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Simon Stockmann Poulsen,1 Hanne Irene Jensen,1,2 Karin Due Bruun,3,4 Morten Rune Blichfeldt-Eckhardt,1,3,4 Nina Kvorning1,5 1Department of Anesthesia, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark; 2Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; 3Pain Center of Southern Denmark, Odense University Hospital, Odense, Denmark; 4Department of Clinical Research, University of Southern Denmark, Odense, Denmark; 5Department of Anesthesia and Intensive Care, Hospital of Nykøbing Falster, Nykøbing Falster, DenmarkCorrespondence: Nina Kvorning, Department of Anesthesia and Intensive Care, Slagelse Hospital, Fælledvej 11, Slagelse, DK, 4200, Denmark, Tel +45 51919022, Fax +45 65413028, Email nkv@regionsjaelland.dkPurpose: Increasing recognition of chronic pain diseases, including Fibromyalgia, warrants the need for tools to monitor the impact of the disease as well as the efficacy of interventions. The Revised Fibromyalgia Impact Questionnaire (FIQR) has previously proved to be a valuable tool in both clinical and research settings. The study objective was to translate and validate the FIQR in Danish.Patients and Methods: A forward/backward translation, following the WHO-guidelines, was used to develop the Danish version of FIQR. The Danish translation of FIQR was answered by 101 patients suffering from fibromyalgia. The patients simultaneously answered the Hospital Anxiety and Depression Scale (HADS) and the 36-Item Short-Form Health Survey (SF-36) for validation.Results: The Danish FIQR showed excellent internal consistency, and reliability with Interclass Correlation Coefficients above 0.9. The correlations to HADS and SF-36 ranged from fair to very good. All results were found to have a p-value < 0.05.Conclusion: The present version of the Danish FIQR presents a valid and reliable tool for monitoring the impact of fibromyalgia.Keywords: fibromyalgia, questionnaire, chronic pain, evaluation, validation, translation

Kristina Kock Hansen,1,2 Ole Hilberg,1,2 Hanne Irene Jensen,2,3 Anders Løkke,1,2 Ingeborg Farver-Vestergaard2,4 1Department of Respiratory Diseases, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark; 2Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; 3Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark; 4Department of Medicine, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, DenmarkCorrespondence: Kristina Kock Hansen, Department of Respiratory Diseases, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, 7100, Denmark, Tel +45 20189828, Email kristina.kock.hansen2@rsyd.dkPurpose: Patients with COPD experience anxiety, depression, and stress more frequently than in the age and gender-matched general population. This cross-sectional study aimed to examine the relationship between cognitive functions and the psychological factors of anxiety, depression and stress among patients with COPD.Patients and Methods: Between January 2021 and January 2023, patients with severe COPD were recruited, along with age-matched controls. Participants completed the Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS). The Montreal Cognitive Assessment (MoCA), a continuous reaction time test (CRT), and a driving simulator were used to assess cognitive impairment. Hierarchical multiple linear regression analyses were used to explain the variance of the correlations.Results: In total, 80 patients (mean age = 64yrs) and 22 controls (mean age = 61yrs) participated in the study. Patients reported significantly higher levels of psychological symptoms compared to the controls (p ≤ 0.001). We found no differences in anxiety (p = 0.31), depression (p = 0.66) and stress (p = 0.37) between patients with and without cognitive impairment. However, stress showed to be a significant predictor of decreased attention (higher stress score resulted in decreasing CRT-index, indication a reduced stability in reaction time) (p = 0.02). Psychological factors did not explain additional variance in cognitive functions beyond sociodemographic factors such as age and sex.Conclusion: Psychological symptom levels are higher in COPD than controls and perceived stress among patients with COPD appears to be associated with decreased attention. However, psychological factors in general did not appear to contribute to the variance in cognitive functions beyond sociodemographic, physical, and self-perceived symptoms.Keywords: chronic obstructive pulmonary disease, cognitive impairment, Montreal Cognitive Assessment, anxiety, depression, stress

Aims: Better prediction of outcome after total hip arthroplasty (THA) is warranted. Systemic inflammation and central neuroinflammation are possibly involved in progression of osteoarthritis and pain. We explored whether inflammatory biomarkers in blood and cerebrospinal fluid (CSF) were associated with clinical outcome, and baseline pain or disability, 12 months after THA., Methods: A total of 50 patients from the Danish Pain Research Biobank (DANPAIN-Biobank) between January and June 2018 were included. Postoperative outcome was assessed as change in Oxford Hip Score (OHS) from baseline to 12 months after THA, pain was assessed on a numerical rating scale, and disability using the Pain Disability Index. Multiple regression models for each clinical outcome were included for biomarkers in blood and CSF, respectively, including age, sex, BMI, and Kellgren-Lawrence score., Results: Change in OHS was associated with blood concentrations of tumour necrosis factor (TNF), interleukin-8 (IL-8), interleukin-6 receptor (IL-6R), glycoprotein 130 (gp130), and IL-1β (R 2 = 0.28, p = 0.006), but not with CSF biomarkers. Baseline pain was associated with blood concentrations of lymphotoxin alpha (LTα), TNFR1, TNFR2, and IL-6R (R 2 = 0.37, p < 0.001) and CSF concentrations of TNFR1, TNFR2, IL-6, IL-6R, and IL-1Ra (R 2 = 0.40, p = 0.001). Baseline disability was associated with blood concentrations of TNF, LTα, IL-8, IL-6, and IL-1α (R 2 = 0.53, p < 0.001) and CSF concentrations of gp130, TNF, and IL-1β (R 2 = 0.26, p = 0.002). Thus, preoperative systemic low-grade inflammation predicted 12-month postoperative outcome after THA, and was associated with preoperative pain and disability., Conclusion: This study highlights the importance of systemic inflammation in osteoarthritis, and presents a possible path for better patient selection for THA in the future. Preoperative central neuroinflammation was associated with preoperative pain and disability, but not change in OHS after THA., Competing Interests: C. Varnum received travel expenses from Stryker and L. E. Rasmussen received travel expenses and fees for participation in advisory board from Stryker, both through a company research grant to their department., (© 2024 Blichfeldt-Eckhardt et al.)

