Faced with medical health-care staff shortages as a result of the coronavirus disease 2019 pandemic in Denmark,1Wu JT Leung K Leung GM Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study.Lancet. 2020; 395: 689-697Summary Full Text Full Text PDF PubMed Scopus (2959) Google Scholar colleagues at Aalborg University and Aalborg University Hospital were able to shift teaching of medical students to a digital platform, employ final year students as temporary residents, and plan and initiate course programmes in ventilator therapy assistance and nursing assistance within 2 days. On March 11, 2020, the Danish Prime Minister called for the mobilisation of all medical staff.2StatsministerietSituationen kommer til at stille kæmpe krav til os alle sammen.https://www.regeringen.dk/nyheder/2020/statsminister-mette-frederiksens-indledning-paa-pressemoede-i-statsministeriet-om-corona-virus-den-11-marts-2020/Date: March 11. 2020Date accessed: April 21, 2020Google Scholar Most universities in the country cancelled lectures and barred buildings. In response to the call to mobilise all medical staff, we decided to keep medical students in their clinical placements and to initiate fast-track courses in ventilator therapy and nursing assistance. In accordance with our undergraduate medical curriculum, we included the courses and the work as a temporary resident, ventilator therapy assistant, or nursing assistant in the teaching programme. Teaching was shifted to digital solutions, and the unique learning opportunity arising from the pandemic emergency health-care work matched the learning objectives in our undergraduate medical curriculum.3Stentoft D Problem-based projects in medical education: extending PBL practices and broadening learning perspectives.Adv Health Sci Educ Theory Pract. 2019; 24: 959-969Crossref PubMed Scopus (30) Google Scholar We constructed a new portfolio to be completed by each student to demonstrate learning activities in courses, clinical placements, and pandemic work. This will be used to emphasise the commitment of medical students to the pandemic emergency health-care workforce and to support progression in medical education at this summer's examinations. Within 2 weeks, all master's students had volunteered, and almost two thirds of students (161 of 257) were working as temporary residents (76 [47%] of 161), ventilator therapy assistants (45 [28%]), or nursing assistants (30 [19%]). More than 70% of bachelor students (329 of 454) had volunteered within 1 week, and 31% (142 students) were working in nine pandemic emergency departments. The processes driving this initiative are illustrated in the figure, and the achievements were acknowledged by the Danish Ministers of Health and Education and the Danish Health Authority. Decisive support from the heads of both Aalborg University and Aalborg University Hospital facilitated the process, which was led by the heads of the medical master's programme in medicine (SR, JE, and SA) together with the heads of the medical students' organisations (PS and MSP). This immediate response to the call for pandemic emergency health-care staff by medical students, without delay to their medical education, follows a historical trend3Stentoft D Problem-based projects in medical education: extending PBL practices and broadening learning perspectives.Adv Health Sci Educ Theory Pract. 2019; 24: 959-969Crossref PubMed Scopus (30) Google Scholar and sets an example, we believe, to be followed by other universities. The support by organisations and close collaboration was key to our success (figure). There is no need to hesitate—medical students are needed just as urgently as ventilators.4Lassen HC A preliminary report on the 1952 epidemic of poliomyelitis in Copenhagen with special reference to the treatment of acute respiratory insufficiency.Lancet. 1953; 1: 37-41Abstract PubMed Scopus (282) Google Scholar, 5Ranney ML Griffeth V Jha AK Critical supply shortages—the need for ventilators and personal protective equipment during the Covid-19 pandemic.N Engl J Med. 2020; (published online March 25.)DOI:10.1056/NEJMp2006141Crossref PubMed Scopus (1367) Google Scholar We declare no competing interests. We thank Lukas Bjørn Leer Bysted (Department of Computer Science, Aalborg University, Aalborg, Denmark) for preparing the graph.
