Protecting Lives: Enhancing Outcomes for Rare Cases of Vasa Previa through Standardized Clinical Practices, finds study

Recent study focused on addressing the challenges in outcome reporting for vasa previa, a rare but high-risk condition in pregnancies that can lead to severe fetal and neonatal complications. The aim was to develop a Core Outcome Set and Reporting Checklist (COVasP) to standardize reporting of patient-important outcomes in research studies on vasa previa, allowing for better data harmonization, evidence synthesis, and patient-centered care.

Addressing Inconsistent Reporting

The research identified inconsistent reporting of patient-important outcomes in vasa previa studies, with essential outcomes such as NICU admission and maternal quality of life being poorly reported or not reported at all. To address this issue, a multi-step process involving Delphi surveys, small group discussions, and a consensus meeting was initiated. The study included a diverse representation of international stakeholders, comprising health service users (HSUs) and healthcare professionals (HCPs), to ensure inclusivity and collaboration in developing the core outcome set.

Strengths and Limitations

Several strengths and limitations were acknowledged throughout the study. Strengths included international representation, equal participation of HSUs and HCPs, and considerations for global applicability in the development of COVasP. Limitations such as participant attrition, potential biases related to the COMET methodology, and language-related biases were also highlighted, emphasizing the need for continuous improvement in future iterations of core outcome sets.

Identification of Relevant Outcomes

The identification of relevant outcomes was based on a systematic review and qualitative study, leading to the identification of 67 unique outcomes that informed the development of the core outcome set. The Delphi survey process involved stakeholders rating outcomes based on importance, resulting in consensus on 13 core outcomes for fetal/neonatal and maternal aspects, along with a 22-item reporting checklist.

Key Discussions

Key discussions during small group meetings highlighted the reassignment of some outcomes to reporting checklist items, the relevance of outcomes based on antenatal screening, and the importance of rewording outcomes for better generalizability. Through collaborative efforts, consensus was achieved on most outcomes, with final inclusion of core outcomes and reporting checklist items agreed upon in the consensus meeting.

Study Conclusion

The study concluded with the presentation of the finalized core outcome set and reporting checklist for studies on vasa previa. The COVasP output represents a minimum set of items to be reported in future research, aiming to enhance data quality, patient-centered care, and global consistency in reporting outcomes for vasa previa. The study emphasized the importance of flexibility in reporting additional outcomes depending on specific study focuses while encouraging the adoption of COVasP to improve research quality and patient outcomes globally.

Key Points

– The study aimed to develop a Core Outcome Set and Reporting Checklist (COVasP) to standardize outcome reporting in research studies on vasa previa, a rare but high-risk condition in pregnancies, for better data harmonization, evidence synthesis, and patient-centered care.

– Inconsistent reporting of patient-important outcomes in vasa previa studies was identified, leading to the initiation of a multi-step process involving Delphi surveys, small group discussions, and a consensus meeting with international stakeholders to develop the core outcome set.

– Strengths of the study included international representation, equal participation of health service users (HSUs) and healthcare professionals (HCPs), and considerations for global applicability, while limitations such as participant attrition and potential biases were noted, highlighting the need for continuous improvement in future core outcome set iterations.

– The identification of relevant outcomes was based on a systematic review and qualitative study, resulting in the development of 13 core outcomes for fetal/neonatal and maternal aspects, along with a 22-item reporting checklist through stakeholder ratings of outcome importance in the Delphi survey process.

– Key discussions during small group meetings focused on outcomes reassessment, antenatal screening relevance, and outcome rewording for better generalizability, leading to consensus on most outcomes and final agreement on core outcomes and reporting checklist items in the consensus meeting.

– The study concluded with the presentation of the finalized core outcome set and reporting checklist, COVasP, aiming to enhance data quality, patient-centered care, and global consistency in reporting outcomes for vasa previa while allowing flexibility in reporting additional outcomes based on specific study focuses.

