Midt- og Vestsjællands Hospital

Background: Clinical levels of depression and anxiety are highly prevalent among individuals with multiple sclerosis (MS) and have deleterious biopsychological outcomes. Despite this, the mechanisms that contribute to the development and maintenance of depression, anxiety and positive adjustment outcomes are largely unknown. Objectives: Assess the utility of Leventhal’s Common-Sense Model in predicting psychological adjustment outcomes depression, anxiety and illness acceptance in individuals with MS. This study focuses on the relations between personality traits neuroticism and optimism, illness perceptions, coping strategies and adjustment outcomes utilising a cross-sectional design. Methods: Individuals with MS (n= 428) completed online questionnaires and were mostly female (86.7%), located in Australia (45%) or the United States (32%) and reported a relapsing remitting course of MS (83.4%). Measures included the NEO-Five Factor Inventory-3; Life Orientation Test Revised; Depression Anxiety and Stress Scale; Acceptance of Chronic Health Conditions Scale; Revised Illness Perceptions Questionnaire; and the BRIEF COPE. Mediation analyses were analysed through PROCESS macro for SPSS. Results: Perceptions of illness coherence, control, timeline, identity, emotional representations and avoidant coping and approach coping were significant simple and parallel mediators in the relationships between personality traits and depression, anxiety and illness acceptance. The serial effects of negative emotional representations on high avoidant coping partially mediated the relationships between neuroticism and depression[β=.05, BCa 95% CI (.02, .11)] and anxiety [β=.04, BCa 95% CI (.02, .09)], whereas the serial effects of less negative emotional representations on lower avoidant coping mediated the relationship between high optimism and low depressive levels [β=.-.06, BCa 95% CI (-.13, -.04)]. Conclusion: Illness perceptions and coping styles, particularly emotional representations and avoidant coping, are significant mechanisms involved in depression, anxiety and illness acceptance and may represent effectual targets for psychological intervention in individuals with MS.

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.

Alt for mange mænd får alt for lidt motion. De sidder for meget stille, bliver oftere end kvinder ramt af en lang række livsstilssygdomme, opsøger sjældnere sundhedstilbud og har en kortere levetid.

Denne rapport præsenterer de første resultater fra evalueringen af forsøgsordningen Direkte adgang til fysioterapi med offentligt tilskud uden lægehenvisning (herefter kaldet Direkte adgang) i Region Sjælland. Ordningen blev lanceret den 31. marts 2025 som led i en regional afprøvning og evalueres af Forsknings- og implementeringsenheden PROgrez, Medicin 3, Næstved, Slagelse og Ringsted sygehuse. Muskel- og ledproblemer er udbredte i Danmark og medfører både personlige gener og samfundsøkonomiske konsekvenser i form af behandlingsudgifter, sygemeldinger og nedsat arbejdsevne. Fysioterapi spiller allerede en central rolle i behandlingen, men i dag kræver det lægehenvisning at opnå offentligt tilskud. For at skabe en tidligere, mere tilgængelig og effektiv indsats afprøver Region Sjælland på vegne af Danske Regioner en forsøgsordning, hvor borgere har direkte adgang til fysioterapi med tilskud uden henvisning fra egen læge. Direkte adgang skal imødekomme behovet for tidligere og mere tilgængelig behandling af muskel- og ledproblemer, aflaste almen praksis og forbedre patienternes oplevelse og handlekraft. Denne første af tre evalueringsrapporter præsenterer resultater fra opstartsperioden (31. marts – 31. juli 2025) af Direkte adgang i Region Sjælland. Rapporten giver et overblik over tidligere nationale og internationale erfaringer, belyser det foreløbige kendskab til ordningen i Region Sjælland, peger på de tendenser, der kan spores i de første måneder og afrundes med en beskrivelse af en konkret patientoplevelse.

Background 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. The objectives were to examine the correlation between arterial blood pH and 0–2- and 3–7-day mortality in adult medical ED visits. Methods 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. Results 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%). 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 < 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 < 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. Discussion and conclusions 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 < 6.90 challenges the prevailing medical consensus, suggesting a critical re-evaluation of prognostic values and treatment approaches for acute patients may be necessary. Trial Registration 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). Funding This study did not receive any specific funding. Ethical approval and informed consent Not needed.

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. 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. 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). 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 > 80 years was most strongly associated with prognosis. 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.

