Background: This study evaluated the knowledge gained and retained by family practice residents w... more Background: This study evaluated the knowledge gained and retained by family practice residents who participated in the Neonatal Resuscitation Program (NRP) course. Methods: Knowledge attainment and its retention was assessed by the administration of pre-, post-, and 6-month follow-up tests using the standard NRP written examination. Twenty-nine residents from the Department of Family Medicine at McGill University completed the pretests and posttests, and 10 of these completed the follow-up tests. The data were analyzed using repeated measures analysis of variance and Student's t tests. Results: The average score was 60.6% (n = 29) for pretest, 90.7% (n = 29) for posttest, and 75.4% (n = 10) for the follow-up test. A significant improvement was shown in posttest examination scores when compared to pretest scores and in the follow-up test scores when compared to pretest scores. No significant difference existed between the posttest and follow-up test scores. However, small sample size may have prevented detection of significant differences. Further, follow-up scores for some subjects had fallen to below the level required to pass the course. Conclusions: The results suggest that participation in an NRP course significantly increased knowledge of neonatal resuscitation by family practice residents, but that knowledge may decrease over time.
Objective: To determine provincial trends in provision of intrapartum care by general practitione... more Objective: To determine provincial trends in provision of intrapartum care by general practitioners and family physicians (GP/FPs) for the 11 years from 1984 to 1995. Design: Analyses of provincial Medical Care Fee-for-Service Utilization data for births from 1984-1985 to 1994-1995. Setting: 10 provinces of Canada. Main outcome measures: Proportion of vaginal births billed by GP/FPs (expressed as total number of vaginal births billed by GP/FPs divided by total number of vaginal births). Results: In 1994-1995, the proportion of vaginal births billed by GP/FPs ranged from 77.2% in British Columbia and 70.8% in Nova Scotia to 28.9% in Ontario and 23.6% in Prince Edward Island. These proportions have remained relatively high and stable during the period studied in some provinces, such as British Columbia and Nova Scotia, and have declined steadily and notably in others. Conclusions: Data show that GP/FPs' involvement in vaginal births in most Canadian provinces is decreasing. This trend demonstrates a shift in GP/FPs' practice patterns and could indicate a coming shortage of obstetrical care providers.
Background and objectives: This study compared the effectiveness of two booster strategies design... more Background and objectives: This study compared the effectiveness of two booster strategies designed to improve retention of skills and knowledge in neonatal resuscitation by family practice residents. Methods: Residents were randomly allocated to one of three groups: video, hands on, or control. Residents in the two experimental groups received a "booster" 3-5 months after the Neonatal Resuscitation Program (NRP) course. All participants completed the follow-up test 6-8 months after taking the course. The main outcome measures consisted of the NRP written examination and the performance checklists. Results: A total of 44 residents completed the study (video, n = 13; hands-on, n = 14; control, n = 17). Overall, participants had significantly lower scores at follow-up than at baseline, indicating deterioration in both neonatal skills and knowledge. Residents in the hands-on booster group made significantly fewer errors across all five checklists in life-supporting but not in lifesaving scores than those allocated to the control and video groups. Conclusions: The beneficial effect of mannequin practice or video boosters on skills and knowledge retention was less than what had been anticipated, and no benefit could be demonstrated in comparison to the control group. Deteriorating knowledge and skills remain a major concern, since boostering by hands-on or video at 3-5 months do not seem to have an impact on the retention of knowledge or lifesaving skills.
