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Maternal postures for foetal malposition in labour for improving the health of mothers and their infants: A Cochrane systematic review
No full textMaternal Posture for Fetal Malposition in Labour for Improving the Health of Mothers and Their Infants – A Cochrane Systematic Review
Barrowclough Jennifer¹ Kool Bridget², Hofmeyr G Justus³, Crowther Caroline¹
1The Liggins Institute, University of Auckland, Auckland, New Zealand
2Faculty of Medical Health Sciences Administration, University of Auckland, Auckland, New Zealand
3Effective Care research Unit, University of Witwatersrand, Walter Sisulu, South Africa
Email: [email protected]
Background: Fetal malposition occurs in 25% of labours. 70% of persistent malposition result in an instrumental birth associated with increased maternal and neonatal morbidity. Studies of maternal posture to facilitate anterior fetal rotation are reported but have not been systematically reviewed. The aim was to undertake such a systematic review.
Methods: A Cochrane systematic review of maternal posture in labour for fetal malposition of randomised controlled trials within the Cochrane Pregnancy and Childbirth Trials Register, ClinicalTrials.gov and the WHO ICTRP. Participants: women in labour with fetal malposition. Interventions: maternal postures compared with standard care or alternative maternal postures. Postures: maternal side lying symmetrical and asymmetrical to fetus/or with extreme hip flexion, hands and knees, standing, lying flat, squatting and others. Outcomes included: mode of birth, persistent occipito-posterior/transverse (POP/T) position, labour duration, neonatal encephalopathy, 5 minute Apgar score <7, admission neonatal intensive care. Trials were assessed for risk of bias and quality of evidence using GRADE. Subgroup analyses were planned for parity, body mass index, birth weight, and fetal position left or right.
Results: A search of literature has located 10 eligible trials (date of search 30/10/19). Data synthesis used RevMan 2014 with any significant heterogeneity explored using sensitivity analyses.
Conclusions: These findings can be used by women, their care givers and by clinical practice guideline developers to improve health for women with a fetal malposition in labour and their infants
Maternal posture for fetal malposition to improve labour and birth outcomes for mothers and their infants
No full textAim: To assess current evidence-based practice for fetal malposition in labour; to investigate
the incidence and outcomes of fetal malposition in New Zealand; and to assess the feasibility
of a randomised controlled trial (RCT) of maternal posture for fetal malposition to improve
maternal and infant health outcomes.
Methods: A Cochrane systematic review of maternal posture for fetal malposition assessed its
efficacy on health outcomes. A retrospective cohort study reviewed records and compared
outcomes of occiput-posterior/transverse and occiput-anterior fetal position in labouring
women at Auckland Hospital in 2018. A mixed method study using web-based surveys and
focus groups (midwives) assessed pregnant women and midwives’ knowledge and views on
fetal malposition and the acceptability of a future RCT of maternal posture.
Findings: Hands and knees and lateral postures had little/no effect on operative birth, serious
neonatal morbidity and other outcomes in the systematic review. However, the evidence was
judged of low/very-low certainty due to risk of bias, heterogeneity and/or imprecision. Two-thirds of the retrospective cohort of women had fetal malposition and a quarter persisted till
birth. Malposition was associated with body mass index ≥30, right-sided fetus, oxytocin
augmentation, epidural-use, longer mean first-stage labour, reduced normal birth and increased
caesarean section. Surveyed midwives mostly (80%) thought posture affects fetal position,
utilise postural changes during labour, would recommend posture if caesareans reduced, and
would collaborate with a trial. Focus-group participants (n=19) linked participation to
relevance, practice flexibility and knowledge/skill development. One-quarter thought the Sims
posture difficult for fetal monitoring. Of 206 surveyed pregnant women, 76% knew of
malposition but only 28% were aware of postural approaches to care. 37% would participate
in an RCT but half were unsure primarily related to comfort concerns, and half would consult
their partner first.
Conclusions: Further research is needed of hands and knees and lateral postures, including
semi-prone and/or same-side-as-fetus postures. Labour interventions facilitating anterior fetal
rotation could potentially improve the health of mothers. New Zealand midwives practice
flexibility of posture. Trial participation by women and midwives may be enhanced by
provision of some free movement, comfort measures and increased awareness of malposition
and the role of posture
Falls Among Community-dwelling Mid- and Older-Adults in New Zealand
No full textBackground: Falls and subsequent injuries among older adults (65 years and over) are a major
public health issue contributing to increased morbidity and mortality. Risk factors for falls
among older adults have been examined extensively over the years. However, there is a dearth
of literature regarding risk factors for falls among middle-aged adults (50 – 84 years) − the age
where the trajectory for fall rates starts to increase.
