Practices and views on fetal heart monitoring:A structured observation and interview study

Objective: To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring. Design: Qualitative study. Setting: Large teaching hospital in the UK. Sample: Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades. Methods: Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. Main outcome measures: Deviations from recommended practice in relation to fetal monitoring and insights into why these occur. Results: All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context. Conclusion: Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution. © RCOG 2006.

Laminar heat transfer to non-Newtonian fluids in pipes with abrupt changes in diameter

In this thesis the results of experimental work performed to determine local heat transfer coefficients for non-Newtonian fluids in laminar flow through pipes with abrupt discontinuities are reported. The fluids investigated were water-based polymeric solutiorrs of time-indpendent, pseudoplastic materials, with flow indices "n" ranging from 0.39 to 0.9.The tube configurations were a 3.3 :1 sudden convergence, and a 1: 3.3 sudden divergence.The condition of a prescribed uniform wall heat flux was considered, with both upstream and downstream tube sections heated. Radial temperature traverses were also under­ taken primarily to justify the procedures used in estimating the tube wall and bulk fluid temperatures and secondly to give further insight into the mechanism of heat transfer beyond a sudden tube expansion. A theoretical assessment of the influence of viscous dissipation on a non-Newtonian pseudoplastic fluid of' arbitrary index "n" was carried out. The effects of other secondary factors such as free convection and temperature-dependent consistency were evaluated empirically. In the present investigations, the test conditions were chosen to minimise the effects of natural convection and the estimates of viscous heat generation showed the effect to be insignificant with the polymeric concentrations tested here. The final results have been presented as the relationships between local heat transfer coef'ficient and axial distance downstream of the discontinuities and relationships between dimensionless wall temperature and reduced radius. The influence of Reynolds number, Prandtl number, non-Newtonian index and heat flux have been indicated.