Practice In Denmark Research Articles

Insomnia in the elderly: reported reasons and their associations with medication in general practice in Denmark

Objective: The aim of this study was to investigate reasons for insomnia symptoms and their associations with sleep medication prescription in elderly patients in general practice.Design: Over a period of 20 weekdays, general practitioners (GPs) recorded reasons and treatment for insomnia symptoms. Patient characteristics and outcomes were analysed using descriptive statistics. Logistic regression was used to analyse the associations between reasons for insomnia symptoms and prescription.Setting: General practices in the Region of Southern Denmark.Subjects: Consultations (n = 405) with patients older than 65 years presenting with insomnia symptoms.Main outcome measures: Reasons for insomnia symptoms and sleep medication prescription.Results: The most commonly reported reasons for insomnia symptoms were somatic illness (34%) and psychiatric diagnosis (29%). Having a psychiatric diagnosis or multiple reported reasons for insomnia increased the odds for prescription (odds ratio (OR) 4.60, 95% confidence interval (CI) 2.41-9.90 and OR 2.10, CI 1.03-4.28), whereas being first consultation regarding insomnia symptoms decreased the odds (OR 0.17, CI 0.10-0.30). A total of 80% received a prescription, most frequently of Z-hypnotics (49%). About half (52%) of the patients consulting their GP for the first time with insomnia symptoms received a prescription.Conclusion: Somatic and psychiatric diseases were the most commonly reported reasons for insomnia symptoms in the elderly, suggesting a high prevalence of comorbid insomnia. Regardless of reason, a majority of the consultations resulted in prescription of sleep medication with potential serious adverse effects. This indicates that there is still room for improving the management of insomnia among older adults. Key PointsAlthough insomnia is common in the elderly, little is known about its reasons and their associations with prescription patterns. The most commonly reported reasons for insomnia symptoms in the elderly are psychiatric diagnosis and somatic illness. According to guidelines, sleep medication with potential serious adverse effects is prescribed too frequently to elderly patients. An effort should be made to identify and optimally treat comorbid insomnia, which appears to be prevalent in older adults.

Handling resolvable uncertainty from incomplete scenarios in future doctors' job choice – Probabilities vs discrete choices

Health economists often use discrete choice experiments (DCEs) to predict behavior, as actual market data is often unavailable. Manski (1990) argues that due to the incompleteness of the hypothetical scenarios used in DCEs, substantial uncertainty surrounds stated choice. Uncertainty can be decomposed into “resolvable” and “unresolvable”; the former is expected to become resolved in actual choice, as individuals collect further information. To enable its identification, Manski suggests eliciting subjective choice probabilities (ECPs) rather than discrete choices. We introduce the ECP approach in health economics and explore its convergent validity. The context is future physicians’ stated choices of job in rural general practice in Denmark. Our results are mixed, but show remarkable similarities in forecasting abilities, despite the ECP models being less econometrically demanding and relying on different preference distributional assumptions.

Examining to what extent pregnancy-related physical symptoms worry women in the first trimester of pregnancy: a cross-sectional study in general practice.

BackgroundWomen often wish to discuss their pregnancy symptoms with their GP. However, the two parties’ understanding of symptoms may not be aligned.AimTo examine to what degree a specific pregnancy-related symptom worried women in the first trimester and analyse the characteristics of the most worried women.Design & settingA cross-sectional study was performed in general practice in Denmark from 1 March 2015–15 August 2016.MethodWomen attending the first prenatal care visit completed a questionnaire about pregnancy-related physical symptoms and worries. Women were recruited from 125 GP practices and 294 GPs participated in the study. Further data were obtained from their pregnancy health record. Multivariable logistic regression analysis was used to assess the associations between the women’s worries and the severity of the symptoms, which were adjusted for age and parity.ResultsA total of 1508 women, aged 16–45 years, were included and 1455 completed the questionnaire. Nausea, vomiting, pelvic cavity pain, and back pain were the most common symptoms, and 88% reported having two or more symptoms simultaneously. Among the 1278 women reporting nausea, only 21% were worried, while 88% of the 252 women reporting vaginal bleeding were worried. Primigravidae (those pregnant for the first time) were significantly more worried about vomiting and nausea than multigravidae (those who have experienced pregnancy previously). Those aged >35 years were more worried about pelvic girdle pain and pelvic cavity pain than younger women.ConclusionPregnancy-related physical symptoms are frequent in the first trimester. The severity of worries depends on the symptom. Vaginal bleeding and pain give rise to the majority of severe worries, especially among young women.

