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At a public office with a staff of 129, twenty people work for short periods with large amounts of self-copying paper. A controlled study has shown a significantly higher incidence of pruritus and nasal congestion amongst staff exposed to large amounts of self-copying paper or its components, no drying of the skin after working with the paper and no increased degree of irritation of the skin were found in the study group at dermatological examination. No differences were found between the study group and the control group with respect to allergy or skin status or working conditions apart from the contact with self-copying paper. The study confirms that contact with fresh self-copying paper may result in pruritus and skin irritation, but allergy to the paper or microcapsule contents could not be demonstrated in this study.

Introduction: According to international standards, Denmark's production of scientific papers is high, but is slowly losing ground. The reformed research education was intended to strengthen Denmark's position, but some fear that it will have the opposite effect., Material and Methods: Based on the Registry of Ph.D. students and data from the Central Office of Civil Registration, we conducted a survey among 1170 persons previously enrolled in a Ph.D. program. Data on published papers were stratified according to gender, age, master degree, institution, year and length of enrolment. The response rate was 46%., Results: A total of 6-7 papers, including 3 first authorships, were published during the Ph.D. study and the first three years thereafter. Only about 10% did not publish in these periods. Over a 10-year time span, the number of publications before, during and three years after the Ph.D. degree was stable. Women and men published the same number of papers based on the Ph.D. project; however the total number of research publications was higher for men., Conclusion: As measured by the number of publications, the Danish Ph.D. education is solid and independent of gender, age, and time. However, in order to strengthen the overall Danish biomedical research production additional public funding and time allocated to clinical research is necessary.

Chronic neuropathic pain is often very difficult to treat effectively and constitutes a significant burden on both the affected patients and society. Invasive neuromodulation, electrical stimulation of specific nerve structures with implanted electrodes, can be a viable treatment option for patients suffering from severe, chronic neuropathic pain where conventional treatment has not provided sufficient pain relief. Careful patient selection is vital. This paper provides an overview of the treatment field in Denmark.

The Danish Health Authority has recently published a new guideline on the treatment of lumbar disc herniation with radiculopathy. This paper goes through the surgical treatment and considers the evidence behind surgical treatment of these patients, along with the outcome reported in literature. The new guideline recommends referring patients to be assessed by a surgeon within 12 weeks in cases, where severe and debilitating pain persists despite non-surgical treatment. This is found to be well in line with literature, as many studies have shown time to be a predictive factor in surgical treatment of these patients.

The objective of this paper is to give insight into evidence-based recommendations on key clinical questions regarding treatment of lumbar disc herniation with radiculopathy. This paper is based on the recently published Danish national clinical guideline for non-operative treatment. Limited evidence is found regarding non-surgical treatment of patients with lumbar radiculopathy. Physiotherapy, in the form of group sessions, seems to have the best level of evidence. However, evidence is still very limited and of poor quality. No evidence has been found with regards to acupuncture or manipulation therapy.

Cannabis is the world's most popular illicit drug, and around half of all Danes have tried it at least once. In this paper we review the pharmacodynamic and pharmacokinetic properties of cannabis. We also discuss the treatment of cannabis intoxication and present data from The Danish Poison Information Center.

In Denmark, hospitals in these years reorganize the overall acute treatment of patients with the aim of providing better quality of treatment during several common interventions. This paper presents a status of the limited number of Danish studies, which have examined the acute care and knowledge about the planned interventions in the emergency departments. The new concept for the reception and treatment of emergency patients opens up new areas of research in a Danish context. The number of preliminary published results that have been presented by Danish acute conferences testify this.

This paper introduces the concept of health literacy to the Danish health field by sharing the definition, conceptual model and matrix from the European Health Literacy Survey (HLS-EU). The general results of the HLS-EU are presented to show how health literacy can be measured, and how limited health literacy is a challenge for various European countries. The fact that the term health literacy is not easily translated into Danish might be a barrier for its wider use and dissemination. However, this should not be an excuse for lack of attention or action in Danish health services.

