US and territory telemedicine policies: identifying gaps in perinatal care

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Okoroh, Ekwutosi M.; Kroelinger, Charlan D.; Smith, Alexander M.; Goodman, David A.; Barfield, Wanda D.

2016-01-01

BACKGROUND Perinatal regionalization is a system of maternal and neonatal risk-appropriate health care delivery in which resources are ideally allocated for mothers and newborns during pregnancy, labor and delivery, and postpartum, in order to deliver appropriate care. Typically, perinatal risk-appropriate care is provided in-person, but with the advancement of technologies, the opportunity to provide care remotely has emerged. Telemedicine provides distance-based care to patients by consultation, diagnosis, and treatment in rural or remote US jurisdictions (states and territories). OBJECTIVE We sought to summarize the telemedicine policies of states and territories and assess if maternal and neonatal risk-appropriate care is specified. STUDY DESIGN We conducted a 2014 systematic World Wide Web–based review of publicly available rules, statutes, regulations, laws, planning documents, and program descriptions among US jurisdictions (N=59) on telemedicine care. Policies including language on the topics of consultation, diagnosis, or treatment, and those specific to maternal and neonatal risk-appropriate care were categorized for analysis. RESULTS Overall, 36 jurisdictions (32 states; 3 territories; and District of Columbia) (61%) had telemedicine policies with language referencing consultation, diagnosis, or treatment; 29 (49%) referenced consultation, 30 (51%) referenced diagnosis, and 35 (59%) referenced treatment. In all, 26 jurisdictions (22 states; 3 territories; and District of Columbia) (44%), referenced all topics. Only 3 jurisdictions (3 states; 0 territories) (5%), had policy language specifically addressing perinatal care. CONCLUSION The majority of states have published telemedicine policies, but few specify policy language for perinatal risk-appropriate care. By ensuring that language specific to the perinatal population is included in telemedicine policies, access to maternal and neonatal care can be increased in rural, remote, and resource

Process value of care safety: women's willingness to pay for perinatal services.

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Anezaki, Hisataka; Hashimoto, Hideki

2017-08-01

To evaluate the process value of care safety from the patient's view in perinatal services. Cross-sectional survey. Fifty two sites of mandated public neonatal health checkup in 6 urban cities in West Japan. Mothers who attended neonatal health checkups for their babies in 2011 (n = 1316, response rate = 27.4%). Willingness to pay (WTP) for physician-attended care compared with midwife care as the process-related value of care safety. WTP was estimated using conjoint analysis based on the participants' choice over possible alternatives that were randomly assigned from among eight scenarios considering attributes such as professional attendance, amenities, painless delivery, caesarean section rate, travel time and price. The WTP for physician-attended care over midwife care was estimated 1283 USD. Women who had experienced complications in prior deliveries had a 1.5 times larger WTP. We empirically evaluated the process value for safety practice in perinatal care that was larger than a previously reported accounting-based value. Our results indicate that measurement of process value from the patient's view is informative for the evaluation of safety care, and that it is sensitive to individual risk perception for the care process. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care.

Trends in Perinatal Care and Implications for Frontline Nurse Leaders.

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Crenshaw, Jeannette T; Adams, Ellise D; Amis, Debby

2016-01-01

The perinatal trends presented in this article are based on recent topics from conferences, journals, the media, as well as from input from perinatal nurses. Trends in patient care are influenced by evidence known for decades, new research, emerging and innovative concepts in healthcare, patient and family preferences, and the media. Trends discussed in this article are rethinking the due date, birth outside the hospital setting, obstetric hospitalists as birth attendants, nitrous oxide for pain in childbirth, hydrotherapy and waterbirth in the hospital setting, delayed cord clamping, disrupters of an optimal infant microbiome, skin-to-skin care during cesarean surgery, and breast-sleeping and the breast-feeding dyad. In addition, the authors developed implications for perinatal nurses related to each trend. The goal is to stimulate reflection on evidence that supports or does not support current practice and to stimulate future research by discussing some of the current trends that may influence the care that perinatal nurses provide during the birthing year.

Contemporary view of the effect of managed care on the ethics in perinatal medicine.

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Schwartz, Peter A

2003-03-01

Managed care has significantly altered the patient-physician relationship, and these changes have created new ethical challenges within that relationship. The physician's obligation of beneficence has been challenged by his contract with managed care. Physicians have faced increasing apparent and real conflicts of interest. The patient's right of choice has been challenged by her contract with managed care. Within perinatal medicine, those challenges have affected mode of delivery, use of technology, length of stay, and pharmaceutical choices. Additional challenges and opportunities to enhance quality of care lie ahead in the evolution of the health care system.

[Risk adjusted assessment of quality of perinatal centers - results of perinatal/neonatal quality surveillance in Saxonia].

Science.gov (United States)

Koch, R; Gmyrek, D; Vogtmann, Ch

2005-12-01

The weak point of the country-wide perinatal/neonatal quality surveillance as a tool for evaluation of achievements of a distinct clinic, is the ignorance of interhospital differences in the case-mix of patients. Therefore, that approach can not result in a reliable bench marking. To adjust the results of quality assessment of different hospitals according to their risk profile of patients by multivariate analysis. The perinatal/neonatal data base of 12.783 newborns of the saxonian quality surveillance from 1998 to 2000 was analyzed. 4 relevant quality indicators of newborn outcome -- a) severe intraventricular hemorrhage in preterm infants 2500 g and d) hypoxic-ischemic encephalopathy -- were targeted to find out specific risk predictors by considering 26 risk factors. A logistic regression model was used to develop the risk predictors. Risk predictors for the 4 quality indicators could be described by 3 - 9 out of 26 analyzed risk factors. The AUC (ROC)-values for these quality indicators were 82, 89, 89 and 89 %, what signifies their reliability. Using the new specific predictors for calculation the risk adjusted incidence rates of quality indicator yielded in some remarkable changes. The apparent differences in the outcome criteria of analyzed hospitals were found to be much less pronounced. The application of the proposed method for risk adjustment of quality indicators makes it possible to perform a more objective comparison of neonatal outcome criteria between different hospitals or regions.

Perinatal staff perceptions of safety and quality in their service.

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Sinni, Suzanne V; Wallace, Euan M; Cross, Wendy M

2014-11-28

Ensuring safe and appropriate service delivery is central to a high quality maternity service. With this in mind, over recent years much attention has been given to the development of evidence-based clinical guidelines, staff education and risk reporting systems. Less attention has been given to assessing staff perceptions of a service's safety and quality and what factors may influence that. In this study we set out to assess staff perceptions of safety and quality of a maternity service and to explore potential influences on service safety. The study was undertaken within a new low risk metropolitan maternity service in Victoria, Australia with a staffing profile comprising midwives (including students), neonatal nurses, specialist obstetricians, junior medical staff and clerical staff. In depth open-ended interviews using a semi-structured questionnaire were conducted with 23 staff involved in the delivery of perinatal care, including doctors, midwives, nurses, nursing and midwifery students, and clerical staff. Data were analyzed using naturalistic interpretive inquiry to identify emergent themes. Staff unanimously reported that there were robust systems and processes in place to maintain safety and quality. Three major themes were apparent: (1) clinical governance, (2) dominance of midwives, (3) inter-professional relationships. Overall, there was a strong sense that, at least in this midwifery-led service, midwives had the greatest opportunity to be an influence, both positively and negatively, on the safe delivery of perinatal care. The importance of understanding team dynamics, particularly mutual respect, trust and staff cohesion, were identified as key issues for potential future service improvement. Senior staff, particularly midwives and neonatal nurses, play central roles in shaping team behaviors and attitudes that may affect the safety and quality of service delivery. We suggest that strategies targeting senior staff to enhance their performance in

Improvement in perinatal care for extremely premature infants in Denmark from 1994 to 2011

DEFF Research Database (Denmark)

Hasselager, Asbjørn Børch; Børch, Klaus; Pryds, Ole Axel

2016-01-01

INTRODUCTION: Major advances in perinatal care over the latest decades have increased the survival rate of extremely premature infants. Centralisation of perinatal care was implemented in Denmark from 1995. This study evaluates the effect of organisational changes of perinatal care on survival......PVL) and intraventricular haemorrhage grade 3-4 (IVH 3-4). RESULTS: A total of 184, 83 and 127 infants were included from the cohorts. Delivery rates at level 3 Neonatal Intensive Care Unit (NICU) hospitals increased from 69% to 87%. Transfer rates to level 3 NICU almost doubled during the period. Survival rates were...

Midwives' perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review.

Science.gov (United States)

Noonan, Maria; Doody, Owen; Jomeen, Julie; Galvin, Rose

2017-02-01

perinatal mental health is an important public health issue and consideration must be given to care provision for effective support and care of women in the perinatal period. to synthesise primary research on midwives' perceived role in Perinatal Mental Health (PMH). integrative review. Whittemore and Knafl's (2005) framework was employed. A systematic search of the literature was completed. Studies were included if they met the following criteria: primary qualitative, quantitative and mixed methods research studies published in peer reviewed journals between January 2006 to February 2016, where the population of interest were midwives and the outcomes of interest were their perceived role in the management of women with PMH problems. The methodological quality of studies was assessed using the relevant CASP (Critical Appraisal Skills Programmes, 2014) criteria for quantitative and qualitative research studies. Data extraction, quality assessment and thematic analysis were conducted. a total of 3323 articles were retrieved and 22 papers were included in the review (15 quantitative, 6 qualitative and one mixed method study). The quality of the studies included was good overall. Two overarching themes emerged relating to personal and professional engagement. Within personal engagement four sub themes are presented: knowledge, skills, decision making and attitude. Within professional engagement four themes are presented: continuous professional development, organisation of care, referral, and support. the findings indicate midwives require continuous professional development opportunities that address knowledge, attitudes to PMH, communication and assessment skills. However educational and training support in the absence of appropriate referral pathways and support systems will have little benefit. Copyright © 2016 Elsevier Ltd. All rights reserved.

Building Perinatal Case Manager Capacity Using Quality Improvement

OpenAIRE

Fitzgerald, Elaine

2015-01-01

Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote a...

End-of-life decisions in perinatal care. A view from health-care providers

Directory of Open Access Journals (Sweden)

Patricia Grether

2015-11-01

Full Text Available Objective. To examine the opinions of a perinatal health team regarding decisions related to late termination of pregnancy and severely ill newborns. Materials and Methods. An anonymous questionnaire was administered to physicians, social workers, and nurses in perinatal care. Differences were evaluated using the chi square and Student’s t tests. Results. When considering severely ill fetuses and newborns, 82% and 93% of participants, respectively, opted for providing palliative care, whereas 18% considered feticide as an alter- native. Those who opted for palliative care aimed to diminish suffering and those who opted for intensive care intended to protect life or sanctity of life. There was poor knowledge about the laws that regulate these decisions. Conclusions. Although there is no consensus on what decisions should be taken with severely ill fetuses or neonates, most participants considered palliative care as the first option, but feticide or induced neonatal death was not ruled out.

Characteristics that perinatal nurse managers desire in new nurse hires.

Science.gov (United States)

Falls, Emily; Hensel, Desiree

2012-04-01

Nursing leaders have proposed that nurses must have the Quality and Safety Education for Nurses (QSEN) competencies to work in complex health care systems. Using the QSEN framework, this study explored what characteristics perinatal nurse managers desired most in new nurses. This study used a survey design and a convenience sample of perinatal nurse managers working in Indiana hospitals (N = 46). Managers were more likely to hire nurses with experience, positive references, and excellent attendance. Of the QSEN competencies, managers looked most for teamwork and collaboration, followed by safety and patient-centered care. In addition to the traditional qualities desired in new nurses, the QSEN competencies are gaining importance among perinatal managers. Copyright 2012, SLACK Incorporated.

Substandard factors in perinatal care in The Netherlands : a regional audit of perinatal deaths

NARCIS (Netherlands)

Wolleswinkel-van den Bosch, JH; Vredevoogd, CB; Borkent-Polet, M; van Eyck, J; Fetter, WPF; Lagro-Janssen, TLM; Rosink, IH; Treffers, PE; Amelink, M; Richardus, JH; Verloove-Vanhorick, P; Mackenbach, JP

Background. To determine: 1) whether substandard factors were present in cases of perinatal death, and to what extent another course of action might have resulted in a better outcome, and 2) whether there were differences in the frequency of substandard factors by level of care, particularly between

Comparison of Perinatal Outcome of Preterm Births Starting in Primary Care versus Secondary Care in Netherlands: A Retrospective Analysis of Nationwide Collected Data

Directory of Open Access Journals (Sweden)

A. J. van der Ven

2014-01-01

Full Text Available Introduction. In Netherlands, the obstetric care system is divided into primary and secondary care by risk level of the pregnancy. We assessed the incidence of preterm birth according to level of care and the association between level of care at time of labor onset and delivery and adverse perinatal outcome. Methods. Singleton pregnancies recorded in Netherlands Perinatal Registry between 1999 and 2007, with spontaneous birth between 25+0 and 36+6 weeks, were included. Three groups were compared: (1 labor onset and delivery in primary care; (2 labor onset in primary care and delivery in secondary care; (3 labor onset and delivery in secondary care. Multivariable logistic regression analyses were performed to calculate the risk of perinatal mortality and Apgar score ≤4. Results. Of all preterm deliveries, 42% had labor onset and 7.9% had also delivery in primary care. Women with labor onset between 34+0 and 36+6 weeks who were referred before delivery to secondary care had the lowest risk of perinatal mortality (aOR 0.49 (0.30–0.79. Risk of perinatal mortality (aOR 1.65; 95% CI 1.20–2.27 and low Apgar score (aOR 1.95; 95% CI 1.53–2.48 were significantly increased in preterm home delivery. Conclusion. Referral before delivery is associated with improved perinatal outcome in the occurrence of preterm labor onset in primary care.

Validity of a questionnaire measuring the world health organization concept of health system responsiveness with respect to perinatal services in the Dutch obstetric care system.

Science.gov (United States)

van der Kooy, Jacoba; Valentine, Nicole B; Birnie, Erwin; Vujkovic, Marijana; de Graaf, Johanna P; Denktaş, Semiha; Steegers, Eric A P; Bonsel, Gouke J

2014-12-03

The concept of responsiveness, introduced by the World Health Organization (WHO), addresses non-clinical aspects of health service quality that are relevant regardless of provider, country, health system or health condition. Responsiveness refers to "aspects related to the way individuals are treated and the environment in which they are treated" during health system interactions. This paper assesses the psychometric properties of a newly developed responsiveness questionnaire dedicated to evaluating maternal experiences of perinatal care services, called the Responsiveness in Perinatal and Obstetric Health Care Questionnaire (ReproQ), using the eight-domain WHO concept. The ReproQ was developed between October 2009 and February 2010 by adapting the WHO Responsiveness Questionnaire items to the perinatal care context. The psychometric properties of feasibility, construct validity, and discriminative validity were empirically assessed in a sample of Dutch women two weeks post partum. A total of 171 women consented to participation. Feasibility: the interviews lasted between 20 and 40 minutes and the overall missing rate was 8%. Construct validity: mean Cronbach's alphas for the antenatal, birth and postpartum phase were: 0.73 (range 0.57-0.82), 0.84 (range 0.66-0.92), and 0.87 (range 0.62-0.95) respectively. The item-own scale correlations within all phases were considerably higher than most of the item-other scale correlations. Within the antenatal care, birth care and post partum phases, the eight factors explained 69%, 69%, and 76% of variance respectively. Discriminative validity: overall responsiveness mean sum scores were higher for women whose children were not admitted. This confirmed the hypothesis that dissatisfaction with health outcomes is transferred to their judgement on responsiveness of the perinatal services. The ReproQ interview-based questionnaire demonstrated satisfactory psychometric properties to describe the quality of perinatal care in the

Perinatal mortality disparities between public care and private obstetrician-led care: a propensity score analysis.

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Adams, N; Tudehope, D; Gibbons, K S; Flenady, V

2018-01-01

To examine whether disparities in stillbirth, and neonatal and perinatal mortality rates, between public and private hospitals are the result of differences in population characteristics and/or clinical practices. Retrospective cohort study. A metropolitan tertiary centre encompassing public and private hospitals. Women accessed care from either a private obstetrician or from public models of care - predominantly midwife-led care or care shared between midwives, general practitioners, and obstetricians. A total of 131 436 births during 1998-2013: 69 037 public and 62 399 private. Propensity score matching was used to select equal-sized public and private cohorts with similar characteristics. Logistic regression analysis was then used to explore the impact of public-private differences in the use of assisted reproductive technologies, plurality, major congenital anomalies, birth method, and gestational age. Stillbirth, and neonatal and perinatal mortality rates. After controlling for maternal and pregnancy factors, perinatal mortality rates were higher in the public than in the private cohort (adjusted odds ratio, aOR 1.53; 95% confidence interval, 95% CI 1.29-1.80; stillbirth aOR 1.56, 95% CI 1.26-1.94; neonatal death aOR 1.48, 95% CI 1.15-1.89). These disparities reduced by 15.7, 20.5, and 19.6%, respectively, after adjusting for major congenital anomalies, birth method, and gestational age. Perinatal mortality occurred more often among public than private births, and this disparity was not explained by population differences. Differences in clinical practices seem to be partly responsible. The impact of differences in clinical practices on maternal and neonatal morbidity was not examined. Further research is required. Private obstetrician-led care: more obstetric intervention and earlier births reduce perinatal mortality. Background Babies born in Australian public hospitals tend to die more often than those born in private hospitals. Our aim was to determine

Two types of health care systems and their influence on the introduction of perinatal care: an epidemiological twin model in Berlin from 1950 to 1990.

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Arabin, B; Raum, E; Mohnhaupt, A; Schwartz, F W

1999-06-01

When perinatal medicine emerged as a new medical discipline in the 1960s, Berlin was as one of the world's leading centers. During that time, the city was separated into two parts, each fostering its own health care system. After the destruction of the Berlin Wall, it was possible to speak with the citizens of East Berlin and to access their database systems. This created the singular opportunity to objectively compare the development of perinatal care in both parts of Berlin. Rates of maternal, perinatal, and infant mortality as well as the rate of preterm deliveries were evaluated over time and between East and West Berlin. The timing of introduction of 20 specific perinatal interventions was evaluated across 18 hospitals with more than 500 deliveries (11 in West Berlin and 7 in East Berlin). Interviews were conducted with 100 gynecologists, 100 midwives, and 100 women who had recently delivered their first child from each side of the city regarding their opinions of the importance of these interventions for the quality of perinatal medicine and how they would distribute a budget to improve maternity care. Maternal, perinatal, and infant mortality decreased in both parts of Berlin until 1990 (p Berlin, though the preterm delivery rate was slightly lower in East Berlin compared with West Berlin (p Berlin. In contrast, certain public health measures--such as maternal transport, screening programs for diabetes, and support of breastfeeding--were introduced much earlier in East Berlin. There were significant differences between the beliefs of gynecologists, midwives, and mothers in East and West Berlin. In general, citizens of East Berlin were more enthusiastic about technological medical advances, whereas citizens of West Berlin were more supportive of public health and alternative methods. In addition, there were significant differences between female and male physicians in their beliefs about how to improve health care, regardless of whether they resided in East

Perinatal health care services for imprisoned pregnant women and associated outcomes: a systematic review.

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Bard, Eleanor; Knight, Marian; Plugge, Emma

2016-09-29

Women are an increasing minority of prisoners worldwide, and most are of childbearing age. Prisons offer unique opportunities for improving the pregnancy outcomes of these high-risk women, and no systematic review to date has looked at their care. This systematic review identified studies describing models of perinatal health care for imprisoned women which report maternal and child health and care outcomes. We systematically searched for literature published between 1980 and April 2014. Studies were eligible if they included a group of imprisoned pregnant women, a description of perinatal health care and any maternal or infant health or care outcomes. Two authors independently extracted data. We described relevant outcomes in prisons (including jails) under models of care we termed PRISON, PRISON+ and PRISON++, depending on the care provided. Where outcomes were available on a comparison group of women, we calculated odds ratios with 95 % confidence intervals. Eighteen studies were reported, comprising 2001 imprisoned pregnant women. Fifteen were in the US, two in the UK and one in Germany. Nine contained a comparison group of women comprising 849 pregnant women. Study quality was variable and outcome reporting was inconsistent. There was some evidence that women in prisons receiving enhanced prison care, PRISON+, were less likely to have inadequate prenatal care (15.4 % vs 30.7 %, p prisons receiving usual care (PRISON). Women participating in two PRISON++ interventions, that is, interventions which included not only enhanced care in prisons but also coordination of community care on release, demonstrated reductions in long term recidivism rates (summary OR 0 · 37, 95 % CI 0 · 19-0 · 70) compared to pregnant women in the same prisons who did not participate in the intervention. Enhanced perinatal care can improve both short and long-term outcomes but there is a lack of data. Properly designed programmes with rigorous evaluation are needed to

Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care.

Science.gov (United States)

Miller, Margaret; Hearn, Lydia; van der Pligt, Paige; Wilcox, Jane; Campbell, Karen J

2014-01-01

Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.

2008 Niday Perinatal Database quality audit: report of a quality assurance project.

Science.gov (United States)

Dunn, S; Bottomley, J; Ali, A; Walker, M

2011-12-01

This quality assurance project was designed to determine the reliability, completeness and comprehensiveness of the data entered into Niday Perinatal Database. Quality of the data was measured by comparing data re-abstracted from the patient record to the original data entered into the Niday Perinatal Database. A representative sample of hospitals in Ontario was selected and a random sample of 100 linked mother and newborn charts were audited for each site. A subset of 33 variables (representing 96 data fields) from the Niday dataset was chosen for re-abstraction. Of the data fields for which Cohen's kappa statistic or intraclass correlation coefficient (ICC) was calculated, 44% showed substantial or almost perfect agreement (beyond chance). However, about 17% showed less than 95% agreement and a kappa or ICC value of less than 60% indicating only slight, fair or moderate agreement (beyond chance). Recommendations to improve the quality of these data fields are presented.

Construction of quality-assured infant feeding process of care data repositories: Construction of the perinatal repository (Part 2).

Science.gov (United States)

García-de-León-Chocano, Ricardo; Muñoz-Soler, Verónica; Sáez, Carlos; García-de-León-González, Ricardo; García-Gómez, Juan M

2016-04-01

This is the second in a series of two papers regarding the construction of data quality (DQ) assured repositories, based on population data from Electronic Health Records (EHR), for the reuse of information on infant feeding from birth until the age of two. This second paper describes the application of the computational process of constructing the first quality-assured repository for the reuse of information on infant feeding in the perinatal period, with the aim of studying relevant questions from the Baby Friendly Hospital Initiative (BFHI) and monitoring its deployment in our hospital. The construction of the repository was carried out using 13 semi-automated procedures to assess, recover or discard clinical data. The initial information consisted of perinatal forms from EHR related to 2048 births (Facts of Study, FoS) between 2009 and 2011, with a total of 433,308 observations of 223 variables. DQ was measured before and after the procedures using metrics related to eight quality dimensions: predictive value, correctness, duplication, consistency, completeness, contextualization, temporal-stability, and spatial-stability. Once the predictive variables were selected and DQ was assured, the final repository consisted of 1925 births, 107,529 observations and 73 quality-assured variables. The amount of discarded observations mainly corresponds to observations of non-predictive variables (52.90%) and the impact of the de-duplication process (20.58%) with respect to the total input data. Seven out of thirteen procedures achieved 100% of valid births, observations and variables. Moreover, 89% of births and ~98% of observations were consistent according to the experts׳ criteria. A multidisciplinary approach along with the quantification of DQ has allowed us to construct the first repository about infant feeding in the perinatal period based on EHR population data. Copyright © 2016 Elsevier Ltd. All rights reserved.

Association of antenatal care with facility delivery and perinatal survival – a population-based study in Bangladesh

Directory of Open Access Journals (Sweden)

Pervin Jesmin

2012-10-01

and after the MNCH program initiation (Sobel test of mediation P Conclusions ANC visits are associated with increased uptake of facility-based delivery and improved perinatal survival in the icddr,b SA. Further testing of the icddr,b approach to simultaneously improving quality of ANC and facility delivery care is needed in the existing health system in Bangladesh and in other low-income countries to maximize health benefits to mothers and newborns.

The SATELLITE Sexual Violence Assessment and Care Guide for Perinatal Patients

Science.gov (United States)

Ross, Ratchneewan; Roller, Cyndi; Rusk, Tom; Martsolf, Donna; Draucker, Claire

2011-01-01

Sexual violence (SV) is a prevalent public health problem affecting millions of women across the lifespan. Poor pregnancy outcomes have been shown to be related to SV experiences; therefore, the perinatal period is an important time for healthcare practitioners (HCPs) to intervene. Various healthcare organizations suggest or even mandate screening for SV. Although SV screening tools are available, many practitioners do not routinely screen their patients. Barriers to screening include lack of comfort with or knowledge about how to screen and intervene, and reluctance on the part of the patient to disclose information. The SATELLITE Sexual Violence Assessment and Care Guide for Patients in the Perinatal Period was designed to overcome these barriers. The guide leads practitioners through the process of setting the context for screening, the screening itself, and the interventions after a positive screen finding, including specific questions to be asked and statements to be made by the practitioner in providing care for an SV survivor. By using this guide, nurse practitioners can increase their feelings of comfort and confidence as they assess and care for SV survivors during the perinatal period. PMID:22506255

Clinical and scientific results in perinatal care of pregnancy complicated by insulin dependent diabetes mellitus in Croatia.

Science.gov (United States)

Djelmis, J

1998-01-01

At the Department of Obstetrics and Gynecology, Perinatal Unit for Diabetes and Fetal Growth, School of Medicine, Zagreb, perinatal care of pregnancies complicated with insulin dependent diabetes melitus (IDDM), has been performed for more than 36 years. The intention of this review is to show our own results in the management of IDDM pregnancies and the latest clinical advances in perinatal care of such pregnancies. Pregnancy complicated with IDDM is at risk because of numerous maternal, fetal and neonatal complications. Recent advances in medicine, especially in diabetology and perinatology, helps clinician avoid or lessen antenatal or perinatal complications in IDDM pregnancies. The main result of improved perinatal care is that today fetal and neonatal mortality in IDDM pregnancy is almost equal to that of healthy pregnant population. Intensive preconceptual care and optimal regulation of IDDM have resulted not only in decreased perinatal mortality but also in a decreased rate of congenital malformation. Tight glycemia control during pregnancy has a beneficial effect on fetal growth. Intensive control of fetal growth, verification of lung maturation at term by amniocenthesis, and control of fetal oxygenation will result in delivery of a mature eutrophic newborn with the lowest rate of neonatal complications possible. Perinatal mortality of less than 2% in IDDM pregnancy can be obtained by planned delivery between 38 and 39 weeks of gestation by either vaginal route or cesarean section, depending on indications. After delivery, intensive care of the newborn is necessary.

Potentially avoidable perinatal deaths in Denmark and Sweden 1991

DEFF Research Database (Denmark)

Langhoff-Roos, J; Borch-Christensen, H; Larsen, S

1996-01-01

to some extent could reflect differences in the quality of care, indicated by the numbers of perinatal deaths in categories of potentially avoidable deaths. MATERIAL AND METHODS: Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing......BACKGROUND: Since 1950 the perinatal mortality has been significantly higher in Denmark than in Sweden. In 1991 the rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries...

Potentially avoidable perinatal deaths in Denmark and Sweden 1991

DEFF Research Database (Denmark)

Langhoff-Roos, J; Borch-Christensen, H; Larsen, S

1996-01-01

BACKGROUND: Since 1950 the perinatal mortality has been significantly higher in Denmark than in Sweden. In 1991 the rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries...... to some extent could reflect differences in the quality of care, indicated by the numbers of perinatal deaths in categories of potentially avoidable deaths. MATERIAL AND METHODS: Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing...

eHealth as the Next-Generation Perinatal Care: An Overview of the Literature.

Science.gov (United States)

van den Heuvel, Josephus Fm; Groenhof, T Katrien; Veerbeek, Jan Hw; van Solinge, Wouter W; Lely, A Titia; Franx, Arie; Bekker, Mireille N

2018-06-05

Unrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions. This study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care. We conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature. The literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable

A Call to Revisit the Prenatal Period as a Focus for Action Within the Reproductive and Perinatal Care Continuum.

Science.gov (United States)

Handler, Arden; Johnson, Kay

2016-11-01

Objectives The broad maternal and child health community has witnessed increased attention to the entire continuum of reproductive and perinatal health concerns over the past few years. However, both recent discouraging trends in prenatal care access and utilization and a renewed understanding of prenatal care as a critical anchor of the reproductive/perinatal health continuum for women who do get pregnant demand a new effort to focus on the prenatal period as a gateway for maternal and infant health. Methods This commentary: describes the Medicaid expansions and the momentum for universal access to prenatal care of the 1980-1990s; examines the pivot away from this goal and its aftermath; provides a rationale for why renewed attention to prenatal care and the prenatal period is essential; and, explores the potential focus of an updated prenatal care agenda. Conclusion We conclude that increasing women's access to high quality prenatal care will require substantial effort at the clinical, community, policy, and system levels. Only when attention is paid to all phases of the reproductive/perinatal health continuum with an emphasis on continuity between all periods, and on the social determinants that affect health and well-being, will our nation be able to ensure the health of all women across the life course (whether or not they ever become mothers), while simultaneously fulfilling our nation's promise that all children-no matter their income or race/ethnicity-will have the opportunity to be born well.

A STUDY OF PERINATAL OUTCOME IN TWIN GESTATION IN A TERTIARY CARE CENTER

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Rinku Girija

2017-02-01

Full Text Available BACKGROUND Perinatal mortality is an index of obstetric care. Twin pregnancy is a high-risk pregnancy since most often the foetus in born prematurely or retarded physically; it may turn out to be a dreaded event, especially in rare instances of simultaneous death of twins or death of one twin in mid trimester thereby worsening the prognosis of the surviving twin. The aim of the study is to study the perinatal mortality and morbidity of twin gestation and factors affecting the same in a tertiary care center. MATERIALS AND METHODS This is a prospective study. 100 successive cases of multiple pregnancy beyond 28 weeks of gestation admitted during the study period were followed from the antenatal period upon their admission to the antenatal ward and the labour room. 100 cases of singleton pregnancies during the same period taken as control. Detailed obstetric history, family history of twins, intake of ovulation inducing agents, time of diagnosis of twin pregnancy confirmed by USS examination were noted. Maternal antenatal complications like anaemia, hypertension, jaundice, etc. noted. The mode of onset of labour, presentation of foetus noted and if possible confirmed by USS, routine and special investigation like PIH profile, FBS, PPBS. Doppler USS done wherever necessary. Study Setting and Design- It is a prospective observational study of 100 consecutive twin gestations of gestational age 28 weeks and above at a tertiary care hospital attached to Government Medical College, Thiruvananthapuram, for a period of 6 months. Perinatal outcome including perinatal morbidity and mortality in relation to gestational age, mode of delivery, chorionicity, birth weight of the baby and NICU admission were analysed. RESULTS Data collected was analysed with descriptive statistics like percentage, proportion, rates, ratio and chi-square test. CONCLUSION In spite of so many advances in Obstetrics and Neonatology, the perinatal mortality and morbidity in twin

Perinatal outcomes of low-risk planned home and hospital births under midwife-led care in Japan.

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Hiraizumi, Yoshie; Suzuki, Shunji

2013-11-01

It has not been extensively studied whether planned home and planned hospital births under primary midwife-led care increase risk of adverse events among low-risk women in Japan. A retrospective cohort study was performed to compare perinatal outcome between 291 women who were given primary midwife-led care during labor and 217 women who were given standard obstetric shared care. Among 291 women with primary midwife-led care, 168 and 123 chose home deliver and hospital delivery, respectively. Perinatal outcomes included length of labor of 24 h or more, augmentation of labor pains, delivery mode, severe perineal laceration, postpartum hemorrhage of 1000 mL or more, maternal fever of 38°C or more and neonatal asphyxia (Apgar score, home delivery (34 vs 21%, P = 0.011). There were no significant differences in the incidence of adverse perinatal outcomes between women with obstetric shared care and women with primary midwife-led care (regardless of being hospital delivery or home delivery). Approximately one-quarter of low-risk women with primary midwife-led care required obstetric care during labor or postpartum. However, primary midwife-led care during labor at home and hospital for low-risk pregnant women was not associated with adverse perinatal outcomes in Japan. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs.

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Nakku, Juliet E M; Okello, Elialilia S; Kizza, Dorothy; Honikman, Simone; Ssebunnya, Joshua; Ndyanabangi, Sheila; Hanlon, Charlotte; Kigozi, Fred

2016-07-22

Perinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda. Six focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach. Participants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training. This study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries.

Poor perinatal care practices in urban slums: Possible role of social mobilization networks

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Khan Zulfia

2009-01-01

Full Text Available Background: Making perinatal care accessible to women in marginalized periurban areas poses a public health problem. Many women do not utilize institutional care in spite of physical accessibility. Home-based care by traditional birth attendants (TBA is hazardous. Inappropriate early neonatal feeding practices are common. Many barriers to perinatal care can be overcome by social mobilization and capacity building at the community level. Objectives: To determine the existing perinatal practices in an urban slum and to identify barriers to utilization of health services by mothers. Study Design: This is a cross-sectional descriptive study. Setting and Participants: The high-risk periurban areas of Nabi Nagar, Aligarh has a population of 40,000 living in 5,480 households. Mothers delivering babies in September 2007 were identified from records of social mobilization workers (Community Mobilization Coordinators or CMCs already working in an NGO in the area. A total of 92 mothers were interviewed at home. Current perinatal practices and reasons for utilizing or not utilizing health services were the topics of inquiry. Statistical Analysis: Data was tabulated and analyzed using SPSS 12. Results: Analyses revealed that 80.4% of mothers had received antenatal care. However, this did not translate into safe delivery practices as more than 60% of the women had home deliveries conducted by traditional untrained or trained birth attendants. Reasons for preferring home deliveries were mostly tradition (41.9% or related to economics (30.7%. A total of 56% of the deliveries were conducted in the squatting position and in 25% of the cases, the umbilical cord was cut using the edge of a broken cup. Although breast-feeding was universal, inappropriate early neonatal feeding practices were common. Prelacteal feeds were given to nearly 50% of the babies and feeding was delayed beyond 24 hours in 8% of the cases. Several mothers had breastfeeding problems

Utilizing leadership to achieve high reliability in the delivery of perinatal care

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Parrotta C

2012-11-01

Full Text Available Carmen Parrotta,1 William Riley,1 Les Meredith21School of Public Health, University of Minnesota, Minneapolis, MN, 2Premier Insurance Management Services Inc, Charlotte, NC, USAAbstract: Highly reliable care requires standardization of clinical practices and is a prerequisite for patient safety. However, standardization in complex hospital settings is extremely difficult to attain and health care leaders are challenged to create care delivery processes that ensure patient safety. Moreover, once high reliability is achieved in a hospital unit, it must be maintained to avoid process deterioration. This case study examines an intervention to implement care bundles (a collection of evidence-based practices in four hospitals to achieve standardized care in perinatal units. The results show different patterns in the rate and magnitude of change within the hospitals to achieve high reliability. The study is part of a larger nationwide study of 16 hospitals to improve perinatal safety. Based on the findings, we discuss the role of leadership for implementing and sustaining high reliability to ensure freedom from unintended injury.Keywords: care bundles, evidence-based practice, standardized care, process improvement

Oocyte Donation Pregnancies- Non-Disclosure of Oocyte Recipient Status to Obstetric Care Providers and Perinatal Outcomes.

LENUS (Irish Health Repository)

2017-11-01

Oocyte donation pregnancies- non-disclosure of oocyte recipient (OR) status to obstetric care providers and perinatal outcomes.Many studies report a higher rate of pregnancy-induced hypertension (PIH) and severe pre-eclampsia (PET) in OR pregnancies. The objective is to determine the rates of non-disclosure of OR pregnancy to obstetric care providers and also the rates of perinatal complications.

Utility of local health registers in measuring perinatal mortality: a case study in rural Indonesia.

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Burke, Leona; Suswardany, Dwi Linna; Michener, Keryl; Mazurki, Setiawaty; Adair, Timothy; Elmiyati, Catur; Rao, Chalapati

2011-03-17

Perinatal mortality is an important indicator of obstetric and newborn care services. Although the vast majority of global perinatal mortality is estimated to occur in developing countries, there is a critical paucity of reliable data at the local level to inform health policy, plan health care services, and monitor their impact. This paper explores the utility of information from village health registers to measure perinatal mortality at the sub district level in a rural area of Indonesia. A retrospective pregnancy cohort for 2007 was constructed by triangulating data from antenatal care, birth, and newborn care registers in a sample of villages in three rural sub districts in Central Java, Indonesia. For each pregnancy, birth outcome and first week survival were traced and recorded from the different registers, as available. Additional local death records were consulted to verify perinatal mortality, or identify deaths not recorded in the health registers. Analyses were performed to assess data quality from registers, and measure perinatal mortality rates. Qualitative research was conducted to explore knowledge and practices of village midwives in register maintenance and reporting of perinatal mortality. Field activities were conducted in 23 villages, covering a total of 1759 deliveries that occurred in 2007. Perinatal mortality outcomes were 23 stillbirths and 15 early neonatal deaths, resulting in a perinatal mortality rate of 21.6 per 1000 live births in 2007. Stillbirth rates for the study population were about four times the rates reported in the routine Maternal and Child Health program information system. Inadequate awareness and supervision, and alternate workload were cited by local midwives as factors resulting in inconsistent data reporting. Local maternal and child health registers are a useful source of information on perinatal mortality in rural Indonesia. Suitable training, supervision, and quality control, in conjunction with computerisation to

Perinatal safety: from concept to nursing practice.

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Lyndon, Audrey; Kennedy, Holly Powell

2010-01-01

Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians' individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient's best interest can be viewed as their "agency for safety." However, collective agency for safety and commitment to support nurses in their role of advocacy is missing in many perinatal care settings. This article draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse's role in maintaining safety during labor and birth in acute care settings and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care.

Perinatal Safety: From Concept to Nursing Practice

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Kennedy, Holly Powell

2010-01-01

Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians’ individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient’s best interest can be viewed as their “agency for safety.” However, collective agency for safety and commitment to support nurses in their advocacy role is missing in many perinatal care settings. This paper draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse’s role in maintaining safety during labor and birth in acute care settings, and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care. PMID:20147827

Common perinatal mental disorders in northern Viet Nam: community prevalence and health care use

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Tran, Thach; La, Buoi thi; Kriitmaa, Kelsi; Rosenthal, Doreen; Tran, Tuan

2010-01-01

Abstract Objective To establish the prevalence of common perinatal mental disorders their determinants, and their association with preventive health care use among women in one rural and one urban province in northern Viet Nam. Methods We conducted a cross-sectional survey of cohorts of pregnant women and mothers of infants recruited systematically in 10 randomly-selected communes. The women participated in psychiatrist-administered structured clinical interviews and separate structured interviews to assess sociodemographic factors, reproductive health, the intimate partner relationship, family violence and the use of preventive and psychiatric health care. Associations between these variables and perinatal mental disorders were explored through univariate analyses and multivariable logistic regression. Findings Among women eligible for the study (392), 364 (93%) were recruited. Of these, 29.9% (95% confidence interval, CI: 25.20–34.70) were diagnosed with a common perinatal mental disorder (CPMD). The frequency of such disorders during pregnancy and in the postpartum period was the same. Their prevalence was higher among women in rural provinces (odds ratio, OR: 2.17; 95% CI: 1.19–3.93); exposed to intimate partner violence (OR: 2.11; 95% CI: 1.12–3.96); fearful of other family members (OR: 3.36; 95% CI: 1.05–10.71) or exposed to coincidental life adversity (OR: 4.40; 95% CI: 2.44–7.93). Fewer women with a CPMD used iron supplements than women without a CPMD, but the results were not statistically significant (P = 0.05). None of the women studied had ever received mental health care. Conclusion Perinatal depression and anxiety are prevalent in women in northern Viet Nam. These conditions are predominantly determined by social factors, including rural residence, poverty and exposure to family violence. At present the needs of women with common perinatal mental disorders are unrecognized and not attended to and their participation in essential

Does a Belief in a "Just World" Affect Health Care Providers' Reactions to Perinatal Illness?

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Clyman, Ronald I.; And Others

1980-01-01

A test was used to assess the degree to which pediatricians and nurses specializing in perinatal care believe in a just world in which good is rewarded and evil is punished. Results indicate that the cause of some perinatal problems are more likely to be attributed to parents by health providers with a greater belief in a just world. (JMD)

Quality maternity care for every woman, everywhere: a call to action.

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Koblinsky, Marjorie; Moyer, Cheryl A; Calvert, Clara; Campbell, James; Campbell, Oona M R; Feigl, Andrea B; Graham, Wendy J; Hatt, Laurel; Hodgins, Steve; Matthews, Zoe; McDougall, Lori; Moran, Allisyn C; Nandakumar, Allyala K; Langer, Ana

2016-11-05

To improve maternal health requires action to ensure quality maternal health care for all women and girls, and to guarantee access to care for those outside the system. In this paper, we highlight some of the most pressing issues in maternal health and ask: what steps can be taken in the next 5 years to catalyse action toward achieving the Sustainable Development Goal target of less than 70 maternal deaths per 100 000 livebirths by 2030, with no single country exceeding 140? What steps can be taken to ensure that high-quality maternal health care is prioritised for every woman and girl everywhere? We call on all stakeholders to work together in securing a healthy, prosperous future for all women. National and local governments must be supported by development partners, civil society, and the private sector in leading efforts to improve maternal-perinatal health. This effort means dedicating needed policies and resources, and sustaining implementation to address the many factors influencing maternal health-care provision and use. Five priority actions emerge for all partners: prioritise quality maternal health services that respond to the local specificities of need, and meet emerging challenges; promote equity through universal coverage of quality maternal health services, including for the most vulnerable women; increase the resilience and strength of health systems by optimising the health workforce, and improve facility capability; guarantee sustainable finances for maternal-perinatal health; and accelerate progress through evidence, advocacy, and accountability. Copyright © 2016 Elsevier Ltd. All rights reserved.

Introduction of a qualitative perinatal audit at Muhimbili National Hospital, Dar es Salaam, Tanzania

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Thomas Angela N

2009-09-01

Full Text Available Abstract Background Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality rate (PMR. Methods From 1st August, 2007 to 31st December, 2007 we conducted an audit of perinatal deaths (n = 133 with birth weight 1500 g or more at Muhimbili National Hospital (MNH. The audit was done by three obstetricians, two external and one internal auditors. Each auditor independently evaluated the cases narratives. Suboptimal factors were identified in the antepartum, intrapartum and early neonatal period and classified into three levels of delay (community, infrastructure and health care. The contribution of each suboptimal factor to adverse perinatal outcome was identified and the case graded according to possible avoidability. Degree of agreement between auditors was assessed by the kappa coefficient. Results The PMR was 92 per 1000 total births. Suboptimal factors were identified in 80% of audited cases and half of suboptimal factors were found to be the likely cause of adverse perinatal outcome and were preventable. Poor foetal heart monitoring during labour was indirectly associated with over 40% of perinatal death. There was a poor to fair agreement between external and internal auditors. Conclusion There are significant areas of care that need improvement. Poor monitoring during labour was a major cause of avoidable perinatal mortality. This type of audit was a good starting point for quality assurance at MNH. Regular perinatal audits to identify avoidable causes of perinatal deaths with feed back to the staff may be a useful strategy to reduce perinatal mortality.

Factors related to main preventable perinatal injuries of public hospital in the Brazilian Federal District.

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Pamella Padilha BRITO

2015-02-01

Full Text Available Introduction: The quality of prenatal care, childbirth and newborn are determinants of perinatal morbidity and mortality. The realization of a adequate prenatal care and skilled birth assistance would reduce the incidence of injuries and perinatal deaths that are largely preventable. Method: Descriptive and exploratory study of quantitative and qualitative nature.  Interview and review of medical records of thirty mothers and newborns were made. The results were chart using the SPSS software, version 20.0, for processing and statistical analysis. We performed thematic analysis of interviews, and tabulated according to their frequencies, identifying the differences and similarities between data. Results: The most frequent perinatal injuries were prematurity (74.2%, Respiratory Distress (71%, Underweight (51.6%, Infection or Sepsis (41.9%, Perinatal Asphyxia (19.4%  and Oligohydramnio (19.4%. These injuries were related to several factors such as inadequate prenatal care, with fewer than six prenatal consultations (70% and late onset (50%, and presence of maternal health problems such as: changes in amniotic fluid (50% and preterm labor (50%. The interviewees added other factors such as failures in the care professional (43%, failures in care and service (33%, difficulty of access (19% and breast self-care failures (16.6%. Conclusion: Stood out in this study the occurrence of perinatal injuries in children of mothers with stable socio-demographic profile and in term newborns as also the percentage of deaths (16.1%. The perinatal injuries and deaths could have been avoided with qualified prenatal care, childbirth and newborn care.

A survey comparing the attitudes toward perinatal bereavement care of nurses from three Asian cities.

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Chan, Moon Fai; Lou, Feng-lan; Arthur, David Gordon

2010-12-01

Caring for parents whose infant has died is extremely demanding, difficult, and stressful. In some situations, nurses may experience personal failure, feel helpless, and need to distance themselves from bereaved parents because they are unable to deal with the enormity of the parental feelings of loss. The aim of the study was to describe and compare attitudes toward perinatal bereavement care across a sample of nurses working in five obstetrics and gynecology settings from three Asian cities, as well as the factors associated with these attitudes. A survey was conducted, and 573 nurses were recruited from 2006 to 2007. The data were collected using the perinatal bereavement attitudes scale, which involves an 11-item self-report questionnaire. Nurses' attitudes were mainly positive, but differed across cities, with the attitude of Jinan nurses being significantly more positive than nurses from the other two cities, and the attitude of Hong Kong nurses being significantly the lowest. Positive attitudes were associated with position, and nurses who were well informed of hospital policy and received training for bereavement care were statistically significantly more likely to have a positive attitude toward perinatal bereavement care. Although nurses' attitudes to prenatal bereavement care differ significantly across the three Asian cities, they are generally similar. The differences observed could be related to the wider social, cultural, and organizational circumstances of nursing practice.

Perinatal death audits in a peri-urban hospital in Kampala, Uganda ...

African Journals Online (AJOL)

Background: The perinatal mortality of 70 deaths per 1,000 total births in Uganda is unacceptably high. Perinatal death audits are important for improvement of perinatal care and reduction of perinatal morality. We integrated perinatal death audits in routine care, and describe its effect on perinatal mortality rate at Nsambya ...

The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands

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van Diem Mariet Th

2012-07-01

Full Text Available Abstract Background Perinatal (mortality audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in mortality are usually part of the audit group. This makes such an audit a delicate matter. Methods The purpose of this study was to implement unit-based perinatal mortality audit in all 15 perinatal cooperation units in the northern region of the Netherlands between September 2007 and March 2010. These units consist of hospital-based and independent community-based perinatal caregivers. The implementation strategy encompassed an information plan, an organization plan, and a training plan. The main outcomes are the number of participating perinatal cooperation units at the end of the project, the identified substandard factors (SSF, the actions to improve care, and the opinions of the participants. Results The perinatal mortality audit was implemented in all 15 perinatal cooperation units. 677 different caregivers analyzed 112 cases of perinatal mortality and identified 163 substandard factors. In 31% of cases the guidelines were not followed and in 23% care was not according to normal practice. In 28% of cases, the documentation was not in order, while in 13% of cases the communication between caregivers was insufficient. 442 actions to improve care were reported for ‘external cooperation’ (15%, ‘internal cooperation’ (17%, ‘practice organization’ (26%, ‘training and education’ (10%, and ‘medical performance’ (27%. Valued aspects of the audit meetings were: the multidisciplinary character (13%, the collective and non-judgmental search for substandard factors (21%, the perception of safety (13%, the motivation to reflect on one’s own professional performance (5%, and the inherent postgraduate education (10%. Conclusion

Training traditional birth attendants on the WHO Essential Newborn Care reduces perinatal mortality.

