Tagged / midwifery

Two BU authored chapters in new book on childbirth

BU Ph.D. student and Consultant Midwife Kathryn Gutteridge and Hannah Dahlen Associate Professor of Midwifery at the University of Western Sydney contributed a chapter to the book ‘The Roar behind the Silence: Why kindness, compassion and respect matter in maternity care’.  Kathryn Gutteridge and Hannah Dahlen wrote under the title ‘Stop the fear and embrace birth’.  BU’s Dr. Jenny Hall also wrote a chapter called ‘Spirituality, compassion and maternity care’.

The  volume edited by Sheena Byrom and Soo Downe was published this week by Pinter & Martin (London).   I received my copy of the book yesterday, but didn’t have a chance to look at it until today.  The Roar Behind the Silence is both a practical and inspirational book, which likely to be of interest to people working in maternity care (midwives, doctors, managers), local and regional maternity-care policy-makers as well as politicians and funders and, of course, to many pregnant women and maternity-care pressure groups.  The book highlights examples of good practice, and offers practical tools for making change happen, advice on how to use evidence and real-life stories.

Prof. Edwin van Teijlingen

CMMPH

Huffington Post Blog BU by PhD student Sheetal Sharma

FHSS PhD student Sheetal Sharma and ICS Integrare’s Petra ten Hoope-Bender  discuss issues around the evidence to support the policy direction after the Millennium Development Goals come to end in 2015.  The global research and policy community has been gathering the evidence and the lessons learnt on what has worked for whom and how.  They remind us that the UN General Assembly’s Open Working Group has identified 17 new goals that cover far-reaching sustainable development issues, such as ending poverty and hunger, improving health and education, making cities more sustainable, combating climate change, and protecting oceans and forests.   Read all at:

http://www.huffingtonpost.com/petra-ten-hoopebender/women-newborns-and-health_b_6459614.html

 

Prof. Edwin van Teijlingen

CMMPH

Examination of the Newborn (EXON) Pilot Project for under-graduate student midwives: an update.

In November last year I published a blog on the first pilot project I undertook with five under-graduate pre-registration midwifery students which was designed to enable them to qualify with the skills and competencies around examination of the newborn (EXON). The students were required to access and study the module with post-graduate midwives. Four of the students successfully completed the course in September 2014 with one student leaving early on in the project due to unforeseen family circumstances. The journey to completion was not smooth. The first hurdle was a clash of assessments. The EXON assessment (a presentation) fell in the same week as Complex Care (CC), a third year unit assessment where students are required to undergo a VIVA and manage two obstetric emergencies. It is a stressful experience and therefore three of the students requested an extension to their EXON presentation with only one choosing to present with her post-registration colleagues. As the EXON assessment took place on the Monday of that particular week and Complex Care assessments were running over three days, the student managed to negotiate to undertake her CC assessment on the Friday. The three students were re-scheduled to present later in the year with a number of other midwives who were on extensions or resits.  One of the advantages of choosing to present in January 2014 was that the student was able to choose a topic that she could use both for her learning around EXON and for her extended essay which was due to be completed somewhat later in the academic year. The student was successful in both endeavours as were all the others but at a later date.

Another hurdle students found themselves confronted with, was a lack of opportunity to undertake newborn examinations including a shortage of midwifery mentors who could support the training requirements of the project. Two of the students could not get any of the examinations done in their own trusts. Fortunately for them, the maternity unit and midwifery staff at Poole NHS Trust Hospital were extremely obliging and supported the students to work there which enabled them to complete the practical newborn checks. All four of the students have successfully qualified as midwives and have obtained midwifery posts in the local area. They remain committed EXON and have volunteered to be EXON ‘champions’ within their respective trusts. I am grateful to Jeanette Elliot, Luzie Schroter, Jenna Penhale and Bex Coleman-Moss for their hard work and dedication during the pilot and for their feedback and advice for the next intake.

