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Ebelhar JS, Brock KE. Communicating difficult news in pediatric radiology. Pediatr Radiol 2024; 54:663-670. [PMID: 38326566 DOI: 10.1007/s00247-024-05861-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
Effective communication is an important aspect of providing quality healthcare. Radiology staff may be called upon to communicate results, even when it is difficult. Simple, efficient communication models can be learned to reduce clinician distress and support patients and families through stressful times. These practical tips ensure essential communication elements are met, including assessing patient and family perspectives, clearly delivering medical information, responding with empathy, and collaborating around next steps. Models such as "Ask-Tell-Ask," "SPIKES," and "NURSE" can be used to disclose results, communicate serious news, and respond to emotion. Lastly, clinicians can also utilize "I wish… I worry… I wonder" statements to align with a patient's hopes and acknowledge a family's concerns, ultimately allowing healthcare professionals to support and guide families through challenging situations.
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Affiliation(s)
- Jonathan S Ebelhar
- Department of Pediatrics, Divisions of Pediatric Hematology/Oncology and Palliative Care, Emory University, 2015 Uppergate Drive, Suite 400, Atlanta, GA, 30322, USA.
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Katharine E Brock
- Department of Pediatrics, Divisions of Pediatric Hematology/Oncology and Palliative Care, Emory University, 2015 Uppergate Drive, Suite 400, Atlanta, GA, 30322, USA
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Kaur E, Arezina J, Bryant L, Pollak KI, Harrison G, Bender Atik R, Coates J, Hardicre NK, Sicklen R, Horwood K, Lardner T, Arnold J, Wallace R, Johnson J. Adapting a communication coaching intervention for obstetric sonographers delivering unexpected news: A qualitative study. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:273-283. [PMID: 37929254 PMCID: PMC10621488 DOI: 10.1177/1742271x221147860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/11/2022] [Indexed: 11/07/2023]
Abstract
Introduction Despite widespread recognition that communicating unexpected news during obstetric ultrasound examinations is challenging, there is a dearth of research investigating how to teach evidence-based communication to sonographers. Communication Coaching is a supportive, positive method that has previously been associated with improvements in communication, patient satisfaction, and reduced burnout in clinicians. However, to date, no study has coached sonographers. This study explored stakeholders' views on a proposed Communication Coaching intervention and used these data to adapt the intervention for use with qualified obstetric sonographers. Methods Semi-structured interviews were conducted with people who have a vested interest in unexpected news delivery and thematic analysis was conducted on the data. Eight sonographers, six people with lived experience of receiving unexpected news and six representatives from third-sector organisations who support expectant parents were recruited (18 women; 2 men, aged between 21 and 75 years). Results Participants viewed the planned Communication Coaching intervention favourably and suggested adaptations. The two main themes were (1) the practicalities of coaching, and (2) content. The first theme had four subthemes: (a) brief and flexible structure, (b) online modality, (c) sensitive and positive coach and (d) organisational awareness. The second theme had three subthemes: (a) specific language and behaviour recommendations, (b) adaptable to different service-users and situations and (c) confer relevant emotional skills and techniques. Conclusions Communication Coaching could be a feasible and acceptable intervention for qualified sonographers if specific, limited adaptations are made as recommended by the stakeholders. Further evaluation of the intervention in practice is necessary.
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Affiliation(s)
- Essie Kaur
- School of Psychology, University of Leeds, Leeds, UK
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Jane Arezina
- Specialist Science Education Department (SSED), Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Louise Bryant
- Division of Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kathryn I Pollak
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Gill Harrison
- Society and College of Radiographers (SCoR), London, UK
- School of Health & Psychological Sciences, City, University of London, London, UK
| | | | | | | | - Roxanne Sicklen
- Barnet Hospital, Royal Free London NHS Foundation Trust, Barnet, UK
| | | | - Teresa Lardner
- Fetal Anomaly Screening Programme, Public Health Commissioning and Operations, NHS England, UK
| | | | - Rebecca Wallace
- Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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Karapanos I, Bolou A, Nazer M, Iliodromiti S, Greco E. Strategies to communicate pregnancy complications: a systematic review and practical points for healthcare professionals. Curr Opin Obstet Gynecol 2023; 35:411-419. [PMID: 37560805 DOI: 10.1097/gco.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE/METHODS This systematic review aims to provide an overview of strategies available for healthcare professionals (HCPs) to effectively communicate unexpected news in pregnancy, specifically for the most common pregnancy complications. Three medical databases and grey literature were searched until March 2023 using subject headings and keywords. Snowball techniques were also used. The articles were reviewed at each stage of screening independently by two separate authors. Qualitative, quantitative and mixed methods studies were included. RECENT FINDINGS Forty-three studies were included and grouped according to the gestational age of the pregnancy complication - miscarriage, increased risk screening, foetal conditions, stillbirth. The main key points for communication were outlined at each specific complication and eventually the six common themes that emerged from all the categories were included in the acronym PRICES (Preparation - Referral - Individualized care - Clarity - Empowerment - Sensitivity). SUMMARY Given the negative impact of failed communications both in pregnancy outcomes and patients' experience, we advocate that communication training for HCP providing pregnancy care should be mandatory, and skills should be updated at regular intervals. Tools like our acronym PRICES can be used during teaching HCPs how to communicate more effectively.
