Collaborative healthcare education programmes for continuing professional education in low and middle-income countries: A Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 65.

BACKGROUND: Large discrepancies exist between standards of healthcare provision in high-income (HICs) and low and middle-income countries (LMICs). The root cause is often financial, resulting in poor infrastructure and under-resourced education and healthcare systems. Continuing professional education (CPE) programmes improve staff knowledge, skills, retention, and practice, but remain costly and rare in low-resource settings. One potential solution involves healthcare education collaborations between institutions in HICs and LMICs to provide culturally appropriate CPE in LMICs. To be effective, educational partnerships must address the challenges arising from differences in cultural norms, language, available technology and organisational structures within collaborating countries. METHODS: Seven databases and other sources were systematically searched on 7 July 2020 for relevant studies. Citations, abstracts, and studies were screened and consensus was reached on which to include within the review. 54 studies were assessed regarding the type of educational programme involved, the nature of HIC/LMIC collaboration and quality of the study design. RESULTS: Studies varied greatly regarding the types and numbers of healthcare professionals involved, pedagogical and delivery methods, and the ways in which collaboration was undertaken. Barriers and enablers of collaboration were identified and discussed. The key findings were: 1. The methodological quality of reporting in the studies was generally poor. 2. The way in which HIC/LMIC healthcare education collaboration is undertaken varies according to many factors, including what is to be delivered, the learner group, the context, and the resources available. 3. Western bias was a major barrier. 4. The key to developing successful collaborations was the quality, nature, and duration of the relationships between those involved. CONCLUSION: This review provides insights into factors that underpin successful HIC/LMIC healthcare CPE collaborations and outlines inequities and quality issues in reporting.

Yersinia enterocolitica Outbreak Associated with Pasteurized Milk.

In July 2019, we investigated a cluster of Yersinia enterocolitica cases affecting a youth summer camp and nearby community in northeastern Pennsylvania. After initial telephone interviews with camp owners and community members, we identified pasteurized milk from a small dairy conducting on-site pasteurization, Dairy A, as a shared exposure. We conducted site visits at the camp and Dairy A where we collected milk and other samples. Samples were cultured for Y. enterocolitica. Clinical and nonclinical isolates were compared using molecular subtyping. We performed case finding, conducted telephone interviews for community cases, and conducted a cohort study among adult camp staff by administering an online questionnaire. In total, we identified 109 Y. enterocolitica cases. Consumption of Dairy A milk was known for 37 (34%); of these, Dairy A milk was consumed by 31 (84%). Dairy A had shipped 214 gallons of pasteurized milk in 5 weekly shipments to the camp by mid-July. Dairy A milk was the only shared exposure identified between the camp and community. Y. enterocolitica was isolated from Dairy A unpasteurized milk samples. Five clinical isolates from camp members, two clinical isolates from community members, and nine isolates from unpasteurized milk were indistinguishable by whole-genome sequencing. The risk for yersinosis among camp staff who drank Dairy A milk was 5.3 times the risk for those who did not (95% confidence interval: 1.6-17.3). Because Dairy A only sold pasteurized milk, pasteurized milk was considered the outbreak source. We recommend governmental agencies and small dairies conducting on-site pasteurization collaborate to develop outbreak prevention strategies.

Preparing midwifery students for traumatic workplace events: Findings from the POPPY (programme for the prevention of posttraumatic stress disorder in midwifery) feasibility study.

