Antenatal Guidelines Research Articles

Validation of Newly Developed Surveys to Evaluate Patients' and Providers' Satisfaction with Telehealth Obstetric Services.

Background: Patient and/or provider satisfaction and experience are among the most important indicators for quality assurance of health care services, including telehealth. Validated surveys should be used for this purpose to provide reliable information for a program evaluation. Objective: To validate the newly developed satisfaction surveys, report patient, and provider satisfaction with Antenatal and Neonatal Guidelines, Education and Learning Systems (ANGELS) telehealth services. Methods: Two self-administered paper surveys were developed by a multidisciplinary team. The surveys were validated among obstetric patients who received telehealth services in 2016 and providers in Arkansas from July to August 2017. Psychometric testing was performed to establish reliability and validity of both the surveys. Descriptive statistics was performed to describe patient and provider satisfaction. Results: A total of 89 patient- and 66 provider surveys were analyzed. Construct validity and internal consistency reliability (Cronbach's α >0.7) were confirmed on both the surveys. The majority of patients were highly satisfied with telehealth services and reported positive perceptions toward future use of services. In the past 12 months, telehealth (78.6%) was the most used ANGELS service by providers. Finally, >90% of the providers reported high satisfaction and rated telehealth services as "excellent." Conclusions: The newly developed patient and provider telehealth surveys were reliable and valid. The surveys also demonstrated that the telehealth services were well-accepted and highly valued in a sample of obstetric patients and providers. As both surveys are short, they can be used in routine evaluation of patient and provider satisfaction with similar telehealth programs in the country.

Exploring woman –Nurse interaction in a Jordanian antenatal clinic: A qualitative study

BackgroundEffective woman-nurse interaction is critical in providing quality nursing care and would improve the health outcomes and the level of women's satisfaction with health and nursing services. AimTo explore how Jordanian nurses and pregnant women perceive their interaction during antenatal visits. MethodsA descriptive qualitative study was conducted using a purposive sample of twelve pregnant women and twelve nurses. Data were collected through four focus group discussions organized at an antenatal clinic of a large hospital in Jordan. The data were analyzed using Giorgi's four stages of data analysis. FindingsApproaches to interaction; barriers to interaction; quality of interaction were the main themes emerged from the data. Nurses and pregnant women also provided suggestions for strengthening the womannurse interaction during antenatal visits. ConclusionThe different aspects of interaction described by the participants of this study may raise awareness and appreciation of the important roles health care providers can play in promoting the health outcomes of pregnant women when effective interaction is built and strengthened. Relevant policies and guidelines on improving appointment systems, and continuing education on communication skills and health education would be needed. More attention is required to adopt appropriate antenatal clinical guidelines and protocols to meet women's needs in Jordan.

Recent developments in asthma in pregnancy.

Asthma affects up to 13% of pregnancies worldwide and has a varying and unpredictable clinical course during pregnancy. Pharmacological asthma treatment is recommended; however, studies show that some pregnant women with asthma cease their medication in early pregnancy. There is likely a large unmet disease burden arising from asthma in pregnancy. Antenatal and asthma guidelines lack sufficient information on asthma management in pregnant women, and implementation of the current guidelines seems inadequate. Prescription databases provide evidence of cessation of asthma medication during pregnancy on a population level. Population-based databases also provide evidence of rare adverse perinatal outcomes. The risk of childhood asthma in the offspring of women with asthma is reduced by adequate control of maternal asthma during pregnancy. Vitamin D sufficiency during pregnancy could also reduce the risk of childhood asthma. The findings of this review demonstrate the need for improved asthma and antenatal guidelines regarding asthma management during pregnancy, and the need of adequate implementation of these guidelines. Furthermore, adequate asthma control during pregnancy is needed to reduce the risk of childhood asthma. To maintain asthma control, prepregnancy medication should be continued throughout pregnancy and adjusted according to the current treatment steps if required.

