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Preparing for obstetric anaesthesia - an educational randomised controlled trial comparing e-learning to written course material
Andersson ML, Duch P, Bessmann EL, Lundstrøm LH, Ekelund K
Acta anaesthesiologica Scandinavica. 2022
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Abstract
BACKGROUND E-learning is increasingly used in postgraduate medical education. Its numerous benefits include an enhanced learning experience through learning style individualisation, interactive elements, and assessment through tests and quizzes. Current meta-analyses conclude that the overall effectiveness of e-learning is comparable to traditional teaching modalities. However, studies demonstrating its benefits are heterogeneous and of varying quality. This randomised controlled trial aims to investigate whether contemporary e-learning completed prior to a course in obstetric anaesthesia prepares the course participants better than self-study of written course material. METHODS A randomised controlled trial allocated second-year resident anaesthetists to receive either e-learning in postpartum haemorrhage and written course material in preeclampsia or e-learning in preeclampsia and written course material in postpartum haemorrhage, prior to a compulsory course in obstetric anaesthesia. The primary outcome was knowledge after completion of e-learning before the course, assessed by type X multiple-choice questions with a score ranging from zero to 35. The secondary outcomes were anxiety level before course simulations, performance during course simulations, and knowledge four and 12 weeks after the course. RESULTS The per protocol analysis of the primary outcome included 45 participants and demonstrated a mean difference of 1.8 (95% CI 0.7 to 2.9; p=0.002) in knowledge after completion of e-learning before the course, in favour of e-learning compared to written course material. There were no statistically significant differences in the secondary outcomes. CONCLUSION This blinded parallel group randomised controlled trial found a numerically small but statistically significant difference in knowledge favouring e-learning over written course material.
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Improving the recognition and management of hemorrhage: A scoping review of nursing and midwifery education
Lavoie, P., Lapierre, A., Maheu-Cadotte, M. A., Rodriguez, D., Lavallée, A., Mailhot, T.
Nurse Education Today. 2022;113:105361
Abstract
BACKGROUND Hemorrhage is a frequent complication that nurses and midwives must recognize and manage to avoid life-threatening consequences for patients. There is currently no synthesis of evidence on educational interventions in nursing and midwifery regarding hemorrhage, thus limiting the definition of best practices. OBJECTIVE To map the literature on nursing and midwifery education regarding the recognition and management of hemorrhage. DESIGN Scoping review based on the Joanna Briggs Institute guidelines. DATA SOURCES Quantitative studies evaluating the effect of educational interventions with students, nurses, or midwives published in English or French, with no time limit. REVIEW METHODS Study selection, data extraction, and quality assessment were conducted by two independent reviewers. We characterized educational interventions based on the Guideline for Reporting Evidence-Based Practice Educational Interventions and Teaching. We categorized learning outcomes using the New World Kirkpatrick Model. Methodological quality appraisal was performed with tools from the Joanna Briggs Institute. Findings were synthesized using descriptive statistics and graphical methods RESULT Most of the 38 studies used a single-group design (n = 26, 68%) and were conducted with professionals (n = 28, 74%) in hospital settings (n = 20, 53%). Most were of low (n = 14; 37%) or moderate (n = 18, 47%) methodological quality. Most interventions focused on postpartum hemorrhage (n = 34, 89%) and combined two or more teaching strategies (n = 25, 66%), often pairing an informational segment (e.g., lecture, readings) with a practical session (e.g., workshop, simulation). Learning outcomes related to the management (n = 27; 71%) and recognition of hemorrhage (n = 19, 50%), as well as results for patients and organizations (n = 9, 24%). CONCLUSION Considerable heterogeneity in interventions and learning outcomes precluded conducting a systematic review of effectiveness. High-quality, controlled studies are needed, particularly in surgery and trauma. Reflection on the contribution of nurses and midwives to the detection, monitoring, and management of hemorrhage could enrich the content and expected outcomes of hemorrhage education.
