Older adults who receive homecare are at increased risk of readmission and mortality following a short ED admission: a nationally register-based cohort study

Background Older adults admitted to an emergency department (ED) who are dependent on homecare may be especially challenged with respect to readmission and mortality. This study aimed to assess whether receiving homecare prior admission was associated with readmission or mortality within 30 days of a short ED admission and to explore whether the amount of homecare received was associated with an increased risk of readmission or mortality. Methods This nationwide register-based cohort study included patients aged 65 or above who were admitted to an ED at any Danish hospital from 1 December 2016 to 30 November 2017 and discharged within 48 h. Data were extracted from national registers through Statistics Denmark. Homecare was categorized into groups; patients without homecare and three groups according to the amount of homecare received per week. Logistic regression analyses were used to explore the association between the four homecare groups and outcomes, readmissions and mortality. Results In total, 80,517 patients (51% female, median age 75 years) were included in the study. Overall, 64,886 patients without homecare, 15,631 (19%) patients received homecare (64% female, median age 83 years), of which 4938 patients received homecare ≤30 min, 4033 received > 30 min to ≤120 min and 6660 received > 120 min per week. The risk of readmission and mortality increased concurrently with the minutes of homecare received: Patients receiving homecare > 120 min per week had the highest odds ratios (ORs) for readmission within 30 days (OR 1.8 95% CI: 1.7–1.9) and mortality within 30 days (OR 4.5 95% CI: 4.1–4.9) compared with patients without homecare. Conclusion Receiving homecare was associated with an increased risk of readmission and death following a short ED admission. Collaboration between the ED and primary health care sector in relation to rehabilitation and end-of-life care is essential to improve quality of care for older adults who receive homecare, particularly those receiving homecare > 2 h a week, because of their increased risk of readmission and mortality.

How did nurses cope with the fast, comprehensive organisational changes at Danish hospital wards during the COVID-19 pandemic? An interview study based on nurses’ experiences

PurposeThe COVID-19 pandemic has influenced hospital work and healthcare workers all over the world. We explored how Danish nurses coped with the fast, comprehensive organisational changes in their workplace and identified barriers to and facilitators for organisations ensuring the best possible conditions for nurses to meet these challenges. The study focuses on the organisational setting and how it did or did not support the nurses in their work.MethodsA qualitative explorative design was used in interviewing 23 nurses who had worked at a COVID-19 ward in one of three hospitals. Data were collected in the summer of 2020, and the analysis was inspired by Paul Ricoeur’s theory of narratives and interpretation.ResultsThe presence of managers in the wards helped the nurses in the form of psychological and practical support. Working within an organisation that provides a safe environment was essential for nurses. The experience of a safe environment allowed nurses to ask questions, which supported them in finding solutions to specific tasks in the new and critical working environment. Barriers to handling the new situation were an absence of managers and a lack of a sense of belongingness and trust.ConclusionThis study highlights the need for management to be present in the ward and for organisational support to be available to nurses so they can provide optimal treatment and care when working in new and unknown conditions during a pandemic. Practical assistance from managers to ease the job is beneficial. Furthermore, the presence of management is essential to provide psychological support and create a safe environment because this allows nurses to ask questions about how to better manage new and critical tasks.

How Socio-Technical Factors Can Undermine Expectations of Human-Robot Cooperation in Hospitals

This research analysed human–robot cooperation and interaction in the basement of a Danish hospital, where kitchen staff and porters conducted their daily routines in an environment shared with mobile service robots. The robots were installed to ease the everyday routines of kitchen staff and carry out physically demanding tasks, such as transporting heavy cargo between destinations in the hospital basement. The cooperation and interaction were studied through ethnographic inspired fieldwork and the results highlighted how robots affect the real-life environments into which they are gradually moving. The analysis revealed how the great human expectations of robots clashed with reality and identified three key elements that influence human–robot cooperation in hospitals: 1) environmental factors, 2) behavioural factors and 3) factors related to human reliance on robots. We emphasise the importance of considering socio-technical factors when deploying robots to cooperate with humans in hospital environments.

