Danish medical journal最新文献

Introduction: In recent years, outpatient surgical treatment for ankle fractures has been introduced for selected fracture types and patients with a low degree of comorbidity. Limited evidence is available to guide the choice between inpatient and outpatient care for ankle fractures. This randomised controlled trial aims to investigate the effect of inpatient versus outpatient surgery of ankle fractures on patient-reported outcomes at 12 weeks.

Methods: This study is a single-centre non-inferiority randomised controlled trial investigating outpatient care for surgically treated ankle fractures. A total of 86 patients will be included in the study and randomised 1:1 to either outpatient or inpatient care. The primary outcome is the Foot and Ankle Outcome Score at three months after surgery. Secondary outcomes will include patient satisfaction, pain, physical function and adverse events.

Conclusions: Conducting a randomised controlled trial investigating inpatient versus outpatient surgery for ankle fractures on both patient-reported outcomes, patient satisfaction, adverse events, pain, function and bone healing will provide evidence to guide future recommendations in the planning of surgical treatment for ankle fractures.

Funding: The study is partially funded by Helsefonden and the North Denmark Region.

Trial registration: The study was pre-registered on Clinicaltrials.gov ID: NCT05389436, 20 May 2022.

Introduction: Patients on warfarin are normally required to interrupt treatment for a fixed number of days prior to an invasive procedure. This study aimed to investigate the potential influence of the warfarin maintenance dose and the initial international normalised ratio (INR) level on the duration of the break required to achieve the planned target INR.

Methods: A total of 120 patients on self-managed warfarin treatment measured INR once daily for five days before the intervention and were guided by the anticoagulation clinic on when to discontinue warfarin. Depending on the bleeding risk of the planned intervention, the target INR on the day of the intervention was ≤ 1.4, ≤ 2.5 or ≤ 3.0.

Results: From day 1 to day 5 after interruption of warfarin, the INR ratio (INRdayX/INRday0) decreased exponentially, with wide interpatient variation in the rate of decrease. Patients with a maintenance warfarin dose less-than 25 mg/week decreased significantly less in INR during the first day after stopping warfarin than patients who received a higher maintenance dose (9% vs 15%; p less-than 0.04). The INR half-life after day 1 was 113 hours for patients receiving less-than 25 mg/week and 101 hours for patients receiving ≥ 25 mg/week.

Conclusions: The duration of pre-interventional discontinuation of warfarin can be individualised by knowing the maintenance dose, baseline INR and target INR for the planned procedure.

Funding: None.

Trial registration: Quality assessment study approved by the legal department of the Capital Region of Denmark. Approval number: p-2024-15914.

Introduction: The slim and muscular body ideals are well-established, and adolescence is a phase sensitive to developing negative body image. This study aimed to identify the BMI at which most adolescents 1) perceive themselves as being the right size and 2) experience high body satisfaction.

Methods: Data from the Danish National Youth Study included 64,451 adolescents aged 15-19 years. Multilevel logistic regression using restricted cubic splines modelled associations between BMI, body size perception and body satisfaction.

Results: The highest ORs for perceiving oneself as "about right size" and experiencing high body satisfaction were at BMIs of 19.0 kg/m2 and 15.9 kg/m2 in females, corresponding to the 21st and second percentiles of the BMI distribution. In males, the highest ORs were at BMIs of 22.2 kg/m2 and 21.9 kg/m2, near the male median of 21.6 kg/m2. Significant variations in ORs for both body size perception and body satisfaction were observed across the entire BMI range, even within the healthy weight range of 18.5-24.9 kg/m2.

Conclusions: Among females, the perception of being "about right size" and experiencing high body satisfaction was most prevalent at BMIs well below the median, whereas for males, these perceptions were most common around the median. These findings strongly confirm that gender-specific body ideals are highly internalized, placing many adolescents at risk of developing a negative body image. TRIAL REGISTRATION not relevant.

Funding: This work was supported by Centre for Childhood Health, Denmark (ID: 2024_F_001).

Introduction: Multimorbidity and polypharmacy present significant challenges for the healthcare system. In Denmark, general practitioners (GPs) play a key role in coordinating patient care, while also relying on specialist support for complex cases. This study reports on the development and implementation of the Telepharmacological Outpatient Clinic (TPOC) (Danish: Telefarmakologisk Ambulatorium), a virtual cross-sectional polypharmacy counselling service.

Methods: The intervention was developed adopting an interdisciplinary approach. The service provided virtual consultations to GPs in the Region of Southern Denmark, offering multidisciplinary specialist counselling for patients with polypharmacy. The process included referral, medication review, video conference and follow-up. Data were collected on referrals, demographics and service utilisation.

