Labor Monitoring Research Articles

Predictors of success of trial of labor after cesarean section: A nested case-control study at public hospitals in Eastern Ethiopia.

Background:One of the primary reasons for an increase in cesarean sections is obstetricians’ uncertainty about labor trial safety following a previous cesarean section. The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%. However, to the best of our knowledge, there is a scarcity of information on the determinants of vaginal birth after cesarean delivery in the study area. As a result, the purpose of this study was to identify predictors of successful vaginal birth after cesarean delivery in public hospitals in Eastern Ethiopia.Methods:A nested case–control study design was used within a prospective follow-up study conducted from June to October 2020. A total of 220 women who tried vaginal birth after cesarean delivery was included, 110 cases and 110 controls. Cases were women with one previous cesarean section scar and successfully proceed with vaginal delivery. The controls were those with an earlier cesarean section scar and delivered by emergency cesarean section after trial of labor. A pre-tested structured questionnaire was used to gather the information. Multiple logistic regression is used to identify the determinants for the success of vaginal birth after cesarean section; odds ratio with its 95% CI are used to report the findings.Results:We found that living in rural areas (AOR = 2.28; 95% CI (1.85, 12.41)), having a current antenatal care follow-up (AOR = 3.20; 95% CI (1.15, 8.87)) and partograph monitoring of labor (AOR = 4.26; 95% CI (1.90, 9.57)) had a positive association with successful vaginal birth after cesarean section. In contrast, the presence of meconium-stained amniotic liquor (AOR = 0.10; 95% CI (0.01, 0.75)) and history of stillbirth (AOR = 0.07; 95% CI (0.02, 0.53)) reducing the chance of success of the trial.Conclusion:Past obstetric history, such as stillbirth, history of labor trial after primary cesarean section, and prior vaginal birth, were significant predictors for achieving vaginal birth after cesarean section. Antenatal care visit, and partograph follow-up were the current obstetric characteristics positively associated with the trial of labor.

Проблеми міжнародно-правового регулювання захисту трудових прав дітей та підлітків

The article is devoted to the analysis of international legal acts regulating labor relations of children and adolescents, as well as the problems of their international legal protection. It has been proven that child labor is considered work that is harmful and dangerous for the child and is prohibited by international and national law. Considerable attention is paid to the analysis of the main categories of child labor: the performance of work by a child who has reached the minimum age in accordance with national legislation and the worst forms of child labor. It has been shown that, in accordance with the provisions of the Universal Declaration of Human Rights, the basis of freedom, justice and universal peace is the recognition of the equal dignity of all members of the human family and of their equal and inalienable rights. Human rights are one of the basic and most precious human values that must be upheld and respected. The future of each person and humanity in general, potentially depends on the younger generation, so ensuring the rights of children and their legal protection, of course, is the main task of today, in which the whole world community should be interested. Proof of this is not only the recognition by the international community that the child, due to his physical and mental immaturity, needs special protection and care, appropriate legal protection, both before and after birth, but also the recognition of children as independent subjects. It is emphasized that the main reason for the use of child labor is not economic efficiency, but the fact that children are easier to manage. Children are not fully aware and are not ready to defend their rights, complain less and adapt more easily to the environment. Also, in case of certain problems, it is easier to sacrifice children. For most employers, children are a reserve of labor that can be hired and fired at will. And if the work of children is illegal, then neither parents nor the children themselves will complain about the fear of losing a job that brings, albeit insignificant, but earnings. It is concluded that despite the fact that the problem of child labor has been eradicated over the centuries, society's attitude to the problem of child labor and its negative consequences, wide awareness of children's rights and ways to protect them, significant reduction of poverty and unemployment, introduction of child labor monitoring and strict state control over compliance with the requirements of child labor legislation should help reduce the scale of child labor and ensure the right of every child to a full childhood. The causes of child labor, their consequences are determined, the priority directions of child labor eradication are indicated.

