Advancing Practice: Facilitating group antenatal care: a new way of working

This article outlines the principles and evidence behind group antenatal care and explores how developing group facilitation skills can enhance midwifery practice. The authors discuss the impact of different training models developed by the REACH Pregnancy Programme to support the implementation of ‘Pregnancy Circles’ as part of a randomised controlled trial of group antenatal care within an NHS context

Limits of 'patient-centredness'; valuing contextually specific communication patterns

Context Globally, doctor–patient communication is becoming synonymous with high-quality health care in the 21st century. However, what is meant by ‘good communication’ and whether there is consensus internationally remain unclear. Objectives Here, we characterise understandings of ‘good communication’ in future doctors from medical schools in three contextually contrasting continents. Given locally specific socio-cultural influences, we hypothesised that there would be a lack of global consensus on what constitutes ‘good communication’. Methods A standardised two-phase methodology was applied in turn to each of three medical schools in the UK, Egypt and India (n = 107 subjects), respectively, in which students were asked: ‘What is good communication?’ Phase I involved exploratory focus groups to define preliminary themes (mean number of participants per site: 17). Phase II involved thematic confirmation and expansion in one-to-one semi-structured interviews (mean number of participants per site: 18; mean hours of dialogue captured per site: 55). Findings were triangulated and analysed using grounded theory. Results The overarching theme that emerged from medical students was that ‘good communication’ requires adherence to certain ‘rules of communication’. A shared rule that doctors must communicate effectively despite perceived disempowerment emerged across all sites. However, contradictory culturally specific rules about communication were identified in relation to three major domains: family; gender, and emotional expression. Egyptian students perceived emotional aspects of Western doctors’ communication strikingly negatively, viewing these doctors as problematically cold and unresponsive. Conclusions Contradictory perceptions of ‘good communication’ in future doctors are found cross-continentally and may contribute to prevalent cultural misunderstandings in medicine. The lack of global consensus on what defines good communication challenges prescriptively taught Western ‘patient-centredness’ and questions assumptions about international transferability. Health care professionals must be educated openly about flexible, context-specific communication patterns so that they can avoid cultural incompetence and tailor behaviours in ways that optimise therapeutic outcomes wherever they work around the globe

Acceptability and use of iron and iron-alloy cooking pots: implications for anaemia control programmes

Abstract Objective To evaluate the acceptability of iron and iron-alloy cooking pots prior to an intervention trial and to investigate factors affecting retention and use. Design Pre-trial research was conducted on five types of iron and iron-alloy pots using focus group discussions and a laboratory evaluation of Fe transfer during cooking was undertaken. Usage and retention during the subsequent intervention trial were investigated using focus group discussions and market monitoring. Setting Three refugee camps in western Tanzania. Subjects Refugee health workers were selected for pre-trial research. Mothers of children aged 6-59 months participated in the investigation of retention and use. Results Pre-trial research indicated that the stainless steel pot would be the only acceptable type for use in this population due to excessive rusting and/or the high weight of other types. Cooking three typical refugee dishes in stainless steel pots led to an increase in Fe content of 3·2 to 17·1 mg/100 g food (P < 0·001). During the trial, the acceptability of the stainless steel pots was lower than expected owing to difficulties with using, cleaning and their utility for other purposes. Households also continued to use their pre-existing pots, and stainless steel pots were sold to increase household income. Conclusions Pre-trial research led to the selection of a stainless steel pot that met basic acceptability criteria. The relatively low usage reported during the trial highlights the limitations of using high-value iron-alloy cooking pots as an intervention in populations where poverty and the availability of other pots may lead to sellin

Winchester - Yei Hospitals Link

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The MindfulBreather: Motion Guided Mindfulness.

For millennia, humans have focused their attention on the breath to develop mindfulness, but finding a scientific way to harness mindful breathing has proven elusive. Existing attempts to objectively measure and feedback on mindfulness have relied on specialist external hardware including electroencephalograms or respirometers that have been impractical for the majority of people learning to meditate. Consequently, training in the key skill of breath-awareness has lacked practical objective measures and guidance to enhance training. Here, we provide a brief technology report on an invention, The MindfulBreather® that addresses these issues. The technology is available to download embedded in a smartphone app that targets, measures and feedbacks on mindfulness of breathing in realtime to enhance training. The current article outlines only the technological concept with future studies quantifying efficacy, validity and reliability to be reported elsewhere. The MindfulBreather works by generating Motion Guided Mindfulness through interacting gyroscopic and touchscreen sensors in a three phase process: Mindfulness Induction (Phase I) gives standardized instruction to users to place their smartphone on their abdomen, breathe mindfully and to tap only at the peak of their inhalation. The smartphone's gyroscope detects periodic tilts during breathing to generate sinusoidal waveforms. Waveform-tap patterns are analyzed to determine whether the user is mindfully tapping only at the correct phase of the breathing cycle, indicating psychobiological synchronization. Mindfulness Maintenance (Phase II) provides reinforcing pleasant feedback sounds each time a breath is mindfully tapped at the right time, and the App records a mindful breath. Lastly, data-driven Insights are fed back to the user (Phase III), including the number of mindful breaths tapped and breathing rate reductions associated with parasympathetic engagement during meditation. The new MGM technology is then evaluated and contrasted with traditional mindfulness approaches and a novel Psychobiological Synchronization Model is proposed. In summary, unlike existing technology, the MindfulBreather requires no external hardware and repurposes regular smartphones to deliver app-embedded Motion-Guided Mindfulness. Technological applications include reducing mindwandering and down-regulation of the brain's default mode through enhanced mindful awareness. By objectively harnessing breath awareness, The MindfulBreather aims to realize the ancient human endeavor of mindfulness for the 21st century

