Danish medical bulletin最新文献

Introduction: The aims of this study were to determine the prevalence of women with gestational diabetes mellitus (GDM) not obtaining HbA1c within the normal range (≤ 5.6%) before delivery and to examine whether elevated HbA1c values are associated with an increased risk of large for gestational age (LGA) infants.

Material and methods: A population of 148 women with singleton pregnancies who had been diagnosed with GDM < 34 weeks, and who had a minimum of two HbA1c tests with a ≥ 3 week interval. They were divided into those obtaining a HbA1c ≤ 5.6%, and those who did not before delivery and further stratified according to baseline HbA1c ≤ or > 5.6%. The primary outcome was LGA infants.

Results: A total of 51 (34%) women did not obtain a HbA1c ≤ 5.6% before delivery. The median HbA1c before delivery was 5.9% versus 5.3% in the two groups. At baseline, body mass index and HbA1c were higher in the women not obtaining the goal (30.9 versus 27.8 kg/m², 5.9% versus 5.1%, both p < 0.01). Women with an elevated HbA1c before delivery had a higher prevalence of LGA infants (adjusted odds ratio (OR) 3.1 (95% confidence interval (CI) 1.3-7.6) and neonatal hypoglycaemia (adjusted OR 6.2 (95% CI 1.3-29.0). Other pregnancy outcomes were similar in the two groups. Stratification according to baseline HbA1c did not seem to change the result.

Conclusion: Women with GDM not obtaining HbA1c within the normal range before delivery had a threefold increased risk of having an LGA infant and a sixfold increased risk of neonatal hypoglycaemia.

Funding: not relevant.

Trial registration: not relevant.

Introduction: Previous studies have shown that preoperative bowel preparation does not influence the frequency of postoperative complications after elective open colonic resections. The Danish Colorectal Cancer Group (DCCG) recommends that mechanical bowel preparation (MBP) should be omitted prior to elective colonic resections. Several surveys show that most surgeons use MBP before colorectal surgery. The aim of this survey was to investigate the use of preoperative bowel preparation in elective colonic and rectal resections in Denmark.

Material and methods: The survey was conducted in 2009. A questionnaire on the use of preoperative bowel preparation in elective colonic and rectal resections performed in 2008 was sent to all the departments of surgery that perform colorectal surgery in Denmark.

Results: 34% of the patients received bowel preparation before open colonic resection compared with 81% before open rectal resection. Overall, the frequency of bowel preparation was significantly higher in laparoscopic (63%) than in open surgery (50%).

Conclusion: MBP before elective open colonic resections remains widely used despite the national DCCG guideline. MBP before laparoscopic colorectal resections was more frequently used than before open colorectal resections as MBP before rectal resections was more frequently used than before colonic resections. The need for preoperative bowel preparation in these procedures has yet to be determined.

Funding: not relevant.

Trial registration: not relevant.

Introduction: Female medical students tend to prefer person-oriented specialties characterized by close doctor-patient contact and aspects of care. Conversely, male medical students tend to seek towards specialties with elements of autonomy, technology and "action" . Furthermore, female doctors will outnumber male doctors in Denmark by 2017 and this may have implications for the availability of specialized doctors.

Material and methods: Data derives from a baseline questionnaire pertaining to a Danish follow-up study. A total of 561 first year medical students enrolled in 2006 and 2007 answered the questionnaire. Binary logistic regression analysis was used to calculate odds ratio estimates of the relationship between gender and specialty preference. Variables measuring self-image were included in the analysis as potential mediators.

Results: 47% female and 19% male students pursued personoriented specialties and 46% female and 68% male students pursued technique-oriented specialties. More female students pursued technique-oriented specialties than in 1992. Female students have 69% less probability of choosing a technique-oriented specialty than males. This association is mediated by lack of self-confidence.

Conclusion: If specialty preferences are persistent during medical school, the results suggest that we will face more difficulties recruiting males to person-oriented specialties than females to technique-oriented specialties in the future. Furthermore, when addressing students' specialty preferences, we should consider both self confidence and gender.

Funding: not relevant.

Trial registration: not relevant.

The use of serotonine reuptake inhibitors (SRIs) is increasing among Danish pregnant women. This systematic review addresses the potential adverse effects on the foetus and child of maternal SRI medication. The literature indicates a slightly increased risk of cardiovascular malformations and persistent pulmonary hypertension of the new-born, while evidence regarding the risk of preterm labour, low birth weight, low Apgar score, prolonged QT interval and miscarriage is less clear. An estimated 20-30% of infants will have neonatal symptoms following intrauterine SRI exposure. The symptoms may be caused by SRI withdrawal, toxicity or their overlap, but symptom aetiology basically remains controversial. The infants may exhibit neurological, gastrointestinal, autonomic, endocrine or respiratory symptoms. Although the symptoms are self-limited, the families may be seriously affected. In general, studies do not address this important aspect. Evidence concerning long-term effects is surprisingly sparse and many studies have important methodological limitations. However, present evidence does not convincingly indicate detrimental long-term effects. Until sufficient safety studies have been carried out, SRI must be used with caution in pregnancy and every treatment of the pregnant woman should be thoroughly considered.

Introduction: We investigated fatal poisonings among drug addicts in 2007. The cause of death, abuse pattern and geographic differences are presented.

Material and methods: All drug-related deaths examined at the three forensic medicine institutes in Denmark in 2007 were evaluated.

Results: The number of drug-related deaths in 2007 was 226. Methadone deaths had increased since 1997 while heroin/morphine deaths decreased. In earlier studies, very few deaths from central stimulants like cocaine and amphetamines occurred (1-1.5%), but in 2007 6% of the deaths were caused by these drugs. Multiple drug use was common. Heroin/morphine, cocaine, amphetamine, cannabis, methadone, benzodiazepines and alcohol were included in the poly-drug use.

Conclusion: This investigation shows stabilization in the number of fatal poisonings in drug addicts. Geographic differences were observed. Methadone was the most frequent cause of fatal poisoning and there was a continuous decrease in heroin/morphine deaths. Fatal deaths from cocaine and amphetamine have increased considerably. Multiple drug use was common.

Funding: not relevant.

Trial registration: not relevant.

Introduction: Political initiatives promoting a more efficient emergency admission process have triggered a reorganisation of the Danish health system with a view to creating fewer and larger admission units counting more experienced physicians. At our hospital, a medical admission unit (MAU) was established. We present the effect of this on the length of hospital stay, mortality rates and the number of readmissions for the last year with the previous structure and the first year of the new MAU structure.

Material and methods: We retrospectively extracted data from the hospital databases on two periods: one year before and the first year after establishment of the MAU.

Results: After establishment of the MAU, the overall average length of hospital stay was reduced from 4.1 to 3.8 days (p < 0.01). No increase in mortality either in-house or within 30 days after discharge was seen. A substantial reduction (26%) in the overall number of readmissions within 30 days after discharge was observed.

Conclusion: The establishment of the MAU improved efficacy at the hospital owing to reduction in the length of hospital stay and the number of readmissions. As judged from mortality rates and indicated by readmission rates, neither the quality of treatment nor patient safety was compromised in a setup, where patients with suspected cardiac diseases are admitted along with patients suspected to suffer from other internal medical diseases. The dynamics between multidisciplinary physicians and nurses seems to improve when they are working close to each other in a setting where team spirit evolves.

Funding: not relevant.

Trial registration: not relevant.