Consistency and timeliness of intrapartum care interventions as predictors of intrapartum stillbirth in public health facilities of Addis Ababa, Ethiopia: a case-control study.

Introductionapproximately one-third of the global stillbirth burden occurs during intrapartum period. Intrapartum stillbirths occurring in the health facilities imply that a foetus was alive on admission to labour and had greater chances of survival with optimum obstetric care. Active monitoring and follow-up by skilled birth attendants becomes critical to determine the progress of labour and to decide any emergency obstetrical care actions. Timely monitoring of labour progress indicators including fetal heart rate (FHR), uterine contraction maternal vital signs, vaginal examination (VE) are vital in reducing intrapartum stillbirth.Methodsa case-control study was conducted using primary data from chart review of medical records of women who experienced intrapartum stillbirth in 20 public health centres and 3 public hospitals of Addis Ababa between July 1st, 2010 to June 30th, 2015. Data were collected from charts of all cases of intrapartum stillbirths meeting the inclusion criteria and randomly selected charts of controls from each public health facility in 2: 1 control to case ratio.Resultsover 90% of both cases and controls received FHR monitoring care albeit the timing was substandard. More women in the live birth group than intrapartum stillbirth group received timely care related to uterine contraction (OR 2.42, 95% CI 1.77 - 3.30) and blood pressure monitoring (aOR 1.41, 95% CI 1.09 - 1.81). 1.2% and 0.3% of women in the intrapartum stillbirth and livebirth groups developed eclampsia respectively.Conclusionsubstandard timing and application of labour monitoring interventions including FHR, uterine contraction can predict intrapartum stillbirth in public health facilities.

Features of social and labour monitoring in the conditions of transition to remote employment

The paper discusses the need to develop effective tools for social and labour monitoring of personnel with regard to the transition to remote employment. It shows that the percentage of employees working remotely has increased over time. The events of 2020 only strengthened this trend and accelerated many processes associated with the digitalization of management and production processes. The purpose of the study is to analyze and assess the features of social and labour monitoring in the context of the transition to remote employment. Many companies use special software tools to judge the effectiveness of the use of working time. The authors have analyzed the software products most often used by companies in the transition to remote employment and identified the principles that companies should adhere to in order to effectively transform their activities in the current environment. The implementation of such systems is always associated with the ethical side of control. Therefore, finding a balance between control and trust is an important condition for effective work. A comparative analysis of the level of technical equipment by country has been carried out. The authors have drawn conclusions about the possibilities of switching to a hybrid mode of operation for certain areas of activity in the future. The greatest potential for remote employment remains among well-qualified workers. The article shows that the possibilities of switching to remote employment directly depend on the structure of the economy (the share of the financial sector and agriculture), as well as on the possibility of automating the type of activity that brings the greatest income to the state.

Maternal Deaths due to Obstetric Haemorrhage in Dodoma Regional Referral Hospital, Tanzania

Background Despite the availability of comprehensive emergency obstetric care at Dodoma Regional Referral Hospital, deaths due to obstetric haemorrhage are still high. This study was carried out to analyse the circumstances that had caused these deaths. Methods A retrospective review of all files of women who had died of obstetric haemorrhage from January 2018 to December 2019 was made. Results A total of 18,296 women gave birth at DRRH; out of these, 61 died of pregnancy-related complications of the deceased while 23 (38%) died of haemorrhage, with many of them 10 (44%) between the age of 30 and 34. Many were grand multiparous women 8 (35%) and almost half of them (11 (48%)) had stayed at DRRH for less than 24 hours. More than half (12 (52%)) had delivered by caesarean section followed by laparotomy due to ruptured uterus (8 (35%)). The leading contributing factors to the deaths of these women were late referral (6 (26%)), delays in managing postpartum haemorrhage due to uterine atony (4 (17%)), inadequate preparations in patients with the possibility of developing PPH (4 (17%)), and delay in performing caesarean section (3 (13%)). Conclusion Maternal mortality due to obstetric haemorrhage is high at Dodoma Regional Referral Hospital where more than one-third of women died between 2018 and 2019. Almost all of these deaths were avoidable. The leading contributing factors were late referral from other health facilities, inadequate skills in managing PPH due to uterine atony, delays in performing caesarean section at DRRH, and inadequate preparation for managing PPH in patients with abruptio placentae and IUFD which are risk factors for the condition. There is a need of conducting supportive supervision, mentorship, and other modes of teaching programmes on the management of obstetric haemorrhage to health care workers of referring facilities as well as those at DRRH. Monitoring of labour by using partograph and identifying pregnant women at risk should also be emphasized in order to avoid uterine rupture.

