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Feltmate C, Easter SR, Gilner JB, Karam AK, Khourry-Callado F, Fox KA. Graduate and Continuing Medical Education of Placenta Accreta Spectrum. Am J Perinatol 2023; 40:1002-1008. [PMID: 37336218 DOI: 10.1055/s-0043-1761640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Surgical training experience in obstetrics-gynecology (OB-GYN) residency and fellowship training, particularly in open abdominal surgeries has declined over the last 2 decades. This is due, in part, due to a universal trend toward non-invasive treatments for gynecologic conditions once treated surgically. Management of placenta accreta spectrum (PAS) often requires complex surgical skills, including, but not limited to highly complex hysterectomy. The decline in surgical case numbers has fallen as the incidence of PAS has risen, which we anticipate will lead to a gap in critical skills needed for graduating obstetrician-gynecologists to able to safely care for people with PAS.
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Affiliation(s)
- Colleen Feltmate
- Division of Gynecologic Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, Massachusetts
| | - Sarah R Easter
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer B Gilner
- Division of Maternal-Fetal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Amer K Karam
- Division of Gynecologic Oncology, Stanford University, Palo Alto, California
| | - Fady Khourry-Callado
- Division of Gynecologic Oncology, Columbia University, Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Karin A Fox
- Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, Texas
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2
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Séris M, Fritz J, Montoya A, Lamadrid-Figueroa H. AMBAR: A midwifery-led training program to improve obstetric and neonatal practices among low-risk births in Mexico. Birth 2023; 50:151-160. [PMID: 36529703 DOI: 10.1111/birt.12699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Birth care in Mexican health institutions is highly medicalized and of poor quality because of the prevalence of outdated and dangerous practices. AMBAR-a training program for health care providers on the use of evidence-based midwifery practices-was implemented during 2016-2018 and evaluated to assess the impact of training on key practices. METHODS For this mixed-methods study, we evaluated the effects of a training program implemented in three public hospital networks in Mexico. Qualitative data were collected and integrated into the program before evaluating the effects of the intervention on 10 birth practices, 5 beneficial and 5 potentially harmful. Quantitative data on birth practices and covariates were collected at six time points (baseline and 5 follow-ups) in a final sample of 330 direct observations. Effect estimates were obtained by longitudinal logistic and Poisson regression models, adjusted for confounding variables. RESULTS AMBAR had a significant effect on 4 of the 10 birth practices that were evaluated. Beneficial practices, such as skin-to-skin contact (P = 0.003) and delayed cord clamping (P = 0.039), increased significantly. Harmful when overused birth practices, such as vaginal examinations (P = 0.001), and cesarean birth (P < 0.001) decreased significantly. CONCLUSIONS Midwifery-based training programs for health care providers can have an impact on the quality of care of birthing people and newborns, increasing the use of evidence-based practices and decreasing frequently overused practices.
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Affiliation(s)
- Marina Séris
- School of Public Health of Mexico, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Jimena Fritz
- Department of Perinatal Health, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Alejandra Montoya
- Department of Perinatal Health, National Institute of Public Health (INSP), Cuernavaca, Mexico
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MacLennan K, Minehart RD, Vasco M, Eley VA. Simulation-based training in obstetric anesthesia: an update. Int J Obstet Anesth 2023; 54:103643. [PMID: 36933323 DOI: 10.1016/j.ijoa.2023.103643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/24/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
In this update we explore the current applications of simulation in obstetric anesthesia, describe what is known regarding its impacts on care and consider the different settings in which simulation programs are required. We will introduce practical strategies, such as cognitive aids and communication tools, that can be applied in the obstetric setting and share ways in which a program might apply these tools. Finally, we provide a list of common obstetric emergencies essential for a program's curriculum and common teamwork pitfalls to address within a comprehensive obstetric anesthesia simulation program.
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Affiliation(s)
| | - R D Minehart
- Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - M Vasco
- Universidad CES, Medellín, Colombia
| | - V A Eley
- Royal Brisbane and Women's Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia.
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Preparedness for maternal and neonatal emergencies in UK midwifery units: a national survey using the UK Midwifery Study System (UKMidSS). Midwifery 2022; 110:103336. [DOI: 10.1016/j.midw.2022.103336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022]
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Topperzer MK, Roug LI, Andrés-Jensen L, Pontoppidan P, Hoffmann M, Larsen HB, Schmiegelow K, Sørensen JL. Twelve tips for postgraduate interprofessional case-based learning. MEDICAL TEACHER 2022; 44:130-137. [PMID: 33761309 DOI: 10.1080/0142159x.2021.1896691] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Based on developing, implementing, and evaluating postgraduate interprofessional case-based learning, we have written these twelve tips for health education planners who wish to apply case-based learning in the clinical setting. Interprofessional case-based learning engages participants in a structured manner towards uncovering decisions processes and patterns of action that resemble the clinical reality in which various healthcare professionals handle multifaceted tasks related to the optimal patient treatment. Postgraduate interprofessional case-based learning has the potential to break down traditional hierarchical structures as interactions generate respectful behaviour. We present two models of case-based learning to assist in standardising, structuring, and systematising postgraduate interprofessional case-based learning. We have created 12 practical tips for the design, implementation, and evaluation of successful postgraduate interprofessional case-based learning integrated into the existing clinical setting.
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Affiliation(s)
- Martha Krogh Topperzer
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Louise Ingerslev Roug
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Liv Andrés-Jensen
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Pontoppidan
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Hoffmann
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Baekgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jette Led Sørensen
- Department of Clinical Medicine, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Schepper SD, Geuens N, Roes L, Fransen E, Hilderson D, Franck E. Generic Crew Resource Management training to improve non-technical skills in acute care - Phase 2: A pre-post multicentric intervention study. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Reassuringly expensive - A commentary on obstetric emergency training in high-resource settings. Best Pract Res Clin Obstet Gynaecol 2021; 80:14-24. [PMID: 34893439 DOI: 10.1016/j.bpobgyn.2021.11.009] [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: 07/25/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 11/22/2022]
Abstract
The pathophysiologic origins of obstetrical emergencies are complicated and may well be influenced by events prior to conception. Such problems are not likely to be resolved soon, and in the meantime, high-resource countries simply cannot afford to divert more and more money to litigation and the costs of preventable morbidities for either mother or child. It is long past time we tackled these acute care problems where most first occur-the Maternity unit. It is reasonable to ask whether hospitals (and society at large) are getting what they believe they are buying. Training to satisfy a regulation without improving patient outcomes functionally erects one more barrier to the pursuit of optimal patient outcomes. Why then continue squandering limited resources and precious lives if current hospital training is not improving outcomes? In this monograph, I focus on training programs for the management of obstetrical emergencies.
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Jaufuraully S, Dromey B, Stoyanov D. Simulation and beyond - Principles of effective obstetric training. Best Pract Res Clin Obstet Gynaecol 2021; 80:2-13. [PMID: 34866004 DOI: 10.1016/j.bpobgyn.2021.10.004] [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: 07/01/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/15/2022]
Abstract
Simulation training provides a safe, non-judgmental environment where members of the multi-professional team can practice both their technical and non-technical skills. Poor teamwork and communication are recurring contributing factors to adverse maternal and neonatal outcomes. Simulation can improve outcomes and is now a compulsory part of the national training matrix. Components of successful training include involving the multi-professional team, high fidelity models, keeping training on-site, and focussing on human factors training; a key factor in adverse patient outcomes. The future of simulation training is an exciting field, with the advent of augmented reality devices and the use of artificial intelligence.
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Affiliation(s)
- Shireen Jaufuraully
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK.
| | - Brian Dromey
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
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Staying alive-training with anaesthetists. Best Pract Res Clin Obstet Gynaecol 2021; 80:55-66. [PMID: 34903435 DOI: 10.1016/j.bpobgyn.2021.10.005] [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: 08/01/2021] [Accepted: 10/05/2021] [Indexed: 11/02/2022]
Abstract
An effective working relationship between obstetricians and anaesthetists is crucial for patient safety in maternity care. Anaesthetists' skills and scope of clinical practice complement those of obstetricians, particularly during obstetric emergencies. Anaesthetists also bring expertise in resuscitation, critical care, and a training programme that is underpinned by non-technical as well as technical skills. Through training together, obstetricians and anaesthetists can help plug one another's knowledge gaps, identify each other's blind spots, aid mutual decision-making, and share relevant national guidance between specialties. Training also aids the development of a shared mental model, which contributes to improved teamwork. To be effective, this training should involve the whole team, be conducted in-house, be used to tackle local as well as national priorities, and be repeated regularly.
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O'Brien S, Attilakos G. A push for evidence: An effective training in operative birth. Best Pract Res Clin Obstet Gynaecol 2021; 80:49-54. [PMID: 34893437 DOI: 10.1016/j.bpobgyn.2021.10.003] [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: 10/09/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022]
Abstract
Effective training in operative birth should be the only type of operative birth that trains the junior obstetricians who are exposed to it. Although it remains difficult to fully characterise, effective training in operative birth is likely to include (i) realistic, local, integrated simulation training and (ii) hands-on senior support for an extended period of time. To further improve skills training in operative birth, an evaluation of the real-world effectiveness of current training should take place, a core outcome set for clinical trials should be developed, and real-time reporting and tracking of practitioner-specific outcome measures should be implemented.
