scholarly journals The acceptability to women of techniques for managing an impacted fetal head at caesarean section and of randomised trials evaluating those techniques: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gabriella Romano ◽  
Eleanor Mitchell ◽  
Rachel Plachcinski ◽  
Natalie Wakefield ◽  
Kate Walker ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Healthcare Professionals ◽  
Informed Choice ◽  
Structured Interviews ◽  
Fetal Head ◽  
Emergency Situations ◽  
Second Stage ◽  
Systematic Sample ◽  
Women’S Views

Abstract Background This study aimed to explore women’s views on the acceptability of different techniques for managing an impacted fetal head at caesarean; and the feasibility and acceptability of conducting a trial in this area. Methods Qualitative semi-structured interviews with a systematic sample of women who experienced second stage emergency caesarean section at a tertiary National Health Service (NHS) hospital in England, UK. Thematic analysis was used to extract women’s views. Results Women varied in their perceptions of the acceptability of different techniques for managing impacted fetal head. Trust in medical expertise and prioritising the safety of the baby were important contextual factors. Greater consensus was found around informed choice in trials where subthemes considered the timing of invitation, reduced capacity to give consent in emergency situations, and the importance of birth outcomes and having good rapport with healthcare professionals who invite women into trials. Finally, women reflected on the importance of supportive antenatal and postpartum education for impacted fetal head. Conclusions This research provides information on the acceptability of techniques and any trial to evaluate these techniques. Findings illustrate the importance of context and quality of care to both acceptability and approaching women to take part in a future trial.

scholarly journals Maternal and foetal outcome in second stage caesarean section: a prospective study

2021 ◽  
Vol 10 (4) ◽  
pp. 1644
Author(s):  
Shuchi Sharma ◽  
Poojan Dogra ◽  
Reena Sharma ◽  
Suraj Bhardwaj
Keyword(s):  
Caesarean Section ◽  
Prospective Study ◽  
Cervical Dilatation ◽  
Bladder Injury ◽  
Fetal Head ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Adjacent Structures ◽  
A Prospective Study

Background: Caesarean section is the most commonly performed abdominal operation in women all over the world. Caesarean sections during the second stage labour accounts for approximately one fourth of all primary caesareans.  Caesarean section at full cervical dilatation is technically difficult and is associated with increased trauma to the lower uterine segment and adjacent structures, as well as increased haemorrhage and infection. Aims and objectives were to determine the indications, maternal and foetal morbidity associated with caesarean section in the second stage of labour.Methods: This prospective study included consecutive 50 cases of caesarean section deliveries conducted in second stage of labor for singleton live pregnancies at term. The data collected in the study was analyzed in terms of maternal demographics, indications of caesarean section, intra-operative and postoperative complications and neonatal outcomes.Results: In our series of 50 deliveries, arrest of descent of fetal head due to malposition was the most common indication of caesarean section accounting for 74% and average procedure time was 45-70 minutes. PPH (62%) was the most common complication. Bladder injury was found in 14% cases. Neonatal outcome variables like APGAR<3 at 5 minutes, respiratory distress and neonatal death were observed in 7, 26 and 2 deliveries respectively.Conclusions: Women undergoing cesarean section in second stage of labour are associated with increased maternal and fetal morbidity. They require special care and hence operation should ideally be performed and supervised by an experienced obstetrician. A proper judgement is required to take a decision for caesarean section at full cervical dilatation.

scholarly journals Birthing experience and quality of life after vacuum delivery and second-stage caesarean section: a prospective cohort study in Uganda

2018 ◽  
Vol 23 (8) ◽  
pp. 914-922 ◽  
Author(s):  
Barbara Nolens ◽  
Thomas van den Akker ◽  
John Lule ◽  
Sulphine Twinomuhangi ◽  
Jos van Roosmalen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Caesarean Section ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Second Stage ◽  
Vacuum Delivery

scholarly journals Dignity of informal caregivers of migrant patients in the last phase of life. A qualitative study.

