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Association of Surgeons in Training Surgical Summit, online, 17 Oct 2020 - 17 Oct 2020 2021 Virtual Annual Meeting / Surgical Research Society, online, 24 Mar 2021 - 25 Mar 2021, National Research Collaborative Meeting, online, 10 Dec 2020 - 10 Dec 2020, Royal Australasian College of Surgeons Annual Academic Surgery Conference, online, 5 Nov 2020 - 5 Nov 2020; The British journal of surgery : BJS 108(12), 1448-1464 (2021). doi:10.1093/bjs/znab336 Published by Wiley, New York, NY [u.a.]

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.

The COVID-19 pandemic has led governments to instate a large number of restrictions on and recommendations for citizens’ behavior. One widely used tool for measuring compliance with these strictures are nationally representative surveys that ask citizens to self-report their behavior. But if respondents avoid disclosing socially undesirable behaviors, such as not complying with government strictures in a public health crisis, estimates of compliance will be biased upwards. To assess the magnitude of this problem, this study compares measures of compliance from direct questions to those estimated from list-experiments - a response technique that allows respondents to report illicit behaviors without individual-level detection. Implementing the list-experiment in two separate surveys of Danish citizens (n>5,000), we find no evidence that citizens under-report non-compliant behavior. We therefore conclude that survey estimates of compliance with COVID-19 regulations do not suffer from social desirability bias.

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.

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.

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?

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.