Mothers have praised the good quality of care provided by NHS maternity services in a survey published today (Tuesday) by the Healthcare Commission.
But the results also highlight specific areas of concern and wide variations between trusts in responses to questions about postnatal care, communication, food and cleanliness.
Responses came from 26,000 women who gave birth in January and February 2007, making it the largest survey ever of maternity experience.
The Commission has chosen to throw the spotlight on maternity services because its investigations have highlighted instances of poor quality care.
It is carrying out a national review of this area of care that will culminate in a comprehensive assessment of services nationally and locally. Early next year all trusts will be ranked on a four-point scale from "excellent" through to "weak".
The survey, which will contribute to the national review, represents the voice of women using these services. The watchdog is also gathering information on clinical outcomes and value for money.
The proportion of women surveyed who said their care was "excellent","very good" or "good" was 89% during pregnancy, 90% during labour and birth, and 80% after the birth. The Commission said that these are positive overall results.
Looking at the three stages of care, positive survey results included:
Antenatal care:
- 91% of women said they saw a health professional about their pregnancy as soon as they wanted
- 90% of women said they had the name and telephone number of a midwife they could contact during pregnancy
Care during labour and birth:
- 92% of women said they "definitely" or "to some extent" got the pain relief they wanted
- 82% of women said they were always spoken to in a way they could understand
Postnatal care:
- 88% of women said they had a postnatal check-up four to six weeks after the birth
- 76% of women saw a midwife as much as they wanted
However women's responses were less positive in the following areas:
Antenatal care (Note that antenatal and postnatal care may or may not be provided by the same trust where women have their baby. Primary care trusts, GPs and community midwives also have a role to play.)
- 43% of women said they were not given a choice of having their baby at home, as NICE guidelines suggest. Responses ranged from one acute trust where only 8% of women said this was not offered to another where 76% were not given this option. This may not be the direct responsibility of the acute trust.
- 36% of women said they were not offered NHS antenatal classes, which trusts were asked to do in the government's National Framework for Children, Young People and Maternity Services. Fourteen per cent of those were first time mums and 76% had previously had a baby. Responses ranged from 11% of all women at one acute trust saying they were not offered NHS classes to 67% saying this at another.
During labour and birth
- 26% reported being left alone during labour or shortly after giving birth at a time that worried them. This suggests midwives may not be adequately reassuring women when they have to leave the room - NICE guidelines say women should not be left alone except for short periods. Looking at labour alone, 9% of women at one trust said they were left alone at a time that worried them, while 33% said this at another. In 18 out of the 148 trusts, more than 20% of women said they were left alone during labour at a time that worried them.
- 57% of women gave birth either lying (30%) or lying with their legs supported in stirrups (27%). The most recently published NICE guidance encapsulating best practice recommends that for normal births women should be discouraged from having their baby in this position. At one trust, 44% reported using stirrups, but only 11% at another. Only 13% of women reported their babies were born using forceps or a vacuum cap - these are medical reasons that may require a women to give birth lying.
- The vast majority of women said they were treated with kindness and understanding but beneath this there were variations. At some trusts this was barely an issue while at one trust 18% of women said they were not treated with kindness and understanding.
Postnatal care
- 19% of women said the food in hospital was "poor". Seventy seven per cent said they had the right amount of food but 23% said they had had too little. At one trust only 6% of women said they had too little, 46% at another. There were 21 trusts where more than 30% of women said they did not get enough food.
- 22% of women said they would have liked to have seen a midwife more often after birth and 22% said their midwife did not discuss feeding their baby with them during pregnancy.
- 8% of women said their hospital room or ward was "not very clean" or "not at all clean" while 18% said this of the toilets or bathrooms. At one trust 63% of women said the toilets and bathrooms were "not very clean" or "not at all clean", while at other trusts only 4% of women said this.
Anna Walker, Healthcare Commission Chief Executive, said:
"We have had well publicised concerns about some maternity services. So now is a good time to carry out a thorough review of the quality of care women are getting. A critical piece of that jigsaw is the views of women. This survey represents their voice.
"Overall women are clearly positive about maternity services. But the results do highlight specific areas of concern and wide variations with issues including postnatal care, communication, food and cleanliness.
"We expect trusts to make full use of their individual results and the opportunity to compare with others. These results show us that many trusts provide very positive services for women. Trusts with less positive results need to learn from the good performers."
The maternity survey was coordinated on behalf of the Commission by the Picker Institute Europe.
Early next year the Commission will publish detailed results of its comprehensive review of maternity services which will include data on outcomes, facilities, resourcing, staffing levels and costs. These survey results will feed into this review.
