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Objective To highlight the errors associated with the use of anti- D immunoglobulin in Rh D antigen-negative women, and their resultant clinical impact during and after pregnancy, and to suggest strategies to reduce these errors. Design Retrospective review of cumulative reporting to the UK confidential haemovigilance scheme, Serious Hazards of Transfusion ( SHOT), between 1996 and 2011. Setting Obstetric departments in the UK. Population Mothers who require anti- D immunoglobulin to prevent Rh D sensitisation during pregnancy or after birth. Methods Hospital transfusion teams reported adverse events to the SHOT database. Main outcome measures Reported number of events and their causes, and morbidity and mortality associated with errors. Results In 15 years of reporting, SHOT haemovigilance has shown a total of 1211 errors related to the administration of anti-D immunoglobulin, particularly regarding omission or late administration (157/249 or 63% reported in 2011). Anti-D immunoglobulin errors comprised 13.7% (249/1815) of all SHOT reports in 2011. Failure to recognise women who already have Rh D sensitisation occurred in 19 cases, and was followed by suboptimal monitoring of the pregnancy. Nine of the infants suffered haemolytic disease of the fetus and newborn ( HDFN): one resulted in neonatal death and three required red cell transfusion. Conclusions Babies as well as their mothers remain at risk from avoidable errors. More active attention at national and local levels to further education and training, particularly for midwives, is an absolute necessity. We recommend the use of a SHOT-devised anti- D administration flowchart, adapted locally into a checklist, to help reduce errors. [ABSTRACT FROM AUTHOR]

Williams Syndrome (WS) is a neurodevelopmental disorder of genetic origin, characterised by relative proficiency in language in the face of serious impairment in several other domains. Individuals with WS display an unusual sensitivity to noise, known as hyperacusis. In this study, we examined the extent to which hyperacusis interferes with the perception of speech in children and adults with WS. Participants were required to discriminate words which differed in one consonant of a cluster when these contrasts were embedded in a background of noise. Although the introduction of noise interfered with performance on a consonant cluster discrimination task equally in the WS and control groups, the severity of hyperacusis significantly predicted individual variability in speech perception within the WS group. These results suggest that alterations in sensitivity to input mediate atypical pathways for language development in WS, where hyperacusis exerts an important influence together with other non-auditory factors. [ABSTRACT FROM AUTHOR]

Between 1996 and 2005 the Serious Hazards of Transfusion (SHOT) scheme analysed 3239 reports of adverse reactions and events associated with transfusion of labile blood components in the UK. 321 reports (10%) related to transfusion of children under 18 years and 147/3239 (4·5%) to infants less than 12 months of age. There were 264 cases in children of ‘incorrect blood component transfused’, resulting from errors at all stages in the transfusion chain; 26/264 suffered actual or potential morbidity. Thirty acute transfusion reactions, three delayed transfusion reactions, 20 cases (three fatal) of transfusion-related acute lung injury, two cases (both fatal) of transfusion-associated graft-versus-host disease and two transfusion transmitted infections were reported. A population-based epidemiological study of transfused patients in 2004 showed that 4·2% of red cells are transfused to patients less than 18 years and 1·7% to infants less than 12 months. Interpretation of SHOT data against this context enabled the estimation of the incidence of an adverse outcome to be 18:100 000 red cells issued for children less than 18 years and 37:100 000 for infants less than 12 months, compared to 13:100 000 for adults. Adherence to relevant guidelines, knowledge of specialist transfusion needs of children and good communication are essential if this risk is to be reduced. [ABSTRACT FROM AUTHOR]

The article discusses a qualitative study that reveals a range of possible ergonomic risk factors that may result in hand pain among an understudied group of health care practitioners. The Health and Safety Executive maintains that work-related musculoskeletal disorders are the most common reported type of work-related illness in Great Britain. The ergonomic risk factors include repetition, high force exertions and fatigue.

The article presents information on the recommended minimum standards for hospital transfusion laboratories in Great Britain by Transfusion Laboratory. It is recommended that the staffing levels and skill mix will be adequate to ensure the safe and effective delivery of routine and emergency services. And, a senior member of staff will be available to provide appropriate specialist transfusion advice.