BACKGROUND: Midwifery students can experience events on clinical placements that they perceive to be traumatic. There is currently no requirement to provide training about the nature of trauma, normal responses, or the most helpful ways of self-managing these. The POPPY programme, developed for qualified midwives, incorporates educational (the POPPY workshop) and supportive resources to prevent the development of Post-Traumatic Stress Disorder in midwives. As part of the feasibility evaluation of POPPY, the POPPY workshop element was adapted for pre-registration midwifery students (PreR-POPPY). Attention to this issue during pre-registration education could improve student experience and support student retention. OBJECTIVES: To identify students' perspectives on the contents (clarity, understandability, organisation of the workshop, utility, relevance), their understanding of trauma and psychological responses, and confidence in recognising and managing early signs of distress following participation in a PreR-POPPY workshop. Perspectives on preferred timing in their midwifery programmes, and methods of delivery were also sought. DESIGN: In keeping with educational evaluations, anonymous feedback was collected from students. SETTING: Two higher education institutes. PARTICIPANTS: Midwifery undergraduate students on the three year or shortened programme for registered nurses (n = 131), and midwifery educators (n = 5). METHODS: Students participated in the workshop and provided feedback immediately. Midwifery educators participated in a meeting with the researchers to provide feedback. RESULTS: High levels of satisfaction with the contents of the workshop were identified. Ninety-nine percent of students would recommend the workshop to other midwifery students. Provision of the workshop early in midwifery programmes, revisited at later points, was strongly endorsed. Learning outcomes were very positive for understanding trauma/early stress responses, and recognising and managing early responses to trauma. Strong endorsement for the provision of the workshop was received from the midwifery educators. CONCLUSIONS: The pre-registration adapted POPPY workshop should be routinely provided in preregistration midwifery.

MBRRACE-UK Report launch December 2016.

December 7th 2016 saw the launch of the third annual MBRRACE-UK Saving lives, improving mothers' care report; a report which provides us with a picture of maternal deaths in the UK between 2012-14 and information on the lessons learned from the UK and Ireland confidential enquiries into maternal deaths and morbidities between 2009-14. Globally, maternal deaths have fallen by over half since the introduction of the millennium development goals in 1990. Although short of the global target to reduce such maternal deaths by three quarters by the year 2015 (United Nations (UN) 2015), maternal deaths within the UK are, in fact, a rare event. This year's report calculates reduction in deaths from previous years to a rate 8.5 death per 100,00 maternities compared to last year's nine deaths per 100,000 maternities. Although not a statistically significant decrease, it is a promising reduction. Here, the key recommendations for practice outlined in the report are summarized in an attempt to further reduce such morbidity and mortality rates in the future.

The fundamental skills: reducing maternal morbidity and mortality.

The accurate assessment of basic observations such as blood pressure, heart rate, arterial oxygen saturation of blood (SpO²), respirations, temperature and level of consciousness (AVPU score) underpin the fundamentals of basic midwifery care provision. However, after identifying that the signs of impending maternal collapse often went unrecognised leading to subsequent morbidities and mortalities, the confidential enquiry into maternal and child health (CEMACH) report in 2007 (Lewis 2007) recommended that all obstetric women's observations were recorded through a modified early obstetric warning system (MEOWS). This allows for the early detection of women who may become critically unwell and provides an opportunity for practitioners to act promptly and prevent deterioration (Knight et al 2016).This article provides an overview of the MEOWS scores as a tool to improve maternal morbidity and mortality within maternity care.

Parental decisions on children participating in research.

AIM: To observe and report rates of, and reasons for, parents' refusal to consent to the participation of their children in appropriate clinical research. METHODS: The parents of children admitted to hospital with a diagnosis of pneumonia or of empyema were asked for informed consent to research involving blood, urine and nasopharyngeal secretion samples from their child. Circumstances and numbers of agreements and refusals were compared and underlying reasons suggested. RESULTS: Of 144 consent requests, ten were refused, which appeared to be linked to: not wanting the child to undergo further tests, lack of interest in participating in studies, research possibly delaying discharge, and anxiety regarding written consent and the length of information sheets. CONCLUSIONS: Severity of the child's illness appeared to determine the parent's decision. Involvement and assistance of non-research nursing and medical staff and previous introductions to the researchers are helpful. The timing and setting for the consent process should be selected carefully. Adequate, accessible study information for parents and children contributes to successful recruitment of participants.

Francisella novicida bacteremia after a near-drowning accident.

We describe a rare case of Francisella novicida bacteremia following a near-drowning event in seawater. We highlight the challenges associated with laboratory identification of F. novicida and differences in the epidemiology of F. novicida and Francisella tularensis infections.

Isolation and characterization of a novel Francisella sp. from human cerebrospinal fluid and blood.

We describe the isolation of a Francisella sp. from normally sterile sites in acutely ill patients in two different states within 2 years. Microbiologic and molecular analyses indicate that this organism represents a novel Francisella sp. Clinicians and microbiologists should be aware of this new potential pathogen, as infection may be more common than recognized.