Research Interests:
Background Simulation-based learning (SBL), used for achieving various learning goals, is spreading around the world. However, it is still open, to what extend SBL needs to be adapted to local cultures. This study aimed to explore how... more
Background Simulation-based learning (SBL), used for achieving various learning goals, is spreading around the world. However, it is still open, to what extend SBL needs to be adapted to local cultures. This study aimed to explore how various stakeholder groups perceive what constitutes a competent simulation facilitator across three different countries. Methods We conducted an interview study with learners, facilitators, and facilitator trainers. Semi-structured interviews with 75 participants underwent content analysis. Participants were recruited from Denmark, Korea, and Australia. Interviews focused on characteristics of simulation faculty, as well as educational behaviours. Interviews were audio-recorded, translated to English, transcribed, and content analysed by inductively developing codes using the Nvivo software. In the first coding round, each interview was treated separately. In the analysis round, the individual codes between countries and stakeholder groups were compar...
Research Interests:
Research Interests:
Teknologi and Profession
Simulation is spreading – now also for research purposes In recent years simulation in the health sciences has spread around the world 1. More disciplines and professions are engaging in education and training activities using simulation... more
Simulation is spreading – now also for research purposes In recent years simulation in the health sciences has spread around the world 1. More disciplines and professions are engaging in education and training activities using simulation as an educational tool. We gave an overview about the use of simulation in an earlier issue of this publication 2. In this paper we explore the connections between simulation and research. Our aim is to describe uses of simulation that go beyond the educational use, while at the same time, helping in generating new knowledge that can inform simulation-based education as well as safe care for patients.
Research Interests:
AIM To investigate whether live video streaming from the bystander's smartphone to a medical dispatcher can improve the quality of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA). METHODS After... more
AIM To investigate whether live video streaming from the bystander's smartphone to a medical dispatcher can improve the quality of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA). METHODS After CPR was initiated, live video was added to the communication by the medical dispatcher using smartphone technology. From the video recordings, we subjectively evaluated changes in CPR quality after themedical dispatcher had used live video to dispatcher-assisted CPR (DA-CPR). CPR quality was registered for each bystander and compared with CPR quality after video-instructed DA-CPR. Data were analysed using logistic regression adjusted for bystander's relation to the patient and whether the arrest was witnessed. RESULTS CPR was provided with live video streaming in 52 OHCA calls, with 90 bystanders who performed chest compressions. Hand position was incorrect for 38 bystanders (42.2%) and improved for 23 bystanders (60.5%) after video-instructed DA-CPR. The compression rate was incorrect for 36 bystanders (40.0%) and improved for 27 bystanders (75.0%). Compression depth was incorrect for 57 bystanders (63.3%) and improved for 33 bystanders (57.9%). The adjusted odds ratios for improved CPR after video-instructed DA-CPR were; hand position 5.8 (95% CI: 2.8-12.1), compression rate 7.7 (95% CI: 3.4-17.3), and compression depth 7.1 (95% CI: 3.9-12.9). Hands-off time was reduced for 34 (37.8%) bystanders. CONCLUSIONS Live video streaming from the scene of a cardiac arrest to medical dispatchers is feasible. It allowed an opportunity for dispatchers to coach those providing CPR which was associated with a subjectively evaluated improvement in CPR performance.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Root cause analyses show that up to 70 % of adverse events are caused by human error. Strong non-technical skills (NTS) can prevent or reduce these errors, considerable numbers of which occur in the operating theatre. Minimally invasive... more
Root cause analyses show that up to 70 % of adverse events are caused by human error. Strong non-technical skills (NTS) can prevent or reduce these errors, considerable numbers of which occur in the operating theatre. Minimally invasive surgery (MIS) requires manipulation of more complex equipment than open procedures, likely requiring a different set of NTS for each kind of team. The aims of this study were to identify the MIS teams' key NTS and investigate the effect of training and assessment of NTS on MIS teams. The databases of PubMed, Cochrane Library, Embase, PsycINFO, and Scopus were systematically searched according to Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles containing outcome measures related to MIS teams' key NTS, training, or assessment of NTS were included. The search yielded 1984 articles, 11 of which were included. All were observational studies without blinding, and they differed in aims, types of evaluation, and outcomes. Only two studies evaluated patient outcomes other than operative time, and overall, the studies' quality of evidence was low. Different communication types were encountered in MIS compared to open surgery, mainly due to equipment- and patient-related challenges. Fixed teams improved teamwork and safety levels, while deficient planning and poor teamwork were found to obstruct workflow and increase errors. Training NTS mitigates these issues and improves staff attitudes towards NTS. MIS teams' NTS are important for workflow and prevention of errors and can be enhanced by working in fixed teams. In the technological complex sphere of MIS, communication revolves around equipment- and patient-related topics, much more so than in open surgery. In all, only a few heterogeneous-design studies have examined this. In the future, the focus should shift to systematically identifying key NTS and developing effective, evidence-based team training programmes in MIS.
