{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T11:59:35Z","timestamp":1774526375052,"version":"3.50.1"},"reference-count":26,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,3,6]]},"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess whether a 2\u2005days training with experts teaching on diagnosis and repair of perineal injuries among Palestinian midwives and physicians could change their level of knowledge towards the correct diagnosis and treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Study design<\/jats:title>\n                  <jats:p>Multicentre observational study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Obstetric departments in 6 government Palestinian hospitals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>All physicians and midwives who attended the training.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A questionnaire comprising of 14 questions on the diagnosis and repair of perineal tears was distributed to all participants before the training (n=150; 64 physicians and 86 midwives) and 3\u2005months after the training (n=124, 53 and 71, respectively). Characteristics, differences of the study population and level of knowledge before and after the training were presented as frequencies and percentages. Consistency in responses was tested by estimating the p value of McNemar test.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among physicians only 11.4% had accurate knowledge on perineal anatomy before the training compared with 78.85% after the training (p&lt;0.001). For midwives, the corresponding numbers were 9.8% and 54.2%, respectively (p&lt;0.001). Before the training, 5.8% of the physicians were aware that rectal examination is mandatory before and after suturing of episiotomies compared with 45.8% after the training (p&lt;0.001). The corresponding numbers for midwives were 0% and 18% (p&lt;0.001), respectively. Physicians knowledge of best practice of skin repair following episiotomy improved from 36.5% to 64.5% (p=0.008) and among midwives from 26.1% to 50.7% (p&lt;0.001). Physicians knowledge of the overlap technique in the repair of full thickness external anal sphincter tears improved from 28.5% to 42.8% (p=0.05), whereas knowledge of repairing torn internal anal sphincter separately improved from 12.8% to 86.8% (p&lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Improvement in the level of knowledge on diagnosis and repair of perineal tears was observed for all physicians and midwives who attended the 2\u2005days' expert training. Regular ongoing training will serve to maintain the newly acquired knowledge.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-014183","type":"journal-article","created":{"date-parts":[[2017,4,7]],"date-time":"2017-04-07T20:10:33Z","timestamp":1491595833000},"page":"e014183","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Diagnosis and repair of perineal injuries: knowledge before and after expert training\u2014a multicentre observational study among Palestinian physicians and midwives"],"prefix":"10.1136","volume":"7","author":[{"given":"Kaled","family":"Zimmo","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Al Aqsa Hospital, Gaza, Palestine"},{"name":"Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway"},{"name":"The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katariina","family":"Laine","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Oslo University Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c5se","family":"Vikanes","sequence":"additional","affiliation":[{"name":"The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik","family":"Fosse","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway"},{"name":"The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Zimmo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway"},{"name":"The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway"},{"name":"Department of Obstetrics, Al Shifa Hospital, Gaza, Palestine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hadil","family":"Ali","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway"},{"name":"The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway"},{"name":"Department of Obstetrics, Palestine Medical Complex Hospital, Ramallah, Palestine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranee","family":"Thakar","sequence":"additional","affiliation":[{"name":"Croydon University Hospital, Croydon, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul H","family":"Sultan","sequence":"additional","affiliation":[{"name":"Croydon University Hospital, Croydon, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sahar","family":"Hassan","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Pharmacy and Health Professions, Birzeit University, Ramallah, Palestine"},{"name":"Institute of Community and Public Health, Birzeit University, Ramallah, Palestine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,4,7]]},"reference":[{"key":"2025101812462768000_7.4.e014183.1","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s00192-015-2850-2","article-title":"Prevalence of unrepaired third and fourth degree tears among women taken to the operating room for repair of presumed obstetric fistula during two fistula camps in Kenya","volume":"27","author":"Lozo","year":"2016","journal-title":"Int Urogynecol 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