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Affiliation(s)
- Ioannis Karapanos
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
| | - Angeliki Bolou
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
- School of Health Sciences, Institute for Lifecourse Development: Centre for Chronic Illness and Ageing, Faculty of Education, Health & Human Sciences, University of Greenwich
| | - Maya Nazer
- Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
| | - Elena Greco
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
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Carr R, White H. Exploring sonographer emotional well-being: NHS sonographers' experience of the restorative function of professional supervision. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:147-154. [PMID: 37144227 PMCID: PMC10152322 DOI: 10.1177/1742271x221131482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022]
Abstract
Introduction Following recommendations of the Francis report (2013), healthcare professional groups have formalised restorative supervision within practice in order to maintain emotional well-being among staff and provide quality of care for patients. There is a scarcity of research available on how professional supervision is utilised as a restorative device within current practice for sonographers. Methodology An online cross-sectional, descriptive survey was used to gain qualitative details and nominal data on sonographer experiences of professional supervision. Themes were developed through thematic analysis. Results A total of 56% of participants did not identify professional supervision as part of their current practice; 50% of participants felt emotionally unsupported within their work. The majority felt 'unsure' of how professional supervision would affect their working day; however, they highlighted that a restorative function would be valued equally as professional development functions of practice. The barriers to professional supervision as a restorative function demonstrate that an understanding of what sonographer needs are should be considered in approaches to professional supervision. Conclusion This study found that participants identify professional supervision in its formative and normative functions more commonly than its restorative functions. It also found that sonographers are found wanting of emotional support, with 50% of sonographers feeling unsupported and identifying a restorative supervision need to their working practice. Implications for practice The need to establish a system that supports the emotional well-being of sonographers is highlighted. This should help with retention of sonographers in a career where burnout is evidenced.
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Affiliation(s)
- Ryan Carr
- Imaging Department, Royal Sussex County
hospital, University Hospitals Sussex, Brighton, UK
| | - Helen White
- Department of Radiography, School of
Health Sciences, Birmingham City University, Birmingham, UK
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Blanchet E, Chantry AA, Sauvegrain P, Anselem O. [Medical attitudes regarding the announcement of suspected foetal abnormality in ultrasound scans]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:753-761. [PMID: 36108917 DOI: 10.1016/j.gofs.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/26/2022] [Accepted: 09/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study's primary objective was to analyse the personal experience of different ultrasonographers during the announcement of suspected foetal abnormalities, seen either in screening or diagnostic ultrasound. The secondary objectives aimed to explore the factors influencing the announcement of the foetal abnormality, whether they complicated or facilitated the consultation. These also comprised the analysis of the knowledge, practice and attitudes of the healthcare professionals as well as the different techniques used during the consultation. Finally, this study aimed to analyse the various tools and skills used by ultrasonographers to improve the quality of their announcement of the diagnosis. METHODS This qualitative study was based on both the observation of consultations and the results of semi-structured interviews with ultrasonographers, in a maternity hospital in France. RESULTS The results highlighted feelings of great discomfort for the ultrasonographers on discovering an abnormality on the scan. The different perceptions and practices regarding the announcement of a diagnosis varied between screening ultrasonographers and specialist doctors. The uncertainty of foetal prognosis seemed to complicate the announcement for specialist doctors. Qualities that made the communication of the diagnosis easier included the ultrasonographer's availability and their attitude. Although professional experience was considered a very powerful skill, training for the communication of a diagnosis accelerates the development of good medical practice. CONCLUSIONS The announcement of suspected foetal abnormalities is a difficult exercice, which impacts the ultrasonographer's personal experience and his attitude. Some professional practices are to be encouraged while others are to be put under question. A trust-based relationship between the healthcare professional and the patient is partly reinforced by the quality of the announcement and its follow-up, as well as the healthcare professional's thoroughness and humanity.
