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The reliability, practicality and acceptability of using ultrasonography to monitor the progress of labour and delivery.Introduction: It had been suggested by a number of recent studies that ultrasonography could become an alternative to digital vaginal examination (VE) for assessing the progress of pregnant women in labour. However, no systematic review and meta-analysis on the effectiveness of ultrasonography was available. Systematic Review: A systematic review and meta-analysis was conducted to investigate the success rate of ultrasonography in comparison with digital VE and the level of agreement between the two methods, in terms of estimating fetal head position, head station and cervical dilatation. Systematic Review Findings: This review found that ultrasonography has a higher success rate than digital VE in estimating fetal head position. Ultrasonography was also in high agreement with digital VE in estimating cervical dilatation, with insignificant difference in the success rate of the two methods in terms of detecting cervical dilatation. There was also a significant correlation between the two methods in estimating head station. However, it was also found by the review that, existing primary studies were mainly conducted in tertiary settings of developed countries. Further research was therefore needed from the perspective of non-tertiary settings and also from developing country settings. In addition, further research was also needed to assess the diagnostic performance of ultrasound in detecting active labour, since it is associated with cervical dilatation. The diagnostic performance of ultrasound in detecting engaged fetal head had also not been investigated, which is necessary because it is associated with head station. Primary Research Aim: As a consequence of these systematic review findings, a primary study was conducted in another clinical setting in a developing country. The aim was to investigate the reproducibility, practicality and acceptability of using ultrasonography to monitor the progress of pregnant women in labour. Research Methods: A cross-sectional study was conducted in a teaching hospital in Ghana. The agreement between ultrasound and digital VE was statistically analysed for the estimation of fetal head position, head station and cervical dilatation. Further statistical analysis was conducted on the diagnostic performance of ultrasound in detecting engaged fetal head, and the diagnostic performance of ultrasound in detecting active labour. A quantitative survey of mothers’ acceptance of intrapartum ultrasound was also conducted. Lastly, caregivers’ views on the practicality of using ultrasound in this developing country setting was also investigated in a qualitative survey. Results of Primary Research: The results regarding reproducibility were as follows: (i) a high between-method agreement was found in the estimation of cervical dilatation, with high ultrasound sensitivity and specificity in detecting active labour; (ii) a statistically significant between-method agreement was found in the estimation of head station, with high ultrasound sensitivity and specificity in detecting engaged fetal head; (iii) a weak between-method agreement was found in the estimation of fetal head position, with ultrasound having a higher success rate than digital VE. The results regarding acceptability showed that most mothers accepted the use of intrapartum ultrasound, and were willing to have the procedure for their future care during labour and childbirth. They also preferred ultrasound to digital VE. With regards to practicality, the responses of caregivers indicate that the introduction of intrapartum ultrasound in this setting could serve as a good complement to digital VE in a number of ways. However, putting it into practice would require wider availability of physical and technical resources. Conclusion: The findings of the reproducibility study were consistent with existing studies in other clinical settings which were investigated in the systematic review. This suggests that ultrasound is a reliable method for assessing the progress of pregnant women in labour. In addition, the unique contribution to existing knowledge obtained from this study was a high ultrasound sensitivity and specificity in detecting active labour and engaged fetal head which were reported for the first time. The findings on mothers’ acceptability were also consistent with existing studies in other settings, which is an indication that there is high acceptance of intrapartum ultrasound by mothers from different settings and cultures. Lastly, caregivers’ views on the practicality of the use of ultrasound during labour indicate that the regular use of intrapartum ultrasound for assessing the progress of labour in pregnant women may require additional resources to make it practicable in this and other similar settings.
