Background: Research examining whether sustained simulation, embedded in everyday clinical routines, can shift staff perceptions of patient safety culture remains limited. Methods: We conducted a controlled multi-site study across eight pediatric departments in Denmark (four intervention, four control; 2023-2024). Departments in the intervention region integrated simulation-based team training into their duty rosters. Patient safety culture was measured pre- and post-intervention using the Safety Attitudes Questionnaire-Danish version. The primary analysis applied a difference-in-differences approach. Results: Of 2,440 distributed questionnaires, 1,412 were returned (58%), and 1,220 were eligible (947 unique respondents). Intervention sites conducted 244 simulation sessions compared with 84 in control sites (a 2.9-fold difference). Relative to controls, intervention departments reported higher scores for perceptions of management ( + 5.1 points, 95% CI: 0.8-9.5) and working conditions ( + 6.1 points, 95% CI: 2.0-10.2); changes in other dimensions were smaller and not statistically significant. Conclusions: A sustained, locally facilitated simulation program was associated with improved perceptions of management and working conditions-domains closely linked to patient safety culture. These findings suggest that, under supportive conditions, simulation may operate not only as a pedagogical method but also as an organizational practice that can influence how staff perceive the culture of their clinical environment. (c) 2026 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )
Women 30-59 years were allocated to either HPV-based screening or cytology-based screening in this Danish health care policy trial. The optimal triage of HPV-positive women could be a combination of cytology triage with HPV genotyping or p16/Ki67 staining. We report number of screen positives, colposcopies, and cervical lesions of three different triage algorithms (p16/Ki67, HPV16/18, or HPV16/18/31/33/52) in HPV-positive women with low-grade cytological abnormalities. We included 178,317 women with a sample in 2021 of which 91,517 were screened with HPV and 86,800 with cytology. All women were followed for 18 months. Almost three times as many women screened positive with HPV-based screening compared to cytology-based screening (RR 2.99, 95% 2.93-3.05) and colposcopies derived from the screening program were also more common (RR 1.68, 95% 1.63-1.73). p16/Ki67 triage resulted in more colposcopies (RR 1.86, 95% 1.76-1.95) than HPV16/18 (RR 1.54, 95% 1.44-1.65) and HPV16/18/31/33/52 (RR 1.63, 95% 1.55-1.71). The excess in colposcopy referrals was reduced when non-screening-derived colposcopies were included (intention-to-treat). Nevertheless, more women with CIN2 or worse were detected in the HPV group than in the cytology group per screened woman; in the p16/Ki67 triage group (RR 1.65, 95% 1.54-1.77), in the HPV16/18 group (RR 1.36, 95% 1.23-1.50), and in the HPV16/18/31/33/52 group (RR 1.48, 95% 1.37-1.59). HPV-based screening, as compared with cytology screening, resulted in more screen positives, but all three triage algorithms substantially reduced the excess number of referrals to colposcopy. p16/Ki67 compared to triage with HPV16/18 may detect more cervical lesions.
PURPOSE:Neoadjuvant immune checkpoint inhibition has shown promise in localized deficient mismatch repair (dMMR) colorectal cancer, yet the optimal treatment duration, regimen, and methods for response evaluation remain undefined. This trial aimed to investigate the efficacy and safety of neoadjuvant pembrolizumab for patients with localized dMMR colon cancer. METHODS:Participants received a single cycle of pembrolizumab (4 mg/kg, max 400 mg, every-6-weeks dosing regimen), followed by a preoperative endoscopy with biopsies and surgery 3-5 weeks later. The primary end point was pathologic complete response (pCR); secondary and exploratory end points included major pathologic response (MPR), safety, survival, and endoscopic response assessment. RESULTS:From February 2023 to March 2024, 85 patients (median age 74 years) were enrolled. All received pembrolizumab; one patient declined surgery. Among 84 patients, pCR was achieved in 44% (37 of 84; 95% CI, 33 to 55), and MPR in 57% (48 of 84; 95% CI, 46 to 68). Two (2%) patients died of complications within 30 days of surgery. At a median follow-up of 18.4 months (IQR, 16.3-21.1), one patient had a recurrence, resulting in overall and disease-free survival rates of 98% and 96%. Grade 3 adverse events occurred in 11% of patients (9 of 85; 95% CI, 3 to 16), with three treatment-related events. In 81 patients, the sensitivity, specificity, and accuracy of the biopsies for predicting pCR were 68%, 75%, and 72%, respectively. In 76 patients, the sensitivity, specificity, and accuracy of the endoscopic images for predicting pCR were 77%, 93%, and 86%, respectively. CONCLUSION:A single cycle of neoadjuvant pembrolizumab led to pCR in nearly half of patients undergoing surgery for localized dMMR colon cancer. The utility of endoscopic evaluation may inform future strategies for patient selection in nonoperative management pathways.