Prevalence and predictors of uterine rupture among Ethiopian women: A systematic review and meta-analysis.

Uterine rupture has a significant public health importance, contributing to 13% of maternal mortality and 74%-92% of perinatal mortality in Sub-Saharan Africa, and 36% of maternal mortality in Ethiopia. The prevalence and predictors of uterine rupture were highly variable and inconclusive across studies in the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence and predictor of uterine rupture in Ethiopia. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist. PubMed, Cochrane Library, Google Scholar, and African Journals Online databases were searched. The Newcastle- Ottawa quality assessment tool was used for critical appraisal. I2 statistic and Egger's tests were used to assess the heterogeneity and publication bias, respectively. The random-effects model was used to estimate the pooled prevalence and odds ratios with a 95% confidence interval. Sixteen studies were included, with a total of 91,784 women in the meta-analysis. The pooled prevalence of uterine rupture was 2% (95% CI: 1.99, 3.01). The highest prevalence was observed in the Amhara regional state (5%) and the lowest was in Tigray region (1%). Previous cesarean delivery (OR = 9.95, 95% CI: 3.09, 32.0), lack of antenatal care visit (OR = 8.40, 95% CI: 4.5, 15.7), rural residence (OR = 4.75, 95% CI: 1.17, 19.3), grand multiparity (OR = 4.49, 95% CI: 2.83, 7.11) and obstructed labor (OR = 6.75, 95%CI: 1.92, 23.8) were predictors of uterine rupture. Uterine rupture is still high in Ethiopia. Therefore, proper auditing on the appropriateness of cesarean section and proper labor monitoring, improving antenatal care visit, and birth preparedness and complication readiness plan are needed. Moreover, early referral and family planning utilization are the recommended interventions to reduce the burden of uterine rupture among Ethiopia women.

Pediatric Mercury Exposure Among Children Involved in Artisanal and Small-Scale Gold Mining

Background: Artisanal and small-scale gold mining (ASGM) accounts for approximately 15 to 25% of the world’s gold production and is one of the largest sources of mercury released into the environment among low- and middle-income countries (LMICs).1 The International Labour Organization states that there are 4 to 5 million women and children working in ASGM. Mercury vapor produced from heating mercury-gold amalgam can lead to tremors, memory loss, and respiratory dysfunction. As of March 2020, 128 signatories have ratified the Minamata Convention, an aggressive policy action designed to protect human and environmental health from adverse effects of mercury. Despite this action, ~1,400 tons of mercury emissions annually from more than 70 countries. Methods: Published literature was examined to summarize adverse pediatric health outcomes associated with gold mining. The literature review included identifying data gaps needed to conduct cohort studies including the age of workers, frequency of exposure, and personal protective equipment utilized, among other indicators. Results: Our preliminary analysis indicates mercury exposure is not only a significant health threat to children in LMICs, but also ASGM has lax child labor standards, and therefore, requires more attention by policy decision-makers and governmental organizations. Countries are not required to provide a comprehensive registry and there is an absence of any reliable census of those engaged in these operations.Conclusions: As a result of our assessment, the total disease burden is likely unknown, limiting what is known to be a neglected broad public health problem. Surveillance is immediately needed, not only to estimate the global burden of disease but also to conduct urgent field testing in highly exposed nations. Given that comprehensive official registries are needed, a journal article and corresponding policy guide are being drafted to detail mechanisms to increase transparency and monitoring of child labor and working conditions in ASGM.

