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Review questions for article : Tussey, C. M., Botsios, E., Gerkin, R. D., Kelly, L. A., Gamez, J., & Mensik, J. (2015). Reducing Length of Labor and Cesarean Surgery Rate Using a Peanut Ball for Women Laboring With an Epidural. The Journal Of Perinatal Education, 24(1), 16-24. doi:10.1891/1058-1243.24.1.16 In a study completed by Tussey, et al. (2015) laboring women who had received an epidural were randomized into two groups and compared. One group was given routine care while the experimental group was provided with a peanut shaped exercise ball. The ball was used to support maternal positioning that promoted spinal flexion, fetal head rotation and widening of the pelvic inlet, outlet and intertuberous diameter. Answer the following questions regarding this study. 1.) What was the purpose of the study? 2.) What are the outcome variables in this study? 3.) What level of measurement are the outcome variables? 4.) Look at table 1. Despite randomization there were significant differences in demographic characteristics noted between the control and experimental groups. Which characteristics had significant differences between the two groups? 5.) Look at table 2. Was there a significant difference in the average length of the second stage of labor between the two groups? How do you know? 6.) Look at table 2. Was there a significant difference in the number of cesarean sections between the two groups? How do you know? 7.) When looking at the differences in these outcome variables, length of the second stage of labor and mode of delivery, two different tests were used. Why? 8.) When offering the option of using a peanut shaped exercise ball to your patient her mother expresses a concern that this type of positioning might increase the risk of the baby being born with a nuchal cord. Use the results of table 2 to address this concern. 9.) The researchers report that parity (number of births) and cervical dilation were different between the two groups. Because these factors can impact the outcome variables and were not controlled for in the sample selection, what technique might you consider that would allow you to include the impact they may have on the outcome? 10.) Look at Table 3. The researchers decided to perform univariate analyses of each independent variable and each of the three outcome variables. Which independent variables were significantly associated with the risk of a cesarean delivery? 11.) Look at Table 4. The researchers included the independent variables that were significantly associated with the outcomes variables in the univariate analysis in their multiple regression analysis. They kept those with a p<0.05 in their final multivariate regression models. Controlling for the other independent variables, which independent variables were significantly associated with the length of the first stage of labor in the multivariate regression model? 12.) Look at table 4. Explain the beta coefficient for cervical dilation. 13.) Look at Table 4. When controlling for the other independent variables in the regression model, was the use of the peanut ball found to significantly impact the length of the first stage of labor? 14.) Look at Table 4. The researchers included the independent variables that were significantly associated with the outcomes variables in the univariate analysis in their multiple regression analysis. They kept those with a p<0.05 in their final multivariate regression models. Controlling for the other independent variables, which independent variables were significantly associated with the length of the second stage of labor in the multivariate regression model? 15.) If the finding about the relationship between using the peanut ball and the length of the first stage of labor was incorrect what type of error would it be? What would be the most likely cause of this type of error? 16.) The researcher discuss in their Power Analysis section that they estimated the effect size from the results of a small pilot study. If the impact of the use of a ball on the length of the first stage of labor was actually overestimated in the pilot study how would this impact the estimate of the effect size used by the researchers? How would the effect size they used impact the sample size selected. How might this impact the results? 17.) The researchers use a logistic regression model rather than a multivariate regression model to assess the delivery mode outcome? Why is this? 18.) Is the use of the ball significantly associated with the risk of a cesarean delivery? How do you know? 19.) Is the use of the ball a protective effect or risk factor for a cesarean section delivery? 20.) Using the ball was significantly associated with a decrease in the length of the second stage of labor. Though this outcome is usually a positive result, nurses should avoid using this intervention for what group of patients? 21.) Based on the results in this study what happened with this nurse lead intervention?

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