Fetal monitoring from 39 weeks’ gestation to identify South Asian-born women at risk of perinatal compromise: a retrospective cohort study

AbstractTo investigate whether earlier “post-term” monitoring of South Asian (SA) pregnancies from 39 weeks’ gestation with amniotic fluid index (AFI) and cardiotocography (CTG) detected suspected fetal compromise. Retrospective cohort study of all SA-born women at an Australian health service with uncomplicated, singleton pregnancies following the introduction of twice-weekly AFI and CTG monitoring from 39 weeks. Monitoring results, and their association with a perinatal compromise composite (including assisted delivery for fetal compromise, stillbirth, and NICU admission) were determined. 771 SA-born women had earlier monitoring, triggering delivery in 82 (10.6%). 31 (4%) had a non-reassuring antepartum CTG (abnormal fetal heart rate or variability, or decelerations) and 21 (2.7%) had an abnormal AFI (≤ 5 cm). Women with abnormal monitoring were 53% (95% CI 1.2–1.9) more likely to experience perinatal compromise and 83% (95% CI 1.2–2.9) more likely to experience intrapartum compromise than women with normal monitoring. Monitoring from 39 weeks identified possible fetal compromise earlier than it otherwise would have been, and triggered intervention in 10% of women. Without robust evidence to guide timing of birth in SA-born women to reduce rates of stillbirth, earlier monitoring provides an alternative to routine induction of labour.

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Effect of ethnicity and other sociodemographic factors on attendance at diabetic eye screening: a 12-month retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-046264 ◽

2021 ◽

Vol 11 (9) ◽

pp. e046264

Author(s):

Abraham Olvera-Barrios ◽

Michael Seltene ◽

Tjebo F C Heeren ◽

Ryan Chambers ◽

Louis Bolter ◽

...

Keyword(s):

Visual Acuity ◽

Cohort Study ◽

South Asian ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Black People ◽

Reference Group ◽

North East ◽

Eye Screening ◽

Diabetic Eye Screening

ObjectivesTo examine the association of sociodemographic characteristics with attendance at diabetic eye screening in a large ethnically diverse urban population.DesignRetrospective cohort study.SettingScreening visits in the North East London Diabetic Eye Screening Programme (NELDESP).Participants84 449 people with diabetes aged 12 years or older registered in the NELDESP and scheduled for screening between 1 April 2017 and 31 March 2018.Main outcome measureAttendance at diabetic eye screening appointments.ResultsThe mean age of people with diabetes was 60 years (SD 14.2 years), 53.4% were men, 41% South Asian, 29% White British and 17% Black; 83.4% attended screening. Black people with diabetes had similar levels of attendance compared with White British people. However, South Asian, Chinese and 'Any other Asian' background ethnicities showed greater odds of attendance compared with White British. When compared with their respective reference group, high levels of deprivation, younger age, longer duration of diabetes and worse visual acuity, were all associated with non-attendance. There was a higher likelihood of attendance per quintile improvement in deprivation (OR, 1.06; 95% CI, 1.03 to 1.08), with increasing age (OR per decade, 1.17; 95% CI, 1.15 to 1.19), with better visual acuity (OR per Bailey-Lovie chart line 1.12; 95% CI, 1.11 to 1.14) and with longer time of NELDESP registration (OR per year, 1.02; 95% CI, 1.01 to 1.03).ConclusionEthnic differences in diabetic eye screening uptake, though small, are evident. Despite preconceptions, a higher likelihood of screening attendance was observed among Asian ethnic groups when compared with the White ethnic group. Poorer socioeconomic profile was associated with higher likelihood of non-attendance for screening. Further work is needed to understand how to target individuals at risk of non-attendance and reduce inequalities.

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Characteristics and predictors of regulatory immediate action imposed on registered health practitioners in Australia: a retrospective cohort study

Australian Health Review ◽

10.1071/ah19293 ◽

2020 ◽

Vol 44 (5) ◽

pp. 784

Author(s):

Owen M. Bradfield ◽

Marie M. Bismark ◽

David M. Studdert ◽

Matthew J. Spittal

Keyword(s):

Substance Abuse ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Clinical Care ◽

