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Stig Holm Ovesen,1,2 Søren Helbo Skaarup,3 Rasmus Aagaard,4 Hans Kirkegaard,1 Bo Løfgren,1,5 Michael Dan Arvig,6– 8 Bo Martin Bibby,9 Stefan Posth,10 Christian B Laursen,11,12 Jesper Weile1,2 1Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark; 2Emergency Department, Horsens Regional Hospital, Horsens, Denmark; 3Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; 4Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark; 5Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark; 6Emergency Department, Slagelse Hospital, Slagelse, Denmark; 7Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; 8Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; 9Department of Biostatistics, Aarhus University, Aarhus, Denmark; 10Emergency Department, Odense University Hospital, Odense, Denmark; 11Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; 12Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, DenmarkCorrespondence: Stig Holm Ovesen, Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J103, Aarhus, 8200, Denmark, Email stigholm@clin.au.dkPurpose: Point-of-care ultrasound (POCUS) helps emergency department (ED) physicians make prompt and appropriate decisions, but the optimal diagnostic integration and potential clinical benefits remain unclear. We describe the protocol and statistical analysis plan for a randomized controlled trial. The objective is to determine the effect of a POCUS-driven diagnostic pathway in adult dyspneic ED patients on the proportion of patients having a hospital stay of less than 24 hours when compared to the standard diagnostic pathway.Patients and Methods: This is a multicenter, randomized, investigator-initiated, open-labeled, pragmatic, controlled trial. Adult ED patients with chief complaint dyspnea are eligible. Patients are randomized (1:1) to the POCUS-driven diagnostic pathway or standard diagnostic pathway, with 337 patients in each group. The primary outcome is the proportion of patients having a hospital stay (from ED arrival to hospital discharge) of less than 24 hours. Key secondary outcomes include hospital length-of-stay, 72-hour revisits, and 30-day hospital-free days.Conclusion: Sparse evidence exists for any clinical benefit from a POCUS-integrated diagnostic pathway. The results from this trial will help clarify the promising signals for POCUS to influence patient care among ED patients with dyspnea.Keywords: focused lung ultrasound, focused cardiac ultrasound, shortness-of-breath, diagnostic effectiveness

Sandra Thun Langsted,1– 3 Kasper Glerup Lauridsen,2– 4 Jesper Bo Weile,2,3,5 Søren Helbo Skaarup,6 Hans Kirkegaard,2,3 Bo Løfgren1– 4 1Department of Emergency Medicine, Randers Regional Hospital, Randers, Denmark; 2Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; 3Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 4Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark; 5Department of Emergency Medicine, Horsens Regional Hospital, Horsens, Denmark; 6Department of Respiratory Medicine, Aarhus University Hospital, Aarhus, DenmarkCorrespondence: Bo Løfgren, Department of Emergency Medicine, Randers Regional Hospital, Skovlyvej 15, Randers, NE, 8930, Denmark, Tel +457842 0000, Email bl@clin.au.dkBackground: Dyspnea caused by pleural effusion is a common reason for admission to the emergency department (ED). In such cases, thoracentesis performed in the ED may allow for swift symptom relief, diagnostics, and early patient discharge. However, the competence level of thoracentesis and training in the ED are currently unclear. This study aimed to describe the current competencies and training in thoracentesis in Danish EDs.Methods: We performed a nationwide cross-sectional study in Denmark. A questionnaire was distributed to all EDs in March 2022 including questions on competencies and thoracentesis training methods. Descriptive statistics were used.Results: In total, 21 EDs replied (response rate 100%) between March and May 2022. Overall, 50% of consultant and 77% of physicians in emergency medicine specialist training were unable to perform thoracentesis independently. Only 2 of 21 EDs (10%) had a formalized training program. In these 2 EDs, there were no requirements of maintaining these competences. Informal training was reported by 14 out 21 (66%) EDs and consisted of ad-hoc bedside procedural demonstration and/or guidance. Among the 19 EDs without formalized training, 9 (47%) had no intention of establishing a formalized training program.Conclusion: We found a major lack of thoracentesis competencies in Danish EDs among both consultant and physicians in emergency medicine specialist training. Moreover, the vast majority of EDs had no formalized thoracentesis training program.Keywords: thoracenteses, training, competencies, emergency medicine

