Danish medical journal最新文献

Bibliometrics, in terms of counting articles and books, has always existed. Since 1955, however, additional parameters such as article citations, impact factors and h-indexes have accompanied science - not least medical science. Today, bibliometrics is big business where private companies sell all kinds of bibliometric data. To handle these, it is essential to become aware of the limitations and pitfalls in bibliometrics. Accordingly, the present review describes five major challenges under the headings: Quality; Impact; Co-authorship; Databases, and Fraud.

Introduction: The risk of cancer increases with age. Furthermore, frailty and age-related impairments significantly impact treatment outcomes. With an aging population, it is crucial to ensure a tailored, evidence-based cancer care approach. This study evaluated the extent to which frailty and age-related considerations are incorporated into current Danish national cancer guidelines across six frequent cancer types.

Methods: We systematically reviewed all guidelines from the Danish Multidisciplinary Cancer Groups on lung, breast, colorectal, ovarian, bladder and prostate cancer. Guidelines were screened to identify how they address age, frailty, performance status (PS), comorbidity, functional status, general health status and individualised assessment. Identified comments were graded based on their level of specificity and clinical applicability.

Results: All cancer guidelines addressed age and comorbidity. Frailty was explicitly mentioned in four out of six, of which only one guideline provided specific recommendations. PS was frequently included (5/6), and individualised assessments were encouraged in four of six guidelines, but lacked clarity regarding implementation.

Conclusions: Danish national cancer guidelines acknowledge age, PS and comorbidity, but lack specific recommendations for frailty assessment and management. By addressing these gaps, we encourage future guidelines to include recommendations on frailty assessment to help clinical decision-making and improve treatment outcomes for older people with cancer.

Funding: None.

Trial registration: Not relevant.

Introduction: Uncertainty in medical practice affects physicians' well-being and decision-making. The Physicians' Reactions to Uncertainty (PRU) scale measures affective and behavioural reactions to uncertainty, but no Danish version exists. This study aimed to translate, culturally adapt and validate the PRU.

Methods: The PRU was translated and culturally adapted in accordance with international guidelines. A pilot test assessed face validity. Reliability and validity were examined in a cross-sectional study with 116 physicians using Cronbach's alpha, the intraclass correlation coefficient (ICC) and confirmatory factor analysis (CFA).

Results: A Danish version (PRU-DK) was developed with minor linguistic adjustments. It showed strong internal consistency (Cronbach's α ≥ 0.75 across subscales) and high item correlations (Spearman's ρ = 0.68-0.93). Test-retest reliability was high (ICC > 0.80 for all subscales except Reluctance to disclose mistakes to physicians, ICC = 0.56). CFA supported the four-factor model (χ²/df = 1.66, Comparative Fit Index = 0.923, Tucker-Lewis Index = 0.901, Root Mean Square Error of Approximation = 0.076, Standardised Root Mean Square Residual = 0.073). Inter-subscale correlations ranged from 0.16 to 0.62.

Conclusions: The PRU-DK is a validated and reliable tool for assessing Danish physicians' reactions to uncertainty, demonstrating solid psychometric properties and acceptable model fit. The original structure was preserved to enable comparison, but periodic revision is warranted to address cultural shifts and refine behavioural components.

Funding: None.

Trial registration: Not relevant.

Introduction: Third-generation aromatase inhibitors (AIs) are the cornerstone of the management of hormone receptor-positive breast cancer. Annually, approximately 4,700 Danish women are diagnosed with breast cancer. A large number of patients treated with long-term AI experience arthralgias and myalgias, described in the literature as AI-induced musculoskeletal symptoms (AIMSS). This report aims to summarise the existing knowledge on the syndrome and present cases of AIMSS referred with refractory foot pain to raise awareness of the syndrome as a diagnostic pitfall.

Methods: In this study, the electronic patient journals of five potential cases of AIMSS were examined. The patients were all Caucasian females with breast cancer receiving treatment with anti-oestrogenic medication.

