Regional Hospital West Jutland

BACKGROUNDSeptic shock disrupts systemic and organ-specific microcirculation, leading to poor tissue perfusion and impaired healing. While mesenteric hemodynamics have been studied, the impact of sepsis on intestinal microcirculation and anastomotic healing remains unclear.AIMTo assess the short-term effects of septic shock on microcirculation in the small intestine and colon, with a focus on hand-sewn and stapled anastomoses, using laser speckle contrast imaging (LSCI).METHODSTen pigs underwent midline laparotomy with the creation of four anastomoses: One hand-sewn and one stapled anastomosis in both the small intestine and colon. LSCI measurements were taken before anastomosis formation (TB), immediately after (TA), and after one hour of rest (T0). Septic shock was induced via intravenous Escherichia coli infusion, with subsequent LSCI measurements at 30-minute intervals (T30-T150). Results were expressed as relative changes compared to TB.RESULTSSeptic shock significantly reduced microcirculation in both untouched intestine and anastomoses. Hand-sewn anastomoses consistently exhibited higher perfusion than stapled anastomoses. At T150, perfusion in hand-sewn anastomoses remained significantly higher than in stapled anastomoses (51% vs 34% of TB, P = 0.002).CONCLUSIONThis study shows that septic shock significantly impairs intestinal microcirculation indicating a risk of intestinal ischemia if bacteriaemia and subsequent septic shock is untreated. Due to diminish blood flow following septic shock, the anastomotic healing may be compromised leading to increased risk of anastomotic leakage. Conclusively, this study provides a foundation for optimizing surgical strategies and improving patient outcomes in this high-risk population.

Introduction

Objective To identify risk factors for and outcomes after SARS-CoV-2 infection and severe COVID-19 in pregnancy Design Prospective population-based cohort study Setting Denmark Population All pregnancies between 1 March and 31 October 2020 Methods Using data from the Danish National Patient Register and Danish Microbiology Database and prospectively registered data from medical records, we compared women with a positive SARS-CoV-2 test during pregnancy to non-infected pregnant women. Severe infection was defined as hospital admission due to COVID-19. Main Outcome Measures Pregnancy, delivery, maternal, and neonatal outcomes. Results Among 82,682 pregnancies, 418 women had SARS-CoV-2 infection during pregnancy, corresponding to an incidence of 5.1 per 1000 pregnancies, 23 (5.5%) of which required hospital admission due to COVID-19. Risk factors for infection were asthma (OR 2.19 [1.41–3.41]) and being foreign born (OR 2.12 [1.70–2.64]). Risk factors for hospital admission due to COVID-19 included obesity (OR 2.74 [1.00–7.51]), smoking (OR 4.69 [1.58–13.90]), infection after gestational age in weeks (GA) 22 (GA 22–27: OR 3.77 [1.16–12.29]; GA 28–36: OR 4.76 [1.60–14.12]) and having asthma (OR 4.53 [1.39–14.79]). We found no difference in any obstetric or neonatal outcomes. Conclusions Severe outcomes of SARS-CoV-2 infection in pregnancy are rare. Funding The Danish Ministry of Higher Education and Science (Reg. 0237-00007B) and The Region of Southern Denmark and Region Zealand’s shared fund for joint health research projects (Reg. A767) Keywords Severe acute respiratory syndrome coronavirus 2; COVID-19; Obstetric delivery; Pregnancy complications; Pregnancy outcome; Cohort studies; Prospective studies.