An outback midwife

Detection and management of antenatal risk factors is critical for quality care.To determine (1) women’s views about when they should be asked about antenatal health factors as recommended in the Australian antenatal guidelines; and (2) the time required to provide recommended care using a clinical scenario.In Phase 1, pregnant women attending an outpatient obstetrics clinic at a public hospital were surveyed about preferred screening for antenatal risk factors during visit(s). In Phase 2, a hypothetical clinical scenario of a woman attending her first antenatal visit with a practising midwife was video-recorded to extrapolate the time taken to ask about and offer assistance to manage clinical, screening and lifestyle risk factors.Most women (96%) perceived they should be asked about each of the risk factors at least once (i.e. at first visit). Total time taken to ask about all risk factors was 52 min. More time was spent discussing clinical (11 min) than lifestyle factors (4 min). Adjusting for the estimated prevalence of each risk factor, the time taken to offer assistance was 8 min per woman. Average time required for detecting and offering assistance to manage risk factors is 60 min per average risk woman.Women are willing to be asked about risk factors; however this process is time-consuming. Strategies to streamline visits and prioritise recommendations so time-efficient yet comprehensive care can be delivered are needed, particularly when factors require monitoring over time and for those who may be ‘at-risk’ for multiple factors.

Women requesting a caesarean birth in an otherwise healthy first pregnancy

Detection and management of antenatal risk factors is critical for quality care.To determine (1) women’s views about when they should be asked about antenatal health factors as recommended in the Australian antenatal guidelines; and (2) the time required to provide recommended care using a clinical scenario.In Phase 1, pregnant women attending an outpatient obstetrics clinic at a public hospital were surveyed about preferred screening for antenatal risk factors during visit(s). In Phase 2, a hypothetical clinical scenario of a woman attending her first antenatal visit with a practising midwife was video-recorded to extrapolate the time taken to ask about and offer assistance to manage clinical, screening and lifestyle risk factors.Most women (96%) perceived they should be asked about each of the risk factors at least once (i.e. at first visit). Total time taken to ask about all risk factors was 52 min. More time was spent discussing clinical (11 min) than lifestyle factors (4 min). Adjusting for the estimated prevalence of each risk factor, the time taken to offer assistance was 8 min per woman. Average time required for detecting and offering assistance to manage risk factors is 60 min per average risk woman.Women are willing to be asked about risk factors; however this process is time-consuming. Strategies to streamline visits and prioritise recommendations so time-efficient yet comprehensive care can be delivered are needed, particularly when factors require monitoring over time and for those who may be ‘at-risk’ for multiple factors.

Reported adherence to current antenatal corticosteroid guidelines in Australia and New Zealand.

Antenatal corticosteroids (ANC) reduce mortality and morbidity in preterm babies, but prescription practices vary. To assess obstetricians' compliance with the recommendations of the Australian and New Zealand clinical practice guidelines on use of ANC. An anonymous online questionnaire was distributed to Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. All respondents reported prescribing an initial course of ANC according to the guidelines if preterm birth at 28weeks' gestation was expected within 24 or 72h. However, 22% reported prescribing ANC even if birth was not expected within sevendays. This was reported more often by practitioners not using adjunct tests to predict preterm birth (14% vs 69%; P < 0.001). An initial course of ANC at ≥35weeks was prescribed by 52% of respondents. However, 93% reported prescribing ANC at ≥35weeks prior to elective caesarean section. Repeat courses of ANC were prescribed by 76% of respondents. Of these, 89% reported prescribing repeat courses beyond the guideline recommendations at ≥33weeks and 29% exceeded the recommendations on number of repeat courses. For infants born at <35weeks, current ANC prescribing patterns in Australia and New Zealand are consistent with the guideline recommendations and result in high rates of administration in this group. However, administration of ANC to groups where benefits have not been demonstrated is commonly reported. Adherence to the guideline recommendations would decrease ANC exposure to babies for whom there is no strong evidence of benefit.

Prenatal diagnosis and implications of microphthalmia and anophthalmia with a review of current ultrasound guidelines: two case reports

