Kirketerp E.,Kolding Hospital
Nursing children and young people | Year: 2016
We asked the children, their families and the staff and found so much hidden but useful and valuable information in creating a new ward for children.
Lee L.A.,Glaxosmithkline |
Maspero J.,Allergy and Respiratory Research Unit |
Clements D.,Glaxosmithkline |
Ellsworth A.,Glaxosmithkline |
Pedersen S.,Kolding Hospital
Journal of Allergy and Clinical Immunology: In Practice | Year: 2014
Background: The effect of fluticasone furoate nasal spray (FFNS) on growth in prepubescent children has not been evaluated. Objective: To characterize the difference in mean prepubescent growth velocities, as determined by stadiometry, between patients treated continuously for 1 year with FFNS 110mcg once daily and placebo nasal spray. Methods: This was a multicenter, randomized, double-blind, placebo-controlled, parallel-group 76-week safety study. Nasal symptom assessments were used as a measure of adherence. Eligible patients were ages 5 to <8.5 years at screening and had at least a 1-year clinical history and diagnosis of perennial allergic rhinitis, including a positive skin test or specific IgE to an appropriate perennial allergen within the past year. Results: One hundred eighty-six patients in the FFNS group and 187 patients in the placebo group completed the entire 52-week treatment period. During treatment, the least squares mean growth velocity was 5.19 cm/y for the FFNS group and 5.46 cm/y for the placebo group; mean difference,-0.270 cm/y (95% CI,-0.48 to-0.06 cm/y). Other safety assessments, including 24-hour urinary cortisol excretion, were comparable between the treatment groups. Daily reflective total nasal symptom scores declined similarly in both the FFNS and placebo groups. Conclusion: Once-daily treatment with FFNS over 52 weeks in prepubescent children resulted in a small reduction in growth velocity compared with placebo. Clinicians will need to balance the reduction in growth observed with FFNS to its potential for clinical benefit. © 2014 American Academy of Allergy, Asthma & Immunology.
Ammentorp J.,University of Southern Denmark |
Jensen H.I.,University of Aarhus |
Uhrenfeldt L.,Kolding Hospital
Journal of Continuing Education in the Health Professions | Year: 2013
Introduction:: In recent years, coaching, as a supplement to professional development, has received increased attention, especially in nursing. Still, only little is known about how health professionals experience participating in coaching sessions. The purpose of this pilot study was to describe and analyze health professionals' experiences from coaching-what coaching meant to them and how it influenced different aspects of their lives. Methods:: The study was designed as a qualitative interview study including 5 health professionals working with quality improvement at the hospital. Depending on the individual's need, they participated in 2 to 4 coaching sessions. Afterwards, they were included in the study and interviewed. Data from the interviews was verbatim transcribed and analysed according to Paul Ricoeur's theory of interpretation. The findings and their importance are discussed in relation to results from research in positive psychology. Results:: By picturing their job in a new perspective, the participants experienced a raised potential for mutual prioritising, actions, and job satisfaction. Two dominant themes were identified: "progressive insight leading to actions" and "expressing needs for leadership aiming for self-realization." The results indicate that coaching can be effective in enhancing not only self-insight and core performance, but also increased positive feelings. Conclusion:: By looking at the experiences of coaching, we have elucidated why coaching in this instance could be a method used to strengthen the individual employee. The results indicate that coaching can improve the work attitude of the participants and pave the way for new and progressive insights. © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.
