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Biomedical subjects

J L Reynolds

Publications and source records attributed to J L Reynolds.

At least 37 records · Page 2Linked to original sources
PubMed1995

Reducing the frequency of episiotomies through a continuous quality improvement program.

OBJECTIVE: To determine the effectiveness of a continuous quality improvement (CQI) program in reducing episiotomy rates. DESIGN: Before-and-after study; CQI methods were used to examine the process of care during labour and birth. INTERVENTIONS: Identification of care factors that would increase the probability of episiotomy. Implementation of initiatives that would change the process of care to minimize the probability of episiotomy. Educational strategies included promotion of better understanding of what constitutes an appropriate episiotomy rate and ways to reduce maternal exhaustion and true fetal distress as well as manoeuvres to protect the perineum during birth. SETTING: Low-risk family practice obstetrics service in a tertiary care hospital in southwestern Ontario. PARTICIPANTS: All 102 family physicians at the study hospital who provided intrapartum care in the year before and the year during which the CQI program was implemented and the women for whom the care was provided (approximately 1,400 per year). OUTCOME MEASURES: Episiotomy rates (overall, among primiparous and multiparous women, and among individual family physicians) and rates of perineal tear, perineal infection and postpartum readmission. RESULTS: Although the planned reduction in the episiotomy rate was not achieved during the study period, the overall rate decreased significantly from 44.5% to 33.3% (p < 0.001). Among the primiparous women the rate decreased from 57.6% to 46.2% (p < 0.001) and among the multiparous women from 34.3% to 23.6% (p < 0.001). The reduced episiotomy rate among the primiparous women was associated with a significant decrease in the rate of third- and fourth-degree perineal tears and a significant increase in the number of women giving birth with an intact perineum or a minor (first-degree) tear. These benefits were not seen among the multiparous women, whose decreased episiotomy rate was associated with a significant increase in the number of women experiencing a second-degree perineal tear. During the intervention period, there was no increase in the rates of vaginal trauma or postpartum bleeding, infection or readmission because of complications related to perineal trauma. The episiotomy rates for most physicians decreased significantly during the intervention period. CONCLUSIONS: The CQI model may be useful in modifying clinical practices such as episiotomy because it focuses on understanding the process of care and the environment in which care is provided, both of which may have a major impact on physician behaviour. Further study is needed to ascertain the sustainability of the effects of this approach and which components of the model had the greatest effect.

Algorithms↗
PubMed1995

Factors associated with the decision of family physicians to provide intrapartum care.

OBJECTIVE: To investigate which characteristics and beliefs of family physicians determine their decision to provide intrapartum care. DESIGN: Confidential survey questionnaire mailed in spring 1993. SETTING: Alberta and Ontario. SUBJECTS: Random selection of 207 physicians who had graduated from medical school between 1953 and 1990 and were thought to be in family or general practice. Of 178 eligible physicians, usable replies were received from 104 (58.4%). OUTCOME MEASURES: Beliefs (measured on a 7-point Likert scale) about the relevance of 16 primary factors to the type of obstetric care provided; demographic, training and practice characteristics. RESULTS: The respondents who provided intrapartum care differed from those who did not in their beliefs about the availability of a local hospital suitable for intrapartum care (p < 0.001), their practice partners' views on the role of family physicians in providing obstetric care (p < 0.002), their own concept of the role of family physicians in providing obstetric care (p < 0.001) and women's views on the type of obstetric care they want (p < 0.002). They also differed, although less significantly, in their beliefs about the adequacy of their obstetric training before entering family practice (p < 0.04), the expected effects of providing obstetric care on their free time (p < 0.006), their fear of malpractice litigation (p < 0.028) and their perceived competence in performing practical obstetric procedures (p < 0.05). Logistic regression analysis revealed that certain secondary factors were particularly relevant to the respondents' provision of intrapartum care at present. These included the physician's perceived competence at managing postpartum maternal hemorrhage (odds ratio [OR] 48.90, 90% confidence interval [CI] 4.70 to 509), the belief that medical insurance premiums should not be affected by the type of obstetric care provided (OR 3.55, 90% CI 1.67 to 7.57]) and the number of practice partners who provided intrapartum care (OR 10.08, 90% CI 2.31 to 44.10). CONCLUSION: Several factors appear to influence family physicians in their decision to provide intrapartum care. This information will help to focus efforts to provide appropriate obstetric training for family practice residents and to retain involvement of family physicians in intrapartum care.

Alberta↗
PubMed1994

A field methodology for the control of musculoskeletal injuries.

A methodology is presented for the evaluation of jobs prone to cumulative trauma disorders (CTDs) and manual material handling (MMH) injuries, which combines various tested ergonomics methodologies into a single, coherent programme. This multi-step procedure is based upon the collection of quantitative data that are used to evaluate ergonomic changes with respect to biomechanical risk, perceived comfort, productivity and quality. A method for prioritizing changes, related to cost-benefit analysis, is proposed to guide the selection of ergonomic changes in order to maximize the potential for injury reduction under specified cost constraints. The ten-step methodology has been extensively applied in industry, leading to examples and a case study.

Journal Article↗
PubMed1994

Intracutaneous sterile water for back pain in labour.