Demand for places for the second pilot project remained high when the call was put out a short while ago. Unfortunately due to some of the barriers described above it was only feasible to recruit five students again and all of them based in the west. The students have commenced their studies and are enjoying the learning so far. The pilot projects are helping to inform what impact these barriers will have on the training needs for midwifery students within our local maternity units as this year we are introducing EXON theory to all midwifery students on our newly validated curriculum with the caveat that students will obtain the necessary theoretical knowledge but not all with qualify with the required skills. However by ‘fast-tracking’ students onto one of our twice yearly CPD EXON modules which has around 20+ midwives enrolled, by the time the students reach their third year there should be many more midwives qualified in EXON and in place to support our under-graduate students to gain the competencies around newborn examination.  If you require any further information please contact Luisa Cescutti-Butler on lcbutler@bournemouth.ac.uk    

 

Congratulations to PhD student Carol Richardson on getting a paper in The Practising Midwife

 

CMMPH PhD student Carol Richardson just had a paper accepted by the editor of The Practising Midwife.  Carol is a Bournemouth University clinical academic doctoral midwife based in Portsmouth.  She is part of a scheme jointly funded by BU and Portsmouth Hospital NHS trust (PHT).

Carol is also a Supervisor of Midwives, and her first paper ‘Chasing time for reflection’ relates to midwifery supervision.

Professor Edwin van Teijlingen

Centre for Midwifery, Maternal & Perinatal Health
Bournemouth University

First issue Journal of Asian Midwives

CMMPH would like to take this opportunity to congratulate the newly established Journal of Asian Midwives on publishing its first issue.  Journal of Asian Midwives (JAM) is the first regional online midwifery journal launched by the South Asian Midwifery Alliance (SAMA).   Prof. Rafat Jan based in Pakistan at Aga Khan University’s School of Nursing and Midwifery is the lead editor.  JAM aims to give a voice to midwives, nurses-midwives, women’s health clinicians, and reproductive health professionals as well as social scientists.

CMMPH proudly announces that one of our Bournemouth University PhD students, Ms. Sheetal Sharma, is on the new journal’s Associate Board.  Sheetal’s research is on maternity care in Nepal.

The journal is Open Access and free.  JAM does not charge subscription fees so it is free for readers nor does it charge a submission fee so it is also free for authors!  The journal can be found at: http://ecommons.aku.edu/jam/

 

Edwin van Teijlingen & Vanora Hundley

CMMPH

Latest HSC Midwifery paper in Open Access

Our latest paper in Midwifery ‘Translation and validation of the German version of the Mother-Generated Index and its application during the postnatal period’ is now freely available through Open Access on the Midwifery (Elsevier) webpages.

 

The lead author Susanne Grylka-Baeschlin, together with my colleagues Kathrin Stoll and Mechthild M. Gross, secured funding from COST to make this paper Open Access. The paper was part of Susanne’s M.Sc. project at the Midwifery Research and Education Unit, Hannover Medical School, Germany.

 

We would like to thank the ISCH Cost Action ISO907 (Childbirth Cultures, Concerns, and Consequences: Creating a dynamic EU framework for optimal maternity care) for funding the Open Access.   COST (European Cooperation in Science & Technology) is one of the longest-running European frameworks supporting cooperation among scientists and researchers across Europe. For further information on COST in general see: www.cost.eu.   UCLan lead this particular COST Action and Prof. Soo Downe is the Chair of the Action (www.iresearch4birth.eu).

 

For my colleagues at Bournemouth University please, note there is also funding available for Open Access publishing within the university: http://blogs.bournemouth.ac.uk/research/2014/05/22/money-available-for-open-access-publishing/

 

 

Prof. Edwin van Teijlingen

CMMPH

Maternity, Midwifery & Baby Conference

A recent free Maternity, Midwifery & Baby Conference held in London offered an ideal opportunity for Bournemouth University to showcase two innovative projects. The first, co-presented by Dr. Sue Way and Sian Ridden, a 2nd year midwifery student, focused on a joint chiropractic and midwifery newborn clinic which was set up with Fusion principles in mind. There are a number of aims of the clinic, of which the main is to optimise women’s opportunities to breastfeed successfully by providing chiropractic care for babies and breastfeeding support and advice to mothers. There are two further important aims, one of which, is to enhance student (undergraduate midwifery students & chiropractic students) learning opportunities and secondly, to provide networking and collaborative opportunities for students and staff in relation to research and dissemination of findings around these particular topics. When it was Sian’s turn to present, she was confident and articulate. She discussed a case study and how her knowledge was enhanced by being part of the clinic. Sian found attending the clinics provided her with a great learning experience and it was empowering that she was able to provide breastfeeding support under the guidance of the experts in the respective fields (Alison Taylor and Dr. Joyce Miller). Preliminary breastfeeding results from the clinic are promising. More details to follow in due course. Finally the seminar concluded by discussing the re-launch of the clinic in September, and to raise awareness of the re-launch, a free local conference (funded by Fusion Funding) for the community will be taking place on the 12th July 2014. For further information on the above clinic or the conference please contact Alison Taylor on ataylor@bournemouth.ac.uk or Dr. Sue Way on sway@bournemouth.ac.uk .