Elevated level of urea is a good predictor for 30-day all-cause mortality in acutely admitted medical patients

Objective: To assess the correlation between urea and mortality in acutely ill medical patients admitted to hospital. Methods: We included consecutively admitted adult patients from the medical admission unit at a regional Danish hospital. Data on mortality was extracted. The association with 30-day mortality was described using cubic splines, and discriminatory power, crude association and adjusted analyses were performed. Results: We included 5,894 patients, with a 30-day mortality of 5.6%. We found a dose-response relation between urea and 30-day mortality with an increase from 2.7% to 19.5% (p<0.001). Conclusion: Elevated urea is strongly associated with 30-day all-cause mortality in acutely admitted medical patients with acceptable discrimination and good calibration.

Vi bygger for livet

This article explores the “medicalization” of contemporary Danish hospital architecture. In the modern age, architecture and spatial design have been mobilized as remedies to further the health of the individual patient and of the population in general. In order to understand the present type of medicalization – as opposed to the early modern and classical modern types – we suggest a distinction between two kinds of biopolitics, in Michel Foucault’s sense of this term, respectively a biopolitics of bodies and a biopolitics of feelings. If the original medicalization was a somatic biopolitics, the contemporary medicalization could be described as an affective biopolitics, we claim. We focus on the ongoing boom in the construction of new hospitals in Denmark, discussing as empirical cases a planned hospital in Northern Zealand and a “multisensorial” delivery room in Herning, a Danish provincial town.

Prenatal and Early Life Exposure to the Danish Mandatory Vitamin D Fortification Policy Might Prevent Inflammatory Bowel Disease Later in Life: A Societal Experiment

This register-based national cohort study of 206,900 individuals investigated whether prenatal exposure to small extra doses of vitamin D from fortified margarine prevented inflammatory bowel disease (IBD) later in life; whether the risk of IBD varied according to month or season of birth; and finally, whether there was an interaction between exposure to extra D vitamin and month or season of birth. Fortification of margarine with vitamin D was mandatory in Denmark from the mid-1930s until 1st June 1985, when it was abolished. Two entire birth cohorts, each including two years, were defined: one exposed and one unexposed to the fortification policy for the entire gestation. All individuals were followed for 30 years from the day of birth for an IBD diagnosis in Danish hospital registers. Logistic regression analyses were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Odds for IBD was lower among those exposed to extra D vitamin compared to those unexposed, OR = 0.87 (95% CI: 0.79; 0.95). No association with month or season of birth was found. However, estimates suggested that particularly children born during autumn may have benefitted from the effect of small extra doses of vitamin D. This is, to our knowledge, the first study to explore if prenatal exposure to vitamin D from fortification influenced the risk of IBD. Our results suggest that prenatal exposure to small amounts of extra vitamin D from food fortification may protect against the development of IBD before 30 years of age.

Wonder-inspired leadership: Cultivating ethical and phenomenon-led healthcare

Three forms of leadership are frequently identified as prerequisites to the re-humanization of the healthcare system: ‘authentic leadership’, ‘mindful leadership’ and ‘ethical leadership’. In different ways and to varying extents, these approaches all focus on person- or human-centred caring. In a phenomenological action research project at a Danish hospital, the nurses experienced and then described how developing a conscious sense of wonder enhanced their ability to hear, to get in resonance with the existential in their meetings with patients and relatives, and to respond ethically. This ability was fostered through so-called Wonder Labs in which the notion of ‘phenomenon-led care’ evolved, which called for ‘slow thinking’ and ‘slow wondrous listening’. For the 10 nurses involved, it proved challenging to find the necessary serenity and space for this slow and wonder-based practice. This article critiques and examines, from a theoretical perspective, the kind of leadership that is needed to encourage this wonder-based approach to nursing, and it suggests a new type of leadership that is itself inspired by wonder and is guided by 10 tangible elements.