A woman 45 years of age or older is considered to be of very advanced maternal age. In Australia, 0.1% of parturients are in this category at present. The investigators undertook a retrospective cohort study of women aged 45 or above at the time of delivery, all of whom delivered at 20 or more weeks of gestation. In the 108,818 women reviewed, 76 women of very advanced maternal age had 77 pregnancies (incidence ϭ 0.7 per 1000 births). The mean age was 46 years. Sixteen women in the study were primiparous. In multiparas, a mean of 8.8 years had passed since the last live birth. More than half the women had had at least one miscarriage and 13 (17% of the total) reported having 3 or more. Only 14% of women required assisted reproduction. The most frequent medical problems were depression, present in 9 women, and uterine leiomyomas in 4. No chromosomal abnormalities were found in the 53% of pregnancies that were evaluated.Two thirds of pregnancies were free of complications. Ten women had pregnancy-related hypertensive disorders compared with 10% of women 20 to 29 years of age. Two women were delivered before term because of preeclampsia. Gestational diabetes was diagnosed in 8% of pregnancies; only one woman received insulin. Labor began spontaneously in 36% of pregnancies and was induced in 17%, most often "electively" or because of postdate status or spontaneous rupture of membranes at term. The rate of cesarean section was 49% compared with 23% in the younger women. Four women required manual removal of the placenta because of bleeding, and 3 had postsection wound infections.Eight of 78 live-born infants were small-for-gestational age, whereas 6 were large-for-gestational age. Seven singleton births and both sets of twins were born prematurely for a variety of reasons, the most common being premature rupture of membranes. Thirteen infants, 17% of the total, were admitted to the special care nursery; prematurity and respiratory distress syndrome accounted for 6 and 4 admissions, respectively. The overall rate of special care was 16.5%. Five infants in the study group (6%) had congenital abnormalities.The findings in this large-scale study of women aged 45 or above are, in general, reassuring for older women who are in good health and who have a chromosomally normal fetus.
Background Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned. Results For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives. In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success. Several lessons learned were repeated across studies: (a) having robust EMR features that support clinical use; (b) redesigning EMR-supported work practices for optimal fit; (c) demonstrating value for money; (d) having realistic expectations on implementation; and (e) engaging patients in the process. Conclusions Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.
BackgroundNeonatal mortality accounts for nearly three quarters of all infant deaths in Vietnam. The nursing team are the largest professional group working with newborns, however do not routinely receive neonatal training and there is a lack of research into the impact of educational provision. This study explored changes in nursing perceptions towards their role following a neonatal educational intervention. Parents perceptions of nursing care were explored to determine any changes as nurses gained more experience.MethodSemi-Structured qualitative interviews were conducted every 6 months over an 18 month period with 16 nurses. At each time point, parents whose infant was resident on the neonatal unit were invited to participate in an interview to explore their experiences of nursing care. A total of 67 parents participated over 18 months. Interviews were conducted and transcribed in Vietnamese before translation into English for manifest content analysis facilitated by NVivo V14.ResultsAnalysis of nursing transcripts identified 14 basic categories which could be grouped (23) into 3 themes: (1) perceptions of the role of the neonatal nurse, (2) perception of the parental role and (3) professional recollections. Analysis of parent transcripts identified 14 basic categories which could be grouped into 3 themes: (1) information sharing, (2) participation in care, and (3) personal experience.ConclusionsQualitative interviews highlighted the short term effect that the introduction of an educational intervention can have on both nursing attitudes towards and parental experience of care in one neonatal unit in central Vietnam. Nurses shared a growing awareness of their role along with its ethical issues and challenges, whilst parents discussed their overall desire for more participation in their infants care. Further research is required to determine the long term impact of the intervention, the ability of nurses to translate knowledge into clinical practice through assessment of nursing knowledge and competence, and the impact and needs of parents. A greater understanding will allow us to continue to improve the experiences of nurses and parents, and highlight how these areas may contribute towards the reduction of infant mortality and morbidity in Vietnam.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-017-0909-6) contains supplementary material, which is available to authorized users.
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