Outcomes of high-risk obstetric transfers in New South Wales and the Australian Capital Territory: The High-Risk Obstetric Transfer Study.

BACKGROUND: In New South Wales and the Australian Capital Territory, in utero transfers to manage maternal or neonatal risks are highly challenging owing to geography and centralisation of tertiary perinatal care. AIMS: The study aims to document the outcomes of high-risk obstetric transfers. MATERIALS AND METHODS: A prospective observational study was conducted from 2010 to 2011 documenting urgent requests for obstetric transfers to tertiary centres across NSW/ACT for pregnancies 20 weeks' gestation or greater. Outcomes of transfers were allocated apriori to 'delivered at the receiving hospital', 'failed/delayed transfer' or 'discharged/transferred undelivered'. Our hypothesis is that each outcome has a specific group of associated clinical factors. RESULTS: Of the 249 transfer requests included in the study, 40% delivered at the receiving hospital, 7% were failed/delayed transfers, and 45% were discharged/transferred undelivered. Cases delivering at the receiving hospital were significantly associated with older mothers, twin pregnancies, pregnancy induced hypertension (PIH) or premature rupture of membranes (PROM) with/without threatened preterm labour (TPL) as the indications for transfer and having three indications for transfer. Cases that were discharged/transferred undelivered were significantly associated with singleton pregnancies, TPL and/or antepartum haemorrhage (APH) as the indication for transfer and having one indication for transfer. There were no significantly associated factors for failed/delayed transfers. CONCLUSIONS: The study confirms the hypothesis that particular transfer outcomes are associated with different factors. The findings also show that less than half of urgent obstetric transfers result in delivery at the receiving hospital, suggesting that there exists significant opportunities for further research into predicting preterm delivery, thereby improving the care of women with high-risk pregnancies.

Potentially avoidable neonatal retrievals in New South Wales: a retrospective analysis.

OBJECTIVE: To identify areas for improvement in outcomes in retrieved newborns by reviewing newborn retrieval activity and evaluating potentially avoidable retrievals from each referring hospital stratified by the level of service delivery over the study period. DESIGN: A retrospective analysis of newborn retrievals from 1 January 2006 to 31 December 2009. SETTING: Newborn and Paediatric Emergency Transport Service (NETS). PARTICIPANTS: Newborns less than 72 hours old retrieved by NETS in the study period. Each retrieval was classified as potentially avoidable, unavoidable or unclassified, based on predefined criteria. MAIN OUTCOME MEASURES: Newborn retrieval rates (per 10,000 live births) and potentially avoidable retrievals for each referring hospital level and overall. RESULTS: There were 2494 newborn retrievals over the study period, with an annual mean of 623 total and 30 potentially avoidable retrievals. There was a reduction in the potentially avoidable retrieval rate (per 10,000 live births) over the study period (from 3.9 in 2006 and 4.2 in 2007 to 2.2 in 2008 and 2.3 in 2009) despite an increase in the total retrieval rate over the same time. Discretionary caesarean, defined as elective (pre-labour) caesarean section without documented fetal or maternal indications before 39 completed weeks of gestation, accounted for two-thirds of the potentially avoidable retrievals. CONCLUSIONS: Potentially avoidable retrievals were a small but significant proportion and are becoming less frequent. Discretionary caesarean is the most common cause of potentially avoidable retrieval. Strict implementation of the elective caesarean section policy directive has the potential to reduce morbidity and the costs related to retrieval.

Scoping review search practices in the social sciences: A scoping review.

A thorough literature search is a key feature of scoping reviews. We investigated the search practices used by social science researchers as reported in their scoping reviews. We collected scoping reviews published between 2015 and 2021 from Social Science Citation Index. In the 2484 included studies, we observed a 58% average annual increase in published reviews, primarily from clinical and applied social science disciplines. Bibliographic databases comprised most of the information sources in the primary search strategy (n = 9565, 75%), although reporting practices varied. Most scoping reviews (n = 1805, 73%) included at least one supplementary search strategy. A minority of studies (n = 713, 29%) acknowledged an LIS professional and few listed one as a co-author (n = 194, 8%). We conclude that to improve reporting and strengthen the impact of the scoping review method in the social sciences, researchers should consider (1) adhering to PRISMA-S reporting guidelines, (2) employing more supplementary search strategies, and (3) collaborating with LIS professionals.

Transporting newborns with transposition of the great arteries.

AIMS: The aim of the study was to examine the prevalence and management of outborn babies with a post-natally confirmed diagnosis of transposition of the great arteries (TGA) requiring transport by the Newborn and Paediatric Emergency Transport Service (NETS), New South Wales during the epoch 1991-2010. METHOD: A retrospective audit of NETS database and case notes. The physiological status, interventions and any complications encountered from the point of referral to NETS (pre-transport), stabilisation (transport) and subsequent admission to the receiving hospital (post-transport) were evaluated. RESULTS: One hundred fifty-seven infants with TGA were transported, with an average of eight per year (1:11,598 births). Seven (4%) had an antenatal diagnosis, and 72 (46%) had a post-natal diagnosis prior to referral. Physiological and clinical parameters demonstrated overall clinical stability; however, 47% of the babies had a PaO(2) <30 mmHg, and approximately one-fifth had oxygen saturations <70%. Rates of mechanical ventilation and prostaglandin E(1) administration were approximately 50%. A quarter of transported babies encountered a transport-related event, including one death and two babies for which a decision was reached to forego life-sustaining treatment at the referring hospital. CONCLUSIONS: Most newborns with TGA remain stable or improve during transport. There is a rate of adverse events; however, this reinforces the need to facilitate delivery where there is ready access to interventional paediatric cardiology services.

