Improving maternal confidence in neonatal care through a checklist intervention

Previous qualitative studies suggest a lack of maternal confidence in care of their newborn child upon discharge into the community. This observation was supported by discussion with healthcare professionals and mothers at University College London Hospital (UCLH), highlighting specific areas of concern, in particular identifying and managing common neonatal presentations. The aim of this study was to design and introduce a checklist, addressing concerns, to increase maternal confidence in care of their newborn child. Based on market research, an 8-question checklist was designed, assessing maternal confidence in: feeding, jaundice, nappy care, rashes and dry skin, umbilical cord care, choking, bowel movements, and vomiting. Mothers were assessed as per the checklist, and received a score representative of their confidence in neonatal care. Mothers were followed up with a telephone call, and were assessed after a 7-day-period. Checklist scores before as compared to after the follow-up period were analysed. This process was repeated for three study cycles, with the placement of information posters on the ward prior to the second study cycle, and the stapling of the checklist to the mother's personal child health record (PCHR) prior to the third study cycle. A total of 99 mothers on the Maternity Care Unit at UCLH were enrolled in the study, and 92 were contactable after a 7-day period. During all study cycles, a significant increase in median checklist score was observed after, as compared to before, the 7-day follow up period (p < 0.001). The median difference in checklist score from baseline was greatest for the third cycle. These results suggest that introduction of a simple checklist can be successfully utilised to improve confidence of mothers in being able to care for their newborn child. Further investigation is indicated, but this intervention has the potential for routine application in postnatal care

The timing of auditory sensory deficits in Norrie disease has implications for therapeutic intervention

Norrie disease is caused by mutation of the NDP gene, presenting as congenital blindness followed by later onset of hearing loss. Protecting patients from hearing loss is critical for maintaining their quality of life. This study aimed to understand the onset of pathology in cochlear structure and function. By investigating patients and juvenile Ndp-mutant mice, we elucidated the sequence of onset of physiological changes (in auditory brainstem responses, distortion product otoacoustic emissions, endocochlear potential, blood-labyrinth barrier integrity) and determined the cellular, histological, and ultrastructural events leading to hearing loss. We found that cochlear vascular pathology occurs earlier than previously reported and precedes sensorineural hearing loss. The work defines a disease mechanism whereby early malformation of the cochlear microvasculature precedes loss of vessel integrity and decline of endocochlear potential, leading to hearing loss and hair cell death while sparing spiral ganglion cells. This provides essential information on events defining the optimal therapeutic window and indicates that early intervention is needed. In an era of advancing gene therapy and small-molecule technologies, this study establishes Ndp-mutant mice as a platform to test such interventions and has important implications for understanding the progression of hearing loss in Norrie disease

Clinical efficacy and safety of a light mask for prevention of dark adaptation in treating and preventing progression of early diabetic macular oedema at 24 months (CLEOPATRA): a multicentre, phase 3, randomised controlled trial

Background: We aimed to assess 24-month outcomes of wearing an organic light-emitting sleep mask as an intervention to treat and prevent progression of non-central diabetic macular oedema. Methods: CLEOPATRA was a phase 3, single-blind, parallel-group, randomised controlled trial undertaken at 15 ophthalmic centres in the UK. Adults with non-centre-involving diabetic macular oedema were randomly assigned (1:1) to wearing either a light mask during sleep (Noctura 400 Sleep Mask, PolyPhotonix Medical, Sedgefield, UK) or a sham (non-light) mask, for 24 months. Randomisation was by minimisation generated by a central web-based computer system. Outcome assessors were masked technicians and optometrists. The primary outcome was the change in maximum retinal thickness on optical coherence tomography (OCT) at 24 months, analysed using a linear mixed-effects model incorporating 4-monthly measurements and baseline adjustment. Analysis was done using the intention-to-treat principle in all randomised patients with OCT data. Safety was assessed in all patients. This trial is registered with Controlled-Trials.com, number ISRCTN85596558. Findings: Between April 10, 2014, and June 15, 2015, 308 patients were randomly assigned to wearing the light mask (n=155) or a sham mask (n=153). 277 patients (144 assigned the light mask and 133 the sham mask) contributed to the mixed-effects model over time, including 246 patients with OCT data at 24 months. The change in maximum retinal thickness at 24 months did not differ between treatment groups (mean change −9·2 μm [SE 2·5] for the light mask vs −12·9 μm [SE 2·9] for the sham mask; adjusted mean difference −0·65 μm, 95% CI −6·90 to 5·59; p=0·84). Median compliance with wearing the light mask at 24 months was 19·5% (IQR 1·9–51·6). No serious adverse events were related to either mask. The most frequent adverse events related to the assigned treatment were discomfort on the eyes (14 with the light mask vs seven with the sham mask), painful, sticky, or watery eyes (14 vs six), and sleep disturbance (seven vs one). Interpretation: The light mask as used in this study did not confer long-term therapeutic benefit on non-centre-involving diabetic macular oedema and the study does not support its use for this indication. Funding: The Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health Research partnership

