Objective To compare the effect of umbilical cord milking (UCM) vs. early cord clamping (ECC) on cerebral blood flow (CBF). Method Preterm infants <31 weeks’ gestation were randomized to receive UCM or ECC at birth. Blood flow velocities and resistive & pulsatility indices of middle and anterior cerebral arteries were measured at 4–6 and 10–12 h after birth as an estimate of CBF. Results Randomization allocated 37 infants to UCM and 36 to ECC. Maternal and antenatal variables were similar. There were no significant differences between groups in middle or anterior CBF velocities and resistive indices at either study time point. CBF variables were not correlated with mean blood pressure, systemic blood flow, or intraventricular hemorrhage. Conclusions In very preterm infants, UCM compared with ECC was not shown to change CBF indices during the first 12 h of age or correlate with other hemodynamic measures or with intraventricular hemorrhage. Trial registration ClinicalTrials.gov: NCT01487187.

BACKGROUND: Delayed cord clamping may be difficult to perform in extremely preterm infants. The effects of the alternative, cord milking, have not been fully evaluated. OBJECTIVES: To determine whether cord milking (CM) at birth improves systemic blood flow and short term outcomes, as compared with immediate cord clamping (ICC). DESIGN/METHODS: Babies born to eligible, consenting women presenting in preterm labor between 24 and 31 weeks' gestation were randomized to receive CM or ICC. Echocardiography was performed at 4-6 and 10-12 hours after birth. The primary outcome was systemic blood flow as represented by echo-derived superior vena cava (SVC) flow. Neonatal care staff, echogardiographer and interpreter were blind to the randomization. Analysis was by intention to treat. RESULTS: A total of 73 eligible infants were randomized (37 to CM and 36 to ICC) during the study period (November 2011-2014). There were no statistically significant differences in maternal demographic and antenatal variables. Mean (SD) gestational age was 26.1 (11) weeks and mean (SD) birth weight was 1025 (308) g. 38% of infants were born by vaginal delivery. No significant differences were found between groups in SVC flow, cardiac outputs or neonatal morbidities [table1]. CONCLUSION: There were no statistically significant differences in functional cardiac outcomes, mortality or morbidity between preterm infants who received CM and those who received ICC. Larger trials are needed to establish the best practice in managing the umbilical cord at birth in extremely preterm infants.

Objective: A pilot study was conducted to examine the characteristics, capacities (beliefs, values and intentions) and skills that distinguish exemplary communicators from less exemplary communicators in patient-physician encounters.Methods: Forty physicians participated in a four-station videotaped OSCE focusing on a variety of adolescent sexual health issues and assessed using seven quantitative measures.Results determined the top 15%, and the bottom 15%. An interviewer reviewed and discussed two of the videotaped scenarios with physicians in both groups. Interviews were analyzed to determine differences between groups. Results: Results consistently identified the top 15% (6) and bottom 15% (6) physicians. The t-tests showed statistically significant differences on all skills and capacity measures. "Notable" differences (25% or higher) were found on two quantitative instruments assessing skills. There were no notable differences in capacities. The qualitative inquiry confirmed notable differences in skills and identified capacities of empathy, non-judgement and self-reflection as restricted to the exemplary group.Conclusion: Using quantitative and qualitative measures, it is possible to determine skills and capacities that distinguish exemplary communicators from less exemplary communicators.Practice implications: In addition to effective skills, physician empathy, non-judgement and self-reflection appear to be necessary components for exemplary physician communication with adolescents. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

PURPOSE:A substantial body of literature demonstrates that communication skills in medicine can be taught and retained through teaching and practice. Considerable evidence also reveals that characteristics such as gender, age, language and attitudes affect communication skills performance. Our study examined the characteristics, attitudes and prior communication skills training of residents to determine the relationship of each to patient-doctor communication. The relationship between communication skills proficiency and clinical knowledge application (biomedical and ethical) was also examined through the use of doctor-developed clinical content checklists, as very little research has been conducted in this area.METHODS:A total of 78 first- and second-year residents across all departments at Dalhousie Medical School participated in a videotaped 4-station objective structured clinical examination presenting a range of communication and clinical knowledge challenges. A variety of instruments were used to gather information and assess performance. Two expert raters evaluated the videotapes.RESULTS:Significant relationships were observed between resident characteristics, prior communication skills training, clinical knowledge and communication skills performance. Females, younger residents and residents with English as first language scored significantly higher, as did residents with prior communication skills training. A significant positive relationship was found between the clinical content checklist and communication performance. Gender was the only characteristic related significantly to attitudes.CONCLUSIONS:Gender, age, language and prior communication skills training are related to communication skills performance and have implications for resident education. The positive relationship between communication skills proficiency and clinical knowledge application is important and should be explored further.