OptiBreech collaborative care versus standard care for women with a breech-presenting fetus at term: A pilot parallel group randomised trial to evaluate the feasibility of a randomised trial nested within a cohort.

OptiBreech collaborative care is a multi-disciplinary care pathway for breech presentation at term, with continuity from a breech specialist midwife, including where chosen, for vaginal breech birth (VBB). Pilot randomised trial using unblinded 1:1 parallel group allocation to OptiBreech versus standard care, within a cohort. Participants were women with a breech-presenting fetus > 33 weeks, at four sites in England, January-June 2022. A two-stage consent process was used. Participants consented to undergo random selection to be offered a 'new care process', with a choice to accept it, or not. Primary objectives were to identify recruitment, acceptance, and attrition rates. Randomisation procedures and potential primary outcomes for a substantive study were also feasibility-tested. 68 women were randomised between January-June 2022. The consent process was acceptable to participants, but randomisation was unacceptable to women who specifically sought OptiBreech care. Two women withdrew due to concerns about sharing personal information. More women planned a VBB when randomised to OptiBreech Care (23.5% vs 0, p = .002, 95% CI = 9.3%,37.8%). Women randomised to OptiBreech care had: lower rates of cephalic presentation at birth (38.2% vs 54.5%), higher rates of vaginal birth (32.4% vs 24.2%), lower rates of in-labour caesarean birth (20.6% vs 36.4%), lower rates of neonatal intensive care (5.9% vs 9.1%), and lower rates of severe neonatal morbidity (2.9% vs 9.1%). Randomisation was stopped on the advice of the steering committee before the planned sample of 104, as lack of access to VBB within standard care prohibited comparison of outcomes. Demand for VBB is sufficient for a cohort study, but comparison of outcomes by 1:1 randomisation is not feasible. OptiBreech care would be best evaluated using stepped wedge cluster randomisation. Funded by the United Kingdom National Institute for Health and Care Research (NIHR300582). Clinical trial registration: ISRCTN 14521381.

The feasibility of team care for women seeking to plan a vaginal breech birth (OptiBreech 1): an observational implementation feasibility study in preparation for a pilot trial.

BACKGROUND: OptiBreech Care is a care pathway for breech presentation at term, including where chosen, physiological breech birth attended by professionals with advanced training and/or proficiency. We aimed to assess the feasibility of implementing OptiBreech team care prior to proceeding with a planned pilot randomised controlled trial. METHODS: Our design was an observational implementation feasibility assessment across England and Wales, January 2021-June 2022. Our objectives were to determine whether Trusts could provide attendants with advanced training (implementation feasibility), who deliver protocol-consistent care (fidelity), within existing resources (costs), while maintaining low neonatal admission rates (safety) and adequate recruitment rates (trial feasibility). Participants included women > 37 weeks pregnant with a breech-presenting foetus, requesting support for a vaginal breech birth following standard counselling, and staff involved in the study. No randomisation occurred in this first stage of feasibility work. RESULTS: Thirteen National Health Service sites were recruited. A total of 82 women planned births in the study. Sites with a breech specialist midwife recruited at double the rate of sites without (0.90/month, 95% CI 0.64-1.16 vs 0.40, 95% CI 0.12-0.68). Referrals into the study came from midwives (46%), obstetricians (34%) and women themselves (20%). Vaginal births were attended by staff with OptiBreech training at 87.5% (35/40, 95% CI 0.732-0.958) and by staff who met additional proficiency criteria at 67.5% (27/40, 95% CI 0.509-0.814). Fidelity criteria were more consistently met by staff who also met proficiency criteria. There were four neonatal admissions (4.9%, 4/82), including one serious adverse outcome (1.2%, 1/82). CONCLUSIONS: A prospective observational cohort of OptiBreech collaborative care, which could potentially support nested or cluster randomisation, appears feasible in sites willing to establish a dedicated clinic and strategically develop further proficient members of staff, with back-up plans for supporting rapidly progressing births. Randomisation procedures remain to be feasibility tested. It is funded by the NIHR (NIHR300582).

Primary hyperparathyroidism during pregnancy: management by minimally invasive surgery based on ultrasound localization.

BACKGROUND: Primary hyperparathyroidism in pregnancy has the potential to seriously impact the mother and foetus. Management may be difficult because the condition is usually diagnosed during pregnancy necessitating a rapid decision to proceed with surgery. Minimally invasive surgery is appealing due to shorter operative times and lower risk of complications. METHOD: We present a consecutive series of eight women diagnosed with hyperparathyroidism during pregnancy. RESULTS: All eight women were treated successfully by parathyroidectomy during pregnancy with no maternal or foetal complications. Seven of these 8 women were treated with minimally invasive parathyroidectomy based on ultrasound localization. CONCLUSION: Where ultrasound localization is performed by experienced endocrine surgeons, minimally invasive parathyroidectomy is a feasible and safe approach in the pregnant patient with primary hyperparathyroidism.

Common pathways toward informing policy and environmental strategies to promote health: a study of CDC's Prevention Research Centers.