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Affiliation(s)
| | - George Attilakos
- Women's Health Division, University College London Hospitals NHS Foundation Trust, London, UK; Institute for Women's Health, University College London, London, UK
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Renwick S, Hookes S, Draycott T, Dey M, Hodge F, Storey J, Winter C, Sengupta N, Benjamin F. PROMPT Wales project: national scaling of an evidence-based intervention to improve safety and training in maternity. BMJ Open Qual 2021; 10:e001280. [PMID: 34675036 PMCID: PMC8532559 DOI: 10.1136/bmjoq-2020-001280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/03/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In healthcare, there is increasing recognition of the importance of developing and testing strategies to scale effective interventions. The NHS long-term plan (2019) acknowledges that often a gold standard approach to a problem already exists somewhere within the NHS, however, it has not been replicated widely across the system. METHODS We describe the approach and process measures for national scaling of PROMPT (Practical Obstetric Multi-Professional Training) across 12 obstetric-led maternity units in Wales. PROMPT is an evidence-based training package for local maternity staff, previously associated with improvements in maternal and neonatal outcomes, reduction in litigation related to preventable harm and improved safety culture. PROMPT has previously been disseminated internationally using a train-the-trainer model. However, this has been associated with variations in uptake, fidelity and impact. In Wales, the project was supported by Welsh Government, and a structured scaling plan was developed, encompassing ongoing implementation support from a multi-professional team. RESULTS PROMPT was successfully implemented in all obstetric led units in Wales, with 326 local PROMPT facilitators trained, and 82.5%-100% of maternity staff attended a local PROMPT course in the first 15 months of the project (January 2019-March 2020). All training courses included evidence-based authentic elements, and 93% of courses in the first year (100/107) were supported by a national implementation team, providing coaching, implementation support and quality assurance. CONCLUSIONS Authentically scaling up complex interventions is a significant challenge. To replicate the improved outcomes demonstrated by PROMPT, intervention reach and fidelity must first be demonstrated.In this national scaling project, our scaling methodology led to the successful implementation of PROMPT across all health boards in Wales. Additionally, we demonstrated reduced variation in adoption, reach, timescale and intervention fidelity between maternity units with varying readiness for change, which had been difficult in two previous large-scale PROMPT implementation projects.
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Affiliation(s)
- Sophie Renwick
- Faculty of Medicine, University of Bristol, Bristol, UK
- PROMPT Maternity Foundation, Bristol, UK
| | - Sarah Hookes
- NHS Wales Shared Services Partnership Legal and Risk Services, Cardiff, UK
| | | | - Madhuchanda Dey
- Department of Obstetrics and Gynaecology, Singleton Hospital, Swansea, UK
| | - Frances Hodge
- Department of Obstetrics and Gynaecology, Singleton Hospital, Swansea, UK
| | | | | | - Niladri Sengupta
- Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board, Bodelwyddan, UK
| | - Fiona Benjamin
- Department of Obstetrics and Gynaecology, Princess of Wales Hospital, Bridgend, UK
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Topperzer MK, Hoffmann M, Larsen HB, Rosthøj S, Fridh MK, Roug LI, Andres-Jensen L, Pontoppidan PEL, Schmiegelow K, Sørensen JL. Postgraduate Interprofessional Case-Based Learning in Childhood Cancer: A Feasibility Study. Cancers (Basel) 2021; 13:cancers13174314. [PMID: 34503122 PMCID: PMC8430868 DOI: 10.3390/cancers13174314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/04/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
This paper presents a feasibility study assessing the acceptability, demand, implementation, and practicality of postgraduate interprofessional case-based learning in childhood cancer at Copenhagen University Hospital-Rigshospitalet. Healthcare professionals included nurses, doctors, social workers, physiotherapists, occupational therapists, pharmacists, pharmacologists, dieticians, nursing assistants, and professionals with a supportive function (teachers, secretaries, priests, and daycare workers). All participated in a postgraduate interprofessional case-based learning session. Feasibility was assessed using Bowen's focus areas of acceptability, demand, implementation, and practicality. Before and after the intervention session, three measurement tools were used 2-3 weeks before participation and 3-4 weeks after participation to collect data: Assessment of Interprofessional Team Collaboration Scale, Readiness for Interprofessional Learning Scale, and Safety Attitudes Questionnaire. Representing 13 occupational groups, 49 participants completed the case-based learning sessions, indicating acceptability and practicality. The pre- and post-intervention questionnaires were completed by 79% of the participants, 88% of whom rated the professional content as good or very good. A change over time was detected on all three scales measuring mean difference post-intervention scores. The outcome measures can be used to assess the effect of the intervention. Postgraduate interprofessional case-based learning in childhood cancer is feasible in terms of acceptability, demand, implementation, and practicality. Implementation requires leadership commitment at all levels.
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Affiliation(s)
- Martha Krogh Topperzer
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (H.B.L.); (M.K.F.); (L.I.R.); (L.A.-J.); (K.S.)
- Correspondence:
| | - Marianne Hoffmann
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (M.H.); (P.E.L.P.)
| | - Hanne Bækgaard Larsen
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (H.B.L.); (M.K.F.); (L.I.R.); (L.A.-J.); (K.S.)
- Department of Clinical Medicine, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Susanne Rosthøj
- Section of Biostatistics, Faculty of Health Sciences, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Martin Kaj Fridh
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (H.B.L.); (M.K.F.); (L.I.R.); (L.A.-J.); (K.S.)
| | - Louise Ingerslev Roug
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (H.B.L.); (M.K.F.); (L.I.R.); (L.A.-J.); (K.S.)
| | - Liv Andres-Jensen
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (H.B.L.); (M.K.F.); (L.I.R.); (L.A.-J.); (K.S.)
| | - Peter Erik Lokto Pontoppidan
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (M.H.); (P.E.L.P.)
| | - Kjeld Schmiegelow
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (H.B.L.); (M.K.F.); (L.I.R.); (L.A.-J.); (K.S.)
- Department of Clinical Medicine, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
- Juliane Marie Centre, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jette Led Sørensen
- Department of Clinical Medicine, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
- Section of Biostatistics, Faculty of Health Sciences, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
- Juliane Marie Centre, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
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A model-based cost-utility analysis of multi-professional simulation training in obstetric emergencies. PLoS One 2021; 16:e0249031. [PMID: 33755716 PMCID: PMC7987166 DOI: 10.1371/journal.pone.0249031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 03/09/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the cost-utility of a multi-professional simulation training programme for obstetric emergencies-Practical Obstetric Multi-Professional Training (PROMPT)-with a particular focus on its impact on permanent obstetric brachial plexus injuries (OBPIs). DESIGN A model-based cost-utility analysis. SETTING Maternity units in England. POPULATION Simulated cohorts of individuals affected by permanent OBPIs. METHODS A decision tree model was developed to estimate the cost-utility of adopting annual, PROMPT training (scenario 1a) or standalone shoulder dystocia training (scenario 1b) in all maternity units in England compared to current practice, where only a proportion of English units use the training programme (scenario 2). The time horizon was 30 years and the analysis was conducted from an English National Health Service (NHS) and Personal Social Services perspective. A probabilistic sensitivity analysis was performed to account for uncertainties in the model parameters. MAIN OUTCOME MEASURES Outcomes for the entire simulated period included the following: total costs for PROMPT or shoulder dystocia training (including costs of OBPIs), number of OBPIs averted, number of affected adult/parental/dyadic quality adjusted life years (QALYs) gained and the incremental cost per QALY gained. RESULTS Nationwide PROMPT or shoulder dystocia training conferred significant savings (in excess of £1 billion ($1.5 billion)) compared to current practice, resulting in cost-savings of at least £1 million ($1.5 million) per any type of QALY gained. The probabilistic sensitivity analysis demonstrated similar findings. CONCLUSION In this model, national implementation of multi-professional simulation training for obstetric emergencies (or standalone shoulder dystocia training) in England appeared to both be cost-saving when evaluating their impact on permanent OBPIs.
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Joudeh A, Ghosh R, Spindler H, Handu S, Sonthalia S, Das A, Gore A, Mahapatra T, Walker D. Increases in diagnosis and management of obstetric and neonatal complications in district hospitals during a high intensity nurse-mentoring program in Bihar, India. PLoS One 2021; 16:e0247260. [PMID: 33735280 PMCID: PMC7971704 DOI: 10.1371/journal.pone.0247260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/04/2021] [Indexed: 11/17/2022] Open
Abstract
Maternal and neonatal mortality in Bihar, India was far higher than the aspirational levels set out by the Sustainable Development Goals. Provider training programs have been implemented in many low-resource settings to improve obstetric and neonatal outcomes. This longitudinal investigation assessed diagnoses and management of postpartum hemorrhage (PPH), hypertensive disorders of pregnancy, birth asphyxia (BA), and low birth weight (LBW), as part of the CARE’s AMANAT program in 22 District Hospitals in Bihar, between 2015 and 2017. Physicians and nurse mentors conducted clinical instruction, simulations and teamwork and communication activities, infrastructure and management support, and data collection for 6 consecutive months. Analysis of diagnosis included 11,259 non-referred and management included 11,800 total (non-referred and referred) admissions that were observed. Data were analyzed using the chi-square test for trend. PPH was diagnosed in 3.7% with no significant trend but diagnosis of hypertensive disorders increased from 1.0% to 1.7%, (ptrend = 0.04), over the 6 months. BA was diagnosed in 5.8% with no significant trend but LBW diagnoses increased from 11% to 16% (ptrend<0.01). Among PPH patients, 96% received fluids, 85% received uterotonics and 11% received Tranexamic Acid (TXA). There was a significant positive trend in the number of patients receiving TXA for PPH (6% to 13.8%, ptrend = 0.03). Of all neonates with BA, there were statistically significant increases in the proportion who were initially warmed, dried, and stimulated (78% to 94%, ptrend = 0.02), received airway suction (80% to 93%, ptrend = 0.03), and supplemental oxygen without positive pressure ventilation (73% to 86%, ptrend = 0.05). Diagnoses of hypertensive disorders and LBW as well as initial management of BA increased during the AMANAT program. However, underdiagnoses of PPH and hypertensive disorders relative to population levels remain critical barriers to improving maternal morbidity and mortality.
