Effect of placental transfusion on neonatal resuscitation attempts

Objective: Overall, neonatal mortality has been shown to be reduced by: placental transfusion (the transfer of blood from the placenta to the neonatal circulation after birth); delayed cord clamping (DCM) (waiting for the umbilical cord to stop pulsating before clamping and cutting the cord); and umbilical cord milking (UCM) (clamping and cutting the cord immediately before milking the cord towards the neonate to expel remaining volume). This systematic review aimed to determine whether placental transfusion negatively impacts resuscitation by delaying it or has any effect on infant mortality, and to identify any barriers to performing it. Methods: CINAHL, MEDLINE, AMED and the British Nursing Index were searched using key terms to identify relevant English language publications between 2017 and 2019. Results: Five papers were selected for critical analysis—three randomised control trials and two cohort studies. Conclusion: Placental transfusion was not found to have a negative impact on neonatal resuscitation but, equally, had no significant effect on Apgar at 5 minutes; however, Apgar is a crude measure of infant mortality. The question remains around the proven multifaceted benefit of placental transfusion in the prehospital environment, which requires further research. There is evidence to suggest prehospital clinicians should be looking to change practice. Further research, considerations and consultations are required to ascertain the best way to implement the procedure with a balanced and proportionate approach considering neonatal thermoregulation and maternal management. The main reported barrier to placental transfusion was a lack of appropriate equipment

The politics of economic policy making in Britain : a re-assessment of the 1976 IMF crisis

Many existing accounts of the IMF crisis have argued that British policy was determined either by the exercise of structural power by markets through the creation of currency instability and the application of loan conditionality, or by demonstrating that only policies of a broadly monetarist persuasion would be sufficient to sustain confidence, a recognition which was reached through a process of policy learning. This paper offers a re-assessment of economic policy-making in Britain during the 1976 IMF crisis to show that policy change did not occur as a result of disciplinary market pressure or a process of social learning. It argues that state managers have to manage the contradictions between the imperatives of accumulation and legitimation, and can do so through the politics of depoliticisation. It then uses archival sources to show how significant elements of the core-executive had established preferences for deflationary policies, which were implemented in 1976 by using market rhetoric and Fund conditionality to shape perceptions about the range of issues within the government‟s scope for discretionary control

From social contract to 'social contrick' : the depoliticisation of economic policy-making under Harold Wilson, 1974–75

The 1974-79 Labour Governments were elected on the basis of an agreement with the TUC promising a redistribution of income and wealth known as the Social Contract. However, the Government immediately began to marginalise these commitments in favour of preferences for incomes policy and public expenditure cuts, which has led the Social Contract to be described as the 'Social Contrick'. These changes were legitimised through a process of depoliticisation, and using an Open Marxist framework and evidence from the National Archives, the paper will show that the Treasury's exchange rate strategy and the need to secure external finance placed issues of confidence at the centre of political debate, allowing the Government to argue there was no alternative to the introduction of incomes policy and the reduction of public expenditure

Medical students working as health care assistants: an evaluation

Background The General Medical Council requires that medical students are taught human values and how to work effectively with colleagues. Health care assistants (HCAs) provide fundamental patient care as part of the wider health care team. Reports suggest that medical students gain valuable insights when working as HCAs. Methods In 2015, a pilot was developed for medical students to work as and with HCAs. The experience involved 3 days training in preparation for three supervised shifts. The pilot was expanded to involve more students and clinical partners. Results A total of 131 students completed the HCA project between 2015 and 2018. Students were asked to complete a questionnaire where they scored a set of statements using a 5‐point Likert scale, and gave open comments that were analysed thematically. A total of 119 students completed the questionnaire, of which 91% of students rated the experience as good or excellent and 98% of students agreed or completely agreed that they had met the learning outcomes. Themes centred around: feeling empathy; building confidence; appreciating the HCA team role; and how this experience may influence their future practice as doctors. A total of 87% of students said the experience should be mandatory. Conclusions Students find the opportunity to work as HCAs meaningful and enjoyable. This brief initiative may help students develop a number of skills and attributes that assist in shaping future doctors. Further to helping medical students understand what values‐based practice actually means and why it matters to patients, it also clarifies HCAs’ and other professionals’ contribution to the wider health care team. A research study is underway to evidence its impact

Oxygen therapy: time to move on?

This analysis examines the roots of clinical practice regarding oxygen therapy and finds that some aspects have changed very little over the past 200 years. Oxygen is commonly prescribed and administered as a therapy across all healthcare settings, particularly for the treatment and management of respiratory conditions, both acute and chronic. Yet despite its widespread use and recent advances in understanding and guidance, poor practice and controversies regarding its use persist. This historical analysis highlights origins in practice that may suggest where the roots of these fallacies lie, highlighting potential ambiguities and myths that have permeated clinical and social contexts. It can be considered that based on clinical presumptions and speculation the prolific and injudicious use of oxygen was encouraged and the legacy for today’s practice seeded. The conjectures proposed here may enable modern day erroneous beliefs to be confronted and clinical practice to move on

Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation

<p>Abstract</p> <p>Background</p> <p>Suboptimal bag ventilation in cardiopulmonary resuscitation (CPR) has demonstrated detrimental physiological outcomes for cardiac arrest patients. In light of recent guideline changes for resuscitation, there is a need to identify the efficacy of bag ventilation by prehospital care providers. The objective of this study was to evaluate bag ventilation in relation to operator ability to achieve guideline consistent ventilation rate, tidal volume and minute volume when using two different capacity self-inflating bags in an undergraduate paramedic cohort.</p> <p>Methods</p> <p>An experimental study using a mechanical lung model and a simulated adult cardiac arrest to assess the ventilation ability of third year Monash University undergraduate paramedic students. Participants were instructed to ventilate using 1600 ml and 1000 ml bags for a length of two minutes at the correct rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated. Ethics approval was granted.</p> <p>Results</p> <p>Suboptimal ventilation with the use of conventional 1600 ml bag was common, with 77% and 97% of participants unable to achieve guideline consistent ventilation rates and tidal volumes respectively. Reduced levels of suboptimal ventilation arouse from the use of the smaller bag with a 27% reduction in suboptimal tidal volumes (p = 0.015) and 23% reduction in suboptimal minute volumes (p = 0.045).</p> <p>Conclusion</p> <p>Smaller self-inflating bags reduce the incidence of suboptimal tidal volumes and minute volumes and produce greater guideline consistent results for cardiac arrest patients.</p