Aim and Objectives: The main aim of this thesis is to identify the risk factors for any type
(injurious and non-injurious), injurious, and recurrent falls among community-dwelling midand older-adults aged 50- 84 years in New Zealand (NZ).
Methods: A systematic review examined the published literature on risk factors for falls among
community-dwelling mid- and older-adults aged 50 years and over which informed the design
of the main analytical component of the thesis.
A secondary analysis was carried out on data collected as part of the Vitamin D Assessment
(ViDA) study; a randomised, double-blind, placebo-controlled trial that recruited 5,108 adults
aged 50-84 years in Auckland with over three years of follow-up. Data analysed included
sociodemographic, lifestyle characteristics, and medical conditions collected at the ViDA
baseline assessment. Prescription data came from the NZ Ministry of Health
Pharmaceutical Information Database. Follow-up data on self-reported falls was collected
from questionnaires mailed initially monthly, and then 4-monthly, to the home of ViDA
participants. Descriptive analyses summarised the distribution of baseline characteristics and
prescription medications. A univariate analysis utilising t-tests and chi-square tests was
conducted to investigate the cumulative fall risk (for any type of fall, injurious falls and
recurrent falls) during follow-up for participants according to different exposure levels. For
cohort analysis, cox proportional hazards and negative binomial regression (plus mean
cumulative function analysis) were used to examine the risk factors for the fall types of interest.
A test for interaction analysis was utilised to compare the relationship between factors across
the three outcome measures of interest. Directed Acyclic Graphs (DAG) were constructed to
assist with interpreting results and identifying interactions between variables and fall outcomes.
Results: 152 studies met the literature review inclusion criteria. Risk factors were classified
into five domains: socio-demographic, lifestyle, physical, medical conditions, and
pharmaceutical risk factors. The key findings revealed the following as risk factors for falls: age, sex, ethnicity (White), living alone, marital status, poor self-rated health, depression,
diabetes, stroke, angina, arthritis, pain, history of fracture, history of falls, respiratory diseases
(asthma, emphysema and shortness of breath), benzodiazepines, antiepileptic/anticonvulsant
medications, antidepressants, psychotropic medications, analgesics, diuretics, and respiratory
medications. While Black/African American was shown to have a protective effect against
falls.
Cohort analyses of the outcome ‘any type of fall’ were carried out on 5,049 participants after
excluding those who did not return a fall questionnaire during follow-up (n=52) or who were
missing time to first fall (n=7). Analyses of the outcomes ‘injurious fall’ and ‘recurrent falls’
were caried out on 5,053 participants after excluding those who did not return a fall
questionnaire during follow-up (n=52) or were missing time-dependent variables (time to
injurious fall/total no. of recurrent falls data, n=3).
Factors associated with increased hazard ratios [HR] of having any fall (all types including
injurious) were female sex [HR 1.44, p<0.0001], living alone [HR 1.16, p=0.01], stroke and/or
transient ischemic attack (TIA) [TIA only; HR 1.28, p=0.03], fall history [HR 1.77, p<0.0001],
decreased confidence to do daily activities without falling [Quite Confident: HR 1.33,
p<0.0001], arthritis [HR 1.10, p=0.03], previous fracture (or broken bone) [HR 1.10, p=0.03],
asthma [HR 1.16, p=0.01], depression [HR 1.34, p<0.0001], antiepileptic medication [HR 1.26,
p=0.02], antidepressants [HR 1.16, p=0.03], and anti-Parkinson medication [HR 1.94, p=0.02].
Medication affecting the renin angiotensin system (ARAS) and education level were the only
protective factors associated with reduced hazard of any fall [HR 0.85, p=0.001].
For injurious falls, significant risk factors included female sex [HR 1.48, p<0.0001], living
alone [HR 1.21, p=0.0004], employment [retired; HR 1.15, p=0.01], stroke and/or angina [TIA
only; HR 1.43, p=0.01], fall history [HR 1.76, p<0.0001], decreased confidence to do daily
activities without falling [Quite Confident; HR 1.33, p<0.0001], arthritis [HR 1.11, p=0.03],
previous fracture (or broken bone) [HR 1.13, p=0.01], asthma [HR 1.15, p=0.02], depression
[HR 1.31, p=0.0002], and anti-Parkinson medications [HR 2.09, p=0.003]. Ethnicity (South
Asian) [HR 0.63, p=0.004] and current smoking [HR 0.79, p=0.02] were the only factors
associated with reduced hazard of injurious falls.
