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Background: Despite the widespread implementation of competency-based education, evidence of ensuing enhancedpatient care and cost-benefit remains scarce. This narrative review uses the Kirkpatrick/Phillips model to investigate thepatient-related and organizational effects of graduate competency-based medical education for five basicanesthetic procedures.Methods: The MEDLINE, ERIC, CINAHL, and Embase databases were searched for papers reporting results inKirkpatrick/Phillips levels 3–5 from graduate competency-based education for five basic anesthetic procedures. A grayliterature search was conducted by reference search in Google Scholar.Results: In all, 38 studies were included, predominantly concerning central venous catheterization. Three studies reportedsignificant cost-effectiveness by reducing infection rates for central venous catheterization. Furthermore, the proceduralcompetency, retention of skills and patient care as evaluated by fewer complications improved in 20 of thereported studies.Conclusion: Evidence suggests that competency-based education with procedural central venous catheterizationcourses have positive effects on patient care and are both cost-effective. However, more rigorously controlled andreproducible studies are needed. Specifically, future studies could focus on organizational effects and the possibility oftransferability to other medical specialties and the broader healthcare system.Keywords: Anesthesia, Graduate medical education, Internship and residency, Catheterization, Central venous, Anesthesia,General, Anesthesia spinal, Anesthesia, Epidural, Airway management, Competency-based education, Mastery learning

BackgroundDisease-modifying therapies (DMT) for multiple sclerosis(MS) has shown to reduce the risk of disabilityprogression. However, injection therapy may not bepreferred by patients because of injection-relatedproblems and may negatively affect the therapeuticoutcome. Low adherence to treatment in MultipleSclerosishas shown to lead to poor health outcomes(ref. 1).Patients outcome could be greatly improved by theintroduction of new orally administered agents, whichmay promote better adherence by avoiding injection-related problems (ref. 2) however few studiesinvestigate adherence.Differences in treatment adherence to various diseasemodifying drugs in the treatment of MS are not wellunderstood and the impact of treatment satisfaction,motivation and quality of life on treatment adherenceis infrequently investigated. Lack of adherence or eventreatment discontinuation may be a result of patientdissatisfaction with the treatment or low motivationto treatment. The unpredictable nature of relapses inRRMS may also lead to perceived lack of efficacy anddecreased adherence.ObjectivesThe objective of this study was to investigate adherenceto fingolimod therapy and to evaluate to whatextend treatment satisfaction, motivation and Qualityof Life influence adherence in Danish patients withRRMS.MethodsThe study was conducted in Denmark from May 2013to May 2016 at 8 out of 10 possible MS clinics. A totalof 195 MS patients treated with fingolimod wereincluded in the study over a period of 6 months (Table1). All patients had received fingolimod treatment forat least 6-months prior to study inclusion. The patientswere asked to bring all their study medication tothe clinic at baseline and at 6 months post baseline.Adherence to fingolimod therapy was measured by pillcount conducted by MS nurses (Table 2).The patients Quality of Life (QoL) was evaluated withthe short form health survey (SF-12). Patient self-motivationwas measured using the treatment self-regulationquestionnaire (TSRQ). Physicians support tomotivate the patient was measured by the Health CareClimate Questionnaire (HCCQ).All questionnaires were completed by the patientsalone at a discrete place after instructions by the clinicpersonnel. The questioners were then filled and sealedby the patients in envelope and sent directly to datamanagement.ResultsA high level of treatment adherence to fingolimod wasinitially calculated (103%). However, the study steeringcommittee decided to limit patient compliance to maximum100%. This meant that 25.7% of the patients hadtheir adherence lowered to 100%. With a limit of 100%(individual adherence) the average adherence was calculatedto 96% (Table 2).BackgroundDisease-modifying therapies (DMT) for multiple sclerosis(MS) has shown to reduce the risk of disabilityprogression. However, injection therapy may not bepreferred by patients because of injection-relatedproblems and may negatively affect the therapeuticoutcome. Low adherence to treatment in MultipleSclerosishas shown to lead to poor health outcomes(ref. 1).Patients outcome could be greatly improved by theintroduction of new orally administered agents, whichmay promote better adherence by avoiding injection-related problems (ref. 2) however few studiesinvestigate adherence.Differences in treatment adherence to various diseasemodifying drugs in the treatment of MS are not wellunderstood and the impact of treatment satisfaction,motivation and quality of life on treatment adherenceis infrequently investigated. Lack of adherence or eventreatment discontinuation may be a result of patientdissatisfaction with the treatment or low motivationto treatment. The unpredictable nature of relapses inRRMS may also lead to perceived lack of efficacy anddecreased adherence.ObjectivesThe objective of this study was to investigate adherenceto fingolimod therapy and to evaluate to whatextend treatment satisfaction, motivation and Qualityof Life influence adherence in Danish patients withRRMS.MethodsThe study was conducted in Denmark from May 2013to May 2016 at 8 out of 10 possible MS clinics. A totalof 195 MS patients treated with fingolimod wereincluded in the study over a period of 6 months (Table1). All patients had received fingolimod treatment forat least 6-months prior to study inclusion. The patientswere asked to bring all their study medication tothe clinic at baseline and at 6 months post baseline.Adherence to fingolimod therapy was measured by pillcount conducted by MS nurses (Table 2).The patients Quality of Life (QoL) was evaluated withthe short form health survey (SF-12). Patient self-motivationwas measured using the treatment self-regulationquestionnaire (TSRQ). Physicians support tomotivate the patient was measured by the Health CareClimate Questionnaire (HCCQ).All questionnaires were completed by the patientsalone at a discrete place after instructions by the clinicpersonnel. The questioners were then filled and sealedby the patients in envelope and sent directly to datamanagement.ResultsA high level of treatment adherence to fingolimod wasinitially calculated (103%). However, the study steeringcommittee decided to limit patient compliance to maximum100%. This meant that 25.7% of the patients hadtheir adherence lowered to 100%. With a limit of 100%(individual adherence) the average adherence was calculatedto 96% (Table 2).ConclusionsAs most of the patients have a high adherence to fingolimodtherapy it was not possible to elucidate a clearlink between adherence and treatment satisfaction,QoL, or patient motivation

