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Imai K, Hashimoto Y, Ito Y, Sakata K, Kawanami M, Nakano-Kobayashi T, Hashii K, Yamahata Y, Kajiyama H, Kotani T. Educational results of the Japan Maternal Emergency Life-Saving (J-MELS) simulation training organized by Japan Council for the Implementation of the Maternal Emergency Life-Saving System (J-CIMELS): a 12-month longitudinal follow-up study in Japan. J Obstet Gynaecol Res 2024. [PMID: 38953341 DOI: 10.1111/jog.16011] [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: 04/03/2024] [Accepted: 06/16/2024] [Indexed: 07/04/2024]
Abstract
AIMS This study aimed to evaluate the long-term results of Japan Maternal Emergency Life-Saving (J-MELS) simulation training on obstetric healthcare providers, over a 12-month follow-up period. METHODS A total of 273 trainees from 17 J-MELS Basic courses conducted between August 2021 and October 2023 were included. The trainees' responses to the pre- and post-tests, questionnaires, and self-reports on the usefulness of the J-MELS scenarios in actual clinical settings at 1, 6, and 12 months after the training were analyzed. Multivariate logistic regression analysis was also conducted to identify the factors influencing knowledge retention. RESULTS We found an overall improvement in clinical knowledge acquisition after J-MELS training and a significant retention of this improvement at least until 12 months later. However, these scores gradually declined over. Trainees reported increased usefulness of J-MELS scenarios in actual clinical practice at 1, 6, and 12 months after training, particularly in managing obstetric emergencies such as atonic postpartum hemorrhage. Knowledge retention was influenced by several specific factors, such as years of clinical experience, affiliated institutions, qualifications, and especially pre-test scores. CONCLUSION Our longitudinal follow-up study demonstrated, for the first time, the long-term results of J-MELS simulation training using post-tests and self-report data. Our findings provide valuable insight into the impact of J-MELS simulation training on maternal emergency care. By elucidating the factors influencing knowledge retention and practical utility, the findings offer actionable recommendations for optimizing training strategies and improving maternal outcomes in actual clinical practice.
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Affiliation(s)
- Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuhei Hashimoto
- Department of Obstetrics and Gynecology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Yumiko Ito
- Department of Obstetrics and Gynecology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | | | - Masashi Kawanami
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - T Nakano-Kobayashi
- Division of Obstetrics and Gynecology, Holy Spirit Hospital, Nagoya, Japan
| | | | - Yoshihiro Yamahata
- Department of Emergency and Disaster Medical Systems, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Smith NT, Muller Spiti J, Padley J, Davies E. Mapping simulation-based activities for health professionals in rural and remote contexts in high-income countries: a scoping review protocol. JBI Evid Synth 2024:02174543-990000000-00298. [PMID: 38655637 DOI: 10.11124/jbies-23-00415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE This scoping review will aim to map the existing academic literature on simulation-based activities that are designed with and delivered for health professionals in geographically rural and remote contexts in high-income countries. INTRODUCTION Simulation-based health care activities are implemented in health services to increase patient safety because they allow health professionals to prepare, learn, practice, rehearse, and improve clinical performance and teamwork. Simulation-based activities are increasingly being used in rural and remote areas, where resources are limited compared with metropolitan areas. INCLUSION CRITERIA This review will include all primary and peer-reviewed research articles and abstracts that report health simulation methodologies and activities that have been used in rural and remote health care contexts in high-income countries. METHODS The proposed review will follow the JBI guidelines for scoping reviews and the PRISMA-ScR reporting guidelines. Databases to be searched will include Embase, Emcare, and MEDLINE (all searched via Ovid), Scopus, PubMed, and the Cochrane Database. The title and abstracts will be screened independently by 2 reviewers, followed by full-text screening. Data will be extracted and analyzed to address the review questions. DETAILS OF THIS REVIEW CAN BE FOUND IN OPEN SCIENCE FRAMEWORK https://doi.org/10.17605/OSF.IO/PU6GV.
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Affiliation(s)
- Naomi Tarus Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Julia Muller Spiti
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - James Padley
- Adelaide Rural Clinical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Ellen Davies
- Adelaide Health Simulation, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Janssens S, Clipperton S, Simon R, Lowe B, Beckmann M, Marshall S. Clinicians' attitudes towards a co-leadership structure for maternity emergency teams: An interview study. J Interprof Care 2022:1-9. [PMID: 35687023 DOI: 10.1080/13561820.2022.2070607] [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: 10/14/2020] [Revised: 02/08/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
Shared leadership improves team performance in many domains and is present in some interprofessional healthcare teams. Despite the dominant paradigm of a singular obstetrician leader in maternity emergencies, co-leadership, a specific form of shared leadership, has been identified as a potentially beneficial to clinical care. This qualitative interview study addresses the gaps in knowledge regarding clinician attitudes toward co-leadership and how a co-leadership structure might be implemented within a maternity care setting. Twenty-five clinicians (midwives, obstetricians and anaesthetists) working in the birthing units of two tertiary maternity units were interviewed and a conventional content analysis conducted. Clinicians viewed co-leadership as potentially beneficial to patient care through improved leadership performance and co-leader back up behavior. Implementation of co-leadership was thought to require a supportive organizational culture, agreed patient management protocols and the participation in simulation training. Enacting co-leadership required adaptable leadership sharing practices, effective communication, and high levels of trust between the co-leaders. These findings inform the future implementation strategies for co-leadership in interprofessional healthcare teams.
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Affiliation(s)
- Sarah Janssens
- Mothers Babies and Womens' Health Services, Mater Misericordiae Brisbane Ltd, Brisbane, Australia
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | | | - Robert Simon
- Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Belinda Lowe
- Department of Obstetrics and Gynaecology, Gold Coast University Hospital, Southport, Australia
- Faculty of Health Sciences and Medicine, Bond University, Southport, Australia
| | - Michael Beckmann
- Mothers Babies and Womens' Health Services, Mater Misericordiae Brisbane Ltd, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Mater Research, University of Queensland, Brisbane, Australia
| | - Stuart Marshall
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia
- Department of Medical Education, University of Melbourne, Melbourne, Australia
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Cullinane M, Zugna SA, McLachlan HL, Newton MS, Forster DA. Evaluating the impact of a maternity and neonatal emergencies education programme in Australian regional and rural health services on clinician knowledge and confidence: a pre-test post-test study. BMJ Open 2022; 12:e059921. [PMID: 35623751 PMCID: PMC9150162 DOI: 10.1136/bmjopen-2021-059921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Almost 78 000 women gave birth in the state of Victoria, Australia, in 2019. While most births occurred in metropolitan Melbourne and large regional centres, a significant proportion of women birthed in rural services. In late 2016, to support clinicians to recognise and respond to clinical deterioration, the Victorian government mandated provision of an emergency training programme, called Maternity and Newborn Emergencies (MANE), to rural and regional maternity services across the state. This paper describes the evaluation of MANE. DESIGN AND SETTING A quasi-experimental study design was used; the Kirkpatrick Evaluation Model provided the framework. PARTICIPANTS Participants came from the 17 rural and regional Victorian maternity services who received MANE in 2018 and/or 2019. OUTCOME MEASURES Baseline data were collected from MANE attendees before MANE delivery, and at four time points up to 12 months post-delivery. Clinicians' knowledge of the MANE learning objectives, and confidence ratings regarding the emergencies covered in MANE were evaluated. The Safety Attitudes Questionnaire (SAQ) assessed safety climate pre-MANE and 6 months post-MANE among all maternity providers at the sites. RESULTS Immediately post-MANE, most attendees reported increased confidence to escalate clinical concerns (n=251/259). Knowledge in the non-technical and practical aspects of the programme increased. Management of perinatal emergencies was viewed as equally stressful pre-MANE and post-MANE, but confidence to manage these emergencies increased post-delivery. Pre-MANE SAQ scores showed consistently strong and poor performing services. Six months post-MANE, some services showed improvements in SAQ scores indicative of improved safety climate. CONCLUSION MANE delivery resulted in both short-term and sustained improvements in knowledge of, and confidence in, maternity emergencies. Further investigation of the SAQ across Victoria may facilitate identification of services with a poor safety climate who could benefit from frequent targeted interventions (such as the MANE programme) at these sites.
