Dimitrios Siassakos

The management of a simulated emergency: Better teamwork, better performance

OBJECTIVESnTo determine whether team performance in a simulated emergency is related to generic teamwork skills and behaviours.nnnMETHODSnDesign - Cross-sectional analysis of data from the Simulation and Fire-drill Evaluation (SaFE) randomised controlled trial. Setting - Six secondary and tertiary Maternity Units in Southwest England. Participants - 140 healthcare professionals, in 24 teams. Assessment - Blinded analysis of recorded simulations. Main outcome measures - Correlation of team performance (efficiency conducting key clinical actions, including the administration of an essential drug, magnesium), and generic teamwork scores (using a validated tool that assesses skills and behaviours, by Weller et al.).nnnRESULTSnThere was significant positive correlation between clinical efficiency and teamwork scores across all three dimensions; skills (Kendalls tau(b)=0.54, p<0.001), behaviours (tau(b)=0.41, p=0.001), and overall score (tau(b)=0.51, p<0.001). Better teams administered the essential drug 2½min more quickly (Mann-Whitney U, p<0.001).nnnCONCLUSIONSnThe clinical conduct of a simulated emergency was strongly linked to generic measures of teamwork. Further studies are needed to elucidate which aspects of team working are critical for team performance, to better inform training programs for multi-professional team working.

More to teamwork than knowledge, skill and attitude

Please cite this paper as: Siassakos D, Draycott T, Crofts J, Hunt L, Winter C, Fox R. More to teamwork than knowledge, skill and attitude. BJOG 2010;117:1262–1269.

The management of retrograde ejaculation: a systematic review and update

OBJECTIVEnTo determine the best management of retrograde ejaculation to optimize the chance of conception.nnnDESIGNnSystematic review.nnnSETTINGnTertiary reproductive medicine center.nnnPATIENT(S)nSubfertile men with retrograde ejaculation.nnnMETHOD(S)nSystematic search of studies using search terms management or therapy or treatment and retrograde ejaculation. We excluded case reports and papers not in English.nnnMAIN OUTCOME MEASURE(S)nPregnancy and live birth rates and rates of achievement of antegrade ejaculation.nnnRESULT(S)nThirty-four studies met our criteria. Studies were mostly observational. Descriptions of predictive and confounding variables were often insufficient. The treatment options included urinary sperm retrieval and medical management with anticholinergics and sympathomimetics. Successful pregnancies and live births were also achieved using surgical techniques and electroejaculation; however, numbers were small.nnnCONCLUSION(S)nMany treatment options exist in the management of retrograde ejaculation; however, current literature is insufficient to allow firm comparisons between interventions. Treatment should be tailored, therefore, to the individual. Our findings support the need for further research in this area-including large randomized controlled trials. However, these would be difficult logistically and may not be possible.

A simple tool to measure patient perceptions of operative birth

Objectiveu2002 To assess the feasibility and validity of a maternal satisfaction measurement tool, the SaFE study Patient Perception Score (PPS), after operative delivery.

Myths and realities of training in obstetric emergencies

Training for intrapartum emergencies is a promising strategy to reduce preventable harm during birth; however, not all training is clinically effective. Many myths have developed around such training. These principally derive from misinformed beliefs that all training must be effective, cheap, independent of context and sustainable. The current evidence base for effective training supports local, unit-based and multi-professional training, with appropriate mannequins, and practice-based tools to support the best care. Training programmes based on these principles are associated with improved clinical outcomes, but we need to understand how and why that is, and also why some training is associated with no improvements, or even deterioration in outcomes. Effective training is not cheap, but it can be cost-effective. Insurers have the fiscal power to incentivise training, but they should demand the evidence of clinical effect; aspiration and proxies alone should no longer be sufficient for funding, in any resource setting.

Multiprofessional ‘fire‐drill’ training in the labour ward

•xa0 nRegular multiprofessional rehearsals of the management of obstetric emergencies have been recommended since 1997. n n•xa0 nIn-house training is cheap and associated with improved outcomes. n n•xa0 nTeamwork failure is associated with poor obstetric outcome but aviation-based team training is not a panacea: we may need to develop and evaluate obstetric-specific interventions. n n n n n nLearning objectives: n n•xa0 nTo comprehend the importance of rehearsals in the labour ward. n n•xa0 nTo understand the components of successful ‘fire-drills’. n n n n n nEthical issues: n n•xa0 nExcessive focusing on the processes of training can lead to neglect of teamworking and prevent sustainable differences in outcomes. n n•xa0 nEntrenched negative attitudes to risk management processes can reduce the impact of training. n n n n n nPlease cite this article as: Siassakos D, Crofts J, Winter C, Draycott T. Multiprofessional ‘fire-drill’ training in the labour ward. The Obstetrician & Gynaecologist 2009;11:55–60.•u2003 Regular multiprofessional rehearsals of the management of obstetric emergencies have been recommended since 1997. •u2003 In‐house training is cheap and associated with improved outcomes. •u2003 Teamwork failure is associated with poor obstetric outcome but aviation‐based team training is not a panacea: we may need to develop and evaluate obstetric‐specific interventions.•xa0Regular multiprofessional rehearsals of the management of obstetric emergencies have been recommended since 1997. n•xa0In-house training is cheap and associated with improved outcomes. n•xa0Teamwork failure is associated with poor obstetric outcome but aviation-based team training is not a panacea: we may need to develop and evaluate obstetric-specific interventions. n n nLearning objectives: n n•xa0To comprehend the importance of rehearsals in the labour ward. n•xa0To understand the components of successful ‘fire-drills’. n n nEthical issues: n n•xa0Excessive focusing on the processes of training can lead to neglect of teamworking and prevent sustainable differences in outcomes. n•xa0Entrenched negative attitudes to risk management processes can reduce the impact of training. n n nPlease cite this article as: Siassakos D, Crofts J, Winter C, Draycott T. Multiprofessional ‘fire-drill’ training in the labour ward. The Obstetrician & Gynaecologist 2009;11:55–60.

