Danish medical bulletin最新文献

Atherosclerosis and PS are prevalent chronic immunoinflammatory diseases with pathophysiological, clinical and epidemiological similarities. Results suggest that PS may be an independent risk factor for cardiovascular disease. Participation of similar immunoinflammatory and prothrombotic mechanisms in PS and cardiovascular disease is supported by evidence that treatment with methotrexate in patients with PS is associated with reduced cardiovascular risk. Furthermore, PS is associated with surrogate markers of cardiovascular disease, e.g. endothelial dysfunction and coronary calcification, and with markers of increased platelet activity. However, results of epidemiological studies of the risk of cardiovascular disease in PS have been conflicting, and surveillance bias has been proposed to contribute to the observed association. Although similar considerations of shared immunoinflammatory pathways with PS can be applied to AF and VTE very little is known about the interaction between PS and these common diseases. With the underlying hypothesis that PS had detrimental effects on all prespecified adverse cardiovascular endpoints the objective of the current thesis was to examine in these patients: 1) the risk of atherothrombotic events and compare it with the risk in patients with DM; 2) the risk of AF and ischaemic stroke; 3) the risk of VTE; and 4) the prognosis after first-time MI. By use of the unique Danish nationwide registries approximately 40,000 patients with PS, including approximately 3000 patients with severe PS were identified in the study period 1997-2006. Paper I provided a comparison of cardiovascular risk between patients with PS, approximately 127,000 patients with DM, and the general population, respectively. Patients with PS were at increased risk of all endpoints including, MI, stroke, invasive coronary revascularization, cardiovascular death, and a composite cardiovascular endpoint (MI, stroke, and cardiovascular death). For the composite endpoint the rate ratios (RRs) were 1.20 (95% confidence interval [CI] 1.14-1.25), 1.58 (CI 1.36-1.85), and 1.59 (CI1.56-1.63) for mild PS, severe PS, and DM, respectively. Paper II documented an up to 2.5 fold increase in risk of AF and ischaemic stroke in patients with PS, with the highest risk estimates for young patients with severe disease. The main results of paper III were that patients with PS had an increased risk of VTE with RR 1.35 (CI 1.21-1.49) and RR 2.06 (CI 1.63-2.61) for mild and severe PS, respectively. Paper IV on post-MI prognosis included 615 patients with PS and a recent MI. The results documented that after first-time MI, these patients had an increased risk of a composite of recurrent MI, stroke, and cardiovascular death with hazard ratio 1.26 (CI 1.12-1.41) as compared to patients without PS. In conclusion, this thesis demonstrated that all patients with PS were at increased risk of atherothrombotic events and that the risk with severe PS was comparable to tha

Introduction: The purpose of the present study was to evaluate the ability of the tumour marker carcinoembryonic antigen (CEA) in combination with cancer antigen 125 (CA-125) to differentiate between malignant ovarian and malignant non-ovarian disease.

Material and methods: All patients attending the Department of Gynaecology, Herlev Hospital, who underwent an "ovary lab investigation" between 1 January 2006 and 31 December 2008 were included. Among a total of 640 patients, 355 had a malignant diagnosis. Preoperative CEA and CA-125 serum levels and final malignant diagnosis after surgery were extracted from the medical records.

Results: Among the patients with CEA levels > 5 ng/ml, 68% had non-ovarian malignancies. This test identified 39% of the non-ovarian cancers correctly. In patients with a CA-125/CEA ratio > 25, an ovarian cancer was found in 82%. The CA-125/CEA test identified 63% of the non-ovarian cancers correctly. The specificity increased to around 85% when the cut-off value of the CA-125/CEA ratio was increased from 25 to 100.

Conclusion: In patients with an undiagnosed tumour in the pelvis, the CA-125/CEA ratio may be used to preoperatively identify a substantial fraction of patients with non-ovarian malignancies. In the study population, the specificity rose to 85% when the cut-off value was increased from 25 to 100, which highlights the usefulness of a higher cut-off level.

Funding: not relevant.

Trial registration: not relevant.

Introduction: The purpose of this study was to assess the coherence between the undergraduate medical program at Aarhus University and the foundation year.

Material and methods: This cross-sectional questionnaire survey included 503 doctors graduated from Aarhus University from the winter of 2007/2008 to the summer of 2009.

Results: The response rate was 73%. Approximately 73% of the respondents were in their foundation year or their first year of specialist training and 83% generally felt well-prepared. Respondents found that most of the learning outcomes of the undergraduate medical curriculum at Aarhus University are important for junior doctors. More than 90% of the respondents estimated that they were sufficiently prepared when it came to core outcomes such as history taking and physical examination. Five issues diverged considerably in importance stated and preparedness experienced: suggestion of diagnoses, initiation of treatment, pharmacotherapy, handling of own emotions and structuring of own learning. Also, 40% stated that their clerkships had only had little value in preparing them for their foundation year.

Conclusion: Overall, graduates felt well-prepared and characterized the education coherent. However, the study raises major questions concerning clerkships and competence in treatments, pharmacotherapy and the more personal aspects of professionalism.

