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Donati S, Buoncristiano M, D’Aloja P, Maraschini A, Corsi Decenti E, Lega I. Uptake and Adherence to National Guidelines on Postpartum Haemorrhage in Italy: The MOVIE before-after Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5297. [PMID: 37047913 PMCID: PMC10093811 DOI: 10.3390/ijerph20075297] [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: 02/16/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
Translating evidence-based guidelines into clinical practice is a complex challenge. This observational study aimed to assess the adherence to the Italian national guidelines on postpartum haemorrhage (PPH) and describe the clinical management of haemorrhagic events in a selection of maternity units (MUs) in six Italian regions, between January 2019 and October 2020. A twofold study design was adopted: (i) a before-after observational study was used to assess the adherence to national clinical and organisational key recommendations on PPH management, and (ii) a cross-sectional study enrolling prospectively 1100 women with PPH ≥ 1000 mL was used to verify the results of the before-after study. The post-test detected an improved adherence to 16/17 key recommendations of the guidelines, with clinical governance and communication with family members emerging as critical areas. Overall, PPH management emerged as appropriate except for three recommended procedures that emphasise different results between the practices adopted and the difference between what is considered acquired and what is actually practised in daily care. The methodology adopted by the MOVIE project and the adopted training materials and tools have proved effective in improving adherence to the recommended procedures for appropriate PPH management and could be adopted in similar care settings in order to move evidence into practice.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Alice Maraschini
- Servizio Tecnico Scientifico di Statistica-Italian National Institute of Health, 00161 Rome, Italy;
| | - Edoardo Corsi Decenti
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
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Smithers-Sheedy H, Swinburn K, Waight E, King R, Hui L, Jones CA, Daly K, Rawlinson W, Mcintyre S, Webb A, Badawi N, Bowen A, Britton PN, Palasanthiran P, Lainchbury A, Shand A. eLearning significantly improves maternity professionals' knowledge of the congenital cytomegalovirus prevention guidelines. Aust N Z J Obstet Gynaecol 2022; 62:445-452. [PMID: 35348198 PMCID: PMC9541485 DOI: 10.1111/ajo.13500] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/17/2021] [Accepted: 01/29/2022] [Indexed: 11/29/2022]
Abstract
Aims Cytomegalovirus (CMV) is a preventable cause of neurodevelopmental disability. Australian guidelines recommend that pregnant women are informed about CMV to reduce their risk of infection; however, less than 10% of maternity health professionals routinely provide prevention advice. The aim was to develop and evaluate the effectiveness of an eLearning course for midwives to improve knowledge and confidence about CMV. Materials and Methods Participants undertaking the course between March and November 2020 were invited to complete an evaluation questionnaire: before the course (T1), immediately after (T2) and three months post completion (T3). A linear mixed model was used to evaluate change in participant scores; P < 0.05 was considered statistically significant. Results Midwives (316/363, 87%), midwifery students (29/363, 8%) and nurses (18/363, 5%) participated. At T1 80% indicated they had not received education about CMV. Total adjusted mean scores for questionnaires completed between T1 (n = 363) and T2 (n = 238) increased significantly (from 17.2 to 22.8, P < 0.001). Limited available T3 scores (n = 27) (−1.7, P < 0.001), while lower than T2, remained higher than at T1 (+3.6, P < 0.001). Participants’ awareness of CMV information resources improved from 10 to 97% from T1 to T2. Confidence in providing CMV advice increased from 6 to 95% between T1 and T2 (P < 0.001) and was maintained at T3. Almost all (99%) participants indicated they would recommend the course to colleagues. Conclusion Participants who completed the eLearning course had significantly improved knowledge and confidence in providing advice about CMV. Programs targeting other maternity health professionals should be considered, to further support the implementation of the congenital CMV prevention guidelines.
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Affiliation(s)
- Hayley Smithers-Sheedy
- Cerebral Palsy Alliance Research Institute, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Katherine Swinburn
- Cerebral Palsy Alliance Research Institute, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Emma Waight
- Cerebral Palsy Alliance Research Institute, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ruth King
- Nursing and Midwifery Office, ACT Health, Canberra, ustralian Capital Territory, Australia
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Cheryl A Jones
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead and Sydney Medical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Kate Daly
- CMV Australia, Normanhurst, New South Wales, Australia
| | - William Rawlinson
- NSW Health Pathology Randwick, Level 4 Campus Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Sarah Mcintyre
- Cerebral Palsy Alliance Research Institute, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Annabel Webb
- Cerebral Palsy Alliance Research Institute, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,The Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Asha Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Philip N Britton
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead and Sydney Medical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Pamela Palasanthiran
- Department of Immunology and Infectious Disease, Sydney Children's Hospitals Network, School of Women's and Child Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Anne Lainchbury
- Royal Hospital for Women, Randwick, Western Australia, Australia
| | - Antonia Shand
- Royal Hospital for Women, Randwick, Western Australia, Australia.,Child Population and Translational Health Research, Children's Hospital at Westmead, Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Donati S, Buoncristiano M, Lega I, D’Aloja P, Maraschini A. The Italian Obstetric Surveillance System: Implementation of a bundle of population-based initiatives to reduce haemorrhagic maternal deaths. PLoS One 2021; 16:e0250373. [PMID: 33891629 PMCID: PMC8064507 DOI: 10.1371/journal.pone.0250373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/06/2021] [Indexed: 12/11/2022] Open
Abstract
In this before and after cross-sectional analysis, the authors aim to assess the impact of the bundle of research and training initiatives implemented between 2013 and 2018, and coordinated by the Italian Obstetric Surveillance System (ItOSS) to reduce obstetric haemorrhagic emergencies in five selected Italian Regions. To this purpose, the haemorrhagic Maternal Mortality Ratios (MMR) per 100,000 live births were estimated before and after implementing the bundle, through the ItOSS's vital statistic linkage procedures and incident reporting and Confidential Enquiries. The research and training bundle was offered to all health professionals involved in pregnancy and birth care in the selected regions, representing 40% of national live births, and participating in the ItOSS audit cycle since its institution. The haemorrhagic MMR significantly decreased from 2.49/100,000 live births [95% CI 1.75 to 3.43] in the years 2007-2013 prior to the bundle implementation, to 0.77/100,000 live births [95% CI 0.31 to 1.58] in the years 2014-2018 after its implementation. According to the study results, the bundle of population-based initiatives might have contributed to reducing the haemorrhagic MMR in the participating regions, thus improving the quality of care of the major obstetric haemorrhage.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
- * E-mail:
| | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - for the ItOSS working group
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
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