A national survey of obstetric early warning systems in the United Kingdom.

BACKGROUND: Despite recommendations in the two most recent Confidential Enquiries into Maternal and Child Health (CEMACH) reports, and improvements in patient care using early warning scoring systems (EWS) in the general adult population, no validated system currently exists for the obstetric population. METHODS: We performed an Obstetric Anaesthetists' Association (OAA) approved postal survey of all UK consultant-led obstetric anaesthetic units in November 2007 to assess opinions on the value and of such a system and how it could be implemented, and invited comments and samples of systems already in use. RESULTS: The response rate was 71%. Of those who replied a median usefulness score of 80% for a standardised national obstetric EWS was demonstrated. Eighty-nine percent of units thought it would be possible to implement a system, and although 96% of UK hospitals already use a non-obstetric EWS, only 23% of respondents thought this to be relevant to obstetric physiology and disease. Nine units returned copies of their obstetric EWS. Using extracts from some of the submitted versions we have designed and implemented a system locally and submitted it to the OAA for consideration. CONCLUSIONS: The survey results support CEMACH recommendations for a nationally agreed obstetric EWS.

A retrospective study of anaesthetic caseload of Specialist Registrars following the introduction of new working patterns in the Wessex region.

The impact of implementing the European Working Time Directive (EWTD) and the consequent reduction in hours of work has led to concerns about training. This retrospective study compared total caseload, obstetric caseload, out-of-hours caseload and supervision levels of trainee anaesthetists in one region of the UK (Wessex) before and after the implementation of EWTD compliant rotas. Anaesthetic trainee logbooks submitted at the annual Record of In-Training Assessment were compared between the years 1999 and 2006. The logbook data was divided into two groups, group A (13-h shift) and group B (24-h on-call rota). There was no difference in total caseload, obstetric caseload or supervision. Out-of-hours caseload was greater in group A (p < 0.01).

Puerperal streptococcal toxic shock syndrome treated with recombinant human activated protein C and intravenous immunoglobulin.

Group A streptococcal sepsis is an uncommon management challenge and has a potentially fulminate course. We present the case of a 25-year-old woman who, within 24h of spontaneous vaginal delivery at 32 weeks of gestation, developed signs of systemic infection and multi-organ failure requiring admission to the intensive care unit. Recombinant human activated protein C and intravenous immunoglobulin were used; subsequently heparin-induced thrombocytopenia and pulmonary embolus also required treatment.

Contribution of man-made activities to the pollution of the Tigris within Mosul area/IRAQ.

This paper presents an overall view of major sources that may lead to the pollution of the Tigris within Mosul city. A stretch exceeding 20kms in length is selected that represents the "sick" path of the river. Many sites along the studied stretch are likely to affect the river quality in some way or another. Samples from 40 sources sites are taken for quality analyses These sources--as huge as 400000 m3 a day--are characterized as (medium - strong) in composition. Such wastewaters with the pollutants they carry alter the river water quality rendering it unsuitable for beneficial uses. Such alterations--do leave--many negative consequences concerning human beings and aquatic life. It is found that domestic discharges are among the most important sources of pollution. Sanitary wastes are often discharged--untreated--into the Tigris. Other illegal practices such as in-house slaughtering add to the pollution as well. Industrial, tourist and institutional wastes put an additional burden on pollution of the river water quality. These wastes contain lead, chrome, and other heavy metals that may pose health risks. Wastewater treatment plants that exist in some sectors do not perform as they are expected. They need proper evaluation and rehabilitation. Eutrophication--a characteristic problem in lakes--finds an access to occur into the Tigris. This problem results from intensive use of detergents rich in nutrients (P&N compounds). In general, pollutants of different sources heavily affect the river water. Recovery and self purification of the river is estimated to occur at 40 km far from reference point. The paper concludes with the necessity of construction of a central treatment plant(s) or tackling the pollutants at their origin. The paper also stresses on importance of environmental education and awareness in order to combat pollution problems.

Safety of preoperative enoxaparin in head and neck cancer surgery.

BACKGROUND: Thromboembolism is a risk in major head and neck cancer surgery patients predisposed to thrombosis. This study was designed to determine whether enoxaparin (a low molecular weight heparin) administered prior to surgery induces perioperative bleeding. METHODS: Forty patients scheduled for major cervicofacial cancer surgery were randomized in a double-blind study to receive either 20 mg enoxaparin or placebo, 12 hours before surgery. Blood losses were measured at the end of surgery and 6 hours later. RESULTS: Bleeding was equal in the placebo group and in the enoxaparin group, with losses of 648 +/- 106 mL and 602 +/- 106 mL (p = 0.76), respectively. Six hours after surgery, blood collected was 159.3 +/- 25.7 mL in the placebo group vs 151.4 +/- 21 mL in the enoxaparin group (p = 0.81). CONCLUSION: Preoperative administration of enoxaparin is safe in head and neck cancer surgery, but further studies are required to evaluate its efficacy in preventing thromboembolism.