bluuebunny/crossref_metadata_2025 huggingface dataset:
Avian-style respiration allowed gigantism in pterosaurs
Authors: Ruxton Graeme
Published: May 2014

Powered flight has evolved three times in the vertebrates: in the birds, the bats and the extinct pterosaurs. The largest bats ever known are at least an order of magnitude smaller than the largest members of the other two groups. Recently it was argued that different scaling of wingbeat frequencies to body mass in birds and bats can help explain why the largest birds are larger than the largest bats. Here I extend this argument in two ways. Firstly, I suggest that different respiratory physiologies are key to understanding the restriction on bat maximum size compared to birds. Secondly, I argue that a respiratory physiology similar to birds would have been a prerequisite for the gigantism seen in pterosaurs.
How To Monitor Maturity of Learners� Scientific World Outlook Components in the Sphere of Natural Sciences
Authors: ��������  , Gilyazova I. , ����������  , Melnikova O.
Published: May 2014

The authors share their experience on how to put in place monitoring procedure to find out whether components of the university students� scientific

world outlook are mature enough. It is described, how to structure questionnaire, also presented are examples of tasks as well as diagnostics results and

results, obtained by statistical processing of invariable section of the questionnaire, filled in by students of higher institutions, specializing in Economics

and Pedagogy. Components of educational process, conducive to sustainable development, are discussed. It is emphasized, that issues concerning environment

protection, care of living and eating healthy should be integral parts of modern world outlook and be properly attended by higher institutions

in organizing educational process. Examples of tasks on chemistry of nutrition, chemistry of environment and chemistry of health are presented, and

the authors recommend to use these tasks in the educational process. The set of diagnostic tools, designed to evaluate components of scientific world

outlook, is provided. The authors have also developed a comprehensive questionnaire, with both invariable (generalized) and variable-based sections

(aimed at developing professional competencies in significant (relevant spheres of natural science). The suggested methodology of monitoring is applicable

in both core and non-core higher educational institutions.
Identifying Expertise to Extract the Wisdom of Crowds
Authors: Budescu David V. , Chen Eva
Published: May 2014

Statistical aggregation is often used to combine multiple opinions within a group. Such aggregates outperform individuals, including experts, in various prediction and estimation tasks. This result is attributed to the “wisdom of crowds.” We seek to improve the quality of such aggregates by eliminating poorly performing individuals from the crowd. We propose a new measure of contribution to assess the judges' performance relative to the group and use positive contributors to build a weighting model for aggregating forecasts. In Study 1, we analyze 1,233 judges forecasting almost 200 current events to illustrate the superiority of our model over unweighted models and models weighted by measures of absolute performance. In Study 2, we replicate our findings by using economic forecasts from the European Central Bank and show how the method can be used to identify smaller crowds of the top positive contributors. We show that the model derives its power from identifying experts who consistently outperform the crowd.

Data, as supplemental material, are available at http://dx.doi.org/10.1287/mnsc.2014.1909 .

This paper was accepted by James Smith, decision analysis.
On the Convergence of the Method of Successive Averages for Calculating Equilibrium in Traffic Networks
Authors: Mounce Richard , Carey Malachy
Published: May 2014

The traffic assignment problem aims to calculate an equilibrium route flow vector, generally by seeking a zero of an appropriate objective function. If a continuous dynamical system follows a descent direction for this objective function at each nonequilibrium route flow vector, the system converges to equilibrium. It is shown that when this dynamical system is discretized with a fixed step length, the system eventually approaches close to equilibrium provided that the objective function is continuously differentiable and that the rate of descent is bounded below. The method of successive averages is widely used in traffic assignment; it has a decreasing step size at each iteration. With the same conditions as above, it is shown that the resulting dynamical system converges to equilibrium. In the steady-state model, the necessary conditions are shown to be satisfied, provided that the route cost vector is a continuously differentiable monotone function of the route flow vector. However, continuous differentiability of the cost function is shown not to hold in the dynamic queueing model.
Micronized progesterone as a neuroprotector in pregnant women with post-trauma brain syndrome
Authors: Tsyganenko Irina Vasilivna , Simrok Vasil Vasilyovich , Ruban Katerina Sergiivna
Published: May 2014

The present article is concerned with the study of glial fibrillary acidic protein (GFAP) level in the blood serum of pregnant women  with post–trauma brain injury syndrome (post-TBI syndrome) as the marker of  hematoencephalic barrier status and predictor of obstetric and perinatal complications development.
Strategies for increasing utilization of maternity services in Njeru, Uganda
Authors: White Ruth C , Carr Katherine Camacho
Published: May 2014

