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Medeiros PDB, Flenady V, Andrews C, Forbes M, Boyle F, Loughnan SA, Meredith N, Gordon A. Evaluation of an online education program for healthcare professionals on best practice management of perinatal deaths: IMPROVE eLearning. Aust N Z J Obstet Gynaecol 2024; 64:63-71. [PMID: 37551966 DOI: 10.1111/ajo.13743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/23/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The IMPROVE (IMproving Perinatal Mortality Review and Outcomes Via Education) eLearning, developed by the Stillbirth Centre of Research Excellence in partnership with the Perinatal Society of Australia and New Zealand was launched in December 2019. Based on the successful face-to-face program, the eLearning aims to increase availability and accessibility of high-quality online education to healthcare professionals providing care for families around the time of perinatal death, to improve the delivery of respectful and supportive clinical care and increase best practice investigation of perinatal deaths. AIMS To evaluate participants' reported learning outcomes (change in knowledge and confidence) and overall acceptability of the program. METHODS Pre- and post-eLearning in-built surveys were collected over two years (Dec. 2019-Nov. 2021), with a mix of Likert and polar questions. Pre- and post-eLearning differences in knowledge and confidence were assessed using McNemar's test. Subgroup analysis of overall acceptability by profession was assessed using Pearson's χ2 . RESULTS One thousand, three hundred and thirty-nine participants were included. The majority were midwives (80.2%, n = 1074). A significant improvement in knowledge and confidence was shown across all chapters (P < 0.01). The chapter showing the greatest improvement was perinatal mortality audit and classification (21.5% pre- and 89.2% post-education). Over 90% of respondents agreed the online education was relevant, helpful, acceptable, engaging. Importantly, 80.7% of participants considered they were likely to change some aspect of their clinical practice after the eLearning. There was no difference in responses to relevance and acceptability of the eLearning program by profession. CONCLUSIONS The IMPROVE eLearning is an acceptable and engaging method of delivery for clinical education, with the potential to improve care and management of perinatal deaths.
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Affiliation(s)
- Poliana de Barros Medeiros
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Christine Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Madeline Forbes
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Fran Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Siobhan A Loughnan
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Natasha Meredith
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Adrienne Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- The University of Sydney, Sydney, New South Wales, Australia
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Dadich A, Blackburn P, Scaife J, Saurman E. Mapping service standards and guidelines to support accreditation processes – a case study of a collaborative effort worth replicating. AUST HEALTH REV 2022; 46:695-700. [PMID: 36395790 DOI: 10.1071/ah22171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Abstract
Health services respond to myriad practice standards and guidelines that regulate, monitor, and improve the safety and quality of healthcare. Although important, information overload and compliance fatigue for accreditation can be burdensome for service managers and clinicians. To address this, and ultimately improve the safety and quality of care, this case study demonstrates how a mapping exercise was completed to synthesise seven practice standards and guidelines relevant to palliative care; and develop an online resource to aid accreditation efforts and improve palliative care. A working group, comprised of service managers, clinicians, and academics, mapped a state-wide blueprint to improve palliative care against seven unique practice standards and guidelines, most of which were national in scope. This project culminated with a freely available online resource to translate the standards and guidelines for accreditation - a resource that supports service managers and clinicians across public and private health sectors to readily determine whether and how they demonstrated safety and quality in the context of palliative care and pursue accreditation. By developing one matrix, there is opportunity to alleviate information overload and compliance fatigue for service managers and clinicians. Despite its focus on palliative care, this case study demonstrates how to collaboratively map distinct practice standards and guidelines and form a resource to aid accreditation efforts to improve healthcare.
