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  • 1
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    Colonization with multiresistant bacteria in acute hospital care: the association of prior antibiotic consumption as a risk factor
    Oxford University Press (OUP) ; 2020
    In:  Journal of Antimicrobial Chemotherapy Vol. 75, No. 12 ( 2020-12-01), p. 3675-3681
    Details
    In: Journal of Antimicrobial Chemotherapy, Oxford University Press (OUP), Vol. 75, No. 12 ( 2020-12-01), p. 3675-3681
    Abstract: Antibiotic resistance poses a worldwide threat and knowledge concerning risk factors for colonization with multiresistant bacteria (MRB) is limited. Objectives To examine the impact of prior antibiotic consumption on MRB colonization, with focus on type of antibiotic and timeline between antibiotic prescription and MRB colonization. Methods A nationwide case–control study was conducted and adults visiting emergency departments were invited to participate. All patients were swabbed in the throat, nose and rectum, and analysed for colonization with ESBL-producing Enterobacteriaceae (ESBL-E), MRSA, carbapenemase-producing enterobacteria and VRE. Antibiotic history 2 years prior to enrolment was collected at an individual level through a national register. Multivariate analyses were performed to examine the association between antibiotic consumption and MRB status. A subgroup analysis of ESBL-E-colonized cases was made. Results We included 256 patients colonized with MRB and 4763 controls. In the 2 years prior to study inclusion, 77% of cases and 68% of controls had at least one antibiotic prescription (P = 0.002). We found a significant increase in risk of colonization with ESBL-E if penicillins (OR = 1.58–1.65) or fluoroquinolones (OR = 2.25–6.15) were prescribed. The analysis of all MRB-colonized patients showed similar results. An assessment of the timeline showed a significant increase in risk of colonization up to 2 years after exposure to penicillins, fluoroquinolones and macrolides. Conclusions The prevalence of ESBL-E colonization was related to fluoroquinolone, macrolide and penicillin consumption for at least 2 years after antibiotic treatment.
    Type of Medium: Online Resource
    ISSN: 0305-7453 , 1460-2091
    URL: Article
    DOI: 10.1093/jac/dkaa365
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 1467478-6
    SSG: 15,3
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  • 2
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    Understanding what matters most to patients in acute care in seven countries, using the flash mob study design
    Springer Science and Business Media LLC ; 2021
    In:  BMC Health Services Research Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: Truly patient-centred care needs to be aligned with what patients consider important, and is highly desirable in the first 24 h of an acute admission, as many decisions are made during this period. However, there is limited knowledge on what matters most to patients in this phase of their hospital stay. The objective of this study was to identify what mattered most to patients in acute care and to assess the patient perspective as to whether their treating doctors were aware of this. Methods This was a large-scale, qualitative, flash mob study, conducted simultaneously in sixty-six hospitals in seven countries, starting November 14th 2018, ending 50 h later. One thousand eight hundred fifty adults in the first 24 h of an acute medical admission were interviewed on what mattered most to them, why this mattered and whether they felt the treating doctor was aware of this. Results The most reported answers to “ what matters most (and why)?” were ‘ getting better or being in good health’ (why: to be with family/friends or pick-up life again) , ‘getting home’ (why: more comfortable at home or to take care of someone) and ‘having a diagnosis’ (why: to feel less anxious or insecure) . Of all patients, 51.9% felt the treating doctor did not know what mattered most to them. Conclusions The priorities for acutely admitted patients were ostensibly disease- and care-oriented and thus in line with the hospitals’ own priorities. However, answers to why these were important were diverse, more personal, and often related to psychological well-being and relations. A large group of patients felt their treating doctor did not know what mattered most to them. Explicitly asking patients what is important and why, could help healthcare professionals to get to know the person behind the patient, which is essential in delivering patient-centred care. Trial registration NTR (Netherlands Trial Register) NTR7538 .
