Danish medical journal最新文献

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.

Introduction: Anaesthetic choices in cancer surgery, including the use of epidural analgesia, may affect immune function during the perioperative period and might play an important role in subsequent cancer spread and recurrence.

Methods: This was a prospective, randomised, controlled, double-blinded, single-centre study allocating patients scheduled for video-assisted thoracoscopic surgery (VATS) lobectomy to post-operative pain management using either thoracic epidural analgesia or oral morphine. We compared pre-, per-, and post-operative plasma levels of interleukin (IL)-6, IL-10, IL-12, and interferon (IFN)-γ using regression analysis, and conducted a two-year survival follow-up.

Results: A total of 66 patients were randomised. Fifty-six received the allocated treatment and were analysed. None of the investigated cytokines exhibited significant between-group differences in plasma concentrations when adjusted for the chosen covariates (p ≥ 0.204). A two-year follow-up showed no difference in survival between the two groups (p = 0.5).

Conclusion: Our study found no differences in the impact on the innate, non-specific immune system related to epidural analgesia for pain management in VATS.

Funding: The Danish Cancer Society (R150-A10139). Oberstinde Kirsten Jensa la Cours Mindelegat (JSP-25076). University of Southern Denmark, Region of Southern Denmark and Department of Anaesthesia and Intensive Care, Odense University Hospital.

Trial registration: NCT02359175 (ClinicalTrials.gov).

Introduction: Evidence in child abuse cases can be scarce and is often centred around the child's testimony. However, child testimony varies with the child's development. Here, an overview of suspects, case decisions and court verdicts from a cohort of children is presented, stratified across children aged 0-3, 4-7, 8-11, and 12-15 years.

Methods: Children seen at the Department of Forensic Medicine, Aarhus University, Denmark, in 2001-2013 were analysed, including all case files from the police, courts and healthcare services.

Results: A total of 647 cases were presented. The most frequent suspect was the child's parents. The police referred to the prosecutor in 69% of all cases, and 37% were tried in court. The lowest proportion of cases of tried cases was found among children aged 0-3 years (20%) and the highest among children aged 8-11 years (57%). Across ages, no corroborating evidence, the accused's refusal of guilt and no case to pursue (insufficient strong evidence) were the most frequent reasons for case closure. Cases relating to children aged 0-3 years were frequently dismissed because the fault could not be placed, whereas cases relating to children aged 12-15 were frequently rejected because of lacking evidence of compulsion (non-consent).

Conclusion: Results show variations across ages regarding children tried in court and case dismissal. A dedicated child court may be considered to ensure equal access to justice. Questioning during the forensic examination and the use of psychologists may strengthen the available evidence.

Funding: These materials have received financial support from the Danish Victims Fund. The execution, content and results of the materials are the sole responsibility of the authors. The analysis and viewpoints made evident from the materials belong to the authors and do not necessarily reflect the views of the Council of The Danish Victims Fund.

Trial registration: Not relevant.

This is a letter to the editor on the article "An algorithm for pharmacological treatment of mania during hospitalisation" Dan Med J 2024;71(5):A08230525.

This is a letter to the editor on the "Correspondence on "An algorithm for pharmacological treatment of mania during hospitalisation" Dan Med J 2024;71(5):A08230525.

Introduction: This study aimed to assess the short-term complication rate after US-guided core needle biopsies with an 18-gauge needle of retroperitoneal or intraabdominal masses (non-kidney group) compared with complications after biopsy from a renal mass (kidney group).

Methods: This was a retrospective analysis of 330 consecutive patients in the non-kidney group and 330 control patients in the kidney group. We recorded baseline characteristics, diagnostic yield, complications graded as Clavien-Dindo (CD) and readmissions within one and seven days.

Results: In all, 245 patients in the non-kidney and 281 patients in the kidney group had a biopsy performed. A total of 54 (22%) patients in the non-kidney group had a complication registered. However, 47 were minor complications (minor bleeding or localised pain, CD 1). In the kidney group, 47 (17%) patients had a complication, with 44 being graded as CD 1. No major complications (CD 3 or higher) were associated with the biopsies. Only 0.8% of patients in the non-kidney group and 0.7% in the kidney group had a treatment-requiring CD 2 complication (i.e. blood transfusion) directly caused by the US-guided biopsy. These complications were recognised less than 30 minutes or more than four hours after the procedure. We found no significant difference in the complication rate, diagnostic yield or risk of re-admission between the two groups.

Conclusion: The observation period for patients who undergo an uncomplicated US-guided biopsy from an intraabdominal or retroperitoneal mass can safely be reduced to 30 minutes.

Funding: None TRIAL REGISTRATION. Not relevant.