Perceptions of the Midwife’s Role: A Technoscience Perspective.

Different patterns of care and a range of lead professionals have influenced care provision in relation to childbirth. The role of a midwife has been influenced by historical factors, research and service changes within the National Health Service. Little is known about how the role of the midwife is perceived. This study explored the views of women and midwives relating to the role of the midwife. Mixed methods of data collection were utilised. In the first phase of the study 4 focus groups (a total of 9 women) were performed. In the second phase of the study longitudinal interviews were conducted. A total of 10 women participated in this phase. The interviews were performed at 4 different time points of their childbearing experience. A total of 40 interviews were conducted. Additionally diaries from the 10 women were completed, to capture information between the interview time points. Following the initial exploratory phase , a postmodern feminist technoscience theoretical stance underpins the second phase of this study; in particular it draws on the work of Donna Haraway. Haraway’s notion of ‘situated knowledges’ provides the opportunity to locate the views of women and midwives. This provided the opportunity to utilise her notions of ‘modest witness’, ‘cyborg’, ‘goddess’, ‘material-semiotic’ and connect to their perceptions. One facet of the study’s originality lies in matching the women’s and midwives’ ‘situated knowledges’, by interviewing the 10 midwives who were present at each of the 10 women’s birth experiences. Analysis using thematic networks was used to construct basic, organising and global themes. The findings indicate that the use of technology has a powerful influence on women’s perceptions in relation to the role of the midwife. Women and midwives connected with technology through material-semiotic connections, which has led to cyborgification within a consultant led model of care and birth environment. Women overwhelmingly perceived that birth was safer in hospital, due to the presence of technology and doctors; doctors were perceived as the decision maker and the midwife as a ‘handmaiden’. ‘Being’ and ‘doing’ midwives were recognised. The midwives were all situated in a different place within these categories, depending on their values and experiences. Generally the ‘doing’ midwives were free to ‘do’, as they supported the biomedical culture of the environment they were working in. ‘Being’ midwives supported the natural elements of the birth process, they adapted to the role of a ‘hybrid’ midwife within a consultant led environment, interchanging their technological skills for normality skills when they were secluded from interferences of the medicalised culture. This study provides evidence to inform practice developments within midwifery and makes a contribution to feminist theorising. It asserts that the culture of childbirth in contemporary society is technological, medically led and the normal birth process is not valued. This has contributed to cyborgification of women and midwives within a consultant led setting. An advancement of Haraway’s theory has been made from the emergence of the way in which the ‘being’ midwife morphs into a ‘doing’ midwife when she feels that she has to conform to the medicalised culture of the environment or from women’s expectations of their birth experience

Developing a protocol to address co-occurring mental health conditions in the treatment of eating disorders

OBJECTIVE: While co-occurring mental health conditions are the norm in eating disorders, no testable protocol addresses management of these in psychotherapy. METHOD: The literature on managing mental health conditions that co-occur with eating disorders is outlined and reviewed. RESULTS: In the absence of clear evidence to inform managing co-occurring mental health conditions, we advocate for use of an iterative, session-by-session measurement to guide practice and research. We identify three data-driven treatment approaches (focus solely on the eating disorder; multiple sequential interventions either before or after the eating disorder is addressed; integrated interventions), and the indications for their use. Where a co-occurring mental health condition/s impede effective treatment of the eating disorder, and an integrated intervention is required, we outline a four-step protocol for three broad intervention approaches (alternate, modular, transdiagnostic). A research program is suggested to test the usefulness of the protocol. DISCUSSION: Guidelines that provide a starting point to improving outcomes for people with eating disorders that can be evaluated/researched are offered in the current paper. These guidelines require further elaboration with reference to: (1) whether any difference in approach is required where the co-occurring mental health condition is a comorbid symptom or condition; (2) the place of biological treatments within these guidelines; (3) precise guidelines for selecting among the three broad intervention approaches when adapting care for co-occurring conditions; (4) optimal approaches to involving consumer input into identifying the most relevant co-occurring conditions; (5) detailed specification on how to determine which adjuncts to add. PUBLIC SIGNIFICANCE: Most people with an eating disorder also have another diagnosis or an underlying trait (e.g., perfectionism). Currently no clear guidelines exist to guide treatment in this situation, which often results in a drift away from evidence-based techniques. This paper outlines data-driven strategies for treating eating disorders and the accompanying comorbid conditions and a research program that can test the usefulness of the different approaches suggested

