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Papers by Kim Lyngby Mikkelsen

Indledning 2. Baggrund Som slutprodukt fra projektet er der blevet udviklet en 'Sikkerhedskasse' ... more Indledning 2. Baggrund Som slutprodukt fra projektet er der blevet udviklet en 'Sikkerhedskasse' bestående af 5 konkrete redskaber til at skabe bedre sikkerhed og sikkerhedskultur, baseret på IU-tilgangen.

Safety Science Monitor, 2003

Survey of Anesthesiology, Oct 1, 2014

† Reliable incident reporting and dissemination of learning improves patient safety. † Establishi... more † Reliable incident reporting and dissemination of learning improves patient safety. † Establishing a 'no blame' safety culture and ensuring legal protection will encourage greater incident reporting. † Standardizing definitions, benchmarking, and closing the patient safety loop are important steps in this process. Background. Critical incident reporting is a key tool in the promotion of patient safety in anaesthesia. Methods. We surveyed representatives of national incident reporting systems in six European countries, inviting information on scope and organization, and intelligence on factors determining success and failure. Results. Some systems are government-run and nationally conceived; others started out as small, specialty-focused initiatives, which have since acquired a national reach. However, both national coordination and specialty enthusiasts seem to be necessary for an optimally functioning system. The role of reporting culture, definitional issues, and dissemination is discussed. Conclusions. We make recommendations for others intending to start new systems and speculate on the prospects for sharing patient safety lessons relevant to anaesthesia at European level.

Science of The Total Environment, 2004

The aim was to elucidate the usefulness of the excess hospitalisation fraction (EHF) approach-as ... more The aim was to elucidate the usefulness of the excess hospitalisation fraction (EHF) approach-as a practical alternative to the calculation of etiological fractions-for prioritising national preventive measures in the total environment. In this study we used the inequality in somatic hospitalisation across industrial sectors as an example. The presented EHFs may provide an estimate of the order of magnitude of the prevention potential, which may also be useful in priority setting in countries comparable to Denmark. All economically active adults in Denmark were followed-up for 6 years after hospital discharge, and industrial specific EHFs for 58 industrial sectors were calculated for 11 main diagnostic groups. Assuming 'education and research' to be the industrial sector which is least exposed to occupational hazards, we calculated the EHFs as a practical approximation to the etiologic fraction for all other industries, using hospitalisation rates adjusted for age. In addition, we also controlled for social class since many risk factors may also be related to life style or living conditions. Compared to 'education and research' the EHF in all other industries was (additional control for social class in brackets): Women 11% (7%), men 15% (8%). The EHFs for some of the main diagnostic groups were as follows: Circulatory diseases: Women 18% (12%), men 16% (10%). Neoplasms: Women 3% (4%), men 8% (6%). Musculoskeletal diseases: Women 19% (12%), men 21% (10%). Diseases in the respiratory system: Women 12% (8%), men 16% (9%). Diseases in the nervous system: Women 12% (7%), men 17% (12%). Violent events (injuries and trauma): Women 6% (5%), men 17% (6%). The advantage of this method is that the EHF can be calculated for all diseases and for the whole population without detailed knowledge of causal risk factors and their distribution in the population. Two main methodological problems are that we cannot control for selection bias related to occupation, and that the control for social class may lead to conservative estimates. Our estimates are, however, close to estimates of etiologic fractions published in the literature. Large unexpected EHFs for diseases of the blood and blood-forming organs should be seen as challenges for future research.

Occupational and Environmental Medicine, 2007

JAMA: The Journal of the American Medical Association, 1993

To evaluate the efficacy of a new nicotine inhaler system for smoking cessation. A 1-year, random... more To evaluate the efficacy of a new nicotine inhaler system for smoking cessation. A 1-year, randomized, double-blind, placebo-controlled study. Medical outpatient clinic with physicians experienced in smoking cessation assistance. A total of 286 volunteers who smoked at least 10 cigarettes daily recruited through a local newspaper. Subjects were randomly allocated to nicotine inhalers (n = 145) or placebo (n = 141) to be used for 3 months followed by tapering for 3 months in the context of minimal levels of advice and support. Continuous smoking abstinence at weeks 6, 12, 24, and 52, verified by measurements of carbon monoxide in expired air. Continuous smoking abstinence was significantly higher for the active nicotine inhaler group compared with the placebo inhaler group. The respective success rates were 28% and 12% after 6 weeks, 21% and 9% after 12 weeks, 17% and 8% after 6 months, and 15% and 5% after 1 year (P = .02 to .001). The mean nicotine substitution based on cotinine determinations after 2 weeks was 43% (SD, 45%) of smoking levels. The treatment was well tolerated, and no serious adverse events were reported. In this setting the nicotine inhaler appeared safe to use and increased success rates of smoking cessation attempts.

