The E-Nurture Project: A Hybrid Virtual Neonatal Follow Up Model for 2021.

Neonatal follow-up has long focused on a model of surveillance and identification of short-term outcomes. This model has long become outdated, with evidence documenting the need for longer follow-up with known school-based challenges and significant gaps in knowledge by educators. This article reviews the history of neonatal follow-up and demonstrates a novel approach to neonatal follow-up, built largely with a hybrid virtual platform, which then became essential with the declaration of the pandemic in 2020.

Transition-of-care program from emergency department to gastroenterology clinics improves follow-up.

OBJECTIVES: Patients discharged from the emergency department (ED) with gastrointestinal (GI) symptoms need to appropriately transition their care to a GI outpatient clinic in a timely manner to have their health needs met and avoid significant morbidity. When this transition isn't optimal, patients are lost to follow-up, potentially placing them at risk for adverse events. We sought to study the effectiveness of implementing an electronic medical record (EMR) based transition-of-care (TOC) program from the ED to outpatient GI clinics. METHODS: We performed a retrospective single center cohort study of patients discharged from the ED of a tertiary care academic medical center referred to outpatient GI clinic before (Pre-TOC patients) and after implementation of an EMR based TOC program (TOC patients). We further stratified patients based on the Distressed Communities Index (DCI), which is a composite measure of economic well-being. We compared rates of appointment scheduling and appointment attendance between the two groups, as well as 30-day readmission rates to the ED. We also performed a subgroup analysis to determine if socioeconomic status would affect patient follow-up rates. RESULTS: We included 380 Pre-TOC and 399 TOC patients in our analysis. TOC patients were found to both schedule appointments (50% vs 27% p-value <0.01) as well as show up to appointments (34% vs 24% p-value <0.01) at significantly higher rates compared to Pre-TOC patients. There was no significant difference between 30-day readmission rates between the two groups. In addition, TOC patients from At-Risk and Distressed Communities were over 22 times more likely to schedule an appointment compared to Pre-TOC patients from similar neighborhoods (OR 22.18, 95% CI 4.23-116.32). CONCLUSION: Our study shows that patients who are discharged from the ED with outpatient GI follow-up are more likely to both schedule and show up to appointments with implementation of an EMR-based direct referral program compared to no patient navigation, particularly among patients of lower socioeconomic status.

Long-term follow-up of cardiac magnetic resonance imaging in myocarditis following messenger ribonucleic acid COVID-19 vaccination: a case report.

Background: Presently, the association between myocarditis and messenger ribonucleic acid (mRNA) COVID-19 vaccination is well established. From the most current data, cases of myocarditis following COVID-19 vaccination seem to be mild with fast clinical recovery. Nevertheless, the complete resolution of the inflammatory process is still unclear. Case summary: We report the case of a 13-year-old boy who developed chest pain following the second dose of the Pfizer-BioNTech COVID-19 vaccine with long-term follow-up of cardiac magnetic resonance (CMR) imaging. An electrocardiogram (ECG) revealed progressively ST-segment elevation on the 2nd day of admission with a rapid improvement within 3 hours where only mild ST-segment elevation remained. The peak level of high-sensitivity cardiac troponin T was 1546 ng/L with rapid reduction. Echocardiogram revealed depressed left ventricular septal wall motion. CMR mapping techniques showed myocardial oedema with an increase in native T1 and extracellular volume (ECV). On the other hand, T1-weighted and T2-weighted images and late gadolinium enhancement (LGE) did not detect inflammation. The patient's symptoms were relieved by oral ibuprofen. After 2 weeks, ECG and echocardiogram were unremarkable. However, the inflammation process was still present based on the CMR by mapping technique. During the 6-month follow-up, CMR returned to normal. Discussion: In our case, the subtle myocardial inflammation was diagnosed by mapping technique with only a T1-based marker according to the updated Lake Louise Criteria and the inflammation of the myocardium returned to normal within 6 months after the onset of the disease. Further follow-up and larger studies are needed to determine the complete resolution of the disease.

