How would you help a colleague dealing with the stress of an adverse outcome?

We will discuss ‘Post-traumatic stress symptoms in Swedish obstetricians and midwives after severe obstetric events: a cross-sectional retrospective survey by Wahlberg and coauthors on the 26th April 2017. This paper is free to view from 17th April.

Start date: 26 April 2017. The discussion will continue for 7 days until 2nd May 2017.

First hosted discussion session(s) on Twitter starts at BST 8pm (3pm EST/12 noon PST) on 26 April 2017 (using hashtag #BlueJC).

Host: @BlueJCHost

Follow us: Twitter

The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues.

The discussion points are below:

Scenario

A colleague working in another part country calls to tell you that she delivered a patient whose full term baby died in the NICU a few days after delivery. During the course of the hospital safety committee’s review of the case, it was determined that a delay in delivery likely contributed to complications leading to the neonate’s death.  Your colleague asks for advice and help “sorting it all out”.

How will you help?

Description of Research:

Participants 1,459 midwives and 706 obstetricians from Sweden. Mostly women.
Exposure A serious and potentially traumatic event on the delivery unit, such as (1) a child died or had severe asphyxia, (2) maternal near-miss or death during delivery, or (3) other difficult event such as violence or threat.
Outcomes Provider experience of probably post-traumatic stress disorder (PTSD) or partial PTSD.
Study design Cross-sectional survey.
Authors’ conclusion A substantial proportion of obstetricians and midwives experiences PTSD-like symptoms after serous traumatic events related to delivery.

Discussion Points:

  • Describe a time when you have been the “second victim” of an adverse event. How did it affect you? Did it have an effect on your other patients?
  • Did the authors have an adequate response rate to their survey? What means could they have used to improve response rates?
  • The authors cite probable selection bias and recall bias as limitations of the study. How would you design a study addressing the same objective, but with less potential for these biases?
  • In what ways might non-responders have biased this study?
  • What were the main differences between obstetrician responders and midwife responders in this study?
  • Obstetricians reported negative experiences with debriefings (or reassembly) in this study. In your experience, what are the ways debriefings can be helpful or harmful?
  • How would you use the results of this study in your own practice?

Suggested reading

  1. Scott et al. The natural history of recovery for healthcare provider “second victim” after adverse patient events. Qual Saf Health Care Care 2009;18:325-330.
  2. Schroder et al. Guilt without fault: a qualitative study into the ethics of forgiveness after traumatic childbirth. Social Science & Medicine 2017;176:14-20.
  3. Grimes and Schulz. Descriptive studies: what they can and cannot do. Lancet 2002;359:145-49.

Induction of labour: should we prefer balloons to prostaglandins?

We will discuss Double-balloon catheter versus prostaglandin E2 for cervical ripening and labour induction by Du and co-authors on the 25th January for 7 days.

This paper is open access: http://bit.ly/2j9ZmNY

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 25 January 2017 (the discussion will continue for 7 days between 25th January and 1st February 2017.

First hosted discussion session(s) on Twitter starts at GMT 8pm (3pm EST/12 noon PST) on 25 January 2017 (using hashtag #BlueJC).

Host: @BlueJCHost

Platforms: Twitter, Facebook and LinkedIn 

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues.

The discussion points are attached below:

 

 

Scenario

A 26 year old woman in her first pregnancy requires induction of labour at term for reduced fetal movements.   She has a normal CTG, normal scan with normal umbilical artery Doppler studies, and no other risk factors.

What method of induction of labour would you recommend? 

Description of Research:

Participants Women with singleton pregnancies with live fetuses in vertex presentation, intact membranes, and unfavourable cervices, requiring induction of labour.
Intervention Transcervical double balloon catheter
Comparison Locally applied prostaglandin E2 analogues
Outcomes Primary:  (1) proportion of women achieving vaginal delivery within 24 hours, (2) proportion of women delivering by Caesarean

Secondary: (1) Uterine hyperstimulation; (2) Neonatal unit admission; (3) Maternal adverse events (PPH, uterine rupture).

Study design Metanalysis of randomised controlled trials

 

 

Discussion Points:

  • How do you currently counsel women similar to the one in the scenario?
  • Have you used double-balloon catheters? Do you find that they are well tolerated?
  • How did the authors assess the quality of individual studies?
  • What were the problems identified by their quality assessment of individual studies?
  • Critically appraise this meta-analysis using the PRISMA checklist (http://prisma-statement.org/PRISMAStatement/Checklist.aspx)
  • Can you briefly summarise the results of this study as a one-sentence take-home message?
  • Would the results of this study influence your management of the woman in the scenario?
  • How would the results of this study influence your daily practice?

 

Suggested reading

Scottish Intercollegiate Guidelines Network. Critical Appraisal: notes and checklists. Methodology checklist 1: Systematic reviews and meta-analyses. http://www.sign.ac.uk/methodology/checklists.html (Last access 20 July 2016)

Is surgical lymph node assessment necessary for women with mucinous ovarian cancer?

Lymph node assessment in ovarian cancer can lead to significant morbidity. Results of this systematic review suggests < 1 in 100 (0.8%) women with stage 1-2 mucinous ovarian cancer undergoing lymph node assessment had metastases in resected lymph nodes.

Is it time to change practice?
Continue reading