Antibody status at delivery and pregnancy outcomes during the first Danish COVID-19 wave.

INTRODUCTION: We aimed to investigate the prevalence of SARS-CoV-2 infection and SARS-CoV-2 antibodies in parturient women and their newborns during the first Danish COVID-19 wave and to identify associations with maternal background characteristics, self-reported symptoms, and pregnancy outcomes. METHODS: In a single-centre, prospective cohort study from Denmark, we invited 1,883 women with singleton pregnancies giving live birth from 25 May 2020 to 2 November 2020. Hereof, 953 (50.6%) women were included. Nasopharyngeal swabs, maternal and umbilical cord blood samples, and questionnaires were collected. Medical records were available for participants and non-participants. RESULTS: SARS-CoV-2 antibodies were found in 1.3% of the women. All newborns of seropositive women had SARS-CoV-2 antibodies in cord blood. No association was found between SARS-CoV-2 antibodies and pregnancy outcomes. Self-reported loss of smell correlated with seropositivity (p less-than 0.001). No women were hospitalised due to COVID-19 during pregnancy or had a positive nasopharyngeal swab intrapartum. CONCLUSIONS: The prevalence of COVID-19 in pregnancy was low during the first wave. Maternal SARS-CoV-2 antibodies were associated with antibodies in cord blood, loss of smell and positive SARS-CoV-2 swab during pregnancy, but not with any adverse pregnancy outcomes. FUNDING: Ferring Pharmaceuticals funded part of the study. TRIAL REGISTRATION: The study was approved by the Regional Committee on Health Research Ethics (H-20028002) and the Danish Data Protection Agency (P-2020-264).

European survey on Paediatric Early Warning Systems, and other processes used to aid the recognition and response to children's deterioration on hospital wards.

BACKGROUND: Internationally, there is an increasing trend in using Rapid Response Systems (RRS) to stabilize in-patient deterioration. Despite a growing evidence base, there remains limited understanding of the processes in place to aid the early recognition and response to deteriorating children in hospitals across Europe. AIM/S: To describe the processes in place for early recognition and response to in-patient deterioration in children in European hospitals. STUDY DESIGN: A cross-sectional opportunistic multi-centre European study, of hospitals with paediatric in-patients, using a descriptive self-reported, web-based survey, was conducted between September 2021 and March 2022. The sampling method used chain referral through members of European and national societies, led by country leads. The survey instrument was an adaptation to the survey of Recognition and Response Systems in Australia. The study received ethics approval. Descriptive analysis and Chi-squared tests were performed to compare results in European regions. RESULTS: A total of 185 questionnaires from 21 European countries were received. The majority of respondents (n = 153, 83%) reported having written policies, protocols, or guidelines, regarding the measurement of physiological observations. Over half (n = 120, 65%) reported that their hospital uses a Paediatric Early Warning System (PEWS) and 75 (41%) reported having a Rapid Response Team (RRT). Approximately one-third (38%) reported that their hospital collects specific data about the effectiveness of their RRS, while 100 (54%) reported providing regular training and education to support it. European regional differences existed in PEWS utilization (North = 98%, Centre = 25%, South = 44%, p < .001) and process evaluation (North = 49%, Centre = 6%, South = 36%, p < .001). CONCLUSIONS: RRS practices in European hospitals are heterogeneous. Differences in the uptake of PEWS and RRS process evaluation emerged across Europe. RELEVANCE TO CLINICAL PRACTICE: It is important to scope practices for the safe monitoring and management of deteriorating children in hospital across Europe. To reduce variance in practice, a consensus statement endorsed by paediatric and intensive care societies could provide guidance and resources to support PEWS implementation and for the operational governance required for continuous quality improvement.

Stable measurement of chemistry, immunochemistry, and hematology analytes in a heparin-based anticoagulant with iloprost additive: A promising candidate for the polyvalent blood collection tube.