Imaging intact human organs with local resolution of cellular structures using hierarchical phase-contrast tomography

Imaging intact human organs from the organ to the cellular scale in three dimensions is a goal of biomedical imaging. To meet this challenge, we developed hierarchical phase-contrast tomography (HiP-CT), an X-ray phase propagation technique using the European Synchrotron Radiation Facility (ESRF)’s Extremely Brilliant Source (EBS). The spatial coherence of the ESRF-EBS combined with our beamline equipment, sample preparation and scanning developments enabled us to perform non-destructive, three-dimensional (3D) scans with hierarchically increasing resolution at any location in whole human organs. We applied HiP-CT to image five intact human organ types: brain, lung, heart, kidney and spleen. HiP-CT provided a structural overview of each whole organ followed by multiple higher-resolution volumes of interest, capturing organotypic functional units and certain individual specialized cells within intact human organs. We demonstrate the potential applications of HiP-CT through quantification and morphometry of glomeruli in an intact human kidney and identification of regional changes in the tissue architecture in a lung from a deceased donor with coronavirus disease 2019 (COVID-19)

Staged Reconstruction of the Inferior Vena Cava After Gunshot Injury

A 23-year-old man with a gunshot injury to the abdomen and cardiac arrest requiring emergency department thoracotomy had a transection of the distal inferior vena cava (IVC) and small bowel injury. Because of persistent hemorrhagic shock, the IVC was ligated. During the next 3 days, he developed worsening bilateral leg edema. He was taken back for reanastomosis of his small bowel and reconstruction of the IVC using autologous femoral vein harvested from the right leg. We think that patients requiring ligation of the vena cava with worsening leg edema can benefit from a staged reconstruction of the IVC

Supplementary processed data for Chandler et al. Single-cell transcriptomics identifies aberrant glomerular angiogenic signalling in the early stages of a murine model of WT1 kidney disease

Summary datafiles for Chandler et al. Processed single-cell RNA sequencing data, derived from murine glomeruli (isolated using the dynabead technique) from n = 2 wild-type Wt1+/+ (Ctrl) and n = 2 mutant Wt1R394W/+ (Mut) littermates of WT1 glomerulopathy, followed by 10x Genomics Chromium v3 platform. Please refer to associated scripts for analysis of the data: https://github.com/daniyal-jafree1995/collaborations/blob/main/Chandleretal_2022_WT1glomerulopathyscRNAseq.R File descriptions as below: barcodes.tsv.gz - barcodes file required for input to Read10X function in Seurat features.tsv.gz - features file required for input to Read10X function in Seurat matrix.mtx.gz - matrix file required for input to Read10X function in Seurat WT1_scRNAseq.rds - RDS file containing processed and annotated Seurat object for downstream analysi

