| 1. |
- Ahlborg, Liv, et al.
(författare)
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Individualized feedback during simulated laparoscopic training : a mixed methods study.
- 2015
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Ingår i: International Journal of Medical Education. - : International Journal of Medical Education. - 2042-6372. ; 6, s. 93-100
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study aimed to explore the value of individualized feedback on performance, flow and self-efficacy during simulated laparoscopy. Furthermore, we wished to explore attitudes towards feedback and simulator training among medical students.METHODS: Sixteen medical students were included in the study and randomized to laparoscopic simulator training with or without feedback. A teacher provided individualized feedback continuously throughout the procedures to the target group. Validated questionnaires and scales were used to evaluate self-efficacy and flow. The Mann-Whitney U test was used to evaluate differences between groups regarding laparoscopic performance (instrument path length), self-efficacy and flow. Qualitative data was collected by group interviews and interpreted using inductive thematic analyses.RESULTS: Sixteen students completed the simulator training and questionnaires. Instrument path length was shorter in the feedback group (median 3.9 m; IQR: 3.3-4.9) as compared to the control group (median 5.9 m; IQR: 5.0-8.1), p<0.05. Self-efficacy improved in both groups. Eleven students participated in the focus interviews. Participants in the control group expressed that they had fun, whereas participants in the feedback group were more concentrated on the task and also more anxious. Both groups had high ambitions to succeed and also expressed the importance of getting feedback. The authenticity of the training scenario was important for the learning process.CONCLUSIONS: This study highlights the importance of individualized feedback during simulated laparoscopy training. The next step is to further optimize feedback and to transfer standardized and individualized feedback from the simulated setting to the operating room.
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| 2. |
- Colmorn, Lotte B., et al.
(författare)
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Mode of first delivery and severe maternal complications in the subsequent pregnancy
- 2017
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 96:9, s. 1053-1062
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Severe obstetric complications increase with the number of previous cesarean deliveries. In the Nordic countries most women have two children. We present the risk of severe obstetric complications at the delivery following a first elective or emergency cesarean and the risk by intended mode of second delivery. Material and methods: A two-year population-based data collection of severe maternal complications in women with two deliveries in the Nordic countries (n = 213 518). Denominators were retrieved from the national medical birth registers. Results: Of 35 450 first cesarean deliveries (17%), 75% were emergency and 25% elective. Severe complications at second delivery were more frequent in women with a first cesarean than with a first vaginal delivery, and rates of abnormally invasive placenta, uterine rupture and severe postpartum hemorrhage were higher after a first elective than after a first emergency cesarean delivery [relative risk (RR) 4.1, 95% confidence intervals (CI) 2.0-8.1; RR 1.8, 95% CI 1.3-2.5; RR 2.3, 95% CI 1.5-3.5, respectively]. A first cesarean was associated with up to 97% of severe complications in the second pregnancy. Induction of labor was associated with an increased risk of uterine rupture and severe hemorrhage. Conclusion: Elective repeat cesarean can prevent complete uterine rupture at the second delivery, whereas the risk of severe obstetric hemorrhage, abnormally invasive placenta and peripartum hysterectomy is unchanged by the intended mode of second delivery in women with a first cesarean. Women with a first elective vs. an emergency cesarean have an increased risk of severe complications in the second pregnancy.
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| 3. |
- Colmorn, Lotte B., et al.
(författare)
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The Nordic Obstetric Surveillance Study: a study of complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery
- 2015
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 94:7, s. 734-744
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the rates and characteristics of women with complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery in the Nordic countries. Design: Prospective, Nordic collaboration. Setting: The Nordic Obstetric Surveillance Study (NOSS) collected cases of severe obstetric complications in the Nordic countries from April 2009 to August 2012. Sample and methods: Cases were reported by clinicians at the Nordic maternity units and retrieved from medical birth registers, hospital discharge registers, and transfusion databases by using International Classification of Diseases, 10th revision codes on diagnoses and the Nordic Medico-Statistical Committee Classification of Surgical Procedure codes. Main outcome measures: Rates of the studied complications and possible risk factors among parturients in the Nordic countries. Results: The studied complications were reported in 1019 instances among 605362 deliveries during the study period. The reported rate of severe blood loss at delivery was 11.6/10000 deliveries, complete uterine rupture was 5.6/10000 deliveries, abnormally invasive placenta was 4.6/10000 deliveries, and peripartum hysterectomy was 3.5/10000 deliveries. Of the women, 25% had two or more complications. Women with complications were more often >35years old, overweight, with a higher parity, and a history of cesarean delivery compared with the total population. Conclusion: The studied obstetric complications are rare. Uniform definitions and valid reporting are essential for international comparisons. The main risk factors include previous cesarean section. The detailed information collected in the NOSS database provides a basis for epidemiologic studies, audits, and educational activities.
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| 4. |
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| 5. |
- Gyllencreutz, Erika, et al.
