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Background: Rapid and accurate detection of pathogens is needed in community-acquired pneumonia (CAP) to enable appropriate antibiotics and to slow the development of antibiotic resistance. We aimed to compare the effect of point-of-care (POC) polymerase chain reaction (PCR) detection of respiratory pathogens added to standard care with standard care only (SCO) on antibiotic prescriptions after acute hospital admission. Methods and findings: We performed a superiority, parallel-group, open-label, multicentre, randomised controlled trial (RCT) in 3 Danish medical emergency departments (EDs) from March 2021 to February 2022. Adults acutely admitted with suspected CAP during the daytime on weekdays were included and randomly assigned (1:1) to POC-PCR (The Biofire FilmArray Pneumonia Panel plus added to standard care) or SCO (routine culture and, if requested by the attending physician, target-specific PCR) analysis of respiratory samples. We randomly assigned 294 patients with successfully collected samples (tracheal secretion 78.4% or expectorated sputum 21.6%) to POC-PCR (n = 148, 50.4%) or SCO (146, 49.6%). Patients and investigators owning the data were blinded to the allocation and test results. Outcome adjudicators and clinical staff at the ED were not blinded to allocation and test results but were together with the statistician, blinded to data management and analysis. Laboratory staff performing standard care analyses was blinded to allocation. The study coordinator was not blinded. Intention-to-treat and per protocol analysis were performed using logistic regression with Huber–White clustered standard errors for the prescription of antibiotic treatment. Loss to follow-up comprises 3 patients in the POC-PCR (2%) and none in the SCO group. Intention-to-treat analysis showed no difference in the primary outcome of prescriptions of no or narrow-spectrum antibiotics at 4 h after admission for the POC-PCR (n = 91, 62.8%) odds ratio (OR) 1.13; (95% confidence interval (CI) [0.96, 1.34] p = 0.134) and SCO (n = 87, 59.6%). Secondary outcomes showed that prescriptions were significantly more targeted at 4-h OR 5.68; (95% CI [2.49, 12.94] p < 0.001) and 48-h OR 4.20; (95% CI [1.87, 9.40] p < 0.001) and more adequate at 48-h OR 2.11; (95% CI [1.23, 3.61] p = 0.006) and on day 5 in the POC-PCR group OR 1.40; (95% CI [1.18, 1.66] p < 0.001). There was no difference between the groups in relation to intensive care unit (ICU) admissions OR 0.54; (95% CI [0.10, 2.91] p = 0.475), readmission within 30 days OR 0.90; (95% CI [0.43, 1.86] p = 0.787), length of stay (LOS) IRR 0.82; (95% CI [0.63, 1.07] p = 0.164), 30 days mortality OR 1.24; (95% CI [0.32, 4.82] p = 0.749), and in-hospital mortality OR 0.98; (95% CI [0.19, 5.06] p = 0.986). Conclusions: In a setting with an already restrictive use of antibiotics, adding POC-PCR to the diagnostic setup did not increase the number of patients treated with narrow-spectrum or without antibiotics. POC-PCR may result in a more targeted and adequate use of antibiotics. A significant study limitation was the concurrent Coronavirus Disease 2019 (COVID-19) pandemic resulting in an unusually low transmission of respiratory virus. Trial registration: ClinicalTrials.gov (NCT04651712). In this multicentre randomised controlled trial, Mariana Bichuette Cartuliares and colleagues evaluate point-of-care multiplex polymerase chain reaction in antibiotic treatment of patients acutely admitted with suspected community-acquired pneumonia in Denmark. Author summary: Why was this study done?: The global rise in antimicrobial resistance fueled by the excessive use and misuse of antibiotics is a major public health concern. Fast and accurate diagnostics is important to counteract this development as it can potentially reduce the use of antibiotics/broad-spectrum antibiotics without sacrificing patient safety. Pneumonia is a common, serious condition where available point-of-care (POC) technology (polymerase chain reaction) allows clinicians to detect possible airway pathogens before treatment decisions are made. What did the researchers do and find?: In this randomised trial of 294 patients admitted with suspected pneumonia, POC did not result in the prescription of less antibiotics or less broad-spectrum antibiotics within 4 h after admission. Based on a subset of patients, the results indicated that more patients in the POC-group were treated with targeted or appropriate antibiotics 48 h and 5 days after admission. Patients in the POC-group had a non-statistically significant reduction in length of hospital stay of approximately 1 day. What do these findings mean?: The use of respiratory POC does not seem to be an effective tool for reducing the use of antibiotics in a setting with a very low level of antimicrobial resistance and already prudent use of antibiotics. The use of respiratory POC may aid to ensure a targeted and/or appropriate treatment in a setting with a restrictive use of antibiotics—and thereby may aid to sustain a restrictive strategy. The concurrent Coronavirus Disease 2019 (COVID-19) pandemic and the unusually low transmission of common respiratory viruses in the period may have affected the results. [ABSTRACT FROM AUTHOR]