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/s12913-021-06459-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2050434-2
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  • 3
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    Chief Complaints, Underlying Diagnoses, and Mortality in Adult, Non-trauma Emergency Department Visits: A Population-based, Multicenter Cohort Study
    California Digital Library (CDL) ; 2022
    In:  Western Journal of Emergency Medicine Vol. 23, No. 6 ( 2022-10-31)
    Details
    In: Western Journal of Emergency Medicine, California Digital Library (CDL), Vol. 23, No. 6 ( 2022-10-31)
    Abstract: Introduction: Knowledge about the relationship between symptoms, diagnoses, and mortality in emergency department (ED) patients is essential for the emergency physician to optimize treatment, monitoring, and flow. In this study, we investigated the association between symptoms and discharge diagnoses; symptoms and mortality; and we then analyzed whether the association between symptoms and mortality was influenced by other risk factors. Methods: This was a population-based, multicenter cohort study of all non-trauma ED patients ≥18 years who presented at a hospital in the Region of Southern Denmark between January 1, 2016–March 20, 2018. We used multivariable logistic regression to examine the association between symptoms and mortality adjusted for other risk factors. Results: We included 223,612 ED visits with a median patient age of 63 and even distribution of females and males. The frequency of the chief complaints at presentation were as follows: non-specific symptoms (19%); abdominal pain (16%); dyspnea (12%); fever (8%); chest pain (8%); and neurologic complaints (7%). Discharge diagnoses were symptom-based (24%), observational (hospital visit for observation or examination, 17%), circulatory (12%), or respiratory (12%). The overall 30-day mortality was 3.5%, with 1.7% dead within 0-7 days and 1.8% within 8-30 days. The presenting symptom was associated with mortality at 0-7 days but not with mortality at 8-30 days. Patients whose charts were missing documentation of symptoms (adjusted odds ratio [aOR] 3.5) and dyspneic patients (aOR 2.4) had the highest mortality at 0-7 days across patients with different primary symptoms. Patients ≥80 years and patients with a higher degree of comorbidity had increased mortality from 0-7 days to 8-30 days (aOR from 24.0 to 42.7 and 1.9 to 2.8, respectively). Conclusion: Short-term mortality was more strongly associated with patient-related factors than with the primary presenting symptom at arrival to the hospital.
    Type of Medium: Online Resource
    ISSN: 1936-900X
    URL: Issue
    URL: Journal
    URL: Article
    DOI: 10.5811/westjem.2022.8.59370
    DOI: 10.5811/westjem
    DOI: 10.5811/westjem.2022.9.56332
    Language: Unknown
    Publisher: California Digital Library (CDL)
    Publication Date: 2022
    detail.hit.zdb_id: 2375700-0
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  • 4
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    Expiratory Technique versus Tracheal Suction to Obtain Good-Quality Sputum from Patients with Suspected Lower Respiratory Tract Infection: A Randomized Controlled Trial
    MDPI AG ; 2022
    In:  Diagnostics Vol. 12, No. 10 ( 2022-10-16), p. 2504-
    Details
    In: Diagnostics, MDPI AG, Vol. 12, No. 10 ( 2022-10-16), p. 2504-
    Abstract: Microbiological diagnostics of good-quality sputum samples are fundamental for infection control and targeted treatment of lower respiratory tract infections (LRTI). This study aims to compare the expiratory technique and tracheal suction on the quality of sputa from adults acutely hospitalized with suspected LRTI. We performed an open-label, randomized controlled trial. Patients were randomized to sputum sampling by tracheal suction (standard care) or the expiratory technique. The primary outcome was quality of sputum evaluated by microscopy and was analysed in the intention-to-treat population. The secondary outcomes were adverse events and patients experience. In total, 280 patients were assigned to tracheal suction (n = 141, 50.4%) or the expiratory technique (n = 139, 49.6%). Sputum samples were collected from 122 (86.5%) patients with tracheal suction and 67 (48.2%) patients with expiratory technique. Good-quality sputa were obtained more often with tracheal suction than with expiratory technique (odds ratio 1.83 [95% CI 1.05 to 3.19]; p = 0.035). There was no statistical difference in adverse events (IRR 1.21 [95% CI, 0.94 to 1.66] ; p = 0.136), but patient experience was better in the expiratory technique group (p 〈 0.0001). In conclusion, tracheal suction should be considered a routine procedure in emergency departments for patients with suspected LRTI.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics12102504
