Inner-city University Research Articles

Comparing Group Versus Individual Prenatal Care on Breastfeeding Practice and Motivational Factors.

Although breastfeeding in the first 6 months postpartum benefits both infants and mothers, breastfeeding rates remain low. This study examined whether group prenatal care was associated with an increased breastfeeding initiation and duration compared with those receiving usual, individual prenatal care. A secondary aim was to investigate whether sociodemographic and motivational factors were associated with breastfeeding initiation and duration across prenatal care groups. Pregnant women in their third trimester ( n = 211) from an innercity university medical center participated. Prenatal care type was identified from the medical chart, and data on breastfeeding duration at 1, 3, and 6 months postpartum were collected. Breastfeeding motivational factors were assessed with a survey. Logistic regressions and independent-samples t tests were used for data analyses. After controlling for demographic factors, group prenatal care was associated with increased breastfeeding at 6 months postpartum (odds ratio = 2.66; P = .045) compared with individual care. Breastfeeding intention ( P < .001), competence ( P = .003), and autonomous motivation ( P < .001) were significantly higher, while amotivation ( P = .034) was significantly lower in group compared with individual prenatal care. Breastfeeding persistence was higher among women receiving group prenatal care, potentially due to motivational factors. Future studies should investigate how breastfeeding motivational factors could be effectively targeted in prenatal care to increase breastfeeding persistence.

Urban Food Infrastructures: The Role of Inner-City Universities

ABSTRACT Urban food infrastructures are oft-forgotten as crucial for sustainability transitions. This ethnographic case study explores the eating spaces of an inner-city university to assess its sustainability outcomes. By considering knowledge as embedded in and through social practices as “general understandings”, the paper argues that the neo-liberal organisation of eating spaces understands campus spaces as assets, conceives students as individualistic consumers, and outsources sustainability initiatives. The paper contends that these understandings have established a dominant pathway for retail prioritised, gentrified and uni-functional eating spaces, marginalising some existing hybrid and convivial food infrastructures that may be pathways for sustainable and just outcomes.

A Drone Logistic Model for Transporting the Complete Analytic Volume of a Large-Scale University Laboratory.

We present a model for drone transport of the complete annual analytic volume of 6.5 million analyses—(routine and emergency) between two inner-city university laboratories at Oslo University Hospital located 1.8 km apart and with a time restriction for the analyses of no more than 60 min. The total laboratory activity was analyzed per min for the complete year of 2018. The time from the clinical ordering of tests to the loading of the drone, drone transport time, and analysis time after the sample arrived at the analyzing laboratory were assessed using the lead time of emergency analyses of C-reactive protein, troponin, and the international normalized ratio. The activity had characteristic diurnal patterns, with the most intensive traffic between 8 and 12 a.m. on weekdays and there being considerably less traffic for the rest of the day, at night and on weekends. Drone schedules with departures 15–60 min apart were simulated. A maximum of 15 min between flights was required to meet the emergency demand for the analyses being completed within 60 min. The required drone weight capacity was below 3.5 kg at all times. In multiple simulations, the drone times were appropriate, whereas variations in the clinic- and laboratory-related time intervals caused violations of the allowed time 50% of the time. Drone transport with regular schedules may potentially improve the transport time compared with traditional ground transport and allow the merging of large laboratories, even when the demand for emergency analyses restricts the maximum transport time. Comprehensive economic evaluations and robust drone technology are needed before such solutions can be ready for implementation.

Group B streptococcal colonization: Prevalence and impact of smoking in women delivering term or near term neonates in a large tertiary care hospital in the southern United States.

