bluuebunny/crossref_metadata_2025 huggingface dataset:
“We’re not liberated yet in South Africa”
Authors: Hankela Elina
Published: July 2014

This article makes a case for employing the concept of humanity as the core category in the struggle(s) for liberation in the context of the Central Methodist Mission (CMM) in inner-city Johannesburg. It does so through engaging with the praxis of the leader of the CMM and, in particular, analysing his theological reflection. The concept of humanity offers a flexible framework for an on-going liberationist ministry in a changing society; it also allows the ministry to retain a liberationist edge while it addresses the complex manifestations of inhumanity in actual communities. Moreover, the case of the CMM shows that the content and method of grassroots liberationist ministry overlap: as much as the concept of humanity defines the content, it also has methodological implications for reading the signs of the times.
High prevalence of somatic MAP2K1 mutations in BRAF V600E–negative Langerhans cell histiocytosis
Authors: Brown Noah A. , Furtado Larissa V. , Betz Bryan L. , Kiel Mark J. , Weigelin Helmut C. , Lim Megan S. , Elenitoba-Johnson Kojo S. J.
Published: July 2014

Key Points

Targeted genome sequencing reveals high-frequency somatic MAP2K1 mutations in Langerhans cell histiocytosis. MAP2K1 mutations are mutually exclusive with BRAF mutations and may have implications for the use of BRAF and MEK targeted therapy.
To what extent are the wishes of a signatory reflected in their advance directive: a qualitative analysis
Authors: Nauck Friedemann , Becker Matthias , King Claudius , Radbruch Lukas , Voltz Raymond , Jaspers Birgit
Published: July 2014

Background

Advance directives (ADs) are assumed to reflect the patients’ preferences, even if these are not clearly expressed. Research into whether this assumption is correct has been lacking. This study explores to what extent ADs reflect the true wishes of the signatories.

Methods

Semi-structured interviews (INT), pretest. Transcribed INT and the contents of ADs were inductively categorised (Mayring) and triangulated. Software: MAXQDA 2007. Participants: Patients receiving palliative care (PPC), healthy (H) and chronically ill (CI) individuals with an AD completed ≥3 months prior to recruitment.

Results

Between 08/2008 and 07/2009, 53 individuals (20 H, 17 CI, 16 PPC) were interviewed (mean age 63.2 years (55–70 years)), 34% male). Most important (in)consistencies between preferences as expressed in INT compared to ADs included preconditions for termination/rejection of life-sustaining measures, refusal of/demand for medical interventions and the nomination of proxies. Standardized AD forms were rarely tailored to the individual. We found a high tendency to use set phrases, such as want to die with dignity or do not want to suffer/vegetate. Likely events in the course of an existing progressive disease were not covered, even in ADs of PPC close to death.

Conclusions

Only some of the incongruities between verbally expressed preferences and the contents of the AD can be put down to use of standardized forms or lack of medical knowledge. Nevertheless, the non-involvement of a doctor in the process of making an AD must be seen as potentially problematic and seeking medical advice should be promoted by politics and physicians. Standardised forms should encourage amendments and present space for free text entries for all aspects covered. Set phrases need to be defined by the individual to enable them to be translated into a specific course of action.
Peer workers in mental health services: literature overview
Authors: Gillard Steve , Holley Jessica
Published: July 2014

Peer worker roles are being introduced in mental health services in the UK and internationally, to support individuals in their recovery. There is substantial qualitative evidence that demonstrates benefits at an individual level and some evidence of impact on service use and costs, although there are currently few high-quality randomised controlled trials supporting these findings, especially from the UK. A growing body of research indicates that careful consideration of organisational issues regarding the introduction of peer worker roles – the distinctiveness and shared expectations of the role, strategic alignment, organisational support – might maximise their impact. Properly supported and valued peer workers are an important resource to the multidisciplinary team, offering experiential knowledge and the ability to engage patients in their treatment through building relationships of trust based on shared lived experience.

LEARNING OBJECTIVES

Appreciate the origins of the peer worker role and how the role has been introduced into mental health services to date.

Understand the evidence for the benefits of peer worker roles, for patients, peer workers and mental health service delivery.

Demonstrate awareness of the organisational and team-level barriers to and facilitators of introducing peer workers into, or alongside, existing multidisciplinary mental health teams.
Beyond year zero: getting the best out of revalidation
Authors: Tacchi Mary Jane
Published: July 2014

Medical revalidation was introduced in the UK in 2012 (‘year zero’) after years of discussion and debate. This article describes what it aims to achieve. The General Medical Council's Good Medical Practice is used as a framework on which to build to provide evidence of competencies. Practical aspects of appraisal and revalidation are discussed, with suggestions of how to get the most out of the process both for patients and doctors.

LEARNING OBJECTIVES

•

Understand the purpose of revalidation.

•

Understand the role of the responsible officer.

