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Cuerva MJ, Villasante P, Cruset M, Pintado C, Perez De Aguado M, Cortes M, Lopez F, Bartha JL. Which type of forceps is better for nonrotational operative births? A simulation study comparing Thierry spatulas and Simpson-Braun and Kielland forceps. Int J Gynaecol Obstet 2024; 167:641-647. [PMID: 38767218 DOI: 10.1002/ijgo.15613] [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: 11/08/2023] [Revised: 04/10/2024] [Accepted: 04/28/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Obstetric forceps play an important role in safe childbirth, yet there is a lack of distinction between various forceps types in clinical practice. This study aimed to evaluate and compare perineal pressure and forces on the baby during nonrotational forceps-assisted births using Simpson-Braun forceps, Kielland forceps, and Thierry spatulas on a simulation model. METHODS This experimental study involved six obstetricians conducting 108 forceps-assisted births on a simulation model. Instruments were assessed for their impact on perineal pressure, traction force, and operator-assessed difficulty. RESULTS Thierry's spatulas exerted the lowest force on the baby, while Kielland forceps exhibited the lowest perineal pressure, though not statistically significant. An experienced obstetrician demonstrated less perineal pressure with Simpson forceps. Notably, no significant differences in difficulty were observed between instruments. CONCLUSION This study highlights distinctions in forceps performance, with Thierry spatulas applying the least force on the fetal head, while an experienced obstetrician fared better with Simpson forceps in terms of perineal pressure. Kielland forceps remain a viable alternative for nonrotational forceps births, showing comparable outcomes.
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Affiliation(s)
- Marcos Javier Cuerva
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
- School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Pilar Villasante
- School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Carmen Pintado
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | | | - Marta Cortes
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - Francisco Lopez
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
- School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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Cuerva MJ, Canilhas B, Aleixo V, Cruset M, Cortes M, Lopez F, Bartha JL. Rotational Forceps: Which technique is superior for blade insertion? A simulation study comparing direct, first posterior, and wandering maneuvers. Eur J Obstet Gynecol Reprod Biol 2024; 301:181-185. [PMID: 39151253 DOI: 10.1016/j.ejogrb.2024.08.015] [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: 04/13/2024] [Revised: 08/04/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE The Kielland's forceps is the most used forceps for assisting rotational operative births. There are various maneuvers described for blade insertion. Among these, the most used ones are the direct, first posterior, and wandering maneuver. The objective of this study was to compare these three maneuvers using a simulator. STUDY DESIGN In this experimental study, 144 rotational forceps-assisted births were conducted using a simulation model, with 72 starting in a right occiput-transverse position and 72 in a left occiput-transverse position. Each of the three maneuvers (direct, first posterior, or wandering) for blade insertion was performed 48 times by a total of 6 operators, comprising 3 obstetricians with over 10 years of experience and 3 trainees. The assessment of forceps application included evaluating the placement of the blades in terms of asymmetry and the distance from the lock to the posterior fontanelle. Additionally, the study evaluated the number of reinsertions and relocations required, the perceived difficulty of the procedure, and the operator's level of experience. RESULTS There were no statistically significant differences in terms of asymmetry with the three maneuvers. Regarding the distance from the lock to the posterior fontanelle, the best results were obtained with the direct maneuver. There were no differences in the number of reinsertions, relocations, and the perceived difficulty by the operators among the three maneuvers. Experienced obstetricians had better outcomes in terms of the need for reinsertions. CONCLUSION The direct maneuver offer advantages in the insertion of blades for rotational forceps.
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Affiliation(s)
- Marcos Javier Cuerva
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain; School of medicine. Universidad Autónoma de Madrid, Spain; School of medicine. Universidad Alfonso X el Sabio, Spain.
| | | | - Vasco Aleixo
- School of medicine. Universidad Alfonso X el Sabio, Spain
| | | | - Marta Cortes
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - Francisco Lopez
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain; School of medicine. Universidad Autónoma de Madrid, Spain
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Pinto L, Paulo-de-Sousa C, Ayres-de-Campos D. Impact of a simulator-based training program on the success rate of external cephalic version. Eur J Obstet Gynecol Reprod Biol 2024; 301:60-63. [PMID: 39098222 DOI: 10.1016/j.ejogrb.2024.07.071] [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: 05/25/2024] [Accepted: 07/31/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE To compare the success and complication rates of external cephalic version before and after the implementation of a simulator-based training program at a tertiary care university centre with a dedicated external cephalic version team. STUDY DESIGN In this single-center intervention study, the success rate and the complication rates of external cephalic version in the two years before the implementation of a simulation-based training program for all specialists and residents, were compared with the two years following the event. T- student, Mann-Whitney, and Chi-square tests were used. All data were extracted from the hospital's electronic patient records. RESULTS A total of 96 external cephalic versions were performed in the 2 years before the training program, and 74 after the training program. The overall success rates were similar between the two groups: 44.8 % before training and 43.2 % after training (p = 0.824). No major complications occurred, and no emergency cesarean deliveries were performed in either period. CONCLUSION In a tertiary care university training center with a dedicated team in external cephalic version, a structured simulation-based training program did not impact the success rate or the complication rates of the procedure.
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Affiliation(s)
- Luísa Pinto
- Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | - Catarina Paulo-de-Sousa
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução, Centro Hospitalar Universitário Santa Maria, Lisboa, Portugal
| | - Diogo Ayres-de-Campos
- Faculdade de Medicina, Universidade de Lisboa, Portugal; Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução, Centro Hospitalar Universitário Santa Maria, Lisboa, Portugal
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Cikwanine JPB, Yoyu JT, Mapatano ES, Lebdai S, Mukwege D, Martin L. Benefits of simulation on multidisciplinary management of severe pre-eclampsia/severe eclampsia in 15 health districts in eastern Democratic Republic of Congo: A randomized educational trial. Int J Gynaecol Obstet 2024. [PMID: 39264068 DOI: 10.1002/ijgo.15893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVE The purpose of the present study was to assess the benefits of simulation for advancing knowledge and assisting healthcare staff in optimization of procedures when managing severe pre-eclampsia/eclampsia (sPE/E). METHODS A randomized educational trial was conducted with two groups: Group I received theoretical training, while group II received the same training along with simulation scenarios based on the management of sPE/E. The study involved 199 healthcare providers, including physicians, midwives, skilled birth attendants, and nurses. The study analyzed the percentage of correct answers on both the multiple-choice questions (MCQ) and the objective structured clinical examinations (OSCE) to evaluate theoretical knowledge and clinical skills objectively. RESULTS Statistically significant differences were found immediately after training between groups I and II, whose mean percentages were 65.0% (±11.2) versus 71.0% (±9.8) (P < 0.001). A statistically significant reduction in the percentage of correct answers was found in both groups and demonstrated a discrepancy between immediate post-training test and post-training test at 3 months scores of 11.6% (±1.3) in group I versus 7.2% (±0.6) in group II. OSCE1 and OSCE2 scores were significantly higher in group II than in group I (P < 0.001). CONCLUSION Simulation combined with theoretical training would appear to be an interesting method of training for advancing knowledge and improving skills of healthcare providers in their management of sPE/E. Our goal is for this method to be used to reduce real-life maternal mortality in the South Kivu region of the Democratic Republic of Congo.
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Affiliation(s)
- Jean Paul Buhendwa Cikwanine
- All'Sims Healthcare Simulation Center, Angers University Hospital, Angers, France
- Healthcare Simulation Center of the Evangelical University in Africa, Panzi, Bukavu, Democratic Republic of Congo
- International Center for Advanced Research and Training, Bukavu, Democratic Republic of Congo
| | - Jonathan Tunangoya Yoyu
- Healthcare Simulation Center of the Evangelical University in Africa, Panzi, Bukavu, Democratic Republic of Congo
- International Center for Advanced Research and Training, Bukavu, Democratic Republic of Congo
- Department of Medical Research Studies, Progressive Medical Systems, Church of Christ in the Congo, Goma, Democratic Republic of Congo
| | - Emile Shalamba Mapatano
- Healthcare Simulation Center of the Evangelical University in Africa, Panzi, Bukavu, Democratic Republic of Congo
| | - Souhil Lebdai
- All'Sims Healthcare Simulation Center, Angers University Hospital, Angers, France
| | - Denis Mukwege
- Healthcare Simulation Center of the Evangelical University in Africa, Panzi, Bukavu, Democratic Republic of Congo
- International Center for Advanced Research and Training, Bukavu, Democratic Republic of Congo
| | - Ludovic Martin
- All'Sims Healthcare Simulation Center, Angers University Hospital, Angers, France
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Doubilet PM, Guo Y. Risk Factors Are Not Very Risky Once a Normal Embryonic Heart Rate is Seen in Early Pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1637-1643. [PMID: 38760971 DOI: 10.1002/jum.16485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/23/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVES To assess first-trimester prognosis when an early pregnancy sonogram demonstrates a normal embryonic heart rate and to determine how a number of risk factors affect prognosis. METHODS Our study population consisted of 6597 first-trimester scans with gestational age (GA) ≤ 7.0 weeks (all with crown-rump length [CRL] <10 mm), normal embryonic heart, and known first-trimester outcome. We recorded GA; CRL; heart rate; first-trimester outcome; maternal age; presence, absence, and size of subchorionic hematoma; presence or absence of vaginal bleeding; and presence, absence, and size of uterine fibroids. We assessed first-trimester outcome in the study population and subsets based on the above data. RESULTS First-trimester outcome was successful in 6030 of the 6597 cases (91.4%). The prognosis was somewhat worse with each of the following risk factors: maternal age ≥35 years, large subchorionic hematoma, and large or multiple uterine fibroids (P < .02, chi-squared or Cochran's test for trend, for all of these items). The rate of successful outcome was in the range of 83-88% with each of these risk factors and 93.8% in the absence of any of these factors. CONCLUSIONS The presence of a normal embryonic heart rate on an early first-trimester sonogram is a reassuring finding, indicating a likelihood of good first-trimester outcome of at least 83% even in the presence of risk factors, and of over 90% in the absence of such factors.
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Affiliation(s)
- Peter M Doubilet
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yang Guo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Molina MSA, Cordioli E, Couto TB, Barreto JKS, Sanchez RDC. Appropriate Delivery Project: Impact of Simulation Training on the Increase in Vaginal Births in Hospitals in Brazil. EINSTEIN-SAO PAULO 2024; 22:eAO0783. [PMID: 39140574 PMCID: PMC11319025 DOI: 10.31744/einstein_journal/2024ao0783] [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: 10/23/2023] [Accepted: 02/09/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE This study aimed to analyze the relationship between the participation of professionals in simulation-based training and an increase in the rate of vaginal deliveries. METHODS This retrospective observational study analyzed professionals' participation in high-fidelity simulation training during the pilot phase of the Appropriate Delivery Project, spanning from May 21, 2015 to May 21, 2016, along with the rates of vaginal deliveries across various hospitals. Data for participation by nurses and physicians were examined using a gamma distribution model to discern the predictors influencing the changes in the percentage of vaginal births. RESULTS Data from 27 hospitals involved in the project were analyzed. A total of 339 healthcare professionals, including 147 nurses and 192 doctors, underwent the simulation-based training. During the pilot test, the percentage of vaginal births increased from 27.8% to 36.1%, which further increased to 39.8% in the post-intervention period, particularly when the participation rate of nurses exceeded the median. CONCLUSION This study suggests that simulation-based training is a valuable strategy for achieving positive changes in obstetric practice, specifically an increase in the rate of vaginal births. These findings underscore the potential advantages of incorporating simulation training into improvement initiatives, as evidenced by the correlation between higher training adoption rates and substantial and sustained enhancements in vaginal birth rates.
