To explore the impact of in situ simulation training in regard to identification of latent safety threats and participant experiences. A prospective study including quantitative and qualitative measures. A Danish hospital shifted from simulation training in centers outside the hospital to training where simulation was conducted where the situations normally took place and with the normal working teams A total of 58 local instructors were educated and subsequently conducted in situ simulations in own departments. After each simulation, a log file was completed containing information on location, the scenario, who took part, time, learning points and findings. Furthermore, interviews were conducted with leaders, instructors and simulation participants. Identified latent safety threats and participant experiences. From June 2017 until December 2018, 323 simulations were conducted representing 35 different wards. They consisted of 40 different scenarios and had both technical and non-technical learning goals. A total of 35 organizational issues were uncovered via the in situ simulation and practice was adjusted accordingly. A total of 11 interviews were conducted. Four themes emerged from the analysis: practice-orientation, endorsement, sense of security and additional impact. Transferring simulation to in situ training resulted in a substantial number of organizational findings. The subsequent follow-up and changes in practice made awareness of what could be latent safety threats. Leaders, instructors and simulation participants experienced in situ simulation as relevant and profitable.

Objective Burnout and mental illness are frequent among healthcare professionals, leading to increased sick leave. Simulation-based team training has been shown to improve job satisfaction and mental health among healthcare professionals. This study seeks to investigate the relationship between simulation-based team training and sick leave. Design Cohort study. Setting and intervention Five Danish hospitals. Participants A total of 15 751 individuals were screened for eligibility. To meet the eligibility criteria, individuals had to be employed in the same group (intervention or control) for the whole study period. A total of 14 872 individuals were eligible for analysis in the study. Intervention From 2017 to 2019, a simulation-based team training intervention was implemented at two hospital sites. Three hospital sites served as the control group. Outcome measures Data on sick leave from 2015 to 2020 covered five hospital sites. Using a difference-in-difference analysis, the rate of sick leave was compared across hospital sites (intervention vs control) and time periods (before vs after intervention). Results Significant alterations in sick leave were evident when comparing the intervention and control groups. When comparing groups over time, the increase in sick leave was −0.3% (95% CI −0.6% to −0.0%) lower in the intervention group than in the control group. The difference-in-difference for the complete case analysis showed that this trend remained consistent, with analysis indicating a comparable lower increase in sick leave by −0.7% (95% CI −1.3% to −0.1%) in the intervention group. Conclusion The increase in sick leave rate was statistically significantly lower in the intervention group, implying that simulation-based team training could serve as a protective factor against sick leave. However, when investigating this simulation intervention over 5 years, other potential factors may have influenced sick leave, so caution is required when interpreting the results.

Introduction Rises in average life expectancy, increased comorbidities and frailty among older patients lead to higher admission rates to intensive care units (ICU). During an ICU stay, loss of physical and cognitive functions may occur, causing prolonged rehabilitation. Some functions may be lost permanently, affecting quality of life (QoL). There is a lack of understanding regarding how many variables are relevant to health-related outcomes and which outcomes are significant for the QoL of frail, elderly patients following discharge from the ICU. Therefore, this scoping review aims to identify reported variables for health-related outcomes and explore perspectives regarding QoL for this patient group. Methods and analysis The Joanna Briggs Institute guidelines for scoping reviews will be employed and original, peer-reviewed studies in English and Scandinavian languages published from 2013 to 2023 will be included. The search will be conducted from July 2023 to December 2023, according to the inclusion criteria in Embase, MEDLINE, PsycINFO and CINAHL. References to identified studies will be hand-searched, along with backward and forward citation searching for systematic reviews. A librarian will support and qualify the search strategy. Two reviewers will independently screen eligible studies and perform data extraction according to predefined headings. In the event of disagreements, a third reviewer will adjudicate until consensus is achieved. Results will be presented narratively and in table form and discussed in relation to relevant literature. Ethics and dissemination Ethical approval is unnecessary, as the review synthesises existing research. The results will be disseminated through a peer-reviewed publication in a scientific journal.

