Centile charts for birthweight for gestational age for Scottish singleton births

Background

Evidence-based practice (EBP) can provide appropriate care for women and their babies; however implementation of EBP requires health professionals to have access to knowledge, the ability to interpret health care information and then strategies to apply care. The aim of this survey was to assess current knowledge of evidence-based practice, information seeking practices, perceptions and potential enablers and barriers to clinical practice change among maternal and infant health practitioners in South East Asia.

Methods

Questionnaires about IT access for health information and evidence-based practice were administered during August to December 2005 to health care professionals working at the nine hospitals participating in the South East Asia Optimising Reproductive and Child Health in Developing countries (SEA-ORCHID) project in Indonesia, Malaysia, Thailand and The Philippines.

Results

The survey was completed by 660 staff from six health professional groups. Overall, easy IT access for health care information was available to 46% of participants. However, over a fifth reported no IT access was available and over half of nurses and midwives never used IT health information. Evidence-based practice had been heard of by 58% but the majority did not understand the concept. The most frequent sites accessed were Google and PubMed. The Cochrane Library had been heard of by 47% of whom 51% had access although the majority did not use it or used it less than monthly. Only 27% had heard of the WHO Reproductive Health Library and 35% had been involved in a clinical practice change and were able to identify enablers and barriers to change. Only a third of participants had been actively involved in practice change with wide variation between the countries. Willingness to participate in professional development workshops on evidence-based practice was high.

Conclusion

This survey has identified the need to improve IT access to health care information and health professionals' knowledge of evidence-based health care to assist in employing evidence base practice effectively.     

Preparation for Childbirth—Evidence for Efficacy

Recent research on pain and psychoprophylaxis in relation to preparation for childbirth are examined. The various findings seem to lead to the value of childbirth preparation classes in lowering anxiety levels and altering patients' assessments of their impending labors. These changes in patients' appraisals are refitted in the experience of childbirth: in lowered perceptions of pain and more positive feelings about the birth.     

Advocacy for legal reform for safe abortion

In Ethiopia, violation of women's reproductive rights is both a cause and a manifestation of women's disempowerment. Obstacles to full realisation of Ethiopian women's reproductive health and rights include the persistence of harmful traditional practices such as female genital mutilation, early marriage and abduction, as well as the disturbing prevalence of rape and HIV/AIDS. Unsafe abortion represents a particularly serious threat to women's health and lives. Ethiopia's status as a signatory to the Convention to Eliminate all Forms of Discrimination Against Women (CEDAW) and its constitutional guarantee of women's equality demand more aggressive action to eradicate such practices and inequities. After years of lobbying by women's organisations, parliamentarians are now reviewing a draft of the 1957 penal code, which includes numerous provisions addressing some of these practices and other conditions that underlie women's poor social and health status.     

Genetic implications for newborn screening for phenylketonuria

The genetic implications for PKU are similar to those for any inherited disorder, but require an intimate knowledge of the dietary care required by these women. Unfortunately, today most women with PKU have discontinued dietary treatment by adulthood and find the restricted phe diet onerous and difficult. Fortunately, this is changing. "Diet for life" is the usual, although not yet universally, adopted practice today, but even so, there are women who conceive "off diet." This inhibits intellectual development of the fetus. If intensive services are provided for such women, fetal outcome can be improved by good blood phe control between 120 and 360 uM/L. Although prenatal diagnosis is available by fetal mutation studies, many women today resist the benefits of genetic counseling. Unfortunately, insurance companies often are unwilling to pay for such procedures as mutation analysis or the provision of low phe diets. Overall, public policy for the care of women with genetic disorders is in a state of flux and strong leadership is required to improve services.     

4Children for parents and for midwives

This article outlines the launch of a new website which will bring together the rich, but sometimes difficult to access, body of best practice, research and evidence, that parents and professionals need when dealing with children aged from birth-five. The article sets out the scale, type and quality of information that is available, highlights what midwives could helpfully share with parents to help them deal with their children's developments, and what they could access themselves to develop their practice and ensure they remain as up to date as possible with early years developments.     

