How institutional logics shape the adoption of virtual reality in mental health care: A qualitative study.

Objective: To analyse institutional logics' role in adopting virtual reality in mental health care. Methods: Data were collected via qualitative, semi-structured interviews with four frontline staff and seven administrative and service staff, two focus group interviews with three frontline staff and four administrative and service staff, and via participant observation in meetings between stakeholders working on virtual reality. Data were collected from May 2021 to February 2022, analysed using thematic analysis, and theoretically driven by the framework of Institutional logics. Results: We identified two different forms of institutional logics being drawn upon by frontline staff and administrative and service staff, respectively, when working with the adoption of virtual reality in mental health care. Frontline staff drew mainly on a Professional logic; administrative and service staff drew on a Diffusion logic. Each logic defined a unique focal point, causal pathway, and perceptions of a meaningful adoption process for virtual reality. Conclusions: By taking institutional logics as our theoretical and analytical point of departure, this study demonstrates how the meaning of virtual reality and its adoption in mental health care is grounded in multiple and sometimes conflicting institutional logics. Acknowledging the existence and influence of often multiple institutional logics in the adoption process is crucial to guide the future adoption of virtual reality in mental health care. Organising collaborative venues for stakeholders where their multiple institutional logics are made the subject of joint reflection is essential to counter frictions.

3D printed skulls in court - a benefit to stakeholders?

Forensic pathologists may use 3D prints as demonstrative aids when providing expert testimony in court of law, but the effects remain unclear despite many assumed benefits. In this qualitative study, the effects of using a 3D print, demonstrating a blunt force skull fracture, in court were explored by thematic analysis of interviews with judges, prosecutors, defence counsels, and forensic pathologists with the aim of improving the expert testimony. Five semi-structured focus groups and eight one-to-one interviews with a total of 29 stakeholders were transcribed ad verbatim and analysed using thematic analysis. The study found that a highly accurate 3D print of a skull demonstrated autopsy findings in detail and provided a quick overview, but sense of touch was of little benefit as the 3D print had different material characteristics than the human skull. Virtual 3D models were expected to provide all the benefits of 3D prints, be less emotionally confronting, and be logistically feasible. Both 3D prints and virtual 3D models were expected to be less emotionally confronting than autopsy photos. Regardless of fidelity, an expert witness was necessary to translate technical language and explain autopsy findings, and low-fidelity models may be equally suited as demonstrative aids. The court infrequently challenged the expert witnesses' conclusions and, therefore, rarely had a need for viewing autopsy findings in detail, therefore rarely needing a 3D print.

Vaccination timeliness of preterm infants hospitalised in a neonatal intensive care unit in Denmark.

AIM: In Denmark, preterm infants are recommended to receive childhood vaccinations without correction for gestational age. This study aimed to describe the timeliness of the Danish Childhood Vaccination Program in preterm infants during the first 13 months of life and to evaluate possible determinants of delay. METHODS: This retrospective cohort study included preterm infants admitted to a level III neonatal intensive care unit between October 2019 and October 2020. Clinical data were retrieved from medical records and the Danish Vaccination Register. Timely vaccination was defined corresponding to chronological age of 3-, 5- and 12 months, within a time interval of 30 days before to 29 days after the expected date. RESULTS: Analyses included 365 infants. Timely vaccination occurred in 91%, 83% and 67% of preterm infants for the first, second and third vaccination, respectively, and timeliness was highest if born before gestational age 28 weeks. Gestational age 28-31 + 6 weeks and delayed former vaccinations negatively influenced the timeliness of the following vaccinations. CONCLUSION: Most preterm infants received the first vaccination timely; however, timeliness decreased with each subsequent vaccination. Efforts to improve timeliness should focus on counselling healthcare personnel and parents to follow the recommendations for the first and the following vaccinations.

Low-dose naltrexone for treatment of pain in patients with fibromyalgia: a randomized, double-blind, placebo-controlled, crossover study.

