Danish medical journal最新文献

Introduction: Even though Denmark has the highest contraceptive use (42%) of the Nordic countries, 19% of all pregnancies in Denmark end in termination. Various contraceptive options are available, and unwanted pregnancies therefore ought to be avoidable. This study aimed to investigate if women received counselling and prescriptions for contraception during their termination and if this or other factors impacted their risk of repeat termination.

Methods: This was an analytical, historical and retrospective cohort study. Data were collected manually from 310 medical records at the Hospital of Southern Jutland between 2016 and 2019.

Results: A total of 82% of patients received contraceptive counselling during their termination, and 35% of these patients received a contraceptive prescription for future use. A total of 17% had a repeat termination within three years after receiving counselling; 23% of the women who did not receive contraceptive counselling experienced one or more repeat pregnancy terminations within the following three-year period. The risk of repeat termination during the follow-up period was significantly higher among the patients with a previous termination.

Conclusions: The majority of the women received contraceptive counselling at the time of their termination. Women who previously had an abortion were twice as likely to undergo a repeat termination during the follow-up period. Further research is necessary to establish whether counselling and prescription of contraceptives have a significant impact on repeat terminations.

Funding: None.

Trial registration: Approval R. no. 20/22908.

Introduction: Most postmenopausal women with early-stage oestrogen receptor-positive breast cancer are allocated to five years of endocrine therapy. This treatment is not without adverse effects, which may lead to treatment discontinuation. This study aimed to assess compliance with endocrine therapy among postmenopausal women with early-stage oestrogen receptor-positive breast cancer and examine its association with disease-free survival.

Methods: This study retrospectively identified a cohort of 360 postmenopausal women diagnosed in the period from 1 January 2015 to 31 December 2017 at Rigshospitalet, Copenhagen, Denmark, with early-stage oestrogen receptor-positive breast cancer in the clinical database of the Danish Breast Cancer Group. Kaplan-Meier was used to estimate compliance and disease-free survival.

Results: A total of 346 patients receiving endocrine therapy were included, 240 were compliant, and 106 were non-compliant. The median follow-up was 6.5 years (95% confidence interval (CI): 6.4-6.7 years). The compliance at 4.5 years was 68.8% (95% CI: 64.1-74.0%). Disease-free survival was significantly higher for the compliant group (adjusted HR = 2.29; 95% CI: 1.34-3.91).

Conclusions: We found a low compliance at 4.5 years and most discontinuations were due to adverse effects. The study provides evidence that low compliance with endocrine therapy had a negative impact on disease-free survival.

Funding: The study was funded by the Danish Cancer Society.

Trial registration: The study was approved by the research overview of the Capital of Denmark and the Center for Health.

Adrenomedullin (AM) exerts strong pulmonary vasodilatory effects. These effects are mediated in part by nitric oxide. Plasma AM levels are increased in patients with pulmonary hypertension and correlate with disease severity and poor outcomes. Acute administration of AM improves the haemodynamics in patients with pulmonary hypertension, while chronic administration prevents the onset of pulmonary hypertension in animal models and delays its progression. Thus, AM is closely related to the pathophysiology of pulmonary hypertension and may be a promising therapeutic target.

Introduction: Percutaneous needle fasciotomy (PNF) is a non-invasive treatment option for finger flexion contractures caused by Dupuytren's disease. Variations in PNF techniques include the use of corticosteroid injection. In the presented randomised controlled trial, we compare the efficacy of PNF +/- corticosteroid injection in terms of reducing the recurrence rate.

Methods: This study is performed as a two-armed, randomised controlled trial with a two-year follow-up. Patients will be allocated 1:1 to either PNF with corticosteroid injection (n = 200) or PNF with saline injection (n = 200). Follow-up is conducted at 90 days, one year, and two years after treatment. A finger goniometer will be used to assess finger extension deficit. Treatment complications and adverse events will be recorded, and patient-reported outcomes will be registered utilizing hand-specific and quality-of-life questionnaires.

Conclusions: This study is expected to be the first randomised controlled trial to compare PNF +/- single corticosteroid injection in a large cohort of patients with Dupuytren's contracture. The results will contribute to evidence-based recommendations for the treatment of Dupuytren's contracture.

Funding: The trial is funded by grants from the Graduate School of Health at Aarhus University, the Danish Rheumatism Association, the Danish Medical Association Foundation and the AP. Møller Foundation.