Trusts are expected to use the results of this survey, and the assessment they receive next year from the maternity service review, to help them focus on areas where improvement is needed.
More information about the survey of NHS maternity services
Notes:
This report builds on a national survey of women's experiences in NHS maternity units published in March which was carried out last year by the The National Perinatal Epidemiology Unit (NPEU) and supported by the Healthcare Commission.
The Healthcare Commission survey extends the findings collated by the NPEU by providing localised results of women's experience's in maternity units at a trust level.
Information on the Healthcare Commission
The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.
Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.
The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.
Healthcare Commission
четверг, 25 августа 2011 г.
четверг, 18 августа 2011 г.
Biomechanics May Be The Key To A Successful IVF Implantation
Engineering Bouncing Babies, One at a Time
As hopeful moms-to-be learn, there are important considerations to the successful implantation of a fertilized human egg. A calm environment, regular hormonal injections and the timing of the implantation can all affect the outcome of an in-vitro procedure.
Now a Tel Aviv University researcher is suggesting that prospective parents and their obstetricians also look at the role that gravity and other biomechanical processes play in its success. New studies by Prof. David Elad from TAU's Department of Biomedical Engineering could help desperate couples give birth to healthy single babies - and avoid the risk of multiple births at the same time.
"I am specifically studying how the uterus contracts before the embryo implants itself onto the uterine wall," he says. These contractions play a vital role in keeping the embryo in the uterus, and knowledge of its mechanics can indicate the optimal time and site for implantation. Physical positioning of the woman and the shape and size of her uterus also affect the results of IVF implantation, Prof. Elad says.
His recent publication in the journal Fertility and Sterility suggests methods to enhance the success rate of fertility treatments.
The Gravity of the Situation
"We are all subject to the Earth's gravity forces, and all biological process must also obey Newton's basic laws of physics," says Prof. Elad, who has been studying the biomechanical engineering of pregnancy for over 15 years. "Uterine contractions push the fluid inside a woman's womb in a peristaltic fashion, which helps sperm reach the ovum in the fallopian tube. And after fertilization, this same peristalsis propels the embryo to its implantation site in the uterine wall. It's a fluid mechanics issue.
"By thinking about these biomechanical processes during IVF treatments, we can help physicians, and prospective parents, see better outcomes," he says. The chance of finding an optimal uterine position could be improved through Prof. Elad's recommendations.
"There is no such thing as a standard uterus," Prof. Elad adds. "Our research offers best practices for women of all shapes and sizes."
Avoiding Multiple Birth Dangers
To increase the chances of a successful IVF implantation, women can opt for three or more viable embryos to be implanted in the womb during one cycle. Many, emotionally and financially exhausted, take this chance even if it means an embryo will need to be sacrificed to ensure the health of another. Prof. Elad's research may spare women from having to make this difficult ethical decision.
"Besides recent reports that IVF babies are slightly more prone to genetic diseases, there is a general notion that when there is more than one embryo in the uterus, all the fetuses are subjected to risks of mild and sometimes severe medical problems in the future," says Prof. Elad. "Parents naturally want to avoid this circumstance."
New Tools for IVF Specialists
Through advanced bioengineering research, Prof. Elad, who is currently a visiting professor at New York's Columbia University, is continuing to provide "stimulating evidence" to the IVF medical community. He is working on a computer simulation program on embryo transport in the uterus, in both natural conception or after IVF procedures, to model how and when artificially inseminated embryos should be implanted in the uterus.
Source: George Hunka
American Friends of Tel Aviv University
As hopeful moms-to-be learn, there are important considerations to the successful implantation of a fertilized human egg. A calm environment, regular hormonal injections and the timing of the implantation can all affect the outcome of an in-vitro procedure.
Now a Tel Aviv University researcher is suggesting that prospective parents and their obstetricians also look at the role that gravity and other biomechanical processes play in its success. New studies by Prof. David Elad from TAU's Department of Biomedical Engineering could help desperate couples give birth to healthy single babies - and avoid the risk of multiple births at the same time.
"I am specifically studying how the uterus contracts before the embryo implants itself onto the uterine wall," he says. These contractions play a vital role in keeping the embryo in the uterus, and knowledge of its mechanics can indicate the optimal time and site for implantation. Physical positioning of the woman and the shape and size of her uterus also affect the results of IVF implantation, Prof. Elad says.
His recent publication in the journal Fertility and Sterility suggests methods to enhance the success rate of fertility treatments.