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Affiliation(s)
- Ammar Joudeh
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, California, United States of America
| | - Rakesh Ghosh
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Hilary Spindler
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Seema Handu
- PRONTO International, State RMNCH+A, Patna, India
| | | | | | | | | | - Dilys Walker
- School of Medicine and Department of Obstetrics-Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
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van Tetering AAC, Segers MHM, Ntuyo P, Namagambe I, van der Hout-van der Jagt MB, Byamugisha JK, Oei SG. Evaluating the Instructional Design and Effect on Knowledge, Teamwork, and Skills of Technology-Enhanced Simulation-Based Training in Obstetrics in Uganda: Stepped-Wedge Cluster Randomized Trial. JMIR MEDICAL EDUCATION 2021; 7:e17277. [PMID: 33544086 PMCID: PMC8081249 DOI: 10.2196/17277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/07/2020] [Accepted: 06/13/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND Simulation-based training is a common strategy for improving the quality of facility-based maternity services and is often evaluated using Kirkpatrick's theoretical model. The results on the Kirkpatrick levels are closely related to the quality of the instructional design of a training program. The instructional design is generally defined as the "set of prescriptions for teaching methods to improve the quality of instruction with a goal of optimizing learning outcomes." OBJECTIVE The aim of this study is to evaluate the instructional design of a technology-enhanced simulation-based training in obstetrics, the reaction of participants, and the effect on knowledge, teamwork, and skills in a low-income country. METHODS A stepped-wedge cluster randomized trial was performed in a university hospital in Kampala, Uganda, with an annual delivery volume of over 31,000. In November 2014, a medical simulation center was installed with a full-body birthing simulator (Noelle S550, Gaumard Scientific), an interactive neonate (Simon S102 Newborn CPR Simulator, Gaumard Scientific), and an audio and video recording system. Twelve local obstetricians were trained and certified as medical simulation trainers. From 2014 to 2016, training was provided to 57 residents in groups of 6 to 9 students. Descriptive statistics were calculated for ten instructional design features of the training course measured by the 42-item ID-SIM (Instructional Design of a Simulation Improved by Monitoring). The Wilcoxon signed rank test was conducted to investigate the differences in scores on knowledge, the Clinical Teamwork Scale, and medical technical skills. RESULTS The mean scores on the ten instructional design features ranged from 54.9 (95% CI 48.5-61.3) to 84.3 (95% CI 80.9-87.6) out of 100. The highest mean score was given on the feature feedback and the lowest scores on repetitive practice and controlled environment. The overall score for the training day was 92.8 out of 100 (95% CI 89.5-96.1). Knowledge improved significantly, with a test score of 63.4% (95% CI 60.7-66.1) before and 78.9% (95% CI 76.8-81.1) after the training (P<.001). The overall score on the 10-point Clinical Teamwork Scale was 6.0 (95% CI 4.4-7.6) before and 5.9 (95% CI 4.5-7.2) after the training (P=.78). Medical technical skills were scored at 55.5% (95% CI 47.2-63.8) before and 65.6% (95% CI 56.5-74.7) after training (P=.08). CONCLUSIONS Most instructional design features of a technology-enhanced simulation-based training in obstetrics in a low-income country were scored high, although intervals were large. The overall score for the training day was high, and knowledge did improve after the training program, but no changes in teamwork and (most) medical technical skills were found. The lowest-scored instructional design features may be improved to achieve further learning aims. TRIAL REGISTRATION ISRCTN Registry ISRCTN98617255; http://www.isrctn.com/ISRCTN98617255. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12884-020-03050-3.
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Affiliation(s)
| | | | - Peter Ntuyo
- Department of Obstetrics and Gynecology, Mulago Hospital, Makerere University College of Health Sciences, Kampala, Uganda
| | - Imelda Namagambe
- Department of Obstetrics and Gynecology, Mulago Hospital, Makerere University College of Health Sciences, Kampala, Uganda
| | - M Beatrijs van der Hout-van der Jagt
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Josaphat K Byamugisha
- Department of Obstetrics and Gynecology, Mulago Hospital, Makerere University College of Health Sciences, Kampala, Uganda
| | - S Guid Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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Gao P, Wang C, Liu S, Tran KC, Wen Q. Simulation of operating room crisis management - hypotension training for pre-clinical students. BMC MEDICAL EDUCATION 2021; 21:60. [PMID: 33461550 PMCID: PMC7814582 DOI: 10.1186/s12909-020-02477-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Simulation training is an essential criterion for medical staff. The majority of residents are trained in operating room crisis management (ORCM), but only a few pre-clinical anesthesia undergraduate students are trained. Anesthesia methodology and technology were studied by the anesthesia undergraduate students in theory, but they were not able to practically resolve all clinical problems scientifically and reasonably. Consequently, there is a need to apply their competencies and bring together their technology knowledge practically. The crisis management of operating room emergencies was a method of choice applied and used over time. Here, we designed the scenarios for comprehensive crisis management to train anesthesia undergraduate students. We tried to establish or identify the problems which occurred during attempts to implement these scenarios. METHODS Anesthesia undergraduate students initially examined the basic theory, fundamental practice techniques, and case studies before the simulation training program. Subsequently, they participated in comprehensive ORCM training. Training outcomes were evaluated through different viewpoints: understanding the subject, crisis management, nontechnical skills, and a user experience evaluation. RESULTS Anesthesia undergraduate students performed significantly better with completion of ORCM, indicated by higher scores in all four tests (P < 0.001), as well as clinical crisis management (P = 0.0016) and nontechnical skills (P = 0.0002). Following the simulation, the students described the experience as helpful in "combining theoretical knowledge with clinical practice", helpful with memorization, and in "promoting understanding of the subject," while "learning clinical logic authentically" and "inspiring learning interests." CONCLUSIONS This research indicates that ORCM could be implemented as a useful learning tool for pre-clinical anesthesia undergraduate students. The ORCM could be an excellent training method to help improve students' professional competence in crisis management and nontechnical skills, integrating the knowledge and technology of the field of anesthesiology.
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Affiliation(s)
- Peng Gao
- Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, NO.222 Zhongshan Road, 116011, Dalian, China.
| | - Chenyu Wang
- Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, NO.222 Zhongshan Road, 116011, Dalian, China
| | - Shijia Liu
- Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, NO.222 Zhongshan Road, 116011, Dalian, China
| | - Kevin C Tran
- Department of Physiology and Cell Biology, The Ohio State College of Medicine, 43210, Columbus, Ohio, USA
| | - Qingping Wen
- Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, NO.222 Zhongshan Road, 116011, Dalian, China.
- Department of Anesthesiology, Dalian Medical University, 116044, Dalian, China.
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Hotton EJ, Merialdi M, Crofts JF. Simulation for intrapartum care: from training to novel device innovation. Minerva Obstet Gynecol 2020; 73:82-93. [PMID: 33196635 DOI: 10.23736/s2724-606x.20.04669-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Improving maternal and perinatal care is a global priority. Simulation training and novel applications of simulation for intrapartum care may help to reduce preventable deaths worldwide. Evaluation studies have published details of the effectiveness of simulation training for obstetric emergencies, exploring clinical and non-clinical factors as well as the impact on patient outcomes (both maternal and neonatal). This review summarized the many uses of simulation in obstetric emergencies from training to assessment. It also described the adaption of training in low-resource settings and the evidence behind the equipment recommended to support simulation training. The review also discussed novel applications for simulation such as its use in the development of a new device for assisted vaginal birth and its potential role in Cesarean section training. This study analyzed the financial implications of simulation training and how this may impact the delivery of such training packages, considering that simulation should be developed and utilized as a key tool in the development of safe intrapartum care in both emergency and non-emergency settings, in innovation and product development.
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Affiliation(s)
- Emily J Hotton
- Department of Women and Children's Research, Southmead Hospital, Translational Health Sciences, University of Bristol, Bristol, UK -
| | | | - Joanna F Crofts
- Department of Women and Children's Research, Southmead Hospital, Translational Health Sciences, University of Bristol, Bristol, UK
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Ramseyer AM, Lutgendorf MA. Implementation of Low-Cost Obstetric Hemorrhage Simulation Training Models for Resident Education. Mil Med 2020; 184:e637-e641. [PMID: 31038159 DOI: 10.1093/milmed/usz098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/11/2019] [Accepted: 04/09/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Simulation is beneficial training for low frequency high acuity events such as management of obstetric hemorrhage. Our objective was to evaluate perceived competency in management of obstetric and pelvic hemorrhage following training with low fidelity task trainers using inexpensive and common medical supplies. MATERIALS AND METHODS This was a prospective observational study of training residents for management of obstetric and pelvic hemorrhage using a brief didactic instruction and low-cost task trainers with inexpensive common medical supplies. Participants practiced placement of a uterine tamponade balloon, uterine packing with gauze, pelvic parachute packing and temporary abdominal closure. Following training, participants completed a self-report survey regarding perceived competency with each technique. The Wilcoxon Signed-Rank Test was used to compare results before and after training. RESULTS Eighteen of 23 residents completed the training and completed the survey on perceived competencies. There was a statistically significant improvement in perceived competency for all participants before and after training, with scores improving by 1.5 points for Bakri placement, from 1.94 to 3.44 (p < 0.001), improving by 1.67 points for uterine packing, from 1.78 to 3.44 (p < 0.001), improving by 1.95 for pelvic parachute packing, from 1.16 to 3.11 (p < 0.001), and improving by 1.89 for temporary abdominal closure, from 1.22 to 3.11 (p < 0.001). CONCLUSIONS Low-cost supplies and task trainers can be utilized to simulate postpartum hemorrhage and improve perceived competency in managing obstetric and pelvic hemorrhage. Similar training programs can be used in small community programs with limited resources.
