Cataract surgery and the optometrist.
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Aftercare↗
Biomedical subjects
P Percival
Publications and source records attributed to P Percival.
Normality and collaboration: mothers' perceptions of birth centre versus hospital care.
OBJECTIVE: to describe women's perceptions of care in Western Australian birth centres following a previous hospital birth. DESIGN, SETTING AND PARTICIPANTS: an exploratory design was used to study the care experiences of 17 women recruited from three Western Australian birth centres. Data were obtained from in-depth interviews that explored women's perceptions of their care in both the birth centre and hospital context. FINDINGS: four key themes emerged from the analysis: 'beliefs about pregnancy and birth', 'nature of the care relationship', 'care interactions', and 'care structures'. The themes of 'beliefs about pregnancy and birth' and 'nature of the care relationship' are discussed in this paper. Beliefs about pregnancy and birth refer to the philosophical underpinnings of pregnancy and birth held by women and their carers. Nature of the care relationship identifies women's perceptions of their relationship with health professionals. Care interactions and care structures will be described in a subsequent paper. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The women's comments suggested differences in philosophy between hospital and birth-centre settings. The philosophy and beliefs of caregivers was an important component of the care experience. Women valued the normality of the birth-centre approach and the opportunity to experience the birth of their child with collaborative support from a midwife.
Adult↗
Ongoing relationships with a personal focus: mothers' perceptions of birth centre versus hospital care.
OBJECTIVE: to describe women's perceptions of care in Western Australian birth centres following a previous hospital birth. DESIGN, SETTING AND PARTICIPANTS: an exploratory study was undertaken to examine the care experiences of women from three Western Australian birth centres. Data were obtained from 17 women whose interviews were audio-recorded and transcribed. The research focused upon women's perceptions of their recent birth centre care as compared to previous hospital care during childbirth. FINDINGS: four key themes emerged from the analysis: 'beliefs about pregnancy and birth', 'nature of the care relationship', 'care interactions' and 'care structures'. The themes of 'care interactions' and 'care structures' will be presented in this paper. Care interactions refer to women's opportunities to develop rapport with their carers. Care structures involved the organisational framework in which care was delivered. The first two themes of 'beliefs about pregnancy and birth' and the 'nature of the care relationship' were discussed in a previous paper. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: differences in opportunities for care interactions and care structures were revealed between birth centre and hospital settings. Ongoing, cumulative contacts with midwives in the birth-centre setting were strongly supported by women as encouraging the development of rapport and perception of 'being known' as an individual. Additionally, care structures tailored to women were advocated over the systematised, fragmented care found in hospital settings.
Adult↗
Birthing at home: the resolution of expectations.
OBJECTIVE: To describe the experience of ten couples who have had a home birth in Western Australia. DESIGN, SETTING AND PARTICIPANTS: Using a phenomenological approach, ten parent couples were interviewed and three home-birth videos observed. Of the ten couples, four discussed their first child's home birth. The remaining six couples had three or four children who had been born at home. FINDINGS: The essence of these parents' experiences of home birth was gained through identifying significant statements from transcripts and field notes and clustering these into the four themes of 'constructing the environment'; 'assuming control'; 'birthing'; and 'resolving expectations'. The first two themes were presented in a previous paper (Morison et al 1998). The latter two themes are now presented. The theme 'birthing' was where parents elaborated on their birth beliefs, discussed the actual birth and shared aspects of the relationship between the couple and the midwife. 'Resolving expectations' concerned the process of parents forming expectations, experiencing the reality of birth and then evaluating whether expectations were met. KEY CONCLUSIONS: The development of a supportive relationship between couples and their midwife was essential during this transition to parenthood. Resolving expectations was an essential process that the parents undertook to clarify the meaning of their birth experience, and thereby acknowledge its uniqueness. IMPLICATIONS FOR PRACTICE: The findings are important to midwives' practice as they reveal the value clients place on a shared philosophy about birth. Midwives, in any setting, can reflect on their own birthing beliefs and determine their compatibility with their clients' beliefs.
Attitude of Health Personnel↗
Vaccine know-how. Kimberley immunisation study: community nurses immunisation education, knowledge and practice.
In the remote Kimberley Region of Western Australia, community nurses administer almost all childhood vaccines. This paper discusses the immunisation education, knowledge and practice of this group of nurses. This research was part of a larger Kimberley immunisation study. The first phase investigated the immunisation cover and timing of vaccine administration to children in the 0-18 month age group in the Kimberley Region of Western Australia. Phase two investigated immunisation education, knowledge and practice. The study findings suggest that community nurses are knowledgeable about vaccine administration, and administer vaccines appropriately to children with multiple infections, weight loss and failure to thrive. They are also 'active' in following up children due and overdue for vaccines. However, a lack of on-going nursing immunisation education was reported.
Child, Preschool↗
Effect of nappy liners on temperature stability in very preterm infants.