Evaluation of the Health and Nutritional Status of Discharged Children From Malnutrition Treatment Centres Using Mobile Phone Calls During the COVID-19 Lockdown in Jharkhand, India.

Background The Indian state of Jharkhand has the highest rate of wasting (29%) among young children. Mobile audio call follow-up can be used to assess such children with severe acute malnutrition (SAM). Aim This study evaluated SAM children during the COVID-19 outbreak and learn more about the status of their home/community care, and caregivers' awareness of integrated child development services (ICDS) and COVID-19 prevention. Methods Contact numbers of caregivers for discharged children were obtained from 54 malnutrition treatment centers (MTCs). In April and June 2020, mentors conducted follow-up interviews using mobile phone calls. Results Seven children (1.72%) were reported dead and 400 were alive, mostly girls (59.5%). Only a few caregivers observed post-discharge ailments (15.4%) and weight loss (7.7%) in their children. Children aged six to 24 months were characterized by continued breastfeeding (88.0%) at most five to six times a day (45.8%). Most of the children were not fed as per maternal infant and young child feeding protocols. Age in months with an adjusted odds ratio (OR) of 0.55 (1.00-1.11) as a 95% confidence interval (CI), age category, with an adjusted OR of 4.32 (1.71- 10.94) as 95% CI, and breastfeeding with adjusted OR 1.85 (1.07- 3.21) as 95% CI were three major predictors for a well-fed child. Conclusion Community involvement is crucial in the follow-up of children with SAM for effective rehabilitation. Mobile phone audio call follow-up is a relatively cost-effective approach to tackle geographic barriers and COVID-19 lockdown-induced situations. There are major gaps mainly in informing caregivers on how to manage COVID-19 with breastfeeding.

Analyze of factors and prognosis of eyes lost to follow-up in retinal vein occlusive disease patients receiving anti-vascular endothelial growth factor therapy.

BACKGROUND: Patients with macular edema (ME) secondary to retinal vein occlusion (RVO) who received at least one intravitreal injection of anti-vascular endothelial growth factor therapy (VEGF) and lost to follow-up (LTFU) for more than six months were analyzed to investigate the factors contributing to the LTFU and the prognosis. METHOD: This was a retrospective, single-center study to analyze the causes and prognosis of LTFU over six months in RVO-ME patients treated with intravitreal anti-VEGF injections at our institution from January 2019 to August 2022 and to collect patients' baseline characteristics along with the number of injections before LTFU, primary disease, best corrected visual acuity (BCVA) before LTFU and after return visit, central macular thickness (CMT), months before LTFU and after LTFU, reasons for LTFU, and complications, to analyze the factors affecting visual outcome at a return visit. RESULTS: This study included 125 patients with LTFU; 103 remained LTFU after six months, and 22 returned after LTFU. The common reason for LTFU was "no improvement in vision" (34.4%), followed by "transport inconvenience" (22.4%), 16 patients (12.8%) were unwilling to visit the clinic, 15 patients (12.0%) had already elected to seek treatment elsewhere, 12 patients (9.6%) were not seen in time due to the 2019-nCov epidemic, and 11 patients (8.8%) cannot do it due to financial reasons. The number of injections before LTFU was a risk factor for LTFU (P < 0.05). LogMAR at the initial visit (P < 0.001), CMT at the initial visit (P < 0.05), CMT before the LTFU (P < 0.001), and CMT after the return visit (P < 0.05) were influential factors for logMAR at the return visit. CONCLUSION: Most RVO-ME patients were LTFU after anti-VEGF therapy. Long-term LTFU is greatly detrimental to the visual quality of patients; thus, the management of RVO-ME patients in follow-up should be considered.

Virtual Post-Intensive-Care Rehabilitation for Survivors of COVID-19: A Service Evaluation.

