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Biomedical subjects

A Symon

Publications and source records attributed to A Symon.

9 recordsLinked to original sources
PubMed2003

The development and pilot evaluation of a nutrition education intervention programme for pregnant teenage women (food for life).

BACKGROUND: A healthy diet in pregnancy is important for both maternal and infant health but this may be difficult to achieve particularly for groups such as teenage pregnant women, many of whom are from disadvantaged backgrounds. To our knowledge this is the first report of a practical nutrition education programme for this group in the UK. METHOD: An intervention was designed incorporating seven informal food preparation sessions, which allowed opportunities for discussion of nutritional, and other topics (e.g. food safety and well-being in pregnancy). Midwives in a community centre setting led the sessions. The acceptability of the package to participants and midwives was recorded and pre- and post-intervention data collected on sociodemographic details, dietary intake (using an eating-habits questionnaire and a 24-h dietary recall) and cooking skills. RESULTS: The midwives found the package easy to follow and use. The 16 (of the 120 invited) women who attended found the courses helpful but objective evaluation of dietary intake was not possible because of poor compliance. CONCLUSIONS: The nutrition education programme was favourably received by midwives and the women who participated. However recruitment was problematic and alternative methods of delivering and evaluating such a package should be investigated.

Adolescent↗
PubMed2000

Litigation and defensive clinical practice: quantifying the problem.

OBJECTIVE: To assess the evidence for claims about a rise in defensive clinical practice, particularly within maternity care; to describe an attempt to quantify the extent of defensive practice; and to identify areas for further research. DESIGN: Review of existing literature and a large scale postal survey. PARTICIPANTS: Over 2000 midwives and obstetricians, mostly based in Scotland. FINDINGS: Several claims have been made about the incidence of litigation, and its apparent effects on clinical practice. These effects, referred to as defensive practice, include both risk avoidance and risk-reduction strategies. Fears about recruitment to and retention within high-risk specialties have been expressed, especially in the USA. A majority of those midwives and obstetricians surveyed believed that litigation has caused a rise in defensiveness, and there was some agreement between the two groups about what constitutes defensive practice. However, there were discrepancies between the examples of defensive practice given by practitioners and what they admitted their own response to be. CONCLUSIONS: Defensiveness is believed to be fairly commonplace, but because of difficulties in defining and quantifying the concept of defensiveness it is unclear what the exact implications for clinical practice may be. Further research is required to establish this.

Data Collection↗
PubMed2000

Litigation and changes in professional behaviour: a qualitative appraisal.

OBJECTIVE: Concerns about an apparent rise in defensive clinical practice have centred on an alleged rise in intervention rates, particularly in maternity care. This, the second of two articles, explores the views of a number of clinical and other practitioners concerning defensive practices. DESIGN: Qualitative using semi-structured interviews. PARTICIPANTS: (a) midwives and obstetricians who had responded to an earlier postal survey, and (b) a purposive sample of others with experience in this area. FINDINGS: Differing views about the extent of defensive practices, and about what constitutes defensiveness, were expressed. A discussion of these, and of the findings of the survey reported in the first article, casts doubt on the view that defensive practices are necessarily detrimental. While an increase in caesarean sections was claimed, and justification of this option made, other more positive responses were also noted. KEY CONCLUSIONS: The definition and extent of defensive practice are difficult to determine. While some responses indicate that the fear of litigation leads to restrictions on client choice through interventions which are difficult to justify clinically, others claim that the same fear has improved standards of communication and documentation.

Female↗
PubMed2000

Obstetric litigation: effects on clinical practice.

Many claims concerning extent and consequences of litigation have been made, despite a lack of comprehensive and widely available data. It has been suggested that a rapidly increasing rate of litigation has caused problems in the recruitment and retention of obstetricians, and has also caused practitioners to practice 'defensively'. This article discusses meaning and significance of defensiveness within obstetrics and midwifery and quantifies the incidence of certain examples of defensive practice. Based on large-scale postal surveys of obstetricians and midwives in Scotland and England, as well as follow-up interviews, it clarifies the significance of what has become known as defensive medicine in maternity care, notably in relation to caesarean sections. It then examines the role of clinical risk management, and the growth of protocols and guidelines in particular, in trying to limit litigation.

Cesarean Section↗
PubMed1999

Media reviews

Explore the source record for details and available documents.

Journal Article↗
PubMed1998

A randomized, controlled trial of computerized physiologic trend monitoring in an intensive care unit.

