Susan McDonald - Academia.edu (original) (raw)

Papers by Susan McDonald

Research in Sports Medicine, 2007

Maternal submaximal aerobic fitness (PWC170) was measured before, during, and after 12 weeks of s... more Maternal submaximal aerobic fitness (PWC170) was measured before, during, and after 12 weeks of swimming training during the second trimester of pregnancy in 23 sedentary women. For comparison, 11 women maintained their normal activities, but did not swim. Training sessions were 3 times per week for 40 min, producing heart rate (HR) responses of 65%-70% of estimated maximum HR and increases in rectal temperature (n = 8) of approximately 0.4 degrees C. Distance swum per session almost doubled over the training period (581 +/- 177 m to 1110 +/- 263 m). PWC170 of the nonswimming group remained stable over time; that of the swimming group increased significantly by 13.8% after 8 weeks of training (790 +/- 145 to 909 +/- 137 kpm/min; p = 0.026). The results indicate that a significant aerobic training effect can be achieved by light-moderate-intensity swimming during pregnancy in previously sedentary women. Further, all women remained healthy, with no adverse outcomes for mother or baby.

In order to minimize risks to data quality associated with respondent burden and fatigue, the mar... more In order to minimize risks to data quality associated with respondent burden and fatigue, the market research industry has become increasingly concerned about balancing survey scope/value and length. Inspired by these concerns, a commercial market research company has applied meta-analytic techniques to provide empirical guidance in improving the efficiency of concept evaluation research. In the present research, we meta-analytically examine relationships among metrics that are commonly included in concept testing research (i.e. ratings of how "compelling", "credible", and "unique" the concept is) in order to understand whether these concepts (a) measure independent constructs and (b) predict the likelihood of a customer to act (i.e. seek additional information or purchase a product/service). Results based on the data from 10 independent studies across three industries (Healthcare, Information Technology, and Transportation) suggest that (1) ratings of "compelling," "credible", and "unique" are correlated with one another, and thus that (2) use of all three metrics as predictors of "likely to take action" nets little incremental gain in predictive validity over the most correlated metric as a single predictor (i.e., compelling). Taken together, these findings indicate that it is possible to limit the number of dimensions on which new concepts are evaluated without sacrificing significant decision-making support.

To determine whether undertaking a swimming program in sedentary women during pregnancy would imp... more To determine whether undertaking a swimming program in sedentary women during pregnancy would improve maternal fitness without adverse fetal consequences. Prospective observational investigation of healthy sedentary pregnant women participating in a monitored swimming program. Twenty-three women attended swimming sessions from 16 to 28 weeks of gestation resulting in increasing distances swum and improved aerobic fitness as measured by physical work capacity (PWC170) (p = 0.003). Resting maternal heart rate decreased (p = 0.041) and resting systolic (p = 0.092) and diastolic (p = 0.971) blood pressures remained unchanged over gestation. The mean fetal heart rates decreased with advancing gestational age (p = 0.001), consistent with normal physiology. Non-stress tests and umbilical artery systolic/diastolic ratios were similar before and after swimming sessions, providing evidence that fetal well-being was unchanged. A structured swimming program in sedentary pregnant women increases maternal fitness without any alteration in maternal and fetal well-being.

The Journal of the American Society of Anesthesiologists, Apr 1, 1999

Ropivacaine is a newly introduced local anesthetic that may be a useful alternative to low-dose b... more Ropivacaine is a newly introduced local anesthetic that may be a useful alternative to low-dose bupivacaine for outpatient spinal anesthesia. However, its relative potency to bupivacaine and its dose-response characteristics are unknown. This double-blind, randomized, crossover study was designed to determine relative potencies of low-dose hyperbaric spinal ropivacaine and bupivacaine and to assess the suitability of spinal ropivacaine for outpatient anesthesia. Eighteen healthy volunteers were randomized into three equal groups to receive one spinal administration with bupivacaine and a second with ropivacaine, of equal-milligram doses (4, 8, or 12 mg) of 0.25% drug with 5% dextrose. The duration of blockade was assessed with (1) pinprick, (2) transcutaneous electrical stimulation, (3) tolerance to high tourniquet, (4) electromyography and isometric force dynamometry, and (5) achievement of discharge criteria. Differences between ropivacaine and bupivacaine were assessed with linear and multiple regression. P < 0.05 was considered significant. Ropivacaine and bupivacaine provided dose-dependent prolongation of sensory and motor block and time until achievement of discharge criteria (R2 ranges from 0.33-0.99; P values from < 0.001 through 0.01). Spinal anesthesia with ropivacaine was significantly different from bupivacaine and was approximately half as potent for all criteria studied. A high incidence of back pain (28%; P = 0.098) was noted after intrathecal ropivacaine was given. Ropivacaine is half as potent and in equipotent doses has a similar profile to bupivacaine with a higher incidence of side effects. Low-dose hyperbaric spinal ropivacaine does not appear to offer an advantage over bupivacaine for use in outpatient anesthesia.