Like parent, like child: Intergenerational transmission of energy consumption practices in Denmark

In this article, we investigate the intergenerational transmission of sustainable consumption practices. Whereas previous studies have used self-reported attitudes and behaviour, this study uses data on actual energy consumption for space-heating and hot water combined with extensive panel data from Danish administrative registers. The paper shows significant intergenerational correlations between the energy consumption patterns of adults and their mothers, also when controlling for the energy consumption of the mother-in-law, where possible. Furthermore, it shows that the intergenerational correlation is slightly stronger for adults with lower income levels. These results suggest that energy consumption practices are shared and reproduced within the family. Following theories of practice, the intergenerational similarities in energy consumption practices refer to bodily learned practices that are indirectly transmitted and negotiated through family relations. In this way, these findings also contribute to a better understanding of how practical understanding regarding how to perform practices is transmitted within more ordinary aspects of consumption that play a less obvious role in distinction. To ensure more sustainable consumption practices in the future, this paper points to the importance of the role of family relations and the transmission of embodied practices.

Total costs of treating venous thromboembolism: implication of different cost perspectives in a Danish setting

Aim: Optimal use of scarce resources is a focus in the healthcare sector, as resources devoted to health care are limited. Costs and health economic analyses can help guide decision-making concerning treatments. One important factor is the choice of cost perspective that can range from a focus on narrow drug budget costs to broader economic perspectives. In the case of treatment with oral anticoagulants in patients with venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, the aim of this cost analysis was to illustrate the differences in costs when applying different cost perspectives.Methods: In a cost analysis, pairwise comparisons of average costs of 6 months standard treatment with either a low molecular weight heparin parenteral anticoagulant (LMWH) and a Vitamin K Antagonist (VKA) versus one of the non-vitamin K oral anticoagulants [NOACs; dabigatran etexilate, rivaroxaban, apixaban, and edoxaban) used in daily clinical practice in Denmark for VTE patients were carried out. Each analysis included the results from five different cost analyses with increasingly broader cost perspectives going from the narrowest “drug cost only” perspective to the broadest “societal” perspective.Results: Focusing on “drug costs only”, LMWH/VKA was associated with the lowest costs compared to all NOACs. However, including the economic impact of preventing recurrent VTE and limit bleedings, apixaban and rivaroxaban resulted in slightly lower health care costs than LMWH/VKA. When applying the “societal perspective”, the total costs saved with apixaban and rivaroxaban compared to LMWH/VKA further increased, with apixaban having the lowest total costs.Conclusions: The present study’s case of oral anticoagulants in VTE treatment illustrated the importance of the cost perspective in the choice of therapy. If decision-making were based on drug costs only, instead of applying a health care sector or societal cost perspective, suboptimal decisions may be likely.

Universal or Targeted Antenatal Care for Immigrant Women? Mapping and Qualitative Analysis of Practices in Denmark.

Inequity in immigrants’ health during pregnancy and childbirth has been shown. We studied the Danish regional organization of public midwifery-based antenatal care (ANC) for immigrant women to assess the strengths and weaknesses of organizing ANC as either universal or immigrant-targeted. A telephone survey in 2012 to all the Danish maternity wards (n = 20) was conducted. Semi-structured interviews with midwives providing targeted care (n = 6) were undertaken and characteristics of care were qualitatively analyzed, having the immigrant density of the facilities, the Danish ANC policy, and theories of cultural competence as the frame of reference. Six maternity wards were providing immigrant-targeted ANC. Targeted care implied longer consultations and increased attention to the individual needs of immigrant women. At these facilities, navigation in the health care system, body awareness, and use of interpreter services were key topics. The selection of women for targeted care was based on criteria (including names) that risk stigmatizing immigrant women. The arguments for not providing targeted care included that immigrant-targeted care was considered stigmatizing. Current universal care may overlook the needs of immigrant women and contribute to inequities. A strategy could be to improve dynamic cultural competencies of midwives, interpreter services, and flexibility of the care provision of the universal ANC system.

Rationalities in the pedagogical regime of practice

Using a Foucauldian governmentality approach, this article examines the connections and tensions between rationalities relying on recognition and democratic ideals, and the educationally and developmentally oriented rationality that characterises the pedagogical regime of practice in Denmark. The conclusion is that rationalities of recognition and democracy are subordinated to an educationally and developmentally oriented rationality. Thus, in practice, the former are transformed into an instrument for fulfilling educational and developmental objectives, with a primary focus on the child achieving an age-appropriate level of development.