Research Interests:
BackgroundA combination of non‐technical skills (NTS) and technical skills (TS) is crucial for anaesthetic patient management. However, a deeper understanding of the relationship between these two skills remains to be explored. We... more
BackgroundA combination of non‐technical skills (NTS) and technical skills (TS) is crucial for anaesthetic patient management. However, a deeper understanding of the relationship between these two skills remains to be explored. We investigated the characteristics of trainee anaesthesiologists’ NTS and TS in a simulated unexpected difficult airway management scenario.MethodsA mixed‐method approach was used to explore the relationship between NTS and TS in 25 videos of 2nd year trainee anaesthesiologists managing a simulated difficult airway scenario. The videos were assessed using the customised version of the Anaesthetists’ Non‐Technical Skills System, ANTSdk, and an adapted TS checklist for calculating the correlation between NTS and TS. Written descriptions of the observed NTS were analysed using directed content analysis.ResultsThe correlation between the NTS and the TS ratings was 0.106 (two‐tailed significance of 0.613). Inter‐rater reliability was substantial. Themes character...
Research Interests:
Handover of surgical patients from ward to operating room is a sensible point for information and communication failures. Guidelines were developed for preparation of surgical patients. Our aim was to explore if patients are sufficiently... more
Handover of surgical patients from ward to operating room is a sensible point for information and communication failures. Guidelines were developed for preparation of surgical patients. Our aim was to explore if patients are sufficiently prepared for surgery according to local guidelines and to identify challenges and solutions for correct preparation through interactive table simulation-based workshops involving the various professions and specialties. Firstly, specific tasks in the hospital guidelines were monitored for all surgical procedures during one week. Secondly, workshops including table simulations involving the various professions and specialties were held. In total, 314 surgical procedures were performed of which 196 were eligible for analysis. Emergency procedures showed the poorest results with non-completed tasks comprising 58% of electronic patient management system tasks, 26% of anaesthesia record tasks, 24% of medication tasks, 14% of blood test tasks and 12% of p...
Research Interests:
This paper describes the introduction of the training of non-technical skills on a mandatory course for surgical trainees. The training consisted of an introduction to non-technical skills in a plenum session and was followed by a... more
This paper describes the introduction of the training of non-technical skills on a mandatory course for surgical trainees. The training consisted of an introduction to non-technical skills in a plenum session and was followed by a full-scale simulation with debriefing in which participants reflected on their actions. Evaluations showed that > 90% of the participants found that the subject was relevant for their further training and some requested more simulation training. The course hereby addresses several of the Danish seven roles of a fully trained specialist doctor.
Research Interests:
Studies show that human errors contribute to up to 70% of mistakes and mishaps in health care. Crisis resource management, CRM, is a conceptual framework for analysing and training individual and team skills in order to prevent and manage... more
Studies show that human errors contribute to up to 70% of mistakes and mishaps in health care. Crisis resource management, CRM, is a conceptual framework for analysing and training individual and team skills in order to prevent and manage errors. Different CRM training methods, e.g. simulation, are in use and the literature emphasises the need of training the full team or organisation for maximal effect. CRM training has an effect on skill improvement, but few studies have shown an effect on patient outcome. However, these studies show great variability of quality.
