Building low-cost simulators for invasive ultrasound-guided procedures using the V-model.

The use of medical simulators for training technical and diagnostic skills has rapidly increased over the past decade. Yet, most available medical simulators have not been developed based on a structured evaluation of their intended uses but rather out of expected commercial value. Moreover, educators often struggle to access simulators because of cost or because no simulators have been developed for a particular procedure. In this report, we introduce "the V-model" as a conceptual framework to illustrate how simulator development can be guided by the intended uses in an iterative fashion. Applying a needs-based conceptual framework when developing simulators is important to increase the accessibility and sustainability of simulation-based medical education. It will minimize the developmental barriers and costs, while at the same time improving educational outcomes. Two new simulators for invasive ultrasound-guided procedures are used as examples, the chorionic villus sampling model and the ultrasound-guided aspiration trainer. Our conceptual framework and the use cases can serve as a template for future simulator development and documentation hereof.

[Diagnosis and treatment of a multisystemic disorder in children called congenital portosystemic shunts].

Congenital portosystemic shunts (CPSS) are rare malformations, which connect the portal venous system and the systemic circulation. The disorder is discovered at prenatal screening, neonatal cholestasis as an incidental finding or by systemic complications such as pulmonary hypertension, encephalopathies or liver nodules. CPSS are associated to cardiac malformations and several syndromes. Intervention radiology plays a key role in treatment by closure of the shunt, which is indicated, if the patient has complications, the shunt is extrahepatic, or it is still persistent at two years of age, using a two-step approach, as summarised and discussed in this review.

[Genetic screening of prospective parents].

Risk of genetic diseases with autosomal recessive or X-linked inheritance can be unknown to prospective parents until an affected child is born. New technology has enabled carrier screening for hundreds of genetic diseases (expanded carrier screening, ECS). I Denmark, each year estimated 100-180 children are born affected with a serious condition which could have been detected with ECS of the parents. This review describes the considerations and perspectives of a systematic genetic screening programme for prospective parents in the Danish healthcare system.

Are the Danish stillbirth rates still record low? A nationwide ecological study.

OBJECTIVES: After introduction of a more proactive post-term induction practice, stillbirth rates have decreased substantially throughout the first decade of this century in Denmark. The aim was to follow up on induction and stillbirth rates in Denmark. DESIGN: Historical ecological study. PARTICIPANTS: We included all delivering women in Denmark during the period 2007-2018. INTERVENTION: Induction rates from 41 weeks of gestation. MAIN OUTCOME MEASURE: Stillbirth rates from 41+0 weeks. RESULTS: Of 739 570 delivered children, 179 734 (24.3%) were born from 41+0 weeks. The proportion of deliveries after 41 weeks which were induced increased from 25.4% in 2007 to 44.4% in 2012. From 2012 to 2015, the induction rates decreased from 44.4% to 39.4%. After 2015 rates were stable.During the same period, stillbirth rates decreased from 1.30 in 2007/2008 to 0.38 per 1000 newborn in 2011/12; -54%. From 2012, however, the rates were doubled from 0.38 per 1000 in 2011/2012 to 0.74 per 1000 in 2015/2018; RR 1.97 (95% CI 1.02 to 3.81), p=0.033.Changes in the included potential confounders cannot explain neither the substantial fall in stillbirth rates from 2007/2008 to 2011/2012, nor the doubling in stillbirth rates after 41 weeks since 2012.During the whole study period, the cumulated risk of intrauterine foetal death increased from week 41+0 to 41+6 from 0.16 to 1.25 per 1000 ongoing pregnancies or 7.8 folds. Going beyond 42 weeks further increased the risk to 2.46 per 1000 ongoing pregnancies. CONCLUSION: We found a consistent inverse correlation between the proportion of women with induction of labour after 41 weeks of gestation and the stillbirth rates during the same period and same gestational ages. This Danish update on post-term inductions and corresponding stillbirth rates thus confirm previous findings suggesting a causal link between these two parameters.

[Prenatal diagnostics in Arhus and Viborg Counties after implementation of first trimester risk assessment]. / Praenatal diagnostik i Arhus og Viborg Amter efter implementering af første trimester-risikovurdering.

INTRODUCTION: In 2004 the Danish National Board of Health issued new guidelines for prenatal diagnostics in Denmark. The guidelines include a general offer to all pregnant women in Denmark of first trimester risk assessment of combined non-invasive tests integrating measurement of nuchal translucency and maternal biochemistry for detection of fetal chromosomal abnormalities like trisomy 21, and replacing the screening criteria of > or =35 of age. MATERIALS AND METHODS: The study is based on registered data covering 5,504 pregnancies during the period 1 July 2005 to 31 December 2005 in Aarhus and Viborg Counties. RESULTS: 77% of the pregnant women had a complete combined test and only 2% declined the program. At a cut off at 1:400 at term the detection rate for trisomy 21 was 85% (CI: 62.1-96.8%) with a false positive rate of 3.4%. There was a significant reduction in the number of prenatal karyotypes from 2002 to 2005 in both counties, with a 58% reduction in Viborg County and 33% in Aarhus County. The percentage of abnormal karyotypes over the same period increased from 2.8%% to 11.4% in Viborg County, and from 7.1% to 15.4% in Aarhus County. CONCLUSION: With a significant reduction in invasive procedures and a detection rate of 85% with a false positive rate of 3.4%, the results of the first trimester risk assessment program comply with the requirements defined by the Danish National Board of Health.