A high fiber diet intervention during pregnancy: The SPROUT (Single goal in PRegnancy to optimize OUTcomes) protocol paper

BACKGROUND

Interventions to prevent excessive gestational weight gain (GWG) have had a limited impact on maternal and infant outcomes. Dietary fiber is a nutrient with benefits that counters many of the metabolic and inflammatory changes that occur during pregnancy. We will determine if a high dietary fiber (HFib) intervention provides benefit to maternal and infant outcomes.

METHODS AND DESIGN

Pregnant women will be enrolled in an 18-week intervention and randomized in groups of 6-10 women/group into the intervention or control group. Weekly lessons will include information on high-dietary fiber foods and behavior change strategies. Women in the intervention group will be given daily snacks high in dietary fiber (10-12 g/day) to facilitate increasing dietary fiber intake. The primary aim will assess between-group differences for the change in maternal weight, dietary fiber intake, dietary quality, and body composition during pregnancy and up to two months post-partum. The secondary aim will assess between-group differences for the change in maternal weight, dietary fiber intake, and dietary quality from two months to one year post-partum and infant body composition from birth to one-year-old.

DISCUSSION

Effective and simple intervention strategies to improve maternal and offspring outcomes are lacking. Changes during the perinatal period are related to the risk of disease development in the mother and offspring. However, it is unknown which changes can be successfully targeted to have a meaningful impact. We will test the effect of an intervention designed to counter many of the metabolic and inflammatory changes that occur during pregnancy.

ETHICS AND DISSEMINATION

The University of Kansas Medical Center Institutional Review Board (IRB) approved the study protocol (STUDY00145397). The results of the trial will be disseminated at conferences and in peer reviewed publications.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT04868110.

Integrating simulation and interpretive description to explore operating room leadership: critical event continuing education

In Obstetrics and Gynecologic operating room emergencies, the surgeon cannot both operate and lead a suddenly expanded and redirected team response. However, one of the most often used approaches to interprofessional continuing education designed to improve teams' ability to respond to unanticipated critical events still emphasizes surgeon leadership. We developed Explicit Anesthesia and Nurse Distributed (EXPAND) Leadership to imagine a workflow that might better distribute emergency leadership task responsibilities and practices. The purpose of this exploratory study was to investigate teams' responses to distributing leadership during an interprofessional continuing education simulated obstetrical emergency. We used interpretive descriptive design in a secondary analysis of teams' post-simulation reflective debriefings. One-hundred sixty providers participated, including OB-Gyn surgeons, anesthesiologists, CRNAs, scrub technicians, and nurses. Using reflective thematic analysis, we identified three core themes: 1) The surgeon is focused on the surgical field, 2) Explicit leadership initiates a nurse transition from follower to leader in a hierarchical environment, and 3) Explicit distributed leadership enhances teamwork and taskwork. Continuing education which uses distributed leadership to improve teams' ability to respond to an obstetric emergency is perceived to enhance team members' response to the critical event . The potential for nurses' career growth and professional transformation was an unexpected finding associated with this continuing education which used distributed leadership. Our findings suggest that healthcare educators should consider ways in which distributed leadership may improve teams' response to critical events in the operating room.

Improving resident well-being: a narrative review of wellness curricula

BACKGROUND

To improve wellness among residents, many graduate medical education programs have implemented formal wellness curricula. Curricular development has recently shifted focus from drivers of burnout to promotion of wellness. The specific components of successful wellness curricula, however, are not yet well defined.

OBJECTIVE

To review the published literature assessing core components of wellness curricula in graduate medical education programs.

METHODS

Searches were conducted through June 2020 in PubMed, Education Resources Information Center, Google Scholar and Web of Science using the search terms wellness curricula, wellness programs, well-being and graduate medical education. Additional articles were identified from reference lists. Curricula from primarily undergraduate medical education, singular interventions, non-peer-reviewed studies and non-English language studies were excluded.

RESULTS

Eighteen articles were selected and reviewed by three authors. Critical drivers of success included support from program leadership and opportunities for resident involvement in the curriculum implementation. Most curricula included interventions related to both physical and mental health. Curricula including challenging components of professionalisation, such as critical conversations, medical errors and boundary setting, seemed to foster increased resident buy-in. The most frequently used curricular assessment tools were the Maslach Burnout Inventory and resident satisfaction surveys.

CONCLUSIONS

Different specialties have different wellness needs. A resource or 'toolbox' that includes a variety of general as well as specialty-specific wellness components might allow institutions and programs to select interventions that best suit their individual needs. Assessment of wellness curricula is still in its infancy and is largely limited to single institution experiences.

Improving resident well-being: a narrative review of wellness curricula

BACKGROUND

To improve wellness among residents, many graduate medical education programs have implemented formal wellness curricula. Curricular development has recently shifted focus from drivers of burnout to promotion of wellness. The specific components of successful wellness curricula, however, are not yet well defined.

OBJECTIVE

To review the published literature assessing core components of wellness curricula in graduate medical education programs.

METHODS

Searches were conducted through June 2020 in PubMed, Education Resources Information Center, Google Scholar and Web of Science using the search terms wellness curricula, wellness programs, well-being and graduate medical education. Additional articles were identified from reference lists. Curricula from primarily undergraduate medical education, singular interventions, non-peer-reviewed studies and non-English language studies were excluded.

RESULTS

Eighteen articles were selected and reviewed by three authors. Critical drivers of success included support from program leadership and opportunities for resident involvement in the curriculum implementation. Most curricula included interventions related to both physical and mental health. Curricula including challenging components of professionalisation, such as critical conversations, medical errors and boundary setting, seemed to foster increased resident buy-in. The most frequently used curricular assessment tools were the Maslach Burnout Inventory and resident satisfaction surveys.

CONCLUSIONS

Different specialties have different wellness needs. A resource or 'toolbox' that includes a variety of general as well as specialty-specific wellness components might allow institutions and programs to select interventions that best suit their individual needs. Assessment of wellness curricula is still in its infancy and is largely limited to single institution experiences.

The effect of high dietary fiber intake on gestational weight gain, fat accrual, and postpartum weight retention: a randomized clinical trial

BACKGROUND

Interventions to prevent excessive gestational weight gain (GWG) have had limited success This pilot study examined the effectiveness of a single goal (SG) high dietary fiber intervention to prevent excessive GWG.

METHODS

Twelve weekly lessons focused on consuming a high fiber diet (≥30 g/day). Snacks containing 10-12 g of dietary fiber were given for the first 6 weeks only. Body composition was measured at baseline and at the end of the intervention. At one-year postpartum, body weight retention and dietary practices were assessed. A p-value is reported for the primary analysis only. For all other comparisons, Cohen's d is reported to indicate effect size.

RESULTS

The SG group increased fiber intake during the study (32 g/day at 6 weeks, 27 g/day at 12 weeks), whereas the UC group did not (~ 17 g/day). No differences were found for the proportion of women classified as excessive gainers (p = 0.13). During the intervention, the SG group gained less body weight (- 4.1 kg) and less fat mass (- 2.8 kg) (d = 1.3). At 1 year postpartum, the SG group retained less weight (0.35 vs. 4.4 kg, respectively, d = 1.8), and reported trying to currently eat high fiber foods.

CONCLUSION

The SG intervention resulted in less weight gain, fat accrual, and weight retention at 1 year postpartum. A residual intervention effect was detected postpartum with the participants reporting continued efforts to consume a high fiber diet.

TRIAL REGISTRATION

NCT03984630; Trial registered June 13, 2019 (retrospectively registered).