301
|
Leung TY, Stuart O, Sahota DS, Suen SSH, Lau TK, Lao TT. Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: a retrospective review. BJOG 2010; 118:474-9. [PMID: 21199293 DOI: 10.1111/j.1471-0528.2010.02834.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the association between head-to-body delivery interval (HBDI) and cord arterial pH and base excess (BE), and the risk of development of hypoxic ischaemic encephalopathy (HIE). DESIGN Retrospective review. SETTING A university hospital. POPULATION Pregnancies complicated with shoulder dystocia during the period 1995-2009. METHODS Cases were identified from a search of the hospital electronic delivery records. Cord arterial pH and BE, and the incidence of HIE and perinatal death, were retrieved from medical records and correlated with HBDI, birth weight, mode of delivery and presence of nonreassuring fetal heart rate pattern and maternal diabetes using univariate analysis, followed by multivariate analysis. MAIN OUTCOME MEASURES Any association between cord pH and HBDI. RESULTS Of the 200 cases identified, the mean (standard deviation) HBDI was 2.5 minutes (1.5 minutes). Both HBDI and the presence of nonreassuring fetal heart rate pattern were independent factors for pH, and HBDI was the only significant factor for BE. Arterial pH dropped at a rate of 0.011 per minute [95% confidence interval (95% CI), 0.017-0.004; P = 0.002] with HBDI. The mode of delivery, birth weight and maternal diabetes did not affect blood gas levels. The respective risks of severe acidosis (pH < 7) and HIE with HBDI of <5 minutes were 0.5% and 0.5% versus 5.9% and 23.5% with HBDI ≥ 5 minutes. CONCLUSIONS Cord arterial pH drops with HBDI during shoulder dystocia, but the risk of acidosis or HIE is very low with HBDI < 5 minutes.
Collapse
Affiliation(s)
- T Y Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, China.
| | | | | | | | | | | |
Collapse
|
302
|
Abstract
The World Health Organisation (WHO) has estimated that 1500 women die every day from preventable complications of pregnancy and childbirth. While barriers to accessing healthcare are undoubtedly multi-factorial, studies have repeatedly shown that providing skilled healthcare workers can result in untold benefits for women and babies in developing countries. The phenomenon of preventable maternal and fetal morbidity and mortality is not limited to the developing world. The Confidential Enquiries into Maternal Deaths (CEMD) and Stillbirths and Infant Deaths (CESDI) in the UK have repeatedly identified substandard care as a major contributor to maternal and neonatal mortality. In 2008 The King's Fund publishedSafe Births: Everybody's business,an independent enquiry into the safety of maternity services in England. This recommended that simulation-based training to assess clinical, communication and team skills should be available to all maternity staff, and that training should form a core activity. Many hospitals in the UK have been running in-house courses for staff for over a decade with measurable improvements in neonatal outcomes. The value of these training schemes is recognised and rewarded through reduced insurance premiums for participating hospital trusts as part of clinical negligence schemes. Gaining competence in managing obstetric emergencies presents particular challenges for trainees. Most emergencies are, thankfully, uncommon but some constitute life-threatening events where management naturally falls to the most experienced available clinician. The skills required are often particular to emergencies and therefore novel to trainees. Utilising emergencies as training opportunities is further complicated by the presence of a conscious patient.
Collapse
|
303
|
Siassakos D, Fox R, Crofts JF, Hunt LP, Winter C, Draycott TJ. The management of a simulated emergency: better teamwork, better performance. Resuscitation 2010; 82:203-6. [PMID: 21144637 DOI: 10.1016/j.resuscitation.2010.10.029] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/14/2010] [Accepted: 10/31/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether team performance in a simulated emergency is related to generic teamwork skills and behaviours. METHODS Design - Cross-sectional analysis of data from the Simulation and Fire-drill Evaluation (SaFE) randomised controlled trial. Setting - Six secondary and tertiary Maternity Units in Southwest England. Participants - 140 healthcare professionals, in 24 teams. Assessment - Blinded analysis of recorded simulations. Main outcome measures - Correlation of team performance (efficiency conducting key clinical actions, including the administration of an essential drug, magnesium), and generic teamwork scores (using a validated tool that assesses skills and behaviours, by Weller et al.). RESULTS There was significant positive correlation between clinical efficiency and teamwork scores across all three dimensions; skills (Kendall's tau(b)=0.54, p<0.001), behaviours (tau(b)=0.41, p=0.001), and overall score (tau(b)=0.51, p<0.001). Better teams administered the essential drug 2½min more quickly (Mann-Whitney U, p<0.001). CONCLUSIONS The clinical conduct of a simulated emergency was strongly linked to generic measures of teamwork. Further studies are needed to elucidate which aspects of team working are critical for team performance, to better inform training programs for multi-professional team working.