Purpose: The purpose of this study was to understand certified registered nurse anesthetists' (CRNAs) experiences of nursing in anesthesia care., Design: An explorative qualitative study was conducted with inspiration from Ricoeur's hermeneutic phenomenological theory of interpretation., Methods: Three focus group interviews were carried out with participants representing 5 anesthesiology departments from 3 hospitals in Denmark (a total of 14 participants). The participants were all CRNAs. The transcribed interviews were examined as one coherent text using a Ricoeur-inspired approach, in which the analysis was conducted on three levels: naive reading, structural analysis, and critical interpretation., Findings: The structural analysis identified three themes relevant to the CRNAs' experiences of nursing: (1) the relationship with the patient, in which caring and professionalism are equally important; (2) differences between professions when sitting in the operating room; and (3) conflicts between production and caring. The study showed that CRNAs are aware of their professional identities as nurses and view anesthesia nursing as an integration of technical tasks and caring, in which the relationship with the patient and serving as the patient's representative are central. A major aspect of nursing is performed while the patient is anesthetized, and the CRNA attends to the patient's basic needs. The study also found that CRNAs find it difficult to define nursing in anesthesia care because of the overlapping tasks and skills between CRNAs and anesthesiologists., Conclusions: CRNAs are very aware of their professional identities as nurses. The professionalism involved in their relationships with patients is evident in the CRNAs' representation of the patients themselves., Competing Interests: Declaration of Competing Interest None to declare., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Background: Critically ill patients experience cognitive impairment throughout their intensive care unit trajectory, in the acute phase and the long-term alike. Cognitive impairment may negatively impact patients' quality of life and rehabilitation outcomes., Aim: To provide an overall examination of literature concerning non-pharmacological interventions that can enhance cognitive functioning in critically ill patients or facilitate their rehabilitation pathway during and after their intensive care unit stay., Study Design: This study was conducted as an umbrella review. A systematic search was conducted in CINAHL, Embase, PubMed and PsychINFO, including all types of peer-reviewed research syntheses published between 2008 and 2023. Eligible studies had to describe interventions capable of improving adult patients' cognitive functioning or supporting their cognitive rehabilitation process throughout the intensive care unit trajectory. All eligible research syntheses were screened systematically; those included were critically appraised., Result: Based on 13 research syntheses, this review summarizes rehabilitative interventions that may be delivered during different phases of critical illness and recovery, in relation to content, delivery and timing. Interventions were: (1) cognitive activities and training, (2) mobilization and physical exercises, (3) emotional, psychological and social support and (4) information., Conclusion: Due to limited evidence, no definitive conclusion can be drawn about which type of intervention is most supportive or effective. Additionally, no recommendations can be made about the optimal timing for intervention delivery., Relevance to Clinical Practice: Clinicians involved in developing and implementing cognitive rehabilitation measures should consider designing individualized, multicomponent interventions with a focus on content, delivery and timing., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Introduction: Decisions to admit patients to intensive care units are often complex, and assessing patients is essential but difficult. In recent years, the Clinical Frailty Scale has been highlighted as a potential assessment tool for triaging patients for admission to the intensive care unit. This study aimed to investigate the clinical differences and Clinical Frailty Scale scores between patients who are refused and those who are admitted to the intensive care unit., Methods: All patients assessed for intensive care therapy at a Danish hospital from December 2020 to December 2021 were prospectively registered. The patients' descriptive data, Clinical Frailty Scale scores, three-month mortality rates and reasons for refusal were retrospectively extracted from hospital records., Results: During the study period, 571 patients were admitted to the intensive care unit, whereas 106 were refused admission. Patients who were refused had a significantly higher median age, a higher (poorer) Clinical Frailty Scale score and a significantly higher three-month mortality rate than patients who were admitted to the intensive care unit., Conclusions: The results indicate that the Clinical Frailty Scale may be one of several useful tools when assessing patients for intensive care therapy. However, this assessment is a multifactorial task, and further research needs to be conducted to examine the usefulness of this scale., Funding: Lillebaelt Hospital, University Hospital of Southern Denmark and the University of Southern Denmark supported this study., Trial Registration: Not relevant., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Introduction: Podcasts have emerged as a promising tool in patient preparation for hospital visits. However, the nuanced experiences of patients who engage with this medium remain underexplored., Objectives: This study explored patients' experiences of receiving information by way of podcasts prior to their hospital visits., Methods: Semi-structured interviews were conducted with patients with suspected chronic obstructive pulmonary disease (COPD), lung cancer, or sleep apnea. The method of data analysis chosen was thematic analysis., Results: Based on data from 24 interviews, five key themes were identified: technical challenges in utilization of podcasts; individual preferences for information prior to hospital visits; building trust and reducing anxiety through podcasts; the role of podcasts as an accessible and convenient source of information; and enhancement of engagement and empowerment through podcasts. Additionally, the study highlighted the critical importance of tailoring podcasts' content to individual preferences to optimize the delivery of healthcare information., Conclusions: Podcasts can serve as a meaningful supplement to traditional information sources for patients. However, it is important to recognize that not all patients may be able to engage with this medium effectively due to technical challenges or personal preferences.

Background: Cognitive impairment poses a significant challenge following critical illness in the intensive care unit. A knowledge gap exists concerning how patients experience cognitive impairments., Objectives: The aim was to explore patients' and relatives' experiences of patients' cognitive impairment due to critical illness following an intensive care unit admission., Methods: A qualitative multicentre study was conducted in Denmark with 3- and 6-month follow-ups using single and dyadic interviews. A phenomenological hermeneutic approach was adopted using a Ricoeur-inspired textual in-depth analysis method. The Consolidated Criteria for Reporting Qualitative Research checklist was used., Results: Three themes emerged from interviews with 18 patients and 14 relatives: 'It feels like living in a parallel world', 'Getting back to a normal everyday life with a vulnerable self', and 'Managing everyday life using self-invented strategies'. Patients used self-invented strategies to manage their vulnerability and newly acquired cognitive impairments when no help or support was provided specifically targeting their cognitive impairments. Not being as cognitively capable as they previously had been turned their lives upside down. Losing control and not being themselves made them vulnerable. Patients did not want to burden others. However, support from relatives was invaluable in their recovery and rehabilitation., Conclusions: Patients experienced multiple cognitive impairments affecting their adaption to everyday life. They strove to overcome their vulnerability using a variety of self-invented strategies and activities., (Copyright © 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Little information exists regarding attitudes related to the presence of the partner in the operation room (OR) during category 1 emergency cesarean section (cat. 1 CS). We investigated how cat. 1 CS under general anesthesia is experienced, both by partners present in the OR and those not., Methods: An explorative prospective cohort trial, with qualitative elements, involving all cat. 1 CS in 2022 in two hospitals. At site 1 the partner was present in the OR during cat. 1 CS, whereas at site 2 the partner was not. Parents and staff answered questionnaires following each cat. 1 CS and semi-structured interviews with partners were held three months after surgery. Qualitative data were analyzed using content analysis. The primary outcome was the partner's answer to the question: "Would you have preferred not being present/being present in the OR?" respectively., Results: Seventeen and eight cat. 1 CS occurred at each site respectively. All parents agreed to participate. No partners in site 1 would have preferred to wait outside, and all evaluated the experience very positively. Partners at site 2 also evaluated not being present positively. Overarching themes from the qualitative analysis were "Being the family witness" and "Experience of being the partner". Mothers and staff from site 1 were very positive about their partners' presence., Conclusion: Partners present in the OR during cat. 1 CS under general anesthesia evaluated this very positively. Most partners, who had not been present in the OR, also evaluated this positively. No partners had post-traumatic stress., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Rises in average life expectancy, increased comorbidities and frailty among older patients lead to higher admission rates to intensive care units (ICU). During an ICU stay, loss of physical and cognitive functions may occur, causing prolonged rehabilitation. Some functions may be lost permanently, affecting quality of life (QoL). There is a lack of understanding regarding how many variables are relevant to health-related outcomes and which outcomes are significant for the QoL of frail, elderly patients following discharge from the ICU. Therefore, this scoping review aims to identify reported variables for health-related outcomes and explore perspectives regarding QoL for this patient group., Methods and Analysis: The Joanna Briggs Institute guidelines for scoping reviews will be employed and original, peer-reviewed studies in English and Scandinavian languages published from 2013 to 2023 will be included. The search will be conducted from July 2023 to December 2023, according to the inclusion criteria in Embase, MEDLINE, PsycINFO and CINAHL. References to identified studies will be hand-searched, along with backward and forward citation searching for systematic reviews. A librarian will support and qualify the search strategy. Two reviewers will independently screen eligible studies and perform data extraction according to predefined headings. In the event of disagreements, a third reviewer will adjudicate until consensus is achieved. Results will be presented narratively and in table form and discussed in relation to relevant literature., Ethics and Dissemination: Ethical approval is unnecessary, as the review synthesises existing research. The results will be disseminated through a peer-reviewed publication in a scientific journal., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Planning for end-of-life (EOL) and future treatment and care through advance care planning (ACP) is being increasingly implemented in different healthcare settings, and interest in ACP is growing. Several studies have emphasized the importance of relatives participating in conversations about wishes for EOL and being included in the process. Likewise, research has highlighted how relatives can be a valuable resource in an emergency setting. Although relatives have a significant role, few studies have investigated their perspectives of ACP and EOL conversations. This study explores relatives' experiences of the benefits and disadvantages of having conversations about wishes for EOL treatment., Methods: Semi-structured telephone interviews were held with 29 relatives who had participated in a conversation about EOL wishes with a patient and physician 2 years prior in a variety of Danish healthcare settings. The relatives were interviewed between September 2020 and June 2022. Content analysis was performed on the qualitative data., Results: The interviews revealed two themes: "gives peace of mind" and "enables more openness and common understanding of EOL." Relatives found that conversations about EOL could help assure that patients were heard and enhance their autonomy. These conversations relieved the relatives of responsibility by clarifying or confirming the patients' wishes, and they also made the relatives reflect on their own wishes for EOL. Moreover, they helped patients and relatives address other issues regarding EOL and made wishes more visible across settings., Significance of Results: The results indicate that conducting conversations about wishes for EOL treatment and having relatives participate in those conversations were perceived as beneficial for both relatives and patients. Involving relatives in ACP should be prioritized by physicians and healthcare personnel when holding conversations about EOL.