Background Previously, physicians from different medical and surgical specialities were dedicated to the role of team leader when receiving critically ill patients. Serious adverse events regarding the trigger teams were reported to the Danish Patient Safety Authority and analyses pointed at lack of communication, safety and leadership as the primary causes. In addition, emergency nurses experienced a low degree of psychological safety, which could challenge patient safety. Aim With this change, it is now a Specialist in Emergency Medicine who must handle the task as team leader in the ED. The aim is to enchance and standardize the quality of the reception, care and treatment provided to adult acutely critical patients and improve psychological safety, thereby improving overall patient safety. Methods Normalization Process Theory (NPT) was selected as overall analysis tool and planning/implementation tool. Data was collected both qualitatively via semistructured research interviews and quantitatively via a questionnaire. All ED physicians went through education and simulation, in the role as team leader and trained their Non-technialcal skills (NTS). All the instructors in the simulation were educated in facilitation at CAMES (Copenhagen Academy for Medical Education and Simulation) The qualitative results were analyzed with theories about psychological safety during new work process in emergency departments by Dieckmann et al. Results Results showed a higher degree of patient safety because of improved psychological safety in the trigger team, better communication and more uniform execution of the patient evaluation. - The nurses felt recognised for their competencies. - Within the team, the organisation was clear, and all team members were heard and involved based on their competencies. - Critical care is no longer felt as delayed due to a lack of leadership and plan for the patient - All patients are now evaluated through the ABCDE concept - During the process of change, ongoing feedback and adjustments have further optimised the use of NTS - Fewer adverse events have been reported after the implementation Conclusion - The staff involved in trigger team activation should be educated in NTS and receive continuing simulation training by instructors educated In simulation. - A clear team leader role enhances the ED nurse’s psychological safety and has improved patient safety.

Baggrund: Patienter med kroniske smerter kan have behov for at arbejde med livsstilsforbedringer som en del af den tværfaglige rehabilitering. Tidligere studier har vist ergoterapiens potentiale i en livsstilsorienteret tilgang til smertebehandling, men der er behov for yderligere forskning i dansk kontekst. Formål: Som forberedelse til et randomiseret kontrolleret studie, blev den ergoterapeutiske intervention REVEAL(OT) [Redesign your EVEryday Activities and Lifestyle with Occupational Therapy] pilotafprøvet som et tillæg til det nuværende tværfaglige behandlingstilbud på et regionalt smertecenter i Region Sjælland. Metoder: Ambulante patienter med kroniske smerter (n=40) mellem 18 og 65 år (85% kvinder) henvist til Tværfagligt Smertecenter på Næstved sygehus deltog i undersøgelsen. Ergoterapeuter har samarbejdet med deltagerne omkring deres personlige mål i relation til daglige aktiviteter, regelmæssig bevægelse og spisevaner. Primære effektmål for studiet var prædefinerede progressionskriterier (ift. progression til det randomiserede studie) for rekruttering, accept af undersøgelsesprocedurer, retention, deltagelsesprocent, uønskede hændelser og planmæssig levering af programmet. Sekundære effektmål var helbredsrelateret livskvalitet, aktivitetsudførelse, aktivitetsbalance, kroppens antropometri og smertesensitisering. Tendenser blev monitoreret ved at sammenligne før- og eftermålingerne. Fokusgruppeinterviews med 8 patienter og 4 klinikere blev gennemført for en dybere indsigt i, hvordan REVEAL(OT) blev oplevet. Resultater: Foreløbige analyser af data fra deltagere (n=30) som har afsluttet programmet, demonstrerede acceptabelt-til-godt niveau i opfyldelsen af de primære effektmål, samt en tendens til signifikant forbedring i de sekundære mål: aktivitetsudførelse (1.76 [95% CI 1.22; 2.29]) og tilfredsheden med aktivitetsudførelsen (1.88 [95% CI 1.01; 2.75]). REVEAL(OT) medvirkede til øget accept af livet med kroniske smerter hos patienterne og deres empowerment for livsstilsændringer. Patienter og klinikere foreslog en række forbedringer i interventionen. Konklusioner: Pilotafprøvningen af det ergoterapeutiske program REVEAL(OT) har givet et indblik i, hvordan der kan arbejdes med daglige aktiviteter og livsstil som led i den tværfaglige smertebehandling. Et randomiseret studie skal afdække effekten af det ergoterapeutiske livsstilsorienterede program for kroniske smertepatienter.

