Exploring Human Milk, Nutrition, Growth, and Breastfeeding Rates at Discharge(HUMMINGBIRD Study): a protocol for a pilot randomised controlled trial

INTRODUCTION

Mother's own breast milk (MOM) is the optimal nutrition for preterm infants as it reduces the incidence of key neonatal morbidities and improves long-term outcomes. However, MOM shortfall is common and either preterm formula or pasteurised donor human milk (DHM) may be used, although practice varies widely. Limited data suggest that the use of DHM may impact maternal beliefs and behaviours and therefore breastfeeding rates. The aim of this pilot study is to determine if longer duration of DHM exposure increases breastfeeding rates, and if a randomised controlled trial (RCT) design is feasible.

METHODS AND ANALYSIS

The Human Milk, Nutrition, Growth, and Breastfeeding Rates at Discharge (HUMMINGBIRD) Study is a feasibility and pilot, non-blinded RCT with a contemporaneous qualitative evaluation. Babies born less than 33 weeks' gestation or with birth weight <1500 g whose mothers intend to provide MOM are randomly assigned to either control (DHM used to make up shortfall until full feeds and preterm formula thereafter) or intervention (DHM used for shortfall until 36 weeks' corrected age or discharge if sooner). The primary outcome is breast feeding at discharge. Secondary outcomes include growth, neonatal morbidities, length of stay, breastfeeding self-efficacy and postnatal depression using validated questionnaires. Qualitative interviews using a topic guide will explore perceptions around use of DHM and analysed using thematic analysis.

ETHICS APPROVAL AND DISSEMINATION

Nottingham 2 Research Ethics Committee granted approval (IRAS Project ID 281071) and recruitment commenced on 7 June 2021. Results will be disseminated in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ISRCTN57339063.

The contribution of late termination of pregnancy to stillbirth rates in Northern England, 1994-2005

The impact of late terminations (> or = 24 weeks) on the overall stillbirth rate was determined for the 12-year period from 1994 to 2005 using data collected by the Regional Maternity Survey Office in the north of England. It is a legal requirement to register late terminations, and this may lead to an overestimation of the true stillbirth rate. In our region, terminations resulting in stillbirth increased the registered stillbirth rate by nearly 10%. The impact remained stable for the period 1998-2005. This suggests that the failure of the national (and regional) stillbirth rate to decline in recent years is not due to an increase in late terminations.

Infrared study of orientational order parameters of a ferroelectric liquid crystal

A method of determining the set of four order parameters S , D , P , and C for a ferroelectric liquid crystal, using complementary results for different sample geometries, is presented. IR measurements have been performed for homeotropic, planar heterogeneous and, planar homogenous sample geometries. Orientational order parameters were determined in two frames of reference to obtain complete information on molecular arrangement. Results for the D , P , and C parameters indicate the importance of both the intrinsic and extrinsic biaxialities. The molecular rotation around the long molecular axis is not free, and the carbonyl dipole and plane of the central phenyl ring are oriented close to the tilt plane. It has been found that transition dipole moments show significant correlations, antiparallel for longitudinal dipoles and parallel for transversal ones.

Patients' attitudes towards the presence of medical students in family practice consultations

BACKGROUND

Patients' consent to being part of medical education is often taken for granted, both in primary and secondary care. Formal consent procedures are not used routinely during teaching and patients are not always aware of teaching activities.

OBJECTIVE

To investigate patients' attitudes and expectations on issues of consent regarding participation in teaching in general practice, and the influence of a student's presence on the consultation.

METHODS

The study took place in 46 teaching practices during the sixth year clinical internship in family medicine. Patients completed questionnaires at the end of 10 consecutive eligible consultations. The questionnaire contained data on the willingness to participate in teaching, the preferred consent procedure and the effects of the student's presence. The doctors were asked to estimate the sociodemographic level in their clinic area.

RESULTS

A total of 375 questionnaires were returned; the response rate was not affected by the clinic's sociodemographic level. Overall, 67% of the patients had come into contact with students in the past; 3.2% of the participants objected to the presence of a student during the consultation; 15% would insist on advance notification of the presence of a student, and another 13.9% would request it; 4% stated that the presence of students had a detrimental influence on the physical examination and history; and 33.6% would refuse to be examined by a student without the doctor's presence.

CONCLUSION

Most patients agreed to have a student present during the consultation; some would like prior notification; a minority refused the student's presence. A large minority would refuse to be examined without the tutor's presence. Our findings need to be taken into account when planning clinical clerkships.