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Affiliation(s)
| | - Eduardo Cordioli
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Thomaz Bittencourt Couto
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Joyce Kelly Silva Barreto
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Rita de Cássia Sanchez
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Falcone V, Catic A, Heinzl F, Steinbauer P, Wagner M, Mikula F, Dorittke T, Roessler B, Farr A. Impact of a virtual reality-based simulation training for shoulder dystocia on human and technical skills among caregivers: a randomized-controlled trial. Sci Rep 2024; 14:7898. [PMID: 38570525 PMCID: PMC10991516 DOI: 10.1038/s41598-024-57785-6] [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: 07/11/2023] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
This study analyzed the adherence to the modified Advanced Life Support in Obstetrics (ALSO) algorithm (HELP-RER) for handling shoulder dystocia (SD) using a virtual reality (VR) training modality. Secondary outcomes were improvements in the post-training diagnosis-to-delivery time, human skills factors (HuFSHI), and perceived task-load index (TLX). Prospective, case-control, single-blind, 1:1 randomized crossover study. Participants were shown a 360° VR video of SD management. The control group was briefed theoretically. Both groups underwent HuFSHI and HELP-RER score assessments at baseline and after the manikin-based training. The TLX questionnaire was then administered. After a washout phase of 12 weeks, we performed a crossover, and groups were switched. There were similar outcomes between groups during the first training session. However, after crossover, the control group yielded significantly higher HELP-RER scores [7 vs. 6.5; (p = 0.01)], with lower diagnosis-to-delivery-time [85.5 vs. 99 s; (p = 0.02)], and TLX scores [57 vs. 68; (p = 0.04)]. In the multivariable linear regression analysis, VR training was independently associated with improved HELP-RER scores (p = 0.003). The HuFSHI scores were comparable between groups. Our data demonstrated the feasibility of a VR simulation training of SD management for caregivers. Considering the drawbacks of common high-fidelity trainings, VR-based simulations offer new perspectives.
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Affiliation(s)
- Veronica Falcone
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Anja Catic
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Florian Heinzl
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Philipp Steinbauer
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Fanny Mikula
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Tim Dorittke
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bernhard Roessler
- Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Atiomo W, Ennab F, Stanley A, Ezimokhai M. Evaluating an obstetrics and gynecology teaching program for medical students incorporating simulation-based education underpinned by cognitive load theory. Front Med (Lausanne) 2024; 11:1304417. [PMID: 38590321 PMCID: PMC10999601 DOI: 10.3389/fmed.2024.1304417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Although there have been previous publications on curriculum innovations in teaching O&G to medical students, especially utilizing simulation-based education, there have been none, as far as we know, incorporating and evaluating the outcomes using cognitive load theory. The aim of this article was to describe the introduction, implementation, and evaluation of an innovative teaching program in O&G, incorporating simulation-based education, underpinned by cognitive load theory. Cognitive load is defined as the amount of information a working memory can hold at any one time and incorporates three types of cognitive load-intrinsic, extraneous, and germane. To optimize learning, educators are encouraged to manage intrinsic cognitive load, minimize extraneous cognitive load, and promote germane cognitive load. In these sessions, students were encouraged to prepare in advance of each session with recommended reading materials; to limit intrinsic cognitive load and promote germane cognitive load, faculty were advised ahead of each session to manage intrinsic cognitive load, an open-book MCQ practice session aimed to reduce anxiety, promote psychological safety, and minimize extraneous cognitive load. For the simulation sessions, the faculty initially demonstrated the role-play situation or clinical skill first, to manage intrinsic cognitive load and reduce extraneous cognitive load. The results of the evaluation showed that the students perceived that they invested relatively low mental effort in understanding the topics, theories, concepts, and definitions discussed during the sessions. There was a low extraneous cognitive load. Measures of germane cognitive load or self-perceived learning were high. The primary message is that we believe this teaching program is a model that other medical schools globally might want to consider adopting, to evaluate and justify innovations in the teaching of O&G to medical students. The secondary message is that evaluation of innovations to teaching and facilitation of learning using cognitive load theory is one way to contribute to the high-quality training of competent future healthcare workers required to provide the highest standard of care to women who are crucial to the overall health and wellbeing of a nation.
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Affiliation(s)
- William Atiomo
- College of Medicine, Dubai Healthcare City, Mohammed Bin Rashid University (MBRU) of Medicine and Health Sciences, Dubai, United Arab Emirates
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Li M, Wright A, Tan LK, Mathur M, Tan KH, Tagore S. Multidisciplinary Obstetric Simulation Training: Experience at KK Women's and Children's Hospital (KKH), Singapore, a Tertiary Referral Centre. Cureus 2024; 16:e55840. [PMID: 38590473 PMCID: PMC11000684 DOI: 10.7759/cureus.55840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/10/2024] Open
Abstract
Background Multidisciplinary simulation training in the management of acute obstetric emergencies has the potential to reduce both maternal and perinatal morbidity. It is a valuable tool that can be adapted for targeted audiences of different specialities at all experience levels from medical students to senior consultants. Methods In this study, pre- and post-course questionnaires of learners with varying levels of clinical experience from Obstetrics and Gynaecology (O&G), Anaesthesia, Neonatology, Emergency Medicine, midwifery, and nursing who undertook two simulation courses (namely the Combined Obstetrics Resuscitation Training course, CORE, and the CORE Lite), which comprised lectures and simulation drills with manikins and standardized patients, between 2015 and 2023 were compared. This also included a period when training was affected by the coronavirus disease 2019 (COVID-19) pandemic. Results The results showed that both simulation courses increased confidence levels among all learners in the management of obstetric emergencies. Pre-course, participants were most confident in the management of neonatal resuscitation and severe pre-eclampsia, followed by postpartum haemorrhage. They were least confident in the management of vaginal breech delivery, uterine inversion, and twin delivery. Post-course, participants were most confident in the management of neonatal resuscitation and shoulder dystocia, followed by postpartum haemorrhage. They were least confident in the management of uterine inversion and maternal sepsis, followed by vaginal breech delivery and twin delivery. Whilst we saw a huge improvement in confidence levels for all obstetric emergencies, the greatest improvement in confidence levels was noted in vaginal breech delivery, twin delivery, and uterine inversion. Conclusion The simulation courses were effective in improving the confidence in the management of obstetric emergencies. While it may be difficult to measure the improvement in clinical outcomes as a result of simulation courses alone, the increase in confidence levels of clinicians can be used as a surrogate in measuring their preparedness in facing these emergency scenarios.
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Affiliation(s)
- Mingyue Li
- Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Ann Wright
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, SGP
| | - Lay Kok Tan
- Maternal Fetal Medicine, OBGYN DUKE-NUS Academic Clinical Program, KK Women's and Children's Hospital, Singapore, SGP
| | - Manisha Mathur
- Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Kok Hian Tan
- Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Shephali Tagore
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, SGP
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Basavarajegowda A, Pai DR, Nalini YC. Simulation in the field of transfusion medicine: Scope and utility. Asian J Transfus Sci 2024; 18:108-114. [PMID: 39036699 PMCID: PMC11259334 DOI: 10.4103/ajts.ajts_109_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/11/2022] [Accepted: 09/18/2022] [Indexed: 07/23/2024] Open
Abstract
Simulation in medical education has made significant inroads in most of the specialties in some form or the other. Transfusion medicine, as a branch, being a new specialty, is imbibing a few things from the world of simulation and provides immense scope for its utilization, given its broad applicability as well as necessity. In the current Indian scenario of transfusion medicine, wherein the transfusion process has undergone significant changes involving critical steps, with fewer but can be serious complications arising due to the transfusion process, it is desirable for students and the staff involved to practice on the simulators to attain the desired level of competency as it allows the practice of hands-on invasive procedures before performing the actual process. The principles, pedagogies, and educational strategies with their modalities used in health care simulation like case-based scenarios, physical models, computer systems, standardized patients, mannequins, virtual reality, and integrated simulators are all being used and the scope for improvisation is always in the fore with technical advancements. The transfusion and related activities include significant risks, so regular training is essential. The costs are also reasonably high, and focusing on being time-efficient is essential as many scenarios need immediate attention and management. Simulation in transfusion medicine has farsighted returns wherein there is the possibility of defining goals and objectives and ensuring that they could be adjusted to the individual learners as per their knowledge and skill level. The simulations can be set up that can train as well as assess cognitive, affective, and psychomotor domains simultaneously in transfusion using multiple modalities.
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Affiliation(s)
- Abhishekh Basavarajegowda
- Department of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Dinker R Pai
- Simulation Centre, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
| | - Y. C. Nalini
- Department of Physiology, Mahatma Gandhi Medical College, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
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Markowitz MA, Ackerman-Banks CM, Oliveira CR, Fashina O, Pathy SR, Sheth SS. Expedited Partner Therapy: A Multicomponent Initiative to Boost Provider Counseling. Sex Transm Dis 2024; 51:15-21. [PMID: 37921862 PMCID: PMC11413968 DOI: 10.1097/olq.0000000000001894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Expedited partner therapy prescription remains low and highly variable throughout the United States, leading to frequent reinfections with Chlamydia trachomatis and Neisseria gonorrhoeae . We examined provider counseling on expedited partner therapy before and after an electronic smart tool-based initiative. METHODS In this quasi-experimental interrupted time-series study, we implemented an initiative of electronic smart tools and education for expedited partner therapy in March 2020. We reviewed the records of patients with chlamydia and/or gonorrhea at an urban, academic obstetrics and gynecology clinic in the preimplementation (March 2019-February 2020) and postimplementation (March 2020-February 2021) groups. Descriptive statistics and an interrupted time-series model were used to compare the percent of expedited partner therapy offered by clinicians to patients in each group. RESULTS A total of 287 patient encounters were analyzed, 155 preintervention and 132 postintervention. An increase in expedited partner therapy counseling of 13% (95% confidence interval [CI], 2%-24%) was observed before the intervention (27.1% [42 of 155]) versus after the intervention (40.2% [53 of 132]). Significant increases in provider counseling were seen for patients who were single (15%; 95% CI, 3%-26%), 25 years or older (21%; 95% CI, 6%-37%), receiving public insurance (15%; 95% CI, 3%-27%), seen by a registered nurse (18%; 95% CI, 4%-32%), or seen for an obstetrics indication (21%; 95% CI, 4%-39%). No difference was seen in patients' acceptance of expedited partner therapy ( P = 1.00). CONCLUSIONS A multicomponent initiative focused on electronic smart tools is effective at increasing provider counseling on expedited partner therapy. Further research to understand patient perceptions and acceptance of expedited partner therapy is critical.