Evaluation of a patient-centered organizational model for multimorbidity in general practice in Denmark - a feasibility study

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Implementing European case law at the bureaucratic frontline: How domestic signalling influences the outcomes of EU law

AbstractThis article analyses the implementation of European case law at the bureaucratic frontline of European member states. Theoretically, insights from street‐level implementation studies are combined with judicial impact research. Empirically, we compare how EU rules on free movement and cross‐border welfare are applied in practice in Denmark, Austria and France. We find that when applying EU rules in practice, street‐level bureaucrats are confronted with a world of legal complexity, consisting of ambiguous rules, underspecified concepts and a recent judicial turn by the Court of Justice of the European Union. In order to manage complexity, street‐level bureaucrats turn to their more immediate superiors for guidance. As a consequence, domestic signals shape the practical application of EU law. Despite bureaucratic discretion and many country differences, domestic signals create uniform, restrictive outcomes of EU law in all three cases. Thus we show that there is considerable room for politics in EU implementation processes.

Agomelatine Drug Utilisation Study in Selected European Countries: A Multinational, Observational Study to Assess Effectiveness of Risk-Minimisation Measures

Hepatotoxic reactions are an important identified risk listed in the agomelatine risk management plan. This post-authorisation safety study evaluated the effectiveness of additional risk-minimisation measures (aRMMs) for agomelatine. The objective of this study was to evaluate, among physicians prescribing agomelatine and their patients, liver function monitoring adherence, compliance with contraindications and patients' reasons for non-compliance with liver monitoring. A non-interventional cohort study was conducted among adults initiating agomelatine in routine clinical practice in Denmark, France, Germany and Spain through a retrospective medical record abstraction (MRA) before and after implementation of aRMMs and a cross-sectional patient survey. Fifty-four sites contributed data on 437 and 404 patients in the before- and after-RMM periods, and 237 patients completed the survey. No patient had cirrhosis in either study period; 98.2% of patients in the before- and 98.0% in the after-RMM period had no active liver disease reported at initiation or during treatment. Compliance to contraindicated medications was > 99% in both periods. The adherence to the liver-monitoring regimen was similar in both periods (15.1% before RMM and 16.3% after RMM). In the after-RMM period, 25.2% of patients had a liver test before or at treatment initiation; 61.5% had a liver test during treatment. Among patients surveyed who did not have a blood test before treatment initiation or during treatment, the most frequently cited reason was a test ordered but not yet performed. The overall adherence to liver-monitoring recommendations remained weakly influenced by aRMMs. However, patients treated with agomelatine are in compliance with relevant contraindications.

Associations between degrees of task delegation and adherence to COPD guidelines on spirometry testing in general practice - a national cross-sectional study

BackgroundThe healthcare systems in the western world have in recent years faced major challenges caused by demographic changes and altered patterns of diseases as well as political decisions influencing the organisation of healthcare provisions. General practitioners are encouraged to delegate more clinical tasks to their staff in order to respond to the changing circumstances. Nevertheless, the degree of task delegation varies substantially between general practices, and how these different degrees affect the quality of care for the patients is currently not known. Using chronic obstructive pulmonary disease (COPD) as our case scenario, the aim of the study was to investigate associations between degrees of task delegation in general practice and spirometry testing as a measure of quality of care.MethodsWe carried out a cross-sectional study comprising all general practices in Denmark and patients suffering from chronic obstructive pulmonary disease. General practitioners (GPs) were invited to participate in a survey investigating degrees of task delegation in their clinics. Data were linked to national registers on spirometry testing among patients with COPD. We investigated associations using multilevel mixed-effects logit models and adjusted for practice and patient characteristics.ResultsGPs from 895 practices with staff managing COPD-related tasks responded, and 61,223 COPD patients were linked to these practices. Hereof, 24,685 (40.3%) had a spirometry performed within a year. Patients had a statistically significant higher odds ratio (OR) of having an annual spirometry performed in practices with medium or maximal degrees of task delegation compared to practices with a minimal degree (OR = 1.27 and OR = 1.33, respectively).ConclusionDelegating more complex tasks to practice staff implies that COPD-patients are more likely to be treated according to evidence-based recommendations on spirometry testing.