English

The use of cesarean section (CS) and oxytocin for labour augmenttion may contribute to increase morbidity and mortality of mothers and newborns. The objective of the study was to evaluate the Criterian Based Audit (CBA) on CS rates and oxytocin use in labouring women. A prospective intervention study by CBA was performed at hospital in Tanzania. Included were 523 labouring women at a gestational age of at least 28 weeks and birth weight ≥1000 g. All data on actual care were compared to criteria for best practice agreed with the staff. Interventions were discussed with the staff followed by a training session. At follow up, data were achieved from 438 women. Performance and outcomes were compared before and after the intervention. The overall CS rate decreased from 46.1 to 38.4% (RR=0.83; CI: 0.72 to 0.97). The use of oxytocin decreased from 76.2 to 47.3% (RR=0.63; CI: 0.45 to 0.85). The study demonstrates suboptimal care in labour monitoring and management, and that CBA resulted in a reduction in CS and use of oxytocin, and suggests that CBA can be used for quality assurance of women’s health care. Key words: Prolonged labor, low-income country, cesarean section, vacuum extraction, criterion-based audit, oxytocin, partograph.

Is short-term-variation of fetal-heart-rate a better predictor of fetal acidaemia in labour? A feasibility study.

Continuous intrapartum fetal monitoring is challenging and its clinical benefits are debated. The project evaluated whether short-term-variation (STV) and other computerised fetal heart rate (FHR) parameters (baseline FHR, long-term-variation, accelerations and decelerations) predicted acidaemia at birth. The aims of the study were to assess the changes in FHR pattern during labour and determine the feasibility of undertaking a definitive trial by reporting the practicalities of using the monitoring device, participant recruitment, data collection and staff training. 200 high-risk women carrying a term singleton, non-anomalous fetus, requiring continuous FHR monitoring in labour were consented to participate from the Jessop Wing maternity unit, Sheffield, UK. The trans-abdominal fetal ECG monitor was placed as per clinical protocol. During the monitoring session, clinicians were blinded to the computerised FHR parameters. We analysed the last hour of the FHR and its ability to predict umbilical arterial blood pH <7.20 using receiver operator characteristics (ROC) curves. Of 200 women, 137 cases were excluded as either the monitor did not work from the onset of labour (n = 30), clinical staff did not return or used the monitor on another patient (n = 37), umbilical cord blood not obtained (n = 25), FHR data not recorded within an hour of birth (n = 34) and other reasons (n = 11). In 63 cases included in the final analysis, the computer-derived FHR parameters did not show significant correlation with umbilical artery cord pH <7.20. Labour was associated with a significant increase in short and long term variation of FHR and number of deceleration (P<0.001). However, baseline FHR decreased significantly before delivery (P<0.001). The project encountered a number of challenges, with learning points crucial to informing the design of a large study to evaluate the potential place of intrapartum computerised FHR parameters, using abdominal fetal ECG monitor before its clinical utility and more widespread adoption can be ascertained.

Advantages of “Life Curve” Mobile Application: An Easier Alternate of Paper Partograph