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Affiliation(s)
| | | | | | | | - Shefali R Pathy
- From the Department of Obstetrics, Gynecology and Reproductive Sciences
| | - Sangini S Sheth
- From the Department of Obstetrics, Gynecology and Reproductive Sciences
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Kriener K, Whiting H, Storr N, Homes R, Lala R, Gabrielyan R, Kuang J, Rubin B, Frails E, Sandstrom H, Futter C, Midwinter M. Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review. JBI Evid Synth 2023; 21:2309-2405. [PMID: 37732940 DOI: 10.11124/jbies-22-00363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The objective of this review was to identify quantitative biomechanical measurements of human tissues, the methods for obtaining these measurements, and the primary motivations for conducting biomechanical research. INTRODUCTION Medical skills trainers are a safe and useful tool for clinicians to use when learning or practicing medical procedures. The haptic fidelity of these devices is often poor, which may be because the synthetic materials chosen for these devices do not have the same mechanical properties as human tissues. This review investigates a heterogeneous body of literature to identify which biomechanical properties are available for human tissues, the methods for obtaining these values, and the primary motivations behind conducting biomechanical tests. INCLUSION CRITERIA Studies containing quantitative measurements of the biomechanical properties of human tissues were included. Studies that primarily focused on dynamic and fluid mechanical properties were excluded. Additionally, studies only containing animal, in silico , or synthetic materials were excluded from this review. METHODS This scoping review followed the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Sources of evidence were extracted from CINAHL (EBSCO), IEEE Xplore, MEDLINE (PubMed), Scopus, and engineering conference proceedings. The search was limited to the English language. Two independent reviewers screened titles and abstracts as well as full-text reviews. Any conflicts that arose during screening and full-text review were mediated by a third reviewer. Data extraction was conducted by 2 independent reviewers and discrepancies were mediated through discussion. The results are presented in tabular, figure, and narrative formats. RESULTS Data were extracted from a total of 186 full-text publications. All of the studies, except for 1, were experimental. Included studies came from 33 countries, with the majority coming from the United States. Ex vivo methods were the predominant approach for extracting human tissue samples, and the most commonly studied tissue type was musculoskeletal. In this study, nearly 200 unique biomechanical values were reported, and the most commonly reported value was Young's (elastic) modulus. The most common type of mechanical test performed was tensile testing, and the most common reason for testing human tissues was to characterize biomechanical properties. Although the number of published studies on biomechanical properties of human tissues has increased over the past 20 years, there are many gaps in the literature. Of the 186 included studies, only 7 used human tissues for the design or validation of medical skills training devices. Furthermore, in studies where biomechanical values for human tissues have been obtained, a lack of standardization in engineering assumptions, methodologies, and tissue preparation may implicate the usefulness of these values. CONCLUSIONS This review is the first of its kind to give a broad overview of the biomechanics of human tissues in the published literature. With respect to high-fidelity haptics, there is a large gap in the published literature. Even in instances where biomechanical values are available, comparing or using these values is difficult. This is likely due to the lack of standardization in engineering assumptions, testing methodology, and reporting of the results. It is recommended that journals and experts in engineering fields conduct further research to investigate the feasibility of implementing reporting standards. REVIEW REGISTRATION Open Science Framework https://osf.io/fgb34.
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Affiliation(s)
- Kyleigh Kriener
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Harrison Whiting
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Clinical Medicine, Royal Brisbane Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Nicholas Storr
- Gold Coast University Hospital, Southport, QLD Australia
| | - Ryan Homes
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Raushan Lala
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Robert Gabrielyan
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Ochsner Clinical School, Jefferson, LA, United States
| | - Jasmine Kuang
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Ochsner Clinical School, Jefferson, LA, United States
| | - Bryn Rubin
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Ochsner Clinical School, Jefferson, LA, United States
| | - Edward Frails
- Department of Chemical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Hannah Sandstrom
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA, United States
| | - Christopher Futter
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Anaesthesia and Intensive Care Program, Herston Biofabrication institute, Brisbane, QLD, Australia
| | - Mark Midwinter
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
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Cuerva MJ, De Santiago B, Cortés M, Lopez F, Espinosa JA, Bartha JL. Vacuum-assisted birth in maternal lateral posture versus lithotomy. A simulation study. Eur J Obstet Gynecol Reprod Biol 2023; 290:88-92. [PMID: 37742455 DOI: 10.1016/j.ejogrb.2023.09.017] [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: 06/28/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Maternal lateral postures provide advantages during childbirth. This study aims to investigate the feasibility of assisting vacuum births in maternal lateral postures in a simulation model. STUDY DESIGN In a simulation model, four obstetricians and four medical students were randomly allocated to perform vacuum-assisted births first in maternal lateral posture or lithotomy. A modification of Aldo Vacca's 5-step technique was developed to assist vacuum-assisted births in lateral posture. The lateral distance, vertical distance, and distance from the cup center to the flexion point were measured for every placement of the cup. RESULTS AND CONCLUSIONS A total of 128 vacuum-assisted births were performed. The mean distance to the flexion point was 1.15 ± 0.71 cm for the lithotomy posture and 1.31 ± 0.82 cm for the lateral posture (P = 0.127). There were no statistically significant differences in vacuum extractor cup placement accuracy based on maternal posture. Performing vacuum-assisted births in maternal lateral posture is feasible in a simulation model. The technique is easy to learn, and the differences in cup placement between the lateral and lithotomy postures are small.
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Affiliation(s)
- Marcos Javier Cuerva
- Hospital Universitario La Paz, Department of Obstetrics, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid, Spain; Hospital San Francisco de Asís, UPA (Affective Birth Unit), Madrid, Spain; School of Health Sciences, Universidad Alfonso X el Sabio, Madrid, Spain.
| | | | - Marta Cortés
- Hospital Universitario La Paz, Department of Obstetrics, Madrid, Spain
| | - Francisco Lopez
- Hospital Universitario La Paz, Department of Obstetrics, Madrid, Spain
| | - Jose Angel Espinosa
- Hospital San Francisco de Asís, UPA (Affective Birth Unit), Madrid, Spain; School of Health Sciences, Universidad Alfonso X el Sabio, Madrid, Spain
| | - José Luis Bartha
- Hospital Universitario La Paz, Department of Obstetrics, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid, Spain
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Kriener K, Ding-Farrington C, Rodgers S, Midwinter M. Tools measuring high haptic fidelity of procedural skills trainers in physician training and education: a scoping review protocol. JBI Evid Synth 2023; 21:2127-2133. [PMID: 37435682 DOI: 10.11124/jbies-22-00348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify instruments that measure the physical haptic fidelity of procedural skills trainers. INTRODUCTION Procedural skills trainers have demonstrated beneficial outcomes for clinicians when used to practice and rehearse procedures. Despite this, several design flaws currently limit the widespread implementation of such trainers. One notable deficit in current trainer designs is haptic fidelity. Identifying measurements of haptic fidelity may maximize the benefit of using certain training devices as well as guiding future design. INCLUSION CRITERIA This review will consider studies that assess the high fidelity haptics of procedural skills training devices in adult physicians above the level of an intern physician. Studies that do not include physicians will be excluded. METHODS The review will follow the JBI methodology for scoping reviews and will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Both published and unpublished studies will be searched for in MEDLINE (PubMed), Scopus, Web of Science Core Collection, Cochrane Central Register of Controlled Trials (CENTRAL), Embase (Ovid), CINAHL (EBSCOhost), ProQuest Dissertations and Theses (ProQuest), and Google Scholar. There will be no date, setting, or geographical limits, but only studies in English will be included. REVIEW REGISTRATION Open Science Framework osf.io/pvazu/.
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Affiliation(s)
- Kyleigh Kriener
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Kreiser K, Sollmann N, Renz M. Importance and potential of simulation training in interventional radiology. ROFO-FORTSCHR RONTG 2023; 195:883-889. [PMID: 37137320 DOI: 10.1055/a-2066-8009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Simulation training is a common method in many medical disciplines and is used to teach content knowledge, manual skills, and team skills without potential patient danger. METHODS Simulation models and methods in interventional radiology are explained. Strengths and weaknesses of both simulators for non-vascular and vascular radiological interventions are highlighted and necessary future developments are addressed. RESULTS Both custom-made and commercially available phantoms are available for non-vascular interventions. Interventions are performed under ultrasound guidance, with computed tomography assistance, or using mixed-reality methods. The wear and tear of physical phantoms can be countered with in-house production of 3D-printed models. Vascular interventions can be trained on silicone models or hightech simulators. Increasingly, patient-specific anatomies are replicated and simulated pre-intervention. The level of evidence of all procedures is low. CONCLUSION Numerous simulation methods are available in interventional radiology. Training on silicone models and hightech simulators for vascular interventions has the potential to reduce procedural time. This is associated with reduced radiation dose for both patient and physician, which can also contribute to improved patient outcome, at least in endovascular stroke treatment. Although a higher level of evidence should be achieved, simulation training should already be integrated into the guidelines of the professional societies and accordingly into the curricula of the radiology departments. KEY POINTS · There are numerous simulation methods for nonvascular and vascular radiologic interventions.. · Puncture models can be purchased commercially or made using 3D printing.. · Silicone models and hightech simulators allow patient-specific training.. · Simulation training reduces intervention time, benefiting both the patient and the physician.. · A higher level of evidence is possible via proof of reduced procedural times.. CITATION FORMAT · Kreiser K, Sollmann N, Renz M. Importance and potential of simulation training in interventional radiology. Fortschr Röntgenstr 2023; 195: 883 - 889.
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Affiliation(s)
- Kornelia Kreiser
- RKU, Department of Neuroradiology, University Hospital Ulm, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Martin Renz
- Departement of Diagnostic and Interventional Neuroradiology, Technical University of Munich Hospital Rechts der Isar, Munchen, Germany
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Kern-Goldberger AR, Booker W, Friedman A, Gyamfi-Bannerman C. Racial and Ethnic Disparities in Cesarean Morbidity. Am J Perinatol 2023; 40:1567-1572. [PMID: 34891196 DOI: 10.1055/s-0041-1739305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Maternal race and ethnicity have been identified as significant independent predictors of obstetric morbidity and mortality in the United States. An appreciation of the clinical contexts in which maternal racial and ethnic disparities are most pronounced can better target efforts to alleviate these disparities and improve outcomes. It remains unknown whether cesarean delivery precipitates these divergent outcomes. This study assessed the association between maternal race and ethnicity and cesarean complications. STUDY DESIGN We conducted a retrospective cohort study from a multicenter observational cohort of women undergoing cesarean delivery. Nulliparous women with non-anomalous singleton gestations who underwent primary cesarean section were included. Race/ethnicity was categorized as non-Hispanic White, non-Hispanic Black, Hispanic, Asian, Native American, or unknown. The primary outcome was a composite of maternal cesarean complications including hysterectomy, uterine atony, blood transfusion, surgical injury, arterial ligation, infection, wound complication, and ileus. A composite of neonatal morbidity was evaluated as a secondary outcome. We created a multivariable logistic regression model adjusting for selected demographic and obstetric variables that may influence the likelihood of the primary outcome. RESULTS A total of 14,570 women in the parent trial met inclusion criteria with an 18.8% incidence of the primary outcome (2,742 women). After adjusting for potential confounding variables, maternal surgical morbidity was found to be significantly higher for non-Hispanic Black (adjusted odds ratios [aORs] 1.96, 95% confidence intervals [CIs] 1.63-2.35) and Hispanic (aOR 1.66, 95% CI 1.37-2.01) women as compared with non-Hispanic white women. Neonatal morbidity was similarly found to be significantly associated with the Black race and Hispanic ethnicity. CONCLUSION In this cohort, the odds of cesarean-related maternal and neonatal morbidity were significantly higher for non-Hispanic Black and Hispanic women. These findings suggest race as a distinct risk factor for cesarean complications, and efforts to alleviate disparities should highlight cesarean section as an opportunity for improvement in outcomes. KEY POINTS · Non-Hispanic Black and Hispanic women experienced more cesarean complications than non-Hispanic White women.. · These findings suggest that disparities in maternal and neonatal outcomes exist specifically following cesarean section.. · Efforts to alleviate disparities in obstetrics should highlight cesarean section as an opportunity for improvement..
