Kim Wildgaard’s research while affiliated with University of Copenhagen and other places

Background Childbirth is a significant life event often accompanied by intense pain. Although pain perception is highly subjective and influenced by multiple factors, its management is frequently focused solely on pain intensity. Epidural analgesia (EA) is the most effective form of labor pain relief; however, there is limited qualitative research on which aspects of pain relief parturients perceive as successful with EA. Understanding parturients’ perspectives on successful pain relief with EA can help improve patient‐centered care and enhance labor pain management strategies. Aim This qualitative study aims to explore parturients' perspectives on successful pain management during labor with EA, identifying key aspects that contribute to their overall childbirth experience. Methods A qualitative, semi‐structured interview study will be conducted at Herlev Hospital, Denmark. Approximately 10–15 parturients who received EA during labor will be recruited using purposive sampling within 24 hours postpartum. Interviews will be recorded, transcribed, and analyzed using Braun and Clarke's thematic analysis framework. Data collection will continue until sufficient information power is reached. Ethical Considerations The study has been approved by the Danish Data Protection Agency (case no. P‐2025‐18241) and adheres to the Declaration of Helsinki. Informed consent will be obtained from all participants, and data will be anonymized to ensure confidentiality. Expected Outcomes The study is expected to generate new insights into parturients’ experiences of labor pain and EA, contributing to the development of patient‐reported outcome measures and informing future clinical practice. Findings may also support the creation of standardized pain assessment tools and influence policies on labor pain management. Dissemination Results will be published in a peer‐reviewed journal and presented at national and international conferences to inform both clinical practice and future research.

Background Epidural analgesia (EA) is widely used for postoperative and labour pain management. Systematic training of healthcare professionals, particularly nurses, is essential for the safe administration and management. This scoping review aimed to identify and map existing EA training programmes. Methods A PRISMA‐ScR‐guided search was conducted across multiple databases and grey literature. Studies on educational interventions for healthcare professionals in EA management were included. Data extraction and categorisation were performed using Kirkpatrick's Four‐Level Training Evaluation Model. Results Eighteen studies were included, covering classroom training, workshops, self‐directed learning, simulation‐based training, and on‐the‐job training. Participants were primarily nurses. Programmes addressed epidural techniques, monitoring and assessment, spinal anatomy and pharmacology, complication management, and patient care. Most studies focused on short‐term knowledge gains, with a limited assessment of long‐term clinical impacts. Conclusion Limited research exists on EA training, with most programmes targeting nurses and relying on classroom‐based training. Training structures varied, and evaluations primarily assessed short‐term knowledge gains. Editorial Comment The authors conducted a literature search to get an overview of programmes that aimed to train healthcare staff in managing epidural pain relief. Most of the identified 18 studies described classroom teaching and focused primarily on knowledge about complications. Patient contact in this type of training was not reported. The effectiveness of this type of training in a clinical context was difficult to evaluate based on the published evidence.

Background Over the past 25 years, global opioid consumption has increased. Denmark ranks fifth in opioid use globally, exceeding other Scandinavian countries. Postsurgical pain is a common reason for opioid prescriptions, but opioid use patterns after patient discharge from the hospital are unclear. This study examines trends in opioid prescription among Danish surgical patients over a year. Methods This register‐based cohort study will use data from Danish governmental databases related to patients undergoing the 10 most frequent surgical procedures in 2018, excluding cancer‐related and minor procedures. The primary outcome will be the dispensed postoperative opioid prescriptions at retail pharmacies over four quarters. Secondary analyses will include associations with sex, age, education attainment, and oral morphine equivalent quotient. Surgical treatments and diagnoses will be identified using NOMESCO procedure codes and ICD‐10 codes. Opioids will be identified by ATC codes N02A and R05DA04. Subjects will be classified as preoperative opioid consumers or non‐opioid consumers based on opioid prescriptions redeemed in the 6 months before surgery. Discussion The study will use extensive national register‐based data, ensuring consistent data collection and enhancing the generalizability of the findings to similar healthcare systems. The study may identify high‐risk populations for long‐term opioids and provide information to support opioid prescribing guidelines and public health policies.

