Region of Southern Denmark

Background Craving alcohol for reward (positive reinforcement) and relief (negative reinforcement) has been proposed as useful phenotypes for precision medicine approaches to alcohol use disorder (AUD) treatment. This study examined reward and relief craving in nonpharmacological treatments, Motivational Enhancement Therapy (MET) versus MET + Community Reinforcement Approach (CRA), among older adults. Methods Secondary analyses of data from The Elderly Study (N = 693; mean age 64.0 years; male 59.7%), a single‐blinded, multisite, randomized controlled trial of two nonpharmacological treatments in an elderly population (60+ years) diagnosed with DSM‐5 AUD. Latent profile analysis (LPA) was used to identify craving profiles based on The Alcohol Abstinence Self‐Efficacy Scale (AASE) temptation subscale scores. The classification performance of clinical cutoff scores on the AASE scale was tested against the LPA solution. Associations between cutoff‐based craving groups and treatment success (binary variable representing change in alcohol consumption and quality of life across profiles pre‐/posttreatment) were analyzed using logistic regression, stratified on MET versus MET + CRA. Differences in alcohol consumption and quality of life scores pre‐/posttreatment were analyzed using the Wilcoxon signed‐rank test. Results Four reward‐relief craving profiles were identified but were more distinguished by variation in relief craving (low relief, medium‐low relief, medium‐high relief, and high relief). Compared to the low relief craving group, the medium‐high relief craving group had lower odds for treatment success when receiving MET: adjusted Odds Ratio (aOR) 0.42 (95% CI 0.21–0.84), and the high relief craving group had lower odds for treatment success when receiving MET + CRA: aOR 0.38 (95% CI 0.15–0.94). Alcohol consumption was reduced, and psychological quality of life was improved at follow‐up across all relief craving groups. Conclusion This study identified reward and relief drinking craving among older adults with AUD. Results indicate that considering relief craving when offering nonpharmacological treatment to older adults suffering from AUD may be clinically relevant.

Purpose To report the rates of risk-reducing surgery (RRS) following germline testing for BRCA1/2 (likely) pathogenic variants (BRCApv) and to assess the impact of RRS and BRCA status on survival after surgical treatment for unilateral breast cancer (BC). Methods We identified 7145 women with BC (2000–2017), a BRCA test and median follow-up of 10.8 years from the Danish Breast Cancer Cooperative Group’s clinical database. Distant recurrence-free (DRFS) and overall survival (OS) according to BRCA status were evaluated using the Kaplan–Meier method. Hazard ratios (HR) for BRCApv vs. BRCA wild-type, contralateral risk-reducing mastectomy (CRRM), and risk-reducing bilateral salpingo-oophorectomy (RRBSO), including interaction tests, were estimated using multivariable Cox models. Results Among BRCA1pv carriers (n = 403), CRRM rates were higher than in BRCA2pv (n = 317) (66% vs. 52%, p < 0.001) and more likely to receive timely testing, i.e., within 6 months of BC diagnosis (75% vs. 52%, p = 0.004). Regarding RRBSO rates, no differences were observed. CRRM was associated with significantly improved DRFS (HR = 0.63, 95% CI 0.51–0.78) and OS (HR = 0.64, 95% CI 0.51–0.82), independently of BRCA status and age. RRBSO was associated with improved OS only in BRCApv carriers, specifically, those aged ≥ 50 years (HR = 0.44, 95% CI 0.26–0.75). BRCApv (irrespective of affected gene) was associated with worse DRFS (HR = 1.31, 95% CI 1.06–1.63); however, this was only evident after 2 years of follow-up (HR = 1.53, 95% CI 1.22–1.93). BRCApv was not significantly associated with worse OS (HR = 1.25, 95%CI 0.98–1.58). Conclusion Timely germline testing at BC diagnosis might increase CRRM rates in BRCApv carriers, thereby improving survival.

