AIMS AND OBJECTIVES:Care home residents represent some of the frailest and most vulnerable members of society due to impaired physical and cognitive functions. In acute situations specifically, residents often rely heavily on others to speak and act on their behalf. This places significant demands on organizational preparedness within care homes and across sectors. However, the contextual and structural processes in these situations are underexplored, potentially overlooking important contextual and clinical processes to support person-centered care in acute situations. We sought to obtain a comprehensive understanding of the circumstances surrounding acute events among residents. METHODOLOGICAL DESIGN AND JUSTIFICATION:A qualitative study was performed with a phenomenological and hermeneutic approach. Field observations (180 h) were conducted in four care homes in one large Danish urban municipality between October 2024 and February 2025. Purposive sampling included care homes of different sizes and districts, and acute events were included based on a predefined definition. Data analysis was inspired by Paul Ricoeur's interpretation theory. ETHICAL ISSUES AND APPROVAL:This study is registered with the Danish Data Protection Agency (24/30952). FINDINGS:Based on 38 acute events, we identified three themes: (1) Care home staff have a crucial but challenged role, (2) Organizational structures in care homes shape the response, and (3) Care home residents rely on mutually dependent systems. Detection and management of acute events were strongly shaped by contextual factors, including staffing, resources, and intersectoral collaboration. CONCLUSIONS:Detection and management of acute events among residents are a systemic lottery, as resident care depends more on circumstances than personal needs and preferences. This misalignment produces a structural vulnerability that puts residents at risk of compromised autonomy and integrity in acute situations and undermines visions of person-centered care.

INTRODUCTION:Acute cholangitis (AC) is associated with a high mortality even among treated patients. Therefore, early diagnosis and treatment are important for improving prognosis. We investigated the discriminatory ability of the Tokyo Guidelines 2018 (TG18) regarding the presence of inflammation (A criterion) and affected liver parameters (B criterion) as a guide to diagnose AC among unselected patients in the emergency department (ED). METHODS:The study was designed as a cohort study of adult ED patient visits in the Region of Southern Denmark. The cohort included patient visits collected from seven EDs between 1 January 2016 and 20 March 2018. We examined the diagnostic accuracy of the TG18 A and B criteria. This project was approved by the Danish Patient Safety Authority (identifier 3-3013-2272/1). The Region of Southern Denmark authorised data storage (identifier 17/24904, amendment identifier 20/24502). RESULTS:We included 202,881 ED patient visits, of which 19,816 met the TG18 A and B criteria. A total of 517 patient visits had a discharge diagnosis compatible with AC. The TG18 had a sensitivity of 85.1% (95% CI: 81.7-88.1%) and a specificity of 90.4% (95% CI: 90.3-90.6%). CONCLUSIONS:The TG18 A and B criteria demonstrated high diagnostic accuracy for predicting AC, even among unselected adult patients in the ED, and were effective at identifying patients who required radiological imaging to confirm or rule out suspected AC. FUNDING:None. TRIAL REGISTRATION:Not relevant.

Background Intermediate care is increasingly used to reduce hospital admissions and support early discharge from hospital. In Denmark and Norway, health reforms have shifted responsibilities from hospitals to municipalities, prompting the development of community-based intermediate care services.Objective To compare how Danish and Norwegian municipalities have organised and implemented municipal intermediate care services.Design A descriptive comparative study based on national legislation, policy documents, research literature and public statistics.Results Both countries have established municipal intermediate care structures centred on service types: acute and non-acute intermediate care. In Denmark, acute intermediate care includes statutory acute care teams and optional acute care beds, whereas Norway provides statutory acute care beds only. Acute services in both countries are regulated by national guidelines and aim to prevent unnecessary hospital admissions. Non-acute intermediate care mainly consists of temporary institutional beds used for early-supported discharge, rehabilitation, recovery, nursing home waiting placements and respite care. These services are less strictly regulated and vary between municipalities. In both countries, intermediate care primarily targets older adults with complex health needs exceeding the capacity of ordinary long-term care services. Differences were observed in referral pathways, clinical capacity and the degree of municipal autonomy, reflecting broader contextual conditions such as geography, governance structures and workforce availability.Conclusion Although Denmark and Norway pursue similar policy goals, their organisational models for municipal intermediate care differ. Distinguishing between acute and non-acute intermediate care highlights the importance of adapting service models to local structural and demographic conditions and informs policy development and cross-country learning.