Collapse
|
304
|
Wayne DB, Holmboe ES. First do no harm: preserving patient safety without sacrificing procedural education. J Grad Med Educ 2010; 2:499-501. [PMID: 22132266 PMCID: PMC3010928 DOI: 10.4300/jgme-d-10-00183.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Diane B. Wayne
- Corresponding author: Diane B. Wayne, MD, Department of Medicine, Northwestern University, Galter 3-150, 251 E Huron Street, Chicago, IL 60611, 312.926.7251,
| | | |
Collapse
|
305
|
Ennen CS, Satin AJ. Training and assessment in obstetrics: the role of simulation. Best Pract Res Clin Obstet Gynaecol 2010; 24:747-58. [DOI: 10.1016/j.bpobgyn.2010.03.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 03/22/2010] [Indexed: 12/20/2022]
|
306
|
Gittens-Williams L. Contemporary Management of Shoulder Dystocia. WOMENS HEALTH 2010; 6:861-9. [DOI: 10.2217/whe.10.65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Shoulder dystocia is an uncommon but potentially catastrophic intrapartum event. Although risk factors such as maternal diabetes, obesity and macrosomia can be identified, shoulder dystocia most frequently occurs in patients who lack risk factors. Many maneuvers have been described to assist the operator in the safe release of the shoulder and subsequent delivery; however, no prospective trials have compared these maneuvers in such a way to suggest that one maneuver is superior to another. This article describes the identification of patients at risk for shoulder dystocia, clinical management of the shoulder dystocia, event documentation and the contemporary use of drills and simulation training to improve team preparedness for this unpredictable and usually unavoidable event.
Collapse
Affiliation(s)
- Lisa Gittens-Williams
- Department of Obstetrics, Gynecology and Women's Health, New Jersey Medical School, 185 South Orange Avenue MSB E 506 Newark, NJ 07103, USA, Tel.: +1 973 972 5344, Fax: +1 973 972 4574,
| |
Collapse
|
307
|
Interdepartmental Simulation Collaboration in Academia: Exploring Partnerships With Other Disciplines. Clin Simul Nurs 2010. [DOI: 10.1016/j.ecns.2010.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
308
|
Siassakos D, Fox R, Hunt L, Farey J, Laxton C, Winter C, Draycott T. Attitudes toward safety and teamwork in a maternity unit with embedded team training. Am J Med Qual 2010; 26:132-7. [PMID: 20935272 DOI: 10.1177/1062860610373379] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of this study was to identify any residual challenges in a unit with a track record of good clinical performance. A cross-sectional survey of frontline caregiver attitudes was conducted using a validated psychometric instrument. A total of 69% (91 of 132) of eligible participants completed questionnaires. The results indicated positive safety culture, teamwork climate, and job satisfaction. Perceptions of high workload and insufficient staffing levels were the most prominent negative observations but not to the detriment of job satisfaction or perception of work conditions. Male staff had consistently better safety attitudes in multivariate analyses. The authors identified 24-hour consultant (attending) presence and better support by management as prerequisites for further improvement. Teamwork and safety attitudes are positive in a unit with established interprofessional team training. Establishing better support by senior clinical and management leaders was identified as a necessary intervention to improve attitudes and safety.
Collapse
|
309
|
Mobile In Situ Obstetric Emergency Simulation and Teamwork Training to Improve Maternal-Fetal Safety in Hospitals. Jt Comm J Qual Patient Saf 2010; 36:443-53. [DOI: 10.1016/s1553-7250(10)36066-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
310
|
Browne M, Jacobs M, Lahiff M, Miller S. Perineal injury in nulliparous women giving birth at a community hospital: reduced risk in births attended by certified nurse-midwives. J Midwifery Womens Health 2010; 55:243-9. [PMID: 20434084 DOI: 10.1016/j.jmwh.2009.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Revised: 11/06/2009] [Accepted: 11/06/2009] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Our objective was to determine if there is a difference in rates of perineal injury sustained by nulliparous women attended by obstetricians compared with certified nurse-midwives (CNMs) at a US community hospital. METHODS We analyzed retrospective data for 2819 women who spontaneously gave birth to singleton, vertex, term, live infants between 2000 and 2005. The independent variable was attendant type (obstetrician or CNM). The main outcome variables were intact perineum, episiotomy, and spontaneous perineal lacerations. Multivariate logistic regression was used to adjust for six potential confounders: macrosomia, maternal age, epidural anesthesia, oxytocin administration, medical insurance status, and ethnicity. RESULTS The odds ratios (ORs) for obstetrician-attended births versus CNM-attended births were significant for a spontaneous minor perineal laceration versus intact perineum (OR = 1.82; 95% confidence interval [CI], 1.33-2.48), spontaneous major laceration versus intact perineum (OR = 2.29; 95% CI, 1.13-4.66), and episiotomy use versus no perineal injury, with or without extension (OR = 2.94; 95% CI, 2.01-4.29). DISCUSSION We found that the prevalence and severity of perineal injury, both spontaneous and from episiotomy use, were significantly lower in CNM-attended births.
