The implementation and evaluation of a mentoring program for Bachelor of Midwifery students in the clinical practice environment.

AIM: To describe the implementation and evaluation of a midwife/midwifery student-mentoring program in one Local Health District in Sydney NSW Australia. BACKGROUND: Evidence suggests well designed and supported midwife/midwifery student mentorship programs can make a difference to the clinical placement experiences and attrition rates of midwifery students. DESIGN: In the evaluation of the mentoring program, we used surveys, focus groups and individual interviews. METHODS: Eighty-six participants, including midwife mentors, midwifery students, non-mentor midwives and midwifery managers participated in the evaluation. Quantitative data were analysed using descriptive statistics and qualitative data, content analysis. RESULTS: The mentoring program increased midwives' mentoring skills and was beneficial to their professional growth and leadership skills. Students reported positive outcomes including someone to talk to, emotional support and a sense of belonging. Mentoring programs require structure, mentor training, organisational support and transparency. CONCLUSION: The mentoring program provided benefits to both midwifery mentors and students and demonstrated the value of a structured and supported mentoring program for midwifery students.

The midwife-student mentor relationship: Creating the virtuous circle.

BACKGROUND: Good mentoring is important for students to support their adjustment to and learning in the clinical environment. The quality of the mentoring relationship is key for students but there is a lack of evidence explaining how a good mentor/mentee relationship establishes and develops over time. AIM: To explore the developing relationship between mentors and mentees participating in a structured midwifery mentoring program in one Local Health District in Sydney, Australia. METHODS: A qualitative interpretive descriptive research design was utilised. Data were collected using 10 focus groups with midwife mentors (n = 31) and seven focus groups and four interviews with Bachelor of Midwifery student mentees (n = 24), over a 12-month period. Thematic analysis using an inductive approach was applied incorporating constant comparison to identify themes and sub-themes. FINDINGS: Three overarching themes and three sub-themes were identified. The first theme was 'The great unknown'. Within the second theme 'Building the relationship' were three subthemes: trying to connect; becoming known; and an insider on your side. The final theme 'the virtuous circle' described the reciprocal relationship and benefits that developed between mentor and mentee. DISCUSSION: The mentor/mentee relationship took time to develop and went through a number of phases. A positive mentor/ mentee relationship flattened hierarchical differences, increased student confidence and capacity for learning, and reflected the midwifery continuity of care relationship between midwife and woman built on respect and partnership. CONCLUSION: Developing a successful midwifery mentoring relationship takes persistence, reassurance, and mutual disclosure ultimately resulting in a recurring cycle of encouragement and support.

Safety and efficacy of subcutaneous alpha-tocopherol in healthy adult horses.

Vitamin E is essential for neuromuscular function. The primary treatment, oral supplementation with natural ('RRR') α-tocopherol, is not effective in all horses. The objectives of this pilot study were to evaluate the safety and efficacy of a subcutaneously administered RRR-α-tocopherol preparation. Horses were randomly assigned in a cross-over design to initially receive RRR-α-tocopherol (5000 IU/450 kg of 600 IU/mL) subcutaneously (n = 3) or orally (n = 3) or were untreated sentinels (n = 2). Tissue reactions following injection in Phase I of the study necessitated adjustment of the preparation with reduction of the RRR-α-tocopherol concentration to 500 IU/mL in Phase 2. Following an 8-week washout period, horses received the reciprocal treatment route with the new preparation (5000 IU/450 kg of 500 IU/mL). Serum, CSF and muscle α-tocopherol concentrations were determined by high-performance liquid chromatography over a 14-day period during each phase. Serum and CSF α-tocopherol concentrations increased significantly postinjection only when the 500 IU/mL product was administered (P<0.0001). There was no significant difference in the muscle concentration of α-tocopherol following either treatment. All eight horses had marked tissue reaction to subcutaneous injection, regardless of product concentration. Whilst we have demonstrated that this route may be a useful alternative to oral supplementation, the marked tissue reaction makes use of such products limited at this time to only the most refractory of cases.

