681 results on '"Obstetrics organization & administration"'
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2. Leveraging In Situ Simulation for Implementation of Teleobstetric Consultation Services in Rural and Community Hospitals.
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Schoen JC, Klipfel JM, Torbenson VE, DeWitt JJ, Sadosty AT, and Theiler RN
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- Humans, Female, Pregnancy, Hospitals, Community organization & administration, Remote Consultation organization & administration, Telemedicine organization & administration, Simulation Training methods, Referral and Consultation organization & administration, Adult, Obstetrics organization & administration, Hospitals, Rural organization & administration
- Abstract
Background: Our institution implemented acute-care obstetric (OB) telemedicine (TeleOB) to address rural disparities across our health system. We sought to determine whether in situ simulations with embedded TeleOB consultation increase participants' comfort managing OB emergencies and comfort with and likelihood of using TeleOB. Methods: Rural site care teams participated in multidisciplinary in situ OB emergency simulations. Physicians in OB and neonatology at the referral center assisted via telemedicine consultation. Participants were surveyed before and after the simulations and six months later regarding their experience during the simulations. Results: Participants reported increased comfort with TeleOB activation, indications, and workflow processes, as well as increased comfort managing OB emergencies. Participants also reported significantly increased likelihood of using TeleOB in the future. Conclusions: Consistent with previous work, in situ simulation with embedded telemedicine consultations is an effective approach to facilitate telemedicine implementation and promote use by rural clinicians.
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- 2024
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3. A mixed-methods descriptive study on the role of continuous quality improvement in rural surgical and obstetrical stability: Considering enablers, challenges and impact.
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Kornelsen J, Cameron A, Stoll K, Skinner T, Humber N, Williams K, and Ebert S
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- Humans, Female, Pregnancy, Obstetrics standards, Obstetrics organization & administration, Surveys and Questionnaires, Quality Improvement, Rural Health Services standards, Rural Health Services organization & administration, Hospitals, Rural organization & administration
- Abstract
Introduction: The Rural Surgical Obstetrical Networks (RSON) initiative in BC was developed to stabilize and grow low volume rural surgical and obstetrical services. One of the wrap-around supportive interventions was funding for Continuous Quality Improvement (CQI) initiatives, done through a local provider-driven lens. This paper reviews mixed-methods findings on providers' experiences with CQI and the implications for service stability., Background: Small, rural hospitals face barriers in implementing quality improvement initiatives due primarily to lack of resource capacity and the need to prioritize clinical care when allocating limited health human resources. Given this, funding and resources for CQI were key enablers of the RSON initiative and seen as an essential part of a response to assuaging concerns of specialists at higher volume sites regarding quality in lower volume settings., Methods: Data were derived from two datasets: in-depth, qualitative interviews with rural health care providers and administrators over the course of the RSON initiative and through a survey administered at RSON sites in 2023., Findings: Qualitative findings revealed participants' perceptions of the value of CQI (including developing expanded skillsets and improved team function and culture), enablers (the organizational infrastructure for CQI projects), challenges in implementation (complications in protecting/prioritizing CQI time and difficulty with staff engagement) and the importance of local leadership. Survey findings showed high ratings for elements of team function that relate directly to CQI (team process and relationships)., Conclusion: Attention to effective mechanisms of CQI through a rural lens is essential to ensure that initiatives meet the contextual realities of low-volume sites. Instituting pathways for locally-driven quality improvement initiatives enhances team function at rural hospitals through creating opportunities for trust building and goal setting, improving communication and increasing individual and team-wide motivation to improve patient care., Competing Interests: Sean Ebert received sessional funding from the Rural Coordination Centre of BC (RCCbc) in his role as medical lead for the Quality Improvement Pillar for the Rural Surgical and Obstetrical Networks (RSON) initiative. In his capacity as medical lead he received funding to travel to the rural communities where the participants we report on in this manuscript work and provide care. Tom Skinner is employed by the Rural Coordination Centre of BC (RCCbc) as the Project Manager of the RSON Initiative. The findings reported in the survey are part of the evaluation of RSON. As an employee, his travel to the rural communities were covered because he was supporting hospital teams in implementing the PROES survey and interpreting the result. Kim Williams received salary funding from the Rural Coordination Centre of BC (RCCbc) in her capacity as administrative co-lead for the Rural Surgical and Obstetrical Networks (RSON) initiative. She received funding to travel to the rural communities where the participants whom we report on in this manuscript work and provide care. Nancy Humber received funding from the Rural Coordination Centre of BC (RCCbc) in her role as a clinical lead for the Rural Surgical Obstetrical Network. In her capacity as a clinical lead, she received funding for travel to the rural communities where the participants whom we report on in this manuscript work and provide care. All other authors are part of the RSON evaluation team at the University of British Columbia, Canada and have no conflicts of interest to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Kornelsen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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4. Virtual Obstetric Hospitalist Support for Obstetric Emergencies and Deliveries: The Mayo Clinic Experience.
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Theiler RN, Torbenson V, Schoen JC, Stegemann H, Heaton HA, Kozhimannil KB, Fang JL, and Sadosty A
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- Humans, Female, Pregnancy, Delivery, Obstetric, Adult, Emergency Service, Hospital statistics & numerical data, Emergency Service, Hospital organization & administration, Obstetrics methods, Obstetrics organization & administration, Emergencies, Hospitalists, Telemedicine organization & administration
- Abstract
Objective: To implement use of obstetric (OB) hospitalist telemedicine services (TeleOB) to support clinicians facing OB emergencies in low-resource hospital settings. Methods: TeleOB was staffed by OB hospitalists working at a tertiary maternity center. The service was available via real-time high-definition audio/video technology for providers at 17 outlying hospitals across a health system spanning two states. The initial 25 service activations are described. Results: TeleOB supported 17 deliveries, two postpartum emergency department (ED) consultations, and four antenatal ED consultations. In 10 of 17 (59%) deliveries, teleneonatology was jointly activated to support neonatal resuscitation. Sixteen (94%) deliveries occurred in multiparas, and five (29%) resulted from spontaneous preterm labor. Eighty percent (20/25) of activations occurred in facilities without maternity services. Conclusions: A TeleOB service staffed by OB hospitalists successfully supports hospitals in an integrated health care system. TeleOB is feasible for support of hospitals with no delivery facilities or with limited maternity care resources.
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- 2024
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5. Postpartum care services and multi-disciplinary collaboration in Japan.
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Suzuki S
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- Humans, Japan, Female, Pregnancy, Postpartum Period, Obstetrics organization & administration, Mothers psychology, Postnatal Care
- Abstract
The Postpartum Care Services (PCS) programme in Japan is intended to promote physical recovery and psychological rest for mothers and their children after discharge from the delivery facility, as well as nurture the mothers' own self-care skills and support healthy childrearing for mothers, children and their families. The subsidies for PCS are based on cooperation between psychiatry and obstetrics and between multiple professions, including the local government. The services should also be implemented based on the instruction to medical institutions and the local governments that they should actively screen and approach pregnant women in need of support. This narrative review describes the challenges of expanding the PCS programme nationwide in Japan., Competing Interests: Declaration of conflicting interestThe author declares that there are no conflicts of interest.
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- 2024
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6. Algorithm of management actions for the formation and implementation of a resilient health care quality system.
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Mykytenko NM
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- Humans, Delivery of Health Care standards, Delivery of Health Care organization & administration, Gynecology organization & administration, Gynecology standards, Obstetrics standards, Obstetrics organization & administration, Female, Quality of Health Care, Algorithms
- Abstract
Objective: Aim: Development of an algorithm of management actions for the formation of a resilient system of quality of medical care in health care institutions of obstetric and gynecological profile and formalization of its closed structural and logical scheme., Patients and Methods: Materials and Methods: A set of theoretical approaches of social medicine and methods of business process reengineering is used, taking into account the dominant ones: systemic and integrated approach and alarm and process approaches; the concept of resilience; quality of medical care; reproductive health care using business ecosystem methods., Results: Results: The algorithm of management actions for the formation of a resilient system of quality of medical care in obstetric and gynecological health care institutions, which is formalized in nine stages: analysis of needs and identification of problems; substantiation of performance requirements; development of a health care quality strategy; involvement of stakeholders; formation of a system of relative indicators; development of an action plan; implementation of a set of measures; monitoring and evaluation; improving the quality of health care., Conclusion: Conclusions: The results made it possible: construction of a closed structural and logical scheme of management actions, taking into account the combination of factors of influence, harmonized with the main functions of the resilient system, which determine the peculiarities of its functioning; justification of the boundaries of managerial and social responsibility of management entities according to the binary components of the medical and social justification of the process of improving the quality of medical care.
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- 2024
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7. Artificial intelligence as a new answer to old challenges in maternal-fetal medicine and obstetrics.
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Medjedovic E, Stanojevic M, Jonuzovic-Prosic S, Ribic E, Begic Z, Cerovac A, and Badnjevic A
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- Humans, Pregnancy, Female, Ultrasonography, Prenatal methods, Machine Learning, Artificial Intelligence, Obstetrics methods, Obstetrics organization & administration
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Background: Following the latest trends in the development of artificial intelligence (AI), the possibility of processing an immense amount of data has created a breakthrough in the medical field. Practitioners can now utilize AI tools to advance diagnostic protocols and improve patient care., Objective: The aim of this article is to present the importance and modalities of AI in maternal-fetal medicine and obstetrics and its usefulness in daily clinical work and decision-making process., Methods: A comprehensive literature review was performed by searching PubMed for articles published from inception up until August 2023, including the search terms "artificial intelligence in obstetrics", "maternal-fetal medicine", and "machine learning" combined through Boolean operators. In addition, references lists of identified articles were further reviewed for inclusion., Results: According to recent research, AI has demonstrated remarkable potential in improving the accuracy and timeliness of diagnoses in maternal-fetal medicine and obstetrics, e.g., advancing perinatal ultrasound technique, monitoring fetal heart rate during labor, or predicting mode of delivery. The combination of AI and obstetric ultrasound can help optimize fetal ultrasound assessment by reducing examination time and improving diagnostic accuracy while reducing physician workload., Conclusion: The integration of AI in maternal-fetal medicine and obstetrics has the potential to significantly improve patient outcomes, enhance healthcare efficiency, and individualized care plans. As technology evolves, AI algorithms are likely to become even more sophisticated. However, the successful implementation of AI in maternal-fetal medicine and obstetrics needs to address challenges related to interpretability and reliability.
