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joi, 15 decembrie 2011

1 In 50 Babies Has Birth Defect: Report Highlights Worrying Gaps In Regional Monitoring

Main Category: Pediatrics / Children's Health
Also Included In: Heart Disease;  Neurology / Neuroscience;  Pregnancy / Obstetrics
Article Date: 15 Dec 2011 - 0:00 PST

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More than one baby in every 50 is born with a birth defect (congenital anomaly) according to the latest annual report by the British Isles Network of Congenital Anomaly Registers (BINOCAR) - significantly more common than previously reported estimates of around one in 80.

The study* - led by researchers at Queen Mary, University of London and commissioned by the Healthcare Quality Improvement Partnership (HQIP) - is the most up-to-date and comprehensive of its kind, bringing together existing data in England and Wales from 2005 to 2009.

However, the report's authors remain concerned that data for substantial parts of the country, including London, are not currently monitored, meaning large regional increases in birth defects could go unnoticed and their causes not investigated.

"This is a major issue," commented Joan Morris, Professor of Medical Statistics at Queen Mary, University of London and editor of the report. "It is essential we know how many babies are being born with anomalies and how good their survival is across the whole country, so we can identify ways to reduce the occurrence of anomalies and plan for the care of these babies."

This national report includes data from five regional registers and two disease specific national registers†. Three additional registers exist and it is hoped that with further funding they will contribute data to future reports. Currently there are no registers in London and the South East, the North West and East Anglia.

Professor Elizabeth Draper from the University of Leicester who is Chair of BINOCAR commented: "This report is important, not least because it highlights the need to increase the number of regional registers in England. We are very grateful for the ongoing support from HQIP, but to provide national coverage will require a sustained commitment of additional resources. Funding for national surveillance of congenital anomalies is being considered as part of the surveillance program in Public Health England and we hope it will be in place by April 2013."

The number and types of birth defects have been monitored since the thalidomide epidemic in the 1960s. Under the original system, cases were notified to the Office for National Statistics by doctors, nurses, midwives and health visitors. Since the 1980s, regional registers have been established in some parts of the country to actively collect data from hospitals, laboratories and health records.

In the intervening years, lack of strategic funding coupled with a lack of support at national level has led to the closure of the national system and some of the regional registers. This report collates data from five regional registers, which together cover 28 per cent of the population of England and Wales, leaving the vast majority of birth defects unreported. Previous estimates, based on data from the Office for National Statistics, suggested that 1.3 per cent of babies have a birth defect. The new report indicates that the figure is more than two per cent. The researchers estimate that there were at least 14,500 babies born with birth defects in England and Wales in 2009. The most common defect was congenital heart disease, which affects at least five in 1,000 births. Some cases require major operations and around six per cent of babies born with a heart defect will die before the age of one. Neural tube defects, such as spina bifida, affect one in 1,000 babies, many of these may be prevented by women taking folic acid supplements before becoming pregnant. Gastroschisis - a defect where the intestines develop outside the abdomen - affect one in 1,000 babies. Regional monitoring has shown that this condition has become more common in some areas including Wales and that babies born to younger mothers are at greater risk. Over half of all major birth defects were detected during pregnancy. Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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marți, 13 decembrie 2011

Blood Pressure Monitoring: Room For Improvement

Main Category: Hypertension
Article Date: 13 Dec 2011 - 0:00 PST

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Inaccurate blood pressure measurements due to faulty technique impact hypertension treatment decisions

Because some clinicians fail to stick to official recommendations for blood pressure monitoring, a number of patients are misclassified, which could have an impact on decisions about their treatment. According to Gretchen Ray and colleagues, from the University of New Mexico College of Pharmacy, when routine blood pressure monitoring in clinics is compared with measurements based on the latest guidelines, 93 percent of patients have different blood pressure readings. The findings appear online in the Journal of General Internal Medicine, published by Springer.

In 2005, the American Heart Association (AHA) released updated recommendations for blood pressure monitoring, to ensure accurate and consistent blood pressure measurements. Numerous factors including body position, arm position, inter-arm differences, cuff size and cuff placement can affect the reading.

Ray and colleagues compared the blood pressure readings of 40 patients obtained by the traditional method routinely used in clinics, as well as by the AHA-recommended method. Based on these two readings for each patient, the researchers produced two medical profile summaries (one for each technique used), covering past medical history, medication list, drug allergies, vital signs, presence or absence of pain, physical examination and laboratory findings, as well as the last two blood pressure readings. These profiles were reviewed by three physicians who provided hypothetical hypertension treatment recommendations.

Ray and colleagues found that overall, individual blood pressure measurements varied greatly between the two methods. As many as 93 percent of patients had a significant blood pressure difference between the two readings (either over 5 mmHg systolic or over 2 mmHg diastolic), with implications for potential cardiovascular complications.

The researchers observed multiple technical errors during the method that most likely accounted for differences between the blood pressure readings. Out of ten possible errors (as defined by the AHA), the average number of errors per patient during the traditional assessment was four. The most common technical error was the absence of measurements on both arms, presumably to save time during measurement. The time to measure blood pressure using the AHA method was over eight minutes (due to the required five minute resting period between arm measurements) versus two minutes using the traditional method.

According to the hypertension medication treatment decisions provided by the three physicians, 45 percent of patients would have received different treatments based on their two blood pressure measurements.

Ray concludes: "Inaccurate blood pressure assessment is common and may impact hypertension treatment. Clinic staff need to be educated on the AHA recommendations for accurate blood pressure measurement, and encouraged to follow them in order to obtain a more accurate reading. More accurate blood pressure measurement could result in improved hypertension management decisions."

Article adapted by Medical News Today from original press release. Source: Springer Science+Business Media
Visit our hypertension section for the latest news on this subject. Springer Science+Business Media Please use one of the following formats to cite this article in your essay, paper or report:

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Springer Science+Business Media. "Blood Pressure Monitoring: Room For Improvement." Medical News Today. MediLexicon, Intl., 13 Dec. 2011. Web.
13 Dec. 2011. APA

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