Midt- og Vestsjællands Hospital

Objective: To compare humoral and T-cell responses to COVID- 19 vaccines in 400 MS patients who were on Ocrelizumab ('OCR') v. other disease-modifying therapies ('non-OCR') at the time of vaccination. Introduction: Peripheral B-cell depletion with anti-CD20 therapies attenuates humoral responses to vaccines. Whether immune responses to COVID-19 vaccines differ between B-cell depleted and non-B cell depleted MS patients is not known. Methods: Consecutive MS patients from NYU MS Care Center were invited to participate if they completed COVID-19 vaccination ≥6 weeks previously. Immune testing included anti-spike RBD antibody (Elecsys Anti-SARS-CoV-2) (Roche Diagnostics);multiplex bead-based immunoassays of antibody-responses to SARS-COV-2 spike proteins;T-cell responses to SARS-CoV-2 Spike protein using IFNγ enzyme-linked immune-absorbent spot (Invitrogen) and TruCulture (Myriad RBM) assays;high dimensional immunophenotyping;and live virus immunofluorescencebased microneutralization assay. Results: As of 7/15/2021, 105 MS subjects were enrolled (mean age: 40.5 years;76% female;41% non-white;38% on OCR;12% with prior COVID-19 infection). 95% were fully vaccinated with mRNA vaccines (Pfizer/Moderna);5% - with adenovirus-based vaccine (JohnsonJp<0.0001). Positive response by multiplex assay (threshold of 'positive' defined as 2 SD below the mean for the non-OCR) were detected in 10/27 (37%) OCR and 29/31 (94%) non-OCR (p<0.00001). T-cell activation based on induced IFNγ secretion (TruCulture) was detected in 20/25 (80%) OCR and 16/19 (84%) non-OCR patients (p=0.71). Conclusions: Preliminary results suggest robust T-cell immune response to SARS-CoV2 vaccines in approximately 80% of both OCR and non-OCR MS patients. Antibody responses were markedly attenuated in OCR compared to non-OCR group. Updated results will be presented.

Fremkomsten af digitale løsninger i sundhedsvæsenet er et svar på demografiske udfordringer og stigende behov. Virtuelle konsultationer er ikke længere fremtid – de er nutid. I denne bog giver forskere og fagpersoner deres bud på, hvordan omsorg og behandling udfolder sig, når mødet mellem patient og sundhedsprofessionel flytter fra det fysiske rum til en skærm.<br/><br/>Med bidrag fra aktuel forskning præsenterer forfatterne perspektiver på etik, kommunikation, relationer og kompetenceudvikling i virtuelle konsultationer. Bogen bidrager med viden og konkrete værktøjer til, hvordan sundhedsprofessionelle kan reflektere og mestre denne nye praksis.<br/><br/>Målgruppen er alle sundhedsprofessionelle som søger indsigt i, hvordan virtuelle konsultationer kan bidrage til fremtidens sundhedsvæsen, og hvilke udfordringer vi samtidig må forholde os til.<br/><br/>Vi ses på skærmen!