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Affiliation(s)
- Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Stefanie A Zugna
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Michelle S Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Maternity Services, Royal Women's Hospital, Parkville, Victoria, Australia
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Mahoney B, Luebbert E. Updates on Simulation in Obstetrical Anesthesiology Through the COVID-19 Pandemic. Anesthesiol Clin 2021; 39:649-665. [PMID: 34776102 PMCID: PMC8584716 DOI: 10.1016/j.anclin.2021.08.001] [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: 01/04/2023]
Abstract
Simulation has played a critical role in medicine for decades as a pedagogical and assessment tool. The labor and delivery unit provides an ideal setting for the use of simulation technology. Prior reviews of this topic have focused on simulation for individual and team training and assessment. The COVID-19 pandemic has provided an opportunity for educators and leaders in obstetric anesthesiology to rapidly train health care providers and develop new protocols for patient care with simulation. This review surveys new developments in simulation for obstetric anesthesiology with an emphasis on simulation use during the COVID-19 pandemic.
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Carpini JA, Calvert K, Carter S, Epee-Bekima M, Leung Y. Validating the Team Emergency Assessment Measure (TEAM) in obstetric and gynaecologic resuscitation teams. Aust N Z J Obstet Gynaecol 2021; 61:855-861. [PMID: 33908031 DOI: 10.1111/ajo.13362] [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] [Received: 11/23/2020] [Revised: 03/04/2021] [Accepted: 03/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Simulation-based training is an effective method of enhancing the knowledge, skill, and technical abilities of individuals and teams encountering obstetric and gynaecologic emergencies. Simulation may also enhance the non-technical performance of teams resulting in improved patient outcomes. Although simulation-based training is widely recognised as an effective educational approach, issues around feasibility - the lack of simulation experts and malleable outcome measures of team performance - remain critical barriers to their implementation. AIM To evaluate the psychometric properties of the Team Emergency Assessment Measure (TEAM) when used by medical professionals in simulated obstetric and gynaecological emergencies. METHODS There were 151 participants (63% female; 60% consultants; 69% no previous simulation-based training) who observed three live high-fidelity obstetric and gynaecological resuscitation simulations and completed the TEAM. RESULTS Confirmatory factor analysis evaluated the construct validity of the TEAM, yielding a second-order structure identified by 'leadership', 'teamwork', and 'team management'. Convergent validity was supported by the average item-to-scale total correlation which was 0.75, P < 0.001 and the average analysis of variance extracted (AVE) 0.88. The individual factors also yielded high factor-to-scale total correlations (mean [M] = 0.87), and AVE (M = 0.89). The internal reliability was high for the whole scale (average alpha = 0.92) and across the sub-factors (average alpha = 0.80). The inter-rater reliability was excellent (inter-class correlation coefficient 1 = 0.98). Participants with differing levels of simulation training experience did not significantly differ. CONCLUSION The TEAM is a viable instrument for the assessment of non-technical performance during simulated obstetric and gynaecologic emergencies, thus enhancing the feasibility of simulation-based training.
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Affiliation(s)
- Joseph A Carpini
- Management & Organisations Department, University of Western Australia Business School, Perth, Western Australia, Australia
| | - Katrina Calvert
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Sean Carter
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | | | - Yee Leung
- Department of the Western Australian Gynaecologic Cancer Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,School of Women's and Infant's Health, University of Western Australia, Perth, Western Australia, Australia
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YILAR ERKEK Z, ALPARSLAN Ö, ÖZTÜRK ALTINAYAK S. THE EFFECT OF SIMULATION-BASED TRAINING ABOUT EMERGENCIES IN AND APPROACHES TO DELIVERY GIVEN TO EMERGENCY PERSONNEL. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.770975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Fransen AF, van de Ven J, Banga FR, Mol BWJ, Oei SG. Multi-professional simulation-based team training in obstetric emergencies for improving patient outcomes and trainees' performance. Cochrane Database Syst Rev 2020; 12:CD011545. [PMID: 33325570 PMCID: PMC8094450 DOI: 10.1002/14651858.cd011545.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Simulation-based obstetric team training focuses on building a system that will anticipate errors, improve patient outcomes and the performance of clinical care teams. Simulation-based obstetric team training has been proposed as a tool to improve the overall outcome of obstetric health care. OBJECTIVES To assess the effects of simulation-based obstetric team training on patient outcomes, performance of obstetric care teams in practice and educational settings, and trainees' experience. SEARCH METHODS The Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) were searched (14 April 2020), together with references checking and hand searching the available proceedings of 2 international conferences. SELECTION CRITERIA We included randomised controlled trials (RCTs) (including cluster-randomised trials) comparing simulation-based obstetric team training with no, or other type of training. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane, to identify articles, assess methodological quality and extract data. Data from three cluster-randomised trials could be used to perform generic inverse variance meta-analyses. The meta-analyses were based on risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). We used the GRADE approach to rate the certainty of the evidence. We used Kirkpatrick's model of training evaluation to categorise the outcomes of interest; we chose Level 3 (behavioural change) and Level 4 (patient outcome) to categorise the primary outcomes. MAIN RESULTS We included eight RCTs, six of which were cluster-randomised trials, involving more than 1000 training participants and more than 200,000 pregnancies/births. Four studies reported on outcome measures on Kirkpatrick level 4 (patient outcome), three studies on Kirkpatrick level 3 (performance in practice), two studies on Kitkpatrick level 2 (performance in educational settings), and none on Kirkpatrick level 1 (trainees' experience). The included studies were from Mexico, the Netherlands, the UK and the USA, all middle- and high-income countries. Kirkpatrick level 4 (patient outcome) Simulation-based obstetric team training may make little or no difference for composite outcomes of maternal and/or perinatal adverse events compared with no training (3 studies; n = 28,731, low-certainty evidence, data not pooled due to different composite outcome definitions). We are uncertain whether simulation-based obstetric team training affects maternal mortality compared with no training (2 studies; 79,246 women; very low-certainty evidence). However, it may reduce neonatal mortality (RR 0.70, 95% CI 0.48 to 1.01; 2 studies, 79,246 pregnancies/births, low-certainty evidence). Simulation-based obstetric team training may have little to no effect on low Apgar score compared with no training (RR 0.99, 95% 0.85 to 1.15; 2 studies; 115,171 infants; low-certainty evidence), but it probably reduces trauma after shoulder dystocia (RR 0.50, 95% CI 0.25 to 0.99; 1 study; moderate-certainty evidence) and probably slightly reduces the number of caesarean deliveries (RR 0.79, 95% CI 0.67 to 0.93; 1 study; n = 50,589; moderate-certainty evidence) Kirkpatrick level 3 (performance in practice) We found that simulation-based obstetric team training probably improves the performance of the obstetric teams in practice, compared with no training (3 studies; 2398 obstetric staff members, moderate-certainty evidence, data not pooled due to different outcome definitions). AUTHORS' CONCLUSIONS Simulation-based obstetric team training may help to improve team performance of obstetric teams, and it might contribute to improvement of specific maternal and perinatal outcomes, compared with no training. However, high-certainty evidence is lacking due to serious risk of bias and imprecision, and the effect cannot be generalised for all outcomes. Future studies investigating simulation-based obstetric team training compared to training courses with a different instructional design should carefully consider how and when to measure outcomes. Particular attention should be paid to effect measurement at the level of patient outcome, taking into consideration the low incidence of adverse maternal and perinatal events.
