Sarah Meaney

The impact of stillbirth on consultant obstetrician gynaecologists: a qualitative study

To explore the personal and professional impact of stillbirth on consultant obstetrician gynaecologists.

Impact of chronic oral mucosal disease on daily life: preliminary observations from a qualitative study.

OBJECTIVE To explore the experience of daily life of persons with chronic oral mucosal conditions. METHODS   Purposive sampling was used to recruit patients from the Oral Medicine Unit of Cork University Dental School and Hospital. An experienced independent facilitator convened the focus groups and conducted individual interviews in a non clinical setting. Focus groups were mixed with regard to gender, age, chronic oral mucosal condition, time since diagnosis and severity. A total of 24 patients took part, including patients with oral lichen planus, mucous membrane pemphigoid, pemphigus vulgaris, recurrent aphthous stomatitis and orofacial granulomatosis. RESULTS   Analysis of the interviews revealed that patient views could be divided into the following themes - biopsychosocial issues, treatment limitations and side effects, unpredictability of the conditions and the potential for malignant transformation and issues for the healthcare professionals. CONCLUSION Chronic oral mucosal conditions impact upon the experience of daily life of patients in a variety of areas from physical health and functioning, to concerns about their future. The role of the oral medicine practitioner in treating patients with chronic oral mucosal diseases extends beyond active management and symptomatic relief to the management of all aspects of these conditions that impact upon their daily lives.

Obstetric and perinatal outcomes of twin pregnancies conceived following IVF/ICSI treatment compared with spontaneously conceived twin pregnancies.

OBJECTIVE Twin pregnancy is associated with increased obstetric and perinatal risk. There are conflicting reports on whether assisted conception (ART) further increases these risks. The aim of this study is to assess the obstetric and perinatal outcomes of twin pregnancies according to mode of conception. STUDY DESIGN A retrospective study of all viable dichorionic-diamniotic (DCDA) twin pregnancies (n=539) delivered at Cork University Maternity Hospital, Ireland between 2009 and 2012, divided according to spontaneous conception (SC) and ART conception, specifically IVF or ICSI. RESULTS The ART conceived group were on average 4 years older (36.8±4.23 vs 32.3±4.93 years) and more frequently nulliparous (73.7%; n=126 vs 36.1%; n=133) than their SC counterparts (p<0.001). There was no significant difference in maternal antenatal complications. ART twins were twice as likely to be delivered by caesarean section (CS) (OR 2.35; 95% CI 1.76-3.14). There was no significant difference in the rates of preterm birth or NICU admission according to mode of conception. ART conceived twins were almost twice as likely to be delivered moderately preterm (32-33(+6)) (OR 1.98, 95% CI 1.21-3.23) and were more likely to have RDS and neonatal hypoglycaemia CONCLUSIONS Twin pregnancy, irrespective of mode of conception, carries an increased risk of morbidity and mortality for both mother and babies and therefore couples should be counselled regarding the increased risk of iatrogenic twinning associated with double embryo transfer. However, for those that do conceive twins, they can be advised that assisted conception conveys no significant disadvantage over naturally conceived twin pregnancies.

Private health care coverage and increased risk of obstetric intervention

BackgroundWhen clinically indicated, common obstetric interventions can greatly improve maternal and neonatal outcomes. However, variation in intervention rates suggests that obstetric practice may not be solely driven by case criteria.MethodsDifferences in obstetric intervention rates by private and public status in Ireland were examined using nationally representative hospital discharge data. A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010. Multivariate logistic regression analysis with correction for the relative risk was conducted to determine the risk of obstetric intervention (caesarean delivery, operative vaginal delivery, induction of labour or episiotomy) by private or public status while adjusting for obstetric risk factors.Results403,642 childbirth hospitalisations were reviewed; approximately one-third of maternities (30.2%) were booked privately. After controlling for relevant obstetric risk factors, women with private coverage were more likely to have an elective caesarean delivery (RR: 1.48; 95% CI: 1.45-1.51), an emergency caesarean delivery (RR: 1.13; 95% CI: 1.12-1.16) and an operative vaginal delivery (RR: 1.25; 95% CI: 1.22-1.27). Compared to women with public coverage who had a vaginal delivery, women with private coverage were 40% more likely to have an episiotomy (RR: 1.40; 95% CI: 1.38-1.43).ConclusionsIrrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have an obstetric intervention. To better understand both clinical and non-clinical dynamics, future studies of examining health care coverage status and obstetric intervention would ideally apply mixed-method techniques.

