Measuring the impact of maternal critical care admission on short- and longer-term maternal and birth outcomes.

PURPOSE: Factors increasing the risk of maternal critical illness are rising in prevalence in maternity populations. Studies of general critical care populations highlight that severe illness is associated with longer-term physical and psychological morbidity. We aimed to compare short- and longer-term outcomes between women who required critical care admission during pregnancy/puerperium and those who did not. METHODS: This is a cohort study including all women delivering in Scottish hospitals between 01/01/2005 and 31/12/2018, using national healthcare databases. The primary exposure was intensive care unit (ICU) admission, while secondary exposures included high dependency unit admission. Outcomes included hospital readmission (1-year post-hospital discharge, 1-year mortality, psychiatric hospital admission, stillbirth, and neonatal critical care admission). Multivariable Cox and logistic regression were used to report hazard ratios (HR) and odds ratios (OR) of association between ICU admission and outcomes. RESULTS: Of 762,918 deliveries, 1449 (0.18%) women were admitted to ICU, most commonly due to post-partum hemorrhage (225, 15.5%) followed by eclampsia/pre-eclampsia (133, 9.2%). Over-half (53.8%) required mechanical ventilation. One-year hospital readmission was more frequent in women admitted to ICU compared with non-ICU populations [24.5% (n = 299) vs 8.9% (n = 68,029)]. This association persisted after confounder adjustment (HR 1.93, 95% confidence interval [CI] 1.33, 2.81, p < 0.001). Furthermore, maternal ICU admission was associated with increased 1-year mortality (HR 40.06, 95% CI 24.04, 66.76, p < 0.001), stillbirth (OR 12.31, 95% CI 7.95,19.08, p < 0.001) and neonatal critical care admission (OR 6.99, 95% CI 5.64,8.67, p < 0.001) after confounder adjustment. CONCLUSION: Critical care admission increases the risk of adverse short-term and long-term maternal, pregnancy and neonatal outcomes. Optimizing long-term post-partum care may benefit maternal critical illness survivors.

Postpartum complications following neuraxial anaesthesia for obstetric physicians.

Neuraxial analgesia and anaesthesia are widely accepted and well-tolerated modes of delivery analgesia, being employed in up to 76% of vaginal deliveries and 94% of caesarean deliveries in the United States.1 A cause of considerable concern for postpartum women, their family and caring health professionals is the occurrence of unexplained postpartum complications, not only for management in the index pregnancy, but the uncertain risk of recurrence in future pregnancies. Complications of neuraxial blocks may impact significantly on the ability of mothers to care for and bond with their newborn. The reported incidence of temporary neurological deficit following obstetric neuraxial blocks is 1 in 3900 procedures, and the risk of permanent neurological harm estimated to be between 1 in 80,000 and 1 in 320,425 procedures.2 Obstetric physicians may be asked to review women with postpartum complications following neuraxial blocks. This article reviews complications that may be seen following neuraxial blocks for delivery.

South African pre-hospital emergency care personnel's lived experiences of managing paediatric emergencies: A qualitative research design utilising one-on-one interviews.

BACKGROUND: The phenomenon of managing paediatric emergencies in the pre-hospital environment within the South African setting is poorly understood with specific regard to what emergency care personnel are experiencing when managing paediatric emergencies. AIM: The aim of this study was to explore and describe the lived experiences of emergency care personnel in managing paediatric patients in the pre-hospital environment and to understand the meaning and the significance of these experiences. SETTING: All participants were purposively sampled from emergency medical services agencies operating within the Johannesburg metropolitan city area. METHODS: This study followed a qualitative, exploratory, descriptive, phenomenological design, whereby participants purposively sampled within the Johannesburg metropolitan city voluntarily consented to one-on-one interviews (n = 10). RESULTS: Three main themes, with 11 contributing categories, were identified and contextualised with available literature. Emerging from the main themes was an overall sense that managing paediatric emergencies is a negative experience, coloured with feelings of inadequacy, stress, anxiety and even fear. CONCLUSIONS: The findings of this study provided new insights into what South African EMS are experiencing when managing paediatric emergencies, which enables future research efforts to identify research and practice gaps that are relevant to paediatric pre-hospital emergency care, and that are specific to the South African environment. CONTRIBUTION: This research provides preliminary insight into the lived experiences of prehospital personnel managing paediatric emergencies as well as emerging recommendations for the improvement of the prehospital care of paediatric patients.

A model to facilitate the teaching of caring to diagnostic radiography students: Original research.

BACKGROUND: Healthcare has moved towards a patient-centred caring environment. Radiography students have described feeling unprepared for daily patient interactions therefore, it is essential for educators to facilitate the development of caring attributes in students. OBJECTIVE: The objective of this article is to describe the process that was followed in order to develop a model to facilitate the teaching of caring to diagnostic radiography students. METHOD: A qualitative, theory-generating, exploratory and descriptive research design was used. Phase one was a descriptive, exploratory study that utilized focus group interviews to explore and describe the concept of caring from the perspective of first year diagnostic radiography students. Phase two, the focus of this article, was the theory generation phase of the study which began with identifying a central concept from the focus group interview results. The central concepts were then defined according to dictionary and literature sources and relationships between the identified concepts were created. Thereafter, the model was developed. RESULTS: The central concept was identified as the "facilitation of a culture of caring". This concept was then defined, classified and described. CONCLUSION: This model as a framework of reference could assist diagnostic radiography educators in facilitating the teaching of caring among student radiographers.

