Student midwives' perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study

BACKGROUND: A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives' perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care. METHODS: This qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded and analysed. RESULTS: Students felt that inevitably there will be a change in the organisation of maternity care, and they were open to change. Participants indicated that good collaboration between professions, including a shared system of maternity notes and guidelines, and mutual trust and respect were important aspects of any alternative model. The students indicated that client-centered care and the safeguarding of the physiological, normalcy approach to pregnancy and birth should be maintained in any alternative model. Students expressed worries that the role of midwives in intrapartum care could become redundant, and thus they are motivated to take on new roles and competencies, so they can ensure their own role in intrapartum care. CONCLUSIONS: Final year student midwives recognise that change in the organisation of maternity care is inevitable and have an open attitude towards changes if they include good collaboration, client-centred care and safeguards for normal physiological birth. The graduating midwives are motivated to undertake an expanded intrapartum skill set. It can be important to involve students' views in the discussion, because they are the future maternity care providers. (aut. ref.

Complications after hip arthroplasty and the association with hospital procedure volume: A nationwide retrospective cohort study on 50,080 total hip replacements with a follow-up of 3 months after surgery

Background and purpose: It has been suggested that a higher procedure volume is associated with less complications af

A Multi-Platform Flow Device for Microbial (Co-) Cultivation and Microscopic Analysis

Novel microbial cultivation platforms are of increasing interest to researchers in academia and industry. The development of materials with specialized chemical and geometric properties has opened up new possibilities in the study of previously unculturable microorganisms and has facilitated the design of elegant, high-throughput experimental set-ups. Within the context of the international Genetically Engineered Machine (iGEM) competition, we set out to design, manufacture, and implement a flow device that can accommodate multiple growth platforms, that is, a silicon nitride based microsieve and a porous aluminium oxide based microdish. It provides control over (co-)culturing conditions similar to a chemostat, while allowing organisms to be observed microscopically. The device was designed to be affordable, reusable, and above all, versatile. To test its functionality and general utility, we performed multiple experiments with Escherichia coli cells harboring synthetic gene circuits and were able to quantitatively study emerging expression dynamics in real-time via fluorescence microscopy. Furthermore, we demonstrated that the device provides a unique environment for the cultivation of nematodes, suggesting that the device could also prove useful in microscopy studies of multicellular microorganisms

A many-analysts approach to the relation between religiosity and well-being

The relation between religiosity and well-being is one of the most researched topics in the psychology of religion, yet the directionality and robustness of the effect remains debated. Here, we adopted a many-analysts approach to assess the robustness of this relation based on a new cross-cultural dataset (N=10,535 participants from 24 countries). We recruited 120 analysis teams to investigate (1) whether religious people self-report higher well-being, and (2) whether the relation between religiosity and self-reported well-being depends on perceived cultural norms of religion (i.e., whether it is considered normal and desirable to be religious in a given country). In a two-stage procedure, the teams first created an analysis plan and then executed their planned analysis on the data. For the first research question, all but 3 teams reported positive effect sizes with credible/confidence intervals excluding zero (median reported β=0.120). For the second research question, this was the case for 65% of the teams (median reported β=0.039). While most teams applied (multilevel) linear regression models, there was considerable variability in the choice of items used to construct the independent variables, the dependent variable, and the included covariates

Point-of-care-testen in de eerstelijnszorg in Nederland : Beheer van patiëntveiligheidsaspecten

