Publications by authors named "Tobias Todsen"

42 Publications

Valid and Reliable Assessment of Upper Respiratory Tract Specimen Collection Skills during the COVID-19 Pandemic.

Diagnostics (Basel) 2021 Oct 26;11(11). Epub 2021 Oct 26.

Copenhagen Academy for Medical Education and Simulation, Capital Region, 2100 Copenhagen, Denmark.

Proper specimen collection is the most important step to ensure accurate testing for the coronavirus disease 2019 (COVID-19) and other infectious diseases. Assessment of healthcare workers' upper respiratory tract specimen collection skills is needed to ensure samples of high-quality clinical specimens for COVID-19 testing. This study explored the validity evidence for a theoretical MCQ-test and checklists developed for nasopharyngeal (NPS) and oropharyngeal (OPS) specimen collection skills assessment. We found good inter-item reliability (Cronbach's alpha = 0.76) for the items of the MCQ-test and high inter-rater reliability using the checklist for the assessment of OPS and NPS skills on 0.86 and 0.87, respectively. The MCQ scores were significantly different between experts (mean 98%) and novices (mean 66%), < 0.001, and a pass/fail score of 91% was established. We found a significant discrimination between checklist scores of experts (mean 95% score for OPS and 89% for NPS) and novices (mean 50% score for OPS and 36% for NPS), < 0.001, and a pass/fail score was established of 76% for OPS and 61% for NPS. Further, the results also demonstrated that a group of non-healthcare educated workers can perform upper respiratory tract specimen collection comparably to experts after a short and focused simulation-based training session. This study, therefore, provides validity evidence for the use of a theoretical and practical test for upper respiratory specimens' collection skills that can be used for competency-based training of the workers in the COVID-19 test centers.
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http://dx.doi.org/10.3390/diagnostics11111987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8622793PMC
October 2021

Accuracy of anterior nasal swab rapid antigen tests compared with RT-PCR for massive SARS-CoV-2 screening in low prevalence population.

APMIS 2021 Nov 10. Epub 2021 Nov 10.

Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

The aim was to determine the accuracy of anterior nasal swab in rapid antigen (Ag) tests in a low SARS-CoV-2 prevalence and massive screened community. Individuals, aged 18 years or older, who self-booked an appointment for real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test in March 2021 at a public test center in Copenhagen, Denmark were included. An oropharyngeal swab was collected for RT-PCR testing, followed by a swab from the anterior parts of the nose examined by Ag test (SD Biosensor). Accuracy of the Ag test was calculated with RT-PCR as reference. We included 7074 paired conclusive tests (n = 3461, female: 50.7%). The median age was 48 years (IQR: 36-57 years). The prevalence was 0.9%, that is, 66 tests were positive on RT-PCR. Thirty-two had a paired positive Ag test. The sensitivity was 48.5% and the specificity was 100%. This study conducted in a low prevalence setting in a massive screening set-up showed that the Ag test had a sensitivity of 48.5% and a specificity of 100%, that is, no false positive tests. The lower sensitivity is a challenge especially if Ag testing is not repeated frequently allowing this scalable test to be a robust supplement to RT-PCR testing in an ambitious public SARS-CoV-2 screening.
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http://dx.doi.org/10.1111/apm.13189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8652940PMC
November 2021

[Methods for collecting upper respiratory tract specimens for COVID-19 diagnostics].

Ugeskr Laeger 2021 08;183(33)

The World Health Organization recommends a comprehensive testing strategy during the current COVID-19 pandemic. For suspected individuals in a community setup, it is recommended to collect an upper respiratory tract specimen to detect SARS-CoV-2. Different upper respiratory specimen collection techniques or a combination of these can be used to increase test sensitivity or decrease patient discomfort depending on the purpose as summarised in this review. However, it is essential that the specimen collection is performed correctly in order to ensure the diagnostic accuracy of testing.
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August 2021

Is oropharyngeal sampling a reliable test to detect SARS-CoV-2?

Lancet Infect Dis 2021 10 4;21(10):1348. Epub 2021 Aug 4.

Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Diseases, Copenhagen University Hospital, Amager-Hvidovre Hospital, Denmark.

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http://dx.doi.org/10.1016/S1473-3099(21)00395-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336970PMC
October 2021

Optimal Insertion Depth for Nasal Mid-Turbinate and Nasopharyngeal Swabs.

