44 research outputs found
The Recognition of Excessive blood loss At ChildbirTh (REACT) Study: a two-phase exploratory, sequential mixed methods inquiry using focus groups, interviews and a pilot, randomised crossover study
Objectives: To explore how childbirth-related blood loss is evaluated and excessive bleeding recognised; and develop and test a theory of postpartum haemorrhage (PPH) diagnosis.
Design: Two-phase, exploratory, sequential mixed methods design using focus groups, interviews and a pilot, randomised crossover study.
Setting: Two hospitals in North West England.
Sample: Women (following vaginal birth with and without PPH), birth partners, midwives and obstetricians.
Methods: Phase one (qualitative): 8 focus groups and 20 one-to-one, semi-structured interviews were conducted with 15 women, 5 birth partners, 11 obstetricians, 1 obstetric anaesthetist and 19 midwives (n=51). Phase two (quantitative): 11 obstetricians and 10 midwives (n=21) completed two simulations of fast and slow blood loss using a high-fidelity childbirth simulator.
Results: Responses to blood loss were described as automatic, intuitive reactions to the speed, nature and visibility of blood flow. Health professionals reported that quantifying volume was most useful after a PPH diagnosis, to validate intuitive decisions and guide on-going management. During simulations, PPH treatment was initiated at volumes at or below 200ml (fast mean blood loss 79.6ml, SD 41.1; slow mean blood loss 62.6ml, SD 27.7). All participants treated fast, visible blood loss, but only half treated slow blood loss, despite there being no difference in volumes (difference 18.2ml, 95% CI -5.6 to 42.2ml, p=0.124).
Conclusions: Experience and intuition, rather than blood loss volume, inform recognition of excessive blood loss after birth. Women and birth partners want more information and open communication about blood loss. Further research exploring clinical decision-making and how to support it is required
A Design Procedure for Aperture Coupled Microstrip Antennas Based on Approximate Equivalent Networks
A Design Procedure for Aperture-Coupled Microstrip Antennas Based on Approximate Equivalent Networks
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Fatigue, Depression and Cognitive Dysfunction in Head and Neck Cancer Patients Undergoing Chemoradiation
Although ''depressive'' symptoms decrease by 4 weeks after cessation of radiation treatment (RT), reports indicate that in over 30% of head and neck (HN) cancer patients, fatigue and appetite loss persist for up to 52 weeks, especially in those with advanced stage tumors and radiation or multimodality treatment. This pilot, prospective surveillance study examines the incidence, magnitude and course of fatigue, depression, and neurocognitive dysfunction in patients receiving RT or RT concurrent with systemic agents for squamous cell carcinoma (SCC) of the head and neck (HN). Fifty men and women with SCC of the HN will undergo definitive radiation therapy (60-70 Gy in six to seven weeks) alone (n = 10), or concurrent chemoradiation with cisplatin (n = 20), or concurrent radiation therapy with cetuximab (n = 20). After obtaining informed consent, subjects will be evaluated utilizing self-report questionnaires to assess fatigue (Multidimensional Fatigue Inventory) and depressive symptoms (Inventory of Depressive Symptomatology), as well as a brief, clinician-administered battery of neurocognitive tests (Brief Visuospatial Memory Test, Trails Making Test A and B, and Controlled Oral Word Association) at baseline, midway through treatment (week #3), at the end of treatment (week #6), and finally at 12 weeks after completing treatment. Radiation and medical oncologists will score toxicity and record compliance and tumor response. To evaluate the effects of time (radiation therapy) and systemic agents, two-way analysis of variance for repeated measures will be used. Relevant patient and disease-related variables (including age, cancer stage and site, history of surgery, radiation dose, etc.) will be entered into these analyses as covariates. Data collection and analysis is ongoing. Our findings will expand the limited information regarding the neurobehavioral effects of RT in combination with systemic chemotherapy or biological therapy in patients with SCC of the HN