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Affiliation(s)
- Abigail M Ramseyer
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Littlerock, AK
| | - Monica A Lutgendorf
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Naval Medical Center San Diego, San Diego, CA
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Rasmussen MB, Tolsgaard MG, Dieckmann P, Østergaard D, White J, Plenge P, Ringsted CV. Social ties influence teamwork when managing clinical emergencies. BMC MEDICAL EDUCATION 2020; 20:63. [PMID: 32131807 PMCID: PMC7057460 DOI: 10.1186/s12909-020-1953-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Our current understanding of medical team competence is traditionally influenced by an individualistic perspective focusing on individual team members' knowledge, skills as well as on effective communication within the team. However, team dynamics may influence team performance more than previously anticipated. In particular, recent studies in other academic disciplines suggest that social ties between team members may impact team dynamics but this has not been explored for medical teams. We aimed to explore intensive care staff's perceptions about teamwork and performance in clinical emergencies focusing particularly on the teams' social ties. METHODS Semi-structured interviews were conducted with a purposive sample of intensive care staff. We used a thematic analysis approach to data interpretation. RESULTS Thematic saturation was achieved after three group interviews and eight individual interviews. Findings demonstrated that social ties influenced teamwork by affecting the teams' ability to co-construct knowledge, coordinate tasks, the need for hierarchy, the degree to which they relied on explicit or implicit communication, as well as their ability to promote adaptive behavior. CONCLUSIONS Social ties may be an important factor to consider and acknowledge in the design of future team training, as well as for work planning and scheduling of team activities during clinical practice. More research is needed into the causal effect of social ties on team performance and outcome.
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Affiliation(s)
- Maria B. Rasmussen
- Department of Obstetrics and Gynecology, University hospital Sealand, Roskilde Hospital. Sygehusvej 10, 4000 Roskilde, Denmark
| | - Martin G. Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark Centre for Human Resource, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark Centre for Human Resource, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark Centre for Human Resource, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark
| | - Jonathan White
- Intensive Care Unit 4131, University Hospital Rigshospitalet, Blegdamsvej 9. 2100, Købenahvn Ø, Denmark
| | - Pernille Plenge
- Intensive Care Unit 4131, University Hospital Rigshospitalet, Blegdamsvej 9. 2100, Købenahvn Ø, Denmark
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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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Cooper N, O'Brien S, Siassakos D. Training health workers to prevent and manage post-partum haemorrhage (PPH). Best Pract Res Clin Obstet Gynaecol 2019; 61:121-129. [DOI: 10.1016/j.bpobgyn.2019.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/02/2019] [Indexed: 02/05/2023]
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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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Ameh CA, Mdegela M, White S, van den Broek N. The effectiveness of training in emergency obstetric care: a systematic literature review. Health Policy Plan 2019; 34:257-270. [PMID: 31056670 PMCID: PMC6661541 DOI: 10.1093/heapol/czz028] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 12/19/2022] Open
Abstract
Providing quality emergency obstetric care (EmOC) reduces the risk of maternal and newborn mortality and morbidity. There is evidence that over 50% of maternal health programmes that result in improving access to EmOC and reduce maternal mortality have an EmOC training component. The objective was to review the evidence for the effectiveness of training in EmOC. Eleven databases and websites were searched for publications describing EmOC training evaluations between 1997 and 2017. Effectiveness was assessed at four levels: (1) participant reaction, (2) knowledge and skills, (3) change in behaviour and clinical practice and (4) availability of EmOC and health outcomes. Weighted means for change in knowledge and skills obtained, narrative synthesis of results for other levels. One hundred and one studies including before-after studies (n = 44) and randomized controlled trials (RCTs) (n = 15). Level 1 and/or 2 was assessed in 68 studies; Level 3 in 51, Level 4 in 21 studies. Only three studies assessed effectiveness at all four levels. Weighted mean scores pre-training, and change after training were 67.0% and 10.6% for knowledge (7750 participants) and 53.1% and 29.8% for skills (6054 participants; 13 studies). There is strong evidence for improved clinical practice (adherence to protocols, resuscitation technique, communication and team work) and improved neonatal outcomes (reduced trauma after shoulder dystocia, reduced number of babies with hypothermia and hypoxia). Evidence for a reduction in the number of cases of post-partum haemorrhage, case fatality rates, stillbirths and institutional maternal mortality is less strong. Short competency-based training in EmOC results in significant improvements in healthcare provider knowledge/skills and change in clinical practice. There is emerging evidence that this results in improved health outcomes.
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Affiliation(s)
- Charles A Ameh
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Mselenge Mdegela
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Sarah White
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Walker SC, Sedlar G, Berliner L, Rodriguez FI, Davis PA, Johnson S, Leith J. Advancing the state-level tracking of evidence-based practices: a case study. Int J Ment Health Syst 2019; 13:25. [PMID: 31007712 PMCID: PMC6457070 DOI: 10.1186/s13033-019-0280-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/25/2019] [Indexed: 01/21/2023] Open
Abstract
Background Despite a sustained focus by policymakers and researchers on improving the standard of clinical care in public mental health services, the use of evidence-based practice remains low. Among other challenges, this reflects the difficulty of translating clinical research into useable policy that can be feasibly funded and monitored by state or large healthcare systems. Case presentation In this paper we present a case study of Washington State’s strategy for monitoring the use of clinical elements at the session level for all Medicaid-funded children’s mental health services. The implementation of this strategy reflects policy actions to promote effective practice while also actively influencing multiple other levels of the implementation ecology. The approach is informed by the Policy Ecology Framework, the Consolidated Framework for Implementation Research, the evidence-based policymaking literature, and common ontology and clinical elements models. Conclusions We found the strategy developed in Washington State to be a feasible method of collecting session level information about the use of effective clinical mental health practices. In addition, the approach appears to be having influence on multiple layers of the implementation ecology that could be explored through further study.
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Affiliation(s)
- Sarah Cusworth Walker
- 1Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE Campus Parkway, Box 358015, Seattle, WA 98105 USA
| | - Georganna Sedlar
- 1Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE Campus Parkway, Box 358015, Seattle, WA 98105 USA
| | - Lucy Berliner
- Harborview Center for Sexual Assault and Trauma, 401 Broadway, Seattle, WA 98104 USA
| | - Felix I Rodriguez
- Washington State Health Care Authority, 626 8th Ave SE, Olympia, WA 98501 USA
| | - Paul A Davis
- Washington State Health Care Authority, 626 8th Ave SE, Olympia, WA 98501 USA
| | - Savannah Johnson
- 4Duke University, 2127 Campus Drive, Box 90065, Durham, NC 27708 USA
| | - Jessica Leith
- 1Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE Campus Parkway, Box 358015, Seattle, WA 98105 USA
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Skills training for operative vaginal birth. Best Pract Res Clin Obstet Gynaecol 2019; 56:11-22. [DOI: 10.1016/j.bpobgyn.2018.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/21/2018] [Accepted: 10/05/2018] [Indexed: 11/19/2022]
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Pettersson K, Westgren M, Götze-Eriksson R, Ajne G. Effect of team training and monitoring on the rate of failed mid and low cavity vacuum extraction: a hospital based intervention study. BMC Pregnancy Childbirth 2019; 19:101. [PMID: 30922258 PMCID: PMC6440163 DOI: 10.1186/s12884-019-2257-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/22/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical team training has been advocated as a means to improve delivery care, and failed extractions is a suggested variable for clinical audit in instrumental vaginal delivery. Other activities may also have intended or unintended effects on care processes or outcomes. METHODS We retrospectively observed 1074 mid and low vacuum extraction deliveries during three time periods (prevalence periods): Baseline (period 0), implemented team training (period 1 and 2) and monitoring of traction force during vacuum extraction (period 2). Our primary outcome was failed extraction followed by emergency cesarean section or obstetric forceps delivery. RESULTS The prevalence proportion (relative risk) of failed extraction decreased significantly after implementation of team training, from 19% (period 0) to 8 % (period 1), corresponding to a relative risk of 0.48 [0.26-0.87]. The secondary procedural outcome complicated delivery (duration > 15 min or number of pulls > 6, or cup detachment > 1) was decreased in period 2 compared to period 1, RR 0.42 [0.23-0.76]. Secondary clinical (neonatal) outcome were not affected. CONCLUSION Clinically based educational efforts and increased monitoring improved procedural outcome without improving neonatal outcome. The study design has inherent limitations in making causal inference.
