PubMed Health⌕ Search

Biomedical subjects

G Chance

Publications and source records attributed to G Chance.

14 recordsLinked to original sources
PubMed1998

A national survey of use of obstetric procedures and technologies in Canadian hospitals: routine or based on existing evidence?

BACKGROUND: The objective of this national survey was to describe the routine use of procedures and technologies in Canadian hospitals providing maternity care, and to determine the extent to which current use was consistent with the existing evidence and recommended guidelines for maternal and newborn care. METHODS: Representatives of 572 hospitals providing maternity care across Canada were sent questionnaires in the spring and summer of 1993; 523 (91.4%) responded. The primary outcome measures consisted of the self-reported use of obstetric procedures and technologies (perineal shaves, enemas/suppositories, intravenous infusions, initial and continuous electronic fetal heart monitoring, episiotomy rates). Hospitals were grouped according to location, size (number of live births per year), and university affiliation status. RESULTS: The hospitals in the Prairie provinces, in Quebec, and in the Atlantic provinces were significantly less likely than those in Ontario to restrict their use of perineal shaves and enemas to women on admission in labor. Small hospitals were significantly more likely than large hospitals (> 1000 live births) to restrict their use of intravenous infusions, and initial and continuous electronic fetal monitoring. The university-affiliated and nonteaching hospitals were significantly less likely than the university teaching hospitals to have episiotomy rates of less than 40 percent for primiparous women. Small hospitals were more likely than large hospitals to report episiotomy rates of less than 20 percent for multiparous women. CONCLUSIONS: Considerable variations occur in the routine use of obstetric procedures and technologies in Canadian hospitals providing maternity care, according to hospital location, size, and university affiliation status. Despite the existing evidence suggesting that the routine use of these practices and procedures is both unnecessary and potentially harmful, a significant number of Canadian hospitals continued to use them routinely in 1993.

Adult↗
PubMed1996

Do parents and professionals agree on the developmental status of high-risk infants?

OBJECTIVES: To examine the degree of agreement between parental reporting of the development of high-risk infants and professional assessment by a multidisciplinary team. METHODS: The developmental status of 196 infants discharged from neonatal intensive care units (NICUs) was assessed by their parents using the Infant Monitoring Questionnaire (IMQ) at 4, 8, or 12 months' corrected age. On the same day, a clinical assessment was done by a multidisciplinary team consisting of a developmental pediatrician, physical therapist, and psychologist. The kappa statistic was used to measure agreement between the assessments. Logistic regression was used to investigate factors that might influence agreement. RESULTS: Both the IMQ and the multidisciplinary team classified infants as developing normally ("normal"), being at risk for abnormal development ("suspect"), or developing abnormally ("abnormal"). Although the same proportion of children fell into the three categories by both assessments, parents and the multidisciplinary team showed poor agreement with respect to the classification of individual infants (kappa = 0.276). No infant or family characteristic was found to have an influence on agreement. CONCLUSIONS: For a group of high-risk infants discharged from NICUs, the agreement between parental assessment of developmental status using the IMQ and the professional assessment by a multidisciplinary team is poor in the first year of life. We do not recommend the use of this questionnaire as a substitute for clinical assessment of biologically at-risk infants discharged from NICUs. However, it may be useful for those groups of infants for whom no other information is available or as an adjunct to clinical assessment when infants are not behaving typically because of an unfamiliar setting or concurrent illness.

Adult↗
PubMed1994

Sound localization in newborn human infants.

Newborns' localization of sounds was examined in two experiments that utilized different psychophysical procedures and imposed different task demands. The results of both experiments were consistent in indicating that neonates not only differentiate the hemifield of a sound source but have some capacity to localize a sound within the hemifields. Adjustment of their initial head turn angle following a within-hemifield shift in location of an ongoing sound indicated that head orientation in neonates is elicited not only by sound onset but also by changes in location of an ongoing sound. Thus, multiple stimulus parameters impact on this neonatal response. Results are related to research on sound localization in older infants, and discussed in light of early development of the central auditory system.

Arousal↗
PubMed1991

Cerebral blood flow, cross-brain oxygen extraction, and fontanelle pressure after hypoxic-ischemic injury in newborn infants.

The relationship between mean arterial pressure, intracranial pressure, cerebral blood flow, cross-brain oxygen extraction, cerebral metabolic rate, and outcome was studied during therapy in nine neonates on 3 consecutive days after severe hypoxic-ischemic cerebral injury. Cross-brain oxygen extraction was significantly higher (5.06 +/- 0.5 vs 2.05 +/- 0.8 ml/dl; p = 0.012) in the five neonates who survived with normal neurologic outcome than in the four who died or sustained severe brain damage. In contrast, global cerebral blood flow in the five neonates with normal neurologic outcome was significantly lower (25.6 +/- 8.2 vs 83.2 +/- 44.9 ml/100 gm brain/min; p less than 0.05) during the study period. The differences in cross-brain oxygen extraction and global cerebral blood flow between infants who had neurologic recovery and those who died or sustained brain damage occurred in the presence of acceptable values for intracranial pressure, mean arterial pressure, and cerebral perfusion pressure. Our preliminary data suggest that cross-brain oxygen extraction and possibly global cerebral blood flow may be important variables associated with severe neuronal injury and death after hypoxic-ischemic cerebral injury.

Asphyxia Neonatorum↗
PubMed1984

Cord blood gases, birth asphyxia, and intraventricular haemorrhage.

The relation between intraventricular haemorrhage, Apgar scores, and cord blood gases was determined prospectively in 150 infants of 34 weeks' gestation, or less. Although there was no significant relation between birth asphyxia and subsequent haemorrhage, a consistent trend for lower Apgar scores in infants who developed haemorrhage was shown.

Apgar Score↗
PubMed1977

Is cerebral palsy a preventable disease?

The causes of cerebral palsy in 96 young patients were analyzed. Potentially avoidable situations including inappropriate obstetric management and inappropriate neonatal care occurred in 38%. There should be a shift in emphasis from the rehabilitation of cerebral palsy to its prevention by improving services for reproductive care. Prevention can be undertaken by 1) identification and referral of the mother with a high-risk pregnancy to a perinatal center for her confinement; 2) fetal monitoring and appropriate resuscitation at delivery; and 3) early transfer of compromised infants to a neonatal care unit under good supervision.

Abruptio Placentae↗
PubMedDate not supplied

Are Canadian hospitals providing family-centered maternity and newborn care?

A philosophy of family-centered maternity and newborn care requires that there be open communication between a woman, her family and health professionals; that the woman be able to choose people to support her, and have those people present during labour and birth; and that the mother and infant remain in close contact whenever possible following birth. Using data from a 1993 survey, the authors conclude that Canadian hospitals still have a long way to go before putting these ideals into practice.

Canada↗