bluuebunny/crossref_metadata_2025_split huggingface dataset:
Active management of third stage of labour: misoprostol or oxytocin?
Authors: Wangwe Peter , Kidanto Hussein , Muganyizi Projestine , Roosmalen Jos van 
Published: May 2014

The aim of this study was to compare the efficacy, safety and cost-effectiveness of rectal misoprostol and intramuscular oxytocin in the management of the third stage of labour using a randomized trial. At Muhimbili National Hospital, Tanzania, 426 pregnant women in the active phase of labour were randomly selected to join the study. Twelve women were excluded from the study because their mode of delivery was caesarean section. Misoprostol 400 μg was administered rectally in 210 participants and intramuscular oxytocin at a dose of 5 IU in 204 participants respectively. There was an equal mean estimated blood loss in both the misoprostol and oxytocin group (161 ml versus 169 ml) respectively. More women in the misoprostol group (18.1%) had a drop in haematocrit of >10% as compared to oxytocin (14.2%). A drop in haematocrit was more sensitive to detect postpartum hemorrhage as compared to estimated blood loss. Duration of the third stage of labour was similar in both groups: 8 minutes in the misoprostol group versus 8.7 minutes in the oxytocin group. The percentage of women who needed additional uterotonic drugs did not differ significantly: 7.4% in the oxytocin group and 4.3% in the misoprostol group (p=0.19). Retained placenta occurred in 3.4% of the oxytocin group versus 1.4% of the misoprostol group (p=0.18). Shivering and nausea were the most prevalent side-effects in the misoprostol group (3.3%) and in the oxytocin group (2.9%). Rectal misoprostol at a dose of 400 μg is as effective as 5 IU of oxytocin in the prevention of postpartum hemorrhage. The advantages of misoprostol are its heat stability and its ease in administration. It does not need storage in a refrigerator and can be used in both institutional and non-institutional deliveries.
Women's perceptions of midwifery care in Lusaka, Zambia
Authors: Kwaleyela Concepta Namukolo , Kearns Elaine Nicolene 
Published: May 2014

Uncovering women's perceptions of maternity care provided give insight into their expectations and needs. This qualitative research study, using modified grounded theory approach, was done to explore views and experiences of women users of lowrisk maternity care services in Lusaka. In this city a series of maternity centres run by midwives were established to relieve pressure on an overworked maternity staff at the only tertiary hospital. Data was collected through semi-structured tape-recorded interviews with eleven women who were determined by theoretical saturation. Two categories of ‘trust in midwives’ and ‘recognition of the women’ were identified. These were integrated in one core category of ‘relationship between the midwife and the woman’. The findings demonstrated that for midwives to offer maternity services that are satisfactory to women, emphasis should not only be on a live baby and mother, but should also include building a good and trusting relationship with the mother.
Capacity building to reduce maternal and neonatal morbidity and mortality
Authors: Lavender T , Lugina H , Vidot P , Chimwaza A , Bedwell C , Donovan P , Kohi T , Dlammani P , Tsekiri E , Msuya M 
Published: May 2014

In sub-Saharan Africa midwifery educators are in short supply and opportunities to pursue advanced education are severely restricted. Postgraduate programmes that encourage critical thinking and strategic planning in midwifery education, practice, management and research are required to empower midwives to lead their profession. A unique user-led distance learning programme was developed by adopting a participatory approach to developing a curriculum for a Masters in Midwifery and Women's Health. Midwives from the East Central and South Africa (ECSA) region and the UK participated along with a representative from the Commonwealth Secretariat and International Confederation of Midwives (ICM). The curriculum was based on shared goals but adaptable to cultural and local context. Brainstorming sessions, informal workshops and formal consensus methods were used to reach decisions regarding modules and subsequent content. This article describes the process of developing a shared curriculum, the challenges faced in working across and within regions, and participants’ views of contributing to the end product.
National management guidelines for obstetric emergencies
Authors: Chodzaza Elizabeth , Bultemeier Kaye 
Published: May 2014