INTRODUCTION: A polyvalent blood collection tube could potentially reduce the number and volume of blood samples drawn from patients and reduce the risk of tube mix-ups in a point-of-care setting in the emergency department and the intensive care unit. METHODS: Four different concentrations of our experimental heparin anticoagulant with iloprost additive (HEP-ILOP 50 nM, 150 nM, 1000 nM, and 10 µM, respectively) were tested for significant differences and bias performance specifications against EDTA for 29 hematology analytes, and the highest concentration (HEP-ILOP 10 µM) against lithium heparin for 14 chemistry and immunochemistry analytes. Samples were drawn from 79 consenting subjects from the Oncology Department (n = 38) and the Intensive and Intermediary Care Unit (n = 41). RESULTS: For hematology analytes, the HEP-ILOP formulation generally provided stable measurement within optimal requirements within 5 h after sampling (mean 104 ± 56 min), with very little difference between the four HEP-ILOP concentrations. Because of differences in platelet and red blood cell swelling between EDTA and HEP-ILOP, all size-dependent analytes required proportional factorization to produce similar results. Platelet count by impedance similarly required factorization, whereas the fluorescent method provided results identical with EDTA. Chemistry and immunochemistry analytes were within optimal requirements except for potassium, lactate dehydrogenase, and glucose, indicating a cytoprotective effect of iloprost reducing cell metabolism and rupture, thereby producing results closer to in vivo conditions. CONCLUSIONS: Our novel dry-sprayed anticoagulant formulation, HEP-ILOP, is a promising candidate for a polyvalent blood collection tube, enabling the analysis of hematology, chemistry, and immunochemistry analytes in the same tube.

Who is supporting the parents during their child's cancer treatment? A qualitative study through the lens of compassion.

PURPOSE: Parents of children/adolescents with cancer are placed in a state of severe suffering due to serious concerns, fears, and radical daily life changes. Human support is an important source of support for successful coping. This study explored fundamental aspects of parents' daily, social, and personal life during their child's treatment to deepen our understanding of 'who' plays a significant role in supporting parents, and how, and to what extent this support is provided. METHODS: This qualitative study was undertaken in a compassion paradigm, designed and guided by Heidegger's and Gadamer's philosophy and compassionate methods. Data were generated through ethnographic observations (144 h), focus group interviews (n = 2), and individual/couple interviews (n = 16) at two Danish hospitals. Inductive content analysis was used to analyse data. RESULTS: Overall, support from peers, health professionals, and social networks constituted significant sources of support. Especially peers and health professionals had a continuous support role, which was fundamental for establishing interpersonal closeness and relieving suffering. Sharing responsibilities between parents and among social networks seemed to ease the emotional and practical burden. However, to ensure effectiveness, social networks must be available, outreach, and responsive to needs. Moreover, parents disclosed little self-awareness and resources and options for self-care due to a combination of lack of awareness, time, and space in the hospitals. CONCLUSION: Safeguarding interpersonal and interparental understanding and closeness in parental care is essential. One way is building resilience and a broader human-to-human-based safety net around the family, including social networks and professional psychosocial support, advantageously using compassion.

Pediatric pain knowledge and attitudes among health care professionals-A National Danish Survey.

Aim: To explore and compare Danish health-care professionals' attitudes and knowledge towards pain management of children. Methods: The cross-sectional study was carried out using the Pediatric Pain Knowledge and Attitudes Questionnaire. The questionnaire was distributed to all health care professionals caring for children in three hospital settings, including nurses and physicians in departments of pediatric, emergency, and anesthesia and medical laboratory technologists. Results: The study was conducted in 2020 and 765 health care professionals participated. Within the six main categories included in the questionnaire, there were significant differences between nurses and physicians in three subcategories: view on the care of children in pain, using drugs to relieve pain, and the four mandatories. Comparing nurses with medical laboratory technicians, there were significant differences in the subcategory "view on the care of children in pain." Comparing types of clinical departments, there were significant differences in the subcategories' view on the care of children in pain, using drugs to relieve pain, and the four mandatories. Overall, we found that the participating health professionals did not have a uniform understanding of pain management and therefore might treat children differently. Conclusion: The present study highlights the need to align health care professionals' knowledge regarding pain assessment and management of children, as well as the need to develop and test interventions that support the use of knowledge in practice.

Sclerotherapy as a primary or salvage procedure for aneurysmal bone cysts: A single-center experience.