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Comparative satisfaction and effectiveness of virtual simulation and usual supervised work for postpartum hemorrhage management: a crossover randomized controlled trial
Voillequin S, Rozenberg P, Letutour K, Rousseau A
BMC medical education. 2022;22(1):709
Abstract
BACKGROUND Because virtual simulation promotes learning and cognitive skill development, it may be useful for teaching students to manage postpartum hemorrhage (PPH) and its complex decision algorithm. OBJECTIVE This study aimed to compare the satisfaction and effectiveness of virtual simulation with usual supervised work in producing knowledge and satisfaction. METHODS This two-center two-stage crossover randomized controlled trial included student midwives. One group underwent the virtual simulation intervention in the first period (January 2018) and the usual supervised classroom work in the second (May 2018); the other group followed the reverse chronology. Satisfaction was the primary outcome. The secondary outcome was knowledge of the PPH management algorithm, assessed by responses to a case vignette after each intervention session. RESULTS The virtual simulation -supervised work (VS-SW) chronology was allocated to 48 students, and its inverse (SW-VS) to 47; Satisfaction was significantly higher for the virtual simulation for its overall grade (6.8 vs. 6.1, P = 0.009), engagingness (very good 82.1% vs. 24.3%, P < 0.001), and ease of use (very good 77.9% vs. 46.1%, P < 0.001). Knowledge did not differ between the two groups (respectively, 89.5% versus 83.5%, P = 0.3). CONCLUSION Satisfaction is higher with virtual simulation without lowering knowledge scores, which argues for the use of such innovative teaching strategies. This could lead to an increase in students' motivation to learn.
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What matters to women and healthcare providers in relation to interventions for the prevention of postpartum haemorrhage: A qualitative systematic review
Finlayson K, Downe S, Vogel JP, Oladapo OT
PloS one. 2019;14(5):e0215919
Abstract
BACKGROUND Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity. Reducing deaths from PPH is a global challenge. The voices of women and healthcare providers have been missing from the debate around best practices for PPH prevention. The aim of this review was to identify, appraise and synthesize available evidence about the views and experiences of women and healthcare providers on interventions to prevent PPH. METHODS We searched eight electronic databases and reference lists of eligible studies published between 1996 and 2018, reporting qualitative data on views and experiences of PPH in general, and of any specific preventative intervention(s). Authors' findings were extracted and synthesised using meta-ethnographic techniques. Confidence in the quality, coherence, relevance and adequacy of data underpinning the resulting themes was assessed using GRADE-CERQual. A line of argument synthesis was developed. RESULTS Thirty-five studies from 29 countries met our inclusion criteria. Our results indicate that women and healthcare providers recognise the dangers of severe blood loss in the perinatal and postpartum period, but don't always share the same beliefs about the causes and consequences of PPH. Skilled birth attendants and traditional birth attendants (TBA's) want to prevent PPH but may lack the required resources and training. Women generally appreciate PPH prevention strategies, especially where their individual needs, beliefs and values are taken into account. Women and healthcare providers also recognize the value of using uterotonics (medications that contract the uterus) to prevent PPH but highlight safety concerns and potential misuse of the drugs as acceptability and implementation issues. CONCLUSIONS Based on stakeholder views and experiences, PPH prevention strategies are more likely to be successful where all stakeholders agree on the causes and consequences of severe postpartum blood loss, especially in the context of sufficient resources and effective implementation by competent, suitably trained providers.
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Benefits of Screen-Based Postpartum Hemorrhage Simulation on Nontechnical Skills Training: A Randomized Simulation Study
Michelet D, Barre J, Job A, Truchot J, Cabon P, Delgoulet C, Tesniere A
Simulation in healthcare : journal of the Society for Simulation in Healthcare. 2019;14(6):391-397
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is the leading cause of maternal death in the world. Nontechnical skills (NTS), such as communication and teamwork, are critical for efficient management of this obstetric emergency. Specific scenarios were designed on a screen-based simulator to train NTS. This study aimed to evaluate the impact of training midwives for NTS with a PPH screen-based simulation. METHODS A total of 24 midwives participated in the study. They were randomized in 2 groups: the NTS group (n = 12) performed 3 screen-based scenarios designed to train NTS and the control group (n = 12) performed 3 basic scenarios of the screen-based simulation without the NTS training. A structured interview followed the simulation. On the same day, each trainee underwent individually an evaluation on a PPH high-fidelity simulation scenario. Three experts, blinded to the study arm, assessed the NTS with the Anesthetists Non-Technical Skills (ANTS) score. RESULTS Midwives from the NTS group achieved higher median scores in each dimension of the ANTS score: task management (4 vs. 2/4, P < 0.0001), team working (4 vs. 2/4, P < 0.0001), situation awareness (4 vs. 2.7/4, P < 0.0001), and decision-making (4 vs. 2/4, P < 0.0001). The median value of the total ANTS score was higher in the NTS group than in the control group (15.5 vs. 8/16, P < 0.0001). CONCLUSIONS Our study highlights that training with a NTS screen-based simulation, with specific scenarios and debriefing, leads to higher midwives' nontechnical skills performance during simulated postpartum hemorrhage.
