Evaluating teamwork among medical staff: How to measure and compare aspects of the team mental models of doctors and nurses.

Shared perceptions of a task among those responsible for its completion are important for achieving successful outcomes. This study proposes a framework for eliciting various aspects of team members' "mental models" (TMMs) of complex medical tasks. The intention is to provide 'proof of concept' for a methodology to measure similarities and differences between team members' perceptions of selected attributes of the task. Applying our framework in a gynecology ward, we use cognitive interviewing and concept mapping to reveal differences between the TMMs of doctor and nurse teams. These group differences are found to reflect limited awareness of the other group's level of involvement, workload, responsibilities and contributions to quality of care. We argue that such differences may lead to frustration, conflict, poor teamwork and risks to patient safety; but once identified, and subject to certain limitations, the differences could be used to develop interventions that will enhance teamwork.

[First year experience using arabin cervical pessary with intravaginal micronized progesterone for the prevention of preterm birth in patients with mid-trimester short cervix].

BACKGROUND: Arabin cervical pessary is a silicone ring pessary for the prevention of preterm birth (PTB] for pregnant women at risk with second trimester short uterine cervix. Progesterone supplementation has been found to prevent PTB. OBJECTIVE: To review our first year of experience using Arabin cervical pessary with intravaginal micronized progesterone in the prevention PTB. METHODS: The study included patients (pt) with singleton and twin pregnancies at 16-30 weeks with uterine cervical length < or = 25 mm treated with Arabin cervical pessary and intravaginal progesterone over one year from September 2011 to September 2012. Progesterone treatment was continued until 34 weeks and pessary was extracted at 36 weeks or in cases of preterm labor, bleeding or other medical indications. RESULTS: The study group included 43 patients, 31 (72.1%) singleton and 12 (27.9%) twins. The average week at admission was 25+2 weeks [w] [SD +/- 3.05], and the average cervical length at admission was 13.5 mm (SD +/- 5.0). A total of 11 patients had previous PTB; in 2 patients the pessary was placed after cerclage failure. The average week of delivery was 35 + 5 weeks SD +/- 3.2 (singleton 36 + w SD +/- 2.6, twins 33 + 4 SD +/- 4.1, p = 0.05); the average time between pessary insertion to delivery 72.1 days SD +/- 26.2 (singleton 76.3 SD +/- 22.9 twins 60.2 SD +/- 28.9 p = 0.02), in 23 patients (53.5%) the pessary was extracted at > or = 36 + 6w, 5 patients 111.6%) delivered < or = 32w (2 singleton, 3 twins, p = 0.08) and 18 patients (41.8%) reported increased vaginal discharge. CONCLUSION: The use of cervical pessary in conjunction with intravaginal progesterone is safe and feasible. Patients with twin pregnancies had a significantly higher rate of preterm birth compared to singleton pregnancies. Further research is needed to assess device efficacy.

Intrapartum measurement of cervical dilatation using translabial 3-dimensional ultrasonography: correlation with digital examination and interobserver and intraobserver agreement assessment.

OBJECTIVE: The purpose of this study was to determine the accuracy and reproducibility of intrapartum translabial 3-dimensional (3D) ultrasonographic measurements of cervical dilatation during labor. METHODS: A prospective observational study was conducted. Three-dimensional ultrasonographic volume data sets from 52 patients were collected during labor and stored. Later, all volumes were randomly reviewed twice offline by 2 examiners blinded to previous clinical and ultrasonographic measurements. The correlation with delivery room personnel digital vaginal examinations and interobserver and intraobserver agreement were determined. RESULTS: Twenty-four patients were examined during the latent phase (0- to 4-cm cervical dilatation), and 28 patients were examined during the active phase (5- to 10-cm cervical dilatation). Translabial 3D ultrasonographic measurements of the cervical mean and maximal diameters and inner cervical area showed a positive correlation with digital vaginal examinations (r(2) = 0.609, 0.587, and 0.469, respectively; all P < .001). The interobserver mean differences +/- SD between paired measurements for the mean and maximal cervical dilatation and inner cervical area were 0.11 +/- 0.49 cm, 0.12 +/- 0.48 cm, and -0.22 +/- 5.69 cm(2), and the intraclass correlation coefficients (ICCs) were 0.82, 0.85, and 0.87. The intraobserver mean differences between paired measurements of the mean and maximal cervical dilatation and inner cervical area were 0.002 +/- 1.15 cm, 0.02 +/- 1.4 cm, and -0.41 +/- 1.15 cm(2), and the ICCs were 0.85, 0.79, and 0.75. CONCLUSIONS: Assessment of cervical dilatation using 3D ultrasonography during labor is feasible and reproducible.

Maternal spleen size throughout normal pregnancy.

Ultrasonography (US) is an accurate method with reproducible results for calculating splenic dimensions. Standards of normal spleen sizes have been developed for the general adult population, for children, and even for tall healthy athletes, thereby enabling US diagnosis of splenomegaly. Extrapolation of data from the normal population to pregnant women might, however, be inaccurate because of the physiological changes throughout gestation. We have recently reported a prospective study evaluating the size of the maternal spleen throughout pregnancy and hereby review the results and their implications.