Danish University Hospital Research Articles

Patient-reported outcome was close to the Danish background population 6 months after non-surgical treatment of Neer 2-part surgical neck fractures: a prospective cohort study in patients aged 60 or above.

Neer 2-part surgical neck fractures are the most common displaced proximal humerus fractures. We aimed to evaluate patient-reported outcome in a consecutive series of older people receiving nonoperative treatment. This is a single-center prospective cohort study. We included patients aged 60 or above referred to a Danish university hospital. The preregistered protocol followed the recommendations from randomized trials. Patients were followed at the outpatient clinic at 2, 6, and 24 weeks. After 24 weeks, they were evaluated with Oxford Shoulder Score (OSS, 0-48, 48 best) and EuroQoL 5 dimensions, 3 levels (EQ-5D-3L, -0.624 to 1, 1 best). Clinical failure was defined as conversion to surgery or OSS ≤ 24. Population norms were reported to interpret the cohort data, but no formal statistical comparisons between historical cohorts were planned. We used descriptive statistics to report rates and proportions. For 36 months, 268 patients (mean age 76, 79% female) with Neer 2-part surgical neck fractures received non-surgical treatment. After excluding patients with concomitant fractures, dementia, or death, complete follow-up was available for 167 patients. 8 patients (3.0%) had surgery. The mean OSS was 37.2 (SD 8.1), which equals 78% of maximum shoulder function. The norm for the population of the same age and gender was 82%. The mean EQ-5D-3L score was 0.79 (SD 0.16), while the norm for the same-age population was 0.82. 16 (10%) had an OSS score of 24 or below. Non-surgical treatment in older people with Neer 2-part surgical neck fractures resulted after 6 months in patient-reported shoulder function and quality of life close to that of the Danish background population.

Patient-reported harm following cancellation of planned surgery at a Danish university hospital: a cross-sectional study.

To estimate the prevalence and severity of patient-reported physical and non-physical harm following surgery cancellation. Cross-sectional study. A large Danish university hospital. Patients (≥18 years) from various surgical specialities, such as orthopaedic, spinal, abdominal, gynaecological, thoracic, vascular and urological surgery whose surgery was cancelled <2 weeks prior to the scheduled date due to hospital-related causes.OutcomePatient-reported physical and non-physical harm, defined as physical worsening, emotional strain and other consequences, measured using a patient-reported survey. We identified 785 patients whose surgery was cancelled from 1 December 2021 to 1 June 2022, of whom 436 (55.5%) responded to the electronic survey. Physical worsening was reported by 42% and emotional strain by 48% of patients. One-third of patients reported an inability to continue daily activities, and 28% reported a need for an increased dose of analgesics. Emotional strain included various negative feelings such as being disappointed (59%) and lonely (31%). Furthermore, 44% of the respondents feared deterioration of their disease and 9% experienced anxiety of dying. The relative risk of emotional strain was higher in females than in males (54% vs 41%, adjusted relative risk (RR)=1.32 (1.08; 1.63)). A waiting period >30 days compared with ≤30 days was associated with a higher risk of physical worsening (25.3% vs 48.9%, adjusted RR=1.93 (1.42; 2.63)). Harm, measured as physical worsening and emotional strain, is reported with severity by nearly half of respondents following cancellation.

Prospective and External Validation of Machine Learning Models for Short- and Long-Term Mortality in Acutely Admitted Patients Using Blood Tests.

Background: Predicting mortality in emergency departments (EDs) using machine learning models presents challenges, particularly in balancing simplicity with performance. This study aims to develop models that are both simple and effective for predicting short- and long-term mortality in ED patients. Our approach uses a minimal set of variables derived from one single blood sample obtained at admission. Methods: Data from three cohorts at two large Danish university hospitals were analyzed, including one retrospective and two prospective cohorts where prognostic models were applied to predict individual mortality risk, spanning the years 2013-2022. Routine biochemistry analyzed in blood samples collected at admission was the primary data source for the prediction models. The outcomes were mortality at 10, 30, 90, and 365 days after admission to the ED. The models were developed using Light Gradient Boosting Machines. The evaluation of mortality predictions involved metrics such as Area Under the Receiver Operating Characteristic Curve (AUC), sensitivity, specificity, negative predictive values, positive predictive values, and Matthews correlation coefficient (MCC). Results: A total of 43,648 unique patients with 65,484 admissions were analyzed. The models showed high accuracy, with very good to excellent AUC values between 0.87 and 0.93 across different time intervals. Conclusions: This study demonstrates that a single assessment of routine clinical biochemistry upon admission can serve as a powerful predictor for both short-term and long-term mortality in ED admissions.

