Danish medical journal最新文献

Introduction: The demand for procedural sedation in the emergency department (ED) has risen. This study aims to 1) investigate the safety of remimazolam as analgosedation, 2) evaluate amnesia and the quality of sedation and 3) determine whether the sedation was successful and effectively managed pain for procedures in the ED.

Methods: This prospective clinical cohort study was performed by registered nurse anaesthetists in the ED at Aalborg University Hospital from February to May 2024. Outcome measures were 1) adverse effects of remimazolam, proportion of patients reporting 2) adequate sedation or amnesia post-procedure and 3) adequate pain or anxiety relief.

Results: A total of 68 patients (median age 59, 58% female) were sedated by remimazolam with a median dose of 7.5 mg. Most patients (97% (n = 66)) had no or mild respiratory problems during sedation. Two patients had transient severe respiratory problems following sedation. Both patients had received large doses of opioids before remimazolam sedation. Patient satisfaction was 97% based on reports of procedural amnesia or satisfaction with sedation and pain control. Almost all (89%) joint reductions were successfully performed. In over half of patients who would have otherwise required general anaesthesia in an operating room (57%, n = 20/35), sedation with remimazolam was sufficient to perform the procedure in the ED.

Conclusions: The use of remimazolam in the ED was a safe and effective sedative treatment with high patient satisfaction levels.

Funding: None.

Trial registration: Not relevant.

Introduction: Ingrown nails (onychocryptosis) is a debilitating condition that often recurs after partial matrixectomy. Therefore, this study investigated the incidence of ingrown nails and identified the risk factors associated with recurrence.

Methods: This retrospective cohort study analysed electronic health records of orthopaedic surgery patients aged 18+ from Bispebjerg and Frederiksberg Hospitals, Denmark (April 2017-November 2020) to assess recurrence and associated risk factors.

Results: The cohort included 53% females (n = 83) and 47% males (n = 75), with 44% (n = 69) aged 18-28 years. Active smokers constituted 73% (n = 115). Common comorbidities were musculoskeletal disorders (32%, n = 51), endocrine (22%, n = 34) and cardiovascular disorders (15%, n = 23). Recurrence occurred in 34% (n = 54, p less-than 0.05). Middle-aged individuals (29-40 years: 64%; 41-50 years: 60%) showed slightly higher recurrence rates, though this finding was non-significant (p = 0.07). Males (OR = 0.24, 95% CI, p = 0.000) and smokers (OR = 0.34, 95% CI, p = 0.016) had lower recurrence odds. Complications were significantly higher in recurrence cases (OR = 4.35, 95% CI, p less-than 0.000), with abscess (100%), panaritium (100%) and onychogryphosis (95%) being the most prevalent.

Conclusions: Recurrence affected one-third of the cohort, with higher rates being observed in younger and middle-aged individuals, whereas males and smokers had lower recurrence rates.

Funding: None.

Trial registration: Not relevant.

Introduction: This report presents a single-institution prospective case series evaluating the feasibility and effect of outpatient local anaesthesia radiofrequency ablation-assisted soft palate volumetric tissue reduction (RFA-SP) and turbinoplasty (RFA-T) for treatment of patients with obstructive sleep apnoea (OSA) and/or snoring.

Methods: A total of 72 patients with Apnea-Hypopnoea Index (AHI) > 5 and/or subjective snoring treated in 2024 were evaluated after surgery, including cardiorespiratory monitoring (CRM) and patient questionnaire evaluation. Main endpoints were AHI, Snore Index (SI), Epworth Sleepiness Scale and scored impact of sleep-disordered breathing on quality of life.

Results: We conclude that the procedures have low morbidity and high patient satisfaction. Approximately one in two patients had improved symptoms. However, improvement in AHI and SI was mainly seen in total or non-supine positions. The main limitations of our study are: the placebo effect in patient self-evaluations, the relatively small study population, the availability of comprehensive and recent pre- and post-surgery CRMs and the underlying premise that the mechanisms of sleep-disordered breathing remain poorly understood.

Conclusions: Outpatient RFA-SP and RFA-T under local anaesthesia effectively improve symptoms and quality of life in patients with OSA and snoring, producing complete resolution in selected cases. The best outcomes are seen in non-supine OSA, highlighting the need for careful preoperative assessment to optimise patient selection.

Funding: None.

Trial registration: The study protocol was approved by the Aarhus University Hospital Management. The Central Denmark Region Committees on Health Research Ethics were consulted and found the project non-notifiable.

Introduction: The Nottingham Clavicle Score (NCS) is a patient-reported outcome measure (PROM) that addresses injuries to the clavicle, acromioclavicular joint (ACJ) and sternoclavicular joint. The aim of this study was to translate and culturally adapt the original NCS to Danish, providing a basis for future validation and clinical use in Denmark.

