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The pathology of Progressive Supranuclear Palsy (PSP) causes Richardson’s syndrome (RS) and variant clinical phenotypes, with differential cognitive, behavioural and motor deficits. Survival is 3-4 years from diagnosis. The PSP Rating Scale (PSPRS) is prognostically informative, but the impact of cognitive and behavioural changes on survival is less clear. We test univariate and multivariate models of survival to determine the best clinically-applicable model for all-cause mortality.The MDS 2017 criteria were used to phenotype patients at the Cambridge Centre for Parkinson-plus (UK). Univariate and multivariate logistic regression models assessed the relationship between survival and clinicalvariables(PSPRS, MMSE, Addenbrooke’s Cognitive Examination,Cambridge Behavioural Inventory).335 people (male=56%, age 71.4±7.2 years) were identified with possible, probable or definite PSP. RS and variant groups had similar disease severity at baseline assessment (p=0.6) and survival (p=0.2). For 3-year mortality, PSPRS was the most reliable single predictor (AUC=0.68). Age, sex and PSPRS improved the model(AUC=0.71), but over all models Akaike’s Information Criterion identified the best model for RS to include PSPRS, CBI and MMSE(AUC=0.79, p=0.01). CBI and MMSE also improved the model for var- iant-PSP(PSPRS, CBI and MMSE AUC=0.89 vs 0.73, p=0.01).Inclusion of cognitive and behavioural measures improves the prediction of mortality in PSP.

ObjectivesSuboptimal intrapartum electronic fetal heart rate monitoring using cardiotocography has remained a persistent problem (EFM-CTG). We aimed to identify the range of influences on the safety of using EFM-CTG in practice.DesignScoping review to identify influences related to the practice of intrapartum EFM.Data sourcesMEDLINE, Embase, CINAHL, Web of Science, Scopus, British Nursing Index, Cochrane Library, from 1 January 2001 to 25 August 2024, and grey literature.Eligibility criteriaArticles that reported potential influences on the clinical practice of intrapartum EFM-CTG in hospital-based intrapartum maternity care settings, including primary studies, secondary analyses, reviews, reports, conference abstracts and investigations relevant to maternity and obstetrics, in English. Evaluations of technological modifications to traditional EFM-CTG monitoring and analysis were excluded.Data extraction and synthesisWe extracted influences on EFM-CTG from the included studies. Findings were synthesised using a best-fit framework approach, structured using an existing 19-domain framework of contributory factors for patient safety incidents in hospitals.Results142 articles and 14 reports were included. Our synthesis identified influences on EFM practice across all 19 domains of the contributory factors framework, including those relating to cognitive, social and organisational factors and interactions between professional work and tools used for fetal monitoring.ConclusionReducing avoidable harm associated with electronic fetal monitoring requires a systems approach based on a sound understanding of the full range of influences on practice.