Danish medical journal最新文献

Introduction: Decisions to admit patients to intensive care units are often complex, and assessing patients is essential but difficult. In recent years, the Clinical Frailty Scale has been highlighted as a potential assessment tool for triaging patients for admission to the intensive care unit. This study aimed to investigate the clinical differences and Clinical Frailty Scale scores between patients who are refused and those who are admitted to the intensive care unit.

Methods: All patients assessed for intensive care therapy at a Danish hospital from December 2020 to December 2021 were prospectively registered. The patients' descriptive data, Clinical Frailty Scale scores, three-month mortality rates and reasons for refusal were retrospectively extracted from hospital records.

Results: During the study period, 571 patients were admitted to the intensive care unit, whereas 106 were refused admission. Patients who were refused had a significantly higher median age, a higher (poorer) Clinical Frailty Scale score and a significantly higher three-month mortality rate than patients who were admitted to the intensive care unit.

Conclusions: The results indicate that the Clinical Frailty Scale may be one of several useful tools when assessing patients for intensive care therapy. However, this assessment is a multifactorial task, and further research needs to be conducted to examine the usefulness of this scale.

Funding: Lillebaelt Hospital, University Hospital of Southern Denmark and the University of Southern Denmark supported this study.

Trial registration: Not relevant.

Introduction: Olecranon fractures, particularly the Mayo Type 2A two-part fracture, are typically treated with Kirschner wires (K-wires) and tension band wiring. While effective, this method is associated with a high complication risk, leading to reoperations. Recently, new suture fixation techniques have been described that do not involve the insertion of metal. This new technique may mitigate risks associated with K-wires and tension band wiring without impacting healing or function. This study compares the reoperation rate and outcome of suture fixation with traditional tension band wiring.

Methods: This is a prospective, randomised, double-blinded, multicentre study. The allocation ratio is 1:1, and the groups are parallel. A total of 88 adult participants will be recruited. Participants will be assigned to receive either suture fixation or traditional tension band wiring. Follow-up is one year. The primary outcome is the reoperation rate. Secondary outcome measures include the Disabilities of the Arm, Shoulder and Hand (DASH), the EuroQol-5 Dimensions (EQ-5D) score, radiological outcomes and complications.

Conclusions: There is room for improvement in treating Mayo Type 2A fractures, and this study will allow us to investigate a new treatment method. The new suture fixation technique for treating olecranon fractures can potentially offer a similar or improved functional outcome compared to tension band wiring while lowering the reoperation rate significantly.

Funding: The study is initiated and conducted by the participating physicians within the financial framework of the participating departments.

Trial registration: The trial is registered with www.

Clinicaltrials: gov, ID number: NCT04189185.

Physical activity and sedentary time are associated with multiple health outcomes, and benefits also extend to those living with chronic conditions. These observations are primarily based on data from studies in which self-reported data assessed physical activity. Recent data where physical activity and sedentary time are measured with devices suggest that the dose-response association between device-measured physical activity and risk of incident diseases and mortality is greater and observed at lower levels of physical activity than indicated by self-reported data.

Introduction: The Patient Activity Treatment Outcome Scale (PATOS) is a novel patient-reported outcome measure (PROM). This study explored patients' and orthopaedic surgeons' experiences with PATOS as part of a PROM battery. It aimed to investigate its influence on patient involvement and healthcare decisions about knee or hip osteoarthritis patients scheduled for knee/hip arthroplasty.

Methods: A qualitative research design was adopted using semi-structured interviews with 19 patients and nine orthopaedic surgeons at a Danish orthopaedic surgery department. Thematic analysis was used to develop key themes from interview transcripts.

Results: This study adds nuanced insights related to the use of PROMs in routine orthopaedic clinical practice. Home-based completion of PROMs prompted patients to reflect on their situations, priorities and goals regarding potential hip or knee arthroplasty, leading to better-prepared discussions with surgeons. The integration of PATOS with other PROMs made it challenging to discuss PATOS exclusively. Therefore, the results relate to the full PROM battery. The experiences of patients and surgeons were organised into four themes: 1) Patient involvement is key, 2) Questionnaire load, 3) Meaningful home-based completion and 4) PROMs were not used in the decision-making process.

