The river of postnatal psychosis: A qualitative study of women's experiences and meanings.

OBJECTIVE: This paper reports findings from a study about women's experience of postpartum psychosis which affects 1-2 women in 1000 in the first four to six weeks following childbirth. Previous research reports many women are relucent to disclose symptoms of mental ill health to healthcare professionals, although they are most likely to discuss symptoms and concerns with a health professional known to them. DESIGN: A qualitative interpretive study using semi-structured interviews. PARTICIPANTS: Ten women in Australia who had recovered from postpartum psychosis in the last ten years were interviewed. DATA ANALYSIS: Data were analysed thematically by three researchers to enhance trustworthiness. RESULTS: The women described their overall experience as traumatic and described what they saw as contributing factors such as a previous history of mental illness or a significant life event that was present before or during pregnancy; the women described how they made meaning of the symptoms they experienced, such as a lack of sleep or changes in their thoughts or behaviours; and the difficulties they experienced during recovery. The women also identified novel ways to support themselves and each other as they recovered. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Midwives require further education to recognise the symptoms of postpartum psychosis, to ask further probing questions to identify postpartum psychosis in its early stages and to support women as they recover from this illness.

Implementing and evaluating the effectiveness of an oral health module for the bachelor of midwifery program at an Australian university.

OBJECTIVE: Although guidelines recommend antenatal care providers such as midwives promote oral health during pregnancy, oral health training is not routinely provided in undergraduate midwifery curricula. The aim of this study was to implement an oral health module into an Australian undergraduate midwifery program, and evaluate its effectiveness in improving the oral health knowledge and confidence of midwifery students. DESIGN: Pre-test post-test study (2015-2017). SETTING: An undergraduate midwifery program within an Australian university. PARTICIPANTS: All first-year undergraduate midwifery students enrolled in two core units at the above university (N = 56). METHODS: Oral health modules were implemented into each of the two core units within the first year of the Bachelor of Midwifery course. Changes in knowledge and confidence were measured using a standardised questionnaire, administered at baseline, immediately following module completion, and at 2 and 3 years following module completion. RESULTS: 44 students participated in the baseline survey (79% response rate), of which 41 completed the first post-module questionnaire, 21 completed the second post-questionnaire, and 24 completed the third post-questionnaire. Knowledge scores significantly increased from baseline (mean 13.12) to follow-up (mean 17.78, p < 0.001), with increases being retained through to the 3-year mark (mean 18.29, p < 0.001). Confidence scores also showed a sustained increase following the module, particularly regarding introducing oral health in the first antenatal appointment (62.1% increase, p < 0.001) and referring pregnant women to a dentist (48.2% increase, p < 0.001). However, the 48.2% increase (p < 0.001) in confidence in conducting a visual mouth check on a pregnant woman following the module was not sustained at subsequent time points, reducing to a 31.5% increase (p = 0.118) by the third year post-module. CONCLUSIONS: The module is effective in improving and sustaining the knowledge and confidence of midwifery students to promote maternal oral health. Ongoing updates may be required to keep confidence high regarding visual mouth checks.

Understanding the experience of women admitted to a psychiatric hospital in Sydney with psychosis or mania following childbirth after World War II (1945-1955).

In the present study, we investigated a unique set of historical health-care records of women admitted to a psychiatric hospital in Sydney, Australia with a diagnosis of psychosis or mania after childbirth in the post-World War II (WWII) period, from 1945 to 1955. This research is part of a larger project examining how the descriptions of these women documented in the health-care records from 1885 to 1975 affected their treatment and the outcome of their admission. In the present paper, we report on the findings from an intensive examination of the post WWII documents. Eighteen health-care records from a psychiatric facility (Gladesville Hospital) were identified from admission registers housed in the State Records Office of New South Wales in 2014. Although seven records had been destroyed, 11 were transcribed verbatim. The records contain demographic information; descriptions of the women's signs and symptoms on admission; and information about the women before, during, and after their admission found in letters from relatives or medical staff. A content analysis of admission information showed how the women were described by health-care professionals, but a textual analysis of the records revealed that there were other factors that could have contributed to the women's condition, which might not have been taken into consideration when treatment and care were devised. The present study demonstrates the value of investigating historical health-care records to understand how prevailing attitudes and practices might affect diagnosis and treatment.

Designing an oral health module for the Bachelor of Midwifery program at an Australian University.