Research Interests:
We describe how simulation and incident reporting can be used in combination to make the interaction between people, (medical) technology and organisation safer for patients and users. We provide the background rationale for our... more
We describe how simulation and incident reporting can be used in combination to make the interaction between people, (medical) technology and organisation safer for patients and users. We provide the background rationale for our conceptual ideas and apply the concepts to the analysis of an actual incident report. Simulation can serve as a laboratory to analyse such cases and to create relevant and effective training scenarios based on such analyses. We will describe a methodological framework for analysing simulation scenarios in a way that allows discovering and discussing mismatches between conceptual models of the device design and mental models users hold about the device and its use. We further describe how incident reporting systems can be used as one source of data to conduct the necessary needs analyses - both for training and further needs for closer analysis of specific devices or some of their special features or modes during usability analyses.
Research Interests:
Research Interests:
Medicine, Pregnancy, Humans, Child, Female, and 4 morePubmed, Aged, Neuromuscular Junction, and atracurium
The purpose of this article was to describe the possibilities gained by using an electronic voting system (EVS), the existing evidence to determine whether an EVS affects learning proceeds, challenges in EVS and perspectives for EVS in... more
The purpose of this article was to describe the possibilities gained by using an electronic voting system (EVS), the existing evidence to determine whether an EVS affects learning proceeds, challenges in EVS and perspectives for EVS in Danish medical training. Audience Response-Systems (ARS) seem suited to enhance participants' activity and attention. The technology as such holds the potential to enhance learning outcome, but changes in the pedagogical method are needed. More studies examining the use of new wireless, mobile voting systems are required.
Research Interests:
Introduction: This study describes (a) process goals, (b) success factors, and (c) barriers for optimizing simulation-based learning environments within the simulation setting model developed by Dieckmann. Methods: Seven simulation... more
Introduction: This study describes (a) process goals, (b) success factors, and (c) barriers for optimizing simulation-based learning environments within the simulation setting model developed by Dieckmann. Methods: Seven simulation educators of different experience levels were interviewed using the Critical Incident Technique. Results: (a) The main process goals were to enhance learning, engage participants, and aid the application of what was learned during the course. (b) As success factors, educators stated their own competencies and attitudes, motivation and openness of participants, and a functional environment. (c) As barriers, educators stated a lack of willingness to actively engage in simulation by the participants and time pressure. The results emphasize the need to consider jointly the interrelated elements of simulation-based learning environments to optimize the use of educational simulation. Discussion: The results support the applicability of Dieckmann’s setting model...
Research Interests:
Aims: Improvement of clinical handover is fundamental to meet the challenges of patient safety. The primary aim of this interview study is to explore healthcare professionals’ attitudes and experiences with critical episodes in patient... more
Aims: Improvement of clinical handover is fundamental to meet the challenges of patient safety. The primary aim of this interview study is to explore healthcare professionals’ attitudes and experiences with critical episodes in patient handover in order to elucidate factors that impact on handover from ambulance to hospitals and within and between hospitals. The secondary aim is to identify possible solutions to optimise handovers, defined as “situations where the professional responsibility for some or all aspects of a patient’s diagnosis, treatment or care is transferred to another person on a temporary or permanent basis”. Methods: We conducted 47 semi-structured single-person interviews in a large university hospital in the Capital Region in Denmark in 2008 and 2009 to obtain a comprehensive picture of clinicians’ perceptions of self-experienced critical episodes in handovers. We included different types of handover processes that take place within several specialties. A total o...