AIM: The objective of this study is to evaluate the safety, utilisation, and effectiveness of a novel, virtual rehabilitation programme for survivors of SARS­CoV­2 infection (COVID-19) and intensive care admission. METHODS: A service evaluation was performed. Adults admitted to a United Kingdom intensive care unit with COVID-19-induced respiratory failure and surviving hospital discharge were invited to an eight-week rehabilitation programme. The programme consisted of virtually delivered exercise classes and support groups led by critical care physiotherapists and follow-up nurses. RESULTS: Thirty-eight of 76 eligible patients (50%) agreed to participate, of which 28 (74%) completed the rehabilitation programme. On completion of the rehabilitation programme, there were significant improvements in exercise capacity (one-minute sit-to-stand test; 20 stands vs. 25 stands, p < 0.001), perceived breathlessness (Medical Research Council dyspnoea scale; 3 vs. 2 p < 0.001), shoulder disability (Quick Dash; 43 vs. 19 p = 0.001), anxiety (Hospital Anxiety Depression Scale; 4 vs. 3 p = 0.021), depression (Hospital Anxiety Depression Scale; 4 vs. 2.5 p = 0.010), and psychological distress (Intensive Care Psychological Assessment Tool; 3 vs. 2 p = 0.002). No adverse events or injuries were recorded during the programme. CONCLUSION: It is feasible to recruit and retain survivors of COVID-19-induced respiratory failure for virtual post-intensive-care rehabilitation. It appears that the virtual rehabilitation programme is safe and improves physical and psychological morbidity.

A one-year follow-up study of systematic impact of long COVID symptoms among patients post SARS-CoV-2 omicron variants infection in Shanghai, China.

Long COVID hinders people from normal life and work, posing significant medical and economic challenges. Nevertheless, comprehensive studies assessing its impact on large populations in Asia are still lacking. We tracked over 20,000 patients infected with COVID-19 for the first time during the Omicron BA.2 outbreak in Shanghai from March-June 2022 for one year. Of the 21,799 COVID-19 patients who participated in the 6-month telephone follow-up, 1939 (8.89%) had self-reported long COVID symptoms. 450 long COVID patients participated in the 6-month outpatient follow-up. Participants underwent healthy physical examinations and questionnaires focused on long-COVID-related symptoms and mental health. Mobility problem (P < 0.001), personal care problem (P = 0.003), usual activity problem (P < 0.001), pain/discomfort (P < 0.001), anxiety/depression (P = 0.001) and PTSD (P = 0.001) were more prevalent in long COVID patients than in healthy individuals, but no significant differences were found between the two groups on chest CT and laboratory examinations. Of the 856 long COVID patients who participated in the 12-month follow-up, 587 (68.5%) had their symptoms resolved. In the multivariable logistic analysis, females (P < 0.001), youth (age <40 years) (P < 0.001), ≥ 2 comorbidities (P = 0.009), and severe infection in the acute phase (P = 0.006) were risk factors for developing long COVID. Middle age (40-60 years) was a risk factor for persistent long COVID one year after hospital discharge (P = 0.013). The study found that long COVID mainly manifested as subjective symptoms and impacts partial patients' quality of life and mental status. After one year, most (68.5%) of the patients recovered from long COVID with no impairment of organ function observed.

Key elements of an evidence-based clinical psychology service within adult critical care.

The COVID-19 pandemic has generated renewed interest in the psychological rehabilitation needs of patients admitted to intensive care units. While the availability of embedded practitioner psychologists within adult critical care teams remains inconsistent, post numbers have increased in response to the clinical needs of the pandemic. As psychology services within adult critical care become more widely established, models for service provision will be required. We describe our experience of developing a model for the delivery of a clinical psychology service within critical care in a District General Hospital with specialist tertiary surgical and cancer services. The current paper describes a service design that is firmly rooted in psychological theory and the broader clinical health psychology evidence base. We hope that our learning will be helpful to others.

A critical care follow-up service evaluation: Acquired peripheral nerve injury after admission with COVID-19 respiratory disease.