OBJECTIVES:Urosepsis is a potential life-threatening complication of urinary tract infections (UTI). This study aimed to determine the incidence rate (IR) of patients hospitalised with urosepsis in the Region of Southern Denmark and identify risk factors associated with intensive care unit (ICU) admission or death within (DW) 30 days among patients admitted with UTI. METHODS:Register-based retrospective multicentre cohort study including all adults hospitalised with UTI or urosepsis in five emergency departments in the Region of Southern Denmark from January 2016 to March 2018. Demographics, microbiological findings, clinical characteristics and treatment outcomes were assessed. Multivariable logistic regression was performed to identify factors associated with a predefined composite outcome of ICU admission or DW 30 days. RESULTS:In total, 478 urosepsis and 1,823 UTI cases were recorded, corresponding to IRs of 2.2 and 8.5 per 10,000 person-years, respectively. IR increased significantly with age. Urosepsis patients had a median age of 77 years and were primarily men (68.4%). The dominant pathogen was E. coli. 7-day and 30-day mortality among urosepsis patients were 3.3% and 9.4%, respectively. The composite outcome occurred more frequently in the urosepsis subgroup (13.6% vs. 7.7%). Risk factors included age >70 years (OR 2.19), urosepsis diagnosis (OR 1.74), elevated creatinine (OR 1.60), Charlson Comorbidity Index and increasing quick Sequential Organ Failure Assessment scores. CONCLUSION:Urosepsis incidence was low but increased significantly with age and was more frequent in men. 30-day mortality was 9.4%. Several risk factors were identified, which may help identify patients at increased risk of severe outcomes.

INTRODUCTION:Frailty is prevalent in older adults attending emergency departments and is associated with adverse health outcomes. Early identification of frailty is important to develop appropriate care plans and targeted interventions that address specific healthcare needs. The Clinical Frailty Scale is a validated tool used to assess an individual's baseline health status and predict the risk of adverse outcomes in adults aged 65 years or older. This study aimed to delineate the demographic characteristics and baseline Clinical Frailty Scale scores of patients aged 65 years and older in three Danish emergency department populations. METHODS:A flash mob study was conducted over two days to collect observational data from 6 AM to midnight at three emergency departments in Southern Denmark. Collected variables included demographics, the reasons for the emergency department presentation and Clinical Frailty Scale scores. The prevalence of frailty was determined using frequency and proportion analyses. RESULTS:A total of 225 patients aged 65 years and older were recruited across three emergency departments. More than 58% exhibited mild or more severe frailty, defined by a Clinical Frailty Score of 4 or higher. Findings show that frailty was more common among the oldest patients. Participants had a median age of 78 years (IQR: 72-83 years), and 46.2% were female. CONCLUSIONS:This study shows that frailty was prevalent among people aged 65 years and older attending the emergency departments. Terminally ill patients were underrepresented in this study, probably because patients who could not give informed consent due to cognitive impairments were excluded. FUNDING:None. TRIAL REGISTRATION:Not relevant.

Objectives Socioeconomic inequalities exist in infectious diseases and sepsis in high-income countries. We investigated the association between income and mortality among patients with sepsis, overall and among those treated in the intensive care unit (ICU) versus general wards.Design A retrospective register-based cohort study.Setting The Region of Southern Denmark (RSD).Participants All adult patients with an unplanned contact with a hospital in the RSD from 1 January 2016 to 20 March 2018. Patients with sepsis were identified based on the following criteria: (1) blood culture(s) performed within 48 hours of arrival, (2) antibiotic(s) administered within 48 hours of arrival, (3) a discharge diagnosis of infection and (4) a SOFA (Sequential Organ Failure Assessment) score of ≥2. The cohort was divided into quartiles according to household income.Primary and secondary outcome measures Cox proportional hazards models were used to estimate the association between income groups and mortality. The primary outcome was 90-day mortality with 7-day and 365-day mortality as secondary outcomes. All outcomes were calculated overall and stratified by general ward treatment only and ICU admission.Results We identified 7813 first-time visits with community-acquired sepsis, including 886 ICU admissions (11.3%). Among patients in the lowest income group, sepsis was associated with a HR of 1.16 (95% CI 1.01 to 1.34) for 90-day mortality compared with the highest income group. This association was particularly pronounced at 365-day follow-up: HR=1.24 (95% CI 1.10 to 1.39). No difference was observed in 7-day all-cause mortality, HR=1.13 (95% CI 0.89 to 1.45). The association was not observed among patients admitted to the ICU.Conclusion Low income was associated with increased mortality in patients with sepsis, particularly during long-term follow-up. The impact of income disparities was not observed among patient admitted to the ICU.

