Danish medical bulletin最新文献

Introduction: Necrotizing external otitis (NEO) is a devastating and life-threatening infection in the external auditory canal and the temporal bone. The aim of this paper is to evaluate the diagnostics and treatment of NEO and to recommend new guidelines.

Material and methods: Eleven patients were retrospectively enrolled under the code DH609 otitis externa without specification from 1 January 2000 to 31 December 2009. Records were reviewed to register: age, symptoms, clinical findings, comorbidity, imaging, microbiology and treatment.

Results: The median age was 75 years and the median time of therapy at the hospital was 6.3 months. All patients belonged to a risk group. A diagnostic delay was found resulting in further progression of the disease. In contrast to current international recommendations, the treatment consisted mostly of local antibiotics in combination with surgery. All patients survived, but most patients were left with hearing loss and psychiatric problems.

Conclusion: A greater awareness of diagnostic criteria and a shift from local antibiotics to prolonged systemic monotherapy with ciprofloxacin in accordance with international concepts is recommended. Surgery should be left for extensive and refractory cases only. A list of diagnostic criteria and treatment guidelines is presented.

Funding: Not relevant.

Trial registration: Not relevant.

Introduction: Mitral valve regurgitation (MR) is the secondmost frequent valve disease in Europe. Untreated MR causes considerable morbidity and mortality. In the elderly, as many as half of these patients are denied surgery because of an estimated high surgical risk. Percutaneous mitral valve repair with the MitraClip system resembles the Alfieristitch where a clip is used to connect the tip of the mitral valve leaflets.

Material and methods: Sixteen patients with MR of various origins (functional/degenerative) were treated with the MitraClip system. All patients were highly symptomatic with dyspnoea (New York Heart Association (NYHA) grade three) and MR grade three or more, and had been turned down for surgery due to an excessively high risk.

Results: MR was reduced in all but one patient, generally from grade 3.5±0.5 to grade 1.4±0.9. A total of four patients (25%) received two clips. Thirty-day complications were as follows: one patient died, one had a stroke (speech sequelae), one patient had a new chord rupture that was treated surgically. During 90 days of follow-up, symptoms of dyspnoea diminished (reduction of 1 NYHA grade) and the 6-minute walk test results improved from 171±99 to 339±134 metres (p<0.001).

Conclusion: Percutaneous mitral valve repair with the MitraClip system is now available in Denmark. The treatment is a reasonable alternative in patients with MR and a high estimated surgery risk.

Funding: Not relevant.

Trial registration: Not relevant.

Mammography screening is offered healthy women, and a high standard on professional and organizational level is mandatory not only in the screening programme but even in the diagnostic work-up and treatment. The main goal is to achieve a substantial reduction in disease specific mortality, but it is not possible to evaluate the effect on mortality until several years later, and continuously monitoring of the quality of all aspects of a screening programme is necessary. Based on other European guidelines, 11 quality indicators have been defined, and guidelines concerning organizational requirements for a Danish screening programme as well as recommendations for the radiographic and radiological work have been drawn up.

Introduction: This was a pilot project performed prior to full implementation of early loop ileostomy closure (within two weeks) following low anterior resection of the rectum in a group of patients selected according to previously recommended criteria for safe, early ileostomy closure.

Material and methods: Retrospective review of medical records. Patients undergoing loop ileostomy closure between December 2009 and October 2010 were analyzed. Data were collected on demographics, tumour characteristics, information about the perioperative period, operative details, postoperative complications, closure operation, the postoperative closure period and follow-up.

Results: Eleven patients were included (men, n = 4) with a median age of 58 years (range 47-79 years). Ileostomy closure was performed at a median of ten days (range 8-13 days) following rectum resection. The median hospital stay was 16 days (range 14-24 days). No re-laparotomies were performed. One patient developed a pelvic pus collection ten days post closure and was treated conservatively. One patient died 32 days after closure for reasons not related to surgery.

Conclusion: The results of this small retrospective study show morbidity rates associated with early loop ileostomy closure that are probably acceptable. Safety, feasibility, timing and selection criteria should be clarified in large randomized studies.

Funding: not relevant.