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- 2024
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8. Mitigating Misogynoir: Inclusive Professionalism as a Health Equity Strategy.
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Tucker Edmonds B, Sharp S, and Walker VP
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- Female, Humans, Black or African American psychology, Black or African American statistics & numerical data, Health Status Disparities, Health Workforce organization & administration, Healthcare Disparities ethnology, Internship and Residency, Organizational Culture, Physicians, Women psychology, Professionalism, Racism prevention & control, United States, Gynecology education, Gynecology organization & administration, Health Equity organization & administration, Obstetrics education, Obstetrics organization & administration
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As Obstetrics and Gynecology begins to recognize how structural racism drives inequitable health outcomes, it must also acknowledge the effects of structural racism on its workforce and culture. Black physicians comprise ~5% of the United States physician population. Unique adversities affect Black women physicians, particularly during residency training, and contribute to the lack of equitable workforce representation. Eliminating racialized inequities in clinical care requires addressing these concerns. By applying historical context to present-day realities and harms experienced by Black women (ie, misogynoir), Obstetrics and Gynecology can identify interventions, such as equity-focused recruitment and retention strategies, that transform the profession., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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9. Inclusive, supportive and dignified maternity care (SDMC)-Development and feasibility assessment of an intervention package for public health systems: A study protocol.
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Avan BI, Hameed W, Khan B, Asim M, Saleem S, and Siddiqi S
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- Delivery, Obstetric psychology, Delivery, Obstetric standards, Feasibility Studies, Female, Government Programs organization & administration, Government Programs standards, Humans, Implementation Science, Infant, Newborn, Maternal Mortality, Obstetrics methods, Obstetrics organization & administration, Obstetrics standards, Pakistan epidemiology, Parturition psychology, Perinatal Mortality, Pregnancy, Prenatal Care organization & administration, Prenatal Care psychology, Prenatal Care standards, Psychosocial Support Systems, Public Health methods, Public Health standards, Attitude of Health Personnel, Maternal Health Services organization & administration, Maternal Health Services standards, Quality of Health Care, Respect, Social Inclusion
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Introduction: Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model exists that effectively demonstrates incorporation of these guidelines in routine facility-based maternity services. This early-phase implementation research aims to develop, implement, and test the feasibility of a service-delivery strategy to promote the culture of supportive and dignified maternity care (SDMC) at public health facilities., Methods: Guided by human-centred design approach, the implementation of this study will be divided into two phases: development of intervention, and implementing and testing feasibility. The service-delivery intervention will be co-created along with relevant stakeholders and informed by contextual evidence that is generated through formative research. It will include capacity-building of maternity teams, and the improvement of governance and accountability mechanisms within public health facilities. The technical content will be primarily based on WHO's intrapartum care guidelines and mental health Gap Action Programme (mhGAP) materials. A mixed-method, pre-post design will be used for feasibility assessment. The intervention will be implemented at six secondary-level healthcare facilities in two districts of southern Sindh, Pakistan. Data from multiple sources will be collected before, during and after the implementation of the intervention. We will assess the coverage of the intervention, challenges faced, and changes in maternity teams' understanding and attitude towards SDMC. Additionally, women's maternity experiences and psycho-social well-being-will inform the success of the intervention., Expected Outcomes: Evidence from this implementation research will enhance understanding of health systems challenges and opportunities around SDMC. A key output from this research will be the SDMC service-delivery package, comprising a comprehensive training package (on inclusive, supportive and dignified maternity care) and a field tested strategy to ensure implementation of recommended practices in routine, facility-based maternity care. Adaptation, Implementation and evaluation of SDMC package in diverse setting will be way forward. The study has been registered with clinicaltrials.gov (Registration number: NCT05146518)., Competing Interests: The authors have declared that no competing interests exist.
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- 2022
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10. An exploration of potential output measures to assess efficiency and productivity for labour and birth in Australia.
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Eklom B, Tracy S, and Callander E
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- Datasets as Topic, Female, Guidelines as Topic, Humans, Maternal Health Services organization & administration, Obstetrics organization & administration, Queensland, Efficiency, Maternal Health Services standards, Obstetrics standards, Outcome Assessment, Health Care, Patient-Centered Care standards
- Abstract
Background: In maternity services, as in other areas of healthcare, increasing emphasis is placed on improving "efficiency" or "productivity". The first step in any efficiency and productivity analysis is the selection of relevant input and output measures. Within healthcare quantifying what is produced (outputs) can be difficult. The aim of this paper is to identify a potential output measure, that can be used in an assessment of the efficiency and productivity of labour and birth in-hospital care in Australia and to assess the extent to which it reflects the principles of woman-centred care., Methods: This paper will survey available perinatal and maternal datasets in Australia to identify potential output measures; map identified output variables against the principles of woman-centred care outlined in Australia's national maternity strategy; and based on this, create a preliminary composite outcome measure for use in assessing the efficiency and productivity of Australian maternity services., Results: There are significant gaps in Australia's maternity data collections with regard to measuring how well a maternity service is performing against the values of respect, choice and access; however safety is well measured. Our proposed composite measure identified that of the 63,215 births in Queensland in 2014, 67% met the criteria of quality outlined in our composite measure., Conclusions: Adoption in Australia of the collection of woman-reported maternity outcomes would substantially strengthen Australia's national maternity data collections and provide a more holistic view of pregnancy and childbirth in Australia beyond traditional measure of maternal and neonate morbidity and mortality. Such measures to capture respect, choice and access could complement existing safety measures to inform the assessment of productivity and efficiency in maternity care., (© 2021. The Author(s).)
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- 2021
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11. Birth Volume and Geographic Distribution of US Hospitals With Obstetric Services From 2010 to 2018.
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Handley SC, Passarella M, Herrick HM, Interrante JD, Lorch SA, Kozhimannil KB, Phibbs CS, and Foglia EE
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- Adult, Cohort Studies, Female, Hospitals trends, Humans, Obstetrics statistics & numerical data, Pregnancy, Retrospective Studies, United States, Birth Rate trends, Geographic Mapping, Hospitals statistics & numerical data, Obstetrics organization & administration
- Abstract
Importance: Timely access to clinically appropriate obstetric services is critical to the provision of high-quality perinatal care., Objective: To examine the geographic distribution, proximity, and urban adjacency of US obstetric hospitals by annual birth volume., Design, Setting, and Participants: This retrospective population-based cohort study identified US hospitals with obstetric services using the American Hospital Association (AHA) Annual Survey of Hospitals and Centers for Medicare & Medicaid provider of services data from 2010 to 2018. Obstetric hospitals with 10 or more births per year were included in the study. Data analysis was performed from November 6, 2020, to April 5, 2021., Exposure: Hospital birth volume, defined by annual birth volume categories of 10 to 500, 501 to 1000, 1001 to 2000, and more than 2000 births., Main Outcomes and Measures: Outcomes assessed by birth volume category were percentage of births (from annual AHA data), number of hospitals, geographic distribution of hospitals among states, proximity between obstetric hospitals, and urban adjacency defined by urban influence codes, which classify counties by population size and adjacency to a metropolitan area., Results: The study included 26 900 hospital-years of data from 3207 distinct US hospitals with obstetric services, reflecting 34 054 951 associated births. Most infants (19 327 487 [56.8%]) were born in hospitals with more than 2000 births/y, and 2 528 259 (7.4%) were born in low-volume (10-500 births/y) hospitals. More than one-third of obstetric hospitals (37.4%; 10 064 hospital-years) were low volume. A total of 46 states had obstetric hospitals in all volume categories. Among low-volume hospitals, 18.9% (1904 hospital-years) were not within 30 miles of any other obstetric hospital and 23.9% (2400 hospital-years) were within 30 miles of a hospital with more than 2000 deliveries/y. Isolated hospitals (those without another obstetric hospital within 30 miles) were more frequently low volume, with 58.4% (1112 hospital-years) located in noncore rural areas., Conclusions and Relevance: In this cohort study, marked variations were found in birth volume, geographic distribution, proximity, and urban adjacency among US obstetric hospitals from 2010 to 2018. The findings related to geographic isolation and rural-urban distribution of low-volume obstetric hospitals suggest the need to balance proximity with volume to optimize effective referral and access to high-quality perinatal care.
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- 2021
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12. The Postpartum Hemorrhage Patient Safety Bundle Implementation at a Single Institution: Successes, Failures, and Lessons Learned.
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Duzyj CM, Boyle C, Mahoney K, Johnson AR, Ogot G, and Ayers C
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- Female, Guideline Adherence, Humans, Obstetrics organization & administration, Organizational Innovation, Patient Care Team, Patient Safety, Tertiary Care Centers, Obstetrics standards, Patient Care Bundles standards, Postpartum Hemorrhage therapy, Practice Guidelines as Topic
- Abstract
Objective: In 2015, a multidisciplinary consensus bundle of recommendations for the anticipation and management of postpartum hemorrhage was published. Our goal was to evaluate the successes and failures of our institutional bundle implementation process., Study Design: An interdisciplinary committee was created to facilitate bundle implementation. All components of the bundle were addressed with cross-disciplinary teaching between stakeholders on the obstetrics units. Tools were built in the electronic medical record to facilitate bundle components of risk stratification, quantitative blood loss calculation, and stage-based hemorrhage management. Bundle components were individually evaluated for acceptability and sustainability. Overall rates of hemorrhage and transfusion from the periods 1 year before and after bundle implementation were also evaluated., Results: Readiness bundle components were successfully implemented, although simulation drills demonstrated limited sustainability. Recognition components were mixed: risk stratification was successfully and sustainably implemented while quantitative blood loss met resistance and was ultimately discontinued as it did not clinically perform superiorly to estimated blood loss. Among response and reporting elements, patient level support and team debriefing were noted as particular deficiencies in our program., Conclusion: The postpartum hemorrhage patient safety bundle provided concrete individual elements, which overall improved the success of a stratified program implementation. Multiple deficiencies in acceptability and sustainability were uncovered during our process, particularly concerns about quantitative blood loss implementation and team communication skills., Key Points: · Supply readiness and protocol development were "quick wins.". · Culture change elements included recognition, response, and communication.. · Dedicated champions and electronic medical record tools improved sustainability.. · Poor acceptability and lack of improved outcomes led to element failure.., Competing Interests: None declared., (Thieme. All rights reserved.)
