Pregnancy complications in hyperemesis-affected pregnancy:a large hospital database study

Objective: Vomiting in pregnancy is a common condition affecting 80% of pregnant women. Hyperemesis is at one end of the spectrum, seen in 0.5–2% of the pregnant population. Known factors such as nulliparity, younger age and high body mass indexare associated with an increased risk of this condition in the first trimester. Late pregnancy complications attributable to hyperemesis, the pathogenesis of which is poorly understood, have not been studied in large population-based studies in the United Kingdom. The objective of this study was to determine a plausible association between hyperemesis and pregnancy complications,such as pregnancy-related hypertension, gestational diabetes and liver problems in pregnancy, and the rates of elective (ElCS) and emergency caesarean section (EmCS). Methods: Using a database based on ICD-10 classification, anonymised data of admissions to a large multi-ethnic hospital in Manchester, UK between 2000 and 2012 were examined.Notwithstanding the obvious limitations with hospital database-based research, this large volume of datasets allows powerful studies of disease trends and complications.Results Between 2000 and 2012, 156 507 women aged 45 or under were admitted to hospital. Of these, 1111 women were coded for hyperemesis (0.4%). A greater proportion of women with hyperemesis than without hyperemesis were coded forhypertensive disorders in pregnancy such as pregnancy-induced hypertension, pre-eclampsia and eclampsia (2.7% vs 1.5%;P=0.001). The proportion of gestational diabetes and liver disorders in pregnancy was similar for both groups (diabetes:0.5% vs. 0.4%; P=0.945, liver disorders: 0.2% vs. 0.1%;P=0.662). Hyperemesis patients had a higher proportion of elective and emergency caesarean sections compared with the non-hyperemesis group (ElCS: 3.3% vs. 2%; P=0.002, EmCS: 5% vs.3%; P=0.00). Conclusions: There was a higher rate of emergency and elective caesarean section in women with hyperemesis, which could reflect the higher prevalence of pregnancy-related hypertensive disorders(but not diabetes or liver disorders) in this group. The factors contributing to the higher prevalence of hypertensive disorders arenot known, but these findings lead us to question whether there is a similar pathogenesis in the development of both the conditions and hence whether further study in this area is warranted.

Patient experiences of serious adverse drug reactions and their attitudes to medicines:a qualitative study of survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis in the UK

Background: Adverse drug reactions (ADRs) cause significant morbidity and mortality and account for around 6.5% of hospital admissions. Patient experiences of serious ADRs and their long-term impact on patients' lives, including their influence on current attitudes towards medicines, have not been previously explored. Objective: The aim of the study was to explore the experiences, beliefs, and attitudes of survivors of serious ADRs, using drug-induced Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) as a paradigm. Methods: A retrospective, qualitative study was undertaken using detailed semi-structured interviews. Fourteen adult survivors of SJS and TEN, admitted to two teaching hospitals in the UK, one the location of a tertiary burns centre, were interviewed. Interview transcripts were independently analysed by three different researchers and themes emerging from the text identified. Results: All 14 patients were aware that their condition was drug induced, and all but one knew the specific drug(s) implicated. Several expressed surprise at the perceived lack of awareness of the ADR amongst healthcare professionals, and described how the ADR was mistaken for another condition. Survivors believed that causes of the ADR included (i) being given too high a dose of the drug; (ii) medical staff ignoring existing allergies; and (iii) failure to monitor blood tests. Only two believed that the reaction was unavoidable. Those who believed that the condition could have been avoided had less trust in healthcare professionals. The ADR had a persisting impact on their current lives physically and psychologically. Many now avoided medicines altogether and were fearful of becoming ill enough to need them. © 2011 Adis Data Information BV. All rights reserved. Conclusions: Life-threatening ADRs continued to affect patients’ lives long after the event. Patients’ beliefs regarding the cause of the ADR differed, and may have influenced their trust in healthcare professionals and medicines. We propose that clear communication during the acute phase of a serious ADR may therefore be important.

Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta

Purpose – The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A&E) unit of a Maltese hospital. Design/methodology/approach – The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients’ requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A&E unit of the hospital. Findings – The major and related problems being faced by the hospital under study were overcrowding at A&E and shortage of beds, respectively. The combined framework ensures better A&E services and patient flow. QFD identifies and analyses the issues and challenges of A&E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A&E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A&E unit. Practical/implications – The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives. Originality/value – Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A&E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta.

Neuropsychiatric manifestations in inflammatory neuropathies:a systematic review

We conducted a systematic literature review on psychological and behavioral comorbidities in patients with inflammatory neuropathies. In Guillain-Barré syndrome (GBS), psychotic symptoms are reported during early stages in 30% of patients. Typical associations include mechanical ventilation, autonomic dysfunction, inability to communicate, and severe weakness. Anxiety and depression are frequent comorbidities. Anxiety may increase post-hospital admissions and be a predictor of mechanical ventilation. Post-traumatic stress disorder may affect up to 20% of ventilated patients. Sleep disturbances are common in early-stage GBS, affecting up to 50% of patients. In chronic inflammatory demyelinating polyradiculoneuropathy, memory and quality of sleep may be impaired. An independent link between depression and pre-treatment upper limb disability and ascites was reported in POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, Skin) syndrome, with an association with early death. Hematological treatment of POEMS appears effective on depression. Published literature on psychological/behavioral manifestations in inflammatory neuropathies remains scarce, and further research is needed. This article is protected by copyright. All rights reserved.