 

The second seminar presentation took place after lunch and it focused on a study which is currently taking place involving five 3rd year midwifery students and the feasibility of incorporating newborn infant physical examination (NIPE) competencies into the pre-registration midwifery programme.  Traditionally these competencies are usually achieved post qualification when midwives have a number of years’ experience under their belt. However BU midwifery students felt differently and Luisa Cescutti-Butler discussed how the study was initiated by Luzie who asked the question: “why couldn’t they learn all the necessary skills in the third year of their programme”? Luzie took to the podium and presented her section like a duck to water. She didn’t shy away from the difficulties from taking this extra study on, but was quite clear that the benefits for women in her care were worth the extra work.  The presentation generated quite a lot of heated discussion with some midwives in the audience quite adamant that students should not be taking on this ‘extended’ skill. However Luzie was able to stand her ground and confidently counter ague as to why students should gain these skills during the undergraduate programme. She received a resounding clap and cheers from the audience.

It takes some courage to stand up in a room full of people and present, and Sian and Luzie were brilliant.  Both students did Bournemouth University and in particular the midwifery team proud. For further information on the above study please contact Luisa Cescutti-Butler on lcbutler@bournemouth.ac.uk

 

 

 

Successful BU Festival of Learning debate of media and fear in childbirth!

Yesterday saw the lively debate organised by Prof. Vanora Hundley on the motion: ‘The media is responsible for creating fear in childbirth.’

 

Elizabeth Duff from the NCT and HSC Prof. Edwin van Teijlingen affiliated with the Centre for Midwifery, Maternal & Perinatal Health and against the motion argued Joanne Dewberry (http://joannedewberry.co.uk/about-joanne/ ), independent blogger, journalist and successful business woman and Dr. Ann Luce from BU’s  Journalism and Communication Academic Group

The debate was part of BU’s Festival of Learning event to explore the role of the mass media in shaping such beliefs and identify whether media portrayals are responsible for rising rates of intervention.  The audience voted in favour of the motion, but the media team managed to get some people to reconsider their views on the impact of the mass media on women’s view of childbirth.

Professors Vanora Hundley and Edwin van Teijlingen

CMMPH

Strong CMMPH presence at ICM conference in Prague!

Dr. Carol Wilkins

In the first week of June members of the Centre for Midwifery, Maternal and Perinatal Health presented BU’s midwifery research and education at the 30th ICM (International Confederation of Midwives) Congress in Prague (Czech Republic).

There were four oral presentations in total, one workshop and three poster presentations.  The oral presentations comprised:

  1. Dr. Carol Wilkins (see picture) presented from her Ph.D. work ‘Emotional processing in childbirth study: exploration of the relationship between maternal emotions in pregnancy and risk of postnatal depression’.
  2. HSC Professor Vanora Hundley presented her international work on clean birth kits.
  3. Senior Lecturer in Midwifery Alison Taylor gave a paper under the titleLetting off steam! Video diaries to share breastfeeding experiences Her Ph.D. thesis research uses a novel approach of giving hand-held cameras to make home video diaries about their ‘realities’ of breastfeeding.
  4. HSC student Sheetal Sharma presented her Ph.D. research ‘Getting women to care: mixed–methods evaluation of maternity care intervention in rural Nepal’.

Dr Susan Way led a workshop on escalating concerns in relation to poor clinical practice and disrespectful care.

 

 

 

 

 

 

 

Furthermore, three HSC posters were displayed as part of a special session on Midwifery in South Asia, all three related to different CMMPH maternity care studies conducted in Nepal.

  1. Sharma, S.  Sicuri, E., Belizan, JM., van Teijlingen, E., Simkhada, P., Stephens J.,  Hundley, V., Angell, C.,  Getting women to care in Nepal: A Difference in Difference analysis of a health promotion intervention
  2. Milne, L, Hundley, V, van Teijlingen, E, Ireland, J, Simkhada, P, Staff perspectives of barriers to women accessing birthing services in Nepal: A qualitative study,
  3. Sharma, S., van Teijlingen, E., Hundley, V. Simkhada, P., Angell, C. Pregnant & Dirty?

