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Background Continuing medical education (CME) is vital for patient care, society, and general practitioners’ (GPs) wellbeing. Despite its benefits, some GPs attend CME infrequently. While GPs’ preferences for CME are well documented, it is unclear if these preferences are shared by infrequent users. Exploring infrequent CME users’ preferences and educational needs is essential to engage them effectively. Aims of the study: To explore infrequent users’ preferences for CME formats and their attitudes towards mandatory CME compared to their CME attending GP colleagues. Methods A cross-sectional questionnaire study was conducted among all 3,257 GPs in Denmark. Descriptive statistics and logistic regression analyses were used. Results Responders were categorized into four CME user types: frequent (42%), partial (44%), infrequent (14%), and “do not know” (< 1%). All responders highly valued teachers and course leaders with insight into general practice. Overall, interactive learning activities and formats directly applicable to clinical practice were preferred, while online education, self-study, fact-based lectures, and sponsored meetings ranked lower. Infrequent users were more positive than frequent users towards reading on their own and fact-based lectures without participant involvement and short travel time. They were less positive about time-consuming learning such as week-long courses and courses abroad. Among infrequent users, 72% were principally opposed to mandatory CME setups, whereas a much smaller proportion opposed the current extent of mandatory CME in Denmark. This suggests a difference between practical acceptance and principled opposition. Despite infrequent users’ reluctance towards participant involvement, they were open to small group learning and in-practice formats. Conclusion Teachers and course leaders with profound insight in general practice and patient-focused content seem to be an unquestionable requirement for successful CME. Infrequent users’ reluctance towards participant involvement, but openness to small group learning and in-practice formats should be used strategically. Offering a variety of accessible, smaller-scale courses supports autonomy and diversity. Mandatory CME is not seen exclusively negatively and can be accepted if perceived relevant or as a valuable break or educational guarantee. However, it must be balanced with voluntary options to avoid causing demotivation.

Background Continuous medical education is essential for the individual patient care, the society, and the wellbeing of the general practitioner. There has been research into the reasons for participation in continuous medical education, but little is known about the barriers to participation. To tailor continuous medical education targeting general practitioners who are currently deselecting education, systematic knowledge of the barriers is needed. Continuous medical education can in addition to professional growth stimulate job satisfaction, diminish burnout, and reinforce feelings of competence. Continuous medical education may have positive implications for patients and for healthcare expenditures. Despite renumeration and a comprehensive continuous education model some Danish general practitioners do not participate in continuous medical education. Methods From a total of 3440 Danish general practitioners 243 did not apply for reimbursement for accredited continuous medical education in a two-year period. Ten general practitioners were selected for an interview regarding maximum variation in practice form, number of listed patients, seniority as a general practitioner, geography, gender, and age. All ten selected general practitioners accepted to be interviewed. The interviews were analysed using Systematic Text Condensation. Results Each of the ten interviewed general practitioners mentioned several barriers for participating in continuous education. The barriers fell into three main categories: barriers related to the individual general practitioner barriers related to the clinic barriers related to the accredited continuous medical education offered Conclusions Approximately 7% of the Danish general practitioners did not participate in accredited remunerated continuous medical education. A knowledge of the barriers for participating in accredited continuous medical education can be used to better target continuous medical education to the general practitioners.

General practitioners' (GPs) participation in continuous medical education (CME) is crucial for patient care, GPs' well-being and healthcare costs. Despite this, 25% of Danish GPs did not participate in CME in 2022. It is vital to understand motivational factors for engaging in CME. To analyze motivation for CME and differences in motivational factors among GPs with different levels of participating. A cross-sectional questionnaire informed from qualitative interviews was conducted among all 3257 GPs in Denmark in May 2023. The response rate was 40%. Responders were categorized as 'frequent', 'partial' and 'infrequent' CME users. We employed descriptive statistics and logistic regression analysis to quantify predefined motivational factors. Free text comments were analyzed using systematic text condensation. We used self-determination theory as a framework in the interpretation. Most reported motivational factors were 'relevant medical update' (98%) and 'topics of interest' (96%). Financial incentives had a minor impact across all groups. Infrequent users were less easy to motivate and were more likely to state controlled motivational factors, e.g. a duty. Frequent and partial users of CME reported more autonomous motivation, i.e. personal development, collegial togetherness and professional well-being. Relevant medical updates that enhance perceived competence in patient care are crucial for all GPs. Infrequent users seem less motivated by avoiding burnout, collegial togetherness and well-being.