JAMA: The Journal of the American Medical Association, 1993

Safety Science …, 2010

... MANAGING OCCUPATIONAL SAFETY HANS HK SÖNDERSTRUP-ANDERSEN THOMAS FLÖCKE KIM L. MIKKELSEN CHRI... more ... MANAGING OCCUPATIONAL SAFETY HANS HK SÖNDERSTRUP-ANDERSEN THOMAS FLÖCKE KIM L. MIKKELSEN CHRISTIAN ROEPSTORFF The National Research Centre for the Working Environment, Denmark ... Frese, M., Kring, W., Soose, A. & Zempel, J. (1996). ...

British Journal of Anaesthesia, 2013

† Reliable incident reporting and dissemination of learning improves patient safety. † Establishi... more † Reliable incident reporting and dissemination of learning improves patient safety. † Establishing a 'no blame' safety culture and ensuring legal protection will encourage greater incident reporting. † Standardizing definitions, benchmarking, and closing the patient safety loop are important steps in this process. Background. Critical incident reporting is a key tool in the promotion of patient safety in anaesthesia. Methods. We surveyed representatives of national incident reporting systems in six European countries, inviting information on scope and organization, and intelligence on factors determining success and failure. Results. Some systems are government-run and nationally conceived; others started out as small, specialty-focused initiatives, which have since acquired a national reach. However, both national coordination and specialty enthusiasts seem to be necessary for an optimally functioning system. The role of reporting culture, definitional issues, and dissemination is discussed. Conclusions. We make recommendations for others intending to start new systems and speculate on the prospects for sharing patient safety lessons relevant to anaesthesia at European level.

International Journal of Obesity, 2000

OBJECTIVE: To describe differences in the 22 y mortality risk associated with body mass index (BM... more OBJECTIVE: To describe differences in the 22 y mortality risk associated with body mass index (BMI), body fat or fatfree mass, in order to examine if the differential health consequences of fat and fat-free mass may be responsible for elevated mortality rates at both high and low BMI. DESIGN: Prospective cohort study, a 22 y follow-up. SETTING: General community. The study of men born in 1913, Gothenburg. SUBJECTS: 787 men aged 60 y. MAIN OUTCOME MEASURES: Number and time of total deaths from 1973 to 1995. RESULTS: The risk of dying was a linear function of percentage fat and fat-free mass, and increased from a relative risk of 1.00 in men belonging to the lowest ®fth to 1.4 (95% con®dence interval 1.11 ± 1.99) in men in the highest ®fth of percentage fat mass. For BMI the lowest risk was observed for men belonging to the middle ®fth of BMI. When the relative risk was set at 1.00 for subjects belonging to the middle ®fth of BMI the risk associated with the low BMI ®fth was 1.3 (95% con®dence interval 0.94 ± 1.68) and that with the highest ®fth was 1.5 (95% con®dence interval 1.09 ± 1.96). Analyses including both body fat and fat-free mass showed that total mortality was a linear increasing function of high fat and low fat-free mass. CONCLUSION: The apparent U-shaped association between BMI and total mortality may be the result of compound risk functions from body fat and fat-free mass.

Nicotine & Tobacco Research, Sep 27, 2012

Introduction: This study evaluated the effect of varenicline in combination with counseling to as... more Introduction: This study evaluated the effect of varenicline in combination with counseling to assist long-term nicotine replacement therapy (NRT) users to quit NRT. Methods: This was a double-blind, placebo-controlled, randomized trial of varenicline or placebo for 12 weeks, with 52-week follow-up, performed in 1 hospital-based smoking cessation specialist clinic. At the first visit, 139 ex-smokers and long-term NRT users were allocated to treatment according to a computer-generated list with random numbers. Visits were scheduled at Weeks 0, 2, 4, 6, 9, 12, and 52. At each visit, nurse-led counseling was delivered, carbon monoxide in expired air, plasma cotinine, and body weight were assessed, and subjects were asked about craving, nausea, and dreams. The primary outcome was 12-week point prevalence quit rate (PPR) of nicotine replacement therapy use. Results: At all time points, the PPR was superior for varenicline versus placebo, although the difference was only statistically significant at 12 and 36 weeks. The PPR was 64.3% (varenicline) versus 40.6% (placebo) at 12 weeks (p = .006), and 42.9% (varenicline) versus 36.2% (placebo) at 52 weeks (NS). The continuous abstinence rate from Week 9 to Week 12 was 48.6 % (varenicline) versus 30.4 % (placebo) (p = .03). Withdrawal symptoms were statistically significantly lower in the varenicline group than the placebo group. Conclusion: Varenicline for 12 weeks combined with supportive visits was superior to placebo to get long-term NRT users to quit NRT. A larger study is needed to evaluate long-term efficacy. Varenicline is the most effective drug for smoking cessation and no abuse potential has been reported with varenicline