Introduction: Fibromyalgia (FM) is a chronic fluctuating, nociplastic pain condition. Naltrexone is a µ-opioid-receptor antagonist; preliminary studies have indicated a pain-relieving effect of low-dose naltrexone (LDN) in patients with FM. The impetus for studying LDN is the assumption of analgesic efficacy and thus reduction of adverse effects seen from conventional pharmacotherapy. Objectives: First, to examine if LDN is associated with analgesic efficacy compared with control in the treatment of patients with FM. Second, to ascertain the analgesic efficacy of LDN in an experimental pain model in patients with FM evaluating the competence of the descending inhibitory pathways compared with controls. Third, to examine the pharmacokinetics of LDN. Methods: The study used a randomized, double-blind, placebo-controlled, crossover design and had a 3-phase setup. The first phase included baseline assessment and a treatment period (days -3 to 21), the second phase a washout period (days 22-32), and the third phase a baseline assessment followed by a treatment period (days 33-56). Treatment was with either LDN 4.5 mg or an inactive placebo given orally once daily. The primary outcomes were Fibromyalgia Impact Questionnaire revised (FIQR) scores and summed pain intensity ratings (SPIR). Results: Fifty-eight patients with FM were randomized. The median difference (IQR) for FIQR scores between LDN and placebo treatment was -1.65 (18.55; effect size = 0.15; P = 0.3). The median difference for SPIR scores was -0.33 (6.33; effect size = 0.13; P = 0.4). Conclusion: Outcome data did not indicate any clinically relevant analgesic efficacy of the LDN treatment in patients with FM.

Response to pneumococcal conjugate and polysaccharide vaccination in children with rheumatic disease.

Children with rheumatic disease and compromised immune system have an increased risk of infection. Streptococcus pneumoniae is a frequent pathogen, and immunization is recommended. In this study, we investigated whether immunocompromised children with rheumatic disease do respond to pneumococcal immunization with 13-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine. The study was conducted at two tertiary referral hospitals in Denmark from 2015 to 2018. Patients with rheumatic disease and compromised immune system aged 2-19 years were eligible. Patients were vaccinated with 13-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine. A blood sample was collected before vaccination and after each vaccination. IgG antibodies were quantified for twelve serotypes. Seroprotection for each serotype was defined as IgG ≥0.35 µg/mL. A total of 27 patients were enrolled. After the conjugate vaccine, an increase in antibody titres compared with pre-vaccination was found for all serotypes and 9/12 were significant. After the polysaccharide vaccine, the antibody titres for all serotypes but one was seen to increase but none reached significance. The proportion of patients protected before immunization ranged from 20.8% to 100% for the individual serotypes. Odds ratio for achieving seroprotection after the conjugate vaccine was >1 for 10/12 serotypes but only significant for three serotypes. After the polysaccharide vaccine, the odds ratio was >1 for 9/12 serotypes but none reached significance. In conclusion, children with rheumatic disease and compromised immune system respond to pneumococcal immunization with 13-valent pneumococcal conjugate vaccine and maintain antibody levels upon subsequent immunization with 23-valent pneumococcal polysaccharide vaccine.

Dancing with death. A historical perspective on coping with Covid-19.

In this paper, we address the question on how societies coped with pandemic crises, how they tried to control or adapt to the disease, or even managed to overcome the death trap in history. On the basis of historical research, we describe how societies in the western world accommodated to or exited hardship and restrictive measures over the course of the last four centuries. In particular, we are interested in how historically embedded citizens' resources were directed towards living with and to a certain extent accepting the virus. Such an approach of "applied history" to the management of crises and public hazards, we believe, helps address today's pressing question of what adaptive strategies can be adopted to return to a normalized life, including living with socially acceptable medical, hygienic and other pandemic-related measures.

