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Biomedical subjects

Stephen D Pratt

Publications and source records attributed to Stephen D Pratt.

4 recordsLinked to original sources
PubMed2007

Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of teamwork training on the occurrence of adverse outcomes and process of care in labor and delivery. METHODS: A cluster-randomized controlled trial was conducted at seven intervention and eight control hospitals. The intervention was a standardized teamwork training curriculum based on crew resource management that emphasized communication and team structure. The primary outcome was the proportion of deliveries at 20 weeks or more of gestation in which one or more adverse maternal or neonatal outcomes or both occurred (Adverse Outcome Index). Additional outcomes included 11 clinical process measures. RESULTS: A total of 1,307 personnel were trained and 28,536 deliveries analyzed. At baseline, there were no differences in demographic or delivery characteristics between the groups. The mean Adverse Outcome Index prevalence was similar in the control and intervention groups, both at baseline and after implementation of teamwork training (9.4% versus 9.0% and 7.2% versus 8.3%, respectively). The intracluster correlation coefficient was 0.015, with a resultant wide confidence interval for the difference in mean Adverse Outcome Index between groups (-5.6% to 3.2%). One process measure, the time from the decision to perform an immediate cesarean delivery to the incision, differed significantly after team training (33.3 minutes versus 21.2 minutes, P=.03). CONCLUSION: Training, as was conducted and implemented, did not transfer to a detectable impact in this study. The Adverse Outcome Index could be an important tool for comparing obstetric outcomes within and between institutions to help guide quality improvement. CLINICAL TRIAL REGISTRATION: (www.ClinicalTrials.gov), NCT00381056 LEVEL OF EVIDENCE: I.

Delivery, Obstetric↗
PubMed2006

Chloroprocaine may not affect epidural morphine for postcesarean delivery analgesia.

STUDY OBJECTIVE: The purpose of this study is to assess the independent effect of epidural chloroprocaine on morphine used for pain relief after cesarean delivery. DESIGN: We used a randomized, double blind, placebo-controlled trial. SETTING: The study took place at the labor and delivery ward of an academic medical center. PATIENTS: Forty pregnant women undergoing elective cesarean delivery under spinal-epidural anesthesia. INTERVENTIONS: Patients were randomized to receive either 150 mg of 3% chloroprocaine or placebo, followed by 3 mg of epidural morphine. MEASUREMENTS: The primary outcome for this investigation was the duration of pain relief after morphine administration, defined as the time at first use of supplemental opioids for analgesia. Secondary outcomes included pain scores, blood pressure, heart rate, respiratory rate, anesthetic sensory level, nausea and vomiting, pruritus, supplemental use of nonsteroidal anti-inflammatory medications, and satisfaction. MAIN RESULTS: The groups were similar in demographics and duration of spinal anesthesia. Using Kaplan-Meier survival analysis of the duration of morphine analgesia, we found no difference between the groups (chloroprocaine, 1191 minutes, vs placebo, 1267 minutes, P = 0.52). There was no difference in pain scores or the need for supplemental analgesics. Side effects of epidural morphine were similar between the groups. CONCLUSIONS: We found that epidural chloroprocaine did not reduce the duration or effectiveness of postoperative analgesia from epidural morphine.

Adult↗
PubMed2003

Small dose bupivacaine-fentanyl spinal analgesia combined with morphine for labor.

UNLABELLED: We investigated the duration of labor analgesia produced by a small dose of spinal bupivacaine/fentanyl alone or in combination with a small dose of morphine. Sixty parturients were enrolled in this placebo-controlled, double-blinded, randomized trial. All women received a spinal injection of 12.5 micro g of fentanyl with 2 mg of bupivacaine. The morphine group (MBF) also received 125 micro g of morphine; the placebo group (BF) received saline. Pain scores were <3 of 10 within 10 min of injection. The median duration of analgesia was similar between groups (89 min versus 84 min; P = not significant), and only 20% of the MBF group experienced prolonged analgesia. During subsequent epidural analgesia, the MBF group had a significantly lesser rate of breakthrough pain (0.15 +/- 0.14 episodes per hour versus 0.26 +/- 0.18 episodes per hour; P = 0.02). Also, during the first 24 h postpartum, the MBF group required significantly fewer medications (3.3 +/- 3.7 doses versus 4.7 +/- 3.5 doses; P = 0.04). Intrathecal injection of this small dose of bupivacaine/fentanyl produced a rapid onset of labor analgesia; the addition of a small dose of morphine did not significantly prolong analgesia, but it improved subsequent pain relief, as measured by the rate of breakthrough pain and postpartum medication requirements. This may provide a clinically useful means of improving intra- and postpartum pain relief. IMPLICATIONS: A small dose of intrathecal fentanyl 12.5 micro g and bupivacaine 2 mg produces effective labor analgesia lasting for approximately 85 min. The addition of a small 125- micro g dose of morphine improves pain control during subsequent epidural analgesia and reduces the requirements for postpartum pain medications.

Adult↗