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【medical-news】Does structured care improve outcomes in la
August 30, 2008
ST LOUIS (MD Consult) - A structured approach to care in labor assessment units produces a small increase in the rate of spontaneous vaginal delivery, along with significant improvements in patient satisfaction with care, suggests a study published by the British Medical Journal.
The randomized controlled trial was carried out at 20 tertiary care teaching and community hospitals in the United States, Canada, and the United Kingdom. At each hospital, a group of nurses or midwives were trained in the structured approach, which focused on assessment of and anticipatory guidance on cognitive-emotional state, pain, and fetal position. A total of 505 nurses and midwives received training in the formalized care approach; another 1,351 provided usual care.
From 2003 to 2007, 5,002 nulliparous women were enrolled in the trial: half were assigned to structured care and half to usual care. The primary endpoint was spontaneous vaginal birth; secondary outcomes included intrapartum interventions, patient satisfaction with care, and measures of maternal and fetal health in the hospital and at 6 to 8 weeks' follow-up. The lead author was Ellen D. Hodnett of University of Toronto.
Outcome data on 4,996 women showed a 64.0% rate of spontaneous vaginal birth in those assigned to structured care versus 61.3% in the usual care group. The odds ratio of 1.2 favoring structured care was nonsignificant.
Some aspects of patient satisfaction with treatment were improved in the structured care group. Women assigned to structured care group were less likely to rate staff helpfulness as less than "very helpful," odds ratio 0.67; and less likely to be disappointed with the amount of attention they received from staff, odds ratio 0.51. None of the other secondary outcome measures were significantly different between groups, including regional analgesia and cesarean delivery rates.
Labor assessment units are a common part of care for laboring women at North American hospitals, providing opportunities for primary and secondary prevention of complications. Spontaneous vaginal birth is accepted as the safest mode of delivery for healthy mothers and low-risk infants. Most previous studies of intrapartum interventions have focused on active labor, showing little effect on cesarean delivery rates.
The structured intervention evaluated in this study produces a small, nonsignificant increase in the rate of spontaneous vaginal birth among women evaluated in labor assessment units. Some aspects of patient satisfaction with care are significantly improved, including perceptions of staff attentiveness and helpfulness.
The results warrant further research into ways to strengthen this complex nursing and midwifery intervention, the authors believe. "A combination of structured care plus strict adherence to a policy of delayed admission to the labour ward until clinically indicated may yield greater benefits," they write.
BMJ. 2008;337:a1021.
http://www.mdconsult.com/das/news/body/103771176-2/mnfp/0/198947/1.html?pos=&tlt=W&date=week&mine=true&general=true 结构护理可以改善临产评价组的结果吗？
认领此文编译，48小时后未交稿，其他战友可自行认领。 Does structured care improve outcomes in labor assessment units?
August 30, 2008
结构护理可以改善分娩评价单位结果吗？
ST LOUIS (MD Consult) - A structured approach to care in labor assessment units produces a small increase in the rate of spontaneous vaginal delivery, along with significant improvements in patient satisfaction with care, suggests a study published by the British Medical Journal.
圣路易斯（医学参考）-发表在英国医学杂志的一项研究说，在分娩评价单位试行一种结构护理的方法可少部分增加自然分娩的比例，并对改善病人满意度有意义。
The randomized controlled trial was carried out at 20 tertiary care teaching and community hospitals in the United States, Canada, and the United Kingdom. At each hospital, a group of nurses or midwives were trained in the structured approach, which focused on assessment of and anticipatory guidance on cognitive-emotional state, pain, and fetal position. A total of 505 nurses and midwives received training in the formalized care approach; another 1,351 provided usual care.
随机控制实验在美国、加拿大和英国的20所三级教学和社区医院进行。每所医院中，一组护士和助产士进行结构护理训练，重点在于评估和预期引导认知情感状态，疼痛和胎儿情况。共有505名护士和助产士正式接受了这项培训，其他1351人提供常规护理。
From 2003 to 2007, 5,002 nulliparous women were enrolled in the trial: half were assigned to structured care and half to usual care. The primary endpoint was spontaneous vaginal birth; secondary outcomes included intrapartum interventions, patient satisfaction with care, and measures of maternal and fetal health in the hospital and at 6 to 8 weeks' follow-up. The lead author was Ellen D. Hodnett of University of Toronto.
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作者:admin@医学,生命科学 2011-01-08 05:14
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