This paper describes the success of an ongoing community-based maternal and child health project in Njeru, Uganda. The project is a collaboration between the Njeru Town Council and an American university's social work programme and College of Nursing. The goal of the programme is to increase utilization of clinic-based maternity services i.e. pre-natal care and skilled attendant at delivery. Using community mobilization, education and capacitybuilding, community health workers (CHWs) were trained by the university-based nursing professors to educate the community about safe motherhood practices. Traditional birth attendants (TBAs) were trained by a nurse-midwife in techniques to reduce infection and maternal haemorrhage, the two main causes of maternal morbidity and mortality in the region. Over a 2-year span the clinic has doubled utilization of pre-natal services and more than doubled utilization of clinic-based labour and delivery services, resulting in more births at the clinic than by TBAs in the clinic's catchment area—an outstanding achievement in a country where more than 70% of women are assisted at birth by an unskilled attendant, including TBAs.
Health diary for young women in Japan and its potential use in Africa
Authors: Iida Miyoko
Published: May 2014

This paper proposes the use of a health diary for young women in order to record self care information such as menstruation. It will empower women to take care of their reproductive health in the long term. It is inexpensive and using a health diary is simple, yet it is remarkably useful for strengthening young women's self-efficacy, as observed in early studies. The specific use of the diary is emphasized by a column to record one's necessary health information and menstruation.
Community perceptions of a PMTCT programme in Malawi
Authors: Kasenga Fyson , Hurtig Anna-Karin , Emmelin Maria
Published: May 2014

Pregnancy and delivery care in the context of HIV/AIDS is a global problem. There is a need to prevent maternal and infant mortality from occurring in many parts of the world, particularly in sub-Saharan Africa. Mother-to-child transmission of HIV (MTCT) accounts for almost two-thirds of the new infections in children yearly. Routine (opt-out) HIV testing in antenatal women has been adopted as a policy in many antenatal care (ANC) and delivery settings to reduce MTCT. In limited resource settings, women fail to access delivery services due to many factors. A qualitative study was conducted in rural Malawi, to explore norms and attitudes among community members and service providers towards the HIV testing and delivery care provided within a PMTCT programme. Ten focus group discussions (FGDs) were conducted with community members (men and women), village headmen, religious leaders, hospital health workers (midwives) and traditional birth attendants (TBAs). Tape-recorded FGDs were analyzed using content analysis. Three themes emerged. The first, ‘acceptable but a potential for conflict and fear’ describes how participants viewed the ANC services including HIV testing. The second, ‘trusted for safety but lacking in respect’ refers to understanding women's reluctance to actually deliver at the hospital and the third, ‘warm and caring but risky’ indicates why women actually may prefer to deliver at home with the assistance of TBAs. There is general community support for the basic components in the PMTCT programme although access and acceptability remains a challenge.
Smoking cessation intervention among pregnant women in South Africa
Authors: Petersen Zaino , Steyn Krisela , Lombard Carl , Everett Katherine , Emmelin Maria
Published: May 2014

The objective was to determine the practices and beliefs of disadvantaged women with high smoking rates, their perceptions of antenatal services and their preference for smoking cessation intervention materials. The readiness of smokers to quit, in terms of stages of change, was also determined.

The study took place in public sector antenatal clinics situated in Cape Town, Kimberley, Port Elizabeth, Johannesburg and Pretoria that provide care to predominantly women of mixed ancestral descent.

A cross-sectional survey was used. Data were collected via a self-administered questionnaire from pregnant women who were currently smoking, had quit smoking before or during pregnancy and who had never smoked.

A total of 796 women were interviewed of which 365 (45.9%) were smokers, 117 (14.7%) were quitters and 314 (39.4%) were non-smokers. Being in the pre-contemplation stage was reported by 28%, 36% indicated that they thought about quitting, while 36% said that they were in the preparation stage. Of the smokers and quitters 9.3% had stopped in the last 6 months (action stage), and 15% had stopped for longer (maintenance phase). 86% of women reported satisfaction with midwives and more than 60% rated interactive intervention methods such as support groups and talks by women who had stopped smoking most favourably.

Most women who smoked were contemplating or preparing to stop smoking. Intervention programmes should target these groups of women and midwives could be used to implement the interventions by facilitating support from women who had successfully quit.
Evaluation of evidence-based episiotomy practice by midwives
Authors: Teckla N , Omoni G , Mwaura J , Omuga B
Published: May 2014

Research-based practice in nursing and midwifery is regarded as a means of ensuring that quality care is provided by integrating individual clinical expertise with the best available clinical evidence from systematic research. Previous studies indicate that few midwives strive to achieve their role of safe motherhood by helping women and their families through the pregnancy and childbirth process using research-based practice. The study documents the practice of episiotomy by midwives in an urban setting.

This is a cross-sectional qualitative and quantitative descriptive study. All midwives working in the labour ward at Pumwani Maternity Hospital in June–July 2009 were eligible for the study. A standard questionnaire was used to collect data regarding socio-demographic characteristics, professional training and evidence-based knowledge. Consenting and qualifying midwives were eligible for study. In-depth interviews were conducted among key informants over the same period. Data were analyzed using Statistical Package for the Social Sciences (SPSS).