Guidelines propose the inclusion of quantitative measurements from 82Rubidium positron emission tomography (RbPET) to discriminate obstructive coronary artery disease (CAD). However, the effect on diagnostic accuracy is unknown. The aim was to investigate the optimal RbPET reading algorithm for improved identification of obstructive CAD. Prospectively enrolled patients (N=400) underwent RbPET and invasive coronary angiography with fractional flow reserve and quantitative coronary angiography. Quantitative measurements (myocardial blood flow (MBF), MBF reserve, transient ischemic dilatation) by RbPET were step-wisely added to a qualitative assessment by the summed stress score based on their diagnostic accuracy of obstructive CAD by invasive coronary angiography-fractional flow reserve. Prespecified cutoffs were summed stress score ≥4, hyperemic MBF 2.00 mL/g per min, and MBF reserve 1.80, respectively. Hemodynamically obstructive CAD was defined as >90% diameter stenosis or invasive coronary angiography-fractional flow reserve ≤0.80, and sensitivity analyses included a clinically relevant reference of anatomically severe CAD (>70% diameter stenosis by invasive coronary angiography-quantitative coronary angiography). Hemodynamically obstructive CAD was present in 170/400 (42.5%) patients. Stand-alone summed stress score showed a sensitivity and specificity of 57% and 93%, respectively, while hyperemic MBF showed similar sensitivity (61%, P=0.57) but lower specificity (85%, P=0.008). With increased discrimination by receiver-operating characteristic curves (0.78 versus 0.85; P<0.001), combining summed stress score, MBF and MBF reserve showed the highest sensitivity of 77% but lower specificity of 74% (P<0.001 for both comparisons). Against anatomically severe CAD, all measures independently yielded high discrimination ≥0.90 with increased sensitivity and lower specificity by additional quantification. The inclusion of quantitative measurements to a RbPET read increases in the identification of obstructive CAD. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03481712.

3512 Background: SOLSTICE, a phase 3 study, tested trifluridine/tipiracil+bevacizumab (FTD/TPI+bev) vs capecitabine+bevacizumab (cape+bev) in first-line for patients with unresectable metastaic CRC who were ineligible for intensive chemotherapy (full-dose doublet/triplet). As previously reported, the study did not meet the primary endpoint (progression-free survival (PFS): 9.4 months [95% CI, 9.1-10.9] for FTD/TPI+bev vs 9.3 months [95% CI: 8.9-9.8] for cape+bev, HR 0.87 [95% CI: 0.75-1.02]). Here we report on the key secondary endpoint – overall survival (OS) and an update of the safety data. Methods: From 21 Mar 2019 to 14 Sep 2020, 856 patients were randomized (1:1) to either FTD/TPI+bev or cape+bev. Stratification factors were: ECOG performance status (0 vs 1 vs 2), reason for non-eligibility for intensive therapy (clinical condition vs non-clinical condition) and tumor localization (right vs left). The primary endpoint was PFS based on investigator assessment according to RECIST 1.1 criteria. The key secondary endpoint was OS, defined as the time from randomization to death from any cause. Other secondary endpoints included overall response rate, disease control rate, quality of life, and safety. OS was analyzed after 578 events to detect a hazard ratio of 0.79 with 80.0% power at one-sided 2.5% level of significance. Results: 426 patients were randomly assigned to FTD/TPI+bev and 430 to cape+bev. The median OS was 19.74 months with FTD/TPI+bev and 18.59 months with cape+bev (HR, 1.06; 95% CI, 0.90, 1.25) with survival probabilies for FTD/TPI+bev vs cape+bev comparable at different timepoints. In the multivariate analysis, factors significantly associated with higher OS in the whole population were age &lt; 70 years, left location of the primary disease, surgical resection of the primary tumor, number of metastatic sites (1-2 vs ≥3 sites), absence of liver metastasis, neutrophils lymphocyte ratio &lt; 3, Charlson score 0 vs 1-2, and ECOG PS 1 vs 2. No significant treatment effect was observed after adjustment for the prognosis factors (HR, 1.08; 95% CI, 0.92, 1.28), which is consistent with the main OS analysis. The updated safety data was consistent with those communicated at the time of the primary PFS analysis. No new safety signal was identified. As previously reported, the most common severe emergent adverse events were neutropenia 54% vs 1%, neutrophil count decreased 19% vs 1%, anemia 16% vs 4%, hand-foot syndrome 0% vs 15%, and hypertension 9% vs 11% in FTD/TPI+bev vs cape+bev, respectively. Conclusions: This was the largest phase 3 study that explored two treatment regimens in a population ineligible for intensive therapy. FTD/TPI+bev was not superior to cape+bev in terms of PFS and OS. The risk of death was similar in both treatment arms. With a different and manageable safety profile, FTD/TPI+bev represents a feasible alternative to cape+bev in this population. Clinical trial information: NCT03869892 .