Kronisk Obstruktiv Lungesygdom (KOL) er associeret med andre sygdomme og øget dødelighed, og forringer ofte patienternes livskvalitet. KOL medfører hyppigt åndenød, hoste, træthed, indskrænket funktionsniveau, angst, følelsesmæssig depression og social isolation. Sygdommen fordrer, at patienterne formår at håndtere de forskellige symptomer i deres hverdag. Der tilbydes, i det danske sundhedsvæsen, gruppebaseret lungerehabilitering til KOL-patienter, som klart bør prioriteres, fordi det styrker deres selvopfattelse og evne til at handle i forhold til sygdommen. De motiveres til at leve sundere og dermed styrke deres helbred og livskvalitet. Gruppeformen bør dog suppleres med individuelle tilbud som støtte i hverdagen.

Kapitel i bogen: Fænomenologi og hermeneutik - Anvendelse og argumentation i sygeplejen Redigeret af Birgit Heimann Hansen. Forlaget samfundslitteratur.

Introduction: Intensified multifactorial intervention for 7.8 years in patients with type 2 diabetes mellitus and microalbuminuria increased life length and reduces complication rates. The present analysis is a sub-study examining the long-term effects specifically on coronary artery disease (CAD) and cerebrovascular disease. Methods: The original intervention (mean treatment duration 7.8 years) involved 160 patients with type 2 diabetes mellitus and microalbuminuria that were randomly assigned to either conventional therapy or intensified, multifactorial treatment including both behavioral and pharmacological approaches. After 7.8 years the study continued as an observational follow-up with all patients offered treatment as for the original intensive-therapy group. The primary end-point of this sub-analysis of the follow-up, 21.2 years after intervention start was the relative risk reduction in CAD (defined as non-fatal acute myocardial infarction or cardiac revascularization) and cerebrovascular disease (defined as non-fatal ischemic or hemorrhagic stroke) and the secondary end-point was a composite of CAD, stroke and death from cardiovascular disease. Results: Hazard rates of CAD, stroke and the composite end-point were all significantly decreased in the intensive-therapy group with HR of 0.43 [95 % CI 0.23 – 0.77; p = 0.005], 0.26 [95 % CI 0.12 – 0.55; p < 0.001] and 0.36 [95 % CI 0.23 – 0.57; p < 0.001], respectively in Cox-regressions adjusted for age and sex. In addition, the risk of recurrent primary events was significantly decreased in the intensive-therapy group (p = 0.049 for CAD and p = 0.003 for stroke). Conclusions: At 21.2 years of follow up of 7.8 years of intensified, multifactorial, target driven treatment of type 2 diabetes mellitus with microalbuminuria, we demonstrate significant risk reductions in coronary and cerebral artery disease. (ClinicalTrials.gov number, NCT00320008.)

INTRODUCTION: The importance of supervision and of surgeons' level of experience in relation to patient outcome have been demonstrated in both hip fracture and arthroplasty surgery. The aim of this study was to describe the surgeons' experience level and the extent of supervision for: 1) fracture-related surgery in general; 2) the three most frequent primary operations and reoperations; and 3) primary operations during and outside regular working hours. MATERIAL AND METHODS: A total of 9,767 surgical procedures were identified from the Danish Fracture Database (DFDB). Procedures were grouped based on the surgeons' level of experience, extent of supervision, type (primary, planned secondary or reoperation), classification (AO Muller), and whether they were performed during or outside regular hours. RESULTS: Interns and junior residents combined performed 46% of all procedures. A total of 90% of surgeries by interns were performed under supervision, whereas 32% of operations by junior residents were unsupervised. Supervision was absent in 14-16% and 22-33% of the three most frequent primary procedures and reoperations when performed by interns and junior residents, respectively. The proportion of unsupervised procedures by junior residents grew from 30% during to 40% (p <0.001) outside regular hours. CONCLUSION: Interns and junior residents together performed almost half of all fracture-related surgery. The extent of supervision was generally high; however, a third of the primary procedures performed by junior residents were unsupervised. The extent of unsupervised surgery performed by junior residents was significantly higher outside regular hours.

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.

One hundred patients scheduled for elective colo-rectal cancer surgery, and with a preoperative haemoglobin level < or = 8.5 mmol/l were included. Eighty-one patients could be evaluated. Thirty-eight patients received r-HuEPO in a dose of 300 IU/kg body weight on day four before surgery and 150 IU/kg, daily, for the following seven days, and 43 patients received placebo. In addition, all patients received daily doses of 200 mg iron, orally, for four days before surgery. On the day of surgery and until discharge the haemoglobin concentration was significantly higher in the erythropoietin group compared to the placebo group. The number of blood transfusions given was significantly lower in the erythropoietin group with a mean of 0.3 units per patient (0-6) compared to 1.6 units (0-9) in the control group (p < 0.05). The clinical implications of these findings has yet to be assessed.