Care Sessions Research Articles

Revisiting Bispectral Index Monitors in the Medical ICU: A Review

SESSION TITLE: Miscellaneous Critical Care SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: The bispectral index (BIS) monitor is one of the most commonly used objective monitor of sedation depth in ventilated intensive care unit patients on neuromuscular blockade. Available guidelines discourage use as primary monitor in non-paralyzed critically ill patients. This study reviews available literature comparing subjective assessment of sedation versus objective assessment with the BIS monitor, of non-paralyzed mechanically ventilated adult patients. METHODS: A systematic literature review was conducted to identify studies comparing BIS monitor use in the ICU to standard subjective assessment in non-paralyzed adult patients on mechanical ventilation. A search of Pubmed reference databases was conducted for published relevant studies. Both observational studies and randomized trials were considered. Using key words “BIS”, “Monitoring”,“ICU” A total 37 English language articles were available on human subjects from 1998 till present. 8 studies met inclusion criteria. RESULTS: Average number of patients evaluated was 27. Most studies were done on consecutive ICU admissions. Study locations were spread out, involving the US, Japan and Europe. Commonest sedative in use was propofol, and the Richmond Agitation Sedation Scale was the most frequently used subjective assessment method. 5 of the 8 studies noted good correlation between the BIS monitor and subjective assessment. 1 study noted better correlation when remifentanil was added to propofol. At deeper levels of sedation, a wide range of BIS value corresponds to highest subjective score. Commonest cited reason for poor correlation was electromyographic interference, and where EMG was used, there was strong correlation between EMG values and BIS. CONCLUSIONS: In non-paralyzed mechanically ventilated patients, BIS monitoring shows good correlation with well validated sedative assessment scales. However, there is not enough evidence to suggest that BIS can be used alone. CLINICAL IMPLICATIONS: In situations where subjective assessment is equivocal, bispectral index monitoring may be a useful adjunct to sedation assessment. DISCLOSURE: The following authors have nothing to disclose: Franklin Njoku No Product/Research Disclosure Information

Group Prenatal Care Attendance: Determinants and Relationship with Care Satisfaction.

Objectives Group prenatal care results in improved birth outcomes in randomized controlled trials, and better attendance at group prenatal care visits is associated with stronger clinical effects. This paper's objectives are to identify determinants of group prenatal care attendance, and to examine the association between proportion of prenatal care received in a group context and satisfaction with care. Methods We conducted a secondary data analysis of pregnant adolescents (n=547) receiving group prenatal care in New York City (2008-2012). Multivariable linear regression models were used to test associations between patient characteristics and percent of group care sessions attended, and between the proportion of prenatal care visits that occurred in a group context and care satisfaction. Results Sixty-seven groups were established. Group sizes ranged from 3 to 15 women (mean=8.16, SD=3.08); 87% of groups enrolled at least five women. Women enrolled in group prenatal care supplemented group sessions with individual care visits. However, the percent of women who attended each group session was relatively consistent, ranging from 56 to 63%. Being born outside of the United States was significantly associated with higher group session attendance rates [B(SE)=11.46 (3.46), p=0.001], and women who received a higher proportion of care in groups reported higher levels of care satisfaction [B(SE)=0.11 (0.02), p<0.001]. Conclusions Future research should explore alternative implementation structures to improve pregnant women's ability to receive as much prenatal care as possible in a group setting, as well as value-based reimbursement models and other incentives to encourage more widespread adoption of group prenatal care.

Person-centredness in direct care workers caring for residents with dementia: Effects of a psycho-educational intervention.

This study assessed the effects of a psycho-educational intervention on direct care workers' person-centredness during morning care to residents with dementia. A controlled pretest-posttest study was conducted in four aged-care facilities with 56 direct care workers (female, mean age 44.72 ± 9.02). Two experimental facilities received a psycho-educational intervention comprising person-centred care competences and stress management skills; control facilities received an education-only intervention, without stress support. In total, 112 video-recorded morning care sessions were coded using the Global Behaviour Scale. Both groups reported significantly higher scores on eight of 11 items of the Global Behaviour Scale and on the Global Behaviour Scale total score at posttest (F=10.59; p=0.02). Global Behaviour Scale total score improvements were higher for the experimental group, with values close to significance (F=3.90; p=0.054). The findings suggest that a psycho-educational intervention may increase care workers' person-centredness. Further research is needed to explore the long-term sustainability and extent of its benefits on workers and residents.

