Evaluation of midwife-led care provided at the Royal Bournemouth Hospital.

OBJECTIVE: To compare the outcome of care given to women 'booking' for delivery in a midwife-led maternity unit with that for comparable women 'booking' for care in a consultant obstetric unit. DESIGN AND METHOD: Prospective cohort study with a quasi-experimental design and data extracted from case notes. SETTING: East Dorset, midwife-led maternity unit at Royal Bournemouth Hospital and consultant-led maternity unit at Poole General Hospital. SUBJECTS: Two cohorts of women who satisfied the criteria for 'booking' at the Royal Bournemouth Hospital. Of these 794 'booked' at Bournemouth from 1 November 1992 to 30 June 1993 and 705 'booked' at Poole over the same period. MAIN PROCESS AND OUTCOME MEASURES: Care given, morbidity in women and their babies, transfers during the antenatal period and in labour. FINDINGS: Of the women who initially 'booked' for Bournemouth, 62.3% actually delivered there, 27.1% transferred before labour and a further 9.2% transferred during labour. No differences were seen between those 'booked' for Bournemouth or Poole in the proportions of low birthweight babies, babies who were transferred to special care or babies who had congenital abnormality. Higher proportions of babies whose mothers 'booked' for delivery in Poole were resuscitated and had one minute Apgar scores below seven but there was no difference in the five minute scores. Similar proportions of women had perineal tears but fewer of the women 'booked' for delivery in Bournemouth had an episiotomy. 'Booking' for Poole was associated with higher rates of induction and augmentation of labour and greater use of anesthesia. 'Booking' for Bournemouth was associated with a shorter first stage and a longer third stage of labour. Women 'booked' for delivery in Bournemouth were no more likely to be delivered by a midwife than those 'booked' for Poole. CONCLUSIONS: There was very little difference between the groups of women who initially 'booked' for delivery at the two units. There were differences in the patterns of care received, but no major differences in the outcome for the women or their babies were detected.

Orthopaedic geriatric care--is it effective? A prospective population-based comparison of outcome in fractured neck of femur.

Orthopaedic geriatric care has become widely accepted despite relatively little formal evaluation. In the East Dorset health authority all patients with fractured neck of femur initially share common orthopaedic facilities but only those from one geographical sector have subsequent access to an orthopaedic geriatric unit, patients from the other sector receiving standard care. We have carried out a prospective population-based comparison of the outcome of 155 consecutive incident cases of fractured neck of femur aged over 65 years. On admission to hospital the two populations were similar in respect of age, sex, fracture type, social status, medical and orthopaedic problems, mental status and dependency (Clifton assessment procedure for the elderly). Multiple regression analysis showed that the mean length of stay was 9.5 days shorter in patients from the sector with access to orthopaedic geriatric care (p less than 0.05, 95% confidence interval 0.6 to 18.4 days). This reduction was not due to any difference between the two groups as regards dependency or the level of support provided on discharge. There was no difference in outcome at 6 months post-operatively in terms of mortality, functional outcome (pain and mobility), change in dependency or social status. We conclude that in the East Dorset health authority this combined approach has resulted in a significant reduction in the length of inpatient stay without any other apparent effect on patient outcome.

Histochemical studies of hepatocellular carcinomas in the rat induced by aflatoxin.

A histochemical study has been done on a group of 18 hepatocarcinomas induced by aflatoxin. One hundred per cent, incidence of hepatocarcinomas is induced by feeding 5 p.p.m. aflatoxin for 6 weeks. The carcinomas were trabecular hepatocarcinomas with a mixed adenomatous pattern and showed considerable variation in histochemical reactions throughout the lesions. There was a patchy distribution of glycogen and glucose-6-phosphate and the membrane ATPase was present along much of the canalicular border of the cells but with an abnormal and tortuous pattern. Aniline hydroxylase was present in varying amounts in both trabecular and adenomatous carcinomas. It is concluded that the histological variants of hepatocarcinoma are all derived from hepatocytes, but no unique changes were observed related to the progress involved in malignant neoplasia. The observations form a basis for comparison with early lesions seen prior to the recognition of carcinoma.

Histochemical studies on the early proliferative lesion induced in the rat liver by aflatoxin.

Male inbred Fischer rats were fed a diet containing 5 p.p.m. aflatoxin for 1, 3, 4 1/2 and 6 weeks at which times groups were killed for histological and histochemical study. Aflatoxin produced a scattered individual cell necrosis of parenchymal cells by 1 week. At 3 weeks small basophilic proliferative foci were seen which increased in size and abundance to 6 weeks. These foci showed starvation-resistant glycogen, variable depletion of glucose-6-phosphatase, succinic dehydrogenase, aniline hydrogenase, membrane ATPase and acid phosphatase. At 6 weeks the foci showed the presence of gamma glutamyl transpeptidase and glucose-6-phosphate dehydrogenase. The basophilic foci were not preceded by other focal histological and histochemical change. The basophilic proliferative lesions are observed when an irreversible change has been induced in the liver. The role of such lesions in the histogenesis of hepatocellular carcinoma is discussed.

Histochemical observations on nodules induced in the mouse liver by phenobarbitone.

This study describes the histochemical reactions seen in nodules of the mouse liver. The nodules were obtained from 13 animals treated for over 80 weeks with phenobarbiotone and three untreated mice. The morphology of the lesion depends upon the preparative techniques and only two lesions with persistent abnormal trabecular pattern metastasised. A varying pattern of histochemical reaction was seen. The aniline hydroxylase reaction was dense in simple nodules and in centrilobular areas of phenobarbitone-treated mice but was weak in the abnormal trabecular lesions. These results suggest that it is possible to predict behavioural characteristics of mouse hepatic nodules on the basis of certain morphological characteristics.