Validity of heart failure diagnoses, treatments, and readmissions in the Danish National Patient Registry

BackgroundThe Danish National Patient Registry (DNPR) is a valuable resource for population-based research, but the validity of routine registration of advanced heart failure (HF) treatments within the registry is unknown. We, therefore, investigated the validity of HF, advanced HF treatments, and HF readmissions in the DNPR. MethodsWe randomly sampled patients registered at a Danish University Hospital during 2017-2021 from the DNPR. We identified 200 patients with first-time HF, 390 patients with one of eight advanced HF treatments, and 133 patients with HF admission after implantable cardioverter-defibrillator (ICD) or cardiac resynchronisation therapy (CRT). Compared with medical record reviews, we calculated positive predictive values (PPVs) with 95 confidence intervals (CIs). ResultsThe PPV for first-time HF was 81 (95 CI: 74-86). For advanced HF treatments, the PPV was 97 (95 CI: 91-99) for ICD, 96 (95 CI: 86-100) for CRT-pacemaker, 88 (95 CI: 76-95) for CRT-defibrillator, 100 (95 CI: 83-100) for left ventricular assist device, 43 (95 CI: 18-71) for intra-aortic balloon pump, 38 (95 CI: 25-35) for impella, 100 (95 CI: 93-100) for cardiopulmonary support, and 100 (95 CI: 94-100) for heart transplantation. The PPV for HF admission after ICD was 25 (95 CI: 16-37) and 18 (95 CI: 9.2-30) after CRT. ConclusionsThe PPV of routine registrations in the DNPR was moderate for first-time HF, high for most advanced HF treatments, and low for HF admissions after ICD or CRT. Thus, the DNPR is a valuable data source for population-based research on first-time HF and many advanced HF treatments.

8331 Melatonin is associated with higher placental weight and higher birth weight

Abstract Disclosure: U. Kampmann: Grant Recipient; Self; Novo Nordisk, Ulla Kampmann. Speaker; Self; Merck, Novo Nordisk. E.S. Lauritzen: None. S. Knorr: None. M. Bjerre: None. L.J. Goodyear: None. R. Middelbeek: None. J. Kusuyama: None. J. Fuglsang: None. P. Ovesen: Grant Recipient; Self; Novo Nordisk. M. Møller: None. Background and aim: Melatonin is both a neuroendocrine hormone which regulates circadian rhythm and an antioxidant. Melatonin is primarily produced in the pineal gland but also in the placenta and the role of melatonin in pregnancy is emerging. We examined melatonin levels during pregnancy and performed correlations with placental weight, birth weight and birth weight Z-score as markers of placental function. Material and methods: Blood samples were obtained in each trimester of pregnancy from a cohort of 400 pregnant women, followed at a Danish University Hospital. Data on pre-gestational BMI, smoking status, placental weight, birth weight and Z-score were collected. Melatonin, and biomarkers of oxidative stress: SOD3, CD 163 and CRP were measured on blood samples collected in the morning. Correlations were calculated using mixed models. Results: We included 372 healthy, singleton pregnancies. Melatonin levels increased significantly throughout pregnancy from 17.0 pg/mL (95% CI: 14.1 - 19.9) and 18.8 pg/mL (95% CI: 15.8 - 21.8) in the 1st and 2nd trimester, respectively, to 45.9 pg/mL (95% CI: 40.8 - 51.0) in the 3rd trimester. There was a significant positive correlation between the antioxidant enzyme SOD3 and melatonin throughout pregnancy with a coefficient of 0.15 (95% CI: 0.13 - 0.17) and there was a significant positive association between placental weight and melatonin (coefficient: 0.014 (95% CI: 0.000 - 0.028)) and Z-score and melatonin levels (coefficient: 1.95 (95% CI: 0.13 - 3.79)). This was however not significant when adjusting for smoking and pre-pregnancy BMI. Conclusion: The current study is to date, the largest study that have performed longitudinal measures of melatonin throughout pregnancy. Melatonin levels increase significantly during pregnancy and indicate that placenta is a major source of melatonin, that plays a protective role against oxidative stress in pregnancy. Presentation: 6/1/2024