Cervical or thoracic anastomosis for esophagectomy for carcinoma

A prospective trial was conducted to compare intrathoracic and cervical anastomoses after esophagectomy for squamous cell carcinoma of the middle or lower one-third of the esophagus. One hundred and twenty-three patients were randomized to have either a cervical or thoracic anastomosis. Thirty-one patients were subsequently excluded either because esophagectomy was performed without thoracotomy or the tumor was unresectable or because the randomization protocol was not complied with. Transfusion requirements and operating time were similar for the 49 patients having esophagectomy by way of the laparotomy and right thoracotomy (TA) and the 43 patients who underwent laparotomy, right thoracotomy and cervicotomy (CA). Forty-three per cent of the CA and 49 per cent of the TA patients had involved lymph nodes. An esophagectomy incorporating a cervical anastomosis resulted in a significantly greater margin of macroscopically normal esophagus above the tumor (median of 4.0 versus 1.5 centimeters for TA). A leak was significantly more frequent after cervical anastomosis (26 per cent) than thoracic (4 per cent) (p less than 0.002). Respiratory complications were more frequent with a thoracic anastomosis, but this was not statistically significant. Thirty day mortality rates were similar for the two groups: 14.3 per cent, TA, and 9.3 per cent, CA (p = N.S.). Postoperative strictures occurred in 14 per cent of TA and 23 per cent of CA patients and were most common after an anastomotic leak. The survival patterns of the two groups were similar. The median survival time for CA patients was 23 months and for TA, 20 months. Excluding hospital mortality, 47 per cent of patients were alive at two years and 30 per cent at 40 months. Survival was related to extent of disease. The greater length of tumor-free esophagus removed with a cervical anastomosis did not result in an improved long term survival period, but was associated with a significantly higher incidence of anastomotic fistula.     

Clinical diagnostic criteria for premenstrual syndrome and guidelines for their quantification for research studies

Premenstrual syndrome (PMS) encompasses a variety of symptoms appearing during the luteal phase of the menstrual cycle. Although PMS is widely recognized, the etiology remains unclear and it lacks definitive, universally accepted diagnostic criteria. To address these issues an international multidisciplinary group of experts evaluated the current definitions and diagnostic criteria of PMS and premenstrual dysphoric disorder (PMDD). Following extensive correspondence, a consensus meeting was held with the aim of producing updated diagnostic criteria for PMS and guidelines for clinical and research applications. This report presents the conclusions and recommendations of the group. It is hoped that the criteria proposed by the group will become widely accepted and eventually be incorporated into the next edition of the World Health Organization's International Classification of Diseases (ICD-11). It is also hoped that the proposed guidelines for quantification of criteria will be used by clinicians and investigators to facilitate diagnostic uniformity in the field as well as adequate treatment modalities when warranted.     

Education for Childbirth: A Time for Change

In earlier times, people were well-acquainted with childbearing and childrearing through their contacts within the extended family. However, during this century, several factors have affected changes in traditional birthing attitudes and practices and have precipitated the need for formal education in childbirth. This position article reviews the history and literature of the development of contemporary education for childbirth classes as well as the research on the effects of formal childbirth education instruction. Suggestions for further research and future directions of change are provided.     

性传播疾病的性伴通知策略

性伴通知是通知被诊断为STD患者(指示患者)的性伴，他们易于感染，有必要到卫生服务机构就诊。其临床目标之一是防止指示患者的再感染：另一个是公共卫生目标，减少STDs的传播。人部分感染STD的人既无感染症状，又无体征。如通过性伴通知识别的淋病男性患者中，22％-68％是无症状的(Holmes1990)。要实现上述目标，性伴通知是能联系到这些个体的两个策略之一，     

Bladder-opening technique for hysterectomy for placenta previa percreta

The “bladder-opening” technique can be applied to cesarean hysterectomy for placenta previa percreta with bladder invasion. Cutting the bladder lateral wall with an automatic stapling/cutting apparatus enables direct visualization of the invaded bladder area and its resection. This may reduce the amount of hemorrhage and avoid accidental bladder injury.