La classification du rythme cardiaque foetal par catégories permet-elle de prédire le statut acido-basique artériel ombilical néonatal ?: travail de Bachelor

Contexte : Lors de son introduction dans les années 1960, la cardiotocographie promettait de réduire de moitié la mortalité intrapartum et la parésie cérébrale. Aujourd’hui, le constat est que si elle réduit le taux de convulsions néonatales, la surveillance du rythme cardiaque foetal n’améliore pas le taux de parésies cérébrales, et est même associée à une augmentation des interventions obstétricales. Néanmoins, la cardiotocographie garde sa place d’honneur en salle d’accouchement, notamment pour des raisons médico-légales. C’est alors sur la signification et l’interprétation des tracés que se focalise le débat, afin que le cardiotocographe puisse effectivement contribuer à promouvoir la sécurité de la dyade mère-enfant. Objectifs : Le but de cette revue est d’examiner les différents systèmes de classification du rythme cardiaque foetal, ainsi que les critères utilisés, afin d’évaluer leur corrélation avec les issues périnatales. De cette manière, nous souhaitons pouvoir déterminer dans quelle mesure la classification par catégories permet de prédire le statut acido-basique artériel ombilical néonatal. Méthode : Sept études et une revue de la littérature ont été sélectionnées pour le corps de cette revue, suite à des recherches sur les bases de données Medline®, Midirs®, Cinahl®, Google Scholar® et BDSP®. Les essais sont quantitatifs et rétrospectifs. Une des études est de type cas-témoins. La revue de littérature est américaine et porte sur des études américaines. Quatre des études ont également été réalisées aux Etats-Unis, deux ont été réalisées en Italie et une au Japon. Résultats : La corrélation des systèmes de classification du RCF avec les issues néonatales augmente avec le nombre de catégories, et c’est le système à 5 catégories qui est le plus apte à prédire le statut acido-basique néonatal. Les systèmes de classification existants manquent d’accord entre eux. Parmi les critères d’interprétation, c’est la tachycardie qui a la meilleure capacité discriminatrice. Pour ce qui est des décélérations, si la hiérarchie traditionnelle (précoces, variables, tardives) est confirmée, c’est surtout leur sévérité (profondeur, durée, nombre, aire totale) qui est associée à un statut acido-basique défavorable, particulièrement pour les décélérations tardives. Une variabilité normale, même en présence de décélérations, est fortement associée à un statut acido-basique favorable. Une variabilité diminuée en présence de décélérations n’est que faiblement associée à une péjoration du statut acido-basique néonatal. Conclusion : Si la classification du RCF par catégories n’est pas une garantie du statut acido-basique néonatal, elle en constitue néanmoins un bon indicateur. En dépit de sa complexité et par rapport à la classification à 3 catégories, la classification à 5 catégories est plus précise, nous renseigne davantage sur l’état foetal in utero, et nous permet de mettre en place les actions les plus appropriées, dans le but d’éviter un statut acido-basique néonatal défavorable. Une bonne classification doit reposer sur la capacité individuelle et collective des différents critères d’interprétation à refléter l’état foetal. Il serait désormais nécessaire d’avoir davantage de preuves scientifiques quant à l’efficacité du système à 5 catégories, ainsi que des moyens pour faciliter son application clinique.Context : When Electronic Fetal heart rate Monitoring [EFM] was introduced in the 1960’s, it was hoped that it would halve the incidence of intrapartum mortality and cerebral palsy. Although it has reduced the number of neonatal convulsions, it has been demonstrated that EFM has not impacted the incidence of cerebral palsy and that it is even associated with an increase in operative deliveries. Nonetheless, EFM plays a key role in delivery rooms, in particular insofar as tracings constitute legally admissible evidence. Consequently, attention must now be focused on the meaning and interpretation of EFM patterns in order for EFM to effectively promote mother and child safety. Objectives : The objective of this review is to examine the various EFM classification systems and criteria in order to evaluate to what extent they correlate with perinatal outcomes. We hope that this will help us to to determine to what extent classifying EFM patterns into categories can help to predict neonatal acid-base status. Method : further to searches on Medline®, Midirs®, Cinahl®, Google Scholar® and BDSP®, seven studies and one study review were selected. All are quantitative and retrospective. One is a case-control study. The study review is American and relates to American studies. Four were performed in the United States ; two in Italy, one in Japan. Resultats : The correlation between the EFM classification systems and neonatal outcomes increases with the number of categories, and the 5-tier system is best able to predict newborn acid-base status. Existing classification systems lack concordance. Tachycardia has the best discriminatory capacity. The generally accepted hierarchy amongst the various types of decelerations (early, variable, late) is confirmed, although their association with a poor acid-base status generally results from their severity (depth, duration, number, total deceleration area), in particular regarding late decelerations. Even associated with decelerations, normal variability is strongly associated with a satisfactory acid-base status. Reduced variability associated with decelerations is only poorly associated with a decline of neonatal acid-base status. Conclusion : Although FHR classification does not guarantee neonatal acid-base status, it constitutes a good indicator. By comparison with the 3-tier classification system, the 5-tier classification system, in spite of its complexity, is more accurate, provides more information on fetal condition, and allows those measures best suited to avoid adverse neonatal acid-base status to be taken. Optimal classification must be based on the individual and collective ability of the various interpretation criteria to correctly reflect fetal condition. Henceforth, more scientific evidence of the efficiency of the 5-tier system, and the means to facilitate its clinical application, are required