Background: The WHO approved paper Partograph is a time tested tool for monitoring the progression of labour to reduce life-threatening complications during labour as well as maternal mortality and morbidity. However, inept manpower for recording and interpreting data, chance of retrograde plotting and limited scope of distance monitoring have become a significant barriers to use this tool. The ‘Life Curve’, an Android Apps, is put forward as an easier alternate of the paper partograph.&#x0D; Objective: To see the advantages of the ‘life curve mobile application’: an Android apps which support any Android operating system. It is a new tool based on WHO partograph to monitor the progression of labor with automatically generated interpretation. Early warning and alarm system is included here for creating an opportunity of early referral and intervention.&#x0D; Method: A cross sectional study was conducted in Department of Gynaecology and Obstetrics, Sir Salimullah Medical College &amp; Mirford Hospital from December 2016 to May 2017 on 30 mothers admitted with labour pain. Labor and all other parameters were recorded and monitored by using “life curve” mobile application along with paper partograph. The research protocol including the ethical clearance was approved by Bangladesh Medical Research Council. It is part of the feasibility study of the “life Curve” mobile application.&#x0D; Results: Mean age of the subjects was 25.9±5.7 yrs, mean gestational age 39.6±.9 wks, and 83% had vaginal delivery. The apps is easy to fill up, automatically generates graph, interesting to work with, provides timely automated reminder to evaluate the parturient, generates digital color coded warning figures, sends automated text message to the supervisor in abnormal situation. The performance parameters were scored in a 1-5 scale. For comparing the advantages of using these two partographs, nine features were compared with a total score of 45. Total score for live curve has 42.7 and that for paper postograph was 19.52 the difference is highly significant (p=.001). The mean±SD score of life curve (4.74±.52) was statistically significantly higher than that of paper partograph (2.17±1.18): p&lt;.0002.&#x0D; Conclusions: The life curve mobile application is found to be a easier tool for monitoring of labour with many advantages; and can be used as an alternative of paper partograph.&#x0D; Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 84-89

Uterine contractions clustering based on electrohysterography

The uterine electromyogram, also named Electrohysterogram (EHG), is a non-invasive technique that has been used for pregnancy and labour monitoring as well as for research work on uterine physiology. This technique is well established in this field. There is however a vast unexplored potential in the EHG that is currently the subject of interdisciplinary research work involving different scientific fields such as medicine, engineering, physics and mathematics.In this paper, an unsupervised clustering method is applied to a previously obtained set of frequency spectral representations of the respective EHG signal contractions that were previously automatically detected and delineated. An innovative approach using the complete spectrum projection is described, rather than a set of relevant points. The feasibility of the method is established despite the concerns of possible computational burden incurred by the processing of the whole spectrum. Given the unsupervised nature of this classification, a validation procedure was performed whereas the obtained clusters were labelled through the correlation with the common knowledge about the most relevant uterine contraction types, as described in the literature. As a result of this study, a spectral description of the Alvarez contractions was obtained where it was possible to breakdown these important events in two different types according to their spectrum. Spectral estimates of Braxton-Hicks contractions were also obtained and associated to one of the clusters. This led to a full spectral characterization of these uterine events.

Aplicação adequada do partograma e o seu impacto na taxa de cesarianas: revisão narrativa

Objetivo: Analisar se a aplicação adequada do partograma influencia na taxa de cesarianas, bem como, discutir sua importância na escolha da via de parto, incluindo possíveis benefícios da utilização desse instrumento no acompanhamento do trabalho de parto e avaliar a qualidade da assistência ao parto em locais onde o partograma é aplicado regular e corretamente. Revisão Bibliográfica: Trata-se de uma revisão narrativa acerca do uso do partograma e o seu impacto no número de cesarianas. Sabe-se que o partograma tem seu uso recomendado amplamente pela OMS, entretanto seu uso ainda não é amplo em qualquer local. Sendo que, o uso do mesmo mostrou-se de maior impacto em países em desenvolvimento, onde há evidências de que o uso adequado pode diminuir a taxa de cesáreas, fato não observado em regiões de serviços de saúde com maiores recursos econômicos. Considerações finais: Não foi possível estabelecer de forma definitiva uma relação entre a diminuição nas taxas de cesariana e o uso do partograma. O resultado inconclusivo aponta para diferenças relativas ao local de aplicação do partograma, sendo necessário mais dados para confirmar sua relevância como uma ferramenta que contribua para diminuir o número de cesáreas realizadas.

Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

BackgroundIn low-resource settings with few health workers, Fetal Heart Rate (FHR) monitoring in labour can be inconsistent and unreliable. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia; the country with the second lowest number of midwives and nurses in the world (1.007 per 10,000 of the population). The initiative assessed the feasibility of educating women in labour to monitor their own FHR and alert a midwife of changes detected.MethodsFour hundred seventy-four women admitted in labour without obstetric complications were approached. Four hundred sixty-one consented to participate (97%) and 13 declined. Those consenting were trained to monitor their FHR using a sonicaid for approximately 1 minute immediately following the end of every uterine contraction and to inform a midwife of changes. If changes were confirmed, standard clinical interventions for fetal distress (lateral tilt, intravenous fluids and oxygen) were undertaken and, when appropriate, accelerated delivery by vacuum or Caesarean section. Participants provided views on their experiences; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded.ResultsFour hundred sixty-one out of 474 women gave consent, of whom 431 of 461 (93%) completed the monitoring themselves. Three hundred eighty-seven of 400 women who gave comments, reported positive and 13 negative experiences. FHR changes were reported in 28 participants and confirmed in 26. Twenty-four of these 26 FHR changes were first identified by mothers. Fetal death was identified on admission during training in one mother. Thirteen neonates required resuscitation, with 12 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes including one of birth weight 1.3 Kg who could not be resuscitated. There were no intrapartum stillbirths in participants.ConclusionsWomen in labour were able to monitor and detect changes in their FHR. Most found the experience beneficial. The absence of intrapartum stillbirths after admission and the low rate of poor neonatal outcomes are promising and warrant further investigation.

Monitoring of regional labor markets and the main trends of labor underutilization in Russia

PurposeIn the recent two decades, a model of the labor market formed in Russia; it differs from the model that is peculiar for most developed countries. Its specific feature consists in the fact that adaptation to the fluctuations of the economic situation takes place by means of changes in the labor price, not by means of changes in employment and unemployment.Design/methodology/approachSuch model ensures high and stable level of employment and low level of unemployment with significant pro-cyclic fluctuations of wages. Changes that take place in the sphere of employment of population in labor markets and gradual implementation of collection of information in view of the forms of labor activities into the practices of different countries led to the necessity for reconsidering the previously adopted international standards.FindingsThis is due to the fact that the normative documents present the treatment of unemployment without the criterion “job search,” and new indicators of measuring potential labor force and incomplete employment were adopted. The authors analyze the situation of labor underutilization, which is important for characterizing a region of the Russian Federation by the indicator of unmet need for employment.Originality/valueThe offered information could be used for wider monitoring of the labor market, studying the volume and tendencies in the sphere of unemployment, evaluating the problems of integration in the labor market, studying the connection between employment and poverty and forecasting the tendencies.

Pharmacist Segments Identified from 2009, 2014, and 2019 National Pharmacist Workforce Surveys: Implications for Pharmacy Organizations and Personnel.