GLA:D\xae Back: group-based patient education integrated with exercises to support self-management of persistent back pain \u2014 feasibility of implementing standardised care by a course for clinicians

BackgroundClinical guidelines for management of low back pain (LBP) are not routinely implemented in practice, and guidelines rarely offer tools for implementation. Therefore, we developed GLA:D® Back, a standardised intervention of patient education and supervised exercises. This pilot study tested the feasibility of implementing GLA:D Back in clinical practice in Denmark by delivering a course for physiotherapists and chiropractors. It should further inform the planning of an implementation-effectiveness study using a pre-post group design alongside nation-wide implementation.MethodsThirty-one clinicians from nine clinics participated. Feasibility of implementation was evaluated in terms of adoption and through focus group interviews and a feedback meeting. Patient-level data, including pain, disability, and pain enablement, were collected from (1) LBP patients visiting the clinics during a pre-specified 2-week period 2 months prior to clinicians attending the GLA:D Back course (n = 84), (2) LBP patients consulting during a 2-week period 2 months after the course (n = 77), and (3) those enrolled in GLA:D Back during 4 months after implementation (n = 89). Patient data were collected at baseline and at 4 months.ResultsClinicians’ evaluations of the course were positive and resulted in several modifications. The clinical intervention was adopted by all test sites. Most patient characteristics were similar across groups. Patients mainly had persistent LBP (73% > 3 months) and most had been treated for more than 4 weeks at inclusion. Patients in GLA:D Back were more often retired (30% vs. 16% before implementation) and at high risk of poor prognosis (25% vs. 13%). Procedures for data collection were feasible, and outcomes after implementation, especially with GLA:D Back, were as good as or better than before implementation. Recruiting patients and achieving comparable pre- and post-groups was difficult.ConclusionsImplementation of the GLA:D Back clinical intervention in Danish primary care physiotherapy and chiropractic clinics was feasible through a 2-day clinician course. Both clinicians and patients were satisfied with the programme, and patient-reported outcomes were slightly better than outcomes in patients registered before implementation. It was not deemed possible to conduct an implementation-effectiveness trial as part of a nation-wide implementation.

Health care inequality in free access health systems: The impact of non-pecuniary incentives on diabetic patients in Danish general practices

Indicators of deprivation based on income and education might offer a blunt tool for inequality analysis in universal health systems with free access to care and thereby preventing the identification of groups experiencing the largest inequality. Also, analysis methods based on ranking the population by income or education, such as concentration curves and indices, are unsuitable for evaluating the impact of a health programme on inequality. This paper uses a new method for inequality analysis based on the Health Care Deprivation profiles’ approach, allowing for: (1) considering multi-dimensional aspects of deprivation in the inequality analysis, (2) a graphical representation of the distribution of inequality, and (3) a range of additive decomposable inequality indices consistent with dominance. We apply this method and a Difference in Differences approach to evaluate the impact of a disease management programme aiming at reducing underutilisation of GP services for diabetic patients in Denmark. The programme introduced a set of non-pecuniary incentives empowering GPs with feedback reports on their performance and comparisons with other peers. Our study population includes 93,849 diabetic patients aged 18 + registered in 563 GP practices in Denmark; a total of 246 of these practices joined the programme, and 317 are used as control. The results show that patients experiencing the largest inequality in the top quintile of the distribution are characterised by deprivation in multiple socio-economic and morbidity dimensions that are not captured fully by income and education. The programme significantly reduced inequality in access to pivotal services, such as blood tests and preventive visits, for all patients and, with greater magnitude, for the most-deprived patients. Non-pecuniary incentives may be an effective tool for GPs to improve access to care in the most vulnerable patients.

Prescription of antibiotics for urinary tract infection in general practice in Denmark

