Induction of labour (IOL) is one of the most commonly performed interventions in maternity care, with outpatient cervical ripening increasingly offered as an option for women undergoing IOL. The ...COVID-19 pandemic has changed the context of practice and the option of returning home for cervical ripening may now assume greater significance. This work aimed to examine whether and how the COVID-19 pandemic has changed practice around IOL in the UK.
We used an online questionnaire to survey senior obstetricians and midwives at all 156 UK NHS Trusts and Boards that currently offer maternity services. Responses were analysed to produce descriptive statistics, with free text responses analysed using a conventional content analysis approach.
Responses were received from 92 of 156 UK Trusts and Boards, a 59% response rate. Many Trusts and Boards reported no change to their IOL practice, however 23% reported change in methods used for cervical ripening; 28% a change in criteria for home cervical ripening; 28% stated that more women were returning home during cervical ripening; and 24% noted changes to women's response to recommendations for IOL. Much of the change was reported as happening in response to attempts to minimise hospital attendance and restrictions on birth partners accompanying women.
The pandemic has changed practice around induction of labour, although this varied significantly between NHS Trusts and Boards. There is a lack of formal evidence to support decision-making around outpatient cervical ripening: the basis on which changes were implemented and what evidence was used to inform decisions is not clear.
Conflict adaptation refers to our ability to modulate our attention in line with changing situational demands, so we can engage in goal-directed behavior. While there is ample evidence demonstrating ...that such adaptation in conflict tasks can be captured using different response modalities, it remains unknown whether these effects rely on domain-general mechanisms applied to different response modalities, or are the result of more inherently response-specific processes. Here, we used an individual-differences approach to evaluate whether conflict adaptation in two highly similar tasks using different response modalities are related. Specifically, participants performed two versions of a Stroop task, one in which they responded via key presses and one in which they responded via mouse movements. In both tasks, we manipulated the item-specific proportion of (in)congruent trials (80% vs. 20% congruent). This allowed us to evaluate the item-specific proportion congruency (ISPC) effect, a hallmark indicator of conflict adaptation. ISPC effects were observed in both response modalities. However, we found no indications that individual differences in the ISPC effects of the two response modalities were related. This raises the question whether findings from studies on conflict adaptation measured by different modalities can reliably be compared. Furthermore, these results suggest that response modality plays a more integrative role in these adaptive processes, rather than being the mere output of a domain-general control mechanism. This is consistent with contingency learning accounts of the ISPC effect and associative learning models of cognitive control.
Many common voice disorders are chronic or recurring conditions that are likely to result from faulty and/or abusive patterns of vocal behavior, referred to generically as vocal hyperfunction. An ...ongoing goal in clinical voice assessment is the development and use of noninvasively derived measures to quantify and track the daily status of vocal hyperfunction so that the diagnosis and treatment of such behaviorally based voice disorders can be improved. This paper reports on the development of a new, versatile, and cost-effective clinical tool for mobile voice monitoring that acquires the high-bandwidth signal from an accelerometer sensor placed on the neck skin above the collarbone. Using a smartphone as the data acquisition platform, the prototype device provides a user-friendly interface for voice use monitoring, daily sensor calibration, and periodic alert capabilities. Pilot data are reported from three vocally normal speakers and three subjects with voice disorders to demonstrate the potential of the device to yield standard measures of fundamental frequency and sound pressure level and model-based glottal airflow properties. The smartphone-based platform enables future clinical studies for the identification of the best set of measures for differentiating between normal and hyperfunctional patterns of voice use.
Objective To compare the effectiveness of an algorithm for diagnosis of active labour in primiparous women with standard care in terms of maternal and neonatal outcomes.Design Cluster randomised ...trial.Setting Maternity units in Scotland with at least 800 annual births.Participants 4503 women giving birth for the first time, in 14 maternity units. Seven experimental clusters collected data from a baseline sample of 1029 women and a post-implementation sample of 896 women. The seven control clusters had a baseline sample of 1291 women and a post-implementation sample of 1287 women.Intervention Use of an algorithm by midwives to assist their diagnosis of active labour, compared with standard care.Main outcomes Primary outcome: use of oxytocin for augmentation of labour. Secondary outcomes: medical interventions in labour, admission management, and birth outcome.Results No significant difference was found between groups in percentage use of oxytocin for augmentation of labour (experimental minus control, difference=0.3, 95% confidence interval −9.2 to 9.8; P=0.9) or in the use of medical interventions in labour. Women in the algorithm group were more likely to be discharged from the labour suite after their first labour assessment (difference=−19.2, −29.9 to −8.6; P=0.002) and to have more pre-labour admissions (0.29, 0.04 to 0.55; P=0.03).Conclusions Use of an algorithm to assist midwives with the diagnosis of active labour in primiparous women did not result in a reduction in oxytocin use or in medical intervention in spontaneous labour. Significantly more women in the experimental group were discharged home after their first labour ward assessment.Trial registration Current Controlled Trials ISRCTN00522952.
Aims Alcohol and hypoglycaemia independently affect cognitive function. This may be relevant for insulin‐treated diabetic patients who drive motor vehicles. The aim of this study was to examine the ...effect of mild hypoglycaemia (2.8 mmol/l) with modest alcohol intoxication (levels below UK driving limits) on intellectual performance in patients with Type 1 diabetes.
