Danish medical bulletin最新文献

Introduction: For the majority of cancers, improved long-term survival may be accessed from survival during the first year after diagnosis. A steady improvement in survival was seen both before and after the introduction of cancer control plans in 2000 and 2005. On the basis of data from 2007-2009, we studied the trend in 1-year survival after the introduction of the 2005 plan.

Material and methods: All cancers from 1995-2009 were studied in five 3-year cohorts of incident cases which were followed-up for death to the end of 2010. Age-standardised 1-, 3- and 5-year relative survival was calculated and 1-year survival presented for 2004-2006 and 2007-2009 to allow comparison with our previous publication.

Results: The improvement over time in overall 1-year age-standardised relative survival was maintained with a three percentage point increase to 72% for men and 75% for women. Exclusion of prostate and breast cancer from calculations lowered relative survival to 65% and 67%, respectively; but improvement was maintained. Cancer sites which previously enjoyed a high survival saw the least or no improvement as was the case for haematological cancers, except for non-Hodgkin lymphoma in men. The differences in survival between men and women are diminishing, especially for cancers of the digestive tract.

Conclusion: The improvements over time in survival after introduction of the cancer plans were maintained for non-haematological cancers. The fast-track system for diagnosis and treatment introduced gradually by cancer sites until the end of 2008 along with some centralisation of elective surgery may have narrowed the gap in cancer survival between men and women for digestive tract cancers and may also have improved survival for other cancers, e.g. the sex-specific types and kidney and brain cancers.

Funding: not relevant.

Trial registration: not relevant.

Background: Although patient-centred communication has provided a focus point in health care for many years, patient surveys continuously reveal serious communication problems as experienced by patients, due to poor communication. Likewise, poor inter-collegial communication can cause problems for both health care staff and patients. So, knowing that patient-centred communication and good inter-collegial communication is for the benefit of both health professionals and patients, the relevance of improving health care professionals' communication skills and investigating the effect on both professionals and patients is beyond doubt.

Aim: The aim of this study was to investigate whether a training course in communication skills for health care professionals could improve: 1) Health care professionals' self-efficacy in communication with patients and colleagues 2) Health care professionals' evaluation of inter-collegial communication 3) Patients' experience of quality of care, and to investigate health care professionals' experience of: a) participation in a communication skills training course b) the influence of the course on their ability to communicate with patients and colleagues.

Methods: The study was carried out in the Department of Orthopaedic Surgery, Kolding Hospital, a part of Lillebaelt Hospital, as an intervention study with baseline measurements and measurements after the intervention. The intervention was an in-house communication skills training course for all health care professionals at the department. The effect was measured partly on the health care professionals' self-efficacy and evaluation of inter-collegial communication, partly on patients' evaluation of quality of information, continuity and care. Data were collected by means of questionnaires and further explored by focus group interviews with health care professionals.

Results: A total of 181 health care professionals were included in the study. The questionnaire was completed by 177 (97.8%) before; 165/169 (97.6%) immediately after and 150/153 (98%) six months after the course. The health care professionals' self-efficacy was significantly increased, both for communication with patients and colleagues. The effect was still present six months after the training course. Also the health care professionals' evaluation of inter-collegial communication showed significant improvements after the course; the effect was more pronounced for inter-professional than for intra-professional communication and more pronounced six months after than immediately after the course. A total of 32 health care professionals participated in the focus group interviews, which showed that, in general, nurses, nursing assistants, medical secretaries and managers principally experienced better control over the patient interview, increased confidence in communication, improved inter-collegial understanding and i

Introduction: In Denmark, Alarm 112 (112) calls and emergency medical dispatch (EMD) are two separate institutions. 112 calls are mainly answered by the police. In Aarhus, a new EMD centre for the Region of Central Jutland (1.2 million people) opened on 1 December 2009. It was the first to employ health-care professionals and to use a new tool for criteria-based dispatch called Danish Index. The aim of the present paper is, for the first time in Denmark, to describe the level of urgency of patients transported by ambulance based on the Danish Index categories A-E and to determine if ambulance response time target values were reached.

Material and methods: The present paper is an observational cohort study based on consecutive, electronically collected data from the initial six months of operation (1 December 2009 to 31 May 2010) of the new EMD centre in Aarhus.

Results: A total of 73,484 patients were included. The distribution according to level of urgency was as follows: A 28.7% (n = 21,104), B 13.5% (n = 9,890), C 21.0% (n = 15,418), D 35.1% (n = 25,818), E 1.7% (n = 1,254). The median ambulance response time intervals for levels A and B were 6.5 and 11.9 min., respectively. Comparison of level A response time intervals with the equivalent target values showed that the 75, 92 and 98 percentiles were 10.0/10 min., 14.6/15 min., 18.6/20 min., respectively.

Conclusion: In a cohort of 73,484 patients, the highest level of urgency (A) was found in 28.7% of cases, while the largest group, 35.1% of patients, were level D cases - these patients had a need for transport, but not by ambulance. The level A target response time requested by 112 was achieved.