Collapse
Affiliation(s)
- Maureen Browne
- Department of Genetics, Kaiser Permanente Northern California, 280 West MacArthur Blvd., Oakland, CA 94611, USA.
| | | | | | | |
Collapse
|
311
|
|
312
|
|
313
|
Evans LV, Dodge KL, Shah TD, Kaplan LJ, Siegel MD, Moore CL, Hamann CJ, Lin Z, D'Onofrio G. Simulation training in central venous catheter insertion: improved performance in clinical practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:1462-9. [PMID: 20736674 DOI: 10.1097/acm.0b013e3181eac9a3] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE To determine whether simulation training of ultrasound (US)-guided central venous catheter (CVC) insertion skills on a partial task trainer improves cannulation and insertion success rates in clinical practice. METHOD This prospective, randomized, controlled, single-blind study of first- and second-year residents occurred at a tertiary care teaching hospital from January 2007 to September 2008. The intervention group (n = 90) received a didactic and hands-on, competency-based simulation training course in US-guided CVC insertion, whereas the control group (n = 95) received training through a traditional, bedside apprenticeship model. Success at first cannulation and successful CVC insertion served as the primary outcomes. Secondary outcomes included reduction in technical errors and decreased mechanical complications. RESULTS Blinded independent raters observed 495 CVC insertions by 115 residents over a 21-month period. Successful first cannulation occurred in 51% of the intervention group versus 37% of the control group (P = .03). CVC insertion success occurred for 78% of the intervention group versus 67% of the control group (P = .02). Simulation training was independently and significantly associated with success at first cannulation (odds ratio: 1.7; 95% confidence interval: 1.1-2.8) and with successful CVC insertion (odds ratio: 1.7; 95% confidence interval: 1.1-2.8)--both independent of US use, patient comorbidities, or resident specialty. No significant differences related to technical errors or mechanical complications existed between the two groups. CONCLUSIONS Simulation training was associated with improved in-hospital performance of CVC insertion. Procedural simulation was associated with improved residents' skills and was more effective than traditional training.
Collapse
Affiliation(s)
- Leigh V Evans
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut 06519, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
314
|
Wayne DB, McGaghie WC. Use of simulation-based medical education to improve patient care quality. Resuscitation 2010; 81:1455-6. [PMID: 20800332 DOI: 10.1016/j.resuscitation.2010.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 07/20/2010] [Indexed: 02/03/2023]
|
315
|
Cooke H, Foureur M, Kinnear A, Bisits A, Giles W. The development and initiation of the NSW Department of Health interprofessional Fetal welfare Obstetric emergency Neonatal resuscitation Training project. Aust N Z J Obstet Gynaecol 2010; 50:334-9. [PMID: 20716260 DOI: 10.1111/j.1479-828x.2010.01167.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Fetal Welfare Obstetric emergency Neonatal resuscitation Training (FONT) project was initiated on a background of rising notifications of adverse events in NSW maternity units, the significant proportion of which were related to fetal welfare assessment. AIMS The aim of the study is to describe the development and introduction of the NSW state-wide interprofessional FONT project. METHODS Following development and risk assessment, FONT was launched in February 2008. The project consists of an online component and two face-to-face training days to be completed each 3 years; the first day for fetal welfare assessment and the second for obstetric and newborn emergencies. Eight, 2-day training sessions were conducted throughout NSW for FONT trainers. Each trainer underwent pre- and post-testing for changes in knowledge of fetal welfare assessment. The 2005-2008 NSW adverse event report numbers were assessed. RESULTS From 20 February to 17 April 2008, 240 trainers had been trained in fetal welfare assessment, and by the end of 2008 these trainers had trained 954 clinicians. There were significant improvements in the interpretation and management planning of electronic fetal heart rate patterns following training. Analysis of Severity Assessment Codes 1 and 2 showed no significant trend in the number of notifications for adverse events related to fetal welfare assessment. CONCLUSIONS In the first 11 months, 25% of the state's maternity practitioners had received training in the first stage of the FONT project. The FONT project has shown short-term improvements in learning and communication skills and in the participants of the project.