Background/Objective: Findings from the 2009 and 2014 National Pharmacist Workforce Surveys showed that approximately 40% of U.S. pharmacists devoted their time primarily to medication providing, 40% contributed a significant portion of their time to patient care service provision, and the remaining 20% contributed most of their time to other health-system improvement activities. The objective of this study was to characterize the U.S. pharmacist workforce into segments based on the proportion of time they spend in medication providing and patient care services and compare changes in these segments between 2009, 2014, and 2019. Methods: Data from 2009, 2014, and 2019 National Pharmacist Workforce Surveys were analyzed. Responses from 1200 pharmacists in 2009, 1382 in 2014, and 4766 in 2019 were used for analysis. Respondents working in the pharmacy or pharmacy-related fields reported both their percent time devoted to medication providing and to patient care services. Medication providing included preparing, distributing, and administering medication products, including associated professional services. Patient care services were professional services designed for assessing and evaluating medication-related needs, monitoring and adjusting patient’s treatments, and other services designed for patient care. For each year of data, pharmacist segments were identified using a two-step cluster analysis. Descriptive statistics were used for describing the characteristics of the segments. Results: For each year, five segments of pharmacists were identified. The proportions of pharmacists in each segment for the three surveys (2009, 2014, 2019) were: (1) medication providers (41%, 40%, 34%), (2) medication providers who also provide patient care (25%, 22%, 25%), (3) other activity pharmacists (16%, 18%, 14%), (4) patient care providers who also provide medication (12%, 13%, 15%), and (5) patient care providers (6%, 7%, 12%). In 2019, other activity pharmacists worked over 45 hours per week, on average, with 12 of these hours worked remotely. Patient care providers worked 41 hours per week, on average, with six of these hours worked remotely. Medication providers worked less than 40 hours per week, on average, with just one of these hours worked remotely. Regarding the number of patients with whom a respondent interacted on a typical day, medication providers reported 18 per day, patient care providers reported 11 per day, and other activity pharmacists reported 6 per day. In 2009, 8% of patient care providers worked in a setting that was not licensed as a pharmacy. In 2019, this grew to 17%. Implications/Conclusions: The 2019 findings showed that 34% of U.S. pharmacists devoted their time primarily to medication providing (compared to 40% in 2009 and 2014), 52% contributed a significant portion of their time to patient care service provision (compared to 40% in 2009 and 2014), and the remaining 14% contributed most of their time to other health-system improvement activities. Distinguishing characteristics of the segments suggested that recent growth in the pharmacist workforce has been in the patient care services, with more being provided through remote means in organizations that are not licensed as pharmacies. The findings have implications for pharmacist training, continuing education, labor monitoring, regulations, work systems, and process designs. These changes will create new roles and tasks for pharmacy organizations and personnel that will be needed to support emerging patient care services provided by pharmacists.

Use of the partograph - Current thinking.

The partograph (sometimes called partogram) is a labour monitoring tool that is used in countries worldwide to enable early detection of complications, so that referral, action or closer observations can ensue. While the partograph has received global support, from health professionals, there are concerns that it has not reached its full potential in improving clinical outcomes. This has resulted in several variations of the tool and a plethora of studies aimed at exploring the barriers and facilitators to its use. In this chapter, we will discuss the history of the partograph, outlining how it has evolved over time. We will also suggest reasons why the tool may not be meeting the needs of all practitioners. In particular, we will explore partograph use as a complex intervention, suggesting that its success is likely to be dependent on multiple contextual factors.

Effects of Dance and Music on Pain and Fear During Childbirth

ObjectiveTo test the effects of dance and music and music alone on pain and fear during the active phase of labor among nulliparous women. DesignSingle-blind, randomized, controlled study. SettingA maternity and children’s hospital in Konya Province, Turkey. ParticipantsA total of 93 nulliparous, pregnant women who were in the active phase of labor at term gestation with single fetuses in cephalic presentation. MethodsWe randomly assigned participants to one of three groups: dance and music, music alone, and usual care (control). We collected data four times during labor using a personal information form, labor monitoring form, visual analog scale (VAS), and Version A of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQA) to measure fear. ResultsBased on multivariate analysis of variance, the effect of time and study group interaction on VAS and W-DEQA scores was statistically significant (p < .05), and the effect of study groups and time on VAS scores was statistically significant (p < .05). The effect of the study groups on W-DEQA scores was statistically significant (p < .05), but there was no statistically significant effect of time on W-DEQA scores (p > .05). ConclusionDance and music and music alone significantly reduced pain and fear in nulliparous women during the active phase of labor. These interventions are easy for nurses and midwives to use, affordable, and effective, and they enable a woman and her partner to be actively engaged in the woman’s care.

Access and outcomes of general practitioner obstetrician (rural generalist)-supported birthing units in Queensland.

