Innføring av standardisert mal for resymédelen i epikriser

Bakgrunn/emne: Fastleger opplever tidvis at epikrisen de mottar fra spesialisthelsetjenesten mangler elementer som ville vært nyttig for oppstart, videreføring eller avslutning av behandling av deres pasienter. Vi ønsker å se på mulighetene for innføring av en mal for epikriseresymeet ved en medisinsk avdeling. Vi valgte å ta utgangspunkt i Hjertemedisinsk avdeling ved Sykehuset Innlandet, Hamar. Kunnskapsgrunnlag: Vi har gjennomført selektivt litteratursøk i databasene Pubmed og Cochrane Library, samt i Tidsskrift for Den norske legeforening. Videre har vi innhentet informasjon direkte fra ledelsen ved medisinsk avdeling ved Hamar Sykehus og enkelte fastleger i Hamarområdet. Begrunnet tiltak og metode: Vi benyttet oss av både norske og internasjonale artikler, data fra norske spørreundersøkelser blant fastleger, og vi forhørte oss med de involverte parter i mikrosystemet for å kartlegge problemstillingen og etablere forslag til løsningstiltak. Med bakgrunn i dette utarbeidet vi et forslag til en mal med fire standardpunkter som kan være med i resymeet. Vår plan er at tiltaket skal gjennomføres gjennom endring i epikrisemalen i DIPS og metodebok, samt undervisning til epikriseskriverne. Organisering: Vi foreslår at det opprettes en prosjektgruppe ved avdelingen som har ansvaret for gjennomføringen. Epikriseskrivere informeres og opplæres i den nye praksisen. Fortløpende evalueringer av effekt og potensielle problemer registreres og behandles. Lokale fastleger tilknyttes som respondenter. Resultater/vurdering: Målet med tiltaket er å forbedre kommunikasjonsflyt i helsevesenet og slik bedre fastlegenes tilfredshet. Resultatene av tiltaket kan måles ved spørreundersøkelse blant fastlegene i den aktuelle sykehuskretsen, og stikkontroll av epikrisene. Vi har ikke oppnådd sikkert grunnlag for å foreslå tiltaket innført, skjønt vi vurderer muligheten for implementering som reell. Vi anbefaler derfor ikke at tiltaket innføres i sin beskrevne form

Use of Swedish smokeless tobacco during pregnancy: a systematic review of pregnancy and early life health risk

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.Background and Aims: Smokeless tobacco is a heterogeneous product group with diverse composition and prevalence globally. Tobacco use during pregnancy is concerning due to the risk of adverse pregnancy outcomes and effects on child health. Nicotine may mediate several of these effects. This systematic review measured health outcomes from Swedish smokeless tobacco (snus) use during pregnancy. Method: Literature search was conducted by an information specialist in May 2022. We included human studies of snus use during pregnancy compared with no tobacco use, assessed risk of bias, conducted a meta-analysis and assessed confidence in effectestimates using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Results: We included 18 cohort studies (42 to 1 006 398 participants). Snus use during pregnancy probably (moderate confidence in risk estimates) increase the risk of neonatal apnea, adjusted odds ratio 95% confidence interval [aOR (95% CI)] 1.96 (1.30 to 2.96). Snus use during pregnancy possibly (low confidence in risk estimates) increase the risk of stillbirths aOR 1.43 (1.02 to 1.99), extremely premature births aOR 1.69 (1.17 to 2.45), moderately premature birth aOR 1.26 (1.15 to 1.38), SGA aOR 1.26 (1.09 to 1.46), reduced birth weight mean difference of 72.47 g (110.58 g to 34.35 g reduction) and oral cleft malformations aOR 1.48 (1.00 to 2.21). It is uncertain (low confidence in risk estimates, CI crossing 1) whether snus use during pregnancy affects risk of preeclampsia aOR 1.11 (0.97 to 1.28), antenatal bleeding aOR 1.15 (0.92 to 1.44) and very premature birth aOR 1.26 (0.95 to 1.66). Risk of early neonatal mortality and altered heart rate variability is uncertain, very low confidence. Snus using mothers had increased prevalence of caesarean sections, low confidence. Conclusions: This systematic review reveals that use of smokeless tobacco (snus) during pregnancy may adversely impact the developing child.publishedVersio

Fetal thoracic circumference and lung volume and their rlation to fetal size and pulmonary artery blood flow