Maternal oral health is important yet many pregnant women are unaware of its significance. Midwives are advised to promote oral health during pregnancy and are supported to do this in Australia through the Midwifery Initiated Oral Health training program. However, limited undergraduate education is being provided to midwifery students in this area. The objective of this paper is to describe how an innovative oral health education module for an undergraduate midwifery course in Australia was designed using a multidisciplinary approach. Midwives experienced in curriculum development and key investigators from the Midwifery Initiated Oral Health program designed the module using existing literature. Constructive alignment, blended learning and scaffolding were used in the design process. The draft module was then reviewed by midwifery academics and their feedback incorporated. The final module involves 4 h of teaching and learning and contains three components incorporated into first year course units. Each component is aligned with existing learning outcomes and incorporates blended learning approaches and tutorials/class activities as well as online quizzes and personal reflection. The module details key information (current evidence; basic anatomy/physiology; common oral conditions; and guidelines during pregnancy) that could better prepare students to promote oral health in clinical practice. This is the first time such an innovative, multidisciplinary approach has been undertaken embedding oral health in an undergraduate midwifery program in Australia.

The barriers and facilitators to evidence-based episiotomy practice in Jordan.

AIM: This paper examines the barriers to evidence-based episiotomy practice in Jordan and identifies strategies that may be effective in introducing evidence-based practice. BACKGROUND: Episiotomy is routinely undertaken during birth in many parts of the world, including in the Middle East with little scientific evidence of benefit. There is a paucity of research examining the underlying drivers for episiotomy rates, and why they are higher in some countries. METHOD: This study, conducted in Jordan, used a quality improvement approach and comprised three phases. In phase one, a retrospective file review of 300 births was conducted. In phase two, 15 face-to-face interviews were conducted with 10 midwives and five key stakeholders (managers and doctors). A feedback and discussion session using the audit and review model was conducted in phase three with 23 health professionals to identify strategies to reduce the episiotomy rate. RESULTS: The episiotomy rate was 41.4% overall (91% of primiparous women and 24% of multiparous women). Six major themes emerged from the thematic analysis of data: 'Policy: written but invisible and unwritten and assumed'; 'the safest way'; 'doctors set the rules'; 'midwives swimming with the tide; 'uncooperative and uninformed women' and 'the way forward'. CONCLUSIONS: Non-evidence based episiotomy practices are widely used during birth in this Jordanian hospital and numerous barriers to change exist. Medical professionals dictate childbirth practice and midwives fear recrimination if they go against the 'unwritten policy'. Strategies to change practice include development of evidence-based information for women, education of midwives and doctors, and policy review.

Historical perspectives: a snapshot of women admitted to psychiatric facilities with psychosis or mania after childbirth in the late Victorian and inter-war periods.

AIM: This study analysed historical healthcare records to investigate how women diagnosed with mania or psychosis and admitted to two mental health facilities in Australia following childbirth, were described in the late Victorian (1885-1895) and inter-war period (1925-1935). BACKGROUND: Although historians have examined the history of mental health systems in Australia, there is no published scholarship that considers the healthcare records of these women. This was a unique opportunity to explore these documents. DESIGN: An historical study examining healthcare records. The data collection occurred in 2012. METHODS: Women admitted to mental health facilities with a diagnosis of psychosis or mania were identified in the admission registers found in the State Record Office of New South Wales and, if available, their healthcare record was transcribed verbatim. The records were imported into NVivo 10 for content analysis to determine the range and scope of information. A further textual analysis was conducted to see if the woman's diagnosis was congruent with the outcome of her admission. RESULTS/FINDINGS: 155 cases were identified across the two periods. Although, demographic data and the description of the women on admission were remarkably similar, 17% of women were physically, rather than mentally, ill and died soon after admission. The findings demonstrate the importance of current practices such as taking a comprehensive healthcare assessment and the use of antibiotics and sanitary measures during labour and in the postnatal period. CONCLUSION: Historical investigations of healthcare records provide legitimacy for current healthcare practices.

Interdisciplinary concepts for design and implementation of mixed reality interactive neurorehabilitation systems for stroke.

Interactive neurorehabilitation (INR) systems provide therapy that can evaluate and deliver feedback on a patient's movement computationally. There are currently many approaches to INR design and implementation, without a clear indication of which methods to utilize best. This article presents key interactive computing, motor learning, and media arts concepts utilized by an interdisciplinary group to develop adaptive, mixed reality INR systems for upper extremity therapy of patients with stroke. Two INR systems are used as examples to show how the concepts can be applied within: (1) a small-scale INR clinical study that achieved integrated improvement of movement quality and functionality through continuously supervised therapy and (2) a pilot study that achieved improvement of clinical scores with minimal supervision. The notion is proposed that some of the successful approaches developed and tested within these systems can form the basis of a scalable design methodology for other INR systems. A coherent approach to INR design is needed to facilitate the use of the systems by physical therapists, increase the number of successful INR studies, and generate rich clinical data that can inform the development of best practices for use of INR in physical therapy.