Postpartum support is recommended to prevent infant and maternal morbidity. This review examined ... more Postpartum support is recommended to prevent infant and maternal morbidity. This review examined the published evidence of the effectiveness of postpartum support programs to improve maternal knowledge, attitudes, and skills related to parenting, maternal mental health, maternal quality of life, and maternal physical health. MEDLINE, Cinahl, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postnatal women. The initial literature search was done in 1999 and was enhanced in 2003 and 2005. Studies were categorized based on the the above outcomes. Data were extracted in a systematic manner, and the quality of each study was reviewed. In the 1999 search, 9 studies met the inclusion criteria. The 2003 and 2005 searches identified 13 additional trials for a total of 22 trials. Universal postpartum support to unselected women at low risk did not result in statistically significant improvements for any outcomes examined. Educational visits to a pediatrician showed statistically significant improvements in maternal-infant parenting skills in low-income primiparous women. In women at high risk for family dysfunction and child abuse, nurse home visits combined with case conferencing produced a statistically significant improvement in home environment quality using the HOME (Home Observation for Measurement of the Environment) program. Similarly, in women at high risk for either family dysfunction or postpartum depression, home visitation or peer support, respectively, produced a statistically significant reduction in Edinburgh Postnatal Depression Scale scores (difference - 2.23, 95% CI -3.72 to -0.74, p= 0.004; and 15.0% vs 52.4%, OR 6.23, 95% CI 1.40 to 27.84, p= 0.01, respectively). Educational programs reduced repeat unplanned pregnancies (12.0% vs 28.3%, p= 0.003) and increased effective contraceptive use (RR 1.35, 95% CI 1.09 to 1.68, p= 0.007). Maternal satisfaction was higher with home visitation programs. No randomized controlled trial evidence was found to endorse universal provision of postpartum support to improve parenting, maternal mental health, maternal quality of life, or maternal physical health. There is some evidence that high-risk populations may benefit from postpartum support.
A philosophy of family-centered maternity and newborn care requires that there be open communicat... more A philosophy of family-centered maternity and newborn care requires that there be open communication between a woman, her family and health professionals; that the woman be able to choose people to support her, and have those people present during labour and birth; and that the mother and infant remain in close contact whenever possible following birth. Using data from a 1993 survey, the authors conclude that Canadian hospitals still have a long way to go before putting these ideals into practice.
... Effectiveness of Postpartum Support. Elizabeth Shaw MD,; Cheryl Levitt MBBCh,; Janusz Kaczoro... more ... Effectiveness of Postpartum Support. Elizabeth Shaw MD,; Cheryl Levitt MBBCh,; Janusz Kaczorowski PhD,; Sharon Wong PhD. Article first published online: 29 MAY 2007. DOI: 10.1111/j.1523-536X.2007.00168_2.x. Issue. Birth. Volume 34, Issue 2, pages 188189, June ...
Background: This study evaluated the knowledge gained and retained by family practice residents w... more Background: This study evaluated the knowledge gained and retained by family practice residents who participated in the Neonatal Resuscitation Program (NRP) course. Methods: Knowledge attainment and its retention was assessed by the administration of pre-, post-, and 6-month follow-up tests using the standard NRP written examination. Twenty-nine residents from the Department of Family Medicine at McGill University completed the pretests and posttests, and 10 of these completed the follow-up tests. The data were analyzed using repeated measures analysis of variance and Student's t tests. Results: The average score was 60.6% (n = 29) for pretest, 90.7% (n = 29) for posttest, and 75.4% (n = 10) for the follow-up test. A significant improvement was shown in posttest examination scores when compared to pretest scores and in the follow-up test scores when compared to pretest scores. No significant difference existed between the posttest and follow-up test scores. However, small sample size may have prevented detection of significant differences. Further, follow-up scores for some subjects had fallen to below the level required to pass the course. Conclusions: The results suggest that participation in an NRP course significantly increased knowledge of neonatal resuscitation by family practice residents, but that knowledge may decrease over time.
Objective: To determine provincial trends in provision of intrapartum care by general practitione... more Objective: To determine provincial trends in provision of intrapartum care by general practitioners and family physicians (GP/FPs) for the 11 years from 1984 to 1995. Design: Analyses of provincial Medical Care Fee-for-Service Utilization data for births from 1984-1985 to 1994-1995. Setting: 10 provinces of Canada. Main outcome measures: Proportion of vaginal births billed by GP/FPs (expressed as total number of vaginal births billed by GP/FPs divided by total number of vaginal births). Results: In 1994-1995, the proportion of vaginal births billed by GP/FPs ranged from 77.2% in British Columbia and 70.8% in Nova Scotia to 28.9% in Ontario and 23.6% in Prince Edward Island. These proportions have remained relatively high and stable during the period studied in some provinces, such as British Columbia and Nova Scotia, and have declined steadily and notably in others. Conclusions: Data show that GP/FPs' involvement in vaginal births in most Canadian provinces is decreasing. This trend demonstrates a shift in GP/FPs' practice patterns and could indicate a coming shortage of obstetrical care providers.