Funding: not relevant.

Trial registration: not relevant.

Introduction: Audience response systems (ARS) are increasingly being used to heighten participants' involvement. Knowledge of technical and pedagogical challenges is, however, limited. The purpose of this paper is to evaluate ARS as a tool for 1) evaluation, 2) knowledge testing, 3) attention raising and 4) discussion stimulation.

Material and methods: ARS was used 33 times at four different courses. Data include voting results, observations, questionnaires and interviews.

Results: A total of 215 participants and 12 teachers were included. The majority of the participants found ARS suitable for course evaluation. The teachers found it useful for obtaining the results immediately and thereby for receiving feedback on their own teaching. The participants and the teachers found ARS suitable for knowledge testing. ARS was used as an instrument to increase activity and attention. The system was found to increase the level of concentration and the interactivity. ARS was used to initiate discussions. The participants found that the questions could be a good starting point for discussion. The teachers found it challenging to comment on answers. Our experiences are that thorough planning and preparation is needed for the successful implementation of ARS.

Conclusion: Our experiences indicate that ARS is suitable for course evaluation. Overall, we find ARS a valuable technology that may stimulate discussion and support learning, but teachers need to be technically and pedagogically well prepared to use the tool. The use of ARS does not in itself entail that the quality of the teaching increases.

Introduction: As we found no recent published reports on the amount and kind of research published from Danish hospitals without university affiliation, we have found it relevant to conduct a bibliometric survey disclosing these research activities.

Material and methods: We retrieved all scientific papers published in the period 2000-2009 emanating from all seven Danish non-university hospitals in two regions, comprising 1.8 million inhabitants, and which were registered in a minimum of one of the three databases: PubMed MEDLINE, Thomson Reuters Web of Science and Elsevier's Scopus.

Results: In 878 of 1,252 papers, the first and/or last author was affiliated to a non-university hospital. Original papers made up 69% of these publications versus 86% of publications with university affiliation on first or last place. Case reports and reviews most frequently had authors from regional hospitals as first and/or last authors. The total number of publications from regional hospitals increased by 48% over the 10-year period. Publications were cited more often if the first or last author was from a university hospital and even more so if they were affiliated to foreign institutions. Cardiology, gynaecology and obstetrics, and environmental medicine were the three specialities with the largest number of regional hospital publications.

Conclusion: A substantial number of scientific publications originate from non-university hospitals. Almost two thirds of the publications were original research published in international journals. Variations between specialities may reflect local conditions.

Funding: not relevant.

Trial registration: not relevant.

Introduction: Venous thromboembolism (VTE) constitutes a major risk factor in hospitalized acutely ill medical patients. It has been demonstrated in numerous papers that by using different forms of prophylaxis, a significant reduction of the incidence of VTE can be achieved. In this article we assessed the tendencies in the use of venous thromboprophylaxis (TP) at internal medicine departments in Denmark. The results were compared with results from a similar study conducted in 2005.

Material and methods: All medical departments in Denmark received a two-page questionnaire on TP. The recipients were asked to evaluate the frequency, use of local instructions, form of administration, side-effects and duration of TP at their departments. One reminder was sent out.

Results: A total of 188 responses were received (90% response rate), 16 were excluded. Virtually all departments indicated that they used TP (92%). At intensive care units, the TP was used according to local guidelines at 77% of the wards and at the other subspecialties of internal medicine, TP was used in less than 50%. By far the most frequently used prophylaxis method was low molecular weight heparin, which was used by more than 80% of the departments. Side-effects, most often superficial bleeding and haematomas, were reported in 25% of the cases. The following serious side-effects were reported: heparininduced thrombocytopenia (n = 2), stroke (n = 1) and gastrointestinal bleeding (n = 3). No difference was observed between the hospitals of larger cities and those of smaller cities.

Conclusion: In Denmark, no significant increase in the use of TP at internal medicine departments has been observed since 2005. The guideline's strong recommendation of TP is still not reflected in daily practice.

Funding: not relevant.

Trial registration: not relevant.