BackgroundMicrophthalmia and anophthalmia are rare congenital fetal abnormalities. The combined incidence is estimated at 1 in 10,000 births. These two conditions arise from complex and incompletely understood genetic and/or environmental causes. Prenatal diagnosis is neither frequent nor easy and relies on precise, high-quality ultrasonography. Current antenatal ultrasound protocols for imaging of the fetal eye are inconsistent and inadequate to screen for the spectrum of ocular malformations, and there are no clear guidelines on detection of these rare abnormalities. Our study of two cases highlights the importance of early detection, and we review current practice and suggest a definitive fetal imaging protocol.Case presentationWe present two antenatal cases, one each of microphthalmia and anophthalmia, both diagnosed at the morphology scan at our tertiary fetal medicine unit. In both cases, the parents (a 36-year-old woman of Mauritanian ethnicity and a non-consanguineous partner of Nepalese descent, and a 31-year-old Caucasian woman and non-consanguineous Caucasian partner) elected to terminate their pregnancies and made unremarkable recoveries. Subsequent fetal autopsy confirmed the ultrasound scan findings.ConclusionsWe recommend that antenatal ultrasound guidelines are updated to specify use of a curvilinear transducer (2–9 MHz) to image both orbits in the axial and coronal planes, aided by use of a transvaginal probe when the transabdominal approach is inadequate to generate these images. When applicable, three-dimensional reverse-face imaging should be obtained to aid the diagnosis. The presence, absence, or non-visualization of lenses and hyaloid arteries should be documented in reports and these cases referred for a tertiary-level ultrasound scan and fetal medicine review. Imaging of the orbits should occur from 12 weeks’ gestation. Magnetic resonance imaging and amniocentesis with chromosome microarray testing may provide additional genetic and structural information that may affect the overall morbidity associated with a diagnosis of microphthalmia or anophthalmia.

Reported Adherence to Current Antenatal Corticosteroid Guidelines in Australasia

Reported Adherence to Current Antenatal Corticosteroid Guidelines in Australasia

Ethiopian women's perspectives on antenatal care and iron-folic acid supplementation: Insights for translating global antenatal calcium guidelines into practice.

After decades of global response to iron-deficiency anemia, lessons learned from antenatal iron-folic acid (IFA) supplementation can inform new micronutrient supplementation efforts. The World Health Organization recommends calcium supplementation for the prevention of preeclampsia; however, little is documented on how to design programs to integrate calcium into the standard of care. Twenty interviews with pregnant women and 22 interviews with health providers and volunteers in two districts in Ethiopia were conducted to examine how barriers and facilitators to antenatal care, IFA supplementation, and initial reactions to calcium supplements and regimen might influence adherence and inform future programs. Women viewed supplementation positively but cited lack of information on benefits and risks, forgetfulness, and inconsistent IFA supply as challenges. Though knowledge and awareness of anemia and IFA supplements were widespread, preeclampsia was mostly unknown. Some symptoms of preeclampsia were viewed as normal in pregnancy, making it difficult to convey risk to motivate supplement use. Some women viewed co-consumption of IFA and calcium as potentially harmful and were confused regarding the simultaneous risks of anemia and hypertension, understood as "low" and "high" blood levels in pregnancy. However, most said they would take both IFA and calcium supplements if provided with supplements and counseling on purpose and benefits. Strategies such as social support from families, stronger community-based counseling, and increased health care provider and community awareness of preeclampsia are critical for women to understand the benefits of supplementation and resolve confusion caused by current descriptors used for anemia and hypertension.

Screening for recommended antenatal risk factors: How long does it take?

BackgroundDetection and management of antenatal risk factors is critical for quality care. AimsTo determine (1) women’s views about when they should be asked about antenatal health factors as recommended in the Australian antenatal guidelines; and (2) the time required to provide recommended care using a clinical scenario. MethodsIn Phase 1, pregnant women attending an outpatient obstetrics clinic at a public hospital were surveyed about preferred screening for antenatal risk factors during visit(s). In Phase 2, a hypothetical clinical scenario of a woman attending her first antenatal visit with a practising midwife was video-recorded to extrapolate the time taken to ask about and offer assistance to manage clinical, screening and lifestyle risk factors. FindingsMost women (96%) perceived they should be asked about each of the risk factors at least once (i.e. at first visit). Total time taken to ask about all risk factors was 52min. More time was spent discussing clinical (11min) than lifestyle factors (4min). Adjusting for the estimated prevalence of each risk factor, the time taken to offer assistance was 8min per woman. Average time required for detecting and offering assistance to manage risk factors is 60min per average risk woman. ConclusionWomen are willing to be asked about risk factors; however this process is time-consuming. Strategies to streamline visits and prioritise recommendations so time-efficient yet comprehensive care can be delivered are needed, particularly when factors require monitoring over time and for those who may be ‘at-risk’ for multiple factors.