Summary Objective Monitoring the influence of cautious iodine fortification ( IF ) on the incidence rate of overt thyrotoxicosis in Denmark with formerly frequent multinodular toxic goitre. Design A 21‐year (1997‐2017) prospective population‐based study identified all new cases of overt biochemical thyrotoxicosis in two open cohorts: a Western cohort with moderate iodine deficiency ( ID ) and an Eastern cohort with mild ID (total n = 533 969 by 1 January 1997). A diagnostic algorithm was applied to all thyroid function tests performed within the study areas. Mandatory IF of salt was initiated in mid‐2000 (13 ppm). This study is a part of DanThyr. Results The standardized incidence rate ( SIR ) of thyrotoxicosis at baseline (1997‐1998) was 128.5/100.000/year in the cohort with moderate ID and 80.1 in the cohort with mild ID . SIR increased markedly in both cohorts during the initial years of IF (moderate/mild ID : +39/+52% in 2000‐2001/2004‐2005) and subsequently decreased to baseline level (mild ID ) or below (moderate ID ) by 2008. The decline was due to a marked decrease in the incidence rate among elderly subjects and a moderate decrease among the middle aged. The follow‐up period for the mildly iodine deficient cohort was restricted to 2008. A continuous decline in SIR was observed for the remainder of the study period in the area with moderate ID (33% below baseline in 2016‐2017). Conclusion The rise in thyrotoxicosis incidence with cautious mandatory IF returned to baseline level after 7‐8 years and levelled out at 33% below baseline in the population with previously moderate ID after 16‐17 years.
The Use of Mathematical Models in the Study of the Epidemiology of Tuberculosis Affiliation Hans Waaler, Anton Geser, and Stig Andersen CopyRight https://doi.org/10.2105/AJPH.52.6.1002 Published Online: August 29, 2011
Introduction The ageing Arctic populations raise the need for work-up of cognitive function that reflects language and cultural understandings. Objectives To translate and evaluate tools for work-up of cognitive impairment in Greenland. Methods Step A: An expert panel was established to select tools suitable for the work-up of cognitive impairment at three different settings in Greenland. Step B: Tools were translated in a multiple-step process of independent translations with back-translation and adaptations by two independent translators and two Greenlandic physicians. Step C: a testing and validation process of the tools at three locations: the national hospital in the capital city; regional hospital in a town; health care centre in a small town. Results Tools selected were Mini-Cog and RUDAS. Participants for testing of tools were 43 of 61 invited, of which six had dementia. RUDAS and Mini-Cog scores were associated (p < 0.001). The smoothed AUC was 0.87 (95%-CI, 0.65–0.95) for Mini-Cog and 0.90 (95%-CI, 0.76–0.97) for RUDAS. The sensitivity of Mini-Cog with a cut-off at ≤3 was 83.3%, and specificity was 62.2%. For RUDAS with a cut-off at ≤23, these were 100% and 75.7%, respectively. Conclusions Requested tools have been translated for assessing cognitive function in the native Arctic setting. Small town residents with a Mini-Cog score of 3 or lower should be referred to a regional hospital for RUDAS, and a score of 23 or less should cause referral to the national hospital for a full work-up of cognitive function. Disclosure No significant relationships.
Abstract Background Hip fractures constitute a major health problem in elderly people and are often fall-related. Several factors can contribute to a fall episode leading to hip fracture, including fall-risk-increasing drugs (FRIDs), which are often used by elderly people. We aimed to investigate the prevalence of medication-related falls and to assess the role of FRIDs and potentially inappropriate medications (PIMs) in a population of elderly patients hospitalized for a hip fracture. Methods We reviewed the patient records of 200 consecutive patients, aged ≥65 years, who were admitted for a hip fracture and evaluated whether medications were likely to have contributed to the fall episode. PIMs were identified using the Screening Tool of Older Persons’ Prescriptions version 2 (STOPP) and by evaluating indications, contra-indications and interactions of the prescribed medications for each patient. Results FRIDs were used by 175 patients (87.5%). Medications were considered a likely contributor to the fall in 82 patients (41%). These were most often psychotropic medications alone or in combination with antihypertensives and/or diuretics. The 82 patients with suspected medication-related falls used more medications, FRIDs and PIMs than the rest of the patients, and in 74 (90%) of the 82 patients, at least one medication considered to be a contributor to the fall was also a PIM. Conclusions The prevalence of suspected medication-related falls was 41%. It seems likely that a medication review could have reduced, though not eliminated, the risk of falling in this group of patients.