Background Shared decision-making (SDM) implementation remains limited in psychosis management, particularly within antipsychotic prescribing. When and why prescribers engage in SDM within these contexts is largely unknown. Part 1 of this two-part realist review aimed to understand the impact of structural and contextual factors on prescriber engagement in SDM within antipsychotic prescribing. Study design CINAHL Plus, Cochrane Library, Embase, PsycINFO, PubMed, Scopus, Sociological Abstracts, Web of Science, and Google Scholar were searched for evidence to develop realist program theories outlining the relationship between macro-level contexts and their impact on prescriber behaviors. Study results From 106 included documents, five program theories explaining relationships between (i) leadership and governance, (ii) workforce development, and (iii) service delivery contexts and their impact on reducing prescriber engagement with behaviors required of SDM application were developed. No facilitative macro-level contexts were identified. Key mechanisms reducing prescriber engagement in desired behaviors include fear of individual blame for adverse outcomes and exposure to liability, pressure from service environments to prioritize decreasing risk of harm, devaluing of experiential knowledge, and beliefs that SDM conflicts with duties of beneficence and non-maleficence. Conclusion Even empirically efficacious interventions will be difficult to implement at scale within real-world settings due to misalignment with complex cultural, legal, and professional realities prominent therein. Mechanisms responsible for reducing prescriber engagement in SDM should be the target of structural interventions necessary to support contextual integration into psychosis management. Part 2 outlines features of service delivery contexts, workforce development, and technology that can increase prescriber engagement in SDM.

Background Shared decision-making (SDM) implementation remains limited in psychosis management, particularly within antipsychotic prescribing. When and why prescribers engage in SDM within these contexts is largely unknown. Part 2 of this 2-part realist review aimed to understand what SDM intervention strategies and local implementation contexts are responsible for successful prescriber engagement and why. Study design CINAHL Plus, Cochrane Library, Embase, PsycINFO, PubMed, Scopus, Sociological Abstracts, Web of Science, and Google Scholar were searched for evidence to develop realist program theories explaining relationships between meso- and micro-level contexts and impact on prescriber behaviors. Study results From 106 included documents, 5 program theories were developed explaining mechanisms responsible for increasing prescriber engagement with desired behaviors, alongside facilitative features within service delivery contexts and workforce development. Key mechanisms included reducing prescriber fear of sole responsibility for harm, reducing the perceived burden of SDM, increasing prescriber confidence in their ability to productively negotiate treatment consultations and their confidence to safely increase patient autonomy within decision-making. These mechanisms should be the focus of those interested in designing SDM interventions to increase prescriber engagement and those responsible for translating results of effective interventions into real-world settings to ensure facilitative contexts are maintained. Conclusion Intervention strategies that should be prioritized for scale-up include attempting SDM within existing therapeutic relationships, adopting a multidisciplinary team (MDT) responsibility for SDM implementation, and workforce training in skillsets required of effective SDM application. Efforts to standardize psychosis care via MDTs and systematically reduce discontinuity and fragmentation of care are required at policy-level.

Background Excessive alcohol consumption is a significant global health issue, often unaddressed in primary care. The 15-method, a three-step opportunistic screening and treatment tool premised on Motivational Interviewing and integrated within the Screening, Brief Intervention and Referral to Treatment framework, offers a structured approach for healthcare professionals to identify and treat alcohol-related problems. The present study aimed to assess healthcare professionals’ perceptions of determinants for early-stage implementation of the 15-method in Danish general practice and to classify these determinants using the Consolidated Framework for Implementation Research (CFIR). Methods This qualitative study involved individual interviews and group interviews with general practitioners and nurses ( N = 28) from 12 general practices participating in the Identification and Treatment of Alcohol Problems in Primary Care (iTAPP) study, a stepped-wedge cluster randomized controlled trial evaluating the effectiveness of the 15-method in Danish general practice. Interviews were semi-structured, guided by the CFIR framework, and analyzed using directed content analysis. Determinants were rated for their influence on implementation. Results Key facilitators included the 15-method’s adaptability, strong evidence base, relative advantage, and compatibility with existing practices. Barriers included structural characteristics in the practices and local conditions. A central finding revealed a tension between patients’ motivation and healthcare professionals’ opportunities and capabilities to deliver the 15-method. Mixed determinants highlighted the complexity of implementing the 15-method across diverse practices. Conclusion Implementing the 15-method in Danish general practice is feasible but requires addressing specific barriers and leveraging facilitators. A multifaceted implementation strategy tailored to individual practices may be necessary to address the variations in contexts and resources across different practices with an emphasis on increasing healthcare professionals’ capabilities and opportunities to deliver the intervention.