Results: A total of 364 patients (median age 74 years, 61.0% female) were referred to the TPOC from March 2019 to February 2024. Referrals increased from a median of 3.5 per month in 2019-2020 to nine per month in 2023-2024. GPs from 21 of 22 municipalities referred patients. The service was well received by GPs and recognised by national authorities as a valuable model for managing multimorbidity.

Conclusions: The TPOC was shown to be a successful model for providing specialist support to GPs. Its growing utilisation and positive reception indicate relevance in addressing multimorbidity and polypharmacy challenges.

Funding: The TPOC is funded by the Region of Southern Denmark.

Trial registration: Not relevant.

Introduction: Early rehabilitation is recommended after cardiac surgery to enhance recovery. However, due to precautions of sternum healing, the initiation of cardiac rehabilitation is often postponed for 6-8 weeks after surgery, leaving patients to face physical and emotional barriers on their own. This study aims to investigate whether early remote cardiac rehabilitation can enhance physical function and reduce the emotional challenges that older patients face after discharge.

Methods: In this bi-entre, randomised controlled trial, 120 patients older than 65 years of age undergoing open heart surgery are assigned to individualised exercise training and step counting supported by a mobile health app and weekly calls with a physiotherapist as an adjunct to standard care (intervention group), or standard care alone (control group) for six weeks after discharge. Outcomes are assessed at baseline, a six-week follow-up and a six-month follow-up. The primary outcome is change in the 30-second Chair Stand Test. Secondary outcomes include health-related quality of life, cost-effectiveness and prevalence of sarcopenia.

Conclusions: This trial will determine if early remote rehabilitation after cardiac surgery can accelerate recovery and alleviate emotional distress, advocating for early post-discharge interventions through digitally delivered care.

Funding: This trial is supported by external funds: the Novo Nordisk Foundation, the Health Foundation and the Eva and Henry Frænkels Memorial Fund.

Trial registration:

Clinicaltrials: gov NCT06370611.

Introduction: The rising burden of basal cell carcinoma (BCC) in Denmark challenges healthcare resources, highlighting the importance of optimal patient treatment and effective resource management. Therefore, this study aimed to compare BCC excisions across specialities in practices and hospitals.

Methods: Data from the Patobank included histopathology records of standard BCC excisions on the head and neck from 1 January 2022 to 31 December 2022, performed by plastic surgeons, dermatologists, ophthalmologists and general practitioners (GPs) in practice and hospital settings. Excisions with intraoperative margin control were excluded. We analysed the number of excisions, BCC subtypes and odds ratios of incomplete BCC excisions across treatment settings. The intended purpose of excision was not registered.

Results: Among 7,774 BCC excisions, most were performed by plastic surgeons in hospitals (43%) and practices (38%), followed by dermatologists in practices (14%). Hospital-based specialists, including plastic surgeons, dermatologists and ophthalmologists, had lower odds of incomplete BCC excision than their practice-based counterparts and GPs.

Conclusions: Substantial variations in excision counts and odds of incomplete BCC excisions are observed across specialities and settings. Addressing this variation is important to ensuring that patients are treated in the appropriate arena and that resources are allocated optimally.

Funding: This work was funded by the Danish Research Center for Skin Cancer, a public-private research partnership between Private Hospital Mølholm, Aalborg University Hospital, and Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital.

Trial registration: Study and data approval were provided by the Danish Research Act and the Team for Records Data.

Introduction: Simulation-based training is used to prepare healthcare professionals for clinical situations in a structured environment. However, participation varies depending on personal, professional and institutional factors. This study aimed to identify factors associated with participation to inform inclusive training programme designs.

Methods: We analysed longitudinal data from 1,825 healthcare professionals across eight paediatric departments in two Danish regions over 15 months. Logistic regression was used to examine associations between simulation participation and factors such as age, gender, profession, experience, hospital type, sick leave, and patient safety culture.

Results: Doctors were more likely to participate than nurses (OR = 1.5, 95% CI: 1.0; 2.1), and staff at regional hospitals were much more likely to participate than staff at university hospitals (OR = 4.8, 95% CI: 3.6; 6.2). Age, experience, sick leave, and safety culture dimensions showed trends, but none were statistically significant. Gender was not associated with participation.

Conclusions: Professional roles and institutional context may influence simulation participation. Tailored strategies targeting nurses, early-career professionals, and university hospital staff may help increase participation and support sustained training efforts.

