Introduction of a standardised maternity early warning system: indicative data from a before-and-after study at a large pilot site before national rollout in Aotearoa New Zealand

Strong evidence now demonstrates that recognition and response systems using standardised early warning scores can help prevent harm associated with in-hospital clinical deterioration in non-pregnant adult patients. However, a standardised maternity-specific early warning system has not yet been agreed in the UK. In Aotearoa New Zealand, following the nationwide implementation of the standardised New Zealand Early Warning Score (NZEWS) for adult inpatients, a modified maternity-specific variation (NZMEWS) was piloted in a major tertiary hospital in Auckland, before national rollout. Following implementation in July 2018, we observed a significant and sustained reduction in severe maternal morbidity as measured by emergency response calls to women who were very unwell (emergency response team call), and a non-significant reduction in cardiorespiratory arrest team calls. Emergency response team calls to maternity wards fell from a median of 0.8 per 100 births at baseline (January 2017-May 2018) to 0.6 per 100 births monthly (from March 2019 to December 2020) (p < 0.0001). Cardiorespiratory arrest team calls to maternity wards fell from 0.14 per 100 births per quarter (quarter 1 2017-quarter 2 2018) to 0.09 calls per 100 births per quarter after NZMEWS was introduced (quarter 3 2018-quarter 4 2020) (p = 0.2593). These early results provide evidence that NZMEWS can detect and prevent deterioration of pregnant women, although there are multiple factors that may have contributed to the reduction in emergency response calls noted.

Shared learning for oral health therapy and dental students: enhanced understanding of roles and responsibilities through interprofessional education

INTRODUCTION

To enhance interprofessional learning outcomes, The School of Dentistry at The University of Queensland redesigned first-year curricula. Courses for Bachelor of Oral Health (OHT) and Bachelor of Dental Science (DS) students were combined, and learning content created to support the development of skills, knowledge and attitudes required for the oral healthcare team to work effectively in providing the best possible care for patients.

METHODS

Over a 2-year period, all commencing OHT and DS students were invited to participate in this study. One cohort (n = 93) was enrolled into a traditional, discipline-specific programme (TRAD), whereas the other cohort (n = 93) experienced an integrated learning programme (INT) with combined courses for OHT and DS students. The Readiness for Interprofessional Learning Scale (RIPLS) and a modified dental and dental care professional roles and responsibilities (DRR) survey were completed to determine students' awareness of dental professionals' roles and responsibilities, and their attitudes to interprofessional education and teamwork.

RESULTS

Following completion of 1 year of learning, both INT and TRAD cohorts showed similar levels of readiness for shared learning. At the commencement of the second year of the study programme, however, there was a significantly better understanding of shared care amongst INT students.

CONCLUSIONS

This study provides initial support for the integrated learning approach adopted by this university. The INT cohort had significantly improved understandings of the roles and responsibilities of dentists and oral health therapists. The results of this study have been used to refine ongoing curriculum developments.

Zidovudine phosphorylation determined sequentially over 12 months in human immunodeficiency virus-infected patients with or without previous exposure to antiretroviral agents

We sought to determine whether the intracellular activation of zidovudine (ZDV) varied over time and with previous antiretroviral exposure in human immunodeficiency virus-infected individuals and to examine whether there is an association between virological responses and intracellular phosphorylation. A total of 23 patients (12 treatment naïve, 11 previously treated with ZDV) who commenced ZDV as part of dual nucleoside therapy were prospectively monitored for 12 months or until withdrawal from the study. No association was observed between virological responses at 2 weeks and 3 months and ZDV phosphorylation. The mean intracellular concentrations of ZDV mono-, di-, and triphosphates did not change significantly over time or with previous ZDV exposure. The rate of formation of total ZDV phosphates was increased in patients with CD4 counts <100 cells/mm(3). Previous reports from in vitro cell culture experiments or cross-sectional cohort studies suggesting alterations of ZDV phosphorylation over time are not confirmed by this longitudinal study.

Acute anaphylaxis

Acute anaphylaxis is a potentially life-threatening condition. It must be recognised early and treatment instituted promptly. Localised, severe allergic reactions and generalised anaphylactoid reactions should be treated in the same way as acute anaphylaxis.

Acute pneumothorax

Pneumothorax may be spontaneous or can occur as a complication of chest trauma. Patients present with a wide range of symptoms, the severity of which may not correlate well with the degree of pneumothorax. Classification and current therapies are presented here.

Severe epistaxis

Epistaxis is a common condition usually requiring only simple treatment. Occasionally, severe epistaxis may present as a medical emergency. The classification and management of this condition are presented here.

Maintaining an airway

Airway maintenance is a vital skill that is often poorly managed due to the failure to observe simple principles. Clearing the airway is essential before the use of airway adjuncts. This always must be in addition to adequate ventilation.

Alcohol intake in selected lines of mice: importance of sex and genotype

Mice selected by McClearn and Kakihana for differences in ethanol-induced sleep time were used as subjects. In Experiment 1, mice from the long-sleep (LS) and short-sleep (SS) lines were offered a choice of water or solution GS consisting of 3% glucose and .16% sodium saccharin (w/v); or a choice of water or solution GS + E that contained GS solution plus 4% ethanol (w/v). In Experiment 2, mice from the first experiment were provided with a three-way choice among water, solution GS, and solution GS + E. In both experiments, SS mice (alcohol-insensitive) consumed more GS + E than LS mice (alcohol-sensitive). In addition, female mice drank considerably more GS + E solution than male mice. Thus, consumption of sweetened ethanol in both a two-way choice (water and GS + E) and a three-way choice (water, GS, and GS + E) is dependent on both genotype and sex. High genetic sensitivity to ethanol was associated with low consumption, and vice versa. Although females consumed more alcohol than males, famales of these lines have not been previously found to show lower sensitivity to acute alcohol administration.

Excretion of enterochelin by exbA and exbB mutants of Escherichia coli

Escherichia coli mutants that are insensitive to colicins B and I hyperproduce and excrete the iron chelator enterochelin, which is an inhibitor of these colicins. These mutants are classified as exbA and exbB. The exbA mutants are chromium sensitive and require iron for growth, and the mutations are located in the tonB region at min 25 of the E. coli chromosome. tonB mutants in which the genome of phage lambda is inserted into the bacterial chromosome within the tonB gene also exhibit enterochelin excretion. The exbB mutants require methionine and probably result from deletions which are located between min 56 and 58. Colicin insensitivity, enterochelin excretion and methionine auxotrophy are recessive in exbB merodiploids. The methionine requirement of exbB strains is satisfied by cystathionine or homocysteine, and exbB mutants are sensitive to ethionine.