Purpose Temporary stays for patients requiring short-term care outside the home, often following hospital discharge, has gained increasing importance. This study aimed to describe the characteristics and care trajectories of older patients in Danish temporary stays to improve care delivery and patient safety. Methods We conducted a descriptive study on a cohort of patients in temporary stays across 14 Danish municipalities from 2016 to 2023, using data from national health registries. Results We identified 11,424 patients with a median age of 81 years (interquartile range [IQR] 73–87 years); 54% were women. Patients exhibited a high level of comorbidity, with a median Charlson Comorbidity Index of 1 (IQR 0–2), and a median of 3 hospital admissions (IQR 2–6) in the year preceding their move into temporary care. The majority (70%) transitioned to temporary stays following hospital discharge, while 30% were admitted directly from their homes. The median duration of temporary stays was 24 days (IQR 11–49 days), with 9.1% staying ≥ 90 days. Additionally, 7.0% of patients were hospitalised directly from the temporary stay facility, with a median time to hospital admission of 13 days (IQR 5–28 days). Median survival after admission to a temporary stay was 23 months (IQR 3.6–57 months). Predictors of mortality included male sex, older age, higher comorbidity burden, and increased number of hospital admissions prior to temporary stay. Conclusion Patients in temporary stays are generally older individuals with multimorbidity and limited life expectancy. Most patients are admitted following hospital discharge, and their stays are often prolonged.

Purpose Patients in temporary stays are typically older individuals with frailty and multimorbidity. However, limited knowledge exists about their medication use. This study aimed to describe prescription drug use among patients in temporary stays in Denmark. Methods We conducted a drug utilisation study on 11,424 patients in public healthcare-operated temporary stay units across 14 Danish municipalities between 2016 and 2023 (median age 81 years; 54% women). Prescription data were sourced from the Danish National Prescription Registry. Results Patients used a median of six drug classes (interquartile range [IQR] 4–10) in the four months before moving into a temporary stay facility; 68% used ≥ 5 drug classes, and 26% used ≥ 10. The most commonly used drug classes were paracetamol (49%), statins (30%), and proton pump inhibitors (29%). The monthly rate of new drug use increased from 23/100 patients six months before move-in to a peak of 262/100 patients in the first month after move-in, driven primarily by laxatives, analgesics, and antibiotics. High-risk drug use increased from 70 to 83% following move-in, with 49% of patients initiating at least one new high-risk drug, most commonly opioids (28%), potassium (17%), and anticoagulants and platelet inhibitors (15%). General practitioners initiated 60–70% of treatments and maintained 80–90%. Hospital physician prescriptions increased around move-in, peaking at 55% for initiation and 25% for maintenance in the first month after move-in. Conclusion Patients in temporary stays in Denmark demonstrate high medication use, including high-risk drugs, with a notable increase in treatment initiations around the time of move-in.

Background Despite the high risk of suicidal behaviour in youth, there is a lack of evidence‐based interventions within school settings for those who are at increased risk. The Project ROS (in Realise, Convince and Refer in Danish Realiser, Overbevis og Send videre) will train teaching staff and implement QPR (Question, Persuade, Refer), a suicide prevention gatekeeper intervention supported by an implementation intervention at specialised schools (FGU) in Denmark. Aim To determine the feasibility of delivering school‐based QPR (Question, Persuade, Refer) gatekeeper training, supported by an implementation intervention based on evidence‐based implementation strategies. Methods A two‐phase case study with a feasibility hybrid evaluation design. The evaluation will include a multimethod approach including pre‐, post‐ and follow‐up survey measurements, field observations and semi‐structured single and focus group interviews. Discussion A multimethod design will be used to validate the results. The use of methodological triangulation will help to reduce bias and deficiencies compared to using a single‐method design.