History and conservation of shopping arcades

Shopping arcades, corridors lined on one or both sides by shops and covered by a glass roof have been neglected as a subject for research. There is little information and no catalogue of British arcades. Their importance as covered thoroughfares, housing small units for specialist traders, has been under estimated, and their contribution to the architecture and townscape of cities requires recognition. The thesis records all extant examples in Britain with an architectural description, history, use, plan, section and photographic account of each. Their evolution is established, showing the influence of arcaded streets and exchanges, and of social and economic forces. The first two arcades were built in Paris and those, together with other major foreign examples are assessed, revealing the inter -relationship of development and architectural style between nations. The British arcades are analysed with regard to plan, location and architectural style. The financial position, management and role in the modern retail centre is assessed. Current trends in retailing are interpreted, from the shopping centre derived from the arcades, to the Speciality Centre. Arcades, like many older buildings have been demolished or 'neglected, having outlived their usefulness, but during the past decade an appreciation of the architectural heritage has grown. As the research has progressed, it has become evident that the requirements for shopping have almost come full circle from the date of the first arcade in 1800. And the shopping arcade is not only worthy of serious consideration architecturally, hut it could re- emerge as an important form of modern retailing. Recommendations are made for the practical conservation and re -use of arcades, particularly emphasising their architectural qualities, utilizing the favourable attitudes towards conservation and 'raking advantage of the desire to return to small specialist shops along a pedestrian route, preferably undercover

Antonio Dal Masetto (1938-): A study of a writer's craft, and an exploration of his place on the Argentine literary map.

I became interested in the work of Antonio Dal Masetto through reading his weekly column in the Argentine newspaper Pdgina/12 when I lived in Buenos Aires for a period in 2002. These were short observational pieces about characters and situations in the city with a narrative perspective which seemed to denote an 'outsider'. As an outsider myself, I found this voice inclusive and intriguing and also sometimes very funny. It struck me that the perceptions in this column were more profound than material I might have expected to appear in a daily broadsheet newspaper. The style of the writing appealed to me this cool observational tone, a gentle humour, a simple prose and a certain implicit quality which reminded me of poetry. This was my initial subjective response

The early careers of Glasgow medical graduates in the second half of the nineteenth century

The thesis studies the immediate post-graduate experience of doctors graduating from Glasgow medical school in the second half of the nineteenth century. The study uses Medical Directories and census records and, for a few individuals, other relevant records; it also compares these graduates with those who obtained a licence from the Royal College of Physicians and Surgeons of Glasgow to see whether there were significant differences in their career experiences. Those graduating in the years 1856, 1876 and 1896 were selected to give a spread over the period of significant professional and educational developments. They also have the advantage that census records were available at the end of the first five years following graduation. The main findings relate to the overall Scottishness of the graduates and to the effect of changes to medical education and regulation. The vast majority of the graduates came from Scotland, in particular from Glasgow and its adjacent area, and sought work there. The changes in medical education and regulation, in particular the 1858 Medical Act, resulted in graduates starting study later and studying for a shorter period; later they obtained fewer additional basic qualifications and the 1876 group moved less frequently, apparently because of less competition. The study also showed the importance of family support in the early years. The licentiates, on the other hand, showed a similar pattern of work, but came from all over the United Kingdom. They came to Glasgow to obtain a qualification and did not always study there

Substance Using Women : The Social Meaning of Substance use for Using Women and the Negotiation of Identities

This thesis is framed as an inquiry into the attitudes and experiences of women to their use of psychoactive substances and the contribution that use makes to their construction of gendered identities and meanings they derive from their use. The thesis also explores how these meanings relate to, and contrast or concur with, wider social attitudes relating to ‘feminine’ identity, issues of resistance and control, self control, happiness, independence and dependence, social roles and relationships, risk-taking and safety. The thesis aims to contribute to feminist understandings concerning substance use and to add a feminist interpretative voice to the alcohol, tobacco and other drug (ATOD) field of inquiry. The inquiry adopts an eclectic approach, being shaped and informed by feminist thought, poststructuralist philosophy, the ATOD field and anti-oppressive research methods. Descriptive narratives of experience were elicited from in-depth guided discussions with three women who are all known to me. All the women are in their thirties, are mothers and currently use legal and illegal psychoactive substances. Utilising recursive, intuitive and interpretive methods, common themes were drawn from the narratives and explored to reveal common and disparate meanings, identities and discourses as they relate to experience with substance use. Within this study narratives are understood to be cultural texts. Analysis involved the examination of gendered discourses that surround women substance users in the ATOD field and society generally and their interplay with those narratives. In keeping with feminist sensibilities I included my own thoughts and feelings, locating myself within the project. Findings suggest women substance users may experience substance use as a site of power and agency rejecting narrow constructions of femininity and embracing independence. The identities and socia1 roles for these women substance users, such as mother, appear to remain largely intact. The relative importance and presentation of alternative identities, however, remain in a constantly fluid state with particular roles being fore-grounded or receding depending on context and mood. The inquiry is viewed as a collaborative experience based on friendship. Knowledge is shared in a reciprocal relationship hopefully allowing alternative understandings and conceptualisations of substance using women to emerge from their experience