The role of smoking as a risk factor for group B streptococcal (GBS) colonization in women during pregnancy has not been previously adequately explored. We hypothesized that women of term or near term neonates who smoked during pregnancy were more likely to have GBS colonization than their non-smoking counterparts. The electronic health records (EHRs) of a convenience sample of women delivering in an inner-city university tertiary care center were reviewed. The outcome variable of interest was maternal GBS colonization during pregnancy. The primary independent variable of interest was tobacco smoking during pregnancy, determined from the EHRs by the number of cigarettes smoked during gestation. Descriptive statistics were conducted and categorical data were compared by the Fischer's exact test. Multiple logistic regression analysis was further conducted to determine the independent impact of tobacco smoke exposure on GBS colonization. The prevalence of maternal GBS colonization was 35% among the study population. In the univariate analyses, factors associated with maternal GBS colonization were tobacco smoking during pregnancy (P of trend <0.001), Race (P<0.001), maternal age <20 years (P = 0.006), low birthweight <2500 gm (P = 0.020), maternal drug use (P = 004), and gestational age <37 (P = 0.041). In a multiple logistic regression analysis, tobacco smoking during pregnancy remained the most significant predictor of GBS colonization. Women who smoked during pregnancy were more than twice more likely to be colonized than their non-smoking counterparts (OR = 2.6; 95% CI = 1.5-4.6; p<0.001). Maternal age was the only other significant predictor with younger mothers more than one and a half time more likely to be colonized than their older counterparts (OR = 1.65; 95% CI = 1.02-2.68; P = 0.04). The prevalence of GBS colonization in this institution was consistent with recent national rates. Smoking and maternal age were identified as two independent risk factors for GBS colonization during pregnancy. Further studies are needed to confirm these findings.

Critical place-based pedagogy in an inner-city university department: truth, reconciliation and neoliberal austerity

ABSTRACT In 2015, Canada’s Truth and Reconciliation Commission of Canada (TRC) described Canada’s residential school policy, established in the 1880’s and active through most of the 20th century, as ‘cultural genocide’. Earlier that same year, Maclean’s magazine described Winnipeg as Canada’s most racist Winnipeg. Winnipeg, situated on Treaty One territory, has the largest Indigenous population of any Canadian City. Situated in the centre of the City, The University of Winnipeg is seeking ways to respond to the TRC Calls to Action and is exploring ways to Indigenise. In this paper I describe the pedagogical approach of a small university department purposefully situated outside of the main campus in a low-income inner-city neighbourhood with a large Indigenous population. The department integrates critical, place-based pedagogies rooted in an understanding of systemic oppression. We agree that reconciliation begins with acknowledging the truth about the past and present damage caused by colonial policies. Despite the fact that what we have learned is essential to reconciliation in the postsecondary education context, we face many obstacles in a political context driven by neoliberal austerity that threatens our approach and makes reconciliation near impossible to achieve.

How can community-university engagement address family violence prevention? One child at a time.

Family violence in Indigenous communities is one of the most pressing policy challenges of our times. This issue is highly related to the stressors caused by the disadvantaged socio-economic circumstances of Indigenous peoples, such as poverty and unemployment, and community trauma attributed to colonization and a loss of culture. This article is a case study based on the evaluations of four community-university engagement initiatives for Indigenous children, youth, and their families at a small inner-city university. It documents six principles for policy development used to engage students in their education and to begin to perceive themselves as high school and post-secondary graduates. These programs are just a few examples of how a small inner-city university took an imaginative community development approach to promoting social change, with each program tantamount to an anti-violence strategy.

Community Learning and University Policy: An Inner-City University Goes Back to School

For at least a decade now, the University of Winnipeg (U of W), an urban institution on Treaty One land in the heart of the Métis Nation, has challenged existing academic models and practices, and has incorporated strategies that address the social divide between Indigenous and non-Indigenous peoples in order to more effectively serve the learning needs of its surrounding community. This article demonstrates how an inner-city university has used internal policies and programs to help support the self-determination of Indigenous peoples. Six community learning initiatives were recently evaluated for impact. This article will provide an overview of the positive outcomes of these learning initiatives on a community of underrepresented learners.

Feminine Role Norms Among Australian and Italian Women: a Cross-Cultural Comparison

Australia and Italy are both nations where complex contradictions exist in the current social roles and expectations for women. The current study used the Conformity to Feminine Norms Inventory (CFNI: Mahalik et al. 2005) to compare the endorsement of eight feminine norms (Nice in Relationships, Thinness, Care for Children, Modesty, Domestic, Romantic Relationships, Sexual Fidelity, Invest in Appearance) by samples of Australian and Italian women, and to demonstrate how any observed differences relate to social and historical differences between the two nations. Two hundred forty-six female undergraduate students from an inner-city university on the East coast of Australia and 187 female undergraduate students from two universities in North-East Italy completed the CFNI. Comparisons were made between the two samples on the eight norms that the inventory examines. Italian women endorsed the Domestic and Romantic Relationships norms to a greater degree than Australian women, whereas Australian women endorsed the Nice in Relationships, Modesty and Sexual Fidelity norms to a greater degree than Italian women. Both samples endorsed the Thinness, Care for Children and Invest in Appearance norms to a similar degree. The current results are discussed in terms of other relevant findings regarding women’s roles in the two nations. The results both highlight the need to avoid the assumption that Western cultures are uniform with their expectations of women, while emphasizing the central roles that physical appearance and child-rearing still play in women’s social roles.