Journal of Occupational and Environmental Medicine, Oct 1, 2003

Although many occupational safety programs are targeted towards large firms, the construction ind... more Although many occupational safety programs are targeted towards large firms, the construction industry is dominated by smaller firms. This study examines the differential effect of firm size on the risk and the reporting of over 3,000 serious and minor nonfatal elevation fall injuries in Danish construction industry trades (1993-1999). Small firms (<20 employees) accounted for 93% of all firms and 55% of worker-years. There was an inverse relationship between firm size and serious injury rates, and a direct relationship between firm size and minor injury rates. An inverse relationship between firm size and injury severity odds ratios (serious versus minor) was found for carpentry, electrical work, general contracting and the remaining other trades. Health and safety issues, legislation and enforcement in the construction industry should, to a greater degree, be focused on smaller firms. Purpose The purpose of this study was to assess the differential effect firm size had on the risk and the reporting of serious and minor nonfatal elevation fall injuries in selected construction trades and in relation to the sources of elevation falls. The study builds on earlier research on the effects of firm size on injuries in construction in three ways: 1) it focuses on one specific hazard  elevation falls, 2) it differentiates between reported serious and minor nonfatal injury incidents, and 3) it applies construction trade-and source-specific analyses. Materials and Methods Data sources This study is based on males' nonfatal elevation fall injury incidents (accidents) reported to the Danish Working Environment Authority (DWEA) during the seven-year period between 1993 and 1999. The reporting of lost-time-injury incidents in Denmark is compulsory, and requires a minimum of one lost workday beyond the day of injury. Nonfatal injuries are divided into serious and minor. Serious injuries, as used in this study, are pre-defined by DWEA as lost-time-injury incidents resulting in amputations, bone fractures, or multi-trauma injuries. Minor injuries include all other reported nonfatal lost-time-injury incidents. Injuries are categorized into serious and minor irrespective of their social and economic consequences. Firm size was coded as 'not given' in 15% and 13% of the reported serious and minor injuries, respectively, and these injuries were excluded from the study. DWEA has estimated 20 that the proportion of underreporting of injury incidents in construction in general is approximately 50%, and across all economic sectors there is an estimated underreporting of amputations (10%) and bone fractures (40%). The proportion of underreporting in respect to firm size was not analyzed in the DWEA study. The effect of underreporting of injury incidents probably has a major effect on the absolute rates of serious and minor injuries. However, the effect on the ratio between serious and minor injuries, as used in this study and described below, will likely be negligible  assuming the patterns of underreporting are similar from year to year. Denominator data for this study encompassed the entire Danish construction workforce in relation to firm size and construction trade, and were obtained from Statistics Denmark for the period between 1993 and 1999. Each year, Statistics Denmark registers Danish residents' primary employment information as of the last week of November. Firm size is determined according to the number of male and female employees as follows: 0 employees (self-employed), 1-4, 5-9, 10-19, 20-49, 50-99, and ≥100 employees. These classifications are similar to those used by the United States Census Bureau. The data are analyzed for construction as a whole, as well as for four selected trade groupings: general construction contracting, carpentry, electrical work, and the remaining other trades combined (i.e., glazier work, insulating, scaffolding, painting, masonry, plumbing, and miscellaneous remaining construction trades). The study mentions general construction contracting, carpentry, and electrical work because, as far as construction is concerned, these trade groups comprise the greatest percentage of worker-years (68%), and serious (73%) and minor 74% elevation fall injuries. The construction trade classifications were taken from the Danish Branch Codes of 1993, which are based on the European Union's NACE (Revision 1) classification system. NACE conforms somewhat to the United Nations' ISIC (Revision 3) classification system. Statistical Analyses The statistical and risk analyses carried out in this study included calculations of proportions (%), nonfatal injury incidence rates per 1,000 worker-years, relative rates (RR), and injury severity odds ratios (OR). 6 Weighted (by worker-years) linear regression analyses were performed on the injury severity odds ratios across firm sizes-that is, the injury severity odds ratios for each trade group were modeled as a line with an estimate for the line's intercept with the Y-axis (i.e., the level Occupational elevation fall injuries referred to an emergency department, 1990-1999