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Affiliation(s)
- E Blanchet
- Maternité Port-Royal, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France.
| | - A A Chantry
- Université Paris Cité, Centre de Recherche en epidémiologie et Statistiques, CRESS, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), INSERM, INRA, 75004 Paris, France; École de sages-femmes de Baudelocque, AP-HP, université Paris Cité, 75006 Paris, France
| | - P Sauvegrain
- Université Paris Cité, Centre de Recherche en epidémiologie et Statistiques, CRESS, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), INSERM, INRA, 75004 Paris, France; Maternité la Pitié Salepêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - O Anselem
- Maternité Port-Royal, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France
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Younan K, Walkley D, Quinton AE, Alphonse J. Burnout in the sonographic environment: The identification and exploration of the causes of sonographer burnout and strategies for prevention and control. SONOGRAPHY 2022. [DOI: 10.1002/sono.12333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Kerolloss Younan
- Medical Sonography, School of Health, Medical and Applied Science Central Queensland University Sydney New South Wales Australia
| | - Daniel Walkley
- MSK Australia Adelaide South Australia Australia
- Fowler Simmons Radiology Adelaide South Australia Australia
| | - Ann Elizabeth Quinton
- Medical Sonography, School of Health, Medical and Applied Science Central Queensland University Sydney New South Wales Australia
- Discipline of Obstetrics, Gynaecology and Neonatology Sydney Medical School Nepean, University of Sydney, Nepean Hospital Penrith Sydney New South Wales Australia
| | - Jennifer Alphonse
- Medical Sonography, School of Health, Medical and Applied Science Central Queensland University Sydney New South Wales Australia
- Sydney Ultrasound for Women Bella Vista New South Wales Australia
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Rockall AG, Justich C, Helbich T, Vilgrain V. Patient communication in radiology: Moving up the agenda. Eur J Radiol 2022; 155:110464. [PMID: 36038410 DOI: 10.1016/j.ejrad.2022.110464] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Abstract
Optimised communication between patients and the imaging team is an essential component of providing patient-centred and value-based care. Communication with patients can be challenging in the setting of busy radiology departments where there is a focus on efficient and accurate diagnosis. Traditionally, most results are provided directly to the referring clinician. However, the importance of direct communication between the radiologist and patient is increasingly relevant, particularly in the context of face-to-face settings such as rapid assessment and ultrasound clinics, and interventional radiology, as well as in written form through electronic patient portals. Artificial intelligence tools may improve efficiency, allowing more time for radiologists to communicate directly with patients. There is a need for dedicated training in communication skills for imaging professionals. This review considers the topic of patient communication in the setting of imaging departments and discusses the ways that communication skills may be improved through training and through harnessing emerging digital technologies that may enhance the quality of communication.
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Affiliation(s)
- Andrea G Rockall
- Department of Cancer and Surgery, Faculty of Medicine, Imperial College London, UK; Department of Radiology, Imperial Healthcare NHS Trust, London, UK.
| | | | - Thomas Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna & General Hospital, Division of Molecular and Structural Preclinical Imaging, Waehringer Guertel 18-20, Floor 7F, 1090 Vienna, Austria
| | - Valerie Vilgrain
- Université Paris Cité and Department of Radiology, Hôpital Beaujon, APHP.Nord, Paris, France
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Ogenyi P, Chiegwu HU, England A, Akanegbu UE, Ogbonna OS, Abubakar A, Luntsi G, Zira DJ, Dauda M. Appraisal of trimester-specific fetal heart rate and its role in gestational age prediction. Radiography (Lond) 2022; 28:926-932. [PMID: 35820355 DOI: 10.1016/j.radi.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate and report normal sonographic FHR values among low-risk singleton women across the three trimesters of pregnancy and determine FHR role in gestational age prediction. METHOD A prospective cross-sectional study of 2727 low-risk singleton pregnant women was undertaken. FHR measurements were obtained by a consultant radiologist and three experienced sonographers using transabdominal approach from January 2019 to December 2020. Two FHR measurements were taken for each participant. The fetal lie and presentation were also documented in the first trimester. Data were analysed using SPSS version 24 (IBM, Armonk, NY, USA). RESULT The maternal mean ± SD age was 25.8 ± 6.5 years and mean FHR for first, second and third trimesters were 151 ± 16, 145 ± 6 and 125±6 bpm respectively. The mean ± SD gestational age were 10 ± 2, 19 ± 3 and 34 ± 2 weeks for the first, second and third trimester respectively. Using ANOVA, there were statistically significant differences in FHR across the three trimesters (p ≤ 0.05). A positive correlation existed between maternal age and FHR (r = 0.57, p ≤ 0.05). CONCLUSION This study has established normal values for FHR in first, second and third trimester respectively. Referring physicians, radiologists, sonographers, obstetricians and gynaecologists may consider FHR of (135-167) bpm (139-151) bpm and (119-131) bpm as normal FHR ranges for the first, second and third trimester respectively. This study has also revealed the possibility of gestational age prediction using FHR with the equation [Gestational Age = 87.8 - (0.47) FHR]. IMPLICATIONS FOR PRACTICE This paper provides the most up-to-date sonographic FHR recommendations for fetal management. More importantly, findings from this study also suggests that ultrasound practitioners can use FHR measurements as a reliable alternative for fetal dating.