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Affiliation(s)
- Annemarie F Fransen
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands
| | - Joost van de Ven
- Department of Obstetrics and Gynaecology, Elkerliek Hospital, Helmond, Netherlands
| | - Franyke R Banga
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - S Guid Oei
- Department of Obstetrics and Gynaecology; Department of Electrical Engineering (University of Technology, Eindhoven), Máxima Medical Centre, Veldhoven, Netherlands
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Hardy L, Garratt JL, Crossley B, Copson S, Nathan E, Calvert K, Epee-Bekima M. A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries. Aust N Z J Obstet Gynaecol 2020; 60:704-708. [PMID: 32067227 DOI: 10.1111/ajo.13132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Following the Term Breech Trial, vaginal breech deliveries are rarely undertaken in Australia. Some women choose to have a breech delivery following counselling, while others will present in labour with an undiagnosed breech. Clinicians need to be skilled in vaginal breech delivery despite this being a rare clinical situation. Simulation training provides a means by which uncommon clinical situations can be practised. AIM This study aims to determine if the introduction of a simulation-based training course is associated with an improvement in the management of vaginal breech delivery and neonatal outcomes. METHODS Cases of term vaginal breech delivery five years prior to introduction of In Time training (2001-2005) and five years after In Time training (2007-2011) were identified in a tertiary obstetric hospital (King Edward Memorial Hospital, Perth). There were 136 women identified in the pre-training (2001-2005, n = 56) and post-training (2007-2011, n = 80) groups. Case note review was undertaken to gather information. RESULTS Apgar scores of <7 at five minutes were higher in the post-training cohort (8.8% vs 0%, P = 0.041). Arterial and venous pH readings were similar between cohorts, with a non-significant trend toward improvement in the post-training cohort. Special care nursery admissions and length of hospital stay were unchanged. The primary accoucheur was more likely to be a consultant (35.0% vs 16.4%) in the post-training cohort. Appropriate manoeuvres were more likely to be used in the post-training cohort (52.5% vs 44.6%). CONCLUSIONS Obstetric In Time simulation training improved seniority of accoucheur and documented appropriate manoeuvres in the management of term vaginal breech delivery.
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Affiliation(s)
- Liesel Hardy
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Jayna-Lee Garratt
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Brendan Crossley
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Sean Copson
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Elizabeth Nathan
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia
| | - Katrina Calvert
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Mathias Epee-Bekima
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
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Cullinane M, McLachlan HL, Newton MS, Zugna SA, Forster DA. Using the Kirkpatrick Model to evaluate the Maternity and Neonatal Emergencies (MANE) programme: Background and study protocol. BMJ Open 2020; 10:e032873. [PMID: 32014872 PMCID: PMC7045237 DOI: 10.1136/bmjopen-2019-032873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Over 310 000 women gave birth in Australia in 2016, with approximately 80 000 births in the state of Victoria. While most of these births occur in metropolitan Melbourne and other large regional centres, a significant proportion of Victorian women birth in local rural health services. The Victorian state government recently mandated the provision of a maternal and neonatal emergency training programme, called Maternal and Newborn Emergencies (MANE), to rural and regional maternity service providers across the state. MANE aims to educate maternity and newborn care clinicians about recognising and responding to clinical deterioration in an effort to improve clinical outcomes. This paper describes the protocol for an evaluation of the MANE programme. METHODS AND ANALYSIS This study will evaluate the effectiveness of MANE in relation to: clinician confidence, skills and knowledge; changes in teamwork and collaboration; and consumer experience and satisfaction, and will explore and describe any governance changes within the organisations after MANE implementation. The Kirkpatrick Evaluation Model will provide a framework for the evaluation. The participants of MANE, 27 rural and regional Victorian health services ranging in size from approximately 20 to 1000 births per year, will be invited to participate. Baseline data will be collected from maternity service staff and consumers at each health service before MANE delivery, and at four time-points post-MANE delivery. There will be four components to data collection: a survey of maternity services staff; follow-up interviews with Maternity Managers at health services 4 months after MANE delivery; consumer feedback from all health services collected through the Victorian Healthcare Experience Survey; case studies with five regional or rural health service providers. ETHICS AND DISSEMINATION This evaluation has been approved by the La Trobe University Science, Health and Engineering College Human Ethics Sub-Committee. Findings will be presented to project stakeholders in a deidentified report, and disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Michelle S Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Stefanie A Zugna
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Maternity Services, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Maternity Services, Royal Women's Hospital, Parkville, Victoria, Australia
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Assessing and managing hypovolemic shock in puerperal women. Best Pract Res Clin Obstet Gynaecol 2019; 61:89-105. [DOI: 10.1016/j.bpobgyn.2019.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 12/17/2022]
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Merriel A, Ficquet J, Barnard K, Kunutsor SK, Soar J, Lenguerrand E, Caldwell DM, Burden C, Winter C, Draycott T, Siassakos D. The effects of interactive training of healthcare providers on the management of life-threatening emergencies in hospital. Cochrane Database Syst Rev 2019; 9:CD012177. [PMID: 31549741 PMCID: PMC6757513 DOI: 10.1002/14651858.cd012177.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preparing healthcare providers to manage relatively rare life-threatening emergency situations effectively is a challenge. Training sessions enable staff to rehearse for these events and are recommended by several reports and guidelines. In this review we have focused on interactive training, this includes any element where the training is not solely didactic but provides opportunity for discussions, rehearsals, or interaction with faculty or technology. It is important to understand the effective methods and essential elements for successful emergency training so that resources can be appropriately targeted to improve outcomes. OBJECTIVES To assess the effects of interactive training of healthcare providers on the management of life-threatening emergencies in hospital on patient outcomes, clinical care practices, or organisational practices, and to identify essential components of effective interactive emergency training programmes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL and ERIC and two trials registers up to 11 March 2019. We searched references of included studies, conference proceedings, and contacted study authors. SELECTION CRITERIA We included randomised trials and cluster-randomised trials comparing interactive training for emergency situations with standard/no training. We defined emergency situations as those in which immediate lifesaving action is required, for example cardiac arrests and major haemorrhage. We included all studies where healthcare workers involved in providing direct clinical care were participants. We excluded studies outside of a hospital setting or where the intervention was not targeted at practicing healthcare workers. We included trials irrespective of publication status, date, and language. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane and Cochrane Effective Practice and Organisation of Care (EPOC) Group. Two review authors independently extracted data and assessed the risk of bias of each included trial. Due to the small number of studies and the heterogeneity in outcome measures, we were unable to perform the planned meta-analysis. We provide a structured synthesis for the following outcomes: survival to hospital discharge, morbidity rate, protocol or guideline adherence, patient outcomes, clinical practice outcomes, and organisation-of-care outcomes. We used the GRADE approach to rate the certainty of the evidence and the strength of recommendations for each outcome. MAIN RESULTS We included 11 studies that reported on 2000 healthcare providers and over 300,000 patients; one study did not report the number of participants. Seven were cluster randomised trials and four were single centre studies. Four studies focused on obstetric training, three on obstetric and neonatal care, two on neonatal training, one on trauma and one on general resuscitations. The studies were spread across high-, middle- and low-income settings.Interactive training may make little or no difference in survival to hospital discharge for patients requiring resuscitation (1 study; 30 participants; 98 events; low-certainty evidence). We are uncertain if emergency training changes morbidity rate, as the certainty of the evidence is very low (3 studies; 1778 participants; 57,193 patients, when reported). We are uncertain if training alters healthcare providers' adherence to clinical protocols or guidelines, as the certainty of the evidence is very low (3 studies; 156 participants; 558 patients). We are uncertain if there were improvements in patient outcomes following interactive training for emergency situations, as we assessed the evidence as very low-certainty (5 studies, 951 participants; 314,055 patients). We are uncertain if training for emergency situations improves clinical practice outcomes as the certainty of the evidence is very low (4 studies; 1417 participants; 28,676 patients, when reported). Two studies reported organisation-of-care outcomes, we are uncertain if interactive emergency training has any effect on this outcome as the certainty of the evidence is very low (634 participants; 179,400 patient population).We examined prespecified subgroups and found no clear commonalities in effect of multidisciplinary training, location of training, duration of the course, or duration of follow-up. We also examined areas arising from the studies including focus of training, proportion of staff trained, leadership of intervention, and incentive/trigger to participate, and again identified no clear mediating factors. The sources of funding for the studies were governmental, local organisations, or philanthropic donors. AUTHORS' CONCLUSIONS We are uncertain if there are any benefits of interactive training of healthcare providers on the management of life-threatening emergencies in hospital as the certainty of the evidence is very low. We were unable to identify any factors that may have allowed us to identify an essential element of these interactive training courses.We found a lack of consistent reporting, which contributed to the inability to meta-analyse across specialities. More trials are required to build the evidence base for the optimum way to prepare healthcare providers for rare life-threatening emergency events. These trials need to be conducted with attention to outcomes important to patients, healthcare providers, and policymakers. It is vitally important to develop high-quality studies adequately powered and with attention to minimising the risk of bias.