The prevalence of body dysmorphic disorder among South African university students

Background. The prevalence of body dysmorphic disorder (BDD) among South African students is explored in this article. BDD is regarded as an obsessive-compulsive-related disorder characterised by a preoccupation with one or more perceived defects or flaws in physical appearance and expressed in repetitive behaviours or mental acts as a response to the appearance concerns, causing clinically significant distress or impairment in functioning. Objectives. To determine the prevalence of BDD among undergraduate students ( N =395) at an inner-city university. Methods. Proportionate stratified random cluster sampling was used to select the sample. The students completed a demographics survey and the Body Image Disturbance Questionnaire. Results and conclusion. An overall prevalence rate of 5.1% was found in this study, which is similar to prevalence rates reported in existing literature among student populations. No clinically significant differences in the severity of the BDD were found on the demographic variables of gender, race or sexual orientation. However, students differed significantly in their experience of the severity of the disorder in terms of age, in that students over the age of 21 reported higher severity levels than students under the age of 21. Although the prevalence of the disorder compares with that in other countries, its severity seems to increase with age among South African students.

The prevalence of body dysmorphic disorder among South African university students

&lt;p&gt;&lt;strong&gt;Background.&lt;/strong&gt;&lt;em&gt; &lt;/em&gt;The prevalence of body dysmorphic disorder (BDD) among South African students is explored in this article. BDD is regarded as an obsessive-compulsive-related disorder characterised by a preoccupation with one or more perceived defects or flaws in physical appearance and expressed in repetitive behaviours or mental acts as a response to the appearance concerns, causing clinically significant distress or impairment in functioning. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives.&lt;/strong&gt; To determine the prevalence of BDD among undergraduate students (&lt;em&gt;N&lt;/em&gt;=395) at an inner-city university. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods.&lt;/strong&gt; Proportionate stratified random cluster sampling was used to select the sample. The students completed a demographics survey and the Body Image Disturbance Questionnaire. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results and conclusion.&lt;/strong&gt; An overall prevalence rate of 5.1% was found in this study, which is similar to prevalence rates reported in existing literature among student populations. No clinically significant differences in the severity of the BDD were found on the demographic variables of gender, race or sexual orientation. However, students differed significantly in their experience of the severity of the disorder in terms of age, in that students over the age of 21 reported higher severity levels than students under the age of 21. Although the prevalence of the disorder compares with that in other countries, its severity seems to increase with age among South African students.&lt;/p&gt;

Do medicine residents triage patients with gastrointestinal bleeding appropriately?

Background: Gastrointestinal specialists depend on internal medicine (IM) teams to accurately identify acute gastrointestinal bleeding (GIB). We evaluated whether IM residents’ assessment of GIB correlated with the impressions of GI specialists during consultations at an inner-city university teaching hospital. Methods: A questionnaire was distributed to house staff requesting GIB consultations and to the GI fellows performing the consults between August 2011 and April 2012. Residents and fellows were asked to assess GIB, specifically melena, using a stool color card and digital rectal examination (DRE) findings. Fellow DRE findings served as controls for stool color identification. Results: Eighty-seven GI consults were eligible for the study. Residents and fellows completed 81 and 86 questionnaires, respectively. A total of 76 questionnaires were included for analysis. A DRE was performed by medical staff before calling a consult in 65% of cases compared with fellows (97% of cases, P = 0.0001). Residents more frequently labeled stool as melena (42%) in patients as compared with fellows (12%, P = 0.0001). Residents inaccurately identified melenic stools in 22 patients (11 based on stool color and 11 based on DRE findings). Residents were more likely to label a consult as emergent than fellows (13.5% vs 4%, P < 0.05). Conclusion: Residents are less likely to perform DRE during an evaluation for GIB and to accurately identify melena based on stool color or DRE findings. There appears to be a need to educate residents on the appropriate terminology for stool color and the importance of DRE to accurately triage patients with acute GIBs.