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Garcés, Ana; McClure, Elizabeth M; Hambidge, Michael; Krebs, Nancy F; Mazariegos, Manolo; Wright, Linda L; Moore, Janet; Carlo, Waldemar A

2012-05-01

To evaluate the impact of birth attendant training using the World Health Organization Essential Newborn Care (ENC) course among traditional birth attendants, with a particular emphasis on the effect of acquisition of skills on perinatal outcomes. Population-based, prospective, interventional pre-post design study. 11 rural clusters in Chimaltenango, Guatemala. Health care providers. This study analyzed the effect of training and implementation of the ENC health care provider training course between September 2005 and December 2006. The primary outcome measure was the rate of death from all causes in the first seven days after birth in fetuses/infants ≥1500g. Secondary outcome measures were overall rate of stillbirth, rate of perinatal death, which included stillbirths plus neonatal deaths in the first seven days in fetuses/infants ≥1500g. Perinatal mortality decreased from 39.5/1000 pre-ENC to 26.4 post-ENC (RR 0.72; 95%CI 0.54-0.97). This reduction was attributable almost entirely to a decrease in the stillbirth rate of 21.4/1000 pre-Essential Newborn Care to 7.9/1000 post-ENC (RR 0.40; 95%CI 0.25-0.64). Seven-day neonatal mortality did not decrease (18.3/1000 to 18.6/1000; RR 1.05; 95%CI 0.70-1.57). Essential Newborn Care training reduced stillbirths in a population-based controlled study with deliveries conducted almost exclusively by traditional birth attendants. Scale-up of this intervention in other settings might help assess reproducibility and sustainability. © Published [2012]. This article is a U.S. Government work and is in the public domain in the USA. Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Perinatal transport: problems in neonatal intensive care capacity.

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Gill, A B; Bottomley, L; Chatfield, S; Wood, C

2004-05-01

To assess the quantity and nature of transfers within the Yorkshire perinatal service, with the aim of identifying suitable outcome measures for the assessment of future service improvements. Collection of data on perinatal transfers from all neonatal and maternity units located in the Yorkshire region of the United Kingdom from May to November 2000. Expectant mothers (in utero transfers) and neonates (ex utero transfers). None Quantification of in utero and ex utero transfers; the reasons for and resources required to support transfers; the nature of each transfer (acute, specialist, non-acute, into or out of region). In the period studied, there were 800 transfers (337 in utero; 463 ex utero); 306 transfers were "acute" (80% of transfers in utero), 214 because of specialist need, and 280 "non-acute". Some 37% of capacity transfers occurred from the two level 3 units in the region. Of 254 transfers out of the 14 neonatal units for intensive care, 44 (17.3%) were transferred to hospitals outside the normal neonatal commissioning boundaries. The study highlights a continuing apparent lack of capacity within the neonatal service in the Yorkshire region, resulting in considerable numbers of neonatal and maternal transfers.

"Can I Ask That?": Perspectives on Perinatal Care After Resettlement Among Karen Refugee Women, Medical Providers, and Community-Based Doulas.

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LaMancuso, Kate; Goldman, Roberta E; Nothnagle, Melissa

2016-04-01

This study characterized the perspectives of Karen refugee women in Buffalo, NY, their medical providers, and Karen interpreters/doulas on perinatal care for Karen women in resettlement. In-depth qualitative interviews with Karen women (14), Karen doulas/interpreters and key informants (8), and medical providers (6) were informed by the social contextual model and focused on women's questions about and opinions of perinatal care in Buffalo and on providers' experiences caring for Karen patients. Karen women expressed gratitude for and understanding of perinatal care in Buffalo, and providers described Karen patients as agreeable but shy. Karen doulas offered an alternative view that exposed women's many questions and concerns, and described how doula training empowered them as patients' advocates. Low self-efficacy, trauma histories, and cultural expectations may contribute to Karen women's seeming agreeability. Doulas/interpreters possess insider knowledge of women's concerns and facilitate communication between patients and the care team.

[Application of Epigenetics in Perinatal Nursing Care].

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Chou, Hsueh-Fen; Kao, Chien-Huei; Gau, Meei-Ling

2017-04-01

Epigenetics is a field of biomedicine that expanded tremendously during the 1980s. Epigenetics is the study of heritable changes in gene expression independent of underlying DNA (DeoxyriboNucleic Acid) sequence, which not only affect this generation but will be passed to subsequent generations. Although conception is the critical moment for making decisions regarding gene mapping and fetal health, studies have shown that perinatal nursing care practices also affect the genetic remodeling processes and the subsequent health of the mother and her offspring. To optimize maternal-infant and the offspring health, it is important to ensure that the new mother get adequate nutrition, reduce stress levels, adopt gentle birth practices, facilitate exclusive breastfeeding, and avoid contacting toxic substances.

Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania.

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Nyamtema, Angelo S; Urassa, David P; Pembe, Andrea B; Kisanga, Felix; van Roosmalen, Jos

2010-06-03

Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved. A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed. Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed. Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions.

[Avoidable perinatal deaths and the environment outside the health care system: a case study in a city in Greater Metropolitan Rio de Janeiro].

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Rosa, Maria L G; Hortale, Virginia Alonso

2002-01-01

This paper focuses on the role of environmental factors external to the health care system in the occurrence of perinatal deaths in maternity hospitals belonging to the local health system in a city in Greater Metropolitan Rio de Janeiro in 1994. Elements from the political and administrative context that contribute to an understanding of the relationship between failures in health care and structural deficiencies in these maternity hospitals were divided into four groups of variables: distribution of resources, spatial and temporal factors, organizational and managerial features, and action by interest groups. Semi-structured interviews were conducted. The study concluded that poor performance in four groups of variables may have contributed to perinatal mortality: distribution of resources was insufficient to provide quality in health care, especially in private maternity hospitals; there was no formal or informal regional or hierarchical organization of obstetric care in the city; Ministry of Health guidelines were ignored in all four maternity hospitals, while in three of the hospitals there were no admissions procedures and delivery and fetal follow-up listed in their own rules; and the level of actual participation was low.

Antenatal interpersonal sensitivity is more strongly associated than perinatal depressive symptoms with postnatal mother-infant interaction quality.

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Raine, Karen; Cockshaw, Wendell; Boyce, Philip; Thorpe, Karen

2016-10-01

Maternal mental health has enduring effects on children's life chances and is a substantial cost driver for child health, education and social services. A key linking mechanism is the quality of mother-infant interaction. A body of work associates maternal depressive symptoms across the antenatal and postnatal (perinatal) period with less-than-optimal mother-infant interaction. Our study aims to build on previous research in the field through exploring the association of a maternal personality trait, interpersonal sensitivity, measured in early pregnancy, with subsequent mother-infant interaction quality. We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine the association between antenatal interpersonal sensitivity and postnatal mother-infant interaction quality in the context of perinatal depressive symptoms. Interpersonal sensitivity was measured during early pregnancy and depressive symptoms in the antenatal year and across the first 21 months of the postnatal period. In a subsample of the ALSPAC, mother-infant interaction was measured at 12 months postnatal through a standard observation. For the subsample that had complete data at all time points (n = 706), hierarchical regression examined the contribution of interpersonal sensitivity to variance in mother-infant interaction quality. Perinatal depressive symptoms predicted little variance in mother-infant interaction. Antenatal interpersonal sensitivity explained a greater proportion of variance in mother-infant interaction quality. The personality trait, interpersonal sensitivity, measured in early pregnancy, is a more robust indicator of subsequent mother-infant-interaction quality than perinatal depressive symptoms, thus affording enhanced opportunity to identify vulnerable mother-infant relationships for targeted early intervention.

Prevalence and factors influencing perinatal mortality in rural mysore, India.

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Siddalingappa, Hugara; Murthy M R, Nrayana; Kulkarni, Praveen; N C, Ashok

2013-12-01

With decreasing Infant Mortality Rate, Perinatal Mortality is gaining importance as it takes into consideration most of the factors influencing child birth and its survival, mortality during this period is a better indicator of quality of Maternal and Child Health services. To estimate the Prevalence of perinatal mortality and its associated risk factors. Cross sectional community based study was carried out in rural field practice area catering 26,700 population. All births during 2010 among permanent residents of this area were included. House to house survey was conducted to collect details regarding Antenatal, intra-natal and post-natal history by interviewing mother using a pre-tested questionnaire. Hospital records were also referred when available. Nine perinatal deaths had occurred out of 314 births in a span of one year with a perinatal, early neonatal mortality rates of 28.93, 19.29 per 1000 live births respectively and still birth rate of 9.55 per 100 total births. Higher Perinatal Mortality Rate(PNMR) was observed in mothers who got married before 18 years, conceived during teenage, having anaemia, delivered at home, normal vaginal deliveries and having suffered by intra-partal and placental complications. Male babies, babies fed with prelacteal feeds, born out of intra-uterine complications, having low birth weight, had delayed first cry, premature births and twin births showed higher risk for mortality. The prevalence of perinatal mortality in the present study was 28.93 per 1000 live births. Even though this was well below the national and state values indicating improved quality of Maternal and Child Health care, it also gives way for relooking into strategies for further bringing down the perinatal deaths.

Eliminating Perinatal HIV Transmission

Centers for Disease Control (CDC) Podcasts

In this podcast, CDC’s Dr. Steve Nesheim discusses perinatal HIV transmission, including the importance of preventing HIV among women, preconception care, and timely HIV testing of the mother. Dr. Nesheim also introduces the revised curriculum Eliminating Perinatal HIV Transmission intended for faculty of OB/GYN and pediatric residents and nurse midwifery students.

Correlation of neonatal intensive care unit performance across multiple measures of quality of care.

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Profit, Jochen; Zupancic, John A F; Gould, Jeffrey B; Pietz, Kenneth; Kowalkowski, Marc A; Draper, David; Hysong, Sylvia J; Petersen, Laura A

2013-01-01

To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance. We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input. Correlations across measures were tested using the Pearson correlation coefficient. Exploratory factor analysis was used to determine whether underlying factors were driving the correlations. Twenty-two regional NICUs in California. In total, 5445 very low-birth-weight infants cared for between January 1, 2004, and December 31, 2007. Pneumothorax, growth velocity, health care-associated infection, antenatal corticosteroid use, hypothermia during the first hour of life, chronic lung disease, mortality in the NICU, and discharge on any human breast milk. The NICUs varied substantially in their clinical performance across measures of quality. Of 28 unit-level correlations, 6 were significant (ρ < .05). Correlations between pairs of measures of quality of care were strong (ρ ≥ .5) for 1 pair, moderate (range, ρ ≥ .3 to ρ < .5) for 8 pairs, weak (range, ρ ≥ .1 to ρ < .3) for 5 pairs, and negligible (ρ < .1) for 14 pairs. Exploratory factor analysis revealed 4 underlying factors of quality in this sample. Pneumothorax, mortality in the NICU, and antenatal corticosteroid use loaded on factor 1; growth velocity and health care-associated infection loaded on factor 2; chronic lung disease loaded on factor 3; and discharge on any human breast milk loaded on factor 4. In this sample, the ability of individual measures of quality to explain overall quality of neonatal intensive care was modest.

The National Network of State Perinatal Quality Collaboratives: A Growing Movement to Improve Maternal and Infant Health.

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Henderson, Zsakeba T; Ernst, Kelly; Simpson, Kathleen Rice; Berns, Scott; Suchdev, Danielle B; Main, Elliott; McCaffrey, Martin; Lee, Karyn; Rouse, Tara Bristol; Olson, Christine K

2018-03-01

State Perinatal Quality Collaboratives (PQCs) are networks of multidisciplinary teams working to improve maternal and infant health outcomes. To address the shared needs across state PQCs and enable collaboration, Centers for Disease Control and Prevention (CDC), in partnership with March of Dimes and perinatal quality improvement experts from across the country, supported the development and launch of the National Network of Perinatal Quality Collaboratives (NNPQC). This process included assessing the status of PQCs in this country and identifying the needs and resources that would be most useful to support PQC development. National representatives from 48 states gathered for the first meeting of the NNPQC to share best practices for making measurable improvements in maternal and infant health. The number of state PQCs has grown considerably over the past decade, with an active PQC or a PQC in development in almost every state. However, PQCs have some common challenges that need to be addressed. After its successful launch, the NNPQC is positioned to ensure that every state PQC has access to key tools and resources that build capacity to actively improve maternal and infant health outcomes and healthcare quality.

Correlation of Neonatal Intensive Care Unit Performance Across Multiple Measures of Quality of Care

Science.gov (United States)

Profit, J; Zupancic, JAF; Gould, JB; Pietz, K; Kowalkowski, MA; Draper, D; Hysong, SJ; Petersen, LA

2014-01-01

Objectives To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance. Design We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input. Correlations across measures were tested using the Pearson correlation coefficient. Exploratory factor analysis was used to determine whether underlying factors were driving the correlations. Setting Twenty-two regional NICUs in California. Patients In total, 5445 very low-birth-weight infants cared for between January 1, 2004, and December 31, 2007. Main Outcomes Measures Pneumothorax, growth velocity, health care–associated infection, antenatal corticosteroid use, hypothermia during the first hour of life, chronic lung disease, mortality in the NICU, and discharge on any human breast milk. Results The NICUs varied substantially in their clinical performance across measures of quality. Of 28 unit-level correlations only 6 were significant (P quality measures were strong (ρ > .5) for 1 pair, moderate (.3 quality in this sample. Pneumothorax, mortality in the NICU, and antenatal corticosteroid use loaded on factor 1; growth velocity and health care–associated infection loaded on factor 2; chronic lung disease loaded on factor 3; and discharge on any human breast milk loaded on factor 4. Conclusion In this sample, the ability of individual measures of quality to explain overall quality of neonatal intensive care was modest. PMID:23403539

Maternal care receptivity and its relation to perinatal and neonatal mortality. A rural study.

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Bhardwaj, N; Hasan, S B; Zaheer, M

1995-04-01

A longitudinal study was conducted on 212 pregnant women from May 1987 to April 1988. Maternal Care Receptivity (MCR) "an innovative approach" was adopted for the assessment of maternal care services provided to pregnant mothers at their door steps. During follow-up, scores were allotted to each of the services rendered and antenatal status of pregnant women. Depending on the score--MCR was classified as high (11 to 8), moderate (7 to 4) or poor (3 to 0). Perinatal and neonatal deaths were recorded and an inverse relationship between MCR and perinatal and mortalities was observed (z = 5.46, p women with high MCR. One of the most important cause of high PNMR and neonatal mortality rate in developing countries is poor MCR, i.e., under utilization of even the existing maternal health services. The main reasons for this under utilization appear to be poverty, illiteracy, ignorance and lack of faith in modern medicine.

Information Architecture for Perinatal Registration in the Netherlands.

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Goossen, William T F; Arns-Schiere, Anne Marieke

In the Netherlands, the perinatal registry has undergone significant changes in the past decades. The purpose of this article is to describe the current health care information architecture for the national perinatal registry, including how the national data set is arranged and how electronic messages are used to submit data. We provide implications for women's health care providers based on the creation and implementation of the Dutch perinatal registry system. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Care for perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative components

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Manandhar Madan

2003-08-01

Full Text Available Abstract Background Maternal, perinatal and neonatal mortality rates remain high in rural areas of developing countries. Most deliveries take place at home and care-seeking behaviour is often delayed. We report on a combined quantitative and qualitative study of care seeking obstacles and practices relating to perinatal illness in rural Makwanpur district, Nepal, with particular emphasis on consultation strategies. Methods The analysis included a survey of 8798 women who reported a birth in the previous two years [of whom 3557 reported illness in their pregnancy], on 30 case studies of perinatal morbidity and mortality, and on 43 focus group discussions with mothers, other family members and health workers. Results Early pregnancy was often concealed, preparation for birth was minimal and trained attendance at birth was uncommon. Family members were favoured attendants, particularly mothers-in-law. The most common recalled maternal complications were prolonged labour, postpartum haemorrhage and retained placenta. Neonatal death, though less definable, was often associated with cessation of suckling and shortness of breath. Many home-based care practices for maternal and neonatal illness were described. Self-medication was common. There were delays in recognising and acting on danger signs, and in seeking care beyond the household, in which the cultural requirement for maternal seclusion, and the perceived expense of care, played a part. Of the 760 women who sought care at a government facility, 70% took more than 12 hours from the decision to seek help to actual consultation. Consultation was primarily with traditional healers, who were key actors in the ascription of causation. Use of the government primary health care system was limited: the most common source of allopathic care was the district hospital. Conclusions Major obstacles to seeking care were: a limited capacity to recognise danger signs; the need to watch and wait; and an

Eliminating Perinatal HIV Transmission

Centers for Disease Control (CDC) Podcasts

2012-11-26

In this podcast, CDC’s Dr. Steve Nesheim discusses perinatal HIV transmission, including the importance of preventing HIV among women, preconception care, and timely HIV testing of the mother. Dr. Nesheim also introduces the revised curriculum Eliminating Perinatal HIV Transmission intended for faculty of OB/GYN and pediatric residents and nurse midwifery students.  Created: 11/26/2012 by Division of HIV/AIDS Prevention.   Date Released: 11/26/2012.

An European concerted action investigating the validity of perinatal mortality as an outcome indicator for the quality of antenatal and perinatal care

NARCIS (Netherlands)

Richardus, J.H.; Graafmans, W.C.; Pal-de Bruin, K.M. van der; Amelink-Verburg, M.P.; Verloove-Vanhorick, S.P.; Mackenbach, J.P.

1997-01-01

In this paper the concepts, objectives, design, and data analysis procedures of the EuroNatal study are described. This sutdy started in 1996 and is a concerted action including 14 countries in Europe. The EuroNatal study aims at determining the validity of national perinatal mortality rates as an

Perinatal Practices & Traditions Among Asian Indian Women.

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Goyal, Deepika

2016-01-01

As the population in the United States grows more diverse, nurses caring for childbearing women must be aware of the many cultural traditions and customs unique to their patients. This knowledge and insight supports women and their families with the appropriate care, information, and resources. A supportive relationship builds trust, offers guidance, and allows for the new family to integrate information from nurses and other healthcare providers with the practice of certain perinatal cultural traditions. The Asian Indian culture is rich in tradition, specifically during the perinatal period. To support the cultural beliefs and practices of Asian Indian women during this time, nurses need to be aware of and consider multiple factors. Many women are navigating the new role of motherhood while making sense of and incorporating important cultural rituals. The purpose of this article is to provide an overview of perinatal cultural practices and traditions specific to the Asian Indian culture that perinatal nurses may observe in the clinical setting. Cultural traditions and practices specific to the pregnancy and postpartum period are described together with symbolism and implications for nursing practice. It is important to note that information regarding perinatal customs is provided in an effort to promote culturally sensitive nursing care and may not pertain to all Asian Indian women living in the United States.

Action plan to reduce perinatal mortality.

Science.gov (United States)

Bhakoo, O N; Kumar, R

1990-01-01

The government of India has set a goal of reducing perinatal mortality from its current rate of 48/1000 to 30-35/1000 by the year 2000. Perinatal deaths result from maternal malnutrition, inadequate prenatal care, complications of delivery, and infections in the postpartum period. Since reductions in perinatal mortality require attention to social, economic, and behavioral factors, as well as improvements in the health care delivery system, a comprehensive strategy is required. Social measures, such as raising the age at marriage to 18 years for females, improving the nutritional status of adolescent girls, reducing the strenuousness of work during pregnancy, improving female literacy, raising women's status in the society and thus in the family, and poverty alleviation programs, would all help eliminate the extent of complications of pregnancy. Measures required to enhance infant survival include improved prenatal care, prenatal tetanus toxoid immunization, use of sterile disposable cord care kits, the provision of mucus extractors and resuscitation materials to birth attendants, the creation of neonatal care units in health facilities, and more efficient referral of high-risk newborns and mothers. Since 90% of births in rural India take place at home priority must be given to training traditional birth attendants in the identification of high risk factors during pregnancy, delivery, and the newborn period.

[Perinatal health and medical administrative data: What uses, which stakeholders, what the issues for birth data? - Special REDSIAM].

Science.gov (United States)

Serfaty, A; Baron, S; Crenn-Hebert, C; Barry, Y; Tala, S

2017-10-01

The uses of medical administrative data (MAD/BDMA) emerged in perinatal health following the work on regionalization of very pre-term birth. They have become more numerous since the late 2000s. The objective of this article is to take stock of the existing work carried out within the REDSIAM-perinatality group, on MAD/BDMA and their uses for the period of "birth". The studied MADs are the Hospital Discharge Data (PMSI) and the French national health database (SNIIRAM). The material includes knowledge shared by the members of the REDSIAM-perinatality group, scientific references and gray literature. Our exploratory study shows that the uses of MAD in perinatal health are diversified at the local, regional and national levels. The works and publications, increasing, take the form of public access of processed data. Collective thinking makes it possible to move from a localized use to an institution, a network or several, to a national use and an inscription in public authorities' responses. In 2015/2016, two institutional sites provide access to data on maternal and child health: Data.Drees and ATIH ScanSanté. MAD/BDMA uses are multiple: epidemiological use (count of births by gestational age, weight in particular; perinatal indicators), quality of care, planning (maternity activities, regionalization of care). There is an increasing interest among stakeholders, producers and/or operators of MAD/BDMA (decision-makers, professionals or researchers). The BDMA, including the PMSI and the SNIIRAM, are used and relevant in Perinatal health with the rise of health networks, the territorialisation of health, in an increased demand for quality of care. Their use will increase the reliability of the data collected and an inscription in the validation studies, more and more numerous in the field of BDMA. The algorithms need to be more finely compiled, validated and enhanced. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Can facility delivery reduce the risk of intrapartum complications-related perinatal mortality? Findings from a cohort study.

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Khanam, Rasheda; Baqui, Abdullah H; Syed, Mamun Ibne Moin; Harrison, Meagan; Begum, Nazma; Quaiyum, Abdul; Saha, Samir K; Ahmed, Saifuddin

2018-06-01

delivered at home, the risk of perinatal mortality among women with intrapartum complications was 43.0% lower for women who delivered in a public health facility (OR = 0.57; 95% CI = 0.42-0.78) and 58.0% lower when delivered in a private health facility (OR = 0.42; 95% CI = 0.28-0.63). Maternal health programs need to promote timely recognition of intrapartum complications and delivery in health facilities to improve perinatal outcomes, particularly in populations where overall facility delivery rates are low. The differential risk between public and private health facilities may be due to differences in quality of care. Efforts should be made to improve the quality of care in all health facilities.

The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands

NARCIS (Netherlands)

van Diem, M.T.; Timmer, A.; Bergman, K.A.; Bouman, K.; van Egmond, N.; Stant, D.A.; Ulkeman, L.H.M.; Veen, W.B.; Erwich, J.J.H.M.

2012-01-01

Background: Perinatal (mortality) audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in

Provider report of the existence of detection and care of perinatal depression: quantitative evidence from public obstetric units in Mexico.

Science.gov (United States)

Castro, Filipa de; Place, Jean Marie; Allen-Leigh, Betania; Rivera-Rivera, Leonor; Billings, Deborah

2016-08-01

To provide evidence on perinatal mental healthcare in Mexico. Descriptive and bivariate analyses of data from a cross-sectional probabilistic survey of 211 public obstetric units. Over half (64.0%) of units offer mental healthcare; fewer offer perinatal depression (PND) detection (37.1%) and care (40.3%). More units had protocols/guidelines for PND detection and for care, respectively, in Mexico City-Mexico state (76.7%; 78.1%) than in Southern (26.5%; 36.4%), Northern (27.3%; 28.1%) and Central Mexico (50.0%; 52.7%). Protocols and provider training in PND, implementation of brief screening tools and psychosocial interventions delivered by non-clinical personnel are needed.

KEMATIAN PERINATAL HUBUNGANNYA DENGAN FAKTOR PRAKTIK KESEHATAN IBU SELAMA KEHAMILAN DI KOTA BEKASI TAHUN 2001

Directory of Open Access Journals (Sweden)

Ning Sulistiyowati

2012-11-01

Full Text Available Infants mortality rate is one of the sensitive indicators to evaluate health level of a country. However Perinatal Mortality Rate (PMR as part of infant mortality rate did not show any decline in the last ten period. The National Household Survey 1995 reported that PMR was within 48 per 1000 life births. Mother and Child Health program had promoted intensive antenatal health care to cover all pregnancies. The purpose of this program is to improve early detection of high risk pregnancies as well as to increase coverage of postnatal care of new borns. Perinatal mortality is influenced by several maternal health service, (antenatal care and delivery assistance, maternal health status, social-economic and environmental background, and traditional behavior. The objective of this analysis is to find the relation between maternal health practice during pregnancy and perinatal mortality in city of Bekasi 2001. Mother's age at delivery, educational level, parity, birth interval, smoking habit, pregnancy complication, and sex of the new born were calculated as covariates. Using case-control method, cases are mothers with perinatal deaths, and control are mothers with 7 days surviving new borns (83 case and 83 control. Based on a statistical analysis with logistic regression test the maternal health practice during pregnancy showed no significant relationship with perinatal mortality. Controlling birth interval, pregnancy complications and mother's ageat delivery, the odds ratio was OR = 2,3 (confidence interval 0,89 - 3,99 with p = 0,029 at 95% probability;, which is not significant. This result may be caused by small sample size or poor quality health service.

Causes of perinatal death at a tertiary care hospital in Northern Tanzania 2000–2010: a registry based study

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Mmbaga Blandina T

2012-12-01

Full Text Available Abstract Background Perinatal mortality reflects maternal health as well as antenatal, intrapartum and newborn care, and is an important health indicator. This study aimed at classifying causes of perinatal death in order to identify categories of potentially preventable deaths. Methods We studied a total of 1958 stillbirths and early neonatal deaths above 500 g between July 2000 and October 2010 registered in the Medical Birth Registry and neonatal registry at Kilimanjaro Christian Medical Centre (KCMC in Northern Tanzania. The deaths were classified according to the Neonatal and Intrauterine deaths Classification according to Etiology (NICE. Results Overall perinatal mortality was 57.7/1000 (1958 out of 33 929, of which 1219 (35.9/1000 were stillbirths and 739 (21.8/1000 were early neonatal deaths. Major causes of perinatal mortality were unexplained asphyxia (n=425, 12.5/1000, obstetric complications (n=303, 8.9/1000, maternal disease (n=287, 8.5/1000, unexplained antepartum stillbirths after 37 weeks of gestation (n= 219, 6.5/1000, and unexplained antepartum stillbirths before 37 weeks of gestation (n=184, 5.4/1000. Obstructed/prolonged labour was the leading condition (251/303, 82.8% among the obstetric complications. Preeclampsia/eclampsia was the leading cause (253/287, 88.2% among the maternal conditions. When we excluded women who were referred for delivery at KCMC due to medical reasons (19.1% of all births and 36.0% of all deaths, perinatal mortality was reduced to 45.6/1000. This reduction was mainly due to fewer deaths from obstetric complications (from 8.9 to 2.1/1000 and maternal conditions (from 8.5 to 5.5/1000. Conclusion The distribution of causes of death in this population suggests a great potential for prevention. Early identification of mothers at risk of pregnancy complications through antenatal care screening, teaching pregnant women to recognize signs of pregnancy complications, timely access to obstetric care

Developing evidence-based maternity care in Iran: a quality improvement study

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Mohammad Kazem

2008-06-01

Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

Perinatal care in British Columbia: Diagnosis and management of hemolytic disease of the newborn

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Hardyment, A. F.; Manning, R. Elizabeth; Kinnis, Claire

1974-01-01

We undertook to measure standards of perinatal care in British Columbia by studying the management of hemolytic disease of the newborn as the sample situation. Our data show that many isoimmunized pregnant women are delivered in hospitals that have infrequent experience with this problem, and by physicians who have little experience with this disease. The physician referral pattern, in regard to maternal isoimmunization, indicated that the more severely affected patients were managed by specialists, particularly those attached to teaching hospitals. However, 25% of the infants treated by exchange transfusion were managed by nonspecialists in nonteaching hospitals. Hospital record search, used as a method of medical audit and as a source of data for comparison with physician reports, did not result in dependable or complete information. Rates of disagreement between items from two data sources, physician report and hospital record, were frequently very high. Our experience suggests that comparison of these two data sources is not an ideal method of assessment of quality of care. A smaller caseload of isoimmunized pregnant women will result from the present prevention program. Nevertheless, cases will continue to occur. Our work supports the conclusion that a program of continuing education covering the diagnosis and management of hemolytic disease of the newborn is still necessary. PMID:4213290

The effectiveness of regionalization of perinatal care services--a systematic review.

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Rashidian, A; Omidvari, A H; Vali, Y; Mortaz, S; Yousefi-Nooraie, R; Jafari, M; Bhutta, Z A

2014-10-01

Several reports recommend the implementation of perinatal regionalization for improvements in maternal and neonatal outcomes, while research evidence on the effectiveness of perinatal regionalization has been limited. The interventional studies have been assessed for robust evidence on the effectiveness of perinatal regionalization on improving maternal and neonatal health outcomes. Bibliographic databases of Medline, EMbase, EconLit, HMIC have been searched using sensitive search terms for interventional studies that reported important patient or process outcomes. At least two authors assessed eligibility for inclusion and the risk of biases and extracted data from the included studies. As meta-analysis was not possible, a narrative analysis as well as a 'vote-counting' analysis has been conducted for important outcomes. After initial screenings 53 full text papers were retrieved. Eight studies were included in the review from the USA, Canada and France. Studies varied in their designs, and in the specifications of the intervention and setting. Only three interrupted time series studies had a low risk of bias, of which only one study reported significant reductions in neonatal and infant mortality. Studies of higher risk of bias were more likely to report improvements in outcomes. Implementing perinatal regionalization programs is correlated with improvements in perinatal outcomes, but it is not possible to establish a causal link. Despite several high profile policy statements, evidence of effect is weak. It is necessary to assess the effectiveness of perinatal regionalization using robust research designs in a more diverse range of countries.

Relationship between maternal hemoglobin and perinatal outcome

International Nuclear Information System (INIS)

Bakhtiar, U.J.; Khan, Y.; Nisar, R.

2007-01-01

To Study the Relationship between Maternal Hemoglobin and Perinatal outcome in a cohort of 860 pregnant women and to highlight the importance of antenatal care regarding maternal health and fetal outcome. All Singleton pregnancies delivering at Pakistan Railway Hospital Rawalpindi from January 2004 to December 2005 that fulfilled the required criteria were included. Out of the 860 patients, 402 were anemic (<11gm/dl) and 458 were non anemic. Perinatal outcome included preterm delivery, low birth weight, intrauterine growth retardation, perinatal death, low apgr scores and intrauterine fetal deaths. Risk of preterm and Low birth weight among anemic women was 3.4 and 1.8 times more than non anaemic women. The neonates of anemic woman also had 1.7 times increased risk of having low apgr scores at 1 min. Among anemic women there was 2.2 times greater risk of intrauterine fetal death than the non-anemic women. Regular antenatal care from first trimester has a vital role in assessing and managing maternal anemia timely and it directly affects the perinatal outcome. The patients with anemia have also higher risk of having low birth weight, preterm births and intra uterine fetal death. (author)

A Randomized Trial of Collaborative Care for Perinatal Depression in Socioeconomically Disadvantaged Women: The Impact of Comorbid Posttraumatic Stress Disorder.

Science.gov (United States)

Grote, Nancy K; Katon, Wayne J; Russo, Joan E; Lohr, Mary Jane; Curran, Mary; Galvin, Erin; Carson, Kathy

2016-11-01

The comorbidity of posttraumatic stress disorder (PTSD) with antenatal depression poses increased risks for postpartum depression and may delay or diminish response to evidence-based depression care. In a secondary analysis of an 18-month study of collaborative care for perinatal depression, the authors hypothesized that pregnant, depressed, socioeconomically disadvantaged women with comorbid PTSD would show more improvement in the MOMCare intervention providing Brief Interpersonal Psychotherapy and/or antidepressants, compared to intensive public health Maternity Support Services (MSS-Plus). A multisite randomized controlled trial with blinded outcome assessment was conducted in the Seattle-King County Public Health System, July 2009-January 2014. Pregnant women were recruited who met criteria for a probable diagnosis of major depressive disorder (MDD) on the Patient Health Questionnaire-9 and/or dysthymia on the MINI-International Neuropsychiatric Interview (5.0.0). The primary outcome was depression severity at 3-, 6-, 12-and 18-month follow-ups; secondary outcomes included functional improvement, PTSD severity, depression response and remission, and quality of depression care. Sixty-five percent of the sample of 164 met criteria for probable comorbid PTSD. The treatment effect was significantly associated with PTSD status in a group-by-PTSD severity interaction, controlling for baseline depression severity (Wald χ²₁ = 4.52, P = .03). Over the 18-month follow-up, those with comorbid PTSD in MOMCare (n = 48), versus MSS-Plus (n = 58), showed greater improvement in depression severity (Wald χ²₁ = 8.51, P depression response (Wald χ²₁ = 4.13, P depression care had a greater impact on perinatal depressive outcomes for socioeconomically disadvantaged women with comorbid PTSD than for those without PTSD. Findings suggest that a stepped care treatment model for high-risk pregnant women with both MDD and PTSD could be integrated into public health systems in

Advancing perinatal patient safety through application of safety science principles using health IT.

Science.gov (United States)

Webb, Jennifer; Sorensen, Asta; Sommerness, Samantha; Lasater, Beth; Mistry, Kamila; Kahwati, Leila

2017-12-19

The use of health information technology (IT) has been shown to promote patient safety in Labor and Delivery (L&D) units. The use of health IT to apply safety science principles (e.g., standardization) to L&D unit processes may further advance perinatal safety. Semi-structured interviews were conducted with L&D units participating in the Agency for Healthcare Research and Quality's (AHRQ's) Safety Program for Perinatal Care (SPPC) to assess units' experience with program implementation. Analysis of interview transcripts was used to characterize the process and experience of using health IT for applying safety science principles to L&D unit processes. Forty-six L&D units from 10 states completed participation in SPPC program implementation; thirty-two (70%) reported the use of health IT as an enabling strategy for their local implementation. Health IT was used to improve standardization of processes, use of independent checks, and to facilitate learning from defects. L&D units standardized care processes through use of electronic health record (EHR)-based order sets and use of smart pumps and other technology to improve medication safety. Units also standardized EHR documentation, particularly related to electronic fetal monitoring (EFM) and shoulder dystocia. Cognitive aids and tools were integrated into EHR and care workflows to create independent checks such as checklists, risk assessments, and communication handoff tools. Units also used data from EHRs to monitor processes of care to learn from defects. Units experienced several challenges incorporating health IT, including obtaining organization approval, working with their busy IT departments, and retrieving standardized data from health IT systems. Use of health IT played an integral part in the planning and implementation of SPPC for participating L&D units. Use of health IT is an encouraging approach for incorporating safety science principles into care to improve perinatal safety and should be incorporated

Mobile phone intervention reduces perinatal mortality in zanzibar

DEFF Research Database (Denmark)

Lund, Stine; Rasch, Vibeke; Hemed, Maryam

2014-01-01

BACKGROUND: Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies......, evidence for its role in health care is sparse. OBJECTIVE: We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. METHODS: This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities...... care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth...

Michigan Health & Hospital Association Keystone Obstetrics: a statewide collaborative for perinatal patient safety in Michigan.

Science.gov (United States)

Simpson, Kathleen Rice; Knox, G Eric; Martin, Morgan; George, Chris; Watson, Sam R

2011-12-01

Preventable harm to mothers and infants during labor and birth is a significant patient safety and professional liability issue. A Michigan Health & Hospital Association Keystone Center for Patient Safety & Quality Obstetric Collaborative Project involved perinatal teams from 15 Michigan hospitals during an 11-month period in 2009. The purpose of the project was to promote safe care practices during labor and birth using the Comprehensive Unit-based Safety Program (CUSP). Consistent with the CUSP model, this project's components included assessing and promoting a culture of safety; interdisciplinary team building; case review; learning from defects through multiple methods of education; team and individual coaching and peer encouragement; administrative support for the establishment of a fundamental safety infrastructure; and ongoing evaluation of care processes and outcomes. Study measures included 32 components of a perinatal patient infrastructure, 6 care processes during labor and birth, and 4 neonatal outcomes. Significant improvements were found in the safety culture (Safety Attitudes Questionnaire), the perinatal patient safety infrastructure components, and all care processes. Although the project was successful, getting buy-in from all members of the clinical team in each hospital for all of the measures was challenging at times. There was initial resistance to some of the measures and their various expected aspects of care. For example, some of the clinicians were initially reluctant to adopt the recommended standardized oxytocin protocol. Peer encouragement and unit-based feedback on progress in minimizing early elective births proved useful in many hospitals. A CUSP in obstetrics can be beneficial in improving the care of mothers and infants during labor and birth.

Perinatal market penetration rate. A tool to evaluate regional perinatal programs.

Science.gov (United States)

Powers, W F; McGill, L

1987-01-01

Very small babies born in tertiary centers fare better than outborn babies referred for tertiary care after birth. Viewing the 1001-1500 gm regional cohort of fetuses as a potential "market" for center delivery, and measuring a center's penetration into this market, quantitates how well a center draws to itself these small, high-risk fetuses for delivery. An Illinois center's annual penetration rate into its regional market for the years 1973-1983 is presented and significant increases are found. The penetration rates of nine Illinois perinatal centers are calculated and wide discrepancies are found. Defining a high-risk regional cohort as a market stresses a perinatal center's obligation to its region. The penetration rate into a defined market measures how well a center fulfills this obligation.

Provider report of the existence of detection and care of perinatal depression: quantitative evidence from public obstetric units in Mexico

Directory of Open Access Journals (Sweden)

Filipa de Castro

2016-07-01

Full Text Available Objective. To provide evidence on perinatal mental healthcare in Mexico. Materials and methods. Descriptive and bivariate analyses of data from a cross-sectional probabilistic survey of 211 public obstetric units. Results. Over half (64.0% of units offer mental healthcare; fewer offer perinatal depression (PND detection (37.1% and care (40.3%. More units had protocols/guidelines for PND detection and for care, respectively, in Mexico City-Mexico state (76.7%; 78.1% than in Southern (26.5%; 36.4%, Northern (27.3%; 28.1% and Central Mexico (50.0%; 52.7%. Conclusion. Protocols and provider training in PND, implementation of brief screening tools and psychosocial interventions delivered by non-clinical personnel are needed.      DOI: http://dx.doi.org/10.21149/spm.v58i4.8028

Professional's Perspectives on Care Management of Young People with Perinatally Acquired HIV during Transition: A Qualitative Study in Adult Care Setting.

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Enora Le Roux

Full Text Available Increasing numbers of young people with perinatally acquired HIV are surviving to adulthood. When they come of age, they leave pediatric services in which they were followed and have to be transferred to the adult health care system. Difficulties in adaptation to adult care and the numbers of young people lost to follow up after transfer to adult care have been reported. This transition phase and their retention in adult care are crucial in maintaining the clinical status of these young with HIV in adulthood. Our study aimed to explore how HIV professionals working in adult care perceive and adapt their practices to young people in transition.Qualitative interviews were conducted with 18 health and social services professionals in hospitals or patient associations in France. A thematic analysis was conducted.Adult care professionals were found to be making a distinction between these young people and their patients who were infected during adulthood. On the basis of the healthcare teams' experience, a simplified categorization of these young people into four levels can be used: those "who have everything good"; those who have some deficiencies that must be addressed; those "who have everything bad"; and those lost to follow up. Professionals interviewed highlighted the difficulties they encountered with young people in transition. Three types of problematic situations were identified: problems of acceptance of the disease; communication problems; and problems of disorientation in the new care environment.Despite the lack of specific training or national policy recommendations for the integration of young people with perinatally acquired HIV into adult services, all the adult healthcare teams interviewed tried to adapt their practice to this population. The results suggested that professional involvement during transition should depend on the characteristics of the patient, not be limited to a single transition model and that a dedicated

[How nationally concordated measures for quality assurance in clinical care of term and preterm infants are put into practice in Baden-Württemberg].

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Boehler, T; Schaeff, B; Hornberg, I; Waibel, B; Mohrmann, M

2009-01-01

By the end of the year 2007, pediatric hospitals in Baden-Württemberg had assigned themselves to one of three levels of perinatal care according to a checklist of the German Federal Joint Committee (F-JC) effective since January 1st, 2006. The Medical Service of Statutory Health Insurance had been assigned to prove the plausibility of that self-assessment according to quality criteria for clinical care of term and preterm newborn infants concordated by the F-JC. Between November 2007 and October 2008 31 providers were audited. Observations were documented in a checklist, reviewed and evaluated by expert auditors. For that purpose, quality criteria given by the F-JC were grouped into 7 quality categories which were weighted according to their practical relevance. In addition, a graded numeric system of evaluation was used for comparative analysis (absolute and relative benchmarking values). 3 of 23 providers fulfilled the quality criteria of the F-JC for PNC level 1 (highest level of care), 6 of 23 fulfilled them in part, and 14 of 23 did not fulfill them as judged by the auditors. Criteria for PNC level 2 were "fulfilled in part" by 2 of 6 providers and "not fulfilled" by 4. Both providers of perinatal special care ("level 3") fulfilled the quality criteria for "level 3" completely. There was no linear correlation between absolute or relative benchmarking values and assessment by expert auditors. If the criteria of the F-JC were interpreted very strictly, it would be difficult to guarantee comprehensive regional delivery of care in the state of Baden-Württemberg at the level formally requested by the F-JC for PNCs.

Role of traditional birth attendants (TBAs) in provision of antenatal and perinatal care at home amongst the urban poor in Delhi, India.

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Singh, Samiksha; Chhabra, Pragti; Sujoy, Rachna

2012-01-01

More than 80% of deliveries amongst the urban poor are conducted at home, mostly by traditional birth attendants (TBAs). In all, 29 eligible TBAs in the study area were identified and interviewed to assess their knowledge and practices regarding antenatal and perinatal care. Their knowledge about complications in antenatal and perinatal period was inadequate. The majority provided inadequate advice to the mothers. Over seventy-nine percent (79.3%) gave injections of oxytocin. Sixteen (55.2%) did not wait or waited for less than 10 minutes for the mother to expel the placenta. Fourteen (48.3%) encountered excessive vaginal bleeding, but none knew how to manage it. Overall knowledge and care provided by the TBAs was poor.

Reaching Perinatal Women Online: The Healthy You, Healthy Baby Website and App

Directory of Open Access Journals (Sweden)

Lydia Hearn

2014-01-01

Full Text Available Overwhelming evidence reveals the close link between unwarranted weight gain among childbearing women and childhood adiposity. Yet current barriers limit the capacity of perinatal health care providers (PHCPs to offer healthy lifestyle counselling. In response, today’s Internet savvy women are turning to online resources to access health information, with the potential of revolutionising health services by enabling PHCPs to guide women to appropriate online resources. This paper presents the findings of a project designed to develop an online resource to promote healthy lifestyles during the perinatal period. The methodology involved focus groups and interviews with perinatal women and PHCPs to determine what online information was needed, in what form, and how best it should be presented. The outcome was the development of the Healthy You, Healthy Baby website and smartphone app. This clinically-endorsed, interactive online resource provides perinatal women with a personalised tool to track their weight, diet, physical activity, emotional wellbeing, and sleep patterns based on the developmental stage of their child with links to quality-assured information. One year since the launch of the online resource, data indicates it provides a low-cost intervention delivered across most geographic and socioeconomic strata without additional demands on health service staff.

MRI of perinatal brain injury

Energy Technology Data Exchange (ETDEWEB)

Rutherford, Mary; Allsop, Joanna [Imperial College, Robert Steiner MR Unit, Perinatal Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London (United Kingdom); Martinez Biarge, Miriam [La Paz University Hospital, Dept of Neonatology, Madrid (Spain); Counsell, Serena [Imperial College, Robert Steiner MR Unit, Neonatal Medicine, MRC Clinical Sciences Centre, Hammersmith Hospital, London (United Kingdom); Cowan, Frances [Imperial College, Dept of Paediatrics, Hammersmith Hospital, London (United Kingdom)

2010-06-15

MRI is invaluable in assessing the neonatal brain following suspected perinatal injury. Good quality imaging requires adaptations to both the hardware and the sequences used for adults or older children. The perinatal and postnatal details often predict the pattern of lesions sustained and should be available to aid interpretation of the imaging findings. Perinatal lesions, the pattern of which can predict neurodevelopmental outcome, are at their most obvious on conventional imaging between 1 and 2 weeks from birth. Very early imaging during the first week may be useful to make management decisions in ventilated neonates but brain abnormalities may still be subtle using conventional sequences. Diffusion-weighted imaging (DWI) is very useful for the early identification of ischaemic tissue in the neonatal brain but may underestimate the final extent of injury, particularly basal ganglia and thalamic lesions. MR imaging is an excellent predictor of outcome following perinatal brain injury and can therefore be used as a biomarker in interventional trials designed to reduce injury and improve neurodevelopmental outcome. (orig.)

MRI of perinatal brain injury

International Nuclear Information System (INIS)

Rutherford, Mary; Allsop, Joanna; Martinez Biarge, Miriam; Counsell, Serena; Cowan, Frances

2010-01-01

MRI is invaluable in assessing the neonatal brain following suspected perinatal injury. Good quality imaging requires adaptations to both the hardware and the sequences used for adults or older children. The perinatal and postnatal details often predict the pattern of lesions sustained and should be available to aid interpretation of the imaging findings. Perinatal lesions, the pattern of which can predict neurodevelopmental outcome, are at their most obvious on conventional imaging between 1 and 2 weeks from birth. Very early imaging during the first week may be useful to make management decisions in ventilated neonates but brain abnormalities may still be subtle using conventional sequences. Diffusion-weighted imaging (DWI) is very useful for the early identification of ischaemic tissue in the neonatal brain but may underestimate the final extent of injury, particularly basal ganglia and thalamic lesions. MR imaging is an excellent predictor of outcome following perinatal brain injury and can therefore be used as a biomarker in interventional trials designed to reduce injury and improve neurodevelopmental outcome. (orig.)

Seeking help for perinatal psychological distress: a meta-synthesis of women's experiences.

Science.gov (United States)

Button, Susan; Thornton, Alexandra; Lee, Suzanne; Shakespeare, Judy; Ayers, Susan

2017-10-01

Women may not seek help for perinatal psychological distress, despite regular contact with primary care services. Barriers include ignorance of symptoms, inability to disclose distress, others' attitudes, and cultural expectations. Much of the evidence has been obtained from North American populations and may not, therefore, extrapolate to the UK. To understand the factors affecting women's decision to seek help for perinatal distress. Meta-synthesis of the available published qualitative evidence on UK women's experiences of seeking help for perinatal distress. Systematic searches were conducted in accordance with PRISMA guidelines. Databases searched were PubMed, Scopus, PsycINFO, PsycARTICLES, CINAHL, and Academic Search Complete. Searches of grey literature and references were also conducted. Studies were eligible for inclusion if they reported qualitative data on UK women's experiences of perinatal distress and contact with healthcare professionals. The synthesis was conducted using meta-ethnography. In all, 24 studies were eligible for inclusion. Metasynthesis identified three main themes: identifying a problem, the influence of healthcare professionals, and stigma. These themes build on current understanding of help seeking by identifying the need for women to be able to frame their experience, for healthcare professionals to educate women about their roles, the need for continuity of care, and the way that being seen as a 'bad mother' causes women to self-silence. Perinatal care provision needs to allow for continuity of care and for staff training that facilitates awareness of factors that influence women's help seeking. Further research is required, particularly in relation to effective means of identifying perinatal psychological distress. © British Journal of General Practice 2017.