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- 2021
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13. Diabetes and Pregnancy.
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Kleinwechter H, Schäfer-Graf U, Bührer C, Hoesli I, Kainer F, Kautzky-Willer A, Pawlowski B, Schunck KU, Somville T, and Sorger M
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- Diabetes Mellitus, Type 1 therapy, Diabetes Mellitus, Type 2 therapy, Endocrinology organization & administration, Endocrinology standards, Female, Germany, Humans, Infant, Newborn, Neonatology organization & administration, Neonatology standards, Obstetrics organization & administration, Obstetrics standards, Pregnancy, Pregnancy, High-Risk physiology, Pregnancy in Diabetics therapy
- Abstract
Competing Interests: The authors declare that they have no conflict of interest.
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- 2021
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14. Scenario modelling as planning evidence to improve access to emergency obstetric care in eastern Indonesia.
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Rambu Ngana F and Eka Karyawati AAIN
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- Female, Geography, Medical, Health Planning methods, Health Planning organization & administration, Humans, Indonesia, Obstetrics standards, Pregnancy, Travel, Emergency Medical Services organization & administration, Health Services Accessibility organization & administration, Models, Organizational, Obstetrics organization & administration, Quality Improvement organization & administration
- Abstract
The rate of maternal deaths in remote areas in eastern Indonesia-where geographic conditions are difficult and the standard of infrastructure is poor-is high. Long travel times needed to reach emergency obstetric care (EMOC) is one cause of maternal death. District governments in eastern Indonesia need effective planning to improve access to EMOC. The aim of this study was to develop a scenario modelling tool to be used in planning to improve access to EMOC in eastern Indonesia. The scenario model was developed using the geographic information system tool in NetLogo. This model has two inputs: the location of the EMOC facility (PONED) and the travel cost of moving across geographical features in the rainy and dry seasons. We added a cost-benefit analysis to the model: cost is the budget for building the infrastructure; benefit is the number of people who can travel to the EMOC in less than 1 hour if the planned infrastructure is built. We introduced the tool to representative midwives from all districts of Nusa Tenggara Timur province and to staff of Kupang district planning agency. We found that the tool can model accessibility to EMOC based on weather conditions; compare alternative infrastructure planning scenarios based on cost-benefit analysis; enable users to identify and mark poor infrastructure; and model travel across the ocean. Lay people can easily use the tool through interactive scenario modelling: midwives can use it for evidence to support planning proposals to improve access to EMOC in their district; district planning agencies can use it to choose the best plan to improve access to EMOC. Scenario modelling has potential for use in evidence-based planning to improve access to EMOC in low-income and lower-middle-income countries with poor infrastructure, difficult geography conditions, limited budgets and lack of trained personnel., Competing Interests: The authors have declared that no competing interests exist.
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- 2021
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15. Implementation Science is Imperative to the Optimization of Obstetric Care.
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Hamm RF, Iriye BK, and Srinivas SK
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- Humans, Obstetrics methods, Evidence-Based Practice organization & administration, Implementation Science, Obstetrics organization & administration, Quality Improvement organization & administration
- Abstract
In an effort aimed at improving outcomes, obstetric teams have enacted comprehensive care bundles and other clinical tools. Yet, these practices have had limited degrees of success on a national scale. Implementation science aims to bridge the divide between the development of evidence-based interventions and their real-world utilization. This emerging field takes into account key stakeholders at the clinician, institution, and health policy levels. Implementation science evaluates how well an intervention is or can be delivered, to whom, in which context, and how it may be up-scaled and sustained. Other medical disciplines have embraced these concepts with success. The frameworks and theories of implementation science can and should be incorporated into both obstetric research and practice. By doing so, we can increase widespread and timely adoption of evidence and further our common goal of decreasing maternal morbidity and mortality. KEY POINTS: · Evidence-based practices have been implemented in obstetrics with variable success.. · Implementation science aims to bridge the divide between the development of evidence-based interventions and their real-world utilization.. · The methodologies of implementation science may be helpful to obstetric research and practice.., Competing Interests: None declared., (Thieme. All rights reserved.)
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- 2021
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16. Use of Telemedicine and Smart Technology in Obstetrics: Barriers and Privacy Issues.
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Eswaran H and Magann EF
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- Female, Health Insurance Portability and Accountability Act, Humans, Internet, Licensure, Pregnancy, Technology, United States, Communication Barriers, Health Services Accessibility ethics, Health Services Accessibility legislation & jurisprudence, Health Services Accessibility organization & administration, Obstetrics ethics, Obstetrics legislation & jurisprudence, Obstetrics methods, Obstetrics organization & administration, Privacy legislation & jurisprudence, Telemedicine ethics, Telemedicine legislation & jurisprudence, Telemedicine methods, Telemedicine organization & administration
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While telemedicine had been utilized in varying ways over the last several years, it has dramatically accelerated in the era of the COVID-19 pandemic. In this article we describe the privacy issues, in relation to the barriers to care for health care providers and barriers to the obstetric patient, licensing and payments for telehealth services, technological issues and language barriers. While there may be barriers to the use of telehealth services this type of care is feasible and the barriers are surmountable., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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17. Availability, utilization and quality of emergency obstetric care services in Sousse, Tunisia.
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Limam M, Hachani F, Ghardallou ME, Bachraoui M, Mellouli M, Mtiraoui A, Khairi H, Ajmi T, and Zedini C
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- Cesarean Section statistics & numerical data, Cross-Sectional Studies, Delivery, Obstetric statistics & numerical data, Emergency Medical Services standards, Female, Health Facilities standards, Health Facilities statistics & numerical data, Humans, Infant, Newborn, Maternal Health Services standards, Maternal Mortality, Obstetrics standards, Perinatal Death, Pregnancy, Tunisia, Emergency Medical Services organization & administration, Maternal Health Services organization & administration, Obstetrics organization & administration, Quality of Health Care
- Abstract
Introduction: emergency obstetric care (EmOC) is a high-impact priority intervention strongly recommended for improving maternal health outcomes. The objectives of this study were to assess the availability, utilization, and quality of emergency obstetric care services in the Governorate of Sousse (Tunisia)., Methods: a cross-sectional study was conducted among public health facilities which performed deliveries in Sousse in 2017. Data were collected by consulting clinical records and registers and interviewing staff using WHO EmOC tools. Emergency obstetric care (EmOC) indicators were calculated., Results: only the University maternity Unit functioned as full comprehensive EmOC facility. No other public facility provided all the 7 Basic EmOC signal functions 3 months prior to the survey. The unperformed signal functions were: administration of parenteral antibiotics, manual removal of placenta and assisted vaginal delivery. The number of EmOC facilities was 0.72 per 500,000 inhabitants. The met need for EmOC was 89.5%. The proportion of caesarean section was 24.2%. The direct obstetric case fatality rate was 0.159% and intrapartum and very early neonatal death rate was 0.65%., Conclusion: raising maternity facilities to a minimum level of basic EmOC status would be a major contributing step towards maternal mortality reduction., Competing Interests: The authors declare no competing interests., (Copyright: Manel Limam et al.)
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- 2021
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18. Notes from the Field: Dynamic Triaging Using Quality Improvement (QI) Methodology to Prevent the Admission of Asymptomatic COVID Positive Obstetric Patients in New Delhi, India.
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Puri M, Agrawal S, Singh A, Singh L, Aggarwal K, Nain S, Chopra K, Triveni GS, and Kapur A
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- COVID-19 diagnosis, Humans, India epidemiology, Mass Screening organization & administration, SARS-CoV-2, Tertiary Care Centers organization & administration, COVID-19 prevention & control, Communicable Disease Control organization & administration, Obstetrics organization & administration, Quality Improvement organization & administration, Triage organization & administration
- Abstract
A single undiagnosed COVID-19 positive patient admitted in the green zone has the potential to infect many Health Care Workers (HCWs) and other patients at any given time with resultant spread of infection and reduction in the available workforce. Despite the existing triaging strategy at the Obstetric unit of a tertiary hospital in New Delhi, where all COVID-19 suspects obstetric patients were tested and admitted in orange zone and non-suspects in green zone, asymptomatic COVID-19 positive patients were found admitted in the green zone. This was the trigger to undertake a quality improvement (QI) initiative to prevent the admission of asymptomatic COVID-19 positive patients in green zones. The QI project aimed at reducing the admission of COVID-19 positive patients in the green zone of the unit from 20% to 10% in 4 weeks' time starting 13/6/2020 by means of dynamic triaging. A COVID-19 action team was made and after an initial analysis of the problem multiple Plan-Do-Study-Act (PDSA) cycles were run to test the change ideas. The main change ideas were revised testing strategies and creating gray Zones for patients awaiting COVID-19 test results. The admission of unsuspected COVID-19 positive cases in the green zone of the unit reduced from 20% to 0% during the stipulated period. There was a significant reduction in the number of HCWs, posted in the green zone, being quarantined or test positive for COVID-19 infection as well. The authors conclude that Quality Improvement methods have the potential to develop effective strategies to prevent spread of the deadly Corona virus.
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- 2021
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19. Impact of the COVID-19 Pandemic on Excess Perinatal Mortality and Morbidity in Israel.