Sexual Misconduct ◽

Health Practitioner ◽

The Public ◽

Australian Health ◽

Health Practitioners

ObjectiveImmediate action is an emergency power available to Australian health practitioner regulatory boards to protect the public. The aim of this study was to better understand the frequency, determinants and characteristics of immediate action use in Australia. MethodsThis was a retrospective cohort study of 11200 health practitioners named in notifications to the Australian Health Practitioner Regulation Agency (AHPRA) between January 2011 and December 2013. All cases were followed until December 2016 to determine their final outcome. ResultsOf 13939 finalised notifications, 3.7% involved immediate action and 9.7% resulted in restrictive final action. Among notifications where restrictive final action was taken, 79% did not involve prior immediate action. Among notifications where immediate action was taken, 48% did not result in restrictive final action. Compared with notifications from the public, the odds of immediate action were higher for notifications lodged by employers (mandatory notifications OR=21.3, 95% CI 13.7–33.2; non-mandatory notifications OR=10.9, 95% CI 6.7–17.8) and by other health practitioners (mandatory notifications OR=11.6, 95% CI 7.6–17.8). Odds of immediate action were also higher if the notification was regulator-initiated (OR=11.6, 95% CI 7.6–17.8), lodged by an external agency such as the police (OR=11.8, 95% CI 7.7–18.1) or was a self-notification by the health practitioner themselves (OR=9.4, 95% CI 5.5–16.0). The odds of immediate action were higher for notifications about substance abuse (OR=9.9, 95% CI 6.9–14.2) and sexual misconduct (OR=5.3, 95% CI 3.5–8.3) than for notifications about communication and clinical care. ConclusionsHealth practitioner regulatory boards in Australia rarely used immediate action as a regulatory tool, but were more likely to do so in response to mandatory notifications or notifications pertaining to substance abuse or sexual misconduct. What is known about this topicHealth practitioner regulatory boards protect the public from harm and maintain quality and standards of health care. Where the perceived risk to public safety is high, boards may suspend or restrict the practice of health practitioners before an investigation has concluded. What does this paper add?This paper is the first study in Australia, and the largest internationally, to examine the frequency, characteristics and predictors of the use of immediate action by health regulatory boards. Although immediate action is rarely used, it is most commonly employed in response to mandatory notifications or notifications pertaining to substance abuse or sexual misconduct. What are the implications for practitioners?Immediate action is a vital regulatory tool. Failing to immediately sanction a health practitioner may expose the public to preventable harm, whereas imposing immediate action where allegations are unfounded can irreparably damage a health practitioner’s career. We hope that this study will assist boards to balance the interests of the public with those of health practitioners.

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Do new trainees pose a threat to the functional outcome of total knee arthroplasty? – The ‘January/July’ effect in a developing South Asian country: A retrospective cohort study

International Journal of Surgery Open ◽

10.1016/j.ijso.2017.09.006 ◽

2017 ◽

Vol 9 ◽

pp. 13-18 ◽

Cited By ~ 2

Author(s):

Azeem Tariq Malik ◽

Arif Ali ◽

Syed Hamza Mufarrih ◽

Shahryar Noordin

Keyword(s):

Total Knee Arthroplasty ◽

Cohort Study ◽

Functional Outcome ◽

South Asian ◽

Knee Arthroplasty ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Asian Country ◽

July Effect ◽

Total Knee

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Low First Trimester Pregnancy-Associated Plasma Protein-A Levels Are Not Associated with an Increased Risk of Intrapartum Fetal Compromise or Adverse Neonatal Outcomes: A Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm9041108 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1108 ◽

Cited By ~ 1

Author(s):

Jessica M. Turner ◽

Sailesh Kumar

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Protein A ◽

First Trimester ◽

Neonatal Outcomes ◽

Increased Risk ◽

Adverse Neonatal Outcomes ◽

Fetal Compromise

The aim of this study was to assess if women with a low first trimester maternal pregnancy-associated plasma protein-A (PAPP-A) level are at increased risk of emergency cesarean (EmCS) for intrapartum fetal compromise (IFC) and/or adverse neonatal outcomes. This was a retrospective cohort study performed at Mater Mother’s Hospital, Brisbane, Australia, between 2016 and 2018. All women with a singleton, euploid, non-anomalous fetus with a documented PAPP-A level measured between 10 +0 and 13 +6 weeks gestation during the study period were included. Data were extracted from the institution’s perinatal database and dichotomized according to PAPP-A level (≤0.4 Multiples of Medium (MoM) vs. >0.4 MoM). The primary outcomes were EmCS-IFC and a composite of severe adverse neonatal outcomes (SCNO). Nine thousand sixty-one pregnancies were included, 3.3% with a PAPP-A ≤ 0.4 MoM. Low maternal PAPP-A was not associated with an increased risk of EmCS-IFC (adjusted odds ratio (aOR) 0.77, 95% confidence interval (CI) 0.24–2.46, p = 0.66) or SCNO (aOR 0.65, 95% CI 0.39–1.07, p = 0.09). Low PAPP-A was associated with increased odds of pre-eclampsia, preterm birth and birthweight < 10th centile. In conclusion, low maternal PAPP-A level is not associated with an increased risk of EmCS IFC or adverse neonatal outcomes despite greater odds of low-birthweight infants and preterm birth.

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