This study examined the roles academic researchers can play to inform policy and environmental strategies that promote health and prevent disease. Prevention Research Centers (PRCs) engage in academic-community partnerships to conduct applied public health research. Interviews were used to collect data on the roles played by 32 PRCs to inform policy and environmental strategies that were implemented between September 2009 and September 2010. Descriptive statistics were calculated in SAS 9.2. A difference in roles played was observed depending on whether strategies were policy or environmental. Of the policy initiatives, the most common roles were education, research, and partnership. In contrast, the most prevalent roles the PRCs played in environmental approaches were research and providing health promotion resources. Academic research centers play various roles to help inform policy and environmental strategies.

A longitudinal examination of career preparation and adjustment during the transition from high school.

Preparing for an adult career and incorporating a career into one's identity is a key task during the transition to adulthood (Erikson, 1968), and completing developmental tasks is considered a major factor in adjustment (Havinghurst, 1972). Previous research has established associations between overall career preparation in high school and adjustment soon after high school graduation. Differences in the developmental patterns of career preparation dimensions (indecision, planning, and confidence) following high school graduation also have been found. The current study builds on that prior work by examining associations between changes in the dimensions of career preparation and changes in 3 aspects of adjustment (emotional stability, social adaptation, and self-actualization) from 12th grade in high school to 4.5 years after high school graduation in a sample of 454 youths, using latent growth curve analysis. Results showed that career preparation both predicts and is predicted by adjustment. Career confidence was a particularly important predictor of adjustment. Both 12th grade career confidence and changes in confidence over time predicted changes in adjustment and adjustment 4.5 years post-high school. In an alternative model, an increase in emotional stability was predictive of higher career confidence and lower indecision. Results are discussed in the context of developmental theories and the notion that adjustment and career are interrelated processes.

Career Preparation: A Longitudinal, Process-Oriented Examination.

Preparing for an adult career through careful planning, choosing a career, and gaining confidence to achieve career goals is a primary task during adolescence and early adulthood. The current study bridged identity process literature and career construction theory (Savickas, 2005) by examining the commitment component of career adaptability, career preparation (i.e., career planning, career decision-making, and career confidence), from an identity process perspective (Luyckx, Goossens, & Soenens, 2006). Research has suggested that career preparation dimensions are interrelated during adolescence and early adulthood; however, what remains to be known is how each dimension changes over time and the interrelationships among the dimensions during the transition from high school. Drawing parallels between career preparation and identity development dimensions, the current study addressed these questions by examining the patterns of change in each career preparation dimension and parallel process models that tested associations among the slopes and intercepts of the career preparation dimensions. Results showed that the career preparation dimensions were not developing similarly over time, although each dimension was associated cross-sectionally and longitudinally with the other dimensions. Results also suggested that career planning and decision-making precede career confidence. The results of the current study supported career construction theory and showed similarities between the processes of career preparation and identity development.

Thriving in stepfamilies: exploring competence and well-being among African American youth.

Although scholars conclude that children/adolescents in two-parent nuclear families have an advantage over those in stepfamilies, emerging evidence indicates that the experiences of African American youths have been overshadowed. In three replicated studies, we detected no differences on several important and commonly assessed well-being and competence indicators among samples of African American youth in two-parent nuclear and stepfamilies.

Gastric banding at the Royal Brisbane and Women's Hospital: trials and tribulations of a public service.

BACKGROUND: The Royal Brisbane and Women's Hospital provides the only gastric banding service for the public to the state of Queensland. Our patients are potentially a different group from the previously reported Australian series with respect to weight, comorbidities and ease of follow up and we therefore present this series of public patient for comparison of medium-term results. METHODS: The service consists of a dedicated fortnightly clinic. Patients are referred from within the hospital and also from other health services throughout Queensland and northern New South Wales. Resources allow a limited number of gastric bands to be placed annually. At follow up, measurement of weight is carried out and band adjustments made as necessary. Data are collected prospectively on a dedicated database (LapBase; AccessMed, Melbourne, Australia). RESULTS: Sixty-nine laparoscopic gastric bands (Lap Band; Inamed Health, Santa Barbara, CA, USA) have been placed as a public service at Royal Brisbane and Women's Hospital since August 2001 in 50 women and 19 men. The mean body mass index (BMI) at surgery was 53 kg/m2 (range 33-81 kg/m2). The mean percentage of excess bodyweight lost at 1, 2 and 3 years is 38.5, 45.7 and 57.9%, respectively. The mean BMI has reduced from the baseline of 53 to 44.5 at 1 year, 41.8 at 2 years and 38.6 at 3 years. The waiting list currently contains 103 patients with a mean BMI of 53 kg/m2 and 250 new referrals are on a waiting list for initial review. CONCLUSION: A banding service for the public is a unique experience. The BMI is greater than in other published series; diverse geographic origin of the patients creates difficulties with review and there are limited surgical resources. The Royal Brisbane and Women's Hospital is leading the way towards a multidisciplinary clinic approach to managing obesity. However, more resources will be required to have an effect on overall public health.