Objective: Burnout and mental illness are frequent among healthcare professionals, leading to increased sick leave. Simulation-based team training has been shown to improve job satisfaction and mental health among healthcare professionals. This study seeks to investigate the relationship between simulation-based team training and sick leave., Design: Cohort study., Setting and Intervention: Five Danish hospitals., Participants: A total of 15 751 individuals were screened for eligibility. To meet the eligibility criteria, individuals had to be employed in the same group (intervention or control) for the whole study period. A total of 14 872 individuals were eligible for analysis in the study., Intervention: From 2017 to 2019, a simulation-based team training intervention was implemented at two hospital sites. Three hospital sites served as the control group., Outcome Measures: Data on sick leave from 2015 to 2020 covered five hospital sites. Using a difference-in-difference analysis, the rate of sick leave was compared across hospital sites (intervention vs control) and time periods (before vs after intervention)., Results: Significant alterations in sick leave were evident when comparing the intervention and control groups. When comparing groups over time, the increase in sick leave was -0.3% (95% CI -0.6% to -0.0%) lower in the intervention group than in the control group. The difference-in-difference for the complete case analysis showed that this trend remained consistent, with analysis indicating a comparable lower increase in sick leave by -0.7% (95% CI -1.3% to -0.1%) in the intervention group., Conclusion: The increase in sick leave rate was statistically significantly lower in the intervention group, implying that simulation-based team training could serve as a protective factor against sick leave. However, when investigating this simulation intervention over 5 years, other potential factors may have influenced sick leave, so caution is required when interpreting the results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To examine associations between socioeconomic factors and (1) adherence to methicillin-resistant Staphylococcus aureus (MRSA) posttreatment follow-up swab sampling after 1 and 6 months and (2) successful decolonization treatment., Design: Cohort study with 2 years of follow-up. Data on patients diagnosed with MRSA were extracted from a regional MRSA database and national registries. We used a cluster-based logistic regression model to estimate the adjusted odds ratios (aOR) and 95% confidence interval (CI) for associations between socioeconomic factors and decolonization treatment., Setting: Danish primary health care., Results: The rate of adherence to posttreatment follow-up swab sampling among 2,536 cases 1 month after decolonization treatment was 66% (95% CI, 64%-68%), and it decreased to 30% (95% CI, 28%-32%) after 6 months. Living in intermediate municipalities (76-159 inhabitants/km2) or having retired were associated with completed posttreatment follow-up swabs 1 month after decolonization treatment: aOR, 1.40 (95% CI, 1.2-1.74) and aOR, 2.67 (95% CI, 1.16-6.13), respectively. The rate of successful decolonization treatment 2 years after initiating treatment was 36% (95% CI, 34%-38%). Factors associated with successful decolonization treatment included individuals with higher education (aOR, 1.62; 95% CI, 1.22-2.15), early retirees (aOR, 1.63; 95% CI, 1.12-2.38), those living in intermediate municipalities (ie, 160-900+ inhabitants/km2; aOR, 1.35; 95% CI, 1.08-1.68), and those living in predominantly urban municipalities (ie, 160-900+ inhabitants/km2; aOR, 2.04; 95% CI, 1.5-2.76)., Conclusions: Disparities in the effect of decolonization treatment and adherence to MRSA follow-up sampling among MRSA-positive individuals appear to be largely explained by the level of education, area of residence, and employment status.

Background: Major ankle and hindfoot surgery (e.g., ankle, triple and subtalar arthrodesis) typically causes severe postoperative pain, especially the first two postoperative days. Current modalities of postoperative analgesic treatment often include continuous peripheral nerve blocks of the saphenous and sciatic nerves via catheters in order to extend the duration of pain- and opioid-free nerve blockade to 48 h. Unfortunately, the 48 h-efficacy of continuous infusion via a catheter is reduced by a high displacement rate. We hypothesised that one-time repetition of the single injection peripheral nerve blocks would provide effective analgesia with a low opioid consumption the first 48 postoperative hours., Methods: Eleven subjects preoperatively received a popliteal sciatic and a saphenous single injection nerve block with a protracted local anaesthetic mixture. Surgery was performed under general anaesthesia. The one-time repetition of the single injection nerve block was carried out approximately 24 h after the primary nerve block. The main outcomes were pain and cumulative opioid consumption during the first 48 postoperative hours., Results: Nine of the 11 (82%) patients had effective analgesia without opioids during the first 48 postoperative hours. Two patients each required a single dose of 7.5 mg of oral morphine equivalents after 43 h., Conclusion: One-time repetition of single injection saphenous and sciatic nerve blocks consistently provided effective analgesia practically without opioids for 48 h after major elective ankle and hindfoot surgery., (© 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Background: Chronic pain is a major health problem worldwide but the limited knowledge of its underlying pathophysiology impairs the opportunities for diagnostics and treatment. Biomarkers of chronic pain are greatly needed to understand the disease and develop new targets for interventions and drug treatments, and potentially introduce more precise diagnostic procedures. Much evidence points to a neuroimmune pathology for many chronic pain conditions and that important neuroimmune biomarkers exist in the cerebrospinal fluid (CSF) of patients with chronic pain. Systematic collection of CSF in large cohorts of chronic pain patients and healthy volunteers has proven difficult, however. We established the Danish Pain Research Biobank (DANPAIN-Biobank) with the aim of studying potential neuroimmune and glia-related biomarkers of chronic pain. In this paper, we describe the methods and the study population of the DANPAIN-Biobank., Methods: In this cross-sectional study, we included (I) participants with high-impact (HI) chronic pain from a tertiary, interdisciplinary pain center; (II) participants with osteoarthritic pain scheduled for arthroplasty surgery of the hip or knee at a regional hospital; and (III) pain-free volunteers. All participants completed a questionnaire assessing pain, functional impairment, anxiety, depression, and insomnia before samples of blood and CSF were extracted. Quantitative sensory tests were performed on participants with HI chronic pain and pain-free volunteers, and postoperative outcome scores were available on participants with osteoarthritic pain., Results: Of the 352 participants included, 201 had HI chronic pain (of which 71% had chronic widespread pain), 81 had chronic osteoarthritic pain, and 70 were pain-free volunteers. Samples were handled uniformly, and CSF samples were frozen within 30 minutes., Conclusions: We describe the content of the DANPAIN-Biobank, which is unique in terms of the number of participants (including pain-free volunteers), extensive clinical data, and uniformity in sample handling. We believe it presents a promising new platform for the study of neuroimmune and glia-related biomarkers of chronic pain., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-5319/coif). CV received travel expenses from Stryker. The other authors have no conflicts of interest to declare., (2023 Annals of Translational Medicine. All rights reserved.)