8331 Melatonin is associated with higher placental weight and higher birth weight

Abstract Disclosure: U. Kampmann: Grant Recipient; Self; Novo Nordisk, Ulla Kampmann. Speaker; Self; Merck, Novo Nordisk. E.S. Lauritzen: None. S. Knorr: None. M. Bjerre: None. L.J. Goodyear: None. R. Middelbeek: None. J. Kusuyama: None. J. Fuglsang: None. P. Ovesen: Grant Recipient; Self; Novo Nordisk. M. Møller: None. Background and aim: Melatonin is both a neuroendocrine hormone which regulates circadian rhythm and an antioxidant. Melatonin is primarily produced in the pineal gland but also in the placenta and the role of melatonin in pregnancy is emerging. We examined melatonin levels during pregnancy and performed correlations with placental weight, birth weight and birth weight Z-score as markers of placental function. Material and methods: Blood samples were obtained in each trimester of pregnancy from a cohort of 400 pregnant women, followed at a Danish University Hospital. Data on pre-gestational BMI, smoking status, placental weight, birth weight and Z-score were collected. Melatonin, and biomarkers of oxidative stress: SOD3, CD 163 and CRP were measured on blood samples collected in the morning. Correlations were calculated using mixed models. Results: We included 372 healthy, singleton pregnancies. Melatonin levels increased significantly throughout pregnancy from 17.0 pg/mL (95% CI: 14.1 - 19.9) and 18.8 pg/mL (95% CI: 15.8 - 21.8) in the 1st and 2nd trimester, respectively, to 45.9 pg/mL (95% CI: 40.8 - 51.0) in the 3rd trimester. There was a significant positive correlation between the antioxidant enzyme SOD3 and melatonin throughout pregnancy with a coefficient of 0.15 (95% CI: 0.13 - 0.17) and there was a significant positive association between placental weight and melatonin (coefficient: 0.014 (95% CI: 0.000 - 0.028)) and Z-score and melatonin levels (coefficient: 1.95 (95% CI: 0.13 - 3.79)). This was however not significant when adjusting for smoking and pre-pregnancy BMI. Conclusion: The current study is to date, the largest study that have performed longitudinal measures of melatonin throughout pregnancy. Melatonin levels increase significantly during pregnancy and indicate that placenta is a major source of melatonin, that plays a protective role against oxidative stress in pregnancy. Presentation: 6/1/2024

Frequency of patients discharged with tube feeding in a Danish university hospital

Frequency of patients discharged with tube feeding in a Danish university hospital

Increased knee-extension strength and steps per day after a novel post-hospitalization rehabilitative program in older adults (65+): Secondary analyses of a randomized controlled single-blinded trial using an expanded sample size

IntroductionOlder adults are at risk of developing new or worsened disability when hospitalized for acute medical illness. This study is a secondary analysis of the STAND-Cph trial on the effect of a simple strength training intervention initiated during hospitalization and continued after discharge. We investigated the between-group difference in change in functional performance outcomes, the characteristics of patients who experienced a relevant effect of the intervention, and the characteristics of those who were compliant with the intervention, using an expanded sample size as protocolized. MethodsThe STAND-Cph was a randomized controlled trial conducted at a major Danish university hospital. Acutely admitted older adult patients (65+) from the Emergency Department were randomized to the intervention group receiving progressive strength training and a protein supplement during and after hospitalization (12 sessions over 4 weeks) or control group receiving usual care. The primary outcome was the de Morton Mobility Index assessed at baseline and 4 weeks after discharge. The secondary outcomes were 24-h mobility (assessed by ActivPAL accelerometers), isometric knee-extension strength, 30 s. sit-to-stand performance, and habitual gait speed. ResultsBetween September 2013 and September 2018, a total of 158 patients were included and randomized to either the intervention group (N = 80; mean age 79.9 ± 7.6 years) or the control group (N = 78; mean age 80.8 ± 7.4 years). We found no significant between-group difference in change in our primary outcome (p > 0.05). Both the intention-to-treat (difference in change 0.14 Nm/kg (95 % CI 0.03;0.24), p = 0.01) and the per protocol (difference in change 0.16 Nm/kg (95 % CI 0.04;0.29), p = 0.008) analyses showed that between baseline and 4 weeks, knee-extension strength increased significantly more in the intervention group than in the control group. Also, the per protocol analysis showed that the intervention group increased their daily number of steps significantly more than the control group (difference in change 1088 steps (95 % CI 44; 2132); p = 0.04). When examining subgroups of patients, we found no significant differences neither between those who experienced a clinically relevant improvement in the de Morton Mobility Index and those who did not, nor between those who were compliant and those who were not. ConclusionThis exploratory analysis indicates that while simple progressive strength training and protein supplementation does not improve functional performance assessed by the de Morton Mobility Index, it can benefit specific facets of physical activity and muscle strength among geriatric patients.