“Type” as central to perceptions of breed differences in behavior of domestic dog

A survey was designed to explore the effect of type classification on perception and expectation of a dog’s behavior. The survey focused on two forms of presentation: the effect of visual image versus breed name in the identification of a breed as a dangerous dog type, and the effect of breed group classification on expectation of a dog’s level of aggressiveness. The findings have serious implications for Staffordshire Bull Terriers. Respondents were over 5 times more likely to misascribe by image alone the Staffordshire Bull Terrier as a dangerous breed as defined under the United Kingdom’s Dangerous Dogs Act 1991. Furthermore, the classification of Terrier attracted high scores in relation to type-specific aggressiveness. These findings highlight the need for more research on personal perception of supposedly dangerous dog breeds to better understand and explain this phenomenon, leading to better protection of the public and better welfare outcomes for dogs

Are interventions to reduce the impact of arsenic contamination of groundwater on human health in developing countries effective? A systematic review

BackgroundWithin developing countries, groundwater provides an alternative drinking source to polluted surface water. However, the presence of arsenic in some groundwater sources has resulted in chronic worldwide poisoning. The aim of this review was to determine the effectiveness of field-based technologies for the removal of arsenic from groundwater in developing countries.MethodsA structured search strategy was conducted in a range of databases. Titles, abstracts and full texts were screened using pre-defined inclusion criteria. Included studies were quality appraised prior to data extraction. The primary outcome was the percentage of effluent water samples meeting WHO guidelines for arsenic concentrations (≤0.01 mg/L). Secondary outcomes included: (a) arsenic concentrations in effluent water samples meeting the national guideline limit (≤0.05 mg/L), (b) arsenic concentrations in human tissue, and (c) knowledge and attitudes related to the interventions.ResultsFifty-one reports, evaluating 50 different technologies, were included. Sixty-seven percent (n = 34) of studies were conducted in Bangladesh. Fifty of the included reports were appraised as ‘weak’, with one ‘strong’ report of a randomised-controlled trial.In summary, the effectiveness of the oxidation and filtration interventions is poor, while the evidence for coagulation, co-precipitation and filtration, subterranean and membrane and electrolytic methods is mixed. Evidence regarding adsorption and zero valent iron interventions is more persuasive with most results suggesting good evidence of effectiveness (i.e. ≥95% of samples with arsenic concentrations ≤0.01 mg/L). In particular, activated alumina and sono/three-kolshi/gagri/pitcher filters have ≥95% of samples meeting national guidelines. Disappointingly, only one study reports excellent evidence of effectiveness: BRAC (2000) for activated alumina (i.e. ≥95% of samples with arsenic concentrations ≤0.01 mg/L).The success of each technology was highly dependent on context, especially their acceptability to users, a sense of ownership and expectations of women’s roles in society.ConclusionsMost studies were poorly conducted and reported. Consequently, although some technologies met national guidelines, the evidence-base for decision-making regarding arsenic mitigation technologies at household- and community-level is weak. To improve this situation, primary research needs to be commissioned with adequate sample sizes, testing the impact of key contextual factors, using valid tools for analysis, and meeting standards for completeness of reporting

Three-year cost utility analysis of mini versus standard slings:A trial based economic evaluation