The most common types of episiotomy preferred by the midwives was medio-lateral and midline. Various factors were reported to have influenced the midwives practices: very tight perineum, breech presentation, premature labour, female genital mutilation, instrumental delivery and status of the fetus. In-depth interviews demonstrated lack of specific guidelines on specific procedures, personal attitudes and inadequate administration support. The study recommends an urgent need to put in place modalities to ensure that guidelines are developed and used appropriately in order to standardize provision of services.
Hypothesis testing: to doubt or not to doubt?
Authors: Delaney Laura
Published: May 2014

In this second article on inferential statistical analysis, the author lookes at how it is used to test hypotheses—to test statements about the population being studied. The aim of this article is to help readers understand the basic systematic process of testing a hypothesis, to be aware of directional and nondirectional tests and when they might be used, and to understand significance levels and why they are used in research.
Primiparous women's experiences of labour in Harare, Zimbabwe
Authors: Murira Nester , Ashford Robert , Sparrow John
Published: May 2014

A study of primiparous women in Harare, Zimbabwe was undertaken to assess women's knowledge about the process of labour and to ascertain whether communication with health professionals increased women's knowledge and whether they understood thr risks of certain bahaviours in labour.

A retrospective qualitative study was undertaken among primiparous women in Harare, Zimbabwe from which a purposive sample was selected. Qualitative interviews were used to collect data from a purposive sample of primiparous women in their homes, one week after delivery of their first babies. Data saturation was achieved after interviewing and collecting data from ten women. Modified grounded analysis was used in the analysis of the qualitative data. The results revealed that primiparous women who delivered in maternity units in Harare did not receive information about labour from health professionals before labour. There were areas of conflict during the labour process between the women's cultural teaching and health professionals' knowledge of labour. The women were most distressed by the pain of labour and the process of acquiring pain relief, as well as poor communication with health professionals in general. The results suggest a need for continuing education for midwives in management of labour and improved communication between health professionals and women before and during labour.
Reconsidering the value of traditional birth attendants: a literature review
Authors: Dietsch Elaine , Mulimbalimba-Masururu Luc
Published: May 2014

The maternal mortality rate is unacceptably high in sub-Saharan African nations. Policies and strategies to reduce the maternal mortality rate focus on encouraging skilled birth attendance and discouraging the practice of traditional birth attendants (TBAs). The purpose of this literature review is to uncover the impact of current, globally accepted policies. An integrative literature review methodology was used and found that current strategies to reduce the maternal mortality rate are proving inadequate. In the interim, the role of the TBA is becoming increasingly more devalued by global institutions, including the World Health Organization. The review argues that the emphasis should be directed away from the category of person providing care to women during childbirth and toward addressing social factors, including reducing poverty, increasing food and water security, reducing conflict/war, improving transport and communication infrastructure and eliminating gender inequity.
Communicating health information in teaching hospitals in Zimbabwe
Authors: Murira Nester , Ashford Robert , Sparrow John
Published: May 2014

An investigation into transferring health information between health professionals in regular contact with women as they seek health services, and women seeking health services, was held with health professionals from three teaching hospitals in Harare, Zimbabwe. The study aim was to investigate health professionals' perspectives about communication with women to identify their models of communication and effectiveness of the models in transferring health information to women. Participants were health professionals in regular contact with women.

Focus group discussions of two multi-professional groups responding to three lead discussion questions were conducted. Data were recorded using pen and paper and transcribed into Microsoft Word. Data analysis was conducted through qualitative content analysis. The results revealed that health professionals experienced various difficulties in communicating health messages to women. Communication styles were attributed to health training curriculum, organizational environment and personal factors. An effective communication model and a review of health professional curricula are needed to develop health professionals' communication skills to enable them to respond to women's information needs.
Adherence to the PMTCT programme and perceived family support
Authors: Tsara Balbina Esinat , Zvinavashe Matilda , Kasu Christine Mary , Gundani Helen Vupenyu
Published: May 2014

A descriptive correlational design was used to determine the relationship between family support and adherence to the prevention of mother-to-child transmission of HIV (PMTCT) programme among a random sample of 80 pregnant women aged 18–35 years attending an antenatal clinic at Kadoma City Health Clinics in Zimbabwe. Data were collected through structured interviews, analyzed, and presented using descriptive statistics in the form of percentages and tables. Pearson's correlation matrix and regression analysis were used to determine the relationship. The results showed that perceived family support has a positive effect (P<0.01) on adherence of pregnant HIV-positive women to the PMTCT programme. The findings showed a moderate positive correlation (r=0.510) at a significance level of 0.01. The effect of the independent variable, perceived family support (R2=0.260), explained 26% of the variance in adherence. Therefore, it is important to involve husbands and significant others in PMTCT activities.
Perceptions of midwife support during labour and delivery in Gambia
Authors: Mbye Mustapha , Tsay Shiow-Luan , Kao Chien-Huei , Lin Kuan-Chia
Published: May 2014