Diagnostics (Basel) 2021 Jul 14;11(7). Epub 2021 Jul 14.

Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, 4600 Køge, Denmark.

Millions of people are tested for COVID-19 daily during the pandemic, and a lack of evidence to guide optimal nasal swab testing can increase the risk of false-negative test results. This study aimed to determine the optimal insertion depth for nasal mid-turbinate and nasopharyngeal swabs. The measurements were made with a flexible endoscope during the collection of clinical specimens with a nasopharyngeal swab at a public COVID-19 test center in Copenhagen, Denmark. Participants were volunteer adults undergoing a nasopharyngeal SARS-CoV-2 rapid antigen test. All 109 participants (100%) completed the endoscopic measurements; 52 (48%) women; 103 (94%) white; mean age 34.39 (SD, 13.2) years; and mean height 176.7 (SD, 9.29) cm. The mean swab length to the posterior nasopharyngeal wall was 9.40 (SD, 0.64) cm. The mean endoscopic distance to the anterior and posterior end of the inferior turbinate was 1.95 (SD, 0.61) cm and 6.39 (SD, 0.62) cm, respectively. The mean depth to nasal mid-turbinate was calculated as 4.17 (SD, 0.48) cm. The optimal depths of insertion for nasal mid-turbinate swabs are underestimated in current guidelines compared with our findings. This study provides clinical evidence to guide the performance of anatomically correct nasal and nasopharyngeal swab specimen collection for virus testing.
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http://dx.doi.org/10.3390/diagnostics11071257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306705PMC
July 2021

Danish citizens' preferences for at-home oropharyngeal/nasal SARS-CoV-2 specimen collection.

Int J Infect Dis 2021 Aug 1;109:195-198. Epub 2021 Jul 1.

Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

Introduction: Diagnostic confirmation of SARS-CoV-2 by self-collection of specimens is a reliable method compared with healthcare worker collected samples. Citizens' preferences for collection methods are unknown, but at-home collection could have several advantages.

Methods: This study investigated the preference for guided at-home self-collection versus at-hospital specimen collection by healthcare workers.

Results: Among the 3709 participants, at-home swab collection was the preferred setting for 2362 (63.7%) compared with 1347 (36.3%) reporting a preference for an at-hospital swabbing procedure.

Conclusion: A high preference for guided at-home self-collection of oropharyngeal/nasal SARS-CoV-2 specimens exists and could be a future norm beyond COVID-19.
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http://dx.doi.org/10.1016/j.ijid.2021.06.060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245307PMC
August 2021

Accuracy and cost description of rapid antigen test compared with reverse transcriptase-polymerase chain reaction for SARS-CoV-2 detection.

Dan Med J 2021 06 14;68(7). Epub 2021 Jun 14.

Introduction: Fast and accurate detection of SARS-CoV-2 is essential in limiting the COVID-19 pandemic. Rapid antigen (AG) tests provide results within minutes; however, their accuracy has been questioned. The study aims to determine the accuracy and cost of the STANDARD Q COVID-19 AG test compared with RT-PCR.

Methods: Individuals 18 years or older with an appointment for a RT-PCR test on 26-31 December 2020 at a public test centre in Copenhagen, Denmark were invited to participate. An oropharyngeal swab was collected for RT-PCR analysis, followed by a nasopharyngeal swab examined by the AG test (SD Biosensor). The diagnostic accuracy of the AG test was calculated with RT-PCR as reference. Costs were evaluated for both tests.

Results: A total of 4,811 paired conclusive test results were collected (median age: 45 years, female: 53%). The RT-PCR test revealed 221 (4.6%) positive tests. The overall sensitivity and specificity of the AG test were 69.7% and 99.5%, respectively. Viral cycle threshold values were significantly higher in individuals with false negative AG tests than in individuals who were true positives. The RT-PCR test and AG test costs were 67.0 DKK (10.8 USD) and 35.0 DKK (5.7 USD), respectively, per positive case detected at 100,000 daily tests.

Conclusions: The AG test enables mass testing and provides immediate results, which is important in SARS-CoV-2 screening. The AG test is a good and relevant supplement to RT-PCR testing in public SARS-CoV-2 screenings.