Congenital malformations, chromosomal abnormalities and perinatal results in IVF/ICSI newborns resulting from very poor quality embryos: a case-control study.

Science.gov (United States)

Mendoza, R; Perez, S; de Los Santos, M J; Larreategui, Z; Ayerdi, F; Expósito, A; Burgos, J; Martínez Indart, L; Pijoan, J I; Matorras, R

2015-01-01

To explore whether the transfer of very poor quality (VPQ) embryos is associated with an increase in congenital malformations or perinatal problems. In this retrospective case-control study, 74 children conceived by in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) resulting exclusively from the transfer of VPQ embryos were compared with 1,507 children born after the transfer of top morphological quality (TQ) embryos over the same period of time in the same centers. The prevalence of birth defects in children resulting from VPQ embryos was 1.35% (1/74), similar to the 1.72% (26/1,507) when only TQ embryos were transferred; the rate of chromosomal abnormalities detected was also similar (0.0 vs. 0.4%), as was perinatal mortality. After correcting for multiplicity (higher in the TQ group), the aforementioned parameters remained similar in the two groups. Congenital malformations and perinatal complications do not seem to be more common in children born after transfer of VPQ embryos in IVF/ICSI cycles. Given our preliminary data, which need to be confirmed in much larger studies, when only VPQ embryos are available for transfer in IVF/ICSI cycles, we do not believe that they should be discarded with the intention of avoiding birth defects or perinatal complications. © 2015 S. Karger AG, Basel.

Quality assessment of perinatal and infant postmortem examinations in Turkey.

Science.gov (United States)

Pakis, Isil; Karapirli, Mustafa; Karayel, Ferah; Turan, Arzu; Akyildiz, Elif; Polat, Oguz

2008-09-01

An autopsy examination is important in identifying the cause of death and as a means of auditing clinical and forensic practice; however, especially in perinatal and infantile age groups determining the cause of death leads to some difficulties in autopsy practice. In this study, 15,640 autopsies recorded during the years 2000-2004 in the Mortuary Department of the Council of Forensic Medicine were reviewed. Autopsy findings of 510 cases between 20 completed weeks of gestation and 1 year of age were analyzed retrospectively. The quality of each necropsy report was assessed using a modification of the system gestational age assessment described by Rushton, which objectively scores aspects identified by the Royal College of Pathologists as being part of a necropsy. According to their ages, the cases were subdivided into three groups. Intrauterine deaths were 31% (158 cases), neonatal deaths were 24% (123 cases), and infantile deaths were 45% (229 cases) of all cases. Scores for the quality of the necropsy report were above the minimum acceptable score with 44% in intrauterine, 88% in neonatal and infantile deaths.

The body and ontology: Perinatal death and bereavement in the techno-scientific landscape of hospital care

Directory of Open Access Journals (Sweden)

Paul Richard Cassidy

2015-08-01

Full Text Available This study takes the body (of mother and child, the technoscientific hospital landscape and professional ritual as the locus of an endeavour to understand the embodied experience of perinatal death, in order to better comprehend how alternate understandings and ontologies of motherhood, personhood and bereavement emerge during care enactments.  Grounded in a descriptive and ethnographic approach the research analyses data from the entries of 22 members of a pregnancy loss support forum and 10 narrative style interviews. The research traces embodied experience from pregnancy, through diagnosis to the spatialised experience of the hospital, including the birth, postmortem contact and disposal of the corpse. Bounded by the sudden destruction of ontological security many of these women experience an existential crisis that results in a destructed stigmatised self. The research explores how overly medicalised obstetric care enacts understandings of perinatal death and bereavement that further problematizes postmortem relationships, creating toxic identities and embodied selves. Conversely, woman-centred midwifery that takes relational and social understandings as a basis for care can create the material conditions of possibility for a restoration of confidence in carnal self and a reconstruction of social bonds and order. Assembled through practice, discourse and policy, these bodies are individually, socially and politically enacted, but they are also multiple, mutable and enfolded assemblages of nature and culture. The research proposes that healthcare practice would benefit by considering natural stillbirths, just as contemporary obstetrics advocates natural childbirth.

Collaborative survey of perinatal loss in planned and unplanned home births. Northern Region Perinatal Mortality Survey Coordinating Group.

Science.gov (United States)

1996-11-23

To document the outcome of planned and unplanned births outside hospital. Confidential review of every pregnancy ending in stillbirth or neonatal death in which plans had been made for home delivery, irrespective of where delivery eventually occurred. The review was part of a sustained collaborative survey of all perinatal deaths. Northern Regional Health Authority area. All 558,691 registered births to women normally resident in the former Northern Regional Health Authority area during 1981-94. Perinatal death. The estimated perinatal mortality during 1981-94 among women booked for a home birth was 14 deaths in 2888 births. This was less than half that among all women in the region. Only three of the 14 women delivered outside hospital. Independent review suggested that two of the 14 deaths might have been averted by different management. Both births occurred in hospital, and in only one was management before admission of the mother judged inappropriate. Perinatal loss to the 64 women who booked for hospital delivery but delivered outside and to the 67 women who delivered outside hospital without ever making arrangements to receive professional care during labour accounted for the high perinatal mortality (134 deaths in 3466 deliveries) among all births outside hospital. The perinatal hazard associated with planned home birth in the few women who exercised this option (unplanned delivery outside hospital.

Bridging between professionals in perinatal care: Towards shared care in The Netherlands

NARCIS (Netherlands)

Posthumus, AP; Schölmerich, V.L.N.; Waelput, AJ; Vos, AA; De Jong-Potjer, LC; Bakker, R.; Bonsel, G.J.; Groenewegen, P.; Steegers, EA; Denktas, S

2013-01-01

Relatively high perinatal mortality rates in the Netherlands have required a critical assessment of the national obstetric system. Policy evaluations emphasized the need for organizational improvement, in particular closer collaboration between community midwives and obstetric caregivers in

Influence of culture and community perceptions on birth and perinatal care of immigrant women: doulas' perspective.

Science.gov (United States)

Kang, Hye-Kyung

2014-01-01

A qualitative study examined the perceptions of doulas practicing in Washington State regarding the influence of cultural and community beliefs on immigrant women's birth and perinatal care, as well as their own cultural beliefs and values that may affect their ability to work interculturally. The findings suggest that doulas can greatly aid immigrant mothers in gaining access to effective care by acting as advocates, cultural brokers, and emotional and social support. Also, doulas share a consistent set of professional values, including empowerment, informed choice, cultural relativism, and scientific/evidence-based practice, but do not always recognize these values as culturally based. More emphasis on cultural self-awareness in doula training, expanding community doula programs, and more integration of doula services in health-care settings are recommended.

Evaluation of a quality improvement intervention for obstetric and neonatal care in selected public health facilities across six states of India.

Science.gov (United States)

Sarin, Enisha; Kole, Subir K; Patel, Rachana; Sooden, Ankur; Kharwal, Sanchit; Singh, Rashmi; Rahimzai, Mirwais; Livesley, Nigel

2017-05-02

While increase in the number of women delivering in health facilities has been rapid, the quality of obstetric and neonatal care continues to be poor in India, contributing to high maternal and neonatal mortality. The USAID ASSIST Project supported health workers in 125 public health facilities (delivering approximately 180,000 babies per year) across six states to use quality improvement (QI) approaches to provide better care to women and babies before, during and immediately after delivery. As part of this intervention, each month, health workers recorded data related to nine elements of routine care alongside data on perinatal mortality. We aggregated facility level data and conducted segmented regression to analyse the effect of the intervention over time. Care improved to 90-99% significantly (p improving provision of routine care, yet these approaches are underused in the Indian health system. We discuss the implications of this for policy makers.

[Perinatal mortality in foreign workers (author's transl)].

Science.gov (United States)

Höfling, H J; Jonas, R; Brusis, E; Lochmüller, H; Selbmann, H K; Holzmann, K; Zander, J

1975-03-01

From 1970 to 1972, there were 216 perinatal deaths among 5595 newborns at the I. Frauenklinik der Universität München. 54 of these deaths were children of foreign workers (so-called "Gastarbeiter"). The data have been processed on punch cards and analysed by a computer. The differences noted underwent significance testing by the CHI-Quadrat test. Only statistical significant results are published. The perinatal mortality in the above period shows no difference between foreign and German ward patients. There is, however, a significant lower perinatal mortality in private patients. We feel that this difference is due to a significant lower rate of prematures in the private patient group. The cocial status as well as higher interest and motivation in health resulting in better prenatal care are discussed as causal reasons for this fact.

Why some women fail to give birth at health facilities: a qualitative study of women’s perceptions of perinatal care from rural Southern Malawi

Directory of Open Access Journals (Sweden)

Kumbani Lily

2013-02-01

Full Text Available Abstract Background Despite Malawi government’s policy to support women to deliver in health facilities with the assistance of skilled attendants, some women do not access this care. Objective The study explores the reasons why women delivered at home without skilled attendance despite receiving antenatal care at a health centre and their perceptions of perinatal care. Methods A descriptive study design with qualitative data collection and analysis methods. Data were collected through face-to-face in-depth interviews using a semi- structured interview guide that collected information on women’s perception on perinatal care. A total of 12 in- depth interviews were conducted with women that had delivered at home in the period December 2010 to March 2011. The women were asked how they perceived the care they received from health workers before, during, and after delivery. Data were manually analyzed using thematic analysis. Results Onset of labor at night, rainy season, rapid labor, socio-cultural factors and health workers’ attitudes were related to the women delivering at home. The participants were assisted in the delivery by traditional birth attendants, relatives or neighbors. Two women delivered alone. Most women went to the health facility the same day after delivery. Conclusions This study reveals beliefs about labor and delivery that need to be addressed through provision of appropriate perinatal information to raise community awareness. Even though, it is not easy to change cultural beliefs to convince women to use health facilities for deliveries. There is a need for further exploration of barriers that prevent women from accessing health care for better understanding and subsequently identification of optimal solutions with involvement of the communities themselves.

Influence of Culture and Community Perceptions on Birth and Perinatal Care of Immigrant Women: Doulas’ Perspective

Science.gov (United States)

Kang, Hye-Kyung

2014-01-01

A qualitative study examined the perceptions of doulas practicing in Washington State regarding the influence of cultural and community beliefs on immigrant women’s birth and perinatal care, as well as their own cultural beliefs and values that may affect their ability to work interculturally. The findings suggest that doulas can greatly aid immigrant mothers in gaining access to effective care by acting as advocates, cultural brokers, and emotional and social support. Also, doulas share a consistent set of professional values, including empowerment, informed choice, cultural relativism, and scientific/evidence-based practice, but do not always recognize these values as culturally based. More emphasis on cultural self-awareness in doula training, expanding community doula programs, and more integration of doula services in health-care settings are recommended. PMID:24453465

Evaluation of cardiopulmonary factors critical to successful emergency perinatal air transport.

Science.gov (United States)

1982-03-01

Regionalization of specialized perinatal care is a fully viable and progressing concept. The two major components of regionalized care are the level III care facility and the air transport service. In descending importance, the medical transport team...

Reproductive health and lifestyle factors associated with health-related quality of life among perinatally HIV-infected adolescents in Uganda.

Science.gov (United States)

Mbalinda, Scovia Nalugo; Kiwanuka, Noah; Kaye, Dan K; Eriksson, Lars E

2015-10-21

With increased survival of perinatally HIV - infected adolescents due to antiretroviral therapy (ART), the focus of HIV care has shifted to health-related quality of life (HRQoL) as a measure of disease progression, effects of ART co-morbidity and prognosis. We assessed factors associated with better HRQoL in perinatally HIV -infected adolescents in Uganda by determining the associations between sexual and reproductive health (SRH) or lifestyle experiences on HRQoL. In a cross-sectional study, data on SRH, lifestyle experiences, socio demographic factors, communication with parents on sexuality and satisfaction of SRH services in ART clinics were collected from 614 HIV perinatally infected adolescents aged 10-19 using an interviewer-administered survey questionnaire. HRQoL data were collected using the Medical Outcomes Study HIV Health Survey instrument (MOS-HIV). Factors associated with better HRQoL were analysed using multiple logistic regression. The mean age was 16.2 ± 2.1 years, 362 (58.8 %) were females and 210 (34.2 %) were sexually active. Adolescents on ART were twice likely to present with better physical health (AOR = 2.07, 95 % CI: 1.24-3.46) and four times more likely to present with better mental health (AOR = 3.9, 95 % CI: 2.22-6.92) than those who were not on ART. There were no statistically significant associations between SRH (ever had sex, ever been pregnant, condom use, contraceptive use) or life style factors and physical health or mental health. Those with secondary or tertiary education were more likely to present with a better mental health (AOR = 5.3, 95 % CI: 1.86-15.41) compared those who had attained primary or no education. Participants who desired to have a child in future more likely (AOR 1.7, 95 % CI: 1.05-3.00) to present with a better mental health. Lack of communication with guardians on sexuality (AOR = 0.6, 95 % CI: 0.40-0.89), or dissatisfaction with SRH services (AOR 0.34, 95 % CI: 0.18-0.62) were

The Social Nature of Perceived Illness Representations of Perinatal Depression in Rural Uganda.

Science.gov (United States)

Sarkar, Nandini D P; Bardaji, Azucena; Peeters Grietens, Koen; Bunders-Aelen, Joske; Baingana, Florence; Criel, Bart

2018-06-07

While the global health community advocates for greater integration of mental health into maternal health agendas, a more robust understanding of perinatal mental health, and its role in providing integrated maternal health care and service delivery, is required. The present study uses the Illness Representation Model, a theoretical cognitive framework for understanding illness conceptualisations, to qualitatively explore multiple stakeholder perspectives on perinatal depression in rural Uganda. A total of 70 in-depth interviews and 9 focus group discussions were conducted with various local health system stakeholders, followed by an emergent thematic analysis using NVivo 11. Local communities perceived perinatal depression as being both the fault of women, and not. It was perceived as having socio-economic and cultural causal factors, in particular, as being partner-related. In these communities, perinatal depression was thought to be a common occurrence, and its negative consequences for women, infants and the community at large were recognised. Coping and help-seeking behaviours prescribed by the participants were also primarily socio-cultural in nature. Placing the dynamics and mechanisms of these local conceptualisations of perinatal depression alongside existing gaps in social and health care systems highlights both the need of, and the opportunities for, growth and prioritisation of integrated perinatal biomedical, mental, and social health programs in resource-constrained settings.

Impacts of online and group perinatal education: a mixed methods study protocol for the optimization of perinatal health services.

Science.gov (United States)

Roch, Geneviève; Borgès Da Silva, Roxane; de Montigny, Francine; Witteman, Holly O; Pierce, Tamarha; Semenic, Sonia; Poissant, Julie; Parent, André-Anne; White, Deena; Chaillet, Nils; Dubois, Carl-Ardy; Ouimet, Mathieu; Lapointe, Geneviève; Turcotte, Stéphane; Prud'homme, Alexandre; Painchaud Guérard, Geneviève; Gagnon, Marie-Pierre

2018-05-29

Prenatal education is a core component of perinatal care and services provided by health institutions. Whereas group prenatal education is the most common educational model, some health institutions have opted to implement online prenatal education to address accessibility issues as well as the evolving needs of future parents. Various studies have shown that prenatal education can be effective in acquisition of knowledge on labour and delivery, reducing psychological distress and maximising father's involvement. However, these results may depend on educational material, organization, format and content. Furthermore, the effectiveness of online prenatal education compared to group prenatal education remains unclear in the literature. This project aims to evaluate the impacts of group prenatal education and online prenatal education on health determinants and users' health status, as well as on networks of perinatal educational services maintained with community-based partners. This multipronged mixed methods study uses a collaborative research approach to integrate and mobilize knowledge throughout the process. It consists of: 1) a prospective cohort study with quantitative data collection and qualitative interviews with future and new parents; and 2) a multiple case study integrating documentary sources and interviews with stakeholders involved in the implementation of perinatal information service networks and collaborations with community partners. Perinatal health indicators and determinants will be compared between prenatal education groups (group prenatal education and online prenatal education) and standard care without these prenatal education services (control group). This study will provide knowledge about the impact of online prenatal education as a new technological service delivery model compared to traditional group prenatal education. Indicators related to the complementarity of these interventions and those available in community settings will

A Qualitative Study of the Maternity Care Experiences of Women with Obesity: "More than Just a Number on the Scale".

Science.gov (United States)

DeJoy, Sharon Bernecki; Bittner, Krystle; Mandel, Deborah

2016-01-01

The prevalence of obesity among pregnant women in the United States is high. Obesity can have long-term health consequences for both women and their offspring, so high-quality perinatal care for women with obesity is essential. However, stigmatizing encounters with health care professionals can decrease quality and promote avoidance of care. The purpose of this study was to explore the experiences of women with obesity in the maternity care system in the United States. In-depth telephone interviews were conducted with 16 women with a body mass index of 30 or greater. The authors used an inductive analytical process to translate women's experiences into themes. Women with obesity reported diverse maternity care experiences, with some reporting appropriate and satisfactory care, while most reported at least one negative encounter over the course of perinatal care. Three major themes emerged from the analysis: personalized care, depersonalized care, and setting the tone. Interactions with providers during pregnancy had psychological and emotional effects on women with obesity and influenced the content and perceived quality of their care. Further research is required to explore this phenomenon and its implications for care of women during pregnancy and birth outcomes. In the meantime, providers may wish to consider greater sensitivity to the needs of women with obesity during the perinatal period. © 2016 by the American College of Nurse-Midwives.

Learning from deaths: Parents' Active Role and ENgagement in The review of their Stillbirth/perinatal death (the PARENTS 1 study).

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Bakhbakhi, Danya; Siassakos, Dimitrios; Burden, Christy; Jones, Ffion; Yoward, Freya; Redshaw, Maggie; Murphy, Samantha; Storey, Claire

2017-10-02

Following a perinatal death, a formal standardised multi-disciplinary review should take place, to learn from the death of a baby and facilitate improvements in future care. It has been recommended that bereaved parents should be offered the opportunity to give feedback on the care they have received and integrate this feedback into the perinatal mortality review process. However, the MBRRACE-UK Perinatal Confidential Enquiry (2015) found that only one in 20 cases parental concerns were included in the review. Although guidance suggests parental opinion should be sought, little evidence exists on how this may be incorporated into the perinatal mortality review process. The purpose of the PARENTS study was to investigate bereaved parents' views on involvement in the perinatal mortality review process. A semi-structured focus group of 11 bereaved parents was conducted in South West England. A purposive sampling technique was utilised to recruit a diverse sample of women and their partners who had experienced a perinatal death more than 6 months prior to the study. A six-stage thematic analysis was followed to explore parental perceptions and expectations of the perinatal mortality review process. Four over-arching themes emerged from the analysis: transparency; flexibility combined with specificity; inclusivity; and a positive approach. It was evident that the majority of parents were supportive of their involvement in the perinatal mortality review process and they wanted to know the outcome of the meeting. It emerged that an individualised approach should be taken to allow flexibility on when and how they could contribute to the process. The emotional aspects of care should be considered as well as the clinical care. Parents identified that the whole care pathway should be examined during the review including antenatal, postnatal, and neonatal and community based care. They agreed that there should be an opportunity for parents to give feedback on both good and

Perinatal outcomes following an earlier post-term labour induction policy

DEFF Research Database (Denmark)

Hedegaard, M.; Lidegaard, Ø; Skovlund, C W

2015-01-01

: Perinatal outcomes were estimated using a logistic regression analysis with adjustment for gestational age, maternal age, parity, plurality, smoking and body mass index. MAIN OUTCOME MEASURES: Perinatal outcomes. RESULTS: A total of 770 926 infants were included. Labour induction from 37 weeks increased...... from 9.7% in 2000-02 to 22.5% in 2011-12. From 2003-05 to 2011-12, the risk of umbilical cord pH care units...

Perinatal mortality rate in the Netherlands compared to other European countries: a secondary analysis of Euro-PERISTAT data.

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de Jonge, Ank; Baron, Ruth; Westerneng, Myrte; Twisk, Jos; Hutton, Eileen K

2013-08-01

the poor perinatal mortality ranking of the Netherlands compared to other European countries has led to questioning the safety of primary care births, particularly those at home. Primary care births are only planned at term. We therefore examined to which extent the perinatal mortality rate at term in the Netherlands contributes to its poor ranking. secondary analyses using published data from the Euro-PERISTAT study. women that gave birth in 2004 in the 29 European regions and countries called 'countries' included in the Euro-PERISTAT study (4,328,441 women in total and 1,940,977 women at term). odds ratios and 95% confidence intervals were calculated for the comparison of perinatal mortality rates between European countries and the Netherlands, through logistic regression analyses using summary country data. combined perinatal mortality rates overall and at term. Perinatal deaths below 28 weeks, between 28 and 37 weeks and from 37 weeks onwards per 1000 total births. compared to the Netherlands, perinatal mortality rates at term were significantly higher for Denmark and Latvia and not significantly different compared to seven other countries. Eleven countries had a significantly lower rate, and for eight the term perinatal mortality rate could not be compared. The Netherlands had the highest number of perinatal deaths before 28 weeks per 1000 total births (4.3). the relatively high perinatal mortality rate in the Netherlands is driven more by extremely preterm births than births at term. Although the PERISTAT data cannot be used to show that the Dutch maternity care system is safe, neither should they be used to argue that the system is unsafe. The PERISTAT data alone do not support changes to the Dutch maternity care system that reduce the possibility for women to choose a home birth while benefits of these changes are uncertain. Copyright © 2013 Elsevier Ltd. All rights reserved.

Barriers to midwives and nurses addressing mental health issues with women during the perinatal period: The Mind Mothers study.

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Higgins, Agnes; Downes, Carmel; Monahan, Mark; Gill, Ailish; Lamb, Stephen A; Carroll, Margaret

2018-01-03

To explore barriers to midwives and nurses addressing mental health issues with women during the perinatal period. Perinatal mental health is considered an important public health issue with health policy internationally identifying the importance of psychological support for women in the perinatal period. Midwives and primary care nurses are ideally positioned to detect mental distress early, but evidence suggests that they are reluctant to discuss mental health issues with women during pregnancy or in the postnatal period. The research used a descriptive design. A total of 809 midwives and nurses completed an anonymous, online or hard copy survey. Designed by the research team, the survey listed 26 potential barriers to the provision of perinatal mental health care. Participants identified organisational factors as presenting the greatest barriers. Organisational barriers included lack of perinatal mental health services, absence of care pathways, heavy workload, lack of time, lack of privacy and not seeing women regularly enough to build a relationship. Over 50% of participants identified practitioner-related barriers, such as lack of knowledge on perinatal mental health and cultural issues; lack of skill, in particular, skills to respond to a disclosure of a mental health issue; and fears of causing women offence and distress. Findings also indicated that the context of care and education influenced the degree to which participants perceived certain items as barriers. Midwives and primary care nurses encounter many organisational- and practitioner-related barriers that negatively impact on their ability to incorporate mental health care into their practice. Midwifery and nursing services need to develop strategies to address system- and practitioner-related barriers, including the development of services and care pathways, and the provision of culturally sensitive education on perinatal mental health in order to support practitioners to address issues with

Psychosocial impact of perinatal loss among Muslim women

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Sutan Rosnah

2012-06-01

Full Text Available Abstract Background Women of reproductive age are vulnerable to psychosocial problems, but these have remained largely unexplored in Muslim women in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women. Methods A qualitative study was conducted in a specialist centre among Muslim mothers who had experienced perinatal loss. Purposive sampling to achieve maximum variation among Muslims in relation to age, parity and previous perinatal death was used. Data was collected by focus group discussion and in-depth unstructured interview until the saturation point met. Sixteen mothers who had recent perinatal loss of wanted pregnancy, had received antenatal follow up from public or private health clinics, and had delivery in our centre participated for the study. All of them had experienced psychological difficulties including feelings of confusion, emptiness and anxiety over facing another pregnancy. Results Two out of sixteen showed anger and one felt guilt. They reported experiencing a lack of communication and privacy in the hospital during the period of grief. Family members and friends play an important role in providing support. The majority agreed that the decision makers were husbands and families instead of themselves. The respondents felt that repetitive reminder of whatever happened was a test from God improved their sense of self-worth. They appreciated this reminder especially when it came from husband, family or friends closed to them. Conclusion Muslim mothers who had experienced perinatal loss showed some level of adverse psychosocial impact which affected their feelings. Husbands and family members were the main decision makers for Muslim women. Health care providers should provide psychosocial support during antenatal, delivery and postnatal care. On-going support involving husband should be available where needed.

Maternity Care in Russia: Issues, Achievements, and Potential.

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Shuvalova, Marina P; Yarotskaya, Ekaterina L; Pismenskaya, Tatiana V; Dolgushina, Nataliya V; Baibarina, Elena N; Sukhikh, Gennady T

2015-10-01

In this review, we provide basic facts about maternity care services within the health care system in Russia. We give a short overview of such key aspects as the demographic situation, reproductive behaviour, regulatory framework for providing health care for women and children, maternal and perinatal mortality, and the availability of medical personnel. In 2012, Russia began registration of births in accordance with the WHO recommendations (births with weight ≥ 500 g at ≥ 22 weeks' gestation). Introduction of this new registration system increased the completeness and quality of the collected information and expanded possibilities for future international comparative assessments. A three-level system of specialized medical care has been introduced in Russia for women and newborns during pregnancy, childbirth, and the postpartum period. In 2014, the system included 1942 state (public) maternity hospitals providing 20 obstetric beds per 10 000 women aged 15 to 49 years. More than 100 perinatal centres (level III) are currently functioning in the country, with 32 new perinatal centres planned to open by 2016. The total number of obstetrician-gynaecologists in Russia is approximately 44 000, providing a ratio of 5.7 specialists per 10 000 women. The total number of midwives is 62 000, providing a ratio of 8.1 midwives per 10 000 women. In recent years we have succeeded in optimizing the maternity care system by increasing its accessibility and quality. This was achieved through qualitative and quantitative progress in the training of neonatologists, the development of intensive care technologies and neonatal critical care, capacity building of medical-genetic services and counselling, prenatal diagnosis, and the standardization of health care with data collection.

Perinatal mortality rate in the Netherlands compared to other European countries: a secondary analysis of Euro-PERISTAT data

NARCIS (Netherlands)

de Jonge, J.; Baron, R.; Westerneng, M.; Twisk, J.; Hutton, E.K.

2013-01-01

Objective: the poor perinatal mortality ranking of the Netherlands compared to other European countries has led to questioning the safety of primary care births, particularly those at home. Primary care births are only planned at term. We therefore examined to which extent the perinatal mortality

Does antenatal care timing influence stillbirth risk in the third trimester? A secondary analysis of perinatal death audit data in South Africa.

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Lavin, T; Pattinson, R C

2018-01-01

To explore stillbirth risk across gestation in three provinces of South Africa with different antenatal care schedules. Retrospective audit of perinatal death data using South Africa's Perinatal Problem Identification Programme. In 2008, the Basic Antenatal Care Programme was introduced in Limpopo and Mpumalanga provinces, reducing appointments to five visits at booking, 20, 26, 32, 38 weeks and 41 weeks if required. In the Western Cape province seven appointments remained at booking, 20, 26, 32, 34, 36, 38 and 41 weeks if required. All audited stillbirths (n = 4211) between October 2013 to August 2015 in Limpopo, Mpumalanga and Western Cape. Stillbirth risk (26-42 weeks of gestation, >1000 g) across gestation was calculated using Yudkin's method. Stillbirth risk was compared between provinces and relative risks were calculated between Limpopo/ Mpumalanga and Western Cape. Stillbirth risk across gestation. Stillbirth risk peaked at 38 weeks of gestation in Limpopo (relative risk [RR] 3.11, 95% CI 2.40-4.03, P risk at 38 weeks gestation in Limpopo and Mpumalanga were statistically greater than both the 37 and 39 weeks gestation within provinces (P risk occurs after a 6-week absence of antenatal care. This calls for a refocus on the impact of reduced antenatal care visits during the third trimester. Reduced antenatal care in the third trimester may increase stillbirth risk. © 2017 Royal College of Obstetricians and Gynaecologists.

The Social Nature of Perceived Illness Representations of Perinatal Depression in Rural Uganda

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Nandini D. P. Sarkar

2018-06-01

Full Text Available While the global health community advocates for greater integration of mental health into maternal health agendas, a more robust understanding of perinatal mental health, and its role in providing integrated maternal health care and service delivery, is required. The present study uses the Illness Representation Model, a theoretical cognitive framework for understanding illness conceptualisations, to qualitatively explore multiple stakeholder perspectives on perinatal depression in rural Uganda. A total of 70 in-depth interviews and 9 focus group discussions were conducted with various local health system stakeholders, followed by an emergent thematic analysis using NVivo 11. Local communities perceived perinatal depression as being both the fault of women, and not. It was perceived as having socio-economic and cultural causal factors, in particular, as being partner-related. In these communities, perinatal depression was thought to be a common occurrence, and its negative consequences for women, infants and the community at large were recognised. Coping and help-seeking behaviours prescribed by the participants were also primarily socio-cultural in nature. Placing the dynamics and mechanisms of these local conceptualisations of perinatal depression alongside existing gaps in social and health care systems highlights both the need of, and the opportunities for, growth and prioritisation of integrated perinatal biomedical, mental, and social health programs in resource-constrained settings.

Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model

OpenAIRE

Moore, Donna; Drey, Nicholas; Ayers, Susan

2017-01-01

BACKGROUND: Perinatal mental illness is a global health concern; however, many women with the illness do not get the treatment they need to recover. Interventions that reduce the stigma around perinatal mental illness have the potential to enable women to disclose their symptoms to health care providers and consequently access treatment. There are many online forums for perinatal mental illness and thousands of women use them. Preliminary research suggests that online forums may promote help-...

The impact of the Perinatal Education Programme on cognitive ...

African Journals Online (AJOL)

Assessment of cognitive knowledge by means of multiple-choice ... midwives use the Perinatal Education Programme in an outreach ... used the Afrikaans translation of the Programme, because .... improvements in patient care practices.

Financial viability of perinatal centers in the longer term, taking legislative requirements into account. An examination of the cost-revenue structure of a Level I perinatal center.

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Lux, Michael P; Kraml, Florian; Wagner, Stefanie; Hack, Carolin C; Schulze, Christine; Faschingbauer, Florian; Winkler, Mathias; Fasching, Peter A; Beckmann, Matthias W; Hildebrandt, Thomas

2013-01-01

Debate is currently taking place over minimum case numbers for the care of premature infants and neonates in Germany. As a result of the Federal Joint Committee (Gemeinsamer Bundesauschuss, G-BA) guidelines for the quality of structures, processes, and results, requiring high levels of staffing resources, Level I perinatal centers are increasingly becoming the focus for health-economics questions, specifically, debating whether Level I structures are financially viable. Using a multistep contribution margin analysis, the operating results for the Obstetrics Section at the University Perinatal Center of Franconia (Universitäts-Perinatalzentrum Franken) were calculated for the year 2009. Costs arising per diagnosis-related group (DRG) (separated into variable costs and fixed costs) and the corresponding revenue generated were compared for 4,194 in-patients and neonates, as well as for 3,126 patients in the outpatient ultrasound and pregnancy clinics. With a positive operating result of € 374,874.81, a Level I perinatal center on the whole initially appears to be financially viable, from the obstetrics point of view (excluding neonatology), with a high bed occupancy rate and a profitable case mix. By contrast, the costs of prenatal diagnostics, with a negative contribution margin II of € 50,313, cannot be covered. A total of 79.4% of DRG case numbers were distributed to five DRGs, all of which were associated with pregnancies and neonates with the lowest risk profiles. A Level I perinatal center is currently capable of covering its costs. However, the cost-revenue ratio is fragile due to the high requirements for staffing resources and numerous economic, social, and regional influencing factors.

Nursing diagnosis of grieving: content validity in perinatal loss situations.

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Paloma-Castro, Olga; Romero-Sánchez, José Manuel; Paramio-Cuevas, Juan Carlos; Pastor-Montero, Sonia María; Castro-Yuste, Cristina; Frandsen, Anna J; Albar-Marín, María Jesús; Bas-Sarmiento, Pilar; Moreno-Corral, Luis Javier

2014-06-01

To validate the content of the NANDA-I nursing diagnosis of grieving in situations of perinatal loss. Using the Fehring's model, 208 Spanish experts were asked to assess the adequacy of the defining characteristics and other manifestations identified in the literature for cases of perinatal loss. The content validity index was 0.867. Twelve of the 18 defining characteristics were validated, seven as major and five as minor. From the manifestations proposed, "empty inside" was considered as major. The nursing diagnosis of grieving fits in content to the cases of perinatal loss according to experts. The results have provided evidence to support the use of the diagnosis in care plans for said clinical situation. © 2013 NANDA International.

PELAYANAN KESEHATAN PERINATAL DI DAERAH PEDESAAN UJUNG BERUNG

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Anna Alisjahbana

2012-09-01

Full Text Available A survey on perinatal care in a rural area at Ujung Berung district, located 15—20 km outside Bandung, West Java was conducted. Three villages with a population of 40,787 were selected. Health services were provided by one health post and several family planning posts. In this study 1303 pregnant women were followed throughout the 28 weeks of pregnancy until the infant is 28 days of age. Among the 1303 pregnant women 5.7% had received tetanus toxoid immunization. Perinatal mortality rate (PMR was 43.6 per thousand and incidence of low birth weight was 14.3 percent. Only 12.8% pregnant women were using some kind of contraception before the last pregnancy. The PMR decreased in spite of the low percentage users. The main causes of death during perinatal period vece asphyxia neonatorum and infections. The incidence of tetanus neonatorum during neonatal period was 17 per thousand live births. An evaluation of health service activities showed 47.5% of these pregnant women had antenatal care. Care during delivery and early postnatal period was carried out by TBAs. No significant difference was found between the PMR of trained and untrained TBAs. Another aspect of health service activities is referral to the health centre or hospital. A total of 3.8 percent infants were referred because of neo­natal problems; among these, refusal was 12.5% due to the totalistic attitude of the parents in the village. The results showed that coverage of pregnant women and their infants by safe health care services is very low. This may be due to lack of facilities and health personnel, and probably also due to the confidence of village people for traditional health care providers. Thus, education and training as well as supervision of traditional health care providers and their integration into the formal health care structure is of extreme importance.  

What Makes for Good Collaboration and Communication in Maternity Care? : A Scoping Study

NARCIS (Netherlands)

Isabel van Helmond; Irene Korstjens; Jessica Mesman; Marianne Nieuwenhuijze; Klasien Horstman; Hubertina Scheepers; Mark Spaanderman; Judit Keulen; Raymond de Vries

2015-01-01

Problems with communication and collaboration among perinatal caregivers threaten the quality and safety of care given to mothers and babies. Good communication and collaboration are critical to safe care for mothers and babies. In this study the researchers focused on studies examining the factors

Factors associated with and causes of perinatal mortality in northeastern Tanzania

DEFF Research Database (Denmark)

Schmiegelow, Christentze; Minja, Daniel; Oesterholt, Mayke

2012-01-01

, including preeclampsia, small-for-gestational age, preterm delivery, anemia, and health-seeking behavior. Fetal growth was monitored using ultrasound. Finally, the specific causes of the perinatal deaths were evaluated. Main outcome measure. Perinatal mortality. Results. Forty-six deaths occurred. Key...... to the antenatal care program (adjusted OR 0.027, 95%CI 0.003-0.26, p = 0.002) protected against perinatal mortality. The cause of death in 43% of cases was attributed to complications related to labor and specifically to intrapartum asphyxia (30%) and neonatal infection (13%). Among the remaining deaths, 27% (7....../26) were attributed to preeclampsia and 23% (6/26) to small-for-gestational age. Of these, 54% (14/26) were preterm. Conclusions. Preeclampsia, small-for-gestational age and preterm delivery were key risk factors and causes of perinatal mortality in this area of Tanzania. Maternal anemia was also strongly...

Advancing obstetric and neonatal care in a regional hospital in Ghana via continuous quality improvement.

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Srofenyoh, Emmanuel; Ivester, Thomas; Engmann, Cyril; Olufolabi, Adeyemi; Bookman, Laurel; Owen, Medge

2012-01-01

To reduce maternal and neonatal death at a large regional hospital through the use of quality improvement methodologies. In 2007, Kybele and the Ghana Health Service formed a partnership to analyze systems and patient care processes at a regional hospital in Accra, Ghana. A model encompassing continuous assessment, implementation, advocacy, outputs, and outcomes was designed. Key areas for improvement were grouped into "bundles" based on personnel, systems management, and service quality. Primary outcomes included maternal and perinatal mortality, and case fatality rates for hemorrhage and hypertensive disorders. Implementation and outcomes were evaluated tri-annually between 2007 and 2009. During the study period, there was a 34% decrease in maternal mortality despite a 36% increase in patient admission. Case fatality rates for pre-eclampsia and hemorrhage decreased from 3.1% to 1.1% (Pcontinuous quality improvement were developed and employed. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Quality Assurance Practices in Obstetric Care: A Survey of Hospitals in California.

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Lundsberg, Lisbet S; Lee, Henry C; Dueñas, Grace Villarin; Gregory, Kimberly D; Grossetta Nardini, Holly K; Pettker, Christian M; Illuzzi, Jessica L; Xu, Xiao

2018-02-01

To assess hospital practices in obstetric quality management activities and identify institutional characteristics associated with utilization of evidence-supported practices. Data for this study came from a statewide survey of obstetric hospitals in California regarding their organization and delivery of perinatal care. We analyzed responses from 185 hospitals that completed quality assurance sections of the survey to assess their practices in a broad spectrum of quality enhancement activities. The association between institutional characteristics and adoption of evidence-supported practices (ie, those supported by prior literature or recommended by professional organizations as beneficial for improving birth outcome or patient safety) was examined using bivariate analysis and appropriate statistical tests. Most hospitals regularly audited adherence to written protocols regarding critical areas of care; however, 77.7% and 16.8% reported not having written guidelines on diagnosis of labor arrest and management of abnormal fetal heart rate, respectively. Private nonprofit hospitals were more likely to have a written protocol for management of abnormal fetal heart rate (P=.002). One in 10 hospitals (9.7%) did not regularly review cases with significant morbidity or mortality, and only 69.0% regularly tracked indications for cesarean delivery. Moreover, 26.3%, 14.3%, and 8.7% of the hospitals reported never performing interprofessional simulations for eclampsia, shoulder dystocia, or postpartum hemorrhage, respectively. Teaching status was associated with more frequent simulations in these three areas (P≤.04 for all), while larger volume was associated with more frequent simulations for eclampsia (P=.04). Hospitals in California engage in a wide range of practices to assure or improve quality of obstetric care, but substantial variation in practice exists among hospitals. There is opportunity for improvement in adoption of evidence-supported practices.

A systematic review of the effectiveness of training in emergency obstetric care in low-resource environments

NARCIS (Netherlands)

van Lonkhuijzen, L.; Dijkman, A.; van Roosmalen, J.; Zeeman, G.; Scherpbier, A.

Background Training of healthcare workers can play an important role in improving quality of care, and reducing maternal and perinatal mortality and morbidity. Objectives To assess the effectiveness of training programmes aimed at improving emergency obstetric care in low-resource environments.

Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health.

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Vogel, J P; Souza, J P; Mori, R; Morisaki, N; Lumbiganon, P; Laopaiboon, M; Ortiz-Panozo, E; Hernandez, B; Pérez-Cuevas, R; Roy, M; Mittal, S; Cecatti, J G; Tunçalp, Ö; Gülmezoglu, A M

2014-03-01

We aimed to determine the prevalence and risks of late fetal deaths (LFDs) and early neonatal deaths (ENDs) in women with medical and obstetric complications. Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS). A total of 359 participating facilities in 29 countries. A total of 308 392 singleton deliveries. We reported on perinatal indicators and determined risks of perinatal death in the presence of severe maternal complications (haemorrhagic, infectious, and hypertensive disorders, and other medical conditions). Fresh and macerated LFDs (defined as stillbirths ≥ 1000 g and/or ≥28 weeks of gestation) and ENDs. The LFD rate was 17.7 per 1000 births; 64.8% were fresh stillbirths. The END rate was 8.4 per 1000 liveborns; 67.1% occurred by day 3 of life. Maternal complications were present in 22.9, 27.7, and 21.2% [corrected] of macerated LFDs, fresh LFDs, and ENDs, respectively. The risks of all three perinatal mortality outcomes were significantly increased with placental abruption, ruptured uterus, systemic infections/sepsis, pre-eclampsia, eclampsia, and severe anaemia. Preventing intrapartum-related perinatal deaths requires a comprehensive approach to quality intrapartum care, beyond the provision of caesarean section. Early identification and management of women with complications could improve maternal and perinatal outcomes. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Globalization and perinatal medicine--how do we respond?

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Kurjak, Asim; Di Renzo, Gian Carlo; Stanojevic, Milan

2010-04-01

Globalization is both inevitable and usually desirable and contains advantageous and disadvantageous issues. It is a source of both hope and of apprehension and is an accelerating process in flow of information, technology, goods and services, and production means. Globalization has a complex influence on perinatal health. The bonds that link perinatologists together transcend geographic, political, religious, and lingual differences, resulting in a globalization that optimizes perinatal care. In this review, we will discuss some of the global problems facing modern perinatologists. Close to 1.5 billion people in the world, live in extreme poverty, a situation which is particularly stark in the developing world, where 80% of them live. Poor people have little or no access to qualified health services and education, and do not participate in the decisions critical to their day-to-day lives. Poverty cannot be defined solely in terms of lack of income. A person, a family, even a nation is not deemed poor only because of low economic resources. Little or no access to health services, lack of access to safe water and adequate nutrition, illiteracy or low educational level, and a distorted perception of rights and needs are also essential components of poverty. Expression of poverty in perinatal health care in developing countries are high maternal death and morbidity rates, huge perinatal and childhood losses, and high birth rates. There are good reasons to define it as a global tragedy in our time. Although the mankind has come quite far because the development of civilization and more advances in the health care were made during the past 100 years than in all previous human history, some inhabitants of our planet are not able to experience it. According to some data, every 3 s a newborn dies, and every minute a pregnant woman dies in the globalized world. All together over 10 million deaths every year, which indicates that health security is not strong enough. It is

Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative

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Kwedza Ru K

2011-03-01

Full Text Available Abstract Background Australia's Aboriginal and Torres Strait Islander (Indigenous populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities. Methods We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4 were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems. Results The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician. Conclusion Participating services had both strengths and weaknesses in the delivery of maternal

Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh

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Rahman Anisur

2011-12-01

Full Text Available Abstract Background Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. Methods This study took advantage of an ongoing health and demographic surveillance system (HDSS and a new Maternal, Neonatal and Child Health (MNCH Project initiated in 2007 in Matlab, Bangladesh in half (intervention area of the HDSS area. In the other half, women received usual care through the government health system (comparison area. The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods--before (2005-2006 and after (2008-2009 implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. Results Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78. The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018. Conclusion The continuum

Effectiveness of a regional self-study perinatal education programme: a successful adaptation in Yucatan, Mexico.

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Osorno, Lorenzo R; Campos, Miriam C; Cook, Lynn J; Vela, Gabriela R; Dávila, Jorge R

2006-08-01

To evaluate the effectiveness of the Perinatal Continuing Education Programme (PCEP) in a Latin American country. We carried out a study within secondary and tertiary care, and rural Mexican Institute of Social Security (IMSS) hospitals on the Yucatan Peninsula. Participants were doctors, nurses and nursing assistants working with pregnant women and newborns at each hospital. The PCEP was translated into Spanish and then implemented between January 1998 and December 2001. Two nurses at each hospital were trained to co-ordinate the programme and the personnel were invited to participate. Participation involved purchasing the self-teaching books, study outside work hours and participation in skills demonstration and practice sessions. Evaluation included the percentage of personnel who participated in and those who completed the programme, an opinion survey of the programme, level of pre- and post-intervention knowledge, and the quality of neonatal care according to expert-recommended routines. Results were analysed with chi-square and Student's t-tests. A total of 65.3% of the 1421 people in the study population began the programme and 72% of those completed it. Improvement was observed in 14 of 23 (Pevaluated neonatal care practices. Participants rated the written material as very clear and useful in daily practice. The PCEP is an effective strategy for improving the level of knowledge and perinatal care in all regional hospitals on the Yucatan Peninsula, Mexico. This initial application of the PCEP in a Spanish-speaking country was successful.

Quantification of EUGR as a Measure of the Quality of Nutritional Care of Premature Infants.

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Zhenlang Lin

Full Text Available To develop an index of the quality of nutritional care of premature infants based on the change in weight Z score from birth to discharge and to illustrate the use of this index in comparing the performance of different NICUs.Retrospective data analysis was performed to compare the growth of premature infants born in three perinatal centers. Infants with gestational age ≤ 32 weeks who survived to discharge from 2006 to 2010 were included. Weight Z scores at birth and discharge were calculated by the method of Fenton. Using data from one NICU as the reference, a multivariable linear regression model of change in weight Z score from birth to discharge was developed. Employing this model, a benchmark value of change in weight Z score was calculated for each baby. The difference between this calculated benchmark value and the baby's observed change in weight Z score was defined as the performance gap for that infant. The average value of the performance gaps in a NICU serves as its quality care index.1,714 infants were included for analysis. Change in weight Z score is influenced by birth weight Z score and completed weeks of gestation; thus the model for calculating the benchmark change in weight Z score was adjusted for these two variables. We found statistically significant differences in the average performance gaps for the three units.A quality care index was developed based on change in weight Z score from birth to discharge adjusted for two initial risk factors. This objective, easily calculated index may be used as a measurement of the quality of nutritional care to rank the performance of different NICUs.

Perinatal death: bereavement interventions used by US and Spanish nurses and midwives.

Science.gov (United States)

Steen, Sue E

2015-02-01

Little research has been published from a global perspective regarding needs of nurses and midwives related to perinatal bereavement. To identify needs and concerns of US and Spanish nurses and midwives who have worked with perinatal death and to identify the bereavement interventions they use to help families with this experience. A cross-sectional study was conducted. Data were collected in 2011 from US (n=44) and Spanish (n=15) nurses and midwives via a questionnaire. Statistically significant differences between the nurses/midwives in each country were found regarding needs relating to knowledge, communication skills and managing personal feelings. Interventions of accompanying, listening, offering keepsakes, baptism discussion, and funeral planning were also found to be significantly different between the two groups. These findings demonstrate a continued need to increase the standard and consistency of perinatal bereavement care worldwide. Bereavement education in nursing curricula and practice settings in both cultures is essential to increase the standard of care.

Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model.

Science.gov (United States)

Moore, Donna; Drey, Nicholas; Ayers, Susan

2017-02-20

Perinatal mental illness is a global health concern; however, many women with the illness do not get the treatment they need to recover. Interventions that reduce the stigma around perinatal mental illness have the potential to enable women to disclose their symptoms to health care providers and consequently access treatment. There are many online forums for perinatal mental illness and thousands of women use them. Preliminary research suggests that online forums may promote help-seeking behavior, potentially because they have a role in challenging stigma. This study draws from these findings and theoretical concepts to present a model of forum use, stigma, and disclosure. This study tested a model that measured the mediating role of stigma between online forum use and disclosure of affective symptoms to health care providers. A Web-based survey of 200 women who were pregnant or had a child younger than 5 years and considered themselves to be experiencing psychological distress was conducted. Women were recruited through social media and questions measured forum usage, perinatal mental illness stigma, disclosure to health care providers, depression and anxiety symptoms, barriers to disclosure, and demographic information. There was a significant positive indirect effect of length of forum use on disclosure of symptoms through internal stigma, b=0.40, bias-corrected and accelerated (BCa) 95% CI 0.13-0.85. Long-term forum users reported higher levels of internal stigma, and higher internal stigma was associated with disclosure of symptoms to health care providers when controlling for symptoms of depression and anxiety. Internal stigma mediates the relationship between length of forum use and disclosure to health care providers. Findings suggest that forums have the potential to enable women to recognize and reveal their internal stigma, which may in turn lead to greater disclosure of symptoms to health care providers. Clinicians could refer clients to trustworthy and

Mortes perinatais evitáveis em Belo Horizonte, Minas Gerais, Brasil, 1999 Avoidable perinatal deaths in Belo Horizonte, Minas Gerais, Brazil, 1999

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Sônia Lansky

2002-10-01

deaths or 60% of all early neonatal deaths could have been prevented, suggesting flaws in prenatal, intrapartum, and neonatal care at both the clinical and health-care organizational levels. To intervene in this situation, progress is needed in improving quality of care and ensuring accountability in the specific health services and the health care system as a whole.

