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Byline: L. Andronis, M. Calvert, L. Magill, J. Mathers, T. D. Pinkney, A. Torrance, H. Talbot, J. M. Blazeby, N. S. Blencowe, J. Coast, T. Draycott, J. Donovan, R. Gooberman-Hill, B. C. Reeves, C. A. Rogers, R. Longman, M. Woodward, T. Young, J. Bird, G. Clayton, L. Ellis, R. Macefield, T. Milne, H. van der Nelson, A. Nicholson, L. Rooshenas, D. Siassakos, S. Strong, D. Townsend, C. McMullan, C. Winter, G. Atherton, H. Tafazal, A. Eriksson, T. Chapman, Z. Zafar, J. Chang, E. Sharma, N. Green, U. Shariff, T. Neito, H. Youssef, P. Marriott, M. Popplewell, N. Ring, A. Sharples, V. Summerour, A. Bhangu, E. Upchurch, T. Hardy, J. Monteiro de Barros, L. Reza, C. Ekere, A. Greenwood, S. Strong, C. Florance, P. Orchard, E. Court, C. Ives, E. Papworth, C. Lee, S. Buchan, J. Bennett, C. Rowlands, L. Frank, K.-A. Ide, E. Noble, H. Sellars, E. Anderson, R. Fallaize, J. Kynaston, E. Hotton, J. Banks, N. Thompson, T. Hodkinson, N. Blencowe, R. Bamford, P. Newman, J. Cutting, Z. Barber, C. Grant, J. Mason, J. Bailey Background Designing RCTs in surgery requires consideration of existing evidence, stakeholders' views and emerging interventions, to ensure that research questions are relevant to patients, surgeons and the health service. When there is uncertainty about RCT design, feasibility work is recommended. This study aimed to assess how feasibility work could inform the design of a future pilot study and RCT (Bluebelle, HTA - 12/200/04). Methods This was a prospective survey of dressings used to cover abdominal wounds. Surgical trainees from 25 hospitals were invited to participate. Information on patient risk factors, operation type and type of wound dressings used was recorded for elective and unplanned abdominal procedures over a 2-week interval. The types of dressing used were summarized, and associations with operation type and patient risk factors explored. Results Twenty hospitals participated, providing data from 727 patients (1794 wounds). Wounds were predominantly covered with basic dressings (1203 of 1769, 68ae0 per cent) and tissue adhesive was used in 27ae4 per cent (485 of 1769); dressing type was missing for 25 wounds. Just 3ae6 per cent of wounds (63 of 1769) did not have a dressing applied at the end of the procedure. There was no evidence of an association between type of dressing used and patient risk factors, type of operation, or elective and unscheduled surgery. Conclusion Based on the findings from this large study of current practice, the pilot study design has evolved. The inclusion criteria have expanded to encompass patients undergoing unscheduled surgery, and tissue adhesive as a dressing will be evaluated as an additional intervention group. Collaborative methods are recommended to inform the design of RCTs in surgery, helping to ensure they are relevant to current practice. Article Note: Co-authors of this study are listed under the heading Collaborators CAPTION(S): Appendix S1 Data collection pro forma

Problem The Commission on Information and Accountability for Women's and Children's Health of the World Health Organization (WHO) reported that national health outcome data were often of questionable quality and "not timely enough for practical use by health planners and administrators". Delayed reporting of poor-quality data limits the ability of front-line staff to identify problems rapidly and make improvements. Approach Clinical "dashboards" based on locally available data offer a way of providing accurate and timely information. A dashboard is a simple computerized tool that presents a health facility's clinical data graphically using a traffic-light coding system to alert front-line staff about changes in the frequency of clinical outcomes. It provides rapid feedback on local outcomes in an accessible form and enables problems to be detected early. Until now, dashboards have been used only in high-resource settings. Local setting An overview maternity dashboard and a maternal mortality dashboard were designed for, and introduced at, a public hospital in Zimbabwe. A midwife at the hospital was trained to collect and input data monthly. Relevant changes Implementation of the maternity dashboards was feasible and 28 months of clinical outcome data were summarized using common computer software. Presentation of these data to staff led to the rapid identification Of adverse trends in outcomes and to suggestions for actions to improve health-care quality. Lessons learnt Implementation of maternity dashboards was feasible in a low-resource setting and resulted in actions that improved health-care quality locally. Active participation of hospital management and midwifery staff was crucial to their success. Probleme La Commission de l'information et de la responsabilisation en matiere de sante de la femme et de l'enfant de l'Organisation mondiale de la Sante (OMS) avait signale que les donnees sur les resultats de sante nationaux etaient souvent de qualite douteuse et qu'elles n'etaient pas publiees a temps pour pouvoir etre utilisees par les planificateurs et les gestionnaires des services de sante. La presentation tardive des donnees de mauvaise qualite limite le personnel en premiere ligne dans sa capacite a identifier rapidement les problemes et a apporter des ameliorations. Approche Des <> cliniques bases sur les donnees disponibles localement offrent un moyen de fournir des informations precises et actualisees. Un tableau de bord est un outil informatique simple qui presente graphiquement les donnees cliniques d'un etablissement de soins de sante, en utilisant un systeme