[The influence of the presence of students on the consultation--attitudes of tutors in family medicine clinics]

BACKGROUND

The consultation is the pivot of clinical teaching in ambulatory care. It is therefore essential that students observe the consultation. The students' presence itself influences the consultation and also requires the patients' consent. Moreover the introduction in Israel of the "Patients' Rights Act" in 1996 has made us more acutely aware of the place of the patient in teaching especially with regard to the consent to be part of the teaching process.

AIM

This study was undertaken in order to investigate how tutors in family medicine perceive changes in the consultation caused by the presence of students.

METHODS

An anonymous physician questionnaire was distributed on the first day of the 6th year clinical clerkship in family medicine. The questions pertained to perceived influence on length and content of the consultation. In addition physician and patient background information was gathered; and the physicians were asked to estimate the patients' willingness to be part of the teaching process.

RESULTS

46 tutors in family medicine participated, 70% of whom were female. Sixty four percent of the doctors thought that the student's presence had an influence on the consultation. Ninety one percent thought that it increased consultation length, especially of the physical part (93%). More than half thought that the student's presence might interfere with asking intimate questions. The majority held the opinion that the patient's gender and socioeconomic background were inconsequential. Ninety two percent of physicians estimated that 5% or less of the patients would refuse the presence of a student.

IN CONCLUSION

Tutors in family medicine think that the presence of a student affects the consultation. Those involved in and responsible for teaching should take this into account. Further research of these changes with objective measurements is needed.

Israel under threat of biological warfare--the reactions of our patients during the 1998 Persian Gulf crisis

BACKGROUND AND OBJECTIVES

During February 1998, there was heightened tension in the Persian Gulf area. Iraq's ruler, Saddam Hussein, threatened Israeli citizens with the use of biological weapons. This study observed the use of health care services by patients visiting our clinics during this period.

METHODS

During the period of February 17, 1998, through March 1, 1998, 12 family physicians classified all clinic visits as "related" or "unrelated" to the crisis. The participating clinics were situated in (A) high-risk and (B) low-risk areas, according to their location as related to missile hits during the 1991 Gulf War.

RESULTS

A total of 1,841 visits were recorded during the crisis period (February 17-23). There were 934 visits in Area A and 907 in Area B. Overall, 194 visits related to the crisis were recorded, of which 155 were in Area A. The rate of crisis-related visits was higher in Area A (16.6% versus 3.4%). There were more visits for authorizations for special masks (8.2% versus .8%), requests for information (3.9% versus 1.3%), and tranquilizers (2.1% versus .5%). In the period subsequent to the agreement reached on February 24, crisis-related visits declined sharply in both areas.

CONCLUSIONS

During the crisis, there was an increase in visits related to the threat of biological warfare. The phenomenon was more pronounced in areas that had sustained missile hits during the 1991 Gulf War.

[The use of "sous vide" technology in the packaging of chilled and ready to serve food]

As chilled precooked dishes show limited to 3-5 days shelf life several additional factors have to be applied to extend it up to 21 or even 42 days as is sometimes allowed for sous vide technology products. Those factors comprise high hygienic standards for raw materials and premises as well as technological steps and parameters that efficiently destroy microbial contamination, and do not allow for recontamination or bacterial growth. Such steps include precooking which also means pasteurisation in high vacuum or anaerobic atmosphere in sealed pouches, blast chilling, low temperature storage parameters as well as high temperature of reheating process and quick serving procedures. Paper specifies parameters for each technological steps and presents microbiological requirements for final products. Sous vide technology allows for good quality and high nutritional value in soups, meats in sauces and stewed vegetables. It is used for individual consumer in chilled "ready to eat" line dishes in supermarkets and supplies such dishes for catering units.

Medical investigations requested by patients: how do primary care physicians react?

BACKGROUND AND OBJECTIVES

We investigated the characteristics of patients who request medical investigations and the type of tests requested to study the manner in which primary care physicians react to these requests.

METHODS

The study was conducted within the framework of a national health insurance system. Twelve primary care practices from three randomly chosen clinics with different population characteristics participated in the study. The attending physicians were instructed to ask all patients who presented to the clinics within a 7-month period and requested a medical test to complete a questionnaire, indicating the type of test(s) requested and the reason. The physicians were asked to rate the manner in which the patient made the request, their own reaction to the request, and whether they ordered the tests that were requested.

RESULTS

During the survey period, 12,322 patients visited the clinics, of whom 295 (2.4%) were reported by a physician to have requested a medical investigation. More-educated patients were more likely to request tests for disease prevention. The types of tests requested were imaging scans, laboratory (blood) tests, and others. The main reason for the request was symptoms (60%), followed by disease prevention (25%). More than 30% of the requests generated self-reported negative feelings in the physician. Physician compliance with patient requests was not significantly correlated with the reason for the request. Laboratory tests were ordered significantly more often than other types. There was a strong correlation between physicians' compliance with the request and physicians' feelings about the request.

