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BMC Health Services Research May 2002We aim to establish the evidence base for the recognition and management of obstetric anal sphincter injury (OASI) and to compare this with current practice amongst UK... (Review)
Review
BACKGROUND
We aim to establish the evidence base for the recognition and management of obstetric anal sphincter injury (OASI) and to compare this with current practice amongst UK obstetricians and coloproctologists.
METHODS
A systematic review of the literature and a postal questionnaire survey of consultant obstetricians, trainee obstetricians and consultant coloproctologists was carried out.
RESULTS
We found a wide variation in experience of repairing acute anal sphincter injury. The group with largest experience were consultant obstetricians (46.5% undertaking > or = 5 repairs/year), whilst only 10% of responding colorectal surgeons had similar levels of experience (p < 0.001). There was extensive misunderstanding in terms of the definition of obstetric anal sphincter injuries. Overall, trainees had a greater knowledge of the correct classification (p < 0.01). Observational studies suggest that a new 'overlap' repair using PDS sutures with antibiotic cover gives better functional results. However, our literature search found only one randomised controlled trial (RCT) on the technique of repair of OASI, which showed no difference in incidence of anal incontinence at three months. Despite this, there was a wide variation in practice, with 337(50%) consultants, 82 (55%) trainees and 80 (89%) coloproctologists already using the 'overlap' method for repair of a torn EAS (p < 0.001). Although over 50% of colorectal surgeons would undertake long-term follow-up of their patients, this was the practice of less than 10% of obstetricians (p < 0.001). Whilst over 70% of coloproctologists would recommend an elective caesarean section in a subsequent pregnancy, only 22% of obstetric consultants and 14% of trainees (p < 0.001).
CONCLUSION
An agreed classification of OASI, development of national guidelines, formalised training, multidisciplinary management and further definitive research is strongly recommended.
Topics: Anal Canal; Clinical Competence; Colorectal Surgery; Continuity of Patient Care; Delivery, Obstetric; Fecal Incontinence; Female; Humans; Obstetric Labor Complications; Obstetrics; Patient Care Management; Practice Patterns, Physicians'; Pregnancy; Randomized Controlled Trials as Topic; Rupture; Treatment Outcome; United Kingdom
PubMed: 12006105
DOI: 10.1186/1472-6963-2-9 -
BMC Pregnancy and Childbirth Mar 2017Regular monitoring and assessment of performance indicators for emergency obstetric and newborn care can help to identify priorities to improve health services for women...
BACKGROUND
Regular monitoring and assessment of performance indicators for emergency obstetric and newborn care can help to identify priorities to improve health services for women and newborns. The aim of this study was to perform a district wide assessment of emergency obstetric and newborn care performance and identify ways for improvement.
METHODS
Facility assessment of 13 dispensaries, four health centers and one district hospital in a rural district in Tanzania was performed in two data collection periods in 2014. Assessment included a facility walk-through to observe facility infrastructure and interviews with facility in-charges to assess available services, staff and supplies. In addition facility statistics were collected for the year 2013. Results were discussed with district representatives.
RESULTS
Approximately 65% of expected births took place in health facilities and 22% of women with complications were treated in facilities expected to provide emergency care. None of the facilities was, however, able to perform at the expected level for emergency obstetric and newborn care since not all required signal functions could be provided. Inadequate availability of essential drugs such as uterotonics, antibiotics and anticonvulsants as well as lack of ability to perform vacuum extraction and blood transfusion limited performance.
CONCLUSIONS
Performance of emergency obstetric and newborn care in Magu District was not in accordance with expected guidelines and highly influenced by lack of available resources and an insufficiently functioning health care system. Improving assessment approaches, to look beyond the signal functions, can capture weaknesses in the system and will help to understand poor performance and identify locally applicable ways for improvement.
