The Coombe Women & Infants University Hospital (Irish: Ospidéal Ollscoile Ban ⁊ Naonáin an Chúim) is a voluntary teaching hospital providing a range of medical services to both women and newborn infants in Dublin, Ireland. It is managed by Dublin Midlands Hospital Group.
Purpose: To evaluate if biliblankets prevents the need for overhead phototherapy in neonates with physiological jaundice approaching the treatment line. Methods: Single-centre randomised trial carried out in a tertiary maternity unit. Infants ≥35 weeks gestation and >24 hours of age with suspected physiological jaundice were eligible if serum bilirubin level was within 35µmol/l of the treatment line. Infants admitted to the neonatal unit or with a positive pre-randomisation direct Coombs test were excluded. Infants were randomised to intervention arm (treatment with Biliblanket) or control arm (routine care). Primary outcome was need for overhead phototherapy. Results: Ninety-seven infants were included in an intention-to-treat analysis, 51 in intervention arm and 46 in control arm with no baseline imbalances. Sixteen percent in the intervention group and 15% in the control group required overhead phototherapy (p>0.99) and no difference in length of stay (p=0.6) was observed. More infants in the intervention arm were discharged receiving formula feeds exclusively (p=0.04) despite no difference in feeding intentions. Conclusion: Use of a biliblanket for physiological jaundice approaching the treatment line in well term infants does not decrease need for overhead phototherapy with no difference in length of stay, but a potential for disruption of breastfeeding establishment. Trial Registration: The trial was retrospectively registered (ISRCTN29045982 - https://www.isrctn.com/) on 08/01/2022.
Background Improving the quality of patient care remains a global necessity. Despite system and professional benefits, current evidence indicates that the spread of improvement principles among front-line healthcare workers remains poor.While education and training alone are unlikely to result in consistent improvement practice, coaching can play a critical role in sustainable, evidence-based improvement implementation. Peer quality improvement coaching (PQIC) places the power and agency in the shared relationship between coach and coachee to shape coachee quality improvement (QI) outcomes.Study objective was to develop and pilot an evidence-based protocol for implementation and evaluation of a PQIC for front-line staff engaged in small to intermediate improvement efforts.Methods We conducted a multistage case-study design and implementation process. First, a systematised literature review identified themes about the theory and practice of QI coaching (QIC). Second, these themes guided the development of a PQIC protocol. Finally, the protocol was piloted and evaluated among staff in a single-centre tertiary maternity hospital. PQIC effectiveness was assessed using evaluation tools identified in the literature.Results Effectiveness; strategies and models; moderating factors and methods for evaluation of QIC emerged from the literature. Together with Bloom’s taxonomy and Kirkpatrick’s educational model, these themes informed the development of this PQIC protocol. It was piloted in three steps: education, coaching and evaluation. A survey revealed that the participants in the education step achieved excellent scores. Following the coaching journey, the coached multidisciplinary team leaders completed their improvement initiatives and demonstrated increased QI knowledge and skills measured by the ‘IHI improvement advisor self-assessment tool’ and ‘IHI assessment scale for collaboratives’.Conclusion Built on established education, peer coaching and QI concepts, this evidence-based PQIC protocol adds to international evidence on how to support front-line healthcare workers in their improvement efforts. Future research needs to assess protocol effectiveness across different settings.