Point-of-care (POC-)testen zijn apparaten of teststrips die aan het bed van patiënten of in de huisartspraktijk kunnen worden gebruikt om snel een diagnose te stellen. Voorbeelden zijn bloedglucosemeters voor diabetes of nitrietteststrips voor urineweginfecties. POC-testen worden steeds meer gebruikt in huisartspraktijken. Er is echter weinig bekend over de manier waarop de gebruikers van de testen de bijbehorende patiëntveiligheidsaspecten beheren. Voor een goede en veilige uitvoering hiervan is het van belang dat de testen op een juiste manier worden gebruikt. Uit het exploratieve onderzoek van het RIVM naar het gebruik van POC-testen in de huisartspraktijk blijkt dat er voor sommige kwaliteitseisen onvoldoende aandacht is. Bevindingen Er is niet altijd voldoende aandacht voor kwaliteitsbeheersing van de testen, bijvoorbeeld bij opslag, kalibratie en onderhoud. Verder voert slechts de helft van de respondenten universele hygiënische maatregelen uit, zoals handen wassen voordat een bloedmonster wordt genomen. Ook worden opfriscursussen voor het gebruik van POC-testen nauwelijks georganiseerd. En als de testen niet goed functioneren, melden slechts enkele huisartsen dat bij de fabrikant. Hierdoor kan de fabrikant geen maatregelen treffen om zijn product of de instructie voor gebruik te verbeteren. Huisartsen zorgen er wel goed voor dat de monsters aan de juiste patiënten worden gekoppeld (patiëntidentificatie). Ook wordt de benodigde actie ondernomen als de testresultaten onduidelijk zijn. Aanbevelingen Om een goede kwaliteit van zorg te handhaven en risico's op fouten met POCtesten in huisartspraktijken te voorkomen, is het aan te bevelen bestaande richtlijnen voor huisartsen uit te breiden met betrekking tot het gebruik van POC-testen.Point-of-care (POC) tests are devices or test strips that can be used near or at the site of patients for a relatively fast diagnosis. Examples are blood glucose meters for diabetes or nitrite test strips to detect a urinary tract infection. Although a majority of general practitioners in the Netherlands is using POC tests in their practice, little is known on how they manage the corresponding patient safety aspects. To maintain good and safe use of POC tests it is important that POC tests are used correctly. Results of the explorative study performed by the RIVM show that some quality aspects receive insufficient attention in GP practices. Results There is not always sufficient attention for quality control measures such as checking the storage conditions, calibration, and maintenance. Furthermore, only half of the respondents take universal hygienic measures, such as washing hands before taking a blood sample. Refresher courses on the use of POC tests are hardly organized. Only a few of the general practitioners contact the manufacturer of the device when a device failure occurs. Without informing the manufacturer of device problems, the manufacturer does not have the opportunity to improve the device or instructions for use, whatever is applicable, so that the problem does not recur. Well-controlled aspects include patient identification, and actions taken when ambiguous test results are obtained. Recommendation To maintain a good quality of care and to prevent the risks of errors with POC tests in GP practices, it is recommended to expand existing general guidelines for GPs with regard to the use of point-of-care tests

Haplotypes of the NR4A2/NURR1 Gene and Cardiovascular Disease. The Rotterdam Study

Nuclear receptor subfamily 4, group A, member 2 (NR4A2, also called Nurr1) has lately become of interest with regard to atherogenesis. We examined the association between common variation in the NR4A2 gene and cardiovascular disease in the Rotterdam Study, a prospective population-based study among persons aged >= 55 years. Three SNPs that tag common haplotypes across a 36-kb region surrounding the NR4A2 gene were determined. Four haplotypes with frequencies > 1% covered 96% of the genetic variation. In 5,650 participants without history of coronary heart disease, 729 coronary heart disease events occurred during a median follow-up time of 11.9 years. NR4A2 haplotypes were neither associated with coronary events nor with intima-media thickness (IMT), carotid plaques, or ankle-arm index (AAI). NR4A2 haplotypes showed a tendency toward associations with aortic and coronary calcification (haplo.score global simulation P values 0.076 and 0.075, respectively), which seemed to be based on haplotype 2 (individual P values were both P = 0.015). Furthermore, NR4A2 haplotype 3 was associated with higher high-density lipoprotein (HDL) cholesterol and haplotype 4 with lower systolic blood pressure. In conclusion, NR4A2/NURR1 haplotypes were not associated with coronary events, carotid IMT, carotid plaques, or AAI. There was a tendency toward associations with aortic calcification and coronary calcification. Associations for NR4A2 were found with both HDL levels and blood pressure. It remains to be investigated which pathophysiological mechanisms pertain to NR4A2 function in cardiovascular disease. Hum Mutat 30, 417-423, 2009. (C) 2009 Wiley-Liss, Inc