Assessing learning needs for breastfeeding: setting the scene

Breastfeeding has a major contribution to make to public health, yet the UK, like many other developed countries, has low rates of breastfeeding. A contributing factor is that practitioners are ill-prepared to support breastfeeding women. There is a mismatch between the care professionals provide and the support women desire. A national breastfeeding learning needs assessment (LNA) was carried out in England to provide a comprehensive picture of professional and practitioner learning needs and existing training opportunities and resources. The LNA comprised five elements, and sought the views of service users through consumer organizations and voluntary breastfeeding supporters. Two elements of the LNA are reported here. A search of RDLearning, a web-based national resource, provided details of existing accredited courses in the UK for practitioners. Ten short courses provided by higher education institutions were identified, along with a range of courses offered by voluntary and other organizations, such as the National Childbirth Trust and UNICEF Baby Friendly Initiative. Second, an e-mail survey of 28 key stakeholder organizations was undertaken, with a response rate of 68% ( n  = 18). All but one acknowledged that their members could benefit from further breastfeeding knowledge and expertise and were supportive of a national breastfeeding education initiative. The most popular forms of education provision were workshops and seminars, online and written information. The topic considered most important for all practitioners was the health outcomes of breastfeeding. Other contributions which stakeholder organizations felt they could make were the provision of information resources and setting up specialist interest groups.     

Parents' experiences of an abnormal ultrasound examination - vacillating between emotional confusion and sense of reality

A system to improve the management of emergencies during pregnancy, childbirth, infancy and childhood in a region of The Gambia (Brikama) with a population of approximately 250,000 has been developed. This was accomplished through formal partnership between the Gambian Ministry of Health, the World Health Organisation, Maternal Childhealth Advocacy International and the Advanced Life Support Group. Since October 2006, the hospital in Brikama has been renovated and equipped and more efficiently provided with emergency medicines. An emergency ambulance service now links the community with the hospital through a mobile telephone system. Health professionals from community to hospital have been trained in obstetric, neonatal and paediatric emergency management using skills' based education. The programme was evaluated in log books detailing individual resuscitations and by external assessment. The hospital now has constant water and electricity, a functioning operating theatre and emergency room; the maternity unit and children's wards have better emergency equipment and there is a more reliable supply of oxygen and emergency drugs, including misoprostol (for treating post partum haemorrhage) and magnesium sulphate (for severe pre-eclampsia). There is also a blood transfusion service. Countrywide, 217 doctors, nurses, and midwives have undergone accredited training in the provision of emergency maternal, newborn and child care, including for major trauma. 33 have received additional education through Generic Instructor Courses and 15 have reached full instructor status. 83 Traditional Birth Attendants and 48 Village Health Workers have been trained in the recognition and initial management of emergencies, including resuscitation of the newborn. Eleven and ten nurses underwent training in peri-operative nursing and anaesthetics respectively, to address the acute shortage required for emergency Caesarean section. Between May 2007 and March 2010, 109 patients, mostly pregnant mothers, were stabilised and transported to hospital by the new emergency ambulance service. 293 resuscitation attempts were documented in personal logbooks. A sustainable system for better managing emergencies has been established and is helping to negate the main obstacle impeding progress: the country's lack of available trained medical and nursing staff. However, insufficient attention was paid to improving staff morale and accommodation representing significant failings of the programme.     

Long-term efficacy of the tension-free vaginal tape procedure for the treatment of urinary incontinence

Introduction and hypothesis  

The aim was to evaluate the long-term cure rates and the late complications of the tension-free vaginal tape (TVT).     

Scaling up breastfeeding in England through the Becoming Breastfeeding Friendly initiative (BBF)

Breastfeeding is the most accessible and cost-effective activity available to public health and has been shown to be one of the most effective preventive measures mothers can take to protect their children's health. Despite the well-documented benefits, the UK has one of the lowest breastfeeding rates in the world. The Becoming Breastfeeding Friendly (BBF) toolkit was developed through highly structured technical and academic collaboration, led by Yale University. It provides an evidence-based process to help countries assess their breastfeeding status and readiness to scale up, and identifies concrete measures countries can take to sustainably increase breastfeeding rates, based on data-driven recommendations. BBF is grounded in the Breastfeeding Gear Model complex adaptive systems framework which is made up of eight simultaneous conditions that sustain breastfeeding. In 2018, a committee of multi-agency stakeholders implemented the BBF process in England, collecting evidence to score the ‘gear’ components of England's breastfeeding environment against 54 benchmarks. The Training and Programme Delivery gear received the highest score, attributable to existing learning outcomes for health professionals and practitioners, peer supporters and specialist services, although there is a need for greater coordination and integration. The lowest scores were given for Promotion and Coordination, Goals and Monitoring due to the lack of a dedicated national strategy for breastfeeding and poor sharing of localised strategies and programmes. The process generated clear recommendations highlighting the need for more robust routine infant feeding data collection and reporting, and the necessity for strengthening leadership, monitoring and oversight to scale up and sustain breastfeeding.     