Intracutaneous sterile water appears to be a simple, effective, and harmless technique for relieving back pain. This technique has been used to relieve pain of renal colic, whiplash, and back pain in labour. Family doctors often practise obstetrics in small or isolated units that have limited options for pain relief in labour. This technique is simple, is easy to learn, and appears effective for relieving back pain, which complicates about one third of all labours.

Anesthesia, Obstetrical↗
PubMed1993

Doing obstetrics and staying alive.

Many family physicians have a love-hate relationship with childbirth care and struggle to balance their personal and family needs with the need to provide high-quality personal care during labour and birth. Many false assumptions undermine family practice obstetrics. Strategies are presented to simplify obstetric care for women and families while promoting reasoned self-care for physicians.

Adaptation, Psychological↗
PubMed1992

Design and evaluation of an optical disk handling tool for a cleanroom environment.

In this paper, we present an application of engineering and ergonomics principles in the design of an optical disk handling tool for use in a cleanroom environment. A qualitative model which considers the task, operator, machines and environment (TOME model) was utilized to guide the design process. A 'before-after' evaluation found a significant improvement in the proposed tool over the existing tool with respect to mechanical, biomechanical and subjective measures. Product yield has improved considerably, as measured after the implementation of the proposed tool in December 1989 until the end of the observation period in June 1991.

Journal Article↗
PubMed1991

Minnesota workplace drug testing. Analysis of policy and procedures.

1. An employer's decision whether to drug test or not was found to correlate with the size of the company and how extensively the employer perceives a drug abuse problem exists among its work force. 2. A company's drug testing program must be designed, implemented, and evaluated within a medical-legal framework. This includes issues of: confidentiality, employee actions that trigger a drug test, the presence of a drug and alcohol policy, communicating the program to employees and unions, the employee's rights, the consequences of an employee's positive drug test, and the procedures to be followed when collecting a specimen. 3. Future studies need to explore the issue of dealing with job performance problems; in particular, the cost and effectiveness of employee drug testing vs. the use of discipline alone.

Data Collection↗
PubMed1990

Embryo research.

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Abortion, Induced↗
PubMed1990

Hearing conservation programs (HCPs): the effectiveness of one company's HCP in a 12-hr work shift environment.

An existing hearing conservation program (HCP), originally designed when an 8-hr work shift schedule was in effect, was evaluated at a plant site where a 12-hr work shift schedule is now utilized. The study included the following phases: a noise analysis of the work environment, HCP evaluation through the use of audiometric data base analysis (ADBA), applying ADBA procedures and a comparison of the shift in hearing threshold levels (HTLs) for the 8-hr and 12-hr work shifts, and an evaluation of the hearing protection devices (HPDs) being used at the facility over the 12-hr work shift by measuring temporary threshold shift (TTS). The mean measured employee time-weighted average (TWA) in the process area where the TTS study was conducted was 92 dBA. It was found that the existing HCP is at best marginal. The most likely causes of this less-than-desirable rating are inadequate audiometric testing procedures and inadequate HPD utilization. Furthermore, it was concluded that, at this time, the introduction of the 12-hr work shift has had no impact on the level of effectiveness of the HCP. In evaluating the three HPDs in use at the facility (3-M foam earplug, E-A-R foam earplug, and Bilsom Soft earplug), it was found that they all offered effective protection from noise at all audiometric test frequencies (0.5 to 6 kHz) except 0.5 kHz. All three HPDs exhibited TTS at 0.5 kHz with the TTS measured significant at the p less than 0.05 level for the E-A-R and 3-M wearer groups.

Audiometry↗
PubMed1989

Abortion USA.

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Abortion, Induced↗
PubMed1989

Precordial catch syndrome in children.

Precordial catch syndrome was diagnosed in ten children whose primary complaint was chest pain. From published reports, nine characteristics of the pain were derived and their occurrence rate determined retrospectively in the ten patients. A close correspondence in type of pain was found between patients in previous reports and those I studied. Precordial catch pain typically is sudden, brief, periapical, easily localized, nonradiating, nonexertional, and importantly, intensified by inspiration. This study further validates the syndrome, reports its occurrence in children in the United States for the first time, and indicates more certainly the pain attributes one seeks for diagnosis.

Adolescent↗
PubMed1988

General practitioner obstetrics: does risk prediction work?

The effectiveness of antenatal risk prediction based on maternal characteristics at booking was examined among 5730 pregnant women booked in an integrated general practitioner obstetric unit over a seven-year period. High rates of transfer to consultant care were found especially for nulliparae. Apart from parity, maternal factors associated with transfer before labour were weight, smoking and social class. Factors associated with transfer in labour were maternal stature and marital status. Reasons for transfer were also identified. The validity of the present booking criteria, which were developed in the 1950s, is questioned.

Adult↗
PubMed1987

Changes in the management of labour: 1. Length and management of the second stage.

An analysis of 18,940 deliveries between 1981 and 1984 in a large British obstetric unit showed marked changes in the management of the second stage of labour. These changes included an increase in the length of the second stage (especially among primiparous women), a rise in the rate of spontaneous delivery and a large decline in the rate of episiotomy. There was no change in neonatal outcome or in the rate of maternal postpartum complications. These findings may have resulted from a more conservative approach to the management of the second stage. They may also reflect a better understanding among obstetric professionals of what constitutes a normal second stage and therefore better decisions about when to act and when to wait.

Analgesia↗