Introduction A long and rich research legacy shows that under the right conditions, simulation-based medical education (SBME) is a powerful intervention to increase medical learner competence. SBME translational science demonstrates that results achieved in the educational laboratory (T1) transfer to improved downstream patient care practices (T2) and improved patient and public health (T3). Method This is a qualitative synthesis of SBME translational science research that employs a critical review approach to literature aggregation. Results Evidence from SBME and health services research programs that are thematic, sustained, and cumulative shows that measured outcomes can be achieved at T1, T2, and T3 levels. There is also evidence that SBME translational science research can yield a favorable return on financial investment and contributes to long-term retention of acquired clinical skills. The review identifies best practices in SBME translational science research, presents challenges and critical gaps in the field, and sets forth a translational science research agenda for SBME. Conclusion Rigorous SBME translational science research can contribute to better patient care and improved patient safety. Consensus conference outcomes and recommendations should be presented and used judiciously.

The mechanisms underlying cervical insufficiency, a cause of spontaneous second-trimester abortion and early preterm birth, remain poorly understood. There is, however, evidence that amniotic fluid (AF) infection is a key factor in pregnancy outcomes and postoperative complications. This study was an attempt to determine the frequency and clinical importance of intraamniotic inflammation in 52 patients with acute cervical insufficiency, defined as cervical dilation of 1.5 cm or more. The patients, seen at 17 to 29 weeks' gestation, had intact membranes, and were not having regular uterine connections. AF samples were cultured for aerobic and anaerobic bacteria and genital mycoplasmas, and assayed for matrix metalloproteinase-8; a level exceeding 23 ng/mL was deemed to represent the presence of intraamniotic inflammation.Intraamniotic inflammation was present in 42 of the 52 study patients (81%), and 4 patients (8%) had a positive AF culture. All culture-positive patients had intraamniotic inflammation. Among patients with intraamniotic inflammation but not AF infection, preterm delivery occurred within 7 days in 50%, and delivery before 34 weeks gestation, in 84%. More than half of newborn infants (55%) whose mothers had inflammation but not infection died within 24 hours of birth. The presence of intraamniotic inflammation was associated with a shorter interval between amniocentesis to delivery. The risk of an adverse pregnancy outcome did not differ between patients with intraamniotic inflammation and a negative culture on the one hand and, on the other, between those with confirmed AF infection. Fetal morbidity was not substantially altered by cesarean delivery.Whether the AF is culture-positive, a large majority of patients with acute cervical insufficiency have intraamniotic inflammation, and this is a risk factor for both preterm delivery and adverse pregnancy outcomes. ABSTRACTShoulder dystocia is an uncommon event that is largely unpredictable, and that may cause serious morbidity in both the mother and infant. Brachial plexus injury may be worsened by inappropriate treatment. This retrospective observational study compared the management and outcome of births complicated by shoulder dystocia before and after introducing 1 day of training that utilized a prototype shoulder dystocia training mannequin. Training included risk factors, recognition, documentation, helpful maneuvers, and a simulated shoulder dystocia scenario.A total of 15,908 pretraining births were compared with 13,117 taking place after the introduction of training. Rates of shoulder dystocia were similar: 2.04% in the pretraining group and 2.00% in the posttraining group. Before training, none of the several maneuvers recommended for the resolution of shoulder dystocia (including McRoberts' position, suprapubic pressure, internal rotation, delivery of the posterior arm, and the All-Fours-Maneuvers) were utilized in half or more of the affected infants. After training, in contrast, at least 1 of the recommended maneuvers was utilized in mor...

All multiprofessional training improved patient-actor perception of care. Training using a patient-actor may be better at improving perception of safety and communication than training with a computerised manikin simulator.

Objective To compare the effectiveness of carbetocin and oxytocin when they are administered after caesarean section for prevention of postpartum haemorrhage (PPH).Study design Double-blind randomised single centre study (1:1 ratio).Setting Teaching hospital in Bristol, UK with 6000 deliveries per annum.Population Women at term undergoing elective or emergency caesarean section under regional anaesthesia, excluding women with placenta praevia, multiple gestation and placental abruption.Methods Women were randomised to receive either carbetocin 100 lg or oxytocin 5 IU intravenously after the delivery of the baby. Perioperative care was otherwise normal and use of additional oxytocics was at the discretion of the operating obstetrician. Analysis was by intention to treat.Primary outcome measure The proportion of women in each arm of the trial that needed additional pharmacological oxytocic interventions.Results Significantly more women needed additional oxytocics in the oxytocin group (45.5% versus 33.5%, Relative risk 0.74, 95% CI 0.57-0.95). The majority of women had oxytocin infusions. There were no significant differences in the secondary outcomes, including major PPH, blood transfusions and fall in haemoglobin.Conclusions Carbetocin is associated with a reduced use of additional oxytocics. It is unclear whether this may reduce rates of PPH and blood transfusions.

Objective To identify specific aspects of teamworking associated with greater clinical efficiency in simulated obstetric emergencies.Design Cross-sectional secondary analysis of video recordings from the Simulation & Fire-drill Evaluation (SaFE) randomised controlled trial.Setting Six secondary and tertiary maternity units.Sample A total of 114 randomly selected healthcare professionals, in 19 teams of six members.Methods Two independent assessors, a clinician and a language communication specialist identified specific teamwork behaviours using a grid derived from the safety literature.Main outcome measures Relationship between teamwork behaviours and the time to administration of magnesium sulfate, a validated measure of clinical efficiency, was calculated.Results More efficient teams were likely to (1) have stated (recognised and verbally declared) the emergency (eclampsia) earlier (Kendall's rank correlation coefficient s b = )0.53, 95% CI from )0.74 to )0.32, P = 0.004); and (2) have managed the critical task using closed-loop communication (task clearly and loudly delegated, accepted, executed and completion acknowledged) (s b = 0.46, 95% CI 0.17-0.74, P = 0.022). Teams that administered magnesium sulfate within the allocated time (10 minutes) had significantly fewer exits from the labour room compared with teams who did not: a median of three (IQR 2-5) versus six exits (IQR 5-6) (P = 0.03, Mann-Whitney U-test).Conclusions Using administration of an essential drug as a valid surrogate of team efficiency and patient outcome after a simulated emergency, we found that more efficient teams were more likely to exhibit certain team behaviours relating to better handover and task allocation.

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