Reference –

Tiffany Yeretsian et al. (2025). Core Outcome Set And Reporting Checklist For Studies On Vasa Previa. *JAMA Network Open*, 8. https://doi.org/10.1001/jamanetworkopen.2025.1000.

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HC slams doctors seeking extension to join Govt service, denies relief

Chennai: Observing that there no extension could be granted, especially for joining the Rural Health Service, the Madras High Court recently dismissed the pleas filed by doctors who sought an extension of the deadline to report and join duty at the Government Primary Health Centre.

“There cannot be any extension of service, particularly, when the petitioners had been called to join in Rural Health Service. The petitioners cannot, as a matter of right, seek extension and claim that only after completing their Post Graduation Course, which course they were already doing even at the time of applying for the post, they would join and render service,” observed the HC bench comprising C.V. Karthikeyan.

The Court was hearing a bunch of pleas seeking directions to the Director of Public Health and Preventive Medicine to extend the time for reporting and joining in duty for the petitioners at the Government Primary Health Centre.

After clearing the National Eligibility-Entrance Test Postgraduate (NEET-PG) examination, the petitioners were placed in the All India Quota at different medical colleges in Tamil Nadu. Each of them had also executed a bond for Rs 40 lakh stating that they would not forego the studies. 

However, the terms of the conditions of the bond were not restricted to not participate in the Medical Service Recruitment Board exam and therefore, after being appointed, the petitioner had given individuals representations seeking extension of time to join duty at the respective Government Primary Health Centres.

Also Read: Madras HC Denies Relief to Doctor seeking Extension to Join Govt Service for PG Studies

The counsel for the petitioners stated that a Single Judge bench of the Madurai bench of the High Court in a similar case had ordered that provided that in special circumstances, the appointing authority may extend the time-limit up to six months for valid reasons. 

While considering the matter, the HC bench noted that the Single Judge, while examining the issue, had arrived at an opinion that the proviso to Section 7(5) of the Tamil Nadu Government Servants (Conditions of Service) Act, 2016, provides for extension of time limit up to six months for valid reasons and in special circumstances.

However, the bench observed that the provision indicated two separate facts to be considered- one, that the circumstances must be special and the reason must be valid.

“Insofar as the petitioners are concerned, even on the date when the petitioners had applied for the post of Assistant Surgeon (General), the petitioners would have known that even if selected, they would never be in a position to join duty. They were doing their Post Graduation in All India Quota at different medical colleges in Tamil Nadu. They had also executed a bond for Rs.40,00,000/- undertaking that they would complete that course of study. If, this fact had been disclosed to the respondents, they would have taken a considered decision to either appoint the petitioners or activate the reserve list and appoint any other deserving candidate,” the bench noted at this outset.

“The petitioners have already enjoyed the benefit of doing Post Graduation and had kept quiet and later, when the appointment order had been issued, now seek advantage of the proviso to Section 7(5) of the aforementioned Act and states that the respondents must grant exemption and extend the time of joining,” it further observed.

The Court noted that the learned Single Judge had placed his observation on the aforementioned provisions of law. However, the said provisions can be put into effect only in special circumstances and in extraordinary circumstances. 

It further observed that

“It could be put into effect in the event of an unforeseen circumstance, which happened after the selection process and the petitioners were not able to join the duty owing to circumstances, which had arisen subsequently disabling them from joining duty. The petitioners however assign reasons, which were evident even before the selection process had commenced. They are neither valid nor could be categorised as a special circumstance.”

The High Court bench opined that there could not be any extension, especially when the petitioners had been called to join in Rural Health Service. It observed that the petitioners could not seek an extension and claim that they would join and render service only after completing their Post Graduation Course, which they were already pursuing at the time of applying for the post.