National standards for the identification and management of obstetric emergencies have been established in Malawi. This study was conducted to determine the level of compliance with national standards and protocols. A cross-sectional descriptive prospective study was conducted. A total of 799 deliveries occurred during the observation period. Management of 42 women who experienced emergency obstetric complications was observed. Emergency complications observed included 12 with eclampsia/pre-eclampsia, 11 cases of postpartum hemorrhage, 8 cases of obstructed labour, 6 cases of ruptured uterus and 5 women with puerperal sepsis. Nine patients died secondary to obstetric emergencies. This study revealed inconsistent and poor compliance with national standards for management of pre-eclampsia and postpartum hemorrhage (PPH). Compliance rates ranged from 0–67% for management of pre-eclampsia/eclampsia, and 9–81% for management of postpartum hemorrhage. This study reveals that there is need for stricter adherence to national standards.
Awareness of premarital genetic counselling in women in Nigeria Nigeria
Authors: Oyetunde Modupe Olusola 
Published: May 2014

Preventive measures such as carrier screening and premarital counselling are the best ways of dealing with genetic disorders. This study assessed the awareness of premarital genetic counselling among female undergraduates in Ibadan, Oyo State, Nigeria. The study consisted of 240 randomly selected and consenting female undergraduates of the University of Ibadan. The instrument was a structured 31-item questionnaire covering social demographic data as well as the objectives of the study. Data were analysed using the Statistical Package for Social Sciences software. The mean age of respondents was 23.3 years old. They had low level of awareness of premarital genetic counselling (68.3%). Only 23% were aware of genetic disorders and 77% were not. About 63% of the respondents claimed that awareness of genetic disorders and premarital genetic counselling would influence their choice of spouse. The study concludes that genetic information is poor and this will influence the uptake of genetic counselling. Efforts should be directed at ensuring mass literacy on the importance of genetic counselling especially among young people.
Birthing support and breastfeeding initiation in Somaliland
Authors: Pieh-Holder Kelly L. 
Published: May 2014

Background: Research has identified a relationship between birthing practices and breastfeeding initiation. Continuous support during labour and delivery is a key component to increasing breastfeeding initiation. Objective: The purpose of this project was to assess the impact of labour support on breastfeeding initiation in a setting in which women receive traditional birthing support from female family members. Methods: Research was conducted at the Edna Adan Maternity Hospital in Hargeisa, Somaliland using the grounded theory method of qualitative research. The CDC EZ-Text, a software programme developed by the Centers for Disease Control and Prevention, was used in managing and analyzing the data. Results: The results indicated that due to cultural influences, contradictory beliefs and practices, lack of critical thinking and lack of long-term planning, traditional birthing support was not always indicative of immediate breastfeeding initiation. Conclusions: The presence of a labour companion is a low-cost, preventative intervention that is consistent with the cultural practices of Somaliland. Breastfeeding education and support should, therefore, include a tertiary approach which involves pregnant and birthing women, labour support persons or family members and health care providers.
Chiropractic care in women's health: A midwifery perspective
Authors: Ramasubramaniam Shanthi , Muliira Rhoda Suubi , Seshan Vidya , Noronha Judith , Raman Savithri 
Published: May 2014

Introduction: Chiropractic care is one of the newer concepts and treatment modalities available to women in coping with the physical stresses of pregnancy, other than pharmacotherapy. Chiropractic care can help to increase the chances of a healthy pregnancy and can ease labour. Therefore midwives in clinical practice may find it useful to know the basic facts about chiropractic care in order to increase awareness of options in midwifery and inter-professional acceptance of chiropractors. Methods: An integrative review was conducted using a multimodal search of databases such as CINAHL, Science Direct, SCOPUS, PubMed and Cochrane. Results: Twelve studies met the inclusion criteria and findings suggest that chiropractic care is beneficial to pregnant women with back pain and mal-presentation during labour. Conclusion: Although there is still limited empirical research about chiropractic care in midwifery practice, the available studies showed that chiropractic treatment can offer women relief from musculoskeletal complaints. To this end, midwives should be educated and given opportunities to learn chiropractic skills to aid the comfort of mothers during pregnancy.
Male involvement in family planning practice
Authors: Chuwa Mary 
Published: May 2014