Rationale: Early detection, standardized therapy, adequate infrastructure, and strategies for quality improvement should constitute essential components of every hospital's sepsis plan. Objectives: To investigate the extent to which recommendations from the sepsis guidelines are implemented and the availability of infrastructure for the care of patients with sepsis in acute-care hospitals. Methods: A multidisciplinary cross-sectional questionnaire was used to investigate sepsis care in hospitals. This included the use of sepsis definitions, the implementation of sepsis guideline recommendations, diagnostic and therapeutic infrastructure, antibiotic stewardship, and quality improvement initiatives (QIIs) in hospitals. Measurements and Main Results: A total of 1,023 hospitals in 69 countries were included. Most of them, 835 (81.6%), were in Europe. Sepsis screening was used in 54.2% of emergency departments (EDs), 47.9% of wards, and 61.7% of ICUs. Sepsis management was standardized in 57.3% of EDs, 45.2% of wards, and 70.7% of ICUs. The implementation of comprehensive QIIs was associated with increased screening (EDs, +33.3%; wards, +44.4%; ICUs, +23.8% absolute difference) and increased standardized sepsis management (EDs, +33.6%; wards, +40.0%; ICUs, +17.7% absolute difference) compared with hospitals without QIIs. A total of 9.8% of hospitals had implemented ongoing QIIs, and 4.6% had invested in sepsis programs. Conclusions: The findings indicate that there is considerable room for improvement in a large number of mainly European hospitals, particularly with regard to early identification and standardized management of sepsis, the availability of guidelines, diagnostic and therapeutic infrastructure, and the implementation of QIIs. Further efforts are required to implement a more comprehensive and appropriate quality of care.

Background: The integration of artificial intelligence (AI) in key cardiac function parameters, such as left ventricular ejection fraction (LVEF), can hold important value for clinicians, both in terms of time consumption and interobserver variability. However, the reproducibility between devices remains unknown. Aim: The purpose of this study was to assess two ultrasound devices with their automated LVEF (auto-LVEF) measurements: the midrange GE venue (GEv), and the handheld Butterfly iQ+(Bfi); regarding correlation in ejection fraction (EF), time consumption, and image quality (IQ). Method: Adult emergency room patients were included and scanned using both ultrasound devices by a novice operator. In each case, the objective was to acquire an apical four-chamber view and calculate the EF with each device’s pre-installed AI software. Out of those, 12 patients were rescanned by a physician experienced in cardiac ultrasound to evaluate the interoperator agreement. Results: A total of 150 patients were included, with a median age of 64 years; 51% were female. The GEv and Bfi successfully generated auto-EF measurements in 73% (95% confidence interval [CI]: 65%–80%) and 52% (95% CI: 44–60%) of cases, respectively. The agreement in EF measurements between the GEv's real-time EF and the Bfi's Simpson monoplane method was high with a correlation coefficient r = 0.70 (0.60–0.77), p < 0.001. Bland-Altman analysis demonstrated a bias of 0.84% (95% upper and lower limits of agreement: 15.0% and -13.3%). The median scanning time in both apparatuses was 2 minutes (IQR GEv 1–2, IQR Bfi 1–3), the median IQ score was 4/5 (IQR 4–5) in GEv and 3.5/5 (IQR 3–4) in Bfi. The interobserver agreement was high, with a Kappa of κGEv = 0.75 and κBfi = 0.82. Conclusion: In conclusion, Bfi had a lower success rate in calculating EF and a lower IQ than GEv. However, when auto-EF was successfully obtained, a strong correlation was observed between the machines.

INTRODUCTION:Erysipelas is a common disease in the emergency department, whereas necrotising soft tissue infections (NSTIs) are rare but more severe. The study aimed to investigate the prevalence, incidence, population-based incidence rate, one-year mortality and clinical presentation of erysipelas and NSTIs, and the aetiology, treatment and recurrence of erysipelas. METHODS:This was a population-based cohort study including acute non-trauma patients ≥ 18 years old with erysipelas or NSTIs from the Region of Southern Denmark in the period from 1 January 2016 to 19 March 2018. RESULTS:Among 223,618 acute non-trauma visits, 2,136 had erysipelas (prevalence 1%), and 20 had NSTIs (prevalence 0.01%), 96.7 and 0.89 per 10,000 visits, respectively. The population-based incidence rates were 72.10 per 100,000 person-years for incident cases of erysipelas and 0.94 for NSTIs. One-year mortality was 15% for erysipelas and 25% for NSTIs. Erysipelas and NSTI patients had similar demographics and vital signs. For erysipelas, the predominant pathogen in blood cultures was Streptococcus dysgalactiae, with two-thirds of patients treated with narrow-spectrum penicillin. One-third of the erysipelas patients had a prior hospitalisation for the condition, and 7.7% of incident cases had recurrence within one year. Obesity and liver disease were risk factors for recurrence. CONCLUSIONS:Erysipelas is a common infection in the emergency department, whereas NSTIs are much rarer but also more severe and, at presentation, not distinctive in clinical parameters, which underlines the importance of clinical judgement. FUNDING:None. TRIAL REGISTRATION:Not relevant.

BACKGROUND:Socially marginalised people face several health-related challenges as they have a high burden of co-existing social issues and chronic diseases, and lack resources to self-manage their care needs. Research has shown that patients experience more individualised treatment and care when supported by a social nurse during hospitalisation. However, knowledge of socially marginalised people's health perceptions is needed to understand what is important to them when receiving healthcare. AIM:To explore the health perceptions of socially marginalised patients and how they perceive themselves in a frame of healthcare. METHODS:A qualitative study was performed with a phenomenological and hermeneutic approach. Data were collected at a hospital in Southern Denmark between January 2023 and March 2023. Purposive sampling was done to include adult patients who had contact with a social nurse during hospital admission. Participants were interviewed once at the hospital and again 7-22 days after discharge. The analysis was performed by systematic text condensation using NVivo 12 for data storage and coding. ETHICAL APPROVAL:The study is registered with the Danish Data Protection Agency (22/47509). The participants gave informed consent to participate. RESULTS:Sixteen patients participated in the study. Three themes were identified: (1) The circle of lifestyles, living conditions and health behaviour, (2) Feeling unwelcome in the healthcare system and (3) The personal impact of stigmatisation. The participants' perceptions of health were closely linked to their ability to participate in their everyday life. Furthermore, participants experienced low-quality healthcare due to their social circumstances and were stigmatised by healthcare professionals. CONCLUSION:This study demonstrates that socially marginalised patients' healthcare needs are complex, and they perceive their health in the context of their daily life. Furthermore, stigmatisation negatively impacted their self-esteem and self-efficacy required for self-care. Understanding the health perceptions of socially marginalised patients and how they view themselves within the healthcare system is crucial for addressing their healthcare needs.

The successful development of sustainable healthcare solutions necessitates an in-depth understanding of the clinical environment and its potential challenges from the user's perspective. Previous research has identified a lack of care and treatment responsibility for patients presenting to the emergency department due to self-harm injuries. The aim of this study was to investigate whether a user-driven approach and participatory design could be leveraged to propose, design, and develop future solutions to improve the pathways for patients admitted to the ED owing to self-harm injuries. Drawing from the participatory design methodology, six one-on-one workshops were conducted with patients and their family members, alongside two workshops involving 33 participants (health-care professionals and patient representatives) with diverse roles in the patient care pathway. The study resulted in the development of two concepts recommended for clinical testing: (1) an outreach function from mental health services to the emergency department and (2) a joint position between the psychiatric and emergency departments. The study concludes that involving vulnerable patients in research is feasible but requires careful consideration of the methods employed, with potential alternatives necessary to ensure successful outcomes.

