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Chirol A, Chirpaz E, Carassou-Maillan A. [The Jacquemier's maneuver: An overview of midwives knowledge and practices in a third level maternity hospital]. ACTA ACUST UNITED AC 2015; 44:67-73. [PMID: 26698219 DOI: 10.1016/j.gyobfe.2015.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/12/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Shoulder dystocia is an uncommon but serious complication occurring in 0.2 to 3% of deliveries. We carried out a study in order to assess the midwives experience, knowledge and practices on shoulder dystocia, at the maternity hospital of Saint-Denis, Reunion Island. METHODS The first part is a confidential questionnaire addressed to midwives working in the delivery unit. The second part is a retrospective desk review of shoulders dystocia which occurred from 2004 to 2014. RESULTS (1) The population was made up of 28 midwives, having between 1 to 27 years of experience. Seventy-five percent of them had been faced with shoulder dystocia, and 62% had realized Jacquemier's maneuver. However, only 25% received this maneuver training. Less than a third of them answered correctly to at least 7 from the 8 theoretical questions about the Jacquemier's maneuver. (2) We studied 34 shoulders dystocia, occurring between 36+5 to 41+2 gestational weeks, mostly with no risk factors found. Mac Roberts' maneuver is used as first-line in 88% of situations. Jacquemier's maneuver is used in 52.9% of cases (5.9% as first-line, 47% as second-line). In 26.4% of situations, the midwife is not able to reduce the dystocia. She usually carries out a combination of maneuvers. The gynecologist is asked only for 23.5% of dystocia and he usually uses Jacquemier's maneuver (70% of situations). CONCLUSION The Jacquemier's maneuver is rarely practiced (uncommon situation, lack of training). Simulation trainings should be put in place, because neonatal sequels can be avoided.
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Affiliation(s)
- A Chirol
- Maternité CHU de Saint-Denis, allée des Topazes, 97400 Saint-Denis, Réunion; Université de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - E Chirpaz
- Unité de soutien méthodologique, CHU de Saint-Denis, allée des Topazes, 97400 Saint-Denis, Réunion
| | - A Carassou-Maillan
- Maternité CHU de Saint-Denis, allée des Topazes, 97400 Saint-Denis, Réunion
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152
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van de Ven J, van Deursen FJHM, van Runnard Heimel PJ, Mol BWJ, Oei SG. Effectiveness of team training in managing shoulder dystocia: a retrospective study. J Matern Fetal Neonatal Med 2015; 29:3167-71. [PMID: 26669821 DOI: 10.3109/14767058.2015.1118037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of simulation team training for the management of shoulder dystocia. Primary outcome measures were the number of reported cases of shoulder dystocia, as well as fetal injury that occurred from it. Secondary outcome is documentation of manoeuvres used to alleviate shoulder dystocia. METHODS Retrospective cohort study in a teaching hospital in the Netherlands, in a 38 month period before and after implementation of team training. RESULTS We compared 3492 term vaginal cephalic deliveries with 3496 deliveries before and after team training. Incidence of shoulder dystocia increased from 51 to 90 cases (RR 1.8 (95% CI: 1.3-2.5)). Fetal injury occurred in 16 and eight cases, respectively (RR 0.50 (95% CI: 0.21-1.2)). Before team training started, the all-fours manoeuvre was never used, while after team training it was used in 41 of 90 cases (45%). Proper documentation of all manoeuvres used to alleviate shoulder dystocia significantly increased after team training (RR 1.6 (95% CI: 1.05-2.5)). CONCLUSIONS Simulation team training increased the frequency of shoulder dystocia, facilitated implementation of the all-fours technique, improved documentation of delivery notes and may have a beneficial effect on the number of children injured due to shoulder dystocia.
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Affiliation(s)
- Joost van de Ven
- a Department of Obstetrics and Gynaecology , Máxima Medical Centre , Veldhoven , The Netherlands
| | - Frank J H M van Deursen
- a Department of Obstetrics and Gynaecology , Máxima Medical Centre , Veldhoven , The Netherlands
| | | | - Ben Willem J Mol
- a Department of Obstetrics and Gynaecology , Máxima Medical Centre , Veldhoven , The Netherlands .,b The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide , Adelaide , Australia , and
| | - S Guid Oei
- a Department of Obstetrics and Gynaecology , Máxima Medical Centre , Veldhoven , The Netherlands .,c Department of Electrical Engineering , Eindhoven University of Technology , Eindhoven , The Netherlands
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153
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Walton A, Kestler E, Dettinger JC, Zelek S, Holme F, Walker D. Impact of a low-technology simulation-based obstetric and newborn care training scheme on non-emergency delivery practices in Guatemala. Int J Gynaecol Obstet 2015; 132:359-64. [PMID: 26797198 PMCID: PMC4780429 DOI: 10.1016/j.ijgo.2015.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/24/2015] [Accepted: 11/23/2015] [Indexed: 11/30/2022]
Abstract
Objective To assess the effect of a low-technology simulation-based training scheme for obstetric and perinatal emergency management (PRONTO; Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) on non-emergency delivery practices at primary level clinics in Guatemala. Methods A paired cross-sectional birth observation study was conducted with a convenience sample of 18 clinics (nine pairs of intervention and control clinics) from June 28 to August 7, 2013. Outcomes included implementation of practices known to decrease maternal and/or neonatal mortality and improve patient care. Results Overall, 25 and 17 births occurred in intervention and control clinics, respectively. Active management of the third stage of labor was appropriately performed by 20 (83%) of 24 intervention teams versus 7 (50%) of 14 control teams (P = 0.015). Intervention teams implemented more practices to decrease neonatal mortality than did control teams (P < 0.001). Intervention teams ensured patient privacy in 23 (92%) of 25 births versus 11 (65%) of 17 births for control teams (P = 0.014). All 15 applicable intervention teams kept patients informed versus 6 (55%) of 11 control teams (P = 0.001). Differences were also noted in teamwork; in particular, skill-based tools were used more often at intervention sites than control sites (P = 0.012). Conclusion Use of PRONTO enhanced non-emergency delivery care by increasing evidence-based practice, patient-centered care, and teamwork.
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Affiliation(s)
- Anna Walton
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Edgar Kestler
- Epidemiological Research Center in Sexual and Reproductive Health, Guatemala City, Guatemala
| | - Julia C Dettinger
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Sarah Zelek
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Francesca Holme
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Dilys Walker
- Department of Obstetrics and Gynecology and Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
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Legendre G, Bouet PE, Sentilhes L. Place de la simulation pour réduire la morbidité néonatale et maternelle secondaire à une dystocie des épaules. ACTA ACUST UNITED AC 2015; 44:1285-93. [DOI: 10.1016/j.jgyn.2015.09.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
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155
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Improvement and retention of emergency obstetrics and neonatal care knowledge and skills in a hospital mentorship program in Lilongwe, Malawi. Int J Gynaecol Obstet 2015; 132:240-3. [PMID: 26658095 DOI: 10.1016/j.ijgo.2015.06.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 06/19/2015] [Accepted: 10/23/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate whether a hospital-based mentoring program could significantly increase short- and longer-term emergency obstetrics and neonatal care (EmONC) knowledge and skills among health providers. METHODS In a prospective before-and-after study, 20 mentors were trained using a specially-created EmONC mentoring and training program at Bwaila Hospital in Lilongwe, Malawi. The mentors then trained an additional 114 providers as mentees in the curriculum. Mentors and mentees were asked to complete a test before initiation of the training (Pre-Test), immediately after training (Post-Test 1), and at least 6 months after training (Post-Test 2) to assess written and practical EmONC knowledge and skills. Mean scores were then compared. RESULTS Scores increased significantly between the Pre-Test and Post-Test 1 for both written (n=134; difference 22.9%, P<0.001) and practical (n=125; difference 29.5%, P<0.001) tests. Scores were still significantly higher in Post-Test 2 than in the Pre-Test for written (n=111; difference 21.0%, P<0.001) and practical (n=103; difference 29.3%, P<0.001) tests. CONCLUSION A hospital-based mentoring program can result in both short- and longer-term improvement in EmONC knowledge and skills. Further research is required to assess whether this leads to behavioral changes that improve maternal and neonatal outcomes.