This study was conducted to investigate women's perceptions of the support given by midwives during labour and delivery in Gambia, and to compare the results with the perceptions reported in similar studies undertaken in other countries and ethnic groups. In 2009, a total of 120 women were recruited with a purposive sampling method from five public health facilities in the western region of the Gambia. The Bryanton Adaptation of Nursing Support in Labour Questionnaire (BANSILQ) was applied to measure various nursing-support behaviours. Results reveal that study participants valued all the categories of nursing support during labour and delivery. Overall, emotional support was valued as the most helpful during childbirth and informational support was reported as being less helpful. The results of this study were contrasted with those of previous studies into different ethnic populations which also applied the BANSILQ to survey the women's perceptions. Further consideration of the pathways in this web of causation would provide key information which could have significant implications for the future of midwifery education and practice.
Utilization of maternal health services among postnatal mothers in Kenya
Authors: Rotich Everlyne
Published: May 2014

Utilization of any health facility has previously been recognized as being influenced by distance and the availability of free services, medicines and other facilities. The purpose of this study was to identify health factors that influence utilization of maternal health services among women delivering at Kenyatta National Hospital and Pumwani Maternity Hospital in Kenya. This cross-sectional study was done from May through July 2006, and 384 women participated. A researcher-administered questionnaire was used to collect data which were analysed using the Statistical Package for the Social Sciences, version 12. The average age of the respondents was 25.4 years and 94.3% of women attended the antenatal clinic at least once during the pregnancy. Relating to factors that influence utilization of health services, 26% of the women mentioned availability of particular health services to be a driving force and 17.4% considered the availability of services and cost to be main factors. This study demonstrates that women seek health services for different reasons, with some women not understanding the importance of the services.
Application of Consolidated Standards of Reporting Trials (Consort)
Authors: Smith Barbara A. , Lee Hyeon-Joo , Lee Ju Hee , Choi Mona , Jones Deborah E. , Bausell R. Barker , Broome Marion E.
Published: May 2014

In the era of evidence-based practice (EBP), randomized controlled trials (RCTs) may provide the best evidence of the efficacy of nursing interventions and yet the quality of Rct reporting in nursing literature has not been evaluated. The purposes of this study were to apply the Consolidated Standards of Reporting Trials (CONSORT) statement to published reports of nursing science, examine how adequately the published reports adhere to the statement, and examine the effect of the adoption of CONSORT on the quality of the Rct published reports. One hundred RCTs from 2002–2005 were identified from four nursing journals. Articles were randomly assigned to four reviewers and the quality of the published reports was evaluated using a modified CONSORT checklist. There was no difference between the four journals in the quality of the published reports of RCTs based on the modified CONSORT checklist employed (F = 1.27, P = 0.29). The quality of reporting of RCTs improved significantly in the only journal, Nursing Research, to adopt the CONSORT statement during the study period (t = -2.70, P = 0.01). Adoption of CONSORT is recommended as it may lead to an overall improvement in quality of reporting of RCTs in nursing journals. The profession may also wish to explore the use or development of standards similar to CONSORT but ones more appropriate for the types of research typical of that published by nurse scientists.
Pain relief strategies for infants taking DPT immunization in health centres
Authors: Achema G , Oyeleye Ba , Olaogun AAE
Published: May 2014

This study examined the efficacy of pain relief strategies among infants receiving intramuscular immunization for diphtheria, pertussis and tetanus (DPT) in Kogi east, nigeria. Sixty infants were purposively selected for the study and randomly assigned to one of three intervention groups: breastfeeding, EMLA™ cream and control. The infants in the breastfeeding group were breastfed by their mothers 60 minutes before the immunization, those in the EMLA group had EMLA cream topically applied 60 minutes before the immunization and those in the control group recieved no intervention. An observational checklist and an interview guide were used to collect data, which was then analysed using descriptive and inferential statistics. The findings showed that most breastfed infants (60%) and most of those who had EMLA cream applied (55%) responded moderately to pain. There was a significant difference in the response to pain among the infants in the breastfeeding, EMLA, and control groups (F = 8.326; P < 0.05). Breastfeeding exerted a significant influence on the infants' pain reaction (F = 1.900; P <0.05), as did EMLA cream (F = 1.700; P < 0.05). In fact, there was no significant difference between the infants on EMLA cream and those being breastfed in their reactions to pain (F = 0.200; P = 0.697). In conclusion, breastfeeding and EMLA cream are effective in reducing pain during intramuscular injection and should therefore be seen as part of a pain management procedure in infants.
The non-pneumatic anti-shock garment for postpartum haemorrhage in nigeria
Authors: Ojengbede O , Galadanci H , Morhason-Bello IO , Nsima D , Camlin C , Morris JL , Butrick E , Meyer C , Mohammed Aminu I , Miller S
Published: May 2014

Objective: This study examines whether the non-pneumatic anti-shock garment (NASG) reduces blood loss and mortality from uterine atony.

