July/Aug. 2011 - Parents Admit Shortcomings When It Comes to Protecting Their Children on Social Networks
Tuesday, 16 August 2011 CF Special Report With about half of young people experiencing some form of cyberbullying or other... Read more... |
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There are certainly sound reasons for your doctor to suggest inducing labor. But a recently published study by a large group of hospitals in Utah provides some of the most up-to-date information on the complications than can arise from inducing labor. “Utah has the highest birthrate in the nation, so it may not be surprising that close to 30,000 babies are delivered every year at Intermountain Healthcare, a Salt Lake City-based system of nonprofit hospitals and clinics,” writes Janie Wilson, M.S., R.N.of Intermountain Hospitals. Here’s her recent article ‘Designing Best Practices through Data Mining’ that explains what her hospital system found about induced labor. Her article was about the hospital’s practice of collecting data about medical procedures, but her research focused on a particular trend they discovered – induced labor. “Since the 1970s, Intermountain has pioneered the use of EMRs to improve patient care. Intermountain’s record system gives clinicians a complete medical history for individual patients, but it also serves as a giant research tool. For more than 30 years, these records – including medical details about every birth – have been compiled in a database, much like large, clinical data warehouse. The database collects medical information from certain data fields in order to track trends and best practice care models across Intermountain’s entire patient population. This means that unlike some other EMR systems that are focused only on individual records, Intermountain’s clinical database allows statisticians to statistically evaluate treatment methods such as the benefits of various interventions or the efficacy of different medications. Using a rigorous statistical analysis of millions of patient records, statisticians can identify trends and make evidence-based decisions about best practices that can improve quality, saving lives and money across the system. As an outgrowth of the clinical database, Intermountain was one of the first health care organizations to implement continuous quality improvement techniques to manage care. These techniques – used for many years in other industry sectors like manufacturing and education – consist of thinking about complex organizations as systems with processes that can be continually improved using objective data. Analyzing statistics from the database, Intermountain has developed best care models or protocols that continually improve medical outcomes in several clinical programs including cardiovascular, oncology, surgical services, primary care, intensive medicine, pediatric specialties, preventive medicine, and behavioral health along with programs for women and newborns. Specifically, the data showed that of babies delivered at 37 weeks gestational age, 8.85 percent were admitted to the neonatal intensive care unit. The number dropped to 4.51 percent of babies delivered at 38 weeks and then bottomed out to 3.34 percent at 39 weeks. The percentage of NICU admissions climbs slowly for babies born at 40 weeks gestational age and beyond. So according to Intermountain’s statistics, hitting the magic 39-week mark seemed to significantly cut the chances of a baby being sent to the NICU. But that wasn’t all the research found. Babies also were more likely to struggle with respiratory distress syndrome if physicians electively induced labor before 39 weeks. The data showed that if delivery occurs at 37 weeks, 1.92 percent of babies were affected. At 38 weeks the percentage drops to .68 percent and bottoms out at .42 percent at 39 weeks, before slightly climbing again at 40 weeks. The need for newborns to be on a ventilator was also significantly reduced if delivery occurred at 39 weeks gestational age. Armed with statistical information from their own hospitals and using standards from the American College of Obstetrics and Gynecologists, Intermountain instituted a new guideline to limit labor inductions before 39 weeks unless a consulting physician agreed that an earlier induction was medically necessary. Many physicians said that in their experience, inducing labor at 38 or even 37 weeks did not result in memorable problems for moms or babies. They also said that that early inductions were being driven by patient demand. But when the Intermountain team showed Utah physicians the composite data indicating that when birth occurred at 37 weeks the risks to babies were up to three times higher than waiting two more weeks, the number of elective inductions dropped. Early adopters helped to encourage their medical colleagues to follow the 39-week guideline. Today there is strong support for the best practice protocol throughout all of Intermountain’s labor and delivery units. In 1999, approximately 28 percent of all inductions at Intermountain’s hospitals occurred before 39 weeks. Today, that percentage is only 3.4 percent. And with the significant drop in early elective inductions, Intermountain has also seen a 90-minute drop in the average length of labor in electively induced patients, with fewer emergency cesarean sections and other medical complications associated with deliveries. The guidelines benefit new babies and their moms. And as icing on the cake, the protocol also saved patients approximately $2 million since the program began. Read 0 Comments... >> |
Staff Report|
But it's important to remember that ultrasounds are medical procedures that should be done on a healthcare provider's order. Yet this test that was once used solely by medical professionals is now being utilized by businesses in strip malls and shopping centers to sell keepsake prenatal portraits and videos. Using technology that allows parents to see high-resolution three- and four-dimensional (moving) images of their babies in the womb, these facilities may employ poorly trained — or even untrained — technicians who aren't given a health provider's order to authorize the procedure and aren't supervised by a physician. The U.S. Food and Drug Administration and the American Institute of Ultrasound in Medicine warn parents-to-be that these nonmedical ultrasounds are unapproved, inappropriate and possibly even risky. A special jelly is applied to the skin on the expectant mother's abdomen, and a wand-like instrument (called a transducer) is positioned over it. Sound waves are generated and reflected back to the transducer as electric impulses, which produce an image of the baby on a computer screen. Images seen on most two-dimensional ultrasounds are difficult for the untrained eye to understand. What might look like a hand to an expectant parent might actually be a foot — which is why the images must be interpreted by a properly trained technician. A doctor will then view the report and make his or her own interpretations. When used correctly — at low power levels and for short periods of time by trained professionals (such as sonographers, radiologists and obstetricians) — ultrasounds are a standard procedure used to: Usually performed between 18 and 20 weeks, an ultrasound can be done sooner or later and sometimes more than once. The FDA is also concerned that these nonmedical ultrasounds can be misinterpreted as medical examinations and so prevent women from seeking standard prenatal care. It might be tempting to get your baby's first portrait before the little bundle of joy is even born, but talk to your OB, nurse-midwife or family doctor if you're expecting and have questions about ultrasounds. If you've already had a nonmedical ultrasound, be sure to follow up with your healthcare provider. Read 0 Comments... >> |
For many expectant parents, ultrasounds offer a window into the world of their growing unborn baby. Unlike most standard prenatal tests that involve nothing more than a urine cup or a needle, ultrasounds allow a sneak preview of what's to come and what's going on inside — if the heart is beating normally or if the baby registry should contain pink or blue items.