Liquid gold from the milk bar: constructions of breastmilk and breastfeeding women in the language and practices of midwives.

Midwives are the main health professional group providing support and assistance to women during the early establishment of breastfeeding. In published accounts of early breastfeeding experiences women report high levels of dissatisfaction with health professional support. To gain an understanding of this dissatisfaction, we examined the way in which midwives represent breastmilk and construct breastfeeding women in their interactions. Seventy seven women and seventy six midwives at two maternity units in NSW, Australia, participated in this study. Eighty five interactions between a midwife and a breastfeeding woman were observed and audio recorded during the first week after birth. In addition, data were collected through observation of nine parenting education sessions, interviews with 23 women following discharge, and 11 managers and lactation consultants (collected between October 2008 and September 2009). Discourse analysis was used to analyse the transcribed interactions, and interview data. The analysis revealed that midwives prioritised both colostrum and mature breastmilk as a 'precious resource', essential for the health and wellbeing of the infant and mother. References to breastmilk as 'liquid gold' were both verbal and implied. Within this discourse, the production and acquisition of 'liquid gold' appeared to be privileged over the process of breastfeeding and women were, at times, positioned as incompetent operators of their bodily 'equipment', lacking knowledge and skill in breastfeeding. In this context breastfeeding became constructed as a manufacturing process for a demanding consumer. The approach taken by midwives revealed an intensive focus on nutrition to the exclusion of relational communication and support. The findings indicate the need to challenge the current 'disciplinary' and 'technological' practices used by midwives when providing breastfeeding support and the need for a cultural change in postnatal care.

Aromatherapy in childbirth: a pilot randomised controlled trial.

OBJECTIVES: We aimed to determine the feasibility of conducting a randomised controlled trial (RCT) on the use of aromatherapy during labour as a care option that could improve maternal and neonatal outcomes. DESIGN: RCT comparing aromatherapy with standard care during labour. SETTING: District general maternity unit in Italy. SAMPLE: Two hundred and fifty-one women randomised to aromatherapy and 262 controls. METHODS: Participants randomly assigned to administration of selected essential oils during labour by midwives specifically trained in their use and modes of application. MAIN OUTCOME MEASURES: Intrapartum outcomes were the following: operative delivery, spontaneous delivery, first- and second-stage augmentation, pharmacological pain relief, artificial rupture of membranes, vaginal examinations, episiotomy, labour length, neonatal wellbeing (Apgar scores) and transfer to neonatal intensive care unit (NICU). RESULTS: There were no significant differences for the following outcomes: caesarean section (relative risk [RR] 0.99, 95% CI: 0.70-1.41), ventouse (RR 1.5, 95% CI: 0.31-7.62), Kristeller manoeuvre (RR 0.97, 95% CI: 0.64-1.48), spontaneous vaginal delivery (RR 0.99, 95% CI: 0.75-1.3), first-stage augmentation (RR 1.01, 95% CI: 0.83-1.4) and second-stage augmentation (RR 1.18, 95% CI: 0.82-1.7). Significantly more babies born to control participants were transferred to NICU, 0 versus 6 (2%), P = 0.017. Pain perception was reduced in aromatherapy group for nulliparae. The study, however, was underpowered. CONCLUSION: This study demonstrated that it is possible to undertake an RCT using aromatherapy as an intervention to examine a range of intrapartum outcomes, and it provides useful information for future sample size calculations.

The use of aromatherapy in intrapartum midwifery practice an observational study.

