A novel algorithm for classification of interatrial communications within the oval fossa in the newborn

BACKGROUND

An interatrial communication is present in most neonates. The majority are considered the "normal" patency of the oval foramen, while a minority are abnormal atrial septal defects. Differentiation between the two with transthoracic echocardiography may be challenging, and no generally accepted method of classification is presently available. We aimed to develop and determine the reliability of a new classification of interatrial communications in newborns.

METHODS AND RESULTS

An algorithm was developed based on echocardiographic criteria from 495 newborns (median age 11[8;13] days, 51.5% females). The algorithm defines three main categories: patency of the oval foramen, atrial septal defect, and no interatrial communication as well as several subtypes. We found an interatrial communication in 414 (83.6%) newborns. Of these, 386 (93.2%) were categorised as patency of the oval foramen and 28 (6.8%) as atrial septal defects.Echocardiograms from another 50 newborns (median age 11[8;13] days, 36.0% female), reviewed by eight experts in paediatric echocardiography, were used to assess the inter- and intraobserver variation of classification of interatrial communications into patency of the oval foramen and atrial septal defect, with and without the use of the algorithm. Review with the algorithm gave a substantial interobserver agreement (kappa = 0.66), and an almost perfect intraobserver agreement (kappa = 0.82). Without the use of the algorithm, the interobserver agreement between experienced paediatric cardiologists was low (kappa = 0.20).

CONCLUSION

A new algorithm for echocardiographic classification of interatrial communications in newborns produced almost perfect intraobserver and substantial interobserver agreement. The algorithm may prove useful in both research and clinical practice.

The association of a past childbirth experience with a variety of early physical and mental symptoms in subsequent pregnancies

BACKGROUND

Some women have a perceived negative experience of childbirth due to various reasons- e.g., obstetric complications or the feeling of loss of control. We do not know enough about the effects of a perceived negative experience of a childbirth on a woman's subsequent pregnancies. The aim of this study was to investigate whether a previously perceived negative childbirth experience affects a woman's physical and mental well-being in a later pregnancy.

METHODS

A prospective cohort study in Danish general practice, based on information about women's childbirth experiences from the Pregnancy Health Record filled in by the general practitioner (GP) and data from an electronic questionnaire completed by the women.

RESULTS

A total of 1288 women were included in the analysis. Women who had given birth before were found to have a significantly higher risk of experiencing nausea, varicose veins and uterine contractions, and a lower risk of pelvic cavity pain in the current pregnancy. Women having given birth before were significantly more likely to assess their physical fitness as poor and to experience poor well-being. Women with a perceived negative experience of childbirth had more sleep problems and a higher prevalence of poor self-rated health than women with unproblematic childbirth experience.

CONCLUSION

This study showed that women with a previously perceived negative experience of childbirth are affected according to their mental health in their subsequent pregnancy.

P2735Ventricular function in a large cohort of healthy, term newborns assessed by tissue doppler imaging and speckle tracking echocardiography; establishment of normal values and z-scores

Background

There is a paucity of published data presenting reference values for ventricular function in newborns.

Purpose

This study was conducted to establish echocardiographic normal data and z-scores for ventricular functional parameters in newborns assessed by Tissue Doppler Imaging (TDI) and Speckle Tracking Echocardiography (STE).

Methods

We included healthy, term newborns from a prospective, population-based study of newborns, who had a comprehensive, systematic echocardiographic (TTE) examination performed within 14 days of birth. Only newborns without any signs of structural or functional cardiac abnormalities were included. Measurements were obtained according to guidelines. Body surface area (BSA) was calculated using the Haycock formula. Z-score models according to birthweight and BSA at time of TTE were developed for TDI and STE parameters.

Results

Four hundred newborns (53% male) with gestational age of (median (IQR)) 40.3 (39.4, 41.1) weeks were included. Age, weight, and BSA at TTE were (mean±SD) 11±3 days, 3.7±0.5 kg, and 0.23±0.02m2, resp. Ejection fraction was 67±4%. TDI and STE measurements of ventricular function are presented as mean±SD (Table). Global longitudinal strain was calculated as the average of all left ventricular segmental strain values from apical 4-, 2-, and 3-chamber views. Results for selected parameters according to BSA are illustrated (Figure).