Impact of decentralized management on sickness absence in hospitals: a two-wave cohort study of frontline managers in Danish hospital wards

BackgroundThis study explores the impact of decentralized management on the sickness absence among healthcare professionals. Sickness absence is a reliable indicator of employees’ wellbeing and it is linked to management quality. However, the influence of decentralized management on sickness absence has not been adequately studied.MethodsThe research design combined a two-wave, web-survey of frontline managers in two Danish university hospitals with administrative data on sickness absence at the ward-level. The first and second wave included data from 163165 and 137 frontline managers linked to 121 wards and 108 wards. Data was analysed using an ordinal logistic regression model.ResultsWards where frontline managers had the highest level of decentralised decision authority compared to none showed lower odds of ward-level sickness absence (ORcrude: 0.20, 95% CI: 0.05–0.87). A very high extent of cross-functional decision authority showed lower odds of sickness absence (ORcrude: 0.08, 95% CI: 0.01–0.49). Overall, the results showed a clear data trend, although not all results were statistically significant.ConclusionHigher levels of decentralized management in wards were positively associated with lower risks of sickness absence in hospital wards. The study supports future research on how to empower decision autonomy at the frontline level of management.

P-351 Reproductive outcomes in a cohort of lymphoma patients

Abstract Study question What are the reproductive outcomes in women with malignant lymphoma Hodgkins (HD) and non-Hodgkins (NH) from a single, experienced center? Summary answer 74 children were born to 43 women (28 with HD, 15 with NH) giving a live birth rate (LBR) of 81% and 72%, respectively. What is known already The risk of premature ovarian insufficiency (POI) after HD and NH is related to female age, type and dose of gonadotoxic treatment. Where ABVD regimens in HD patients and CHOEP regimens in most young NH patients, rarely results in POI and reduced fertility, treatment with BEACOPP or BEAM and stem cell transplantation seems to be associated with a much higher risk of ovarian failure. However, studies are heterogeneous and there is still a need for studies with structural follow up on repeated measurements of ovarian function markers in relation to clinical outcomes. Study design, size, duration This cohort study was conducted as a single center study at the fertility clinic in a large public Danish university hospital. Data was collected retrospectively from medical records from 1999 to 2020 and prospectively from 2020 to 2023. We included all female patients with HD (n = 63) and NH (n = 32), who were referred to our clinic for fertility preservation between 1999 and 2022. End of follow up was December 31st, 2023. Participants/materials, setting, methods Age at referral ranged from 14 to 33 years. Information about diagnoses, gonadotoxic treatment, gynecologic (including endocrine parameters) and obstetric history was retrieved from medical records. Permission to obtain retrospective data from 1999 to 2020 was given by the Danish Patient Safety Authorities (jrn 3-3013-2790/1) and prospective data collection was given by informed consent from the patients from 2020 and onwards. Main results and the role of chance 33% of patients with HD had ABVD only, and the remaining BEACOPP or other high-dose alkylating regimens. 72% of patients with NH had CHOEP, and the rest other high-dose alkylating regimens. 78/95 women had fertility preservation. Of these, 95% had ovarian tissue cryopreservation (OTC), 5% had IVF with vitrification of oocytes or embryos. Following chemotherapy 33 women (52%) with HD and 18 (56%) with NH became pregnant. Of these, 28 women with HD had 51 deliveries, and 15 with NH had 23 deliveries. The LBR was 0,81 for HD and 0,72 for NH. For HD patients, 54% of the deliveries were achieved by women who had ABVD compared to about 40% after other high-dose alkylating regimens. For NH patients, 73% of deliveries were achieved by women who had CHOEP compared to 13% after other high-dose alkylating regimens. Most pregnancies were conceived spontaneously. A total of 15/74 women had ovarian tissue transplantation (OTT). Of these, 7 women with HD became pregnant resulting in 4 deliveries, and 4 women with NH became pregnant resulting in 2 deliveries giving an overall pregnancy rate of 73% in this group of women and a LBR of 40%. Limitations, reasons for caution This study is based on information from medical records in public Danish hospitals, containing information on all deliveries. Pregnancies and deliveries outside of Denmark might therefore not be included. Furthermore, for some women the follow-up period was only one year, which could underestimate the fertility in this group of patients. Wider implications of the findings This study shows a reassuringly high rate of spontaneous pregnancies in female survivors of malignant lymphomas. Only 20% of the women have so far used their tissue stored before chemotherapy. Current results might question whether we overtreat our lymphoma patients by offering OTC to the majority Trial registration number not applicable

