Amanda Grant-Orser, Charlotte Pooler, Nathan Archibald, Charlene Fell, Giovanni Ferrara, Kerri A Johannson, Meena Kalluri
The diagnostic pathway for patients with interstitial lung disease: a mixed-methods study of patients and physicians
BMJ open respiratory research
background major cause maternal death globally postpartum hemorrhage pph pph develops early detection bleeding rapid treatment evidencebased guidelines prevent pphrelated severe morbidity mortality bundle care approach pph management could potential solution inefficient uneven evidencebased practice implementation worldwide bundle care collection discrete evidencebased interventions given every eligible person simultaneously quick succession requires teamwork communication cooperation primary objective study analyze whether implementing pph bundle care may reduce maternal morbidity mortality institution methods singlecenter retrospective prepost casecontrol study carried tertiary care center teaching hospital varanasi eastern uttar pradesh state india january 2021 june 2021 pretraining data pre collected retrospectively births department obstetrics gynecology sir sunderlal hospital institute medical sciences banaras hindu university subsequently medical paramedical personnel hospital trained postpartum hemorrhage emergency care using bundle approach pph emc per guidelines laid world health organization pph management implemented july 2021 posttraining data post collected retrospectively deliveries hospital august 2021 january 2022 data within two periods computed analyzed results compared significant changes incidences maternal mortality morbidity terms rates blood transfusion required type management used medical medicalsurgical use tranexamic acid additional uterotonics results expressed proportions p005 considered statistically significant using ibm spss statistics windows version 240 ibm corp armonk ny usa results total 1304 women gave birth january 2021 january 2022 107 patients 61 pre 57 post group diagnosed treated pph significant difference incidence pph pre post groups p0581 significant increase use tranexamic acid p0041 significant reduction blood transfusion rates p0032 implementation bundled care post group odds pph nonoccurrence pre posttest 1103 95 ci0747 1635 significant difference observed maternal mortality pre post groups p096 requirement radical surgical treatment pph included hysterectomies also significantly reduced 2727 pre group 1154 post group p0032 conclusions pph care bundles might improve morbidity pph use fewer resources fewer interventions required data promising studies needed analyze bundle cares longterm effects