ORCID Profile
0000-0002-1196-8426
Current Organisations
La Trobe University
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Mercy Health
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Signal Processing | Electrical and Electronic Engineering | Diagnostic Applications |
Information processing services | Child health | Diagnostic methods
Publisher: Wiley
Date: 11-07-2013
Publisher: IEEE
Date: 07-2012
Publisher: Oxford University Press (OUP)
Date: 18-02-2013
Publisher: Elsevier BV
Date: 10-2021
Publisher: JMIR Publications Inc.
Date: 07-01-2019
Abstract: dentifying mental health disorders in migrant and refugee women during pregnancy provides an opportunity for interventions that may benefit women and their families. Evidence suggests that perinatal mental health disorders impact mother-infant attachment at critical times, which can affect child development. Postnatal depression resulting in suicide is one of the leading causes of maternal mortality postpartum. Routine screening of perinatal mental health is recommended to improve the identification of depression and anxiety and to facilitate early management. However, screening is poorly implemented into routine practice. This study is the first to investigate routine screening for perinatal mental health in a maternity setting designed for refugee women. This study will determine whether symptoms of depression and anxiety are more likely to be detected by the screening program compared with routine care and will evaluate the screening program’s feasibility and acceptability to women and health care providers (HCPs). he objectives of this study are (1) to assess if refugee women are more likely to screen risk-positive for depression and anxiety than nonrefugee women, using the Edinburgh Postnatal Depression Scale (EPDS) (2) to assess if screening in pregnancy using the EPDS enables better detection of symptoms of depression and anxiety in refugee women than current routine care (3) to determine if a screening program for perinatal mental health in a maternity setting designed for refugee women is acceptable to women and (4) to evaluate the feasibility and acceptability of the perinatal mental health screening program from the perspective of HCPs (including the barriers and enablers to implementation). his study uses an internationally recommended screening measure, the EPDS, and a locally developed psychosocial questionnaire, both administered in early pregnancy and again in the third trimester. These measures have been translated into the most common languages used by the women attending the clinic and are administered via an electronic platform (iCOPE). This platform automatically calculates the EPDS score and generates reports for the HCP and woman. A total of 119 refugee women and 155 nonrefugee women have been recruited to evaluate the screening program’s ability to detect depression and anxiety symptoms and will be compared with 34 refugee women receiving routine care. A subs le of women will participate in a qualitative assessment of the screening program’s acceptability and feasibility. Health service staff have been recruited to evaluate the integration of screening into maternity care. he recruitment is complete, and data collection and analysis are underway. t is anticipated that screening will increase the identification and management of depression and anxiety symptoms in pregnancy. New information will be generated on how to implement such a program in feasible and acceptable ways that will improve health outcomes for refugee women. ERR1-10.2196/13271
Publisher: Springer Science and Business Media LLC
Date: 27-11-2014
Publisher: Wiley
Date: 29-08-2017
Publisher: Elsevier BV
Date: 12-1995
DOI: 10.1016/0266-6138(95)90004-7
Abstract: to determine whether the incidence of perineal outcomes, including episiotomy, at the Royal Women's Hospital (RWH) Brisbane reflected trends reported in the literature. retrospective record review. RWH Brisbane. 953 women who delivered vaginally at the RWH in 1986 and 1992. there was a decline in the episiotomy rate from 65% in 1986 to 36% in 1992. This was accompanied by an increase in the incidence of intact perinea and spontaneous perineal tears. There was no difference in the incidence of spontaneous third degree tears. The decline in the incidence of episiotomy was found when other factors, such as parity, were considered, with the exception of operative vaginal delivery, where no difference in the use of episiotomy was found. There was no significant increase in the number of babies with an Apgar score of < 7 at one minute of age, despite a significant reduction in the use of episiotomy when delivering these babies (55% in 1986 and 19% in 1992 P < 0.001). The second stage was significantly longer in 1992 (P < 0.01). the findings reflect the decline in the incidence of episiotomy reported in the literature. This decline in rate was accompanied by an increase in the length of second stage and in the incidence of both intact perinea and perineal tears. Lowering the incidence of episiotomy did not result in a rise in the rate of babies with an Apgar score of < 7 at one minute.
Publisher: Wiley
Date: 23-10-2023
DOI: 10.1111/JOCN.16912
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.PREGHY.2014.03.005
Abstract: Four putative single nucleotide polymorphism (SNP) risk variants at the preecl sia susceptibility locus on chromosome 2q22 rs2322659 (LCT), rs35821928 (LRP1B), rs115015150 (RND3) and rs17783344 (GCA), were recently shown to associate with known cardiovascular risk factors in a Mexican American cohort. This study aimed to further evaluate the pleiotropic effects of these preecl sia risk variants in an independent Australian population-based cohort. The four SNPs were genotyped in the Western Australian Pregnancy Cohort (Raine) Study that included DNA, clinical and biochemical data from 1246 mothers and 1404 of their now adolescent offspring. Genotype association analyses were undertaken using the SOLAR software. Nominal associations (P<0.05) with cardiovascular risk factors were detected for all four SNPs. The LCT SNP was associated with decreased maternal height (P=0.005) and decreased blood glucose levels in adolescents (P=0.022). The LRP1B SNP was associated with increased maternal height (P=0.026) and decreased maternal weight (P=0.044). The RND3 SNP was associated with decreased triglycerides in adolescents (P=0.001). The GCA SNP was associated with lower risk in adolescents to be born of a preecl tic pregnancy (P=0.003) and having a mother with prior preecl tic pregnancy (P=0.033). Our collective findings support the hypothesis that genetic mechanisms for preecl sia and CVD are, at least in part, shared, but need to be interpreted with some caution as a Bonferroni correction for multiple testing adjusted the statistical significance threshold (adjusted P<0.001).