Background: Serial point-of-care ultrasound (PoCUS) has the potential for improving acute patient care through modifying treatment to the dynamic ultrasound findings. The objective was to investigate if treatment guided by serial PoCUS of the heart and the lungs in patients admitted to an emergency department (ED) with acute dyspnoea could reduce the severity of dyspnoea compared to usual care.<br/><br/>Methods: The study was a randomised, controlled, blinded-outcome trial in one ED in Denmark between Oct 9, 2019, to May 26, 2021, with a follow-up period of 30 days. In a convenience sample, patients  18 years admitted with a primary complaint of dyspnoea and no trauma were included and allocated 1:1 to a serial ultrasound and control group. Patients in both groups received standard care within one hour from arrival, including a single cardiopulmonary PoCUS. In the serial ultrasound group, additional two extra PoCUS was performed with two hours interval. The primary outcome was a reduction of dyspnoea on a verbal dyspnoea scale (VDS) from 0-10, where 10 was worst, registered at inclusion and after two, four, and five hours. Outcome assessors were blinded, whereas the treating physician and patients were not. The secondary outcomes in both groups were length of stay, 7- and 30-days mortality, number of readmissions, and the proportion of patients with a correct presumptive diagnosis in agreement with a final audit diagnosis. The sample size was calculated based on the primary outcome. The primary outcome was analysed with a mixed-effect model. <br/><br/>Results: We included 102 patients in the serial ultrasound group and 104 in the control group. Median age was 76, sex was even distributed, many were previous smokers, and had chronic obstructive pulmonary disease or arterial hypertension as the most common comorbidities. The mean difference in VDS between patients in the serial ultrasound and the control group was -1·09 (95% CI -1·51 to -0·66) and -1·66 (95% CI -2·09 to -1·23) after four and five hours, respectively. The treatment in the two groups differed, with a larger proportion of patients receiving diuretics in the serial ultrasound group. No differences were observed between the two groups regarding the secondary outcomes. No adverse events were present.<br/><br/>Discussion and conclusion: Serial PoCUS-guided treatment can, together with standard care, reduce the severity of dyspnoea compared to standard care alone because it gives the ED physician the possibility to tailor the treatment according to ultrasound findings. PoCUS could therefore be considered for routine use to aid the physician in stabilising the patients and thereby handling crowding and flow. <br/><br/>Trial registration number: ClinicalTrial.gov, NCT04091334.<br/><br/>Funding: Department of Emergency Medicine, Slagelse Hospital; Naestved, Slagelse, and Ringsted Hospitals’ Research Fund; Research Fund of Region Zealand and Region of Southern Denmark; and the University of Southern Denmark. <br/><br/>Ethical approval and informed consent: Approved by the Regional Committee on Health Research Ethics for Region Zealand, Denmark (SJ-744). The participants gave informed consent to participate in the study.

This project examines nurses’ use of computers for real-time documentation in patient rooms in the pediatric emergency department, as well as the barriers that influence this practice. Real-time documentation is a legal requirement according to the Danish Record-Keeping Order and the Authorization Act, and it plays a significant role in patient safety, quality, and continuity of care. At the same time, presence, communication, and family involvement are central elements of family-centered care, as recommended by the WHO.Through a questionnaire distributed to nurses in the pediatric and adolescent department, we collected both quantitative and qualitative data to identify barriers to in-room documentation. Of 19 responses, nurses primarily reported technical errors, reduced sense of presence, interruptions from the family, and time pressure as challenges. Based on these findings, we developed a driver diagram and a SMART goal aimed at increasing the proportion of triage nurses documenting in the patient room to 65% by the end of 2025.As part of the improvement work, defective computers were replaced or repaired, and a smartphrase was developed to simplify documentation and ensure compliance with legal requirements. To explore families’ experiences of the nurse’s use of the computer in the room, we conducted a questionnaire survey via QR codes, which 19 families completed. The results showed that most did not experience reduced presence or disturbances when the nurse documented in the room.The project demonstrates that technical conditions and workflows significantly affect nurses’ ability to document in real time, while families’ experiences are generally positive. The project supports the importance of documentation close to the patient to ensure high quality, fewer misunderstandings, and increased family involvement, in line with the principles of family-centered care.

Background<br/>The acid-base balance in arterial blood is critical in determining patient outcomes during emergency care. Although acid-base imbalances are common, the impact of pH levels on short-term mortality in emergency department (ED) settings is not well studied. Most evidence comes from intensive care unit settings where interventions can affect pH levels and outcomes, raising concerns about these findings' generalisability to the ED setting.<br/>The objectives were to examine the correlation between arterial blood pH and 0–2- and 3–7-day mortality in adult medical ED visits.<br/><br/>Methods<br/>This population-based, multicentre cohort study included all adult medical ED visits of 18 years or older from seven departments in the Region of Southern Denmark from January 1, 2016, to March 19, 2018. The inclusion criteria required an arterial blood gas (ABG) analysis within four hours of arrival. The outcomes were 0–2- and 3–7-day mortality rates stratified by pH levels and adjusted for confounders with hazard ratios (HRs) compared to normal pH levels.<br/><br/>Results<br/>The study included 64,725 adult medical ED visits and 31,650 unique individuals with ABG testing. Most patients had normal pH (54.2%), followed by alkalosis (31.8%), acidosis (11.3%), and severe acidosis (2.7%). Dyspnoea was the most common symptom (29.5%), and 64% of patients were aged ≥65. The largest group of patients had no comorbidities. The most frequent discharge diagnoses were respiratory diseases (29.2%), unspecific findings (18.6%), and circulatory diseases (12.4%). <br/>The mortality rates for patients within 0–2 days and 3–7 days of the index visits were 2.4% and 2.1%, respectively. Patients with severe acidosis (pH &lt; 7.20) had the highest risk, with mortality rates of 20.8% and 8.9% (HR 9.6 and 5.2, respectively). Acidosis (pH 7.20–7.34) was associated with mortality rates of 7.4% and 5.2% (HR 4.1 and 2.7, respectively). Within two days, nearly 60% of patients with pH &lt; 6.90 died. In the adjusted analysis, lower pH levels, increased burden of comorbidities, and advanced age were associated with increased risk of short-term mortality. <br/><br/>Discussion and conclusions<br/>Our study highlights that lower pH, increased comorbidities, and older age are linked to higher short-term mortality risk in the ED. Notably, 40% survival among patients with pH &lt; 6.90 challenges the prevailing medical consensus, suggesting a critical re-evaluation of prognostic values and treatment approaches for acute patients may be necessary.<br/><br/>Trial Registration<br/>Permission to obtain and store data was obtained from the regional authorities (identifier 3-3013-2272/1 and identifier 17/24904, amendment identifier 20/24502). <br/><br/>Funding<br/>This study did not receive any specific funding.<br/><br/>Ethical approval and informed consent<br/>Not needed.