2020 ◽  
Author(s):  
Xanthe de Voogd ◽  
Dick Willems ◽  
Marieke Torensma ◽  
Bregje Onwuteaka-Philipsen ◽  
Jeanine Suurmond
Keyword(s):  
Quality Of Life ◽  
Healthcare Professionals ◽  
Informal Caregiver ◽  
Informal Caregivers ◽  
Good Care ◽  
Structured Interviews ◽  
Value Differences ◽  
Centered Care ◽  
Family Centered

Abstract Background An important aim of palliative care is to improve the family’s and patient’s quality of life. To ensure quality of life for migrant patients’ families, the objective of this study was to get insight into the dignity of informal caregivers. This could provide insight on family-centered care for migrant patients. Methods 20 semi-structured interviews with informal caregivers with a Turkish, Moroccan or Surinamese migration background living in the Netherlands were analyzed thematically. Results We found the dignity of the patient and the dignity of the informal caregiver were strongly related. Most important for the dignity of the informal caregiver was to ensure good care for and preserve the dignity of the patient. Ensuring good care encompassed advocating for good and dignified care and wishes of the patient. For many caregivers, it also included delivering care to the patient themselves or with other family members, despite having to give up a part of their own lives. Giving care themselves was part of maintaining a good relationship, it could cater to the patient’s preferences or preserve the patient’s dignity, and it could come with valuable aspects such as times for good conversations. The informal caregiver’s dignity and the patient’s dignity were often compromised simultaneously. When informal caregivers felt healthcare professionals were impairing the dignity of the patient, their own dignity suffered. Also, dignified behavior by the patient such as thankfulness influenced the informal caregiver’s dignity positively, undignified behavior of the informal caregiver themselves, such as showing their emotions to significant others could influence it negatively. According to informal caregivers, healthcare professionals can help them preserve their dignity by taking their advice about the patient seriously, informing them about the disease and the patient’s prognosis, and dealing respectfully with value differences at the end of life. Conclusion The dignity of migrant patients’ informal caregivers in the last phase of the patient’s life is entwined with ensuring good care for and dignity of the patient. Healthcare professionals could strengthen the informal caregiver’s dignity by supporting their role.

scholarly journals A comparison of technicques to disimpact the fetal head on a second stage caesearean simulator

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Anastasia Martin ◽  
Diane Nzelu ◽  
Annette Briley ◽  
Graham Tydeman ◽  
Andrew Shennan
Keyword(s):  
Caesarean Section ◽  
Neonatal Morbidity ◽  
Previous Experience ◽  
Fetal Head ◽  
Digital Technique ◽  
Second Stage ◽  
Head Elevation ◽  
Digital Elevation ◽  
Single Operator ◽  
Established Technique

Abstract Background The rate of second stage caesarean section (CS) is rising with associated increases in maternal and neonatal morbidity, which may be related to impaction of the fetal head in the maternal pelvis. In the last 10 years, two devices have been developed to aid disimpaction and reduce these risks: the Fetal Pillow (FP) and the Tydeman Tube (TT). The aim of this study was to determine the distance of upward fetal head elevation achieved on a simulator for second stage CS using these two devices, compared to the established technique of per vaginum digital disimpaction by an assistant. Methods We measured elevation of the fetal head achieved with the two devices (TT and FP), compared to digital elevation, on a second stage Caesearean simulator (Desperate Debra ™ set at three levels of severity. Elevation was measured by both a single operator experienced with use of the TT and FP and also multiple assistants with no previous experience of using either device. All measurements were blinded Results The trained user achieved greater elevation of the fetal head at both moderate and high levels of severity with the TT (moderate: 30mm vs 12.5mm p<0.001; most severe: 25mm vs 10mm p<0.001) compared to digital elevation. The FP provided comparable elevation to digital at both settings (moderate: 10 vs 12.5mm p=0.149; severe 10 vs 10mm p=0.44). With untrained users, elevation was also significantly greater with the TT compared to digital elevation (20mm vs 10mm p<0.01). However digital disimpaction was significantly greater than the FP (10mm vs 0mm p<0.0001). Conclusion On a simulator, with trained operators, the TT provided greater fetal head elevation than digital elevation and the FP. The FP achieved similar elevation to the digital technique, especially when the user was trained in the procedure.

scholarly journals Dignity of informal caregivers of migrant patients in the last phase of life. A qualitative study.