Flu vaccination in pregnancy = 3 for 1 benefits. Good for:

NIDA research monograph

Pharmacologic Effects of Methamphetamine Vapor Inhalation (Smoking) in Man Mario Perez-Reyes, Rei... more Pharmacologic Effects of Methamphetamine Vapor Inhalation (Smoking) in Man Mario Perez-Reyes, Reid White, Susan McDonald, Judy Hill, Robert Jeffcoat, and C. Edgar Cook The popularity of methamphetamine (ice) smoking is rapidly increasing. To investigate the ...

International Journal of Childbirth, 2011

ABSTRACT The Education Standing Committee (ESC) supports the International Confederation of Midwi... more ABSTRACT The Education Standing Committee (ESC) supports the International Confederation of Midwives (ICM) in defining and safeguarding its educational requirements at global, regional, and national levels. Begun in 2005, it was reestablished and expanded at the 28th ICM Triennial Congress in Glasgow, Scotland, 2008. Currently, the committee consist of three cochairs: Prof. Dr. Mary Barger (Americas/Africa), Prof. Dr. Susan McDonald (Asia Pacific), and Prof. Dr. Ans Luyben (Europe), and 26 other members covering the ICM regions.ESC member work takes place within several categories, including strategic planning, program planning, networking, initial midwifery education/higher education, ICM competencies and standards of practice and education, practice and placements, development and transfer/exchange of students, and safe motherhood educational issues. Midwifery educators communicate through the Education Network (midwifery-reprohealtheducation@jiscmail.ac.uk).Current activities include contributing to the development of the Global Standards for Midwifery Education, contributing to the World Health Organization (WHO) Multidisciplinary Patient Safety Curriculum, and preparing workshops for the 2011 ICM conference in Durban, South Africa.

BMC Pregnancy and Childbirth, 2015

Background: A Melbourne (Australia) university affiliated, tertiary obstetric hospital provides l... more Background: A Melbourne (Australia) university affiliated, tertiary obstetric hospital provides lay and professional education about influenza vaccine in pregnancy annually each March, early in the local influenza season. Responding to a 2011 survey of new mothers' opinions, the hospital made influenza vaccine freely available in antenatal clinics from 2012. We wished to determine influenza vaccination uptake during pregnancy with these strategies 5 years after 2009 H1N1. Methods: Face to face interviews based on US Center for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System with new mothers in postnatal wards each July, 2010 to 2014. We calculated recalled influenza vaccine uptake each year and assessed trends with chi square tests, and logistic regression.

Research in Sports Medicine, 2007

Maternal submaximal aerobic fitness (PWC170) was measured before, during, and after 12 weeks of s... more Maternal submaximal aerobic fitness (PWC170) was measured before, during, and after 12 weeks of swimming training during the second trimester of pregnancy in 23 sedentary women. For comparison, 11 women maintained their normal activities, but did not swim. Training sessions were 3 times per week for 40 min, producing heart rate (HR) responses of 65%-70% of estimated maximum HR and increases in rectal temperature (n = 8) of approximately 0.4 degrees C. Distance swum per session almost doubled over the training period (581 +/- 177 m to 1110 +/- 263 m). PWC170 of the nonswimming group remained stable over time; that of the swimming group increased significantly by 13.8% after 8 weeks of training (790 +/- 145 to 909 +/- 137 kpm/min; p = 0.026). The results indicate that a significant aerobic training effect can be achieved by light-moderate-intensity swimming during pregnancy in previously sedentary women. Further, all women remained healthy, with no adverse outcomes for mother or baby.

Pharmacology Biochemistry and Behavior, 1991

Six healthy male, paid volunteers smoked one NIDA cigarette containing 1.0% THC each day for 13 c... more Six healthy male, paid volunteers smoked one NIDA cigarette containing 1.0% THC each day for 13 consecutive days. They were tested before and after the period of drug administration by the following procedure: the subjects smoked one NIDA marijuana cigarette containing 1.0% THC followed 15 minutes later by the intravenous infusion of 52 micrograms/min of deuterated THC for 50 minutes. The THC plasma concentrations, ratings of "high" and heart rate effects produced by the combined drug administration were measured, and absolute bioavailability of smoked THC was calculated on Days 1 and 22. Statistical analyses indicate that the only significant changes induced by daily marijuana exposure were in cardioacceleration.

