Danish medical journal最新文献

Introduction: Although well-documented asthma treatments are available, many patients with asthma remain symptomatic, even when managed by respiratory specialists. We aimed to describe barriers to optimal asthma management in Danish respiratory specialist practice.

Methods: This was a qualitative study of 20 patients (mean age 37.6 years, six 40+ years; 17 women) with asthma from two specialist practices, with interviews conducted by phone.

Results: Many patients were unaware of the timeline for their course of treatment or what it entailed to be a patient in a pulmonary clinic, including being uncertain about how many consultations they were entitled to, the agenda of the next appointment and what the exact goals of the treatment were. Patients expressed doubts regarding the dosage and effectiveness of their medication. Some questioned whether they were taking their medication correctly and whether it was acceptable to take additional doses. Patients reported that they occasionally forgot to take their medication because they had not established a consistent routine for it.

Conclusions: Barriers were often quite practical and simple, and can most likely be broken down by focusing on simple behavioural aspects rather than by providing more information.

Funding: This study was funded by Fonden for Faglig Udvikling i Speciallægepraksis, Danske Regioner.

Trial registration: Not relevant.

Introduction: Ultrasound (US) is an accessible and non-invasive method for assessing pathology in the musculoskeletal system. Its application may include assessment of glenohumeral (GH) instability. Whereas GH instability is typically assessed in symptomatic patients, US measurements of anterior-posterior (AP) GH translation have shown good to excellent reliability in healthy populations. The aim of this study was to test the intra- and interrater reliability of measurements of AP GH translation in a clinical setting.

Methods: Two clinicians performed measures of AP GH translation in patients with anterior shoulder instability. Measurements were conducted from both an anterior and a posterior view. The primary outcome was the intraclass correlation coefficient (ICC(2,1)).

Results: Twenty-three patients were included. The intrarater ICCs ranged from 0.70 to 0.76. The interrater ICCs ranged from 0.20 to 0.49. The most reliable test was a simulated "Load and Shift" test. The minimal detectable changes ranged from 2.16 to 3.42 mm for the same rater, and from 2.71 to 4.78 mm between raters.

Conclusions: When performed in a clinical setting by raters with limited US experience, the US measurements of AP GH translation in patients with anterior shoulder instability demonstrated moderate to good intrarater reliability and poor interrater reliability. These findings suggest that while US may have potential for clinical use, its reliability may be limited when performed by novice raters.

Funding: Amager and Hvidovre Hospitals Forskningspulje.

Trial registration:

Clinicaltrials: gov (ID: NCT05250388).

Introduction: The patterns of drug use and causes of fatal poisonings among persons who use drugs (PWUD) have been reported every fifth year since 1991 by the Danish Departments of Forensic Medicine. The present study aimed to describe these patterns in 2022.

Methods: All fatal poisonings among PWUD undergoing legal autopsy at the three Departments of Forensic Medicine in Denmark in 2022 were included in the study.

Results: The number of fatal poisonings among PWUD was 199. The median age was 42 years and 23% were female. Heroin/morphine and methadone were the most frequent main intoxicants, responsible for 22% and 37% of the poisonings, respectively. However, the proportion of deaths caused by other opioids and central stimulants has increased compared to previous years. Oxycodone deaths increased tenfold to 6% from 0.6% in 2017. Cocaine and amphetamine caused 11% and 4.5% of fatal poisonings, respectively. Methadone remained the most frequently detected drug, followed by cocaine, tetrahydrocannabinol, clonazepam and heroin/morphine, detected in 52%, 45%, 37%, 35% and 26% of cases, respectively. Tramadol and oxycodone were most frequently detected among PWUD aged 15-25 years.

Conclusions: Our findings indicate an increasing diversity of opioids causing fatal poisonings in PWUD and a rising detection rate and proportion of deaths linked to central stimulants.

Funding: None.

Trial registration: Not relevant.

Introduction: Research on pneumonia in patients undergoing treatment for alcohol withdrawal symptoms (AWS) is sparse. This study describes the microbiological aetiology in this patient group within an intensive care unit (ICU).

Methods: We conducted a retrospective, observational study at Copenhagen University Hospital, Bispebjerg, Denmark. Patients admitted to the ICU between 1 June 2017 and 31 December 2020 who had received at least 200 mg of chlordiazepoxide for AWS within the preceding days were identified through electronic health records. Admissions presenting with clinical symptoms of pneumonia were included in the study.

