Biomedical subjects

Judith Fullerton

Publications and source records attributed to Judith Fullerton.

10 recordsLinked to original sources

PubMed2005

Pragmatic strategies that enhance the reliability of data abstracted from medical records.

The processes and procedures used to promote interrater reliability in the abstraction of data from medical records are described. Several proactive strategies that serve the purpose of leading to standard interpretations of clinical data are discussed. These include (a) establishment of priorities for the sources of information; (b) creation of orders of value for the likeliness of validity of recorded data; (c) standardization of terminology; and (d) reaffirmation of decisions, based on an evolving body of evidence. Lessons learned from this project can assist nurse researchers to develop high-quality information retrieval methods, when multiple observers (or abstractors) are used during a medical record abstraction data collection process.

Data Collection↗

PubMed2003

The International Confederation of Midwives' study of essential competencies of midwifery practice.

OBJECTIVE: To delineate the knowledge, skills, and behaviours that would characterise the domain of competencies of the midwife who is educated according to the international definition of the profession. DESIGN: Phase I: a qualitative Delphi study; Phase II: a descriptive survey research process. PARTICIPANTS: A stratified random sample of member organisations of the International Confederation of Midwives (ICM) and regulatory representatives from these same countries. FINDINGS: A list of basic (essential) and additional competencies for midwives who have been educated in keeping with the ICM/WHO/FIGO international definition of the midwife was developed through an interative Delphi process, and then affirmed, using a survey research method. The final list includes 214 individual task statements within six domains of midwifery practice. IMPLICATIONS FOR PRACTICE: This list of competencies can serve as a basis for educational curriculum design, as a guideline for regulatory policy development, as a reference document for individual practitioners in an assessment of their initial and continued competency and by the ICM and its member associations as a resource for advocating for the role of midwifery within health-care systems world-wide.

Adult↗

PubMed2003

A case/comparison study in the Eastern Region of Ghana on the effects of incorporating selected reproductive health services on family planning services.

OBJECTIVE: to assess the impact on the provision of family planning (FP) services when FP providers were also trained to provide additional, selected, reproductive health services. DESIGN: case/comparison study. PARTICIPANTS AND SETTINGS: twenty-four FP service delivery points in which training in sexually transmitted infection prevention and control services or post-abortion care services had been initiated (case facilities), were compared to 19 control facilities in which similar provider training had not yet been targeted. All settings were located in the Eastern Region of Ghana. MEASUREMENTS: service statistics for three study years (1996-1998) were reviewed. Structured interviews with providers, managers and clients provided qualitative data concerning impact and satisfaction. FINDINGS: case facilities which had integrated these additional reproductive health (RH) services experienced consistently higher numbers of clients and the total number of clients receiving FP services increased over time. There was also a statistically significant increase in continuing FP clients within case facilities. In contrast, the number of FP clients serviced in the comparison area remained basically unchanged over time. KEY CONCLUSIONS: interviews conducted with providers and managers in both types of settings indicated strong support for receipt of training to provide these integrated services and a request for additional training in an even broader array of RH and adult/child services. Clients also perceived the benefit of additional RH services and perceived these services to be of high quality. IMPLICATIONS FOR PRACTICE: expanding the repertoire of clinical skills of FP providers, enabling these practitioners to render RH services that augment basic FP services, has the potential to increase the number of new and continuing FP clients, and increases the satisfaction of both providers and consumers with respect to these services.

Abortion, Induced↗

PubMed2003

The interrelationship of maternal stress, endocrine factors and inflammation on gestational length.

Preterm birth rates continue to rise in the United States despite the advent of tocolytic agents and the identification of risk factors for preterm birth, such as vaginal infection and a shortened cervix. Although improvement in gestational-age-related survival of preterm infants has occurred as a result of the use of antenatal corticosteroids, neonatal surfactant therapy, and regionalization of perinatal care, there has been no reduction in the incidence of preterm birth. Recently, investigators have appreciated that the etiology of preterm birth is heterogeneous, perhaps accounting for one reason for the failure of current interventions to improve pregnancy outcome. Both abnormal maternal hormonal homeostasis and intrauterine inflammatory responses appear to contribute to a significant proportion of the cases of preterm birth, and the interaction of the maternal endocrine and immunologic systems may contribute to the pathophysiology of this condition. An important modulator of endocrine and immune function is perceived emotional and social stress. Maternal stress has been strongly associated with preterm birth, but the links between maternal stress and resultant aberrations of maternal endocrine and immune function remain difficult to quantify and investigate. However, new insights into the role of perceived maternal stress on gestational length suggest that specific interventions to alleviate stress could contribute to an increase in gestational length and a decrease in the risk for preterm birth. This review addresses the role of maternal stress on the regulation of maternal hormone and inflammatory responses and how aberrations in these systems may lead to preterm birth.