Research Interests:
Nursing, Communication, Organizational Culture, Patient Safety, Qualitative Research, and 11 moreMedicine, Handover, Safety Culture, Denmark, Humans, Public health systems and services research, University Hospitals, Continuity of Patient Care, Health Personnel, interprofessional relations, and Patient transfer
The aim of this study was to estimate the incidence, staff awareness and subsequent mortality of patients with abnormal vital signs on general wards in a Danish university hospital. Prospective data collection in two surgical and three... more
The aim of this study was to estimate the incidence, staff awareness and subsequent mortality of patients with abnormal vital signs on general wards in a Danish university hospital. Prospective data collection in two surgical and three medical wards at Herlev University Hospital, Copenhagen. Study personnel measured vital signs of all patients present on the wards at random points during the evening and interviewed nursing staff about patients with abnormal vital signs. Simplified medical emergency team (MET) calling criteria were used to define abnormal vital signs. None. During the 2-month data collection period, 877 patients were included in the study and 155 (18%) had abnormal vital signs. The 30-day mortality in this group was 13% compared to 5% among patients with normal vital signs (p<0.0001). Of the 155 patients with abnormal signs, nursing staff were not aware of all of the patient's abnormalities in 67 (43%) cases. For 20 patients (13%), staff were aware of some of their abnormalities, while for 52 patients (34%), staff were aware of all their abnormalities. One out of five patients in the general wards developed abnormal vital signs during the 2-month study period and these patients had a 3-fold increased 30-day mortality. For almost half of the patients, nursing staff were unaware of their abnormal vital signs. Strategies to improve identification of patients at risk should be an initial step in preventing serious adverse events on the general wards.
Research Interests:
Forty‐one ASA I patients, aged 2–6 years, anaesthetized for elective ear, nose and throat surgery, were studied in a double blind and randomized fashion in order to examine the effect of tracheally administered atropine 0.02 mg·kg−1 or... more
Forty‐one ASA I patients, aged 2–6 years, anaesthetized for elective ear, nose and throat surgery, were studied in a double blind and randomized fashion in order to examine the effect of tracheally administered atropine 0.02 mg·kg−1 or saline 0.9% on heart rate. In patients receiving atropine heart rate increased 8.8 beats·min−1 (8.7%) and 16.2 beats·min−1 (16.0%) after 3 and 5 min respectively. No increase in heart rate was seen in the saline group. Because of the late onset of action and only moderate increase in heart rate it is concluded that tracheal administration of atropine 0.02 mg·kg−1 to children is insufficient in emergency situations.
Research Interests:
This study evaluated the feasibility of two different scoring forms for assessing the clinical performance of residents in anaesthesiology. One of the forms had a checklist format including task-specific items and the other was a global... more
This study evaluated the feasibility of two different scoring forms for assessing the clinical performance of residents in anaesthesiology. One of the forms had a checklist format including task-specific items and the other was a global rating form with general dimensions of competence including 'clinical skills', 'communication skills' and 'knowledge'. Thirty-two clinicians representing 25 (83%) of the 30 training hospitals in the country participated in the study. The clinicians were randomized into two groups, each of which used one of the scoring formats to assess a resident's performance in four simulated clinical scenarios on videotape. Clinicians' opinions about the appropriateness of the scoring forms were rated on a scale of 1-5. The checklist format was rated significantly higher compared with the global rating form (mean 4.6, 0.5 vs. mean 3.5, 1.4, p < 0.001). The inter-rater agreement regarding pass/fail decisions was poor irrespective of the scoring form used. This was explained by clinicians' leniency as assessors rather than by lack of vigilance in the observations or disagreements on standards for good performance.
