Nerys Benfield

Fistula after attended delivery and the challenge of obstetric care capacity in the eastern Democratic Republic of Congo

To analyze the history of women with fistula in the eastern Democratic Republic of Congo (DRC) to understand the determinants of fistula development.

Cassava flour slurry as a low‐cost alternative to commercially available gel for obstetrical ultrasound: a blinded non‐inferiority trial comparison of image quality

amongst pregnant women undergoing routine scans, thereby suggesting the growing need of implementation of patient-safety procedures during pregnancy management and subsequent clinical follow-up. The authors convincingly demonstrated a lack of significant difference between the perceived image quality obtained with CFS (mean = 6.2; SD = 1.2) and that obtained with commercial gel (mean = 6.4; SD = 1.2): t(28) = 1.1 (P = 0.3). Despite the negative and non-significant statistical output, it was interesting to observe that all five experienced sonographers rated CFS as being easy to use to obtain clear images, and simple for patient and machine clean-up, thereby emphasising the patient-friendliness, cost-effectiveness, and feasibility of incorporating CFS in routine diagnostics in lowresource settings. The pilot data suggest that CFS produced comparable image quality to that achieved with commercial ultrasound gel. We would like to add that technical artefacts and inter-observer differences in the interpretation(s) of image quality and resolution may be further evaluated in pooled case cohorts with a large sample size of women with singleton, twin, and multiple pregnancies, for further corroboration of the current findings. As experienced clinical researchers propagating good practice in research, teaching and meaningful patient-centric interactions at the Indira Fertility Academy, Indira-IVF Hospital, Udaipur, India, we would recommend additional research along similar lines with diverse population subsets and cohorts of reproductive-aged pregnant women for a Wider investigation of these results. We strongly agree with the study group that the simple CFS recipe could significantly increase access to ultrasound for screening, monitoring, and diagnostic purposes in resource-limited settings on a global platform.& References

Family planning knowledge and use among women in camps for internally displaced people in the Democratic Republic of the Congo

To describe family planning awareness and needs among internally displaced women residing in the Mugunga camps in North Kivu, eastern Democratic Republic of the Congo.

Healthcare providers' perspectives on the social reintegration of patients after surgical fistula repair in the eastern Democratic Republic of Congo☆

To understand perspectives of local health providers on the social reintegration of patients who have undergone fistula repair in the eastern Democratic Republic of Congo.

Analysis of a pilot program to implement physical therapy for women with gynecologic fistula in the Democratic Republic of Congo

To describe components of a physical therapy pilot program for women with gynecologic fistula, and to report prospective data from the first 2 years of program implementation.

A data extraction algorithm for assessment of contraceptive counseling and provision

BACKGROUND: Contraception counseling and provision is an essential preventative service. Real‐time assessment of these services is critical for quality improvement and comparative study. Direct observation is not feasible on a large scale, so indirect measures (such as chart review) have been determined to be acceptable tools for this assessment. Computer‐aided chart review has significant benefits over manual chart review as far as greater efficiency and ease of repeated measurements. The wide use of electronic medical records provides an opportunity to create a data extraction algorithm for computer‐aided chart review that is sharable among institutions. We provide a useful schema for others who use electronic medical record systems and are interested in real‐time assessment of contraception counseling and provision for the purposes of baseline assessment of services and quality improvement. OBJECTIVE: The purpose of this study was to create a comprehensive and accurate data extraction algorithm that is useful in the assessment of contraception counseling and provision rates in the outpatient setting. STUDY DESIGN: We included all visits between August 2015 and May 2016 at 8 outpatient clinics that are affiliated with a large, urban academic medical center in which nonpregnant women who were 14–45 years old were seen by a nurse practitioner, physicians assistant, or physician. Contraception‐related prescriptions, International Classification of Diseases codes, current procedural terminology codes, and search‐term capture were extracted with the use of structured query language from electronic medical record data that were stored in a relational database. The algorithms hierarchy was designed to query prescription data first, followed by International Classification of Diseases and current procedural terminology codes, and finally search‐term capture. Visits were censored when the first positive evidence of contraceptive service was obtained. Search terms were selected based on group discussion of investigators and providers. This algorithm was then compared with manual chart review and refined 3 times until high sensitivity and specificity, when compared with manual chart review, were achieved. RESULTS: There were 22,134 visits of reproductive‐aged women who our inclusion criteria. Electronic medical record evidence of contraception counseling or provision was found in 56.9% of these visits. Of these, 21.3% were captured by prescriptions; 8.9% were captured by International Classification of Diseases codes, and 69.7% were captured by search‐term capture with the use of our algorithm. Among visits with evidence of contraception counseling without provision, 15.7% were captured by diagnosis codes and 84.3% were captured by search‐term capture. When compared with manual chart review, sensitivity and specificity improved from 0.79 and 0.85 to 0.99 and 0.98, respectively, over the 3 rounds of testing and revision. CONCLUSION: Data extraction algorithms can be used effectively for computer‐aided chart review of contraception counseling and provision measures, but testing and refinement are extremely important. Search‐term capture from unstructured data is a critical component of a comprehensive algorithm, especially for the capture of instances of contraception counseling without provision. The algorithm that we developed here could be used by others with an electronic medical record system who are interested in real‐time assessment, quality improvement, and comparative study of the delivery of contraceptive services. The ease of execution of this algorithm also allows for its repeated use for ongoing assessments over time.

W258 FISTULA AFTER ATTENDED DELIVERY: THE CHALLENGE OF OBSTETRICAL CARE CAPACITY IN EASTERN DEMOCRATIC REPUBLIC OF CONGO

been commenced on Prednisolone 60mg. She had an uneventful pregnancy since then until 38+ weeks of gestation when she had a still birth. Her platelet count was shown to be normal. Conclusions: Both cases illustrate the complexity of ITP. Early diagnosis is necessary in order to optimise anaesthetic options for delivery and reduce the risk of post-partum haemorrhage. Management of ITP in pregnancy is therefore challenging, requiring a multidisciplinary collaboration.