Prophylactic progesterone and preterm birth.

This review summarises the present knowledge of prophylactic progesterone and preterm birth. Preterm birth (less-than 37 weeks) is a leading cause of neonatal mortality and morbidity worldwide. The incidence varies globally but remains low in the Nordic countries (5-6%). Prediction and prevention are complicated due to diverse aetiology, but obstetric history and cervical length can improve prediction. Prophylactic vaginal progesterone initiated between 12 and 24 weeks of gestation is recommended to reduce preterm birth less-than 33-35 weeks in singleton pregnancies with a history of preterm birth or with a short cervix (less-than 25 mm) and can be considered for twin pregnancies with the same risk factors.

Anorexia nervosa in pregnancy and the post-partum period.

Anorexia nervosa (AN) is a mental disorder with the greatest incidence amongst women of the childbearing age. The prevalence of AN in pregnancy is marginal, yet the risk of exacerbation or reactivation is significant. Adverse perinatal complications of mental and physical nature pertain to both mother and child and through early diagnosis and monitoring during the perinatal period manageable. This preview describes the importance of enabling optimal perinatal care through a multidisciplinary management team.

Making the best of the worst: Care quality during emergency cesarean sections.

OBJECTIVE: This study aimed to identify factors influencing mothers' and their partners' perceptions of care quality, and to identify associated clinical factors. METHODS: Questionnaires were developed based on eight interviews with couples after emergency Cesarean Sections (ECS). The internal structure of the questionnaires was examined using Rasch analysis. Cronbach's alpha was calculated to evaluate internal consistency of questionnaire items. Finally, associations between questionnaire scores and ECS characteristics were determined. RESULTS: Thematic analysis of interview data demonstrated that team-dynamics, professionalism, information, safety, leadership and mother-child continuity of care are important to patient- perceived quality of care. Questionnaire responses from 119 women and 95 partners were included in the validation and demonstrated satisfying fit to the Rasch model. The questionnaires had acceptable internal consistency with Cronbach's alpha 0.8 and 0.7 for mothers and partners, respectively. Perceived quality of care was negatively associated with increasing urgency of the CS. Spearman rank correlation coefficients were -0.34 (p <0.001) and -0.32 (p = 0.004) for mothers and partners, respectively. Perceived quality of care differed significantly across CS indications for both mothers (p = 0.0006) and their partners (p<0.0001). CONCLUSION: Team-dynamics, professionalism, information, safety, leadership and mother-child-continuity affect patients' perceptions of care. Perceptions of care were highly influenced by CS indications and urgency.

Social ties between team members affect patient satisfaction: a data-driven approach to handling complex network analyses.

Research from outside the medical field suggests that social ties between team-members influence knowledge sharing, improve coordination, and facilitate task completion. However, the relative importance of social ties among team-members for patient satisfaction remains unknown. In this study, we explored the association between social ties within emergency teams performing simulated caesarean sections (CS) and patient-actor satisfaction. Two hundred seventy-two participants were allocated to 33 teams performing two emergency CSs in a simulated setting. We collected data on social ties between team-members, measured as affective, personal and professional ties. Ties were rated on 5-point Likert scales. In addition, participants' clinical experience, demographic data and their knowledge about team members' roles were surveyed. Perceived patient satisfaction was measured on a 5-point Likert scale. Data was analysed with a linear regression model using elastic net regularization. In total, 109 predictor variables were analysed including 84 related to social ties and 25 related to clinical experience, demographics and knowledge test scores. Of the 84 variables reflecting social ties, 34 (41%) had significant association with patient satisfaction, p < 0.01. By contrast, a significant association with patient satisfaction was found for only one (4%) of the 25 variables reflecting clinical experience, demographics and knowledge of team roles. Affective ties and personal ties were found to be far more important predictors in the statistical model than professional ties and predictors relating to clinical experience. Social ties between emergency team members may be important predictors of patient satisfaction. The results from this study help to enhance our conceptual understanding of social ties and their implications for team-dynamics. Our study challenges existing views of team-performance by placing emphasis on achieving collective competence through affective and personal social ties, rather than focusing on traditional measures of expertise.

Effect of engaging trainees by assessing peer performance: a randomised controlled trial using simulated patient scenarios.

INTRODUCTION: The aim of this study was to explore the learning effect of engaging trainees by assessing peer performance during simulation-based training. METHODS: Eighty-four final year medical students participated in the study. The intervention involved trainees assessing peer performance during training. Outcome measures were in-training performance and performance, both of which were measured two weeks after the course. Trainees' performances were videotaped and assessed by two expert raters using a checklist that included a global rating. Trainees' satisfaction with the training was also evaluated. RESULTS: The intervention group obtained a significantly higher overall in-training performance score than the control group: mean checklist score 20.87 (SD 2.51) versus 19.14 (SD 2.65) P = 0.003 and mean global rating 3.25 SD (0.99) versus 2.95 (SD 1.09) P = 0.014. Postcourse performance did not show any significant difference between the two groups. Trainees who assessed peer performance were more satisfied with the training than those who did not: mean 6.36 (SD 1.00) versus 5.74 (SD 1.33) P = 0.025. CONCLUSION: Engaging trainees in the assessment of peer performance had an immediate effect on in-training performance, but not on the learning outcome measured two weeks later. Trainees had a positive attitude towards the training format.