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Affiliation(s)
- Kristina Pettersson
- Department of Obstetrics and Gynecology, Karolinska University Hospital at Huddinge, K57, 141 86 Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
| | | | - Rebecca Götze-Eriksson
- Department of Obstetrics and Gynecology, Karolinska University Hospital at Huddinge, K57, 141 86 Stockholm, Sweden
| | - Gunilla Ajne
- Department of Obstetrics and Gynecology, Karolinska University Hospital at Huddinge, K57, 141 86 Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
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Brogaard L, Kierkegaard O, Hvidman L, Jensen KR, Musaeus P, Uldbjerg N, Manser T. The importance of non-technical performance for teams managing postpartum haemorrhage: video review of 99 obstetric teams. BJOG 2019; 126:1015-1023. [PMID: 30771263 DOI: 10.1111/1471-0528.15655] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Little is known about how teams' non-technical performance influences clinical performance in obstetric emergencies such as postpartum haemorrhage. DESIGN Video review - observational study. SETTING A university hospital (5000 deliveries) and a regional hospital (2000 deliveries) in Denmark. POPULATION Obstetric teams managing real-life postpartum haemorrhage. METHODS We systematically assessed 99 video recordings of obstetric teams managing real-life major postpartum haemorrhage. Exposure was the non-technical score (AOTP); outcomes were the clinical performance score (TeamOBS) and the delayed transfer to the operating theatre (defined as blood loss >1500 ml in the delivery room). RESULTS Teams with an excellent non-technical score performed significantly better than teams with a poor non-technical score: 83.7 versus 0.3% chance of a high clinical performance score (P < 0.001), 0.2 versus 80% risk of a low clinical performance score (P < 0.001), and 3.5 versus 31.7% risk of delayed transfer to the operating theatre (P = 0.008). The results remained robust when adjusting for potential confounders such as bleeding velocity, aetiology, time of day, team size, and hospital. The specific non-technical skills associated with high clinical performance were vigilance, role assignment, problem-solving, management of disruptive behavior, and leadership. Communication with the patient and closing the loop were of minor importance. All performance assessments showed good reliability: the intraclass correlation was 0.97 (95% CI 0.96-0.98) for the non-technical score and 0.84 (95% CI 0.76-0.89) for the clinical performance score. CONCLUSION Video review offers a new method and new perspectives for research in obstetric teams to identify how teams become effective and safe; the skills identified in this study can be included in future obstetric training programmes. TWEETABLE ABSTRACT Non-technical performance is important for teams managing postpartum haemorrhage; video review of 99 obstetric teams.
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Affiliation(s)
- L Brogaard
- Department of Obstetrics and Gynaecology, Regional Hospital in Horsens, Horsens, Denmark
| | - O Kierkegaard
- Department of Obstetrics and Gynaecology, Regional Hospital in Horsens, Horsens, Denmark
| | - L Hvidman
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - K R Jensen
- Department of Obstetrics and Gynaecology, Regional Hospital in Horsens, Horsens, Denmark
| | - P Musaeus
- Centre for Health Sciences Education, INCUBA Science Park, Aarhus, Denmark
| | - N Uldbjerg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - T Manser
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Altan, Switzerland
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Greer JA, Haischer-Rollo G, Delorey D, Kiser R, Sayles T, Bailey J, Blosser C, Middlebrooks R, Ennen CS. In-situ Interprofessional Perinatal Drills: The Impact of a Structured Debrief on Maximizing Training While Sensing Patient Safety Threats. Cureus 2019; 11:e4096. [PMID: 31032156 PMCID: PMC6472716 DOI: 10.7759/cureus.4096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/19/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction In-situ interprofessional emergency team training improves participants' with confidence and knowledge and identifies latent safety threats. This study examined the impact of a structured debrief on an interprofessional perinatal team's ability to identify latent safety threats and assess competency in managing perinatal emergencies. It was hypothesized that latent safety threats would be reduced and checklist compliance would increase during subsequent in-situ perinatal team training. Methods Two in-situ training sessions were held six months apart. The perinatal emergency response team provided care for a standardized patient with preterm twin gestation. Each session included off-ward delivery and resuscitation of the first infant, transportation to appropriate inpatient units, cesarean delivery, and resuscitation of the second twin. Postpartum hemorrhage ensued, requiring massive transfusion protocol activation. Medical experts assessed team performance with critical action checklists. A structured debrief identified latent safety threats, developed action plans, and reviewed checklist compliance. Checklist compliance rates were analyzed using a z-ratio test. Results The first training session: seven teams (75 staff) completed 75% (292/391) critical action checklist items and identified 34 latent safety threats. Second training session: four teams (45 staff) completed 89% (94/106) critical action checklist items. Ten latent safety threats were mitigated during the second session. Utilizing a z-ratio, a significant difference was detected between the overall checklist compliance rates of the two sessions, z = -3.069, p = .002. Post-hoc power calculation was <10%. Conclusions In-situ interprofessional perinatal emergency team training is feasible, identifies latent patient safety threats, and may improve team competency.
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Affiliation(s)
- Joy A Greer
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
| | | | | | - Rebecca Kiser
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
| | - Timothy Sayles
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
| | - Jennifer Bailey
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
| | - Colleen Blosser
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
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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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Marker S, Mohr M, Østergaard D. Simulation-based training of junior doctors in handling critically ill patients facilitates the transition to clinical practice: an interview study. BMC MEDICAL EDUCATION 2019; 19:11. [PMID: 30621668 PMCID: PMC6323692 DOI: 10.1186/s12909-018-1447-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/28/2018] [Indexed: 05/06/2023]
Abstract
BACKGROUND Junior doctors lack confidence and competence in handling the critically ill patient including diagnostic skills, decision-making and team working with other health care professionals. Simulation-based training on managing emergency situations can have substantial effects on satisfaction and learning. However, there are indications of problems when applying learned skills to practice. Our aim was to identify first-year doctors' perceptions, reflections and experiences on transfer of skills to a clinical setting after simulation-based training in handling critically ill patients. METHODS We used a qualitative approach and conducted semi-structured telephone interviews with a sample of twenty first-year doctors six months after a 4-day simulation-based training course in handling critically ill patients. Interviews were transcribed verbatim. A content-analysis approach was used to analyse the data. RESULTS The following main themes were identified from the interviews: preparedness for clinical practice, organisational readiness, use of algorithms, communication, teamwork, situational awareness and decision making. The doctors gave several examples of simulation-based training increasing their preparedness for clinical practice and handling the critically ill patient. The usefulness of algorithms and the appreciation of non-technical skills were highlighted and found to be helpful in managing clinical difficulties. Concern was expressed related to staff willingness and preparedness in using these tools. CONCLUSIONS Overall, the simulation-based training seemed to facilitate the transition from being a medical student to become a junior doctor. The doctors experienced an ability to transfer the use of algorithms and non-technical skills trained in the simulated environment to the clinical environment. However, the application of these skills was more difficult if these skills were unfamiliar to the surrounding clinical staff. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Søren Marker
- Copenhagen Academy for Medical Education and Simulation, Herlev Hospital, Capital Region of Denmark and Copenhagen University, Herlev Ringvej 75, 2730 Herlev, Copenhagen, Denmark
- Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 5, 2100 Copenhagen, Denmark
| | - Marlene Mohr
- Copenhagen Academy for Medical Education and Simulation, Herlev Hospital, Capital Region of Denmark and Copenhagen University, Herlev Ringvej 75, 2730 Herlev, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, Herlev Hospital, Capital Region of Denmark and Copenhagen University, Herlev Ringvej 75, 2730 Herlev, Copenhagen, Denmark
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Rose K, Jensen K, Guo R, Afshar Y. Simulation to Improve Trainee Skill and Comfort with Forceps-Assisted Vaginal Deliveries. AJP Rep 2019; 9:e6-e9. [PMID: 30680251 PMCID: PMC6340792 DOI: 10.1055/s-0039-1677736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/29/2018] [Indexed: 01/07/2023] Open
Abstract
Objective Simulation training is a powerful learning tool for low frequency events. Forceps-assisted vaginal deliveries (FAVD) are an important tool in reducing cesarean deliveries. The aim of this study is to create a high-fidelity simulation-based curriculum for residency education and investigate pre- and posttest skill and confidence. Methods A prospective cohort study was conducted involving obstetrics and gynecology residents over 2 academic years. Residents participated in one to three FAVD simulation trainings. All sessions involved video, didactic, and hands-on practice. Pre- and postsurvey and skills assessment were conducted to assess confidence, ability to consent, and perform a FAVD. Wilcoxon's signed-rank tests and Kruskal-Wallis tests were used. Results Thirty residents (73%) completed at least one forceps simulation training session. Participants demonstrated significant improvement in confidence ( p < 0.005) following training. Before the intervention, there was a disparity in confidence by postgraduate level ( p < 0.005); however, this difference was not seen postsimulation ( p = 0.24). Residents demonstrated significant improvement in their FAVD skills ( p < 0.05), as well as their ability to consent ( p < 0.01). Conclusion Simulation training improves residents' perceived confidence in FAVD. Simulation helped to better equalize confidence across classes. FAVD simulations improves resident confidence, skill, and more broadly broadened the armamentarium to decrease the cesarean delivery rate.
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Affiliation(s)
- Kelsey Rose
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Kirsten Jensen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Rong Guo
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Yalda Afshar
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
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Cronie D, Rijnders M, Jans S, Verhoeven CJ, de Vries R. How good is collaboration between maternity service providers in the Netherlands? J Multidiscip Healthc 2018; 12:21-30. [PMID: 30613150 PMCID: PMC6307488 DOI: 10.2147/jmdh.s179811] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS To examine the experiences of inter-professional collaboration of maternity service providers in the Netherlands and to identify potential enhancing and inhibiting factors for inter-professional collaboration within maternity care in the Netherlands. BACKGROUND Good collaboration between health care professionals is a key element of safe, effective care, but creating a collaborative culture can be challenging. Good collaboration requires, among other things, negotiating different professional orientations and the organizational constraints of hierarchies and scheduling. Good collaboration is especially important in maternity care. In the Netherlands, suboptimal collaboration has been cited as a significant factor in maternal deaths and in adverse incidents occurring in hospitals during evenings, nights, and weekends. In spite of its importance for effective maternity care, little is known about the nature and quality of collaboration between maternity care professionals. In order to fill this gap, we examined the inter-professional collaboration within multi-disciplinary teams (MDTs) providing maternity services in the Netherlands. METHODS Online survey of MDTs (consisting of hospital and PCMs, doctors, and carers) involved in the provision of maternity services in the Netherlands. We used a validated measure of collaboration (the Leiden Quality of Work Questionnaire) to analyze the attitudes of those involved in the provision of maternity services about multi-disciplinary collaboration in their work. We used descriptive and inferential statistics to assess differences between the groups. RESULTS 40% of all respondents were not satisfied with collaboration within their MDT. Overall, mean collaboration scores (MCS) were low. We found significant differences in MCS between professional groups. Midwives - community and hospital based - were pessimistic about collaboration in future models of maternity care. DISCUSSION In the Netherlands, collaboration in maternity care is less than optimal. Poor collaboration is associated with negative consequences for patient safety and quality of care. Strategies to address suboptimal collaboration exist; however, no one-size-fits-all approach is identified in the literature. CONCLUSION Suboptimal collaboration exists within the midwifery model of care in the Netherlands and the relationship between care providers is under pressure. This could affect patient safety and quality of care, according to the literature. PRÉCIS This paper presents an in-depth examination of the nature of, and attitudes about, collaboration between members of the MDT involved in the provision of maternity services in the Netherlands.