Interhospital transport of children with confirmed or suspected intussusception: experience at the New South Wales Newborn and Paediatric Emergency Transport Service over 10 years.

OBJECTIVE: The objective of this study was to compare medical and paramedic retrieval of children requiring interhospital transport with suspected or confirmed intussusception. METHODS: Cases of confirmed or suspected intussusception referred to the New South Wales Newborn and Paediatric Emergency Transport Service from January 2001 to August 2011 were identified retrospectively using the Newborn and Paediatric Emergency Transport Service database. Univariate analyses were used to compare patients transported by medical and paramedic escort teams, and multivariable logistic regression was used to determine independent predictors of the decision to use medical escort teams. RESULTS: Two hundred twenty-two cases were identified over the 10-year period. Paramedic escort teams were used in 48% of cases. There were no major complications recorded during retrieval by medical and paramedic escort teams. Only the presence of blood-stained stools (odds ratio, 1.9; 95% confidence interval, 0.93-3.86; P = 0.08) and increasing heart rate (odds ratio, 1.03; 95% confidence interval, 1.01-1.04; P = 0.002) were found to be predictors of the decision to use a medical escort retrieval team. No factors were found to be associated with increased medical intervention in the subgroup of patients transported by a medical escort team. CONCLUSIONS: Well children requiring interhospital transport for suspected or confirmed intussusception can be transported safely without a medical escort team if they have normal heart rates.

Being a woman: perspectives of low-german-speaking mennonite women.

Understanding the beliefs and knowledge related to women's sexuality is important when working with unique religious groups in order to provide culturally appropriate care. An exploratory, descriptive qualitative study generated knowledge, beliefs, and practices related to menstruation, ovulation, and family planning among Low German-speaking (LGS) Mennonite women (n = 38). There is a pervasive silence that surrounds sexuality among this group, who have a limited understanding of the physiological changes they experience. Honoring religious principles and family and community expectations through acceptable female behavior is essential. Adherence to religious principles varies by family but is not shared with the group to avoid disfavor.

Childbearing beliefs among Low-German-speaking Mennonite women.

BACKGROUND: Low-German-speaking (LGS) Mennonites are a conservative religious group that has migrated from Eastern Europe to Canada and then to countries such as Mexico. They are now returning to Canada in large numbers. They adhere to religious principles based upon a literal interpretation of the Bible. This conservative religious group provides opportunities for nurses and midwives to implement culturally competent care. AIM: The purpose of this article is to discuss LGS Mennonite women's childbearing knowledge and beliefs to develop and implement care that considers and includes their conservative religious beliefs. METHODS: An exploratory, descriptive study was conducted to generate information through open-ended interviews with 38 LGS Mennonite women about their knowledge, beliefs and practices related to childbearing. Data collection and analysis occurred simultaneously; emerging themes were discussed by the research team to ensure a contextual understanding of the data. FINDINGS: The participants engage in proscribed practices ('turning the baby') and adhere to specific dietary measures (increasing dairy products) during pregnancy to ensure a healthy birth outcome. During the post-partum, extensive support is provided by other Mennonite women to assist the mother and newborn during this important transition. CONCLUSION: Building trust and working in a respectful manner with religious groups such as the LGS Mennonites are a cornerstone of culturally competent nursing practice.

Childbearing practices in anadier Mennonite women.

Cross-cultural nursing practices call for attention to be paid to the unique beliefs and practices of the groups with which nurses come in contact. The Kanadier Mennonites are a conservative religious group who live in Alberta, Manitoba and Ontario. An exploratory, descriptive study was conducted with this group in southern Alberta to generate information about their health and illness beliefs. This article focuses on their knowledge, beliefs and practices in relation to childbearing. Interviews were conducted with 45 women, the majority of whom were married and had been born in Mexico. Among the sample there had been a range of one to 16 pregnancies. The participants noted that childbearing is not a topic openly discussed with others. Women learn about childbearing from their mothers and other women but also from physicians and books. During pregnancy there are particular activities to be avoided including the use of strong cleaning fluids and hand milking of cows. Foods such as milk need to be ingested to ensure a healthy pregnancy Prenatal care was not emphasized in Mexico nor has it become a customary practice in Canada but deliveries in hospital are the norm in both these countries. During the postpartum the women receive support from their immediate and extended family in order to recuperate. Nurses need to explore individual Kanadier Mennonite beliefs regarding childbearing and work with this group in developing acceptable health promotion programs to help ensure healthy pregnancy outcomes. The blending of nursing practice knowledge in a non-intrusive manner with a group of people with differing belief systems is a necessary and achievable goal.