Postpartum Hemorrhage: Improving Patient Outcomes With Improved Communication and Post-Drill Debriefing

Abstract Background: A woman is at risk of dying from postpartum hemorrhage every four minutes. Maternal hemorrhage is found to be the direct cause of maternal mortality, overall accounting for 27% to 75% of maternal deaths worldwide. In the United States, 54% to 93% of maternal mortality could have been prevented. Postpartum hemorrhage remains among the top causes of pregnancy-related deaths worldwide. The purpose of this project is to educate providers of obstetrical care regarding best practices for effective communication during a postpartum hemorrhage by implementing a debriefing educational tool during postpartum hemorrhage mock code drills. Methods: The postpartum hemorrhage team review and debriefing form were implemented during mock postpartum hemorrhage code drills to improve debriefing after critical events. Five educational sessions which lasted ten minutes each along with a pre-survey for recruitment were offered prior to mock postpartum hemorrhage code drills about debriefing. The communication was evaluated after the mock postpartum hemorrhage code drills using the Clinical Teamwork Scale (CTS). Results: Twenty-five nurses participated in the pre-brief survey (n = 25). There were 3 groups of nurses for the 3 mock postpartum hemorrhage code drills, which included 11 nurses (n = 11). The groups rated their performance/teamwork using the itemized tasks after the mock code trainings. Conclusion: Structured debriefing was shown to improve skills and increase knowledge concerning interventions in an emergency. Improved knowledge and confidence with debriefing can lead to improved performance during an actual postpartum hemorrhage. Communication and collaboration during an emergency were shown to improve patient outcomes. Keywords: postpartum hemorrhage, postpartum hemorrhage risk factors, postpartum hemorrhage debriefing, postpartum hemorrhage management, treatment

Quality of life in multiple sclerosis: translation in French Canadian of the MSQoL-54.

Background: Multiple Sclerosis (MS) is a neurodegenerative disease which runs its course for the remainder of the patient's life frequently causing disability of varying degrees. Negative effects on Health-related quality of life (HRQOL) are well documented and a subject of clinical study. The Multiple Sclerosis QOL 54 (MSQOL-54) questionnaire was developed to measure HRQOL in patients with MS. It is composed of 54 items, and is a combination of the SF-36 and 18 diseasespecific items. Objective: The objective of this project was to translate the MSQOL-54 into French Canadian, and to make it available to the Canadian scientific community for clinical research and clinical practice. Methods: Across all French speaking regions, there are occurrences of variation. They include the pronunciation, sentence structure, and the lexicon, where the differences are most marked. For this reason, it was decided to translate the US original MSQOL-54 into French Canadian instead of adapting the existing French version. The SF-36 has been previously validated and published in French Canadian, therefore the translation work was performed solely on the 18 MS specific items. The translation followed an internationally accepted methodology into 3 steps: forward translation, backward translation, and patients' cognitive debriefing. Results: Instructions and Items 38, 43, 45 and 49 were the most debated. Problematic issues mainly resided in the field of semantics. Patients' testing (n = 5) did not reveal conceptual problems. The questionnaire was well accepted, with an average time for completion of 19 minutes. Conclusion: The French Canadian MSQOL-54 is now available to the Canadian scientific community and will be a useful tool for health-care providers to assess HRQOL of patients with MS as a routine part of clinical practice. The next step in the cultural adaptation of the MSQOL-54 in French Canadian will be the evaluation of its psychometric properties.The authors gratefully acknowledge the grant provided for this study by Aventis Pharma Canada, and Dr Barbara Vickrey for her support

Health Status transitions in community-living elderly with complex care needs: a latent class approach.

ckground: For older persons with complex care needs, accounting for the variability and interdependency in how health dimensions manifest themselves is necessary to understand the dynamic of health status. Our objective is to test the hypothesis that a latent classification can capture this heterogeneity in a population of frail elderly persons living in the community. Based on a person-centered approach, the classification corresponds to substantively meaningful groups of individuals who present with a comparable constellation of health problems. Methods: Using data collected for the SIPA project, a system of integrated care for frail older people (n = 1164), we performed latent class analyses to identify homogenous categories of health status (i.e. health profiles) based on 17 indicators of prevalent health problems (chronic conditions; depression; cognition; functional and sensory limitations; instrumental, mobility and personal care disability) Then, we conducted latent transition analyses to study change in profile membership over 2 consecutive periods of 12 and 10 months, respectively. We modeled competing risks for mortality and lost to follow-up as absorbing states to avoid attrition biases. Results: We identified four health profiles that distinguish the physical and cognitive dimensions of health and capture severity along the disability dimension. The profiles are stable over time and robust to mortality and lost to follow-up attrition. The differentiated and gender-specific patterns of transition probabilities demonstrate the profiles' sensitivity to change in health status and unmasked the differential relationship of physical and cognitive domains with progression in disability. Conclusion: Our approach may prove useful at organization and policy levels where many issues call for classification of individuals into pragmatically meaningful groups. In dealing with attrition biases, our analytical strategy could provide critical information for the planning of longitudinal studies of aging. Combined, these findings address a central challenge in geriatrics by making the multidimensional and dynamic nature of health computationally tractable.This research was funded through a PhD dissertation grant supplied to the first author by the Quebec Network for Research on Aging

Community exchange and time currencies: a systematic and in-depth thematic review of impact on public health outcomes.