Health-care workers may experience uncertainty regarding legal matters when attending to medical needs of undocumented migrants. This paper applies a pragmatic focus when addressing the legal aspects involved in providing health-care services to undocumented migrants with examples from the Danish Health Act and international conventions. The delivery of medical care to vulnerable groups such as pregnant women and children is described.

In-hospital cardiac arrest carries a poor prognosis. Registries of in-hospital cardiac arrest provide the opportunity to improve quality of care and conduct research of disease mechanisms and treatment. This paper describes the preliminary experience with systematic registration of in-hospital cardiac arrest at Aarhus University Hospital, Denmark. Data from 102 patients are presented and practical aspects and challenges of establishing a registry and implementing the collection of data in daily clinical practice are discussed.

Introduction: Medically relevant fiction and biographies are thought to possibly improve the reader's emotional competences, thus contributing to the (postgraduate) study of medicine. This paper evaluates whether medical novels might be relevant in the (postgraduate) study of medicine., Materials and Methods: The contents of four medical novels were evaluated qualitatively as regard to the professional and cultural contents and relevance., Results: The medical novels were composed uniformly and considered to be both professional and cultural subjects. The professional subjects were mostly described correctly, and milieu and cultural subjects were realistic., Discussion: The contents of the medical novels were relevant, but briefly described. Students of medicine and junior doctors may identify with the environment and the cultural subjects. It is not ruled out that medical novels can be used to acquire cultural competences, but - as regards professional knowledge - the study of professional literature will be more time-effective.

Systematic process triage is a relatively unknown concept in Denmark. Currently there are no national recommendations regarding triage models for use in the emergency department (ED). Four medium-sized EDs from different regions across the country cooperated in a joint venture to develop a new triage model, Danish Emergency Process Triage (DEPT). DEPT is inspired by the Swedish ADAPT system, but modified for a Danish context. This paper summarizes the cumulated experience with the new system.

The Faculty of Health Sciences, University of Southern Denmark has developed a course in research training for residents, where traditional face-to-face teaching is mixed with computer-supported collaborative learning. The course focuses on the ability to ask research questions, retrieve information and appraise scientific papers. Initially, many course participants are reluctant to the course concept. Yet a majority of participants are very active online and give the course good evaluations. The course concept seems well-suited to "scaffold" participants' acquisition of research methodology competences.

In this paper we describe the first four phases of a curriculum reform covering the three clinical years of medical school at Aarhus University. The reform intends to ease students' transition from medical school to the foundation year, increase focus on communication, create more coherence between subjects, increase students' active participation, and align learning outcomes and assessments. More than 80 stakeholders participated in the first phases and five task forces gave their recommendations on how to achieve the intentions. The next phases are initiated on the basis of this solid work.

The Danish Act of Patient Safety entered into force in 2004. This paper studies the consequences of the Act for the health care system and its users by a literature evaluation and an interview study with key persons. Despite the substantial resources spent on the reporting system, no evidence is found that the Act has an improved effect on patient safety. One of the biggest barriers for reporting adverse events is a lack of follow-up and feedback. Research into the patient's role on preventing adverse events is limited. The possibilities created by the Act should be utilized to their full potential.

Danish health law does not explicitly consider the participation of patients in clinical training of medical students. This causes uncertainty with regards to patients' rights and to the obligations of the hospital and the medical student. In this paper, we evaluate the legal aspects as regards information, consent and privacy in situations where patients are involved in the training of medical students. We conclude that it is necessary to elucidate the legal aspects and develop legal and practical guidelines for these situations.

Peer-led training has been identified as a useful tool for delivering undergraduate healthcare training. In this paper we describe the implementation of the European Resuscitation Council BLS/AED Course as a peer-led training program for medical students.

