Danish medical journal最新文献

Introduction: In various countries, an increasing proportion of general practitioner (GP) referrals is returned by hospitals. We aimed to uncover the causes and consequences of referral returns from the perspective of GP liaisons.

Methods: Individual interviews with 20 GP liaison officers from various departments in Southern Denmark, serving 1.2 million citizens, were analysed using systematic text condensation.

Results: The collaboration between general practice and hospital departments was generally viewed as both effective and constructive. Well-argued returns include relevant advice on how to manage the patient and enhance the capabilities of general practice. In contrast, poorly motivated returns harm collaboration and lead to mistrust between GPs, hospitals and patients. Patients with an unclear diagnosis, multimorbidity or social problems do not fit into standard patient pathways, and their referrals are returned more frequently. They may face prolonged diagnostic processes and receive a lower quality of treatment, contributing to health inequalities and the risk of delayed diagnosis or treatment. Furthermore, the return of referrals transfers tasks to general practice.

Conclusions: Facilitating dialogue-based collaboration between primary and secondary care may improve patient care. However, referral returns may pose risks, particularly for frail or complex patients, and could potentially complicate the collaboration between GPs and hospitals. The underlying reasons and consequences of referral returns are diverse.

Funding: Funded by the Quality Improvement Committee Southern Denmark. RIO/SDU 12.228.

Trial registration: Not relevant.

Introduction: Reverse total shoulder arthroplasty is a well-established treatment for patients with rotator cuff tear arthropathy. The outcome after reverse total shoulder arthroplasty has been investigated in several studies and national registries. However, the treatment has not been compared to non-surgical treatment. The primary aim of this trial is to investigate whether reverse total shoulder arthroplasty is superior to exercise in patients with rotator cuff tear arthropathy who are eligible for reverse total shoulder arthroplasty.

Methods: In this Nordic multicentre, randomised, controlled clinical trial, 102 patients with rotator cuff tear arthropathy who are eligible for reverse total shoulder arthroplasty will be allocated (1:1) to either reverse total shoulder arthroplasty followed by usual care or to an exercise intervention. The exercise intervention comprises 12 weeks of exercise with one weekly physiotherapist-supervised session and two home-based exercises. The primary outcome is the total Western Ontario Osteoarthritis of the Shoulder index score at a 12-month follow-up.

Conclusions: The ongoing randomised controlled trial will provide insights into treatment decisions for patients with rotator cuff tear arthropathy.

Funding: This study is funded by Aarhus University, the Health Research Foundation of the Central Denmark Region, the Danish Rheumatism Association, the Association of Danish Physiotherapists, the Health Foundation (Helsefonden), the Hartmann's Foundation and the Emil Hertz Foundation in Denmark.

Trial registration:

Clinicaltrials: gov ID: NCT04864158.

Introduction: A no-biopsy approach has been suggested for diagnosing coeliac disease (CD) in adult patients. This approach is already well established in diagnosing children with CD. This study aimed to evaluate the accuracy of IgA anti-tissue transglutaminase (IgA anti-tTG) in predicting duodenal mucosal lesions diagnostic of CD in adult patients.

Methods: We included all patients aged ≥ 18 years referred for CD diagnostics at our department in the period from 1 January 2019 to 31 December 2023 with raised IgA anti-tTG levels and in whom duodenal biopsies had been evaluated for CD-specific lesions. Data regarding IgA anti-tTG levels and duodenal histology evaluated by the modified Marsh classification were retrieved from the patient records.

Results: A total of 235 adult patients had positive IgA anti-tTG levels and an available duodenal histology. High IgA anti-tTG levels (> 10 × upper limit of normal (ULN)) were associated with more severe enteropathy. The PPV of IgA anti-tTG for identifying Marsh ≥ 2 or 3 lesions increased when the serological cut-off was raised. The positive predictive value of IgA anti-tTG > 10 × ULN was 99.2% (95% CI: 95.8-100%) and 97.7% (95% CI: 93.4-99.5%) for predicting Marsh ≥ 2 and 3 lesions, respectively.

Conclusions: This study confirms that high titers of IgA anti-tTG may accurately identify adults with diagnostic duodenal mucosal lesions associated with CD. Our data support the use of a no-biopsy approach for diagnosing CD in adults with high IgA anti-tTG titers.

Funding: None.

Trial registration: Not relevant.