A qualitative study analysing the journey towards an embedded approach to service user involvement

Service user involvement in the design and delivery of education programmes for professionals is a key tenet of current policy. This study used a qualitative approach to explore the experiences of young mothers, students and academics who participated in an initiative aimed to coproduce and deliver a teaching resource focusing on becoming a mother and receiving services. The findings from the focus group interviews suggested that involving service users in student learning can provide an opportunity for open and honest dialogue, where assumptions and stereotypes can be challenged and better understood. It can also encourage users who are often seen as ‘hard to reach’ to be more actively involved in shaping the development of professionals

New Targeted Treatments for Fragile X Syndrome

Fragile X Syndrome (FXS) is the most common cause of inherited intellectual disability with prevalence rates estimated to be 1:5,000 in males and 1:8,000 in females. The increase of \u3e200 Cytosine Guanine Guanine (CGG) repeats in the 5\u27 untranslated region of the Fragile X Mental Retardation 1 (FMR1) gene results in transcriptional silencing on the FMR1 gene with a subsequent reduction or absence of fragile X mental retardation protein (FMRP), an RNA binding protein involved in the maturation and elimination of synapses. In addition to intellectual disability, common features of FXS are behavioral problems, autism, language deficits and atypical physical features. There are still no currently approved curative therapies for FXS, and clinical management continues to focus on symptomatic treatment of comorbid behaviors and psychiatric problems. Here we discuss several treatments that target the neurobiological pathway abnormal in FXS. These medications are clinically available at present and the data suggest that these medications can be helpful for those with FXS

1971 Ruby Yearbook

A digitized copy of the 1971 Ruby, the Ursinus College yearbook.https://digitalcommons.ursinus.edu/ruby/1074/thumbnail.jp

Application of Ji Koutei Kanketsu in highways design process improvement

This paper provides an introduction to ‘Ji Koutei Kanketsu’ (JKK) as a recently developed Lean method and illustrates its potential to support the improvement of BIM-based highways design work processes. JKK is developed based on the concept of jidoka to enhance the autonomation in non-physical work processes. This method provides the employees the confidence to complete their own processes without defects, while requiring a strong collaboration between the managers and their teams. The paper is based on an action research study for trialing the use of JKK in a large engineering company. It is concluded that JKK, when its prescription is compared to the current state, focuses attention to the following issues: defining individual work activities, their support factors, their pre-conditions, the judgment criteria of their outputs, and continuous improvement. JKK is also evaluated by comparing it to other, overlapping methods

