Clinical problem-solving using video simulation: an investigation

This paper examines the use of videotape simulation as a research method for the exploration of clinical problem-solving, the challenges posed and the strategies employed to overcome the difficulties encountered are discussed. The simulation forms part of a larger comparative study of outcomes of pre-registration nurse education programmes, commissioned by the English National Board for Nursing, Midwifery and Health Visiting.     

IGFBP-1检测在妊娠晚期气囊引产中的临床意义

【目的】比较宫颈Bishop评分和宫颈胰岛素样生长因子结合蛋白 1(IGFBP 1)检测在妊娠晚期气囊助产中的临床意义。【方法】将妊娠晚期有引产指征的 15 0例初产妇随机分成 3组 ,每组 5 0例。A组在气囊助产前使用宫颈IGFBP 1检测作为引产时机预测 ,B组在气囊助产前使用宫颈Bishop评分作为引产时机预测 ,C组则单纯催产素引产同时使用宫颈Bish op评分作为引产时机预测。【结果】总引产时间、潜伏期、活跃期、第一产程、第二产程 ,A、B两组较C组短 (P <0 0 1) ;A组总引产时间较B组短 (P <0 0 5 ) ;A组潜伏期、活跃期、第一产程、第二产程的较B组短 ,但差别无统计学意义 ;阴道分娩率A组 >B组 >C组 ,剖宫产率A组 相似文献   

Collaborative working in health and social care: Lessons learned from post-hoc preliminary findings of a young families’ pregnancy to age 2 project in South Wales,United Kingdom

Children of young and socially disadvantaged parents are more likely to experience adverse outcomes. In response to this, a unique young families’ project in Swansea, UK, was created, which drew together a team of multi-agency professionals, to support people aged 16–24 from 17 weeks of pregnancy throughout 1,001 days of the child's life. The aim of the JIGSO (the Welsh word for Jigsaw) project is for young people to reach their potential as parents and to break the cycle of health and social inequality. This evaluation analysed routinely collected data held by the project from January 2017 to December 2018 exploring health and social outcomes, including smoking and alcohol use in pregnancy, breastfeeding, maternal diet and social services outcomes. Outcomes were compared to local and national averages, where available. Data relating to parenting knowledge and skills were available via records of 10-point Likert scales, one collected at the start of the JIGSO involvement and one around 4–6 months later. Findings showed higher than average levels of breastfeeding initiation and lower smoking and alcohol use in pregnancy. Parents also reported enhanced knowledge and confidence in their child care skills, as well as improved family relationships. Parents with high levels of engagement with JIGSO also appeared to have positive outcomes with Social Services (their child's name was removed from child protection register or their case was closed to social services). This was a post-hoc evaluation, not an intervention study or trial, and thus findings must be interpreted with caution. Despite this, the findings are promising and more prospective research exploring similar services is required.     

持续性枕后位的处理

目的：探讨如何处理持续性枕后位,以尽可能减少母儿并发症。方法：总结分析了１２０例持续性枕后位的孕周、胎儿体重、产重长短对分娩方式的影响以及不同分娩方式对母儿的影响。结果：当孕周大于等于４０周,胎儿体重大于等于３５００ｇ,潜伏期大于８ｈ,活跃期大于４ｈ时,剖宫产率明显增高,持续性枕后位所致的产程延长及手术助产增加了新生儿窒息率和产妇的并发症。结论：对持续性枕后位应正确观察处理各产程,早期诊断,充分估计其阴道分娩的可能性,对不适于阴道分娩者,应果断行剖宫产术,以降低母儿并发症。［     

Use of the Optimality Index-United States in perinatal clinical research: a validation study

The objective of this study was to assess the validity and observed effect size of a new instrument, the Optimality Index-United States (OI-US), for use in perinatal clinical research. Using a large, hospital-based, midwifery service clinical database that included complete obstetric data for 3425 women, we examined discriminant validity and the effects of two different scoring methods used with the OI-US. Discriminant validity was confirmed by comparing OI scores for women who remained low risk and did not require physician involvement in their care (OI score mean = 84%; standard deviation [SD] = 8%) compared to those whose condition changed to require physician involvement in their care (mean = 71%; SD = 10%; P < .001). Two methods of scoring the OI-US were compared, finding no significant difference and suggesting that the types of data available and the research question can drive this decision. Finally, effect size was calculated by two methods: Cohen's d (-1.4) and the effect size correlation (r = -0.548), the latter of which corresponds to a d of -1.3, both resulting in a similarly large effect size estimation. The OI-US is a new instrument that shows promise for use in perinatal clinical research, particularly when assessing more subtle clinical differences in outcomes between study groups.     

