Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial

Background

Epidural analgesia is the most effective labour pain relief but is associated with increased rates of instrumental vaginal delivery and other effects, which might be related to the poor motor function associated with traditional epidural. New techniques that preserve motor function could reduce obstetric intervention. We did a randomised controlled trial to compare low-dose combined spinal epidural and low-dose infusion (mobile) techniques with traditional epidural technique.
Methods

Between Feb 1, 1999, and April 30, 2000, we randomly assigned 1054 nulliparous women requesting epidural pain relief to traditional (n=353), low-dose combined spinal epidural (n=351), or low-dose infusion epidural (n=350). Primary outcome was mode of delivery, and secondary outcomes were progress of labour, efficacy of procedure, and effect on neonates. We obtained data during labour and interviewed women postnatally.
Findings

The normal vaginal delivery rate was 35·1% in the traditional epidural group, 42·7% in the low-dose combined spinal group (odds ratio 1·38 [95% CI 1·01–1·89]; p=0·04); and 42·9% in the low-dose infusion group (1·39 [1·01–1·90]; p=0·04). These differences were accounted for by a reduction in instrumental vaginal delivery. Overall, 5 min APGAR scores of 7 or less were more frequent with low-dose technique. High-level resuscitation was more frequent in the low-dose infusion group.

Bellwether procedures for monitoring and planning essential surgical care in low- and middle-income countries: caesarean delivery, laparotomy and treatment of open fractures

BACKGROUND: Surgical conditions represent a significant proportion of the global burden of disease, and therefore, surgery is an essential component of health systems. Achieving universal health coverage requires effective monitoring of access to surgery. However, there is no widely accepted standard for the required capabilities of a first-level hospital. We aimed to determine whether a group of operations could be used to describe the delivery of essential surgical care.

METHODS: We convened an expert panel to identify procedures that might indicate the presence of resources needed to treat an appropriate range of surgical conditions at first-level hospitals. Using data from the World Health Organization Emergency and Essential Surgical Care Global database, collected using the WHO Situational Analysis Tool (SAT), we analysed whether the ability to perform each of these procedures-which we term "bellwether procedures"-was associated with performing a full range of essential surgical procedures.

FINDINGS: The ability to perform caesarean delivery, laparotomy, and treatment of open fracture was closely associated with performing all obstetric, general, basic, emergency, and orthopaedic procedures (p < 0.001) in the population that responded to the WHO SAT Survey. Procedures including cleft lip, cataract, and neonatal surgery did not correlate with performing the bellwether procedures.

INTERPRETATION: Caesarean delivery, laparotomy, and treatment of open fractures should be standard procedures performed at first-level hospitals. With further validation in other populations, local managers and health ministries may find this useful as a benchmark for what first-level hospitals can and should be able to perform on a 24/7 basis in order to ensure delivery of emergency and essential surgical care to their population. Those procedures which did not correlate with the bellwether procedures can be referred to a specialized centre or collected for treatment by a visiting specialist team.

Two approaches to workplace flexible delivery and assessment in a rural community

The implementation of forms of flexible delivery and workplace training and assessment in rural areas presents particular difficulties for providers and employers alike. This article discusses some of the outcomes of a case-study research and professional development project undertaken in north-west Victoria. It describes the development and implementation of two different approaches to flexible delivery in the areas of engineering and office administration at Sunraysia Institute of TAFE. These two separate developments reversed the decline in the departments' fortunes and proved to be successful from the perspective of the staff who developed the courses, and the clients-employers and especially the students. The implications of these approaches in terms of catering for the learning preferences and contexts of the students are discussed.

Consumer issues in navigating health care services for type I diabetes

• Despite increasing interest in consumer awareness and participation in health care service delivery, there has been little exploration of consumer views in relation to services for people with type I diabetes. • The purpose of this qualitative exploratory study was to identify strategies people with type I diabetes used to access health services and the barriers they perceived in accessing the services they needed. • Data gathered in semi-structured interviews revealed that consumers experience significant barriers when navigating the health care system. • Three dominant themes were identified. They relate to access to specialist medical skill, to the transition from teenager to young adult and to pre-pregnancy and obstetric care. • Directions for change in service delivery and policy development are discussed.

Learners and their workplaces: towards a strategic model of flexible delivery of training in the workplace

Although the flexible delivery of training in the workplace has become a favoured policy position for training authorities in both Britain and Australia, this article reviews research that indicates neither learners nor their workplaces are well prepared. Drawing on the author's own research and that from the broader literature, the article develops a model for the preparation of learners and workplaces for flexible delivery of training. Deriving from the proposed model, the article suggests a wide range of strategies that may be used in preparing learners and workplaces for successful engagement with the flexible delivery of training.