Background: Azole resistance complicates treatment of patients with invasive aspergillosis with an increased mortality. Azole resistance in Aspergillus fumigatus is a growing problem and associated with human and environmental azole use. Denmark has a considerable and highly efficient agricultural sector. Following reports on environmental azole resistance in A. fumigatus from Danish patients, the ministry of health requested a prospective national surveillance of azole‐resistant A. fumigatus and particularly that of environmental origin. Objectives: To present the data from the first 2 years of the surveillance programme. Methods: Unique isolates regarded as clinically relevant and any A. fumigatus isolated on a preferred weekday (background samples) were included. EUCAST susceptibility testing was performed and azole‐resistant isolates underwent cyp51A gene sequencing. Results: The azole resistance prevalence was 6.1% (66/1083) at patient level. The TR34/L98H prevalence was 3.6% (39/1083) and included the variants TR34/L98H, TR343/L98H and TR34/L98H/S297T/F495I. Resistance caused by other Cyp51A variants accounted for 1.3% (14/1083) and included G54R, P216S, F219L, G54W, M220I, M220K, M220R, G432S, G448S and Y121F alterations. Non‐Cyp51A‐mediated resistance accounted for 1.2% (13/1083). Proportionally, TR34/L98H, other Cyp51A variants and non‐Cyp51A‐mediated resistance accounted for 59.1% (39/66), 21.2% (14/66) and 19.7% (13/66), respectively, of all resistance. Azole resistance was detected in all five regions in Denmark, and TR34/L98H specifically, in four of five regions during the surveillance period. Conclusion: The azole resistance prevalence does not lead to a change in the initial treatment of aspergillosis at this point, but causes concern and leads to therapeutic challenges in the affected patients. [ABSTRACT FROM AUTHOR]

The case of the Danish construction company Christiani & Nielsen in the period 1941-1945 shows that Scandinavian companies were not just pawns in a bigger political game but were to a certain degree capable of promoting their own interests. This paper reveals that the political imperative is not only a matter of political risk but also of political opportunity. The history of Christiani & Nielsen offers a useful case of the political risks and fiscal opportunities faced by multinationals working in dictatorial settings. The paper concludes that, in a choice between a forestalling strategy and an absorption strategy, the latter offers a better way of managing such risks and to minimise exposure. [ABSTRACT FROM AUTHOR]

This article focuses on issues related to professionalisation of tourism industry in Denmark. Various suggestions have been made for improving quality of services, upgrading of competences and qualification of employees. The top priority of tourism industry is to expand and improve training of employees. One of the most enduring problems of human resources in tourist sector is the rapid turnover of staff. There are no training opportunities specifically for the tourist sector at university level in Denmark. In one of the studies conducted in Denmark it was observed that education is important in tourism as it is in other sectors of the economy. Cooks and waiters, who have the most well-established and recognized educational qualifications in tourism, also have significantly higher average incomes. Employment in the tourism industry is increasingly based on qualifications. Although starting from a very low level, more persons with a formal education are being employed in the sector. The lack of retention of professionals in tourism can be claimed to be a problem of definition of the sector as such. In terms of qualification and careers, tourism is becoming too narrow. Although staff with dedicated professional training can be retained in the tourist industry slightly longer than other groups of personnel, tenure is still very short and cannot be compared with professionals in other sectors.

A highly virulent sub-lineage of the Streptococcus pyogenes M1 clone has been rapidly expanding throughout Denmark since late 2022 and now accounts for 30% of the new invasive group A streptococcal infections. We aimed to investigate whether a shift in variant composition can account for the high incidence rates observed over winter 2022/23, or if these are better explained by the impact of COVID-19-related restrictions on population immunity and carriage of group A Streptococcus .

A Markov model was constructed to simulate the resource use and health outcomes of one year of treatment comparing the fentanyl transdermal therapeutic system (fentanyl-TTS) with oral sustained-release (SR) morphine in outpatients with noncancer pain in Denmark. Effectiveness was assessed in terms of days of good pain control and days on initial treatment. Costs included those of baseline pain management, including breakthrough pain; co-medication costs; and control of adverse events. Fentanyl-TTS was more effective than SR-morphine in achieving good pain control (99 vs. 64 days, respectively) and the incremental cost-effectiveness of fentanyl-TTS was US dollars 10.26 per extra day of good pain control. Patients treated with fentanyl-TTS remained considerably longer on initial treatment compared with those treated with SR-morphine (166 days vs. 117 days, respectively). The results of this study suggest that fentanyl-TTS is a competitive therapeutic and economic choice for the treatment of chronic noncancer pain.