3-Dimensional versus standard 2-D laparoscopy for benign hysterectomy: A randomized clinical trial

ObjectiveOur aim was to evaluate possible short and long-term benefits of 3-dimensional (3-D) compared to 2-dimensional (2-D) laparoscopy for benign hysterectomy.Primary outcomes were long-term quality of life and postoperative pain. Secondary outcomes were operative time, surgical complications, time to return to work and length of hospitalization. Study designA randomized controlled trial conducted at two Danish university hospitals. In each arm, 190 patients were needed for an alpha of 3.3 % and a power of 90 %. For various reasons, however, the study was prematurely terminated after including 97 patients. Patients were randomized to either 2-D (n = 48) or 3-D (n = 49) laparoscopy. A laparoscopic hysterectomy was performed. Quality of life was assessed by the Short Form Health Survey 36 (SF-36) questionnaire at the time of inclusion and 6 weeks postoperatively. Postoperative pain was assessed using a Numeric Rating Scale (NRS) and by monitoring the amount of analgesic consumption. ResultsOut of the 97 randomized patients, 77 patients completed both SF-36 questionnaires. No significant differences in mental (p = 0.5) and physical status (p = 0.9) were found. The 2-D group had significantly higher pain-score registered in the post anesthesia care unit (PACU) (p = 0.004) and higher consumption of oral morphine equivalent dose (MEqD) (p = 0.003) than the 3-D group. This regardless a higher rate of minilaparotomies in the 2D (n = 7) than in the 3D (n = 1) group (p < 0.03). The 2-D group had also higher rate of Clavien-Dindo 2 (CD2) (n = 2) and Clavien-Dindo 3 (CD3) complications (n = 3) (p = 0.03) than 3-D (n = 0). The other secondary outcome parameters did not vary between groups. ConclusionsThe results are severely hampered by the premature termination of the study, as less than 25 percent of the patients were recruited. Thus, no firm conclusions can be drawn regarding the quality of life and many of the secondary outcomes, as the lack of difference may be attributed to a type 2 error. However, the significant differences in postoperative pain and in complication rates suggest a greater advantage of 3-D laparoscopy than originally expected. Despite the methodological problems, the current data deserve attention in a sparsely investigated field, emphasizing the urgent need for further studies.

Managing Shifting Visitor Restrictions in Hospitals during the COVID-19 Pandemic from National Authority Level to Charge Nurses’ Practice: A Descriptive Study

Introduction. Little is known about how shifting hospital visitor restrictions issued by national health authorities were communicated, managed, and adapted by hospital charge nurses during the COVID-19 pandemic. Aims. To describe the shifting visitor restrictions and the passing on of restrictions from the national authority level to charge nurses and secondly describe charge nurses’ management of the restrictions and their challenges when enforcing them. Methods. The study consisted of a document analysis and a cross-sectional survey including open-ended questions. Descriptive statistics and qualitative content analysis were used. The survey was distributed online to 88 charge nurses in somatic units in a Danish university hospital from March 2020 to April 2021. Results. Restrictions were communicated from national authority level in an effective administrative cascade. The charge nurses led their enforcement in each unit. In total, 71 charge nurses (81%) responded to the survey. For 70%, the wording of the restrictions was clear, while 31% found them challenging to handle. On a weekly or daily basis, 68% of the charge nurses deviated from the restrictions. They identified both upsides and downsides to the absence of relatives. Communication, collaboration, and leadership were experienced as key tools in the ongoing processes of adapting to shifting restrictions. Conclusion. During this severe health crisis, essential information was passed on through well-defined management levels in an effective communication pathway. Charge nurses and their professional values were challenged when balancing shifting national restrictions against individual needs of patients and relatives. Implications for Nursing Management. Charge nurses serve as vital intermediaries between national authorities and frontline nursing practice in managing shifting visitor restrictions during a pandemic. Their experiences can contribute to further qualifying nurse managers’ considerations when designing family-centred hospital visitor policies for the future. Also, they may strengthen the handling of future sudden major organizational changes.