BMC Musculoskeletal Disorders, Jul 21, 2018

Background: Tibial plateau fractures (TPFs) are sometimes overlooked in the emergency room (ER). ... more Background: Tibial plateau fractures (TPFs) are sometimes overlooked in the emergency room (ER). Using a national register covering 18 years we aimed to find out why and to evaluate if use of a specific radiographic decision rule, Pittsburgh Knee Rules (PKRs), could have reduced the number of overlooked TPFs. Methods: Medical records for 137 patients, prospectively registered during 18 years by the Danish Patient Compensation Association (DPCA) (a national register), were studied. The inclusion criterion was a delayed diagnosis of a fracture in the knee following a trauma. Case records, legal assessments, and evaluations by specialist doctors were reviewed, and the consequences of the delayed diagnosis for outcome and treatment were registered. Results: Only 58 patients (42%) had been evaluated according to PKRs. In 53 patient cases, the fracture was not diagnosed on radiographs obtained at the first medical contact. However, in 84% of these cases, the fracture was visible or was suspected by retrospective evaluation. 50 out of 79 patients, for whom X-rays were not obtained, were candidates for radiographs according to PKRs, 17 cases lacked information to evaluate by PKRs and 12 cases were not candidates. In 53% of all cases, it was evaluated that the fracture position had worsened at the time of diagnosis. A significant disability compensation was granted in 36% of cases due to the delayed identification of fractures, totaling 841,000 EUR. Conclusions: The major reasons for overlooking TPFs were 1) difficulty in recognizing the fractures on X-rays and 2) that X-ray decision rules were not employed. Two thirds of the patients, for whom a radiograph had not been prescribed, would have had an X-ray, if the PKRs had been used. Overlooking TPFs significantly increased patient disability in one third of cases. We recommend that healthcare professionals in the ER use X-ray decision rules in addition to clinical examination to avoid overlooking TPFs. When standard radiographs are evaluated as normal in patients that are clinically suspect of a TPF, oblique X-rays, magnetic resonance imaging (MRI) or Computed Tomography (CT)-scan should be considered.

International Journal for Quality in Health Care, Oct 8, 2020

Objectives: To study the effects of the reorganization on patient compensation claim contents rel... more Objectives: To study the effects of the reorganization on patient compensation claim contents relating to health care quality and patient safety. Design and settings: Danish emergency care has developed considerably over the past decades, including a major reorganization to improve health care quality and patient safety through ensuring easier access to specialist treatment. Analysis of compensation claim patterns is used to evaluate the effects of such health care system changes. Participants, interventions and main outcome measures: A sample of 1613 compensation claims to the Danish Patient Assurance organization was reviewed using a standardized taxonomy (the Healthcare Complaints Analysis Tool [HCAT]). Using trend analysis, we compared the proportions of claims categorized under HCAT domains, problem categories and sub-categories before and after the reorganization, with particular emphasis on the 'Clinical problems' domain covering health care quality and patient safety issues. Results: We observed a baseline increase in claims relating to clinical problems (P < 0.01), but this increase was less pronounced following the reorganization. This appeared to be driven mainly by a decrease in claims about clinician skills (P = 0.03) and health care neglects (P = 0.01). However, claims about diagnostic errors and patient outcomes showed a tendency (insignificant) to increase. Conclusions: Emergency care reorganization apparently has been followed by a shift in claim contents towards fewer claims about health care neglect and staff competencies, although claims about other matters may have become more common. Present analyses of compensation claim trends should be supplemented by effect studies using traditional outcome measures such as mortality and readmission rates.

 Users may download and print one copy of any publication from the public portal for the purpose... more  Users may download and print one copy of any publication from the public portal for the purpose of private study or research.  You may not further distribute the material or use it for any profit-making activity or commercial gain  You may freely distribute the URL identifying the publication in the public portal If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

Background: Sleep apnea mainly in supine position - positional obstructive sleep apnea (POSA) – a... more Background: Sleep apnea mainly in supine position - positional obstructive sleep apnea (POSA) – allows other treatment modalities than continuous positive airway pressure (CPAP). There is no consensus on the definition of POSA. Aims and objectives: We wanted to evaluate the number of patients diagnosed with POSA according to different definitions and identify differences in patient characteristics between the groups. The POSA definitions of Cartwright, Mador & Permut, Bignold and Amsterdam Positional OSA Classification I (APOC I) were used (Frank, MH et al. Sleep Breath 2014; Epub ahead of print). Methods: All patients newly tested with cardiorespiratory monitoring (CRM) in Danish Center of Sleep Medicine in 2013 were evaluated. CRM reports and patient files were retrospectively reviewed. Results: A total of 735 patients were included. 25.2 % did not have obstructive sleep apnea (OSA) (Apnea Hyponea Index (AHI) Conclusion: The number of patients diagnosed with POSA fundamentally depends on the used definition. Mean value of POSA among OSA patients is 37.3%. The observed differences in patient characteristics between POSA and non-POSA correlate to what is formerly described in the literature.