Potential causes of ethnic group disparities in infertility:a hospital database study

Introduction - Lower success rates of in vitro fertilisation (IVF) in South East Asian countries compared to Western countries in informal studies and surveys was considered a reflection of variations in methodology and expertise. However, recent studies on the effects of ethnicity on success rates of infertility procedures in western countries have suggested other inherent contributing factors to the ethnic disparity but the evidence evaluating these is lacking. In our study we aim to investigate some of the comorbidities that might cause ethnic disparity to infertility and related procedures from hospital admissions data. Methods - Anonymous hospital admissions data on patients of various ethnic groups with infertility, comorbidities and infertility procedures from multiple hospitals in Birmingham andManchester, UK between 2000 and 2013 were obtained from the local health authority computerised hospital activity analysis register using ICD-10 and OPCS coding systems. Statistical analysis was performed using SPSS version 20.Results Of 522 223 female patients aged 18 and over, there were44 758 (8.4%) patients from South Asian (SA) community. 1156(13.4%) of the 8653 patients coded for infertility were SA, whichis a considerably higher proportion of the background SA population. For IVF procedures, the percentage of SA increased to15.4% (233 of the total 1479 patients). The mean age of SA codedfor infertility (30.6 ± 4.7 SD years versus 32.8 ± 4.9 SD years)and IVF (30.4 ± 4.3 SD years versus 32.7 ± 4.4 SD years) was significantly lower than caucasian patien ts (P < 0.001). A multivariate logistic regression model looking at patients with infertility, accounting for variations in age, showed that SA have significantly higher prevalence of hypothyroidism, obesity andiron-deficiency anaemia compared to caucasians but lower prevalence of endometriosis. Interestingly, psychiatric and psychological conditions diagnoses were seldom registered in infertility patients. Conclusion - Other studies suggest that various cultural, lifestyles, psychosocial and socio-economic factors may explain the disparities in IVF success rates between South Asians and caucasians. The fact that SA infertility and IVF patients, in ou rstudy, were significantly younger than caucasians and that their proportion is considerably higher than the background South Asian population suggests the influence of these factors. A significant psychiatric disease burden in other conditions and low numbers in our data suggest under diagnosis in this group.Despite the limitations of the coding data, from our study, we propose that hypothyroidism, obesity and/or iron-deficiency anaemia should be considered for the ethnic disparity. Further research in this topic is essential to fully investigate the reasons for such ethnic disparities.

Diabetes in the very elderly:need for an individualised approach

Background: Intensive risk factor management is recommended for individuals with diabetes. However, it is not known if such an approach is appropriate in the elderly with multiple comorbidities and limited life expectancy. The aim of this study was to characterise a cohort of very elderly individuals with diabetes and assess the impact of known risk factors on mortality. Methods: This was a retrospective audit approved by the clinical audit lead. All patients aged >80 years who attended diabetes outpatient clinics 2 years prior to the date of the audit (April 2012) were identified from clinic records. A detailed history including demographics, comorbidities and treatment were collected. Blood pressure readings, HbA1c, cholesterol and renal function were extracted and the mean of these readings was recorded. Survival status at 2 years was recorded for all patients. Statistical analysis was performed using SPSS19. Results: Data were available for 864 (381 male, 483 female) patients. The majority (75%) lived in their own home. More than 60% had multiple comorbidities and 25% had a prior history of cardiovascular disease. Two-thirds of the patients had more than one hospital admission in 2 years and a third had more than three admissions. 60% were on either insulin or a sulfonylurea. Mean HbA1c was 7.6%, cholesterol 4.2mmol/l, systolic blood pressure 145mmHg and eGFR 53ml/min. Over 2 years, 174 (20%)had died. Age, creatinine and previous coronary heart disease were significant predictors of death. Conclusion: The benefits of intensive diabetes management appear to be uncertain in very elderly patients. The need for intensive treatment must therefore be individualised to each patient.

Florida International University College of Medicine Policy Manual

A draft of the College of Medicine's Policy Manual. Contains information on Admissions, Student Services, and the Learning Environment.

Florida International University College of Medicine Medical Student Catalog

A draft of the College of Medicine's Student Catalog. Details information on the history of Florida International University and the College of Medicine, as well as Admissions information, an overview of the College of Medicine's curriculum, requirements, and student services.

Florida International University College of Medicine Medical Student Catalog

Provides information on the College of Medicine's history, curriculum, admissions, and requirements as well as other information for students admitted to the program. Draft copy.

