Forskningssymposium 2019

Kære deltagere i Forskningssymposiet 2019

Velkommen til årets Forskningssymposium - en værdsat tradition på Regionshospitalet Randers.

Forskning har i flere år haft høj prioritet på Regionshospitalet Randers, da forskning og udvikling bidrager til

høj faglighed i diagnostik og behandling af patienter samt til rekruttering af dygtige og kvalificerede

medarbejdere. Forskning er en kerneopgave på enhver afdeling med inddragelse af forskellige faggrupper.

Et forskningssymposium er det ideelle forum, hvor man får mulighed for at høre om de forskellige

projekter, der foregår rundt omkring i huset, hvor man kan lade sig inspirere, udvikle nye ideer og

kvalificere igangværende projekter samt møde fremtidige samarbejdspartnere på tværs af hospitalets

afdelinger.

Denne Abstractbog for årets Forskningssymposium giver et fint indblik i de mange igangsatte forsknings- og

udviklingsprojekter på hospitalet. Symposiet rummer store tværfaglige projekter og stort set alle specialer

og sundhedsfaglige grupper er repræsenteret i de indsendte abstrakter.

Det stigende antal forsknings- og udviklingsprojekter, videnskabelige publikationer, ph.d.- og forskningsårs-

studerende samt forsknings- og samarbejdsprojekter Kliniske Forskningsenhed på Regionshospitalet

Randers, afspejler hospitalets høje sundhedsfaglige forskningsprofil, som vi kan være stolte af.

Med ønsket om et godt udbytte i forbindelse med deltagelse i Regionshospitalet Randers'

Forskningssymposium 2019!

Lone Winther Jensen Pinar Bor

Lægefaglig direktør Forskningskoordinerende overlæge

Akademisk koordinator

15.00 Velkomst

v/Forskningskoordinerende overlæge, akademisk koordinator Pinar Bor, ph.d.

15.05 Åbningstale

v/Lægefaglig direktør, Lone Winther Jensen

15.15 Session 1: (10 min per oplæg + 2 min spørgsmål)

- Ortopædkirurgisk Afdeling

v/ Rikke Thorninger, overlæge

v/ Karen Romme, reservelæge

- Børn og Unge

v/ Esben Thyssen Vestergaard, overlæge, ph.d., lektor

v/ Jakob Granild, afdelingslæge, ph.d.-studerende

- Afdeling for Folkeundersøgelser

v/ Berit Andersen, professor, ledende overlæge

v/ Camilla Rahr Tatari, videnskabelig assisent

- Mave-Tarmkirurgisk Afdeling

v/ Rune Erichsen, afdelingslæge, ph.d.

v/ Susanne Haas, reservelæge

- Kvindesygdomme og Fødsler

v/ Pinar Bor, overlæge, ph.d., lektor

v/ Berit Bargum Booth, ph.d.-studerende

- Medicinsk Afdeling

v/ Pernille Sarto, ledende overlæge v/ Bo Løfgren, professor, ph.d.

16.30 Fremtidens forskning i Institut for Klinisk Medicin AU og RegionMidt

v/Institutleder på IKM, professor Jørgen Frøkjær

16.50 Pause med kaffe/kage og walk-and-talk ved postergangen

17.30 Session 2: (10 min oplæg+ 2 min spørgsmål)

- Operation og Intensiv

v/ Thorbjørn Grøfte, overlæge, ph.d., lektor

v/ Asger Grandfeldt, 1.reservelæge

- Fysio- og Ergoterapien

v/Gitte Madsen, udviklingsterapeut

- Forskningsenheden v/ Mette Spliid Ludvigsen, professor, seniorforsker

- Patologi

v/ Ida Holm, ledende overlæge, ph.d., dr.med.

v/ Margarita Melnikova Jørgensen, ph.d.-studerende

- Røntgen og Skanning

v/ Mahican Gielen, ledende overlæge

- Apoteket

v/ Charlotte Arp Sørensen, cand. pharm., ph.d.-studerende

v/ Tina Birkeskov Axelsen, cand. pharm., ph.d.-studerende

- Aktiv patient støtte

v/Birgith Hasselkvist, ledende sygeplejerske

- Udviklingsprojekter

v/Rikke Mossin, udviklingssygeplejerske

v/Helle Gøtzsche Olesen, udviklingssygeplejerske

19.00 Afrunding

v/Forskningskoordinerende overlæge, akademisk koordinator, Pinar Bor

19.05 Let middag på Restaurant

19.30 Prisuddeling

v/ Forskningskoordinerende overlæge, akademisk koordinator, Pinar Bor

Abstracts

1

Konservativ behandling af degenerative meniskskader 1Romme KL,

1Nicolini P,

1Thorninger R

1Ortopædkirurgisk Afdeling, Regionshospitalet Randers

Baggrund Indikationen for hvornår menisk patologi er behandlingskrævende har i mange år været flydende. I 2016 kom der nye Nationale Kliniske Retningslinjer for menisk patologi. Disse anbefaler at man primært tilbyder ikke kirurgisk behandling til patienter med degenerative meniskskader uden mekaniske symptomer, i stedet for operation i form af artroskopi. Det har medvirket at der nu laves ca. 50% færre artroskopier på Ortopædkirurgisk afdeling Regionshospitalet Randers. Patienterne med ledlinjeømhed og uden traume henvises i stedet til GLA:D træning, som de selv skal finansiere. I dette studie ønskes det at belyse om den konservative behandlings strategi har effekt således at patienterne undgår operation, og om patienterne gennemfører GLA:D træningen. Metoder Studiet er retrospektivt. Patienter med degenerative meniskskader verificeret ved MR, både med og uden artrose forandringer, som er henvist til GLAD træning, adspørges minimum 6 måneder efter deres ambulante besøg. Patienterne spørges om de har været til GLA:D træningen, og om de er blevet opereret, også hvis de er blevet henvist til den private sektor. Desuden udspørges de til sygemelding, medicin forbrug og BMI. For at afdække komplikationer anvendes validerede scoresystemer; KOOS, EQD5 og VAS. Resultater Der inkluderes 100 patienter som er blevet set i idrætsambulatioriet. De patienter som er noteret til projektet er fordelt; 62 mænd og 38 kvinder. 70 % af patienterne har artrose i mindst et led kammer. 78 % har skade på den mediale menisk, 8% på den laterale og 14% har degenerativ skade på både mediale og laterale menisk. Indtil nu er der indsamlet data for 14 patienter. 9 patienter har været til GLA:D træning. 3 patienter er blevet opereret. Konklusion/diskussion Det forventes at studiet kan være med til at belyse hvorvidt konservativ behandling har langvarig effekt så patienterne undgår operation. Desuden om man kan finde indikatorer til videre undersøgelser om hvilke patienter som bør tilbydes operation.

Abstracts

2

Zoledronat mod knoglebrud hos børn med spastisk lammelse 1Granild-Jensen JB,

2Rackauskaite, G,

3 Søndergaard C,

2Farholt S,

4Langdahl B,

5 Møller-Madsen B,

1 Vestergaard, ET

1Børn og Unge, Regionshospitalet Randers,

2Børn og Unge, Aarhus Universitetshospital,

3Børn og Unge,

Hospitalsenheden Vest, 4Klinik for Knogleskørhed, Aarhus Universitetshospital,

5Ortopædkirurgisk afdeling, Aarhus

Universitetshospital

Baggrund Forekomsten af knoglebrud hos de 2000-2500 danske børn med spastisk lammelse er ikke undersøgt. I et svensk studie fandtes knoglebrud hos op til 4% årligt hos børn med svær spastisk lammelse. Knoglebrud medfører betydelige smerter, lægeundersøgelser og behandling. Desuden et betydeligt ressourceforbrug i familien og i samfundet. I Danmark anbefales forebyggende tilskud af kalk og D-vitamin, men videnskabelige studier indikerer, at bisfosfonater kan øge knogletætheden mere effektivt. Zoledronat er et bisfosfonat, som kan gives skånsomt, men der foreligger utilstrækkelig dokumentation for dets effekt på børn med spastisk lammelse, hvilket forhindrer rutinemæssig anvendelse. Vi vil bidrage til forebyggelsen af knoglebrud ved at undersøge den knoglestyrkende og smertelindrende effekt af zoledronat. Metode Ifølge vores powerberegning skal der inkluderes 52 børn i projektet. Børn i alderen 5 til 17 år med svær cerebral parese randomiseres til to doseringer af zoledronat eller saltvand. Behandlingerne gives intravenøst med 6 måneders mellemrum. Før behandlingen og efter 12 måneder laves knogletæthedsmålinger med DXA og forældrene gennemfører spørgeskemaet CPCHILD. Vi vil lave knogletæthedsmålinger på både distale femur og lumbal columna. Resultater Projektet inkluderer aktuelt fra de pædiatriske afdelinger i Aalborg, Viborg, Herning, Aarhus og Randers. 21 børn er inkluderet siden november 2017 og inklusionen fortsætter til og med februar 2020. Præliminære resultater for baseline knogletæthed vil blive præsenteret. Konklusion Præliminært kan vi vise knogletætheden på distale femur sammenholdt med lumbal columna. Ingen deltager er droppet ud af studiet, men det ser ikke ud til at nå de planlagte 52 børn, hvilket kan svække resultatet.

