Kim Watts

Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK): a regional survey

BackgroundSmartphone usage has spread to many settings including that of healthcare with numerous potential and realised benefits. The ability to download custom-built software applications (apps) has created a new wealth of clinical resources available to healthcare staff, providing evidence-based decisional tools to reduce medical errors.Previous literature has examined how smartphones can be utilised by both medical student and doctor populations, to enhance educational and workplace activities, with the potential to improve overall patient care. However, this literature has not examined smartphone acceptance and patterns of medical app usage within the student and junior doctor populations.MethodsAn online survey of medical student and foundation level junior doctor cohorts was undertaken within one United Kingdom healthcare region. Participants were asked whether they owned a Smartphone and if they used apps on their Smartphones to support their education and practice activities. Frequency of use and type of app used was also investigated. Open response questions explored participants’ views on apps that were desired or recommended and the characteristics of apps that were useful.Results257 medical students and 131 junior doctors responded, equating to a response rate of 15.0% and 21.8% respectively. 79.0% (n=203/257) of medical students and 74.8% (n=98/131) of junior doctors owned a smartphone, with 56.6% (n=115/203) of students and 68.4% (n=67/98) of doctors owning an iPhone.The majority of students and doctors owned 1–5 medical related applications, with very few owning more than 10, and iPhone owners significantly more likely to own apps (Chi sq, p<0.001). Both populations showed similar trends of app usage of several times a day. Over 24hours apps were used for between 1–30 minutes for students and 1–20 minutes for doctors, students used disease diagnosis/management and drug reference apps, with doctors favouring clinical score/calculator apps.ConclusionsThis study found a high level of smartphone ownership and usage among medical students and junior doctors. Both groups endorse the development of more apps to support their education and clinical practice.

Protocol for the Smoking, Nicotine and Pregnancy (SNAP) trial: double-blind, placebo-randomised, controlled trial of nicotine replacement therapy in pregnancy

BackgroundSmoking in pregnancy remains a public health challenge. Nicotine replacement therapy (NRT) is effective for smoking cessation in non-pregnant people, but because women metabolise nicotine and cotinine much faster in pregnancy, it is unclear whether this will be effective for smoking cessation in pregnancy. The NHS Health Technology Assessment Programme (HTA)-funded smoking, nicotine and pregnancy (SNAP) trial will investigate whether or not nicotine replacement therapy (NRT) is effective, cost-effective and safe when used for smoking cessation by pregnant women.Methods/DesignOver two years, in 5 trial centres, 1050 pregnant women who are between 12 and 24 weeks pregnant will be randomised as they attend hospital for ante-natal ultrasound scans. Women will receive either nicotine or placebo transdermal patches with behavioural support. The primary outcome measure is biochemically-validated, self-reported, prolonged and total abstinence from smoking between a quit date (defined before randomisation and set within two weeks of this) and delivery. At six months after childbirth self-reported maternal smoking status will be ascertained and two years after childbirth, self-reported maternal smoking status and the behaviour, cognitive development and respiratory symptoms of children born in the trial will be compared in both groups.DiscussionThis trial is designed to ascertain whether or not standard doses of NRT (as transdermal patches) are effective and safe when used for smoking cessation during pregnancy.

Recruiting pregnant smokers for a placebo-randomised controlled trial of nicotine replacement therapy

BackgroundSmoking in pregnancy is a public health problem and effective methods for reducing this are required. Although nicotine replacement therapy (NRT) is effective for smoking cessation in non-pregnant people, there is no direct evidence concerning its effectiveness in pregnancy. Despite this, clinical guidelines recommend the cautious use of NRT during pregnancy. Randomised controlled trials are needed to determine the safety and efficacy of NRT when used by pregnant women for smoking cessation, but the feasibility of recruiting women to such trials is unknown. Consequently, in this study we aimed to determine i) the feasibility of recruiting women to a RCT of NRT in pregnancy as they attend hospital antenatal ultrasound examinations, ii) the proportion of such women who are eligible for and interested in trial enrolment and iii) research staff perceptions of how one method of trial recruitment could be improved.MethodsDuring a one month period, all women attending for antenatal ultrasound examination in an English teaching hospital were asked to complete a questionnaire which determined their eligibility to enrol in a proposed placebo controlled randomised trial investigating the effectiveness of NRT in pregnancy. Women who were eligible to participate were asked whether they would do so and those who accepted enrolment were offered an appointment with a smoking cessation advisor.ResultsOver 99% (851/858) of women agreed to complete a questionnaire about smoking habits whilst waiting for ultrasound examinations. 10.3% (88/851) of women attending for antenatal ultrasound fitted eligibility criteria for a proposed RCT of NRT in pregnancy, but only 3.6% [(31/851), 95% CI, 2.4 to 4.9%] indicated on the questionnaire that they would like to take part in a study involving randomisation to placebo or active patches. Researchers offered trial enrolment to 26 of these 31 women and 96% (25) accepted. Staff recruiting women believed that trial recruitment would be maximised if women attending the ultrasound department knew about trial recruitment before attending and greater staff resources were made available for this. It was also perceived that women generally under-reported the amount they smoked on questionnaires completed whilst waiting in ultrasound department areas.ConclusionsIt is feasible to recruit women for a trial of NRT in pregnancy as they wait for antenatal ultrasound examinations. Using similar recruitment methods, researchers can expect to recruit between 24 and 49 women per 1000 approached.