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Affiliation(s)
- Doug Cronie
- Department of Midwifery, OLVG (West) Hospital, Amsterdam, The Netherlands,
- Department of Midwifery Science, Faculty of Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands,
| | | | - Suze Jans
- Department of Child Health, TNO, Leiden, The Netherlands
- Editorial Department, Dutch Journal for Midwives (KNOV), Utrecht, The Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Raymond de Vries
- Faculty of Midwifery Education & Studies, Zuyd University, Maastricht, The Netherlands
- CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Whittington JR, Poole AT. Introduction of Posterior Axilla Sling Traction in Simulated Shoulder Dystocia. AJP Rep 2018; 8:e247-e250. [PMID: 30473906 PMCID: PMC6193804 DOI: 10.1055/s-0038-1675350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022] Open
Abstract
Objective Aim of this study was to introduce posterior axilla sling traction (PAST) in delivering providers and nursing staff as an adjunct to the management of shoulder dystocia and evaluate comfort in performing the maneuver. Methods A presimulation questionnaire had given to all participants. A brief training on how to perform PAST was also given. A simulated shoulder dystocia was run where usual maneuvers failed. Participants used PAST for delivery of posterior shoulder, delivery of posterior arm, and to assist with rotation. Participants were then given a post-simulation questionnaire. A Chi-squared test was used to evaluate comfort with performing the procedure pre and post-simulation. Results Data were collected from 43 participants at pre and post-simulation. Designations (attending, resident, midwife, registered nurse) and responses were recorded to the questionnaires. There was a statistically significant increase in the number of providers and nurses who would feel comfortable using PAST for shoulder dystocia management and for rotational maneuvers. Ninety-three percent of participants would consider using PAST in future shoulder dystocia when usual maneuvers failed. Conclusion PAST is an adjunct to management of shoulder dystocia that has not previously been taught in our facility. The majority of participants in our simulation felt comfortable with using PAST.
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Affiliation(s)
- Julie R Whittington
- Division of MFM, Department of OB/GYN, Naval Medical Center Portsmouth, Portsmouth, Virginia.,Division of MFM, Department of OB/GYN, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Aaron T Poole
- Division of MFM, Department of OB/GYN, Naval Medical Center Portsmouth, Portsmouth, Virginia
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Montagu D, Sudhinaraset M, Diamond-Smith N, Campbell O, Gabrysch S, Freedman L, Kruk ME, Donnay F. Where women go to deliver: understanding the changing landscape of childbirth in Africa and Asia. Health Policy Plan 2018; 32:1146-1152. [PMID: 28541422 PMCID: PMC5886217 DOI: 10.1093/heapol/czx060] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2017] [Indexed: 11/13/2022] Open
Abstract
Growing evidence from a number of countries in Asia and Africa documents a large shift towards facility deliveries in the past decade. These increases have not led to the improvements in health outcomes that were predicted by health policy researchers in the past. In light of this unexpected evidence, we have assessed data from multiple sources, including nationally representative data from 43 countries in Asia and Africa, to understand the size and range of changing delivery location in Asia and Africa. We have reviewed the policies, programs and financing experiences in multiple countries to understand the drivers of changing practices, and the consequences for maternal and neonatal health and the health systems serving women and newborns. And finally, we have considered what implications changes in delivery location will have for maternal and neonatal care strategies as we move forward into the next stage of global action. As a result of our analysis we make four major policy recommendations. (1) An expansion of investment in mid-level facilities for delivery services and a shift away from low-volume rural delivery facilities. (2) Assured access for rural women through funding for transport infrastructure, travel vouchers, targeted subsidies for services and residence support before and after delivery. (3) Increased specialization of maternity facilities and dedicated maternity wards within larger institutions. And (4) a renewed focus on quality improvements at all levels of delivery facilities, in both private and public settings.
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Affiliation(s)
- Dominic Montagu
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California, San Francisco; San Francisco, CA, USA
| | - May Sudhinaraset
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California, San Francisco; San Francisco, CA, USA.,Community Health Sciences; University of California, Los Angeles; Los Angeles, CA, USA
| | - Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California, San Francisco; San Francisco, CA, USA
| | - Oona Campbell
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Lynn Freedman
- Population and Family Health, Columbia University, New York, NY, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard University, Cambridge, MA, USA
| | - France Donnay
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
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Dettinger JC, Kamau S, Calkins K, Cohen SR, Cranmer J, Kibore M, Gachuno O, Walker D. Measuring movement towards improved emergency obstetric care in rural Kenya with implementation of the PRONTO simulation and team training program. MATERNAL AND CHILD NUTRITION 2018; 14 Suppl 1. [PMID: 29493898 DOI: 10.1111/mcn.12465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 11/30/2022]
Abstract
As the proportion of facility-based births increases, so does the need to ensure that mothers and their newborns receive quality care. Developing facility-oriented obstetric and neonatal training programs grounded in principles of teamwork utilizing simulation-based training for emergency response is an important strategy for improving the quality care. This study uses 3 dimensions of the Kirkpatrick Model to measure the impact of PRONTO International (PRONTO) simulation-based training as part of the Linda Afya ya Mama na Mtoto (LAMMP, Protect the Health of mother and child) in Kenya. Changes in knowledge of obstetric and neonatal emergency response, self-efficacy, and teamwork were analyzed using longitudinal, fixed-effects, linear regression models. Participants from 26 facilities participated in the training between 2013 and 2014. The results demonstrate improvements in knowledge, self-efficacy, and teamwork self-assessment. When comparing pre-Module I scores with post-training scores, improvements range from 9 to 24 percentage points (p values < .0001 to .026). Compared to baseline, post-Module I and post-Module II (3 months later) scores in these domains were similar. The intervention not only improved participant teamwork skills, obstetric and neonatal knowledge, and self-efficacy but also fostered sustained changes at 3 months. The proportion of facilities achieving self-defined strategic goals was high: 95.8% of the 192 strategic goals. Participants rated the PRONTO intervention as extremely useful, with an overall score of 1.4 out of 5 (1, extremely useful; 5, not at all useful). Evaluation of how these improvements affect maternal and perinatal clinical outcomes is forthcoming.
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Affiliation(s)
- Julia C Dettinger
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Kimberly Calkins
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Susanna R Cohen
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - John Cranmer
- School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Minnie Kibore
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Onesmus Gachuno
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Dilys Walker
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
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Urbutė A, Paulionytė M, Jonauskaitė D, Machtejevienė E, Nadišauskienė RJ, Dambrauskas Ž, Dobožinskas P, Kliučinskas M. Perceived changes in knowledge and confidence of doctors and midwives after the completion of the Standardized Trainings in Obstetrical Emergencies. MEDICINA-LITHUANIA 2018; 53:403-409. [PMID: 29482880 DOI: 10.1016/j.medici.2018.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 12/22/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES There are only few training programs in obstetric emergencies currently in use and only some of them were evaluated with an adequate sample of participants. Therefore, we present the evaluation of the novel Standardized Trainings in Obstetrical Emergencies (STrObE), conducted in Lithuania. The aim of this study was to analyze whether participants' self-reported knowledge and confidence increased after the trainings, and whether the impact of the trainings was long-lasting. MATERIALS AND METHODS Data was collected across the majority of hospitals providing secondary and tertiary obstetrical care in Lithuania in 2015. A total of 650 obstetricians-gynecologists and midwives attended the trainings; 388 (response rate 59.7%) of them filled in the initial questionnaire before the trainings, 252 (64.9%) immediately after, 160 (41.2%) 6 weeks after, and 160 (41.2%) 6 months after the trainings, which was the final sample for the analyses. Participants used a Likert-type scale to evaluate their knowledge and confidence about management of urgent obstetrical situations: vacuum-assisted vaginal delivery, shoulder dystocia, postpartum hemorrhage, preeclampsia/eclampsia, early preterm labor, and dystocia. We assessed how participants' self-reported knowledge and confidence changed after the trainings (compared to before the trainings) and how long the effect was retained for. RESULTS The mean score of self-reported knowledge in obstetrical emergencies increased immediately after the trainings comparing to the scores before the trainings (P<0.001) and it did not differ further between the three time points after the trainings (i.e. immediately, 6 weeks, and 6 months; P>0.05). The same pattern was observed for self-reported confidence scores. The increase in self-reported knowledge and confidence after the trainings was stable. Moreover, the self-reported knowledge and confidence gains were greater for those participants with lower work experience, although benefit was seen across all experience levels. CONCLUSIONS STrObE improved participants' self-reported knowledge and confidence and lasting positive effects were observed for at least 6 months after the initial trainings. Moreover, the trainings were more beneficial for those with lower work experience, although they benefited all the participants.
