1771 Use of Oximeter in Clinical Assessment of Infants at Birth in Low Risk Deliveries after Home Birth in the Netherlands

Since the start of the COVID-19 pandemic, online supervision has increased markedly, including within the Dutch probation services. In the present research, we systematically collected and analysed both clients and probation officers’ experiences of working online in the prior year. Although the clients were generally positive about remote supervision, some expressed that they missed the personal contact. According to most of the probation officers, remote working is flexible (efficient, saves time, travel costs), appropriate for certain phases of the probation process (especially at a later stage when a working alliance has been established) and particularly suitable for probationers with mild problems and low risk profiles. The general experience was that conversations are both more pragmatic and business-like, which, in turn, can produce both strengths and limitations. Once a foundation has been established, it appears to be possible to continue working remotely with clients, albeit the probation officers stressed that this depended on the type of client, type of offence and risk level.

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NAČRTOVAN POROD NA DOMU: PREGLEDNI ČLANEK

Slovenian Medical Journal ◽

10.6016/zdravvestn.1458 ◽

2016 ◽

Vol 85 (3) ◽

Author(s):

Tamara Serdinšek ◽

Iztok Takač

Keyword(s):

United Kingdom ◽

The Netherlands ◽

Home Birth ◽

The United States ◽

Home Births ◽

Mortality And Morbidity ◽

Advantages And Disadvantages ◽

Birth Attendants ◽

Definition Of ◽

At Home

Background: Home birth is as old as humanity, but still most middle- and high-income countries consider hospitals as the safest birth settings, as complications regarding birth are highly unpredictable. Despite this there are a few countries in which home birth in integrated into official healthcare system (the Netherlands, United Kingdom, Canada etc.). Home births can be divided into unplanned and planned, and the latter can be further categorized by the presence of the birth attendants. This review focuses on planned home births, which are differently represented throughout the world. In the United States 0.6-1.0% of all children are born at home, in the United Kingdom 2-3%, in Canada 1.6% and in the Netherlands 20-30%. For Slovenia, the number of planned home births is unknown; however, in 2010 0.1% of children were born outside medical facilities.Conclusions: The safety of home birth in still under the debate. While research confirms smaller number of obstetric interventions and some complications in mothers who give birth at home, the data regarding the neonatal and perinatal mortality and morbidity is still conflicting. This confirms the need for large multicentric trials in this field. Current home birth guidelines emphasize that women should be well informed regarding the possible advantages and disadvantages of home births. In addition, the emphasis is on definition of selection criteria for home birth, indications for intrapartal transfer to the hospital and appropriate education of birth attendants.

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Clinical Surveillance vs. Anticoagulation For low-risk patiEnts with isolated SubSegmental Pulmonary Embolism: protocol for a multicentre randomised placebo-controlled non-inferiority trial (SAFE-SSPE)

BMJ Open ◽

10.1136/bmjopen-2020-040151 ◽

2020 ◽

Vol 10 (11) ◽

pp. e040151

Author(s):

Christine Baumgartner ◽

Frederikus A Klok ◽

Marc Carrier ◽

Andreas Limacher ◽

Jeanne Moor ◽

...

Keyword(s):

