Background: A high rate of attrition is a key contributor to the current midwifery workforce crisis. Burnout is linked to high attrition, and aspects of midwifery work and the midwifery profession contribute to high rates of burnout. Aim: To describe the prevalence of burnout and associated factors in a sample of midwives in Victoria, Australia. Methods: An online, cross-sectional survey of midwives working in Victoria was conducted between March and October 2021. We explored burnout using the Copenhagen Burnout Inventory (CBI), which includes three domains: personal, work-related and client-related burnout. Univariate and multivariable logistic regression explored associations between each of the burnout domains and respondents' characteristics and occupational stressors. Findings: A total of 1017/5185 (19.6%) midwives participated in the FUCHSIA survey. Seventy-two percent of midwives scored as having personal, 67% work-related and 19% client-related burnout. Across three domains, inadequate acknowledgement (personal AOR 2.57; 95% CI 1.72, 3.84, work AOR 2.35; 95% CI 1.56, 3.54 client AOR 1.80: 95% CI 1.06, 3.06), lack of job satisfaction (personal AOR 2.87; 95% CI 1.70, 4.85, work AOR 4.60; 95% CI 2.62, 8.08, client AOR 2.76; 95% CI 1.83, 4.17) and considering skill mix to be unsafe (personal AOR 2.57; 95% CI 1.69, 3.87, work AOR 2.53; 95% CI 1.63, 3.92, client AOR 1.77; 95% CI 1.00, 3.12) were associated with a higher level of burnout. Those who worked in large services, part-time or casually, who rotated through more than one area of maternity care, were unable to take adequate breaks, and needed more support were more likely to experience work-related burnout Conclusion: The prevalence of burnout in this sample of Victorian midwives was high, with at least two-thirds of the sample experiencing personal and work-related burnout. Strategies to address factors such as providing adequate acknowledgement, support, and job satisfaction and providing a safe and flexible work environment may be key to addressing burnout for midwives.

Background Improving palliative care for inpatients is urgently needed. Data from patient-reported experience measures (PREM) can assist in identifying areas for focused improvement. This study aimed to describe patient reported experience of care in inpatients with palliative care needs, to inform a baseline understanding of care experience and identify key areas for improvement. Methods Cross-sectional study design where inpatients with palliative care needs were invited to complete ‘consideRATE,’ a patient reported experience measure of care, over six months in 2022. Inpatients with palliative care needs receiving care on an oncology, general medicine/renal and general medicine/respiratory ward ( n = 3) at an Australian metropolitan hospital were screened for eligibility. Carers could provide proxy responses where inpatients were unable to participate. Descriptive statistics were used to analyse quantitative ratings, whilst free text responses were analysed using integrated thematic analysis. Results One-hundred and twenty participants (108 patients and 12 carers) completed consideRATE. The questions with the highest number of ‘very good’ responses were attention to symptoms, attention to feelings and attention to what matters most; the questions with the lowest number of ‘very good’ responses was attention to patients’ affairs, what to expect, and the environment of care. Almost half ( n = 57, 48%) indicated that attention to patients’ affairs ‘did not apply’ to their inpatient stay. Analysis of 532 free text responses across 8 questions highlighted the importance of feeling supported, feeling informed, feeling heard and navigating the clinical environment. Conclusion Enabling inpatients with palliative care needs to provide feedback about their experience of care is one method of ensuring improvements matter to patients. Supporting clinical teams to understand and use these data to make tailored improvements is the next step in this multi-phase research.

