Semaglutide (Ozempic®) Use in Denmark 2018 Through 2023 ‒ User Trends and off-Label Prescribing for Weight Loss.

Purpose: A surge in the use of semaglutide injection (Ozempic®) approved to treat type 2 diabetes (T2D) has led to a global supply shortage. We investigated contemporary user rates and clinical characteristics of semaglutide (Ozempic®) users in Denmark, and the extent of "off-label" prescribing for weight loss. Patients and Methods: Nationwide population-based cross-sectional study based on linked health registries January 2018 through December 2023. All adults who received a first prescription of semaglutide once weekly (Ozempic®) were included. We examined quarterly rates of new users and total user prevalences, using other glucagon-like peptide-1 receptor agonists and weight loss medications as comparison. We also investigated user characteristics including T2D, glucose control, comedications, and cardiorenal disease. Results: The new user rate of semaglutide (Ozempic®) remained stable at approximately 4 per 1000 adult person-years between 2019 and 2021 and then accelerated, peaking at 10 per 1000 in the first quarter of 2023 after which it declined sharply. User prevalence increased to 91,626 users in Denmark in 2023. The proportion of semaglutide (Ozempic®) new users who had a record of T2D declined from 99% in 2018 to only 67% in 2022, increasing again to 87% in 2023. Among people with T2D who initiated semaglutide (Ozempic®) in 2023, 52% received antidiabetic polytherapy before initiation, 39% monotherapy, and 8% no antidiabetic therapy. Most T2D initiators had suboptimal glucose control, with 83% having an HbA1c ≥48 mmol/mol and 68% ≥53 mmol/mol despite use of antidiabetic medication, and 29% had established atherosclerotic cardiovascular disease or kidney disease. Conclusion: The use of semaglutide (Ozempic®) in Denmark has increased dramatically. Although not approved for weight loss without T2D, one-third of new users in 2022 did not have T2D. Conversely, most initiators with T2D had a clear medical indication for treatment intensification, and "off-label" use can only explain a minor part of the supply shortage.

A novel lozenge containing bupivacaine as topical alleviation of oral mucositis pain in patients with head and neck cancer: a pilot study.

Introduction: Oral mucositis induces severe oral pain in head and neck cancer patients. There is at this point no effective pain treatment without considerable side effects. Objective: The aim of this pilot study was to investigate pain reduction in oral cavity and pharynx in patients with head and neck cancer (HNC) with oral mucositis, the location of anesthetic effect, and duration of pain relief, after a single-dose administration of a 25 mg bupivacaine lozenge. Methods: Ten patients with HNC suffering from oral mucositis pain were included. The patients assessed pain in the oral cavity and pharynx on a visual analogue scale (from 0 to 100 mm) at baseline and up to 3 hours after the lozenge was dissolved. Possible adverse events were registered. Results: The baseline pain was 51 mm (range: 30-73 mm) in the oral cavity and 58 mm (range: 35-70 mm) in the pharynx. When the lozenge was dissolved, both oral (-27 mm; range: -3 to -52 mm; P = 0.0003) and pharynx pain (-20 mm; range: -3 to -45 mm; P = 0.008) were significantly reduced. After 180 minutes, the mean reduction in pain was significant in the oral cavity (-18 mm; range: -8 to -30 mm; P < 0.0001) but not in the pharynx (-8 mm; range: +4 to -23 mm; P = 0.12). No adverse events were observed. Conclusion: The results indicate that the bupivacaine lozenge has a clinically significant and long-lasting pain-relieving effect on pain because of oral mucositis in patients with HNC.

Republished error management: Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals.

INTRODUCTION: Poor teamwork and communication between healthcare staff are correlated to patient safety incidents. However, the organisational factors responsible for these issues are unexplored. Root cause analyses (RCA) use human factors thinking to analyse the systems behind severe patient safety incidents. The objective of this study is to review RCA reports (RCAR) for characteristics of verbal communication errors between hospital staff in an organisational perspective. METHOD: Two independent raters analysed 84 RCARs, conducted in six Danish hospitals between 2004 and 2006, for descriptions and characteristics of verbal communication errors such as handover errors and error during teamwork. RESULTS: Raters found description of verbal communication errors in 44 reports (52%). These included handover errors (35 (86%)), communication errors between different staff groups (19 (43%)), misunderstandings (13 (30%)), communication errors between junior and senior staff members (11 (25%)), hesitance in speaking up (10 (23%)) and communication errors during teamwork (8 (18%)). The kappa values were 0.44-0.78. Unproceduralized communication and information exchange via telephone, related to transfer between units and consults from other specialties, were particularly vulnerable processes. CONCLUSION: With the risk of bias in mind, it is concluded that more than half of the RCARs described erroneous verbal communication between staff members as root causes of or contributing factors of severe patient safety incidents. The RCARs rich descriptions of the incidents revealed the organisational factors and needs related to these errors.

[Checklists have a potential in health care]. / Tjeklister har et potentiale i sundhedsvæsnet.

A checklist is a cognitive tool specifying the actions necessary to complete a given task. It serves to improve the quality of care, support the memory of the user and it may serve to indicate the necessary communicative steps within a team. Checklists are used increasingly in health care. Preliminary results indicate a potential for patient safety. However, no evidence indicates that a checklist in itself is sufficient to obtain clinical results: training and motivating staff, supporting implementation, and conducting follow-up and evaluation are as important as the checklist itself to achieve results.

Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals.

