Infant and perinatal outcomes of triplet pregnancy in Auckland: better than expected?

AIM

There were two aims to the study: (1) to provide local outcome data that would be useful in counselling prospective parents of triplets; and (2) to address the deficit in accurate contemporary data on neurodevelopmental outcome and neonatal morbidity for those infants weighing less than 1500 g at birth.

METHODS

We reviewed the outcome of triplet pregnancies born at National Women's Hospital / Auckland City Hospital (Auckland, New Zealand) for 1995-2005 inclusive. For this study triplet pregnancy was defined as a pregnancy beyond 20 weeks leading to registration of at least one birth.

RESULTS

For the study period, 55 triplet pregnancies were identified. Forty-five percent of the pregnancies were reported as spontaneously conceived and 60% had no major complications other than premature delivery. One pregnancy spontaneously aborted; three fetuses from one pregnancy were stillborn, and four infants died in delivery suite. The median gestational age at birth was 32 (23-37) weeks and birth weight 1620 (530-2780) g. The median (range) Apgar score, for liveborns, was 8 (2-10) and 10 (4-10) for 1 and 5 minutes respectively. There were five neonatal deaths. Fifty-three infants, <1500g at birth, underwent formal developmental assessment. Three had cerebral palsy (2 hemiplegia and 1 spastic diplegia); one had marked motor delay and one hearing impairment requiring aids. The median Bayley II MDI was 95 (71-105) and PDI 94 (65-110). Outcomes were categorised in surviving triplets <1500 g as normal in 66%, mild abnormality in 17%, moderate abnormality in 15% and severely abnormal in only 2%.

CONCLUSION

Although triplets represent a significant burden on the regional NICUs the outcome, including those <1500 g at birth, compares favourably with that reported.

Thermal plasma technology for the treatment of wastes: a critical review

This review describes the current status of waste treatment using thermal plasma technology. A comprehensive analysis of the available scientific and technical literature on waste plasma treatment is presented, including the treatment of a variety of hazardous wastes, such as residues from municipal solid waste incineration, slag and dust from steel production, asbestos-containing wastes, health care wastes and organic liquid wastes. The principles of thermal plasma generation and the technologies available are outlined, together with potential applications for plasma vitrified products. There have been continued advances in the application of plasma technology for waste treatment, and this is now a viable alternative to other potential treatment/disposal options. Regulatory, economic and socio-political drivers are promoting adoption of advanced thermal conversion techniques such as thermal plasma technology and these are expected to become increasingly commercially viable in the future.

[Community-based health promotion--a challenge for the evaluation]

PURPOSE

Community-based health promotion (CBHP) aims at mobilising citizens for health-related issues in their environment, and at implementing health-promoting projects on the community level. Whereas recent political decisions support this approach, scientific studies dealing with theories and consequences of CBHP are scarce in Germany. Evaluation of CBHP could help identify (in)effective factors and elements of community programmes and thus improve future planning. In Germany, however, there is a deficit in systematic concepts and recommendations for the evaluation of CBHP. This work outlines basic ideas and core principles of CBHP and deduces implications for the assessment of health-promoting community projects.

METHODS

Based on different international models and studies and on discussions with health promotion professionals, we developed a framework for the evaluation of CBHP.

RESULTS

The proposed framework includes a guideline for CBHP programme planning. Its strategic and operational criteria can serve as a basis for a strategy evaluation. In terms of process evaluation, indicators for the dimensions (1) programme implementation and service delivery, (2) capacity building, and (3) reach of and acceptability in the target group were developed. In addition, we present different areas of OUTCOME EVALUATION; it is advisable to distinguish between measurement on the individual and on the community level. The framework further proposes strategies for the evaluation of the core principles empowerment and participation.

CONCLUSION

The presented framework can serve as a basis for the development of flexible and individual instruments for the evaluation of CBHP, which should not ignore the perspective of the citizens, or complex aspects like changes on the community level. Some aspects, e.g., the potential evaluation of further targets of CBHP (improvement of quality of life, reduction of social and health inequalities), the responsibility of evaluation or the effects of financial constraints, are important questions to be addressed in the future.

CHESS: ten years of research and development in consumer health informatics for broad populations, including the underserved

This paper reviews the research and development around a consumer health informatics system CHESS (The Comprehensive Health Enhancement Support System) developed and tested by the Center for Health Systems Research and Analysis at the University of Wisconsin. The review will place particular emphasis on what has been found with regard to the acceptance and use of such systems by high risk and underserved groups.

