ISSN:0091-2182    

DOI:10.1016/0091-2182(93)90035-F

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACTTuberculosis (TB) has reemerged as a major public health concern in the United States, with increasing impact upon women of childbearing and childrearing age. As a primary health care provider, the certified nurse‐midwife (CNM) must be able to respond to a variety of client concerns and questions. This article reviews the natural history and changing epidemiology of TB. An in‐depth focus on skin testing describes common errors in administration and interpretation, and how to clearly explain the meaning of a positive PPD result. Clinical presentations of active TB are summarized, with their implications for pregnancy and fertility. The final sections discuss the workup of latent TB to rule out active disease and outline standards for management and therapy. Combining a sound knowledge base with expertise in client education and counseling enables CNMs to make unique contributions to the broad effort to contain the new TB epide

ISSN:0091-2182    

DOI:10.1016/0091-2182(93)90036-G

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACTThe purpose of this retrospective cohort study was to explore the safety and cost‐effectiveness of conservatively managed premature rupture of the membranes (PROM) in term and near‐term pregnancy. The records of 909 women with PROM at or near term were reviewed. Outcomes of those women and infants who were managed conservatively were compared with those who were managed aggressively. Those who were managed conservatively experienced one‐third the rate of cesarean sections, with no increase in intrauterine or neonatal infections, and were hospitalized a half‐day longer than those managed aggressively. These findings are consistent with previously published studies and support the position that conservative management can be safe for both mother and infant. The findings also confirm that, with minor adjustments in institutional protocols, conservative management can be cost‐

ISSN:0091-2182    

DOI:10.1016/0091-2182(93)90037-H

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACTRecent advances in understanding the mechanisms of dominance of the healthful microecology byLactobacillus acidophilusthrough microbicidal enzyme systems has led to renewed interest in ecologic approaches to vaginal health maintenance and treatment of vaginosis and vaginitis. Review of pertinent research suggests that due to inadequate adherence of lactobacilli from dairy sources, contaminants in commercial sources, and lack of evidence of effectiveness in sparse clinical trials, intravaginal applications ofL. acidophiluscannot be recommended. Bacterial vaginosis is described in this article as a microecologic shift in the dominant organism of the microecology fromL. acidophilustoGardnerella vaginalis.This results in conditions favorable to vaginal establishment of many anaerobic organisms. The ability to identify and nurture healthful lactobacilli in the vaginal microflora is suggested as a future direction for health‐enhancement‐oriented research, practice, and screen

ISSN:0091-2182    

DOI:10.1016/0091-2182(93)90038-I

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACTThis quasi‐experimental study examined the influence of postpartum home visits on clinic attendance at six‐week postpartum appointments. The sample of 82 subjects consisted of two groups from a nurse‐midwifery service: 43 clients who gave birth in 1986 and did not receive home visits, and 39 clients who gave birth in 1989 and received one postpartum home visit by their nurse‐midwife.Twenty‐five (58%) of the clients who did not receive home visits and 29 (74%) of the home‐visited clients kept their six‐week appointment; this difference was not significant. However, home‐visited clients missed and were rescheduled for fewer six‐week appointments than were those who did not receive home visits. After controlling for age and parity, this result remained significant. It is suggested that home visitation enhances a client's “connectedness” with the health care system and thus lessens the number of missed appointments for the six‐week postpartum exam. Limitations of the study, implications for practice, and suggestions for future

ISSN:0091-2182    

DOI:10.1016/0091-2182(93)90039-J

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACTCertified nurse‐midwives (CNMs) and physicians (MDs) are thought to differ in philosophy of pregnancy care and childbirth. However, these differences have not been documented quantitatively. This article describes and compares the beliefs and care philosophies of CNMs and MDs toward aspects of antepartum and intrapartum care of low‐risk women. The sample included seven CNMs and 10 obstetricians at a large territary‐care hospital. Using stringent statistical criteria for testing differences between the two groups, significantly more teaching was done by the CNMs than by the MDs. Other differences were all in expected direc

ISSN:0091-2182    

DOI:10.1016/0091-2182(93)90040-N

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACTThe demands of clinical practice seldom allow for time to pursue academic writing, teaching, or the development of individual advanced skills. The burnout rate in professions such as nurse‐midwifery cannot be ignored. This article describes how one nurse‐midwifery clinical practice implemented a short, rotating sabbatical; specific goals and guidelines are presented. It concludes that a sabbatical leave can be considered as one of many job‐related ben

ISSN:0091-2182    

DOI:10.1016/0091-2182(93)90041-E

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACTThere has been an increasing emphasis on the use of technology for the assessment and evaluation of women during the antepartum and intrapartum periods. As a result, “hands‐on” skills, such as abdominal palpation and clinical pelvimetry, receive less emphasis in educational programs and practice. Are nurse‐midwifery educational programs turning the focus of their curriculum too frequently toward high‐risk pregnancy and away from the normal pregnancy? There is a need to balance nurse‐midwifery education, to consider the needs of all pregnant women while incorporating advances in technology appropriately. Some recent graduates are not adequately trained in the use of assessment skills that are not dependent upon technology; thus, their capability as practitioners is compromised. Integration of new content into nurse‐midwifery curricula should always reflect the philosophy of each program. Renewed attention to teaching, using, and assessing these skills should

ISSN:0091-2182    

DOI:10.1016/0091-2182(93)90042-F

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACTMexican society contains a variety of indigenous cultures as well as European influences. Most babies in rural areas are delivered by midwives. Traditional midwives, government‐trained and empirical midwives, nurse‐midwives, and foreign‐trained midwives all practice in Mexico. Nurse‐midwives in one project are demonstrating their ability to meet the needs of urban childbearing women. A midwifery organization is developing under the leadership of midwives influenced by the contemporary midwifery movement in the United States. In this article, some traditional Mexican midwifery practices are discussed and interviews with several different Mexican midwives from a variety of backgrounds are pr

ISSN:0091-2182    

DOI:10.1016/0091-2182(93)90043-G

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0091-2182    

DOI:10.1016/0091-2182(93)90044-H

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY