Asger Roer Pedersen

To assess: (1) reach (patients screened for dysphagia), (2) dose (patients receiving 4 Questionnaire Test (4QT), 30 ml water swallow test, and if positive, dysphagia specialist referral), (3) acceptability of the dysphagia screening intervention among stakeholders, and (4) adaptations made or planned. A process evaluation using a mixed methods approach was conducted at an orthopaedic surgery department in Denmark. Patients aged ≥65 years admitted with hip fracture were dysphagia screened. Data from electronic health records, semi-structured interviews with health professionals, management, and patients, and a logbook were analysed. The screening procedure was performed by a multidisciplinary group of health professionals in 141 patients, achieving 94% reach and 92% completion of the 4QT and 30 ml water swallow tests, and near the success criterion for dysphagia specialist referrals (89%). The screening intervention was accepted by the participants, with positive feedback and no serious unexpected consequences. Three adaptations were made immediately, and four were planned. The dysphagia screening intervention is feasible and acceptable, providing a strong basis for further research on diagnostic performance and broader clinical implementation. Enabling early identification and management of dysphagia may reduce disability, support effective rehabilitation, and improve outcomes.

Background/Objectives: Patients with acquired brain injury (ABI) often face complex challenges during the transition from in-hospital rehabilitation to everyday life. This study aimed to investigate disability, health-related quality of life (HRQoL), work, and other aspects of functioning as indicators of a meaningful life in this transition phase. Additionally, we assessed how disability three months post-discharge correlates with known risk factors. Methods: We conducted a prospective observational follow-up study including patients aged ≥18 years with ABI discharged from a specialized rehabilitation clinic. Patient-reported outcomes, including disability and HRQoL, were collected at discharge and three months later. Associations between disability and known risk factors were analyzed using multiple linear regression. Results: A total of 137 patients were included (mean age 63), with a follow-up completion rate of 59%. At follow-up, 11% reported complete recovery, while a moderate level of disability persisted overall, with no systematic change from discharge. HRQoL improved significantly, reaching a mean score of 0.83. Fatigue, sex, and time from injury to rehabilitation were significantly associated with disability levels. Conclusions: The transition phase after rehabilitation posed challenges for patients with ABI, with 38% experiencing moderate disability. Despite this, HRQoL improved to levels comparable with the general population. Fatigue, sex, and rehabilitation timing emerged as key factors influencing disability outcomes.

Background/Objectives: Patients with acquired brain injury (ABI) often face complex challenges during the transition from in-hospital rehabilitation to everyday life. This study aimed to investigate disability, health-related quality of life (HRQoL), work, and other aspects of functioning as indicators of a meaningful life in this transition phase. Additionally, we assessed how disability levels three months post-discharge correlate with known risk factors. Methods: We conducted a prospective observational follow-up study including patients aged ≥18 years with ABI discharged from a specialized rehabili-tation clinic. Patient-reported outcomes, including disability and HRQoL, were collected at discharge and three months later. Associations between disability and known risk fac-tors were analyzed using multiple linear regression. Results: A total of 137 patients were included (mean age 63), with a follow-up completion rate of 59%. At follow-up, 11% re-ported complete recovery, while a moderate level of disability persisted overall, with no systematic change from discharge. HRQoL improved significantly, reaching a mean score of 0.83. Fatigue, gender, and time from injury to rehabilitation were significantly associat-ed with disability levels. Conclusions: The transition phase after rehabilitation posed challenges for patients with ABI, with 38% experiencing moderate disability. Despite this, HRQoL improved to levels comparable to the general population. Fatigue, gender, and rehabilitation timing emerged as key factors influencing disability outcomes.