OBJECTIVE: To report on the cost-effectiveness of adjustable anchored single-incision mini-slings (mini-slings) compared with tension-free standard mid-urethral slings (standard slings) in the surgical management of female stress urinary incontinence (SUI).PATIENTS AND METHODS: Data on resource use and quality were collected from women aged ≥18 years with predominant SUI undergoing mid-urethral sling procedures in 21 UK hospitals. Resource use and quality of life (QoL) data were prospectively collected alongside the Single-Incision Mini-Slings versus standard synthetic mid-urethral slings Randomised Control Trial (SIMS RCT), for surgical treatment of SUI in women. A health service provider's (National Health Service [NHS]) perspective with 3-year follow-up was adopted to estimate the costs of the intervention and all subsequent resource use. A generic instrument, EuroQol EQ-5D-3L, was used to estimate the QoL. Results are reported as incremental costs, quality adjusted life years (QALYs) and incremental cost per QALY.RESULTS: Base case analysis results show that although mini-slings cost less, there was no significant difference in costs: mini-slings versus standard slings: £-6 [95% CI -228-208] or in QALYs: 0.005 [95% CI -0.068-0.073] over the 3-year follow-up. There is substantial uncertainty, with a 56% and 44% probability that mini-slings and standard slings are the most cost-effective treatment, respectively, at a £20 000 willingness-to-pay threshold value for a QALY.CONCLUSIONS: At 3 years, there is no significant difference between mini-slings and standard slings in costs and QALYs. There is still some uncertainty over the long-term complications and failure rates of the devices used in the treatment of SUI; therefore, it is important to establish the long-term clinical and cost-effectiveness of these procedures.</p

Does electronic consent improve the logistics and uptake of hpv vaccination in adolescent girls? A mixed methods theory informed evaluation of an intervention

Abstract Background Technological solutions may improve the logistics of obtaining parental consent in school-based immunisation programmes. In 2018/19 a health care organisation in London, England, piloted an electronic consent intervention in the adolescent girls’ HPV vaccination programme. We conducted a mixed-methods evaluation to examine the usability and acceptability of the intervention and assess its impact on consent form returns and HPV vaccine uptake. Methods The intervention was implemented in 14 secondary schools in seven South London boroughs. Each e-consent school was matched with a school that used standard paper consent. Matching was based on location and the proportion of students: i. with English as a second language, ii. receiving free school meals (socio-economic status proxy). Consent form return rates and HPV vaccine uptake were compared quantitatively between intervention and matched schools. Data from immunisation session observations (n=7), school feedback forms (n=14), individual and group interviews with implementers (n=8), parents and adolescents (n=12) and a focus group discussion with adolescents was analysed thematically to document user’s experiences investigate the implementation of the intervention. Results HPV vaccination uptake did not differ between e-consent and matched paper consent schools, but timely consent form return was significantly lower in the e-consent schools (73.3% (n=11) vs 91.6% (n=11), p=0.008). The transition to using the system was not straightforward, whilst schools and staff understood the potential benefits, they found it difficult to adapt to new ways of working which removed some level of control from schools. Part of the reason for lower consent form return in e-consent schools was that some parents found the intervention difficult to access and use. Adolescents highlighted the potential for e-consent interventions to by-pass their information needs. Conclusions The e-consent intervention did not improve consent form return or vaccine uptake due to challenges encountered in transitioning to a new way of working. New technologies require embedding before they become incorporated in everyday practice. The intervention is undergoing further iterative development to improve its usability, ensure schools are appropriately involved and adolescents receive tailored immunisation information. A re-evaluation once stakeholders are accustomed to e-consent may be required to understand its impact.</jats:p

Three-year cost utility analysis of mini versus standard slings : A trial based economic evaluation