Historically, family planning (FP) programmes in Tanzania have had an inadequate focus on men. Consequently, little is known on men's knowledge and practices on family planning. Therefore, this study aimed to determine the factors that influence male involvement in family planning practice in Moshi rural district of Tanzania. A descriptive cross-sectional design was conducted. Recruitment of respondents was carried out at the household level. Information on factors influencing male involvement in family planning practice was obtained through administering a structured questionnaire and conducting in-depth interviews. A total of 218 men aged 18–60 years were interviewed. The results indicated that respondents were highly (85.3%) aware of modern contraceptives but contraceptive use was low (47.0%). It was found that the most commonly used contraceptives were male condoms, pills, injectables, IUCD and implants. Respondents with no formal education were twice as likely not to use contraceptive than those with primary education. Moreover, the study showed that both users and non-users have positive attitudes towards family planning practice. Furthermore, less than half of the respondents (45.4%) reported that they discussed issues pertaining to family planning with their spouses. There are multifaceted factors that influence male involvement in family planning practice, such as service provision, accessibility, inadequate contraceptive information, religious opposition, cultural issues, side effects and misconceptions.
Partner's reaction towards prevention of mother–to–child transmission of HIV
Authors: Tilahun Marelign , Degu Getu 
Published: May 2014

Background: The male partner's reaction is an important determinant in the uptake of prevention of mother–to–child transmission of HIV (PMTCT) service. Without knowing the determinant factors of male partner's reaction on PMTCT programmes, change will be very difficult or impossible to implement. Therefore, this study was conducted to identify the determinant factors of male partner's influence on pregnant women towards the PMTCT programme in Gondar town, North West Ethiopia. Methods: A cross-sectional quantitative study based in a health institution was conducted in Gondar town from 22 July–18 August 2011. A total of 410 pregnant women attending antenatal care (ANC) were recruited to participate using stratified sampling technique. Data were collected using a structured interviewer administered questionnaire. Multiple logistic regression analysis was employed using SPSS version 16. Results: Of the 400 pregnant women who actively participated in this study, 314 (78.5%) expected a negative reaction for HIV positive test result from their partners. A positive reaction from the partner was associated with women having their own income (Adjusted odds ratio (AOR) (95% CI)=2.180(1.213, 3.920)), residing in the urban areas (AOR (95%CI)=2.259(1.210, 4.217)), having education level of secondary level and above (AOR (95%CI)=6.048(3.121, 11.720)), not having a stigmatising attitude towards people living with HIV (AOR (95%CI)=2.149 (1.240, 3.725)), having a positive attitude towards counsellors (AOR (95%CI)=2.455(1.419, 4.246)) and being able to access health facilities (AOR (95%CI)=2.345(1.223, 4.498)). Conclusions: Most of the participants in this study expected their partner to react negatively towards a positive HIV test result. Since having their own income is strongly associated with a positive partner's reaction to PMTCT services, emphasis should be given for education and economic empowerment of women. A well functioning and accessible health facility with PMTCT service is important, especially in rural areas.
Assessment of Practising Midwives on the Management of the Third Stage of Labour
Authors: Hammah Juliana , Donkor Ernestina Safoa 
Published: May 2014