Attention-Deficit/Hyperactivity Disorder–Related Impulsivity and Cyberbullying in Social Media

Sarah is a 13-year-old eighth grader who was recently diagnosed for the first time with attention-deficit/hyperactivity disorder (ADHD)-inattentive type, and the family elected to treat her with behavioral interventions to help her organization and attention. She had struggled with distractibility and disorganization since the fourth grade. At home, Sarah's mother described her as "spacey" and unable to complete the morning routine without constant supervision. Over time, her mother observed that it seemed as if Sarah had given up on school.As Sarah became an adolescent, her self-esteem suffered because of her academic struggles, and she placed increasing emphasis on her appearance, including focus on remaining thin and refusing to leave the house without makeup. It was in this context that Sarah recently posted photographs of herself in various stages of undress and/or drinking alcohol on Snapchat, a photograph-sharing application in which users can send "snaps"-photographs that disappear soon after opening. However, snap recipients can take a screenshot or photograph of the snap, thereby saving the image. For unknown reasons, Sarah's close female friend took screenshots of these provocative photographs and sent them to their classmates and Sarah's older brother.Sarah's family contacted the police and has been working with her school to address this incident. This experience resulted in significant family stress and distrust of Sarah. For example, her mother took away her cell phone and laptop and has "grounded her" for a month from all out of school activities.Sarah's family seeks guidance regarding teaching Sarah about using social media responsibly and preventing this from happening again. Sarah's mom comes to your urgent care session asking for help because she does not feel that Sarah has "learned her lesson." What would you do next?

Evaluation of an Education Intervention in Hispanic Women at Risk for Gestational Diabetes Mellitus.

Experts estimate that 1–14% of pregnant women in the United States will develop gestational diabetes mellitus (GDM) (1). Women with a history of GDM have a 60–70% chance of developing the metabolic disorder with a subsequent pregnancy (2). Among women with GDM, it is well established that risk of adverse pregnancy outcomes such as fetal macrosomia are associated with less than optimal blood glucose control during pregnancy (2). Health care providers must promote access to medical/obstetrical care, proper treatment, and optimal GDM diabetes self-management education (DSME). GDM occurs more frequently in women of certain ethnic groups (e.g., Hispanic/Latino American), who are also at higher risk for recurrent GDM (3). In fact, GDM is increasing among U.S. women with various racial/ethnic backgrounds, including Hispanic women (4,5). Our aim was to develop, implement, and evaluate a culturally sensitive education intervention for Hispanic women at risk for GDM within our existing CenteringPregnancy (CP) model at a University of Kentucky prenatal clinic. The CP model provides prenatal care encompassing three components: health assessment, education, and support services (6). The program is composed of 10 prenatal care sessions offered in a small-group setting once monthly for 4 months and then twice monthly for the remainder of the pregnancy. Women who participate in CP group prenatal care have been reported to have improved birth outcomes compared to women who receive traditional prenatal care (7,8). Efforts to Maximize Perinatal Outcomes in Women at Risk (EMPOWR) is an ongoing research study that utilizes the evidence-based CP model. Before 20 weeks’ gestation, specialized CP care is offered for Medicaid or Medicaid-eligible patients. Evidence-based interventions throughout prenatal care for patients within the diabetes/obesity arm of the EMPOWR protocol include, but are not limited to: 1 ) baseline intensive review of nutrition in pregnancy, with emphasis …

Anaphyl Actic Reaction After the Intravenous Administration of Omeprazole: A Case Report