“This could also be viewed as suppression of a fact and deliberate attempt at preventing an opportunity being granted to yet another candidate, who would be very much willing to join Rural Health Service in any nook and corner of the State and serve the poor people of the State. I am not impressed with the reasons given seeking extension. To that extent since the learned Single Judge had not addressed the issue from this perspective, I would hold the order of the learned Single Judge as per incuriam applicable only to the writ petitions decided by the learned Single Judge,” the bench noted.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/posting-madras-hc-284809.pdf

Also Read: HC denies relief to Super-Speciality medicos seeking extension to join Bond Service

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ED visits for asthma spiked during 2023 Canadian wildfires, study finds

New research in the Canadian Medical Association Journal found an increase in asthma-related emergency department (ED) visits across Ontario following heavy smoke in early June 2023.

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New radiotherapy technique aims to protect the heart during lung cancer treatment

A new study presented at ESTRO 2025 introduces the RAPID-RT study, which uses an innovative rapid-learning approach to evaluate the impact of treatment modifications in radiotherapy. The paper also appears in Radiotherapy and Oncology.

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Molecular profiling can safely reduce radiation for women with endometrial cancer: Clinical trial results

Endometrial cancer is the most common gynecological cancer in highly-developed countries, most often affecting women after menopause. The majority of women are diagnosed at an early stage, when treatment outcomes are generally favorable.

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The MMR vaccine doesn’t contain ‘aborted fetus debris,’ as RFK Jr has claimed: Here’s the science

Robert F. Kennedy Jr, the United States’ top public health official, recently claimed some religious groups avoid the measles, mumps and rubella (MMR) vaccine because it contains “aborted fetus debris” and “DNA particles”.

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What are the symptoms of measles? How long does the vaccine last? Experts answer 6 key questions

So far in 2025 (as of May 1), 70 cases of measles have been notified in Australia, with all states and territories except Tasmania and the Australian Capital Territory having recorded at least one case. Most infections have occurred in New South Wales, Victoria and Western Australia.

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West Bengal to Set Up Organ Retrieval Centres at 24 Govt Medical College Hospitals

Kolkata: To address the acute shortage of organs available for transplant, the West Bengal government has announced plans to establish Non-Transplant Organ Retrieval Centres (NTORCs) at all 24 state-run medical colleges. These centres will be equipped to retrieve organs from brain-dead patients but will not perform transplant surgeries. 

Currently, only three state-run hospitals—SSKM Hospital, Medical College Kolkata, and NRS Medical College and Hospital—are authorized to conduct organ transplants. The remaining 21 teaching hospitals lack the infrastructure to even retrieve organs from deceased donors, a gap that officials now aim to close.

Doctors have long highlighted the dire need to boost organ donation in Bengal, where the demand for organs far exceeds the supply. Patients with end-stage organ failure often die waiting for a transplant.

Establishing organ retrieval infrastructure in all medical colleges would significantly enhance the frequency of cadaveric organ donations, thereby increasing the availability of organs for transplant and offering renewed hope to patients on waiting lists.

Despite a hopeful surge in cadaveric donations in 2018, growth has since stalled. According to Manimoy Bandyopadhyay, director of the Regional Organ and Tissue Transplant Organisation (ROTTO), only 13 donors were recorded in 2018, compared to 14 in 2024—a marginal increase over six years.

Speaking to Telegraph India, the official of the state health department said, “We will set up non-transplant organ retrieval centres (NTORC) in all 24 state-run medical colleges in Bengal.”

Also Read: Kerala HC dismisses plea for Guidelines on Brain-Dead Persons Organ Transplantation

The expansion is part of a boarded initiative aimed at increasing the cadaveric organ donations across the state. According to Telegraph India, another official said that if organ harvesting facilities were not set up in more hospitals, the medical fraternity would lose out on many families who might agree to donate the organs of someone who was declared brain dead at the hospital. But the same hospitals may not have qualified surgeons or the necessary infrastructure to conduct the transplant surgery and to provide post-transplant care.