Chapman K.R.,University of Western Ontario |
Barnes N.C.,London Chest Hospital |
Greening A.P.,Western General Hospital |
Jones P.W.,St George's, University of London |
Pedersen S.,Kolding Hospital
Thorax | Year: 2010
The use of a combination inhaler containing budesonide and formoterol as both maintenance and quick relief therapy (SMART) has been recommended as an improved method of using inhaled corticosteroid/long-acting β agonist (ICS/LABA) therapy. Published double-blind trials show that budesonide/ formoterol therapy delivered in SMART fashion achieves better asthma outcomes than budesonide monotherapy or lower doses of budesonide/formoterol therapy delivered in constant dosage. Attempts to compare budesonide/formoterol SMART therapy with regular combination ICS/LABA dosing using other compounds have been confounded by a lack of blinding and unspecified dose adjustment strategies. The asthma control outcomes in SMART-treated patients are poor; it has been reported that only 17.1% of SMART-treated patients are controlled. In seven trials of 6-12 months duration, patients using SMART have used quick reliever daily (weighted average 0.92 inhalations/day), have awakened with asthma symptoms once every 7-10 days (weighted average 11.5% of nights), have suffered asthma symptoms more than half of days (weighted average 54.0% of days) and have had a severe exacerbation rate of one in five patients per year (weighted average 0.22 severe exacerbations/patient/year). These poor outcomes may reflect the recruitment of a skewed patient population. Although improvement from baseline has been attributed to these patients receiving additional ICS therapy at pivotal times, electronic monitoring has not been used to test this hypothesis nor the equally plausible hypothesis that patients who are non-compliant with maintenance medication have used budesonide/formoterol as needed for self-treatment of exacerbations. Although the longterm consequences of SMART therapy have not been studied, its use over 1 year has been associated with significant increases in sputum and biopsy eosinophilia. At present, there is no evidence that better asthma treatment outcomes can be obtained by moment-to-moment symptom-driven use of ICS/LABA therapy than conventional physician-monitored and adjusted ICS/LABA therapy.
Kristensen G.S.,Kolding Hospital |
Schledermann D.,University of Southern Denmark |
Mogensen O.,University of Southern Denmark |
Jochumsen K.M.,University of Southern Denmark
International Journal of Gynecological Cancer | Year: 2014
Objective: Borderline ovarian tumors (BOTs) are treated surgically like malignant ovarian tumors with hysterectomy, salpingectomy, omentectomy, and multiple random peritoneal biopsies in addition to removal of the ovaries. It is, however, unknown how often removal of macroscopically normal-appearing tissues leads to the finding of microscopic disease. To evaluate the value of random biopsies, omentectomy, and hysterectomy in operations for BOT, the macroscopic and microscopic findings in a cohort of these patients were reviewed retrospectively. Materials: Women treated for BOTat Odense University Hospital from 2007 to 2011 were eligible for this study. Data were extracted from electronic records. Intraoperative assessment of tumor spread (macroscopic disease) and the microscopic evaluation of removed tissues were the main outcome measures. Results: The study included 75 patients, 59 (78.7%) in International Federation of Gynecology and Obstetrics stage I, 9 (12%) in stage II, and 7 (9.3%) in stage III. The histologic subtypes were serous (68%), mucinous (30.7%), and Brenner type (1.3%). Macroscopically radical surgery was performed in 62 patients (82.7%), and 46 (61.3%) received complete staging. The surgeon's identification of macroscopic tumor spread to the contralateral ovary and the peritoneum had a sensitivity of 88% and 69.2% and a specificity of 90.2% and 92.5%, respectively. The macroscopic assessment of the uterine surface, the omentum, and the pelvic and para-aortal lymph nodes was not a good predictor of microscopic disease. During follow-up, 4 patients (5.3%) relapsed with no relation to surgical radicality or the extent of staging procedures. Conclusions: Ovaries and peritoneal surfaces with a macroscopically normal appearance rarely contain a microscopic focus of BOT. Copyright © 2014 by IGCS and ESGO.
Fuchtbauer L.M.,Kolding Hospital
Danish medical journal | Year: 2013
In modern hospital medicine, there is a growing awareness of the need for efficient and secure -patient care. Authorities seek to improve this by adding requirements for documentation, administrative tasks and standardized patient programmes. However, it is rarely investigated how much time physicians spend on these tasks and it is therefore difficult to assess how changes in the system might affect workflow and thus time efficacy. The aim of this study was to investigate how physicians in the emergency department (ED) of a public hospital in Denmark spend their time. Results were stratified for physicians working in the emergency room (ER) and the admission area of our ED. We used a work sampling approach and observed nine physicians at three-minute -intervals for a total of 137 hours during day shifts. Activities were documented in predefined categories. Results showed that physicians spent 25% of their time in direct patient contact, 5.8% with indirect patient care, 24% communicating with other staff, 31% documenting their work and 6% on transport. Personal time ac-counted for 5% and other activities for 3%. Interestingly, no -differences in main categories were observed between -physicians admitting patients and physicians working in the fast track of the ER. Our results confirm earlier studies. Furthermore, they suggest that the specialty, the severity of disease and the nature of the contact (in-patient versus out-patient) have only a minor influence on the time spent on various tasks. We speculate whether it is really administrative systems and IT-solutions that influence time distribution in physicians' work. Not relevant. ClinicalTrials.gov NCT01722721.