Objective: The aim of this study was to describe and characterize the prescription of antibiotics for urinary tract infection (UTI) in general practice in Denmark and to evaluate compliance with current recommendations.Design: National registry-based studySetting: Danish general practicePatients: 267.539 patients who redeemed a prescription for antibiotics with the clinical indication UTI at community pharmacies between July 1st 2012 and June 31st 2013.Main outcome measures: Antibiotics prescribed for 1) acute lower UTI, 2) acute upper UTI and 3) recurrent UTI presented as amount of prescriptions, number of treatments per 1000 inhabitants per day (TID) and defined daily doses per 1000 inhabitants per day (DID).Results: A total of 507.532 prescriptions were issued to 267.539 patients during the one year study period, representing 2.35 DID. Acute lower UTI was the most common reason for prescription of antibiotics (89.5%) followed by recurrent UTI (8.4%). The majority of the prescriptions were issued to people above 60 year old (57.6%). Pivmecillinam was the most commonly prescribed antibiotic in acute lower (45.8%) and acute upper (63.3%) UTI. Trimethroprim was the most commonly prescribed antibiotic in recurrent UTI (45.9%). Prescription of quinolones increased with increasing patient-age (p = <.0001).Conclusion: Compliance with current Danish recommendations was moderately high. Pivmecillinam is the first line antibiotic for the management of acute lower and upper UTI, and trimethroprim is the first line option of recurrent UTI. A high proportion of the antibiotic prescriptions were issued in the elderly population including a relatively high prescription rate of quinolones.Key pointsUrinary tract infection (UTI) is a common cause for prescription of antibiotics in general practicePoor compliance in general practice with recommendations for first-line treatment of UTI may increase antibiotic resistanceDanish general practitioners are generally compliant with national and regional guidelines for antibiotic treatment of UTIThere is high use of antibiotics in the elderly population including a worrisome high use of broad-spectrum antibiotics, such as Quinolones.

Degeneration, Protestantism, and Social Democracy: The Case of Alcoholism and “Illiberal” Policies and Practices in Denmark 1900–43

Through a case study of the emergence of rights-infringing “illiberal” policies and practices in the field of Danish alcohol treatment from 1900 to 1943, this article shows how new scientific ideas on “degeneration” as the cause of alcoholism and the use of force in treatment were adapted and promoted by Protestant revivalist groups and Social Democrats alike. The article analyzes how new scientific ideas resonated with the cultural ideals of Danish Social Democracy and the evangelical temperance organization the Blue Cross. The article challenges the established view in the literature that eugenic and similar illiberal practices were the result of a “high modernist” state ethos and “communitarian-organic” thinking on the left. Building on secondary literature and archival sources, it is shown that illiberal policies and practices as well as theories of heredity in the case of Danish alcohol treatment were adopted as the result of common liberal-conservative ideals regarding the value of family shared by Social Democrats and Protestant activists across the civil society and state spheres.

Nitrogen fertilizer replacement value of digestates from three green manures

Green manure mixtures including legumes and forbs can help to increase N availability in organic arable systems. Anaerobic digestion of green manures may provide ammonium rich digestate, which can be redistributed as fertilizer. The aim of this study was to investigate the effect of plant species composition, cutting strategy and anaerobic digestion on the N fertilizer replacement value (NFRV) of different green manures. Digestates obtained from silages of pure stand lucerne (four cuts/year) and a mixture including lucerne, grass and forbs (two or four cuts/year) were used to fertilize winter wheat (surface banding) and spring barley (injection). In general, NFRV was 46–173% higher in spring barley than winter wheat, due to the different application method and timing, which reflect the common practices in Denmark. NFRV of digestates were 25–63% higher than the corresponding silages, with the largest increase with the most fibrous material (mixture at two cuts/year). Total N concentration (DM based) in the silages largely explained NFRV of the digestates. To obtain NFRV above 60%, total N concentration of silage should exceed 3.5 g 100 g−1 DM, achievable with silages from four-cut strategies. Silages of plant materials with different composition and N content may be similar in terms of biomethane production, but the fertilizer value of the digestates varies considerably depending on total N concentration.

User involvement in a Danish project on the empowerment of cancer patients \u2013 experiences and early recommendations for further practice

BackgroundThis paper reports on the process of involving former and current cancer patients and carers as co-researchers in a Danish mixed methods research project on patient empowerment of cancer patients in follow up (The Empowerment study 2015–2019). User-Involvement in health care research is a relatively new practice in Denmark and the Empowerment project was one of the first to systematically involve patients and carers in its research design, conduct and reporting. The paper has two aims: first, it provides a detailed account of the process of involving co-researchers in the Empowerment project and second, it presents findings from a workshop held with academic researchers and co-researchers on the project to discuss their experiences and recommendations for user-involvement in the Danish context.MethodsThe Empowerment project adopted a consultative and collaborative approach to user involvement and co-researchers were involved from the early stages and all through the project. Users gave feedback on the proposal, helped develop project documents and research tools, acted as peer interviewers in qualitative interviews, participated in data analysis and development of questionnaires, and co-authored journal articles. The workshop held with the academic researchers and co-researchers consisted of two parallel focus groups and a joint group discussion, following an interactive and informal format to facilitate discussion and exchange of ideas.FindingsThe focus group resulted in eleven recommendations for the further development of user-involvement in Denmark. Key issues encountered were the general lack of guidelines on user-involvement in the Danish context and the need for more organisational support. Particular issues, such as payment, recruitment and training, need to be carefully considered within individual projects and within the national context in which projects are carried out.ConclusionThe paper adds to the current very limited knowledge base on user-involvement in the Danish context and provides a set of early recommendations for the further development of the practice in Danish Health Research. User-involvement needs to be developed with consideration to the local context, but common challenges also emphasise the usefulness of cross-country comparisons and knowledge exchange.