Abstracts

3

Skræddersyede tilbud om kræftscreening til kvinder med indvandrerbaggrund i socialt udsatte boligområder 1Tatari CR,

1,2Andersen B,

3Brogaard T,

1Badre-Esfahani SK,

4Jaafar N,

1Kirkegaard P

1Afdeling for Folkeundersøgelser, Regionshospitalet Randers,

2Institut for Klinisk Medicin,

3Lægerne Brogaard og Skibsted, Brabrand,

4Afdeling for Gynækologi og Obstetrik, Aarhus Universitetshospital

Introduktion I Danmark tilbydes systematisk kræftscreening for livmoderhals-, bryst- og tarmkræft. Kvinder med indvandrerbaggrund i socialt udsatte boligområder har en højere forekomst af nogle kræftformer sammenlignet med den øvrige danske befolkning. Ved yderligere sammenligning deltager kvinder med indvandrerbaggrund sjældnere i screening, og får ofte stillet kræftdiagnoser i et senere stadie. Endvidere er de karakteriseret ved lavere beskæftigelse, disponibel indkomst og uddannelse. Disse forhold gør det aktuelt og hensigtsmæssigt at undersøge indvandrerkvinders syn på de eksisterende screeningstilbud. Dette gøres med særligt henblik på at udforme et robust skræddersyet screeningstilbud til denne udsatte målgruppe baseret på brugerinddragelse. Materialer og metoder Interviewundersøgelsen indeholder fem fokusgruppeinterviews, to gruppeinterviews med tolk og tre individuelle interviews alle med kvinder med indvandrerbaggrund rekrutteret fra det socialt udsatte boligområde Gellerupparken i Aarhus. Dataanalysen fulgte etnografiske principper, hvor data blev underlagt en iterativ fortolkning med henblik på en tematisk analyse. Resultater Kvinder med indvandrerbaggrund er generelt positive overfor de eksisterende screeningstilbud. Deres manglende deltagelse havde flere årsager og varierede både indenfor og på tværs af kvindernes herkomst. Fælles barrierer for deltagelse var manglende forståelse for forebyggelse samt manglende viden om kræft og screening. Sproglige udfordringer vanskeliggjorde kvindernes deltagelse på flere niveauer, herunder kontakten til sundhedspersonale. Endeligt var der kulturelle forestillinger som eksempelvis beskyttelse af mødommen, der kunne hæmme deltagelsen. Konklusion Manglende viden om kræft og screening, sproglige barrierer og kulturelle forestillinger om mødommen var ifølge indvandrerkvinderne de vigtigste årsager til deres manglende deltagelse i de eksisterende screeningsprogrammer. Kvinderne kunne udpege forbedringspotentialer i screeningstilbuddene, der formentlig vil øge deltagelsen gennem opsøgende undervisning, synlighed og kulturel tilpasning af screeningstilbuddene.

Abstracts

4

The European Polyp Surveillance (EPoS) Trial 1,2

Nymann HS, 1,2

Hvam HL, 1,2

Erichsen R 1On behalf of the International EPoS Group,

2Department of Surgery, Randers Regional Hospital, Denmark

Background Current guidelines recommend surveillance colonoscopies after polyp removal depending on the number and characteristics of polyps, but there is a lack of evidence supporting the recommendations. This abstract outlines the rationale and design of two randomized trials and one observational study investigating evidence-based surveillance strategies following polyp removal. Methods The EPoS studies started to recruit patients in Randers in January 2018. Recruitment has been ongoing in other European countries since April 2015. In Denmark, hospitals in Horsens, Viborg and Herning are also including patients. EPoS study I randomizes 13 746 patients with low-risk adenomas (1–2 tubular adenomas size <10mm, low-grade dysplasia) to surveillance after 5 and 10 years, or 10 years only. EPoS study II randomizes 13704 patients with high-risk adenomas (3-10 adenomas or adenoma ≥10mm in diameter, or adenoma with high-grade dysplasia, or >25% villous features) to surveillance after 3, 5, and 10 years, or 5 and 10 years only. EPoS study III offers surveillance after 5 and 10 years to patients with serrated polyps ≥10mm in diameter at any location, or serrated polyps ≥5mm in diameter proximal to the splenic flexure. All polyps are removed before patients enter the trials. The primary endpoint is colorectal cancer incidence after 10 years. Results In October 2019, roughly 500 patients have been included in Randers. In total, roughly 2000 patients have been included in Denmark and more than 17,000 patients have been included in Europe. Conclusion The present trials aim to develop evidence-based strategies for polyp surveillance, thereby maximizing

effectiveness and minimizing resources. Recruitment is ongoing.

Abstracts

5

Injection of freshly collected autologous adipose tissue into complicated pilonidal lesions 1Haas S,

1Sørensen MJ,

2Lundby L,

1Pedersen AG

1Randers Regional Hospital, Department of Surgery, Denmark,

2Aarhus University Hospital, Department of surgery, Denmark

Background Freshly collected autologous adipose tissue injected into perianal fistulas seems to promote healing. We investigated this technique in 9 pilonidal sinus (PS) patients with non-healing wounds after cleft lift surgery (6), anal near lesions (2) and one primary manifestation of chronic PS. Methods In a prospective interventional pilot study autologous adipose tissues freshly collected on the patient’s abdomen, were injected into chronic PS lesions after surgical revision. The wounds were left open. The procedure was carried out as day case surgery and patients were followed every 2 to 3 weeks until complete healing (skin coverage, no undermining) with the option of repeating treatment if patients presenting with progression but insufficient healing after 3 months. Results On average the procedure lasted 77± 6 minutes and a mean of 22 ± 3 mL of freshly collected autologous adipose tissues was injected into the lesion. 7 (77%) patients healed after a median 60 days (14-195) and the remaining 2 (33%) patients showed significant improvement evaluated by clinical examination and photo documentation. 4 patients needed a re-transplantation (all non-healing after closed incision surgery). We had no complications to the procedure. Conclusion Freshly collected autologous adipose tissue injected into chronical pilonidal lesions seems safe and efficient.

Abstracts

6

Quality of life in patients with pilonidal disease 1Korsgaard PD,

2Sørensen MJ,

3,4Pedersen AG,

1Haas S

1Kirurgisk Afdeling, RHR,

4Kirurgisk afdeling RHH

Background It is a common assumption that chronic pilonidal sinus (PS) decreases quality of life (Qol) and fitness for work in those affected, however, very little evidence exists to support this. The aim of this study was to describe how chronic PS affects the patients’ Qol using two questionnaires, as no validated Qol-score exist for this patient category. Methods 145 patients with chronic PS filled in questionnaires before having Cleft Lift surgery; 95 completed the Eq-5D-3L Qol and 50 completed a symptom-based questionnaire made in our department. The questionnaires’ ability to capture the impact of the condition was evaluated. Results Age(p=0.89), gender(p=0.22), debut of disease(p=0.53) and BMI(p=0.66) was comparable for the two

groups. Using the Eq-5D-L3 we found no difference in any of the five questions compared to the general

Danish population (all p>0.05). Using the symptom-based score 48% reported that PS affected their Qol and

48% had affected fitness to work.

Conclusion

The Eq-5D-L3 can’t capture the impact of PS in patients’ Qol. The symptom-based reveals that patients are

bothered and that we need to be asking symptom-based questions to describe their Qol.

Abstracts

7

LASCCA (Adjuvant Low dose ASpirin in Colorectal CAncer) 1Haas S,

1Emmertsen KJ,

1Demming R

1Mave-tarmkirurgisk Afdeling, Regionshospitalet Randers

Baggrund Studier har vist at små doser Magnyl nedsætter risikoen for tarmkræft, nedsætter forekomsten af spredning efter diagnosticeret tarmkræft og forbedrer sygdomsfri- og / eller samlet overlevelse. Magnyl virker ved at hæmme et enzym (COX-2), der er overudtrykt ved tarmkræft. Generne PIK3CA, PIK3R1 IGF2, IGR2 og PTEN har en stor betydning for udvikling og spredning af tarmkræft. Undersøgelser tyder på, at sådanne ændringer i PIK3CA genet kan bruges til at forudsige eventuel effekt af behandling med Magnyl. Hovedformålet med dette studie er at undersøge, om supplerende behandling med 160 mg acetylsalicylsyre (Magnyl) én gang dagligt i 3 år kan forlænge den gennemsnitlige tid til sygdomstilbagefald (Time To Recurrence, TTR) hos patienter med tarmkræft der har ændringer i PI3K signalvejen, sammenlignet med placebo. Metode Internationalt, multicenter dobbelblindet, randomiseret forsøg inkluderende 204 colorectal cancer patienter med PIK3CA genet. Randomiseres til behandling med 160 mg Magnyl dagligt eller placebo i 3 år. Inklusionskriterier: Colorectal cancer stadie II-III med genmutationer i PI3KCA, PIK3R1 eller PTEN. Radikalt opereret, ingen kontraindikationer mod magnylbehandling og i god almentilstand. Patienter med mutationen der allerede behandles med magnyl indgår i ekstra kontrolgruppe. Patienterne screenes for eksklusionskriterier ved diagnosetidspunktet. Kan de medvirke, bliver der taget en særlig biopsi fra tumor efter operationen som analyseres for genmutationerne. Patienter med mutationerne bliver randomiseret til Magnyl eller placebo-behandling i 3 år. Opfølges hver 3. måned med telefon konsultation/fremmøde indtil 3 år efter operationen. Herefter en afsluttende kontrol efter 5 år. Resultater Time to recurrence (TTR) er det primære endepunkt, Disease free survival (DFS) og Overall survival (OS) vil ligeledes blive udregnet. Konklusion Studiet inkluderer fortsat, her i Randers har vi indtil nu inkluderet 6 patienter med mutationen.