Norgaard B.,Kolding Hospital
Scandinavian journal of trauma, resuscitation and emergency medicine | Year: 2012
Time is a crucial factor in an emergency department and the effectiveness of diagnosing depends on, among other things, the accessibility of rapid reported laboratory test results; i.e.: a short turnaround time (TAT). Former studies have shown a reduced time to action when point of care technologies (POCT) are used in emergency departments. This study assesses the hypothesis, that using Point of Care Technology in analysing blood samples versus tube transporting blood samples for laboratory analyses results in shorter time from the blood sample is collected to the result is reported in an emergency department. The study was designed as a randomised controlled trial with consecutive allocation into two groups and rated 1:1. Blood samples were collected on all included patients and then randomised into either POCT analyses or tube transporting for central laboratory analyses. Blood samples from a total of 319 patients were included.The mean time from collecting to reporting was 24 minutes for the POCT analysis and 70 minutes for the tube transported analysis. An unpaired Students t-test showed a significant reduction in time from collecting to reporting using POCT (p<.0001). We found a significantly reduced time from collecting to reporting using Point of Care Technology (POCT) in an emergency department compared to tube transported blood samples for central laboratory analyses.
Houlind K.,Kolding Hospital |
Houlind K.,University of Southern Denmark
Future Cardiology | Year: 2013
Off-pump coronary artery bypass surgery has been purported to be safer than conventional coronary artery bypass surgery performed using cardiopulmonary bypass. This theory was supported by a number of early series, but failed to be confirmed by a number of small, randomized, controlled trials. Conversely, it has been suggested that revascularization after off-pump surgery is associated with fewer grafts and lower graft patency, potentially leading to a higher risk of cardiovascular morbidity and need for repeated coronary interventions. Since 2009, four major randomized controlled trials have been published, increasing the level of evidence significantly. © 2013 Future Medicine Ltd.
Pedersen S.,Kolding Hospital
Primary Care Respiratory Journal | Year: 2010
Variability is a characteristic feature of asthma, and the aim of asthma management is to eliminate or minimise disease variability. Controlled asthma shows little or no variability, and is achievable and sustainable in the majority of patients. New international guidelines recommend control-driven management rather than management based on disease severity. Good asthma control is associated with reductions in patients' perception of the asthma burden, reduced healthcare resource utilisation, lower levels of impairment/restriction, normal quality of life, and low risk of exacerbations. Asthma control involves the control of several outcomes. Its assessment should include components relevant to achievement of best possible clinical control and reduction of future risk of adverse outcomes. Focusing on a single or a few outcomes can lead to incorrect control assessment and increased risk of under-treatment. Several validated asthma control assessment tools have been developed to facilitate correct assessment of the level of control in clinical practice. It is hoped that focusing on control will reduce the frequency of sub-optimal treatment in the primary care setting. Further validation of the best way to assess control easily and accurately, and the implementation of control-driven management, are the two most important challenges for the future of asthma management. © 2010 Primary Care Respiratory Society UK. All rights reserved.
Ammentorp J.,University of Southern Denmark |
Kofoed P.-E.,University of Southern Denmark |
Kofoed P.-E.,Kolding Hospital
Patient Education and Counseling | Year: 2011
Objective: To describe how a specific communication course for health professionals has been evaluated and implemented in clinical practice and how it will be transferred and evaluated at the entire hospital. Methods: The different phases of the research process from generating the hypothesis to implementing the results are described and exemplified by means of published studies and a study under planning. RE-AIM, an acronym for Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance, is used to describe the process. Results: In descriptive studies we identified a need for improving the communication with patients. By evaluating the efficacy and effectiveness of communication skills training we showed that the courses could improve clinicians' self-efficacy in specific communication tasks. After all clinicians had participated in the communication course the proportion of satisfied parents increased significantly. Based on these experiences a program for implementing the communication course at the entire hospital is being planned. Conclusion: To succeed in translating the research results into practice, long-term commitment is needed in order to create a conducive climate for the implementation. Practice implications: This focused and goal-oriented approach may inspire other researchers when planning, conducting, and evaluating their research. © 2011 Elsevier Ireland Ltd.