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Background: Pregnancy-related low back pain is considered an important health problem and potentially leads to long-lasting pain and disability. Investigators draw particular attention to biomedical factors but there is growing evidence that psychosocial and social factors might be important. It prompted us to start a large cohort study (n = 7526) during pregnancy until one year after delivery and a nested randomized controlled intervention study in the Netherlands. Methods: A randomized controlled trial (n = 126) nested within a cohort study, of brief self-management techniques versus usual care for treatment of women with persisting non-specific pregnancy-related low back pain three weeks after delivery. Women in the intervention group were referred to a participating physiotherapist. Women in the usual care group were free to choose physiotherapy, guidance by a general practitioner or no treatment. Follow up took place at 3 months, 6 months and one year after delivery. Outcomes included change in limitations in activities (RDQ), pain (VAS), severity of main complaints (MC), global feeling of recovery (GPE), impact on participation and autonomy (IPA), pain-related fear (TSK), SF-36, EuroQol and a cost diary. For the outcome measures, series of mixed models were considered. For the outcome variable global perceived effect (GPE) a logistic regression analysis is performed. Results: Intention-to-treat outcomes showed a statistical significant better estimated regression coefficient RDQ -1.6 {-2.9;-0.5} associated with treatment, as well as better IPA subscale autonomy in self-care -1.0 {-1.9;-0.03} and TSK -2.4 {-3.8;-1.1} but were not clinical relevant over time. Average total costs in the intervention group were much lower than in usual care, primarily due to differences in utilization of sick leave but not statistically significant. Conclusion: Brief self-management techniques applied in the first 3 months after delivery may be a more viable first-line approach but further research is needed to draw inference on costs and to determine whether no care is a better option in the long term. Trial Registration: [ISRCTN08477490] [ABSTRACT FROM AUTHOR]

Background: For the moment, scientific evaluation of programs on treatment of pregnancy-related pelvic girdle and/or low back pain after delivery is hardly available with only one study with a positive result, suggesting uncertainty about the optimal approach. Investigators draw particular attention to biomedical factors but there is growing evidence that biopsychosocial factors appear to be even more important as a basis of an intervention program. Methods: We studied the effectiveness of a tailor-made program with respect to biopsychosocial factors (intervention group) in women with pregnancy-related pelvic girdle and/ or low back pain versus usual care based on a pain contingent basis (control group) shortly after delivery in a randomized controlled trial. Women with severe complaints shortly after delivery were selected from a longitudinal prospective cohort study (n = 7526), aimed at pregnancy-related pelvic girdle and/or low back pain in the Netherlands. A concealed block randomization was performed after collecting baseline data. Researchers were blinded to treatment assignment. Outcomes were evaluated within the domains of the biopsychosocial approach. Primary outcome concerned limitations in activities (RDQ). Follow-up measurements were performed 12 weeks after delivery. Results: Since May 2001 until July 2003, 869 women out of the cohort made a request for treatment by a physiotherapist, 10 days after delivery. Because of a quick recovery in two weeks time, we included only 126 women three weeks after delivery. There was a statistically significant and clinically relevant difference in improvement on the primary outcome (RDQ) between the two groups in favor of the experimental intervention. Conclusion: The results favored the hypotheses. Women's worries about their condition were major targets in the experimental intervention. The prognosis after delivery, especially in de first weeks, turned out to be favorable. [ABSTRACT FROM AUTHOR]

Background: Absence of knowledge of pregnancy-related pelvic girdle pain (PPGP) has prompted the start of a large cohort study in the Netherlands. The objective of this study was to investigate the prevalence and incidence of PPGP, to identify risk factors involved in the onset and to determine the prognosis of pregnancy-related pelvic girdle pain. Methods/design: 7,526 pregnant women of the southeast of the Netherlands participated in a prospective cohort study. During a 2-year period, they were recruited by midwives and gynecologists at 14 weeks of pregnancy. Participants completed a questionnaire at baseline, at 30 weeks of pregnancy, at 2 weeks after delivery, at 6 months after delivery and at 1 year after delivery. The study uses extensive questionnaires with questions ranging from physical complaints, limitations in activities, restriction in participation, work situation, demographics, lifestyle, pregnancy-related factors and psychosocial factors. Discussion: This large-scale prospective cohort study will provide reliable insights in incidence, prevalence and factors related to etiology and prognosis of pregnancy-related pelvic girdle pain. [ABSTRACT FROM AUTHOR]

Background: Pregnancy-related pelvic girdle and/or low back pain is a controversial syndrome because insight in etiology and prognosis is lacking. The controversy relates to factors eliciting pain and some prognostic factors such as the interpretation of pain at the symphysis. Recent research about treatment strategies also reflects those various opinions, in fact suggesting there is professional uncertainty about the optimal approach. Currently, physiotherapists often prescribe a pain-contingent treatment regime of relative rest and avoiding several day-today activities. Additionally, treatment more often includes an exercise program to guide rectification of the muscle imbalance and alignment of the pelvic girdle. Effectiveness of those interventions is not proven and the majority of the studies are methodologically flawed. Investigators draw particular attention to biomedical factors but there is growing evidence that important prognostic issues such as biopsychosocial factors appear to be even more important as point of action in a treatment program. Methods/design: This pragmatic randomized controlled trial is designed to evaluate the effectiveness of a tailormade treatment program with respect to biopsychosocial factors in primary care. The effect of the experimental intervention and usual care are evaluated as they are applied in primary health care. The trial is embedded in a cohort study that is designed as a longitudinal, prospective study, which studies prevalence, etiology, severity and prognosis during pregnancy until one year after delivery. The present paper focuses on choices regarding recruitment procedures, in-/exclusion criteria and the development of a well-timed intervention. Discussion: This section briefly discusses the actions taken to minimize bias in the design, the proper time-window for the experimental intervention and the contrast between the experimental intervention and usual care. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about pregnancy-related pelvic girdle pain in the April 2007 issue.

