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  • COVID-19

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  • Open Access English
    Authors: 
    McLean, K A; Kamarajah, S K; Chaudhry, D; Gujjuri, R R; Raubenheimer, K; Trout, I; Al Ameer, E; Creagh-Brown, B; Harrison, E M; Nepogodiev, D; +204 more
    Publisher: Oxford University Press
    Countries: Netherlands, Italy, Finland, Italy, Denmark, Italy, Finland, Italy, Italy, United Kingdom ...

    BACKGROUND: This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHODS: This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January-October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. RESULTS: This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). CONCLUSION: Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection. This study compared death rates in patients who developed pulmonary complications of surgery before and during the pandemic in two large, international studies. Patients who underwent surgery during the pandemic tended to be younger and fitter. Overall, 4.3 per cent were diagnosed with SARS-CoV-2 infection after surgery in the pandemic cohort. Deaths within 30 days after surgery tripled during the first wave of the pandemic (from 0.7 to 2.0 per cent), whereas the rate of pulmonary complications remained the similar (7.1 to 6.3 per cent). Over half of these excess deaths (54.8 per cent) were estimated to be related to SARS-CoV-2 infection. eng

  • Open Access English
    Authors: 
    Shujing Chen; Dingyu Zhang; Tianqi Zheng; Yongfu Yu; Jinjun Jiang;
    Country: Denmark

    AbstractFew data are available on the incidence of deep vein thrombosis (DVT) in critically ill COVID-19 with thrombosis prophylaxis. This study retrospectively included 88 patients in the ICU with critically ill COVID-19 at Jinyintan Hospital in Wuhan, China. All patients underwent compression ultrasonography for identifying DVT. Firth logistic regression was used to examine the association of DVT with sex, age, hypoalbuminemia, D-dimer, and SOFA score. The median (interquartile range [IQR]) age and SOFA score of 88 patients were 63 (55–71) years old and 5 (4–6), respectively. Despite all patients receiving guideline-recommended low-molecular-weight heparin (LMWH) thromboprophylaxis, the incidence of DVT was 46% (95% CI 35–56%). Proximal DVT was recognized in 9% (95% CI 3–15%) of the patients, while 46% (95% CI 35–56%) of patients had distal DVT. All of the proximal DVT combined with distal DVT. Risk factors of DVT extension occurred in all distal DVT patients. As Padua score ≥ 4 or IMPROVE score ≥ 2, 53% and 46% of patients had DVT, respectively. Mortality was higher in patients with acute DVT (30%) compared with non-DVT (17%), but did not reach statistical significance. Hypoalbuminemia (odds ratio [OR], 0.17; 95% CI 0.06–0.05, P = 0.001), higher SOFA score (OR per IQR, 2.07; 95% CI 1.38–3.39, P = 0.001), and elevated D-dimer (OR per IQR, 1.04; 95% CI 1.03–1.84, P = 0.029) were significant DVT risk factors in multivariable analyses. High incidence of DVT was identified in patients with critically ill COVID-19, despite the use of guideline-recommended pharmacologic thromboprophylaxis. The presence of hypoalbuminemia, higher SOFA score, and elevated D-dimer were significantly independent risk factors of DVT. More effective VTE prevention and management strategies may need to be addressed.

  • Open Access English
    Authors: 
    Jensby, Anne; Mogensen, Oliver Bendix Gammeljord; Svejvig, Per;
    Publisher: Aarhus University
    Country: Denmark