AbstractWe describe the cloning and expression of a nonreceptor tyrosine kinase, cymric ( Uro-1 ), a HTK-16-like ( HydraTyrosineKinase-16 ) gene, identified in a subtractive screen for maternal ascidian cDNAs in Molgula oculata , an ascidian species with a tadpole larva. The cymric gene encodes a 4-kb mRNA expressed in gonads, eggs, and embryos in the tailed M. oculata but is not detected in eggs or embryos of the closely related tailless species Molgula occulta . There is a large insertion in cymric in the M. occulta genome, as shown by transcriptome and genome analyses, resulting in it becoming a pseudogene. The cymric amino acid sequence encodes a nonreceptor tyrosine kinase with an N-terminal region containing two SH2 domains and five ankyrin repeats, similar to the HTK-16-like gene found in other ascidians. Thus, the ascidian cymric genes are members of the SHARK (Src-homology ankyrin-repeat containing tyrosine kinase) family of nonreceptor tyrosine kinases, which are found throughout invertebrates and missing from vertebrates. We show that cymric is lacking the tyrosine kinase domain in the tailless M. occulta , although the truncated mRNA is still expressed in transcriptome data. This maternal and zygotic HTK-16-like tyrosine kinase is another described pseudogene from M. occulta and appears not to be necessary for adult development.

Introduction: Treatment with modern technology in an intensive care unit has increased critical illness survival. However, many patients are affected by their critical illness for months or years following discharge, as they experience cognitive impairments. Long-term cognitive impairments can severely affect patients' quality of life. Exploring patients' experiences on how and which cognitive impairments affect their everyday lives is important to improve planning of relevant research into interventions that may alleviate the burden of post-intensive cognitive impairments., Aim: To review the literature on patients' experiences of cognitive impairment following critical illness treated in an intensive care unit., Methods: A systematic search was conducted in PubMed, Cinahl, PsycInfo and Embase in March-May 2021. References and citations in relevant studies were explored. The Covidence tool was used by two independent researchers to identify relevant studies for inclusion. The Mixed Methods Appraisal Tool was used for critical appraisal. The JBI methodology for scoping reviews and the PRISMA-ScR checklist were used (Supporting Information File 1)., Results: We identified 11 relevant qualitative and/or quantitative studies. Four themes were found: 'Experiencing poor memory', 'Managing everyday life', 'Unsupported by the healthcare system' and 'Strategies for support in recovery'. Patients used various strategies during their recovery and rehabilitation to regain independence and avoid being a burden. They needed information to support their recovery and rehabilitation; otherwise, they felt unsupported and betrayed by the healthcare system., Conclusion: Patients experienced various cognitive impairments following critical illness in the intensive care unit, affecting and challenging their quality of life and adaption to everyday life., Relevance to Clinical Practice: Knowledge gained by exploring patients' experience of cognitive impairments following critical illness in the intensive care unit can contribute to improve clinical practice by targeting and optimising patients' rehabilitation process., Patient or Public Contribution: No patient or public involvement in this scoping review., (© 2022 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Objectives: To examine the frequency, clinical characteristics and nurse-led rapid response team experiences of calls that involve end-of-life issues., Research Methodology and Design: The study consisted of two parts: 1) a retrospective journal audit of registered rapid response team calls for 2011-2019 that involved end-of-life issues, and 2) interviews with intensive care rapid response team nurses. The quantitative data were analysed with descriptive statistics and the qualitative data with content analysis., Setting: The study was conducted at a Danish university hospital., Results: Twelve percent (269/2,319) of the rapid response team calls involved end-of-life issues. "No indication for intensive care therapy" and "Do not resuscitate" were the main medical end-of-life orders. The patients had a mean age of 80 years, and the main reason for the calls was a respiratory problem. Ten rapid response team nurses were interviewed, and four themes evolved from the analysis: "Uncertain roles for the rapid response team nurses", "Solidarity with ward nurses", "Lack of information" and "Timing of decision-making"., Conclusion: Twelve percent of the rapid response team calls involved end-of-life issues. The main reason for these calls was a respiratory problem, and the rapid response team nurses often found their role uncertain and experienced lack of information and sub-optimal timing of decision-making., Implications for Clinical Practice: Intensive care nurses working in a rapid response team often face end-of-life issues during calls. Therefore, end-of-life care should be included in training for rapid response team nurses. Furthermore, advanced care planning is recommended to secure high-quality end-of-life care and to decrease uncertainty in acute medical situations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: One way in which patients can participate in care is by taking part in medical documentation. Producing documentation together with patients has been found to decrease the amount of incorrect information, help patients to be involved, and promote shared decision-making. The aims of this study were to develop and implement a practice of producing documentation together with patients and to examine staff and patient experiences of this practice., Methods: A quality improvement study was conducted from 2019 to 2021 at a Day Surgery Unit in a Danish University Hospital. Before implementing a practice of documenting together with patients, nurses' perceptions of doing documentation together with patients were examined via a questionnaire survey. After an implementation period, a similar follow-up survey with staff was conducted, together with structured patient phone interviews., Results: A total of 24 nursing staff out of 28 (86%) filled in the questionnaire at baseline and 22 out of 26 (85%) at follow-up. A total of 61 out of 74 invited patients (82%) were interviewed. At baseline, the majority (71-96%) of participants agreed that documentation done together with the patient would contribute to increased patient safety, fewer errors, real-time documentation, patient involvement, visible patient perspective, correction of errors, more accessible information and less duplication of work. At follow-up, significant decreases in the staffs' positive perceptions of the benefits of documenting together with patients were found for all areas except for "real-time documentation" and "less duplication of work". Almost all patients found it okay that the nurses wrote up medical documentation during the interview, and more than 90% of patients found the staff responsive or very responsive and present during the reception interview., Conclusion: Before implementation of a practice of documenting together with patients, the majority of staff assessed such documentation as being beneficial, but a significant decrease in positive assessment was found at follow-up, with challenges such as feeling less connected with the patient and practical, IT-related issues being described. The patients found the staff to be present and responsive and felt that it was important to know what was being written in their medical record., (© 2023. The Author(s).)

Objective: In 2019, the Danish parliament issued legislation requiring Danish physicians to clarify and honor seriously ill patients' treatment preferences. The American POLST (Physician Orders for Life-Sustaining Treatment) document could be a valuable model for this process. The aim of the study was to examine patients' preferences for life-sustaining treatment and participant assessment of a Danish POLST form., Methods: The study is a prospective intervention based on a pilot-tested Danish POLST form. Participant assessments were examined using questionnaire surveys. Patients with serious illness and/or frailty from seven hospital wards, two general practitioners, and four nursing homes were included. The patients and their physicians completed the POLST form based on a process of shared decision-making., Results: A total of 95 patients (aged 41-95) participated. Hereof, 88% declined cardiopulmonary resuscitation, 83% preferred limited medical interventions or comfort care, and 74% did not require artificial nutrition. The preferences were similar within age groups, genders, and locations, but with a tendency toward younger patients being more in favor of full treatment and nursing home residents being more in favor of cardiopulmonary resuscitation. Questionnaire response rates were 69% (66/95) for patients, 79% (22/28) for physicians, and 31% (9/29) for nurses. Hereof, the majority of patients, physicians, and nurses found that the POLST form was usable for conversations and decision-making about life-sustaining treatment to either a high or very high degree., Significance of Results: The majority of seriously ill patients did not want a resuscitation attempt and opted for selected treatments. The majority of participants found that the Danish POLST was usable for conversations and decisions about life-sustaining treatment to either a high or a very high degree, and that the POLST form facilitated an opportunity to openly discuss life-sustaining treatment.