•

Describe the types of supporting information necessary for revalidation.
Are specialist psychiatric services losing the PbR race?: commentary on… clustering in mental health payment by results
Authors: Radhakrishnan Vishwa
Published: July 2014

Payment by results (PbR) is a payment platform for healthcare services. Introduced to acute physical healthcare services in England in 2003–2004, the system has continued to expand and is currently being implemented in acute mental health services. Owing to the variations and complexities of the patients who access specialist psychiatric services, existing clusters do not always accurately capture their needs. The development of PbR tools specific to psychiatric subspecialties is ongoing, but might not be available in the short term. The funding of acute mental health services through PbR might have funding implications for specialist services such as psychiatry of intellectual disability.
Impact of Brachytherapy on Local Recurrence Rates After Sublobar Resection: Results From ACOSOG Z4032 (Alliance), a Phase III Randomized Trial for High-Risk Operable Non–Small-Cell Lung Cancer
Authors: Fernando Hiran C. , Landreneau Rodney J. , Mandrekar Sumithra J. , Nichols Francis C. , Hillman Shauna L. , Heron Dwight E. , Meyers Bryan F. , DiPetrillo Thomas A. , Jones David R. , Starnes Sandra L. , Tan Angelina D. , Daly Benedict D.T. , Putnam Joe B.
Published: July 2014

Purpose

A major concern with sublobar resection (SR) for non–small-cell lung cancer (NSCLC) is high local recurrence (LR). Adjuvant brachytherapy may reduce LR This multicenter randomized trial compares SR to SR with brachytherapy (SRB).

Patients and Methods

High-risk operable patients with NSCLC ≤ 3 cm were randomly assigned to SR or SRB. The primary end point was time to LR, where LR included recurrence at the staple line (local progression), in the primary tumor lobe away from the staple line, and in ipsilateral hilar nodes. The trial was designed to have a 90% power to detect a hazard ratio (HR) of 0.315 in favor of SRB, using a one-sided type I error rate of 0.05 with a sample size of 100 eligible patients in each arm.

Results

Two hundred twenty-four patients were randomly assigned; 222 patients were evaluable for intent-to-treat analysis. Median age was 71 years (range, 49 to 87 years). No differences were found in baseline characteristics. Median follow-up time was 4.38 years (range, 0.04 to 5.59 years). There was no difference in time to LR (HR, 1.01; 95% CI, 0.51 to 1.98; log-rank P = .98) or in the types of LR. Local progression occurred in only 17 (7.7%) of 222 patients. In patients with potentially compromised margins (margin < 1 cm, margin-to-tumor ratio < 1, positive staple line cytology, wedge resection, nodule size > 2.0 cm), SRB did not reduce LR, although trends favored the SRB arm. This was most marked in 14 patients with positive staple line cytology (HR, 0.22; P = .24). Three-year overall survival rates were similar for patients in the SR (71%) and SRB (71%) arms (P = .97).

Conclusion

Brachytherapy did not reduce LR after SR. This finding may have been related to closer attention to parenchymal margins by surgeons participating in this study.
Loan Repayment among Sm all-Holder Maize Farmers in Kanke Local Government Area of Plateau State, Nigeria
Authors: Ezihe J. A. C. , Oboh V. U. , Hyande A. A.
Published: July 2014

The main objectives of this study were to access the loan repayment performance of small-holder maize farmers in Kanke Local Government Area of Plateau State. A sample of 90 farmers was randomly selected and analyzed using percentages, means, and multiple regression. Results show that farmers received on average of ₦75,000 as loan. A large proportion of the farmers adopted mixed varieties of maize. Untimely loan disbursement, low market price of farm produce, and high interest rate were the major constraints militating against loan repayment. It was recommended that more credit from formal sources should be made available in large loan size to farmers. In addition, loan disbursement should be timely to avoid diversion while successful applicants should be trained on proper loan management.
Nutrition in palliative and end-of-life care
Authors: Gillespie Loraine , Raftery Anne-Marie
Published: July 2014

Recent publications regarding nutrition highlight the importance of eating and drinking for patients and their family/carer. This article focuses on the importance of nutrition and early nutritional intervention, giving guidance for nurses when caring for patients with palliative and end-of-life care needs when the focus of nutrition centres around symptom control and quality of life. Clear, sensitive communication, with agreed nutritional goals set with the patient and their family/carer, and regular review and adaptation throughout any ‘cancer journey’ are paramount in order to minimise anxiety and distress. A multidisciplinary team approach is often required in order to support ethical decision-making and to assist in devising an individualised nutritional management plan. Although this article aims to focus upon the nutritional aspects associated with advancing cancer, many aspects will clearly be transferrable to patients with other life-limiting illnesses such as dementia and advanced cardiac and pulmonary disease.
Picking up the pieces: the post-delivery stress clinic
Authors: Allott Helen
Published: July 2014

Many women experience either emotional or physical trauma as a result of their birth experience. There is a need to provide support services for such women. In some centres services have been established by both midwives and obstetricians, one of which is described here. An analysis has been made of the strategies offered to women to enable them to cope with another birth.
Client abuse and the personal cost of accountability
Authors: Jones Shirley R
Published: July 2014

If verbal reports from clients, their relatives, students, and sometimes midwives, are to be believed client abuse occurs too frequently. This article considers professional accountability when such misconduct is observed.
Complaining about complaints
Authors: Robinson Jean
Published: July 2014

