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Kellie Owens

As maternal mortality increases in the United States, birth providers and policymakers are seeking new solutions to address what scholars have called the “C-section…

Abstract

As maternal mortality increases in the United States, birth providers and policymakers are seeking new solutions to address what scholars have called the “C-section epidemic.” Hospital cesarean rates vary tremendously, from 7 to 70 percent of all births. Based on in-depth, semi-structured interviews with 47 obstetricians and family physicians in the United States, I explore one reason for this variation: differences in how physicians perceive and manage risk in American obstetrics. While the dominant model of risk management encourages high levels of intervention and monitoring, I argue that a significant portion of physicians are concerned about high intervention rates in childbirth and are working to reduce cesarean rates and/or the use of monitoring technologies like continuous fetal heart rate monitors. Unlike prior theories of biomedicalization, which suggest that health risks are managed through increased monitoring and intervention, I find that many physicians are resisting this model of risk management by ordering fewer interventions and collecting less information about their patients. These providers acknowledge that interventions designed to mitigate risks may only provide an illusion of control, rather than an actual mastery of risks. By limiting interventions, providers may lose this illusion of control but also mitigate the iatrogenic effects of intervention and continuous monitoring. This alternative approach to risk management is growing in many medical fields and deserves more attention from medical sociologists.

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Reproduction, Health, and Medicine
Type: Book
ISBN: 978-1-78756-172-4

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Article

Abhijit Basu, Deepa Gopinath, Naheed Anjum and Susan Hotchkies

The purpose of this paper is to determine the prevalence of feedback following adverse clinical incident reporting among trainee doctors in obstetrics and gynaecology…

Abstract

Purpose

The purpose of this paper is to determine the prevalence of feedback following adverse clinical incident reporting among trainee doctors in obstetrics and gynaecology within the Northwestern Deanery of England.

Design/methodology/approach

An anonymous questionnaire was circulated among the Specialist Registrar trainees within the specialty attending a regional teaching session. The questionnaire was analysed.

Findings

There were 50 responses, of those 45 (90 per cent) had been involved in an adverse clinical incident; 44 had submitted an incident form related to the incident. Three had submitted incident forms without being involved in an adverse incident. Most (80 per cent) had submitted an incident form as well as a related statement. Feedback was available to 23 (51 per cent) of those involved in adverse incidents. More of the senior trainees received feedback than the junior ones. A lecture on clinical incident reporting was available to only 35(70 per cent) of the respondents on the hospital induction day at their latest clinical placement.

Research limitations/implications

This study is limited to adverse clinical incident reporting among the trainees in a single specialty within one deanery in UK; hence the small numbers.

Practical implications

This study demonstrates the presence of awareness regarding adverse incident reporting among the trainees in a high‐risk specialty. It also shows the suboptimal rate of feedback following adverse incident reporting, which does not encourage a learning environment. It is suggested that a lecture should be dedicated to incident reporting at the junior doctors' induction day programme in every hospital.

Originality/value

This paper highlights the lack of adequate feedback following adverse clinical incident reporting.

Details

Clinical Governance: An International Journal, vol. 14 no. 1
Type: Research Article
ISSN: 1477-7274

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Sandra C. Buttigieg, Emanuela-Anna Azzopardi and Vincent Cassar

Medical errors in obstetric departments are commonly reported and may involve both mother and neonate. The complexity of obstetric care, the interactions between various…

Abstract

Medical errors in obstetric departments are commonly reported and may involve both mother and neonate. The complexity of obstetric care, the interactions between various disciplines, and the inherent limitations of human performance make it critically important for these departments to provide patient-safe and friendly working environments that are open to learning and participative safety. Obstetric care involves stressful work, and health care professionals are prone to develop burnout, this being associated with unsafe practices and lower probability for reporting safety concerns. This study aims to test the mediating role of burnout in the relationship of patient-safe and friendly working environment with unsafe performance. The full population of professionals working in an obstetrics department in Malta was invited to participate in a cross-sectional study, with 73.6% (n = 184) of its members responding. The research tool was adapted from the Sexton et al.’s Safety Attitudes Questionnaire – Labor and Delivery version and surveyed participants on their working environment, burnout, and perceived unsafe performance. Analysis was done using Structural Equation Modeling. Results supported the relationship between the lack of a perceived patient-safe and friendly working environment and unsafe performance that is mediated by burnout. Creating a working environment that ensures patient safety practices, that allows communication, and is open to learning may protect employees from burnout. In so doing, they are more likely to perceive that they are practicing safely. This study contributes to patient safety literature by relating working environment, burnout, and perceived unsafe practice with the intention of raising awareness of health managers’ roles in ensuring optimal clinical working environment for health care employees.