The Gravity of the Situation
"We are all subject to the Earth's gravity forces, and all biological process must also obey Newton's basic laws of physics," says Prof. Elad, who has been studying the biomechanical engineering of pregnancy for over 15 years. "Uterine contractions push the fluid inside a woman's womb in a peristaltic fashion, which helps sperm reach the ovum in the fallopian tube. And after fertilization, this same peristalsis propels the embryo to its implantation site in the uterine wall. It's a fluid mechanics issue.
"By thinking about these biomechanical processes during IVF treatments, we can help physicians, and prospective parents, see better outcomes," he says. The chance of finding an optimal uterine position could be improved through Prof. Elad's recommendations.
"There is no such thing as a standard uterus," Prof. Elad adds. "Our research offers best practices for women of all shapes and sizes."
Avoiding Multiple Birth Dangers
To increase the chances of a successful IVF implantation, women can opt for three or more viable embryos to be implanted in the womb during one cycle. Many, emotionally and financially exhausted, take this chance even if it means an embryo will need to be sacrificed to ensure the health of another. Prof. Elad's research may spare women from having to make this difficult ethical decision.
"Besides recent reports that IVF babies are slightly more prone to genetic diseases, there is a general notion that when there is more than one embryo in the uterus, all the fetuses are subjected to risks of mild and sometimes severe medical problems in the future," says Prof. Elad. "Parents naturally want to avoid this circumstance."
New Tools for IVF Specialists
Through advanced bioengineering research, Prof. Elad, who is currently a visiting professor at New York's Columbia University, is continuing to provide "stimulating evidence" to the IVF medical community. He is working on a computer simulation program on embryo transport in the uterus, in both natural conception or after IVF procedures, to model how and when artificially inseminated embryos should be implanted in the uterus.
Source: George Hunka
American Friends of Tel Aviv University
четверг, 11 августа 2011 г.
Progress Made In Understanding Causes And Treatment Of Endometriosis
Endometriosis is a poorly understood chronic disease characterized by infertility and chronic pelvic pain during intercourse. It affects between 5 to 10 million women in the U.S.
Serdar Bulun, M.D., George H. Gardner Professor of Clinical Gynecology at Northwestern University's Feinberg School of Medicine, has spent the past 15 years investigating and identifying the causes of this disease. Bulun, and colleagues in his lab, discovered key epigenetic abnormalities in endometriosis and identified existing chemicals that now help treat it.
Bulun describes his lab's findings over the past 10 years in the Jan. 15 issue of the New England Journal of Medicine.
One of the abnormalities he discovered is the presence of the enzyme aromatase -- which produces estrogen -- in endometriosis, the diseased tissue that exists on pelvic organs and mimics the uterine lining. (Normal endometrium, located in the uterine cavity, does not contain aromatase.) As a result, women with endometriosis have excessive estrogen in this abnormal tissue found on surfaces of pelvic organs such as the ovaries. Bulun found the protein SF1 that produces aromatase, which is supposed to be shut down, is active in endometriosis.
"Estrogen is like fuel for fire in endometriosis," Bulun said. "It triggers the endometriosis and makes it grow fast."
As a result of the aromatase finding, Bulun launched clinical trials in 2004 and 2005 testing aromatase inhibitors -- currently used in breast cancer treatment -- for women with endometriosis. The drug blocks estrogen formation and secondarily improves progesterone responsiveness.
"We came up with a new treatment of choice for post-menopausal women with endometriosis," Bulun said. Moreover, treatment with an aromatase inhibitor is a very good option for premenopausal women with endometriosis not responding to existing treatments, he noted.
Another molecular abnormality Bulun found is that women with endometriosis have a progesterone receptor that is inappropriately turned off. Normal progesterone action would be beneficial because it blocks the growth of endometriosis. In the absence of appropriate progesterone action, endometriosis tissue remains inflamed and continues to grow.
Bulun believes that these abnormalities result from epigenetic defects that occur very early on during embryonic development and may be the result of early exposure to environmental toxins. In fact, other investigators have implicated the environmental pollutant dioxin and the synthetic estrogen DES in the etiology of endometriosis.
"This may be a disease that women are born with," Bulun said. "Perhaps when a baby girl is born, it has already been determined that she is predisposed to have endometriosis. Maybe research can now be directed toward the fetal origins of the disease and raise the awareness of how the disease develops."
Source: Marla Paul
Northwestern University
Serdar Bulun, M.D., George H. Gardner Professor of Clinical Gynecology at Northwestern University's Feinberg School of Medicine, has spent the past 15 years investigating and identifying the causes of this disease. Bulun, and colleagues in his lab, discovered key epigenetic abnormalities in endometriosis and identified existing chemicals that now help treat it.
