Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy: The BUMP 1 Randomized Clinical Trial.

Importance: Inadequate management of elevated blood pressure (BP) is a significant contributing factor to maternal deaths. Self-monitoring of BP in the general population has been shown to improve the diagnosis and management of hypertension; however, little is known about its use in pregnancy. Objective: To determine whether self-monitoring of BP in higher-risk pregnancies leads to earlier detection of pregnancy hypertension. Design, Setting, and Participants: Unblinded, randomized clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. Final follow-up was completed in April 2020. Interventions: Participating individuals were randomized to either BP self-monitoring with telemonitoring (n = 1223) plus usual care or usual antenatal care alone (n = 1218) without access to telemonitored BP. Main Outcomes and Measures: The primary outcome was time to first recorded hypertension measured by a health care professional. Results: Among 2441 participants who were randomized (mean [SD] age, 33 [5.6] years; mean gestation, 20 [1.6] weeks), 2346 (96%) completed the trial. The time from randomization to clinic recording of hypertension was not significantly different between individuals in the self-monitoring group (mean [SD], 104.3 [32.6] days) vs in the usual care group (mean [SD], 106.2 [32.0] days) (mean difference, -1.6 days [95% CI, -8.1 to 4.9]; P = .64). Eighteen serious adverse events were reported during the trial with none judged as related to the intervention (12 [1%] in the self-monitoring group vs 6 [0.5%] in the usual care group). Conclusions and Relevance: Among pregnant individuals at higher risk of preeclampsia, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly earlier clinic-based detection of hypertension. Trial Registration: ClinicalTrials.gov Identifier: NCT03334149.

Current prevalence of self-monitoring of blood pressure during pregnancy: the BUMP Survey.

OBJECTIVE: To understand the current prevalence of, and attitudes to, self-monitoring of blood pressure (BP) during pregnancy. METHODS: Five thousand, five hundred and fifty-five pregnant women from antenatal clinics in 16 hospitals in England were invited to complete a survey. MAIN OUTCOME MEASURES: The primary outcome was the proportion of women currently BP self-monitoring. Secondary outcomes included self-monitoring schedules and women's interactions with clinicians regarding self-monitoring. Population characteristics including risk factors for preeclampsia, ethnicity and deprivation level were considered. RESULTS: Completed surveys were received and analysed from 5181 pregnant women (93% response rate). Comparison to hospital demographic data suggests that respondents were representative of the UK population. Nine hundred and eighty-three of 5181 (19%) women were currently self-monitoring their BP, constituting 189 of 389 (49%) hypertensive women and 794 of 4792 (17%) normotensive women. However, only 482 of 983 (49%) reported ever sharing this information with antenatal care teams. Of those who self-monitored, 68% (668/983) were able to provide a previous BP reading, compared with 1% (67/5181) of those who did not self-monitor. CONCLUSION: Many women are now choosing to self-monitor their BP during pregnancy and clinicians should enquire about this proactively and consider providing better information on BP monitoring. Those who self-monitor appear to have better knowledge about their blood pressure. If these findings were replicated nationwide, around 125 000 pregnant women would be currently self-monitoring BP in the UK, yet only half of these women may communicate their readings to their antenatal care teams, suggesting a missed opportunity for enhanced care. Current trials will make the place of self-monitoring in pregnancy clearer.

Trainee Therapists' Experiences of Supervision During Training: A Meta-synthesis.

PURPOSE: Supervision is typically mandatory for therapists in training and plays an important role in their professional development. A number of qualitative studies have considered specific aspects of supervision. This systematic review aimed to synthesize these studies' findings and explore the experience and impact of supervision for trainee therapists. METHODS: A systematic search of the literature was conducted, and inclusion/exclusion criteria were applied. This led to a sample of 15 qualitative studies, with which a meta-synthesis was conducted. RESULTS: The meta-synthesis led to four key concepts: supervision as a learning opportunity, the supervisory relationship, power in supervision and the impact of supervision. These themes explored helpful and unhelpful aspects of supervision, including some concerns regarding the evaluation of supervision. CONCLUSIONS: Supervision can effectively support trainee therapists in their personal and professional development. However, it can also lead to feelings of distress and self-doubt. Supervisors need to consider the power differential within supervision and attend to different factors within the supervisory relationship. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Supervision can encourage personal and professional development, but it can also have a detrimental impact on trainee therapists' well-being, and consequently their clinical work and clients' experiences. Supervisees may not disclose unhelpful events or impacts from supervision, for fear of negative evaluation. Evaluation of supervisors should be facilitated and encouraged, to maintain good practice.

A qualitative study of teachers' experiences of a school reintegration programme for young children following a burn injury.

School reintegration programmes provide support to both children absent from school as a result of a serious health problem and their teachers, but little is known regarding their efficacy, or the impact of the situation on teachers. This qualitative study explored the experience of primary school teachers who were involved in a school reintegration programme, following a burn injury to a child in their class. Data was collected using semi-structured interviews with four primary school teachers. Transcripts were analysed using interpretative phenomenological analysis. The findings indicated that participants were positive regarding the programme, but detailed aspects which could be improved, for example better communication before the child's return. They discussed their fears and concerns, including a strong need to protect the child from further harm. Implications of this study include the need to provide adequate support to teachers in similar positions, and further develop school reintegration programmes to best facilitate the child's return to school.