Funding Information: This work was funded by the National Institute of Health Research, Health Technology Assessment programme: project number HTA‐12/127/157. Funding information Dr. Dwayne Boyers reports grants from UK NIHR during the conduct of the study. Ms. Mary Kilonzo reports grants from UK NIHR during the conduct of the study. Kiron Bhal: I have been a speaker and trainer for the following companies in the past Astellas, Pfizer, AMS, Contura, Allergan and others, where I have received honorariums and sponsorship towards attending scientific conferences. Professor James N'Dow reports HTA General Committee 2016–2018. Professor Graeme MacLennan reports grants from UK NIHR during the conduct of the study. Professor John Norrie reports grants from the University of Edinburgh, outside the submitted work; and past and present member of the following: HTA Commissioning Sub‐Board (EOI), NIHR CTU Standing Advisory Committee, NIHR HTA & EME Editorial Board, Pre‐Exposure Prophylaxis Impact Review Panel, EME Strategy Advisory Committee, EME—Funding Committee Members, EME Funding Committee Sub‐Group Remit & Comp Check, HTA General Committee, HTA Funding Committee Policy Group (formerly CSG) and HTA Commissioning Committee. HTA post‐funding committee teleconference 2016–2019; COVID‐19 reviewing 2020. Professor Mohamed Abdel‐Fattah: None in the last 5 years. Before 2015, I have been a speaker, consultant and/or surgical trainer for a number of industrial companies (Astellas, Ethicon, Bard, Pfizer, AMS, Coloplast and others): I have been reimbursed my travel expenses; and on occasions received personal honorariums; proctorship fees and sponsorship towards attending scientific conferences. Research grant from Coloplast managed by the University of Aberdeen. A limited number of my trainees attended pharmaceutical‐sponsored educational/leadership workshops and/or received assistance in presenting their research work at scientific conferences. Was Chairman of the Scottish Pelvic Floor Network (SPFN), which at the time received financial sponsorship from various industrial companies (including all those mentioned above) and non‐profit organisations for its annual meetings and surgical workshops. The SPFN provided an educational grant funding the PI at the highest recruiting site to attend the International Continence Society annual scientific conference in Brazil in 2014. Ongoing: I receive travel sponsorship and occasionally speaker‘s fees from numerous national and international conferences and non‐profit organisations when invited as a guest speaker and/or expert surgeon. In 2019, and at request from NHS Grampian, I attended 2 educational meetings for setting up sacral nerve stimulation service partially funded by Medtronic. I am the Chief Investigator for four NIHR—HTA‐funded studies. I do not hold (and never held) any shares (or similar) in any of the industrial companies (medical or non‐medical). To the best of my knowledge, none of the above have influenced my research or clinical practice. Publisher Copyright: © 2023 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.Peer reviewedPublisher PD

Patient preferences for stress urinary incontinence treatments : a discrete choice experiment

Funding: The study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number: 12/127/157). The full project report is available from the funder’s website: https://www.journalslibrary.nihr.ac.uk/hta/BTSA6148%23/abstract. The full citation for the funder report is: Abdel-Fattah M, Cooper D, Davidson T, Kilonzo M, Boyers D, Bhal K, et al. Single-incision mini-slings versus standard synthetic mid-urethral slings for surgical treatment of stress urinary incontinence in women: The SIMS RCT. Health Technol Assess 2022;26(47). The Health Economics Research Unit and Health Services Research Unit are both funded by the Chief Scientist’s Office (CSO) of the Scottish government health directorates. The SIMS trial was registered as: ISRCTN93264234.Peer reviewedPublisher PD

Single-Incision Mini-Slings for Stress Urinary Incontinence in Women

Supported by the NIHR (NIHR Evaluation, Health Technology Assessment Programme; funder number, 12/127/157). We thank all the SIMS trial patients without whom this trial would not have been possible; the members of the independent trial steering committee (Chris Mayne [chair], Isobel Montgomery, Dudley Robinson, Lynda Harper, Eleanor Mitchell, and Khaled Ismail) for their supervision of the trial and their guidance and support; the members of the independent data monitoring committee (Peter Brocklehurst [chair], Lee Middleton, Christian Phillips, and Doug Tincello) for their work in assessing all serious adverse events reported to the trial office in real time; Phil Assassa for his substantive role in the trial, including the obtaining of funding, the design of the protocol, and the recruitment of patients; Athele Khunda for his role in patient recruitment and for his contribution to the trial; and Ahmed Mansor and Katie Gillespie for their contribution with the systematic review.Peer reviewedPostprin