RepoMed (Medizinische Hochschule Hannover)
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Midwifery care providers' childbirth and immediate newborn care competencies: A cross-sectional study in Benin, Malawi, Tanzania and Uganda.
Get PDFEvidence-based quality care is essential for reducing sub-Saharan Africa's high burden of maternal and newborn mortality and morbidity. Provision of quality care results from interaction between several components of the health system including competent midwifery care providers and the working environment. We assessed midwifery care providers' ability to provide quality intrapartum and newborn care and selected aspects of the working environment as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) project in Benin, Malawi, Tanzania, and Uganda. We used a self-administered questionnaire to assess provider knowledge and their working environment and skills drills simulations to assess skills and behaviours. All midwifery care providers including doctors providing midwifery care in the maternity units were invited to take part in the knowledge assessment and one third of the midwifery care providers who took part in the knowledge assessment were randomly selected and invited to take part in the skills and behaviour simulation assessment. Descriptive statistics of interest were calculated. A total of 302 participants took part in the knowledge assessment and 113 skills drills simulations were conducted. The assessments revealed knowledge gaps in frequency of fetal heart rate monitoring and timing of umbilical cord clamping. Over half of the participants scored poorly on aspects related to routine admission tasks, clinical history-taking and rapid and initial assessment of the newborn, while higher scores were achieved in active management of the third stage of labour. The assessment also identified a lack of involvement of women in clinical decision-making. Inadequate competency level of the midwifery care providers may be due to gaps in pre-service training but possibly related to the structural and operational facility characteristics including continuing professional development. Investment and action on these findings are needed when developing and designing pre-service and in-service training. Trial registration: PACTR202006793783148-June 17th, 2020
Using network meta-analysis to predict the percentage of missing participants for a future trial
No full textBackground Using evidence synthesis to design a clinical trial has long been advocated as the key against research waste. However, the relevant methodology does not deal with possible missing participants (MP) that may occur in a future trial. We illustrated the synergism of the baseline effects model and network meta-analysis (NMA) to predict the percentage of MP for a future trial. Methods We considered the network of a published systematic review as a case study. We applied the baseline effects model, followed by the relative effects model using Bayesian methods to predict the percentage of MP in each intervention when conducting NMA and a series of pairwise meta-analyses. We illustrated the posterior distribution of the predicted percentage MP under both synthesis methods alongside the MP reported in the corresponding trials for each intervention. Results Selecting different interventions for the baseline effects model yielded different predicted baseline effects and led to different predicted percentages of MP for the remaining interventions, highlighting the need to carefully pre-specifying the intervention for the baseline effects model. Both synthesis methods provided almost identical posterior distributions of predicted percentage MP for estimating similar summary odds ratios. There was great variability in the percentage of MP across the trials for each intervention, manifesting as considerable variability in the percentage difference in MP compared to NMA. Conclusions Incorporating predictions and absolute effects in the context of MP in NMA aids in determining the anticipated percentage of MP in the compared interventions to plan a future trial efficiently
The potential role of diffusion weighted imaging in the diagnosis of early carotid and vertebral artery dissection
No full textRegulatory Roles of the Mitochondrial Metabolism and the Nuclear Repressor BACH1 in Inflammatory Macrophages
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