The third stage of labour is the separation and expulsion of the placenta and membranes following the birth of a baby. The management of this stage can directly influence postpartum haemorrhage (PPH), which is one of the world’s leading causes of maternal mortality. This study investigates adherence to the active management of the third stage of labour (AMTSL) using the protocol of the International Confederation of Midwives (ICM) and the International Federation of Gynaecology and Obstetrics (FIGO) by practising midwives, and identifies major barriers to its use. A quantitative research design was used. All 50 midwives working in the labour wards of a hospital and a health centre in Accra, Ghana, were recruited for the study. Data collection tools comprised a checklist on AMTSL and a questionnaire for assessment of the knowledge and perception of midwives. One hundred and fifty facility-based deliveries were observed and the midwives were rated using a checklist, with each of the 50 midwives observed three times. Data were analysed using the Statistical Package for the Social Sciences (SPSS). The findings indicate that the majority (40; 80%) of the midwives stated that they practised AMTSL while the remainder (10; 20%) stated that they used both active and expectant management. Further research demonstrated that the majority (36; 72%) administered oxytocin within 1 minute after the delivery of the baby which conforms to the ICM/FIGO protocol. Additionally, more than half (26; 52%) of the midwives said the best time to deliver the placenta by controlled cord traction (CCT) is when the contraction of the uterus is felt by the midwife. The overall mean skill performance was 45.7 ± 3.1 suggesting that the midwives’ performance was average on the ICM/FIGO protocol for AMTSL on a five-point Likert Scale. With respect to barriers to the correct use of AMTSL, the midwives cited various reasons including shortage and inadequate training of staff, improper storage of oxytocic drugs, lack of knowledge and skill on AMTSL, and decisions to adhere to other methods of managing the third stage of labour. The findings of this study have implications for midwives in managing the third stage of labour.
An audit of a specialist nurse-led rapid-access chest pain clinic
Authors: Moore Helen , Caton Jane , Williams Susan , Houghton Patricia , Naqvi Nayyar , Metcalfe Claire 
Published: May 2014

Objective: Rapid-access chest pain clinics, typically run by doctors, allow the rapid assessment of suspected new-onset angina. Five years ago specialist nurse-led rapid-access chest pain clinics were established at Royal Albert Edward Infirmary. The objective of this audit was to assess safety and effectiveness of these clinics. Method: Retrospective data were collected from all patients from January 2002 to December 2006. Results: GPs referred 1464 patients. Of those, 1349 (92.14%) patients were seen within the 14-day government target. The clinic had 1417 (96.8%) patients who under went exercise testing and 234 (16%) of these were positive. Of those patients 143 (61.8%) under went cardiac catheterization. Coronary artery disease was found in 110 patients. Eighty one patients under went revascularization and 29 patients were treated medically. Conclusions: This audit demonstrates that specialist nurse–led rapid -access chest pain clinics are safe and effective. They identify patients who are more likely to have coronary artery disease, therefore allowing early medical/surgical intervention and reducing patient morbidity and mortality. The burden on doctors is reduced and government targets are met.
Introduction to cardiac catheterization part 1: Diagnostic coronary angiography
Authors: Edmond John , Strange Julian , Baumbach Andreas 
Published: May 2014

Cardiac catheterization and diagnostic coronary angiography remains the gold standard for the investigation of many forms of coronary and structural heart disease, and as such is an extremely important component of the cardiac clinician’s diagnostic armamentarium. It is, however, an invasive procedure with attendant risks, and therefore it is important for all members of the catheter laboratory team to understand the processes involved and work well together to ensure that the patient has as safe and painless a journey as possible. In this article we review the indications for cardiac catheterization, the contra-indications and the important potential complications of this procedure, as well as discussing the basics of coronary anatomy demonstrated by coronary angiography.
Atrial septal defects: Not always so simple
Authors: Francis Marie L 
Published: May 2014

There are an estimated 250 000 adults with congenital heart disease in the UK. Atrial septal defect is the most common congenital heart condition diagnosed in adulthood. Management of this defect has been much debated but within the last decade a number of studies have shown that there are clear benefits to closing ASDs, even at a late stage. Untreated atrial septal defects can be a cause of significant morbidity including arrhythmia, right-sided heart failure, thromboembolism, pulmonary hypertension and potentially pulmonary vascular disease. The increasingly prevalent use of percutanous devices to close secundum defects has enhanced the attractiveness of the closure option for patients and clinicians alike. While to date, short-term outcomes have been encouraging, greater follow up is needed if the long-term effects of device closure are to be properly understood. This article addresses the presentation and management of atrial septal defects and late complications in defects that go untreated. It argues that while atrial septal defects may be regarded as ‘simple’ management is not always straight forward, and they can, if left untreated, significantly influence morbidity and mortality.
The clinical effectiveness of exercise training for patients with chronic heart failure
Authors: Leslie Rosalind , Buckley John P 
Published: May 2014