Abstracts

8

Accuracy of colposcopy-directed biopsy versus Dynamic Spectral Imaging directed biopsy in correctly identifying the grade of cervical dysplasia in women undergoing conization 1Booth BB,

2Petersen LK,

3Blaakaer J,

4Johansen T,

4Mertz H,

5Dahl K,

1Bor P

1Afdeling for Kvindesygdomme og Fødsler, Regionshospitalet Randers,

2Afdeling for Kvindesygdomme og Fødsler, Odense

Universitetshospital, 3Klinisk Institut, Odense Universitet,

4Patologisk Afdeling, Regionshospitalet Randers,

5Afdeling for

Kvindesygdomme og Fødsler, Aarhus Universitetshospital

Background Dynamic Spectral Imaging (DSI) colposcopy has previously been found to improve sensitivity of CIN2+ detection. The aim of this study was to compare the histological diagnosis of Colposcopic-Directed Biopsies (CDB) to that DSI-directed biopsies in women undergoing conization, using the histological diagnosis of the conization specimen as gold standard. Methods Women referred to colposcopy were included in a prospective cohort study at Randers Regional Hospital, Denmark from January 2016 to February 2019. All women had four cervical punch biopsies taken. The first biopsy was taken from the area that appeared most abnormal by conventional colposcopy (i.e. CDB) and the second biopsy from the area that appeared most abnormal using the DSI map. An additional two biopsies were taken from either other visible lesions or as random biopsies. Biopsies were analyzed separately. If any biopsies revealed cervical dysplasia of such a degree that excisional treatment was recommended the patient was referred for conization. Subsequently, we compared the histological diagnosis of CDB and DSI-directed biopsies to that of the cone biopsy. Results A total of 573 women were enrolled, 170 of which underwent conization. In women with an adequate colposcopy and representative biopsies (n=124) there was an overall agreement rate between the worst biopsy diagnosis (of any four) and the conization diagnosis in 95.2% (95% CI 89.8-98.2) of women. CDB diagnosis matched the cone diagnosis in 80.6% (95% CI 72.6-87.2) of women. DSI-directed biopsy matched the cone diagnosis in 83.9% (95% CI 76.2-89.9) of women. The difference in detection rate between the CDB and the DSI-directed biopsy was however not significant (p=0.54). Taking four biopsies increase the detection rate of cervical dysplasia to 95.2%, this was a significant increase from both CDB alone (p=0.0008) and DSI-directed biopsy alone (p=0.0053). Conclusions We found no significant difference in the ability to identify the cervical dysplasia grade between CDB and DSI-directed biopsies. A greater detection rate of cervical dysplasia was achieved through four biopsies compared to one CDB biopsy or one DSI-directed biopsy.

Abstracts

9

Evidence of involvement interventions for older adults in transitional care between hospital and primary care - A scoping review 1,2,3

Ludvigsen MS, 1Høy B

1Clinical Research Unit, Randers Regional Hospital,

2Institute of Clinical Medicine, Aarhus University,

3Faculty of Nursing and Health

Sciences, Nord University

Background In Denmark, older adults (+65) account for more than 40 percent of hospitalizations, however they represent as much as 20% of the population. There are shortcomings in access, coordination, and patient-centered care, and in 2015 were 18% of reported adverse events related to transition. It was not until after the discharge that the primary care professionals identified the events. The objective of this scoping review was to identify and map existing evidence of involvement interventions for older adults in transitional care between hospital and primary care. Methods Following the JBI Scoping Review methodology a systematic search was conducted in Medline [PubMed], CINAHL [EBSCO], PsycINFO [Ovid], EMBASE [Ovid], and Web of Science. A narrative summary accompanied the charted results. Results We included sixteen studies published between 2003 and 2017 from USA (five), Norway and Sweden (three), Denmark (two), Netherlands, Switzerland, France, Canada, Australia and New Zealand (one), and covering a population of 10.762. Identified involvement interventions were based on: electronic devices (four), discharge planning (four), coaching (two), and as home visit and home follow-up interventions (four). Four interventions could not be categorized. Where an intervention principle could be identified, contact with the care provider was essential. Thirteen out of nineteen studies showed successful outcomes i.e. decreased readmission rates, patients were more engaged in their care, improved self-care, improved interdisciplinary cooperation, improved quality of care provision, increased patient and family satisfaction and decreased costs. Conclusion We identified several types of involvement interventions for older adults in transitional care between hospital and primary care, which are to be evaluated before further development and implementation in a Danish setting.

Abstracts

10

Biological and molecular tumor profile is dependent on the tumor microenvironment 1,2

Jørgensen MM, 2Bramsen JB,

2Andersen CL,

3Hamilton-Dutoit SJ,

1,2Holm IE

1Department of Pathology, Randers Regional Hospital,

2Department of Clinical Medicine, Aarhus University,

2Department of Clinical

Medicine (MOMA), Aarhus University, 3Institute of Pathology, Aarhus University Hospital

Background Colorectal cancer (CRC) is the third most common cancer form worldwide. Pathologically similar tumors often vary in prognosis and treatment response due to underlying molecular heterogeneity, which is not taken into account by pathological classification. Several studies highlighted the importance of the cellular composition around the tumor (tumor microenvironment (TME)) for tumorigenesis. Our group has stratified CRC into prognostic groups based on gene expression profile and TME composition. However, this classification cannot be utilized clinically due to high cost and technically demanding analysis. The aims of this PhD study are to identify prognostic biomarkers within TME using immunohistochemistry (IHC) and to improve our understanding of tumor biology. Methods This project includes 281 CRC samples from 257 patients subjected to gene expression profiling. IHC panel consists of markers for T-cells (CD3), B-cells (CD20), macrophages (CD68, CD163), and cancer associated fibroblasts (CAF) (α-SMA, FAP). Biomarker expression has been quantified at the tumor core (TC) and invasive margin (for carcinomas) / neoplasia border (for adenomas) (IM/NB) as areal fraction with digital pathology software (Visiopharm). Results All the biomarkers had a strong correlation between expression in the two regions and were significantly higher expressed at the IM/NB compared to TC (except for anti-CD68 in adenomas). In more advanced pathological tumor stages T-cell (CD3) expression in TC and IM/NB and B-cell expression in IM/NB were decreasing, whereas CAF expression was increasing. Expression level of macrophages and B-cells was significantly associated with anatomical tumor location. In carcinomas CD68-positive macrophages were more prevalent compared to CD163-positive cells, while there was no significant difference in adenomas. Microsatellite instable tumors were associated with high macrophage expression, and low macrophage expression was associated with microsatellite stable tumors. Furthermore, high expression of CD163-positive cells was associated with presence of BRAF mutation(s). Conclusion This study provides insight into relationship between TME and molecular/biological tumor profile.

Abstracts

11

Operation Feedback -changing the culture of learning - An Action Research study 1Stochholm A,

2Mossin R,

3Skipper M,

4Poulsen CS,

5Krogh K

1Dept. of Anaesthesiology and Intensive Care, Herning Regional Hospital,

2Anaesthesiology Dept. of. and Intensive Care, Randers

Regional Hospital, 3Nothern Postgraduate Medical Training Region, Centre for Health Sciences Education, Aarhus University,

4Dept.

of Anaesthesiology and Intensive care, Viborg Regional Hospital, 5Research Center for Emergency Medicine, Aarhus University Hospital, Dept. of Anaesthesiology and Intensive Care, Aarhus University Hospital.

Background How do you give unsolicited feedback to your superior? And in a way that both of you benefit, develop, become wiser, and at the same time strengthen your relationship? Methods An inductive thematic analysis of semistructured interviews was done with the frontrunnergroup as well as with a control group. Results at baseline Culture: When it comes to the positive feedback it works great, but it's really hard to say: "in my opinion you didn't perform that well" Enables: You must dare to put you self in play. And that can be tough. But if didn't speak up, it gets more difficult with time. Barriers: The expectation of how the receiver will handle feedback – is a barrier. Development: If we created a culture where it was ok to question each other actions from a perspective of curiousity, then we would gain knowledge. Practicalities: We are often good at following up on acute situations, because then we know to talk about. But when it comes to more daily rutines, we tend to neglect or forget to talk about it. Results at 18 month follow up Culture: Focus has shiftet from feedback towards exploring the differenties in the way we do things. Enables: You can approach feedback with curiousity: "Why did we do it this way?" Questions like that open the dialogue. Barriers: If you look at the feedback as professional sparring, it changes and becomes less personal. Development: Feedback is now in the back of our minds – not that it wasn't before, but now we have become more conclous about it. And we have spread the word to other departments tool. Practicalities: Using the word "I" is af good place to start: "I was experiencing.." "I have the feeling.." etc. Because a feeling is never wrong. Conclusion Overall, the feedback culture in which verbal feedback is actively embedded in intercollegiate cooperative relation seems to changed to be more constructive as barriers are beeing diminished. We saw a positive change towards a more constructive learning culture. But initiating the feedback conversation is still dependent on interpersonal relations, and much easier to initiate with a curious approach – or by an invitation from the superior.