Criteria-based audit of quality of care to women with severe pre-eclampsia and eclampsia in a referral hospital in Accra, Ghana.

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Joyce L Browne

Full Text Available Severe pre-eclampsia and eclampsia are one of the major causes of maternal mortality globally. Reducing maternal morbidity and mortality demands optimizing quality of care. Criteria-based audits are a tool to define, assess and improve quality of care. The aim of this study was to determine applicability of a criteria-based audit to assess quality of care delivered to women with severe hypertensive disorders in pregnancy, and to assess adherence to protocols and quality of care provided at a regional hospital in Accra, Ghana.Checklists for management of severe preeclampsia, hypertensive emergency and eclampsia were developed in an audit cycle based on nine existing key clinical care protocols. Fifty cases were audited to assess quality of care, defined as adherence to protocols. Analysis was stratified for complicated cases, defined as (imminent eclampsia, perinatal mortality and/or one or more WHO maternal near miss C-criteria.Mean adherence to the nine protocols ranged from 15-85%. Protocols for 'plan for delivery' and 'magnesium sulphate administration' were best adhered to (85%, followed by adherence to protocols for 'eclampsia' (64%, 'severe pre-eclampsia at admission' (60%, 'severe pre-eclampsia ward follow-up' (53% and 'hypertensive emergency' (53%. Protocols for monitoring were least adhered to (15%. No difference was observed for severe disease. Increased awareness, protocol-based training of staff, and clear task assignment were identified as contributors to better adherence.A criteria-based audit is an effective tool to determine quality of care, identify gaps in standard of care, and allow for monitoring and evaluation in a health facility, ultimately resulting in improved quality of care provided and reduced maternal morbidity and mortality. In our audit, good adherence was observed for plan for delivery and treatment with magnesium sulphate. Substandard adherence to a number of protocols was identified, and points towards

Maternal and perinatal outcome in gestational diabetes mellitus in a Tertiary Care Hospital in Delhi

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Rajesh Kumari

2018-01-01

Full Text Available Background: Gestational diabetes mellitus (GDM is defined as a carbohydrate intolerance first diagnosed in pregnancy and may be associated with adverse maternal and perinatal outcome. Aim: The aim of the study was to determine the maternal and perinatal outcome in GDM during pregnancy. Materials and Methods: It is a retrospective analysis of women diagnosed with GDM who got antenatal care and delivered in our hospital in previous 5 years. Another 191 women with normal pregnancy without GDM and other medical conditions were taken as control. The baseline characteristics (age, body mass index, religion, and socioeconomic status were noted in all cases. Diagnosis of GDM was made using oral glucose tolerance test with 75 g glucose. GDM patients were started on diet following which insulin or oral hypoglycemic agents were given if required. Maternal and perinatal outcome was noted in all women.Results: The prevalence of GDM was 5.72% (170/2970. Most patients (79.41% could be controlled on diet alone. However, 21 (12.35% needed insulin and 14 (8.23% needed oral hypoglycemic agents. Middle socioeconomic status was more common in GDM than control and pregnancy-induced hypertension was more common in GDM (13.5% than in control (6.3% (P = 0.019. Mode of delivery was not different in two groups. Instrumental deliveries and postpartum hemorrhage were also similar. However, mean birth weight was significantly higher in GDM (2848 ± 539 g than in control (2707 ± 641 g (P = 0.004. Incidence of large-for-date babies was also higher (28.2% in GDM than control (19.4% (P = 0.005. In neonatal complication, hypoglycemia was significantly higher in GDM (20.6% than in control (5.2% (P = 0.001. However, the incidence of hyperbilirubinemia and congenital malformations was not significantly different in two groups. Conclusion: The prevalence of GDM was 5.72% in this study. Adequate treatment of GDM on diet, oral hypoglycemic agents, or insulin to achieve euglycemia can

Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

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Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; OʼKeeffe, Daniel F

2015-05-01

Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have a role in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now.

A current landscape of provincial perinatal data collection in Canada.

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Massey, Kiran A; Magee, Laura A; Dale, Sheryll; Claydon, Jennifer; Morris, Tara J; von Dadelszen, Peter; Liston, Robert M; Ansermino, J Mark

2009-03-01

The Canadian Perinatal Network (CPN) was launched in 2005 as a national perinatal database project designed to identify best practices in maternity care. The inaugural project of CPN is focused on interventions that optimize maternal and perinatal outcomes in women with threatened preterm birth at 22+0 to 28+6 weeks' gestation. To examine existing data collection by perinatal health programs (PHPs) to inform decisions about shared data collection and CPN database construction. We reviewed the database manuals and websites of all Canadian PHPs and compiled a list of data fields and their definitions. We compared these fields and definitions with those of CPN and the Canadian Minimal Dataset, proposed as a common dataset by the Canadian Perinatal Programs Coalition of Canadian PHPs. PHPs collect information on 2/3 of deliveries in Canada. PHPs consistently collect information on maternal demographics (including both maternal and neonatal personal identifiers), past obstetrical history, maternal lifestyle, aspects of labour and delivery, and basic neonatal outcomes. However, most PHPs collect insufficient data to enable identification of obstetric (and neonatal) practices associated with improved maternal and perinatal outcomes. In addition, there is between-PHP variability in defining many data fields. Construction of a separate CPN database was needed although harmonization of data field definitions with those of the proposed Canadian Minimal Dataset was done to plan for future shared data collection. This convergence should be the goal of researchers and clinicians alike as we construct a common language for electronic health records.

Ethics in Perinatal Medicine | Adinma | Nigerian Journal of Paediatrics

African Journals Online (AJOL)

Background: The current trend in perinatal medicine addresses the challenge posed to newborn survival by newborn prematurity and other morbidities requiring neonatal newborn intensive care. These ethical concerns span through the spectrum of education, clinical practice and research, domicile in obstetrics and ...

Suboptimal care and perinatal mortality in ten European regions: Methodology and evaluation of an international audit

NARCIS (Netherlands)

Richardus, J.H.; Graafmans, W.C.; Bergsjø, P.; Lloyd, D.J.; Bakketeig, L.S.; Bannon, E.M.; Borkent-Polet, M.; Davidson, L.L.; Defoort, P.; Esparteiro Leitão, A.; Langhoff-Roos, J.; Moral Garcia, A.; Papantoniou, N.E.; Wennergren, M.; Amelink-Verburg, M.P.; Verloove-Vanhorick, S.P.; Mackenbach, J.P.

2003-01-01

Background: A European concerted action (the EuroNatal study) investigated differences in perinatal mortality between countries of Europe. This report describes the methods used in the EuroNatal international audit and discusses the validity of the results. Methods: Perinatal deaths between 1993 and

Mortalidade perinatal por sífilis congênita: indicador da qualidade da atenção à mulher e à criança Perinatal mortality due to congenital syphilis: a quality-of-care indicator for women's and children's healthcare

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Valéria Saraceni

2005-08-01

Full Text Available A sífilis permanece como causa importante de mortalidade perinatal no Município do Rio de Janeiro, Brasil, onde o presente estudo foi realizado utilizando os dados do Sistema de Informação de Mortalidade e das Fichas de Notificação e Investigação de Óbitos Fetais e Neonatais, obrigatórias para as maternidades municipais. Entre 1996 e 1998, a sífilis congênita foi responsável por 13,1% dos óbitos fetais e 6,5% dos neonatais nas maternidades municipais. Entre 1999 e 2002, os percentuais foram de 16,2% e 7,9%, respectivamente. Para o Município do Rio de Janeiro, de 1999 a 2002, os percentuais foram 5,4% e 2,2%, para óbitos fetais e neonatais. A taxa de mortalidade perinatal por sífilis congênita permanece estável no Município do Rio de Janeiro apesar dos esforços iniciados com as campanhas para eliminação do agravo em 1999 e 2000. Propomos a utilização da taxa de mortalidade perinatal por sífilis congênita como indicador de impacto das ações de controle e eliminação da sífilis congênita e sugerimos a utilização das fichas de notificação e investigação de óbitos fetais e neonatais para a vigilância de outros agravos evitáveis.Syphilis is a persistent cause of perinatal mortality in Rio de Janeiro, Brazil, where this study was performed using data from the mortality data system and investigational reports for fetal and neonatal deaths, mandatory in municipal maternity hospitals. From 1996 to 1998, 13.1% of fetal deaths and 6.5% of neonatal deaths in municipal maternity hospitals were due to congenital syphilis. From 1999 to 2002, the proportions were 16.2% and 7.9%, respectively. For the city of Rio de Janeiro as a whole from 1999 and 2002, the proportions were 5.4% of fetal deaths and 2.2% of neonatal deaths. The perinatal mortality rate due to congenital syphilis remains stable in Rio de Janeiro, despite efforts initiated with congenital syphilis elimination campaigns in 1999 and 2000. We propose that the

An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan.

Science.gov (United States)

Jokhio, Abdul Hakeem; Winter, Heather R; Cheng, Kar Keung

2005-05-19

There are approximately 4 million neonatal deaths and half a million maternal deaths worldwide each year. There is limited evidence from clinical trials to guide the development of effective maternity services in developing countries. We performed a cluster-randomized, controlled trial involving seven subdistricts (talukas) of a rural district in Pakistan. In three talukas randomly assigned to the intervention group, traditional birth attendants were trained and issued disposable delivery kits; Lady Health Workers linked traditional birth attendants with established services and documented processes and outcomes; and obstetrical teams provided outreach clinics for antenatal care. Women in the four control talukas received usual care. The primary outcome measures were perinatal and maternal mortality. Of the estimated number of eligible women in the seven talukas, 10,114 (84.3 percent) were recruited in the three intervention talukas, and 9443 (78.7 percent) in the four control talukas. In the intervention group, 9184 women (90.8 percent) received antenatal care by trained traditional birth attendants, 1634 women (16.2 percent) were seen antenatally at least once by the obstetrical teams, and 8172 safe-delivery kits were used. As compared with the control talukas, the intervention talukas had a cluster-adjusted odds ratio for perinatal death of 0.70 (95 percent confidence interval, 0.59 to 0.82) and for maternal mortality of 0.74 (95 percent confidence interval, 0.45 to 1.23). Training traditional birth attendants and integrating them into an improved health care system were achievable and effective in reducing perinatal mortality. This model could result in large improvements in perinatal and maternal health in developing countries. Copyright 2005 Massachusetts Medical Society.

Rural maternity care.

Science.gov (United States)

Miller, Katherine J; Couchie, Carol; Ehman, William; Graves, Lisa; Grzybowski, Stefan; Medves, Jennifer

2012-10-01

To provide an overview of current information on issues in maternity care relevant to rural populations. Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed. This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3. Rural maternity care services should be supported through active policies aligned with these recommendations. 4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in

Asian Care Certificate (ACC): a care quality assurance framework.

Science.gov (United States)

Talaie, Tony

2018-04-16

Purpose Quality assuring elderly care through a viable and feasible standard framework is a major challenge for Asian governments. Although several attempts have been made to tackle foreign care worker (FCW) shortage, assuring the quality of the care they provide has been overlooked. The original framework allowed a better control over service quality to assure the elderly about their care according to the agreed standards. The paper aims to discuss these issues. Design/methodology/approach Through several Japanese Governmental meetings, a new Asian Care Certificate (ACC) program is discussed based on the Japanese Care Certificate (JCC). The governments' representatives adopted the JCC to form the ACC, which enables the ACC board to evaluate care workers and to intervene whenever the desired quality level is not achieved. Findings The author describes a new program. The findings of this paper will be confirmed when the ACC is implemented. Practical implications Using the ACC framework, the challenge in providing a high-quality care service using FCWs across Asia would be partly resolved. FCWs' quality of life might also gradually improve especially regarding to their human rights. Originality/value The ACC provides a new framework. Its value is recognized if one considers that many Asian populations are rapidly aging and many governments compromise quality by employing overseas workers to solve care worker shortages.

Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes.

Science.gov (United States)

Cunningham, Shayna D; Lewis, Jessica B; Thomas, Jordan L; Grilo, Stephanie A; Ickovics, Jeannette R

2017-05-18

Despite biomedical advances and intervention efforts, rates of preterm birth and other adverse outcomes in the United States have remained relatively intransigent. Evidence suggests that group prenatal care can reduce these risks, with implications for maternal and child health as well as substantial cost savings. However, widespread dissemination presents challenges, in part because training and health systems have not been designed to deliver care in a group setting. This manuscript describes the design and evaluation of Expect With Me, an innovative model of group prenatal care with a strong integrated information technology (IT) platform designed to be scalable nationally. Expect With Me follows clinical guidelines from the American Congress of Obstetricians and Gynecologists. Expect With Me incorporates the best evidence-based features of existing models of group care with a novel integrated IT platform designed to improve patient engagement and support, enhance health behaviors and decision making, connect providers and patients, and improve health service delivery. A multisite prospective longitudinal cohort study is being conducted to examine the impact of Expect With Me on perinatal and postpartum outcomes, and to identify and address barriers to national scalability. Process and outcome evaluation will include quantitative and qualitative data collection at patient, provider, and organizational levels. Mixed-method data collection includes patient surveys, medical record reviews, patient focus groups; provider surveys, session evaluations, provider focus groups and in-depth interviews; an online tracking system; and clinical site visits. A two-to-one matched cohort of women receiving individual care from each site will provide a comparison group (n = 1,000 Expect With Me patients; n = 2,000 individual care patients) for outcome and cost analyses. By bundling prevention and care services into a high-touch, high-tech group prenatal care model

Perinatal outcomes of pregnancies conceived by assisted reproductive technologies

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Šljivančanin Tamara

2015-01-01

Full Text Available Introduction. Recent epidemiological studies showed significantly higher incidence of perinatal complications in newborns and women after the use of assisted reproductive technologies (ART. Multiple pregnancies are more frequent after the use of ART. Singleton pregnancies following ART are more prone to preterm birth, low and very low birth weight (LBW and VLBW, small for gestational age (SGA and perinatal mortality. Objective. The aim of this study was to summarize the results of relevant articles and to evaluate whether the mode of conception is the determining factor for different pregnancy outcomes after assisted and natural conceptions. Methods. Eleven studies were included in this review. The following outcomes were observed: preterm and very preterm birth, SGA, LBW, VLBW, perinatal mortality, admission to neonatal intensive care unit (NICU, and Apgar score (As ≤7 at fifth minute. Qualitative analysis and quantitative assessment were performed. Results. For singletons, odds ratios were 1.794 (95% confidence interval 1.660-1.939 for preterm birth, 1.649 (1.301-2.089 for LBW, 1.265 (1.048-1.527 for SGA. Admission to NICU, As≤7 at fifth minute and perinatal mortality showed significantly different frequency after assisted conception. Summary of results for twin gestations showed no significant difference between ART and spontaneous conception for preterm birth (32-36 weeks, very preterm birth (<32 weeks, LBW and VLBW. Conclusion. Analyzed studies showed that infants from ART have significantly worse perinatal outcome compared with natural conception. More observational studies should be conducted in order to establish the exact mechanism leading to more frequent perinatal morbidity and mortality after the use of ART.

Development of quality indicators for low-risk labor care provided by midwives using a RAND-modified Delphi method.

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Ueda, Kayo; Ohtera, Shosuke; Kaso, Misato; Nakayama, Takeo

2017-09-22

In childbirth, most deliveries are low-risk, defined as spontaneous labor at full term without special high-risk facts or complications, especially in high-resource countries where maternal and perinatal mortality rates are very low. Indeed, the majority of mothers and infants have no serious conditions during labor. However, the quality of care provided is not assured, and performance may vary by birthing facility and provider. The overuse of technology in childbirth in some parts of the world is almost certainly based on assumptions like, "something can go wrong at any minute." There is a need to assess the quality of care provided for mothers and infants in low-risk labor. We aimed to develop specific quality indicators for low-risk labor care provided primarily by midwives in Japan. We used a RAND-modified Delphi method, which integrates evidence review with expert consensus development. The procedure comprises five steps: (1) literature review, including clinical practice guidelines, to extract and develop quality indicator candidates; (2) formation of a multidisciplinary panel; (3) independent panel ratings (Round 1); (4) panel meeting and independent panel ratings (Round 2); and (5) independent panel ratings (Round 3). The three independent panel ratings (Rounds 1-3) were held between July and December 2012. The assembled multidisciplinary panel comprised eight clinicians (two pediatricians, three obstetricians, and three midwives) and three mothers who were nonclinicians. Evidentiary review extracted 166 key recommendations from 32 clinical practice guidelines, and 31 existing quality indicators were added. After excluding duplicate recommendations and quality indicators, the panel discussed 25 candidate indicators. Of these, 18 were adopted, one was modified, six were not adopted, and four were added during the meeting, respectively. We established 23 quality indicators for low-risk labor care provided by midwives in labor units in Japan.

Perinatal outcome and near-miss morbidity between placenta previa versus abruptio placentae

International Nuclear Information System (INIS)

Siddique, S.A.; Tariq, G.; Sheikh, A.; Hussain, F.S.U.; Memon, K.A.

2010-01-01

To compare perinatal outcome and near-miss morbidities between placenta previa versus abruptio placentae in patients of antepartum haemorrhage (APH). Patients with APH diagnosed as placenta previa and abruptio placentae who delivered after 24 weeks of regnancy were selected from labour room. Outcome measures were birth weight, neonatal intensive care admission, stillbirth, perinatal mortality rates, near-miss, surgical intensive care admission, postpartum haemorrhage, hysterectomy, massive transfusion, renal failure, coagulopathy and maternal death. Stillbirth was defined as a fetus weighing greater or equal to 500 gm showing no sign of life after birth. Near-miss was defined as severe organ dysfunction which if not treated appropriately, could result in death. Descriptive statistics were calculated and chi-square was applied with significance level < 0.05. Stillbirths and perinatal mortality rates were significantly higher in abruptio placentae, 52.97% versus 18.18% and 534/1000 versus 230/1000 (p < 0.01). Near-miss cases were also significantly higher in abruptio placentae, 22.27%. Verus 11.18% (p < 0.01). Hypovolemic shock and coagulation failure were also significantly higher in abruptio placentae (p < 0.05). (author)

Perinatal mental health service provision in Switzerland and in the UK.

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Amiel Castro, Rita T; Schroeder, Katrin; Pinard, Claudia; Blöchlinger, Patricia; Künzli, Hansjörg; Riecher-Rössler, Anita; Kammerer, Martin

2015-01-01

The epidemiology of maternal perinatal-psychiatric disorders as well as their effect on the baby is well recognised. Increasingly well researched specialised treatment methods can reduce maternal morbidity, positively affect mother-baby bonding and empower women's confidence as a mother. Here, we aimed to compare guidelines and the structure of perinatal-psychiatric service delivery in the United Kingdom and in Switzerland from the government's perspective. Swiss cantons provided information regarding guidelines and structure of service delivery in 2000. A subsequent survey using the same questionnaire was carried out in 2007. In the UK, similar information was accessed through published reports from 2000-2012. Guidelines for perinatal psychiatry exist in the UK, whereas in Switzerland in 2000 none of the 26 cantons had guidelines, and in 2007 only one canton did. Joint mother-baby admissions on general psychiatric wards were offered by 92% of the Swiss cantons. In the UK, pregnant women and joint mother-baby admissions are only advised onto specialised perinatal-psychiatric units. In Switzerland, in 2007, three specialised units (max. 24 beds) were in place corresponding to 1 unit per 2.5 million people, while in the UK there were 22 mother-baby units (168 beds) in 2012 (1 unit per 2.8 million). In the UK, less than 50% of trusts provided specialised perinatal-psychiatric health care. The main difference between the UK and Switzerland was the absence of guidelines, regular assessment and plans for future development of perinatal psychiatry in Switzerland. There are still geographical differences in the provision of perinatal-psychiatric services in the UK.

Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda.

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Scholastic Ashaba

Full Text Available The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28-35], a median of 3 living children [IQR: 2-5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member

Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda.

Science.gov (United States)

Ashaba, Scholastic; Kaida, Angela; Coleman, Jessica N; Burns, Bridget F; Dunkley, Emma; O'Neil, Kasey; Kastner, Jasmine; Sanyu, Naomi; Akatukwasa, Cecilia; Bangsberg, David R; Matthews, Lynn T; Psaros, Christina

2017-01-01

The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28-35], a median of 3 living children [IQR: 2-5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as policy

Maternal hemoglobin in Peru: regional differences and its association with adverse perinatal outcomes

OpenAIRE

Gonzales, Gustavo F.; Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima, Perú. Unidad de Reproducción, Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia. Lima, Perú. Doctor en Medicina.; Tapia, Vilma; Unidad de Reproducción, Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia. Lima, Perú. Obstetríz.; Gasco, Manuel; Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima, Perú. Biólogo.; Carrillo, Carlos; Unidad de Reproducción, Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia. Lima, Perú. Doctor en Medicina.

2011-01-01

Objectives. To evaluate hemoglobin (Hb) levels in pregnant women from different geographical regions from Peru; to establish anemia and erythrocytocis rates and to establish the role of Hb on adverse perinatal outcomes using the Perinatal Information System (PIS) database of Peruvian Ministry of Health. Materials and methods. Data were obtained from 379,816 births of 43 maternity care units between 2000 and 2010. Anemia and erythrocytocis rates were determined in each geographical region as w...

Children and young people with perinatal HIV in Europe

DEFF Research Database (Denmark)

Grarup, Jesper; Kirk, Ole; Lundgren, Jens

2016-01-01

undertook an online survey of HIV cohort studies participating in the EuroCoord Network of Excellence to ascertain the number of perinatally HIV-infected (pHIV) patients included, to compare it with those published by the European Centre for Disease Prevention and Control (ECDC) and the World Health......Accurate ascertainment of the number of children living with human immunodeficiency virus (HIV) is important to plan paediatric and adolescent health services. In Europe, the first generation of perinatally HIV-infected survivors are transferring to adult care and their health needs are unknown. We...... Organization (WHO) and to assess the ability of countries to follow up pHIV patients after transfer to adult care. At the end of 2013, 16 countries in EuroCoord reported 8,229 pHIV patients in follow-up in cohorts, compared with 5,160 cumulative diagnoses reported by the ECDC in the same area. Follow-up of pHIV...

Perinatal stress and food allergy: a preliminary study on maternal reports.

Science.gov (United States)

Polloni, L; Ferruzza, E; Ronconi, L; Lazzarotto, F; Toniolo, A; Bonaguro, R; Muraro, A

2015-01-01

Maternal stress in fetal and early life has been associated with the development of respiratory allergies, but no studies exist about food allergy. Stressful events and the quality of caregiving provided, as they affect the emotional and physiologic regulation of the infant, could alter the hypothalamic-pituitary-adrenal and immune system, facilitating an increased allergic response. This study aimed to investigate the influence of perinatal stress, as perceived by mothers, on developing food allergy in childhood. A survey on pregnancy and the first three months after giving birth was submitted to 59 Italian mothers of at least one child suffering from severe food allergy and one completely healthy child, for a total of 118 children examined. The presence of stressful events and the quality of perinatal period for each child were assessed retrospectively. The food allergic children's data were compared to siblings' data through inferential statistics. The results showed a significantly higher number of stressful events occurred during patients' perinatal period, compared to siblings, in particular bereavements in pregnancy and parenting difficulties in postpartum. Mothers reported harder pregnancies and more stressful, harder, and, in general, worse postpartum when referring to their food-allergic children, in comparison with their siblings (p stress and perinatal psychosocial factors in the pathogenesis of food allergy; further studies are necessary to understand individual psychological impact and its relations with genetic and biological factors.

Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births

NARCIS (Netherlands)

de jonge, A.; van der Goes, B. Y.; Ravelli, A. C. J.; Amelink-Verburg, M. P.; Mol, B. W.; Nijhuis, J. G.; Bennebroek Gravenhorst, J.; Buitendijk, S. E.

2009-01-01

OBJECTIVE: To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care. DESIGN: A nationwide cohort study. SETTING: The entire Netherlands. POPULATION: A total of 529,688 low-risk women

FACTORS CONTRIBUTING TO PERINATAL MORTALITY : OPTIMIZING OUTCOME

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Lakshmi

2015-03-01

Full Text Available OBJECTIVE: To evaluate the various causes of perinatal deaths and adopt strategies to improve perinatal outcome at a referral teaching hospital in North Kerala. METHODS: A prospective observational study conducted at Institute of Maternal and Child Health, Government Medical College, Kozhikode. All perinatal deaths during the period January 2013 to December 2014 were analysed and from this factors responsible for perinatal deaths were identified. RESULTS: Out of total 30,042 deliveries , there were 966 perinatal deaths during the study period. 566 were still births and 400 early neonatal deaths. The perinatal mortality rate was 31.1 per 1000 live births. Perinatal asphyxia was the major cause of perinatal mortality. The important factors contributing to perinatal asphyxia were prematurity (39%, abruptio placenta (19% and MSAF ( 12%. Among the antenatal factors, hypertensive disorders of pregnancy leading to iatrogenic elective preterm delivery were the most important. CONCLUSION: Perinatal asphyxia due to prematurity and low birth weight emerged as the most important cause of perinatal mortality in this study and hypertensive disorders of pregnancy were the most important antenatal complication leading to prematurity

Continuity and change in mothers' narratives of perinatal hospice.

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Lathrop, Anthony; VandeVusse, Leona

2011-01-01

(1) To broadly explore the experiences of women who chose to continue pregnancies affected by lethal fetal diagnoses and (2) to develop knowledge useful to nurses and other healthcare professionals who provide perinatal hospice (PH) care. Qualitative descriptive study using narrative analysis. Fifteen women who learned during their pregnancies of a lethal fetal diagnosis and chose to continue the affected pregnancies. Participants' stories of their PH experiences were recorded in face-to-face interviews. A qualitative approach using narrative analysis was used to identify themes and develop suggestions for care. The element of time was prevalent in mothers' stories. Some aspects of mothers' experiences continued, particularly feelings of love and connection to their babies. Mothers also reported evolving changes in their thoughts and feelings. Personal changes such as increased compassion, faith, and strength were frequently mentioned. Mothers described transient phases of highs and lows. Drawing personal meanings or life lessons was the main way mothers connected their experiences to their present lives. Mothers' descriptions of their experiences can enhance nurses' understanding of perinatal loss. Established care practices, such as birth planning and creating mementoes, were supported. Nurses can help mothers experiencing loss by elucidating and reflecting their personal meanings.

Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

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Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; O'Keeffe, Daniel F

2015-01-01

Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have roles in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

A matched pair cluster randomized implementation trail to measure the effectiveness of an intervention package aiming to decrease perinatal mortality and increase institution-based obstetric care among indigenous women in Guatemala: study protocol.

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Kestler, Edgar; Walker, Dilys; Bonvecchio, Anabelle; de Tejada, Sandra Sáenz; Donner, Allan

2013-03-21

Maternal and perinatal mortality continue to be a high priority problem on the health agendas of less developed countries. Despite the progress made in the last decade to quantify the magnitude of maternal mortality, few interventions have been implemented with the intent to measure impact directly on maternal or perinatal deaths. The success of interventions implemented in less developed countries to reduce mortality has been questioned, in terms of the tendency to maintain a clinical perspective with a focus on purely medical care separate from community-based approaches that take cultural and social aspects of maternal and perinatal deaths into account. Our innovative approach utilizes both the clinical and community perspectives; moreover, our study will report the weight that each of these components may have had on reducing perinatal mortality and increasing institution-based deliveries. A matched pair cluster-randomized trial will be conducted in clinics in four rural indigenous districts with the highest maternal mortality ratios in Guatemala. The individual clinic will serve as the unit of randomization, with 15 matched pairs of control and intervention clinics composing the final sample. Three interventions will be implemented in indigenous, rural and poor populations: a simulation training program for emergency obstetric and perinatal care, increased participation of the professional midwife in strengthening the link between traditional birth attendants (TBA) and the formal health care system, and a social marketing campaign to promote institution-based deliveries. No external intervention is planned for control clinics, although enhanced monitoring, surveillance and data collection will occur throughout the study in all clinics throughout the four districts. All obstetric events occurring in any of the participating health facilities and districts during the 18 months implementation period will be included in the analysis, controlling for the cluster

Infertility and Perinatal Loss: When the Bough Breaks

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Byatt, Nancy

2016-01-01

Infertility and perinatal loss are common, and associated with lower quality of life, marital discord, complicated grief, major depressive disorder, anxiety disorders, and posttraumatic stress disorder. Young women, who lack social supports, have experienced recurrent pregnancy loss or a history of trauma and / or preexisting psychiatric illness are at a higher risk of experiencing psychiatric illnesses or symptoms after a perinatal loss or during infertility. It is especially important to detect, assess, and treat depression, anxiety, or other psychiatric symptoms because infertility or perinatal loss may be caused or perpetuated by such symptoms. Screening, psychoeducation, provision of resources and referrals, and an opportunity to discuss their loss and plan for future pregnancies can facilitate addressing mental health concerns that arise. Women at risk of or who are currently experiencing psychiatric symptoms should receive a comprehensive treatment plan that includes the following: (1) proactive clinical monitoring, (2) evidence-based approaches to psychotherapy, and (3) discussion of risks, benefits, and alternatives of medication treatment during preconception and pregnancy. PMID:26847216

Addressing access barriers to services for mothers at risk for perinatal mood disorders: A social work perspective.

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Keefe, Robert H; Brownstein-Evans, Carol; Rouland Polmanteer, Rebecca S

2016-01-01

This article identifies variables at the micro/individual, mezzo/partner/spouse and family, and macro/health care-system levels that inhibit mothers at risk for perinatal mood disorders from accessing health and mental health care services. Specific recommendations are made for conducting thorough biopsychosocial assessments that address the mothers' micro-, mezzo-, and macro-level contexts. Finally, the authors provide suggestions for how to intervene at the various levels to remove access barriers for mothers living with perinatal mood disorders as well as their families.

[Quality management in intensive care medicine].

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Martin, J; Braun, J-P

2013-09-01

Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to extern quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system.

Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country

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Ali Mohammed

2011-06-01

Full Text Available Abstract Background In developed countries, perinatal death is known to cause major emotional and social effects on mothers. However, little is known about these effects in low income countries which bear the brunt of perinatal mortality burden. This paper reports the impact of perinatal death on psychological status and social consequences among mothers in a rural area of Bangladesh. Methods A total of 476 women including 122 women with perinatal deaths were assessed with the Edinburgh Postnatal Depression Scale (EPDS-B at 6 weeks and 6 months postpartum, and followed up for negative social consequences at 6 months postpartum. Trained female interviewers carried out structured interviews at women's home. Results Overall 43% (95% CI: 33.7-51.8% of women with a perinatal loss at 6 weeks postpartum were depressed compared to 17% (95% CI: 13.7-21.9% with healthy babies (p = Conclusions This study highlights the greatly increased vulnerability of women with perinatal death to experience negative psychological and social consequences. There is an urgent need to develop appropriate mental health care services for mothers with perinatal deaths in Bangladesh, including interventions to develop positive family support.

Measuring Inpatient Rehabilitation Facility Quality of Care: Discharge Self-Care Functional Status Quality Measure.

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Pardasaney, Poonam K; Deutsch, Anne; Iriondo-Perez, Jeniffer; Ingber, Melvin J; McMullen, Tara

2018-06-01

To describe the calculation and psychometric properties of the discharge self-care functional status quality measure implemented in the Centers for Medicare & Medicaid Services' (CMS) Inpatient Rehabilitation Facility (IRF) Quality Reporting Program on October 1, 2016. Medicare fee-for-service (FFS) patients from 38 IRFs that participated in the CMS Post-Acute Care Payment Reform Demonstration were included in this cohort study. Data came from the Continuity Assessment Record and Evaluation Item Set, IRF-Patient Assessment Instrument, and Medicare claims. For each patient, we calculated an expected discharge self-care score, risk-adjusted for demographic and baseline clinical characteristics. The performance score of each IRF equaled the percentage of patient stays where the observed discharge self-care score met or exceeded the expected score. We assessed the measure's discriminatory ability across IRFs and reliability. IRFs. Medicare FFS patients aged ≥21 years (N=4769). Not applicable. Facility-level discharge self-care quality measure performance score. A total of 4769 patient stays were included; 57% of stays were in women, and 12.1% were in patients aged quality measure showed strong reliability, with intraclass correlation coefficients of .91. The discharge self-care quality measure showed strong discriminatory ability and reliability, representing an important initial step in evaluation of IRF self-care outcomes. A wide range in performance scores suggested a gap in quality of care across IRFs. Future work should include testing the measure with nationwide data from all IRFs. Published by Elsevier Inc.

Quality Assessment in the Primary care

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Muharrem Ak

2013-04-01

Full Text Available -Quality Assessment in the Primary care Dear Editor; I have read the article titled as “Implementation of Rogi Kalyan Samiti (RKS at Primary Health Centre Durvesh” with great interest. Shrivastava et all concluded that assessment mechanism for the achievement of objectives for the suggested RKS model was not successful (1. Hereby I would like to emphasize the importance of quality assessment (QA especially in the era of newly established primary care implementations in our country. Promotion of quality has been fundamental part of primary care health services. Nevertheless variations in quality of care exist even in the developed countries. Accomplishment of quality in the primary care has some barriers like administration and directorial factors, absence of evidence-based medicine practice lack of continuous medical education. Quality of health care is no doubt multifaceted model that covers all components of health structures and processes of care. Quality in the primary care set up includes patient physician relationship, immunization, maternal, adolescent, adult and geriatric health care, referral, non-communicable disease management and prescribing (2. Most countries are recently beginning the implementation of quality assessments in all walks of healthcare. Organizations like European society for quality and safety in family practice (EQuiP endeavor to accomplish quality by collaboration. There are reported developments and experiments related to the methodology, processes and outcomes of quality assessments of health care. Quality assessments will not only contribute the accomplishment of the program / project but also detect the areas where obstacles also exist. In order to speed up the adoption of QA and to circumvent the occurrence of mistakes, health policy makers and family physicians from different parts of the world should share their experiences. Consensus on quality in preventive medicine implementations can help to yield

A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression adapted for women with low incomes.

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O'Mahen, Heather; Himle, Joseph A; Fedock, Gina; Henshaw, Erin; Flynn, Heather

2013-07-01

Perinatal women with identified depression in prenatal care settings have low rates of engagement and adherence with depression-specific psychotherapy. We report the feasibility and symptom outcomes of Cognitive Behavioral Therapy (CBT) modified (mCBT) to address the needs of perinatal, low-income women with Major Depressive Disorder (MDD). Pregnant women (n = 1421) were screened for depressive symptoms in obstetrics clinics in conjunction with prenatal care visits. A total of 59 women met diagnostic criteria for MDD; 55 women were randomly assigned to mCBT or Treatment as Usual (TAU). The mCBT intervention included an initial engagement session, outreach, specific perinatal content and interpersonal components. Measures were gathered at pre-treatment, 16 week post-randomization, and 3-month follow-up. Most participants attended at least one CBT session and met study criteria for treatment adherence. Active research staff outreach promoted engagement and retention in the trial. Treatment satisfaction was rated as very good. In both observed and multiple imputation results, women who received mCBT demonstrated greater improvement in depressed mood than those in TAU at 16-week post-randomization and 3-month follow-up, Cohen's d = -0.71 (95% CI -4.93, -5.70). Modified CBT offers promise as a feasible and acceptable treatment for perinatal women with low-incomes in prenatal care settings. Targeted delivery and content modifications are needed to engage populations tailored to setting and psychosocial challenges specific to the perinatal period. © 2013 Wiley Periodicals, Inc.

Mental health trajectories and related factors among perinatal women.

Science.gov (United States)

Lin, Pei-Chao; Hung, Chich-Hsiu

2015-06-01

To investigate Taiwanese women's mental health trajectories from the third trimester of pregnancy to four weeks postpartum and the correlations of these trajectories with perceived social support and demographic characteristics. Previous studies have reported differences between prenatal and postpartum mental health status. A repeated design study was conducted in a medical hospital in Southern Taiwan. One-hundred and ninety-four Taiwanese women completed the Chinese Health Questionnaire and Social Support Scale at the 36th prenatal week and first and fourth week postpartum. Three linear mental health trajectories for perinatal women were identified. Consistently poor perinatal mental health was reported by 16·0% of the participants. Less social support was associated with lower prenatal mental health scores. Younger age was a risk factor for consistently poor perinatal health. Vaginal delivery was associated with improved mental health after childbirth. Mental health was worse in the third trimester of pregnancy than postpartum. Less social support was associated with lower prenatal mental health scores, and this association was similarly distributed between women with consistently poor and improved mental health after birth. Health care providers should assess women's mental health status and provide timely interventions during the perinatal period. Social support should be provided for pregnant women, especially younger women or those with lower perceived social support. © 2015 John Wiley & Sons Ltd.

Tendência da mortalidade perinatal em Belo Horizonte, 1984 a 2005 Tendencia de la mortalidad perinatal en Belo Horizonte, 1984 a 2005 Tendency of perinatal mortality in Belo Horizonte, 1984 to 2005

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Eunice Francisca Martins

2010-06-01

information in the system and of the mortality taxes. The improvement of the quality of the information went significant just for the maternal education and weight when being born. The medium reduction of the mortality perinatal in the period was of 57,52%. The decrease of the mortality perinatal in the last two decades in Belo Horizonte it was significant, but efforts should be addressed in the sense of improving the complete of the System of Information of Mortality for important variables in the elaboration of the indicators perinatais.

Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country.

Science.gov (United States)

Gausia, Kaniz; Moran, Allisyn C; Ali, Mohammed; Ryder, David; Fisher, Colleen; Koblinsky, Marge

2011-06-09

In developed countries, perinatal death is known to cause major emotional and social effects on mothers. However, little is known about these effects in low income countries which bear the brunt of perinatal mortality burden. This paper reports the impact of perinatal death on psychological status and social consequences among mothers in a rural area of Bangladesh. A total of 476 women including 122 women with perinatal deaths were assessed with the Edinburgh Postnatal Depression Scale (EPDS-B) at 6 weeks and 6 months postpartum, and followed up for negative social consequences at 6 months postpartum. Trained female interviewers carried out structured interviews at women's home. Overall 43% (95% CI: 33.7-51.8%) of women with a perinatal loss at 6 weeks postpartum were depressed compared to 17% (95% CI: 13.7-21.9%) with healthy babies (p = death to experience negative psychological and social consequences. There is an urgent need to develop appropriate mental health care services for mothers with perinatal deaths in Bangladesh, including interventions to develop positive family support.

Older Patients' Perspectives on Quality of Serious Illness Care in Primary Care.

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Abu Al Hamayel, Nebras; Isenberg, Sarina R; Hannum, Susan M; Sixon, Joshua; Smith, Katherine Clegg; Dy, Sydney M

2018-01-01

Despite increased focus on measuring and improving quality of serious illness care, there has been little emphasis on the primary care context or incorporation of the patient perspective. To explore older patients' perspectives on the quality of serious illness care in primary care. Qualitative interview study. Twenty patients aged 60 or older who were at risk for or living with serious illness and who had participated in the clinic's quality improvement initiative. We used a semistructured, open-ended guide focusing on how older patients perceived quality of serious illness care, particularly in primary care. We transcribed interviews verbatim and inductively identified codes. We identified emergent themes using a thematic and constant comparative method. We identified 5 key themes: (1) the importance of patient-centered communication, (2) coordination of care, (3) the shared decision-making process, (4) clinician competence, and (5) access to care. Communication was an overarching theme that facilitated coordination of care between patients and their clinicians, empowered patients for shared decision-making, related to clinicians' perceived competence, and enabled access to primary and specialty care. Although access to care is not traditionally considered an aspect of quality, patients considered this integral to the quality of care they received. Patients perceived serious illness care as a key aspect of quality in primary care. Efforts to improve quality measurement and implementation of quality improvement initiatives in serious illness care should consider these aspects of care that patients deem important, particularly communication as an overarching priority.

Measuring relatives’ perspectives on the quality of palliative care: the Consumer Quality Index Palliative Care.

NARCIS (Netherlands)

Claessen, S.J.J.; Francke, A.L.; Sixma, H.J.; Veer, A.J.E. de; Deliens, L.

2013-01-01

Context: A Consumer Quality Index (CQ-index) is a questionnaire assessing the actual care experiences and how important the recipient finds certain care aspects, as well as the priorities for improving quality. A CQ-index Palliative Care (CQ-index PC) for bereaved relatives was developed to measure

EVALUATION OF HEALTH CARE QUALITY

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Zlatko Fras

2002-12-01

Full Text Available Background. It is possible to evaluate quality characteristics of different aspects of health care by many different measures. For these purposes, in various countries all over the world authorised institutions and/or agencies developed number of methodological accessories, criteria and tools for selection of more or less appropriately and optimally defined criteria and indicators of quality clinical performance.Conclusions. Recently we have started with activities for gradual introduction of systematic monitoring, assessment and improvement of quality of health care in Slovenia as well. One of the key prerequisites for selection of valid, practicable, efficient and reliable quality indicators is the establishment of continuous and methodologically appropriate system of development and implementation of evidence-based clinical practice guidelines. We started this process within the framework of national Health Sector Management Project, where all potential key stakeholders from health care sector participated. Also the project on Quality in Health Care in Slovenia, started, leaded and performed by the Medical Chamber of Slovenia, represents one of the important parallel starting steps towards assurance of reliable data on development/establishment of appropriate set of quality indicators and standards of health care in our country.

Quality of care in European home care programs using the second generation interRAI Home Care Quality Indicators (HCQIs).

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Foebel, Andrea D; van Hout, Hein P; van der Roest, Henriëtte G; Topinkova, Eva; Garms-Homolova, Vjenka; Frijters, Dinnus; Finne-Soveri, Harriet; Jónsson, Pálmi V; Hirdes, John P; Bernabei, Roberto; Onder, Graziano

2015-11-14

Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI's second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the quality of home care services in six European countries using these HCQIs as well as the two derived summary scales. Data for this study were derived from the Aged in Home Care (AdHOC) study - a cohort study that examined different models of community care in European countries. The current study selected a sub-sample of the AdHOC cohort from six countries whose follow-up data were complete (Czech Republic, Denmark, Finland, Germany, Italy and the Netherlands). Data were collected from the interRAI Home Care instrument (RAI-HC) between 2000 and 2002. The 23 HCQIs of interest were determined according to previously established methodology, including risk adjustment. Two summary measures, the Clinical Balance Scale and Independence Quality Scale were also determined using established methodology. A total of 1,354 individuals from the AdHOC study were included in these analyses. Of the 23 HCQIs that were measured, the highest proportion of individuals experienced declines in Instrumental Activities of Daily Living (IADLs) (48.4 %). Of the clinical quality indicators, mood decline was the most prevalent (30.0 %), while no flu vaccination and being alone and distressed were the most prevalent procedural and social quality indicators, respectively (33.4 and 12.8 %). Scores on the two summary scales varied by country, but were concentrated around the median mark. The interRAI HCQIs can be used to determine the quality of home care services in Europe and identify areas for improvement. Our results suggest functional declines may prove the most beneficial targets for interventions.

[Quality management is associated with high quality services in health care].

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Nielsen, Tenna Hassert; Riis, Allan; Mainz, Jan; Jensen, Anne-Louise Degn

2013-12-09

In these years, quality management has been the focus in order to meet high quality services for the patients in Danish health care. This article provides information on quality management and quality improvement and it evaluates its effectiveness in achieving better organizational structures, processes and results in Danish health-care organizations. Our findings generally support that quality management is associated with high quality services in health care.

Domestic Violence Enhanced Perinatal Home Visits: The DOVE Randomized Clinical Trial.

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Sharps, Phyllis W; Bullock, Linda F; Campbell, Jacquelyn C; Alhusen, Jeanne L; Ghazarian, Sharon R; Bhandari, Shreya S; Schminkey, Donna L

2016-11-01

Perinatal intimate partner violence (IPV) is common and has significant negative health outcomes for mothers and infants. This study evaluated the effectiveness of an IPV intervention in reducing violence among abused women in perinatal home visiting programs. This assessor-blinded multisite randomized control trial of 239 women experiencing perinatal IPV was conducted from 2006 to 2012 in U.S. urban and rural settings. The Domestic Violence Enhanced Home Visitation Program (DOVE) intervention group (n = 124) received a structured abuse assessment and six home visitor-delivered empowerment sessions integrated into home visits. All participants were screened for IPV and referred appropriately. IPV was measured by the Conflicts Tactics Scale2 at baseline through 24 months postpartum. There was a significant decrease in IPV over time (F = 114.23; p < 0.001) from baseline to 1, 3, 6, 12, 18, and 24 months postpartum (all p < 0.001). Additional models examining change in IPV from baseline indicated a significant treatment effect (F = 6.45; p < 0.01). Women in the DOVE treatment group reported a larger mean decrease in IPV scores from baseline compared to women in the usual care group (mean decline 40.82 vs. 35.87). All models accounted for age and maternal depression as covariates. The DOVE intervention was effective in decreasing IPV and is brief, thereby facilitating its incorporation within well-woman and well-child care visits, as well as home visiting programs, while satisfying recommendations set forth in the Affordable Care Act for IPV screening and brief counseling.

Assessing Community Quality of Health Care.

Science.gov (United States)

Herrin, Jeph; Kenward, Kevin; Joshi, Maulik S; Audet, Anne-Marie J; Hines, Stephen J

2016-02-01

To determine the agreement of measures of care in different settings-hospitals, nursing homes (NHs), and home health agencies (HHAs)-and identify communities with high-quality care in all settings. Publicly available quality measures for hospitals, NHs, and HHAs, linked to hospital service areas (HSAs). We constructed composite quality measures for hospitals, HHAs, and nursing homes. We used these measures to identify HSAs with exceptionally high- or low-quality of care across all settings, or only high hospital quality, and compared these with respect to sociodemographic and health system factors. We identified three dimensions of hospital quality, four HHA dimensions, and two NH dimensions; these were poorly correlated across the three care settings. HSAs that ranked high on all dimensions had more general practitioners per capita, and fewer specialists per capita, than HSAs that ranked highly on only the hospital measures. Higher quality hospital, HHA, and NH care are not correlated at the regional level; regions where all dimensions of care are high differ systematically from regions which score well on only hospital measures and from those which score well on none. © Health Research and Educational Trust.

Experiences with maternal and perinatal death reviews in the UK--the MBRRACE-UK programme.

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Kurinczuk, J J; Draper, E S; Field, D J; Bevan, C; Brocklehurst, P; Gray, R; Kenyon, S; Manktelow, B N; Neilson, J P; Redshaw, M; Scott, J; Shakespeare, J; Smith, L K; Knight, M

2014-09-01

Established in 1952, the programme of surveillance and Confidential Enquiries into Maternal Deaths in the UK is the longest running such programme worldwide. Although more recently instituted, surveillance and confidential enquiries into perinatal deaths are also now well established nationally. Recent changes to funding and commissioning of the Enquiries have enabled both a reinvigoration of the processes and improvements to the methodology with an increased frequency of future reporting. Close engagement with stakeholders and a regulator requirement for doctors to participate have both supported the impetus for involvement of all professionals leading to greater potential for improved quality of care for women and babies. © 2014 Royal College of Obstetricians and Gynaecologists.