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662336-5
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  • 5
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    Risk of hematoma after hemithyroidectomy in an outpatient setting: a systematic review and meta-analysis
    Springer Science and Business Media LLC ; 2022
    In:  European Archives of Oto-Rhino-Laryngology Vol. 279, No. 8 ( 2022-08), p. 3755-3767
    Details
    In: European Archives of Oto-Rhino-Laryngology, Springer Science and Business Media LLC, Vol. 279, No. 8 ( 2022-08), p. 3755-3767
    Abstract: After thyroid surgery, the overriding concern is the risk of post-thyroid bleeding (PTB). This systematic review and meta-analysis aimed to assess the safety of hemithyroidectomy in an outpatient setting compared to an inpatient setting. The objectives were to (1) find the proportion of PTB in patients scheduled for outpatient hemithyroidectomy, (2) examine if outpatient hemithyroidectomy is clinically safe compared to an inpatient setting and (3) evaluate which selection criteria are most relevant for hemithyroidectomy in an outpatient setting. Methods A systematic review was conducted using the following databases: MEDLINE (Ovid), EMBASE (Ovid) and the Cochrane Library from inception until September 2021. We included studies reporting on PTB of patients after hemithyroidectomy in an outpatient setting. The risk of bias was assessed using the Newcastle-Ottawa tool. The results were synthesised using Bayesian meta-analysis. Certainty in evidence was assessed using the GRADE approach. Results This review included 11 cohort studies and 9 descriptive studies reporting solely on outpatients resulting in a total of 46,866 patients. PTB was experienced by 58 of the 9025 outpatients (0.6%) and 415 of the 37,841 inpatients (1.1%). There was no difference between the PTB rate of outpatients and inpatients (RR 0.715 CrI [0.396–1.243]). The certainty of the evidence was very low due to the high risk of bias. Conclusion The risk of PTB in an outpatient setting is very low, and outpatient hemithyroidectomy should be considered clinically safe. The most relevant selection criteria to consider in outpatient hemithyroidectomy are (1) relevant comorbidities and (2) psycho/-social factors.
    Type of Medium: Online Resource
    ISSN: 0937-4477 , 1434-4726
    URL: Article
    DOI: 10.1007/s00405-022-07312-y
    RVK:
    XA 26650
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1459042-6
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  • 6
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    Healthcare professionals’ experiences and attitudes to care coordination across health sectors: an interview study
    Springer Science and Business Media LLC ; 2022
    In:  BMC Geriatrics Vol. 22, No. 1 ( 2022-12)
    Details
    In: BMC Geriatrics, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-12)
    Abstract: The number of older people is increasing, resulting in more people endure chronic diseases, multimorbidities and complex care needs. Insufficient care coordination across healthcare sectors has negative consequences for health outcomes, costs and patient evaluation. Despite introducing initiatives to solve coordination challenges within healthcare, the need remains for more consistent solutions. In particular, improved care coordination would benefit older adults characterised by complex care needs, high use of healthcare resources and multiple care providers. Aims and objectives To identify and analyse healthcare professionals’ perspectives and approaches to care coordination across sectors when older people are acutely hospitalised. Design Qualitative interview study. Methods Semi-structured, individual interviews with 13 healthcare professionals across health sectors and professions were conducted. The strategy for the qualitative analysis was inspired by Kirsti Malterud and labelled ‘systematic text condensation’. This strategy is a descriptive and explorative method for thematic cross-case analysis of qualitative data. Results Four themes/categories emerged from the analysis; “Organisational factors”, “Approaches to care”, “Communication and knowledge”, and “Relations”. Conclusion Different organisational cultures can discourage intersectoral care coordination. Approaches to care vary at all levels across health sectors and professions. Organisational, leadership and professional identity affect the working cultures and must be considered in the future recruitment and socialisation of healthcare staff. Our research suggests that combinations of healthcare standardisations and flexible, adaptive solutions are required to improve intersectoral care coordination.