Funding: The Elsass Foundation and the Central Denmark Region.

Trial registration:

Clinicaltrials: gov (no. NCT06064045).

Introduction: Correct use of tuberculosis (TB) diagnosis codes is essential for patient care, surveillance and resource allocation. We aimed to assess the positive predictive value (PPV) of TB diagnosis codes.

Methods: In this retrospective cohort study, we identified patients with International Classification of Diseases, tenth version (ICD-10) TB diagnosis codes from 1 July 2020 to 30 June 2023, at two TB centres in the Central Denmark Region. Confirmed TB was defined as microbiologically confirmed TB, prescription of ≥ 3 first- or second-line TB drugs, or TB notification. All patients who did not meet these criteria and those who received fewer than three TB drugs or lacked TB notification underwent manual hospital record review to verify or exclude the TB diagnosis. PPVs were calculated as the proportion of confirmed TB diagnoses among all patients with a TB diagnosis code.

Results: In total, 185/230 patients were confirmed to have TB, yielding a PPV of 80% (95% CI: 75; 85). The PPVs for TB microbiology, TB prescriptions and TB notification exceeded 95% individually. Excluding TB lupus codes increased the PPV to 89% (95% CI: 84; 93). Patients with more than one different type of TB diagnosis code had a PPV of 100% (95% CI: 93; 100). Additionally, PPVs were high when TB diagnosis codes appeared on multiple occasions, increasing with the number of occurrences (≥ 2: 85%, ≥ 3: 89%, ≥ 4: 93%).

Conclusion: TB ICD-10 diagnosis codes demonstrate a moderately high PPV in Denmark, particularly when excluding TB lupus codes, highlighting the importance and complexities of diagnostic coding.

Funding: None.

Trial registration: Not relevant.

Introduction: About 40% of all new HIV cases in Denmark are migrants. Studies show that migrants are typically diagnosed several years after arriving in Denmark, indicating a worrying missed opportunity for testing. The aim of this study was therefore to explore the experience of accessing HIV testing among migrants living in Denmark.

Methods: The study participants were recruited from April to July 2021 at the outpatient HIV clinics in the departments of infectious diseases at two large hospitals in Denmark. We included informants who were: 1) > 17 years, 2) born in Eastern Europe, Asia, Latin America or Africa, and 3) had tested positive with HIV after 1 January 2013 in Denmark. In total, 19 particpants were included. We conducted interviews based on a semi-structured interview guide and analysed them through thematic network analysis.

Results: The study found that risk perception and stigma were important factors in seeking HIV testing among migrants. From the study, three pathways to diagnosis emerged: 1) feeling ill and seeking healthcare, 2) fertility or pregnancy-related screening and 3) routine HIV testing. Pathways differed considerably between men who have sex with men and heterosexual informants.

Conclusions: The study showed an increased need for provider-initiated testing to promote early diagnosis of HIV among migrants in Denmark. Structural policies and practices should be introduced to ensure this.

Funding: This work was supported by AIDS Foundation Denmark.

Trial registration: Not relevant.

Introduction: More than 31,000 Ukrainian refugees have been resettled in Denmark. To mitigate related health challenges, the Danish Health Authority issued Guidelines for Healthcare Professionals on Displaced Ukrainians in 2022, stating that general practitioners (GPs) should conduct a health assessment at one of the first contacts with a Ukrainian refugee. We aimed to explore how GPs had implemented this health policy into practice.

Methods: From 11 May to 22 June 2023, we distributed a self-administered online questionnaire to 3,284 GPs through the newsletter of the Danish Organisation of General Practitioners (PLO). Analyses included frequencies and statistical logistic regression analyses.

Results: A total of 55 GP responded. Those who were knowledgeable about the guidelines were significantly more likely to ask adults (OR = 4.0; 95% confidence interval (CI): 2.1-7.9) and children (odds ratio (OR) = 4.7; 95% CI: 1.4-16.1) about vaccination status and infectious diseases (OR = 5.0; 95% CI: 3.6-19.3) as part of a general health assessment. GPs experienced language barriers and a lack of knowledge about refugee health as obstacles to implementing the guidelines. GPs also found that Ukrainian refugees had a high need for interpreters and lacked the competencies needed to navigate healthcare services. Lastly, GPs expressed that intersectoral cooperation and referral possibilities were lacking.

Conclusions: Our study highlights the importance of providing structural support and evaluation to ensure that migrant health policies effectively impact the target groups in practice.

Funding: None.

Trial registration: Regional Data Protection Centre (P-504-0406/23-5000).