Decision aids to improve informed decision-making in pregnancy care: a systematic review

Rapid development in health care has resulted in an increasing number of screening and treatment options. Consequently, there is an urgency to provide people with relevant information about benefits and risks of healthcare options in an unbiased way. Decision aids help people to make decisions by providing unbiased non-directive research evidence about all treatment options. To determine the effectiveness of decision aids to improve informed decision making in pregnancy care. We searched MEDLINE (1953-2011), EMBASE (1980-2011), CENTRAL (CENTRAL, the Cochrane Library; 2011, Issue 4), Psycinfo (1806-2011) and Research Registers of ongoing trials (www.clinicaltrials.gov, www.controlled-trials.com). We included randomised controlled trials comparing decision aids in addition to standard care. The study population needed to be pregnant women making actual decisions concerning their pregnancy. Two independent researchers extracted data on quality of the randomised controlled trial (GRADE criteria), quality of the decision aid (IPDAS criteria), and outcome measures. Data analysis was undertaken by assessing group differences at first follow up after the interventions. Ten randomised controlled trials could be included. Pooled analyses showed that decision aids significantly increased knowledge, (weighted mean difference 11.06, 95% confidence interval 4.85-17.27), decreased decisional conflict scores (weighted mean difference -3.66, 95% confidence interval -6.65 to -0.68) and decreased anxiety (weighted mean difference -1.56, 95% confidence interval -2.75 to -0.43). Our systematic review showed the positive effect of decision aids on informed decision making in pregnancy care. Future studies should focus on increasing the uptake of decision aids in clinical practice by identifying barriers and facilitators to implementatio

Atosiban versus fenoterol as a uterine relaxant for external cephalic version: randomised controlled trial

Objective To compare the effectiveness of the oxytocin receptor antagonist atosiban with the beta mimetic fenoterol as uterine relaxants in women undergoing external cephalic version (ECV) for breech presentation. Design Multicentre, open label, randomised controlled trial. Setting Eight hospitals in the Netherlands, August 2009 to May 2014. Participants 830 women with a singleton fetus in breech presentation and a gestational age of more than 34 weeks were randomly allocated in a 1:1 ratio to either 6.75 mg atosiban (n=416) or 40 μg fenoterol (n=414) intravenously for uterine relaxation before ECV. Main outcome measures The primary outcome measures were a fetus in cephalic position 30 minutes after the procedure and cephalic presentation at delivery. Secondary outcome measures were mode of delivery, incidence of fetal and maternal complications, and drug related adverse events. All analyses were done on an intention-to-treat basis. Results Cephalic position 30 minutes after ECV occurred significantly less in the atosiban group than in the fenoterol group (34% v 40%, relative risk 0.73, 95% confidence interval 0.55 to 0.93). Presentation at birth was cephalic in 35% (n=139) of the atosiban group and 40% (n=166) of the fenoterol group (0.86, 0.72 to 1.03), and caesarean delivery was performed in 60% (n=240) of women in the atosiban group and 55% (n=218) in the fenoterol group (1.09, 0.96 to 1.20). No significant differences were found in neonatal outcomes or drug related adverse events. Conclusions In women undergoing ECV for breech presentation, uterine relaxation with fenoterol increases the rate of cephalic presentation 30 minutes after the procedure. No statistically significant difference was found for cephalic presentation at delivery

Atosiban versus fenoterol as a uterine relaxant for external cephalic version: randomised controlled trial