Objectives To evaluate general practitioners’ (GPs’) ability to perform focused lung ultrasound (FLUS) following a training program and assess FLUS feasibility in general practice. Also, to describe FLUS findings and evaluate GPs’ ability to interpret these in adults with acute lower respiratory tract infection (LRTI) when pneumonia is suspected and assess GPs’ perception of FLUS impact.Methods Nine GPs, using point-of-care ultrasound, completed a FLUS training program. Adults (≥ 18 years) with acute cough (< 28 days) and at least one other symptom of acute LRTI, where the GP suspected pneumonia, were subsequently included. All patients received FLUS. The GPs reported FLUS findings, feasibility, and perception of FLUS impact. Recorded FLUS videos from all patients were reviewed by two specialists (Specialist Reference). The specialists assessed FLUS image quality. Agreements between the GPs and the Specialist Reference on FLUS findings were used to evaluate GPs’ ability to interpret FLUS.Results Of 91 patients included, FLUS image quality was acceptable or higher in 84 patients (92.4%). FLUS proved feasible with only two scans not completed. The GPs reported FLUS pathological findings in 51.7% of patients in 78% agreement with the Specialist Reference and Cohen’s kappa 0.56. Focal B-lines represented the most frequent pathological findings. The GPs perceived that FLUS impacted change in tentative diagnosis and/or plans for treatment and/or visitation in 29 (32.0%) of patients.Conclusion After the training, the GPs performed FLUS well. Interpretation of FLUS pathology presence was of moderate agreement. The GPs perceived that FLUS had impact on patient management.Trial registration number ClinicalTrials.gov NCT04711031

Introduction Colposcopy is a standard procedure for evaluating cervical abnormalities and collecting cervical biopsies. The procedure is associated with intra- and inter-observer variation. A colposcopic scoring system, Swedescore, has been designed to standardise and facilitate colposcopy training. Swedescore has performed well in a routine clinical setting when used by expert colposcopists to find or exclude high-grade lesions. Danish clinical guidelines for colposcopy differ from other countries, as they recommend collecting four cervical biopsies in all women regardless of risk factors or colposcopy findings. Swedescore has never been examined to assess the reduction of cervical biopsies in a real-world clinical setting. This study aims to investigate whether the implementation of Swedescore can optimise the diagnostic work-up for whom the collection of biopsies can be safely omitted or reduced.Methods and analysis The design is a clinical multicentre non-randomised intervention study in Denmark. According to a power calculation, we will need to include 586 women referred for colposcopy. Colposcopy with Swedescore will be compared with conventional colposcopy with no Swedescore. Cervical biopsies will be divided into two separate vials (target and random biopsies). The primary outcome will be normal or cervical intraepithelial neoplasia grade 1 detected in cervical biopsies. χ2 and logistic regression will be used to compare estimates between arms.Ethics and dissemination The study protocol has been submitted to the Ethical Committee in Central Denmark region and is not notifiable to the Committee (j.no.: 1-10-72-124-22). Results will be published in a peer-reviewed journal and presented at scientific meetings.Trial registration number NCT05870787.Protocol version Version 3 (date 12. November 2024).

Introduction Spontaneous pneumothorax (SP) affects both young, otherwise healthy individuals and older persons with known underlying pulmonary disease. Initial management possibilities are evolving and range from observation to chest tube insertion. SP guidelines suggest an individualized approach based on multiple factors such as symptoms, size of pneumothorax, comorbidity and patient preference.Aim With this Danish national survey we aimed to map organization of care including involved specialties, treatment choice, training, and follow-up plans to identify aspects, and optimization of spontaneous pneumothorax management.Method A survey developed by the national interest group for pleural medicine was sent to all departments of emergency medicine, thoracic surgery, respiratory medicine, and to relevant departments of abdominal or orthopaedic surgery.Results The response rate was 75 % (47 of 65). Overall, 21% of responding departments had no guideline for SP management, which was provided by multiple specialties with marked heterogeneity in choice of treatment including tube size, management during admission, and referral procedure to follow-up. Few departments required procedure training, and nearly all of the responders called for improvements in management of pneumothorax.Conclusion This survey suggests that SP management and care is delivered heterogeneously across Danish hospitals with marked difference between respiratory physicians, emergency physicians, general surgeons and thoracic surgeons. It is therefore likely that management is sub-optimal. There is a need for a common Danish SP guideline to ensure optimal treatment across involved specialties.