Funding: This project received no external funding. Copenhagen Medical A/S delivering the rapid AG tests and provided test personnel but were not otherwise involved.

Trial Registration: Clinicaltrials.org: NCT04716088.
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June 2021

SARS-CoV-2 in saliva, oropharyngeal and nasopharyngeal specimens.

Dan Med J 2021 Apr 7;68(5). Epub 2021 Apr 7.

Introduction: The reference test to evaluate patients with suspected respiratory virus infection is a real-time reverse transcription-polymerase chain reaction (RT-PCR) from a nasopharyngeal swab (NPS). However, other specimen collection methods such as an oropharyngeal swab (OPS) or saliva specimen are also used for SARS-CoV-2 testing during the ongoing COVID-19 pandemic. However, it remains unclear if rates of SARS-CoV-2 detection differ between sampling methods. This study will compare the rates of SARS-CoV-2 detection by saliva, OPS, and NPS sampling in a public setting.

Methods: Individuals referred for outpatient SARS-CoV-2 testing will be invited to participate in a prospective clinical study. They will have saliva, OPS and NPS specimens collected that will be analysed separately for SARS-CoV-2 RNA by RT-PCR. The rate of SARS-CoV-2 detection in saliva, OPS and NPS will be compared using a logistic regression mixed-effect model analysis. A sample of 19,110 participants is required at an expected 1.5% test-positive rate in order to detect a 25.6% difference. The total sample size will be adjusted as the test-positive rate changes.

Conclusions: This study will provide evidence for the optimal site of specimen collection to detect SARS-CoV-2. The results may help guide the health authorities.

Funding: This is an investigator-initiated trial based on an unrestricted grant from the Novo Nordisk Foundation and the Aage og Johanne Louis-Hansens Fond. The foundations have had no say in the decisions on study design or reporting.

Trial Registration: ClinicalTrials.gov (ID: NCT04715607).
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April 2021

Surgeon-performed Transoral Ultrasound-Guided Aspiration of Peritonsillar Abscess.

Laryngoscope 2021 10 20;131(10):2241-2245. Epub 2021 Mar 20.

Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

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http://dx.doi.org/10.1002/lary.29525DOI Listing
October 2021

[Head and neck ultrasound examination].

Ugeskr Laeger 2021 02;183(7)

Head and neck ultrasound examination is increasingly used as point-of-care imaging among clinicians from different specialities to improve the diagnostic workup and perform ultrasound-guided interventions. Ultrasound can provide immediate information about morphology and anatomic relation of lumps and bumps of the neck and guide treatment of various lesions varying from patients with putative head and neck cancer to patients with acute neck abscess. This review describes the principles of a systematic head and neck ultrasound examination and the most common pathologies diagnoses with benefit by ultrasound.
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February 2021

[Ødem af uvula efter inhalation af lattergas].

Ugeskr Laeger 2020 12;182(53)

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December 2020

Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules.

Head Neck 2021 03 28;43(3):1009-1013. Epub 2020 Dec 28.

Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.

Fine needle aspiration biopsy (FNAB) remains crucial in the evaluation of thyroid nodules with suspicious clinical findings or ultrasound (US) features suggestive of malignancy. The use of US-guidance for FNAB allows real-time visualization of the needle, but is also highly operator-dependent. Physicians from many specialties (endocrinologists, otolaryngologists/endocrine surgeons, nuclear medicine physicians, radiologists, and pathologists) are involved in the diagnostic workup of thyroid nodules and a standardized and meticulous technique for US-FNAB is essential for lowering the yield of nondiagnostic specimens and false-negative results. This video, therefore, demonstrates a well-proved technique and technical tips to increase the diagnostic results from US-FNAB.
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http://dx.doi.org/10.1002/hed.26598DOI Listing
March 2021

Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers : A Randomized Controlled Trial.

Ann Intern Med 2021 03 18;174(3):335-343. Epub 2020 Nov 18.

Herlev & Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark (J.B.N., P.B.N., K.F., R.H., J.H.K., K.I.).

Background: Observational evidence suggests that mask wearing mitigates transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is uncertain if this observed association arises through protection of uninfected wearers (protective effect), via reduced transmission from infected mask wearers (source control), or both.

Objective: To assess whether recommending surgical mask use outside the home reduces wearers' risk for SARS-CoV-2 infection in a setting where masks were uncommon and not among recommended public health measures.