The Steno-2 Study has previously demonstrated marked risk reductions in cardiovascular disease with intensified polypharmacological treatment of patients with type 2 diabetes and microalbuminuria after 8 years of intensified multifactorial intervention. The present long-term follow-up demonstrates an absolute 20% risk reduction in total and 13% in cardiovascular mortality. Risk reductions for cardiovascular disease were even more pronounced after 13 years of follow-up than after 8 years. The earlier intensive treatment was initiated, the more patients seemed to benefit.

Background: Dyspnoea is one of the most common reasons for emergency department (ED) visits, and admission due to dyspnoea is associated with a poor prognosis. Point-of-care ultrasound (PoCUS) improves ED diagnosis of dyspnoeic patients, but it remains uncertain whether serial PoCUS in this setting impacts prognosis. <br/>The objectives were to investigate temporal changes in serial PoCUS findings in dyspnoeic ED patients and to examine if PoCUS findings were associated with short-term mortality and hospitalisation.<br/><br/>Methods: This is a substudy of a randomised, controlled, blinded-outcome multicentre trial in Denmark between October 9, 2019, and May 26, 2021, with a follow-up period of 30 days. In a random sample, patients aged 18 or older admitted with a primary complaint of dyspnoea and no trauma were included and allocated 1:1 to a serial ultrasound or control group. Patients in both groups received standard care within one hour of arrival, including a single cardiopulmonary PoCUS. In the serial ultrasound group, two additional cardiopulmonary PoCUS investigations were performed at two-hour intervals. The main study showed that treatment guided by serial PoCUS significantly reduced the degree of dyspnoea compared to usual care. In this secondary analysis, we examined if the PoCUS findings changed within the first 5 hours in the ED by comparing median values by visualisation of box plots. Associations between the sum of B-lines, inferior vena cava collapsibility index (IVC-CI), tricuspid annular plane systolic excursion (TAPSE), right ventricular dilatation, and ejection fraction (EF) and 30-day all-cause mortality and 30-day hospitalisation after discharge were examined with a multivariable logistic regression model with the Firth method applied because of low event rates, adjusted for age, sex, and baseline vital signs. The sample size was powered to the primary outcome in the main study (change in the degree of dyspnoea).<br/><br/>Results: Overall, 206 patients were included. The median age was 76 years, sex was evenly distributed, and the most common comorbidities were chronic obstructive pulmonary disease and arterial hypertension. Besides decreasing B-lines, PoCUS findings did not fluctuate during the initial ED stay. Thirty-day all-cause mortality was 9 (4.3%), and 47 patients (22.8%) were hospitalised. PoCUS findings were not associated with mortality or hospitalisation. Age &gt; 80 years was most strongly associated with prognosis.<br/><br/>Discussion and conclusion: PoCUS is essential for the initial diagnostic workup. In the short term, only B-lines showed dynamic changes. However, PoCUS parameters do not provide prognostic information, but a larger sample size is necessary to draw definitive conclusions. Nevertheless, the potential use of serial focused lung ultrasound and B-line trajectories by ED physicians as a tool to tailor treatment, along with usual care, is a promising approach.