Trial registration: The trial is registered with the CTIS (EU CT: 2022-501549-57-00) and Clinicaltrials.gov (NCT05440240).

Introduction: Among all Danish dying patients, 80% rely on non-specialised palliative care, an area lacking national and international guidelines. In this pilot study, we developed and tested an acute basic palliation concept (ABPC), a structured end-of-life (EOL) care plan for patients discharged from the emergency department to die at home compared with standard care.

Methods: This study compared symptom scores and EOL care statement scores during a standard care period with an ABPC period using unvalidated questionnaires. Each period included 25 patients. The study was conducted across two emergency departments in Denmark and included patients aged ≥ 18 nearing EOL. Furthermore, we asked if healthcare professionals would use the ABPC again.

Results: Relatives reported better symptom scores for three of four symptoms during the ABPC period. Doctors and municipal caregivers reported better scores for most EOL care statements during the ABPC period, whereas hospital nurses' scores remained unchanged between periods. All (100%, n = 67) healthcare professionals would use the ABPC again, and 96% provided positive free-text comments.

Conclusions: Relatives and healthcare professionals reported better symptom and EOL care scores during the ABPC period, with all healthcare professionals stating that they would use the ABPC again. Larger sample sizes and validated questionnaires are needed to verify our findings.

Funding: Funding was provided by Beta.Health, the Health Innovation Fund of the North Denmark Region, and Health Hub by Spar Nord Fund.

Trial registration: Not relevant.

Introduction: High tibial osteotomy (HTO) is used to treat medial knee osteoarthritis (OA). A simple clinical test to select the patients most likely to benefit from the procedure was suggested by R. A. Teitge., MD, Professor Emeritus, a pioneer in osteotomies. This study aimed to investigate the interrater reliability of the Teitge test.

Methods: A reliability study was performed. The Teitge test consists of a varus stress test to provoke the patient's known symptoms, followed by a valgus stress test to simulate the realignment achieved by HTO. The test is considered positive if valgus stress relieves pain. Two experienced orthopaedic surgeons performed the test. The inclusion criteria were unicompartmental medial knee OA Kellgren-Lawrence type 2-3, pain at the medial joint line, varus malalignment > 5 degrees and English or Danish proficiency. Reliability was determined using Cohen's kappa (κ).

Results: A total of 18 patients, mean age (± SD) 56.7 (± 8.7), male/female 6/12 were included. Agreement was found in 12/18 cases, resulting in κ = 0.22 (95% confidence interval (CI): -0.29-0.72). Due to a weighted number of positive test results (11/18 and 15/18, respectively) a prevalence and bias-adjusted kappa was applied, reaching κ = 0.33 (95% CI: -0.1-0.77).

Conclusions: Fair agreement was found. We do not recommend the Teitge test for absolute decision-making, but it could be a valuable contributor to the complex mechanics of decision-making. Clinicians should be careful when interpreting the test due to the low interrater agreement.

Funding: None.

Trial registration: Not relevant.

Introduction: Refractory malignant ascites (RMA) is a manifestation of end-stage cancer disease with a major impact on quality of life due to the symptom burden and need for repeated hospitalisations. We previously described the implantation of the permanent PleurX catheter as a treatment of RMA. The present study aimed to evaluate and describe our experience with the permanent PleurX catheter system in the largest cohort to date.

Methods: A total of 97 consecutive patients had a PleurX catheter implanted from 2015 to 2021. We retrieved retrospective data on patients and procedures using the patient's medical records.

Results: A total of 96 (99%) of implantations were successful, and all patients had symptom relief. Six patients (6%) experienced minor or moderate adverse events: three due to infection, two due to leakage and one because of hypotension. The mean residual lifetime was 77 days.

Conclusions: We established that implantation of the permanent peritoneal PleurX catheter is a safe and efficient treatment of RMA. We emphasise the importance of early detection and intervention in the management of RMA by implantation of a permanent peritoneal catheter.

Funding: None.

Trial registration: Not relevant.

Introduction: While diagnosis rates of autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD) vary within countries at a large-scale municipal level, small neighbourhood geographic variation remains understudied. In this nationwide study, we describe the rates of ASD and ADHD diagnoses in children and adults by geographical data zones of approximately 2,500 residents across Denmark.

