The Certification Ranking of Stroke Treatment Centers Is Unclear to the General Public.

BACKGROUND: Certified stroke treatment centers are classified based on their available resources to treat stroke including an Acute Stroke Ready Hospital (ASRH), a primary stroke center (PSC), a Thrombectomy-Capable Stroke Center (TCSC), and comprehensive stroke centers (CSCs). These hospitals all provide varying levels of care with CSCs being the most able to treat all types and complexities of stroke. This undergraduate nursing-led study explored the public's preference for treatment at different certified stroke treatment centers.

Critical Care Clinicians' Knowledge of Post-Intensive Care Syndrome.

Background: The term post-intensive care syndrome refers to a group of symptoms that commonly occur after intensive care unit discharge, leading to worsening physical or mental health. The incidence of this syndrome is increasing. Critical care clinicians can play a pivotal role in improving patient outcomes through knowledge of post-intensive care syndrome risk factors and symptoms.

Implementation of a Novel Seizure Assessment Tool for Unified Seizure Evaluation Improves Nurse Response.

BACKGROUND: Ictal and postictal testing is an essential aspect of clinical care when diagnosing and treating seizures. The epilepsy monitoring unit (EMU) has standard operating procedures for nursing care during and after seizure events, but there is limited interrater reliability. Streamlining ictal and postictal testing processes may enhance care consistency for patients in the EMU unit.

FERN: is it possible to conduct a randomised controlled trial of intervention or expectant management for early-onset selective fetal growth restriction in monochorionic twin pregnancy - protocol for a prospective multicentre mixed-methods feasibility study.

Introduction: Selective fetal growth restriction (sFGR) in monochorionic twin pregnancy, defined as an estimated fetal weight (EFW) of one twin <10th centile and EFW discordance ≥25%, is associated with stillbirth and neurodisability for both twins. The condition poses unique management difficulties: on the one hand, continuation of the pregnancy carries a risk of death of the smaller twin, with a high risk of co-twin demise (40%) or co-twin neurological sequelae (30%). On the other, early delivery to prevent the death of the smaller twin may expose the larger twin to prematurity, with the associated risks of long-term physical, emotional and financial costs from neurodisability, such as cerebral palsy.

Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey.

Objective: To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies.

Design: Cross-sectional survey.

Setting: International.

Foetal amplitude-integrated electroencephalography: proof of principle of a novel foetal monitoring technique in adult volunteers.

Peripartum hypoxic neonatal brain injury cannot be accurately predicted with current foetal monitoring techniques. Neonatal brain monitoring through amplitude-integrated electroencephalography (aEEG) is utilised when brain injury is suspected. Intrapartum aEEG assessment may improve detection of foetal hypoxia, facilitating earlier intervention.

Facile Synthesis of Chitosan-Based Hydrogels and Microgels through Thiol-Ene Photoclick Cross-Linking.

Polysaccharide-based microgels are effective vectors for the delivery of biopharmaceutics and functional components in tissue engineering due to their bioactivity and biocompatibility. Currently, the synthesis of chemically cross-linked microgels typically requires long reaction times and a high-energy input and are low yielding due to low volumes of the water phase used. Herein, we report the synthesis of norbornene-derived chitosan (CS-nbn-COOH), which can undergo rapid gelation in the presence of a thiolated cross-linker through the highly efficient thiol-ene photoclick reaction.

The Combined Use of Ultrasound and Fetal Magnetic Resonance Imaging for a Comprehensive Fetal Neurological Assessment in Fetal Congenital Cardiac Defects: Scientific Impact Paper No. 60.

Heart problems are common in newborn babies, affecting approximately 5-10 in 1000 babies. Some are more serious than others, but most babies born with heart problems do not have other health issues. Of those babies who have a serious heart problem, almost 1 in 4 will have heart surgery in their first year.

Cerebral White Matter Maturation Patterns in Preterm Infants: An MRI T2 Relaxation Anisotropy and Diffusion Tensor Imaging Study.