Method: The sample was taken from delivering women at four referral facilities in nigeria who suffered obstetric haemorrhage, from which a subset of women with aetiology of post-partum uterine atony were examined. Data were collected by hospital staff and included 139 women, 54 in the pre-intervention phase and 85 in the NASG intervention phase. Differences in demographics, condition on study entry, treatment and outcomes were examined. Relative risks and 95% confidence intervals were used for primary outcomes of blood loss and mortality.

Results: Median measured blood loss decreased from 360 ml pre-intervention to 30 ml in the NASG phase (P < 0.001). Mortality was reduced 72% for women treated with the NASG from 16.7% pre-intervention to 4.7% during the NASG phase (relative risk = 0.28, 95% confidence interval 0.09–0.87).

Conclusion: The NASG shows promise for reducing blood loss and death from haemorrhage and shock due to uterine atony.
Developing a national continuing professional development framework
Authors: Iliffe Jill
Published: May 2014

The African Health Professions Regulatory Collaborative, a partnership between the United States Centers for Disease Control and Prevention, Emory University, the Commonwealth Secretariat, and the East, Central and Southern Africa Health Community has provided an opportunity for countries in the east, central and southern Africa region to strengthen their nursing and midwifery regulation. Some countries have chosen to develop a national continuing professional development (CPD) programme. This article explores what some of the key features of a national CPD framework might be, drawing on the elements of other national programmes both inside and outside of Africa. The variations in national programmes are outlined, as they related to definition, principles, scope, requirement and monitoring. The article concludes that there is no ‘perfect’ model of CPD; that countries can learn from each other; and that each country should develop a model that suits its particular circumstances.
Preferences for traditional or modern practitioners: A comparative study
Authors: Akpabio Idongesit I. , Edet Olaide B. , Etifit Rita E. , Robinson-Bassey G.C.
Published: May 2014

Objective:

This study compared two groups of women—those with a preference for traditional birth attendants (TBAs) and those with a preference for modern health care practitioners (MHCPs)—at Akpabuyo, Cross River state, Nigeria with regard to their level of knowledge about the risks of patronizing the TBAs; perception of costs of services; educational qualifications; traditional beliefs; and income status.

Method:

A comparative descriptive design and a multistage systematic random-sampling technique were used to study 300 women of child-bearing age, 18–45 years, who had delivered at least one baby or were pregnant and residing at the study area. A validated questionnaire was the instrument for data collection.

Results:

Most of the participants, 156 (52.0%), had primary education, 113 (37.7%) had secondary education, 26 (8.7%) had tertiary education and 5 (1.7%) had no formal education. There were statistically significant differences between the two groups of respondents with regard to knowledge of the risks involved in patronizing TBAs; perception of costs of delivery with MHCPs; traditional beliefs; and income levels (Cal. t =3.26; 4.96; 6.61 and 3.88 > Crit. t = 1.96; df 298; P = 0.05). Women with a preference for MHCPs had a higher mean score (mean = 3.78) for knowledge; perception of lower cost of delivery services with MHCPs (mean = 7.57); lower adherence to traditional beliefs (mean = 5.25) but poorer and lower income level (mean = 1.12) compared with those who preferred TBAs (mean = 2.99; 8.88; 6.33 and 1.75 respectively). Most of the respondents (n = 54; 67.5%) whose educational level was below secondary education preferred TBAs compared with 113 (51.4%) of those with secondary education and above who preferred MHCPs.

Conclusion:

Recommendations focused on improvement of women's educational level to enhance their decision-making abilities with respect to choice of delivery services.
Unintended pregnancy, unsafe abortion and emergency contraception
Authors: Shewamene Zewdneh , Legesse Befikadu , Wodajo Derbe
Published: May 2014

Purpose:

The aim of this study was to examine the magnitude of unintended pregnancy, unsafe abortion and to assess awareness towards emergency contraception (EC) among women attending antenatal care in Ethiopia.

Method:

A cross sectional study was conducted from 19 August to 30 September 2011 among 310 women attending antenatal care (aged of 15–49 years) that were selected by using simple random sampling technique. A structured five page questionnaire was developed and pretested before the interview. The data were entered and analysed using SPSS version 16.0.