Abstract Background In group-based pregnancy models, antenatal care and childbirth/parenting education are provided in groups of eight to 10 women, usually with two midwives, and six to eight sessions. Current evidence is inconclusive regarding potential benefit or harm. We aimed to explore the feasibility of implementing an adequately powered randomised controlled trial (RCT). Methods A two-arm pilot RCT was conducted in a tertiary maternity hospital in Melbourne, Australia. Women were randomly allocated to either the intervention to receive group-based antenatal care and education (group care) or to usual care, which included hospital-based midwife, caseload midwifery, team midwifery, or GP shared care. Participants were English-speaking, primiparous, low risk, and < 24 weeks gestation at booking. Data collection: feasibility measures throughout pilot, baseline questionnaire at recruitment, clinical outcome data from the medical record, and a telephone-administered questionnaire 6 weeks postpartum. A focus group explored midwives’ views. Results Seventy-four women were recruited from May to June 2017 (group care = 40, usual care = 34). Study uptake was 35%. Women allocated to group care rated their overall pregnancy care more highly (88% good/very good vs 77% in usual care). There was no evidence of harm related to group care. Overarching themes from the midwives were that group care helped ‘build connections’ and ‘empower women’. All midwives would work in the model again and believed it should be expanded. Conclusion Group care was acceptable to both women and midwives with no evidence of harm. The pilot demonstrated the feasibility of undertaking a large adequately powered RCT, important given the inconclusive evidence on clinical outcomes regarding the model, and its current relatively widespread implementation. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000858695.

BackgroundPrior to the COVID-19 pandemic there were midwifery workforce deficits reported in Australia, but inadequate workforce data to identify retention and attrition in the profession. In the post-pandemic era, workforce deficits continue. This paper reports on midwives' intentions to leave the profession and explores reasons for and factors associated with having high intention to leave, to inform strategies that can address retention and attrition of midwives.MethodsA cross-sectional survey with midwives was conducted in 2017 via an online survey in two maternity care sites in Victoria, Australia. Plans for remaining in or leaving the profession were explored along with reasons for leaving or intending to leave the profession. Other data collected included demographic and workforce characteristics and occupational stressors. Burnout was measured using the Copenhagen Burnout Inventory and job satisfaction using the Midwifery Process Questionnaire. Descriptive statistics, univariate, multivariate analyses, and content analysis were used for data analysis.ResultsOf the 326 respondents (326/508, 64%), over half had considered leaving the midwifery profession in 12 months prior to the study, 20% had thought about leaving frequently and 12% were planning on leaving in the next five years. The main reasons for leaving were not wanting to do shift work, feeling worn out, and experiencing work-related stress. Factors associated with a high intention to leave the profession were work-related burnout, poor job satisfaction and a high intention to leave the workplace. Age did not impact intention to leave but was influential on the reasons for leaving.ConclusionsPre-pandemic, midwives in Victoria, Australia had a high intention to leave the profession regardless of age. Approaches that address midwifery stress, burnout, and fatigue need to be considered, including developing options that offer employment that does not require shift work. To provide safe quality care that supports positive outcomes for women and their families, an appropriate midwifery workforce must be achieved and maintained. Understanding midwives' intentions to leave the profession is critical and requires ongoing attention given the workforce is likely to remain under significant stress until the major contributing factors are addressed.

BACKGROUND: Monoclonal antibodies are widely used anticancer therapies. Increasing demand for ambulatory care necessitates exploration of efficiency measures. OBJECTIVES: The primary objective was to evaluate the impacts on chair time and associated cost of priming IV administration sets with a bolus of the prescribed monoclonal antibody drugs. A secondary objective was to assess the associated incidence of hypersensitivity reactions. METHODS: A large tertiary hospital in Brisbane, Australia, conducted a randomized controlled trial (N = 128) with a two-arm design. Included monoclonal antibodies were daratumumab, obinutuzumab, pembrolizumab, and nivolumab. FINDINGS: There was a statistically significant reduction in chair time for obinutuzumab, pembrolizumab, and nivolumab compared with the control. Findings suggest that this priming intervention reduces chair time and cost for some monoclonal antibody drugs. Future research could assess this practice in other oncology therapies.