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156
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Kallianidis AF, Smit M, Van Roosmalen J. Shoulder dystocia in primary midwifery care in the Netherlands. Acta Obstet Gynecol Scand 2015; 95:203-9. [PMID: 26458503 DOI: 10.1111/aogs.12800] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 10/03/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In the Netherlands, low-risk pregnancies are managed by midwives in primary care. Despite strict definitions of low risk, obstetric complications can occur. Midwives seldom encounter uncommon labour complications, but are sufficiently trained to manage these. We assessed neonatal and maternal outcome after management of shoulder dystocia in primary midwifery care. MATERIALS AND METHODS In this 2-year prospective cohort study from April 2008 to April 2010, primary-care midwives, who participated in an obstetric emergency course, reported all obstetric complications. Main outcome was neonatal and maternal outcome. RESULTS In sixty-four cases of shoulder dystocia McRoberts was the first maneuver in 42/64 (65.6%) cases with a success rate of 23.8%. All-fours maneuver was most frequently used as the second maneuver (24/45; 53.3%). No neonatal mortality occurred, none of the infants suffered from hypoxic ischemic injury, two (3.1%) had transient brachial plexus injuries, two (3.1%) had fractured clavicles and one (1.6%) had a fractured humerus. Eight (12.5%) neonates were successfully resuscitated because of birth asphyxia. All infants fully recovered. In neonates with immediate adverse outcome significantly more maneuvers were used compared with those without adverse neonatal outcome (p = 0.02). Postpartum hemorrhage occurred in 2/64 (3.1%) women, deep vaginal lacerations in 2/64 (3.1%), perineal tears in 23/64 (35.9%). No anal sphincter injuries occurred. CONCLUSIONS McRoberts and all-fours maneuvers are widely used by primary-care midwives in the management of shoulder dystocia. Low rates of adverse neonatal and maternal outcomes were observed in cases of shoulder dystocia up to 6 weeks postpartum.
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Affiliation(s)
| | - Marrit Smit
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jos Van Roosmalen
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.,Athena Institute, VU University, Amsterdam, the Netherlands
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157
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Simulation Training in Obstetrics and Gynaecology Residency Programs in Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:1025-32. [DOI: 10.1016/s1701-2163(16)30053-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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158
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Edwards SE, Platt S, Lenguerrand E, Winter C, Mears J, Davis S, Lucas G, Hotton E, Fox R, Draycott T, Siassakos D. Effective interprofessional simulation training for medical and midwifery students. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2015; 1:87-93. [PMID: 35515198 PMCID: PMC8936651 DOI: 10.1136/bmjstel-2015-000022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 11/04/2022]
Abstract
Introduction Good interprofessional teamworking is essential for high quality, efficient and safe clinical care. Undergraduate interprofessional training has been advocated for many years to improve interprofessional working. However, few successful initiatives have been reported and even fewer have formally assessed their educational impact. Methods This was a prospective observational study of medical and midwifery students at a tertiary-level maternity unit. An interprofessional training module was developed and delivered by a multiprofessional faculty to medical and midwifery students, including short lectures, team-building exercises and practical simulation-based training for one obstetric (shoulder dystocia) and three generic emergencies (sepsis, haemorrhage, collapse). Outcome measures were interprofessional attitudes, assessed with a validated questionnaire (UWE Interprofessional Questionnaire) and clinical knowledge, measured with validated multiple-choice questions. Results Seventy-two students participated (34 medical, 38 midwifery). Following training median interprofessional attitude scores improved in all domains (p<0.0001), and more students responded in positive categories for communication and teamwork (69-89%, p=0.004), interprofessional interaction (3-16%, p=0.012) and interprofessional relationships (74-89%, p=0.006). Scores for knowledge improved following training for medical students (65.5% (61.8-70%) to 82.3% (79.1-84.5%) (median (IQR)) p<0.0001) and student midwives (70% (64.1-76.4%) to 81.8% (79.1-86.4%) p<0.0001), and in all subject areas (p<0.0001). Conclusions This training was associated with meaningful improvements in students' attitudes to teamwork, and knowledge acquisition. Integrating practical tasks and teamwork training, in authentic clinical settings, with matched numbers of medical and non-medical students can facilitate learning of both why and how to work together. This type of training could be adopted widely in undergraduate healthcare education.
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Affiliation(s)
- S E Edwards
- University of Bristol, School of Clinical Sciences, Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
| | - S Platt
- Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol, UK
| | - E Lenguerrand
- University of Bristol School of Clinical Sciences, RISQ Research, Southmead Hospital, Bristol, UK
| | - C Winter
- Department of Obstetrics and Gynaecology, RISQ Research, Southmead Hospital, Bristol, UK
| | - J Mears
- Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
| | - S Davis
- University of West of England, Health and Life Sciences, Bristol, UK
| | - G Lucas
- University of West of England, Health and Life Sciences, Bristol, UK
| | - E Hotton
- Department of Obstetrics and Gynaecology, Royal United Hospitals, Bath, UK
| | - R Fox
- Department of Obstetrics and Gynaecology, RISQ Research, Southmead Hospital, Bristol, UK
| | - T Draycott
- University of Bristol, School of Clinical Sciences, Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
| | - D Siassakos
- University of Bristol, School of Clinical Sciences, Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
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159
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Raimond E, Delorme C, Pelissier A, Bonneau S, Graesslin O. [Training achieves an internal version and a total breech extraction at birth of second twin]. ACTA ACUST UNITED AC 2015; 43:646-51. [PMID: 26411390 DOI: 10.1016/j.gyobfe.2015.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/13/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate French residents in obstetrics and gynaecology's training to internal version and breech extraction during vaginal delivery of the second twin. METHODS A national descriptive survey conducted among 1064 residents between July and October 2014. Respondents were invited by email to specify the type of theoretical and practical training they had received, their university hospital obstetrical practices and the number of vaginal internal version and breech extraction of the second twin they had seen and performed. RESULTS Response rate was 38.7% (n=412). Regarding the type of theoretical training, 39.8% of residents (n=164) had received the obstetrical mechanics and techniques degree; 47.6% (n=196) had got a teaching during special education classes and 29.4% (n=121) a training on mannequin. There were important differences between regions. At the end of residency, 45.6% of residents (n=36) had practiced more than five vaginal internal version and breech extraction of the second twin. CONCLUSION Internal version and breech extraction are difficult but essential maneuvers for the management of twin delivery. The French residents in obstetrics and gynaecology's training for these maneuvers seems to be insufficient. It is necessary to improve their teaching, this teaching must also be equivalent between regions.