This paper presents an empirical study and related activity system analysis regarding the implementation and use of Moodle specifically, and learning management systems in general, in problem-based learning. The research involved an exploration of the characteristics that defined use of Moodle at a Danish university, the reasons why Moodle was or was not used in specific contexts and the way in which Moodle use was perceived by students. Some of the obstacles and challenges identified through this study highlighted the need for a deeper analysis of the elements that characterised the activity system(s) and their contradictions in this contextual setting, leading to a consideration of possible implications for change processes. The investigation consisted of a literature review, a survey of 345 students regarding their experiences with Moodle in conjunction with a nomination for the best Moodle course, an analysis of the 178 nominated courses and interviews with four university teachers about their use of Moodle. This examination revealed that many existing Moodle activities at Aalborg University focus more on sharing information and teaching materials and less on the students' problem-based learning activities and projects. This finding is intriguing, as use of Moodle does not reflect that problem-based learning comprises the pedagogical foundation of Aalborg University's academic programme. The investigation uncovered several reasons for the lack of focus on problem-based learning in Moodle structures and content and explored them through the contradictions identified within the activity systems and between the double contextual frame surrounding the interacting activity system.

This article presents the main findings of an applied research project, which studied student experiences of the challenges and opportunities of Problem-Based Learning (PBL) in two master programmes (MPs) at Aalborg University (AAU) characterised by diverse student groups, who bring different educational backgrounds, skills and experiences to the table. Research shows that PBL holds a potential for integrating and promoting learning outcomes for diverse student population, but also that heterogeneity can have negative influence on group dynamics and collaboration central in PBL, but how students experience this is under-researched. The investigation shows that diversity in terms of age differences and varieties in educational backgrounds are experienced both as challenges in teaching situations, but also as an opportunity to increase student learning over time. The study concludes with recommendations for practical alterations of the introduction to and conditions for the PBL model.

Abstract Introduction During the initial Coronavirus Disease 2019 (COVID-19) pandemic wave, sparse personal protection equipment made telephone triage of suscpeted COVID-19 patients for ambulance transport necessary. To spare resources, stable patients were often treated and released on-scene, but reports from Italy suggested that some later detoriated. We implemented a prehospital sit-stand test to identify patients in risk for detoriation. Methods The test was implemented as part of a new guideline in stable suspected COVID-19 patients younger than 70 years with no risk factors for serious disease triaged by general practitioners to ambulance response in the Central Denmark Region. Data were collected from April 6th to July 6th 2020. The primary outcome for this study was the proportion of patients treated with oxygen within 7 days among patients decompensating vs patients not decompensating during the test. Results Data on 156 patients triaged to ambulance response by general practioners were analysed. In total 86/156 (55%) were tested with the sit-stand test. Due to off-guideline use of the test, 30/86 (34.8%) were either older than 70 or had risk factors for serious disease. 10/156 (6%) of patients had a positive COVID-19-test. In total, 17/86 (20%) decompensated during the test and of these, 9/17 (53%) were treated with oxygen compared to 2/69 (3%) in patients who did not decompensate (p