2020 ◽  
Author(s):  
Xanthe de Voogd ◽  
Dick Willems ◽  
Marieke Torensma ◽  
Bregje Onwuteaka-Philipsen ◽  
Jeanine Suurmond
Keyword(s):  
Quality Of Life ◽  
Healthcare Professionals ◽  
Informal Caregiver ◽  
Informal Caregivers ◽  
Good Care ◽  
Structured Interviews ◽  
Positive Interaction ◽  
Migrant Communities ◽  
Centered Care

Abstract Background: A key aim of palliative care is to improve the quality of life of patients and their families. To help ensure quality of life for the families of patients with migrant backgrounds, this study sought insights into the dignity of informal caregivers in migrant communities. This could improve understanding of family-centered care for migrant patients.Methods: Twenty semi-structured interviews with informal caregivers of Turkish, Moroccan, or Surinamese background living in the Netherlands were analyzed thematically.Results: The dignity of the patient and that of their informal caregivers were found to be strongly interrelated. Most important for the dignity of caregivers was ensuring good care for their patients and preserving the patients’ dignity. Ensuring good care involved advocating for good and dignified care and for satisfaction of a patient’s wishes. For many informal caregivers, it also included delivering care to the patient by themselves or together with other family members, despite having to give up part of their own lives. Providing care themselves was part of maintaining a good relationship with the patient; the care was to cater to the patient’s preferences and help preserve the patient’s dignity, and it could be accompanied by valuable aspects such as times for good conversations. Positive interaction between an informal caregiver and a patient positively influenced the informal caregiver’s dignity. Informal caregiver and patient dignity were often compromised simultaneously; when informal caregivers felt healthcare professionals were undermining a patient’s dignity, their own dignity suffered. According to informal caregivers, healthcare professionals can help them preserve dignity by taking seriously their advice about the patient, keeping them informed about the prognosis of the disease and of the patient, and dealing respectfully with differences in values at the end of life. Conclusion: The dignity of migrant patients’ informal caregivers in the last phase of a patient’s life is closely entwined with ensuring good care and dignity for the patient. Healthcare professionals can strengthen the dignity of informal caregivers by supporting their caregiving role.

scholarly journals Considering Health Literacy in Cardiovascular Disease Management: A Qualitative Study on Healthcare Professionals’ and Patients' Perspectives

2021 ◽  
Author(s):  
Adèle PERRIN ◽  
Eléonore Damiolini ◽  
Anne-Marie Schott ◽  
Jéremy Zermati ◽  
Estelle Bravant ◽  
...  
Keyword(s):  
Health Literacy ◽  
Healthcare Professionals ◽  
Implementation Strategies ◽  
Structured Interviews ◽  
Face To Face ◽  
Implementing Change ◽  
Fishbone Diagram ◽  
Patient Health ◽  
Health Action

