An Index of Nayrūz Occurrences in Abbasid Literary Sources.

This volume is the result of a two-years research project, focusing on an exhaustive indexing of all edited Arabic sources mentioning the Iranian festival of Nayrūz (Nawrūz) in the Abbasid age (750-1258 CE). The Index is meant as a first step towards filling a void in the study of the Abbasid age, providing a ground-breaking instrument for scholars interested in the study of chronology and socio-economical history of the classical Islamicate world. Further studies on this subjects are sorely needed, in light of the literary presence of this festival and its connection to fiscal matters, as a quick look to the present volume will make clear to the reader. Moreover, this is in agreement with all contemporary studies on the history of Iranian strands in Islamic pre-modern societies, which seldom fails to mention the need for a systematic study of literary evidence

Women’s Utilisation, Experiences and Satisfaction with Postnatal Follow-up Care: Systematic literature review

Postnatal follow-up care is reported to be the ‘underutilised’ aspect of the maternity care continuum. This review explores women’s utilisation of early and late postnatal follow-up and their experiences and satisfaction with it. Five online databases were searched for English or Arabic articles published between 2011 and 2021. Methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool; the Andersen healthcare utilisation model was the framework for data analysis. A total of 19 articles met all inclusion criteria. Utilisation facilitators included complications, travel distance, knowledge of the importance for attending and being offered a telephonecall and home visit or clinic visit as options for follow-up. Impediments included lack of perceived need and notbeing provided with information about postnatal care. Comprehensive discussions with and examination by health providers were reported as positive experiences and influenced repeat utilisation. Dissatisfaction was associated with inconsistent information provided by health providers.Keywords: Postpartum Period; Postnatal Care; Women; Literature Review

Women’s Views on Factors that Influence Utilisation of Postnatal Follow-Up in Oman: A descriptive, qualitative study

Objective: Postnatal follow-up care (PNFC) is important to promote maternal and newborn health and wellbeing. In Oman, women’s utilisation of postnatal follow-up services has declined with rates as low as 0.29 (mean visits) in some Governorates; well below the recommended postnatal follow up visits at two- and six-weeks for assessment of mother and newborn. The reasons for low utilisation are not well understood. The aim of this study is to explore women’s views and identify factors that influence their utilisation of postnatal follow-up services. Methods: Purposive sampling and semi-structured telephone interviews with 15 women aged 20 to 39 years at six to eight weeks post childbirth between May 2021 to August 2022. Data were analysed using Erlingsson and Brysiewicz content analysis approach. Results: Six categories were identified as influencing PNFC utilisation: 1) need for information; 2) experiences and expectations; 3) family support, expectations and customs; 4) sociocultural beliefs and practice; 5) impact of Covid-19 and 6) the healthcare environment. Influencing factors within each category include the need to: empower women, provide individualised care, address family and community expectations, offer alternatives to face-to-face clinic visits, provide organised, scheduled appointments. Conclusion: Women in Oman identified the need for consistent information from health care providers (HCPs), a more organised postnatal follow-up service including scheduled appointments and a woman-centred approach to PNFC. Keywords: Postnatal care; postpartum period; qualitative research

Quantifying physiological vital sign differences in newborns from 34+0/7 weeks of gestation and establishment of vital sign reference ranges for the late preterm population