Anticipated sequelae of critical care admission for COVID-19 disease remain unclear. Our Edinburgh-based critical care follow-up service identified patterns with nerve injury in 13 of 35 patients who attended following a critical care admission between 15/03/2020 and 25/12/2020. This included 7 cases of meralgia parasthetica, 1 brachial plexopathy, 2 common peroneal neuropathies and 3 ulnar neuropathies. All cases of upper limb neuropathy and foot drop occurred in patients in whom prone positioning was used, with meralgia parasthetica occurring additionally in patients who remained supine.

Developing a mobile health application for wound telemonitoring: a pilot study on abdominal surgeries post-discharge care.

BACKGROUND: Many early signs of Surgical Site Infection (SSI) developed during the first thirty days after discharge remain inadequately recognized by patients. Hence, it is important to use interactive technologies for patient support in these times. It helps to diminish unnecessary exposure and in-person outpatient visits. Therefore, this study aims to develop a follow-up system for remote monitoring of SSIs in abdominal surgeries. MATERIAL AND METHODS: This pilot study was carried out in two phases including development and pilot test of the system. First, the main requirements of the system were extracted through a literature review and exploration of the specific needs of abdominal surgery patients in the post-discharge period. Next extracted data was validated according to the agreement level of 30 clinical experts by the Delphi method. After confirming the conceptual model and the primary prototype, the system was designed. In the pilot test phase, the usability of the system was qualitatively and quantitatively evaluated by the participation of patients and clinicians. RESULTS: The general architecture of the system consists of a mobile application as a patient portal and a web-based platform for patient remote monitoring and 30-day follow-up by the healthcare provider. Application has a wide range of functionalities including collecting surgery-related documents, and regular assessment of self-reported symptoms via systematic tele-visits based on predetermined indexes and wound images. The risk-based models embedded in the database included a minimum set with 13 rules derived from the incidence, frequency, and severity of SSI-related symptoms. Accordingly, alerts were generated and displayed via notifications and flagged items on clinicians' dashboards. In the pilot test phase, out of five scheduled tele-visits, 11 (of 13) patients (85%), completed at least two visits. The nurse-centered support was very helpful in the recovery stage. Finally, the result of a pilot usability evaluation showed users' satisfaction and willingness to use the system. CONCLUSION: Implementing a telemonitoring system is potentially feasible and acceptable. Applying this system as part of routine postoperative care management can provide positive effects and outcomes, especially in the era of coronavirus disease when more willingness to telecare service is considered.

A case series of diabetic ketoacidosis associated with SGLT2 inhibitors

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are increasingly initiated as treatment for type 2 diabetes due to favourable cardiorenal characteristics. However, studies have identified an increased risk of diabetic ketoacidosis (DKA). We carried out a retrospective, case-based study at East and North Herts NHS Trust between February 2018 and December 2020. Fifteen cases of SGLT2i associated DKA were identified in people with presumed type 2 diabetes;33.3% were classed as euglycaemic DKA with a blood glucose of <11mmol/L. All cases were associated with a significant precipitating factor including diarrhoea, vomiting, reduced oral intake and sepsis. One case was related to COVID-19. Two people were subsequently found to have raised islet autoantibodies suggesting type 1 diabetes or latent autoimmune diabetes in adults. It is important that awareness of SGLT2i associated DKA is raised among users and health care practitioners, including the recognition of euglycaemic DKA. Sick day rules should be emphasised and reiterated at clinical encounters. Non-specialists in primary care, oncology and in perioperative settings should be empowered to advocate for temporary withdrawal and there should be readier access to blood ketone monitoring when required. When SGLT2i associated DKA occurs, due consideration should be given to evaluate the diabetes classification and investigate the circumstances of the event. Copyright © 2023 John Wiley & Sons.Copyright © 2023 John Wiley & Sons, Ltd.