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Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, 169 Macquarie Street, Parramatta, NSW 2150, Australia
| | - Pippa Blackburn
- Illawarra Shoalhaven Local Health District, Unit 28-29 Piccadilly Centre, 341-349 Crown Street, Wollongong, NSW 2500, Australia
| | - Jessica Scaife
- Department of Palliative Care, Calvary Mater Newcastle, Corner of Edith and Platt Streets, Waratah, NSW 2298, Australia
| | - Emily Saurman
- Broken Hill University Department of Rural Health, University of Sydney, Corrindah Court, Morgan Street, PO Box 457, Broken Hill, NSW 2880, Australia
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Barker CIS, Groeneweg G, Maitland-van der Zee AH, Rieder MJ, Hawcutt DB, Hubbard TJ, Swen JJ, Carleton BC. Pharmacogenomic testing in paediatrics: clinical implementation strategies. Br J Clin Pharmacol 2021; 88:4297-4310. [PMID: 34907575 PMCID: PMC9544158 DOI: 10.1111/bcp.15181] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022] Open
Abstract
Pharmacogenomics (PGx) relates to the study of genetic factors determining variability in drug response. Implementing PGx testing in paediatric patients can enhance drug safety, helping to improve drug efficacy or reduce the risk of toxicity. Despite its clinical relevance, the implementation of PGx testing in paediatric practice to date has been variable and limited. As with most paediatric pharmacological studies, there are well‐recognised barriers to obtaining high‐quality PGx evidence, particularly when patient numbers may be small, and off‐label or unlicensed prescribing remains widespread. Furthermore, trials enrolling small numbers of children can rarely, in isolation, provide sufficient PGx evidence to change clinical practice, so extrapolation from larger PGx studies in adult patients, where scientifically sound, is essential. This review paper discusses the relevance of PGx to paediatrics and considers implementation strategies from a child health perspective. Examples are provided from Canada, the Netherlands and the UK, with consideration of the different healthcare systems and their distinct approaches to implementation, followed by future recommendations based on these cumulative experiences. Improving the evidence base demonstrating the clinical utility and cost‐effectiveness of paediatric PGx testing will be critical to drive implementation forwards. International, interdisciplinary collaborations will enhance paediatric data collation, interpretation and evidence curation, while also supporting dedicated paediatric PGx educational initiatives. PGx consortia and paediatric clinical research networks will continue to play a central role in the streamlined development of effective PGx implementation strategies to help optimise paediatric pharmacotherapy.
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Affiliation(s)
- Charlotte I S Barker
- Department of Medical & Molecular Genetics, King's College London, London, UK.,Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gabriella Groeneweg
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Anke H Maitland-van der Zee
- Respiratory Medicine/Pediatric Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael J Rieder
- Departments of Paediatrics, Physiology and Pharmacology and Medicine, Western University, London, Ontario, Canada.,Molecular Medicine Group, Robarts Research Institute, London, Ontario, Canada
| | - Daniel B Hawcutt
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.,NIHR Clinical Research Facility, Alder Hey Children's Hospital, Liverpool, UK
| | - Tim J Hubbard
- Department of Medical & Molecular Genetics, King's College London, London, UK.,Genomics England, London, UK
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Network for Personalized Therapeutics, Leiden, The Netherlands
| | - Bruce C Carleton
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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Huynh N, Burgess A, Wing L, Mellis C. Anatomy by Whole Body Dissection as an Elective: Student Outcomes. JOURNAL OF SURGICAL EDUCATION 2021; 78:492-501. [PMID: 32958420 DOI: 10.1016/j.jsurg.2020.07.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/24/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Anatomy education has long been considered fundamental to the medical profession. Recently, Australasian medical schools have favored prosected human material, models and medical imaging in their anatomy curriculum with only 3 medical schools offering whole-body dissection. The aim of this study was to explore the knowledge acquisition and perceptions of an elective anatomy by whole body dissection (AWBD) course for senior medical students. METHODS In the 2017 AWBD course, 53 self-selected senior medical students carried out dissections over an 8-week period. Students were assessed via true/false questions and practical tests involving the identification of structures on anatomical images at precourse, mid-course and end-course. In addition, at completion of the course, students completed a questionnaire using a 5-point Likert scale and 2 open-ended questions. Quantitative data analysis was conducted on test scores and questionnaire data using a paired-sample t-test and descriptive statistics. Qualitative data were coded and categorised into themes. RESULTS There was a significant improvement (p < 0.0001) in student test scores from pre-course (mean 34.1 ± 12.9%) to mid-course (mean 74.8 ± 9.4%) and end-course (mean 75.4 ± 9.8%). Analysis of the questionnaire data showed strongly favorable perceptions of the course, highlighting dissection, complemented by Structure, Clinical, Objective-Referenced, Problem-Based, Integrated and Organized (SCORPIO) teaching, frequent testing and senior surgeon supervision as beneficial teaching methods. CONCLUSIONS Dissecting in small groups has been shown to be an effective part of anatomy learning. Our study suggests complementary teaching methods as possible augmenters to a well-structed, small group AWBD course. We have presented a framework suitable for an intensive AWBD course within medical curricula, that was valued by participants, and improved students' knowledge of anatomy.