Abstract Background: Implementing practices adapted to patient health literacy (HL) is a promising avenue for improving their outcomes in the context of cardiovascular diseases (CVD). The health communication skills of healthcare professionals (HCPs) and the quality of information provided are essential for low-HL patients. We aimed to explore HCPs knowledge about HL, patients and HCPs views on current practices regarding low-HL patients, and facilitators and barriers to adapting communication to patients’ HL level, in order to prepare the implementation of a complex intervention dedicated to improve CVD management for low-HL patients.Methods: We conducted face-to-face semi-structured interviews with HCPs practicing in cardiology units and patients hospitalized for CVD. Study design and analysis were based on the Theory of Planned Behavior for HCPs and the framework of Health Literacy and Health Action for patients. Deductive and inductive thematic analysis were used. Barriers and facilitators were structured into an Ishikawa fishbone diagram and implementation strategies were selected to address resulting themes from the Expert Recommendations for Implementing Change (ERIC).Results: Fifteen patients and 14 HCPs were interviewed. HCPs had partial knowledge of HL dimensions. Perceptions of HCPs and patients were not congruent regarding HCP-patient interactions and information provided by hospital and community HCPs. HCPs perceived they lacked validated tools and skills, and declared they adapted spontaneously their communication when interacting with low-HL patients. Patients expressed unmet needs regarding communication during hospital discharge and at return to home. Conclusion: To implement HL-tailored practices in this setting, our results suggest that several implementation strategies will be valuable at individual (engaging patients and their family), interactional (educating and training of HCPs about HL) and organizational levels (creating a multidisciplinary HCPs interest group dedicated to HL). Trial registration: The study was registered on Clinical Trials: NCT03949309.

scholarly journals Dignity of informal caregivers of migrant patients in the last phase of life. A qualitative study.

2020 ◽  
Author(s):  
Xanthe de Voogd ◽  
Dick Willems ◽  
Marieke Torensma ◽  
Bregje Onwuteaka-Philipsen ◽  
Jeanine Suurmond
Keyword(s):  
Quality Of Life ◽  
Healthcare Professionals ◽  
Informal Caregiver ◽  
Informal Caregivers ◽  
Good Care ◽  
Structured Interviews ◽  
Positive Interaction ◽  
Migrant Communities ◽  
Centered Care

Abstract Background: A key aim of palliative care is to improve the quality of life of patients and their families. To help ensure quality of life for the families of patients with migrant backgrounds, this study sought insights into the dignity of informal caregivers in migrant communities. This could improve understanding of family-centered care for migrant patients.Methods: Twenty semi-structured interviews with informal caregivers of Turkish, Moroccan, or Surinamese background living in the Netherlands were analyzed thematically.Results: The dignity of the patient and that of their informal caregivers were found to be strongly interrelated. Most important for the dignity of caregivers was ensuring good care for their patients and preserving the patients’ dignity. Ensuring good care involved advocating for good and dignified care and for satisfaction of a patient’s wishes. For many informal caregivers, it also included delivering care to the patient by themselves or together with other family members, despite having to give up part of their own lives. Providing care themselves was part of maintaining a good relationship with the patient; the care was to cater to the patient’s preferences and help preserve the patient’s dignity, and it could be accompanied by valuable aspects such as times for good conversations. Positive interaction between an informal caregiver and a patient positively influenced the informal caregiver’s dignity. Informal caregiver and patient dignity were often compromised simultaneously; when informal caregivers felt healthcare professionals were undermining a patient’s dignity, their own dignity suffered. According to informal caregivers, healthcare professionals can help them preserve dignity by taking seriously their advice about the patient, keeping them informed about the prognosis of the disease and of the patient, and dealing respectfully with differences in values at the end of life. Conclusion: The dignity of migrant patients’ informal caregivers in the last phase of a patient’s life is closely entwined with ensuring good care and dignity for the patient. Healthcare professionals can strengthen the dignity of informal caregivers by supporting their caregiving role.

scholarly journals Perceptions of youth healthcare professionals of the concept Positive Health in the Netherlands

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
C M A de Bot ◽  
E van Meerten ◽  
J A J Dierx
Keyword(s):  
Public Health ◽  
Mixed Methods Research ◽  
Healthcare Professionals ◽  
Daily Practice ◽  
Structured Interviews ◽  
Positive Health ◽  
Social Challenges ◽  
Public Health Professionals ◽  
Health Concept