Methods: The translation process followed best-practice guidelines from the International Society for Pharmacoeconomics and Outcomes Research. It was conducted using the cross-cultural adaptation guidelines described by Beaton. Two independent translators and an expert committee performed the translation from English into Danish. The final NCS translation was presented to Danish patients undergoing treatment for a clavicle fracture or an ACJ dislocation.

Results: The NCS was translated into Danish and cross-culturally adapted. The translation process included forward and backward translations, expert committee review and pilot testing by nine patients. The Danish version was well-understood by the target population, and only minimal adjustments were needed to achieve conceptual and linguistic equivalence. Patients reported that the questionnaire was relevant and comprehensible.

Conclusions: The NCS has been translated and cross-culturally adapted to Danish. It was well-received by the target population, with patients finding it relevant and comprehensible. However, further validation is required to confirm its reliability and consistency in a Danish population.

Funding: None.

Trial registration: Not relevant.

Introduction: A burst abdomen is a severe complication after emergency laparotomy and is known to increase the risk of mortality, morbidity, incisional hernia and decreased body image. No studies have explored Health-Related Quality of Life (HRQoL) in patients with a burst abdomen. This study aimed to investigate and describe patient-reported consequences of a burst abdomen using HRQoL.

Methods: This prospective, observational single-centre cohort study included 281 patients undergoing emergency laparotomy during a one-year period. Abdominal wall closure was standardised and documented during the study period. HRQoL was assessed using the EuroQol 5-Dimension 5-Level questionnaire four times during the study: in the immediate post-operative period as a baseline (assessed retrospectively) and on the fourth, 30th, 90th and 180th post-operative days.

Results: Among the total of 281 included patients undergoing emergency laparotomy, 15 patients (5.3%) experienced a burst abdomen. Patients with a burst abdomen reported a lower HRQoL (46.7% versus 25.2%; p = 0.035), and fewer patients with a burst abdomen had high HRQoL (13.3% versus 38.3%; p = 0.035) on the 30th post-operative day than patients without a burst abdomen. Reasons for lower HRQoL in patients with a burst abdomen were found to be due to a negative impact on usual activities, self-care and mobility.

Conclusions: Following emergency laparotomy, patients with a burst abdomen experienced a short-term decline in quality of life and reported more difficulties with usual activities, self-care and mobility than those without this complication.

Funding: None.

Trial registration: Not relevant.

Introduction: Since 2022, Denmark has received approx. 50,000 Ukrainian refugees. We examined the sociodemographic characteristics, disease patterns and associated risk factors of Ukrainian refugees receiving a general health assessment (GHA) at the Migrant Health Outpatient Clinic, Hvidovre Hospital.

Methods: This cross-sectional study based on a prospective inclusion of patients, included all Ukrainian adults assessed between April 2022 and December 2024. The GHAs included blood samples (biochemistry and screening for infectious diseases), a questionnaire, a medical interview and a physical examination. Data were analysed using descriptive and inferential statistics.

Results: A total of 101 participants were included. Common findings were poor oral health (44%) and PTSD symptoms (22%). Screening for infectious diseases revealed previous hepatitis B infection (15%), tuberculosis infection (12%) and HIV infection (4%). COVID-19 vaccine adherence was low (50%). We also found that exposure to war trauma was associated with PTSD symptoms.

Conclusions: The study population had a significant burden of mental and physical health problems and indications of low vaccine coverage, highlighting the need for increased awareness of the health needs of Ukrainian refugees in Denmark and the importance of providing GHAs to at-risk individuals.

Funding: None.

Trial registration: Ethical approval was granted by the Team for Medical Records Data, Capital Region of Denmark.

Introduction: In late 2023, the Danish national guideline on treatment of gestational diabetes mellitus (GDM) introduced tighter glucose control to prevent foetal and maternal complications. The change was expected to lead to an increased use of insulin therapy in GDM treatment. This study aimed to evaluate insulin usage and obstetric outcomes when adhering to the new guideline.

Methods: This retrospective cohort study evaluated women diagnosed with GDM (n = 67) from May to October 2024 at Gødstrup Hospital, compared with women diagnosed with GDM (n = 46) in a three-month period in 2023 before implementation of the new guideline. Data on maternal age, pre-pregnancy BMI, ethnicity, education, oral glucose tolerance test 2-h values, insulin treatment, induction of labour and foetal characteristics were collected.

