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https://www.readbyqxmd.com/read/28625301/maintenance-of-epidural-labour-analgesia-the-old-the-new-and-the-future
#1
REVIEW
Ban Leong Sng, Alex Tiong Heng Sia
Neuraxial analgesia is considered the gold standard in labour analgesia, providing the most effective pain relief during childbirth. Improvements have enhanced the efficacy and safety of epidural analgesia through better drugs, techniques and delivery systems. This review describes the history of epidural labour analgesia and recent improvements in labour epidural analgesia. We discuss the role of the combined spinal epidural technique, low-concentration local anaesthetic-opioid epidural solutions, patient-controlled epidural analgesia, and programmed intermittent or automated mandatory boluses in the maintenance of epidural labour analgesia...
March 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/28608597/perineal-techniques-during-the-second-stage-of-labour-for-reducing-perineal-trauma
#2
REVIEW
Vigdis Aasheim, Anne Britt Vika Nilsen, Liv Merete Reinar, Mirjam Lukasse
BACKGROUND: Most vaginal births are associated with trauma to the genital tract. The morbidity associated with perineal trauma can be significant, especially when it comes to third- and fourth-degree tears. Different interventions including perineal massage, warm or cold compresses, and perineal management techniques have been used to prevent trauma. This is an update of a Cochrane review that was first published in 2011. OBJECTIVES: To assess the effect of perineal techniques during the second stage of labour on the incidence and morbidity associated with perineal trauma...
June 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28601727/does-serial-3rd-trimester-ultrasound-improve-detection-of-small-for-gestational-age-babies-comparison-of-screening-policies-in-2-european-maternity-units
#3
Vesna Sokol Karadjole, Umber Agarwal, Edina Berberovic, Borna Poljak, Zarko Alfirevic
OBJECTIVE: Methods for the antenatal detection of small for gestational age babies (SGA) differ between countries. The aim of this study was to compare the diagnostic accuracy of routine versus selective small for gestational age babies screening policy using data from two European Maternity Units. STUDY DESIGN: This was a retrospective cohort study from Liverpool Women's Hospital, UK, that uses selective third trimester sonography and from the University Hospital Centre Zagreb, Croatia, that uses routine third trimester sonography for SGA detection...
June 3, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28600829/small-for-gestational-age-babies-after-37-weeks-an-impact-study-of-a-risk-stratification-protocol
#4
M Veglia, A Cavallaro, A Papageorghiou, R Black, L Impey
OBJECTIVES: Although no clear evidence exists, many international guidelines advocate early term delivery of small for gestational age (SGA) fetuses. The aim of this study was to determine whether a protocol that included monitoring SGA fetuses beyond 37 weeks affected perinatal and maternal outcomes. METHODS: The impact of the introduction in 2014 of a protocol for management of SGA, which included risk stratification with surveillance and expectant management after 37 weeks for lower risk babies (Group 2), was compared with the previous strategy, which recommended delivery at around 37 weeks (Group 1)...
June 10, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28592237/labour-management-guidelines-for-a-tanzanian-referral-hospital-the-participatory-development-process-and-birth-attendants-perceptions
#5
Nanna Maaløe, Natasha Housseine, Jos van Roosmalen, Ib Christian Bygbjerg, Britt Pinkowski Tersbøl, Rashid Saleh Khamis, Birgitte Bruun Nielsen, Tarek Meguid
BACKGROUND: While international guidelines for intrapartum care appear to have increased rapidly since 2000, literature suggests that it has only in few instances been matched with reviews of local modifications, use, and impact at the targeted low resource facilities. At a Tanzanian referral hospital, this paper describes the development process of locally achievable, partograph-associated, and peer-reviewed labour management guidelines, and it presents an assessment of professional birth attendants' perceptions...