Pulmonary Embolism ◽

The Netherlands ◽

Ethics Committees ◽

Low Risk ◽

Resource Utilisation ◽

Anticoagulant Treatment ◽

Double Blind ◽

Vein Thrombosis ◽

Clinical Surveillance ◽

Risk Patients

IntroductionThe clinical significance of subsegmental pulmonary embolism (SSPE) is currently unclear. Although growing evidence from observational studies suggests that withholding anticoagulant treatment may be a safe option in selected patients with isolated SSPE, most patients with this condition receive anticoagulant treatment, which is associated with a 90-day risk of recurrent venous thromboembolism (VTE) of 0.8% and major bleeding of up to 5%. Given the ongoing controversy concerning the risk-benefit ratio of anticoagulation for isolated SSPE and the lack of evidence from randomised-controlled studies, the aim of this clinical trial is to evaluate the efficacy and safety of clinical surveillance without anticoagulation in low-risk patients with isolated SSPE.Methods and analysisSAFE-SSPE (Surveillance vs. Anticoagulation For low-risk patiEnts with isolated SubSegmental Pulmonary Embolism, a multicentre randomised placebo-controlled non-inferiority trial) is an international, multicentre, placebo-controlled, double-blind, parallel-group non-inferiority trial conducted in Switzerland, the Netherlands and Canada. Low-risk patients with isolated SSPE are randomised to receive clinical surveillance with either placebo (no anticoagulation) or anticoagulant treatment with rivaroxaban. All patients undergo bilateral whole-leg compression ultrasonography to exclude concomitant deep vein thrombosis before enrolment. Patients are followed for 90 days. The primary outcome is symptomatic recurrent VTE (efficacy). The secondary outcomes include clinically significant bleeding and all-cause mortality (safety). The ancillary outcomes are health-related quality of life, functional status and medical resource utilisation.Ethics and disseminationThe local ethics committees in Switzerland have approved this protocol. Submission to the Ethical Committees in the Netherlands and Canada is underway. The results of this trial will be published in a peer-reviewed journal.Trial registration numberNCT04263038.

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Analysis of emergency department prediction tools in evaluating febrile young infants at risk for serious infections

Emergency Medicine Journal ◽

10.1136/emermed-2018-208210 ◽

2019 ◽

pp. emermed-2018-208210 ◽

Cited By ~ 2

Author(s):

Sarah Hui Wen Yao ◽

Gene Yong-Kwang Ong ◽

Ian K Maconochie ◽

Khai Pin Lee ◽

Shu-Ling Chong

Keyword(s):

At Risk ◽

Emergency Department ◽

Clinical Assessment ◽

Low Risk ◽

Assessment Tools ◽

Predictive Values ◽

Nice Guideline ◽

Risk Criteria ◽

Young Infants ◽

Serious Infections

ObjectiveFebrile infants≤3 months old constitute a vulnerable group at risk of serious infections (SI). We aimed to (1) study the test performance of two clinical assessment tools—the National Institute for Health and Care Excellence (NICE) Traffic Light System and Severity Index Score (SIS) in predicting SI among all febrile young infants and (2) evaluate the performance of three low-risk criteria—the Rochester Criteria (RC), Philadelphia Criteria (PC) and Boston Criteria (BC) among well-looking febrile infants.MethodsA retrospective validation study was conducted. Serious illness included both bacterial and serious viral illness such as meningitis and encephalitis. We included febrile infants≤3 months old presenting to a paediatric emergency department in Singapore between March 2015 and February 2016. Infants were assigned to high-risk and low-risk groups for SI according to each of the five tools. We compared the performance of the NICE guideline and SIS at initial clinical assessment for all infants and the low-risk criteria—RC, PC and BC—among well-looking infants. We presented their performance using sensitivity, specificity, positive, negative predictive values and likelihood ratios.ResultsOf 1057 infants analysed, 326 (30.8%) were diagnosed with SI. The NICE guideline had an overall sensitivity of 93.3% (95% CI 90.0 to 95.7), while the SIS had a sensitivity of 79.1% (95% CI 74.3 to 83.4). The incidence of SI was similar among infants who were well-looking and those who were not. Among the low-risk criteria, the RC performed with the highest sensitivity in infants aged 0–28 days (98.2%, 95% CI 90.3% to 100.0%) and 29–60 days (92.4%, 95% CI 86.0% to 96.5%), while the PC performed best in infants aged 61–90 days (100.0%, 95% CI 95.4% to 100.0%).ConclusionsThe NICE guideline achieved high sensitivity in our study population, and the RC had the highest sensitivity in predicting for SI among well-appearing febrile infants. Prospective validation is required.

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