Prevalence of missed nursing care and its association with work experience: A cross-sectional survey

BackgroundNurses faced with multiple demands in hospitals are often compelled to prioritize nursing care. Knowledge of missed nursing care provides insight into whether necessary nursing care is delivered, what is missed, and the reasons for missed nursing care. This insight is essential to support evidence-based policy and practice to improve patient care, enhance nursing practice, and optimize the work environment. Research on factors influencing missed nursing care is imperative to implement targeted strategies. However, studies investigating work experience as a predictor are inconclusive, and no identified studies have examined how nurses’ work experience is associated with different elements of missed nursing care. ObjectivesTo investigate the prevalence and reasons for missed nursing care and whether nurses' work experience was associated with missed nursing care. DesignThe design was cross‐sectional, using the Danish version of the MISSCARE survey. SettingThe study was conducted at a public Danish university hospital with 1,150 beds and approximately 10,350 employees. ParticipantsAcross 34 surgical, medical, and mixed bed wards for adults, 1,241 nurses were invited by email to respond anonymously to the Danish MISSCARE survey. Of these nurses, 50.3% responded, and 42.6% fully completed the questionnaire. MethodsA total score mean and a mean score were calculated and then compared between experience (≤5 years/>5 years) in a linear regression model adjusting for unequally distributed variables. ResultsMore than two thirds of the nurses reported that emotional support, patient bathing, ambulation, mouth care, interdisciplinary conferences, documentation, and assessing effectiveness of medication were frequently missed elements of nursing care. The most significant reasons for missed nursing care were an inadequate number of nurses, an unexpected rise in patient volume, urgent patient situations, heavy admission, and discharge activity. Nurses with work experience of less than 5 years reported more missed nursing care, especially within fundamental care. ConclusionsNursing elements to avoid potentially critical situations and nursing related to treatment observations were rarely missed, while nursing care elements visible only to the patient and the nurse were most often missed. By increasing transparency and explicitness within nursing care, the results enable critical evaluation of prioritization of nursing care elements. The number of staff not balancing the number and acuity of patients was the main reason for missed nursing care. The perception of missed nursing care was most pronounced in less experienced nurses. The study contributes to the global research community to achieve a broader understanding of missed nursing care. Tweetable abstractNursing to avoid potentially critical situations and treatment observations are prioritized over fundamental care, perceived mainly by less experienced nurses.

Implementation of nutritional care in hospitals: A qualitative study of barriers and facilitators using implementation theory.

Disease-related malnutrition is prevalent among hospitalised patients, but not all patients achieve the needed nutritional care. At a Danish University Hospital, focus has been on implementing nutritional practices based on clinical guidelines, but there is continuously variation between the wards regarding the quality of nutritional care. The aim of this study was to identify the potential barriers and facilitators for implementation of the clinical guidelines for nutritional practices and to recommend suggestions for development of nutritional practices, using a theoretical implementation strategy. The design was a qualitative interview study of employees at a Danish University Hospital, using a semi-structured interview guide. The participants were nurses, nurse's assistant, nurse nutrition expert, head nurse and dieticians. We recruited 11 employees, representing eight different wards. The analysis identified six themes: (1) clear allocation of responsibilities and committed management enhances nutrition practices, (2) leadership support is essential, (3) physical settings and tools affect possibilities for action, (4) selection of equivalent staff is core, (5) teaching promotes the knowledge and skills and (6) a dietitian in the ward facilitates implementation of nutritional care. Barriers and facilitators among the themes were identified and has led to suggestions to strengthen nutritional care, based on implementation theory. Various factors were identified as having impact on the implementation of nutrition practices and different suggestions have emerged to accommodate those factors, as well as to apply an implementation strategy to facilitate change in practice.