Collapse
Affiliation(s)
- Helen Cooke
- NSW Department of Health, New South Wales, Australia
| | | | | | | | | |
Collapse
|
316
|
Exploratory Randomized Controlled Trial of Hybrid Obstetric Simulation Training for Undergraduate Students. Simul Healthc 2010; 5:193-8. [DOI: 10.1097/sih.0b013e3181d3ee0b] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
317
|
|
318
|
Siassakos D, Draycott TJ, Crofts JF, Hunt LP, Winter C, Fox R. More to teamwork than knowledge, skill and attitude. BJOG 2010; 117:1262-9. [PMID: 20618313 DOI: 10.1111/j.1471-0528.2010.02654.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess whether team performance in simulated eclampsia is related to the knowledge, skills and attitudes of individual team members. DESIGN Cross-sectional analysis of data from the Simulation and Fire Drill Evaluation randomised controlled trial. SETTING Six secondary and tertiary maternity units in south-west England. PARTICIPANTS One hundred and fourteen maternity professionals in 19 teams of six members; one senior and one junior obstetrician; two senior and two junior midwives. METHODS We validated a team performance ranking scheme with respect to magnesium administration (Magnesium Administration Rank, MAR) by expert consensus (face validity) and correlation with clinical measures (construct validity). We tested for correlation between MAR and measures of knowledge, skills and attitudes. MAIN OUTCOME MEASURES Correlation between team performance (MAR) and scores in validated multiple-choice questionnaires (MCQs) (knowledge), a measure of individual manual skill to manage an obstetric emergency (skill) and scores in a widely used teamwork/safety attitude questionnaire (attitude). RESULTS There was no relationship between team performance and cumulative individual MCQs, skill or teamwork/safety attitude scores. CONCLUSIONS The knowledge, manual skills and attitudes of the individuals comprising each team, measured by established methods, did not correlate in this study with the team's clinical efficiency in the management of simulated eclampsia. The inference is that unidentified characteristic(s) play a crucial part in the efficiency of teams managing emergencies. Any emphasis of training programmes to promote individual knowledge, skills and attitudes alone may have to be re-examined. This highlights a need to understand what makes a team efficient in dealing with clinical emergencies.
Collapse
|
319
|
Sorensen BL, Rasch V, Massawe S, Nyakina J, Elsass P, Nielsen BB. Impact of ALSO training on the management of prolonged labor and neonatal care at Kagera Regional Hospital, Tanzania. Int J Gynaecol Obstet 2010; 111:8-12. [PMID: 20646704 DOI: 10.1016/j.ijgo.2010.04.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 04/23/2010] [Accepted: 05/20/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the management of prolonged labor and neonatal care before and after Advanced Life Support in Obstetrics (ALSO) training. METHODS Staff involved in childbirth at Kagera Regional Hospital, Tanzania, attended a 2-day ALSO provider course. In this prospective intervention study conducted between July and November 2008, the management and outcomes of 558 deliveries before and 550 after the training were observed. RESULTS There was no significant difference in the rate of cesarean deliveries owing to prolonged labor, and vacuum delivery was not practiced after the intervention. During prolonged labor, action was delayed for more than 3 hours in half of the cases. The stillbirth rate, Apgar scores, and frequency of neonatal resuscitation did not change significantly. After the intervention, there was a significant increase in newborns given to their mothers within 10 minutes, from 5.6% to 71.5% (RR 12.71; 95% CI, 9.04-17.88). There was a significant decrease from 6 to 0 neonatal deaths before discharge among those born with an Apgar score after 1 minute of 4 or more (P=0.03). CONCLUSION ALSO training had no effect on the management of prolonged labor. Early contact between newborn and mother was more frequently practiced after ALSO training and the immediate neonatal mortality decreased.
Collapse
Affiliation(s)
- Bjarke Lund Sorensen
- Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen K, Denmark.
| | | | | | | | | | | |
Collapse
|
320
|
Abstract
Research on medical education is translational science when rigorous studies on trainee clinical skill and knowledge acquisition address key health care problems and measure outcomes in controlled laboratory settings (T1 translational research); when these outcomes transfer to clinics, wards, and offices where better health care is delivered (T2); and when patient or public health improves as a result of educational practices (T3). This Commentary covers features of medical education interventions and environments that contribute to translational outcomes, reviews selected research studies that advance translational science in medical education at all three levels, and presents pathways to improve medical education translational science.
Collapse
Affiliation(s)
- William C McGaghie
- Northwestern University Feinberg School of Medicine and the Northwestern University Clinical and Translational Sciences (NUCATS) Institute, Chicago, IL 60611, USA.
