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Biomedical subjects

Declan Devane

Publications and source records attributed to Declan Devane.

9 recordsLinked to original sources
PubMed2006

Information, knowledge and expectations of the routine ultrasound scan.

OBJECTIVE: To examine the current provision of pre-ultrasound information to women; to determine if the information provided was related to women's knowledge of the routine second trimester ultrasound; and to describe women's expectations of the scan. DESIGN: A descriptive survey, before and after design. SETTING: Tertiary referral centre in the Republic of Ireland. PARTICIPANTS: A convenience sample of pregnant women attending for routine second trimester ultrasound scan. MEASUREMENTS: Self-report questionnaires were used to explore the availability of information about the test, the extent of women's knowledge and expectations of the examination, and the degree to which expectations were achieved. FINDINGS: Most women received little information from health professionals about the capability and limitations of the scan, and had expectations that exceeded the purpose and ability of the examination. Most women, however, stated that their expectations were met in most cases. Although the routine ultrasound in the study site is not a targeted fetal anatomical survey, most women were concerned with this aspect of the test. KEY CONCLUSIONS: If women are to have realistic expectations of the routine ultrasound scan, then improvements are required in the provision of pre-ultrasound information, particularly in relation to the technological limitations of the examination. Consideration should be given to the context of the high appeal associated with visualising the fetus for women when unachievable expectations are reported as having been met. IMPLICATIONS FOR PRACTICE: Any development of prenatal screening programmes that will uncover fetal abnormalities needs to be considered in context, in particular when termination of pregnancy is not available within the jurisdiction. Women had expectations of the examination that could not, because of technological limitations, have been met by the examination, but which they perceived to have been met. Knowledge of the purpose, capabilities and limitations of the routine second trimester ultrasound scan was not influenced by the mode of information provision.

Adult↗
PubMed2006

A randomised-controlled trial evaluating a fetal monitoring education programme.

OBJECTIVE: to evaluate the effectiveness of a fetal monitoring education programme on midwives' fetal monitoring knowledge and intrapartum cardiotocograph interpretation skills. DESIGN: two group, before-after, randomised-controlled trial. SETTING: two maternity hospitals in the Republic of Ireland. PARTICIPANTS: 55 midwives were randomly assigned to either the experimental group (n=27) or the control group (n=28). INTERVENTIONS: the experimental group participated in a 1.5 hr fetal monitoring education programme, whereas the control group attended an alternative education programme consisting of a non-fetal-monitoring-related video presentation. MEASUREMENTS: the primary outcomes of interest were fetal monitoring knowledge and intrapartum cardiotocograph interpretation skills test. FINDINGS: in the fetal monitoring knowledge post-test, the median percentage correct responses for the control and experimental groups were 56% (IQR 18.75) and 88% (IQR 12.5), respectively. This difference, 31.2%, was statistically significant (U=78.5, 95.1% CI -31.25 to -18.75, p<0.001). In the intrapartum cardiotocograph interpretation skills post-test, the median percentage correct responses for the control and experimental groups were 55.6% (IQR 16.7) and 66.7% (IQR 22.2), respectively. This difference, of 11.1%, was statistically significant (U=186, 95.2% CI -16.67 to -5.56, p<0.001). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: attendance at a short (1.5 hr), in-service fetal monitoring education programme can increase midwives' fetal monitoring knowledge and cardiotocograph interpretation skills. The availability of in-service fetal monitoring education programmes is sporadic, often less than recommended, and is a cause for concern.

Adult↗
PubMed2006

Childbirth policies and practices in Ireland and the journey towards midwifery-led care.

OBJECTIVE: To describe the dominant policies and practices that have governed childbirth in Ireland, and to outline the progress made towards the introduction of midwifery-led care in one health region. LITERATURE REVIEW: A review of maternity-care policies in Ireland was conducted using government and regional health-authority documents and two historical reviews of government policies. A search was also carried out in PubMed and cinahl databases, using the keywords 'maternity care', 'childbirth', 'policy', 'midwifery-led', 'Ireland/Irish', with relevant Boolean and string operands. Childbirth as a social process is influenced by the model of care, and affects the physical and psychological outcomes for the woman and her family. In Ireland, routine intervention in labour is common, but, since the early 1990s, some changes in the Irish maternity services have taken place. Pilot projects on community midwifery have been introduced in some areas. Challenges to the provision of maternity care in the Health Service Executive, North Eastern area (formerly the North-Eastern Health Board) led to the production of the Kinder report, which included a recommendation to introduce pilot midwifery-led units (MLUs). THE INTRODUCTION OF MIDWIFERY-LED CARE: A Maternity Services Taskforce was established in January 2002 with a wide remit, including facilitation of the establishment of MLUs in Cavan General Hospital, Cavan and Our Lady of Lourdes Hospital, Drogheda, Co. Louth. The MLUs are being evaluated within the context of a randomised trial known as 'the MidU study', which compares midwife-led care with the present system of medical-led care for women who are at low risk of complications during pregnancy and labour. CONCLUSION: The journey to midwifery-led care in Ireland has been a long one. The phased introduction of MLUs, which are subject to rigorous evaluation, will provide quality evidence upon which to base the future development of maternity care across Ireland.