Investigating whether a poor physical or psychosocial work environment is associated with low labour market participation in early adulthood is important to avoid negative health-related consequences and to improve job prospects. To investigate associations between the physical or psychosocial work environment and labour market participation in early adulthood. The study was based on data from the West Jutland Cohort, an ongoing study of individuals born in 1989 who lived in the western part of Jutland, Denmark, in 2004. Participants were employed individuals who had questionnaire data on their work environment at age 28 and register information on labour market participation at ages 28-29 (n = 1312). The outcome was categorized into low (>4 weeks) versus high (≤4 weeks) labour market participation based on the total number of weeks receiving any unemployment or health-related benefits during a 52-week period. Logistic regression analyses were performed to examine associations between work environment factors and labour market participation, taking confounders into account. Low influence, low quality of leadership, high job insecurity and temporary employment were associated with low labour market participation. High job insecurity (OR: 2.2; 95% CI 1.5-3.1) and temporary employment (OR: 3.1; 95% CI 2.1-4.5) were strongly associated with low labour market participation. An association was seen between hard physical work and low labour market participation. Several physical and psychosocial work environment factors, especially high job insecurity and temporary employment, have a negative impact on labour market participation in early adulthood.

ObjectiveEasily available clinical tests to evaluate postural control are needed. Furthermore, motion sickness (MS) and postural control are correlated. The aims of this study were to compare the internal validity of a set of clinical tests of postural control with the internal validity of static posturography and to evaluate possible associations between postural control and MS. MethodsWe included healthy subjects from a primary school in Denmark who completed questionnaires about MS and underwent two rounds of clinical tests of postural control and static posturography using a Tetrax Interactive Balance System two weeks apart. For clinical tests of postural control, subjects were observed for up to 30 s standing on both legs, on one leg, on a pillow both with their eyes open and again with their eyes closed. ResultsTwenty-one subjects were included: 71% males with an average age of 13.7 years. Agreement rates ranged from 62% to 95% between test and retest in clinical tests.; lowest for subjects standing on their non dominant leg with their eyes open and highest for subjects performing Romberg's test with their eyes closed along with subjects standing on a pillow with their eyes open. For several of these tests, almost all subjects were able to hold their balance for the full 30 s. Test-retesting using static posturography by Bland Altman plot showed datapoints scattered equally above and below the mean line indicating no systematic bias. Results of clinical tests and static posturography were not associated. MS was reported from 43% of subjects and a trend was observed with high sway scores from subjects suffering from MS. This was statistically insignificant. ConclusionsDue to a ceiling effect, subjects achieved the same scores in both rounds of testing in several of the clinical tests, reducing the clinical importance of these tests. Compared to clinical tests, static posturography seemingly remains the superior method when it comes to evaluation of postural control, although not as easily applicable in a daily clinical setting. When comparing MS and postural control a trend was observed, indicating higher sway scores in subjects suffering from MS.

PurposeWork-related violence is a major occupational safety and health (OSH) issue. According to the concept of violence prevention climate, managers play a pivotal role in preventing the risk of violence at work. However, research on this is scarce. The objective of this study was, therefore, to examine line managers' use of violence preventive practices in high-risk sectors.Design/methodology/approach The authors employed three different sources of data (semi-structured interviews and field notes from both leadership seminars and coaching sessions) that were collected in the context of an intervention study in Denmark aimed at improving violence prevention. The authors conducted a thematic analysis of violence prevention experiences among 16 line managers – eight from the prison and probation services and eight from psychiatric hospitals.FindingsUsing an existing prevention framework, the authors categorized the descriptions into three types of violence preventive practices used by the line managers across the two sectors: “preventing violence”, “managing episodes of violence” and “promoting the positive”. Especially the category “promoting the positive” is often neglected in the intervention literature.Originality/value The study identified new aspects of managers' violence preventive practices than those included in the violence prevention climate concept. Such knowledge may help organizations devise improved systems for violence prevention in high-risk sectors.