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Affiliation(s)
- E Raimond
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - C Delorme
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - A Pelissier
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - S Bonneau
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - O Graesslin
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
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Abstract
The obstetrics/gynecology (OB/GYN) hospitalist is the latest subspecialist to evolve from obstetrics and gynecology. Starting in 2002, academic leaders recognized the impact of such coalescing forces as the pressure to reduce maternal morbidity and mortality, stagnant reimbursements and the increasing cost of private practice, the decrease in applications for OB/GYN residencies, and the demand among practicing OB/GYNs for work/life balance. Initially coined laborist, the concept of the OB/GYN hospitalist emerged. Thinking of becoming an OB/GYN hospitalist? Here is what you need to know.
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162
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Secher AL, Bytoft B, Tabor A, Damm P, Mathiesen ER. Fetal sonographic characteristics associated with shoulder dystocia in pregnancies of women with type 1 diabetes. Acta Obstet Gynecol Scand 2015; 94:1105-11. [PMID: 26178663 DOI: 10.1111/aogs.12707] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 06/30/2015] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Shoulder dystocia is a rare but severe complication of vaginal delivery and diabetic women are at high risk. The aim of this study was to identify fetal sonographic and maternal glycemic characteristics associated with shoulder dystocia in pregnant women with type 1 diabetes. MATERIAL AND METHODS Twelve cases (5%) of shoulder dystocia among 241 consecutive vaginal deliveries in women with type 1 diabetes followed at Rigshospitalet University Hospital in 2009-2013 were retrospectively identified in a local database. Fetal sonographic and clinical data were compared with 69 women with type 1 diabetes and uncomplicated vaginal deliveries. RESULTS Women experiencing shoulder dystocia compared with women with uncomplicated deliveries had a higher glycated hemoglobin (HbA1c) in early pregnancy [median 7.0% (range 5.9-8.1) vs. 6.6% (range 5.4-10.0, P = 0.04)], whereas in late pregnancy, HbA1c in the two groups of women was comparable [6.1% (range 5.5-6.9) vs. 6.0% (range 4.7-8.4, P = 0.30)]. Fetal biometry at 36 weeks showed a higher estimated fetal weight of 3597 g (range 3051-4069) vs. 2989 g (range 2165-4025), P < 0.001, corresponding to 20% (4-41%) vs. 5% (-20 to 44%) above the mean estimated fetal weight for gestational age (P = 0.002) and a greater abdominal circumference SD score of 2.51 (range 1.56-4.20) vs. 1.33 (range -1.08 to 4.25), P = 0.001). Head circumference was comparable. Vacuum extraction was more frequent during deliveries with shoulder dystocia (58 vs. 17%, P = 0.005). Seven (58%) newborns with shoulder dystocia had brachial plexus injuries, fractures, intra-abdominal bleeding or needed resuscitation. CONCLUSIONS Excessive estimated fetal weight and abdominal circumference at 36 weeks' sonographic examination may help in identifying diabetic women at high risk of later shoulder dystocia.
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Affiliation(s)
- Anna L Secher
- Center for Pregnant Women with Diabetes, Rigshospitalet University Hospital, Copenhagen, Denmark.,Department of Endocrinology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Birgitte Bytoft
- Center for Pregnant Women with Diabetes, Rigshospitalet University Hospital, Copenhagen, Denmark.,Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ann Tabor
- Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark.,Center of Fetal Medicine and Pregnancy, Rigshospitalet University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet University Hospital, Copenhagen, Denmark.,Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet University Hospital, Copenhagen, Denmark.,Department of Endocrinology, Rigshospitalet University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Draycott TJ, Collins KJ, Crofts JF, Siassakos D, Winter C, Weiner CP, Donald F. Myths and realities of training in obstetric emergencies. Best Pract Res Clin Obstet Gynaecol 2015; 29:1067-76. [PMID: 26254842 DOI: 10.1016/j.bpobgyn.2015.07.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/09/2015] [Indexed: 01/21/2023]
Abstract
Training for intrapartum emergencies is a promising strategy to reduce preventable harm during birth; however, not all training is clinically effective. Many myths have developed around such training. These principally derive from misinformed beliefs that all training must be effective, cheap, independent of context and sustainable. The current evidence base for effective training supports local, unit-based and multi-professional training, with appropriate mannequins, and practice-based tools to support the best care. Training programmes based on these principles are associated with improved clinical outcomes, but we need to understand how and why that is, and also why some training is associated with no improvements, or even deterioration in outcomes. Effective training is not cheap, but it can be cost-effective. Insurers have the fiscal power to incentivise training, but they should demand the evidence of clinical effect; aspiration and proxies alone should no longer be sufficient for funding, in any resource setting.
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164
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Draycott T, Sagar R, Hogg S. The role of insurers in maternity safety. Best Pract Res Clin Obstet Gynaecol 2015; 29:1126-31. [PMID: 26323546 DOI: 10.1016/j.bpobgyn.2015.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
Adverse events in maternity care are frequently avoidable and litigation costs for maternity care are rising for many health services across the world. Whilst families for whom this injury was preventable suffer from this tragedy, there is an enormous loss of resource to healthcare in general. It is axiomatic that preventing avoidable harm is better for women, their families and society in general, and downstream this improvement should also reduce both litigation and costs. However, there are few initiatives that have reduced adverse clinical events in maternity services and fewer still that have demonstrated decreases in litigation costs. Where these data do exist, the involvement and engagement of insurers seem to have been crucial, but often unrecognized. Insurers could play a much broader role in preventing harm, and this article explores this potential.
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Affiliation(s)
- Tim Draycott
- Department of Womens Health, North Bristol NHS Trust, Bristol, UK.
| | - Rachel Sagar
- Department of Womens Health, North Bristol NHS Trust, Bristol, UK.
| | - Susannah Hogg
- Department of Womens Health, North Bristol NHS Trust, Bristol, UK
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166
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Irani M, Deering S. Challenges affecting access to cesarean delivery and strategies to overcome them in low-income countries. Int J Gynaecol Obstet 2015; 131:30-4. [DOI: 10.1016/j.ijgo.2015.04.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 03/31/2015] [Accepted: 06/09/2015] [Indexed: 11/28/2022]
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167
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Abstract
Maintenance of certification (MOC) is a process through which practitioners are able to show continuing competence in their areas of expertise. Simulation plays an increasingly important role in the assessment of students and residents, as well as in the initial practice certification for health care professionals. The use of simulation as an assessment tool in MOC has been sluggish to be universally accepted. This article discusses the role of simulation in health care education, how simulation might be effectively applied in the MOC process, and the future role of simulation in the MOC process.