Trial registration: not relevant.

Introduction: Studies have shown that early warning score systems can identify in-patients at high risk of catastrophic deterioration and this may possibly be used for an emergency department (ED) triage. Bispebjerg Hospital has introduced a multidisciplinary team (MT) in the ED activated by the Bispebjerg Early Warning Score (BEWS). The BEWS is calculated on the basis of respiratory frequency, pulse, systolic blood pressure, temperature and level of consciousness. The aim of this study is to evaluate the ability of the BEWS to identify critically ill patients in the ED and to examine the feasibility of using the BEWS to activate an MT response.

Material and methods: This study is based on an evaluation of retrospective data from a random sample of 300 emergency patients. On the basis of documented vital signs, a BEWS was calculated retrospectively. The primary end points were admission to an intensive care unit (ICU) and death within 48 hours of arrival at the ED. This study was registered at clinicaltrials.gov (NCT01243021).

Results: A BEWS ≥ 5 is associated with a significantly increased risk of ICU admission within 48 hours of arrival (relative risk (RR) 4.1; 95% confidence interval (CI) 1.5-10.9) and death within 48 hours of arrival (RR 20.3; 95% CI 6.9-60.1). The sensitivity of the BEWS in identifying patients who were admitted to the ICU or who died within 48 hours of arrival was 63%. The positive predictive value of the BEWS was 16% and the negative predictive value 98% for identification of patients who were admitted to the ICU or who died within 48 hours of arrival.

Conclusion: The BEWS is a simple scoring system based on readily available vital signs. It is a sensitive tool for detecting critically ill patients and may be used for ED triage and activation of an MT response.

Introduction: The aim of the present study was to describe the developmental outcome of routine follow-up assessments at the age of five years in a regional cohort of children born at a gestational age < 32 weeks and to investigate neonatal risk factors associated with developmental problems.

Material and methods: The cohort consisted of 237 infants with a gestational age ≥ 24 and < 32 weeks born in the 1996-2000 period. The children were assessed using the Movement Assessment Battery for Children and Miller Assessment for Preschoolers. The presenting clinical and demographic features were investigated for their association with developmental problems at five years of age by determining odds ratios in univariate analysis. The results are given with 95% confidence intervals.

Results: 14% died. 86% of the surviving children were routinely assessed at five years of age. 40% of the children had a normal developmental outcome, 41% were to be observed for developmental deficiencies and 19% had developmental deficiencies. Male gender, low social group, a gestational age < 28 weeks, sepsis, persistent ductus arteriosus, bronchopulmonary dysplasia and abnormal cerebral ultrasound were significantly associated with an unfavourable developmental outcome.

Conclusion: More than half of the assessed very prematurely born children had developmental problems at five years of age. Children who were to be observed for developmental deficiencies outnumbered children with deficiencies at a two to one ratio. Follow-up assessments of very prematurely born children are still needed to evaluate changes in neonatal practise and developmental outcome in the future.

Funding: not relevant.

Trial registration: not relevant.

Introduction: Bispebjerg Hospital has implemented a multidisciplinary team reception of critically ill and severely injured patients at the Emergency Department (ED), termed emergency call (EC) and trauma call (TC). The aim of this study was to describe the course, medical treatment and outcome for patients received by this multidisciplinary team and to evaluate the quality of acute medical treatment of these patients.

Material and methods: A retrospective evaluation was made of all ECs and TCs registered during a six-month period. Information on sex, age, interventions at the ED, time spent at the ED and outcome measures (admission, Intensive Care Unit (ICU) admission and death) were obtained. The quality of the acute medical treatment during the ED stay and the first 48 hours of admission were evaluated by senior consultants from the departments receiving the patients.

Results: A total of 150 ECs and 47 TCs were included. The median time spent at the ED was 65 minutes for ECs and 95 minutes for TCs. In EC patients a median of eight interventions were performed at the ED, while a median of five interventions were performed in TC patients. A total of 137 EC patients were admitted to hospital including 32 patients admitted to the ICU. In all, 49 EC patients died during admission. Forty percent of TC patients were discharged to their homes. Only one trauma patient died and none were admitted to the ICU. The acute medical treatment was found to be satisfactory in 87% of EC patients and 96% of TC patients.