Conclusions: The questionnaire load and limited integration into healthcare decision processes raised concerns about the application of the PROM battery. The results emphasise the importance of refining the application of PROMs in orthopaedic practice from the perspectives of patients and surgeons alike.

Funding: This work was supported by Innovation Fund Denmark [0172-01258B] TRIAL REGISTRATION. Not relevant.

Introduction: A procedural change in the treatment of patients with femoral neck fracture from uncemented to cemented hemiarthroplasty was to be implemented to follow new national guidelines. In accordance with implementation science, it is important to understand the team's thoughts and educational needs. The study aimed to explore surgeons', scrub nurses', anaesthesiologists' and anaesthesia nurses' perceptions of barriers and facilitators to foster a safe educational introduction.

Methods: We conducted four semi-structured group interviews with 15 team members. The interviews were recorded, transcribed, and analysed using systematic text condensation to define important factors.

Results: We found barriers, e.g., potential fear related to handling the cement and "thoughts" concerning limited time. Patient, individual and organisational factors were also identified. A "cement-time-out" was suggested to prepare and complete cementation safely. The interviewees emphasised continuous training to ensure the procedure's success and maintain skills and confidence after the initial training. The importance of a safe learning culture, team collaboration and the provision of feedback was discussed.

Conclusions: The study provides novel insights into the specific educational needs that may arise during the transition to cemented hemiarthroplasty. A training package including simulation was proposed to maintain a safe learning environment and ensure patient safety. The team highlighted the importance of maintaining their competence. Results are relevant for departments introducing procedural change.

Funding: None.

Trial registration: Not relevant.

Introduction: The transition from medical student to resident is often stressful and challenging. Medical graduates' sense of preparedness for residency increases as they spend more time in the clinic. In Denmark, temporary short-term locum doctor employment (LDE) may be an opportunity to increase preparedness for future residency and ease the expected and experienced stress of the transition. This study aimed to explore how medical students and first-year residents experience holding an LDE and the expected or experienced impact on the transition from medical student to residency.

Methods: A qualitative design was chosen. Last-year medical students and first-year residents with LDE experience were included. A total of 23 participants were recruited and interviewed. A semi-structured interview guide was used. Data were analysed using thematic analysis.

Results: The analysis showed four main themes: 1) An opportunity to postpone and prepare for residency, 2) Negotiating uncertainty and responsibility, 3) Enhancing professional and personal competencies and 4) Impact on transition.

Conclusions: An LDE can offer medical students and first-year residents the opportunity to gain more clinical experience, postpone residency and enhance professional and personal competencies. Although uncertainty and insufficiency were common at the beginning of the LDE, adequate support and training may counterbalance these feelings. LDEs can contribute positively to the transition from medical student to residency.

Funding: Central Region Denmark TRIAL REGISTRATION. Not relevant.

Introduction: Patient and public involvement (PPI) in research integrates patient and public perspectives to improve research relevance and quality. The experiences of PPI partners have revealed mixed findings in countries where PPI is well established, but accounts from areas less accustomed to PPI in research are limited. This study aimed to explore the knowledge, motivations, expectations and experiences of PPI representatives in such a setting.

Methods: This was a qualitative study based on semi-structured interviews. Patient and public partners who had recently been engaged in a PPI collaboration to redesign the written patient material for a clinical study were interviewed. The interviews were analysed using inductive content analysis in which quotations were extracted, coded, categorised and interpreted into themes.

Results: Interviews indicated a lack of knowledge concerning PPI in research. Despite their motivation to collaborate, the PPI partners expressed anxiety and doubts about their abilities as laypeople. A sense of societal obligation to collaborate was noted. Groups-based, repetitive sessions fostered productivity, while challenges included off-topic discussions and skepticism.

Conclusions: The findings provide valuable insights for shaping PPI processes and recruitment strategies in regions that are new to PPI. This highlights the need to describe the PPI concept when recruiting participants elaborately and to utilise repetitive group-based sessions in the design.

Funding: Supported by the Novo Nordisk Foundation and the Chief Scientist Office, Scotland.

Trial registration: Not relevant.