Aim and Objective: To explore Rapid Response Team nurses' perceptions of what it means being a Rapid Response Team nurse including their perceptions of the collaborative and organisational aspects of the rapid response team (RRT)., Background: For more than 20 years, RRT nurses have been on the frontline of critical situations in acute care hospitals. However, a few studies report nurses' perceptions of their role as RRT nurses, including collaboration with general ward nurses and physicians. This knowledge is important to guide development and adjustment of the RRT to benefit both patients' safety and team members' job satisfaction., Design: Qualitative focus group interviews., Methods: A qualitative approach was applied. Throughout 2018 and across three regions and three acute care settings in Denmark, eight focus group interviews were conducted in which 27 RRT nurses participated. Transcribed interviews were analysed using inductive content analysis. Reporting of this study followed the COREQ checklist., Results: One overarching theme 'Balancing responsibilities, rewards, and challenges' was derived, comprising six categories: 'Becoming, developing and fulfilling the RRT nurse role', 'Helping patients as the core function of RRT', 'The RRT-call at its best', 'The obvious and the subtle RRT tasks', 'Carrying the burden of the RRT', and 'Organisational benefits and barriers for an optimal RRT'., Conclusion: Being a RRT nurse is a complex task. Nurses experience professional satisfaction and find it meaningful helping deteriorating patients. The inadequate resources available to train general ward staff how to manage basic clinical tasks are an added stress to nurses., Relevance to Clinical Practice: Organisational managers need a better understanding of the necessary staffing requirements to attend patients' needs, train staff and handle the increasing acuity of ward patients. Failure to do so will be detrimental to patient outcomes and compromise RRT nurses' job satisfaction., (© 2022 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Conducting a conversation about wishes for treatment at end of life (EOL) has been shown to improve EOL care for patients and relatives. Still, only a minority of physicians conduct the conversation, which might lead to unwanted interventions and treatments., Objectives: The purpose of this survey was to examine which factors facilitate and hinder physicians across a wide range of health care facilities to initiate the conversation about wishes for treatment at EOL., Design: A questionnaire survey based on a Delphi-developed questionnaire., Setting/subjects: The questionnaire was sent to both hospital physicians and general practitioners (GPs) in a Danish region., Results: More than 3000 physicians were invited to participate in the survey. Of these, 782 responded, 622 working at a hospital department, and 160 from general practice clinics. Results showed that senior physicians, GPs, and physicians working in a medical department feel best equipped to conduct the conversation. Moreover, senior physicians pointed to their experience as physicians as being of great importance for conducting the conversation, whereas junior physicians found training in conducting the conversation as an important factor., Conclusion: Our study indicates that different factors depending on the health care setting and the seniority of the physician facilitate or hinder physicians from conducting the conversation about wishes for treatment at EOL. Being aware of these differences and making a concerted effort depending on setting and seniority might help implement and conduct the conversation., Competing Interests: No competing financial interests exist., (© Mette Aaby Smith et al., 2022; Published by Mary Ann Liebert, Inc.)

Background: Relevance to clinical practice The findings from the study highlighting family involvement, high-quality communication and flexible visiting policy as central aspects of family care may inspire clinicians to identify aspects of everyday family care in their ICUs calling for further improvement., Aims and Objectives: To describe family involvement, communication practices and visiting policies in adult ICUs., Design: A cross-sectional survey., Method: A questionnaire consisting of 11 sections was developed, pilot tested and e-mailed to 196 ICUs. The participants were intensive care nurses in adult ICUs in four Nordic countries., Results: The survey was conducted in October to December 2019. The response rate was 81% (158/196) of the invited ICUs. Most of the units had fewer than 11 beds. Family participation in patient care, including involvement in ward rounds and presence during cardiopulmonary resuscitation, varied between the countries, whereas most families in all countries were involved in decision-making. Family conferences were generally initiated by staff or family members. Children under 18 did not always receive information directly from the staff, and parents were not advised about how to inform their children. Although most respondents described open visiting, restrictions were also mentioned in free-text comments., Conclusions: The level of family care in ICUs in the four Nordic countries is generally based on nurses' discretion. Although most Nordic ICUs report having an open or flexible visiting policy, a wide range of potential restrictions still exists. Children and young relatives are not routinely followed up. Family members are included in communication and decision-making, whereas family involvement in daily care, ward rounds and family-witnessed resuscitation seem to be areas with a potential for improvement., (© 2021 The Authors. Nursing in Critical Care published by John Wiley & Sons, Ltd on behalf of British Association of Critical Care Nurses.)