Low temperature district heating is recognized as a key technology for the (cost-) efficient integration of renewable energy and waste heat sources in our energy systems. Several studies indicate that a deployment of local district heating schemes is a key measure for reaching the politically set climate goals. Further, implementation of low temperature district heating systems are recommended for taking maximum advantages of synergies with other sectors for decarbonization of the heating sector. Within the IEA DHC Annex TS2 project already realized low temperature community energy system concepts as well as planned or designed systems are identified and visualized. Furthermore, projects showing an innovative heat use or operation of buildings are also included in the analyses. The different projects are assessed and compared. The presentation of the demonstrators is set up in such a way that knowledge is generated about the indoor heating system, the district heating system and of the competitiveness of low temperature district heating systems, giving the evidence that these systems are feasible, efficient and reliable under various boundary conditions. The demonstrators further indicate that there are existing challenges, where further research on innovative district heating concepts for integrating decentral feed-in of renewable energy is required. The demonstrators included in the IEA DHC Annex TS2 are analysed in regard to which elements of new knowledge they can generate. For each demonstrator there are specific innovations in focus. Furthermore, the case studies show that the related business models for the utilities change when system temperatures are lowered. The paper presents and discusses the results from current research work within of the IEA DHC Annex TS2 on Implementation of Low Temperature District Heating Systems (Averfalk et al., 2021; Annex TS2, 2021 [1]).

The diagnostic accuracy of handheld ultrasound (HHUS) devices operated by newly certified operators for pneumonia is unknown. This multicenter diagnostic accuracy study included patients prospectively suspected of pneumonia from February 2021 to February 2022 in four emergency departments. The index test was a 14-zone focused lung ultrasound (FLUS) examination, with consolidation with air bronchograms as diagnostic criteria for pneumonia. FLUS examinations were performed by newly certified operators using HHUS. The reference standard was computed tomography (CT) and expert diagnosis using all medical records. The sensitivity and specificity of FLUS and chest X-ray (CXR) were compared using McNemar's test. Of the 324 scanned patients, 212 (65%) had pneumonia, according to the expert diagnosis. FLUS had a sensitivity of 31% (95% CI 26–36) and a specificity of 82% (95% CI 78–86) compared with the experts' diagnosis. Compared with CT, FLUS had a sensitivity of 32% (95% CI 27–37) and specificity of 81% (95% CI 77–85). CXR had a sensitivity of 66% (95% CI 61–72) and a specificity of 76% (95% CI 71–81) compared with the experts' diagnosis. Compared with CT, CXR had a sensitivity of 69% (95% CI 63–74) and a specificity of 68% (95% CI 62–72). Compared with the experts' diagnosis and CT diagnosis, FLUS performed by newly certified operators using HHUS devices had a significantly lower sensitivity for pneumonia when compared to CXR (p < 0.001). FLUS had a significantly higher specificity than CXR using CT diagnosis as a reference standard (p = 0.02). HHUS exhibited low sensitivity for pneumonia when used by newly certified operators. [ABSTRACT FROM AUTHOR]