Results: The number of women treated with insulin increased from 26% (2023) to 58% (2024), p less-than 0.01, but the maximum insulin dose did not change (0.42 IU/kg/day). Birthweight and birthweight z-scores were comparable. In 2024, induction of labour was more prevalent (63% versus 39%, p less-than 0.01) without a corresponding rise in obstetric and perinatal complications.

Conclusions: Implementation of the new GDM guideline increased the number of women requiring insulin treatment but did not affect the maximum dose of insulin per kg. The increase in insulin treatment led to a higher labour induction rate, increasing the workload for the obstetric department. Our data showed no decrease in birthweight or the incidence of large-for-gestational-age offspring.

Funding: None.

Trial registration: Not relevant.

Introduction: Women with postcoital bleeding (PCB) are traditionally referred for colposcopy. A 2022 regional strategy recommends colposcopy only if abnormalities are found in cytology, human papillomavirus testing or by gynaecological examination (GE). This study explores the number of reduced colposcopies using this triad to detect precancerous or cancer lesions and examines the potential for implementing this strategy with general practitioners (GPs).

Methods: Between 1 January 2022 and 15 October 2024, a retrospective cohort study was conducted on women referred with PCB identified using the International Classification of Diseases, tenth version (ICD-10) diagnosis codes "DN930 Bleeding after coitus" and "DN930B Contact bleeding". Data were collected from the hospital's electronic patient files and the Danish Pathology Database.

Results: Data from a total of 392 patients were analysed. Among 199 low-risk patients with normal tests, 161 (81%) avoided colposcopy. The combined sensitivity of cytology and hrHPV tests was 97%, detecting 33 of 34 CIN2+ cases. One CIN2+ case was missed by both tests but identified by GE. GP agreed with gynaecologists in 53% of abnormal GE findings, whereas 47% were misclassified as normal GE findings.

Conclusions: Combining cytology, hrHPV testing and GE reduces unnecessary colposcopies in low-risk women with PCB by 81%. The triadic approach successfully identified all CIN2+ cases. Implementing the new strategy with GPs is challenging due to GPs' limited accuracy in identifying abnormal GE findings.

Funding: None.

Trial registration: Not relevant.

Introduction: Oesophageal food impaction (EFI) is a common and potentially serious condition where a piece of food becomes lodged in the oesophagus. No significantly effective pharmacological treatment exists. Nitroglycerin (NTG) is a potent vasodilator that might induce sufficient smooth muscle relaxation to resolve the EFI. We aim to evaluate the efficacy and safety of NTG in EFI treatment.

Methods: The study is an investigator-initiated, double-blind, multicentre, randomised, placebo-controlled, parallel-arm trial to assess the efficacy, safety and feasibility of NTG for patients with EFI. The study targets patients > 18 years of age with EFI. Patients will be randomised (1:1) to receive either oral NTG dissolved in 10 of ml tap water or oral placebo dissolved in 10 ml of tap water for up to two administrations separated by at least 30 minutes. The treatment resolves the food impaction if the patient can drink and eat afterwards.

Conclusion: The results of the study may guide future research and provide evidence for a pharmacological treatment option for oesophageal food impaction.

Funding: Fru Olga Bryde Nielsens Fond. The funding source had no influence on the trial design, data collection, analysis or publication of the paper.

Trial registration: European Union Clinical Trials Register, EU trial number: 2023-503983-17-00. Authorisation date 28082023.

Introduction: The aim of this study was to establish a consensus on criteria to determine readiness for hospital discharge to the patient's own home after pulmonary surgery in Denmark.

Methods: All Danish board-certified thoracic surgeons were invited to give their expert opinion on which criteria they use to determine readiness for discharge following pulmonary surgery. Opinions were collected and a consensus was achieved through a three-round Delphi survey. In round 1, experts gave their opinions in free text. In round 2, answers were grouped and rated using a five-point Likert scale. In round 3, group answers from round 2 were presented for re-evaluation, and experts were given the opportunity to change their ranking in accordance with the Delphi methodology. To minimise peer influence, individual responses were anonymised and presented without attribution. Consensus was achieved when at least 75% of the experts in round 3 rated discharge criteria and endpoints four or more on a Likert scale.

Results: Among 31 experts, 30 (97%) participated in all three rounds. Consensus was achieved on 23 specific endpoints covering chest drain removal, respiratory function, pain management, mobilisation, arrhythmia, infection, oral intake and self-care.

Conclusions: A consensus was reached on discharge criteria after pulmonary surgery based on opinions from specialist thoracic surgeons across all institutions performing thoracic surgery in Denmark. These results may facilitate future research in enhanced recovery after surgery and enable differentiation between readiness for discharge and actual discharge.

Funding: None.

Trial registration: Not relevant.