    The purpose of this report is to outline the evaluation and comparison approach and the knowledge obtained through a detailed data collection process, in order to examine the implementation and application of the Half Double Methodology (HDM) at Forsvarsministeriets Material- og Indkøbsstyrelse (FMI), as well as compare and contrast pilot and reference projects. State-owned FMI is the Danish Ministry of Defence Acquisition and Logistics Organization (English abbreviation: DALO), and thus a unit under the Ministry of Defence and the Danish public sector. It is likely that the Half Double Methodology has had a positive impact on FMI and their team collaboration. The procurement process is faster, which especially is evident in pilot case 3, but also the initial versions of pilot case 1 and 2. However, here, the cases were subject to external conditions which increased the duration. FMI experiences satisfaction from stakeholders involved in the procurement. This satisfaction is also present in most of the team members engaging with the methodology. Hence overall, integrating the Half Double Methodology in FMI’s team collaboration is perceived as a success in FMI and continues to be applied. However, there is still room for improvements in the procurement process and team configuration. This relates to the application of HDM, but also other constraints in FMI, which is related to a lack of resources to develop interdisciplinary teams, as well as challenges from covid-19 restrictions. The purpose of this report is to outline the evaluation and comparison approach and the knowledge obtained through a detailed data collection process, in order to examine the implementation and application of the Half Double Methodology (HDM) at Forsvarsministeriets Material- og Indkøbsstyrelse (FMI), as well as compare and contrast pilot and reference projects. State-owned FMI is the Danish Ministry of Defence Acquisition and Logistics Organization (English abbreviation: DALO), and thus a unit under the Ministry of Defence and the Danish public sector. It is likely that the Half Double Methodology has had a positive impact on FMI and their team collaboration. The procurement process is faster, which especially is evident in pilot case 3, but also the initial versions of pilot case 1 and 2. However, here, the cases were subject to external conditions which increased the duration. FMI experiences satisfaction from stakeholders involved in the procurement. This satisfaction is also present in most of the team members engaging with the methodology. Hence overall, integrating the Half Double Methodology in FMI’s team collaboration is perceived as a success in FMI and continues to be applied. However, there is still room for improvements in the procurement process and team configuration. This relates to the application of HDM, but also other constraints in FMI, which is related to a lack of resources to develop interdisciplinary teams, as well as challenges from covid-19 restrictions.

  • Open Access English
    Authors: 
    Martin Baekgaard; Kim Sass Mikkelsen; Jonas Krogh Madsen; Julian Christensen;
    Country: Denmark
    Project: EC | POAB (802244)

    State actions impact the lives of citizens in general and government benefit recipients in particular. However, little is known about whether experiences of psychological costs among benefit recipients can be relieved by reducing compliance demands in interactions with the state. Across three studies, we provide evidence that reducing demands causes relief. In a survey experiment, we show that psychological costs experienced by Danish unemployment insurance recipients change in response to information about actual reduced compliance demands. In two field studies, we exploit survey data collected around a sudden, exogenous shock (the COVID-19 lockdown of the Danish society in March 2020), which led to immediate reductions in compliance demands in Denmark's active labor market policies. We test whether two groups of benefit recipients experienced reduced psychological costs in response to these sudden reductions in compliance demands imposed by the state. Across all studies, we find that the reduction of compliance demands is associated with an increased sense of autonomy, and in two of the three studies, it is associated with reduced stress. Overall, our findings suggest that psychological costs experienced by benefit recipients are indeed affected by state actions in the form of compliance demands. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the Public Management Research Association.

  • Restricted English
    Authors: 
    Donovan, Maria Margaret O;
    Publisher: Center for Undervisningsudvikling og Digitale Medier, Aarhus Universitet
    Country: Denmark

    An extended brief overviewing a bread swath of responses from higher educational institutions worldwide, to the COVID-19 pandemic.

  • Open Access English
    Authors: 
    Jacob Bodilsen; Peter Brønnum Nielsen; Mette Søgaard; Michael Dalager-Pedersen; Lasse Speiser; Troels Yndigegn; Henrik Nielsen; Torben Larsen; Flemming Skjøth;
    Publisher: BMJ Publishing Group Ltd.
    Country: Denmark