| |
Collapse
|
321
|
Siassakos D, Draycott T, Montague I, Harris M. Content analysis of team communication in an obstetric emergency scenario. J OBSTET GYNAECOL 2010; 29:499-503. [DOI: 10.1080/01443610903039153] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
322
|
Kobayashi L, Lindquist DG, Jenouri IM, Dushay KM, Haze D, Sutton EM, Smith JL, Tubbs RJ, Overly FL, Foggle J, Dunbar-Viveiros J, Jones MS, Marcotte ST, Werner DL, Cooper MR, Martin PB, Tammaro D, Jay GD. Comparison of sudden cardiac arrest resuscitation performance data obtained from in-hospital incident chart review and in situ high-fidelity medical simulation. Resuscitation 2010; 81:463-71. [DOI: 10.1016/j.resuscitation.2010.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 11/20/2009] [Accepted: 01/06/2010] [Indexed: 11/27/2022]
|
323
|
Obstetric care in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obstet 2010; 107 Suppl 1:S21-44, S44-5. [PMID: 19815204 DOI: 10.1016/j.ijgo.2009.07.017] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Each year, approximately 2 million babies die because of complications of childbirth, primarily in settings where effective care at birth, particularly prompt cesarean delivery, is unavailable. OBJECTIVE We reviewed the content, impact, risk-benefit, and feasibility of interventions for obstetric complications with high population attributable risk of intrapartum-related hypoxic injury, as well as human resource, skill development, and technological innovations to improve obstetric care quality and availability. RESULTS Despite ecological associations of obstetric care with improved perinatal outcomes, there is limited evidence that intrapartum interventions reduce intrapartum-related neonatal mortality or morbidity. No interventions had high-quality evidence of impact on intrapartum-related outcomes in low-resource settings. While data from high-resource settings support planned cesarean for breech presentation and post-term induction, these interventions may be unavailable or less safe in low-resource settings and require risk-benefit assessment. Promising interventions include use of the partograph, symphysiotomy, amnioinfusion, therapeutic maneuvers for shoulder dystocia, improved management of intra-amniotic infections, and continuous labor support. Obstetric drills, checklists, and innovative low-cost devices could improve care quality. Task-shifting to alternative cadres may increase coverage of care. CONCLUSIONS While intrapartum care aims to avert intrapartum-related hypoxic injury, rigorous evidence is lacking, especially in the settings where most deaths occur. Effective care at birth could save hundreds of thousands of lives a year, with investment in health infrastructure, personnel, and research--both for innovation and to improve implementation.
Collapse
|
324
|
Bredmose PP, Habig K, Davies G, Grier G, Lockey DJ. Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model. Scand J Trauma Resusc Emerg Med 2010; 18:13. [PMID: 20230636 PMCID: PMC2845090 DOI: 10.1186/1757-7241-18-13] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 03/15/2010] [Indexed: 11/21/2022] Open
Abstract
Introduction We describe a system of scenario-based training using simple mannequins under realistic circumstances for the training of pre-hospital care providers. Methods A simple intubatable mannequin or student volunteers are used together with a training version of the equipment used on a routine basis by the pre-hospital care team (doctor + paramedic). Training is conducted outdoors at the base location all year round. The scenarios are led by scenario facilitators who are predominantly senior physicians. Their role is to brief the training team and guide the scenario, results of patient assessment and the simulated responses to interventions and treatment. Pilots, fire-fighters and medical students are utilised in scenarios to enhance realism by taking up roles as bystanders, additional ambulance staff and police. These scenario participants are briefed and introduced to the scene in a realistic manner. After completion of the scenario, the training team would usually be invited to prepare and deliver a hospital handover as they would in a real mission. A formal structured debrief then takes place. Results This training method technique has been used for the training of all London Helicopter Emergency Medical Service (London HEMS) doctors and paramedics over the last 24 months. Informal participant feedback suggests that this is a very useful teaching method, both for improving motor skills, critical decision-making, scene management and team interaction. Although formal assessment of this technique has not yet taken place we describe how this type of training is conducted in a busy operational pre-hospital trauma service. Discussion The teaching and maintenance of pre-hospital care skills is essential to an effective pre-hospital trauma care system. Simple mannequin based scenario training is feasible on a day-to-day basis and has the advantages of low cost, rapid set up and turn around. The scope of scenarios is limited only by the imagination of the trainers. Significant effort is made to put the participants into "the Zone" - the psychological mindset, where they believe they are in a realistic setting and treating a real patient, so that they gain the most from each teaching session. The method can be used for learning new skills, communication and leadership as well as maintaining existing skills. Conclusion The method described is a low technology, low cost alternative to high technology simulation which may provide a useful adjunct to delivering effective training when properly prepared and delivered. We find this useful for both induction and regular training of pre-hospital trauma care providers.