Depression Severity Among Patients with Psychiatric Disorders during the COVID-19 Pandemic

Objectives: The impact of the COVID-19 pandemic on mental health is not yet well-studied. This study's objective is to describe demographic characteristics of the population diagnosed with depression or anxiety, and to compare PHQ9 scores before and after the pandemic. Method(s): A retrospective cohort study was performed using Komodo Health's healthcare claims and EMR data, which included Patient Health Questionnaire-9 (PHQ9) survey responses. The study's baseline and follow-up periods were set as one year before and after 03/01/2020. Patients selected were >=18 years of age, had a MDD, GAD, or other psychiatric diagnosis in both periods, and had taken at least one PHQ9 survey in both periods, resulting in 10,433 patients. Demographic characteristics were described across age, gender, and race/ethnicity, and a subgroup analysis was performed on PHQ9 scores and depression categories using averages (mean, SD) and odds ratios. Result(s): Demographic analysis showed depression severity correlated with patients who were younger, female, and Black or Hispanic. Younger patients (<30) were more likely than older (>=30) to be in the moderately severe category or worse (PHQ9 score >=15) in both time periods (ORs 1.72 and 1.62, p<0.001). This was also true for female as compared to male (ORs 1.45 and 1.49, p<0.001), and Black or Hispanic as compared to White (ORs 1.87 and 1.47, p<0.001). However, mean PHQ9 scores tended to decrease in the follow-up period. The overall mean decreased slightly from 6.28 (SD 6.05) to 5.68 (SD 5.82), which was consistent in nearly all age, gender, and race/ethnicity subcategories. Conclusion(s): While the improvements in average PHQ9 scores were counterintuitive, given the harmful impacts of the pandemic, existing correlations between demographics and depression severity remained. One possible explanation is that this cohort definition selected for patients who received more consistent mental healthcare. Further study will investigate this and other possible factors.Copyright © 2023

Certolizumab

Certolizumab is a Fab fragment of a humanized monoclonal antibody against tumor necrosis factor-alpha (TNF-alpha). Differing from the other TNF-alpha inhibitors due to the absence of Fc fragment and pegylation, it binds to both the soluble and transmembrane forms of TNF-alpha, creating a strong TNF-alpha blockage. Previously approved for psoriatic arthritis, certolizumab received another approval from FDA in 2018 for the treatment of moderate to severe chronic plaque psoriasis that does not respond to conventional systemic treatments or for which these treatments are contraindicated. Administered via subcutaneous injections, certolizumab also has a low-dose option for patients weighing less than 90 kg. Certolizumab is considered a safe biological drug that can be preferred during pregnancy and lactation.Copyright © 2022 by Turkish Society of Dermatology and Venereology.

Supporting practice nurses in diabetes, revalidation and appraisal programme: A practical course for new practice nurses (PN) undertaken diabetes care

Aims: To upskilling PN to undertake diabetes clinics and ensure high quality healthcare for our patients by maintain the nursing workforce in primary care. Method(s): The programme was delivered over two days, one month apart with follow up day's at six months and 1 year. During Covid-19 we had adapted the session to 4 half days over a 2 month period and are waiting to do our follow up day face to face. The programme included a broad range of topics and skills required to undertake diabetes clinics. Result(s): 13 PN attended from different geographical areas in our healthboard;having a various amount of experience as a PN from 16 yrs to 1 month but limited diabetes experience. Through anonymous questionnaire responses we showed an improvement in confidence across a broad range of core skills and management. Asked if they felt individually confident pre and post course -new diabetes diagnosis (38% to 92%), hypoglycaemia (53% to 92%), pens and meters (8% to 76%), sick day rules (30% to 84%), foot screening (61% to 92%) and advising on oral medication (30% no confidence improving to 84%). Increasing PN knowledge will ultimately improve patient's care thus reducing the risk of complications. preceptorship throught the course was offered by experience Diabetes Specialist Nurses. Conclusion(s): Even in these challenging times we have to maintain a skilled workforce by delivering education and preceptorship to PN. The Supporting prActice Nurses in Diabetes, Revalidation and Appraisal programme provides PN the tools to undertake diabetes clinics with confidence and ensure excellent patient care.