OBJECTIVES:The prehospital use of blood lactate measurements is increasing. The blood lactate level is a well-recognized biomarker of poor outcomes, mainly investigated in potentially critically ill patients or patients with specific illnesses. However, evidence of a correlation in a broad prehospital setting with undifferentiated patients is lacking. This study aimed to investigate the correlation between prehospital blood lactate levels and the risks of poor outcomes in undifferentiated prehospital patients with apparent non-life-threatening conditions. METHODS:This was a large cohort study of undifferentiated prehospital patients aged ≥18 years old who required intravascular accesses during prehospital care from February 3 to June 14, 2020. StatStrip Xpress Lactate Meter analyzed the lactate levels. The primary outcome was the risk of 7-day mortality. Follow-up was 90 days. The categorical secondary outcomes were 30-day and 90-day mortality risks and risks of mechanical ventilation, vasopressor treatment, or acute renal replacement therapy. Other secondary outcomes were the number of days alive within 30 days outside the hospital, outside the intensive care unit, and without mechanical ventilation. The primary analyses were uni- and multivariate logistic regressions presented as odds ratios (OR) with 95% confidence intervals (CI) and p-values. RESULTS:The study included 11,515 patients. The overall 7-day mortality rate was 3.1%. The 7-day mortality rates were 2.0%, 3.6%, and 12.8% in patients with lactate levels of <2.0 mmol/L, 2.0-3.9 mmol/L and ≥4.0 mmol/L, respectively. The risk of 7-day mortality increased with elevated lactate level, OR = 1.43 (95% CI: 1.36-1.51), p < 0.001. The ORs were similar in all prespecified diagnostic subgroups except for patients receiving diagnoses within the nervous system. Patients with elevated lactate levels had increased risks of all categorical secondary outcomes. They stayed longer in the hospital, in the intensive care unit, and on mechanical ventilation than the patients with normal prehospital lactate levels. CONCLUSIONS:: This study found evidence of correlations between elevated lactate levels and poor outcomes in all acute prehospital patients except patients receiving diagnoses within the nervous system. Implementing prehospital lactate measurements is useful if knowledge of the patient's lactate levels adds to existing parameters in the prehospital setting.

Objectives: Ethical considerations are central to deciding on resuscitation in a prehospital setting. A systematic study of ethical views can enlighten the area and potentially reveal variations in decision-making. We aimed to explore the ethical views on resuscitation and their impact on the reasoning of prehospital healthcare professionals using a qualitative approach and a structured questionnaire. This study describes the validation of a structured questionnaire designed to explore the ethical views on resuscitation and its impact on the reasoning of prehospital healthcare professionals. Methods: This observational cross-sectional study used a mixed-methods approach. The questionnaire included qualitative free-text fields and quantitative scales. Its first version was developed based on data from a systematic review and an ethnographic study. Validation involved face-to-face interviews and a two-round Delphi process with experts in qualitative research, philosophy, epidemiology, and prehospital medicine. The final questionnaire was field-tested among Danish prehospital physicians. Exploratory factor analysis assessed underlying relationships, and Cronbach’s alpha measured internal consistency. Results: 216 out of 380 invited Danish prehospital physicians completed the questionnaire. The ethical aspects addressed in the cases included “do-not-attempt cardiopulmonary resuscitation,” “socioeconomic status,” “quality of life,” “the patient and family’s cultural background,” and “relatives’ emotional reaction.” The questionnaire demonstrated satisfactory internal consistency, with a Cronbach’s alpha of 0.71. Conclusions: The questionnaire was validated as a tool for assessing moral reasoning and variations in perspectives in prehospital decision-making. The survey can be used to assess the moral reasoning and variations therein in prehospital resuscitation decision-making.

INTRODUCTION. Acid-base disturbances are common in the emergency department, with acidosis and alkalosis being associated with an elevated risk of mortality and morbidity. Understanding the relationship between pH and mortality may serve to optimise patient outcomes. The primary objective was to describe the association between arterial blood pH and 0-2-day mortality in adult non-traumatic acute visits. The secondary objective was to describe this association for 3-7-day mortality. METHODS. This population-based, multicentre cohort study included all adult non-traumatic acute visits in the Region of Southern Denmark between 2016 and 2018 who had an arterial blood gas (ABG) drawn within four hours of arrival. We described 0-2- and 3-7-day mortality stratified by pH level, controlled for confounding factors and reported as hazard ratio (HR) compared to normal pH. RESULTS. A total of 64,725 acute visits in 31,650 individuals with an ABG were included. The overall mortality rate for index visits was 2.4% on days 0-2 and 2.1% on days 3-7. Patients with severe acidosis (pH < 7.20) had 20.8% and 8.9% mortality rates (HR = 9.6 and 5.2), whereas patients with acidosis (pH 7.20-7.34) had mortality rates of 7.4% and 5.2% (HR = 4.1 and 2.7) on day 0-2 and 3-7, respectively. Our secondary analysis found a 0-2-day mortality rate of nearly 60% in patients with a pH < 6.90. CONCLUSION. The short-term mortality rates increased with the severity of acidosis. The highest mortality rate was found in patients with a pH < 6.90.