Introduction: Critical illness and admission to an intensive care unit (ICU) can affect patients for months or years following discharge as many suffer from cognitive impairment. Long-term cognitive impairment affects patients' quality of life and ability to adapt to everyday life. Exploring their experiences on how and which cognitive impairments are affecting their everyday lives facilitates planning of relevant research on interventions that may serve to alleviate the burden of post-ICU cognitive impairment. The objective of this scoping review is to map the existing research on patients' experiences of cognitive impairment following critical illness., Methods and Analysis: The methodology will follow the Joanna Briggs Institute guidelines for scoping reviews. The databases MEDLINE, CINAHL, PsycINFO and Embase will be searched to identify studies appropriate for inclusion. Any peer-reviewed original studies meeting the inclusion criteria and include statements from adult patients about how they experience cognitive impairment following critical illness and ICU admission will be considered. Studies published in English and Scandinavian languages will be included, with no further geographical or cultural limitations. The included studies will be screened by two independent researchers using a standardised data extraction tool and the Mixed Methods Appraisal Tool will be used for critical appraisal. The results will be presented in a tabular form, and data will be supported by narrative descriptions or a narrative summary., Ethics and Dissemination: Since the scoping review methodology aims at synthetising existing research on patients' experiences of cognitive impairment following critical illness, the scoping review does not require ethical approval. The results will be disseminated though a peer-reviewed publication in a scientific journal., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: There is a growing awareness on minimizing sedation in ICUs. In the NONSEDA trial 700 critically ill patients were randomized to light sedation or non-sedation during mechanical ventilation. Approximately 40% of patients randomized to non-sedation needed sedation. The aim of this study is to obtain knowledge on patients, who experienced failure of non-sedation., Materials and Methods: This study is a retrospective post-hoc analysis of the NONSEDA trial. Patients, who were randomized to non-sedation are sub-divided into those who did not require sedation during mechanical ventilation ("non-sedation success"), and those who needed continuous sedation at least once ("non-sedation failure")., Results: 348 patients were randomized to non-sedation, 199 experienced non-sedation success, whereas 149 experienced non-sedation failure. Patients in the two groups were comparable with regards to age, BMI, disease severity scores and admission diagnoses. Patients with non-sedation failure were more often male. Propofol was mainly used as rescue sedation. Patients with non-sedation failure had less days alive without sedation, coma, delirium, organ support, mechanical ventilation, ICU- and hospital admission. Mortality and long-term outcomes did not differ between groups., Conclusion: Patients with non-sedation success had better in-hospital outcomes, but mortality and long-term outcomes were not affected by success or failure of non-sedation., Competing Interests: Declaration of Competing Interest All authors declare that we have no conflicts of interests., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Iatrogenic opioid use by patients with chronic malignant pain remains an important focus point. The positive effects of opioids seem to decline over time, whereas tapering will have positive effects in many patients. The purpose of the project was to optimise the process for patients with a wish or a need to taper opioids., Methods: Patients were referred to a multidisciplinary pain treatment centre with the aim of tapering their opioid use. The use of opioids before and after the intervention at the pain treatment centre was registered. Questionnaires about quality of life, sleep quality and level of depression were completed before and after the study, participants were allowed to add comments to the questionnaires and interviews were conducted., Results: A total of 22 patients participated. They had complex pain issues and had received opioids for a median period of nine years. The participants achieved a significant reduction of opioids (median 23 mg). Four patients completely stopped using opioids in the project period, four did not benefit from the project and two achieved reductions to the lowest dose possible allowing them to maintain an acceptable level of function. The remaining patients had a tapering plan to be continued in cooperation with their general practitioner. Most patients experienced the process as very satisfactory or satisfactory but achieved no measurable improvements in quality of life, sleep quality or level of depression., Conclusion: Even though the tapering of opioids had appeared difficult beforehand, a significant reduction in opioid consumption was achieved., Funding: The project was funded by the Danish Health Authority., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Objective: To explore patients' and physicians' perspectives on a decision-making conversation for life-sustaining treatment, based on the Danish model of the American Physician Orders for Life Sustaining Treatment (POLST) form., Design: Semi-structured interviews following a conversation about preferences for life-sustaining treatment., Setting: Danish hospitals, nursing homes, and general practitioners' clinics., Subjects: Patients and physicians., Main Outcome Measures: Qualitative analyses of interview data., Findings: After participating in a conversation about life-sustaining treatment using the Danish POLST form, a total of six patients and five physicians representing different settings and age groups participated in an interview about their experience of the process. Within the main research questions, six subthemes were identified: Timing, relatives are key persons, clarifying treatment preferences, documentation across settings, strengthening patient autonomy, and structure influences conversations. Most patients and physicians found having a conversation about levels of life-sustaining treatment valuable but also complicated due to the different levels of knowledge and attending to individual patient needs and medical necessities. Relatives were considered as key persons to ensure the understanding of the treatment trajectory and the ability to advocate for the patient in case of a medical crisis. The majority of participants found that the conversation strengthened patient autonomy., Conclusion: Patients and physicians found having a conversation about levels of life-sustaining treatment valuable, especially for strengthening patient autonomy. Relatives were considered key persons. The timing of the conversation and securing sufficient knowledge for shared decision-making were the main perceived challenges.KEY POINTSConversations about preferences for life-sustaining treatment are important, but not performed systematically.When planning a conversation about preferences for life-sustaining treatment, the timing of the conversation and the inclusion of relatives are key elements.Decision-making conversations can help patients feel in charge and less alone, and make it easier for health professionals to provide goal-concordant care.Using a model like the Danish POLST form may help to initiate, conduct and structure conversations about preferences for life-sustaining treatment.

Aim: This study explores how healthcare professionals included in the COVID-19 contingency plan experienced organizational changes, and explores factors associated with the experiences. Additionally, the study aimed to identify learning points for future similar scenarios., Design: A cross-sectional study., Methods: A questionnaire survey of healthcare professionals at three Danish hospitals, June 2020., Results: A total of 1,448 healthcare professionals completed the questionnaire. Hereof, 813 (57%) were relocated to new settings/new jobs. The majority experienced that their relocation was totally (49%) or partially (31%) imposed, and 51% reported that the overall experience of the new job function was satisfactory. Type of profession and whether relocation to the new job function was imposed were the main variables associated with the overall experience of being part of the contingency plan. Suggestions for future scenarios included training adjusted to individual competencies, more targeted information, voluntariness with consideration of individual needs and clarification of expectations., (© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: A growing body of evidence supports the existence of an association between patient safety culture (PSC) and patient outcomes. PSC refers to shared perceptions and attitudes towards norms, policies and procedures related to patient safety. Existing literature shows that PSC varies among health professionals depending on their specific profession and specialty. However, these studies did not investigate whether PSC can be improved. This study investigates whether length of education is associated with improvements in PCS following a simulation intervention., Methods: From April 2017 to November 2018, a cross-sectional intervention study was conducted at two regional hospitals in Denmark. Two groups with altogether 1230 health professionals were invited to participate. One group included nurses, midwives and radiographers; the other group included doctors. A train-the-trainer intervention approach was applied consisting of a 4-day simulation instructor course that emphasised team training, communication and leadership. Fifty-three healthcare professionals were trained as instructors. After the course, instructors performed in situ simulation in their own hospital environment., Outcomes: The Safety Attitude Questionnaire (SAQ), which has 6 dimensions and 32 items, was used to collect main outcome variables. All employees from both groups were surveyed before the intervention and again four and nine months after the intervention., Results: Mean baseline scores were higher among doctors than among nurses, midwives and radiographers for all SAQ dimensions. At the second follow-up, four of six dimensions improved significantly (p ≤ 0.05) among nurses, midwives and radiographers, whereas no dimensions improved significantly among doctors., Conclusion: Over time, nurses, midwives and radiographers improved more in PSC attitudes than doctors did., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The purpose of this study was to investigate interaction in the handovers between anesthesia and the recovery room and to examine the effect of using the Identification, Situation, Background, Analysis, and Recommendation (ISBAR) instrument as a structured dialogue tool during hand over., Design: A prospective quality improvement project with pre/post assessment., Methods: Fifty handovers in the postanaesthesia care unit were observed. Data were collected regarding parameters associated with ISBAR. Both certified registered nurse anesthetists and registered nurses (RNs) from postanaesthesia care unit were subsequently asked about their satisfaction with the handover via an electronic questionnaire survey. After 6 months, the questionnaire survey was repeated, and 50 observations were conducted identical to the baseline observations., Findings: Results showed that from baseline to follow-up, RNs were more prepared to receive the patient (from 84% to 95%), read the patient records more frequently (from 18% to 54%), and were assigned to patients from the start of the day (from 86% to 100%). The content of the oral handover was more structured using the ISBAR, and handovers became more concentrated and undisturbed (from 12% to 86%). At baseline, certified registered nurse anesthetists were more satisfied with the handover than RNs (38% difference). At the follow-up, there was no discrepancy between the two groups., Conclusions: Knowledge and focus on the verbal handover influence communication, team effectiveness, and quality of handovers. The ISBAR structured approach reduced disturbances to handover because everybody involved had a clear expectation of the different items to be reviewed and were less likely to interrupt to question or clarify. Using ISBAR as a structured tool along with organizational changes can improve the quality of patient handover and thereby improve patient safety., (Copyright © 2021 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Objectives: To examine conditions and strategies to meet the challenges imposed by the coronavirus disease 2019 (COVID-19)-related visiting restrictions in Scandinavian intensive care units., Research Methodology/design: A cross-sectional survey., Setting: Adult intensive care units in Denmark, Norway and Sweden., Main Outcome Measures: Likert scale responses and free-text comments within six areas: capacity and staffing, visiting policies and access to the unit, information and conferences with relatives, written information, children as relatives and follow-up initiatives., Results: The overall response rate was 53% (74/140 participating units). All intensive care units had planned for capacity extensions; the majority ranging between 11 and 30 extra beds. From March-June 2020, units had a mean maximum of 9.4 COVID-19 patients simultaneously. Allowing restricted visiting was more common in Denmark (52%) and Norway (61%) than in Sweden where visiting was mostly denied except for dying patients (68%), due to a particular increased number of COVID-19 patients. The restrictions forced nurses to compromise on their usual standards of family care. Numerous models for maintaining contact between relatives and patients were described., Conclusion: Visitation restrictions compromised the quality of family care and entailed dilemmas for healthcare professionals but also spurred initiatives to developing new ways of providing family care., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Medically frail and/or chronically ill patients are often admitted to Danish hospitals without documentation of patient preferences. This may lead to inappropriate care. Modelled on the American Physician Orders for Life-Sustaining Treatment (POLST) form, the purpose of the study was to develop and pilot test a Danish POLST form to ensure that patients' preferences for levels of life-sustaining treatment are known and documented., Methods: The study was a mixed methods study. In the initial phase, a Danish POLST form was developed on the basis of literature and recommendations from the National POLST organisation in the US. A pilot test of the Danish POLST form was conducted in hospital wards, general practitioners' clinics, and nursing homes. Patients were eligible for inclusion if death was assessed as likely within 12 months. The patient and his/her physician engaged in a conversation where patient values, beliefs, goals for care, diagnosis, prognosis, and treatment alternatives were discussed. The POLST form was completed based on the patient's values and preferences. Family members and/or nursing staff could participate. Participants' assessments of the POLST form were evaluated using questionnaires, and in-depth interviews were conducted to explore experiences with the POLST form and the conversation., Results: In total, 25 patients participated, 45 questionnaires were completed and 14 interviews were conducted. Most participants found the POLST form readable and understandable, and 93% found the POLST form usable to a high or very high degree for discussing preferences regarding life-sustaining treatment. Three themes emerged from the interviews: (a) an understandable document is essential for the conversation, (b) handling and discussing wishes, and (c) significance for the future., Conclusion: The Danish version of the POLST form is assessed by patients, families, physicians, and nurses as a useful model for obtaining and documenting Danish patients' preferences for life-sustaining treatment. However, this needs to be confirmed in a larger-scale study., (© 2022. The Author(s).)

