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Article ; Online: Reducing laboratory costs through rational testing in suspected pre-eclampsia.

Jakes, Adam Daniel / Cox, Marsha / Drane, Simon / Johnson, Antoinette

BMJ open quality

2022 Volume 11, Issue 1

Abstract: The current electronic laboratory order set at Epsom and St Helier University Hospitals NHS Trust for suspected pre-eclampsia includes a full blood count, urea and electrolytes, liver function, gamma-glutamyltransferase and uric acid. Local and national ... ...

Abstract	The current electronic laboratory order set at Epsom and St Helier University Hospitals NHS Trust for suspected pre-eclampsia includes a full blood count, urea and electrolytes, liver function, gamma-glutamyltransferase and uric acid. Local and national guidelines do not recommend the use of gamma-glutamyltransferase or uric acid for the investigation or monitoring of pre-eclampsia, as they are poor predictors of maternal and neonatal outcomes. We aimed to remove the automatic inclusion of gamma-glutamyltransferase and uric acid from the electronic laboratory order set for suspected pre-eclampsia. Stakeholders were approached to gain an understanding of whether gamma-glutamyltransferase and uric acid were being used in the clinical assessment of suspected pre-eclampsia. Obstetric consultants and maternity staff confirmed that they do not use uric acid in their clinical assessment, despite the laboratory phoning with abnormal results. In addition, an isolated gamma-glutamyltransferase rise is of no particular significance and is not part of the National Institute for Health and Care Excellence (NICE) diagnostic criteria for pre-eclampsia. The baseline number of gamma-glutamyltransferase and uric acid requests from the maternity department was identified over 2 months. The hospital information technology service was then asked to remove gamma-glutamyltransferase and uric acid from the electronic laboratory order set. The number of gamma-glutamyltransferase and uric acid requests from the maternity department following the intervention was identified over 2 months. A significant reduction in both gamma-glutamyltransferase and uric acid requests were noted. In addition, the midwives within the maternity assessment unit noted a significant reduction in phone calls from the laboratory to escalate abnormal blood results. This has saved the trust money and reduced staff time answering phone calls regarding abnormal blood results. A repeat assessment at 8 months following the removal of gamma-glutamyltransferase and uric acid demonstrated sustainability of the project.
MeSH term(s)	Costs and Cost Analysis ; Female ; Humans ; Infant, Newborn ; Pre-Eclampsia/diagnosis ; Pregnancy ; Uric Acid ; gamma-Glutamyltransferase
Chemical Substances	Uric Acid (268B43MJ25) ; gamma-Glutamyltransferase (EC 2.3.2.2)
Language	English
Publishing date	2022-03-10
Publishing country	England
Document type	Journal Article
ISSN	2399-6641
ISSN (online)	2399-6641
DOI	10.1136/bmjoq-2021-001684
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Deranged liver function in pregnancy.

Jiwa, Afra / Jakes, Adam D / Banerjee, Anita

BMJ (Clinical research ed.)

2021 Volume 372, Page(s) n645

MeSH term(s)	Acetaminophen/toxicity ; Adult ; Aftercare ; Analgesics, Non-Narcotic/toxicity ; Antiemetics/therapeutic use ; Diagnosis, Differential ; Female ; Fluid Therapy/methods ; Humans ; Hyperemesis Gravidarum/complications ; Hyperemesis Gravidarum/diagnosis ; Hyperemesis Gravidarum/drug therapy ; Liver Diseases/blood ; Liver Diseases/etiology ; Liver Function Tests/methods ; Pregnancy ; Treatment Outcome ; Withholding Treatment
Chemical Substances	Analgesics, Non-Narcotic ; Antiemetics ; Acetaminophen (362O9ITL9D)
Language	English
Publishing date	2021-03-31
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.n645
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Article ; Online: Acute maternal confusion and neonatal seizure postpartum.

Jakes, Adam D / Lloyd, Jillian / Nelson-Piercy, Catherine

BMJ (Clinical research ed.)

2019 Volume 364, Page(s) k5399

MeSH term(s)	Adult ; Confusion/etiology ; Drinking ; Female ; Fluid Therapy/adverse effects ; Humans ; Hyponatremia/complications ; Hyponatremia/diagnosis ; Hyponatremia/therapy ; Infant, Newborn ; Postpartum Period ; Seizures/etiology
Language	English
Publishing date	2019-01-17
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.k5399
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Article ; Online: The maternal six week postnatal check.

Jakes, Adam D / Oakeshott, Pippa / Bick, Debra

BMJ (Clinical research ed.)

2019 Volume 367, Page(s) l6482

MeSH term(s)	Adult ; Aftercare/methods ; Female ; Humans ; Postnatal Care/methods ; Pregnancy ; Pregnancy Complications/therapy ; Puerperal Disorders/diagnosis
Language	English
Publishing date	2019-12-02
Publishing country	England
Document type	Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.l6482
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Article ; Online: Implementation of vaginal preparation prior to caesarean section.