All Fools Day — April 1st — was just the right time to launch the new NHS complaints system, but it was the public who were fooled. Most of them were naive enough to believe that the new system would be better than the old. The government were already aware of a growing swell of protest from the consumer cognoscenti and realised that if they held a press launch even the spin doctors could not suppress it, so publicity outside the NHS was non-existent. Meanwhile, managers were frantically pawing through the newly issued Guidance, wondering how on earth they could get the new system up and running in time.
Caseload practice: a recipe for burn out?
Authors: Leap Nicky
Published: July 2014

A frequently expressed reservation about caseload practice is that it leads to burn out and that it is unfair to expect midwives with ‘families’ to work this way. ‘I hear that you are all burnt out’ is the occasional rumour.
Antenatal screening and diagnosis in a multiracial society
Authors: Schott Judith , Henley Alix
Published: July 2014

Antenatal screening and diagnosis for fetal abnormality are a major and increasing part of antenatal care. The choices and dilemmas facing women are complex, especially for those with specific cultural or religious beliefs and needs.
Demystifying the writing process
Authors: Killingworth Anita , Nolan Peter , Nolan Mary
Published: July 2014

The aim of this article is to demystify the writing process and encourage midwives to write more, sharing their experiences and expertise with other practitioners.
Post-traumatic stress disorder and childbirth: 2
Authors: Crompton Judy
Published: July 2014

Little has been written about the midwife and her role in the care of previously traumatized women, the acknowledgment of post-traumatic stress disorder in her clients, or how the knowledgable and empathic midwife may use her understanding of her client's vulnerability to promote a positive birth experience. This second in a two-part article seeks to increase that knowlege.
Daily fetal movement counts: a reappraisal
Authors: Ranjan V
Published: July 2014

Decreased fetal movement is a warning signal of impending fetal demise. Measures to record fetal movements have not proved satisfactory. This article examines the need for a system which takes into account variations in fetal movements as pregnancy advances.
A neonatal Bacillus Calmette-Guérin vaccination programme
Authors: Halfpenny Sheila , Ford Lyn
Published: July 2014

This article describes the implementation of a Bacillus Calmette-Guérin vaccination programme for newborn infants by a team of community neonatal midwives. The aim was to increase the uptake of vaccination through early identification, referral and improved communication.
Quantitative and qualitative approaches to research
Authors: Rees Colin
Published: July 2014

Quantitative and qualitative approaches to research are two distinct ways of conducting midwifery research. This article outlines the differences between the two and shows how they can be useful to the midwife. A third option of combining the two in a single project is suggested as a way of gaining the best from each alternative.
Enough work for everyone
Authors: Jackson Kate
Published: July 2014

There has always been a competitive element among the different professional groups involved in the delivery of maternity care. While midwives, GPs and obstetricians would all accept that each professional group has a contribution to make, it often seems that each group believes that the particular expertise they bring is the key tenet of good maternity care. This belief comes to light when discussion takes place about who should play the key role in the provision of maternity care. Each group will normally put up a robust argument as to why women would be best advised (within the context of informed choice) to seek at least some care from them. At a time when resources appear to be limited, and in some instances decreasing, this approach seems somewhat perverse.
Death of a mother
Authors: Robinson Jean
Published: July 2014

‘Midwives should not have agreed to supervise the labour under these circumstances.’ One of the cautionary tales in the latest Report of Confidential Enquiries into Maternal Deaths in the UK suggests that one woman's life might have been saved if the midwives had been more assertive.
Improving communication: apologies and explanations
Authors: Symon Andrew
Published: July 2014

Apologies and explanations are an essential feature of good staff–patient communication, especially when an outcome is suboptimal. Sensitively carried out, they may help to reduce the number of legal cases which are based on a misunderstanding. Insensitive explanations can inflame a sense of grievance, and have been known to promote rather than discourage recourse to legal action.
A randomized controlled trial of two interventions to provide social support
Authors: Reid Margaret
Published: July 2014

This is two-centred trial of two forms of postnatal support, assessing the benefits of providing postnatal support to first-time mothers. Women were randomly allocated into one of four groups, with two interventions, one an invitation to attend a support group and the other a postnatal support pack. The project methods and evaluation are described.
Changing times: Practice and practicalities
Authors: Downe Soo
Published: July 2014

It seems that we are constantly being asked to reconsider and redefine ourselves and our practice. It doesn't help that most of us are employed by a service that is subject regularly to the vagaries of political change, both locally and nationally, and we have to compete for priority with other disciplines. Recently, most of the change we have experienced has been institutional, and for many of us it has been both exhilarating and painful. Perhaps the time has come for us to rest from the disruption of organizational change, and reflect on our practice. Maybe, within that space, we can take charge of future developments, both on our behalf, and for the women we support.
Delays 1: tracing case records and staff
Authors: Symon Andrew
Published: July 2014

Delays in legal cases may occur for several reasons. At times the case records are not quickly identified or traced; this may be due to inefficient storage and retrieval procedures. Tracing the relevant staff is more difficult if cases are not initiated for several years. Problems are compounded if entries are illegible or unsigned, or if no accurate record exists of staff identities or whereabouts at the relevant time.
The Standard of case records
Authors: Symon Andrew
Published: July 2014