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.IJNURSTU.2009.10.017
Abstract: The incubator environment is essential for optimal physiological functioning and development of the premature infant but the infant is ultimately required to make a successful transfer from incubator to open cot in order to be discharged from hospital. Criteria for transfer lack a systematic approach because no clear, specific guideline predominates in clinical practice. Practice variation exists between continents, regions and nurseries in the same countries, but there is no recent review of current practices utilised for transferring premature infants from incubators to open cots. To document current practice for transferring premature infants to open cots in neonatal nurseries. A descriptive, cross-sectional survey. Twenty-two neonatal intensive care units and fifty-six high dependency special care baby units located in public hospitals in Australia and New Zealand. A s le of 78 key clinical nursing leaders (nurse unit managers, clinical nurse consultants or clinical nurse specialists) within neonatal nurseries identified through email or telephone contact. Data were collected using a web-based survey on practice, decision-making and strategies utilised for transferring premature infants from incubators to open cots. Descriptive statistics (frequencies and crosstabs) were used to analyse data. Comparisons between groups were tested for statistical significance using Chi-squared or Fisher's exact test. Significant practice variation between countries was found for only one variable, nursing infants clothed (p=0.011). Processes and practices undertaken similarly in both countries include use of incubator air control mode, current weight criterion, thermal challenging, single-walled incubators and heated mattress systems. Practice variation was significant between neonatal intensive care units and special care baby units for weight range (p=0.005), evidence-based practice (p=0.004), historical nursery practice (p=0.029) and incubator air control mode (p=0.001). Differences in these variables were also found between nurseries in metropolitan and rural locations. Practice variation exists however many practices are uniformly performed throughout neonatal nurseries in Australian and New Zealand. Commonality was seen between countries and in nurseries with a neonatal intensive care unit. Variation was significant between neonatal intensive care units and special care baby units and nurseries in metropolitan and rural locations.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.PRRV.2014.02.003
Abstract: Lung recruitment is used as an adjunct to lung protective ventilation strategies. Lung recruitment is a brief, deliberate elevation of transpulmonary pressures beyond what is achieved during tidal ventilation levels. The aim of lung recruitment is to maximise the number of alveoli participating in gas exchange particularly in distal and dependant regions of the lung. This may improve oxygenation and end expiratory levels. Restoration of end expiratory levels and stabilisation of the alveoli may reduce the incidence of ventilator induced lung injury (VILI). Various methods of lung recruitment have been studied in adult and experimental populations. This review aims to establish the evidence for lung recruitment in the pediatric population.
Publisher: Wiley
Date: 16-05-2012
Publisher: John Wiley & Sons, Ltd
Date: 31-03-0100
Publisher: Springer Science and Business Media LLC
Date: 30-04-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2007
DOI: 10.1213/01.ANE.0000268493.90073.F3
Abstract: Fetal monitoring during labor aims to identify fetal problems which, if uncorrected, may result in morbidity or death. A nonreassuring or abnormal fetal heart rate trace by cardiotocography (CTG) does not necessarily equate with fetal hypoxia and/or acidosis. However, in the absence of more objective data, the use of CTG often results in variable, but inappropriately high, operative delivery rates (forceps, vacuum, or cesarean delivery) for nonreassuring fetal status in many hospitals. The addition of fetal pulse oximetry (FPO) has the potential to improve the assessment of fetal well-being during labor. In this review we consider several aspects of FPO. Several factors, such as sensor to skin contact, uterine contractions, fetal hair, and caput succedaneum, influence the performance and use of FPO. Issues such as clinicians' perspectives of FPO sensor placement, maternal perspectives of FPO during labor, and an economic analysis have all favored FPO. Several randomized controlled trials (RCTs) of FPO reported a reduction in cesarean delivery for nonreassuring fetal status when FPO was added to conventional CTG monitoring, with no difference in overall cesarean delivery rates. One large RCT reported no difference in mode of birth for any indication. Several issues relevant to the future of FPO have been addressed by these RCTs, the major issue being that it makes no difference to cesarean rates. It may be argued that FPO has a valid clinical use in monitoring the fetus with congenital heart block. Additionally, in situations of nonreassuring fetal status and dystocia, FPO may provide the necessary reassurance until adequate resources for cesarean delivery are available.
Publisher: John Wiley & Sons, Ltd
Date: 18-10-2006
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.MIDW.2014.07.002
Abstract: to identify the perceptions of midwives and doctors at Monash Women's regarding their educational preparation and practices used for perineal management during the second stage of labour. anonymous cross-sectional semi-structured questionnaire ('The survey'). the three maternity hospitals that form Monash Women's Maternity Services, Monash Health, Victoria, Australia. midwives and doctors attending births at one or more of the three Monash Women's maternity hospitals. a semi-structured questionnaire was developed, drawing on key concepts from experts and peer-reviewed literature. surveys were returned by 17 doctors and 69 midwives (37% response rate, from the 230 surveys sent). Midwives and doctors described a number of techniques they would use to reduce the risk of perineal trauma, for ex le, hands on the fetal head erineum (11.8% of doctors, 61% of midwives), the use of warm compresses (45% of midwives) and maternal education and guidance with pushing (49.3% of midwives). When presented with a series of specific obstetric situations, respondents indicated that they would variably practice hands on the perineum during second stage labour, hands off and episiotomy. The majority of respondents indicated that they agreed or strongly agreed that an episiotomy should sometimes be performed (midwives 97%, doctors 100%). All the doctors had training in diagnosing severe perineal trauma involving anal sphincter injury (ASI), with 77% noting that they felt very confident with this. By contrast, 71% of the midwives reported that they had received training in diagnosing ASI and only 16% of these reported that they were very confident in this diagnosis. All doctors were trained in perineal repair, compared with 65% of midwives. Doctors were more likely to indicate that they were very confident in perineal repair (88%) than the midwives (44%). Most respondents were not familiar with the rates of perineal trauma either within their workplace or across Australia. Midwives and doctors indicated that they would use the hands on or hands off approach or episiotomy depending on the specific clinical scenario and described a range of techniques that they would use in their overall approach to minimising perineal trauma during birth. Midwives were more likely than doctors to indicate their lack of training and/or confidence in conducting perineal repair and diagnosing ASI. many midwives indicated that they had not received training in diagnosing ASI, perineal repair and midwives' and doctors' knowledge of the prevalence of perineal outcomes was poor. Given the importance of these skills to women cared for by midwives and doctors, the findings may be used to inform the development of quality improvement activities, including training programs and opportunities for gaining experience and expertise with perineal management. The use of episiotomy and hands on/hands off the perineum in the survey scenarios provides reassurance that doctors and midwives take a number of factors into account in their clinical practice, rather than a preference for one or more interventions over others.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/AH16066
Abstract: Objective The aim of the study was to improve the engagement of professional interpreters for women during labour. Methods The quality improvement initiative was co-designed by a multidisciplinary group at one Melbourne hospital and implemented in the birth suite using the plan-do-study-act framework. The initiative of offering women an interpreter early in labour was modified over cycles of implementation and scaled up based on feedback from midwives and language services data. Results The engagement of interpreters for women identified as requiring one increased from 28% (21/74) at baseline to 62% (45/72) at the 9th month of implementation. Conclusion Improving interpreter use in high-intensity hospital birth suites is possible with supportive leadership, multidisciplinary co-design and within a framework of quality improvement cycles of change. What is known about the topic? Despite Australian healthcare standards and policies stipulating the use of accredited interpreters where needed, studies indicate that services fall well short of meeting these during critical stages of childbirth. What does the paper add? Collaborative approaches to quality improvement in hospitals can significantly improve the engagement of interpreters to facilitate communication between health professionals and women with low English proficiency. What are the implications for practice? This language services initiative has potential for replication in services committed to improving effective communication between health professionals and patients.