Background And Purpose: Preterm birth is associated with worse neurodevelopmental outcome, but brain maturation in preterm infants is poorly characterized with standard methods. We evaluated white matter (WM) of infant brains at term-equivalent age, as a function of gestational age at birth, using multimodal magnetic resonance imaging (MRI).

Methods: Infants born very preterm (<32 weeks gestation) and late preterm (33-36 weeks gestation) were scanned at 3 T at term-equivalent age using diffusion tensor imaging (DTI) and T2 relaxometry.

Diagnostic accuracy of placental growth factor and ultrasound parameters to predict the small-for-gestational-age infant in women presenting with reduced symphysis-fundus height.

Objectives: To assess the diagnostic accuracy of placental growth factor (PlGF) and ultrasound parameters to predict delivery of a small-for-gestational-age (SGA) infant in women presenting with reduced symphysis-fundus height (SFH).

Methods: This was a multicenter prospective observational study recruiting 601 women with a singleton pregnancy and reduced SFH between 24 and 37 weeks' gestation across 11 sites in the UK and Canada. Plasma PlGF concentration < 5(th) centile, estimated fetal weight (EFW) < 10(th) centile, umbilical artery Doppler pulsatility index > 95(th) centile and oligohydramnios (amniotic fluid index < 5 cm) were compared as predictors for a SGA infant < 3(rd) customized birth-weight centile and adverse perinatal outcome.

Fetal hemivertebra: associations and perinatal outcome.

Objectives: To assess the accuracy of antenatal diagnosis of hemivertebra, to quantify the association with coexisting anomalies and to determine the perinatal outcome.

Method: This was a retrospective observational study of all cases of suspected fetal or neonatal hemivertebra identified via the UK Southwest Congenital Anomaly Register (SWCAR) between 2002 and 2012.

Results: From a total of 88 cases of hemivertebra identified during the study period, data were obtained for 67 of them: 45 (10 isolated and 35 with coexisting anomalies) cases were suspected antenatally and 22 (10 isolated and 12 with coexisting anomalies) were diagnosed postnatally.

TORCH screening in pregnancy. Where are we now? An audit of use in a tertiary level centre.

This audit was performed in the obstetrics and gynaecology department of a tertiary referral hospital, to investigate the use and results of TORCH screening. St Michael's Hospital delivers approximately 6,000 women from South Bristol a year and receives tertiary referrals from the South West of England and South Wales. It was found that 739 patients over a 6-year period from April 2006 to January 2012 underwent testing.

Neonatal outcomes of pregnancies affected by haemolytic disease of the foetus and newborn and managed with intrauterine transfusion: a service evaluation.

Background: This study, conducted in the tertiary Foetal Medicine Unit at St Michael's Hospital, Bristol, was designed to obtain information regarding neonatal outcomes of pregnancies affected by haemolytic disease of the foetus and newborn and managed by intrauterine transfusion, and to determine whether a change in intrauterine transfusion protocol in 2004 had improved safety. The new protocol included attendance of two Foetal Medicine Unit consultants, foetal sedation and use of the intrahepatic vein as an alternative route to placental cord insertion if deemed safer.

Materials And Methods: Data for pregnancies affected by haemolytic disease of the foetus and newborn as a result of haemolytic red cell alloimmunisation and managed with intrauterine transfusion at St Michael's Hospital between 1999 and 2009 were retrospectively collected using local databases, and medical note review.

Amniotic fluid index in low-risk, post-dates pregnancies.

Objective: To determine normal values for amniotic fluid index (AFI) in uncomplicated post-dates singleton pregnancies and compare it to current reference ranges.

Population: Four hundred and forty-eight women with singleton, uncomplicated pregnancies, presenting for post-dates assessment (gestation 40+0 to 42+0 weeks) between January 1, 2004 and June 30, 2005.

Methods: Ultrasound assessment of liquor to calculate the AFI.

Management and outcome of pregnancies with parvovirus B19 infection over seven years in a tertiary fetal medicine unit.

Objectives: To determine rates of fetal anaemia and pregnancy outcome in susceptible pregnant women infected with human parvovirus B19 infection in a tertiary fetal medicine department over a 7-year period. Additional features enabling identification of fetuses that progress to severe anaemia were also investigated.

