Advancing Practice: Facilitating group antenatal care: a new way of working

This article outlines the principles and evidence behind group antenatal care and explores how developing group facilitation skills can enhance midwifery practice. The authors discuss the impact of different training models developed by the REACH Pregnancy Programme to support the implementation of ‘Pregnancy Circles’ as part of a randomised controlled trial of group antenatal care within an NHS context

Limits of 'patient-centredness'; valuing contextually specific communication patterns

Context Globally, doctor–patient communication is becoming synonymous with high-quality health care in the 21st century. However, what is meant by ‘good communication’ and whether there is consensus internationally remain unclear. Objectives Here, we characterise understandings of ‘good communication’ in future doctors from medical schools in three contextually contrasting continents. Given locally specific socio-cultural influences, we hypothesised that there would be a lack of global consensus on what constitutes ‘good communication’. Methods A standardised two-phase methodology was applied in turn to each of three medical schools in the UK, Egypt and India (n = 107 subjects), respectively, in which students were asked: ‘What is good communication?’ Phase I involved exploratory focus groups to define preliminary themes (mean number of participants per site: 17). Phase II involved thematic confirmation and expansion in one-to-one semi-structured interviews (mean number of participants per site: 18; mean hours of dialogue captured per site: 55). Findings were triangulated and analysed using grounded theory. Results The overarching theme that emerged from medical students was that ‘good communication’ requires adherence to certain ‘rules of communication’. A shared rule that doctors must communicate effectively despite perceived disempowerment emerged across all sites. However, contradictory culturally specific rules about communication were identified in relation to three major domains: family; gender, and emotional expression. Egyptian students perceived emotional aspects of Western doctors’ communication strikingly negatively, viewing these doctors as problematically cold and unresponsive. Conclusions Contradictory perceptions of ‘good communication’ in future doctors are found cross-continentally and may contribute to prevalent cultural misunderstandings in medicine. The lack of global consensus on what defines good communication challenges prescriptively taught Western ‘patient-centredness’ and questions assumptions about international transferability. Health care professionals must be educated openly about flexible, context-specific communication patterns so that they can avoid cultural incompetence and tailor behaviours in ways that optimise therapeutic outcomes wherever they work around the globe

Including the Newborn Physical Examination (NIPE) in the pre-registration midwifery curriculum: National Survey

This document is the Accepted Manuscript version of a Published Work that appeared in final form in British Journal of Midwifery, copyright © MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work see https://doi.org/10.12968/bjom.2017.25.1.26An online questionnaire was sent to all Lead Midwives for Education to assess the scope of NIPE education in programmes of pre-registration midwifery education. Findings are reported in two parts: part A (the current paper) examines the education provision for the inclusion of NIPE in the midwifery curriculum. Part B (a subsequent paper) explores NIPE education as a post-registration module. 68.9% of AEIs completed the questionnaire. 25% stated that NIPE training is included in in their pre-registration midwifery programmes. 37.5% reported plans to implement this within the next 2-5 years and 30% had no plans to do so. Benefits for practice partners, commissioners, students and service-users were identified. Challenges were noted, particularly in relation to resources and student support in practice. Although barriers doubtless exist, the success of the few institutions which have incorporated NIPE into their curricula is evidence that this is not only possible, but has proven benefits.Peer reviewedFinal Accepted Versio

Postpartum maternal morbidity requiring hospital admission in Lusaka, Zambia – a descriptive study

BACKGROUND: Information on the extent of postpartum maternal morbidity in developing countries is extremely limited. In many settings, data from hospital-based studies is hard to interpret because of the small proportion of women that have access to medical care. However, in those areas with good uptake of health care, the measurement of the type and incidence of complications severe enough to require hospitalisation may provide useful baseline information on the acute and severe morbidity that women experience in the early weeks following childbirth. An analysis of health services data from Lusaka, Zambia, is presented. METHODS: Six-month retrospective review of hospital registers and 4-week cross-sectional study with prospective identification of postpartum admissions. RESULTS: Both parts of the study identified puerperal sepsis and malaria as, respectively, the leading direct and indirect causes of postpartum morbidity requiring hospital admission. Puerperal sepsis accounted for 34.8% of 365 postpartum admissions in the 6-month period. Malaria and pneumonia together accounted for one-fifth of all postpartum admissions (14.5% & 6% respectively). At least 1.7% of the postpartum population in Lusaka will require hospital-level care for a maternal morbidity. CONCLUSIONS: In developing country urban settings with high public health care usage, meticulous review of hospital registers can provide baseline information on the burden of moderate-to-severe postpartum morbidity

Treatment of polymyalgia rheumatica: British Society for Rheumatology guideline scope

The last British Society for Rheumatology (BSR) guideline on PMR was published in 2009. The guideline needs to be updated to provide a summary of the current evidence for pharmacological and non-pharmacological management of adults with PMR. This guideline is aimed at healthcare professionals in the UK who directly care for people with PMR, including general practitioners, rheumatologists, nurses, physiotherapists, occupational therapists, pharmacists, psychologists and other health professionals. It will also be relevant to people living with PMR and organisations that support them in the public and third sector, including charities and informal patient support groups. This guideline will be developed using the methods and processes outlined in the BSR Guidelines Protocol. Here we provide a brief summary of the scope of the guideline update in development

Still too far to walk: Literature review of the determinants of delivery service use