    Objective To determine the incidence of hospital admissions and associated mortality rates for non-covid medical conditions during the covid-19 pandemic.Design Nationwide, population based cohort study.Setting Denmark from 13 March 2019 to 27 January 2021.Participants All Danish residents gt;1 year of age.Main outcomes measures Population based healthcare registries that encompass the entire Danish population were used to compare hospital admission and mortality rates during the covid-19 pandemic (from 11 March 2020 to 27 January 2021) with the prepandemic baseline data (from 13 March 2019 to 10 March 2020). Hospital admissions were categorised as covid-19 when patients were assigned a diagnosis code for covid-19 within five days of admission. All patients were followed until migration, death, or end of follow-up, whichever came first. Rate ratios for hospital admissions were computed using Poisson regression and were directly standardised using the Danish population on 1 January 2019 as reference. 30 day mortality rate ratios were examined by Cox regression, adjusted for age and sex, and covid-19 diagnosis was used as a competing risk.Results 5 753 179 residents were identified during 567.8 million person weeks of observation, with 1 113 705 hospital admissions among 675 447 people. Compared with the prepandemic baseline period (mean hospital admission rate 204.1 per 100 000/week), the overall hospital admission rate for non-covid-19 conditions decreased to 142.8 per 100 000/week (rate ratio 0.70, 95.66 to 0.74) after the first national lockdown, followed by a gradual return to baseline levels until the second national lockdown when it decreased to 158.3 per 100 000/week (0.78, 0.73 to 0.82). This pattern was mirrored for most major diagnosis groups except for non-covid-19 respiratory diseases, nervous system diseases, cancer, heart failure, sepsis, and non-covid-19 respiratory infections, which remained lower throughout the study period. Overall 30 day mortality rates were higher during the first national lockdown (mortality rate ratio 1.28, 95.23 to 1.32) and the second national lockdown (1.20, 1.16 to 1.24), and these results were similar across most major diagnosis groups. For non-covid-19 respiratory diseases, cancer, pneumonia, and sepsis, the 30 day mortality rate ratios were also higher between lockdown periods.Conclusions Hospital admissions for all major non-covid-19 disease groups decreased during national lockdowns compared with the prepandemic baseline period. Additionally, mortality rates were higher overall and for patients admitted to hospital with conditions such as respiratory diseases, cancer, pneumonia, and sepsis. Increased attention towards management of serious non-covid-19 medical conditions is warranted. Objective: To determine the incidence of hospital admissions and associated mortality rates for non-covid medical conditions during the covid-19 pandemic. Design: Nationwide, population based cohort study. Setting: Denmark from 13 March 2019 to 27 January 2021. Participants: All Danish residents >1 year of age. Main outcomes measures: Population based healthcare registries that encompass the entire Danish population were used to compare hospital admission and mortality rates during the covid-19 pandemic (from 11 March 2020 to 27 January 2021) with the prepandemic baseline data (from 13 March 2019 to 10 March 2020). Hospital admissions were categorised as covid-19 when patients were assigned a diagnosis code for covid-19 within five days of admission. All patients were followed until migration, death, or end of follow-up, whichever came first. Rate ratios for hospital admissions were computed using Poisson regression and were directly standardised using the Danish population on 1 January 2019 as reference. 30 day mortality rate ratios were examined by Cox regression, adjusted for age and sex, and covid-19 diagnosis was used as a competing risk. Results: 5 753 179 residents were identified during 567.8 million person weeks of observation, with 1 113 705 hospital admissions among 675 447 people. Compared with the prepandemic baseline period (mean hospital admission rate 204.1 per 100 000/week), the overall hospital admission rate for non-covid-19 conditions decreased to 142.8 per 100 000/week (rate ratio 0.70, 95% confidence interval 0.66 to 0.74) after the first national lockdown, followed by a gradual return to baseline levels until the second national lockdown when it decreased to 158.3 per 100 000/week (0.78, 0.73 to 0.82). This pattern was mirrored for most major diagnosis groups except for non-covid-19 respiratory diseases, nervous system diseases, cancer, heart failure, sepsis, and non-covid-19 respiratory infections, which remained lower throughout the study period. Overall 30 day mortality rates were higher during the first national lockdown (mortality rate ratio 1.28, 95% confidence interval 1.23 to 1.32) and the second national lockdown (1.20, 1.16 to 1.24), and these results were similar across most major diagnosis groups. For non-covid-19 respiratory diseases, cancer, pneumonia, and sepsis, the 30 day mortality rate ratios were also higher between lockdown periods. Conclusions: Hospital admissions for all major non-covid-19 disease groups decreased during national lockdowns compared with the prepandemic baseline period. Additionally, mortality rates were higher overall and for patients admitted to hospital with conditions such as respiratory diseases, cancer, pneumonia, and sepsis. Increased attention towards management of serious non-covid-19 medical conditions is warranted.