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The effect of speed and precaution technique on postpartum bleeding among midwifery students in the clinical field
Mohamadirizi S, Noroozi M, Mohamadirizi S
Journal of education and health promotion. 2019;8:72
Abstract
BACKGROUND Cooperative teaching methods have been used widely in medical education. The aim of this study was to determine the effect of theater in the clinical stage on postpartum hemorrhage management among midwifery student. MATERIALS AND METHODS This was an experimental study, performed in 2016 among midwifery students in Isfahan University of Medical Sciences and selected through the random sampling method. Satisfaction questionnaire and clinical practice checklist were completed by both groups before and after the education. The collected data were analyzed using independent t-test and paired test. The significant level was considered statistically <0.05. RESULTS The findings of independent t-test did not show any significant difference between satisfaction and clinical practice scores of theater and control group before intervention while a statistically significant difference was observed in after intervention between the scores of two groups (P = 0.001). Paired t-test showed a statistically significant difference in satisfaction and clinical practice score in two groups after intervention theater and control group, respectively (P = 0.002, P = 0.002). CONCLUSION Theater method in postpartum hemorrhage can be increased satisfaction and clinical practice levels in midwifery students. Hence, the conduction of this educational model is recommended as an effective learning.
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Effect of the competency-based Helping Mothers Survive Bleeding after Birth (HMS BAB) training on maternal morbidity: a cluster-randomised trial in 20 districts in Tanzania
Alwy Al-Beity F, Pembe A, Hirose A, Morris J, Leshabari S, Marrone G, Hanson C
BMJ global health. 2019;4(2):e001214
Abstract
Background: Training health providers is an important strategy to improve health. We conducted a cluster-randomised two-arm trial in Tanzania to assess the effect of a 1-day competency-based training 'Helping Mothers Survive Bleeding after Birth (HMS BAB)' followed by eight weekly drills on postpartum haemorrhage (PPH)-related morbidity and mortality. Methods: Twenty districts in four purposefully selected regions in Tanzania included 61 facilities. The districts were randomly allocated using matched pairs to ensure similarity in terms of district health services in intervention and comparison districts. In the 10 intervention districts 331 health providers received the HMS BAB training. The other half continued with standard practices. We used the WHO's near miss tool to collect information on severe morbidity (near misses) of all women admitted to study facilities. We performed interrupted time series analysis to estimate differences in the change of near miss per delivery rate and case fatality rates. We also assessed implementation of evidence-based preventive and basic management practices for PPH as secondary outcomes. Results: We included 120 533 facility deliveries, 6503 near misses and 202 maternal deaths in study districts during study period (November 2014 to January 2017). A significant reduction of PPH near misses was found among women who suffered PPH in the intervention district compared with comparison districts (difference-in-differences of slopes -5.3, 95% CI -7.8 to -2.7, p<0.001) from a baseline PPH-related near miss rate of 71% (95% CI 60% to 80%). There was a significant decrease in the long-term PPH near miss case fatality (difference-in-differences of slopes -4 to 0) (95% CI -6.5 to -1.5, p<0.01) in intervention compared with the comparison districts. The intervention had a positive effect on the proportion of PPH cases treated with intravenous oxytocin (difference-in-differences of slopes 5.2, 95% CI 1.4 to 8.9) (p <0.01). Conclusion: The positive effect of the training intervention on PPH morbidity and case fatality suggests that the training addresses important deficits in knowledge and skills. Trial registration number: PACTR201604001582128.
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Peer-assisted learning after onsite, low-dose, high-frequency training and practice on simulators to prevent and treat postpartum hemorrhage and neonatal asphyxia: A pragmatic trial in 12 districts in Uganda
Evans CL, Bazant E, Atukunda I, Williams E, Niermeyer S, Hiner C, Zahn R, Namugerwa R, Mbonye A, Mohan D
PloS one. 2018;13((12):):e0207909.
Abstract
An urgent need exists to improve and maintain intrapartum skills of providers in sub-Saharan Africa. Peer-assisted learning may address this need, but few rigorous evaluations have been conducted in real-world settings. A pragmatic, cluster-randomized trial in 12 Ugandan districts provided facility-based, team training for prevention and management of postpartum hemorrhage and birth asphyxia at 125 facilities. Three approaches to facilitating simulation-based, peer assisted learning were compared. The primary outcome was the proportion of births with uterotonic given within one minute of birth. Outcomes were evaluated using observation of birth and supplemented by skills assessments and service delivery data. Individual and composite variables were compared across groups, using generalized linear models. Overall, 107, 195, and 199 providers were observed at three time points during 1,716 births across 44 facilities. Uterotonic coverage within one minute increased from: full group: 8% (CI 4%12%) to 50% (CI 42%59%); partial group: 19% (CI 9%30%) to 42% (CI 31%53%); and control group: 11% (5%7%) to 51% (40%61%). Observed care of mother and newborn improved in all groups. Simulated skills maintenance for postpartum hemorrhage prophylaxis remained high across groups 7 to 8 months after the intervention. Simulated skills for newborn bag-and-mask ventilation remained high only in the full group. For all groups combined, incidence of postpartum hemorrhage and retained placenta declined 17% and 47%, respectively, from during the intervention period compared to the 69 month period after the intervention. Fresh stillbirths and newborn deaths before discharge decreased by 34% and 62%, respectively, from baseline to after completion, and remained reduced 69 months post-implementation. Significant improvements in uterotonic coverage remained across groups 6 months after the intervention. Findings suggest that while short, simulation-based training at the facility improves care and is feasible, more complex clinical skills used infrequently such as newborn resuscitation may require more practice to maintain skills. Trial Registration: ClinicalTrials.gov NCT03254628.