Introduction: Critical intersectorial problems of co-operation are revealed through an organizational psychological analysis focusing on intergroup dynamics. The aim of the paper is to examine and improve the intersectorial co-operation in psychiatry and present a new trio-interview design that includes patients as well as staff., Material and Methods: Results from a follow-up study investigating the co-operation between Psychiatric Center Amager (PCA) and socialpsychiatric institutions (SPI) in Copenhagen is presented and analysed. The study was based on data gathered via structured interviews with patients and staff from both sectors (n = 60 in 2005, n = 87 in 2007), employing quantitative as well as qualitative methods. The newly developed trio-interview design with informant-triads for studies of the quality of intersectorial co-operation in psychiatry was applied to the study., Results: Quantitative data from the patients showed that the co-operation was generally considered to be unsatisfactory in 2005 and 2007. SPI satisfaction estimates concerning the latest hospitalization period were higher in 2007 than in 2005. Staff from both sectors estimated that co-operation was significantly higher during 2007 than during 2005. Qualitative data showed that in 2007, staff was the decisive factor., Conclusion: The co-operation was estimated to be unsatisfactory in 2005 and 2007. Measures to strengthen intersectorial co-operation were implemented in 2006, but had limited effect.

Introduction: Varicoceles are present in about 15% of the male population. The treatment is surgical and internationally there has been an increase in the use of a subinguinal microsurgical approach in which the veins of the spermatic cord are ligated. The purpose of this paper is to evaluate the results of the first microsurgical varicocelectomies performed in Denmark., Material and Methods: The medical records of boys and men who underwent microsurgical varicocelectomy between 1 February 1999 and 1 June 2007 at Rigshospitalet, Gentofte Hospital and Herlev Hospital, were reviewed., Results: A total of 132 patients were included in the study. Ten recurrences (8%) and ten complications (8%) were found (one lesion of the vas deferens, six haematomas, two hydroceles and one patient with haematoma/infection). Following surgery, two patients underwent orchiectomy due to a lack of blood flow and sustained pain from the scrotum one year after the operation, respectively. When pain was the indication for surgery, resolution of this symptom was seen in 69 of 77 patients (90%). In one patient, the pain increased. After the implementation of a structured surgery schedule and after assigning the procedure to a single surgeon only, the number of recurrences and complications for the last 47 operated patients decreased to 0% and 4%, respectively., Conclusion: In trained hands microsurgical varicocelectomy was an effective method with few complications and recurrences.

Egg-donation is an efficient treatment of female infertility caused by ovarian failure. Although the use of volunteer donors has been allowed in Denmark since 1 January 2007, there is a shortage of oocyte donors, which is in contrast to the increasing demand from couples in need of donor eggs. In this paper we discuss possibilities to enhance the recruitment of volunteer donors. In order to increase the number of egg-donations, the Danish legislation should be changed to allow the use of crossed anonymous donation.

The study shows that GPs perceive systematic reviews of patient cases as potential learning vehicles. This is in line with adult learning theories, which argue that professional capability is best enhanced by situating learning in real-life contexts. This paper argues that we should think pragmatically when developing learning methods, and strengthen future efforts to develop methods that ensure reliable learning based on reviews of patient cases.

In 2007 the Faculty of Health Sciences, Aarhus University, took a first step towards outcome-based education. During an educational development process, all courses developed clear, consistent descriptions of learning outcomes and extensive, template-based course descriptions. This enabled the Faculty to implement a new national grading system and to prepare for Aarhus University's application for an ECTS label. Furthermore, the process created the basis for alignment of outcomes, assessment and teaching. In this paper, we share results, problems encountered and lessons learned.

Introduction: This paper discusses the optimal distribution of responsibility between general practitioners (GPs) and hospitals for follow-up of patients with chronic diseases. We investigated a set of risk stratification criteria developed to optimize specialist shared care for patients with diabetes mellitus., Material and Methods: We included patients with diabetes from the catchment areas of four diabetes out-patient clinics in southern Denmark. Patients were risk-stratified to 3 follow-up levels (level 1 - follow-up only by their GP, level 2 - intensified follow-up by GP and/or shared care schemes, level 3 - follow-up only in out-patient clinics). The results were subsequently compared with the patients' actual follow-up status., Results: A total of 647 patients (563 type 2 diabetes and 84 type 1 diabetes) were included from 15 GPs. Among these, 139 were stratified to level 1, 409 to level 2 and 99 to level 3. A total of 444 patients were actually being followed by their GP, 129 in shared care and 74 in out-patient clinics. The frequency of out-patient and shared care control varied from 13% to 39% between the four centres., Conclusion: Patients generally had a higher risk profile than anticipated. The model could select high-risk patients to be followed in specialized out-patient clinics. The model was less suitable for patients with low or moderate risk, and it should be modified before its general introduction.