  • Restricted Danish
    Authors: 
    Hougaard, Rikke Frøhlich; Nielsen, Birgitte Lund; Pyrz, Magdalena;
    Country: Denmark

    Oplægget samler og diskuterer erfaringer fra tre forskellige cases - kurser fra ST på AU - der inkluderer laboratorieundervisning. Hvilke valg er truffet ift. forårets COVID 19 nedlukning (online, simulation, video, padlet mm)? Hvilke muligheder og udfordringer relateret til studerendes læring fremhæves af underviserne? Hvilke fremadrettede perspektiver kan fremhæves - er der ideer og tilgange, der tages med videre?

  • Open Access English
    Authors: 
    Stefano Bisoffi; Lilia Ahrné; Jessica Aschemann-Witzel; András Báldi; Kerstin Cuhls; Fabrice DeClerck; Fabrice DeClerck; Jessica Duncan; Henning Otte Hansen; Richard L. Hudson; +5 more
    Publisher: Frontiers Media S.A.
    Countries: Germany, Denmark, Netherlands

    Three key transitions leading to a “safe and just” operating space, with a focus on food systems, emerged during the development of a Foresight study promoted by SCAR (Standing Committee on Agricultural Research1): (a) sustainable and healthy diets for all; (b) full circularity in the use of resources; (c) diversity as a key component of stable systems. As consequence of COVID-19, food emerged again as a central element of life, along with health, after decades in which food security was taken for granted, at least in most developed countries. The COVID-19 outbreak offered the opportunity for a reflection on the importance of resilience in emergencies. Sustainable and healthy diets for all, was shown, during the pandemic, to depend much more on social and economic conditions than on technical aspects of food production and processing. Agriculture and the agro-industry have now a potential to absorb, at least temporarily, workers laid out in other sectors; the pandemic could be an opportunity to re-think and re-value labor relationships in the sector as well as local productions and supply chains. A full circularity in food systems also would benefit from stronger links established at the territorial level and increase the attention on the quality of the environment, leading to the adoption of benign practices, regenerating rather than impoverishing natural resources. Diversity is a key component of a resilient system, both in the biophysical sphere and in the social sphere: new business models, new knowledge-sharing networks, new markets. The three transitions would operate in synergy and contribute to the resilience of the whole food system and its preparation for a possible next emergency. Science can support policy making; however, science needs to be better embedded in society, to have a clear direction toward the grand challenges, to address the social, economic, behavioral spheres, to aim clearly at the common good. We need to re-think the conundrum between competition and cooperation in research, devising ways to boost the latter without sacrificing excellence. We need to improve the way knowledge is generated and shared and we need to ensure that information is accessible and unbiased by vested interests.

  • Open Access English
    Authors: 
    COVIDSurg Collaborative; GlobalSurg Collaborative; A, M.; Abdelhamid, M. H. S.; Alhabdan, S.; Nekoval, V.; Nel, C.; Nel, D.; Nel, H.; Nelihela, P.; +190 more
    Countries: Germany, Italy, Italy, Denmark, Croatia, Italy, Italy, United Kingdom, Turkey, Germany ...

    Abstract Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population. The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous.

  • Open Access English
    Authors: 
    Einstein, A. J.; Shaw, L. J.; Hirschfeld, C.; Williams, M. C.; Villines, T. C.; Better, N.; Vitola, J. V.; Cerci, R.; Dorbala, S.; Raggi, P.; +24 more
    Publisher: The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
    Countries: Denmark, Netherlands, United Kingdom, United States, Netherlands, Italy

    Background The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives The study sought to assess COVID-19’s impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world’s economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted. Central Illustration

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