The prevalence of an elevated F cell population in a maternal and gynaecology cohort.

OBJECTIVES: This study aimed to determine F cell prevalence in a cohort of maternal and gynaecology specimens using QuikQuant anti-HbF flow cytometry (FC) kit and to investigate if the presence of maternal F cells can lead to fetomaternal haemorrhage (FMH) overestimation. BACKGROUND: The gold standard to estimate FMH is the Kleihauer-Betke test (KBT). The KBT has proved to be insufficiently sensitive to detect low numbers of circulating fetal cells due to the presence of maternal F cells. At present, the prevalence of false positive KBT results due to raised maternal F cell population, defined as >5%, is poorly characterised. METHODS: A total of 120 specimens were tested for the presence of F cells and fetal cells by KBT and anti-HbF FC. The results calculated were compared to determine FMH overestimation. RESULTS: Of our cohort, 32% showed an elevated F cell population, of which 69% (27 of 39) were clinically significant according to KBT (>2 mL FMH). The mean FMH volumes by KBT and anti-HbF FC were 3·90 mL (0·20-35·40 mL) and 4·09 mL (0·20-9·70 mL), respectively. CONCLUSION: The study highlighted that an elevated F cell level could be found in the cohort tested, with an F cell level of >10% causing significant FMH overestimation by KBT.

Resuscitation interventions in a tertiary level pediatric emergency department: implications for maintenance of skills.

OBJECTIVE: To describe the frequency and proportion of successful resuscitation interventions in a pediatric emergency department (PED). METHODS AND MATERIAL: This was a retrospective chart review of children at the BC Children's Hospital (BCCH) PED who were admitted to the BCCH pediatric intensive care unit (PICU) in 2004 and 2005. Demographic data, diagnosis, and resuscitation interventions in the PED and within the first 24 hours of PICU admission were recorded. The training of the operator and the number of attempts needed were also recorded. RESULTS: There were 75,133 PED visits; 304 of 329 (92.4%) who met inclusion criteria were reviewed. Diagnoses included respiratory distress (n=115, 35%), trauma (n=50, 15%), sepsis (n=36, 11%), seizures (n=37, 11%), and cardiac disease (n=22, 7%). Ninety-nine patients required intubation. Intubations in the PED were performed by residents (20%), pediatric emergency medicine (PEM) fellows (15%), PEM attending staff (29%), and PICU fellows (12%); 81% of these were successful on the first attempt. In the PED, seven central lines were placed, seven intraosseous needles were inserted, 15 patients required inotropes, and 9 patients required chest compressions. CONCLUSION: Critical illness in our emergency department is a rare event; hence, opportunities to resuscitate, secure airways, and place central venous catheters are limited. Additional training, close working relationships between the PED and the PICU teams, and resuscitation protocols for early PICU involvement may be needed.

Physician executives in the '90s: report of a national survey.

In fall 1990, Witt Associates again catalogued the progress of physicians as they obtain management positions of increasing importance. The firm has conducted a continuing study of the position since 1979. The current survey of vice presidents of medical affairs/medical directors renders a candid portrait of the physician manager. The profile that emerges is a 53-year-old white male, working almost 50 hours a week in a full-time position, appointed by the hospital and reporting to the Chief Executive Officer. This individual is board certified and has major responsibilities for quality assurance, credentialing, risk management, and utilization review. His or her salary is into six figures.