People with severe mental illness die 10-20 years earlier than the general population, mostly from preventable physical diseases. Fragmented care, under-screening and undertreatment of cardiovascular, respiratory, infectious and cancer conditions widen this gap. Embedding physical screening, proactive treatment, smoking cessation, cancer checks and multidisciplinary, person-centred care into psychiatric services could close this mortality divide.

Introduction: People with rheumatic and musculoskeletal diseases are advised to do aerobic exercise for symptom relief and to reduce the risk of cardiovascular disease. Continuous exercise at an intensity causing a rate of perceived exertion of 15, on a 6-20-point Borg scale, exemplifies such exercise. Also, the instruction "Now you need to increase your heart rate" is used before aerobic exercise. However, the exercise intensity caused by that instruction is unknown. We tested the hypothesis that intensity during cycling, initiated with the instruction "Now you need to increase your heart rate", is lower than when targeting a Borg scale score of 15.

Methods: Participants (n = 15) with various types of rheumatic and musculoskeletal diseases cycled at a self-selected power output. Subsequently, we determined the relationship between Borg scale score and exercise intensity (heart rate and power output), including intensity at a target score of 15. Additionally, intensity was measured during 20 minutes of cycling exercise executed after the instruction "Now you need…".

Results: Power output and percentage of maximal heart rate were 89 (± 40) W and 86% (± 9%), respectively, at a Borg scale score of 15, whereas values were 81 (± 33) W and 81% (± 7%) during the instructed cycling exercise (p less-than 0.05).

Conclusions: Intensity, in the form of power output and percentage of maximal heart rate, during cycling exercise, initiated with the instruction "Now you need to increase your heart rate", was 8 W and 5 percentage points lower, respectively, than during cycling targeting a Borg scale score of 15.

Funding: None.

Trial registration: Not relevant.

Introduction: Erysipelas is a common disease in the emergency department, whereas necrotising soft tissue infections (NSTIs) are rare but more severe. The study aimed to investigate the prevalence, incidence, population-based incidence rate, one-year mortality and clinical presentation of erysipelas and NSTIs, and the aetiology, treatment and recurrence of erysipelas.

Methods: This was a population-based cohort study including acute non-trauma patients ≥ 18 years old with erysipelas or NSTIs from the Region of Southern Denmark in the period from 1 January 2016 to 19 March 2018.

Results: Among 223,618 acute non-trauma visits, 2,136 had erysipelas (prevalence 1%), and 20 had NSTIs (prevalence 0.01%), 96.7 and 0.89 per 10,000 visits, respectively. The population-based incidence rates were 72.10 per 100,000 person-years for incident cases of erysipelas and 0.94 for NSTIs. One-year mortality was 15% for erysipelas and 25% for NSTIs. Erysipelas and NSTI patients had similar demographics and vital signs. For erysipelas, the predominant pathogen in blood cultures was Streptococcus dysgalactiae, with two-thirds of patients treated with narrow-spectrum penicillin. One-third of the erysipelas patients had a prior hospitalisation for the condition, and 7.7% of incident cases had recurrence within one year. Obesity and liver disease were risk factors for recurrence.

Conclusions: Erysipelas is a common infection in the emergency department, whereas NSTIs are much rarer but also more severe and, at presentation, not distinctive in clinical parameters, which underlines the importance of clinical judgement.

Funding: None.

Trial registration: Not relevant.

Introduction: Cardiac amyloidosis is an underdiagnosed disease, and its prevalence is probably higher than previously estimated. We aimed to investigate the effect of introducing a systemic diagnostic algorithm for cardiac amyloidosis in clinical practice.

Methods: A systematic diagnostic algorithm was developed and clinically applied in two hospitals in Eastern Denmark. Elderly patients (males > 60 years, females > 70 years) with left ventricular hypertrophy (≥ 12 mm) and diastolic dysfunction leading to a suspicion of cardiac amyloidosis were referred for standardised workup, including biochemistry and bone scintigraphy.

Results: A total of 224 patients (median age 76 years (70-83); 65% males) were included in the analysis. In total, 43 (19%) patients (84% males) were diagnosed with cardiac amyloidosis. Among the 43 diagnosed patients, 38 had transthyretin wild-type amyloidosis, one had the hereditary form and four had monoclonal-immunoglobulin-light-chain amyloidosis. Patients with cardiac amyloidosis were significantly older (81 versus 75 years old, p less-than 0.001) and more often male (84% versus 61%, p = 0.004) than the overall screened population.

Conclusions: Systematic screening for cardiac amyloidosis in older patients with cardiac hypertrophy and echocardiographic signs of diastolic dysfunction is feasible and shows a diagnostic yield of 19% in the assessed population.