Long-term intended and unintended experiences after Advanced Life Support training.

AIM: Highly structured simulation-based training (SBT) on managing emergency situations can have a significant effect on immediate satisfaction and learning. However, there are some indications of problems when applying learned skills to practice. The aim of this study was to identify long-term intended and unintended learner reactions, experiences and reflections after attending a simulation based Advanced Life Support (ALS) course. METHOD: Semi-structured interviews were conducted by telephone with a purposive sample of prior ALS-course participants. A constructivist grounded theory approach was used to analyze the data. RESULTS: Seventeen former participants were interviewed. The main themes related to context adaptation, communities of practice and to transfer of skills. Interviewees described challenges in adapting to the structured simulation setting and going back to the uncertain and unstructured clinical world. In part, a result of the several conflicting communities of practice - one being the ALS-community and the others relating to professional roles. Despite reporting transferring a more systematic approach to managing patients in emergency situations and during ward rounds, surgery, and in their teaching, participants also reported poor transfer in emergency situations where not all team members had the same ALS-structured approach. CONCLUSION: The result from this study indicates that the efficiency dimension of ALS competence is taught well in ALS courses, but that the form and content of these highly structured/model courses are insufficient in training the innovative dimension of competence that is needed for transfer of skills in unstructured, emergency situations.

The significance of clinical experience on learning outcome from resuscitation training-a randomised controlled study.

CONTEXT: The impact of clinical experience on learning outcome from a resuscitation course has not been systematically investigated. AIM: To determine whether half a year of clinical experience before participation in an Advanced Life Support (ALS) course increases the immediate learning outcome and retention of learning. MATERIALS AND METHODS: This was a prospective single blinded randomised controlled study of the learning outcome from a standard ALS course on a volunteer sample of the entire cohort of newly graduated doctors from Copenhagen University. The outcome measurement was ALS-competence assessed using a validated composite test including assessment of skills and knowledge. INTERVENTION: The intervention was half a year of clinical work before an ALS course. The intervention group received the course after a half-year of clinical experience. The control group participated in an ALS course immediately following graduation. RESULTS: Invitation to participate was accepted by 154/240 (64%) graduates and 117/154 (76%) completed the study. There was no difference between the intervention and control groups with regard to the immediate learning outcome. The intervention group had significantly higher retention of learning compared to the control group, intervention group mean 82% (CI 80-83), control group mean 78% (CI 76-80), P=0.002. The magnitude of this difference was medium (effect size=0.57). CONCLUSIONS: Half a year of clinical experience, before participation in an ALS course had a small but statistically significant impact on the retention of learning, but not on the immediate learning outcome.

[Prevention of vertical transmission of HIV in Denmark]. / Forebyggelse af vertikal transmission af human immundefektvirus i Danmark.

INTRODUCTION: Human immunodeficiency virus (HIV) is a RNA virus that can be transmitted parenterally, sexually or vertically. An effective prevention strategy has been implemented in industrialised countries, thereby reducing vertical transmission from 15-25% to < 1%. The aim of this study was to describe vertical transmission of HIV in Denmark after the introduction of ART. MATERIALS AND METHODS: The study was a retrospective study of all HIV-infected women who gave birth in Denmark between 1 January 2000 and 31 May 2005 and their children. RESULTS: 83 HIV-infected women gave birth to 96 children during the study period. In 79% of the cases, the woman knew her HIV status at the beginning of her pregnancy. The median CD4 count before delivery was 447 x 10(6)/l, and in 76% of the cases the HIV-RNA was < 20 copies/ml. 88% of the women delivered by Caesarean section. None of the children were breastfed. None of the children were infected during pregnancy, delivery or after birth. During the same period of time, 8 children were diagnosed with HIV in Denmark; they were born to mothers whose HIV infection was not diagnosed during pregnancy or delivery and therefore preventive treatment was not initiated. CONCLUSION: As long as preventive treatment strategies are followed, there is no transmission of HIV from mother to child, neither during pregnancy nor during or after birth.

Newly graduated doctors' competence in managing cardiopulmonary arrests assessed using a standardized Advanced Life Support (ALS) assessment.

AIM OF THE STUDY: Several studies using a variety of assessment approaches have demonstrated that young doctors possess insufficient resuscitation competence. The aims of this study were to assess newly graduated doctors' resuscitation competence against an internationally recognised standard and to study whether teaching site affects their resuscitation competence. MATERIALS AND METHODS: The entire cohort of medical students from Copenhagen University expected to graduate in June 2006 was invited to participate in the study. Participants' ALS-competence was assessed using the Advanced Life Support Provider (ALS) examination standards as issued by the European Resuscitation Council (ERC). The emergency medicine course is conducted at three different university hospital teaching sites and teaching and assessment might vary across sites, despite the common end objectives regarding resuscitation teaching issued by the university. RESULTS: Participation was accepted by 154/240 (64%) graduates. Only 23% of the participants met the ALS pass criteria. They primarily lacked skills in managing cardiopulmonary arrest. There were significant differences in ALS-competence between teaching sites. CONCLUSION: Newly graduated doctors do not have sufficient competence in managing cardiopulmonary arrests according to the current guidelines published by ERC. There were significant differences in ALS-competence between sites. Change in teaching and assessment practice in undergraduate emergency medicine courses is needed in order to increase the level of ALS-competence of newly graduated doctors.