Obstetric Safety Patient

AbstractIn healthcare, the patient safety system which has been developed following the study of the various phases necessary for its determination, supplies strategies to avoid the repetition of circumstances that originally has led an individual to make mistakes. In fact, the culture of risk management, starting from the consideration that the errors are not eliminable, is based on the belief that they need to be properly analyzed, implementing intervention strategies that avoid its repetition, in order to become good learning opportunities

Rapid emergence of SARS-CoV-2 Omicron variant is associated with an infection advantage over Delta in vaccinated persons

BACKGROUND: The SARS-CoV-2 Omicron variant became a global concern due to its rapid spread and displacement of the dominant Delta variant. We hypothesized that part of Omicron’s rapid rise was based on its increased ability to cause infections in persons that are vaccinated compared to Delta. METHODS: We analyzed nasal swab PCR tests for samples collected between December 12 and 16, 2021, in Connecticut when the proportion of Delta and Omicron variants was relatively equal. We used the spike gene target failure (SGTF) to classify probable Delta and Omicron infections. We fitted an exponential curve to the estimated infections to determine the doubling times for each variant. We compared the test positivity rates for each variant by vaccination status, number of doses, and vaccine manufacturer. Generalized linear models were used to assess factors associated with odds of infection with each variant among persons testing positive for SARS-CoV-2. FINDINGS: For infections with high virus copies (Ct < 30) among vaccinated persons, we found higher odds that they were infected with Omicron compared to Delta, and that the odds increased with increased number of vaccine doses. Compared to unvaccinated persons, we found significant reduction in Delta positivity rates after two (43.4%–49.1%) and three vaccine doses (81.1%), while we only found a significant reduction in Omicron positivity rates after three doses (62.3%). CONCLUSION: The rapid rise in Omicron infections was likely driven by Omicron’s escape from vaccine-induced immunity. FUNDING: This work was supported by the Centers for Disease Control and Prevention (CDC)

Safety Culture in the Maternity Units: a census survey using the Safety Attitudes Questionnaire

Background: Patient safety has been a priority for many societies and health care systems in the last decades. Identification of preventable risks and aversion of potentially unsafe situations and fatal complications in maternity units is life saving. The explicit need to focus on quality of care underpins the aim of the study to initially evaluate the safety culture and teamwork climate in the public Maternity Units of the 5 Regional Hospitals in Cyprus as measured by a validated safety attitudes tool. Methods. Data were collected from 140 midwives working in the public sector all over Cyprus by the Greek Version of the Safety Attitudes Questionnaire-Labor version. Results: One hundred and six (75.71%) registered midwives completed the questionnaire fully. The median of total work experience as a registered midwife was 3 years (IQR: 2-18.25); whereas the median of total working experience in the nursing and maternity units was 5 years (IQR: 2-21.75). Experienced midwives rated the following domains higher: team work, safety climate, job satisfaction and working conditions as opposed to the midwives with less experience. Additionally those with a longer working life in the current maternity units rated these domains higher: safety climate, job satisfaction and working conditions as opposed to the less experienced midwives. Conclusions: The high mean total score on team work and safety climate in the more experienced group of midwives is a predominant finding for the maternity units of Cyprus. In Cyprus where facilities are small in size and midwives know each other, share more responsibility towards patient safety. It could be suggested that younger midwives need more support and teamwork practice to enhance the safety and teamwork climate towards self-confidence

Proteomics Mapping of Cord Blood Identifies Haptoglobin “Switch-On” Pattern as Biomarker of Early-Onset Neonatal Sepsis in Preterm Newborns

Intra-amniotic infection and/or inflammation (IAI) are important causes of preterm birth and early-onset neonatal sepsis (EONS). A prompt and accurate diagnosis of EONS is critical for improved neonatal outcomes. We sought to explore the cord blood proteome and identify biomarkers and functional protein networks characterizing EONS in preterm newborns.We studied a prospective cohort of 180 premature newborns delivered May 2004-September 2009. A proteomics discovery phase employing two-dimensional differential gel electrophoresis (2D-DIGE) and mass spectrometry identified 19 differentially-expressed proteins in cord blood of newborns with culture-confirmed EONS (n = 3) versus GA-matched controls (n = 3). Ontological classifications of the proteins included transfer/carrier, immunity/defense, protease/extracellular matrix. The 1(st)-level external validation conducted in the remaining 174 samples confirmed elevated haptoglobin and haptoglobin-related protein immunoreactivity (Hp&HpRP) in newborns with EONS (presumed and culture-confirmed) independent of GA at birth and birthweight (P<0.001). Western blot concurred in determining that EONS babies had conspicuous Hp&HpRP bands in cord blood ("switch-on pattern") as opposed to non-EONS newborns who had near-absent "switch-off pattern" (P<0.001). Fetal Hp phenotype independently impacted Hp&HpRP. A bayesian latent-class analysis (LCA) was further used for unbiased classification of all 180 cases based on probability of "antenatal IAI exposure" as latent variable. This was then subjected to 2(nd)-level validation against indicators of adverse short-term neonatal outcome. The optimal LCA algorithm combined Hp&HpRP switch pattern (most input), interleukin-6 and neonatal hematological indices yielding two non-overlapping newborn clusters with low (≤20%) versus high (≥70%) probability of IAI exposure. This approach reclassified ∼30% of clinical EONS diagnoses lowering the number needed to harm and increasing the odds ratios for several adverse outcomes including intra-ventricular hemorrhage.Antenatal exposure to IAI results in precocious switch-on of Hp&HpRP expression. As EONS biomarker, cord blood Hp&HpRP has potential to improve the selection of newborns for prompt and targeted treatment at birth

Intestinal microbiota in human health and disease: the impact of probiotics

The complex communities of microorganisms that colonise the human gastrointestinal tract play an important role in human health. The development of culture-independent molecular techniques has provided new insights in the composition and diversity of the intestinal microbiota. Here, we summarise the present state of the art on the intestinal microbiota with specific attention for the application of high-throughput functional microbiomic approaches to determine the contribution of the intestinal microbiota to human health. Moreover, we review the association between dysbiosis of the microbiota and both intestinal and extra-intestinal diseases. Finally, we discuss the potential of probiotic microorganism to modulate the intestinal microbiota and thereby contribute to health and well-being. The effects of probiotic consumption on the intestinal microbiota are addressed, as well as the development of tailor-made probiotics designed for specific aberrations that are associated with microbial dysbiosis

Geburtseinleitung

Die Geburtseinleitung ist ein häufig angewendetes Vorgehen, wenn eine Entbindung vor dem Einsetzen spontaner Wehen angestrebt werden soll, sie betrifft etwa 20-25 % aller Schwangerschaften. Da die Einleitung den natürlichen Verlauf der Schwangerschaft beeinflusst, muss eine entsprechende Aufklärung über die Vor- und Nachteile und die unterschiedlichen Einleitungsmethoden erfolgen und dokumentiert werden. Neben medizinischen Indikationen kann auch eine elektive "Wunscheinleitung" gerechtfertigt sein. Die unterschiedlichen Einleitungsverfahren, wie Oxytocin, Prostaglandine und mechanische Methoden, müssen abhängig von den Vorbedingungen sorgfältig gegeneinander abgewogen werden. Vor Beginn einer Einleitung muss neben der Überprüfung des fetalen und maternalen Zustands die Einleitungsindikation, das Gestationsalter und der Cervixbefund beurteilt werden