The microbial pathology of maternal perinatal sepsis: A single-institution retrospective five-year review

INTRODUCTION

Greater than half of in-hospital maternal deaths are caused by sepsis, a condition that occurs when infection exceeds local tissue containment and results in organ dysfunction. Determining the source of infection can be challenging. Microbiological cultures of the uterine cavity are often difficult to obtain, so antimicrobial susceptibility results may not be available to guide treatment. The aim of this retrospective study was to assess the potential clinical value of microbiology samples used in the maternal "septic screen" of patients in an Irish maternity hospital.

METHODS

A review was completed of all maternal "septic screen" (i.e., high vaginal swabs, placenta swabs, blood cultures, throat swabs and urine samples) microbiology results from July 2016 to December 2021.

RESULTS

In the relevant period, 845 patients were subject to a "septic screen", of whom 430 also had a placental swab collected. These 430 patients comprise our study population. 2% of blood cultures yielded potential pathogens, compared with 37%, 33%, 9% and 7% respectively for placental swabs, high vaginal swabs, throat swabs and urine specimens. 95% of blood cultures were sterile, compared with 52%, 0%, 0% and 53% respectively for placental swabs, high vaginal swabs, throat swabs and urine specimens.

CONCLUSION

Of the five microbiological specimen types examined, placental swabs yielded the highest number of potential pathogens. Our results suggest that placental swabs are useful specimens for detecting potential pathogens from the uterine cavity, the most common source of perinatal infections.

Trends in instrument preference for operative vaginal delivery in a tertiary referral center: 2008-2021

OBJECTIVE

To examine temporal trends in operative vaginal deliveries as well as the ratio between vacuum and forceps deliveries over 15 years in a large tertiary hospital.

METHODS

This retrospective study assessed prospectively collected data from 2008 to 2021. Women with greater than 37 weeks of gestation who underwent an operative vaginal delivery were included. The rate and ratio of instrumental deliveries and perineal trauma were recorded.

RESULTS

From 2008 to 2021 there was a total of 109 230 term deliveries, of which 20 151 were an operative vaginal delivery. The rate of operative vaginal delivery as a proportion of all term deliveries decreased from 21.9% (1547 of 7069) in 2008 to 17.1% in 2021 (1428 of 8338, P < 0.001). The ratio between vacuum and forceps-assisted deliveries decreased significantly over the study period, from 7.06 in 2008 to 2.39 in 2021 (P < 0.001). Perineal trauma remained unchanged during the study period.

CONCLUSION

Operative vaginal delivery rates declined over the 15-year study period. While vacuum-assisted vaginal deliveries remain the favored instrument, forceps-assisted deliveries are becoming more prevalent. The cause for this change in practice is unclear but is likely multifactorial.

Educational Interventions to Enhance Situation Awareness: A Systematic Review and Meta-Analysis

STATEMENT

We conducted a systematic review to evaluate the comparative effectiveness of educational interventions on health care professionals' situation awareness (SA). We searched MEDLINE, CINAHL, HW Wilson, ERIC, Scopus, EMBASE, PsycINFO, psycARTICLES, Psychology and Behavioural Science Collection and the Cochrane library. Articles that reported a targeted SA intervention or a broader intervention incorporating SA, and an objective outcome measure of SA were included. Thirty-nine articles were eligible for inclusion, of these 4 reported targeted SA interventions. Simulation-based education (SBE) was the most prevalent educational modality (31 articles). Meta-analysis of trial designs (19 articles) yielded a pooled moderate effect size of 0.61 (95% confidence interval = 0.17 to 1.06, P = 0.007, I = 42%) in favor of SBE as compared with other modalities and a nonsignificant moderate effect in favor of additional nontechnical skills training (effect size = 0.54, 95% confidence interval = 0.18 to 1.26, P = 0.14, I = 63%). Though constrained by the number of articles eligible for inclusion, our results suggest that in comparison with other modalities, SBE yields better SA outcomes.

Microwave assisted slurry conversion crystallization for manufacturing of new co-crystals of sulfamethazine and sulfamerazine

Formation of co-crystals is faster using microwaves than simple conductive/convective heating to the same temperature.

The heterogeneous crystallization of a novel solvate of clozapine base in the presence of excipients

This paper reports the heterogeneous crystallization of a novel solvate of clozapine base in the presence of excipients.