The Change of Perinatal Mortality Over Three Decades in a Reference Centre in the Aegean Region: Neonatal Mortality has decreased but Foetal Mortality Remains Unchanged

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Nilgün Kültürsay

2017-12-01

Full Text Available Background: Perinatal, foetal and neonatal mortality statistics are important to show the development of a health care system in a country. However, in our country there are very few national and regional data about the changing pattern of perinatal neonatal mortality along with the development of new technologies in this area. Aims: Evaluation of the changes in mortality rates and the causes of perinatal and neonatal deaths within years in a perinatal reference centre which serves a high-risk population. Study Design: Cross-sectional retrospective study. Methods: The perinatal, neonatal and foetal mortality rates in the years 1979-1980 (1st time point and 1988-1989 (2nd time point were compared with the year 2008 (3rd time point. The causes of mortality were assessed by Wigglesworth classification and death reports. The neonatal mortality in the neonatal intensive care unit was also calculated. Results: Foetal mortality rates were 44/1000, 31.4/1000 and 41.75/1000 births, perinatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 births, and neonatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 live births for the three study time points, respectively. The mortality rate in neonatal intensive care unit decreased consistently from 33%, to 22.6% and 10%, respectively, together with decreasing neonatal mortality rates. The causes of perinatal deaths were foetal death 85%, immaturity 4%, and lethal congenital malformations 8% according to Wigglesworth classification in 2008, showing the high impact of foetal deaths on this high perinatal mortality rate. Infectious causes of neonatal deaths decreased but congenital anomalies increased in the last decades. Conclusion: Although neonatal mortality rate decreased significantly; foetal mortality rate has stayed unchanged since the late eighties. In order to decrease foetal and perinatal mortality rates more efficiently, reducing consanguineous marriages and providing better antenatal care for

The influence of the war on perinatal and maternal mortality in Bosnia and Herzegovina.

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Fatusić, Z; Kurjak, A; Grgić, G; Tulumović, A

2005-10-01

To investigate the influence of the war on perinatal and maternal mortality during the war conflict in Bosnia and Herzegovina. In a retrospective study we analysed perinatal and maternal mortality in the pre-war period (1988-1991), the war period (1992-1995) and the post-war period (1996-2003). We also analysed the number of deliveries, the perinatal and maternal mortality rates and their causes. During the analysed period we had a range of 3337-6912 deliveries per year, with a decreased number in the war period. During the war period and immediately after the war, the perinatal mortality rate increased to 20.9-26.3% (average 24.28%). After the war the rate decreased to 8.01% in 2003 (p war was 39/100,000 deliveries, during the war it increased to 65/100,000 and after the war it decreased to 12/100,000 deliveries (p war was because of an increased number of uterine ruptures, sepsis and bleeding due to shell injury of pregnant women. During the war we could expect a decreased number of deliveries, and an increased rate of perinatal and maternal mortality and preterm deliveries due to: inadequate nutrition, stress factors (life in refugee's centers, bombing, deaths of relatives, uncertain future...), and break down of the perinatal care system (lack of medical staff, impossibility of collecting valid health records, particularly perinatal information, and the destruction of medical buildings).

New Fathers' Perinatal Depression and Anxiety-Treatment Options: An Integrative Review.

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O'Brien, Anthony P; McNeil, Karen A; Fletcher, Richard; Conrad, Agatha; Wilson, Amanda J; Jones, Donovan; Chan, Sally W

2017-07-01

More than 10% of fathers experience depression and anxiety during the perinatal period, but paternal perinatal depression (PPND) and anxiety have received less attention than maternal perinatal mental health problems. Few mainstream treatment options are available for men with PPND and anxiety. The aim of this literature review was to summarize the current understanding of PPND and the treatment programs specifically designed for fathers with perinatal depression. Eight electronic databases were searched using a predefined strategy, and reference lists were also hand searched. PPND and anxiety were identified to have a negative impact on family relationships, as well as the health of mothers and children. Evidence suggests a lack of support and tailored treatment options for men having trouble adjusting to the transition to fatherhood. Of the limited options available, cognitive behavioral therapy, group work, and blended delivery programs, including e-support approaches appear to be most effective in helping fathers with perinatal depression and anxiety. The review findings have important implications for the understanding of PPND and anxiety. Future research is needed to address the adoption of father-inclusive and father-specific models of care to encourage fathers' help-seeking behavior. Inclusion of male-specific requirements into support and treatment options can improve the ability of services to engage new fathers. Psychotherapeutic intervention could assist to address the cognitive differences and dissonance for men adjusting to the role of father, including male identity and role expectations.

Quality Improvement in Athletic Health Care.

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Lopes Sauers, Andrea D; Sauers, Eric L; Valier, Alison R Snyder

2017-11-01

  Quality improvement (QI) is a health care concept that ensures patients receive high-quality (safe, timely, effective, efficient, equitable, patient-centered) and affordable care. Despite its importance, the application of QI in athletic health care has been limited.   To describe the need for and define QI in health care, to describe how to measure quality in health care, and to present a QI case in athletic training.   As the athletic training profession continues to grow, a widespread engagement in QI efforts is necessary to establish the value of athletic training services for the patients that we serve. A review of the importance of QI in health care, historical perspectives of QI, tools to drive QI efforts, and examples of common QI initiatives is presented to assist clinicians in better understanding the value of QI for advancing athletic health care and the profession. Clinical and Research Advantages:  By engaging clinicians in strategies to measure outcomes and improve their patient care services, QI practice can help athletic trainers provide high-quality and affordable care to patients.

Quality of care for people with multimorbidity

DEFF Research Database (Denmark)

Schiøtz, Michaela L.; Høst, Dorte; Christensen, Mikkel B.

2017-01-01

BACKGROUND: Multimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people ...... includes formally assigned responsibility for care coordination, a change in the financial incentive structure towards a system rewarding high quality care and care focusing on prevention of disease exacerbation, as well as implementing shared medical record systems.......BACKGROUND: Multimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people...... with multimorbidity in the publicly funded healthcare system in Denmark. METHODS: To investigate the quality of care for people with multimorbidity different groups of clinicians from the hospital, general practice and the municipality reviewed records from 23 persons with multimorbidity and discussed them in three...

Causes of death and associated conditions (Codac) - a utilitarian approach to the classification of perinatal deaths

NARCIS (Netherlands)

Froen, J. Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W.; Facchinetti, Fabio; Fretts, Ruth C.; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J.; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C.; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon C. S.; Torabi, Rozbeh

2009-01-01

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose

[Quality assurance concepts in intensive care medicine].

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Brinkmann, A; Braun, J P; Riessen, R; Dubb, R; Kaltwasser, A; Bingold, T M

2015-11-01

Intensive care medicine (ICM) is characterized by a high degree of complexity and requires intense communication and collaboration on interdisciplinary and multiprofessional levels. In order to achieve good quality of care in this environment and to prevent errors, a proactive quality and error management as well as a structured quality assurance system are essential. Since the early 1990s, German intensive care societies have developed concepts for quality management and assurance in ICM. In 2006, intensive care networks were founded in different states to support the implementation of evidence-based knowledge into clinical routine and to improve medical outcome, efficacy, and efficiency in ICM. Current instruments and concepts of quality assurance in German ICM include core intensive care data from the data registry DIVI REVERSI, quality indicators, peer review in intensive care, IQM peer review, and various certification processes. The first version of German ICM quality indicators was published in 2010 by an interdisciplinary and interprofessional expert commission. Key figures, indicators, and national benchmarks are intended to describe the quality of structures, processes, and outcomes in intensive care. Many of the quality assurance tools have proved to be useful in clinical practice, but nationwide implementation still can be improved.

Perinatal tuberculosis: a diagnostic challenge

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Edna Lúcia S. de Souza

Full Text Available Despite the high prevalence of tuberculosis in adults and children, the congenital and perinatal forms of tuberculosis are rare. In Brazil, there has been only one published case of congenital tuberculosis and two cases of the perinatal form of this disease. We report a case of perinatal tuberculosis presenting with pneumonia. Alcohol-acid-resistant bacilli were found in the gastric lavage. Diagnosis of this disease presentation requires a high index of suspicion.

Development and validation of the quality care questionnaire -palliative care (QCQ-PC): patient-reported assessment of quality of palliative care.

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Yun, Young Ho; Kang, Eun Kyo; Lee, Jihye; Choo, Jiyeon; Ryu, Hyewon; Yun, Hye-Min; Kang, Jung Hun; Kim, Tae You; Sim, Jin-Ah; Kim, Yaeji

2018-03-05

In this study, we aimed to develop and validate an instrument that could be used by patients with cancer to evaluate their quality of palliative care. Development of the questionnaire followed the four-phase process: item generation and reduction, construction, pilot testing, and field testing. Based on the literature, we constructed a list of items for the quality of palliative care from 104 quality care issues divided into 14 subscales. We constructed scales of 43 items that only the cancer patients were asked to answer. Using relevance and feasibility criteria and pilot testing, we developed a 44-item questionnaire. To assess the sensitivity and validity of the questionnaire, we recruited 220 patients over 18 years of age from three Korean hospitals. Factor analysis of the data and fit statistics process resulted in the 4-factor, 32-item Quality Care Questionnaire-Palliative Care (QCQ-PC), which covers appropriate communication with health care professionals (ten items), discussing value of life and goals of care (nine items), support and counseling for needs of holistic care (seven items), and accessibility and sustainability of care (six items). All subscales and total scores showed a high internal consistency (Cronbach alpha range, 0.89 to 0.97). Multi-trait scaling analysis showed good convergent (0.568-0.995) and discriminant (0.472-0.869) validity. The correlation between the total and subscale scores of QCQ-PC and those of EORTC QLQ-C15-PAL, MQOL, SAT-SF, and DCS was obtained. This study demonstrates that the QCQ-PC can be adopted to assess the quality of care in patients with cancer.

PARENTS 2 study protocol: pilot of Parents' Active Role and ENgagement in the review of Their Stillbirth/perinatal death.

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Bakhbakhi, Danya; Siassakos, Dimitrios; Storey, Claire; Heazell, Alexander; Lynch, Mary; Timlin, Laura; Burden, Christy

2018-01-10

The perinatal mortality review meeting that takes place within the hospital following a stillbirth or neonatal death enables clinicians to learn vital lessons to improve care for women and their families for the future. Recent evidence suggests that parents are unaware that a formal review following the death of their baby takes place. Many would welcome the opportunity to feedback into the meeting itself. Parental involvement in the perinatal mortality review meeting has the potential to improve patient satisfaction, drive improvements in patient safety and promote an open culture within healthcare. Yet evidence on the feasibility of involving bereaved parents in the review process is lacking. This paper describes the protocol for the Parents' Active Role and Engangement iN the review of their Stillbirth/perinatal death study (PARENTS 2) , whereby healthcare professionals' and stakeholders' perceptions of parental involvement will be investigated, and parental involvement in the perinatal mortality review will be piloted and evaluated at two hospitals. We will investigate perceptions of parental involvement in the perinatal mortality review process by conducting four focus groups. A three-round modified Delphi technique will be employed to gain a consensus on principles of parental involvement in the perinatal mortality review process. We will use three sequential rounds, including a national consensus meeting workshop with experts in stillbirth, neonatal death and bereavement care, and a two-stage anonymous online questionnaire. We will pilot a new perinatal mortality review process with parental involvement over a 6-month study period. The impact of the new process will be evaluated by assessing parents' experiences of their care and parents' and staff perceptions of their involvement in the process by conducting further focus groups and using a Parent Generated Index questionnaire. This study has ethical approval from the UK Health Research Authority. We will

[Care quality in intensive care evaluated by the patients using a service quality scale (SERVQUAL)].

Science.gov (United States)

Regaira Martínez, E; Sola Iriarte, M; Goñi Viguria, R; Del Barrio Linares, M; Margall Coscojuela, M A; Asiain Erro, M C

2010-01-01

The evaluation made by the patients on the quality of service received is important to introduce improvement strategies in the care quality. 1. To evaluate the care quality through the analysis of the differences obtained between expectations and perceptions, that the patients have of the service received in the ICU. 2. To analyze if there is any relationship between care quality evaluated by the patients and the sociodemographic variables. A total of 86 patients who were conscious and oriented during their stay in the ICU were studied prospectively. At 24h of the discharge from the ICU, the SERVQUAL (Service Quality) scale, adapted for the hospital setting by Babakus and Mangold (1992), was applied. This scale measures the care quality based on the difference in scores obtained between expectations and perceptions of the patients. The positive scores indicate that the perceptions of the patients exceed their expectations. The scale has 5 dimensions: Tangibility, Reliability, Responsiveness, Assurances and Empathy. It includes 15 items for perceptions and the same for expectations, with 5 grades of response (1 totally disagree - 5 totally agree). The mean score of perceptions 66.92) exceeded that of the expectations (62.30). The mean score of the difference between perceptions and expectations for the total of the SERVQUAL scale was 4.62. It was also positive for each one of the dimensions: Tangibility=1.44, Reliability=0.53, Responsiveness=0.95, Assurances=0.99, Empathy=0.71. No statistically significant associations were found between care quality evaluated by the patients and the sociodemographic variables. The care quality perceived by the patients in the ICU exceeds their expectations, and had no relationship with the sociodemographic characteristics. Copyright 2009 Elsevier España, S.L. y SEEIUC. All rights reserved.

A process evaluation exploring the lay counsellor experience of delivering a task shared psycho-social intervention for perinatal depression in Khayelitsha, South Africa.

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Munodawafa, Memory; Lund, Crick; Schneider, Marguerite

2017-07-01

Task sharing of psycho-social interventions for perinatal depression has been shown to be feasible, acceptable and effective in low and middle-income countries. This study conducted a process evaluation exploring the perceptions of counsellors who delivered a task shared psycho-social counselling intervention for perinatal depression in Khayelitsha, Cape Town together with independent fidelity ratings. Post intervention qualitative semi-structured interviews were conducted with six counsellors from the AFrica Focus on Intervention Research for Mental health (AFFIRM-SA) randomised controlled trial on their perceptions of delivering a task shared psycho-social intervention for perinatal depression. Themes were identified using the framework approach and were coded and analysed using Nvivo v11. These interviews were supplemented with fidelity ratings for each counsellor and supervision notes. Facilitating factors in the delivery of the intervention included intervention related factors such as: the content of the intervention, ongoing training and supervision, using a counselling manual, conducting counselling sessions in the local language (isiXhosa) and fidelity to the manual; counsellor factors included counsellors' confidence and motivation to conduct the sessions; participant factors included older age, commitment and a desire to be helped. Barriers included contextual factors such as poverty, crime and lack of space to conduct counselling sessions and participant factors such as the nature of the participant's problem, young age, and avoidance of contact with counsellors. Fidelity ratings and dropout rates varied substantially between counsellors. These findings show that a variety of intervention, counsellor, participant and contextual factors need to be considered in the delivery of task sharing counselling interventions. Careful attention needs to be paid to ongoing supervision and quality of care if lay counsellors are to deliver good quality task shared

Maternal and perinatal outcomes of dengue in PortSudan, Eastern Sudan

Directory of Open Access Journals (Sweden)

Elbashir Hagir M

2010-07-01

Full Text Available Abstract Aim To investigate maternal and perinatal outcomes (maternal death, preterm delivery, low birth weight and perinatal mortality of dengue at PortSudan and Elmawani hospitals in the eastern Sudan. Method This was a retrospective Cohort study where medical files of women with dengue were reviewed. Results There were 10820 deliveries and 78 (0.7% pregnant women with confirmed dengue IgM serology at the mean (SD gestational age of 29.4(8.2 weeks. While the majority of these women had dengue fever (46, 58.9%, hemorrhagic fever and dengue shock syndrome were the presentations in 18 (23.0% and 12, (15.3% of these women, respectively. There were 17(21.7% maternal deaths. Fourteen (17.9% of these 78 women had preterm deliveries and 19 (24.3% neonates were admitted to neonatal intensive care unit. Nineteen (24.3% women gave birth to low birth weight babies. There were seven (8.9% perinatal deaths. Eight (10.2% patients delivered by caesarean section due to various obstetrical indications. Conclusion Thus dengue has poor maternal and perinatal outcomes in this setting. Preventive measures against dengue should be employed in the region, and more research on dengue during pregnancy is needed.

Mobile phone intervention reduces perinatal mortality in zanzibar: secondary outcomes of a cluster randomized controlled trial.

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Lund, Stine; Rasch, Vibeke; Hemed, Maryam; Boas, Ida Marie; Said, Azzah; Said, Khadija; Makundu, Mkoko Hassan; Nielsen, Birgitte Bruun

2014-03-26

Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse. We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in Zanzibar as the unit of randomization. At their first antenatal care visit, 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery. Twenty-four primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth as a proxy of neonatal mortality. Within the first 42 days of life, 2482 children were born alive, 54 were stillborn, and 36 died. The overall perinatal mortality rate in the study was 27 per 1000 total births. The rate was lower in the intervention clusters, 19 per 1000 births, than in the control clusters, 36 per 1000 births. The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93). Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74). Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings. Clinical

Father-Inclusive Perinatal Parent Education Programs: A Systematic Review.

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Lee, Joyce Y; Knauer, Heather A; Lee, Shawna J; MacEachern, Mark P; Garfield, Craig F

2018-06-14

Fathers contribute to their children's health starting at the beginning of life. Few parent education programs include fathers. Among those that do, there is little effort to report program effects on father outcomes. In this systematic review, we examined father-inclusive perinatal parent education programs in the United States as they relate to a range of father outcomes. The databases searched were PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and PsycINFO. Studies were included if they included an evaluation of a parent education program and a report of father outcomes measured within 1 year of the child's birth and were conducted within the United States. Of 1353 total articles, 21 met study criteria. The overall state of the father-inclusive perinatal parent education program literature was poor, with few interventions available to fathers. Available programs were associated with increased father involvement, coparenting relationship, partner relationship quality, father's mental health, and father's supportive behaviors. Program effects on father-infant interaction, parenting knowledge, and attitudes and parenting self-efficacy were inconclusive. Three programs emerged as best evidence-based interventions. Risk of bias was high for many studies. Outcome variability, small sample size, and publication bias contributed to the weak evidence base. There is a need for more evidence-based interventions to support fathers. Clinicians play a key role in engaging fathers in early parent education programs and health care settings. PROSPERO registration number: CRD42017050099. Copyright © 2018 by the American Academy of Pediatrics.

The relational dimension of care for maternity blues and its relation to decompensation of a psychiatric disorder during the intermediate postpartum period in Cameroon.

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Mboua, C P; Nkoum, B A; Abessouguié, S P

2016-08-01

In a setting such as Cameroon, where perinatal care offers few services for women with psychiatric problems during pregnancy, delivery, and the immediate postpartum period, the development of the relational dimension of care may help prevent severe psychiatric disorders . This study evaluates the role of the relational dimension of perinatal and early postpartum care (providing perinatal counseling and a space to speak) on women with blues on the intermediate-term outcomes of decompensation, in view of the importance of the emotional issues occurring in the perinatal period. Data collection used both diagnostic and clinical methods on a sample of 50 women from three hospitals in Cameroon who gave birth during the study period and agreed to participate. Of the 38 diagnosed with blues, 10 were available for observation during the intermediate post-partum: they were sorted into an experimental group that received perinatal counseling (n=5) and a control group that did not. The results suggest the importance to women with blues of a space for talking during the post-partum period. In particular, the quality of this counseling, in terms of the emotional responses of the nursing staff, determines the outcome of this management and can help to reduce the outset of depression and decompensation.

[Quality assurance and quality management in intensive care].

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Notz, K; Dubb, R; Kaltwasser, A; Hermes, C; Pfeffer, S

2015-11-01

Treatment success in hospitals, particularly in intensive care units, is directly tied to quality of structure, process, and outcomes. Technological and medical advancements lead to ever more complex treatment situations with highly specialized tasks in intensive care nursing. Quality criteria that can be used to describe and correctly measure those highly complex multiprofessional situations have only been recently developed and put into practice.In this article, it will be shown how quality in multiprofessional teams can be definded and assessed in daily clinical practice. Core aspects are the choice of a nursing theory, quality assurance measures, and quality management. One possible option of quality assurance is the use of standard operating procedures (SOPs). Quality can ultimately only be achieved if professional groups think beyond their boundaries, minimize errors, and establish and live out instructions and SOPs.

Dusukasi-The Heart That Cries: An Idiom of Mental Distress Among Perinatal Women in Rural Mali.

Science.gov (United States)

Lasater, Molly E; Beebe, Madeleine; Warren, Nicole E; Souko, Fatoumata; Keita, Mariam; Murray, Sarah E; Bass, Judith K; Surkan, Pamela J; Winch, Peter J

2018-04-25

Perinatal mental health problems such as depression and anxiety are prevalent in low and middle-income countries. In Mali, the lack of mental health care is compounded by few studies on mental health needs, including in the perinatal period. This paper examines the ways in which perinatal women experience and express mental distress in rural Mali. We describe a process, relying on several different qualitative research methods, to identify understandings of mental distress specific to the Malian context. Participants included perinatal women, maternal health providers, and community health workers in rural southwest Mali. Participants articulated several idioms of distress, including gèlèya (difficulties), tôôrô (pain, suffering), hamin (worries, concerns), and dusukasi (crying heart), that occur within a context of poverty, interpersonal conflict, and gender inequality. These idioms of distress were described as sharing many key features and operating on a continuum of severity that could progress over time, both within and across idioms. Our findings highlight the context dependent nature of experiences and expressions of distress among perinatal women in Mali.

Do competition and managed care improve quality?

Science.gov (United States)

Sari, Nazmi

2002-10-01

In recent years, the US health care industry has experienced a rapid growth of managed care, formation of networks, and an integration of hospitals. This paper provides new insights about the quality consequences of this dynamic in US hospital markets. I empirically investigate the impact of managed care and hospital competition on quality using in-hospital complications as quality measures. I use random and fixed effects, and instrumental variable fixed effect models using hospital panel data from up to 16 states in the 1992-1997 period. The paper has two important findings: First, higher managed care penetration increases the quality, when inappropriate utilization, wound infections and adverse/iatrogenic complications are used as quality indicators. For other complication categories, coefficient estimates are statistically insignificant. These findings do not support the straightforward view that increases in managed care penetration are associated with decreases in quality. Second, both higher hospital market share and market concentration are associated with lower quality of care. Hospital mergers have undesirable quality consequences. Appropriate antitrust policies towards mergers should consider not only price and cost but also quality impacts. Copyright 2002 John Wiley & Sons, Ltd.

Causes of death and associated conditions (Codac): a utilitarian approach to the classification of perinatal deaths.

Science.gov (United States)

Frøen, J Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W; Facchinetti, Fabio; Fretts, Ruth C; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon C S; Torabi, Rozbeh

2009-06-10

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes.We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions.The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal).For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured.The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the most

Improvement of perinatal and newborn care in rural Pakistan through community-based strategies: a cluster-randomised effectiveness trial.

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Bhutta, Zulfiqar A; Soofi, Sajid; Cousens, Simon; Mohammad, Shah; Memon, Zahid A; Ali, Imran; Feroze, Asher; Raza, Farrukh; Khan, Amanullah; Wall, Steve; Martines, Jose

2011-01-29

Newborn deaths account for 57% of deaths in children younger than 5 years in Pakistan. Although a large programme of trained lady health workers (LHWs) exists, the effectiveness of this training on newborn outcomes has not been studied. We aimed to evaluate the effectiveness of a community-based intervention package, principally delivered through LHWs working with traditional birth attendants and community health committees, for reduction of perinatal and neonatal mortality in a rural district of Pakistan. We undertook a cluster randomised trial between February, 2006, and March, 2008, in Hala and Matiari subdistricts, Pakistan. Catchment areas of primary care facilities and all affiliated LHWs were used to define clusters, which were allocated to intervention and control groups by restricted, stratified randomisation. The intervention package delivered by LHWs through group sessions consisted of promotion of antenatal care and maternal health education, use of clean delivery kits, facility births, immediate newborn care, identification of danger signs, and promotion of careseeking; control clusters received routine care. Independent data collectors undertook quarterly household surveillance to capture data for births, deaths, and household practices related to maternal and newborn care. Data collectors were masked to cluster allocation; those analysing data were not. The primary outcome was perinatal and all-cause neonatal mortality. Analysis was by intention to treat. This trial is registered, ISRCTN16247511. 16 clusters were assigned to intervention (23,353 households, 12,391 total births) and control groups (23,768 households, 11,443 total births). LHWs in the intervention clusters were able to undertake 4428 (63%) of 7084 planned group sessions, but were only able to visit 2943 neonates (24%) of a total 12,028 livebirths in their catchment villages. Stillbirths were reduced in intervention clusters (39·1 stillbirths per 1000 total births) compared with

The quality-value proposition in health care.

Science.gov (United States)

Feazell, G Landon; Marren, John P

2003-01-01

Powerful forces are converging in US health care to finally cause recognition of the inherently logical relationship between quality and money. The forces, or marketplace "drivers," which are converging to compel recognition of the relationship between cost and quality are: (1) the increasing costs of care; (2) the recurrence of another medical malpractice crisis; and (3) the recognition inside and outside of health care that quality is inconsistent and unacceptable. It is apparent that hospital administrators, financial officers, board members, and medical staff leadership do not routinely do two things: (1) relate quality to finance; and (2) appreciate the intra-hospital structural problems that impede quality attainment. This article discusses these factors and offers a positive method for re-structuring quality efforts and focusing the hospital and its medical staff on quality. The simple but compelling thesis of the authors is that health care must immediately engage in the transformation to making quality of medical care the fundamental business strategy of the organization.

Exploring perinatal shift-to-shift handover communication and process: an observational study.

NARCIS (Netherlands)

Poot, E.P.; Bruijne, M.C. de; Wouters, M.G.A.J.; Groot, C.J.M. de; Wagner, C.

2014-01-01

Rationale, aims and objectives: Loss of situation awareness (SA) by health professionals during handover is a major threat to patient safety in perinatal care. SA refers to knowing what is going on around. Adequate handover communication and process may support situation assessment, a precursor of

Living with diabetes: quality of care and quality of life

Directory of Open Access Journals (Sweden)

Pilar Isla Pera

2011-01-01

Full Text Available Pilar Isla PeraDepartment of Public Health Nursing, Mental and Mother and Child Health, University of Barcelona, SpainBackground: The aim of this research was to characterize the experience of living with diabetes mellitus (DM and identify patients’ opinions of the quality of care received and the results of interventions.Methods: A descriptive, exploratory evaluation study using qualitative methodology was performed. Participants consisted of 40 adult patients diagnosed with DM and followed up in a public hospital in Barcelona, Spain. A semistructured interview and a focus group were used and a thematic content analysis was performed.Results: Patients described DM as a disease that is difficult to control and that provokes lifestyle changes requiring effort and sacrifice. Insulin treatment increased the perception of disease severity. The most frequent and dreaded complication was hypoglycemia. The main problems perceived by patients affecting the quality of care were related to a disease-centered medical approach, lack of information, limited participation in decision-making, and the administrative and bureaucratic problems of the health care system.Conclusion: The bureaucratic circuits of the health care system impair patients’ quality of life and perceived quality of care. Health professionals should foster patient participation in decision-making. However, this requires not only training and appropriate attitudes, but also adequate staffing and materials.Keywords: diabetes mellitus, health care quality, quality of life, qualitative research

Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals.

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Geurtzen, R; Van Heijst, Arno; Hermens, Rosella; Scheepers, Hubertina; Woiski, Mallory; Draaisma, Jos; Hogeveen, Marije

2018-01-03

Since 2010, intensive care can be offered in the Netherlands at 24 +0  weeks gestation (with parental consent) but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling. Our aim is to explore preferred prenatal counselling at the limits of viability by Dutch perinatal professionals and compare this to current care. Online nationwide survey as part of the PreCo study (2013) amongst obstetricians and neonatologists in all Dutch level III perinatal care centers (n = 205).The survey regarded prenatal counselling at the limits of viability and focused on the domains of organization, content and decision-making in both current and preferred practice. One hundred twenty-two surveys were returned out of 205 eligible professionals (response rate 60%). Organization-wise: more than 80% of all professionals preferred (but currently missed) having protocols for several aspects of counselling, joint counselling by both neonatologist and obstetrician, and the use of supportive materials. Most professionals preferred using national or local data (70%) on outcome statistics for the counselling content, in contrast to the international statistics currently used (74%). Current decisions on initiation care were mostly made together (in 99% parents and doctor). This shared decision model was preferred by 95% of the professionals. Dutch perinatal professionals would prefer more protocolized counselling, joint counselling, supportive material and local outcome statistics. Further studies on both barriers to perform adequate counselling, as well as on Dutch outcome statistics and parents' opinions are needed in order to develop a national framework. Clinicaltrials.gov, NCT02782650 , retrospectively registered May 2016.

Job satisfaction of primary care team members and quality of care.

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Mohr, David C; Young, Gary J; Meterko, Mark; Stolzmann, Kelly L; White, Bert

2011-01-01

In recent years, hospitals and payers have increased their efforts to improve the quality of patient care by encouraging provider adherence to evidence-based practices. Although the individual provider is certainly essential in the delivery of appropriate care, a team perspective is important when examining variation in quality. In the present study, the authors modeled the relationship between a measure of aggregate job satisfaction for members of primary care teams and objective measures of quality based on process indicators and intermediate outcomes. Multilevel analyses indicated that aggregate job satisfaction ratings were associated with higher values on both types of quality measures. Team-level job satisfaction ratings are a potentially important marker for the effectiveness of primary care teams in managing patient care.

Factors associated with perinatal mortality among public health deliveries in Addis Ababa, Ethiopia, an unmatched case control study.

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Getiye, Yemisrach; Fantahun, Mesganaw

2017-07-26

perinatal mortality is the sum of still birth (fetal death) and early neonatal death (ENND) i.e. death of live newborn before the age of 7 completed days. Perinatal mortality accounts three fourth of the deaths of the neonatal period and is one of the major challenges for under-five mortality. Therefore this study was conducted to better understand the common and avoidable factors that affect perinatal mortality in Addis Ababa, Ethiopia. An unmatched case control study design using secondary data as a source of information was conducted. Cases were still births or early neonatal deaths and controls were live births and neonates who were discharged alive from the hospital and did not die before the age of 7 days. The study period was from 1st January up to 30th February 2015. Epi-Info version 7.0 and SPSS Version 21 were used for data entry and analysis. Descriptive statistics, frequencies, proportions and diagrams were used to check the distribution of outcome variable and describe the study population. Logistic regression model was used to identify the important factors that are associated with perinatal mortality. A total of 1113(376 cases and 737 controls) maternal charts were reviewed. The mean age of the mothers for cases and controls were 26.47 ± 4.87 and 26.95 ± 4.68 respectively. Five hundred ninety seven (53.6%) mothers delivered for the first time. Factors that are significantly associated with increased risk of perinatal mortality were birth interval less than 2 years, preterm delivery, anemia, congenital anomaly, previous history of early neonatal death and low birth weight. Use of partograph was also associated with decreased risk of perinatal mortality. From factors that are associated with perinatal mortality, some of them can be prevented with early investigation of pregnant mothers on their antenatal care follow. Appropriate labor follow-up and monitoring with regular use of partograph, immediate newborn care and interventions to delay

[Maternal hemoglobin in Peru: regional differences and its association with adverse perinatal outcomes].

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Gonzales, Gustavo F; Tapia, Vilma; Gasco, Manuel; Carrillo, Carlos

2011-01-01

To evaluate hemoglobin (Hb) levels in pregnant women from different geographical regions from Peru; to establish anemia and erythrocytocis rates and to establish the role of Hb on adverse perinatal outcomes using the Perinatal Information System (PIS) database of Peruvian Ministry of Health. Data were obtained from 379,816 births of 43 maternity care units between 2000 and 2010. Anemia and erythrocytocis rates were determined in each geographical region as well as rates of adverse perinatal outcomes. To analyze data the STATA program (versión 10.0,Texas, USA) was used. The results were considered significant at panemia rate was higher in the coast (25.8%) and low forest (26.2%). Moderate/severe anemia rate in low forest was 2.6% and at the coast was 1.0%. In the highland, the highest rate of moderate/severe anemia was in the southern highlands (0.6%). The highest rate of erythrocytocis was found in the central highland (23.7%), 11.9% in the southern highland and 9.5% in the north highland. Severe anemia and erythrocytocis were associated with adverse perinatal outcomes. There are differences by Peruvian geographical region in anemia rates. In the central highlands were found the highest rates of erythrocytocis due to hypoxia effect in the high altitudes; however in the southern highlands, erythrocytocis was lower. Severe anemia and erythrocytosis were associated with increased adverse perinatal outcomes.

Tackling perinatal loss, a participatory action research approach: research protocol.

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Pastor-Montero, Sonia María; Romero-Sánchez, José Manuel; Paramio-Cuevas, Juan Carlos; Hueso-Montoro, César; Paloma-Castro, Olga; Lillo-Crespo, Manuel; Castro-Yuste, Cristina; Toledano-Losa, Ana Cristina; Carnicer-Fuentes, Concepción; Ortegón-Gallego, José Alejo; Frandsen, Anna J

2012-11-01

  The aim of this study was to promote changes to improve the care provided to parents who have experienced a perinatal loss through participatory action research.   The birth of a child is a joyful event for most families, however, unfortunately some pregnancies end in loss. Perinatal loss creates a heavy emotional impact not only on parents but also on health professionals, where in most cases there is an evident lack of skills, strategies and resources to cope with these kinds of situations.   Participatory action research is the methodology proposed to achieve the purpose of this study.   Participatory action research consists of five stages: outreach and awareness, induction, interaction, implementation and systematization. The working group will include professionals from the Mother and Child Unit for patients at a tertiary level public hospital in Spain. The duration of the study will be 3 years since the approval of the protocol in January 2011. The qualitative techniques used will include group dynamics such as the SWOT analysis the nominal group technique, focus groups and brainstorming, among others that will be recorded and transcribed, generating reports throughout the evolution of the group sessions and about the consensus reached. Content analysis will be conducted on the field diaries kept by the participants and researchers. This project has been funded by the Andalusian Regional Ministry of Health.   Participatory action research is a methodological strategy that allows changes in clinical practice to conduct a comprehensive transformative action in the care process for perinatal loss. © 2012 Blackwell Publishing Ltd.

Redefining Perinatal Experience: A Philosophical Exploration of a Hypothetical Case of Gender-Diversity in Labour and Birth.

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Richardson, Brianna; Price, Sheri; Campbell-Yeo, Marsha

2018-05-18

Using a queer phenomenological approach, the objective of this philosophical analysis is to explore the transgender experience in highly gendered clinical areas, such as the birth unit, and make recommendations on how to provide perinatal care that is inclusive of gender diversity within these areas. This paper aims to describes a hypothetical clinical experience to provide insight on the institutional barriers that currently exist and to provide nurses and midwives with pragmatic strategies to enhance gender-diverse care in general and gendered clinical areas. Currently, general healthcare providers are not sufficiently educated on how to care for and meet the needs of people who identify as lesbian, gay, bisexual, trans, queer, queer or questioning and other communities (LGBTQ+). This vulnerable population continually faces stigma, discrimination, and marginalization, which act as barriers to accessing healthcare services. Although transgender people often have difficulty accessing healthcare in general settings, they experience an even greater challenge within traditionally gendered clinical care areas. Queer Phenomenology was used to guide a critical philosophical analysis of hypothetical case reflecting a clinical scenario regarding a transgender man's experience in labour and birth. Healthcare professionals often provide insufficient care to transgender persons, inadvertently leading to further marginalization of this vulnerable population. Special consideration to provide gender-diverse care throughout the perinatal period is needed. Structures and supports are essential to enhance the care from providers in attending to the unique needs of transgender individuals and reduce oppressive effects from heteronormative environments. Nurses and midwives are leading exemplars of providing person-centered care and are capable of advocating for equitable care amongst all populations to influence systemic change. Strategies for implementing changes that address LGBTQ

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

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Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

Study of the Relevance of the Quality of Care, Operating Efficiency and Inefficient Quality Competition of Senior Care Facilities.

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Lin, Jwu-Rong; Chen, Ching-Yu; Peng, Tso-Kwei

2017-09-11

The purpose of this research is to examine the relation between operating efficiency and the quality of care of senior care facilities. We designed a data envelopment analysis, combining epsilon-based measure and metafrontier efficiency analyses to estimate the operating efficiency for senior care facilities, followed by an iterative seemingly unrelated regression to evaluate the relation between the quality of care and operating efficiency. In the empirical studies, Taiwan census data was utilized and findings include the following: Despite the greater operating scale of the general type of senior care facilities, their average metafrontier technical efficiency is inferior to that of nursing homes. We adopted senior care facility accreditation results from Taiwan as a variable to represent the quality of care and examined the relation of accreditation results and operating efficiency. We found that the quality of care of general senior care facilities is negatively related to operating efficiency; however, for nursing homes, the relationship is not significant. Our findings show that facilities invest more in input resources to obtain better ratings in the accreditation report. Operating efficiency, however, does not improve. Quality competition in the industry in Taiwan is inefficient, especially for general senior care facilities.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

OpenAIRE

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

Perinatal services and outcomes in Quang Ninh province, Vietnam.

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Nga, Nguyen T; Målqvist, Mats; Eriksson, Leif; Hoa, Dinh P; Johansson, Annika; Wallin, Lars; Persson, Lars-Åke; Ewald, Uwe

2010-10-01

We report baseline results of a community-based randomized trial for improved neonatal survival in Quang Ninh province, Vietnam (NeoKIP; ISRCTN44599712). The NeoKIP trial seeks to evaluate a method of knowledge implementation called facilitation through group meetings at local health centres with health staff and community key persons. Facilitation is a participatory enabling approach that, if successful, is well suited for scaling up within health systems. The aim of this baseline report is to describe perinatal services provided and neonatal outcomes. Survey of all health facility registers of service utilization, maternal deaths, stillbirths and neonatal deaths during 2005 in the province. Systematic group interviews of village health workers from all communes. A Geographic Information System database was also established. Three quarters of pregnant women had ≥3 visits to antenatal care. Two hundred and five health facilities, including 18 hospitals, provided delivery care, ranging from 1 to 3258 deliveries/year. Totally there were 17 519 births and 284 neonatal deaths in the province. Neonatal mortality rate was 16/1000 live births, ranging from 10 to 44/1000 in the different districts, with highest rates in the mountainous parts of the province. Only 8% had home deliveries without skilled attendance, but those deliveries resulted in one-fifth of the neonatal deaths. A relatively good coverage of perinatal care was found in a Vietnamese province, but neonatal mortality varied markedly with geography and level of care. A remaining small proportion of home deliveries generated a substantial part of mortality. © 2010 The Author(s)/Journal Compilation © 2010 Foundation Acta Paediatrica.

Perinatal mortality in Indonesia: an unfinished agenda

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Riawati Jahja

2011-10-01

Full Text Available Perinatal mortality is a profound issue in maternal and child health due to its close relation with the maternal condition. There exist Millennium Development Goals (MDGs which are to be achieved by 2015. These are coupled with a continuing need for comprehensively monitoring and identifying factors associated with perinatal mortality, which is a primary concern for developing countries inclusive of Indonesia. Previous and on-going health programs could have brought about strategic interventions but as different attributes can emerge due to epidemiological transition, and given the fact that associated factors may remain persistent, forward thinking strategies in public health are forever in need of renewal.     Results from our research show that educational variables, poor awareness towards proper antenatal care visits and weak services at the front-line of healthcare delivery (community outreach worsen the condition of childbearing women, raising the question of biological risk factors in line with socio-economic variables.

Characteristics of primary care practices associated with high quality of care.

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Beaulieu, Marie-Dominique; Haggerty, Jeannie; Tousignant, Pierre; Barnsley, Janet; Hogg, William; Geneau, Robert; Hudon, Éveline; Duplain, Réjean; Denis, Jean-Louis; Bonin, Lucie; Del Grande, Claudio; Dragieva, Natalyia

2013-09-03

No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care. We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling. The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0-35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8-14.4), presence of allied health professionals (15.3; 95% CI 5.4-25.2) and/or specialist physicians (19.6; 95% CI 8.3-30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0-12.4) and average organizational access to the practice (4.9; 95% CI 2.6-7.2). The number of physicians (1.2; 95% CI 0.6-1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1-2.5) were modestly associated with high-quality care. We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes.

Hospital heterogeneity: what drives the quality of health care.

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Ali, Manhal; Salehnejad, Reza; Mansur, Mohaimen

2018-04-01

A major feature of health care systems is substantial variation in health care quality across hospitals. The quality of stroke care widely varies across NHS hospitals. We investigate factors that may explain variations in health care quality using measures of quality of stroke care. We combine NHS trust data from the National Sentinel Stroke Audit with other data sets from the Office for National Statistics, NHS and census data to capture hospitals' human and physical assets and organisational characteristics. We employ a class of non-parametric methods to explore the complex structure of the data and a set of correlated random effects models to identify key determinants of the quality of stroke care. The organisational quality of the process of stroke care appears as a fundamental driver of clinical quality of stroke care. There are rich complementarities amongst drivers of quality of stroke care. The findings strengthen previous research on managerial and organisational determinants of health care quality.

Experiencing health care service quality: through patients' eyes.

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Schembri, Sharon

2015-02-01

The primary aim of the present study was to consider health care service quality from the patients' perspective, specifically through the patient's eyes. A narrative analysis was performed on 300 patient stories. This rigorous analysis of patient stories is designed to identify and describe health care service quality through patients' eyes in an authentic and accurate, experiential manner. The findings show that there are variant and complex ways that patients experience health care service quality. Patient stories offer an authentic view of the complex ways that patients experience health care service quality. Narrative analysis is a useful tool to identify and describe how patients experience health care service quality. Patients experience health care service quality in complex and varying ways.

Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases

NARCIS (Netherlands)

de Jonge, A.; Geerts, C.C.; van der Goes, B.Y.; Mol, B.W.; Buitendijk, S.E.; Nijhuis, J.G.

2015-01-01

Objective To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births. Design A nationwide cohort study. Setting The Netherlands. Population Low-risk women in midwife-led care at the onset of labour. Methods Analysis of national registration data. Main

Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases

NARCIS (Netherlands)

de jonge, A.; Geerts, C. C.; van der Goes, B. Y.; Mol, B. W.; Buitendijk, S. E.; Nijhuis, J. G.

2015-01-01

To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births. A nationwide cohort study. The Netherlands. Low-risk women in midwife-led care at the onset of labour. Analysis of national registration data. Intrapartum and neonatal death, Apgar scores, and

Managing Quality in Health Care: Involving Patient Care Information Systems and Healthcare Professionals in Quality Monitoring and Improvement

NARCIS (Netherlands)

M. de Mul (Marleen)

2009-01-01

textabstractIt is no longer possible to ignore the issue of quality in health care. Care institutions strive to provide all patients with effective, efficient, safe, timely, patient-centered care. Increased attention for quality is also found in discussions regarding use of information

Causes of death and associated conditions (Codac – a utilitarian approach to the classification of perinatal deaths

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Harrison Catherine

2009-06-01

Full Text Available Abstract A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD, although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes. We tested the Causes of Death and Associated Conditions (Codac classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions. The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies, two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy, a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal. For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured. The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions

Causes of death and associated conditions (Codac) – a utilitarian approach to the classification of perinatal deaths

Science.gov (United States)

Frøen, J Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W; Facchinetti, Fabio; Fretts, Ruth C; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon CS; Torabi, Rozbeh

2009-01-01

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes. We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions. The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal). For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured. The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the

INCODE-DK 2014. Classification of cause of intrauterine fetal death – a new approach to perinatal audit

DEFF Research Database (Denmark)

Maroun, Lisa Leth; Ramsing, Mette; Olsen, Tina Elisabeth

on a national level as described in the national guideline for IUFD. Multidisciplinary perinatal audit is an important tool in the evaluation of stillbirth, however, the establishment of the C-IUFD has until now been hampered by the lack of a recommended classification system. Material and methods...... on the perinatal audit system in use as introduced by K. Vitting Andersen. The scheme is adapted to INCODE in main categories and allows grading and coding of C-IUFD. INCODE –DK and INCODE perinatal audittabel are available in an updated version of the IUFD guideline 2014, as well as in a separate excel file...... of the working group that the new audit scheme in combination with the new national classification system will improve the uniformity and quality of perinatal audits on a national level....

Assessing primary care data quality.

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Lim, Yvonne Mei Fong; Yusof, Maryati; Sivasampu, Sheamini

2018-04-16

Purpose The purpose of this paper is to assess National Medical Care Survey data quality. Design/methodology/approach Data completeness and representativeness were computed for all observations while other data quality measures were assessed using a 10 per cent sample from the National Medical Care Survey database; i.e., 12,569 primary care records from 189 public and private practices were included in the analysis. Findings Data field completion ranged from 69 to 100 per cent. Error rates for data transfer from paper to web-based application varied between 0.5 and 6.1 per cent. Error rates arising from diagnosis and clinical process coding were higher than medication coding. Data fields that involved free text entry were more prone to errors than those involving selection from menus. The authors found that completeness, accuracy, coding reliability and representativeness were generally good, while data timeliness needs to be improved. Research limitations/implications Only data entered into a web-based application were examined. Data omissions and errors in the original questionnaires were not covered. Practical implications Results from this study provided informative and practicable approaches to improve primary health care data completeness and accuracy especially in developing nations where resources are limited. Originality/value Primary care data quality studies in developing nations are limited. Understanding errors and missing data enables researchers and health service administrators to prevent quality-related problems in primary care data.

Characteristics of administrators and quality of care in Ontario care facilities

OpenAIRE

Keays, Sean Charles

2007-01-01

This exploratory study investigated administrator and facility predictors of quality of care (QOC) in care facilities (CF). Surveys were mailed to all 602 CF administrators in Ontario; half of whom responded. Quality was measured using the last certification inspection report obtained from the Ontario Ministry of Health and Long-Term Care public report on certified CF. Quality predictors were found using multiple regression analysis. Education and experience as an administrator in current pos...

Research into care quality criteria for long-term care institutions.

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Wang, Wen-Liang; Chang, Hong-Jer; Liu, An-Chi; Chen, Yu-Wen

2007-12-01

The purpose of this paper was to determine the criteria that reflect the quality of care provided by long-term care institutions. Research was conducted using a two-step procedure that first utilized the SERVQUAL model with Fuzzy Delphi Method to establish the proper criteria by which service quality could be measured. A total of 200 questionnaires were mailed to expert respondents, of which 89 were returned and 77 deemed valid for use in this study. We then applied the Multi-Criteria Decision Making Process to determine the degree of importance of each criterion to long-term care institution service quality planning work. Secondly, 200 questionnaires were distributed and 74 valid responses were returned. Based on the 5 SERVQUAL model constructs, this study found 17 of the 28 criteria, to be pertinent to nursing care quality, with those in the Responsiveness and Empathy domains being the ones most critical.

THE COMPARISON OF SLOVENIAN AND EUROPEAN PERINATAL DATA OR AS MORE BACK WE LOOK FURTHER INTO THE FUTURE WE WILL SEE

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Živa Novak

2018-02-01

Full Text Available Background: Slovenian perinatal results are compared with European results: sometimes they are in the higher, sometimes in the lower range. Analysing trends and comparisons with other countries helps in planning changes in organisation and function so we are prepared for future challenges. Introduction of new technologies demands appropriate answers to challenges, including ethical ones. Methods: We compared perinatal results in Slovenia from 1987 to 1996, the PERISTAT project results from the year 2000 and the EURO-PERISTAT project with 2004 perinatal results including the Slovenian. Results: Some of the more prominent Slovenian perinatal results are shown. Cesarean section rate is the lowest among 26 countries in Europe. Deliveries after artificial reproductive techniques are second most frequent. Teenage pregnancies are very rare. Seemingly high maternal mortality mirrors also strict recording and cross checking with other data bases. Relatively high stillbirth rate may reflect the fact that all induced labours for fetal malformations are recorded. Conclusions: In Slovenia we do have tools for quality collection of perinatal results which should be used and audited. To have comparable results inside Slovenia, definitions should be written at http://www.obgyn-si.org/. When changing delivery record markers of prenatal care should be added – they could be easily obtained from maternity booklets (electronic or paper. In maternity booklet there is a place to write about grand dad prostate cancer; let us replace it with risk factors for preterm delivery (medical history and cervical length, 12 weeks screening for preeclampsia and intrauterine growth restriction (ultrasonic and biochemi- cal markers, gestational diabetes and obesity (body mass index, waist – hips ratio and hypothyroidism; let us leave some free space for the future screening tests. Known and proven efficient management (e.g. progesterone for recurrent preterm delivery prevention

Cultural processes in psychotherapy for perinatal loss: Breaking the cultural taboo against perinatal grief.

