Optimising Down Syndrome screening : a study to access the possibilities of improving current screening methods

Screening for Down's syndrome has been in practice since it became possible to diagnose this chromosomal defect prenatally. Optimising a screening process involves increasing the sensitivity and specificity so that as many as possible of the affected individuals are identified (in this case, pregnant women carrying fetuses affected by Down's syndrome) with as few as possible 'normal' pregnancies being labelled as 'increasing risk'. Screening always requirs further tests to verify its results. Should a screening process identify all the affected individuals and none of the unaffected (ie 100% sensitivity and 100% specificity), then it would be considered a diagnostic test. By definition, screening will never achiever the same detection efficiency as a diagnostic test, and as such, a comparison between the two modalities is inappropriate. Over the last 12 years, there has been a constant drive to optimise Down's syndrome screening. In this thesis, several ways of improving Down's syndrome screening have been investigated. ... Zie: Summary

Contemporary Clinical Management of the Cerebral Complications of Preeclampsia

The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality arising from these conditions, for women and their infants alike. This paper outlines the evidence base for contemporary management principles pertaining to the neurological sequelae of preeclampsia, primarily from the maternal perspective, but with consideration of fetal and neonatal aspects as well. It concludes with a discussion regarding future directions in the management of this potentially lethal condition

Contemporary Clinical Management of the Cerebral Complications of Preeclampsia

The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality arising from these conditions, for women and their infants alike. This paper outlines the evidence base for contemporary management principles pertaining to the neurological sequelae of preeclampsia, primarily from the maternal perspective, but with consideration of fetal and neonatal aspects as well. It concludes with a discussion regarding future directions in the management of this potentially lethal condition

Patients' perceptions of safety and quality of maternity clinical handover

<p>Abstract</p> <p>Background</p> <p>Maternity clinical handover serves to address the gaps in knowledge existing when transitions between individuals or groups of clinicians occur throughout the antenatal, intra-partum and postnatal period. There are limited published studies on maternity handover and a paucity of information about patients' perceptions of the same. This paper reports postnatal patients' perceptions of how maternity handover contributes to the quality and safety of maternity care.</p> <p>Methods</p> <p>This paper reports on a mixed-methods study consisting of qualitative interviews and quantitative medical record analysis. Thirty English-speaking postnatal patients who gave birth at an Australian tertiary maternity hospital participated in a semi-structured interview prior to discharge from hospital. Interview data were coded thematically using the constant comparative method and managed via NVivo software; this data set was supplemented by medical record data analysed using STATA.</p> <p>Results</p> <p>Almost half of the women were aware of a handover process. Clinician awareness of patient information was seen as evidence that handover had taken place and was seen as representing positive aspects of teamwork, care and communication by participants, all important factors in the perception of quality health care. Collaborative cross-checking, including the use of cognitive artefacts such as hand held antenatal records and patient-authored birth plans, and the involvement of patients and their support people in handover were behaviours described by participants to be protective mechanisms that enhanced quality and safety of care. These human factors also facilitated team situational awareness (TSA), shared decision making and patient motivation in labour.</p> <p>Conclusions</p> <p>This study illustrates that many patients are aware of handover processes. For some patients, evidence of handover, through clinician awareness of information, represented positive aspects of teamwork, care and communication.</p> <p>Cross-checking and cognitive artefacts were observed to support handover. Patient-authored birth plans were described by some to enhance the quality and safety of the handover by providing a 'voice' to the patient in this process. This was a novel and potentially important perspective.</p> <p>Future research involving patients and their support people in supporting and evaluating handover should be considered.</p