Introduction: The present paper describes the surgical procedure that typically causes a lesion of the sural nerve and the most common symptoms of such lesion. The medical and legal aspects in relation to the Patient Insurance Association (PIA) are discussed., Materials and Methods: The study includes 29 cases with an isolated lesion of the sural nerve during the period 1996 to 2004. We registered gender, age, disease, type of operation, compensable claims, degree of impairment, symptoms, need for medication, supplementary examination, size of compensation, time from operation to filing of claims and time from filing to final resolution., Results: A total of 52% of the lesions were caused by venous surgery, 27.7% by Achilles tendon surgery. A total of 38% of the patients underwent further examination, and 7% had to receive treatment in specialised pain-clinics. The following symptoms were typical: reduced sensibility or numbness, weakness of the foot, reduced range of motion, pain in the heel, radiating pain to the forefoot, more constant burning pain and painful paraestesia or hypersensibility. A total of 52% of the claims were considered compensable, 38% according to "the specialist rule" (Section 2.1.1) and 13.8% according to "the tolerance rule" (Section 2.1.4). The median amount of compensation was DKK 29,731. The mean casework time in the PIA was 278 days., Conclusion: Lesion of the sural nerve most frequently occurs after surgery to the Achilles tendon or after venous surgery, leading to symptoms varying from loss of sensibility to severe hypersensibility and burning paraestesia. With the significant anatomical variation and the documented risk of disabling damage following lesion to the sural nerve, the surgeon needs to be very attentive when operating in the proximity of the sural nerve.

Introduction: The "Medicinprofilen" on the website www.sundhed.dk was introduced in 2004. This paper describes the application of this tool for the evaluation of compliance of patients in pharmacological treatment of hypertension in a general practice (single)., Materials and Methods: Data about all patients with ICPC treatment code "K86 Ukompliceret hypertension", who were undergoing pharmacological treatment was used for the study. (n=296). All patients should have been treated for at least 1 year up to the data collection period which took place in the second half of the year 2005., Results: We found that the "Medicinprofilen" was a suitable tool to estimate compliance. Among the patients examined we found that compliance was 95% (92.4-97.4)., Conclusion: The "Medicinprofilen" is a suitable tool to estimate compliance of patients undergoing pharmacological treatment in general practice. A few methodical problems exist. The study showed a high rate of compliance for the group of patients undergoing treatment of hypertension.

The frequency of multi resistant bacteria (MRB) is also increasing in Denmark. This creates problems in hospitals as well as in primary health care. This paper focuses on the increase in MRSA and resistance against beta-lactams and quinolones in Enterobacteriaceae, including infection control measures against the transmission of these bacteria. The increase in MRB is a direct threat against the Danish antibiotic policy and MRB should continuously be handled without hesitation.

Aim: Developmental delay (DD) is a serious, lifelong handicap, often accompanied by additional conditions/handicaps. The paper describes the prevalence and aetiology of DD in children in Copenhagen County, Denmark, and discusses how to ensure referral of the children to neuro-paediatric examinations and neurobiological investigations., Materials and Methods: From a cohort of 95,400 children, aged 4-15 y, from Copenhagen County, Denmark, 1126 children with IQ=80 were included (98% of the estimated number of children with DD). The children were included from the paediatric department and from school psychologists. Three groups of children were compared with respect to prevalence, aetiology and presence of additional diagnoses: IQ=50 (moderate to profound DD), IQ 51-70 (mild DD) and IQ 71-80 (borderline DD)., Results: The prevalence of moderate to profound DD was 4.0/1000, the prevalence of mild DD was 4.9/1000 and the prevalence of borderline DD was 2.9/1000. The aetiology in the three groups was clear in 67%, 40% and 29% of the children respectively. Most commonly, it was prenatal. Additional diagnoses were present in 52% of the children. In total, 26% had never been examined by a neuro-paediatrician., Conclusions: The prevalence of DD corresponds to studies from the other Nordic countries, but the aetiology is less known in the present material. The aetiology and presence of additional diagnoses could possibly be found in more children if the level of referral to neuro-paediatric examinations is changed.