Circulating tumour cells (CTCs) are rare yet crucial biomarkers with significant prognostic potential across different cancer types. However, their role in high-grade serous ovarian cancer (HSGC) is not well defined. To capture the full spectrum of CTCs found in HGSC, we employed an EpCAM independent enrichment technique in patients with advanced HGSC and investigated the prognostic value and molecular signatures of these rare cells. CTC enumeration was performed in 43 newly diagnosed patients with HGSC using Parsortix® CTC enrichment and benchmarked against a metastatic breast cancer (MBC) cohort for which the device is FDA approved. CTCs were also isolated from the ovarian vein of patients with HGSC during primary cytoreductive surgery. CTCs were assessed as prognostic markers in patients with HGSC. FACS single cell sorting and scRNAseq was performed on CTCs isolated from the ovarian vein. CTCs isolated using Parsortix® enrichment in HGSC ranged between 1-22 cells/7.5 ml blood. Concordance was seen between Parsortix® enrichment and CellSearch® enumeration in patients with MBC (R2 = 0.8786). CTC clusters were isolated from the ovarian vein (P = 0.0195) and were cloaked in platelets/immune cells. Detection of CTCs in patients with HGSC was predictive of a poorer progression free survival (P = 0.0183). Patients with CTCs were found to have increased serum levels of CD73 (P = 0.0311). scRNAseq of CTCs isolated from the ovarian vein identified enrichment in genes associated with immune signalling. Peripheral CTCs isolated from patients with HGSC were predictors of a poor prognosis. The ovarian vein was found to be a rich source of disseminating CTC clusters in HGSC. Further studies are warranted to investigate the utility of CTCs as markers of neoadjuvant chemotherapy response as well as for longitudinal monitoring. Molecular analysis of CTCs in HGSCs reveals a potential role of the immune system in CTC-mediated haematogenous metastasis.
OBJECTIVE:To investigate the effects of aspirin on the distribution of birthweight and its impact on the rates of large-for-gestational-age (LGA) neonates. DESIGN:Secondary analysis of the Combined Multimarker Screening and Randomised Patient Treatment with Aspirin for Evidence-based Preeclampsia Prevention (ASPRE) trial. SETTING:Thirteen hospitals in England, Spain, Belgium, Greece, Italy and Israel. POPULATION:Participants of the ASPRE trial at increased risk of preterm pre-eclampsia (PE) who had a live birth. METHODS:We compared the birthweight distributions and the rates of LGA neonates between the trial groups. Analyses were stratified according to the presence of pre-existing diabetes mellitus and the development of PE, and logistic regression was used to investigate independent predictors of LGA neonates with birthweight above the 90th percentile. MAIN OUTCOME MEASURES:Birthweight distribution and rates of LGA neonates. RESULTS:Among 1571 singleton, live neonates (777 from the aspirin group and 794 from the placebo group), aspirin was associated with a shift in birthweight from < 2500 to 2500-4000 g, and birthweight percentile from < 25th to 25th-75th percentiles, with no significant increase in LGA neonates (5.5% vs. 6.2%, p = 0.667). Logistic regression demonstrated a significant interaction between treatment and pre-existing diabetes (p-value 0.034), and a positive association between maternal weight and LGA neonates (adjusted odds ratio 1.040, 95% confidence interval 1.030-1.051, p < 0.001). CONCLUSIONS:Aspirin use is associated with increased birthweight without increasing the rate of LGA neonates. Among women with pre-existing diabetes, aspirin may be associated with a higher rate of LGA neonates, warranting further investigation.
Preterm birth (PTB), defined as delivery before 37 weeks of gestation, affects approximately 13.4 million infants annually worldwide (9.9% of all births). PTB is a complex obstetrical syndrome with a diverse range of aetiologies, complicating screening and prevention strategies. Primary prevention of PTB should include access to appropriate antenatal care, dating ultrasound, screening for and treatment of infection, adequate nutritional status, and avoidance of iatrogenic PTB where modifiable risks are present. Secondary preventative approaches include progesterone, cervical cerclage, and the use of cervical pessaries. In cases of unavoidable PTB, the optimisation of perinatal outcomes can be achieved with timed antenatal maternal corticosteroid administration, magnesium sulphate, and access to specialised neonatal care. To review the burden of both spontaneous and iatrogenic preterm births globally. To understand primary, secondary, and tertiary interventions to reduce the incidence of preterm birth in both high‐and low‐resource settings. To understand how perinatal outcomes can be optimised in cases where PTBs are unavoidable. Resource allocation and equity in low‐ and middle‐income countries. Counselling patients on the complexities of both preventing and preparing for, a spontaneous preterm birth. Optimising care for extremely preterm infants to reduce morbidity and mortality.
