Pregnant women (N = 91).
Results: BMI is recorded for 98% of patients. Over a quarter of women with BMI > 30 did not have postprandial blood tests at 20 and 26 weeks.
Conclusion: BMI is calculated and recorded for most patients, but uptake of postprandial blood tests is suboptimal in patients with BMI > 30.
Recommendations: To add a section on obesity in the maternity notes.
Institution: (Aumeer) East Cheshire NHS Trust, Macclesfield, United Kingdom
Extract from The King’s Fund: NHS Confederation
Involving children and young people in health services
This report highlights the key findings and recommendations from an event held in September 2011 to discuss the key priorities for child health.
Inquiry into how to improve dementia diagnosis rates in the UK
The APPG has launched its next inquiry which will focus on improving dementia diagnosis rates across the UK. An inquiry into this area will bring together more evidence and understanding about the current problems there are to improving diagnosis of dementia. It will also find good practice examples where services have been helpful to people with dementia getting an early diagnosis, and ensuring they have proper information and support afterwards, so that these examples can be shared. The APPG is seeking evidence from people with dementia and their carers, health and social care providers and practitioners, and key stakeholder organisations and professional bodies. The deadline for submission of evidence is 2nd March 2012.
The ICT Department informs us that the ECDL course is no longer offered through the NHS and there is no replacement.
Alternatively, staff at work may access the website at: at http://customer.cheshireict.nhs.uk/training/Pages/LearnInMinutesResources.aspx to view recorded ‘virtual classroom’ sessions and How Do I Guides.
There is also the Microsoft Office Specialist course in Office 2003, 2007 or 2010. Staff can register for their chosen course and receive access to all the workbooks, study materials and details on how to register for Microsoft E-learning.
Bone Joint Surg Br.2011 Dec;93(12):1610-6.
Examination of ten fractured Oxford unicompartmental knee bearings.
Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK.
Since the Oxford knee was first used unicompartmentally in 1982, a small number of bearings have fractured. Of 14 retrieved bearings, we examined ten samples with known durations in situ (four Phase 1, four Phase 2 and two Phase 3). Evidence of impingement and associated abnormally high wear (> 0.05 mm per year) as well as oxidation was observed in all bearings. In four samples the fracture was associated with the posterior radio-opaque wire. Fracture surfaces indicated fatigue failure, and scanning electron microscopy suggested that the crack initiated in the thinnest region. The estimated incidence of fracture was 3.20% for Phase 1, 0.74% for Phase 2, 0.35% for Phase 3, and 0% for Phase 3 without the posterior marker wire. The important aetiological factors for bearing fracture are impingement leading to high wear, oxidation, and the posterior marker wire. With improved surgical technique, impingement and high wear should be prevented and modern polyethylene may reduce the oxidation risk. A posterior marker wire is no longer used in the polyethylene meniscus. Therefore, the rate of fracture, which is now very low, should be reduced to a negligible level.
Title: Occult breast carcinoma presenting with axillary lymphadenopathy
Citation: Breast Cancer Research, November 2011, vol./is. 13/(S11-S12), 1465-5411 (04 Nov 2011) Author(s): Crotch-Harvey M.A.
Abstract: Introduction Occult breast carcinoma presenting with axillary lymphadenopathy is an uncommon but difficult clinical problem. The most appropriate diagnostic pathway, the prognosis and the best form of treatment may be uncertain. To answer these questions, we have examined the outcomes of women presenting in this way over a number of years. Methods Thirteen women were identified prospectively over a 12- year period, presenting with suspicious lymphadenopathy but no identifiable breast tumour on initial mammography or ultrasound. Biopsy of the abnormal nodes was consistent with a breast primary in all cases. All women had further imaging with breast MRI (11 cases), breast scintigraphy (one case) and CT scanning of the chest and abdomen. Second-look ultrasound was targeted to suspicious areas identified on second-line imaging. The type of treatment, presence of distant metastases and survival were recorded. Results Further imaging revealed a primary breast lesion in seven cases, six remained truly occult. Follow-up ranged from 3 to 144 months (mean 38 months). Three patients died, one is alive with distant metastases and nine remain disease free. Those with no identifiable primary were treated with chemotherapy usually in combination with radiotherapy. Conclusion The use of MRI and targeted ultrasound-guided biopsy revealed primary tumours in approximately half our cases presenting with lymphadenopathy and negative conventional imaging. Chemotherapy with radiotherapy appears to be an effective treatment for occult breast cancer. The initial staging tests are crucial and if clear the prognosis appears similar to patients with breast cancer and positive axillary nodes.
Publication Type: Journal: Conference Abstract
In this issue:
This article is all about developing you and your staff. The advice is kept as practical as possible and include things that you can apply immediately. The intention is to try and provoke you to think differently about how you manage and encourage you to innovate and experiment.
Staff Appraisal – chore or golden opportunity?
