A multi-disciplinary e-learning starter course - would you like some salt with that?

Introduction: Peripartum hyponatraemia is a potentially serious condition with implications for both mother and baby [1,2]. Pregnant women are more at risk of developing hyponatraemia due to a lower baseline sodium, impaired ability to excrete water, the antidiuretic effect of oxytocin and excessive fluid intake during labour. We found that peripartum hyponatraemia was often poorly managed and there was no trust guidance for diagnosis and management. Hence, we designed a new departmental protocol based on the GAIN guidelines [2]. Due to the impact of COVID 19 on traditional teaching methods,we upskilled staff by designing a tailored e-learning package using articulate software and re-assessed the team’s knowledge of the condition. Methods: After trust approval and advice from the hospital’s audit department, a local survey was sent out to members of the obstetric multi-disciplinary team before and after the introduction of a departmental peripartum hyponatraemia guideline together with its associated e-learning package. Results: We received a total of 74 responses. Initially, we identified a large proportion of the team were not confident in managing hyponatraemia. After implementation of our e-learning package, we demonstrated an increase in staff confidence (Figure). The initial survey showed much uncertainty surrounding the indications for fluid balance monitoring, prescription of intravenous fluids and management of hyponatraemia. However, results from the post e-learning survey showed improved knowledge in all these areas. Discussion: Our survey suggests that many members of the obstetric multi-disciplinary team were unfamiliar and not confident in managing peripartum hyponatraemia. However, a tailored e-learning programme is an extremely useful adjunct in highlighting new guidance, upskilling members of the team and changing the attitudes of the multidisciplinary team to unfamiliar medical conditions. (Figure Presented)

Missouri's Fentanyl Problem: The China Connection

Recently, Missouri has followed an overall upward trend in opioid overdose deaths. In 2018, Missouri was the state with the largest absolute and percentage increase in opioid-related overdose fatality rates per capita over the previous year (18.3% and 3.1/100,000). This increase occurred despite an overall decrease in U.S. opioid-related death rates in the same period. This report identifies illicitly manufactured fentanyl (IMF) (and analogues) as the drug most responsible for this rise in opioid deaths in Missouri, with stimulant overdoses (primarily from methamphetamine) in second place. Within Missouri, we find the areas where opioid deaths are highest: St. Louis and the city's fringe areas, following the national trend for high rates in fringe areas. Based on reports from CDC Wonder data, county medical examiners, law enforcement agencies, and drug addiction prevention agencies, we conclude that IMF and related synthetic opioids arriving from China are primarily responsible for fatal narcotic overdoses in Missouri. Despite the COVID-19 disruption of fentanyl manufacturing and distribution centers in and around Wuhan, China early in the pandemic, preliminary 2020 data from medical examiners' offices show an upswing in opioid deaths, an indicator that Chinese fentanyl producers have restored the supply chain.