Objective: One of the challenging goals of gynaecological education is preparing trainees for independent practice of surgery. Research, however, on how to acquire surgical skills in the operating room safely, effectively and efficiently is scarce. We performed this study to explore trainers' and trainees' mutual expectations concerning operative training, to identify key aspects for improving learning and teaching in the operating theatre., Study Design: We conducted a focus group study in different teaching hospitals in The Netherlands. Three focus groups were composed of gynaecology consultants representing over half of the training hospitals in The Netherlands. Four groups were composed of gynaecology trainees at different stages of training, from university and non-university hospitals and of both sexes. The interviews were recorded, transcribed verbatim and entered into qualitative data analysis software and two researchers performed a thematic analysis., Results: Teaching and learning in the operating theatre are complicated by the dynamics of trainer-trainee interaction, which are fraught with potentially conflicting interests. Trainer and trainee have to consider each other's interests, while their primary concern must be patient safety. Trainers want to feel in control and trainees want to be given a free hand within a safe atmosphere. Structuring of the teaching and learning process appears to hold the key to creating positive dynamics between trainer, trainee and their responsibility towards the patient. Structuring can be achieved before, during and after an operation. Before the operation both trainer and trainee can take the initiative to talk about learning objectives, plan of action, and task allocation. During the operation, the trainee can verbalise actions before actually performing them. This makes trainee actions predictable, enhances trainer confidence and thus may increase the trainee's chance of actually performing (a portion of) a procedure. After the operation, both trainer and trainee can initiate an evaluation the trainee's performance., Conclusion: Interaction between trainer and trainee is complicated by their shared responsibility towards the patient. Structured interactions before, during and after operations appear to offer opportunities for improving learning and teaching in the operating theatre., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

A teacher-training program for residents was designed and piloted in the St. Elisabeth Hospital in Curaçao, Netherlands Antilles. The program comprised of six modules namely: effective teaching, self-knowledge and teaching ability, feedback, assessing prior knowledge, trouble shooting and time management., Method: Instruction was provided during a two-day workshop with eight hours instruction time per day. Residents in the first three years of training participated, and the instructors were experienced clinicians. Lectures, group discussions, case simulations, video presentations and role-plays were the forms of instruction., Results: Using standardized questionnaires, the participants rated the quality of the workshop highly. They considered it to be a feasible and appropriate educational intervention and that it had a positive impact on their teaching skills., Conclusion: This workshop was developed based on careful analysis of medical residents' perceived educational needs and systematically implemented and evaluated. The results show that it is a suitable and effective educational intervention.

The growing interest in pregnancy-related low back and/or pelvic girdle pain has invoked research projects to this subject. Although it seems a modern syndrome, historical articles show that pregnancy-related pelvic girdle pain (PPGP) was already known centuries ago. The purpose of the present article is to provide a summary review of performed studies on pregnancy-related pelvic girdle pain. Remarkably, these studies show large differences in results with regard to, for example, incidence rates and relevant etiologic factors of pregnancy-related pelvic girdle pain. These differences can be explained by the use of different definitions and descriptions of pregnancy-related pelvic girdle pain between studies. In conclusion, it is necessary to search for an evidence-based overall definition of pregnancy-related pelvic girdle pain in order to provide more knowledge about incidence rates, etiologic factors and other related subjects.

Objective: Although there has been much debate on whether women should be allowed to eat and drink during labour, little scientific data are available on the effects of caloric intake on the course of labour., Design: Double-blind, randomised, placebo controlled., Setting: Leyenburg Hospital, The Hague, The Netherlands., Population: Two hundred and one consecutive nulliparous women, pregnant of a single fetus in cephalic presentation., Methods: All women were included in early labour (2cm-4cm of cervical dilatation) and were allowed to drink at will., Main Outcome Measures: The duration of labour, the need for augmentation and pain medication and the incidence of abdominal and vaginal instrumental deliveries., Results: Drinking of carbohydrate solutions was well tolerated, but did not show any beneficial effects regarding labour outcome when compared with the control group. In the carbohydrate group, a higher caesarean section rate was observed (RR 2.9, 95% CI 1.29-6.54)., Conclusions: Women in the carbohydrate group had worse labour outcome. It is unclear whether a statistical coincidence, a negative effect of the carbohydrate intake or an incorrect carbohydrate intake strategy is responsible for these results. Further studies are necessary before any definite conclusion can be drawn.

Residents play an important role in teaching and they consider teaching medical students as one of their primary responsibilities. Teaching is, however, limited due to lack of teaching skills and the time constraints involved in preparing and conducting teaching. Eighteen residents involved in teaching medical students and who took part in an initial study on teaching were interviewed on the perceived benefits of teaching and the role of residents in the teaching process. They also provided recommendations on how a training programme for residents could be created. The findings showed that enthusiasm and enjoying teaching were qualities of good teachers. Lack of time and support from attending staff were factors that contributed considerably to poor quality of teaching. There was a need for basic teaching skills and the recommendations provided included literature on teaching, training workshops, constructive evaluation and feedback and interactive sessions with experts.