Adherence to Clinical Practice Guidelines during Antenatal Management of Gestational Diabetes Mellitus: An Integrative Review

The number of pregnant women affected by gestational Diabetes (GDM) is increasing globally with an estimated prevalence as high as 15%. Gestational Diabetes Miletus is associated with birth complications for women and newborn, includes development of type II diabetes, preeclampsia during pregnancy, increasing the risk of fetal loss, stillbirth and perinatal death. An integrative literature review applied, systematic search from different data base obtained from international and middle east countries to assess adherence level of guidelines. Clinical guidelines are set to ensure and assure homogeneity as well as the quality of provision of care. National and international consensus has yet to be achieved in the management of diabetes in pregnancy, adherence of recommended antenatal care content to a minimum level appears to be unmet. Complete provider adherence to first antenatal guidelines was 48.1%, Guideline dissemination alone does not change practice; assessment of barriers/enablers and implementation is important. Guidelines are useless when they are not used or adhered to. Each guideline needs an Appendix on how adherence has to be measured, there is a need for some uniformity across guidelines to measure adherence. Diabetes management is an essential constituent to prevent prognosis of diabetes complications.

Maternal urogenital schistosomiasis; monitoring disease morbidity by simple reagent strips.

BackgroundUrine analysis is one of the recommended antenatal guidelines for early diagnosis of pregnancy-associated complications. While in practice, urine analysis by dipstick had been used to provide useful information on other urinary tract infections, its applications for early detection of urogenital schistosomiasis in pregnant women is often times not given due attention in most endemic areas. Our study therefore assessed the performance of some common urinalysis parameters in the diagnosis of maternal urogenital schistosomiasis in endemic rural communities of Nigeria.Methodology/Principal findingsThe cross-sectional epidemiologic survey of urogenital schistosomiasis was conducted among pregnant women in Yewa North Local Government, Ogun State, Nigeria. The women were microscopically examined for infection with Schistosoma haematobium, visually observed for macrohematuria, and screened for microhematuria and proteinuria using standard urine chemical reagent strips. Of 261 volunteered participants, 19.9% tested positive for S. haematobium infection. The proportion of microhematuria (23.8%) was significantly higher than that of macrohematuria (3.8%) and proteinuria (16.8%) (P<0.05). Microhematuria with sensitivity (82.7%) and specificity (89.0%) was the best diagnostic indicator of urogenital schistosomiasis. Macrohematuria with the least sensitivity (11.8%) was however the most specific (98.1%) for diagnosing urogenital schistosomiasis in pregnant women. Maximum microhematuria sensitivity (100.0%) was observed in women between 15–19 years but sensitivity was consistently low in older age groups. Maximum sensitivity, specificity and predictive values (100.0%) were recorded for microhematuria in first trimester women. Diagnostic efficiency of proteinuria and macrohematuria was also better in the first trimester women except the 25.0% specificity recorded for proteinuria. The overall diagnostic performance of microhematuria and proteinuria was better in secundigravidae.Conclusions/SignificanceMicrohematuria can be used for early detection of urogenital schistosomiasis in endemic areas especially in younger women. However because microhematuria is a condition that occurs during pregnancy and in several other diseases, it is necessary to compliment the diagnosis with other diagnostic tools such as microscopy and serology. Treatment with praziquantel is recommended for the women in their late trimesters after follow up test in order to avert associated adverse pregnancy outcomes.

Developing the national antenatal guidelines: A journey to improve antenatal care for Australian women

Developing the national antenatal guidelines: A journey to improve antenatal care for Australian women

MATERNAL UROGENITAL SCHISTOSOMIASIS, MONITORING DISEASE MORBIDITY BY SIMPLE REAGENT STRIPS

BackgroundUrine analysis is one of the recommended antenatal guidelines for early diagnosis of pregnancy-associated complications. While urine analysis by dipstick had been used in practice to provide useful information on...

Public health facility resource availability and provider adherence to first antenatal guidelines in a low resource setting in Accra, Ghana

