Relapsing polychondritis

This is a case report of a 67-year-old man with the rare autoimmune disease relapsing polychondritis. The patient was initially diagnosed by general practitioners with erysipelas around his left ear, which was found red, swollen, and painful. Due to the lack of effect from antibiotics, the patient was referred to an emergency department. A rheumatologist recognised the patterns of the rare disease, diagnosed the patient and initiated proper treatment. The case clarifies the difficulty in diagnosing relapsing polychondritis, mainly due to the rarity and lack of knowledge of the disease

Relapsing polychondritis

This is a case report of a 67-year-old man with the rare autoimmune disease relapsing polychondritis. The patient was initially diagnosed by general practitioners with erysipelas around his left ear, which was found red, swollen, and painful. Due to the lack of effect from antibiotics, the patient was referred to an emergency department. A rheumatologist recognised the patterns of the rare disease, diagnosed the patient and initiated proper treatment. The case clarifies the difficulty in diagnosing relapsing polychondritis, mainly due to the rarity and lack of knowledge of the disease

Relapsing polychondritis

This is a case report of a 67-year-old man with the rare autoimmune disease relapsing polychondritis. The patient was initially diagnosed by general practitioners with erysipelas around his left ear, which was found red, swollen, and painful. Due to the lack of effect from antibiotics, the patient was referred to an emergency department. A rheumatologist recognised the patterns of the rare disease, diagnosed the patient and initiated proper treatment. The case clarifies the difficulty in diagnosing relapsing polychondritis, mainly due to the rarity and lack of knowledge of the disease

Case report – Kronisk nefropati og polyfarmaci – en potentielt livsfarlig situation

En 65-årig comorbid mand med flere dages anamnese af diarré samt nedsat muskelkraft, blev efter en faldepisode indlagt på akutmodtagelsen. Han var i forvejen kendt med blandt andet kronisk nefropati og i behandling med medicin, der vides at kunne påvirke nyrefunktionen samt medføre hyperkaliæmi.På baggrund af kombinationen af polyfarmaci, bestående nyresygdom og diarré udviklede patienten akut nyresvigt med svær hyperkaliæmi og hjertepåvirkning til følge.Casen illustrerer, hvordan polyfarmaceutisk behandling af comorbide patienter nemt kan tage en uheldig drejning, og hvor vigtigt det er, at der passes ekstra godt på disse patienter

POSAiDA: presence of Staphylococcus aureus/MRSA and Enterococcus/VRE in Danish ambulances. A cross-sectional study

BACKGROUND: Every year approximately one out of ten Danish patients contracts a healthcare associated infection (HAI). Staphylococcus aureus and Enterococcus are prominent in the group of pathogenic bacteria that underlie HAIs, causing unnecessary inconvenience and prolonging hospitalization. Bacterial colonization often occurs due to indirect patient-to-patient transmission, caused by poor hygiene compliance. This study aims to determine the level of contamination with S. aureus/MRSA and Enterococcus/VRE on presumed clean blood pressure cuffs in the Danish ambulances. METHOD: Blood pressure cuffs were tested for contamination with S. aureus and Enterococcus when being cleaned according to everyday guidelines in this cross-sectional study. Imprints were performed with specific agar plates after cleaning with ethanol wipes. Positive imprints were typed and antibiotic susceptibility was determined. RESULTS: Both S. aureus and Enterococcus were found on blood pressure cuffs thought to be clean, however, to a limited extent. The average level of contamination by S. aureus was 0.54 CFU per 25 cm(2) (SD 1.98). Minimum and maximum values ranged from 0 to 12 CFU per 25 cm(2) and 10 % of the 50 samples were positive. The average level of contamination by Enterococcus was 0.06 CFU per 25 cm(2) (SD 0.42). Minimum and maximum values ranged from 0 to 3 CFU per 25 cm(2) and 2 % of the 50 samples were positive. All S. aureus isolates were found to be methicillin susceptible S. aureus (MSSA) and the one Enterococcus isolate was identified as Enterococcus faecalis, negative for vancomycin resistance genes. CONCLUSION: Staphylococcus aureus and Enterococcus were detectable on equipment thought to be clean. However, all detected bacteria showed susceptibility towards methicillin or vancomycin. Findings of pathogens after cleaning may be due to cross-contamination, improper cleaning and limited effect of the currently used cleaning procedure and are thought to affect the risk of infection. Therefore, we recommend a thorough evaluation of current cleaning procedures as well as increased focus on and further research into hygiene challenges in a prehospital setting. Future studies should be performed in order to demonstrate the level of bacterial contamination in all areas of the medical service, e.g., the ambulance environment, medical equipment, staff uniform and hand hygiene. Furthermore, in order to establish evidence for different cleaning procedures in situ we recommend testing the effect of different cleaning interventions by interventional designs