Injury prevention training: a cluster randomised controlled trial assessing its effect on the knowledge, attitudes, and practices of midwives and health visitors

Objective: To evaluate the effectiveness of injury prevention training. Design: Cluster randomised controlled trial. Setting: Primary care facilities in the East Midlands area of the United Kingdom. Subjects: Midwives and health visitors. Intervention: Evidence based training session on the risks associated with baby walkers. Main outcome measures: The primary outcome measures were knowledge of baby walker use and walker related injury, attitudes towards walkers and towards walker education, and practices relating to walker health education. Results: Trained midwives and health visitors had greater knowledge of the risks associated with baby walkers than untrained midwives and health visitors (difference between the means 0.22; 95% confidence interval (CI) 0.12 to 0.33). Trained health visitors had more negative attitudes to baby walkers (difference between the means 0.35; 95% CI 0.10 to 0.59) and more positive attitudes towards baby walker health education (difference between the means 0.31; 95% CI 0.00 to 0.62) than untrained health visitors. Midwives who had been trained were more likely to discuss baby walkers in the antenatal period than those who were not trained (odds ratio 9.92; 95% CI 2.02 to 48.83). Conclusions: Injury prevention training was associated with increased knowledge, more negative attitudes towards walkers, and more positive attitudes towards walker education. Trained midwives were more likely to give advice antenatally. Training did not impact on other practices. Larger trials are required to assess the impact of training on parental safety behaviours, the adoption of safety practices, and injury reduction.

The impact of the establishment of a midwife managed unit on women in a rural setting in England

OBJECTIVE to determine what impact the changes from consultant-led care to midwife-led care in a local maternity service have had on women using that service. DESIGN case study, data were collected by postal questionnaire, semi-structured, tape-recorded interviews, observations and scrutiny of records. SETTING a small town in rural England. PARTICIPANTS all pregnant women eligible for a midwife-managed unit (MMU) birth in a small rural town in England. FINDINGS the women using the MMU were satisfied with the care they received and the MMU style of care. Women giving birth at the MMU and at home required less pain relief and were more likely to have an intact perineum than a similar group of women giving birth in hospital. Continuity of carer did not appear to be an issue for women as long as they felt supported by a known team of midwives. Transfer for complications during the birthing process was a cause for anxiety and stress for women and their partners. Women, whilst satisfied with the MMU, would prefer the consultant-led maternity hospital to be re-established in the town. The home-birth rate rose by 28% when the consultant unit closed. IMPLICATIONS FOR PRACTICE while the establishment of a midwife-managed unit has provided increased choice for a minority of women, the removal of the consultant unit in the town has disadvantaged the majority of pregnant women. While guidelines are needed when establishing these units the application of restrictive inclusion and exclusion criteria can sometimes force women to make less appropriate birth choices.

Women's use of nicotine replacement therapy in pregnancy—a structured review of the literature

OBJECTIVE to review the literature of womens use of nicotine replacement therapy (NRT) during pregnancy. The review will examine NRT and nicotine, interventions and barriers to smoking cessation and the literature exploring womens views on using NRT in pregnancy. METHOD a structured review of the literature was undertaken by accessing internet and library sources, restricted to English written articles between 1989 and 2003. Keywords were used to refine the search: pregnancy, smoking, NRT and smoking cessation. FINDINGS several papers had examined interventions employed to aid pregnant women in smoking cessation and the efficacy of NRT. However, papers exploring the views of women on the use of NRT during pregnancy were limited. CONCLUSIONS smoking cessation is unique to individual women; as such, appropriate support and advice should be tailored accordingly. Further research is needed to explore the views of women using NRT during pregnancy to aid smoking cessation. IMPLICATIONS FOR PRACTICE the findings from this structured review raise awareness of the importance of smoking cessation during pregnancy, and the inclusion of womens views when discussing the use of NRT. Understanding womens views may enhance the care and advice given by midwives, thus improving smoking cessation rates in pregnancy.

An integrative review of the impact of mobile technologies used by healthcare professionals to support education and practice

The aim of this study was to provide evidence of the impact of mobile technologies among healthcare professionals in education and practice settings.

Exploring the views of women on using nicotine replacement therapy in pregnancy.

