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Liszewski MC, Smalley R, Boulais J, Winant AJ, Vargas SO, Lee EY. Neonatal Chest Imaging: Congenital and Acquired Disorders. Semin Roentgenol 2024; 59:238-248. [PMID: 38997179 DOI: 10.1053/j.ro.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Mark C Liszewski
- Department of Radiology, Columbia University Irving Medical Center, New York, NY.
| | - Robert Smalley
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Jaclyn Boulais
- Division of Neonatology, Department of Pediatrics, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Sara O Vargas
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
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Chen Y, Zhao R, Huang Z, Chu C, Xiao Y, Hu X, Wang X. A small-scale external quality assessment for PCR detection of group B streptococcus in China. Clin Chim Acta 2024; 553:117733. [PMID: 38128816 DOI: 10.1016/j.cca.2023.117733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Group B streptococcus (GBS) is considered a leading cause of maternal and infant morbidity and mortality. Molecular diagnosis is a routinely used approach for GBS screening to protect pregnant women and prevent early-onset GBS neonatal disease. The objective of this study was to identify issues and guarantee the dependability of GBS molecular diagnosis by an external quality assessment (EQA) scheme. METHODS The EQA panel comprised eight samples spiked with 10-fold dilutions of GBS suspension (20-2,000,000 copies/mL), and 2 negative control samples. The panels were coded randomly and distributed to participating laboratories for GBS detection. RESULTS In total, 44 participating laboratories submitted results with eight commercial GBS PCR assays and one in-house assay. Among them, 36 obtained an acceptable or higher performance score, while 8 required improvement. Among the 440 results returned, 62 (14.1 %) were incorrect, including 5 false positives and 57 false negatives. CONCLUSIONS Our small-scale EQA showed that most participating laboratories have reliable diagnostic capacities for GBS PCR detection. Nonetheless, further improvements in the detection performance of some laboratories are required, particularly with low-concentration samples. Our survey also reinforces the use of EQA as an essential tool to evaluate the overall proficiency of clinical laboratories.
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Affiliation(s)
- Yingwei Chen
- Department of Quality Control Material R&D, Shanghai Center for Clinical Laboratory, Shanghai, China
| | - Ran Zhao
- Department of Quality Control Material R&D, Shanghai Center for Clinical Laboratory, Shanghai, China
| | - Zhongqiang Huang
- Department of Molecular Biology, Shanghai Center for Clinical Laboratory, Shanghai, China
| | - Chengxiang Chu
- Department of Quality Control Material R&D, Shanghai Center for Clinical Laboratory, Shanghai, China
| | - Yanqun Xiao
- Department of Molecular Biology, Shanghai Center for Clinical Laboratory, Shanghai, China
| | - Xiaobo Hu
- Department of Quality Control Material R&D, Shanghai Center for Clinical Laboratory, Shanghai, China; Department of Molecular Biology, Shanghai Center for Clinical Laboratory, Shanghai, China.
| | - Xueliang Wang
- Department of Quality Control Material R&D, Shanghai Center for Clinical Laboratory, Shanghai, China; Department of Molecular Biology, Shanghai Center for Clinical Laboratory, Shanghai, China.
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Regional and clinical guidelines for prevention and care of obstetric anal sphincter injuries - A critical frame analysis. Midwifery 2023; 119:103608. [PMID: 36739637 DOI: 10.1016/j.midw.2023.103608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Policy documents govern how the prevention and care of obstetric anal sphincter injuries (OASIS) are implemented. Thus, in the absence of Swedish national guidelines on OASIS, differing views may be visible in the regional and local policy documents. Therefore, we aimed to analyse regional and local policies, guidelines, and care programs on the prevention of OASIS and care for OASIS-affected women in a Swedish context by applying a critical frame analysis inspired by Verloo. DESIGN AND SETTING A cross-sectional study of existing policy documents from Swedish healthcare regions was performed. The documents were analysed using Verloo's critical frame analysis. FINDINGS We found that OASIS was framed as a preventable problem addressed by skilled protective manoeuvres of the healthcare staff. Education, communication, and teamwork were three frames of crucial solutions to minimise the prevalence of OASIS. However, complicating power dimensions between professional groups and between professionals and birthing women were identified. Furthermore, several discursive struggles were found, predominantly regarding the scientific evidence for the suggested prevention and care. CONCLUSION The policy documents emphasised that OASIS is preventable, and improved education, communication, and teamwork could diminish the OASIS prevalence. Nevertheless, power dimensions and discursive struggles may challenge the preventive efforts. Furthermore, each Swedish region has the sovereignty to develop its policies, which was reflected in our findings and may imply inequities in care provision. Thus, there is an urgent need to develop comprehensive national high-quality guidelines of high quality for OASIS prevention and care so that all women giving birth have access to equal care and treatment in Sweden.