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Affiliation(s)
- Nguyen Huynh
- Faculty of Medicine and Health, the University of Sydney School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.
| | - Annette Burgess
- Faculty of Medicine and Health, The University of Sydney School of Medicine - Education Office, The University of Sydney, Sydney, New South Wales, Australia
| | - Lindsay Wing
- Division of Surgery, Faculty of Medicine and Health, University of Sydney School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig Mellis
- Faculty of Medicine and Health, The University of Sydney School of Medicine - Education Office, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney School of Medicine - Central, The University of Sydney, Sydney, New South Wales, Australia
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Wang Q, Du T. Implementation of the college student mental health education course (CSMHEC) in undergraduate medical curriculum: effects and insights. BMC MEDICAL EDUCATION 2020; 20:505. [PMID: 33308205 PMCID: PMC7731140 DOI: 10.1186/s12909-020-02438-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 12/08/2020] [Indexed: 05/11/2023]
Abstract
BACKGROUND Extant literature reveals that medical students suffer from various mental health problems in the process of learning medicine. However, there are few studies evaluating the implementation of a mental health education course in medical curriculum. The current study aimed to test the effectiveness of an 8-week intensive mental health education course, the College Student Mental Health Education Course (CSMHEC), and to gain further insights on how the course could be improved from students' feedback. METHODS This is a quasi-experimental study with both quantitative and qualitative analyses. We recruited 374 first year medical students as our subjects with 188 (age = 17.97 ± 0.65 years, 37.2% male) for the experiment group and 186 (age = 18.02 ± 0.63 years, 40.3% male) for the control group. For quantitative analysis, Depression Anxiety Stress Scales-21 (DASS-21), Chinese College Student Academic Burnout Inventory (CCSABI) and Satisfaction With Life Scale (SWLS) were used and a 5-point Likert scale was used to indicate students' overall satisfaction with CSMHEC. For qualitative analysis, a thematic analysis method was adopted to gain insights from the feedback of medical students. RESULTS Medical students in the experiment group saw a significant decline in psychological distress (p < 0.001, d = 0.31) and academic burnout (p < 0.001, d = 1.46), while they experienced a significant increase in life satisfaction levels after the intervention (p < 0.001, d = 0.48). Compared with students in the control group, students in the experiment group had statistically significant lower levels of psychological distress (p < 0.05, d = 0.23) and academic burnout (p < 0.001, d = 0.70), but statistically significant higher levels of life satisfaction in the post-test (p < 0.01, d = 0.31). Most students in the experiment group were satisfied with CSMHEC and themes extracted in the thematic analysis shed light on how the course could be improved. CONCLUSIONS Implementing a mental health education course like CSMHEC in medical curriculum can be effective in helping medical students improve psychological health. More research needs to be conducted on further refinement and better design of such a course to implement in medical education.