Background: Life expectancy increases, leading to growth in an older population where frailty and comorbidities are more prevalent. Subsequent increased intensive care unit (ICU) treatment results in prolonged rehabilitation and post-discharge loss of physiological and intellectual functions, negatively influencing quality of life (QoL). Methods: This scoping review aims to identify existing research on assessment methods for frailty, QoL, and health-related outcomes for these ICU survivors. The review followed Joanna Briggs Institute guidelines for scoping reviews and reported using the PRISMA-P checklist. Systematic searches were conducted in Embase, Medline, PsycINFO, and CINAHL (2013 to 2023). Included studies were primary, peer-reviewed, or empirical studies written in English or Scandinavian, patients aged 70+, admitted to ICU more than 48 h, and inclusion of both frailty and QoL. A librarian qualified the search. Two reviewers independently screened articles and extracted data; a third reviewer resolved discrepancies. Results: A total of 5,198 articles were identified. Nine met the eligibility criteria. Different tools assessed frailty and QoL. For frailty, Clinical Frailty Scale, Karnofsky Performance Status, Modified Katz Index of Activities of Daily Living, Groningen Frailty Indicator, CGA questionnaire, or Barthel Index were used. A combination of scales (SF-12, SF-36, EQ-5D, EQ-5D-5 L, or EQ-5D-3 L), questionnaires, or interviews (regarding residential and functional status and self-reported health-related QoL) was used for QoL. Conclusion: Frail older ICU survivors experience persistent physical, cognitive, and symptom-related challenges poorly captured by conventional QoL assessments, particularly regarding psychological and subjective experiences. The few studies addressing both frailty and QoL make it difficult to establish evidence, highlighting the need for standardised, multidimensional, patient-centred frameworks. Trial registration: Not applicable.

Background: The American Society of Anesthesiologists Physical Status (ASA-PS) classification is widely used for perioperative communication and research with known variation in agreement amongst assessors. Large language models (LLM) are increasingly considered for uniform decision making due to agreement challenges within clinicians under identical inputs. The study compared four contemporary LLMs against clinician-derived consensus and quantified within-model stability across repeated assessments. Methods: In a cross-sectional vignette study, 228 anesthesiologists from Denmark, England, and India classified 20 standardized perioperative vignettes through online survey. The modal response per vignette was considered as clinician consensus. Four LLMs (ChatGPT-5.2 Plus, Gemini 3 Pro, Perplexity AI Pro, Claude 4 Sonnet) received same set of vignettes through identical prompts. Temporal stability was assessed by repeating each vignette query nine times per model (three-time windows across three nonconsecutive days) in fresh sessions. Primary outcome was exact agreement with clinician consensus. Results: Consensus agreement for modal LLM classifications was 18/20 (90%) for ChatGPT, 17/20 (85%) for Gemini, 17/20 (85%) for Claude, and 15/20 (75%) for Perplexity. Disagreement is clustered in vignettes with weak or split clinician consensus. Stability differed by model: Claude was fully stable across all vignettes (20/20), Gemini 19/20, ChatGPT 18/20, and Perplexity 14/20; instability typically involved adjacent-class shifts. Conclusions: Contemporary LLMs often match clinician modal judgement and are largely temporally stable, with discordance concentrated in clinically ambiguous boundary cases.

Background/Objectives: Intensive postoperative pain is a common challenge after knee surgeries such as total knee arthroplasty, arthroscopy, cruciate ligament or meniscus repair, and fixation of tibial plateau or distal femoral fractures. This scoping review mapped and summarized non-regional postoperative analgesia strategies to provide an overview of available approaches when regional blocks or neuraxial anesthesia are not feasible. Methods: We followed established methodological guidance for scoping reviews and report the data in accordance with the PRISMA-ScR checklist. We searched PubMed/MEDLINE, EMBASE, Scopus, and ClinicalTrials.gov in January 2025. Eligible designs included randomized controlled trials, non-randomized trials, observational studies, case series, and pilot studies. Results: We screened 3390 records and assessed 332 in full text. A total of 43 studies met the inclusion criteria, and the literature was grouped into: (1) arthroplasty, (2) arthroscopy, (3) cruciate ligament or meniscus repair, and (4) tibial plateau or distal femoral fractures. We identified substantial heterogeneity in interventions, comparators, and outcome measures across the first three sets of literature but found no focused articles for tibial plateau or distal femoral fractures. Most studies evaluated multimodal approaches combining systemic analgesics with local periarticular or intraarticular techniques. Evidence on functional recovery and mobilization was limited. Conclusions: Current evidence on non-regional postoperative analgesia in knee surgery is fragmented and varies considerably in design, intervention, and reported outcomes. Multimodal regimens and pre-emptive NSAID use were frequently associated with reduced early postoperative pain and lower opioid requirements, although comparability across studies remains limited. As existing evidence largely focuses on outcomes during hospitalization, future research should prioritize standardized pain and functional outcome reporting and directly compare systemic and local multimodal strategies, while extending follow-up beyond discharge to better characterize sustained clinical relevance.