BACKGROUND: Aneurysmal bone cysts (ABC) are benign cystic bone tumors of an osteolytic and locally aggressive nature. As an alternative to the primary treatment of choice, which consists of curettage with bone grafting, alternative treatment methods with promising results have been described. At our department, we have, in recent years, used percutaneous sclerotherapy with polidocanol. The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol. AIM: To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC. METHODS: Twenty-two consecutive patients (median age 12.5 years; range 1-27) with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively. Eleven patients (48%) had undergone different forms of previous treatment with recurrence. Under general anesthesia and fluoroscopic guidance, repeated percutaneous injections of 4mg polidocanol/kg body weight were performed. Through review of the electronic medical records, the following were identified: healing and recurrence rate, number of treatments, gender, age, comorbidity, location of the tumor and side effects / complications, as well as any previous surgery for ABC. The median length of radiographic follow-up was 19.5 mo. RESULTS: All ABCs except one (96%) showed healing or stable disease after a median of 4 (range 1-8) injections. Complete clinical and radiographic healing was observed in 16 cysts (70%), while partial radiographic healing with resolution of pain was seen in 6 cases (26%) and considered as stable disease. The cyst that failed to heal had previously undergone curettage twice with recurrence. One patient with a large pelvic ABC experienced, right after two injections, a sudden drop in blood pressure, which could quickly be reversed. One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity. Beyond that, no complications were observed. CONCLUSION: Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts. In our series of both primary and recurrent cysts, it showed the ability to achieve healing or stable disease in 22 of 23 cases (96%). Further studies are needed to decide if this provides a long-lasting effect.

Pyrocardan Implant Arthroplasty for Carpometacarpal Osteoarthritis of the Thumb: A Comparative Study with a Historical Control Group.

Background New and improved surgical techniques are warranted to treat osteoarthritis of the thumb carpometacarpal joint (CMC-1). The Pyrocardan implant yields striking results but only few series exist, making the evidence scarce. Purpose The aim of this study was to conduct a prospective series using the Pyrocardan implant. Methods We compared the outcomes to a matched historical control group of patients operated on with ligament reconstruction and tendon interposition. The hypothesis was that the Pyrocardan implant would yield better patient-reported outcomes as well as the procedure would be safe and effective in relieving symptoms of CMC-1 osteoarthritis. In total, 30 patients were included in the prospective series. These 30 patients were compared, in a 1:3 design, to a matched historical group. Results Results were promising with visual analogue scale scores of 0.7 (rest) and 2.1 (function), key-pinch score of 5.1 kg, and shortened Disability of the Arm, Shoulder, and Hand score of 14.3 after 1 year when using the Pyrocardan implant. The revision rate was 10%. We found no evidence of subsidence of the thumb. We found no differences in patient-reported outcomes between the two groups. Conclusions In conclusion, the Pyrocardan implant is a viable option in the treatment of CMC-1 osteoarthritis but with a significant revision rate. When comparing the Pyrocardan implant to a historical control group, we failed to find any differences in patient-reported outcomes. Level of Evidence IV - case series.

Nursing interventions for pediatric patients with cancer and their families: a scoping review protocol.

OBJECTIVE: This scoping review will identify and map available nursing interventions provided by pediatric oncology hospital services to pediatric patients with cancer and/or their family members. The aim is to develop a comprehensive overview of the characteristics of nursing interventions and to identify potential knowledge gaps. INTRODUCTION: Clinical nursing care is an essential part of pediatric oncology. In pediatric oncology nursing research, a shift from explanatory studies to intervention studies is recommended. The body of research on interventions for pediatric oncology patients and their families has grown in recent years. However, there are no reviews on nursing interventions currently available for pediatric oncology. INCLUSION CRITERIA: Studies will be considered for inclusion if they refer to pediatric patients with cancer, and/or family members of a pediatric patient with cancer, who have received non-pharmacological and non-procedural nursing interventions provided by a pediatric oncology hospital service. Studies must also be peer-reviewed, published from the year 2000 onward, and written in English, Danish, Norwegian, or Swedish. METHODS: The review will be conducted in accordance with the JBI guidelines for scoping reviews. A 3-step search strategy will be followed using the PCC mnemonic (Population, Concept, Context). The databases to be searched will include Scopus, PubMed, CINAHL, PsyclNFO, and Embase. The identified studies will be screened based on title and abstract, as well as full text, by 2 independent reviewers. Data will be extracted and managed in Covidence. A summary of the results will be presented as a narrative description, supported by tables.

