Maternal and infant morbidity following birth before 27 weeks of gestation: a single centre study

Delivery at extreme preterm gestational ages (GA) [Formula: see text] weeks is challenging with limited evidence often focused only on neonatal outcomes. We reviewed management and short term maternal, fetal and neonatal outcomes of births for 132 women (22 + 0 to 26 + 6 weeks' GA) with a live fetus at admission to hospital and in labour or at planned emergency Caesarean section: 103 singleton and 29 (53 live fetuses) twin gestations. Thirty women (23%) had pre-existing medical problems, 110 (83%) had antenatal complications; only 17 (13%) women experienced neither. Major maternal labour and delivery complications affected 35 women (27%). 151 fetuses (97%) were exposed to antenatal steroids, 24 (15%) to tocolysis and 70 (45%) to magnesium sulphate. Delivery complications affected 11 fetuses, with 12 labour or delivery room deaths; survival to discharge was 75% (117/156), increasing with GA: 25% (1/4), 75% (18/24), 69% (29/42), 73% (33/45) and 88% (36/41) at 22, 23, 24, 25 and 26 weeks GA respectively (p = 0.024). No statistically important impact was seen from twin status, maternal illness or obstetric management. Even in a specialist perinatal unit antenatal and postnatal maternal complications are common in extreme preterm births, emphasising the need to include maternal as well as neonatal outcomes

Temporal artery biopsies in south-east Scotland:a five year review

Temporal artery biopsy is the gold standard investigation for the diagnosis of giant cell arteritis. The aim of this retrospective study was to investigate the use of temporal artery biopsy in diagnosing giant cell arteritis in south-east Scotland over a five-year period. We aimed to quantify success rates, and predictive factors for a positive biopsy, as well as compare the different specialities performing the biopsies. The data should enable the development of better criteria for referral for investigation of giant cell arteritis. Methods Patients were identified using a database of temporal artery biopsies generated by the pathology department in NHS Lothian (south east Scotland), for all biopsies examined between January 2010 and December 2015. An electronic patient record was used to retrospectively examine the records of patients in the database. Results A total of 715 biopsies were included in the study, of which 250 (35.0%) showed features of giant cell arteritis. The main predictors for a positive biopsy were age at biopsy, specialty performing biopsy, erythrocyte sedimentation rate, jaw claudication/pain, and ophthalmic symptoms. The most important predictor of a positive biopsy was erythrocyte sedimentation rate. The length of biopsy was not found to be a predictor of positive biopsy; however, diameter of biopsy was predictive. Conclusions We have shown that many temporal artery biopsies are negative, and finding ways to reduce the number of patients unnecessarily undergoing biopsy will be essential in reducing workload and streamlining services. This study demonstrates some key predictive factors for patients with positive biopsies. The study also shows that a large proportion of biopsies taking place do not result in the recommended length of specimen, but this does not necessarily reduce the likelihood of a positive biopsy

Reliability (inter-rater agreement) of the Barthel index for assessment of stroke survivors: systematic review and meta-analysis

<br>Background and Purpose—The Barthel Index (BI) is a 10-item measure of activities of daily living which is frequently used in clinical practice and as a trial outcome measure in stroke. We sought to describe the reliability (interobserver variability) of standard BI in stroke cohorts using systematic review and meta-analysis of published studies.</br> <br>Methods—Two assessors independently searched various multidisciplinary electronic databases from inception to April 2012 inclusive. Inclusion criteria comprised: original research, human stroke participants, and inter-rater reliability data on equivalent methods of BI administration. Manuscripts were reviewed against prespecified inclusion criteria. Primary outcome for meta-analysis was reliability, measured by weighted κ (κw).</br> <br>Results—From 20 210 titles, 306 abstracts were reviewed, 12 studies met inclusion criteria, and 10 were included in meta-analysis (n=543 participants; range of participants in studies, 7–21). There was substantial clinical heterogeneity with respect to method of BI application; population studied and assessors. Two papers were graded high quality. Overall interobserver reliability of standard administration of the BI was excellent (κw, 0.93; 95% confidence interval, 0.90–0.96 random effects modeling).</br> <br>Conclusions—The BI has excellent inter-rater reliability for standard administration after stroke. However, included studies were modest in size, with clinical heterogeneity and variable methodological quality. Despite these limitations, standard BI seems an appropriate outcome measure for stroke trials and practice.</br&gt