Influence of acid washing on the surface morphology of ionomer glasses and handling properties of glass ionomer cements

Acid washing is known to influence the handling properties of ionomer glasses used in glass ionomer cements due to the production of an ion depleted-zone on the surface of the glass particles. The influence of acid washing on the particle size distribution and surface area of four glasses was examined by scanning electron microscopy (SEM), particle size analysis (PSA) and accelerated surface area porosimetry (ASAP) and the working and setting times of cements, produced from the glasses, correlated to changes in surface morphology. A linear relationship was found between the specific surface area of acid-washed SiO(2)-Al(2)O(3)-XF(2)-P(2)O(5) glasses (X being either calcium or strontium) and their cement working and setting times. These changes directly correlated with increases in the mesopore volume. However, the influence of acid washing on the surface morphology was also found to be glass composition-dependent with the addition of sodium into the glass network resulting in no significant change in the surface area or mesopore volume despite changes in the working and setting time. Through examination of the influence of acid washing and glass composition on the specific surface area improvements in the control of the working and setting times of glass ionomer cements may be achieved.

The influence of capsule geometry and cement formulation on the apparent viscosity of dental cements

OBJECTIVES

This work examines the influence of specific aspects of capsule design and cement formulation on the handling properties of the extruded glass polyalkenoate cement (GPC) pastes.

METHODS

A commercial metal reinforced GPC, HiDense, and experimental GPCs were extruded using a tensometer at loads and rates maintained within end-user limits and the apparent viscosity of the cement paste was determined by applying Poiseuille's law. The influence of the extrusion procedure (mixing time and ram speed), capillary geometry (length and diameter) and cement composition (powder: liquid (P:L) ratio, tartaric acid content and poly(acrylic acid) molar mass) on the apparent viscosity of the cement paste was evaluated.

RESULTS

The examined GPCs behaved as non-Newtonian, pseudoplastic materials and exhibited a yield stress. Variation of the geometry of the capsule capillary resulted in the apparent viscosity of HiDense increasing by 7% as the length increased from 5 to 15mm whilst halving the capillary diameter from 2 to 1mm resulted in a 63% decrease in the apparent viscosity and a 600% increase in the extrusion load. The apparent viscosity of the experimental GPCs was increased by an increase in the P:L ratio and, in general, by the PAA molar mass, whilst the concentration-dependent effect of (+)-tartaric acid (TAA) indicates a working time dependence on TAA content.

CONCLUSIONS

Using this approach optimisation of the rheological properties can be achieved by manipulation of the capsule design and cement formulation due to the dependency of the apparent viscosity on the capillary diameter, TAA content, P:L ratio and poly(acrylic acid) molar mass.

A histologic study of retrodiscal tissues of the human temporomandibular joint in the open and closed position

Specialized roles for the different components of the retrodiscal tissues have been previously postulated. This study compared the histologic features of the retrodiscal tissues of temporomandibular joints, taken from human cadavers, in the open and closed position; it was concluded that the primary role of these components was to provide a volumetric compensatory mechanism for pressure equilibration. This mechanism was still active in joints that demonstrated disc displacement and degenerative changes. Elastin was found in the upper and lower strata of the retrodiscal tissues, as well as in the central zone. The concept of an elastic upper stratum that has a recoil mechanism to control disc movement was not supported by this study, as the upper stratum was folded on itself in the closed position and only became stretched near maximal opening.

Prevention of nosocomial respiratory syncytial virus infections through compliance with glove and gown isolation precautions

To determine whether increased compliance with a policy of glove and gown isolation precautions could reduce the high rate of nosocomial respiratory syncytial virus (RSV) infection on an infant and toddler ward, we conducted a longitudinal intervention trial during three RSV seasons, from 1982 to 1985, with an intervention to increase compliance introduced midway through the second season. The risk of acquiring RSV infection in the hospital was adjusted for the intensity of nosocomial exposure to the virus by assigning each study week to one of five strata, defined by the proportion of hospital days on which virus was shed by children on the ward. Overall, 37 patients acquired nosocomial RSV infections during 7547 days at risk. The adjusted relative risk, comparing the infection rate in the period before the intervention (when compliance with isolation precautions was noted in only 38.5 percent of the observed patient contacts) with the infection rate in the postintervention period (when compliance more than doubled) was 2.9 (95 percent confidence interval, 1.5 to 5.7). Rates of nosocomial RSV infection increased linearly with increasing levels of exposure to patients shedding virus, but the rise in the infection rate with increasing exposure was less than one fourth as great (P less than 0.001) in the period after the intervention as it was before. We conclude that glove and gown precautions can substantially reduce the nosocomial transmission of RSV, particularly with increasing exposure to patients shedding the virus.

Interlibrary loan of audiovisual materials in the health sciences: how a system operates in New Jersey

An audiovisual loan program developed by the library of the College of Medicine and Dentistry of New Jersey is described. This program, supported by an NLM grant, has circulated audiovisual software from CMDNJ to libraries since 1974. Project experiences and statistics reflect the great demand for audiovisuals by health science libraries and demonstrate that a borrowing system following the pattern of traditional interlibrary loan can operate effectively and efficiently to serve these needs.