Indledning 2. Baggrund Som slutprodukt fra projektet er der blevet udviklet en 'Sikkerhedskasse' ... more Indledning 2. Baggrund Som slutprodukt fra projektet er der blevet udviklet en 'Sikkerhedskasse' bestående af 5 konkrete redskaber til at skabe bedre sikkerhed og sikkerhedskultur, baseret på IU-tilgangen.

Safety Science Monitor, 2003

Survey of Anesthesiology, Oct 1, 2014

† Reliable incident reporting and dissemination of learning improves patient safety. † Establishi... more † Reliable incident reporting and dissemination of learning improves patient safety. † Establishing a 'no blame' safety culture and ensuring legal protection will encourage greater incident reporting. † Standardizing definitions, benchmarking, and closing the patient safety loop are important steps in this process. Background. Critical incident reporting is a key tool in the promotion of patient safety in anaesthesia. Methods. We surveyed representatives of national incident reporting systems in six European countries, inviting information on scope and organization, and intelligence on factors determining success and failure. Results. Some systems are government-run and nationally conceived; others started out as small, specialty-focused initiatives, which have since acquired a national reach. However, both national coordination and specialty enthusiasts seem to be necessary for an optimally functioning system. The role of reporting culture, definitional issues, and dissemination is discussed. Conclusions. We make recommendations for others intending to start new systems and speculate on the prospects for sharing patient safety lessons relevant to anaesthesia at European level.

Science of The Total Environment, 2004

The aim was to elucidate the usefulness of the excess hospitalisation fraction (EHF) approach-as ... more The aim was to elucidate the usefulness of the excess hospitalisation fraction (EHF) approach-as a practical alternative to the calculation of etiological fractions-for prioritising national preventive measures in the total environment. In this study we used the inequality in somatic hospitalisation across industrial sectors as an example. The presented EHFs may provide an estimate of the order of magnitude of the prevention potential, which may also be useful in priority setting in countries comparable to Denmark. All economically active adults in Denmark were followed-up for 6 years after hospital discharge, and industrial specific EHFs for 58 industrial sectors were calculated for 11 main diagnostic groups. Assuming &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;education and research&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; to be the industrial sector which is least exposed to occupational hazards, we calculated the EHFs as a practical approximation to the etiologic fraction for all other industries, using hospitalisation rates adjusted for age. In addition, we also controlled for social class since many risk factors may also be related to life style or living conditions. Compared to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;education and research&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; the EHF in all other industries was (additional control for social class in brackets): Women 11% (7%), men 15% (8%). The EHFs for some of the main diagnostic groups were as follows: Circulatory diseases: Women 18% (12%), men 16% (10%). Neoplasms: Women 3% (4%), men 8% (6%). Musculoskeletal diseases: Women 19% (12%), men 21% (10%). Diseases in the respiratory system: Women 12% (8%), men 16% (9%). Diseases in the nervous system: Women 12% (7%), men 17% (12%). Violent events (injuries and trauma): Women 6% (5%), men 17% (6%). The advantage of this method is that the EHF can be calculated for all diseases and for the whole population without detailed knowledge of causal risk factors and their distribution in the population. Two main methodological problems are that we cannot control for selection bias related to occupation, and that the control for social class may lead to conservative estimates. Our estimates are, however, close to estimates of etiologic fractions published in the literature. Large unexpected EHFs for diseases of the blood and blood-forming organs should be seen as challenges for future research.

Occupational and Environmental Medicine, 2007

JAMA: The Journal of the American Medical Association, 1993

To evaluate the efficacy of a new nicotine inhaler system for smoking cessation. A 1-year, random... more To evaluate the efficacy of a new nicotine inhaler system for smoking cessation. A 1-year, randomized, double-blind, placebo-controlled study. Medical outpatient clinic with physicians experienced in smoking cessation assistance. A total of 286 volunteers who smoked at least 10 cigarettes daily recruited through a local newspaper. Subjects were randomly allocated to nicotine inhalers (n = 145) or placebo (n = 141) to be used for 3 months followed by tapering for 3 months in the context of minimal levels of advice and support. Continuous smoking abstinence at weeks 6, 12, 24, and 52, verified by measurements of carbon monoxide in expired air. Continuous smoking abstinence was significantly higher for the active nicotine inhaler group compared with the placebo inhaler group. The respective success rates were 28% and 12% after 6 weeks, 21% and 9% after 12 weeks, 17% and 8% after 6 months, and 15% and 5% after 1 year (P = .02 to .001). The mean nicotine substitution based on cotinine determinations after 2 weeks was 43% (SD, 45%) of smoking levels. The treatment was well tolerated, and no serious adverse events were reported. In this setting the nicotine inhaler appeared safe to use and increased success rates of smoking cessation attempts.