SESSION TITLE: Critical Care SESSION TYPE: Case Report Poster PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM INTRODUCTION: Omeprazole, one of proton pump inhibitors, is widely used and a rare cause of anaphylactic reactions such as dyspnea and shock, which could be extremely life threatening. This is an observational descriptive case report. CASE PRESENTATION: A 64-year-old non-atopic man with lung cancer was admitted in our unit for chemotherapy. He had two similar allergic episodes with good outcomes after active treatment in the past month. For the first time, allergic reaction, including urticaria, dyspnea, appeared within a few minutes after the intravenous administration of 800mg pemetrexed disodium for injection followed by 40mg omeprazole. In the second preparation we adjusted the medication order. Omeprazole (40mg) was infused firstly, unfortunately, severe allergic event occurred within 10 minutes. The patient experienced urticaria, wheeze, decline of oxygen saturation (less than 90%), low systolic blood pressure (less than 90 mmHg), and tachycardia (more than 130 beats per min). Serum IgE measurement was significantly higher than that in normal subjects within 24 h after the second event and intradermal skin test with omepazole was positive (the patients had signed written informed consent before treatment and check). He received immediate treatment with oxygen inhalation followed by intravenous dexamethasone and promethazine, and the symptoms disappeared in less than 2 hours. Under strict medical supervision, no adverse reaction was found induced by lansoprazole for replacement therapy after skin test came back negative. DISCUSSION: It was reported that omeprazole would lead to allergic reactions. In this case, intradermal skin test with omepazole was positive. Several of these reports described anaphylactic symptoms occurring within few minutes of ingestion of omeprazole, which was suggestive of an IgE-mediated event. In our patient, the level of serum IgE was significantly higher than that in normal subjects after exposure to omeprazole. Although more studies would be needed to confirm this result, it is highly suggestive that omeprazole is capable of triggering a specific IgE mediated response. Some reports showed lansoprazole caused anaphylactic reaction during oral or intravenous infusion. It had been proved that skin test had high sensitivity and specificity. In this case, skin test with lansoprazole was negative, therefore we used lansoprazole instead of omeprazole to combate the potential GI side effects of chemotherapy. The patient showed good tolerance. CONCLUSIONS: It is highly suggestive that omeprazole is capable of triggering anaphylactic reaction mediated by IgE. Reference #1: Ottervanger JP, Phaff RA, Vermeulen EG, Stricker BH: Anaphylaxis to omeprazole. The Journal of allergy and clinical immunology 1996, 97(6):1413-1414. [PMID: 8648040] DISCLOSURE: The following authors have nothing to disclose: Kun Xiao, Yi Hu, Lixin Xie No Product/Research Disclosure Information

Factors Influencing Fast Track Extubation Following Liver Transplant Surgery: A 3 Year Mayo Clinic Experience

SESSION TITLE: Critical Care SESSION TYPE: Original Investigation Slide PRESENTED ON: Sunday, April 17, 2016 at 02:15 PM - 03:45 PM PURPOSE: Liver transplantation (LT) is a complex surgery with potential for a number of short term peri and post operative complications including bleeding, vascular compromise and hemodynamic instability. Most transplant centers utilize some kind of formal or informal approach to assess readiness for early extubation after LT. What is currently lacking in the literature is a risk predictor tool to determine which patients would be a candidate for rapid extubation. The goal of this study was to identify pre and intra-operative factors that could help identify factors associated with successful early extubation post LT. METHODS: Retrospective analysis of all patients who underwent LT from Jan 1st 2012 to December 31th, 2014. A total of 313 patients (including pediatric subjects) comprised the study cohort. A total of 154 patients remained intubated longer than six hours (late extubation group) and 159 patients were extubated within first 6 hours post LT surgery (early extubation group). We compared the demographics, preoperative and intraoperative clinical and laboratory markers between the two groups RESULTS: Baseline characteristics such as age, gender, MELD, MELD-Na, BMI and length of the surgery were no different between two groups (P > 0.05). On univariate analysis; coagulation parameters obtained at the end of surgery including higher INR (p= 0.03), lower platelets (p= 0.006) and lower fibrinogen (p= 0.003) were all associated with delayed extubation. Similarly intraoperative transfusion volume of RBC, platelets, FFP, autologous PRBC, cryoprecipitate, crystalloids, volume of ascitic fluid removed and low urine output were all significantly associated with delayed extubation (P <0.001). On multivariate analysis the only variable that was associated with delayed extubation was the transfusion of more than 6 units in OR (P=0.02). CONCLUSIONS: Our data suggest that several important intra-operative variables including last intraoperative coagulation labs, intraoperative transfusion requirements, lower urine output, large volume ascitic fluid removed and amount of crystalloid infused are associated with prolonged time to extubation. However on multivariate modelling only FFP transfusion of more than 6 units was associated with prolonged extubation time CLINICAL IMPLICATIONS: With identification of factors associated with early extubation in patient post liver transplant surgery, our hope is to ultimately develop risk predictor tool to determine which patients would be a candidate for rapid extubation. DISCLOSURE: The following authors have nothing to disclose: Devang Sanghavi, Kumar Sarvottam, Rahul Kashyap, Bibek Pannu, Julie Heimbach, Vivek Iyer No Product/Research Disclosure Information