Using the Construct of the Didactic Contract to Understand Student Transition into University Mathematics Education

In this article the concept of the Didactic Contract is used to investigate student ‘transition’ from upper secondary into university mathematics education. The findings are anchored in data from the TransMaths project, more particularly the case of an ethnic minority student's journey from his school to a university mathematics course taught at a large inner-city university in England. Results show that there is a transformation (or rupture) of the Didactic Contract from school to university mathematics, and that this is likely to have serious consequences for students' success, or failure, at this crossroads of students' mathematical development, in particular if students are left to ‘bridge the gap’ from one contract to the other. Further, the author argues that in order to help to smooth the passage, a refinement of the Didactic Contract is helpful, a re-conceptualisation in terms of Normative Didactic Contract and Personal Didactic Contract, and each needs to be considered at each level of development. This is likely to raise awareness about the necessary conditions for success at both sides of the transition junction, and providing appropriate support for students at both levels is likely to provide access for more students to successfully stay in higher education mathematics.

An asthma sports camp series to identify children with possible asthma and cardiovascular risk factors

Background: The prevalence of asthma and obesity in children has increased over the past several years, with obesity being associated with higher rates of asthma. In response to known disparities in asthma prevalence and morbidity, along with barriers to diagnosis, assessment and education, a comprehensive asthma sports camp series was developed and implemented.Objective: The primary objective was to evaluate the effectiveness of utilizing a sports camp model to identify children with undiagnosed and uncontrolled asthma, and to provide recommendations for follow-up care. The secondary objectives were to identify the presence of and associations between related co-morbidities and risk factors for asthma morbidity such as obesity, hypertension and exposure to tobacco smoke; and to assess asthma medication use.Methods: Six daylong camps at an inner-city university were offered to children 5–17 years of age over a period of two years. Asthma, body mass index, blood pressure (BP) and carbon monoxide screenings were conducted at each camp.Results: In this sample, 43.7% of children had previously diagnosed asthma, and 12.6% were classified as having potential, undiagnosed asthma. Of the children with previously diagnosed asthma, 76% were considered uncontrolled. Thirty-eight percent were determined to be overweight or obese and 17% had elevated BP.Conclusions: An interdisciplinary sports camp model can be used to identify children with undiagnosed and uncontrolled asthma and cardiovascular risk factors; and to provide recommendations for follow-up care.

Two-Year Outcomes of an Initial Series of DSAEK Cases in Normal and Abnormal Eyes at an Inner-City University Practice

To report our initial series of Descemet stripping automated endothelial keratoplasty (DSAEK) patients with 2 years of follow-up and to compare the complications and outcomes between normal and abnormal eyes. Records of all patients who underwent DSAEK between April 2007 and April 2009 were reviewed. Eyes were categorized as "normal" or "abnormal" for comparison. Two risk factors, anterior chamber compromise and glaucoma tube/bleb, were analyzed for association with tissue detachment. Thirteen DSAEKs were performed on 13 "normal" eyes, and 18 DSAEKs were performed on 15 "abnormal" eyes. The lenticule detachment rates were 15.4% in the normal group and 41.2% in the abnormal group (P = 0.13). The difference in endothelial cell loss was not significant until 1.5 years postoperatively in favor of the abnormal group (P = 0.024). The mean starting vision was 20/115 for the normal group and 20/322 for the abnormal group (P = 0.06). At 2 years, the mean visual acuity was 20/47 for the normal group and 20/34 for the abnormal group (P = 0.44). Risk factor analyses indicated that glaucoma tubes/blebs were not related to lenticule detachment (P = 0.45), whereas anterior chamber compromise was related to lenticule detachment (P = 0.031). Complication rates for abnormal eyes are higher than those for normal eyes, and risk factor analyses suggest that marked anterior chamber compromise is related to lenticule detachment. However, if DSAEK is successful for these compromised eyes, the visual outcomes compare favorably with normal eyes through 2 years of follow-up.