En este artículo abordamos la cuestión de cómo las sociedades enfrentaron las crisis pandémicas, cómo intentaron controlar o adaptarse a la enfermedad, o incluso cómo lograron superar la trampa mortal de la historia. Basándonos en la investigación histórica, describimos cómo las sociedades del mundo occidental se adaptaron o salieron de las dificultades y las medidas restrictivas durante los últimos cuatro siglos. En particular, estamos interesados en cómo los recursos de los ciudadanos históricamente arraigados se dirigieron a vivir con el virus y, hasta cierto punto, a aceptarlo. Creemos que este enfoque de "historia aplicada" a la gestión de crisis y peligros públicos ayuda a abordar la urgente cuestión actual de qué estrategias de adaptación se pueden adoptar para volver a una vida normalizada, que abarque vivir con servicios médicos y de higiene socialmente aceptables y otras medidas relacionadas con la pandemia.

Response to influenza vaccination in immunocompromised children with rheumatic disease: a prospective cohort study.

BACKGROUND: Prevention of illness due to infection by influenza viruses is important for children with rheumatic diseases. Biological disease modifying antirheumatic drugs have become increasingly important in the treatment of juvenile idiopathic arthritis, and combinations of immunosuppressive drugs are used for the treatment of systemic disorders, which increase the risk of secondary immunodeficiency. Therefore, we investigated whether children with rheumatic disease can mount a protective antibody response after influenza immunization. METHODS: The prospective multicentre cohort study was conducted in Denmark during the influenza season 2015-2016. Children with rheumatic disease aged six months to 19 years were eligible. Controls were immunologically healthy children. A blood sample was collected before and after vaccination and analysed by haemagglutination inhibition (HI) assay for the 2015-2016 influenza vaccine-strains. In case of flu-like symptoms the child was tested for influenza. For statistical analyses the patients were grouped according to medical treatment or disease. RESULTS: A total of 226 patients and 15 controls were enrolled. No differences were found for the increase of antibodies from pre-vaccine to post-vaccine between the groups in our primary analyses: A/Cal H1N1pdm09 (p = 0.28), A/Swi H3N2 (p = 0.15) and B/Phu Yamagata (p = 0.08). Only when combining patients across groups a lower increase in antibodies was found compared to controls. Among all patients the pre-vaccine rates for seroprotection using the HI-titer cut-off ≥ 40 were 93.1-97.0 % for all three strains. For seroprotection using the HI-titer cut-off ≥ 110 the pre-vaccine rates for all patients were 14.9-43.6 % for all three strains and an increase in the proportions of patients being seroprotected after vaccination was found for A/Cal H1N1pdm09 and A/Swi H3N2. None of the children with flu-like symptoms tested positive for the vaccine strains. CONCLUSIONS: Children with rheumatic diseases increase in antibody titres after influenza immunization, however, it remains uncertain whether a protective level is achieved.

Antibody response to vaccination after haematopoietic cell transplantation in children using a reduced dose schedule-A retrospective cohort study.

Children receiving HCT loose protective immunity to vaccines received pre-HCT. Therefore, revaccination post-HCT is of major importance. In Denmark, a vaccination schedule with fewer doses post-HCT has been used, including two doses for diphtheria, tetanus, polio, measles, mumps, and rubella, and one dose only for Haemophilus influenzae type B. The background for this was the presumption that post-HCT immunization constituted booster vaccination of donor immunity. Our objective was to evaluate the proportion of children protected after the scheduled vaccination programme. A nationwide retrospective cohort study of all children who have received an HCT in Denmark during 1994-2012. Antibody levels were analysed in blood samples drawn before and after vaccination, and the probability of achieving protection after the scheduled immunization programme was estimated. A total of 198 children were included. The protection post-immunization was as follows: diphtheria 75.3%, tetanus 89.1%, polio 97.7%, and Haemophilus influenzae type B 94.8%. For diphtheria and tetanus, the probability of achieving protection increased to 93.8% and 97.3%, respectively, after a third dose. For measles, mumps, and rubella, the probability of achieving protection was 89.4%, 80.9%, and 94.2%, respectively. In conclusion, our findings support a more extensive vaccination schedule including three doses for diphtheria and tetanus which are in line with current international guidelines.

