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Background: Proteinuria is one of the essential criteria for the clinical diagnosis of pre-eclampsia. Increasing levels of proteinuria is considered to be associated with adverse maternal and fetal outcomes. We aim to determine the accuracy with which the amount of proteinuria predicts maternal and fetal complications in women with pre-eclampsia by systematic quantitative review of test accuracy studies.

Context: While formative workplace based assessment can improve learners' skills, it often does not because the procedures used do not facilitate feedback which is sufficiently specific to scaffold improvement. Provision of pre-formulated strategies to address predicted learning needs has potential to improve the quality and automate the provision of written feedback. Objectives:To systematically develop, validate and maximise the utility of a comprehensive list of strategies for improvement of consultation skills through a process involving both medical students and their clinical primary and secondary care tutors.Methods: Modified Delphi study with tutors, modified nominal group study with students with moderation of outputs by consensus round table discussion by the authors.Results: 35 hospital and 21 GP tutors participated in the Delphi study and contributed 153 new or modified strategies. After review of these and the 205 original strategies, 265 strategies entered the nominal group study to which 46 year 4 and 5 students contributed, resulting in the final list of 249 validated strategies. Conclusions:We have developed a valid and comprehensive set of strategies which are considered useful by medical students. This list can be immediately applied by any school which uses the Calgary Cambridge Framework to inform the content of formative feedback on consultation skills. We consider that the list could also be mapped to alternative skills frameworks and so be utilised by schools which do not use the Calgary Cambridge Framework.

The successful outcome of intracytoplasmic sperm injection (ICSI) with round-headed spermatozoa (globozoospermia) is reported. A couple with infertility secondary to globozoospermia received ICSI treatment. Fertilization, cleavage and pregnancy outcomes were recorded. This couple experienced 40, 10 and 42% fertilization rates after ICSI in their first, second and third cycles respectively. Pregnancy did not occur in the first or second cycle but was successfully achieved after the third ICSI cycle. It is concluded that current ICSI procedures may overcome the infertility associated with globozoospermia and result in normal healthy livebirth without assisted oocyte activation.