Officials also point to the importance of counselling families of accident victims and trauma patients, who are often declared brain dead, to consider organ donation. 

“A well-equipped intensive care unit (ICU) and ventilators will be required to harvest the organs from the brain-dead person,” said a doctor who worked in Bengal’s public healthcare sector for several decades, Telegraph India reports.

Also Read: Kauvery Hospital performs three lung transplants in three consecutive days

Doctors have long argued that transporting brain-dead patients to distant hospitals for organ harvesting is risky and could result in cardiac arrest, rendering the organs unusable. Having retrieval centres closer to where deaths occur will reduce transit times and preserve organ viability, they said.

In a recent conference on organ donation and transplant held in the city, senior doctors and health department officials raised concerns over the stagnation of organ donation rates in West Bengal.

A senior official from a state-run medical college hospital noted that Bengal lags significantly behind southern and some western Indian states in terms of organ donation rates. Doctors at the conference emphasized that increasing the number of deceased organ donations could play a crucial role in curbing organ trafficking by reducing the dependency on live donors. This shift would not only address ethical concerns but also safeguard the health of potential live donors.

Former ROTTO-East joint director Dr. Arpita Ray Chaudhury emphasized the necessity of not just harvesting organs, but also managing long-term care for recipients.

According to the news reports, Ray Chaudhury, a nephrology and transplant consultant at Manipal Hospitals, emphasized that the government should also operate regular and well-managed post-transplant clinics.

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AGMC and GBP Hospital doctors save 7-month-old after adenovirus diagnosis

Agartala: Doctors at the Agartala Government Medical College (AGMC) and Govind Ballabh Pant Hospital successfully treated a critically ill 7-month-old infant suffering from adenovirus-induced pneumonia. 

The infant, Rudranil Biswas, was admitted to the hospital in a critical state and was placed on high-frequency nasal cannula oxygen therapy. The timely administration of life-saving medication, provided free of charge under the Ayushman Bharat scheme, played a crucial role in his recovery.

The pediatric team, led by Prof Dr Sanjib Kumar Debbarma, worked tirelessly to save the child’s life. Dr Sribas Das, a senior paediatrician, highlighted the critical nature of the case and the importance of the hospital’s infrastructure in treating such cases.

“Initially, we suspected pneumonia, but after thorough diagnosis and testing, it was confirmed as an adenovirus infection–a dangerous and often life-threatening condition in infants for which no specific antiviral treatment exists,” said Dr Debbarma.

Also Read:Tripura launches low-cost midday meals for patients, their families at GBP Hospital

Fortunately, Rudranil did not require mechanical ventilation, but was placed on high-frequency nasal cannula oxygen therapy, stabilising his breathing. The child’s recovery was aided by the timely administration of three vials of an essential intravenous medication–each costing approximately Rs12,000–provided entirely free of charge under the Ayushman Bharat scheme, with support from the Tripura state government.

“Rudranil was admitted to our ICU on April 11 in a near-fatal condition. Our team, including junior residents and nursing staff, worked round the clock. The adenovirus is comparable in severity to COVID-19, and many such cases in neighbouring states, particularly West Bengal, resulted in fatalities,” said Dr Sribas Das.

Rudranil’s mother, Suparna Biswas, spoke to ANI and said, “When we brought him to GBP, he was in such a serious state we couldn’t bear to look at him. But the doctors and nurses didn’t give up. Today, he can smile, look around, and play. We are forever indebted to the medical team who brought our baby back to life.”

The family, from a modest background–Rudranil’s father is an auto-rickshaw driver–could not have afforded the life-saving medication without state and central support.

“This success story underscores the impact of government health schemes like Ayushman Bharat and the relentless dedication of our healthcare workers,” Dr Das added, reports ANI.

This marks the third serious case of adenovirus pneumonia handled in 2025 by the paediatric department at AGMC & GBP Hospital. With 48 viral pneumonia cases reported last year 46 linked to adenovirus–the department remains on high alert.