OBJECTIVES: Austerity in government funding, and public service reform, has heightened expectations on UK communities to develop activities and resources supportive of population health and become part of a transformed place-based system of community health and social care. As non-monetary place-based approaches, Community Exchange/Time Currencies could improve social contact and cohesion, and help mobilise families, neighbourhoods, communities and their assets in beneficial ways for health. Despite this interest, the evidence base for health outcomes resulting from such initiatives is underdeveloped. STUDY DESIGN: A systematic review. METHODS: A literature review was conducted to identify evidence gaps and advance understanding of the potential of Community Exchange System. Studies were quality assessed, and evidence was synthesised on 'typology', population targeted and health-related and wider community outcomes. RESULTS: The overall study quality was low, with few using objective measures of impact on health or well-being, and none reporting costs. Many drew on qualitative accounts of impact on health, well-being and broader community outcomes. Although many studies lacked methodological rigour, there was consistent evidence of positive impacts on key indicators of health and social capital, and the data have potential to inform theory. CONCLUSIONS: Methodologies for capturing impacts are often insufficiently robust to inform policy requirements and economic assessment, and there remains a need for objective, systematic evaluation of Community Exchange and Time Currency systems. There is also a strong argument for deeper investigation of 'programme theories' underpinning these activities, to better understand what needs to be in place to trigger their potential for generating positive health and well-being outcomes

Constructing Integrable Third Order Systems:The Gambier Approach

We present a systematic construction of integrable third order systems based on the coupling of an integrable second order equation and a Riccati equation. This approach is the extension of the Gambier method that led to the equation that bears his name. Our study is carried through for both continuous and discrete systems. In both cases the investigation is based on the study of the singularities of the system (the Painlev\'e method for ODE's and the singularity confinement method for mappings).Comment: 14 pages, TEX FIL

Developing Age-Friendly Cities: An evidence-based evaluation tool

Recent years have seen a proliferation of initiatives aimed at enhancing the age-friendliness of urban settings. The World Health Organization's (WHO) global Age-Friendly Cities (AFC) programme has been central to these. Cities seeking to become more age-friendly need reliable ways of assessing their efforts. This article describes an evidence-based evaluation tool for age-friendly initiatives whose development was informed by fieldwork in Liverpool/UK. The tool complements existing assessment frameworks, including those provided by WHO, by paying particular attention to the structures and processes underlying age-friendly initiatives. It reflects the complexity of age-friendliness by reconciling a focus on breadth with detail and depth, and it allows for a highly accessible visual presentation of findings. Using selected examples from Liverpool, the article illustrates how the evaluation tool can be applied to guide policy and practice with an age-friendly focus in different urban contexts. Pilot testing in further settings is underway to refine the tool as a practical method for evaluation and for supporting city-level decision making. Key words: Age-Friendly City; evaluation tool; ageing; urbanisation; complex intervention

What is a population-level approach to prevention, and how could we apply it to dementia risk reduction?

The World Health Organisation's 2022 ‘blueprint for dementia research’ highlights the need for more research into population-level risk reduction. However, definitions of population-level prevention vary, and application to dementia is challenging because of its multi-factorial aetiology and a maturing prevention evidence base. This paper compares and contrasts key concepts of ‘population-level prevention’ from the literature, explores related theoretical models and policy frameworks, and applies this to dementia risk reduction. We reach a proposed definition of population-level risk reduction of dementia, which focusses on the need to change societal conditions such that the population is less likely to develop modifiable risk factors known to be associated with dementia, without the need for high-agency behaviour change by individuals. This definition, alongside identified policy frameworks, can inform synthesis of existing evidence and help to co-ordinate the generation of new evidence

Linearisable Mappings and the Low-Growth Criterion

We examine a family of discrete second-order systems which are integrable through reduction to a linear system. These systems were previously identified using the singularity confinement criterion. Here we analyse them using the more stringent criterion of nonexponential growth of the degrees of the iterates. We show that the linearisable mappings are characterised by a very special degree growth. The ones linearisable by reduction to projective systems exhibit zero growth, i.e. they behave like linear systems, while the remaining ones (derivatives of Riccati, Gambier mapping) lead to linear growth. This feature may well serve as a detector of integrability through linearisation.Comment: 9 pages, no figur

Manifeste à propos des femmes en STIM : 50 textes positifs et percutants

En 2022, qu’en est-il de la situation des femmes en STIM (sciences, technologies, ingénierie, mathématiques) ? Le Manifeste à propos des femmes en STIM propose 50 textes qui s’adressent à l’ensemble de la population. Il rassemble les réflexions de plusieurs auteures, auteurs et regroupements issus des milieux scolaires, universitaires et privés qui oeuvrent à propos des femmes en STIM dans la francophonie canadienne. Ce Manifeste se veut positif et percutant, même s’il reste du chemin à faire vers l’équité et la parité. Plusieurs enjeux de taille demeurent d’actualité, comme la conciliation travail-famille et la maternité sans pénalité. Des enjeux comme l’intersectionnalité, l’EDI (équité, diversité et inclusion) et l’impact de la pandémie de COVID-19 sur les femmes en STIM sont également explorés. Soulignons les textes proposés à l’intersection entre les STIM et les domaines de la santé, des arts, de l’éducation et de la philosophie. D’autres textes montrent la préoccupation pour les femmes doublement minorisées, comme les femmes autochtones et les femmes non hétérosexuelles dans les domaines des STIM. Des pionnières témoignent de leur cheminement pavé d’obstacles, mais aussi de plaisirs. Sept recommandations sont proposées pour une société qui vise l’équité, la diversité et l’inclusion des femmes en STIM dans une perspective intersectionnelle

Midlife Approaches to Prevention of Ill Health in Later Life

This work was funded by the National Institute for Health and Care Excellence (NICE), invitation to tender reference DDER 42013, and supported by the National Institute for Health Research School for Public Health Research (NIHR SPHR) Ageing Well Programme