Adult↗
PubMed2006

Exploring painful experiences: impact of emotional narratives on members of a qualitative research team.

AIM: This paper reports a study of the impact of emotional narratives on the well-being of members of a qualitative research team during the conduct of sensitive research. BACKGROUND: Qualitative data are frequently collected from participants using repeated in-depth interviews when exploring sensitive issues such as loss and grief. The research process can evoke highly emotional responses in the participant and others involved in the study. While consideration has been given to the impact of the research process on participants when a highly affective component is involved, relatively little attention has been given to research team members' experiences. METHOD: Through analysis of fieldwork records from a grounded theory study of the experiences of women who were carrying a baby with a foetal abnormality, we discuss the affective issues arising in conducting sensitive research. Data sources included two reflexive journals, written comments from two transcribers and the transcript of an interview with the research supervisor. FINDINGS: The core category of 'Connecting with the data' emerged, to which each substantive category relates. Three substantive categories -'bearing to watch,''bearing to listen' and 'bearing to support'- emerged as independent but inter-related aspects of the research process as experienced by the researcher, transcribers and supervisor. Methods of protecting the research team and the integrity of the study when the substantive issue is highly emotive are discussed. CONCLUSION: The emotional impact of research on participants is normally considered prior to the conduct of any sensitive research, and efforts are made to protect them. The potential for researchers, transcribers and supervisors to be harmed should also be carefully considered when planning a project with significant affective elements.

Adaptation, Psychological↗
PubMed2005

Midwives' visual interpretation of intrapartum cardiotocographs: intra- and inter-observer agreement.

AIM: This paper reports an examination of intra- and inter-observer agreement in midwives' visual interpretation of intrapartum cardiotocographs (CTGs). BACKGROUND: The issue of intra- and inter-observer agreement in the interpretation of CTG interpretation has serious implications for the validity of electronic fetal heart rate monitoring and subsequent decisions on intrapartum management. However, no studies were found that assessed intra- and inter-observer agreement in midwives' interpretations of CTG tracings. METHODS: Twenty-eight midwives independently interpreted three intrapartum CTG tracings on two separate occasions using a self-administered Cardiotocograph Interpretation Skills Test. Inter-rater agreement in interpretation was assessed by cross-tabulating the two sets of raw data obtained at time 1 and time 2 and computing Cohen's Kappa (kappa). Intra-rater agreement was assessed by computing kappa for each rater with the two sets of raw data (time 1 and time 2) obtained from each individual. The data were collected in 2000. RESULTS: Overall intra-rater agreement ranged from 'fair to good' (kappa = 0.48) to 'excellent' (kappa = 0.92). Raters' classifications altered in 18% (n = 5) of cases for the normal tracing, in 29% (n = 8) for the suspicious tracing and in 11% (n = 3) for the pathological tracing. Inter-rater agreement was fair to good, with kappa statistics ranging from 0.65 to 0.74, respectively. Agreement was highest in the classification of decelerations (kappa = 0.79) and lowest in the assessment of baseline variability (kappa = 0.50). Overall inter-rater agreement was highest in the suspicious tracing (kappa = 0.77, excellent) and lowest in the normal tracing (kappa = 0.54, fair to good). CONCLUSION: Inter- and intra-observer variability are intrinsic characteristics of the interpretation of intrapartum CTGs. Levels of agreement revealed degrees of variation that expose room for improvement. Efforts are needed to reduce inter- and intra-observer variation in interpretation of intrapartum CTG tracings. In addition, research should focus on the development and evaluation of non-invasive, low observer variability methods of intrapartum assessment of fetal well-being. The subjectivity of CTG interpretation and inconsistencies in interpretation should also be considered in intrapartum management, clinical audit and in medico-legal settings.

Adult↗
PubMed2004

How many do I need? Basic principles of sample size estimation.

BACKGROUND: In conducting randomized trials, formal estimations of sample size are required to ensure that the probability of missing an important difference is small, to reduce unnecessary cost and to reduce wastage. Nevertheless, this aspect of research design often causes confusion for the novice researcher. AIM: This paper attempts to demystify the process of sample size estimation by explaining some of the basic concepts and issues to consider in determining appropriate sample sizes. METHOD: Using a hypothetical two group, randomized trial as an example, we examine each of the basic issues that require consideration in estimating appropriate sample sizes. Issues discussed include: the ethics of randomized trials, the randomized trial, the null hypothesis, effect size, probability, significance level and type I error, and power and type II error. The paper concludes with examples of sample size estimations with varying effect size, power and alpha levels. CONCLUSION: Health care researchers should carefully consider each of the aspects inherent in sample size estimations. Such consideration is essential if care is to be based on sound evidence, which has been collected with due consideration of resource use, clinically important differences and the need to avoid, as far as possible, types I and II errors. If the techniques they employ are not appropriate, researchers run the risk of misinterpreting findings due to inappropriate, unrepresentative and biased samples.

Data Interpretation, Statistical↗