Introduction: Over the years town gas has caused many fatal carbon monoxide poisonings. The aim of this paper is to document the circumstances surrounding town gas deaths in Denmark between 1995-1999 and to trace the development of these deaths in recent decades., Materials and Methods: A retrospective study of death certificates and report material concerning carbon monoxide deaths in Denmark between 1995-1999 caused by town gas. Of 449 non-fire related carbon monoxide poisonings, 22 (4.9%) were caused by town gas., Results: The deaths consisted of fourteen suicides, six accidents, and two with undetermined manner of death. Ten (71%) of the suicide victims were men and four (29%) were women, with an average age of 48 years (24-82 years); all had turned on two or more gas rings. The accident victims were one man and five women, with an average age of 84 years (77-92 years); all had only turned on one gas ring., Conclusion: The number of town gas deaths has been drastically reduced since 1969, which can be explained by the reduced number of town gas installations containing carbon monoxide as well as preventive measures. Most deaths can probably be avoided when the town gas supply is switched to carbon monoxide-free town gas in 2007, but it is important to be aware that incomplete combustion of carbon monoxide-free town gas can still lead to carbon monoxide poisonings.

On the basis of two case reports, this paper gives an overview of hepatitis E with respect to clinical features and occurrence in a non-endemic country like Denmark. Both reported cases were imported from endemic countries. The article includes a brief overview of the recent virology, epidemiology and clinical features of hepatitis E, with emphasis on the most frequently imported cases in Denmark.

The first multidisciplinary intensive care unit in the world was established at the Copenhagen Municipal Hospital in December 1953. The man behind the concept was the Danish anesthesiologist Bjørn Ibsen (born: 1915). The paper outlines the conditions that made it possible for Ibsen to establish a unit where all categories of severely-ill patients were monitored and treated around the clock along the lines used in the operating theatres. The history of the technological and scientific evolution of intensive care therapy is briefly summarised. It is concluded that despite the increased sophistication of intensive care therapy, it often meets with failure because it is started too late. The development of an early warning system is urgently needed.

Introduction: This paper illustrates how reporting of adverse events can be used to introduce changes in an organization. Starting from reports of incidents on wrong-site surgery, a method to prevent them and its implementation in the Copenhagen Hospital Corporation (H:S) are described., Materials and Methods: The H:S adverse event database, the Danish Patient Insurance Association and international sources were searched to estimate the extent of wrong-site surgery. A method to prevent wrong-site surgery developed by the U.S. Department of Veterans Affairs was adapted for Danish conditions. It was introduced as "The Five Steps" in H:S in May 2005, accompanied by an information campaign., Results: Wrong-site surgery incidents are rare: reports in the H:S show an occurrence of 1:32,500 surgical procedures, consistent with international figures. Seven root cause analyses were performed and showed a need for a more structured identification and communication process among the members of the operating team. The Five Steps were designed to prevent such problems. None of the Five Steps is in itself new or revolutionary. The crucial parts are systematization of the identification process and increased communication among the members of the operating team. The procedure is not associated with substantial resource utilization and involves more a change in culture than an investment. The method can be widely implemented in hospitals in Denmark without major changes., Conclusion: Wrong-site surgery is a rare but serious adverse event. This paper describes the results of root cause analyses after reports of incidents in the H:S. The analyses showed a need for better and more structured communication and identification of patients before surgical intervention.

Introduction: Few studies have been published about the attitudes of doctors and nurses towards reporting and handling adverse events. However, knowledge about staff attitudes is relevant and may be essential to dealing with potential problems and barriers that staff might have, as well as to supporting cultural change in relation to reporting and learning., Materials and Methods: From February to March 2002, a questionnaire comprising 133 questions was distributed to 4019 doctors and nurses in four counties in Denmark. This paper deals with only a subset of the results of the survey., Results: Responses were obtained from 703 doctors and 881 nurses, yielding an overall response rate of 51%. Statistical analysis was performed with non-parametric tests (Mann-Whitney, Kruskal-Wallis). The survey shows large differences in attitudes among different staff groups towards reporting adverse events, and errors, in their reasons for not reporting and their degree of distress at the prospect of making mistakes. Doctors are more reluctant (34%) than nurses (21%) to bring up adverse events and errors, indicating as their main reasons: lack of tradition, fear of the press, and the risk of being reprimanded. In contrast to consultants, "non-consultants" (staff specialists and junior doctors), and especially the female members of this group, show a greater agreement with each of the proposed reasons. The thought that one may cause injury to a patient induces 35% of "non-consultants" to consider giving up their job "now and then/often"., Discussion: Efforts to improve patient safety culture can become more effective via knowledge about similarities and differences among staff groups that have been uncovered in this survey.