Retrospective evaluation of exposure indicators: a pilot study of exposure technique in digital radiography.

INTRODUCTION: Digital radiography lacks visual clues of exposure techniques used to obtain radiographs, therefore manufacturers have included exposure indicators (EIs). EIs provides feedback about exposure techniques used and evaluating EIs will yield much needed information about exposure trends used in digital radiography. METHODS: A retrospective explorative quantitative study was conducted at nine randomly selected imaging departments in Gauteng, South Africa. Data pertaining to EI was retrospectively collected using quota sampling and compared to manufacturer recommended (MR) standards. RESULTS: A total of 1422 EIs were collected. 50% of these were within the MR standard. 27% of EI indicated overexposure and 23% indicated underexposure. CONCLUSIONS: Greater evidence of overexposure was noted in the retrospective analysis of the EI. This pilot study shows the need for further investigation into exposure technique practices in digital radiography and the need for measures to halt the evidenced overexposure.

Radiofrequency Interference in the Clinical Laboratory.

OBJECTIVES: Radiofrequency interference (RFI) is a known medical device safety issue, but there are no documented cases of interference resulting in erroneous laboratory results. METHODS: We investigated unexpected failure of a hematology analyzer resulting in erroneous WBC counts. Hardware failure was initially suspected, but temporal association with increased power output from a nearby antenna prompted investigation for RFI. RESULTS: Power output from an antenna located approximately 4 feet from the analyzer was increased to ensure sufficient signal for emergency communications in the building. Interference from the antenna resulted in aberrant side scatter and abnormal WBC counts. Powering down the antenna returned the instrument to normal working conditions. CONCLUSIONS: We have shown RFI as the root cause of erroneous WBC counts in a hematology analyzer. We propose that RFI should be on the list of potential interfering mechanisms when clinical laboratory instruments generate inconsistent or unreliable results.

Increased Arctic influence on the midlatitude flow during Scandinavian Blocking episodes.

Recent studies have suggested that Arctic teleconnections affect the weather of the midlatitudes on time-scales relevant for medium-range weather forecasting. In this study, we use several numerical experimentation approaches with a state-of-the-art global operational numerical weather prediction system to investigate this idea further. Focusing on boreal winter, we investigate whether the influence of the Arctic on midlatitude weather, and the impact of the current Arctic observing system on the skill of medium-range weather forecasts in the midlatitudes is more pronounced in certain flow regimes. Using so-called Observing System Experiments, we demonstrate that removing in situ or satellite observations from the data assimilation system, used to create the initial conditions for the forecasts, deteriorates midlatitude synoptic forecast skill in the medium-range, particularly over northern Asia. This deterioration is largest during Scandinavian Blocking episodes, during which: (a) error growth is enhanced in the European-Arctic, as a result of increased baroclinicity in the region, and (b) high-amplitude planetary waves allow errors to propagate from the Arctic into midlatitudes. The important role played by Scandinavian Blocking, in modulating the influence of the Arctic on midlatitudes, is also corroborated in relaxation experiments, and through a diagnostic analysis of the ERA5 reanalysis and reforecasts.

Computer-aided detection tool development for teaching chest radiograph pattern recognition to undergraduate radiography students: A context needs and capability analysis.

BACKGROUND: Medical imaging (MI) education has experienced a shift aligned with the advances in technology and the role played by radiographers in pattern recognition. This has led to increased use of technology-enhanced teaching and simulated learning approaches (e.g. computer-aided detection [CAD] tools) which also support the increasing requirement to develop pattern-recognition skills at undergraduate level. However, the development of these approaches need to be explored and planned carefully to be context-relevant. AIM: The aim of this study was to explore and describe the need for and capability of a CAD tool for teaching chest radiography pattern recognition in an undergraduate radiography programme. SETTING: The setting was a university that offers MI education. METHOD: The study employed a qualitative descriptive design with an interpretive research paradigm. Purposive sampling was used to recruit information-rich participants for a focus group interview. Information-rich participants were considered to be those who were involved in teaching clinical skills, such as those required in pattern recognition, to radiography students. Data were transcribed verbatim and analysed in a step-by-step approach. RESULTS: Three main themes emerged: (1) a structured approach to enhance implicit skills is critical in the CAD tool design; (2) an authentic tool which is able to simulate real-world experiences in image analysis is essential; and (3) a tool which encourages self-directed learning using a wide variety of pathological conditions would be ideal. CONCLUSION: The results of this study are essential in guiding radiography educators in designing CAD tools for teaching chest radiography pattern recognition.

The concept of caring amongst first year diagnostic radiography students: Original research.

