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1.
Dan Med J ; 68(9)2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34477097

RESUMO

INTRODUCTION: Women very rarely die during pregnancy and childbirth in Denmark. Although maternal deaths are registered worldwide, various studies indicate that underreporting does occur. This paper presents validated Danish register data for two periods between 1985 and 2017. METHODS: Maternal deaths were identified from 1985 to 1994 and from 2002 to 2017 by linking four national health registers, death certificates and notifications from maternity wards. A group of obstetricians categorised and assessed all medical records, classifying each case by cause of death. RESULTS: Linkage of four registers yielded valid data, leading to the identification of 143 maternal deaths in the abovementioned periods. From 1985-1994 there were 73 deaths and 618,021 live births, resulting in a maternal mortality rate of 11.8 per 100,000 live births with a non-significant 2% annual increase (95% confidence interval (CI): -6.0-11.0%). From 2002 to 2017 there were 70 maternal deaths and 999,206 live births, resulting in a maternal mortality rate of 7.0 per 100,000 live births (95% CI: 5.5-8.9) with a significant 9% annual decrease (95% CI: 4.0-14.0%). CONCLUSIONS: Overall maternal mortality decreased in the course of the two periods (n = 33 years), with a significant decrease during the last period. This is suggested to be a result of multiple clinical and organisational improvements as discussed in the paper. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Mortalidade Materna , Complicações na Gravidez , Causas de Morte , Dinamarca/epidemiologia , Feminino , Humanos , Registros Médicos , Gravidez
2.
PLoS One ; 15(2): e0227988, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32084173

RESUMO

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.


Assuntos
Cesárea/normas , Emergências , Qualidade da Assistência à Saúde/normas , Feminino , Humanos , Entrevistas como Assunto , Gravidez , Reprodutibilidade dos Testes , Inquéritos e Questionários
3.
Adv Health Sci Educ Theory Pract ; 25(3): 581-606, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31691181

RESUMO

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.


Assuntos
Relações Interprofissionais , Equipe de Assistência ao Paciente , Satisfação do Paciente , Adulto , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Simulação de Paciente
4.
Ugeskr Laeger ; 176(13)2014 Mar 24.
Artigo em Dinamarquês | MEDLINE | ID: mdl-25349930

RESUMO

Development of professional identity is essential for medical students to become good doctors. Introduction to the clinical setting, role models, reflection, structure, learning strategy and inclusion in community of practice are important factors. Four observations and 15 interviews were made and revealed big differences in educational practice in four different clinical departments. The departments with low evaluation scores need to improve their practice. Individual guidance inside the department, which adjusts for medical specialty, potentials and challenges, could initiate future progress.


Assuntos
Estágio Clínico/normas , Departamentos Hospitalares/normas , Preceptoria/normas , Estudantes de Medicina/psicologia , Comunicação , Educação de Graduação em Medicina/normas , Estudos de Avaliação como Assunto , Humanos , Aprendizagem , Observação , Pesquisa Qualitativa , Inquéritos e Questionários
5.
Eur J Obstet Gynecol Reprod Biol ; 142(2): 124-8, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19058903

RESUMO

OBJECTIVES: In Denmark, maternal mortality has been reported over the last century, both locally through hospital reports and in national registries. The purpose of this study was to analyze data from national medical registries of pregnancy-related deaths in Denmark 1985-1994 and to classify them according to the UK Confidential Enquiry into Maternal Deaths (CEMD). STUDY DESIGN: All deaths of women with a registered pregnancy within 12 months prior to the death were identified by comparing the Danish medical registries, death certificates, and relevant codes according to International Classification of Diseases (ICD-10). All cases were classified using the UK CEMD classification. Cases of maternal death were further evaluated by an audit group. RESULTS: 311 cases were classified. 92 deaths (29.6%) occurred 42 days), 1 woman died from a direct obstetric cause, 46 from indirect causes, and 172 from fortuitous causes. Hypertensive disorders of pregnancy were the major cause of direct maternal deaths. The rate of maternal deaths constituted 9.8/100,000 maternities (i.e. the number of women delivering registrable live births at any gestation or stillbirths at 24 weeks of gestation or later). CONCLUSION: This is the first systematic report on deaths in Denmark based on data from national registries. The maternal mortality rate in Denmark is comparable to the rates in other developed countries. Fortunately, statistics are low, but each case represents potential learning. Obstetric care has changed and classification methods differ between countries. Prospective registration and registry linkage seem to be a way to ensure completion. This retrospective study has provided the background for a prospective study on registration and evaluation of maternal mortality in Denmark.