Evaluating real world clinical response of once weekly subcutaneous semaglutide and its daily oral formulation for the treatment of type 2 diabetes in primary care practice

Objective: Semaglutide is the first glucagon-like peptide- 1 receptor agonist with oral and subcutaneous formulations. We studied patient adherence and clinical response following their prescription in a primary care setting. Method(s): We searched for patients starting semaglutide between October 2020 to November 2021 in primary care registries in Dudley, West Midlands. We tracked their collection of medications for up to six months, changes in HbA1C and weight if these data were available at 26 weeks (range 22-52 weeks), with significance tested using a t-test. Patients prescribed both formulations were excluded. Result(s): Clinical data were available in 180 of the 443 patients. Baseline HbA1c was 79.0 +/- 18.6mmol/mol (Ozempic) and 81.9 +/- 19.3mmol/mol (Rybelsus) and pre-treatment weight was 108.4 +/- 10.5 kg (Ozempic) and 104.3 +/- 26.7 kg (Rybelsus). 62.8% of patients were of non-white ethnicity and 82.8% were on >= two anti-diabetic drugs. In patients with six-month follow-up data, mean reduction in HbA1c and weight was 17.1 +/- 20.8mmol/ mol and 3.9 +/- 6.2 kg (Ozempic n = 53, p < 0.01) and 18.2 +/- 14.5mmol/mol and 5.9 +/- 4.2 kg (Rybelsus n = 5, p < 0.05). Drug continuation rates were measured in 324 patients. 3.2% and 19.0% of patients for Ozempic and Rybelsus respectively did not obtain further prescriptions after their initial script. At six months, 87.2% continued with Ozempic and 57.2% with Rybelsus. Conclusion(s): This study demonstrates similarly significant reductions in HbA1c and weight with Ozempic and Rybelsus, despite the complexity of follow-up during Covid-19 restrictions. The lower adherence to Rybelsus warrants further study.

Social connectedness for socially withdrawn and vulnerable young people's well-being: A qualitative study

Aims: The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic. A key focus investigated young people's attitudes and experiences of social connection, and how they perceived this to be related to their mental health and future recovery needs. Method(s): Semi-structured interviews were completed with 16 young people (aged 20 to 25) with pre-existing and complex mental health and social problems, between January to December 2021. N = 6 completed follow up interviews approximately 6 months after their initial interview. Interviews were analysed using thematic analysis. Results and Conclusion(s): Four themes were identified. These centred around a preference for balancing solitude and quality relationships within small social worlds, the complex role of in-person versus online connection and interaction, how the COVID-19 lockdowns were a facilitator of both social connection and disconnection, and the importance of relationships, talking and being listened to for well-being. The findings suggest that in-person, and to some extent online connection, is a key component of well-being, and is an active recovery goal that socially withdrawn young people with complex pre-existing mental health problems would like to work on.

ENgagENYOY: A digital transdiagnostic clinical - and peermoderated treatment platform for youth with mental health complaints in the Netherlands

The onset of mental disorders typically occurs between the ages of 12 and 25, and the burden of mental health problems is the most consequential for this group. Indicated prevention interventions to target individuals with subclinical symptoms to prevent the transition to clinical levels of disorders, even leading to suicide, have shown to be effective. However, the threshold to seek help appears to be high. Digital interventions could offer a solution, especially during the Covid-19 pandemic. In this talk, the presenters will take you on a journey through the background, effects and experience of the digital indicated prevention intervention ENgage YOung people Early (ENYOY). ENYOY specifically addresses young people with emerging mental health complaints, and offers a new approach for treatment in the Netherlands through a clinical- and peer- moderated treatment platform. Considering the waiting lists in (child and adolescent)- psychiatry and the increase in suicides amongst youth, early lowthreshold and non-stigmatizing help to support young people with emerging psychiatric symptoms is of crucial importance. Moreover, this project aims to bridge the gap between child and adolescent and adult psychiatry. We included 125 young people with subclinical mental health problems (stage 1b), age 16-25 years. Using a combined peer and clinical support approach participants followed their personalized digital therapeutic treatment journey for up to 12 months. The first results demonstrate that at 3 and 6 months follow-up complaints significantly decrease (K-10) and social functioning increase (SOFAS) (p < .05). This new approach may offer perspective for young people and the healthcare system.