Wider institutional research cultures and their influence on patient and public involvement and engagement in health research – An institutional ethnography

Focus on patient and public involvement and engagement (PPIE) is increasing in health policy and research governance. PPIE is considered by some to be a democratic right, and by others to be a way to improve health care and research outcomes and implementation. Most recently, policy makers, funders and (clinical) research institutions are making PPIE a strategic requirement for health research urging researchers to invite patients and relatives into their research activities.Our study is based in a Danish university hospital where PPIE has been introduced as one of five strategic research goals. We investigated how researchers experienced this new practice and how their research practices connect to the wider context of the Danish health care system. Ten cases were studied during a year using observations, interviews, and document analysis. As our method of inquiry, we used institutional ethnography to look at researchers’ work from their perspective and to understand how PPIE practices are part of a larger institutional research culture reaching far beyond the individual. We found that current research culture has implications for the selection of patients and relatives and for what they are asked to do. Researchers who experienced that PPIE outcomes aided their existing research practices felt motivated. Researchers who engaged patients and relatives before it was a strategy, were ideologically driven and their approaches resulted in an increased diversity of inclusion and researcher assimilation.These findings add to the current knowledge on PPIE practices and help us understand that further development towards collaborative research practices require a change in key performance indicators and training and perhaps call for attention to our shared acceptance of knowledge generation in research.

Vancomycin-resistant Enterococcus faecium: impact of ending screening and isolation in a Danish University hospital

Substantial resources are used in hospitals worldwide to counteract the ever-increasing incidence of vancomycin-resistant and vancomycin-variable Enterococcus faecium (VREfm and VVEfm), but it is important to balance patient safety, infection prevention, and hospital costs. To investigate the impact of ending VREfm/VVEfm screening and isolation at Odense University Hospital (OUH), Denmark, on patient and clinical characteristics, risk of bacteraemia, and mortality of VREfm/VVEfm disease at OUH. The burden of VREfm/VVEfm bacteraemia at OUH and the three collaborative hospitals in the Region of Southern Denmark (RSD) was also investigated. A retrospective cohort study was conducted including first-time VREfm/VVEfm clinical isolates (index isolates) detected at OUH and collaborative hospitals in the period 2015-2022. The intervention period with screening and isolation was from 2015 to 2021, and the post-intervention period was 2022. Information about clinical isolates was retrieved from microbiological databases. Patient data were obtained from hospital records. At OUH, 436 patients were included in the study, with 285 in the intervention period and 151 in the post-intervention period. Ending screening and isolation was followed by an increased number of index isolates. Besides a change in van genes, only minor non-significant changes were detected in all the other investigated parameters. Mortality within 30 days did not reflect the VREfm/VVEfm-attributable deaths, and in only four cases was VREfm/VVEfm infection the likely cause of death. Despite an increasing number of index isolates, nothing in the short follow-up period supported a reintroduction of screening and isolation.

Auditory Profile-Based Hearing Aid Fitting: Self-Reported Benefit for First-Time Hearing Aid Users.

Background: Although hearing aids (HAs) can compensate for reduced audibility, functional outcomes and benefits vary widely across individuals. As part of the Danish 'Better hEAring Rehabilitation' (BEAR) project, four distinct auditory profiles differing in terms of audiometric thresholds and supra-threshold hearing abilities were recently identified. Additionally, profile-specific HA-fitting strategies were proposed. The aim of the current study was to evaluate the self-reported benefit of these profile-based HA fittings in a group of new HA users. Methods: A total of 205 hearing-impaired older adults were recruited from two Danish university hospitals. Participants were randomly allocated to one of two treatment groups: (1) NAL-NL2 gain prescription combined with default advanced feature settings ('reference fitting') or (2) auditory profile-based fitting with tailored gain prescription and advanced feature settings ('BEAR fitting'). Two months after treatment, the participants completed the benefit version of the short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ12-B) and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire. Results: Overall, participants reported a clear benefit from HA treatment. However, no significant differences in the SSQ12-B or IOI-HA scores between the reference and BEAR fittings were found. Conclusion: First-time users experience clear benefits from HA treatment. Auditory profile-based HA fitting warrants further investigation.

Frontline nurses' experiences of managing visitor restrictions during the COVID-19 pandemic in a Danish university hospital - Lessons learned.