de code couleur (identique aux feux de signalisation) pour alerter le personnel en premiere ligne des changements de frequence des resultats cliniques. II fournit un retour d'information rapide sur les resultats locaux dans une forme accessible, et cela permet de detecter precocement les problemes. Jusqu'a present, les tableaux de bord ont ete utilises uniquement dans les pays a ressources elevees. Environnement local Un tableau de bord de maternite (vue d'ensemble) et un tableau de bord de la mortalite maternelle ont ete concus et introduits dans un hopital public au Zimbabwe. Une sagefemme de l'hopital a ete formee pour recueillir et saisir les donnees mensuellement. Changements significatifs La mise en oeuvre des tableaux de bord de maternite etait realisable et 28 mois de resultats cliniques ont ete resumes en utilisant un logiciel informatique standard. La presentation de ces donnees au personnel a permis l'identification rapide des tendances defavorables dans les resultats et la formulation de suggestions d'actions a entreprendre pour ameliorer la qualite des soins de sante. Lecons tirees La mise en ceuvre de tableaux de bord de maternite etait realisable dans un pays a faibles ressources et cela a abouti a des actions qui ont ameliore localement la qualite des soins de sante. La participation active de la direction de l'hopital et de l'equipe obstetrique fut determinante dans ce succes. Problema La Comision de informacion y rendicion de cuentas para la salud de la Mujer y el Nino de la Organizacion Mundial de la salud (OMS) informo de que los datos de los resultados relativos a la salud nacional eran a menudo de dudosa calidad y <>. La presentacion con retraso de datos de mala calidad limita la capacidad del personal para identificar problemas rapidamente y hacer mejoras. Enfoque Los <> clinicos basados en los datos disponibles a nivel local ofrecen una manera de proporcionar informacion precisa y oportuna. Un panel es una sencilla herramienta informatica que presenta graficamente los datos clinicos de un centro de salud por medio de un sistema basado en el codigo de colores dei <> para alertar al personal de primera linea sobre los cambios en la frecuencia de los resultados clinicos. Proporciona retroalimentacion rapida sobre los resultados Iocales de forma accesible y permite que los problemas se detecten a tiempo. Hasta ahora, solo se han utilizado paneles en entornos de altos recursos. Marco regional Se disenaron y presentaron en un hospital publico de Zimbabwe un panel de maternidad resumen y un panel de mortalidad materna, y se capacito a un comadron del hospital para recoger e introducir los datos mensuales. Cambios importantes La aplicacion de los paneles de maternidad fue factible. Por medio de un software informatico comun se resumieron los datos de los resultados clinicos de 28 meses. La presentacion de estos datos al personal condujo a la identificacion rapida de las tendencias adversas en los resultados y a las propuestas de accion para mejorar la calidad de la atencion sanitaria. Lecciones aprendidas La aplicacion de paneles de maternidad fue factible en un entorno de baios recursos y dio lugar a acciones que mejoraron la calidad de la atencion sanitaria local. La participacion activa del personal de administracion y de la parteria del hospital fue decisiva para el exito., Introduction Global efforts to improve maternal and perinatal health continue. However, quality improvement demands quality measurement: we can only improve things we can measure. Moreover, if we wish to make [...]

Objective: To compare intramuscular oxytocin, Syntometrine® and carbetocin for prevention of postpartum haemorrhage after vaginal birth. Design: Randomised double‐blinded clinical trial. Setting: Six hospitals in England. Population: A total of 5929 normotensive women having a singleton vaginal birth. Methods: Randomisation when birth was imminent. Main outcome measures: Primary: use of additional uterotonic agents. Secondary: weighed blood loss, transfusion, manual removal of placenta, adverse effects, quality of life. Results: Participants receiving additional uterotonics: 368 (19.5%) oxytocin, 298 (15.6%) Syntometrine and 364 (19.1%) carbetocin. When pairwise comparisons were made: women receiving carbetocin were significantly more likely to receive additional uterotonics than those receiving Syntometrine (odds ratio [OR] 1.28, 95% CI 1.08–1.51, P = 0.004); the difference between carbetocin and oxytocin was non‐significant (P = 0.78); Participants receiving Syntometrine were significantly less likely to receive additional uterotonics than those receiving oxytocin (OR 0.75, 95% CI 0.65–0.91, P = 0.002). Non‐inferiority between carbetocin and Syntometrine was not shown. Use of Syntometrine reduced non‐drug PPH treatments compared with oxytocin (OR 0.64, 95% CI 0.42–0.97) but not carbetocin (P = 0.64). Rates of PPH and blood transfusion were not different. Syntometrine was associated with an increase in maternal adverse effects and reduced ability of the mother to bond with her baby. Conclusions: Non‐inferiority of carbetocin to Syntometrine was not shown. Carbetocin is not significantly different to oxytocin for use of additional uterotonics. Use of Syntometrine reduced use of additional uterotonics and need for non‐drug PPH treatments compared with oxytocin. Increased maternal adverse effects are a disadvantage of Syntometrine. IM carbetocin does not reduce additional uterotonic use compared with IM Syntometrine or oxytocin. IM carbetocin does not reduce additional uterotonic use compared with IM Syntometrine or oxytocin. [ABSTRACT FROM AUTHOR]