June 7, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28591672/global-variation-in-pregnancy-complications-in-women-with-epilepsy-a-meta-analysis
#6
John Allotey, David Aroyo-Manzano, Patricia Lopez, Luz Viale, Javier Zamora, Shakila Thangaratinam
OBJECTIVE: Women with epilepsy are at risk of pregnancy complications. Whether these vary globally is unknown. We undertook a systematic review to assess the overall rates of obstetric outcomes in women with epilepsy, and variations in estimates across geographical region, economic status of country, and over time. STUDY DESIGN: We searched Medline, Embase, Cochrane, AMED and CINAHL, (January 1, 1990 and November 29, 2016), without any language restrictions for studies reporting core maternal and fetal outcomes in women with epilepsy...
May 30, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28583159/exploring-the-strategies-that-midwives-in-british-columbia-use-to-promote-normal-birth
#7
Michelle M Butler
BACKGROUND: Rates of normal birth have been declining steadily over the past 20 years, despite the evidence of the benefits to mother and baby. This is most obvious in steadily increasing caesarean section rates across countries and studies of the factors involved suggest it may be more to do with the organization of maternity care and the preferences of healthcare providers than changes in maternal or demographic conditions. The proportion of women in British Columbia (BC) receiving care from a midwife continues to grow and there is a particular focus on promoting and supporting normal pregnancy and birth in the midwifery philosophy of care...
June 5, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28581507/isotope-evidence-for-agricultural-extensification-reveals-how-the-world-s-first-cities-were-fed
#8
Amy K Styring, Michael Charles, Federica Fantone, Mette Marie Hald, Augusta McMahon, Richard H Meadow, Geoff K Nicholls, Ajita K Patel, Mindy C Pitre, Alexia Smith, Arkadiusz Sołtysiak, Gil Stein, Jill A Weber, Harvey Weiss, Amy Bogaard
This study sheds light on the agricultural economy that underpinned the emergence of the first urban centres in northern Mesopotamia. Using δ(13)C and δ(15)N values of crop remains from the sites of Tell Sabi Abyad, Tell Zeidan, Hamoukar, Tell Brak and Tell Leilan (6500-2000 cal bc), we reveal that labour-intensive practices such as manuring/middening and water management formed an integral part of the agricultural strategy from the seventh millennium bc. Increased agricultural production to support growing urban populations was achieved by cultivation of larger areas of land, entailing lower manure/midden inputs per unit area-extensification...
June 5, 2017: Nature Plants
https://www.readbyqxmd.com/read/28576895/has-the-nhs-111-urgent-care-telephone-service-been-a-success-case-study-and-secondary-data-analysis-in-england
#9
Catherine Pope, Joanne Turnbull, Jeremy Jones, Jane Prichard, Ali Rowsell, Susan Halford
OBJECTIVES: To explore the success of the introduction of the National Health Service (NHS) 111 urgent care service and describe service activity in the period 2014-2016. DESIGN: Comparative mixed method case study of five NHS 111 service providers and analysis of national level routine data on activity and service use. SETTINGS AND DATA: Our primary research involved five NHS 111 sites in England. We conducted 356 hours of non-participant observation in NHS 111 call centres and the urgent care centres and, linked to these observations, held 6 focus group interviews with 47 call advisors, clinical and managerial staff...
June 2, 2017: BMJ Open
https://www.readbyqxmd.com/read/28566573/from-a-viewpoint-of-clinical-settings-pharmacoepidemiology-as-reverse-translational-research-rtr
#10
Junichi Kawakami
 Clinical pharmacology and pharmacoepidemiology research may converge in practise. Pharmacoepidemiology is the study of pharmacotherapy and risk management in patient groups. For many drugs, adverse reaction(s) that were not seen and/or clarified during research and development stages have been reported in the real world. Pharmacoepidemiology can detect and verify adverse drug reactions as reverse translational research. Recently, development and effective use of medical information databases (MID) have been conducted in Japan and elsewhere for the purpose of post-marketing safety of drugs...