JAMA: The Journal of the American Medical Association, 1993

Safety Science …, 2010

... MANAGING OCCUPATIONAL SAFETY HANS HK SÖNDERSTRUP-ANDERSEN THOMAS FLÖCKE KIM L. MIKKELSEN CHRI... more ... MANAGING OCCUPATIONAL SAFETY HANS HK SÖNDERSTRUP-ANDERSEN THOMAS FLÖCKE KIM L. MIKKELSEN CHRISTIAN ROEPSTORFF The National Research Centre for the Working Environment, Denmark ... Frese, M., Kring, W., Soose, A. &amp; Zempel, J. (1996). ...

British Journal of Anaesthesia, 2013

† Reliable incident reporting and dissemination of learning improves patient safety. † Establishi... more † Reliable incident reporting and dissemination of learning improves patient safety. † Establishing a 'no blame' safety culture and ensuring legal protection will encourage greater incident reporting. † Standardizing definitions, benchmarking, and closing the patient safety loop are important steps in this process. Background. Critical incident reporting is a key tool in the promotion of patient safety in anaesthesia. Methods. We surveyed representatives of national incident reporting systems in six European countries, inviting information on scope and organization, and intelligence on factors determining success and failure. Results. Some systems are government-run and nationally conceived; others started out as small, specialty-focused initiatives, which have since acquired a national reach. However, both national coordination and specialty enthusiasts seem to be necessary for an optimally functioning system. The role of reporting culture, definitional issues, and dissemination is discussed. Conclusions. We make recommendations for others intending to start new systems and speculate on the prospects for sharing patient safety lessons relevant to anaesthesia at European level.

International Journal of Obesity, 2000

OBJECTIVE: To describe differences in the 22 y mortality risk associated with body mass index (BM... more OBJECTIVE: To describe differences in the 22 y mortality risk associated with body mass index (BMI), body fat or fatfree mass, in order to examine if the differential health consequences of fat and fat-free mass may be responsible for elevated mortality rates at both high and low BMI. DESIGN: Prospective cohort study, a 22 y follow-up. SETTING: General community. The study of men born in 1913, Gothenburg. SUBJECTS: 787 men aged 60 y. MAIN OUTCOME MEASURES: Number and time of total deaths from 1973 to 1995. RESULTS: The risk of dying was a linear function of percentage fat and fat-free mass, and increased from a relative risk of 1.00 in men belonging to the lowest ®fth to 1.4 (95% con®dence interval 1.11 ± 1.99) in men in the highest ®fth of percentage fat mass. For BMI the lowest risk was observed for men belonging to the middle ®fth of BMI. When the relative risk was set at 1.00 for subjects belonging to the middle ®fth of BMI the risk associated with the low BMI ®fth was 1.3 (95% con®dence interval 0.94 ± 1.68) and that with the highest ®fth was 1.5 (95% con®dence interval 1.09 ± 1.96). Analyses including both body fat and fat-free mass showed that total mortality was a linear increasing function of high fat and low fat-free mass. CONCLUSION: The apparent U-shaped association between BMI and total mortality may be the result of compound risk functions from body fat and fat-free mass.

Nicotine & Tobacco Research, Sep 27, 2012

Introduction: This study evaluated the effect of varenicline in combination with counseling to as... more Introduction: This study evaluated the effect of varenicline in combination with counseling to assist long-term nicotine replacement therapy (NRT) users to quit NRT. Methods: This was a double-blind, placebo-controlled, randomized trial of varenicline or placebo for 12 weeks, with 52-week follow-up, performed in 1 hospital-based smoking cessation specialist clinic. At the first visit, 139 ex-smokers and long-term NRT users were allocated to treatment according to a computer-generated list with random numbers. Visits were scheduled at Weeks 0, 2, 4, 6, 9, 12, and 52. At each visit, nurse-led counseling was delivered, carbon monoxide in expired air, plasma cotinine, and body weight were assessed, and subjects were asked about craving, nausea, and dreams. The primary outcome was 12-week point prevalence quit rate (PPR) of nicotine replacement therapy use. Results: At all time points, the PPR was superior for varenicline versus placebo, although the difference was only statistically significant at 12 and 36 weeks. The PPR was 64.3% (varenicline) versus 40.6% (placebo) at 12 weeks (p = .006), and 42.9% (varenicline) versus 36.2% (placebo) at 52 weeks (NS). The continuous abstinence rate from Week 9 to Week 12 was 48.6 % (varenicline) versus 30.4 % (placebo) (p = .03). Withdrawal symptoms were statistically significantly lower in the varenicline group than the placebo group. Conclusion: Varenicline for 12 weeks combined with supportive visits was superior to placebo to get long-term NRT users to quit NRT. A larger study is needed to evaluate long-term efficacy. Varenicline is the most effective drug for smoking cessation and no abuse potential has been reported with varenicline