Conclusion: A multidisciplinary team reception ensures early initiation of diagnostic procedures and treatment, short ED stays and admission to relevant departments in critically ill and severely injured patients.

Introduction: Assessment of visual function can be a complex task and objective means of measurement of visual function do not always correlate with patients' self-perceived visual abilities. The purpose of this study was to translate the visual function questionnaire (VFQ)-25 into Danish with particular focus on its use in patients with late age-related macular degeneration (AMD).

Material and methods: The translation was done in accordance with standard internationally adopted methods. This includes forward translation, back translation, examination of translation quality, and adjudication by bilingual speakers. We presented the questionnaire to 120 consecutive patients with exudative AMD referred to our department and to 25 healthy individuals. We tested the reliability of the Danish version by measuring test-retest reliability, estimated the internal consistency of the questionnaire (Cronbach's α-value) and analysed the discriminatory power (validity) of the questionnaire by comparing scores of patients with scores from control individuals without known eye disease.

Results: The translated questionnaire produced high test-retest correlations (range 0.8-0.9), had a relatively high-level of internal consistency (range 0.4-0.9) and a high discriminatory power.

Conclusion: The Danish version of VFQ-25 produces acceptable values of validity and reliability in patients with AMD.

Introduction: Bispebjerg Hospital has introduced a triage system at the Emergency Department (ED) based on "primary criteria" and a physiological scoring system named the Bispebjerg Early Warning Score (BEWS). A BEWS is calculated on the basis of five vital signs which are accessible bedside. Patients who have a "primary criterion" or a BEWS ≥ 5 are presumed to be critically ill or severely injured and should be received by a multidisciplinary team, termed the Emergency Call (EC) and Trauma Call (TC), respectively. The aim of this study was to examine compliance with this triage system at Bispebjerg Hospital.

Material and methods: Retrospective evaluation of the triage of a random sample of 300 ED patients. ED medical charts were searched for "primary criteria", documentation of vital signs and a BEWS score. If a BEWS score had not been calculated, this was done retrospectively by the author. An evaluation was made to determine whether ECs or TCs had been correctly activated.

Results: In 47 patients, all five vital signs for calculation of a BEWS had been documented. A BEWS had been calculated in 22 patients. Nine patients had a TC activation criterion, and in all these cases a TC was activated. A total of 48 patients had an EC activation criterion, but an EC had only been activated in 24 patients. Among the 24 patients for whom an EC had not been activated, eight had a "primary criterion" and 16 patients had a retrospective BEWS ≥ 5.

Conclusion: The triage system is not being used systematically and documentation of vital signs is insufficient at Bispebjerg Hospital. As a consequence, many patients who are presumed to be critically ill are not allocated to an EC. Initiatives have been taken to raise compliance with the system.

Introduction: This observational study examines changes in paediatric hospital-seeking behaviour at Kolding Hospital in The Region of Southern Denmark (RSD) following a major change in administrative units in Denmark on 1 January 2007.

Material and methods: Data on the paediatric admissions from 2004 to 2009 reported by department of paediatrics and municipalities were drawn from the Danish National Hospital Registration. Patient hospital-seeking behaviour was related to changes in the political/administrative units. Changes in number of admissions were compared with distances to the corresponding departments.

Results: From 2006 to 2009, the number of acute and planned admissions at the Department of Paediatrics in Kolding for children living in the RSD increased by 46.1% and 65.0%, respectively. The corresponding changes for children living in the neighboring region, the Central Denmark Region (CDR), were -69.9% and -78.6%.

Conclusion: The geographical location of the department under study and the changes in administrative units created a "natural experiment" that showed major changes in paediatric hospital-seeking behaviour. Within the RSD, the free choice of hospitals seemed to work, whereas the new boundary between the CDR and the RSD meant that paediatric patients were admitted at hospitals situated in the CDR even though the distances to these hospitals were considerably longer than those to other hospitals. One could question whether patients really have a free choice across administrative borders as political and economic concerns seemed to outweigh free patient choice.

Funding: not relevant.

Trial registration: not relevant.