Background In Danish GP training we had the ambition to enhance and assess global reflection ability, but since we found no appropriate validated method in the literature, we decided to develop a new assessment tool. This tool is based on individual trainee developed mind maps and structured trainer-trainee discussions related to specific complex competencies. We named the tool Global Assessment of Reflection ability (GAR) and conducted a mixed method validation study. Our goal was to investigate whether it is possible to enhance and assess reflection ability using the tool. Methods In order to investigate acceptability, feasibility, face validity, and construct validity of the tool we conducted a mixed method validation study that combined 1) qualitative data obtained from 750 GP trainers participating in train-the-trainer courses, 2) a questionnaire survey sent to 349 GP trainers and 214 GP trainees and 3) a thorough analysis of eight trainer-trainee discussions. Results Our study showed an immediate high acceptance of the GAR tool. Both trainers and trainees found the tool feasible, useful, and relevant with acceptable face validity. Rating of eight audio recordings showed that the tool can demonstrate reflection during assessment of complex competencies. Conclusions We have developed an assessment tool (GAR) to enhance and assess reflection. GAR was found to be acceptable, feasible, relevant and with good face- and construct validity. GAR seems to be able to enhance the trainees’ ability to reflect and provide a good basis for assessment in relation to complex competencies.

Continuous medical education is essential for the individual patient care, the society, and the wellbeing of the general practitioner. There has been research into the reasons for participation in continuous medical education, but little is known about the barriers to participation. To tailor continuous medical education targeting general practitioners who are currently deselecting education, systematic knowledge of the barriers is needed. From a total of 3440 Danish general practitioners 243 did not apply for reimbursement for accredited continuous medical education in a two-year period. Ten general practitioners were selected for an interview regarding maximum variation in practice form, number of listed patients, seniority as a general practitioner, geography, gender, and age. All ten selected general practitioners accepted to be interviewed. The interviews were analysed using Systematic Text Condensation. Each of the ten interviewed general practitioners mentioned several barriers for participating in continuous education. The barriers fell into three main categories: Approximately 7% of the Danish general practitioners did not participate in accredited remunerated continuous medical education. A knowledge of the barriers for participating in accredited continuous medical education can be used to better target continuous medical education to the general practitioners.

Continuing medical education (CME) is vital for patient care, society, and general practitioners' (GPs) wellbeing. Despite its benefits, some GPs attend CME infrequently. While GPs' preferences for CME are well documented, it is unclear if these preferences are shared by infrequent users. Exploring infrequent CME users' preferences and educational needs is essential to engage them effectively. A cross-sectional questionnaire study was conducted among all 3,257 GPs in Denmark. Descriptive statistics and logistic regression analyses were used. Responders were categorized into four CME user types: frequent (42%), partial (44%), infrequent (14%), and \"do not know\" (< 1%). All responders highly valued teachers and course leaders with insight into general practice. Overall, interactive learning activities and formats directly applicable to clinical practice were preferred, while online education, self-study, fact-based lectures, and sponsored meetings ranked lower. Infrequent users were more positive than frequent users towards reading on their own and fact-based lectures without participant involvement and short travel time. They were less positive about time-consuming learning such as week-long courses and courses abroad. Among infrequent users, 72% were principally opposed to mandatory CME setups, whereas a much smaller proportion opposed the current extent of mandatory CME in Denmark. This suggests a difference between practical acceptance and principled opposition. Despite infrequent users' reluctance towards participant involvement, they were open to small group learning and in-practice formats. Teachers and course leaders with profound insight in general practice and patient-focused content seem to be an unquestionable requirement for successful CME. Infrequent users' reluctance towards participant involvement, but openness to small group learning and in-practice formats should be used strategically. Offering a variety of accessible, smaller-scale courses supports autonomy and diversity. Mandatory CME is not seen exclusively negatively and can be accepted if perceived relevant or as a valuable break or educational guarantee. However, it must be balanced with voluntary options to avoid causing demotivation.