Purpose: Haemato-oncology patients who require treatment for infections in the hospital receive intravenous antibiotics (IVABs) and intravenous therapy (IVT) via an infusion pump attached to a pole on wheels. This IV pole can hinder a patient’s mobility and ability to perform activities of daily living. A computerized ambulatory delivery device (CADD), often used in the outpatient or home setting, is a portable infusion pump that delivers IVABs and IVT without the need of a wheel-based pole. This study will investigate the use of portable CADDs in the inpatient setting to determine if they improve patients’ mobility when compared with using the IV pole. Methods: A randomized controlled trial of patients requiring IVABs or IVT, of two haemato-oncology wards in a large, quaternary hospital, will recruit 110 adults randomized on a 1:1 basis into either a CADD arm or an IV pole arm. The primary outcome is mobility as assessed by number of steps per day (recorded via accelerometer). Secondary outcomes include sleep disturbance, quality of life, and hospital-acquired complications. All randomized patients will be analyzed by intention to treat.

Conduct a workshop to develop strategies for creating a sustainable midwifery workforce. Current Australian midwifery and nursing workforce data will underpin this workshop and inform discussions and recommendations. The workshop will include a presentation of study findings, a brainstorming activity to generate and prioritise key issues, small group work to tackle identified issues and generate possible solutions and ways forward (for application in local contexts and at state and national levels), and a ‘where to from here’ session with a focus on short- and long-term strategies. Six recent studies exploring midwifery and/or nursing workforce will be presented, including employee centred rostering; what a good shift looks like and how organisations can facilitate this; a Victorian statewide study of midwives’ satisfaction, burnout, recruitment and retention; clinical supervision as a workforce strategy; and creative solutions to support midwives. Collaborators include La Trobe University, Royal Women’s Hospital, Safer Care Victoria, Victorian Department of Health, ANMF, Western Health, Deakin University, Royal Melbourne Hospital, Echuca Regional Health, Northeast Health, Northern Health, Austin Health, Royal Melbourne Hospital, and UTS. We are facing critical workforce shortages in midwifery. The reasons are complex and multifactorial, so the solutions need also to be. This workshop will help inform a national approach. The group running the workshop are experts in the field, and experienced at facilitating workshops. The projects chosen were conducted across both metropolitan and regional services and provide critical data to inform our thinking. The intent is to capitalise on the synergies of the projects. The workshop will be an opportunity for midwives from all areas of the profession to come together to exchange ideas and concerns, and to formulate strategies. We will compile a report to disseminate to clinical leaders, policy makers and health services, and will present outcomes at relevant forums.

Background: In Australia, there is a lack of accurate data on midwifery workforce staffing and skill mix, which in turn hinders workforce policy and planning. Aim: To describe the current staffing levels of the midwifery workforce in Victoria, Australia, explore workforce challenges and assess the impact of COVID-19 pandemic on staffing. Design: Cross-sectional. Methods: Midwifery managers in all public and private maternity services in Victoria, Australia were invited to complete a survey exploring midwifery staffing numbers and adequacy. Topics explored included midwifery turnover, recruitment, and skill mix. Descriptive statistics were used. Findings: The survey was open March to October 2021, and 56 % (38/68) of managers responded. Of these, 76 % reported inadequate midwifery staff levels, with deficits ranging from one to 19 estimated Full-Time Equivalent (EFT) midwives, with a combined total deficit of 135 EFT. In the 12 months prior to the survey, 73 % of services had found it difficult to recruit midwives, with increased difficulty during the COVID-19 pandemic. Managers were concerned about retaining and recruiting 'experienced' midwives due to an ageing workforce and high turnover due to work/life imbalance and job dissatisfaction. These issues have led to a predominantly early career midwifery workforce and created concern about skill mix. Conclusion: Victorian maternity services have a midwifery workforce shortage and are experiencing significant skill mix issues. The pandemic has exacerbated these considerable gaps in the workforce. Urgent implementation of retention and recruitment schemes are needed, along with strategies to improve the working conditions for the current workforce.