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Affiliation(s)
- Brian K Ross
- Department of Anesthesiology and Pain Medicine, University of Washington, Box 356540, Seattle, WA 98195, USA.
| | - Julia Metzner
- Department of Anesthesiology and Pain Medicine, University of Washington, Box 356540, Seattle, WA 98195, USA
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Noblot E, Raia-Barjat T, Lajeunesse C, Trombert B, Weiss S, Colombié M, Chauleur C. Training program for the management of two obstetric emergencies within a French perinatal care network. Eur J Obstet Gynecol Reprod Biol 2015; 189:101-5. [DOI: 10.1016/j.ejogrb.2015.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 03/05/2015] [Accepted: 03/19/2015] [Indexed: 12/12/2022]
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169
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Deutsch ES, Wiet GJ, Seidman M, Hussey HM, Malekzadeh S, Fried MP. Simulation Activity in Otolaryngology Residencies. Otolaryngol Head Neck Surg 2015; 153:193-201. [PMID: 26019133 DOI: 10.1177/0194599815584598] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 04/08/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Simulation has become a valuable tool in medical education, and several specialties accept or require simulation as a resource for resident training or assessment as well as for board certification or maintenance of certification. This study investigates current simulation resources and activities in US otolaryngology residency programs and examines interest in advancing simulation training and assessment within the specialty. STUDY DESIGN Web-based survey. SETTING US otolaryngology residency training programs. SUBJECTS AND METHODS An electronic web-based survey was disseminated to all US otolaryngology program directors to determine their respective institutional and departmental simulation resources, existing simulation activities, and interest in further simulation initiatives. Descriptive results are reported. RESULTS Responses were received from 43 of 104 (43%) residency programs. Simulation capabilities and resources are available in most respondents' institutions (78.6% report onsite resources; 73.8% report availability of models, manikins, and devices). Most respondents (61%) report limited simulation activity within otolaryngology. Areas of simulation are broad, addressing technical and nontechnical skills related to clinical training (94%). Simulation is infrequently used for research, credentialing, or systems improvement. The majority of respondents (83.8%) expressed interest in participating in multicenter trials of simulation initiatives. CONCLUSION Most respondents from otolaryngology residency programs have incorporated some simulation into their curriculum. Interest among program directors to participate in future multicenter trials appears high. Future research efforts in this area should aim to determine optimal simulators and simulation activities for training and assessment as well as how to best incorporate simulation into otolaryngology residency training programs.
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Affiliation(s)
- Ellen S Deutsch
- Department of Anesthesiology and Critical Care Medicine, the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gregory J Wiet
- Department of Otolaryngology, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Michael Seidman
- Department of Otolaryngology-Head and Neck Surgery; Henry Ford Health System, Detroit, Michigan, USA
| | - Heather M Hussey
- Department of Research and Quality Improvement, American Academy of Otolaryngology Head and Neck Surgery, Alexandria, Virginia, USA
| | - Sonya Malekzadeh
- Department of Otolaryngology-Head and Neck Surgery; MedStar Georgetown University Hospital, Washington, DC, USA
| | - Marvin P Fried
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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170
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Frequent brief on-site simulation training and reduction in 24-h neonatal mortality--an educational intervention study. Resuscitation 2015; 93:1-7. [PMID: 25957942 DOI: 10.1016/j.resuscitation.2015.04.019] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/23/2015] [Accepted: 04/21/2015] [Indexed: 11/22/2022]
Abstract
AIM OF THE STUDY "Helping Babies Breathe" (HBB) is a simulation-based educational program developed to help reduce perinatal mortality worldwide. A one-day HBB training course did not improve clinical management of neonates. The objective was to assess the impact of frequent brief (3-5 min weekly) on-site HBB simulation training on newborn resuscitation practices in the delivery room and the potential impact on 24-h neonatal mortality. METHODS Before/after educational intervention study in a rural referral hospital in Northern Tanzania. Baseline data was collected from 01.02.2010 to 31.01.2011 and post-intervention data from 01.02.2011 to 31.01.2012. All deliveries were observed by research assistants who recorded information about labor, newborn delivery room management, perinatal characteristics, and neonatal outcomes. A newborn simulator was placed in the labor ward and frequent brief HBB simulation training was implemented on-site; 3-min of weekly paired practice, assisted by local-trainers. Local-trainers also facilitated 40-min monthly re-trainings. Outcome measures were; delivery room management of newborns and 24-h neonatal outcomes (normal, admitted to a neonatal area, death, or stillbirths). RESULTS There were 4894 deliveries pre and 4814 post-implementation of frequent brief simulation training. The number of stimulated neonates increased from 712(14.5%) to 785(16.3%) (p = 0.016), those suctioned increased from 634(13.0%) to 762(15.8%) (p ≤ 0.0005). Neonates receiving bag mask ventilation decreased from 357(7.3%) to 283(5.9%) (p = 0.005). Mortality at 24-h decreased from 11.1/1000 to 7.2/1000 (p = 0.040). CONCLUSION On-site, brief and frequent HBB simulation training appears to facilitate transfer of new knowledge and skills into clinical practice and to be accompanied by a decrease in neonatal mortality.
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171
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Stefanidis D, Sevdalis N, Paige J, Zevin B, Aggarwal R, Grantcharov T, Jones DB. Simulation in Surgery. Ann Surg 2015; 261:846-53. [DOI: 10.1097/sla.0000000000000826] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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172
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Bergh AM, Baloyi S, Pattinson RC. What is the impact of multi-professional emergency obstetric and neonatal care training? Best Pract Res Clin Obstet Gynaecol 2015; 29:1028-43. [PMID: 25937554 DOI: 10.1016/j.bpobgyn.2015.03.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 03/16/2015] [Indexed: 11/30/2022]
Abstract
This paper reviews evidence regarding change in health-care provider behaviour and maternal and neonatal outcomes as a result of emergency obstetric and neonatal care (EmONC) training. A refined version of the Kirkpatrick classification for programme evaluation was used to focus on change in efficiency and impact of training (levels 3 and 4). Twenty-three studies were reviewed - five randomised controlled trials, two quasi-experimental studies and 16 before-and-after observational studies. Training programmes had all been developed in high-income countries and adapted for use in low- and middle-income countries. Nine studies reported on behaviour change and 13 on process and patient outcomes. Most showed positive results. Every maternity unit should provide EmONC teamwork training, mandatory for all health-care providers. The challenges are as follows: scaling up such training to all institutions, sustaining regular in-service training, integrating training into institutional and health-system patient safety initiatives and 'thinking out of the box' in evaluation research.
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Affiliation(s)
- Anne-Marie Bergh
- MRC Maternal and Infant Health Care Strategies Unit, Obstetrics and Gynaecology Department, University of Pretoria, Pretoria, South Africa.
| | - Shisana Baloyi
- MRC Maternal and Infant Health Care Strategies Unit, Obstetrics and Gynaecology Department, University of Pretoria, Pretoria, South Africa.
| | - Robert C Pattinson
- MRC Maternal and Infant Health Care Strategies Unit, Obstetrics and Gynaecology Department, University of Pretoria, Pretoria, South Africa.
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173
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Utz B, Kana T, van den Broek N. Practical aspects of setting up obstetric skills laboratories – A literature review and proposed model. Midwifery 2015; 31:400-8. [DOI: 10.1016/j.midw.2014.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 10/09/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
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174
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Team training for safer birth. Best Pract Res Clin Obstet Gynaecol 2015; 29:1044-57. [PMID: 25979351 DOI: 10.1016/j.bpobgyn.2015.03.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/23/2015] [Indexed: 11/24/2022]
Abstract
Effective and coordinated teamworking is key to achieving safe birth for mothers and babies. Confidential enquiries have repeatedly identified deficiencies in teamwork as factors contributing to poor maternal and neonatal outcomes. The ingredients of a successful multi-professional team are varied, but research has identified some fundamental teamwork behaviours, with good communication, proficient leadership and situational awareness at the heart. Simple, evidence-based methods in teamwork training can be seamlessly integrated into a core, mandatory obstetric emergency training. Training should be an enjoyable, inclusive and beneficial experience for members of staff. Training in teamwork can lead to improved clinical outcomes and better birth experience for women.