Science.gov (United States)

Markin, Rayna D; Zilcha-Mano, Sigal

2018-03-01

This paper argues that there is a cultural taboo against the public recognition and expression of perinatal grief that hinders parents' ability to mourn and their psychological adjustment following a loss. It is proposed that this cultural taboo is recreated within the therapy relationship, as feelings of grief over a perinatal loss are minimized or avoided by the therapist and parent or patient. Importantly, it is suggested that if these cultural dynamics are recognized within the therapy relationship, then psychotherapy has the immense opportunity to break the taboo by validating the parent's loss as real and helping the parent to mourn within an empathic and affect-regulating relationship. Specifically, it is suggested that therapists break the cultural taboo against perinatal grief and help parents to mourn through: acknowledging and not pathologizing perinatal grief reactions, considering intrapsychic and cultural factors that impact a parent's response to loss, exploring cultural reenactments within the therapy relationship, empathizing with the parent's experience of loss and of having to grieve within a society that does not recognize perinatal loss, coregulating the parent's feelings of grief and loss, and helping patients to create personally meaningful mourning rituals. Lastly, the impact of within and between cultural differences and therapist attitudes on the therapy process is discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Domestic violence and perinatal mental disorders: a systematic review and meta-analysis.

Directory of Open Access Journals (Sweden)

Louise M Howard

Full Text Available Domestic violence in the perinatal period is associated with adverse obstetric outcomes, but evidence is limited on its association with perinatal mental disorders. We aimed to estimate the prevalence and odds of having experienced domestic violence among women with antenatal and postnatal mental disorders (depression and anxiety disorders including post-traumatic stress disorder [PTSD], eating disorders, and psychoses.We conducted a systematic review and meta-analysis (PROSPERO reference CRD42012002048. Data sources included searches of electronic databases (to 15 February 2013, hand searches, citation tracking, update of a review on victimisation and mental disorder, and expert recommendations. Included studies were peer-reviewed experimental or observational studies that reported on women aged 16 y or older, that assessed the prevalence and/or odds of having experienced domestic violence, and that assessed symptoms of perinatal mental disorder using a validated instrument. Two reviewers screened 1,125 full-text papers, extracted data, and independently appraised study quality. Odds ratios were pooled using meta-analysis. Sixty-seven papers were included. Pooled estimates from longitudinal studies suggest a 3-fold increase in the odds of high levels of depressive symptoms in the postnatal period after having experienced partner violence during pregnancy (odds ratio 3.1, 95% CI 2.7-3.6. Increased odds of having experienced domestic violence among women with high levels of depressive, anxiety, and PTSD symptoms in the antenatal and postnatal periods were consistently reported in cross-sectional studies. No studies were identified on eating disorders or puerperal psychosis. Analyses were limited because of study heterogeneity and lack of data on baseline symptoms, preventing clear findings on causal directionality.High levels of symptoms of perinatal depression, anxiety, and PTSD are significantly associated with having experienced domestic

Domestic violence and perinatal mental disorders: a systematic review and meta-analysis.

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Howard, Louise M; Oram, Sian; Galley, Helen; Trevillion, Kylee; Feder, Gene

2013-01-01

Domestic violence in the perinatal period is associated with adverse obstetric outcomes, but evidence is limited on its association with perinatal mental disorders. We aimed to estimate the prevalence and odds of having experienced domestic violence among women with antenatal and postnatal mental disorders (depression and anxiety disorders including post-traumatic stress disorder [PTSD], eating disorders, and psychoses). We conducted a systematic review and meta-analysis (PROSPERO reference CRD42012002048). Data sources included searches of electronic databases (to 15 February 2013), hand searches, citation tracking, update of a review on victimisation and mental disorder, and expert recommendations. Included studies were peer-reviewed experimental or observational studies that reported on women aged 16 y or older, that assessed the prevalence and/or odds of having experienced domestic violence, and that assessed symptoms of perinatal mental disorder using a validated instrument. Two reviewers screened 1,125 full-text papers, extracted data, and independently appraised study quality. Odds ratios were pooled using meta-analysis. Sixty-seven papers were included. Pooled estimates from longitudinal studies suggest a 3-fold increase in the odds of high levels of depressive symptoms in the postnatal period after having experienced partner violence during pregnancy (odds ratio 3.1, 95% CI 2.7-3.6). Increased odds of having experienced domestic violence among women with high levels of depressive, anxiety, and PTSD symptoms in the antenatal and postnatal periods were consistently reported in cross-sectional studies. No studies were identified on eating disorders or puerperal psychosis. Analyses were limited because of study heterogeneity and lack of data on baseline symptoms, preventing clear findings on causal directionality. High levels of symptoms of perinatal depression, anxiety, and PTSD are significantly associated with having experienced domestic violence. High-quality

Using action research to develop midwives' skills to support women with perinatal mental health needs.

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Madden, Deirdre; Sliney, Annmarie; O'Friel, Aoife; McMackin, Barbara; O'Callaghan, Bernie; Casey, Kate; Courtney, Lisa; Fleming, Valerie; Brady, Vivienne

2018-02-01

The aim of the research was to identify and develop midwives' skills to support women with mental health needs during pregnancy, using an action research approach. A review of perinatal mental health services in a large Dublin maternity unit revealed a high number of referred women who 'did not attend' the perinatal mental health service with few guidelines in place to support midwives in identifying and referring women for specialist help. Action research using cooperative inquiry involved a mental health nurse specialist and a team of midwives, who were drawn to each other in mutual concern about an area of practice. Data were gathered from three Cooperative Inquiry meetings, which incorporated one main Action Research Cycle of constructing, planning, taking and evaluating action. Data were analysed using a thematic content analysis framework. Participants experienced varying levels of uncertainty about how to support women with perinatal mental health needs. Cooperative inquiry supported participants in making sense of how they understood perinatal mental health and how they managed challenges experienced when caring for women with perinatal mental health issues. Participants developed a referral pathway, highlighted the significance of education to support women with perinatal mental health issues and identified the value of using open questions to promote conversation with pregnant women about mental health. Midwives value education and support to identify and refer women at risk of perinatal mental health issues. Cooperative inquiry, with a focus on action and shared reflection, facilitated the drawing together of two professional groups with diverse knowledge bases to work together to develop practice in an area of mutual concern. Perinatal mental health is a significant public health issue and midwives need support to make psychosocial assessments and to negotiate access to specialist services where available and when required. © 2017 John Wiley & Sons

Quality care as ethical care: a poststructural analysis of palliative and supportive district nursing care.

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Nagington, Maurice; Walshe, Catherine; Luker, Karen A

2016-03-01

Quality of care is a prominent discourse in modern health-care and has previously been conceptualised in terms of ethics. In addition, the role of knowledge has been suggested as being particularly influential with regard to the nurse-patient-carer relationship. However, to date, no analyses have examined how knowledge (as an ethical concept) impinges on quality of care. Qualitative semi-structured interviews were conducted with 26 patients with palliative and supportive care needs receiving district nursing care and thirteen of their lay carers. Poststructural discourse analysis techniques were utilised to take an ethical perspective on the current way in which quality of care is assessed and produced in health-care. It is argued that if quality of care is to be achieved, patients and carers need to be able to redistribute and redevelop the knowledge of their services in a collaborative way that goes beyond the current ways of working. Theoretical works and extant research are then used to produce tentative suggestions about how this may be achieved. © 2015 The Authors Nursing Inquiry Published by John Wiley & Sons Ltd.

Quality management in Irish health care.

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Ennis, K; Harrington, D

1999-01-01

This paper reports on the findings from a quantitative research study of quality management in the Irish health-care sector. The study findings suggest that quality management is what hospitals require to become more cost-effective and efficient. The research also shows that the culture of health-care institutions must change to one where employees experience pride in their work and where all are involved and committed to continuous quality improvement. It is recommended that a shift is required from the traditional management structures to a more participative approach. Furthermore, all managers whether from a clinical or an administration background must understand one another's role in the organisation. Finally, for quality to succeed in the health-care sector, strong committed leadership is required to overcome tensions in quality implementation.

Tei index in neonatal respiratory distress and perinatal asphyxia

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Ahmed Anwer Attia Khattab

2015-09-01

Full Text Available Cardiovascular compromise is a common complication of neonatal respiratory distress and perinatal asphyxia. Tei index is a Doppler-derived index for the assessment of overall left ventricular function that combines systolic and diastolic time intervals. Aim: Assess the role of MPI versus cardiac troponin I as early indicator of hypoxic cardiac damage in neonates with respiratory distress or perinatal asphyxia. The present work was conducted on forty neonates, 15 with neonatal respiratory distress (group I, 15 with perinatal asphyxia (group II, and 10 apparently healthy neonates as a control (group III. All have: Detailed history-thorough clinical examination-Plain X-ray-ECG-Two dimensional, M-mode and Doppler echocardiographic examination with the measurement of both myocardial performance index (MPI of the right and left ventricle-Serum cardiac troponin I. Results: There was statistically significant increase in serum cardiac troponin I in groups I and II than group III. Left and right ventricular myocardial performance index (MPI were increased in group I and II than the control group. No correlation between Tei index and each of postnatal age, apgar score at 5-min, heart rate, serum cardiac troponin I, ejection fraction and fractional shortening, but there was direct relationship between MPI and LVEDD and inverse relationship between MPI and each of EF% and FS%. But there was significant correlation between L.V. MPI and gestational age. Conclusion: Tei index was higher in neonates with respiratory distress and neonates with perinatal asphyxia than in normal neonates despite normal or even increased ejection fraction which indicates that these patients may have subclinical ventricular dysfunction which should be followed up carefully.

Long-Term Care Workforce Issues: Practice Principles for Quality Dementia Care.

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Gilster, Susan D; Boltz, Marie; Dalessandro, Jennifer L

2018-01-18

This article is one in a series of articles in this supplement addressing best practice for quality dementia care. The Alzheimer's Association, in revising their Dementia Care Practice Recommendations for 2017 has identified staff across the long-term care spectrum as a distinct and important determinant of quality dementia care. The purpose of this article is to highlight areas for developing and supporting a dementia-capable workforce. The Alzheimer's Association Principles For Advocacy To Assure Quality Dementia Care Across Settings provide a framework to examine interventions to support the dementia care workforce in long-term care settings. Evidence-based approaches that represent these principles are discussed: (a) staffing, (b) staff training, (c) compensation, (d) supportive work environments, (e) career growth and retention, and (f) engagement with family. Although not all settings currently require attention to the principles described, this article proposes these principles as best practice recommendations. Recommendations and future research considerations to further improve the lives of those who live and work in nursing homes, assisted living, hospice, and home care, are proposed. Additional areas to improve the quality of a dementia care workforce person-centered care information, communication and interdepartmental teamwork, and ongoing evaluation are discussed. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Potential Utility of Melatonin in Preeclampsia, Intrauterine Fetal Growth Retardation, and Perinatal Asphyxia.

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Marseglia, Lucia; D'Angelo, Gabriella; Manti, Sara; Reiter, Russel J; Gitto, Eloisa

2016-08-01

Reactive oxygen species play an important role in the pathogenesis of several diseases during gestation and the perinatal period. During pregnancy, increased oxygen demand augments the rate of production of free radicals. Oxidative stress is involved in pregnancy disorders including preeclampsia and intrauterine fetal growth retardation (IUGR). Moreover, increased levels of oxidative stress and reduced antioxidative capacities may contribute to the pathogenesis of perinatal asphyxia. Melatonin, an efficient antioxidant agent, diffuses through biological membranes easily and exerts pleiotropic actions on every cell and appears to be essential for successful gestation. This narrative review summarizes current knowledge concerning the role of melatonin in reducing complications during human pregnancy and in the perinatal period. Melatonin levels are altered in women with abnormally functioning placentae during preeclampsia and IUGR. Short-term melatonin therapy is highly effective and safe in reducing complications during pregnancy and in the perinatal period. Because melatonin has been shown to be safe for both mother and fetus, it could be an attractive therapy in pregnancy and is considered a promising neuroprotective agent in perinatal asphyxia. We believe that the use of melatonin treatment during the late fetal and early neonatal period might result in a wide range of health benefits, improved quality of life, and may help limit complications during the critical periods prior to, and shortly after, delivery. © The Author(s) 2015.

Birth weight discordance and perinatal mortality among triplets

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Egić Amira

2005-01-01

Full Text Available INTRODUCTION. The incidence of multiple births has increased in the last decade. Perinatal mortality in triplets is significantly greater than in twin and singleton births. OBJECTIVE. The objective of this study was to describe the extent of birth weight discordance among triplets and to identify its association with an increased risk of perinatal mortality. METHOD A retrospective analysis of triplet births, for the period 1993-2003, was conducted at the Gynaecological-Obstetric Clinic "Narodni Front" in Belgrade. Birth weight discordance was defined as the difference in birth weight between the largest and the smallest triplet's weight of more than 20%. RESULTS. The rate of triplets has increased by almost 75% between the first (7.7% and the last (29.6% 5-year period of the last decade. Triplets are becoming more common because of the frequent use of assisted reproductive technology as a treatment for infertility. In the period 1993-2003, there were a total of 40 triplet live births (24 weeks and greater with incidence of 0.06%. There was no clear association between maternal age, parity, method of conception, birth gestational age, and disorders complicating pregnancy with birth discordance more than 20%. Regarding birth weight groups, statistical significance occurred only in the <999 grams group for discordant and in the 2000-2499 grams group for concordant triplets. Overall, the perinatal mortality rate in the group was 10.8%, the foetal mortality rate was 1.7% (2/120, and the neonatal (0-28 days mortality rate was 9.1% (11/120. An odds ratio of 95% confidence interval shows 3 times greater risk for adverse perinatal outcome in the discordant group. However, the difference was not significant. CONCLUSION. Increasing birth weight discordance may increase the risk of adverse perinatal outcome. Triplet pregnancies, being high risk, require intensive antenatal care in order to prevent preterm delivery and ultrasound in order to diagnose foetal

Bringing quality improvement into the intensive care unit.

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McMillan, Tracy R; Hyzy, Robert C

2007-02-01

During the last several years, many governmental and nongovernmental organizations have championed the application of the principles of quality improvement to the practice of medicine, particularly in the area of critical care. To review the breadth of approaches to quality improvement in the intensive care unit, including measures such as mortality and length of stay, and the use of protocols, bundles, and the role of large, multiple-hospital collaboratives. Several agencies have participated in the application of the quality movement to medicine, culminating in the development of standards such as the intensive care unit core measures of the Joint Commission on Accreditation of Healthcare Organizations. Although "zero defects" may not be possible in all measurable variables of quality in the intensive care unit, several measures, such as catheter-related bloodstream infections, can be significantly reduced through the implementation of improved processes of care, such as care bundles. Large, multiple-center, quality improvement collaboratives, such as the Michigan Keystone Intensive Care Unit Project, may be particularly effective in improving the quality of care by creating a "bandwagon effect" within a geographic region. The quality revolution is having a significant effect in the critical care unit and is likely to be facilitated by the transition to the electronic medical record.

Utility of qualitative methods in a clinical setting: perinatal care in the Western Province.

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Jayasuriya, V

2012-03-01

A peculiar paradox that has been observed in previous studies of antenatal care is where patients are satisfied with the services despite obvious lack of basic facilities. Qualitative methods were used to describe the experience of perinatal care in the Western province with the objective of demonstrating application of this method in a clinical setting. This paper used a 'naturalistic' approach of qualitative methods. In-depth interviews conducted with 20 postnatal mothers delivering in tertiary care institutions in the Western province was tape recorded, transcribed and content analysed. To ensure objectivity and validity of results, the principle investigator received only the anonymised data to prevent any prejudices or pre-conceptions affecting the results. The main themes emerging from the text demonstrated 'naïve trust' in the carer and a state of 'hero worship' where patients were distanced and therefore unable and unwilling to query the decisions made by the carers. This is similar to a state of patient-carer relationship described in a published model known as guarded alliance, where the relationship develops though four phases based on the level of trust and confidence in the relationship. This state explains not only why patients fail to recognise and report any deficiencies in the services but also the need for them to justify the behaviour of caregivers even when it amounts to incompetence and negligence. Qualitative methods allow the researcher to capture experiences in its 'natural' form rather than based on pre-determined protocols or plans, which may be limited to our own understanding and expectations and therefore unable to explain many idiosyncrasies of the programmes. This paper argues favourably for the use of qualitative methods in other clinical settings.

Differential susceptibility to parenting and quality child care.

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Pluess, Michael; Belsky, Jay

2010-03-01

Research on differential susceptibility to rearing suggests that infants with difficult temperaments are disproportionately affected by parenting and child care quality, but a major U.S. child care study raises questions as to whether quality of care influences social adjustment. One thousand three hundred sixty-four American children from reasonably diverse backgrounds were followed from 1 month to 11 years with repeated observational assessments of parenting and child care quality, as well as teacher report and standardized assessments of children's cognitive-academic and social functioning, to determine whether those with histories of difficult temperament proved more susceptible to early rearing effects at ages 10 and 11. Evidence for such differential susceptibility emerges in the case of both parenting and child care quality and with respect to both cognitive-academic and social functioning. Differential susceptibility to parenting and child care quality extends to late middle childhood. J. Belsky, D. L. Vandell, et al.'s (2007) failure to consider such temperament-moderated rearing effects in their evaluation of long-term child care effects misestimates effects of child care quality on social adjustment.

Perinatal grief in Latino parents.

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Whitaker, Claudia; Kavanaugh, Karen; Klima, Carrie

2010-01-01

Extensive research exists that describes the meaning of perinatal loss to some parents, but the experience of loss from the perspective of Latino parents is not clearly understood. Additionally, current perinatal bereavement practices used often to facilitate memory making for parents (such as viewing or holding the baby, taking photographs, or collecting mementos) are based on research done primarily with non-Latino families. Are these common practices appropriate for this population? Because there is a paucity of research on this topic, this article describes what has been written over the past 30 years on the topic of grief and perinatal loss in Latino culture.

Quality of care and health-related quality of life of climacteric stage women cared for in family medicine clinics in Mexico

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Pérez-Cuevas Ricardo

2010-02-01

Full Text Available Abstract Objectives 1 To design and validate indicators to measure the quality of the process of care that climacteric stage women receive in family medicine clinics (FMC. 2 To assess the quality of care that climacteric stage women receive in FMC. 3 To determine the association between quality of care and health-related quality of life (HR-QoL among climacteric stage women. Methods The study had two phases: I. Design and validation of indicators to measure the quality of care process by using the RAND/UCLA Appropriateness Method. II. Evaluation of the quality of care and its association with HR-QoL through a cross-sectional study conducted in two FMC located in Mexico City that included 410 climacteric stage women. The quality of care was measured by estimating the percentage of recommended care received (PRCR by climacteric stage women in three process components: health promotion, screening, and treatment. The HR-QoL was measured using the Cervantes scale (0-155. The association between quality of care and HR-QoL was estimated through multiple linear regression analysis. Results The lowest mean of PRCR was for the health promotion component (24.1% and the highest for the treatment component (86.6%. The mean of HR-QoL was 50.1 points. The regression analysis showed that in the treatment component, for every 10 additional points of the PRCR, the global HR-QoL improved 2.8 points on the Cervantes scale (coefficient -0.28, P Conclusion The indicators to measure quality of care for climacteric stage women are applicable and feasible in family medicine settings. There is a positive association between the quality of the treatment component and HR-QoL; this would encourage interventions to improve quality of care for climacteric stage women.

Sick of Health Care Politics? Comparing Views of Quality of Care Between Democrats and Republicans.

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Scott, Kirstin W; Blendon, Robert J; Benson, John M

Improving the quality of care delivered by the U.S. health care system is a topic of important policy and political debate. Although public opinion surveys have shown concerns regarding the state of quality of care nationally, the majority of Americans are satisfied with the quality of care they personally receive. Studies have shown that Republicans and Democrats may differ in these views. We used a 2012 national survey of 1,508 American adults that captured perceptions of quality, political party, medical experiences, and self-reported interactions with the health care system due to an illness to examine these differences. Regardless of having a recent illness or hospitalization, Democrats generally expressed greater concerns about the country's state of health care quality relative to Republicans. Partisan differences also emerged when identifying the most important problems contributing to quality-of-care deficiencies in the nation. However, partisan differences were nonexistent on measures related to self-reported experiences with quality of care. Although their individual experiences with quality of care do not differ, Republicans and Democrats differ in their views on national quality-of-care issues. This may have implications for efforts to improve quality of care in the current polarized healthcare environment.

Measuring health care process quality with software quality measures.

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Yildiz, Ozkan; Demirörs, Onur

2012-01-01

Existing quality models focus on some specific diseases, clinics or clinical areas. Although they contain structure, process, or output type measures, there is no model which measures quality of health care processes comprehensively. In addition, due to the not measured overall process quality, hospitals cannot compare quality of processes internally and externally. To bring a solution to above problems, a new model is developed from software quality measures. We have adopted the ISO/IEC 9126 software quality standard for health care processes. Then, JCIAS (Joint Commission International Accreditation Standards for Hospitals) measurable elements were added to model scope for unifying functional requirements. Assessment (diagnosing) process measurement results are provided in this paper. After the application, it was concluded that the model determines weak and strong aspects of the processes, gives a more detailed picture for the process quality, and provides quantifiable information to hospitals to compare their processes with multiple organizations.

Customer Quality during Prenatal Care in Health Care Centers in Tabriz City

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Jafar Sadegh Tabrizi

2015-07-01

Full Text Available Background and Objectives :  Customer Quality (CQ refers to customer’s characteristics and is concerned with the knowledge, skills and confidence of health services customers who actively participate with health team in proper decision-making, appropriate activities and changing environment and health related behaviors. The purpose of this study was measuring customer quality of pregnant women during prenatal care. Materials and Methods :  This is a cross- sectional study which was conducted with the participation of 185 pregnant women who received prenatal care from urban health centers in Tabriz city. All participants were selected randomly from 40 health centers. Customer quality was measured based on CQMH-CQ questionnaire.  Questionnaire content validity was reviewed and confirmed by 10 experts and its reliability was confirmed based on Cronbach's alpha index (α = 0.714. Spss v.17 was used for data analysis. Results : According to the results, the mean score of customer quality among pregnant women was (11.29± 67.79   and only %14 of the participants reported the highest customer quality score and ability of continuity of care under stressful situations. There was a positive relationship between customer quality score and visiting midwife and a better evaluation of overall quality of care, but there was inverse relationship with early registration at health centers. Conclusion :  The participation of pregnant women in service delivery process and decision-making can promote costumer quality. Furthermore, training health care providers in empowering patients and using their abilities to improve quality of care and paying attention to patient-centered care will be helpful. ​

interRAI home care quality indicators

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Morris, J.N.; Fries, B.E.; Frijters, D.H.M.; Hirdes, J.P.; Steel, R.K.

2013-01-01

Background: This paper describe the development of interRAI's second-generation home care quality indicators (HC-QIs). They are derived from two of interRAI's widely used community assessments: the Community Health Assessment and the Home Care Assessment. In this work the form in which the quality

Quality of care and quality of life of people with dementia living at green care farms: a cross-sectional study.

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de Boer, Bram; Hamers, Jan P H; Zwakhalen, Sandra M G; Tan, Frans E S; Verbeek, Hilde

2017-07-19

Many countries are introducing smaller, more home-like care facilities that represent a radically new approach to nursing home care for people with dementia. The green care farm is a new type of nursing home developed in the Netherlands. The goal of this study was to compare quality of care, quality of life and related outcomes in green care farms, regular small-scale living facilities and traditional nursing homes for people with dementia. A cross-sectional design was used. Three types of nursing homes were included: (1) green care farms; (2) regular small-scale living facilities; (3) traditional nursing homes. All participating nursing homes were non-profit, collectively funded nursing homes in the south of the Netherlands. One hundred and fifteen residents with a formal diagnosis of dementia were included in the study. Data on quality of care was gathered and consisted of outcome indicators (e.g. falling incidents, pressure ulcers), structure indicators (e.g. hours per resident per day), and process indicators (e.g. presence, accessibility and content of protocols on care delivery). Furthermore, questionnaires on cognition, dependence in activities of daily living, quality of life, social engagement, neuropsychiatric symptoms, agitation, and depression were used. Data showed that quality of care was comparable across settings. No large differences were found on clinical outcome measures, hours per resident per day, or process indicators. Higher quality of life scores were reported for residents of green care farms in comparison with residents of traditional nursing homes. They scored significantly higher on the Quality of Life - Alzheimer's disease Scale (p quality of life. In addition, residents of green care farms scored higher on three quality of life domains of the Qualidem: positive affect, social relations and having something to do (p  0.7). No differences with regular small-scale living facilities were found. Green care farms seem to be a valuable

Impact of Performance Obstacles on Intensive Care Nurses‘ Workload, Perceived Quality and Safety of Care, and Quality of Working Life

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Gurses, Ayse P; Carayon, Pascale; Wall, Melanie

2009-01-01

Objectives To study the impact of performance obstacles on intensive care nurses‘ workload, quality and safety of care, and quality of working life (QWL). Performance obstacles are factors that hinder nurses‘ capacity to perform their job and that are closely associated with their immediate work system. Data Sources/Study Setting Data were collected from 265 nurses in 17 intensive care units (ICUs) between February and August 2004 via a structured questionnaire, yielding a response rate of 80 percent. Study Design A cross-sectional study design was used. Data were analyzed by correlation analyses and structural equation modeling. Principal Findings Performance obstacles were found to affect perceived quality and safety of care and QWL of ICU nurses. Workload mediated the impact of performance obstacles with the exception of equipment-related issues on perceived quality and safety of care as well as QWL. Conclusions Performance obstacles in ICUs are a major determinant of nursing workload, perceived quality and safety of care, and QWL. In general, performance obstacles increase nursing workload, which in turn negatively affect perceived quality and safety of care and QWL. Redesigning the ICU work system to reduce performance obstacles may improve nurses‘ work. PMID:19207589

Perinatal risk factors for strabismus

DEFF Research Database (Denmark)

Torp-Pedersen, Tobias; Boyd, Heather A; Poulsen, Gry

2010-01-01

Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype.......Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype....

Hospital-based perinatal outcomes and complications in teenage pregnancy in India.

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Mukhopadhyay, Prianka; Chaudhuri, R N; Paul, Bhaskar

2010-10-01

Teenage pregnancy is a worldwide problem bearing serious social and medical implications relating to maternal and child health. A cross-sectional observational study was undertaken to compare the different sociodemographic characteristics and perinatal outcomes of teenage primigravida mothers with those of adult primigravida mothers in a tertiary-care hospital in eastern India. A sample of 350 each in cases and comparison group comprised the study subjects. Data were collected through interviews and by observations using a pretested and predesigned schedule. Results revealed that the teenage mothers had a higher proportion (27.7%) of preterm deliveries compared to 13.1% in the adult mothers and had low-birthweight babies (38.9% vs 30.4% respectively). Stillbirth rate was also significantly higher in teenage deliveries (5.1% vs 0.9% respectively). The teenage mothers developed more adverse perinatal complications, such as preterm births, stillbirths, neonatal deaths, and delivered low-birthweight babies, when compared with those of the adult primigravida mothers. Teenage pregnancy is still a rampant and important public-health problem in India with unfavourable perinatal outcomes and needs to be tackled on a priority basis.

Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol

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van der Roest, Henriëtte; van Hout, Hein; Declercq, Anja

2016-01-01

Introduction: Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care. Aim: This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six European countries. Methods: Data on elements at the macro-level (policy), meso-level (care organisations) and micro-level (clients) are of importance in determining job satisfaction and quality of care. Macro-level indicators will be identified in a previously published literature review. At meso- and micro-level, data will be collected by means of two questionnaires utilsed with both care organisations and care professionals, and by means of interRAI Home Care assessments of clients. The client assessments will be used to calculate quality of care indicators. Subsequently, data will be analysed by means of linear and stepwise multiple regression analyses, correlations and multilevel techniques. Conclusions and Discussion: These results can guide health care policy makers in their decision making process in order to increase the quality of home care in their organisation, in their country or in Europe. PMID:28435423

Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol

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Liza Van Eenoo

2016-08-01

Full Text Available Introduction: Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care. Aim: This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six European countries. Methods: Data on elements at the macro-level (policy, meso-level (care organisations and micro-level (clients are of importance in determining job satisfaction and quality of care. Macro-level indicators will be identified in a previously published literature review. At meso- and micro-level, data will be collected by means of two questionnaires utilsed with both care organisations and care professionals, and by means of interRAI Home Care assessments of clients. The client assessments will be used to calculate quality of care indicators. Subsequently, data will be analysed by means of linear and stepwise multiple regression analyses, correlations and multilevel techniques. Conclusions and Discussion: These results can guide health care policy makers in their decision making process in order to increase the quality of home care in their organisation, in their country or in Europe.

Perinatal Outcomes in Pregnant Women Users of Illegal Drugs.

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Oliveira, Tenilson Amaral; Bersusa, Ana Aparecida Sanches; Santos, Tatiana Fiorelli Dos; Aquino, Márcia Maria Auxiliadora de; Mariani Neto, Corintio

2016-04-01

Objective The purpose of this study was to evaluate the perinatal outcomes in pregnant women who use illicit drugs. Methods A retrospective observational study of patients who, at the time of delivery, were sent to or who spontaneously sought a public maternity hospital in the eastern area of São Paulo city. We compared the perinatal outcomes of two distinct groups of pregnant women - illicit drugs users and non-users - that gave birth in the same period and analyzed the obstetric and neonatal variables. We used Student's t-test to calculate the averages among the groups, and the Chi-square test or Fisher's exact test to compare categorical data from each group. Results We analyzed 166 women (83 users and 83 non-users) in both groups with a mean of age of 26 years. Ninety-five percent of the drug users would use crack or pure cocaine alone or associated with other psychoactive substances during pregnancy. Approximately half of the users group made no prenatal visit, compared with 2.4% in the non-users group (p illicit drugs. Conclusions The use of illicit drugs, mainly crack cocaine, represents an important perinatal risk. Any medical intervention in this population should combine adherence to prenatal care with strategies for reducing maternal exposure to illicit drugs. Thieme Publicações Ltda Rio de Janeiro, Brazil.

How natural is the supernatural? Synthesis of the qualitative literature from low and middle income countries on cultural practices and traditional beliefs influencing the perinatal period.

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Raman, Shanti; Nicholls, Rachel; Ritchie, Jan; Razee, Husna; Shafiee, Samaneh

2016-08-01

to review qualitative research studies conducted in low resource settings around the perinatal continuum over the past two decades, with particular focus on the cultural realm; to identify common themes in the research-base, in order to provide policy direction for culturally appropriate perinatal interventions. systematic literature search of electronic databases from 1990 to 2014, including Medline, Embase, CINAHL and PsycINFO, using relevant search terms such as traditional beliefs, practices, pregnancy, childbirth; established criteria used to determine quality of studies; and thematic synthesis of the literature enabled by NVivo 10 software. low and middle income countries using the World Bank classification. religious and spiritual beliefs strongly influenced behaviour over the perinatal period. Beliefs in supernatural influences, particularly malevolent forces were widespread, such that pregnancy was concealed in many parts of Africa and Asia. In most low resource settings, pregnancy and childbirth were seen as normal phenomena. Rituals played an important part for women and their infants, reinforced by inter-generational support. Cross-cutting themes that emerged were: (1) the role of women as mothers, demonstrating their'goodness' by bearing pain and suffering; (2) the idea of the 'natural' incorporating the supernatural; and (3) negotiating change across generations. a diverse repertoire of cultural practices influences perinatal well-being across low resource settings. Health practitioners and policy-makers need to acknowledge the primacy of women's reproductive roles, the cultural constructions of motherhood; that supernatural forces are believed to exert powerful influences on the health of mother and infant; that inter-generational tensions result in resisting or embracing change. Public health planners and practitioners need to take culture seriously, not ignore the contribution of culture in shaping women's behaviours and choices throughout the

Atenção hospitalar perinatal e mortalidade neonatal no município de Juiz de Fora, Minas Gerais Perinatal health care and neonatal mortality in the municipality of Juiz de Fora in the9* State of Minas Gerais

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Maria da Consolação Magalhães

2003-09-01

Full Text Available OBJETIVOS: identificar os possíveis fatores que têm contribuído para o excesso da mortalidade neonatal no município de Juiz de Fora e avaliar a qualidade do preenchimento dos prontuários hospitalares. MÉTODOS: estudo caso-controle baseado em informações colhidas nos prontuários das três principais maternidades do município. Foram analisados 103 óbitos neonatais e amostra de 232 nascidos vivos. RESULTADOS: as variáveis peso ao nascer e índice de Apgar no quinto minuto foram importantes fatores preditivos para o óbito neonatal, independente do local de nascimento. Quando se comparou, o risco de morrer, entre os hospitais verificou-se que no Hospital 1 o risco foi 3,97 vezes maior que no Hospital 3. Baseado em consulta a especialistas, foi criado um escore para avaliação do prontuário, onde o Hospital 1 apresentou mediana mais baixa, tanto entre casos como em controles. CONCLUSÕES: a ausência de informações adequadamente registradas no prontuário é um indicador de precariedade na assistência, e, certamente, retarda a realização de conduta indicada. A pesquisa apontou deficiências, particularmente nos registros, da assistência perinatal oferecida nos três hospitais.OBJECTIVES: to identify possible causes for the excessive rates of neonatal mortality in the municipality of Juiz de Fora and to assess the quality of hospital records. METHODS: a case control study based on information from the medical records of the three main maternity hospitals in the municipality. One hundred and three neonatal deaths were analyzed together with the sample of 232 liveborn babies. RESULTS: birth weight and Apgar index in the fifth minute were important predictive factors for neonatal deaths regardless of the maternity ward. The odd ratio in Hospital 1 was 3,97 times higher than in Hospital 3. Based on specialists' opinion, a medical record score was implemented which indicated that Hospital 1 had the lowest mean not only in relation to

Rate and Time Trend of Perinatal, Infant, Maternal Mortality, Natality and Natural Population Growth in Kosovo

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Azemi, Mehmedali; Gashi, Sanije; Berisha, Majlinda; Kolgeci, Selim; Ismaili-Jaha, Vlora

2012-01-01

Aim: The aim of work has been the presentation of the rate and time trends of some indicators of the heath condition of mothers and children in Kosovo: fetal mortality, early neonatal mortality, perinatal mortality, infant mortality, natality, natural growth of population etc. The treated patients were the newborn and infants in the post neonatal period, women during their pregnancy and those 42 days before and after the delivery. Methods: The data were taken from: register of the patients treated in the Pediatric Clinic of Prishtina, World Health Organization, Mother and Child Health Care, Reproductive Health Care, Ministry of Health of the Republic of Kosovo, Statistical Department of Kosovo, the National Institute of Public Health and several academic texts in the field of pediatrics. Some indicators were analyzed in a period between year 1945-2010 and 1950-2010, whereas some others were analyzed in a time period between year 2000 and 2011. Results: The perinatal mortality rate in 2000 was 29.1‰, whereas in 2011 it was 18.7‰. The fetal mortality rate was 14.5‰ during the year 2000, whereas in 2011 it was 11.0‰, in 2000 the early neonatal mortality was 14.8‰, in 2011 it was 7.5‰. The infant mortality in Kosovo was 164‰ in 1950, whereas in 2010 it was 20.5‰. The most frequent causes of infant mortality have been: lower respiratory tract infections, acute infective diarrhea, perinatal causes, congenital malformations and unclassified conditions. Maternal death rate varied during this time period. Maternal death in 2000 was 23 whereas in 2010 only two cases were reported. Regarding the natality, in 1950 it reached 46.1 ‰, whereas in 2010 it reached 14‰, natural growth of population rate in Kosovo was 29.1‰ in 1950, whereas in 2011 it was 11.0‰. Conclusion: Perinatal mortality rate in Kosovo is still high in comparison with other European countries (Turkey and Kyrgyzstan have the highest perinatal mortality rate), even though it is in a

Strategies to improve quality of childbirth care

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farahnaz Changaee

2015-01-01

Full Text Available Background: Access to affordable and quality health care is one of the most important ways for reducing maternal and child mortality. The purpose of this study was to provide strategies to promote the quality of care during childbirth in Lorestan province in 2011. Materials and Methods: This research was a mixed method (quantitative, qualitative, study in which quality of 200 care during childbirth in hospitals of Lorestan Province were evaluated. Data gathered through self-made tools (Checklists prepared according to the guidelines of the ministry of health. Descriptive statistics and SPSS software were used to data analysis.In the second part of the study which was qualitative, interview with service providers, hospital officials and high-ranking officials of Lorestan university of medical sciences (decision makers was used to discuss strategies to improve the quality of care. Results: The results showed that the care of the first stage delivery in %54.5, second stage %57 and third stage 66% were in accordance with the desired status and care in this three stages was of moderate quality. Based on the interviews, the officials who are in charge of Lorestan university of medical sciences, proposed strategies such as financial incentives and in-service training of midwives as suitable strategies to improve quality of services. Conclusion: According to the results, strategies such as financial incentives, increased use of private sector services to reduce the workload of the public sector and increase of quality and use of more in-service training, to improve the quality of services, are recommended.

Quality-of-care indicators for non-small cell lung cancer.

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Tanvetyanon, Tawee

2009-10-01

Quality-of-care indicators are measurable elements of practice performance that can be used to assess the quality or change in quality of the care provided. To date, the literature on quality-of-care indicators for non-small cell lung cancer (NSCLC) has not been reviewed. A search was performed to identify articles reporting on quality-of-care indicators specific for NSCLC published from January 2003 to May 2009 (using MEDLINE and American Society of Clinical Oncology abstract databases). Web sites of major quality care organizations were also searched. The identified indicators were then classified by their aspect of care provision (structure-of-care, process-of-care, or outcome-of-care indicator). For structure-of-care quality indicators, the most cited indicators were related to the quality of lung surgery. These included being National Cancer Institute-designated cancer centers or high-volume hospitals. For process-of-care quality indicators, the most common indicators were the receipt of surgery for early-stage NSCLC and the administration of chemotherapy for advanced-stage NSCLC. For outcome-of-care quality indicators, the most cited indicators were related to postoperative morbidity or mortality after lung surgery. Several quality-of-care indicators for NSCLC are available. Process-of-care indicators are the most studied. The use of these indicators to measure practice performance holds the promise of improving outcomes of patients with NSCLC.

Does Medical Malpractice Law Improve Health Care Quality?

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Frakes, Michael; Jena, Anupam B.

2016-01-01

We assess the potential for medical liability forces to deter medical errors and improve health care treatment quality, identifying liability’s influence by drawing on variations in the manner by which states formulate the negligence standard facing physicians. Using hospital discharge records from the National Hospital Discharge Survey and clinically-validated quality metrics inspired by the Agency for Health Care Research and Quality, we find evidence suggesting that treatment quality may improve upon reforms that expect physicians to adhere to higher quality clinical standards. We do not find evidence, however, suggesting that treatment quality may deteriorate following reforms to liability standards that arguably condone the delivery of lower quality care. Similarly, we do not find evidence of deterioration in health care quality following remedy-focused liability reforms such as caps on non-economic damages awards. PMID:28479642

Women's and care providers' perspectives of quality prenatal care: a qualitative descriptive study

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2012-01-01

Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of quality prenatal care, clinical and

Perinatal interventions and survival in resource-poor settings: which work, which don't, which have the jury out?

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Osrin, David; Prost, Audrey

2010-12-01

Perinatal conditions make the largest contribution to the burden of disease in low-income countries. Although postneonatal mortality rates have declined, stillbirth and early neonatal mortality rates remain high in many countries in Africa and Asia, and there is a concentration of mortality around the time of birth. Our article begins by considering differences in the interpretation of 'intervention' to improve perinatal survival. We identify three types of a single action, a collection of actions delivered in a package and a broader social or system approach. We use this classification to summarise the findings of recent systematic reviews and meta-analyses. After describing the growing evidence base for the effectiveness of community-based perinatal care, we discuss current concerns about integration: of women's and children's health programmes, of community-based and institutional care, and of formal and informal sector human resources. We end with some thoughts on the complexity of choices confronting women and their families in low-income countries, particularly in view of the growth in non-government and private sector healthcare.

Nonprice competition and quality of care in managed care: the New York SCHIP market.

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Liu, Hangsheng; Phelps, Charles E

2008-06-01

To examine the effect of nonprice competition among managed care plans on the quality of care in the New York SCHIP market. U.S. Census 2000; 2002 New York State Managed Care Plan Performance Report; and 2001 New York State Managed Care Annual Enrollment Report. Each market is defined as a county, and competition is measured as the number of plans in a market. Quality of care is measured in percentages using three Consumer Assessment of Health Plans Survey and three Health Plan Employer Data and Information Set scores. Two-stage least squares is applied to address the endogeneity between competition and the quality of care, using population as an instrument. We find a negative association between competition and quality of care. An additional managed care plan is significantly associated with a decrease of 0.40-2.31 percentage points in four out of six quality measures. After adjusting for production cost, a positive correlation is observed between price and quality measures across different pricing regions. It seems likely that pricing policy is a constraint on quality production, although it may not be interpreted as a causal relationship and further study is needed.

Standards of care and quality indicators for multidisciplinary care models for psoriatic arthritis in Spain.

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Gratacós, Jordi; Luelmo, Jesús; Rodríguez, Jesús; Notario, Jaume; Marco, Teresa Navío; de la Cueva, Pablo; Busquets, Manel Pujol; Font, Mercè García; Joven, Beatriz; Rivera, Raquel; Vega, Jose Luis Alvarez; Álvarez, Antonio Javier Chaves; Parera, Ricardo Sánchez; Carrascosa, Jose Carlos Ruiz; Martínez, Fernando José Rodríguez; Sánchez, José Pardo; Olmos, Carlos Feced; Pujol, Conrad; Galindez, Eva; Barrio, Silvia Pérez; Arana, Ana Urruticoechea; Hergueta, Mercedes; Coto, Pablo; Queiro, Rubén

2018-06-01

To define and give priority to standards of care and quality indicators of multidisciplinary care for patients with psoriatic arthritis (PsA). A systematic literature review on PsA standards of care and quality indicators was performed. An expert panel of rheumatologists and dermatologists who provide multidisciplinary care was established. In a consensus meeting group, the experts discussed and developed the standards of care and quality indicators and graded their priority, agreement and also the feasibility (only for quality indicators) following qualitative methodology and a Delphi process. Afterwards, these results were discussed with 2 focus groups, 1 with patients, another with health managers. A descriptive analysis is presented. We obtained 25 standards of care (9 of structure, 9 of process, 7 of results) and 24 quality indicators (2 of structure, 5 of process, 17 of results). Standards of care include relevant aspects in the multidisciplinary care of PsA patients like an appropriate physical infrastructure and technical equipment, the access to nursing care, labs and imaging techniques, other health professionals and treatments, or the development of care plans. Regarding quality indicators, the definition of multidisciplinary care model objectives and referral criteria, the establishment of responsibilities and coordination among professionals and the active evaluation of patients and data collection were given a high priority. Patients considered all of them as important. This set of standards of care and quality indicators for the multidisciplinary care of patients with PsA should help improve quality of care in these patients.

Suicide During Perinatal Period: Epidemiology, Risk Factors and Clinical Correlates

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Laura Orsolini

2016-08-01

Full Text Available Perinatal period may pose a great challenge for the clinical management and treatment of psychiatric disorders in women. In fact, several mental illnesses can arise during pregnancy and/or following childbirth. Suicide and infanticide have been considered relatively rare events during the perinatal period. However, in some mental disorders (i.e. postpartum depression, bipolar disorder, postpartum psychosis, etc. have been reported a higher risk of suicidal ideation, suicide attempt or suicide. Therefore, a complete screening of mothers’ mental health should also take into account thoughts of suicide and thoughts about harming infants as well. Clinicians should carefully monitor and early identify related clinical manifestations, potential risk factors and alarm symptoms related to suicide. The present paper aims at providing a focused review about epidemiological data, risk and protective factors and an overview about the main clinical correlates associated with the suicidal behaviour during the pregnancy and postpartum period.

Op weg naar de landelijke invoering van perinatale audit

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Leeman LD; Waelput AJM; Eskes M; Achterberg PW; VTV

2007-01-01

In the near future perinatal audit will start in the Netherlands, with a systematic critical analysis of the quality of care of perinatal mortality. The National Institute for Public Health and the Environment designed a plan for the implementation of perinatal audit. The slower decline of perinatal mortality in the Netherlands in comparison to surrounding countries gave cause to this plan. There are suggestions that improvement of (preventive) care can lead to perinatal health gains. Perinat...

Quality management in home care: models for today's practice.

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Verhey, M P

1996-01-01

In less than a decade, home care providers have been a part of two major transitions in health care delivery. First, because of the advent of managed care and a shift from inpatient to community-based services, home care service delivery systems have experienced tremendous growth. Second, the principles and practices of total quality management and continuous quality improvement have permeated the organization, administration, and practice of home health care. Based on the work of Deming, Juran, and Crosby, the basic tenets of the new quality management philosophy involve a focus on the following five key areas: (1) systems and processes rather than individual performance; (2) involvement, collaboration, and empowerment; (3) internal and external "customers"; (4) data and measurement; and (5) standards, guidelines, and outcomes of care. Home care providers are among those in the forefront who are developing and implementing programs that integrate these foci into the delivery of quality home care services. This article provides a summary of current home care programs that address these five key areas of quality management philosophy and provide models for innovative quality management practice in home care. For further information about each program, readers are referred to the original reports in the home care and quality management journal literature, as cited herein.

Slack resources and quality of primary care.

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Mohr, David C; Young, Gary J

2012-03-01

Research generally shows that greater resource utilization fails to translate into higher-quality healthcare. Organizational slack is defined as extra organizational resources needed to meet demand. Divergent views exist on organizational slack in healthcare. Some investigators view slack negatively because it is wasteful, inefficient, and costly, whereas others view slack positively because it allows flexibility in work practices, expanding available services, and protecting against environmental changes. We tested a curvilinear relationship between organizational slack and care quality. The study setting was primary care clinics (n=568) in the Veterans Health Administration. We examined organizational slack using the patient panel size per clinic capacity ratio and support staff per provider ratio staffing guidelines developed by the Veterans Health Administration. Patient-level measures were influenza vaccinations, continuity of care, and overall quality of care ratings. We obtained 2 independent patient samples with approximately 28,000 and 62,000 observations for the analysis. We used multilevel modeling and examined the linear and quadratic terms for both organizational slack measures. We found a significant curvilinear effect for panel size per clinic capacity for influenza vaccinations and overall quality of care. We also found support staff per provider exhibited a curvilinear effect for continuity of care and influenza vaccinations. Greater available resources led to better care, but at a certain point, additional resources provided minimal quality gains. Our findings highlight the importance of primary care clinic managers monitoring staffing levels. Healthcare systems managing a balanced provider workload and staff-mix may realize better patient care delivery and cost management.

[Access to prenatal care and quality of care in the Family Health Strategy: infrastructure, care, and management].

