Retention of emergency cricothyroidotomy skills: A multicenter randomized controlled trial.

Objectives: Emergency cricothyroidotomy is the final approach to establishing a secure airway. The procedure is acute and highly infrequent, making it difficult to achieve and maintain competence in the clinic. Simulation-based training in emergency cricothyroidotomy is effective but it is unknown how often training should be repeated to maintain skills. This study aimed to assess novices' retention of technical skills in emergency cricothyroidotomy after completing SBT. Methods: Novices in emergency cricothyroidotomy completed a structured, simulation-based training program and were randomized to retention tests after 1, 3, or 6 months. Participants completed two emergency cricothyroidotomy tests at end-of-training and follow-up retention testing. Test performances were video recorded and evaluated by two experienced blinded raters using a structured assessment tool. Differences in the performances and the pass/fail rates were analyzed. Results: Eighty-two medical students from two different Danish universities were included from April 2021 to February 2022. Paired t-tests showed skills decay significantly after 1 month (mean loss 6.7 points, p < 0.001). The mean loss of points, representing the difference in global score points, from the end-of-training to retention test was 6.7 points (95% confidence interval [CI] 4.5-8.8) for the 1-month group, 8.2 points (95% CI 5.8-10.0) for the 3-months group, and 9.9 points (95% CI 8.1-11.7) for the 6-months group. Six participants in both the 1-month group (23.1%) and the 3-month group (24%) passed the first retention test, but no one in the 6-months group had a passing performance. Conclusions: Novices' technical skills performance in emergency cricothyroidotomy decay significantly already after 1 month. This initial loss of skill seems to be stable until 3 months, after which there is a further significant loss of skills. Recurring training should be implemented for the benefit of patient safety and outcomes.

Tonsillectomy and risk of post-tonsillectomy haemorrhage - a protocol for a randomised clinical trial.

INTRODUCTION: Tonsillectomy is one of the most common procedures in the ear, nose and throat field, and 7.7% of the Danish population had undergone a tonsillectomy by the age 20 years in 2012. One feared complication is post-tonsillectomy haemorrhage (PTH), which in a Danish register-based study was found to increase from 3% in 1991 to 13% in 2012. PTH represents a significant risk and deaths are reported in the literature. The aim of the trial is to compare hot and cold haemostasis during tonsillectomy and assess, firstly, the risk of PTH and, secondly, the reported pain perception. METHODS: This is a single-centre, two-arm, interventional randomised controlled trial. The study targets patients > 12 years of age referred for tonsillectomy. Participants will have both tonsils removed; on one side cold haemostasis will be performed and on the other hot diathermia will secure haemostasis. The participants will subsequently receive three questionnaires in the course of a month concerning bleeding episodes and pain perception. Owing to the study design, patients and surgeons act as their own controls. CONCLUSIONS: The results of the study may guide future research and practice of tonsillectomy to reduce the risk of PTH. FUNDING: Lizzi and Mogens Staal Fonden and Nordsjællands Hospital. The funding sources had no influence on trial design, data collection, analysis or publication. CLINICALTRIALS: gov Identifier: NCT05161754. Registration date: 20042021; version 2: 20042021.

Core needle biopsy is an inferior tool for diagnosing cervical lymphoma compared to lymph node excision.

