Perinatal mental health screening trial

Background: Pregnancy is a time of great joy and happiness but is also a time of great change, where the woman is at increased risk of onset and relapse of mental health disorders. However, unfortunately many patients go undiagnosed. --- Method: A trial for perinatal mental health screening was set up at Mater Dei Hospital. Mothers under the care of four consultant obstetricians were included in the study. All were asked a series of screening questions to assess necessity of referral to mental health services. If positive for one of the questions, a telephone consultation was carried out by one of the perinatal mental health midwives, giving them the necessary information about the mental health services available. The services offer a multidisciplinary approach with perinatal midwives, a specialised psychiatric team, social worker and psychologists. --- Results: A total of 283 mothers were screened. 105 of which were positive for a screening question, requiring mental health services. 8 accepted an office session with the perinatal midwives, and 12 were followed-up up by psychiatric team in the perinatal mental health clinic. --- Conclusion: Previous data at Mater Dei Hospital stated that 3% of all mothers delivering in labour ward were being referred to the perinatal mental health clinic. During this trial 6% of the mothers screened were making use of the service. This points towards ⁓3% of mothers who would otherwise have been suffering in the dark, proving the necessity of a screening program.peer-reviewe

Assessing the see-and-treat approach for the management of high-grade squamous intraepithelial cervical lesions

Objectives: To assess local histological outcomes in patients with HSIL cytology results on cervical smears, in both the see-and-treat and three-step approach. Study Design: A retrospective analysis of patients with HSIL on cervical cytology was performed, obtaining an 83 patient cohort. The histological result following the primary investigation (colposcopic-directed biopsy or excisional procedure) was noted for each patient together with their demographic variables and HPV status. Results: Of 83 patients with HSIL cytology on cervical smear, 43 underwent LLETZ as a primary procedure, while 40 patients underwent a colposcopic-directed biopsy. There was no statistically significant difference in terms of dermographics and HPV status between the two groups. In those patients who had LLETZ as a primary procedure, 29 had CIN2+ on histology. On the other hand, following colposcopic-directed biopsies, 17 resulted in CIN2+ on histology. Conclusion: The conventional approach within our local setting potentially has inferior sensitivity in picking up CIN2+ lesions when compared to the see-and-treat approach. On the other hand, primary excisional procedures were associated with an overtreatment rate of at least 20.9%, subjecting patients to unnecessary risks. Local improvement of colposcopic skill will aid to reduce this overtreatment rate and missed lesions at biopsy.peer-reviewe

The Perspective of Gozitan Teachers on Factors Affecting Students’ Achievement

This study aims at exploring the impact of factors at pupil, teacher and school levels on students’ academic achievement. Moreover, the main purpose was that of investigating which one of the three levels is most likely to affect students’ educational accomplishment. A questionnaire was administered to 100 Gozitan teachers. Results were analysed through the independent-samples t-test and one-way ANOVA. The outcomes of the study showed that all of the presented factors tend to make an impact on students’ academic attainment. However, results showed that 49% of participants chose the student level, 31% chose the teacher level and 20% chose the school level

Term admissions to neonatal intensive care unit : a Maltese observational study

Objective: This study aimed to identify the number of term infants admitted to the Maltese Neonatal and Paediatric Intensive Care Unit (NPICU) between January and June 2016, as well as factors contributing to their admission. Methods: All term infants (37+ weeks gestation) born in January-June 2016, transferred from Central Delivery Suite or Obstetric Wards to NPICU were identified. Patient registers, electronic case summaries, and the National Obstetric Information System (NOIS) database were used, with approval from the Data Protection Office, to collect data for a retrospective case control study. Results: Of the term infants born in these 6 months, 5.2% (101) were admitted to NPICU resulting in 42.6% of all admissions. The mean gestational age was 39 weeks (95% CI 38.8, 39.3) and mean birth weight was 3.3kg (95% CI 3.2, 3.4). More than half had been born by elective and emergency Caesarean section (26% and 27% respectively). Commonest reason for admission was respiratory distress (37%). Others included non-bilious vomiting (20%), congenital abnormalities (13%), hyperbilirubinaemia (8%), and infection (4%). Statistically significant factors associated with admission were operative delivery, threatened abortion and maternal infection during pregnancy, maternal insulin dependent diabetes mellitus, and low Apgar scores. Conclusion: The significant contributing factors should be targeted and further evaluation over a longer time-frame with an interdisciplinary team carried out in an effort to reduce rate of admissions and improve quality of care.peer-reviewe