Abstracts

12

D vitamin deficiency among Danish pregnant women – a need for an increased supplementation in pregnancy? 1Vestergaard AL,

2Justesen S,

2Volqvartz T,

1Aagaard SK,

3Andreasen MF,

4Lesnikova I,

5Uldbjerg N,

2 Larsen A,

5 Bor P

1Department of Obstetrics and Gynecology, Randers Regional Hospital ,

2Department of Biomedicine, Pharmacology, Aarhus

University, 3Section for Forensic Chemistry, Department of Forensic Medicine, Aarhus University,

4Department of Pathology, Vidant

Medical Center, Greenville NC, US, 5Department of Obstetrics and Gynecology, Aarhus University Hospital

Background Vitamin D deficiency is associated with an increased risk of pregnancy complications related to placental function like Intrauterine Growth Retardation (IUGR), Pre-eclampsia (PE) and gestational diabetes, although the underlying mechanisms are far from elucidated. Pregnancy complications increase the risk of preterm delivery, perinatal morbidity and mortality. Accumulating evidence links exposure to pregnancy complications and vitamin D deficiency itself to long-term health problems for both the mother and the child. This underlines the need for sufficient vitamin D supply during pregnancy where the fetus is highly dependent of the maternal vitamin D supply. Methods To investigate prevalence of vitamin D deficiency and relationship with maternal lifestyle and pregnancy health, 223 women were included in a prospective cohort, when attending the national prenatal program (week 10-13, 94% participation), June-December 2016. Plasma 25(OH)D level was determined and lifestyle information obtained upon inclusion and correlated to pregnancy outcome. Placental samples were collected to assess vitamin D metabolism by qPCR. Results Though the majority (92%) followed official recommendations i.e. a 10µg daily vitamin D supplementation, 43.8% was vitamin D deficient (25(OH)D <75 nmol/L), and 12.1% and 1.8% respectively were severely (25(OH)D<50 nmol/L) or very severely deficient (25(OH)D<25 nmol/L). Deficiency (25(OH)D<75 nmol/L), was more common (51.8%) among women with BMI>30. Maternal 25(OH)D were 45.6% and 13.3% below average in IUGR and PE pregnancies respectively, albeit only significant for IUGR (p=0.007). Increasing maternal Body-Mass-Index (BMI) was correlated with increased mRNA expression of the vitamin D degrading enzyme CYP24A1 (p=0.003, n=30), but not expression of the activating enzyme CYP27B1. Conclusion Vitamin D deficiency is common in Danish pregnant women despite high adherence to official guidelines indicating current guidelines might be insufficient. Women with high BMI are especially affected and may have an altered placental vitamin D metabolism. Future studies should investigate the benefits of increased vitamin D supplements with regard to both obstetric outcomes and underlying changes in placental vitamin D metabolism.

Abstracts

13

IMPROVE-IT2: Implementing non-invasive circulating tumor DNA analysis to optimize the operative and postoperative treatment for patients with colorectal cancer – Intervention Trial 2. Study protocol 1Nors J,

2Henriksen TV,

1 Gotschalck KA,

3 Juul T,

4 Søgaard J,

3Iversen LH,

5 Andersen CL

1Kirurgisk Afdeling, Regionshospitalet Randers,

2Molekylærmedicinsk Afdeling, Aarhus Universitetshospital,

3Mave- og Tarmkirurgi,

Aarhus Universitetshospital, 4Dansk Center for Sundhedsøkonomisk Forskning, Syddansk Universitet,

5 Molekylærmedicinsk Afdeling,

Aarhus Universitetshospital.

Background Despite combined treatment with surgery and adjuvant chemotherapy still 33% of UICC stage III CRC patients experience recurrence. With current standard-of-care radiological surveillance, only approximately 15% of recurrences are detected sufficiently early to allow curative intended intervention. Recent studies have shown that longitudinal circulating tumor DNA (ctDNA) analysis detects recurrence up to 16.5 months (average ~9 months) earlier than standard-of-care surveillance, opening up new venues for surveillance. We here describe the IMPROVE-IT2 protocol, a multicenter randomized controlled trial investigating if ctDNA guided surveillance of adjuvant chemotherapy treated CRC patients result in earlier detection of recurrent disease and identify more patients eligible for curative treatment than standard-of-care radiological surveillance. Methods In the experimental arm, longitudinal ctDNA analysis will be performed every 4 months postoperatively. At time of first positive ctDNA test, patients shift to intensive radiological assessment by FDG-PET/CT scans every 3 months. The control arm will undergo surveillance according to current Danish Guidelines with CT scans at 12 and 36 months. The primary outcome is the proportion of recurrence patients receiving curative resection or local treatment. The overall survival, quality of life, and fear of cancer recurrence will be compared in the two arms. Discussion The central hypotheses of this study is that ctDNA guided postoperative surveillance will lead to shorter time to recurrence, lower tumor burden at time of recurrence, an increased rate of curative intended intervention, increased effectiveness of non-curative interventions. Altogether, this is expected to improve overall survival. Trial registration This study is approved by the Danish Ethics Committee (j. no. 1-10-72-162-19). ClinicalTrials.gov Identifier: NCT04084249

Abstracts

14

Assessment of postoperative gastrointestinal motility in colorectal surgery: A study with the Motilis 3D-Transit system 1Nors J,

2 Klinge MW,

1 Sommer T,

3 Laurberg S,

2 Krogh K,

3 Funder JA

1Kirurgisk Afdeling, Regionshospitalet Randers,

2Lever-, Mave- og Tarmsygdomme, Aarhus Universitetshospital,

3Mave- og

Tarmkirurgi, Aarhus Universitetshospital

Background Postoperative recovery following colorectal surgery remains impaired by severe complications including postoperative ileus (POI). Human studies of POI have been limited by a lack of safe and easy-to-use objective methods. Motilis 3D-Transit is a completely ambulatory, minimally invasive system whereby electromagnetic capsules are followed by external sensors during their passage of the gastrointestinal (GI) tract. The aim of this study was to evaluate the applicability of the 3D-Transit system in a surgical setting. Method We included 12 patients undergoing elective segmental colonic resection with primary anastomosis. To study region specific motility, three electromagnetic capsules were administered. One was taken three hours before surgery, the next was taken one hour before surgery, while the third was placed distal to the anastomosis during surgery. Total and regional GI transit times as well as time until first propulsive colonic contraction were determined. Results All patients tolerated the setup well with no adverse events related to the 3D-Transit system. Large variations were found in total GI (26.7-127.6 hours), gastric emptying (0.07->106.9 hours), small intestinal (1.2-58.4 hours) and colorectal transit time (14.3->118.1 hours). Time from end of surgery to first propulsive movement in the colon varied from 3.9 to 85 hours. No correlation was found between parameters of GI motility and tolerance of an oral diet or recovery of bowel function. Conclusion The 3D-Transit system allows safe assessment of GI motility in patients operated with segmental colonic resections and primary anastomosis for colorectal cancer. Postsurgical motility varies significantly between patients

Abstracts

15

Nearly one third of woman with non-native background, neither attend HPV-vaccination nor cervical cancer screening - results from a nationwide register-based cohort study 1Badre-Esfahani S,

1Larsen MB,

2Seibæk L,

3Petersen LK,

3Blaakær J,

1Andersen B

1Afdeling for Folkeundersøgelser, Regionshospitalet Randers,

2Afdeling for Kvindesygdomme og Fødsler, Aarhus

Universitetshospital, 3Gynækologisk Obstetrisk Afdeling, Odense Universitetshospital

Background Cervical cancer is preventable through Human Papilloma Virus (HPV) vaccination and routine cervical cancer screening. However, due to socio-cultural barriers, it is likely that non-natives, especially from Middle-Eastern and North-African (MENA) countries, are more prone than natives, neither to attend HPV-vaccination nor cervical cancer screening (combined non-attendance). We aimed to investigate differences in degree of combined non-attendance in Denmark among native and non-native women; and to analyze the association between country of origin and combined non-attendance adjusted for socio-economic status (SES). Methods Logistic regression was performed to estimate the adjusted odds ratio (adj. OR) with 95% CI for combined non-attendance compared to some degree of attendance. Results A total of 170,158 women were included. Degree of combined non-attendance was 10.0 % [9.8-10.1] among natives and 27.1% [26.4-27.7] among non-natives. Degree of combined non-attendance was highest for women from the MENA region (30.1% [29.2-30.9]), with a large country specific variation. There was furthermore a strong association between origin from MENA and combined non-attendance. Somali women showed the strongest association (adj. OR=7.5 [6.3-8.9]. Conclusion Denmark has relatively low degree of combined non-attendance in HPV vaccination and cervical cancer screening programs. However, these programs seem to be better tailored to the needs of native women and may not be sufficiently cater for the needs of the fast-growing and diverse non-native population. In order to secure more equal attendance in cervical cancer prevention in the future, health authorities should address this apparent ethnic inequality and studies should focus on developing interventions sensitive to socio-cultural factors.

Abstracts

16

Assessing the specimen quality of cervico-vaginal self-samples - A pilot study 1Christensen P,

1Brøndum R,

1Andersen RH,

2Tranberg M,

1Department of Pathology, Randers Regional Hospital, Denmark,

2Department of Public Health Programmes, Randers Regional

Hospital, Denmark

Background The low specificity of high-risk human papillomavirus (HPV) testing in self-sampled cervico-vaginal specimens requires triaging of HPV-positive self-samplers before referral for colposcopy. Cytology is the standard triage-test for women with an HPV positive sample collected at the general practitioner (GP), but self-sampled material is inaccurate for cytological assessment, because of lower specimen quality. However, it remains unknown if the specimen quality improves then using a specially designed self-sampling device (Evalyn brush). The aims were to assess the specimen quality of the self-samples and to compare the cytological diagnosis between the self-sample and the GP-sample. Methods Paired HPV positive GP-samples and self-samples collected from 15 women aged 65-69 years were included. The self-sample was collected at home using the dry Evalyn brush. For both sample types, cell material was fixed on a glass slide using thin-layer technology. The glass slides were PAP stained and interpreted by three cytotechnologists. Specimen quality was evaluated based on the detection of sufficient endocervical cells, cytomorphological examination, and the amount of cell material. Cytological diagnoses were categorized per the Bethesda 2001 grading system and the GP-sample served as the gold standard. Results Sufficient endocervical cells were found in 40% of the self-samples compared to 100% in the GP-samples. More than half of the self-samples (53%) were classified with satisfied cytomorphological examination, while this was the case for all GP-samples. The self-samples showed 14 cases of normal cytology and one case of high-grade cytological lesions. For the GP-sample, these numbers were 8 cases of normal cytology, four cases of low-grade cytological lesions, and three cases of high-grade cytological lesions. The overall percentage of agreement in cytological diagnosis between cytology on self-samples versus GP-samples was 60%. All self-samples had a high amount of squamous cells. Conclusions Cytology as a triage-test on HPV positive self-samples is inaccurate, even when using a specially designed self-sampling device. However, the use of HPV testing in self-samples is justified by the high amount of squamous cells.