Pediatric Critical Care Medicine, 2006

Pediatric Anesthesia, 2007

Background: The Multidimensional Assessment Pain Scale (MAPS), was developed to measure postopera... more Background: The Multidimensional Assessment Pain Scale (MAPS), was developed to measure postoperative pain in critically ill preverbal children. Following preliminary psychometric testing, additional validation of this 5-category 10-point scale was required. This article reports the results of a follow-up validation study that aimed to evaluate the clinical validity and utility of the MAPS. Methods: The MAPS includes five categories and was tested in response to analgesics in a convenience sample of 19 postoperative critically ill children (94% intubated) aged between 0 and 31 months at a tertiary referral hospital in Western Australia. Convergent and concurrent validity was tested using the MAPS, Faces Legs Activity Cry Consolability (FLACC), and Visual Analog Scale observer (VAS obs) . Clinical utility of the MAPS was also evaluated. Results: The Multidimensional Assessment Pain Scale scores decreased significantly by four points (40% of total score) after the administration of a potent dose of morphine (P < 0.001). Agreement measurements between MAPS and FLACC and MAPS and VAS obs showed that the risk of measurement error was small. Internal consistency of the MAPS would improve if the physiologic item was deleted (Cronbach's a 0.79-0.64). However, the actual values of heart rate, systolic, mean, and diastolic arterial pressure were shown to decrease significantly (7-14% decrease) at 15, 30, and 60 min after a potent bolus of morphine (P < 0.001). The MAPS also demonstrated clinical feasibility. Conclusions: This study showed that 'MAPS like FLACC and VAS obs decreases similarly following rescue morphine. MAPS-revised can be recommended for clinical application.

Pediatric Anesthesia, 2007

Background: This study aimed to test the preliminary psychometric properties of the Multidimensio... more Background: This study aimed to test the preliminary psychometric properties of the Multidimensional Assessment Pain Scale (MAPS), a clinical instrument developed for assessing postoperative pain in critically ill preverbal children. Methods: The MAPS was developed using pain indicators observed in postoperative critically ill infants. Content validity was established by a panel of experts. The scale was tested for validity and reliability in 43 postoperative children aged 0-31 months admitted to the pediatric intensive care units of two tertiary referral hospitals. Pain was measured concurrently by three independent assessors using the MAPS, the Face, Leg, Activity, Cry, and Consolability scale (FLACC) and the Visual Analog Scale (VAS) to assess concurrent and convergent validity. Results: Internal consistency was moderate (r ¼ 0.68). Interrater reliability of the MAPS was good (j: 0.68-0.84) for all categories and moderate for breathing pattern (j ¼ 0.54). Excellent interrater reliability was shown for total MAPS (intraclass correlation 0.91). Agreement measurements between MAPS and FLACC, and MAPS and VAS showed that the risk of measurement error was small. Conclusion: Although initial psychometric testing of the MAPS shows promising results, the tool requires further psychometric testing, including responsiveness to analgesic effect (currently in progress).

Life Sciences, 1991

ABSTRACT To investigate whether the nonsteroidal anti-inflammatory drug (NSAID) indomethacin anta... more ABSTRACT To investigate whether the nonsteroidal anti-inflammatory drug (NSAID) indomethacin antagonized the effects of marihuana, an exploratory single-blind, placebo-controlled study was conducted. Subjects (n = 4) smoked marihuana after pre-treatment with placebo and indomethacin. The subjective rating of marihuana &quot;high&quot;, heart rate, word recall, time estimation/production, and plasma concentrations of THC and PGE2 were measured. It was found that: 1) indomethacin pre-treatment decreased the elevation of prostaglandins induced by THC; 2) indomethacin significantly attenuated the subjective &quot;high&quot; and the heart rate accelerating effects of THC, although the magnitude of this effect was modest; 3) indomethacin abolished the profound effect of THC on time estimation and production; and 4) indomethacin pretreatment did not affect the decremental effects of THC on word recall. We conclude that prostaglandins are involved in the neurophysiologic mechanisms that mediate some of the typical clinical effects of THC, particularly the distortion of time perception.

Life Sciences, 1991

Despite the increasing popularity of crystalline methamphetamine (&quot;ice&quot;) vapor ... more Despite the increasing popularity of crystalline methamphetamine (&quot;ice&quot;) vapor inhalation, no investigations have reported drug plasma concentrations and effects. Under controlled laboratory conditions, six subjects were studied. Plasma concentrations of methamphetamine were determined, and subjective and cardiovascular effects were measured. Methamphetamine appeared in plasma rapidly, increased slowly over the next four hours and then progressively declined. The dose of methamphetamine administered produced modest ratings of subjective drug effects, and moderate changes in cardiovascular parameters. Both subjective and cardiovascular effects rapidly decreased despite the presence of sustained concentrations of methamphetamine in plasma.