BACKGROUND: In Denmark, fine needle aspiration is the standardized tool for obtaining tissue samples from lymph nodes (LN) of the neck. However, because of a low specificity toward lymphomas, LNs suspicious for this disease are often surgically removed and examined. International studies have implied that a core needle biopsy (CNB) is sufficient for detecting lymphomas, thereby potentially avoiding surgery. However, all studies have been conducted retrospectively and the goal of this prospective study was to find the true sensitivity of CNB. MATERIAL AND METHODS: Fifty-seven patients were enrolled in the study, one was excluded due to lack of CNB material. LNs suspected for lymphoma were surgically removed from the neck, whereafter a CNB was obtained from the removed LN. The CNB and the remaining part of the LN were sent to the Department of Pathology for further processing and the samples were blinded and examined by two pathologists separately. A consensus diagnosis was reached in cases with divergent diagnostic proposals. Sensitivity of the CNB method in comparison to whole tissue sections for lymphoma diagnosis was calculated. RESULTS: The CNB method gave the correct diagnosis in 66% of lymphoma cases, was inconclusive in 14% and gave an incorrect lymphoma subtype in 18%. In 2% the CNB wrongly resulted in a benign diagnosis. CNB was correct in all the non-lymphoma cases; thereby retaining a specificity of 100%. CONCLUSION: This prospective study found a sensitivity of 66% for diagnosing lymphoma with a CNB. As the CNB in this study was obtained under optimal conditions, unlike in clinical practice, we conclude that CNB cannot be recommended as a standard tool for diagnosing lymphomas.

Regional variation in surgery for pancreatic cancer in Denmark 2011-2015.

INTRODUCTION: Surgical treatment for pancreatic cancer carries a high risk of both morbidity and mortality. Even so, it remains the best curative treatment option. In Denmark, pancreatic surgery has been extensively centralised since the millennium, but the effect of this centralisation on patient outcome has not been evaluated. This study describes regional variation within pancreatic surgery on a malignant indication, focusing on production volume, length of stay, readmission rates and mortality. METHODS: This is a retrospective cohort study of all patients with pancreatic cancer who underwent surgical treatment in Denmark from 2011 to 2015. We obtained data from the Danish National Patient Registry and the National Pathology Data Bank on length of stay, transfers, mortality (both short and long term), age, co-morbidity, and disease stage. RESULTS: Four hospital units performed a total of 691 surgical procedures (476 pancreaticoduodenectomies) in the study period. Production volume varied considerably across units with two units accounting for nearly 80% of surgery performed. Data revealed variation on rates of transfers and readmissions as well as disease stage and mortality (both short and long term). CONCLUSIONS: Data suggest that mortality is linked to production volume as well as disease stage, but the small data quantity impedes rigorous statistical analysis. Further studies on the observed associations are required. FUNDING: none. TRIAL REGISTRATION: not relevant.

A nationwide study of the quality of surgical guidelines and written patient information.

INTRODUCTION: Clinical practice guidelines (CPGs) support enhanced post-operative recovery and decrease morbidity. In addition, patient information leaflets (PILs) are associated with enhanced overall outcomes and improved patient satisfaction. The aim of this study was to provide an overview of the quality of CPGs and PILs in cancer surgery departments undertaking pulmonary lobectomy, nephrectomy, cystectomy, whipples, colorectal and ovarian surgery. METHODS: We conducted a cross-sectional descriptive study within 44 surgical departments in six cancer subspecialties: lung (n = 4), kidney (n = 9), bladder (n = 5), pancreas (n = 4), colorectal (n = 18) and ovarian (n = 4). Local CPGs were assessed according to nine key elements, i.e. discharge criteria and plans for mobilisation, pain management, nutrition, fluid, nausea and vomiting, antibiotics, bowel movements and urinary drainage. The PILs were evaluated using the DISCERN tool. RESULTS: All departments had CPGs and PILs. Overall, 43% of the departments incorporated all nine key elements in the CPGs. Yet, a third of the CPGs lacked well-defined discharge criteria, and half of the PILs were of poor/very poor quality (48%); the remainder were fair (43%) or good (10%). CONCLUSIONS: CPGs and PILs are highly available in Danish departments that perform cancer surgery. However, this study revealed that local CPGs lacked discharge criteria, and the majority of the PILs were considered of poor quality, suggesting that post-operative management after cancer surgery is of varying quality. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Auditory brainstem response - a valid and cost-effective screening tool for vestibular schwannoma?

