scholarly journals Examining the Impact of the Vaginal Birth After Cesarean Risk Calculator Estimation on Trial of Labor After Cesarean Counseling

2019 ◽  
Vol 4 (1) ◽  
pp. 238146831985083
Author(s):  
Erin Jeffries ◽  
Amy Falcone-Wharton ◽  
Joanne Daggy ◽  
Brownsyne Tucker Edmonds
Keyword(s):  
Risk Estimation ◽  
Vaginal Birth ◽  
Vaginal Birth After Cesarean ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Trial Of Labor ◽  
Patient Morbidity ◽  
Survey Responses ◽  
The Impact

Background. Because failed trial of labor after cesarean (TOLAC) is associated with greater morbidity than planned cesarean, it is important to distinguish women with a high likelihood of successful vaginal birth after cesarean (VBAC) from those likely to fail. The VBAC Calculator may help make this distinction but little is known about how often providers use it; nor whether use improves risk estimation and/or influences TOLAC counseling. Methods. In a cross-sectional survey, a convenience sample of obstetrical providers reported their likelihood (4-point Likert-type scale) to “Recommend,”“Offer,” or “Agree to” TOLAC for patients presented first through five clinical vignettes; then, in different order, by corresponding VBAC calculator estimates. Results. Of the 85 (of 101, 84% response rate) participants, 88% routinely performed TOLAC, but only 21% used the Calculator. The majority (67.1% to 89.3%) overestimated the likelihood of success for all but one vignette (which had the highest estimate of success). Most providers (42% to 89%) recommended TOLAC for all five vignettes. Given calculated estimates, the majority of providers (67% to 95%) recommended TOLAC for success estimates exceeding 40%. For estimates between 20% and 40%, most providers offered (58%) or agreed (68%) to TOLAC; and even below 20%, over half still agreed to TOLAC. The vignette with the lowest estimate of success (18.7%) had the weakest intraprovider agreement (kappa = 0.116; confidence interval [CI] = 0.045–0.187), whereas the strongest agreement was found in the two vignettes with highest success estimates: 77.9% (kappa = 0.549; CI = 0.382–0.716) and 96.6% (kappa = 0.527; CI = 0.284–0.770). Limitations. Survey responses may not reflect actual practice patterns. Conclusion. Providers are overly optimistic in their clinical estimation of VBAC success. Wider use of decision support could aid in risk stratification and TOLAC counseling to reduce patient morbidity.

scholarly journals Impact of postgraduate study on healthcare professionals' academic and clinical practice

2020 ◽  
Vol 26 (7) ◽  
pp. 171-178
Author(s):  
Samantha Holloway ◽  
Ann Taylor ◽  
Michal Tombs
Keyword(s):  
Clinical Practice ◽  
Personal Growth ◽  
Healthcare Professionals ◽  
Healthcare Setting ◽  
Subject Area ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Postgraduate Study ◽  
The Impact

Aims/Background Existing literature in the healthcare setting indicates that individuals enter higher education, particularly postgraduate programmes, to gain in-depth knowledge of a subject area, with a view to improving their career opportunities. Evidence also suggests that, in addition to perceived career enhancement, individuals also report benefits such as personal growth and broadening of perspectives, which have helped their clinical practice. The aim of this study was to examine the impact of postgraduate study on healthcare professionals' academic practice and discuss the potential links to improvements in clinical practice. Method This was a descriptive cross-sectional survey of a convenience sample of graduates from a range of postgraduate healthcare programmes at one UK university. A survey comprising 18 questions was designed to explore perceptions of impact and was distributed to 962 graduates with a response rate of 9.81% (n=98). Results The majority of respondents were doctors (n=54, 55.1%), women (n=59, 60.2%), based within the UK (n=36, 36.7%) and had completed their programme between 2014 and 2016 (n=72, 73.4%). With regards to achievements in professional practice, participants felt more confident in relation to research and evaluating evidence. In relation to impact on clinical practice, improvements in multidisciplinary team working as well as increased confidence emerged as main themes. Conclusions Findings support existing evidence in relation to the importance of postgraduate study, which is able to instil an increased sense of confidence in graduates' ability. This was particularly related to having a better understanding of speciality-related evidence and its application in clinical practice. This is something that previous studies do not seem to have reported and may reflect the multiprofessional nature of many of the postgraduate programmes provided.

scholarly journals Is Early Amniotomy Associated with Higher Likelihood of Vaginal Birth after Cesarean?