Users' Experiences With Home Mechanical Ventilation: A Review of Qualitative Studies.

BACKGROUND: Users of home mechanical ventilation encounter major psychological and physiologic challenges. To ensure well-functioning home mechanical ventilation, users' experiences of care and treatment are important knowledge to supplement clinical perspectives. This systematic review aimed to summarize current qualitative evidence regarding experiences of home mechanical ventilation users. METHODS: By following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, 9 databases were systematically searched. Seven studies met the inclusion criteria after title and/or abstract screening and full-text assessment. These were appraised by using the Relevance, Appropriateness, Transparency, Soundness checklist. Thematic analysis guided data extraction and identification of the findings. The Confidence in the Evidence for Reviews of Qualitative Research tool was applied to assess the confidence of the findings. RESULTS: The review showed high confidence in 4 findings: an increase in quality of life, feeling forced to accept home mechanical ventilation, collaboration between home-care assistants and users of home mechanical ventilation is challenging, and information about the technology from a user's perspective. The review showed moderate confidence in 2 findings: living at home is pivotal for a normalized everyday life, and home mechanical ventilation causes a life with continued worries and uncertainty. CONCLUSIONS: According to the users, treatment by home mechanical ventilation resulted in increased well-being and facilitated a community- and home-based lifestyle compared with institutional-based treatment. However, the users also expressed difficulties in coming to terms with the necessary extensive surveillance, which gave rise to a sense of undermined autonomy and self-determinism as well as continued worries and uncertainty. The users called this situation dependent independency. As a result of the review we call for an increased focus on a patient-centered treatment and care.

What is the impact of physicians in prehospital treatment for patients in need of acute critical care? - An overview of reviews.

OBJECTIVES: The aim of this overview was to systematically identify and synthesize existing evidence from systematic reviews on the impact of prehospital physician involvement. METHODS: The Medline, Embase, and Cochrane library were searched from 1 January 2000 to 17 November 2017. We included systematic reviews comparing physician-based with non-physician-based prehospital treatment in patients with one of five critical conditions requiring a rapid response. RESULTS: Ten reviews published from 2009 to 2017 were included. Physician treatment was associated with increased survival in patients with out-of-hospital cardiac arrest and patients with severe trauma; in the latter group, the result was based on more limited evidence. The success rate of prehospital endotracheal intubation (ETI) has improved over the years, but ETI by physicians is still associated with higher success rates than intubation by paramedics. In patients with severe traumatic brain injury, intubation by paramedics who were not well skilled to do so markedly increased mortality. CONCLUSIONS: Current evidence is hinting at a benefit of physicians in selected aspects of prehospital emergency services, including treatment of patients with out-of-hospital cardiac arrest and critically ill or injured patients in need of prehospital intubation. Evidence is, however, limited by confounding and bias, and comparison is hampered by differences in case mix and the organization of emergency medical services. Future research should strive to design studies that enable appropriate control of baseline confounding and obtain follow-up data for the proportion of patients who die in the prehospital setting.

Beyond Activity Based Funding. An experiment in Denmark.

Over past decades Activity Based Funding has been an attractive tool for hospital funding and governance, but there has been growing frustration especially with its unintended effects. There are numerous examples of alternative models, but there is little in-depth knowledge about how these models came about. The aim of our study was to analyse how the discourse of Activity Based Funding was successfully challenged. This contributes insights into how international/national debates are translated into concrete alternative models through specific discursive mechanisms. The analysis used a discursive policy approach and was based on a case study from Denmark ('New Governance'). The data consisted of project and policy documents as well as qualitative interviews with regional and national experts. The analysis identified four discursive mechanisms: the problem definitions underlying 'New Governance' were clear and simple; the underlying assumptions both accepted and challenged the premises of Activity Based Funding; the alternative of 'New Governance' was defined in rather broad terms; and it was produced, disseminated and defended as part of interweaving processes regionally but also nationally. Our study showed that new models of hospital funding and governance need to be carefully engineered and that they draw on a mix of governance logics. Future research needs to study more examples from a broad range of institutional contexts and points in time.