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Affiliation(s)
- Qinghua Wang
- English Department, School of Fundamental Sciences, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province People’s Republic of China
| | - Tianjiao Du
- Department of Psychology, School of Humanities and Social Sciences, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province People’s Republic of China
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van der Aa JE, Aabakke AJM, Ristorp Andersen B, Settnes A, Hornnes P, Teunissen PW, Goverde AJ, Scheele F. From prescription to guidance: a European framework for generic competencies. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:173-187. [PMID: 31451981 PMCID: PMC7018687 DOI: 10.1007/s10459-019-09910-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/09/2019] [Indexed: 06/01/2023]
Abstract
In postgraduate medical education, required competencies are described in detail in existing competency frameworks. This study proposes an alternative strategy for competency-based medical education design, which is supported by change management theories. We demonstrate the value of allowing room for re-invention and creative adaptation of innovations. This new strategy was explored for the development of a new generic competency framework for a harmonised European curriculum in Obstetrics and Gynaecology. The generic competency framework was developed through action research. Data were collected by four European stakeholder groups (patients, nurses, midwives and hospital boards), using a variety of methods. Subsequently, the data were analysed further in consensus discussions with European specialists and trainees in Obstetrics and Gynaecology. These discussions ensured that the framework provides guidance, is specialty-specific, and that implementation in all European countries could be feasible. The presented generic competency framework identifies four domains: 'Patient-centred care', 'Teamwork', 'System-based practice' and 'Personal and professional development'. For each of these four domains, guiding competencies were defined. The new generic competency framework is supported by European specialists and trainees in Obstetrics and Gynaecology, as well as by their European stakeholders. According to change management theories, it seems vital to allow room for re-invention and creative adaptation of the competency framework by medical professionals. Therefore, the generic competency framework offers guidance rather than prescription. The presented strategy for competency framework development offers leads for implementation of competency-based medical education as well as for development of innovations in postgraduate medical education in general.
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Affiliation(s)
- Jessica E van der Aa
- Department of Research and Education, OLVG Hospital, Amsterdam, The Netherlands.
- Athena Institute, Faculty of Science, VU, Amsterdam, The Netherlands.
| | - Anna J M Aabakke
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark
- European Network of Trainees in Obstetrics and Gynaecology (ENTOG), Brussels, Belgium
| | - Betina Ristorp Andersen
- Department of Gynaecology and Obstetrics, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Annette Settnes
- Department of Gynaecology and Obstetrics, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Hornnes
- Department of Gynaecology and Obstetrics, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
- European Board and College of Obstetrics and Gynaecology (EBCOG), Brussels, Belgium
| | - Pim W Teunissen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Angelique J Goverde
- European Board and College of Obstetrics and Gynaecology (EBCOG), Brussels, Belgium
- Department of Reproductive Medicine and Gynaecology, University Medical Centre, Utrecht, The Netherlands
| | - Fedde Scheele
- Department of Research and Education, OLVG Hospital, Amsterdam, The Netherlands
- Athena Institute, Faculty of Science, VU, Amsterdam, The Netherlands
- European Board and College of Obstetrics and Gynaecology (EBCOG), Brussels, Belgium
- Department of Obstetrics and Gynaecology, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
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Bond D, Raynes-Greenow C, Gordon A. Bereaved parents' experience of care and follow-up after stillbirth in Sydney hospitals. Aust N Z J Obstet Gynaecol 2017; 58:185-191. [PMID: 28776636 DOI: 10.1111/ajo.12684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/09/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite stillbirth being identified as one of the most traumatic events a woman can experience, there is a lack of evidence on which to inform best practice in hospital and follow-up care. AIMS The aim of this study was to identify which strategies are most valued by parents regarding care following stillbirth in order to improve the support and management of grieving families. METHOD Mixed methods questionnaires were sent to bereaved participants of the Sydney Stillbirth Study. Questionnaires included a combination of fixed and open-ended responses regarding two critical areas: the participant's hospital stay and their follow-up care. We analysed the qualitative data using thematic analysis. RESULTS Of the 103 women who experienced a stillbirth, 36 responded to the questionnaire. Responders were more likely to have private obstetric care (odds ratio (OR) 4.7, 95% CI 1.7-12.7) and be tertiary educated (OR 6.2, 95% CI 2.3-16.8). Three key themes relating to hospital management of stillbirth were identified: the emotional response to grief, the educational importance of being guided through the grief process, and the environmental aspects of adequate time and appropriate physical space. Families preferred not to be seen in an antenatal setting for follow-up. CONCLUSIONS Simple key components of care including a sensitive and respectful approach, offering guidance as to creating memories, and arranging follow-up care in a quiet and private environment are valued by families experiencing a stillbirth. Incorporating these into practice is achievable and could benefit both families and caregivers.