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175
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Crofts JF, Mukuli T, Murove BT, Ngwenya S, Mhlanga S, Dube M, Sengurayi E, Winter C, Jordan S, Barnfield S, Wilcox H, Merriel A, Ndlovu S, Sibanda Z, Moyo S, Ndebele W, Draycott TJ, Sibanda T. Onsite training of doctors, midwives and nurses in obstetric emergencies, Zimbabwe. Bull World Health Organ 2015; 93:347-51. [PMID: 26229206 PMCID: PMC4431513 DOI: 10.2471/blt.14.145532] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 01/20/2015] [Accepted: 01/23/2015] [Indexed: 11/27/2022] Open
Abstract
PROBLEM In Zimbabwe, many health facilities are not able to manage serious obstetric complications. Staff most commonly identified inadequate training as the greatest barrier to preventing avoidable maternal deaths. APPROACH We established an onsite obstetric emergencies training programme for maternity staff in the Mpilo Central Hospital. We trained 12 local staff to become trainers and provided them with the equipment and resources needed for the course. The trainers held one-day courses for 299 staff at the hospital. LOCAL SETTING Maternal mortality in Zimbabwe has increased from 555 to 960 per 100,000 pregnant women from 2006 to 2011 and 47% of the deaths are believed to be avoidable. Most obstetric emergencies trainings are held off-site, away from the clinical area, for a limited number of staff. RELEVANT CHANGES Following an in-hospital train-the-trainers course, 90% (138/153) of maternity staff were trained locally within the first year, with 299 hospital staff trained to date. Local system changes included: the introduction of a labour ward board, emergency boxes, colour-coded early warning observation charts and a maternity dashboard. In this hospital, these changes have been associated with a 34% reduction in hospital maternal mortality from 67 maternal deaths per 9078 births (0.74%) in 2011 compared with 48 maternal deaths per 9884 births (0.49%) in 2014. LESSONS LEARNT Introducing obstetric emergencies training and tools was feasible onsite, improved clinical practice, was sustained by local staff and associated with improved clinical outcomes. Further work to study the implementation and effect of this intervention at scale is required.
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Affiliation(s)
- Joanna F Crofts
- School of Social and Community Medicine, University of Bristol, Bristol, BS10 5NB, England
| | | | | | | | | | | | | | - Cathy Winter
- School of Social and Community Medicine, University of Bristol, Bristol, BS10 5NB, England
| | - Sharon Jordan
- School of Social and Community Medicine, University of Bristol, Bristol, BS10 5NB, England
| | - Sonia Barnfield
- School of Social and Community Medicine, University of Bristol, Bristol, BS10 5NB, England
| | - Heather Wilcox
- School of Social and Community Medicine, University of Bristol, Bristol, BS10 5NB, England
| | - Abi Merriel
- School of Clinical & Experimental Medicine, Birmingham Women's Hospital Foundation Trust, Birmingham, England
| | | | | | | | | | - Tim J Draycott
- School of Social and Community Medicine, University of Bristol, Bristol, BS10 5NB, England
| | - Thabani Sibanda
- Bay of Plenty District Health Board, Whakatane Hospital, Whakatane, New Zealand
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176
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Crofts JF, Lenguerrand E, Bentham GL, Tawfik S, Claireaux HA, Odd D, Fox R, Draycott TJ. Prevention of brachial plexus injury-12 years of shoulder dystocia training: an interrupted time-series study. BJOG 2015; 123:111-8. [PMID: 25688719 DOI: 10.1111/1471-0528.13302] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate management and outcomes of incidences of shoulder dystocia in the 12 years following the introduction of an obstetric emergencies training programme. DESIGN Interrupted time-series study comparing management and neonatal outcome of births complicated by shoulder dystocia over three 4-year periods: (i) Pre-training (1996-99), (ii) Early training (2001-04), and (iii) Late training (2009-12). SETTING Southmead Hospital, Bristol, UK, with approximately 6000 births per annum. POPULATION Infants and their mothers who experienced shoulder dystocia. METHOD A bi-monthly multi-professional 1-day intrapartum emergencies training course, that included a 30-minute practical session on shoulder dystocia management, commenced in 2000. MAIN OUTCOMES Neonatal morbidity (brachial plexus injury, humeral fracture, clavicular fracture, 5-minute Apgar score <7) and documented management of shoulder dystocia (resolution manoeuvres performed, traction applied, head-to-body delivery interval). RESULTS Compliance with national guidance improved with continued training. At least one recognised resolution manoeuvre was used in 99.8% (561/562) of cases of shoulder dystocia in the late training period, demonstrating a continued improvement from 46.3% (150/324, P < 0.001) pre-training, and 92% (241/262, P < 0.001) in the early training period. In parallel there was reduction in the brachial plexus injury at birth (24/324 [7.4%, P < 0.01], pre-training, 6/262 [2.3%] early training, and 7/562 [1.3%] late training. CONCLUSIONS There are significant benefits to long-term, embedded training programmes with improvements in both management and outcomes. A decade after the introduction of training there were no cases of brachial plexus injury lasting over 12 months in 562 cases of shoulder dystocia.
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Affiliation(s)
- J F Crofts
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - E Lenguerrand
- School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - G L Bentham
- North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - S Tawfik
- North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - H A Claireaux
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - D Odd
- School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - R Fox
- Taunton and Somerset NHS Trust, Taunton, UK
| | - T J Draycott
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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177
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Development of a Novel Task Trainer for Second Trimester Ultrasound-guided Uterine Evacuation. Simul Healthc 2015; 10:49-53. [DOI: 10.1097/sih.0000000000000063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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178
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Gosai J, Purva M, Gunn J. Simulation in cardiology: state of the art. Eur Heart J 2015; 36:777-83. [DOI: 10.1093/eurheartj/ehu527] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/27/2014] [Indexed: 01/01/2023] Open
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179
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York SL, Maizels M, Cohen E, Stoltz RS, Jamil A, McGaghie WC, Gossett DR. Development and evaluation of cesarean section surgical training using computer-enhanced visual learning. MEDICAL TEACHER 2014; 36:958-964. [PMID: 25072410 DOI: 10.3109/0142159x.2014.917156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Skilled performance of cesarean deliveries is essential in obstetrics and gynecology residency. A computer-enhanced visual learning module (CEVL Cesarean) was developed to teach cesarean deliveries. METHODS An online module presented cesarean deliveries as a series of components using text, audio, video and animation. First-year residents used CEVL Cesarean and were evaluated intra-operatively by trained raters, then provided feedback about surgical performance. Clinical outcomes were collected for approximately 50 cesarean deliveries for each resident. RESULTS From 2010 to 2011, 12 first-year residents participated in the study. About 406 unique observed cesarean deliveries were analyzed. Procedures up to each resident's 70th case were analyzed by grouping cases in 10 s (cases 1-10 and 11-20), or deciles. Resident performance significantly improved by decile [χ(2)(6) = 47.56, p < 0.001]. When examining each resident's performance, surgical skill acquisition plateaued by cases 21-30. Procedural performance, independent of resident, also improved significantly by decile [χ(2)(6) = 186.95, p < 0.001], plateauing by decile 4 (cases 31-40). Throughout the observation period, operative time decreased by 3.84 min (p = 0.006). CONCLUSIONS Pre-clinical teaching using computer-based modules for cesarean sections is feasible to develop. Novice surgeons required at least 30 procedures before performing the procedure competently. When residents performed competently, operative time and complications decreased.