Background: Intermediate care in primary care settings occurs widely in different shapes and forms and is mainly intended to provide an alternative to hospital care for older people. In the international context, the Nordic states are often looked to because of their model of universal welfare and integrated municipal health and long-term care services. In Denmark and Norway, nationwide municipal acute intermediate care services have been implemented in the last decade, following national healthcare reforms. Objective: The main objective is to map the similarities and differences in organisation and structure of municipal based intermediate services in two Nordic welfare states, Denmark and Norway. Secondary objectives are (i) to describe the challenges the different services aim to address and (ii) to assess the mechanisms in which the different types of intermediate services seek to address these challenges. This will, in turn, contribute to conceptual clarification, facilitating future comparative studies in the field. Design and methods: This a study is a descriptive-comparative analysis of intermediate care in Denmark and Norway. We applied a narrative approach to search for statistics, health policy documents, scientific articles, statistics and reports. An analytic framework was designed to identify main characteristics of intermediate care, inspired by a Delphi study defining characteristics of intermediate care models and a study comparing international models of integrated care. Results: In the research literature, intermediate care services are often divided into ‘admission avoidance’ and ‘early supported discharge’ (ESD). Intermediate care services in Denmark and Norway can be further divided into ‘acute’ and ‘non-acute’ services. In 2022, Denmark had 3.223 intermediate care beds and Norway had 10.061 intermediate care beds. The main target population is people who would benefit from short-term care after or instead of hospitalisation and people who are not safe staying at home. In both countries, non-acute intermediate care beds have no national guidelines and are often used for early discharge from hospital. The implementation of acute intermediate care is based on mandatory guidelines in both countries. In Norway, municipal acute beds for admission avoidance are obligatory, whereas in Denmark, acute beds are optional. However, Danish municipalities are obligated to have acute care teams, which serve both an admission avoidance and ESD function. Conclusion: Municipal intermediate care services are used to maintain people with complex health needs in the community setting, to support early discharge from hospital and to avoid hospital admission. Our study shows that Danish and Norwegian municipal intermediate care can be divided into acute and non-acute services. The implementation of Norway and Denmark’s acute intermediate care services has been driven by national health authorities, whereas the different non-acute intermediate care beds shows a more diverse landscape of services with no formal national policy or guidelines. To ensure the quality of different intermediate care services and resource utilisation it is important to increase research and policy attention in this field.

BACKGROUND:Ageing populations necessitate innovative approaches to health-care services. In 2018, Denmark introduced statutory municipal acute nursing care as part of community-based health care to improve care for adults with complex health needs. We evaluated the potential interactions of the acute care team Odense (ATO) on (1) acute hospital contacts; (2) acute hospital contacts caused by specific infection diagnoses, hypernatraemia, delirium, or confusion; and (3) acute ambulance transports. METHODS:In this retrospective, population-based, longitudinal study, we employed interrupted time series analysis to evaluate the association of ATO on adults in Odense Municipality from Jan 1, 2015, to Feb 28, 2019. Subgroup analyses were used to examine the data of people aged 80 years or older, nursing home residents, and people living at home with home or nursing care. FINDINGS:The people treated by ATO were older, had more comorbidities, and were more dependent on municipal health care than the average population. The implementation of ATO was not statistically significantly associated with the monthly rate of acute hospital contacts but associated with a substantial reduction of the monthly rates of acute hospital contacts caused by specific infection diagnoses, hypernatraemia, delirium, or confusion (-2·8 [95% CI -5·5 to -0·1]), and acute ambulance transports (-9·5 [-16·2 to -2·9]). For nursing home residents, the monthly rates decreased for acute hospital contacts caused by specific infection diagnoses, hypernatraemia, delirium, or confusion (-0·8 [-1·7 to 0·0]), and acute ambulance transports (-2·1 [-3·7 to -0·4]). Among those aged 80 years or older, acute ambulance transports decreased monthly (-3·8 [-6·6 to -0·9]). INTERPRETATION:This framework shows potential in minimising transitions between sectors, particularly in the context of acute ambulance transports and acute hospital contacts caused by specific infection diagnoses, hypernatraemia, delirium, or confusion. These findings could offer valuable insights for policy makers on the role of municipal acute nursing care. According to acute hospital contacts, a proportion of numbers might fall beyond the scope of what this framework can prevent, making it valuable to focus on specific groups. FUNDING:Østifterne, Region of Southern Denmark, Odense University Hospital, and Odense Municipality.