Publisher: Wiley
Date: 13-03-2017
DOI: 10.1111/AJO.12593
Abstract: Severe fetal growth restriction (FGR) (< third centile) in a singleton pregnancy undelivered by 40 weeks is one of a number of Victorian Perinatal Services Performance Indicators, which aim to provide a measure of the quality and safety of maternity care. Women of refugee background have been found to have poorer perinatal outcomes compared to others and these outcomes can in part be explained by previous history. However, less access to and engagement with pregnancy care may also be contributing factors. This study examined the impact of likely refugee background on severe FGR in a singleton pregnancy undelivered by 40 weeks. A retrospective study was undertaken utilising data on women who gave birth to a severely growth-restricted infant at Monash Health during January 2013-July 2015. Unadjusted and adjusted analyses were undertaken to examine the association between the mother being of likely refugee background and severe FGR in singletons delivered after 40 weeks. There was an association between the mother being of likely refugee background and giving birth to a severely growth-restricted baby after 40 weeks with these mothers at two and half times the odds compared to mothers of non-refugee background (adjusted odds ratio 2.52 95% confidence interval: 1.44-4.42). While detecting FGR is clinically challenging, our findings suggest that maternity services need to be supported to offer care tailored to the specific needs of vulnerable and disadvantaged populations. Providing quality, culturally responsive and accessible care is fundamental to addressing refugee maternal and perinatal health inequalities.
Publisher: John Wiley & Sons, Ltd
Date: 06-07-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2010
Publisher: Wiley
Date: 11-04-2015
DOI: 10.1111/BIRT.12159
Abstract: The relationship between migration and pregnancy outcomes is complex, with little insight into whether women of refugee background have greater risks of adverse pregnancy outcomes than other migrant women. This study aimed to describe maternal health, pregnancy care, and pregnancy outcomes among migrant women from humanitarian and nonhumanitarian source countries. Retrospective, observational study of singleton births, at a single maternity service in Australia 2002-2011, to migrant women born in humanitarian source countries (HSCs, n = 2,713) and non-HSCs (n = 10,606). Multivariable regression analysis assessed associations between maternal HSC-birth and pregnancy outcomes. Compared with women from non-HSCs, the following were more common in women from HSCs: age < 20 years (0.6 vs 2.9% p < 0.001), multiparity (51 vs 76% p < 0.001), body mass index (BMI) ≥ 25 (38 vs 50% p < 0.001), anemia (3.2 vs 5.9% p < 0.001), tuberculosis (0.1 vs 0.4% p = 0.001), and syphilis (0.4 vs 2.5% p 41 weeks gestation) (OR 2.5 [95% CI 1.9-3.4]). Stillbirth (0.8 vs 1.2% p = 0.04, OR 1.5 [95% CI 1.0-2.4]) and unplanned birth before arrival at the hospital (0.6 vs 1.2% p < 0.001, OR 1.3 [95% CI 0.8-2.1]) were more common in HSC-born women but not independently associated with maternal HSC-birth after adjusting for age, parity, BMI and relative socioeconomic disadvantage. These findings suggest areas where women from HSCs may have additional needs in pregnancy compared with women from non-HSCs. Refugee-focused strategies to support engagement in pregnancy care and address maternal health needs would be expected to improve health outcomes in resettlement countries.
Publisher: Wiley
Date: 13-03-2017
DOI: 10.1111/AJO.12598
Abstract: In 2015 Nippita and colleagues developed a novel system to classify women undergoing induction of labour (IOL), which sought to overcome the problems of indication-based classification. We explored the utility and feasibility of this new system at Monash Health in Melbourne. We found overall induction rates of 24.7% compared with the New South Wales rates of 25.4% reported by Nippita et al. The classification system was easy to apply because it uses routinely and accurately collected data. There was no misinterpretation of the classification groups. The system provides a robust means for auditing IOLs and reviewing their appropriateness.
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.MIDW.2010.11.009
Abstract: To establish the prevalence of perineal pain, the effects of pain on postnatal recovery, analgesia used to relieve pain and the perceived effectiveness of such analgesia at the Royal Women's Hospital, Victoria, Australia. We conducted structured interviews of 215 women in the postnatal ward of a tertiary hospital, within 72 hours of a vaginal birth. The structured interviews revealed that 90% of women reported some perineal pain, with 37% reporting moderate or severe pain. The degree of perineal trauma predicted women's ratings of perineal pain on a visual analogue scale, with more severe trauma related to higher pain scores. Over a third of women experienced moderate or severe perineal pain, particularly when walking (33%) or sitting (39%), while 45% noted that pain interfered with their ability to sleep. Women reported moderate or severe perineal pain when they undertook activities involving feeding their infant (12%) or caring for their infant (12%). Women used a range of analgesia, including a combination of ice packs (69%), oral analgesia (75%), narcotic analgesia (4%) and anti-inflammatory suppositories (25%). The majority of women rated these forms of analgesia as effective and identified very few side effects. Following vaginal birth, women commonly reported pain from perineal trauma. This pain affected women's ability to mobilise and was relieved by a variety of agents. Side effects from analgesia were rare. The prevalence of perineal pain and the associated impact on women's recovery from childbirth warrants midwives' proactive care in offering a range of effective pain relief options to women.
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJOPEN-2020-048271
Abstract: Pregnancy and early parenthood are key opportunities for interaction with health services and connecting to other families at the same life stage. Public antenatal care should be accessible to all, however barriers persist for families from refugee communities to access, navigate and optimise healthcare during pregnancy. Group Pregnancy Care is an innovative model of care codesigned with a community from a refugee background and other key stakeholders in Melbourne, Australia. Group Pregnancy Care aims to provide a culturally safe and supportive environment for women to participate in antenatal care in a language they understand, to improve health literacy and promote social connections and inclusion. This paper outlines Froup Pregnancy Care and provides details of the evaluation framework. The evaluation uses community-based participatory research methods to engage stakeholders in codesign of evaluation methods. The study is being conducted across multiple sites and involves multiple phases, use of quantitative and qualitative methods, and an interrupted time series design. Process and cost-effectiveness measures will be incorporated into quality improvement cycles. Evaluation measures will be developed using codesign and participatory principles informed by community and stakeholder engagement and will be piloted prior to implementation. Ethics approvals have been provided by all six relevant authorities. Study findings will be shared with communities and stakeholders via agreed pathways including community forums, partnership meetings, conferences, policy and practice briefs and journal articles. Dissemination activities will be developed using codesign and participatory principles.