CONCLUSION

Our findings raise questions about the frequency with which physicians order tests solely in response to patients' requests and provide information about circumstances in which patients make requests for medical investigations.

Trials and tribulations of country doctors: a qualitative study of doctor-patient relationships in rural Israel

Rural areas of Israel are organized into small villages that attract physicians by offering inexpensive accommodation and the promise of a high quality of life. However, conflicts often arise in the relationship between the village residents and the doctor, leading to dissatisfaction and physician turnover. In order to examine the issues, we conducted a qualitative study of rural physicians using a group interviewing technique, called focus groups. The sample consisted of 46 physicians, aged between 35 and 45, of whom 60% were male. In the focus groups, the physicians mainly discussed issues of unclear boundaries between private life and physician roles, exaggerated expectations on the part of community members, difficulties with teamwork, the impact of the physician's family, work satisfaction, and burnout. Recommendations for physicians considering rural practice include making a careful and studied choice of a village before making a final decision, setting both clear professional limits and an overall time limit for service, allowing for mistakes, and organizing Balint-type physician support groups.

[Influence of cryotherapy in the inhibition of collagenase activity in experimental corneal burns by hydrochloric acid. Doctoral thesis summary]

Investigations were carried-out on corneas of rabbit eyes burned with 1N HCl and then treated with low temperature. It was found that cryotherapy has advantageous influence on collagenase activity. In early period after burn cryotherapy could prevent collagenolysis and later inhibited collagenase activity.

[The most frequent causes of loss or impairment of vision in children and adolescents]

On the basis of examination of 100 persons aged 3-18 years registered in the Olsztyn Division of the Union of the Blind the authors determined the causes which led to the loss of vision or of its impairment. The most frequent cause of the invalidism of the visual system were: errors of refraction (32%), optic atrophy (24%), congenital cataract (16%), retinal and choroidal degeneration (9%), retrolental fibroplasia (6%), anophthalmia or malformation of the globe (4%), coloboma of the iris or choroid (3%), retinoblastoma (3%), injuries (2%) and congenital glaucoma (1%).

[Physical activity habits of primary care clinic patients]

764 registered clinic patients, between the ages of 18-60, in 2 primary-care clinics, filled out questionnaires about exercise habits. One clinic is in a moshav in which the population is principally of European origin and of high socioeconomic status. The other clinic is in a town in which the population is mainly of North African or Asian origin and of low socioeconomic status. Only 38.6% of those studied defined their work as involving physical or marked physical activity. These tended to be males 18-30 years old living on the moshav. Only 14.2% reported regular sports activity, none of whom were from the town. No differences were noted in sex or age-distribution. Women tended to engage in gymnastics, walking or folk-dancing; men in running or ball sports. Our results are similar to those of other studies which show that Israelis do not tend to engage regularly in sports. It is emphasized that health organizations should encourage sport activity by their members.

[Use of diuretics in family practice]

Of 1894 patients registered in a family medicine clinic, 101 (5.3%) had been taking diuretics for at least 6 months. The sex distribution was equal and the average age was 68.7 years. 60% were taking Kaluril, 30% Aquadon and 10% Frusemide. Most had hypertension or heart failure, or both. 6 patients developed hyperglycemia, 2 hyponatremia, 5 hypokalemia, 2 hyperkalemia and 10 hyperuricemia. In 19 the ECG showed arrhythmias. 5 of 56 patients had hypomagnesemia and another 12 had low borderline levels. In the light of these results and those in the literature, we conclude that diuretics are not as safe as previously thought.

Adrenal insufficiency in a general hospital over a 14-year period

Over a 14-year period, 26 patients with adrenal insufficiency of multiple etiology were evaluated. Eight were diagnosed at autopsy, six of whom had acute bilateral adrenal hemorrhage. Nine had chronic adrenal insufficiency. Of these, five were idiopathic and three had polyglandular disorders. Four others had tuberculosis. Six of nine patients with chronic adrenal insufficiency were hyperpigmented. Unusual manifestations of adrenal hypocorticism included hypercalcemia, flaccid paralysis, and joint contractures. The presence of multiple hormonal deficiencies focused the diagnosis on hypopituitarism. Two cases of isolated ACTH deficiency were detected. Patients with familial Mediterranean fever with amyloidosis commonly presented with reduced adrenal reserve rather than overt insufficiency. Metastatic cancer of the adrenal glands was a rare cause of reduced adrenal reserve.