The authors report the process and results of an evaluation of a midwifery aromatherapy service for mothers in labour: This study of 8058 mothers in childbirth, is the largest research initiative in the use of aromatherapy within a health-care setting. The study involved a wide range of participants, from mothers who experienced a low risk, spontaneous labour and birth, to those whose labour was induced, and those who had vaginal operative delivery and Caesarean section. The study-took place over a period of 8 years, which enabled a more challenging test of the effect of aromatherapy on intrapartum midwifery practice and outcomes. In the study a total of 10 essential oils were used, plus a carrier oil, which were administered to the participants via skin absorption and inhalation. The study found little direct evidence that the practice of aromatherapy per se reduces the need for pain relief during labour, or the incidence of operative delivery. But a key finding of this study suggests that two essential oils, clary sage and chamomile are effective in alleviating pain. The evidence from this study suggests that aromatherapy can be effective in reducing maternal anxiety, fear and/or pain during labour. The use of aromatherapy appeared to facilitate a further reduction in the use of systemic opioids in the study centre, from 6% in 1990 to 0.4% in 1997 (per woman). Aromatherapy is an inexpensive care option. In 1997 when 1592 mothers used aromatherapy, the total cost was 769.17 Pounds. The study reports a minimal incidence of associated symptoms. Out of 8058 mothers, 1% (100) recorded an associated symptom. These were mild in nature. The successful model of integrated practice that this aromatherapy study presents, offers a useful example for other units to consider.

Biological time and in vivo research: a field guide to pitfalls.

Biological rhythmicity is a fundamental characteristic of all life forms, from primitive bacteria to man. The molecular biology, genetics, and the neurobiology of the biological clock(s) are being elucidated. Daily (circadian) statistically significant fluctuations occur in all of the normal biological variables studied in the experimental animal and the human. Many researchers, however, are not aware of the negative impact biological rhythmicity can have on experimental design and/or data interpretation. This article serves not as a review, but as a "field guide" to the pitfalls that can occur when research is performed in the absence of an understanding of biological rhythmicity. The major topics discussed are: 1) data transfer from the diurnally in-active/resting/sleeping lab animal to the diurnally active human, 2) frequency of sampling, 3) free-running vs. synchronization, 4) alternating periods of resistance and susceptibility, 5) phase shifting of a rhythm, 6) the assumption that one mean +/- S.E. from control animals can be "stretched" across an experimental time span, and 7) plotting data on an "hours after treatment" format vs. a "time of day" format. The hope is that by avoiding the pitfalls, biological time will become an ally in the endeavor to understand human biology.

An investigation into the use of aromatherapy in intrapartum midwifery practice.

OBJECTIVE: The principal aim of the study was to examine the contribution of aromatherapy to the promotion of maternal comfort during labor and as a tool to improve the quality of midwifery care. DESIGN: Evaluative study. SETTING: Delivery suite in a large British teaching hospital with approximately 6,500 deliveries per annum. SUBJECTS: A total of 8,058 mothers were evaluated between 1990 and 1998. INTERVENTIONS: Women were offered aromatherapy to relieve anxiety, pain, nausea and/or vomiting or to strengthen contractions. Routine data collected on the use of aromatherapy over the period were analyzed. Data from the unit audit were used to provide a comparison group of mothers not given aromatherapy (n = 15,799) from the study center. OUTCOME MEASURES: Outcome measures include mothers' ratings of effectiveness, outcomes of labor, use of pharmacologic pain relief, uptake of intravenous oxytocin, reported associated symptoms, and annual costs. RESULTS: The use of aromatherapy during childbirth was an increasingly popular care option with mothers and midwives. More than 50% of mothers rated it as helpful, and only 14% found it unhelpful. The use of aromatherapy was not confined to low-risk mothers. Sixty percent of the sample were primigravidae, and 32% overall had had their labor induced. The administration of aromatherapy in childbirth did appear to reduce the need for additional pain relief in a proportion of mothers. More than 8% of primigravidae and 18% of multigravidae used no conventional pain relief during labor after using essential oils. During the years of the study, the use of pethidine in the study center declined from 6% to 0.2% of women. The study also showed that aromatherapy may have the potential to augment labor contractions for women in dysfunctional labour. A very low number of associated adverse symptoms were reported (1%). CONCLUSION: This study represents a successful example of the integration of a complementary therapy into mainstream midwifery practice and forms a basis for future research.