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Improving non-technical skills (teamwork) in post-partum haemorrhage: a grouped randomised trial
Letchworth PM, Duffy SP, Phillips D
European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2017;217:154-160.
Abstract
OBJECTIVE To determine the effect of a decision support technology on teamwork and associated non-technical (NTS) and technical skills when teams manage post-partum haemorrhage (PPH) in the simulated environment. METHODS Multidisciplinary (MDT) maternity teams were taught how to manage post partum haemorrhage. They were randomised to the intervention: using a decision support mobile digital platform or a control group. Each team managed a post-partum simulation, which was recorded and reviewed by assessors. Primary outcome measures to assess teams NTS were the validated Global Assessment of Obstetric Team Performance (GAOTP) and Clinical Teamwork Scale (CTS). Secondary outcome measures were the 'friends and family test', technical skills, and the System Usability Scale (SUS). Sample size estimation was calculated by using 80% power 5% significance two tailed test (p1=85% p2=40%) n=34. RESULTS 38 teams from August 2014-February 2016, were recruited, technical issues with failure of recording equipment meant 4 teams were excluded from teamwork analysis (1 intervention 3 control). Teamwork improved across all domains with the intervention (using a decision support mobile digital platform) p <0.01. CTS improved between 6.7-16.8% (average 14.2%) and GAOTP between 8.6-17.1% (average 13.5%) for all domains. Using the control group as baseline, the intervention improved teamwork by 25% using CTS and 22% using GAOTP. Fewer technical skills were missed with the intervention (p<0.01). There was no statistical difference in the time technical skills were achieved. Assessors were more likely to recommend intervention teams 87.5% (77/88) than control teams 63.6% (56/88) p<0.01 to their friends or family. The SUS was 'Good' (69) becoming excellently 'Usable' (81.6) over the study period. CONCLUSION We report a decision support system, which improved NTS when managing PPH. Lack of teamwork is often cited as the cause of failures in care and we report a usable technology that assists with and improves teamwork during an emergency.
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Simulation training program for midwives to manage postpartum hemorrhage: a randomized controlled trial
Kato C, Kataoka Y
Nurse Education Today. 2017;51:88-95.
Abstract
PURPOSE To explore the effectiveness of a simulation training program for midwives in performance and knowledge for the management of postpartum hemorrhage (PPH). METHODS The study design was a randomized controlled trial. Midwives working at one obstetrics ward in an urban area were randomly assigned to simulation training program or no training. This "simulation program" included pre study e-learning and simulation. Inclusion criteria were midwives who: 1) had two or three years of clinical experience, 2) worked in an obstetrics ward, and 3) had experience with birth assistance. There was one exclusion criterion namely prior experience of simulation training for PPH. Change in performance was evaluated using a PPH scenario performance test at one month after the simulation training. Change in knowledge was evaluated by a 25-item multiple-choice questionnaire completed shortly before the training and one month after the training. The ethical review committee of St Luke's International University granted approval (No. 14-096). RESULTS Eighty-one midwives were randomly assigned to either the intervention group (n=40) or the control group (n=41). Performance in the simulation training group was significantly better in comparison to the no training group; mean performance score was 23.85(SD 2.71) in the training group versus 18.00(SD 3.01) in the no training group (MD 5.85 95% CI 4.85-7.12, t=9.17, p<0.001). Knowledge was significantly increased in the simulation training group; amount of knowledge score was 3.65(SD 3.40) in the training group versus -0.02(SD 3.02) in the no training group (MD 3.67 95% CI 2.25-5.10, t=5.14, p<0.001). CONCLUSION Both performance and knowledge about the management of PPH were significantly improved after simulation training. However, assessments of long-term effects on performance, and knowledge and the clinical outcomes in managing of obstetric complications are necessary to adequately evaluate the effectiveness of simulation training.