Labour assessment programs to delay admission to labour wards.

BACKGROUND: The aim of labour assessment programs is to delay hospital admission until labour is in the active phase, and thereby to prevent unnecessary interventions in women who are not in established labour. OBJECTIVES: The objective of this review was to assess the effects of labour assessment programs that aim to delay hospital admission until labour is in the active phase. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: January 2001. SELECTION CRITERIA: Randomised trials which compare labour assessment programs with direct admission to labour wards. DATA COLLECTION AND ANALYSIS: Trial quality was assessed. MAIN RESULTS: One study of 209 women was included. The trial was of excellent quality. Women who were randomised to the labour assessment unit spent less time in the labour ward (weighted mean difference -5.20 hours, 95% confidence interval -7.06, -3.34), were less likely to receive intrapartum oxytocics (odds ratio 0.45, 95% confidence interval 0.25 to 0.80) and analgesia (odds ratio 0.36, 95% confidence interval 0.16 to 0.78), than women who were admitted directly to the labour ward. Women in the labour assessment group reported higher levels of control during labour (weighted mean difference 16.00, 95% confidence interval 7.52 to 24.48). There is insufficient evidence to assess effects on rate of caesarean section and other important measures of maternal and neonatal outcome. REVIEWER'S CONCLUSIONS: Labour assessment programs, which aim to delay hospital admission until active labour, may benefit women with term pregnancies.

Antenatal education for self-diagnosis of the onset of active labour at term.

BACKGROUND: A specific program designed to teach women to recognise active labour may be beneficial through potentially decreasing the incidence of early admission to hospital, increasing women's confidence and decreasing their anxiety. OBJECTIVES: The objective of this review was to assess the effects of teaching pregnant women specific criteria for self-diagnosis of active labour onset in term pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials comparing a structured antenatal education intervention for the identification of symptoms for self-diagnosis of active labour with usual care. DATA COLLECTION AND ANALYSIS: Trial quality was assessed. MAIN RESULTS: One study involving 245 women was included. Method of randomisation was unclear and 15% of the sample was lost to follow-up in this trial. A specific antenatal education program was associated with a reduction in the mean number of visits to the labour suite before the onset of labour (weighted mean difference -0. 29, 95% confidence interval -0.47 to -0.11). It is unclear whether this resulted in fewer women being sent home because they were not in labour. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of a specific set of criteria for self-diagnosis of active labour.

Caregivers' use of strict criteria for diagnosing active labour in term pregnancy.

BACKGROUND: Application of specific criteria for diagnosis of active labour as part of a labour assessment program aims to differentiate more accurately between latent and active phases of labour. OBJECTIVES: The objective of this review was to assess the effects of the use of specific criteria by caregivers in diagnosing active labour in term pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: January 1998. SELECTION CRITERIA: Randomised trials comparing caregivers' application of strict diagnostic criteria for active labour with routine care. DATA COLLECTION AND ANALYSIS: Trial quality was assessed. MAIN RESULTS: One study of 209 women was included. The trial was of excellent quality. Women who experienced early labour assessment were less likely to receive intrapartum oxytocics than women who received standard care (odds ratio 0.45, 95% confidence interval 0.25 to 0.80) and analgesia (odds ratio 0.36, 95% confidence interval 0.16 to 0.78). They reported higher levels of control during labour and birth (weighted mean difference 16.00, 95% confidence interval 7.52 to 24.48). There were no differences detected for rate of caesarean section and other important measures of maternal and neonatal outcome. REVIEWER'S CONCLUSIONS: Early labour assessment (which includes use of specific criteria for diagnosis of active labour) may have some positive outcomes for women at term pregnancy.

Release of Ca(2+) from intracellular stores and entry of extracellular Ca(2+) are involved in sea squirt sperm activation.