Recycled PMMA prepared directly from crude MMA obtained from thermal depolymerization of mixed PMMA waste.

Recycled PMMA was prepared by directly polymerizing crude pyrolysis oils from lab-scale pyrolysis of collected industrial waste PMMA. The pyrolysis oils consisted mainly of methyl methacrylate (MMA, >85%), while the type and number of by-products from the thermal process were assigned through GC-MS analysis showing a clear correlation to the pyrolysis temperature. By-products can be removed by distillation; however, directly employing the crude oils to prepare PMMA through solution, suspension, emulsion, or casting polymerization was investigated to assess the potential for omitting this costly step. It was found that the crude pyrolysis oils could be polymerized efficiently via solution, emulsion, and casting polymerization to produce a polymer similar to the PMMA prepared from a pristine monomer. The impurities in the PMMAs prepared from the crude mixtures were investigated by extraction analyses followed by screening by GC-MS. In the case of casting polymerization, the GC-MS analysis, as expected, revealed various residual by-products, while solution and emulsion polymerization showed only very few impurities, mainly originating from the polymerization and not the feed material. Additional purification of the crude pyrolysis oils would be required for applications in casting polymerization. In contrast, direct polymerization by emulsion or solution polymerization is considered applicable for producing pristine PMMA from crude waste PMMA pyrolysis oil.

Mini TightRope Suspension Allows for Accelerated Rehabilitation following Ligament Reconstruction Interposition Arthroplasty of the Basal Joint of the Thumb.

Introduction Surgical treatment of thumb trapeziometacarpal osteoarthritis usually involves 4 to 8 weeks of postoperative casting and splinting followed by varying mobilization protocols. Suspension arthroplasty has been described as an alternative to allow earlier range of motion exercises. The purpose of this study was to compare patient-reported outcomes (PRO) when adding a two-string suture-button suspension arthroplasty (Mini TightRope, MTR) to our usual procedure of ligament reconstruction and tendon interposition (LRTI), allowing early mobilization. Can we allow early mobilization using this technique without jeopardizing the PRO results at the 1 year follow-up and without an increased risk of complication? Materials and Methods A prospective study using the MTR system (Arthrex) as a suture-button suspensionplasty was conducted. Twelve patients (MTR group) and 36 historical patients (LRTI alone) were included. Results At 12 months, the median value for quick disabilities of the arm, shoulder, and hand was 11.3 (range, 0-43.2) in the MTR group and 13.6 (range, 0-88.6) in the LRTI group, resulting in similar improvements, p = 0.46. One in twelve patients in the MTR group was dissatisfied and 9 in 36 in the LRTI group were dissatisfied, p = 0.41. No complications were observed during the first year. Conclusion Supplemental suture-button suspensionplasty can be utilized for high demand patients and patients who want to reduce immobilization time without major complications and with similar PRO as LRTI at 6 and 12 months. Level of evidence Four case series.

Occlusive wound closure prevents prolonged wound discharge-A randomised controlled trial in patients undergoing tumour resection and endoprosthetic reconstruction of the proximal femur because of metastatic bone disease.

Prolonged wound discharge is a common postoperative complication of orthopaedic procedures and a risk factor for implant-related infection. Occlusive wound closure methods have previously been suggested to reduce or even prevent this complication. We performed a randomised controlled trial on 70 patients who underwent surgical treatment for metastatic bone disease involving the proximal femur at our centre between January 2017 and August 2018. At conclusion of the tumour resection and endoprosthetic reconstruction procedure, patients were randomised to either occlusive wound closure (n = 35), using the Dermabond Prineo-22 skin closure system, or routine wound closure with conventional skin staples (n = 35). Skin closure with occlusive wound closure resulted in a lesser degree (P < .0001) and shorter duration of postoperative wound discharge (HR 2.89 [95% CI 1.6-5.05], P < .0018). Compared with staples, surgical wounds were already dry after a mean of 3.5 days [95% CI 3.2-3.9] versus 6.1 days [95% CI 4.8-7.3] (P < .0001). Prolonged wound discharge for 7 days or more was observed in 23% of patients (n = 8) in the Staples-group but was entirely absent in the occlusive wound closure group (P < .003). This study provides strong evidence that occlusive wound closure reduces frequency, degree, and duration of wound discharge in a patient population at particularly high risk for this complication.