Funding: not relevant.

Trial registration: not relevant.

Introduction: Previous studies demonstrated a 3-5-fold increased cancer risk in kidney allograft recipients compared with the general population. Our aim was to estimate cancer frequencies among kidney allograft recipients who were transplanted in 1997-2000 and who were immunosuppressed according to a more modern steroid-free standard protocol based on basixilimab, ciclosporine and mycophenolate mofetil.

Material and methods: This was a retrospective cohort study of patients receiving their first kidney allograft in 1997-2000 at Odense University Hospital, Denmark (n = 90). Histologically verified cancers were identified from a detailed search of the individual patient's medical records.

Results: During an average follow-up time of 8.4 years, a total of 14 cancers were observed. The cancer incidence rate was 18.5 (95% confidence interval (CI): 11.0-31.3) per 1,000 years, and the cancer prevalence was 13.4% (95% CI: 5.6-21.2%) among survivors in 2007. The relative risk of prevalent cancer was 3.6 (95% CI: 2.0-6.5) compared with the general population. Patients with cancer had a poorer survival than patients without cancer.

Conclusion: The observed cancer incidence rate and prevalence were similar to figures derived from studies performed in the earlier eras of kidney transplantation. Reducing cancer rates after kidney transplantation remains an important challenge for nephrologists.

Funding: not relevant.

Trial registration: not relevant.

Introduction: Nodular toxic and non-toxic goitres are seen in approximately 15% of Danish women, and the pros and cons of thyroidectomy versus radioiodine (RI) therapy are often discussed. The purpose of this study was to evaluate the type and number of patients treated on the indication of hyperthyroidism or benign goitre who did not achieve a sufficient effect of RI therapy and therefore needed thyroidectomy.

Material and methods: Between 1 January 2003 and 1 January 2008, a total of 873 patients were treated with RI on the indication of benign thyroid disease at Herlev Hospital (Denmark). Data concerning these patients were listed consecutively in a database. The data were subsequently cross-checked with the Danish Thyroid Surgery Quality Register (THYKIR) which contains data on all patients treated with thyroid surgery at Danish departments of ear, nose and throat and head and neck surgery since 1 January 2001. Patient data were also cross-checked with the National Patient Register data. The unique Danish social security numbers were used to compare data.

Results: Among the 873 patients treated with RI, 36 were listed in the THYKIR database. Eleven of these had primary thyroid surgery and subsequently underwent RI treatment due to goitre recurrence. Twenty-five patients first received RI therapy and subsequently thyroidectomy due to persisting symptoms (17 had non-toxic goitre and compression symptoms (among these eight had a large goitre with a thyroid volume of > 100 ml (range 100-389 ml)), five had nodular toxic goitre and three had diffuse toxic goitre and continuing hyperthyroidism despite RI treatment. Thyroid surgery revealed a small (2-3 mm) cancer in two patients, both from the group of patients with nodular toxic goitre.

Conclusion: The effect of RI therapy sufficiently solved the problem (hyperthyroidism or goitre) and surgery was hence avoided in 848 of 873 (97%) patients. However, within the group of patients with nontoxic goitre, a subgroup of patients with large goitres seems to be resistant to RI treatment and does not achieve sufficient effect under the current RI therapy regime.

Funding: not relevant.

Trial registration: Danish Data Protection Agency (Datatilsynet) HEH.afd.O.750.86-7 and 2010-231-0068.

Percutaneous dilatational tracheostomy is a common procedure in intensive care. This guideline from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM) describes indications and contraindications, timing, complications compared to surgical tracheostomy, anaesthesia and technique, decannulation strategy, as well as training and education.

Introduction: High consumption of macrolides has been linked to increased macrolide resistance in the common pathogens of respiratory tract infections (RTIs). According to Danish recommendations, penicillin is the first-choice treatment for RTIs and macrolides should only be prescribed when a patient is allergic to penicillin or for treatment of mycoplasma pneumonias. The aim of the present study was to explore the prescription of macrolides for different RTIs to patients without penicillin allergy in general practice in Denmark.

Material and methods: This was a cross-sectional study. Data were collected during a three-week period in January 2008 as part of the EU-funded project Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT). A total of 102 Danish general practitioners participated and registered patients with RTIs according to the Audit Project Odense method.

Results: A total of 3,904 patients with RTIs were registered and 1,351 patients received antibiotics. Among these, 198 patients received a macrolide. In all, 136 patients received a macrolide without being allergic to penicillin. This proportion was highest for patients diagnosed with acute otitis media (71%), acute bronchitis (71%) or pneumonia (76%).

Conclusion: Overall, there was a considerable overuse of macrolide for treatment of all types of RTIs. The macrolide overuse found in this study cannot be explained by the aetiology of Mycoplasma pneumoniae since there was no epidemic in 2008.

Funding: Data for the macrolide study were collected from the HAPPY AUDIT study which was funded by the EU. The two first-authors each received DKK 30,000 from the PLU foundation for their work on the article.

Trial registration: The HAPPY AUDIT method was registered and published in the BioMed Central.