Aim: To explore how healthcare professionals experience motivational interviewing as a useful? technique when working with pregnant women with obesity. Design: A qualitative, descriptive study based on interviews with eleven healthcare professionals. Setting: Face to face interviews with obstetric healthcare professionals. Sample(size?): Eleven healthcare professionals. Methods: A qualitative descriptive method was applied to semi-structured interviews. The healthcare professional’s experiences were recorded during individual semi-structured qualitative interviews, transcribed verbatim and analysed using a descriptive analysis methodology. Results: Motivational interviewing is an excellent technique in the operation of daily clinics in obstetrics when communicating with obese pregnant women or pregnant women in general. The technique makes the healthcare professionals more aware of their own communication style. Time must be dedicated to the technique, but it enables the healthcare professionals to become more professional and assists them in handling difficult workloads. Conclusion: Healthcare professionals experienced motivational interviewing to be a useful tool when working in obstetrics. Awareness regarding their communication with the patients is increased and their ability to handle difficult workloads. is improved. Lack of time (- or personel?) seems to be a restriction in using the motivational technique

To examine the experience of women with a pre-pregnant BMI >30 kg/m², in their encounters with healthcare professionals during pregnancy.

Objective To examine the experience of women with a pre-pregnant BMI >30 kg/m 2, in their encounters with healthcare professionals during pregnancy. Design Qualitative study using a phenomenological methodology approach. Setting Face-to-face interviews with pregnant women in their own home who were referred from their general practitioner to specialist antenatal follow-up at their local hospital. Sample Sixteen women with pre-pregnant BMI >30 kg/m 2. Methods Qualitative in-depth interviews. Participant's experiences of their encounters with health care professionals were recorded verbatim, transcribed and analysed using a phenomenological approach. Results Two main themes were identified, an accusatorial response from healthcare professionals and a lack of advice and helpful information on how being obese and pregnant might affect the women's health and that of their child. Conclusions Pregnant women with obesity may experience prejudice from healthcare professionals. These women felt they were treated with a lack of respect, an accusatorial response, and the feeling that information which could have been helpful was not forthcoming. Communication between obese pregnant woman and healthcare professionals appears to be lacking. Improved training in communication skills, less judgemental behaviour and better dissemination of information from healthcare professionals working with pregnant women with obesity are needed.

These clinical guidelines were developed by the Danish Pediatric Asthma Center in collaboration with the Danish Paediatric Society. Key messages in the guidelines are: 1) Inhaled steroids are the most effective preventive medication and are first choice in children with persistent symptoms. 2) There is rarely indication for more than low to moderate doses of inhaled steroids as preventive medication. 3) There is insufficient evidence for preventive medication in pre-school children with intermittent asthma; a trial of leukotriene-receptor-antagonists or inhaled steroids could be done.