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Affiliation(s)
- Abi Merriel
- University of BristolPopulation Health Sciences, Bristol Medical SchoolDepartment of Women's and Children's HealthThe ChilternsBristolUKBS10 5NB
| | - Jo Ficquet
- Royal United Hospital NHS Foundation TrustWomen and Children's DivisionCoombe ParkBathUKBA1 3NG
| | - Katie Barnard
- North Bristol TrustLearning and Research, Southmead HospitalBristolUKBS10 5NB
| | - Setor K Kunutsor
- University of BristolTranslational Health Sciences, Bristol Medical SchoolBristolUK
| | - Jasmeet Soar
- North Bristol NHS Trust, Southmead HospitalAnaesthetic DepartmentBristolUKBS10 5NB
| | - Erik Lenguerrand
- University of BristolTranslational Health Sciences, Bristol Medical SchoolBristolUK
| | - Deborah M Caldwell
- University of BristolPopulation Health Sciences, Bristol Medical SchoolDepartment of Women's and Children's HealthThe ChilternsBristolUKBS10 5NB
| | - Christy Burden
- University of BristolPopulation Health Sciences, Bristol Medical SchoolDepartment of Women's and Children's HealthThe ChilternsBristolUKBS10 5NB
| | - Cathy Winter
- North Bristol NHS TrustDepartment of Women's HealthBristolUK
| | - Tim Draycott
- North Bristol NHS TrustDepartment of Women's HealthBristolUK
| | - Dimitrios Siassakos
- University College LondonUCL EGA Institute for Women's Health86‐96 Chenies MewsBloomsburyLondonUKWC1E 6HX
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14
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An observational study using eye tracking to assess resident and senior anesthetists' situation awareness and visual perception in postpartum hemorrhage high fidelity simulation. PLoS One 2019; 14:e0221515. [PMID: 31465468 PMCID: PMC6715225 DOI: 10.1371/journal.pone.0221515] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 08/08/2019] [Indexed: 11/19/2022] Open
Abstract
Background The postpartum hemorrhage (PPH) is the leading cause of maternal mortality in the world. Human factors and especially situation awareness has primarily responsibility to explain suboptimal cares. Based on eye tracking and behavior analysis in high fidelity simulation of PPH management, the goal of this study is to identify perceptual and cognitive key parameters of the expertise. Methods Two groups of fifteen anesthetists (residents and experienced anesthetists) watched the beginning of a severe simulated PPH management. During this first experimental phase, situation awareness was assessed using SAGAT (Situation Awareness Global Assessment Technique) questionnaire and visual behavior was analyzed with eye tracking. In the continuity of the video sequence, they have to step in the PPH situation and to provide care to the simulated patient. Performance of cares was evaluated and self-assessed as well as cognitive load. Results No statistical difference between the residents and experienced anesthetists was observed on performance of simulated PPH management. The mean expected practice score was 76.9 ± 13.9%). Assessment of situation awareness (65 ± 7%), cognitive load (74.4 ± 11.3%) and theoretical knowledge of PPH (52.4 ± 3.5%) were also not statistically different between the two groups. Only results of self-assessed performance (respectively 66.1 ± 16.6 and 47.0 ± 20.8 for experts and residents) and eye-tracking data revealed that experts tended to get accurate evaluation of their performance and to monitor more the blood loss of the patient. Experts have in average 8.28% more fixating points than Novices and gazed the blood loss region longer (865 ms ± 439 vs. 717 ms ± 362). Conclusions This study pointed out the limits of classical assessment of performance, and human factors based on questionnaires to identify expertise in simulated PPH care. A neuroscientific approach with new technology like eye tracking could provide new objective and more sensitive insights on human factors in simulated medical emergency situations.
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15
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Alwy Al-Beity F, Pembe A, Hirose A, Morris J, Leshabari S, Marrone G, Hanson C. Effect of the competency-based Helping Mothers Survive Bleeding after Birth (HMS BAB) training on maternal morbidity: a cluster-randomised trial in 20 districts in Tanzania. BMJ Glob Health 2019; 4:e001214. [PMID: 30997164 PMCID: PMC6441296 DOI: 10.1136/bmjgh-2018-001214] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/05/2019] [Accepted: 02/10/2019] [Indexed: 11/17/2022] Open
Abstract
Background Training health providers is an important strategy to improve health. We conducted a cluster-randomised two-arm trial in Tanzania to assess the effect of a 1-day competency-based training ‘Helping Mothers Survive Bleeding after Birth (HMS BAB)’ followed by eight weekly drills on postpartum haemorrhage (PPH)-related morbidity and mortality. Methods Twenty districts in four purposefully selected regions in Tanzania included 61 facilities. The districts were randomly allocated using matched pairs to ensure similarity in terms of district health services in intervention and comparison districts. In the 10 intervention districts 331 health providers received the HMS BAB training. The other half continued with standard practices. We used the WHO’s near miss tool to collect information on severe morbidity (near misses) of all women admitted to study facilities. We performed interrupted time series analysis to estimate differences in the change of near miss per delivery rate and case fatality rates. We also assessed implementation of evidence-based preventive and basic management practices for PPH as secondary outcomes. Results We included 120 533 facility deliveries, 6503 near misses and 202 maternal deaths in study districts during study period (November 2014 to January 2017). A significant reduction of PPH near misses was found among women who suffered PPH in the intervention district compared with comparison districts (difference-in-differences of slopes −5.3, 95% CI −7.8 to −2.7, p<0.001) from a baseline PPH-related near miss rate of 71% (95% CI 60% to 80%). There was a significant decrease in the long-term PPH near miss case fatality (difference-in-differences of slopes −4 to 0) (95% CI −6.5 to −1.5, p<0.01) in intervention compared with the comparison districts. The intervention had a positive effect on the proportion of PPH cases treated with intravenous oxytocin (difference-in-differences of slopes 5.2, 95% CI 1.4 to 8.9) (p <0.01). Conclusion The positive effect of the training intervention on PPH morbidity and case fatality suggests that the training addresses important deficits in knowledge and skills. Trial registration number PACTR201604001582128.
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Affiliation(s)
- Fadhlun Alwy Al-Beity
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.,Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Atsumi Hirose
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - Jessica Morris
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
| | - Sebalda Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gaetano Marrone
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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16
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Simulation of Shoulder Dystocia for Skill Acquisition and Competency Assessment: A Systematic Review and Gap Analysis. Simul Healthc 2019; 13:268-283. [PMID: 29381590 DOI: 10.1097/sih.0000000000000292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STATEMENT Mastery of shoulder dystocia management skills acquired via simulation training can reduce neonatal brachial plexus injury by 66% to 90%. However, the correlation between simulation drills and reduction in clinical injuries has been inconsistently replicated, and establishing a causal relationship between simulation training and reduction of adverse clinical events from shoulder dystocia is infeasible due to ethical limitations. Nevertheless, professional liability insurance carriers increasingly are mandating simulation-based rehearsal and competency assessment of their covered obstetric providers' shoulder dystocia management skills-a high-stakes demand that will require rapid scaling up of access to quality shoulder dystocia simulation. However, questions remain about differing simulation training schemes and instructional content used among clinically effective and ineffective educational interventions. This review of original research compares curricular content of shoulder dystocia simulation and reveals several critical gaps: (1) prescriptive instruction prioritizing maneuvers shown to decrease strain on the brachial plexus is inconsistently used. (2) Proscriptive instruction to avoid placing excessive and laterally directed traction on the head or to observe a brief hands-off period before attempting traction is infrequently explicit. (3) Neither relative effectiveness nor potential interaction between prescriptive and proscriptive elements of instruction has been examined directly. (4) Reliability of high-fidelity mannequins capable of objective measurement of clinician-applied traction force as compared with subjective assessment of provider competence is unknown. Further study is needed to address these gaps and inform efficient and effective implementation of clinically translatable shoulder dystocia simulation.
