The effect of briefing videos in medical simulation-based education:a randomised controlled trial

The aim of this study is to compare the effects of an affective briefing video with a textual briefing on cognitive appraisal (threat or challenge response). It is hypothesized that briefing videos will cause a threat response, which is associated with increase in cortisol and memory consolidation

The impact of transmural multiprofessional simulation-based obstetric team training on perinatal outcome and quality of care in the Netherlands

Background Perinatal mortality and morbidity in the Netherlands is relatively high compared to other European countries. Our country has a unique system with an independent primary care providing care to low-risk pregnancies and a secondary/tertiary care responsible for high-risk pregnancies. About 65% of pregnant women in the Netherlands will be referred from primary to secondary care implicating multiple medical handovers. Dutch audits concluded that in the entire obstetric collaborative network process parameters could be improved. Studies have shown that obstetric team training improves perinatal outcome and that simulation-based obstetric team training implementing crew resource management (CRM) improves team performance. In addition, deliberate practice (DP) improves medical skills. The aim of this study is to analyse whether transmural multiprofessional simulation-based obstetric team training improves perinatal outcome. Methods/Design The study will be implemented in the south-eastern part of the Netherlands with an annual delivery rate of over 9,000. In this area secondary care is provided by four hospitals. Each hospital with referring primary care practices will form a cluster (study group). Within each cluster, teams will be formed of different care providers representing the obstetric collaborative network. CRM and elements of DP will be implemented in the training. To analyse the quality of care as perceived by patients, the Pregnancy and Childbirth Questionnaire (PCQ) will be used. Furthermore, self-reported collaboration between care providers will be assessed. Team performance will be measured by the Clinical Teamwork Scale (CTS). We employ a stepped-wedge trial design with a sequential roll-out of the trainings for the different study groups. Primary outcome will be perinatal mortality and/or admission to a NICU. Secondary outcome will be team performance, quality of care as perceived by patients, and collaboration among care providers. Conclusion The effect of transmural multiprofessional simulation-based obstetric team training on perinatal outcome has never been studied. We hypothesise that this training will improve perinatal outcome, team performance, and quality of care as perceived by patients and care providers

Validation of a short form Three Facet Mindfulness Questionnaire (TFMQ-SF) in pregnant women

Emotional distress during pregnancy has been frequently related to adverse outcomes, not only for the pregnant woman but also for the developing fetus. Self-reported mindfulness has been associated with several indices of well-being such as life satisfaction, physical well-being, and mental health. This study focused on the relationship between self-reported mindfulness and psychological distress (depressive symptomatology and pregnancy-related distress) in pregnant women, as research on this association during pregnancy is largely lacking. In this study, a brief Three-Facet Mindfulness Questionnaire (TFMQ-SF) was tested and validated using explorative factor analysis (EFA) and confirmative factor analysis (CFA) in two large samples of pregnant women from the same study (total N = 905). The TFMQ-SF showed adequate psychometric properties and correlated negatively with symptoms of depression and pregnancy-related distress, with medium to large effect sizes. This study showed the 12-item TFMQ-SF to be a valid instrument to evaluate self-reported mindfulness in pregnant women. Keywords: Mindfulness, Questionnaire, Self-report, Validation, Distress, Pregnanc

Hormonal and psychological factors in nausea and vomiting during pregnancy

Background The aetiology of nausea and vomiting during pregnancy (NVP) is multifactorial, but the relative contribution of biological and psychological determinants is insufficiently understood. We examined the association of human chorionic gonadotropin (hCG), thyroid hormones (thyroid-stimulating hormone and thyroxin) and psychological factors with NVP. Methods Blood chemistry and psychological measures were obtained in 1682 pregnant women participating in the Holistic Approach to Pregnancy and the first Postpartum Year (HAPPY) study between 12 and 14 weeks of gestation. The presence of NVP was measured using the Pregnancy-Unique Quantification of Emesis scale. Depressive symptoms were assessed using the Edinburgh Depression Scale. Multivariable logistic regression analyses were used to investigate the independent role of hCG, thyroid hormones and depression as related to NVP, adjusting for age, body mass index, education, parity, smoking status, unplanned pregnancy and history of depression. Results Elevated levels of NVP were observed in 318 (18.9%) participants. High hCG levels [odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.11–1.95], elevated depressive symptoms in the first trimester (OR = 1.67, 95% CI = 1.15–2.43) and a history of depression (OR = 1.53, 95% CI = 1.11–2.11) were independently related to high NVP. Multiparity (OR = 1.47, 95% CI = 1.12–1.92) and younger age (OR = 0.91, 95% CI = 0.87–0.94) were also associated with high NVP, whereas (sub)clinical hyperthyroidism was not related to high NVP. Conclusions The current study is the first to demonstrate that a combination of hCG hormone and psychological factors are independently related to nausea and vomiting during early pregnanc

