Danish medical journal最新文献

Introduction: Post-operative pain following open heart surgery is a clinical challenge usually requiring significant amounts of opioids. Long-acting local infiltration anaesthesia may effectively reduce post-operative opioid consumption and improve recovery. The trial is a publicly funded, double-blinded, randomised, placebo-controlled trial evaluating the effect of long-acting local infiltration anaesthesia in open heart surgery.

Methods: Two Danish centres are planning to randomise 100 patients undergoing coronary artery bypass grafting to treatment with long-acting infiltration anaesthesia or placebo. We compare an active solution of bupivacaine, adrenaline, clonidine and dexamethasone with saline placebo. The primary outcome measure is the accumulated opioid use within the first 24 post-operative hours. Secondary outcome measures include evaluation of respiratory function, patient-reported pain scores, mobilisation, opioid-associated side effects and long-term opioid consumption.

Conclusion: This trial will define whether the use of long-acting infiltration anaesthesia during heart surgery may reduce acute and prolonged post-operative opioid consumption. Reduction of opioid-related adverse effects may improve recovery.

Funding: The trial is supported by public grants (Dansk Selskab for Anæstesiologi og Intensiv Medicin: 40,000 DKK; Regionernes Medicin og Behandlingspulje 2022: 686,000 DKK). The work of I. S. Modrau is supported by an unrestricted grant from the Health Research Foundation of the Central Denmark Region.

Trial registration: EudraCT 2021-005886-41.

Introduction: Patients from Greenland are transferred overseas for highly specialised treatment, mainly to the National University Hospital, Rigshospitalet, Denmark. We aimed to investigate the pattern of transfers from Greenland to Denmark, focusing on cardiology.

Methods: This descriptive quality assurance study included all Greenlandic citizens receiving healthcare services at Rigshospitalet from 2017-2021. Unique patients and disease courses were accounted for and patients were stratified across specialties.

Results: A total of 3,201 unique patients (56% males, mean age 51.0 years, 325 were 18 years or younger) from Greenland received healthcare services at Rigshospitalet. As some patients were seen two or more times, this corresponds to almost 900 patients (approximately 1,500 disease courses) or 1.2% of the entire Greenlandic population being referred annually. The referrals increased by 52% during the period. The Centre of Head and Orthopaedics received most referrals, followed by the Heart Centre. A modest increase in referrals due to heart diseases was observed with ischaemic heart disease being the more prevalent diagnosis. Coronary artery revascularisation rates in Greenlandic citizens aged 55-74 years were at least as high as in the same age-group for all Danes.

Conclusion: During the past five years, a 52% increase has been observed in the referral rate from Greenland to Rigshospitalet for diagnostics and treatment. In cardiology, ischaemic heart disease represented the largest share with a high revascularisation rate being observed in older Greenlandic citizens.

Funding: None.

Trial registration: Not relevant.

Introduction: In recent years, the waiting time for outpatient echocardiography has been increasing. This has potential consequences for patients with de novo systolic heart failure (HF). Thus, screening methods for HF are needed. One method may be electrocardiogram (ECG). We assessed the diagnostic value of the ECG in identifying HF with reduced left ventricle ejection fraction (LVEF) in patients referred from primary care.

Methods: A 2020-2021 observational retrospective study was conducted on patients referred from primary care on suspicion of HF. All patients had ECG performed before LVEF was documented by echocardiography.

Results: In total, 248 patients (61.5%) presented with an abnormal ECG. Among these patients, 4.8% had LVEF 41-49% and 7.7% had LVEF ≤ 40%. An abnormal ECG was found to be associated with reduced LVEF. The negative predictive value of the ECG was 99%, regardless of whether the ECG was interpreted by the cardiologist or automatically. Adding the ECG to a logistic model with traditional risk factors, the ECG increased the area under curve from 0.72 to 0.79.

Conclusion: This study is the first study to assess the value of automatic ECG interpretation compared with a cardiologist's interpretation. The normal ECG can safely exclude HF with LVEF less-than 50% and may serve as a gatekeeping tool to further assist the primary care physician in identifying patients with de novo systolic HF.

Funding: None.

Trial registration: Not relevant.

Skeletal muscle is an endocrine organ that produces and secretes hundreds of myokines, allowing for crosstalk between the muscle and other organs. The discovery of myokines has contributed to laying the groundwork for exercise as medicine. Exercise activates multiple signalling pathways of importance for health. However, for the individual and society to benefit from such exercise effects, a true translational perspective on exercise as medicine is needed, ranging from molecular and physiological events to political decisions with direct implications for clinical practice and public health.

Introduction: Physical child abuse is a well-known global health problem. Considerable efforts have been devoted to identifying predictors of physical abuse.

Methods: This study included all 397 cases in the cohort of children aged 0-18 years referred to the Department of Forensic Medicine, Aarhus University, Denmark, between 2000 and 2020 on suspicion of exposure to physical abuse. The number, character and location of skin lesions were described. Bone fractures were recorded. A total of 59 cases involving weapons and sharp force violence related to attack or fighting between young people were assessed as a separate group.

Results: The annual number of cases referred increased. The male-to-female ratio in the cohort was 6:4. Bruising was the most common skin manifestation in the blunt force violence (BFV) group; 72.2% of the individuals had skin lesions on the head and neck, thus visible on a normally dressed child. Lesions on the hands and arms were present in 69.8% of the BFV cases and may partially reflect defensive reactions. One or more bone fractures were recorded in 19.5% of the BFV group. Occult fractures were observed in 40% of the children in the BFV group ≤ 2 years of age.