Mental Health Disorders in Elderly People Receiving Home Care: Prevalence and Correlates in the National U.S. Population.

Current evidence on mental health disorders (MHDs) in the U.S. elderly home care population is highly varied and limited to the local level. The objective of this study was to examine the prevalence and characteristics of U.S. elders with MHDs on the national level. This is a primary analysis of secondary use data from a 5% random sample of the 2010 National Outcome and Assessment Information Set (OASIS) data spanning a 60-day home care session. MHDs included depression, anxiety, substance abuse, psychotic disorders, aggression, and socially inappropriate behaviors and were identified by diagnosis, symptoms, or mental health service order in the plan of care. Logistic regression was used to identify correlates of MHD. The final analysis was conducted on records from 28,475 elderly patients with an average age of 79 (range 65-110). Patients were primarily female, White, Medicare beneficiaries, referred from short-stay acute hospitals, and living with others at home. Prevalence of MHDs was approximately 40%; depression (28.0%) and anxiety (18.9%) were common. Factors associated with MHDs were younger age, female, smokers, frail, living alone, referred from psychiatric hospitals, cognitively or sensory impaired, poorer health status, recent history of falls or multiple hospitalizations, and insufficient social support. Only about one third of patients identified with MHD received mental health services during the 60-day home care episode, including psychiatric nursing services and depression interventions. MHDs are a national health concern in the older U.S. home care population and are common but largely undermanaged. Future research in the home care sector should be aimed at developing targeted MHD screening and interventional protocols and training the current workforce, as well as expanding the future workforce to improve psychiatric care for the homebound elderly.

Ergonomia odontológica: integrando teoria e prática para o avanço do ensino

O estudo objetiva descrever e analisar a experiência de uma estratégia inovadora na disciplina de ergonomia odontológica, com uso de tecnologias digitais e método ativo de ensino-aprendizagem. Foi realizado um estudo observacional, descritivo em Laboratório de Ensaios Ergonômicos de um curso de Odontologia, sobre uma estratégia de aprendizado baseado em problemas (PBL) e emprego de filmagem de atendimento clínico. Participaram 20 alunos do último ano do curso de graduação e o estudo foi desenvolvido em duas etapas: na primeira, os acadêmicos tiveram aulas expositivas dialogadas sobre princípios ergonômicos na prática odontológica para introdução do assunto; na segunda etapa, os alunos foram divididos em dois grupos: um de observadores e outro de operadores para o atendimento a pacientes. Enquanto o grupo de operadores era filmado, o outro fazia observações em tempo real, em sala anexa, com visualização direta do ambiente de atendimento através de uma janela de vidro espelhado. O entendimento dos alunos e suas respostas aos estímulos para resolução de problemas ergonômicos foram verificados, permitindo ponderar sobre as vantagens do método de ensino. Observou-se boa participação dos acadêmicos nas atividades, com apontamento dos erros, resolução dos problemas posturais, de organização de bandeja e de todo o processo de trabalho. Os alunos corrigiam sua postura durante os atendimentos realizados após as primeiras observações, mantendo-as mais adequadas durante o trabalho. Em conclusão, a metodologia empregada, aliando a aprendizagem baseada em problemas e o uso de tecnologias digitais foi importante no ensino da ergonomia odontológica.