Result:

Of 310 respondents, 87 (28%) reported their pregnancy was unintended and 56 (18%) had practiced unsafe abortion one or more times. Only 105 (34%) of respondents had heard about EC and of those, only 11.8% had used the method previously. Of the 105 respondents who had heard about EC, 80 (76.2%) did not know the maximum acceptable time to use EC after unprotected sexual intercourse. A considerable proportion of respondents (59.1%) reported their fear on using EC due to safety misconceptions.

Conclusion:

This study indicated unintended pregnancy and unsafe abortion are very high due to lack of knowledge, practice and misconception towards EC among women attending antenatal care. Therefore, it is necessary to promote EC awareness using appropriate education methods.
Sleep disturbances in pregnancy, length of labour and type of delivery
Authors: Ali Akbari Sedigheh Amir , Bolouri Bayan , Najafi Arezu , Haghighi Khosro Sadeghniiat , Majd Hamid Alavi
Published: May 2014

Background:

Sleep patterns in pregnancy are often affected at different times for many reasons. Approximately two thirds of pregnant women complain of their sleeping patterns. Such problems impose further physical and psychological strain on women. This can influence the length and nature of labour and the type of delivery. This study was conducted to determine the association between sleep disturbances in the last month of pregnancy, the length of labour and type of delivery.

Methods:

A sequential non-randomised sampling method was used in this cohort study. This study followed 139 women (59 without sleep disturbances and 85 with sleep disturbances) in the last month of pregnancy until delivery. Demographic, obstetrical characteristics of mothers and items regarding general sleep disorders were collected using a questionnaire and observation checklist. SPSS software (version 18) was used for data analysis.

Results:

The mean duration of the first stage of labour in women with sleep disturbances was 65 minutes more than those who did not experience sleep disturbances. In the second stage of labour, the mean duration in sleep disturbed women was 25 minutes more than the control group (P<0.001). The difference between mean duration of third stage of labour in the two groups was not significant (P>0.05). The results also showed that caesarean section among the disturbed group was 2.7 times greater than in the other group (CI=0.83–8.5, RR=2.7).

Conclusions:

Sleep disturbances in pregnancy were found to negatively affect the duration of the first and second stages of labour. It may also influence the type of delivery; however, more research is needed on this subject.
Breast milk boosts growth of beneficial gut flora
Authors: Bainbridge Jane
Published: May 2014

A US study has shown that breastfed babies are better able to absorb nutrients due to the boost in growth of gut flora breast milk provides.
The community midwifery model in Kenya: Expanding access to comprehensive reproductive health services at the community level
Authors: Liambila Wilson , Obare Francis , Undie Chi-Chi , Birungi Harriet , Kuria Shiphrah Njeri , Muia Ruth Wayua , Matekwa Assumpta
Published: May 2014

The ‘community midwifery approach’ is an innovation involving the engagement of skilled midwives residing in communities to take critical maternal health services to women's homes, thus improving maternal, newborn and infant health. This paper is based on a study that aimed to assess the effect of expanding community midwives’ mandate to go beyond the provision of delivery services alone, to incorporate a more comprehensive package of reproductive health and HIV services. This operations research project involved pre- and post-intervention data collection without a comparison group to assess intervention effects. The project was implemented in the Bungoma and Lugari Districts of Western Province, Kenya. Findings from the project indicate that the expanded community midwifery model improved clients’ access to a comprehensive package of family planning, reproductive health and HIV services at the community level. However, the intervention was less successful in improving the provision of a continuum of care by community midwives.
Intimate partner violence to HIV sexual risk among married rural women in Tarime, Tanzania
Authors: Nyamhanga Tumaini , Frumence Gasto
Published: May 2014

This study examined the relationship between intimate partner violence and high-risk sexual behaviours (unprotected sex and partner promiscuity) among 392 married women. The findings show that about half (44.9%) of the respondents experienced physical violence. Furthermore, 47.5% of the respondents reported that they were made to have sex when they did not want to, without a condom. About two thirds (64.5%) of women were both physically hurt and made to have sex when they did not want to (P=0.03). Likewise, about half (42.8%) of women who reported to have experienced physical violence also admitted that their partners engaged in sexual intercourse outside their union (P=0.001). This study found a strong association between experience of physical violence and engagement in non-consensual sex without a condom and having an unprotected sex with an unfaithful husband.
ACE inhibitors’ use in preventing and managing heart disease
Authors: Walthall Helen
Published: May 2014

Clinical trials have shown that angiotensin converting enzyme (ACE) inhibitors play an important role in the management of patients with, or at risk of heart disease, in particluar those with hypertension, heart failure and ventricular dysfunction after a myocardial infarction. The following paper will review the relevant physiology and pharmacology of ACE inhibitors and present the research evidence of this drug group in relation to these patients. It can be seen that the benefit of ACE inhibitors lies in their ability to reduce vasoconstriction and volume reabsorption through the blockade of Angiotensin II production and the positive effects this has on bradykinin activities.
The diagnosis and management of hypertrophic cardiomyopathy
Authors: Mason Naomi
Published: May 2014

