Prenatal diagnosis and psychological distress: Amniocentesis or chorionic villus biopsy?

The psychological reactions of 211 women undergoing prenatal diagnosis (PND) with amniocentesis (group A, n = 122) or chorionic villus biopsy (group V, n = 90) were exmained by questionnaires and interviews. The distress experienced while waiting for the test, during the test procedure, and while waiting for the result was reported by the women, both in questionnaires and in interviews. In the questionnaires, no difference between the two diagnostic methods was observed. In the interviews, however, the women undergoing amniocentesis appeared significantly more distressed by the procedure. In group A 97 per cent and in group V 100 per cent wished a method which, like chorionic villus biopsy, could be used in the first weeks of pregnancy. The risk of miscarriage was, as described in other studies, regarded as a serious threat by the pregnant women.     

Fetoscopic tracheal occlusion for treatment of non-isolated congenital diaphragmatic hernia

Fetoscopic endotracheal occlusion (FETO) is a prenatal treatment that may increase survival in severe congenital diaphragmatic hernia (CDH). In the USA, FETO is offered for isolated severe left-sided CDH in the context of an FDA-approved feasibility study. FETO in non-isolated cases of severe CDH is only performed with a compassionate use exemption from US regulatory bodies. Anomalies frequently associated with CDH include congenital cystic lesions of the lung and cardiac defects. We describe two cases of non-isolated severe left-sided CDH that underwent prenatal FETO, survived after birth and underwent postnatal surgical repair. The potential benefit of FETO in this setting is discussed. © 2017 John Wiley & Sons, Ltd.     

On-Scene Injury Severity Prediction (OSISP) Algorithm for Truck Occupants

Objective: The aim of this study is to develop an on-scene injury severity prediction (OSISP) algorithm for truck occupants using only accident characteristics that are feasible to assess at the scene of the accident. The purpose of developing this algorithm is to use it as a basis for a field triage tool used in traffic accidents involving trucks. In addition, the model can be valuable for recognizing important factors for improving triage protocols used in Sweden and possibly in other countries with similar traffic environments and prehospital procedures.

Methods: The scope is adult truck occupants involved in traffic accidents on Swedish public roads registered in the Swedish Traffic Accident Data Acquisition (STRADA) database for calendar years 2003 to 2013. STRADA contains information reported by the police and medical data on injured road users treated at emergency hospitals. Using data from STRADA, 2 OSISP multivariate logistic regression models for deriving the probability of severe injury (defined here as having an Injury Severity Score [ISS] > 15) were implemented for light and heavy trucks; that is, trucks with weight up to 3,500 kg and ??16,500 kg, respectively. A 10-fold cross-validation procedure was used to estimate the performance of the OSISP algorithm in terms of the area under the receiver operating characteristic curve (AUC).

Results: The rate of belt use was low, especially for heavy truck occupants. The OSISP models developed for light and heavy trucks achieved cross-validation AUC of 0.81 and 0.74, respectively. The AUC values obtained when the models were evaluated on all data without cross-validation were 0.87 for both light and heavy trucks. The difference in the AUC values with and without use of cross-validation indicates overfitting of the model, which may be a consequence of relatively small data sets. Belt use stands out as the most valuable predictor in both types of trucks; accident type and age are important predictors for light trucks.

Conclusions: The OSISP models achieve good discriminating capability for light truck occupants and a reasonable performance for heavy truck occupants. The prediction accuracy may be increased by acquiring more data. Belt use was the strongest predictor of severe injury for both light and heavy truck occupants. There is a need for behavior-based safety programs and/or other means to encourage truck occupants to always wear a seat belt.