Clinical Instructor, Anesthesiology, Perioperative and Pain Medicine
Board Certification: Royal College of Anaesthetists, Anesthesia (2017)
Residency: South East Thames School of Anaesthesia Training (2020) United Kingdom
Residency: Barts and the London School of Anaesthesia (2014) United Kingdom
Internship: Dorset County Hospital (2011) United Kingdom
Medical Education: Hull York Medical School (2009) United Kingdom
Obstetric services in the UK during the COVID-19 pandemic: A national survey.
Anaesthesia, critical care & pain medicine
The management of obstetric patients with coronavirus disease 2019 (COVID-19) due to human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires unique considerations. Many aspects of labour and delivery practice required adaptation in response to the global pandemic and were supported by guidelines from the Royal College of Obstetrics and Gynaecologists. The adoption and adherence to these guidelines is unknown.Participating centres in "Quality of Recovery in Obstetric Anaesthesia study - a multicentre study" (ObsQoR) completed an electronic survey based on the provision of services and care related to COVID-19 in October 2021. The survey was designed against the Royal College of Obstetricians and Gynaecologists COVID-19 guidelines.One hundred and five of the 107 participating centres completed the survey (98% response rate representing 54% of all UK obstetric units). The median [IQR] annual number of deliveries among the included sites was 4389 [3000-5325]. Ninety-nine of the 103 (94.3%) sites had guidelines for the management of peripartum women with COVID-19. Sixty-one of 105 (58.1%) had specific guidance for venous thromboembolism (VTE) prophylaxis. Thirty-seven of 104 (35.6%) centres restricted parturient birthing plans if a positive diagnosis of COVID-19 was made. A COVID-19 vaccination referral pathway encouraging full vaccination for all pregnant women was present in 63/103 centres (61.2%).We found variability in care delivered and adherence to guidelines related to COVID-19. The clinical implications for this related to quality of peripartum care is unclear, however there remains scope to improve pathways for immunisation, birth plans and VTE prophylaxis.
View details for DOI 10.1016/j.accpm.2022.101137
View details for PubMedID 35914704
Assessment of Patient-Reported Outcome Measures for Maternal Postpartum Depression Using the Consensus-Based Standards for the Selection of Health Measurement Instruments Guideline: A Systematic Review.
JAMA network open
2022; 5 (6): e2214885
Importance: Maternal depression is frequently reported in the postpartum period, with an estimated prevalence of approximately 15% during the first postpartum year. Despite the high prevalence of postpartum depression, there is no consensus regarding which patient-reported outcome measure (PROM) should be used to screen for this complex, multidimensional construct.Objective: To evaluate psychometric measurement properties of existing PROMs of maternal postpartum depression using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline and identify the best available patient-reported screening measure.Evidence Review: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. PubMed, CINAHL, Embase, and Web of Science were searched on July 1, 2019, for validated PROMs of postpartum depression, and an additional search including a hand search of references from eligible studies was conducted in June 2021. Included studies evaluated 1 or more psychometric measurement properties of the identified PROMs. A risk-of-bias assessment was performed to evaluate methods of each included study. Psychometric measurement properties of each PROM were rated according to COSMIN criteria. A modified Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the level of evidence supporting each rating, and a recommendation class (A, recommended for use; B, further research required; or C, not recommended) was given based on the overall quality of each included PROM.Findings: Among 10 264 postpartum recovery studies, 27 PROMs were identified. Ten PROMs (37.0%) met the inclusion criteria and were used in 43 studies (0.4%) involving 22 095 postpartum women. At least 1 psychometric measurement property was assessed for each of the 10 validated PROMs identified. Content validity was sufficient in all PROMs. The Edinburgh Postnatal Depression Scale (EPDS) demonstrated adequate content validity and a moderate level of evidence for sufficient internal consistency (with sufficient structural validity), resulting in a recommendation of class A. The other 9 PROMs evaluated received a recommendation of class B.Conclusions and Relevance: The findings of this systematic review suggest that the EPDS is the best available patient-reported screening measure of maternal postpartum depression. Future studies should focus on evaluating the cross-cultural validity, reliability, and measurement error of the EPDS to improve understanding of its psychometric properties and utility.
View details for DOI 10.1001/jamanetworkopen.2022.14885
View details for PubMedID 35749118
Enhancing recovery after cesarean delivery - A narrative review.
Best practice & research. Clinical anaesthesiology
2022; 36 (1): 89-105
Enhanced recovery after cesarean delivery (ERAC) is increasingly being implemented worldwide with the aim to improve patient care for women undergoing this procedure. ERAC is associated with superior maternal outcomes including decreased length of hospital stay, opioid consumption, pain scores, times to mobilization and urinary catheter removal and hospitalization costs,without increasing hospital readmission rates. A number of preoperative, intraoperative, and postoperative interventions have been incorporated into ERAC protocols. The evidence base for each intervention varies, and there is a lack of consensus as to which are the best and most appropriate interventions. The quality of evidence of studies evaluating ERAC is low, and the measurements for reporting its success are varied and disparate. Protocols rarely assess patient-reported outcome measures, patient satisfaction, or patient experience. The best measures of ERAC success are yet to be fully elucidated. Further work is required to evaluate protocols, interventions, and how best to measure the effect of ERAC.
View details for DOI 10.1016/j.bpa.2022.01.001
View details for PubMedID 35659963
Development and validation of a Portuguese version of Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese).
Anaesthesia, critical care & pain medicine
BACKGROUND: We aimed to develop and validate a Portuguese version of the Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese) patient-reported outcome measure and evaluate its psychometric properties.METHODS: After ethical approval, we recruited term pregnant women undergoing uncomplicated elective cesarean delivery in a single Brazilian institution. Women were invited to complete the translated ObsQoR-10-Portuguese and EuroQoL (EQ-5D) questionnaires (including a global health visual analog scale [GHVAS]) at 24hours (±6hours) following delivery, and a subset of women an hour later. We assessed validity and reliability of ObsQoR-10-Portuguese.RESULTS: One hundred thirteen and 29 enrolled women completed the surveys at 24h and 25h (100% response rate).VALIDITY: (i) Convergent validity: ObsQoR-10-Portuguese correlated moderately with EuroQoL score (r=-0.587) and GHVAS score (r=0.568) at 24h. (ii) Discriminant validity: ObsQoR-10 discriminated well between good versus poor recovery (GHVAS score ≥ 70 versus < 70; difference in mean scores 14.2; p<0.001). (iii) Hypothesis testing: 24-h ObsQoR-10-Portuguese scores correlated with gestational age (r=0.191; p=0.043). (iv) Cross-cultural validity: Differential item functioning analysis suggested bias in 2 items. Reliability: (i) Internal consistency was good (Cronbach's alpha=0.82 and inter-item correlation=0.31). (ii) Split-half reliability was very good (Spearman-Brown Prophesy Reliability Estimate=0.80). (iii) Test re-test reliability was excellent (intra-class correlation coefficient=0.87). (iv) Floor and ceiling effects: <5% women scored either 0 or 100 (lowest and highest scores, respectively).CONCLUSION: ObsQoR-10-Portuguese is valid and reliable, and should be considered for use in Portuguese-speaking women to assess their quality of inpatient recovery following cesarean delivery.
View details for DOI 10.1016/j.accpm.2022.101085
View details for PubMedID 35487408