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Mor M, Kugler N, Jauniaux E, Betser M, Wiener Y, Cuckle H, and Maymon R
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- Delayed Diagnosis psychology, Delayed Diagnosis statistics & numerical data, Emergency Medical Services methods, Emergency Medical Services statistics & numerical data, Female, Humans, Infant, Newborn, Israel epidemiology, Perinatal Mortality, Pregnancy, Prenatal Care methods, Prenatal Care statistics & numerical data, Retrospective Studies, SARS-CoV-2, COVID-19 epidemiology, COVID-19 prevention & control, COVID-19 psychology, Communicable Disease Control methods, Communicable Disease Control organization & administration, Delivery, Obstetric methods, Delivery, Obstetric statistics & numerical data, Obstetrics methods, Obstetrics organization & administration, Obstetrics trends, Pregnancy Complications diagnosis, Pregnancy Complications epidemiology, Stillbirth epidemiology
- Abstract
Objective: The 2020 COVID-19 pandemic has been associated with excess mortality and morbidity in adults and teenagers over 14 years of age, but there is still limited evidence on the direct and indirect impact of the pandemic on pregnancy. We aimed to evaluate the effect of the first wave of the COVID-19 pandemic on obstetrical emergency attendance in a low-risk population and the corresponding perinatal outcomes., Study Design: This is a single center retrospective cohort study of all singleton births between February 21 and April 30. Prenatal emergency labor ward admission numbers and obstetric outcomes during the peak of the first COVID-19 pandemic of 2020 in Israel were compared with the combined corresponding periods for the years 2017 to 2019., Results: During the 2020 COVID-19 pandemic, the mean number of prenatal emergency labor ward admissions was lower, both by daily count and per woman, in comparison to the combined matching periods in 2017, 2018, and 2019 (48.6 ± 12.2 vs. 57.8 ± 14.4, p < 0.0001 and 1.74 ± 1.1 vs. 1.92 ± 1.2, p < 0.0001, respectively). A significantly ( p = 0.0370) higher rate of stillbirth was noted in the study group (0.4%) compared with the control group (0.1%). All study group patients were negative for COVID-19. Gestational age at delivery, rates of premature delivery at <28, 34, and 37 weeks, pregnancy complications, postdate delivery at >40 and 41 weeks, mode of delivery, and numbers of emergency cesarean deliveries were similar in both groups. There was no difference in the intrapartum fetal death rate between the groups., Conclusion: The COVID-19 pandemic stay-at-home policy combined with patient fear of contracting the disease in hospital could explain the associated higher rate of stillbirth. This collateral perinatal damage follows a decreased in prenatal emergency labor ward admissions during the first wave of COVID-19 in Israel., Key Points: · Less obstetrical ER attendance is observed during the pandemic.. · There is a parallel increase in stillbirth rate.. · Stillbirth cases tested negative for COVID-19.. · Lockdown and pandemic panic are possible causes.., Competing Interests: None declared., (Thieme. All rights reserved.)
- Published
- 2021
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20. Maternity services at Bedford Hospital must improve urgently, says regulator.
- Author
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Dyer C
- Subjects
- England, Hospitals standards, Humans, Obstetrics organization & administration, Obstetrics standards, Quality of Health Care
- Published
- 2021
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21. COVID-19 and its implications for obstetrics and gynecology practice in Africa.
- Author
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Oluwasola TAO and Bello OO
- Subjects
- Africa, Delivery of Health Care organization & administration, Delivery of Health Care standards, Female, Gynecology standards, Health Personnel organization & administration, Humans, Obstetrics standards, Pregnancy, Quality of Health Care, COVID-19, Gynecology organization & administration, Obstetrics organization & administration
- Abstract
Having to cope with corona virus disease 2019 (COVID-19) is likely to create imbalances in health care provision in the obstetrics and gynecology practices in Africa where most countries still battle with high rate of maternal morbidities and mortalities as well as poor or inadequate quality gynecological care. COVID-19 has spread to the continents of the world including all African nations since it was first reported in Wuhan, China in December 2019. Its impact and implications on the obstetrics and gynecology practice in Africa are yet to be fully explored. Routine essential services are being disrupted; therefore, giving rise to the need to redeploy the already limited health personnel across health services in Africa. This is an attempt to discuss the potential implications for obstetrics and gynecologic practice in Africa., Competing Interests: The authors declare no competing interests., (Copyright: Timothy Abiola Olusesan Oluwasola et al.)
- Published
- 2021
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22. National Surgical, Obstetric, and Anesthesia Plans: Bridging the Cardiac Surgery Gap.
- Author
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Vervoort D
- Subjects
- Anesthesiology organization & administration, Delivery of Health Care, Integrated legislation & jurisprudence, Government Regulation, Health Services Accessibility legislation & jurisprudence, Health Services Needs and Demand organization & administration, Heart Diseases diagnosis, Heart Diseases mortality, Humans, Needs Assessment organization & administration, Obstetrics organization & administration, Policy Making, Cardiac Surgical Procedures legislation & jurisprudence, Cardiology organization & administration, Delivery of Health Care, Integrated organization & administration, Global Health, Health Services Accessibility organization & administration, Heart Diseases surgery, National Health Programs organization & administration
- Abstract
Six billion people worldwide lack access to safe, timely, and affordable cardiac surgical care when needed, despite cardiovascular diseases remaining the world's leading cause of mortality. The large surgical backlog of rheumatic heart disease, stable and high incidence of congenital heart disease, and growing burden of ischemic heart disease around the world calls for urgent scaling of cardiovascular services beyond mere prevention. National Surgical, Obstetric, and Anesthesia Plans are being developed by countries as holistic health systems interventions to increase access to surgical care, but to date, limited to no attention has been given to the inclusion of cardiovascular care., Competing Interests: None., (Thieme. All rights reserved.)
- Published
- 2021
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23. COVID-19 does not stop obstetrics: what we need to change to go on safely birthing. The experience of a University Obstetrics and Gynecology Department in Milan.
- Author
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Alfieri N, Manodoro S, and Marconi AM
- Subjects
- COVID-19, COVID-19 Testing, Clinical Laboratory Techniques, Coronavirus Infections diagnosis, Coronavirus Infections therapy, Delivery, Obstetric methods, Female, Gynecology methods, Gynecology organization & administration, Humans, Italy epidemiology, Obstetrics methods, Pneumonia, Viral diagnosis, Pneumonia, Viral therapy, Postnatal Care methods, Pregnancy, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious prevention & control, Pregnancy Complications, Infectious virology, Prenatal Care methods, SARS-CoV-2, Betacoronavirus, Coronavirus Infections epidemiology, Hospitals, University organization & administration, Obstetrics organization & administration, Pandemics, Pneumonia, Viral epidemiology
- Abstract
Since SARS-COV-2 appeared in Wuhan City, China and rapidly spread throughout Europe, a real revolution occurred in the daily routine and in the organization of the entire health system. While non-urgent clinical services have been reduced as far as possible, all kind of specialists turned into COVID-19 specialists. Obstetric assistance cannot be suspended and, at the same time, safety must be guaranteed. In addition, as COVID-19 positive pregnant patients require additional care, some of the clinical habits need to be changed to face emerging needs for a vulnerable but unstoppable kind of patients. We report the management set up in an Obstetrics and Gynecology Unit during the COVID-19 era in a University Hospital in Milan, Italy.
- Published
- 2020
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24. Clinical pharmacy and obstetrics.
- Author
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Gnadt S
- Subjects
- Female, Humans, Pregnancy, Professional Role, Obstetrics organization & administration, Pharmacists organization & administration, Pharmacy Service, Hospital organization & administration
- Published
- 2020
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25. Building an obstetric intensive care unit during the COVID-19 pandemic at a tertiary hospital and selected maternal-fetal and delivery considerations.
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Aziz A, Ona S, Martinez RH, Ring LE, Baptiste C, Syeda S, Sheen JJ, Gyamfi-Bannerman C, D'Alton ME, Goffman D, Landau R, Valderrama NE, and Moroz L
- Subjects
- COVID-19 therapy, Facility Design and Construction, Female, Fetal Monitoring, Humans, Patient Care Team, Personnel Staffing and Scheduling, Pregnancy, Pregnancy Complications, Infectious therapy, Tertiary Care Centers, Workflow, Critical Care organization & administration, Delivery Rooms organization & administration, Intensive Care Units organization & administration, Obstetrics organization & administration, Pregnancy Complications therapy
- Abstract
During the novel Coronavirus Disease 2019 pandemic, New York City became an international epicenter for this highly infectious respiratory virus. In anticipation of the unfortunate reality of community spread and high disease burden, the Anesthesia and Obstetrics and Gynecology departments at NewYork-Presbyterian / Columbia University Irving Medical Center, an academic hospital system in Manhattan, created an Obstetric Intensive Care Unit on Labor and Delivery to defray volume from the hospital's preexisting intensive care units. Its purpose was threefold: (1) to accommodate the anticipated influx of critically ill pregnant and postpartum patients due to novel coronavirus, (2) to care for critically ill obstetric patients who would previously have been transferred to a non-obstetric intensive care unit, and (3) to continue caring for our usual census of pregnant and postpartum patients, who are novel Coronavirus negative and require a higher level of care. In this chapter, we share key operational details for the conversion of a non-intensive care space into an obstetric intensive care unit, with an emphasis on the infrastructure, personnel and workflow, as well as the goals for maternal and fetal monitoring., (Copyright © 2020. Published by Elsevier Inc.)
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- 2020
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26. Gynecologic Considerations for Adolescents and Young Women With Cardiac Conditions: ACOG Committee Opinion Summary, Number 813.
- Subjects
- Adolescent, Adult, Expert Testimony, Female, Gynecology organization & administration, Gynecology standards, Humans, Obstetrics organization & administration, Obstetrics standards, Pregnancy, Pregnancy Complications, Cardiovascular etiology, Societies, Medical, Young Adult, Contraception standards, Family Planning Services standards, Heart Defects, Congenital complications, Pregnancy Complications, Cardiovascular prevention & control
- Abstract
Congenital heart conditions are the most common type of congenital anomaly, affecting nearly 1% of U.S. births, or approximately 40,000 neonates, each year. As more female patients with congenital heart disease enter adolescence and adulthood, there is a growing need to address reproductive health in this population. Addressing contraceptive needs is particularly important for adolescents and young women with congenital heart disease, many of whom may have limited knowledge about how their condition or medications may affect their long-term health, including reproductive health. Decisions regarding the most appropriate contraceptive method require discussion of future pregnancy desires and personal preferences, as well as critical assessment of the patient's underlying disease and the relative risks and benefits of the contraceptive option. Because of the morbidity associated with pregnancy in individuals with cardiac conditions, the initiation of contraception should not be delayed due to concerns about potential contraindication. For those patients with valvular heart disease, cardiomyopathy, or hypertension, it is reasonable to initiate a progestin-only method until clarification of the safety of an estrogen-containing method is determined in conjunction with the patient's cardiologist. Contraceptive counseling should be patient-centered, free of coercion, and should address the most common misperceptions about contraceptive methods in a way that is age-appropriate and compatible with the patient's health literacy. To optimize maternal and infant health outcomes, planning for future pregnancies in these patients should be done in collaboration with maternal-fetal medicine subspecialists and cardiology specialists. Patients who continue their pregnancy should be referred to a pregnancy heart team.