Acculturation↗

PubMed2003

Outcomes, safety, and resource utilization in a collaborative care birth center program compared with traditional physician-based perinatal care.

OBJECTIVE: We compared outcomes, safety, and resource utilization in a collaborative management birth center model of perinatal care versus traditional physician-based care. METHODS: We studied 2957 low-risk, low-income women: 1808 receiving collaborative care and 1149 receiving traditional care. RESULTS: Major antepartum (adjusted risk difference [RD] = -0.5%; 95% confidence interval [CI] = -2.5, 1.5), intrapartum (adjusted RD = 0.8%; 95% CI = -2.4, 4.0), and neonatal (adjusted RD = -1.8%; 95% CI = -3.8, 0.1) complications were similar, as were neonatal intensive care unit admissions (adjusted RD = -1.3%; 95% CI = -3.8, 1.1). Collaborative care had a greater number of normal spontaneous vaginal deliveries (adjusted RD = 14.9%; 95% CI = 11.5, 18.3) and less use of epidural anesthesia (adjusted RD = -35.7%; 95% CI = -39.5, -31.8). CONCLUSIONS: For low-risk women, both scenarios result in safe outcomes for mothers and babies. However, fewer operative deliveries and medical resources were used in collaborative care.

Adult↗

PubMed2002

Predicting risk of preterm birth: the roles of stress, clinical risk factors, and corticotropin-releasing hormone.

The relationships and predictive abilities of perceived stress, selected clinical risk factors, and corticotropin-releasing hormone (CRH) levels in maternal plasma were investigated for their association with preterm labor (PTL), preterm birth, and gestational age at delivery. An exploratory, prospective, longitudinal research design was used to measure CRH 4 times over pregnancy, perceived stress at 24 and 32 weeks of pregnancy, clinical risk factors, and genitourinary infections in low-income women. Multiple regression analyses revealed that a model of measurement ofperceived stress at 24 or 32 weeks, CRH at 24 or 32 weeks, and PTL (indicated by a diagnosis by the physicians on the medical record and greater than 5 contractions per hour on the fetal monitor) was predictive of as much as 0.23 to 0.27 of the variance in gestational age at birth. Entering ethnicity as a variable into a model did not improve the predictive value. An analysis of variance between Caucasian and Hispanic ethnic groups revealed differences in CRH levels. However, simple regression analysis of ethnicity as a predictor showed a weak r2 with no significance for prediction. There was some evidence of an association of smoking with stress and both PTL and preterm birth. The measurement of stress combined with the measurement of CRHfrom maternal plasma may improve the prediction of which pregnant women are at riskfor pretern birth. The measurement of CRH has potential as an early biological marker of preterm birth.

Adult↗

PubMedDate not supplied

Findings from the analysis of the American College of Nurse-Midwives' membership surveys: 2000-2003.

Findings from the American College of Nurse-Midwives (ACNM) membership data provide descriptive information about selected characteristics of certified nurse-midwives (CNMs), certified midwives (CMs), and students enrolled in ACNM-accredited programs who are members of the organization. This article presents findings from the analysis of membership data for the years 2000 to 2003. Members remain predominantly white and female, with their age averaging in the mid-40s. Similarly, student demographics reflect little change from those reported in prior years. Students are primarily white, female, and in the mid-30s. Proportionately, there has been little increase in the diversity of members. The proportion of CNMs/CMs with a bachelor's degree continues to rise, as does the proportion of CNMs/CMs holding doctoral degrees. The majority of CNMs/CMs identified a broad domain of clinical midwifery practice as their primary responsibility in their primary employment, and hospitals remain the largest employer of responding midwives. The salaries of employed midwives appear to be increasing, although the modal salary (60,000 US dollars to 69,000 US dollars ) is unchanged from prior years. The profile of the membership has remained fairly constant, with small changes in the trend over time noted for age, employment patterns, and attendance at birth sites for the 4 years analyzed.