Design: Randomized controlled trial (DANMASK-19 [Danish Study to Assess Face Masks for the Protection Against COVID-19 Infection]). (ClinicalTrials.gov: NCT04337541).

Setting: Denmark, April and May 2020.

Participants: Adults spending more than 3 hours per day outside the home without occupational mask use.

Intervention: Encouragement to follow social distancing measures for coronavirus disease 2019, plus either no mask recommendation or a recommendation to wear a mask when outside the home among other persons together with a supply of 50 surgical masks and instructions for proper use.

Measurements: The primary outcome was SARS-CoV-2 infection in the mask wearer at 1 month by antibody testing, polymerase chain reaction (PCR), or hospital diagnosis. The secondary outcome was PCR positivity for other respiratory viruses.

Results: A total of 3030 participants were randomly assigned to the recommendation to wear masks, and 2994 were assigned to control; 4862 completed the study. Infection with SARS-CoV-2 occurred in 42 participants recommended masks (1.8%) and 53 control participants (2.1%). The between-group difference was -0.3 percentage point (95% CI, -1.2 to 0.4 percentage point;  = 0.38) (odds ratio, 0.82 [CI, 0.54 to 1.23];  = 0.33). Multiple imputation accounting for loss to follow-up yielded similar results. Although the difference observed was not statistically significant, the 95% CIs are compatible with a 46% reduction to a 23% increase in infection.

Limitation: Inconclusive results, missing data, variable adherence, patient-reported findings on home tests, no blinding, and no assessment of whether masks could decrease disease transmission from mask wearers to others.

Conclusion: The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50% in a community with modest infection rates, some degree of social distancing, and uncommon general mask use. The data were compatible with lesser degrees of self-protection.

Primary Funding Source: The Salling Foundations.
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http://dx.doi.org/10.7326/M20-6817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7707213PMC
March 2021

[Ultrasound-guided radiofrequency ablation of benign symptomatic thyroid nodules].

Ugeskr Laeger 2020 10;182(43)

Ultrasound-guided radiofrequency ablation is an effective and safe treatment option for solid and cystic, cold, benign symptomatic thyroid nodules of ≥ 2 cm and less-than 20 ml. It is non-invasive, and in this review, we consider it well supported in the current literature for its efficacy, safety, patient satisfaction and cost. In addition, it is also a promising alternative therapy for hyperfunctioning nodules.
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October 2020

Otorhinolaryngologist performed transcervical versus transoral ultrasonography in the management of peritonsillar abscess.

Authors:
Tobias Todsen

Am J Otolaryngol 2021 Sep-Oct;42(5):102768. Epub 2020 Oct 22.

Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark; Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark. Electronic address:

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http://dx.doi.org/10.1016/j.amjoto.2020.102768DOI Listing
September 2021

Self-Collected versus Healthcare Worker-Collected Swabs in the Diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2.

Diagnostics (Basel) 2020 Sep 9;10(9). Epub 2020 Sep 9.

Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark.

The aim of this study was to compare the sensitivity of self-collected versus healthcare worker (HCW)-collected swabs for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing. Symptomatic individuals referred for SARS-CoV-2 testing were invited to provide mobile-phone video-instructed self-collected oropharyngeal and nasal samples followed by a HCW-collected oropharyngeal sample. All samples were sent for analysis to the same microbiology laboratory, and the number of SARS-CoV-2-positive participants in the two tests was compared. A total of 109 participants were included, and 19 participants had SARS-CoV-2-positive results. The diagnostic sensitivity of the self-collected and HCW-collected swabs was 84.2% and 89.5%, respectively, with an acceptable agreement, Cohens kappa 0.82, < 0.001. Further, results from a questionnaire answered by the participants found that loss of smell as a self-reported symptom was a strong predictor for a SARS-CoV-2-positive test. In conclusion, we found that self-collected oropharyngeal and nasal swabs for SARS-CoV-2 testing can be reliable compared to HCW-collected oropharyngeal samples.
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http://dx.doi.org/10.3390/diagnostics10090678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554687PMC
September 2020

Face masks for the prevention of COVID-19 - Rationale and design of the randomised controlled trial DANMASK-19.

Dan Med J 2020 Aug 18;67(9). Epub 2020 Aug 18.