Journal of Occupational and Environmental Medicine, Oct 1, 2003

Although many occupational safety programs are targeted towards large firms, the construction ind... more Although many occupational safety programs are targeted towards large firms, the construction industry is dominated by smaller firms. This study examines the differential effect of firm size on the risk and the reporting of over 3,000 serious and minor nonfatal elevation fall injuries in Danish construction industry trades (1993-1999). Small firms (<20 employees) accounted for 93% of all firms and 55% of worker-years. There was an inverse relationship between firm size and serious injury rates, and a direct relationship between firm size and minor injury rates. An inverse relationship between firm size and injury severity odds ratios (serious versus minor) was found for carpentry, electrical work, general contracting and the remaining other trades. Health and safety issues, legislation and enforcement in the construction industry should, to a greater degree, be focused on smaller firms. Purpose The purpose of this study was to assess the differential effect firm size had on the risk and the reporting of serious and minor nonfatal elevation fall injuries in selected construction trades and in relation to the sources of elevation falls. The study builds on earlier research on the effects of firm size on injuries in construction in three ways: 1) it focuses on one specific hazard  elevation falls, 2) it differentiates between reported serious and minor nonfatal injury incidents, and 3) it applies construction trade-and source-specific analyses. Materials and Methods Data sources This study is based on males' nonfatal elevation fall injury incidents (accidents) reported to the Danish Working Environment Authority (DWEA) during the seven-year period between 1993 and 1999. The reporting of lost-time-injury incidents in Denmark is compulsory, and requires a minimum of one lost workday beyond the day of injury. Nonfatal injuries are divided into serious and minor. Serious injuries, as used in this study, are pre-defined by DWEA as lost-time-injury incidents resulting in amputations, bone fractures, or multi-trauma injuries. Minor injuries include all other reported nonfatal lost-time-injury incidents. Injuries are categorized into serious and minor irrespective of their social and economic consequences. Firm size was coded as 'not given' in 15% and 13% of the reported serious and minor injuries, respectively, and these injuries were excluded from the study. DWEA has estimated 20 that the proportion of underreporting of injury incidents in construction in general is approximately 50%, and across all economic sectors there is an estimated underreporting of amputations (10%) and bone fractures (40%). The proportion of underreporting in respect to firm size was not analyzed in the DWEA study. The effect of underreporting of injury incidents probably has a major effect on the absolute rates of serious and minor injuries. However, the effect on the ratio between serious and minor injuries, as used in this study and described below, will likely be negligible  assuming the patterns of underreporting are similar from year to year. Denominator data for this study encompassed the entire Danish construction workforce in relation to firm size and construction trade, and were obtained from Statistics Denmark for the period between 1993 and 1999. Each year, Statistics Denmark registers Danish residents' primary employment information as of the last week of November. Firm size is determined according to the number of male and female employees as follows: 0 employees (self-employed), 1-4, 5-9, 10-19, 20-49, 50-99, and ≥100 employees. These classifications are similar to those used by the United States Census Bureau. The data are analyzed for construction as a whole, as well as for four selected trade groupings: general construction contracting, carpentry, electrical work, and the remaining other trades combined (i.e., glazier work, insulating, scaffolding, painting, masonry, plumbing, and miscellaneous remaining construction trades). The study mentions general construction contracting, carpentry, and electrical work because, as far as construction is concerned, these trade groups comprise the greatest percentage of worker-years (68%), and serious (73%) and minor 74% elevation fall injuries. The construction trade classifications were taken from the Danish Branch Codes of 1993, which are based on the European Union's NACE (Revision 1) classification system. NACE conforms somewhat to the United Nations' ISIC (Revision 3) classification system. Statistical Analyses The statistical and risk analyses carried out in this study included calculations of proportions (%), nonfatal injury incidence rates per 1,000 worker-years, relative rates (RR), and injury severity odds ratios (OR). 6 Weighted (by worker-years) linear regression analyses were performed on the injury severity odds ratios across firm sizes-that is, the injury severity odds ratios for each trade group were modeled as a line with an estimate for the line's intercept with the Y-axis (i.e., the level Occupational elevation fall injuries referred to an emergency department, 1990-1999

