Implications for practice and research Identification of anxiety and mental health implications needs to be implicit in caring for women finding out the diagnosis of a baby having anencephaly. With ...the current news of areas in the USA restricting abortion, these experiences are likely to increase.1 This paper, based in Ireland, offers insight into the impact of the diagnosis of anencephaly of a baby during pregnancy on the lives of women and their families. The study outlines the journey to acceptance and love for their baby and documents the pain of also having to say goodbye to their baby from the initial rejection of their babies by some of the mothers at the beginning.
Highlights • Little research has been undertaken to prevent catheter-associated urinary tract infection in long-term catheterization. • Evidence of the effectiveness of implementing clinical ...guidelines is mixed. • Feasibility work could explore interventions that hold promise of effectiveness.
Bloodstream infections resulting from intravascular catheters (catheter-BSI) in critical care increase patients' length of stay, morbidity and mortality, and the management of these infections and ...their complications has been estimated to cost the NHS annually £19.1-36.2M. Catheter-BSI are thought to be largely preventable using educational interventions, but guidance as to which types of intervention might be most clinically effective is lacking.
To assess the effectiveness and cost-effectiveness of educational interventions for preventing catheter-BSI in critical care units in England.
Sixteen electronic bibliographic databases - including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), NHS Economic Evaluation Database (NHS EED), EMBASE and The Cochrane Library databases - were searched from database inception to February 2011, with searches updated in March 2012. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify any additional references.
References were screened independently by two reviewers using a priori selection criteria. A descriptive map was created to summarise the characteristics of relevant studies. Further selection criteria developed in consultation with the project Advisory Group were used to prioritise a subset of studies relevant to NHS practice and policy for systematic review. A decision-analytic economic model was developed to investigate the cost-effectiveness of educational interventions for preventing catheter-BSI.
Seventy-four studies were included in the descriptive map, of which 24 were prioritised for systematic review. Studies have predominantly been conducted in the USA, using single-cohort before-and-after study designs. Diverse types of educational intervention appear effective at reducing the incidence density of catheter-BSI (risk ratios statistically significantly < 1.0), but single lectures were not effective. The economic model showed that implementing an educational intervention in critical care units in England would be cost-effective and potentially cost-saving, with incremental cost-effectiveness ratios under worst-case sensitivity analyses of < £5000/quality-adjusted life-year.
Low-quality primary studies cannot definitively prove that the planned interventions were responsible for observed changes in catheter-BSI incidence. Poor reporting gave unclear estimates of risk of bias. Some model parameters were sourced from other locations owing to a lack of UK data.
Our results suggest that it would be cost-effective and may be cost-saving for the NHS to implement educational interventions in critical care units. However, more robust primary studies are needed to exclude the possible influence of secular trends on observed reductions in catheter-BSI.
The study is registered with PROSPERO as CRD42012001840.
The National Institute for Health Research Health Technology Assessment programme.
This is a new standard series to supplement our Cochrane Corner and Research Unwrapped evidence series. The aim of Guideline commentary is to support you to critique and utilise newly published ...guidelines enabling translation of appropriate recommendations to practice. The objective is to scrutinise recent guidelines to encourage an understanding of the key issues, recommendations and midwifery practice implications.
Moving forward together Cooper, Tracey
The practising midwife
18, Številka:
6
Journal Article
Recenzirano
Reading the Kirkup report (2015) there is enormous sadness for the relatives and parents affected, and disappointment about the culture of lack of either transparency or honesty. The failings of the ...clinical governance structures at the hospital and within the trust were evident, which was impacted by poor relationships between professional groups. 5 references
Addition of a range of organolithium and Grignard reagents to (E)-O-(1-phenylbutyl)benzyloxyacetaldoxime 1 in the presence of boron trifluoride diethyl etherate is highly diastereoselective. The ...resulting hydroxylamines undergo N-O bond cleavage upon treatment with zinc-acetic acid or molybdenum hexacarbonyl to give, after N-protection, protected 1,2-aminoalcohols 3 in high enantiomeric purity. Debenzylation of 3a and 3d gave N-Boc (R)-alaninol and (S)-phenylalaninol respectively. The hydroxylamines 2 also serve as alpha-amino acid precursors, 2i being converted into N-formyl-(R)-alaninyl-(S)-(4-bromo)phenylalanine ester 7, the N-terminal dipeptide of a natural depsipeptide. The versatility of the 1,2-aminoalcohol derivatives was further illustrated by their conversion into 5-, 6- and 7-membered 2-hydroxymethyl nitrogen heterocycles 15-19 in high enantiomeric excess by a ring-closing metathesis reaction. Further reaction of the dihydropyrrole 15 gave the iminosugar 1,4-dideoxy-1,4-imino-D-ribitol.
A new asymmetric synthesis of alpha-amino acids is described in which the key step is the highly diastereoselective addition of organolithium carboxyl synthons (2-furyllithium, phenyllithium, ...vinyllithium) to (R)- and (S)-O-(1-phenylbutyl) oximes to give hydroxylamines, with vinyllithium being the most satisfactory nucleophilic reagent. Subsequent reductive cleavage of the N-O bond in hydroxylamines, followed by N-protection, and oxidative cleavage of the carboxyl precursor gave a range of N-protected amino acids and esters. The method was exemplified by the synthesis of a range of derivatives of non-proteinogenic amino acids such as 4-bromophenylalanine, tert-leucine, norvaline, cyclohexyl- and aryl-glycines, 2-amino-8-oxodecanoic acid (Aoda) and alpha-methylvaline.
Pelvic girdle pain (PGP) continues to cause morbidity for a significant number of pregnant women (around one in five). Although research into the causes of PGP has not identified significant or ...preventable causes, the understanding of contributing factors has evolved significantly in recent years. It was previously thought that PGP was a hormonal problem caused by relaxin production and subsequent ‘loosening’ or laxity of pelvic joints; current evidence suggests that it is an asymmetry of mobility of the pelvic joints, in particular the sacroiliac joints. Treatment has evolved to provision of manual, hands-on therapy treatment, restoring symmetry of pelvic joint movement and function, rather than rest, crutches and support belts; hence the woman's overall biomechanical function and her mobility and independence are restored. This article seeks to raise awareness of this change of focus regarding treatment and promote its adoption across the UK, in line with national guidelines, with the goal of reducing the significant morbidity experienced by many women. Midwives are ideally placed to identify women with PGP early and make the most of the opportunity to access effective treatment, as well as supporting birth-planning that takes PGP into account, thus avoiding long-term physical and psychological morbidity.
Review of Part A of the 'Choice Framework for Local Policy and Procedures 01-01 (CFPP 01-01) - Management and decontamination of surgical instruments (medical devices) used in acute care' (Department ...of Health, 2012) and collaborative working between the Infection Prevention Society, Institute of Decontamination Sciences and the Association for Perioperative Practice. 7 references
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