 

Prof. Edwin van Teijlingen

CMMPH

Highest marks for International Fellowship for Midwives research in Nepal

 

In 2013 Wellbeing of Women joined the Royal College of Midwives (RCM) to offer the International Fellowship for Midwives (worth £20,000).  Their first ever recipient was BU Lesley Milne with her supporting team.  Lesley is a Senior Lecturer in Midwifery based at BU’s Portsmouth Branch Campus and her proposal set out to undertake a research project to explore barriers to facility birth in Nepal.

 

Delivery bed small hospital Nepal

Apart from Lesley herself the BU team comprises Vanora Hundley, Professor in Midwifery, Edwin van Teijlingen, Professor of Reproductive Health Research, and two HSC Visiting Faculty members, namely Dr. Padam Simkhada, Senior Lecturer at the University of Sheffield, and Ms. Jillian Ireland, Community Midwife NHS Poole Hospitals.

 

Small commercial pharmacy outside local hospital (Nepal)

Small commercial pharmacy outside local hospital (Nepal)

At the end of March 2014 we submitted the final report on the research to Well-Being of Women and the RCM and this report gained an ‘A’ in their scoring system.  Last week at the feedback meeting in Well-Being of Women’s office in London Lesley presented some of her key findings which she illustrated with some of her photographs.  The comments from those round the table were that the topic was well researched and that the qualitative research findings could help focus the funders in their future work.

 

Having reached the dissemination stage, we are planning scientific papers as well as a feedback session in Kathmandu (in September this year). Currently we are working on two academic papers, one is in an advanced stage approaching submission and the other is just passed its draft stage.

 

 

Lesley Milne, Vanora Hundley, Jillian Ireland (Visiting Faculty),Edwin van Teijlingen & Padam Simkhada (Visiting Faculty)

 

Centre for Midwifery, Maternal & Perinatal Health

School of Health & Social Care

 


EXON by the sea!

 

After many months of negotiation I packed my weekend bag and set off to Eastbourne to provide the first of a six day programme spread over three months on newborn examination, to a select cohort of nine midwives who work for the East Sussex NHS Healthcare Trust. The nearest university (Brighton) does not provide the module and I regularly have midwives travelling up from Brighton to attend the two courses provided annually at the Lansdowne Campus.

Midwives from the midwife led unit (EMU as it is fondly referred to) at Eastbourne Hospital, the acute trust at Hastings and Crowbridge Birthing Unit all joined the module at the beginning of January 2014. Some of the midwives were undertaking the unit in work time and some during their annual leave, but all were enthusiastic and very excited to be finally learning the skills and competencies necessary to become newborn examiners. Currently no midwives in the combined trusts undertake newborn examination and all babies are either examined by junior doctors in training or general practitioners (GPs) in the community setting. For a number of years there have been concerns expressed in the literature around the quality of the newborn examination when undertaken by junior doctors and GPs mainly around training and on-going education. Traditionally doctors in NHS hospitals were taught newborn examination under the mantra ‘see one – do one – teach one’, midwives on the other hand, have had to undergo many months of extra training and are required to undertake between 40 & 60 newborn examinations before being deemed competent. These conditions became onerous for midwives as it became difficult for them to find mentors and assessors to support them in practice. Many requested extensions and in some cases took almost two years to complete. This model of learning was not sustainable in the long run for both the clinical workplace and for university processes. Therefore an opportunity arose to change how BU provided examination of the newborn (EXON) when the post registration framework was re-validated in 2012, with the main difference being in relation to the examinations.

Midwifery is a self-regulating profession; therefore it is up to individual practitioners to judge whether they are component when providing midwifery care. The philosophy of self-regulation underpinning competency guided the provision of the new EXON course in relation to the number of examinations required. Midwives have to carry out a minimum of 10 mentored newborn checks, with five examinations being directly supervised. Once 10 examinations have been carried out midwives can undertake as many self-assessed newborn checks until they feel competent. Once they have reached this point they put themselves forward for one summative assessment which is a newborn examination evaluated in practice.  Midwives have nine months to complete the module. In addition, to further support midwives in training for this role, experienced midwives around the BU patch and as far as West Wiltshire have been provided with a half day update focusing on mentoring/assessing and understanding the EXON paperwork. These midwives have now taken on the role of mentoring and assessing midwives through EXON.

