Pregnant women should receive information about what they might expect to experience during their delivery. Despite this, research shows many women are inadequately prepared for anaesthetic interventions during labour. We surveyed 903 postnatal women across 28 Greater London hospitals about: the analgesic and anaesthetic information that they recalled receiving during pregnancy and delivery; their confidence to make decisions on analgesia; and their satisfaction with the analgesia used. Wide variation was observed between hospitals. Overall, 67 of 749 (9.0%) women recalled receiving antenatal information covering all aspects of labour analgesia, and 108 of 889 (12.1%) covering anaesthesia for caesarean section. Regarding intrapartum information, 256 of 415 (61.7%) respondents recalled receiving thorough information before epidural insertion for labour analgesia, and 102 of 370 (27.6%) before anaesthesia for caesarean section. We found that 620 of 903 (68.7%) women felt well enough informed to be confident in their analgesic choices, and 675 of 903 (74.8%) stated that their analgesia was as expected or better. Receiving information verbally, regardless of provider, was the factor most strongly associated with respondents recalling receiving full information: odds ratio (95%CI) for labour analgesia 20. 66 (8.98-47.53; p < 0.0001); epidural top-up for caesarean section 5. 93 (1.57-22.35; p = 0.01); and general anaesthesia for caesarean section 12. 39 (2.18-70.42; p = 0.01). A large proportion of respondents did not recall being fully informed before an anaesthetic intervention. Collaboration with current antenatal service providers, both in promoting information delivery and providing resources to assist with delivery, could improve the quality of information offered and women's retention of that information.

Lowering blood pressure (BP) reduces the risk of major cardiovascular mortality and morbidity. Current consensus targets for BP reduction are less than 140/90 mm Hg in uncomplicated hypertension and less than 130/80 mm Hg in those patients with diabetes, chronic kidney disease, and coronary artery disease or in those who are at high risk for developing coronary artery disease (defined as a Framingham risk score of > or = 10%). There is solid epidemiologic evidence for lower BP targets, supported by some clinical studies with surrogate end points. On the other hand, there are meager data from clinical trials using hard end points, and there is a concern that overly aggressive BP lowering, especially of diastolic BP, may impair coronary perfusion, particularly in patients with left ventricular hypertrophy and/or coronary artery disease. This review evaluates the evidence for the benefit of lower BP targets in hypertension management.

No abstract

Small and Medium Enterprises play a significant role in economic well-being of a society, but unfortunately there is lack of proper structure and system for application of performance measurement in most of the SMEs. Hence, an inconsistency amongst the performance measures can be observed. The following paper focuses upon distinctive nature of small and medium business organizations (SMEs) and proposes a framework for effective performance measurement with respect to (SMEs). This research aims to provide such a framework for performance measurement that can ensure a balance between internal and external performance measures by introducing the concept of inclusive optimal performance (IOP) as a resultant of inclusive working between internal simultaneous performance (ISP) and external simultaneous performance (ESP). The need for inclusive strategic approach to internal and external performance factors has arrived primarily because of one sided competitiveness is produced due to exclusive strategic approach to inclusive and external performance factors of organization. In order to explore the legitimacy of the depicted argument the following research is based on concept review methodology of literature review through which this research assess the extensive literature with respect to performance measurement systems within SMEs. Through the integration of the psychology-oriented constructs of the internal and external locus of control theory, this research stem the inclusive nature and working of internal and external factors of performance analogy as a basis of the proposed framework that can be applied to ensure effective performance measurement at SMEs.