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Exploring standardisation, monitoring and training of medical devices in assisted vaginal birth studies: protocol for a systematic review.

ABSTRACT: INTRODUCTION:Assisted vaginal birth (AVB) can markedly improve maternal and neonatal outcomes arising from complications in the second stage of labour. Historically, both forceps and ventouse devices have been used to assist birth; however, they are not without risk and are associated with complications, such as cephalohaematoma, retinal haemorrhage and perineal trauma. As new devices are developed to overcome the limitations of existing techniques, it is necessary to establish their efficacy and effectiveness within randomised controlled trials (RCTs). A major challenge of evaluating complex interventions (ie, invasive procedures/devices used to assist vaginal birth) is ensuring they are delivered as intended. It can be difficult to standardise intervention delivery and monitor fidelity, and account for the varying expertise of clinicians (accoucher expertise). This paper describes the protocol for a systematic review aiming to investigate the reporting of device standardisation, monitoring and training in trials evaluating complex interventions, using AVB as a case study. METHODS AND ANALYSIS:Relevant keywords and subject headings will be used to conduct a comprehensive search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature and ClinicalTrials.gov, for RCTs and pilot/feasibility studies evaluating AVB. Abstracts will be screened and full-text articles of eligible studies reviewed for inclusion. Information relating to the following categories will be extracted: standardisation of device use (ie, descriptions of operative steps, including mandatory/flexible parameters), monitoring of intervention delivery (ie, intervention fidelity, confirming that an intervention is delivered as intended) and accoucher expertise (ie, entry criteria for participation, training programmes and previous experience with the device). Risk of bias of included studies will be assessed. ETHICS AND DISSEMINATION:Ethical approval is not required because primary data will not be collected. Findings will be disseminated by publishing in a peer-reviewed journal and presentations at relevant conferences.

SUBMITTER: Hotton EJ

PROVIDER: S-EPMC6500334 | biostudies-other | 2019 Apr

REPOSITORIES: biostudies-other

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Exploring standardisation, monitoring and training of medical devices in assisted vaginal birth studies: protocol for a systematic review.

Hotton Emily J EJ Renwick Sophie S Barnard Katie K Lenguerrand Erik E Wade Julia J Draycott Tim T Crofts Joanna F JF Blencowe Natalie S NS

BMJ open 20190414 4

<h4>Introduction</h4>Assisted vaginal birth (AVB) can markedly improve maternal and neonatal outcomes arising from complications in the second stage of labour. Historically, both forceps and ventouse devices have been used to assist birth; however, they are not without risk and are associated with complications, such as cephalohaematoma, retinal haemorrhage and perineal trauma. As new devices are developed to overcome the limitations of existing techniques, it is necessary to establish their eff ...[more]

PMID: 30987994

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Project description:ObjectiveAssisted vaginal birth (AVB) is a complex intervention involving medical devices, comprising multiple components. This complexity creates difficulties when designing and conducting randomised controlled trials (RCTs), in terms of describing, standardising and monitoring the intervention, and accounting for differing clinician expertise. This review examines the reporting standards of complex interventions involving a medical device, in the context of AVB RCTs.Study designSearches were undertaken from the start of indexing to March 2021, and limited to RCTs, feasibility and pilot studies including at least one device for AVB. RCTs were selected if they included participants having an AVB with any device, with or without a comparator group. Reporting details were assessed according to the Consolidating Standards of Reporting Trials extension for non-pharmacological treatments (CONSORT-NPT), focusing on intervention descriptions, standardization, adherence and clinician expertise. Screening of abstracts, full-text articles and data extraction was performed by two independent reviewers.ResultsOf 4098 abstracts and 83 full-text articles, 39 papers were included, investigating 80 interventions. Twenty-seven different named devices were identified. Intervention descriptions were provided in 20 (55%) papers with varying levels of detail and with only one covering the entire procedure. Standardization of interventions was mentioned in 25 papers (64%). Only eight (21%) papers reported any form of adherence to the intended procedure. Some data regarding expertise were reported in 25 (64%) papers.ConclusionsDespite some compliance with reporting standards, there is a lack of detail regarding intervention description, standardization, adherence and expertise in RCTs of AVB. This creates difficulties in understanding how intervention delivery was intended and what actually occurred. Clearer guidelines for the reporting of invasive procedures and devices are required.