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Affiliation(s)
- Aivara Urbutė
- Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev, Denmark; Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Marija Paulionytė
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Eglė Machtejevienė
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rūta J Nadišauskienė
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Žilvinas Dambrauskas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Paulius Dobožinskas
- Department of Emergency Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mindaugas Kliučinskas
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Dalal AR, Purandare AC. The Partograph in Childbirth: An Absolute Essentiality or a Mere Exercise? J Obstet Gynaecol India 2018; 68:3-14. [PMID: 29391669 PMCID: PMC5783902 DOI: 10.1007/s13224-017-1051-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022] Open
Abstract
WHO has recommended use of the partograph, a low-tech paper form that has been hailed as an effective tool for the early detection of maternal and fetal complications during childbirth. Yet despite decades of training and investment, implementation rates and capacity to correctly use the partograph remain low in resource-limited settings. Nevertheless, competent use of the partograph, especially using newer technologies, can save maternal and fetal lives by ensuring that labor is closely monitored and that life-threatening complications such as obstructed labor are identified and treated. To address the challenges for using partograph among health workers, health-care systems must establish an environment that supports its correct use. Health-care staff should be updated by providing training and asking them about the difficulties faced at their health center. Then only the real potential of this wonderful tool will be maximally utilized.
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Affiliation(s)
- Asha R. Dalal
- Department of Obstetrics and Gynecology, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Ameya C. Purandare
- Purandare’s Chowpatty Maternity and Gynecological Hospital, 31/C, Dr N A Purandare Marg, Chowpatty Seaface, Mumbai, 400007 India
- K J Somaiya Medical College and Superspeciality Hospital, Mumbai, India
- Bhatia General Hospital, Mumbai, India
- Masina Hospital, Apollo Spectra Hospital, Mumbai, India
- Police Hospital, Mumbai, India
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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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Ellard DR, Chimwaza W, Davies D, Simkiss D, Kamwendo F, Mhango C, Quenby S, Kandala NB, O'Hare JP. Up-skilling associate clinicians in Malawi in emergency obstetric, neonatal care and clinical leadership: the ETATMBA cluster randomised controlled trial. BMJ Glob Health 2017; 1:e000020. [PMID: 28588915 PMCID: PMC5321302 DOI: 10.1136/bmjgh-2015-000020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/08/2022] Open
Abstract
Background The ETATMBA (Enhancing Training And Technology for Mothers and Babies in Africa) project-trained associate clinicians (ACs/clinical officers) as advanced clinical leaders in emergency obstetric and neonatal care. This trial aimed to evaluate the impact of training on obstetric health outcomes in Malawi. Method A cluster randomised controlled trial with 14 districts of Malawi (8 intervention, 6 control) as units of randomisation. Intervention districts housed the 46 ACs who received the training programme. The primary outcome was district (health facility-based) perinatal mortality rates. Secondary outcomes included maternal mortality ratios, neonatal mortality rate, obstetric and birth variables. The study period was 2011–2013. Mortality rates/ratios were examined using an interrupted time series (ITS) to identify trends over time. Results The ITS reveals an improving trend in perinatal mortality across both groups, but better in the control group (intervention, effect −3.58, SE 2.65, CI (−9.85 to 2.69), p=0.20; control, effect −17.79, SE 6.83, CI (−33.95 to −1.64), p=0.03). Maternal mortality ratios are seen to have improved in intervention districts while worsening in the control districts (intervention, effect −38.11, SE 50.30, CI (−157.06 to 80.84), p=0.47; control, effect 11.55, SE 87.72, CI (−195.87 to 218.98), p=0.90). There was a 31% drop in neonatal mortality rate in intervention districts while in control districts, the rate rises by 2%. There are no significant differences in the other secondary outcomes. Conclusions This is one of the first randomised studies looking at the effect of structured training on health outcomes in this setting. Notwithstanding a number of limitations, this study suggests that up-skilling this cadre is possible, and could impact positively on health outcomes. Trial registration number ISRCTN63294155; Results.
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Affiliation(s)
- David R Ellard
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
| | | | - David Davies
- Educational Development & Research Team, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Doug Simkiss
- Division of Mental Health & Wellbeing, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Francis Kamwendo
- Obstetrics and Gynaecology Department, Malawi University, College of Medicine, Blantyre, Malawi
| | - Chisale Mhango
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Siobhan Quenby
- Division of Reproductive Health, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Ngianga-Bakwin Kandala
- Faculty of Engineering and Environment, Department of Mathematics and Information sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Joseph Paul O'Hare
- Division of Metabolic & Vascular Health, Warwick Medical School, The University of Warwick, Coventry, UK
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Yau CWH, Pizzo E, Morris S, Odd DE, Winter C, Draycott TJ. The cost of local, multi-professional obstetric emergencies training. Acta Obstet Gynecol Scand 2017; 95:1111-9. [PMID: 27496301 DOI: 10.1111/aogs.12956] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/24/2016] [Indexed: 01/21/2023]
Abstract
INTRODUCTION We aim to outline the annual cost of setting up and running a standard, local, multi-professional obstetric emergencies training course, PROMPT (PRactical Obstetric Multi-Professional Training), at Southmead Hospital, Bristol, UK - a unit caring for approximately 6500 births per year. MATERIAL AND METHODS A retrospective, micro-costing analysis was performed. Start-up costs included purchasing training mannequins and teaching props, printing of training materials and assembly of emergency boxes (real and training). The variable costs included administration time, room hire, additional printing and the cost of releasing all maternity staff in the unit, either as attendees or trainers. Potential, extra start-up costs for maternity units without established training were also included. RESULTS The start-up costs were €5574 and the variable costs for 1 year were €143 232. The total cost of establishing and running training at Southmead for 1 year was €148 806. Releasing staff as attendees or trainers accounted for 89% of the total first year costs, and 92% of the variable costs. The cost of running training in a maternity unit with around 6500 births per year was approximately €23 000 per 1000 births for the first year and around €22 000 per 1000 births in subsequent years. CONCLUSIONS The cost of local, multi-professional obstetric emergencies training is not cheap, with staff costs potentially representing over 90% of the total expenditure. It is therefore vital that organizations consider the clinical effectiveness of local training packages before implementing them, to ensure the optimal allocation of finite healthcare budgets.
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Affiliation(s)
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London, UK
| | - Steve Morris
- Department of Applied Health Research, University College London, London, UK
| | - David E Odd
- The Chilterns, Southmead Hospital, Bristol, UK
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Marlow SL, Hughes AM, Sonesh SC, Gregory ME, Lacerenza CN, Benishek LE, Woods AL, Hernandez C, Salas E. A Systematic Review of Team Training in Health Care: Ten Questions. Jt Comm J Qual Patient Saf 2017; 43:197-204. [PMID: 28325208 DOI: 10.1016/j.jcjq.2016.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND As a result of the recent proliferation of health care team training (HTT), there was a need to update previous systematic reviews examining the underlying structure driving team training initiatives. METHODS This investigation was guided by 10 research questions. A literature search identified 197 empirical samples detailing the evaluation of team training programs within the health care context; 1,764 measures of HTT effectiveness were identified within these samples. Trained coders extracted information related to study design and training development, implementation, and evaluation to calculate percentages detailing the prevalence of certain training features. RESULTS HTT was rarely informed by a training needs analysis (k = 47, 23.9%) and most commonly addressed communication strategies (k = 167, 84.8%). HTT programs that incorporated practice (k = 163, 82.7%) often employed high-fidelity patient simulators (k = 38, 25.2%) and provided participants with feedback opportunities (k = 107, 65.6%). Participants were typically practicing clinicians (k = 154, 78.2%) with a lower prevalence of health care students (k = 35, 17.8). Evaluations primarily relied on repeated measures designs (k = 123, 62.4%) and self-reported data (k = 1,257, 71.3%). Additional trends were identified and are discussed. CONCLUSIONS Many trends in HTT practice and evaluation were identified. The results of this review suggested that, in the literature, HTT programs are more frequently following recommendations for training design and implementation (for example, providing feedback) in comparison to findings from previous reviews. However, there were still many areas in which improvement could be achieved to improve patient care.
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Irresponsible and responsible resource management in obstetrics. Best Pract Res Clin Obstet Gynaecol 2017; 43:87-106. [PMID: 28268060 DOI: 10.1016/j.bpobgyn.2016.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 01/02/2023]
Abstract
Low budgets constrain and high budgets stimulate choices. In high-income countries, this economic reality may lead to overuse of healthcare services and pose unnecessary risks for mothers and infants. Options for improvement can be created at different levels of healthcare systems. Pregnancy provides an effective opportunity to profile maternal risks and represents a vulnerable but potentially modifiable period from prenatal life to adulthood. In response to system-inherent false incentives, professional responsibility requires obstetricians to strive to improve the future health of families and their offspring despite disincentives for doing so. This chapter addresses professionally responsible resource management in obstetrics and identifies implications for patients, care givers, communities, policy makers, and academic faculties.