2017: Yakugaku Zasshi: Journal of the Pharmaceutical Society of Japan
https://www.readbyqxmd.com/read/28562719/-validation-of-a-scale-to-assess-the-labour-quality-of-life-in-public-hospitals-from-tlaxcala
#11
Irma Alejandra Hernández-Vicente, Marivel Lumbreras-Guzmán, Pablo Méndez-Hernández, Elodia Rojas-Lima, Margarita Cervantes-Rodríguez, Clara Arlina Juárez-Flores
Objective: To validate a scale for assessing the labour quality of life in public hospitals (LQL-PH) from Tlaxcala, Mexico. Materials and methods: The instrument was validated among 669 health workers from six hospitals from the Ministry of Health of Tlaxcala, Mexico. Content validity was by inquiry to experts, construct validity by factor analysis, criterion validity by comparing with other scales, and reliability with Cronbach's Alpha. Results: The factor analysis uncovered four dimensions: "individual welfare", "conditions and labour environment", "organization", and "well-being accomplished by the work"; reliability was 0...
March 2017: Salud Pública de México
https://www.readbyqxmd.com/read/28555937/market-driven-production-of-biospecimens-and-the-role-of-nhs-hospital-led-biobanks
#12
Stephen Timmons, Paraskevas Vezyridis
Biobanks are vital for biospecimen production in research, despite the regulatory, recruitment and commercial difficulties they face. We conducted interviews with clinicians, researchers, volunteers who recruit biobank participants, regulators and NHS managers about the integration of a biobank into an NHS hospital. We show that medical waste collected for biomedical research acquires its socio-ethical and economic value from the level of integration (both technologically and organisationally) of the biobank into the NHS hospital...
May 27, 2017: Sociology of Health & Illness
https://www.readbyqxmd.com/read/28528578/a-cluster-randomized-trial-to-reduce-caesarean-delivery-rates-in-quebec-cost-effectiveness-analysis
#13
Mira Johri, Edmond S W Ng, Clara Bermudez-Tamayo, Jeffrey S Hoch, Thierry Ducruet, Nils Chaillet
BACKGROUND: Widespread increases in caesarean section (CS) rates have sparked concerns about risks to mothers and infants and rising healthcare costs. A multicentre, two-arm, cluster-randomized trial in Quebec, Canada assessed whether an audit and feedback intervention targeting health professionals would reduce CS rates for pregnant women compared to usual care, and concluded that it reduced CS rates without adverse effects on maternal or neonatal health. The effect was statistically significant but clinically small...
May 22, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28514959/prevention-of-postpartum-haemorrhage-by-community-based-auxiliary-midwives-in-hard-to-reach-areas-of-myanmar-a-qualitative-inquiry-into-acceptability-and-feasibility-of-task-shifting
#14
Kyu Kyu Than, Yasmin Mohamed, Victoria Oliver, Theingi Myint, Thazin La, James G Beeson, Stanley Luchters
BACKGROUND: In Myanmar, postpartum haemorrhage is the leading cause of maternal mortality and contributes to around 30% of all maternal deaths. The World Health Organization recommends training and supporting auxiliary midwives to administer oral misoprostol for prevention of postpartum haemorrhage in resource-limited settings. However, use of misoprostol by auxiliary midwives has not formally been approved in Myanmar. Our study aimed to explore community and provider perspectives on the roles of auxiliary midwives and community-level provision of oral misoprostol by auxiliary midwives...
May 17, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28514779/low-back-pain-in-pregnancy-investigations-management-and-role-of-neuraxial-analgesia-and-anaesthesia-a-systematic-review
#15
Herman Sehmbi, Rohan D'Souza, Anuj Bhatia
BACKGROUND: Low back pain (LBP) is commonly experienced during pregnancy and is often poorly managed. There is much ambiguity in diagnostic work-up, appropriate management and decision-making regarding the use of neuraxial analgesia and anaesthesia during labour and delivery in these patients. This systematic review summarises the evidence regarding investigations, management strategies and considerations around performing neuraxial blocks for pregnant women with LBP. METHODS: We searched 3 databases and reviewed literature concerning LBP in pregnancy with regards to diagnostic modalities, management strategies and use of neuraxial techniques for facilitating labour and delivery...