Introduction: Monitoring patient safety is a challenging task. The lack of a golden standard has contributed to the recommendation and introduction of several methods. In 2000 the Danish Lung Cancer Registry (DLCR) was established to monitor the clinical management of lung cancer. In 2008 the Global Trigger Tool (GTT) was recommended in Denmark as a tool for the monitoring of patient safety. Ideally, the recommendation of a new tool should be preceded by a critical assessment of its added value.

Material and methods: Data on complications related to lung cancer surgery from the Department of Cardiothoragic Surgery at Odense University Hospital were collected using the DLCR and the GTT in 2008. The capacity of these two methods to identify complications is compared and discussed.

Results: A total of 59 complications were registered in the DLCR, while 58 complications were registered using the GTT. The two methods were equally good at identifying complications, but the DLCR seemed to be borderline significantly better at detecting arrhythmia, while the GTT was significantly better at detecting "other events".

Conclusion: Nearly half of the adverse events identified with the GTT were complications which were also registered by type in the DLCR. The two methods were almost equally good at identifying specific types of complications, but the GTT identified more "other events". The majority of these events were well-known to clinicians. The comparison illustrates why the implementation of new methods should be preceded by critical assessment. In this case, it is crucial to assess whether the current method should be modified by the addition of more patient safety indicators rather than by introducing a new method that partly duplicates existing data.

The main aim of the thesis was to evaluate the impact of modern treatment strategies on disease activity and disease course in patients with rheumatoid arthritis (RA), and to identify predictors for treatment response. Two different treatment strategies were investigated: (A) Aggressive, conventional treatment aiming at achieving inflammatory control in patients with recent-onset RA and (B) Treatment with tumour necrosis factor alpha (TNFα) inhibitors in patients with RA, who had an incomplete response to conventional treatment. (A) was studied in a randomized, placebo-controlled clinical trial (CIMESTRA), whereas (B) was investigated in an observational, nationwide cohort study (the DANBIO database). The main findings were: 1. Treatment strategy (A) with methotrexate (MTX) and injections of glucocorticoids into swollen joints had rapid and sustained effect and reduced disease activity and halted joint damage. Addition of cyclosporine during the first 2 years reduced disease activity for as long as it was given, but had no effect on the development of joint damage. After 5 years, the majority of the patients was in remission and had no progression of structural joint damage. 2. Bone marrow oedema by Magnetic resonance imaging (MRI) scans of the wrists predicted the development of structural joint damage 2 to 5 years later (based on x-rays). Anti-CCP antibodies and structural joint damage at the start of treatment were also independent predictors for joint damage after 5 years. 3. Routine registration of adverse events observed in patients who received treatment with etanercept or infliximab (TNFα inhibitors) in the DANBIO database picked up twice as many serious adverse events than the spontaneous, mandatory reports to the Danish Medicines Agency. 4. Despite changes in prescription practice for the treatment with TNFα inhibitors in clinical practice from year 2000 to year 2005 towards less stringent treatment criteria, DANBIO data showed an improved treatment response. 5. High age, low functional status and concomitant treatment with prednisolone were negative predictors of a EULAR good response and remission after 6 months of treatment with TNFα inhibitors in clinical practice. 6. In patients, who were naïve to treatment with TNFα inhibitors, significant differences between drugs were observed regarding treatment responses and adherence to therapies. Infliximab had the lowest treatment response, remission rates and adherence to therapy. Adalimumab had the highest treatment response and remission rates, whereas etanercept had the highest adherence. In conclusion, the results from the CIMESTRA trial and the DANBIO database showed that an aggressive treatment strategy with conventional drugs and intra-articular injections with betamethasone effectively controlled disease activity and prevent structural joint damage in patients with early RA. TNFα inhibitors were efficacious in clinical practice in the treatment of RA patien

Introduction: The Oxford Shoulder Score (OSS) is a patient-administered condition-specific questionnaire for patients with degenerative or inflammatory shoulder disease. The purpose of this study was to validate a Danish translation of the OSS and to compare it with the Constant Score (CS).

Material and methods: A total of 102 consecutive patients referred to our shoulder unit were recruited for the study. The OSS was translated into Danish according to recommendations presented by Guillemin and co-workers. We established the psychometric properties of the scoring system. Test-retest reliability was assessed by inviting 32 patients to complete another OSS 72 hours after the first test. The Bland-Altman plot was used to show absolute differences between test and retest.

Results: The validity expressed as a Spearman's rank correlation coefficient comparing the OSS with the CS was 0.74. The test-retest reliability correlation coefficient was 0.98. Bland-Altman plots revealed limits of agreement between the scores of -4.5 and -5.4. Internal consistency tested by Cronbach's alpha was 0.93.

Conclusion: The psychometric properties of the Danish version of OSS showed good validity and reliability with a substantial correlation between the OSS and the CS. Internal consistency was high. The OSS is recommended for the evaluation of patients with degenerative or post-traumatic shoulder diseases.

Funding: not relevant.

Trial registration: not relevant.