"Hand hygiene perception and self-reported hand hygiene compliance among emergency medical service providers : a Danish survey"

BackgroundHand hygiene (HH), a cornerstone in infection prevention and control, lacks quality in emergency medical services (EMS). HH improvement includes both individual and institutional aspects, but little is known about EMS providers' HH perception and motivations related to HH quality. Therefore, we aimed to investigate the HH perception and assess potential factors related to self-reported HH compliance among the EMS cohort.MethodsA cross-sectional, self-administered questionnaire consisting of 24 items (developed from the WHOs Perception Survey for Health-Care Workers) provided information on demographics, HH perceptions and self-reported HH compliance among EMS providers from Denmark.ResultsOverall, 457 questionnaires were answered (response rate 52%). Most respondents were advanced-care providers, males, had >5years of experience, and had received HH trainingPeer reviewe

Can clinicians identify community-acquired pneumonia on ultralow-dose CT?:A diagnostic accuracy study

Background: Without increasing radiation exposure, ultralow-dose computed tomography (CT) of the chest provides improved diagnostic accuracy of radiological pneumonia diagnosis compared to a chest radiograph. Yet, radiologist resources to rapidly report the chest CTs are limited. This study aimed to assess the diagnostic accuracy of emergency clinicians’ assessments of chest ultralow-dose CTs for community-acquired pneumonia using a radiologist’s assessments as reference standard. Methods: This was a cross-sectional diagnostic accuracy study. Ten emergency department clinicians (five junior clinicians, five consultants) assessed chest ultralow-dose CTs from acutely hospitalised patients suspected of having community-acquired pneumonia. Before assessments, the clinicians attended a focused training course on assessing ultralow-dose CTs for pneumonia. The reference standard was the assessment by an experienced emergency department radiologist. Primary outcome was the presence or absence of pulmonary opacities consistent with community-acquired pneumonia. Sensitivity, specificity, and predictive values were calculated using generalised estimating equations. Results: All clinicians assessed 128 ultralow-dose CTs. The prevalence of findings consistent with community-acquired pneumonia was 56%. Seventy-eight percent of the clinicians’ CT assessments matched the reference assessment. Diagnostic accuracy estimates were: sensitivity = 83% (95%CI: 77–88), specificity = 70% (95%CI: 59–81), positive predictive value = 80% (95%CI: 74–84), negative predictive value = 78% (95%CI: 73–82). Conclusion: This study found that clinicians could assess chest ultralow-dose CTs for community-acquired pneumonia with high diagnostic accuracy. A higher level of clinical experience was not associated with better diagnostic accuracy.</p

UniStatus - a cross-sectional study on the contamination of uniforms in the Danish ambulance service

BACKGROUND: Patients are at risk of contracting infections due to the presence of disease-causing microorganisms that can be transmitted from the medical staff’s uniforms to the patient. The dual purpose of this study was to examine the contamination level of the uniforms worn by ambulance staff after a shift and to test the effect of washing of the uniform with and without a detergent containing acetic peroxide. METHODS: This was a cross-sectional study in which 30 ambulance staff uniforms were randomly selected for inclusion and divided into two groups. Before washing, 90 prints were performed with specific agar plates to determine bacterial contamination and to establish the prevalence of a variety of microorganisms. Group A uniforms were washed with a detergent without acetic peroxide; Group B uniforms were washed with a detergent containing acetic peroxide. RESULTS: Before washing, the 90 prints had an average colony-forming units (CFU) of potentially pathogenic bacteria of 68.89 per 25 cm(2) and a prevalence of: E. coli and Pseudomonas 0%, Bacillus cereus 27.78% (CI 95% ± 9.80), Clostridium and Enterococcus 2.22% (CI 95% ± 1.96), Staphylococcus aureus 21.11% (CI 95% ± 7.80). After washing, CFU was reduced to 3.09 (CI 95% ± 5.04) per 25 cm(2) in Group A and to 1.47 (CI 95% ± 4.77) per 25 cm(2) in Group B. The prevalence of specific bacteria in either group was 0%, except for S. aureus which had a prevalence rate of 4.40% (CI 95% ± 6.10) in Group A. The difference between the contamination degrees of the two groups was not significant in either test (p > 0.05). CONCLUSION: Potentially pathogenic bacteria are detectable on ambulance staff uniforms when a shift ends. Optimal prevention of bacterial infection may be achieved by daily changing, washing at a minimum of 60 degrees Celsius and use of a detergent containing acetic peroxide