May 18, 2017: Gynecologic and Obstetric Investigation
https://www.readbyqxmd.com/read/28506815/postpartum-diabetes-testing-rates-after-gestational-diabetes-mellitus-in-canadian-women-a-population-based-study
#16
Sonia Butalia, Lois Donovan, Anamaria Savu, Jeffrey Johnson, Alun Edwards, Padma Kaul
OBJECTIVES: We assessed the rate and type of postpartum glycemic testing in women with impaired glucose tolerance of pregnancy (IGTp) and gestational diabetes mellitus (GDM). We examined whether the likelihood of testing was modulated by patients' characteristics and pregnancy outcomes. METHODS: Our population-level cohort study included data from 132,905 pregnancies between October 1, 2008, and December 31, 2011, in Alberta, Canada. Laboratory data within 270 days before and 1 year after delivery were used to identify pregnancies involving IGTp/GDM and postpartum glycemic testing, respectively...
May 12, 2017: Canadian Journal of Diabetes
https://www.readbyqxmd.com/read/28506430/george-e-palade-memorial-lecture-my-life-in-pancreatic-research-unexpected-results-may-open-the-door
#17
REVIEW
Makoto Otsuki
The Palade Prize is the most distinguished award of the IAP for achievement in pancreatic research. It is named after George E. Palade, who in 1974 was awarded the Nobel Prize for his work on protein trafficking in pancreatic acinar cells. It is a great honor to be awarded the 2016 Palade Prize. While I was in graduate school, I was conducting research on hypothalamo-pituitary-thyroid axis; after finishing graduate school, I began research on amylase isoenzymes. This was the first step of my pancreatic research...
May 6, 2017: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/28500997/does-a-policy-of-earlier-induction-affect-labour-outcomes-in-women-induced-for-postmaturity-a-retrospective-analysis-in-a-tertiary-hospital-in-the-north-of-england
#18
Anna Proctor, Paul Marshall
OBJECTIVES: to investigate whether a change in the management of postmature pregnancy to earlier induction affects the length of labour and the induction process. Secondly, to assess the feasibility of the research process to inform a future larger study. DESIGN: a change in management of postmature pregnancy in an NHS hospital in October 2013, from induction at 42 weeks gestation to induction between 41-42 weeks, provided an opportunity to conduct a retrospective analysis...
April 25, 2017: Midwifery
https://www.readbyqxmd.com/read/28486979/mediation-of-the-effect-of-malaria-in-pregnancy-on-stillbirth-and-neonatal-death-in-an-area-of-low-transmission-observational-data-analysis
#19
Kerryn A Moore, Freya J I Fowkes, Jacher Wiladphaingern, Nan San Wai, Moo Kho Paw, Mupawjay Pimanpanarak, Verena I Carrara, Jathee Raksuansak, Julie A Simpson, Nicholas J White, François Nosten, Rose McGready
BACKGROUND: Malaria in pregnancy is preventable and contributes significantly to the estimated 5.5 million stillbirths and neonatal deaths that occur annually. The contribution of malaria in pregnancy in areas of low transmission has not been quantified, and the roles of maternal anaemia, small-for-gestational-age status, and preterm birth in mediating the effect of malaria in pregnancy on stillbirth and neonatal death are poorly elucidated. METHODS: We analysed observational data routinely collected at antenatal clinics on the Thai-Myanmar border (1986-2015)...
May 10, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28467225/managing-ulceration-and-lymphorrhea-in-chronic-oedema
#20
Marie Todd, Karen Lay-Flurrie, Janet Drake
This clinical review article on the combined use of JOBST FarrowWrap and Cutimed® Sorbion® Sachet XL uses a case study methodology to demonstrate how effective this approach is in managing superficial ulceration and/or lymphorrhea in the presence of chronic oedema and lymphoedema. The blend of these symptoms causes significant physical and psychosocial issues for patients and is highly labour and resource intensive. However, there is often inadequate treatment choice leading to protracted input by nurses and delayed or failed healing...
May 1, 2017: British Journal of Community Nursing
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