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17
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Battin M, Sadler L. Neonatal encephalopathy: How can we improve clinical outcomes? J Paediatr Child Health 2018; 54:1180-1183. [PMID: 29873135 DOI: 10.1111/jpc.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Malcolm Battin
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Lynn Sadler
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
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18
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Kumar A, Sturrock S, Wallace EM, Nestel D, Lucey D, Stoyles S, Morgan J, Neil P, Schlipalius M, Dekoninck P. Evaluation of learning from Practical Obstetric Multi-Professional Training and its impact on patient outcomes in Australia using Kirkpatrick's framework: a mixed methods study. BMJ Open 2018; 8:e017451. [PMID: 29455162 PMCID: PMC5855459 DOI: 10.1136/bmjopen-2017-017451] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the implementation of the Practical Obstetric Multi-Professional Training (PROMPT) simulation using the Kirkpatrick's framework. We explored participants' acquisition of knowledge and skills, its impact on clinical outcomes and organisational change to integrate the PROMPT programme as a credentialing tool. We also aimed to assess participants' perception of usefulness of PROMPT in their clinical practice. STUDY DESIGN Mixed methods approach with a pre-test/post-test design. SETTING Healthcare network providing obstetric care in Victoria, Australia. PARTICIPANTS Medical and midwifery staff attending PROMPT between 2013 and 2015 (n=508); clinical outcomes were evaluated in two cohorts: 2011-2012 (n=15 361 births) and 2014-2015 (n=12 388 births). INTERVENTION Attendance of the PROMPT programme, a simulation programme taught in multidisciplinary teams to facilitate teaching emergency obstetric skills. MAIN OUTCOME MEASURE Clinical outcomes compared before and after embedding PROMPT in educational practice. SECONDARY OUTCOME MEASURE Assessment of knowledge gained by participants through a qualitative analysis and description of process of embedding PROMPT in educational practice. RESULTS There was a change in the management of postpartum haemorrhage by early recognition and intervention. The key learning themes described by participants were being prepared with a prior understanding of procedures and equipment, communication, leadership and learning in a safe, supportive environment. Participants reported a positive learning experience and increase in confidence in managing emergency obstetric situations through the PROMPT programme, which was perceived as a realistic demonstration of the emergencies. CONCLUSION Participants reported an improvement of both clinical and non-technical skills highlighting principles of teamwork, communication, leadership and prioritisation in an emergency situation. An improvement was observed in management of postpartum haemorrhage, but no significant change was noted in clinical outcomes over a 2-year period after PROMPT. However, the skills acquired by medical and midwifery staff justify embedding PROMPT in educational programmes.
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Affiliation(s)
- Arunaz Kumar
- Monash Women’s Service, Monash Health, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Sam Sturrock
- Monash Women’s Service, Monash Health, Melbourne, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Debra Nestel
- School of Rural Health, Monash University, Melbourne, Australia
| | - Donna Lucey
- Monash Women’s Service, Monash Health, Melbourne, Australia
| | - Sally Stoyles
- Monash Women’s Service, Monash Health, Melbourne, Australia
| | - Jenny Morgan
- Monash Women’s Service, Monash Health, Melbourne, Australia
| | - Peter Neil
- Monash Women’s Service, Monash Health, Melbourne, Australia
| | | | - Philip Dekoninck
- Monash Women’s Service, Monash Health, Melbourne, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
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19
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Abstract
An obstetric-specific crisis team allows institutions to optimize the care response for patients with emergent maternal or fetal needs. Characteristics of optimal obstetric rapid response teams are team member role designations; streamlined communication; prompt access to resources; ongoing education, rehearsal, and training; and continual team quality analysis. The outcomes must be incorporated into team responses and reinforced in training. Team response provides a key resource to reassure staff, physicians, and patients that prompt crisis care is only a single call away. Data show that team activation is common, improves the care process, and has promise to improve outcomes.
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20
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Internal Podalic Version and Breech Extraction: Enhancing Realistic Sensations in a Simulation Model. Obstet Gynecol 2018; 131:360-363. [PMID: 29324597 DOI: 10.1097/aog.0000000000002424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Experience with internal podalic version and breech extraction is diminishing, especially in the younger generation of obstetricians. Simulation training is essential to teach and maintain these skills. INSTRUMENT We present a mannequin-based simulation method that enhances realistic sensations during training. EXPERIENCE By positioning the fetal mannequin into a thin plastic bag filled with water, the impression of palpating, grabbing, and pulling the fetal feet through the plastic bag is similar to reaching feet through intact membranes. The unique approach of this realistic simulation model makes the experience fun and memorable, which contributes to the didactic value and success of the model. CONCLUSION The simulation model we present mimics the situation and sensation obstetricians experience while performing internal podalic version and breech extraction.
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21
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Banke-Thomas A, Wilson-Jones M, Madaj B, van den Broek N. Economic evaluation of emergency obstetric care training: a systematic review. BMC Pregnancy Childbirth 2017; 17:403. [PMID: 29202731 PMCID: PMC5716021 DOI: 10.1186/s12884-017-1586-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/20/2017] [Indexed: 12/20/2022] Open
Abstract
Background Training healthcare providers in Emergency Obstetric Care (EmOC) has been shown to be effective in improving their capacity to provide this critical care package for mothers and babies. However, little is known about the costs and cost-effectiveness of such training. Understanding costs and cost-effectiveness is essential in guaranteeing value-for-money in healthcare spending. This study systematically reviewed the available literature on cost and cost-effectiveness of EmOC trainings. Methods Peer-reviewed and grey literature was searched for relevant papers published after 1990. Studies were included if they described an economic evaluation of EmOC training and the training cost data were available. Two reviewers independently searched, screened, and selected studies that met the inclusion criteria, with disagreements resolved by a third reviewer. Quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. For comparability, all costs in local currency were converted to International dollar (I$) equivalents using purchasing power parity conversion factors. The cost per training per participant was calculated. Narrative synthesis was used to summarise the available evidence on cost effectiveness. Results Fourteen studies (five full and nine partial economic evaluations) met the inclusion criteria. All five and two of the nine partial economic evaluations were of high quality. The majority of studies (13/14) were from low- and middle-income countries. Training equipment, per diems and resource person allowance were the most expensive components. Cost of training per person per day ranged from I$33 to I$90 when accommodation was required and from I$5 to I$21 when training was facility-based. Cost-effectiveness of training was assessed in 5 studies with differing measures of effectiveness (knowledge, skills, procedure cost and lives saved) making comparison difficult. Conclusions Economic evaluations of EmOC training are limited. There is a need to scale-up and standardise processes that capture both cost and effectiveness of training and to agree on suitable economic evaluation models that allow for comparability across settings. Trial registration PROSPERO_CRD42016041911. Electronic supplementary material The online version of this article (10.1186/s12884-017-1586-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Megan Wilson-Jones
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Barbara Madaj
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK.
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22
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McLelland G, Perera C, Morphet J, McKenna L, Hall H, Williams B, Cant R, Stow J. Interprofessional simulation of birth in a non-maternity setting for pre-professional students. NURSE EDUCATION TODAY 2017; 58:25-31. [PMID: 28823781 DOI: 10.1016/j.nedt.2017.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 06/27/2017] [Accepted: 07/30/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Simulation-based learning is an approach recommended for teaching undergraduate health professionals. There is a scarcity of research around interprofessional simulation training for pre-professional students in obstetric emergencies that occur prior to arrival at the maternity ward. OBJECTIVES The primary aims of the study were to examine whether an interprofessional team-based simulated birth scenario would improve undergraduate paramedic, nursing, and midwifery students' self-efficacy scores and clinical knowledge when managing birth in an unplanned location. The secondary aim was to assess students' satisfaction with the newly developed interprofessional simulation. DESIGN Quasi-experimental descriptive study with repeated measures. SETTING Simulated hospital emergency department. PARTICIPANTS Final year undergraduate paramedic, nursing, and midwifery students. METHODS Interprofessional teams of five students managed a simulated unplanned vaginal birth, followed by debriefing. Students completed a satisfaction with simulation survey. Serial surveys of clinical knowledge and self-efficacy were conducted at three time points. RESULTS Twenty-four students participated in one of five simulation scenarios. Overall, students' self-efficacy and confidence in ability to achieve a successful birth outcome was significantly improved at one month (p<0.001) with a magnitude of increase (effect) of 40% (r=0.71) and remained so after a further three months. Clinical knowledge was significantly increased in only one of three student groups: nursing (p=0.04; r=0.311). Students' satisfaction with the simulation experience was high (M=4.65/5). CONCLUSIONS Results from this study indicate that an interprofessional simulation of a birth in an unplanned setting can improve undergraduate paramedic, nursing and midwifery students' confidence working in an interprofessional team. There was a significant improvement in clinical knowledge of the nursing students (who had least content about managing birth in their program). All students were highly satisfied with the interprofessional simulation experience simulation.