A robust, skilled midwifery workforce is integral to provision of safe maternity care. In Australia there is a lack of evidence regarding adequacy of the midwifery workforce, recruitment, retention and distribution of midwives in rural, regional, and metropolitan settings. We aimed to explore the state of the midwifery workforce in Victoria from the perspective of managers of maternity services and currently working midwives. An online, population-based cross-sectional survey of midwifery managers and midwives in all Victorian public and private maternity services was conducted between March and October 2021. Questions explored midwifery staffing numbers and adequacy, recruitment, staff turnover, midwives’ years of experience, career plans, and intention to leave the profession. Fifty-six percent (38/68) of managers of Victorian maternity services and 1016/5134 midwives responded (20% of midwives in Victorian maternity services). Of the managers, 76% reported inadequate midwifery staffing levels in their services, with a reported combined total deficit of 135 full-time equivalent midwives. Public metropolitan hospitals had higher rates of turnover than public regional/rural services, but regional/rural services experienced a greater impact. Managers ascribed staff turnover to midwives retiring or ‘experienced’ midwives choosing to leave to seek new opportunities with better work/life balance. Most (73%) managers reported difficulties in recruiting midwives. More than half (61%) of midwives in this study were ten years or less post-qualification. One in five midwives were unsure how long they would stay in the midwifery profession, and over a quarter were planning to leave the profession in the next five years. However, almost 40% of midwives were regularly thinking about leaving the profession. The Victorian midwifery workforce is currently inadequately staffed and lacking in experienced midwives. A significant number of midwives are considering leaving the profession. A focus on supporting recruitment and retention in urgently required.

BACKGROUND:Nutrition education for clinicians providing pregnancy care has the potential to enhance pregnant women's diet quality, leading to healthier outcomes for mother and baby. Following a study demonstrating nutrition knowledge gaps, an online training module was developed, implemented, and evaluated. METHODS:Antenatal care providers completed a pregnancy nutrition knowledge questionnaire to assess knowledge levels at baseline (n = 97) and nine months after the introduction of online training (n = 64). FINDINGS:Knowledge scores at baseline and post-training implementation were not significantly different. Sub-group post-training knowledge scores between clinicians who completed the training module was higher than for those that did not complete the training module. User experience of the training module was positive and they felt it was useful in enhancing nutrition knowledge. Just under half of clinicians felt more confident in providing nutrition advice as part of their pregnancy care. Clinicians reported that time constraints prevented them from completing the nutrition training and/or providing nutrition education. Despite the positive experience of completing the online training module, a majority of clinicians surveyed indicated they preferred face-to-face training. CONCLUSION:Further research exploring how nutrition is prioritised in antenatal appointments and how knowledge levels influence nutrition education practices is needed.

Due to the COVID-19 pandemic, rapid service changes were made to maternity care provision in Victorian maternity services. From March 2020 many routine face-to-face visits in pregnancy were replaced by telehealth (telephone or video), along with changes to routine screening. Many providers plan to continue these changes despite a lack of evidence to guide practice. We aimed to describe the changes in maternity care provision, understand the perceived impact and explore services' future plans regarding these changes. A population-based cross-sectional study of midwifery managers of all Victorian public and private maternity services was conducted between March and October 2021. Questions explored health service characteristics, changes to maternity care delivery, telehealth practices, perceived impact of changes, and future plans. Fifty percent of services (34/68, 27 public and 6 private) responded, with broad representation of location, birth numbers and size of service. Around 50% of all pregnancy visits became telehealth. There were multiple combinations of which visits were face-to-face and which were telehealth. No visit was conducted face-to-face by all responding services. Visits most likely to be face-to-face were at 39 and 40 weeks gestation (65%). For telehealth appointments there was an ad hoc approach to advising women on routine screening, e.g., measuring blood pressure (11% did not advise at all), fetal growth (26% – no specific strategy) and fetal heart rate (15% – no specific strategy). Over half (52%) would consider maintaining telehealth post-pandemic. Even in a single state there is great variation in telehealth timing, when pregnant women should have face-to-face visits, and what routine screening is maintained. In light of emerging evidence of some potentially poorer clinical outcomes associated with telehealth in pregnancy, these findings need to be considered.

