The case for increased use of cadavers.

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ObjectiveMeasure fetal brain volume and surface area at specific developmental time points. Several studies describe cerebral cortical development; none attempt to measure this.DesignTo allow measurement throughout fetal development specimens at 10.5, 14.5, 16, 19, 24, 28 and 32 weeks gestational age were chosen.Subjects and MethodsThe Smith Collection of four fetal specimens and three separate fetal specimens were scanned with permission from the University of Edinburgh Anatomy department. T2 high-resolution MRI scans were performed. Brain volume was measured using the Cavalieri section method and application of stereological methods was used to estimate brain surface area.ResultsFetal brain volume shows a non-linear increase with exponential increase in volume after week 24. Fetal brain surface area shows a non-linear increase with exponential increase in surface area after week 24.ConclusionCombined with current literature this data confirms that there is a non-linear rate of fetal brain development; the rate of gyri and sulci development corresponds to fetal brain volume and surface area increase. This has clinical implications in assessment and diagnosis of abnormal fetal and neonatal brain development. The data presented here could be used as a baseline for comparison of fetal and neonatal data within a neurological setting, e.g., assessment of brain development in congenital and neonatal brain malformations such as hydrocephalus or ventriculomegaly, congenital infections and assess the impact of acquired conditions such as hypoxic injury, haemorrhage, arachnoid cysts and fetal tumours.

Introduction The National Confidential Enquiry into Perioperative Deaths (NCEPOD) report recommended that ‘fluid prescribing be given the same value as drug prescribing’, yet fluid prescription is commonly delegated to junior doctors despite being a notoriously challenging topic. When antibiotics are given as an infusion they are diluted in 100ml of fluid, which is often unaccounted for when thinking about a patient’s fluid requirements. This closed-loop audit aimed to assess first, intravenous (IV) fluid therapy and second, electrolyte prescribing compliance with National Institute for Health and Care Excellence (NICE) guidelines, with and without the additional fluid given with antibiotic administration. Methods Two retrospective audits were performed. Total fluid and electrolyte volume received with and without antibiotic fluids was correlated with recommendations in the NICE guidelines. Between cycles 1 and 2, potassium chloride with sodium chloride and glucose (PSG) was introduced as an alternative to IV maintenance fluid, and bolusing of antibiotics was mandatory. Results When analysing total fluid volume input per day, 10.4% and 7.45% of patients met their fluid requirement accurately in the first and second cycles, respectively. Within cycle 1, the mean total additional fluid that was given over 3 days with antibiotics was 1,572.73ml. In cycle 2, this decreased to 469.44ml when antibiotics were given as a bolus. Conclusions In this closed-loop audit we noted that patients receiving IV fluids and IV antibiotics received too much additional fluid when the antibiotic dilution fluid was taken into account. Additional fluid was reduced alongside the proportion of electrolyte complications when bolusing of antibiotics was introduced. We recommend that that all nurses are trained to give antibiotics as a bolus because it can help to reduce fluid-related complications.