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Affiliation(s)
- Gayle McLelland
- School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, Victoria 3199, Australia.
| | - Chantal Perera
- Faculty of Science Health and Engineering, School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Queensland 4556, Australia.
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, Victoria 3199, Australia.
| | - Lisa McKenna
- Nursing and Midwifery, George Singer Building room 317, College of Science Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing and Midwifery, University of Queensland, Australia.
| | - Helen Hall
- School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, Victoria 3199, Australia.
| | - Brett Williams
- Department of Community Emergency Health and Paramedic Practice, Monash University, PO BOX 527, Frankston, Victoria 3199, Australia.
| | - Robyn Cant
- School of Nursing and Midwifery, Monash University, Building 903, Clyde Road, Berwick, Victoria 3806, Australia.
| | - Jill Stow
- School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, Victoria 3199, Australia.
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23
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Taekman JM, Foureman MF, Bulamba F, Steele M, Comstock E, Kintu A, Mauritz A, Olufolabi A. A Novel Multiplayer Screen-Based Simulation Experience for African Learners Improved Confidence in Management of Postpartum Hemorrhage. Front Public Health 2017; 5:248. [PMID: 29018791 PMCID: PMC5623004 DOI: 10.3389/fpubh.2017.00248] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/01/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Postpartum hemorrhage (PPH) remains a global challenge, affecting thirteen million women each year. In addition, PPH is a leading cause of maternal mortality in Asia and Africa. In the U.S.A., care of critically ill patients is often practiced using mannequin-based simulation. Mannequin-based simulation presents challenges in global health, particularly in low- or middle-income countries. We developed a novel multiplayer screen-based simulation in a virtual world enabling the practice of team coordination with PPH. We used this simulation with learners in Mulago, Uganda. We hypothesized that a multiplayer screen-based simulation experience would increase learner confidence in their ability to manage PPH. Methods The study design was a simple pre- and a post-intervention survey. Forty-eight interprofessional subjects participated in one of nine 1-h simulation sessions using the PPH software. A fifteen-question self-assessment administered before and after the intervention was designed to probe the areas of learning as defined by Bloom and Krathwohl: affective, cognitive, and psychomotor. Results Combined confidence scores increased significantly overall following the simulation experience and individually in each of the three categories of Bloom’s Taxonomy: affective, cognitive, and psychomotor. Conclusion We provide preliminary evidence that multiplayer screen-based simulation represents a scalable, distributable form of learning that may be used effectively in global health education and training. Interestingly, despite our intervention being screen-based, our subjects showed improved confidence in their ability to perform psychomotor tasks. Although there is precedent for mental rehearsal improving performance, further research is needed to understand this finding.
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Affiliation(s)
- Jeffrey M Taekman
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States.,Duke University Medical Center, Durham, NC, United States.,Duke University School of Medicine, Durham, NC, United States
| | | | - Fred Bulamba
- Department of Anesthesia, Makerere University College of Health Sciences, Kampala, Uganda
| | - Michael Steele
- Duke University School of Medicine, Durham, NC, United States
| | - Emily Comstock
- Duke University School of Nursing, Durham, NC, United States
| | - Andrew Kintu
- Department of Anesthesia, Makerere University College of Health Sciences, Kampala, Uganda
| | - Amy Mauritz
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States.,Duke University Medical Center, Durham, NC, United States
| | - Adeyemi Olufolabi
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States.,Duke University Medical Center, Durham, NC, United States
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24
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Stone H, Crane J, Johnston K, Craig C. Retention of Vaginal Breech Delivery Skills Taught in Simulation. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:205-210. [PMID: 28821414 DOI: 10.1016/j.jogc.2017.06.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/15/2017] [Accepted: 06/20/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The optimal frequency of conducting simulation training for high-acuity, low-frequency events in obstetrics and gynaecology residency programs is unknown. This study evaluated retention over time of vaginal breech delivery skills taught in simulation, by comparing junior and senior residents. In addition, the residents' subjective comfort level to perform this skill clinically was assessed. METHODS This prospective cohort study included 22 obstetrics and gynaecology residents in a Canadian residency training program. Digital recordings were completed for pre-training, immediate post-training, and delayed (10-26 weeks later) post-training intervals of a vaginal breech delivery simulation, with skill assessment by a blinded observer using a binary checklist. Residents also completed questionnaires to assess their subjective comfort level at each interval. RESULTS Junior and senior residents had significant improvements in vaginal breech delivery skills from the pre-training assessment to both the immediate post-training assessment (junior, P <0.001; senior, P <0.001) and the delayed post-training assessment (P <0.001 and P = 0.001, respectively). There was a significant decline in skills between the immediate and delayed post-training sessions for junior and senior residents (P = 0.003 and P <0.001, respectively). Both junior and senior residents gained more comfort immediately after the training (P <0.001 and P <0.001, respectively), without a significant change between immediate post-training and delayed post-training comfort levels (P = 0.19 and P = 0.11, respectively). CONCLUSION Residents retained vaginal breech delivery skills taught in simulation 10-26 weeks later, although a decline in skills occurred over this time period. Comfort level was positively affected and retained. These results will aid in determining the frequency of simulation teaching for high-acuity, low-frequency events in a residency simulation curriculum.
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Affiliation(s)
- Heather Stone
- Department of Obstetrics and Gynaecology, IWK Health Centre, Halifax, NS.
| | - Joan Crane
- Department of Obstetrics and Gynaecology, Health Sciences Centre, Memorial University of Newfoundland, St. John's, NL
| | | | - Catherine Craig
- Department of Obstetrics and Gynaecology, IWK Health Centre, Halifax, NS
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25
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Whitelaw C, Calvert K, Epee M. Keeping in time: Issues affecting the sustainability of obstetric emergency simulation training in outer metropolitan, rural and remote centres in Western Australia. Aust N Z J Obstet Gynaecol 2017; 58:98-101. [DOI: 10.1111/ajo.12678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/19/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Claire Whitelaw
- King Edward Memorial Hospital; Perth Subiaco Western Australia Australia
| | - Katrina Calvert
- King Edward Memorial Hospital; Perth Subiaco Western Australia Australia
| | - Mathias Epee
- King Edward Memorial Hospital; Perth Subiaco Western Australia Australia
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van de Ven J, van Baaren GJ, Fransen AF, van Runnard Heimel PJ, Mol BW, Oei SG. Cost-effectiveness of simulation-based team training in obstetric emergencies (TOSTI study). Eur J Obstet Gynecol Reprod Biol 2017; 216:130-137. [PMID: 28763738 DOI: 10.1016/j.ejogrb.2017.07.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/16/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Team training is frequently applied in obstetrics. We aimed to evaluate the cost-effectiveness of obstetric multi-professional team training in a medical simulation centre. STUDY DESIGN We performed a model-based cost-effectiveness analysis to evaluate four strategies for obstetric team training from a hospital perspective (no training, training without on-site repetition and training with 6 month or 3-6-9 month repetition). Data were retrieved from the TOSTI study, a randomised controlled trial evaluating team training in a medical simulation centre. We calculated the incremental cost-effectiveness ratio (ICER), which represent the costs to prevent the adverse outcome, here (1) the composite outcome of obstetric complications and (2) specifically neonatal trauma due to shoulder dystocia. RESULTS Mean costs of a one-day multi-professional team training in a medical simulation centre were €25,546 to train all personnel of one hospital. A single training in a medical simulation centre was less effective and more costly compared to strategies that included repetition training. Compared to no training, the ICERs to prevent a composite outcome of obstetric complications were €3432 for a single repetition training course on-site six months after the initial training and €5115 for a three monthly repetition training course on-site after the initial training during one year. When we considered neonatal trauma due to shoulder dystocia, a three monthly repetition training course on-site after the initial training had an ICER of €22,878. CONCLUSION Multi-professional team training in a medical simulation centre is cost-effective in a scenario where repetition training sessions are performed on-site.