22 papers on clinical decision support (CDS) for computer physician order entry (CPOE) and the ability to reduce medication errors were reviewed. Among the 22 original clinical trials, 21 demonstrated a reduced number of medication errors after the implementation of CDS. The effect was strongest for 2nd and 3rd generation of the CDS-systems. CPOE with CDS is time consuming and may generate new medication errors in itself. All the trials had poor designs. A Danish data source for CDS has not yet been established.

Introduction: The aim of this study was to determine the prevalence of delirium based on the CAM scale in a geriatric ward in a university hospital. This paper describes the numbers of predisposing and precipitating factors are compared with the development of delirium. Finally, we present a discussion about treatment and prophylaxis., Materials and Methods: Over a period of eight weeks, all newly admitted patients were interviewed and scored with CAM. The numbers of predisposing and precipitating factors were registered. Finally, the treatment was focused upon., Results: 270 patients were admitted, 222 patients were interviewed and 48 patients were excluded. The prevalence of delirium was 7%. We were unable to find a correlation between risk factors or precipitating factors and delirium for this population., Conclusion: The prevalence of 7% is a satisfying result. There is a discrepancy between diagnosing delirium with CAM and the doctors' routine. All patients must be considered as high-risk patients. Treatment has not been completely standardised.

The Barthel Index is widely used in the evaluation of function. In Denmark at least three versions are used without a consensus of their specific formulation. The term ''Modified Barthel Index'' is used for several versions. A Barthel Index score without version has no meaning since a maximum score in one version indicates very poor function in another. This paper describes the proper usage of the Barthel Index and suggests the terminology ''Barthel-20'' and ''Barthel-100'' for the recommended versions published by Collin et al and Shah et al. The number after ''Barthel-'' indicates the maximum score.

An increasing number of patients in contact with the Danish health services have a non-Danish background. What are the ethical questions and dilemmas doctors face with this patient population in relation to their participation in medical research? This paper discusses the core medical ethical principles, including autonomy, beneficence, non-maleficence and justice in relation to the participation in research of members of various ethnic groups.

Introduction: On Denmark's decision to join the war in Iraq, it was decided to immunise all personnel to be deployed there with anthrax vaccine. This paper describes the types and frequency of adverse reactions to the vaccine., Materials and Methods: Between March 2003 and February 2004, 1,899 immunisations against anthrax in 755 personnel were registered at the health care facilities of the Danish Defence., Results: No serious or life-threatening adverse reactions were reported. The data showed a statistically significant decrease in adverse reactions between the four immunisation series. For males, adverse reactions after the second immunisation depended on possible adverse reactions to the first immunisation. In females, this correlation was not found. No differences in the frequency of adverse reactions between males and females were found., Discussion: None of the vaccinated persons suffered serious or life-threatening adverse reactions. Compared to other studies on self-reported adverse reactions, the overall frequency was low. The data showed a statistically significant decrease in adverse reactions between the four immunisation series. This has been described in comparable studies. The correlation between adverse reactions in the second immunisation being dependent on adverse reactions to the first immunisation has been partly confirmed by other studies. No differences between the sexes were found, probably because only a few females were included in the study. In case of a significant level of threat concerning biological weapons, immunisation against anthrax is considered appropriate.

The paper describes the current organisation of clinical trials in Danish hospitals, with particular emphasis on the relationship between hospitals and the pharmaceutical industry. Legal responsibilities as well as mutual agreements on collaboration and organisation are described and discussed.

