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  • 1
    Electronic Resource
    Electronic Resource
    The scandal of the century (1998)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 105 (1998), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1998.tb10116.x
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  • 2
    Electronic Resource
    Electronic Resource
    STORM RUNOFF PREDICTION BASED ON A SPATIALLY DISTRIBUTED TRAVEL TIME METHOD UTILIZING REMOTE SENSING AND GIS (2004)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of the American Water Resources Association 40 (2004), S. 0 
    Details
    ISSN: 1752-1688
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Architecture, Civil Engineering, Surveying , Geography
    Notes: : In this study, remotely sensed data and geographic information system (GIS) tools were used to estimate storm runoff response for Simms Creek watershed in the Etonia basin in northeast Florida. Land cover information from digital orthophoto quarter quadrangles (DOQQ), and enhanced thematic mapper plus (ETM+) were analyzed for the years 1990, 1995, and 2000. The corresponding infiltration excess runoff response of the study area was estimated using the U.S. Department of Agriculture (USDA), Natural Resources Conservation Service Curve Number (NRCS-CN) method. A digital elevation model (DEM)/GIS technique was developed to predict stream response to runoff events based on the travel time from each grid cell to the watershed outlet. A comparison of predicted to observed stream response shows that the model predicts the total runoff volume with an efficiency of 0.98, the peak flow rate at an efficiency of 0.85, and the full direct runoff hydrograph with an average efficiency of 0.65. The DEM/GIS travel time model can be used to predict the runoff response of ungaged watersheds and is useful for predicting runoff hydrographs resulting from proposed large scale changes in the land use.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1752-1688.2004.tb01051.x
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  • 3
    Electronic Resource
    Electronic Resource
    Maternity Satisfaction Studies and Their Limitations: “What Is, Must Still Be Best” (2003)
    Malden, USA : Blackwell Science Inc
    Birth 30 (2003), S. 0 
    Details
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: : Background: Health policymakers throughout the developed world are paying close attention to factors in maternity care that may influence women's satisfaction. This paper examines some of these factors in the light of observations from previous studies of satisfaction with health services.Methods: The Scottish Birth Study, a cross-sectional questionnaire survey, sought the views of all women in Scotland delivering during a 10-day period in 1998. A total of 1,137 women completed and returned questionnaires (response rate = 69%).Results: Women were overwhelmingly satisfied with their prenatal, intrapartum, and postnatal care. As is common in this type of study, reports of dissatisfaction were relatively low. However, differences occurred in satisfaction levels between subgroups; for example, the fewer the number of caregivers the woman had during childbirth, the more likely she was to be satisfied with the care received. A range of factors appeared to influence reported satisfaction levels, such as characteristics of the care provided and the woman's psychosocial circumstances.Conclusions: In addition to the inherent limitations of satisfaction studies found in the literature, problems may arise if such surveys are used uncritically to shape the future provision of maternity services, because service users tend to value the status quo over innovations of which they have no experience. Therefore, although satisfaction surveys have a role to play, we argue that they should only be used with caution, and preferably as part of an array of tools. (BIRTH 30:2 June 2003)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1523-536X.2003.00224.x
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  • 4
    Electronic Resource
    Electronic Resource
    Improving Skilled Attendance at Delivery: A Preliminary Report of the SAFE Strategy Development Tool (2003)
    Malden, USA : Blackwell Science Inc
    Birth 30 (2003), S. 0 
    Details
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract:  Background:  Increasing the proportion of births with skilled attendance is advocated by international agencies as a key factor in reducing maternal and perinatal mortality and morbidity. The SAFE Strategy Development Tool is designed to enable policy makers and planners to gather and interpret information systematically to develop strategies for improving skilled attendance at birth.Method:  Five modules were developed with partners in Bangladesh, Ghana, Jamaica, Malawi, and Mexico to guide the identification of problems related to skilled attendance, the collection of primary and secondary evidence, and the synthesis of this evidence to formulate strategies. The involvement of key players, including policy makers, is emphasized throughout the application of the tool and is vital to its success.Results:  The SAFE Strategy Development Tool was field tested in five collaborating countries. The methods employed by this tool were found to be feasible and produced evidence that will be useful in the formulation of strategies. Application of the tool can be completed in 3 to 5 months, and was estimated to cost between US$12,938 and US$15,627 for applications at district or subdistrict level. The final strategy options developed from the findings were presented at an international workshop in Aberdeen, Scotland, in February 2003.Conclusion:  The SAFE Strategy Development Tool is now available to governments, organizations, and institutions involved in the implementation of maternal health programs. (BIRTH 30:4 December 2003)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1523-536X.2003.00252.x
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  • 5
    Electronic Resource
    Electronic Resource
    A randomised controlled trial of microwave endometrial ablation without endometrial preparation in the outpatient setting: patient acceptability, treatment outcome and costs (2005)
    Oxford, UK and Malden, USA : Blackwell Science Ltd