ObjectiveTo describe characteristics and outcomes of women birthing within GP‐obstetrician (rural generalist) supported rural (level 3) obstetric units in Queensland.DesignRetrospective descriptive study.Setting21 GP‐obstetrician supported birthing units in Queensland.ParticipantsWomen (n = 3111) birthing from January 2017 to December 2017.Main outcome measuresPatient, pregnancy and labour characteristics and key maternal and neonatal outcomes routinely recorded in the Queensland Perinatal Data Collection and Queensland Hospital Admitted Patient Data Collection were compared to Queensland public hospital aggregate data.ResultsWomen birthing in rural maternity units were significantly more likely to be Aboriginal or Torrs Strait Islander (16% v 9%), < 20 years old (7% v 4%), term deliveries (96% v 91%), achieve spontaneous onset of labour (67% v 51%), and birth (71% v 60%) (p<0.001) compared with all Queensland public hospitals. They were significantly less likely to be nulliparous (36% v 40%), use pharmacological analgesia (65% v 69%), or have continuous electronic fetal monitoring in labour (54% v 66%) (p<0.001). Neonatal outcomes were comparable; with no significant difference in stillbirth rate between rural units and all Queensland public hospitals (4.8 v 7.3 per 1000 births). Precipitate delivery was the most common labour complication (36% v 33%) (p<0.001).ConclusionGP‐obstetrician (rural generalist) supported rural birthing units in Queensland provide important access for low and medium risk women to deliver locally, with strong indicators of quality and safety.

The completion of partograms: knowledge, attitudes and practices of midwives in a public health obstetric unit in Bloemfontein, South Africa.

Introductionmost maternal and 24.3% of infant deaths occur during childbirth. Interventions during childbirth may reduce maternal and neonatal deaths. The Guidelines for maternity care in South Africa (2015) stipulates that all observations during labour should be recorded on a partogram. The objective of this study was to assess the knowledge and attitudes of nursing personnel and to evaluate their practices of completing partograms at National District Hospital, South Africa.Methodsa two-phase, quantitative, cross-sectional, descriptive study design was used. In phase 1, the knowledge and attitudes of midwives and nurses were evaluated. Midwives and nurses completed anonymous, self-administered questionnaires that assessed their knowledge and attitudes. In Phase 2, partogram practices were measured by assessing completed partograms using a data collection tick sheet.Resultstwelve of the 17 nursing personnel completed the questionnaires. More than 90% of participants answered basic partogram knowledge questions correctly, but only two thirds knew the criteria for obstructive labour and just more than half that for foetal distress. Participants displayed a positive attitude toward the use of partograms. Of the 171 randomly selected vaginal deliveries during the study period, only 57.1% delivered with a completed partogram. Most elements of foetal monitoring and progress of labour scored above 80%, however, for maternal monitoring scored poorly in 26.4% of cases.Conclusionalthough 71.4% of partograms scored more than 75% for completion, the critical components that influence maternal and foetal death, like the identification of foetal distress, maternal wellbeing and progress of labour, were lacking.

Does Chief Investment Officer Pay Reflect Performance? Evidence from Non-profits

This paper examines the compensation of Chief Investment Officers (CIOs) of nonprofit endowments, which have different economic models and monitoring arrangements than those of other institutional investors. We find that compensation reflects the demands of the job, abilities and experience that individuals bring to the job and how well the endowment performs. Pay relies heavily on bonuses and is positively linked to the CIO's education and professional experience. Large endowments hire CIOs with stronger backgrounds, pay them more and structure pay significantly linked to endowment performance. Even controlling for size, compensation depends on an endowment’s governance and location. The results are consistent with the increased investment skills needed to manage large pools of capital often involving alternative assets, and with differences in labor market and monitoring arrangements across endowments. For large endowments the sensitivity of pay to performance is greater than often reported for mutual fund managers.