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Sørensen JL, Østergaard D, LeBlanc V, Ottesen B, Konge L, Dieckmann P, Van der Vleuten C. Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation. BMC MEDICAL EDUCATION 2017; 17:20. [PMID: 28109296 PMCID: PMC5251301 DOI: 10.1186/s12909-016-0838-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 12/05/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Simulation-based medical education (SBME) has traditionally been conducted as off-site simulation in simulation centres. Some hospital departments also provide off-site simulation using in-house training room(s) set up for simulation away from the clinical setting, and these activities are called in-house training. In-house training facilities can be part of hospital departments and resemble to some extent simulation centres but often have less technical equipment. In situ simulation, introduced over the past decade, mainly comprises of team-based activities and occurs in patient care units with healthcare professionals in their own working environment. Thus, this intentional blend of simulation and real working environments means that in situ simulation brings simulation to the real working environment and provides training where people work. In situ simulation can be either announced or unannounced, the latter also known as a drill. This article presents and discusses the design of SBME and the advantage and disadvantage of the different simulation settings, such as training in simulation-centres, in-house simulations in hospital departments, announced or unannounced in situ simulations. DISCUSSION Non-randomised studies argue that in situ simulation is more effective for educational purposes than other types of simulation settings. Conversely, the few comparison studies that exist, either randomised or retrospective, show that choice of setting does not seem to influence individual or team learning. However, hospital department-based simulations, such as in-house simulation and in situ simulation, lead to a gain in organisational learning. To our knowledge no studies have compared announced and unannounced in situ simulation. The literature suggests some improved organisational learning from unannounced in situ simulation; however, unannounced in situ simulation was also found to be challenging to plan and conduct, and more stressful among participants. The importance of setting, context and fidelity are discussed. Based on the current limited research we suggest that choice of setting for simulations does not seem to influence individual and team learning. Department-based local simulation, such as simulation in-house and especially in situ simulation, leads to gains in organisational learning. The overall objectives of simulation-based education and factors such as feasibility can help determine choice of simulation setting.
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Affiliation(s)
- Jette Led Sørensen
- Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, 2730 Herlev, Denmark
| | - Vicki LeBlanc
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada
- University of Ottawa Skills and Simulation Centre, The Ottawa Hospital, & University of Ottawa, K1Y 4E9 Ottawa, Canada
| | - Bent Ottesen
- Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Capital Region of Denmark and University of Copenhagen, 2100 Copenhagen, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, 2730 Herlev, Denmark
| | - Cees Van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 Maastricht, Netherlands
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Lumala A, Sekweyama P, Abaasa A, Lwanga H, Byaruhanga R. Assessment of quality of care among in-patients with postpartum haemorrhage and severe pre-eclampsia at st. Francis hospital nsambya: a criteria-based audit. BMC Pregnancy Childbirth 2017; 17:29. [PMID: 28086822 PMCID: PMC5237263 DOI: 10.1186/s12884-016-1219-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 12/31/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The maternal mortality ratio of Uganda is still high and the leading causes of maternal mortality are postpartum haemorrhage (PPH), severe pre-eclampsia and eclampsia. Criteria-based audit (CBA) is a way of improving quality of care that has not been commonly used in low income countries. This study aimed at finding out the quality of care provided to patients with these conditions and to find out if the implementation of recommendations from the audit cycle resulted in improvement in quality of care. METHODS This study was a CBA following a time series study design. It was done in St. Francis Hospital Nsambya and it involved assessment of adherence to standards of care for PPH, severe pre-eclampsia and eclampsia. An initial audit was done for 3 consecutive months, then findings were presented to health workers and recommendations made; we implemented the recommendations in a subsequent month and this comprised three interventions namely continuing medical education (CME), drills and displaying guidelines; a re-audit was done in the proceeding 3 consecutive months and analysis compared adherence rates of the initial audit with those of the re-audit. RESULTS Pearson Chi-Square test revealed that the adherence rates of 7 out of 10 standards of care for severe pre-eclampsia/eclampsia were statistically significantly higher in the re-audit than in the initial audit; also, the adherence rates of 3 out of 4 standards of care for PPH were statistically significantly higher in the re-audit than in the initial audit. CONCLUSION The giving of feedback on quality of care and the implementation of recommendations made during the CBA including CME, drills and displaying guidelines was associated with improvements in the quality of care for patients with PPH, severe pre-eclampsia and eclampsia.
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Affiliation(s)
| | - Peter Sekweyama
- Uganda Martyrs University Mother Kevin Postgraduate Medical School, Kampala, Uganda
| | | | | | - Romano Byaruhanga
- Uganda Martyrs University Mother Kevin Postgraduate Medical School, Kampala, Uganda
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Bedwell C, Levin K, Pett C, Lavender DT. A realist review of the partograph: when and how does it work for labour monitoring? BMC Pregnancy Childbirth 2017; 17:31. [PMID: 28086823 PMCID: PMC5237234 DOI: 10.1186/s12884-016-1213-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 12/29/2016] [Indexed: 11/29/2022] Open
Abstract
Background The partograph (or partogram) is recommended by the World Health Organisation (WHO), for monitoring labour wellbeing and progress. Concerns about limitations in the way the partograph is used in the clinical context and the potential impact on its effectiveness have led to this realist systematic review of partograph use. Methods This review aimed to answer two key questions, 1) What is it about the partograph that works (or does not work); for whom does it work; and in what circumstances? 2) What are the essential inputs required for the partograph to work? A comprehensive search strategy encompassed key databases; including papers of varying methodologies. Papers were selected for inclusion if the focus of the paper was the partograph and related to context, mechanism or outcome. Ninety five papers were included for data synthesis. Two authors completed data extraction and synthesis. Results The evidence synthesis relates the evidence to identified theories of health worker acceptability, health system support, effective referral systems, human resources and health worker competence, highlighting barriers and facilitators. Conclusions This first comprehensive realist synthesis of the partograph, provides the international community of maternity clinicians with a picture of potential issues and solutions related to successful labour recording and management, which is also translatable to other monitoring approaches.
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Affiliation(s)
- Carol Bedwell
- School of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Karen Levin
- Monitoring and Evaluation, Fistula Care Plus project, EngenderHealth, 440 9th Avenue, New York, NY, 10001, USA
| | - Celia Pett
- Fistula Care Plus project, EngenderHealth, 440 9th Ave, 12th floor, New York, NY, 10001, USA
| | - Dame Tina Lavender
- School of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Varghese B, Krishnamurthy J, Correia B, Panigrahi R, Washington M, Ponnuswamy V, Mony P. Limited Effectiveness of a Skills and Drills Intervention to Improve Emergency Obstetric and Newborn Care in Karnataka, India: A Proof-of-Concept Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2016; 4:582-593. [PMID: 27993924 PMCID: PMC5199176 DOI: 10.9745/ghsp-d-16-00143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 09/20/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The majority of the maternal and perinatal deaths are preventable through improved emergency obstetric and newborn care at facilities. However, the quality of such care in India has significant gaps in terms of provider skills and in their preparedness to handle emergencies. We tested the feasibility, acceptability, and effectiveness of a "skills and drills" intervention, implemented between July 2013 and September 2014, to improve emergency obstetric and newborn care in the state of Karnataka, India. METHODS Emergency drills through role play, conducted every 2 months, combined with supportive supervision and a 2-day skills refresher session were delivered across 4 sub-district, secondary-level government facilities by an external team of obstetric and pediatric specialists and nurses. We evaluated the intervention through a quasi-experimental design with 4 intervention and 4 comparison facilities, using delivery case sheet reviews, pre- and post-knowledge tests among providers, objective structured clinical examinations (OSCEs), and qualitative in-depth interviews. Primary outcomes consisted of improved diagnosis and management of selected maternal and newborn complications (postpartum hemorrhage, pregnancy-induced hypertension, and birth asphyxia). Secondary outcomes included knowledge and skill levels of providers and acceptability and feasibility of the intervention. RESULTS Knowledge scores among providers improved significantly in the intervention facilities; in obstetrics, average scores between the pre- and post-test increased from 49% to 57% (P=.006) and in newborn care, scores increased from 48% to 56% (P=.03). Knowledge scores in the comparison facilities were similar but did not improve significantly over time. Skill levels were significantly higher among providers in intervention facilities than comparison facilities (mean objective structured clinical examination scores for obstetric skills: 55% vs. 46%, respectively; for newborn skills: 58% vs. 48%, respectively; P<.001 for both obstetric and newborn), along with their confidence in managing complications. However, this did not result in significant differences in correct diagnosis and management of complications between intervention and comparison facilities. Shortage of trained nurses and doctors along with unavailability of a consistent supply chain was cited by most providers as major health systems barriers affecting provision of care. CONCLUSIONS Improvements in knowledge, skills, and confidence levels of providers as a result of the skills and drills intervention was not sufficient to translate into improved diagnosis and management of maternal and newborn complications. System-level changes including adequate in-service training may also be necessary to improve maternal and newborn outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Prem Mony
- St. Johns Research Institute, Bangalore, India
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Raynal P. [Simulation' benefits in obstetrical emergency: Which proof level?]. ACTA ACUST UNITED AC 2016; 44:584-590. [PMID: 27663913 DOI: 10.1016/j.gyobfe.2016.08.001] [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: 05/25/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
Simulation in obstetrical emergency is in expansion. The important economic and human cost in simulation needs a real evaluation about enhancement in technical and non-technical skills, maternal and neonatal morbidity and mortality. We present a literature review of the results published on the subject in shoulder dystocia, post-partum haemorrhage, eclampsia and cord prolaps with a selection of publications with high evidence level or positive impact of training on obstetrical emergencies. There are few publications with a positive impact of training on obstetrical emergencies. Some publications from 10years by the same obstetrical team for training and shoulder dystocia reveal a 75% reduction in brachial plexus injury after 4years of training, and 100% reduction in permanent injury after a decade of training. Only one publication is in accordance with a reduction of severe post-partum haemorrhage with training. For all obstetrical emergencies, crew resource management (communication, self-confidence…) and team training are improved.
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Affiliation(s)
- P Raynal
- Service de gynécologie-obstétrique, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
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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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Simulation to Improve Trainee Knowledge and Comfort About Twin Vaginal Birth. Obstet Gynecol 2016; 128 Suppl 1:34S-39S. [DOI: 10.1097/aog.0000000000001598] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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