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.
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Objective To explore how to build and maintain the resilience of frontline healthcare professionals exposed to COVID-19 outbreak working conditions. Design Scoping review supplemented with expert interviews to validate the findings. Setting Hospitals. Methods We searched PubMed, Embase, PsycINFO, CINAHL, bioRxiv and medRxiv systematically and grey literature for articles focusing on the impact of COVID- 19-like working conditions on the physical and/or mental health of healthcare professionals in a hospital setting. Articles using an empirical design about determinants or causes of physical and/or mental health and about interventions, measures and policies to preserve physical and/or mental health were included. Four experts were interviewed to reflect on the results from the scoping review. Results In total, 4471 records were screened leading to an inclusion of 73 articles. Recommendations prior to the outbreak fostering resilience included optimal provision of education and training, resilience training and interventions to create a feeling of being prepared. Recommendations during the outbreak consisted of (1) enhancing resilience by proper provision of information, psychosocial support and treatment (eg, create enabling conditions such as forming a psychosocial support team), monitoring the health status of professionals and using various forms and content of psychosocial support (eg, encouraging peer support, sharing and celebrating successes), (2) tasks and responsibilities, in which attention should be paid to kind of tasks, task mix and responsibilities as well as the intensity and weight of these tasks and (3) work patterns and working conditions. Findings of the review were validated by experts. Conclusions Recommendations were developed on how to build and maintain resilience of frontline healthcare professionals exposed to COVID-19 outbreak working conditions. These practical and easy to implement recommendations can be used by hospitals and other healthcare organisations to foster and preserve short-term and long-term physical and mental health and employability of their professionals.
Ruim 10% van de Nederlandse bevolking heeft chronische nierschade. Jaarlijks komen er zo’n 2.000 patiënten met nierfalen bij. Bij terminaal nierfalen is uiteindelijk nierfunctie vervangende therapie noodzakelijk (1, 2). Nierfalen en nierfunctievervangende therapie hebben grote invloed op de voedingstoestand van de patiënt wat leidt tot ondervoeding wat zich uit in verlies van spiermassa, spierkracht, verminderde zelfredzaamheid, verminderd fysiek functioneren, hogere mortaliteit, meer ziekenhuis opnames en een lagere kwaliteit van leven (3). Gezien deze associatie kan een interventie die het verlies van spiermassa kan voorkomen, grote impact hebben voor nierpatiënten. Echter is er nog geen informatie over de voedselinname van de Nederlandse hemodialysepatiënt. Dit belemmert de diëtetiek in het optimaal behandelen van hemodialysepatiënten. In samenwerking met het kennisnetwerk Diëtisten Nierziekten Nederland (DNN) en MKB hebben wij de volgende vragen gedefinieerd: 1) Wat is de huidige dagelijkse inname van macro- en micronutriënten van hemodialysepatiënten en 2) Bestaan er effectieve interventies op het gebeid van voeding en beweging om spiermassa verlies te voorkomen en/of te behandelen? Samenvattend bestaat dit voorstel uit de volgende activiteiten: Werkpakket 1: Landelijk multicenter studie naar de huidige inname van macro- en micronutriënten van hemodialysepatiënten, Werkpakket 2: Formeren van (inter)nationaal netwerk van professionals en wetenschappers die zich focussen op de rol van voeding en beweging bij nierziekten aangevuld met patiënten perspectief vanuit de patiëntenverenigingen, Werkpakket 3: Systematic review naar effectieve voedings- en beweeginterventies bij patiënten met nierfalen en Werkpakket 4: Het schrijven van een projectvoorstel dat de behoefte, rol en implementatie van eiwitrijke voeding en beweging onderzoekt op het behoud en/of verbeteren van spiermassa, fysiek functioneren en kwaliteit van leven van mensen met een nierziekte.