Adequate case records are a legal requirement. When investigating allegations of negligence, they may do much to help those involved remember events with greater accuracy; at times they may be the only source of information. A lack of documentation can delay a legal case significantly; it may also make a case much harder to defend.
The Child Bereavement Trust: caring for bereaved families
Authors: Thomas Jenni
Published: July 2014

Every year in the UK, more than 7000 babies are born dead or die around birth (SANDS; Stillbirth and Neonatal Death Society, 1997). This figure does not take into account the many thousands of babies who are born dead before 24 weeks gestation which is the legal definition of a stillbirth according to the Stillbirth Definition Act 1992. Any baby born with signs of life, however brief, is considered a live birth, regardless of age. Legal definitions dictate which births and deaths must be registered, and what happens to the baby's body. They are important insofar as they confirm the baby's existence or negate it. However, legal definitions of when a fetus becomes a baby, seldom coincide with women's feelings and experiences, or the varied religious and cultural definitions (Moulder, 1990).
Reflection, supervision and the practitioner
Authors: Swann Yvonne
Published: July 2014

Reflective practice is a process of continual learning once formal learning is complete. Recently the idea of reflective practice has gained considerable interest, both in education and practice. The question is, what is the potential value or significance of these skills for the midwife?
Practice and prejudice
Authors: Downe Soo
Published: July 2014

Many of my friends wonder why I am so nervous about my third pregnancy. After all, I have had two normal deliveries at home — what is the problem? I think I have hit on a phenomenon. I have often noticed in the past that women having their third babies seem to have a strangely bad time. I have decided that the rationale for this fear goes something like this. For the first birth, you don't know what to expect. You hope you are going to manage, bur you are not really sure. The excitement and anticipation carry you through. You feel pretty wonderful at the end of the first labour, simply because you have done it. The second labour can be anticipated to be better than the first — after all, everyone says so. Then, when it isn't, the terrible realization sets in — birth is painful. Labour number three can be anticipated with much more clarity, and in the context of simultaneously caring for other young children. Oh for the heady anticipation of the first pregnancy!
Intrapartum continuity of carer in a Welsh rural community
Authors: Price Sian , Williams Elizabeth
Published: July 2014

In Powys there has long been the assumption that there is a high level of intrapartum continuity of carer, this has never been objectively assessed. A quantitative study was undertaken to assess this and the importance attached to it. The implications of the findings are discussed.
Letters
Authors: Salariya Ellena M , Stewart Sarah
Published: July 2014

A recent review, ‘Hyperbilirubinaemia in henlthy breastfed infants’ (June 1997), suggests that ‘midwives need to discern more accurately the need for diagnostic test and to challenge our-dated management protocols that aim to "treat" healthy infants’.
Undergraduate preparation of student midwives.
Authors: Hindley Carol
Published: July 2014

I recently read with interest an article published in BJM on undergraduate preparation for student midwives and the role of education in advancing the profession (Hunt, 1997). While the author raised some interesting points, I believe some of them are fundamentally naive.
The Putnam Natural Birth System
Authors: Holland Caroline
Published: July 2014

It was pure coincidence that Debra Saund was the first midwife in the country to use the Putnam Natural Birth System. She was simply in the right place at the right time. But contradictory as it may sound, it was the sort of coincidence that was meant to be.
New reproductive technologies: developments in Canada
Authors: King Marion
Published: July 2014

This article summarizes developments in the area of reproductive technologies in Canada. In 1996 a Bill was introduced into Parliament subsequent to the recommendations of the 1993 report of a Royal Commission which examined the social, ethical, health, research and economic implications of medical and scientific advances In the field of infertility and its treatment. The Bill would have banned, with criminal sanctions, certain procedures in the area of reproductive technology. The proposed legislation ultimately died in the final stages of consideration when an early election was called.
Midwifety by distance: a challenge
Authors: Glover Pauline A
Published: July 2014

Every woman has the right to have an appropriately educated, qualified and competent midwife in attendance during pregnancy, labour and birth. This will help to ensure that mortaliry and levels of ill health will be reduced by the year 2000 in line with the Safe Motherhood Programme. In Australia the national perinatal mortality rate declined by 63% from 27.1 per 1000 births in 1973 to 8 per 1000 births in 1994 (Day et al, 1997).
Birth after multiple miscarriages: emotional needs
Authors: Robinson Jean
Published: July 2014

The GP was furious, and threatened to strike her off his list. The supervisor of midwives came to the house to shroud-wave. Surely Sally, with her medical history, would not put this ‘very precious baby’ at risk by insisting on a home birth? But Sally's assessment of risk was very different, as we shall see.
Breast-feeding: the next ‘tough choice’?
Authors: Hawkey Mary
Published: July 2014