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Affiliation(s)
- Diana Bond
- RPA Newborn Care, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Menzies Centre for Health Policy/Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Gordon
- RPA Newborn Care, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, Obstetrics, Gynaecology and Neonatology, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
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Impact of a new aggressive nutrition policy incorporating early introduction of parenteral nutrition and mother's own milk on growth of preterm infants. World J Pediatr 2016; 12:450-454. [PMID: 27286688 DOI: 10.1007/s12519-016-0037-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/31/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND Most of the evidence on early feeding of preterm infants was derived from high income settings, it is equally important to evaluate whether it can be successfully implemented into less resourced settings. This study aimed to compare growth and feeding of preterm infants before and after the introduction of a new aggressive feeding policy in Penang Hospital, a tertiary referral hospital in a middle income country. METHODS The new aggressive feeding policy was developed mainly from Cochrane review evidence, using early parenteral and enteral nutrition with standardized breastfeeding counselling aimed at empowering mothers to provide early expressed milk. A total of 80 preterm babies (34 weeks and below) discharged from NICU were included (40 pre- and 40 post-intervention). Pre and post-intervention data were compared. The primary outcome was growth at day 7, 14, 21 and at discharge and secondary outcomes were time to full oral feeding, breastfeeding rates, and adverse events. RESULTS Complete data were available for all babies to discharge. One baby was discharged prior to day 14 and 10 babies before day 21, so growth data for these babies were unavailable. Baseline data were similar in the two groups. There was no significant weight difference at 7, 14, 21 days and at discharge. More post-intervention babies were breastfed at discharge than pre-intervention babies (21 vs. 8, P=0.005). Nosocomial infection (11 vs. 4, P=0.045), and blood transfusion were significantly lower in the postintervention babies than in the pre-intervention babies (31 vs. 13, P=0.01). The post-intervention babies were more likely to achieve shorter median days (interquartile range) to full oral feeding [11 (6) days vs. 13 (11) days, P=0.058] and with lower number affecting necrotising enterocolitis (0 vs. 5, P=0.055). CONCLUSION Early aggressive parenteral nutrition and early provision of mother's milk did not result in improved growth as evidenced by weight gain at discharge. However we found more breastfeeding babies, lower nosocomial infection and transfusion rates. Our findings suggest that implementing a more aggressive feeding policy supported by high level scientific evidence is able to improve important outcomes.
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Burstein PD, Zalenski DM, Edwards JL, Rafi IZ, Darden JF, Firneno C, Santos P. Changing Labor and Delivery Practice: Focus on Achieving Practice and Documentation Standardization with the Goal of Improving Neonatal Outcomes. Health Serv Res 2016; 51 Suppl 3:2472-2486. [PMID: 27766653 DOI: 10.1111/1475-6773.12589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To establish multifactorial shoulder dystocia response and management protocol to promote sustainable practice change. DATA SOURCES/STUDY SETTING Primary data collection was conducted over 3 years. Implementation of the protocol spanned 13 months. Data collection occurred at five sites, which were chosen for their diversity in both patient mix and geographical location. STUDY DESIGN Case study evaluation methodology was used to examine clinician engagement and protocol adoption. DATA COLLECTION METHODS The training completion for all practice engagement team activities was collected by the site project manager and entered into a flat file. Data from the labor and delivery notes, medical records, and interviews with labor and delivery teams were gathered and analyzed by the senior investigator. PRINCIPAL FINDINGS In the first year, there was a threefold increase in shoulder dystocia reporting, which continued in years 2 and 3. In the first year, 96 percent of clinicians completed all training elements and in subsequent years, 98 percent completed the follow-up training. Overall teams reached a 99 percent adoption rate of the shoulder dystocia protocol. CONCLUSIONS System and site management teams implemented a standardized shoulder dystocia protocol that fostered effective teamwork and obstetric team readiness for managing shoulder dystocia emergencies.