Introduction The patient's right to autonomy confirmed by informed consent is a cornerstone in modern medicine. Epidural analgesia is increasingly popular in obstetric analgesia, but physicians disagree whether labour pain impairs parturient decision‐making. We investigated the fraction of parturients feeling capable of giving informed consent including their knowledge of risks. Methods Bedside survey postpartum women at the Herlev Hospital, Denmark. The inclusion criteria were recipient of epidural analgesia during labour. A power calculation based on the recognition of genuine and false side effects required the inclusion of 50 participants. Results Forty out of fifty (80%) of the participants felt they could make a judicious consent during labour and 46 out of 50 (92%) felt they knew enough about epidural analgesia to give consent to the procedure again if necessary. Participants spontaneously reported a median of two risks associated with epidural analgesia. Additionally, when prompted with a cued list of true and false risks from epidural analgesia, the participants reported on average 5.1 genuine risks compared with 0.4 made‐up risks. The difference (4.7) suggests the included women could discern genuine risks from made‐up risks. Discussion The majority of participants reported the capacity to give informed consent. Our quantitative results show the participants could clearly distinguish genuine risks of epidural labour analgesia from made‐up risks. Our qualitative data likewise suggest that participants understood the information and consequently their informed consent was genuine. Accordingly, parturients are able to give informed consent. This is supported by parturients' ability to identify risks from epidural labour analgesia.

Background: Epidural analgesia is an effective technique advocated worldwide for postoperative analgesia after a wide range of surgical procedures. Despite the benefits of epidural analgesia for pain management, systematic education of ward nurses in managing epidural analgesia appears to be lacking. Methods: The aim of the proposed scoping review is to map the body of evidence and identify training programmes for healthcare professionals in the safe management of postoperative epidural analgesia. The methodology will follow the Preferred Reporting Items for Systematic and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). In addition, the five main steps set forth by Arksey and O'Malley and refined by Levac for guidance of the process will be used. The scoping review will include any study design of any date, design, setting and duration. Results: We will present results descriptively, accompanied with visual presentations as tables and graphs. Conclusion: The outlined scoping review will provide an overview of existing training programmes for healthcare professionals in the safe management of postoperative epidural analgesia and map the body of available evidence on the topic. The study may support the development of a training programme for ward nurses caring for patients receiving postoperative epidural analgesia.

Perioperative management of patients declining transfusions of blood products can be challenging both ethically and clinically. Jehovah's Witnesses (JW) decline treatment with blood products and have published a list of interventions they might accept as substitutes. No detailed documentation of available substitute interventions at Danish hospitals exists. Likewise, no national guidelines exist on how to optimise patients who refuse to receive treatment with blood products. The primary aim was to investigate which treatments are currently available to healthcare professionals in Denmark when treating patients who refuse transfusion of blood components. Additionally, we wanted to investigate how many departments have local guidelines for treatment for this group of patients. Based on our findings we would suggest potential improvements in the treatment of patients declining transfusion of blood components. Consultants from Danish departments of anaesthesiology, abdominal surgery and obstetrics were invited to participate in a nationwide cross-sectional online survey. The questionnaire explored available interventions offered perioperatively. Respondents were all on-call consultants. The questionnaire underwent content, face and technical validation during pilot testing. Ninety-six of 108 (89%) respondents from 55 departments completed the questionnaire. Thirty-five (36%) respondents reported having a departmental guideline mostly dealing with judicial aspects regarding patients declining transfusions with blood, and 34 (35%) would in collaboration with other professionals make an interdisciplinary strategy for patients declining transfusions with blood. For patients declining treatment with blood products in anticoagulant treatment, and hence with a greater risk of bleeding, reverting treatment is essential. Depending on the type of anticoagulant, between 31 (32%) and 59 (60%) of respondents reported locally available guidelines for reverting anticoagulant treatments. We found a considerable variation and limited availability of interventions to minimise blood loss in patients declining transfusion of blood components. This scarcity of local guidelines together with the considerable variation of available treatment documented in our survey could possibly be enhanced by a lack of national guidelines.

A growing worldwide focus on opioid-free anaesthesia entails multimodal analgesic strategies involving non-opioids such as magnesium sulphate (MgSO4). Several systematic reviews have concluded there is beneficial analgesic effect of MgSO4 administration but do not take considerable heterogeneity among the studies into consideration. Medical literature published until June 2021 was searched in PubMed/Medline, Embase, Central and Web of Science: The final search yielded a total of 5,672 articles. We included only randomised controlled trials assessing the effect of intravenous MgSO4 on opioid consumption and acute postoperative pain when compared to either placebo or standardized analgesic treatment. The primary aim was to compare the homogeneity of essential variables and confounders. A post-hoc meta-analysis demonstrated a reduction in both postoperative morphine consumption (−6.12 mg) and pain score (−12.32 VAS points) in favour of the MgSO4-groups. Data for meta-analysis was missing from 19 studies (45%) on morphine consumption and 29 studies (69%) for pain score, the majority of which reports no effect for either morphine consumption or pain score. The calculated heterogeneity among the included studies was considerable for both outcomes; I2=91% for morphine consumption and I2=96% for pain score. Although we found a per se reduction in opioid consumption and pain score, methodological heterogeneity and clinical shortcomings of pre-, intra-, and post anaesthetic data precludes conclusions on clinical importance of intraoperative intravenous MgSO4. In addition, the reduction is likely less than what can be gained from using standardized analgesic treatment.