Worldwide visitor restrictions forced nurses to separate patients from their relatives. However, the experience of implementing shifting restrictions from the frontline nurses' perspectives in a Danish context has yet to be assessed. The aim of this descriptive qualitative study was to explore frontline nurses' experiences of managing shifting visitor restrictions in a Danish somatic university hospital during the COVID-19 pandemic. An online questionnaire, including open-ended questions, was developed. Data were analysed using descriptive statistics and content analysis. 116 nurses from 29 departments participated; they were informed about restrictions primarily by their charge nurses and hospital intranet. Shifting visitor restrictions compelled the nurses to constantly adjust and negotiate their practices. When deciding to suggest deviating from the restrictions, they shared their decision-making with colleagues. Visitor restrictions left the hospital environment quieter, but they also created a lack of overview and predictability, an emotional burden, and a negative impact on the quality of care. Restricting relatives' access challenged the nurses' professional values, and it seems to have affirmed their appreciation of relatives' role as important partners in contemporary hospital-based health care.

Communication, Cognition and Competency Development in Healthcare: A Model for Integrating Cognitive Ethnography and Communication Skills Training in Clinical Interventions.

The aim of this study was to conduct and evaluate the Blended Learning communication skills training program. The key objective was to investigate (i) how clinical intervention studies can be designed to include cognitive, organizational, and interactive processes, and (ii) how researchers and practitioners could work with integrated methods to support the desired change. The method combined design and implementation of a 12-week Blended Learning communication skills training program based on the Calgary-Cambridge Guide. The training was implemented in a patient clinic at a Danish university hospital and targeted all healthcare professionals at the clinic. Cognitive ethnography was used to document and evaluate healthcare professionals' implementation and individual competency development, and support the design of in-situ simulation training scenarios. Thirteen participants completed the program. The synergy within the teams, as well as the opportunities for participants to coordinate, share, discuss, and reflect on the received knowledge with a colleague or on-site researcher, affected learning positively. The knowledge transfer process was affected by negative feedback loops, such as time shortages, issues with concept development and transfer, disjuncture between the expectations of participants and instructors of the overall course structure, as well as participant insecurity and a gradual loss of motivation and compliance. We propose a novel 3-step model for clinical interventions based on our findings and literature review. This model will effectively support the implementation of educational interventions in health care by narrowing the theory-practice gap. It will also stimulate desired change in individual behavior and organizational culture over time. Furthermore, it will work for the benefit of the clinic and may be more suitable for the implementation of communication projects than, for example, randomized setups.

Postoperative lordosis distribution index, patient reported outcome measures, and revision surgery following transforaminal lumbar interbody fusion

ObjectiveLordosis Distribution Index (LDI) is a new radiographic parameter associated with postoperative residual symptoms in patients undergoing Transforaminal Lumbar Interbody Fusion (TLIF). Recently, it has been applied on patients undergoing instrumented spine surgery, however not correlated to Patient Related Outcome Measures (PROMs). This study investigates whether the obtained the postoperative LDI after TLIF surgery correlates with the clinical outcome measured with PROMs. MethodsThis study was based on prospectively obtained data in patients undergoing TLIF throughout 2017 at a Danish university hospital. Medical records and the DaneSpine Database were accessed to obtain preoperative, operative and follow-up data. Primary outcome was Oswestry Disability Index (ODI) 12 months postoperatively. Secondary outcomes included revision rate and additional PROMs. Results126 patients were included. 70 patients were classified with normolordosis (56 %), 42 hypolordosis (33 %) and 14 hyperlordosis (11 %). All groups experienced significant radiological changes undergoing surgery. Average reduction in ODI at 12 months postoperatively was −15.3 (±20.0). Minimally clinical important difference was achieved in 68 patients (54.0 %). No significant difference in PROMs between LDI-groups was observed in unadjusted or adjusted analyses. Revision surgery was performed in 8 patients with normolordosis (11.4 %), 7 hypolordosis (16.7 %) and 4 hyperlordosis (28.6 %). ConclusionsWe found no significant correlation between postoperative LDI subgroups of normolordotic, hypo- or hyperlordotic patients and the clinical outcome of posterolateral fusion and TLIF surgery. A trend towards lower rate of revision surgery in the normolordotic group compared to the hypo- and hyperlordotic group was observed.