1,721,048 research outputs found
Community engagement in maternal and perinatal death surveillance and response: a realist review
Full text linkBackgroundCommunity engagement in maternal and perinatal death surveillance and response (MPDSR) could support health systems in providing people-centred care and ensure accountability for the prevention of maternal and perinatal deaths. Although community engagement activities in MPDSR have been described, the literature does not adequately explain which community engagement in MPDSR strategies succeed, the contexts in which they work, the outcomes they produce, and for whom.MethodsWe conducted a realist review, which involved the identification and refinement of programme theories. An initial literature search identified four initial programme theories (IPTs) that explain how community engagement works in the different parts of the MPDSR cycle.Six databases (Medline, Embase, Scopus, Global Health, CINAHL Plus and Web of Science) and Google were searched for papers and grey literature published between 2004 and August 2022. We used retroductive analysis on included articles to support the identification of generative causation using the heuristic of ‘context-mechanism-outcome configuration’ (CMOCs), which explained what mechanisms were triggered in different contexts and the outcomes that were produced. The findings were then used to refine the IPTs and produce final programme theories.ResultsForty-five articles from 40 studies reported some form of community engagement in MPDSR. We identified 20 CMO configurations that were synthesised into five programme theories:(1)Fear of blame demotivates community members and health professionals from engaging in MPDSR.(2)Dialogue between health professionals and community members improves collaboration and empowers community members to propose innovative solutions.(3)Trusted social connections between bereaved families and community volunteers enables them to identify and report deaths.(4)Financial and non-financial incentives motivate community members and health professionals to engage in MPDSR.(5)Community engagement is more sustainable when it is routinised and integrated into the health system.ConclusionImplementing community engagement in MPDSR requires a systems approach that addresses the five Programme Theories collectively, rather than implementing community engagement in specific parts of the MPDSR cycle as our initial programme theories had suggested. Establishing conducive participatory spaces that promote dialogue, trust and minimise blame culture is critical for the success of community engagement in MPDSR programmes. Community members can be engaged in MPDSR processes in health facilities and community settings and high- and low-income countries
A cross-sectional study of partograph utilization as a decision making tool for referral of abnormal labour in primary health care facilities of Bangladesh.
No full textBACKGROUND:In Bangladesh, female paramedics known as Family Welfare Visitors (FWVs), conduct normal deliveries in first-level primary care facilities, or Union Health and Family Welfare Centres (UH&FWC). Utilization of partographs allow for early identification of abnormal labour and referral for advanced care to Emergency Obstetric Care (EmOC) facilities. A systematic assessment of the quality of partograph utilization in clinical-decision making will contribute to understanding the use of the tool by health workers. METHODS:In 2013, the USAID supported MaMoni HSS project, led in country by Save the Children, trained FWVs on the use of partographs in five UH&FWCs in Habiganj district. As part of the follow-up after training, intrapartum case record forms, accompanying partographs, and referral registers for all obstetric cases managed in these five facilities from July 2013 to June 2014 were reviewed. Partographs were reviewed to identify abnormal labour cases based on pre-defined indications. All referred cases were ascertained from the case records in the referral registers. Five health workers were interviewed to assess their knowledge, attitude and experience in partograph use and to explore the challenges for referral decision making associated with the tool. RESULTS:A total of 1,198 deliveries were managed at the study sites, of which 663 presented with cervical dilatation of 8 cm or less. Partographs were initiated in 98% of these cases. Indication of abnormal labour was found in 71 partographs (11%) and among them, only 1 was referred to a higher-level facility. Foetal heart rate and cervical dilatation were appropriately recorded in 61% and 70% of the partographs, respectively. Interviews with health workers revealed poor interpretation of referral indications from the partographs. Limited accessibility to the nearest EmOC facility, inadequate time for referral, and non-compliance to referral by clients were identified by the interviewed health workers as the key barriers for referral decision making. CONCLUSIONS:Supporting the health workers at first-level primary care facilities to better interpret and act on partograph data in a timely manner, and strengthening the referral systems are needed to ensure that women in labour receive the prompt quality care they and their babies require to survive
Early warning systems to improve maternal health in Nigeria: design, validation, and evaluation of a modified obstetric early warning chart for use in low-resource settings
Full text linkBackground: One basic way to prevent maternal deaths in healthcare facilities is through early detection of changes in physiological parameters that are suggestive of clinical deterioration before such changes become irreversible and fatal. This is the aim of the Early Warning Systems (EWS). The objectives of this PhD were to introduce and evaluate the use of obstetric EWS in Nigerian tertiary hospitals.
Methods: A preliminary investigation of the evidence supporting the usefulness of EWS in obstetric practice was achieved via a systematic literature review. The baseline formative research employed mainly qualitative methods to assess the feasibility of implementing EWS in three Nigerian tertiary hospitals. Then a robust dataset, consisting of 4360 women with severe maternal outcome (SMO: maternal death or near miss) and 1000 obstetric admissions without SMO diagnosis, collected across 42 Nigerian tertiary hospitals, was used to develop a statistically derived obstetric EWS model and score-based chart for use in low-resource settings using a case-control multivariate logistic regression analysis. The resulting EWS chart was implemented across all obstetric units of a university teaching hospital in Nigeria. Two other teaching hospitals were recruited as control facilities. Following implementation, we employed mixed research methods to assess the effectiveness of EWS in improving health outcomes and explore the experience of health workers/managers implementing the EWS.
Results: The systematic review showed that EWS are effective in predicting severe obstetric morbidity and mortality, can potentially contribute to improved quality of care/health outcomes, and may be feasible to implement in low-resource settings. The feasibility study confirmed the absence of EWS, a checklist or any guidelines on how to trigger response to obstetric emergencies across the three hospitals. Vital signs were routinely monitored despite shortages of monitoring equipment and human resources. However, understanding of their potential utility as early pointers to maternal deterioration was deficient among healthcare workers.
The resulting EWS from our SMO model consisted of seven clinical parameters (respiratory rate, temperature, systolic blood pressure, pulse rate, consciousness level, urine output and delivery mode for postpartum patients). The model had excellent screening characteristics for SMO (86% (95% CI 81–90) sensitive and 92% (95% CI 89–94) specific and maintained good discriminatory power across all our internal validation data sets (area under ROC curves consistently above 90%).
Following implementation, nurses and doctors found EWS easy to use, easy to evaluate at a glance, and accurate, but, usage rate was considerably low (<50%). Significant improvement in quality of vital signs monitoring was experienced in the intervention, but not in any of the control sites. Rotation of clinical staff, shortages of monitoring equipment and human resources for health were identified challenges.
Conclusion: To the best of our knowledge, this research reports for the first time an internally validated statistically developed diagnostic predictive model for obstetric morbidity and mortality among all women admitted to obstetric wards in a low-resource setting. Our findings showed that it is feasible to implement the obstetric EWS in low-resource settings and this can improve the quality of patient care through better monitoring frequency and medical review based on abnormally high EWS scores. The EWS we developed could be used to evaluate quality of patient care through assessing whether trigger events result in clinical action, and timeliness of clinical action. Surveillance of patients who trigger action could allow for further evaluation and discussion of quality of care, for example at maternal morbidity and mortality meetings.
Overall, with staff education on usefulness of EWS, coupled with continuous training and retraining, it is feasible to implement obstetric EWS as a potentially acceptable patient monitoring tool to cope with the unique demands faced by obstetric practice in low-resource tertiary healthcare settings
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
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