Letter regarding "Arterial pH and short-term mortality in adult non-traumatic acute patients" Dan Med J 2025;72(1):A06240407. doi: 10.61409/A06240407.

Introduction: Emergency departments worldwide are faced with in-hospital crowding and fast-paced admissions, creating an increasingly high workload for health care personnel. In recent years, emergency departments have also experienced an increase in emergency admissions, resulting in burdened workplaces. This has led to debates about nurses' work environment and mental well-being. This study aimed to gain knowledge on the prevalence of depression, anxiety, and stress, as well as insight into the factors influencing the mental wellbeing of the nursing staff in a Danish emergency department. Methods: This is a mixed-methods study with an explanatory sequential design. A questionnaire (the Depression, Anxiety, and Stress Scale - 21 Items) was sent to nursing staff (N = 146) in a large emergency department in the Region of Southern Denmark. Afterward, a smaller sample participated in semistructured interviews. The quantitative data were analyzed using descriptive statistics, the Mann-Whitney U test, and the chisquare test. In the qualitative part, a thematic analysis was performed. Results: Completed surveys were received from 78 nursing staff (53.4%). Overall, the nursing staff reported severe to extremely severe levels of depression (14.1%), anxiety (23.1%), or stress (47.2%) within a week before completing the survey. Higher levels of psychological distress were significantly associated with fewer years of clinical experience and having previously experienced or received treatment for depression, anxiety, or stress. Ten staff members later volunteered to participate in the interviews. The qualitative results formed 3 themes: (1) high work pace and responsibility, (2) professional community and nursing identity, and (3) culture with an increased focus on mental well-being. Discussion: The nursing staff reported high mental strain, especially in the forms of high stress and anxiety levels. They explained that their mental health was affected by overcrowding, a pressured work environment, and lack of resources.

Objectives Studies have reported high incidences of stroke in patients hospitalised with SARS-CoV-2, but the impact of disease severity is unexplored. We aimed to estimate the risk of incident ischaemic stroke in SARS-CoV-2 test-positive individuals compared with test-negative individuals stratified by disease severity during acute infection and post infection.Design A register-based cohort study.Setting A Danish nationwide study.Participants All Danish adults who had PCR tests for SARS-CoV-2 performed between 1 March 2020 and 30 November 2021. Test-positive individuals were included at their first positive test. For individuals tested prior to 30 November 2021, we randomly sampled an index date from the distribution of test dates among SARS-CoV-2 test-positive individuals. Test-positive individuals were followed during the acute phase of infection (days 0–14) and post infection (180 days after the acute phase). Test-negative individuals were followed in equivalent time periods.Primary and secondary outcome measures Incident ischaemic stroke risk in SARS-CoV-2 test-positive individuals compared with test-negative individuals during acute infection and post infection. We calculated subdistribution HRs (SHR) with death as a competing risk using propensity score weighting as confounder control. The risk was stratified according to disease severity: community managed, hospitalised, or admission to the intensive care unit.Results Among 3 910 219 SARS-CoV-2 PRC-tested individuals, 356 421 test-positive and 3 067 456 test-negative individuals were included. A positive SARS-CoV-2 test was associated with an SHR of 3.32 (95% CI 2.60 to 4.25) overall for stroke compared with test negative in the acute phase. In the postinfection period, the risk of stroke remained increased in individuals hospitalised during the acute phase (SHR 1.85, 95% CI 1.45 to 2.37). Individuals with community-managed SARS-CoV-2 had no increased long-term risk of stroke (SHR 1.01, 95% CI 0.88 to 1.16).Conclusion SARS-CoV-2 infection is associated with increased stroke risk. Disease severity seems to be an important factor. Individuals with community-managed SARS-CoV-2 had no increased stroke risk.