Epidemiology of Neonatal Jaundice at the University Hospital of the West Indies

Objective: To describe the epidemiology of neonatal jaundice at the University Hospital of the West Indies (UHWI). Methods: A retrospective review of all neonates at the UHWI with clinically significant jaundice between January 1, 2006 and June 30, 2007 was performed. Demographic, clinical and laboratory data were collected. Descriptive analyses were performed. Results: The incidence of clinically significant neonatal jaundice at the UHWI was 4.6% for the study period. There were 103 male (61%) and 67 (39%) female infants. The aetiology of jaundice in the infant was attributed to ABO incompatibility in 59 (35%), infection in 30 (18%), prematurity in 19 (11%), G6PD deficiency in 8 (5%), Rhesus incompatibility in 6 (3.5%) and no cause was identified in 16 (9%) infants. There was a low incidence (26%) of screening for G6PD deficiency although it was the most common aetiology for infants presenting from home. Nine (5%) neonates required exchange blood transfusion. Infants admitted from home had a significantly higher mean total bilirubin value at presentation, a significantly higher mean peak bilirubin level and presented significantly later than those who were admitted from the postnatal ward (p < 0.001). One patient was discharged with a diagnosis of bilirubin encephalopathy but defaulted from follow-up. Two neonates died but from causes unrelated to neonatal jaundice. Sixty-two patients (37%) were followed-up post discharge; 50% had hearing tests done, all tests were normal. Sixty-one (98%) infants had normal development at the time of the study; one patient had impaired motor development but this infant also had a myelomeningocoele. Conclusion: To further reduce morbidity associated with neonatal jaundice at the UHWI, there should be increased screening for G6PD deficiency; current systems in place for follow-up and monitoring of infants discharged from hospital prior to 72 hours must also be expanded and strengthened. Keywords: Neonatal jaundice "Epidemiología de la Ictericia Neonatal en el Hospital Universitario de West Indies" RESUMEN Objetivo: Describir la epidemiología de ictericia neonatal en el Hospital Universitario de West Indies (UHWI). Métodos: Se llevó a cabo una revisión retrospectiva de todos los recién nacidos con ictericia clínicamente significativa, en UHWI entre el 1ero de enero de 2006 y el 30 de junio de 2007. Se recogieron datos demográficos, clínicos y de laboratorio. Se realizaron análisis descriptivos. Resultados: La incidencia de la ictericia neonatal clínicamente significativa en UHWI fue de 4.6% para el periodo en estudio. Había 103 recién nacidos varones (61%) y 67 (39%) hembras. La etiología de la ictericia en los neonatos se atribuyó a la incompatibilidad de ABO en 59 (35%), infección en 30 (18%), prematuridad en 19 (11%), deficiencia de G6PD en 8 (5%), e incompatibilidad de Rhesus en 6 (3.5%). No se identificó ninguna causa en 16 (9%) de los recién nacidos. Hubo una baja incidencia (26%) de tamizaje para la deficiencia de G6PD, aún cuando ésta es la etiología más común en el caso de los infantes provenientes de casa. Nueve (5%) recién nacidos requirieron cambio de sangre mediante transfusión. Infantes ingresados desde sus casas presentaban un valor promedio de bilirrubina total significativamente mayor en el momento de su hospitalización, así como un nivel pico promedio de bilirrubina significativamente más alto, y se presentaron significativamente más tarde que aquellos ingresados directamente de las sala de atención postnatal (p < 0.001). Un paciente fue dado de alta con un diagnóstico de encefalopatía bilirrubínica, pero no se presentó a las sesiones de seguimiento. Dos recién nacidos murieron, pero por causas no relacionadas con la ictericia neonatal. Sesenta y dos pacientes (37%) tuvieron seguimiento luego del alta; al 50% se les realizó pruebas de audición; todas las pruebas arrojaron resultados normales. Sesenta y un infantes (98%) presentaban un desarrollo normal en el momento del estudio. Un paciente tenía discapacidad del desarrollo motor, pero también presentaba un mielomeningocele Conclusión: A fin de lograr una reducción de la morbosidad asociada con la ictericia neonatal en UHWI, debe realizarse un tamizaje de la deficiencia de G6PD. Asimismo, es necesario ampliar y fortalecer los sistemas actuales establecidos para el seguimiento y monitoreo de los infantes dados de alta del hospital antes de las 72 horas. Palabras claves: ictericia neonata

Compliance of Dutch orthopedic departments with national guidelines on thromboprophylaxis. A survey of Dutch orthopedic thromboprohylaxis

All 110 Dutch orthopedic departments were sent a survey on perioperative thromboprophylaxis protocols, and 79% responded. After hip and knee replacements, all used pharmacological thromboprophylaxis: a low-molecular weight heparin (LMWH) in 87% of departments, which was most often combined with vitamin K antagonists (VKAs). LMWH was usually started preoperatively (91%). After discharge, VKAs were mostly prescribed (79%) for at least 6 weeks, and often for 3 months. 17% of departments used LMWH for 6 weeks, whereas in only 3% no post-discharge prophylaxis was given. In day-care surgery, including arthroscopies, 58% use LMWH and in short-stay surgery 80% administer LMWH during the hospital stay. Because of lack of conclusive evidence for day-care surgery, the national guidelines cannot support pharmacological prophylaxis in this setting. In general, Dutch orthopedic departments comply poorly with the national guidelines on extended thromboprophylaxis for hip and knee replacement surgery, which recommends postoperative LMWH for 6 weeks. They are divided in the use of pharmacological prophylaxis in day-care surger