Efficacy and safety of a clinical protocol for expectant management of selected women diagnosed with a tubal ectopic pregnancy

To validate the efficacy and safety of our clinical protocol for expectant management of selected women diagnosed with tubal ectopic pregnancy. This was a prospective observational study carried out in the early pregnancy unit of a London inner-city university teaching hospital from 1(st) January 2008 to 31(st) May 2011. All women presenting with suspected early pregnancy complications were assessed clinically and by transvaginal ultrasound. Those with a conclusive ultrasound diagnosis of tubal ectopic pregnancy were selected for either surgical or expectant management. Selection criteria for expectant management were clinical stability with no or minimal abdominal pain, no evidence of significant hemoperitoneum on ultrasound scan, ectopic pregnancy measuring < 30 mm in mean diameter with no evidence of embryonic cardiac activity, serum β-human chorionic gonadotropin (β-hCG) < 1500 IU/L and the woman's consent. All women selected for expectant management were followed up as outpatients until the ectopic pregnancy regressed spontaneously (resolution of clinical symptoms, serum β-hCG < 20 IU/L/negative urine pregnancy test) or surgical intervention was required. We recorded the rate of interventions, complications and length of follow-up. During the study period 339/11 520 (2.9% (95% CI, 2.59-3.21%)) women were diagnosed with tubal ectopic pregnancy. Six women opted to participate in an ongoing randomized controlled trial and were excluded from further analysis. One hundred and sixty-five (49.5% (95% CI, 44.2-55.0%)) of the 333 remaining women met the criteria for expectant management; 146/333 (43.8% (95% CI, 38.5-49.1%)) of them opted for expectant management and 104/333 (31.2% (95% CI, 26.2-36.2%)) of all tubal ectopics resolved without requiring any intervention. All women with failed expectant management were treated by laparoscopic salpingectomy/salpingotomy and none of them required a blood transfusion. Our clinical protocol for expectant management of tubal ectopic pregnancies eliminates the need for medical or surgical treatment in more than a third of women diagnosed with tubal ectopic pregnancy with a minimum risk of adverse outcome.

E-Learning, Ethics and ‘Non-traditional’ Students: Space to Think Aloud

This paper considers the piloting of an online learning component of a final-year social work degree ethics module at an inner-city English university. An Action Research approach was used to evaluate this pilot project and the paper illustrates how students were involved in developing and designing the teaching programme as part of the Action Research cycle. The paper explores theoretical aspects of e-learning pedagogy through an analysis of issues emerging during the planning and delivery of this pilot project. The cognitive and affective impact of both face-to-face and electronic learning is discussed. It is suggested that some students may experience e-learning as a safe space for thinking about ethical dilemmas. The challenges for teachers and learners are highlighted and the author argues that in order to support student learning, online teaching needs to be carefully designed and appropriately resourced.

Mo1271 Comparison of Internal Medicine Residents to GI Fellows in the Assessment of Patients With GIB at an Inner-City University Teaching Hospital: Are Patients Triaged Appropriately?

Comparison of Internal Medicine Residents to GI Fellows in the Assessment of Patients With GIB at an Inner-City University Teaching Hospital: Are Patients Triaged Appropriately? Priti Bijpuria*, Alexander Schlachterman, Scott Naples, Asyia S. Ahmad Gastroenterology, Drexel University, Philadelphia, PA Background: It is essential for physicians to accurately identify acute gastrointestinal bleeding (GIB) as urgent endoscopy may be indicated in patient with melena or hematemesis and for those patients with significant comorbidities such as coronary artery disease (CAD). GI specialists are dependent on primary medicine teams to accurately communicate patient information in the setting of GIB. There has been no study to date identifying the accuracy of internal medicine residents’ initial evaluation of GIB. Objective: To evaluate whether the accuracy of internal medicine (IM) residents’ assessment of GIB in patients correlates with the impression of GI specialists during consultation at an innercity university teaching hospital. Methods: Prospective study of inpatient GIB consultations requested from 8/2011 to 11/2011. A questionnaire was distributed to house staff requesting GIB consultations as well as to the GI fellows performing the consult. The questionnaire assessed physical exam, treatment, medications and past medical history. In addition, both the residents and fellows were asked to assess GIB, specifically melena, based on 1) stool color using a stool color card and 2) by rectal findings. Fellow digital rectal exam (DRE) findings served as a control for stool color identification. Results: There were 142 residents and 6 GI fellows eligible for this study. Thirty-nine GI consults have been evaluated to date. Of these consults, residents completed the questionnaire in 37 patients and fellows completed all 39 questionnaires. Residents were less likely to do a DRE to support their diagnosis of GIB 22 of 36 (61%) compared to fellows 34 of 38 (89%); p 0.006. When asked to characterize the stool of a presumed GIB, residents more frequently labeled stool as melena in 13 of 33 (39%) patients as compared with fellows in 3 of 38 (7.9%) patients; p 0.002. Residents inaccurately identified melanotic stools in ten patients. Four were incorrect based on the stool color and the other 6 were inaccurately labeled melena based on DRE findings that contradicted fellow findings. Finally, residents’ identified CAD in 14 of 29 patients (48%) whereas fellows identified CAD in only 7 of 34 patients (21%); p 0.03. Conclusion: Preliminary data indicates residents are less likely to perform DRE during evaluation for GIB and are less likely to accurately identify melena based on stool color or DRE findings. Surprisingly, residents were more likely than GI fellows to ascertain a history of CAD in GIB patients even though CAD is a significant comorbidity that impacts both the approach and timing of endoscopy. There appears to be a need to educate both residents and GI fellows on the appropriate triage of patients with acute GIBs. In addition, improved communication between services is necessary especially in high-risk patients.