Journal of Neonatal Nursing, 2014

ABSTRACT Introduction Sick and or preterm neonates who are admitted to the Neonatal Intensive Car... more ABSTRACT Introduction Sick and or preterm neonates who are admitted to the Neonatal Intensive Care Unit (NICU) frequently require inotropes and vasopressors which support the cardiovascular system to function adequately. There are many different clinical practices that nurses can adopt to perform inotrope and vasopressor infusion line and syringe changes, some of which have the theoretical potential to cause fluctuations in blood pressure. The purpose of this study was to identify current inotrope infusion line change practices in the neonatal intensive care population of Australia and New Zealand and examine what drives these current clinical practices. Methodology An observational, exploratory quantitative study was carried out in all 28 Australian and NICUs. An electronic survey tool was distributed to one member of each unit who responded on behalf of their clinical setting. Results The results showed that variation exists in the practice of inotrope and vasopressor line change practices across the 22 participating NICUs. The most popular method was the quick change method with 54.5% of Neonatal Intensive Care Units implementing this practice in their unit. The most frequently reported basis for current practice was literature (54.5%) followed by expert opinion (40.9%), previous clinical practices (36.4%) and multidisciplinary consensus (22.7%). Conclusion This study has identified areas requiring further research in order for a standard, safe and efficient practice to be implemented in the Neonatal Intensive Care Unit for these critically sick neonates.

Journal of Midwifery & Women's Health, 2007

Management of the third stage of labor has been an issue of discussion, concern, and continued de... more Management of the third stage of labor has been an issue of discussion, concern, and continued debate for the past two decades. Despite the many strategies employed and the divergent approaches to care and philosophies espoused, there has not been a significant, consistent reduction in the postpartum hemorrhage rates reported in industrialized countries in recent times. This article explores the strategies that have been and are currently being used in an effort to reduce the risk of postpartum hemorrhage.

Journal of Medical Economics, 2010

To use time trade-off (TTO) to compare patient preferences for profiles of two glucagon-like pept... more To use time trade-off (TTO) to compare patient preferences for profiles of two glucagon-like peptide (GLP-1) products for the treatment of type 2 diabetes (liraglutide and exenatide) that vary on four key attributes - efficacy (as measured by hemoglobin A(1C)), incidence of nausea, incidence of hypoglycemia, and dosing frequency (QD vs. BID) - and measure the contribution of those attributes to preferences. A total of 382 people with T2DM were recruited to participate in an internet-based survey consisting of a series of health-related questions, a conjoint exercise and a set of time trade-off items. In the conjoint exercise, respondents were presented with eight pairs of hypothetical GLP-1 profiles, and completed a time-tradeoff exercise for each pair. The product profile representing liraglutide was preferred by 96% of respondents and resulted in significantly higher health utilities (0.038) than the product profile representing exenatide (0.978 vs. 0.94, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Estimated preference scores from the conjoint analysis revealed that efficacy measured by hemoglobin A(1C) is the most important attribute, followed by nausea, hypoglycemia, and dosing schedule. On-line participants may not represent &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;typical&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; type 2 diabetes patients, and brief product profiles represented results from clinical trials, not clinical practice Based on the four attributes presented, patients prefer liraglutide over exenatide. Preference is based on superior efficacy and less nausea more than less hypoglycemia and once-daily dosing.

Journal of Cardiothoracic and Vascular Anesthesia, 2005

Objective: The purpose of this study was to investigate if the preoperative use of new platelet i... more Objective: The purpose of this study was to investigate if the preoperative use of new platelet inhibitors and lowmolecular-weight heparins may contribute to bleeding after cardiac surgery.

Emergency Medicine Journal, 2013

Applying the Australasian Triage Scale to pregnant women presenting to emergency departments (EDs... more Applying the Australasian Triage Scale to pregnant women presenting to emergency departments (EDs) is difficult as the descriptors may not reflect the urgency of the obstetric condition. This study aimed to examine whether condition-specific algorithms and triage education improved triage assessment and documentation of pregnant women presenting to the ED. Algorithms with a decision aid for triage with minimum agreed descriptors were developed to triage two pregnancy conditions (pre-eclampsia and antepartum haemorrhage). Triage documentation was then audited before (n=50) and after (n=50) a triage education programme which introduced algorithms for both conditions. Significant differences were examined using χ(2) test with significance set at p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05. The quality of documentation of specific clinically significant symptoms of pre-eclampsia improved considerably, including the presence of headache from 58% pre-education to 80% post-education (p=0.002), visual disturbances from 58% to 90% (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), epigastric pain from 24% to 80% (p=0.002) and the presence of fetal movements from 62% to 90% (p=0.001). Documentation of descriptors for vaginal bleeding &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;20 weeks gestation improved for estimation of blood loss from 54% to 86% (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), patient &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;appearance&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; from 32% to 62% (p=0.003) and, importantly, descriptions of patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s own assessment of their well-being from 8% to 28% (p=0.009). The introduction of triage education and condition-specific decision aids for triage markedly improved triage assessment and documentation. The application of algorithms may reduce clinical risk resulting from suboptimal triage of pregnant women presenting to EDs.

