Högskolan i Skövde

Background: Sterile water injections have been demonstrated to effectively manage back pain experienced during labour with no side effects other than the administration pain. Abdominal labour pain differs to back pain in location and likely physiological derivation. It is not known if sterile water injections would be efficacious in the relief of abdominal labour contraction pain.

Objective: To assess the efficacy of sterile water injections to reduce abdominal labour contraction pain. Design: A two-arm superiority randomised placebo-controlled trial. Setting: A referral maternity hospital in Brisbane, Australia. Participants: Women in spontaneous or induced labour at term requesting analgesia.

Methods: Between April 2022 and November 2023 consenting participants were assigned (1:1) by an independently generated randomisation schedule to injections of either sterile water or saline placebo. The primary outcome was the difference between groups in self-reported visual analogue pain score at 30 min following allocated treatment. Secondary outcomes included use of pharmacologic analgesia following allocation. Analysis was by intention to treat.

Results: 160 women were randomised to sterile water injections (n = 81) or injections of saline placebo (n = 79). Seven participants withdrew prior to treatment. Primary outcome data was provided by 68 women (intervention) and 64 (placebo). The mean visual analogue scores at 30 min were: intervention: 52.13 mm (with 100 mm indicating worst conceivable pain) and placebo: 71.14 mm; mean difference: − 19.00 mm (95 % Confidence interval (CI) − 26.10 to − 11.91). Pain scores in the secondary repeated measures model at 60 min post treatment were (61.28 mm vs.76.15 mm) − 14.84 (95 % CI − 22.23 to − 7.46). There was no difference in pain scores at 90 min, use of other pharmacological analgesia, or maternal or neonatal outcomes.

Conclusion: Sterile water injections provided a statistically significant reduction in pain when compared to a placebo for up to 60 min following treatment. However, the use of other pharmacological analgesia such as epidural did not differ between groups.

Trial registration: The trial is registered at the Australian and New Zealand Clinical Trials Registry (Trial ID: ACTRN12621001036808). Registration date 5/08/2021. First recruitment 29th April 2022.

This study aimed to investigate common features and ways of understanding quality culture (QC) within higher education institutions (HEIs) in Nordic countries. While the concept of QC is commonly accepted and often used, its meaning is not always clear. This paper focuses on how Nordic universities frame QC in their internal documentation. The Nordic context was chosen due to the close cooperation on quality issues that characterise HEIs within the Nordic region. The discussion section of this paper outlines QC in relation to quality assurance (QA) among HEIs within the European and Nordic regions. Sixteen universities participated in the study by sharing documents describing their QCs. The data were analysed using qualitative content analysis and discussed from different perspectives, such as regarding how the universities use the concept of QC and how QC is created. Based on the results, a model was created that provides an overview of how QC emerges and how the concept is implemented in documentation. It is hoped that the results will both contribute useful input to the ongoing collaboration on quality issues among HEIs in the Nordic region and will also be useful in enhancing QC at universities in other regions.

Background: Antepartum hemorrhage (APH) is an obstetric emergency that complicates pregnancy worldwide and continues to lead to hemorrhagic conditions in parts of Tanzania. Midwifery education received by midwives consists theoretical knowledge on the subject but with no or minimal practical skills in the laboratory, which may reduce their practical capacity as graduated midwives. This study therefore aimed to explore midwives’ clinical actions and experiences regarding the care of women with APH in Mwanza region.

Method: Qualitative, inductive approach with critical incident technique was used. Data were analysed using the critical incident technique, and a question guide consisting of eleven open-ended questions was used to collect data from 44 out of 60 midwives who graduated not less than one year. A total of 522 critical incidents, with 199 actions and 323 experiences, were identified and categorized into five main areas. Ethical approval was obtained.

Results: Midwives’ clinical actions and experiences in caring for women with APH are affected by the knowledge and skills obtained during training at school. They have insufficient theoretical knowledge and practical skills, leading to inadequate identification of the problem and the implementation of care. A need for additional preventive care is described and structural issues, such as co-operation, referral to other instances, access to equipment and relevant treatments need to be improved.

Conclusion: The actions taken to provide care for women with APH were related to their ability to identify problems, implement care and carry out structural initiatives. However, the midwives’ experience was influenced by an attempt to understand the seriousness of the situation and the existence of an organizational challenge. The results can provide knowledge and tools to improve midwives’ education and clinical practice and in the long run, prevent complications, improves health and minimize suffering in women with APH.

Background

Recent trials demonstrated the safety and efficacy of sterile water injections to provide relief from labour back pain. While four injections is the most common approach variations in technique, such as employing two injections, are also used.

Aim

To determine if the analgesic effect of two sterile water injections is clinically equivalent to four.

Methods

238 women in labour with a Visual Analogue Scale pain score (VAS) of 70 millimetres (mm) (0 = no pain; 100 = worst pain imaginable) were randomised to two or four sterile water injections. The primary outcome was pain measured on a VAS at 30 min post treatment. A priori margin of equivalence was set at ±10 mm. Secondary outcomes included the likelihood of achieving an at least 30% and 50% reduction in pain, birth and neonatal outcomes.

Results

At 30 min post-injection the difference in VAS scores between the techniques was −5.97 (95% Confidence Interval [CI] −13.18–1.22). As the lower end of the CI exceeds the margin of −10 mm equivalence was not demonstrated. Both techniques achieved an at least 30% reduction in pain in over 75% of participants though duration of effect was longer in the four injection group. There was no difference in other birth related secondary outcomes.

Conclusion

Four injections provided a margin of benefit over two injections in level and duration of analgesia.DiscussionFour injections remains the technique of choice though two injections still provided significant pain relief and would be suitable where it was not possible or desirable to provide four.