An enhanced Enterovirus surveillance system allows identification and characterization of rare and emerging respiratory enteroviruses in Denmark, 2015-16.

BACKGROUND: The potential for outbreaks due to Enteroviruses (EV) with respiratory tropism, such as EV-D68, and the detection of new and rare EV species C is a concern. These EVs are typically not detected in stool specimens and may therefore be missed by standard EV surveillance systems. Following the North American outbreak of EV-D68 in 2014, Denmark piloted an enhanced EV surveillance system that included the screening of respiratory samples. OBJECTIVES: We aim to report clinical manifestations and phylogenetic descriptions from the rare and emerging EVs identified thereby demonstrating the usefulness of this system. STUDY DESIGN: Positive EV samples received through the enhanced non-polio EV pilot surveillance system were characterized by sequencing fragments of VP1, VP2 and VP4 capsid proteins and clinical observations were compiled. RESULTS: Between January 2015 and October 2016, six cases of rare genotypes EV-C104, C105 and C109 and nine cases of EV-D68 were identified. Patients presented with mild to moderately severe respiratory illness; no paralysis occurred. Distinct EV-C104, EV-C109 and EV-D68 sequences argue against a common source of introduction of these genotypes in the Danish population. CONCLUSIONS: The enhanced EV surveillance system enabled detection and characterization of rare EVs in Denmark. In order to improve our knowledge of and our preparedness against emerging EVs, public health laboratories should consider expanding their EV surveillance system to include respiratory specimens.

Parental response to severe or lethal prenatal diagnosis: a systematic review of qualitative studies.

OBJECTIVE: A severe or lethal prenatal diagnosis places great demands on prospective parents, who face choices of far-reaching consequences, such as continuing or terminating the pregnancy. How best to support these parents is a clinical challenge. This systematic review aimed to identify and synthesize the qualitative evidence regarding prospective parents' responses to such prenatal diagnoses. METHODS: Following PRISMA guidelines, four databases were systematically searched and 28 studies met the inclusion criteria. Thematic analysis guided data extraction and synthesis of findings. The Confidence in the Evidence for Reviews of Qualitative research assessment tool was utilized to assess confidence in the findings. RESULTS: Prospective parents experienced multiple losses, for example, of the healthy child, normal pregnancy and envisioned future. After diagnosis, they requested timely and reliable information and empathetic continued interaction with clinicians. Prospective parents who continued the pregnancy wished to be acknowledged as parents and engaged in planning to obtain a sense of meaning and control. Selective disclosure and concerns about negative responses were issues both for the parents who terminated and those who continued a pregnancy. CONCLUSION: Clinicians can support parental coping following a severe prenatal diagnosis through continued dialogue and collaboration. Further research is needed on the experiences of parents who choose to terminate a pregnancy following prenatal diagnosis. © 2017 John Wiley & Sons, Ltd.

Psychiatric service users' experiences of emergency departments: a CERQual review of qualitative studies.