Adult↗

PubMedDate not supplied

Presidential priorities: 50 years of wisdom as the basis of an action agenda for the next half-century.

Each of the living presidents of the American College of Nurse-Midwives (ACNM), past and current, was asked to select one or more issues that were of particular importance during her term(s) in office. Some of the issues identified by the presidents were amenable to review using existing quantitative data; this article presents those findings. The substantial increase in growth of ACNM membership in the 1980s and 1990s as well as the plateau that occurred at the beginning of the 21st century is documented. The relationship between ACNM and the professions of nursing, medicine, and other public health providers is illustrated. The increase in the number of Certified Nurse-Midwife/Certified Midwife (CNM/CM) education programs and the evolution and current profile of curriculum models are discussed. Finally, expansion of the scope of midwifery practice and the growing number of opportunities for entrepreneurial practice are presented in terms of current practice profiles, practice sites and settings, various employer-employee relationships, and the variety of financial reimbursement streams. This article is intended to complement the broader body of information about ACNM's history, and particularly, to supplement the richness of information derived from the qualitative and historical research inquiries conducted by others.

Adult↗

PubMedDate not supplied

The 1999-2000 task analysis of American nurse-midwifery/midwifery practice.

A master list of tasks, which contained 200 task statements, 23 professional issues statements, and 177 clinical conditions, was divided into three equivalent survey forms and distributed to those certified nurse-midwives (CNMs) and certified midwives (CMs) certified by the ACNM Certification Council, Inc. during the 5-year period from 1995 to 1999. Specific efforts were made to encourage the participation of CMs, because they represented a new professional cohort. A total of 627 valid responses were obtained. Reasonably similar numbers of respondents contributed data related to each of the three versions of the survey form. The responsibilities have expanded substantially within the domains of nonreproductive primary health care and gynecologic care of the well woman, including advances in assisted reproductive technology. A diminished emphasis on the CNM/CM role in the provision of newborn care was documented. The ACC Research Committee recommended the revision of the entry-level certification examination blueprint, and this was approved by the ACC Board of Directors. The specific recommendations included the development of a new primary care domain and the reconfiguration of content emphasis with percentage allocations as follows: Primary Care, 5-10%; Well-Woman/Gynecology, 15-20%; Newborn, 5-10%; Postpartum, 5-10%; Antepartum, 25-30%; Intrapartum, 25-35%; Professional Issues, up to 5%.

Adult↗

PubMedDate not supplied

The utility of fFN for the prediction of preterm birth in twin gestations.

OBJECTIVE: To determine the sensitivity, specificity, and positive predictive value (PPV) of fetal fibronectin (fFN) and to determine its usefulness, in conjunction with selected other clinical assessment measures, in the prediction of preterm birth for women with twin gestations. DESIGN: A prospective, descriptive, longitudinal design. SETTING: An obstetrical high-risk clinic that received patient referrals from several surrounding communities in central Texas. PATIENTS/PARTICIPANTS: Forty-eight women identified with twin gestations prior to the 22nd week of pregnancy; primarily of Hispanic ethnicity. MAIN OUTCOME MEASURES: A substantial number of outcome variables were assessed in this study. In the present report, data derived from weekly assessments for the identification of the presence of fFN, the diagnosis of bacterial vaginosis, and the measurement of cervical length were reviewed for their relationship to prematurity, birth weight, birth weight discordancy and placental chorionicity. RESULTS: The relative risk of birth prior to 35 weeks gestation, fetal death, or discordance of twin birth weights of greater than 20% was 2.22 (CI: 1.09, 4.55, P < 0.015) when fFN was found to be positive at any weekly testing after 22 to 24 weeks gestation (sensitivity 76.82%, specificity 58.33%, PPV 66.7%). The presence of fFN was most highly predictive of preterm birth when performed during the 24th to 28th gestational week. Shorter cervical lengths were highly correlated with preterm birth (r = -0.6). An association between bacterial vaginosis and preterm birth was not demonstrated in this sample. CONCLUSION: Sampling for the presence of fetal fibronectin can be easily accomplished by RNs in labor triage units and by advanced practice nurses in outpatient settings. The identification of fFN, particularly during the 24 to 28 weeks gestational time frame, is highly predictive of preterm birth, and particularly so for women with twin gestations.

Adolescent↗