A common challenge facing clinicians entering management roles is how to conduct appraisals for the staff now reporting to them. Quite apart from practical issues such as finding the time and an appropriate environment, the employer may also have a particular format to follow, and the whole process can end up looking like one big distraction from the main objective – providing care.
Health Technology Assessments
New study into fluid in the middle ear funded
A new study looking at the best treatment for children with fluid in the middle ear has been funded by the NIHR HTA programme.
Cleft lip and palate are among the most common inherited abnormalities effecting around one in 700 individuals and approximately 1000 children being born with cleft lip and palate each year. Historically, care for this group of children was delivered in a fragmented way across 57 centres in the UK. [more…]
The library is staffed from 10.00am – 4:00pm on
Wednesday 28th and Thursday 29th December.
For anyone with 24hr access the library is accessible
but not staffed as follows:
- Friday afternoon 23rd December
- Monday 26th
- Tuesday 27th
- Friday 30th
- Monday 2 January
from all of us in the library … Angela, Jan, Carole, Alison and Steve
Some excellent news from NICE announced yesterday 20 December.
National Institute for Health and Clinical Excellence (NICE) has signed a 3 year agreement to provide staff with access to The Lancet via NHS Evidence (www.evidence.nhs.uk) – the service provided by NICE.From 3 January 2012, every member of staff who is eligible for an NHS Athens password can access the latest online editions of The Lancet, as well as back copies from the last 4 years, removing the need for NHS library services and individual members of staff to subscribe to access The Lancet online – a move which will save time and money and which will provide NHS-wide access to this valued resource.The agreement will also cover healthcare students from an NHS-commissioned education programme involving practice and placement within NHS services across England.
In addition, a free print copy of the Lancet will be sent to your NHS library every month for the next three years, starting with the first issue in January 2012.
Please share this information with colleagues. Thank you.
Coagulation parameters are routinely requested among all age-groups in pediatrics to identify abnormalities which may contribute to bleeding manifestations or thrombotic complications. These results are vital especially in the management of sick children although in some cases, they may be helpful in identifying those with inherited bleeding disorders and to confirm or exclude non-accidental injury. Despite the usefulness of these screening tests, it is important that the professionals who are responsible for the care of children interpret the results of these tests in the most accurate manner to avoid unnecessary further investigations and inappropriate management.
Link to full text
J Thachil… – Indian Journal of Pediatrics, 2011
GA Whitehead Department of Child Health, Macclesfield General Hospital
Royal College of Psychiatrists
From The King’s Fund:
This audit has identified a need for significant improvements in hospital ward environments, staff training and the overall approach to care delivery for patients with dementia. Although the majority of wards meet basic safety requirements, it shows that many had not addressed simple measures that could lessen the distress caused to dementia patients by an unfamiliar and confusing hospital environment. It also reveals deficiencies in staff training.
Stroke pathway: delivering through improvement 2009
Although this information was published a couple of years ago, I include it here as an example of what is available on QIPP – which stands for Quality, Innovation, Productivity and Prevention
The NHS Institute supported Chief Executives and senior leadership to champion change and improvement across NHS organisations in all areas of the stroke pathway. Quality was improved by reducing mortality, time in A&E, and delay in CT. Read more at https://www.evidence.nhs.uk/qipp
The latest e-newsletter from the National Library for Public Health is now available at http://ymlp.com/zXnTZr If you prefer you can subscribe to receive the newsletter every month by clicking here.
All the public health resources can be found at https://www.evidence.nhs.uk/nhs-evidence-content/public-health such as Public Health NICE Pathways – ‘bringing together all related NICE guidance and associated products in a set of interactive topic-based diagrams’. There are four Public Health pathways:
British Journal of Anaesthesia: Volume 107, Issue suppl 1 p116-126
Many anaesthesia practitioners caring for patients with a cardiac implantable electronic device (CIED) lack the knowledge, experience, and requisite programming devices to independently manage these patients perioperatively. A recently updated ASA task force Practice Advisory presents expert opinion regarding the perioperative management of patients with CIEDs, and the Heart Rhythm Society (HRS) recently published a consensus statement on this subject in collaboration with the ASA, American Heart Association (AHA), and Society of Thoracic Surgeons (STS).
The abstract is free and the full text article may be requested as an inter library loan.
Board governance assurance framework for aspirant foundation trusts (FTs)
To help prepare aspirant FTs to meet this competency, the Department of Health has commissioned a mandatory board assurance framework, developed in partnership with existing FTs and other stakeholders.
The Critical Appraisal Skills Programme (CASP) was developed in Oxford in 1993 and has over the past ten years helped to develop an evidence based approach in health and social care, working with local, national and international partner organisations.
CASP’s workshops and resources aim to help participants put knowledge into practice by learning how to systematically formulate questions, find research evidence, appraise research evidence and act on research evidence.
One of the resources worth noting on their website – Crib Sheets
Cribsheets are core questions that aid you to critically appraise a research paper.