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180
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Clec’h C, Préau S. Place de la simulation aux examens de réanimation. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0931-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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181
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Youssef A, Salsi G, Ragusa A, Ghi T, Pacella G, Rizzo N, Pilu G. Caregiver's satisfaction with a video tutorial for shoulder dystocia management algorithm. J OBSTET GYNAECOL 2014; 35:461-4. [PMID: 25357086 DOI: 10.3109/01443615.2014.969208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In our questionnaire, a video tutorial illustrating the management of shoulder dystocia was considered by health personnel as a useful complementary training tool. We prepared a 5-min video tutorial on the management of shoulder dystocia, using a simulator that includes maternal pelvic and baby models. We performed a survey among obstetric personnel in order to assess their opinion on the tutorial by inviting them to watch the video tutorial and answer an online questionnaire. Five multiple-choice questions were set, focusing on the video's main objectives: clarity, simplicity and usefulness. Following the collection of answers, global and category-weighted analyses were conducted for each question. Out of 956 invitations sent, 482 (50.4%) answered the survey. More than 90% of all categories found the video tutorial to be clinically relevant and clear. For revising the management of shoulder dystocia most obstetric personnel would use the video tutorial together with traditional textbooks. In conclusion, our video tutorial was considered by health personnel as a useful complementary training tool.
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Affiliation(s)
- A Youssef
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - G Salsi
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - A Ragusa
- b Department of Obstetrics and Gynecology , Niguarda Hospital , Milan , Italy
| | - T Ghi
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - G Pacella
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - N Rizzo
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - G Pilu
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
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182
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Sigalet EL, Donnon TL, Grant V. Insight into team competence in medical, nursing and respiratory therapy students. J Interprof Care 2014; 29:62-7. [DOI: 10.3109/13561820.2014.940416] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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183
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Morgan P, Tregunno D, Brydges R, Pittini R, Tarshis J, Kurrek M, DeSousa S, Ryzynski A. Using a situational awareness global assessment technique for interprofessional obstetrical team training with high fidelity simulation. J Interprof Care 2014; 29:13-9. [PMID: 25006870 DOI: 10.3109/13561820.2014.936371] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Evidence suggests that breakdowns in communication and a lack of situation awareness contribute to poor performance of medical teams. In this pilot study, three interprofessional obstetrical teams determined the feasibility of using the situation awareness global assessment technique (SAGAT) during simulated critical event management of three obstetrical scenarios. After each scenario, teams were asked to complete questionnaires assessing their opinion of how their performance was affected by the introduction of questions during a SAGAT stop. Fifteen obstetrical professionals took part in the study and completed the three scenarios in teams consisting of five members. At nine questions per stop, more participants agreed or strongly agreed that there were too many questions per stop (57.1%) than when we asked six questions per stop (13%) and three questions per stop (0%). A number of interprofessional differences in response to this interprofessional experience were noted. A team SAGAT score was determined by calculating the proportion of correct responses for each individual. Higher scores were associated with better adherence to outcome times, although not statistically significant. A robust study design building on our pilot data is needed to probe the differing interprofessional perceptions of SAGAT and the potential association between its scores and clinical outcome times.
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Affiliation(s)
- Pamela Morgan
- Department of Anesthesia, Women's College Hospital , University of Toronto, Toronto, ON , Canada
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184
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Leigh S, Granby P, Turner M, Wieteska S, Haycox A, Collins B. The incidence and implications of cerebral palsy following potentially avoidable obstetric complications: a preliminary burden of disease study. BJOG 2014; 121:1720-8. [DOI: 10.1111/1471-0528.12897] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 01/23/2023]
Affiliation(s)
- S Leigh
- Liverpool Health Economics; Management School; University of Liverpool; Liverpool UK
- Lifecode , the Old Vicarage; Lindley Huddersfield UK
| | - P Granby
- Liverpool Health Economics; Management School; University of Liverpool; Liverpool UK
- Lifecode , the Old Vicarage; Lindley Huddersfield UK
| | - M Turner
- Liverpool Women's NHS Foundation Trust; Merseyside UK
| | - S Wieteska
- The Advanced Life Support Group; ALSG Centre for Training & Development; Manchester UK
| | - A Haycox
- Liverpool Health Economics; Management School; University of Liverpool; Liverpool UK
| | - B Collins
- Liverpool Health Economics; Management School; University of Liverpool; Liverpool UK
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185
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Abstract
Though subjective in nature, both the American College of Obstetricians and Gynecologists practice bulletin and the Royal College of Obstetricians and Gynaecologists green guideline are in agreement on the descriptor of shoulder dystocia: requirement of additional obstetric maneuvers when gentle downward traction has failed to affect the delivery of the shoulders. The rate of shoulder dystocia is about 1.4% of all deliveries and 0.7% for vaginal births. Compared to non-diabetics (0.6%), among diabetics, the rate of impacted shoulders is 201% higher (1.9%); newborns delivered by vacuum or forceps have 254% higher likelihood of shoulder dystocia than those born spontaneously (2.0% vs. 0.6%, respectively). When the birthweight is categorized as <4000, 4000-4449, and >4500 g, the likelihood of shoulder dystocia in the US vs. other countries varies significantly. Future studies should focus on lowering the rate of shoulder dystocia and its associated morbidities, without concomitantly increasing the rate of cesarean delivery.
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Affiliation(s)
- Alexandra Hansen
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA
| | - Suneet P Chauhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UT Health Science Center at Houston, Houston, Texas.
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186
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Chauhan SP, Blackwell SB, Ananth CV. Neonatal brachial plexus palsy: incidence, prevalence, and temporal trends. Semin Perinatol 2014; 38:210-8. [PMID: 24863027 DOI: 10.1053/j.semperi.2014.04.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Epidemiological knowledge of the incidence, prevalence, and temporal changes of neonatal brachial plexuses palsy (NBPP) should assist the clinician, avert unnecessary interventions, and help formulate evidence-based health policies. A summary of 63 publications in the English language with over 17 million births and 24,000 NBPPs is notable for six things. First, the rate of NBPP in the US and other countries is comparable: 1.5 vs. 1.3 per 1000 total births, respectively. Second, the rate of NBPP may be decreasing: 0.9, 1.0 and 0.5 per 1,000 births for publications before 1990, 1990-2000, and after 2000, respectively. Third, the likelihood of not having concomitant shoulder dystocia with NBPP was 76% overall, though it varied by whether the publication was from the US (78%) vs. other countries (47%). Fourth, the likelihood of NBPP being permanent (lasting at least 12 months) was 10-18% in the US-based reports and 19-23% in other countries. Fifth, in studies from the US, the rate of permanent NBPP is 1.1-2.2 per 10,000 births and 2.9-3.7 per 10,000 births in other nations. Sixth, we estimate that approximately 5000 NBPPs occur every year in the US, of which over 580-1050 are permanent, and that since birth, 63,000 adults have been afflicted with persistent paresis of their brachial plexus. The exceedingly infrequent nature of permanent NBPP necessitates a multi-center study to improve our understanding of the antecedent factors and to abate the long-term sequela.
