Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence.

OBJECTIVE: To compare pre-eclampsia risk factors identified by clinical practice guidelines (CPGs) with risk factors from hierarchical evidence review, to guide pre-eclampsia prevention. DESIGN: Our search strategy provided hierarchical evidence of relationships between risk factors and pre-eclampsia using Medline (Ovid), searched from January 2010 to January 2021. SETTING: Published studies and CPGs. POPULATION: Pregnant women. METHODS: We evaluated the strength of association and quality of evidence (GRADE). CPGs (n = 15) were taken from a previous systematic review. MAIN OUTCOME MEASURE: Pre-eclampsia. RESULTS: Of 78 pre-eclampsia risk factors, 13 (16.5%) arise only during pregnancy. Strength of association was usually 'probable' (n = 40, 51.3%) and the quality of evidence was low (n = 35, 44.9%). The 'major' and 'moderate' risk factors proposed by 8/15 CPGs were not well aligned with the evidence; of the ten 'major' risk factors (alone warranting aspirin prophylaxis), associations with pre-eclampsia were definite (n = 4), probable (n = 5) or possible (n = 1), based on moderate (n = 4), low (n = 5) or very low (n = 1) quality evidence. Obesity ('moderate' risk factor) was definitely associated with pre-eclampsia (high-quality evidence). The other ten 'moderate' risk factors had probable (n = 8), possible (n = 1) or no (n = 1) association with pre-eclampsia, based on evidence of moderate (n = 1), low (n = 5) or very low (n = 4) quality. Three risk factors not identified by the CPGs had probable associations (high quality): being overweight; 'prehypertension' at booking; and blood pressure of 130-139/80-89 mmHg in early pregnancy. CONCLUSIONS: Pre-eclampsia risk factors in CPGs are poorly aligned with evidence, particularly for the strongest risk factor of obesity. There is a lack of distinction between risk factors identifiable in early pregnancy and those arising later. A refresh of the strategies advocated by CPGs is needed.

Geographic variation in point of care ultrasound provision: results from a national audit.

BACKGROUND: There is an emerging consensus that point-of-care ultrasound is an essential skill in acute care. This is reflected in recent changes to the Acute Internal Medicine curriculum in the UK. The need to develop and maintain specific ultrasound competencies is now a mandatory component of training. There is a degree of uncertainty as to how existing training infrastructure can best accommodate these changes. METHODS: Data were obtained from the latest annual Society for Acute Medicine Benchmarking Audit 2021. All Acute Medical Units in the UK are eligible to participate. Data pertaining to the number of ultrasound machines and number of clinicians that regularly use point of care ultrasound were collected. This was used to develop a series of maps demonstrating variation in provision at the national level. RESULTS: In total, 123 AMUs responded to the questions related to ultrasound prevalence and numbers of trained clinicians. Of these, 78.9% (97/123) reported having access to at least one ultrasound machine. There was at least one clinician that regularly used ultrasound in 81 responding hospitals (65.9%). There was significant geographic heterogeneity in the use of ultrasound and availability of accredited supervisors. At a regional level, ultrasound expertise is typically concentrated within a relatively small number of hospitals. CONCLUSION: Geographic variation in the use of ultrasound and availability of registered supervisors represents a significant challenge to ultrasound training provision at the national level. Targeted interventions in areas with less developed training infrastructure, such as regional training hubs may be required to ensure more equitable access to training opportunities.

The Driving Factors Important for Evaluation Student's Opinion which Influenced Decision Making of Career Choice: Pediatrics as a Career Choice as an Example.

BACKGROUND: Reducing the maternal and neonatal mortality rate are the predominant goals of achieving sustainable development for which it is important to ensure adequate health workforce, especially pediatric professionals at all levels of health care. Recent trends reveal a significant decline in the number of doctors opting for pediatrics specialization. OBJECTIVE: This study was carried out to explore the career preferences of the undergraduate medical students and factors influencing career choice. METHODS: This cross sectional study was carried out among 362 undergraduate medical students studying in prefinal and final year during a period of three months. A self administered questionnaire was used to obtain information regarding the career preferences and factors influencing the decision making. Attitudes regarding career choice was assessed using Likert scale and later recoded into binomial variables. Statistical analysis was carried out using SPSS software. RESULTS: Majority of the participants were females (61.8%). The individual choice of specialty revealed that 12.2% of the males and 18.5% of the females wanted to take up pediatrics as their first career choice while 5.5% of the males and 7.7% of the females had pediatrics as their second choice. Overall, more females preferred pediatrics as a career choice compared to the males. The observed difference was statistically significant (p<0.0001). CONCLUSION: Adequate motivation, driven with passion for patient care can be inculcated at the young age and will go a long way in not only addressing the pediatric needs of the society, but also improve health indicators and sustainable development of the country.