Project description:BackgroundMonitoring resistance training has a range of unique difficulties due to differences in physical characteristics and capacity between athletes, and the indoor environment in which it often occurs. Traditionally, methods such as volume load have been used, but these have inherent flaws. In recent times, numerous portable and affordable devices have been made available that purport to accurately and reliably measure kinetic and kinematic outputs, potentially offering practitioners a means of measuring resistance training loads with confidence. However, a thorough and systematic review of the literature describing the reliability and validity of these devices has yet to be undertaken, which may lead to uncertainty from practitioners on the utility of these devices.ObjectiveA systematic review of studies that investigate the validity and/or reliability of commercially available devices that quantify kinetic and kinematic outputs during resistance training.MethodsFollowing PRISMA guidelines, a systematic search of SPORTDiscus, Web of Science, and Medline was performed; studies included were (1) original research investigations; (2) full-text articles written in English; (3) published in a peer-reviewed academic journal; and (4) assessed the validity and/or reliability of commercially available portable devices that quantify resistance training exercises.ResultsA total of 129 studies were retrieved, of which 47 were duplicates. The titles and abstracts of 82 studies were screened and the full text of 40 manuscripts were assessed. A total of 31 studies met the inclusion criteria. Additional 13 studies, identified via reference list assessment, were included. Therefore, a total of 44 studies were included in this review.ConclusionMost of the studies within this review did not utilise a gold-standard criterion measure when assessing validity. This has likely led to under or overreporting of error for certain devices. Furthermore, studies that have quantified intra-device reliability have often failed to distinguish between technological and biological variability which has likely altered the true precision of each device. However, it appears linear transducers which have greater accuracy and reliability compared to other forms of device. Future research should endeavour to utilise gold-standard criterion measures across a broader range of exercises (including weightlifting movements) and relative loads.

Project description:BACKGROUND:When certain complications arise during the second stage of labour, assisted vaginal delivery (AVD), a vaginal birth with forceps or vacuum extractor, can effectively improve outcomes by ending prolonged labour or by ensuring rapid birth in response to maternal or fetal compromise. In recent decades, the use of AVD has decreased in many settings in favour of caesarean section (CS). This review aimed to improve understanding of experiences, barriers and facilitators for AVD use. METHODS:Systematic searches of eight databases using predefined search terms to identify studies reporting views and experiences of maternity service users, their partners, health care providers, policymakers, and funders in relation to AVD. Relevant studies were assessed for methodological quality. Qualitative findings were synthesised using a meta-ethnographic approach. Confidence in review findings was assessed using GRADE CERQual. Findings from quantitative studies were synthesised narratively and assessed using an adaptation of CERQual. Qualitative and quantitative review findings were triangulated using a convergence coding matrix. RESULTS:Forty-two studies (published 1985-2019) were included: six qualitative, one mixed-method and 35 quantitative. Thirty-five were from high-income countries, and seven from LMIC settings. Confidence in the findings was moderate or low. Spontaneous vaginal birth was most likely to be associated with positive short and long-term outcomes, and emergency CS least likely. Views and experiences of AVD tended to fall somewhere between these two extremes. Where indicated, AVD can be an effective, acceptable alternative to caesarean section. There was agreement or partial agreement across qualitative studies and surveys that the experience of AVD is impacted by the unexpected nature of events and, particularly in high-income settings, unmet expectations. Positive relationships, good communication, involvement in decision-making, and (believing in) the reason for intervention were important mediators of birth experience. Professional attitudes and skills (development) were simultaneously barriers and facilitators of AVD in quantitative studies. CONCLUSIONS:Information, positive interaction and communication with providers and respectful care are facilitators for acceptance of AVD. Barriers include lack of training and skills for decision-making and use of instruments.

Project description:BackgroundVaginal birth management is vital to midwifery education and practice in which midwives are most likely to be directly involved. This situation requires strong cognitive, technical, communicational, and teamwork skills. Therefore, the present study was conducted to evaluate the effect of normal vaginal birth simulation training before formal clinical education on the clinical skills of midwifery students compared with routine clinical education.MethodsThis quasi-experimental study was conducted at the Shoushtar Faculty of Medical Sciences from September 2018 to August 2021. Sixty-one midwifery students participated in the intervention group (n = 31) and in the control group (n = 30). The intervention group participated in the simulation-based training before entering the formal clinical education courses. The control group received no simulation-based training before their formal clinical education. The clinical skills of these students for performing normal vaginal birth in the real field were evaluated by observational examination in the three years (fourth, fifth, and sixth semesters). Data were analyzed by descriptive (mean, SD, and percentage) and inferential statistics (independent t-test and chi-square). A P-value less than 0.05 was considered significant.ResultsThe mean score of midwives' skills in the control group was (28.10 ± 3.42) and in the intervention group, it was (31.15 ± 4.30). The difference in the skill score between the groups was statistically significant (3.40 ± 0.68). The results showed that in the intervention group, 29 students (93.93%) were evaluated from a good to an excellent level, while only ten students (32.71%) in the control group achieved a good level, and others (n = 30) were evaluated at a low level (p < .001).ConclusionThe results of the present study indicated that the simulation situation for critical skills, such as vaginal birth skills, was significantly more effective than workplace-based learning situations.

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Exploring standardisation, monitoring and training of medical devices in assisted vaginal birth studies: protocol for a systematic review.

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Exploring standardisation, monitoring and training of medical devices in assisted vaginal birth studies: protocol for a systematic review.

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