Now having delivered the six day programme the midwives in Eastbourne have successfully completed the academic requirement,s with all passing their ‘enquiry-based learning’ presentations which focused on an aspect of newborn physiology/pathology. The presentations were of an extremely high standard and feedback from the unit leader recommended writing up their work for publication in the British Journal of Midwifery. Their unit evaluations were 100% positive. One of the main benefits centered on the midwives forming a cohesive group and getting to know each other better.  These midwives are leading the way at East Sussex Healthcare. Once they qualify, they in turn, can become mentors and assessors for the next cohort. Perhaps even more importantly, evidence demonstrates that when midwives undertake this expanded role, women’s satisfaction and midwifery autonomy is increased and crucially, there is continuity of care for the woman and her baby and for the midwife herself.

 

For further information on the EXON module please contact Luisa Cescutti-Butler, Senior Lecturer, Lansdowne Campus: lcbutler@bournemouth.ac.uk

 

Good start of the year: Early crop of 2014 publications

HSC staff saw the fruit of their hard work in 2013 as a great number of papers have been accepted for publication or actually appeared in print in the first three weeks of January.  

 

 

There are a number of 2014 papers in health care journals, including papers in Nurse Education in Practice, The Practising Midwife, Journal of Clinical Nursing, Birth, ISRN Family Medicine, Perspective in Public Health, an editorial in Midwifery and two in the same issue of Health Science Journal.  There was also an early contribution from our social science colleagues in The Journal of Adult Protection and, last but not least a book chapter in Case Studies in e-Learning Research.

 

  1. Morley, D., 2014. Supporting student nurses in practice with online communication tools. Nurse Education in Practice, 14, 69-75.
  2. Bennett, S and Scammell, J (2014) Midwives caring for asylum-seeking women: research findings.  The Practising Midwife. 17 (1) p9-12
  3. Whitford, H., Aitchison, P., Entwistle V.A., van Teijlingen, E., Davidson, T., Humphrey, T., Tucker, J. Use of a birth plan within woman-held maternity records: a qualitative study with women and staff in northeast Scotland, Birth (accepted).
  4. Norton, E. 2014 The application of humanization theory to health-promoting practice. Perspectives in Public Health, (online first 2013)
  5. Sapkota, T., Simkhada, P., van Teijlingen, E. (2014) Nepalese health workers’ migration to the United Kingdom: A qualitative study.  Health Science Journal 8(1):  57-74.
  6. Hunt, J.A., Hutchings, M. (2014) Innovative group-facilitated peer and educator assessment of nursing students’ group presentations, Health Science Journal 8(1): 22-31.
  7. Harding, A., Sanders, F., Medina Lara, A., van Teijlingen, E., Wood, C., Galpin, D. Baron, S., Crowe, S., Sharma, S. Patient choice for older people in English NHS primary care: theory & practice,  ISRN Family Medicine (accepted).
  8. Norton, E., Holloway, I., Galvin K. 2014. Comfort vs risk: a grounded theory about female adolescent behaviour in the sun. Journal of Clinical Nursing. (online first 2013)
  9. van Teijlingen, E., Hundley, V., Matthews, Z., Lewis, G., Graham, W.J., Campbell, J., ten Hoope-Bender, P., Sheppard, Z.A., Hulton, L. (2014) Millennium Development Goals: All good things must come to an end, so what next? Midwifery 30: 1-2.
  10. Parker, J.,  Ashencaen Crabtree, S. (2014) Covert research and adult protection and safeguarding: an ethical dilemma? The Journal of Adult Protection (accepted).
  11. Hutchings, M, Quinney, A., Galvin, K.  Clark, V. book chapter IN: ‘The Yin/Yang of Innovative Technology Enhanced Assessment for Promoting Student Learning’ Case Studies in e-Learning Research.   Book is now available at:  http://www.academic-bookshop.com/ourshop/prod_2915879-Case-Studies-in-eLearning-Research-for-Researchers-teachers-and-Students.html

 

 

Prof. Edwin van Teijlingen

Centre for Midwifery, Maternal & Perinatal Health

BU presents at first National Midwifery Conference in Nepal

 

Lesley Milne, senior lecturer in Midwifery at Bournemouth University, presented this weekend at the First National Midwifery Conference in Kathmandu, Nepal.  She is part of a team studying why women in Nepal don’t use health services when giving birth in areas where such facilities are available.    After her presentation Lesley (picture first right) was awarded a certificate and token in true Nepali style.