A well-supported, skilled midwifery workforce is critical to the provision of safe maternity care that optimises outcomes for women and babies. Issues such as burnout, workplace culture and workplace safety can affect how midwives' function, and the quality of care they provide, but there is limited evidence regarding these factors in the midwifery context. We aimed to measure burnout, workplace culture and workplace safety among Victorian midwives. An online population-based cross-sectional survey of midwives in all private and public maternity services in Victoria, Australia was conducted between March and October 2021. Measures included the Copenhagen Burnout Inventory; the Australian Midwifery Workplace Culture survey; specifically designed questions to assess skill mix safety, level of occupational violence and bullying; and an open-ended question about key messages on the midwifery workforce. In total, 1016/5134 midwives responded (20% of midwives in Victorian maternity services). A large proportion of the respondents were experiencing personal burnout (72%) and work-related burnout (67%). Three-quarters felt midwifery skill mix was unsafe at some point in an average week. Half had experienced occupational violence and a quarter had experienced bullying in the 12 months prior to the survey. The majority of midwives (72%) felt their concerns were not taken seriously by their managers or midwifery units and that they had inadequate support when short-staffed. Only one in five felt their workplace had a positive culture. Midwives reported that they felt they were providing unsafe and inadequate care due to staffing issues and unsustainable workloads. Victorian midwives are experiencing very high levels of burnout and poor workplace culture and safety. Strategies are urgently needed to address these issues for Victorian midwives. It would be of value to repeat this work in other jurisdictions to understand these challenges at a national level.

Background:Strategies to improve outcomes for Australian First Nations mothers and babies are urgently needed. Caseload midwifery, where women have midwife-led continuity throughout pregnancy, labour, birth and the early postnatal period, is associated with substantially better perinatal health outcomes, but few First Nations women receive it. We assessed the capacity of four maternity services in Victoria, Australia, to implement, embed, and sustain a culturally responsive caseload midwifery service.Methods:A prospective, non-randomised research translational study design was used. Site specific culturally responsive caseload models were developed by site working groups in partnership with their First Nations health units and the Victorian Aboriginal Community Controlled Health Organisation. The primary outcome was to increase the proportion of women having a First Nations baby proactively offered and receiving caseload midwifery as measured before and after programme implementation. The study was conducted in Melbourne, Australia. Data collection commenced at the Royal Women's Hospital on 06/03/2017, Joan Kirner Women's and Children's Hospital 01/10/2017 and Mercy Hospital for Women 16/04/2018, with data collection completed at all sites on 31/12/2020.Findings:The model was successfully implemented in three major metropolitan maternity services between 2017 and 2020. Prior to this, over a similar timeframe, only 5.8% of First Nations women (n = 34) had ever received caseload midwifery at the three sites combined. Of 844 women offered the model, 90% (n = 758) accepted it, of whom 89% (n = 663) received it. Another 40 women received standard caseload. Factors including ongoing staffing crises, prevented the fourth site, in regional Victoria, implementing the model.Interpretation:Key enablers included co-design of the study and programme implementation with First Nations people, staff cultural competency training, identification of First Nations women (and babies), and regular engagement between caseload midwives and First Nations hospital and community teams. Further work should include a focus on addressing cultural and workforce barriers to implementation of culturally responsive caseload midwifery in regional areas.Funding:Partnership Grant (# 1110640), Australian National Health and Medical Research Council and La Trobe University.