Introduction: The coronavirus disease 19 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), progresses globally, and means to reduce the transmission are needed. In the community, the use of face masks is increasing world-wide, but documentation for the efficacy of this remedy is lacking. This trial investigates whether the use of face masks in the community will reduce wearers' risk of SARS-CoV-2 infection.

Methods: This study will be a two-arm, unblinded, randomised controlled trial. We will include adults (>18 years of age) without prior confirmed COVID-19 or symptoms suggestive of COVID-19, who spend more than three hours per day outside the home with exposure to other people. A total of 6,000 participants are randomly assigned 1:1 to use face masks or not for a 30-day period during the pandemic. Participants will perform self-testing; quick test for SARS-CoV-2 antibodies (immunoglobulin M (IgM) and immunoglobulin G (IgG)) (the Livzon lateral flow test) and oropharyngeal/nasal swabs for viral detection using polymerase chain reaction (PCR). The primary endpoint following the 30-day study period is the difference in the number of SARS-CoV-2-infected individuals between the two study groups as assessed by a positive nasopharyngeal swap, a positive antibody test or a hospital-based diagnosis of SARS-CoV-2 infection.

Conclusions: We will study whether a face mask protects the wearer of the mask against SARS-CoV-2 infection. The findings are expected to apply to the present pandemic and to future viral outbreaks and to provide evidence for authority recommendations across the world.

Funding: This study was funded by Salling Fondene.

Trial Registration: ClinicalTrials.gov Identifier: NCT04337541.
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August 2020

African Head and Neck Society Clinical Practice guidelines for thyroid nodules and cancer in developing countries and limited resource settings.

Head Neck 2020 08 7;42(8):1746-1756. Epub 2020 Mar 7.

Department of Otohinolaryngology, University of Cape Town, Cape Town, South Africa.

Background: International thyroid nodule and cancer management guidelines generally fail to take into account potential limitations in diagnostic and treatment resources.

Methods: Thyroid cancer specialists from the African Head and Neck Society and American Head & Neck Society Endocrine Section developed guidelines for diagnosis and management of thyroid nodules and cancer in low resource settings. Recommendations were based on literature review and expert opinion, with level of evidence defined.

Results: Using the ADAPTE process, diagnostic and treatment algorithms were adapted from the National Comprehensive Cancer Network (NCCN). Low resource settings were simulated by systematically removing elements such as availability of laboratory testing, hormone replacement, imaging, and cytopathology from NCCN guidelines.

Conclusions: Successful management of thyroid nodules and cancer in low resource settings requires adaptation of treatment methodologies. These guidelines define specific scenarios where either more or less aggressive intervention for thyroid pathology may be advisable based on limited available resources.
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http://dx.doi.org/10.1002/hed.26094DOI Listing
August 2020

Point-of-care ultrasound for general practitioners: a systematic needs assessment.

Scand J Prim Health Care 2020 Mar 20;38(1):3-11. Epub 2020 Jan 20.

Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark.

The aim of the study was to achieve consensus among a group of ultrasound proficient general practitioners (GPs) from Denmark, Norway, Sweden and Finland on which ultrasound scanning modalities and ultrasound-guided procedures are essential to GPs in their daily work for the purpose of including them in a basic ultrasound curriculum. The Delphi methodology was used to obtain consensus. Sixty Scandinavian GPs with more than two years of point-of-care ultrasound (POCUS) experience were invited to join the Delphi expert panel. In the first Delphi round each member of the panel was asked to produce a list of scanning modalities and procedures which they found relevant to include in a basic ultrasound curriculum. In Delphi round two, these suggestions were presented to the entire panel who assessed whether they found them essential in their daily work. Items not reaching consensus in round two, were presented to the panel in a third and final round. Items reaching more than 67% agreement were included. Forty-five GPs were included in the study and 41 GPs completed all rounds. Agreement was obtained on 30 scanning modalities and procedures primarily within the musculoskeletal (8), abdominal (5), obstetric (5) and soft tissue (3) diagnostic areas. Four ultrasound-guided procedures were also agreed upon. A prioritized list of 30 scanning modalities and procedures was agreed upon by a group of ultrasound proficient GPs. This list could serve as a guideline when planning future POCUS educational activities for GPs.Key pointsPoint-of-care ultrasound (POCUS) is increasingly being used by general practitioners (GPs), but little is known about which ultrasound applications are most used.We performed a systematic needs assessment among a group of ultrasound proficient GPs using the Delphi methodology for the purpose of establishing a basic POCUS curriculum.The process resulted in a prioritized list of 30 scanning modalities and ultrasound guided procedures.Our study provides the basis for an evidence-based basic POCUS curriculum for GPs.
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http://dx.doi.org/10.1080/02813432.2020.1711572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054965PMC
March 2020

Protocol for a randomised clinical trial of transoral ultrasound versus standard of care in the diagnosis of peritonsillar abscess.