Acute pain treatment of children in the Danish emergency departments.

INTRODUCTION: Preconditions for good pain treatment in children include education and guidelines. This study investigated whether the guidelines on acute pain treatment of children in Danish emergency departments reflected the national guideline, examined the knowledge and use of guidelines, and explored the approach adopted to treating pain in children. METHODS: This cross-sectional study consisted of two parts. Part I compared the guidelines in each emergency department with a national guideline; Part II was a structured interview with the emergency department doctors regarding their approach to treating pain in children. RESULTS: Several guidelines did not include pain assessment, dose schedules and non-pharmacological methods as recommended in the national guideline. The doctors knew where to find the guidelines, but a considerable share of them did not use the guidelines. Most doctors felt competent in treating children, but reported a reluctance to using opioids and reported using pain assessment irregularly. CONCLUSION: The Danish guidelines on acute pain treatment of children in many emergency departments vary compared with the national guideline. We found that several doctors do not use the guidelines, are reluctant to use opioids and do not use pain assessment. We suggest a thorough implementation of a national guideline in emergency departments to standardise pain treatment. FUNDING: none. TRIAL REGISTRATION: not relevant.

Sensitivity and performance of three novel quantitative assays of SARS-CoV-2 nucleoprotein in blood.

To assess if SARS-CoV-2 (COVID-19) systemic disease can be determined by available nucleoprotein assays, we compared the performance of three commercial SARS-CoV-2 nucleoprotein (N) assays in plasma. A total of 272 plasma samples collected in the period November-December 2021 were analyzed by the methods Simoa SARS CoV-2 N Protein Advantage Kit [Quanterix Simoa], Solsten SARS-CoV-2 Antigen enzyme immunosorbent assay (ELISA) [Solsten ELISA], and Elecsys SARS-CoV-2 Antigen electrochemiluminescence immunoassay [Elecsys ECLIA]. Additionally, a dilution series of inactivated virus culture was analyzed by the three assays. The SARS CoV-2 PCR-status was not known for the patients. Linear correlation in the pairwise correlation between assays as well as linearity of dilution series of inactivated virus culture was estimated by Spearman score. Sensitivity and specificity were estimated by pairwise comparison. The three assays showed poor agreement on patient samples with regards to concentration. Performance on virus culture was excellent but with different level of detection (LOD). Positive vs negative results show comparable sensitivity and specificity of Quanterix Simoa and Solsten ELISA, with a higher LOD in Elecsys ECLIA and thus lower sensitivity and high specificity. N by all tested assays can be used as a marker for systemic COVID-19 disease.

The challenges of maintaining patient confidentiality in pediatric settings.

PURPOSE: The study investigated challenges encountered by healthcare professionals in complying with the duty of confidentiality in a pediatric department. DESIGN AND METHODS: In this qualitative study, we conducted two focus group interviews with healthcare professionals from two pediatric departments in Denmark using the methodology described by Kvale and Brinkmann. RESULTS: We identified three challenges related to maintaining confidentiality. 1) Time pressure and physical surroundings in the clinical setting. 2) Communication challenges (where and with whom). 3) Navigation in the clinical setting to uphold privacy. In general, nurses and physicians struggle to maintain patient confidentiality in a setting where sensitive information is shared quickly. CONCLUSION: Pediatric nurses and physicians experience challenges related to patient confidentiality that impact their clinical practice. These challenges relate to privacy and dignity and communicating with children and their parents. PRACTICE IMPLICATIONS: Building design or renovation of pediatric departments should underpin confidentiality and privacy issues. Our study makes an important and novel contribution to existing knowledge regarding healthcare professionals' experiences in maintaining patient privacy and confidentiality.

Effects of different treatments of manure on mitigating methane emissions during storage and preserving the methane potential for anaerobic digestion.