Abstracts

17

Expanding the upper age limit for cervical cancer screening- a nationwide study 1Tranberg M,

2Petersen LK,

3Elfström KM,

4Hammer A,

5Blaakær J,

6Jensen JS,

1,7Andersen B

1Department of Public Health Programmes, Randers Regional Hospital, Denmark,

2Department of Obstetrics and

Gynecology, Odense University Hospital, Odense, Denmark, 3Karolinska University, Stockholm, Sweden,

4Aarhus

University Hospital, Denmark, 5Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark,

6Statens Serum Institut, Copenhagen, Denmark,

7Department of Clinical Medicine, Aarhus University

Background Cervical cancer screening in many countries including Denmark stops at the age of 64. However, an incidence peak of cervical cancer in women beyond the current screening age combined with the increasing female life expectancy has raised the question if the upper age limit should be changed to 69 years. This study, the first of its kind, evaluates the effect of expanding the target population in the Danish cervical cancer screening program to include women aged 65-69 years. The study also evaluates if HPV self-sampling is an appropriate supplementary screening method among older women. Methods The study is a nationwide population-based non-randomized intervention study. We consecutively include all 65-69-year-old women without a record of a cervical cytology sample or screening invitation within the last five years. Women deemed ineligible for screening are excluded. Eligible women residing in the Central Denmark Region are allocated to the intervention group (n=20,000) and invited for HPV-based screening by having a cervical cytology sample taken at the general practitioner (GP) or to request a self-sampling kit. The HPV testing is performed using the Cobas 4800 assay (Roche Diagnostics). Women residing in the other Danish regions are allocated to the control group receiving standard care (n=71,500), which is no invitation for cervical cancer screening, but with the possibility to have an opportunistic sample taken at the GP in case of symptoms. Outcomes in the intervention group are the proportion of targeted women participating by GP-based screening or self-sampling, HPV prevalence, compliance to follow-up among HPV-positive self-samplers, proportion of abnormal cytological and histological findings, and the screening history of participants and non-participants. The following outcomes are compared between the intervention and control group: testing rate, proportion of abnormal cytological and histological findings, and the incidence and mortality of cervical cancer developed within 5 and 10 years. Results The study inclusion began in April 2019 and will be on-going in the next two years. Conclusion This study provides important evidence allowing us to determine the effect including the pros and cons of expanding the upper age limit in an organized cervical cancer screening program.

Abstracts

18

Venous thromboembolisms following laparoscopic hysterectomy for benign disease in a Danish cohort 1Mengu HLM,

2Dueholm MD,

3Bach CB,

4Al-Taie RT,

5 Raaby VR,

1 Bor P,

1Department of Obstetrics and Gynecology, Regional Hospital of Randers,

2Department of Obstetrics and Gynecology, Aarhus

University Hospital, 3Department of Obstetrics and Gynecology, Regional Hospital of Horsens,

4Department of Obstetrics and

Gynecology, Regional Hospital of Viborg, 5Department of Obstetrics and Gynecology, Regional Hospital of Herning, Department of

Obstetrics and Gynecology, Regional Hospital of Randers

Background Postoperative venous thromboembolism (VTE) is a common complication following gynaecologic procedures, particularly for women undergoing open surgery or with malignancy. However, there is limited knowledge about the risk of postoperative VTE after laparoscopic procedures for benign disease. Based on retrospective studies the risk appears to be present but low which has led authors to discuss whether thromboprophylaxis (TP) is indicated. To date there are no evidence-based guidelines that specifically provide recommendations to prevent VTE in this patient category. The aim of our project was to investigate the incidence of VTE and the current use of thromboprophylaxis in Danish women undergoing laparoscopic hysterectomy for benign disease. Methods Women who underwent hysterectomy for benign indication between January 1st 2015 and December 31st 2017 were included. The Danish Hysterectomy and Hysteroscopy Database (DHHD) and the Danish National Patient Registry were used to collect data on patient and operation characteristics, postoperative complications and thromboprophylaxis. Information about the current use of thromboprophylaxis in Denmark was retrieved through electronic surveys sent to all Gynaecologic departments in Denmark reporting data to DHHD. Results Ongoing study, preliminary results are presented. Out of 11731 hysterectomized women, 81% (n=9507) underwent minimally invasive hysterectomy in which 66% (n=7739) were laparoscopic. Pharmacologic TP was used in 86% (n=6646) of laparoscopic hysterectomies. Data concerning VTE incidence will be completed in November 2019. Data from the electronic survey were provided by 25 Gynecologic departments (83%). Eighty-eight percent gave TP to all patients, while 12% only to high risk patients. Pharmacological TP was used by 88% and most commonly used was Fragmin ranging in doses between 2500 and 5000 IE. Perioperative thromboembolic- deterrent (TED)-stockings was used by 56%. Conclusion Our preliminary results suggest that the majority of women undergoing laparoscopic hysterectomy in Denmark are given thromboprophylaxis. The type and dosage vary between departments.

Abstracts

19

Use of over-the-counter drugs and prescription drugs among Danish pregnant women 1,2

Volqvartz T, 1,2

Vestergaard AL, 1,2

Aagaard SK, 3Andreasen MF,

4Lesnikova I,

5Uldbjerg N,

2Larsen A,

1Bor P

1Department of Obstetrics and Gynaecology, Randers Regional Hospital, Denmark

2Department of Biomedicine, Pharmacology, Aarhus University, Aarhus, Denmark

3Section for Forensic Chemistry, Department of Forensic Medicine, Aarhus University, Aarhus, Denmark

4Department of Pathology, Vidant Medical Center, Greenville NC, USA

5Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark

Background Intrauterine exposures affect perinatal and late-life health. In later years, the potential risks of popular over-the-counter drugs such as acetaminophen have received increasing attention. However, subtle toxic effects are hard to determine and avoid if exposure patterns are not known. The purpose of this study was to assess their use of both prescription drugs and over-the-counter (OTC) drugs. Methods A total of 225 women were included in the study when attending the national perinatal risk assessment program (nuchal translucency scan) at Randers Regional Hospital, in the period between June until December 2016. Results According to their self-reported information, 24.4% had used prescription drugs during their pregnancy, and 48.4% had used OTC drugs mainly acetaminophen (41.8%). Not less than 9.3% were habitual smokers, 44.4% stated a daily use of caffeinated beverages, and 1.3% used illegal drugs. According to ultra-performance liquid chromatography with high-resolution time-of-flight mass spectrometry (UPLC-HR-TOFMS) analysis on blood samples, 5.3% had traces of prescription drugs and 8.9% of OTC drugs (acetaminophen 7.1%). Traces of smoking were identified in 9.3%, caffeine in 83.6 %, and illegal drugs in 0.9%. Conclusion These results indicate a substantial use of OTC drugs and caffeine among Danish pregnant women. Blood analysis and self-reported information on medicine, illegal drugs and smoking exposure were aligned, but many women appear unaware of their caffeine intake. As common substances may be associated with adverse pregnancy outcomes, healthcare professionals should inquire about such habits during pregnancy.

Abstracts

20

NT-proBNP Measurements to Rule-out Heart Failure among Atrial Fibrillation Patients: A Prospective Clinical Study 1Budolfsen C,

1Schmidt AS,

1Lauridsen KG,

2Bang C,

1Nguyen DT,

3Poulsen CB,

2Rickers H,

2,3,4Løfgren B,

1Department of Internal Medicine and Clinical Research Unit, Randers Regional Hospital, Denmark,

2Department of Internal

Medicine, Randers Regional Hospital, Denmark, 3Department of Clinical Medicine, Aarhus University, Denmark,

4Department of

Cardiology, Aarhus University Hospital, Denmark

Background Heart failure and atrial fibrillation often co-exist and heart failure is important to identify. Performing an echocardiography is considered gold-standard for diagnosing heart failure, but echocardiography may not always be readily available. The biomarker N-terminal pro brain natriuretic peptide (NT-proBNP) can be used to rule out acute heart failure in patients with sinus rhythm, however, atrial fibrillation affects the level of NT-proBNP in the blood. The objective of this study is to identify an optimal NT-proBNP threshold for ruling-out heart failure among atrial fibrillation patients. Methods This is an observational clinical study including patients admitted to hospital with atrial fibrillation. We aim to include a total of 403 patients from The Emergency Department and Acute Heart Clinic at Randers Regional Hospital. Project examinations will include blood-sampling for quantification of NT-proBNP levels, an echocardiography, and a chest X-ray. Lastly, patients will be asked to answer a questionnaire regarding their symptoms. The primary endpoint will be the negative predictive value of the optimal NT-proBNP cut-off level for ruling out heart failure among atrial fibrillation patients. Results Results are pending and the study design will be presented at the symposium. Conclusion This study will evaluate if the use of NT-proBNP.