Dan Med J 2019 Nov;66(11)

Introduction: Peritonsillar infection is a common complication to acute tonsillitis in younger adults. If peritonsillar cellulitis progresses to a peritonsillar abscess (PTA), the primary treatment is surgical drainage. But distinguishing cellulitis from PTA on a standard clinical examination is difficult. This trial aims to explore whether point-of-care transoral ultrasound can improve diagnostic accuracy and guide successful needle aspiration in patients referred with PTA.

Methods: A randomised, controlled multicentre trial will be conducted at the departments of otorhinolaryngology, head and neck surgery at Rigshospitalet and Odense University Hospital. Patients referred with PTA will be randomised to either standard clinical examination (control) or standard clinical examination with supplemental transoral ultrasound (intervention). The diagnostic accuracy, the total number of performed needle aspirations and the proportion of successful needle aspirations will be compared between the two groups. The difference will be evaluated using binary logistic regression and a generalised estimating equation to adjust for clustering of data within each physician and each hospital. A total of 88 patients are necessary to measure the clinical effect of adding transoral ultrasound.

Conclusions: This study will explore the clinical benefits of adding transoral ultrasound to the diagnostic work-up of patients with peritonsillar infections.

Funding: The Rigshospitalet and Odense University Hospital Foundation.

Trial Registration: Clinicaltrials NCT03824288.
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November 2019

Vedvarende periorbital hævelse hos en syvårig.

Ugeskr Laeger 2019 Apr;181(16)

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April 2019

A Novel Technique for Intraoral Ultrasound-Guided Aspiration of Peritonsillar Abscess.

Diagnostics (Basel) 2018 Aug 2;8(3). Epub 2018 Aug 2.

Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet University Hospital, 2100 Copenhagen, Denmark.

Peritonsillar abscess (PTA) is a common complication to acute tonsillitis. The treatment is drainage of the abscess, but many needle aspirations are unsuccessful due to a low diagnostic accuracy based on oral examination only. In this article, we describe how intraoral ultrasound can be added to improve the diagnostic work-up of PTA and present a novel technique for ultrasound-guided aspiration of PTA, using a small pencil-shaped transducer. We present our first clinical experiences with this technique and describe how it could be integrated in a clinical setting to guide safe and successful needle aspirations of PTA.
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http://dx.doi.org/10.3390/diagnostics8030050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174334PMC
August 2018

Vedvarende stikkende fremmedlegemefornemmelse i svælg.

Ugeskr Laeger 2018 Jun;180(26)

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June 2018

[Vedvarende stikkende fremmedlegemefornemmelse i svælg].

Ugeskr Laeger 2018 Martch 2;180(10)

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March 2019

Surgeon-performed ultrasonography.

Authors:
Tobias Todsen

Dan Med J 2017 Nov;64(11)