Bulun describes his lab's findings over the past 10 years in the Jan. 15 issue of the New England Journal of Medicine.
One of the abnormalities he discovered is the presence of the enzyme aromatase -- which produces estrogen -- in endometriosis, the diseased tissue that exists on pelvic organs and mimics the uterine lining. (Normal endometrium, located in the uterine cavity, does not contain aromatase.) As a result, women with endometriosis have excessive estrogen in this abnormal tissue found on surfaces of pelvic organs such as the ovaries. Bulun found the protein SF1 that produces aromatase, which is supposed to be shut down, is active in endometriosis.
"Estrogen is like fuel for fire in endometriosis," Bulun said. "It triggers the endometriosis and makes it grow fast."
As a result of the aromatase finding, Bulun launched clinical trials in 2004 and 2005 testing aromatase inhibitors -- currently used in breast cancer treatment -- for women with endometriosis. The drug blocks estrogen formation and secondarily improves progesterone responsiveness.
"We came up with a new treatment of choice for post-menopausal women with endometriosis," Bulun said. Moreover, treatment with an aromatase inhibitor is a very good option for premenopausal women with endometriosis not responding to existing treatments, he noted.
Another molecular abnormality Bulun found is that women with endometriosis have a progesterone receptor that is inappropriately turned off. Normal progesterone action would be beneficial because it blocks the growth of endometriosis. In the absence of appropriate progesterone action, endometriosis tissue remains inflamed and continues to grow.
Bulun believes that these abnormalities result from epigenetic defects that occur very early on during embryonic development and may be the result of early exposure to environmental toxins. In fact, other investigators have implicated the environmental pollutant dioxin and the synthetic estrogen DES in the etiology of endometriosis.
"This may be a disease that women are born with," Bulun said. "Perhaps when a baby girl is born, it has already been determined that she is predisposed to have endometriosis. Maybe research can now be directed toward the fetal origins of the disease and raise the awareness of how the disease develops."
Source: Marla Paul
Northwestern University
четверг, 4 августа 2011 г.
Legislatures In Colorado, Mississippi, South Dakota, Utah Take Actions On Abortion-Related Legislation
The following highlights recent news of state actions on abortion-related legislation.
Colorado: The Senate Judiciary Committee on Monday voted 4-3 to reject a bill (SB 143) that would have banned all abortions except in cases of rape or incest or to save the life of a pregnant woman, the Denver Post reports (Clausing, Denver Post, 2/13). The bill would have made performing an abortion a class three felony (Boyle, Greeley Tribune, 2/13). All four Democrats on the committee voted against the measure, while all three Republicans voted for it (Slevin, AP/Denver Rocky Mountain News, 2/13). In related news, the House Health and Human Services Committee on Monday unanimously approved a bill (SB 60) that would require hospitals in the state to inform rape survivors about the availability of emergency contraception, which can prevent pregnancy if taken up to 72 hours after sexual intercourse (Denver Post, 2/13).
Mississippi: The Senate last week voted 34-5 to approve a bill (SB 2795) that would ban abortion in the state except in cases of rape or incest or to save the life of the pregnant woman, the Columbus Commercial Dispatch reports. Under the legislation, anyone who provides an illegal abortion could be fined up to $5,000 and face one year in jail. The measure heads to the House Public Health and Human Services Committee. Rep. Steve Holland (D), who chairs the committee, said he will not take up the legislation. The Senate last week also voted 51-0 to pass a bill (SB 2801) that would require doctors in the state to give women seeking abortion a chance to listen to the fetus' heartbeat and view a sonogram. It also voted 51-0 to pass a bill (SB 2391) that would require minors seeking abortions who do not have parental consent to obtain a court's permission before undergoing the procedure. Holland said, "I have no intention of taking up any pro-life bills this year" (Coffey, Columbus Commercial Dispatch, 2/8).
South Dakota: A House committee on Monday voted 10-3 to approve a bill (HB 1293) that would ban all abortions except in cases of rape or incest or to save the life of a pregnant woman, the Sioux Falls Argus Leader reports (Myers, Sioux Falls Argus Leader, 2/13). The bill would allow rape survivors to undergo abortions if they report the rape to authorities within 50 days. Physicians would be required to confirm the report with authorities, as well as to take blood from aborted fetuses and give that information to police for DNA testing. For incest survivors, a doctor would be required to obtain the woman's consent to report the crime along with the identity of the alleged perpetrator before an abortion could be performed. Blood samples from fetuses also would have to be provided to police. Abortions could be performed until the 17th week of pregnancy in cases of incest or rape. The bill carries a maximum penalty of 10 years in prison for performing illegal abortions. The measure also would allow a pregnant woman to undergo an abortion if her health could be seriously damaged by carrying the pregnancy to term. Under the bill, a doctor from another practice must agree that the woman's health is in jeopardy before the abortion could be performed (Kaiser Daily Women's Health Policy Report, 2/5). The bill passed the committee after Rep. Thomas Deadrick (R) introduced an amendment that would send the measure to a vote during the state's next general election, according to the Argus Leader (Sioux Falls Argus Leader, 2/13).