Abstracts

21

Maximum-Fixed Energy Shocks for Cardioverting Atrial Fibrillation 1Schmidt AS,

1Lauridsen KG,

1Torp P,

2Bach LF,

1Rickers H,

1Løfgren B

1Medicinsk Afdeling, Regionshospitalet Randers,

2Operation og Intensiv, Regionshospitalet Randers;

Background Direct-current cardioversion is one of the most commonly performed procedures in cardiology. Low-escalating energy shocks are common practice but the optimal energy selection is unknown. We compared maximum-fixed and low-escalating energy shocks for cardioverting atrial fibrillation. Methods In a single-centre, single-blinded, randomized trial we allocated elective atrial fibrillation patients to cardioversion using maximum-fixed (360-360-360 J) or low-escalating (125-150-200 J) biphasic truncated exponential shocks. The primary endpoint was sinus rhythm one minute after cardioversion. Safety endpoints were any arrhythmia, myocardial injury, skin burns, and patient-reported pain after cardioversion. Results We randomized 276 patients, and baseline characteristics were well-balanced between groups (mean ±standard deviation age: 68±9 years, male: 72%, atrial fibrillation duration >one year: 30%). Sinus rhythm one minute after cardioversion was achieved in 114 of 129 patients (88%) in the maximum-fixed energy group, and in 97 of 147 patients (66%) in the low-escalating energy group (between-group difference; 22 percentage points, 95%-confidence interval; 13-32, P<0.001). Sinus rhythm after first shock occurred in 97 of 129 patients (75%) in the maximum-fixed energy group compared to 50 of 147 patients (34%) in the low-escalating energy group (between-group difference; 41 percentage points, 95%-confidence interval; 30-51). There was no significant difference between groups in any safety endpoint. Conclusion Maximum-fixed energy shocks were more effective compared with low-escalating energy shocks for cardioverting atrial fibrillation. We found no difference in any safety endpoint.

Abstracts

22

At være ægtefælle til en patient indlagt på intensivafdeling: En pludselig og uventet livsomvæltning 1Dahl LS,

2Norlyk A

1Intensiv Terapiafsnit, Regionshospitalet Randers,

2Institut for Folkesundhed, Aarhus Universitet

Baggrund Op mod 60 % af pårørende på intensivafdelinger (ITA) er i risiko for at udvikle posttraumatisk stress. Flere studier peger på, at ægtefæller er den gruppe pårørende, som oplever størst belastning. Samtidig spiller ægtefæller en betydelig rolle som støtte for patienten på intensivafdeling og i rehabiliteringsforløbet. Ægtefællers oplevelse af være involveret i denne turbulente fase er underbelyst inden for intensivsygepleje. Litteraturen peger på, at ægtefællernes oplevelser er præget af eksistentielle aspekter, som de holder for sig selv. Formålet med studiet var at undersøge, hvordan eksistentielle fænomener træder frem hos ægtefæller, der har sin partner indlagt med akut og kritisk sygdom på ITA. Metode En fænomenologisk undersøgelse baseret på Karin Dahlbergs Reflective Lifeworld Research. Der blev i foråret 2019 udført semistrukturerede, dybdegående interview af fem ægtefæller til patienter med akut og kritisk sygdom indlagt på ITA i Randers. Analysen bevæger sig fra det vertikale til det horisontale niveau, med henblik på at identificere meningsenheder, som kan samles til essensen og konstituenter af ægtefællers eksistentielle oplevelser. Resultat Essensen af ægtefællers eksistentielle oplevelser træder gennem analysen frem som en pludselig og uventet livsomvæltning, hvor ægtefællerne pendulerer mellem håb og håbløshed, livsmod og uvished. De er på kanten til det ukendte og kan ikke gøre andet end at blive i situationen. De tager én dag ad gangen og forestillingen, om det fælles levede liv, bliver med ét forandret. Ægtefællerne befinder sig i en lidelse, som de udholder alene. Følelser skjules udadtil, men i kroppen opstår ubehagelige tegn. Den eksistentielle alenehed opleves til trods for, at ægtefællerne oplever ITA som et midlertidigt tilholdssted, hvor de kan være med deres partner og føler sig set af personalet. Konklusion Ægtefæller har brug for at blive set som mennesker med behov for omsorg, og ikke kun som en praktisk hjælp og ressource for patient og personale.

Abstracts

23

Association between nutritional status and surgical outcomes in elderly patients with colorectal cancer in Randers, Denmark 1Bhuller CM,

1Emmertsen KJ

1Mave- og Tarmkirurgisk Afsnit, Regionshospital Randers

Background In Denmark, approximately 4000 new cases of colorectal cancer are diagnosed each year (2). Out of these, about 80% of the patients undergo resection with curative intent. As our population ages, we are also faced with higher number of individuals that get cancer at a later stage. This is also associated with higher levels of morbidity and mortality within this group. Malnutrition is a common manifestation of colorectal cancer and is often underdiagnosed. Research shows that ageing patients with cancer have a higher risk of mortality and treatment-associated morbidity than younger patients. In this study, we aim to investigate if pre-, peri- postoperative nutritional status affects outcomes in elderly patients; if nutritional status affects length of hospital stay, and if age affects readmission rates and further hospital stay after colorectal surgery. Materials This is a retrospective study, including all patients undergoing colon resection in Randers between June 2016 – June 2018, aged 70 years and above. Data on pre-, peri- and postoperative nutritional status, postoperative complications, length of stay, readmission rates and overall recovery status 2 weeks postoperatively will be retrieved from medical records. One year survival will be calculated. Methods & Conclusion Data are currently being collected and we expect results to be ready within the next 3 months. The results will help us understand if current level of care provided for the elderly is sufficient in acquiring full recovery or whether regime change needs to occur to improve outcomes for our frail patients.

Abstracts

24

Differentiated effectiveness of colorectal cancer screening according to socioeconomic status - A nationwide cohort study 1Larsen MB,

1Njor S,

2Jensen TM,

3Ingeholm P,

1Andersen B

1Afd. for Folkeundersøgelser, Regionshospitalet Randers,

2Intern Medicin, Regionshospitalet Horsens,

3Patologisk Afdeling, Herlev

Hospital

Background Even though evidence of social disparity in colorectal cancer (CRC) incidence is inconsistent, the risk of dying from CRC is higher among people with low socioeconomic position. The aim of this study was to analyse if the effectiveness of CRC screening regarding removal of adenomas and detection of CRC was modified by socioeconomic and demographic factors. Methods A register-based retrospective cohort study with a study period from 1 March 2014 to 30 June 2015. The study population included all men and women resident in Denmark and aged 50-72 years on 1 January 2014. To determine if the effectiveness of the programme was modified by age, gender, ethnicity, marital status, educational attainment and income, stratified relative risks (RR) were calculated and differences were tested with the Mantel–Haenszel test for homogenity. Results The effectiveness regarding removal of adenomas was lower for women (RRwomen 4.7, RRmen 5.7), non-Western immigrants (RRnon-Western 3.6, RRWestern 5.5, RRDanish 5.3), people living alone (RRAlone 4.8, RRCohabiting 5.5) and those with lowest income (RRLow 4.8, RRMiddle 5.6, RRHigh 5.3). The effectiveness regarding detection of CRC tended to be lower for the young (ranging from RR50-59 1.7 to RR70-72 2.2), women (RRWomen 1.8, RRMen 2.2), non-Western immigrants (RRnon-western 1.3, RRWestern 1.9, RRDanish 2.0) and those with lowest income (RRLow 1.8, RRMiddle 2.0, RRHigh 2.2). Conclusion Effectiveness of screening depends on the underlying prevalence of undiagnosed CRC and actual participation. Even though women are more likely to participate in CRC screening, this study shows that the effectiveness is higher among men than women which is consistent with the slightly higher risk of CRC among men. Otherwise, the results demonstrate lowest effectiveness of screening among those most likely not to participate, stressing the need for interventions increasing screening participation in vulnerable groups.

Abstracts

25

Screening participation after a false-positive cervical cancer screening - A nationwide register-based cohort study 1Larsen PT,

1,2Jørgensen SF,

1Tranberg M,

1,2Njor S

1Afdeling for Folkeundersøgelser, Regionshospitalet Randers,

2Institut for Klinisk Medicin, Aarhus Universitet

Background Various factors are associated with participation in cervical cancer screening programs, but little is known about the importance of a false-positive cervical cytology screening result for subsequent screening participation. Therefore, we investigated whether a false-positive cervical cytology screening result was associated with subsequent cervical cancer screening participation. Methods This Danish nationwide register-based cohort study included 591,105 women aged 22.5-49 attending cervical cytology screening in 2012-2014 with a negative (n=589,838) or false-positive (n=1,267) screening result. Women with a false-positive result were defined as having a cervical cytology showing severe dysplasia with a negative or ‘Cervical Intraepithelial Neoplasia grade 1’ biopsy result. Women were categorized as subsequent participants if they had a cervical cytology within 24 to 42 months after the last screening or surveillance test. Odds ratios (OR) including 95% confidence intervals (CI) were used as association measures. Results Among women testing negative, 74.1% (95% CI: 74:0;74:2) participated subsequently, whereas 76.3% (95% CI: 73.9;78.6) of women with a false-positive result participated subsequently. After adjustment for age and screening history, women with false-positive results were more likely to participate (OR adjusted 1.31 (95% CI: 1.14;1.49)). Sensitivity analysis allowing for opportunistic screening showed a strong association (OR adjusted 2.40 (95% CI: 1.81;3.17)). Conclusion Women receiving a false-positive result may generally be more likely to participate in subsequent cervical cancer screening and may even be more frequent users of opportunistic screening. This is new, important knowledge as false-positive screening rates are expected to increase following implementation of HPV-testing as primary screening method.