What every midwife has long known — that breast-feeding is good for both baby and mother — received further endorsement in a publication from the American Academy of Pediatrics (AAP) in December of last year. Besides extolling the diversity of nutritional and health enhancing benefits of breast-feeding — decreasing the incidence of infections for the baby, and reducing the risk of premenopausal breast and ovarian cancer for the mother — the AAP also pointed to ‘… the significant social and economic benefits to the nation, including reduced health care costs and reduced employee absenteeism for care attributable to child illness.’ Moreover, a study by Wilson et al (1998) suggests that there is the likelihood of a significant reduction in respiratory illnesses if the child is fed exclusively on breast milk for 15 weeks, with no solid foods being introduced during this time.
Is sex education in the Netherlands better organized than in Britain?
Authors: Dolby Evelyn
Published: July 2014

This article explores some of the differences between the format of sex education in the Netherlands with that used in the United Kingdom. Ideas that could be utilized and suggestions for future British initiatives are discussed. The possibilityof using midwifery skills and knowledge to facilitate effective education for sexual health is also explored
Developing and delivering a paramedic obstetric course
Authors: Payne Sheena , Hobbs Julie
Published: July 2014

Recent changes within the health service have caused the disbandment of the obstetric flying squad. Therefore, there is a need to ensure paramedics are adequately trained to meet obstetric emergencies. This article details the development and delivery of one such course and considers both the educational principles and the collaborative/interprofessional approach that underpins this training. Of particular interest to midwives is the appreciation and understanding of the reciprocal roles of the paramedic and midwife which emerged from the development of this course.
Iron supplementation in pregnancy: can it be justified?
Authors: Day Lindsay
Published: July 2014

The provision of routine iron supplementation to correct ‘anaemia’ in pregnancy is common practice among many midwives and obstetricians. This article seeks to uncover the true nature of such anaemia and raises questions regarding the use and safety of iron supplementation. It will be demonstrated that a fall of haemoglobin in pregnancy is not an accurate measure of developing anaemia, rather just reflective of normal physiological changes. In this age of evidence-based practice when professionals are being urged to justify their actions, we need to challenge the assumption that failing haemoglobin levels requires correction and examine the usefulness of iron supplementation.
Aromatherapy and evidence based practice
Authors: Hawkey Mary
Published: July 2014

In her excellent book, Aromatherapy for Pregnancy and Childbirth, Margaret Fawcett describes aromatherapy as ‘a treatment using pure aromatic plant oils to enhance or restore well-being by stimulating the body's own natural healing processes.’
When interpersonal skills fail
Authors: Hadikin Ruth
Published: July 2014

Mrs S, a 20 year old primigravida with hyperteneion was told labour would be induced. At 12 noon a doctor put up an intra-venous drip and ruptured her membranes. By 7pm she was in conesiderable pain so she was given pethidine and transferred to a dalivery room. She was alone. Her husband and mother were outside but were not allowed in. She says she was very frightened and didn't have a clue What was happening or how far on she was. She had wanted her mother with her. She became aware of a midwife in the room. She had her back to Mrs S and appeared to be busy. Mrs S doesn't remember her coming into the room and hadn't seen her before, Mrs S remembers moaning loudly with the pain but says she wasn't screaming. The midwife turned around and slapped Mrs S full across the face, saying: ‘Shut up. Don't be silly, you're only having" baby.’ Mrs S says she will never forget It. As a result of this experience she refused to have her second baby in hospital and still feels nervous of hospitals.
Home birth: is it a real option?
Authors: Hosein Michelle Carol
Published: July 2014

In spite of the Department of Health's (1993) recommendation that women should be given more choice about where they give birth, there is evidence which suggests that this option is now restricted by community midwives’ attitudes (Reld, 1993; Cronk, 1995). In order to identify whether having a home birth is a real option, this study investigated community attitudes about home births. Consistent with the findings of the literature review, it revealed that certain personal attitudes and views which midwives possess can act as barriers to woman being offered true choice, regarding the place of birth. Additionally, the study identified that organizational factors such as staff shortages and policies relating to the criteria used to select women for home births, also prevent women from being given this option. The study concluded that In order to provide the service advocated by the Department of Health (1993), midwives must be willing to adopt their role as ‘Independent practitioners’ (UKCC, 1993) and support women's choices. Further investigation into the effects of organizational factors on choice is also necessary.
The case of the Newcastle knickers
Authors: Robinson Jean
Published: July 2014

You made reference to Mrs S's knickers, commenting that they must be London knickers and not Newcastle knickers.’
Caring and sharing: developing the art and science of midwifery
Authors: Downe Soo
Published: July 2014

I recently attended the morning session of a meeting which taught me more in a few hours than I have learnt in the last few years' study day attendance. The presentations I saw were very different, one on normal delivery of the baby presenting by breech, and one on a novel approach to understanding the psychology of neonatal hypoglycaemia. The first speaker, Mary Cronk, wasn't even present, since she was awaiting a birth, and couldn't leave base to attend. However, her slides had arrived, and her talk to accompany them was read. What came over from the presentation was the voice of experience. She was sure, competent, rightly cautious, rightly optimistic, and informed both by belief in the process of birth and the knowledge born of years of experience and study.
Midwifery group practices: what do hospital based midwives think?
Authors: Fenwick Natalie , Morgan Myfanwy , Wolfe Charles , McKenzie Christina
Published: July 2014

