Understanding the clinical utility of stillbirth investigations: a scoping review

BACKGROUND

Investigating the causes of stillbirth is crucial for both parents and healthcare providers as it helps explain why the baby died, guides clinical care in future pregnancies, and aids in developing strategies to prevent stillbirth. The usefulness or utility of investigations for stillbirth is poorly defined and unclear. As a result, protocols for investigating the causes of stillbirth are currently based on clinical consensus and fail to prioritise investigative approaches that are most effective at determining a cause of death.

OBJECTIVES

The objectives of this scoping review were to identify the available evidence, key characteristics, and knowledge gaps regarding the utility of stillbirth investigations.

SEARCH STRATEGY

An a priori protocol was implemented and included a systematic search in MEDLINE, CINAHL, EMBASE, Scopus, and Cochrane from inception until 28 May 2024.

SELECTION CRITERIA

Studies examining stillbirth investigations, yield, and value were included.

DATA COLLECTION AND ANALYSIS

Data were collected using a purpose-built data extraction tool and an analysis was undertaken.

RESULTS

57 potentially eligible studies were identified, and 34 studies (with 11,410 stillbirths) were included. Three studies examined clinical utility using a comprehensive testing protocol. Definition of utility or value of investigations varied across the studies, classification system for cause of death and investigation protocols varied. Placental pathology was reported as the most useful investigation in 65%-96% of cases, identified a cause of death in 61-71% of cases and impacting the medical management in 36% of cases (13 studies, 5,169 stillbirths). Autopsy can identify the cause of death in 36-77% of cases and provided new information in 17-26% of cases (17 studies, 4,336 stillbirths). Genetic analysis was useful in 29% of cases (seven studies, 1,886 stillbirths). One study (512 stillbirths) examined the value of investigation by presenting clinical scenario.

CONCLUSIONS

This review indicates that Investigation protocols for stillbirth should include placental pathology, autopsy, and genetic testing. Future studies should address the value of tests by presenting clinical scenarios, use of a consistent definition of stillbirth, classification system and measurement of investigation value.

Exploring the Implementation of Workplace-Focused Primary Prevention Efforts to Reduce Family Violence in a Regional City: The Need for Clarity, Capacity, and Communication

In response to the high burden of family and domestic violence (FDV), The Australian National Plan to End Violence Against Women and Children has established that primary prevention measures are necessary to reduce FDV's harmful impacts on health. The Community, Respect, and Equality (CRE) project is a primary prevention initiative aimed towards changing harmful social norms and practices that enable FDV in Geraldton, Western Australia. Organizations affiliated with the CRE are required to promote gender equality and a respectful work environment. However, there is a gap in the literature regarding the impact and effectiveness of such interventions, especially in rural/regional areas. As such, this study served to evaluate the project's effectiveness in a CRE-certified workspace, a local non-profit social services provider. Investigators conducted interviews to learn how the organization had implemented the CRE, and whether the CRE had had an impact on social norms and practices within the work environment. Findings indicated that the project had largely failed to permeate workplace culture due to a lack of effective promotion, low perceived benefits, and low resources. Future interventions must take persuasive measures, even for organizations perceived to be receptive to change.

Barriers and enablers of dementia training in healthcare workers in rural and remote Australia: A scoping review to inform future approaches to training

INTRODUCTION

Dementia is now responsible for the greatest burden of disease of any chronic illness in older Australians. Rural and remote communities bear the impacts of this disproportionately. Additional training and education for healthcare staff to support people living with dementia is needed.

OBJECTIVE

The objective of this scoping review was to map and synthesise the evidence related to barriers and enablers of accessing dementia training for Australian healthcare workers located in rural and remote areas.

DESIGN

This scoping review systematically searched multiple databases in January 2023 for peer-reviewed literature on the topic. Reviewers used Covidence to screen titles and abstracts of located sources, and to screen full-text articles.

FINDINGS

From 187 articles screened, seven peer-reviewed journal articles were included in the final data analysis; all were from Australia or Canada. The most common barrier described was low staffing, precluding release of staff for dementia training. Enablers to participation in dementia training were availability of online training programs, as well as training providers collaborating with end users to ensure the training met their learning needs.

DISCUSSION

This review provides evidence of barriers and enablers specific to rural and remote healthcare workers accessing dementia training. It also explores other approaches to training that have been trialled successfully in different settings.

CONCLUSION

Addressing the identified barriers and enablers may assist in developing training approaches appropriate for existing staff, and in meeting training needs for the future workforce.