Surgeons are increasingly using ultrasonography (US) in their clinical management of patients. However, US is a very user-dependent imaging modality and proper skills of the US operator are needed to ensure quality in patient care. This thesis explores the validity evidence for assessment of competence in abdominal and head & neck ultrasonography using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. With the use of Messick's unitary framework of validity, five sources of validity evidence were explored: test content, response processes, inter-nal structure, relations to other variables, and consequences. Research paper I examined validity evidence for the use of the OSAUS scale to assess physicians' abdominal point-of-care US competence in an experimental setting using patient cases with and without pathological conditions. The RESULTS provided validity evidence of the internal structure of the OSAUS scale and a deci-sion study predicted that four cases and two raters or five cases and one rater could ensure sufficient reliability in future test setups. The relation to other variables was supported by a signifi-cant difference in scores between US experience levels, and by a strong correlation between the OSAUS score and diagnostic accuracy. Research paper II explored the transfer of learning from formal point-of-care US training to performance on patients in a randomized controlled study. The RESULTS supported validity evi-dence regarding OSAUS scores' relation to other variables by demonstrating a significant discrimination in the progress of training-a more refined validity evidence than the relation to difference experience levels. The RESULTS showed that physicians could transfer the skills learned on an ultrasonography course to improved US performance and diagnostic accuracy on patients. However, the RESULTS also indicated that following an initial course, additional training is needed for physicians to achieve competence in US. Research paper III evaluated validity evidence supporting an OSAUS score used to establish pass/fail standards for head & neck US skills. Good reliability between raters from different specialties to assess head & neck competence further supported the internal structure of OSAUS scale. A strong correla-tion to the diagnostic accuracy supported the relation to other variables and the consequences of the assessment were explored by a receiver operator characteristic curve for different pass/fail standards of head & neck US skills. In summary this PhD thesis established sources of validity evi-dence supporting the interpretation of the OSAUS scale to evalu-ate surgeon-performed US skills of the abdominal and head & neck diseases. We therefore recommend the OSAUS scale for formative in-training assessment and high-stakes summative decisions as certification for independent practice in surgeon-performed US. Further, we find formal "hands on" courses an essential part of initial US training with good transfer of learning to improved diagnostic accuracy. This thesis can therefore be used to support the move towards competency-based training in abdominal and head & neck US.
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November 2017

Cost-Effectiveness of Mobile App-Guided Training in Extended Focused Assessment with Sonography for Trauma (eFAST): A Randomized Trial.

Ultraschall Med 2017 Dec 26;38(6):642-647. Epub 2017 Sep 26.

Simulationscenter Rigshospitalet, Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.

Purpose:  Ultrasound training is associated with a long learning curve and use of substantial faculty resources. Self-directed ultrasound training may decrease the need for faculty-led teaching. Mobile apps seem promising for use in self-directed ultrasound training, but no studies have examined the cost-effectiveness of mobile app-guided training versus traditional formats such as textbook-guided training. This study evaluated the cost-effectiveness of mobile app-guided versus textbook-guided ultrasound training.

Material And Methods:  First-year residents (n = 38) with no previous ultrasound experience were randomized into mobile app-guided versus textbook-guided self-directed ultrasound training groups. Participants completed a transfer test involving four patient cases and a theoretical test on diagnostic accuracy. Two ultrasound experts assessed the residents' performance using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. The costs of developing mobile app and textbook material were calculated and used for the analysis of cost-effectiveness.

Results:  34 participants completed the transfer test. There was no statistically significant difference in test performance or diagnostic accuracy between the mobile app-guided (mean-OSAUS 42.3 % [95 %CI38.5 - 46.0 %]) and textbook-guided groups (mean-OSAUS 45.3 % [95 %CI39.3 - 51.3 %]) (d.f. [1.33] = 0.45, p = 0.41). However, development costs differed greatly for each instructional format. Textbook-guided training was significantly more cost-effective than mobile app-guided training (Incremental Cost Effectiveness Ratio -861 967 [95 %CI-1071.7 to-3.2] USD/pct. point change in OSAUS score).

Conclusion:  Mobile app-guided ultrasound training is less cost-effective than textbook-guided self-directed training. This study underlines the need for careful evaluation of cost-effectiveness when introducing technological innovations for clinical skills training.
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http://dx.doi.org/10.1055/s-0043-119354DOI Listing
December 2017

Competency-based assessment in surgeon-performed head and neck ultrasonography: A validity study.

Laryngoscope 2018 06 4;128(6):1346-1352. Epub 2017 Sep 4.

Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, University of Copenhagen and the Capital Region of Denmark, Copenhagen.

Objective: Head and neck ultrasonography (HNUS) increasingly is used as a point-of-care diagnostic tool by otolaryngologists. However, ultrasonography (US) is a very operator-dependent image modality. Hence, this study aimed to explore the diagnostic accuracy of surgeon-performed HNUS and to establish validity evidence for an objective structured assessment of ultrasound skills (OSAUS) used for competency-based assessment.

Study Design: A prospective experimental study.