Since the publication of Changing Childbirth (Department of Health, 1993), maternity units have organized midwives into partnerships, teams and group practices by recruiting self-selected midwives committed to the principles of the schemes. Little is known, however, about what the general population of midwives think about working in this way. This article reports the findings of a survey of hospital based midwives working within a trust which was piloting community based midwifery group practices. It explores their reasons for or against applying to group practice work, and considers implications for the sustainability of such schemes.
Assessing midwifery workload on a labour ward
Authors: Hurley Jane , Dickson Katie
Published: July 2014

On a labour ward, providing an objective means of assessing midwifery staffing is essential to match workload with available resources thereby ensuring effective utilization of staff, and to maintain quality intrapartum care. This report describes the application of a workforce planning tool, based upon GRASP® systems workload methodology, to identify staffing needs based on patient dependency levels on a labour ward, some findings relating to trends in unit activity and projected work time equivalents are provided.
The value of listening skills to midwifery practice
Authors: Butler Margaret S , Jackson Leigh
Published: July 2014

Effective communication between midwife and client is a critical component in determining client satisfaction with care. Listening skills are an essential component of the communication process. It cannot be taken for granted that all midwives utilize listening skills effectively in practice. Recognition of potential barriers to listening as well as the enhancement of listening utilizing both a cognitive and skills perspective is required in order to meet the needs of the clients.
Management and leadership in midwifery: part 1
Authors: Pashley Glenys
Published: July 2014

In a changing and increasingly complex health service, midwifery leadership and management are essential elements for effective professional practice. This paper critically explores the meaning of leadership and management and the implications for the development of the midwife. The paper is presented in two parts: Part 3. adopts a theoretical perspective and examines some of the theories underpinning management and leadership; Part 2 looks in more detail at the implications for the development of management and leadership skills.
An analysis of Oxford hip and knee scores following primary hip and knee replacement performed at a specialist centre
Authors: Matharu G. S. , McBryde C. W. , Robb C. A. , Pynsent P. B.
Published: July 2014

The Oxford hip and knee scores (OHS and OKS) are validated patient-reported outcome measures used in patients undergoing total hip replacement (THR), hip resurfacing (HR), total knee replacement (TKR) and unicompartmental knee replacement (UKR). We analysed the absolute OHS and OKS and change in scores following THR, HR, TKR, and UKR performed at one specialist centre. All patients undergoing and completing at least one Oxford score were eligible for inclusion in the study which included 27 950 OHS and 19 750 OKS in 13 682 patients. Data were analysed using non-linear quantile regression. The median absolute Oxford scores for THR, HR, TKR and UKR were pre-operative 68.8% (15.0/48), 58.3% (20.0/48), 66.7% (16.0/48), 60.4% (19.0/48) respectively: and post-operative asymptote was 14.6% (41.0/48), 5.8% (45.2/48), 31.2% (33.0/48), 29.2% (34.0/48). The median asymptotic change from the pre-operative score for THR, HR, TKR and UKR were 47.9% (23.0/48), 47.9% (23.0/48), 33.3% (16.0/48) and 32.4% (15.5/48), respectively. The median time at which no further appreciable change in score was achieved post-operatively was 0.7 years for THR, 1.1 years for HR, 0.9 years for TKR and 1.1 years for UKR.

The curves produced from this analysis could be used to educate patients, and to audit the performance of a surgeon and an institution. The time to achieve a stable improvement in outcome varied between different types of joint replacement, which may have implications for the timing of post-operative review.

Cite this article: Bone Joint J 2014; 96-B:928–35.
Incidence and risk factors for post-operative complications after scoliosis surgery in patients with Duchenne muscular dystrophy
Authors: Duckworth A. D. , Mitchell M. J. , Tsirikos A. I.
Published: July 2014

We report the incidence of and risk factors for complications after scoliosis surgery in patients with Duchenne muscular dystrophy (DMD) and compare them with those of other neuromuscular conditions.

We identified 110 (64 males, 46 females) consecutive patients with a neuromuscular disorder who underwent correction of the scoliosis at a mean age of 14 years (7 to 19) and had a minimum two-year follow-up. We recorded demographic and peri-operative data, including complications and re-operations.

There were 60 patients with cerebral palsy (54.5%) and 26 with DMD (23.6%). The overall complication rate was 22% (24 patients), the most common of which were deep wound infection (9, 8.1%), gastrointestinal complications (5, 4.5%) and hepatotoxicity (4, 3.6%). The complication rate was higher in patients with DMD (10/26, 38.5%) than in those with other neuromuscular conditions (14/84, 16.7% (p = 0.019). All hepatotoxicity occurred in patients with DMD (p = 0.003), who also had an increased rate of deep wound infection (19% vs 5%) (p = 0.033). In the DMD group, no peri-operative factors were significantly associated with the rate of overall complications or deep wound infection. Increased intra-operative blood loss was associated with hepatotoxicity (p = 0.036).

In our series, correction of a neuromuscular scoliosis had an acceptable rate of complications: patients with DMD had an increased overall rate compared with those with other neuromuscular conditions. These included deep wound infection and hepatotoxicity. Hepatotoxicity was unique to DMD patients, and we recommend peri-operative vigilance after correction of a scoliosis in this group.