BACKGROUND: Skilled attendance at childbirth is crucial for decreasing maternal and neonatal mortality, yet many women in low- and middle-income countries deliver outside of health facilities, without skilled help. The main conceptual framework in this field implicitly looks at home births with complications. We expand this to include "preventive" facility delivery for uncomplicated childbirth, and review the kinds of determinants studied in the literature, their hypothesized mechanisms of action and the typical findings, as well as methodological difficulties encountered. METHODS: We searched PubMed and Ovid databases for reviews and ascertained relevant articles from these and other sources. Twenty determinants identified were grouped under four themes: (1) sociocultural factors, (2) perceived benefit/need of skilled attendance, (3) economic accessibility and (4) physical accessibility. RESULTS: There is ample evidence that higher maternal age, education and household wealth and lower parity increase use, as does urban residence. Facility use in the previous delivery and antenatal care use are also highly predictive of health facility use for the index delivery, though this may be due to confounding by service availability and other factors. Obstetric complications also increase use but are rarely studied. Quality of care is judged to be essential in qualitative studies but is not easily measured in surveys, or without linking facility records with women. Distance to health facilities decreases use, but is also difficult to determine. Challenges in comparing results between studies include differences in methods, context-specificity and the substantial overlap between complex variables. CONCLUSION: Studies of the determinants of skilled attendance concentrate on sociocultural and economic accessibility variables and neglect variables of perceived benefit/need and physical accessibility. To draw valid conclusions, it is important to consider as many influential factors as possible in any analysis of delivery service use. The increasing availability of georeferenced data provides the opportunity to link health facility data with large-scale household data, enabling researchers to explore the influences of distance and service quality

Identifying the deficiencies of current diagnostic criteria for neurofibromatosis 2 using databases of 2777 individuals with molecular testing

Purpose We have evaluated deficiencies in existing diagnostic criteria for neurofibromatosis 2 (NF2). Methods Two large databases of individuals fulfilling NF2 criteria (n = 1361) and those tested for NF2 variants with criteria short of diagnosis (n = 1416) were interrogated. We assessed the proportions meeting each diagnostic criterion with constitutional or mosaic NF2 variants and the positive predictive value (PPV) with regard to definite diagnosis. Results There was no evidence for usefulness of old criteria “glioma“ or “neurofibroma.” “Ependymoma” had 100% PPV and high levels of confirmed NF2 diagnosis (67.7%). Those with bilateral vestibular schwannoma (VS) alone aged ≥60 years had the lowest confirmation rate (6.6%) and reduced PPV (80%). Siblings as a first-degree relative, without an affected parent, had 0% PPV. All three individuals with unilateral VS and an affected sibling were proven not to have NF2. The biggest overlap was with LZTR1-associated schwannomatosis. In this category, seven individuals with unilateral VS plus ≥2 nondermal schwannomas reduced PPV to 67%. Conclusions The present study confirms important deficiencies in NF2 diagnostic criteria. The term “glioma” should be dropped and replaced by “ependymoma.” Similarly “neurofibroma” should be removed. Dropping “sibling” from first-degree relatives should be considered and testing of LZTR1 should be recommended for unilateral VS

Zambian women's experiences of urban maternity care: results from a community survey in Lusaka

Urban African maternity care systems face problems, as rapid population growth puts them under increasing pressure. In 1983 a decentralised system with midwife-run maternity units at health centres was initiated in Lusaka. A community-based survey of 1210 women conducted in 1999 examined access, coverage and quality of care in these maternity services. Results were generally positive: 99% of respondents received some antenatal check-ups and three quarters had five or more. Institutional delivery rate was 89.5%. Home birth was associated with belonging to a “very poor” household. Sixty three per cent of births were in the decentralised units. Eighty nine per cent reported care as “good” or “very good”, but 21% remembered someone who had treated them badly during labour, principally by shouting or scolding. One fifth of women reported having been left alone for “too long” in labour. Less than half of the women said they would like a lay labour companion and three quarters would prefer a companion at the delivery. (Afr J Reprod Health 2003; 7[1]: 92–102) Résumé Les expériences des femmes zambiennes à l\'égard des soins de maternité urbains: résultats d\'une enquête dans une communauté à Lusaka. Les systèmes de soins de maternité urbains ont beaucoup de problèmes car une croissance démographique rapide fait de plus en plus pression sur eux. En 1983, on a introduit à Lusaka un système décentralisé avec des centres de maternité dirigés par les sages-femmes dans des centres médicaux. Une enquête de 1210 femmes basée sur la communauté et menée en 1999 a examiné l\'accès, la couverture et la qualité de soin de ces services de maternité. En général, les résultats ont été positifs: 99% des interrogés ont subi quelques examens médicaux prénatals alors que 75% en ont subi cinq on plus. Le taux d\'accouchement était 89,5%. L\'accouchement à domicile était lié à l\'appartenance à une famille “très pauvre”. Soixante-trois pourcent des naissances ont eu lieu dans les centres décentralisées. 89% ont déclaré que les soins étaient “bien” ou “très bien”, mais 21% se souvenaient que quelqu\'un les avait mal-traitées pendant le travail, surtout en criant ou en engeulant. Un cinquième des femmes ont déclaré qu\'elles ont été délaissées pour “trop longtemps” pendant le travail. Moins de la moitié des femmes ont dit qu\'elles préféreraient un compagnon à l\'accouchement. (Rev Afr Santé Reprod 2003; 7[1]: 92–102) Key Words: Zambia, maternity services, labour companions, home birt