Methods: We included a population of children born from 1993 through 2020 and an adult population born from 1977 through 2003. We followed children from their first birthday and adults from their 18th birthday to either diagnosis, death, emigration or 31 December 2021, whichever came first. Data were analysed using multilevel log-linear Poisson regression adjusting for age and sex. Data zones, a data-driven approach to define small geographical neighbourhoods, were used as the unit for spatial analyses. We present incidence rates in data zones and median incidence rate ratios (MRRs) as estimates of the variation in rates of the disorders between data zones.

Results: ASD and ADHD diagnoses among children showed considerable variations between data zones (ASD: MRR = 1.44; 95% confidence interval (CI): 1.42-1.47, ADHD: MRR = 1.38; 95% CI: 1.36-1.40), suggesting that the incidence can be 44% and 38% higher in high incidence zones than in others. Similar variations were observed for diagnoses among adults (ASD: MRR = 1.44; 95% CI: 1.40-1.48, ADHD: MRR = 1.44; 95% CI: 1.41-1.46).

Conclusions: The large variations might reflect differential treatment seeking, referral practice and diagnostic procedures across Denmark.

Funding: This study received funding from BERTHA - the Danish Big Data Centre for Environment and Health, and the Novo Nordisk Foundation Challenge Programme (grant NNF17OC0027864).

Trial registration: Not relevant.

Introduction: Shared decision-making (SDM) enables individually tailored treatment plans. This survey explored patients' and surgeons' perceptions of SDM in consultations on thyroid nodules. Furthermore, we aimed to explore possible discrepancies between the groups, identify factors influencing patients' perceived levels of SDM and evaluate decisional regret.

Methods: A prospective survey study was conducted among patients attending surgical consultations for thyroid nodules. Patients and surgeons completed SDM questionnaires to measure perceived levels of SDM. Six-month decisional regret was assessed by the Decisional Regret Scale.

Results: The median SDM scores were 86.7 (interquartile range (IQR) = 20) and 80.0 (IQR = 28.9) for patients and doctors, respectively, showing a significant mean difference of 7.9 (95% confidence interval: 4.0-11.8; p less-than 0.001) with higher scores for patients than surgeons. A high SDM score was positively associated with preliminary examinations (p = 0.04) but not with other consultation types or sociodemographic factors (SDF). A total of 12.2% of patients showed decisional regret. Regret was not correlated with the patient's SDM score (Spearman's rank correlation coefficient = -0.06; p = 0.6).

Conclusions: Patients and surgeons reported high levels of perceived SDM. Perceived levels of SDM and decisional regret were not associated with SDF, except for the consultation type. Factors affecting the perceived SDM level remain largely unknown and could be identified by adding objective SDM measures in future studies.

Funding: None.

Trial registration: Not relevant.

Introduction: Studies have shown varying patient adherence to long-term non-invasive positive airway pressure therapy (nPAP). We aimed to investigate adherence to long-term nPAP in a Danish cohort of patients with chronic respiratory insufficiency and/or sleep-disordered breathing (SDB) due to neuromuscular disorders (NMD), obesity-hypoventilation syndrome (OHS) or other reasons.

Methods: This cohort study included all adult patients with association to the Respiratory Center East treated with long-term nPAP: bilevel (BiPAP), automatic (APAP) and continuous (CPAP) or adaptive servo-ventilation (ASV) with a remote monitoring system in April 2022. The primary outcome was adherence, defined as a median use of nPAP ≥ 4 hrs/day in April 2022. A preplanned extended subgroup analysis was conducted for patients with data on adherence from initiation and six months onwards.

Results: The primary analysis included 241 patients, of whom 90% were diagnosed with NMD (54%) or OHS (36%). The nPAP was used ≥ 4 hrs/day by 175 patients (73%), including 22 (100%) with ASV, 129 (72%) with BiPAP and 24 (59%) with APAP/CPAP. Treatment adherence was seen in 75% of patients with NMD, 64% with OHS and 84% with other reasons for SDB. The proportion of adherent subjects in the subgroup analysis of 55 patients was relatively stable throughout the six-month period, ranging from 67% to 75% with slight intraindividual variation.

Conclusion: In this retrospective analysis of adults primarily with NMD and OHS, 73% used the prescribed nPAP therapy ≥ 4 hrs/day.

Funding: None TRIAL REGISTRATION.

Clinicaltrials: gov(NCT05379309).