Background: Postvoid residual urine (PVR) can be an unknown chronic disorder, or it can occur after surgery. A pilot study led to development of a flowchart suggesting performing preoperative and postoperative bladder scans and recommending men with PVR further diagnostic work-up. This study aimed to determine the prevalence of preoperative and postoperative PVR in men older than 65 years undergoing major elective orthopaedic surgery and also to determine risk factors and possibility of prediction. Methods: This was a single-center cohort study. The patients were consecutively included for 1 year from April 2022. Data were extracted from the electronic patient files: age, lower urinary tract symptoms (LUTS), comorbidity, type of surgery and anesthesia, opioid use, and preoperative and postoperative PVR which was defined as ≥150 ml. Results: A total of 796 men were eligible for inclusion: 316 knee, 276 hip, and 26 shoulder arthroplasties and 178 lower back spinal surgeries. Preoperative bladder scans were acquired in 95% of the eligible patients, and PVR was found in 15% (confidence interval [CI] 12-18). There was a higher risk of preoperative PVR in men reporting LUTS, OR 1.97 (1.28-3.03); neurological disease, OR 3.09 (1.41-6.74); and the risk increased with higher age, OR 1.08 per year (1.04-1.12). PVR was found in 9% of the men without risk factors. A postoperative bladder scan was performed in 72% of the men. Among men without preoperative PVR, 15% (CI 12-19) had postoperative PVR de novo. The highest risk for PVR postoperative was PVR preoperatively. Conclusions: Preoperatively, 15% had PVR. Neurological disease, LUTS, and higher age were identified as risk factors, but PVR was found in 9% of the men without risk factors. In men without preoperative PVR, 15% had postoperative PVR de novo. It is not possible to conclude whether PVR is transient or chronic, and it is unclear whether a PVR of 150 ml is associated with complications or if the threshold should be higher. This study highlights the importance of awareness regarding voiding issues before and after surgery. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

Introduction: Patients with multimorbidity attend multiple outpatient clinics. We assessed the effects on hospital use of scheduling several outpatient appointments to same-day visits in a multidisciplinary outpatient pathway (MOP). Methods: This study used a quasi-experimental design. Eligible patients had multimorbidity, were aged ≥18 years and attended ≥2 outpatient clinics in five different specialties. Patients were identified through forthcoming appointments from August 2018 to March 2020 and divided into intervention group (alignment of appointments) and comparison group (no alignment). We used patient questionnaires and paired analyses to study care integration and treatment burden. Using negative binomial regression, we estimated healthcare utilisation as incidence rates ratios (IRRs) at one year before and one year after baseline for both groups and compared IRR ratios (IRRRs). Results: Intervention patients had a 19% reduction in hospital visits (IRRR: 0.81, 95% CI: 0.70–0.96) and a 17% reduction in blood samples (IRRR: 0.83, 0.73–0.96) compared to comparison patients. No effects were found for care integration, treatment burden, outpatient contacts, terminated outpatient trajectories, hospital admissions, days of admission or GP contacts. Conclusion: The MOP seemed to reduce the number of hospital visits and blood samples. These results should be further investigated in studies exploring the coordination of outpatient care for multimorbidity. Research question: Can an intervention of coordinating outpatient appointments to same-day visits combined with a multidisciplinary conference influence the utilisation of healthcare services and the patient-assessed integration of healthcare services and treatment burden among patients with multimorbidity?

Fluxes of the powerful greenhouse gas nitrous oxide (N ₂ O) are mainly quantified using manually operated or automatic non‐steady‐state chambers. With both systems, fluxes are calculated as the change in N ₂ O concentration over time using linear or non‐linear regression, but the type of regression selected can have a strong influence on the N ₂ O flux magnitude. The HMR package, a regression‐based implementation of the Hutchinson & Mosier Regression, is a widely used software for trace gas flux calculation that provides a recommendation on the most appropriate regression method based on several criteria. New parameters were recently introduced which allow for pre‐filtering based on sample variance ( pfvar and pfalpha) , and for constraining the curvilinearity of concentration‐time series( SatPct and SatTimeMin) . Currently, there are no guidelines on how to choose the best parameters for specific user conditions. Here we address this knowledge gap using datasets from manual and automatic chambers, and sensitivity analyses. We found that the effect of parameter settings on the cumulative fluxes was greater for manual chamber data compared to the automatic chamber data, with ranges of up to 67.3% and 1.5%, respectively. The parameter pfvar was identified as highly sensitive for both manual and automatic chambers; it is, therefore, critical to select a threshold for when to allow for non‐linear flux calculation that accurately represents the given measurement precision. This can be estimated from the variance of N ₂ O measurements at ambient concentration levels. The parameter SatTimeMin was critical for manual chamber data where the curvature is much less constrained due to the lower number of observations. The parameter pfalpha was the least sensitive and can be set at a p ‐value equal to 0.05 following common statistical practice. Parameter values depend on the expected flux characteristics with a given chamber design and are currently best selected based on visual inspection of the data. This study identifies where and how specific care should be taken for the selection of parameters in the HMR package, which may contribute to standardizing the methodologies used worldwide for N ₂ O flux calculations, supporting initiatives in which data from many studies need to be combined. Highlights: The HMR package, an implementation of the Hutchinson & Mosier Regression, is a widely used software for trace gas flux calculation that provides a recommendation on the most appropriate regression method based on several criteria. New parameters in the updated HMR package constrains the use of nonlinear flux calculation and inclusion of outliers. The new parameters affect the cumulative emissions of N ₂ O obtained with manual and automated chambers differently. We found that the choice of parameter values led to differences in cumulative N ₂ O emissions of up to 67.3% This study identifies where and how specific care should be taken for the selection of parameters.