This study aimed to estimate the effects of preoperative psychological health on postoperative outcomes in patients undergoing surgery for cervical spondylotic radiculopathy. This retrospective cohort study included data from patients enrolled in the Canadian Spine Outcomes and Research Network who underwent anterior cervical discectomy and fusion for radiculopathy. Preoperative psychological health was measured with the Patient Health Questionnaire-8 (PHQ-8), and depression and severe psychological symptomology were measured with the Mental Component Score of the Short Form Survey-12 (MCS). Surgical outcomes comprised trajectory subgroups for neck pain and arm pain (numeric rating scales) and disability (neck disability index) measured preoperatively and 3, 12, and 24 months after surgery. For each outcome, patients were dichotomized as following either a poor or a fair-to-excellent trajectory. Average treatment effects were estimated with doubly robust propensity score models using inverse probability of treatment weights accounting for multiple confounders. We included data from 352 patients (43.8% female). Approximately half (52.1%) of patients were identified as depressed based on the PHQ-8, while 61.8% and 33.1% were classified as experiencing depression or severe psychological symptomology, respectively, on the MCS. In fully adjusted models, patients with PHQ-8-measured depression were at increased risk of poor postoperative outcomes for disability (risk ratio[95% CI] = 6.73[1.85 to 24.45]) and neck pain (RR[95% CI] = 1.90[1.09 to 3.32]). Patients with MCS-measured depression were at elevated risk of a poor disability outcome (RR[95% CI] = 2.77[1.30 to 5.90]). Patients reporting severe psychological symptomatology had an increased likelihood of poor disability, neck pain, and arm pain outcomes (RR[95% CI] = 1.82 [1.17 to 2.82] to 2.84[1.58 to 5.09]). These findings highlight the high prevalence of negative psychological features and their impacts on neck surgery outcomes. Future research should prioritize the development and evaluation of preoperative interventions to optimize psychological well-being and improve surgical outcomes in this population.

Background: Increasing demand for healthcare due to demographic changes and shortage of healthcare professionals challenges the provision of unplanned care. In Denmark, different organizational changes across all regions have been implemented to meet these challenges. This provides great potential for research on the effect of different organizational choices on the use and quality of healthcare. Thus, we aim to provide a comprehensive overview of the current organizational models for acute unplanned out-of-hours primary care (OOHPC) across the five Danish regions, incorporating key contextual factors to characterize these regional systems. Methods: Nationwide cross-sectional survey study on OOHPC models in all Danish regions (North, Central, Southern, Capital, and Zealand). Survey questions covered a list of predefined topics created in the author group. One survey was completed per region. Results: OOHPC models differ across regions and time of day. In the North, Central, and Southern regions from 4 PM-11 PM, general practitioner (GP) cooperatives deliver OOHPC (telephone triage, tele- and clinic consultations, and home visits). From 11 PM-8 AM, the regional emergency medical services provide OOHPC in the North (GPs/physicians, paramedics) and Central (physicians, nurses, paramedics) regions. In the Southern region, the administrative responsibility of the OOHPC lies with the emergency department, but GPs provide healthcare aided by paramedics. The Capital, Central (nights), and Zealand regions have nurses and physicians performing telephone triage. All regions provide clinic consultations with physicians. In the Capital region, these consultations are hospital-based. Currently, no OOHPC data is transferred to national registries in four regions during nighttime. Conclusion: Danish OOHPC models differ substantially regarding the use of healthcare professionals for delivering acute unplanned care. All regions still provide gatekeeping, where OOHPC performs a primary evaluation before a possible hospital contact. Delivery of relevant data to registries has decreased substantially with the current models, potentially creating a barrier for nationwide research on OOHPC.

Introduction Cardiovascular diseases remain the leading cause of mortality worldwide. Tirzepatide is approved for the treatment of type 2 diabetes mellitus and overweight and is increasingly used. The adverse effects with tirzepatide may not be disease-specific and have not been assessed previously. Methods and analysis We will conduct a systematic review and search major medical databases (Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Latin American and Caribbean Health Sciences Literature (LILACS), Science Citation Index Expanded (SCI-EXPANDED), Conference Proceedings Citation Index—Science (CPCI-S)) and clinical trial registries from their inception and onwards to identify relevant randomised clinical trials. We expect to conduct the literature search in January 2025. Two review authors will independently extract data and perform risk of bias assessments. We will include randomised clinical trials comparing tirzepatide versus placebo or no intervention in all patient groups with an increased risk of cardiovascular events. Primary outcomes will be all-cause mortality and serious adverse events. Secondary outcomes will be myocardial infarction, stroke, all-cause hospitalisation and non-serious adverse events. Data will be synthesised by meta-analyses and Trial Sequential Analysis, risk of bias will be assessed with the Cochrane Risk of Bias tool—version 2. We will systematically assess if the thresholds for statistical and clinical significance are crossed, and the certainty of the evidence will be assessed by Grading of Recommendations, Assessment, Development and Evaluations. Ethics and dissemination This protocol does not present any results. Findings of this systematic review will be published in international peer-reviewed scientific journals. PROSPERO registration number CRD42024599035.