Selecting a college or university: A study of students and their parents

This case study investigated the decision-making process of high-achieving high school students and their parents in selecting a college or university. The conceptual framework that guided this study included theoretical and empirical research framed around a three-phase model of college choice. Parental influence dominated the first phase of this model. The search phase, which was the second and the most crucial one, included financial considerations related to this decision, admissions considerations during the search phase, the psychology of decision making, and advertising strategies for teenagers. Once students completed the search phase they developed expectations of the institutions they considered prior to making the final decision. The study employed qualitative methods using individual interviews with students and their parents. ^ Six high-achieving high school seniors from a South Florida high school and their parents were selected to participate in this study. Of these students, four were female and two were male. Participants were individually interviewed on two separate occasions over a three-month period. Students and their parents were interviewed separately, with one exception, during the first set of interviews and together during the second. The data obtained from these interviews were transcribed and these transcripts were coded, categorized, analyzed, and sorted into major themes and submitted to interpretive analysis. ^ In-depth descriptions of participants' experiences during the decision-making process are described in the study. Financial factors—which included the cost of college, the socio-economic status of the family, and scholarship possibilities—drove the selection process for these students and their parents, most of whom reported their family incomes between the lower-middle to upper-middle class range. All of these students took advantage of the Bright Futures Scholarship Program, other scholarship opportunities, and the lower tuition costs of in-state public institutions. The effectiveness of recruitment techniques, such as brochures, campus visits, the development of college Web sites, and the overall impact of Internet resources, was assessed by the researcher. ^ As these students had progressed through the search phase, they developed perceptions of potential institutions as they were assisted by those around them. The value of familiarity with institutions and the use of heuristics were quite evident in the final analysis of this study, based on what the students communicated about how their knowledge of and comfort in these institutions affected their decisions. Parental influence played an important role in the selection process for the students in this study as the parents clearly directed the process, by the constant advice they gave their children and by the financial limitations they communicated to them. ^

Perceptions regarding intercollegiate alliance among administrators of Taiwanese technological higher education institutions

This study explored Taiwanese technological higher education administrators' perceptions about the motivation and capability of their institutions to form intercollegiate alliance, their preferred areas of collaboration, and their preferred partner attributes. Possible differences in perceptions of administrators from public and private institutions were also explored. ^ The study targeted six chief administrators in each of 88 technological and vocational higher education institutions in Taiwan. A mix of quantitative and qualitative research designs was used to collect and analyze data. Quantitative data were collected from 328 administrators through a questionnaire and analyzed using univariate and multivariate statistical techniques. In addition, to obtain a deeper understanding of the process of alliance formation, qualitative data were collected through interviews with 13 administrators and content analyzed using emergent themes analysis. ^ Findings revealed that Taiwanese technological education administrators were not strongly confident in the competitive positions of their institutions. They perceived themselves as non-competitive in faculty research performance, in getting financial support, and having easy-access locations. Administrators believed that forming an alliance would help them obtain more external resources, achieve academic enhancement, provide better services, have a stronger voice, and obtain promotion to a higher institutional level. Cost cutting was not believed to be an attainable goal. ^ Strong interest was expressed for an alliance in the sharing of technology, information networks, and library resources; cross-registration; admissions and recruitment practices; school-industry endeavors; and international academic exchanges. Sharing of administrators and staff, joint bidding and purchasing, and cooperative fundraising were considered of less interest. ^ Administrators favored partners who have excellent academic programs, who have complementary skills, who are willing to share resources, and who are enthusiastic leaders. They also wanted partners to match their institutions in performance and prestige and to be geographically close to them. ^ Multivariate analysis of variance did not reveal significant differences between the perceptions of the administrators from public and private institutions. It was concluded that despite governmental encouragement and the institutions' eagerness for forming an alliance, the administrators had little confidence that a sustainable alliance could be arranged. ^

Intercollegiate athletics and college rankings: An analysis of the relationship between athletic success and the U.S. News and World Report college rankings

The purpose of this study was to gain a greater understanding of the relationship between athletic success of football and men's basketball and the U.S. News and World Report (USNWR) college rankings. There has been consistent debate among researchers who study institutional quality about whether intercollegiate athletics enhances reputation. This study is similar to other studies attempting to measure the relationship between athletic success and possible indirect benefits to the university from athletics, such as increased admissions applications and increased alumni donations and giving. This study offered a more nuanced model for measuring athletic success, a concept that has been difficult to measure quantitatively. The method used here also measured change over time (in this case, from year-to-year over an eleven year period). The research questions for this study were (a) is there a correlation between athletic success and the USNWR college ranking; and (b) is there a correlation in the change from year-to-year in athletic success with the change from year-to-year in the USNWR college rankings? Spearman Rho correlation and ANOVA tests were used to answer these research questions. The results from the statistical tests demonstrated little correlation between athletic success, whether in football or men's basketball, with the USNWR college rankings. Although the relationships were weak, men's basketball success consistently demonstrated a stronger relationship than football success. This finding differed from what is most often found in the literature, which often favors football success. The ANOVA test results did reveal some results that suggest athletic participation is a factor in the USNWR college rankings. As the debate continues about whether intercollegiate athletics enhances reputation, and as colleges and universities continue spending enormously on athletics, a keener understanding about the possible indirect benefits to the university from athletic programs is needed. The "advertising" provided by spectator sports such as football and men's basketball is often assumed by university leaders to present substantial indirect benefits for the university. However, the existing research along with this study provides little evidence of such opportunities.