Cite this article: Bone Joint J 2014; 96-B:943–9.
Durability and complications of photoselective vaporisation of the prostate with the 120W high performance system GreenLight™ lithium triborate laser
Authors: Batura D , Sahibzada I , Elkabir J , Feyisetan O , Izegbu V , Hellawell G , Webster J
Published: July 2014

Introduction

The aim of this study was to examine the durability of photoselective vaporisation of the prostate (PVP) with the 120W GreenLight HPS® laser (American Medical Systems, Minnetonka, MN, US), and to examine the incidence, nature and factors associated with complications from the procedure.

Methods

Clinical records of PVP patients were reviewed to compare details between patients who developed complications and those who did not. Kaplan–Meier survival curves were used to assess durability. Cox regression was used to examine associations between complications and perioperative factors.

Results

Successful outcomes were maintained in 84% of 117 patients at the 2-year follow-up appointment. Complication rates were low and comparable with transurethral resection of the prostate (TURP). Complications were developed by 18 patients (15.4%) over a mean follow-up duration of 20.8 months. The most common complications were residual prostate requiring another surgery (5/117, 4.3%) and urethral stricture (4/117, 3.4%). Patients with complications had significantly longer catheterisation duration. Length of hospital stay, lasing energy, pre and postoperative levels of prostate specific antigen (PSA), pre and postoperative maximum flow rate (Qmax), and age at surgery were not found to influence development of complications.

Conclusions

Results from PVP with an HPS® laser are durable. Complications are low and compare favourably with TURP. Lasing energy, PSA, Qmax, patient age and length of stay are not associated with development of complications. However, a longer postoperative catheterisation after PVP is associated with development of complications.
Devolution? (AG) Barr humbug
Authors: Spinnbarkeit
Published: July 2014

Already worrying about the consequences of devolution? A fizzy drink and a boiled sweet will take your mind off it...
Na senda da inovação tecnológica na Educação a Distância
Authors: Gomes Maria João
Published: July 2014

Este texto aborda a temática da relação entre a evolução das tecnologias e as mudanças nos sistemas e modelos de educação a distância, tomando como ponto de partida a importância das tecnologias na mediatização dos conteúdos e na mediatização da comunicação entre professores e alunos e destes entre si. Neste contexto, discute-se o conceito de “geração de inovação tecnológica”, primeiramente utilizado por outros autores. Identifica-se a existência de cinco gerações de modelos de educação a distância possibilitados pela evolução tecnológica, e perspectiva-se o surgimento de uma sexta geração com base nos desenvolvimentos tecnológicos mais recentes, no domínio dos “mundos virtuais”. Procede-se também à caracterização de cada uma das gerações de educação a distância considerando como principais dimensões os aspectos relacionados com a mediatização e distribuição dos conteúdos educativos e com a mediatização e valorização da interacção e comunicação entre os sujeitos envolvidos em situações de educação a distância.
Role of G-proteins in the differentiation of epiphyseal chondrocytes
Authors: Chagin Andrei S , Kronenberg Henry M
Published: July 2014

Herein, we review the regulation of differentiation of the growth plate chondrocytes by G-proteins. In connection with this, we summarize the current knowledge regarding each family of G-protein α subunit, specifically, Gαs, Gαq/11, Gα12/13, and Gαi/o. We discuss different mechanisms involved in chondrocyte differentiation downstream of G-proteins and different G-protein-coupled receptors (GPCRs) activating G-proteins in the epiphyseal chondrocytes. We conclude that among all G-proteins and GPCRs expressed by chondrocytes, Gαshas the most important role and prevents premature chondrocyte differentiation. Receptor for parathyroid hormone (PTHR1) appears to be the major activator of Gαsin chondrocytes and ablation of either one leads to accelerated chondrocyte differentiation, premature fusion of the postnatal growth plate, and ultimately short stature.
Prioritizing a Research Agenda: A Delphi Study of the Better Outcomes Through Research for Newborns (BORN) Network
Authors: Simpson Elizabeth , Goyal Neera K. , Dhepyasuwan Niramol , Flaherman Valerie J. , Chung Esther K. , Von Kohorn Isabelle , Burgos Anthony , Taylor James
Published: July 2014

Background:

There is a paucity of evidence to guide clinical management for term and late preterm newborns. The Better Outcomes through Research for Newborns (BORN) network is a national collaborative of clinicians formed to increase the evidence-base for well newborn care.

Objective:

To develop a consensus-based, prioritized research agenda for well newborn care.

Design:

A two-round modified Delphi survey of BORN members was conducted. Round 1 was an open-ended survey soliciting 5 clinical questions identified as important and under-researched. Using qualitative methods, 20 most common themes were extracted and transformed into research questions. Round 2 survey respondents ranked the top 20 questions using a 5- point Likert scale and a quantitative analysis was conducted.

Results:

Round 1 survey generated 439 unique research questions that fell into 57 themes. In the Round 2 survey, the highest rated questions were: 1) At what weight-loss percentage is it medically necessary to formula supplement a breastfeeding infant? 2) What is the optimal management of infants with neonatal abstinence syndrome? 3) How and when should we initiate a workup for sepsis, and how should these newborns be managed?