Background and objectives: This study compared the effectiveness of two booster strategies design... more Background and objectives: This study compared the effectiveness of two booster strategies designed to improve retention of skills and knowledge in neonatal resuscitation by family practice residents. Methods: Residents were randomly allocated to one of three groups: video, hands on, or control. Residents in the two experimental groups received a "booster" 3-5 months after the Neonatal Resuscitation Program (NRP) course. All participants completed the follow-up test 6-8 months after taking the course. The main outcome measures consisted of the NRP written examination and the performance checklists. Results: A total of 44 residents completed the study (video, n = 13; hands-on, n = 14; control, n = 17). Overall, participants had significantly lower scores at follow-up than at baseline, indicating deterioration in both neonatal skills and knowledge. Residents in the hands-on booster group made significantly fewer errors across all five checklists in life-supporting but not in lifesaving scores than those allocated to the control and video groups. Conclusions: The beneficial effect of mannequin practice or video boosters on skills and knowledge retention was less than what had been anticipated, and no benefit could be demonstrated in comparison to the control group. Deteriorating knowledge and skills remain a major concern, since boostering by hands-on or video at 3-5 months do not seem to have an impact on the retention of knowledge or lifesaving skills.
Postpartum support is recommended to prevent infant and maternal morbidity. This review examined ... more Postpartum support is recommended to prevent infant and maternal morbidity. This review examined the published evidence of the effectiveness of postpartum support programs to improve maternal knowledge, attitudes, and skills related to parenting, maternal mental health, maternal quality of life, and maternal physical health. MEDLINE, Cinahl, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postnatal women. The initial literature search was done in 1999 and was enhanced in 2003 and 2005. Studies were categorized based on the the above outcomes. Data were extracted in a systematic manner, and the quality of each study was reviewed. In the 1999 search, 9 studies met the inclusion criteria. The 2003 and 2005 searches identified 13 additional trials for a total of 22 trials. Universal postpartum support to unselected women at low risk did not result in statistically significant improvements for any outcomes examined. Educational visits to a pediatrician showed statistically significant improvements in maternal-infant parenting skills in low-income primiparous women. In women at high risk for family dysfunction and child abuse, nurse home visits combined with case conferencing produced a statistically significant improvement in home environment quality using the HOME (Home Observation for Measurement of the Environment) program. Similarly, in women at high risk for either family dysfunction or postpartum depression, home visitation or peer support, respectively, produced a statistically significant reduction in Edinburgh Postnatal Depression Scale scores (difference - 2.23, 95% CI -3.72 to -0.74, p= 0.004; and 15.0% vs 52.4%, OR 6.23, 95% CI 1.40 to 27.84, p= 0.01, respectively). Educational programs reduced repeat unplanned pregnancies (12.0% vs 28.3%, p= 0.003) and increased effective contraceptive use (RR 1.35, 95% CI 1.09 to 1.68, p= 0.007). Maternal satisfaction was higher with home visitation programs. No randomized controlled trial evidence was found to endorse universal provision of postpartum support to improve parenting, maternal mental health, maternal quality of life, or maternal physical health. There is some evidence that high-risk populations may benefit from postpartum support.
A philosophy of family-centered maternity and newborn care requires that there be open communicat... more A philosophy of family-centered maternity and newborn care requires that there be open communication between a woman, her family and health professionals; that the woman be able to choose people to support her, and have those people present during labour and birth; and that the mother and infant remain in close contact whenever possible following birth. Using data from a 1993 survey, the authors conclude that Canadian hospitals still have a long way to go before putting these ideals into practice.
... Effectiveness of Postpartum Support. Elizabeth Shaw MD,; Cheryl Levitt MBBCh,; Janusz Kaczoro... more ... Effectiveness of Postpartum Support. Elizabeth Shaw MD,; Cheryl Levitt MBBCh,; Janusz Kaczorowski PhD,; Sharon Wong PhD. Article first published online: 29 MAY 2007. DOI: 10.1111/j.1523-536X.2007.00168_2.x. Issue. Birth. Volume 34, Issue 2, pages 188189, June ...
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