TDI and STE of ventricular function Parameter View and modality Value Unit Mitral annulus septal wall e' Apical 4-chamber Tissue Doppler 5.7±0.8 cm/s Mitral annulus septal wall a' Apical 4-chamber Tissue Doppler 5.9±1.0 cm/s Mitral annulus septal wall s' Apical 4-chamber Tissue Doppler 4.6±0.6 cm/s Mitral annulus lateral wall e' Apical 4-chamber Tissue Doppler 6.9±1.0 cm/s Mitral annulus lateral wall a' Apical 4-chamber Tissue Doppler 6.0±1.1 cm/s Mitral annulus lateral wall s' Apical 4-chamber Tissue Doppler 4.8±0.6 cm/s Left ventricular longitudinal strain, 4-chamber Apical 4-chamber 2D 19±2 % Left ventricular longitudinal strain, 2-chamber Apical 2-chamber 2D 20±2 % Left ventricular longitudinal strain, 3-chamber Apical 3-chamber 2D 19±2 % Left ventricular global strain 19±2 % Right ventricular longitudinal strain, free wall Apical 4-chamber 2D 23±4 %

Percentile charts

Conclusion

Normal data for TDI and STE assessment of ventricular function in 400 healthy, term newborns ispresented. An online z-score calculator will be available. Normal data is necessary for the evaluation of pathological changes, and these results contribute substantially to a field where available data is limited.

Acknowledgement/Funding

Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Gangsted Found.

The work and challenges of care managers in the implementation of collaborative care: A qualitative study

WHAT IS KNOWN ON THE SUBJECT?: In collaborative care models between psychiatry and general practice, mental health nurses are used as care managers who carry out the treatment of patients with anxiety or depression in general practice and establish a collaborating relationship with the general practitioner. Although the care manager is the key person in the collaborative care model, there is little knowledge about this role and the challenges involved in it. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our study shows that before the CMs could start treating patients in a routine collaborative relationship with GPs, they needed to carry out an extensive amount of implementation work. This included solving practical problems of location and logistics, engaging GPs in the intervention, and tailoring collaboration to meet the GP's particular preferences. Implementing the role requires high commitment and an enterprising approach on the part of the care managers. The very experienced mental health nurses of this study had these skills. However, the same expertise cannot be presumed in a disseminated model. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When introducing new collaborative care interventions, the care manager role should be well defined and be well prepared, especially as regards the arrival of the care manager in general practice, and supported during implementation by a coordinated leadership established in collaboration between hospital psychiatry and representatives from general practice.

ABSTRACT

Introduction In collaborative care models for anxiety and depression, the care manager (CM), often a mental health nurse, has a key role. However, the work and challenges related to this role remain poorly investigated. Aim To explore CMs' experiences of their work and the challenges they face when implementing their role in a collaborative care intervention in the Capital Region of Denmark. Methods Interviews with eight CMs, a group interview with five CMs and a recording of one supervision session were analysed by thematic analysis. Results The CM carried out considerable implementation work. This included finding suitable locations; initiating and sustaining communication with the GPs and maintaining their engagement in the model; adapting to the patient population in general practice; dealing with personal security issues, and developing supportive peer relations and meaningful supervision. Discussion We compare our findings to previous studies of collaborative care and advanced nursing roles in general practice. The importance of organizational leadership to support the CM's bridge-building role is emphasized. Implications for practice The planners of new collaborative care interventions should not only focus on the CM's clinical tasks but also on ensuring the sufficient organizational conditions for carrying out the role.

A systematic review of controlled interventions to reduce overweight and obesity in people with schizophrenia

OBJECTIVE

Overweight and obesity are generally found among patients with schizophrenia. This may lead to serious implications for health and wellbeing. The aim was to review controlled intervention studies on reducing overweight/obesity and/or reducing physical illness in patients with schizophrenia.

METHOD

A systematic literature search was carried out in the bibliographic databases PubMed (MEDLINE), Embase (Ovid), PsycInfo (Ovid) and Cinahl (Ebsco). We included all randomised and non-randomised clinically controlled studies that compared a non-pharmacological intervention, aimed at weight reduction and/or reducing physical illness, with standard care for patients with schizophrenia.

RESULTS

All 1713 references were evaluated for inclusion in the review. Twenty-three met the inclusion criteria and were categorised into four subgroups according to tested interventions: diet, exercise and cognitive behavioural therapy, or mixed combinations of the three. In this review, interventions showed efficacy in reducing weight and improving physical health parameters confirming that physical health improvement was possible in patients with schizophrenia.

CONCLUSION

The included studies indicate that the interventions reduced weight and improved physical health parameters in patients with schizophrenia.