Assuntos
Mortalidade Materna , Sistema de Registros , Adolescente , Adulto , Dinamarca/epidemiologia , Feminino , Humanos , Classificação Internacional de Doenças , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Adulto Jovem
6.
Acta Obstet Gynecol Scand ; 86(12): 1427-31, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17851824

RESUMO

BACKGROUND: The purpose of this study was to determine the incidence of polyhydramnios, the related maternal and perinatal morbidity, and to estimate the association between perinatal outcome and the degree of polyhydramnios in a Danish population. METHODS: The study population consisted of 168 women with singleton pregnancies and polyhydramnios diagnosed by ultrasound as a largest two-diameter pocket of > 50 cm2. Mild polyhydramnios defined as > 50 and < 100 cm2, and severe polyhydramnios defined as > or = 100 cm2. The background population consisted of 8,347 pregnant women from the same hospital. Outcome measures were compared using chi2 test or Fisher's exact test. RESULTS: The incidence of polyhydramnios was 2%, with 66.7% of cases mild, and 33.3% were severe polyhydramnios. The study population had an increased risk of emergency (19 versus 10.5%, p<0.001) and elective (11.3 versus 5.0%, p<0.001) caesarean section, as well as perinatal death (1.2 versus 0.3%, p<0.05) compared to the background population. In cases of severe polyhydramnios, there was an increased risk of caesarean section (44.6 versus 23.1%, p<0.005), birth weight > 4,000 g (28.6 versus 14.3%, p<0.05), and need for neonatal care (8.9 versus 0.9%, p<0.01) compared to mild cases. Apgar score < 7, perinatal death and structural malformations only occurred in women with severe polyhydramnios. CONCLUSION: It is reasonable to distinguish between mild and severe polyhydramnios regarding special attention and follow-up, as caesarean section and perinatal morbidity and mortality are related to the degree of polyhydramnios. A two-diameter pocket > or = 100 cm2 could be used to separate mild from severe cases.


Assuntos
Poli-Hidrâmnios/diagnóstico por imagem , Poli-Hidrâmnios/epidemiologia , Ultrassonografia Pré-Natal , Adolescente , Adulto , Parto Obstétrico/estatística & dados numéricos , Dinamarca/epidemiologia , Feminino , Hospitais Estaduais/estatística & dados numéricos , Humanos , Incidência , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Poli-Hidrâmnios/etiologia , Poli-Hidrâmnios/patologia , Gravidez , Resultado da Gravidez , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Índice de Gravidade de Doença
7.
World J Surg ; 26(4): 397-400, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11910469

RESUMO

Studies of connective tissue from patients with inguinal hernia have shown that smoking may be associated with hernia formation due to a defective connective tissue metabolism. Whether smoking is a risk factor for recurrence, too, was examined in this study. From December 1990 through December 1995, 649 patients underwent hernia repair as open sutured repair (Cooper ligament or abdominal ring repair) or as open mesh repair. Five hundred forty-four eligible patients were evaluated for recurrence 2 years postoperatively. Association between recurrence and 17 patient-, disease-, and intraoperative variables were analyzed by multiple logistic regression. The results showed that smoking was significantly and independently associated with recurrence compared to nonsmoking [odds ratio (OR = 2.22; 95% confidence interval (95% CI) = 1.19-4.15)]. Open sutured repair compared to open mesh repair was the most significant predictor for recurrence (OR = 7.23; 95% CI = 3.01-17.37). Surprisingly, local anesthesia was associated with a higher risk of recurrence compared to general anesthesia (OR = 2.44; 95% CI = 1.19-5.09). Potential confounders and other risk factors for hernia recurrence such as age, alcohol consumption, previous surgery, and anatomical characteristics of the hernia were adjusted for in the analysis. In conclusion, smoking is an important risk factor for recurrence of groin hernia, presumably due to an abnormal connective tissue metabolism in smokers.


Assuntos
Hérnia Inguinal/epidemiologia , Fumar/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia Inguinal/cirurgia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Telas Cirúrgicas , Suturas
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