- Published
- 2020
- Full Text
- View/download PDF
27. Mobilization of health professions students during the COVID-19 pandemic.
- Author
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Rupley D, Grilo SA, Kondragunta S, Amiel J, Matseoane-Peterssen D, Catallozzi M, and Westhoff CL
- Subjects
- Clinical Clerkship, Female, Humans, New York City, Patient Portals, Personal Protective Equipment supply & distribution, Pregnancy, SARS-CoV-2, Students, Medical, Students, Nursing, Students, Public Health, Telemedicine organization & administration, Telephone, COVID-19, Delivery of Health Care organization & administration, Obstetrics organization & administration, Postnatal Care organization & administration, Prenatal Care organization & administration, Students, Health Occupations, Volunteers
- Abstract
The COVID-19 pandemic has posed challenges for medical education and patient care, which were felt acutely in obstetrics due to the essential nature of pregnancy care. The mobilization of health professions students to participate in obstetric service-learning projects has allowed for continued learning and professional identify formation while also providing a motivated, available, and skilled volunteer cohort to staff important projects for obstetric patients., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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28. A multidisciplinary telemedicine model for management of coronavirus disease 2019 (COVID-19) in obstetrical patients.
- Author
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Reforma LG, Duffy C, Collier AY, Wylie BJ, Shainker SA, Golen TH, Herlihy M, Lydeard A, and Zera CA
- Subjects
- Adult, Female, Humans, Models, Organizational, Patient Care Team, Pregnancy, Quality Improvement, SARS-CoV-2 isolation & purification, Tertiary Care Centers, United States epidemiology, Ambulatory Care methods, Ambulatory Care trends, COVID-19 epidemiology, COVID-19 prevention & control, COVID-19 therapy, Infection Control methods, Infection Control organization & administration, Obstetrics organization & administration, Obstetrics trends, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious epidemiology, Pregnancy Complications, Infectious therapy, Telemedicine methods
- Abstract
Background: The COVID-19 pandemic caused by the SARS-CoV-2 has increased the demand for inpatient healthcare resources; however, approximately 80% of patients with COVID-19 have a mild clinical presentation and can be managed at home., Objective: This study aimed to describe the feasibility and clinical and process outcomes associated with a multidisciplinary telemedicine surveillance model to triage and manage obstetrical patients with known exposures and symptoms of COVID-19., Study Design: We implemented a multidisciplinary telemedicine surveillance model with obstetrical physicians and nurses to standardize ambulatory care for obstetrical patients with confirmed or suspected COVID-19 based on the symptoms or exposures at an urban academic tertiary care center with multiple hospital-affiliated and community-based practices. All pregnant or postpartum patients with COVID-19 symptoms, exposures, or hospitalization were eligible for inclusion in the program. Patients were assessed by means of regular nursing phone calls and were managed according to illness severity. Patient characteristics and clinical and process outcomes were abstracted from the electronic medical record., Results: A total of 135 patients were enrolled in the multidisciplinary telemedicine model from March 17 to April 19, 2020, of whom 130 were pregnant and 5 were recently postpartum. In this study, 116 of 135 patients (86%) were managed solely in the outpatient setting and did not require an in-person evaluation; 9 patients were ultimately admitted after ambulatory or urgent evaluations, and 10 patients were observed after hospital discharge. Although only 50% of the patients were tested secondary to limitations in ambulatory testing, 1 in 3 of those patients received positive results for SARS-CoV-2 (N=22, 16% of entire cohort). Patients were enrolled in the telemedicine model for a median of 7 days (interquartile range, 4-8) and averaged 1 phone call daily, resulting in 891 nursing calls and 20 physician calls over 1 month., Conclusion: A multidisciplinary telemedicine surveillance model for outpatient management of obstetrical patients with COVID-19 symptoms and exposures is feasible and resulted in rates of ambulatory management similar to those seen in nonpregnant patients. A centralized model for telemedicine surveillance of obstetrical patients with COVID-19 symptoms may preserve inpatient resources and prevent avoidable staff and patient exposures, particularly in centers with multiple ambulatory practice settings.
- Published
- 2020
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29. Obstetrics and gynecology emergency services during the coronavirus disease 2019 pandemic.
- Author
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Salsi G, Seidenari A, Diglio J, Bellussi F, Pilu G, and Bellussi F
- Subjects
- Adult, Disease Transmission, Infectious prevention & control, Female, Humans, Italy epidemiology, Organizational Innovation, Pregnancy, SARS-CoV-2, Triage statistics & numerical data, COVID-19 epidemiology, COVID-19 prevention & control, COVID-19 psychology, Communicable Disease Control methods, Communicable Disease Control statistics & numerical data, Emergencies epidemiology, Emergencies psychology, Emergency Medical Services methods, Emergency Medical Services statistics & numerical data, Emergency Medical Services trends, Gynecology methods, Gynecology organization & administration, Gynecology statistics & numerical data, Obstetrics methods, Obstetrics organization & administration, Obstetrics statistics & numerical data
- Published
- 2020
- Full Text
- View/download PDF
30. Contributions, Aspirations, and Challenges of Academic Specialist Divisions in Obstetrics and Gynecology.
- Author
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LaCoursiere DY, Scott JR, Chelmow D, Young AE, Sawaya GF, Delancey J, and Learman LA
- Subjects
- Academic Medical Centers, Advisory Committees, Faculty, Medical organization & administration, Female, Gynecology education, Gynecology organization & administration, Humans, Obstetrics education, Obstetrics organization & administration, Pregnancy, Societies, Medical, Faculty, Medical trends, Gynecology trends, Obstetrics trends, Specialization trends
- Abstract
Shortly after its inception, the Society for Academic Specialists in General Obstetrics and Gynecology recognized that no data described the composition and faculty activities of "academic generalist divisions." Consequently, in 2018, the Society for Academic Specialists in General Obstetrics and Gynecology appointed a presidential task force and conducted the current surveys of chairs and division directors and key informant interviews to understand the composition and faculty activities in divisions of academic specialists in departments of obstetrics and gynecology and propose criteria for excellence in each mission area to guide development of divisions. In 2014, with Society for Academic Specialists in General Obstetrics and Gynecology's guidance, these divisions were referred to as academic specialists divisions and the faculty within as academic specialists to emphasize that they provide specialized women's health care in academic settings. The divisions comprised approximately 30% of departments' full-time faculty (median 12). In 27% of the departments, these divisions contributed more than half of departmental revenue, and 49% contributed 26-50%. Nearly 90% of divisions provided a sizeable proportion of the department's total teaching efforts. Compensation relied more on clinical productivity than on seniority, quality, academic contributions, or academic rank. Subsequently, five performance domains were identified to help divisions define divisional excellence: clinical, education, research, service & advocacy, and academic environment. Furthermore, excellent divisions were characterized as those with outstanding clinicians and educators who emphasize scholarly productivity. Although academic specialists contribute significantly to their departments' financial, clinical, and educational productivity, many have limited opportunities for scholarly activity. Achieving divisional excellence likely will depend on the ability to recruit and retain faculty with career expectations that align with the division's prioritized performance domains.
- Published
- 2020
- Full Text
- View/download PDF
31. Gynecologic Considerations for Adolescents and Young Women With Cardiac Conditions: ACOG Committee Opinion, Number 813.
- Subjects
- Adolescent, Adult, Expert Testimony, Female, Gynecology organization & administration, Gynecology standards, Humans, Obstetrics organization & administration, Obstetrics standards, Pregnancy, Pregnancy Complications, Cardiovascular etiology, Societies, Medical, Young Adult, Contraception standards, Family Planning Services standards, Heart Defects, Congenital complications, Pregnancy Complications, Cardiovascular prevention & control
- Abstract
Congenital heart conditions are the most common type of congenital anomaly, affecting nearly 1% of U.S. births, or approximately 40,000 neonates, each year. As more female patients with congenital heart disease enter adolescence and adulthood, there is a growing need to address reproductive health in this population. Addressing contraceptive needs is particularly important for adolescents and young women with congenital heart disease, many of whom may have limited knowledge about how their condition or medications may affect their long-term health, including reproductive health. Decisions regarding the most appropriate contraceptive method require discussion of future pregnancy desires and personal preferences, as well as critical assessment of the patient's underlying disease and the relative risks and benefits of the contraceptive option. Because of the morbidity associated with pregnancy in individuals with cardiac conditions, the initiation of contraception should not be delayed due to concerns about potential contraindication. For those patients with valvular heart disease, cardiomyopathy, or hypertension, it is reasonable to initiate a progestin-only method until clarification of the safety of an estrogen-containing method is determined in conjunction with the patient's cardiologist. Contraceptive counseling should be patient-centered, free of coercion, and should address the most common misperceptions about contraceptive methods in a way that is age-appropriate and compatible with the patient's health literacy. To optimize maternal and infant health outcomes, planning for future pregnancies in these patients should be done in collaboration with maternal-fetal medicine subspecialists and cardiology specialists. Patients who continue their pregnancy should be referred to a pregnancy heart team.