Background Major incidents evolving from occupational accidents are very infrequent in Scandinavia and therefore, case reports are called for. On 26 November, 2024, a fatal occupational accident took place during the construction of a concrete silo in the small rural town of Flemløse (population 574), Denmark. Three people died and six were injured as the result of a collapsing concrete roof during construction. We aim to describe the incident response by the emergency medical services (EMS), to identify areas of improvement, and to evaluate the adherence to current national major incident guidelines and communication grids. Case presentation The initial call to the emergency medical dispatch center described an accident comprising fifteen injured persons, all of whom were migrant workers. Seventeen EMS units including two helicopter EMS units were dispatched to scene. Three critically injured patients were admitted to a nearby trauma center, whereas three lightly injured were taken to a regional trauma hospital. The initial reports overestimated the number of possible casualties and therefore, the available resources were ample. The very construction of the silo resulted in challenging conditions for evacuation of the injured patients. Chemical, biological, radiological, nuclear, and explosive (CBRNE) aspects of the incident added to the inherent complexity in major incident management. Although potentially detrimental to the patients, the prolonged extrication of the patients enabled the prehospital services to procure a timely organization of the incident site according to guidelines and an organized transport prioritization of the victims. The communication within EMS and between authorities was generally as per national guideline. Conclusions The EMS response to this major incident generally adhered to the national guidelines and, furthermore, the communication within and between authorities was established according to guidelines. Important findings included the use of local resources by the incident command and improvised means for the evacuation of victims from a highly hostile environment. The triage of patients adhered to local and national major incident guidelines. Migrant workers have increased risk for occupational accidents.

Background Cue Exposure Therapy (CET) is a behavioristic psychological intervention for treating substance use disorders (SUDs). Recently, CET has been examined in technology-assisted formats to increase intervention efficacy. No systematic review has examined the efficacy of different CET formats across types of SUDs. Objectives We aimed to examine the efficacy of CET across SUDs and examine the efficacy of non-technology-assisted (NT-CET) and technology-assisted CET (T-CET). Methods We conducted a systematic literature search in MEDLINE, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials up to June 2024. The efficacy of CET was inspected trough a qualitative synthesis and the quality assessment of all the included studies was performed using the Cochrane risk-of-bias tool for randomized trials, version 2. Results Forty-four controlled trials were identified (NT-CET; n=21; T-CET: n=23). Most studies were conducted on alcohol- and nicotine use disorders. No study reported effect sizes on craving, while one study reported a small effect of NT-CET on alcohol consumption at 6- and 12-months follow-up. Compared to control interventions, CET was found more effective in 41% of the studies that examined cravings, and in 57% of the studies that examined consumption. In these studies, there was on overrepresentation of studies that combined CET with cognitive behavioral therapy (CBT) or CBT-related approaches. Only one study directly compared the effect of NT- and T-CET alcohol craving or consumption and found no difference up to 6 months follow-up. Among NT-CET and T-CET studies, the proportion of studies reporting significantly better outcomes than control interventions were 17% and 60% for craving, respectively, and 38% and 80% for consumption, respectively. High heterogeneity and risk of bias were found among the included studies. Conclusions Across the different substance use disorders, most studies found significant reduction in craving and consumption after CET. No conclusions can be made on the efficacy of CET compared to active control interventions, due to limiting reporting of effect sizes. Technology-assisted CET reported significant reduction in craving and consumption relatively more often than conventional CET studies, particularly when delivered in virtual reality. Future high-quality studies are warranted to enable more firm conclusions and quantitative synthesis. Systematic review registration https://www.crd.york.ac.uk, identifier CRD42022308806.