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Choi Y, Han HS, Chong GO, Le TM, Nguyen HDT, Lee OEM, Lee D, Seong WJ, Seo I, Cha HH. Updates on Group B Streptococcus Infection in the Field of Obstetrics and Gynecology. Microorganisms 2022; 10:microorganisms10122398. [PMID: 36557651 PMCID: PMC9780959 DOI: 10.3390/microorganisms10122398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Group B Streptococcus (GBS, Streptococcus agalactiae) is a Gram-positive bacterium that is commonly found in the gastrointestinal and urogenital tracts. However, its colonization during pregnancy is an important cause of maternal and neonatal morbidity and mortality worldwide. Herein, we specifically looked at GBS in relation to the field of Obstetrics (OB) along with the field of Gynecology (GY). In this review, based on the clinical significance of GBS in the field of OBGY, topics of how GBS is being detected, treated, and should be prevented are addressed.
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Affiliation(s)
- Yeseul Choi
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hyung-Soo Han
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Department of Physiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea
| | - Gun Oh Chong
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Tan Minh Le
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hong Duc Thi Nguyen
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Olive EM Lee
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Donghyeon Lee
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Won Joon Seong
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Incheol Seo
- Department of Immunology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Correspondence: (I.S.); (H.-H.C.)
| | - Hyun-Hwa Cha
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Correspondence: (I.S.); (H.-H.C.)
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Santillan DA, Hubb AJ, Nishimura TE, Rosenfeld-O'Tool SR, Schroeder KJ, Conklin JM, Karras AE, Gumusoglu SB, Brandt DS, Miller E, Hunter SK, Santillan MK. Group B Streptococcus Screening and Treatment Adherence in Pregnancy: A Retrospective Cohort Study and Opportunities for Improvement. AJPM FOCUS 2022; 1:100028. [PMID: 37791233 PMCID: PMC10546507 DOI: 10.1016/j.focus.2022.100028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Pregnancy is a time of increased healthcare screening, and past adherence to evolving guidelines informs best practices. Although studies of Group B Streptococcus guideline adherence have focused primarily on treatment of Group B Streptococcus carriers, this study broadly evaluated long-term adherence to both Group B Streptococcus screening and treatment guidelines. Adherence was evaluated across provider types (obstetrics and gynecology, certified nurse midwives, and family medicine). Methods We conducted a retrospective cohort study. Demographic and clinical information were extracted from all prenatal care and delivery patients at a single institution in a single year. Vancomycin prescriptions in pregnancy were tracked for 10 years to determine long-term adherence. Adherence was defined as no deviation from 2010 Group B Streptococcus screening and treatment guidelines. Results Adherence occurred in 89% (1,610/1,810) of patients. Reasons for deviations from guidelines could not always be determined. There was no significant difference in maternal age, race, prenatal provider type, provider type at delivery, gestational age at delivery, delivery mode, or whether antibiotic sensitivities were performed between compliant and noncompliant groups. Significant differences in adherence were found between obstetric clinics (high-risk obstetrics clinic, maternal‒fetal medicine fellows clinic, continuity of care clinic, and faculty private clinic) (p<0.0001) and between the faculty family medicine clinic and resident family medicine clinic (p=0.001). Vancomycin prescription practice did not change significantly over the10-year period. Conclusions High rates of adherence to Group B Streptococcus screening and treatment guidelines in pregnancy have positive implications for reducing antibiotic resistance. Given evolving guidelines, there is a need to periodically evaluate adherence and to re-educate providers about standard practices and best documentation practices.
