When will we change practice and stop directing pushing in labour?

There have been many papers written about the issue of pushing in the second stage of labour, and yet anecdotally some midwives are still restricted by labour ward policies of timed second stages, active pushing once fully dilated and subsequent interventions when time runs out. Research is fraught with frustration on occasion; some studies stop early because of preliminary findings indicating obvious benefits, while others, although offering beneficial findings, are often ignored and traditional practices continue. This article considers the research supporting spontaneous pushing in labour; it asks why change is so difficult and then considers what could be done to encourage a change in practice. The article finds that women should be allowed to push spontaneously. A change in clinical practice is recommended. It considers whether further research is necessary, or whether a change in the definitions used for the stages of labour would allow midwives to let women dictate when to push. </jats:p

The safe insertion of peripheral intravenous catheters : a mixed methods descriptive study of the availability of the equipment needed

Background: Intravenous cannulation is undertaken in a high proportion of hospitalised patients. Much international attention has been given to the use of care bundles to reduce the incidence of infection in these patients. However, less attention has been given to the systems required to ensure availability of the equipment needed to support these care bundles. Our objectives were to assess how reliably the equipment recommended for a peripheral intravenous care bundle was available for use, and to explore factors which contributed to its non-availability. Methods: We studied 350 peripheral cannula insertions in three NHS hospital organisations across the UK. Staff inserting cannulae were asked to report details of all equipment problems. Key staff were then interviewed to identify the causes of problems with equipment availability, using semi-structured qualitative interviews and a standard coding frame. Results: 47 equipment problems were recorded during 46 of 350 cannulations, corresponding to a reliability of 87%, or 94% if problems with sharps disposal were excluded. Overall reliability was similar in all three organisations, but the types of problem varied. Interviews revealed a variety of causes including issues associated with purchasing policies, storage facilities, and lack of teamwork and communication in relation to reordering. The many human factors related to the supply chain were highlighted. Often staff had adopted work-arounds to deal with these problems. Conclusions: Overall, 87% of cannulations had the correct and functional equipment available. Different problems were identified in different organisations, suggesting that each had resolved some issues. Supply chain management principles may be useful to support best practice in care bundle delivery. Keywords: Cannulation, Patient safety, Equipment, Care bundles, Hospital acquired bacteraemia, Systems reliabilit

Facial Mimicry Versus Perspective-Taking: Decoding Instructional Sets As Empathy-Inducing Strategies

Much of human interaction and communication comprises verbal and nonverbal information. While verbal communication contains important lexical information, research has shown that nonverbal communication is often more important to the success of an interaction than is verbal. Improper use and interpretations of nonverbal communication have been shown to be related to social and personal distress due, in part, to a lack of understanding and empathy for the target. Previous research has identified both perspective-taking and facial mimicry as potential strategies that can be used to understand or decode nonverbal communication, which promote empathic responding and prosocial behaviors toward a target. The current study sought to understand better these two decoding strategies by presenting participants with an interpersonal situation (a betrayal) that would require the use of empathic responding to achieve conflict resolution between friends. The results demonstrated that when individuals engaged in either of the two decoding strategies, they reported significantly higher empathic understanding of the target and self-other overlap (a prosocial outcome) relative to those not instructed to engage in a particular strategy. These findings support the use of both nonverbal decoding strategies (perspective-taking and facial mimicry) as means of enhancing interpersonal communication

Roads as a contributor to landscape-scale variation in bird communities.

Roads and their traffic can affect wildlife over large areas and, in regions with dense road networks, may influence a high proportion of the ecological landscape. We assess the abundance of 75 bird species in relation to roads across Great Britain. Of these, 77% vary significantly in abundance with increasing road exposure, just over half negatively so. The effect distances of these negative associations average 700 m from a road, covering over 70% of Great Britain and over 40% of the total area of terrestrial protected sites. Species with smaller national populations generally have lower relative abundance with increasing road exposure, whereas the opposite is true for more common species. Smaller-bodied and migratory species are also more negatively associated with road exposure. By creating environmental conditions that benefit generally common species at the expense of others, road networks may echo other anthropogenic disturbances in bringing about large-scale simplification of avian communities

How safe are clinical systems?