    Type of Medium: Online Resource
    ISSN: 1471-2318
    URL: Article
    DOI: 10.1186/s12877-022-03200-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2059865-8
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  • 7
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    The lack of transparency regarding the phosphate content of drugs
    Springer Science and Business Media LLC ; 2023
    In:  International Journal of Clinical Pharmacy Vol. 45, No. 4 ( 2023-08), p. 1019-1021
    Details
    In: International Journal of Clinical Pharmacy, Springer Science and Business Media LLC, Vol. 45, No. 4 ( 2023-08), p. 1019-1021
    Type of Medium: Online Resource
    ISSN: 2210-7703 , 2210-7711
    URL: Article
    DOI: 10.1007/s11096-023-01594-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2601204-2
    SSG: 15,3
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  • 8
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    Improved diagnostics of infectious diseases in emergency departments: a protocol of a multifaceted multicentre diagnostic study
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 9 ( 2021-09), p. e049606-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 9 ( 2021-09), p. e049606-
    Abstract: The major obstacle in prescribing an appropriate and targeted antibiotic treatment is insufficient knowledge concerning whether the patient has a bacterial infection, where the focus of infection is and which bacteria are the agents of the infection. A prerequisite for the appropriate use of antibiotics is timely access to accurate diagnostics such as point-of-care (POC) testing. The study aims to evaluate diagnostic tools and working methods that support a prompt and accurate diagnosis of hospitalised patients suspected of an acute infection. We will focus on the most common acute infections: community-acquired pneumonia (CAP) and acute pyelonephritis (APN). The objectives are to investigate (1) patient characteristics and treatment trajectory of the different acute infections, (2) diagnostic and prognostic accuracy of infection markers, (3) diagnostic accuracy of POC urine flow cytometry on diagnosing and excluding bacteriuria, (4) how effective the addition of POC analysis of sputum to the diagnostic set-up for CAP is on antibiotic prescriptions, (5) diagnostic accuracy of POC ultrasound and ultralow dose (ULD) computerized tomography (CT) on diagnosing CAP, (6) diagnostic accuracy of specialist ultrasound on diagnosing APN, (7) diagnostic accuracy of POC ultrasound in diagnosing hydronephrosis in patients suspected of APN. Methods and analysis It is a multifaceted multicentre diagnostic study, including 1000 adults admitted with suspicion of an acute infection. Participants will, within the first 24 hours of admission, undergo additional diagnostic tests including infection markers, POC urine flow cytometry, POC analysis of sputum, POC and specialist ultrasound, and ULDCT. The primary reference standard is an assigned diagnosis determined by a panel of experts. Ethics, dissemination and registration Approved by Regional Committees on Health Research Ethics for Southern Denmark, Danish Data Protection Agency and clinicaltrials.gov. Results will be presented in peer-reviewed journals, and positive, negative and inconclusive results will be published. Trial registration numbers NCT04661085 , NCT04681963 , NCT04667195 , NCT04652167 , NCT04686318 , NCT04686292 , NCT04651712 , NCT04645030 , NCT04651244 .