BMC Musculoskeletal Disorders, Jul 21, 2018

Background: Tibial plateau fractures (TPFs) are sometimes overlooked in the emergency room (ER). ... more Background: Tibial plateau fractures (TPFs) are sometimes overlooked in the emergency room (ER). Using a national register covering 18 years we aimed to find out why and to evaluate if use of a specific radiographic decision rule, Pittsburgh Knee Rules (PKRs), could have reduced the number of overlooked TPFs. Methods: Medical records for 137 patients, prospectively registered during 18 years by the Danish Patient Compensation Association (DPCA) (a national register), were studied. The inclusion criterion was a delayed diagnosis of a fracture in the knee following a trauma. Case records, legal assessments, and evaluations by specialist doctors were reviewed, and the consequences of the delayed diagnosis for outcome and treatment were registered. Results: Only 58 patients (42%) had been evaluated according to PKRs. In 53 patient cases, the fracture was not diagnosed on radiographs obtained at the first medical contact. However, in 84% of these cases, the fracture was visible or was suspected by retrospective evaluation. 50 out of 79 patients, for whom X-rays were not obtained, were candidates for radiographs according to PKRs, 17 cases lacked information to evaluate by PKRs and 12 cases were not candidates. In 53% of all cases, it was evaluated that the fracture position had worsened at the time of diagnosis. A significant disability compensation was granted in 36% of cases due to the delayed identification of fractures, totaling 841,000 EUR. Conclusions: The major reasons for overlooking TPFs were 1) difficulty in recognizing the fractures on X-rays and 2) that X-ray decision rules were not employed. Two thirds of the patients, for whom a radiograph had not been prescribed, would have had an X-ray, if the PKRs had been used. Overlooking TPFs significantly increased patient disability in one third of cases. We recommend that healthcare professionals in the ER use X-ray decision rules in addition to clinical examination to avoid overlooking TPFs. When standard radiographs are evaluated as normal in patients that are clinically suspect of a TPF, oblique X-rays, magnetic resonance imaging (MRI) or Computed Tomography (CT)-scan should be considered.

International Journal for Quality in Health Care, Oct 8, 2020

Objectives: To study the effects of the reorganization on patient compensation claim contents rel... more Objectives: To study the effects of the reorganization on patient compensation claim contents relating to health care quality and patient safety. Design and settings: Danish emergency care has developed considerably over the past decades, including a major reorganization to improve health care quality and patient safety through ensuring easier access to specialist treatment. Analysis of compensation claim patterns is used to evaluate the effects of such health care system changes. Participants, interventions and main outcome measures: A sample of 1613 compensation claims to the Danish Patient Assurance organization was reviewed using a standardized taxonomy (the Healthcare Complaints Analysis Tool [HCAT]). Using trend analysis, we compared the proportions of claims categorized under HCAT domains, problem categories and sub-categories before and after the reorganization, with particular emphasis on the 'Clinical problems' domain covering health care quality and patient safety issues. Results: We observed a baseline increase in claims relating to clinical problems (P < 0.01), but this increase was less pronounced following the reorganization. This appeared to be driven mainly by a decrease in claims about clinician skills (P = 0.03) and health care neglects (P = 0.01). However, claims about diagnostic errors and patient outcomes showed a tendency (insignificant) to increase. Conclusions: Emergency care reorganization apparently has been followed by a shift in claim contents towards fewer claims about health care neglect and staff competencies, although claims about other matters may have become more common. Present analyses of compensation claim trends should be supplemented by effect studies using traditional outcome measures such as mortality and readmission rates.

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Background: Sleep apnea mainly in supine position - positional obstructive sleep apnea (POSA) – a... more Background: Sleep apnea mainly in supine position - positional obstructive sleep apnea (POSA) – allows other treatment modalities than continuous positive airway pressure (CPAP). There is no consensus on the definition of POSA. Aims and objectives: We wanted to evaluate the number of patients diagnosed with POSA according to different definitions and identify differences in patient characteristics between the groups. The POSA definitions of Cartwright, Mador & Permut, Bignold and Amsterdam Positional OSA Classification I (APOC I) were used (Frank, MH et al. Sleep Breath 2014; Epub ahead of print). Methods: All patients newly tested with cardiorespiratory monitoring (CRM) in Danish Center of Sleep Medicine in 2013 were evaluated. CRM reports and patient files were retrospectively reviewed. Results: A total of 735 patients were included. 25.2 % did not have obstructive sleep apnea (OSA) (Apnea Hyponea Index (AHI) Conclusion: The number of patients diagnosed with POSA fundamentally depends on the used definition. Mean value of POSA among OSA patients is 37.3%. The observed differences in patient characteristics between POSA and non-POSA correlate to what is formerly described in the literature.