Introduction There is a lack of comprehensive clinical research to assess potential benefits of mHealth solutions in post discharge follow-up care after spinal surgery. Purpose This quasi-experimental study evaluated the effectiveness, usability, and patient satisfaction of an mHealth pathway with an electronic Patient-Reported Outcome (ePRO)-based post-discharge nurse-led intervention for patients undergoing surgery for lumbar spine degenerative disorders, compared to standard care. Methods Conducted at a Danish tertiary spine center, this study represents the final stage of a three-phase participatory design. The primary outcome was patient quality of recovery, measured by the Quality of Recovery-15 (QoR-15) questionnaire. Secondary outcomes included patient-perceived usability, assessed with the Danish System Usability Scale (SUS). To capture additional patient insights, an open-ended feedback question was included at the end of the survey. Results Data from 150 patients (77 women and 73 men) were analyzed, with 104 in the intervention group and 46 in the comparison group. Both groups showed significant improvement over time, but no significant difference between groups. Of 154 potential SUS respondents, 110 participated. Analysis revealed 48 statements, categorized into five themes: (1) Usability and functionality of the mHealth solution, (2) Feedback on the QoR-15 questionnaire, (3) Safety and support, (4) Missing functions and suggestions for improvements, and (5) Patient satisfaction. Conclusion No significant differences in effectiveness between the mHealth pathway and standard care were found for post-surgery recovery in lumbar spine patients. Usability and patient satisfaction were generally high, though suggestions for improvements were noted. The study highlighted the importance of post-discharge support, suggesting that the intervention provided crucial security and support, potentially demonstrating compassion through nurse-led care.

The transition from nursing education to professional practice is a critical period for newly graduated nurses, marked by significant moral challenges that can lead to moral distress and impact the development and application of clinical judgment. Understanding how moral distress affects newly graduated nurses is vital to support their integration into professional roles and ensure the delivery of quality care. Newly graduated nurses may experience moral distress due to conflicts between professional values and institutional constraints, which impact their ability to exercise effective clinical judgment. The purpose of this qualitative meta-ethnographic review is to investigate the phenomenon of moral distress among newly graduated nurses and its implications for clinical judgment. The research question is: How do newly graduated nurses experience moral distress, and how does it affect their clinical judgment? Methodologically, the study is grounded in Ricoeur’s three-fold mimesis, which offers a rich interpretative framework for exploring the complexities of moral distress in nursing practice. Guided by the seven steps of meta-ethnography, the analysis reveals significant variations in the conceptualization and experiences of moral distress, thus highlighting inadequacies in existing definitions. The findings from 12 qualitative studies were synthesized into an integrative model of moral challenges. This integrative model presents moral distress as a multifaceted phenomenon that intersects with clinical judgment. The integrative model of moral challenges demonstrates how institutional constraints, moral uncertainty, moral conflict and lack of moral attention can hinder newly graduated nurses' ability to exercise effective clinical judgment and deliver quality care. The integrative model of moral challenges is a crucial contribution to research on moral distress. The review reveals limited research on the way moral distress affects the clinical judgment of newly graduated nurses and highlights the importance of promoting reflective practice and moral deliberation among newly graduated nurses to strengthen their clinical judgment and professional development.

Background Flexible optical intubation (FOI) is the preferred technique for managing anticipated difficult airways, particularly in awake patients when anatomical factors complicate conventional laryngoscopy. Mastering the procedure requires skills, but a comprehensive overview of the evidence on training and assessment of FOI skills is lacking. There is no evidence‐based consensus on educational strategies and recommendations for skill acquisition and retention, thus highlighting a significant gap in airway management training. Accordingly, we aim to assess the current evidence on training and assessment in FOI for future educational recommendations. Methods This scoping review adheres to the Preferred Reporting Items for Systematic and Meta‐Analysis (PRISMA) statement and the PRISMA Extension for Scoping Reviews guideline. Eligible studies include qualitative and quantitative research focusing on education, technical training, and assessment of FOI skills in clinical personnel with no obligate comparator. Outcomes should be assessable using Kirkpatrick's four levels of training evaluation. A systematic literature search will be conducted across multiple databases, including Cochrane Library, EMBASE, Cinahl, Scopus, and PubMed. Two independent authors will screen the studies, with discrepancies resolved by a third reviewer. Extracted data will be analyzed descriptively, with a discussion on potential biases in the included literature. The quality of the studies will be assessed using the Medical Education Research Study Quality Instrument (MERSQI). Discussion The results of this scoping review may serve as a foundation for educational recommendations. By synthesizing available evidence, this review aims to guide future research and policy recommendations for FOI skill acquisition and maintenance.

