Towards a building typology and terminology for Irish hospitals.

BACKGROUND: The physical form of the hospital environment shapes the care setting and influences the relationship of the hospital to the community. Due to ongoing demographic change, evolving public health needs, and advancing medical practice, typical hospitals are frequently redeveloped, retrofitted, or expanded. It is argued that multi-disciplinary and multi-stakeholder approaches are required to ensure that hospital design matches these increasingly complex needs. To facilitate such a conversation across different disciplines, experts, and community stakeholders, it is helpful to establish a hospital typology and associated terminology as part of any collaborative process. AIMS: Examine the literature around hospital design, and review the layout and overall form of a range of typical Irish acute public hospitals, to outline an associated building typology, and to establish the terminology associated with the planning and design of these hospitals in Ireland. METHODS: Searches in 'Academic Search Complete', 'Compendex', 'Google', 'Google Scholar', 'JSTOR', 'PADDI', 'Science Direct', 'Scopus', 'Web of Science', and Trinity College Dublin Library. The search terms included: 'hospital design history'; 'hospital typology'; 'hospital design terminology'; and 'hospital design Ireland'. RESULTS: Typical hospitals are composed of different layouts due to development over time; however, various discrete building typologies can still be determined within many hospitals. This paper presents a typology illustrating distinct layout, circulation, and physical form characteristics, along with a hospital planning and design terminology of key terms and definitions. CONCLUSION: This typology and terminology define the main components of Irish hospital building design to create a shared understanding around design, and support stakeholder engagement, as part of any collaborative design process.

Obstetric and neonatal outcome in fetuses with absent end-diastolic velocities of the umbilical artery: a case-controlled study.

Absence of end-diastolic velocities (AEDV) is the most severe waveform abnormality detected by Doppler ultrasound examination of the umbilical artery. It is associated with fetal hypoxemia and acidemia. If AEDV predisposed to more neonatal complications, then it might be an indication for earlier delivery. This was investigated in 21 preterm fetuses with AEDV who were matched for gestational age at delivery with 21 with end-diastolic velocities. All fetuses were delivered electively before 36 weeks' gestation of mothers who were hypertensive. The fetal heart rate (FHR) variability, birthweight, and umbilical arterial blood pH were significantly lower in the AEDV group. However, the neonatal outcomes were similar except for less severe hyaline membrane disease and lower initial platelet counts in the AEDV group. At present, fetuses with umbilical arterial AEDV need not be delivered earlier than indicated by the FHR pattern, nor should neonatal management be altered on the basis of antenatal AEDV.

The value of Doppler assessment of the uteroplacental circulation in predicting preeclampsia or intrauterine growth retardation.

Flow velocity waveforms of the uteroplacental arteries were analyzed at 20 and 24 weeks of gestation, by means of duplex pulsed Doppler ultrasonography, in 93 women at risk for preeclampsia or intrauterine growth retardation. The ability of an elevated resistance index to predict these conditions was tested. At 20 and 24 weeks an abnormal resistance index was significantly associated with intrauterine growth retardation but not with preeclampsia, with or without proteinuria. A low fetal abdominal circumference at 20 or 24 weeks or an increasing maternal plasma uric acid concentration at 24 weeks was as predictive as an elevated resistance index. In a second group of 43 women, screened in the same way, the only association was of an elevated resistance index at 20 weeks with intrauterine growth retardation. Although elevated resistance indices occur more commonly in women who develop intrauterine growth retardation and/or preeclampsia, the correlation is not close enough to be clinically useful as a screening test.