2020 ◽  
Vol 10 (01) ◽  
pp. e37-e41
Author(s):  
Megan S. Varvoutis ◽  
Lauren C. Sayres ◽  
Sarah K. Dotters-Katz
Keyword(s):  
Foley Catheter ◽  
Secondary Analysis ◽  
Vaginal Birth ◽  
Vaginal Birth After Cesarean ◽  
Singleton Pregnancy ◽  
Maternal Fetal Medicine ◽  
Trial Of Labor ◽  
Nulliparous Women ◽  
The Impact ◽  
Labor Length

Abstract Objective The study aims to reduce cesarean rates, eligible women are being offered an option of vaginal birth after cesarean (VBAC). However, little data exist regarding efficacy of amniotomy as a tool in this population. We sought to evaluate the impact of early amniotomy on VBAC success. Study Design This is a secondary analysis case-control study using the MFMU (Maternal-Fetal Medicine Units Network) Cesarean Registry. Women were included if they had a singleton pregnancy, were attempting VBAC, and underwent induction with artificial rupture of membranes. Cases were defined as subjects with successful VBAC; controls were defined as subjects with failed trial of labor after cesarean (TOLAC). Early amniotomy was defined as amniotomy at <4 cm. Demographic and obstetric characteristics were compared and multivariate logistic regression was performed. Results A total of 1,490 women were included. Early amniotomy occurred in 59.5% with VBAC versus 63.2% with failed TOLAC (p = 0.24). After controlling for body mass index, prior vaginal delivery, African–American race, labor length, gestational age, birthweight, epidural use, Foley catheter balloon ripening, induction method and oxytocin use, early amniotomy was associated with a 34% decrease in VBAC success (p < 0.01). Women who had early amniotomy did not have higher rates of chorioamnionitis (2.8 vs. 2.9%, p > 0.99). Conclusion Unlike data from nulliparous women, our data suggest that induction with early amniotomy does not increase the likelihood of VBAC.

scholarly journals Engagement with daily testing instead of self-isolating in contacts of confirmed cases of SARS-CoV-2

2021 ◽  
Author(s):  
Alex F Martin ◽  
Sarah Denford ◽  
Nicola Love ◽  
Derren Ready ◽  
Isabel Oliver ◽  
...  
Keyword(s):  
Pilot Study ◽  
Minority Groups ◽  
Service Evaluation ◽  
Future Research ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Negative Test ◽  
Survey Responses ◽  
The Impact ◽  
Close Contacts

AbstractBackgroundIn December 2020, Public Health England with NHS Test and Trace initiated a pilot study in which close contacts of people with confirmed COVID-19 were given the option to carryout lateral flow device antigen tests at home, as an alternative to self-isolation for 10-14 days. In this study, we evaluated acceptability of and engagement with daily testing, and assessed levels of adherence to the rules relating to behaviour following positive or negative test results.MethodsWe conducted a service evaluation of a pilot study, involving an online cross-sectional survey offered to adult (> 18 years) contacts of confirmed COVID-19 cases who were invited to participate in seven days of daily testing instead of isolation. We used a comparison group of contacts who were not offered testing and performed self-isolation. Herein, we examine survey responses from a subset of those who took part in the pilot study and who responded to the evaluation questionnaire.ResultsAcceptability of daily testing was lower among survey respondents who were not offered the option of having it and among people from ethnic minority groups. Overall, 52% of respondents reported being more likely to share details of people that they had been in contact with following a positive test result, if they knew that their contacts would be offered the option of daily testing. Only 2% reported that they would be less likely to provide details of their contacts. On the days that they were trying to self-isolate, 19% of participants reported that they left the house, with no significant demographic group differences. Following a negative test, 13% of respondents reported that they increased their contacts, but most (58%) reported having fewer risky contacts.ConclusionsOur data suggest that daily testing is potentially acceptable, and may facilitate sharing contact details of close contacts among those who test positive for COVID-19, and promote adherence to self-isolation. A better understanding is needed of how to make this option more acceptable for all households. The impact of receiving a negative test on behaviour remains a risk that needs to be monitored and mitigated by appropriate messaging. Future research should examine attitudes and behaviour in a context where infection levels are lower, testing is more familiar, much of the population has been vaccinated and restrictions on activity have been reduced.