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Affiliation(s)
- Adina R Kern-Goldberger
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Whitney Booker
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
- Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
| | - Alexander Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
- Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
- Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
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Baayd J, Lloyd M, Garcia G, Smith S, Sylvester H, Clark E, Cross B, Gero A, Cohen S. Catalyzing Collaboration Among Interprofessional Birth Transfer Teams Through Simulation. J Midwifery Womens Health 2023; 68:458-465. [PMID: 37114662 DOI: 10.1111/jmwh.13497] [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: 09/06/2022] [Revised: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Planned home or birth center births sometimes require emergency transfers to a hospital. Poor communication among members of the birth care team during a transfer can lead to unfavorable outcomes for the birthing person and newborn. To improve the quality of birth transfers in Utah, the Utah Women and Newborns Quality Collaborative partnered with the LIFT Simulation Design Lab to develop and pilot an interprofessional birth transfer simulation training. METHODS We engaged community stakeholders to identify learning objectives and co-design the simulation trainings using principles of participatory design. We conducted 5 simulation trainings featuring birth transfers during a postpartum hemorrhage. The LIFT Lab evaluated the trainings to determine if they were feasible, acceptable, and effective. Measures included a post-training form asking participants to evaluate the quality of the training and a 9-question pre- and post-training survey measuring changes in participants' self-efficacy regarding components of birth transfer. The changes were assessed for significance using a paired t test. RESULTS A total of 102 participants attended the 5 trainings; all health care provider groups were well represented. Most participants felt the simulations were similar to real situations and would benefit others in their professions. All participants said the trainings were a good use of their time. Following the training, participants had significantly higher levels of self-efficacy regarding their ability to manage birth transfers. DISCUSSION Birth transfer simulation trainings are an acceptable, feasible, and effective method for training interprofessional birth care teams.
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Affiliation(s)
- Jami Baayd
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake, Utah
| | - Mikelle Lloyd
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake, Utah
| | - Gabriela Garcia
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake, Utah
| | | | | | - Erin Clark
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake, Utah
| | - Brett Cross
- Handtevy Pediatric Emergency Standards, Inc., Davie, Florida
| | - Alexandra Gero
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake, Utah
| | - Susanna Cohen
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake, Utah
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Pajohideh ZS, Mohammadi S, Keshmiri F, Jahangirimehr A, Honarmandpour A. The effects of normal vaginal birth simulation training on the clinical skills of midwifery students: a quasi-experiment study. BMC MEDICAL EDUCATION 2023; 23:353. [PMID: 37208680 DOI: 10.1186/s12909-023-04319-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/04/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Vaginal birth management is vital to midwifery education and practice in which midwives are most likely to be directly involved. This situation requires strong cognitive, technical, communicational, and teamwork skills. Therefore, the present study was conducted to evaluate the effect of normal vaginal birth simulation training before formal clinical education on the clinical skills of midwifery students compared with routine clinical education. METHODS This quasi-experimental study was conducted at the Shoushtar Faculty of Medical Sciences from September 2018 to August 2021. Sixty-one midwifery students participated in the intervention group (n = 31) and in the control group (n = 30). The intervention group participated in the simulation-based training before entering the formal clinical education courses. The control group received no simulation-based training before their formal clinical education. The clinical skills of these students for performing normal vaginal birth in the real field were evaluated by observational examination in the three years (fourth, fifth, and sixth semesters). Data were analyzed by descriptive (mean, SD, and percentage) and inferential statistics (independent t-test and chi-square). A P-value less than 0.05 was considered significant. RESULTS The mean score of midwives' skills in the control group was (28.10 ± 3.42) and in the intervention group, it was (31.15 ± 4.30). The difference in the skill score between the groups was statistically significant (3.40 ± 0.68). The results showed that in the intervention group, 29 students (93.93%) were evaluated from a good to an excellent level, while only ten students (32.71%) in the control group achieved a good level, and others (n = 30) were evaluated at a low level (p < .001). CONCLUSION The results of the present study indicated that the simulation situation for critical skills, such as vaginal birth skills, was significantly more effective than workplace-based learning situations.
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Affiliation(s)
- Zahra Sadat Pajohideh
- MSc of Midwifery, Department of Midwifery, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Solmaz Mohammadi
- Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Keshmiri
- Medical Education Department, Educational Developmental Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Azam Jahangirimehr
- MSc of Biostatistics, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Azam Honarmandpour
- MSc of Midwifery, Department of Midwifery, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran.
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Vidotti SP, Batista NA. Clinical Simulation in the Training of Obstetrics and Gynecology Resident from the Perspective of Medical Residency Programs. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:266-272. [PMID: 37339646 PMCID: PMC10281772 DOI: 10.1055/s-0043-1770127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE This study analyzes the role of clinical simulation in internal medical residency programs (IMRP) in Obstetrics and Gynecology (OB/GYN), attributed by the supervisors, in the training of residents in the city of São Paulo (SP). METHODS Cross-sectional descriptive, qualitative, and exploratory approach. Semi-structured interviews were performed with ten supervisors of Medical Residency programs in Obstetrics and Gynecology. Interviews were analyzed by means of content analysis under the thematic modality, starting with the core the role of clinical simulation in Obstetrics and Gynecology Medical Residency Programs. RESULTS: Supervisors view Clinical simulation as: a complementary tool for the teaching and learning process, a possibility of a safe teaching and learning environment, an opportunity to learn from mistakes, a support for professional practice committed to patient safety, a learning scenario for teamwork, a scenario for reflection on the work process in Obstetrics and Gynecology, a scenario for evaluative processes in the medical residency. Still according to supervisors, Clinical Simulation favors decision-making and encourages the resident participation in activities. CONCLUSION Supervisors recognize Clinical Simulation as a powerful pedagogical tool in the learning process of resident doctors in Obstetrics and Gynecology Residency Programs.
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Alimena S, Freret TS, King C, Lassey SC, Economy KE, Easter SR. Simulation to improve trainee knowledge and comfort in managing maternal cardiac arrest. AJOG GLOBAL REPORTS 2023; 3:100182. [PMID: 36941863 PMCID: PMC10023915 DOI: 10.1016/j.xagr.2023.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Maternal cardiac arrest is a rare outcome, and thus there are limited opportunities for specialists in obstetrics and gynecology to acquire the skills required to respond to it through routine clinical practice. OBJECTIVE This study aimed to evaluate gaps in medical education in maternal cardiac arrest and whether a simulation-based training program improves resident knowledge and comfort in the diagnosis and treatment of maternal cardiac arrest. STUDY DESIGN A 2-hour training for obstetrics and gynecology residents at an academic medical center was conducted, consisting of a didactic presentation, defibrillator skills station, and 2 high-fidelity simulations. Consenting residents completed a 21-item pretest followed by a 12-item posttest exploring knowledge of and exposure to maternal cardiac arrest. The McNemar and Wilcoxon signed-rank tests were used to compare pre- and posttest data. RESULTS Of 21 residents, 15 (71.4%) had no previous education about maternal cardiac arrest, and 17 (81.0%) had never responded to a maternal code. Participants demonstrated increased knowledge about maternal cardiac arrest after the session, providing more correct answers on the reversible causes of pulseless electrical activity arrest (median 4 vs 7 correct responses; P<.01). After the training, more residents were able to identify the correct gestational age to perform a cesarean delivery during maternal cardiac arrest (19.0% vs 90.5%; P<.01) and the correct location for this procedure (52.4% vs 95.2%; P<.01). All residents reported that maternal cardiac arrest training was important and that they would benefit from additional sessions. Median composite comfort level in managing maternal cardiac arrest significantly increased after participation (pretest, 24.0 [interquartile range, 21.5-28.0]; posttest, 37.0 [interquartile range, 34.3-41.3]; P<.01). CONCLUSION Residents report limited exposure to maternal cardiac arrest and desire more training. Simulation-based training about maternal cardiac arrest is needed during residency to ensure that graduates are prepared to respond to this high-acuity event.
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Affiliation(s)
- Stephanie Alimena
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Dr Alimena)
- Corresponding author: Stephanie Alimena, MD.
| | - Taylor S. Freret
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA (Dr Freret)
| | - Chih King
- Department of Anesthesia, Brigham and Women's Hospital, Boston, MA (Dr King)
| | - Sarah C. Lassey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Drs Lassey, Economy, and Easter)
| | - Katherine E. Economy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Drs Lassey, Economy, and Easter)
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Drs Lassey, Economy, and Easter)
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Taneja S, Tenpas W, Jain M, Alfonsi P, Ratagiri A, Saterbak A, Theiling J. Simulation device for shoulder reductions: overview of prototyping, testing, and design instructions. Adv Simul (Lond) 2023; 8:8. [PMID: 36895024 PMCID: PMC9999631 DOI: 10.1186/s41077-023-00246-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/12/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Shoulder dislocations are common occurrences, yet there are few simulation devices to train medical personnel on how to reduce these dislocations. Reductions require a familiarity with the shoulder and a nuanced motion against strong muscle tension. The goal of this work is to describe the design of an easily replicated, low-cost simulator for training shoulder reductions. MATERIALS AND METHODS An iterative, stepwise engineering design process was used to design and implement ReducTrain. A needs analysis with clinical experts led to the selection of the traction-countertraction and external rotation methods as educationally relevant techniques to include. A set of design requirements and acceptance criteria was established that considered durability, assembly time, and cost. An iterative prototyping development process was used to meet the acceptance criteria. Testing protocols for each design requirement are also presented. Step-by-step instructions are provided to allow the replication of ReducTrain from easily sourced materials, including plywood, resistance bands, dowels, and various fasteners, as well as a 3D-printed shoulder model, whose printable file is included at a link in the Additional file 1: Appendix. RESULTS A description of the final model is given. The total cost for all materials for one ReducTrain model is under US $200, and it takes about 3 h and 20 min to assemble. Based on repetitive testing, the device should not see any noticeable changes in durability after 1000 uses but may exhibit some changes in resistance band strength after 2000 uses. DISCUSSION The ReducTrain device fills a gap in emergency medicine and orthopedic simulation. Its wide variety of uses points to its utility in several instructional formats. With the rise of makerspaces and public workshops, the construction of the device can be easily completed. While the device has some limitations, its robust design allows for simple upkeep and a customizable training experience. CONCLUSION A simplified anatomical design allows for the ReducTrain model to serve as a viable training device for shoulder reductions.
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Affiliation(s)
- Sorab Taneja
- Duke Engineering Design Pod, 308 Research Dr, Durham, NC, 27710, USA
| | - Will Tenpas
- Duke Engineering Design Pod, 308 Research Dr, Durham, NC, 27710, USA
| | - Mehul Jain
- Duke Engineering Design Pod, 308 Research Dr, Durham, NC, 27710, USA
| | - Peter Alfonsi
- Duke Engineering Design Pod, 308 Research Dr, Durham, NC, 27710, USA
| | - Abhinav Ratagiri
- Duke Engineering Design Pod, 308 Research Dr, Durham, NC, 27710, USA
| | - Ann Saterbak
- Department of Biomedical Engineering, Duke University, 101 Science Dr, Box 90281, Durham, NC, 27708, USA.
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Zhang C. A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4487. [PMID: 36901496 PMCID: PMC10002261 DOI: 10.3390/ijerph20054487] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.
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Affiliation(s)
- Cevin Zhang
- School of Media and Design, Beijing Technology and Business University, Sunlight South Road 1, Beijing 102488, China
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Kriener K, Whiting H, Futter C, Midwinter M. Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review protocol. JBI Evid Synth 2022; 20:3067-3075. [PMID: 36065947 DOI: 10.11124/jbies-22-00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify the availability of quantitative biomechanical measurements from human tissues. This review will also consider the primary motivations for collecting biomechanical measurements of human tissues. The overall purpose of our research is to develop medical skills trainers that provide better haptic fidelity than those that are currently available. INTRODUCTION Medical skills trainers are commonly used in clinician training, but trainers do not always have the same haptic properties as patients. This could be due to the limited availability or application of documented biomechanical properties of human tissues when developing trainers. INCLUSION CRITERIA This scoping review will examine studies that have quantitatively measured the mechanical properties of human tissues. Only macroscopic specimens will be included, and articles primarily considering optical, acoustic, and thermal properties will be excluded. Included sources of evidence are from primary research, systematic reviews, meta-analyses, and conference proceedings. METHODS This review will follow the JBI methodology for scoping reviews. Sources of evidence will be extracted from CINAHL, IEEE Xplore, MEDLINE, Scopus, and biomedical engineering conference proceedings. The search is limited to articles in English. Full articles will be retrieved if their title or abstract meet the inclusion criteria. Tabular, visual, and narrative summaries will be used to present the results. SCOPING REVIEW PROTOCOL REGISTRATION Open Science Framework https://osf.io/fgb34.