Th is study was commissioned by the Health Foundation to examine the extent, type and causes of failures in reliability in different healthcare systems: failures which have the potential to create risk or cause patient harm

Mask Projection Microstereolithography of Novel Biocompatible Polymers

Mask Projection Microstereolithography (MPμSL) selectively cures entire layers of photopolymer to create three-dimensional parts with features on the micron scale. The resolution and scale of MPμSL are ideal for fabricating tissue engineering scaffolds with designed mesostructure. While MPμSL have excellent resolution, there are few biocompatible materials that are compatible with the vat photopolymerization processes. A novel diacrylate functionalized Pluronic L-31 block-copolymer and poly(propylene glycol diacrylate) were synthesized and processed with MPμSL. The resulting structures were analyzed for biocompatibility, as well as accuracy and mechanical strength to assess feasibility for use in tissue engineering scaffold fabrication. Preliminary fabricated scaffold geometries are presented to validate experimental results.Mechanical Engineerin

The intervening role of urgency on the association between childhood maltreatment, PTSD, and substance-related problems

A range of risk factors lead to opioid use and substance-related problems (SRP) including childhood maltreatment, elevated impulsivity, and psychopathology. These constructs are highly interrelated such that childhood maltreatment is associated with elevated impulsivity and trauma-related psychopathology such as posttraumatic stress disorder (PTSD), and impulsivity-particularly urgency-and PTSD are related. Prior work has examined the association between these constructs and substance-related problems independently and it is unclear how these multi-faceted constructs (i.e., maltreatment types and positive and negative urgency) are associated with one another and SRP. The current study used structural equation modeling (SEM) to examine the relations among childhood maltreatment, trait urgency, PTSD symptoms, and SRP in a sample of individuals with a history of opioid use. An initial model that included paths from each type of childhood maltreatment, positive and negative urgency, PTSD and SRP did not fit the data well. A pruned model with excellent fit was identified that suggested emotional abuse, positive urgency, and negative urgency were directly related to PTSD symptoms and only PTSD symptoms were directly related to SRP. Furthermore, significant indirect effects suggested that emotional abuse and negative urgency were related to SRP via PTSD symptom severity. These results suggest that PTSD plays an important role in the severity of SRP

Quantifying tumour-infiltrating lymphocyte subsets : a practical immuno-histochemical method

Background: Efficient histological quantification of tumour-infiltrating T and B lymphocyte (TIL) subsets in archival tissues would greatly facilitate investigations of the role of TIL in human cancer biology. We sought to develop such a method. Methods: Ten ×40 digital images of 4 μ sections of 16 ductal invasive breast carcinomas immunostained for CD3, CD4, CD8, and CD20 were acquired (a total of 640 images). The number of pixels in each image matching a partition of Lab colour space corresponding to immunostained cells were counted using the ‘Color range’ and ‘Histogram’ tools in Adobe Photoshop 7. These pixel counts were converted to cell counts per mm2 using a calibration factor derived from one, two, three or all 10 images of each case/antibody combination. Results: Variations in the number of labelled pixels per immunostained cell made individual calibration for each case/antibody combination necessary. Calibration based on two fields containing the most labelled pixels gave a cell count minimally higher (+ 5.3%) than the count based on 10-field calibration, with 95% confidence limits − 14.7 to + 25.3%. As TIL density could vary up to 100-fold between cases, this accuracy and precision are acceptable. Conclusion: The methodology described offers sufficient accuracy, precision and efficiency to quantify the density of TIL sub-populations in breast cancer using commonly available software, and could be adapted to batch processing of image files

Nurses’ education, knowledge and perceptions of peripheral intravenous catheter management: A web-based, cross-sectional survey

Background: Peripheral intravenous catheters (PIVCs) are the most used invasive medical device. Unfortunately, PIVCs fail for a variety of reasons and failure often results in serious adverse events leading to patient discomfort, infection, delays in treatment, increased healthcare costs, and even death. In Australia, qualified nurses assess, manage, and remove a PIVC as part of their clinical role. To date, no study has described the current state of knowledge and confidence (self-efficacy) about PIVCs from the perspectives of qualified nurses working in Australian hospital settings. Aims: To describe the current state of knowledge and confidence (self-efficacy) about PIVC management from the perspectives of qualified nurses working in Australian hospital settings. To explore how these related to the education received by these nurses. Methods: An online cross-sectional survey. Findings: Qualified nurses in Australia thought that education about PIVCs was important and that it should be underpinned by evidence-based guidelines. Knowledge Test score for the sample was 12.4/17 (SD 2.1), this equates to a mean grade of 73.0%. Respondents reported very high levels of confidence about caring for a patient with a PIVC in situ. Conclusion: Despite the frequent and increasing use of PIVCs and importantly the documented adverse events associated with poor assessment, management and inappropriate removal, qualified nurses’ knowledge and confidence remain poorly reported. We demonstrated fundamental gaps in qualified nurses’ knowledge in relation to assessment, management, and removal of PIVCs