Objective: Research on early origins of lung disease suggests the need for studying the relationships of thoracic and lung size with fetal size and pulmonary circulation. The primary aim of this study is therefore to explore the associations between fetal thoracic circumference, lung volume, and fetal size. We also aim to assess if lung volume and thoracic circumference are associated with fetal pulmonary artery blood flow velocity measures. Methods: Cross-sectional assessment of singleton pregnancies from the general population (n = 447) at 30 gestational weeks (GW) was performed using ultrasound measurement of fetal thoracic circumference, lung volume, head and abdominal circumference, and femur length. We obtained Doppler blood flow velocity measures from the proximal branches of the fetal pulmonary artery. Associations between variables were studied using Pearson's correlation and multiple linear regression analyses. Results: Both thoracic circumference and lung volume correlated with fetal size measures, ranging from r = 0.64 between thoracic circumference and abdominal circumference, to r = 0.28 between lung volume and femur length. Adjustment for gestational age, maternal nicotine use, pre-pregnancy body mass index, and fetal sex marginally influenced the associations with abdominal circumference. The correlations of thoracic circumference and lung volume with pulmonary artery blood flow velocity measures were weak (r ≤ 0.17). Conclusion: We found moderate to low correlation between thoracic circumference, lung volume, and fetal size at 30 GW. The closest relationship was with the abdominal circumference. We found low correlations of thoracic circumference and lung volume with pulmonary artery blood flow velocity measures.publishedVersio

The effect of nicotine-containing products and fetal sex on placenta-associated circulating midpregnancy biomarkers

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The use of nicotine products and effects of snus in pregnancy

Snus is the most commonly used nicotine product among young women in Scandinavia, but the extent of use during pregnancy is less investigated. Normal fetal growth is dependent on a healthy placenta. The possible effects of snus on biomarkers that might be useful in identifying placenta dysfunction have not previously been studied. Also there is conflicting evidence regarding the effects of snus on birth weight. Environmental factors might affect males and females differentially, but it is unknown if this also applies for snus. The aims of this thesis were to determine the maternal prevalence of snus and nicotine use, identify risk factors for snus use in pregnancy, determine if maternal snus use affect placenta biomarkers and infant birth size, and explore if the effects of snus differ by fetal sex focusing on placenta biomarkers. The results are based on a study including 2697 pregnant women and their 2397 infants. Overall 11.3% reported use of any type nicotine product during pregnancy, with snus alone being the most commonly used product reported by 6.5%, followed by 4.1% cigarette smoke, 0.6% dual smoke and snus use, and 0.2% use of nicotine replacement therapies/electronic cigarettes. However, 87.2% of women using snus reported quitting within pregnancy week 6. Risk factors for cigarette smoking were younger age, urban living, being cohabitant and native born in Norway or Sweden and a personal or in-utero history of smoking. The early snus exposure was associated with a lower level of the placenta biomarker called placental growth factor. Further testing showed that this applied only for women carrying a male fetus supporting the assumption that male fetuses are more susceptible to environmental factors in-utero. Snus exposure during early pregnancy did not affect infant birth size. Snus is the most commonly used nicotine product in pregnancy, but with most women quitting in the first trimester, potential effects of continued use are unknown

Skilled attendance at delivery; how skilled are institutional birth attendants? : An explorative study on birth attendants at Bansang Hospital, The Gambia

Abstract Background: As reflected in the United Nations Millennium Development Goals (UN MDG 5), reducing maternal mortality represents an important area of concern. The common causes of maternal deaths may be preventable and treatable by having access to emergency obstetric care (EmOC), including skilled birth attendance (SBA), when needed. Measuring the presence of a birth attendant has been the main focus until now, not their skills and qualifications, and by this we cannot presuppose that they are skilled in delivery care. We explored the subjective level of confidence in skills and abilities defined by the WHO, among the birth attendants at Bansang Hospital, The Gambia, and how work conditions affected their practice. Methods: This study is exploratory in nature. We used a structured interview to investigate specific skills, and added a qualitative component. Results: Our results show that there is a difference between the self reported skills and abilities among the untrained and trained birth attendants. Formal education makes you feel more confident in performing the procedures expected from a SBA. The majority felt the need for additional training, especially in EmOC procedures. Our study also reveals several problems concerning management, material and human resources. Conclusion: There is a need for further examinations to objectively measure the skills and abilities of the birth attendants in The Gambia. Knowledge is needed on how to increase the quality and capacity of pre- and in-service training among birth attendants in order to reach future goals of every woman having access to skilled birth attendance

An update on prevalence and risk of snus and nicotine replacement therapy during pregnancy and breastfeeding

Aim In parallel with falling smoking rates, use of the oral moist tobacco product snus increases among women in reproductive age. We report an update on prevalence and effects of maternal use of snus and nicotine replacement therapy (NRT) during pregnancy and breastfeeding. Methods A literature search of human studies in Medline, PubMed and EMBASE was conducted from September 2016 to May 2018, with stepwise screening of abstracts and subsequent relevant full‐text papers for inclusion in Scandinavian and English languages. Results Based on three studies, the prevalence of snus use in pregnancy was up to 3.4% in the first trimester and 2.1% in the third trimester. In 12 studies, we found increased risk of several adverse effects, especially preterm delivery, stillbirth and small for gestational age associated with maternal snus use during pregnancy. Knowledge on effects of NRT during pregnancy was conflicting and inconclusive in 10 studies. We did not identify any studies on prevalence or potential health effects of snus or NRT during breastfeeding. Conclusion Few studies with updated data on the prevalence and adverse health effects of maternal use of snus and NRT during pregnancy were found. No studies during breastfeeding were identified

Snus in pregnancy and infant birth size: a mother–child birth cohort study

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