Background: To ensure continued adaptation to extra-uterine life, all newborns have their physiological vital signs monitored intermittently post birth until discharge; these are tracked against pre-defined ‘normal’ reference ranges. Ascertaining an evidence base for ‘normal’ reference ranges is important for the early detection of deterioration in this population, who are at risk of not adapting to the extra-uterine environment due to being born prior to term.\ua0Aim: The studies in this thesis aim to determine\ua0physiological vital sign reference ranges for well newborns between 34+0/7\ua0and 36+6/7\ua0weeks of gestation.\ua0Objectives: The objectives of the studies in this thesis were to: systematically summarise the evidence in peer-reviewed literature on physiological vital sign reference ranges for well newborns greater than or equal to 34 weeks of gestation; to review\ua0contemporary\ua0neonatal and midwifery\ua0textbooks\ua0and publicly available grey literature\ua0(i.e. organisational websites, hospital policies and early warning tools) for vital sign reference ranges pertaining to well newborns of\ua0≥ 34+0/7\ua0weeks of gestation; to determine whether there are differences in vital signs in gestational age groups; and, if differences are identified, to establish physiological vital sign reference ranges for the well late preterm group and validate the reference ranges.\ua0Research Design: A systematic review of literature was initially undertaken followed by a scoping review of textbooks and grey literature to identify vital sign reference ranges for newborns\ua0≥ 34+0/7\ua0weeks of gestation.\ua0Quantitative research methods were used to meet the remaining study objectives. Study One was conducted as a single site prospective observational study of 30 newborns, comprised of three gestational age groups: late preterm (34+0/7\ua0– 36+6/7), early term (37+0/7\ua0– 38+6/7), and term (39+0/7\ua0– 40+6/7). This involved continuously recording heart rate, respiratory rate, and peripheral oxygen saturation for up to six hours\ua0and periodic monitoring of temperature and blood pressure to determine whether physiological vital signs differed between the groups. The results of Study One informed the design of Study Two. This involved a shorter recording time of up to two hours and periodic monitoring of temperature and blood pressure on 120 well, late preterm newborns in a single site prospective observational study. The reference ranges established in Study Two underwent validation in Study Three, in which a cross-sectional design was used to validate the data with data from the medical records of a group of late preterm newborns.\ua0Results: The searches of literature resulted in\ua0primary studies (n\ua0= 10), textbooks (n\ua0= 7) and grey literature (n\ua0= 11). Inconsistencies in and a dearth of vital sign ranges for gestational age groups other than term were identified. Details of how reference ranges were calculated were only provided in the peer reviewed literature.\ua0Study One generated a combined total of 284,542 heart rate values, 275,826 respiratory rate values, 287,572 peripheral\ua0oxygen saturation\ua0values, and 60 temperature and 60 blood pressure data points for analysis. Heart rate was found to be significantly different, with late preterm heart rates on average 13.4 beats per minute (bpm) (95 % CI 6.5 – 20.4) higher than term newborns. Respiratory rate was on average -2.0 respirations per minute (rpm) (95 % CI -6.8 – 2.7) lower for late preterm newborns compared with term newborns. Peripheral\ua0oxygen saturation\ua0was on average -1.17 log units (95 % CI -2.32 – -0.01) lower for late preterm newborns compared with term newborns. There were statistically non-significant differences between gestational age groups for temperature (p\ua0= 0.38) and blood pressure (systolic\ua0p\ua0= 0.93, diastolic\ua0p\ua0= 0.54, mean arterial pressure\ua0p\ua0= 0.64).Study Two generated a total of\ua0364,596\ua0heart rate,\ua0365,208\ua0respiratory rate,\ua0360,494\ua0peripheral oxygen saturation, 240 temperature and 240 blood pressure data points for analysis to establish reference ranges for each physiological vital sign. Established reference ranges were: heart rate (bpm) 102-164; respiratory rate (rpm) 15 – 67; peripheral oxygen saturation (%) 85 – 100; temperature (°C) 36.4 – 37.6; systolic blood pressure (mmHg) 51 – 86; diastolic blood pressure (mmHg) 28 – 61; and mean arterial pressure (mmHg) 35 – 68.Study Three demonstrated the validation of some of the reference ranges using data from 20 measurands. It was not possible to validate blood pressure, as this vital sign is not routinely measured on well newborns in either the postnatal ward or special care nursery. Heart rate was not validated with either the initial measurands or the subsequent 20 measurands. Examination of\ua0the analytical procedures and biological characteristics of the measurands revealed a common factor of the occurrence of a maternal complication during pregnancy. When excluding these complications, the heart rate reference range was validated.Conclusions: Well late preterm newborns have a number of physiological vital sign differences compared to term newborns. Vital sign reference ranges were established for late preterm newborns with respiratory rate, temperature and peripheral oxygen saturation reference ranges validated. Heart rate was validated when excluding newborns born to mothers with pregnancy related complications. Blood pressure could not be validated as it is not routinely conducted on the postnatal ward

Neonatal early warning tools: A literature review

Background: All newborns are potentially at risk of deterioration as a result of failing to make the transition to extrauterine life. Clinicians in busy maternity and neonatal settings may not identify subtle early signs of deterioration. It has been postulated that the use of early warning tools (EWTs) would better assist clinicians in identifying deterioration in the 'at-risk' newborn. Aim: The aim of this review was to examine the literature to identify the use and efficacy of EWTs in earlier identification of deterioration in neonates. Methods: Electronic searches of CINAHL, MEDLINE, Academic Health Research, The Cochrane Library and Google Scholar databases were conducted. Results: The included study compared a newly developed EWT with the standard observation tool in identifying early deterioration of neonates. Of the 19 infants who received an intervention, only nine were identified as a result of the use of the EWT. Conclusion: There is not a standardised, validated EWT for use in preterm and/or term newborns in maternity settings. There is a paucity of research on the validity and effectiveness of the use of EWTs in this population. Further robust studies are needed to determine the efficacy of EWTs for use in the neonatal population cared for in maternity settings

Neonatal Early Warning Tools for recognising and responding to deterioration in neonates cared for in the maternity setting: a retrospective case-control study