- Published
- 2020
- Full Text
- View/download PDF
32. Brazilian doctors condemn new rules on abortion.
- Author
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Alves L
- Subjects
- Brazil epidemiology, Confidentiality, Female, Gynecology organization & administration, Health Services Accessibility trends, Humans, Obstetrics organization & administration, Physician-Patient Relations, Physicians statistics & numerical data, Pregnancy, Risk Factors, Sex Offenses psychology, Women's Health ethics, Abortion, Induced legislation & jurisprudence, Health Workforce legislation & jurisprudence, Physicians psychology, Women's Health legislation & jurisprudence
- Published
- 2020
- Full Text
- View/download PDF
33. Foreword: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know.
- Author
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Hillard PJA
- Subjects
- Adolescent, Child, Child Health Services organization & administration, Female, Humans, Pregnancy, Psychology, Public Health, Sexual Behavior physiology, Women's Health Services organization & administration, Child Abuse, Sexual prevention & control, Child Abuse, Sexual statistics & numerical data, Genital Diseases, Female epidemiology, Genital Diseases, Female therapy, Gynecology methods, Gynecology organization & administration, Gynecology trends, Obstetrics methods, Obstetrics organization & administration, Obstetrics trends, Pregnancy in Adolescence prevention & control, Pregnancy in Adolescence statistics & numerical data
- Published
- 2020
- Full Text
- View/download PDF
34. Forecasting the impact of coronavirus disease during delivery hospitalization: an aid for resource utilization.
- Author
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Putra M, Kesavan M, Brackney K, Hackney DN, and Roosa KM
- Subjects
- Adult, Female, Forecasting, Humans, Incidence, Maternal Mortality trends, Monte Carlo Method, Patient Acceptance of Health Care, Pregnancy, SARS-CoV-2, United States epidemiology, COVID-19 epidemiology, COVID-19 prevention & control, Delivery, Obstetric methods, Delivery, Obstetric statistics & numerical data, Delivery, Obstetric trends, Health Care Rationing methods, Health Care Rationing trends, Hospitalization statistics & numerical data, Hospitalization trends, Obstetrics organization & administration, Obstetrics statistics & numerical data, Obstetrics trends, Pregnancy Complications, Infectious epidemiology, Pregnancy Complications, Infectious prevention & control, Resource Allocation methods, Resource Allocation trends
- Abstract
Background: The ongoing coronavirus disease 2019 pandemic has severely affected the United States. During infectious disease outbreaks, forecasting models are often developed to inform resource utilization. Pregnancy and delivery pose unique challenges, given the altered maternal immune system and the fact that most American women choose to deliver in the hospital setting., Objective: This study aimed to forecast the first pandemic wave of coronavirus disease 2019 in the general population and the incidence of severe, critical, and fatal coronavirus disease 2019 cases during delivery hospitalization in the United States., Study Design: We used a phenomenological model to forecast the incidence of the first wave of coronavirus disease 2019 in the United States. Incidence data from March 1, 2020, to April 14, 2020, were used to calibrate the generalized logistic growth model. Subsequently, Monte Carlo simulation was performed for each week from March 1, 2020, to estimate the incidence of coronavirus disease 2019 for delivery hospitalizations during the first pandemic wave using the available data estimate., Results: From March 1, 2020, our model forecasted a total of 860,475 cases of coronavirus disease 2019 in the general population across the United States for the first pandemic wave. The cumulative incidence of coronavirus disease 2019 during delivery hospitalization is anticipated to be 16,601 (95% confidence interval, 9711-23,491) cases, 3308 (95% confidence interval, 1755-4861) cases of which are expected to be severe, 681 (95% confidence interval, 1324-1038) critical, and 52 (95% confidence interval, 23-81) fatal. Assuming similar baseline maternal mortality rate as the year 2018, we projected an increase in maternal mortality rate in the United States to at least 18.7 (95% confidence interval, 18.0-19.5) deaths per 100,000 live births as a direct result of coronavirus disease 2019., Conclusion: Coronavirus disease 2019 in pregnant women is expected to severely affect obstetrical care. From March 1, 2020, we forecast 3308 severe and 681 critical cases with about 52 coronavirus disease 2019-related maternal mortalities during delivery hospitalization for the first pandemic wave in the United States. These results are significant for informing counseling and resource allocation., (© 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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35. Knowledge, attitude and practice towards abortion and post abortion care among Egyptian private obstetricians and gynaecologists.
- Author
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Ibrahim ZM, Mohamed ML, Taha OT, Ghoneim HM, Mohamed HS, Abdellah AM, Aboelroose AA, Fiala LA, Nassr AA, Abbas AM, and Atwa KA
- Subjects
- Adult, Attitude of Health Personnel, Cross-Sectional Studies, Egypt, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Pregnancy, Abortion, Induced psychology, Aftercare psychology, Gynecology organization & administration, Obstetrics organization & administration, Physicians psychology, Private Practice
- Abstract
Objective: To assess the knowledge, attitude, and practice of private obstetricians and gynaecologists towards abortion, post-abortion care, and post-abortion family planning., Patients and Methods: A cross-sectional study, from June 2017 to May 2018, using a self-administered questionnaire of 150 obstetricians/gynaecologists at private clinics, centres, hospitals in Ismailia, Egypt. The questionnaire was composed of four broad sections: section one was about the socio-demographic characteristics of the participants; section two was about physicians' knowledge, attitude and practices regarding abortion; section three was about their attitudes and practices regarding post-abortion family planning and screening for sexually transmitted diseases (STDs) in patients presenting for induced abortion; and section four was about the socio-demographic characteristics of women seeking induced abortion taken from the physicians' views., Results: Only 15.2% of participants had performed an abortion for unwanted pregnancies at ≤12 weeks vs. 3.8% for unwanted pregnancies >12 weeks' gestation. The most common reason for not performing an abortion was religious prohibition (80.35% vs. 86.6% for unwanted pregnancy ≤12 and > 12 weeks, respectively). Social causes were the most common reason for seeking an induced abortion. None of the physicians used manual vacuum aspiration (MVA) for abortion or had received training in MVA. Post-abortion family planning counselling was offered by 20.5% of physicians, while 13.6% screened for STDs., Conclusions: The majority of private obstetricians/gynaecologists in Ismailia, Egypt, do not perform abortions for unwanted pregnancies because of their religious beliefs. Post-abortion screening for STDs and family planning services are not sufficiently integrated into post-abortion care.
- Published
- 2020
- Full Text
- View/download PDF
36. Provision of obstetrics and gynaecology services during the COVID-19 pandemic: a survey of junior doctors in the UK National Health Service.
- Author
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Rimmer MP and Al Wattar BH
- Subjects
- Attitude of Health Personnel, COVID-19, Coronavirus Infections epidemiology, Coronavirus Infections transmission, Female, Humans, Medical Staff, Hospital, Pneumonia, Viral epidemiology, Pneumonia, Viral transmission, Pregnancy, SARS-CoV-2, Surveys and Questionnaires, United Kingdom, Betacoronavirus, Coronavirus Infections prevention & control, Gynecology organization & administration, Maternal Health Services organization & administration, Obstetrics organization & administration, Pandemics prevention & control, Pneumonia, Viral prevention & control, State Medicine organization & administration
- Abstract
Objective: The coronavirus disease 2019 (COVID-19) pandemic is disrupting health services worldwide. We aimed to evaluate the provision of obstetrics and gynaecology services in the UK during the acute phase of the COVID-19 pandemic., Design: Interview-based national survey., Setting: Women's healthcare units in the National Health Service., Population: Junior doctors in obstetrics and gynaecology., Methods: Participants were interviewed by members of the UK Audit and Research in Obstetrics and Gynaecology trainees' collaborative between 28 March and 7 April 2020. We used a quantitative analysis for closed-ended questions and a thematic framework analysis for open comments., Results: We received responses from 148/155 units (95%), most of the participants were in years 3-7 of training (121/148, 82%). Most completed specific training drills for managing obstetric and gynaecological emergencies in women with COVID-19 (89/148, 60.1%) and two-person donning and doffing of Personal Protective Equipment (PPE) (96/148, 64.9%). The majority of surveyed units implemented COVID-19-specific protocols (130/148, 87.8%), offered adequate PPE (135/148, 91.2%) and operated dedicated COVID-19 emergency theatres (105/148, 70.8%). Most units reduced face-to-face antenatal clinics (117/148, 79.1%) and suspended elective gynaecology services (131/148, 88.5%). The 2-week referral pathway for oncological gynaecology was not affected in half of the units (76/148, 51.4%), but half reported a planned reduction in oncology surgery (82/148, 55.4%)., Conclusion: The provision of obstetrics and gynaecology services in the UK during the acute phase of the COVID-19 pandemic seems to be in line with current guidelines, but strategic planning is needed to restore routine gynaecology services and ensure safe access to maternity care in the long term., Tweetable Abstract: Provision of obstetrics and gynaecology services during the acute phase of COVID-19 is in line with current guidelines, strategic planning is needed to restore routine services and ensure safe access to care in the long term., (© 2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.)
- Published
- 2020
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- View/download PDF
37. The Shifting Roles of the SOGC in the Face of the COVID-19 Pandemic.
- Author
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Blake J
- Subjects
- COVID-19, Canada, Humans, SARS-CoV-2, Betacoronavirus, Coronavirus Infections prevention & control, Gynecology organization & administration, Obstetrics organization & administration, Pandemics prevention & control, Pneumonia, Viral prevention & control, Professional Role, Societies, Medical organization & administration
- Published
- 2020
- Full Text
- View/download PDF
38. Coronavirus disease 2019 pandemic: staged management of surgical services for gynecology and obstetrics.
- Author
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Weber LeBrun EE, Moawad NS, Rosenberg EI, Morey TE, Davies L, Collins WO, and Smulian JC
- Subjects
- Betacoronavirus, COVID-19, Female, Gynecologic Surgical Procedures, Humans, Pandemics, Pregnancy, Risk Assessment, SARS-CoV-2, Coronavirus Infections epidemiology, Gynecology organization & administration, Obstetrics organization & administration, Pneumonia, Viral epidemiology, Surgery Department, Hospital organization & administration
- Abstract
The coronavirus disease 2019 pandemic warrants an unprecedented global healthcare response requiring maintenance of existing hospital-based services while simultaneously preparing for high-acuity care for infected and sick individuals. Hospitals must protect patients and the diverse healthcare workforce by conserving personal protective equipment and redeployment of facility resources. While each hospital or health system must evaluate their own capabilities and surge capacity, we present principles of management of surgical services during a health emergency and provide specific guidance to help with decision making. We review the limited evidence from past hospital and community responses to various health emergencies and focus on systematic methods for adjusting surgical services to create capacity, addressing the specific risks of coronavirus disease 2019. Successful strategies for tiered reduction of surgical cases involve multidisciplinary engagement of the entire healthcare system and use of a structured risk-assessment categorization scheme that can be applied across the institution. Our institution developed and operationalized this approach over 3 working days, indicating that immediate implementation is feasible in response to an unforeseen healthcare emergency., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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- View/download PDF