Research in Sports Medicine, 2007

Maternal submaximal aerobic fitness (PWC170) was measured before, during, and after 12 weeks of s... more Maternal submaximal aerobic fitness (PWC170) was measured before, during, and after 12 weeks of swimming training during the second trimester of pregnancy in 23 sedentary women. For comparison, 11 women maintained their normal activities, but did not swim. Training sessions were 3 times per week for 40 min, producing heart rate (HR) responses of 65%-70% of estimated maximum HR and increases in rectal temperature (n = 8) of approximately 0.4 degrees C. Distance swum per session almost doubled over the training period (581 +/- 177 m to 1110 +/- 263 m). PWC170 of the nonswimming group remained stable over time; that of the swimming group increased significantly by 13.8% after 8 weeks of training (790 +/- 145 to 909 +/- 137 kpm/min; p = 0.026). The results indicate that a significant aerobic training effect can be achieved by light-moderate-intensity swimming during pregnancy in previously sedentary women. Further, all women remained healthy, with no adverse outcomes for mother or baby.

In order to minimize risks to data quality associated with respondent burden and fatigue, the mar... more In order to minimize risks to data quality associated with respondent burden and fatigue, the market research industry has become increasingly concerned about balancing survey scope/value and length. Inspired by these concerns, a commercial market research company has applied meta-analytic techniques to provide empirical guidance in improving the efficiency of concept evaluation research. In the present research, we meta-analytically examine relationships among metrics that are commonly included in concept testing research (i.e. ratings of how "compelling", "credible", and "unique" the concept is) in order to understand whether these concepts (a) measure independent constructs and (b) predict the likelihood of a customer to act (i.e. seek additional information or purchase a product/service). Results based on the data from 10 independent studies across three industries (Healthcare, Information Technology, and Transportation) suggest that (1) ratings of "compelling," "credible", and "unique" are correlated with one another, and thus that (2) use of all three metrics as predictors of "likely to take action" nets little incremental gain in predictive validity over the most correlated metric as a single predictor (i.e., compelling). Taken together, these findings indicate that it is possible to limit the number of dimensions on which new concepts are evaluated without sacrificing significant decision-making support.

To determine whether undertaking a swimming program in sedentary women during pregnancy would imp... more To determine whether undertaking a swimming program in sedentary women during pregnancy would improve maternal fitness without adverse fetal consequences. Prospective observational investigation of healthy sedentary pregnant women participating in a monitored swimming program. Twenty-three women attended swimming sessions from 16 to 28 weeks of gestation resulting in increasing distances swum and improved aerobic fitness as measured by physical work capacity (PWC170) (p = 0.003). Resting maternal heart rate decreased (p = 0.041) and resting systolic (p = 0.092) and diastolic (p = 0.971) blood pressures remained unchanged over gestation. The mean fetal heart rates decreased with advancing gestational age (p = 0.001), consistent with normal physiology. Non-stress tests and umbilical artery systolic/diastolic ratios were similar before and after swimming sessions, providing evidence that fetal well-being was unchanged. A structured swimming program in sedentary pregnant women increases maternal fitness without any alteration in maternal and fetal well-being.

The Journal of the American Society of Anesthesiologists, Apr 1, 1999

Ropivacaine is a newly introduced local anesthetic that may be a useful alternative to low-dose b... more Ropivacaine is a newly introduced local anesthetic that may be a useful alternative to low-dose bupivacaine for outpatient spinal anesthesia. However, its relative potency to bupivacaine and its dose-response characteristics are unknown. This double-blind, randomized, crossover study was designed to determine relative potencies of low-dose hyperbaric spinal ropivacaine and bupivacaine and to assess the suitability of spinal ropivacaine for outpatient anesthesia. Eighteen healthy volunteers were randomized into three equal groups to receive one spinal administration with bupivacaine and a second with ropivacaine, of equal-milligram doses (4, 8, or 12 mg) of 0.25% drug with 5% dextrose. The duration of blockade was assessed with (1) pinprick, (2) transcutaneous electrical stimulation, (3) tolerance to high tourniquet, (4) electromyography and isometric force dynamometry, and (5) achievement of discharge criteria. Differences between ropivacaine and bupivacaine were assessed with linear and multiple regression. P &lt; 0.05 was considered significant. Ropivacaine and bupivacaine provided dose-dependent prolongation of sensory and motor block and time until achievement of discharge criteria (R2 ranges from 0.33-0.99; P values from &lt; 0.001 through 0.01). Spinal anesthesia with ropivacaine was significantly different from bupivacaine and was approximately half as potent for all criteria studied. A high incidence of back pain (28%; P = 0.098) was noted after intrathecal ropivacaine was given. Ropivacaine is half as potent and in equipotent doses has a similar profile to bupivacaine with a higher incidence of side effects. Low-dose hyperbaric spinal ropivacaine does not appear to offer an advantage over bupivacaine for use in outpatient anesthesia.