Aims: The efficacy of a supervised exercise-training programme, for patients with chronic heart failure, was assessed by comparing programme results with recommendations from current national ser vice frameworks and key systematic reviews. Methods: Retrospective data, on 22 Caucasian patients (18 male) aged 47 to 81 years were collected before and following a 12-week course of supervised exercise training, including: step test performance, New York Heart Association (NYHA) functional classification and brain natriuretic peptide (BNP). Results: For the same heart rate (~60% heart rate reserve), mean (SD) step test levels increased from 4.5 (0.2) to 5.1 (0.3) metabolic equivalents (P=0.0001) and NYHA scores improved from 2.1 (0.4) to 1.8 (0.5) (P=0.004). Mean BNP levels were 1563 (664) nanograms/ litre before the exercise programe and 1351 (536) nanograms/litre, after it (P=00.075). Conclusions: This audit clearly reflects the recommendations of national guidelines and systematic reviews, that exercise is not detrimental to the health and wellbeing of CHF patients and enhances physical functioning. The trend of improved BNP levels appears favourable and demonstrated to be of clinical significance in spite of not reaching statistical significance. This area requires further study on a greater number and wider variety of patients, where it is hypothesized that exercise will be both clinically and statistically significant.
Cardiac tamponade following heart surgery
Authors: Laidler Sandra 
Published: May 2014

This article explores cardiac tamponade in postoperative cardiac patients and highlights the role and responsibilities bestowed upon the cardiac nurse in assessing, preventing, recognising and managing this situation. Cardiac tamponade is the compression of the heart that occurs when blood builds up in the space between the myocardium and the pericardium. In this condition, blood collects in the pericardium and mediastinum; this can prevent the ventricles from expanding fully. Excess pressure from the fluid prevents the heart from functioning normally. The signs of cardiac tamponade and cardiogenic shock are discussed, as are the urgent treatments they require. The cardiac nurse requires specialist skills and knowledge in managing surgical patients postoperatively. A thorough assessment, observation, early detection and quick intervention can mean the difference between life and death for patients who suffer cardiac tamponade following cardiac surgery. The standards of care suggested throughout this article are based on local practice in association with national and European guidelines.
‘Do not attempt resuscitation’ orders: a review of the law
Authors: Griffith Richard 
Published: May 2014

Controversy surrounding the use of do not resuscitate orders on patients often without their knowledge and without apparent good reason have led some to question the lawfulness of such orders ( An NHS Trust v Mr and Mrs H [2012] ). In this article Richard Griffith considers the legal basis for do not resuscitate orders and outlines decisions from the courts that will assist nurses in deciding whether making such an order is lawful.
Nurse-led community diuretics for heart failure patients
Authors: Quinn Miriam , Read Haley 
Published: May 2014

Heart failure is a chronic condition that results in a high incidence of hospital admissions, often due to decompensation and fluid retention. Patients often require intravenous (IV) diuretics, and until recently these were routinely delivered in secondary care settings. The British Heart Foundation is currently evaluating the delivery of IV diuretics within patients' homes. As IV diuretics have traditionally been delivered in secondary care, there are challenges in implementing such a service in the community. New ways of working and delivering care need to be considered, along with the development of clinical skills. This article explores the development of a community IV diuretics service and how challenges were embraced and overcome in order to deliver a robust and effective service. A case study highlights how the IV diuretics service was implemented in practice and how patients can benefit from such a service. Recommendations are made for future service delivery.