Results: AIMSS was found to be the most probable explanation in all five cases. AI-associated musculoskeletal syndrome is reported in 30-70% of patients in AI treatment. Among the five summarised cases, no clinically relevant additional information was gained from extensive imaging. The symptoms led to surgery at our department, in one case with no effect.

Conclusions: AIMSS may affect all joints, including the ankles and feet. Lack of patient information regarding AIMSS can lead to unnecessary, time-consuming, costly and potentially harmful diagnostic procedures and treatment.

Funding: None.

Trial registration: Not relevant.

Introduction: Emergency Medicine was introduced as a speciality in Denmark in 2018 to ensure efficient, evidence-based management of acute patients. At North Zealand Hospital, an independent emergency department (ED) was fully implemented in 2021, followed by a consolidation phase. This study aimed to assess how the design of an ED influences the rest of the hospital by examining bed-day consumption during a time with increasing patient volume.

Methods: Activity and bed-day utilisation were compared across two 12-month periods: before (1-JUL-2018 to 30-JUN-2019) and after implementation of an independent ED (1-JUN-2023 to 30-JUL-2024). Included were all patients admitted to somatic departments (excluding gynaecology, paediatrics and a casualty unit). For each contact, the responsible speciality at discharge from the ED was registered.

Results: Patient contacts increased by 20% (from 40,061 to 48,193). The proportion of patients managed entirely by emergency medicine rose by 139%, whereas the share handled by the other specialities decreased by 23%. Despite the higher intake, total bed-days decreased by 21%.

Conclusions: Establishment of an independent ED contributed to reduced hospital bed utilisation despite increasing patient load. Emergency medicine qualifies the selection of patients in need of hospitalisation, improves the operational efficiency of the hospital and minimises unnecessary admissions.

Funding: None.

Trial registration: Data were drawn fully anonymised for statistical purposes only and therefore did not require formal registration.

Introduction: Gallstone-related diseases are common in Denmark, with acute cholecystitis being a painful presentation. Historically, cholecystectomy was performed within five days of symptom onset. In 2022, national guidelines abandoned this limit due to evidence suggesting similar outcomes for early and delayed surgery. This study aimed to assess the impact of an extended surgical window on the frequency of acute cholecystitis operations, complication rates and patient outcomes.

Methods: All cholecystectomies performed between 1 June 2022 and 31 May 2023 were identified using the procedural codes KJKA20 and KJKA21. Patients with gallstone pancreatitis, biliary colic or choledocholithiasis were excluded. Medical records were reviewed, and a statistical analysis was conducted.

Results: Among 180 patients identified, 128 met the inclusion criteria. Thirty-nine patients had > 5 days of symptoms at the time of surgery. No significant differences were observed in operative duration, hospital stay, reoperation, conversion to open surgery or mortality. However, complications graded Clavien-Dindo > 1 were more frequent in the group with a duration of > 5 days (28.2% versus 10.1%, p = 0.009). Multivariate analysis showed that long symptom duration and older age were associated with an increased risk (p less-than 0.05).

Conclusions: Extended symptom duration before surgery was associated with a higher rate of post-operative complications. Larger, multicentre studies are needed to confirm these findings and guide clinical decisions.

Funding: None.

Trial registration: Not relevant.

Introduction: Transoral robotic surgery for base-of-tongue reduction (TORS-BOT) is an effective treatment for obstructive sleep apnoea (OSA) in patients with tongue base collapse and lingual tonsil hypertrophy. However, post-operative complications may considerably affect recovery. This study evaluated post-operative outcomes, particularly dysphagia, pain management and nutritional challenges, in a Danish cohort.

Methods: This retrospective cohort study included patients who underwent TORS-BOT at a single Danish centre between April 2022 and September 2024. Data were extracted from electronic medical records. Outcomes included dysphagia, pain management, nasogastric tube (NGT) use and infection rates.

