南非一家地区医院对实施普遍脐动脉乳酸分析的态度。
Attitudes towards the implementation of universal umbilical artery lactate analysis in a South African district hospital.
作者信息
Allanson Emma R, Grobicki Kate, Pattinson Robert C, Dickinson Jan E
机构信息
School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Australia.
SAMRC Maternal and Infant Health Care Strategies unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa.
出版信息
BMC Pregnancy Childbirth. 2016 Jul 18;16(1):166. doi: 10.1186/s12884-016-0968-y.
BACKGROUND
Of the 5.54 million stillbirths and neonatal deaths occurring globally each year, a significant amount of these occur in the setting of inadequate intrapartum care. The introduction of universal umbilical artery lactate (UA) measurements in this setting may improve outcomes by providing an objective measurement of quality of care and stimulating case reflection, audit, and practice change. It is important that consideration is given to the barriers and facilitators to implementing this tool outside of a research setting.
METHODS
During the period 16/11/2014 -13/01/2015, we conducted a training course in cardiotocograph (CTG) interpretation, fetal physiology, and the sampling and analysing of UA lactate, with a pre and post questionnaire aimed at assessing the barriers and facilitators to the introduction of universal UA lactate in a district hospital in the Eastern Cape, South Africa.
RESULTS
Thirty-five pre-training questionnaires available (overall response rate 95 %) and 22 post training questionnaires (response rate 63 %) were available for analysis. Prior to training, the majority gave positive responses (strongly agree or agree) that measuring UA lactate assists neonatal care, is protective for staff medicolegally, and improves opportunities for audit and teaching of maternity practice (n = 33, 30, 32; 94.4 %, 85.7 %, 91.4 % respectively). Respondents remained positive about the benefits post training. An increased workload on medical or midwifery staff was less likely to be seen as barrier following training (71 vs. 38.9 % positive response, p = 0.038). A higher rate of respondents felt that expense and lack of equipment were likely to be barriers after completing training, although this wasn't significant. There was a trend towards lack of time and expertise being less likely to be seen as barriers post training.
CONCLUSION
The majority of participants providing intrapartum care in this setting are positive about the role of universal UA lactate analysis and the potential benefits it provides. Training aids in overcoming some of the perceived barriers to implementation of universal UA lactate analysis.
背景
全球每年发生554万例死产和新生儿死亡，其中很大一部分发生在产时护理不足的情况下。在此背景下引入普遍的脐动脉乳酸（UA）测量，可能通过提供护理质量的客观测量以及促进病例反思、审核和实践改变来改善结局。重要的是要考虑在研究环境之外实施此工具的障碍和促进因素。
方法
在2014年11月16日至2015年1月13日期间，我们举办了一次关于胎心监护仪（CTG）解读、胎儿生理学以及UA乳酸采样和分析的培训课程，并通过前后问卷来评估在南非东开普省一家地区医院引入普遍的UA乳酸测量的障碍和促进因素。
结果
有35份培训前问卷可供分析（总体回复率95%），22份培训后问卷（回复率63%）可供分析。培训前，大多数人给出了肯定回答（强烈同意或同意），即测量UA乳酸有助于新生儿护理、在医学法律上对工作人员有保护作用，并改善产科实践的审核和教学机会（分别为n = 33、30、32；94.4%、85.7%、91.4%）。培训后，受访者对这些益处仍持肯定态度。培训后，医疗或助产人员工作量增加不太可能被视为障碍（肯定回答率从71%降至38.9%，p = 0.038）。完成培训后，更高比例的受访者认为费用和设备短缺可能是障碍，尽管这并不显著。培训后，时间和专业知识不足不太可能被视为障碍有一定趋势。
结论
在这种情况下提供产时护理的大多数参与者对普遍的UA乳酸分析的作用及其潜在益处持肯定态度。培训有助于克服一些普遍认为的实施UA乳酸分析的障碍。
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