Objective, To compare the effectiveness of the oxytocin receptor antagonist atosiban with the beta mimetic fenoterol as uterine relaxants in women undergoing external cephalic version, ECV, for breech presentation. Design, Multicentre, open label, randomised controlled trial. Setting, Eight hospitals in the Netherlands, August, to May, . Participants, women with a singleton fetus in breech presentation and a gestational age of more than, weeks were randomly allocated in a, ratio to either, ., mg atosiban, n, or, μg fenoterol, n, intravenously for uterine relaxation before ECV. Main outcome measures, The primary outcome measures were a fetus in cephalic position, minutes after the procedure and cephalic presentation at delivery. Secondary outcome measures were mode of delivery, incidence of fetal and maternal complications, and drug related adverse events. All analyses were done on an intention-to-treat basis. Results, Cephalic position, minutes after ECV occurred significantly less in the atosiban group than in the fenoterol group, v, relative risk, ., confidence interval, ., to, ., . Presentation at birth was cephalic in, n, of the atosiban group and, n, of the fenoterol group, ., ., to, ., and caesarean delivery was performed in, n, of women in the atosiban group and, n, in the fenoterol group, ., ., to, ., . No significant differences were found in neonatal outcomes or drug related adverse events. Conclusions, In women undergoing ECV for breech presentation, uterine relaxation with fenoterol increases the rate of cephalic presentation, minutes after the procedure. No statistically significant difference was found for cephalic presentation at delivery.Joost Velzel, Floortje Vlemmix, Brent C Opmeer, Jan F M Molkenboer, Corine J Verhoeven, Mariëlle G van Pampus, Dimitri N M Papatsonis, Joke M J Bais, Karlijn C Vollebregt, Liesbeth van der Esch, Joris A M Van der Post, Ben Willem Mol, Marjolein Ko

Successful implementation of new technologies in nursing care: a questionnaire survey of nurse-users

<p>Abstract</p> <p>Background</p> <p>A growing number of new technologies are becoming available within nursing care that can improve the quality of care, reduce costs, or enhance working conditions. However, such effects can only be achieved if technologies are used as intended. The aim of this study is to gain a better understanding of determinants influencing the success of the introduction of new technologies as perceived by nursing staff.</p> <p>Methods</p> <p>The study population is a nationally representative research sample of nursing staff (further referred to as the Nursing Staff Panel), of whom 685 (67%) completed a survey questionnaire about their experiences with recently introduced technologies. Participants were working in Dutch hospitals, psychiatric organizations, care organizations for mentally disabled people, home care organizations, nursing homes or homes for the elderly.</p> <p>Results</p> <p>Half of the respondents were confronted with the introduction of a new technology in the last three years. Only half of these rated the introduction of the technology as positive.</p> <p>The factors most frequently mentioned as impeding actual use were related to the (kind of) technology itself, such as malfunctioning, ease of use, relevance for patients, and risks to patients. Furthermore nursing staff stress the importance of an adequate innovation strategy.</p> <p>Conclusions</p> <p>A prerequisite for the successful introduction of new technologies is to analyse determinants that may impede or enhance the introduction among potential users. For technological innovations special attention has to be paid to the (perceived) characteristics of the technology itself.</p

Breech presentation at term and associated obstetric risks factors-a nationwide population based cohort study

Purpose The aim of this study was to estimate whether breech presentation at term was associated with known individual obstetric risk factors for adverse fetal outcome. Methods This was a retrospective, nationwide Finnish population-based cohort study. Obstetric risks in all breech and vertex singleton deliveries at term were compared between the years 2005 and 2014. A multivariable logistic regression model was used to determine significant risk factors. Results The breech presentation rate at term for singleton pregnancies was 2.4%. The stillbirth rate in term breech presentation was significantly higher compared to cephalic presentation (0.2 vs 0.1%). The odds ratios (95% CIs) for fetal growth restriction, oligohydramnios, gestational diabetes, a history of cesarean section and congenital fetal abnormalities were 1.19 CI (1.07-1.32), 1.42 CI (1.27-1.57), 1.06 CI (1.00-1.13), 2.13 (1.98-2.29) and 2.01 CI (1.92-2.11). Conclusions The study showed that breech presentation at term on its own was significantly associated with antenatal stillbirth and a number of individual obstetric risk factors for adverse perinatal outcomes. The risk factors included oligohydramnios, fetal growth restriction, gestational diabetes, history of caesarean section and congenital anomalies.Peer reviewe

Maternal thyroid function and the outcome of external cephalic version: a prospective cohort study