Piloting of an oral health education programme and knowledge test for midwives.

Research shows limited emphasis being placed on oral health by midwives in Australia and the need for further education in this area. The study aim was to pilot a midwifery oral health education programme and knowledge test and identify any flaws in its content and design. Twenty-two midwives from an antenatal ward in South-Western Sydney completed the programme and 12 feedback forms/knowledge tests were returned. Data was analysed using descriptive statistics and content analysis. Feedback data showed all midwives appreciated that the programme was available online and self-paced. Most found the programme extremely informative and following completion were more confident in promoting maternal oral health. The mean correct responses in the knowledge test was 79% (SD = 12.3) which suggests most items were suitable for assessing knowledge improvement. However, in three items midwives had low correct responses. Various aspects that could be improved or clarified were identified and suggestions discussed.

Piloting of an oral health education program and knowledge test for midwives.

Abstract Research shows limited emphasis being placed on oral health by midwives in Australia and the need for further education in this area. The study aim was to pilot a midwifery oral health education program and knowledge test and identify any flaws in its content and design. Twenty two midwives from an antenatal ward in South-western Sydney completed the program and 12 feedback forms/knowledge tests were returned. Data was analysed using descriptive statistics and content analysis. Feedback data showed all midwives appreciated that the program was available online and self-paced. Most found the program extremely informative and following completion were more confident in promoting maternal oral health. The mean correct responses in the knowledge test was 79 % (SD=12.3) which suggests most items were suitable for assessing knowledge improvement. However, in 3 items midwives had low correct responses. Various aspects that could be improved or clarified were identified and suggestions discussed.

Adaptive mixed reality rehabilitation improves quality of reaching movements more than traditional reaching therapy following stroke.

BACKGROUND: Adaptive mixed reality rehabilitation (AMRR) is a novel integration of motion capture technology and high-level media computing that provides precise kinematic measurements and engaging multimodal feedback for self-assessment during a therapeutic task. OBJECTIVE: We describe the first proof-of-concept study to compare outcomes of AMRR and traditional upper-extremity physical therapy. METHODS: Two groups of participants with chronic stroke received either a month of AMRR therapy (n = 11) or matched dosing of traditional repetitive task therapy (n = 10). Participants were right handed, between 35 and 85 years old, and could independently reach to and at least partially grasp an object in front of them. Upper-extremity clinical scale scores and kinematic performances were measured before and after treatment. RESULTS: Both groups showed increased function after therapy, demonstrated by statistically significant improvements in Wolf Motor Function Test and upper-extremity Fugl-Meyer Assessment (FMA) scores, with the traditional therapy group improving significantly more on the FMA. However, only participants who received AMRR therapy showed a consistent improvement in kinematic measurements, both for the trained task of reaching to grasp a cone and the untrained task of reaching to push a lighted button. CONCLUSIONS: AMRR may be useful in improving both functionality and the kinematics of reaching. Further study is needed to determine if AMRR therapy induces long-term changes in movement quality that foster better functional recovery.

Midwives and oral health care during pregnancy: perceptions of pregnant women in south-western Sydney, Australia.

AIMS AND OBJECTIVE: This study sought to explore the perceptions of pregnant women in Australia towards oral health care during pregnancy and their views regarding midwives providing oral health education, assessment and referrals as part of antenatal care. BACKGROUND: Maintaining oral health during pregnancy is important. Yet, many pregnant women do not access dental services during this time. Antenatal care providers are now recommended to promote maternal oral health, and various countries have adopted this strategy. However, in Australia, a lack of emphasis is placed on maternal oral health especially by antenatal care providers. Currently, a preventive programme is being developed to promote maternal oral health with the help of midwives in Australia. Very little is known about the perceptions of such an approach from pregnant women. DESIGN: Qualitative approach. METHOD: Data were collected via semi-structured telephone interviews with 10 pregnant women residing in south-western Sydney. RESULTS: Thematic analyses of the data suggest a high prevalence of poor oral health among pregnant women, especially those socioeconomically disadvantaged. The findings also highlight various barriers deterring these women from seeking dental care the most significant being lack of dental awareness, high treatment costs and misconceptions about dental treatment during pregnancy. The absence of affordable dental care remains a major barrier in Australia. The proposed preventive programme was well received by women although issues such as education for midwives and referral pathways were highlighted. CONCLUSIONS: The findings suggest that a tailored midwifery-initiated oral health programme has potential in Australia, especially for low-income families as it addresses many existing barriers to dental care. RELEVANCE TO CLINICAL PRACTICE: Antenatal care providers in Australia should provide more information about oral health. These health professionals should be adequately educated to promote oral health. Health services should also consider offering pregnant women affordable and accessible dental services.