CONCLUSION: Contemporary auditory brainstem response (ABR) is not valid as a screening tool for VS, when considering the sensitivity of 80%, the specificity of 77%, and the positive predictive value of 3.4%, MRI screening is superior to ABR in Denmark when considering cost-effectiveness. OBJECTIVES: The aim of this study is to assess the sensitivity, specificity, and cost-effectiveness of ABR vs MRI, when screening for VS in a clinical setting. METHOD: Data was collected on all patients subjected to an ABR during a 3-year period (2005-2008) at a tertiary referral center. The data were compared to results of MRI and with data from The Danish National VS Database. In total, 1447 adults underwent ABR, of whom 349 were referred for a subsequent MRI. Sensitivity and specificity were calculated. To assess the cost-effectiveness of ABR vs MRI, procedure costs for ABR and MRI were retrieved from the National Board of Health. RESULTS: Twelve (3.4%) of 349 patients were diagnosed with a VS. Of the 1098 patients not referred for MRI, three (0.3%) were later diagnosed with a VS. The sensitivity and specificity of ABR in diagnosing a VS were 80% and 77%, respectively. Procedure costs were 326 EURO for the ABR and 319 EURO for the MRI.

Preparing for emergency: a valid, reliable assessment tool for emergency cricothyroidotomy skills.

OBJECTIVE: Emergency cricothyrodotomy (EC) is a lifesaving procedure. Evidence-based assessment of training effects and competency levels is relevant to all departments involved in emergency airway management. As most training uses low-fidelity models, the predictive value of good performance on such a model becomes relevant with regard to performance on a high-fidelity model (cadaver). This requires a valid assessment tool for EC performance. STUDY DESIGN: Psychometric study on low-fidelity models and human cadavers. SETTING: University hospital. SUBJECTS AND METHODS: An assessment tool was created. Sixteen physicians (7 experienced surgeons and 9 novice physicians) performed an EC on a low-fidelity model and a cadaver. Two blinded raters assessed video recordings of performances using the assessment tool. RESULTS: We found a high interrater reliability, based on a Pearson's r (0.81), and good evidence for validity, based on successfully distinguishing the 2 groups, using an independent samples t test (P < .001). We found a good correlation between performance on a low-fidelity model and the cadaver with an R (2) = 0.78. CONCLUSION: The tool for assessing EC competence proved reliable and valid. Performance on a low-fidelity model measured this way is a good predictor of performance in a more lifelike situation.

Risk of perforation using rigid oesophagoscopy in the distal part of oesophagus.

INTRODUCTION: Endoscopic examination and treatment of disorders in the oesophagus have been a part of the otolaryngological specialty since the introduction of the rigid endoscope. Today, both flexible and rigid oesophagoscopy (RO) is used to that end. The aim of this study was to evaluate the safety of the RO. MATERIAL AND METHODS: We conducted a retrospective cohort study of all ROs performed at a head & neck department in a Danish hospital in the 2003-2011-period. Perforation of the oesophageal wall was the primary endpoint. Secondary endpoints included: dental injury, mortality and, in case of a foreign body: location and successful removal. RESULTS: A total of 483 ROs were performed. Four patients (0.8%) suffered perforation; three during removal of a foreign body in the lower part of the oesophagus and one as part of investigation for cancer. 46.2% of the procedures were performed to remove a foreign body and 32.7% as investigation for cancer. The majority of the foreign bodies were located in the superior part of the oesophagus and the objects were successfully removed in all but one case. CONCLUSION: Our results are well within the range of previously published material. We recommend that the risk of serious complications is taken into consideration when choosing this modality. Furthermore, we believe that this risk increases in the distal part of the oesophagus and recommend that the use of the RO in this area is reserved as a last resort option. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

[A bleeding gastrointestinal stromal tumour in a Meckel's diverticulum]. / Blødende gastrointestinal stromatumor i et Meckels divertikel.

We present at rare case of severe upper gastrointestinal bleeding in a 57-year-old patient due to a gastrointestinal stromal tumour located in a Meckel's diverticulum (MD) without ectopic tissue. We discuss indications and pro et cons of prophylactic resection of MD.