Background To investigate the relation between maternal thyroid function and the outcome of external cephalic version (ECV) in breech presentation. Methods Prospective cohort study in 141 women (= 35 weeks gestation) with a singleton fetus in breech. Blood samples for assessing thyroid function were taken prior to ECV. Main outcome measure was the relation between maternal thyroid function and ECV outcome indicated by post ECV ultrasound. Results ECV success rate was 77/141 (55%), 41/48 (85%) in multipara and 36/93 (39%) in primipara. Women with a failed ECV attempt had significantly higher TSH concentrations than women with a successful ECV (p <0.001). Multiple logistic regression showed that TSH (OR: 0.52, 95% CI: 0.30-0.90), nulliparity (OR: 0.11, 95% CI: 0.03-0.36), frank breech (OR: 0.30, 95% CI: 0.10-0.93) and placenta anterior (OR: 0.31, 95% CI: 0.11-0.85) were independently related to ECV success. Conclusions Higher TSH levels increase the risk of ECV failure

The Knight of Malta

BACKGROUND: For most women, participation in decision-making during maternity care has a positive impact on their childbirth experiences. Shared decision-making (SDM) is widely advocated as a way to support people in their healthcare choices. The aim of this study was to identify quality criteria and professional competencies for applying shared decision-making in maternity care. We focused on decision-making in everyday maternity care practice for healthy women. METHODS: An international three-round web-based Delphi study was conducted. The Delphi panel included international experts in SDM and in maternity care: mostly midwives, and additionally obstetricians, educators, researchers, policy makers and representatives of care users. Round 1 contained open-ended questions to explore relevant ingredients for SDM in maternity care and to identify the competencies needed for this. In rounds 2 and 3, experts rated statements on quality criteria and competencies on a 1 to 7 Likert-scale. A priori, positive consensus was defined as 70% or more of the experts scoring >/=6 (70% panel agreement). RESULTS: Consensus was reached on 45 quality criteria statements and 4 competency statements. SDM in maternity care is a dynamic process that starts in antenatal care and ends after birth. Experts agreed that the regular visits during pregnancy offer opportunities to build a relationship, anticipate situations and revisit complex decisions. Professionals need to prepare women antenatally for unexpected, urgent decisions in birth and revisit these decisions postnatally. Open and respectful communication between women and care professionals is essential; information needs to be accurate, evidence-based and understandable to women. Experts were divided about the contribution of professional advice in shared decision-making and about the partner's role. CONCLUSIONS: SDM in maternity care is a dynamic process that takes into consideration women's individual needs and the context of the pregnancy or birth. The identified ingredients for good quality SDM will help practitioners to apply SDM in practice and educators to prepare (future) professionals for SDM, contributing to women's positive birth experience and satisfaction with care

Improving management of breech presentation at term

Dit proefschrift gaat over het verbeteren van het beleid rondom de uitwendige versie voor stuitliggingen. De uitwendige versie is de enige behandeling om stuitligging bij de geboorte te voorkomen en dient derhalve aan elke zwangere met een stuitligging te worden aangeboden. Het eerste deel beschrijft het belang van de behandeling: succesvolle versies leiden tot minder vaginale stuitbevallingen en minder keizersneden. Dit leidt tot minder maternale en neonatale morbiditeit en mortaliteit in de huidige en volgende zwangerschappen. In deel twee en deel drie staat de implementatie van de uitwendige versie centraal. Eerst wordt beschreven hoe nieuwe implementatie strategieën zijn ontwikkeld op basis van een kwalitatieve en kwantitatieve determinanten analyse. De gemiddelde implementatiegraad in Nederland bleek behoorlijk goed (72%), maar er waren grote regionale verschillen. De ontwikkelde strategieën moesten er toe leiden dat de kern aanbevelingen uit de Nederlands richtlijnen die gaan over stuitligging en uitwendige versie (NVOG, stuitligging 2.0 en KNOV, standpunt uitwendige versie) beter worden nageleefd. Evaluatie in een cluster gerandomiseerd onderzoek liet geen significant verschil tussen de implementatie strategieën op het aantal verrichtte versiepogingen. De evaluatie van de onderzoeksresultaten in een kosteneffectiviteitsstudie wijzen in de richting van een potentieel effect van de gecombineerde cliënt en zorgverlener strategie. Het effect van deze strategie dient verder onderzocht te worden in die clusters met een lage implementatiegraad. Om deze clusters te identificeren is een landelijke registratie van de uitwendige versie een vereiste