Funding: None.

Trial registration: Not relevant.

Introduction: Long-term cardiac monitoring has become more accessible with the advent of consumer-oriented wearable devices. Smartwatches (SWs) hold promise for extended rhythm monitoring owing to their availability and direct electronic health record (EHR) integration. We studied the clinical consequences of SW implementation in patients with palpitations.

Methods: Patients referred for palpitations or with inconclusive diagnostics were issued a SW for up to three months. They were instructed to take an SW-electrocardiogram (ECG) during symptoms and transfer it to the EHR. A cardiologist interpreted the ECGs, diagnosed the patient and initiated relevant clinical actions.

Results: We included 50 patients with a median age of 57 years (IQR: 45-64), 56% women. The following ECG diagnoses were made: 20 (40%) had sinus rhythm, six (12%) had extrasystoles and 24 (48%) had clinically relevant arrhythmias. Consequently, 25 (50%) completed their arrhythmia evaluation, whereas clinical actions were taken in 25 (50%). Notably, more than 20% underwent an electrophysiology study and ablation. Patients found the SW to be user-friendly with minimal impact on their daily life.

Conclusions: SW use for symptom-based diagnosis had a high yield for both arrhythmia detection and completion of arrhythmia evaluation. Additional studies are needed to determine if SWs may replace traditional ECG monitoring.

Funding: The project was funded by internal funds at the Department of Cardiology, Herlev and Gentofte University Hospital (HGH), Denmark.

Trial registration: As a quality assurance project, no ethical board approval was needed under Danish law. The study was approved by the HGH directors.

Introduction: National data has the potential to advance future research and drive quality improvements for patients with major lower-extremity amputations (MLEA). This study aimed to evaluate the implementation of the Danish Amputation Database (DanAmp) by investigating data completeness and validity.

Methods: Demographic, surgical and post-surgery data were collected during hospital admission. After implementation at three departments, completeness and validity were evaluated from 1 February to 1 June 2024. Completeness was evaluated by comparing the number of surgical procedures in the hospital's electronic system with registrations in DanAmp. Data validity was evaluated by an audit of up to 15 consecutive patient records per department. The percentage agreement was calculated (agreement (n)/total possible numbers (N)). Variables with an agreement exceeding 90% were considered satisfactory.

Results: A total of 68 procedures were registered in DanAmp across the three departments, and 71 procedures were registered in the hospital's electronic system, corresponding to 96% completeness for all types of procedures. A total of 43 patient records were audited, revealing that 29 of 35 variables had a satisfactory validity exceeding 90% agreement.

Conclusions: This study demonstrated a high completeness and satisfactory validity of data from three orthopaedic departments, underscoring DanAmp's potential in driving research and quality improvements for MLEA.

Funding: The project is funded by the Region Zealand and Region of Southern Denmark Research Fund (2022) and the Independent Research Fund Denmark (DFF), grant ID: 10.46540/3165-00053B (2023).

Trial registration: Not relevant.

Introduction: Retrograde cricopharyngeal dysfunction (R-CPD) is the inability to belch due to impaired upper oesophageal sphincter relaxation. Botulinum toxin A injection shows promise, but standardised protocols are lacking.

Objective: To evaluate the effect of botulinum toxin A for R-CPD in a Danish population.

Methods: A retrospective case series study at Aarhus University Hospital included R-CPD patients treated from January 2021 to December 2024. The diagnosis was clinical, supported by otorhinolaryngological examination, modified barium swallow and oesophagoscopy. Under general anaesthesia, all patients received 50 IU of botulinum toxin A into the cricopharyngeal muscle. Symptom relief and adverse effects were assessed at follow-ups performed at two weeks and three months. Statistical analysis with Fisher's exact test compared treatment responses in patients aged 18-25 years versus those over 25 years.

Results: Among 40 patients (22 males, 18 females, mean age 27.5 years), 35 experienced symptom relief within two weeks. Long-term follow-up (31 patients) showed that 18 continued to belch after three months. Thirteen patients required additional treatments with botulinum toxin A doses increased to 75-100 IU, 24 achieved satisfactory results, while nine await further procedures.

Conclusions: Botulinum toxin A is a safe, effective R-CPD treatment with minor side effects (transient dysphagia, mild sore throat, sour eructation) and no vocal fold or respiratory complications. Over half of the patients improved after 50 IU treatment, whereas one-third required dose escalation, suggesting that 100 IU may enhance outcomes.

Funding: None.

Trial registration: Not relevant.