Developing preparedness for flexible delivery of training in enterprises

On a basis of research and literature review, Smith, in 2001, suggested a model for the development of preparedness of learners and their workplaces to support the flexible delivery of training in enterprises. Using the model as a framework, he then developed a detailed set of strategies that may be used in operating workplaces to develop learners and workplaces for effective flexible delivery. The research reported here was designed to test that strategy set in 12 different enterprises to assess the feasibility of their implementation in operating workplaces. The research shows that a majority of suggested strategies are feasible for implementation; some are feasible with qualification; and a minority were not seen as feasible.

Workplace learning and flexible delivery

Workplace learning has developed as a field both of practice and of research over the past decade. The increase in interest is due in part to heightened awareness that workplace knowledge and skills contribute to enterprise and national competitiveness, but it is also due to an increased focus on the connections to be made between theory and practice as part of an education or training experience. At the same time, new learning technologies have enhanced delivery of instruction and learning materials in workplaces. This article reviews some of the conceptualizations of workplace learning and its cognitive bases. It also examines workplaces as learning environments and considers the special challenges involved in the flexible delivery of training to workplaces.

Learning strategies used by apprentices in flexible delivery

Using a stimulated recall technique, eight apprentices were interviewed to identify the detailed learning strategies they used while constructing knowledge from flexible learning packages designed to develop workplace skills. The research shows that in their use of metacognitive, cognitive and social/affective learning strategies the apprentices in the sample made greatest use of those strategies that assisted them to construct knowledge as it was structured and presented by the learning package or by their instructors, trainers or supervisors. Little use was made of strategies that would indicate self-directed learning, working outside the structure provided, or learning independently of a sociocultural and hands-on context comprising their peers and their instructors. At the level of detail of learning strategies these results provide support for the larger scale quantitative research that has been previously conducted with apprentice learning preferences.

Planning, delivery and evaluation of information literacy training for engineering and technology students

Information literacy has become an important skill for undergraduate students due to societal changes that have seen information become a valuable commodity, the need for graduates to become lifelong learners, and the recognition that information literacy is an underpinning generic skill for effective learning in higher education. This paper describes a sequence of activities and technologies designed to help students learn and practice information literacy skills. These activities have been purposefully designed and integrated into a first-year engineering and technology study unit as a core syllabus element. A formal evaluation of aspects of these activities was planned and undertaken in semester one 2003.

Minicast: a multicast-anycast protocol for message delivery

Anycast and multicast are two important Internet services. Combining the two protocols can provide new and practical services. In this paper we propose a new Internet service, Minicast: in the scenario of n replicated or similar servers, deliver a message to at least m members, 1 m n. Such a service has potential applications in information retrieval, parallel computing, cache queries, etc. The service can provide the same Internet service with an optimal cost, reducing bandwidth consumption, network delay, and so on. We design a multi-core tree based architecture for the Minicast service and present the criteria for calculating the subcores among a subset of Minicast members. Simulation shows that the proposed architecture can even the Minicast traffic, and the Minicast application can save the consumptions of network resource.

Using on-line delivery to support students during practicum placements.

Finding ways to effectively support students while on placement remains a continuing endeavour for those who teach in professional education programmes. In The present paper, the multiple challenges and learning opportunities that social work students encounter during practicum learning will be discussed. Next, drawing from constructivist pedagogy and using authentic examples from an online discussion board, ways to supplement the support and educational input provided to students on placement will be demonstrated. Finally, some of the risks and limitations in engaging with on-line delivery are examined with the view to understanding how e-learning can be facilitated most effectively for students during the practicum.

Insulin delivery devices

Everyone with type 1 diabetes requires insulin from diagnosis and more than 30% of people with type 2 diabetes eventually need insulin because of progressive failure of pancreatic beta cells. People with type 2 diabetes are often reluctant to commence insulin and some will require assistance with their injections. Over the past five years a number of new insulin delivery systems have become available that can make insulin administration easier. A number of factors, including patient preference, influence the choice of device. A thorough assessment of the individual's self-care capacity is important and appropriate education is imperative when starting insulin.

An investigation of the development of navigation design guidelines for online educational applications delivery to a primary school audience

Despite growing interest in educational websites for children, there has been surprisingly little research conducted into the design of websites intended for a younger audience. This research aims to determine how the design principles identified in the extant body of literature, might be fused with the development practices currently employed within a focus organisation (case study organisation), to synthesise and partially validate a set of website navigation design guidelines for use when developing website navigation for primary school students, between the ages of nine and twelve years.