Results: Forty patients, primarily middle-aged, overweight males, underwent TORS-BOT. Most also received additional sleep surgery procedures. The median hospital stay was 3.5 days. Readmission occurred in 20%, mainly due to pain, infection or bleeding. More than 80% experienced complications, with dysphagia (70%) being the most common, often requiring NGT support. Pain control was frequently insufficient, resulting in impaired oral intake. Constipation was prevalent (68%), whereas laxative prophylaxis was inconsistent. Antibiotics were administered to 40%, mainly for aspiration pneumonia.

Conclusions: Post-operative dysphagia, pain and nutritional issues were common after TORS-BOT for OSA. Standardised post-operative protocols focusing on pain management, dysphagia interventions and nutritional support are needed.

Funding: None.

Trial registration: Not relevant.

Introduction: Flattening of a paralytic hemidiaphragm by plication may alleviate respiratory symptoms. For decades, the operation was performed through a thoracotomy that caused substantial morbidity, but now minimally invasive video-assisted thoracoscopic approaches are available. We technically modified the procedure using CO2 insufflation and pledged sutures and aimed to investigate changes in lung function and satisfaction rates in adult patients with hemidiaphragmatic paralysis.

Methods: We retrospectively searched the electronic patient record system for pre- and post-operative pulmonary function tests and satisfaction rates at clinical follow-up.

Results: During a three-year period (2021-2023), 15 patients were operated on at a median age of 58 years. Pulmonary function tests improved significantly after diaphragmatic plication (p less-than 0.01), and nine of 12 patients with available data reported symptomatic improvement (p = 0.02). The median length of hospital stay was one day.

Conclusions: Minimally invasive diaphragmatic plication improves pulmonary function and respiratory symptoms in patients with hemidiaphragmatic paralysis.

Funding: None.

Trial registration: Retrospective follow-up.

Introduction: Postural changes are known to have a significant influence on lung function and gas exchange due to the gravitational influence on the lungs, as postural changes alter the lungs' orientation relative to gravity. Previously, assessing lung function in more challenging postures was difficult due to limitations of available equipment. However, with the development of handheld equipment, it is now possible to investigate lung function in different postures. Therefore, this study aimed to investigate the effects of postural changes, including supine and quadruped postures, as well as handstands, on airway resistance and pulmonary diffusing capacity.

Methods: Twelve healthy young participants underwent measurements of impulse oscillometry and pulmonary diffusing capacity with carbon monoxide corrected for haemoglobin (DL,COc) during upright standing, as well as in the supine, quadruped, and handstand postures.

Results: Total airway resistance increased from upright standing to supine (p less-than 0.001) and handstand (p less-than 0.001), and small airway resistance increased from upright standing to handstand (p = 0.019). DL,COc increased from upright standing to supine (p less-than 0.001), quadruped (p = 0.028) and handstand (p less-than 0.001), whereas DL,COc were lower in quadruped posture compared to supine (p = 0.007) and handstand (p = 0.022), with no difference between supine and handstand (p = 0.17).

Conclusion: Both supine posture and handstand increase airway resistance compared to upright standing, whereas supine and quadruped postures, as well as handstand, increase pulmonary diffusing capacity similarly.

Funding: The Centre for Physical Activity Research (CFAS) is supported by TrygFonden (grants ID 101390, ID 20045, ID 125132, and ID 177225).

Trial registration: None.

Introduction: Patient involvement has increased in recent years and has been requested by both patients and patient organisations, e.g., in relation to prioritising research questions and outcomes. However, when planning new research, patients are not automatically involved.

Methods: This study aimed to describe and elaborate on patient involvement in research in multiple sclerosis (MS) from both patients' and researchers' perspectives.

Results: In total, 141 patients with (pw) MS and ten doctors responded to the questionnaires. Patient involvement was considered important by pwMS, mean score 8.9, standard deviation 1.4 (min. 5-max 10) on a 0-10 numeric rating scale (0 = no importance, 10 = very important), and 43% of pwMS answered that they could imagine themselves being a co-researcher.

Conclusions: Patient involvement is considered important for pwMS. This study may serve as a source of inspiration or a guideline for future studies using patient involvement.

Funding: The Danish Multiple Sclerosis Society.

Trial registration: Not relevant.