This article aims to provide an overview of the diagnosis and management of the patient and family with hypertrophic cardiomyopathy (HCM). It is a relatively common disease of the hear t muscle which is usually genetically inherited from parents in an autosomal dominant pattern. Disease presentation can vary greatly between each individual and can be picked up through routine clinical screening, following the onset of symptoms such as breathlessness, chest pain, fainting or palpitations. Tragically, diagnosis in a family can be made for the first time at post-mortem following a sudden cardiac death.
The use of digoxin in the treatment of arrhythmias and heart failure
Authors: Chung Christine
Published: May 2014

Digoxin is one of the oldest cardiac medicines still used in current practice. Over the years its place in the treatment of arrhythmias has changed following the advent of other anti-arrhythmic medications which have comparable effectiveness and tolerability.

Digoxin inhibits the Na+-K+ pump and Ca2+ currents in the atrioventricular node and has a relatively slow onset of action when compared with other anti-arrhythmics such as β-blockers and calcium channel blockers. Its narrow therapeutic window requires serum levels to be taken for reasons such as the exclusion of toxicity.

Digoxin is indicated for ventricular rate control in fast atrial fibrillation (AF) but it is ineffective in in cardioverting patients. It is not indicated for paroxysmal AF, where it may, in fact, worsen the condition. Digoxin is proven to benefit patients with heart failure and it should not be withdrawn from patients whose condition has previously been stabilized on digoxin.
The winding road to becoming an arrhythmia nurse specialist
Authors: Griffiths Angela
Published: May 2014

Angela Griffiths describes her role in the care of patients with electrophysiology-related problems and how she got there…
Corroborative echocardiographic procedures: The multidisciplinary approach
Authors: Oxborough David
Published: May 2014

Ultrasound evaluation of the hear t is primarily assessed using transthoracic echocardiography. There are limitations to this standard assessment and other advanced ultrasound techniques and tools are available. This article provides a basic introduction to three corroborative procedures (transoesophageal echocardiography, stress echocardiography and contrast echocardiography) which contribute to the overall ultrasound assessment of cardiac structure and function. Unlike standard transthoracic imaging these procedures use a multi-disciplinary team and therefore this article highlights these potential roles.
Pioneering times in arrhythmia care
Authors: Bell Winifred
Published: May 2014

Winifred Bell—the winner of the Lifetime Achievement Award in Cardiac Nursing at the 2007 Cardiac Nursing Awards—reflects on how the role of the specialist arrhythmia nurse has developed
Combining clinical, strategic, education and development
Authors: Butler Jane
Published: May 2014

Vicqui Stuart-Jones talked to Jane Butler about her varied responsibilities as Nurse Consultant, how she got there and the importance of an active approach to self-development
Promoting oral health for overall health
Authors: Carter Nigel
Published: May 2014

Nigel Carter explains why this year’s National Smile Month has a message for cardiovascular nurses concerned with prevention and health promotion to support
Descriptive statistics: Simply telling a story
Authors: Delaney Laura
Published: May 2014

Laura Delaney introduces the principles of descriptive statistical analysis and presents an over view of the various ways in which data can be presented by researchers.
The physical and psychosocial impact of being an unpaid carer for a heart failure patient
Authors: Whittingham Katharine
Published: May 2014

By offering case management throughout the unpredictable patient journey the specialist heart failure nurse is pivotal in nurturing relationships with carers and is seen as an essential point of contact. Yet to date evidence of this aspect of the service is not collated formally.

There appears to be limited information about the carer profile in heart failure including the activities they undertake and the impact it has on their lives. There is a lack of consensus about the guidance that should be provided to carers to support them in their role.

This review examines the published literature relating to the demands on carers of heart failure patients (from 2000 onwards), briefly discusses how the heart failure specialist nurse assists in supporting carers with these demands and outlines recommendations for further work in this area.
An introduction to ambulatory electrocardiography
Authors: Richley Dave
Published: May 2014

Ambulatory electrocardiography, incorporating Holter and patientactivated ECG recording, aims to provide information additional to that obtained from a standard ECG. Its main purpose is to explain intermittent symptoms, such as palpitations, dizziness or loss of consciousness, that may be due to a disturbance of cardiac rhythm. The success of the technique depends largely on its ability to record the patient’s ECG at the time of symptoms and this is determined mainly by the frequency of those symptoms and the duration of the recording period. Holter electrocardiography has other uses, including the assessment of ventricular rate during atrial fibrillation, particularly with regard to optimizing drug therapy, and the investigation of possible intermittent pacemaker malfunction.
Acute heart failure: Patient assessment and management
Authors: Whitlock Anna , MacInnes Julie
Published: May 2014