Topics: Adult; Delivery, Obstetric; Emergency Medical Services; Female; Hospitals, District; Humans; Infant, Newborn; Obstetrics; Perinatal Care; Pregnancy; Quality Indicators, Health Care; Tanzania
PubMed: 28320332
DOI: 10.1186/s12884-017-1282-z -
Ultrasound in Obstetrics & Gynecology :... Apr 2014To explore the association between clinical training characteristics and trainees' level of confidence in performing ultrasound scans independently. (Review)
Review
OBJECTIVE
To explore the association between clinical training characteristics and trainees' level of confidence in performing ultrasound scans independently.
METHODS
A cross-sectional e-survey was distributed to members of the national societies of junior obstetricians/gynecologists in Denmark, Sweden and Norway (n = 973). Multiple linear regression models were used to explore the effect that amount of time spent in specialized ultrasound units and clinical experience had on trainees' confidence in performing ultrasonography independently. Exploratory factor analysis was used to identify factors that contributed to trainees' confidence in performing ultrasonography. Trainees' ultrasound confidence was finally compared with their expected levels of performance.
RESULTS
Of the 682 respondents (response rate 70.1%), 621 met the inclusion criteria. Clinical experience and time spent in specialized ultrasound units were predictors of trainees' confidence in performing ultrasonography independently (P < 0.001). Trainees required more than 24 months of clinical experience and 12-24 days of training in specialized ultrasound units in order to feel confident about performing transvaginal and transabdominal ultrasound scans independently. Three factors were related to ultrasound confidence: technical aspects, image perception and integration of scan into patient care. There were significant differences between trainees' level of confidence and their expected levels of performance (P < 0.001).
CONCLUSIONS
Clinical experience and time spent in specialized ultrasound units were predictors of trainees' confidence in performing ultrasonography independently. Discrepancies between trainees' confidence and their expected levels of performance raised concerns about the adequacy of current ultrasound training programs.
Topics: Adult; Attitude of Health Personnel; Clinical Competence; Cross-Sectional Studies; Denmark; Education, Medical, Continuing; Education, Medical, Graduate; Female; Gynecology; Humans; Male; Middle Aged; Norway; Obstetrics; Pregnancy; Surveys and Questionnaires; Sweden; Ultrasonics
PubMed: 24105723
DOI: 10.1002/uog.13211 -
Acta Obstetricia Et Gynecologica... 2006C-reactive protein is an acute phase protein widely used as an indicator of infectious or inflammatory conditions. Traditionally it has been used as an adjunctive test... (Review)
Review
C-reactive protein is an acute phase protein widely used as an indicator of infectious or inflammatory conditions. Traditionally it has been used as an adjunctive test for inflammation and as a marker of disease activity. Though sensitive, its nonspecific nature imposes limitation on its clinical use. Currently C-reactive protein is used in the management of chorioamnionitis, preterm premature rupture of membranes, pelvic inflammatory disease, and urinary tract infection. Interestingly, several obstetric conditions such as pre-eclampsia and gestational diabetes are now known to have an underlying inflammatory basis and there is an emerging role of C-reactive protein testing in managing these diseases. Additionally C-reactive protein testing has an established place in management of several acute abdominal conditions. The aim of this paper is to review the place of C-reactive protein in modern obstetric and gynecological practice.
Topics: Biomarkers; C-Reactive Protein; Diagnosis, Differential; Female; Female Urogenital Diseases; Gynecology; Humans; Inflammation; Obstetrics; Pregnancy; Pregnancy Complications
PubMed: 16639846
DOI: 10.1080/00016340500432614 -
Journal of Graduate Medical Education Feb 2020Medical podcasts have the potential to educate residents and fellows in specialized or uncommon disciplines, but the acceptability and benefits of educational podcasts... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Medical podcasts have the potential to educate residents and fellows in specialized or uncommon disciplines, but the acceptability and benefits of educational podcasts are unclear.
OBJECTIVE
We compared knowledge acquisition and engagement of audio-only (podcast) versus written curricular formats and assessed podcast feasibility and uptake for teaching obstetrical neurology to residents and fellows.