BACKGROUND: There is increased clinical and political attention towards integrating general and psychiatric emergency departments (ED). However, research into psychiatric service users' experiences regarding general EDs is limited. AIM: To identify and summarize current, qualitative evidence regarding service users' experiences attending EDs. A secondary aim is to apply and test the newly developed CERQual approach to summarizing qualitative review findings. METHODS: A systematic literature review of five databases based on PRISMA guidelines yielded 3334 unique entries. Screening by title/abstract identified 57 studies and, after full text assessment, nine studies were included. The included studies were critically appraised using CASP. Thematic synthesis was applied for data extraction and identification of findings. The CERQual approach was utilized to assess the confidence of the findings. RESULTS: The results of the review showed moderate confidence in the findings that service users experience meeting caring and judgmental ED staff, and that waiting times and a stressful environment are integral to their ED experiences. In contrast, low-to-very low confidence was seen in the findings that service users experience having their symptoms ignored and that EDs are used due to a lack of alternatives. A companion may improve service users experience and outcome of ED visits. CONCLUSION: Service users experience stress and discomfort in the ED. Service users highly appreciate knowing staff who can ease the discomfort. Overall, the results of this review speak in favour of integrated EDs where service users' needs are more likely to be recognized and accommodated.

Community families: A qualitative study of families who volunteer to support persons with severe mental illness.

BACKGROUND: Social interventions targeted at people with severe mental illness (SMI) often include volunteers. Volunteers' perspectives are important for these interventions to work. This article investigates the experiences of volunteer families who befriend a person with SMI. MATERIAL: Qualitative interviews with members of volunteer families. DISCUSSION: The families were motivated by helping a vulnerable person and by engaging in a rewarding relationship. However, the families often doubted their personal judgement and relied on mental health workers to act as safety net. CONCLUSION: The volunteer involvement is meaningful but also challenging. The families value professional support.

Factors affecting physicians' use of a dedicated overview interface in an electronic health record: The importance of standard information and standard documentation.

BACKGROUND: It remains a continual challenge to present information in user interfaces in large IT systems to support overview in the best possible way. We here examine how an electronic health record (EHR) supports the creation of overview among hospital physicians with a particular focus on the use of an interface designed to provide clinicians with a patient information overview. The overview interface integrates information flexibly from diverse places in the EHR and presents this information in one screen display. Our study revealed widespread non-use of the overview interface. We explore the reasons for its use and non-use. METHOD: We conducted exploratory ethnographic fieldwork among physicians in two hospitals and gathered statistical data on their use of the overview interface. From the quantitative data, we identified where the interface was used most and conducted 18 semi-structured, open-ended interviews framed by the theoretical framework and the findings of the initial ethnographic fieldwork. We interviewed both physicians and employees from the IT units in different hospitals. We then analysed notes from the ethnographic fieldwork and the interviews and ordered these into themes forming the basis for the presentation of findings. RESULTS: The overview interface was most used in departments or situations where the problem at hand and the need for information could be standardized-in particular, in anesthesiological departments and outpatient clinics. However, departments with complex and long patient histories did not make much use of the overview interface. Design and layout were not mentioned as decisive factors affecting its use or non-use. Many physicians questioned the completeness of data in the overview interface-either because they were skeptical about the hospital's or the department's documentation practices, or because they could not recognize the structure of the interface. This uncertainty discouraged physicians from using the overview interface. CONCLUSION: Dedicating a specific function or interface to supporting overview works best where information needs can be standardized. The narrative and contextual nature of creating clinical overview is unlikely to be optimally supported by using the overview interface alone. The use of these kinds of interfaces requires trust in data completeness and other clinicians' and administrative staff's documentation practices, as well as an understanding of the underlying structure of the EHR and how information is filtered when data are aggregated for the interface.

The risk of manipulation under anesthesia due to unsatisfactory knee flexion after fast-track total knee arthroplasty.

