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Nilsson C.,Nordsjaellands Hospital | Sorensen B.L.,Copenhagen University | Sorensen J.L.,Copenhagen University
Acta Obstetricia et Gynecologica Scandinavica | Year: 2014

The objective was to compare two teaching methods for postpartum hemorrhage management: interactive hands-on training and non-interactive video training. In a controlled intervention study at a secondary health care center in Kenya, the two training methods, based on the Advanced Life Support in Obstetrics curriculum, were evaluated utilizing structured observation of a standardized scenario before and after training. Both intervention groups significantly increased in performance scores after receiving hands-on training: 40% (95% CI 29.5-47.0) and video training: 34.5% (95% CI 25.0-42.0); likewise, pass rates improved significantly. No significant differences in performance score or pass rates were found between the two methods. The findings indicate that postpartum hemorrhage management training by mobile media might be just as effective as conventional hands-on training and a feasible way to overcome the outreach gap in sub-Saharan Africa's rural areas, where peripheral health facilities are generally difficult to reach with conventional training programs. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.


We present two cases in which the patients were admitted to a local hospital with acute abdominal pain four or five months after having undergone laparoscopic gastric bypass. In both cases, operation revealed a perforation of the small bowel close to the distal anastomosis. In the first case, a massive constipation of the small bowel was most likely a contributing factor. In the second case, the cause was a kink of the entero-entero anastomosis leading to obstruction and finally perforation of the biliary limp. Late perforations are among the rarely reported complications associated with gastric bypass but as our two cases illustrate they are important to keep in mind.


Strandbygaard J.,Copenhagen University | Bjerrum F.,Copenhagen University | Maagaard M.,Copenhagen University | Rifbjerg Larsen C.,Nordsjaellands Hospital | And 2 more authors.
Acta Obstetricia et Gynecologica Scandinavica | Year: 2014

Objective The objective of this study was to develop a four-step curriculum in basic laparoscopy consisting of validated modules integrating a cognitive component, a practical component and a procedural component. Design A four-step curriculum was developed. The methodology was different for each step. Step 1: A 1-day course in basic laparoscopy developed on the background of a regional needs analysis. Step 2: A multiple-choice test, developed and validated through interviews with experts in laparoscopy and subsequently through a Delphi audit involving regional chief physicians. Step 3: A procedural training task (a salpingectomy) on a validated virtual reality simulator. Step 4: An operation on a patient (a salpingectomy) with following formative assessment based on a validated assessment scale. Setting University hospital, Copenhagen, Denmark. Population Fifty-two first-year residents in obstetrics and gynecology from 2009 to 2011. Method Observational cohort study. Main outcome measure Completion rate. Results All participants completed step 1 and improved post-course test scores compared with pre-course test scores, p = 0.001. Step 2 was completed by 75% (37/52); all improved test scores after 6 months, p = 0.001. Step 3 was completed by 75%. Participants used 238 min (range 75-599) and 38 repetitions (range 8-99) to reach proficiency level on a virtual reality simulator. Step 4 was completed by 55%. There was no correlation between test scores and simulator training time. Protected training time was correlated with increasing completion rate. Conclusion A four-step curriculum in basic laparoscopy is applicable in residency training. Protected training time correlated with increasing completion rate. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.


Uldum S.A.,Statens Serum Institute | Bangsborg J.M.,Herlev University Hospital | Gahrn-Hansen B.,University of Southern Denmark | Ljung R.,Nordsjaellands Hospital | And 3 more authors.
Eurosurveillance | Year: 2012

Denmark experienced two waves of Mycoplasma pneumoniae infection during autumn and early winter in 2010 and 2011, respectively. Both affected the whole country. The proportion of positive results was almost the same for both, indicating that the two waves were probably of equal size. High macrolide consumption during the epidemics did not seem to affect levels of macrolide resistance in M. pneumoniae, which remain low in Demark (1% to 3%).


Fleischer J.,Aarhus University Hospital | Cichosz S.L.,Aarhus University Hospital | Hoeyem P.,Aarhus University Hospital | Laugesen E.,Aarhus University Hospital | And 5 more authors.
Diabetes Care | Year: 2015

OBJECTIVE To investigate the sex differences in cardiac autonomic modulation in patients with newly diagnosed type 2 diabetes and to determine whether cardiac autonomic modulation is associated with glycemic variability. RESEARCH DESIGN AND METHODS We investigated a cohort consisting of 48men and 39womenwith non-insulin-treated type 2 diabetes and a known duration of diabetes<5 years.All patients were equipped with a continuous glucose monitoring sensor for 3 days, and the mean amplitude of glycemic excursions (MAGE) was calculated to obtain individual glycemic variability. Cardiac autonomic modulation was quantified by analysis of heart rate variability (HRV) in time and frequency domains and during cardiovascular reflex tests (response to standing [RS], deep breathing [expiration-inspiration], and Valsalva maneuver). RESULTS Sex differences in age- and heart rate-adjusted HRV measures were observed in both active and passive tests. Lowfrequency (LF; P = 0.036), LF/high frequency (HF; P < 0.001), and RS (P = 0.006) were higher in men, whereas expiration-inspiration (P < 0.001), but not HF, was higher in women. In women, reduced cardiac autonomic modulation as assessed by the standard deviation of normal-to-normal intervals (P = 0.001), the root mean square of successive differences (P = 0.018), LF (P < 0.001), HF (P = 0.005), total power (P = 0.008), RS ratio (P = 0.027), and expiration-to-inspiration ratio (P = 0.006) was significantly associated with increased glycemic variability as assessed by MAGE. This was not the case in men. The association in women persisted in a multivariate regression analysis controlling for weight, mean heart rate, blood pressure (systolic), and triglycerides. CONCLUSIONS In patients with newly diagnosed and well-controlled type 2 diabetes, increased glycemic variabilitywas associated with reduced cardiac autonomicmodulation in women but not in men. © 2015 by the American Diabetes Association.

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