Obstetric emergencies

For more than 60 years the Confidential Enquiries into Maternal Deaths triennial reports have helped build a picture of maternity care within the UK, highlighting not only our successes but failures in caring for women within the puerperal period. Despite most obstetric emergencies being well described and having clear management strategies and guidance, there continues to be substandard management with poor outcomes recorded and this has been highlighted within the latest triennium report. This article describes some common obstetric emergencies with which the anaesthetist will become involved. It emphasizes management related to some deficiencies identified in the Centre for Maternal and Child Enquiries report as well as highlighting a multidisciplinary approach throughout. Good communication between team members is paramount in all aspects of medical care, but this approach should be fostered routinely to ensure that rapid and appropriate decisions are made in a safe and timely manner.     

Development of an instrument for the identification of frail older people as a target population for integrated care

Background

Primary care is increasingly interested in the identification of frailty, as it selects the target population for integrated care. However, instruments for the identification of frailty specifically validated for use in primary care are scarce. This study developed the Easycare Two-step Older persons Screening (Easycare-TOS), which provides a valid, efficient, and pragmatic screening procedure to identify frail older people.

Aim

This paper aims to describe the development of the Easycare-TOS and the data from the pilot studies.

Design and setting

Observational pilot study in seven academic GP practices in and around Nijmegen, The Netherlands.

Method

The Easycare-TOS was developed in a cyclic process with the input of stakeholders. In every cycle, the requirements were first defined, then translated into a prototype that was tested in a pilot study. The Easycare-TOS makes optimal use of prior knowledge of the GP, and the professionals’ appraisal is decisive in the frailty decision, instead of a cut-off score. Further, it considers aspects of frailty, as well as aspects of the care context of the patient.

Results

The pilot data have shown that after step 1, two-thirds of the patients do not need further assessment, because they are judged as not frail, based on prior knowledge of the GP. The overall prevalence of frailty in this pilot study is 24%. Most professionals who participated in the pilot studies considered the time investment acceptable and the method to be of added value.

Conclusion

The Easycare-TOS instrument meets the predefined efficiency, flexibility, and acceptability requirements for use as an identification instrument for frailty in primary care.     

Personality,Cognition, and Adaptability to the COVID-19 Pandemic: Associations with Loneliness,Distress, and Positive and Negative Mood States

The current research examined personality and individual difference factors associated with the perceived ability to adapt to the significant challenges accompanying the ongoing public health crisis concerning the COVID-19 pandemic. This cross-sectional study investigated the associations among self-reported adaptability to the pandemic and personality predispositions (dependency, self-criticism, mattering, and self-esteem), cognitive factors (positive, negative, and loneliness automatic thoughts), loneliness, distress, and mood states. A sample of 462 college students from Israel completed an online questionnaire after 10 weeks of social distancing during the COVID-19 pandemic. The results confirmed that personality vulnerability factors underscored by a negative sense of self (i.e., self-criticism and dependency) and individual difference factors reflecting self-esteem, feelings of mattering, and fear of not mattering are associated in meaningful ways with adaptability to the pandemic, loneliness, distress, negative mood states, and positive mood states. Most notably, higher self-reported adaptability to the pandemic is associated with lower dependency, self-criticism, and fear of not mattering, and higher levels of self-esteem and mattering. The findings attest to the central role of adaptability and related individual difference factors in acclimatizing to the numerous changes and challenges associated with the COVID-19 crisis. The theoretical and practical implications of our findings are discussed.

     

Elevated Concentrations of Neurofilament Light Chain in the Cerebrospinal Fluid of Bipolar Disorder Patients

Bipolar disorder (BD) is characterized by mood swings between manic and depressive states. The etiology and pathogenesis of BD is unclear, but many of the affected cognitive domains, as well as neuroanatomical abnormalities, resemble symptoms and signs of small vessel disease. In small vessel disease, cerebrospinal fluid (CSF) markers reflecting damages in different cell types and subcellular structures of the brain have been established. Hence, we hypothesized that CSF markers related to small vessel disease may also be applicable as biomarkers for BD. To investigate this hypothesis, we sampled CSF from 133 patients with BD and 86 healthy controls. The concentrations of neurofilament light chain (NF-L), myelin basic protein (MBP), S100B, and heart-type fatty acid binding protein (H-FABP) were measured in CSF and analyzed in relation to diagnosis, clinical characteristics, and ongoing medications. Hereby we found an elevation of the marker of subcortical axonal damage, NF-L, in bipolar subjects. We also identified positive associations between NF-L and treatment with atypical antipsychotics, MBP and lamotrigine, and H-FABP and lithium. These findings indicate axonal damage as an underlying neuropathological component of bipolar disorder, although the clinical value of elevated NF-L remains to be validated in follow-up studies. The associations between current medications and CSF brain injury markers might aid in the understanding of both therapeutic and adverse effects of these drugs.     

Characterization of the effects of cultured vascular cells on the activation of blood coagulation

The coagulant properties of intact bovine vascular cells (aortic endothelial and smooth muscle cells) and human vascular cells (cutaneous and foreskin microvascular cells, umbilical venous endothelium) grown in vitro were studied. Compared to nonvascular cells (fibroblasts, corneal endothelial cells, fetal lung or intestinal mucosal cells), vascular cells had little procoagulant activity. Radioimmunologic measurement of thrombin in recalcified plasma demonstrated markedly lower concentrations of thrombin in the presence of vascular endothelial and smooth muscle cells compared to corneal endothelial and fetal lung cells. The low thrombin concentrations were not a consequence of thrombin binding to the vascular cells nor were they due to accelerated thrombin inactivation by antithrombin-III or alpha 2-macroglobulin. Neither vascular cells nor the nonvascular cells promoted contact activation of plasma as measured by a sensitive specific assay for kallikrein. Studies with intact cell monolayers and purified factors VIIa and X indicated that while nonvascular cells express tissue factor activity, vascular cells do not exhibit this property. These data suggest that the nonthrombogenic nature of intact vascular cells is due to their failure to initiate contact activation and to express tissue factor activity. In addition, the primary difference in coagulant potential between vascular cells and nonvascular cells is the lack of tissue factor expression by the vascular cells.     

贵池日本血吸虫对江苏沿海地区钉螺感染性的初步研究

目的　了解异地血吸虫品系对江苏省沿海残存钉螺的感染性。方法　用安徽省贵池现场感染性钉螺逸出的尾蚴感染家兔所取得的毛蚴 ,以毛蚴与钉螺 2 0∶ 1感染现场采集的钉螺 ,比较钉螺感染率和尾蚴逸出前期。结果　贵池血吸虫对如东、东台和贵池 3地钉螺感染率分别为 4 .35 %、16 .0 0 %和 4 0 .5 8% ,尾蚴平均逸出前期分别为 (72 .6 9± 8.73) d、(6 8.35± 5 .78) d和 (71.5 0± 9.0 7)d,贵池血吸虫对当地钉螺感染率显著高于对江苏沿海钉螺的感染率 (x1 2 =2 4 .5 8,x2 2 =14 .35 ,P <0 .0 1) ,尾蚴逸出前期差异无显著性 (t1 =0 .0 2 35 ,t2 =0 .1732 ,P>0 .1)。结论　江苏沿海地区钉螺在室内能被贵池血吸虫实验感染 ,长江流域血吸虫的输入 ,有可能导致血吸虫病的再流行