Development and implementation of a pregnancy heart team at a Southeastern United States tertiary hospital: a qualitative study

BACKGROUND

The United States has seen a significant rise in maternal mortality and morbidity associated with cardiovascular disease over the past 4 decades. Contributing factors may include an increasing number of parturients with comorbid conditions, a higher rate of pregnancy among women of advanced maternal age, and more patients with congenital heart disease who survive into childbearing age and experiencing pregnancy. In response, national medical organizations have recommended the creation of multidisciplinary obstetric-cardiac teams, also known as pregnancy heart teams, to provide comprehensive preconception counseling and coordinated pregnancy management that extend through the postpartum period.

OBJECTIVE

We sought to describe the development and implementation of a pregnancy heart team for parturients with cardiac disease at a southeastern United States tertiary hospital.

STUDY DESIGN

This was a qualitative study that was conducted among healthcare team members involved during the pregnancy heart team formation. Semi-structured interviews were conducted between April and May 2022, professionally transcribed, and the responses were thematically coded for categories and themes using constructs from The Consolidated Framework for Implementation Research.

RESULTS

Themes identified included intentional collaboration to improve outpatient and inpatient coordination through earlier awareness of patients who meet the criteria and via documented care planning. The pregnancy heart team united clinicians around best practices and coordination to promote the success and safety of pregnancies and not only to minimize maternal health risks. Developing longitudinal care plans was critical among the pathway team to build on collective expertise and to provide clarity for those on shift to reduce hesitancy and achieve timely, vetted practices without additional consults. Establishing a proactive approach of specialists offering their perspectives was viewed as positively contributing to a culture of speaking up. Barriers to the successful development and sustainability of the pregnancy heart team included unmet administrative needs and clinician turnover within a context of shortages in staffing and high workload.

CONCLUSION

This study described the process of developing and implementing a pregnancy heart team at 1 institution, thereby offering insights for future multidisciplinary care for maternal cardiac patients. Establishing pregnancy heart teams can enhance quality care for high-risk patients, foster learning and collaboration among physician and nursing specialties, and improve coordination to manage complex maternal cardiac cases.

Cultural shift in mental illness: a comparison of stress responses in World War I and the Vietnam War

Objectives

Post-traumatic stress disorder is an established diagnostic category. In particular, over the past 20 years, there has been an interest in culture as a fundamental factor in post-traumatic stress disorder symptom manifestation. However, only a very limited portion of this literature studies the historical variability of post-traumatic stress within a particular culture.

Design

Therefore, this study examines whether stress responses to violence associated with armed conflicts have been a culturally stable reaction in Western troops.

Setting

We have compared historical records from World War I to those of the Vietnam War. Reference is also made to observations of combat trauma reactions in pre-World War I conflicts, World War II, the Korean War, the Falklands War, and the First Gulf War.

Participants

The data set consisted of literature that was published during and after these armed conflicts.

Main outcome measures

Accounts of World War I Shell Shock that describe symptom presentation, incidence (both acute and delayed), and prognosis were compared to the observations made of Vietnam War post-traumatic stress disorder victims.

Results

Results suggest that the conditions observed in Vietnam veterans were not the same as those which were observed in World War I trauma victims.

Conclusions

The paper argues that the concept of post-traumatic stress disorder cannot be stretched to cover the typical battle trauma reactions of World War I. It is suggested that relatively subtle changes in culture, over little more than a generation, have had a profound effect on how mental illness forms, manifests itself, and is effectively treated. We add new evidence to the argument that post-traumatic stress disorder in its current conceptualisation does not adequately account, not only for ethnocultural variation but also for historical variation in stress responses within the same culture.

Cultural shift towards sustainability in the construction industry of Hong Kong

Sustainable development is forward-looking; it is a continuous mission for future developments of human society. A genuinely sustainable society is one that initiates developments in sustainable ways. The development of a genuinely sustainable society is supported by its citizens who think and act according to a recognized code of conduct - the sustainable culture. Similar to other forms of culture, sustainable culture of a society is not static, but changes over time. The changes found in a sustainable culture are reflections of the status of sustainability in a society and these changes should be measured from time to time. The resulting measurement gives very important information for decision-makers, in the government and in the private sector, to examine the magnitude of changes that have taken place in a given period of time. The results will also enable them to review and adjust policies in order to better accommodate changes according to the trends of society. This paper provides a method - the T-model, to investigate and measure the extent of change of sustainable culture through two extensive surveys among participants of the construction industry of Hong Kong. The change in sustainable culture is reflected by the change in attitude and practice among construction participants, this can be found in their performance in project development, design and construction operations. The data of these changes are collected and converted to numerical scores. The T-model synthesized these scores and revealed the change of sustainable culture within the specific study time frame.