Prevalence of herbal medicine use and associated factors among pregnant women attending antenatal care at public health facilities in Hossana Town, Southern Ethiopia: facility based cross sectional study.

BackgroundThe use of herbal medicine has been on increase in many developing and industrialized countries. More pregnant women use herbal remedies to treat pregnancy related problems due to cost-effectiveness of therapy and easy access of these products. We sought to assess the prevalence of herbal medicine use and associated factors among pregnant women attending antenatal clinics of public health facilities.MethodsFacility based cross sectional study was conducted among 363 pregnant women attending antenatal clinics from May to June 2015 at public health facilities in Hossana town, Hadiya zone, Southern Ethiopia. Pretested structured questionnaire was used to collect data from each study subject. Bivariate logistic regression analysis was used to see significance of association between the outcome and independent variables. Odds ratios at 95 % CI were computed to measure the strength of the association between the outcome and the independent variables. P-value <0.05 was considered as a statistically significant in multivariate analysis.ResultTwo hundred fifty eight (73.1 %) of pregnant women used herbal medicine during current pregnancy . The herbal medicines commonly taken during current pregnancy were ginger (55.8 %), garlic (69.8 %), eucalyptus (11.6 %), tenaadam (rutachalenssis) (26.4 %), damakesse (ocimumlamiifolium) (22.8 %), feto (3.5 %) and omore (3.1 %). Being students (AOR: (5.68, 95 % CI: (1.53, 21.13), second trimester of pregnancy (AOR: 0.22, 95 % CI: (0.08, 0.76), sufficient knowledge on herbal medicine (AOR: 0.37, 95 % CI: (0.19, 0.79), no formal education (AOR: 4.41, 95 % CI: (1.11, 17.56), primary education (AOR: 4.15, 95 % CI: (1.51, 11.45) and secondary education (AOR: 2.55, 95 % CI: (1.08,6.03) were significantly associated with herbal medicine use.ConclusionThe findings of this study showed that herbal medicine use during pregnancy is a common experience. Commonly used herbal medicines during current pregnancy were garlic, ginger, tenaadam, damakasse and eucalyptus. Educational status, occupation, knowledge on herbal medicine and second trimester of pregnancy were the major factors affecting use of herbal medicine. Health education about the effects of herbal medicine on pregnancy should be given during antenatal care sessions and through media. Health care providers, especially those that are involved in antenatal care should aware of evidence regarding potential benefits or harm of herbal medicinal agents when used by pregnant women.

La salud mental y la atención primaria en México. Experiencias de un modelo de atención colaborativa

Resumen Introducción. En México, existe poca experiencia en el desarrollo de modelos en atención primaria en salud mental. Objetivo. Estructurar y aplicar un modelo de atención colaborativa en salud mental, basado en evidencias científicas probadas en otros países. Método. Se diseñó un modelo acorde a las características del sistema de salud de la Ciudad de México. El modelo consistió en: la capacitación del equipo de salud para detectar posibles casos, la aplicación del instrumento de tamizaje (K-10), para el diagnóstico de depresión y ansiedad, así como realizar reuniones de atención colaborativa entre los médicos generales y el especialista en psiquiatría para la supervisión de casos. Se aplicó una entrevista de opinión a los médicos generales. Resultados. Se capacitaron 104 profesionistas. Durante tres años se detectaron 830 (50.5%) posibles casos, se valoraron el 38% de éstos en sesiones de atención colaborativa entre el médico general y el psiquiatra. El 50% de las sesiones fueron suspendidas por motivos administrativos principalmente; la asistencia de los médicos generales y de los pasantes de medicina fue regular. Discusión y conclusión. El modelo de atención colaborativa entre el médico general y el especialista en este contexto puede funcionar. Sin embargo, se deben resolver algunas barreras administrativas, como la organización de los servicios y el número de programas que se desarrollan en el primer nivel de atención. Ante esta limitación, y dada la experiencia, se propone que los estudiantes de servicio social de medicina se involucren en este tipo de modelos, con el apoyo de los médicos generales.