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Affiliation(s)
- Kyleigh Kriener
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Harrison Whiting
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,School of Clinical Medicine, Royal Brisbane Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Christopher Futter
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Anaesthesia and Intensive Care Program, Herston Biofabrication Institute, Brisbane, QLD, Australia
| | - Mark Midwinter
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Voillequin S, Rozenberg P, Letutour K, Rousseau A. Comparative satisfaction and effectiveness of virtual simulation and usual supervised work for postpartum hemorrhage management: a crossover randomized controlled trial. BMC MEDICAL EDUCATION 2022; 22:709. [PMID: 36203183 PMCID: PMC9540154 DOI: 10.1186/s12909-022-03761-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Because virtual simulation promotes learning and cognitive skill development, it may be useful for teaching students to manage postpartum hemorrhage (PPH) and its complex decision algorithm. OBJECTIVE This study aimed to compare the satisfaction and effectiveness of virtual simulation with usual supervised work in producing knowledge and satisfaction. METHODS This two-center two-stage crossover randomized controlled trial included student midwives. One group underwent the virtual simulation intervention in the first period (January 2018) and the usual supervised classroom work in the second (May 2018); the other group followed the reverse chronology. Satisfaction was the primary outcome. The secondary outcome was knowledge of the PPH management algorithm, assessed by responses to a case vignette after each intervention session. RESULTS The virtual simulation -supervised work (VS-SW) chronology was allocated to 48 students, and its inverse (SW-VS) to 47; Satisfaction was significantly higher for the virtual simulation for its overall grade (6.8 vs. 6.1, P = 0.009), engagingness (very good 82.1% vs. 24.3%, P < 0.001), and ease of use (very good 77.9% vs. 46.1%, P < 0.001). Knowledge did not differ between the two groups (respectively, 89.5% versus 83.5%, P = 0.3). CONCLUSION Satisfaction is higher with virtual simulation without lowering knowledge scores, which argues for the use of such innovative teaching strategies. This could lead to an increase in students' motivation to learn.
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Affiliation(s)
| | - P Rozenberg
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300, Poissy, France
- Clinical Epidemiology, Paris Saclay University, CESP, UVSQ, Inserm, Team U1018, 78180, Montigny- le-Bretonneux, France
| | - K Letutour
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300, Poissy, France
- Midwifery Department, UVSQ, 78180, Montigny-le-Bretonneux, France
| | - A Rousseau
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300, Poissy, France
- Clinical Epidemiology, Paris Saclay University, CESP, UVSQ, Inserm, Team U1018, 78180, Montigny- le-Bretonneux, France
- Midwifery Department, UVSQ, 78180, Montigny-le-Bretonneux, France
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Gauthier S, Jeanneteau P, Legendre G, Boulvais E, Collin R, Malo L, Rolland D, Courtin O, Thubert T, Winer N, Dochez V. Vaginal delivery of the second twin: A simulation program for residents in obstetrics and gynecology in a type III university maternity hospital. J Gynecol Obstet Hum Reprod 2022; 51:102434. [DOI: 10.1016/j.jogoh.2022.102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
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Muacevic A, Adler JR. Medical Liability in Obstetrics/Gynecology and Co-liability With Anesthesiology in Greece: A Retrospective Study. Cureus 2022; 14:e30931. [PMID: 36465757 PMCID: PMC9710962 DOI: 10.7759/cureus.30931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 01/25/2023] Open
Abstract
Objective To evaluate the current landscape regarding medical liability in obstetric-gynecology (OB/GYN) physicians in Greece. Materials and methods Published court decisions of criminal, civil, administrative, and disciplinary content were searched in legal information banks for the years 1988-2021. The causes that led to the adverse outcome and the decisions were analyzed. Results A total of 184 decisions were directed against OB/GYNs. One hundred seventeen records concerned criminal cases and 67 civil cases. Thirty-four decisions concerned criminal cases of negligent homicide, 35 criminal cases of bodily harm, and 19 were acquittals. The most common causes of bodily injuries were neonatal encephalopathy, obstetric paralysis - quadriplegia and brachial plexus paralysis, and obstetric bleeding. Conclusion According to our results, there is a great need and challenge to maintain high standards in daily practice with continuous training and the use of international protocols. Furthermore, for each case, continuous monitoring of parturients and newborns and coordinated cooperation are necessary to reduce mortality and morbidity.
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Abstract
Simulation is a critical part of training for obstetric emergencies. Incorporation of this training modality has been shown to improve outcomes for patients and is now required by national accrediting organizations.
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Kaijomaa M, Gissler M, Äyräs O, Sten A, Grahn P. Impact of simulation training on the management of shoulder dystocia and incidence of permanent brachial plexus birth injury: an observational study. BJOG 2022; 130:70-77. [PMID: 36052568 PMCID: PMC10087175 DOI: 10.1111/1471-0528.17278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/05/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the impact of shoulder dystocia (SD) simulation training on the management of SD and the incidence of permanent brachial plexus birth injury (BPBI). DESIGN Retrospective observational study. SETTING Helsinki University Women's Hospital, Finland. SAMPLE Deliveries with SD. METHODS Multi-professional, regular and systematic simulation training for obstetric emergencies began in 2015, and SD was one of the main themes. A study was conducted to assess changes in SD management and the incidence of permanent BPBI. The study period was from 2010 to 2019; years 2010-2014 were considered the pre-training period and years 2015-2019 were considered the post-training period. MAIN OUTCOME MEASURES The primary outcome measure was the incidence of permanent BPBI after the implementation of systematic simulation training. Changes in the management of SD were also analysed. RESULTS During the study period, 113 085 vertex deliveries were recorded. The incidence of major SD risk factors (gestational diabetes, induction of labour, vacuum extraction) increased and was significantly higher for each of these factors during the post-training period (p < 0.001). The incidence of SD also increased significantly (0.01% vs 0.3%, p < 0.001) during the study period, but the number of children with permanent BPBI decreased by 55% after the implementation of systematic simulation training (0.05% vs 0.02%, p < 0.001). The most significant change in the management of SD was the increased incidence of successful delivery of the posterior arm. CONCLUSIONS Systematic simulation-based training of midwives and doctors can translate into improved individual and team performance and can significantly reduce the incidence of permanent BPBI.
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Affiliation(s)
- M. Kaijomaa
- Department of Obstetrics and Gynaecology University of Helsinki and Helsinki University Hospital Finland
| | - M. Gissler
- Finnish Institute for Health and Welfare Helsinki, Finland; Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden; Karolinska Institutet, Department of Molecular Medicine and Surgery Stockholm Sweden
| | - O. Äyräs
- Department of Obstetrics and Gynaecology University of Helsinki and Helsinki University Hospital Finland
| | - A. Sten
- Department of Obstetrics and Gynaecology University of Helsinki and Helsinki University Hospital Finland
| | - P. Grahn
- Department of Orthopaedics and Traumatology, New Children’s Hospital University of Helsinki and Helsinki University Hospital Finland
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Falcone V, Catic A, Wagner M, Steinbauer P, Bibl K, Kiss H, Farr A. Schulterdystokie-Training mittels Virtual Reality: eine Pilot-Studie. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1750239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- V Falcone
- Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Comprehensive Center for Pediatrics, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien
| | - A Catic
- Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Comprehensive Center for Pediatrics, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien
| | - M Wagner
- Klinische Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Comprehensive Center for Pediatrics, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien
| | - P Steinbauer
- Klinische Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Comprehensive Center for Pediatrics, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien
| | - K Bibl
- Klinische Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Comprehensive Center for Pediatrics, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien
| | - H Kiss
- Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Comprehensive Center for Pediatrics, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien
| | - A Farr
- Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Comprehensive Center for Pediatrics, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien
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Thiyagarajan DK, Wheatley C, Ramanathan A. Development of a Novel, Low-Cost, Low-Fidelity Simulation Model for Pudendal Nerve Block Application. J Grad Med Educ 2022; 14:229-232. [PMID: 35463159 PMCID: PMC9017260 DOI: 10.4300/jgme-d-21-01045.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/12/2021] [Accepted: 02/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pudendal nerve block is an important alternative to neuraxial anesthesia, yet studies demonstrate that 3% to 50% of pudendal nerve blocks are ineffective. Lack of clinician training is the most common cause, and there are no simulation models currently described. OBJECTIVE To develop and test a novel, low-cost, low-fidelity simulation model for training residents in the placement of a pudendal nerve block. METHODS A pudendal nerve block model was developed using commonly found supplies, with a cost of $20.57. First-year to fourth-year obstetrics and gynecology (OB/GYN) and family medicine (FM) residents were invited to 1 of 4 pudendal nerve block 1-hour simulation sessions from December 2019 to March 2021 during their required teaching sessions. Expert faculty led a discussion of pudendal nerve blocks, then participants practiced with the described model. A survey about the model was created by the authors and administrated prior to and immediately after the session. Pre- and post-surveys were analyzed by Wilcoxon signed rank tests, and Bonferroni correction was performed. RESULTS Thirty-four out of a total of 36 eligible residents participated (94%). Residents showed improvement in knowledge (median pre-simulation score 43.99 compared with 70.06 post-simulation, P<.00625) and self-assessed confidence (median pre-simulation score 1.7 compared with 3.2 post-simulation, P<.00625) of a pudendal block placement after simulation training. CONCLUSIONS This new, low-cost, reusable, low-fidelity simulation model for pudendal nerve block placement improved knowledge and confidence in OB/GYN and FM residents after 1 hour of simulation training.
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Affiliation(s)
- Dhanalakshmi K. Thiyagarajan
- All authors are with the University of Illinois at Chicago
- Dhanalakshmi K. Thiyagarajan, MD, is a PGY-3 Resident, Department of Obstetrics and Gynecology
| | - Catherine Wheatley
- All authors are with the University of Illinois at Chicago
- Catherine Wheatley, MD, is Assistant Professor, Department of Obstetrics and Gynecology
| | - Aparna Ramanathan
- All authors are with the University of Illinois at Chicago
- Aparna Ramanathan, MD, MPH, is Assistant Professor, Department of Obstetrics and Gynecology
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The impact of a multilevel approach to reduce emergency hysterectomy for postpartum haemorrhage: insights from a tertiary referral centre in Northern Italy. Eur J Obstet Gynecol Reprod Biol 2022; 271:152-157. [DOI: 10.1016/j.ejogrb.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 12/13/2022]
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Scharf JL, Bringewatt A, Dracopoulos C, Rody A, Weichert J, Gembicki M. La Machine: Obstetric Phantoms of Madame Du Coudray … Back to the Roots. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221090168. [PMID: 35465582 PMCID: PMC9021482 DOI: 10.1177/23821205221090168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
For 300 years now, obstetrics has drawn on the concept of simulation training to not only teach anatomy and physiology theoretically, but to literally infuse it practically. In an 18th century scientific culture, which was predominantly patriarchal, the French royal midwife Angelique Marguerite Le Boursier du Coudray excelled in this field. Using La Machine, one of the first obstetric phantoms, she taught thousands of midwives and even physicians. The exponential increase in publications on obstetric simulations in recent years continues to underline their current relevance, and Madame du Coudray was once at the forefront with her mannequin, probably the most sophisticated phantom of its time, a symbiosis of practical-robust architecture and anatomical-theoretical accuracy. In retrospect, it is therefore worthwhile to take a closer look at this pioneer and her obstetric phantoms, applied in the first national simulation-based training course, and to evaluate them in the overall picture of the development of anatomically correct replicas for practice-oriented training with detailed, flexible exercise - back to the roots.
