Bladder visualisation as a prognostic sign in oligohydramnios-polyhydramnios sequence in twin pregnancies treated using therapeutic amniocentesis

Oligohydramnios-polyhydramnios sequence in twin pregnancies may be managed by aggressive amniocentesis and is described in nine consecutive cases. In four of the nine pregnancies both twins survived, one pair died in the neonatal period, and the other four pairs all suffered intrauterine death. The median number of amnioreductions performed was five (range 2–7). In this series the reaccumulation of urine in the bladder of the 'stuck twin' was a predictive prognostic marker of survival in both twins, with a sensitivity and specificity of 100%.     

A case study identifying nursing staffs'' perception of the delivery method of nursing care in practice on a particular ward

The research describes how nursing staff on a general surgical ward in a district general hospital perceived the delivery method of nursing care in practice. The study design was based on ethnographic methods and data were collected by diary keeping and semi-structured interviews. An organizational method based on the principles of primary nursing had been implemented on the ward for 2 years prior to the study commencing. As well as talking in general terms about primary nursing, the nursing staff talked at some length about specific issues related to their practice.     

Neonatal mortality amongst Scottish preterm singleton births (1985–1994)

Objective To provide a valid estimate of singleton neonatal mortality based on birthweight and gestational age at delivery.
Design Record linkage of maternity data and neonatal mortality data.
Setting Scotland, UK.
Population All singleton preterm deliveries from 24 to 36 weeks inclusive between 1985 and 1994.
Main outcome measure Neonatal death.
Results There were 625,646 liveborn singleton deliveries over the study period, of which 33,912 were preterm (5.4%). The overall neonatal mortality in the preterm group was 41/1000 and the data have been presented by both gestational age and birthweight. The neonatal mortality rate fell with advancing gestation from 795/1000 live births at 24 weeks to 9/1000 live births at 36 weeks and was higher at the extremes of birthweight for a given gestational age. There was a significant increase in the proportion of babies delivered iatrogenically over the study period (χ test for trend   P < 0.001  ).
Conclusion This is the largest recent series to consider neonatal mortality using both birthweight and gestational age. These figures will be of use in obstetric management when elective preterm delivery is considered, and for providing prognostic guidance following preterm delivery.     

The nurse''s decision-making process and the implementation of psychogeriatric nursing in a mental hospital

This study looks at the psychogeriatric nurse's decision-making process and on this basis seeks to describe the implementation of psychogeriatric nursing in a mental hospital. The subjects consist of 26 nurses working on the psychogeriatric wards of one hospital. The data were collected using a questionnaire (n = 26), a 1-week time-usage analysis, content analysis of nursing plans (n = 56), and observation of planning meetings (n = 15). The results for different phases of the decision-making process suggested that nurses had little difficulty with the identification of problems. Data collection tended to concentrate on the physical side of nursing work. The setting of explicit targets for nursing care proved to be difficult. The vast majority of the nurses (85%) felt that decision-making on different nursing alternatives was only moderately or not at all successful. Over half of the nurses felt that their ability to evaluate the outcome of treatment and nursing was either satisfactory or poor. Time-usage analysis indicated that the nurses had frequent interaction with their patients in connection with basic care, although the nurses themselves did not regard this part of their work as active interaction with the patient.