Development of an online education program for midwives in australia to improve perinatal oral health.

It is recommended that all pregnant women should receive a comprehensive oral health evaluation because poor maternal oral health may affect pregnancy outcomes and the general health of the woman and her baby. Midwives are well placed to provide dental health advice and referral. However, in Australia, little emphasis has been placed on the educational needs of midwives to undertake this role. This article outlines the development of an online education program designed to improve midwives' dental health knowledge, prepare them to assess the oral health of women, refer when required, and provide appropriate dental education to women and their families. The program consists of reading and visual material to assist with the oral health assessment process and includes competency testing.

Exploring the bases for a mixed reality stroke rehabilitation system, Part II: design of interactive feedback for upper limb rehabilitation.

BACKGROUND: Few existing interactive rehabilitation systems can effectively communicate multiple aspects of movement performance simultaneously, in a manner that appropriately adapts across various training scenarios. In order to address the need for such systems within stroke rehabilitation training, a unified approach for designing interactive systems for upper limb rehabilitation of stroke survivors has been developed and applied for the implementation of an Adaptive Mixed Reality Rehabilitation (AMRR) System. RESULTS: The AMRR system provides computational evaluation and multimedia feedback for the upper limb rehabilitation of stroke survivors. A participant's movements are tracked by motion capture technology and evaluated by computational means. The resulting data are used to generate interactive media-based feedback that communicates to the participant detailed, intuitive evaluations of his performance. This article describes how the AMRR system's interactive feedback is designed to address specific movement challenges faced by stroke survivors. Multimedia examples are provided to illustrate each feedback component. Supportive data are provided for three participants of varying impairment levels to demonstrate the system's ability to train both targeted and integrated aspects of movement. CONCLUSIONS: The AMRR system supports training of multiple movement aspects together or in isolation, within adaptable sequences, through cohesive feedback that is based on formalized compositional design principles. From preliminary analysis of the data, we infer that the system's ability to train multiple foci together or in isolation in adaptable sequences, utilizing appropriately designed feedback, can lead to functional improvement. The evaluation and feedback frameworks established within the AMRR system will be applied to the development of a novel home-based system to provide an engaging yet low-cost extension of training for longer periods of time.

Maintaining oral health during pregnancy: perceptions of midwives in Southwest Sydney.

Current evidence highlights the importance of maintaining good oral health during pregnancy, unfortunately, many women in Australia do not access dental services at this time. Compounding the situation is the lack of importance placed on the value of good maternal oral health by prenatal care providers. These constraints highlight the potential value of having preventive oral health advice and referral to an appropriate care pathway during the prenatal period. Midwives are in an excellent position to offer such a service, although the specific aspects of the role have not been clearly defined in Australia. As a preliminary step to the development of an oral health service program, initiated by midwives, this study assesses the midwives' perceptions of such an approach. Data were collected for this qualitative study via a focus group with 15 midwives. Thematic analyses of the data showed that despite the high prevalence of poor oral health in the area, most midwives were unaware of its possible ill-effects on maternal and child health. Midwives were also reluctant to discuss oral health with pregnant women because of a lack of appropriate referral pathways to the Public Dental Services. Midwives were receptive to the idea of establishing this new service but highlighted barriers such as the time involved, the competencies required and the need for referral pathways. The findings suggest that a midwifery-initiated oral health service has potential although issues such as training, time constraints and referral pathways must be addressed.

A novel adaptive mixed reality system for stroke rehabilitation: principles, proof of concept, and preliminary application in 2 patients.

This article presents the principles of an adaptive mixed reality rehabilitation (AMRR) system, as well as the training process and results from 2 stroke survivors who received AMRR therapy, to illustrate how the system can be used in the clinic. The AMRR system integrates traditional rehabilitation practices with state-of-the-art computational and motion capture technologies to create an engaging environment to train reaching movements. The system provides real-time, intuitive, and integrated audio and visual feedback (based on detailed kinematic data) representative of goal accomplishment, activity performance, and body function during a reaching task. The AMRR system also provides a quantitative kinematic evaluation that measures the deviation of the stroke survivor's movement from an idealized, unimpaired movement. The therapist, using the quantitative measure and knowledge and observations, can adapt the feedback and physical environment of the AMRR system throughout therapy to address each participant's individual impairments and progress. Individualized training plans, kinematic improvements measured over the entire therapy period, and the changes in relevant clinical scales and kinematic movement attributes before and after the month-long therapy are presented for 2 participants. The substantial improvements made by both participants after AMRR therapy demonstrate that this system has the potential to considerably enhance the recovery of stroke survivors with varying impairments for both kinematic improvements and functional ability.

