Region of Southern Denmark

Nearly 5,000 out-of-hospital cardiac arrests occur annually in Denmark. Three in four take place in the patient’s home, often witnessed by relatives. In 60–70

We aimed to study how the timing of incident maternal emotional disorders is associated with male offspring’s cognitive ability in early adulthood using cognitive test data from military conscription in a population-based cohort. We linked all males (conscripts) born in Denmark 1996–2001 to parental hospital records to identify anxiety or depression (emotional disorders). Linear regression assessed the association between the timing of the first maternal diagnosis (before, during, or after birth (0–1, 1–5, 6–17 years)) and cognitive ability measured at the Danish Conscription Board Examination 2014–2019. Paternal emotional disorders served as negative controls to differentiate maternal pregnancy exposures from genetic and postnatal influences. The study included 119,387 males, with 9,959 (8.3 https://doi.org/10.17605/OSF.IO/SV7W4 ).

This study examines how organizational culture shapes the effectiveness and sustainability of Quality Improvement (QI) initiatives in healthcare. We conducted a qualitative embedded case study at a Danish university hospital, exploring six clinical units across surgery, internal medicine, and related specialties. Participants included managers, frontline staff, and QI facilitators. Guided by the Competing Values Framework (CVF), we analyzed how four cultural archetypes: Clan, Adhocracy, Market, and Hierarchy-influenced QI processes across initiation, execution, and evaluation phases. Data included 15 semi-structured interviews and internal QI documents. Reflexive thematic analysis combined deductive CVF-based coding with inductive insights, while researcher positionality and reflexivity were addressed through team dialogue and systematic documentation of interpretive choices. Findings show that culture shaped implementation pathways. In Clan-oriented units, staff involvement fostered ownership: "The more we involve staff in shaping the process, the more ownership they take, and the changes stick." Market cultures emphasized performance metrics but risked shallow engagement, while Hierarchy and Adhocracy cultures provided structure and innovation but faced limits in sustainability. The study demonstrates that tailoring QI strategies to cultural contexts enhances engagement and outcomes. We reflect on the CVF's limits in capturing cultural complexity and suggest complementary frameworks such as CFIR to strengthen conceptual grounding.

Collaboration between General Practitioners (GPs) and specialised hospital services is essential for efficient, patient-centred care. In Denmark, GPs manage patients’ conditions and coordinate referrals to specialised services. Hospital referral triage consultants act as second-line gatekeepers, assessing the appropriate allocation of the patient or returning the referral to the GP when criteria are not met. The proportion of referrals rejected has increased, and inadequate communication between GPs and hospitals may contribute to these rejections. Understanding how triage consultants make decisions and coordinate care is critical for optimising referral pathways. This study aimed to explore the decision-making and coordination processes involved in rejected referrals from the perspective of hospital triage consultants. A qualitative design was employed using individual telephone interviews. Data were analysed following Braun and Clarke’s reflective thematic analysis. Ten hospital triage consultants participated, with 1 to 18 years of clinical experience, representing, orthopaedic surgery, urology, endocrinology, radiology, psychiatry, neurology, general medicine and haematology; four were female. Interviews lasted 21–37 min. Four themes emerged: (1) The referral process is influenced by specialisation and regulatory mandates, (2) Communication within the referral process – a remnant of the past, (3) The referral as a requested clinical task – Defining Scope and Responsibility, and (4) Selection of “the right patients” for specialised treatment. Findings indicate that triage consultants act as gatekeepers between GPs and specialist departments, balancing clinical information with departmental capacity. Structural and procedural constraints limit system flexibility. The consultants had several suggestions to improve the referral process quality and efficiency. Efficiency could be enhanced by revising legal and administrative constraints and optimising consultants’ workloads. Pathways work well for clearly defined cases, e.g., cancer-suspect cases, but poorly for patients with complex conditions requiring tailored approaches. Establishing accessible and flexible referral criteria can improve triage and the identification and prioritisation of patients with the greatest clinical needs. Improved collaboration between triage consultants, GPs, and patients, e.g., through direct contact or further correspondence, may enhance referral quality and overall patient care. These findings have identified practical strategies to strengthen hospital–primary care coordination and support resource-efficient, patient-centred pathways. Creating better opportunities for consultants to contact the GP and patient during triage of referrals. Enhancing communication through telephonic advice, video consultations, and correspondence. Improving the quality of, agreement on, and accessibility to criteria for referral acceptance. Expanding GPs’ role in coordinating complex patient care to ensure continuity. Reviewing regulative time constraints for patient management after an accepted referral. Reviewing workload and increasing efficiency while maintaining focus on high-priority cases. Creating an expansive referral strategy with fewer time constraints for patients with complex health conditions.

Background Trauma-focused psychological interventions are central to treating PTSD and CPTSD among trauma-affected refugees, yet it remains unclear how patient-reported outcome measures (PROMs) can be meaningfully implemented in high-complexity clinical settings. This study examined real-world use of a web-based PROM system embedded in routine care for trauma-affected refugees in Denmark.Methods We conducted a convergent, embedded mixed-methods case study at a specialist outpatient clinic participating in the Danish Trauma Database for Refugees (DTD). Quantitative data comprised (a) system-generated flow data for all patients referred between February 2023 and August 2025 (N = 634), describing registration, consent, and assessment completion at baseline, end of treatment, and 6-month follow-up, and (b) a clinician survey on usability and clinical value (n = 15). Qualitative data consisted of 10 semi-structured interviews with two clinician-patient dyads conducted at baseline, mid-treatment, and post-treatment, analyzed using reflexive thematic analysis. Findings were integrated across data sources to address implementation, perceived usability, experiences of use, and how these perspectives intersect.Results Of 634 registered patients, 270 (42%) provided active research consent. Baseline PROM completion was moderate, with most patients contributing at least partial data, whereas completion declined substantially at post-treatment and follow-up (e.g., 77% and 90% of assessments unregistered, respectively). Clinicians rated technical usability as acceptable but reported limited perceived impact on clinical insight, personalized care, and interdisciplinary collaboration; half expressed concern that research demands risked overshadowing clinical priorities. Qualitative analyses identified three overarching themes: (1) the therapeutic relationship as the primary outcome, with PROMs secondary to being heard and recognized; (2) PROMs as routinised yet relationally negotiated tools, used mainly at intake; and (3) ongoing tension between standardization and flexibility as clinicians adapted PROM use to patients' capacities and perceived vulnerability.Conclusion In this trauma-focused refugee service, PROMs were only partially implemented and mainly used at baseline. Barriers were primarily epistemic and ethical rather than technical, reflecting concerns about clinical relevance, workflow fit, and protection of "vulnerable" patients. Sustainable PROM implementation in such settings likely requires co-created, reflexive approaches that prioritize epistemic fit, relational care, and proportionate inclusion over procedural compliance.