Exploring Group Composition among Young, Urban Women of Color in Prenatal Care: Implications for Satisfaction, Engagement, and Group Attendance

PurposeGroup models of prenatal care continue to grow in popularity. However, little is known about how group composition (similarity or diversity between members of groups) relates to care-related outcomes. The current investigation aimed to explore associations between prenatal care group composition with patient satisfaction, engagement, and group attendance among young, urban women of color. MethodsData were drawn from two studies conducted in New Haven and Atlanta (2001–2004; n = 557) and New York City (2008–2011; n = 375) designed to evaluate group prenatal care among young, urban women of color. Women aged 14 to 25 were assigned to group prenatal care and completed surveys during their second and third trimesters of pregnancy. Group attendance was recorded. Data were merged and analyzed guided by the Group Actor–Partner Interdependence Model using multilevel regression. Analyses explored composition in terms of age, race, ethnicity, and language. Main FindingsWomen in groups with others more diverse in age reported greater patient engagement and, in turn, attended more group sessions, b(se) = −0.01(0.01); p = .04. ConclusionThe composition of prenatal care groups seems to be associated with young women's engagement in care, ultimately relating to the number of group prenatal care sessions they attend. Creating groups diverse in age may be particularly beneficial for young, urban women of color, who have unique pregnancy needs and experiences. Future research is needed to test the generalizability of these exploratory findings.

Effects of a psycho-educational intervention on direct care workers’ communicative behaviors with residents with dementia

This study assessed the effects of a person-centered care-based psycho-educational intervention on direct care workers’ communicative behaviors with people with dementia living in aged-care facilities. An experimental study with a pretest–posttest control-group design was conducted in four aged-care facilities. Two experimental facilities received an 8-week psycho-educational intervention aiming to develop workers’ knowledge about dementia, person-centered care competences, and tools for stress management. Control facilities received education only, with no support to deal with stress. In total, 332 morning care sessions, involving 56 direct care workers (female, mean age 44.72 ± 9.02 years), were video-recorded before and 2 weeks after the intervention. The frequency and duration of a list of verbal and nonverbal communicative behaviors were analyzed. Within the experimental group there was a positive change from pre- to posttest on the frequency of all workers’ communicative behaviors. Significant treatment effects in favor of the experimental group were obtained for the frequency of inform (p < .01, η2partial = 0.09) and laugh (p < .01, η2partial = 0.18). Differences between groups emerged mainly in nonverbal communicative behaviors. The findings suggest that a person-centered care-based psycho-educational intervention can positively affect direct care workers’ communicative behaviors with residents with dementia. Further research is required to determine the extent of the benefits of this approach.

Effects of a Psychoeducational Intervention for Direct Care Workers Caring for People With Dementia: Results From a 6-Month Follow-Up Study.

This study aimed to assess the effects of a psychoeducational intervention, designed to improve direct care workers' stress, burnout and job satisfaction, and person-centered communicative behavior in people with dementia. A pretest-posttest control group design was conducted in 4 aged-care facilities. Two experimental facilities received a psychoeducational intervention, and 2 control facilities received an education only. Data were gathered from 53 care workers at baseline, immediately, and 6 months after the intervention, through self-administrated instruments and video-recorded morning care sessions. The experimental group showed a significant decrease in care workers' burnout and a significant improvement in several communicative behaviors (e.g., involvement). Stress levels deteriorated at 6 months, and no intervention effects were found for job satisfaction. The findings highlight the importance of providing care workers with both technical competences and tools for stress management, as this might be associated with a reduction in their levels of exhaustion and improved communicative behaviors.

A failing heart and the downside of life-prolonging technology.

For a man with end-stage heart failure, a left ventricular assist device prolongs life but brings dire complications.

Enhancing the Role of the Nurse in Primary Care: The RN "Co-Visit" Model.

Enhancing the Role of the Nurse in Primary Care: The RN "Co-Visit" Model.

APhA2015: You made it a success!

APhA2015: You made it a success!

Effects of yoga on utero-fetal-placental circulation in high-risk pregnancy: a randomized controlled trial.