BACKGROUND:Burnout is an occupational phenomenon with the potential to affect a person's physical and mental health, job satisfaction and quality of work. There is evidence of burnout occurring in the midwifery profession, but inadequate data on the prevalence of, and the factors associated with, burnout.AIM:Identify the prevalence of burnout in a population of midwives and explore what individual and workforce characteristics, and what occupational stressors, were associated with burnout.METHODS:A cross-sectional survey of permanently employed midwives was conducted in a tertiary maternity service in Melbourne, Australia in 2017. Data collected included individual and workforce-related characteristics and occupational stressors. Burnout was explored using the Copenhagen Burnout Inventory. Univariate and multivariate analyses were conducted to ascertain associations between respondents' characteristics, stressors, and burnout levels.FINDINGS:A total of 257/266 midwives (97%) responded. There were significant levels of exhaustion and fatigue among respondents; 68% of midwives were experiencing personal burnout, 51% work-related burnout, and 10% were experiencing client-related burnout. Being aged ≤ 35 years, and/or having inadequate support was associated with personal and work-related burnout. Having inadequate acknowledgement was associated with client-related burnout.CONCLUSION:Health services need to understand the risk factors for burnout among midwives, identify and support groups that are most vulnerable, and address areas that are amenable to intervention. In our context this means ensuring midwives receive adequate acknowledgement and support, particularly younger midwives. These findings need to be tested in other settings to help inform a broader understanding and ensure the sustainability of the midwifery profession.

The COVID-19 pandemic meant there were significant changes to the way maternity care was provided. Postnatal care was impacted by restrictions on visitors and support people in hospitals as well as decreased home-based midwifery care after birth. Anecdotally, many providers report considering maintaining some of the restrictions post-pandemic. Women's views and health outcomes should be considered in policy decisions. Explore the impact of changes to postnatal care for women who birthed during COVID-19 restrictions in Melbourne. A cross-sectional survey of all women who birthed at one tertiary service in Melbourne in September and October 2020 was undertaken. Women were invited to participate in the study when their baby was four to six months old. They could choose to complete the survey via telephone or online. In total, 483 out of 1002 eligible women (48%) participated, of whom 40%rated their hospital postnatal care as 'Very good', with 53% rating their baby's care as 'Very good'. Two-thirds felt postnatal hospital visitor restrictions impacted their experience, with most reporting this was a negative impact (72%). During the first six weeks postpartum, 75% of respondents felt the restrictions impacted the support they received from their partner, family or friends, and two-thirds felt this was a negative impact. At four months, 83% of women were giving any breast milk, and 60% were giving only breast milk. Eighty-three percent of reported that the way they were feeding their baby was affected, and 73% of these considered it had a negative impact. The COVID-19 pandemic affected women's postpartum experiences in a variety of ways, most often negatively. As we emerge from the pandemic, it is important to reflect on women's experiences and outcomes and refocus on what the women themselves consider to be the important elements of support for optimum outcomes.

BACKGROUND:Significant factors affecting the Australian maternity care context include an ageing, predominantly part-time midwifery workforce, increasingly medicalised maternity care, and women with more complex health/social needs. This results in challenges for the maternity care system. There is a lack of understanding of midwives' experiences and job satisfaction in this context.AIM:To explore factors affecting Australian midwives' job satisfaction and experience of work.METHODS:In 2017 an online cross-sectional questionnaire was used to survey midwives employed in a tertiary hospital. Data collected included characteristics, work roles, hours, midwives' views and experiences of their job. The Midwifery Process Questionnaire was used to measure midwives' satisfaction in four domains: Professional Satisfaction, Professional Support, Client Interaction and Professional Development. Data were analysed as a whole, then univariate and multivariate logistic regression analyses conducted to explore any associations between each domain, participant characteristics and other relevant factors.FINDINGS:The overall survey response rate was 73% (302/411), with 96% (255/266) of permanently employed midwives responding. About half (53%) had a negative attitude about their Professional Support and Client Interaction (49%), and 21% felt negatively about Professional Development. The majority felt positively regarding Professional Satisfaction (85%). The main factors that impacted midwives' satisfaction was inadequate acknowledgment from the organisation and needing more support to fulfil their current role.CONCLUSION:Focus on leadership and mentorship around appropriate acknowledgement and support may impact positively on midwives' satisfaction and experiences of work. A larger study could explore how widespread these findings are in the Australian maternity care setting.

