Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Objective To assess in women with early-onset severe preeclampsia whether longitudinal changes in angiogenic factors improve the prediction of adverse outcome. Design Prospective cohort study. Setting Maternity units in two Spanish hospitals. Population Women with diagnosis of early-onset severe pre-eclampsia. Methods Levels of placental growth factor (PlGF), soluble fms-like tyrosine kinase (sFlt-) and sFlt-1/PlGF ratio were measured at admission and before delivery, and average daily change calculated. The association of longitudinal changes of angiogenic factors with the time interval to delivery and with complications was evaluated by logistic and Cox regression. Main outcome measures Interval to delivery and composite of adverse outcomes. Results We included 63 women, of which 26 (41.3%) had a complication. Longitudinal changes of sFlt-1 were more pronounced in complicated pregnancies (median: 1047 versus 342 pg/ml/day; P = 0.04). On the multivariate analysis, the clinical risk score and sFlt-1 at admission explained 6.2% of the uncertainty for complication; the addition of sFlt-1 longitudinal changes improved this to 25.3% (P = 0.002). The median time from admission to delivery was 4 days (95% CI 1.6-6.04) in those in the highest quartile of sFlt-1 longitudinal changes versus 16 days (95% CI 12.4-19.6) in the remaining women (Log-rank test P < 0.001). Conclusions Longitudinal changes in sFlt-1 maternal levels from admission for confirmed early-onset severe pre-eclampsia add to baseline characteristics in the prediction of adverse outcome and interval to delivery.

Objective This study aims to predict perinatal death or severe sequelae in isolated small‐for‐gestational‐age fetuses, diagnosed at a periviable gestational age, based on ultrasound and Doppler parameters at diagnosis. Design Observational study. Setting A tertiary perinatal centre. Population A cohort of singleton non‐malformed fetuses suspected to be small for gestational age (estimated fetal weight, EFW, <10th centile) diagnosed at 22.0–25.6 weeks of gestation. The following parameters were recorded at diagnosis: severe smallness (<3rd centile); absent or reversed end‐diastolic velocity in umbilical artery; abnormal middle cerebral artery Doppler; abnormal cerebroplacental ratio; abnormal uterine artery Doppler; and absent or reversed end‐diastolic velocity in the ductus venosus. Methods Logistic regression analysis. Main outcome measures Predictive performance of EFW and Doppler parameters for short‐term adverse outcome of perinatal morbimortality and composite serious adverse outcomes (death, neurological impairment or severe bronchopulmonary dysplasia). Results A total of 155 pregnancies were included. There were 13 (8.4%) intrauterine and 11 (7.7%) neonatal deaths. A short‐term adverse perinatal outcome occurred in 40 (25.8%) pregnancies. There were 31 (20%) cases of serious adverse outcomes. For the prediction of serious adverse outcomes, the combination of absent or reversed end‐diastolic velocity in the umbilical artery and impaired middle cerebral artery detected by Doppler evaluation achieved a detection rate of 87%, with a false‐positive rate of 14% (accuracy 86%). Conclusion In periviable isolated small‐for‐gestational‐age fetuses, a Doppler evaluation of the umbilical and fetal brain circulation can accurately predict short‐term adverse perinatal complications and serious adverse outcomes.

Descriptive cross-sectional study which uses self-administered surveys to evaluate the data from three independent samples: professionals, relatives of users of the tracking device and relatives of users who do no use it. Methods: specific survey for 30 professionals. For 7 relatives of users who make use of the device: Quebec survey (QUEST 2.0), Zarit scale and caregiver strain index. For 7 relatives of users who do not make use of the device: Zarit Scale and caregiver strain index. Results: 20% of the professionals are aware of the existence of some kind of gps device, only 13.3% can specify the sort of gps. The benefits with the highest score in the Liker scale from 0 to 5 are the tranquillity of the family (4.60), followed by the need of information (4.46), and the item with the lowest score is the tranquillity of the user (3.79). Among those patients carrying a tracking device, 85.71% are men, whereas this percentage turns to a 71,43% among those who do not carry a tracking device. The burden degree of caregivers is an average of 77.86% in those who do not use a tracking device, whereas it goes down to 66.58% in those who do. Caregivers using the tracking device get a 57.1% of greater burden, and a 14.3% of minimum burden. Caregivers who do not use the tracking device get a 100% of greater burden. In the strain index test the results show that a 92.9% of caregivers reach high levels of burden, whereas for 7.1% there was no strain at all. 84.6% of caregivers are women. Conclusions: professionals do not know the tracking device, and the burden of caregivers decreases when they use it. The use of the tracking device should be discussed in an ethical debate by professionals of all areas and relatives of patients.