A proposed prognostic prediction tool for a live birth among women with recurrent pregnancy loss

PURPOSE

To develop a prognostic tool to predict the live birth rate in cases of repeated pregnancy losses.

STUDY DESIGN

A retrospective cohort study including patients treated in the dedicated RPL clinic between 2000 and 2015. Background data was collected in the primary visit via questionnaires and medical records. The recurrent pregnancy loss workup includes a genetic testing, endocrine testing, and anatomic abnormalities as well as thrombophilia.The prognostic tool took into account the unique contribution of the different risk factors, including maternal age, number of pregnancy losses, primary vs. secondary RPL and positive RPL workup.

RESULTS

A total of 675 women were included in the study. The live birth rate was 72% (484). It was significantly associated with age (p=.002), number of previous pregnancy losses (p=.016), primary and secondary RPL and positive RPL workup. Each variable was assigned points according to the odds ratio found in the logistic regression to create two prediction models, before and after the RPL workup. Both models show a rise in the live birth rate as the score increases.

CONCLUSIONS

We constructed a proposed innovative prognostic tool to predict the chance of a live birth on the consecutive pregnancy following the visit to the RPL clinic. Locating, identifying and improving risk assessment can enable the provision of up-to-date information to couples and the treating staff. This knowledge will reduce stress among the patients and will allow the staff to constructed custom intervention programs.

Decreased Norton's functional score is an independent long-term prognostic marker in hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction II (SAMI-II) project

BACKGROUND

Patient function is a risk factor of mortality following acute myocardial infarction (AMI). Norton scale (NS) was originally developed to estimate the risk for pressure ulcers. It contains 5 domains: mental condition, physical condition, mobility, activity in daily living and incontinence.

OBJECTIVE

To evaluate NS as long-term prognostic marker following AMI.

METHODS

A retrospective study based on computerized medical records of AMI patient hospitalized in a tertiary medical center in 2004-2012. NS scores and patients' characteristics were collected from computerized databases. The primary outcome was all-cause long-term (up-to 10-years) mortality.

RESULTS

Overall 6964 patients were included; mean age 67.3±14.1years, 68.1% males. Mean NS score was 17.8±3; of which 21.1% had low-NS (≤16). Patients with low-NS had increased prevalence of hypertension, diabetes and renal disease, 3-vessel coronary artery disease, more often Non ST-Elevation Myocardial Infarction (NSTEMI) and in-hospital complications. Throughout the follow-up period cumulative mortality rate in patients with low- and high-NS groups were 97.3% and 43% respectively (AdjHR 1.66; 95% CI: 1.521-1.826; p<0.001). Furthermore, a reduction in one point in the NS score inversely associated with increased risk for mortality (AdjHR 1.10; 95% CI: 1.12-1.22; p<0.001).

CONCLUSIONS

NS is an independent long-term prognostic marker for all-cause mortality in hospital survivors with a gradual "dose-response" effect. This data emphasizes the importance prognostic implication of the general functional status on the prognosis of AMI patients.

Physicians' and nurses' preferences in using life-sustaining treatments

The aim of this study was to examine physicians' and nurses' preferences regarding the use of life-sustaining treatments (LST) for severely ill elderly patients, and the patient- and social-centered factors that influence them. Physicians and nurses working in Israeli general hospitals completed structured questionnaires referring to their preferences for using LST in three severe health conditions (metastatic cancer, mental illness and being bedridden/incontinent). The participants were also asked about factors influencing these preferences, including patients' wishes, quality of life, religiosity and the current law. Both physicians and nurses indicated that they would use less LST for patients with metastatic cancer than with those suffering from the other two health conditions. Our findings indicate that the attitudes of professionals involved in these processes are influenced not only by the patient's condition but also by their professional orientations and personal values. Open communication among professionals for clarifying the various beliefs, as well as the antecedents of these beliefs, is important for the benefit of professional teams, patients and families.

Nurses' and social workers' attitudes and beliefs about and involvement in life-sustaining treatment decisions

Data were collected from 213 nurses and 61 social workers at major hospitals across Israel. Whereas nurses reported being more involved in the daily care of terminally ill patients, social workers reported being more involved in discussions with patients and family members. Nurses were more willing than social workers to use artificial feeding and less willing to use mechanical ventilation and CPR for all conditions. Social workers expressed stronger beliefs about their involvement in end-of-life issues. These findings, which reflect the differences in the professional values and experiences of both groups, encourage the use of interdisciplinary teams to improve end-of-life decision making.