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Structural Approaches to Address Issues in Patient Safety
Type: Book
ISBN: 978-1-83867-085-6

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Lauren Nicholas

Twin to Twin Transfusion Syndrome (TTTS) is a well understood, yet under-recognized, placental disease affecting any given pregnancy at a rate of 1 in 1,000. There is no…

Abstract

Purpose

Twin to Twin Transfusion Syndrome (TTTS) is a well understood, yet under-recognized, placental disease affecting any given pregnancy at a rate of 1 in 1,000. There is no clustering of TTTS; instead the threat remains pathologically distinctive due to its pervasiveness. However, while incidence rates are random, survival rates are not. Despite compliant acceptance of “routine prenatal care,” sadly, there are many women who for currently unknown reasons are not receiving the advanced prenatal care needed to appropriately screen for, diagnosis and treat TTTS. And these women are paying the ultimate price for such obstetrical oversight.

Methodology

This study hypothesizes that differential care being given by primary obstetricians of TTTS patients is resulting in experienced inequalities. Utilizing social reproduction theory, and through ethnographic and quantitative analyses of primary data, this study seeks to divulge the complex social processes taking place (or failing to take place) within the world of American obstetrics, and begin to understand how they are affecting TTTS mortality and morbidity rates.

Findings

Findings illuminate a profound imbalance of power and influence amongst the following entities: American Congress of Obstetricians and Gynecologists and Society of Maternal Fetal Medicine; obstetrical training and practice; and levels of patient awareness and advocacy.

Value

This study argues that the current social relations being reproduced by these entities are perpetuating a climate that allows for disregard of proper TTTS management. Specifically, this study theoretically explores what social relations and subsequent (in)actions are being reproduced prior to TTTS diagnoses, and applies the effects of those observations.

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Family and Health: Evolving Needs, Responsibilities, and Experiences
Type: Book
ISBN: 978-1-78441-126-8

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Paola Bertoli and Veronica Grembi

In healthcare, overuse and underuse of medical treatments represent equally dangerous deviations from an optimal use equilibrium and arouse concerns about possible…

Abstract

In healthcare, overuse and underuse of medical treatments represent equally dangerous deviations from an optimal use equilibrium and arouse concerns about possible implications for patients’ health, and for the healthcare system in terms of both costs and access to medical care. Medical liability plays a dominant role among the elements that can affect these deviations. Therefore, a remarkable economic literature studies how medical decisions are influenced by different levels of liability. In particular, identifying the relation between liability and treatments selection, as well as disentangling the effect of liability from other incentives that might be in place, is a task for sound empirical research. Several studies have already tried to tackle this issue, but much more needs to be done. In this chapter, we offer an overview of the state of the art in the study of the relation between liability and treatments selection. First, we reason on the theoretical mechanisms underpinning the relationship under investigation by presenting the main empirical predictions of the related literature. Second, we provide a comprehensive summary of the existing empirical evidence and its main weaknesses. Finally, we conclude by offering guidelines for further research.

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Health Econometrics
Type: Book
ISBN: 978-1-78714-541-2

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Book part

Terri A Winnick

Language is a fundamental and yet extraordinarily powerful medium. Language is more than the primary feature distinguishing humans from other species. As our principle…

Abstract

Language is a fundamental and yet extraordinarily powerful medium. Language is more than the primary feature distinguishing humans from other species. As our principle means of communication, language links us to culture, and in so doing, shapes our perceptions and determines the way in which we think (Clark, Eschholz & Rosa, 1981; Thorne, Kramarae & Henley, 1983). Language is inseparable from social life. Through language, individuals learn cultural patterns and political and social values (Mueller, 1973). Language also reflects the prejudices of society, with assumptions about relative status, power or appropriate behavior often built into the words we use to talk about different groups of people. As Frank and Anshen (1983) note, ageism, racism, and most importantly for this discussion, sexism, are all perpetuated by our language, even among those who consciously reject those prejudices.

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Gendered Perspectives on Reproduction and Sexuality
Type: Book
ISBN: 978-0-76231-088-3

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Article

Figen Alp Yilmaz and Yeter Durgun Ozan

The impact of birth beliefs on pregnancy and delivery are universally recognized, but the factors that affect birth beliefs vary across regions depending on individual and…

Abstract

Purpose

The impact of birth beliefs on pregnancy and delivery are universally recognized, but the factors that affect birth beliefs vary across regions depending on individual and cultural characteristics. This study aimed to determine women's birth beliefs and examine their associated factors.

Design/methodology/approach

This cross-sectional study was conducted with 548 primiparas in the obstetrics clinic of a university hospital located in the Southeastern Anatolian Region of Turkey from February to June 2019. Descriptive characteristics, form and the Birth Beliefs Scale were used in data collection. To analyze the data, descriptive statistics, T-tests and ANOVA analyses were used.

