scholarly journals Multiple Trauma in Pregnant Women: Injury Assessment, Fetal Radiation Exposure and Mortality. A Multicentre Observational Study.

2022 ◽  
Author(s):  
Paër-sélim Abback ◽  
Alison Benchetrit ◽  
nathalie Delhaye ◽  
Jean-Luc Daire ◽  
Arthur James ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Observational Study ◽  
Pregnant Women ◽  
Radiation Exposure ◽  
Penetrating Trauma ◽  
Research Network ◽  
Fetal Mortality ◽  
Severe Traumatic Injury ◽  
Injury Assessment ◽  
Type Of Injury

Abstract Purpose: Fetal radiation exposure in pregnant women with trauma is a concern. The purpose of this study was to evaluate fetal radiation exposure with regard to the type of injury assessment performed.Methods: It is a multicentre observational study. The cohort study included all pregnant women suspected of severe traumatic injury in the participating centres of a national trauma research network. The primary outcome was the cumulative radiation dose (mGy) received by the fetus with respect to the type of injury assessment initiated by the physician in charge of the pregnant patient. Secondary outcomes were maternal and fetal morbi-mortality, the incidence of haemorrhagic shock and the physicians’ imaging assessment with consideration of their medical specialty.Results: Fifty-four pregnant women were admitted for potential major trauma between September 2011 and December 2019 in the 21 participating centres. The median gestational age was 22 weeks [12-30]. Seventy-eight percent of women (n=42) underwent WBCT. The remaining patients underwent radiographs, ultrasound or selective CT scans based on clinical examination. The median fetal radiation doses were 38 mGy [23-63] and 0 mGy [0-1]. Maternal mortality (5.6%) was lower than fetal mortality (16.7%). Two women (out of 3 maternal deaths) and 7 fetuses (out of 9 fetal deaths) died within the first 24 hours following trauma.Conclusion: Immediate WBCT for initial injury assessment in pregnant women with trauma was associated with a fetal radiation dose below the 100 mGy threshold. Among the selected population with either a stable status with a moderate and nonthreatening injury pattern or isolated penetrating trauma, a selective strategy seemed safe.

scholarly journals Internal exposure risk due to radiocesium and the consuming behaviour of local foodstuffs among pregnant women in Minamisoma City near the Fukushima nuclear power plant: a retrospective observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e023654 ◽  
Author(s):  
Kana Yamamoto ◽  
Shuhei Nomura ◽  
Masaharu Tsubokura ◽  
Michio Murakami ◽  
Akihiko Ozaki ◽  
...  
Keyword(s):  
Observational Study ◽  
Pregnant Women ◽  
Radiation Exposure ◽  
Screening Programme ◽  
Local Food ◽  
Food Products ◽  
Internal Exposure ◽  
Retrospective Observational Study ◽  
Internal Radiation ◽  
Internal Contamination

ObjectivesThis study aimed to evaluate the internal cesium (Cs) level among pregnant women in Minamisoma City (the area straddling the evacuation zones) over a 5-year period after Japan’s 2011 Fukushima nuclear accident and assess the status and transition of their food-acquiring preferences during this period.DesignA retrospective observational study of a screening along with a questionnaire survey.SettingThis study was conducted in an obstetrics and gynaecology service in Minamisoma City in Fukushima, Japan.ParticipantsParticipants included pregnant women who applied for the voluntary internal radiation exposure screening programme.Primary and secondary outcome measuresInternal radiation exposure was evaluated using the whole-body counter (WBC) in the screening programme. Data from a food acquisition preference questionnaire administered to the participants were analysed and compared across the 5-year period after adjusting for covariates.ResultsOverall, 804 screening programmes were conducted with 579 participants during the study period. All participants had internal contamination levels below the detection limit of the WBC unit (220 and 250 Bq/body for Cs-134 and Cs-137, respectively). Based on the most conservative assumption, their maximum annual effective doses by Cs-134 and Cs-137 together were estimated at 16 µSv/year. Contrary to limited internal contamination risks and counter-dose initiatives by the government, a considerable number of pregnant women were still concerned about consuming potentially contaminated local food products when purchasing them at supermarkets between 2012 (78.4%) and 2015 (75.0%).ConclusionsHealth effects from post-accident internal radiation exposure were likely to be insignificant in pregnant women. National/local action is urgently needed to promote scientific understanding in pregnant women regarding limited internal exposure risks from local food products in the market. However, few mothers chose to participate in the internal radiation exposure screening programme, and thus, caution is required in interpreting the results of analyses.

scholarly journals The Epidemiology of and Outcome from Pancreatoduodenal Trauma in the UK, 1989–2013

2015 ◽  
Vol 97 (2) ◽  
pp. 125-130 ◽  
Author(s):  
DA O’Reilly ◽  
O Bouamra ◽  
A Kausar ◽  
EJ Dickson ◽  
F Lecky
Keyword(s):  
Blunt Trauma ◽  
Injury Severity ◽  
Road Traffic ◽  
Penetrating Trauma ◽  
Research Network ◽  
Common Mechanism ◽  
Female Ratio ◽  
Road Traffic Collision ◽  
The Uk ◽  
Type Of Injury

IntroductionPancreatoduodenal (PD) injury is an uncommon but serious complication of blunt and penetrating trauma, associated with high mortality. The aim of this study was to assess the incidence, mechanisms of injury, initial operation rates and outcome of patients who sustained PD trauma in the UK from a large trauma registry, over the period 1989–2013.MethodsThe Trauma Audit and Research Network database was searched for details of any patient with blunt or penetrating trauma to the pancreas, duodenum or both.ResultsOf 356,534 trauma cases, 1,155 (0.32%) sustained PD trauma. The median patient age was 27 years for blunt trauma and 27.5 years for penetrating trauma. The male-to-female ratio was 2.5:1. Blunt trauma was the most common type of injury seen, with a ratio of blunt-to-penetrating PD injury ratio of 3.6:1. Road traffic collision was the most common mechanism of injury, accounting for 673 cases (58.3%). The median injury severity score (ISS) was 25 (IQR: 14–35) for blunt trauma and 14 (IQR: 9–18) for penetrating trauma. The mortality rate for blunt PD trauma was 17.6%; it was 12.2% for penetrating PD trauma. Variables predicting mortality after pancreatic trauma were increasing age, ISS, haemodynamic compromise and not having undergone an operation.ConclusionsIsolated pancreatic injuries are uncommon; most coexist with other injuries. In the UK, a high proportion of cases are due to blunt trauma, which differs from US and South African series. Mortality is high in the UK but comparison with other surgical series is difficult because of selection bias in their datasets.

EVALUATION OF OCCUPATIONAL RADIATION EXPOSURE IN A RADIO-DIAGNOSTIC FACILITY IN KATSINA- NIGERIA

2020 ◽  
Vol 4 (2) ◽  
pp. 722-729
Author(s):  
Usman Sani ◽  
Bashir Gide Muhammad ◽  
Dimas Skam Joseph ◽  
D. Z. Joseph
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Short Exposure ◽  
Skin Dose ◽  
Continuous Training ◽  
Short Exposure Time ◽  
Occupational Dose ◽  
Dose Limits ◽  
Radiation Workers ◽  
Occupational Radiation

Poor implementation of quality assurance programs in the radiation industry has been a major setback in our locality. Several studies revealed that occupational workers are exposed to many potential hazards of ionizing radiation during radio-diagnostic procedures, yet radiation workers are often not monitored. This study aims to evaluate the occupational exposure of the radiation workers in Federal Medical Centre Katsina, and to compare the exposure with recommended occupational radiation dose limits. The quarterly readings of 20 thermo-luminescent dosimeters (TLDs') used by the radiation workers from January to December, 2019 were collected from the facility's radiation monitoring archive, and subsequently assessed and analyzed. The results indicate that the average annual equivalent dose per occupational worker range from 0.74 to 1.20 mSv and 1.28 to 2.21 mSv for skin surface and deep skin dose, measured at 10 mm and 0.07 mm tissue depth respectively. The occupational dose was within the recommended national and international limits of 5 mSv per annum or an average of 20 mSv in 5 years. Therefore, there was no significant radiation exposure to all the occupational workers in the study area. Though, the occupational radiation dose is within recommended limit, this does not eliminate stochastic effect of radiation. The study recommended that the occupational workers should adhere and strictly comply with the principles of radiation protection which includes distance, short exposure time, shielding and proper monitoring of dose limits. Furthermore, continuous training of the radiation workers is advised.

scholarly journals Radiation Dose Reduction in CT Torsion Measurement of the Lower Limb: Introduction of a New Ultra-Low Dose Protocol

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1209
Author(s):  
Gabriel Keller ◽  
Simon Götz ◽  
Mareen Sarah Kraus ◽  
Leonard Grünwald ◽  
Fabian Springer ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Lower Limb ◽  
Low Dose ◽  
Body Volume ◽  
Reconstruction Algorithms ◽  
Pelvic Radiograph ◽  
Lower Radiation Dose ◽  
Median Total Dose ◽  
Image Reconstruction Algorithms

This study analyzed the radiation exposure of a new ultra-low dose (ULD) protocol compared to a high-quality (HQ) protocol for CT-torsion measurement of the lower limb. The analyzed patients (n = 60) were examined in the period March to October 2019. In total, 30 consecutive patients were examined with the HQ and 30 consecutive patients with the new ULD protocol comprising automatic tube voltage selection, automatic exposure control, and iterative image reconstruction algorithms. Radiation dose parameters as well as the contrast-to-noise ratio (CNR) and diagnostic confidence (DC; rated by two radiologists) were analyzed and potential predictor variables, such as body mass index and body volume, were assessed. The new ULD protocol resulted in significantly lower radiation dose parameters, with a reduction of the median total dose equivalent to 0.17 mSv in the ULD protocol compared to 4.37 mSv in the HQ protocol (p < 0.001). Both groups showed no significant differences in regard to other parameters (p = 0.344–0.923). CNR was 12.2% lower using the new ULD protocol (p = 0.033). DC was rated best by both readers in every HQ CT and in every ULD CT. The new ULD protocol for CT-torsion measurement of the lower limb resulted in a 96% decrease of radiation exposure down to the level of a single pelvic radiograph while maintaining good image quality.

