Complicated ectopic pregnancies with severe bleeding (CEPSB) are life-threatening situations and should be considered maternal near-miss cases. Previous studies have found an association between ...severe maternal morbidity secondary to CEPSB and substandard care. Almost all women with CEPSB are hospitalized, generating administrative and medical records. The objective of this study was to propose a method to measure the validity of the hospital discharge database (HDD) to detect CEPSB among hospital stays in two gynecological units.
We included all hospital stays of women who were 18-45 years old and hospitalized for acute pelvic pain or/and metrorrhagia in the two hospitals. The HDD was compared to medical data (gold standard). Two algorithms constructed from the International Classification of Disease (ICD-10) and Common Classification of Medical Procedures (CCAM), were applied to the HDD: a "predefined algorithm" according to coding guidelines and a "pragmatic algorithm" based on coding practices. Sensitivity, specificity and positive likelihood-ratios were calculated. False negatives and positives were analyzed to describe coding practices.
Among 370 hospital stays included, 52 were classified as CEPSB cases. The "predefined algorithm" gave a sensitivity of 23.1% (95% CI: 11.6-34.5) and a specificity of 99.1% (95% CI: 98.0-100.0) to identify CEPSB. The "pragmatic algorithm" gave a sensitivity of 63.5% (95% CI: 50.4-76.5) and a specificity of 94.7% (95% CI: 92.2-97.5) to identify CEPSB. Coding errors (77.6%) were due to misuse of diagnosis codes and because complications were not coded.
HDD is not reliable enough to detect CEPSB due to incorrect coding practices. However, it could be an ideal tool to monitor quality of care if a culture in data quality assessment is developed to improve quality of medical information.
Pregnancy-related venous thromboembolism is a leading cause of maternal morbidity and mortality, and thromboprophylaxis is indicated in pregnant and post-partum women with a history of venous ...thromboembolism. The optimal dose of low-molecular-weight heparin to prevent recurrent venous thromboembolism in pregnancy and the post-partum period is uncertain.
In this open-label, randomised, controlled trial (Highlow), pregnant women with a history of venous thromboembolism were recruited from 70 hospitals in nine countries (the Netherlands, France, Ireland, Belgium, Norway, Denmark, Canada, the USA, and Russia). Women were eligible if they were aged 18 years or older with a history of objectively confirmed venous thromboembolism, and with a gestational age of 14 weeks or less. Eligible women were randomly assigned (1:1), before 14 weeks of gestational age, using a web-based system and permuted block randomisation (block size of six), stratified by centre, to either weight-adjusted intermediate-dose or fixed low-dose low-molecular-weight heparin subcutaneously once daily until 6 weeks post partum. The primary efficacy outcome was objectively confirmed venous thromboembolism (ie, deep-vein thrombosis, pulmonary embolism, or unusual site venous thrombosis), as determined by an independent central adjudication committee, in the intention-to-treat (ITT) population (ie, all women randomly assigned to treatment). The primary safety outcome was major bleeding which included antepartum, early post-partum (within 24 h after delivery), and late post-partum major bleeding (24 h or longer after delivery until 6 weeks post partum), assessed in all women who received at least one dose of assigned treatment and had a known end of treatment date. This study is registered with ClinicalTrials.gov, NCT01828697, and is now complete.
Between April 24, 2013, and Oct 31, 2020, 1339 pregnant women were screened for eligibility, of whom 1110 were randomly assigned to weight-adjusted intermediate-dose (n=555) or fixed low-dose (n=555) low-molecular-weight heparin (ITT population). Venous thromboembolism occurred in 11 (2%) of 555 women in the weight-adjusted intermediate-dose group and in 16 (3%) of 555 in the fixed low-dose group (relative risk RR 0·69 95% CI 0·32–1·47; p=0·33). Venous thromboembolism occurred antepartum in five (1%) women in the intermediate-dose group and in five (1%) women in the low-dose group, and post partum in six (1%) women and 11 (2%) women. On-treatment major bleeding in the safety population (N=1045) occurred in 23 (4%) of 520 women in the intermediate-dose group and in 20 (4%) of 525 in the low-dose group (RR 1·16 95% CI 0·65–2·09).
In women with a history of venous thromboembolism, weight-adjusted intermediate-dose low-molecular-weight heparin during the combined antepartum and post-partum periods was not associated with a lower risk of recurrence than fixed low-dose low-molecular-weight heparin. These results indicate that low-dose low-molecular-weight heparin for thromboprophylaxis during pregnancy is the appropriate dose for the prevention of pregnancy-related recurrent venous thromboembolism.
French Ministry of Health, Health Research Board Ireland, GSK/Aspen, and Pfizer.
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•NaCl deposit strongly increases the corrosion rate of Ti-6Al-2Sn-4Zr-2Mo-Si alloy.•An active oxidation mechanism involving metal chlorides is thought to be responsible for the ...material degradation.•Role of the alloying elements is related to the active oxidation mechanism.•New insights on the nature of the internal oxidation area that forms in presence of NaCl.
This study focuses on the corrosion behaviour of Ti-6Al-2Sn-4Zr-2Mo-Si alloy in presence of NaCl deposit in air at 560 °C. The active oxidation mechanism at the origin of the corrosion phenomenon enhancement in presence of solid NaCl is thought to be connected to the formation of both external and internal thick oxidation areas. Thermodynamic calculations allowed showing the role played by the different alloying elements in the formation of the external oxide and detailed TEM characterisations brought new insights regarding the nature and origin of the internal oxidation area.