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Affiliation(s)
- Suneet P Chauhan
- Department of Obstetrics and Gynecology, University of Texas, Houston, TX.
| | - Sean B Blackwell
- Department of Obstetrics and Gynecology, University of Texas, Houston, TX
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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187
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Abstract
Shoulder dystocia is an obstetric emergency that has been reported to occur in 0.2-3% of all vaginal deliveries. Several characteristics of shoulder dystocia make it a particular challenge to manage effectively. It is relatively infrequent, the diagnosis cannot be made according to a single objective criterion that can be recognized to exist by all members of the care team who are present, it is unpredictable, and there is the need for coordinated actions of all members of the health care team who have come together on the day of the delivery and may not have worked together before or specifically during a shoulder dystocia. In general, there is evidence from different medical disciplines that checklists/protocols and simulation may be used to enhance team performance. There is also some evidence, albeit limited, that such techniques may be used to improve shoulder dystocia outcomes.
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Affiliation(s)
- William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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188
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Kellicut DC, Kuncir EJ, Williamson HM, Masella PC, Nielsen PE. Surgical Team Assessment Training: improving surgical teams during deployment. Am J Surg 2014; 208:275-83. [PMID: 24946726 DOI: 10.1016/j.amjsurg.2014.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 01/27/2014] [Accepted: 03/04/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Simulation and team training are accepted as critical patient safety strategies to improve team performance and can help achieve better outcomes. Standardized and realistic drills conducted by skilled physicians and nurses who demonstrate consistent use of principles which enhance communication and teamwork increase the likelihood of improved clinical outcomes. METHODS Two, 4-member surgeon/nurse teams traveled to 8 Army surgical resuscitation medical treatment facilities in Iraq during July and August 2011. At each site, a new program called Surgical Team Assessment Training was introduced and implemented to 220 military personnel. Two multi-patient scenarios were designed to test resuscitative and operating room medical decision-making, communication, and co-ordination of care. In addition, 2 hours of didactic instruction emphasized principles of TeamSTEPPS applied to emergency and operating rooms during care of patients with multiple, complex traumatic injuries. Anonymous surveys were completed by participants following the training. RESULTS Participants were significantly more likely to rate this training as very helpful following training compared with their opinion before participation (53% vs 37%, P < .05). Seventy-seven percent felt that it would improve overall patient outcomes, 78% said it would likely contribute to saving lives in combat, and 98% felt it should be provided to military Emergency Medicine and Surgical residents. CONCLUSIONS Surgical Team Assessment Training can be successfully implemented in an austere, hostile environment and improve trauma team function by incorporating simulation training models and TeamSTEPPs concepts. Expansion of this program for predeployment and resident training is currently under investigation based on the extremely positive responses.
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Affiliation(s)
- Dwight C Kellicut
- Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859-5000, USA.
| | | | | | - Pamela C Masella
- Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859-5000, USA
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189
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Trentzsch H, Urban B, Sandmeyer B, Hammer T, Strohm PC, Lazarovici M. [Does simulator-based team training improve patient safety?]. Unfallchirurg 2014; 116:900-8. [PMID: 24097241 DOI: 10.1007/s00113-013-2444-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient safety became paramount in medicine as well as in emergency medicine after it was recognized that preventable, adverse events significantly contributed to morbidity and mortality during hospital stay. The underlying errors cannot usually be explained by medical technical inadequacies only but are more due to difficulties in the transition of theoretical knowledge into tasks under the conditions of clinical reality. Crew Resource Management and Human Factors which determine safety and efficiency of humans in complex situations are suitable to control such sources of error. Simulation significantly improved safety in high reliability organizations, such as the aerospace industry.Thus, simulator-based team training has also been proposed for medical areas. As such training is consuming in cost, time and human resources, the question of the cost-benefit ratio obviously arises. This review outlines the effects of simulator-based team training on patient safety. Such course formats are not only capable of creating awareness and improvements in safety culture but also improve technical team performance and emphasize team performance as a clinical competence. A few studies even indicated improvement of patient-centered outcome, such as a reduced rate of adverse events but further studies are required in this respect. In summary, simulator-based team training should be accepted as a suitable strategy to improve patient safety.
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Affiliation(s)
- H Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, Campus Innenstadt, Schillerstraße 53, 80336, München, Deutschland,
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190
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191
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Doyle J, Newhouse L, Flora R, Burkett A. Planning a collaborative conference to provide interdisciplinary education with a focus on patient safety in obstetrics. Nurs Womens Health 2014; 18:130-6. [PMID: 24750652 DOI: 10.1111/1751-486x.12109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Collaboration is an important component of evidence-based practice in modern health care. A number of publications have touted the benefits of "team training" to improve obstetric outcomes during emergent situations. In August 2011, the Ohio sections of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the American Congress of Obstetricians and Gynecologists (ACOG) held a joint conference that focused on interdisciplinary education to promote patient safety. This joint venture drew more than 120 attendees, 12 exhibitors and 17 poster displays. Evaluations were positive and attendees cited planned practice changes for themselves as well as for their respective institutions.
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192
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Singh H, Kalani M, Acosta-Torres S, El Ahmadieh TY, Loya J, Ganju A. History of simulation in medicine: from Resusci Annie to the Ann Myers Medical Center. Neurosurgery 2014; 73 Suppl 1:9-14. [PMID: 24051890 DOI: 10.1227/neu.0000000000000093] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Medical and surgical graduate medical education has historically used a halstedian approach of "see one, do one, teach one." Increased public demand for safety, quality, and accountability in the setting of regulated resident work hours and limited resources is driving the development of innovative educational tools. The use of simulation in nonmedical, medical, and neurosurgical disciplines is reviewed in this article. Simulation has been validated as an educational tool in nonmedical fields such as aviation and the military. Across most medical and surgical subspecialties, simulation is recognized as a valuable tool that will shape the next era of medical education, postgraduate training, and maintenance of certification.
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Affiliation(s)
- Harminder Singh
- *Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; ‡Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Shoushtarian M, Barnett M, McMahon F, Ferris J. Impact of introducing practical obstetric multi-professional training (PROMPT) into maternity units in Victoria, Australia. BJOG 2014; 121:1710-8. [PMID: 24751206 DOI: 10.1111/1471-0528.12767] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the introduction of Practical Obstetric Multi-professional Training (PROMPT) into maternity units and evaluate effects on organisational culture and perinatal outcomes. DESIGN A retrospective cohort study. SETTING Maternity units in eight public hospitals in metropolitan and regional Victoria, Australia. POPULATION Staff in eight maternity units and a total of 43,408 babies born between July 2008 and December 2011. METHODS Representatives from eight Victorian hospitals underwent a single day of training (Train the Trainer), to conduct PROMPT. Organisational culture was compared before and after PROMPT. Clinical outcomes were evaluated before, during and after PROMPT. MAIN OUTCOME MEASURES The number of courses run and the proportion of staff trained were determined. Organisational culture was measured using the Safety Attitude Questionnaire. Clinical measures included Apgar scores at 1 and 5 minutes (Apgar 1 and Apgar 5), cord lactate, blood loss and length of baby's stay in hospital. RESULTS Seven of the eight hospitals conducted PROMPT. Overall about 50% of staff were trained in each year of the study. Significant increases were found in Safety Attitude Questionnaire scores representing domains of teamwork (Hedges' g 0.27, 95% confidence interval [95% CI] 0.13-0.41), safety (Hedges' g 0.28, 95% CI 0.15-0.42) and perception of management (Hedges' g 0.17, 95% CI 0.04-0.31). There were significant improvements in Apgar 1 (OR 0.84, 95% CI 0.77-0.91), cord lactates (odds ratio 0.92, 95% CI 0.85-0.99) and average length of baby's stay in hospital (Hedges' g 0.03, 95% CI 0.01-0.05) during or after training, but no change in Apgar 5 scores or proportion of cases with high blood loss. CONCLUSION PROMPT can be introduced using the Train the Trainer model. Improvements in organisational culture and some clinical measures were observed following PROMPT.