Abstracts

26

Does simplification of guidelines improve retention of BLS skills 3 months after training? 1Nguyen DT,

1Lauridsen KG,

1Johnsen J,

2Krogh K,

1Løfgren B

1Clinical Research Unit and Department of Internal Medicine, Randers Regional Hospital,

2Department of Anesthesiology and

Intensive Care, Aarhus University Hospital

Background The European Resuscitation Council (ERC) 2015 basic life support (BLS) guidelines introduced a simplified algorithm compared to the ERC 2010 BLS guidelines. This study aimed to compare the retention of BLS skills 3 months after training using the ERC 2010 or 2015 guidelines. Methods This was an observational study including video recordings of laypersons being skill tested 3 months after participation in a standardized ERC BLS/AED course using either the ERC 2010 guidelines or the simplified ERC 2015 guidelines. The endpoints were 1) remembering the correct sequence of BLS/AED algorithm, 2) remembering the correct sequence of the BLS/AED algorithm and performing all skills correctly, 3) time to: emergency medical service (EMS) call, first compression, and shock delivery. Results We analyzed videos of 133 laypersons skill tested 3 months after initial training; 64 trained using the 2010 guidelines (mean ±standard deviation (SD) age: 40 ±11 years, male sex: 19 (30%)) and 69 trained using the 2015 guidelines (age: 44 ±10 years, male sex: 36 (52%)). Participants in the 2015 guidelines group improved the retention of the BLS/AED algorithm compared to the 2010 guidelines group (29 (42%) vs. 10 (16%), relative risk (RR): 2.7 (95% confidence interval (CI): 1.4 - 5.1) P=0.001). Both BLS/AED algorithm and all skills were correctly performed by 13 (19%) vs. 3 (5%) (RR: 4.0 (95% CI: 1.2 - 13.5) P=0.01) in the 2015 and 2010 groups respectively. No significant difference was found in time to EMS call (difference: 3 sec (95% CI: -2 - 9 sec) P=0.27), time to first compression (difference: 4 sec, (95% CI: -3 - 10 sec) P=0.28), and time to first shock (difference: 4 sec (95% CI: -5 - 14 sec) P=0.33) between the groups. Conclusion BLS/AED training using ERC 2015 guidelines was associated with better skill retention compared to training using ERC 2010 guidelines. There was no difference in time to EMS call, first compression, or shock delivery.

Abstracts

27

Health care resources for investigation and treatment of abnormalities in cervical cancer screening: A nationwide register-based cohort study 1Jørgensen SF,

1Andersen BA,

2Rebolj M,

1Njor SH

1Department of Public Health Programmes, Randers Regional Hospital, Department of Clinical Medicine Aarhus University,

2Cancer

Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London

Background Cancer screening can be hampered by unavailability of diagnostic services to investigate potential screen-detected abnormalities. Starting with cervical cancer screening, we designed an extensive register-based study, mapping diagnostic and treatment services in Danish cancer screening programs to explore their availability and use for follow-up of potential screen-detected abnormalities. Methods We followed women aged 23-59 years with screen-detected abnormalities between 2012-2014 through their pathway of follow-up testing, treatment and surveillance, determining the number of tests and treatments from different healthcare providers and their timing. We assessed variations in diagnostic and treatment resources to determine how and how often a woman’s care deviates from the national recommendations and whether this is associated with age, geographic area or any healthcare provider characteristics. Results For women with inadequate or HSIL+ primary screening results, timely follow-up was 60% and 93%, respectively. Women with a screening test showing ASCUS/LSIL, were followed depending on their HPV-status, showing that a positive reflex-HPV-DNA test led to a high proportion of timely follow-up (95%), while having negative reflex-HPV-DNA testing led to excessive testing beyond recommendations in approximately 36 % of cases. When including the appropriate test type and provider in the assessment of adherence to the recommended follow-up, only 50 % received exactly the recommended follow-up care. Conclusion Systematic evaluations of population-based screening are rare in Danish cancer screening research. This study will propose a framework for monitoring of diagnostic screening resources adaptable to other diseases and address inconsistencies in management of abnormal screening results in Denmark, providing the knowledge to propose initiatives furthering uniform, high-quality follow-up on cancer screening.

Abstracts

28

Introduction of the 2015 Cardiac Arrest Guidelines and Survival after Adult and Pediatric Out-of-Hospital Cardiac Arrest 1Grandfeldt A,

2Holmberg MJ,

3Donnino DW,

4Andersen LW

1Operation og intensiv afdeling Regionshospitalet Randers,

2Center for Akutforskning, Aarhus Universitetshospital og

Regionshospitalet Horsens, 3Center for Resuscitation Science Beth Israel Deaconess Medical Center,

4Center for Akutforskning,

Aarhus Universitetshospital og Regionshospitalet Randers

Background Resuscitation guidelines are published as an instrument to improve survival from cardiac arrest, however its impact on outcomes is unknown. Aim To evaluate whether the introduction of the 2015 Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS) guidelines were associated with a change in outcomes after adult and pediatric out-of-hospital cardiac arrest. Methods Using the CARES database, we included out-of-hospital cardiac arrests from January 1st, 2013 to December 31st, 2018. Patients were divided into adults (≥ 18 years) and pediatric cases (< 18 years). An interrupted time-series analysis was used to compare survival before (pre-guidelines January 1st, 2013 and October 31st, 2015) and after (post-guidelines May 1st, 2016 and December 31st, 2018) introduction of the 2015 guidelines. We fitted a regression model after dividing the time-period into segments (e.g., “pre-guidelines” and “post-guidelines”) with separate intercept and slope estimates. Results We included 309,499 adults and 8,668 children with out-of-hospital cardiac arrest in the study period. For both adult and pediatric cases, the baseline characteristics of each cohort were comparable between the periods. There was no difference in survival to hospital discharge with a favorable functional outcome per year between the two periods for neither adults (slope: -0.07% [95%CI -0.30, 0.16], p = 0.55) nor pediatric cases (slope: -0.01% [95%CI: -1.35, 1.32], p = 0.98). Likewise, we found no immediate change in survival between the two periods for adults (intercept: 0.20% (95%CI -0.21, 0.61], p = 0.33) nor pediatric cases (intercept -1.08 [95% -3.44, 1.27], p = 0.37). For adults, we observed a decrease in ROSC of -0.90% [95%CI -1.34, 0.47] per year, p < 0.001 between the periods. Conclusion Publication of the 2015 BLS/ACLS and PALS guidelines did not result in an increase in survival to hospital discharge with a good neurological outcome after out-of-hospital cardiac arrest.

Abstracts

29

New method for evaluating the stiffness of the human uterine cervix based on elastography and a force-measuring device 1Thomsen CR,

1Bor P,

2Uldbjerg N,

2Sandager P,

3Hinge M,

1Department of Obstetrics and Gynecology, Randers Regional Hospital,

2Department of Obstetrics and Gynecology, Aarhus

University Hospital, Skejby, 3Department of Engineering, Aarhus University.

Background Preterm birth is a leading cause of neonatal morbidity as well as mortality. Very often softening of the uterine cervix precedes preterm birth. Today, the methods for evaluating the biomechanical properties of the human uterine cervix are inconsistent. Vaginal ultrasound scanning combined with elastography software constitutes a promising tool for evaluating the cervix. However, a standardization of the force applied by the ultrasound transducer has long been called for. The aim of this project is to develop a new principle for identification of pregnant women at risk of preterm birth. The principle is based on the ultrasound technique termed elastography combined with a force measurement device, developed in collaboration with Massachusetts Institute of Technology (MIT), USA. Methods The compressibility is determined by the force applied by the transvaginal transducer to the cervix and consequently the changes in greyscale observed in the placed ROI (region of interest). The biomechanical properties of the cervix, hence the compressibility, are defined by the connective tissue. The ROI should therefore be placed within the area consisting of the connective tissue. Results We have shown an association between the compressibility and the physiological softening of the cervix observed during pregnancy. Moreover, we have shown that placing the ROI is of utmost importance, when performing elastography and evaluating the compressibility. Conclusion Though, our results are very preliminary, the method looks promising. We will now perform more scans in order to test and refine the method. The perspective is better identification and treatment of pregnant women at risk of preterm delivery. In addition, the method could be used to plan induction of labor for post-term pregnancy.

Abstracts

30

Routine follow-up in women conservatively treated for endometrial hyperplasia must be recommended 1Maarup C,

1Stentebjerg M,

2Bennetsen MH,

1Bor P,

1Department of Obstetrics and Gynaecology, Randers Regional Hospital,

2Department of Pathology, Randers Regional Hospital,

3Petersen LK,

3OPEN and Department of Obstetrics and Gynaecology, Odense University Hospital

Background Endometrial hyperplasia characterized by excessive proliferation of the endometrium is strongly related to the development of endometrial carcinoma (EC). There is no standardized follow-up and no data available to estimate risk of subsequent EC or atypical hyperplasia (AH) in Danish women initially diagnosed with all types of endometrial hyperplasia. Therefore, the aim of this study is to investigate the long-term risk of AH and EC in Danish women initially diagnosed with all types of endometrial hyperplasia and to evaluate the need for long-term specialized follow-up. Methods This study recruited 102 women diagnosed with endometrial hyperplasia at Randers Regional Hospital, Randers, Denmark, between 2000 and 2015, who did not have a hysterectomy performed within 3.5 months after their initial diagnosis. Transvaginal ultrasound examination and office mini-hysteroscopy with biopsies were performed in all non-hysterectomized women. Data regarding subsequent hysterectomy or endometrial sampling were obtained from medical records and the Danish Pathology Registry (Patobank). Results A total of 16 women were diagnosed with either AH or EC during follow-up. AH/EC was diagnosed in 7% (5/74) initially diagnosed with simple hyperplasia without atypia (median follow-up of 5.2 years) and in 35% (7/20) with complex hyperplasia without atypia (median follow-up of 4.6 years). Over half of these women (simple: 80%, complex: 57%) were diagnosed with AH/EC more than 1 year after initial diagnosis, but only one was diagnosed after more than 5.2 years. EC was diagnosed in 50% (4/8) of women initially diagnosed with AH (median follow-up: 2.3 years). Conclusion The risk of being diagnosed with AH or EC more than five years after initial diagnosis with endometrial hyperplasia without atypia seems to be low in Danish women. Specialized follow-up more than five years after diagnosis with endometrial hyperplasia without atypia may not be necessary.