BackgroundLack of resources has been identified as a reason for non-adherence to clinical guidelines. Our aim was to describe public health facility resource availability in relation to provider adherence to first antenatal visit guidelines.MethodsA cross-sectional analysis of the baseline data of a prospective cohort study on adherence to first antenatal care visit guidelines was carried out in 11 facilities in the Greater Accra Region of Ghana. Provider adherence was studied in relation to health facility resource availability such as antenatal workload for clinical staffs, routine antenatal drugs, laboratory testing, protocols, ambulance and equipment.ResultsEleven facilities comprising 6 hospitals (54.5 %), 4 polyclinics (36.4 %) and 1 health center were randomly sampled. Complete provider adherence to first antenatal guidelines for all the 946 participants was 48.1 % (95 % CI: 41.8–54.2 %), varying significantly amongst the types of facilities, with highest rate in the polyclinics. Average antenatal workload per month per clinical staff member was higher in polyclinics compared to the hospitals. All facility laboratories were able to conduct routine antenatal tests. Most routine antenatal drugs were available in all facilities except magnesium sulphate and sulphadoxine-pyrimethamine which were lacking in some. Antenatal service protocols and equipment were also available in all facilities.ConclusionAlthough antenatal workload varies across different facility types in the Greater Accra region, other health facility resources that support implementation of first antenatal care guidelines are equally available in all the facilities. These factors therefore do not adequately account for the low and varying proportions of complete adherence to guidelines across facility types. Providers should be continually engaged for a better understanding of the barriers to their adherence to these guidelines.

Client Factors Affect Provider Adherence to Clinical Guidelines during First Antenatal Care.

BackgroundThe first antenatal clinic (ANC) visit helps to distinguish pregnant women who require standard care, from those with specific problems and so require special attention. There are protocols to guide care providers to provide optimal care to women during ANC. Our objectives were to determine the level of provider adherence to first antenatal visit guidelines in the Safe Motherhood Protocol (SMP), and assess patient factors that determine complete provider adherence.MethodsThis cross-sectional study is part of a cohort study that recruited women who delivered in eleven health facilities and who had utilized antenatal care services during their pregnancy in the Greater Accra region of Ghana. A record review of the first antenatal visit of participants was carried out to assess the level of adherence to the SMP, using a thirteen-point checklist. Information on their socio-demographic characteristics and previous pregnancy history was collected using a questionnaire. Percentages of adherence levels and baseline characteristics were estimated and cluster-adjusted odds ratios (OR) calculated to identify determinants.ResultsA total of 948 women who had delivered in eleven public facilities were recruited with a mean age (SD) of 28.2 (5.4) years. Overall, complete adherence to guidelines pertained to only 48.1% of pregnant women. Providers were significantly more likely to completely adhere to guidelines when caring for multiparous women [OR = 5.43 (1.69–17.44), p<0.01] but less likely to do so when attending to women with history of previous pregnancy complications [OR = 0.50 (0.33–0.75), p<0.01].ConclusionComplete provider adherence to first antenatal visit guidelines is low across different facility types in the Greater Accra region of Ghana and is determined by parity and history of previous pregnancy complication. Providers should be trained and supported to adhere to the guidelines during provision of care to all pregnant women.

Fetuses with right aortic arch: a multicenter cohort study and meta-analysis.

Use of recent antenatal screening guidelines for cardiac abnormalities has increased fetal diagnoses of right aortic arch (RAA). We aimed to establish the outcome of fetal RAA without intracardiac abnormalities (ICA) to guide postnatal management. In the retrospective cohort part of our study, outcome measures were rates of chromosomal abnormalities, 22q11.2 deletion, fetal extracardiac abnormalities (ECA), postnatal ICA and ECA, and symptoms of and surgery for vascular ring. A systematic review and meta-analysis was also performed; results are reported as proportions. Kaplan-Meier analysis of vascular ring cases with surgery as endpoint was performed. Our cohort included 86 cases; 41 had a vascular ring. Rates of chromosomal abnormalities, 22q11.2 deletion and fetal ECA were 14.1%, 6.4% and 17.4%, respectively. Sixteen studies including our cohort (312 fetuses) were included in the systematic review. Overall rates of chromosomal abnormalities and 22q11.2 deletion were 9.0% (95% CI, 6.0-12.5%) and 6.1% (95% CI, 3.6-9.3%), whilst the respective rates for cases with no ECA were 4.6% (95% CI, 2.3-7.8%) and 5.1% (95% CI, 2.4-8.6%). ECA were seen in 14.6% (95% CI, 10.6-19.0%) prenatally and in 4.0% (95% CI, 1.5-7.6%) after birth. Postnatal ICA were identified in 5.0% (95% CI, 2.7-7.9%). Rate of symptoms of vascular rings (follow-up ≥ 24 months postpartum) was 25.2% (95% CI, 16.6-35.0%), and 17.1% (95% CI, 9.9-25.7%) had surgery. Two-year freedom from surgery was 83.0% (95% CI, 74.3-90.1%). Fetal RAA without ICA is more frequently associated with ECA than with chromosomal abnormalities. Most cases, however, are isolated. Vascular-ring symptoms occur in about 25% of cases. Postnatal surveillance is required mainly in the first 2 years after delivery.