Collapse
Affiliation(s)
- Per P Bredmose
- London Helicopter Emergency Medical Service, Department of Pre-hospital Care, The Royal London Hospital, London E1 1BB, UK
| | | | | | | | | |
Collapse
|
325
|
Okuda Y, Bryson EO, DeMaria S, Jacobson L, Quinones J, Shen B, Levine AI. The utility of simulation in medical education: what is the evidence? ACTA ACUST UNITED AC 2010; 76:330-43. [PMID: 19642147 DOI: 10.1002/msj.20127] [Citation(s) in RCA: 533] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Medical schools and residencies are currently facing a shift in their teaching paradigm. The increasing amount of medical information and research makes it difficult for medical education to stay current in its curriculum. As patients become increasingly concerned that students and residents are "practicing" on them, clinical medicine is becoming focused more on patient safety and quality than on bedside teaching and education. Educators have faced these challenges by restructuring curricula, developing small-group sessions, and increasing self-directed learning and independent research. Nevertheless, a disconnect still exists between the classroom and the clinical environment. Many students feel that they are inadequately trained in history taking, physical examination, diagnosis, and management. Medical simulation has been proposed as a technique to bridge this educational gap. This article reviews the evidence for the utility of simulation in medical education. We conducted a MEDLINE search of original articles and review articles related to simulation in education with key words such as simulation, mannequin simulator, partial task simulator, graduate medical education, undergraduate medical education, and continuing medical education. Articles, related to undergraduate medical education, graduate medical education, and continuing medical education were used in the review. One hundred thirteen articles were included in this review. Simulation-based training was demonstrated to lead to clinical improvement in 2 areas of simulation research. Residents trained on laparoscopic surgery simulators showed improvement in procedural performance in the operating room. The other study showed that residents trained on simulators were more likely to adhere to the advanced cardiac life support protocol than those who received standard training for cardiac arrest patients. In other areas of medical training, simulation has been demonstrated to lead to improvements in medical knowledge, comfort in procedures, and improvements in performance during retesting in simulated scenarios. Simulation has also been shown to be a reliable tool for assessing learners and for teaching topics such as teamwork and communication. Only a few studies have shown direct improvements in clinical outcomes from the use of simulation for training. Multiple studies have demonstrated the effectiveness of simulation in the teaching of basic science and clinical knowledge, procedural skills, teamwork, and communication as well as assessment at the undergraduate and graduate medical education levels. As simulation becomes increasingly prevalent in medical school and resident education, more studies are needed to see if simulation training improves patient outcomes.
Collapse
Affiliation(s)
- Yasuharu Okuda
- Department of Emergency Medicine and Medical Education, Mount Sinai School of Medicine, New York, NY, USA.
| | | | | | | | | | | | | |
Collapse
|
326
|
Daniels K, Arafeh J, Clark A, Waller S, Druzin M, Chueh J. Prospective Randomized Trial of Simulation Versus Didactic Teaching for Obstetrical Emergencies. Simul Healthc 2010; 5:40-5. [DOI: 10.1097/sih.0b013e3181b65f22] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
327
|
McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical review of simulation-based medical education research: 2003-2009. MEDICAL EDUCATION 2010; 44:50-63. [PMID: 20078756 DOI: 10.1111/j.1365-2923.2009.03547.x] [Citation(s) in RCA: 866] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES This article reviews and critically evaluates historical and contemporary research on simulation-based medical education (SBME). It also presents and discusses 12 features and best practices of SBME that teachers should know in order to use medical simulation technology to maximum educational benefit. METHODS This qualitative synthesis of SBME research and scholarship was carried out in two stages. Firstly, we summarised the results of three SBME research reviews covering the years 1969-2003. Secondly, we performed a selective, critical review of SBME research and scholarship published during 2003-2009. RESULTS The historical and contemporary research synthesis is reported to inform the medical education community about 12 features and best practices of SBME: (i) feedback; (ii) deliberate practice; (iii) curriculum integration; (iv) outcome measurement; (v) simulation fidelity; (vi) skill acquisition and maintenance; (vii) mastery learning; (viii) transfer to practice; (ix) team training; (x) high-stakes testing; (xi) instructor training, and (xii) educational and professional context. Each of these is discussed in the light of available evidence. The scientific quality of contemporary SBME research is much improved compared with the historical record. CONCLUSIONS Development of and research into SBME have grown and matured over the past 40 years on substantive and methodological grounds. We believe the impact and educational utility of SBME are likely to increase in the future. More thematic programmes of research are needed. Simulation-based medical education is a complex service intervention that needs to be planned and practised with attention to organisational contexts.
Collapse
Affiliation(s)
- William C McGaghie
- Augusta Webster, MD, Office of Medical Education and Faculty Development, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611-3008, USA.