Publisher: Wiley
Date: 30-01-2023
DOI: 10.1111/AJO.13647
Abstract: Delayed reporting of decreased fetal movements (DFM) could represent a missed opportunity to prevent stillbirth. Mobile phone applications (apps) have the potential to improve maternal awareness and reporting of DFM and contribute to stillbirth prevention. To evaluate the effectiveness of the My Baby's Movements (MBM) app on late‐gestation stillbirth rates. The MBM trial evaluated a multifaceted fetal movements awareness package across 26 maternity services in Australia and New Zealand between 2016 and 2019. In this secondary analysis, generalised linear mixed models were used to compare rates of late‐gestation stillbirth, obstetric interventions, and neonatal outcomes between app users and non‐app users including calendar time, cluster, primiparity and other potential confounders as fixed effects, and hospital as a random effect. Of 140 052 women included, app users comprised 9.8% ( n = 13 780). The stillbirth rate was not significantly lower among app users (1.67/1000 vs 2.29/1000) (adjusted odds ratio (aOR) 0.79 95% CI 0.51–1.23). App users were less likely to have a preterm birth (aOR 0.81 0.75–0.88) or a composite adverse neonatal outcome (aOR 0.87 0.81–0.93) however, they had higher rates of induction of labour (IOL) (aOR 1.27 1.22–1.32) and early term birth (aOR 1.08 1.04–1.12). The MBM app had low uptake and its use was not associated with stillbirth rates but was associated with some neonatal benefit, and higher rates of IOL and early term birth. Use and acceptability of tools designed to promote fetal movement awareness is an important knowledge gap. The implications of increased IOL and early term births warrant consideration in future studies.
Publisher: Wiley
Date: 23-03-2021
DOI: 10.1111/AJO.13327
Abstract: Fetal scalp blood s ling for lactate measurement (FBSLM) is sometimes used to assist in identification of the need for expedited birth in the presence of an abnormal cardiotocograph (CTG). However, there is no randomised controlled trial evidence to support this. To determine whether adding FBSLM reduces the risk of birth by emergency caesarean section in labours complicated by an abnormal CTG, compared with CTG without FBS. Labouring women at a tertiary maternity hospital in Melbourne, Australia with a singleton, cephalic presentation, at ≥37 weeks gestation with an abnormal CTG pattern were randomised to the intervention ( n = 61), with intermittent FBSLM in addition to CTG monitoring, or control (CTG without FBS, n = 62). The primary outcome was rate of birth by caesarean section. Secondary outcomes included overall operative birth and fetal and neonatal safety endpoints. Trial registration: ACTRN12611000172909. The smaller than anticipated s le was unable to demonstrate an effect from adding FBSLM to CTG monitoring on birth by caesarean section vs monitoring by CTG without FBS (25/61 and 28/62 respectively, P = 0.64, risk ratio 0.91, 95% confidence intervals 0.60–1.36). One newborn infant in the CTG group met the criteria for the composite neonatal outcome of death or serious outcome, neonatal encephalopathy, five‐minute Apgar score 4, neonatal resuscitation, admission to neonatal intensive care unit for 96 h or more. We were unable to provide robust evidence of the effectiveness of FBSLM to improve the specificity of the CTG in the assessment of fetal wellbeing.
Publisher: Springer Science and Business Media LLC
Date: 11-10-2017
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.WOMBI.2015.07.186
Abstract: Birth at home is a safe and appropriate choice for healthy women with a low risk pregnancy. However there is a small risk of emergencies requiring immediate, skilled management to optimise maternal and neonatal outcomes. We developed and implemented a simulation workshop designed to run in a home based setting to assist with emergency training for midwives and paramedical staff. The workshop was evaluated by assessing participants' satisfaction and response to key learning issues. Midwifery and emergency paramedical staff attending home births participated in a simulation workshop where they were required to manage birth emergencies in real time with limited availability of resources to suit the setting. They completed a pre-test and post-test evaluation form exploring the content and utility of the workshops. Content analysis was performed on qualitative data regarding the most important learning from the simulation activity. A total of 73 participants attended the workshop (midwifery=46, and paramedical=27). There were 110 comments, made by 49 participants. The most frequently identified key learning elements were related to communication (among midwives, paramedical and hospital staff and with the woman's partner), followed by recognising the role of other health care professionals, developing an understanding of the process and the importance of planning ahead. Home birth simulation workshop was found to be a useful tool by staff that provide care to women who are having a planned home birth. Developing clear communication and teamwork were found to be the key learning principles guiding their practice.
Publisher: Elsevier BV
Date: 05-1996
DOI: 10.1016/S0002-9378(96)70612-9
Abstract: Our purpose was to assess the level of agreement between oxygen saturation values obtained from two identical sensors used on different sides of the face of the same human fetus during labor. Two identical fetal pulse oximeter sensors were placed on 12 fetuses during uncomplicated labor at < or = 38 weeks' gestation. Oxygen saturation, fetal heart rate, and uterine activity were recorded. The agreement between synchronous values of oxygen saturation was assessed by calculating the mean difference and SD of the difference. The SD of a single sensor was estimated as the SD of the difference ided by the square root of 2. The mean oxygen saturation value returned from one sensor was 49.2% and from the other 49.9% the mean difference was -0.7%. The SD of the difference was 7.5%, and the 95% limits (+/- 2 SDs of the difference) were -15.5% to 14.1%. The SD from a single sensor was estimated as 5.3%. There was no clinically significant difference between the oxygen saturation values returned from two identical sensors on the one fetus. The magnitude of the SD from a single sensor must be taken into account when an arbitrary "cutoff" or "action" oxygen saturation value in a clinical setting or trial is defined.
Publisher: John Wiley & Sons, Ltd
Date: 17-03-2010
Publisher: MDPI AG
Date: 30-03-2023
DOI: 10.3390/HEALTHCARE11070994
Abstract: There is a need to ensure that healthcare organisations enable their workforces to use digital methods in service delivery. This study aimed to evaluate the current level of digital understanding and ability in nursing, midwifery, and allied health workforces and identify some of the training requirements to improve digital literacy in these health professionals. Representatives from eight healthcare organizations in Victoria, Australia participated in focus groups. Three digital frameworks informed the focus group topic guide that sought to examine the barriers and enablers to adopting digital healthcare along with training requirements to improve digital literacy. Twenty-three participants self-rated digital knowledge and skills using Likert scales and attended the focus groups. Mid-range scores were given for digital ability in nursing, midwifery, and allied health professionals. Focus group participants expressed concern over the gap between their organizations’ adoption of digital methods relative to their digital ability, and there were concerns about cyber security. Participants also saw a need for the inclusion of consumers in digital design. Given the widening gap between digital innovation and health workforce digital capability, there is a need to accelerate digital literacy by rapidly deploying education and training and policies and procedures for digital service delivery.
Publisher: JMIR Publications Inc.