Purpose: The COVID-19 pandemic has influenced hospital work and healthcare workers all over the world. We explored how Danish nurses coped with the fast, comprehensive organisational changes in their workplace and identified barriers to and facilitators for organisations ensuring the best possible conditions for nurses to meet these challenges. The study focuses on the organisational setting and how it did or did not support the nurses in their work., Methods: A qualitative explorative design was used in interviewing 23 nurses who had worked at a COVID-19 ward in one of three hospitals. Data were collected in the summer of 2020, and the analysis was inspired by Paul Ricoeur's theory of narratives and interpretation., Results: The presence of managers in the wards helped the nurses in the form of psychological and practical support. Working within an organisation that provides a safe environment was essential for nurses. The experience of a safe environment allowed nurses to ask questions, which supported them in finding solutions to specific tasks in the new and critical working environment. Barriers to handling the new situation were an absence of managers and a lack of a sense of belongingness and trust., Conclusion: This study highlights the need for management to be present in the ward and for organisational support to be available to nurses so they can provide optimal treatment and care when working in new and unknown conditions during a pandemic. Practical assistance from managers to ease the job is beneficial. Furthermore, the presence of management is essential to provide psychological support and create a safe environment because this allows nurses to ask questions about how to better manage new and critical tasks., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The coronavirus (COVID-19) pandemic and the risk of an extensive overload of the healthcare systems have elucidated the need to make decisions on the level of life-sustaining treatment for patients requiring hospitalisation. The purpose of the study was to investigate the proportion and characteristics of COVID-19 patients with limitation of life-sustaining treatment decisions and the degree of patient involvement in the decisions., Methods: A retrospective observational descriptive study was conducted in three Danish regional hospitals, looking at all patients ≥ 18 years of age admitted in 2020 with COVID-19 as the primary diagnosis. Lists of hospitalised patients admitted due to COVID-19 were extracted. The data registration included age, gender, comorbidities, including mental state, body mass index, frailty, recent hospital admissions, COVID-19 life-sustaining treatment, ICU admission, decisions on limitations of life-sustaining treatment before and during current hospitalisation, hospital length of stay, and hospital mortality., Results: A total of 476 patients were included. For 7% (33/476), a decision about limitation of life-sustaining treatment had been made prior to hospital admission. At the time of admission, one or more limitations of life-sustaining treatment were registered for 16% (75/476) of patients. During the admission, limitation decisions were made for an additional 11 patients, totaling 18% (86/476). For 40% (34/86), the decisions were either made by or discussed with the patient. The decisions not made by patients were made by physicians. For 36% (31/86), no information was disclosed about patient involvement., Conclusions: Life-sustaining treatment limitation decisions were made for 18% of a COVID-19 patient cohort. Hereof, more than a third of the decisions had been made before hospital admission. Many records lacked information on patient involvement in the decisions., (© 2021. The Author(s).)

Aim: To explore how nurses experienced working in a newly organized COVID-19 ward with high-risk patients during a new and unknown pandemic., Design: A qualitative explorative study using a phenomenological-hermeneutic approach., Methods: Semi-structured individual telephone interviews were conducted in June-July 2020 with 23 nurses working in COVID-19 wards from three regional hospitals in Denmark. The nurses had been transferred from other departments at their hospital to the newly organized COVID-19 wards. Data analysis was influenced by Paul Ricoeur's theory of narrative and interpretation, including three analytical levels: naïve reading, structural analysis and critical interpretation and discussion., Results: During the structural analysis four themes were generated: (a) Challenging and uncertain situation, but also a positive experience (b) Professional and personal development (c) Lack of nurses' rights during a pandemic (d) Reward in itself or a desire for financial reward., (© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Objectives: With the International Classification of Diseases 11th revision (classifying fibromyalgia as a primary pain disorder) soon to be implemented, the importance of pain physicians being able to identify patients with fibromyalgia is emphasized. The diagnostic criteria proposed in 2016 are based on self-reported pain distribution and symptom severity. The study aimed to evaluate the diagnostic accuracy of the 2016 diagnostic criteria for fibromyalgia applied in a population of patients with high impact chronic pain referred for pain rehabilitation., Methods: The study was performed as a diagnostic accuracy study at two Danish interdisciplinary pain rehabilitation centers, including 215 participants. All participants were evaluated clinically to identify patients with fibromyalgia. The diagnosis was based on expert opinion, but the minimum requirements were: (1) pain in all four body quadrants and axially for at least three months and (2) minimum 8 of 18 positive tender points. Participants filled in the fibromyalgia survey questionnaire, the patient version of the 2016 diagnostic criteria. Sensitivity, specificity, likelihood ratios, and positive and negative post-test probabilities were calculated using a clinical diagnosis of fibromyalgia as the reference standard., Results: Based on clinical diagnosis 45% of the participants were diagnosed with fibromyalgia; of these, only 19% had been diagnosed previously. The 2016 diagnostic criteria demonstrated a sensitivity of 88.5%, a specificity of 81.5%, a positive likelihood ratio of 4.79, a negative likelihood ratio of 0.14, a positive post-test probability of 79.4%, and a negative post-test probability of 10.2%., Conclusions: Fibromyalgia was severely under-diagnosed among patients with high impact chronic pain referred to tertiary care in two pain rehabilitation centers in Denmark. The 2016 diagnostic criteria showed sufficient discriminatory properties suggesting that the fibromyalgia survey questionnaire can be used as a screening tool assisting the identification of fibromyalgia in this patient population., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

