Risk perception and choice of place of birth in women with high risk pregnancies: A qualitative study

Objective To examine the perception of risk among a group of women with high risk pregnancies who were either planning to give birth in hospital, or at home despite medical advice to the contrary. The intention was to consider differences and similarities between the groups to examine how perception of risk relates to choice of place of birth.Design Qualitative study using semi-structured interviews. Setting Maternity department in a hospital in South East England.Participants Twenty-six women with high risk pregnancies, at least 32 weeks pregnant. Half were planning hospital births and half homebirths.Measurements and findings Semi-structured interviews to investigate women's understanding and assessment of risk. Results were analysed using thematic analysis. Five themes emerged: understanding of situation; judgement of risk; reassuring factors; impact of risk; and coping with risk. Women from both groups had some understanding of the implications of their medical/obstetric conditions. They displayed concerns about their babies' wellbeing. Women planning homebirths assessed their risks as lower and expressed less concerns than women planning hospital births. Women planning hospital births more frequently described following professional advice.Key conclusions Risk perception is individual and subjective. Women with high risk pregnancies who plan to give birth at home perceive risk differently to women who plan hospital births.Implications for practice Healthcare professionals working with women with high risk pregnancies should be aware of the potential for differences in definitions and perceptions of risk within this group.     

Too far away to work with each other: Does location impact on pharmacists’ perceptions of interprofessional interactions?

In recent years, the delivery of health services has seen a shift towards interprofessional teamwork in order to effectively utilise the skills of each member of the healthcare team to deliver optimal patient care. Nevertheless, a variety of barriers, including lack of communication between healthcare professionals (HCPs), have been identified. The expanding clinical services provided by community pharmacies have increased the potential for pharmacist-HCP interaction; however, primary care pharmacy environments vary from individual distinct premises to part of interprofessional ‘health centres’. As such, one potential factor affecting interprofessional communication could be the geographical location (‘space’) of HCPs. This study sought to determine whether these different primary healthcare ‘spaces’ impact on the frequency of interprofessional interactions. An anonymous, self-complete questionnaire was sent to all community pharmacies in Wales (n = 716) to quantify the frequency of interprofessional interactions between community pharmacists and other HCPs. A response rate of 62% was achieved. Results showed that pharmacists working in pharmacies physically linked to general practitioner (GP) surgeries had significantly more frequent interaction with HCPs based within the surgeries. This suggests that housing HCPs in the same physical space will enable more interprofessional interaction, supporting the drive to improve the quality of patient care.     

Development of socio-communicative skills in 9- to 12-month-old individuals with fragile X syndrome

We investigated the early socio-communicative development of individuals with fragile X syndrome (FXS) by undertaking a retrospective analysis of family videos. Videos were analyzed to identify existing communicative forms and functions. Analyses were undertaken on seven children who were later diagnosed with FXS. The children were filmed when they were 9–12 months old and before being diagnosed. Fourteen different communicative forms and six different communicative functions were observed. All participants were observed to express the functions of ‘Attention to self’ and ‘Answering’, but none indicated ‘Requesting action’, ‘Requesting information’, ‘Choice making’, or ‘Imitating’. Results suggest that children with FXS may have a limited range of communicative forms and functions when they are from 9 to 12 months of age. However, further research is necessary to gain a specific developmental profile of socio-communicative forms and functions in FXS.     

‘Pre-Run,Re-Run’: An innovative research capacity building exercise

Within higher education it is ironic that experienced and novice researchers rarely take the opportunity to come together to share their research – whether these be to discuss findings, puzzles or developing projects. Within this paper, an innovative strategy building on these assumptions is described. It is entitled: ‘Pre-run, Re-run’ and is a learning community where specific processes are modelled by all to help build professional communication, collegial respect, and scholarship.Our evaluation showed that there is value in bringing together researchers especially when they have diverse profiles. Also, mixing experience with naivety, by inviting professors and junior staff to fraternize equally, offers the possibility for wide ranging discussion, as well as sharing a range of successful techniques, knowledge of the big picture and ways around obstacles that would otherwise be off-putting for novices. The less experienced perspective can equally be revitalizing because newcomers to scholarship often bring a fresh focus and enthusiasm and energy for practice. While this was a local innovation, which may not be generalizable to all settings, others hoping to bring together disciplines may benefit from utilizing the successful methods to build a productive, mixed research culture.     