There are strong pragmatic and moral reasons for receiving societies to address access to healthcare for migrants. Receiving societies have a pragmatic interest in sustaining migrants' health to facilitate integration; they also have a moral obligation to ensure migrants' access to healthcare according to international human rights principles. The intention of this thesis is to increase the understanding of migrants' access to healthcare by exploring two study aims: 1) Are there differences in migrants' access to healthcare compared to that of non-migrants? (substudy I and II); and 2) Why are there possible differences in migrants' access to healthcare compared to that of non-migrants? (substudy III and IV). The thesis builds on different methodological approaches using both register-based retrospective cohort design, cross-sectional design and survey methods. Two different measures of access were used to explore differences: 1) cancer stage at diagnosis as a clinical outcome and 2) emergency room (ER) contacts as a utilisation measure. Both informal and formal barriers to access were studied to explore why possible differences existed including: 1) motivation for using ER; and 2) asylum seekers' healthcare entitlements. Different definitions of migration and ethnicity were investigated including: country of birth and residence status. Substudy I showed a tendency towards more advanced stage at diagnosis or unknown stage among most subgroups of migrant women with a history of cancer compared to non-migrant women. Sub-study II found that some migrants (those born in Somalia, Turkey and Ex-Yugoslavia) use ER services more frequently than do non-migrants whereas others have the same or lower utilisation levels. As a consequence, substudy III was undertaken, which documented that more migrant within all subgroups had considered contacting a primary caregiver before visiting the ER compared to non-migrants, but that migrants experienced communication problems herein. Additionally, more migrants had irrelevant ER visits as evaluated by caregivers. Substudy IV addressed formal and informal barriers to access and screening. According to the law asylum seekers are entitled to emergency care only in 10 out of 24 countries. Medical screening was carried out in all but one of the 24 EU countries; however, the content and extent of screening programmes vary. The thesis aimed to explore if there are differences in migrants' access to healthcare compared to that of non-migrants. Differences in utilisation and clinical outcome were identified between migrants and non-migrants. Reasons why disparities exist were also identified in relation to communication with primary care and on policy level. The thesis shows that various perspectives and scientific problems are important to get a full understanding of the process of access to healthcare for different migrant groups. Moreover, various complementary methodological approaches are needed when studyin

Introduction: As falls in the elderly are a major problem, the Danish National Board of Health recommends systematic screening of 65+ year-olds who visit an emergency department following a fall.

Material and methods: As part of a fall prevention programme, screening for fall risk was carried out in four different settings where health staff meets elderly fallers. All falls were recorded and patients interviewed.

Results: A total of 2,016 falls were registered. Among these, 1,074 were accidental episodes of which 413 occurred in elderly patients with good balance. There were significant differences between the various screening locations. Need for fall prevention ranged from 50% to 84%. Elderly who were cognitively or physically impaired and elderly with abuse issues fell frequently and a need for fall preventive actions was observed in up to two of three falls in this subgroup of elderly.

Conclusion: The study shows that the need for fall prevention is considerable and that the estimated need for fall prevention far exceeds the capacity of geriatric fall clinics. As the number of elderly will increase in coming years, it should be explored to which extent recommendations concerning identification and assessment of elderly fallers are followed and whether recommendations result in fall preventive actions.

Funding: The project was supported by the Ministry of Interior and Health and by The Fund for Scientific Work in the Geriatric Field within the former Copenhagen Hospital Corporation.

Trial registration: not relevant.

Rotavirus infections are the most common cause of severe diarrhoea in children worldwide. Two internationally licensed rotavirus vaccines have proven to be efficacious in middle and high-income countries and they could potentially be valuable tools for the prevention of rotavirus-associated diarrhoea in low-income countries where the disease burden is greatest. However, before the vaccines can be introduced into the national immunisation programmes in these countries, many challenges related to the financing of vaccine purchase, the cold chain capacity and vaccine efficacy must be overcome. There is also a need for political commitment to prevent rotavirus infections as well as a need for an overall strengthening of the health systems in low-income countries. If these challenges were met, rotavirus vaccination could substantially improve child health and survival from rotavirus-associated diarrhoea.

Introduction: The purpose of this study was to investigate patient-reported outcome in terms of satisfaction in two study groups that had undergone hip resurfacing arthro-plasty (HRA) or total hip replacement (THR). The procedure consists of placing a hollow, mushroom-shaped metal cap over the femoral head while a matching metal cup is placed in the acetabulum (pelvis socket).

Material and methods: The two study groups included a total of 84 patients with an average age of 57 years who had idiopathic hip osteoarthritis or secondary arthritis based on mild dysplasia with arthritis. A descriptive cross-sectional design was used. A patient-reported questionnaire was used to evaluate patient outcome three years after hip surgery.

Results: The study showed that both groups (HRA and THR) reported high levels of overall satisfaction, with 97% and 93% being very satisfied or satisfied. Men were more satisfied with their ability to walk longer distances than women (p < 0.05) and the THR group claimed to be treating their artificial hip with more caution than the HRA group (p < 0.05).

Conclusion: The choice of prosthesis (HRA or THR) does not appear to affect the overall satisfaction or patient-perceived functional outcome three years after surgery in patients who on average were 57 years old and who had idiopathic hip osteoarthritis or secondary arthritis based on mild dysplasia.

Funding: A number of the patients included in this study were enrolled in a randomized controlled trial that was financially supported by Protesekompagniet. Furthermore, Centre for Applied Health Services Research and Technology Assessment (CAST) has paid wages in the preparation of the qualitative aspect of the research.

Trial registration: The survey was not registered at Clinical Trials because the starting point for this study was a health technology assessment report based on a randomized controlled trial (RCT). This RCT was registered at Clinical Trials with the identification number NCT01113762. The patient population was partly taken from this RCT and partly from an earlier pilot study conducted at Odense University Hospital. The present study was registered at the Danish Data Protection Agency, registration number 2010-41-5661.