INTRODUCTION: Poor teamwork and communication between healthcare staff are correlated to patient safety incidents. However, the organisational factors responsible for these issues are unexplored. Root cause analyses (RCA) use human factors thinking to analyse the systems behind severe patient safety incidents. The objective of this study is to review RCA reports (RCAR) for characteristics of verbal communication errors between hospital staff in an organisational perspective. METHOD: Two independent raters analysed 84 RCARs, conducted in six Danish hospitals between 2004 and 2006, for descriptions and characteristics of verbal communication errors such as handover errors and error during teamwork. RESULTS: Raters found description of verbal communication errors in 44 reports (52%). These included handover errors (35 (86%)), communication errors between different staff groups (19 (43%)), misunderstandings (13 (30%)), communication errors between junior and senior staff members (11 (25%)), hesitance in speaking up (10 (23%)) and communication errors during teamwork (8 (18%)). The kappa values were 0.44-0.78. Unproceduralized communication and information exchange via telephone, related to transfer between units and consults from other specialties, were particularly vulnerable processes. CONCLUSION: With the risk of bias in mind, it is concluded that more than half of the RCARs described erroneous verbal communication between staff members as root causes of or contributing factors of severe patient safety incidents. The RCARs rich descriptions of the incidents revealed the organisational factors and needs related to these errors.

Outcomes of classroom-based team training interventions for multiprofessional hospital staff. A systematic review.

CONTEXT: Several studies show that communication errors in healthcare teams are frequent and can lead to adverse events. Team training has been suggested as a way to safer communication and has been implemented in healthcare as classroom-based or simulation-based team training or a combination of both. The objective of this paper is to systematically review studies evaluating the outcomes of classroom-based multiprofessional team training for hospital staff. METHOD: The authors searched PubMed, EMBASE, ERIC, PsycInfo, Cinahl and the Cochrane Reviews database and selected 18 studies for description and comparison of learners and setting, objective, design, intervention, evaluation methods (reaction, learning, behaviour and results), intervention time before evaluation, outcomes and risk of bias. RESULTS: Participant reactions were positive. Learning and behaviour were positive in all studies, but for some only partially. The effect on clinical processes was in most instances positive. Results at patient level were limited. Only one study reported results at all four evaluation levels. Fifteen studies were uncontrolled, and 17 studies had a moderate or high risk of bias. More than half of the studies ended evaluation within 6 months. No studies reported qualitative measures that could have provided an insight as to why the interventions had the effect they had. CONCLUSION: Classroom-based team training for multiprofessional hospital staff is recommended as a way to improve patient safety. This review shows mainly positive effects of the intervention on participant reaction, learning and behaviour. The results at clinical level are still very limited.

[Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease]. / Iltbehandling ved akut eksacerbation af kronisk obstruktiv lungesygdom.

Acute exacerbation of COPD is a major cause of hospitalisation in Denmark. Most of the patients require supplemental oxygen in the acute phase and some patients continue oxygen therapy at home after discharge. In this paper we discuss the physiological mechanisms of respiratory failure seen in acute exacerbations of COPD. The principles for oxygen therapy in the acute phase are described and recommendations for oxygen therapy are suggested.

[Unexpected events in patient complaints and insurance cases at Hvidovre Hospital, Denmark, 2002-2003]. / Utilsigtede haendelser i patientklage- og forsikringssager på H:S Hvidovre Hospital i 2002 og 2003.

INTRODUCTION: The aim of this study was to do a systematic evaluation patients' complaints and insurance cases, to produce knowledge that will allow the prevention of future similar events. MATERIALS AND METHODS: 143 cases filed as patients' complaints or insurance cases during the period 1 January 2002-30 June 2003 were evaluated for the occurrence of adverse events. In the case of an adverse event, a classification score, ranging from mild to serious, was allotted based on the SAC matrix score. An audit of the case, involving the specialist who had treated the patient, was performed in all cases of serious adverse events. RESULTS: In 61% of the reviewed cases, an adverse event had occurred. It was estimated that in approximately 90% of the cases, the adverse events would not have been reported by the hospital staff, since they did not fit into the categories for mandatory reporting. In 38% of the cases where an audit was carried out, the event was found to have been preventable. DISCUSSION: The study shows that systematic evaluation of patients' complaints and insurance cases, plus audit, is potentially an effective method of preventing future adverse events.

Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study.

BACKGROUND: Laparoscopic colonic surgery has been claimed to hasten recovery and reduce hospital stay compared with open operation. Recently, enforced multimodal rehabilitation (fast-track surgery) has improved recovery and reduced hospital stay in both laparoscopic and open colonic surgery. Since no comparative data between laparoscopic and open colonic resection with multimodal rehabilitation are available, the value of laparoscopy per se is unknown. METHODS: In a randomized, observer-and-patient, blinded trial, 60 patients (median age 75 years) underwent elective laparoscopic or open colonic resection with fast-track rehabilitation and planned discharge after 48 hours. Functional recovery was assessed in detail during the first postoperative month. RESULTS: Median postoperative hospital stay was 2 days in both groups, with early and similar recovery to normal activities as assessed by hours of mobilization per day, computerized monitoring of motor activity assessed, pulmonary function, cardiovascular response to treadmill exercise, pain, sleep quality, fatigue, and return to normal gastrointestinal function. There were no significant differences in postoperative morbidity, mortality, or readmissions, although 3 patients died in the open versus nil in the laparoscopic group. CONCLUSION: Functional recovery after colonic resection is rapid with a multimodal rehabilitation regimen and without differences between open and laparoscopic operation. Further large-scale studies are required on potential differences in serious morbidity and mortality.