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ACOG Issues New Guidelines On Fetal Monitoring To Resolve Inconsistencies In Interpretation
The American College of Obstetrics and Gynecology recently published new guidelines on electronic fetal monitoring in an attempt to increase consistency in the way physicians interpret and act on the results, the New York Times reports. Electronic fetal monitoring, which was introduced in the 1970s, is used during labor for more than 85% of the four million infants born alive in the U.S. annually, the Times reports. According to the Times, use of fetal monitors became standard obstetrical practice before it was known if the benefits outweighed the risks. The new guidelines refine the meaning of various readings from fetal monitors and could help doctors make better decisions about whether to intervene during labor.According to experts, the widespread adoption of fetal monitoring has produced both negative and positive consequences, including significant increases in caesarean deliveries and the use of forceps during vaginal deliveries. Monitoring has not been found to reduce the risk of either cerebral palsy or fetal death resulting from inadequate oxygen to the fetal brain, as it was intended to do. Furthermore, lawyers commonly use monitoring results to support malpractice cases that might have little merit, which in turn has driven rising malpractice insurance costs and prompted some obstetricians to stop delivering infants.The new guidelines divide monitor readings into three categories to help doctors interpret readings more consistently. The old guidelines had two categories -- reassuring and non-reassuring -- and it was up to the obstetrician to determine whether a non-reassuring reading required intervention. Under the new guidelines, the first category applies when tracings of the fetal heart rate are normal and no specific action is required. The second category is for indeterminate tracings that require evaluation, continuous surveillance and re-evaluation. Obstetricians treating patients in this category should consider other clinical factors that could affect the fetus and whether the patient could be safely moved to category one, according to Catherine Spong of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which produced recommendations on which the guidelines are based. The final category is for abnormal tracings that require immediate evaluation and efforts to reverse the abnormal heart rate. The Times reports that more refinements to the guidelines are expected to be released in 2010 (Brody, New York Times, 7/7).

Complaints Of Fatigue And Tiredness In People With OSA Improve With CPAP Treatment
A study in the June 15 issue of the Journal of Clinical Sleep Medicine shows that the complaints of fatigue and tiredness in patients with obstructive sleep apnea (OSA) improved significantly with good adherence to continuous positive airway pressure (CPAP) therapy, suggesting that - like the symptom of excessive daytime sleepiness - these complaints are important symptoms of OSA.
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Three Hospitals Honored For Commitment To Quality
Three U.S. hospitals were recognized today for their leadership and innovation in quality, safety and commitment to patient care. The 2009 American Hospital Association-McKesson Quest for Quality Prize® was awarded to Bronson Methodist Hospital in Kalamazoo, Mich., which will receive $75,000. Bronson Methodist Hospital, a 380-bed hospital serving patients and communities in southwest Michigan and northern Indiana, was selected by a multi-disciplinary committee of health care quality and patient safety experts based on its culture of quality and efforts to achieve the Institute of Medicine"s six quality aims for health care. Beth Israel Deaconess Medical Center in Boston was honored as the finalist and will receive $12,500. Duke University Hospital in Durham, N.C., received the Citation of Merit.
Diagnostics

Oral Evidence Continues On The Tobacco And Primary Medical Services Bill, Scotland

Oral evidence to the Scottish Parliament"s Health and Sport Committee on the Tobacco and Primary Medical Services (Scotland) Bill has now begun. This Bill proposes to ban the use of tobacco vending machines and to ban the display of tobacco products. Rod Bullough, due to give evidence on 20 May on behalf of the vending machine industry states, "We have put forward the potential number of people and businesses that will be affected by this proposed ban. These people hadn"t been taken into consideration; it was as if they didn"t exist. We are hoping that they will take heed of these figures and give consideration to the 14 companies based in Scotland." There are 14 independent and one national vending machine operator in Scotland employing over 40 staff, and over 3,500 machines. A ban on vending machine sales of tobacco will destroy these companies and livelihoods. Initial debate by the Scottish Government Bill team revealed irregularities in how the Bill had been handled. Mary Cuthbert, head of the tobacco control team, had to issue a correction on the number employed by the vending machine industry, and was also questioned on how this law could be upheld at sea since the government had no jurisdiction outside 12 miles of the coast. Ross Finnie MSP pointed out that the policy proposals treat tobacco as more dangerous than alcohol, since it must be hidden from potential customers. Under these circumstances, he asked why the police had not been involved right from the start of consultations. Given the radical change in the government"s treatment of tobacco he would not accept the answer that "it is trading standards officers who implement tobacco sales law". This line of questioning draws attention to the enormity of the proposals, and the issues for agencies that must implement them. Eddie Douthwaite of Freedom To Choose (Scotland) is surprised that he has not been invited to give evidence along with other respondents to the consultation. "We are the only independent voice, representing the general public," he states. "We have previously petitioned the government as these consultations are unworthy of the Scottish parliament. They should be based on accurate information and solid, scientific data and these consultations are not." The Tobacco Retailers" Association will also be providing evidence on the same day and Freedom To Choose (Scotland) are fully aware of their concerns. "In Canada, where displays of tobacco have been banned, there has been no change in youth-smoking prevalence, and in Saskatchewan, the highest prevalence is found where the first display bans took place," Eddie Douthwaite continues. "Similar results occurred in Iceland where youth smokers actually increased by 3.1% after the display ban. I find it hard to believe that this failed policy is being considered in Scotland and understand the fury amongst retailers who now find they face financial burdens during these hard economic times." Scottish Parliament


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