Date: 19-08-2019
DOI: 10.2196/13271
Abstract: Identifying mental health disorders in migrant and refugee women during pregnancy provides an opportunity for interventions that may benefit women and their families. Evidence suggests that perinatal mental health disorders impact mother-infant attachment at critical times, which can affect child development. Postnatal depression resulting in suicide is one of the leading causes of maternal mortality postpartum. Routine screening of perinatal mental health is recommended to improve the identification of depression and anxiety and to facilitate early management. However, screening is poorly implemented into routine practice. This study is the first to investigate routine screening for perinatal mental health in a maternity setting designed for refugee women. This study will determine whether symptoms of depression and anxiety are more likely to be detected by the screening program compared with routine care and will evaluate the screening program’s feasibility and acceptability to women and health care providers (HCPs). The objectives of this study are (1) to assess if refugee women are more likely to screen risk-positive for depression and anxiety than nonrefugee women, using the Edinburgh Postnatal Depression Scale (EPDS) (2) to assess if screening in pregnancy using the EPDS enables better detection of symptoms of depression and anxiety in refugee women than current routine care (3) to determine if a screening program for perinatal mental health in a maternity setting designed for refugee women is acceptable to women and (4) to evaluate the feasibility and acceptability of the perinatal mental health screening program from the perspective of HCPs (including the barriers and enablers to implementation). This study uses an internationally recommended screening measure, the EPDS, and a locally developed psychosocial questionnaire, both administered in early pregnancy and again in the third trimester. These measures have been translated into the most common languages used by the women attending the clinic and are administered via an electronic platform (iCOPE). This platform automatically calculates the EPDS score and generates reports for the HCP and woman. A total of 119 refugee women and 155 nonrefugee women have been recruited to evaluate the screening program’s ability to detect depression and anxiety symptoms and will be compared with 34 refugee women receiving routine care. A subs le of women will participate in a qualitative assessment of the screening program’s acceptability and feasibility. Health service staff have been recruited to evaluate the integration of screening into maternity care. The recruitment is complete, and data collection and analysis are underway. It is anticipated that screening will increase the identification and management of depression and anxiety symptoms in pregnancy. New information will be generated on how to implement such a program in feasible and acceptable ways that will improve health outcomes for refugee women. DERR1-10.2196/13271
Publisher: Wiley
Date: 07-10-2014
Publisher: Wiley
Date: 05-2015
Publisher: John Wiley & Sons, Ltd
Date: 18-04-2007
Publisher: Wiley
Date: 04-2010
Publisher: Springer Science and Business Media LLC
Date: 03-11-2015
Publisher: John Wiley & Sons, Ltd
Date: 12-05-2015
Publisher: Public Library of Science (PLoS)
Date: 10-07-2020
Publisher: Elsevier BV
Date: 06-2017
Publisher: Elsevier BV
Date: 02-2014
Publisher: Wiley
Date: 10-2002
DOI: 10.1046/J.1440-1754.2002.00038.X
Abstract: To examine the fate of research presented at the first annual Perinatal Society of Australia and New Zealand (PSANZ) Congress in 1997, by determining: the rate of publication in peer-reviewed biomedical journals publication rate by discipline journals in which work was published concordance for aims, conclusions, authors and number of study subjects and time from presentation to publication. A MEDLINE search was conducted for any publication in a peer-reviewed journal resulting from a publishable abstract from the proceedings of the first annual PSANZ Congress in 1997. Searching was completed 42 months post-congress. The concordance of aims, conclusions, authors and number of subjects between abstract and published paper was determined. There were 172 publishable abstracts in the proceedings of the PSANZ Congress in 1997, and 78 (45%) were published as 83 articles. Basic sciences had the highest publication rate (67%) and midwifery the lowest (20%). Articles were published in 41 journals, with one-third of the articles in three paediatric journals. There was a match with aims in 75%, and with conclusions in 65%. There were 47/77 with the same number of subjects, 20/77 with more and 10/77 with fewer. There were 22 articles with one author added, 12 had more than one author added, 11 had one author removed and five had more than one author removed. Median time-to-publication was 18 months (interquartile range 9-26 months). A publication rate of 45% is comparable to other conferences. Basic science and neonatology had the highest publication rates. There were considerable differences between abstract and published article in terms of aims, conclusions, number of subjects and authors.
Publisher: Wiley
Date: 18-05-2017
DOI: 10.1111/JAN.13004
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.MIDW.2017.04.006
Abstract: To determine the feasibility and acceptability and measure the effects of a mindfulness intervention compared to a pregnancy support program on stress, depressive symptoms and awareness of present moment experience. A pilot randomised trial using mixed methods. Forty-eight women attending a maternity service were randomly allocated to a mindfulness-based or pregnancy support program. Perceived Stress Scale, Edinburgh Postnatal Depression Scale, Mindfulness Attention Awareness Scale, and Birth Outcomes. Women's perceptions of the impact of the programs were examined via summative evaluation, interviews, diaries and facilitator field notes. Nine women in the mindfulness program and 11 in the pregnancy support program completed post-program measures. There were no statistically significant differences between groups. Of practical significance, was an improvement in measures for both groups with a greater improvement in awareness of present moment experience for the intervention group. The intervention group reported learning how to manage stressors, fear, anxiety, and to regulate their attention to be more present. The control group reported learning how to calm down when stressed which increased their confidence. Intervention group themes were: releasing stress, becoming aware, accepting, having options and choices, connecting and being compassionate. Control group themes were:managing stress, increasing confidence, connecting, focussing, being accepted, preparing. The feasibility and acceptability of the intervention was confirmed. Programs decreased women's self-reported stress in different ways. Women in the mindfulness program accepted themselves and their experiences as they arose and passed in the present moment, while those in the control group gained acceptance primarily from external sources such as peers. Mindfulness programs can foster an internalised locus of self-acceptance which may result in woman becoming less dependent on others for their wellbeing. Adequately powered RCTs, with an active control, long-term follow up and economic evaluation are recommended.
Publisher: Wiley
Date: 21-05-2018
DOI: 10.1111/MCN.12616
Publisher: Wiley
Date: 10-01-2015
DOI: 10.1111/AOGS.12557
Abstract: To examine associations between maternal Asian ethnicity (South Asian and South East/East Asian) and anal sphincter injury. Retrospective cross-sectional study, comparing outcomes for Asian women with those of Australian and New Zealand women. A large metropolitan maternity service in Victoria, Australia. Australian/New Zealand, South Asian and South East/East Asian women who had a singleton vaginal birth from 2006 to 2012. The relation between maternal ethnicity and anal sphincter injury was assessed by logistic regression, adjusting for potential confounders. Anal sphincter injury was defined as a third or fourth degree tear (with or without episiotomy). Among 32,653 vaginal births there was a significant difference in the rate of anal sphincter injury by maternal region of birth (p < 0.001). After adjustment for confounders, nulliparous women born in South Asian and South East/East Asia were 2.6 (95% confidence interval 2.2-3.3 p < 0.001) and 2.1 (95% confidence interval 1.7-2.5 p < 0.001) times more likely to sustain an anal sphincter injury than Australian/New Zealand women, respectively. Parous women born in South Asian and South East/East Asia were 2.4 (95% confidence interval 1.8-3.2 p < 0.001) and 2.0 (95% confidence interval 1.5-2.7 p < 0.001) times more likely to sustain an anal sphincter injury than Australian/New Zealand women, respectively. There are ethnic differences in the rates of anal sphincter injury not fully explained by known risk factors for such trauma. This may have implications for care provision.
