Danish medical journal最新文献

Introduction: Graves' disease (GD) is the leading cause of hyperthyroidism in women of fertile age. Register-based studies rely on diagnostic codes; this study examined the validity of diagnosed thyrotoxicosis among women of fertile age in the Danish National Hospital Register (DNHR).

Methods: All women in the North Denmark Region aged 18-45 years with a diagnosis of thyrotoxicosis (Tenth International Classification of Diseases: E05.0-05.9) in the DNHR from 2017-2018 were identified and medical records reviewed.

Results: Among 263 women included, thyrotoxicosis was confirmed in 249 cases with a positive predictive value (PPV) of 94.7% (95% confidence interval (CI): 91.2-97.1%) for the diagnostic group (E05.0-05.9). Autoimmune hypothyroidism was the leading cause of misclassification. GD was the aetiology in 150 women, resulting in a PPV for GD of 57.0% (95% CI: 50.8-63.1%) in the diagnostic group (E05.0-05.9), increasing to 83.6% (95% CI: 76.4-89.3%) when restricted to women who were prescribed an antithyroid drug (ATD). The PPV for GD was highest when the specific diagnosis (DE05.0) was considered (PPV 91.1% (95% CI: 84.7-95.5%); however, 42 women with GD (28.0%) were first given a diagnosis of unspecified thyrotoxicosis (E05.9).

Conclusions: The validity of thyrotoxicosis identified in the DNHR among women of fertile age was high. Results emphasise the importance of how subtypes of thyrotoxicosis are defined and show that the combined use of diagnoses and prescriptions of ATD is warranted to define GD.

Funding: Novo Nordisk Foundation (grant no: NNF20OC0059465).

Trial registration: Not relevant.

Introduction: Delirium is an acute and severe syndrome, commonly occurring in elderly hospitalised or terminal patients, causing cognitive and psychotic symptoms due to somatic illness or medication. This study aimed to investigate the prevalence of delirium across hospitals and nursing homes in Denmark.

Methods: This Danish cohort study, part of a global survey on March 15, 2023, examined delirium prevalence in hospitals and nursing homes. Data was collected on delirium screening practices, prevalence and staff experience.

Results: Of 69 recruited hospitals and nursing homes, 66 participated, and 63 provided complete data for analysis. Participants included 79.4% nurses and 14.3% researchers. Delirium prevalence was 13.6% at 8 a.m. (general ward 9.7%, intensive care unit (ICU) 29.7%, emergency department 40.0% and nursing home 8.9%) and 13.9% at 8 p.m. (general ward 12.0%, ICU 19.8%, emergency department 27.2% and nursing home 10.8%) on March 15, 2023. The Confusion Assessment Method (CAM) was used by 23.8% of participants, and the confusion-assessment method for the ICU (CAM-ICU) was used by 28.6% of participants and was the most frequently used screening tool.

Conclusions: On March 15, 2023, delirium prevalence in Denmark was 13.6% at 8 a.m. and 13.9% at 8 p.m. across 63 hospital departments and nursing homes. The CAM, brief CAM, and CAM-ICU were the most used assessment tools.

Funding: There was no funding allocated to this study.

Trial registration: The study was registered in the German Registry for Clinical Trials (DRKS00030002).

Introduction: Research shows that structured data use can optimise treatment in general practice clinics. This qualitative feasibility study evaluated a one-year intervention (DataSam) to assess whether increased use of population data can enhance type 2 diabetes treatment and workflows in general practice clinics.

Methods: Audio-recordings of visits from 12 clinics at baseline, six and 12 months and end-of-intervention semi-structured interviews (n = 14) explored data use, workflow changes and implementation challenges. The data analysis was inspired by qualitative content analysis.

Results: Clinics were positive about project activities and how structured data use enhanced management and patient overview while optimising treatment and prescribing practices. Most clinics experienced workflow improvements, such as nurses taking on more responsibilities and heightened staff skills, knowledge, job satisfaction and confidence in data-driven decision-making, medications and guidelines. However, approximately half of the clinics faced some implementation challenges, including technical issues and time constraints. Furthermore, some raised concerns about overtreatment, data misuse and de-prioritisation of other diagnoses.

Conclusions: DataSam emphasises the potential of population data to optimise patient care, though further attention to implementation is needed.

Funding: This study received an internal grant from Steno Diabetes. Centre Copenhagen.

