Background: The most common reason for caesarean section (CS) is repeat CS following previous CS. Vaginal birth after caesarean section (VBAC) rates vary widely in different healthcare settings and countries. Obtaining deeper knowledge of clinicians’ views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Interview studies with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of ‘OptiBIRTH’, an ongoing research project. The study reported here is based on interviews in high VBAC countries. The aim of the study was to investigate the views of clinicians working in countries with high VBAC rates on factors of importance for improving VBAC rates. Methods: Individual (face-to-face or telephone) interviews and focus group interviews with clinicians (in different maternity care settings) in three countries with high VBAC rates were conducted during 2012–2013. In total, 44 clinicians participated: 26 midwives and 18 obstetricians. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country. Results: The findings are presented in four main categories with subcategories. First, a common approach is needed, including: feeling confident with VBAC, considering VBAC as the first alternative, communicating well, working in a team, working in accordance with a model and making agreements with the woman. Second, obstetricians need to make the final decision on the mode of delivery while involving women in counselling towards VBAC. Third, a woman who has a previous CS has a similar need for support as other labouring women, but with some extra precautions and additional recommendations for her care. Finally, clinicians should help strengthen women’s trust in VBAC, including building their trust in giving birth vaginally, recognising that giving birth naturally is an empowering experience for women, alleviating fear and offering extra visits to discuss the previous CS, and joining with the woman in a dialogue while leaving the decision about the mode of birth open. Conclusions: This study shows that, according to midwives and obstetricians from countries with high VBAC rates, the important factors for improving the VBAC rate are related to the structure of the maternity care system in the country, to the cooperation between midwives and obstetricians, and to the care offered during pregnancy and birth. More research on clinicians’ perspectives is needed from countries with low, as well as high, VBAC rates.
MULTIFILE
Background To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) the CR guideline from the Dutch Royal Society for Physiotherapists (KNGF) has been updated. This guideline can be considered an addition to the 2011 Dutch Multidisciplinary CR guideline, as it includes several novel topics. Methods A systematic literature search was performed to formulate conclusions on the efficacy of exercise-based interventions during all CR phases in patients with CHD. Evidence was graded (1–4) according the Dutch evidence-based guideline development (EBRO) criteria. In case of insufficient scientific evidence, recommendations were based on expert opinion. This guideline comprised a structured approach including assessment, treatment and evaluation. Results Recommendations for exercise-based CR were formulated covering the following topics: preoperative physiotherapy, mobilisation during the clinical phase, aerobic exercise, strength training, and relaxation therapy during the outpatient rehabilitation phase, and adoption and monitoring of a physically active lifestyle after outpatient rehabilitation. Conclusions There is strong evidence for the effectiveness of exercise-based CR during all phases of CR. The implementation of this guideline in clinical practice needs further evaluation as well as the maintenance of an active lifestyle after supervised rehabilitation. LinkedIn: https://www.linkedin.com/in/tinusjongert/
Physical and psychosocial stress and recovery are important performance determinants. A holistic approach that monitors these performance determinants over a longer period of time is lacking. Therefore this study aims to investigate the effect of a player’s physical and psychosocial stress and recovery on field-test performance. In a prospective non-experimental cohort design 10 female Dutch floorball players were monitored over 6 months. To monitor physical and psychosocial stress and recovery, daily training-logs and three-weekly the Recovery-Stress Questionnaire for Athletes (RESTQ-Sport) were filled out respectively. To determine field-test performance 6 Heart rate Interval Monitoring System (HIMS) and 4 Repeated Modified Agility T-test (RMAT) measurements were performed. Multilevel prediction models were applied to account for within-players and between-players field-test performance changes. The results show that more psychosocial stress and less psychosocial recovery over 3 to 6 weeks before testing decrease HIMS performance (p≤0.05). More physical stress over 6 weeks before testing improves RMAT performance (p≤0.05). In conclusion, physical and psychosocial stress and recovery affect submaximal interval-based running performance and agility up to 6 weeks before testing. Therefore both physical and psychosocial stress and recovery should be monitored in daily routines to optimize performance.
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Electrohydrodynamic Atomization (EHDA), also known as Electrospray (ES), is a technology which uses strong electric fields to manipulate liquid atomization. Among many other areas, electrospray is used as an important tool for biomedical application (droplet encapsulation), water technology (thermal desalination and metal recovery) and material sciences (nanofibers and nano spheres fabrication, metal recovery, selective membranes and batteries). A complete review about the particularities of this tool and its application was recently published (2018), as an especial edition of the Journal of Aerosol Sciences. One of the main known bottlenecks of this technique, it is the fact that the necessary strong electric fields create a risk for electric discharges. Such discharges destabilize the process but can also be an explosion risk depending on the application. The goal of this project is to develop a reliable tool to prevent discharges in electrospray applications.