(författare)
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Validation of a computerized algorithm to quantify fetal heart rate deceleration area
- 2018
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley Online Library. - 0001-6349 .- 1600-0412. ; 97:9, s. 1137-1147
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Tidskriftsartikel (refereegranskat)abstract
- Introduction.Reliability in visual cardiotocography interpretation isunsatisfying, which has led to the development of computerizedcardiotocography. Computerized analysis is well established for antenatal fetalsurveillance but has yet not performed sufficiently during labor. We aimed toinvestigate the capacity of a new computerized algorithm compared with visualassessment in identifying intrapartum fetal heart rate baseline anddecelerations.Material and methods.In all, 312 intrapartum cardiotocographytracings with variable decelerations were analyzed by the computerizedalgorithm and visually examined by two observers, blinded to each other andthe computer analysis. The width, depth and area of each deceleration wasmeasured. Four cases (>100 variable decelerations) were subjected to in-depthdetailed analysis. The outcome measures were bias in seconds (width), beatsper minute (depth), and beats (area) between computer and observers usingBland–Altman analysis. Interobserver reliability was determined by calculatingintraclass correlation and Spearman rank analysis.Results.The analysis (312cases) showed excellent intraclass correlation (0.89–0.95) and very strongSpearman correlation (0.82–0.91). The detailed analysis of>100 decelerationsin four cases revealed low bias between the computer and the two observers;width 1.4 and 1.4 seconds, depth 5.1 and 0.7 beats per minute, and area 0.1and–1.7 beats. This was comparable to the bias between the two observers:0.3 seconds (width), 4.4 beats per minute (depth) and 1.7 beats (area). Theintraclass correlation was excellent (0.90–.98).Conclusion.A novelcomputerized algorithm for intrapartum cardiotocography analysis is asaccurate as gold standard visual assessment, with high correlation and low bias.
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| 6. |
- Jakobsson, Maija, et al.
(författare)
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Emergency peripartum hysterectomy: results from the prospective Nordic Obstetric Surveillance Study (NOSS)
- 2015
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 94:7, s. 745-754
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the prevalence and risk factors of emergency peripartum hysterectomy. Design:Nordic collaborative study. Population605362 deliveries across the five Nordic countries. Methods: We collected data prospectively from patients undergoing emergency peripartum hysterectomy within 7days of delivery from medical birth registers and hospital discharge registers. Control populations consisted of all other women delivering on the same units during the same time period. Main outcome measures: Emergency peripartum hysterectomy rate. Results: The total number of emergency peripartum hysterectomies reached 211, yielding an incidence rate of 3.5/10000 (95% confidence interval 3.0-4.0) births. Finland had the highest prevalence (5.1) and Norway the lowest (2.9). Primary indications included an abnormally invasive placenta (n=91, 43.1%), atonic bleeding (n=69, 32.7%), uterine rupture (n=31, 14.7%), other bleeding disorders (n=12, 5.7%), and other indications (n=8, 3.8%). The delivery mode was cesarean section in nearly 80% of cases. Previous cesarean section was reported in 45% of women. Both preterm and post-term birth increased the risk for emergency peripartum hysterectomy. The number of stillbirths was substantially high (70/1000), but the case fatality rate stood at 0.47% (one death, maternal mortality rate 0.17/100000 deliveries). Conclusions: A combination of prospective data collected from clinicians and information gathered from register-based databases can yield valuable data, improving the registration accuracy for rare, near-miss cases. However, proper and uniform clinical guidelines for the use of well-defined international diagnostic codes are still needed.
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| 8. |
- Lindqvist, Pelle G., et al.
(författare)
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The relationship between sun exposure and all-cause mortality
- 2017
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Ingår i: Photochemical and Photobiological Sciences. - 1474-905X. ; 16:3, s. 354-361
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to conduct a narrative review of the rapid advances in knowledge regarding sun exposure and all-cause mortality. Data support the hypothesis that sun exposure avoidance is a major risk factor for all-cause mortality in adjusted analysis (age, income, education, marital status, smoking, and comorbidity). This was caused by an increased risk of death due to cardiovascular disease (CVD) and noncancer/non-CVD. However, the increased life span among those with high sun exposure naturally results in an increased prevalence of cancer death. In addition, sun exposure increases the incidence, but is related to better prognosis of skin cancer. The new findings indicate that there is a need for modification of guidelines regarding sun exposure. They may also add to our knowledge regarding the increasing incidence of diabetes mellitus and increased mortality among non-Caucasians in western countries. According to the present knowledge, in a low solar intensity region we should aim for sound and safe sun exposure habits, especially for those at increased risk of CVD or noncancer/non-CVD.
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| 9. |
- Lu, Ke, et al.
(författare)
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Fetal heart rate short term variation during labor in relation to scalp blood lactate concentration
- 2018
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 97:10, s. 1274-1280
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionFetal heart rate short term variation (STV) decreases with severe chronic hypoxia in the antenatal period. However, only limited research has been done on STV during labor. We have tested a novel algorithm for a valid baseline estimation and calculated STV. To explore the value of STV during labor, we compared STV with fetal scalp blood (FBS) lactate concentration, an early marker in the hypoxic process. Material and methodsSoftware was developed which estimates baseline frequency using a novel algorithm and thereby calculates STV according to Dawes and Redman in up to four 30-minute blocks prior to each FBS. Cardiotocography traces from 1070 women in labor who had had FBS performed on 2134 occasions were analyzed. ResultsIn acidemic cases (lactate >4.8mmol/L; Lactate Pro), median STV 30minutes prior to FBS was 7.10milliseconds compared with 6.09milliseconds in the preacidemic (4.2-4.8mmol/L) and 5.23milliseconds in the normal (<4.2mmol/L) groups (P<.05). There was a positive correlation between lactate and STV (rho=0.16-0.24; P<.05). Median lactate concentration in cases with STV <3.0milliseconds (n=160) was 2.3mmol/L. When 2 FBS were performed within 60minutes the change rate of lactate correlated to STV (rho=0.33; P<.001). Cases with increasing lactate concentration had a median STV of 5.29milliseconds vs 4.41milliseconds in those with decreasing lactate (P<.001). ConclusionsIn the early stages of intrapartum hypoxia, STV increases, contrary to findings regarding chronic hypoxia in the antenatal period. The increase in the adrenergic surge is a likely explanation.
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