Current agricultural practices in regards to storage of manure come with a significant GHG contribution, due, to a big extent, to CH4 emissions. For example, in Denmark, the agricultural sector is responsible for about 11.1 metric tons of CO2 equivalents; only about 0.2 metric tons come directly from CO2, while 6.0 tons come from CH4. The present study aims at evaluating and comparing two methods based on their effect on suppressing CH4 emissions during storage as well as on preserving and enhancing CH4 yield in a subsequent anaerobic digestion step: the commonly applied acidification with H2SO4 as acidifying agent and thermal treatment at the mild temperatures of 70 and 90 °C (pasteurization). Although both treatments effectively suppressed CH4 emissions during storage, they exhibited a significant difference in preserving and/or enhancing the CH4 potential of manure. Specifically, thermal treatment resulted in 16-35% enhancement of CH4 potential, while acidification resulted in decreasing the CH4 yield by 6-23% compared to non-treated manure. Further investigation showed that storage itself positively affected the CH4 potential of treated manure in a subsequent anaerobic digestion step; this was attributed to microbial activity other than biomethanation during storage. In overall and based on the results obtained regarding suppression of CH4 emissions during storage as well as CH4 potential enhancement, pasteurization at the temperatures tested is a promising alternative to the broadly applied acidification of manure.

Dysphagia and QoL 3 Years After Treatment of Oropharyngeal Cancer With TORS or Radiotherapy.

OBJECTIVE(S): To investigate dysphagia and quality of life (QoL) outcomes 3 years after treatment of oropharyngeal cancer with either primary trans oral robotic surgery (TORS) or radiotherapy (RT). METHODS: A prospective cohort study conducted at the Copenhagen University Hospital. Endpoints were objective swallowing function, examined using fiberoptic endoscopic evaluation of swallowing (FEES) and video fluoroscopy (VF). QoL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30), Head & Neck Module (EORTC QLQ-HN35), and MD Anderson Dysphagia Inventory (MDADI). A comparison was made between 1-, and 3-year results. RESULTS: Forty-four patients were included prior to treatment, 31 treated with TORS and 13 with RT. One-year results for this cohort have previously been published (https://doi.org/10.1080/00016489.2020.1836395). Significant improvement on FEES in retention at the piriform sinus was noted in both groups. Patients treated with TORS had improved safety scores as well as dynamic imaging grade of swallowing toxicity (DIGEST) and efficiency scores, whereas patients treated with RT only had improvements in the latter two. Improvement in QoL scores was only noted for patients treated with TORS in composite MDADI scores. CONCLUSION: We found significant improvements in objective swallowing function from one to 3 years after treatment, particularly in patients treated with TORS. However, these improvements were not reflected as clinically meaningful improvements in QoL. LEVEL OF EVIDENCE: 3, cohort follow-up study Laryngoscope, 133:1893-1898, 2023.

Three-Year Recurrence of Dupuytren Contracture after Needle Fasciotomy or Collagenase Injection: A Randomized Controlled Trial.

BACKGROUND: In this randomized controlled trial, the authors compared the recurrence of Dupuytren disease at 3 years following needle fasciotomy or collagenase injection treatment for isolated metacarpophalangeal joint contractures. METHODS: The study was conducted between 2013 and 2015. The study design was a single-center, randomized controlled clinical trial with an independent blinded observer. Patients were randomized between collagenase clostridium histolyticum injections (Xiapex) and percutaneous needle fasciotomy (collagenase clostridium histolyticum versus percutaneous needle fasciotomy). A total of 36 patients were followed in the percutaneous needle fasciotomy group and 32 in the collagenase clostridium histolyticum group. RESULTS: Patients who were treated with collagenase clostridium histolyticum had a significantly lower recurrence rate than patients treated with percutaneous needle fasciotomy during the 3-year period ( P = 0.007). Of the 36 patients who were followed in the percutaneous needle fasciotomy group, 17 (47%) had recurrence of extension deficit or progression of the disease leading to further treatment. Of the 32 patients who were followed in the collagenase clostridium histolyticum group, six (19%) had recurrence or progression. No serious adverse event was reported in any of the patients. CONCLUSIONS: In this randomized controlled trial, we found less recurrence and progression of Dupuytren disease using collagenase injection as compared to percutaneous needle fasciotomy 3 years following treatment for isolated metacarpophalangeal joint contractures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Danish translation and cultural adaptation of the 'What do you think of hospital' patient reported experience measure for children and adolescents in outpatient settings.