scholarly journals Consent in pregnancy - an observational study of ante-natal care in the context of Montgomery: all about risk?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jacqueline A. Nicholls ◽  
Anna L. David ◽  
Joseph Iskaros ◽  
Dimitrios Siassakos ◽  
Anne Lanceley
Keyword(s):  
Qualitative Research ◽  
Observational Study ◽  
Pregnant Women ◽  
Social Factors ◽  
Healthcare Professionals ◽  
Effective Interaction ◽  
Clinical Decision ◽  
Place Of Birth ◽  
Clinical Risk ◽  
In Pregnancy

Abstract Background How to best support pregnant women in making truly autonomous decisions which accord with current consent law is poorly understood and problematic for them and their healthcare professionals. This observational study examined a range of ante-natal consultations where consent for an intervention took place to determine key themes during the encounter. Methods Qualitative research in a large urban teaching hospital in London. Sixteen consultations between pregnant women and their healthcare professionals (nine obstetricians and three midwives) where ante-natal interventions were discussed and consent was documented were directly observed. Data were collectively analysed to identify key themes characterising the consent process. Results Four themes were identified: 1) Clinical framing - by framing the consultation in terms of the clinical decision to be made HCPs miss the opportunity to assess what really matters to a pregnant woman. For many women the opportunity to feel that their previous experiences had been ‘heard’ was an important but sometimes neglected prelude to the ensuing consultation; 2) Clinical risk dominated narrative - all consultations were dominated by information related to risk; discussion of reasonable alternatives was not always observed and women’s understanding of information was seldom verified making compliance with current law questionable; 3) Parallel narrative - woman-centred experience – for pregnant women social factors such as the place of birth and partner influences were as or more important than considerations of clinical risk yet were often missed by HCPs; 4) Cross cutting narrative - genuine dialogue - we observed variably effective interaction between the clinical (2) and patient (3) narratives influenced by trust and empathy and explicit empowering language by HCPs. Conclusion We found that ante-natal consultations that include consent for interventions are dominated by clinical framing and risk, and explore the woman-centred narrative less well. Current UK law requires consent consultations to include explicit effort to gauge a woman’s preferences and values, yet consultations seem to fail to achieve such understanding. At the very least, consultations may be improved by the addition of opening questions along the lines of ‘what matters to you most?’

scholarly journals Multidisciplinary Unit Improves Pregnancy Outcomes in Women with Rheumatic Diseases and Hereditary Thrombophilias: An Observational Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1487
Author(s):  
Isabel Añón-Oñate ◽  
Rafael Cáliz-Cáliz ◽  
Carmen Rosa-Garrido ◽  
María José Pérez-Galán ◽  
Susana Quirosa-Flores ◽  
...  
Keyword(s):  
High Risk ◽  
Observational Study ◽  
Medical Care ◽  
Pregnant Women ◽  
Rheumatic Diseases ◽  
Absolute Risk ◽  
University Hospital ◽  
Obstetric Outcomes ◽  
Number Needed To Treat ◽  
Foetal Death

Rheumatic diseases (RD) and hereditary thrombophilias (HT) can be associated with high-risk pregnancies. This study describes obstetric outcomes after receiving medical care at a multidisciplinary consultation (MC) and compares adverse neonatal outcomes (ANOs) before and after medical care at an MC. This study is a retrospective observational study among pregnant women with RD and HT treated at an MC of a university hospital (southern Spain) from 2012 to 2018. Absolute risk reduction (ARR) and number needed to treat (NNT) were calculated. A total of 198 pregnancies were registered in 143 women (112 with RD, 31 with HT), with 191 (96.5%) pregnancies without ANOs and seven (3.5%) pregnancies with some ANOs (five miscarriages and two foetal deaths). Results previous to the MC showed 60.8% of women had more than one miscarriage, with 4.2% experiencing foetal death. MC reduced the ANO rate by AAR = 60.1% (95%CI: 51.6−68.7%). The NNT to avoid one miscarriage was 1.74 (95%CI: 1.5–2.1) and to avoid one foetal death NNT = 35.75 (95CI%: 15.2–90.9). A total of 84.8% of newborns and 93.2% of women did not experience any complication. As a conclusion, the follow-up of RD or HT pregnant women in the MC drastically reduced the risk of ANOs in this population with a previous high risk.

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