Publisher: Springer Science and Business Media LLC
Date: 14-01-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2009
Publisher: Wiley
Date: 31-01-2013
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.WOMBI.2015.08.006
Abstract: Perinatal stress is associated with adverse maternal and infant outcomes. Mindfulness training may offer a safe and acceptable strategy to support perinatal mental health. To critically appraise and synthesise the best available evidence regarding the effectiveness of mindfulness training during pregnancy to support perinatal mental health. The search for relevant studies was conducted in six electronic databases and in the grey literature. Eligible studies were assessed for methodological quality according to standardised critical appraisal instruments. Data were extracted and recorded on a pre-designed form and then entered into Review Manager. Nine studies were included in the data synthesis. It was not appropriate to combine the study results because of the variation in methodologies and the interventions tested. Statistically significant improvements were found in small studies of women undertaking mindfulness awareness training in one study for stress (mean difference (MD) -5.28, 95% confidence intervals (CI) -10.4 to -0.42, n=22), two for depression (for ex le MD -5.48, 95% CI -8.96 to -2.0, n=46) and four for anxiety (for ex le, MD -6.50, 95% CI -10.95 to -2.05, n=32). However the findings of this review are limited by significant methodological issues within the current research studies. There is insufficient evidence from high quality research on which to base recommendations about the effectiveness of mindfulness to promote perinatal mental health. The limited positive findings support the design and conduct of adequately powered, longitudinal randomised controlled trials, with active controls.
Publisher: Hindawi Limited
Date: 2011
DOI: 10.1155/2011/375653
Abstract: Introduction . The experience of normal pregnancy is often disrupted for women with preecl sia (PE). Materials and Methods . Postal survey of the 112 members of the consumer group, Australian Action on Pre-Ecl sia (AAPEC). Results . Surveys were returned by 68 women ( 61 % response rate) and from 64 ( 57 % ) partners, close relatives or friends. Respondents reported experiencing pre-ecl sia ( n = 53 ), ecl sia ( n = 5 ), and/or Hemolysis, Elevated Liver enzymes, and Low Platelets (HELLP syndrome) ( n = 26 ). Many women had no knowledge of PE prior to diagnosis ( 77 % ) and, once diagnosed, did not appreciate how serious or life threatening it was ( 50 % ). Women wanted access to information about PE. Their experience contributed substantial anxiety towards future pregnancies. Partners/friends/relatives expressed fear for the woman and/or her baby and had no prior understanding of PE. Conclusions . The PE experience had a substantial effect on women, their confidants, and their babies and affected their approach to future pregnancies. Access to information about PE was viewed as very important.
Publisher: Wiley
Date: 13-11-2014
DOI: 10.1111/AJO.12147
Abstract: The effects of place of birth on birth outcomes have been examined in several studies both locally and internationally. However, none has examined the impact on caesarean section rates of different level maternity hospitals operating within the one health service. This study aimed to examine the impact of place of (Hospital level 6 4-5 or 4) on birth outcomes in a large metropolitan health service in Victoria. A cross-sectional study utilising data on births to low-risk first-time mothers during 2010-2011. Data were obtained from the Birthing Outcome System (BOS) database of Monash Health. Unadjusted and adjusted analyses were undertaken using logistic regression to examine the association between place of birth and caesarean section. In this group of low-risk nulliparae, there was evidence of a significant association between place of birth and caesarean section. The lower the acuity of the hospital, the higher the odds for the caesarean section. Compared with the level 6 hospital, the AdjOR for caesarean section at the level 4 hospital was 1.81 (95% CI: 1.37-2.41) and at the level 4-5 hospital, 1.30 (95% CI: 1.0-1.7). Low-risk nulliparae in spontaneous labour giving birth at the level 4 hospital in this health service are at significantly increased risk of caesarean section. This may have implications for the organisation and resource management of other level 4 public maternity units. Care in a tertiary (level 6) service may not necessarily equate to the higher rates of intervention reported by others.
Publisher: Springer Science and Business Media LLC
Date: 18-11-2016
Publisher: IEEE
Date: 05-2010
Publisher: Wiley
Date: 17-01-2015
DOI: 10.1016/J.IJGO.2014.10.036
Abstract: To compare maternal health, prenatal care, and pregnancy outcomes among women of refugee background (born in Asian humanitarian source countries [HSCs]) and non-refugee background (born in Asian non-HSCs) at Monash Health (Melbourne, VIC, Australia). In a retrospective study, data were obtained for women born in HSCs and non-HSCs from the same region who received government-funded health care for singleton pregnancies between 2002 and 2011. Multivariable regression analyses assessed associations between maternal HSC origin and pregnancy outcomes. Data were included for 1930 women from South Asian HSCs and 7412 from non-HSCs, 107 from Southeast Asian HSCs and 5574 from non-HSCs, 287 from West Asian HSCs and 990 from non-HSCs. Overweight, anemia, and teenage pregnancy were generally more common in the HSC groups. Birth in an HSC was independently associated with poor/no pregnancy care attendance (OR 4.2 95% CI 2.5-7.3), late booking visit (OR 1.3 95% CI 1.1-1.5), and post-term birth (OR 3.0 95% CI 2.0-4.5) among women from South Asia. For Southeast Asia, HSC birth was independently associated with labor induction (OR 2.0 95% CI 1.1-3.5). No independent associations were recorded for West Asia. Women born in Afghanistan, Bhutan, Iraq, and Myanmar had poorer general maternal health. Those from South Asian HSCs had increased risks of lower engagement in prenatal care, and post-term birth.
Publisher: Wiley
Date: 24-05-2006
DOI: 10.1111/J.0730-7659.2006.00086.X
Abstract: Fetal pulse oximetry improves the assessment of fetal well-being during labor. The objective of this study was to evaluate women's satisfaction with their experience with this additional technology. We surveyed women participating in the FOREMOST trial, a randomized controlled trial comparing the addition of fetal pulse oximetry (FPO) to conventional cardiotocograph (CTG) monitoring (intervention group), versus CTG-only (control group), in the presence of nonreassuring fetal status during labor. Our survey evaluated 3 aspects of women's experience: labor, fetal monitoring, and participation in the research. The survey was administered within a few days of giving birth and repeated 3 months later. No differences were found between the intervention and control groups for women's evaluations of their labor, fetal monitoring, research, or overall experiences when surveyed on both occasions. Within each study group, a small but statistically significant decline occurred in women's scores for their experience of labor and overall experience from the initial survey close to the time of giving birth, to 3 months later. The magnitude of differences in responses over time was similar for the both groups. Women were more satisfied after a spontaneous or assisted vaginal birth than after cesarean section. Length of time the research midwife was present had a significant positive effect on women's ratings of their experience several days after giving birth (p = 0.006), but no effect at 3 months. The addition of fetal pulse oximetry for the assessment of fetal well-being during labor did not affect childbearing women's perceptions of fetal monitoring or their labor. Women evaluated their experience in the research process positively overall. Small changes occurred in women's perception of their satisfaction over time.
