Background The number of caesarean sections (CS) is increasing globally, and repeat CS after a previous CS is a significant contributor to the overall CS rate. Vaginal birth after caesarean (VBAC) can be seen as a real and viable option for most women with previous CS. To achieve success, however, women need the support of their clinicians (obstetricians and midwives). The aim of this study was to evaluate clinician-centred interventions designed to increase the rate of VBAC. Methods The bibliographic databases of The Cochrane Library, PubMed, PsychINFO and CINAHL were searched for randomised controlled trials, including cluster randomised trials that evaluated the effectiveness of any intervention targeted directly at clinicians aimed at increasing VBAC rates. Included studies were appraised independently by two reviewers. Data were extracted independently by three reviewers. The quality of the included studies was assessed using the quality assessment tool, ‘Effective Public Health Practice Project’. The primary outcome measure was VBAC rates. Results 238 citations were screened, 255 were excluded by title and abstract. 11 full-text papers were reviewed; eight were excluded, resulting in three included papers. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. One study evaluated the effects of external peer review on CS birth in 45 hospitals, and the third evaluated opinion leader education and audit and feedback in 16 hospitals. The use of external peer review, audit and feedback had no significant effect on VBAC rates. An educational strategy delivered by an opinion leader significantly increased VBAC rates. The use of XRP significantly increased CS rates. Conclusions This systematic review indicates that few studies have evaluated the effects of clinician-centred interventions on VBAC rates, and interventions are of varying types which limited the ability to meta-analyse data. A further limitation is that the included studies were performed during the late 1980s-1990s. An opinion leader educational strategy confers benefit for increasing VBAC rates. This strategy should be further studied in different maternity care settings and with professionals other than physicians only.
MULTIFILE
Vertical and horizontal alignment within organizations are seen as prerequisites for meeting strategic objectives and indications of effective management. In the area of safety management, the concept of vertical alignment has been followed through the introduction of hierarchical structures and bidirectional communication, but horizontal alignment has been given little attention. The principal goal of this study was the assessment of horizontal alignment within an aviation organization with the use of data from safety investigations, audits and meetings in order to explore the extent to which (1) causal factors recorded in safety investigation reports comprised topics discussed by safety committees and focus areas of internal safety auditors, and (2) the agendas of safety committees include weak points revealed during safety audits. The study employed qualitative and quantitative analysis of data collected over a 6 years’ period at three organizational levels. The results suggested a low horizontal alignment across the three pairs of the corresponding safety management activities within each organizational level. The findings were attributed to the inadequacy of procedures and lack of a safety information database for consistently sharing safety information, cultural factors and lack of planning for the coordination of safety management activities. The current research comprises a contribution to the literature and practice and introduces a technique to assess the intra-alignment of safety management initiatives within various organizational levels. Future research is needed in order to investigate the association between horizontal alignment of safety management practices and safety performance.
The study of human factors in forensic science informs our understanding of the interaction between humans and the systems they use. The Expert Working Group (EWG) on Human Factors in Forensic DNA Interpretation used a systems approach to conduct a scientific assessment of the effects of human factors on forensic DNA interpretation with the goal of recommending approaches to improve practice and reduce the likelihood and consequence of errors. This effort resulted in 44 recommendations. The EWG designed many of these recommendations to improve the production, interpretation, evaluation, documentation, and communication of DNA comparison results.
MULTIFILE
The issue addressed by the project is the necessity to implement European coordinated approaches for the management of Waste from Electrical, Electronic Equipment (WEEE).WEEE Directive 2012/19/EU established for 2016 a minimum collection rate of 45% of all WEEE placed on the market in the preceding 3 years (in 2018, the EU rate was 47%), but from 2019 the rate rose to 56% (or 85% of the WEEE generated on the country).European Court of Auditors 2021 review “EU actions and existing challenges on electronic waste” point out that the collection, recycling and reuse of 3-waste are not equally effective in all Member States.Unfortunately, each country in the EU has decided a way to implement the Directive, which means 27 different implementations. In 2019, only Bulgaria, Croatia and Poland achieved the 65% target, while other countries such as Italy, Romania or Germany were at the bottom of EU list with 40%.WEEEWaste aims to implement better national, regional and local policies for management of WEEE, covering the main recommendations of the “Circular Electronics Initiative” from the EU Circular Economy AP.The final objective of WEEEWaste is to promote reuse, collection, recycling and other forms of recovery of WEEE, supporting thus the achievement of the WEEE Directive 2012/19/EU.Partners from 9 regions (Czechia, Italy, Germany, Spain, Romania, Hungary, Poland, Slovenia, Netherlands) will exchange practices in a discovery journey to modify their policies, focusing on: To improve the interregional coordination of municipalities an regions in order to fight more effectively against illegal shipment between areas and WEE dumping.