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Guimarães, Wilderi Sidney Gonçalves; Parente, Rosana Cristina Pereira; Guimarães, Thayanne Louzada Ferreira; Garnelo, Luiza

2018-05-10

This study focuses on access to prenatal care and quality of care in the Family Health Strategy in Brazil as a whole and in the North region, through evaluation of infrastructure characteristics in the health units, management, and supply of care provided by the teams, from the perspective of regional and state inequalities. A cross-sectional evaluative and normative study was performed, drawing on the external evaluation component of the second round of the Program for Improvement of Access and Quality of Primary Care, in 2013-2014. The results revealed the inadequacy of the primary healthcare network's infrastructure for prenatal care, low adequacy of clinical actions for quality of care, and the teams' low management capacity to guarantee access and quality of care. In the distribution according to geopolitical regions, the findings pertaining to the units' infrastructure indicate a direct relationship between the infrastructure's adequacy and social contexts with higher municipal human development indices and income. For the clinical actions in patient care, the teams in all the regions scored low on adequacy, with slightly better results in the North and South regions of the country. There were important differences between the states of the North, and the states with higher mean income and human development scored higher on adequacy. The results indicate important organizational difficulties in both access and quality of care provided by the health teams, in addition to visible insufficiency in management activities aimed to improve access and quality of prenatal care.

Impact of Training of Traditional Birth Attendants on Maternal Health Care: A Community-based Study.

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Satishchandra, D M; Naik, V A; Wantamutte, A S; Mallapur, M D; Sangolli, H N

2013-12-01

To study the impact of Training of Traditional Birth Attendants (TBAs) on maternal health care in a rural area. An interventional study in the Primary Health Center area was conducted over 1-year period between March 2006 and February 2007, which included all the 50 Traditional Birth Attendants (30 previously trained and 20 untrained), as study participants. Pretest evaluation regarding knowledge, attitude, and practices about maternal care was done. Post-test evaluation was done at the first month (early) and at the fifth month (late) after the training. Analysis was done by using Mc. Nemer's test, Chi-square test with Yates's correction and Fischer's exact test. Early and late post-test evaluation showed that there was a progressive improvement in the maternal health care provided by both the groups. Significant reduction in the maternal and perinatal deaths among the deliveries conducted by TBAs after the training was noted. Training programme for TBAs with regular follow-ups in the resource-poor setting will not only improve the quality of maternal care but also reduce perinatal deaths.

Many quality measurements, but few quality measures assessing the quality of breast cancer care in women: a systematic review.

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Schachter, Howard M; Mamaladze, Vasil; Lewin, Gabriela; Graham, Ian D; Brouwers, Melissa; Sampson, Margaret; Morrison, Andra; Zhang, Li; O'Blenis, Peter; Garritty, Chantelle

2006-12-18

Breast cancer in women is increasingly frequent, and care is complex, onerous and expensive, all of which lend urgency to improvements in care. Quality measurement is essential to monitor effectiveness and to guide improvements in healthcare. Ten databases, including Medline, were searched electronically to identify measures assessing the quality of breast cancer care in women (diagnosis, treatment, followup, documentation of care). Eligible studies measured adherence to standards of breast cancer care in women diagnosed with, or in treatment for, any histological type of adenocarcinoma of the breast. Reference lists of studies, review articles, web sites, and files of experts were searched manually. Evidence appraisal entailed dual independent assessments of data (e.g., indicators used in quality measurement). The extent of each quality indicator's scientific validation as a measure was assessed. The American Society of Clinical Oncology (ASCO) was asked to contribute quality measures under development. Sixty relevant reports identified 58 studies with 143 indicators assessing adherence to quality breast cancer care. A paucity of validated indicators (n = 12), most of which assessed quality of life, only permitted a qualitative data synthesis. Most quality indicators evaluated processes of care. While some studies revealed patterns of under-use of care, all adherence data require confirmation using validated quality measures. ASCO's current development of a set of quality measures relating to breast cancer care may hold the key to conducting definitive studies.

Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators

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D. Stalpers (Dewi); R.A.M.M. Kieft (Renate A. M. M.); D. van der Linden (Dimitri); M.J. Kaljouw (Marian J.); M.J. Schuurmans (Marieke )

2016-01-01

textabstractBackground: Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between

Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies.

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Ford, Elizabeth; Lee, Suzanne; Shakespeare, Judy; Ayers, Susan

2017-08-01

Up to 20% of women experience anxiety and depression during the perinatal period. In the UK, management of perinatal mental health falls under the remit of GPs. This review aimed at synthesising the available information from qualitative studies on GPs' attitudes, recognition, and management of perinatal anxiety and depression. Meta-synthesis of the available published qualitative evidence on GPs' recognition and management of perinatal anxiety and depression. A systematic search was conducted on Embase, Medline, PsycInfo, Pubmed, Scopus, and Web of Science, and grey literature was searched using Google, Google Scholar, and British Library EThOS. Papers and reports were eligible for inclusion if they reported qualitatively on GPs' diagnosis or treatment of perinatal anxiety or depression. The synthesis was constructed using meta-ethnography. Five themes were established from five eligible papers: labels: diagnosing depression; clinical judgement versus guidelines; care and management; use of medication; and isolation: the role of other professionals. GPs considered perinatal depression to be a psychosocial phenomenon, and were reluctant to label disorders and medicalise distress. GPs relied on their own clinical judgement more than guidelines. They reported helping patients make informed choices about treatment, and inviting them back regularly for GP visits. GPs sometimes felt isolated when dealing with perinatal mental health issues. GPs often do not have timely access to appropriate psychological therapies and use several strategies to mitigate this shortfall. Training must focus on these issues and must be evaluated to consider whether this makes a difference to outcomes for patients. © British Journal of General Practice 2017.

Providing quality nutrition care in acute care hospitals: perspectives of nutrition care personnel.

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Keller, H H; Vesnaver, E; Davidson, B; Allard, J; Laporte, M; Bernier, P; Payette, H; Jeejeebhoy, K; Duerksen, D; Gramlich, L

2014-04-01

Malnutrition is common in acute care hospitals worldwide and nutritional status can deteriorate during hospitalisation. The aim of the present qualitative study was to identify enablers and challenges and, specifically, the activities, processes and resources, from the perspective of nutrition care personnel, required to provide quality nutrition care. Eight hospitals participating in the Nutrition Care in Canadian Hospitals study provided focus group data (n = 8 focus groups; 91 participants; dietitians, dietetic interns, diet technicians and menu clerks), which were analysed thematically. Five themes emerged from the data: (i) developing a nutrition culture, where nutrition practice is considered important to recovery of patients and teams work together to achieve nutrition goals; (ii) using effective tools, such as screening, evidence-based protocols, quality, timely and accurate patient information, and appropriate and quality food; (iii) creating effective systems to support delivery of care, such as communications, food production and delivery; (iv) being responsive to care needs, via flexible food systems, appropriate menus and meal supplements, up to date clinical care and including patient and family in the care processes; and (v) uniting the right person with the right task, by delineating roles, training staff, providing sufficient time to undertake these important tasks and holding staff accountable for their care. The findings of the present study are consistent with other work and provide guidance towards improving the nutrition culture in hospitals. Further empirical work on how to support successful implementation of nutrition care processes is needed. © 2013 The British Dietetic Association Ltd.

Multimorbidity and quality of preventive care in Swiss university primary care cohorts.

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Sven Streit

Full Text Available Caring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings.We examined a retrospective cohort composed of a random sample of 1,002 patients aged 50-80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND's Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator.Participants (mean age 63.5 years, 44% women had a mean of 2.6 (SD 1.9 comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9. Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47% and those with schizophrenia (35%.In Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care.

Why babies die in unplanned out-of-institution births: an enquiry into perinatal deaths in Norway 1999-2013.

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Gunnarsson, Björn; Fasting, Sigurd; Skogvoll, Eirik; Smárason, Alexander K; Salvesen, Kjell Å

2017-03-01

The aims were to describe causes of death associated with unplanned out-of-institution births, and to study whether they could be prevented. Retrospective population-based observational study based on data from the Medical Birth Registry of Norway and medical records. Between 1 January 1999 and 31 December 2013, 69 perinatal deaths among 6027 unplanned out-of-institution births, whether unplanned at home, during transportation, or unspecified, were selected for enquiry. Hospital records were investigated and cases classified according to Causes of Death and Associated Conditions. 63 cases were reviewed. There were 25 (40%) antepartum deaths, 10 (16%) intrapartum deaths, and 24 neonatal (38%) deaths. Four cases were in the unknown death category (6%). Both gestational age and birthweight followed a bimodal distribution with modes at 24 and 38 weeks and 750 and 3400 g, respectively. The most common main cause of death was infection (n = 14, 22%), neonatal (n = 14, 22%, nine due to extreme prematurity) and placental (n = 12, 19%, seven placental abruptions). There were 86 associated conditions, most commonly perinatal (n = 32), placental (n = 15) and maternal (n = 14). Further classification revealed that the largest subgroup was associated perinatal conditions/sub-optimal care, involving 25 cases (40%), most commonly due to sub-optimal maternal use of available care (n = 14, 22%). Infections, neonatal, and placental causes accounted for almost two-thirds of perinatal mortality associated with unplanned out-of-institution births in Norway. Sub-optimal maternal use of available care was found in more than one-fifth of cases. © 2016 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

Reduced perinatal mortality following enhanced training of birth attendants in the Democratic Republic of Congo: a time-dependent effect

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Wallace Dennis

2011-08-01

Full Text Available Abstract Background In many developing countries, the majority of births are attended by traditional birth attendants, who lack formal training in neonatal resuscitation and other essential care required by the newly born infant. In these countries, the major causes of neonatal mortality are birth asphyxia, infection, and low-birth-weight/prematurity. Death from these causes is potentially modifiable using low-cost interventions, including neonatal resuscitation training. The purpose of this study was to evaluate the effect on perinatal mortality of training birth attendants in a rural area of the Democratic Republic of Congo (DRC using two established programs. Methods This study, a secondary analysis of DRC-specific data collected during a multi-country study, was conducted in two phases. The effect of training using the WHO Essential Newborn Care (ENC program was evaluated using an active baseline design, followed by a cluster randomized trial of training using an adaptation of a neonatal resuscitation program (NRP. The perinatal mortality rates before ENC, after ENC training, and after randomization to additional NRP training or continued care were compared. In addition, the influence of time following resuscitation training was investigated by examining change in perinatal mortality during sequential three-month increments following ENC training. Results More than two-thirds of deliveries were attended by traditional birth attendants and occurred in homes; these proportions decreased after ENC training. There was no apparent decline in perinatal mortality when the outcome of all deliveries prior to ENC training was compared to those after ENC but before NRP training. However, there was a gradual but significant decline in perinatal mortality during the year following ENC training (RR 0.73; 95% CI: 0.56-0.96, which was independently associated with time following training. The decline was attributable to a decline in early neonatal mortality

Reduced perinatal mortality following enhanced training of birth attendants in the Democratic Republic of Congo: a time-dependent effect.

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Matendo, Richard; Engmann, Cyril; Ditekemena, John; Gado, Justin; Tshefu, Antoinette; Kinoshita, Rinko; McClure, Elizabeth M; Moore, Janet; Wallace, Dennis; Carlo, Waldemar A; Wright, Linda L; Bose, Carl

2011-08-04

In many developing countries, the majority of births are attended by traditional birth attendants, who lack formal training in neonatal resuscitation and other essential care required by the newly born infant. In these countries, the major causes of neonatal mortality are birth asphyxia, infection, and low-birth-weight/prematurity. Death from these causes is potentially modifiable using low-cost interventions, including neonatal resuscitation training. The purpose of this study was to evaluate the effect on perinatal mortality of training birth attendants in a rural area of the Democratic Republic of Congo (DRC) using two established programs. This study, a secondary analysis of DRC-specific data collected during a multi-country study, was conducted in two phases. The effect of training using the WHO Essential Newborn Care (ENC) program was evaluated using an active baseline design, followed by a cluster randomized trial of training using an adaptation of a neonatal resuscitation program (NRP). The perinatal mortality rates before ENC, after ENC training, and after randomization to additional NRP training or continued care were compared. In addition, the influence of time following resuscitation training was investigated by examining change in perinatal mortality during sequential three-month increments following ENC training. More than two-thirds of deliveries were attended by traditional birth attendants and occurred in homes; these proportions decreased after ENC training. There was no apparent decline in perinatal mortality when the outcome of all deliveries prior to ENC training was compared to those after ENC but before NRP training. However, there was a gradual but significant decline in perinatal mortality during the year following ENC training (RR 0.73; 95% CI: 0.56-0.96), which was independently associated with time following training. The decline was attributable to a decline in early neonatal mortality. NRP training had no demonstrable effect on early

Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators

NARCIS (Netherlands)

Stalpers, Dewi; Kieft, Renate A M M; Van Der Linden, Dimitri; Kaljouw, Marian J.; Schuurmans, Marieke J.

2016-01-01

Background: Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive

Fertility rates and perinatal outcomes of adolescent pregnancies: a retrospective population-based study

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Maria de Lourdes de Souza

Full Text Available ABSTRACT Objective: analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil. Methods: a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests. Results: differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 years. Adolescents had fewer prenatal care appointments than mothers ≥20 years, and a higher proportion had no partner. Mothers aged 15-19 years were more likely to experience preterm birth (OR:1.1; CI:1.08-1.13; p<0.001, have an infant with low birthweight (OR:1.1; CI:1.10-1.15; p<0.001 and low Apgar score at 5 minutes (OR:1.4; CI:1.34-1.45; p<0.001 than mothers ≥20 years, with the odds for adverse outcomes greater for those aged 10-14 years. Conclusion: this study provides evidence of fertility rates among adolescents remaining higher in regions of social and economic deprivation. Adolescent mothers and their infants more likely to experience adverse perinatal outcomes. Nurses, public health practitioners, health and social care professionals and educators need to work collaboratively to better target strategies for adolescents at greater risk; to help reduce fertility rates and improve outcomes.

From Perspectives of the Elderly: Quality of care in Germany

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Dorian R. Woods

2014-06-01

Full Text Available This article reviews state-of-the-art findings on care and quality from published research from 2003-2014 in Germany, specifically from the perspective of the elderly. It is based on a larger project on care and quality in Germany that was funded by the Hans Böckler Foundation. The study provides a much needed overview of current issues on quality and care in light of increased pressure to address care and changes in German social policy. Although quality also encompasses conditions for professional care work and informal carers, this article focuses on the elderly as recipients of care, their perspectives and the ways in which they are involved in their care. Research on care quality from the perspective of the elderly is highlighted in the following themes: 1 the rights of the elderly to quality care 2 elderly perception of satisfaction and quality of outcomes of care, 3 documentation of care as quality control and time, 4 active aging and 5 equality of access. Results show that long-term care rights are more clearly defined and expanded, but enforcement problems are present. Satisfaction with care is traced to good communication with carers, but time for care is scarce. Active aging has become a central focus of care and more research on equal access is needed. The article outlines strengths and weaknesses in German quality care provision as well as learning effects for other countries.

Perinatal mortality and socio-spatial inequalities

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Eunice Francisca Martins

2013-09-01

Full Text Available OBJECTIVE: to analyze the social inequalities in the distribution of perinatal mortality in Belo Horizonte. MATERIAL AND METHODS: the perinatal deaths of residents in Belo Horizonte in the period 2003 to 2007 were studied on the basis of the Information Systems on Mortality and Newborns. The space analysis and the Health Vulnerability Index were used to identify existing inequalities in the sanitary districts regarding coverage and risk, determined by the Odds Ratio and a value p<0.05. The multivariate analysis was used to describe a model for perinatal mortality. RESULTS: there was a proved variation in the numbers of perinatal mortality per one thousand total births in the sanitary districts (12.5 to 19.4, coverage areas (5.3 to 49.4 and areas of risk (13.2 to 20.7. The mortality rate diminished as the maternal schooling increased. The death rates deriving from asphyxia/hypoxia and non-specified fetal death grew with the increase of risk in the area. CONCLUSION: it was verified that the perinatal deaths are distributed in a differentiated form in relation to the space and the social vulnerabilities. The confrontation of this complex problem requires the establishment of intersecting partnerships.

Nurses' work environments, care rationing, job outcomes, and quality of care on neonatal units.

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Rochefort, Christian M; Clarke, Sean P

2010-10-01

This paper is a report of a study of the relationship between work environment characteristics and neonatal intensive care unit nurses' perceptions of care rationing, job outcomes, and quality of care. International evidence suggests that attention to work environments might improve nurse recruitment and retention, and the quality of care. However, comparatively little attention has been given to neonatal care, a specialty where patient and nurse outcomes are potentially quite sensitive to problems with staffing and work environments. Over a 6-month period in 2007-2008, a questionnaire containing measures of work environment characteristics, nursing care rationing, job satisfaction, burnout and quality of care was distributed to 553 nurses in all neonatal intensive care units in the province of Quebec (Canada). A total of 339 nurses (61.3%) completed questionnaires. Overall, 18.6% were dissatisfied with their job, 35.7% showed high emotional exhaustion, and 19.2% rated the quality of care on their unit as fair or poor. Care activities most frequently rationed because of insufficient time were discharge planning, parental support and teaching, and comfort care. In multivariate analyses, higher work environment ratings were related to lower likelihood of reporting rationing and burnout, and better ratings of quality of care and job satisfaction. Additional research on the determinants of nurse outcomes, the quality of patient care, and the impact of rationing of nursing care on patient outcomes in neonatal intensive care units is required. The Neonatal Extent of Work Rationing Instrument appears to be a useful tool for monitoring the extent of rationing of nursing care in neonatal units. © 2010 Blackwell Publishing Ltd.

Many quality measurements, but few quality measures assessing the quality of breast cancer care in women: A systematic review

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Zhang Li

2006-12-01

Full Text Available Abstract Background Breast cancer in women is increasingly frequent, and care is complex, onerous and expensive, all of which lend urgency to improvements in care. Quality measurement is essential to monitor effectiveness and to guide improvements in healthcare. Methods Ten databases, including Medline, were searched electronically to identify measures assessing the quality of breast cancer care in women (diagnosis, treatment, followup, documentation of care. Eligible studies measured adherence to standards of breast cancer care in women diagnosed with, or in treatment for, any histological type of adenocarcinoma of the breast. Reference lists of studies, review articles, web sites, and files of experts were searched manually. Evidence appraisal entailed dual independent assessments of data (e.g., indicators used in quality measurement. The extent of each quality indicator's scientific validation as a measure was assessed. The American Society of Clinical Oncology (ASCO was asked to contribute quality measures under development. Results Sixty relevant reports identified 58 studies with 143 indicators assessing adherence to quality breast cancer care. A paucity of validated indicators (n = 12, most of which assessed quality of life, only permitted a qualitative data synthesis. Most quality indicators evaluated processes of care. Conclusion While some studies revealed patterns of under-use of care, all adherence data require confirmation using validated quality measures. ASCO's current development of a set of quality measures relating to breast cancer care may hold the key to conducting definitive studies.

Knowledge Sharing, Control of Care Quality, and Innovation in Intensive Care Nursing

DEFF Research Database (Denmark)

Paunova, Minna; Li-Ying, Jason; Egerod, Ingrid Eugenie

This study investigates the influence of nurse knowledge sharing behavior on nurse innovation, given different conditions of control of care quality within the intensive care unit (ICU). After conducting a number of interviews and a pilot study, we carried out a multi-source survey study of more...... control of care quality and innovate may be conflicting, unless handled properly....

Perinatal Mortality Among Twins In Lagos University Teaching ...

African Journals Online (AJOL)

Background: Perinatal mortality rate is reported to be higher in twins than in singletons. More than two decades ago, Abudu and Agarin reported a twinning rate of 21.1/1000 maternities and perinatal mortality rate of 142.6/1000 among twins in Lagos. Objective: To determine the current perinatal mortality rate and risk factors ...

Maternal and perinatal outcome of eclampsia in tertiary health institution in Southeast Nigeria.

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Adinma, Echendu Dolly

2013-01-01

To evaluate the maternal and perinatal outcome in patients with eclampsia at Nnamdi-Azikiwe-University-Teaching-Hospital (NAUTH), Nnewi, Nigeria. A retrospective study of cases of eclampsia managed at NAUTH over a 10 year period - 1st January, 2000 to 31st December, 2009. Maternal outcome was measured in terms of complications and maternal death. Foetal outcome was assessed in terms of low birth weight, pre-term births, low apgar score, and perinatal deaths. There were 57 cases of eclampsia out of a total of 6,262 deliveries within the study period, giving a prevalence of 0.91%. Majority, 71.7%, had caesarean section. There were 17.4% maternal deaths mainly from pulmonary oedema, 6 (13.0%), acute renal failure, 4 (8.7%), and coagulopathy, 3 (6.5%). Perinatal deaths were 25.5% as a result of prematurity, 42 (82.4%), and low birth weight, 36 (70.6%). Twenty-one (41.2%) of the new born had Apgar score of less than seven at 5 min while 13.0% were severely asphyxiated. Eclampsia was associated with high maternal and perinatal morbidity and mortality in this study. There is need to review existing protocol on eclampsia management with emphasis on appropriate health education of pregnant mothers, good antenatal care, early diagnosis of pre-eclampsia with prompt treatment.

Cytomegalovirus Infection among Infants in California Neonatal Intensive Care Units, 2005–2010

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Lanzieri, Tatiana M.; Bialek, Stephanie R.; Bennett, Mihoko V.; Gould, Jeffrey B.

2016-01-01

Aim Assess the burden of congenital and perinatal cytomegalovirus (CMV) disease among infants hospitalized in neonatal intensive care units (NICUs). Methods CMV infection was defined as a report of positive CMV viral culture or PCR at any time since birth in an infant hospitalized in a NICU reporting to California Perinatal Quality Care Collaborative during 2005–2010. Results 156 (1.7 per 1000) infants were reported with CMV infection, representing an estimated 5% of the expected number of live births with symptomatic CMV disease. Prevalence was higher among infants with younger gestational ages and lower birth weights. Infants with CMV infection had significantly longer hospital stays; 14 (9%) died. Conclusions Reported prevalence of CMV infection in NICUs represents a fraction of total expected disease burden from CMV in the newborn period, likely resulting from underdiagnosis and milder symptomatic cases that do not require NICU care. More complete ascertainment of infants with congenital CMV infection that would benefit from antiviral treatment may reduce the burden of CMV disease in this population. PMID:24334425

Óbitos perinatais investigados e falhas na assistência hospitalar ao parto Muertes perinatales investigadas y los fracasos en la atención hospitalaria al parto Perinatal deaths investigated and failures in hospital care delivery

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Eunice Francisca Martins

2013-03-01

Full Text Available Objetivou-se analisar as falhas na assistência hospitalar ao parto, o perfil materno e as características do feto e do recém-nascido que evoluíram para óbito perinatal, em Belo Horizonte. MÉTODOS: Estudo transversal, dos óbitos perinatais investigados pelo Comitê de Prevenção de Óbitos de Belo Horizonte, ocorridos entre 2003 e 2007. A fonte dos dados foram as fichas de investigação do Comitê. Os dados foram analisados pela distribuição de frequência das variáveis e análise bivariada utilizando-se o teste de Qui-quadrado de Pearson, considerando o nível de significância de 5% (pAnalizar las deficiencias en la prestación de la atención hospitalaria al parto, el perfil materno y las características del feto y del recién nacido que murió durante el período perinatal, en Belo Horizonte (MG. MÉTODOS: eEstudio transversal de las muertes perinatales investigadas por el Comité para la Prevención de Muertes de Belo Horizonte, que se produjo entre 2003 y 2007. La fuente de datos fueron informes de investigación del Comité. Los datos fueron analizados mediante distribución de frecuencias de las variables y el análisis bivariado se utilizó la prueba de Qui-Quadrado, teniendo en cuenta el nivel de significación del 5% (p To analyze the shortcomings in hospital care delivery, the maternal profile and characteristics of the fetus and newborn that died perinatally, in Belo Horizonte. METHODS: Cross sectional study of perinatal deaths investigated by the Committee for the Prevention of Deaths of Belo Horizonte, which occurred between 2003 and 2007. The data source was the Committee's investigation forms. Data were analyzed by frequency distribution of variables and the bivariate analysis used the chi-square test, considering the significance level of 5% (p <0.05. RESULTS: We studied 253 deaths, most born at term with adequate weight infants. In 65.6% of cases there were gaps in care, mainly related to the monitoring of pregnant

Quantitative comparison of measurements of urgent care service quality.

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Qin, Hong; Prybutok, Victor; Prybutok, Gayle

2016-01-01

Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.

Quality in the provision of headache care. 2: defining quality and its indicators.

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Peters, Michele; Jenkinson, Crispin; Perera, Suraj; Loder, Elizabeth; Jensen, Rigmor; Katsarava, Zaza; Gil Gouveia, Raquel; Broner, Susan; Steiner, Timothy

2012-08-01

The objective of this study was to define "quality" of headache care, and develop indicators that are applicable in different settings and cultures and to all types of headache. No definition of quality of headache care has been formulated. Two sets of quality indicators, proposed in the US and UK, are limited to their localities and/or specific to migraine and their development received no input from people with headache. We first undertook a literature review. Then we conducted a series of focus-group consultations with key stakeholders (doctors, nurses and patients) in headache care. From the findings we proposed a large number of putative quality indicators, and refined these and reduced their number in consultations with larger international groups of stakeholder representatives. We formulated a definition of quality from the quality indicators. Five main themes were identified: (1) headache services; (2) health professionals; (3) patients; (4) financial resources; (5) political agenda and legislation. An initial list of 160 putative quality indicators in 14 domains was reduced to 30 indicators in 9 domains. These gave rise to the following multidimensional definition of quality of headache care: "Good-quality headache care achieves accurate diagnosis and individualized management, has appropriate referral pathways, educates patients about their headaches and their management, is convenient and comfortable, satisfies patients, is efficient and equitable, assesses outcomes and is safe." Quality in headache care is multidimensional and resides in nine essential domains that are of equal importance. The indicators are currently being tested for feasibility of use in clinical settings.

The association between culture, climate and quality of care in primary health care teams.

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Hann, Mark; Bower, Peter; Campbell, Stephen; Marshall, Martin; Reeves, David

2007-09-01

Culture and climate represent shared beliefs and values that may influence quality of care in health care teams, and which could be manipulated for quality improvement. However, there is a lack of agreement on the theoretical and empirical relationships between climate and culture, and their relative power as predictors of quality of care. This study sought to examine the association between self-report measures of climate and culture in primary care teams and comprehensive measures of quality of care. The data were derived from a cross-sectional survey of 492 professionals in 42 general practices in England. Self-report measures of culture (the Competing Values Framework) and climate (the Team Climate Inventory) were used, together with validated measures of quality of care from medical records and self-report. The majority of practices could be characterized as 'clan' culture type. Practices with a dominant clan culture scored higher on climate for participation and teamwork. There were no associations between culture and quality of care, and only limited evidence of associations between climate and quality. The current analysis would not support the hypothesis that culture and climate are important predictors of quality of care in primary care. Although larger studies are required to provide a definitive test, the results may suggest the need for a more complex model of the associations between culture, climate and outcomes, and further research may be required into the interaction between culture and climate with other determinants of behaviour such as internal and external incentives.

Providing high-quality care in primary care settings: how to make trade-offs.

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Beaulieu, Marie-Dominique; Geneau, Robert; Del Grande, Claudio; Denis, Jean-Louis; Hudon, Eveline; Haggerty, Jeannie L; Bonin, Lucie; Duplain, Réjean; Goudreau, Johanne; Hogg, William

2014-05-01

To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Three regions of Quebec. Health care professionals and staff of 5 PC practices. Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Irrespective of their models, PC practices' pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. Copyright© the College of Family Physicians of Canada.

Occupational Therapy in the Neonatal Intensive Care Unit for a Neonate with Perinatal Stroke: A Case Report.

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Roan, Cecilia; Bell, Alison

2017-08-01

This case report describes an occupational therapy intervention based on synactive theory for a neonate born full-term with a diagnosis of perinatal stroke. Occupational therapy was provided 4-5 times a week for 3 weeks. The focus was improving infant state regulation and motor skills to support developmentally appropriate behaviors through environmental modifications, positioning, guided progression of sensory stimulation, and promotion of motor and postural skills. At discharge on day 24, the infant had improved state regulation, behavioral organization, and motor performance. Occupational therapy based on synactive theory was an effective therapeutic approach for improving the behavioral and motor organization of a full term infant diagnosed with perinatal stroke.

Importance of good teamwork in urgent care services.

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Meier, Curtis

2014-11-01

High quality, safe care for patients depends on effective teamwork, and where multi-professional teams work together there is higher patient satisfaction, increased staff innovation, less stress and more communication ( West 2013 ). Conversely, lapses in teamwork and poor communication can result in adverse events ranging from retained foreign objects to perinatal events and medication errors ( Peter and Pronovost 2013 ), and even the death of patients ( Resuscitation Council UK 2011 ). Teamwork requires a set of skills and behaviours that, once learned by clinicians, can save lives ( Peter and Pronovost 2013 ). This article refers to a case study to explore the topic of teamwork in a tertiary care emergency setting.

The ReACH Collaborative--improving quality home care.

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Boyce, Patricia Simino; Pace, Karen B; Lauder, Bonnie; Solomon, Debra A

2007-08-01

Research on quality of care has shown that vigorous leadership, clear goals, and compatible incentive systems are critical factors in influencing successful change (Institute of Medicine, 2001). Quality improvement is a complex process, and clinical quality improvement applications are more likely to be effective in organizations that are ready for change and have strong leaders, who are committed to creating and reinforcing a work environment that supports quality goals (Shortell, 1998). Key leadership roles include providing clear and sustained direction, articulating a coherent set of values and incentives to guide group and individual activities, aligning and integrating improvement efforts into organizational priorities, obtaining or freeing up resources to implement improvement activities, and creating a culture of "continuous improvement" that encourages and rewards the pursuit and achievement of shared quality aims (Institute of Medicine, 2001, 70-71). In summary, home health care is a significant and growing sector of the health care system that provides care to millions of vulnerable patients. There seems little doubt that home health agencies want to focus on quality of care issues and provide optimal care to home-based patients. Furthermore, there is a growing awareness of the value for adapting innovative, effective models for improving the culture of home care practice. This awareness stems from the notion that some agencies see quality improvement activities as a way for them to distinguish themselves not only to regulators and customers, but also to meet the cultural and transformational needs to remain viable in a constantly evolving and competitive health care industry.

Maternal nutritional status & practices & perinatal, neonatal mortality in rural Andhra Pradesh, India.

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Bamji, Mahtab S; V S Murthy, P V; Williams, Livia; Vardhana Rao, M Vishnu

2008-01-01

Despite a vast network of primary health centres and sub-centres, health care outreach in rural parts of India is poor. The Dangoria Charitable Trust (DCT), Hyderabad, has developed a model of health care outreach through trained Village Health and Nutrition Entrepreneur and Mobilisers (HNEMs) in five villages of Medak district in Andhra Pradesh, not serviced by the Integrated Child Development Scheme (ICDS) of the Government of India. Impact of such a link worker on perinatal/ neonatal mortality has been positive. The present study attempts to examine the association of maternal nutrition and related factors with perinatal, and neonatal mortality in these villages. Women from five selected villages who had delivered between June 1998 and September 2003, were identified. Those who had lost a child before one month (28 days), including stillbirths, (group 1- mortality group), who could be contacted and were willing to participate, were compared with those who had not lost a child (group II- no mortality), through a structured questionnaire and physical examination for anthropometric status and signs and symptoms of nutritional deficiency. Categorical data were analysed using Pearson chi square analysis. Continuous data were analysed using Student's t test. Mortality during perinatal, neonatal period was 8.2 per cent of all births. Malnutrition was rampant. Over 90 per cent women had 3 or more antenatal check-ups, had taken tetanus injections and had complied with regular consumption of iron-folic acid tablets. Higher percentage of women in group I (mortality group) tended to have height less than 145 cm (high risk) and signs and symptoms of micronutrient deficiencies. However, differences between groups I and II were not statistically significant. Pre-term delivery, difficult labour (use of forceps), first parity, birth asphyxia (no cry at birth) and day of initiating breastfeeding showed significant association with mortality. Significant association between signs

La mortalidad perinatal según 2 fuentes de información Perinatal mortality according to 2 information sources

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Adriana Freitas Ramírez

2008-08-01

Full Text Available Objetivo: Evaluar la diferencia en muertes perinatales (MP ocurridas en Cataluña y su evolución según 2 fuentes de información sanitaria. Métodos: Los datos proceden de la estadística de mortalidad (Departament de Salut e Institut d'Estadística de Catalunya y del Conjunto Mínimo Básico de Datos de Altas Hospitalarias (CMBDAH del Servei Català de la Salut del período 2000-2003. Se describen las frecuencias totales de MP según si cumplen o no criterio legal de declaración. Resultados: La estadística de mortalidad registró un 27,2% menos de MP, un 44,77% menos de muertes fetales y un 13,5% más de muertes neonatales precoces que el CMBDAH. Estos porcentajes son menores considerando sólo los casos con criterios legales de declaración. Conclusión: Las diferencias de casos entre ambas fuentes están relacionadas con características del recién nacido: bajo peso al nacer, prematuridad y lugar en que se produjo. Los datos hospitalarios podrían mejorar la estadística de mortalidad perinatal.Objective: To evaluate differences in the number of cases of perinatal mortality in Catalonia (Spain recorded in 2 health information systems, as well as trends in this phenomenon. Methods: Data were obtained from the mortality statistics (Health Department and the Catalan Institute of Statistics and the minimum data set (MDS for hospital discharges of the Catalan Health Service from 2000-2003. The frequencies are given for the cases reported and for cases following the legal criteria for reporting. Results: The mortality statistics registered 27.2% fewer perinatal deaths, 44.77% fewer fetal deaths and 13.5% more early neonatal deaths than the MDS. These percentages were lower when only the cases following the legal criteria for reporting were considered. Conclusion: The differences between the two sources were related to low birth weight, prematurity, and the place of occurrence. Use of hospital data might improve the quality of perinatal

Gauging food and nutritional care quality in hospitals

Directory of Open Access Journals (Sweden)

Diez-Garcia Rosa

2012-09-01

Full Text Available Abstract Background Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. Methods Investigation of the Hospital Food and Nutrition Service (HFNS of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ and hospital food service quality (FSQ. HFNS was also evaluated with respect to human resources per hospital bed and per produced meal. Results Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p = 0.02 and per dietitian (p  Conclusions Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent.

Value of the perinatal autopsy : Critique

NARCIS (Netherlands)

Gordijn, SJ; Erwich, JJHM; Khong, TY

2002-01-01

In consenting to a perinatal autopsy, the primary motive of parents may be to find the exact cause of death. A critical review on the value of perinatal autopsies was performed to see whether parents could be counseled regarding their main motive. A literature search was performed in MEDLINE,

[Tobacco control policies and perinatal health].

Science.gov (United States)

Peelen, M J; Sheikh, A; Kok, M; Hajenius, P; Zimmermann, L J; Kramer, B W; Hukkelhoven, C W; Reiss, I K; Mol, B W; Been, J V

2017-01-01

Study the association between the introduction of tobacco control policies in the Netherlands and changes in perinatal outcomes. National quasi-experimental study. We used Netherlands Perinatal Registry data (now called Perined) for the period 2000-2011. We studied whether the introduction of smoke-free legislation in workplaces plus a tobacco tax increase and mass media campaign in January 2004, and extension of the smoke-free law to the hospitality industry accompanied by another tax increase and media campaign in July 2008, was associated with changes in perinatal outcomes. We studied all singleton births (gestational age: 24+0 to 42+6 weeks). Our primary outcome measures were: perinatal mortality, preterm birth and being small-for-gestational-age (SGA). Interrupted time series logistic regression analyses were performed to investigate changes in these outcomes occurred after the introduction of the aforementioned tobacco control policies (ClinicalTrials.gov: NCT02189265). Among 2,069,695 singleton births, 13,027 (0.6%) perinatal deaths, 116,043 (5.6%) preterm live-births and 187,966 (9.1%) SGA live-births were observed. The policies introduced in January 2004 were not associated with significant changes in any of the primary outcome measures. A -4.4% (95% CI: -6.4 to -2.4; p hospitality industry, a further tax increase and another media campaign. This translates to an estimated over 500 cases of SGA being averted per year. A reduction in SGA births, but not preterm birth or perinatal mortality, was observed in the Netherlands after extension of the smoke-free workplace law to include bars and restaurants, in conjunction with a tax increase and media campaign in 2008.

Qualitative Comparison of Barriers to Antiretroviral Medication Adherence Among Perinatally and Behaviorally HIV-Infected Youth.

Science.gov (United States)

Fields, Errol L; Bogart, Laura M; Thurston, Idia B; Hu, Caroline H; Skeer, Margie R; Safren, Steven A; Mimiaga, Matthew J

2017-07-01

Medication adherence among youth living with HIV (28%-69%) is often insufficient for viral suppression. The psychosocial context of adherence barriers is complex. We sought to qualitatively understand adherence barriers among behaviorally infected and perinatally infected youth and develop an intervention specific to their needs. We conducted in-depth interviews with 30 youth living with HIV (aged 14-24 years) and analyzed transcripts using the constant comparative method. Barriers were influenced by clinical and psychosocial factors. Perinatally infected youth barriers included reactance, complicated regimens, HIV fatigue, and difficulty transitioning to autonomous care. Behaviorally infected youth barriers included HIV-related shame and difficulty initiating medication. Both groups reported low risk perception, medication as a reminder of HIV, and nondisclosure, but described different contexts to these common barriers. Common and unique barriers emerged for behaviorally infected and perinatally infected youth reflecting varying HIV experiences and psychosocial contexts. We developed a customizable intervention addressing identified barriers and their psychosocial antecedents.

Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges.

Science.gov (United States)

Lowenthal, Elizabeth D; Bakeera-Kitaka, Sabrina; Marukutira, Tafireyi; Chapman, Jennifer; Goldrath, Kathryn; Ferrand, Rashida A

2014-07-01

Worldwide, more than three million children are infected with HIV, 90% of whom live in sub-Saharan Africa. As the HIV epidemic matures and antiretroviral treatment is scaled up, children with HIV are reaching adolescence in large numbers. The growing population of adolescents with perinatally acquired HIV infection living within this region presents not only unprecedented challenges but also opportunities to learn about the pathogenesis of HIV infection. In this Review, we discuss the changing epidemiology of paediatric HIV and the particular features of HIV infection in adolescents in sub-Saharan Africa. Longstanding HIV infection acquired when the immune system is not developed results in distinctive chronic clinical complications that cause severe morbidity. As well as dealing with chronic illness, HIV-infected adolescents have to confront psychosocial issues, maintain adherence to drugs, and learn to negotiate sexual relationships, while undergoing rapid physical and psychological development. Context-specific strategies for early identification of HIV infection in children and prompt linkage to care need to be developed. Clinical HIV care should integrate age-appropriate sexual and reproductive health and psychological, educational, and social services. Health-care workers will need to be trained to recognise and manage the needs of these young people so that the increasing numbers of children surviving to adolescence can access quality care beyond specialist services at low-level health-care facilities. Copyright © 2014 Elsevier Ltd. All rights reserved.

Experiences with perinatal loss from the health professionals’ perspective La vivencia de la pérdida perinatal desde la perspectiva de los profesionales de la salud A experiência da perda perinatal a partir da perspectiva dos profissionais de saúde

Directory of Open Access Journals (Sweden)

Sonia María Pastor Montero

2011-12-01

Full Text Available The purpose of this paper is to know the experience of health professionals in situations of perinatal death and grief and to describe their action strategies in the management of perinatal loss. A qualitative study with a phenomenological approach was carried out through interviews conducted with 19 professionals. Three thematic categories were identified: Healthcare practice, feelings aroused by perinatal loss and meaning and beliefs about perinatal loss and grief. The results revealed that the lack of knowledge and skills to deal with perinatal loss are identified as the main reason behind unsuitable attitudes that are usually adopted in these situations. This generates anxiety, helplessness and frustration that compromise professional competency. The conclusion reached is that the promotion of training programs to acquire knowledge, skills and abilities in management of perinatal bereavement and the development of a clinical practice guideline for perinatal loss are necessary.El objetivo de este artículo es conocer la experiencia vivida por los profesionales de la salud en situaciones de muerte y duelo perinatal y describir las estrategias de actuación ante la pérdida perinatal. Se trata de un estudio cualitativo con un enfoque fenomenológico realizado a 19 profesionales a través de entrevistas. Se identificaron 3 categorías temáticas: la práctica asistencial, los sentimientos que despierta la pérdida perinatal y significado y creencias sobre la pérdida y el duelo perinatal. Los resultados ponen de manifiesto que la falta de conocimientos y de recursos para enfrentar la pérdida perinatal hace que se adopten actitudes poco adecuadas en estas situaciones, generando una sensación de ansiedad, impotencia y frustración que compromete la competencia profesional. Se concluye que es fundamental promover programas de formación para adquirir conocimientos y destrezas sobre el duelo perinatal y elaborar una guía de práctica cl

Effects of quality improvement in health facilities and community mobilization through women's groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial.

Science.gov (United States)

Colbourn, Tim; Nambiar, Bejoy; Bondo, Austin; Makwenda, Charles; Tsetekani, Eric; Makonda-Ridley, Agnes; Msukwa, Martin; Barker, Pierre; Kotagal, Uma; Williams, Cassie; Davies, Ros; Webb, Dale; Flatman, Dorothy; Lewycka, Sonia; Rosato, Mikey; Kachale, Fannie; Mwansambo, Charles; Costello, Anthony

2013-09-01

Maternal, perinatal and neonatal mortality remains high in low-income countries. We evaluated community and facility-based interventions to reduce deaths in three districts of Malawi. We evaluated a rural participatory women's group community intervention (CI) and a quality improvement intervention at health centres (FI) via a two-by-two factorial cluster randomized controlled trial. Consenting pregnant women were followed-up to 2 months after birth using key informants. Primary outcomes were maternal, perinatal and neonatal mortality. Clusters were health centre catchment areas assigned using stratified computer-generated randomization. Following exclusions, including non-birthing facilities, 61 clusters were analysed: control (17 clusters, 4912 births), FI (15, 5335), CI (15, 5080) and FI + CI (14, 5249). This trial was registered as International Standard Randomised Controlled Trial [ISRCTN18073903]. Outcomes for 14,576 and 20,576 births were recorded during baseline (June 2007-September 2008) and intervention (October 2008-December 2010) periods. For control, FI, CI and FI + CI clusters neonatal mortality rates were 34.0, 28.3, 29.9 and 27.0 neonatal deaths per 1000 live births and perinatal mortality rates were 56.2, 55.1, 48.0 and 48.4 per 1000 births, during the intervention period. Adjusting for clustering and stratification, the neonatal mortality rate was 22% lower in FI + CI than control clusters (OR = 0.78, 95% CI 0.60-1.01), and the perinatal mortality rate was 16% lower in CI clusters (OR = 0.84, 95% CI 0.72-0.97). We did not observe any intervention effects on maternal mortality. Despite implementation problems, a combined community and facility approach using participatory women's groups and quality improvement at health centres reduced newborn mortality in rural Malawi.

Low cerebral blood flow in hypotensive perinatal distress

DEFF Research Database (Denmark)

Lou, H C; Lassen, N A; Friis-Hansen, B

1977-01-01

was used for the cerebral blood flow measurements. The study confirmed that perinatal distress may be associated with low arterial blood pressure, and it was shown that cerebral blood flow is very low, 20 ml/100 g/min or less, in hypotensive perinatal distress. It is concluded that cerebral ischaemia plays...... a crucial role in the development of perinatal hypoxic brain injury....

A Systematic Review of the Physical, Mental, Social, and Economic Problems of Immigrant Women in the Perinatal Period in Japan.

Science.gov (United States)

Kita, Sachiko; Minatani, Mariko; Hikita, Naoko; Matsuzaki, Masayo; Shiraishi, Mie; Haruna, Megumi

2015-12-01

The perinatal mortality of immigrants in Japan is higher than that of Japanese women. However, details of the problems of immigrant perinatal women that contribute to worsening of their health are still unknown. This review describes the physical, psychological, social, and economic problems of immigrant women during the perinatal period in Japan. Medline, CINAHL, PsycINFO, and Igaku-Chuo Zasshi were searched and 36 relevant articles were reviewed. The related descriptions were collected and analyzed by using content analysis. The results showed that immigrant perinatal women in Japan experienced the following problems: language barriers, a problematic relationship with a partner, illegal residency, emotional distress, physical distress, adjustment difficulties, lack of utilization of services, social isolation, lack of support, lack of information, low economic status, unsatisfactory health care, and discrimination. These results indicated that multilingual services, strengthening of social and support networks, and political action are necessary to resolve their problems.

Stakeholders' roles and responsibilities regarding quality of care.

Science.gov (United States)

Huotari, Päivi; Havrdová, Zuzana

2016-10-10

Purpose The purpose of this paper is to describe how different stakeholders (society, managers, employees and clients) can together ensure the quality of care. Design/methodology/approach Qualitative data were collected from four focus group interviews conducted in three countries. All interviewees were pursuing a master's degree in social and/or health care management and had begun working in their field after completing their bachelor's degree. The data were analysed using inductive content analysis. Findings The society and managers are responsible for the care system as a whole and must apply system-oriented, rather than sector-oriented, thinking. Employees are responsible for ensuring the continuity of client services in their work, and managers and employees share the responsibility of achieving the organisational goals and quality standards. The clients are responsible for acting as responsible service users and providing the required information to obtain care. Communication was strongly emphasised in the data, and it necessitates cross-professional and organisational boundaries, professional and political boundaries, as well as boundaries between the professional and the client. Research limitations/implications Since the interviewees were all pursuing a master's degree in social and/or health care management, when reflecting on their work experience, they may have also been reflecting what they had learned in university. Practical implications This study emphasises the importance of collaboration and communication between stakeholders in ensuring the quality of care. Unpredictable economies, the ageing population and the ongoing integration and reorganisation of health and social care services in Europe highlight systematic and strategic approach in quality of care. Originality/value This paper claims that communication between different care stakeholders gives a more systematic and coherent framework for the quality of care. Quality of care is a

[Quality Indicators of Primary Health Care Facilities in Austria].

Science.gov (United States)

Semlitsch, Thomas; Abuzahra, Muna; Stigler, Florian; Jeitler, Klaus; Posch, Nicole; Siebenhofer, Andrea

2017-07-11

Background The strengthening of primary health care is one major goal of the current national health reform in Austria. In this context, a new interdisciplinary concept was developed in 2014 that defines structures and requirements for future primary health care facilities. Objective The aim of this project was the development of quality indicators for the evaluation of the scheduled primary health care facilities in Austria, which are in accordance with the new Austrian concept. Methods We used the RAND/NPCRDC method for the development and selection of the quality indicators. We conducted systematic literature searches for existing measures in international databases for quality indicators as well as in bibliographic databases. All retrieved measures were evaluated and rated by an expert panel in a 2-step process regarding relevance and feasibility. Results Overall, the literature searches yielded 281 potentially relevant quality indicators, which were summarized to 65 different quality measures for primary health care. Out of these, the panel rated and accepted 30 measures as relevant and feasible for use in Austria. Five of these indicators were structure measures, 14 were process measures and the remaining 11 were outcome measures. Based on the Austrian primary health care concept, the final set of quality indicators was grouped in the 5 following domains: Access to primary health care (5), quality of care (15), continuity of care (5), coordination of care (4), and safety (1). Conclusion This set of quality measures largely covers the four defined functions of primary health care. It enables standardized evaluation of primary health care facilities in Austria regarding the implementation of the Austrian primary health care concept as well as improvement in healthcare of the population. © Georg Thieme Verlag KG Stuttgart · New York.