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Affiliation(s)
- J van de Ven
- Department of Obstetrics and Gynaecology, Elkerliek Hospital, Helmond, The Netherlands.
| | - G J van Baaren
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - A F Fransen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P J van Runnard Heimel
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Eindhoven, Veldhoven, The Netherlands
| | - B W Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, and The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - S G Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Eindhoven, Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Bracco F, Masini M, De Tonetti G, Brogioni F, Amidani A, Monichino S, Maltoni A, Dato A, Grattarola C, Cordone M, Torre G, Launo C, Chiorri C, Celleno D. Adaptation of non-technical skills behavioural markers for delivery room simulation. BMC Pregnancy Childbirth 2017; 17:89. [PMID: 28302085 PMCID: PMC5356378 DOI: 10.1186/s12884-017-1274-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Simulation in healthcare has proved to be a useful method in improving skills and increasing the safety of clinical operations. The debriefing session, after the simulated scenario, is the core of the simulation, since it allows participants to integrate the experience with the theoretical frameworks and the procedural guidelines. There is consistent evidence for the relevance of non-technical skills (NTS) for the safe and efficient accomplishment of operations. However, the observation, assessment and feedback on these skills is particularly complex, because the process needs expert observers and the feedback is often provided in judgmental and ineffective ways. The aim of this study was therefore to develop and test a set of observation and rating forms for the NTS behavioural markers of multi-professional teams involved in delivery room emergency simulations (MINTS-DR, Multi-professional Inventory for Non-Technical Skills in the Delivery Room). METHODS The MINTS-DR was developed by adapting the existing tools and, when needed, by designing new tools according to the literature. We followed a bottom-up process accompanied by interviews and co-design between practitioners and psychology experts. The forms were specific for anaesthetists, gynaecologists, nurses/midwives, assistants, plus a global team assessment tool. We administered the tools in five editions of a simulation training course that involved 48 practitioners. Ratings on usability and usefulness were collected. RESULTS The mean ratings of the usability and usefulness of the tools were not statistically different to or higher than 4 on a 5-point rating scale. In either case no significant differences were found across professional categories. CONCLUSION The MINTS-DR is quick and easy to administer. It is judged to be a useful asset in maximising the learning experience that is provided by the simulation.
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Affiliation(s)
- Fabrizio Bracco
- Department of Educational Sciences, University of Genoa, Corso A. Podestà, 2, 16128, Genoa, Italy. .,V.I.E. srl, Spinoff of the University of Genoa, Genoa, Italy. .,Advanced Simulation Center, University of Genoa, Genoa, Italy. .,M.G. Vannini Hospital, Rome, Italy.
| | - Michele Masini
- V.I.E. srl, Spinoff of the University of Genoa, Genoa, Italy
| | | | | | - Arianna Amidani
- IRCCS Giannina Gaslini Children's Research Hospital, Genoa, Italy
| | - Sara Monichino
- IRCCS Giannina Gaslini Children's Research Hospital, Genoa, Italy
| | | | - Andrea Dato
- IRCCS Giannina Gaslini Children's Research Hospital, Genoa, Italy
| | | | - Massimo Cordone
- IRCCS Giannina Gaslini Children's Research Hospital, Genoa, Italy.,Advanced Simulation Center, University of Genoa, Genoa, Italy
| | - Giancarlo Torre
- Advanced Simulation Center, University of Genoa, Genoa, Italy
| | - Claudio Launo
- Advanced Simulation Center, University of Genoa, Genoa, Italy
| | - Carlo Chiorri
- Department of Educational Sciences, University of Genoa, Corso A. Podestà, 2, 16128, Genoa, Italy.,V.I.E. srl, Spinoff of the University of Genoa, Genoa, Italy
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28
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Kehila M, Derouich S, Touhami O, Belghith S, Abouda HS, Cheour M, Chanoufi MB. [Macrosomia, shoulder dystocia and elongation of the brachial plexus: what is the role of caesarean section?]. Pan Afr Med J 2016; 25:217. [PMID: 28270907 PMCID: PMC5326265 DOI: 10.11604/pamj.2016.25.217.10050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022] Open
Abstract
The delivery of a macrosomic infant is associated with a higher risk for maternofoetal complications. Shoulder dystocia is the most feared fetal complication, leading sometimes to a disproportionate use of caesarean section. This study aims to evaluate the interest of preventive caesarean section. We conducted a retrospective study of 400 macrosomic births between February 2010 and December 2012. We also identified cases of infants with shoulder dystocia occurred in 2012 as well as their respective birthweight. Macrosomic infants weighed between 4000g and 4500g in 86.25% of cases and between 4500 and 5000 in 12.25% of cases. Vaginal delivery was performed in 68% of cases. Out of 400 macrosomic births, 9 cases with shoulder dystocia were recorded (2.25%). All of these cases occurred during vaginal delivery. The risk for shoulder dystocia invaginal delivery has increased significantly with the increase in birth weight (p <10-4). The risk for elongation of the brachial plexus was 11 per thousand vaginal deliveries of macrosomic infants. This risk was not correlated with birthweight (p = 0.38). The risk for post-traumatic sequelae was 0.71%. Shoulder dystocia affectd macrosoic infants in 58% of cases. Shoulder dystocia is not a complication exclusively associated with macrosomia. Screening for risky deliveries and increasing training of obstetricians on maneuvers in shoulder dystocia seem to be the best way to avoid complications.
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Affiliation(s)
- Mehdi Kehila
- Service C de Gynécologie-Obstétrique, Centre de Maternité et de Néonatologie de Tunis, Université Tunis El Manar, Tunisie
| | - Sadok Derouich
- Service C de Gynécologie-Obstétrique, Centre de Maternité et de Néonatologie de Tunis, Université Tunis El Manar, Tunisie
| | - Omar Touhami
- Service C de Gynécologie-Obstétrique, Centre de Maternité et de Néonatologie de Tunis, Université Tunis El Manar, Tunisie
| | - Sirine Belghith
- Service A de Gynécologie-Obstétrique, Centre Hospitalier Universitaire, Charles Nicole, Université Tunis El Manar, Tunisie
| | - Hassine Saber Abouda
- Service C de Gynécologie-Obstétrique, Centre de Maternité et de Néonatologie de Tunis, Université Tunis El Manar, Tunisie
| | - Mariem Cheour
- Service de Néonatologie, Centre de Maternité et de Néonatologie de Tunis, Université Tunis El Manar, Tunisie
| | - Mohamed Badis Chanoufi
- Service C de Gynécologie-Obstétrique, Centre de Maternité et de Néonatologie de Tunis, Université Tunis El Manar, Tunisie
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29
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Fransen AF, van de Ven J, Schuit E, van Tetering A, Mol BW, Oei SG. Simulation-based team training for multi-professional obstetric care teams to improve patient outcome: a multicentre, cluster randomised controlled trial. BJOG 2016; 124:641-650. [PMID: 27726304 DOI: 10.1111/1471-0528.14369] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether simulation-based obstetric team training in a simulation centre improves patient outcome. DESIGN Multicentre, open, cluster randomised controlled trial. SETTING Obstetric units in the Netherlands. POPULATION Women with a singleton pregnancy beyond 24 weeks of gestation. METHODS Random allocation of obstetric units to a 1-day, multi-professional, simulation-based team training focusing on crew resource management (CRM) in a simulation centre or to no such team training. Intention-to-treat analyses were performed at the cluster level, including a measurement 1 year prior to the intervention. MAIN OUTCOME MEASURES Primary outcome was a composite outcome of obstetric complications during the first year post-intervention, including low Apgar score, severe postpartum haemorrhage, trauma due to shoulder dystocia, eclampsia and hypoxic-ischaemic encephalopathy. Maternal and perinatal mortality were also registered. RESULTS Each study group included 12 units with a median unit size of 1224 women, combining for a total of 28 657 women. In total, 471 medical professionals received the training course. The composite outcome of obstetric complications did not differ between study groups [odds ratio (OR) 1.0, 95% confidence interval (CI) 0.80-1.3]. Team training reduced trauma due to shoulder dystocia (OR 0.50, 95% CI 0.25-0.99) and increased invasive treatment for severe postpartum haemorrhage (OR 2.2, 95% CI 1.2-3.9) compared with no intervention. Other outcomes did not differ between study groups. CONCLUSION A 1-day, off-site, simulation-based team training, focusing on teamwork skills, did not reduce a composite of obstetric complications. TWEETABLE ABSTRACT 1-day, off-site, simulation-based team training did not reduce a composite of obstetric complications.
