Theory-based evaluation of the impact of Master's programmes in development studies: Insights from a mixed-methods and multicultural alumni action research project.

To understand the impact of the international Master's programmes offered at the Institute of Development Policy (University of Antwerp), a theory-based evaluation was undertaken. In the first phase, a Theory of Change (ToC) was elaborated, distinguishing between three levels of impact (individual, organisational and societal), four learning dimensions (knowledge, skills, attitudes and networks) and five implicit pathways (change agent, social network, widening access, academic diversity, international understanding). Given the multifaceted and vague nature of the 'impact' concept under study, we selected an international, gender-balanced, multi-sectoral team of alumni researchers who fostered inclusiveness of different perspectives, at the same time capitalising on their depth of understanding, having gone through the study experience themselves. A mixed-methods approach was adopted to validate the ToC, combining a Most Significant Change approach, categorisation and text analysis of 101 alumni impact stories. Our findings demonstrate the importance of the three levels of impact and four learning dimensions in capturing graduate impact. While the impact stories confirmed the dominant 'change agent' pathway, they also hinted at the importance of hybrid complementary configurations of pathways to fully grasp how impact materialises.

Implementation of the RCOG guidelines for prevention of obstetric anal sphincter injuries (OASIS) at two London Hospitals: A time series analysis.

OBJECTIVE: To audit the impact of implementation of the RCOG guidelines for prevention of Obstetric anal sphincter injuries (OASIS) by introducing antenatal perineal massage, manual perineal protection, and cutting episiotomies at 60° to the midline at the time of crowning. DESIGN: Time series analysis; Setting - Two London teaching hospitals; Royal Free London (RFL) and Barnet; Population or Sample - All nulliparous women undergoing vaginal birth; Methods - Training was provided for above techniques. EPISCISSORS-60 were introduced to perform 60° episiotomies. Data were extracted from maternity databases and dashboards; Main Outcome Measures - OASIS rates before and after implementation. RESULTS: Data from 2566 births were analysed. In operative vaginal deliveries (OVD), OASIS declined from 9.6% to 2% (p = 0.001) at Barnet and from 5.6% to 4.2% (p = 0.4) at RFL. OASIS reduced in nulliparous OVD's given episiotomies from 6.3% in the 'before' period to 0.6% in the 'after' period [p = 0.01] at Barnet. Before introduction of the EPISCISSORS-60, OASIS rate was 6.3% with episiotomies and 30% without episiotomies (p = 0.000). After introduction of the EPISCISSORS-60, OASIS rate was 0.63% with episiotomies v 16% without episiotomies (p = 0.000) at Barnet. At RFL, OASIS rate was 2.6% with episiotomies, and 42% without episiotomy (p = 0.000). In SVD's at Barnet, OASIS declined from 6.6% before to 0% after (p = 0.000) in women given episiotomies while it declined from 5.4% to 3% (p = 0.12) in those not given episiotomies. After introduction of the EPISCISSORS-60, OASIS was 0% in women with episiotomies and 3% in those without episiotomies (p = 0.04). In SVD's at RFL, OASIS was 0% in women given episiotomy v 4.7% without episiotomy (p = 0.03). CONCLUSIONS: Deliveries with EPISCISSORS-60 episiotomies had lesser OASIS than those without episiotomies in both nulliparous OVD's and SVD's. OASIS was lower with EPISCISSORS-60 episiotomies than those with eyeballed episiotomies.

Is induced labour in the nullipara associated with more maternal and perinatal morbidity?

PURPOSE: To ascertain any differences in foetomaternal outcomes in induced and spontaneous labour among nulliparous women delivering at term. METHODS: A retrospective matched cohort study consisting of 403 nulliparous women induced at ≥ 292 days and 806 nulliparous women with spontaneous labour at 285-291 days. RESULTS: Compared to those in spontaneous labour, women who had induction of labour were three times more likely to have a caesarean delivery (OR 3.1, 95% CI 2.4-4.1; P < 0.001). Women who had induction of labour were 2.2 times more likely to have oxytocin augmentation (OR 2.2, 95% CI 1.7-2.8; P < 0.001), 3.6 times more likely to have epidural anaesthesia (OR 3.6, 95% CI 2.8-4.6; P < 0.001), 1.7 times more likely to have uterine hyperstimulation (OR 1.7, 95% CI 1.1-2.6), 2 times more likely to have a suspicious foetal heart rate trace (OR 2.0, 95% CI 1.5-2.6), 4.1 times more likely to have blood loss over 500 ml (OR 4.1, 95% CI 2.9-5.5; P < 0.001), and 2.9 times more likely to stay in hospital beyond 5 days (OR 2.9, 95% CI 1.5-5.6; P < 0.001). Babies born to mothers who had induction of labour were significantly more likely to have an Apgar score of <5 at 5 min and an arterial cord pH of <7.0. CONCLUSION: Compared to those with spontaneous labour, nulliparous women with induced labours are more likely to have uterine hyperstimulation, caesarean delivery, and babies with low Apgar scores. Nulliparous women should be made aware of this, as well as potential risks of expectant management during counseling.

Produção do conhecimento em ergonomia na enfermagem / Knowledge production on ergonomics in nursing

O objetivo desta pesquisa foi caracterizar o estado da arte do conhecimento em Ergonomia na Enfermagem com base no estudo de teses e dissertações produzidas no campo de conhecimento da Enfermagem no Brasil. Buscando identificar convergências na percepção da abordagem ergonômica nas atividades de enfermagem em pesquisadores no Brasil, foram analisados 2162 resumos de pesquisas produzidas no período de 1963 a 2000, catalogados na Associação Brasileira de Enfermagem. As pesquisas foram caracterizadas em relação às seguintes variáveis: grau acadêmico, instituições, ano de defesa e áreas do conhecimento. Os estudos sobre trabalho e ergonomia, foram analisados e classificados por áreas da Ergonomia. Paralelamente ao desenvolvimento do trabalho, foram feitas pesquisas em bases de dados nacionais e internacionais com o.propósito buscar bases teóricas à sustentação dos dados empíricos encontrados. Evidenciadas pesquisas sobre Trabalho, referentes a aspectos físicos, cognitivos, psíquicos e organizacionais além de estudos sobre satisfação, prazer, sofrimento, desconforto e dor relacionados à postura e movimentação, demonstraram a contribuição da Ergonomia na Enfermagem. A utilização dos conhecimentos da Ergonomia pode significar a possibilidade de mudanças, criação de novas áreas de atuação e contribuição para o trabalho e à saúde do trabalhador de enfermagem. Este estudo ressalta a importância da pesquisa na produção do conhecimento transformando a prática em obra acadêmica enfatizando a caracterização das inter-relações entre a abordagem da Ergonomia e a produção do saber na Enfermagem, bem como a contribuição da Enfermagem no saber da Ergonomia.