Knowledge Sharing, Control of Care Quality, and Innovation in Intensive Care Nursing

DEFF Research Database (Denmark)

Paunova, Minna; Li-Ying, Jason; Egerod, Ingrid Eugenie

2016-01-01

affect innovation differently, depending on the strength as well as type of control of care quality within the unit. Healthcare organizations face an increasing pressure to innovate while controlling and accounting for care quality. This study demonstrates that the increasing pressures to implement...

Inter-regional competition and quality in hospital care.

Science.gov (United States)

Aiura, Hiroshi

2013-06-01

This study analyzes the effect of episode-of-care payment and patient choice on waiting time and the comprehensive quality of hospital care. The study assumes that two hospitals are located in two cities with different population sizes and compete with each other. We find that the comprehensive quality of hospital care as well as waiting time of both hospitals improve with an increase in payment per episode of care. However, we also find that the extent of these improvements differs according to the population size of the cities where the hospitals are located. Under the realistic assumptions that hospitals involve significant labor-intensive work, we find the improvements in comprehensive quality and waiting time in a hospital located in a small city to be greater than those in a hospital located in a large city. The result implies that regional disparity in the quality of hospital care decreases with an increase in payment per episode of care.

Older people's perceptions of quality of care.

NARCIS (Netherlands)

Sixma, H.J.

2001-01-01

Purpose: User views on quality of care are generally assessed by patients satisfaction questionnaires. However, doubts have been cast on the validity and reliability of such instruments. Aim of this paper are: (1) to describe the development of a new instrument measuring quality of care from the

[Perinatal sources of stem cells].

Science.gov (United States)

Piskorska-Jasiulewicz, Magdalena Maria; Witkowska-Zimny, Małgorzata

2015-03-08

Recently, stem cell biology has become an interesting topic. Several varieties of human stem cells have been isolated and identified in vivo and in vitro. Successful application of hematopoietic stem cells in hematology has led to the search for other sources of stem cells and expanding the scale of their application. Perinatal stem cells are a versatile cell population, and they are interesting for both scientific and practical objectives. Stem cells from perinatal tissue may be particularly useful in the clinic for autologous transplantation for fetuses and newborns, and after banking in later stages of life, as well as for in utero transplantation in the case of genetic disorders. In this review paper we focus on the extraction and therapeutic potential of stem cells derived from perinatal tissues such as the placenta, the amnion, amniotic fluid, umbilical cord blood and Wharton's jelly.

Patient-reported assessment of quality care at end of life: development and validation of Quality Care Questionnaire-End of Life (QCQ-EOL).

Science.gov (United States)

Yun, Young Ho; Kim, Soo-Hyun; Lee, Kyoung-Min; Park, Sang Min; Lee, Chang Geol; Choi, Youn Seon; Lee, Won Sup; Kim, Si-Young; Heo, Dae Seog

2006-09-01

Our goal was to validate an instrument with which terminally ill patients could evaluate the quality of care they receive at the end of life (EOL). Questionnaire development followed a four-phase process: item generation and reduction, construction, pilot testing, and field-testing. Using relevance and priority criteria and pilot testing, we developed a 16-item questionnaire. Factor analyses of data from 235 patients resulted in the Quality Care Questionnaire-End of Life (QCQ-EOL) covering dignity-conserving care, care by health care professionals, individualised care, and family relationships. All subscales and total scores showed high internal consistency (Cronbach alpha range, 0.73-0.89). The ability of total score and selective subscale scores clearly differentiated patients on the basis of clinical situation, sense of dignity, and general rating of care quality. Correlations of scores between patients and caregivers were substantial. The QCQ-EOL can be adopted to assess the quality of care received by terminally ill patients.

Differential Susceptibility to Parenting and Quality Child Care

Science.gov (United States)

Pluess, Michael; Belsky, Jay

2010-01-01

Research on differential susceptibility to rearing suggests that infants with difficult temperaments are disproportionately affected by parenting and child care quality, but a major U.S. child care study raises questions as to whether quality of care influences social adjustment. One thousand three hundred sixty-four American children from…

Quality in the provision of headache care. 1

DEFF Research Database (Denmark)

Peters, Michele; Perera, Suraj; Loder, Elizabeth

2012-01-01

and improvement of headache services in other settings. Some studies had evaluated the use of existing disability and quality of life instruments, but their findings had not been incorporated into quality indicators. Existing headache care quality indicators are incomplete and inadequate for purpose......Widely accepted quality indicators for headache care would provide a basis not only for assessment of care but also, and more importantly, for its improvement. The objective of the study was to identify and summarize existing information on such indicators: specifically, did indicators exist, how...... had they been developed, what aspects of headache care did they relate to and how and with what utility were they being used? A systematic review of the medical literature was performed. A total of 32 articles met criteria for inclusion. We identified 55 existing headache quality indicators of which...

Pediatric Palliative Care: A Personal Story

Medline Plus

Full Text Available ... The story demonstrates how palliative care can positively influence a patient's and family's experience with illness. Category ... Cancer: Palliative Care - Duration: 3:29. American Cancer Society 4,364 views 3:29 Perinatal Palliative Care - ...

Quality of Big Data in health care.

Science.gov (United States)

Sukumar, Sreenivas R; Natarajan, Ramachandran; Ferrell, Regina K

2015-01-01

The current trend in Big Data analytics and in particular health information technology is toward building sophisticated models, methods and tools for business, operational and clinical intelligence. However, the critical issue of data quality required for these models is not getting the attention it deserves. The purpose of this paper is to highlight the issues of data quality in the context of Big Data health care analytics. The insights presented in this paper are the results of analytics work that was done in different organizations on a variety of health data sets. The data sets include Medicare and Medicaid claims, provider enrollment data sets from both public and private sources, electronic health records from regional health centers accessed through partnerships with health care claims processing entities under health privacy protected guidelines. Assessment of data quality in health care has to consider: first, the entire lifecycle of health data; second, problems arising from errors and inaccuracies in the data itself; third, the source(s) and the pedigree of the data; and fourth, how the underlying purpose of data collection impact the analytic processing and knowledge expected to be derived. Automation in the form of data handling, storage, entry and processing technologies is to be viewed as a double-edged sword. At one level, automation can be a good solution, while at another level it can create a different set of data quality issues. Implementation of health care analytics with Big Data is enabled by a road map that addresses the organizational and technological aspects of data quality assurance. The value derived from the use of analytics should be the primary determinant of data quality. Based on this premise, health care enterprises embracing Big Data should have a road map for a systematic approach to data quality. Health care data quality problems can be so very specific that organizations might have to build their own custom software or data

Regional variations in health care intensity and physician perceptions of quality of care.

Science.gov (United States)

Sirovich, Brenda E; Gottlieb, Daniel J; Welch, H Gilbert; Fisher, Elliott S

2006-05-02

Research has documented dramatic differences in health care utilization and spending across U.S. regions with similar levels of patient illness. Although patient outcomes and quality of care have been found to be no better in regions of high health care intensity, it is unknown whether physicians in these regions feel more capable of providing good patient care than those in low-intensity regions. To determine whether physicians in high-intensity regions feel better able to care for patients than physicians in low-intensity regions. Physician telephone survey. 51 metropolitan and 9 nonmetropolitan areas of the United States and a supplemental national sample. 10,577 physicians who provided care to adults in 1998 or 1999 were surveyed for the Community Tracking Study (response rate, 61%). The End-of-Life Expenditure Index, a measure of spending that reflects differences in the overall quantity of medical services provided rather than differences in illness or price, was used to determine health care intensity in the physicians' community. Outcomes included physicians' perceived availability of clinical services, ability to provide high-quality care to patients, and career satisfaction. Although the highest-intensity regions have substantially more hospital beds and specialists per capita, physicians in these regions reported more difficulty obtaining needed services for their patients. The proportion of physicians who felt able to obtain elective hospital admissions ranged from 50% in high-intensity regions to 64% in the lowest-intensity region (P market factors (for example, managed care penetration); the difference in perceived ability to provide high-quality care was no longer statistically significant (P = 0.099). The cross-sectional design prevented demonstration of a causal relationship between intensity and physician perceptions of quality. Despite more resources, physicians in regions of high health care intensity did not report greater ease in obtaining

Guidelines on treatment of perinatal depression with antidepressants: An international review.

Science.gov (United States)

Molenaar, Nina M; Kamperman, Astrid M; Boyce, Philip; Bergink, Veerle

2018-04-01

Several countries have developed Clinical Practice Guidelines regarding treatment of perinatal depressive symptoms and perinatal use of antidepressant. We aimed to compare guidelines to guide clinicians in best clinical practice. An extensive search in guideline databases, MEDLINE and PsycINFO was performed. When no guidelines were (publicly) available online, we contacted psychiatric-, obstetric-, perinatal- and mood disorder societies of all first world countries and the five largest second world countries. Only Clinical Practice Guidelines adhering to quality criteria of the Appraisal of Guidelines for Research and Evaluation instrument and including a systematic review of evidence were included. Data extraction focussed on recommendations regarding continuation or withdrawal of antidepressants and preferred treatment in newly depressed patients. Our initial search resulted in 1094 articles. After first screening, 40 full-text articles were screened. Of these, 24 were excluded for not being an official Clinical Practice Guidelines. In total, 16 Clinical Practice Guidelines were included originating from 12 countries. Eight guidelines were perinatal specific and eight were general guidelines. During pregnancy, four guidelines advise to continue antidepressants, while there is a lack of evidence supporting this recommendation. Five guidelines do not specifically advise or discourage continuation. For new episodes, guidelines agree on psychotherapy (especially cognitive behavioural therapy) as initial treatment for mild to moderate depression and antidepressants for severe depression, with a preference for sertraline. Paroxetine is not preferred treatment for new episodes but switching antidepressants for ongoing treatment is discouraged (three guidelines). If mothers use antidepressants, observation of the neonate is generally recommended and breastfeeding encouraged.

Evaluating the Effect of Software Quality Characteristics on Health Care Quality Indicators

Directory of Open Access Journals (Sweden)

Sakineh Aghazadeh

2015-07-01

Full Text Available Introduction: Various types of software are used in health care organizations to manage information and care processes. The quality of software has been an important concern for both health authorities and designers of Health Information Technology. Thus, assessing the effect of software quality on the performance quality of healthcare institutions is essential. Method: The most important health care quality indicators in relation to software quality characteristics are provided via an already performed literature review. ISO 9126 standard model is used for definition and integration of various characteristics of software quality. The effects of software quality characteristics and sub-characteristics on the healthcare indicators are evaluated through expert opinion analyses. A questionnaire comprising of 126 questions of 10-point Likert scale was used to gather opinions of experts in the field of Medical/Health Informatics. The data was analyzed using Structural Equation Modeling. Results: Our findings showed that software Maintainability was rated as the most effective factor on user satisfaction (R2 =0.89 and Functionality as the most important and independent variable affecting patient care quality (R2 =0.98. Efficiency was considered as the most effective factor on workflow (R2 =0.97, and Maintainability as the most important factor that affects healthcare communication (R2 =0.95. Usability and Efficiency were rated as the most effectual factor affecting patient satisfaction (R2 =0.80, 0.81. Reliability, Maintainability, and Efficiency were considered as the main factors affecting care costs (R2 =0.87, 0.74, 0.87. Conclusion: We presented a new model based on ISO standards. The model demonstrates and weighs the relations between software quality characteristics and healthcare quality indicators. The clear relationships between variables and the type of the metrics and measurement methods used in the model make it a reliable method to assess

Does quality influence utilization of primary health care? Evidence from Haiti.

Science.gov (United States)

Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

2018-06-20

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

Science.gov (United States)

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

Mitochondria, Bioenergetics and Excitotoxicity: New Therapeutic Targets in Perinatal Brain Injury

Directory of Open Access Journals (Sweden)

Bryan Leaw

2017-07-01

Full Text Available Injury to the fragile immature brain is implicated in the manifestation of long-term neurological disorders, including childhood disability such as cerebral palsy, learning disability and behavioral disorders. Advancements in perinatal practice and improved care mean the majority of infants suffering from perinatal brain injury will survive, with many subtle clinical symptoms going undiagnosed until later in life. Hypoxic-ischemia is the dominant cause of perinatal brain injury, and constitutes a significant socioeconomic burden to both developed and developing countries. Therapeutic hypothermia is the sole validated clinical intervention to perinatal asphyxia; however it is not always neuroprotective and its utility is limited to developed countries. There is an urgent need to better understand the molecular pathways underlying hypoxic-ischemic injury to identify new therapeutic targets in such a small but critical therapeutic window. Mitochondria are highly implicated following ischemic injury due to their roles as the powerhouse and main energy generators of the cell, as well as cell death processes. While the link between impaired mitochondrial bioenergetics and secondary energy failure following loss of high-energy phosphates is well established after hypoxia-ischemia (HI, there is emerging evidence that the roles of mitochondria in disease extend far beyond this. Indeed, mitochondrial turnover, including processes such as mitochondrial biogenesis, fusion, fission and mitophagy, affect recovery of neurons after injury and mitochondria are involved in the regulation of the innate immune response to inflammation. This review article will explore these mitochondrial pathways, and finally will summarize past and current efforts in targeting these pathways after hypoxic-ischemic injury, as a means of identifying new avenues for clinical intervention.

Socioeconomic differences in perinatal health and disease

DEFF Research Database (Denmark)

Mortensen, Laust Hvas; Andersen, Anne-Marie Nybo; Helweg-Larsen, Karin

2011-01-01

been used to examine the influence of socioeconomic factors on perinatal health. Conclusion: Danish register data is an invaluable source of information on socioeconomic differences in perinatal health. Danish registers continue to provide excellent opportunities for research and surveillance...

Antenatal care strengthening for improved quality of care in Jimma, Ethiopia

DEFF Research Database (Denmark)

Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe

2015-01-01

and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia. METHODS: The intervention comprised trainings, supervisions, equipment, development of health education material, and adaption of guidelines. It was implemented at public facilities and control sites were included...... in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems....... The effect of the intervention was assessed by comparing the change in quality of care from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. RESULTS: The continued attention to the ANC provision during implementation stimulated...

Pregnancy outcomes in perinatally HIV-infected young women in Madrid, Spain: 2000-2015.

Science.gov (United States)

Prieto, Luis M; Fernández McPhee, Carolina; Rojas, Patricia; Mazariegos, Diana; Muñoz, Eloy; Mellado, Maria José; Holguín, África; Navarro, María Luisa; González-Tomé, María Isabel; Ramos, José Tomás

2017-01-01

An increasing number of perinatally HIV-infected women (PHIV) are reaching adulthood and becoming pregnant. Most PHIV women have been exposed to a high number of antiretroviral regimens, and they may have difficulties to achieve viral suppression. Psychosocial problems are not uncommon and could be an important barrier for treatment adherence. The effects of chronic HIV infection and long-term exposure to antiretroviral treatment of PHIV women cause concerns on the developing fetus. The aims of this study were to describe the prevention of mother-to-child transmission strategies in PHIV women and the infant outcomes in the Madrid Cohort of HIV-infected mother-infant pairs. All PHIV pregnant women registered in the Cohort that gave birth from 2000 to 2015 were included in the study. Twenty-eight pregnancies in twenty-two perinatally infected women were registered. Most women were Caucasian and heavily treatment-experienced. Nine cases (32.1%) were at high risk of HIV mother-to-child transmission. Maternal HIV-1 viral load was detectable close to delivery in four women (14.3%). The management of these cases was described, and the treatment strategies were discussed. None of the newborns acquired HIV infection. Eight infants (28.6%) were small for gestational age. This study included a large series of pregnancies among PHIV women attended according to a youth-centered care model. The challenges in the management of this population by health-care providers were described. Specific strategies to minimize perinatal transmission risks should be addressed in future collaborative studies.

Next level of board accountability in health care quality.

Science.gov (United States)

Pronovost, Peter J; Armstrong, C Michael; Demski, Renee; Peterson, Ronald R; Rothman, Paul B

2018-03-19

Purpose The purpose of this paper is to offer six principles that health system leaders can apply to establish a governance and management system for the quality of care and patient safety. Design/methodology/approach Leaders of a large academic health system set a goal of high reliability and formed a quality board committee in 2011 to oversee quality and patient safety everywhere care was delivered. Leaders of the health system and every entity, including inpatient hospitals, home care companies, and ambulatory services staff the committee. The committee works with the management for each entity to set and achieve quality goals. Through this work, the six principles emerged to address management structures and processes. Findings The principles are: ensure there is oversight for quality everywhere care is delivered under the health system; create a framework to organize and report the work; identify care areas where quality is ambiguous or underdeveloped (i.e. islands of quality) and work to ensure there is reporting and accountability for quality measures; create a consolidated quality statement similar to a financial statement; ensure the integrity of the data used to measure and report quality and safety performance; and transparently report performance and create an explicit accountability model. Originality/value This governance and management system for quality and safety functions similar to a finance system, with quality performance documented and reported, data integrity monitored, and accountability for performance from board to bedside. To the authors' knowledge, this is the first description of how a board has taken this type of systematic approach to oversee the quality of care.

Systems and processes that ensure high quality care.

Science.gov (United States)

Bassett, Sally; Westmore, Kathryn

2012-10-01

This is the second in a series of articles examining the components of good corporate governance. It considers how the structures and processes for quality governance can affect an organisation's ability to be assured about the quality of care. Complex information systems and procedures can lead to poor quality care, but sound structures and processes alone are insufficient to ensure good governance, and behavioural factors play a significant part in making sure that staff are enabled to provide good quality care. The next article in this series looks at how the information reporting of an organisation can affect its governance.

Effects of quality improvement in health facilities and community mobilization through women’s groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial

Science.gov (United States)

Colbourn, Tim; Nambiar, Bejoy; Bondo, Austin; Makwenda, Charles; Tsetekani, Eric; Makonda-Ridley, Agnes; Msukwa, Martin; Barker, Pierre; Kotagal, Uma; Williams, Cassie; Davies, Ros; Webb, Dale; Flatman, Dorothy; Lewycka, Sonia; Rosato, Mikey; Kachale, Fannie; Mwansambo, Charles; Costello, Anthony

2016-01-01

Background Maternal, perinatal and neonatal mortality remains high in low-income countries. We evaluated community and facility-based interventions to reduce deaths in three districts of Malawi. Methods We evaluated a rural participatory women’s group community intervention (CI) and a quality improvement intervention at health centres (FI) via a two-by-two factorial cluster randomized controlled trial. Consenting pregnant women were followed-up to 2 months after birth using key informants. Primary outcomes were maternal, perinatal and neonatal mortality. Clusters were health centre catchment areas assigned using stratified computer-generated randomization. Following exclusions, including non-birthing facilities, 61 clusters were analysed: control (17 clusters, 4912 births), FI (15, 5335), CI (15, 5080) and FI + CI (14, 5249). This trial was registered as International Standard Randomised Controlled Trial [ISRCTN18073903]. Outcomes for 14 576 and 20 576 births were recorded during baseline (June 2007–September 2008) and intervention (October 2008–December 2010) periods. Results For control, FI, CI and FI + CI clusters neonatal mortality rates were 34.0, 28.3, 29.9 and 27.0 neonatal deaths per 1000 live births and perinatal mortality rates were 56.2, 55.1, 48.0 and 48.4 per 1000 births, during the intervention period. Adjusting for clustering and stratification, the neonatal mortality rate was 22% lower in FI + CI than control clusters (OR = 0.78, 95% CI 0.60–1.01), and the perinatal mortality rate was 16% lower in CI clusters (OR = 0.84, 95% CI 0.72–0.97). We did not observe any intervention effects on maternal mortality. Conclusions Despite implementation problems, a combined community and facility approach using participatory women’s groups and quality improvement at health centres reduced newborn mortality in rural Malawi. PMID:24030269

Preventive Care Quality of Medicare Accountable Care Organizations: Associations of Organizational Characteristics With Performance.

Science.gov (United States)

Albright, Benjamin B; Lewis, Valerie A; Ross, Joseph S; Colla, Carrie H

2016-03-01

Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for 8 measures of preventive care quality. To create composite measures of preventive care quality and examine associations of ACO characteristics with performance. This is a cross-sectional study of Medicare Shared Savings Program and Pioneer participants. We linked quality performance to descriptive data from the National Survey of ACOs. We created composite measures using exploratory factor analysis, and used regression to assess associations with organizational characteristics. Of 252 eligible ACOs, 246 reported on preventive care quality, 177 of which completed the survey (response rate=72%). In their first year, ACOs lagged behind PPO performance on the majority of comparable measures. We identified 2 underlying factors among 8 measures and created composites for each: disease prevention, driven by vaccines and cancer screenings, and wellness screening, driven by annual health screenings. Participation in the Advanced Payment Model, having fewer specialists, and having more Medicare ACO beneficiaries per primary care provider were associated with significantly better performance on both composites. Better performance on disease prevention was also associated with inclusion of a hospital, greater electronic health record capabilities, a larger primary care workforce, and fewer minority beneficiaries. ACO preventive care quality performance is related to provider composition and benefitted by upfront investment. Vaccine and cancer screening quality performance is more dependent on organizational structure and characteristics than performance on annual wellness screenings, likely due to greater complexity in eligibility determination and service administration.

Sexual activity and sexual dysfunction of women in the perinatal period: a longitudinal study.

Science.gov (United States)

Wallwiener, Stephanie; Müller, Mitho; Doster, Anne; Kuon, Ruben Jeremias; Plewniok, Katharina; Feller, Sandra; Wallwiener, Markus; Reck, Corinna; Matthies, Lina Maria; Wallwiener, Christian

2017-04-01

Reduced sexual activity and dysfunctional problems are highly prevalent in the perinatal period, and there is a lack of data regarding the degree of normality during pregnancy. Several risk factors have been independently associated with a greater extent of Female Sexual Dysfunction (FSD). Therefore, this study aimed to assess the prevalence of sexual inactivity and sexual dysfunctions in German women during the perinatal period and the verification of potential risk factors. Questionnaires were administered to 315 women prenatally (TI 3rd trimester) and postpartum (TII 1 week, TIII 4 months), including the Female Sexual Function Index (FSFI), the Edinburgh Postnatal Depression Scale (EPDS), and the Questionnaire of Partnership (PFB). The frequency of sexual inactivity was 24% (TI), 40.5% (TII), and 19.9% (TIII). Overall, 26.5-34.8% of women were at risk of sexual dysfunction (FSFI score Sexual desire disorder was the most prevalent form of Female sexual dysfunction. Furthermore, especially breastfeeding and low partnership quality were revealed as significant risk factors for sexual dysfunctional problems postpartum. Depressive symptoms having a cesarean section and high maternal education were correlated with dysfunctional problems in several subdomains. Findings indicated that women at risk of FSD differed significantly in aspects of partnership quality, breastfeeding, mode of delivery, maternal education, and depressive symptoms. Aspects of perinatal sexuality should be routinely implemented in the counseling of couples in prenatal classes.

Patients' Evaluation of the Quality of Diabetes Care (PEQD)

DEFF Research Database (Denmark)

Pouwer, F; Snoek, Frank J

2002-01-01

aspects of the quality of diabetes care as delivered by the specialist in internal medicine (internist) and the diabetes nurse specialist (DNS). Two principal components analyses (internist/DNS) both yielded one 14 item factor with a high internal consistency. Satisfaction with diabetes care, fewer......OBJECTIVES: To develop a brief measure of patients' evaluation of the quality of diabetes care and to study predictors of consumers' rating of the quality of diabetes care. DESIGN: A prospective design. SUBJECTS: 176 adults with type 1 (39%) or type 2 (61%) diabetes. MAIN MEASURES: Demographic...... variables, HbA1c, number of diabetes complications, satisfaction with diabetes care, diabetes related distress, and fear of hypoglycaemia were assessed by self-report. In addition, satisfaction with diabetes care and evaluations about quality of the care were measured at 16 month follow up. Statistical...

Midwives' perceptions and experiences of engaging fathers in perinatal services.

Science.gov (United States)

Rominov, Holly; Giallo, Rebecca; Pilkington, Pamela D; Whelan, Thomas A

2017-08-01

The active engagement of fathers in maternity care is associated with long-term benefits for the father, their partner, and their child. Midwives are ideally placed to engage fathers, but few studies have explored midwives' experiences of working with men. Therefore, the aim of this study was to describe midwives' perceptions and experiences of engaging fathers in perinatal services. A multi-method approach was utilised. Registered midwives (N=106) providing perinatal services to families in Australia participated in an online survey. Of these, 13 also participated in semi-structured telephone interviews. Descriptive analyses summarised the online survey data. The interview data were coded using semantic thematic analysis. Survey results indicated that midwives unanimously agreed that engaging fathers is part of their role and acknowledged the importance of receiving education to develop knowledge and skills about fathers. Analysis of the telephone interviews led to the identification of a range of strategies, facilitators and barriers to engaging fathers in midwifery services. Some of these were related to characteristics of midwives, factors related specifically to fathers, and several external factors relating to organisational policies. Findings from this study could inform maternity health care policies, as well the development of resources, education and ongoing professional training for midwives to promote father-inclusive practice. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Pediatric Palliative Care: A Personal Story

Medline Plus

Full Text Available ... The Keeney Family discuss pediatric palliative care - Duration: 12:07. Hospice of the Western Reserve 12,073 views 12:07 Perinatal Palliative Care - The Zimmer Family Story - ...

Assessment of the Quality of Delivered Care for Iranian patients with Rheumatoid Arthritis by Using Comprehensive Quality Measurement Model in Health Care (CQMH

Directory of Open Access Journals (Sweden)

Saeed Karimi

2015-12-01

Full Text Available Introduction: Quality of care has become increasingly critical in the evaluation of healthcare and healthcare services. The aim of this study was to assess quality of delivered care among patients with rheumatoid arthritis using a model of Comprehensive Quality Measurement in Health Care (CQMH. Methods: This cross-sectional study was conducted on 172 patients with rheumatoid arthritis (RA who were received care from private clinics of Isfahan University of medical sciences in 2013. CQMH questionnaires were used for assessing the quality of care. Data were analyzed using SPSS for Windows. Results: The mean scores of Quality Index, Service Quality (SQ, Technical Quality (TQ, and Costumer Quality (CQ were 72.70, 79.09, 68.54 and 70.25 out of 100, respectively. For CQ only 19.8% of participations staying the course of action even under stress and financial constraints, there is a significant gap between what RA care they received with what was recommended in the guideline for TQ. Scores of service quality was low in majority of aspects especially in "availability of support group" section. Conclusion: Study shows paradoxical findings and expresses that quality scores of service delivery for patients with arthritis rheumatoid from patient's perspective is relatively low. Therefore, for fixing this paradoxical problem, improving the participation of patients and their family and empowering them for self-management and decision should be regarded by health systems.

Perinatal sources of stem cells

Directory of Open Access Journals (Sweden)

Magdalena Maria Piskorska-Jasiulewicz

2015-03-01

Full Text Available Recently, stem cell biology has become an interesting topic. Several varieties of human stem cells have been isolated and identified in vivo and in vitro. Successful application of hematopoietic stem cells in hematology has led to the search for other sources of stem cells and expanding the scale of their application. Perinatal stem cells are a versatile cell population, and they are interesting for both scientific and practical objectives. Stem cells from perinatal tissue may be particularly useful in the clinic for autologous transplantation for fetuses and newborns, and after banking in later stages of life, as well as for in utero transplantation in the case of genetic disorders. In this review paper we focus on the extraction and therapeutic potential of stem cells derived from perinatal tissues such as the placenta, the amnion, amniotic fluid, umbilical cord blood and Wharton’s jelly.

"Quality of prenatal and maternal care: bridging the know-do gap" (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa.

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Blank, Antje; Prytherch, Helen; Kaltschmidt, Jens; Krings, Andreas; Sukums, Felix; Mensah, Nathan; Zakane, Alphonse; Loukanova, Svetla; Gustafsson, Lars L; Sauerborn, Rainer; Haefeli, Walter E

2013-04-10

Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline "Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice". The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on

Perinatal Mortality Trends in Ethiopia | Berhan | Ethiopian Journal of ...

African Journals Online (AJOL)

BACKGROUND: Although the magnitude of perinatal mortality in Ethiopia was among the highest in Sub Saharan Africa, there was no systematic review done to assess the trend and causes of perinatal death. The objective of this review was to assess the trend of perinatal mortality rate (PMR) and the causes attributed to ...

A dementia care management intervention: which components improve quality?

Science.gov (United States)

Chodosh, Joshua; Pearson, Marjorie L; Connor, Karen I; Vassar, Stefanie D; Kaisey, Marwa; Lee, Martin L; Vickrey, Barbara G

2012-02-01

To analyze whether types of providers and frequency of encounters are associated with higher quality of care within a coordinated dementia care management (CM) program for patients and caregivers. Secondary analysis of intervention-arm data from a dementia CM cluster-randomized trial, where intervention participants interacted with healthcare organization care managers (HOCMs), community agency care managers (CACMs), and/ or healthcare organization primary care providers (HOPCPs) over 18 months. Encounters of 238 patient/caregivers (dyads) with HOCMs, CACMs, and HOPCPs were abstracted from care management electronic records. The quality domains of assessment, treatment, education/support, and safety were measured from medical record abstractions and caregiver surveys. Mean percentages of met quality indicators associated with exposures to each provider type and frequency were analyzed using multivariable regression, adjusting for participant characteristics and baseline quality. As anticipated, for all 4 domains, the mean percentage of met dementia quality indicators was 15.5 to 47.2 percentage points higher for dyads with HOCM--only exposure than for dyads with none (all P < .008); not anticipated were higher mean percentages with increasing combinations of provider-type exposure-up to 73.7 percentage points higher for safety (95% confidence interval 65.2%-82.1%) with exposure to all 3 provider types compared with no exposure. While greater frequency of HOCM-dyad encounters was associated with higher quality (P < .04), this was not so for other provider types. HOCMs' interactions with dyads was essential for dementia care quality improvement. Additional coordinated interactions with primary care and community agency staff yielded even higher quality.

Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey.

Science.gov (United States)

Aeyels, Daan; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Coeckelberghs, Ellen; Bruyneel, Luk; Vanhaecht, Kris

2017-12-13

Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.

Preventing Workplace Injuries Among Perinatal Nurses.

Science.gov (United States)

Harolds, Laura; Hurst, Helen

2016-01-01

Many aspects of perinatal nursing put nurses at risk for injuries, including frequent repetitive bending, lifting of clients, and exposure to potentially large amounts of body fluids such as blood and amniotic fluid. Violence is also a potential risk with stressful family situations that may arise around childbirth. Workplace injuries put a health care facility at risk for staff turnover, decreases in the number of skilled nurses, client dissatisfaction, workers' compensation payouts, and employee lawsuits. Through the use of safety equipment, improved safety and violence training programs, "no manual lift" policies, reinforcement of personal protective equipment usage, and diligent staff training to improve awareness, these risks can be minimized. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

Maternal Pseudo-Bartter Syndrome Associated with Severe Perinatal Brain Injury.

Science.gov (United States)

Vora, Shrenik; Ibrahim, Thowfique; Rajadurai, Victor Samuel

2017-09-15

Maternal electrolyte imbalance is rarely reported as causative factor of severe perinatal brain injury. This case outlines a unique maternal and neonatal pseudo-Bartter syndrome presented with metabolic alkalosis and hypochloremia due to maternal severe vomiting. Neonatal MRI brain revealed extensive brain hemorrhages with porencephalic cysts. Subsequent investigation workup points towards maternal severe metabolic alkalosis as its cause. Careful medical attention should be paid to pregnant women with excessive vomiting to ensure a healthy outcome for both the mother and the baby.

Surgical adverse outcomes and patients' evaluation of quality of care: inherent risk or reduced quality of care?

Science.gov (United States)

Marang-van de Mheen, Perla J; van Duijn-Bakker, Nanny; Kievit, Job

2007-12-01

Previous research has shown that sicker patients are less satisfied with their healthcare, but specific effects of adverse health outcomes have not been investigated. The present study aimed to assess whether patients who experience adverse outcomes, in hospital or after discharge, differ in their evaluation of quality of care compared with patients without adverse outcomes. In hospital adverse outcomes were prospectively recorded by surgeons and surgical residents as part of routine care. Four weeks after discharge, patients were interviewed by telephone about the occurrence of post-discharge adverse outcomes, and their overall evaluation of quality of hospital care and specific suggestions for improvements in the healthcare provided. Of 2145 surgical patients admitted to the Leiden University Medical Center in 2003, 1876 (88%) agreed to be interviewed. Overall evaluation was less favourable by patients who experienced post-discharge adverse outcomes only (average 19% lower). These patients were also more often dissatisfied (OR 2.02, 95% CI 1.24 to 3.31) than patients without adverse outcomes, and they more often suggested that improvements were needed in medical care (OR 2.07, 1.45 to 2.95) and that patients were discharged too early (OR 3.26, 1.72 to 6.20). The effect of in hospital adverse outcomes alone was not statistically significant. Patients with both in hospital and post-discharge adverse outcomes also found the quality of care to be lower (on average 33% lower) than patients without adverse outcomes. Post-discharge adverse outcomes negatively influence patients' overall evaluation of quality of care and are perceived as being discharged too early, suggesting that patients need better information at discharge.

Does integrated care lead to both improved service quality and lower care cost

Science.gov (United States)

Waldeyer, Regina; Siegel, Achim; Daul, Gisela; Gaiser, Karin; Hildebrandt, Helmut; Köster, Ingrid; Schubert, Ingrid; Stunder, Brigitte; Stützle, Yvonne

2010-01-01

Purpose and context ‘Gesundes Kinzigtal’ is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications. The management company and its contracting partners (the physicians’ network in the region and two statutory health insurers) strive to reach a higher quality of care at a lower overall cost as compared with the German standard. During its first two years of operation (2006–2007), the Kinzigtal project achieved surprisingly positive financial results compared with its reference value. To gain independent evidence on the quality aspects of the system, the management company and its partners provided a remarkable budget for its evaluation by independent scientific institutions. Case description and data sources We will present interim results of a population-based controlled cohort study. In this study, quality of care is checked by relying on health and service quality indicators that have been constructed from health insurers’ administrative data (claims data). Interim results are presented for the intervention region (Kinzigtal area) and the control region (the rest of Baden-Württemberg, i.e., Southwest Germany). Preliminary conclusions and discussion The evaluation of ‘Gesundes Kinzigtal’ is in full progress. Until now, there is no evidence that the surprisingly positive financial results of the Kinzigtal system have been achieved at the expense of care quality. Rather, Gesundes Kinzigtal Integrated Care seems to be about to increasingly realize comparative advantages regarding health service quality (in comparison to the control region).

Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review.

Science.gov (United States)

Ford, Elizabeth; Shakespeare, Judy; Elias, Fatin; Ayers, Susan

2017-02-01

Perinatal anxiety and depression are widespread, with up to 20% of women affected during pregnancy and after birth. In the UK, management of perinatal mental health falls under the remit of general practitioners (GPs). We reviewed the literature on GPs' routine recognition, diagnosis and management of anxiety and depression in the perinatal period. A systematic search of Embase, Medline, PsycInfo, Pubmed, Scopus and Web of Science was conducted. Studies were eligible if they reported quantitative measures of GPs' or Family Physicians' assessment, recognition and management of anxiety or depression in pregnancy or post-partum. Thirteen papers, reporting 10 studies, were identified from the United States, Australia, UK, Netherlands and Canada. All reported on depression; two included anxiety disorders. Reported awareness and ability to diagnose perinatal depression among GPs was high. GPs knew about and used screening tools in the UK but less so in US settings. Antidepressants were the first line of treatment, with various SSRIs considered safest. Counseling by GPs and referrals to specialists were common in the post-natal period, less so in pregnancy. Treatment choices were determined by resources, attitudes, knowledge and training. Data on GPs' awareness and management of perinatal depression were sparse and unlikely to be generalizable. Future directions for research are proposed; such as exploring the management of anxiety disorders which are largely missing from the literature, and understanding more about barriers to disclosure and recognition in primary care. More standardized training could help to improve recognition and management practices. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Evidence-based medicine and quality of care.

Science.gov (United States)

Dickenson, Donna; Vineis, Paolo

2002-01-01

In this paper we set out to examine the arguments for and against the claim that Evidence-Based Medicine (EBM) will improve the quality of care. In particular, we examine the following issues: 1. Are there hidden ethical assumptions in the methodology of EBM? 2. Is there a tension between the duty of care and EBM? 3. How can patient preferences be incorporated into quality guidelines and effectiveness studies? 4. Is there a tension between the quality of a particular intervention and overall quality of care? 5. Are certain branches of medicine and patient groups innately or prima facie disadvantaged by a shift to EBM? In addition we consider a case study in the ethics of EBM, on a clinical trial concerning the collection of umbilical cord blood in utero and ex utero, during or after labour in childbirth.

A systematic review of perinatal depression interventions for adolescent mothers.

Science.gov (United States)

Lieberman, Kate; Le, Huynh-Nhu; Perry, Deborah F

2014-12-01

Poor, adolescent, racial/ethnic minority women are at great risk for developing perinatal depression. However, little research has been conducted evaluating interventions for this population. We conducted a systematic review of preventive and treatment interventions for perinatal depression tested with adolescents, with a focus on low income, minority populations. Nine research-based articles (including one that reported on two studies) were reviewed systematically, and quality ratings were assigned based on a validated measure assessing randomization, double-blinding, and reporting of participant withdrawals. Two treatment studies were identified, both of which were successful in reducing depression. Eight prevention studies were located, of which four were more efficacious than control conditions in preventing depression. Studies sampled mostly minority, low socioeconomic status adolescents. No consistent characteristics across efficacious interventions could be identified. This review underscores the need for researchers to further investigate and build an evidence base. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Trends in perinatal health after assisted reproduction

DEFF Research Database (Denmark)

Henningsen, Anna-Karina Aaris; Gissler, M.; Skjaerven, R.

2015-01-01

STUDY QUESTIONS Has the perinatal outcome of children conceived after assisted reproductive technology (ART) improved over time? SUMMARY ANSWER The perinatal outcomes in children born after ART have improved over the last 20 years, mainly due to the reduction of multiple births. WHAT IS KNOWN...... with ART outcome and health data from Denmark, Finland, Norway and Sweden. PARTICIPANTS, SETTING AND METHODS We analysed the perinatal outcome of 62 379 ART singletons and 29 758 ART twins, born from 1988 to 2007 in four Nordic countries. The ART singletons were compared with a control group of 362 215...

Postacute rehabilitation quality of care: toward a shared conceptual framework.

Science.gov (United States)

Jesus, Tiago Silva; Hoenig, Helen

2015-05-01

There is substantial interest in mechanisms for measuring, reporting, and improving the quality of health care, including postacute care (PAC) and rehabilitation. Unfortunately, current activities generally are either too narrow or too poorly specified to reflect PAC rehabilitation quality of care. In part, this is caused by a lack of a shared conceptual understanding of what construes quality of care in PAC rehabilitation. This article presents the PAC-rehab quality framework: an evidence-based conceptual framework articulating elements specifically pertaining to PAC rehabilitation quality of care. The widely recognized Donabedian structure, process, and outcomes (SPO) model furnished the underlying structure for the PAC-rehab quality framework, and the International Classification of Functioning, Disability and Health (ICF) framed the functional outcomes. A comprehensive literature review provided the evidence base to specify elements within the SPO model and ICF-derived framework. A set of macrolevel-outcomes (functional performance, quality of life of patient and caregivers, consumers' experience, place of discharge, health care utilization) were defined for PAC rehabilitation and then related to their (1) immediate and intermediate outcomes, (2) underpinning care processes, (3) supportive team functioning and improvement processes, and (4) underlying care structures. The role of environmental factors and centrality of patients in the framework are explicated as well. Finally, we discuss why outcomes may best measure and reflect the quality of PAC rehabilitation. The PAC-rehab quality framework provides a conceptually sound, evidence-based framework appropriate for quality of care activities across the PAC rehabilitation continuum. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Op weg naar de landelijke invoering van perinatale audit

NARCIS (Netherlands)

Leeman LD; Waelput AJM; Eskes M; Achterberg PW; VTV

2007-01-01

In the near future perinatal audit will start in the Netherlands, with a systematic critical analysis of the quality of care of perinatal mortality. The National Institute for Public Health and the Environment designed a plan for the implementation of perinatal audit. The slower decline of perinatal

Nationwide quality improvement in lung cancer care

DEFF Research Database (Denmark)

Jakobsen, Erik Winther; Green, Anders; Oesterlind, Kell

2013-01-01

To improve prognosis and quality of lung cancer care the Danish Lung Cancer Group has developed a strategy consisting of national clinical guidelines and a clinical quality and research database. The first edition of our guidelines was published in 1998 and our national lung cancer registry...... was opened for registrations in 2000. This article describes methods and results obtained by multidisciplinary collaboration and illustrates how quality of lung cancer care can be improved by establishing and monitoring result and process indicators....

The analysis of perinatal morbidity and mortality in conditions of perinatal center and the ways of its decrease

Directory of Open Access Journals (Sweden)

Нана Мерабівна Пасієшвілі

2016-01-01

Full Text Available Aim of research. The analysis of perinatal morbidity and mortality in the condition of one perinatal center of Ukraine and optimization of the possible ways of its decrease.Methods of research. There was analyze the work of Kharkiv regional center in 2011–2015 years taking into account the rates of perinatal morbidity and mortality and factors that have influence on it. There were studied the next parameters: the number of newborns, its apportionment on the weight category, survival, general morbidity, mortality structure of the full-term and premature children. Statistical processing of the received results was carried out using Statistica 6.0 program.Results of research. The frequency of normal delivery in perinatal center is in average 58,9 %. The rates of neonatal mortality decreased– 4,11 ‰ (in 2011 year – 8,23 ‰ and early neonatal one – 3,34 ‰ (in 2011 year – 6,44 ‰. The survival of newborns with extremely low body weight (500- 999 g in first 0-168 hours was 62,50 %; with body weight 1000 – 1499 g – 82,35 %; with body weight at delivery 1500-2499 g was 98,17 %, survival of newborns with body weight > 2500 g in the first 0-6 days was 99,75 % .The morbidity structure of full-term children still almost unchangeable during the last 5 years: asphyxia, congenital defects of development, arrest of foetus growth, cerebral ischemia, intrauterine infection, birth trauma. The morbidity structure of premature ones: respiratory disorder syndrome, intrauterine infection; asphyxia, congenital defects of development, arrest of foetus growth.Among the mortality causes the main ones were congenial defects of development (prevailed in full-term children and intrauterine infection (on the first place in premature children. The perinatal mortality rate in 2015 year was 18,22 %о, in 2011year – 26,65 %о . The maternal foetus infection is the very frequent cause of stillbirth and pre-term birth and as the result the birth of small

Monitoring quality in Israeli primary care: The primary care physicians' perspective

Directory of Open Access Journals (Sweden)

Nissanholtz-Gannot Rachel

2012-06-01

Full Text Available Abstract Background Since 2000, Israel has had a national program for ongoing monitoring of the quality of the primary care services provided by the country's four competing non-profit health plans. Previous research has demonstrated that quality of care has improved substantially since the program's inception and that the program enjoys wide support among health plan managers. However, prior to this study there were anecdotal and journalistic reports of opposition to the program among primary care physicians engaged in direct service delivery; these raised serious questions about the extent of support among physicians nationally. Goals To assess how Israeli primary care physicians experience and rate health plan efforts to track and improve the quality of care. Method The study population consisted of primary care physicians employed by the health plans who have responsibility for the quality of care of a panel of adult patients. The study team randomly sampled 250 primary-care physicians from each of the four health plans. Of the 1,000 physicians sampled, 884 met the study criteria. Every physician could choose whether to participate in the survey by mail, e-mail, or telephone. The anonymous questionnaire was completed by 605 physicians – 69% of those eligible. The data were weighted to reflect differences in sampling and response rates across health plans. Main findings The vast majority of respondents (87% felt that the monitoring of quality was important and two-thirds (66% felt that the feedback and subsequent remedial interventions improved medical care to a great extent. Almost three-quarters (71% supported continuation of the program in an unqualified manner. The physicians with the most positive attitudes to the program were over age 44, independent contract physicians, and either board-certified in internal medicine or without any board-certification (i.e., residents or general practitioners. At the same time, support for the

Headache service quality: evaluation of quality indicators in 14 specialist-care centres.

Science.gov (United States)

Schramm, Sara; Uluduz, Derya; Gouveia, Raquel Gil; Jensen, Rigmor; Siva, Aksel; Uygunoglu, Ugur; Gvantsa, Giorgadze; Mania, Maka; Braschinsky, Mark; Filatova, Elena; Latysheva, Nina; Osipova, Vera; Skorobogatykh, Kirill; Azimova, Julia; Straube, Andreas; Eren, Ozan Emre; Martelletti, Paolo; De Angelis, Valerio; Negro, Andrea; Linde, Mattias; Hagen, Knut; Radojicic, Aleksandra; Zidverc-Trajkovic, Jasna; Podgorac, Ana; Paemeleire, Koen; De Pue, Annelien; Lampl, Christian; Steiner, Timothy J; Katsarava, Zaza

2016-12-01

The study was a collaboration between Lifting The Burden (LTB) and the European Headache Federation (EHF). Its aim was to evaluate the implementation of quality indicators for headache care Europe-wide in specialist headache centres (level-3 according to the EHF/LTB standard). Employing previously-developed instruments in 14 such centres, we made enquiries, in each, of health-care providers (doctors, nurses, psychologists, physiotherapists) and 50 patients, and analysed the medical records of 50 other patients. Enquiries were in 9 domains: diagnostic accuracy, individualized management, referral pathways, patient's education and reassurance, convenience and comfort, patient's satisfaction, equity and efficiency of the headache care, outcome assessment and safety. Our study showed that highly experienced headache centres treated their patients in general very well. The centres were content with their work and their patients were content with their treatment. Including disability and quality-of-life evaluations in clinical assessments, and protocols regarding safety, proved problematic: better standards for these are needed. Some centres had problems with follow-up: many specialised centres operated in one-touch systems, without possibility of controlling long-term management or the success of treatments dependent on this. This first Europe-wide quality study showed that the quality indicators were workable in specialist care. They demonstrated common trends, producing evidence of what is majority practice. They also uncovered deficits that might be remedied in order to improve quality. They offer the means of setting benchmarks against which service quality may be judged. The next step is to take the evaluation process into non-specialist care (EHF/LTB levels 1 and 2).

Palliative Care Specialist Consultation Is Associated With Supportive Care Quality in Advanced Cancer.

Science.gov (United States)

Walling, Anne M; Tisnado, Diana; Ettner, Susan L; Asch, Steven M; Dy, Sydney M; Pantoja, Philip; Lee, Martin; Ahluwalia, Sangeeta C; Schreibeis-Baum, Hannah; Malin, Jennifer L; Lorenz, Karl A

2016-10-01

Although recent randomized controlled trials support early palliative care for patients with advanced cancer, the specific processes of care associated with these findings and whether these improvements can be replicated in the broader health care system are uncertain. The aim of this study was to evaluate the occurrence of palliative care consultation and its association with specific processes of supportive care in a national cohort of Veterans using the Cancer Quality ASSIST (Assessing Symptoms Side Effects and Indicators of Supportive Treatment) measures. We abstracted data from 719 patients' medical records diagnosed with advanced lung, colorectal, or pancreatic cancer in 2008 over a period of three years or until death who received care in the Veterans Affairs Health System to evaluate the association of palliative care specialty consultation with the quality of supportive care overall and by domain using a multivariate regression model. All but 54 of 719 patients died within three years and 293 received at least one palliative care consult. Patients evaluated by a palliative care specialist at diagnosis scored seven percentage points higher overall (P specialist consultation is associated with better quality of supportive care in three advanced cancers, predominantly driven by improvements in information and care planning. This study supports the effectiveness of early palliative care consultation in three common advanced cancers within the Veterans Affairs Health System and provides a greater understanding of what care processes palliative care teams influence. Published by Elsevier Inc.

The effect of mobile application interventions on influencing healthy maternal behaviour and improving perinatal health outcomes: a systematic review protocol.

Science.gov (United States)