Abstract Background Based on public health professionals’ opinions, Huber et al. (2011) described health as a dynamic concept that has the potential to increase or decrease depending on contextual factors, yet with the broadness as the WHO definition. She proposed defining health ’as the ability to adapt and self-manage, in the light of physical, emotional and social challenges of life’. Healthcare professionals are exploring how the new concept can be further specified for various fields of healthcare. This study examines the perceptions of youth healthcare professionals to Positive Health and to what extent they experience this concept in current working practice. Methods A mixed-methods research has been used; both quantitative and qualitative data have been collected. A questionnaire survey (n = 97) has been done and semi-structured interviews (n = 12) have taken place to question youth healthcare professionals in public health about the positive health concept. Results Youth healthcare professionals find all the dimensions of positive health important. However, not all dimensions of positive health are suitable in daily practice of youth healthcare professionals in public health. The dimension ’Quality of life’ is seen as the most important dimension in terms of positive health. The concept of positive health can be applied within the workfield of youth healthcare professionals. However, the implementation of new concept should be explored. Conclusions This study shows that youth healthcare professionals have a positive attitude towards Positive Health. Youth healthcare professionals consider the all the dimensions important and also embed the aspects of it in their daily practice. However, the implementation of new concept should be explored. Key messages The Positive Health concept in youth healthcare care is promising. Positive Health gives a broader look at health.

scholarly journals Preliminary Investigation of the Usability Characteristics Required for Wound Management Products by Semi-Structural Interview of Medical Staff

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 152
Author(s):  
Kaoru Hirose ◽  
Yayoi Kawano ◽  
Nahoko Shigeno ◽  
Yoshikatsu Mizutani ◽  
Hiraku Onishi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Thematic Analysis ◽  
Healthcare Professionals ◽  
Preliminary Investigation ◽  
Wound Management ◽  
Medical Professionals ◽  
Development Projects ◽  
Structured Interviews ◽  
Care Clinic

Consideration of drug usability characteristics is important during the design process. Although many wound management products have been developed in recent years, there are few studies on their usability. We investigated the needs and characteristics of wound management products required by medical professionals, so as to consider these in future development projects. Semi-structured interviews were conducted in a group of healthcare professionals. Interview responses were analyzed based on thematic analysis. Four themes common to all facilities were secondary wounds, adaptability of materials, convenience, and physicochemical properties. Economic efficiency of medical care was found to be considered only at the hospital, and quality of life of patients was found to be considered only at the home palliative care clinic. Requirements for wound management products can be affected by participants’ roles and their facility settings. However, there were needs common to all fields that all wound management products should aim to incorporate.

Defining Successful Performance Among Pediatric Residents

PEDIATRICS ◽  
1990 ◽  
Vol 85 (2) ◽  
pp. 139-143
Author(s):  
Elizabeth M. Altmaier ◽  
Gail McGuinness ◽  
Peggy Wood ◽  
Randall R. Ross ◽  
James Bartley ◽  
...  
Keyword(s):  
Clinical Judgment ◽  
Critical Incident ◽  
Medical Information ◽  
Structured Interviews ◽  
Successful Performance ◽  
Emergency Situations ◽  
Teaching Faculty ◽  
Information Recognition ◽  
Selection Of

The pediatric literature has documented a growing attention to defining the nature and quality of residency training. The critical incident technique, a method widely accepted in industrial settings, was used in this study to determine attitudes and behaviors deemed critical for successful performance of residents in a pediatric training program. Structured interviews with 17 senior teaching faculty produced descriptions of resident behavior that were classified into the following mutually exclusive categories: commitment to learning, clinical judgment, communicating medical information, recognition ion of limits, professional behavior, interpersonal skills with patients, and dealing with emergency situations. Only 30% of the critical incidents obtained from the faculty were related to criteria traditionally used to select and evaluate residents, such as knowledge and technical skills, while the remaining incidents were noncognitive in nature. The results of this study have implications for the evaluation and selection of residents and suggest that pediatric program directors and faculty must give attention to the means by which noncognitive skills are fostered in residents.

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