Remote links: Redesigning maternity care for Aboriginal women from remote communities in Northern Australia – A comparative cohort study

Objectiveto compare the quality of care before and after the introduction of the new Midwifery Group Practice. Designa cohort study. Settingthe health centers (HCs) in two of the largest remote Aboriginal communities (population 2200–2600) in the Top End of the Northern Territory (NT), each located approximately 500km from Darwin. The third study site was the Royal Darwin Hospital (RDH) which provides tertiary care. Methodsa 2004–06 retrospective cohort (n=412 maternity cases) provided baseline data. A clinical redesign of maternity services occurring from 2009 onwards focused on increasing Continuity of Carer, Communication, Choice, Collaboration and Co-ordination of Care (5Cs). Data from a 2009–11 prospective cohort (n=310 maternity cases) were collected to evaluate the service redesign. Outcome measures included indicators on the quality of care delivery, adherence to recommended antenatal guidelines and maternal and neonatal health outcomes. Findingsstatistically significant improvements were recorded in many areas reflecting improved access to, and quality of, care. For example: fewer women had <4 visits in pregnancy (14% versus 8%), a higher proportion of women had routine antenatal tests recorded (86% versus 97%) and improved screening rates for urine (82% versus 87%) and sexual tract infections (78% versus 93%). However, the treatment of conditions according to recommended guidelines worsened significantly in some areas; for example antibiotics prescribed for urine infections (86% versus 52%) and treatment for anaemia in pregnancy (77% versus 67%). High preterm (21% versus 20%), low birth weight (18% versus 20%) and PPH (29% versus 31%) rates did not change over time. The out of hospital birth rate remained high and unchanged in both cohorts (10% versus 10%). Conclusionthis model addresses some of the disparities in care for remote-dwelling Aboriginal women. However, much work still needs to occur before maternity care and outcomes are equal to that of non-Aboriginal women. Targeted program interventions with stronger clinical governance frameworks to improve the quality of care are essential. A complete rethink of service delivery and engagement may deliver better results.

Needed The Private Part of The Women to be Examined by Perspective Maqasid Al-Shari’ah] Keperluan Membuka Aurat Ketika Rawatan Antenatal Menurut Perspektif Maqasid Al-Syari’ah

Antenatal care is a health treatment provided for pregnant woman throughout their pregnancy periods. Usually the treatment and procedures included will be conducted in health clinics or hospitals. The procedures involved aimed to provide the best health care treatment for both mothers and the baby. The periodic treatment given were according to the level of pregnant woman’s health to preserve the maslahah and to avoid the mafsadah. However, the step to achieve this maqasid al-shari’ah need to be defined especially regarding the procedure that need the private part of the women to be examined. The confusion to define the limitation for this procedure will lead into the misconception of the Islamic’s law permission regarding this matter. Therefore, this research intended to identify the permission and it’s limit in exposing the aurat especially the genital part from the perspective of maqasid al-shariah. Through the analysis of Muslim jurists literatures, manuals of antenatal treatment guidelines and interview had been conducted to Obstetrican and Gynecologist, the study found that in emergency condition which threatening life and body, exposing the part of the body is considered as daruriy. However, in ordinary situation to ease the treatment procedure, this was considered as hajiy. Hence the application of maslahah and mafsadah will be the reference point to identify the levels of daruriy or hajiy that is acknowledging by Islam in procedures.&#x0D; &#x0D; Keywords: aurat; antenatal care; objectives of syari’ah; medical; maslahah and mafsadah

NICE antenatal and postnatal mental health clinical guidelines

CommentFree Access NICE antenatal and postnatal mental health clinical guidelines Caroline Parker FFRPS, FRPharmS, FCMHP, Caroline Parker FFRPS, FRPharmS, FCMHPSearch for more papers by this author Caroline Parker FFRPS, FRPharmS, FCMHP, Caroline Parker FFRPS, FRPharmS, FCMHPSearch for more papers by this author First published: 13 October 2015 https://doi.org/10.1002/pnp.393Citations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume19, Issue5September/October 2015Pages 4-5 RelatedInformation