Developing a clinical care pathway for obese pregnant women: a quality improvement project

Problem: Obesity in pregnancy is associated with an increased incidence of maternal and foetal morbidity and mortality, from conditions like preeclampsia, gestational diabetes, preterm birth and stillbirth. Between 20% and 25% of pregnant women in Australia are presenting to their first antenatal appointment with a body mass index (BMI) ≥30kg/m², defined as obesity in pregnancy. These figures are concerning for midwifery and obstetric staff directly involved in the clinical care of these women and their families. In the absence of national or state clinical practice guidelines for managing the risks for obese pregnant women, a local quality improvement project was conducted. Aim: To plan, implement, and evaluate the impact of an alternative clinical care pathway for pregnant women with a BMI≥35kg/m² at their first antenatal visit. Project setting: The project was undertaken in the antenatal clinic of a rural referral hospital in NSW, Australia. Subjects: Eighty-two women with a BMI=35kg/m2 were eligible for the alternative care pathway, offered between January and December 2010. Intervention: The alternative care pathway included the following options, in addition to usual care: written information on obesity in pregnancy, referral to a dietitian, early plus repeat screening for gestational diabetes, liver and renal function pathology tests, serial self-weighing, serial foetal growth ultrasounds, and a pre-labour anaesthetic consultation. Findings: Despite being educated on the risk associated with obesity in pregnancy, women did not take up the offers of dietetic support or self-weighing at each antenatal visit. Ultrasounds were well received and most women underwent gestational diabetes screening

Enhancing Nursing Simulation Education: A Case for Extended Reality Innovation

This concept paper explores the use of extended reality (XR) technology in nursing education, with a focus on three case studies developed at one regional university in Australia. Tertiary education institutions that deliver nursing curricula are facing challenges around the provision of simulated learning experiences that prepare students for the demands of real-world professional practice. To overcome these barriers, XR technology, which includes augmented, mixed, and virtual reality (AR, MR, VR), offers a diverse media platform for the creation of immersive, hands-on learning experiences, situated within virtual environments that can reflect some of the dynamic aspects of real-world healthcare environments. This document analysis explores the use of XR technology in nursing education, through the narrative and discussion of three applied-use cases. The collaboration and co-design between nursing educators and XR technology experts allows for the creation of synchronous and asynchronous learning experiences beyond traditional nursing simulation media, better preparing students for the demands of real-world professional practice

Effects of Nutritional Interventions during Pregnancy on Infant and Child Cognitive Outcomes:A Systematic Review and Meta-Analysis

Background: Epidemiological studies have demonstrated that folate, iodine and iron intake during pregnancy impacts on foetal brain development and cognitive function. However, in human studies, the relationship with other dietary nutrients is less clear. Objective: This systematic review aims to critically appraise the current literature and meta-analyses results from nutritional interventions during pregnancy that aimed to optimise infant and child cognitive outcomes. Design: Ten electronic databases were searched for articles published up to August 2017. The search was limited to articles published in English. Randomised controlled trials (RCTs) testing the impact of any nutritional intervention (dietary counselling, education, nutrient supplementation, fortified foods and/or foods) during pregnancy on cognitive outcomes of children (<10 years old). Two independent reviewers assessed study eligibility and quality using the American Dietetic Association quality criteria checklist for primary research. Standardised mean differences were used for nine cognitive domains to measure effects for meta-analyses. Results: A total of 34 RCTs were included (21 studies included children aged less than 35 months, 10 studies included children aged 36–60 months and 3 studies included children aged 61–119 months). The types of nutritional interventions included nutrient supplements, whole foods, fortified foods and nutrition education. The following nine cognition outcomes: attention, behaviour, crystallised intelligence, fluid intelligence, global cognition, memory, motor skills, visual processing, and problem solving were not significantly impacted by nutritional interventions, although 65% of studies conducted post-hoc data analyses and were likely to be underpowered. Although, long chain polyunsaturated fatty acids (LCPUFA) supplementation was associated with a marginal increase in crystallised intelligence (Effect size (ES): 0.25; 95% confidence interval (95% CI): −0.04, 0.53), the effect was not statistically significant (p = 0.09), with significant study heterogeneity (p = 0.00). Conclusions: LCPUFA supplementation may be associated with an improvement in child crystallised intelligence, however further research is warranted. The remaining eight cognition domains were not significantly impacted by maternal nutritional interventions

Nutrition in pregnancy: the balancing act

Pregnant women are exposed to a large number of confusing messages on weight gain, nutrient supplements and food avoidance. This article presents a summary of the evidence so that the risks and benefits of nutrition information can be weighed up. In most cases the evidence is not as clear as guidelines and recommendations present. Differences of scientific opinion usually reflect legitimate debate over data quantity, quality and interpretation, and advances in knowledge lead to changes in practice over time. Evidence-based guidelines typically have long periods between release and review. To date there are known risks and benefits associated with gaining too much or not enough weight during pregnancy, taking nutrient supplements, consuming foods at-risk of contamination with listeria including fish and seafood, which is also a source of mercury. The benefits from no versus very low alcohol during pregnancy are debatable but while there is uncertainty not drinking is the safest option

Translation of the Weight-Related Behaviours Questionnaire into a Short-Form Psychosocial Assessment Tool for the Detection of Women at Risk of Excessive Gestational Weight Gain

The identification and measurement of psychosocial factors that are specific to pregnancy and relevant to gestational weight gain is a challenging task. Given the general lack of availability of pregnancy-specific psychosocial assessment instruments, the aim of this study was to develop a short-form psychosocial assessment tool for the detection of women at risk of excessive gestational weight gain with research and clinical practice applications. A staged scale reduction analysis of the weight-related behaviours questionnaire was conducted amongst a sample of 159 Australian pregnant women participating in the Women and Their Children’s Health (WATCH) pregnancy cohort study. Exploratory factor analysis, univariate logistic regression, and item response theory techniques were used to derive the minimum and most predictive questions for inclusion in the short-form assessment tool. Of the total 49 questionnaire items, 11 items, all 4 body image items, n = 4 attitudes towards weight gain, and n = 3 self-efficacy items, were retained as the strongest predictors of excessive gestational weight gain. These within-scale items were highly correlated, exhibiting high item information function value statistics, and were observed to have high probability (p < 0.05) for excessive gestational weight gain, in the univariate analysis. The short-form questionnaire may assist with the development of tailored health promotion interventions to support women psychologically and physiologically to optimise their pregnancy weight gain. Confirmatory factor analysis is now required

The Civil War as Constitutional Interpretation (reviewing \u3ci\u3eLincoln\u27s Constitution\u3c/i\u3e by Daniel Farber)

Spreadsheet of values used for data analysis. (XLSX 13 kb