Life cycle assessment (LCA) has been used in many studies to evaluate the effect of feeding strategy on the environmental impact of pig production. However, because most studies have been conducted ...in European conditions, the question of possible interactions with the context of production is still under debate. The objective of this study was to evaluate these effects in 2 contrasted geographic contexts of production, South America (Brazil) and Europe (France). The LCA considered the process of pig fattening, including production and transport of feed ingredients and feed, raising of fattening pigs, and manure storage, transport, and spreading. Impacts were calculated at the farm gate, and the functional unit considered was 1 kg of BW gain over the fattening period. The performances of pigs were simulated for each scenario using the InraPorc population model (2,000 pigs per scenario considering between-animal variability). The LCA calculations were performed for each pig according to its own performance and excretion, and the results were subjected to variance analysis. The results indicate that for some impacts there are clear interactions between the effects of the feeding program, the origin of soybean, and the location of production. For climate change, interest in phase feeding and incorporation of crystalline AA (CAA) is limited and even counterproductive in Brazil with soybeans from the South (without deforestation), whereas they appear to be efficient strategies with soybeans from the Center West (with deforestation), especially in France. Rather similar effects, as those for climate change, were observed for cumulative energy demand. Conversely, potential eutrophication and acidification impacts were reduced by phase feeding and CAA addition in a rather similar way in all situations. Individual daily feeding, the only strategy that took into account between-animal variability, was the most effective approach for reducing the life cycle impact of pig fattening in all situations, whereas the potential of phase feeding programs and CAA was dependent on soybean origin and the geographical context of pig production, in contrast with previous results.
Animal feeding has a major contribution to the environmental impacts of pig production. One potential way to mitigate such effects is to incorporate an assessment of these impacts in the feed ...formulation process. The objective of this study was to test the ability of innovative formulation methodologies to reduce the impacts of pig production while also taking into account possible effects on growth performance. We compared three different formulation methodologies: least-cost formulation, in accordance with standard practices on commercial farms; multiobjective (MO) formulation, which considered feed cost and environmental impacts as calculated by life cycle assessment (LCA); and MO formulation, which prioritized locally produced feed ingredients to reduce the impact of transport. Ninety-six pigs were distributed between three experimental groups, with pigs individually weighted and fed using an automatic feeding system from 40 to 115 kg body weight. Based on the experimental results, six categories of impacts were evaluated: climate change (CC), demand in non-renewable energy (NRE), acidification (AC), eutrophication (EU), land occupation (LO), and phosphorus demand (PD), at both feed plant gate and farm gate, with 1 kg of feed and 1 kg of live pig as functional units, respectively. At feed level, MO formulations reduced CC, NRE, AC, and PD impacts but sometimes increased LO and EU impacts. These formulations reduced the proportion of cereals and oil meals into feeds (feed ingredients with high impacts), while the proportion of alternative protein sources, like peas, faba beans, or high-protein agricultural coproducts increased (feed ingredients with low impacts). Overall, animal performance was not affected by the dietary treatment; because of this, the general pattern of results obtained with either MO formulation at farm gate was similar to that obtained at feed level. Thus, MO diet formulation represents an efficient way to reduce the environmental impacts of pig production without compromising animal performance.
The determination of foetal Rhesus D (RHD) status allows appropriate use of IgRh prophylaxis by restricting its use to cases of RHD feto-maternal incompatibilities. There is a degree of uncertainty ...about the cost-effectiveness of foetal RHD determination, yet screening programs are being introduced into clinical practice in many countries. This paper evaluates the impact of non-invasive foetal Rhesus D (RHD) status determination on the costs of managing RHD-negative pregnant women and on the appropriate use of anti-D prophylaxis in a large sample of RHD-negative pregnant women using individual prospectively collected clinical and economic data.
A prospective two-armed trial of RHD negative pregnant women was performed in 11 French Obstetric Departments. Non-invasive foetal RHD genotyping was performed before 26 weeks' gestation in the experimental arm whereas the control arm participants received usual care. The costs associated with patient management in relation to their RHD negative status (biological tests, anti-D prophylaxis and visits) were calculated from inclusion to the end of the postpartum period. The costs of hospital admissions during pregnancy and delivery were also determined.
A total of 949 patients were included by 11 centres between 2009 and 2012, and 850 completed follow-up, including medical and biological monitoring. Patients were separated into two groups: the genotyping group (n=515) and the control group (n=335). The cost of the genotyping was estimated at 140 euros per test. The total mean cost per patient was estimated at €3,259 (SD ± 1,120) and €3,004 (SD ± 1,004) in the genotyping and control groups respectively. The cost of delivery represented three quarters of the total cost in both groups. The performance of managing appropriately RHD negative anti-D prophylaxis was 88% in the genotyping group, versus 65% in the control group. Using the costs related to RHD status (biological tests, anti-D immunoglobulin injections and visits) the incremental cost-effectiveness ratio (ICER) was calculated to be €578 for each percentage gain in women receiving appropriate management.
Early knowledge of the RHD status of the foetus using non-invasive foetal RHD genotyping significantly improved the management of RHD negative pregnancies with a small increase in cost.
Clinical trials registry- NCT00832962 -13 January 2009 - retrospectively registered.
Ewing sarcoma of the abdomen is a rare entity in pediatric oncology and represents a technical challenge both for surgeons and radiation oncologists. We document the case of a young female patient ...with primary disseminated, intraperitoneal Ewing sarcoma who after an excellent response to chemotherapy received preoperative whole abdominal-pelvic radiotherapy with good tolerance.
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