The medical fraternity in Tripura has hailed this case as a shining example of how integrated healthcare infrastructure, timely diagnosis, and compassionate treatment can save lives, even in the most precarious situations.

Also Read:Agartala GBP Hospital marks 64th Foundation Day, Tripura Govt partners with ONGC for new 3-storeyed building

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In Heart Failure, Gait Speed Matters More Than Muscle Strength for Prognosis: Study Finds

Austria: A recent prospective cohort study has revealed that gait speed (GS) is a crucial prognostic factor in patients with chronic heart failure (HF), offering new insights into predicting cardiovascular outcomes. The study found that slower gait speed was linked to an increased risk of cardiovascular death or worsening heart failure in patients with stable heart failure, while muscle strength and mass did not show a connection to these outcomes. 

“Assessing muscular function related to locomotion is more critical for evaluating the risk of adverse cardiovascular events than focusing solely on muscle strength and mass,” the researchers wrote in ESC Heart Failure.

Heart failure affects skeletal muscle mass and function, leading to reduced physical performance. In the study, Nicolas Verheyen, Division of Cardiology, Department of Internal Medicine, University Heart Center, Medical University of Graz, Graz, Austria, and colleagues examined the prognostic impact of gait speed, handgrip strength (HG), and appendicular skeletal muscle index (ASMI) on cardiovascular outcomes in a prospective HF cohort.

For this purpose, the researchers conducted a single-center prospective cohort study involving adults with stable chronic HF who had a previous diagnosis of overtly reduced left ventricular ejection fraction (LVEF) <40% and LVEF <50% at enrolment. Gait speed was measured using the 4-meter GS test, maximal HG was assessed with a hydraulic dynamometer, and appendicular skeletal muscle index (ASMI) was determined using dual-energy X-ray absorptiometry.

The primary combined outcome was cardiovascular death or worsening HF, with Fine and Gray regression models used to account for non-cardiovascular death as a competing event.

The investigation uncovered the following findings:

  • A total of 205 patients (78% male) were included in the study, with a median age of 66 years. 31% of participants had diabetes mellitus, and the median left ventricular ejection fraction was 37%.
  • The median gait speed was 1.0 m/s, the median handgrip strength (HG) was 32 kg, and the median appendicular skeletal muscle index was 8.0 kg/m².
  • During a median follow-up period of 4.7 years, 52 patients experienced the primary outcome.
  • After adjusting for key clinical covariates, lower GS was found to predict a higher risk of cardiovascular death or worsening heart failure (subdistribution hazard ratio [SHR] per 0.1 m/s increase = 0.81).
  • In contrast, HG (SHR per 5 kg increase = 0.97) and ASMI (SHR per 1 kg/m² increase = 1.17) did not show significant associations with the outcome.
  • The associations between GS and cardiovascular outcomes were consistent across key clinical subgroups.

“In patients with stable heart failure and either reduced or improved left ventricular ejection fraction, our study found that among gait speed, handgrip strength, and appendicular skeletal muscle index, only GS had a significant prognostic impact on adverse cardiovascular outcomes,” the researchers wrote.

“These findings suggest that evaluating muscular function, particularly about locomotion, is more crucial for assessing the risk of adverse cardiovascular events than focusing solely on muscle strength and mass,” they concluded.

Reference:

Cejka, V., Riepl, H., Schwegel, N., Kolesnik, E., Zach, D., Santner, V., Höller, V., Schweighofer, N., Obermayer-Pietsch, B., Pieber, T., Morbach, C., Frantz, S., Zirlik, A., Störk, S., Posch, F., Ablasser, K., & Verheyen, N. Prognostic impact of gait speed, muscle strength and muscle mass in chronic heart failure—A prospective cohort study. ESC Heart Failure. https://doi.org/10.1002/ehf2.15221

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