FETAL SCALP BLOOD SAMPLING

Fetal scalp blood sampling (FSBS), in conjunction with fetal heart rate monitoring, is a method of fetal surveillance that may avoid cesarean delivery of the healthy fetus or indicate the need for immediate delivery of a compromised fetus. Some researchers have recently begun to question the efficacy of FSBS. In this article, three nurse-midwives discuss FSBS as a tool in assessing fetal well-being during labor and consider whether FSBS is a nurse-midwifery procedure.     

The 5-Step family intervention in primary care: II. The views of primary healthcare professionals

Background: This is the second of two papers using qualitative methods from a study of an intervention for family members affected by close relatives' substance misuse problems.

Participants: 168 primary healthcare professionals (PHCPs: GPs, practice nurses and health visitors) working in general practices in two areas of England, and who took part in the study.

Data sources: Recruitment and post-session forms completed by PHCPs; telephone interviews with each PHCP 12 weeks after recruitment of a family member; interviews with PHCPs at the end of the study.

Results: At the end of the project PHCPs were overwhelmingly positive about the family member intervention and about primary care as the appropriate site. Difficulties were encountered, however, in identifying and engaging affected family members, who were often excluded on grounds of the complexity of their problems or the level of their distress. Shortage of PHCP time and other practice-related factors added to the difficulty. Active work by a PHCP was often necessary in order to make the link between presenting symptoms of physical or mental ill-health and the existence of a family substance misuse problem. When family members were identified and recruited, PHCPs were usually positive about what was achieved. Nearly all were in favour of an approach that combined giving a self-help manual with some follow-up contact with a family member as needed.

Conclusions: Taken in conjunction with statistical outcome findings of significant reductions in symptoms and changes in ways of coping, plus qualitative analysis of the views of family members, the present results encourage the view that a flexible form of this intervention should be developed for use in primary healthcare, and that further work should build on existing strengths and attempt to overcome weaknesses identified.     

Doctors as managers: investors and reluctants in a dual role.

Government reform of the NHS in the UK has sought to increase the involvement of doctors (clinicians) in hospital management. Using frameworks from the psychological contract and organisational misbehaviour literatures, this paper examines the processes involved when clinicians assume management roles. This literature seeks to explain breaches to expectations regarding prior agreements with management and subsequent actions of 'getting even' as a result of breaches to the employment relationship. A qualitative methodology using interviews was undertaken, which identified two distinct groups of clinician-manager. Investors actively pursued a management opportunity as an alternative to clinical medicine, whilst reluctants tended to assume a management role to protect particular specialities from outside influence or from those they thought would be inappropriate clinician-managers. Investors and reluctants often had very little prior experience of management and managers and had problems reconciling their dual clinician-management role. Poor relationships with hospital managers who often had no understanding of their dual responsibilities led to tensions and conflict, which questions continued developments in this important area of UK health policy. Suggestions for improving this process are outlined.     

Craniofacial development in children with unilateral clefts of the lip, alveolus, and palate treated according to four different regimes. II. Mandibular and vertical development.

Lateral skull radiographs of 85 patients with unilateral clefts of the lip, alveolus and palate treated according to four different regimes were compared longitudinally, at three different ages, regarding mandibular and vertical facial development. It was found that there were no lasting differences in mandibular morphology resulting from regimes including primary or early secondary bone grafting. The non grafted group, however, showed increased mandibular length and anterior height. The jaw angle was increased and there was a more favourable sagittal jaw relationship. Regimes that included primary bone grafting were associated with reduced upper anterior facial height, which resulted in less harmonious facial proportions compared with treatment regimes including early secondary bone grafting done during the mixed dentition, or no bone grafting at all. Vertical development was greatest where bone grafting was excluded.     

A controlled evaluation of hypnobehavioural treatment for bulimia nervosa: Immediate pre-post treatment effects

The study reports the pre-post findings from a controlled comparative evaluation of treatments for bulimia nervosa. These pre-post results allow comparison of the hypnobehavioural and cognitive behavioural treatments with a waiting list control group and a comparison of the immediate effects of the two modalities. One hundred and thirty subjects were screened to enter the study. Seventy-eight subjects entered the investigation after being randomly allocated to either a waiting list control group, or to hypnobehavioural or cognitive behavioural groups. The treatments were delivered individually and matched in duration (8 weeks) and the number of sessions. Pre to posttreatment outcome indicated significant differences between the control group and the two treatments in reductions in bulimic behaviours and related eating pathology. The immediate effects of both treatments were equal. There were no differences at posttreatment between the treatments in abstinence from either bingeing or purging. The treatment effects were also similar to the immediate effects obtained by longer therapeutic approaches.     

Usefulness of the minute ventilation test in predicting successful extubation in newborn infants: a randomized controlled trial.

OBJECTIVE: We performed a prospective, randomized clinical trial to compare the usefulness of the minute ventilation test (MVT) with clinical judgement in predicting readiness for extubation in preterm newborns with respiratory distress syndrome requiring surfactant therapy and mechanical ventilation. STUDY DESIGN: A total of 42 preterm infants with respiratory distress syndrome were randomized when they reached preselected ventilator settings. The primary outcome measure was the time from study entry to extubation, provided the infant remained extubated for at least 24 hours. RESULTS: Infants evaluated by the MVT were extubated in a significantly shorter period of time (mean of 8 hours) than those evaluated clinically (mean of 36 hours). The extubation failure rate was similar in the two groups. CONCLUSION: The MVT is an easily performed objective measure that can be used to predict readiness for extubation in preterm infants. In this study, it significantly shortened the time for extubation and was not associated with a higher rate of reintubation.     

Adult nephroblastoma--five cases treated by surgery, radiotherapy and chemotherapy

Nephroblastoma in adults is rare; consequently very little experience of treatment for adult cases has been reported. We report five cases of adult nephroblastoma managed by nephrectomy, radiotherapy and combination chemotherapy. The treatment schedules were derived from childhood nephroblastoma regimens. However, four of the five patients were dead within 12 months of nephrectomy and all five had progression of disease whilst on combination chemotherapy. A good prognosis should not be anticipated for adult nephroblastoma. The chemotherapy schedules which are so successful in childhood nephroblastoma may require modification to improve prognosis in adults.     

The early recognition of dementia in the elderly: A preliminary communication about a longitudinal study using the gms–agecat package (community version)

A random community sample of 1070 subjects aged over 65 was interviewed by trained non-medical interviewers using the Geriatric Mental State, community version (GMSA). A sub-sample of 126 subjects was selected so as to contain possible early cases of dementia, pseudo-dementia, and normal subjects; and re-interviewed, a mean 1 year and 23 weeks later, by a group of psychiatrists in training. The computer diagnosis AGECAT, based on GMSA applied by non-medical raters, had predicted at initial interview, nine out of twelve cases of dementia at follow-up and five out of nine borderline cases. An Organic/Depression Index may prove useful in predicting which of those cases with early organic levels will eventually develop dementia, depression or recover.