Introduction: We aimed to explore the impact of social distancing on the incidence, severity and microbiology of patients with acute tonsillitis (AT).

Methods: In this single-centre study, we retrospectively included all patients with AT referred to the Ear-Nose-Throat Department, Aarhus University Hospital, Denmark, in the two years preceding versus the two years after the COVID-19 lockdown in Denmark (11 March 2020).

Results: In total, 425 patients were included. The incidence of AT was significantly lower in the post-lockdown period (n = 128) than in the pre-lockdown period (n = 297) (p less-than 0.001). Reduced incidence was observed across all age groups. No significant differences were found in patient characteristics between periods. The proportion of hospitalised patients was significantly lower in the post- than in the pre-lockdown period (36% versus 25%, p = 0.032). Prevalent culture findings were Streptococcus pyogenes (15%), S. anginosus group (11%) and Fusobacterium necrophorum (5%). No statistically significant differences in the relative prevalence of individual bacteria were found between periods.

Conclusions: The incidence of patients with AT referred to hospital decreased by 57% in the two-year period after the COVID-19 lockdown compared with the period leading up to the lockdown. Our findings suggest that this decrease mirrored a general decline in AT incidence rather than altered referral patterns.

Funding: None.

Trial registration: The study was approved by the Danish Data Protection Agency (#1-16-02-134-23) and the Danish Patient Safety Authority (#1-45-70-41-23).

Introduction: Venous thromboembolism (VTE) carries a high risk of recurrence, and this risk is strongly related to the nature of the index event. Thus, extended anticoagulation treatment is recommended for patients with a high recurrence risk and should be considered for patients with an intermediate risk. This study aimed to provide insight into the clinical practice of extended anticoagulation for VTE patients METHODS. This was a retrospective study of VTE patients covering the period from January 2020 through June 2021. We categorised patients by their estimated risk of recurrence as low (less-than 3% per year), intermediate (3-8% per year) or high (> 8% per year). The decision to stop or extend anticoagulation was made in a multidisciplinary VTE clinic.

Results: A total of 343 patients were included; 315 patients were eligible for analysis. The majority of patients (58.7%) had an intermediate recurrence risk. In total 80.3% received extended treatment. The use was highest (97.9%) among patients with a high recurrence risk, whereas 82.7% with an intermediate risk and 15.2% with a low risk received extended therapy. Non-vitamin K antagonist oral anticoagulants were preferred for extended therapy (82.2%), whereas 5.1% received warfarin and 12.6% low molecular weight heparin.

Conclusions: In this real-world clinic, the majority of VTE patients switched to extended treatment after initial standard anticoagulation. The role of patient and physician preference as determinants driving this decision should be investigated further.

Funding: This study received an unrestricted grant from Bayer, which had no involvement in the study design, data collection, analysis, or manuscript preparation.

Trial registration: Not relevant.

Introduction: Different approaches and techniques are used to apply a transversus abdominis plane block (TAP), but their characteristics are poorly described. Precise injection of local anaesthetic is considered crucial to achieving the desired block effect. Laparoscopic-assisted TAP (L-TAP) is a blind technique and potentially less reliable than ultrasound (US)-guided techniques. This study assessed the cutaneous sensory block area (CSBA) after an L-TAP adopting a subcostal dual block approach.

Methods: Thirty elective laparoscopic cholecystectomy patients received bilateral L-TAPs. The CSBA was mapped 150 min. after block application using cold sensation and a sterile marker, photo-documented and transferred to a transparency sheet from which the area was calculated.

Results: The median CSBA of the subcostal bilateral dual L-TAP was 161 cm2 (interquartile range: 131-217 cm2; range: 67-408 cm2). In all patients, the CSBA mainly covered the skin over the epigastrium, whereas 23% also had an infraumbilical component. In none of the patients did the CSBA cover the abdominal wall laterally to a vertical line through the anterior superior iliac spine.

Conclusion: The subcostal bilateral dual L-TAP produces a heterogeneous non-dermatomal CSBA of varying size and distribution across the medial epigastric abdominal wall, similar to the CSBA described in the existing literature on US-guided subcostal TAP.

Funding: The authors have no sources of funding to declare for this manuscript.

Trial registration: Not relevant.