Student radiographers start their work integrated learning from their first year of studying and they are in constant contact with patients. Based on this interaction, it is imperative for all diagnostic radiography students to be caring professionals. The purpose of this study was to gain an understanding of caring amongst diagnostic student radiographers by exploring and describing their experiences of caring in the clinical environment. A qualitative, exploratory, descriptive and contextual research design was utilized. Focus group interviews were conducted with first year diagnostic radiography students. Purposive sampling was used to ensure information rich data was obtained. In keeping with qualitative research, participants were interviewed until data saturation was reached. Appreciative inquiry was used as an interview technique to encourage storytelling and to engage in narrative - rich communication. The 4-D model of appreciative inquiry, namely; Discovery, Dream, Destiny and Design, formed the basis for the interview questions. Data was analysed and coded and themes were created based on the interpretation of the data. Three themes were identified as being; caring as an integral part of a career choice, unpreparedness for interpersonal interactions and barriers and enablers for the development of a caring identity. Participants expressed an idealistic vision of what caring means to them as a student radiographer. Participants felt unprepared for their daily interpersonal interactions with patients and other staff. Recommendations to radiography educators would be to engage in more role-playing exercises, reflective practices and peer discussions.

Psychosexual experiences of men following radiotherapy for prostate cancer in Johannesburg, South Africa.

BACKGROUND: Radiation-induced erectile dysfunction (RiED) often occurs among patients diagnosed with prostate cancer (PCa) who undergo radiation treatment. However, sexual health care (SHC) is not a common practice in radiation oncology departments worldwide. Sexual health care in this context refers to a practice of integrating discussions around sexual well-being into the routine follow-up appointments of PCa patients to achieve better patient-centred care. Previous research identified unmet patient needs and mismatched expectations between patients and health care providers regarding SHC, but no such studies have been conducted in a South African setting. AIM: The aim of this study was to explore and describe the psychosexual experiences of men following radiotherapy for PCa treated in Johannesburg. SETTING: A qualitative phenomenology design with an interpretive research paradigm was employed, which allowed the study objectives to be achieved. Purposive sampling was used to recruit participants from a population of 305 patients. Data were transcribed verbatim and analysed in a step-by-step approach. METHOD: Data saturation was reached after completing semi-structured individual interviews (n = 9). RESULTS: Feedback received from the participants was classified into three main themes: (1) their sexual experiences after PCa diagnosis, (2) the impact of losing sexual function on their relationships and (3) the lack of information from medical oncology staff regarding sexual health. Diverse psychosexual experiences and emotional reactions associated with erectile dysfunction before and after radiation therapy were identified. CONCLUSION: The loss of sexual function had a detrimental impact on the men's quality of life, psychological well-being and intimate relationships. Participants shared unsatisfactory feelings about inconsistent and unmet SHC expectations in the radiation oncology clinic.

The experiences of mine workers with cancer.

BACKGROUND: Cancer is a disease that instils a fear of death in the minds of most people. For South African mine workers, the fear of death is compounded by a fear of being unable to fulfil work obligations in an industry where employment is central to the miners' identity. AIM: The purpose of this research was to explore and describe the experiences of mine workers experiencing a cancer diagnosis requiring radiation therapy. SETTING: Mining towns in the Limpopo province, Thabazimbi and Lephalale. METHODS: A qualitative, descriptive and exploratory study design was utilised. The purposeful sample consisted of 11 mine workers receiving treatment at a radiotherapy centre in the North West province. Data were collected using an open-ended questionnaire and individual in-depth telephonic interviews. Data were analysed using open coding to identify themes. RESULTS: The themes identified were the emotional experience resulting from the diagnosis, changing family dynamics and information needs from radiotherapy professionals. The psychosocial support required by this group of patients is unique and radiation therapists need to provide wholistic support that is tailored to address the contextual needs of this group of patients. CONCLUSIONS: Mine workers often live far away from their family and are forced to face the cancer journey alone without family support. Oncology professionals, therefore, need to create supportive structures, including emotional and financial counselling, to ensure compliance with treatment protocols, thus facilitating a positive treatment outcome.

FGF21 regulates metabolism and circadian behavior by acting on the nervous system.

Fibroblast growth factor 21 (FGF21) is a hepatokine that acts as a global starvation signal to modulate fuel partitioning and metabolism and repress growth; however, the site of action of these diverse effects remains unclear. FGF21 signals through a heteromeric cell-surface receptor composed of one of three FGF receptors (FGFR1c, FGFR2c or FGFR3c) in complex with ß-Klotho, a single-pass transmembrane protein that is enriched in metabolic tissues. Here we show that in addition to its known effects on peripheral metabolism, FGF21 increases systemic glucocorticoid levels, suppresses physical activity and alters circadian behavior, which are all features of the adaptive starvation response. These effects are mediated through ß-Klotho expression in the suprachiasmatic nucleus of the hypothalamus and the dorsal vagal complex of the hindbrain. Mice lacking the gene encoding ß-Klotho (Klb) in these regions are refractory to these effects, as well as those on metabolism, insulin and growth. These findings demonstrate a crucial role for the nervous system in mediating the diverse physiologic and pharmacologic actions of FGF21.