Hanan Mf Al Kadri

Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study

PurposeOne of the major problems in international literature is how to measure postpartum blood loss with accuracy. We aimed in this research to assess the accuracy of visual estimation of postpartum blood loss (by each of two main health-care providers) compared with the gravimetric calculation method.MethodsWe carried out a prospective cohort study at King Abdulaziz Medical City, Riyadh, Saudi Arabia between 1 November 2009 and 31 December 2009. All women who were admitted to labor and delivery suite and delivered vaginally were included in the study. Postpartum blood loss was visually estimated by the attending physician and obstetrics nurse and then objectively calculated by a gravimetric machine. Comparison between the three methods of blood loss calculation was carried out.ResultsA total of 150 patients were included in this study. There was a significant difference between the gravimetric calculated blood loss and both health-care providers’ estimation with a tendency to underestimate the loss by about 30%. The background and seniority of the assessing health-care provider did not affect the accuracy of the estimation. The corrected incidence of postpartum hemorrhage in Saudi Arabia was found to be 1.47%.ConclusionHealth-care providers tend to underestimate the volume of postpartum blood loss by about 30%. Training and continuous auditing of the diagnosis of postpartum hemorrhage is needed to avoid missing cases and thus preventing associated morbidity and mortality.

Exploring factors affecting undergraduate medical students’ study strategies in the clinical years: a qualitative study

The aim of this study is to explore the effects of clinical supervision, and assessment characteristics on the study strategies used by undergraduate medical students during their clinical rotations. We conducted a qualitative phenomenological study at King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia during the period from November 2007 to December 2008. We conducted semi-structured focus groups interviews with students and conducted individual interviews with teachers and students to explore students’ and clinical teachers’ perceptions and interpretations of factors influencing students’ study strategies. Data collection was continued until saturation was reached. We used Atlas-ti Computer Software (Version 5.2) to analyse the data, apply the obtained themes to the whole dataset and rearrange the data according to the themes and sub-themes. Analysis of data from interviews with twenty-eight students and thirteen clinical supervisors yielded three major themes relating to factors affecting students’ study strategies: “clinical supervisors and supervision”, “stress and anxiety” and “assessment”. The three themes we identified played a role in students’ adoption of different study strategies in the “community of clinical practice”. It appeared that teachers played a key role, particularly as assessors, clinical supervisors and as a source of stress to students.

Students' perceptions of the impact of assessment on approaches to learning: a comparison between two medical schools with similar curricula

Objectives: The aim of the study was to investigate students? perceptions of assessment and the resulting learning styles. Methods Qualitative semi-structured interviews were conducted with 14 students and 8 clinical supervisors from Sydney Medical School and 12 students and 13 clinical supervisors from King Saud bin Abdulaziz University. Both institutions have similar curricula but a different assessment approach. The interviews were transcribed and analyzed using thematic analysis. Interview transcripts were stored and analyzed using ATLAS.ti. Results Three themes emerged from analyses of the interviews: the function of assessment, learning outcomes and, finally, authentic assessment in the clinical environment. A model is presented to show the relationship between contextual and different personal factors and students’ perceptions of the impact of assessment on learning styles. Conclusions Cultural differences and emotions can affect students’ perceptions of assessment and learning styles. A combination of formative and summative assessment based on learning objectives is required. This combination should take into consideration students’ cultural background, values and the implemented education system. This balance should be sufficient to motivate students in order to maintain their focus and attention, and reduce the potential negative impacts of a hidden curriculum. The experience of authentic assessment was a powerful motivator for students’ approaches to learning.

Obstetric medical emergency teams are a step forward in maternal safety

Background and Aim: The medical emergency team (MET) system was introduced successfully worldwide. With the exception of a few research publications, most of the described teams are based on patients’ medical rather than obstetric management. The objective of this study was to review literature on the outcome of obstetric MET implementation. Materials and Methods: Systematic review has been done through searching MEDLINE, the Cochrane Library, relevant articles references, and contact with experts. The author and one other researcher independently selected literature on the establishment or implementation of obstetric MET. There were no restrictions on language, sample size, type of publication, or duration of follow up. Results: Three publications were identified: Catanzarite et al., Gosman et al., and Skupski et al. They were heterogeneous in terms of the method of implementation and the outcomes discussed. None of them discussed obstetric MET implementation in developing countries. Conclusion: In the literature, there is a lack of reporting and probably of implementation of Obstetrics METs. Therefore, there is a need for more standardized experiences and reports on the implementation of various types of Obstetrics METs. We propose here a design for Obstetrics METs to be implemented in developing countries, aiming to reduce maternal mortality and morbidity resulting from obstetric hemorrhage.

Antibiotic use and risk of gynecological cancer

OBJECTIVES Several studies addressed the association between antibiotic use and breast cancer risk. The objective of this study was to assess the association between antibiotic use and risk of cervical, ovarian, and uterine cancer. STUDY DESIGN We carried out a population-based case-control study using data from Saskatchewan Health administrative databases (Canada) between the years 1981 and 2000. Cases were matched to 4 controls, using incidence density sampling. The effect of dosage and timing of antibiotic use, over a minimum of 15 years before diagnosis, on cervical, ovarian, or uterine cancer risk was assessed. Number of prescriptions and number of pills were used as exposure definitions. The effect of different classes of antibiotics on cancer risk was also studied. RESULTS A total of 1225 cancer cases [192 cervical, 445 ovarian, and 588 uterine] and 4900 matched controls were included in this study. Antibiotic exposure (number of prescriptions) during the period of 1-15 years in the past was significantly associated with a reduced risk of cervical cancer; Relative Risk (RR)=0.40, 0.31, 0.26, and 0.29 for the four exposure quartiles, respectively. No association was found for ovarian or uterine cancer. When number of pills was considered, similar results were found. There was no effect of the timing or class of antibiotic exposure on cervical cancer risk. CONCLUSIONS Antibiotic exposure up to 15 years in the past was associated with a decreased risk of cervical cancer. The lack of temporal trends and the absence of class specific effects suggest a non-causal relationship.