A screening and intervention program aimed to reduce mortality and serious morbidity associated with severe neonatal alloimmune thrombocytopenia

The study's objective was to identify HPA 1a-negative women and to offer them an intervention program aimed to reduce morbidity and mortality of neonatal alloimmune thrombocytopenia (NAIT). HPA 1 typing was performed in 100 448 pregnant women. The HPA 1a-negative women were screened for anti-HPA 1a. In immunized women, delivery was performed by Cesarean section 2 to 4 weeks prior to term, with platelets from HPA 1a-negative donors reserved for immediate transfusion if petechiae were present and/or if platelet count was less than 35 x 10(9)/L. Of the women screened, 2.1% were HPA 1a negative, and anti-HPA 1a was detected in 10.6% of these. One hundred seventy pregnancies were managed according to the intervention program, resulting in 161 HPA 1a-positive children. Of these, 55 had severe thrombocytopenia (< 50 x 10(9)/L), including 2 with intracranial hemorrhage (ICH). One woman with a twin pregnancy missed the follow-up and had one stillborn and one severely thrombocytopenic live child. In 15 previous prospective studies (136 814 women) there were 51 cases of severe NAIT (3 intrauterine deaths and 7 with ICH). Acknowledging the limitation of comparing with historic controls, implementation of our screening and intervention program seemed to reduce the number of cases of severe NAIT-related complications from 10 of 51 to 3 of 57.     

Occupational health complaints and adverse patient reactions as perceived by personnel in public dentistry

A questionnaire survey on health complaints experienced by personnel in public dentistry was undertaken in 1979 and repeated in 1988/89. The reply rates were about 80% and 83%. In both surveys, about one half of the personnel reported occupation-related health complaints, a majority of which were dermatoses of hands and fingers. The dermatoses were attributed to seasonal air quality problems, or to contact with chemically active substances relevant to hygienic measures, treatment patterns, or other activities connected with the running of a dental clinic. The majority of the dermatoses were probably irritative. Some presumably hypersensitivity reactions occurred after handling of dental materials. Latex gloves, which were in general use only at the time of the last survey, seemed to have prevented some dermatoses formerly attributed to handwashing procedures. However, latex gloves per se had also induced dermatoses. Non-dermatological ailments of a transient nature comprised eye, respiratory, or systemic reactions and were connected with volatiles from X-ray liquids, methylmethacrylate monomer, and disinfectants. Adverse patient reactions occurred at a frequency of about one per 2600 treated patients. The observations comprised skin reactions (head/face), gingival/mucosal ulcerations, and sometimes systemic/urticarial reactions. The reactions were associated with the use of local anesthetics, orthodontic appliances, and other biomaterials. Two reactions were related to contact with the dentists' latex gloves.     

Physicians' views on resource availability and equity in four European health care systems

Background  

In response to limited resources, health care systems have adopted diverse cost-containment strategies and give priority to differing types of interventions. The perception of physicians, who witness the effects of these strategies, may provide useful insights regarding the impact of system-wide priority setting on access to care.     

The long-term effects of conductive education courses in young children with cerebral palsy: a randomized controlled trial

ABSTRACT

Purpose: To assess the additional long-term effects of multiple conductive education (CE) courses followed by conventional practice on functional skills and quality of life in children with cerebral palsy (CP) compared to a 4-month CE-course delay including conventional practice.

Methods: Twenty-one children with CP, 3–6 years and varied functional levels, were randomized to 3-week CE course(s) followed by conventional practice or 4 months on a waiting list, including conventional practice and followed by CE-courses. Outcomes were measured 8 and 12 months after baseline. A web-based log collected data on conventional practice.

Results: We found no interaction between group assignment and time on functional skills and quality of life in children with CP at 8 and 12 months. Two thirds of the children in both groups performed a large amount of conventional practice.

Conclusions: No added long-term effects of CE courses were found. Larger controlled CE studies are needed.     

The usage of fasting glucose and glycated hemoglobin for the identification of unknown type 2 diabetes in high risk patients with morbid obesity

Background: In spite of increased vigilance of undiagnosed type 2 diabetes (DM2), the prevalence of unknown DM2 in subjects with morbid obesity is not known.

Aim: To assess the prevalence of undiagnosed DM2 and compare the performance of glycated A1c (HbA1c) and fasting glucose (FG) for the diagnosis of DM2 and prediabetes (preDM) in patients with morbid obesity.

Patients and methods: We measured fasting glucose and HbA1c in 537 consecutive patients with morbid obesity without previously known DM2.

Results: A total of 49 (9%) patients with morbid obesity had unknown DM2 out of which 16 (33%) fulfilled both the criteria for HbA1c and FG. Out of 284 (53%) subjects with preDM, 133 (47%) fulfilled both the criteria for HbA1c and FG. Measurements of agreement for FG and HbA1c were moderate for DM2 (κ?=?0.461, p?<?.001) and fair for preDM (κ?=?0.317, p?<?.001). Areas under the curve for FG and HbA1c in predicting unknown DM2 were 0.970 (95% CI 0.942, 0.998) and 0.894 (95% CI 0.837, 0.951) respectively. The optimal thresholds to identify unknown DM2 were FG ≥6.6?mmol/L and HbA1c ≥ 6.1% (43?mmol/mol).

Conclusions: The prevalence of DM2 remains high and both FG and HbA1c identify patients with unknown DM2. FG was slightly superior to HbA1c in predicting and separating patients with unknown DM2 from patients without DM2. We suggest that an FG ≥6.6?mmol/L or an HbA1c ≥6.1% (43?mmol/mol) may be used as primary cut points for the identification of unknown DM2 among patients with morbid obesity.     

The relationships between the combination of person- and organization-related conditions and patients’ perceptions of palliative care quality

Background

Little is known about the combination of person- and organization- related conditions and the relationships with patients’ perspectives of care quality. Such a combination could contribute knowledge reflecting the complexity of clinical practice, and enhance individualized care. The aim was to investigate the relationships between the combination of person- and organization-related conditions and patients’ perceptions of palliative care quality.

Methods

A cross-sectional study, including 191 patients in the late palliative phase (73% response rate) admitted to hospice inpatient care (n =?72), hospice day care (n =?51), palliative units in nursing homes (n =?30) and home care (n =?38), was conducted between November 2013 and December 2014, using the instrument Quality from the Patients’ Perspective specific to palliative care (QPP-PC). Data were analysed, using analysis of covariance, to explore the amount of the variance in the dependent variables (QPP-PC) that could be explained by combination of the independent variables – Person- and organization-related conditions, ? while controlling for differences in covariates.

Results

Patients scored the care received and the subjective importance as moderate to high. The combination of person- and organization - related conditions revealed that patients with a high sense of coherence, lower age (person – related conditions) and being in a ward with access to and availability of physicians (organization-related condition) might be associated with significantly higher scores for the quality of care received. Gender (women), daily contact with family and friends, and low health-related quality of life (person-related conditions) might be associated with higher scores for subjective importance of the aspects of care quality.

Conclusion

Healthcare personnel, leaders and policy makers need to pay attention to person- and organization-related conditions in order to provide person-centered palliative care of high quality. Further studies from palliative care contexts are needed to confirm the findings and to investigate additional organizational factors that might influence patients’ perceptions of care quality.