Background:In Denmark, Omalizumab is approved to treat children with severe persistent allergic asthma older than 6 years of age. No systematic registration of the efficacy in the Danish child population according to asthma symptoms or of the efficacy on co-morbid allergic symptoms exists. Results from a pilot study show that a broad panel of outcome measures is necessary to evaluate the efficacy of Omalizumab treatment as no change in lung function could be demonstratedAim:To provide a standardized systematic registration in order to create a database enrolling children with severe allergic asthma treated with Omalizumab. Method and study design:A national multicenter registration and follow-up study based on children with clinical persistent severe allergic asthma including both retrospective and prospective registration. Inclusion criteria: • 6-18 years of age.• Severe persistent allergic asthma according to GINA treated with Omalizumab • Total serum IgE >?• Planned and accepted off-label treatmentOutcome registration:A broad panel of outcome measures is scheduled at baseline and during treatment:Outcomes: • Asthma exacerbations• Hospitalizations• Medication• Lung function• ACT score • Peak-flow • FeNO• Mannitol/Methacholin test• Tolerable dose of allergen (oral allergen provocation) • Skin prick-test• Total serum IgE• Specific IgE • Quality of life score. (Juniper)• Rhinitis score, R-RTSS• SCORAD score The Follow-up programme (after ?) will be presented in a flowchart.Conclusion:We believe that a national systematic registration would improve sufficient data collection and increase knowledge regarding efficacy of Omalizumab treatment in this rare group of severe allergic asthmatic children.

Aims: This study aimed to explore parents’ perception and experience of a brief intervention (BI), focusingon their alcohol consumption habits to assess the impact on parents of staff members using motivationalinterviewing (MI) and to gain knowledge of how to reinforce initiatives regarding behavioural changes oflifestyle problems in a clinical setting.Background: Substantial parental alcohol consumption influences children’s development negatively. Nursingstaff lacks knowledge and training in communicating with parents about alcohol issues. Little is known aboutparents’ attitudes towards, and perception of, nursing staff addressing issues concerning their use of alcohol.Methods: A qualitative approach by use of phenomenological and hermeneutic methods was applied.Through interviews with 15 parents, their opinions and perceptions of a brief alcohol intervention wereexplored.Results: Three themes emerged from the phenomenological reduction: (1) experiencing respect and genuineinterest from the nursing staff, (2) BI causing reflections on own use of alcohol, and (3) reflections continuingand developing over time.Conclusion and practice implications: The parents did not mind having their lifestyle habits discussed inconnection with having their child admitted to hospital. The method MI proved effective in getting theparents to talk about and reflect on alcohol consumption habits. The effects of the intervention seemed to lastbeyond the first months after the intervention took place.

Duodenal injury following a blunt abdominal trauma is a rare condition. It poses a diagnostic challenge since symptoms are often subtle in the beginning and the trauma may initially remain undisclosed. We present a case of a 16 month-old girl, who was admitted to hospital due to critical illness after a tumble the day before. An explorative laparotomy revealed a perforation of the duodenum. This case demonstrates the importance of thoroughly evaluating anamnesis information and emphasises the need of considering a variety of potential diagnoses when assessing the critically ill child.

Background: There is no systematic identification of parentswith excessive alcohol use who have a child admitted tohospital. Children in families with excessive alcohol issuesform a high risk group as substantial alcohol consumptionhas a damaging influence on a child emotionally, cognitively,socially and physically. Alcohol consumption is asensitive issue, and health staff needs knowledge, qualificationsand adequate training in communicating withparents about this taboo.Aim:• To identify specific patterns in subgroups of parents bycomparing results from screening and demographicvariables• To identify systematic patterns in staff members bydemographic variables to decide whether these factorsinfluence the screening results.Methods: During 1 year, screening and brief intervention(SBI) was accomplished, including health staff conductingdialogues with parents of a hospitalized child using motivationalinterviewing (MI) and screening for risky alcoholbehaviour by Cut down, Annoyance from others, feelGuilty, Early-morning Craving (CAGE)-C. Data wereanalysed by descriptive statistics, and relationships weretested with a statistical significance level of 0.05, usingSPSS (version 16.0).Results: Motivational dialogues with 779 parents were conductedby 43 staff members, and 11% of the parents werescreened positive for risky alcohol behaviour. Drinkingalcohol 4 days a week or more and drinking alcohol outsidemealtimes were main risk factors. Parents’ gender was thestrongest predictor of screening positive and OR was 6.8 formen (CI 4.03–11.74) compared to women, p < 0.0001. AnOR of 1.2 for parents’ age (CI 1.02–1.42) indicates the risk ofscreening positive increases with age, p = 0.027.Conclusions: Brief intervention using CAGE-C and MI hasproven successful in mapping parents’ alcohol consumptionpatterns and in identifying parents with risky alcoholconsumption habits. Health staff is able to manage healthpromotion and prevention when having the right competencesand when being supervised.