Background: In Canada, one in seven adults has diabetes (i.e., 2.3 million) and the lifetime risk of developing diabetes is approximately 30% by age 65. Although 30% of patients admitted to the hospital have diabetes, data from inpatient hospitalizations for patients with diabetes are lacking, both in Canada and globally. Objective: To validate International Classification of Diseases 10th edition Canadian version (ICD-10-CA) codes for the identification of patients with diabetes, to create a multicenter database of patients with diabetes hospitalized under internal medicine in Ontario, and to determine their baseline characteristics, medication use, and admission characteristics. Study design: We created a database of people who had diabetes and were hospitalized between 2010 and 2020 at 8 hospitals in Ontario that were part of the General Medicine Inpatient Initiative (GEMINI) hospital data-sharing network. Patients who had diabetes were identified using chart review, based upon either (i) a previous physician diagnosis of diabetes, (ii) a recorded hemoglobin A1c ≥ 6.5% or (iii) outpatient prescription of a diabetes medication preceding the hospitalization. The test characteristics of ICD-10-CA codes for diabetes were evaluated. We compared baseline demographics, medication use and hospitalization details among patients with and without diabetes. For hospitalization details, we collected information on the admission diagnosis, comorbidity index, length of stay, receipt of ICU-level care, and inpatient mortality. Results: There were 384,588 admissions within the total study cohort, of which 118,987 (30.9%) had an ICD-10-CA diagnosis code of diabetes (E10.x, E11.x, E13.x, E14.x). The sensitivity and specificity of ICD-10-CA diagnostic codes was 95.9% and 98.8%, respectively. Most patients with an ICD-10-CA code for diabetes had a code for type 2 diabetes (93.9%) and a code for type 1 diabetes was rare (6.1%). The mean age was 66.4 years for patients without diabetes and 71.3 years for those with an ICD-10-CA diagnosis code for diabetes. Patients with diabetes had a higher prevalence of hypertension (64% vs. 37.9%), coronary artery disease (28.7% vs. 15.3%), heart failure (24.5% vs. 12.1%) and renal failure (33.8% vs. 17.3%) in comparison to those without diabetes. The most prevalent diabetes medications received in hospital were metformin (43%), DPP4 inhibitors (22.7%) and sulfonylureas (18.8%). The most common reason for admission among patients with diabetes was heart failure (9.0%), and among patients without diabetes was pneumonia (7.8%). Median length of stay was longer for patients with diabetes (5.5 vs. 4.5 days) and in-hospital mortality was similar between groups (6.8% with diabetes vs. 6.5% without diabetes). Importance: Diabetes is one of the most prevalent chronic medical conditions, affecting roughly one third of all patients hospitalized on an internal medicine ward and is associated with other comorbidities and longer hospital stays. ICD-10-CA codes were highly accurate in identifying patients with diabetes. The development of an inpatient cohort will allow for further study of in-hospital practices and outcomes among patients with diabetes. [ABSTRACT FROM AUTHOR]

Pesticide pollution has raised public concern in Denmark due to potential negative health impacts and frequent findings of new substances after a recent expansion of the groundwater monitoring programme. Danish drinking water comes entirely from groundwater. Both the raw groundwater and the treated drinking water are regularly monitored, and the chemical analyses are reported to a publicly available national database (Jupiter). Based on these data, in this study we (1) provide a status of pesticide content in drinking water supplied by public waterworks in Denmark and (2) assess the proportion of Danish households exposed to pesticides from drinking water. ‘Pesticides’ here refers also to their metabolites, degradation and reaction products. The cleaned dataset represents 3004 public waterworks distributed throughout the country and includes 39 798 samples of treated drinking water analysed for 449 pesticides (971 723 analyses total) for the period 2002–2019. Of all these chemical analyses, 0.5% (n = 4925) contained a quantified pesticide (>0.03 μg/l). Pesticides were found at least once in the treated drinking water at 29% of all sampled public waterworks for the period 2002–2019 and at 21% of the waterworks for the recent period 2015–2019. We estimate that 56% of all Danish households were potentially exposed at least once to pesticides in drinking water at concentrations of 0.03–4.00 μg/l between 2002 and 2019. However, in 2015–2019, the proportion of the Danish households exposed to pesticides (0.03–4.00 μg/l) was 41%. The proportion of Danish households potentially exposed at least once to pesticides above the maximum allowed concentration (0.1 μg/l) according to the EU Drinking Water Directive (and the Danish drinking water standard) was 19% for 2002–2019 and 11% for 2015–2019. However, the maximum concentrations were lower than the World Health Organization’s compound-specific guidelines. Lastly, we explore data complexity and discuss the limitations imposed by data heterogeneity to facilitate future epidemiological studies.

Abstract Aims The present study had two aims: (i) compare echocardiographic parameters in COVID‐19 patients with matched controls and (2) assess the prognostic value of measures of left (LV) and right ventricular (RV) function in relation to COVID‐19 related death. Methods and results In this prospective multicentre cohort study, 214 consecutive hospitalized COVID‐19 patients underwent an echocardiographic examination (by pre‐determined research protocol). All participants were successfully matched 1:1 with controls from the general population on age, sex, and hypertension. Mean age of the study sample was 69 years, and 55% were male participants. LV and RV systolic function was significantly reduced in COVID‐19 cases as assessed by global longitudinal strain (GLS) (16.4% ± 4.3 vs. 18.5% ± 3.0, P