Diagnosis and management of postpartum hemorrhage and intrapartum asphyxia in a quality improvement initiative using nurse-mentoring and simulation in Bihar, India.

BackgroundIn the state of Bihar, India a multi-faceted quality improvement nurse-mentoring program was implemented to improve provider skills in normal and complicated deliveries. The objective of this analysis was to examine changes in diagnosis and management of postpartum hemorrhage (PPH) of the mother and intrapartum asphyxia of the infant in primary care facilities in Bihar, during the program.MethodsDuring the program, mentor pairs visited each facility for one week, covering four facilities over a four-week period and returned for subsequent week-long visits once every month for seven to nine consecutive months. Between- and within-facility comparisons were made using a quasi-experimental and a longitudinal design over time, respectively, to measure change due to the intervention. The proportions of PPH and intrapartum asphyxia among all births as well as the proportions of PPH and intrapartum asphyxia cases that were effectively managed were examined. Zero-inflated negative binomial models and marginal structural methodology were used to assess change in diagnosis and management of complications after accounting for clustering of deliveries within facilities as well as time varying confounding.ResultsThis analysis included 55,938 deliveries from 320 facilities. About 2% of all deliveries, were complicated with PPH and 3% with intrapartum asphyxia. Between-facility comparisons across phases demonstrated diagnosis was always higher in the final week of intervention (PPH: 2.5-5.4%, intrapartum asphyxia: 4.2-5.6%) relative to the first week (PPH: 1.2-2.1%, intrapartum asphyxia: 0.7-3.3%). Within-facility comparisons showed PPH diagnosis increased from week 1 through 5 (from 1.6% to 4.4%), after which it decreased through week 7 (3.1%). A similar trend was observed for intrapartum asphyxia. For both outcomes, the proportion of diagnosed cases where selected evidence-based practices were used for management either remained stable or increased over time.ConclusionsThe nurse-mentoring program appears to have built providers' capacity to identify PPH and intrapartum asphyxia cases but diagnosis levels are still not on par with levels observed in Southeast Asia and globally

The Experiences of Mid-career and Seasoned Orchestral Musicians in the UK During the First COVID-19 Lockdown

The introduction of social distancing, as part of efforts to try and curb the spread of the COVID-19 pandemic, has brought about drastic disruption to the world of the performing arts. In the UK the majority of professional orchestral musicians are freelance and therefore self-employed. These players, previously engaged in enjoyable, busy, successful, portfolio careers, are currently unable to earn a living carrying out their everyday work of performing music, and their future working lives are surrounded by great uncertainty. The aim of the present study was to examine how established professional musicians are experiencing this period, and to look for similarities and differences between the experiences of musicians in the middle of their performing careers (aged 35–45), with those of older players (aged 53 and over). Single semi-structured interviews were carried out over Zoom with 24 freelance, self-employed orchestral musicians; 12 mid-career musicians aged 35–45, and 12 seasoned musicians aged 53 and over. Thematic analysis identified themes common to both groups: the loss of a much-loved performing career, missing music making and colleagues, and anxiety about the future of the music profession. It also identified differences between the two groups: challenges to their identity as a musician, the extent of their anxiety about finances, the extent of their emotional distress, attitudes toward practicing and engaging in collaborative music making, and confusion over future career plans. Findings are discussed with reference to lifespan models of musicians' career development, the PERMA model of wellbeing, and the concept of resilience

Tracking and debriefing birth data at scale: A mobile phone application to improve obstetric and neonatal care in Bihar, India.

AimThis analysis assessed changes over time in skill and knowledge related to the use of evidence-based practices associated with quality of maternal and neonatal care during a nurse midwife mentoring intervention at primary health clinics (PHCs) in Bihar, India.DesignNurse midwife mentors (NMMs) entered live birth observation data into a mobile App from 320 PHCs.MethodsThe NMMs completed prompted questions in the App after every live birth witnessed. The App consisted of questions around three main themes, "What went well?", "What needed improvement?" and "What can be done differently next time?".ResultsObservational data from 5,799 births was recorded by 120 NMMs in 320 PHCs. Knowledge and skill during normal spontaneous vaginal deliveries and complicated deliveries with either a postpartum haemorrhage or non-vigorous infant all showed statistically significant improvement (p < .001) over time using a Chi-squared test for trend with a mean increase of 41% across all indicators

The role of personality and self-efficacy in music students’ health-promoting behaviours

Evidence of the high prevalence of physical and psychological problems among professional and student classical musicians has led to investigations of music students’ health-promoting behaviours. These have indicated lower levels of engagement in health-promoting behaviours among music students compared to non-music students and resulted in the recent introduction of health education courses in a number of tertiary music education institutions. Investigations of health-promoting behaviours in a wide range of contexts have shown that personality and general self-efficacy are significantly associated with health-promoting behaviours. Although previous studies of music students’ health-promoting behaviours provide evidence of positive associations between general self-efficacy and health-promoting behaviours, the contribution of personality to health-promoting behaviours and the influence of general self-efficacy on the associations between personality and music students’ health-promoting behaviours have not yet been investigated. The current study examined associations between the personality, general self-efficacy, and health-promoting behaviours of 154 undergraduate music students. Hierarchical regression analyses showed that Conscientiousness was the most consistent significant predictor of health-promoting behaviours. Conscientiousness, Extraversion, and Neuroticism were found to predict general self-efficacy. Mediation analyses were carried out and showed that general self-efficacy mediated the associations between both Conscientiousness and Neuroticism, and health-promoting behaviours. The implications of the findings for future health education courses are discussed.http://msx.sagepub.comhj2021Musi

Can an integrated obstetric emergency simulation training improve respectful maternity care? Results from a pilot study in Ghana

BackgroundFew evidence‐based interventions exist on how to improve respectful maternity care (RMC) in low‐resource settings. We sought to evaluate the effect of an integrated simulation‐based training on provision of RMC.MethodsThe pilot project was in East Mamprusi District in northern Ghana. We integrated specific components of RMC, emphasizing dignity and respect, communication and autonomy, and supportive care, into a simulation training to improve identification and management of obstetric and neonatal emergencies. Forty‐three providers were trained. For evaluation, we conducted surveys at baseline (N = 215) and endline (N = 318) 6 months later, with recently delivered women to assess their experiences of care using the person‐centered maternity care scale. Higher scores on the scale represent more respectful care.ResultsCompared to the baseline, women in the endline reported more respectful care. The average person‐centered maternity care score increased from 50 at baseline to 72 at endline, a relative increase of 43%. Scores on the subscales also increased between baseline and endline: 15% increase for dignity and respect, 87% increase for communication and autonomy, and 55% increase for supportive care. These differences remained significant in multivariate analysis controlling for several potential confounders.ConclusionsThe findings suggest that integrated provider trainings that give providers the opportunity to learn, practice, and reflect on their provision of RMC in the context of stressful emergency obstetric simulations have the potential to improve women’s childbirth experiences in low‐resource settings. Incorporating such trainings into preservice and in‐service training of providers will help advance global efforts to promote RMC.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151352/1/birt12418.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151352/2/birt12418_am.pd