scholarly journals 106 Understanding the Impact of COVID-19 on Healthcare for Medically-Complex Children and Youth

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e75-e75
Author(s):  
Jennifer Baumbusch ◽  
Jennifer E V Lloyd ◽  
Shawna Bennett
Keyword(s):  
Negative Impact ◽  
Functional Dependence ◽  
Healthcare Services ◽  
Subject Area ◽  
Children And Youth ◽  
Cross Sectional Survey ◽  
Service Usage ◽  
Cross Sectional ◽  
Convenience Sample ◽  
The Impact

Abstract Primary Subject area Complex Care Background COVID-19 and associated pandemic measures have disproportionately affected already vulnerable populations, including medically-complex children and youth. In Canada, about one percent of children and youth aged 0 to 18 years (inclusive) are medically complex, which is characterized by having complex, chronic conditions that require specialized care, high healthcare service usage, and functional dependence. In addition to being high users of formal healthcare services, it is estimated that parents spent an average of 52 hours per week providing unpaid care. Objectives As part of a larger study exploring the effect of the pandemic on these children and their families, the impact on healthcare usage by this population was investigated. Design/Methods In August 2020, a web-based cross-sectional survey was conducted with parents of medically-complex children and youth in British Columbia, Canada. A convenience sample was recruited through posting advertisements on social media platforms, word of mouth, and amplifying the study via the media. The survey, co-created with parent co-researchers, was comprised of 93 questions. It was divided into three sections that focused on pre- and post-pandemic questions about a) medically complex child(ren), b) family/household/community characteristics, and c) respondent demographics. Data were analyzed using descriptive statistics. Results Results illustrate the largely negative impact of the pandemic on this population’s healthcare usage. The survey was completed by 156 parents, mainly mothers (92.3%) who reported information for 188 medically complex children and youth. The children ranged in age from 0 to 18 years, with an average age of 9.5 years, and 58.0% were boys. Between February and August 2020, 30.3% of children had visited the emergency department and the same percentage had parents who avoided taking them in circumstances where they typically would have. 36.2% of the children had been admitted to hospital during that period. The children typically saw an average of four medical specialists and during the pandemic 63.8% had a specialist appointment cancelled or postponed by the clinic. During this time, there was also a steep decline or stoppage of all allied health therapies. Conclusion These results demonstrate a lack of pandemic preparedness to ensure continuity of services. Consequently, medically complex children and youth may be missing key interventions to address ongoing health issues and maintain functional abilities. More proactive planning and coordination are needed to ensure that future situations will not lead to lack of access or therapy for this vulnerable group.

scholarly journals Acceptance of Vaginal Birth After Caesarean Section Trial in Shree Birendra Hospital, Kathmandu, Nepal: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (233) ◽  
Author(s):  
Ratna Khatri ◽  
Arju Chand ◽  
Manish Thapa ◽  
Sumana Thapa ◽  
Shailaja Khadka
Keyword(s):  
Cesarean Section ◽  
Tertiary Care ◽  
Previous History ◽  
Cross Sectional Study ◽  
Vaginal Birth ◽  
Care Hospital ◽  
Sectional Study ◽  
Vaginal Birth After Cesarean ◽  
Cross Sectional ◽  
Trial Of Labor

