OBJECTIVES To understand current practices, challenges, and opportunities for a systematic assessment of family caregiversʼ needs and risks in primary care. DESIGN Qualitative study consisting of in‐depth semi‐structured interviews. SETTING Four primary care practices located in urban and rural settings. PARTICIPANTS Primary care clinicians, staff, and administrators (N = 30), as well as older adult patients and family caregivers (N = 40), recruited using purposive and maximum variation sampling. MEASUREMENTS Current experiences, challenges, and opportunities for integrating standardized caregiver assessment into primary care delivery. Interviews were audio‐recorded and transcribed; transcripts were analyzed using the constant comparative method of data analysis. RESULTS Participating clinicians had been in practice for an average of 12.8 years (range = 1‐36 y). Patients had a mean age of 84.0 years (standard deviation [SD] = 9.7); caregivers had a mean age of 67.0 years (SD = 9.3). There was wide variability in current practices for identifying caregiversʼ needs and risks, encompassing direct and indirect approaches, when such issues are considered. Participants posited that integrating standardized caregiver assessment into primary care delivery could help improve patient care, enhance clinician‐caregiver communication, and validate caregiversʼ efforts. Barriers to assessment included insufficient time and reimbursement, liability concerns, lack of awareness of community resources, and concerns about patient autonomy. To facilitate future uptake of caregiver assessment, participants recommended brief self‐administered assessment tools and post‐screen discussions with practice staff. CONCLUSION Identification of caregiversʼ needs and risks in primary care is highly variable. Integration of standardized caregiver assessment into practice requires coordinated changes to policy, revision of practice workflows, and an interdisciplinary approach to the development of appropriate assessment tools. J Am Geriatr Soc 68:1262–1270, 2020.

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Transcatheter arterial embolization is becoming the therapy of choice for controlling obstetric hemorrhage, affording the ability to control persistent bleeding from pelvic vessels while avoiding the morbidity of surgical exploration. The clinicians are left with little choice if pelvic hemorrhage continues after hysterectomy and ligation of anterior division of both internal iliac arteries. We present one such case of intractable post-obstetric hysterectomy hemorrhage in which an ovarian artery pseudoaneurysm was diagnosed angiographically and successfully embolized, highlighting the role of transcatheter embolization.

OBJECTIVE:To confirm the clinical diagnosis in patient with first trimester bleeding. To evaluate the role of pelvic ultrasound, in management of first trimester bleeding. To correlate the outcome of pregnancy, with fetal activity seen on pelvic ultrasound. METHODS: Study includes all Obstetric cases attending Bhabha Atomic Research Centre and Hospital with history of bleeding per vaginum in first trimester of pregnancy during the study period October 2011 to September 2013. RESULT: In our study we have evaluated 100 cases of bleeding in the first trimester of pregnancy to know the role of ultrasound examination. On mere clinical examination, it was not possible to diagnose many cases correctly. There was a disparity of 72% between clinical and sonological diagnosis. Out of 86 cases clinically diagnosed as threatened abortion only 50 cases were confirmed as threatened abortion by ultrasonography. Rest 36 cases were misdiagnosed clinically. Sonographically diagnosed 50 cases were followed and all 50cases continued as normal pregnancy. 8 cases of these 50 threatened abortions had chorionic hemorrhage in ultrasonography findings, but all 8 cases also continued as normal pregnancy. These 36 clinically misdiagnosed cases were diagnosed correctly on ultrasonography as 12 cases of complete abortion, 4 cases of incomplete abortion, 1 case of inevitable abortion, 11 cases of missed abortion, 1 case of complete mole and 7 cases of blighted ovum. 1 cases of complete abortion was diagnosed by sonography only. 3 cases were clinically diagnosed as incomplete abortion, but only 1 was confirmed on sonography, rest 2 cases were case of missed abortion and blighted ovum. All 8 cases of blighted ovum was ultrasonography diagnosis only. None of them could be diagnosed clinically. 3 cases of ectopic pregnancy were diagnosed clinically and also confirmed on ultrasonography. 1 case of complete mole was an ultrasonography diagnosis only. CONCLUSION: Bleeding per vaginum in the first trimester is one of the most common causes for the majority of emergency admissions to the obstetrics department and also vaginal bleeding is most frequent indication of first trimester ultrasonography. The common causes of bleeding during first trimester include abortions, ectopic pregnancy and molar pregnancy. Ultrasound is a non-invasive, non-ionizing and easily available method of investigation to assess the patients with first trimester bleeding which is highly accurate in diagnosing the actual causes of bleeding and guides the clinician in choosing the appropriate line of management and prevents mismanagement of the cases. Ultrasound can assess some findings which are helpful in predicting the prognosis of the pregnancy. Life threatening emergency like ectopic when evaluated by ultrasound gives scope for conservative approach without affecting the fertility status.

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