Acute heart failure (AHF) is a life-threatening episode that requires immediate assessment and treatment and nurses are at the forefront of this care. This article considers the key elements of patient assessment including vital signs, assessment of fluid status, and diagnostic investigations. Symptoms of HF not only affect physical aspects of health but have a significant impact on everyday life; hence, psychosocial assessment is also important. The rapid instigation of pharmacological and other treatments such as non-invasive ventilation is central to care management in this client group. During treatment close, continuous monitoring is essential in recognizing changes in the patient’s condition and instigating alterations in medications or treatment options. Patient education, follow-up care and the involvement of specialist HF and palliative care nurses is advocated.
Independent prescribing within a paediatric electrophysiology service
Authors: Renwick Catherine
Published: May 2014

Catherine Renwick explains how non-medical prescribing has enhanced her role within a specialist service for children with arrhythmias
Providing individualized education to patients post myocardial infarction: A literature review
Authors: Garvey Niamh , Noonan Brendan
Published: May 2014

Aim: This article aims to review the published literature on providing individualized education to patients post myocardial infarction with focus on education methods.

Background: Myocardial infarction (MI) is a leading cause of death worldwide. Patient education is vital to cardiac rehabilitation to reduce morbidity and mortality. Many factors increase a patient’s risk of reoccurrence of MI including smoking, obesity, hypertension, high cholesterol and sedentary lifestyle. Cardiac rehabilitation is vital to increase patient’s awareness of risk factors in order to improve their chance of recovery and survival. The participation of patients in their own care has also been shown to improve cardiac rehabilitation. Research has demonstrated that information plays a vital role in patient recovery and prevention of further MI. Nonetheless, research studies continue to conclude that patient education needs are not being met.

Conclusions: In this literature review individualized education was identified as the most effective rehabilitation for MI patients. Patient education needs, preferences, social factors and stage of recovery need to be individually assessed. Only then can education specific to the individual patient be compiled and the most appropriate education method chosen through which the information can be delivered.

Relevance to clinical practice: Nurses are in a prime position to assess patient education needs and with the help of evidence-based practice and research findings, nurses can implement cardiac rehabilitation programmes that will provide the most effective education for the individual patient and family.
Pharmacological conversion of AV nodal re-entry tachycardia with adenosine
Authors: Mullord Penelope , Sargent Andrew
Published: May 2014

This paper reviews the current practice and guidelines in the pharmacological management of supraventricular tachycardia, in particular atrioventricular nodal re-entry tachycardia (AVNRT). The discussion draws on guidelines from the Resuscitation Council UK and European Cardiological Society. Adenosine is a viable alternative to electrical cardioversion in circumstances where a rapid conversion of the arrhythmia is required.
What is patient and public involvement really like?
Authors: McGregor Suzanna , McCray Janet
Published: May 2014

This study compares the actual experiences of patient representatives, with government legislation and policy on patient and public involvement (as outlined in the Health and Social Care Act 2001, and the Local Government and Public Involvement in Health Act 2007).

The research was time-limited and small-scale and comprised a focus group, six formal and two informal interviews with cardiac patients who had completed the British Heart Foundation (BHF) Hearty Voices training.

One of the most prominent findings of the study was that patients who had a varied role and were at a more strategic level in representation reported feeling most rewarded in their efforts.
Conducting a nurse consultation
Authors: Perry Graham
Published: May 2014

Until recently it was doctors who patients saw for consultations in the outpatients department of hospitals or in general practice. Over the past three decades there has been a dramatic rise in the number of specialist nurses within the health-care setting i.e. the development of the consultant nurse, advanced nurse practitioner and clinical nurse specialist. Many of these roles have evolved in response to the developments in medical care and the advancement of medical technology.

The success of the nurse consultation depends not only on the clinician’s clinical knowledge and interview skills but also on the nature of the relationship that exists between the nurse and patient. Increasing emphasis is now being placed on communication skills alongside history taking in postgraduate courses for nurses to enhance the nurse–patient relationship and promote more effective consultations. How nurses portray themselves is just as important as what they say. The patient needs to feel sufficiently at ease during the consultation to disclose any problems and express any concerns. The patient also needs to reach a shared understanding with the nurse about the nature of any illness, any investigations planned and what treatment is proposed to deal with it. As well as being more supportive for patients, good communication skills make taking the patient’s history more accurate and effective.
Clinical skills: history taking in cardiac patients
Authors: Tagney Jenny , Younker Jackie
Published: May 2014

People with cardiovascular disease may present to nurses in various settings and at varying stages of their disease. Accurate assessment ensures that patients receive the care and treatment they need. Eliciting a clear clinical history from patients helps to guide a targeted clinical examination and is a critical step in the assessment process that will ensure suitable management and treatment are started in an appropriate time frame. This article will give an overview of the skills and techniques required to obtain an accurate patient history from a patient presenting with possible cardiac problems.