Ear-canal impedance and reflection coefficient in human infants and adults.

The ear-canal impedance and reflection coefficient were measured in an adult group and in groups of infants of age 1, 3, 6, 12, and 24 months over frequency range 125-10,700 Hz. The development of the external ear canal and middle ear strongly affect input impedance and reflection coefficient responses, and this development is not yet complete at age 24 months. Contributing factors include growth of the area and length of the ear canal, a resonance in the ear-canal walls of younger infants, and a probable influence of growth of the middle-ear cavities. The middle-ear compliance is lower in infants than adults, and the middle-ear resistance is higher. The power transfer into the middle ear of the infant is much less than into that of the adult. Such differences in power transfer directly influence both behavioral and physiological measurements of hearing. The difficulties of interpretation of neonatal tympanograms are shown to be a consequence of ear-canal wall vibration. Impedance and reflectance measurements in the 2-4-kHz range are recommended as a potentially useful clinical tool for circumventing these difficulties.

Effects of contralateral acoustic stimulation on spontaneous otoacoustic emissions.

Spontaneous otoacoustic emissions (SOAEs) were measured in the ear canal of adult humans prior to, during, and following presentation of tonal and broadband stimuli to the contralateral ear. Tones were presented at a fixed level at ten frequencies relative to the SOAE. Broadband noise was presented at eight levels, from 6 to 76 dB SPL. Shifts in SOAE frequency and amplitude were observed for some subjects, for some tone conditions. Frequency shifts were always positive, whereas amplitude shifts were variable. No apparent pattern of tuning was seen, such that tones with a particular frequency relationship to the SOAEs induced greater changes in the SOAEs. Systematic changes in frequency and amplitude of SOAEs were observed for increasing level of broadband noise for all subjects. Results are discussed with respect to possible mechanism(s) responsible for the alterations in SOAEs: Transcranial conduction; the olivocochlear system; and/or the middle-ear reflex arc.

Voluntary contraction of middle ear muscles: effects on input impedance, energy reflectance and spontaneous otoacoustic emissions.

Two types of measurements were performed on a subject able to voluntarily contract her middle ear muscles (MEM). First, wideband measurements (0-11 kHz) of middle ear input impedance and energy reflectance were obtained when the subject was relaxed and when she contracted her MEM. The changes in impedance observed with voluntary MEM contraction were similar to those reported in the literature for acoustically-elicited MEM contractions. The energy reflectance increased for frequencies below about 4 kHz. Second, the effects of voluntary MEM contraction on the frequencies and levels of spontaneous otoacoustic emissions (SOAEs) were measured and compared to effects evoked by contralateral acoustic stimulation. Effects on SOAEs appear to be a more sensitive indicator of MEM activity than changes in impedance, and the effects due to voluntary MEM contraction were qualitatively similar to those evoked by contralateral acoustic stimulation. These results suggest that in subjects with normally-functioning middle ears, only some effects on otoacoustic emissions caused by contralateral stimuli whose levels are below the contralateral acoustic reflex threshold can be unequivocally attributed to the action of cochlear efferents. The temporal aspects of SOAE frequency shifts caused by voluntary contraction of MEM show that voluntary contraction fatigues rapidly over a time period of tens of seconds.

The relation between the human frequency-following response and the low pitch of complex tones.