Publisher: Public Library of Science (PLoS)
Date: 29-09-2010
Publisher: John Wiley & Sons, Ltd
Date: 28-03-2013
Publisher: Wiley
Date: 06-12-2012
Publisher: IEEE
Date: 12-2011
Publisher: Wiley
Date: 11-07-2012
Publisher: Future Medicine Ltd
Date: 12-2008
Abstract: Fetal pulse oximetry (FPO) has evolved through various phases of technical development and calibration. Clinical studies have addressed the issue of determining threshold action values and how well the technology is accepted by childbearing women and their caregivers. This article considers a variety of situations and factors that commonly occur during labor and that may influence fetal oximetry values. These include uterine contractions, supplemental oxygen and intravenous fluids administered to the mother, maternal position and epidural analgesia. The five randomized, controlled trials that compared the use of FPO in addition to fetal heart-rate monitoring with fetal heart-rate monitoring alone, have been systematically reviewed and subjected to meta-analysis where appropriate. Current clinical practice guidelines do not support the routine use of FPO however, the recent emergence of robust multiwavelength oximeters may, in the future, offer further clinical applications for FPO.
Publisher: Wiley
Date: 12-2000
DOI: 10.1046/J.1440-1762.2000.00379.X
Abstract: The aim of this study was to determine clinicians' perceptions of placing a fetal oximetry sensor. A survey was developed seeking details of staff category, birth suite experience, previous sensor placement, ease of application and use of epidural analgesia. Following staff feedback, the survey was revised from asking clinicians to rate women's comfort during sensor placement, to a visual analogue scale (VAS) of the clinician's assessment of the women's pain during sensor placement. Survey validity was sought from experts during development and for specific questions using item-total correlation in this analysis. Ease of sensor placement (n = 131) was rated as good or excellent 71% of the time. Clinicians rated women's comfort during sensor placement as good or excellent in 90% of cases. Median pain VAS was 0 (range 0-7.5). Item-total correlations of survey questions were all significant. Fetal oximetry sensor placement was rated well by clinicians in this purpose-designed survey.
Publisher: Springer Science and Business Media LLC
Date: 04-07-2009
Publisher: BMJ
Date: 03-08-2012
Abstract: To determine the effects on weight gain and temperature control of transferring preterm infants from incubators to open cots at a weight of 1600 g versus a weight of 1800 g. Randomised controlled trial. One tertiary and two regional neonatal units in public hospitals in Queensland, Australia. 182 preterm infants born with a birth weight less than 1600 g, who were at least 48 h old had not required ventilation or continuous positive airways pressure within the last 48 h were medically stable with no oxygen requirement, or significant apnoea or bradycardia did not require phototherapy and were enterally fed with an intake (breast milk/formula) of at least 60 ml/kg/day. Transfer into an open cot at 1600 or 1800 g. The primary outcomes were temperature stability and average daily weight gain over the first 14 days following transfer to an open cot. 90 infants in the 1600 g group and 92 infants in the 1800 g group were included in the analysis. Over the first 72 h, more infants in the 1800 g group had temperatures 37.1°C (p=0.02). Average daily weight gain in the 1600 g group was 17.07 (SD±4.5) g/kg/day and in the 1800 g group, 13.97 (SD±4.7) g/kg/day (p=<0.001). Medically stable, preterm infants can be transferred to open cots at a birth weight of 1600 g without any significant adverse effects on temperature stability or weight gain. ACTRN12606000518561 (www.anzctr.org.au).
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.AUCC.2009.11.002
Abstract: Ventilator Associated Lung Injury (VALI) is an iatrogenic phenomena that significantly impacts on the morbidity and mortality of critically ill patients. The hazards associated with mechanical ventilation are becoming increasingly understood courtesy of a large body of research. Barotrauma, volutrauma and biotrauma all play a role in VALI. Concomitant to this growth in understanding is the development of strategies to reduce the deleterious impact of mechanical ventilation. The majority of the research is based upon adult populations but with careful extrapolation this review will focus on paediatrics. This review article describes the physiological basis of VALI and discusses the various lung protective strategies that clinicians can employ to minimise its incidence and optimise outcomes for paediatric patients.
Publisher: Elsevier BV
Date: 03-2006
DOI: 10.1016/J.AJOG.2005.08.051
Abstract: The objective of the study was to compare operative delivery rates for nonreassuring fetal status between 2 groups of laboring women: those having conventional cardiotocograph monitoring and those having cardiotocograph monitoring plus fetal pulse oximetry. The intrapartum fetal oximetry prospective, multicenter, randomized, controlled trial (the FOREMOST trial) was conducted in 4 Australian maternity hospitals. The primary outcome was operative birth rates for nonreassuring fetal status. There was a statistically significant 23% relative risk reduction in operative delivery for nonreassuring fetal status in the fetal pulse oximetry + cardiotocograph group (n = 75 of 305, 25%), compared with those in the cardiotocograph-only group (n = 95/295, 32%) (relative risk 0.77, 95% confidence interval 0.599, 0.999, P = .048). There were no significant between-group differences in overall operative births (fetal pulse oximetry + cardiotocograph group 73%, cardiotocograph-only group 71%, relative risk 1.04, 95% confidence interval 0.94, 1.15, P = .478) or neonatal outcomes. The use of fetal pulse oximetry to augment fetal well-being assessment during labor resulted in a statistically significant reduction in the operative intervention for nonreassuring fetal status, compared with the use of conventional cardiotocograph monitoring alone. This reduction was achieved with no significant difference in neonatal outcomes.
Publisher: IEEE
Date: 08-2011
Publisher: Georg Thieme Verlag KG
Date: 2002
DOI: 10.1055/S-2002-25312
Abstract: The use of maternal epidural analgesia in labor may be associated with nonreassuring fetal heart rate (FHR) patterns. Fetal oxygen saturation (FSpO2) monitoring may improve assessment of fetal well-being during this time. Mean FSpO2 values were compared over seven 5-minute epochs: 5 minutes prior to an epidural event (combined insertion of epidural/top-up epidural analgesia and infusion pump bolus), to 30 minutes following the event, including possible effects of maternal position and FHR pattern on FSpO2 values. Mean FSpO2 values were significantly different between the 5 minutes prior (49.5%) versus 16-20 minutes (44.3%, p <0.05), 21-25 minutes (43%, p <0.01), and 26-30 minutes (43.8%, p <0.05) epochs and 6-10 minutes (48.3%) versus 21-25 minutes (43%, p <0.05) epochs, but were not influenced by FHR pattern or maternal position. There were no differences in mean FSpO2 values following administration of an epidural infusion bolus. We conclude that fetal oxygenation was affected following initial or top-up epidural analgesia and that fetal intrapartum pulse oximetry may be useful in assessing fetal status following these events.