Trial registration: Registered as "not required approval" with the Regional Ethics Committee of the Capital Region (F-22073139).

Introduction: Piperacillin/tazobactam (Pip/Taz) is a broad-spectrum antibiotic, often prescribed in emergency departments (EDs). Excessive use of broad-spectrum antibiotics may lead to the rise of antimicrobial resistance, a concerning health issue. We investigated physicians' adherence to regional guidelines and their considerations when prescribing Pip/Taz in the ED.

Methods: In this cross-sectional survey, a ten-item survey questionnaire was administered to ED physicians in five EDs from 10 January to 7 February 2024.

Results: A total of 261 physicians employed in the ED were invited to participate in the survey. Among these, 144 physicians completed the survey, yielding a response rate of 55.2%. Based on the results, 25% were unaware of the regional guidelines on the prescription of Pip/Taz. In addition, over the past month, 25% had prescribed Pip/Taz in situations where regional guidelines recommended a narrow-spectrum antibiotic, primarily because of concerns regarding the patient's condition (74.3%); 30.6% of those who deviated from guidelines were consultants.

Conclusions: This study found that a fourth of physicians in EDs were unaware of regional guidelines for prescribing Pip/Taz. Moreover, one in every four physicians purposely deviated from the recommended type of antibiotics, mainly because of concerns about the patient's clinical condition.

Funding: None.

Trial registration: Not relevant.

Introduction: Long COVID, characterised by persistent symptoms following COVID-19, affects about 10% of individuals recovering from SARS-CoV-2. The overlap of symptoms described in long COVID and functional somatic disorder (FSD) raises questions about shared pathophysiology. This report compares the prevalence and profiles of physical symptoms among patients with long COVID, patients with FSD and the general population.

Methods: Data from a cohort of patients with long COVID referred for diagnostics, a cohort of patients seen in a regional clinic for FSD and individuals from the general population were used. Questionnaires, including the bodily distress syndrome checklist, were used to assess physical symptoms.

Results: A total of 436 patients with long COVID, 264 patients with FSD and 9,656 individuals from the general population were included. A lower prevalence of symptoms was observed in patients with long COVID than in patients with FSD. However, the prevalence of symptoms in patients with long COVID remained higher than in the general population. In patients with long COVID, dominant symptoms were from the general symptoms (GS) cluster (concentration difficulties, fatigue, headache, memory problems) and muscle pain. Additionally, 11% met the criteria for multi-organ FSD, exhibiting a similar symptom profile to patients with FSD.

Conclusions: A total of 11% of long COVID patients had a symptom profile similar to that of patients with multi-organ FSD. GS, including fatigue and muscle pain, were common. These findings highlight the need for prospective studies to identify patients with similar symptoms, pathogenesis and treatment options.

Funding: None.

Trial registration: Not relevant.

Introduction: The Dizziness Handicap Inventory (DHI) is a widely used patient-reported outcome measure assessing the impact of dizziness on daily life. A Danish version (DHI-DK) was developed to facilitate its use in Danish-speaking populations.

Methods: The DHI was translated into Danish following standard cross-cultural adaptation procedures. The psychometric properties of the DHI-DK were evaluated in a sample of 100 patients with dizziness. Internal consistency was assessed using Cronbach's alpha, test-retest reliability with intraclass correlation coefficients (ICCs), and construct validity through correlations with the visual analogue scale (VAS).

Results: The DHI-DK demonstrated high internal consistency (Cronbach's alpha = 0.88) and excellent test-retest reliability (ICC = 0.95). A strong correlation was observed between DHI-DK and VAS scores (r = 0.60, p less-than 0.001), supporting construct validity.

Conclusions: The DHI-DK is a reliable and valid instrument for assessing the self-perceived handicap due to dizziness in Danish-speaking patients. It is suitable for use in both clinical practice and research settings.

Funding: This study received no external funding.

Trial registration: Not relevant.

Introduction: In Denmark, general practitioners are the primary providers, referring patients to specialised spine care. Re-referral may indicate unresolved spinal pain, but can also reflect inefficiencies in patient management. This study determined the rate of re-referrals to a Danish regional spine centre within 500 days of the initial visit and identified patient-specific factors associated with re-referrals.

Methods: A cohort study of patients at the Spine Centre of Southern Denmark was conducted from January 2019 to December 2023. Re-referrals were defined as visits between 50 and 500 days after the initial consultation. Factors investigated included referral diagnoses, patient-reported outcomes and clinical services initiated. Multivariable logistic regression identified associations with re-referral.