39. Implementation and upscaling of midwifery continuity of care: The experience of midwives and obstetricians.
- Author
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Styles C, Kearney L, and George K
- Subjects
- Adult, Female, Focus Groups, Health Plan Implementation, Humans, Organizational Culture, Organizational Innovation, Pregnancy, Qualitative Research, Queensland, Workload, Continuity of Patient Care organization & administration, Midwifery organization & administration, Nurse Midwives psychology, Obstetrics organization & administration, Physicians psychology
- Abstract
Problem: Despite high quality evidence supporting midwifery continuity of care, access to this model is limited in many parts of Australia and internationally., Background: The models of care provided to women have a strong influence on their perinatal experience and clinical outcomes. Midwifery Continuity of Care (CoC) is arguably the most significant factor in enhancing women's clinical outcomes during child-bearing and facilitating a positive childbirth experience. Health system change is required, yet little literature has detailed the actualisation of this in the context of upscaling midwifery CoC., Research Question/aim: This study aimed to explore the perceptions and experiences of midwifery and obstetric staff during the implementation and upscaling of midwifery CoC within a regional hospital and health service in coastal Queensland, Australia., Methods: A single-site, qualitative enquiry. Obstetricians and midwives participated in semi-structured interviews or focus groups at two-time points: within 2 months of introduction of the CoC service (obstetricians n=6; midwives n=15); and 2-years after implementation (obstetricians n=5; midwives n=17). Data were analysed thematically., Findings: Four key themes and several categories were generated from the data: hopes and expectations; clinical and practice changes; organisational and structural change; and, future directions., Discussion: Organisational culture, structural change, communication processes and collaborative relationships can be used to inform future scale-up and sustain midwifery caseload care. Specifically, communication, inter-disciplinary collegial relationships, and managerial support are crucial to the sustainability and ultimate upscaling of caseload midwifery care., Conclusion: System change is challenging, but in order to improve access to midwifery CoC is necessary., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)
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- 2020
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40. Evaluation of Hidradenitis Suppurativa Disease Course During Pregnancy and Postpartum.
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Lyons AB, Peacock A, McKenzie SA, Jacobsen G, Naik HB, Shi VY, Hamzavi IH, and Hsiao JL
- Subjects
- Adult, Dermatology organization & administration, Disease Progression, Female, Gynecology organization & administration, Hidradenitis Suppurativa therapy, Humans, Obstetrics organization & administration, Patient Care Team organization & administration, Postpartum Period, Pregnancy, Pregnancy Complications therapy, Retrospective Studies, Severity of Illness Index, Young Adult, Hidradenitis Suppurativa diagnosis, Pregnancy Complications diagnosis
- Abstract
Importance: Hidradenitis suppurativa (HS) disproportionately affects women of childbearing potential. There is a paucity of data regarding the HS disease course during pregnancy and in the postpartum period., Objective: To explore the HS disease course during pregnancy and in the postpartum period., Design, Setting, and Participants: A retrospective cohort study was conducted on patients in the Henry Ford Health System, Detroit, Michigan-a large, academic, urban referral center. Women with a diagnosis of HS who became pregnant between January 1, 2008, and December 31, 2018, were included. International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, were used for identification of the diagnosis., Exposures: Pregnancy in patients with HS., Main Outcomes and Measures: Hidradenitis suppurativa disease status during pregnancy and the postpartum period., Results: A total of 127 women with HS were included in this study and accounted for 202 pregnancies. Of the 202 pregnancies, 171 were in black women, 25 in white women, 3 in women of other race/ethnicity, and 3 had unreported data. Mean (SD) age at HS onset was 19.3 (5.6) years; at time of HS diagnosis, 24.4 (5.3) years; and at time of pregnancy, 25.9 (5.0) years. The disease worsened during pregnancy in 70 pregnancies (61.9%), did not change in 34 pregnancies (30.1%), and improved in 9 pregnancies (8.0%). Hidradenitis suppurativa exacerbated in the postpartum period after 82 of 124 pregnancies (66.1%). Dermatologists were involved in managing HS in 28 pregnancies (14.4%) and for a higher proportion of patients with more severe Hurley stage as compared with cases of mild disease (stage 3: 7 of 18 [38.9%] vs stage 1: 10 of 100 [10.0%] or stage 2: 11 of 67 [16.4%]; P = .004). In addition, HS medical treatment was administered during 77 pregnancies (38.1%), while HS procedural treatment was administered during 34 pregnancies (16.8%). A significantly higher proportion of patients whose care was managed by dermatologists vs those without dermatologist involvement received any HS medication (22 [78.6%] vs 53 [31.7%], P < .001) or any HS procedure (14 [50%] vs 19 [11.4%], P < .001) during pregnancy., Conclusions and Relevance: Despite a high rate of HS exacerbation during pregnancy and postpartum, this cohort study found that most of the patients did not receive HS-directed medical treatment or care from a dermatologist during pregnancy. Close monitoring and improved collaborative care between dermatology and obstetrics-gynecology services is warranted.
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- 2020
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41. The Availability of Emergency Obstetric Care in Birthing Centres in Rural Nepal: A Cross-sectional Survey.
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Banstola A, Simkhada P, van Teijlingen E, Bhatta S, Lama S, Adhikari A, and Banstola A
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- Adolescent, Adult, Birthing Centers organization & administration, Cross-Sectional Studies, Emergency Medical Services statistics & numerical data, Female, Health Care Surveys, Humans, Middle Aged, Nepal, Obstetrics organization & administration, Pregnancy, Rural Health Services statistics & numerical data, Young Adult, Birthing Centers statistics & numerical data, Health Services Accessibility statistics & numerical data, Obstetrics statistics & numerical data
- Abstract
Objective: The purpose of this health system's study is to assess the availability of Emergency Obstetric Care (EmOC) services in birthing centres in Taplejung District of eastern Nepal., Methods: A cross-sectional survey was conducted in 2018 in all 16 public health facilities providing delivery services in the district. Data collection comprised: (1) quantitative data collected from health workers; (2) observation of key items; and (3) record data extracted from the health facility register. Descriptive statistics were used to calculate readiness scores using unweighted averages., Results: Although key health personnel were available, EmOC services at the health facilities assessed were below the minimum coverage level recommended by the World Health Organisation. Only the district hospital provided the nine signal functions of Comprehensive EmOC. The other fifteen had only partially functioning Basic EmOC facilities, as they did not provide all of the seven signal functions. The essential equipment for performing certain EmOC functions was either missing or not functional in these health facilities., Conclusions for Practice: The Ministry of Health and Population and the federal government need to ensure that the full range of signal functions are available for safe deliveries in partially functioning EmOC health facilities by addressing the issues related to training, equipment, medicine, commodities and policy.
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- 2020
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42. Caring for Pregnant Patients with COVID-19: Practical Tips Getting from Policy to Practice.
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London V, McLaren R Jr, Stein J, Atallah F, Fisher N, Haberman S, McCalla S, and Minkoff H
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- Betacoronavirus isolation & purification, COVID-19, Evidence-Based Practice trends, Female, Humans, Interdisciplinary Communication, Obstetrics organization & administration, Obstetrics trends, Organizational Innovation, Pregnancy, SARS-CoV-2, United States epidemiology, Coronavirus Infections epidemiology, Coronavirus Infections prevention & control, Infection Control methods, Infection Control organization & administration, Pandemics prevention & control, Perinatal Care methods, Perinatal Care organization & administration, Perinatal Care trends, Pneumonia, Viral epidemiology, Pneumonia, Viral prevention & control, Pregnancy Complications, Infectious epidemiology, Pregnancy Complications, Infectious prevention & control, Standard of Care trends
- Abstract
Novel coronavirus disease 2019 (COVID-19) is a pandemic with most American cases in New York. As an institution residing in a high-prevalence zip code, with over 8,000 births annually, we have cared for over 80 COVID-19-infected pregnant women, and have encountered many challenges in applying new national standards for care. In this article, we review how to change outpatient and inpatient practices, develop, and disseminate new hospital protocols, and we highlight the psychosocial challenges for pregnant patients and their providers. KEY POINTS: · Novel coronavirus disease 2019 (COVID-19) information rapidly changes.. · Multidisciplinary communication is key.. · This study addresses psychosocial challenges.., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
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- 2020
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43. A protocol for evaluating a multi-level implementation theory to scale-up obstetric triage in referral hospitals in Ghana.
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Williams CR, Bogdewic S, Owen MD, Srofenyoh EK, and Ramaswamy R
- Subjects
- Evidence-Based Practice organization & administration, Ghana, Humans, Learning Health System organization & administration, Maternal-Child Health Services standards, Midwifery standards, Obstetrics standards, Risk Assessment, Time Factors, Triage, Implementation Science, Maternal-Child Health Services organization & administration, Midwifery organization & administration, Obstetrics organization & administration, Quality Improvement organization & administration
- Abstract
Background: Ghana significantly reduced maternal and newborn mortality between 1990 and 2015, largely through efforts focused on improving access to care. Yet achieving further progress requires improving the quality and timeliness of care. Beginning in 2013, Ghana Health Service and Kybele, a US-based non-governmental organization, developed an innovative obstetric triage system to help midwives assess, diagnosis, and determine appropriate care plans more quickly and accurately. In 2019, efforts began to scale this successful intervention into six additional hospitals. This protocol describes the theory-based implementation approach guiding scale-up and presents the proposed mixed-methods evaluation plan., Methods: An implementation theory was developed to describe how complementary implementation strategies would be bundled into a multi-level implementation approach. Drawing on the Interactive Systems Framework and Evidenced Based System for Implementation Support, the proposed implementation approach is designed to help individual facilities develop implementation capacity and also build a learning network across facilities to support the implementation of evidence-based interventions. A convergent design mixed methods approach will be used to evaluate implementation with relevant data drawn from tailored assessments, routinely collected process and quality monitoring data, textual analysis of relevant documents and WhatsApp group messages, and key informant interviews. Implementation outcomes of interest are acceptability, adoption, and sustainability., Discussion: The past decade has seen a rapid growth in the development of frameworks, models, and theories of implementation, yet there remains little guidance on how to use these to operationalize implementation practice. This study proposes one method for using implementation theory, paired with other kinds of mid-level and program theory, to guide the replication and evaluation of a clinical intervention in a complex, real-world setting. The results of this study should help to provide evidence of how implementation theory can be used to help close the "know-do" gap. Every woman and every newborn deserves a safe and positive birth experience. Yet in many parts of the world, this goal is often more aspiration than reality. In 2006, Kybele, a US-based non-governmental organization, began working with the Ghanaian government to improve the quality of obstetric and newborn care in a large hospital in Greater Accra. One successful program was the development of a triage system that would help midwives rapidly assess pregnant women to determine who needed what kind of care and develop risk-based care plans. The program was then replicated in another large hospital in the Greater Accra region, where a systematic theory to inform triage implementation was developed. This paper describes the extension of this approach to scale-up the triage program implementation in six additional hospitals. The scale-up is guided by a multi-level theory that extends the facility level theory to include cross-facility learning networks and oversight by the health system. We explain the process of theory development to implement interventions and demonstrate how these require the combination of local contextual knowledge with evidence from the implementation science literature. We also describe our approach for evaluating the theory to assess its effectiveness in achieving key implementation outcomes. This paper provides an example of how to use implementation theories to guide the development and evaluation of complex programs in real-world settings.