Publisher: Wiley
Date: 26-03-2013
Abstract: To investigate the aggregation of obstetric anal sphincter injuries (OASIS) in relatives. Population-based cohort study. The Medical Birth Registry of Norway from 1967 to 2008. All singleton, vertex-presenting infants weighing 500 g or more. Through linkage by national identification numbers, 393 856 mother-daughter pairs, 264 675 mother-son pairs, 134 889 mothers whose sisters later became mothers, 132 742 fathers whose brothers later became fathers, 131 702 mothers whose brothers later became fathers and 88 557 fathers whose sisters later became mothers were provided. Comparison of women with and without a history of OASIS in their relatives. Relative risk of OASIS after a previous OASIS in the family. The risk of OASIS was increased if the woman's mother or sister had OASIS in a delivery (aRR 1.9, 95% CI 1.6-2.3 aRR 1.7, 95% CI 1.6-1.7, respectively). If OASIS occurred in one brother's partner at delivery, the risk of OASIS in the next brother's partner was modestly increased (aRR 1.2, 95% CI 1.1-1.4). If OASIS occurred in one sister at delivery, the risk of OASIS in the brother's partner was also increased a little (aRR 1.2, 95% CI 1.1-1.4). However, there was no excess occurrence in sisters whose brothers' partners had previously had OASIS (aRR 1.1, 95% CI 0.9-1.3). There appears to be increased familial aggregation of OASIS. These risks are stronger through the maternal rather than the paternal line of transmission, suggesting a strong genetic role that shapes aggregation of OASIS within families. These observations must be cautiously interpreted because of bias from unmeasured confounding factors may have impacted the findings.
Publisher: Wiley
Date: 28-06-2018
DOI: 10.1111/AJO.12659
Abstract: Simulation-based programs are increasingly being used to teach obstetrics and gynaecology examinations, but it is difficult to establish student learning acquired through them. Assessment may test student learning but its role in learning itself is rarely recognised. We undertook this study to assess medical and midwifery student learning through a simulation program using a pre-test and post-test design and also to evaluate use of assessment as a method of learning. The interprofessional simulation education program consisted of a brief pre-reading document, a lecture, a video demonstration and a hands-on workshop. Over a 24-month period, 405 medical and 104 midwifery students participated in the study and were assessed before and after the program. Numerical data were analysed using paired t-test and one-way analysis of variance. Students' perceptions of the role of assessment in learning were qualitatively analysed. The post-test scores were significantly higher than the pre-test (P < 0.001) with improvements in scores in both medical and midwifery groups. Students described the benefit of assessment on learning in preparation of the assessment, reinforcement of learning occurring during assessment and reflection on performance cementing previous learning as a post-assessment effect. Both medical and midwifery students demonstrated a significant improvement in their test scores and for most students the examination process itself was a positive learning experience.
Publisher: Wiley
Date: 27-05-2003
DOI: 10.1046/J.1523-536X.2003.00228.X
Abstract: Many women who suffer from postnatal depression are never diagnosed or treated. The objective of this study was to develop an index for use in maternity settings that identifies women who may be at risk for postnatal depression. Women (n = 1762) attending the "booking-in" clinic were screened for antenatal risk factors for postnatal depression. On the third postnatal day eligible women were screened for postnatal risk factors. The Edinburgh Postnatal Depression Scale was mailed to participants 16 weeks after the birth. A predictive index was developed, based on the mean Edinburgh Postnatal Depression Scale scores for each risk factor. The sensitivity, specificity, positive predictive value, and negative predictive value were used to assess the diagnostic value of the index. Seven hundred and twenty-three (50.1%) of the eligible women completed all phases of the study. Of this group, 93 (12.2%) women scored higher than 12 on the Edinburgh Postnatal Depression Scale. At a cutoff of 6, the index had positive predictive value of 39.8 percent for postnatal depression, a threefold improvement over the base rate. The Brisbane Postnatal Depression Index provides a clinically useful method for identifying women at risk for developing postnatal depression. It has applications for early intervention or to identify high-risk groups for research purposes.
Publisher: Elsevier BV
Date: 05-2017
Publisher: Wiley
Date: 02-2002
Publisher: Elsevier BV
Date: 09-2023
Publisher: Wiley
Date: 03-2016
Publisher: Wiley
Date: 25-03-2016
Publisher: Public Library of Science (PLoS)
Date: 14-03-2012
Publisher: Wiley
Date: 30-07-2014
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.AUCC.2009.06.004
Abstract: Recruitment manoeuvres play an important role in minimising ventilator associated lung injury (VALI) particularly when lung protective ventilation strategies are employed and as such clinicians should consider their application. This paper provides evidence-based recommendations for clinical practice with regard to alveolar recruitment. It includes recommendations for timing of recruitment, strategies of recruitment and methods of measuring the efficacy of recruitment manoeuvres and contributes to knowledge about the risks associated with recruitment manoeuvres. There are a range of methods for recruiting alveoli, most notably by manipulating positive end expiratory pressure (PEEP) and peak inspiratory pressure (PIP) with consensus as to the most effective not yet determined. A number of studies have demonstrated that improvement in oxygenation is rarely sustained following a recruitment manoeuvre and it is questionable whether improved oxygenation should be the clinician's goal. Transient haemodynamic compromise has been noted in a number of studies with a few studies reporting persistent, harmful sequelae to recruitment manoeuvres. No studies have been located that assess the impact of recruitment manoeuvres on length of ventilation, length of stay, morbidity or mortality. Recruitment manoeuvres restore end expiratory lung volume by overcoming threshold opening pressures and are most effective when applied after circuit disconnection and airway suction. Whether this ultimately improves outcomes in adult or paediatric populations is unknown.
Publisher: Wiley
Date: 16-05-2012
Publisher: Wiley
Date: 25-08-2006
DOI: 10.1111/J.1471-0528.2006.01044.X
Abstract: To report an economic analysis of the Australian intrapartum fetal pulse oximetry (FPO) multicentre randomised controlled trial (the FOREMOST trial), which examined whether adding FPO to conventional cardiotocographic (CTG) monitoring (intervention group) was cost-effective in reducing operative delivery rates for non-reassuring fetal status compared with the use of CTG alone (control group). Cost-effectiveness analysis of the FOREMOST trial. Four Australian maternity hospitals, each with more than 4000 births/year. Women in labour at > or =36 weeks of gestation, with a non-reassuring CTG. Costs were for treatment-related expenses, incorporating diagnosis-related grouping costs and direct costs (including fetal monitoring). Incremental cost-effectiveness ratio (ICER) and cost-effectiveness plane were calculated, and sensitivity analysis was conducted. The primary outcome was that of the clinical trial: operative delivery for non-reassuring fetal status avoided in the intervention group relative to that in the control group. The ICER. The ICER demonstrated a saving of $A813 for each operative birth for non-reassuring fetal status averted by the addition of FPO to CTG monitoring compared with the use of CTG monitoring alone. The addition of FPO to CTG monitoring represented a less costly and more effective use of resources to reduce operative delivery rates for non-reassuring fetal status than the use of conventional CTG monitoring alone.
Publisher: John Wiley & Sons, Ltd
Date: 06-10-2010
Start Date: 2010
End Date: 12-2013
Amount: $150,000.00
Funder: Australian Research Council
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