Objective To measure condition‐specific detection rates for 14 physical conditions screened for by the NHS fetal anomaly screening programme (FASP) fetal anomaly (FA) ultrasound scan. Design Retrospective audit of 12 694 diagnoses across a 3‐year national cohort. Setting All English NHS and crown‐dependency hospital trusts providing maternity services. Population Pregnancies booked for maternity services with an expected date of delivery between 1 April 2017 and 31 March 2020 and at least one diagnosis of a condition screened for by FASP. Methods Active multi‐source ascertainment, linkage, audit and validation of clinical information to identify the subset of diagnoses meeting the condition‐specific positivity threshold for the FA scan. Main outcome measure The accuracy of the FA scan compared with diagnostic reference standards. Results FA scan detection rates were: anencephaly 96.3% (95% confidence interval [CI] 81.7–99.3%), atrioventricular septal defect: 69.2% (95% CI 65.8–72.4%), bilateral renal agenesis: 98.7% (95% CI 95.4–99.6%), cleft lip: 89.5% (95% CI 87.8–90.9%), congenital diaphragmatic hernia: 60.8% (95% CI 56.5–65%), Edwards syndrome: 73.8% (95% CI 67.5–79.3%), exomphalos: 59.4% (95% CI 49.4–68.7%), gastroschisis: 88.6% (95% CI 79–94.1%), hypoplastic left heart syndrome: 92.7% (95% CI 90–94.8%), lethal skeletal dysplasia: 93.2% (95% CI 88.6–96%), Patau syndrome: 82.3% (95% CI 72.4–89.1%), spina bifida: 93.8% (95% CI 91.8–95.3%), tetralogy of Fallot: 75.4% (95% CI 72.1–78.4%) and transposition of the great arteries: 84.9% (95% CI 81.7–87.5%). Conclusions The performance of the FA scan is above the expectations set in 2010 for most conditions. For the remaining conditions, the majority of fetuses and babies affected are detected before the FA scan.
the intracavernous pressure and duration) was used to denote the erectile response. RESULTSExperimental PBOO in rats significantly increased the mean ( SEM ) bladder weight, to 256 (25) mg in PBOO rats vs 123 (24) mg in sham controls, and the voiding frequency to 1.01 (0.1) voids/min vs 0.72 (0.14) voids/min in sham controls ( P < 0.05). There was no significant difference between the erectile response to EFS, with a mean AUC in sham control rats at 1.5, 3.0 and 4.5 V of 2603 (372), 3200 (332) and 3357 (166), respectively, vs 2273 (183), 3794 (211) and 4177 (306) in PBOO rats ( P > 0.05); or to the erectogenic agents, the AUC for DEA-NO being 9000 (975) in PBOO rats vs 13 201 (2756) in sham controls, and the AUC for Y-27 632 being 44 915 (2462) and 45 907 (7408), respectively ( P > 0.05). There was greater immunoreactivity to RhoA in bladder and penile tissues of PBOO than control rats. CONCLUSIONPBOO does not affect erectile function in rats. Additional mechanisms or pathways might be involved in lower urinary tract symptom-related erectile dysfunction in humans. KEYWORDSbladder outlet obstruction, erectile function, Rho-A, rats OBJECTIVETo evaluate, in a well-controlled study, the effect of surgically induced partial bladder outlet obstruction (PBOO) on male erectile function in a rat model. MATERIALS AND METHODSPBOO was created in 17 adult male SpragueDawley rats by partial ligation of the proximal urethra. Sham-operated and PBOO rats were evaluated for urodynamic and erectile function at 4-8 weeks after surgery. Erectile responses to electrical field stimulation (EFS) to the major pelvic ganglion, and to erectogenic agents (1,1-diethyl-2-hydroxy-2-nitroso-hydrazine, DEA-NO, and Y-27632) were evaluated and the area under the curve (AUC, a product of
Objectives Prehospital protocols vary across local emergency medical service (EMS) agencies in California. We sought to develop evidence‐based recommendations for the out‐of‐hospital evaluation and treatment of pediatric respiratory distress, and we evaluated the protocols for pediatric respiratory distress used by the 33 California local EMS agencies. Methods Evidence‐based recommendations were developed through an extensive literature review of the current evidence regarding out‐of‐hospital treatment of pediatric patients with respiratory distress. The authors compared the pediatric respiratory distress protocols of each of the 33 California local EMS agencies with the evidence‐based recommendations. Our focus was on the treatment of 3 main pediatric respiratory complaints by presentation: stridor (croup), wheezing < 24 months (bronchiolitis), and wheezing > 24 months (asthma). Results Protocols across the 33 California local EMS agencies varied widely. Stridor (croup) had the highest protocol variability of the 3 presentations we evaluated, with no treatment having uniform use among all agencies. Only 3 (9.1%) of the local EMS agencies differentiated wheezing in children < 24 months of age, referencing this as possible bronchiolitis. All local EMS agencies included albuterol and epinephrine (intravenous/intramuscular) in their pediatric wheezing (asthma) treatment protocols. The least common treatments for wheezing (asthma) included nebulized epinephrine (3/33) and magnesium (2/33). No agencies included steroids in their treatment protocols (0/33). Conclusion Protocols for pediatric respiratory distress vary widely across the state of California, especially among those for stridor (croup) and wheezing in < 24 months (bronchiolitis). The evidence‐based recommendations that we present for the prehospital treatment of these conditions may be useful for EMS medical directors tasked with creating and revising these protocols.
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