METHODS
Key concepts in obstetrical neurology were developed into parallel case-based modules: written reviews and podcasts interwove patient and expert voices with narration. In 2017, we tested this curriculum among 60 volunteer residents and fellows in obstetrics and gynecology, neurology, emergency medicine, internal medicine, and family medicine training programs at a single institution. Participants took content-based pretests, were randomized, and then completed written (n = 32) or podcast (n = 28) modules, and finally, completed posttests and feedback questionnaires.
RESULTS
Among all participants, there was an increase in immediate posttest scores compared with pretest scores (46 of 60, 77% ± 17% pretest versus 56 of 60, 93% ± 10% posttest, < .05), with participants in the podcast and written groups performing equally well. However, listeners rated the podcasts somewhat higher than written materials in the areas of maintaining interest, enjoyability, entertaining, and desire for wider use.
CONCLUSIONS
Written and podcast curricula improved immediate knowledge similarly, but the narrative-style podcasts were perceived as more enjoyable by residents and fellows from several specialties, suggesting narrative podcasting can be an engaging and feasible educational alternative for trainees to acquire information.
Topics: Clinical Competence; Curriculum; Humans; Internship and Residency; Narration; Neurology; Obstetrics; Rhode Island; Surveys and Questionnaires; Webcasts as Topic
PubMed: 32089798
DOI: 10.4300/JGME-D-19-00505.1 -
Health Policy and Planning May 2019Providing quality emergency obstetric care (EmOC) reduces the risk of maternal and newborn mortality and morbidity. There is evidence that over 50% of maternal health...
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.
Topics: Competency-Based Education; Delivery, Obstetric; Emergency Medicine; Female; Health Personnel; Humans; Infant, Newborn; Obstetrics; Pregnancy; Program Evaluation
PubMed: 31056670
DOI: 10.1093/heapol/czz028 -
British Medical Journal Dec 1960
Topics: Equipment and Supplies; Female; Obstetrics; Pregnancy
PubMed: 13772714
DOI: 10.1136/bmj.2.5215.1804 -
Archives of Gynecology and Obstetrics Sep 2017Work-related musculoskeletal injuries (WRMSI) have been well known amongst obstetrics and gynaecology (O&G) practitioners, but limited data have been reported. Our aim...
PURPOSE
Work-related musculoskeletal injuries (WRMSI) have been well known amongst obstetrics and gynaecology (O&G) practitioners, but limited data have been reported. Our aim is to determine the prevalence, severity and characteristics of WRMSI amongst O&G trainees.
METHODS
A musculoskeletal ergonomic survey was conducted amongst the O&G trainees in the East-Midlands region of United Kingdom (UK). The survey comprised of demographic details, year of training, previous manual handling training, any work-related orthopaedic injury, the type of injury, any treatment received in addition to any sick leave incurred after the injury were also documented.
RESULTS
The response rate for the survey was 76% (59/78). The majority (22%) were senior specialist trainee, seventh year (ST7) and between 30 and 34 age groups. Approximately 90% of the trainees reported to have experienced pain in the last year. The most common site was the back, which was followed by the shoulders and the upper limbs. 63% of trainees reported injuries that were attributed to WRMSI. One in ten of the trainees needed time off work due to injury. A total of 20 days were lost in the last 12 months as a result of pain or discomfort attributed to obstetric work.
CONCLUSIONS
Our results demonstrate the prevalence of work-related injuries and its detrimental effects. Such injuries are underreported on incident reporting system. Ergonomics and WRMSI prevention in obstetrics and gynaecology is an area seldom discussed. Obstetric training sessions should incorporate ergonomic interventions. Further research is required to establish relevant aetiological factors related to WRMSI in this specialty.
Topics: Adult; Cross-Sectional Studies; Gynecology; Humans; Obstetrics; Occupational Injuries; Physicians; Prevalence; United Kingdom
PubMed: 28702699
DOI: 10.1007/s00404-017-4449-y -
International Journal of Gynaecology... May 2021To evaluate obstetrician/gynecologist and midwife perspectives and experiences with vaginal breech deliveries in Ghana.
