No abstract

SUMMARY It has been suggested that because of vascular interchange between the monozygous twins vascular disruptions from a deceased cotwin with disseminated intravascular coagulation causes embolisation in the surviving twin. This study reports six cases in which all the surviving monozygous twins had central nervous system infarcts and three had multiple organ infarcts, including pulmonary and hepatic infarcts, which have not been reported previously. Fetal death in utero occurred 1-11 weeks before the live birth of the monozygous survivor. In three cases there was pathological confirmation of a continuing process with infarcts ranging in age from a few days to eight weeks. Four infants died in the early neonatal period, and the remaining two survived with considerable handicap. A review of the published reports confirmed the high risk of vascular disruption affecting many organ systems and the extremely poor prognosis for subsequent death or handicap. We recommend that after detection of fetal death in utero in a suspected monozygous twin pregnancy careful consideration should be given to prompt delivery of the survivor and investigations should be carried out to rule out infarction in the central nervous system and other organs that are at risk.

Use of ELS significantly increased after the training day most commonly supporting a decision to stop resuscitation. This change in practice has been maintained.

Medical inpatients often have important risk factors for venous thromboembolism (VTE). In our institution, VTE prophylaxis in this group was underused. The main barriers identified were inattention to VTE prophylaxis, competing priorities and lack of confidence in the decision-making. We aimed to improve the rate of VTE prophylaxis use by introducing a paper-based risk assessment tool, with actionable management recommendations within the prescription chart. The rationale was that an assessment tool at the point of prescribing can reduce steps between decision-making and prescribing process, thus promoting confidence and acting as a reminder. A total of 552 prescription charts completed over a period of 29 weeks were examined during the baseline period. In the postintervention period, 871 charts completed over 40 weeks period were examined. The risk assessment tool was completed in 51% of the cases examined in the postintervention period. The introduction of the risk assessment tool was associated with a significant change in the pattern of VTE pharmacological prophylaxis use. The change occurred when the form was made highly visible and enclosed in the prescription chart. The pharmacological prophylaxis use was higher with a completed assessment form than without (mean (SD) 97.5% (7.6%) vs 70.1% (19.4%); p<0.0001). The rate of appropriate prophylaxis decision was 98.2% (SD 5.2%) with a completed assessment form, and 80.7% (SD 17.9%) when it was not used. The qualitative interviews revealed positive themes; many users found it useful, easy and convenient to use. Our data have shown that a paper-based VTE risk assessment tool placed within the prescription chart could substantially improve the rate of appropriate assessment and VTE prophylaxis implementation. This suggests that tool clearly needs to be a seamless integration into the workflow to capture users’ attention and mitigate the influence of time perception.

History: Objectives: Recent studies have reported that playing golf has overall physical and mental health benefits. Through being placed in the sun for extended periods of time, the golfing population faces an increased risk of ultraviolet radiation (UVR) associated skin problems, most importantly skin cancer. Our aim was to collate and summarise current literature on the relationship between golf and skin cancer. Methods: We searched multiple web-based, health-focused databases (Medline, Embase, Cinahl, Web of science, Scopus, Sportdiscus, UK clinical trials, Current controlled trials and Prospero) to identify records. Relevant papers were critically appraised and reported using a descriptive analysis. Results: A total of 11 studies are included in the review. Golf is associated with relatively more UVR exposure than other outdoor activities such as fishing, tennis, pool swimming, cricket, gardening, 'sun-worshipping' and sailing. Calculated relative risk of non-melanoma skin cancer, based on cumulative UV exposure, is higher in golfers than non-golfers. Mid morning tee-times or playing golf between 11am-3pm associated with highest UVR exposures. Golfers can be exposed to potentially harmful levels of UVR during play in winter at some latitudes. Vertex (scalp), shoulders, back, back of neck and posterior arms exposed to more UVR than front of body during play. Common golf attire is of limited value in protecting the neck. Targeted skin cancer skin cancer prevention and early detection campaigns are well received among the golfing population. Conclusions: Overall, playing golf is associated with longevity and both physical and mental health benefits. Studies to date indicate that golfers (professionals > recreational players) are exposed to potentially harmful levels of UVR during play, but the true morbidity/mortality associated with this exposure is not known. Playing golf should be encouraged in all age groups, though golfers, the golf industry and policy makers should act to minimize the harmful effects of UVR exposure, and have they have ability to also be hugely influential on an important public health message.