ABSTRACT
OBJECTIVE: To characterize the range of symptoms experienced by pregnant methadone-maintained (MM) and buprenorphine-maintained (BM) women to determine whether these differ from those experienced by a control group of nonopioid exposed pregnant women. Opioid-maintained (OM) patients report high rates of symptoms related to direct opioid effects and withdrawal. Pregnancy is associated with a range of symptoms, some overlapping with opioid effects and withdrawal. METHODS: Prospective, nonrandomized, open-label comparison study undertaken in a large teaching maternity hospital in South Australia. Pregnant BM (n = 25), MM (n = 25) and nonopioid exposed controls (n = 25) were recruited and matched for age, parity, gravidity, alcohol consumption, and smoking status. Symptom report patterns, maternal withdrawal, and additional substance use were assessed. RESULTS: MM women reported 10 and BM women reported 2 symptoms throughout pregnancy at rates greater than controls. Methadone-maintained women reported significantly (P < 0.05) more symptoms than BM women compared to controls throughout pregnancy. Methadone-maintained women reported 8 and BM women reported 3 symptoms in the third trimester at rates greater than controls. Methadone-maintained women reported greater opioid withdrawal than controls; this did not occur in BM women. Additional substance use was comparable between BM and MM women but greater than controls. CONCLUSIONS: Patterns of symptom reports may have clinical implications for maternal and fetal health during pregnancy for OM women including optimization of opioid dosing regimens, education regarding maternal nutritional intake and preventing postnatal depression, thereby ensuring maternal health and fetal development during pregnancy and enhancing mother-infant bonding and healthy child development postnatally.
Subject(s)
Buprenorphine/adverse effects , Buprenorphine/therapeutic use , Methadone/adverse effects , Methadone/therapeutic use , Opiate Substitution Treatment/adverse effects , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/rehabilitation , Pregnancy Complications/chemically induced , Pregnancy Complications/epidemiology , Adult , Case-Control Studies , Female , Humans , Opiate Substitution Treatment/statistics & numerical data , Pregnancy , Pregnancy Complications/diagnosis , Self Report , Substance Withdrawal Syndrome/diagnosis , Substance Withdrawal Syndrome/epidemiologyABSTRACT
Graduates' perception of the value of their undergraduate program is a critical component of professional program evaluation and contributes a viewpoint rarely reported in the literature. It has been proposed that Problem Based Learning (PBL) enhances knowledge acquisition, clinical competency and professionalism as a consequence of students assuming the role of registered nurse as they work through real practice situations on a daily basis in the classroom. The purpose of this study was to determine how PBL graduates describe the contribution of the educational experience to their professional practice as nurses. Using focused ethnography, PBL graduates (N=45) participated in the study as individuals or through focus group discussions. Graduates described themselves as: self aware and self directed critical thinkers, patient advocates able to engage in evidence based holistic practice and interdisciplinary team members able to take on leadership roles and handle conflict.
