Objective  To determine whether the introduction of multi‐professional simulation training was associated with improvements in the management of cord prolapse, in particular, the diagnosis–delivery interval (DDI). Design  Retrospective cohort study. Setting  Large tertiary maternity unit within a University Hospital in the United Kingdom. Sample  All cases of cord prolapse with informative case record: 34 pre‐training, 28 post‐training. Methods  Review of hospital notes and software system entries; comparison of quality of management for umbilical cord prolapse pre‐training (1993–99) and post‐training (2001–07). Main outcome measures  Diagnosis–delivery interval; proportion of caesarean section (CS) in whom actions were taken to reduce cord compression; type of anaesthesia for CS births; rate of low (<7) 5‐minute Apgar scores; rate of admission to neonatal intensive care unit (NICU) (if birthweight >2500 g). Results  After training, there was a statistically significant reduction in median DDI from 25 to 14.5 minutes (P < 0.001). Post‐training, there was also a statistically significant increase in the proportion of CS where recommended actions had been performed (from 34.78 to 82.35%, P = 0.003). There was a nonsignificant increase in the use of spinal anaesthesia for CS, from 8.70 to 17.65%, and a nonsignificant reduction in the rate of low Apgar scores from 6.45 to 0% and in the rate of admission to NICU from 38.46 to 22.22%. Conclusions  The introduction of annual training, in accordance with national recommendations, was associated with improved management of cord prolapse. Future studies could assess whether this improved management translates into better outcomes for babies and their mothers.

E El le ec ct tr ro os st ta at ti ic c c ch ha ar rg ge e o on n a a p pl la as st ti ic c s sp pa ac ce er r d de ev vi ic ceABSTRACT: The aim of this study was to determine whether electrostatic charge on a plastic spacer decreases the delivery of salbutamol from a pressurized metereddose inhaler (pMDI) and, if so, to find an optimal and practical treatment to remove the charge. Ten single actuations from a salbutamol pMDI were drawn through different Volumatic® spacers at a constant flow of 60 L·min -1 . The efficacies of different methods of removing charge were tested, including detergent coating of the spacers. A multistage liquid impinger was used to determine the particle size distribution of the output of the pMDI through the Volumatic® spacers. The electrostatic charge on the inner surface of the spacers was measured both quantitatively with an electrometer, and qualitatively by the attraction of a thin strip of cellulose membrane to the wall of the spacer. Each experiment was repeated four times.Ionic detergent coating of the spacers removed the charge for at least 24 h. This resulted in an increase of 55-70% in small particle (<6.8 µm) delivery compared to delivery from new spacers with high charge.We have demonstrated that electrostatic charge plays a major role in the delivery of salbutamol through plastic spacers. Adequate treatment with ionic detergent removes the charge and improves drug delivery.

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A study was designed to determine the incidence of atypical or geriatric presentation of infection in a long-term-care-hospital population of aged veterans. During the 6-month period of surveillance there were 65 instances of functional decline among the 143 veterans, with 50 episodes of infection. Although the symptoms and signs of infection were attenuated in many patients, a diagnosis was reached by careful examination and investigation. The majority of patients had a temperature of at least 38 degrees C in the presence of infection and it is concluded that the afebrile response to infection is rare in this population. During the course of this study the death rate in this institution dropped to about half of what was anticipated, and returned to previous levels following completion of the study. Infection can be recognized at a very early stage despite an atypical geriatric presentation and early treatment reduces morbidity and mortality.

Objective To assess whether team performance in simulated eclampsia is related to the knowledge, skills and attitudes of individual team members.Design Cross-sectional analysis of data from the Simulation and Fire Drill Evaluation randomised controlled trial.Setting Six secondary and tertiary maternity units in south-west England.Participants One hundred and fourteen maternity professionals in 19 teams of six members; one senior and one junior obstetrician; two senior and two junior midwives.Methods We validated a team performance ranking scheme with respect to magnesium administration (Magnesium Administration Rank, MAR) by expert consensus (face validity) and correlation with clinical measures (construct validity). We tested for correlation between MAR and measures of knowledge, skills and attitudes.Main outcome measures Correlation between team performance (MAR) and scores in validated multiple-choice questionnaires (MCQs) (knowledge), a measure of individual manual skill to manage an obstetric emergency (skill) and scores in a widely used teamwork/safety attitude questionnaire (attitude).Results There was no relationship between team performance and cumulative individual MCQs, skill or teamwork/safety attitude scores.Conclusions The knowledge, manual skills and attitudes of the individuals comprising each team, measured by established methods, did not correlate in this study with the team's clinical efficiency in the management of simulated eclampsia. The inference is that unidentified characteristic(s) play a crucial part in the efficiency of teams managing emergencies. Any emphasis of training programmes to promote individual knowledge, skills and attitudes alone may have to be re-examined. This highlights a need to understand what makes a team efficient in dealing with clinical emergencies.