Midwifery data collection: options and opportunities

Most midwives are aware of the need to collect clinical practice data and of its usefulness in supporting the care they provide, which contributes to healthy outcomes for mothers and babies. For the individual midwife, there is more than one easily accessible, standardized data collection instrument from which to choose. However, despite these choices, in an American College of Nurse-Midwives (ACNM) Division of Research (DOR) survey on midwifery clinical data collection (N = 263), the majority of member respondents (n = 135; 51%) reported using a self-designed data collection tool, and more than one-third did not know of the ACNM Nurse-Midwifery Clinical Data Sets (NMCDS). On a larger scale, the midwifery profession is also in need of an organized and consistent approach to data collection for the purpose of capturing midwifery practice and outcomes in order to provide data to support legislation, practice, and policy changes. However, the profession currently lacks a single common midwifery practice database. In order to facilitate data aggregation that captures a larger view of midwifery practice at the local, regional, and national levels, it is imperative that all midwives collect relevant data that are uniform and standardized, and that the midwifery professional organizations move forward with the development of a common electronic database. This article describes currently available data collection tools as well as their best uses, applications to practice, and future directions.     

The Shenandoah University Midwifery Initiative: a model for midwifery education

There has been a significant decline in the number of nurse-midwifery education programs in the United States in the past decade. This decline presents a challenge as the profession seeks to respond to the Pew Foundation's call to increase access to midwifery care in the United States. Collaborative arrangements between universities that house nurse-midwifery programs and other universities in the region could be an effective strategy to increase access to nurse-midwifery education, thereby increasing access to nurse-midwifery care.     

Aromatherapy in childbirth: a pilot randomised controlled trial

Objectives  We aimed to determine the feasibility of conducting a randomised controlled trial (RCT) on the use of aromatherapy during labour as a care option that could improve maternal and neonatal outcomes.
Design  RCT comparing aromatherapy with standard care during labour.
Setting  District general maternity unit in Italy.
Sample  Two hundred and fifty-one women randomised to aromatherapy and 262 controls.
Methods  Participants randomly assigned to administration of selected essential oils during labour by midwives specifically trained in their use and modes of application.
Main outcome measures  Intrapartum outcomes were the following: operative delivery, spontaneous delivery, first- and second-stage augmentation, pharmacological pain relief, artificial rupture of membranes, vaginal examinations, episiotomy, labour length, neonatal wellbeing (Apgar scores) and transfer to neonatal intensive care unit (NICU).
Results  There were no significant differences for the following outcomes: caesarean section (relative risk [RR] 0.99, 95% CI: 0.70–1.41), ventouse (RR 1.5, 95% CI: 0.31–7.62), Kristeller manoeuvre (RR 0.97, 95% CI: 0.64–1.48), spontaneous vaginal delivery (RR 0.99, 95% CI: 0.75–1.3), first-stage augmentation (RR 1.01, 95% CI: 0.83–1.4) and second-stage augmentation (RR 1.18, 95% CI: 0.82–1.7). Significantly more babies born to control participants were transferred to NICU, 0 versus 6 (2%), P = 0.017. Pain perception was reduced in aromatherapy group for nulliparae. The study, however, was underpowered.
Conclusion  This study demonstrated that it is possible to undertake an RCT using aromatherapy as an intervention to examine a range of intrapartum outcomes, and it provides useful information for future sample size calculations.     

Midwifery education and maternal and neonatal health issues: challenges in Pakistan

Although numerous health care interventions have been implemented in Pakistan, the high maternal and neonatal mortality rates still remain a challenge. Developed countries have reduced maternal and neonatal mortality rates by improving the skill and knowledge levels of nurse-midwives. This paper reviews maternal and neonatal health issues, challenges in current midwifery education, and the role of government and international agencies in Pakistan. The exact maternal and neonatal mortality rates in Pakistan are unknown; a census has not occurred since 1998, and data provided in more recent studies were presented in summary format. A number of factors that contribute to the high mortality rate could easily be controlled by using competent nurse-midwives throughout all levels of the Pakistani health care system. A reduction in the maternal mortality rate is likely to occur if the Pakistan government and international agencies work together to implement specific recommendations in maternal and neonatal health. These recommendations include: 1) holding an invitational conference; 2) strengthening the existing midwifery and Lady Health Visitor curricula; 3) pilot testing an expanded midwifery program; and 4) advocating for and obtaining political commitments and resources for midwifery education.     

The evidence for physiologic management of the active phase of the first stage of labor

The active phase of first stage labor is generally defined as the period between 3 cm to 4 cm to complete cervical dilatation, in the presence of regular uterine contractions. Most women will experience this portion of labor within hospital obstetric units, where care commonly features restriction to bed, electronic fetal monitoring, early treatment of "slow" labors, and few pain management options beyond epidurals and narcotics. However, the available evidence on appropriate care for healthy childbearing women favors activity in labor, intermittent auscultation, patience from caregivers, and nonpharmacologic methods of pain relief. This article reviews the evidence for care practices that support physiologic labor. Modifying intrapartum care to reflect current evidence will improve women's health, and will require a multilevel approach and consistent midwifery demonstration of the model.