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Affiliation(s)
- Donna A. Santillan
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Alexander J. Hubb
- Carver College of Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa
- Department of Obstetrics & Gynecology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Taryn E. Nishimura
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Sandra R. Rosenfeld-O'Tool
- Department of Family Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa
- Department of Family Medicine, University of New Mexico Hospital, Albuquerque, New Mexico
| | - Kathleen J. Schroeder
- Department of Family Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa
- Department of Family Medicine, Northwestern Medicine Central DuPage Hospital, Wheaton, Ilinois
| | - Jona M. Conklin
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
- MercyOne Perinatal Center, Perinatal Center of Iowa, Des Moines, Iowa
| | - Alexandra E. Karras
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Serena B. Gumusoglu
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Debra S. Brandt
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Emily Miller
- College of Nursing, The University of Iowa, Iowa City, Iowa
- UCHealth, Loveland, Colorado
| | - Stephen K. Hunter
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Mark K. Santillan
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
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Pangerl S, Sundin D, Geraghty S. Adherence to screening and management guidelines of maternal Group B Streptococcus colonization in pregnancy. J Adv Nurs 2022; 78:3247-3260. [PMID: 35429021 PMCID: PMC9546437 DOI: 10.1111/jan.15249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/22/2022] [Accepted: 03/11/2022] [Indexed: 12/03/2022]
Abstract
Aims To investigate Group B Streptococcus (GBS) colonization in pregnancy; adherence to antenatal GBS screening and adherence to the intrapartum antibiotics protocol within two models of care (midwifery and non‐midwifery led). Design This retrospective quantitative study has employed a descriptive design using administrative health data. Methods Data from five maternity hospitals in metropolitan and regional Western Australia that included 22,417 pregnant women who gave birth between 2015 and 2019 were examined, applying descriptive statistics using secondary data analysis. Results The study revealed an overall GBS colonization rate of 21.7% with similar rates in the different cohorts. A lower adherence to screening was found in the midwifery led model of care (MMC, 68.76%, n = 7232) when compared with the non‐midwifery led model of care (NMMC, 90.49%, n = 10,767). Over the 5 years, screening rates trended down in the MMC with stable numbers in the counterpart. Adherence in relation to intrapartum antibiotic prophylaxis revealed discrepant findings between the study groups. Conclusion Adherence to screening and management guidelines of maternal GBS colonization in pregnancy is lower within the MMC when compared with the NMMC. Impact This is the first cohort study to describe the adherence to the recommended Western Australian GBS screening guidelines in the two different models of care. Findings may assist in the guidance and improvement of clinical protocols as well as the planning of clinical care in relation to GBS screening to reduce the risk of neonatal GBS infection.
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Affiliation(s)
- Sabine Pangerl
- King Edward Memorial Hospital Perth Western Australia Australia
| | - Deborah Sundin
- Edith Cowan University Perth Western Australia Australia
| | - Sadie Geraghty
- The University of Notre Dame Australia Fremantle Western Australia Australia
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Poor Adherence to the Screening-Based Strategy of Group B Streptococcus Despite Colonization of Pregnant Women in Greece. Pathogens 2021; 10:pathogens10040418. [PMID: 33915970 PMCID: PMC8067163 DOI: 10.3390/pathogens10040418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/17/2021] [Accepted: 03/28/2021] [Indexed: 02/05/2023] Open
Abstract
Group B streptococcus (GBS) is a leading cause of serious neonatal infections. Maternal GBS colonization is associated with early- and late-onset neonatal disease (EOD/LOD). In Greece, a screening-based strategy is recommended, in which concurrent vaginal-rectal cultures should be obtained between 36 0/7 and 37 6/7 weeks’ gestation. We sought to examine the level of adherence to the GBS screening guidelines and estimate the prevalence of GBS colonization among pregnant women. Although in Greece the screening-based strategy is followed, we also examined known EOD risk factors and linked them to GBS colonization. A cross-sectional study of 604 women postpartum in three hospitals and maternity clinics was conducted. Following written informed consent, data were collected via a short self-completed questionnaire and review of patients’ records. In 34.6% of the enrolled pregnant women, no culture had been taken. Of the remaining, 12.8% had proper vaginal-rectal sample collections. The overall maternal colonization rate was 9.6%. At least one risk factor for EOD was identified in 12.6% of participants. The presence of risk factors was associated with positive cultures (p = 0.014). The rate of culture collection did not differ between women with or without an EOD risk factor. Adherence to a universal screening of pregnant women with vaginal-rectal cultures was poor. Despite probable underestimation of GBS carrier status, almost 1 in 10 participants were GBS positive during pregnancy. Screening of women with risk factors for EOD should, at least, be prioritized to achieve prevention and prompt intervention of EOD.
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