Abstracts

31

Safety first: Elderly women’s experiences with HPV testing, cytology, and colposcopy, and views on preventive treatment for cervical cancer 1Kirkegaard P,

1,2Gustafson LW,

3Petersen LK,

1,2Andersen B

1Department of Public Health Programmes, Randers Regional Hospital, Denmark,

2Department of Clinical Medicine, Aarhus

University, Denmark, 3Open Patient Data Explorative Network (OPEN) and Department of Gynecology and Obstetrics, Odense

University Hospital, Denmark

Background Screening has reduced the incidence and mortality of cervical cancer. Previous studies have suggested that older women may find cervical cytology sampling to be associated with discomfort. However, not much is known about older women’s preferences in terms of follow-up and treatment of abnormal screening tests. It is well known that the sensitivity of cervical cytology and the performance of colposcopy decline with age. Thus, to obtain sufficient biopsies and an accurate diagnosis, a strategy could be to perform a diagnostic cone biopsy if colposcopy is unsuccessful. However, this strategy may pose a significant risk of overtreatment. In this study, we aimed to assess older women's experience with colposcopy and their view on preventive treatment of cervical cancer precursor lesions and to identify preferences and unmet needs. Methods We conducted a qualitative interview study, including 17 women aged 60+ from gynecological departments or at a private gynecologist. All participants had a record of an abnormal smear and had undergone a colposcopy; some women also had a cone biopsy. A dynamic semi-structured interview guide was used, and interviews were audio-recorded and transcribed verbatim. A thematic analysis was conducted, based on an interpretive tradition of ethnography. Results We found the following themes:

Low perceived risk of having HPV (a 'young woman's infection'?)

Feeling insecure about treatment equipoise and risk of not being properly diagnosed

Wish for an unambiguous oral recommendation from the gynecologist regarding treatment options

Preference for direct referral to colposcopy over regular HPV testing in general practice.

Preference for a diagnostic cone biopsy ('see-and-treat') despite a high risk of overtreatment Conclusion The women emphasized that getting a certain diagnosis was important to them, even though a certain diagnosis was associated with considerable risk of unnecessary treatment - “safety first!”

Abstracts

32

CONDISOX- Continued versus discontinued oxytocin stimulation of induced labour in a double-blind randomised controlled trial 1Boie S,

2Glavind J,

3Steer P,

3Uldbjerg N,

1Bor P

1Regionshospitalet Randers,

2Aarhus Universitetshospital,

3Imperial College London, England

Background Oxytocin is an effective drug for induction of labour, but is associated with serious adverse effects of which uterine tachysystole, fetal distress and the need of immediate delivery are the most common. Discontinuation of oxytocin once the active phase of labour is established could reduce the adverse effects. The objective is to investigate how the caesarean section rate is affected when oxytocin stimulation is discontinued in the active phase of labour compared to labours where oxytocin is continued. Methods CONDISOX is a double-blind multicentre randomised controlled trial conducted at Danish and Dutch Departments of Obstetrics and Gynaecology. The first participant was recruited on April 8 2016. Based on a clinically relevant relative reduction in caesarean section rate of 7%, an alpha of 0.05, a beta of 80%, we aim for 1200 participating women (600 in each arm). The CONDISOX trial includes women at a gestational age of 37-42 complete weeks of pregnancy, who have uterine activity stimulated with oxytocin infusion for the induction of labour. Women are randomised when the active phase of labour becomes established, to study medication containing either oxytocin (continuous group) or placebo (discontinued group) infusion. Women are stratified by birth site, indication for oxytocin stimulation (induction of labour, prelabour rupture of membranes) and parity (nulliparous, parous +/- previous caesarean section). We will compare the primary outcome, caesarean section rate, in the two groups using a chi-square test with a p-value of 0.05. If superiority is not demonstrated, we have a pre-defined post hoc non-inferiority boundary (margin, delta) at 1.09. Secondary outcomes include duration of the active phase of labour, incidence of uterine tachysystole, postpartum haemorrhage, admission to the neonatal intensive care unit, Apgar score, umbilical arterial blood pH, and birth experience. Discussion: The high frequency of oxytocin use and the potential risks of both maternal and fetal adverse effects of oxytocin emphasise the need to determine the optimal oxytocin regime for induction of labour.

Abstracts

33

The Childbirth Experience Questionnaire (CEQ) - validation of its use in a Danish-speaking population of new mothers stimulated with oxytocin during labour 1Boie S,

2Lauridsen HH,

3Glavind J,

4Smed M,

3Uldbjerg N,

1Bor P,

1Regionshospitalet Randers,

2Odense Universitet,

3Aarhus Universitetshospital,

4Rigshospitalet

Background When determining optimal treatment regimens, patient reported outcomes including satisfaction are increasingly appreciated. Furthermore, it is well established that the birth experience may affect the postnatal attachment to the newborn and on the management of subsequent pregnancies and deliveries. As we have no robust validated Danish tool to evaluate the childbirth experience exists, we aimed to perform a transcultural adaptation of the Childbirth Experience Questionnaire (CEQ) to a Danish context. Methods In accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), we translated the CEQ from Swedish to Danish. The Danish CEQ was tested for content validity among 10 new mothers. In a population of women who have had their labour induced with oxytocin, we then assessed the electronic questionnaire for validity and reliability using factor analytical design, hypothesis testing, and internal consistency. Based on these data, we determined criterion and construct responsiveness in addition to floor and ceiling effects. Results The content validation resulted in minor adjustments in two items. This improved the comprehensibility. The electronic questionnaire was completed by 377 of 495 women (76.2%). The original Swedish CEQ was four-dimensional, however an exploratory factor analysis revealed a three-dimensional structure in our Danish population (Own capacity, Participation, and Professional support). Parous women, women who delivered vaginally, and women with a labour duration <12 hours had a higher score in each domain. The internal consistency (Cronbach’s alpha) ranged between 0.75 and 0.89 and the ICC between 0.68-0.93. We found ceiling effects of 57.6% in the domain Professional support and of 25.5% in the domain Participation. Conclusion This study offers a transcultural adaptation of the CEQ to a Danish context. The 3-dimensional Danish version of the CEQ demonstrates construct validity and reliability. Our results revealed a significant ceiling effect especially in the domain Professional support, which needs to be acknowledged when considering implementing the CEQ into trials and clinical practice.

Abstracts

34

Are Basic Life Support Instructors Competent? 1,2,3

Stærk M, 3,4

Vammen L, 1,2,3,4

Hansen C, 3,4

Krogh K 1,2,5,6

Løfgren, B, 1Clinical Research Unit, Randers Regional Hospital,

2Department of Internal Medicine, Randers Regional Hospital,

3Research Center

for Emergency Medicine, Aarhus University Hospital, 4Department of Anesthesiology and Intensive Care, Aarhus University Hospital,

4Department of Cardiology, Herlev and Gentofte Hospital,

5Department of Clinical Medicine, Aarhus University,

6Department of

Cardiology, Aarhus University Hospital.

Background Bystander basic life support (BLS) and automated external defibrillation (AED) improve survival after out-of-hospital cardiac arrest. Certified BLS/AED instructors are expected to master and disseminate these skills correctly. The aim of this study was to evaluate certified BLS instructors’ competencies in demonstrating cardiopulmonary resuscitation (CPR) and the use of an AED. Methods Certified BLS instructors demonstrated CPR and the use of an AED on a resuscitation manikin in a simulated setting. Skill quality was evaluated with data collected from the resuscitation manikin as well as video recordings and compared to international resuscitation guidelines. Further, participants completed questionnaires regarding recommended resuscitation guidelines and rating of their own BLS skills. Results Overall, we analyzed data from 125 participants. Of all chest compressions, only 22% were within guideline recommendations regarding depth. Participants performed chest compressions with excessive depth (mean depth 64 mm (7.3)). Also, instructors often misplaced the left AED electrode (median distance 7.6 cm (5.0;10.5), 25% placed within 5 cm of recommendation), while the right AED electrode usually was placed correctly (median distance 2.9 cm (1.5;4.0), 85% placed within 5 cm of recommendation). Nearly half of the participants failed to state correct answers regarding how to diagnose a cardiac arrest and where to place the AED electrodes. Despite their performance, participants rated their own BLS skills high. Conclusion A vast majority of certified BLS instructors performed chest compressions with excessive depth. When demonstrating the use of an AED, instructors in general misplaced the left AED electrode. Moreover, only half could correctly describe the recommended position of the AED electrodes. Overall, this study found severe gaps in BLS instructors’ competencies, which indicates a need for thorough and revised BLS instructor education and faculty development.