The Prevalence and Influence of the Combination of Humor and Violence in Super Bowl Commercials

The growing concern over violence in the media has led to vast amounts of research examining the effects of violent media on viewers. An important subset of this research looks at how humor affects this relationship. While research has considered this subset in television programming, almost no research has explored this in the context of advertising. This paper builds on the little research that exists by examining the effects of combining humor and violence, as well as the theoretical approaches that underlie these effects. A content analysis is conducted to identify the prevalence of violence, humor, and the combination of these elements in a longitudinal sample of Super Bowl commercials (2005, 2007, and 2009). Further, we investigate the relationship between the joint occurrence of humor and violence in ads and ad popularity. We conclude that violent acts are rampant in these commercials and that many acts are camouflaged by the simultaneous presence of humor, especially in the most popular ads

The feasibility of using a parenting programme for the prevention of unintentional home injuries in the under-fives: A cluster randomised controlled trial

Background: Unintentional injury is the leading cause of preventable death of children over the age of 1 year in the UK and a major cause of attendance at emergency departments. Children having one injury are at increased risk of further injuries. Parenting programmes can reduce injuries in preschool children if delivered in the home and on a one-to-one basis. It is not known if group-based programmes delivered outside the home are effective. Objectives: To develop (1) a parenting programme to prevent recurrent unintentional home injuries in preschool children and (2) a tool for parents to report unintentional home injuries occurring to their preschool children. To assess the feasibility of delivering and evaluating the parenting programme through a cluster randomised controlled trial, specifically to (1) assess methods for the recruitment and retention of parents; (2) determine the training, equipment and facilities needed for the delivery of the programme; (3) establish appropriate primary and secondary outcome measures and methods for their collection; (4) determine how 'normal care' in a comparison arm should be defined; and (5) determine the resource utilisation and costing data that would need to be collected for the cost-effectiveness component of a future trial; and (6) produce estimates of effect sizes to inform sample size estimation for a main trial. Design: Feasibility multicentre, cluster, randomised, unblinded trial. Setting: Eight children's centres in Bristol and Nottingham, UK. Participants: Ninety-six parents of preschool children who had sustained an unintentional injury requiring medical attention in the previous 12 months. Interventions: The First-aid Advice and Safety Training (FAST) parent programme, comprising parenting support and skills combined with first aid and home safety advice. Main outcome measures: Parent-reported medically attended injuries in the index child and any preschool siblings sustained during a 6-month period of observation. Results: An 8-week parenting programme was produced, designed with participant-friendly, incrementally progressive content. A slimline, month-to-a-view injury calendar, spiral bound and suitable for hanging on a wall, was designed for parents to record injuries occurring to their preschool children during the 6-month period of observed time. Fifty-one parents were recruited (40 meeting eligibility criteria plus 11 following 'open invite' to participate); 15 parents completed the FAST parent programme and 49 provided data at baseline and during follow-up. Completion of the programme was significantly greater for participants using the 'open invite' approach (85%) than for those recruited using the original eligibility criteria (31%). Prototype resource use checklists, unit costs and total costs were developed for phases 0, 1 and 2 of the study for use in a future trial. Conclusions: This feasibility study has developed an innovative injury prevention intervention and a tool to record parent-reported injuries in preschool children. It was not feasible to recruit parents of children who had sustained a recent injury, or to ask health visitor teams to identify potential participants and to deliver the programme. A trial should target all families attending children's centres in disadvantaged areas. The intervention could be delivered by a health professional supported by a member of the children's centre team in a community setting. Trial registration: Current Controlled Trials ISRCTN03605270. Source of funding: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 3. See the NIHR Journals Library website for further project information. © Queen's Printer and Controller of HMSO 2014