The relation between the auditory brain stem potential called the frequency-following response (FFR) and the low pitch of complex tones was investigated. Eleven complex stimuli were synthesized such that frequency content varied but waveform envelope periodicity was constant. This was accomplished by repeatedly shifting the components of a harmonic complex tone upward in frequency by delta f of 20 Hz, producing a series of six-component inharmonic complex tones with constant intercomponent spacing of 200 Hz. Pitch-shift functions were derived from pitch matches for these stimuli to a comparison pure tone for each of four normal hearing adults with extensive musical training. The FFRs were recorded for the complex stimuli that were judged most divergent in pitch by each subject and for pure-tone signals that were judged equal in pitch to these complex stimuli. Spectral analyses suggested that the spectral content of the FFRs elicited by the complex stimuli did not vary consistently with component frequency or the first effect of pitch shift. Furthermore, complex and pure-tone signals judged equal in pitch did not elicit FFRs of similar spectral content.

Pure-tone pitch anomalies. II. Pitch-intensity effects and diplacusis in impaired ears.

Pitch-intensity functions and psychophysical tuning curves (PTC's) were measured in ten listeners with sensorineural impairments of presumed cochlear origin. Masking patterns, frequency jnd's, diplacusis measurements, and octave adjustments were also obtained for selected conditions in selected listeners. The results showed a tendency for increased frequency jnd's and increased pitch-matching variability in frequency regions where frequency resolution, as determined by PTC Q10 estimates, was degraded. The results also showed exaggerated pitch-level effects, both in regions where frequency resolution was degraded and, in many cases, in regions where thresholds and frequency resolution were apparently normal. The usual manifestation of exaggerated pitch-level effect was an abnormally large negative pitch shift with increasing level, particularly at low frequencies. The limited data from diplacusis measurements and octave adjustments suggest that the exaggerated negative pitch shifts are the consequence of a large increase in pitch at low stimulus levels which "recruits" at higher levels. These results are difficult to explain with simple tonotopic models, or presently formulated temporal models, of pure-tone pitch encoding.

Review of the etiology and treatment of premenstrual syndrome.

Premenstrual syndrome (PMS) is a diagnostic enigma that causes significant morbidity in many woman. Numerous theories have been proposed in an attempt to explain the varied symptoms that occur cyclically in women with PMS. Suggested etiologic theories of PMS include psychological abnormalities, nutritional deficiencies, aberrations in the renin-angiotensin-aldosterone axis, altered prostaglandin activity, hormonal imbalances, and changes in endogenous opioid peptide activity. Because of the lack of standardized diagnostic criteria, clinical drug trials for PMS have been severely compromised. For every proposed cause of PMS, there exists a drug or drug class that has been investigated for treatment of the associated symptoms. Many clinical studies are uncontrolled, a significant deficiency in study design for a disorder that is associated with a high placebo response rate. At the present time, no definitive treatment for PMS exists and therapy must be individualized according to clinical response. This review article defines PMS, describes one of the current approaches to the diagnostic work-up, discusses the proposed etiologies of PMS, and reviews the various proposed treatment modalities.

Raynaud's disease.

We report five children who presented with Raynaud's disease in whom we could find no clinical, haematological, or immunological evidence of a collagen disorder. Oral phenoxybenzamine proved useful for maintenance treatment in most, with infusions of prostacyclin, nitroprusside, and ketanserin during acute attacks.

Pure-tone anomalies. I. Pitch-intensity effects and diplacusis in normal ears.

Pitch-intensity functions were obtained in both ears of five normal-hearing subjects, together with measurements of binaural diplacusis as a function of intensity. The results show that pitch-intensity functions are often significantly different in the two ears of a given subject at a given frequency. Furthermore, for each subject and frequency condition tested, an intensity existed for which no significant diplacusis was found. For these conditions, therefore, binaural diplacusis as a function of intensity could be accounted for by the interaural differences in pitch-intensity functions. Forward-masking patterns (FMP's) as a function of intensity were also obtained in both ears of several subjects. The FMP's were compared with pitch-intensity functions, obtained for the same conditions, for evidence of a covariation in the direction of shifts in masking patterns as a function of intensity with the direction of pitch shifts as a function of intensity. No convincing evidence of such a covariation was found. The implications of the results of these experiments are discussed relative to the question of temporal versus tonotopic coding of pure-tone pitch.