Introduction: Delirium is a syndrome characterised by disturbance of consciousness and is a common complication to hip fractures. This systematic review was conducted to investigate the effect of simple preoperative interventions for the prevention of delirium in patients with hip fractures. The aim was to establish an easily implementable and resource-sparring treatment for the initial admission phase of hip fracture patients aimed at reducing the incidence of delirium. Mehods: Five databases were searched to identify randomised controlled trials comparing preoperative interventions other than geriatric assessment to placebo or usual care. Our primary outcome was incidence of delirium using a well-defined delirium-screening tool. Secondary outcomes included need for pharmacological treatment, duration of delirium and mortality. Results: A total of 13 RCTs provided data on 2,222 patients who had been exposed to 11 different interventions. Four interventions significantly reduced of the incidence of delirium: methylprednisolone (odds ratio (OR) = 0.42; 95% confidence interval (CI): 0.17-1.00; p = 0.048), fascia iliaca block (OR = 0.39; 95% CI: 0.18-0.84; p = 0.02), hypertonic saline (OR = 0.21; 95% CI: 0.08-0.55; p = 0.001) and rivastigmine patches (OR = 0.23; 95% CI: 0.07-0.77; p = 0.013). All studies were rated as having a high risk of overall bias. Conclusions: Robust conclusions are precluded by study heterogeneity and high risk of bias in the included studies. However, this systematic review provides an indication of treatments that should be investigated further to establish any effect on delirium in the preoperative setting in hip fracture patients.

Aim The aim of the study is to describe the current frequency of physical restraint and the use of analgesics and sedatives for treating paediatric pain in emergency departments (EDs) in Scandinavia. Methods We performed a nation‐wide electronic survey asking nurses in the emergency departments in Denmark, Norway and Sweden about their experience treating children in pain. Results Responses from 103 Danish, Norwegian and Swedish nurses were included (79% response rate). Physical restraint was reported used at 79% [70.0‐85.9] (N = 78) of the surveyed departments (DK: 96%, NO: 67%, SE: 77%) with two participants reporting daily use of physical restraint. Paracetamol was available at all departments and used most frequently. Sedation was available at 88% [78.8‐92.0] of the departments with midazolam as the most recurrent sedative (83%, [74.8‐89.4]). Seventy‐three percent of respondents reported a need for better treatments. Lack of education was the most frequently reported obstacle for providing both pain treatment (29%) and sedation (43%) followed by lack of guidelines. Conclusion Physical restraint of children during painful procedures is used in the majority of Scandinavian emergency departments (79%). There appears to be a lack of local guidelines for both pain treatment and sedation.

Introduction Music festivals are popular events often including camping at the festival site. A mix of music, alcohol, drugs, and limited hygiene increases health risks. This study aimed to assess the use of medical supplies at a major music festival, thereby aiding planning at similar events in the future. Method The Medical Health Care Organization (MHCO) at Roskilde Festival 2016 (Denmark) collected prospective data on disposable medical supply use and injuries and illnesses presenting to the MHCO. Results A total of 12,830 patient presentations were registered by the MHCO and a total of 104 different types of disposable medical supplies were used by the MHCO from June 25, 2016 through July 3, 2016. Out of 12,830 cases, 594 individuals (4.6%) had a potential or manifest medical emergency, 6,670 (52.0%) presented with minor injuries, and 5,566 (43.4%) presented with minor illnesses. The overall patient presentation rate (PPR) was 99.0/1,000 attendees and the transport-to-hospital rate (TTHR) was 2.1/1,000 attendees. For medical emergencies, the most frequently used supplies were aluminum rescue blankets (n = 627), non-rebreather masks (n = 121), and suction catheters for an automatic suction unit (ASU) for airway management (n = 83). Most used diagnostic equipment were blood glucose test strips (n = 1,155), electrocardiogram electrodes (n = 960), and urinary test strips (n = 400). The most frequently used personal protection equipment were non-sterile gloves (n = 1,185 pairs) and sterile gloves (n = 189). Conclusion This study demonstrates a substantial use of disposable medical supplies at a major music festival. The results provide aid for planning similar mass-gathering (MG) events.