October update
Cervical cerclage, PCOS, TLH analgesia, identity and inclusion conflict, restorative justice, human-centred culture, preterm neonatal neurology, impacted fetal head and Zoom background choices.
Hey everyone,
I’m writing this update from the RACMA 2023 conference in Auckland. In case you aren’t aware, RACMA are the Royal Australasian College of Medical Administrators. As well as training College Fellows who are destined for organisational senior leadership, RACMA Associate Fellowship offers a Leadership for Clinicians training pathway for clinicians interested in leadership principles and practice, but who may not be targeting Exec level positions. I did this training and found it to be excellent.
Topics from this month’s update include: preterm birth & neurological outcomes, team huddles in medicine, the role of TA vs TV cervical cerclage after fully-dilated CS, latest PCOS guidelines, an update on sFlt-1 and PlGF in screening, prediction, diagnosis and monitoring of pre-eclampsia and fetal growth restriction. I’ve included a tool for calling out conflict relating to identity and inclusion in a team setting, information about restorative justice culture frameworks and learnings from IBM about building a human-centred organisation. Finally, a guide to obstetric doppler interpretation.
Cheers for now,
Danny
Defining the Neurologic Consequences of Preterm Birth
As perinatal professionals, we're deeply committed to safeguarding the brain health of newborns during their time in utero —ideally, a full 40 weeks. This insightful review sheds light on the three main types of brain injury linked to preterm birth, their long-term developmental impact, and the factors that can influence outcomes.
Team huddles - MDT, medics only or both?
Multidisciplinary huddles are an established method of improving quality and safety in healthcare settings. They promote stronger teamwork, communication, and situational awareness on the unit floor, leading to more patient-centered, coordinated, and effective healthcare. On the other hand, physician-only huddles may have their own advantages in terms of focusing specifically on physician-related issues and concerns. This article and associated Editorial explore the place of physician-only huddles and their potential utility in improving patient safety outcomes. Key findings of the article include the positive impact of huddles on physician engagement, burnout reduction, and quality of patient care.
Transvaginal or transabdominal cerclage after full-dilatation CS and subsequent adverse pregnancy outcome
Women who have undergone full dilatation cesarean deliveries are at a substantially elevated risk of early and recurrent late miscarriage, as well as spontaneous preterm birth. Transvaginal cerclage (TVC), a common intervention to prevent these outcomes, has been found to be less effective in these cases. Limited data exist on the efficacy of an alternative approach, transabdominal cerclage (TAC). The theory posits that cervical damage sustained during cesarean delivery may be a key contributing factor to subsequent pregnancy loss, and that TAC placement above the scar could be more efficacious.
The research was a retrospective cohort study conducted at a tertiary-level maternity unit in London, comparing pregnancy outcomes of women with a history of full dilatation cesarean deliveries who subsequently had either TAC or TVC. The primary outcome was a ‘live baby at discharge,’ while secondary outcomes examined spontaneous preterm births at different gestational ages. The study found TAC to be significantly more effective than TVC. In the TAC group, 100% of pregnancies resulted in a live baby at discharge compared to 54.8% in the TVC group. The data strongly suggest that TAC is superior in preventing recurrent pregnancy loss and merits consideration as a primary procedure.
Clinical utility of sFlt-1 and PlGF in screening, prediction, diagnosis and monitoring of pre-eclampsia and fetal growth restriction
Pre-eclampsia (PE) is a complex obstetric condition characterised by placental and maternal endothelial dysfunction, and is implicated in adverse pregnancy outcomes such as fetal growth restriction and preterm delivery. Angiogenic factors, namely soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF), have been found to be altered in PE and other placenta-related disorders. Therefore, understanding these biomarkers is critical for the early identification and management of PE. This review brings you up to date with the biochemistry of these factors and the evidence for the clinical utility of currently available tests. A must read for exam candidates.
2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome
NHMRC-sponsored, produced by Monash University and endorsed by ESHRE and ASRM, these 2023 evidence-based guidelines for diagnosing and managing polycystic ovary syndrome (PCOS), were developed through a multi-disciplinary international collaboration. Using the GRADE framework for best practice, the guidelines recommend a revised diagnostic criteria for PCOS.
Advocating for a holistic approach to management, encompassing reproductive, metabolic, cardiovascular, and psychological aspects, these guidelines aim to standardise care, urging integrated models that emphasise shared decision-making and patient self-empowerment.
What does your Zoom background say about you?
First impressions have always been topical, particularly how they're influenced by variables like facial expressions and gender. The Covid-19 pandemic threw us a curveball, shifting our interactions online. Videoconferencing is the new norm, and we haven't fully understood how different factors, like the video background, influence our judgements of others in this virtual setting.
This study found that certain video backgrounds, like those with plants or books, make you look more trustworthy and competent. Smiling faces had a similar effect. Interestingly, female faces were seen as both more trustworthy and competent, regardless of what their video background. These findings may be useful for anyone interested in making a positive impression in online meetings.
Building a human-centred organisation: Breaking down insights from 7 years of research and application
I often enjoy reading about learnings from non-medical fields because we come across either new ideas or ideas that have been thoroughly tested in situations of potential relevance. Humans are humans after all. This article explores the challenges and opportunities organisations face in a rapidly changing landscape, based on 7 years of research and application at IBM. It discusses the importance of human-centred design in aligning organisational values with stakeholder needs.
For medical leaders, the article offers a valuable framework for fostering more adaptive, resilient, and patient-focused organisations. The insights are universally applicable and might inform our strategic planning.
https://www.ibm.com/design/thinking/page/hco
How to address conflict related to identity and inclusion in a team setting: A tool
The article presents a comprehensive approach for leaders to address incidents that undermine organisational and personal values of equity and inclusion, focusing on immediate and sustained actions. It outlines a three-step method: addressing the behaviour immediately, engaging productively with the responsible team member, and supporting impacted staff from underrepresented groups.
For medical leaders, this guide offers valuable insights into fostering a culture of inclusion within healthcare settings. Implementing the discussed strategies not only sustains a sense of safety and belonging for underrepresented staff but also serves as a blueprint for modelling organisational values effectively. These practices are essential in an industry where the well-being of staff directly correlates with patient care quality.
And finally a few others of note:
That’s all today, thanks for following along.
Danny