BMJ open
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Gestational diabetes mellitus (GDM) affects a significant number of women. Evidence regarding the association between GDM and offspring body mass index (BMI) is unclear due to small samples and lack of adequate confounding control. The objective of this study was to investigate the association between GDM and offspring BMI z-scores from birth to early adolescence and to examine the role of maternal pre-gestational BMI in this relationship. ⋯ We observed that in the association between GDM and offspring BMI z-scores, there is a predominant role for maternal nutritional status before pregnancy and that the association between GDM and newborn's BMI is apparent only among those born to overweight or obese mothers.
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Hospital redevelopment projects typically intend to improve hospital functioning and modernise the delivery of care. There is research support for the proposition that redevelopment along evidence-based design principles can lead to improved quality and safety. However, it is not clear how redevelopment influences the wider context of the hospital and its functioning. That is, beyond a limited examination of intended outcomes (eg, improved patient satisfaction), are there additional consequences (positive, negative or unintended) occurring within the hospital after the physical environment is changed? Is new always better? The primary purpose of this study is to explore the ripple effects of how hospital redevelopment may influence the organisation, staff and patients in both intended and unintended ways. ⋯ The study has been reviewed and approved by the relevant Ethics Committee in New South Wales, Australia. The results will be actively disseminated through peer-reviewed journals, conference presentations and in report format to the stakeholders.
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Observational Study
Prehospital triage of patients with suspected stroke symptoms (PRESTO): protocol of a prospective observational study.
The efficacy of both intravenous treatment (IVT) and endovascular treatment (EVT) for patients with acute ischaemic stroke strongly declines over time. Only a subset of patients with ischaemic stroke caused by an intracranial large vessel occlusion (LVO) in the anterior circulation can benefit from EVT. Several prehospital stroke scales were developed to identify patients that are likely to have an LVO, which could allow for direct transportation of EVT eligible patients to an endovascular-capable centre without delaying IVT for the other patients. We aim to prospectively validate these prehospital stroke scales simultaneously to assess their accuracy in predicting LVO in the prehospital setting. ⋯ The Institutional Review Board of the Erasmus MC University Medical Centre has reviewed the study protocol and confirmed that the Dutch Medical Research Involving Human Subjects Act (WMO) is not applicable. The findings of this study will be disseminated widely through peer-reviewed publications and conference presentations. The best performing scale, or the simplest scale in case of clinical equipoise, will be integrated in a decision model with other clinical characteristics and real-life driving times to improve prehospital triage of suspected stroke patients.
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To explore the current status to which Canadian obstetrics and gynaecology (Ob-Gyn) programmes teach residents about pregnancy in patients with physical disabilities, and to assess the level of interested in providing formal education sessions in this field. This study also assesses the residents' perception of their knowledge and their comfort level caring for women with physical disabilities (WWPD), which will further determine the need for incorporation of this topic into the residency curriculum. ⋯ This survey indicated that there is both a need for and interest in education in the area of pregnancy and physical disability in the Canadian Ob-Gyn residency programme. This information suggests that the development of educational materials in this area should be considered to address an unmet need with the ultimate goal of improving the care provided to WWPD in pregnancy. Future projects in this area should focus on content development taking into account the CanMEDS and competency-based medical education framework.
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Three types of central venous access devices (CVADs) are routinely used in the delivery of intravenous systemic anticancer therapy (SACT): peripherally inserted central catheters (PICCs), subcutaneously tunnelled central catheters (Hickman-type devices) and totally implantable chest wall ports (Ports). This qualitative study, nested within a multicentre, randomised controlled trial, sought to explore patient acceptability and experiences of the three devices. ⋯ Patient experiences and preferences have not been systematically used to inform policy and practice regarding CVAD availability and selection. Our research identified patterns of patient device preferences that favoured Ports, although this was not universal. Results of this study could improve support for patients and offer greater scope for incorporating patient perspectives into decision-making processes.