Utah: The House recently voted 51-23 to substitute a bill (HB 235) that would have banned abortions in the state except in the cases of rape or incest or to protect the health of the woman with a bill (HB 235 second substitute) that would outlaw abortions if the Supreme Court overturns Roe v. Wade, the AP/ABC4 reports. Roe is the 1973 Supreme Court case that effectively barred state abortion bans. The House voted 62-12 to pass the substitute bill, which now goes to the Senate. The state's attorney general office estimated that it would have cost $2 million to defend the previous bill with in-house counsel, or $4 million with outside counsel, if it were challenged (AP/ABC4, 2/12).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Colorado: The Senate Judiciary Committee on Monday voted 4-3 to reject a bill (SB 143) that would have banned all abortions except in cases of rape or incest or to save the life of a pregnant woman, the Denver Post reports (Clausing, Denver Post, 2/13). The bill would have made performing an abortion a class three felony (Boyle, Greeley Tribune, 2/13). All four Democrats on the committee voted against the measure, while all three Republicans voted for it (Slevin, AP/Denver Rocky Mountain News, 2/13). In related news, the House Health and Human Services Committee on Monday unanimously approved a bill (SB 60) that would require hospitals in the state to inform rape survivors about the availability of emergency contraception, which can prevent pregnancy if taken up to 72 hours after sexual intercourse (Denver Post, 2/13).
Mississippi: The Senate last week voted 34-5 to approve a bill (SB 2795) that would ban abortion in the state except in cases of rape or incest or to save the life of the pregnant woman, the Columbus Commercial Dispatch reports. Under the legislation, anyone who provides an illegal abortion could be fined up to $5,000 and face one year in jail. The measure heads to the House Public Health and Human Services Committee. Rep. Steve Holland (D), who chairs the committee, said he will not take up the legislation. The Senate last week also voted 51-0 to pass a bill (SB 2801) that would require doctors in the state to give women seeking abortion a chance to listen to the fetus' heartbeat and view a sonogram. It also voted 51-0 to pass a bill (SB 2391) that would require minors seeking abortions who do not have parental consent to obtain a court's permission before undergoing the procedure. Holland said, "I have no intention of taking up any pro-life bills this year" (Coffey, Columbus Commercial Dispatch, 2/8).
South Dakota: A House committee on Monday voted 10-3 to approve a bill (HB 1293) that would ban all abortions except in cases of rape or incest or to save the life of a pregnant woman, the Sioux Falls Argus Leader reports (Myers, Sioux Falls Argus Leader, 2/13). The bill would allow rape survivors to undergo abortions if they report the rape to authorities within 50 days. Physicians would be required to confirm the report with authorities, as well as to take blood from aborted fetuses and give that information to police for DNA testing. For incest survivors, a doctor would be required to obtain the woman's consent to report the crime along with the identity of the alleged perpetrator before an abortion could be performed. Blood samples from fetuses also would have to be provided to police. Abortions could be performed until the 17th week of pregnancy in cases of incest or rape. The bill carries a maximum penalty of 10 years in prison for performing illegal abortions. The measure also would allow a pregnant woman to undergo an abortion if her health could be seriously damaged by carrying the pregnancy to term. Under the bill, a doctor from another practice must agree that the woman's health is in jeopardy before the abortion could be performed (Kaiser Daily Women's Health Policy Report, 2/5). The bill passed the committee after Rep. Thomas Deadrick (R) introduced an amendment that would send the measure to a vote during the state's next general election, according to the Argus Leader (Sioux Falls Argus Leader, 2/13).
Utah: The House recently voted 51-23 to substitute a bill (HB 235) that would have banned abortions in the state except in the cases of rape or incest or to protect the health of the woman with a bill (HB 235 second substitute) that would outlaw abortions if the Supreme Court overturns Roe v. Wade, the AP/ABC4 reports. Roe is the 1973 Supreme Court case that effectively barred state abortion bans. The House voted 62-12 to pass the substitute bill, which now goes to the Senate. The state's attorney general office estimated that it would have cost $2 million to defend the previous bill with in-house counsel, or $4 million with outside counsel, if it were challenged (AP/ABC4, 2/12).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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