Results: Among 30,872 patients, re-referrals were observed in 10.3% (n = 3,095). Previous back surgery (OR = 1.23), pain medication (OR = 1.37), MRI referrals (OR = 1.6), provision of rehabilitation plans (OR = 1.26), extremity pain (OR = 1.02) and loneliness (OR = 1.02) were associated with increased odds of re-referrals. In contrast, non-specific spinal pain diagnosis reduced the likelihood (OR = 0.83). Model discrimination was limited (Tjur's coefficient of discrimination (D) = 0.017), indicating weak predictive performance.

Conclusions: Re-referrals were common. Certain clinical factors were associated with re-referrals to a spine centre. Still, their predictive value was limited, making it difficult to recommend strategies to reduce re-referrals from general practice.

Funding: None.

Trial registration: Not relevant.

Introduction: A prevalent approach in sepsis research is pairing obtained cultures with antibiotic treatment to identify suspected infections. However, cultures are insensitive and nonspecific. Therefore, the present study aimed to examine the proportion of patients with infections admitted to an emergency department (ED) with and without having cultures obtained and to estimate 28-day mortality and prognostic factors of mortality according to culture status.

Methods: We conducted a secondary analysis of prospectively collected data from adult ED patients with suspected or documented infections (1 October 2017 - 31 March 2018). Patients receiving both cultures and antibiotics were compared to those treated solely with antibiotics. Logistic regression analyses assessed mortality differences.

Results: Among 2,055 patients, 1,441 (70.1%) had at least one culture obtained in addition to antibiotic treatment. Among patients without cultures, 163 (26.6%) had a Sequential Organ Failure Assessment score (SOFA) ≥ 2 on admission, compared to 528 (36.6%) among patients with cultures obtained (difference: 5.7-14.3). The 28-day mortality was 7.3% and 7.7%, respectively (difference: -2.1-2.9). Age, SOFA and the Charlson Comorbidity Index were the most important prognostic factors in both groups.

Conclusions: Defining suspected infections using cultures and antibiotics may introduce bias in sepsis research. Data sources relying on these criteria should be validated to examine their applicability.

Funding: The Region Zealand Health Research Foundation and the Naestved, Slagelse and Ringsted Hospital Research Fund.

Trial registration: Not relevant.

Introduction: Biologic therapies like infliximab and vedolizumab effectively treat inflammatory bowel disease (IBD), but post-infusion observation consumes considerable clinical resources. This study evaluated whether post-infusion observation periods may be safely reduced or eliminated.

Methods: A retrospective analysis included all IBD patients receiving infliximab or vedolizumab from January 2019 to December 2020 at Sygehus Lillebaelt, Denmark. Data included infusion counts, observation duration, timing and severity of reactions.

Results: Among 380 patients receiving 3,847 infusions, 43 reactions (1.1%) occurred exclusively during infusions, mostly within the first 15 minutes. No reactions were reported after infusion had concluded.

Conclusions: Routine post-infusion observation after infliximab and vedolizumab appears unnecessary. Reducing or eliminating this practice may optimise clinical resources without compromising patient safety.

Funding: None.

Trial registration: Not relevant.

Introduction: Tinea pedis is a common disease that affects up to 70% of adults during a lifetime. Most cases are caused by Trichophyton species. Worldwide, terbinafine resistance among dermatophytes is rising, which is concerning as terbinafine is the first-line treatment. Due to concerns regarding potential epidemics, this study was conducted to investigate whether rental climbing and bowling shoes are a source of societal spread.

Methods: A sampling was conducted on 103 pairs of rental climbing shoes and 102 pairs of bowling shoes across four climbing clubs and four bowling clubs, utilising a previously published swabbing technique and culturing. Positive cultures were identified by microscopy and internal transcribed spacer sequencing. Additionally, a questionnaire was completed regarding shoe material and disinfection method.

Results: No dermatophytes were detected on any of the rental shoes. All bowling clubs and one climbing club employed fungicidal cleaning methods.

Conclusion: Rental climbing and bowling shoes are unlikely to present an immediate risk for the societal transmission of dermatophytes.

Funding: The Royal Hofbundtmager Age Bang Foundation is acknowledged for funding the laboratory work (number 9622-3439).

Trial registration: The local committee of research ethics (Region Zealand, Denmark, EMN-2021-01399) waived ethical approval.