Results: A total of 76 patients with 88 admissions met the inclusion criteria. We identified 58 bacterial species, with the most common being Staphylococcus aureus (n = 14; 24%), Haemophilus influenzae (n = 12; 21%) and Streptococcus pneumoniae (n = 11; 19%). In the overall ICU population, excluding our cohort study, 516 bacterial samples from the lower airways were identified. The prevalence rate in the study period for S. aureus was 25.6% (n = 132), for H. influenzae 8.3% (n = 43) and for S. pneumoniae 8.5% (n = 44).

Conclusions: Pneumonia was prevalent in patients with AWS in the ICU, and it had a predominantly bacterial aetiology. The most frequently isolated bacteria were S. aureus, H. influenzae and S. pneumoniae. Notably, the prevalence of S. aureus in our study cohort was similar to that in the overall ICU population at the study site.

Funding: None.

Trial registration: The study was approved by the Hospital Board of Directors as a quality study.

Introduction: Breast cancer accounts for 14% of all cancer-related deaths among women. Women aged 50-69 years are offered biennial mammography, which reduces breast cancer-specific mortality. Simulations suggest that risk-stratified screening detects more early-stage cancers while lowering the number of unnecessary recalls, assessments and biopsies in low-risk women. This trial will investigate whether multifactorial risk-stratified screening, including polygenic score, is feasible, acceptable, cost-efficient and safe.

Methods: A minimum of 962 consenting women aged 50-67 years will be randomised 1:1 into a control group receiving standard screening or an intervention group offered screening intervals based on individual risk. Risk factor data collection, communication and follow-up will occur online using a tool co-designed with women in the target group. The primary outcome will be the proportion of low-risk women who, within 800 days of their baseline mammogram, will refrain from their legally ensured two-year mammogram interval. Secondary outcomes include quality of life, anxiety and breast cancer worry, measured at baseline and repeated three times during follow-up. In addition, health economy analyses will be conducted.

Conclusions: The findings will inform the development of large-scale risk-stratified screening trials.

Funding: Novo Nordisk Foundation, grant no. NNF21OC0070842. ACA is supported by Cancer Research UK grants: PPRPGM-Nov20100002 and SEBCD3-2024/100001.

Trial registration:

Clinicaltrials: gov Identifier: NCT06060938. Registration date: 11092023.

Introduction: Atrial fibrillation (AF) prevalence is projected to double in the coming decades, necessitating innovative management strategies. This study evaluated the feasibility of a decentralised clinical trial for home-based sleep apnoea (SA) screening, activity tracking and heart rhythm monitoring in patients with AF.

Methods: This prospective cohort study enrolled patients with AF without known SA. Participants underwent a 12-week study using three home-monitoring systems: NightOwl for SA evaluation, FibriCheck for heart rhythm monitoring and SENS Motion for activity tracking. Patients completed questionnaires assessing AF-related quality of life, symptom severity, sleep quality and eHealth literacy at baseline and 12 weeks.

Results: The study included 18 patients with AF with a median age of 68.0 (interquartile range: 60.0-71.5) years, 11 (61%) women and 15 (83%) with paroxysmal AF. The study demonstrated high feasibility of remote monitoring, with data completeness rates of 83.3% for SA home evaluations, 97.6% for questionnaires, 91.7% for activity tracking and 88.8% for heart rhythm measurements. A drop-out rate of only 5.6% was recorded.

Conclusions: The study reports the feasibility of a decentralised digital platform for comprehensive AF patient monitoring. High patient engagement and data completeness suggest that digital health technologies can effectively integrate into clinical trials for patients with AF.

Funding: The Danish Heart Foundation (2023-12410) and Helsefonden (20-B-0269).

Trial registration: NCT06188247.

Introduction: Tucatinib in combination with trastuzumab and capecitabine is approved for the treatment of metastatic human epidermal growth factor receptor 2 (HER2) positive breast cancer in third-line and later based on the results of the HER2CLIMB trial. In this short report, we evaluate the extent and efficacy of tucatinib treatment among Danish patients.

Methods: This is a retrospective study that includes all known Danish patients who initiated tucatinib prior to June 1, 2024. We utilised the nationwide clinical database of the Danish Breast Cancer.

Results: In total, 38 patients were treated. Nineteen (50%) of the patients had central nervous system (CNS) metastases, and 21 (55%) had visceral disease. Median progression-free survival was 8.7 months (95% CI: 6.2; 13.3) and median overall survival was 22.4 months (95% CI: 13.1; N/A). Nine patients exhibited a performance status of 2-3 (n = 5) or uncontrollable CNS metastases (n = 4), not meeting the inclusion criteria applied in the HER2CLIMB trial.

Conclusions: Our results align with data presented from the HER2CLIMB trial. Considerably fewer patients than initially expected have been treated in Denmark.