Introduction. Impaired placentation and inadequate trophoblast invasion have been associated with the etiology of many pregnancy complications and have been correlated with the first trimester uterine artery resistance. Previous studies have shown the benefits of yoga in improving pregnancy outcomes and those of yogic visualization in revitalizing the human tissues. Methods. 59 high-risk pregnant women were randomized into yoga (n = 27) and control (n = 32) groups. The yoga group received standard care plus yoga sessions (1 hour/day, 3 times/week), from 12th to 28th week of gestation. The control group received standard care plus conventional antenatal exercises (walking). Measurements were assessed at 12th, 20th, and 28th weeks of gestation. Results. RM-ANOVA showed significantly higher values in the yoga group (28th week) for biparietal diameter (P = 0.001), head circumference (P = 0.002), femur length (P = 0.005), and estimated fetal weight (P = 0.019). The resistance index in the right uterine artery (P = 0.01), umbilical artery (P = 0.011), and fetal middle cerebral artery (P = 0.048) showed significantly lower impedance in the yoga group. Conclusion. The results of this first randomized study of yoga in high-risk pregnancy suggest that guided yogic practices and visualization can improve the intrauterine fetal growth and the utero-fetal-placental circulation.

Patient-physician relationship and ante-natal seeking behaviour in public hospitals

This study examines the roles of patient-physician relationship as the underpinning factor that may inhibit or motivate early booking of pregnancy among women in Ijebu Ogun State. The study utilizes a triangulation method of survey including in-depth interview. Ijebu-Ode carries 32.2 % (141) and Ijebu- Igbo 64.8 % (259) of the total sample representing the urban and rural populace. A structured questionnaire was administered to randomly select 400 consenting women attending ante-natal clinics session in equally randomly selected hospitals in Ijebu-Ode and Ijebu-Igbo. In addition ten percent of the women were selected through a stratified sampling method for in-depth interview. And ten in-depth interviews (IDIs) were conducted among gynaecologist nurses and other health workers. The study identifies a non-cordial relationship between physicians and ante-natal patients which in turn serves as a reason for late booking of pregnancy and irregular attendance of pregnant women at ante-natal care sessions. Qualitative data reveal that many of the pregnant women stay away from ante-natal care because of the uncooperative manner of the physician by not giving enough attention and the use of abusive vague and ambiguous words which are not discernable to barely literate patients. The study concludes that early booking of pregnancy by women is influenced by their closeness and mutual relationship with their physician. And therefore suggests that physicians should pay due diligence to the relationship that exists between them and patients and the appropriate organs of government agency and non-governmental organizations (NGOs) should encourage the dissemination of maternal health education.

Does knowledge of danger signs of pregnancy predict birth preparedness? A critique of the evidence from women admitted with pregnancy complications.

BackgroundImproved knowledge of obstetric danger signs, birth preparedness practices, and readiness for emergency complications are among the strategies aimed at both enhancing utilization of maternal health services and increasing access to skilled care during childbirth, particularly for women with obstetric complications. It is unclear whether knowledge of danger signs translates into improved birth preparedness and complication readiness. The objective was to assess the association between knowledge of danger signs and birth preparedness among women admitted with pregnancy complications.MethodsThe study included 810 women admitted in the antepartum period to Mulago hospital, Uganda. Data was collected on socio-demographic characteristics, reproductive history, pregnancy complications, knowledge of danger signs, and birth preparedness/complication readiness (BPCR). Logistic regression analyses were conducted to explore the relationship between knowledge of danger signs and birth preparedness.ResultsOnly about 1 in 3 women were able to mention at least three of the five basic components of BPCR, and could be regarded as ‘knowledgeable on BPCR’. One in every 4 women could not mention any of the five components. Women with history of obstetric problems during the previous pregnancy were more likely to be knowledgeable on danger signs when compared to those who had no complications in prior pregnancy. Women who were knowledgeable on danger signs were four times more likely to be knowledgeable on BPCR as compared to those who were not knowledgeable.ConclusionsThough awareness about danger signs was low, knowledge of danger signs was associated with knowledge of birth preparedness. More emphasis should be given to emergency/complication readiness during antenatal care sessions. There is a need to strengthen existing policy interventions to address birth preparedness and complication readiness for obstetric emergencies.