In Danish GP training we had the ambition to enhance and assess global reflection ability, but since we found no appropriate validated method in the literature, we decided to develop a new assessment tool. This tool is based on individual trainee developed mind maps and structured trainer-trainee discussions related to specific complex competencies. We named the tool Global Assessment of Reflection ability (GAR) and conducted a mixed method validation study. Our goal was to investigate whether it is possible to enhance and assess reflection ability using the tool. In order to investigate acceptability, feasibility, face validity, and construct validity of the tool we conducted a mixed method validation study that combined 1) qualitative data obtained from 750 GP trainers participating in train-the-trainer courses, 2) a questionnaire survey sent to 349 GP trainers and 214 GP trainees and 3) a thorough analysis of eight trainer-trainee discussions. Our study showed an immediate high acceptance of the GAR tool. Both trainers and trainees found the tool feasible, useful, and relevant with acceptable face validity. Rating of eight audio recordings showed that the tool can demonstrate reflection during assessment of complex competencies. We have developed an assessment tool (GAR) to enhance and assess reflection. GAR was found to be acceptable, feasible, relevant and with good face- and construct validity. GAR seems to be able to enhance the trainees' ability to reflect and provide a good basis for assessment in relation to complex competencies.

Background To estimate the direct and indirect costs of stroke in patients and their partners. Description Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients and compared with 364,433, 103,741 and 500,490 matched controls, respectively. Results Independent of age and gender, stroke patients had significantly higher rates of mortality, health-related contacts, medication use and lower employment, lower income and higher social-transfer payments than controls. The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls for hemorrhagic, ischemic and unspecified stroke, respectively. The negative social- and health-related status could be identified up to eleven years before the first diagnosis. Conclusion Stroke has significant mortality, morbidity and socioeconomic consequences for patients, their partners and society.

ObjectivesThe study sought to describe whether psychotropic medication may have long-term side effects in patients with stroke compared with controls.SettingUse of national register data from healthcare services were identified from the Danish National Patient Registry in Denmark. Information about psychotropic medication use was obtained from the Danish Register of Medicinal Product Statistics.ObjectivesWe aimed to evaluate all-cause mortality in relation to the use of benzodiazepines, antidepressants and antipsychotics in patients with stroke and matched controls.ParticipantsPatients with a diagnosis of stroke and either no drug use or preindex use of psychotropic medication (n=49 968) and compared with control subjects (n=86 100) matched on age, gender, marital status and community location.Primary outcome measureAll-cause mortality.ResultsAll-cause mortality was higher in patients with previous stroke compared with control subjects. Mortality HRs were increased for participants prescribed serotonergic antidepressant drugs (HR=1.699 (SD=0.030), p=0.001 in patients; HR=1.908 (0.022), p<0.001 in controls, respectively), tricyclic antidepressants (HR=1.365 (0.045), p<0.001; HR=1.733 (0.022), p<0.001), benzodiazepines (HR=1.643 (0.040), p<0.001; HR=1.776 (0.053), p<0.001), benzodiazepine-like drugs (HR=1.776 (0.021), p<0.001; HR=1.547 (0.025), p<0.001), first-generation antipsychotics (HR=2.001 (0.076), p<0.001; HR=3.361 (0.159), p<0.001) and second-generation antipsychotics (HR=1.645 (0.070), p<0.001; HR=2.555 (0.086), p<0.001), compared with no drug use. Interaction analysis suggested statistically significantly higher mortality HRs for most classes of psychotropic drugs in controls compared with patients with stroke.ConclusionsAll-cause mortality was higher in patients with stroke and controls treated with benzodiazepines, antidepressants and antipsychotics than in their untreated counterparts. Our findings suggest that care should be taken in the use and prescription of such drugs, and that they should be used in conjunction with adequate clinical controls.

The oligoadenylate synthetase (OAS) proteins are traditionally considered intracellular antiviral proteins that mediate antiviral activity through the synthesis of 2′-5′-linked oligoadenylates and subsequent activation of the endoribonuclease RNase L. However, we have recently demonstrated that exogenous recombinant OAS1 is taken up by cells and reduces viral replication both in cell culture and in vivo, independent of RNase L. These results demonstrate a novel paracrine antiviral activity of OAS working in parallel with the classical RNase L pathway. In this study, we investigate the uptake kinetics of recombinant porcine OAS1 and show that it is rapidly and efficiently internalized in a manner that can be blocked by heparin. Heparin, furthermore, abolishes the antiviral activity of OAS1, demonstrating the requirement of the intracellular localization of OAS1 to inhibit the virus. In addition, we demonstrate that exogenous OAS1 affects an early step of the viral replication cycle.