Background

Sterile water injections can provide effective pain relief during childbirth, particularly for low back pain related to childbirth. However, the pain associated administering the injections can negatively impact women’s impressions of the procedure. It may discourage women from considering repeat doses despite the quality of analgesia experienced. Determining strategies to reduce the pain related to the administration of sterile water injections would improve the acceptability of the technique. Therefore, the aim of this study was to evaluate the effect of topical local anesthesia on the pain associated with administration of sterile water injections.

Methods

The study was designed as a multi-arm single-blind, randomized, controlled trial and 120 female healthy students were randomly divided according to one of four groups. The Intervention group received sterile water injections with topical local anesthesia. Control group 1 received sterile water injections without topical local anesthesia, control group 2 received injections of isotonic saline 0.9% with topical local anesthesia and control group 3 received injections of isotonic saline 0.9% without topical local anesthesia. Pain Immediately after the injections and subsidence in pain were recorded using a visual analogue scale. Sensations in the injection area were reported 15 min and the day after the injections.

Results

The main finding of this study was that local anesthesia with EMLA® reduces the pain associated with the administration of intracutaneous sterile water injections. There was a significant difference in the self-assessed pain score immediately following the injections between the control (73.3 mm) and intervention groups (50.0 mm), p = 0.001. No adverse side effects were reported.

Conclusion

Local anesthesia with EMLA® reduces the pain associated with intracutaneous administration of sterile water injections.

Background

In today's society, people are experiencing the rapid development of digitalisation. Expecting parents may have difficulties evaluating the information online; they are not always sure which sources of information are trustworthy, and this exacerbates their feelings of anxiety. More research is needed to broaden the knowledge about how their use of digital sources may influence their health.

Question

The focus of this study was to explore expecting parents’ use of digital sources and how this influences their health during pregnancy.

Methods

A systematic review covered the thematic analysis of 39 articles.

Findings

The analysis resulted in the following theme: The digitalised society involves both opportunities and challenges, and expecting parents express a need for a variety of digital sources to improve their health, and sub-themes: Digital sources could promote parents’ health and well-being in a digitalised society; Consuming digital health information facilitates understanding, different feelings and social connections; and A variety of digital sources may facilitate parental identification and adaption to parenthood.

Conclusion

Different digital sources in our digitalised society mean access to information and opportunities to extend social connections for expecting parents. This can promote their ability to understand and adapt to parenthood, as well as to improve their health and well-being and make the parental transition. However, professional support during face-to-face consultations cannot always be exchanged to digital sources. It is important to base digital sources devoted to expecting parents and digitalisation overall on multi-sectorial collaborations and coordination between different organisations and the digital sources they provide.

Background

Since the 1950s a small number of centres have used sterile water injections (SWI) to treat renal colic pain. We undertook this review to determine the efficacy of SWI to manage the pain of renal colic.

Methods

We searched the electronic databases PubMed, Cochrane Central Register, CINAHL, and Scopus from database inception to 7 November 2021 for randomized controlled trials that met the inclusion criteria.

Results

Six trials were included in the review (n = 894 patients). Two placebo controlled trials were included in the meta-analysis. Other trials compared SWI to Diclofenac, Morphine, or oral Paracetamol. The overall quality of the trial was low. Compared to a placebo SWI demonstrated a significant reduction in self-reported pain at 30 min (Mean difference [MD] = −4.68, 95% Confidence Interval [CI] = −5.21, −4.15. p < 0.001, I2 = 0%) and at or beyond 60 min post-injection (MD = −5.34 95% CI = −5.85, −4.82, p ≤ 0.001, I2 = 0%). Pain relief provided by SWI was significantly better than oral paracetamol and equivalent to Diclofenac and Morphine. No significant side-effects were attributed to SWI use in any trials.

Discussion/conclusion

SWI could be a suitable alternative for management of renal colic pain where alternatives such as non-steroidal anti-inflammatory and opioid drugs are either unavailable or contraindicated. However, further research is required to establish the role of SWI in renal colic pain management.

Background: Up to 80% of women use some form of pharmacological analgesia during labour and birth. The side effects of pharmacological agents are often incompatible with the concurrent use of non-pharmacological pain-relieving strategies, such as water immersion, ambulation and upright positioning, or may have negative effects on both the mother and foetus. Sterile water injections given into the skin of the lumbar region have been demonstrated to reduce back pain during labour. However, the injections given for back pain have no effect on abdominal contraction pain. The analgesic efficacy of sterile water injections for abdominal pain during childbirth is unknown. The injections cause an immediate, brief but significant pain that deters some women from using the procedure. This study aims to investigate the use of water injections given intradermally into the abdomen to relieve labour contraction pain. A vapocoolant spray will be applied to the skin immediately prior to the injections to reduce the injection pain. Methods: In this pragmatic, placebo-controlled trial, 154 low-risk women in labour at term with a labour pain score ≥ 60 on a 100-ml visual analogue scale (VAS) will be randomly allocated to receive either six injections of sterile water or a sodium chloride 0.9% solution as a placebo (0.1–0.3 ml per injection). Three injections are given along the midline from the fundus to the supra-pubis and three laterally across the supra-pubis. The primary outcome will be the difference in VAS score 30 min post-injection between the groups. Secondary outcomes include VAS score of the injection pain on administration, VAS score of labour pain at 60 and 90 min and maternal and neonatal birth outcomes. Discussion: Access to effective pain relief during labour is fundamental to respectful and safe maternity care. Pharmacological analgesics should support rather than limit other non-pharmacological strategies. Sterile water injections have the potential to provide an alternative form of labour pain relief that is easy to administer in any labour and birth setting and is compatible with other non-pharmacological choices. Trial registration: ANZCTR ACTRN12621001036808. Registered on 05 August 2021.