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Affiliation(s)
- M Shoushtarian
- VicPROMPT Pilot Project, Women and Children's Program, Eastern Health, Melbourne, Vic., Australia
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194
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McGaghie WC, Issenberg SB, Barsuk JH, Wayne DB. A critical review of simulation-based mastery learning with translational outcomes. MEDICAL EDUCATION 2014; 48:375-85. [PMID: 24606621 DOI: 10.1111/medu.12391] [Citation(s) in RCA: 346] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/02/2013] [Accepted: 09/30/2013] [Indexed: 05/07/2023]
Abstract
OBJECTIVES This article has two objectives. Firstly, we critically review simulation-based mastery learning (SBML) research in medical education, evaluate its implementation and immediate results, and document measured downstream translational outcomes in terms of improved patient care practices, better patient outcomes and collateral effects. Secondly, we briefly address implementation science and its importance in the dissemination of innovations in medical education and health care. METHODS This is a qualitative synthesis of SBML with translational (T) science research reports spanning a period of 7 years (2006-2013). We use the 'critical review' approach proposed by Norman and Eva to synthesise findings from 23 medical education studies that employ the mastery learning model and measure downstream translational outcomes. RESULTS Research in SBML in medical education has addressed a range of interpersonal and technical skills. Measured outcomes have been achieved in educational laboratories (T1), and as improved patient care practices (T2), patient outcomes (T3) and collateral effects (T4). CONCLUSIONS Simulation-based mastery learning in medical education can produce downstream results. Such results derive from integrated education and health services research programmes that are thematic, sustained and cumulative. The new discipline of implementation science holds promise to explain why medical education innovations are adopted slowly and how to accelerate innovation dissemination.
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Affiliation(s)
- William C McGaghie
- Ralph P Leischner Jr, MD Institute for Medical Education, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
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Monod C, Voekt CA, Gisin M, Gisin S, Hoesli IM. Optimization of competency in obstetrical emergencies: a role for simulation training. Arch Gynecol Obstet 2014; 289:733-8. [PMID: 24346119 PMCID: PMC3949012 DOI: 10.1007/s00404-013-3111-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/21/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE In obstetrical emergency situations, optimal management requires the immediate coordinated actions of a multi-disciplinary and multi-professional team. This study investigated the influence of simulation training on four specific skills: self-confidence, handling of emergency situation, knowledge of algorithms and team communication. METHODS Clinical algorithms were first presented to the participants. Training for six emergency situations (shoulder dystocia, postpartum haemorrhage, pre-eclampsia, maternal basic life support, neonatal resuscitation and operative vaginal birth) was performed using high- and low-fidelity simulation mannequins. General impression of the simulation training and the four above-mentioned skills were evaluated anonymously through a self-assessment questionnaire with a five-point Likert scale immediately after the training and 3 months later. RESULTS From November 2010 to March 2012, 168 participants, distributed over six one-day courses, took part in the training. 156 participants returned the questionnaire directly after the course (92.9 %). The questionnaire return rate after 3 months was 36.3 %. The participants gave higher Likert scale answers for the questions on the four specific skills after 3 months compared to immediately after the course. The improvement was statistically significant (p ≤ 0.05) except for the question regarding team communication. CONCLUSION Implementation of simulation training strengthens the professional competency.
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Affiliation(s)
- Cécile Monod
- Department of Obstetrics, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Cora A. Voekt
- Department of Obstetrics, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Martina Gisin
- Department of Obstetrics, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Stefan Gisin
- Department of Anaesthesiology, University Hospital Basel, Spitalstrasse 21, Basel, Switzerland
- Swiss Center for Medical Simulation “SimBa”, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Irene M. Hoesli
- Department of Obstetrics, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
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Jan H, Guimicheva B, Gosh S, Hamid R, Penna L, Sarris I. Evaluation of healthcare professionals’ understanding of eponymous maneuvers and mnemonics in emergency obstetric care provision. Int J Gynaecol Obstet 2014; 125:228-31. [DOI: 10.1016/j.ijgo.2013.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 12/10/2013] [Accepted: 02/26/2014] [Indexed: 11/27/2022]
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A Randomized, Controlled Trial of In Situ Pediatric Advanced Life Support Recertification (“Pediatric Advanced Life Support Reconstructed”) Compared With Standard Pediatric Advanced Life Support Recertification for ICU Frontline Providers*. Crit Care Med 2014; 42:610-8. [DOI: 10.1097/ccm.0000000000000024] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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198
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Fang TY, Wang PC, Liu CH, Su MC, Yeh SC. Evaluation of a haptics-based virtual reality temporal bone simulator for anatomy and surgery training. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 113:674-681. [PMID: 24280627 DOI: 10.1016/j.cmpb.2013.11.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 11/04/2013] [Accepted: 11/08/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Virtual reality simulation training may improve knowledge of anatomy and surgical skills. We evaluated a 3-dimensional, haptic, virtual reality temporal bone simulator for dissection training. METHODS The subjects were 7 otolaryngology residents (3 training sessions each) and 7 medical students (1 training session each). The virtual reality temporal bone simulation station included a computer with software that was linked to a force-feedback hand stylus, and the system recorded performance and collisions with vital anatomic structures. Subjects performed virtual reality dissections and completed questionnaires after the training sessions. RESULTS Residents and students had favorable responses to most questions of the technology acceptance model (TAM) questionnaire. The average TAM scores were above neutral for residents and medical students in all domains, and the average TAM score for residents was significantly higher for the usefulness domain and lower for the playful domain than students. The average satisfaction questionnaire for residents showed that residents had greater overall satisfaction with cadaver temporal bone dissection training than training with the virtual reality simulator or plastic temporal bone. For medical students, the average comprehension score was significantly increased from before to after training for all anatomic structures. Medical students had significantly more collisions with the dura than residents. The residents had similar mean performance scores after the first and third training sessions for all dissection procedures. DISCUSSION The virtual reality temporal bone simulator provided satisfactory training for otolaryngology residents and medical students.
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Affiliation(s)
- Te-Yung Fang
- Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan; Fu Jen Catholic University School of Medicine, New Taipei City, Taiwan
| | - Pa-Chun Wang
- Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan; Fu Jen Catholic University School of Medicine, New Taipei City, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Hsien Liu
- Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan
| | - Mu-Chun Su
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan
| | - Shih-Ching Yeh
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan.
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Cooper SJ, Cant RP. Measuring non-technical skills of medical emergency teams: An update on the validity and reliability of the Team Emergency Assessment Measure (TEAM). Resuscitation 2014; 85:31-3. [DOI: 10.1016/j.resuscitation.2013.08.276] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/25/2013] [Accepted: 08/01/2013] [Indexed: 11/29/2022]
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Fox R, Yelland A, Draycott T. Analysis of legal claims-informing litigation systems and quality improvement. BJOG 2013; 121:6-10. [DOI: 10.1111/1471-0528.12491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/29/2022]
Affiliation(s)
- R Fox
- Maternity Unit; Taunton & Somerset NHS Trust; Taunton UK
| | - A Yelland
- Faculty of Health & Life Sciences; University of the West of England; Glenside Campus; Bristol UK
| | - T Draycott
- Maternity Unit; North Bristol NHS Trust; Bristol UK
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