Search

Background: Canada’s first alongside midwifery unit (AMU) was intentionally informed by evidence-based birth environment design principals, building on the growing evidence that the built environment can shape experiences, satisfaction, and birth outcomes. Objectives: To assess the impact of the built environment of the AMU for both service users and midwives. This study aimed to explore the meanings that individuals attribute to the built environment and how the built environment impacted people’s experiences. Methods: We conducted a mixed-methods study using a grounded theory methodology for data collection and analysis. Our research question and data collection tools were underpinned by a sociospatial conceptual approach. All midwives and all those who received midwifery care at the unit were eligible to participate. Data were collected through a structured online survey, interviews, and focus group. Results: Fifty-nine participants completed the survey, and interviews or focus group were completed with 28 service users and 14 midwives. Our findings demonstrate high levels of satisfaction with the birth environment. We developed a theoretical model, where “making space” for midwifery in the hospital contributed to positive birth experiences and overall satisfaction with the built environment. The core elements of this model include creating domestic space in an institutional setting, shifting the technological approach, and shared ownership of the unit. Conclusions: Our model for creating, shifting, and sharing as a way to make space for midwifery can serve as a template for how intentional design can be used to promote favorable outcomes and user satisfaction.

Globally, midwife-led units are associated with improved clinical outcomes and childbirth satisfaction, but little is known about the impact of the model on health professionals themselves and interprofessional collaboration. The aim of this research was to describe the experiences of health professionals providing care in Canada's first Alongside Midwifery Unit.A mixed-methods evaluation exploring healthcare provider's experiences using an online survey and qualitative semi-structured interviews and focus groups.Canada's first Alongside Midwifery Unit, opened at X in 2018. In the Ontario context, the model reorganizes the way in which midwifery services are integrated in the hospital.Midwives, obstetricians, nurses, pediatricians, anesthetists, and other healthcare providers participated.82 online surveys, 17 semi-structured interviews and one focus group were completed. Providers agreed that they perceived the Alongside Midwifery Unit was a success (89%) and perceived satisfaction among those receiving care on the unit(93%). The majority of providers were satisfied working on the unit (82%) and reported greater role clarity in the new model (85%) compared to the traditional model of midwifery services. Four main themes emerged from the health professionals' perspectives regarding how the unit impacted care: promoting safety, clarifying roles, facilitating collaboration, and managing change.Overall, healthcare professionals had positive experiences working on the AMU, including improved role clarity and interprofessional relationships, and they perceived high levels of satisfaction among those giving birth on the unit. Our findings indicate the Alongside Midwifery Unit model can be beneficial for health professionals, women and birthing people.

Introduction The North of Scotland Paediatric Gastroenterology, Hepatology and Nutrition Network (NoSPGHANN) manages children over an area of 53,000 km2. Travel distances to Royal Aberdeen Children’s Hospital (RACH) were previously felt to preclude the adoption of home bowel preparation (HBP) for elective colonoscopies but a trial period of HBP commenced in March 2020. The same drugs (senna and Picolax) were used for inpatient bowel preparation (IPBP) or HBP but the timings were changed for HBP to complete all doses on the day prior to procedure to allow travel to RACH. This audit evaluates the impact of this change of practice. Methods All children undergoing elective colonoscopy at RACH between December 2019 and November 2020 were identified. Electronic were records reviewed to determine IPBP vs HBP, distance to RACH from patient’s home, bowel preparation score, morning or afternoon list, requirement for intravenous (IV) fluids during the procedure, day case procedure and length of stay. Bowel preparation score was derived from the Aronchick Scale and converted as follows: 0 (unacceptable), 1 (poor), 2 (fair), 3 (good) and 4 (excellent). Results Summary The high standard of bowel preparation achieved with IPBP was maintained when delivered at home, despite some children travelling >100 miles and having travelling times of >3 hours. Delivering all doses of drugs on the day before procedure did not affect the quality of bowel preparation for afternoon lists. There is a trend to a higher proportion of children with HBP receiving IV fluids during anaesthetic which may suggest that some are dehydrated. The proportion of day case procedures has increased from 0% to 72%, which since March 2020, has saved NHS Grampian £18,000. Conclusion Home bowel preparation delivered on day prior to procedure is well tolerated and as effective as inpatient delivered, even for children with long travelling times to hospital. Covid-19 distancing measures have reduced the number of available inpatient beds so HBP has aided bed management in addition to providing a cost saving. The risk of dehydration may be higher for HBP and guidance will be changed to increase the emphasis on oral fluid intake, including during travelling time, on day of procedure.

The safety, clinical efficacy, and cost-effectiveness of biosimilar infliximab in adult inflammatory bowel disease (IBD) have now been extensively shown. Limited data have been collected in the paediatric setting. We report nationwide, prospective, clinical safety and effectiveness data for patients from all 3 Scottish paediatric inflammatory bowel disease networks switching from originator to biosimilar infliximab. Prospective clinical data were collected for 33 patients. Information was collected from electronic patient records, laboratory reports, and patient case notes. There were no clinically significant changes to disease activity, biomarkers, antidrug antibodies, or trough drug levels (P 0.1) within a 12-month follow-up period; in addition, there were no significant adverse events reported. No infusion reactions were seen in the 264 infusions delivered. Switching from originator infliximab to the biosimilar (CT-P13) appears to be associated with neither an increase in infusion reactions nor significant loss of effectiveness in the short term.