Conclusions:

Research priorities of clinicians include criteria for medically indicated formula supplementation of the breastfed newborn, management of neonatal abstinence syndrome and management of newborns at-risk for sepsis.
Placenta Accreta: An Increasingly Common Problem
Authors: Yeaton-Massey Amanda , Lyell Deirdre J.
Published: July 2014

Placenta accreta is characterized by abnormal placental adherence to the uterine wall, frequently requiring cesarean hysterectomy and resulting in massive maternal hemorrhage at delivery, and other maternal, and potentially neonatal, morbidity. Blood loss at delivery often ranges from 2,000 mL to 5,000 mL, sometimes more. The incidence of placenta accreta is rising in parallel with the increasing cesarean delivery rate, as history of a previous cesarean delivery in the setting of a placenta previa is the greatest risk factor for accreta. Among women with placenta previa undergoing their second through fifth repeat cesarean, the rate of accreta is 11%, 40%, 61%, and 67%, respectively. Placenta accreta can be suspected on antenatal ultrasound, aided by maternal history and maternal-serum analytes. When accreta is suspected, maternal and neonatal morbidity can be reduced by a scheduled delivery in a tertiary care center by a multidisciplinary team that includes a 24-hour in-house obstetrician gynecologist, anesthesiologist, and immediately available gynecologic oncologist and interventional radiologist, with a large, well-stocked blood bank. Other morbidities and mortality, including maternal intensive care unit (ICU) admission, neonatal respiratory distress syndrome, cerebral palsy, mental retardation, and infant death, may be minimized by scheduling delivery at 34 weeks' gestation.
Fads and fashions in management: the case of ERP
Authors: Caldas Miguel P. , Wood Jr. Thomaz
Published: July 2014

This article discusses the Enterprise Resource Planning (ERP) rage. ERP represents immense investments for companies around the globe and has been promoted as a management panacea. Not surprisingly, many implementations fail to match expectations. In this study, we propose a broader perspective to comprehend the substantive, institutional, and political factors involved in the ERP phenomenon, as an alternative to the "techno-reductionism" that has characterized the prevailing approach on the subject, and present an exploratory survey of 28 implementation experiences, concentrating on the process of adoption, chosen implementation approaches and outcome assessment.
Tecnologia de informação e mudança: uma abordagem crítica
Authors: Pitassi Claudio , Proença Leitão Sergio
Published: July 2014

Este artigo caracteriza-se pela análise crítica da perspectiva puramente instrumental e tecnicista dos seguidores da Tecnologia de Informação (TI). Nessa crítica, diferenciam-se as mudanças adaptativas das mudanças paradigmáticas e restringe-se a mudança habilitada pela TI aos esforços para melhorar a performance das organizações ainda dentro do paradigma dominante. Assim, evidencia-se como as distorções, causadas pela razão instrumental na percepção dos stakeholders a respeito dos fenômenos de informação, linguagem, comunicação e cognição, implicam sérios problemas para a gestão estratégica de sistemas de informação. Em que pesem as sérias conseqüências dessas distorções, defende-se que o fetiche da TI traz prejuízos ainda maiores, ao induzir à ilusão de que ela, sozinha, pode mudar o mundo. Partindo-se do princípio de que, para confrontar a visão instrumental, são necessárias novas epistemologias, apresentam-se elementos da visão sistêmica, da teoria crítica e do pós-modernismo. Por fim, propõese uma mudança paradigmática e ideológica, fundada em uma razão substantiva que propicie um desenvolvimento sustentado e a prática da justiça social, buscando um debate ético-valorativo da mudança.
Estudos críticos em administração: aprodução científica brasileira nos anos 1990
Authors: Davel Eduardo , Alcadipani Rafael
Published: July 2014

A década de 1990 marca a emergência de um movimento de estudos críticos em administração no contexto anglo-saxão que se distingue de outras abordagens críticas pela originalidade de sua proposta. Levando em consideração a emergência e a sedimentação desse movimento, este artigo apresenta o desenvolvimento da produção acadêmica brasileira, ressalta seus avanços, suas nuanças e as possíveis contribuições para se sofisticar a pesquisa e a prática organizacional. Examinando-se, então, a produção de abordagens críticas no Brasil ao longo da década de 1990, constata-se (a) uma carência de pesquisas que aprofundem conhecimento sobre práticas e organizações locais e (b) o potencial de renovação da produção teórica em administração que tais abordagens possuem.
Organizações, confiabilidade e tecnologia
Authors: Queiroz Ana Carolina S. , Vasconcelos Flávio Carvalho de
Published: July 2014

Este artigo tem o objetivo de analisar o aumento da complexidade organizacional oriunda do emprego crescente de novas tecnologias e discutir suas implicações para a organização e seus membros. A estratégia de pesquisa adotada foi o estudo de dois casos de implementação de novas tecnologias em uma organização hospitalar privada de grande porte. Este estudo oferece novas perspectivas sobre os efeitos adversos oriundos da implementação de novas tecnologias para as organizações e o processo de adaptação adotado por elas.