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Affiliation(s)
- Jann Lennard Scharf
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Arne Bringewatt
- Gynecological Clinic, West Coast Clinic, Esmarchstraße 50, 25746 Heide, Germany
| | - Christoph Dracopoulos
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Achim Rody
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Jan Weichert
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Michael Gembicki
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Perry JD, Maples JM, Deisher HN, Trimble H, van Nes JV, Morton K, Zite NB. A Novel Approach to Teaching the Cervical Exam: A Versatile, Low-Cost Simulation for Labor and Delivery Learners. Cureus 2021; 13:e20235. [PMID: 35004050 PMCID: PMC8730796 DOI: 10.7759/cureus.20235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/05/2022] Open
Abstract
This technical report describes the making of cervical exam models that can be used to teach cervical dilation and effacement, with the versatility to teach additional obstetrical skills including artificial rupture of membranes (AROM) and fetal scalp electrode (FSE) placement. These models, primarily constructed from materials that are low cost and/or easily accessible within a healthcare setting, can be used to educate nurses, medical students, residents, and other healthcare professionals to improve the evaluation of the labor progress.
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Affiliation(s)
- Jamie D Perry
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, USA
| | - Jill M Maples
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, USA
| | - Heather N Deisher
- Brookwood Women's Health PC, Brookwood Baptist Medical Center, Birmingham, USA
| | - Hayley Trimble
- Obstetrics and Gynecology, Pikeville Medical Center, Pikeville, USA
| | - Jaclyn V van Nes
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, USA
| | - Kaitlin Morton
- Kinesiology, Recreation, and Sport, University of Tennessee, Knoxville, USA
| | - Nikki B Zite
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, USA
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Zhong B, Sarkar M, Menon N, Devi S, Budanoor JK, Beerappa N, Malhotra A, Kumar A. Obstetric neonatal emergency simulation workshops in remote and regional South India: a qualitative evaluation. Adv Simul (Lond) 2021; 6:36. [PMID: 34649628 PMCID: PMC8518143 DOI: 10.1186/s41077-021-00187-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background Healthcare facilities in remote locations with poor access to a referral centre have a high likelihood of health workers needing to manage emergencies with limited support. Obstetric and neonatal clinical training opportunities to manage childbirth emergencies are scant in these locations, especially in low- and middle-income countries. Objectives This study aimed to explore the factors, which influenced healthcare worker experience of attending birth emergencies in remote and regional areas of South India, and the perceived impact of attending the Obstetric and Neonatal Emergency Simulation (ONE-Sim) workshop on these factors. Design Qualitative descriptive study using pre- and post-workshop qualitative surveys. Settings Primary healthcare facilities in remote/regional settings in three states of South India. Participants A total of 125 healthcare workers attended the workshops, with 85 participants completing the pre- and post-workshop surveys included in this study. Participants consisted of medical and nursing staff and other health professionals involved in care at childbirth. Methods ONE-Sim workshops (with a learner-centred approach) were conducted across three different locations for interprofessional teams caring for birthing women and their newborns, using simulation equipment and immersive scenarios. Thematic analysis was employed to the free-text responses obtained from the surveys consisting of open-ended questions. Results Participants identified their relationship with the patient, the support provided by other health professionals, identifying their gaps in knowledge and experience, and the scarcity of resources as factors that influenced their experience of birth emergencies. Following the workshops, participant learning centred on improving team and personal performance and approaching future emergencies with greater confidence. Conclusions Challenges experienced by healthcare workers across sites in remote and regional South India were generally around patient experience, senior health professional support and resources. The technical and interpersonal skills introduced through the ONE-Sim workshop may help to address some of these factors in practice.
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Affiliation(s)
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | | | | | | | - Naresh Beerappa
- Tata Global Beverages Ltd. High Range Hospital, Munnar, Kerala, India
| | - Atul Malhotra
- Department of Paediatrics, Monash University, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia.
| | - Arunaz Kumar
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
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Does simulation improve clinical performance in management of postpartum hemorrhage? Am J Obstet Gynecol 2021; 225:435.e1-435.e8. [PMID: 34052191 DOI: 10.1016/j.ajog.2021.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although simulation is now widely used to improve teamwork and communication, data demonstrating improvement in clinical outcomes are limited. OBJECTIVE This study aimed to examine the clinical performance and outcomes associated with postpartum hemorrhage because of uterine atony following the implementation of a multidisciplinary simulation program. STUDY DESIGN This was a prospective observational study of response to postpartum hemorrhage because of uterine atony in an academic medical center before (epoch 1: July 2017-June 2018) and after (epoch 2: July 2019-June 2020) implementing a multidisciplinary simulation program. A total of 22 postpartum hemorrhage simulations were performed from July 2018 to June 2019 involving more than 300 nursing, obstetrical, and anesthesia providers. The simulation program focused on managing postpartum hemorrhage events and improving teamwork and communication of the multidisciplinary teams. To evaluate the clinical effectiveness of the simulation program, the primary outcome was response to postpartum hemorrhage defined as the time from the administration of uterotonic medications to transfusion of the first unit of blood in the first 12 hours following delivery, comparing epoch 2 to epoch 1 following the implementation of a simulation program. Statistical analysis included the use of the Pearson chi-square test, Wilcoxon rank-sum test, Hodges-Lehmann statistic for differences, and bootstrap methods with a P value of <.05 considered significant. RESULTS Between July 1, 2017, and June 30, 2018, there were 12,305 patients who delivered, of which 495 patients (4%) required transfusion. Between July 1, 2019, and June 30, 2020, there were 12,414 patients who delivered, of which 480 patients (4%) required transfusion. When isolating cases of postpartum hemorrhage because of uterine atony in both transfused groups, there were 157 women in the presimulation group (epoch 1) and 165 women in the postsimulation group (epoch 2), respectively. There was no difference in age, race, parity, or perinatal outcomes between the 2 epochs. Women in epoch 2 began receiving blood products significantly earlier in the first 12 hours following delivery compared with women in epoch 1 (51 [range, 28-125] minutes vs 102 [range, 32-320] minutes; P=.005). In addition, there was a significantly decreased variation in the time from the administration of uterotonic medications to transfusion of blood in epoch 2 (P=.035). Furthermore, women in epoch 2 had significantly lower estimated blood loss than women in epoch 1 (1250 [range, 1000-1750] mL vs 1500 [range, 1000-2000] mL; P=.032). CONCLUSION The implementation of a multidisciplinary simulation program at a large academic center focusing on the management of postpartum hemorrhage was associated with an improved clinical response. Specifically, there were significantly faster times from the administration of uterotonic medications to transfusion of blood, decreased variance in the time from the administration of uterotonic medications to transfusion of blood, and lower estimated blood loss following the implementation of a simulation program. Because delay in treatment is a major cause of preventable maternal death in obstetrical hemorrhage, the results in our study provided clinical evidence that a simulation program may improve patient outcomes in such emergencies.
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Kogutt BK, Kim JM, Will SE, Sheffield JS. Development of an Obstetric Hemorrhage Response Intervention: The Postpartum Hemorrhage Cart and Medication Kit. Jt Comm J Qual Patient Saf 2021; 48:120-128. [PMID: 34952828 DOI: 10.1016/j.jcjq.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity in the United States, and timely treatment is imperative. Delay in treatment of PPH can lead to significant blood loss and increased morbidity and mortality. Supplies and medications essential for treating PPH are typically not located in close proximity to the hemorrhaging patient, leading to inefficiency and delay in timely response to hemorrhage. METHODS An in situ hemorrhage simulation was created dictating the collection of a prespecified list of supplies commonly used in response to PPH on labor and delivery (L&D). Baseline data were collected, then Lean Six Sigma tools were used to construct a process map, including recording times and cumulative distance traveled for collection of each item. The simulation was repeated after development, creation, and deployment of each intervention. For the first intervention, a PPH cart was created containing the supplies most used in response to PPH. Second, a PPH medication kit was created consisting of a refrigerated box containing all medications typically administered during a PPH. RESULTS The average time to collect a prespecified list of supplies and medications in response to a PPH scenario was 11 minutes 5 seconds (standard deviation [SD] = 3 minutes 33 seconds), with an average cumulative distance traveled of 4,092 feet. Following Intervention 1, the time decreased to 4 minutes 0 seconds, with 918 feet traveled (only one trial performed). Intervention 2 further reduced the average time and cumulative distance to 2 minutes 14 seconds (SD = 16 seconds) and 462 feet, respectively. This represents a 79.8% reduction in time and an 88.7% reduction in distance from baseline to postintervention. CONCLUSION A PPH cart and medication kit can significantly reduce the amount of time and distance traveled to obtain materials necessary to treat hemorrhage, thus optimizing a team's ability to efficiently treat PPH.
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Simulation-based teaching and models for caesarean sections: a systematic review to evaluate the tools for the 'See One, Practice Many, Do One' slogan. Curr Opin Obstet Gynecol 2021; 32:305-315. [PMID: 32796165 DOI: 10.1097/gco.0000000000000655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Caesarean sections are the most commonly performed procedure globally. Simulation-based training for caesarean sections can provide healthcare practitioners a safe and controlled environment to develop this life-saving skill. We systematically reviewed the use of simulation-based training for caesarean section and its effectiveness. Embase, Pubmed, Scopus and Web of Science were searched from inception to June 2019, without language restriction, for studies that included methods of simulation for caesarean section. Studies were selected and data extracted in duplicate. Synthesis analysed common themes on simulation-based training strategies. RECENT FINDINGS There were 19 relevant studies including the following simulation-based methods: simulators (high and low fidelity), scenario-based drills training, e-learning and combinations. A common theme was simulation for rare events such as perimortem caesarean, impacted foetal head and uterine rupture. Combination studies appeared to provide a more comprehensive training experience. Studies rarely adequately assessed the educational or clinical effectiveness of the simulation methods. SUMMARY There are different types of simulator models and manikins available for caesarean section training. Simulation-based training may improve technical skills and nontechnical skills, in a risk-free environment. More research is needed into simulation training effectiveness and its efficient incorporation into practice for improving outcomes.
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Kinsman L, Cooper S, Champion R, Kim JA, Boyle J, Cameron A, Cant RP, Chung C, Connell C, Evans L, McInnes D, McKay A, Norman L, Penz E, Rana M, Rotter T. The impact of web-based and face-to-face simulation education programs on nurses' response to patient deterioration: A multi-site interrupted time series study. NURSE EDUCATION TODAY 2021; 102:104939. [PMID: 33934038 DOI: 10.1016/j.nedt.2021.104939] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 12/13/2020] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Nurses' response to patient deterioration in acute hospital wards is a priority issue. Simulation education programs improve nurses' knowledge and confidence, but the translation into better care is largely unknown for both web based (WB) and face to face (F2F) simulation programs. AIM To measure the impact of simulation education on nurses' response to patient deterioration in acute medical ward settings, and to compare the impact of WB and F2F versions. DESIGN An interrupted time series, non-randomised trial across four medical wards in Victoria, Australia. Wards were allocated to either web-based or face-to-face versions of the same simulation program, FIRST2ACT. Interrupted time series measurement for six fortnights both before and after the intervention were used to measure and compare responses to deterioration. Responses to patient deterioration were extracted from medical records and grouped into outcomes for escalation (e.g. initiation of clinical review), assessment and observation (e.g. increased recording of vital signs, conscious state and pain scores) and clinical interventions (e.g. oxygen administration). RESULTS 126 nurses (89%) participated across the four wards. 946 patient records (506 in the F2F; 440 in the WB group) were included in analyses. There were significant and sustained improvements between pre and post samples in outcomes for escalation (13.0% to 28.8%; p = 0.000) and assessment and observation (conscious state recorded increased from 91.1% to 100%; p = 0.000, and pain score recorded increased from 97.8% to 99.8%; p = 0.000). There were no differences between the web-based and face-to-face groups except in appropriate oxygen application which increased by 7.7% in the F2F group and decreased by 11.8% in the WB group (p = 0.046). CONCLUSIONS There was a significant improvement in nurses' response to patient deterioration following both versions of simulation, indicating that both have a role to play in supporting nurses' response to patient deterioration.