OBJECTIVE to explore womens views surrounding the use of nicotine replacement therapy (NRT) to aid smoking cessation. DESIGN AND SETTING a qualitative approach using semi-structured interviews undertaken on 10 pregnant women in a semi-rural area of England. FINDINGS the two main themes that emerged from the study were that NRT was an important component in stopping smoking, but this was in conjunction with support given by the midwife advisor. Both themes appeared to be equally important to the women in aiding their attempts at smoking cessation. Also, the importance of tailored interventions should not be dismissed when aiding women in smoking cessation. CONCLUSIONS exploring the views of women enabled the researchers to gain a greater understanding of the problems and achievements that women encountered when using NRT as an aid to stop smoking during pregnancy. The study also demonstrated that smoking cessation strategies can be successful if they are tailored to the individual needs of each woman, taking into account her dependency, domestic circumstances and willingness to change. IMPLICATIONS FOR PRACTICE the findings of this study add to the available research surrounding the efficacy of NRT in pregnancy. There is little evidence that the views of pregnant women have been taken into account prior to this study; as such, this report offers a different dimension to the available evidence. Although these findings could be adopted and utilized by practitioners, there is still the need for further research in this area on a larger scale.

Changes in maternal self-efficacy, postnatal depression symptoms and social support among Chinese primiparous women during the initial postpartum period: A longitudinal study

BACKGROUND There are many parenting problems during infancy for Chinese primiparous women. As an important determinant of good parenting, maternal self-efficacy (MSE) should be paid more attention by researchers. At present, the limitations of previous research examining MSE during infancy are that most studies were conducted with a homogeneous sample and there were few studies with Chinese women. Secondly, the trajectory of change in MSE, postnatal depression symptoms and social support for Chinese primiparous women was not clear during the initial postpartum period in earlier studies. OBJECTIVES This study aimed to describe changes in MSE, postnatal depression symptoms and social support among Chinese primiparous women in the first three months postnatally. DESIGN A quantitative longitudinal study using questionnaires was conducted. SETTING Obstetric wards at three hospitals in Xiamen City, South-East China. PARTICIPANTS In total, 420 Chinese primiparous women were recruited. METHODS Initial baseline questionnaires to measure socio-demographic and clinical characteristics at three days postnatally were distributed to participants face-to-face by the researcher on the postnatal ward. Follow-up questionnaires at six and 12 weeks postnatally were sent via e-mail by the researcher to participants, including the Self-efficacy in Infant Care Scale (SICS), the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Social Support Scale (PSSS) to measure MSE, postnatal depression symptoms and social support, respectively. These were returned by participants via e-mail. Quantitative data were analysed using SPSS. RESULTS The mean MSE score at six weeks postnatally was 74.92 (SD = 11.05), and increased to 77.78 (SD = 11.13) at 12 weeks postnatally. The mean social support scores at six and 12 weeks postnatally were 40.99 (SD = 9.31) and 43.00 (SD = 9.55). The mean EPDS scores decreased from 9.09 (SD = 4.33) at six weeks postnatally to 8.63 (SD = 4.40) at 12 weeks postnatally; the proportion of women with an EPDS score of ten or more and 13 or more at the two time points declined from 47.4% to 38.3%, and from 21.4% to 18.2%, respectively. CONCLUSIONS In this study, Chinese primiparous women had a moderate level of MSE and received a moderate level of social support at six and 12 weeks postnatally, and a higher proportion of Chinese women had postnatal depression symptoms than did women in Western countries. From six to 12 weeks postnatally, the mean MSE scores and social support scores had a statistically significant increase; the mean EPDS scores had a statistically significant decrease.

Chinese primiparous women's experience of the traditional postnatal practice of “Doing the month”: A descriptive method study: Women's experience of “Doing the month”

Abstract Aim “Doing the month” has been a traditionally postnatal practice that women follow for one full month after giving birth. The aim of this study was to explore Chinese primiparous womens experience of “Doing the month” and why Chinese women felt satisfied or dissatisfied with the experience. Methods This was a descriptive survey using open and closed questions. In total, 420 Chinese primiparous women were recruited in obstetric wards at three hospitals in Xiamen City, China. Baseline questionnaires were distributed to the participants face‐to‐face by the researcher on the postnatal ward at 3 days’ postnatally. Follow‐up questionnaires of “Doing the month” were sent via email by the researcher to the participants at 6 weeks’ postnatally and were returned by the participants via email. The quantitative data were analyzed with SPSS and the qualitative data were analyzed by using a thematic text analysis. Results Most of the women thought that “Doing the month” after childbirth was necessary. Some women felt satisfied with “Doing the month” because their family helped them to have a good rest, they felt a sense of achievement when taking care of their baby, and that having an appreciative attitude helped them to get along with the older generations. In contrast, some women felt dissatisfied with “Doing the month” because of being tired of following taboos, having conflicts with their mother‐in‐law, the lack of family help and care, and undue expectations of “Doing the month.” Conclusions In order to improve postnatal care for Chinese primiparous women, health professionals could be more aware of how health care needs to be customized to fit the special tradition of “Doing the month.”