    BJOG 112 (2005), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective  To compare outpatient microwave endometrial ablation (MEA) in the postmenstrual phase to standard MEA treatment after drug preparation in a day case theatre environment.Design  A randomised controlled trial.Setting  A large United Kingdom teaching hospital.Population  Two hundred and ten women complaining of excessive menstrual loss.Methods  Two hundred and ten women with excessive menstrual loss were randomised. Ninety-seven women were treated as outpatients in the immediate post-menstrual phase and 100 were treated in an operating theatre after hormonal preparation. All procedures were commenced under local anaesthesia with or without conscious sedation. Analysis was by modified intention to treat.Main outcome measures  Primary outcome measures were satisfaction with treatment (measured at one year) and acceptability of treatment (measured at two weeks). Secondary outcome measures were menstrual outcome and financial cost.Results  Significantly more women found treatment post-menses acceptable; 86 (89.5%) versus 76 (76.0%) [difference in proportions 13.6%, 95% CI (3.0%, 23.9%)]. Similar numbers in each arm were totally or generally satisfied with the treatment, 86 (92.5%) versus 84 (88.4%) [difference in proportions 4.1%, 95% CI (−4.7%, 12.9%)] while amenorrhoea rates at one year were comparable, 52 (55.9%) versus 60 (61.9%). [difference in proportions −5.9%, 95% CI (−19.8%, 7.6%)]. The mean health service costs were £124 (95% CI £86–194) lower for the patients in the post-menses group.Conclusion  MEA performed under local anaesthesia (with or without conscious sedation) in the post-menstrual phase achieves high levels of satisfaction is very acceptable to patients and results in significantly reduced health service costs. Importantly menstrual outcomes are not affected by omission of drug preparation. There is now good evidence to support the use of MEA, without drug endometrial preparation, in the outpatient setting.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.2005.00630.x
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  • 6
    Electronic Resource
    Electronic Resource
    Midwife-led care (1997)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 104 (1997), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1997.tb11488.x
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  • 7
    Electronic Resource
    Electronic Resource
    Can obstetric complications explain the high levels of obstetric interventions and maternity service use among older women? A retrospective analysis of routinely collected data (2001)
    Oxford, UK : Blackwell Science Ltd
    BJOG 108 (2001), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To determine whether the higher levels of obstetric intervention and maternity service use among older women can be explained by obstetric complications.Design A retrospective analysis of routinely collected data from the Aberdeen Maternity and Neonatal Databank.Participants All residents of Aberdeen city district delivering singleton infants at the Maternity Hospital 1988-1997 (28,484 deliveries).Main outcome measures Odds ratios for each intervention in older maternal age groups compared with women aged 20-29. Interventions considered include obstetric interventions (induction of labour, augmentation, epidural use, assisted delivery, caesarean section) and raised maternity service use (more than two prenatal scans, amniocentesis, antenatal admission to hospital, admission at delivery of more than five days, infant resuscitation, and admission to the neonatal unit).Methods Logistic regression was used to investigate the association between maternal age and the incidence of interventions. The odds ratios for each intervention were then adjusted for relevant obstetric complications and maternal socio-demographic characteristics.Results Levels of amniocentesis, caesarean section, assisted delivery, induction, and augmentation (in primiparae) are all higher among older women. Maternity service use also increases significantly with age: older women are more likely to have an antenatal admission, more than two scans, a hospital stay at delivery of more than five days, and have their baby admitted to a neonatal unit. Controlling for relevant obstetric complications reveals several examples of effect modification, but does not eliminate the age effect for most interventions in most groups of women.Conclusions Higher levels of intervention among older women are not explained by the obstetric complications we considered.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.2001.00214.x
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  • 8
    Electronic Resource
    Electronic Resource
    The cost of microwave endometrial ablation under different anaesthetic and clinical settings (2003)
    Oxford, UK : Blackwell Science Ltd
    BJOG 110 (2003), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To compare the costs of microwave endometrial ablation under local anaesthetic and general anaesthetic in an operating theatre and to estimate the cost of performing treatment under local anaesthetic in a dedicated clinic setting.Design The costing study was undertaken alongside a randomised controlled trial comparing the acceptability of microwave endometrial ablation using local versus general anaesthetic in a theatre setting.Setting Department of Gynaecology, Aberdeen Royal Infirmary, Scotland.Sample One hundred and twenty-seven women undergoing microwave endometrial ablation who had been randomly allocated to general or local anaesthetic.Methods Health and non-health service resource use was recorded prospectively. Data on resource use were combined with unit costs estimated using standardised methods to determine the cost per patient for microwave endometrial ablation under local or general anaesthetic in theatre. A model was developed to estimate the health service cost of microwave endometrial ablation under local anaesthetic in a clinic setting.Main outcome measures Health and non-health service costs.Results There was little difference in cost when treatments were performed under local or general anaesthetic in theatre. The median health and non-health cost of microwave endometrial ablation was £440 and £120, respectively, under general anaesthetic and £428 and £125 per women under local anaesthetic. The health service cost of microwave endometrial ablation using local anaesthetic in a clinic setting was estimated to be £432 per treatment; however, this varied from £389 to £491 in the sensitivity analysis.Conclusion There are minimal cost savings to the patient or health service from using local rather than general anaesthetic for microwave endometrial ablation in a theatre setting. Cost modelling suggests that in a clinic setting microwave endometrial ablation has a similar cost to theatre based treatment once re-admissions for treatment under general anaesthetic are considered. Sensitivity analysis indicated that these findings were sensitive to assumptions in the model.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.2003.02179.x