Different patterns of depressive symptoms during pregnancy

Recently, the US Preventive Services Task Force has advocated to screen pregnant and postpartum women for depression. However, we questioned the meaning of a single elevated depression score: does it represent just one episode of depression or do these symptoms persist throughout the entire pregnancy? This study assessed depressive symptoms at each trimester in a cohort of 1813 pregnant women and evaluated whether women with different patterns of depressive symptoms showed other characteristics. Depending on the trimester, elevated depression scores were prevalent in 10–15% of the pregnant women. Up to 4% reported persistent symptoms of depression throughout pregnancy. Different patterns of depressive symptoms were observed, for which persistent symptoms were related to other characteristics than incidentally elevated symptoms. Besides a previous history of mental health problems as best overall predictor, incidentally elevated depression scores were related to major life events. Furthermore, persistently depressive symptoms were related to unplanned pregnancy and multiparity. An EDS assessment at 12 weeks of gestation including three additional items (history of mental health problems, unplanned pregnancy and multiparity) enabled us to identify 83% of the women with persistent depressive symptoms. A depression screening strategy in pregnant women should take into account the potential chronicity of depressive symptoms by repeated assessments in order to offer an intervention to the most vulnerable women. Keywords: Depression, Depressive symptoms, Pregnancy, EDS, Questionnaire assessment

Antenatal mother–infant bonding scores are related to maternal reports of infant crying behaviour

Objective: To assess the relation between antenatal mother–infant bonding scores and maternal reports of infant crying behaviour. Background: Crying is normal behaviour and it is important for parent–infant bonding. Even though bonding starts antenatally, the relation between antenatal bonding scores and infant crying behaviour has never been studied. Method: A secondary analysis was performed on data that were gathered in a large prospective study within our region. Bonding was assessed using an antenatal bonding questionnaire at 32 weeks gestational age. The crying behaviour of infants was assessed with three questions at six weeks postpartum. Crying was termed excessive (EC+) when mothers perceived the crying to be ‘every day’, ‘often’ or ‘very often’, and with ‘crying episodes lasting more than 30 minutes’; in other words, when mothers scored high on all three questions. The relation between bonding and crying was examined using a multiple logistic regression analysis, including adjustment for relevant variables, especially maternal depression as measured with the Edinburgh Depression Scale. Results: In total, 894 women were included of whom 47 reported EC+ infants (5.3%). Antenatal bonding scores were significantly related to the reporting of crying behaviour, even after adjustment for relevant variables (p = 0.02). Each extra point on the bonding scale reduced the EC+ risk with 14% (OR = 0.86, 95% CI [0.76–0.97]). Conclusion: Mothers with lower antenatal bonding scores were more likely to report an EC+ infant. Future research should further explore the concept of antenatal bonding, its relation with EC and risks associated with EC. Keywords: Antenatal, mother–infant, bonding, crying, depressio

A new concept of maternity blues: Is there a subgroup of women with rapid cycling mood symptoms?