Methods: Forty-seven susceptible, pregnant women with confirmed parvovirus infection referred to a regional fetal medicine unit, over a 7-year period (1999-2006), were identified.

Prognosis of spina bifida in the era of prenatal diagnosis and termination of pregnancy.

Objective: To evaluate the current outcome of a selected prenatally diagnosed spina bifida group.

Materials And Methods: We analyzed and followed up 74 cases of prenatally diagnosed spina bifida.

Results: Termination of pregnancy was chosen in 72% of the cases and 28% were live-born.

A small-angle neutron scattering and rheology study of the composite of chitosan and gelatin.

The composite chitosan/gelatin solutions and films formed from these solutions were studied by rheological measurements, SANS and tensile tests. The relationship between the inter-molecule interactions with microstructure, rheological behaviour of a solution and eventually the mechanical performance of formed films was established. It was found that the complex formed between chitosan and gelatin was mainly through hydrogen bond but the size of the structure was also affected by electrostatic repulsions.

Early detection of cell-free fetal DNA in maternal plasma.

Objectives: We aimed to establish the earliest gestational age at which fetal DNA in maternal plasma could be detected and whether this was reliable at 12-13 weeks' gestation.

Study Design: A prospective observational cohort study of 32 pregnancies either after IVF or before prenatal diagnosis by CVS. Maternal blood was taken and RT-PCR was carried out to detect the multi-copy Y chromosome associated DSY14 gene.

Detection of cell-free fetal DNA in maternal urine.

Objective: To evaluate the presence of cell-free fetal DNA signals in maternal urine as a potential source of material for non-invasive prenatal diagnosis.

Study Design: Patients referred to the regional fetal medicine unit who underwent prenatal diagnosis by chorionic villus sampling (CVS) were asked to give blood and urine immediately before the procedure. Maternal blood and urine were centrifuged at 10,000 g for 10 min.

Determinants of flow along arterio-arterial anastomoses in monochorionic placentae by dynamic computer modelling of chorionic plate vasculature.

Objectives: To investigate anatomical and physiological determinants of inter-fetal transfusion along arterio-arterial (AA) anastomoses in monochorionic placentae.

Methods: A computer model of chorionic arterial vasculature was constructed in QuickBASIC using data collected from experimentation and the published literature. After validating the model, the influence of various physiological and anatomical variables on anastomotic flow rates was examined.

Optimal interval between middle cerebral artery velocity measurements when monitoring pregnancies complicated by red cell alloimmunization.

Objective: To evaluate the optimal interval between middle cerebral artery (MCA) Doppler measurements when monitoring pregnancies complicated by red cell alloimmunization.

Methods: Thirty-nine fetal blood samplings (FBS) performed on 24 pregnant women with red blood cell alloimmunization followed up using both MCA peak systolic velocity and time-averaged mean velocity measurements on weekly basis.

Results: In total, 65.

Outcome of fetal pleural effusions treated by thoracoamniotic shunting.

Objective: Fetal pleural effusions are uncommon, and treatment options for moderate or severe effusions include drainage and thoracoamniotic shunting. However, relatively few records of effusions treated by thoracoamniotic shunting are available in the literature, so our objective was to study the outcome after thoracoamniotic shunting in our unit.

Methods: We searched the database of our tertiary fetal medicine unit for all cases of fetal pleural effusion treated by thoracoamniotic shunting between 1997 and 2003 inclusive, and studied the maternal and neonatal records.

Comparison of different reference values of fetal blood flow velocity in the middle cerebral artery for predicting fetal anemia.

Objectives: To compare different normal reference ranges of fetal blood flow velocity in the middle cerebral artery for predicting fetal anemia.

Methods: Eight reference ranges of either middle cerebral artery peak or time-averaged mean velocities were compared using the area under the receiver-operating characteristics (ROC) curve for 113 fetal blood samples from 60 women at risk of fetal red blood cell alloimmunization.

Results: The areas under the ROC curves of the different ranges were not significantly different but there were marked differences in sensitivity (range, 7.