Introduction: The clinical behaviour of General Practitioners (GPs) can best be influenced by identifying their incitements and barriers in the first place. The purpose of this paper was to describe a model for the outreach visits, in which the purpose was to facilitate and evaluate the desired changes in the clinical behaviour of the GPs. We demonstrate the usefulness and workability of the model as a tool to be used in future implementations., Materials and Methods: A total of 41 GPs in the Counties of Aarhus and Vejle participated in the spring of 2000 in an advanced educational programme about how to diagnose and treat patients with functional disorders. All participating GPs received an invitation for a six-month follow-up visit. The purpose of the follow-up visit was to facilitate and evaluate their educational benefits and experience in using psychiatric rating scales. The strategy of the visit was to structure the dialogue with reference to identifying incitements and barriers and to emphasize their strengths, weaknesses, opportunities and threats in connection with the change of their clinical behaviour., Results: Thirty-eight (93%) of the GPs participated in the follow-up outreach visits. The chosen strategy proved to be useful in primary care settings. We identified several areas in which the motivation of the GPs and their possibilities to implement the desired behavioural changes could be strengthened., Conclusion: The results suggest that the incitements and barriers of the GPs to change their clinical behaviour can be identified using the strategy described. We suggest that the strategy should form part of the development and evaluation of outreach visits in Denmark.

Recent analyses place Danish health science with the highest scientific impact per investment and the greatest share of most-cited papers globally. Several fields have international top score impact implying that they achieve more frequent citing than the average (Matthew effect). This appears paradoxical in view of the drastic reductions in Danish research budgets through the last 20 years--and the concomitant switch from long-term government grants to short-term external/private funding implying that continuity is replaced by demands for prompt results. Danish health research has thus proved remarkably robust under the steady downward tendency, but it is doubtful how far it will withstand current policy without irreversible damage. The methodologies applied in assessment of the excellence of research become increasingly sophisticated. They are still not completely reliable. At present they are primarily retrospective. It is imperative that future instruments monitor the actual research position.

This paper is a review of the literature on health professionals with substance abuse and it deals with the epidemiology, treatment, and results. A similar study has been carried out on health professionals in Denmark. Very few data are available for this group. The prevalence of substance abuse in health personnel seems to be equal to that in the general population, and from these data it is estimated that 3300 doctors/nurses in Denmark have an active alcohol abuse whereas the prevalence of other drug abuse is not known. The National Board of Health receives 150 new cases a year, in which decisions about specific treatment are made. Not all these cases are about substance abuse. Today, no organised treatment is on offer to health personnel with substance abuse, and they are forced to find their own. Results from abroad indicate that treatment with some degree of monitoring gives better results for health personnel than no monitoring, perhaps because of the risk of losing their authorisation, which is the penalty in this group, if substance abuse continues. From the results of a Danish study, the treatment in Greater Copenhagen seems less effective than the treatment given abroad. It is, therefore, recommended that the treatment of health personnel should be centralised in three or four places in Denmark, each with capacity for 30 outpatients. It is furthermore recommended that inpatient treatment of health personnel in work, which, generally speaking will be that needed in connection with detoxification, takes place in departments with a special interest in treating this kind of patient. Inpatient treatment is furthermore recommended for patients with psychiatric or somatic co-morbidity in addition to the substance abuse, or where repeated attempts at outpatient treatment have been unsuccessful. The estimated need is the possibility of admittance to two psychiatric beds per centre. Lastly, it is recommended that structured treatment in this group of patients should be established in close co-operation with the unions for advisory or legal assistance in the case of early retirement or change of job.

Between one third and half of all consultations result in a prescription, and general practitioners are responsible for more than 80 per cent of the use of reimbursed prescription drugs in Denmark. Good prescribing habits imply the use of a limited number of drugs of which the doctor has a good knowledge. The risk of inappropriate prescribing is higher among doctors who prescribe many different drugs. The prescribing habits of the individual physician are quite stable, and changes usually occur slowly and as a result of various influences, including scientific papers, specialist recommendations, meetings, colleagues, patients, and drug companies. Previous development initiatives were often based on the assumption that suboptimal prescribing practice was due to lack of knowledge. It was, thus, expected that easily understandable information alone could improve the prescribing in general practice. However, continuous medical education based on didactic methods such as lectures and clinical guidelines have proved ineffective. Quality development should include thorough problem identification and analysis, elucidation of barriers towards change, and a combination of several targeted interventions. The implementation of changes should be seen as a complex, slowly progressing process in which continuous evaluation should be carried out with a view to adjusting the interventions.