Flu vaccination in pregnancy = 3 for 1 benefits. Good for:

NIDA research monograph

Pharmacologic Effects of Methamphetamine Vapor Inhalation (Smoking) in Man Mario Perez-Reyes, Rei... more Pharmacologic Effects of Methamphetamine Vapor Inhalation (Smoking) in Man Mario Perez-Reyes, Reid White, Susan McDonald, Judy Hill, Robert Jeffcoat, and C. Edgar Cook The popularity of methamphetamine (ice) smoking is rapidly increasing. To investigate the ...

International Journal of Childbirth, 2011

ABSTRACT The Education Standing Committee (ESC) supports the International Confederation of Midwi... more ABSTRACT The Education Standing Committee (ESC) supports the International Confederation of Midwives (ICM) in defining and safeguarding its educational requirements at global, regional, and national levels. Begun in 2005, it was reestablished and expanded at the 28th ICM Triennial Congress in Glasgow, Scotland, 2008. Currently, the committee consist of three cochairs: Prof. Dr. Mary Barger (Americas/Africa), Prof. Dr. Susan McDonald (Asia Pacific), and Prof. Dr. Ans Luyben (Europe), and 26 other members covering the ICM regions.ESC member work takes place within several categories, including strategic planning, program planning, networking, initial midwifery education/higher education, ICM competencies and standards of practice and education, practice and placements, development and transfer/exchange of students, and safe motherhood educational issues. Midwifery educators communicate through the Education Network (midwifery-reprohealtheducation@jiscmail.ac.uk).Current activities include contributing to the development of the Global Standards for Midwifery Education, contributing to the World Health Organization (WHO) Multidisciplinary Patient Safety Curriculum, and preparing workshops for the 2011 ICM conference in Durban, South Africa.

BMC Pregnancy and Childbirth, 2015

Background: A Melbourne (Australia) university affiliated, tertiary obstetric hospital provides l... more Background: A Melbourne (Australia) university affiliated, tertiary obstetric hospital provides lay and professional education about influenza vaccine in pregnancy annually each March, early in the local influenza season. Responding to a 2011 survey of new mothers' opinions, the hospital made influenza vaccine freely available in antenatal clinics from 2012. We wished to determine influenza vaccination uptake during pregnancy with these strategies 5 years after 2009 H1N1. Methods: Face to face interviews based on US Center for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System with new mothers in postnatal wards each July, 2010 to 2014. We calculated recalled influenza vaccine uptake each year and assessed trends with chi square tests, and logistic regression.

Research in Sports Medicine, 2007

Maternal submaximal aerobic fitness (PWC170) was measured before, during, and after 12 weeks of s... more Maternal submaximal aerobic fitness (PWC170) was measured before, during, and after 12 weeks of swimming training during the second trimester of pregnancy in 23 sedentary women. For comparison, 11 women maintained their normal activities, but did not swim. Training sessions were 3 times per week for 40 min, producing heart rate (HR) responses of 65%-70% of estimated maximum HR and increases in rectal temperature (n = 8) of approximately 0.4 degrees C. Distance swum per session almost doubled over the training period (581 +/- 177 m to 1110 +/- 263 m). PWC170 of the nonswimming group remained stable over time; that of the swimming group increased significantly by 13.8% after 8 weeks of training (790 +/- 145 to 909 +/- 137 kpm/min; p = 0.026). The results indicate that a significant aerobic training effect can be achieved by light-moderate-intensity swimming during pregnancy in previously sedentary women. Further, all women remained healthy, with no adverse outcomes for mother or baby.

Pharmacology Biochemistry and Behavior, 1991

Six healthy male, paid volunteers smoked one NIDA cigarette containing 1.0% THC each day for 13 c... more Six healthy male, paid volunteers smoked one NIDA cigarette containing 1.0% THC each day for 13 consecutive days. They were tested before and after the period of drug administration by the following procedure: the subjects smoked one NIDA marijuana cigarette containing 1.0% THC followed 15 minutes later by the intravenous infusion of 52 micrograms/min of deuterated THC for 50 minutes. The THC plasma concentrations, ratings of &quot;high&quot; and heart rate effects produced by the combined drug administration were measured, and absolute bioavailability of smoked THC was calculated on Days 1 and 22. Statistical analyses indicate that the only significant changes induced by daily marijuana exposure were in cardioacceleration.