OBJECTIVE: To determine whether absorbent liners used in posturally supportive cloth nappies influence temperature stability in infants < 31 weeks gestation. METHODOLOGY: Randomized cross-over trial conducted at King Edward Memorial Hospital for Women, Perth, Western Australia. Twenty-three infants nursed in incubators on Infant Servo Control were randomly assigned to wear cloth postural support nappies alternately with or without absorbent liners for 24-h periods over 4 days. Measurements of skin and incubator temperatures were recorded hourly. Times of all nappy changes and infant handling procedures were also recorded. RESULTS: There was no change in any temperature measurement over time, between days, or between day/night periods. Infants nursed with the liner demonstrated a higher skin temperature (0.04 degrees C), and a lower incubator temperature (1.05 degrees C). A drop in skin temperature of 0.02 degrees C and an increase in incubator temperature of 0.28 degrees C occurred following handling of infants. There was no effect due to sex, gestational age, or actual age of the infants. CONCLUSION: Use of an absorbent liner within a cloth postural support nappy promotes better temperature regulation in infants < 31 weeks gestation, by reducing incubator temperature and increasing skin temperature.
Analysis of Variance↗
Constructing a home birth environment through assuming control.
OBJECTIVE: The purpose of this qualitative study was to describe the experience of couples who have had a home birth. DESIGN, SETTING AND PARTICIPANTS: A phenomenological approach was used to provide an understanding of the human experience of home birth in Western Australia. The research design consisted of a field study, in which 10 parent couples were interviewed and three videos of home births observed. Of the ten couples, four couples spoke of their first baby's home birth and the remaining six couples had three or four children who had been born at home. FINDINGS: The couples' experiences of home birth were gained through identifying significant statements from transcripts and field notes, and clustering these into the following four themes: 'constructing the environment'; 'assuming control'; 'birthing'; and 'resolving expectations'. The themes of 'constructing the environment' and 'assuming control' are described in detail in this paper. 'Constructing the environment' describes how couples adapted the physical environment, and established support to create a positive birth environment. 'Assuming control' discusses exerting control and taking responsibility for the birth. The remaining themes of 'birthing' and 'resolving expectations' are described in a subsequent paper (Morison et al, in press). KEY CONCLUSIONS: The research furnishes an insight into the couples' experience of home birth. The lived experience of birthing at home involved a process where a couple actively created an environment that enabled them to assume control and responsibility for the birth. IMPLICATIONS FOR PRACTICE: The findings are important for midwives in any setting, as they reveal the extent to which some parents value the right to assume control and responsibility for the birth of their baby. Although the physical environment of a home birth cannot be replicated in every setting, issues specific to the birth environment are relevant to all midwives.
Adult↗
Positive effects of an antenatal group teaching session on postnatal nipple pain, nipple trauma and breast feeding rates.
OBJECTIVE: To assess whether an antenatal teaching session on position and attachment of the baby on the breast had an effect on postnatal nipple pain, nipple trauma and breast feeding duration. The study was planned as a pilot study to allow an adequate sample size to be calculated for a larger study. DESIGN: An observer blind experimental design was used. Women were randomly assigned to either the experimental group teaching session or the control group. SETTING: One public hospital in Western Australia. PARTICIPANTS: 70 primiparae who intended to breast feed their baby were recruited from the antenatal clinic of the study hospital at 36 weeks' gestation. INTERVENTION: Antenatal group sessions on position and attachment of the baby on the breast were conducted by a lactation consultant. MEASUREMENTS AND FINDINGS: During the first four postnatal days, position and attachment was measured by LATCH (Latch on, Audible swallow, Type of nipple, Comfort and Help) (Jensen et al 1994), nipple pain was measured by the Visual Analogue Scale (VAS) and nipple trauma was measured by the Nipple Trauma Index (NTI). The analysis of variance (ANOVA) results indicated that the women in the experimental group were better able to attach the baby on the breast and had significantly less nipple pain and trauma than the control group. At six weeks postnatally, 31 of the 35 women in the experimental group were breast feeding compared to 10 of the 35 in the control group. CONCLUSIONS AND IMPLICATIONS: These initial findings suggest that midwives can make the best use of decreasing resources by using practical 'hands on' antenatal group teaching as an effective strategy to increase breast feeding rates.
Adult↗
Clear cornea sutureless phacoemulsification and astigmatic decay after two years.
PURPOSE: To determine whether clear cornea temporal sutureless sections lead to astigmatic decay over a 2 year period. METHOD: The difference between (a) pre-operative keratometric cylinder and keratometric cylinder at final follow-up, and (b) spectacle cylinder at 1 month post-operation and final follow-up, was calculated for 43 eyes. RESULTS: The mean difference in keratometric cylinder between pre-operation and final follow-up was 0.12 D with the rule (WTR) or against the wound. The range was from 0.7 D WTR to 0.4 D against the rule (ATR). Eighty-two per cent of eyes did not change by more than 0.3 D. The mean change in spectacle prescription between 1 month post-operation and final follow-up was 0.05 D ATR, range 0.5 D WTR to 1.0 D ATR. At final follow-up 93% of eyes were seeing 20/40 or better unaided. CONCLUSION: A carefully constructed temporal wound can remain astigmatically neutral.