Foreign studies mainly describe errors in medicine prescriptions in context with adverse drug events unlike most Danish studies and projects, which focus on documentation. Current methods of prescribing medicines in Denmark only partially follow the guidelines given by the National Board of Health. About two thirds of the prescriptions are unambiguous. Errors of potential clinical significance are estimated to occur in 4.5% of prescriptions. Transcription errors occur mainly from patients' records to the medication forms and are found in 23% to 83% of transcribed prescriptions. Several departments have intervened by using only one prescription form, a paper or electronic version, which reduced the number of ambiguous prescriptions and eliminated transcription errors. Dispensing errors are common and demonstrate the importance of further quality improvement.

Introduction: In Denmark, the National Register of Patients has, by law since 1977, received discharge diagnoses, surgical codes, and, in recent years, also codes for specific medical treatments for all hospitalised patients. It is an important source of administrative data and for epidemiological research. This paper summarises the results of an evaluation of the register as a tool for assessing quality in gynaecological departments in Denmark., Material and Methods: We obtained data describing production and quality of abortions, ectopic pregnancies, hysterectomies, endometrial ablations, ovarian cysts, ovarian, cervical, and endometrial cancer, in vitro fertilisation, insemination, and urine incontinence. A search was also made for possible miscodings in order to evaluate the extent of such miscoding and to obtain more valid quality estimates., Results: The validity and completeness of the diagnosis codes were generally poorer than that of the surgical codes, especially that of the newer medical treatment codes. We found a rather different clinical practice and quality at the 38 gynaecological departments studied. In order to reduce this stochastic noise, we analysed all small departments as a single unit. Generally, the quality was the same in both the larger and the smaller units., Conclusion: The register seems well suited for routine production and quality control.

Introduction: Since 1991, the Danish Junior Doctors' Association has carried out annual investigations among its members in regard to education. In 2001, the questionnaire included a special section about scientific activities., Materials and Methods: The investigation included approximately 70 questions which were sent to all members of the Danish Junior Doctors' Association. A total of 76.2% answered the questionnaire. The age of the junior doctors and the year of graduating are comparable in the investigations from 1993 to 2001., Results: 52.7% of the junior doctors make research in their spare time, and 47.1% have published at least once as primary researcher. The comparison of the investigations from 1993 to 2001 shows a significant fall in the average publications per doctor and in the number of doctors with at least one published paper. From 1999, there were 7% doctors less with one published paper (chi 2 = 53.4; p < 0.001). The average number of published articles per primary researcher has declined from 6.69/doctor in 1993 to 2.48/doctor in 2001 (t = -25.04, p < 0.001). As a whole, 11.9% of all junior doctors had a PhD-degree and 3.0% had a doctor's degree. 7.6% were in the process of a PhD-study. The number of junior doctors with a PhD is significantly rising. The number of doctors seeking positions at universities is less than 2%, the rest seek clinical education and work., Discussion: The publication rate has declined over the past ten years, which has many reasons. One reason is the increasing number of PhD-degrees and an increase in the impact factor, which means qualitative research improvement. A changed procedure in the postgraduate education is a factor as well. The low recruitment of junior doctors for pregraduate education seems to be a constant problem.

This paper describes drug development based on pharmacogenetic experiences and the inherent implications for the health professions in the primary health care service sector. Pharmacogenetics involves increased demands for competence in extracting the newest knowledge for the benefit of the patients, and the need for advising patients about of usage and the ethical aspects of drugs, which are prescribed on the basis of the genetic profile of a specific patient. International experiences show that the health professions in general are poorly trained to handle this task. There is no evidence that the health professionals in the primary health care service sector in Denmark are any better prepared. This paper concludes that if the positive prospects of pharmacogenetics are to benefit patients, systematized training of the health professionals in the primary health care sector is needed.