Pediatric Critical Care Medicine, 2006

Pediatric Anesthesia, 2007

Background: The Multidimensional Assessment Pain Scale (MAPS), was developed to measure postopera... more Background: The Multidimensional Assessment Pain Scale (MAPS), was developed to measure postoperative pain in critically ill preverbal children. Following preliminary psychometric testing, additional validation of this 5-category 10-point scale was required. This article reports the results of a follow-up validation study that aimed to evaluate the clinical validity and utility of the MAPS. Methods: The MAPS includes five categories and was tested in response to analgesics in a convenience sample of 19 postoperative critically ill children (94% intubated) aged between 0 and 31 months at a tertiary referral hospital in Western Australia. Convergent and concurrent validity was tested using the MAPS, Faces Legs Activity Cry Consolability (FLACC), and Visual Analog Scale observer (VAS obs) . Clinical utility of the MAPS was also evaluated. Results: The Multidimensional Assessment Pain Scale scores decreased significantly by four points (40% of total score) after the administration of a potent dose of morphine (P < 0.001). Agreement measurements between MAPS and FLACC and MAPS and VAS obs showed that the risk of measurement error was small. Internal consistency of the MAPS would improve if the physiologic item was deleted (Cronbach's a 0.79-0.64). However, the actual values of heart rate, systolic, mean, and diastolic arterial pressure were shown to decrease significantly (7-14% decrease) at 15, 30, and 60 min after a potent bolus of morphine (P < 0.001). The MAPS also demonstrated clinical feasibility. Conclusions: This study showed that 'MAPS like FLACC and VAS obs decreases similarly following rescue morphine. MAPS-revised can be recommended for clinical application.

Pediatric Anesthesia, 2007

Background: This study aimed to test the preliminary psychometric properties of the Multidimensio... more Background: This study aimed to test the preliminary psychometric properties of the Multidimensional Assessment Pain Scale (MAPS), a clinical instrument developed for assessing postoperative pain in critically ill preverbal children. Methods: The MAPS was developed using pain indicators observed in postoperative critically ill infants. Content validity was established by a panel of experts. The scale was tested for validity and reliability in 43 postoperative children aged 0-31 months admitted to the pediatric intensive care units of two tertiary referral hospitals. Pain was measured concurrently by three independent assessors using the MAPS, the Face, Leg, Activity, Cry, and Consolability scale (FLACC) and the Visual Analog Scale (VAS) to assess concurrent and convergent validity. Results: Internal consistency was moderate (r ¼ 0.68). Interrater reliability of the MAPS was good (j: 0.68-0.84) for all categories and moderate for breathing pattern (j ¼ 0.54). Excellent interrater reliability was shown for total MAPS (intraclass correlation 0.91). Agreement measurements between MAPS and FLACC, and MAPS and VAS showed that the risk of measurement error was small. Conclusion: Although initial psychometric testing of the MAPS shows promising results, the tool requires further psychometric testing, including responsiveness to analgesic effect (currently in progress).

Life Sciences, 1991

ABSTRACT To investigate whether the nonsteroidal anti-inflammatory drug (NSAID) indomethacin anta... more ABSTRACT To investigate whether the nonsteroidal anti-inflammatory drug (NSAID) indomethacin antagonized the effects of marihuana, an exploratory single-blind, placebo-controlled study was conducted. Subjects (n = 4) smoked marihuana after pre-treatment with placebo and indomethacin. The subjective rating of marihuana &quot;high&quot;, heart rate, word recall, time estimation/production, and plasma concentrations of THC and PGE2 were measured. It was found that: 1) indomethacin pre-treatment decreased the elevation of prostaglandins induced by THC; 2) indomethacin significantly attenuated the subjective &quot;high&quot; and the heart rate accelerating effects of THC, although the magnitude of this effect was modest; 3) indomethacin abolished the profound effect of THC on time estimation and production; and 4) indomethacin pretreatment did not affect the decremental effects of THC on word recall. We conclude that prostaglandins are involved in the neurophysiologic mechanisms that mediate some of the typical clinical effects of THC, particularly the distortion of time perception.

Life Sciences, 1991

Despite the increasing popularity of crystalline methamphetamine (&quot;ice&quot;) vapor ... more Despite the increasing popularity of crystalline methamphetamine (&quot;ice&quot;) vapor inhalation, no investigations have reported drug plasma concentrations and effects. Under controlled laboratory conditions, six subjects were studied. Plasma concentrations of methamphetamine were determined, and subjective and cardiovascular effects were measured. Methamphetamine appeared in plasma rapidly, increased slowly over the next four hours and then progressively declined. The dose of methamphetamine administered produced modest ratings of subjective drug effects, and moderate changes in cardiovascular parameters. Both subjective and cardiovascular effects rapidly decreased despite the presence of sustained concentrations of methamphetamine in plasma.