Background Rapid cycling mood symptoms during the first postpartum week are an important aspect of maternity blues. The aim of this study is to identify women with these rapid cycling mood symptoms in the general population and to investigate possible risk factors of these symptoms. Methods The Maternity Blues Scale (MBS) was validated in The Netherlands in 949 women at one week postpartum. Personal and family history of mood disorders and obstetric demographics were collected and the Edinburgh Postnatal Depression Scale (EPDS) was completed. A 16-item three-factor MBS solution was found: depression, negative and positive affect. The latter two were used to define a rapid cycling mood symptoms group. Results Using the 75th percentile cut-off, 20 (2%) women reported high negative/high positive affect (rapid cycling mood group) and 65 (7%) women were depressed (EPDS≥11). A previous episode of depression, major life events and instrumental delivery were independently related to depression (OR 3.5, 2.5 and 2.3, respectively) while only a history of depression in first-degree relatives was independently related to rapid cycling mood (OR 3.4, 95% CI 1.2–9.8). Limitations First, no syndromal diagnoses were obtained for depression and rapid cycling mood disorder. Second, history of depression was self-reported (not based on structural psychiatric interviews). Third, our study was not designed to study the longitudinal follow-up of women with rapid cycling mood symptoms. Conclusion the 16-item MBS could be useful in screening programs in detecting postpartum women at risk for (severe) mood disorders. Postpartum women with ‘rapid cycling mood symptoms’ can be identified with a possible more familiar form of mood disorder. Keywords: Maternity blues, Postpartum, Depression, Rapid cycling mood, Self-assessment, Questionnair

Development of the Pregnancy and Childbirth Questionnaire (PCQ):Evaluating quality of care as perceived by women who recently gave birth

Objective To develop an instrument to the assess quality of care during pregnancy and delivery as perceived by women who recently gave birth. Study design Prospective design from focus group interviews to validation of the questionnaire. The focus groups consisted of seven care providers, ten pregnant women and six women who recently gave birth. With the results of the focus group interviews, a draft questionnaire of 52 items was composed and its psychometric properties were tested in a first cohort of 300 women who recently gave birth (sample I) by means of exploratory factor analysis (EFA) and reliability analysis. The final version was further explored by confirmatory factor analyses (CFA) in another sample of 289 women (sample II) with similar characteristics as sample I. Results EFA in sample I suggested an 18-item scale with two components concerning the quality of care during pregnancy: ‘personal treatment’ (11 items, Cronbach's alpha (α) = 0.87) and ‘educational information’ (7 items, α = 0.90); the ‘delivery’ scale showed a single domain (7 items, α = 0.88). CFA in sample II confirmed both factor structures with an adequate model fit. Overall, satisfaction with care was highest among women who only received midwife-led care, while women who were referred to an obstetrician during pregnancy reported less satisfaction. Conclusions The 25-item PCQ, primarily based on the experiences and perceptions of pregnant women and women who recently gave birth, showed adequate psychometric properties evaluating the quality of care during pregnancy and delivery. This user-friendly instrument might be a valuable instrument for future research to further evaluate the quality of care to pregnant women. Keywords: Patient perspective, Satisfaction, Quality of care, Pregnancy, Childbirt

Development of a Pre- and Postnatal Bonding Scale (PPBS)

Objective: Bonding is a major topic in the field of developmental psychology, due to its importance in adequate childhood development. Studies investigating the relationship between pre- and postnatal bonding show moderate correlations. However, an important limitation is that no similar instruments were used to measure bonding pre- and post-natally. In the current study, a user-friendly questionnaire has been developed to assess maternal bonding during pregnancy and postpartum. Psychometric properties were also investigated. Methods: In a large unselected sample of 1050 pregnant women, 14 positive items, based on the literature, were used to construct a pre- and postnatal bonding scale (PPBS) questionnaire. The sample was randomly split into two equal sub-samples: group I was used for reliability and Exploratory Factor Analysis; group II for Confirmatory Factor Analysis (CFA). The bonding scale was assessed at 32 weeks pregnancy and at eight and 12 months postpartum. The Edinburgh Depression Scale (EDS) and the subscale Partner Involvement of the Tilburg Pregnancy Distress Scale (TPDS) were used to assess concurrent validity. Results: After CFA, a five-item bonding scale remained with excellent model fit (CFI: 0.97, TLI: 0.97, NFI: 0.98; RMSEA: 0.06 lower bound 0.03. Cronbach’s alpha’s at 32 weeks gestation and at eight and 12 months' postpartum were: 0.87, 0.80 and 0.79, respectively. Test-retest correlations of the PPBS at 32 weeks gestation and at eight and 12 months postpartum were high: 0.42 and 0.41 and 0.67 between eight and 12 months post-partum, respectively. At 32 weeks gestation, the PPBS correlated significantly with partner support (TPDS): 0.38 and depression (EDS): -0.24. Similar correlations with depression were found at eight and 12 months post-partum. Conclusion: The five-item PPBS seems to be a user-friendly self-rating scale with good psychometric properties and concurrent validity, both pre- and post-natally