Findings

It was determined that factors such as age group, income level, any problems during pregnancy and preferred delivery mode statistically affected women's birth beliefs.

Originality/value

Based on the findings from this study, healthcare personnel should provide training and consultation services to pregnant women starting from the prenatal period to help ensure a positive labor experience.

Details

Journal of Health Research, vol. 34 no. 4
Type: Research Article
ISSN: 0857-4421

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Article

B. Jadoon, D. Tucker, V. Miller, V. Rai and B. White

The aim of this paper is to examine an audit to assess compliance with the national standards for intimate examination and to identify areas where changes are required to…

Abstract

Purpose

The aim of this paper is to examine an audit to assess compliance with the national standards for intimate examination and to identify areas where changes are required to improve the quality of patient's care.

Design/methodology/approach

A patient‐based questionnaire was designed. The total numbers of clinics analyzed were 16. All the new patients, who had vaginal examinations, were asked to complete the semi‐anonymous questionnaire after their consultation. These questionnaires were designed on the basis of RCOG and GMC standards for the intimate examination.

Findings

The overall response rate was 50 per cent. Only 27 patients (36 per cent) received the offer for a chaperone. Of the total 75 patients, 40 (53 per cent) patients have received the chaperone without an offer. The remaining eight patients (11 per cent), neither had the chaperone offered nor had one present at the time of examination. The presence of a chaperone was recorded for only 47 (62 per cent) patients.

Practical implications

It is recommended that all patients undergoing an intimate examination should be given a choice of having a chaperone after adequate explanation irrespective of the gender of the gynaecologist. The documentation regarding chaperones can be improved by increasing the awareness of its use among clinical staff through regular audits. The pre‐printed chaperone tick box as a part of history/examination sheet is recommended.

Originality/value

This audit is different from previous audits in terms of its setting in secondary care. The majority of audits with a chaperone have been performed in a primary care setting. Its application has not been studied in secondary care settings before.

Details

Clinical Governance: An International Journal, vol. 14 no. 1
Type: Research Article
ISSN: 1477-7274

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Article

A. Nooh and G.P. Downey

The aim of this audit was to determine if patients with a diagnosis of a suspected ectopic pregnancy had been managed in accordance with the evidence‐based guidelines…

Abstract

Purpose

The aim of this audit was to determine if patients with a diagnosis of a suspected ectopic pregnancy had been managed in accordance with the evidence‐based guidelines policy of the obstetrics and gynaecology department at City Hospital, Birmingham. In particular, the authors wished to review the surgical management of tubal ectopic pregnancy.

Design/methodology/approach

The authors retrospectively analysed 50 cases of tubal ectopic pregnancy managed over 15 months between October 2001 and December 2002.

Findings

A total of 26 patients (52 per cent) were managed successfully by the laparoscopic approach with no major intraoperative or postoperative complications; 24 patients (48 per cent) had a laparotomy. Salpingectomy was the preferred procedure performed either laparoscopically or by traditional open surgery. A total of 30 patients (60 per cent) had their surgery where the registrar at various grades of training was the main surgeon. The estimated blood loss, the need for blood transfusion and the length of hospital stay in the laparoscopy group were significantly less than those in the laparotomy group.

Originality/value

This audit demonstrates that, in the hands of trained personnel, laparoscopic management of tubal ectopic pregnancy is more beneficial with maximum safety and efficacy.

Details

Clinical Governance: An International Journal, vol. 10 no. 3
Type: Research Article
ISSN: 1477-7274

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Article

Lambert J.G.G. Panis, Frank W.S.M. Verheggen, Peter Pop and Martin H. Prins

Appropriate hospital stay should be effective, efficient and tailored to patient needs. Previous studies have found that on average 20 per cent of hospital stay is…

Abstract

Appropriate hospital stay should be effective, efficient and tailored to patient needs. Previous studies have found that on average 20 per cent of hospital stay is inappropriate. Within obstetrics, inappropriate hospital stay consists mostly of delays in hospital discharge. The specific goals of this study were to reduce inappropriate hospital stay by fine‐tuning patient logistics, increasing efficiency and providing more comfortable surroundings. New policies using strict discharge criteria were implemented. Total inappropriate hospital stay decreased from 13.3 to 7.2 per cent. The delay in discharge procedures halved. P‐charts showed a decrease in inappropriate hospital stay, indicating the current process to be stable. Concludes that a significant reduction in inappropriate hospital stay was found following the implementation of innovative hospital discharge policies, indicating greater efficiency and accessibility of hospital services.

Details

International Journal of Health Care Quality Assurance, vol. 17 no. 4
Type: Research Article
ISSN: 0952-6862

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