South Asian Indian ageing: A qualitative investigation into expectations of co-residence and care amongst second and third generation adults of South Asian Indian origin in LeicesterAbstract Today in the United Kingdom (UK), ageing is considered to be an important aspect of social life in general and although overall South Asian Indians (SAIs) are relatively young compared to the indigenous white population, the number over the age of 60 is rapidly increasing. Over the last decade or so evidence-based practice within social work has been given a great deal of emphasis in public and professional life. This study is based in this spirit and emanates from personal and professional experience of working with an ageing population from a South Asian Indian background and focuses on the second and third generation of this settled minority. The aspect of co-residence within South Asian Indian cultures has been given little attention both within academic and professional studies. The key aims underpinning this work and of the research reported in this thesis were to illuminate and explicate the problematical and challenging expectations of ageing, co-residence and care within different generations of SAIs in Leicester. Thus this study investigates the expectations of co-residence and care amongst a cohort of second and third generation SAIs who have been settled in the UK for 30 or more years. Using interpretivist theoretical perspectives, 12 participants (8 from the second generation and 4 from the third generation of SAI ‘settlers’) were interviewed using in-depth semi-structured one-to-one interview techniques to collect data regarding their views and understandings of co-residence and care within the context of living in the UK. The data collected was thematically analysed and three themes, co-residence, expectations and acculturation/enculturation were identified for detailed exploration and analysis. Using interpretivist perspectives, these themes were used to identify meaningful patterns of behaviour and sentiment and to analyse the underlying symbolic sociocultural systems within the context of ageing within the SAI community in the United Kingdom. The research highlighted the onset of some enculturation processes and a rapid change in social attitudes, particularly in relation to altruism, concepts of family, a gap in understanding the expectations of co-residence between generations and the impact of these on second generation SAIs. The older participants yearned to be looked after by their adult children, feared being on their own and displayed anxiety at the prospect of not being looked after in their old age. They experienced and expressed concern at a loss of control in the decisions relating to co-residence for their current and future lives. The study points to the lack of wider scale academic and practice-based research studies focused on the impact of changes in culture and family expectations, particularly in relation to co-residence, and recommends that :(a) the academic and professional discourses and theories on ageing incorporate aspects and experiences of migration and diversity of cultures and (b) researchers, practitioners and policy makers examine the needs of the ageing SAI communities in the UK in order to explore policies, procedures and initiatives that could enhance various forms of family living and to develop relevant evidence - based practice. The outcomes of the research have implications for teaching and for practice. This is particularly so in cases where there has been a perceived failure to adopt understandings and practices in response to the identified changes. To this end a flow chart was developed that is recommended to be used as a guide and a tool for initial assessment for practitioners when working with this vulnerable group. It is hoped that this guide will have utility in terms of scope and reach when applied to the analysis and understanding of ageing in SAI communities in the UK.
Working with psychological trauma: an interpretative phenomenological analysis of trauma-focused CBT and EMDRPurpose: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for post-traumatic stress disorder (PTSD), acknowledged repeated or extreme indirect exposure to aversive details of traumatic event(s) in the course of professional duties, can lead to symptoms of PTSD. This has led to discussions around impact and prevalence of vicarious trauma in psychological therapists treating trauma clients. This study considers how therapists delivering trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) make sense of their experiences and protect themselves from any negative effects of the work. Furthermore, it considers if there is a distinction in therapist experience between the two modalities. Methodology/Method: An Interpretative Phenomenological Analysis (IPA) was conducted to explore how trauma-focused CBT and EMDR therapists engaged in trauma work, interpreted and made sense of their experiences; with a view to identifying any protective practice that informed clinical practice and helped ameliorate vicarious trauma. Recorded, semi-structured interviews were conducted with CBT and EMDR therapists (N=11). Before analysis, interviews were transcribed verbatim and sent to individual participants for validation of their authenticity. Data was analysed using descriptive, linguistic and conceptual comments to identify an initial seventy nine emergent themes. When refined, four master themes of ‘Nature of Trauma’, ‘Participant sense of self and managing the process of hearing trauma narrative’, ‘Participant experience of delivering the trauma models’ and ‘Protecting and sustaining the participant sense of self’ were identified to answer the research question and are discussed herein. Findings: This study forms part of the growing body of evidence towards understanding therapist vicarious traumatisation. It both supports and challenges findings of previous studies. It also introduces new concepts in relation to the vicarious trauma phenomenon. Whilst there are clear limitations associated with making generalisations from an IPA study, the findings from the study suggest EMDR may be a protective factor against the negative effects of hearing repeated trauma narrative. Furthermore, certain strategies such as time management, comprehensive trauma training and specific trauma supervision, may also reduce the negative effects of hearing trauma narrative. Finally, regardless of the difficulties faced, therapists enjoy their trauma work and feel a great sense of professional satisfaction. Implications/Recommendations: Indications from the findings of the study are that therapists working within primary care in particular, are becoming increasingly pressurised by cuts to funding within mental health services. Recommendations are that those components of trauma work which promote therapist wellbeing should be supported. In particular, realistic timeframes within which to work, good quality training and supervisors, ideally external to the workplace, who can provide trauma-specific supervision.