Review of advanced nursing practice in Denmark with an exemplar

Advances in independent nursing practice can expand the professional identity of nurses. Although there is no formal recognition for an advance practice nursing role in Denmark, there are clear examples of nursing expanding its scope to meet the meet of individual patients and larger community needs. Many Danish nurses work with expanded competencies in surgical settings, medical settings, psychiatric environments, and are instrumental in promoting continuity of care for patients who have chronic conditions. Expansion of the nursing role is an example of health care evolving to meet societal and patient needs, even within a controlled research environment, and will promote job satisfaction and retention among its most experienced nurses. This paper offers a review of expanded nursing roles in Denmark and offers further evidence of expanded autonomy for nurses in a clinical research environment.

Can external interventions crowd in intrinsic motivation? A cluster randomised field experiment on mandatory accreditation of general practice in Denmark

Motivation crowding studies have demonstrated that external interventions can harm effort and performance through crowding out of intrinsic motivation, when interventions are perceived as lack of trust. However, motivation crowding theory also presents a much less investigated crowding in effect, which occurs when external interventions increase intrinsic motivation. This study empirically tests the motivational effect of a specific external intervention and its associations with the perception of the intervention. We draw on a cluster randomised stepwise introduction of a mandatory accreditation system in general practice in Denmark combined with baseline and follow-up questionnaires of 1146 GPs. Based on a series of mixed effects multilevel models, we find no evidence of motivation crowding out among surveyed GPs, although most GPs perceived accreditation as a tool for external control prior to its implementation. Rather, our results indicate that being accredited crowds in intrinsic motivation. This is especially the case when GPs perceive accreditation as an instrument for quality improvement. External interventions can therefore, at least in some cases, foster intrinsic motivation of health care professionals.

21 century learning skills revisited - a conceptual paper on leaving 'gaps' and going deep

This paper revisits the 21st-century learning skills (21CLS) and discusses the need to leave 'gaps' in the curriculum while pursuing chosen topics more in-depth. The paper suggests ways to choose both 'gaps' and in-depth topics; furthermore, the paper investigates relevant technologies for bridging the gaps and for going deep. The paper discusses the connection between 'Das Exemplarische Prinzip' (exemplary teaching) and what may be interpreted to be the initial thoughts behind the formulation of the 21CLS presented in the document 'A Nation at Risk'. The two concepts are separated by three decades (1951 'Tübinger resolution -1981 'A Nation at Risk'). However, they share the same conviction that not every bit of knowledge available can be taught/learned and, furthermore, that some knowledge is more important than other. We wish to revisit this notion because we believe that the advances in Artificial Intelligence (AI) and the automation of increasingly complex processes in our everyday lives will influence education. This indicates that we may need to adjust the topic- and activity-selection principles that teachers and curriculum developers deploy to select what to teach and what to outsource to networked learning and digital learning materials. The discourse of the 21CLS seems to have materialised into a specific practice in Denmark, a practice that embraces programming exercises (Dot/Dash, LEGO Mindstorms, Scratch, Python etc.), tinkering with electronics, playing computer games, 3D printing and Laser cutting in workshops called 'Maker spaces'. The 21CLS, in a Danish context, are distilled into; Collaboration, Critical Thinking, Creativity, Communication (the 4Cs). In our research and in the development projects in schools we have taken part in, we have the positive experience that the way the 21CLS are practiced in a Danish context gave some pupils a sense of pride in their products and that some pupils acted more as designers of solutions for real problems than as pupils doing school work. On a more negative note, the 21CLS activities may come across as isolated events with little connection to curriculum or exams. Finally, we raise the discussion of how Teacher Education can develop a practice that incorporates the convictions of the 21CLS in other ways. We suggest a focus on technology that supports dialogue and reflection and bridges both knowledge 'gaps' and time and space 'gaps'. Furthermore, we suggest learning designs that revisit 21CLS as a framework for learning to learn.