Implementation strategies – moving guidance into practice

The importance of guideline development. The gap between knowledge and practice. Evidence for implementation strategies.

IMPROVING COLLABORATION IN MATERNITY WITH INTERPROFESSIONAL LEARNING

We applaud the recent article by Downe et al.1 The issue they discuss, collaboration between different maternity professions, is critical for women and their partners as well as for staff and health care organizations. Unfortunately, we also agree thatmuch could and should be done to improve the current conditions. Interprofessional barriers often exist as early as the undergraduate level. However, there is emerging evidence that interprofessional training can make a difference at both undergraduate2 and postgraduate3 levels. Indeed, the characteristics of effective collaboration in our unit were similar to those thatDowne et al propose: supportive organizational culture, a history of collaboration, and positive interprofessional attitudes. With these characteristics in mind, as well as the active components of effective interprofessional training,4 we attempted to foster an “opportunity to develop positive relationships with clinical staff and witnessing delivery of evidence-based quality care”5 for our medical students. We offered a variety of interprofessional experiences spanning the students’ clinical attachment to our department (clerkship) and opportunities to participate in interprofessional research teams and simulation exercises. We initiated new teaching sessions led by midwifery lecturers, withmidwifery students as tutors, to improve the learning experience of medical students. Medical students also were assigned to midwives rather than doctors for their laborward experiences, to avoid professionalmarginalization. The focus was on interprofessional working relationships on the job rather than ad hoc learning exercises. The scheme was successful in transforming the students’ idealism into positive attitudes2 and is now part of the curriculum. We believe the success could be attributed to both the design of the intervention and the excellent climate of collaboration in the unit as a result of regular training in interprofessional teams.3 We hope our experiences will help other organizations that want to provide interprofessional learning experiences.

Tubal disease and assisted reproduction

•u2003 Surgery can be useful in selected cases of tubal infertility and may have a complementary role for some women undergoing in vitro fertilisation (IVF). •u2003 Salpingectomy for women with large hydrosalpinges can improve the success rate of IVF. •u2003 There is little evidence that laparoscopy offers any advantage over laparotomy for tubal surgery. •u2003 Structured training in reproductive surgical techniques is of critical importance.•xa0Surgery can be useful in selected cases of tubal infertility and may have a complementary role for some women undergoing in vitro fertilisation (IVF). n•xa0Salpingectomy for women with large hydrosalpinges can improve the success rate of IVF. n•xa0There is little evidence that laparoscopy offers any advantage over laparotomy for tubal surgery. n•xa0Structured training in reproductive surgical techniques is of critical importance. n n nLearning objectives: n n•xa0To understand the selection criteria for tubal surgery and evaluate the supporting evidence. n•xa0To understand the limitations of the existing evidence. n•xa0To be able to counsel infertile couples appropriately. n n nEthical issues: n n•xa0Couples seeking fertility treatment may receive unreliable or biased information when considering tubal surgery. n•xa0Is it ethical to perform tubal surgery on women with a low chance of success simply because they are unable to have IVF? n n nPlease cite this article as: Siassakos D, Syed A, Wardle P. Tubal disease and assisted reproduction. The Obstetrician & Gynaecologist 2008;10:80–87.•xa0 nSurgery can be useful in selected cases of tubal infertility and may have a complementary role for some women undergoing in vitro fertilisation (IVF). n n•xa0 nSalpingectomy for women with large hydrosalpinges can improve the success rate of IVF. n n•xa0 nThere is little evidence that laparoscopy offers any advantage over laparotomy for tubal surgery. n n•xa0 nStructured training in reproductive surgical techniques is of critical importance. n n n n n nLearning objectives: n n•xa0 nTo understand the selection criteria for tubal surgery and evaluate the supporting evidence. n n•xa0 nTo understand the limitations of the existing evidence. n n•xa0 nTo be able to counsel infertile couples appropriately. n n n n n nEthical issues: n n•xa0 nCouples seeking fertility treatment may receive unreliable or biased information when considering tubal surgery. n n•xa0 nIs it ethical to perform tubal surgery on women with a low chance of success simply because they are unable to have IVF? n n n n n nPlease cite this article as: Siassakos D, Syed A, Wardle P. Tubal disease and assisted reproduction. The Obstetrician & Gynaecologist 2008;10:80–87.