Research Interests:
Research Interests:
Education, Anesthesiology, Educational Measurement, Medical Education, Medicine, and 14 moreDenmark, Humans, Female, Male, Graduate medical education, Questionnaires, Postgraduate Education, Clinical Competence, Confidence Interval, Medical, Psychology and Cognitive Sciences, Inservice training, internship and residency, and Medical and Health Sciences
Research Interests:
Public Opinion, Patient Safety, Health Care, Risk Management, Japan, and 15 moreMedicine, Medical errors, Denmark, Humans, Disclosure, Applied Ergonomics, Danish, Medical Physiology, Safety Management, Questionnaires, Adverse Event, Health surveys, Patient Centered Care, Distrust, and attitude to health
Background The short duration of action of mivacurium results from its rapid hydrolysis by plasma cholinesterase. Bambuterol, an oral bronchodilator, has an inhibiting effect on plasma cholinesterase. The purpose of this study was to... more
Background The short duration of action of mivacurium results from its rapid hydrolysis by plasma cholinesterase. Bambuterol, an oral bronchodilator, has an inhibiting effect on plasma cholinesterase. The purpose of this study was to evaluate the effect of bambuterol-induced low plasma cholinesterase activity on the pharmacokinetics and pharmacodynamics of mivacurium. Methods Fourteen patients received 20 mg bambuterol and 14 patients received placebo orally 2 h before induction of anesthesia. During anesthesia the neuromuscular block was monitored at the thumb using train-of-four nerve stimulation every 12 s and mechanomyography. The times to different levels of neuromuscular recovery after 0.2 mg/kg mivacurium were measured. The concentrations in venous blood of the three isomers and the metabolites of mivacurium were measured using high-performance liquid chromatography. Results Plasma cholinesterase activity was inhibited a median of 90% (range, 67-97%) after bambuterol. The tim...
Research Interests:
Research Interests:
Handover has major implications for patient care. The handover process between ambulance and emergency department (ED) staff has been sparsely investigated. The purpose of this paper is, based on a literature review, to identify and... more
Handover has major implications for patient care. The handover process between ambulance and emergency department (ED) staff has been sparsely investigated. The purpose of this paper is, based on a literature review, to identify and elaborate on the major factors influencing the ambulance to ED handover, and to bring suggestions on how to optimize this process. A literature search on handovers to EDs was performed in PubMed, Embase, Web of Science and Cochrane databases. A total of 18 papers were included. Issues regarding transfer of information are highlighted. Newer studies suggest that implementing a structured handover format holds the possibilities for improving the process. Electronic equipment could play a part in reducing problems. Cultural and organizational factors impact the process in different ways. The professions perceive the value and quality of information given differently. Giving and taking over responsibility is an important issue. The handover of patients to the ED has the potential to be improved. Cultural issues and a lack of professional recognition of handover importance need to be approached. Multidisciplinary training in combination with a structured tool may have a potential for changing the culture and improving handover.
Research Interests:
The object of this study was to investigate whether pretreatment with pancuronium before i.v. injection of suxamethonium could cause prolonged neuromuscular blockade in patients heterozygous for the usual and the atypical plasma... more
The object of this study was to investigate whether pretreatment with pancuronium before i.v. injection of suxamethonium could cause prolonged neuromuscular blockade in patients heterozygous for the usual and the atypical plasma cholinesterase gene (E*1E*1). Forty‐three patients, 23 with genotype E*1E*1* and 20 with normal genotype (E*1E*1), were pretreated with pancuronium 0.01 mg‐kg‐1 followed by suxamethonium 1.5 mg‐kg‐1, and received either neurolept anaesthesia or halothane anaesthesia. Seven patients (E*1E*1) were given suxamethonium 1.5 mg‐kg‐1 without pretreatment. The duration and type of neuromuscular block were evaluated using train‐of‐four (TOF) nerve stimulation. Type of anaesthesia did not significantly influence the results. The duration of block following pretreatment was significantly longer in heterozygous patients than in normal patients. Time to 90% twitch height recovery was 10.7 ± 1.2 min (mean ± s.d.) in genotypically normal patients, and 18.0 ± 4.2 min in pat...