| | | | | | | |
Collapse
|
328
|
DuPree E, O'Neill L, Anderson RM. Achieving a Safety Culture in Obstetrics. ACTA ACUST UNITED AC 2009; 76:529-38. [DOI: 10.1002/msj.20144] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
329
|
Deering SH, Chinn M, Hodor J, Benedetti T, Mandel LS, Goff B. Use of a postpartum hemorrhage simulator for instruction and evaluation of residents. J Grad Med Educ 2009; 1:260-3. [PMID: 21975989 PMCID: PMC2931261 DOI: 10.4300/jgme-d-09-00023.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Postpartum hemorrhage is a common and potentially life-threatening obstetric emergency. We sought to create a realistic simulation and validate a standardized grading form to evaluate competency in the management of postpartum hemorrhage. METHODS Residents from 3 programs underwent training with a postpartum hemorrhage simulation using a standard obstetric birthing model equipped with an inflatable uterus to simulate uterine atony. All simulations were graded by staff physicians with a standardized grading sheet constructed from the current literature on the topic. Residents were expected to recognize the hemorrhage and take appropriate steps, including asking the assistant to administer medications, to correct the problem. Objective and subjective performance was measured with standardized grading sheets, and results were analyzed for reliability using Cronbach α and intraclass correlation coefficients. This project was conducted in accordance with the hospital Institutional Review Board policies at each institution. RESULTS Forty residents from 3 institutions underwent simulation training. The majority were unable to correct the hemorrhage within 5 minutes and almost half also made at least 1 error, either the dose or route, in the medications they requested. Reliability was evaluated with Cronbach α and demonstrated the grading sheets were valid and had good interrater reliability. DISCUSSION A simulated postpartum hemorrhage scenario can identify important deficiencies in resident knowledge and performance, with no risk to patients. The standardized grading form worked well for our purposes and was reliable in our study. Further testing is needed to evaluate whether the training improves performance in real-life hemorrhages.
Collapse
Affiliation(s)
- Shad H. Deering
- Corresponding author: Shad H Deering, MD, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, 4030 Fitzsimmons Drive, Tacoma, WA 98431, 253.968.2296,
| | | | | | | | | | | |
Collapse
|
330
|
Raemer DB. Simulation in cardiothoracic surgery: A paradigm shift in education? J Thorac Cardiovasc Surg 2009; 138:1065-6. [DOI: 10.1016/j.jtcvs.2009.07.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 07/23/2009] [Indexed: 11/29/2022]
|
331
|
Morgan P, Tarshis J, LeBlanc V, Cleave-Hogg D, DeSousa S, Haley M, Herold-McIlroy J, Law J. Efficacy of high-fidelity simulation debriefing on the performance of practicing anaesthetists in simulated scenarios. Br J Anaesth 2009; 103:531-7. [DOI: 10.1093/bja/aep222] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
332
|
Siassakos D, Clark J, Sibanda T, Attilakos G, Jefferys A, Cullen L, Bisson D, Draycott T. A simple tool to measure patient perceptions of operative birth. BJOG 2009; 116:1755-61. [PMID: 19775304 DOI: 10.1111/j.1471-0528.2009.02363.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the feasibility and validity of a maternal satisfaction measurement tool, the SaFE study Patient Perception Score (PPS), after operative delivery. DESIGN Cross-sectional survey. SETTING A large maternity unit in England. SAMPLE 150 women who had had an operative birth. METHODS We recruited women within 24 hours of birth and quantified their satisfaction with two questionnaires: PPS, and the Mackey Childbirth Satisfaction Rating Scale (CSRS; modified). MAIN OUTCOME MEASURES Participation rate to determine feasibility; Cronbach's alpha as measure of internal consistency; PPS satisfaction scores for groups of accoucheurs of different seniority to assess construct validity; correlation coefficient of PPS scores with total scores from the CSRS questionnaire to establish criterion validity. RESULTS Participation rate approached 85%. We observed high scores for most births except a few outliers. Internal consistency of the PPS was high (Cronbach's alpha=0.83). Total PPS scores correlated strongly with total CSRS scores (Spearman's r=0.64, P<0.001). CONCLUSIONS The PPS is a simple and valid tool for patient-centred assessments. High scores were observed for most births but there were a small minority of accoucheurs who consistently scored poorly and these data could be used during appraisal and training.
Collapse
Affiliation(s)
- D Siassakos
- Women's Health, Chilterns, Southmead Hospital, Westbury on Trym, BS10 5NB, Bristol, UK.
| | | | | | | | | | | | | | | |
Collapse
|
333
|
|
334
|
Siassakos D, Crofts JF, Winter C, Weiner CP, Draycott TJ. The active components of effective training in obstetric emergencies. BJOG 2009; 116:1028-32. [PMID: 19438497 DOI: 10.1111/j.1471-0528.2009.02178.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Confidential enquiries into poor perinatal outcomes have identified deficiencies in team working as a common factor and have recommended team training in the management of obstetric emergencies. Isolated aviation-based team training programmes have not been associated with improved perinatal outcomes when applied to labour ward settings, whereas obstetric-specific training interventions with integrated teamwork have been associated with clinical improvements. This commentary reviews obstetric emergency training programmes from hospitals that have demonstrated improved outcomes to determine the active components of effective training. The common features identified were: institution-level incentives to train; multi-professional training of all staff in their units; teamwork training integrated with clinical teaching and use of high fidelity simulation models. Local training also appeared to facilitate self-directed infrastructural change.