Background: All newborns are at risk of deterioration as a result of failing to make the transition to extra uterine life. Signs of deterioration can be subtle and easily missed. It has been postulated that the use of an Early Warning Tool may assist clinicians in recognising and responding to signs of deterioration earlier in neonates, thereby preventing a serious adverse event

Physiological vital sign ranges in newborns from 34 weeks gestation: a systematic review

The birth process and the moments thereafter are a crucial time for newborns as they adapt to extra uterine life. The adaptive process begins immediately and can take a number of days to complete. The process involves initiating and maintaining respirations, thermoregulation, and the change from foetal circulation to newborn circulation. The majority of newborns successfully adapt to extra uterine life, some experience difficulty. Early warning tools may assist clinicians identify early signs of failure to adapt and/or deterioration but these are dependent on 'Normal' vital sign reference ranges for triggering an escalation of care. Age-matched early warning tools may improve the sensitivity of tools.To identify physiological vital sign reference ranges for newborns ≥34 weeks gestation from two hours of age.Systematic Review.Between August 2016 and January 2017, PubMed, CINAHL, Embase, The Cochrane Library databases, and conference abstracts were searched for primary studies published between 1946 and 2017. Reference lists of retrieved articles were reviewed for potential studies.Primary studies published in English that reported physiological vital sign reference ranges pertaining to well newborns born from 34 weeks gestation were selected. Two authors independently assessed eligibility of studies for inclusion. Titles and abstracts were matched with the inclusion criteria: studies investigating heart or respiratory rate, temperature, blood pressure and oxygen saturations in well newborns greater than 34 weeks gestational age. Assessment of quality and grading of level of evidence were assessed using National Health and Medical Research Council level of Evidence Hierarchy Table and the Quality Assessment Tool for Quantitative Studies. Any disagreements were resolved by consensus. Data were extracted by two reviewers.A total of 1497 primary studies were retrieved. Following screening and removal of duplicates and screening, 10 primary studies investigating heart rate (n=1), respiratory rate (n=1), temperature (n=1), blood pressure (n=4) and oxygen saturations (n=3) were eligible for inclusion in this review. The populations studied included term (n=6) or both preterm and term newborns (n=4). No reference ranges for any vital sign measurements could be identified from the included literature. In addition, inconsistencies between vital sign parameters of newborns were identified between the studies.There is paucity of normal vital sign data in the late preterm >34 weeks and post term gestational age cohorts despite literature suggesting differences in physiological maturity between these cohorts

Physiological vital sign differences between well newborns greater than 34 weeks gestation: a pilot study

Background: Newborns have their vital signs measured as part of routine care. However, there is inconsistency in accepted physiological ranges for well newborns beyond the post-delivery stabilisation period which has implications for the identification of illness. Objective: To explore differences in physiological vital signs between three gestational age groups: late preterm (34 - 36), early term (37–38) and term (≥39) weeks gestation. Design: A single site prospective observational study. Setting: A postnatal ward and special care baby unit in a major tertiary hospital in Australia. Participants: Newborns from 34 weeks gestation admitted to either the postnatal ward or special care baby unit. Methods: Heart rate, respiratory rate and oxygen saturation were continuously monitored for up to 6 h. Newborn temperature and blood pressure were measured twice during the monitoring period. Results: Continuous monitoring resulted in 284,542 heart rate, 275,826 respiratory rate, 287,572 SpO values, and 60 temperature and 60 blood pressure data points. Heart rate was significantly different between gestational age groups with late preterm heart rates 13.4 bpm (95% CI 6.5–20.4) higher than term newborns. Early term heart rates were 2.3 bpm (95% CI -4.6 – 9.3) higher than term newborns, although not statistically significantly different. Heart rate was significantly different based on sex with females on average 7.7 beats per minute (bpm) (95% CI 1.9–13.5) higher than males. Respiratory rate was not significantly different between gestational age groups however, on average, was −2.0 respiration rate per minute (rpm) (95% CI -6.8 – 2.7) lower for late preterm babies and −1.3 rpm (95% CI -6.0 – 3.4) lower for early term babies compared to term newborns. SpO was not significantly different between gestational age groups, however, on average was −1.17 log units (95% CI -2.32 to −0.01) lower for late preterm newborns and −1.00 log units (95% CI -2.16 – 0.15) lower for early term newborns compared to term newborns. Respiratory rate and SpO were neither clinically nor statistically significantly different by sex. There were no significant differences between gestational age groups for temperature (p = 0.38) or blood pressure (systolic p = 0.93, diastolic p = 0.54). No significant mean differences were observed based on sex for temperature (p = 0.57) or blood pressure (systolic p = 0.98, diastolic p = 0.40). Conclusions: This study demonstrated a clinically significant higher heart rate in those born late preterm. This may have implications for current “one-size fits all” newborn early warning tools, as well as care of well late preterm infants in maternity units