Introduction and Objectives: In a Danish Hospital, 70% of all activations of the rapid response team (RRT) in 2016 were related to adult patients with respiratory insufficiency. The most frequent RRT intervention was continuous positive airway pressure (CPAP). However, there was no systematic follow-up and patients could not receive CPAP outside of daytime hours. The aim of the study was to implement and evaluate a CPAP intervention to improve healthcare., Patients and Methods: A quality inter-professional intervention project was conducted. The interventions consisted of: theoretical and practical education in respiratory insufficiency (including use of CPAP) of nurses and physicians from the general wards, physiotherapists and staff from the RRT; development of an instruction leaflet and video; an update of the existing guidelines. The interventions entailed patients being able to receive CPAP a minimum of 3 times for 5-10min within a 24-h period. All RRT activations were registered and compared in a before-after evaluation of the intervention. Additionally, all staff groups received an electronic questionnaire after implementation., Results: After implementation, respiratory insufficiency was still the highest primary course for RRT activation. The use of CPAP increased, and the number of patients needing a transfer to the intensive care unit decreased. The response rate for the questionnaire was 44% (203 out of 465), and staff experienced new competences, improved inter-professional cooperation and improved healthcare. However, a substantial number of staff did not feel sufficiently trained or that the intervention was well-implemented., Conclusion: The intervention entailed new competences for the staff, as well as improved system performance, inter-professional cooperation and healthcare. However, there is a need for continuous focus on the intervention., (Copyright © 2021 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

HLA-DPA1*01:46 differs from HLA-DPA1*01:03 in exon 2 at amino acid 85; Aspartate to Asparagine substitution., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Cytokine networks in cerebrospinal fluid (CSF) are important to our understanding of several neuroinflammatory diseases. Knowledge about optimal handling of samples is limited but important to minimize bias and reduce costs in CSF biomarker studies. The aim of this study was to examine the effect of storage temperature and time delay from CSF sample collection until freezing on the concentration of 11 different cytokines thought to be associated with chronic pain. CSF samples from 21 individuals undergoing hip or knee arthroplasty under spinal anesthesia were divided between two tubes. One tube was stored and centrifuged (within 30 min) at room temperature, and one tube was stored in ice water and centrifuged (within 30 min) at 4 °C. Each tube was split into six vials that were frozen at -80 °C, 0.5, 1, 2, 3, 4, or 5 h after collection. Cytokines were analyzed using a multiplex panel. A random effect panel data regression was conducted for each biomarker including the variables of storage temperature until freezing and time delay. Four cytokines had detectable levels: Fractalkine, monocyte chemoattractant protein 1(MCP-1), interleukine 6 (IL-6), and interleukine 8 (IL-8). There was no significant effect of storage temperature and time delay on MCP-1, IL-6, or IL-8 concentrations. Fractalkine concentration showed no clear trend. No concentration differences were observed between samples kept in ice water and those at room temperature except at the 3-h time point, and there was no overall significant effect of time delay on fractalkine concentration. We found no clear effect of storage temperature and time delay up to five hours from sample collection until freezing on the CSF concentrations of fractalkine, MCP-1, IL-6, or IL-8., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

The importance of the human leukocyte antigen (HLA) system in kidney transplantation is well-known, but it remains unexplored if patient HLA antigens constitute independent risk factors in complications after transplantation. We hypothesized that specific HLA class II phenotypes associated with immune-mediated disease (HLA-IMD) predispose to immunological activity and/or complications after kidney transplantation. Based on the literature we defined HLA-DR2-DQ6; -DR3-DQ2 and -DR4-DQ8 as HLA-IMD phenotypes. We investigated associations between HLA-IMD phenotypes in patients, biomarkers of systemic chronic inflammation at the time of transplantation, and the outcome after kidney transplantation in a retrospective cohort study of 611 kidney transplanted patients. The HLA-IMD phenotypes were associated with higher levels of biomarkers of systemic inflammation. The HLA-DR4-DQ8 phenotype was associated with mortality after transplantation in Cox analyses with adjustments for confounders. Data support the hypothesis that specific HLA class II phenotypes affects immunological pathways that determine the midterm clinical outcome of kidney transplantation., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: Critical illness impairs physical function. The NONSEDA trial was a multicenter randomized trial, assessing non-sedation versus sedation during mechanical ventilation. The aim of this sub-study was to assess the effect of non-sedation on physical function., Methods: All patients from one NONSEDA trial site were included. At ICU discharge and three months thereafter, survivors were assessed for physical function., Results: 205 patients were included, 118 survived to follow-up, 116 participated (98%)., Primary Outcome: Three months after ICU-discharge, health-related quality of life (SF-36, physical component score) was similar (non-sedated 38.3 vs sedated 36.6, mean difference 1.7, 95% CI -1.7 to 5.1), as was function in activities of daily living (Barthel Index, non-sedated 19.5 vs sedated 18, median difference 1.5, 95% CI -0.2 to 3.2)., Secondary Outcomes: Non-sedated patients had a better Barthel Index at ICU-discharge (median 9 vs 4, median difference 5, 95% CI 2.5 to 7.5). At three months post-ICU discharge, the two groups did not differ regarding handgrip strength, walking distance, muscle size or biomechanical data., Conclusion: Non-sedation did not lead to improved quality of life regarding physical function or better function in activities of everyday living. Non-sedated patients had a better physical recovery at ICU discharge., Trial Registration: Clinicaltrials.govNCT02034942, registered January 14., 2014., Competing Interests: Declaration of Competing Interest All authors declare that we have no conflicts of interests. The authors declare that they have no competing interests., (Copyright © 2020. Published by Elsevier Inc.)

Background: Critical illness is associated with severely impaired health-related quality of life (HRQoL) for years following discharge. The NONSEDA trial was a multicenter randomized trial on non-sedation versus sedation with a daily wake-up trial in critically ill, mechanically ventilated patients in Scandinavia. The aim of this sub-study was to assess the effect of non-sedation on HRQoL and degree of independence in activities in daily living (ADL) 3 months post-ICU., Methods: All survivors were asked to complete the Medical Outcomes Study Short-Form 36 questionnaire (SF-36) and the Barthel Index 3 months post-ICU. To limit missing data, reminders were sent. If unsuccessful, telephone interviews could be used. Outcomes were the level of HRQoL and ADL-function in each group. All outcomes were assessed blinded., Results: Of the 700 patients included 412 survived to follow-up. A total of 344 survivors participated (82%). Baseline data were equal between the two groups. Mean SF-36 scores for the non-sedated vs sedated patients were as follows: Physical Function 45 vs 40, P = .69, Bodily Pain: 61 vs 52, P = .81, General Health: 50 vs 50, P = .84, Vitality: 42 vs 44, P = .85, Social Function: 75 vs 63, P = .85, Role Emotional: 58 vs 50, P = .82, Mental Health: 70 vs 70, P = .89, Role Physical: 25 vs 28, P = .32, Physical Component Score: 38 vs 37, P = .81, Mental Component Score: 48 vs 46, P = .94, Barthel Index: 20 vs 20, P = .74., Conclusion: Randomization to non-sedation neither improved nor impaired health-related quality of life or degree of independence in activities in daily living 3 months post-ICU discharge., (© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)