A rise in intracellular free Ca(2+) concentration ([Ca(2+)](i)) is required to activate sperm of all organisms studied. Such elevation of [Ca(2+)](i) can occur either by influx of extracellular Ca(2+) or by release of Ca(2+) from intracellular stores. We have examined these sources of Ca(2+) in sperm from the sea squirt Ascidia ceratodes using mitochondrial translocation to evaluate activation and the Ca(2+)-sensitive dye fura-2 to monitor [Ca(2+)](i) by bulk spectrofluorometry. Sperm activation artificially evoked by incubation in high-pH seawater was inhibited by reducing seawater [Ca(2+)], as well as by the presence of high [K(+)](o) or the Ca channel blockers pimozide, penfluridol, or Ni(2+), but not nifedipine or Co(2+). The accompanying rise in [Ca(2+)](i) was also blocked by pimozide or penfluridol. These results indicate that activation produced by alkaline incubation involves opening of plasmalemmal voltage-dependent Ca channels and Ca(2+) entry to initiate mitochondrial translocation. Incubation in thimerosal or thapsigargin, but not ryanodine (even if combined with caffeine pretreatment), evoked sperm activation. Activation by thimerosal was insensitive to reduced external calcium and to Ca channel blockers. Sperm [Ca(2+)](i) increased upon incubation in high-pH or thimerosal-containing seawater, but only the high-pH-dependent elevation in [Ca(2+)](i) could be inhibited by pimozide or penfluridol. Treatment with the protonophore CCCP indicated that only a small percentage of sperm could release enough Ca(2+) from mitochondria to cause activation. Inositol 1,4,5-trisphosphate (IP(3)) delivered by liposomes or by permeabilization increased sperm activation. Both of these effects were blocked by heparin. We conclude that high external pH induces intracellular alkalization that directly or indirectly activates plasma membrane voltage-dependent Ca channels allowing entry of external Ca(2+) and that thimerosal stimulates release of Ca(2+) from IP(3)-sensitive intracellular stores.

Expression of a Conserved Family of Cytoplasmic Low Molecular Weight Heat Shock Proteins during Heat Stress and Recovery.

Plants synthesize several families of low molecular weight (LMW) heat shock proteins (HSPs) in response to elevated temperatures. We have characterized two cDNAs, HSP18.1 and HSP17.9, that encode members of the class I family of LMW HSPs from pea (Pisum sativum). In addition, we investigated the expression of these HSPs at the mRNA and protein levels during heat stress and recovery. HSP18.1 and HSP17.9 are 82.1% identical at the amino acid level and are 80.8 to 92.9% identical to class I LMW HSPs of other angiosperms. Heat stress experiments were performed using intact seedlings subjected to a gradual temperature increase and held at a maximum temperature of 30 to 42 degrees Celsius for 4 hours. HSP18.1 and HSP17.9 mRNA levels peaked at the beginning of the maximum temperature period and declined rapidly after the stress period. Antiserum against a HSP18.1 fusion protein recognized both HSP18.1 and HSP17.9 but not members of other families of LMW HSPs. The accumulation of HSP18.1-immunodetected protein was proportional to the severity of the heat stress, and the protein had a half-life of 37.7 +/- 8 hours. The long half-life of these proteins supports the hypothesis that they are involved in establishing thermotolerance.

Accumulation, stability, and localization of a major chloroplast heat-shock protein.

Diverse higher plant species synthesize low molecular weight (LMW) heat shock proteins (HSPs) which localize to chloroplasts. These proteins are homologous to LMW HSPs found in the cytoplasm of all eukaryotes, a class of HSPs whose molecular mode of action is not understood. To obtain basic information concerning the role of chloroplast HSPs, we examined the accumulation, stability, tissue specificity, and intra-chloroplast localization of HSP21, the major LMW chloroplast HSP in pea. Intact pea plants were subjected to heat stress conditions which would be encountered in the natural environment and HSP21 mRNA and protein levels were measured in leaves and roots. HSP21 was not detected in leaves or roots before stress, but the mature, 21-kD protein accumulated in direct proportion to temperature and HSP21 mRNA levels in both tissues. All of the HSP21 in leaves was localized to chloroplasts; there was no evidence for its transport into other organelles. In chloroplast fractionation experiments, greater than 80% of HSP21 was recovered in the soluble chloroplast protein fraction. The half-life of HSP21 at control temperatures was 52 +/- 12 h, suggesting the protein's function is critical during recovery as well as during stress. We hypothesize that HSP21 functions in a catalytic fashion in both photosynthetic and nonphotosynthetic plastids.

Development of a quality assurance tool for critical care.

Current conditions in the health care arena demand that nurses be held accountable for the quality of nursing care delivered. Nursing administrators today face multiple challenges which include incorporating the expanding role of the nurse, dealing with financial constraints, and meeting the demands of an increasingly informed public. These factors combine to emphasize the need to examine the quality of care delivered and to identify and promote effective nursing care behaviours. The use of a quality assurance tool can be invaluable in revealing areas of both excellence and weakness in the care of clients, as well as providing a solid foundation for change. This paper will follow the authors through the development and implementation of a unit-specific quality assurance tool for a critical care area. We begin with a brief review of the literature and explore the factors relevant to our decision to choose a concurrent chart audit as our tool. We then describe the discovery of standards, the design of the tool itself, and follow the process of testing, approval and implementation of the tool for use in our institution. Finally, we explain the methods used to introduce the tool to staff and elicit their support to monitor and thus improve the quality of nursing care delivered.