Screening and systematic follow-up for cardiopulmonary comorbidity in elective surgery for colorectal cancer: a randomised feasibility study.

BACKGROUND: One third of patients with colorectal cancer (CRC) have comorbidity, which impairs their postoperative outcomes. Scoring systems may predict mortality, but there is limited evidence of effective interventions in high-risk patients. Our aim was to test a trial setup to assess the effect of extra postoperative medical visits and follow-up on 1-year mortality and other outcomes in patients with cardiopulmonary risk factors undergoing elective surgery for colorectal tumours. METHODS: Patients preoperatively screened positive for cardiopulmonary comorbidity were eligible. On postoperative day 4, they were randomised to either routine follow-up (RFU) or RFU with one extra medical visit and additional visits to the Cardiology and Respiratory Medicine Clinics 1 and 3 months postoperatively. The primary outcome measure was 1-year mortality; secondary outcome measures were length of stay (LOS), complications, and readmissions. RESULTS: Of 673 screened patients 326 (48%) were found eligible, 108 declined participation, and 198 were randomised. Postoperative medical problems and/or need for intervention were found in 15-23% of the patients at the extra medical visits. The 90-day mortality was 0 and the 1-year mortality only 2.6% with no differences between the two groups. LOS and complication rates did not differ, but there were significantly fewer readmissions in the intervention group. CONCLUSIONS: The 1-year mortality after elective CRC surgery was low, even in the presence of cardiopulmonary risk factors. There was no evidence of reduced mortality with additional medical follow-up in these patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT02328365 registered 31 December 2014 (retrospectively registered).

Machine learning in diagnostic support in medical emergency departments.

Diagnosing patients in the medical emergency department is complex and this is expected to increase in many countries due to an ageing population. In this study we investigate the feasibility of training machine learning algorithms to assist physicians handling the complex situation in the medical emergency departments. This is expected to reduce diagnostic errors and improve patient logistics and outcome. We included a total of 9,190 consecutive patient admissions diagnosed and treated in two hospitals in this cohort study. Patients had a biochemical workup including blood and urine analyses on clinical decision totaling 260 analyses. After adding nurse-registered data we trained 19 machine learning algorithms on a random 80% sample of the patients and validated the results on the remaining 20%. We trained algorithms for 19 different patient outcomes including the main outcomes death in 7 (Area under the Curve (AUC) 91.4%) and 30 days (AUC 91.3%) and safe-discharge(AUC 87.3%). The various algorithms obtained areas under the Receiver Operating Characteristics -curves in the range of 71.8-96.3% in the holdout cohort (68.3-98.2% in the training cohort). Performing this list of biochemical analyses at admission also reduced the number of subsequent venipunctures within 24 h from patient admittance by 22%. We have shown that it is possible to develop a list of machine-learning algorithms with high AUC for use in medical emergency departments. Moreover, the study showed that it is possible to reduce the number of venipunctures in this cohort.

Using the Danish National Evaluation as a tool to measure patient-perceived drug information.

INTRODUCTION: In 2017, as part of the Danish National Evaluation (LUP), some patients at Lillebaelt Hospital reported receiving insufficient information about their drug treatment. The aim of this study was to evaluate the effect of a multifaceted clinical pharmacist intervention on patient-reported levels of drug information received and patients' perceptions of safety and comfortability with their drug treatment. METHODS: In this feasibility study, the intervention consisted of a multifaceted service including two patient interviews using a motivational interviewing approach. The interviews were held during admission and after discharge as a follow-up phone call. Patients were asked questions similar to those used in the LUP about the level of information they had received, and they self-evaluated their safety and comfortability with their drug treatment. RESULTS: A total of 157 patients received the intervention; 135 patients were eligible for follow-up. Approximately 60% of the patients responded that the intervention had positively affected their feelings of safety and comfortability with their drug treatment. There was no significant difference in the patients' responses to the LUP questions regarding the level of information they had received before and after the intervention. CONCLUSIONS: The intervention improved the majority of the patients' perceptions of safety and comfortability with their drug treatment. Although all patients received information about their drug treatment and their questions were answered, this was not reflected in their responses to the LUP questions. FUNDING: The Development Council of Lillebaelt Hospital. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency.

[Cancer patients' experiences contribute to more patient-centred care]. / Kræftpatienters oplevelser bidrager til øget patientcentrering.

In the Region of Southern Denmark, Vejle Hospital has taken the first step toward measuring patient-centred care from cancer patient's perspective. Based on results from a local patient survey this article aims to evaluate how Vejle Hospital is per­forming with regard to principles for patient-centred care in different parts of the cancer trajectory. The survey provides unique data at ward level and opportunities to initiate targeted improvement efforts for cancer patients to monitor improve­ments in patient-experienced care, which is crucial to become truly patient-centred.

[Cancer patients' experiences contribute to more patient-centred care].

In the Region of Southern Denmark, Vejle Hospital has taken the first step toward measuring patient-centred care from cancer patient's perspective. Based on results from a local patient survey this article aims to evaluate how Vejle Hospital is performing with regard to principles for patient-centred care in different parts of the cancer trajectory. The survey provides unique data at ward level and opportunities to initiate targeted improvement efforts for cancer patients to monitor improve-ments in patient-experienced care, which is crucial to become truly patient-centred.

[Referral of patients with fever for ultrasound abdominal scans]. / Henvisning til ultralydskanning af abdomen af patienter med feber.

INTRODUCTION: The purpose of this study was to evaluate the quality of ultrasound referrals of patients with fever and/or inflammation markers based on C-reactive protein (CRP) from the department of medicine to the department of radiology. MATERIALS AND METHODS: The quality of 109 referrals was evaluated retrospectively based on sufficient anamnesis, description of objective findings, and presence of fever and/or inflammation markers and/or liver parameters. Fever was defined as a temperature above 37.5 degrees Celsius. RESULTS: Ultrasound scans proved 50 positive findings and 59 were categorised normal. There was no significant difference in the referrals of registrars and other medical doctors with regard to the presence of positive scanning findings (p=0.26). No significant difference between radiologists and trained radiographers was observed with regard to the ultrasound scan result (p=0.34). In 55% of the cases the referrals contained no information on symptoms, objective findings (60%), presence of fever (26%) and CRP +/- liver parameters (36%) CONCLUSION: The quality of the referrals of patients with fever from the department of medicine to the department of radiology is not optimal. Prospective studies are needed.

[Educational specialists' function in Southern Denmark]. / Uddannelsesansvarlige overlaegers funktion i Region Syd.

A new educational training concept was introduced with the latest Danish national reform of specialist training of doctors in 2004. We performed a questionnaire survey, the aim of which was to explore the result of the implementation so far and to get ideas facilitating a sharper focus of our efforts to further develop the educational reform. The results showed high commitment within the system and also pointed to management support as an essential prerequisite for job satisfaction. The development and assessment of the specialist training, however, need further observation.

[Integrated clinical educational project]. / Integreret klinisk uddannelse.

This paper describes a two-year postgraduate educational project involving three different clinical departments. The educational climate was enhanced through different interventions, such as training tutors, more effective supervision, improved daily routines, and repeated educational seminars. Evaluation was made by questionnaires involving all physicians once a year. In addition to the repetition of interventions, the importance of support from leaders and general engagement in the process of changing the educational climate is underlined.