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Affiliation(s)
- P Ogenyi
- Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
| | - H U Chiegwu
- Department of Radiography, Nnamdi Azikiwe University, Awka
| | - A England
- School of Medicine, University College Cork, Ireland
| | - U E Akanegbu
- Department of Radiography, Nnamdi Azikiwe University, Awka
| | - O S Ogbonna
- Department of Radiography, Nnamdi Azikiwe University, Awka
| | - A Abubakar
- Department of Radiography, University of Maiduguri, Nigeria
| | - G Luntsi
- Department of Radiography, University of Maiduguri, Nigeria
| | - D J Zira
- Department of Radiography, Federal University Lafia, Nigeria
| | - M Dauda
- Department of Medical Physics, Nasarawa State University, Keffi, Nigeria
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Moncrieff G, Finlayson K, Cordey S, McCrimmon R, Harris C, Barreix M, Tunçalp Ö, Downe S. First and second trimester ultrasound in pregnancy: A systematic review and metasynthesis of the views and experiences of pregnant women, partners, and health workers. PLoS One 2021; 16:e0261096. [PMID: 34905561 PMCID: PMC8670688 DOI: 10.1371/journal.pone.0261096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background The World Health Organization (WHO) recommends one ultrasound scan before 24 weeks gestation as part of routine antenatal care (WHO 2016). We explored influences on provision and uptake through views and experiences of pregnant women, partners, and health workers. Methods We undertook a systematic review (PROSPERO CRD42021230926). We derived summaries of findings and overarching themes using metasynthesis methods. We searched MEDLINE, CINAHL, PsycINFO, SocIndex, LILACS, and AIM (Nov 25th 2020) for qualitative studies reporting views and experiences of routine ultrasound provision to 24 weeks gestation, with no language or date restriction. After quality assessment, data were logged and analysed in Excel. We assessed confidence in the findings using Grade-CERQual. Findings From 7076 hits, we included 80 papers (1994–2020, 23 countries, 16 LICs/MICs, over 1500 participants). We identified 17 review findings, (moderate or high confidence: 14/17), and four themes: sociocultural influences and expectations; the power of visual technology; joy and devastation: consequences of ultrasound findings; the significance of relationship in the ultrasound encounter. Providing or receiving ultrasound was positive for most, reportedly increasing parental-fetal engagement. However, abnormal findings were often shocking. Some reported changing future reproductive decisions after equivocal results, even when the eventual diagnosis was positive. Attitudes and behaviours of sonographers influenced service user experience. Ultrasound providers expressed concern about making mistakes, recognising their need for education, training, and adequate time with women. Ultrasound sex determination influenced female feticide in some contexts, in others, termination was not socially acceptable. Overuse was noted to reduce clinical antenatal skills as well as the use and uptake of other forms of antenatal care. These factors influenced utility and equity of ultrasound in some settings. Conclusion Though antenatal ultrasound was largely seen as positive, long-term adverse psychological and reproductive consequences were reported for some. Gender inequity may be reinforced by female feticide following ultrasound in some contexts. Provider attitudes and behaviours, time to engage fully with service users, social norms, access to follow up, and the potential for overuse all need to be considered.
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Affiliation(s)
- Gill Moncrieff
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
- * E-mail:
| | - Kenneth Finlayson
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Sarah Cordey
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Rebekah McCrimmon
- School of Health and Community Studies, University of Central Lancashire, Preston, United Kingdom
| | - Catherine Harris
- Applied Health Research Hub, University of Central Lancashire, Preston, United Kingdom
| | - Maria Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soo Downe
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
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