Research Interests:
Research Interests:
Research Interests:
Background Continuous medical education is essential in Helicopter Emergency Medical Services (HEMS). In-situ simulation training makes it possible to train in a familiar environment. The use of a dedicated facilitator is essential;... more
Background Continuous medical education is essential in Helicopter Emergency Medical Services (HEMS). In-situ simulation training makes it possible to train in a familiar environment. The use of a dedicated facilitator is essential; however, when an in-situ simulation training session is interrupted by a live mission, the efforts invested in the training are left unfulfilled. This study aims to evaluate if HEMS mission observation and debriefing by the simulation facilitator is a feasible alternative to mission-interrupted simulation training, and how this alternative to simulation training is perceived by both facilitators and HEMS crew members. Methods Facilitator observation during live missions and post-mission debriefing was offered as an alternative to mission-interrupted simulation training over a one-year period at three HEMS bases. Immediate feedback was requested from crews and facilitators after each observed live mission on a predefined questionnaire. At the end of the s...
Research Interests:
IntroductionMedical simulation is used in helicopter emergency services as a tool for training the crew. Using in situ simulation we aimed to evaluate the degree of implementation, factors for successful simulation and the crew’s attitude... more
IntroductionMedical simulation is used in helicopter emergency services as a tool for training the crew. Using in situ simulation we aimed to evaluate the degree of implementation, factors for successful simulation and the crew’s attitude towards this form for training.MethodsA one year prospective study on simulation at all Norwegian helicopter emergency services bases and one search and rescue base. Local facilitators were educated and conducted simulations at their own discretion.ResultsAll bases participated, but the number of simulations attempted at each base varied from 1 to 46. Busier bases had a significantly higher number of aborted simulations. Regardless of base and number of attempted simulations, participating crews scored self-evaluated satisfaction with this form of training highly. The number of local facilitators and their travel distance to work seemed to make no difference to the number of attempted simulations.DiscussionOur study reveals large differences in the...
Research Interests:
Simulation-based training of emergency teams offers a safe learning environment in which training in the management of the critically ill patient can be planned and practiced without harming the patient. We developed a concept for in situ... more
Simulation-based training of emergency teams offers a safe learning environment in which training in the management of the critically ill patient can be planned and practiced without harming the patient. We developed a concept for in situ simulation that can be carried out during on-call time. The aim of this study is to investigate the feasibility of introducing in situ, simulation-based training for the on-call team on a busy helicopter emergency medical service (HEMS) base.We carried out a one-year prospective study on simulation training during active duty at a busy Norwegian HEMS base, which has two helicopter crews on call 24/7. Training was conducted as low fidelity in situ simulation while the teams were on call. The training took place on or near the HEMS base. Eight scenarios were developed with learning objectives related to the mission profile of the base which includes primary missions for both medical and trauma patients of all ages, and interhospital transport of adul...
Research Interests:
... SummaryNadja Ausker, Peter la Cour, Christian Busch, Henning Nabe-Nielsen & Lotte Mørk Pedersen: Existential thoughts and religious life of Danish patientsUgeskr Læger 2008;170:####Introduction:The purpose of this investigation is... more
... SummaryNadja Ausker, Peter la Cour, Christian Busch, Henning Nabe-Nielsen & Lotte Mørk Pedersen: Existential thoughts and religious life of Danish patientsUgeskr Læger 2008;170:####Introduction:The purpose of this investigation is to determine whether Danish ...
Research Interests:
Poor teamwork and communication between healthcare staff are correlated to patient safety incidents. However, the organisational factors responsible for these issues are unexplored. Root cause analyses (RCA) use human factors thinking to... more
Poor teamwork and communication between healthcare staff are correlated to patient safety incidents. However, the organisational factors responsible for these issues are unexplored. Root cause analyses (RCA) use human factors thinking to analyse the systems behind severe patient safety incidents. The objective of this study is to review RCA reports (RCAR) for characteristics of verbal communication errors between hospital staff in an organisational perspective. Two independent raters analysed 84 RCARs, conducted in six Danish hospitals between 2004 and 2006, for descriptions and characteristics of verbal communication errors such as handover errors and error during teamwork. Raters found description of verbal communication errors in 44 reports (52%). These included handover errors (35 (86%)), communication errors between different staff groups (19 (43%)), misunderstandings (13 (30%)), communication errors between junior and senior staff members (11 (25%)), hesitance in speaking up (...