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2021-049606
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2599832-8
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  • 9
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    A longterm prospective follow-up study of resurfacing miniprosthesis suitable for patients above sixtyfive years with localized cartilage lesions or early osteoarthritis in the knee
    Springer Science and Business Media LLC ; 2020
    In:  Journal of Experimental Orthopaedics Vol. 7, No. 1 ( 2020-12)
    Details
    In: Journal of Experimental Orthopaedics, Springer Science and Business Media LLC, Vol. 7, No. 1 ( 2020-12)
    Abstract: The aim of the study was to investigate the long-term outcomes of the Focal Femoral Condyle Resurfacing Prosthesis for treatment of localized cartilage lesion in patients 〉  65 years. Methods This was a prospective case series study. Non-reopererated patients initially treated with resurfacing condylar miniprothesis (HemiCAP/UniCAP) were evaluated clinically and radiographically at 7–10 years follow-up (mean 9 years). The clinical examination included the Knee Society Score (KSS) and Visual Analogue Scale (VAS) pain score and EQ5D. The radiographic examination included the Kellgren-Lawrence (KL) grade for investigate of OA progression. A comparison analysis of the preoperative and follow-up subjective outcome data and a Kaplan-Meier implant survival analysis were performed. Results Twenty-three patients were included in the study (9 HemiCAP and 14 UniCAP). There were seven revisions (one HemiCap and six UniCap respectively) (30%) and three patients had died. Follow-up examinations were performed on 10 patients. When comparing follow-up with the preoperative state, there were significant increases in the KSS objective (50.0 ± 8.3) vs. 90.0 ± 6.3)) and KSS function (45.0 ± 11.7) vs. 85.0 ± 4.7)) scores, a decrease in the pain VAS score (7.0 ± 0.9) vs. (4.0 ± 1.9)). Radiographic evaluation demonstrated increase in osteoarthritis development with a KL medial score (2.0 ± 0.6) and KL lateral score (1.4 ± 0.6) vs. (2.0 ± 0.9)).The EQ5D-score was 86 ± 8.4 and patients Health-score was 85 ± 18). Conclusions Resurfacing implant treatment for early OA in patients above 65 years can require revision to knee arthroplasty in 30% of patients. But in patients that are not revised long-term improvements in subjective clinical outcome was demonstrated. This suggests that even elderly patients with isolated cartilage lesions or early OA might benefit from the limited invasive resurfacing implant treatment. Level of evidence IV
    Type of Medium: Online Resource
    ISSN: 2197-1153
    URL: Article
    DOI: 10.1186/s40634-020-00308-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2780021-0
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  • 10
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    Healthcare professionals’ practice and interactions in older peoples’ cross-sectoral clinical care trajectories when acutely hospitalized - a qualitative observation study
    Springer Science and Business Media LLC ; 2021
    In:  BMC Health Services Research Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: Healthcare services have become more complex, globally and nationally. Denmark is renowned for an advanced and robust healthcare system, aiming at a less fragmented structure. However, challenges within the coordination of care remain. Comprehensive restructures based on marketization and efficiency, e.g. New Public Management (NPM) strategies has gained momentum in Denmark including. Simultaneously, changes to healthcare professionals’ identities have affected the relationship between patients and healthcare professionals, and patient involvement in decision-making was acknowledged as a quality- and safety measure. An understanding of a less linear patient pathway can give rise to conflict in the care practice. Social scientists, including Jürgen Habermas, have highlighted the importance of communication, particularly when shared decision-making models were introduced. Healthcare professionals must simultaneously deliver highly effective services and practice person-centered care. Co-morbidities of older people further complicate healthcare professionals’ practice. Aim This study aimed to explore and analyse how healthcare professionals’ interactions and practice influence older peoples’ clinical care trajectory when admitted to an emergency department (ED) and the challenges that emerged. Methods This qualitative study arises from a hermeneutical stand within the interpretative paradigm. Focusing on the healthcare professionals’ interactions and practice we followed the clinical care trajectories of seven older people (aged 〉  65, receiving daily homecare) acutely hospitalized to the ED. Participant observations were combined with interviews with healthcare professionals involved in the clinical care trajectory. We followed-up with the older person by phone call until four weeks after discharge. The study followed the code of conduct for research integrity and is reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines. Results The analysis revealed four themes: 1)“The end justifies the means – ‘I know what is best for you’”, 2)“Basic needs of care overruled by system effectiveness”, 3)“Treatment as a bargain”, and 4)“Healthcare professionals as solo detectives”. Conclusion Dissonance between system logics and the goal of person-centered care disturb the healthcare practice and service culture negatively affecting the clinical care trajectory. A practice culture embracing better communication and more person-centered care should be enhanced to improve the quality of care in cross-sectoral trajectories.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/s12913-021-06953-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2050434-2
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