Factors associated with increased incidence rate ratios [IRR] of recurrent falls included female
sex [IRR 1.17, p=0.0003], living alone [IRR 1.22, p= 0.0001], employment (retired) [IRR 1.24,
p<0.0001], heart attack and/or angina [Angina only; IRR 1.25, p=0.02], stroke and/or TIA [TIA only; IRR 1.47, p=0.0003], fall history (last four weeks) [IRR 1.92, p<0.0001], decreased
confidence to do daily activities without falling [Quite, IRR 1.49, p<0.0001; Not at all, IRR
2.14, p<0.0001], chronic pain [IRR 1.23, p<0.0001], depression [IRR 1.24, p=0.002],
antidepressants [IRR 1.18, p=0.01] and anti-Parkinson’s medications [IRR 4.07, p<0.0001].
Factors associated with reduced incidence rate of recurrent falls were ethnicity (South Asian)
[IRR 0.64, p<0.0001] and BMI (underweight and overweight) [IRR 0.40, p=0.01; HR 0.86,
p=0.002 respectively].
A test for interaction indicated that the hazard/rate of falls was consistent across all three fall
outcomes, and the following are the most significant risk factors for falls among mid and older
adults in NZ: sex (female), living alone, employment (retired), angina, TIA, fall history (last
four weeks), arthritis, previous fracture, chronic pain, asthma, depression, antiepileptic
medication, antidepressants, and anti-Parkinson medication; while ethnicity (South Asian),
education (secondary), current smokers, and BMI (under-weight and overweight) were
significantly protective against falls across all three fall outcomes. DAG diagrams were created
for all variables that were included in the final multivariable models, which provided a clear
picture of mediators and confounding factors that may impede the association of certain factors
with falls. These variables (i.e., marital status) were then not included in the final multivariable
models.
Conclusion: This study indicates that risk factors for falls (any, injurious and recurrent) among
mid and older community-dwelling older adults are complex and multifaceted. In addition to
traditional risk factors identified, other factors not commonly researched − such as asthma, TIA
only, anti-Parkinson’s medications, and antiepileptic drugs − were shown to be associated with
significantly increased risk of falls; while ethnicity (South Asian) and current smokers were
shown to have a reduced fall risk in this population sub-group. This is the first cohort study to
use pharmaceutical dispensing data to examine the association between certain medications
such as psychotropic, antipsychotics, laxatives and fall risk. The findings indicate that older
adult fall prevention strategies need to commence in middle age, and consideration needs to be
given to addressing novel factors in future risk prevention strategies. Additional research is
required to reaffirm the association between medical conditions and specific medication classes
on fall risk and to understand why there is a lower risk of falls among South Asian population
groups
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
Relationship between prehospital time and 24-hour mortality following injury in patients with major trauma in New Zealand
No full textAim:
To explore the relationship between time spent in the prehospital phase and 24-hour mortality
following injury in patients with major trauma in New Zealand (NZ).
Methods:
Following a systematic review to describe the incidence and characteristics of major trauma in
NZ, analysis of routinely collected data from a retrospectively designed prospective cohort
study was undertaken. Individuals of any age attended by an Emergency Medical Services
(EMS) provider in NZ immediately following major trauma between 1 December 2016 and 30
November 2018 were included. Factors predictive of prehospital mortality were explored using
modified Poisson regression. Models were built for total prehospital time and EMS time
intervals, and were adjusted by patient sociodemographic, triage and injury characteristics.
Results:
A total of 3,334 patients met the eligibility criteria, of which 105 (3.1%) died prehospital and
111 (3.4%) died 24 hours following injury. Median total prehospital time was 74.6 minutes
(IQR: 50.6–104.8). Response and transport times were significantly lower for those patients
who died 24 hours following` injury (p<0.05). In the univariate analysis, total prehospital time
greater than 60 minutes was a predictor of survival, reducing the risk of death in 49% (RR:
0.51; 95%CI: 0.35-0.76). Response time greater than 14 minutes, on-scene time between 30-
45 minutes and transport times of 10 minutes or more were predictive of less risk of death
(p<0.001). In the multivariable analysis response time between 5-10 minutes (adjusted RR
(aRR): 0.39; 95%CI: 0.18-0.84) or greater than 14 minutes (aRR: 0.37; 95%CI: 0.18-0.80)
predicted survival. Other factors increasing the risk of 24-hour mortality in this cohort included
age (80-84 years), triage (purple/red), having one or two previous hospital admissions,
experiencing non-blunt trauma, and having an injury severity score greater than 24.
Conclusion:
Although longer total prehospital times were found to predict reduced 24-hour mortality,
analysis of the components of prehospital time was less conclusive and highlighted the
importance of factors such as age, triage, and other related-injury factors, namely the severity
of trauma. Studies considering 30-day mortality as an outcome and exploring reasons for onscene and transport delays would be useful extensions to this research
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