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Affiliation(s)
- Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Port Macquarie Base Hospital, Port Macquarie, NSW 2444, Australia.
| | - Simon Cooper
- Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia.
| | | | - Jeong-Ah Kim
- Federation University Australia, University Drive, Mt Helen, VIC 3350, Australia.
| | - Jayne Boyle
- St John of God Health Care, Bendigo, PO Box 478, Bendigo, Victoria 3350, Australia.
| | - Amanda Cameron
- Latrobe Regional Hospital, 10 Village Ave, Traralgon, VIC 3844, Australia.
| | - Robyn P Cant
- Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia.
| | - Catherine Chung
- Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia.
| | - Cliff Connell
- Monash University, Room E2.31, Building E, Peninsula Campus, McMahons Road, Frankston, P O Box 527, Frankston, VIC, Australia.
| | - Lisa Evans
- St John of God Health Care Berwick, Gibb St, Berwick, Victoria 3806, Australia.
| | - Denise McInnes
- Central Gippsland Health Service, 155 Guthridge Parade, Sale, VIC 3850, Australia.
| | - Angela McKay
- University of Tasmania, Locked Bag 1322, Launceston, TAS 7250, Australia.
| | - Lisa Norman
- St John of God Health Care Berwick, Gibb St, Berwick, Victoria 3806, Australia.
| | - Erika Penz
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Canada.
| | - Masud Rana
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Canada.
| | - Thomas Rotter
- Healthcare Quality Programs, Queens' University, Kingston, Canada.
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G Shilkrut A, C Hsu R, M Fuks A. Fetal Heart Rate Tracing Category II: A Broad Category in Need of Stratification. Neoreviews 2021; 22:e88-e94. [PMID: 33526638 DOI: 10.1542/neo.22-2-e88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Fetal heart rate (FHR) tracings are classified into 3 categories per the National Institute of Child Health and Human Development guidelines. There exists broad consensus on the recognition and management of categories I and III. However, a category II FHR tracing is considered "indeterminate" and cannot be classified as either reassuring or non-reassuring. Absence of variability and high frequency and increased depth of decelerations are the key determining factors that make a category II tracing non-reassuring and are associated with fetal metabolic acidosis. Periodic category II tracing is present in the majority of normal laboring patients. In the setting of a category II tracing, an initial attempt should be made for in utero resuscitation of the fetus. If the tracing fails to improve over a period of 1 to 2 hours, or the fetal tracing gradually deteriorates, a decision should be made for operative vaginal or cesarean delivery. Category II tracing management algorithms can aid in decision-making in this uncertain clinical scenario. Team training and simulation may improve team performance and have a positive impact on neonatal outcomes.
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Affiliation(s)
- Alexander G Shilkrut
- Department of Obstetrics and Gynecology, New York Medical College, Metropolitan Hospital, NYC Health+Hospitals, New York, NY
| | - Richard C Hsu
- Wayne State University School of Medicine, Detroit, MI
| | - Aleksandr M Fuks
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, Queens Hospital, NYC Health+Hospitals, New York, NY
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Evans MI, Britt DW, Evans SM. Mid forceps did not cause "compromised babies" - "compromise" caused forceps: an approach toward safely lowering the cesarean delivery rate. J Matern Fetal Neonatal Med 2021; 35:5265-5273. [PMID: 33494634 DOI: 10.1080/14767058.2021.1876657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Over 5 decades, Cesarean Delivery rates (CDR) have risen 6-fold while vaginal operative deliveries [VODs] decreased from >20% to ∼3%. Poor outcomes (HIE and cerebral palsy) haven't improved. Potentiating the virtual abandonment of forceps (F), particularly midforceps (Mid), were allegations about various poor neonatal outcomes. Here, we evaluate VOD and CDR outcomes controlling for prior fetal risk metrics (PR) ascertained an hour before birth. METHODS Our 45-year-old database from a labor research unit of moderate/high risk laboring patients (288 NSVDs, 120 Lows, 30 Mids, and 32 CDs) had multiple fetal scalp samples for base excess (BE), pH, cord blood gases (CB), and umbilical artery bloods. ANOVA established relationships between birth methods and outcomes (Cord blood BE and pH and 1 and 5 min Apgar scores); correlations, and two-step multiple regression assessed PR for delivery method and neonatal outcomes. The main outcome measures were correlations of outcome measures with fetal scalp sample BE and pH up to an hour before delivery and fetal reserve index scores scored concurrently. RESULTS NSVDs had the best immediate neonatal outcomes with significantly higher CB pH and BE as compared to forceps and CDs. However, controlling for PR revealed: (1) PR at 1 h before delivery correlated with delivery mode, i.e. the decrements in outcomes were already present before the delivery was performed; and (2) The presumed deleterious effects of interventional deliveries, per se, were significantly reduced, and (3) Fetal Reserve Index predicted neonatal outcomes better than fetal scalp sample BE, pH, or delivery mode. CONCLUSION The historical belief that MF deliveries caused poorer outcomes than NSVDs seems mostly backwards. Appreciating PR's impact on delivery routes, and when appropriate, properly performing VODs could safely reduce CDR. If our approach lowered CDR by only ∼2%, in the United States about 80,000 CDs might be avoided, saving ∼$750 Million yearly. In the post pandemic world, safely apportioning medical expenses will be even more critical than previously.
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Affiliation(s)
- Mark I Evans
- Comprehensive Genetics, Fetal Medicine Foundation of America, New York, NY, USA.,Department of Obstetrics & Gynecology, Icahn School of Medicine at Mt Sinai, Mt Sinai, NY, USA
| | - David W Britt
- Comprehensive Genetics, Fetal Medicine Foundation of America, New York, NY, USA
| | - Shara M Evans
- Comprehensive Genetics, Fetal Medicine Foundation of America, New York, NY, USA.,Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Benlolo S, Nensi A, Campbell DM, Assouad C, Taylor TS, Shore EM. The Use of In Situ Simulation to Enhance COVID-19 Pandemic Preparedness in Obstetrics. Cureus 2021; 13:e12906. [PMID: 33654591 PMCID: PMC7904388 DOI: 10.7759/cureus.12906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Simulation’s benefits in medical education are well established. However, its use for pandemic preparedness in obstetrics is lacking. Management of obstetrical patients with suspected COVID-19 infection is a complex task with safety considerations for mother, fetus and healthcare workers. Implementation of new workflow algorithms to ensure safety is critical but is challenging to implement in real-time. We sought to improve pandemic preparedness by designing and deploying a high-fidelity simulation exercise involving the admission of a labouring obstetrical patient with suspected COVID-19 into a labour room, urgent transfer to the operating room and neonatal resuscitation. The creation of the simulation scenario was a multi-disciplinary effort with input from a focus group of key clinical stakeholders from within and outside of our centre to ensure clinical validity. Simulations were performed on the clinical unit during regular work hours so workflow could be observed in real-time with access to the equipment and personnel in which this clinical scenario would occur. We completed a total of 11 simulation sessions involving 42 participants. Feedback, obtained from debrief sessions and anonymous surveys, was categorized based on the human factors framework, and used as part of an iterative process to adapt, revise and improve the simulation scenario. The result of this iterative process was the creation of validated departmental infection control protocols that continue to be implemented through the second wave of the COVID-19 pandemic.
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Affiliation(s)
- Samantha Benlolo
- Obstetrics and Gynaecology, St. Michael's Hospital, Unity Health Toronto, Toronto, CAN
| | - Alysha Nensi
- Obstetrics and Gynaecology, St. Michael's Hospital, Unity Health Toronto, Toronto, CAN
| | | | - Caroline Assouad
- Obstetrics and Gynaecology, St. Michael's Hospital, Unity Health Toronto, Toronto, CAN
| | - Taryn S Taylor
- Obstetrics and Gynaecology, London Health Sciences Centre, Schulich School of Medicine and Dentistry, London, CAN
| | - Eliane M Shore
- Obstetrics and Gynaecology, St. Michael Hospital, Unity Health Toronto, Toronto, CAN
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MacCuish AH, McNulty M, Bryant C, Deaner A, Birns J. Simulation training for clinicians returning to practice. Br J Hosp Med (Lond) 2021; 82:1-13. [PMID: 33512294 DOI: 10.12968/hmed.2020.0587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Many doctors take time out of clinical practice, and then have decreased confidence and poor performance ratings on their return. Simulation training provides a safe and effective learning platform for healthcare professionals to become immersed in realistic scenarios that provide an opportunity to develop technical and non-technical skills. A standardised, 1-day, multi-fidelity, interprofessional, simulation training course was developed and delivered at four sites, focusing on human factors, patient safety and acute clinical scenarios relevant for clinicians returning to practice in internal medicine. A total of 56 participants, with a median time out of training of 3.6 years, attended seven courses. Quantitative and qualitative analysis showed a significant pre/post-course increase in candidates' self-reported confidence in returning to practice along with learning in non-technical skills. The carefully designed standardised format may facilitate wider expansion of such training.
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Affiliation(s)
- A H MacCuish
- Department of Ageing & Health, St Thomas' Hospital, London, UK
| | - M McNulty
- Health Education England, London, UK
| | - C Bryant
- Health Education England, London, UK
| | - A Deaner
- Health Education England, London, UK
| | - J Birns
- Department of Ageing & Health, St Thomas' Hospital, London, UK.,Health Education England, London, UK
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Baaklini C, Menassa N, Larios JT, Ballas DA. A Simulation Model for External Cephalic Version. Cureus 2020; 12:e12382. [PMID: 33527060 PMCID: PMC7842254 DOI: 10.7759/cureus.12382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Breech presentation complicates as many as 4% of all deliveries. External cephalic version (ECV) is a procedure that involves the external rotation of the fetus through the mother’s abdomen from a breech position into a cephalic position. It provides a beneficial alternative to cesarean section (CS) as it is less invasive, more cost-effective, and mitigates many of the maternal health risks associated with CS. Though ECV has become more widely used in recent years, studies have shown that a large percentage of residency programs lack proper training pertaining to ECV, increasing the need for additional educational intervention. A well-supported method of procedural training that has demonstrated efficacy among trainees is the incorporation of simulation models. While many models have already been developed for various obstetrical procedures, few easily reproducible models currently exist for ECV. The purpose of this study was to develop a reconstructible ECV model that could be utilized for practice by trainees in the field of obstetrics. This study’s proposed ECV model along with a lecture that was presented to residents and data on the effectiveness of the model and comfort with performing the procedure was collected and analyzed. The results demonstrated that when compared to baseline prior to training, levels of comfort with performing an ECV increased amongst trainees after practicing on the model.