Evidence into practice for midwifery-led care: part 3

This is the third article in this series describing the development, implementation and evaluation of evidence-based guidelines for midwifery-led care in the labour ward of an inner-city university teaching hospital. This article presents two final strands of the evaluation: 1) measurement of changes of practice through the use of routinely available data and 2) views of users of the maternity services. Perceptions of changes in practice previously identified by midwives, in the areas of electronic fetal monitoring and amniotomy, were also demonstrated in the routinely available data. Local user groups found the guidelines both ‘acceptable’ and ‘useful’. The Maternity Forum spoke positively about a cultural change they felt the guidelines represented. This initiative took place in one setting and the outcome is of greatest relevance to this locality. However, acknowledging that and the relatively small numbers involved in certain elements of the evaluation, both the process and the findings may be applicable to similar initiatives in other settings.

Prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure.

To describe prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure. Analysis of prospectively collected data. A multidisciplinary intensive care unit of an inner-city university hospital. Patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure from August 1995 through July 1998. Data were obtained concerning demographics, arterial blood gas, Acute Physiology and Chronic Health Evaluation (APACHE) II score, sepsis, mechanical ventilation, organ failure, complications, and hospital mortality rate. Fifty-nine percent of patients were male, 63% white, and 36% African-American; the mean age was 63.1 +/- 8.9 yrs. Noninvasive mechanical ventilation was tried in 40% of patients and was successful in 54% of them. Invasive mechanical ventilation was required in 61% of the 250 admissions. Sepsis developed in 31% of patients, nonpulmonary organ failure in 20%, pneumothorax in 3%, and acute respiratory distress syndrome in 2%. Multiple organ failure developed in 31% of patients with sepsis compared with 3% without sepsis (p <.0001). Predicted and observed hospital mortality rates were 30% and 15%, respectively. Differences in age and arterial carbon dioxide and oxygen tensions between survivors and nonsurvivors were not significant. Arterial pH was lower in nonsurvivors than in survivors (7.21 vs. 7.25, p =.0408). The APACHE II-predicted mortality rate (p =.0001; odds ratio, 1.046; 95% confidence interval, 1.022-1.070) and number of organ failures (p <.0001; odds ratio, 5.524; 95% confidence interval, 3.041-10.031) were independent predictors of hospital outcome; invasive mechanical ventilation was not an independent predictor. Physiologic abnormalities at admission to an intensive care unit and development of nonrespiratory organ failure are important predictors of hospital outcome for critically ill patients with chronic obstructive pulmonary disease who have acute respiratory failure. Improved outcome would require prevention and appropriate treatment of sepsis and multiple organ failure.

Evidence into practice for midwifery-led care: part 2

This paper is the second in our series following the development of evidence-based guidelines for midwifery-led care in the labour ward of an inner-city university teaching hospital. The first part of the evaluation of the initiative is presented here. It sought midwives' views through group discussions using the SWOT analysis technique and semi-structured interviews with a random and purposive sample and it measured the guidelines against an external appraisal instrument. The midwives were positive about being involved in the process of development and found the guidelines useful in defining and supporting autonomous midwifery practice. They also perceived significant changes in practice. The guidelines complied well with the majority of the criteria in the appraisal tool.