Objective To assess the cesarean delivery (CD) rate among low-risk pregnancies before and after implementation of a hospital-based program in Canada. Methods A prospective before-and-after study was conducted to assess the effects of the CARE (CAesarean REduction) strategy, which was developed and implemented at Markham Stouffville Hospital, Toronto, ON, Canada, in 2010 to reduce CD among low-risk women. Hospital records were reviewed to identify changes in the proportions of CD performed during 12 months (April 2009–March 2010) before implementation of the CARE strategy versus 12 months after implementation (April 2012–March 2013) at Markham Stouffville Hospital and 36 hospitals of the same level in the same province. Results At the intervention hospital, 30.3% (964/3181) of women underwent CD in 2009–2010, compared with 26.4% (803/3045) in 2012–2013 (difference –3.9%, P

The First Year Experience Programme (FYE) at the University of Auckland’s Faculty of Arts is in its second year of operation. After a year of focusing on pastoral care, things were running smoothly. We were able to implement a special project in the second year focused on two significant areas of academic support which are increasingly underused by first year students: student willingness to access to university wide teaching support services; and low usage of tutor office hours when students are preparing for a major assignment. The solution was the creation of Targeted Learning Sessions which are designed to attract students in selected large year one courses to engage with an easy-access option of discipline-specific academic support. This article sets up factors influencing the conception of the project and then provides a systematic breakdown of the way in which course convenors, the First Year Experience programme, library and student learning personnel combined forces to offer students a new way of seeking academic support that was not behind a closed office door.

Background. Health care–associated, central venous catheter–related bloodstream infections (HA-BSIs) are a major cause of morbidity and mortality. Needleless connectors (NCs) are an important component of the intravenous system. NCs initially were introduced to reduce health care worker needlestick injuries, yet some of these NCs may increase HA-BSI risk. Methods. We compared HA-BSI rates on wards or intensive care units (ICUs) at 5 hospitals that had converted from split septum (SS) connectors or needles to mechanical valve needleless connectors (MV-NCs). The hospitals (16 ICUs, 1 entire hospital, and 1 oncology unit; 3 hospitals were located in the United States, and 2 were located in Australia) had conducted HA-BSI surveillance using Centers for Disease Control and Prevention definitions during use of both NCs. HA-BSI rates and prevention practices were compared during the pre-MV period, MV period, and post-MV period. Results. The HA-BSI rate increased in all ICUs and wards when SS-NCs were replaced by MV-NCs. In the 16 ICUs, the HA-BSI rate increased significantly when SS-NCs or needles were replaced by MV-NCs (6.15 vs 9.49 BSIs per 1000 central venous catheter [CVC]–days; relative risk, 1.54; 95% confidence interval, 1.37–1.74; P ! ). The 14 ICUs that switched back to SS-NCs had significant reductions in their BSI rates (9.49 vs 5.77 BSIs .001 per 1000 CVC-days; relative risk, 1.65; 95% confidence interval, 1.38–1.96; ). BSI infection prevention P ! .001 strategies were similar in the pre-MV and MV periods. Conclusions. We found strong evidence that MV-NCs were associated with increased HA-BSI rates, despite similar BSI surveillance, definitions, and prevention strategies. Hospital personnel should monitor their HA-BSI rates and, if they are elevated, examine the role of newer technologies, such as MV-NCs.

A retrospective, population-based study of patients hospitalised with the haemolytic-uraemic syndrome in Western Australia from 1980 to 1994 was undertaken to describe the epidemiology of the disease in this state. We identified 41 patients. Episodes were commonest in children under five years of age (63.4 per cent) and were more frequent in females (58.5 per cent) than in males; only one Aboriginal patient was detected. More than 90 per cent of episodes had a gastrointestinal prodrome lasting from one to 22 days; in 47.6 per cent of these episodes patients had bloody diarrhoea. The average hospital stay was 26 days, and 63.4 per cent of patients required dialysis (mean 10 days). More than 20 per cent of patients developed chronic renal failure, 9.7 per cent died, two patients developed hypertension and one child became epileptic; three of the 10 patients over 16 years of age (30 per cent) died. The haemolytic-uraemic syndrome is potentially fatal, affects mostly young children, and is usually preceded by a gastrointestinal illness. Episodes can occur in common-source outbreaks but, with the exceptions of related cases in families, that appears not to have been so in Western Australia since 1980. There is a need for increased awareness of the haemolytic-uraemic syndrome to enhance prospects for earlier detection and better clinical outcomes. Improved public health surveillance is also needed to reduce the risks of the syndrome in the community.

Background Biliary atresia (BA) is a rare, poorly understood liver disease of infancy that is fatal if not treated through early biliary drainage via the Kasai procedure. BA surgery was rationalised to three UK centres in 2002 following data supporting improved outcomes in institutions performing >5 Kasai per year. We have previously shown that outcomes in Scottish children were worse than expected in the years following initial rationalisation. Aims We aimed to expand the post-rationalisation cohort of BA cases in Scotland to examine epidemiology and outcomes. Methods Outcomes of the previously published 2002–2009 incident cohort was first expanded. New Scottish incident cases of BA born between 2010–2013, were obtained using data from specialist nurse/team knowledge. New data collection focussed on demographics, details of Kasai and outcomes (particularly 2 year transplant-free survival [2YTFS]). Accurate regional and national population data was obtained from the General Register Office for Scotland and statistics performed in R with Poisson regression analysis for incidence trends. Results 48 infants were initially identified, of whom 5 were excluded from outcome analysis (three with Kasai performed in Edinburgh, one with Conclusion BA atresia incidence appears relatively stable in Scotland but with an unexplained cluster of cases in Lanarkshire; examination of this cluster may provide epidemiological insight into disease pathogenesis Despite a significant reduction in time to Kasai, the 2YTFS in Scotland remains disappointing, is lower than the pre-rationalisation figure of 65% and is not currently an endorsement of centralisation of BA surgery in Scotland.