Journal of Neonatal Nursing, 2014

ABSTRACT Introduction Sick and or preterm neonates who are admitted to the Neonatal Intensive Car... more ABSTRACT Introduction Sick and or preterm neonates who are admitted to the Neonatal Intensive Care Unit (NICU) frequently require inotropes and vasopressors which support the cardiovascular system to function adequately. There are many different clinical practices that nurses can adopt to perform inotrope and vasopressor infusion line and syringe changes, some of which have the theoretical potential to cause fluctuations in blood pressure. The purpose of this study was to identify current inotrope infusion line change practices in the neonatal intensive care population of Australia and New Zealand and examine what drives these current clinical practices. Methodology An observational, exploratory quantitative study was carried out in all 28 Australian and NICUs. An electronic survey tool was distributed to one member of each unit who responded on behalf of their clinical setting. Results The results showed that variation exists in the practice of inotrope and vasopressor line change practices across the 22 participating NICUs. The most popular method was the quick change method with 54.5% of Neonatal Intensive Care Units implementing this practice in their unit. The most frequently reported basis for current practice was literature (54.5%) followed by expert opinion (40.9%), previous clinical practices (36.4%) and multidisciplinary consensus (22.7%). Conclusion This study has identified areas requiring further research in order for a standard, safe and efficient practice to be implemented in the Neonatal Intensive Care Unit for these critically sick neonates.

Journal of Midwifery & Women's Health, 2007

Management of the third stage of labor has been an issue of discussion, concern, and continued de... more Management of the third stage of labor has been an issue of discussion, concern, and continued debate for the past two decades. Despite the many strategies employed and the divergent approaches to care and philosophies espoused, there has not been a significant, consistent reduction in the postpartum hemorrhage rates reported in industrialized countries in recent times. This article explores the strategies that have been and are currently being used in an effort to reduce the risk of postpartum hemorrhage.

Journal of Medical Economics, 2010

To use time trade-off (TTO) to compare patient preferences for profiles of two glucagon-like pept... more To use time trade-off (TTO) to compare patient preferences for profiles of two glucagon-like peptide (GLP-1) products for the treatment of type 2 diabetes (liraglutide and exenatide) that vary on four key attributes - efficacy (as measured by hemoglobin A(1C)), incidence of nausea, incidence of hypoglycemia, and dosing frequency (QD vs. BID) - and measure the contribution of those attributes to preferences. A total of 382 people with T2DM were recruited to participate in an internet-based survey consisting of a series of health-related questions, a conjoint exercise and a set of time trade-off items. In the conjoint exercise, respondents were presented with eight pairs of hypothetical GLP-1 profiles, and completed a time-tradeoff exercise for each pair. The product profile representing liraglutide was preferred by 96% of respondents and resulted in significantly higher health utilities (0.038) than the product profile representing exenatide (0.978 vs. 0.94, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Estimated preference scores from the conjoint analysis revealed that efficacy measured by hemoglobin A(1C) is the most important attribute, followed by nausea, hypoglycemia, and dosing schedule. On-line participants may not represent &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;typical&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; type 2 diabetes patients, and brief product profiles represented results from clinical trials, not clinical practice Based on the four attributes presented, patients prefer liraglutide over exenatide. Preference is based on superior efficacy and less nausea more than less hypoglycemia and once-daily dosing.

Journal of Cardiothoracic and Vascular Anesthesia, 2005

Objective: The purpose of this study was to investigate if the preoperative use of new platelet i... more Objective: The purpose of this study was to investigate if the preoperative use of new platelet inhibitors and lowmolecular-weight heparins may contribute to bleeding after cardiac surgery.

Emergency Medicine Journal, 2013

Applying the Australasian Triage Scale to pregnant women presenting to emergency departments (EDs... more Applying the Australasian Triage Scale to pregnant women presenting to emergency departments (EDs) is difficult as the descriptors may not reflect the urgency of the obstetric condition. This study aimed to examine whether condition-specific algorithms and triage education improved triage assessment and documentation of pregnant women presenting to the ED. Algorithms with a decision aid for triage with minimum agreed descriptors were developed to triage two pregnancy conditions (pre-eclampsia and antepartum haemorrhage). Triage documentation was then audited before (n=50) and after (n=50) a triage education programme which introduced algorithms for both conditions. Significant differences were examined using χ(2) test with significance set at p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05. The quality of documentation of specific clinically significant symptoms of pre-eclampsia improved considerably, including the presence of headache from 58% pre-education to 80% post-education (p=0.002), visual disturbances from 58% to 90% (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), epigastric pain from 24% to 80% (p=0.002) and the presence of fetal movements from 62% to 90% (p=0.001). Documentation of descriptors for vaginal bleeding &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;20 weeks gestation improved for estimation of blood loss from 54% to 86% (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), patient &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;appearance&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; from 32% to 62% (p=0.003) and, importantly, descriptions of patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s own assessment of their well-being from 8% to 28% (p=0.009). The introduction of triage education and condition-specific decision aids for triage markedly improved triage assessment and documentation. The application of algorithms may reduce clinical risk resulting from suboptimal triage of pregnant women presenting to EDs.