OBJECTIVE: To assess whether the provision of computerized physiologic trend data could improve outcome in newborn infants requiring intensive care. DESIGN: Randomized, controlled trial, with subsidiary questionnaire studies. SETTING: Tertiary neonatal intensive care unit with 12 intensive care cots. PATIENTS: All infants admitted between January 1991 and September 1993 who were < or =32 wks gestation or >32 wks gestation, and ventilated for >4 hrs or asphyxiated. INTERVENTIONS: Randomization to one of four groups for first 7 days of life: A) no display of trend data; B) continuous display of trend data; C1) alternating 24-hr display of trend data, starting with display in first 24 hrs; and C2) alternating 24-hr display of trend data, starting with no display in first 24 hrs. MEASUREMENTS AND MAIN RESULTS: The short-term effects of monitoring on patient outcome was judged by volume of colloid given, number of blood gases taken, and by measurement taken from cranial Doppler ultrasound. Medium-term measures included time ventilated, time given supplemental oxygen, death, time to death or discharge, and cranial ultrasound at discharge. Long-term outcome was assessed by neurodevelopmental status at age 1 to 4 yrs of age. Staff and parent questionnaires assessed their respective attitudes to the introduction of this technology. None of the patient outcome measures, short-, medium-, or long-term, demonstrated any significant benefit from the provision of computerized physiologic trend monitoring. Staff questionnaires demonstrated an acceptance of the system and an improved understanding of neonatal physiology as a result of computerized physiologic trends. Parent questionnaires demonstrated increased anxiety caused by the system in 11% of parents, although only 1% of parents continued to have concerns if the system were able to help their child. CONCLUSIONS: A randomized, controlled trial was unable to demonstrate any benefit to patients resulting from the introduction of a computerized physiologic trend monitoring system. Benefits of the system have been recognized, however, in subsidiary studies, staff education, and research studies.

Attitude of Health Personnel↗
PubMed1988

The effects of propranolol on hepatic encephalopathy in patients with cirrhosis and portal hypertension.

Beta adrenoreceptor blocking drugs have been used for the prevention of haemorrhage from oesophageal varices. However, it is possible that these agents, by virtue of their effects on hepatic blood flow, may impair liver function and precipitate hepatic encephalopathy. We have therefore studied the effect of the beta blocking drug propranolol on hepatic encephalopathy in patients with cirrhosis and portal hypertension. Twenty patients were randomly assigned to receive 4 weeks treatment with propranolol or an identical-looking placebo, the former given in a dose sufficient to reduce resting pulse rate by greater than or equal to 25%. Before and after treatment patients were assessed for the severity of liver disease and the presence of encephalopathy. EEG mean cycle frequency and fasting arterial ammonia concentrations were also measured, and in order to detect latent hepatic encephalopathy, each patient underwent a battery of psychometric tests. Patients were blinded as to their treatment, as were those assessing their responses. Neither propranolol nor placebo had any significant effect on the parameters measured. On propranolol median EEG mean cycle frequency fell from 9.08 ct s-1 (range 8.63-11.0 ct s-1) to 8.73 ct s-1 (range 8.27-11.44 ct s-1), and median fasting arterial ammonia concentration fell from 66 mumol litre-1 (range 40-329 mumol litre-1) to 49 mumol litre-1 (range 37-188 mumol litre-1). Psychometric test values, while initially abnormal and suggestive of latent hepatic encephalopathy in the majority of patients, did not change significantly during the study.

Adult↗
PubMedDate not supplied

Handling premature neonates: a study using time-lapse video.

Handling procedures in the neonatal intensive care unit (NICUs) constitute a potential hazard for very pre-term infants. This study examines whether the presence of continuous physiological trend data on a cot-side monitor affects the overall length of time an infant is handled. This was done by pairing infants by gestational age and assessing the frequency and length of handling procedures, using a video recorder in time-lapse mode. No consistent correlation was found between handling duration and either continuous monitoring, gestational age, birth weight or ventilatory status. We also compare the actual numbers of handling episodes and the length of time spent being handled with the perceptions of handling among NICU staff. The study was constrained by the requirements of a larger study examining the effects of the cot-side monitors, and so numbers recruited were small and our conclusions tentative at best; however, the discrepancy between what staff thought handling rates were and what we observed indicates that there may be room for considerable improvements in the planning of care giving to very vulnerable infants.

Clinical Nursing Research↗