Funding: None.

Trial registration: Approved by the Capital Regions Research Overview (P-2024-175774) and the Centre for Health Research (R-24065900).

Introduction: AI represents a conceptual change in medicine, and AI-based tools are rapidly being developed and implemented in clinical medicine. This study aimed to evaluate how clinicians at selected Danish cardiology departments perceive the role of AI in clinical decision-making.

Methods: We conducted a ten-item anonymous survey among clinicians in Danish cardiology departments to evaluate physicians' attitudes towards AI support in clinical decision-making for ischaemic heart disease. Key focus areas included perceived impact on patient outcomes, safety, workflow and clinician training. Responses were measured on a five-point Likert scale (1 = strongly disagree, 5 = strongly agree), with 4 or 5 collectively categorised as agreement. Participants were stratified by seniority (less-than 10 years versus ≥ 10 years).

Results: A total of 60 Danish clinicians at cardiology departments participated. The highest level of agreement was observed for AI optimism/expectations (68%, mean: 3.7), willingness to invest time in training (65%, mean: 3.8) and interest in AI use (63%, mean: 3.6). Although nosignificant, junior clinicians showed greater enthusiasm for training and adoption, whereas concerns about trust, safety and time-saving potential persisted across seniority.

Conclusions: Danish cardiologists generally expressed moderate to high expectations, interest and willingness towards AI support in clinical decision-making. However, the study revealed concerns about accuracy, patient safety and whether AI will ultimately save clinicians' time.

Funding: This project was supported by NordForsk (PM-Heart grant number 90580), Novo Nordisk Foundation (grant no. NNF14CC0001, NNF17OC0027594 and NNF22OC0079382), Innovation Fund Denmark (BigTempHealth grant no. 5153-00002B, case no. 8114-00033B and 8114-00034B), Rigshospitalets Forskningspulje and Rigshospitalets Forskningspulje Rammebevilling (#A11336). The funders had no role in the design or interpretation of the study.

Trial registration: Not relevant.

Introduction: The Clinical Frailty Scale (CFS) assesses frailty in older adults. Although the scale has been translated into Danish, the accompanying questionnaire and classification tree have not. The questionnaire includes seven questions about basic and instrumental activities of daily living, chronic conditions, self-rated health, energy level and physical activity, guiding the respondent to a CFS level through the classification tree. This study translated and cross-culturally adapted the CFS questionnaire and classification tree into Danish and assessed the interobserver agreement in a hospital setting.

Methods: The Danish version of the CFS short questionnaire and classification tree was developed in five stages: forward translations, synthesis, back-translation, review by a committee panel and pre-testing, followed by comprehension interviews and an interobserver agreement study.

Results: The back-translations closely matched the original. Minor discrepancies in contextual and idiomatic expressions were resolved through committee review. Pre-test confirmed comprehension, requiring no further changes. The kappa for interobserver agreement was 0.78.

Conclusions: The CFS questionnaire and classification tree were translated and cross-culturally adapted into Danish and are attached to this paper. The interobserver agreement achieved is considered acceptable for applying the CFS in emergency and orthopaedic departments.

Funding: None.

Trial registration: Not relevant.

Introduction: Fibroadenoma is a benign tumour with a prevalence of 9-22% and the third most common palpable breast tumour. Management is primarily conservative, but treatment varies due to a lack of national guidelines. We aimed to estimate the proportion of women diagnosed with fibroadenoma who underwent surgical excision in Denmark between 2011 and 2014, including regional differences in age, tumour size and year of surgery.

Methods: In this nationwide registry-based cohort study, we identified all patients who underwent surgical excision of a fibroadenoma from 1 January 2011 to 31 December 2014, using the Danish National Register of Pathology. This registry provided information on age and region. Operation rates were calculated using population data from Statistics Denmark.

Results: We identified 1,843 patients. The mean size of surgically removed fibroadenomas was 25.5 mm, and the mean age at surgery was 37 years. Patients > 50 years had a significantly higher proportion of small fibroadenomas (less-than 20 mm) removed than younger patients (p less-than 0.01). The overall operation rate was 20.6 per 100,000 women per year, highest in the 18-25-year age group (56.8 per 100,000 per year). Significant regional variation was found (p less-than 0.01), with the North Denmark Region having the highest operation rate (43.6 per 100,000 per year).

Conclusions: Despite conservative management being recommended in Denmark during the study period, many fibroadenomas were surgically removed, and considerable regional variations were recorded. National guidelines are needed to ensure uniform, evidence-based treatment and reduce overtreatment.

Funding: None.

Trial registration: nr. SABN 3-3013-1306/1.