Making it happen, level 2

Invited Commentar

WHO expert consultation on new and emeging evidence on the use of antiretroviral drugs for the prevention of mother-to-child transmission of HIV

publishedVersio

An Abrupt Transition to Digital Teaching—Norwegian Medical Students and Their Experiences of Learning Output during the Initial Phase of the COVID-19 Lockdown

Norwegian universities closed almost all on-campus activities on the 12 March 2020 following a lockdown decision of the Norwegian government in response to the COVID-19 pandemic. Online and digital teaching became the primary method of teaching. The goal of this study was to investigate how the transition to digital education impacted on medical students enrolled at the University of Bergen (UiB). Key points were motivation, experience of learning outcomes, and fear of missing out on important learning. Using an online questionnaire, students were asked to evaluate the quality of both lectures and taught clinical skills and to elaborate on their experience of learning output, examination, and digital teaching. Answers from 230 students were included in the study. Opinions on the quality and quantity of lectures offered and their experience of learning output varied based on gender, seniority and the amount of time spent on part time jobs. Students at UiB were generally unhappy with the quality of teaching, especially lessons on clinical skills, although both positive and negative experiences were reported. Securing a satisfying offer of clinical teaching will be important to ensure and increase the student experience of learning output in the time ahead.publishedVersio

Computerized Childbirth Monitoring Tools for Health Care Providers Managing Labor: A Scoping Review

Background: Proper monitoring of labor and childbirth prevents many pregnancy-related complications. However, monitoring is still poor in many places partly due to the usability concerns of support tools such as the partograph. In 2011, the World Health Organization (WHO) called for the development and evaluation of context-adaptable electronic health solutions to health challenges. Computerized tools have penetrated many areas of health care, but their influence in supporting health staff with childbirth seems limited. Objective: The objective of this scoping review was to determine the scope and trends of research on computerized labor monitoring tools that could be used by health care providers in childbirth management. Methods: We used key terms to search the Web for eligible peer-reviewed and gray literature. Eligibility criteria were a computerized labor monitoring tool for maternity service providers and dated 2006 to mid-2016. Retrieved papers were screened to eliminate ineligible papers, and consensus was reached on the papers included in the final analysis. Results: We started with about 380,000 papers, of which 14 papers qualified for the final analysis. Most tools were at the design and implementation stages of development. Three papers addressed post-implementation evaluations of two tools. No documentation on clinical outcome studies was retrieved. The parameters targeted with the tools varied, but they included fetal heart (10 of 11 tools), labor progress (8 of 11), and maternal status (7 of 11). Most tools were designed for use in personal computers in low-resource settings and could be customized for different user needs. Conclusions: Research on computerized labor monitoring tools is inadequate. Compared with other labor parameters, there was preponderance to fetal heart monitoring and hardly any summative evaluation of the available tools. More research, including clinical outcomes evaluation of computerized childbirth monitoring tools, is needed.publishedVersio

An Algorithm (LaD) for Monitoring Childbirth in Settings Where Tracking All Parameters in the World Health Organization Partograph Is Not Feasible: Design and Expert Validation

Background: After determining the key childbirth monitoring items from experts, we designed an algorithm (LaD) to represent the experts’ suggestions and validated it. In this paper we describe an abridged algorithm for labor and delivery management and use theoretical case to compare its performance with human childbirth experts. Objective: The objective of this study was to describe the LaD algorithm, its development, and its validation. In addition, in the validation phase we wanted to assess if the algorithm was inferior, equivalent, or superior to human experts in recommending the necessary clinical actions during childbirth decision making. Methods: The LaD algorithm encompasses the tracking of 6 of the 12 childbirth parameters monitored using the World Health Organization (WHO) partograph. It has recommendations on how to manage a patient when parameters are outside the normal ranges. We validated the algorithm with purposively selected experts selecting actions for a stratified sample of patient case scenarios. The experts’ selections were compared to obtain pairwise sensitivity and false-positive rates (FPRs) between them and the algorithm. Results: The mean weighted pairwise sensitivity among experts was 68.2% (SD 6.95; 95% CI 59.6-76.8), whereas that between experts and the LaD algorithm was 69.4% (SD 17.95; 95% CI 47.1-91.7). The pairwise FPR among the experts ranged from 12% to 33% with a mean of 23.9% (SD 9.14; 95% CI 12.6-35.2), whereas that between experts and the algorithm ranged from 18% to 43% (mean 26.3%; SD 10.4; 95% CI 13.3-39.3). The was a correlation (mean 0.67 [SD 0.06]) in the actions selected by the expert pairs for the different patient cases with a reliability coefficient (α) of .91. Conclusions: The LaD algorithm was more sensitive, but had a higher FPR than the childbirth experts, although the differences were not statistically significant. An electronic tool for childbirth monitoring with fewer WHO-recommended parameters may not be inferior to human experts in labor and delivery clinical decision support.publishedVersio