BACKGROUND:Intraoperative hypotension is a common occurrence in patients undergoing anaesthesia, although there is no standardised definition of hypotension. International consensus statements provide some guidelines for the management of intraoperative hypotension, but general clinical practice is unknown. We aimed to survey anaesthesiologists' values and preferences regarding intraoperative blood pressure management, including whether they would support future research on this topic. METHODS:We conducted an international, online survey of routine practice and opinion. The target population was anaesthesiologists who regularly anaesthetise adult patients. Results are reported descriptively and in accordance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) checklist. RESULTS:A total of 1640 anaesthesiologists from 11 European countries participated in the survey. The majority of respondents were specialists (1322 of 1640, 80.6%, 95% CI 78.7-82.6). Almost all respondents worked in public hospitals (1613 of 1640, 98.4%). The overall response rate was 22.7%. Most respondents reported using absolute mean arterial pressure as their main unit of measurement to quantify hypotension (1098 of 1640, 67.0%, 95% CI 64.6-69.2). Respondents were most likely to initiate vasoactive treatment at a mean arterial pressure below 60 or 65 mmHg. Chronic arterial hypertension, traumatic brain injury and surgical procedures involving head-up positioning of the patient were the three most common scenarios where respondents would raise their threshold for treatment. Most respondents considered the establishment of safe intraoperative blood pressure thresholds a critical research question, and almost all respondents (1509 of 1640, 92.0%) indicated a willingness to randomise patients to specific blood pressure targets. For 72.9% (1196 of 1640), the lowest acceptable mean arterial pressure for randomisation was 60 mmHg. Respondents were also interested in the comparison of efficacy and safety of vasoactive agents, and the most sought-after comparison was phenylephrine versus noradrenaline (1252 of 1640, 76.3%). The willingness of respondents to administer these agents in peripheral venous access differed according to geography. CONCLUSION:In this international survey, mean arterial pressures of 60 or 65 mmHg were the most commonly reported blood pressure thresholds leading to initiation of treatment with vasoactive agents. Almost all respondents indicated patient groups for whom they would alter their treatment threshold, namely those suffering from chronic arterial hypertension, those undergoing surgery in a head-up position, and patients with traumatic brain injury. The majority of respondents supported future trials establishing optimal mean arterial pressure threshold and choice of vasoactive agent. We noticed a geographical variation in willingness to administer vasoactive agents in peripheral venous access. EDITORIAL COMMENT:This survey of anaesthesiologists from European countries queried practitioner perceptions of blood pressure management in adults during anaesthesia with focus on hypotension. Queries and responses also concerned circumstances and blood pressure levels which clinicians report being willing to treat actively, and how they might do this practically.
Patients admitted with viral respiratory tract infections are at risk ofbacterial co-infections that may exacerbate disease severity. Detection of atypical bacteria requires specific laboratory diagnostic modality and specific antibiotics. In this retrospective regionwide cohort study we included all patients admitted to a hospital in the Central Denmark Region with COVID-19, influenza A, influenza B, or Respiratory Syncytial Virus (RSV) from February 2019 to February 2024. Firstly, we investigated the number of patients testing positive for atypical bacterial co-infection. Secondly, we evaluated associations with diagnostic testing for these atypical bacteria, and the use and associations with administration of empirical treatment with clarithromycin. During the study period a total of 19,651 patients were admitted with one of the viral respiratory tract infections. Only 21 patients tested positive for atypical bacterial co-infection, corresponding to 0.1