Introduction: The rate of primary cesarean section is on the rising trend. Vaginal birth after cesarean section can be an alternative to reduce cesarean section worldwide. Antenatal examination and intrapartum monitoring are the most important factors for a vaginal birth after a cesarean section. This study aims to determine the acceptance of vaginal birth after cesarean section trial in a tertiary care hospital in Nepal. Methods: This is a descriptive cross-sectional study carried out in Shree Birendra Hospital, Kathmandu, Nepal, from March 2019 to March 2020. All pregnant women with a previous history of cesarean section meeting Royal College of Obstetrics and Gynecology criteria were included. A trial of labor was conducted on the patients who accepted vaginal birth after cesarean section. Results: A total of 85 cases with previous lower section cesarean section were included in the study. Out of which, 75 (88.2%) refused vaginal birth after cesarean section, and only 10 cases (11.8%) accepted to undergo a trial of labor. Five women (50%) had a successful vaginal birth. Complications were less among the vaginal birth after cesarean section group than the repeat cesarean section group. There was no maternal and neonatal mortality. Conclusions: The acceptance of vaginal birth after cesarean section is very low in this study. No complications were observed among vaginal birth after cesarean section in our study.

Psychological Impacts of COVID-19 During the First Nationwide Lockdown in Vietnam: Web-Based, Cross-Sectional Survey Study (Preprint)

2020 ◽  
Author(s):  
Khanh Ngoc Cong Duong ◽  
Tien Nguyen Le Bao ◽  
Phuong Thi Lan Nguyen ◽  
Thanh Vo Van ◽  
Toi Phung Lam ◽  
...  
Keyword(s):  
Psychological Distress ◽  
General Population ◽  
Psychological Health ◽  
Online Survey ◽  
Survey Study ◽  
Limited Information ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Event Scale ◽  
The Impact

BACKGROUND The first nationwide lockdown due to the COVID-19 pandemic was implemented in Vietnam from April 1 to 15, 2020. Nevertheless, there has been limited information on the impact of COVID-19 on the psychological health of the public. OBJECTIVE This study aimed to estimate the prevalence of psychological issues and identify the factors associated with the psychological impact of COVID-19 during the first nationwide lockdown among the general population in Vietnam. METHODS We employed a cross-sectional study design with convenience sampling. A self-administered, online survey was used to collect data and assess psychological distress, depression, anxiety, and stress of participants from April 10 to 15, 2020. The Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were utilized to assess psychological distress, depression, anxiety, and stress of participants during social distancing due to COVID-19. Associations across factors were explored using regression analysis. RESULTS A total of 1385 respondents completed the survey. Of this, 35.9% (n=497) experienced psychological distress, as well as depression (n=325, 23.5%), anxiety (n=195, 14.1%), and stress (n=309, 22.3%). Respondents who evaluated their physical health as average had a higher IES-R score (beta coefficient [B]=9.16, 95% CI 6.43 to 11.89), as well as higher depression (B=5.85, 95% CI 4.49 to 7.21), anxiety (B=3.64, 95% CI 2.64 to 4.63), and stress (B=5.19, 95% CI 3.83 to 6.56) scores for DASS-21 than those who rated their health as good or very good. Those who self-reported their health as bad or very bad experienced more severe depression (B=9.57, 95% CI 4.54 to 14.59), anxiety (B=7.24, 95% CI 3.55 to 10.9), and stress (B=10.60, 95% CI 5.56 to 15.65). Unemployment was more likely to be associated with depression (B=3.34, 95% CI 1.68 to 5.01) and stress (B=2.34, 95% CI 0.84 to 3.85). Regarding worries about COVID-19, more than half (n=755, 54.5%) expressed concern for their children aged &lt;18 years, which increased their IES-R score (B=7.81, 95% CI 4.98 to 10.64) and DASS-21 stress score (B=1.75, 95% CI 0.27 to 3.24). The majority of respondents (n=1335, 96.4%) were confident about their doctor’s expertise in terms of COVID-19 diagnosis and treatment, which was positively associated with less distress caused by the outbreak (B=–7.84, 95% CI –14.58 to –1.11). CONCLUSIONS The findings highlight the effect of COVID-19 on mental health during the nationwide lockdown among the general population in Vietnam. The study provides useful evidence for policy decision makers to develop and implement interventions to mitigate these impacts. CLINICALTRIAL

scholarly journals COVID-19 Psychological Impact on Health Care Workers in Saudi Arabia