Jakes, Adam D / Bell, Annie / Chiwera, Lilian / Lloyd, Jilly

BMJ open quality

2020 Volume 9, Issue 3

Abstract: Introduction: Surgical site infections following caesarean section are associated with significant morbidity. Vaginal preparation is the cleansing of the vaginal epithelium with an antibacterial solution to reduce the bacterial load and therefore reduce ...

Abstract	Introduction: Surgical site infections following caesarean section are associated with significant morbidity. Vaginal preparation is the cleansing of the vaginal epithelium with an antibacterial solution to reduce the bacterial load and therefore reduce ascending genital tract infection. It is recommended by the WHO and a Cochrane review in 2018 concluded that vaginal preparation immediately before caesarean section probably reduces the rates of postoperative endometritis. Objective: To implement vaginal preparation prior to caesarean section at Guy's and St Thomas' Hospital NHS Foundation Trust and reduce rates of deep surgical site infections. Methods: The protocol (included within the appendices) for vaginal preparation prior to caesarean section was developed after reviewing the available evidence. Two vaginal preparation champions, a midwife and a scrub nurse, were selected to help promote and assist in the implementation. The first implementation cycle included elective and category II and III caesarean sections. To ensure acceptability, 20 women were asked to complete a questionnaire following vaginal preparation. Once the intervention was being performed in >85% of eligible women, the inclusion criteria was expanded to include category I caesarean sections. Results: Twelve months following implementation, vaginal preparation was still being performed in 89% of eligible women. The deep surgical site infection rate is now the lowest recorded in the last 6 years. Vaginal preparation prior to caesarean section was acceptable to pregnant women and no adverse effects were reported. Conclusions: Vaginal preparation prior to caesarean section has been successfully implemented at Guy's and St Thomas' Hospital NHS Foundation Trust. This simple, cheap intervention, performed with readily available materials, is still being performed in a high number of caesarean sections 12 months post-implementation. It has resulted in a reduction in deep surgical site infections. Involvement of key stakeholders and the recruitment of vaginal preparation champions were key to success.
MeSH term(s)	Anti-Infective Agents, Local/therapeutic use ; Cesarean Section/methods ; Cesarean Section/standards ; Cesarean Section/statistics & numerical data ; Female ; Humans ; Pregnancy ; Preoperative Care/methods ; Surgical Wound Infection/prevention & control ; Vagina
Chemical Substances	Anti-Infective Agents, Local
Language	English
Publishing date	2020-08-12
Publishing country	England
Document type	Journal Article
ISSN	2399-6641
ISSN (online)	2399-6641
DOI	10.1136/bmjoq-2020-000976
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Article ; Online: Breast cancer-related lymphoedema and venepuncture: a review and evidence-based recommendations.

Jakes, Adam D / Twelves, Chris

Breast cancer research and treatment

2015 Volume 154, Issue 3, Page(s) 455–461

Abstract: Lymphoedema is a recognised complication of axillary surgery in women with early breast cancer. Such women are widely advised to avoid venepuncture on the ipsilateral side lest this cause complications including lymphoedema. This can lead to multiple ... ...

Abstract	Lymphoedema is a recognised complication of axillary surgery in women with early breast cancer. Such women are widely advised to avoid venepuncture on the ipsilateral side lest this cause complications including lymphoedema. This can lead to multiple failed venepuncture attempts causing distress to both patient and healthcare professional. We reviewed current guidelines and critically appraised the evidence relating the development of lymphoedema to venepuncture to educate healthcare professionals and develop evidence-based guidelines. A systematic search of bibliographic databases was performed and an Internet search undertaken to identify patient information leaflets from societies and support groups. Seven published articles were identified together with 15 published patient information leaflets. Only one small prospective study was identified (level of evidence 2), the remainder being case-control studies (level 3) or retrospective reviews (level 4). There is no good evidence that venepuncture can precipitate lymphoedema. New, patient-centred, evidence-based recommendations for venepuncture in women with breast cancer are proposed. Whenever possible, venepuncture should be performed on the contralateral arm. If this is not readily achieved, in the absence of lymphoedema it is preferable to consider venepuncture in the ipsilateral arm or insertion of a central venous device than to make further attempts in the contralateral arm or resort to sites such as veins in the foot. In the absence of lymphoedema, venesection in the ipsilateral arm carries little, if any, risk of additional complications. We offer evidence-based, patient-centred guidelines for venepuncture in patients with breast cancer following an axillary intervention.
MeSH term(s)	Axilla/surgery ; Breast Neoplasms/surgery ; Evidence-Based Medicine ; Female ; Humans ; Lymph Node Excision/adverse effects ; Lymphedema/etiology ; Phlebotomy/adverse effects ; Phlebotomy/methods ; Practice Guidelines as Topic ; Prospective Studies ; Retrospective Studies
Language	English
Publishing date	2015-12
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	604563-7
ISSN	1573-7217 ; 0167-6806
ISSN (online)	1573-7217
ISSN	0167-6806
DOI	10.1007/s10549-015-3639-1
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Case report: Hereditary angioedema in pregnancy.