Social identity influences stress appraisals and cardiovascular reactions to acute stress exposure

OBJECTIVES This study tested a recent theoretical development in stress research to see whether group membership influenced cardiovascular reactions following exposure to acute stress. METHODS Participants (N = 104) were exposed to a message in which a maths test was described as stressful or challenging by an ingroup member (a student) or outgroup member (a stress disorder sufferer). Systolic blood pressure and diastolic blood pressure(DBP) and heart rate (HR) were monitored throughout a standard reactivity study. RESULTS As expected, a significant interaction was found; relative to those who were told that the task was challenging, ingroup members reported more stress and had higher DBP and HR reactivity when told by an ingroup member that the maths task was stressful; task information did not have the same effect for outgroup members. CONCLUSION These results indicate that informational support is not constant but varies as a function of group membership. Finally, this recent development in stress research may prove useful for those interested in investigating the interactions between social, psychological and physiological processes underlying health disparities. STATEMENT OF CONTRIBUTION What is already known on this subject? Stress is a common risk factor for hypertension and coronary heart disease. Social support has been found to reduce cardiovascular reactions to acute psychological stress. The influence of social support on stress varies as a consequence of social identity. What does this study add? The social group that one belongs to influences how one appraises and responds to stress. Social identity provides a useful framework for understanding how social processes are associated with health disparities.

A patient-centered approach to developing a quality-of-life questionnaire for chronic oral mucosal diseases

OBJECTIVE The objective of this study was to develop a self-completion questionnaire measuring quality of life in patients with chronic oral mucosal diseases. STUDY DESIGN The stages of development involved the use of both clinical expert input, via a modified Delphi technique, and patient input, via qualitative interviews, in the generation of items. Item reduction was carried out using a judgment method. RESULTS Expert input was derived from 5 professors or consultants in oral medicine. Qualitative interviews were conducted with 24 patients during the item-generation phase of development. An initial item pool of 28 items was generated from the clinician and patient input. Importance ratings ranged from 4.0 to 0.44. Items with importance ratings below 1 were reviewed and considered for exclusion. Three items were subsequently excluded and 1 item added resulting in a final 26-item instrument. CONCLUSIONS This is the first discipline-specific quality-of-life measure developed in the field of oral medicine.

Quality of life in health care workers with latex allergy.

BACKGROUND Exposure to latex gloves and glove powder makes health care workers (HCWs) particularly susceptible to developing an allergy to latex. AIMS To assess the impact on the quality of life (QOL) of HCWs who are allergic to latex products before removal from latex exposure and after removal from exposure. METHODS We studied 39 latex allergic HCWs from the Health & Safety Executive south area. Twenty-nine attended for an assessment with the occupational physician and were asked to fill out a questionnaire. Spirometry, immunoglobulin E levels and latex radioallergosorbent test levels were measured. RESULTS In total, 29/39 (74%) of patients responded. All of the participants had a type 1 allergy to latex. All individuals reported a significant improvement of symptoms once latex was removed from their working environment. Of those that reported skin complaints, 83% reported that their skin no longer had an impact on their QOL once latex was removed. Over 90% (n = 26) of all participants stated that their eye/nose symptoms had no longer an impact on their QOL and 86% (n = 25) of all participants stated that their respiratory symptoms had no impact on their QOL following the removal of latex from their working environment. Overall, 45% of the respondents had changed jobs: 61% of this group changed to a completely nonclinical post. CONCLUSIONS On average, 86% of latex allergic HCWs reported that their QOL had improved significantly since their removal from latex. In employees who are latex allergic/sensitized, taking latex avoidance measures results in cessation or diminution of symptoms.

Parents’ concerns about future pregnancy after stillbirth: a qualitative study

As stillbirth has a devastating impact, it is imperative to understand the importance of clinical and emotional care after stillbirth and how it influences subsequent pregnancies. The aim of the study was to gain insight into the consideration and planning of a subsequent pregnancy by parents in the weeks following stillbirth.

Parental decision making around perinatal autopsy: a qualitative investigation

Decades of decline in uptake rates of perinatal autopsies has limited investigation into the causes and risk factors for stillbirth.

The provision of spiritual and pastoral care following stillbirth in Ireland: a mixed methods study

Background The death of a baby is recognised as one of the most difficult bereavements with life-long impact for parents. How bereaved parents are cared for influences their grief journey. Optimal holistic care is provided when the physical, emotional, spiritual and social needs of parents are attended to. This study reviewed how spiritual care is provided to bereaved parents following stillbirth in maternity units in Ireland and the impact of stillbirth on healthcare chaplains. Methods This was a mixed methods study using semistructured qualitative interviews with hospital chaplains in Irish maternity units. Quantitative data about the provision of services to bereaved parents were collated from the interviews. Qualitative data were analysed thematically to identify key themes. Results 20 chaplains from 17 units participated in the study (85% of Irish maternity units). 12 chaplains (60%) are formally accredited chaplains; only one has received specialist training in perinatal bereavement care. 11 chaplains (55%) provide follow-up bereavement care. Seven chaplains (35%) did not feel part of the multidisciplinary team. The main themes that emerged were the impact of stillbirth, suffering and the challenge to faith creating inner conflict and doubt. Conclusions The provision of spiritual care following stillbirth in Ireland is diverse. Spiritual care in this specialised area by chaplains who are not professionally trained and accredited potentially impacts quality and depth of care. Chaplains experience considerable impact and challenge to personal faith and belief as they provide care. Recommendations are made for ongoing education and greater support for chaplains.