Do parents understand the medical information provided in paediatric emergency departments? A prospective multicenter study

Aim: We evaluated the extent to which parents understood the medical information about hospitalization of their child in an emergency department and looked for characteristics likely to increase the risk of poor comprehension. Methods: Prospective multicenter study in thirteen paediatric emergency departments. The parents and doctors completed questionnaires based on closed‐ended questions with a common core of four items: reasons of hospitalization, diagnosis, treatment and seriousness of child condition. We evaluated concordance between parents and doctor answers for these items by comparing their responses. Results: This study included 380 parents. Percentage of concordance was 55% for the reason of hospitalization, 78% for the diagnosis, 92% for the treatment, 48% for the seriousness of the condition and 19% for all four items. The mean number of concordant items was 2.76 (CI 95%, 2.66–2.86). Parents whose children seemed not in pain and parents who received additional information from the nurse showed significantly slightly higher levels of concordance with doctor’s answers (2.98 vs 2.66, p = 0.006 and 2.89 vs 2.60, p = 0.004, respectively). Conclusion: This study shows that improvements are required in the clarity of the information delivered to the parents. The assistance of nurses and optimal pain management may help to improve communication.     

On the relationships between ultrasonic calling and anxiety-related behavior in rats

In the present review, the phenomenon of ultrasonic vocalization in rats will be outlined, including the three classes of vocalizations, namely 40-kHz calls of pups, and 22- and 50-kHz calls of juvenile and adult rats, their general relevance to behavioral neuroscience, and their special relevance to research on anxiety, fear, and defense mechanisms. Here, the emphasis will be placed on 40- and 22-kHz calls, since they are typical for various situations with aversive properties. Among other topics, we will discuss whether such behavioral signals can index a certain affective state, and how these signals can be used in social neuroscience, especially with respect to communication. Furthermore, we will address the phenomenon of inter-individual variability in ultrasonic calling and what we currently know about the mechanisms, which may determine such variability. Finally, we will address the current knowledge on the neural and pharmacological mechanisms underlying 22-kHz ultrasonic vocalization, which show a substantial overlap with mechanisms known from other research on fear and anxiety, such as those involving the periaqueductal gray or the amygdala.     

基于移动通讯技术的新型院外远程实时心电监测系统的临床研究

目的 评价一种自主研发的基于移动通讯技术的新型院外远程实时心电监测系统数据传输的实时性及对心律失常检测的敏感性.方法 通过测定心电信号传输的延时评估系统的实时性;通过与动态心电图对比评估远程监测对心律失常检测的敏感性.结果 远程监测时心电数据传输的最短延时为9s,最长延时为17s,平均延时为（13.4±4.5）s.在100例受试者中,远程监测和动态心电图分别检测到偶发房性期前收缩62例、57例,频发房性期前收缩22例、25例,心房颤动均为9例,非阵发性室性心动过速16例、12例,差异均无统计学意义（均P ＞0.05）.同时均发现二度Ⅱ型房室传导阻滞5例、三度房室传导阻滞2例.结论 该系统有较好的实时性,对心律失常检出的敏感性与动态心电图相仿.     

Tailoring antimicrobials in febrile neutropenia: using faster diagnostic and communication tools to improve treatment in the era of extensively resistant pathogens

Febrile Neutropenia represents a medical emergency and the use of appropriate antimicrobial therapy is essential for a better outcome. Although being time-consuming, conventional cultures and antimicrobial susceptibility tests remain the golden standard practices for microbiology identification. Final reports are typically available within several days. Faster diagnostic tools, such as species identification trough Matrix Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) and molecular techniques might help to shorten time to diagnostic and also guide definitive therapy in this scenario. Here we present a case in which the use of a diagnostic molecular workflow combining MALDI-TOF and real-time PCR for relevant genes codifying antibiotic resistant integrated with instant communication report, led to a tailored and more appropriate treatment in a patient presenting with febrile neutropenia.