Jakes, Adam D / Thorne, Iona / Guly, John / Kiani-Alikhan, Sorena / Banerjee, Anita

Obstetric medicine

2020 Volume 14, Issue 3, Page(s) 177–180

Abstract: Hereditary angioedema (HAE) is a rare genetic condition associated with episodic swelling due to dysfunction of bradykinin regulation pathways. This is most frequently caused by low level and/or function of the C1-esterase inhibitor protein (C1INH) which ...

Abstract	Hereditary angioedema (HAE) is a rare genetic condition associated with episodic swelling due to dysfunction of bradykinin regulation pathways. This is most frequently caused by low level and/or function of the C1-esterase inhibitor protein (C1INH) which is known as hereditary angioedema with C1 inhibitor deficiency (C1INH-HAE). Pregnancy and labour can precipitate an attack, but the majority of women have an uncomplicated, spontaneous vaginal delivery. Intravenous C1INH is the first-line therapy in pregnancy and breastfeeding. It should be given if any obstetric intervention is planned. Routine prophylactic administration for uncomplicated vaginal birth is not mandatory but may be appropriate if symptoms recur frequently during the third trimester. Pregnant women with C1INH-HAE should deliver in a hospital with C1INH replacement, fiberoptic intubation and front-of-neck access equipment readily available. A documented treatment plan should be developed within a multi-disciplinary team to pre-empt complications. We describe a case of C1INH-HAE diagnosed in pregnancy.
Language	English
Publishing date	2020-10-07
Publishing country	England
Document type	Case Reports
ZDB-ID	2612229-7
ISSN	1753-4968 ; 1753-495X
ISSN (online)	1753-4968
ISSN	1753-495X
DOI	10.1177/1753495X20958225
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Article ; Online: Reduced fetal movements.

Jakes, Adam D / Whybrow, Rebecca / Spencer, Clare / Chappell, Lucy C

BMJ (Clinical research ed.)

2018 Volume 360, Page(s) k570

MeSH term(s)	Adult ; Consumer Health Information ; Female ; Fetal Movement ; Heart Auscultation ; Heart Rate, Fetal ; Humans ; Internet ; Medical History Taking ; Patient Education as Topic ; Physical Examination ; Pregnancy ; Pregnancy Complications/diagnosis ; Pregnancy Complications/psychology ; Pregnancy Complications/therapy
Language	English
Publishing date	2018-03-06
Publishing country	England
Document type	Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.k570
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Article ; Online: Validation of the BPro radial pulse waveform acquisition device in pregnancy and gestational hypertensive disorders.

Jakes, Adam / Wade, Julie / Vowles, Zoe / Seed, Paul T / Shennan, Andrew H / Chappell, Lucy C / Nzelu, Diane

Blood pressure monitoring

2021 Volume 26, Issue 5, Page(s) 380–384

Abstract: Objective: To validate the BPro blood pressure (BP) wrist device for use in pregnancy and preeclampsia according to the Universal Standard protocol.: Participants and methods: BP was measured sequentially in 45 pregnant women (including 15 with ... ...

Abstract	Objective: To validate the BPro blood pressure (BP) wrist device for use in pregnancy and preeclampsia according to the Universal Standard protocol. Participants and methods: BP was measured sequentially in 45 pregnant women (including 15 with preeclampsia, 15 with gestational hypertension and 15 who remained normotensive) alternating between a mercury sphygmomanometer and BPro device. Results: The BPro is accurate in pregnancy with a mean device-observer difference of -1.7 ± 6.1 and 0.1 ± 4.6 mmHg for SBP and DBP, respectively. In women with preeclampsia, BPro also met the validation criteria for the Universal Standard protocol with a mean device-observer difference of -2.7 ± 7.1 and 0.3 ± 4.7 mmHg for SBP and DBP, respectively. However, the number of absolute BP differences within 5 mmHg was considerably fewer in those with preeclampsia when compared to the other two subgroups. Conclusion: The BPro device can be recommended for BP measurement in pregnancy but should be used with caution in those with confirmed preeclampsia.
MeSH term(s)	Blood Pressure ; Blood Pressure Determination ; Female ; Humans ; Hypertension/diagnosis ; Hypertension, Pregnancy-Induced/diagnosis ; Pregnancy ; Radial Artery ; Sphygmomanometers
Language	English
Publishing date	2021-06-15
Publishing country	England
Document type	Journal Article
ZDB-ID	1324472-3
ISSN	1473-5725 ; 1359-5237
ISSN (online)	1473-5725
ISSN	1359-5237
DOI	10.1097/MBP.0000000000000552
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Article ; Online: Investigating polyuria.

Jakes, Adam D / Bhandari, Sunil

BMJ (Clinical research ed.)

2013 Volume 347, Page(s) f6772

MeSH term(s)	Adult ; Diabetes Insipidus/complications ; Diabetes Insipidus/diagnosis ; Humans ; Male ; Medical History Taking ; Osmolar Concentration ; Physical Examination ; Polyuria/diagnosis ; Polyuria/epidemiology ; Polyuria/etiology ; Urinalysis ; Urine
Language	English
Publishing date	2013-12-02
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.f6772
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