Background To address the unique challenges faced by refugees diagnosed with complex post-traumatic stress disorder (CPTSD), psychotherapy needs to be personalized. The integration of self-tracking instruments into therapy offers a promising approach to personalizing treatment. This feasibility pilot study develops and explores a preliminary self-tracking assisted treatment concept using a wearable self-tracking instrument called the One Button Tracker (OBT). The OBT is a single-purpose self-tracking instrument, designed to track subjectively experienced phenomena. Methods The feasibility pilot study adopted a participatory action research design, involving close collaboration between two therapists, two refugees diagnosed with CPTSD, and a research team. Quantitative data was collected from the OBT and qualitative data consisted of semi-structured post-treatment interviews and session logbooks. Reflexive thematic analysis was used for the interpretation of interview data. Quantitative data was used descriptively. Results The integration of OBT into psychotherapy with refugees was found to be feasible, marked by consistent high engagement as seen in the self-tracking data. Five themes were generated from the interview analyses, across two contexts: therapy sessions (navigating between precision and alliance with the OBT, and data usefulness in therapy) and daily life (paradox of awareness, OBT as a sign of treatment, and following the Doctor’s orders). Conclusion This feasibility pilot study illustrates the feasibility and therapeutic potential for integrating the OBT into psychotherapy for refugees with CPTSD to enhance engagement and personalization. The findings emphasize the necessity of an adaptive, personalized approach, vigilance regarding potential risks, and consideration of cultural factors. Further research is needed to refine this novel therapeutic approach.

Background Early identification of potential alcohol-problems is central for timely intervention and treatment referral. The Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-Consumption (AUDIT-C) serve as globally recognized and validated screening tools for this purpose. We aimed to evaluate the diagnostic validity of internationally recommended AUDIT cut-off scores ≥ 8, ≥16, ≥ 20, and AUDIT-C cut-off scores ≥ 4, ≥5 using the Danish language versions of questionnaires in a hospital setting. Methods Questionnaire data were collected from 2/15/2023, to 4/27/2023 at the Department of Gastroenterology and Hepatology, Odense University Hospital, Denmark. We tested the World Health Organization’s recommended AUDIT cut-offs: ≥8 for hazardous use, ≥ 16 suggestive of dependence, ≥ 20 high likelihood of dependence, along with AUDIT-C ≥ 4 and ≥ 5 using the following reference standard: Danish low-risk drinking guidelines (≤ 10 standard drinks/week) for hazardous use and self-reported ICD-10 alcohol dependence criteria for alcohol dependence. Analyses included ROC curves, AUC, sensitivity, specificity, predictive values, and agreement. Results Three hundred patients participated, mean age 52 years (SD 17.4, median 54) and 51.3% males. Mean AUDIT score was 4.5 (SD 5.8, median 3) with fourteen (4.7%) meeting at least three self-reported ICD-10 criteria for alcohol dependence. The prevalence of hazardous use was 10.7%. AUDIT ≥ 8 exhibited a sensitivity of 56% (95% CI 40.6–73.6) and specificity 91% (95% CI 87.8–94.5) for detecting hazardous use. Against at least three self-reported ICD-10 criteria for alcohol dependence, AUDIT cut-off ≥ 16 showed a sensitivity of 85% (95% CI 66.1–98.2) with 97% specificity (95% CI 96.0-99.2), while cut-off ≥ 20 had a sensitivity of 71% (95% CI 49.2–91.6) with 99% specificity (95% CI 98.1–99.9). The AUDIT-C cut-offs ≥ 4 and ≥ 5 exhibited low positive predictive values in detecting hazardous use (30.8% for ≥ 4 and 36.8% for ≥ 5) and dependence (13.5% for ≥ 4 and 18.4% for ≥ 5) and demonstrated a specificity ranging from 68.5 to 82.1% with negative predictive values from 98.2 to 100%. Conclusion In Danish gastroenterology and hepatology departments, the AUDIT and AUDIT-C may be used to identify patients who are unlikely to have an alcohol problem, while positive screen results should be carefully considered and followed by more exhaustive assessment.