Reliability of the metro vehicles is a key factor for providing of regular, safe and undisturbed passenger transport in the urban agglomerations. The research contains failure analyses of the two types of metro vehicles, and comparison of their reliability functions. Data on damages of the metro rail vehicles have been obtained in the form of complaint protocols. Having extracted the damages from the same protocols the next step was to allocate in the established groups. The two subgroups have been created: mechanical and electrical failures.The results of analysis have shown that the rolling stock of two types is subject to a significant number of damages in the initial phase of exploitation. Among vehicles of the same type there are differences in number of damages of one kind (mechanical or electrical) and considered damage group.

Although pediatric surgeons have lower rates of burnout compared to other surgical subspecialists, they still struggle with work-home conflict, depersonalization, and emotional exhaustion. Prior surveys have measured career satisfaction and burnout, but none have identified factors that contribute to physician well-being or provided potential solutions.Members of the American Pediatric Surgical Association were surveyed regarding sources of distress and institutional practices intended to promote well-being. Responses were analyzed using content analysis.There was a 31.5% response rate to the survey. The most frequently cited sources of distress were administrative issues (45.2%), work/life balance (42.3%), personal issues (18.8%), and relationships with coworkers (17.9%). In open-ended questions, other sources of distress included poor leadership, loss of autonomy, lack of support and mentorship, and patient complications. Successful wellness strategies included relief from clinical burden, substantive wellness programming, surgeon inclusion in administrative decision making, support after adverse events, appropriate compensation and benefits, and opportunities for career development in research, teaching, and clinical care.Pediatric surgeons are affected by multiple sources of distress. Interventions that ameliorate stress in pediatric surgeons were identified and should be considered by local institutions and national organizations to promote well-being.n/a

The relationship between diabetes mellitus and pancreatic cancer risk from is uncertain based on the results of existing publications. The current report updated and re-evaluated the possible association between diabetes mellitus and pancreatic cancer risk in China.Six databases (PubMed, Embase, Web of Science, the Cochrane Library, the Chinese Biomedical Database, and the Chinese National Knowledge Infrastructure) were used for the literature search up to October 2017.Twenty-six case-control studies involving 7702 pancreatic cancer cases and 10186 controls were screened out. The overall summary estimate for the relationship between diabetes and pancreatic cancer was 3.69 (95% CI, 3.12–4.37). The subgroup analysis indicated positive associations among northern and southern Chinese, as well as studies with healthy population or hospital controls. In addition, the risk of developing pancreatic cancer was inversely associated with the duration of diabetes, with the highest risk of pancreatic cancer occurring among patients with diabetes <2 years. Individuals who had diabetes <2 years had a >2-fold higher risk of developing pancreatic cancer than individuals who had diabetes for 2–4 years or 5–10 years (OR, 4.92; 95% CI, 4.16–5.80 vs. OR, 1.92; 95% CI, 1.30–2.85/OR, 2.14; 95% CI, 1.49–3.09).This meta-analysis strongly supports that an association exists between diabetes and an increased risk of pancreatic cancer in China, which should be confirmed with other ethnic groups.

Spontaneous newborn skull fracture is rarely cited in nursing literature as a potential outcome of persistent fetal occiput posterior position. Although most newborns seem unaffected by the condition initially, some may show symptoms several hours after the birth, when nursing assessments are less frequent. This case report illustrates delayed newborn symptoms that led to an unexpected diagnosis of spontaneous skull fracture.