Methods A hyperinsulinaemic glucose clamp (60 mU/m2) was used to study 17 subjects age 35 ± 8 years, HbA1c 8.1 ± 1.4% (mean ± sd) on four occasions: (A) euglycaemia (4.5 mmol/l) with placebo, (B) euglycaemia with alcohol, (C) hypoglycaemia (2.8 mmol/l) with placebo, and (D) hypoglycaemia with alcohol. Cognitive performance was assessed using four‐choice reaction time (4CRT, primary outcome), measurements of general intellectual skills trail making B (TMB) and digit symbol substitution (DSST), and visual information processing visual change detection (VCD). A test related to driving performance (hazard perception) was also used.
Results In experiments B and D the average blood alcohol level was 43 mg/dl. This was associated with deterioration in 4CRT {+ 35 ms 95% confidence interval (CI) 20, 50} and TMB, whereas hypoglycaemia without alcohol increased 4CRT only + 39 ms (95% CI 5, 73). However, when alcohol was combined with hypoglycaemia, there was marked deterioration in all the cognitive function tests 4CRT 74 ms (95% CI 35, 113), TMB, DSST and VCD. Hazard perception was not affected. The effect of alcohol was no different in euglycaemia than in hypoglycaemia, i.e. there was no interaction. Whereas hypoglycaemia did not reduce the likelihood that the subjects would drive, alcohol did.
Conclusions The cumulative effect of alcohol and hypoglycaemia on cognitive function together has implications for driving in patients with Type 1 diabetes. Both independently impair cognitive function and together the effects are additive. Patients with Type 1 diabetes should be educated about hypoglycaemia and driving and should avoid alcohol completely if planning to drive.
Suicide is a tragic outcome with devastating consequences. In 2018, Scotland experienced a 15% increase in suicide from 680 to 784 deaths. This was marked among young people, with an increase of 53% ...in those aged 15-24, the highest since 2007. Early intervention in those most at risk is key, but identification of individuals at risk is complex, and efforts remain largely targeted towards universal suicide prevention strategies with little evidence of effectiveness.Recent evidence suggests childhood adversity is a predictor of subsequent poor social and health outcomes, including suicide. This protocol reports on methodology for harmonising lifespan hospital contacts for childhood adversity, mental health, and suicidal behaviour. This will inform where to 1) focus interventions, 2) prioritise trauma-informed approaches, and 3) adapt support avenues earlier in life for those most at risk.
This study will follow a case-control design. Scottish hospital data (physical health SMR01; mental health SMR04; maternity/birth record SMR02; mother's linked data SMR01, SMR04, death records) from 1981 to as recent as available will be extracted for people who died by suicide aged 10-34, and linked on Community Health Index unique identifier. A randomly selected control population matched on age and geography at death will be extracted in a 1:10 ratio. International Classification of Disease (ICD) codes will be harmonised between ICD9-CM, ICD9, ICD10-CM and ICD10 for childhood adversity, mental health, and suicidal behaviour.
ICD codes for childhood adversity from four key studies are reported in two categories, 1) Maltreatment or violence-related codes, and 2) Codes suggestive of maltreatment. 'Clinical Classifications Software' ICD codes to operationalise mental health codes are also reported. Harmonised lifespan ICD categories were achieved semi-automatically, but required labour-intensive supplementary manual coding. Cross-mapped codes are reported.
There is a dearth of evidence about touchpoints prior to suicide. This study reports methods and harmonised ICD codes along the lifespan to understand hospital contact patterns for childhood adversity, which come to the attention of hospital practitioners.
Childhood Adversity, Adverse Childhood Experiences, Mental Health, Self-harm, Suicide, Suicidality, Violence, Hospital episodes, Routine Data, Data Linkage, Study Protocol.
Women who were sent home from hospital in the latent phase of labour were asked to keep a diary to reflect on their experiences. Twenty-one women consented to complete the diary but only six returned ...it. These six women were approached to participate in a one-to-one interview at home to further explore the effects of being discharged home. Five women agreed to be interviewed. Interviews were tape-recorded and transcribed verbatim. The data were analyzed using latent content analysis. Five themes were identified: influence of others, reassurance, coping/pain, sleep deprivation and undervaluing of the latent phase. Women were strongly influenced regarding when to go into hospital by the anxiety of family and partners. Most women sought reassurance but being sent home made them feel unsupported and this may have increased their anxiety. Further research is needed into how best to support women planning a hospital delivery who in the latent phase of labour at home.
It has been suggested that the continuous glucose monitoring system may be a useful tool for detecting unrecognised hypoglycaemia, especially at times when finger prick testing is difficult or ...impossible (e.g., at night). Studies suggest that subcutaneous glucose levels closely mimic blood glucose levels with a lag time of only a few minutes. However, no studies have been published to show how well the sensor performs during sustained or in recovery from hypoglycaemia. This study involved using a hyperinsulinaemic glucose clamp (60 mU/m2) in nine healthy volunteers. Each subject had two sensors inserted the day before the study. Blood glucose levels were maintained at euglycaemia for the first 60 min, then decreased to 45 mg/dL (2.5 mmol/L) for 60 min, and finally restored to euglycaemia. Blood glucose measurements were compared with interstitial values recorded by the sensor. Sensor profiles showed acceptable agreement with blood glucose levels at each of the three plateaus with a correlation coefficient of 0.79, slope of 0.85, and mean absolute error of 7%. The sensor drop closely matched the drop in blood glucose, but the recovery from hypoglycaemia was delayed by an average of 26 min. Continuous glucose sensing provides a useful means of detecting unrecognised hypoglycaemia in type 1 diabetes, although the duration of hypoglycaemia may be overestimated.
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