Predicting the Unpredictable - Harder than Expected

Introduction: An earthquake is a hazard that may cause urgent needs requiring international assistance. To ensure rapid funding for such needs-based humanitarian assistance, swift decisions are needed. However, data to guide needs-based funding decisions are often missing in the acute phase, causing delays. Instead, it may be feasible to use data building on existing indexes that capture hazard and vulnerability information to serve as a rapid tool to prioritize funding according to the scale of needs: needs-based funding. However, to date, it is not known to what extent the indicators in the indexes can predict the scale of disaster needs. The aim of this study was to identify predictors for the scale of disaster needs after earthquakes. Methodology: The predictive performance of vulnerability indicators and outcome indicators of four commonly used disaster risk and severity indexes were assessed, both individually and in different combinations, using linear regression. The number of people who reportedly died or who were affected was used as an outcome variable for the scale of needs, using data from the Emergency Events Database (EM-DAT) provided by the Centre for Research on the Epidemiology of Disasters at the Université Catholique de Louvain (CRED; Brussels, Belgium) from 2007 through 2016. Root mean square error (RMSE) was used as the performance measure. Results: The assessed indicators did not predict the scale of needs. This attempt to create a multivariable model that included the indicators with the lowest RMSE did not result in any substantially improved performance. Conclusion: None of the indicators, nor any combination of the indicators, used in the four assessed indexes were able to predict the scale of needs in the assessed earthquakes with any precision.publishedVersio

Preventable admissions and emergency-department-visits in pediatric asylum-seeking and non-asylum-seeking patients

Background Migrant health has become an essential part of public health. According to the World Health Organization, many health systems in Europe have not yet adapted adequately to the needs of asylum-seekers, which might result in untimely and inefficient health care for asylum-seeking patients. The aim of this study was to assess the number of preventable hospital admissions and emergency department visits in asylum-seeking and non-asylum-seeking pediatric patients. Methods This is a retrospective, hospital-based study. The study was done at the University Children’s Hospital Basel in Switzerland. Patients admitted or presenting to the emergency department were included and split into the groups of asylum-seeking and non-asylum-seeking patients. All admissions and emergency-department visits were extracted from the administrative electronic health records from 1st Jan 2016-31st Dec 2017. The main outcome was the proportion of admissions due to ambulatory-care-sensitive conditions (which refer to conditions for which admission can be prevented by early interventions in primary care) in asylum-seeking and non-asylum-seeking patients. Ambulatory-care-sensitive conditions were defined by a validated list of ICD-10 codes. The secondary objective was to assess the number of preventable emergency-department visits by asylum-seeking patients defined as proportion of visits with a non-urgent triage score. Results A total of 75′199 hospital visits were included, of which 63′405 were emergency department visits and 11′794 were admissions. Ambulatory-care-sensitive conditions accounted for 12.1% (18/149) of asylum-seeking and 10.9% (1270/11645) of non-asylum seeking patients’ admissions. Among the emergency department visits by asylum-seeking patients, non-urgent conditions accounted for 82.2% (244/297). Conclusions Admissions due to ambulatory-care-sensitive conditions are comparable in asylum-seeking and non-asylum-seeking children, suggesting few delayed presentations to ambulatory care facilities. Strategies to prevent non-urgent visits at pediatric emergency department facilities are needed.publishedVersio

Health care provided to recent asylumseeking and non-asylum-seeking pediatric patients in 2016 and 2017 at a Swiss tertiary hospital - a retrospective study

Background Asylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital. Methods We performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups. Results A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1–2) in the asylum-seeking and 2 (IQR 1–4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (> 15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients. Conclusions Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.publishedVersio

"She would sit with me": mothers' experiences of individual peer support for exclusive breastfeeding in Uganda

Background: Different strategies have been used to improve the initiation and duration of breastfeeding. Peer counsellors are reported to improve exclusive breastfeeding levels, but few studies have assessed the satisfaction of women with the support given, especially in Africa. In this paper we describe women’s experiences of peer counselling for exclusive breastfeeding in an East African setting. Methods: In the Ugandan site of PROMISE-EBF, a multi-centre community randomised trial to evaluate the effect of peer counselling for exclusive breastfeeding on infant health, 370 women in the intervention arm participated in a study exit interview. Individual peer counselling was offered to women in 12 of the 24 study clusters, scheduled as five visits: before childbirth and during weeks 1, 4, 7 and 10 after childbirth. During the visits, the women were given information and skills to help them breastfeed exclusively. After the 10-week visit, they were interviewed about their feelings and experiences related to the peer counselling. Results: Overall, more than 95% of the women expressed satisfaction with the various aspects of peer counselling offered. Those who had received five or more visits were more likely to give positive responses about their experience with peer counselling than those who had received fewer visits. They explained their satisfaction with time spent with the peer counsellor in terms of how much she discussed with them. Most women felt their knowledge needs about breastfeeding were covered by the peer counsellors, while others expressed a desire to learn about complementary feeding and family planning. Attributes of the peer counsellors included their friendliness, being women and giving support in a familiar and relaxed way. Women were positive about the acquisition of knowledge and the benefit to their babies from the peer counselling. They preferred a peer counsellor to a health worker for support of exclusive breastfeeding because of their friendly approach. Conclusions: Individual peer counselling to support exclusive breastfeeding was positively received by the women