Collapse
Affiliation(s)
- D Siassakos
- Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK.
| | | | | | | | | |
Collapse
|
335
|
Sibanda T, Crofts JF, Barnfield S, Siassakos D, Epee MJ, Winter C, Draycott T. PROMPT education and development: saving mothers’ and babies’ lives in resource poor settings. BJOG 2009; 116:868-9. [DOI: 10.1111/j.1471-0528.2009.02117.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
336
|
Lombaard H, Pattinson RC. Common errors and remedies in managing postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol 2009; 23:317-26. [PMID: 19230783 DOI: 10.1016/j.bpobgyn.2009.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 01/21/2009] [Indexed: 11/17/2022]
Abstract
Postpartum haemorrhage (PPH) is a major contributor to maternal morbidity and mortality. By only examining mortality, the full extent of the problem is not revealed and also it is important to evaluate the avoidable factors. This will identify the areas that need attention. The common errors include not treating anaemia in pregnancy, not practicing active management of the third stage of labour, delay in recognition, substandard care and lack of skills. The remedies include the correct medical treatment of PPH and the use of uterine tamponade. Cell savers can help to reduce the need for transfusion and transfusion associated complications. There are new treatment modalities such as embolisation that can be of value in certain settings.
Collapse
Affiliation(s)
- Hennie Lombaard
- Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Pretoria, South Africa.
| | | |
Collapse
|
337
|
Leung TY, Chung TKH. Severe chronic morbidity following childbirth. Best Pract Res Clin Obstet Gynaecol 2009; 23:401-23. [PMID: 19223240 DOI: 10.1016/j.bpobgyn.2009.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 01/05/2009] [Indexed: 10/21/2022]
Abstract
Three special, chronic morbidities of childbirth are reviewed with the most up-to-date knowledge in this article. Firstly, obstetric fistulas secondary to prolonged obstructed labour are still prevalent tragedies in underdeveloped countries. The damage is not only physical but psychosexual and social. The surgical skill and technology required to prevent and to treat obstetric fistulas are simple, but culture-social antagonism, geographic distance, political instability and financial constraint have to be overcome before effective management can take place. Congenital brachial plexus palsy is associated with shoulder dystocia and macrosomia, and both excessive exogenous traction and strong endogenous pushing forces contribute to its occurrence. As shoulder dystocia and macrosomia are not easily predictable, regular training and drill is essential to ensure proper management of shoulder dystocia. Most of the babies with brachial palsy will recover in 3 months but a minority of patients will suffer a more severe degree of damage, requiring early micro-neurosurgical intervention. Finally, although birth asphyxia is not the major cause of cerebral palsy, brain injury resulting from acute intrapartum hypoxic-ischemic insult is potentially alleviated by early neonatal hypothermic therapy. Both clinical and radiological assessments are essential in selecting suitable candidates for this innovative neuroprotective strategy.
Collapse
Affiliation(s)
- Tak Yeung Leung
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China SAR.
| | | |
Collapse
|
338
|
Quality improvement in maternity care: promising approaches from the medical and public health perspectives. Curr Opin Obstet Gynecol 2009; 20:574-80. [PMID: 18989134 DOI: 10.1097/gco.0b013e3283184040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Quality-improvement activities affect every obstetrician and every birthing service in the country. This review will serve to introduce the obstetric practitioner to the latest evidence of effective quality-improvement methods and provide an understanding of the different roles of the various organizations involved. RECENT FINDINGS Maternity quality improvement is an interrelated process with quality-improvement activities that occur at the hospital (e.g. protocols, checklists, drills, simulations, data collection and feedback and rapid-cycle quality-improvement projects), quality-improvement activities that occur at the level of a multihospital system or region (e.g. development of materials to support the hospital, development of quality-improvement leaders, provide pressure for change, benchmark outcomes), quality-improvement activities that occur within public agencies (e.g. public education campaigns) and still others that occur at governmental levels (e.g. selecting measures and targets, setting incentives and regulations, collecting administrative data). Quality collaboratives are relatively new, but can serve to jumpstart and coordinate the quality-improvement process among all the institutions involved. SUMMARY This review helps hospital leaders identify the quality-improvement activities that will be most effective for their needs.
Collapse
|
339
|
Curtis K, Guillien L. Shoulder dystocia drills: how one unit prepares for potential obstetric emergencies. Nurs Womens Health 2009; 13:65-69. [PMID: 19207506 DOI: 10.1111/j.1751-486x.2009.01381.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Kathleen Curtis
- Labor and Delivery at Gundersen Lutheran Medical Center in La Crosse, WI, USA.
| | | |
Collapse
|
340
|
Building Team and Technical Competency for Obstetric Emergencies: The Mobile Obstetric Emergencies Simulator (MOES) System. Simul Healthc 2009; 4:166-73. [DOI: 10.1097/sih.0b013e31819aaf2a] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
341
|
Current world literature. Curr Opin Obstet Gynecol 2008; 20:602-7. [PMID: 18989138 DOI: 10.1097/gco.0b013e32831ceeb3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
342
|
|