Aerobic exercise is an effective treatment to improve aerobic capacity following stroke and might also improve cognitive impairments in sub-acute stroke survivors. The aim of the study was to assess the effect of high-intensity aerobic exercise on cognitive impairments in sub-acute stroke survivors. A pilot, randomised controlled trial on the effects of aerobic exercise on cognitive impairments of stroke patients in the sub-acute (1-3 months) phase was conducted. Thirty patients with moderate cognitive impairments (maximum score of 5 on at least two items on the cognitive subscales of the Functional Independence Measure [FIM]) were included in the study and randomly assigned to either the intervention group – performing high-intensity aerobic exercise (above 70% of maximum heart rate), or the control group – performing low-intensity aerobic exercise (below 60%). Patients in both groups exercised for 50 min twice a week for 4 weeks. Primary neuropsychological outcome: Trail Making Test B. Thirty stroke patients completed the interventions. The results showed that the high-intensity group, compared with the low-intensity group, achieved significant improvements on Trail Making Test B, which assesses processing speed and divided attention (P = .04 after training and P = .01 at follow-up). However, the significant improvements on Trail Making Test B might relate to a ceiling effect in the control group. This study does not provide evidence to support that aerobic exercise can improve cognition in stroke survivors, even though significant improvement was revealed on the primary outcome in sub-acute stroke survivors following high-intensity aerobic exercise compared with low-intensity general exercise.

Primary objective: Rehabilitation scales following neurological injury can be useful for monitoring patient progress. However, too often, rehabilitation scales are administered unnecessarily placing an extra burden on clinicians and patients. The primary objective was to reduce redundant testing by providing guidelines for the concurrent use of the Functional Independence Measure (FIM) and Early Functional Abilities (EFA) scales during rehabilitation in patients with brain injury. Methodology: In total, 3289 concurrent FIM and EFA scores from 929 patients were examined. We proposed, using clinically sound and operational criterion, that the FIM should be used throughout rehabilitation, EFA should be used as a supplement when the FIM is ≤36 and FIM should be administered before the EFA on each testing occasion. Results: Around 24% of patients should be measured with the FIM and EFA throughout rehabilitation, 35% of patients should be measured with the EFA and FIM initially but not require EFA measurements when there is an increase in function and 39% of patients should only be measured with the FIM. According to these guidelines, the EFA was administered unnecessarily 53% of the time. Conclusions and implications: These guidelines ensure that the EFA is used when it is sensitive. This will optimize clinician time and minimize redundant testing, without compromising the measurement of clinical progress.

The TTH48 trial aims to determine whether prolonged duration (48 hours) of targeted temperature management (TTM) at 33 (±1) °C results in better neurological outcomes compared to standard duration (24 hours) after six months in comatose out-of-hospital cardiac arrest (OHCA) patients. TTH48 is an investigator-initiated, multicentre, assessor-blinded, randomised, controlled superiority trial of 24 and 48 hours of TTM at 33 (±1) ° C performed in 355 comatose OHCA patients aged 18 to 80 years who were admitted to ten intensive care units (ICUs) in six Northern European countries. The primary outcome of the study is the Cerebral Performance Category (CPC) score observed at six months after cardiac arrest. CPC scores of 1 and 2 are defined as good neurological outcomes, and CPC scores of 3, 4 and 5 are defined as poor neurological outcomes. The secondary outcomes are as follows: mortality within six months after cardiac arrest, CPC at hospital discharge, Glasgow Coma Scale (GCS) score on day 4, length of stay in ICU and at hospital and the presence of any adverse events such as cerebral, circulatory, respiratory, gastrointestinal, renal, metabolic measures, infection or bleeding. With the planned sample size, we have 80% power to detect a 15% improvement in good neurological outcomes at a two-sided statistical significance level of 5%. We present a detailed statistical analysis protocol (SAP) that specifies how primary and secondary outcomes should be evaluated. We also predetermine covariates for adjusted analyses and pre-specify sub-groups for sensitivity analyses. This pre-planned SAP will reduce analysis bias and add validity to the findings of this trial on the effect of length of TTM on important clinical outcomes after cardiac arrest. ClinicalTrials.gov: NCT01689077 , 17 September 2012