Conclusions: More than 70% of the children in the BFV group had lesions on the head and neck visible on a normally dressed child. Skin lesions on hands and arms, which are visible on a lightly dressed child, were just as frequent. Persons with close relation to children should be aware of this opportunity to spot non-accidental skin injuries.

Funding: none.

Trail registration: not relevant.

Introduction: This study aimed to investigate changes in parental sick leave after tympanostomy tube (TT) insertion in children with otitis media (OM) and to estimate the overall cost reduction in case of decreased caregiver sick leave from work during a 12-month period after TT insertion.

Methods: A total of 4,708 children less-than 12 years from the database of the Danish ENT Specialists Organisation were included. Questionnaires were sent two days prior to TT insertion and subsequently 1, 3, 6, 9, 12, 15, 18, 21 and 24 months after TT insertion. The questions included symptom duration, patient satisfaction and symptom relief. Furthermore, parental sick leave occurrence was registered before and after TT insertion. The overall cost reduction estimate was based on comparison of the direct and indirect costs of two treatment regimes. Treatment A was non-surgical and antibiotics only. Treatment B comprised TT insertion and antibiotics as needed.

Results: The main results were that the risk of parental sick leave decreased significantly (p less-than 0.005) one month after TT insertion compared with baseline; odds ratio = 0.21 (95% confidence interval: 0.19-0.24). The decrease remained stable during the entire follow-up period. The estimate of the total cost reduction between Treatment A (non-TT insertion) and Treatment B (TT insertion) was 3,118.34 DKK/child/year.

Conclusion: TT insertion is associated with a significant decrease in parental sick leave and may possibly contribute to substantial socioeconomic savings.

Funding: None.

Trial registration: Not relevant.

Introduction: The detection of incidental pancreatic cysts (PCs) is increasing due to frequent use of imaging. The aim of the present study was to evaluate the clinical consequences of regular multidisciplinary team (MDT) conferences for patients with PCs.

Methods: All patient data were obtained by review of patient medical records. PCs were assessed at the weekly MDT in accordance with the revised Fukuoka guidelines.

Results: A total of 455 patients were evaluated within 12 months. A large proportion of the cysts could not be characterised and was handled as branch duct (BD)-intraductal papillary mucinous neoplasia (IPMN). A total of 245 patients were included in a follow-up programme, whereas 175 patients were excluded. Further diagnostic work-up was recommended for 31 patients. A total of 66 patients were reviewed on MDT a second time during the study period, eight of whom received a diagnosis different from that given at the first MDT. A total of 35 patients with mucinous PC or cysts treated as BD-IPMN had either worrisome features (WF) or high-risk stigmata (HRS), four of these patients had a PC ≤ 10 mm. Indication for surgery was WF or HRS and, in the course of 12 months, six patients were recommended surgery taking their PS into account. Two patients had a malignant and two had a premalignant lesion.

Conclusion: In all, 455 patients were evaluated to find 35 patients with suspected premalignant PCs. This means that almost 8% of the referred patients had suspicious lesions, which indicates a need for a regular MDT conference.

Funding: None.

Trial registration: Not relevant.

Lipids are essential in human physiology, triglycerides for energy and cholesterol as a structural component in cells and as a precurser for hormones and vitamins. However, high blood levels of cholesterol cause atherosclerosis, leading to cardiovascular disease, which is the number one cause of death globally. Genetic evidence suggests that lipoprotein(a) and remnant cholesterol, cholesterol in very low-density and intermediate-density lipoproteins, are causally involved in the development of cardiovascular disease together with low-density lipoproteins and this has spurred the development of drugs potently lowering these.

Introduction: In cases of parental opposition to emergency medical care for minors, defined as children below 15 years of age, involving the social authorities may be necessary. When medical personnel assess that an intervention is in the minor's best interests, approval for such intervention is warranted from the local authorities in the municipality of residence. It was the primary aim of this study to assess the urgent availability of these authorities.

Methods: The urgent phone availability of social authorities at the 98 Danish local municipal offices was assessed during both regular hours and off-hours. The primary objective was to assess availability during regular hours. Urgent availability was predefined as obtained contact to a self-proclaimed accountable authority within 30 minutes. Secondary objectives were assessment of off-hour availability, time until obtained contact and number of contact links.

Results: Contact was obtained within 30 minutes in 59 inquiries (~ 58%) made during regular hours, with a median of three contact links and a median time until contact of eight minutes (interquartile range (IQR): 5.5-11 minutes). During off-hours, contact was obtained within 30 minutes in 91 inquiries (~ 93%), with a median of two contact links and a median time until contact of seven minutes (IQR: 5-12 minutes).

Conclusion: During regular hours, we found that an accountable authority was urgently available for attendance to a case of parental opposition to emergency medical care of a minor within 30 minutes at the local municipal office in 58% of Danish municipalities.

Funding: None.

Trial registration: Not relevant.

The prevalence of obesity is increasing across all geographies. Obesity develops due to a disruption of the energy balance regulation. However, the cause is not well understood. Identification of causal factors that may be modified is crucial to reduce the prevalence of obesity. However, the interventions needed will likely differ between life stages. Hence, obesity research should span from pre-conception to adulthood. In this review, we point to gaps and limitations in existing research, highlight recently initiated studies from which we are awaiting results and point to future directions.