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Affiliation(s)
- Carla Baaklini
- Medicine, Northeast Ohio Medical University, Rootstown, USA
| | | | | | - Derek A Ballas
- Obstetrics and Gynecology, Summa Health System, Akron, USA
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Dillon SJ, Kleinmann W, Seasely A, Ames R, Dyess-Nugent P, McIntire DD, Suen E, Nelson DB. How personality affects teamwork: a study in multidisciplinary obstetrical simulation. Am J Obstet Gynecol MFM 2020; 3:100303. [PMID: 33383231 DOI: 10.1016/j.ajogmf.2020.100303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multidisciplinary simulation has been shown to improve teamwork in the obstetrical literature by providing a safe, but realistic, environment for participants to learn. However, the impact of team members' personality traits on how the team performs during an obstetrical emergency has not been studied in medicine. OBJECTIVE Our objective was to evaluate teamwork and communication of simulation participants in association with personality traits within a multidisciplinary obstetrical simulation program. STUDY DESIGN This was a prospective observational study of postpartum hemorrhage simulations involving participants from Obstetrics, Nursing, Midwifery, and Anesthesia. Before simulation, individual personality testing was performed on participants using the Big Five Inventory. Each team was scored using the Clinical Teamwork Scale after simulation. Communication and teamwork scores were evaluated for association, and personality traits were analyzed for association with teamwork and communication. For each personality trait, an interaction model was tested for 3 of the team scores: teamwork, communication, and situational awareness. Analysis of variance with 2 level interactions was used in this effort. RESULTS From July 2018 to June 2019, 22 obstetrical simulations were performed with a total of 270 staff. Overall, teamwork was significantly associated with communication for each team. When examining individual personality scores, neuroticism was negatively associated with teamwork when coupled with communication. That is, increased neuroticism was significantly associated with increased communication that was detrimental to the overall teamwork. Other personality traits were not significantly associated with teamwork and communication (P=.03). CONCLUSION In a multidisciplinary simulation, communication was positively associated with teamwork, and specific personality traits negatively affected team performance.
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Affiliation(s)
- Shena J Dillon
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Whitney Kleinmann
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Angela Seasely
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Rebecca Ames
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Phyllis Dyess-Nugent
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Donald D McIntire
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ellen Suen
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - David B Nelson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
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Bajpai S, Lindeman B. The Trainee's Role in Patient Safety: Training Residents and Medical Students in Surgical Patient Safety. Surg Clin North Am 2020; 101:149-160. [PMID: 33212075 DOI: 10.1016/j.suc.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
"The focus on patient safety offers a new framework not only for delivering health care but also for training physicians. Medical school and surgical graduate medical education must transition to a more holistic approach by teaching technical and nontechnical skills. Formalized safety curricula can be developed by adopting recommended guidelines and content from national and international organizations, existing validated practices of training programs, frequent simulation exercises, and objective evaluation tools."
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Affiliation(s)
- Swara Bajpai
- Department of Surgery, 1808 7th Avenue South, BDB 202, Birmingham, AL 35294, USA
| | - Brenessa Lindeman
- Endocrine Surgery, General Surgery, Department of Surgical Oncology, BDB 603, Birmingham, AL, USA.
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Ogunyemi D, Haltigin C, Vallie S, Ferrari TM. Evolution of an obstetrics and gynecology interprofessional simulation-based education session for medical and nursing students. Medicine (Baltimore) 2020; 99:e22562. [PMID: 33120744 PMCID: PMC7581067 DOI: 10.1097/md.0000000000022562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022] Open
Abstract
Simulation and Objective Structured Clinical Examination assessment of learners can teach clinical skills proficiency in a safe environment without risk to patients. Interprofessional simulation-based education (IPSE) contributes to a transformation in students' understanding of teamwork and professional roles. Long term outcomes for stimulation and IPSE sessions, are less well studied. We hypothesized that a progressive interprofessional education simulation program incorporating both faculty and interprofessional student collaboration would improve medical students' knowledge retention, comfort with procedural skills, positive teamwork and respectful interaction between students.An Obstetrics and Gynecology IPSE for medical and nursing students (NS) was developed in collaboration between a school of medicine and a school of nursing from 2014 to 2017. By 2017, content includedFrom 2014 to 2016, medical students completed attitude, knowledge, and perception surveys both pre and immediately post simulation, at 4 months, and 8 months. In 2017; all students completed self-assessments and received faculty-assessments.The program trained 443 medical and 136 NS. Medical students' knowledge, comfort, and interest increased significantly post simulation. Outcome scores decreased but were still significantly improved at 4 months but nearly dissipated by 8 months. There were no significant differences between medical and NS self-assessment or faculty-assessment scores regarding IUD insertion, cervical examination, or contraception quiz scores. Medical students' birth simulation self-assessment versus faculty-assessment scores were 8.6 vs 8.9, P < .001.Simulation improved students' short-term medical knowledge, comfort, and perception with some long-term persistence at 4-8 months. Medical and NS learned obstetrics and gynecology skills in a collaborative environment and in role-specific situations. Medical students had the opportunity to learn from NS. Positive teamwork and respectful interaction occurred between the students.
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Affiliation(s)
- Dotun Ogunyemi
- Arrowhead Regional Medical Center
- California University of Science and Medicine, Colton, California
| | - Christopher Haltigin
- Beaumont Health, Department of Obstetrics and Gynecology, Royal Oak
- Oakland University William Beaumont School of Medicine
| | - Stephanie Vallie
- Oakland University, School of Nursing, Rochester Hills, Michigan
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Cuerva MJ, Espinosa JÁ, Barras S, Gonzalez-Cerron S, Ojeda F, Cortés M. Which technique is better to place a manoeuvrable vacuum extractor cup on the flexion point? Vacca vs. Bird technique. J Perinat Med 2020; 48:694-699. [PMID: 32692705 DOI: 10.1515/jpm-2020-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/24/2020] [Indexed: 11/15/2022]
Abstract
Objectives The purpose of this study is to compare the vacuum extractor cup application technique described by Bird vs. the technique described by Vacca on a simulation model. Methods Six obstetricians participated in the study. Each obstetrician performed eight vacuum assisted deliveries using the Bird technique and eight vacuum assisted deliveries using the Vacca 5-Steps technique. Results A total of 96 vacuum assisted deliveries were performed. The mean distance from the centre of the cup to the flexion point was 1.78±0.96 cm for the Bird technique and 1.05±0.60 cm for the Vacca technique (p<0.001). The lateral distance (over the parietal bone) was 1.16±0.69 cm for the Bird technique and 0.66±0.52 cm for the Vacca technique (p<0.001). The vertical distance (towards the frontal or occipital bone) was 1.12±1.02 cm for the Bird technique and 0.67±0.55 cm for the Vacca technique (p=0.009). In occipito anterior positions, there were no significant differences between both techniques. Conclusions The Vacca technique was better in transverse and posterior positions.
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Affiliation(s)
| | - Jose Ángel Espinosa
- Department of Affective Childbirth (UPA), Hospital San Francisco de Asís, Madrid, Spain
| | - Silvia Barras
- Department of Obstetrics and Gynaecology, Hospital Universitario Infanta Cristina, Madrid, Spain
| | - Silvia Gonzalez-Cerron
- Department of Obstetrics and Gynaecology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Faride Ojeda
- Department of Affective Childbirth (UPA), Hospital San Francisco de Asís, Madrid, Spain
| | - Marta Cortés
- Department of Obstetrics, Hospital Universitario La Paz, Madrid, Spain
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Foglia LM, Eubanks AA, Peterson LC, Hickey K, Hammons CB, Borgia LB, Light MR, Jackson A, Deering S. Creation and Evaluation of a Cesarean Section Simulator Training Program for Novice Obstetric Surgeons. Cureus 2020; 12:e10324. [PMID: 33052285 PMCID: PMC7546603 DOI: 10.7759/cureus.10324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND We evaluated a novel simulation-based cesarean section training program to teach critical techniques for cesarean section and hemorrhage management. Methods: This was a prospective educational intervention. After Institutional Review Board approval, we recruited Obstetrics and Gynecology, Family Medicine, and General Surgery residents at three hospitals. All participants received didactic education. Participants were then randomized into two arms with one group to receive task-trainer based training and the other no training. Afterwards, all residents had their performance of a complete cesarean section and management of a post-partum hemorrhage evaluated on a high-fidelity simulator. Evaluators were blinded to randomization. EXPERIENCE Thirty-three participants were recruited between July 2017 and January 2019. There were 19 trainees in the control group and 14 in the intervention group. The intervention group scored significantly higher on performance of the cesarean delivery (p-value 0.007), hemorrhage management (p-value 0.0002), and overall skill (p-value 0.008). There were no differences in the other categories. CONCLUSION Participants trained with a combination of didactic education and task-trainers versus didactic education alone performed significantly better on all procedural aspects of a cesarean section and hemorrhage management on a high-fidelity simulator, demonstrating that simulation-based training allows trainees to gain procedural experience while decreasing patient risk.
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Affiliation(s)
- Lisa M Foglia
- Maternal Fetal Medicine, Womack Army Medical Center, Fort Bragg, USA
| | - Allison A Eubanks
- Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, USA
| | - Logan C Peterson
- Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, USA
| | - Kimberly Hickey
- Maternal Fetal Medicine, Walter Reed National Military Medical Center, Bethesda, USA
| | | | - Lindsey B Borgia
- Obstetrics and Gynecology, Fort Belvoir Community Hospital, Fort Belvoir, USA
| | - Morgan R Light
- Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, USA
| | - Amanda Jackson
- Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, USA
| | - Shad Deering
- Obstetrics and Gynecology, Christus Health, San Antonio, USA
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Abstract
PURPOSE OF REVIEW Simulation training (crew resource management training and scenario training) has become an important tool in the education of anesthesiologists. This review summarizes recent research performed in this area, focusing more specifically on obstetric anesthesia. RECENT FINDINGS Simulation training is becoming more integrated in the modern education of anesthesiologists. Research regarding the most effective way to perform simulation training in terms of learning outcomes and long-term skill retention has started to appear. Scenarios which are played independently and that allow for simulated mortality, as well as relaxation techniques before debriefing might have positive effects in this regard. Furthermore, simulation has been investigated as a tool to improve patient safety in low-resource settings. In addition, simulation training in the domain of obstetrics has been rapidly expanding and has an important role in this field of medicine as well. SUMMARY Simulation training has acquired a central role in modern education of anesthesiologists. Further research regarding elements to optimize simulation training in terms of learning outcomes and long-term skill retention is desirable. In addition, little data exist concerning the effect of simulation training on possible improvement of patient outcomes in anesthesia.
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Pouypoudat L, Tomczyk L, Gauchotte E, Morel O, Bertholdt C. [Intrauterine tamponade: Practices and training assessment]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:409-413. [PMID: 32084572 DOI: 10.1016/j.gofs.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The main objective was to describe the practices of a French center regarding the use of intrauterine tamponade. The secondary objective was to describe the training of residents in the use of intrauterine tamponade (IUT). METHODS This was a practice survey conducted through an anonymous quiz sent to residents in France between May 1, 2018 and July 1, 2019. Responses from first year residents were excluded. The data concerned the practices of the centers (mode of delivery, mode of insertion, ultrasound control, use of vaginal gauze or antibiotic prophylaxis) as well as the feeling of the residents concerning their training in using of the intrauterine tamponade (frequency, training sessions, learning difficulties). RESULTS We obtained 145 responses to represent all regions of France. Responses from 27/28 centres were obtained. All the centres use it during cesarean section and after vaginal delivery. Vaginal gauze is used in 74% of cases and 65% use antibiotic prophylaxis. A specific training during the residentship is described in only 26% of cases and 21% of residents say they have never used an IUT. CONCLUSION Intrauterine tamponade is a technique widely used in France, regardless of the mode of delivery. The training of residents is essential, especially since the simulation is perfectly adapted to the learning for using intrauterine tamponade.
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Affiliation(s)
- L Pouypoudat
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France
| | - L Tomczyk
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France
| | - E Gauchotte
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France
| | - O Morel
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France; Inserm U1254, IADI, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - C Bertholdt
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France; Inserm U1254, IADI, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
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