Tests for predicting complications of pre-eclampsia: A protocol for systematic reviews

Background Pre-eclampsia is associated with several complications. Early prediction of complications and timely management is needed for clinical care of these patients to avert fetal and maternal mortality and morbidity. There is a need to identify best testing strategies in pre eclampsia to identify the women at increased risk of complications. We aim to determine the accuracy of various tests to predict complications of pre-eclampsia by systematic quantitative reviews. Method We performed extensive search in MEDLINE (1951–2004), EMBASE (1974–2004) and also will also include manual searches of bibliographies of primary and review articles. An initial search has revealed 19500 citations. Two reviewers will independently select studies and extract data on study characteristics, quality and accuracy. Accuracy data will be used to construct 2 × 2 tables. Data synthesis will involve assessment for heterogeneity and appropriately pooling of results to produce summary Receiver Operating Characteristics (ROC) curve and summary likelihood ratios. Discussion This review will generate predictive information and integrate that with therapeutic effectiveness to determine the absolute benefit and harm of available therapy in reducing complications in women with pre-eclampsia

Motivational Reasons Associated with the Participation of Registered Nurses in the Nursing Degree Program

The nursing degree program is becoming popular among the registered nurses in Malaysia. This is despite the fact that most organisations do not make it a compulsory criterion for upward mobility or promotion. Therefore, it is important for nursing educators or HRD managers to understand why registered nurses participate voluntarily in the nursing degree program. The purpose of this study is to identify the motivational reasons influencing the participation of registered nurses in the program. It is aimed to determine: (1) the major reasons for participation in the nursing degree program; (2) the differences in motivational reasons for participation between registered nurses in clinical, management and teaching positions; (3) the relationship between selected personal, professional and organisational variables and the reasons for participation and (4) whether nurses doing the program full time had different reasons for participation compared to nurses doing the program part time.The study was based on a descriptive / correlational design and employed a survey methodology. The instrument used was the four-section questionnaire: personal, professional, organisational data and the 30 statement Participation Reasons Scale. A total of 107 valid responses was analysed. The highest ranked statement was centered around the maintainance of professional competence. The above findings support existing studies where professional knowledge and skills were found to be the strongest motivators. The predetermined factor which had the highest average mean score was Professional Improvement and Development, followed by Professional Service, Professional Commitment and Reflection, Collegial Learning and Interaction and Personal Benefits and Job Security. There were no significant relationships between selected personal, professional and organizational variables with reasons for participation. However, a significant difference in relationship was found between nurses doing the program full time and part time with one participation factor - Professional Service. Further analysis showed that the Nursing Sisters doing the program part time had low mean scores for reasons associated with Professional Service compared to the other group of nurses. This requires further research to determine the underlying reasons behind it. The study findings indicate that registered nurses were highly motivated towards the nursing degree program. It is highly recommended that HRD managers and educators take advantage of this current positive behaviour. Attempts should be made to increase the accessibility and availability of degree opportunities for nurses while maintaining the credibility of the program

Learning from the experience of maternity healthcare workers in Malawi:a qualitative study leading to ten low-cost recommendations to improve working lives and quality of care

BACKGROUND: In Malawi there are too few maternity healthcare workers to enable delivery of high quality care to women. These staff are often overworked and have low job satisfaction. Skilled maternity healthcare workers are essential to improve outcomes for mothers and babies. This study focuses on understanding the working life experience of maternity staff at district hospitals in Malawi with the aim of developing relevant low-cost solutions to improve working life.METHODS: A qualitative study using semi-structured interviews was undertaken in three district hospitals around Malawi's Capital city. Thirty-one staff formed a convenience sample, purposively selected to cover each cadre. Interviews were recorded, transcribed and then analysed using Interpretative Phenomenological Analysis complemented by Template Analysis to elicit the experience of maternity staff.RESULTS: Staff describe a system where respect, praise and support is lacking. Many want to develop their skills, however, there are barriers to advancement. Despite this, staff are motivated; they are passionate, committed professionals who endeavor to treat patients well, despite having few resources. Their 'superdiverse' background and experience helps them build resilience and strive to provide 'total care'.CONCLUSIONS: Improving working lives can improve the care women receive. However, this requires appropriate health policy and investment of resources. There are some inter-relational aspects that can be improved with little cost, which form the ten recommendations of this paper. These improvements in working life center around individual staff (respecting each other, appreciating each other, being available when needed, performing systematic clinical assessments and communicating clearly), leadership (supportive supervision and leading by example) and the system (transparent training selection, training being need driven, clinical skills being considered in rotation of staff). To improve working lives in this way will require commitment to change throughout the health system. Thus, it could help address preventable maternal and newborn deaths.</p

Predicting Allograft Requirement in the Management of Patients With Major Burn Injuries

• Early debridement and coverage of burn wounds saves lives. • Allograft is the ‘gold-standard’ for temporary coverage of acute burns