OBJECTIVE
To evaluate obstetrician/gynecologist and midwife perspectives and experiences with vaginal breech deliveries in Ghana.
METHODS
Respondents completed a survey on their experiences, training, comfort levels, and decision making about vaginal breech deliveries. Comparisons were made across obstetricians/gynecologists and midwives. Multiple logistic regression explored predictors of comfort performing vaginal breech deliveries.
RESULTS
Respondents comprised 93 (36.5%) obstetricians/gynecologists and 162 (63.5%) midwives. Most believed that some breech fetuses should be delivered vaginally, with higher agreement from obstetricians/gynecologists than from midwives (n = 86, 97.7% versus n = 207, 80.8%, P = 0.001). Midwives were more likely to strongly agree that training was adequate for obstetricians/gynecologists (n = 65, 55.6% versus n = 8, 9.8%, P < 0.001) and midwives (n = 60, 49.6% versus n = 6, 7.4%, P < 0.001). Most (n = 192, 94%) respondents wanted more experience and/or training. Despite most providers performing only one ot five breech vaginal deliveries yearly, 77.4% (n = 199) were comfortable performing them and 79.5% (n = 202) were comfortable supervising them. Significant predictors of comfort performing vaginal breech delivery were perceived adequacy of training (odds ratio 8.74, 95% CI 3.39-22.52) and belief that vaginal breech deliveries should be performed (odds ratio 4.28, 95% CI 1.33-13.72).
CONCLUSION
Respondents were more likely to feel comfortable performing breech vaginal deliveries if they felt that their training was adequate. Vaginal breech deliveries can only be offered as safe alternatives to cesarean delivery if training and experience are maintained in low-resource settings.
Topics: Adult; Attitude of Health Personnel; Breech Presentation; Delivery, Obstetric; Female; Ghana; Humans; Infant, Newborn; Midwifery; Obstetrics; Pregnancy; Surveys and Questionnaires
PubMed: 33188705
DOI: 10.1002/ijgo.13478 -
Family Medicine May 2019The number of family physicians providing obstetric deliveries is decreasing, but high numbers of new graduates report they intend to include obstetric deliveries in...
BACKGROUND AND OBJECTIVES
The number of family physicians providing obstetric deliveries is decreasing, but high numbers of new graduates report they intend to include obstetric deliveries in their practices. The objective of this study was to understand barriers to providing obstetrical care faced by recent family medicine residency graduates who intended to provide obstetrical care at graduation.
METHODS
Email surveys were sent to graduating family medicine residents who indicated intention to include obstetrics in their practice on the American Board of Family Medicine (ABFM) Certification Examination Registration Survey (2014-2016). We used descriptive and bivariate statistics to analyze the data.
RESULTS
Of our sample of 2,098 early career family physicians, 1,016 (48.4%) responded. Seven hundred (68.9%) currently include obstetrics in their practices. Those currently including obstetrics were more likely to practice in a small rural or isolated (15.4% vs 5.2% and 4.6% vs 1.7%, P<0.001) community and report credentialing was easy (85.2% and 26.5%, respectively, P<0.001). Physicians not currently including obstetrics in their practice reported "found a job without OB" and "lifestyle concerns" as the most significant barriers. Respondents living in the Middle Atlantic and West South Central regions were least likely to provide obstetric deliveries, with fewer than 50% doing so.
CONCLUSIONS
Among recent graduates who intended to practice obstetrics, finding a job without obstetrics and lifestyle concerns were the most significant barriers to realizing the scope of practice they intended.
Topics: Adult; Career Choice; Family Practice; Female; Humans; Male; Maternal Health Services; Obstetrics; Physicians, Family; Surveys and Questionnaires; Workforce
PubMed: 30869800
DOI: 10.22454/FamMed.2019.845581