BACKGROUND: Fast-track TKA has significantly shortened the time available for physiotherapists to optimize knee ROM before discharge. Safety aspects concerning knee stiffness and the need for manipulation in a fast-track setting need to be illuminated. The study aims were to analyze if fast-track TKA can be considered safe considering rates of knee manipulation and if there is an association between knee ROM at time of discharge and the need for later manipulation. METHODS: Primary TKAs operated in 2011 at our institution were eligible for inclusion. The study group consisted of 359 TKAs. RESULTS: Manipulation of the knee was performed in 21 of 359 TKAs (5.8%). Seventy-one percent were discharged with a flexion ≥70° combined with an extension deficit of ≤10°. The occurrence of MUA for these patients was 4.3%. The prevalence of knee manipulation showed a statistically significant association with the achieved knee flexion at discharge (p=0.02). Median length of stay was two days. CONCLUSION: Compared with literature findings fast-track TKA surgery may be considered safe based on the acceptable rate of knee manipulations after TKA (5.8%). We suggest ROM of ≥70° flexion combined with an extension deficit of ≤10° as an "optimal-zone" for ROM at discharge. The reason for this is the low occurrence of MUA (4.3%) in relation to the large amount of TKAs it represents (71%). The indication for MUA is multifactorial and ROM at discharge serves only as an indicator of later MUA risk.

Diabetes is associated with lower tuberculosis antigen-specific interferon gamma release in Tanzanian tuberculosis patients and non-tuberculosis controls.

BACKGROUND: Diabetes is increasingly common in TB endemic regions and plays a role as a possible risk factor for increased progression from latent TB infection (LTBI) to active TB disease. Although the pathophysiological mechanisms are not fully understood, the immune system is weakened in diabetes patients and therefore the validity of interferon gamma release assays (IGRA) may be compromised. The aim of the present study was to assess the association between diabetes and Mycobacterium tuberculosis (Mtb) antigen-specific interferon gamma (IFN-γ) release in a TB endemic area among culture-confirmed TB patients and non-TB controls. METHODS: Culture-confirmed pulmonary TB patients (n = 187) and healthy non-TB neighbourhood controls (n = 190) from Mwanza, Tanzania were tested for the presence of circulating T cells recognizing Mtb antigens using an IGRA. The diabetes status of all participants was assessed using a standard oral glucose tolerance test. The impact of diabetes on the performance of the IGRA was estimated using robust linear and logistic regression. RESULTS: Compared to normal glucose tolerance, diabetes was associated with reduced levels of Mtb-specific IFN-γ. Increasing levels of fasting blood glucose (B - 0.3, 95% confidence interval - 0.6 to - 0.03, p = 0.033) was negatively associated with IFN-γ. Although TB patients had higher specific and lower unspecific mitogen IFN-γ responses compared to non-TB controls, the association between diabetes and IFN-γ did not depend on TB status. CONCLUSION: Diabetes is associated with lower levels of Mtb antigen-specific IFN-γ, and the validity of IFN- γ tests for LTBI may be questionable in individuals with diabetes.

Clinical overview: a framework for analysis.

In this presentation, we investigate concepts and theories for analysing how healthcare professionals achieve overview of patient cases. By 'overview' we mean the situation in which a healthcare professional with sufficient certainty and in concrete situations knows how to proceed based on available information upon a patient. Achieving overview is central for the efficient and safe use of healthcare IT systems, and for the realization of the potential improvements of healthcare that are behind investments in such systems. We focus on the theories of decision-making, sensemaking, narratives, ethnomethodology and distributed cognition. Whereas decision-making theory tend to be sequential and normative, we find the concept of 'functional deployment' in sensemaking theory, 'emplotment' in narrative theory, the focus on 'members' methods' in ethnomethodology and the inclusion of 'computational artifacts' in distributed cognition helpful.

[Salmonella is a rare cause of meningitis in infants]. / Salmonella er en sjælden årsag til meningitis hos nyfødte.

In developed countries, invasive disease caused by non typhoidal Salmonella spp. is rare. Here we present a Danish case of Salmonella enterica serovar Enteritidis (S. Enteritidis) meningitis in an infant who had no underlying diseases. The child had had no known expositions, and the source of the infection was never identified. The chance of finding uncommon microorganisms as cause of invasive infections such as meningitis and the choice of initial empiric antimicrobial treatments is discussed.