2021 ◽  
Vol 18 (11) ◽  
pp. 6076
Author(s):  
Hasan S. Alamri ◽  
Wesam F. Mousa ◽  
Abdullah Algarni ◽  
Shehata F. Megahid ◽  
Ali Al Bshabshe ◽  
...  
Keyword(s):  
Health Care ◽  
Saudi Arabia ◽  
Health Care Workers ◽  
Psychological Impact ◽  
Psychological Outcomes ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Care Workers ◽  
The Impact

Objective: Little is known about the impact of Coronavirus (COVID-19) among the health care workers in Saudi Arabia. Therefore, the present study aimed to assess the psychological impact of COVID-19 among the health care workers. Methods: A cross-sectional survey was conducted from May till mid-July among 389 health care workers from government and private hospitals in Saudi Arabia. Data was collected using a pre-structured online questionnaire that measured adverse psychological outcomes, including the Patient Health Questionnaire-9 (PHQ-9) scale and the Generalized Anxiety Disorder 7-item (GAD-7) scale. The Pearson chi-square test was used to assess the distribution of depression and anxiety among health care workers. Results: A high level of anxiety was recorded among the health care workers, and 69.3% of health care workers below the age of 40 were found to have depression. There was a significant increase in depression among staff with chronic health problems (72.1% vs. 61.9%; p = 0.048). High anxiety levels were detected among young staff compared to others (68.7% vs. 43.8%; p = 0.001). Moreover, 82.1% of the female staff were anxious, as compared to 55.6% of the males (p = 0.001). Conclusions: We found increased prevalence of adverse psychological outcomes among the health care workers in Saudi Arabia during the outbreak of COVID-19. Therefore, there is a need for proper screening and development of corresponding preventive measures to decrease the adverse psychological outcomes.

Are e-learning Webinars the future of medical education? An exploratory study of a disruptive innovation in the COVID-19 era

2020 ◽  
pp. 1-10
Author(s):  
Colin J. McMahon ◽  
Justin T. Tretter ◽  
Theresa Faulkner ◽  
R. Krishna Kumar ◽  
Andrew N. Redington ◽  
...  
Keyword(s):  
Deep Learning ◽  
Carbon Footprint ◽  
Quantitative Research ◽  
Survey Design ◽  
Hybrid Approach ◽  
Disruptive Innovation ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
E Learning ◽  
The Impact

Abstract Objective: This study investigated the impact of the Webinar on deep human learning of CHD. Materials and methods: This cross-sectional survey design study used an open and closed-ended questionnaire to assess the impact of the Webinar on deep learning of topical areas within the management of the post-operative tetralogy of Fallot patients. This was a quantitative research methodology using descriptive statistical analyses with a sequential explanatory design. Results: One thousand-three-hundred and seventy-four participants from 100 countries on 6 continents joined the Webinar, 557 (40%) of whom completed the questionnaire. Over 70% of participants reported that they “agreed” or “strongly agreed” that the Webinar format promoted deep learning for each of the topics compared to other standard learning methods (textbook and journal learning). Two-thirds expressed a preference for attending a Webinar rather than an international conference. Over 80% of participants highlighted significant barriers to attending conferences including cost (79%), distance to travel (49%), time commitment (51%), and family commitments (35%). Strengths of the Webinar included expertise, concise high-quality presentations often discussing contentious issues, and the platform quality. The main weakness was a limited time for questions. Just over 53% expressed a concern for the carbon footprint involved in attending conferences and preferred to attend a Webinar. Conclusion: E-learning Webinars represent a disruptive innovation, which promotes deep learning, greater multidisciplinary participation, and greater attendee satisfaction with fewer barriers to participation. Although Webinars will never fully replace conferences, a hybrid approach may reduce the need for conferencing, reduce carbon footprint. and promote a “sustainable academia”.

scholarly journals The impact of COVID‐19 on work, training and well‐being experiences of nursing associates in England: A cross‐sectional survey

Nursing Open ◽  
2021 ◽  
Author(s):  
Rachel King ◽  
Tony Ryan ◽  
Michaela Senek ◽  
Emily Wood ◽  
Bethany Taylor ◽  
...  
Keyword(s):  
Well Being ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Work Training ◽  
The Impact
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