The association between Medically Assisted Reproduction (MAR) and thromboembolic complications has been reported widely in multiple published studies. Although venous thromboembolism (VTE) is not thought to be a common complication of MAR, it is associated with high morbidity and is often preventable. Since VTE usually occurs after completion of MAR treatment and is often managed outside of the treating fertility unit, these complications are likely to be underreported and there may be limited awareness of the risks among clinicians. As we continue to see a rise in the total number of MAR treatment cycles, particularly in women over 40 years of age, along with a steady increase in the number of fertility preservation cycles for both medical and social indications, it is likely that we will see an increase in absolute numbers of VTE complications. Currently, there is a lack of management guidance and reporting of VTE events associated with assisted conception treatment. The aim of this guidance is to provide clinicians with information on VTE risk factors, guidance on assessing VTE risk and the best practice recommendations on risk reducing strategies for individuals at risk of VTE undergoing ovarian stimulation and embryo transfer cycles.

Background It is likely that a proportion of poststroke cognitive impairment is sometimes attributable to unidentified prestroke decline; prestroke cognitive function is also clinically relevant because it is associated with poor functional outcomes, including death. We investigated the radiological and prognostic associations of preexisting cognitive impairment in patients with ischemic stroke or transient ischemic attack associated with atrial fibrillation. Methods and Results We included 1102 patients from the prospective multicenter observational CROMIS-2 (Clinical Relevance of Microbleeds in Stroke 2) atrial fibrillation study. Preexisting cognitive impairment was identified using the 16-item Informant Questionnaire for Cognitive Decline in the Elderly. Functional outcome was measured using the modified Rankin scale. Preexisting cognitive impairment was common (n=271; 24.6%). The presence of lacunes (odds ratio [OR], 1.50; 95% CI, 1.03-1.05; P =0.034), increasing periventricular white matter hyperintensity grade (per grade increase, OR, 1.38; 95% CI, 1.17-1.63; P <0.0001), deep white matter hyperintensity grade (per grade increase, OR, 1.26; 95% CI, 1.05-1.51; P =0.011), and medial temporal atrophy grade (per grade increase, OR, 1.61; 95% CI, 1.34-1.95; P <0.0001) were independently associated with preexisting cognitive impairment. Preexisting cognitive impairment was associated with poorer functional outcome at 24 months (mRS >2; adjusted OR, 2.43; 95% CI, 1.42-4.20; P =0.001). Conclusions Preexisting cognitive impairment in patients with atrial fibrillation-associated ischemic stroke or transient ischemic attack is common, and associated with imaging markers of cerebral small vessel disease and neurodegeneration, as well as with longer-term functional outcome. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02513316.

Objective: To highlight the errors associated with the use of anti-D immunoglobulin in RhD antigen-negative women, and their resultant clinical impact during and after pregnancy, and to suggest strategies to reduce these errors., Design: Retrospective review of cumulative reporting to the UK confidential haemovigilance scheme, Serious Hazards of Transfusion (SHOT), between 1996 and 2011., Setting: Obstetric departments in the UK., Population: Mothers who require anti-D immunoglobulin to prevent RhD sensitisation during pregnancy or after birth., Methods: Hospital transfusion teams reported adverse events to the SHOT database., Main Outcome Measures: Reported number of events and their causes, and morbidity and mortality associated with errors., Results: In 15 years of reporting, SHOT haemovigilance has shown a total of 1211 errors related to the administration of anti-D immunoglobulin, particularly regarding omission or late administration (157/249 or 63% reported in 2011). Anti-D immunoglobulin errors comprised 13.7% (249/1815) of all SHOT reports in 2011. Failure to recognise women who already have RhD sensitisation occurred in 19 cases, and was followed by suboptimal monitoring of the pregnancy. Nine of the infants suffered haemolytic disease of the fetus and newborn (HDFN): one resulted in neonatal death and three required red cell transfusion., Conclusions: Babies as well as their mothers remain at risk from avoidable errors. More active attention at national and local levels to further education and training, particularly for midwives, is an absolute necessity. We recommend the use of a SHOT-devised anti-D administration flowchart, adapted locally into a checklist, to help reduce errors., (© 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.)