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Affiliation(s)
- Paul D Burstein
- Department of Obstetrics and Gynecology, Columbia St. Mary's, Milwaukee, WI
| | - David M Zalenski
- Department of Obstetrics and Gynecology, St. John Hospital & Medical Center, Detroit, MI
| | - John L Edwards
- Department of Obstetrics and Gynecology, St. Vincent's Birmingham, Birmingham, AL
| | - Ishrat Z Rafi
- Department of Obstetrics and Gynecology, Saint Agnes Hospital, Baltimore, MD
| | | | - Cassandra Firneno
- Meyers Primary Care Institute, University of MassachusettsMedical School, Worcester, MA
| | - Palmira Santos
- Institute on Healthcare Systems, Brandeis University, Waltham, MA
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Impact of a Central Line Infection Prevention Bundle in Newborn Infants. Infect Control Hosp Epidemiol 2016; 37:1029-36. [PMID: 27289400 DOI: 10.1017/ice.2016.127] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare central line use and central line-associated bloodstream infection in newborn infants before and after the introduction of a central line infection prevention bundle in order to determine the effectiveness of the bundle and to identify areas for further improvement. DESIGN Retrospective cohort analysis of prospectively collected data. SETTING Level 5 neonatal intensive care unit in Sydney, Australia. PATIENTS Newborn infants admitted to the Royal Prince Alfred Hospital Neonatal Intensive Care Unit who had a central venous catheter (CVC) inserted. METHODS Data regarding clinical characteristics, CVC use, and infection were collected before and after the introduction of a bundle of interventions. The bundles encompassed (1) insertion of CVC, (2) maintenance of CVC, (3) an education program, and (4) ongoing surveillance and feedback. RESULTS Baseline and intervention groups were comparable in clinical characteristics. The number of CVCs inserted was reduced in the intervention group (central line utilization rate, 0.16 vs 0.2, P<.0001). Overall CVC dwell time was reduced, resulting from significant reduction in peripherally inserted CVC dwell time (6 days [95% CI, 5.0-11.8 days] vs 7.3 days [4.0-10.4 days], P=.0004). Central line-associated bloodstream infections were significantly reduced, predominantly secondary to decreased peripherally inserted CVC-related bloodstream infections (1.2/1,000 central line-days vs 11.5/1,000 central line-days, P<.0001). CONCLUSION This central line infection bundle was effective in reducing CVC use, dwell time, and central line-associated bloodstream infections. Infect Control Hosp Epidemiol 2016;37:1029-1036.
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Warland J, Glover P. Talking to pregnant women about stillbirth: Evaluating the effectiveness of an information workshop for midwives using pre and post intervention surveys. NURSE EDUCATION TODAY 2015; 35:e21-e25. [PMID: 26282192 DOI: 10.1016/j.nedt.2015.07.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 07/23/2015] [Accepted: 07/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The project aimed to establish the level of knowledge a group of midwives had about risk factors for stillbirth and identify their current willingness to raise and discuss stillbirth with pregnant women during standard antenatal care. DESIGN Surveys were administered pre and post an education intervention. The intervention consisted of a half day education workshop. A change in knowledge pre and post intervention was measured as a means to determine the effectiveness of the workshop. SETTINGS The workshop first provided participants with up-to-date information about modifiable and preventative risk factors for stillbirth and then provided them with the opportunity to practice a range of strategies to assist them to becoming confident in raising and discussing the topic of stillbirth. PARTICIPANTS Three workshops were offered and a total of 109 qualified midwives attended. METHODS In order to explore the level of knowledge increase and retention of knowledge about stillbirth as well as participants willingness to discuss stillbirth with pregnant women, comparisons were made between the pre workshop survey responses and those given to the two follow-up surveys immediately following and 3 months after the workshop. RESULTS There was a statistically significant improvement in knowledge about stillbirth as well as in participant willingness to engage the pregnant women in their care in a conversation about stillbirth. KEY CONCLUSIONS Providing a workshop on stillbirth for registered midwives is quite effective in raising their awareness about stillbirth. However, before substantial changes can be made in stillbirth awareness, ways and means to sensitively promote public awareness of stillbirth need to be explored and anxieties and taboos addressed. Research could explore whether or not a stillbirth awareness message actually does make women anxious, and if so the nature of this anxiety and how this anxiety might best be ameliorated.
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Affiliation(s)
- Jane Warland
- University of South Australia, School of Nursing and Midwifery, City East Campus, Centenary Building, North Terrace, Adelaide, SA 5000, Australia.
| | - Pauline Glover
- The Flinders University Adelaide, School of Nursing and Midwifery, GPO Box 2100, Adelaide, SA 5001, Australia.
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