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  • 9
    Electronic Resource
    Electronic Resource
    The importance of conducting and reporting pilot studies: the example of the Scottish Births Survey (2001)
    Oxford UK : Blackwell Science Ltd
    Journal of advanced nursing 34 (2001), S. 0 
    Details
    ISSN: 1365-2648
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The importance of conducting and reporting pilot studies: the example of the Scottish Births Survey Background.  In many research papers, pilot studies are only reported as a means of justifying the methods. This justification might refer to the overall research design, or simply to the validity and reliability of the research tools. It is unusual for reports of pilot studies to include practical problems faced by the researcher(s). Pilot studies are relevant to best practice in research, but their potential for other researchers appears to be ignored. Objective.  The primary aim of this study was to identify the most appropriate method for conducting a national survey of maternity care. Methods.  Pilot studies were conducted in five hospitals to establish the best of four possible methods of approaching women, distributing questionnaires and encouraging the return of these questionnaires. Variations in the pilot studies included (a) whether or not the questionnaires were anonymous, (b) the staff involved in distributing the questionnaires and (c) whether questionnaires were distributed via central or local processes. For this purpose, five maternity hospitals of different sizes in Scotland were included. Results.  Problems in contacting women as a result of changes in the Data Protection Act (1998) required us to rely heavily on service providers. However, this resulted in a number of difficulties. These included poor distribution rates in areas where distribution relied upon service providers, unauthorized changes to the study protocol and limited or inaccurate information regarding the numbers of questionnaires distributed. Conclusions.  The pilot raised a number of fundamental issues related to the process of conducting a large-scale survey, including the method of distributing the questionnaire, gaining access to patients, and reliance on ‘gatekeepers’. This paper highlights the lessons learned as well as the balancing act of using research methods in the most optimal way under the combined pressure of time, ethical considerations and the influences of stakeholders. Reporting the kinds of practical issues that occur during pilot studies might help others avoid similar pitfalls and mistakes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2648.2001.01757.x
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  • 10
    Electronic Resource
    Electronic Resource
    Raising research awareness among midwives and nurses: does it work? (2000)
    Oxford UK : Blackwell Science Ltd
    Journal of advanced nursing 31 (2000), S. 0 
    Details
    ISSN: 1365-2648
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Raising research awareness among midwives and nurses: does it work? Objective The primary aim of the study was to evaluate the effectiveness of two approaches to increase research awareness among midwives and nurses. Design Quasi-experimental with the attitudes of staff in the two groups being measured at two points (January and October 1997). Sample All midwives and nurses working in four clinical areas in an acute NHS Trust. The intervention arm of the study involved all midwives and nurses in the Clinical Directorate of Obstetrics and Gynaecology, while the control arm involved all nurses working in a specialist oncology and haematology unit and in the children’s directorate. Ethics The Joint Ethics Committee considered approval unnecessary because the study involved staff and not patients. Data collection Data were collected by self-complete questionnaires. Interventions A programme of education with policy and practice interventions targeted at ward sisters. Outcome measures Staff attitudes to, knowledge of, and level of involvement in, research. Results The study demonstrated a significant increase in both knowledge and use of research resources. Following the programme of education, staff in the intervention group were significantly more likely to use resources associated with research utilization and to report that they had read a research paper within the last month. Study limitations The time scale of the intervention was restricted by the funding available; a significant Hawthorne effect was evident with both groups showing an increase in knowledge; the pragmatic nature of the study meant that it was not possible to randomize the study groups; the scale of the study did not permit an economic evaluation. Conclusions The introduction of clinical governance challenges healthcare providers to improve the care they deliver. There are huge opportunities for Trusts to invest in developing staff knowledge and use of research. However, staff will only seize these opportunities if there is an appropriate, enabling environment — an environment that delivers intensive interventions and is sensitive to the wider structural factors in the NHS affecting staff morale and commitment. In the absence of this environment, what may be seen as opportunities to managers may be regarded as just another burden by staff.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2648.2000.01257.x
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