Research Interests:
Communication, Patient Safety, Human Factors, Medicine, British medical history, and 11 moreDenmark, Teamwork, Humans, Information Exchange, Root Cause Analysis, Danish, Interdisciplinary Communication, Quality and safety in health care, Continuity of Patient Care, Cooperative Behavior, and BMJ Quality & Safety
Poor teamwork and communication between healthcare staff are correlated to patient safety incidents. However, the organisational factors responsible for these issues are unexplored. Root cause analyses (RCA) use human factors thinking to... more
Poor teamwork and communication between healthcare staff are correlated to patient safety incidents. However, the organisational factors responsible for these issues are unexplored. Root cause analyses (RCA) use human factors thinking to analyse the systems behind severe patient safety incidents. The objective of this study is to review RCA reports (RCAR) for characteristics of verbal communication errors between hospital staff in an organisational perspective. Two independent raters analysed 84 RCARs, conducted in six Danish hospitals between 2004 and 2006, for descriptions and characteristics of verbal communication errors such as handover errors and error during teamwork. Raters found description of verbal communication errors in 44 reports (52%). These included handover errors (35 (86%)), communication errors between different staff groups (19 (43%)), misunderstandings (13 (30%)), communication errors between junior and senior staff members (11 (25%)), hesitance in speaking up (...
Research Interests:
© 2015 Rikke MHG Jepsen et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use of work provided the original work is properly cited.
PREFACE Ultrasound has become a core diagnostic examination in multiple medical specialties, including obstetrics-gynecology. Before ultrasound became readily available as a routine examination, clinicians had to rely on their physical... more
PREFACE Ultrasound has become a core diagnostic examination in multiple medical specialties, including obstetrics-gynecology. Before ultrasound became readily available as a routine examination, clinicians had to rely on their physical examination findings when diagnosing pelvic masses and pathology during pregnancy. Today, almost every clinician in obstetrics-gynecology is using ultrasound, and unceasing technological advances have continued to provide new applications for its clinical use. Despite these developments, one key aspect of ultrasound has not changed much since its introduction, and that is the highly operator-dependent nature of the ultrasound examination. In ultrasound, the quality of the examination in terms of diagnostic accuracy depends not only on the equipment, but also on the skills of the clinician performing the ultrasound scan. Although this aspect has profound implications for patient safety, the role of training and assessment of ultrasound skills has recei...
Research Interests:
Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical... more
Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define—for the first time—the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally. Methods and findings The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and...
Research Interests:
Research Interests:
Background Our current understanding of medical team competence is traditionally influenced by an individualistic perspective focusing on individual team members’ knowledge, skills as well as on effective communication within the team.... more
Background Our current understanding of medical team competence is traditionally influenced by an individualistic perspective focusing on individual team members’ knowledge, skills as well as on effective communication within the team. However, team dynamics may influence team performance more than previously anticipated. In particular, recent studies in other academic disciplines suggest that social ties between team members may impact team dynamics but this has not been explored for medical teams. We aimed to explore intensive care staff’s perceptions about teamwork and performance in clinical emergencies focusing particularly on the teams’ social ties. Methods Semi-structured interviews were conducted with a purposive sample of intensive care staff. We used a thematic analysis approach to data interpretation. Results Thematic saturation was achieved after three group interviews and eight individual interviews. Findings demonstrated that social ties influenced teamwork by affectin...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Modern patient care requires collaboration among health-care workers belonging to various functional units, departments and hospitals. When the responsibility for patients is handed over, information is easily lost. This literature review... more
Modern patient care requires collaboration among health-care workers belonging to various functional units, departments and hospitals. When the responsibility for patients is handed over, information is easily lost. This literature review identifies problems in patient handover situations and proposes solutions to these. We reviewed 417 papers and the analysis comprises 29 papers. The paper points out numerous problems in connection with the transfer of responsibility, showing the importance of focusing on patient handover as a vulnerable phase in patient care.