Lesley is currently in Nepal for fieldwork as part of the first International Fellowship for Midwives worth £20,000.  Her study uses a mixed-methods approach which comprises observation and interviews with staff.  The Fellowship has been awarded by the charity Wellbeing of Women, in association with the Royal College of Midwives (RCM), for research into maternity services and women’s health from an international perspective.

The team consists of Prof. Vanora Hundley, Professor in Midwifery, Prof. Edwin van Teijlingen, Professor of Reproductive Health Research at BU, and BU Visiting Faculty Dr. Padam Simkhada based at ScHARR, the University of Sheffield

A second paper with BU input was presented by Joy Kemp Global who is the RCM’s Professional Advisor (Global Midwifery Twinning Project).  The presentation ‘A Feasibility Study of Professional Midwives in Nepal’ is based on a paper recently accepted for publication by the international journal Midwifery.  This health policy planning paper is led by Swedish midwife Malin Bogren and in collaboration with Prof. Marie Berg (The Sahlgrenska Academy at the University of Gothenburg and Prof. Edwin van Teijlingen.

 

Professors Edwin van Teijlingen & Vanora Hundley

Centre for Midwifery, Maternal & Perinatal Health , HSC.

Comment on BU Blog leads to academic publication

Authorship differs between disciplines

Paper by Hundley et al. published 2013

Last year Prof. Matthew Bennett1 raised some interesting issues about academic authorship on this award-winning BU Blog.  Authorship is an issue that many academic colleague see as challenging.   On September 27th, 2012 two of us replied to this blog by adding some of our own observations on the web. Having penned our online comments we discussed the issue with BU Visiting Faculty Dr. Padam Simkhada Senior Lecturer in International Health at ScHARR, University of Sheffield (www.shef.ac.uk/scharr/sections/ph/staff/profiles/padamsimkhada).  Between the three of us we came to the conclusion that the issue of academic authorship can be very confusing as well as tricky.

 

We discussed a wide-range of issues around academic authorship, including who should be an author and who should not be so, the order of authors, and that there are different conventions between different academic disciplines.  Being academic we rapidly came to the conclusion that there was a paper in this.  We drafted our ideas, searched the literature for other discussions on authorship, general guidelines on authorship, etc.   We wrote the paper and submitted it to the academic journal Health Renaissance; an Open-Access journal, which is freely available world-wide.  The editor liked it and published our paper ‘Academic authorship: who, why and in what order?’ this month as a guest editorial. 3

 

 

We would like to highlight that there are two separate messages in the publication of this paper.  The first message is about academic scholarship; some of our colleagues may find the content of this paper is a useful guide in deciding authorship order, or at least in helping to open the debate about who should be included as co-author and who is not eligible.  The second message is more about academic citizenship, namely that messages on the BU Blog and even comments in reply to other people’s messages may contain useful information to the wider academic community and should be taken further.  Our message here is don’t see the BU Blog as an end point, see it as a stepping stone to the wider academic world!

 

Prof. Edwin van Teijlingen*, Prof. Vanora Hundley* & Dr. Padam Simkhada**

* Centre for Midwifery, Maternal & Perinatal Health, HSC, Bournemouth University

** ScHARR, The University of Sheffield

 

References:

1.      Bennett, M. (2012) What’s in a list?, BU Research Blog, http://blogs.bournemouth.ac.uk/research/2012/09/27/whats-in-a-list/?utm_source=digest&utm_medium=email&utm_campaign=daily

 

2.      Hundley, V., van Teijlingen, E. (2012) Response to What’s in a list?, http://blogs.bournemouth.ac.uk/research/2012/09/27/whats-in-a-list/#comment-17234

 

3.      Hundley, V., van Teijlingen,      E., Simkhada, P. (2013) Academic authorship: who, why and in what order? Health Renaissance 11      (2):98-101  www.healthrenaissance.org.np/uploads/Download/vol-11-2/Page_99_101_Editorial.pdf