Danish medical journal最新文献

Introduction: Blunt cerebrovascular injuries (BCVI) associated with cervical spine injuries (CSI) carry a high risk of morbidity and mortality. This nationwide Danish study, covering the years 2017-2023, aimed to identify key BCVI predictors in patients with CSI to support improved early detection and management strategies.

Methods: The study analysed data from four level-1 trauma centres using the Abbreviated Injury Scale to classify BCVI cases. Factors assessed included age, sex, type of cervical injury and the Injury Severity Score (ISS).

Results: Age and sex were not significant predictors of BCVI (p = 0.12, p = 0.65). However, any form of CSI was a strong predictor (p less-than 0.001; odds ratios (OR) = 26.3; confidence intervals (95% CI): 16.84-41.12), as were cervical spine ligamentous injuries (p = 0.0007; OR = 5.4; 95% CI: 2.3-12.89). An increase in ISS score significantly correlated with BCVI risk (p = 0.001; OR = 1.03 per unit increase; 95% CI: 1.01-1.05). Specific cervical fractures were not independent predictors of BCVI.

Conclusions: From a Danish cohort of patients admitted to a level 1 trauma centre, we found a BCVI incidence of three per thousand. In case of verified injury to the cervical region, the incidence rose to 6.25%. Our findings underscore the need for increased vigilance and a standardised nationwide algorithm to prevent disability, loss of health-related quality of life, and mortality in CSI patients at risk of BCVI.

Funding: The study was funded by Offerfonden, Dagmar Marshall Fonden, and Torben and Alice Frimodt Fonden.

Trial registration: The data collection was approved by the local ethical committee and the Central Denmark Region Office for Research: 1-45-70-19-23.

Introduction: This study aimed to report the components of optometrist-facilitated eye health checks in optician chain stores in Denmark.

Methods: In this survey-based cross-sectional study, we screened the 600 optician stores listed on the website of Fight for Sight Denmark and included optician store chains with more than 50 stores nationwide. The websites of each chain were reviewed to identify current trends in eye health checks, from which an interview guide was developed. Survey data were collected by conducting in-person interviews in three different optician stores from each chain.

Results: Five optician store chains were eligible for inclusion in this study. All but one chain included at least non-contact air-puff tonometry and non-mydriatic colour fundus photography in their eye health check. In two of the chains, telemedical evaluation was mandatory for all abnormal results found by the in-store optometrists, whereas telemedical services were optional in the remaining optician chains.

Conclusions: This study reported the contents and organisation of optometrist-facilitated eye health checks across the five largest optician store chains in Denmark. We found that the content of eye health checks differs between chains and that their results are evaluated differently. Standardisation of the area and development of guidelines may be necessary if optometrists are to play a role in eye health screening.

Funding: None.

Trial registration: Not relevant.

Introduction: Acid-base disturbances are common in the emergency department, with acidosis and alkalosis being associated with an elevated risk of mortality and morbidity. Understanding the relationship between pH and mortality may serve to optimise patient outcomes. The primary objective was to describe the association between arterial blood pH and 0-2-day mortality in adult non-traumatic acute visits. The secondary objective was to describe this association for 3-7-day mortality.

Methods: This population-based, multicentre cohort study included all adult non-traumatic acute visits in the Region of Southern Denmark between 2016 and 2018 who had an arterial blood gas (ABG) drawn within four hours of arrival. We described 0-2- and 3-7-day mortality stratified by pH level, controlled for confounding factors and reported as hazard ratio (HR) compared to normal pH.

Results: A total of 64,725 acute visits in 31,650 individuals with an ABG were included. The overall mortality rate for index visits was 2.4% on days 0-2 and 2.1% on days 3-7. Patients with severe acidosis (pH less-than 7.20) had 20.8% and 8.9% mortality rates (HR = 9.6 and 5.2), whereas patients with acidosis (pH 7.20-7.34) had mortality rates of 7.4% and 5.2% (HR = 4.1 and 2.7) on day 0-2 and 3-7, respectively. Our secondary analysis found a 0-2-day mortality rate of nearly 60% in patients with a pH less-than 6.90.

Conclusion: The short-term mortality rates increased with the severity of acidosis. The highest mortality rate was found in patients with a pH less-than 6.90.

Funding: None.

Trial registration: Not relevant.

Introduction: Large language models have recently gained interest within the medical community. Their clinical impact is currently being investigated, with potential application in pharmaceutical counselling, which has yet to be assessed.

Methods: We performed a retrospective investigation of ChatGPT 3.5 and 4.0 in response to 49 consecutive inquiries encountered in the joint pharmaceutical counselling service of the Central and North Denmark regions. Answers were rated by comparing them with the answers generated by physicians.

Results: ChatGPT 3.5 and 4.0 provided answers rated better or equal in 39 (80%) and 48 (98%) cases, respectively, compared to the pharmaceutical counselling service. References did not accompany answers from ChatGPT, and ChatGPT did not elaborate on what would be considered most clinically relevant when providing multiple answers.

Conclusions: In drug-related questions, ChatGPT (4.0) provided answers of a reasonably high quality. The lack of references and an occasionally limited clinical interpretation makes it less useful as a primary source of information.

Funding: None.

Trial registration: Not relevant.

Introduction: Ankyloglossia in breastfeeding infants has been proposed to cause maternal nipple pain. Lingual frenotomy has been cited to reduce maternal nipple pain. The aim of this systematic review was to investigate if frenotomy in infants with ankyloglossia and breastfeeding problems reduces maternal nipple pain.

Methods: We conducted a systematic literature search for RCTs comparing frenotomy to a sham procedure or usual care in mother-infant dyads with ankyloglossia and maternal nipple pain. Maternal nipple pain was registered as the main outcome. We conducted a meta-analysis and assessed the risk of bias using Rob 2.0 and the quality of evidence, adopting the GRADE approach.

Results: Five RCTs were included in the review. Three RCTs were used for the meta-analysis. The meta-analysis showed a significant pre-post intervention reduction in maternal nipple pain in the frenotomy group compared with the comparison group: mean difference = -1.23; 95% confidence interval: -1.88 to -0.57. The overall bias was assessed to range from "some concerns" to "high". The quality of evidence for the assessed outcome, maternal nipple pain, was classified as "low" to "very low".

Conclusions: We found that frenotomy reduced maternal nipple pain in the short term. Despite being statistically significant, the clinical relevance of a 1.2-point reduction on a ten-point VAS must be questioned. Due to a considerable risk of bias along with a low study quality, the definitive benefit of frenotomy on maternal nipple pain remains unproven. Hence, quality large-scale RCTs are warranted.

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.