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Affiliation(s)
- A F Fransen
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Eindhoven-Veldhoven, the Netherlands.,Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J van de Ven
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Eindhoven-Veldhoven, the Netherlands
| | - E Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,Stanford Prevention Research Center, Stanford University, Stanford, California, USA
| | - Aac van Tetering
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Eindhoven-Veldhoven, the Netherlands
| | - B W Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health University of Adelaide and the South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - S G Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Eindhoven-Veldhoven, the Netherlands.,Department of Electrotechnical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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30
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Merriel A, van der Nelson HA, Lenguerrand E, Chung Y, Soar J, Ficquet J, Grey S, Winter C, Draycott T, Siassakos D. Emergency training for in-hospital-based healthcare providers: effects on clinical practice and patient outcomes. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Abi Merriel
- University of Birmingham; School of Clinical and Experimental Medicine; C/o Academic Unit, 3rd Floor, Birmingham Women's Hospital Foundation Trust Mindelsohn Way Birmingham UK B15 2TG
- University of Bristol; School of Social and Community Medicine; Bristol UK
| | - Helen A van der Nelson
- Southmead Hospital, North Bristol NHS Trust; Department of Obstetrics; Southmead Road Bristol Avon UK BS10 5NB
| | | | - Yealin Chung
- North Bristol NHS Trust; Department of Women’s Health; Southmead Hospital, Southmead Road Bristol Avon UK BS10 5NB
| | - Jasmeet Soar
- North Bristol NHS Trust, Southmead Hospital; Anaesthetic Department; Bristol UK BS10 5NB
| | - Jo Ficquet
- Royal United Hospital NHS Foundation Trust; Women and Children's Division; Coombe Park Bath UK BA1 3NG
| | | | - Cathy Winter
- University of Bristol; School of Social and Community Medicine; Bristol UK
| | - Tim Draycott
- North Bristol NHS Trust; Department of Women's Health; Southmead Hospital, Southmead Road Westbury-on-Trym Bristol Avon UK BS10 5NB
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31
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Simulation based training in a publicly funded home birth programme in Australia: A qualitative study. Women Birth 2016; 29:47-53. [DOI: 10.1016/j.wombi.2015.07.186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 07/26/2015] [Accepted: 07/28/2015] [Indexed: 11/20/2022]
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Legendre G, Bouet PE, Sentilhes L. Place de la simulation pour réduire la morbidité néonatale et maternelle secondaire à une dystocie des épaules. ACTA ACUST UNITED AC 2015; 44:1285-93. [DOI: 10.1016/j.jgyn.2015.09.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
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Maternal collapse: Training in resuscitation. Best Pract Res Clin Obstet Gynaecol 2015; 29:1058-66. [PMID: 26277335 DOI: 10.1016/j.bpobgyn.2015.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 07/09/2015] [Indexed: 11/23/2022]
Abstract
The National Committee for the Confidential Enquiries into Maternal Deaths (NCCEMD) of South Africa has recommended in the Sixth Saving Mothers Report that health-care professionals (HCPs) training in managing obstetric emergencies be improved. One such measure is to ensure that the Essential Steps in Managing Obstetric Emergencies (ESMOE) with its Emergency Obstetric Simulation Training (EOST) be rolled out to every HCP working in the obstetric environment. The programme has been strengthened and rolled out in the province of KwaZulu-Natal, South Africa. This review focuses on the various teaching methods used to improve maternal resuscitation training in a South African context. Evidence-based interventions in maternal resuscitation will be highlighted, and recommendations for clinical practice will be suggested. Common causes of maternal collapse will be explored, and measures to improve training in these areas will be outlined. In order to ensure sustainability, quality improvement measures need to be introduced and evaluated.
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34
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Affiliation(s)
- Jason Abbott
- Royal Hospital for Women, Sydney, NSW, Australia. .,University of New South Wales, Sydney, NSW, Australia.
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35
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Dresang LT, González MMA, Beasley J, Bustillo MC, Damos J, Deutchman M, Evensen A, de Ancheta NG, Rojas-Suarez JA, Schwartz J, Sorensen BL, Winslow D, Leeman L. The impact of Advanced Life Support in Obstetrics (ALSO) training in low-resource countries. Int J Gynaecol Obstet 2015; 131:209-15. [PMID: 26294169 DOI: 10.1016/j.ijgo.2015.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 05/07/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the effects of the Advanced Life Support in Obstetrics (ALSO) program on maternal outcomes in four low-income countries. METHODS Data were obtained from single-center, longitudinal cohort studies in Colombia, Guatemala, and Honduras, and from an uncontrolled prospective trial in Tanzania. RESULTS In Colombia, maternal morbidity and the number of near misses increased after ALSO training, but maternal mortality decreased. In Guatemala, sustained reductions in overall maternal mortality and mortality from postpartum hemorrhage (PPH) were recorded after ALSO implementation. In Honduras, there was a significant decrease in episiotomy rates, and increases in active management of the third stage of labor (AMTSL), vacuum-assisted delivery, and reported comfort managing obstetric emergencies. In Tanzania, the frequency of PPH and severe PPH decreased after training, while management improved. CONCLUSION In low-income countries, ALSO training was associated with decreased in-hospital maternal mortality, episiotomy use, and PPH. AMTSL and vacuum-assisted vaginal delivery increased in frequency after ALSO training.
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Affiliation(s)
- Lee T Dresang
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | | | - John Beasley
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Jim Damos
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mark Deutchman
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ann Evensen
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - José A Rojas-Suarez
- Department of Obstetric Medicine, Intensive Care and Obstetric Investigation Group, Sociedad Colombiana de Anestesiologia y Reanimación, Cartagena, Colombia
| | | | - Bjarke L Sorensen
- Department of Obstetrics and Gynecology, Centre for Innovative Medical Technology, Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Diana Winslow
- American Academy of Family Physicians, Leawood, KS, USA
| | - Lawrence Leeman
- Department of Family and Community Medicine, Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Draycott TJ, Collins KJ, Crofts JF, Siassakos D, Winter C, Weiner CP, Donald F. Myths and realities of training in obstetric emergencies. Best Pract Res Clin Obstet Gynaecol 2015; 29:1067-76. [PMID: 26254842 DOI: 10.1016/j.bpobgyn.2015.07.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/09/2015] [Indexed: 01/21/2023]
Abstract
Training for intrapartum emergencies is a promising strategy to reduce preventable harm during birth; however, not all training is clinically effective. Many myths have developed around such training. These principally derive from misinformed beliefs that all training must be effective, cheap, independent of context and sustainable. The current evidence base for effective training supports local, unit-based and multi-professional training, with appropriate mannequins, and practice-based tools to support the best care. Training programmes based on these principles are associated with improved clinical outcomes, but we need to understand how and why that is, and also why some training is associated with no improvements, or even deterioration in outcomes. Effective training is not cheap, but it can be cost-effective. Insurers have the fiscal power to incentivise training, but they should demand the evidence of clinical effect; aspiration and proxies alone should no longer be sufficient for funding, in any resource setting.
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Vieille P, Mousty E, Letouzey V, Mares P, de Tayrac R. Évaluation de la formation des internes de gynécologie obstétrique sur simulateur d’accouchement. ACTA ACUST UNITED AC 2015; 44:471-8. [DOI: 10.1016/j.jgyn.2014.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 07/30/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
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Affiliation(s)
- Jan E Dickinson
- School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
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