Low incidence of deep vein thrombosis after knee arthroscopy without thromboprophylaxis: a prospective cohort study of 335 patients

BACKGROUND: There is little data on the risk of deep vein thrombosis after knee arthroscopy. PATIENTS AND METHODS: We performed a prospective cohort study to establish the incidence of venous thrombo-embolic (VTE) complications after knee arthroscopy in daycare, as detected by bilateral complete compression ultrasonography (CCUS) at day 14 (11-17) postoperatively. 335 patients completed bilateral extended ultrasound. No thromboprophylaxis was given. RESULTS: 19 (5.7%; 95% CI: 3.5%-8.7%) showed VTE on CCUS, of whom 2 were symptomatic. 1 patient developed a non-fatal pulmonary embolus during the 8-week follow-up period. There was no difference in immobilization characteristics between the patients who developed postoperative DVT and those who did not; nor could other risk factors be identified. INTERPRETATION: Since the incidence of VTE is low and a specific high-risk group for the development of VTE could not be identified, it seems justified to withhold routine pharmacological thromboprophylaxis after arthroscopy of the knee in a daycare settin

Hoover Dam and the Evolution of Uplift Theory

The earliest technical article by an American engineer on hydraulic uplift was the ASCE Presidential Address by James B. Francis in 1888. He suggested applying full hydrostatic pressure at the upstream heel of a dam, diminishing to zero pressure at the downstream toe. Thoughts on the potentially destabilizing role of uplift were mentioned by John R. Freeman in 1911 in his comments on the failure of Bayless Dam near Austin, PA. Between 1911-1918 Arnold C. Koenig, J. B. T. Coleman, and James B. Hays discussed how to account for uplift in masonry dams in the ASCE Proceedings and Transactions. Up until 1927-28 most engineers assumed that uplift pressure was tied to the permeability of the foundation and that of the dam structure. Most assumed that concrete was impervious and incapable of transmitting meaningful pore pressure. The textbooks cited by the engineers who drafted the plans for the St. Francis Dam cited examples that appeared in textbooks published between 1908-18. In 1918 Edward Wegmann asserted that it was impossible to accurately estimate the uplift that might develop beneath a dam and that engineers should rely on their own judgment. Others suggested that an uplift pressure diagram in the shape of a trapezoid be employed, assuming development of two-Thirds the theoretical uplift, varying lineally to zero at the toe, unless uplift relief wells were employed. All the various theories were called into question when Hoover Dam was filled to capacity in 1934-41 and excessive uplift pressures developed beneath the dam\u27s downstream face. This led to tripling the depth of the grout curtain, which took nine years complete. In 1936 Karl Terzaghi introduced his theory of effective stress, which established a distinction between total stress and those ascribable to hydrostatic (pore water) pressure. In 1939 ASCE formed a Subcommittee on Uplift in Masonry Dams. In 1945 Terzaghi summarized the results of experimental work that suggested water was able to transmit pore pressures in concrete. The ASCE committee released their final report in 1952, which included uplift measurements of a modest number of high-head dams and commented on what they felt constituted reasonable bounds on how much uplift could develop if relief wells were installed immediately downstream of grout curtains

Delivering stepped care for depression in general practice:Results of a survey amongst general practitioners in the Netherlands

<p>Background: Revised guidelines for depression recommend a stepped care approach. Little is known about the implementation of the stepped care model by general practitioners (GPs) in daily practice.</p><p>Objectives: To evaluate the performance of Dutch GPs in their general practice regarding important elements of the stepped care model (identification, severity assessment and stepped care treatment allocation) shortly before the revised Dutch multidisciplinary guideline for Depressive Disorders was published.</p><p>Methods: Data was collected through a self-report questionnaire sent to 500 randomly selected GPs. Multivariate logistic regression analyses were employed to investigate whether GP-related characteristics were associated with GPs' self-reported performance.</p><p>Results: The study involved 194 GPs (response rate: 39%). Responses indicated that 37% paid systematic attention to depression identification, 33% used a screening instrument, and 63% determined the severity of newly diagnosed depression, generally without using an instrument. Most GPs (72%) indicated to allocate stepped care treatment to the majority of their patients newly diagnosed with depression. However, more than 40% indicated to start with antidepressants, either alone or in combination with psychotherapy. Assessing the severity of newly diagnosed depression and clinical experience were positively associated with allocating stepped care treatment. Structural collaboration with mental health professionals was positively associated with assessing severity.</p><p>Conclusion: Delivering stepped care for depression in daily general practice could be further improved. Collaboration with mental health professionals and routine severity assessment of diagnosed depression are positively associated with allocating stepped care.</p>