Low-dose aspirin use in the first trimester of pregnancy and odds of congenital anomalies: A meta-analysis of randomized controlled trials.

BACKGROUND: Daily low-dose aspirin (LDA) is recommended in high-risk pregnancies. However, its safety profile in the first trimester has not been well documented. OBJECTIVES: To determine if LDA exposure during the first trimester of pregnancy is associated with higher odds of congenital structural anomalies. SEARCH STRATEGY: PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were systematically searched. SELECTION CRITERIA: Randomized controlled trials (RCTs) that assigned participants to LDA (≤150 mg) or placebo/no intervention at less than 14 weeks of pregnancy were eligible. DATA COLLECTION AND ANALYSIS: Random-effects models were performed using the inverse-variance method to calculate pooled effect sizes. Quality of evidence was appraised according to Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. MAIN RESULTS: Eight RCTs that included 7564 participants assigned to receive daily LDA and 7670 participants that served as controls were analyzed. Low-certainty evidence showed no significant difference in the odds of congenital anomalies (odds ratio 0.87, 95% confidence interval 0.62-1.23, I2  = 0%). CONCLUSIONS: In this meta-analysis, there is no evidence to suggest safety concerns regarding LDA teratogenicity. However, given the overall low quality of evidence, further research (e.g. individual participant data meta-analysis) is needed to confirm LDA safety profile.

Continuing professional development challenges in a rural setting: A mixed-methods study.

INTRODUCTION: Health professionals in rural settings encounter a wide range of medical conditions requiring broad knowledge for their clinical practice. This creates the need for ongoing continuing professional development (CPD). In this study, we explored the barriers that health professionals in a rural healthcare context faced participating in CPD activities and their preferences regarding educational strategies to overcome these challenges. METHODS: This mixed-methods (exploratory sequential) study in a community hospital in rural Mexico includes 22 interviews, 3 focus groups, 40 observational hours, and a questionnaire of healthcare staff. RESULTS: Despite low engagement with CPD activities (67% not motivated), all participants expressed interest and acknowledged the importance of learning for their practice. Barriers to participating include a disparity between strategies used (lecture-based) and their desire for practical learning, institutional barriers (poor leadership engagement, procedural flaws, and lack of resources), and collaboration barriers (adverse interprofessional education environment, ineffective teamwork, and poor communication). Additional barriers identified were inconvenient scheduling of sessions (75%), inadequate classrooms (65%), high workload (60%), ineffective speakers (60%), and boring sessions (55%). Participants' preferred learning strategies highlighted activities relevant to their daily clinical activities (practical workshops, simulations, and case analysis). The questionnaire had an 18% response rate. DISCUSSION: The barriers to CPD in this rural setting are multifactorial and diverse. A strong interest to engage in context-specific active learning strategies highlighted the need for leadership to prioritize interprofessional education, teamwork, and communication to enhance CPD and patient care. These results could inform efforts to strengthen CPD in other rural contexts.

Training for the surgical management of postpartum hemorrhage: a multicenter survey of resident physicians.

BACKGROUND: To actively address maternal morbidity and mortality in Mexico, proficiency among obstetrics and gynecology (OBGYN) residents in the surgical management of postpartum hemorrhage (PPH) is a priority. However, the capacity of programs to provide this training is unknown. OBJECTIVE: The self-reported knowledge, education, and proficiency of common surgical techniques for the management of PPH among OBGYN residents in Mexico was evaluated. Educational resources, perceived barriers to acquiring skills, and clinical decision-making were explored. MATERIALS AND METHODS: In July of 2018, an anonymous electronic survey was sent to 86 residents at four hospitals throughout Mexico. Surgical techniques queried included uterine tamponade (UT), uterine compression sutures (UCS), uterine devascularization (UD), hypogastric artery ligation (HAL), and gravid hysterectomy (HT). Participants also answered case-based questions about a patient with PPH. RESULTS: The survey response rate was 59.3% (51/86). Seventy-nine percent of residents reported understanding the rationale and techniques for the surgical intervention of PPH. However, 43.9% reported limited ability to perform these procedures with autonomy. Eighty-six percent of residents reported exposure to these techniques while performing a rescue procedure during PPH and 49% reported learning these procedures while performing prophylactic techniques in patients without PPH. Only 25.5% had been exposed to simulation training. Lack of a training module for these skills in their curriculum was noted by 74.5%. The majority of the participants chose UCS, UD, HAL, and HT as the first, second, third, and fourth rescue procedures to perform for PPH, respectively. CONCLUSION: Most residents reported theoretical knowledge of surgical interventions for PPH, but their self-rated ability to independently perform such skills and a curriculum focused on PPH management was suboptimal.

Journal Club Using Virtual Breakout Rooms: Interactive Continuing Education with No Learner Preparation During COVID-19.

INTRODUCTION: As a result of the COVID-19 pandemic, the authors rapidly transitioned an in-person, learner-led medical education journal club (MEJC) to the virtual environment. The "interactive, no-prep" approach, using breakout rooms within a videoconferencing system, required no prior learner preparation. METHODS: From March to May 2020, learners were invited to participate in a monthly 60-minute virtual MEJC. A needs assessment survey informed article selection. Facilitators developed a presentation to provide background and describe the article's research question(s). In breakout groups, learners generated study designs to answer the research question(s). After the actual study methodology and results were revealed, learners engaged in facilitated open discussion. After the session, learners completed an electronic survey to rate perceived usefulness and suggest improvement areas. RESULTS: A total of 15 learners participated; most completed the survey (13/15; 87%). The MEJC was rated as very or extremely useful. Qualitative feedback indicated that it was convenient, allowed creativity, and enabled rich discussion without prior preparation. When possible, improvement suggestions were implemented. DISCUSSION: The authors offer an evidence-based MEJC approach that is free, interactive with virtual breakout rooms and requires no prior learner preparation. Early indicators suggest that others navigating the COVID-19 crisis may want to implement this approach.

Journal Club Using Virtual Breakout Rooms: Interactive Continuing Education with No Learner Preparation During COVID-19.

INTRODUCTION: As a result of the COVID-19 pandemic, the authors rapidly transitioned an in-person, learner-led medical education journal club (MEJC) to the virtual environment. The "interactive, no-prep" approach, using breakout rooms within a videoconferencing system, required no prior learner preparation. METHODS: From March to May 2020, learners were invited to participate in a monthly 60-minute virtual MEJC. A needs assessment survey informed article selection. Facilitators developed a presentation to provide background and describe the article's research question(s). In breakout groups, learners generated study designs to answer the research question(s). After the actual study methodology and results were revealed, learners engaged in facilitated open discussion. After the session, learners completed an electronic survey to rate perceived usefulness and suggest improvement areas. RESULTS: A total of 15 learners participated; most completed the survey (13/15; 87%). The MEJC was rated as very or extremely useful. Qualitative feedback indicated that it was convenient, allowed creativity, and enabled rich discussion without prior preparation. When possible, improvement suggestions were implemented. DISCUSSION: The authors offer an evidence-based MEJC approach that is free, interactive with virtual breakout rooms and requires no prior learner preparation. Early indicators suggest that others navigating the COVID-19 crisis may want to implement this approach.