PURPOSE: The aim of this study was to translate the patient reported experience measure (PREM) questionnaire"What do you think of the hospital? Help us to get better!" into Danish used in outpatient clinics and to explore its face and content validity. DESIGN AND METHODS: The translation process followed WHO recommendations and included forward translation, expert panel evaluation, back translation, pre-testing and cognitive interviews with 23 children and adolescents. RESULTS: Children and adolescents were positive to using PREM as a way to express their experiences. The layout of the questionnaire was important as use of colours was more appealing and the topics of the questionnaire were better visualised. The concepts in the original questionnaire related to distinguishing between different rooms for examination and conversation are not used in a Danish context. Otherwise, only minor translation adjustments were needed to match the Danish target group. CONCLUSION: Children and adolescents found that the Danish version of the PREM questionnaire tool was easy to read and understand, and the layout emphasised that they are the target group. After pre-testing among 23 children and adolescents, the questionnaire is now ready for pilottest in a larger group. PRACTICE IMPLICATIONS: The present study provides a tool to generate knowledge and evaluate the experiences of children and adolescents in an outpatient clinic. Using the questionnaire, healthcare staff may monitor the quality of the experiences of children and adolescents and collect data for research purposes. Likewise, it will be possible to compare hospitals and organizations nationally.

Evaluation of a novel heparin-iloprost-based antithrombotic formulation blood collection tube for clinical usage.

BACKGROUND: The objective of our study was to evaluate a single blood collection tube with a novel antithrombotic formulation to measure both hematological, biochemical, and d-dimer analytes. METHODS: Paired samples of gold standard blood tubes (EDTA, lithium heparin, sodium citrate) and a new antithrombotic formulation blood tube were collected from 187 patients. The new antithrombotic tube is a lithium heparin tube preloaded with a liquid form of prostacyclin analog. The novel tube was tested on seventeen hematological parameters and smears against EDTA, on fourteen biochemical parameters against lithium heparin and on d-dimer against sodium citrate. RESULTS: All correlation coefficients were close to 0.99. The Bland-Altman analyses presented a satisfactory correspondence for all analytes. All the hematological examinations demonstrated comparable results between EDTA and the novel formulation, except for platelet counts analyzed by impedance method, but not by fluorescence. We detected lower mean platelet volume with/without outliers (5.06%)/(5.13%) in the novel formulation and increased mean corpuscular hemoglobin concentration (2.55%). All the biochemistry analytes demonstrated comparable results between lithium heparin and the novel tube. d-dimer showed comparable results between citrated blood and the novel formulation after dilution correction. CONCLUSIONS: We describe a novel antithrombotic formulation tube with the potential to be introduced into clinical laboratories for simultaneous analysis of thirty-two blood analytes.

Consensus on patient cases for hospitalised children with a high paediatric track and trigger tool score that raises no mounting concern: a Delphi process study.

BACKGROUND: Paediatric track and trigger tools (PTTTs) based on vital parameters have been implemented in hospitals worldwide to help healthcare professionals identify signs of critical illness and incipient deterioration in hospitalised children. It has been documented that nurses do not use PTTT as intended, but deviate from PTTT protocols because, in some situations, PTTT observations make little sense to them. The present study aimed to reach consensus on whether automatically generated PTTT scores that are higher than deemed reasonable by healthcare professionals according to their professional experience and clinical expertise may be downgraded. METHODS: A two-round modified Delphi technique was used to explore consensus on 14 patient cases for hospitalised children with a high PTTT score that did not raise concerns by systematically collating questionnaire responses. Participants rated their level of agreement on a 9-point Likert scale. IQR and median were calculated for each case. FINDINGS: A total of 221 participants completed round 1 and 101 participants completed round 2. Across the two rounds, majority of the participants were from paediatric departments, nurses and women. In round 1, consensus on inclusion was reached on 2 of the 14 cases. In round 2, consensus was reached on one additional patient case. Three of the 11 non-consensus cases remaining after rounds 1 and 2 were included by the research group based on predefined criteria. CONCLUSION: In conclusion, a consensus opinion was achieved on six patient cases where the child had a high PTTT score but where the healthcare professionals were not as concerned as indicated by the PTTT score.