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Background: This study involves two stand-alone tertiary level maternity hospitals with a combined average of 17,000 births per year, and with approximately 300 obstetric high dependency unit (OHDU) admissions annually. Many midwives feel that working in an OHDU does not constitute normal midwifery work and they have voiced concerns regarding their training in this setting. Midwives and nurses from different departments throughout the two hospitals are often asked to care for the OHDU patients. Co-location and expansion of a new OHDU, as well as a discussion around staffing, prompted this questionnaire., Aims: The aim of this study was to formally assess midwives' and nurses' attitudes and confidence working in an OHDU., Methods: After obtaining ethics committee approval, we conducted a survey and collected information on previous training in critical care, level of competence with HDU-related equipment and management of common HDU conditions., Results: In total, 188 staff participated in the survey (38% response rate). The majority (n = 142, 76%) did not feel competent caring for critically ill patients despite almost 40% (n = 69) saying they had experience doing so. Nurses or dual trained midwives were more likely to state they felt competent caring for critically ill patients, with only 2 midwives feeling competent (2.2%) compared to 32 nurses or dual trained staff (34.4%), p < 0.01. One hundred forty-seven (78%) and 136 (72%) respondents felt confident managing major haemorrhage and sepsis respectively. One hundred sixty-nine (89%) respondents would be interested in further training., Conclusions: A greater proportion of nurses and dual trained midwives feel confident caring for ODHU patients. This survey suggests that a mixture of specialty-trained critical care nurses and midwives is required in order to provide a full complement of HDU care to both the antenatal and postnatal women., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: Young women with breast cancer (YWBC) represent 7-12% of breast cancer diagnoses and ostensibly have more biologically aggressive subtypes with higher relapse and mortality rates. We studied the clinical and pathological characteristics in YWBC and examined how outcomes and treatment have evolved., Methods: YWBC were identified from pathology databases at two tertiary centers. Patients were divided into two cohorts: those diagnosed from 2000 to 2005 (C1) and from 2006 to 2015 (C2). Data were retrieved from clinical, radiology, and histology databases. Statistical analysis was performed using R® (V3.2.0)., Results: We identified 345 patients. Median age was 36 years (23-39 years). Mastectomy was performed in 232 patients (67.2%) and axillary lymph node clearance (ALNC) in 207 patients (60% [C1 82.7 vs. C2: 49.4%, p < 0.001]). One hundred-seventy patients (49%) were ER + HER2-, 88 (25.5%) were HER2+, and 58 (16.8%) were triple negative. Eighty patients (23.2%) received neoadjuvant therapy. Pathological complete response rates were statistically similar between C1 and C2 [C1 1 (0.9%) vs C2 16 (6.8%) p = 0.1]. Distant relapse occurred in 59 (19%) patients. There was a higher relapse rate (RR) in C1 [27 (32.1%) vs. 32 (15.7%), p < 0.002). HER2+ and ER+ HER2- patients in C1 had higher RRs than C2. Median overall survival in patients with metastatic disease was 29 months (range 2-119 months)., Conclusion: Locally advanced disease was more prevalent in YWBC. Mastectomy and ALNC rates were high and most received multimodal treatment. The extent of axillary surgery declined over time. Outcomes were unchanged in triple negative patients. These remain a priority for research.