Adult↗
Local anaesthesia revisited.
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Anesthesia, Local↗
Satisfaction with nursing home care of a relative: does inviting greater input make a difference?
This study examined whether a formal invitation to have greater involvement in the nursing home care of their relatives resulted in increased satisfaction in former care-givers. The conceptual framework guiding the study was based on Roy's Adaptation model of Nursing (Roy 1984, 1989), since it was believed that the intervention might aid the adaptation of family members to the institutionalisation of a close friend or relative. Increased satisfaction with care was measured as evidence of adaptation. In the study, 31 former care-givers were randomly assigned to two groups, one of which was offered greater involvement in care. Of the participants in the experimental group, the four who accepted this opportunity all had relatives admitted in the past 6 months. After 6 weeks there was no significant difference between the groups. Trends suggest that similar programs may be most useful in the early months following admission, while care-givers are in the process of adapting to their new circumstances. It appears that nursing staff must be sensitive to the different needs for involvement in the care of relatives.
Adaptation, Psychological↗
Effect of a postural support nappy on 'flattened posture' of the lower extremeties in very preterm infants.
OBJECTIVE: To determine whether the use of a postural support nappy (PSN) would reduce the features of 'flattened posture' in the lower extremities of infants < 31 weeks gestation who are nursed prone. METHODOLOGY: Randomized, observer blind, controlled trial conducted at King Edward Memorial Hospital for Women, Perth, Western Australia. Infants were randomly assigned and stratified by gestational age to be nursed in a conventional nappy (n = 29) or a PSN (n = 31) when in the prone position. The features of 'flattened posture' were measured as angles and assessed by blinded observers prior to commencement of the intervention, 4 weeks post intervention, then bi-weekly until discharge. RESULTS: A significant reduction in the features of 'flattened posture' occurred in the PSN group after 4-6 weeks of intervention and stabilized by 8 weeks until discharge. No changes were detected in the control group. No significant difference was observed between infants < 29 weeks gestation compared to infants of 29-30 weeks gestation in either treatment group. CONCLUSIONS: Use of the PSN in infants < 31 weeks gestation who are nursed in the prone position significantly reduces the features of 'flattened posture' in the lower extremities. This is of benefit in the short term, and follow up of these infants into childhood will demonstrate whether the long-term effects of 'flattened posture' can be prevented.
Chi-Square Distribution↗
An update on multifocal lens implants.
The performance of multifocals is partly determined by the degree to which contrast at the focussed image is reduced by out of focus images. This paper discusses how optical performance may vary with lens design and includes consideration, with available core study results, of multifocal designs marketed by Iolab, 3M, AMO, Ioptex, Storz and Domilens. For most lenses an acuity of 20/40 and J3 can be achieved unaided in over 70% of best case eyes and J2 with the distance correction in over 80%. However the risk of disappointment tends to prevent a more widespread use of multifocals among surgeons, and an explanation is given as to possible reasons.
Cataract Extraction↗
Use of heparin-modified lenses in high-risk cases for uveitis.
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Cataract Extraction↗
Rationale for the Salz Super Single blade for radial keratotomy.
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Humans↗
Indications for the multizone bifocal implant.
A significant improvement in unaided visual standards may be achieved by switching from a monofocal to a 3M diffractive bifocal implant; however, this results in a loss of clarity, particularly for small print, in some patients. In a prospective study of 55 bifocal eyes and 55 monofocal eyes, best-case analysis showed 81% of 52 eyes with bifocal implants could read J5 with their distance correction compared with 21% of the control eyes and 56% could read J2 with the distance correction compared with 2% of the control eyes; 75% of bifocal eyes could read both 20/40 and J3 without any aid compared with 33% of the control eyes. The 3.5 diopter focus difference in the bifocal lens produced commendable results, with 52% requiring no spectacle reading addition. However, the fact that 17% of bifocal eyes could not read J2 highlights certain drawbacks that are relevant to indications for use.
Accommodation, Ocular↗
Prospective study comparing hydrogel with PMMA lens implants.
A prospective study has been undertaken to assess the relative merits of one-piece polymethylmethacrylate (PMMA) and poly 2 hydroxyethylmethacrylate "hydrogel" (P-HEMA) lenses in uncomplicated eyes after uncomplicated surgery. Two groups of 125 eyes each were matched in terms of patient age and sex. One group received PMMA lenses; the other group received P-HEMA lenses. Six months after surgery the visual acuity of 42% of eyes with P-HEMA lenses was 20/15, whereas that of 29% of eyes with PMMA lenses was 20/15 (p = 0.02). Major decentration occurred in two cases of P-HEMA lens implantation, but asymptomatic subclinical decentration was more common with PMMA lenses (p less than 0.001). The looped PMMA lens was considered adaptable to a wider variety of surgical conditions.
Acrylates↗