Fit of implant-supported fixed prostheses fabricated on master casts made from a dental stone and a dental plaster

STATEMENT OF PROBLEM

The impression and cast on which an implant-supported fixed prosthesis is fabricated must accurately reproduce the intraoral relations.

PURPOSE

The fit of fixed prostheses fabricated on master casts poured in a conventional die stone and in an ultra-low-expansion plaster was investigated in vitro.

MATERIAL AND METHODS

An impression was made of patient replicas with inter-implant abutment distances of 50 and 35 mm. Ten master casts were poured in a conventional die stone (Velmix, Kerr) and 10 in an ultra-low-expansion plaster (Gnathostone, Zeus). A simulated plaster fixed prosthesis was fabricated on each master cast and then returned in a random order to the appropriate patient replica. The fixed prostheses were screwed into place on one abutment with a torque of 10 Ncm. Vertical discrepancies were measured at the other abutment by an operator blinded to the cast on which the fixed prosthesis was fabricated. A 2-way analysis of variance was performed for distance and materials, and significant differences were identified with regression analysis.

RESULTS

For the 50-mm inter-abutment distance, die stone master casts produced a mean vertical discrepancy of 80 microm (SD 32.50 microm). Plaster master casts produced a mean vertical discrepancy of 42.8 microm (SD 12.17 microm). The means were significantly different (P=.01). For the 35-mm inter-abutment distance, the mean vertical discrepancy produced from the die stone and plaster master casts was 84.33 microm (SD 49.9 microm) and 0 microm (SD 0), respectively. The means were significantly different (P<.001). A significant difference was found between the mean vertical seating discrepancies of fixed prostheses produced from plaster casts with inter-abutment differences of 50 mm and plaster casts with inter-abutment distances of 35 mm (P=.003). No significant differences were found between mean vertical seating discrepancies for fixed prostheses fabricated on die stone casts.

CONCLUSION

In this in vitro study, master casts poured in an ultra-low-expansion plaster limited to a maximum inter-abutment dimension of 35 mm were more accurate than casts with 50-mm inter-abutment spans or those poured in a conventional die stone.

Accuracy of administrative and trauma registry databases

OBJECTIVE

Accurate data are needed to evaluate clinical outcomes, therapeutic modalities, and quality of care in trauma. Administrative data, usually used for billing, and trauma registries, have been used to perform these functions. This study compares data for trauma patients from administrative and trauma registry databases at a Level I trauma center.

METHODS

Data from patients injured in 1998 were obtained from both the trauma registry and administrative database. These International Classification of Diseases, Ninth Revision, Clinical Modification codes signify an admitting diagnosis of trauma. Patients from each database were "matched" by admission date, medical record number, age, and name. The two matched data sets were compared for accuracy in recording data. Chi-square analysis was used to compare groups.

RESULTS

There were 2,702 patients found in both databases. One hundred eighteen patients with significant trauma were recorded in the trauma registry, but not in the administrative database. Comparison of recorded data for "matched" patients is as follows. The underreporting of mechanism of injury, diagnoses, diagnostic interventions, surgical procedures, and complications was rampant throughout the administrative database. Statistical significance was seen in the comparison between the trauma registry and the administrative database with motor vehicle collisions (458 vs. 391), abdominal injuries (346 vs. 293), orthopedic injuries (1,243 vs. 1,101), and thoracic injuries (486 vs. 397). Diagnostic interventions such as diagnostic peritoneal lavage, head computed tomographic scans, and abdominal computed tomographic scans were all grossly underrecorded, with only 40%, 12%, and 9% captured by the administrative database, respectively. Analysis of surgical procedures revealed these same trends, with statistical significance seen in abdominal and orthopedic procedures. Complications such as acute respiratory distress syndrome and deep venous thrombosis showed statistically significant differences. Mortality was underreported in the administrative database, with 14 deaths omitted.

CONCLUSION

This study shows that administrative data have copious omissions of specific injuries, diagnostic and therapeutic interventions, as well as complications. The trauma registry recorded more of the diagnoses, diagnostics, procedures, and outcomes in the care of trauma patients. Trauma registries may be more useful than administrative databases in assessing quality of care and diagnostic and therapeutic interventions.