BACKGROUND: Allergic rhinoconjunctivitis is a risk factor for asthma development. Treating the underlying allergy may represent an attractive method of asthma prevention. No regulatory guidance exists in this area, and, to our knowledge, no clinical investigations meeting modern regulatory standards have been published. OBJECTIVE: The objective of this publication is to describe the rationale behind the design of and report on the recruitment for the ongoing pediatric Grazax Asthma Prevention (GAP) trial. METHODS: The trial was designed for assessment of the preventive effect of an SQ-standardized grass allergy immunotherapy tablet (AIT) on asthma development, both during treatment and after the end of treatment. (The standardized quality [SQ] procedure is a standardization procedure comprising 3 components: total potency, major allergen content, and assessment of extract complexity.) The trial design was discussed with several European Competent Authorities. RESULTS: The GAP trial is a multinational, parallel-group, double-blind, placebo-controlled randomized trial. Main eligibility criteria were age of 5 to 12 years, grass pollen-induced allergic rhinoconjunctivitis, no asthma, and no overlapping symptomatic allergies. The children have been randomized 1:1 to receive the grass AIT or placebo once daily for 3 years, followed by a blinded observational period of 2 years. Asthma is assessed by the investigators according to specific diagnostic criteria, used at screening visits before randomization to exclude children with existing asthma, and evaluated at least half-yearly during the trial. Seven months of screening resulted in 812 randomized children at 101 centers in 11 countries. CONCLUSIONS: To our knowledge, the GAP trial represents the first double-blind, placebo-controlled randomized trial to assess the preventive effect of allergen-specific immunotherapy on asthma development. A total of 812 children were successfully recruited into the trial. EudraCT number: 2009-011235-12.

INTRODUCTION: In theory, lactate may be used as a more precise measure of the degree of metabolic acidosis than other previous methods, thereby enabling differentiation between acute and chronic foetal hypoxia. The aim of the study was to describe lactate in arterial and venous cord blood in an unselected population of newborn children without signs of foetal hypoxia or perinatal asphyxia. MATERIAL AND METHODS: The study included 208 newborn children. The umbilical cord of the children was double clamped within 30 seconds and thereafter blood was drawn from an umbilical arterial and venous cord. The inclusion criteria were gestational age above 35 weeks and no signs of foetal hypoxia or perinatal asphyxia. RESULTS: Out of 208 newborn children, 105 children were excluded in accordance with the above criteria, thus the remaining 103 newborn children were included. We demonstrated that lactate and CO2 in arterial umbilical cord blood was higher than in venous umbilical cord blood; furthermore, that O2 and pH in arterial umbilical cord blood were lower than in venous umbilical cord blood. Regression analysis including the factors lactate and "active second stage of labour" showed that lactate significantly increased the longer the "active second stage of labour" lasted. CONCLUSION: A reference interval for lactate in arterial and venous umbilical cord blood should be related to the length of "active second stage of labour". This study demonstrates lactate values in arterial and venous umbilical cord blood in an unselected population of newborn children without signs of foetal hypoxia or perinatal asphyxia stratified on mode of delivery. Udgivelsesdato: 2010-Feb-1

This is an intervention-study discussing the long-term effects of a 3-day "Train the trainers course" (TTC). In the intervention (I) group 98.4% of doctors participated in a TTC, both specialists and trainees. Knowledge about teaching skills increased in the I group by 25% after the TTC; a result which was sustained at six months. Teaching behaviour was significantly changed as the use of feedback and supervision had increased from a score of 4 to 6 (max. score = 9). CONCLUSION: A 3-day residential TTC has a significant impact on knowledge gain concerning teaching skills, teaching behaviour and clinical learning culture after six months. Udgivelsesdato: 2008-Oct-27

Udgivelsesdato: 2006-Jun BACKGROUND: Motivational interviewing has been shown to be broadly usable in a scientific setting in the management of behavioural problems and diseases. However, data concerning implementation and aspects regarding the use of motivational interviewing in general practice is missing. AIM:To evaluate GPs' conception of motivational interviewing in terms of methods, adherence to and aspects of its use in general practice after a course. STUDY DESIGN: In a randomised controlled trial concerning intensive treatment of newly diagnosed patients with type 2 diabetes detected by screening, the GPs were randomised to a course in motivational interviewing or not. The study also included a third group of GPs outside the randomised controlled trial, who had 2 years previously received a similar course in motivational interviewing. SETTING: General practice in Denmark. METHOD: The intervention consisted of a 1.5-day residential course in motivational interviewing with 0.5-day follow-ups, twice during the first year. Questionnaire data from GPs were obtained. RESULTS: We obtained a 100% response-rate from the GPs in all three groups. The GPs trained in motivational interviewing adhered statistically significantly more to the methods than did the control group. More than 95% of the GPs receiving the course stated that they had used the specific methods in general practice. CONCLUSION: A course in motivational interviewing seems to influence GPs professional behaviour. Based on self-reported questionnaires, this study shows that the GPs after a course in motivational interviewing seemed to change their professional behaviour in daily practice using motivational interviewing compared with the control group. GPs evaluated motivational interviewing to be more effective than 'traditional advice giving'. Furthermore, GPs stated that the method was not more time consuming than 'traditional advice giving'.

Udgivelsesdato: Januar