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Objective: The OptiBIRTH intervention was developed to enhance women-centred care for pregnant women who had had one previous caesarean section. Firstly, systematic reviews and focus group interviews with clinicians and women were carried out. Another systematic review focused on computer-based behavioural change interventions informed the design of an online component of the OptiBIRTH intervention, which was then tested in the trial to assess its impact on the VBAC rate in the German sites, as well as on interventions and events during labour. Methods: A cluster randomised trial (ISRCTN10612254) was carried out in 15 sites in three European countries (Ireland, Italy, Germany). The German part of the study was led by the Midwifery Research and Education Unit at Hannover Medical School (MiREdU). The participating sites were Buergerhospital Frankfurt, Diakovere Krankenhaus Henriettenstift Hannover, Klinikum Dritter Orden Muenchen, University hospital Wuppertal, and Hannover Medical School. The sites were randomly allocated into three intervention and two control sites. Recruitment of women took place between May 2014 and October 2015. Main international analysis was performed by Queen's University Belfast. Intranational comparisons in Germany were performed by MiREdU using descriptive statistics. Data of the baseline rate came from 2012 compared with data from 2015, which is an interim analysis pending the final comparison to 2016. Results: Overall, there was no statistically significant difference in the change in the proportion of women having a VBAC between 2012 and 2015 in the intervention sites compared to the controls. Although there were significant changes in Italy and Ireland, there were none in Germany. The 2015 VBAC rates in the German sites showed an increase compared to baseline (2012) in one intervention site (+1.0%) and in one control site (+3.2%) but decreases in the three other sites (-0.1, -6.2 and -10.1%). Regarding German OptiBIRTH participants, th

Objective: The OptiBIRTH intervention was developed to enhance women-centred care for pregnant women who had had one previous caesarean section. Firstly, systematic reviews and focus group interviews with clinicians and women were carried out. Another systematic review focused on computer-based behavioural change interventions informed the design of an online component of the OptiBIRTH intervention, which was then tested in the trial to assess its impact on the VBAC rate in the German sites, as well as on interventions and events during labour. Methods: A cluster randomised trial (ISRCTN10612254) was carried out in 15 sites in three European countries (Ireland, Italy, Germany). The German part of the study was led by the Midwifery Research and Education Unit at Hannover Medical School (MiREdU). The participating sites were Buergerhospital Frankfurt, Diakovere Krankenhaus Henriettenstift Hannover, Klinikum Dritter Orden Muenchen, University hospital Wuppertal, and Hannover Medical School. The sites were randomly allocated into three intervention and two control sites. Recruitment of women took place between May 2014 and October 2015. Main international analysis was performed by Queen's University Belfast. Intranational comparisons in Germany were performed by MiREdU using descriptive statistics. Data of the baseline rate came from 2012 compared with data from 2015, which is an interim analysis pending the final comparison to 2016. Results: Overall, there was no statistically significant difference in the change in the proportion of women having a VBAC between 2012 and 2015 in the intervention sites compared to the controls. Although there were significant changes in Italy and Ireland, there were none in Germany. The 2015 VBAC rates in the German sites showed an increase compared to baseline (2012) in one intervention site (+1.0%) and in one control site (+3.2%) but decreases in the three other sites (-0.1, -6.2 and -10.1%). Regarding German OptiBIRTH participants, th

We describe a case of Lyme carditis with intra-hisian 2:1 atrioventricular (AV) block documented by electrophysiological study. To our knowledge, only two cases of AV block at the level of the His bundle has been described in the literature. Sinus rhythm was restored after 4 days of i.v. ceftriaxone

Aims A high degree of collateral supply to a vascular area where a percutaneous transluminal coronary angioplasty (PTCA) has been performed represents a haemodynamic force competing with the antegrade flow through the dilated lesion. Therefore, our purpose was to determine whether patients with restenosis following PTCA have a higher collateral flow to the recipient vessel than patients without restenosis. Methods and Results In 200 consecutive PTCA patients, an intracoronary pressure-derived collateral flow index (CFI) was determined quantitatively during balloon occlusion, using simultaneous measurements of the mean aortic pressure (Pao) and of the intracoronary pressure distal to the occluded stenosis (Poccl), as well as the estimated central venous pressure (CVP=5mmHg): CFI=(Poccl−CVP)/(Pao−CVP). Sixty-four patients had an angiographic follow-up examination after at least 2 months, and were subdivided into patients with restenosis (>50% diameter stenosis, n=34) and patients without restenosis (n=30). Patients with restenosis had a significantly higher collateral flow index at the initial coronary angiography than patients without restenosis (0·26±0·14 vs 0·12±0·09;P<0·0001). Conclusions Patients with restenosis after PTCA show a more extended collateral supply to this recipient area than patients without restenosis. Well developed collaterals to a revascularized region are a risk factor for restenosis of the treated lesion

We describe a case of Lyme carditis with intra-hisian 2:1 atrioventricular (AV) block documented by electrophysiological study. To our knowledge, only two cases of AV block at the level of the His bundle has been described in the literature. Sinus rhythm was restored after 4 days of i.v. ceftriaxone

Aims A high degree of collateral supply to a vascular area where a percutaneous transluminal coronary angioplasty (PTCA) has been performed represents a haemodynamic force competing with the antegrade flow through the dilated lesion. Therefore, our purpose was to determine whether patients with restenosis following PTCA have a higher collateral flow to the recipient vessel than patients without restenosis. Methods and Results In 200 consecutive PTCA patients, an intracoronary pressure-derived collateral flow index (CFI) was determined quantitatively during balloon occlusion, using simultaneous measurements of the mean aortic pressure (Pao) and of the intracoronary pressure distal to the occluded stenosis (Poccl), as well as the estimated central venous pressure (CVP=5mmHg): CFI=(Poccl−CVP)/(Pao−CVP). Sixty-four patients had an angiographic follow-up examination after at least 2 months, and were subdivided into patients with restenosis (>50% diameter stenosis, n=34) and patients without restenosis (n=30). Patients with restenosis had a significantly higher collateral flow index at the initial coronary angiography than patients without restenosis (0·26±0·14 vs 0·12±0·09;P<0·0001). Conclusions Patients with restenosis after PTCA show a more extended collateral supply to this recipient area than patients without restenosis. Well developed collaterals to a revascularized region are a risk factor for restenosis of the treated lesion