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- 2020
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44. Working with women: Semi-structured interviews with Australian complementary medicine maternity care practitioners.
- Author
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Steel A, Diezel H, Wardle J, and Adams J
- Subjects
- Australia, Female, Humans, Obstetrics organization & administration, Parturition, Pregnancy, Complementary Therapies organization & administration, Delivery, Obstetric, Health Personnel organization & administration, Maternal Health Services organization & administration
- Abstract
Problem: Despite the known prevalence of complementary medicine use by women during pregnancy and childbirth and the evolution of preferred models of maternity care, very little is known about the nature and characteristics of the care provided to women by complementary medicine practitioners during this important life stage., Background: Woman-centred care is a speciation of person-centred care which has achieved prominence in maternity care policy in recent years. There is also evidence that the core principles of some complementary medicine systems of medicine emphasise patient-centredness and that these principles are core drivers toward complementary medicine use in multiple populations., Aim: This study aims to explore the approach to care delivered by complementary medicine practitioners to women during pregnancy and birth., Methods: Semi-structured individual interviews were conducted with 23 complementary medicine practitioners who identified as specialising in maternity care. Data from the interviews were analysed using a framework approach., Findings: The analysis of the perspective of complementary medicine practitioner's experiences providing care to pregnant and birthing women identified three main themes: Responding to women's expectations of care; providing woman-centred care; and the therapeutic relationship at the heart of woman-centred care., Discussion: The approach to maternity care reported by complementary medicine practitioners aligns with the principles of woman-centred care, possibly due to the similarities between woman-centred care and the core features of many systems of medicine within complementary medicine., Conclusion: Complementary medicine practitioners may contribute to an overall experience of woman-centred maternity care for pregnant and birthing women., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)
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- 2020
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45. Identified themes of interactive visualizations overlayed onto EHR data: an example of improving birth center operating room efficiency.
- Author
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Stirling A, Tubb T, Reiff ES, Grotegut CA, Gagnon J, Li W, Bradley G, Poon EG, and Goldstein BA
- Subjects
- Female, Humans, Medical Records Systems, Computerized, North Carolina, Obstetrics organization & administration, Pregnancy, Quality Improvement, User-Computer Interface, Birthing Centers organization & administration, Computer Graphics, Electronic Health Records, Operating Rooms organization & administration
- Abstract
Objective: While electronic health record (EHR) systems store copious amounts of patient data, aggregating those data across patients can be challenging. Visual analytic tools that integrate with EHR systems allow clinicians to gain better insight and understanding into clinical care and management. We report on our experience building Tableau-based visualizations and integrating them into our EHR system., Materials and Methods: Visual analytic tools were created as part of 12 clinician-initiated quality improvement projects. We built the visual analytic tools in Tableau and linked it within our EPIC environment. We identified 5 visual themes that spanned the various projects. To illustrate these themes, we choose 1 exemplary project which aimed to improve obstetric operating room efficiency., Results: Across our 12 projects, we identified 5 visual themes that are integral to project success: scheduling & optimization (in 11/12 projects); provider assessment (10/12); executive assessment (8/12); patient outcomes (7/12); and control and goal charts (2/12)., Discussion: Many visualizations share common themes. Identification of these themes has allowed our internal team to be more efficient and directed in developing visualizations for future projects., Conclusion: Organizing visual analytics into themes can allow informatics teams to more efficiently provide visual products to clinical collaborators., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2020
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46. [Protection suggestions on medical staff in obstetrics and gynecology in COVID-19-designated hospitals].
- Author
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Yang XQ, Su M, Zou Y, Shi Q, Zhao XX, Zhao JM, Zhou XY, Cao DL, Wang YG, and Zhang YQ
- Subjects
- Betacoronavirus, COVID-19, Female, Hospitals, Humans, Pregnancy, SARS-CoV-2, Coronavirus Infections prevention & control, Gynecology organization & administration, Medical Staff, Obstetrics organization & administration, Pandemics prevention & control, Personal Protective Equipment, Pneumonia, Viral prevention & control
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- 2020
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47. Moving From Knowledge to Action: Improving Safety and Quality of Care for Patients With Limited English Proficiency.
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Fox MT, Godage SK, Kim JM, Bossano C, Muñoz-Blanco S, Reinhardt E, Wu L, Karais S, and DeCamp LR
- Subjects
- Baltimore, Female, Focus Groups, Gynecology organization & administration, Humans, Male, Obstetrics organization & administration, Organizational Culture, Pediatrics organization & administration, Surveys and Questionnaires, Cultural Competency organization & administration, Healthcare Disparities, Limited English Proficiency, Patient Safety standards, Professional-Patient Relations, Quality Improvement organization & administration, Translating
- Abstract
Objective . This study assessed safety culture and staff communication with patients with limited English proficiency (LEP) to identify system-level approaches to increasing interpreter use and reducing health care disparities. Methods . An electronic survey and 7 focus groups were conducted with health care professionals in pediatrics and obstetrics/gynecology. Survey data were examined with univariate descriptive analysis. Focus group transcripts were coded through an iterative consensus process. Results . Survey participants (n = 68) reported less confidence in their ability to communicate effectively (74%) and form therapeutic relationships (56%) with LEP patients versus English-proficient patients. Focus groups identified knowledge as a facilitator of interpreter use. Workflow constraints, supply-demand mismatch, variable interpretation quality, and gaps in communication with interpretation services management were barriers. Conclusion . Knowledge gaps may not be a primary cause of interpreter underuse. Strategies to address workflow barriers and engage with interpretation services are critical to move from knowledge to action to improve LEP patient care.
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- 2020
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48. Ethiopian and American Collaboration: Process, Accomplishments, and Lessons Learned.
- Author
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Negussie D, Bekele D, Curran D, Ogburn T, Peterson H, Clem F, and Chescheir N
- Subjects
- Ethiopia, Gynecology standards, Internship and Residency standards, Obstetrics standards, Periodicals as Topic, Gynecology organization & administration, International Cooperation, Obstetrics organization & administration
- Abstract
From 2015 to 2018, the Ethiopian Society of Obstetricians & Gynecologists (ESOG), the American College of Obstetricians and Gynecologists, the Ethiopian Federal Ministry of Health, and the Center for International Reproductive Health Training at the University of Michigan collaborated to define and execute the goals of ESOG to enhance education, research, publishing, and clinical care in Ethiopia. We outline the processes used to define and execute these goals, accomplishments toward achieving them, and key lessons learned.
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- 2020
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49. [Borderline Ovarian Tumours: CNGOF guidelines for Clinical Practice - Methods & Organization].
- Author
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Huchon C, Bourdel N, and Daraï E
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- Female, France, Humans, Carcinoma, Ovarian Epithelial therapy, Gynecology methods, Gynecology organization & administration, Obstetrics methods, Obstetrics organization & administration, Ovarian Neoplasms therapy, Practice Guidelines as Topic
- Abstract
This text presents organizational and methodological aspects of the development of the French guidelines on the management of borderline ovarian tumours., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)
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- 2020
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50. Chinese obstetricians' attitudes, beliefs, and clinical practices related to cesarean delivery on maternal request.
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Sun N, Yin X, Qiu L, Yang Q, and Gong Y
- Subjects
- Adult, China epidemiology, Cross-Sectional Studies, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Physician-Patient Relations, Pregnancy, Attitude of Health Personnel, Cesarean Section, Obstetrics organization & administration, Physicians psychology, Physicians statistics & numerical data, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Background: Obstetricians' beliefs, attitudes, and clinical practices related to cesarean delivery on maternal request appears particularly important in the context of high cesarean section rate. However, few relative studies have been conducted., Aim: To examine Chinese obstetricians' attitudes, beliefs, and clinical practices with regard to cesarean delivery on maternal request, and to explore influencing factors associated with their practices of cesarean delivery on maternal request., Methods: A cross-sectional design was used. Self-administered anonymous questionnaires were distributed to eligible obstetricians at the Congress of the Shanxi Society of Gynecology and Obstetrics as well as the Congress of the Hainan Society of Gynecology and Obstetrics. The overall response rate was 526/649 (81.05%). Multivariate logistic regression models were used to examine independent effects on obstetrician's clinical practices related to cesarean delivery on maternal request., Findings: Obstetricians who agreed with pregnant women's decision to choose cesarean section directly and believed the benefits of this procedure outweigh the risks had higher odds of performing cesarean delivery on maternal request. In addition, measures to decrease cesarean section at hospitals were associated with reduced likelihood to perform cesarean delivery on maternal request., Conclusions: The present study showed a strong correlation between obstetricians' attitudes, beliefs, as well as interventions to decrease cesarean section at hospitals and their clinical practices of cesarean delivery on maternal request. Measures to enhance the training of obstetricians and reduce CS at hospitals are essential to decrease the overall cesarean section rate in China., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)
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- 2020
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