Methods: Six otolaryngologists and 11 US novices were included in a standardized test setup for which they had to perform focused HNUS of eight patients suspected for different head and neck lesions. Their diagnostic accuracy was calculated based on the US reports, and two blinded raters assessed the video-recorded US performance using the OSAUS scale.

Results: The otolaryngologists obtained a high diagnostic accuracy on 88% (range 63%-100%) compared to the US novices on 38% (range 0-63%); P < 0.001. The OSAUS score demonstrated good inter-case reliability (0.85) and inter-rater reliability (0.76), and significant discrimination between otolaryngologist and US novices; P < 0.001. A strong correlation between the OSAUS score and the diagnostic accuracy was found (Spearman's ρ, 0.85; P < P 0.001), and a pass/fail score was established at 2.8.

Conclusion: Strong validity evidence supported the use of the OSAUS scale to assess HNUS competence with good reliability, significant discrimination between US competence levels, and a strong correlation of assessment score to diagnostic accuracy. An OSAUS pass/fail score was established and could be used for competence-based assessment in surgeon-performed HNUS.

Level Of Evidence: NA. Laryngoscope, 128:1346-1352, 2018.
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http://dx.doi.org/10.1002/lary.26841DOI Listing
June 2018

An Addition to the Technical Skills Assessment Toolbox.

Ann Surg 2017 08;266(2):e37

Centre for Clinical Education, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark. Faculty of Health, Aarhus University, Aarhus, Denmark.

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http://dx.doi.org/10.1097/SLA.0000000000001377DOI Listing
August 2017

Rating scale for the assessment of competence in ultrasound-guided peripheral vascular access - a Delphi Consensus Study.

J Vasc Access 2016 Sep 1;17(5):440-445. Epub 2016 Aug 1.

Department of Emergency Medicine, Regional Hospital West Jutland, Herning - Denmark.

Introduction: Peripheral vascular access is vital for treatment and diagnostics of hospitalized patients. Ultrasound-guided vascular access (UGVA) is superior to the landmark technique. To ensure competence-based education, an assessment tool of UGVA competence is needed. We aimed to develop a global rating scale (RS) for assessment of UGVA competence based on opinions on the content from ultrasound experts in a modified Delphi consensus study.

Methods: We included experts from anesthesiology, emergency medicine and radiology across university hospitals in Denmark. Nine elements were drafted based on existing literature and recommendations from international societies. In a multi-round survey, the experts rated the elements on a five-point Likert scale according to importance, and suggested missing elements. The final Delphi round occurred when >80% of the experts rated all elements ≥4 on the Likert scale.

Results: Sixteen experts consented to participate in the study, one withdrew consent prior to the first Delphi round, and 14 completed all three Delphi rounds. In the first Delphi round the experts excluded one element from the scale and changed the content of two elements. In the second Delphi round, the experts excluded one element from the scale. In the third Delphi round, consensus was obtained on the eight elements: preparation of utensils, ergonomics, preparation of the ultrasound device, identification of blood vessels, anatomy, hygiene, coordination of the needle, and completion of the procedure.

Conclusions: We developed an RS for assessment of UGVA competence based on opinions of ultrasound experts through a modified Delphi consensus study.
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http://dx.doi.org/10.5301/jva.5000581DOI Listing
September 2016

Self-directed simulation-based training of emergency cricothyroidotomy: a route to lifesaving skills.

Eur Arch Otorhinolaryngol 2016 Dec 5;273(12):4623-4628. Epub 2016 Jul 5.

Department of Otorhinolaryngology, Head and Neck Surgery, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.

The emergency cricothyroidotomy (EC) is a critical procedure. The high cost of failures increases the demand for evidence-based training methods. The aim of this study was to present and evaluate self-directed video-guided simulation training. Novice doctors were given an individual 1-h simulation training session. One month later, an EC on a cadaver was performed. All EC's were video recorded. An assessment tool was used to rate performance. Performance was compared with a pass/fail level for the EC. We found a high reliability, based on Pearson's r (0.88), and a significant progression of skill during training (p < 0.001). Eleven out of 14 succeeded in creating an airway on the cadaver in 64 s (median, range 39-86 s), but only four achieved a passing score. Our 1-h training protocol successfully raised the competence level of novice doctors; however, the training did not ensure that all participants attained proficiency.
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http://dx.doi.org/10.1007/s00405-016-4169-0DOI Listing
December 2016
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