Two-stage methods for the analysis of pooled data.

Epidemiologic studies of disease often produce inconclusive or contradictory results due to small sample sizes or regional variations in the disease incidence or the exposures. To clarify these issues, researchers occasionally pool and reanalyse original data from several large studies. In this paper we explore the use of a two-stage random-effects model for analysing pooled case-control studies and undertake a thorough examination of bias in the pooled estimator under various conditions. The two-stage model analyses each study using the model appropriate to the design with study-specific confounders, and combines the individual study-specific adjusted log-odds ratios using a linear mixed-effects model; it is computationally simple and can incorporate study-level covariates and random effects. Simulations indicate that when the individual studies are large, two-stage methods produce nearly unbiased exposure estimates and standard errors of the exposure estimates from a generalized linear mixed model. By contrast, joint fixed-effects logistic regression produces attenuated exposure estimates and underestimates the standard error when heterogeneity is present. While bias in the pooled regression coefficient increases with interstudy heterogeneity for both models, it is much smaller using the two-stage model. In pooled analyses, where covariates may not be uniformly defined and coded across studies, and occasionally not measured in all studies, a joint model is often not feasible. The two-stage method is shown to be a simple, valid and practical method for the analysis of pooled binary data. The results are applied to a study of reproductive history and cutaneous melanoma risk in women using data from ten large case-control studies.     

The use of the serum protein factor XIIIB (F XIIIB) in parentage testing

Three thousand thirty-eight white and 313 black paternity cases were phenotyped for genetic variants of the coagulation Factor XIIIB (F XIIIB). Gene frequencies obtained by testing with agarose gel isoelectric focusing clearly differentiated the white and black populations. The expected probability of exclusion (P) for white subjects was P = 0.19 and for black subjects P = 0.25. The observed rates of exclusions for F XIIIB in white and black subjects were close to expected values. The results indicate that F XIIIB is a valuable tool in parentage testing, and the procedures are reasonably easy and inexpensive.     

The effect of tetracycline and erythromycin in a model of acne-type inflammation.

The effects of systemically administered oxytetracycline and erythromycin in a guinea pig model of acne-type inflammation were assessed histologically and by tissue measurement techniques. It was found that oxytetracycline significantly reduced the volume and maximum area of inflammation compared with both control and erythromycin treated groups. Oxytetracycline also altered the morphology of the inflammatory infiltrate significantly reducing the proportion of polymorphonuclear leucocytes present. In this model, erythromycin did not alter the inflammatory response but did seem to reduce the amount of transepidermal elimination of inflammatory debris.     

Comparison of minimal and conventional surgery in patients with bleeding peptic ulcer: a multicentre trial.

A multicentre randomized prospective trial compared minimal surgery (under-running the vessel or ulcer excision and adjuvant ranitidine) with conventional ulcer surgery (vagotomy and pyloroplasty or partial gastrectomy) for the treatment of bleeding peptic ulcer. This report is based on 137 patients (eight withdrawn through misdiagnosis or lost data), of whom 62 received conservative surgery and 67 conventional operation. Twenty-nine patients died, 16 (26 per cent) after conservative surgery and 13 (19 per cent) after conventional operations. The only significant difference between the groups was the incidence of fatal rebleeding, which occurred in six patients after conservative surgery compared with none after conventional surgery (P less than 0.02, Fisher's exact test).     

A thalamic terminus of the lateral cervical nucleus: the lateral division of the posterior nuclear group

The submodality and receptive field properties of single units in the lateral cervical nucleus (LCN) of barbiturate anesthetized cats were studied with glass microelectrodes. In other experiments, a region of the posterior thalamus containing neurons with properties comparable to those seen in the LCN was examined with tungsten microelectrodes. The responses of most units in the LCN reflected a major input from large myelinated afferent fibers innervating guard hairs but no input from Pacinian afferent fibers. The large size of the receptive fields indicated that excitatory input converged selectively from afferent fibers serving hairs over large areas of the body. In the posterior thalamus rapidly adapting neurons characterized by very large receptive fields and driven by the movement of guard hairs were observed to a region identified histologically as the rostral extension of the lateral division of the posterior nuclear group (POl). Caudally this region was located immediately adjacent to the dorsolateral part of the ventroposterior inferior nucleus (VPI). In more rostral parts of the thalamus it was located more dorsally and the ventroposterior lateral nucleus intervened between it and the VPI. This region was less than 1 mm wide in the frontal plane but extended rostrocaudally for several millimeters. Horseradish peroxidase injected into the region of the VPI and the POl labeled many cells in the LCN and the caudal pole of the dorsal column nuclei demonstrating that neurons in the LCN relay information to this part of the thalamus. These data, plus previous experiments showing that the VPI receives a major projection from the caudal poles of the dorsal column nuclei, suggest that the rostral portion of the POl receives an important afferent supply from the LCN. The responses of neurons in the POl appear to arise from specific classes of sensory receptors and cannot be considered less precise or more primitive than responses observed in the ventroposterior nucleus of the thalamus.