Workbooks to virtual worlds: a pilot study comparing educational tools to foster a culture of safety and respect in Ontario.

Nurses frequently experience horizontal violence in their interactions with nursing colleagues within the workplace. By definition, horizontal violence includes such disrespectful behaviours as intimidation, coercion, bullying, criticism, exclusion or belittling. Educational programs addressing horizontal violence have been developed, but few have been evaluated with respect to knowledge acquisition and transfer. The purpose of this paper is to describe an experimental effectiveness study, using a pre/post design with a control group (total N=164). The research evaluated an innovative educational program in which nurses, using avatars, role-played strategies to address horizontal violence within a virtual nursing unit developed on the Second Life platform. The results of participating in this program were compared with more traditional educational methodologies, such as a workbook and a self-directed e-learning module. While all strategies were perceived by participants as beneficial, the findings from this study suggest that learning through the self-directed e-learning module followed with practice in a virtual world is an effective way of acquiring knowledge, skills and abilities to better address horizontal violence.

Design of a home-based adaptive mixed reality rehabilitation system for stroke survivors.

This paper presents the design of a home-based adaptive mixed reality system (HAMRR) for upper extremity stroke rehabilitation. The goal of HAMRR is to help restore motor function to chronic stroke survivors by providing an engaging long-term reaching task therapy at home. The system uses an intelligent adaptation scheme to create a continuously challenging and unique multi-year therapy experience. The therapy is overseen by a physical therapist, but day-to-day use of the system can be independently set up and completed by a stroke survivor. The HAMMR system tracks movement of the wrist and torso and provides real-time, post-trial, and post-set feedback to encourage the stroke survivor to self-assess his or her movement and engage in active learning of new movement strategies. The HAMRR system consists of a custom table, chair, and media center, and is designed to easily integrate into any home.

Mixed reality rehabilitation for stroke survivors promotes generalized motor improvements.

This paper presents results from a clinical study of stroke survivors using an adaptive, mixed-reality rehabilitation (AMRR) system for reach and grasp therapy. The AMRR therapy provides audio and visual feedback on the therapy task, based on detailed motion capture, that places the movement in an abstract, artistic context. This type of environment promotes the generalizability of movement strategies, which is shown through kinematic improvements on an untrained reaching task and higher clinical scale scores, in addition to kinematic improvements in the trained task.

An adaptive mixed reality training system for stroke rehabilitation.

This paper presents a novel mixed reality rehabilitation system used to help improve the reaching movements of people who have hemiparesis from stroke. The system provides real-time, multimodal, customizable, and adaptive feedback generated from the movement patterns of the subject's affected arm and torso during reaching to grasp. The feedback is provided via innovative visual and musical forms that present a stimulating, enriched environment in which to train the subjects and promote multimodal sensory-motor integration. A pilot study was conducted to test the system function, adaptation protocol and its feasibility for stroke rehabilitation. Three chronic stroke survivors underwent training using our system for six 75-min sessions over two weeks. After this relatively short time, all three subjects showed significant improvements in the movement parameters that were targeted during training. Improvements included faster and smoother reaches, increased joint coordination and reduced compensatory use of the torso and shoulder. The system was accepted by the subjects and shows promise as a useful tool for physical and occupational therapists to enhance stroke rehabilitation.

Physical activity in pregnancy: women's perceptions, practices, and influencing factors.

INTRODUCTION: Evidence shows that physical activity during and after pregnancy results in health gains for women. There is no clear understanding apparent in the literature of women's experiences with physical activity during their pregnancy. The aim of this study was to describe women's perceptions and participation in physical activity during pregnancy and identify factors influencing participation. METHODS: In this qualitative descriptive study, face-to-face interviews were conducted with 19 women, all at different stages of pregnancy, who were asked about their experiences with physical activity. RESULTS: Data analysis resulted in four categories describing "meaning of physical activity," "perceived benefits of physical activity in pregnancy," "barriers to and motives for participation in physical activity," and "process of engagement in physical activity." The process of engagement in physical activity by women was shown to have three marked phases: "uncertainty," "engaging," and "compromise." DISCUSSION: To facilitate women's self-management across these phases, support is needed that focuses on providing strategies to strengthen individual approaches by women. Such support might promote activities of daily living as a specific entity of physical activity, expose myths about activity during pregnancy, and endorse the benefits of weight management arising from physical activity, not just during pregnancy, but across the lifespan.