Use of Continuous External Tissue Expanders for Fasciotomy Closure

Introduction and Objectives Revascularization of traumatic arterial injuries and acute arterial occlusions of the extremities with significant ischemia time often develop compartment syndrome requiring fasciotomy. Many of these open wounds heal by secondary intention due to edema limiting delayed primary closure. They can involve the expense of negative pressure wound therapy (NPWT) and skin grafting. Continuous external tissue expanders (CETE) are a novel alternative for delayed fasciotomy closure. We report our early experience using CETE. Methods IRB approval was granted for retrospective review of patients undergoing emergency open revascularization for acute limb ischemia and traumatic arterial injury requiring fasciotomy and CETE. Data collected include patient demographics, location of arterial injury/occlusion, type of open bypass or repair, type of fasciotomy, and subsequent surgical management. Results We identified 37 patients undergoing emergency revascularization and fasciotomy in which CETE was used. The average age was 58 (20-87 years) and 68% (n=25) were male. 11% (n=4) of patients had traumatic arterial injury and 33 patients had open bypass surgery for acute limb ischemia. After CETE application, 78% (n=29) underwent delayed primary closure with staples, sutures or both, 11% (n=4) required grafting, 8% (n=3) required amputation due to vascular insufficiency, and 3% (n=1) required Integra application. The infection rate was 13.5% (n=5) including two patients with chronic systemic infections. Conclusions Our early experiences show a high rate of success in wound closure (78%) with a low rate of grafting (8%). The average time to wound closure was 4.8 days, which avoids long-term outpatient wound care. Based on our early success, we feel further study is indicated especially in the area of cost analysis between CETE and NPWT in fasciotomy wound closure

Use of Continuous External Tissue Expanders for Fasciotomy Closure

Introduction and Objectives Revascularization of traumatic arterial injuries and acute arterial occlusions of the extremities with significant ischemia time often develop compartment syndrome requiring fasciotomy. Many of these open wounds heal by secondary intention due to edema limiting delayed primary closure. They can involve the expense of negative pressure wound therapy (NPWT) and skin grafting. Continuous external tissue expanders (CETE) are a novel alternative for delayed fasciotomy closure. We report our early experience using CETE. Methods IRB approval was granted for retrospective review of patients undergoing emergency open revascularization for acute limb ischemia and traumatic arterial injury requiring fasciotomy and CETE. Data collected include patient demographics, location of arterial injury/occlusion, type of open bypass or repair, type of fasciotomy, and subsequent surgical management. Results We identified 37 patients undergoing emergency revascularization and fasciotomy in which CETE was used. The average age was 58 (20-87 years) and 68% (n=25) were male. 11% (n=4) of patients had traumatic arterial injury and 33 patients had open bypass surgery for acute limb ischemia. After CETE application, 78% (n=29) underwent delayed primary closure with staples, sutures or both, 11% (n=4) required grafting, 8% (n=3) required amputation due to vascular insufficiency, and 3% (n=1) required Integra application. The infection rate was 13.5% (n=5) including two patients with chronic systemic infections. Conclusions Our early experiences show a high rate of success in wound closure (78%) with a low rate of grafting (8%). The average time to wound closure was 4.8 days, which avoids long-term outpatient wound care. Based on our early success, we feel further study is indicated especially in the area of cost analysis between CETE and NPWT in fasciotomy wound closure

Use of Continuous External Tissue Expanders for Fasciotomy Closure

Introduction and Objectives Revascularization of traumatic arterial injuries and acute arterial occlusions of the extremities with significant ischemia time often develop compartment syndrome requiring fasciotomy. Many of these open wounds heal by secondary intention due to edema limiting delayed primary closure. They can involve the expense of negative pressure wound therapy (NPWT) and skin grafting. Continuous external tissue expanders (CETE) are a novel alternative for delayed fasciotomy closure. We report our early experience using CETE. Methods IRB approval was granted for retrospective review of patients undergoing emergency open revascularization for acute limb ischemia and traumatic arterial injury requiring fasciotomy and CETE. Data collected include patient demographics, location of arterial injury/occlusion, type of open bypass or repair, type of fasciotomy, and subsequent surgical management. Results We identified 37 patients undergoing emergency revascularization and fasciotomy in which CETE was used. The average age was 58 (20-87 years) and 68% (n=25) were male. 11% (n=4) of patients had traumatic arterial injury and 33 patients had open bypass surgery for acute limb ischemia. After CETE application, 78% (n=29) underwent delayed primary closure with staples, sutures or both, 11% (n=4) required grafting, 8% (n=3) required amputation due to vascular insufficiency, and 3% (n=1) required Integra application. The infection rate was 13.5% (n=5) including two patients with chronic systemic infections. Conclusions Our early experiences show a high rate of success in wound closure (78%) with a low rate of grafting (8%). The average time to wound closure was 4.8 days, which avoids long-term outpatient wound care. Based on our early success, we feel further study is indicated especially in the area of cost analysis between CETE and NPWT in fasciotomy wound closure