Assessment of palliative approach in the pain management in endodontic emergencies during Covid-19 outbreak: Retrospective cohort study

Aim: During the coronavirus disease, a palliative approach was recommended for the management of endodontic emergencies. This retrospective cohort study was conducted to investigate the effectiveness of dexamethasone or ibuprofen-acetaminophen combination for pain management in endodontic emergencies. Material(s) and Method(s): One hundred and eight records of patients who presented to the emergency department with dental pain were evaluated retrospectively. Since interventional procedures were not performed during the pandemic period, Specific analgesics/antibiotics for the management of pain were preferred. A follow-up protocol with a questionnaire was developed to observe the effectiveness of palliative treatment and make changes if necessary. All participants received a questionnaire to rate the pain levels 6, 12, 18, 24, 48, and 72 hours after taking the drug. All data were collected from the patient file and assessed. After inclusion and exclusion criteria, 32 patients were included (n = 19, ibuprofen + acetaminophen;n = 13, dexamethasone). Data were analyzed using the chi-square test (P = 0.05). Result(s): In both groups, a significant decrease in pain was experienced immediately after medication and at 6, 12, and 18 hours, with no significant difference (P >.05). However, dexamethasone (Group II) resulted in lower pain levels than ibuprofen\acetaminophen (Group I) at 24 and 48 hours (P <.05) Discussion: Both dexamethasone and ibuprofen-acetaminophen can be good palliative choices in endodontic emergencies in pandemic conditions. However, at 24 and 48 hours, dexamethasone resulted in lower pain levels.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Analysis of Maternal Critical Care at the Mid Yorkshire Hospitals NHS Trust

Introduction: Perinatal admissions to Critical Care are increasing due to rising maternal age, obesity, and comorbid disease.1 The MBRRACE Report 2021 stated that of 191 maternal deaths in 2017-2019, only 17% had good care.2 Since the COVID-19 pandemic, there was a subjective increase in perinatal admissions to Mid Yorkshire Hospitals Critical Care. Objective(s): To investigate whether MYH Critical Care maternal admissions have increased, if there has been a change in admission trends and to evaluate the care of critically ill pregnant and postpartum women compared to FICM standards.3 Methods: Retrospective audit of notes of all pregnant and up to 6 weeks postpartum women admitted to critical care between 24/02/2019 and 05/09/2021. Data collected included gestation, duration of admission, organ support, days reviewed by obstetrics and mortality outcomes. Result(s): * There was 1 maternal death and 3 fetal deaths during the study period * 50% of the admissions were antenatal and 50% were postnatal * During the COVID-19 pandemic we have seen a 47% increased rate of admissions from 1 per 29 critical care bed days to 1 per 19 critical care bed days * 50% of patients were supported with ventilation and CPAP during admission, 13% with CPAP only. Prior to the COVID pandemic, no maternal admission required CPAP on our Critical Care unit during the data collection period * 63% of patients were reviewed by obstetrics at least one during their admission, but obstetric review was documented on only 37 of 112 patient days * There is no critical care SOP for perimortem Caesarean section * There is no specialist neonatal resuscitation equipment available on ICU * There is no named ICM consultant responsible for Maternal Critical Care * There is no SOP for support of maternal contact with baby * There is no critical care/obstetric services MDT follow-up Conclusion(s): This study shows that Critical Care admissions have increased, and that care does not follow all the FICM recommendations. Considering this, the following recommendations have been made: * Introduce an SOP and simulation training for peri-mortem section * Introduce neonatal resuscitation equipment box * Nomination of a named ICM Consultant lead for Maternal Critical Care to ensure quality of care and act as liaison * Train critical care staff in supporting contact between a mother and baby, with support from midwifery services * Introduction of Obstetric and Critical Care MDT follow-up.