Assessment of obstetric and gynaecology emergency service at Mater Dei Hospital

INTRODUCTION: Busy and overcrowded Emergency Departments (ED) are a major concern worldwide. Their ease of access results in overutilisation and inappropriate use with patients presenting with non-urgent health problems. The aim of this study was to quantify and assess the workload on the Obstetric and Gynaecology Emergency Service at Mater Dei Hospital and, by means of this data, assess what improvements could be put forward to improve the service.METHOD: A retrospective analysis of patients attending Gynaecology Admission Room at Mater Dei Hospital over a period of 140 days. Patient demographics and presenting complaints were noted. Patients were divided into three main cohorts: Early Pregnancy, Advanced Pregnancy and Gyaecology cases.RESULTS: 3357 cases seen in total over the 140 days. Therefore, on average 24 cases were seen every day. 62% were gynaecology cases, 30% were early pregnancy cases and 8% were advanced pregnancy cases.CONCLUSION: The Gynaecology Admission Room is a very busy unit which is currently being overcrowded with non-urgent referrals. This points towards an improvement of the primary care obstetric and gynaecology service, as well as an appropriate triage system to be put in place. The establishment of an Early Pregnancy Assessment Unit may help further to streamline early obstetric care.peer-reviewe

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Physicians’ views and experiences of discussing weight management within routine clinical consultations: A thematic synthesis

Objective To systematically search and synthesise qualitative studies of physicians’ views and experiences of discussing weight management within a routine consultation. Methods A systematic search of four electronic databases identified 11,169 articles of which 16 studies met inclusion criteria. Quality was appraised using the Critical Appraisal Skills Programme tool and a thematic synthesis conducted of extracted data. Results Four analytical themes were found: (1) physicians’ pessimism about patients’ weight loss success (2) physicians’ feel hopeless and frustrated (3) the dual nature of the physician-patient relationship (4) who should take responsibility for weight management. Conclusion Despite clinical recommendations barriers remain during consultations between physicians and patients about weight management. Many of these barriers are potentially modifiable

Ther Adv Chronic Dis

To assess the effect of a pharmacist-led intervention, using Barrows cards method, during the first year after renal transplantation, on patient knowledge about their treatment, medication adherence and exposure to treatment in a French cohort. We conducted a before-and-after comparative study between two groups of patients: those who benefited from a complementary pharmacist-led intervention [intervention group (IG),  = 44] those who did not [control group (CG),  = 48]. The pharmacist-led intervention consisted of a behavioral and educational interview at the first visit (visit 1). The intervention was assessed 4 months later at the second visit (visit 2), using the following endpoints: treatment knowledge, medication adherence [proportion of days covered (PDC) by immunosuppressive therapy] and tacrolimus exposure. At visit 2, IG patients achieved a significantly higher knowledge score than CG patients (83.3% 72.2%,  = 0.001). We did not find any differences in treatment exposure or medication adherence; however, the intervention tended to reduce the proportion of non-adherent patients with low knowledge scores. Using the PDC by immunosuppressive therapy, we identified 10 non-adherent patients (10.9%) at visit 1 and six at visit 2. Our intervention showed a positive effect on patient knowledge about their treatment. However, our results did not show any improvement in overall medication adherence, which was likely to be because of the initially high level of adherence in our study population. Nevertheless, the intervention appears to have improved adherence in non-adherent patients with low knowledge scores

Are Standard Dosing Regimens of Ceftriaxone Adapted for Critically Ill Patients with Augmented Creatinine Clearance?

ABSTRACT The objective of the present study was to determine whether augmented renal clearance (ARC) impacts negatively on ceftriaxone pharmacokinetic (PK)/pharmacodynamic (PD) target attainment in critically ill patients. Over a 9-month period, all critically ill patients treated with ceftriaxone were eligible. During the first 3 days of antimicrobial therapy, every patient underwent 24-h creatinine clearance (CL CR ) measurements and therapeutic drug monitoring of unbound ceftriaxone. ARC was defined by a CL CR of ≥150 ml/min. Empirical underdosing was defined by a trough unbound ceftriaxone concentration under 2 mg/liter (percentage of the time that the concentration of the free fraction of drug remained greater than the MIC [ fT \textgreaterMIC ], 100%). Monte Carlo simulation (MCS) was performed to determine the probability of target attainment (PTA) of different dosing regimens for various MICs and three groups of CL CR (\textless150, 150 to 200, and \textgreater200 ml/min). Twenty-one patients were included. The rate of empirical ceftriaxone underdosing was 62% (39/63). A CL CR of ≥150 ml/min was associated with empirical target underdosing with an odds ratio (OR) of 8.8 (95% confidence interval [CI] = 2.5 to 30.7; P \textless 0.01). Ceftriaxone PK concentrations were best described by a two-compartment model. CL CR was associated with unbound ceftriaxone clearance ( P = 0.02). In the MCS, the proportion of patients who would have failed to achieve a 100% fT \textgreaterMIC was significantly higher in ARC patients for each dosage regimen (OR = 2.96; 95% CI = 2.74 to 3.19; P \textless 0.01). A dose of 2 g twice a day was best suited to achieve a 100% fT \textgreaterMIC . When targeting a 100% fT \textgreaterMIC for the less susceptible pathogens, patients with a CL CR of ≥150 ml/min remained at risk of empirical ceftriaxone underdosing. These data emphasize the need for therapeutic drug monitoring in ARC patients