Danish medical journal最新文献

Introduction: The use of coronary CT angiography (CCTA) is increasing in Denmark, which leads to more incidental extracardiac findings (ECF), especially lung nodules. While ECF often need further investigation, only a small percentage is ultimately confirmed to be cancer. This study investigates ECF found on CCTA and presents information about patients ultimately diagnosed with cancer.

Methods: This registry-based retrospective study included data from 1 January 2018 to 31 December 2022 from the Department of Cardiology and Endocrinology at the North Denmark Regional Hospital. The patients' personal identification numbers (CPR numbers) were used to obtain data in the electronic patient journal systems. The ECF and characteristics of the patients with cancer are presented in tables using descriptive statistics.

Results: In the study period, 2,635 patients underwent CCTA. ECF were identified in 643 patients and were predominantly lung nodules (40.9%). A total of 406 patients (63.1%) were referred for an acute lung cancer conference and/or to a control programme. Among patients who underwent CCTA (2,635), 17 (0.65%) were diagnosed with cancer.

Conclusions: ECF are common incidental findings in CCTA. However, in our study, only 0.65% of the ECF were subsequently identified as cancer.

Funding: None TRIAL REGISTRATION. The use of the data in this quality assurance study was approved by the participating hospitals and by the Data Responsible Unit of the North Denmark Region (approval No. K2023-066).

Introduction: Tramadol is an opioid analgesic used to treat moderately severe pain. Overuse and recreational use of tramadol may cause seizures, but the extent of this problem remains unclear. This study evaluates admissions with tramadol-induced seizures (TIS) among young adults admitted to the emergency department (ED).

Methods: A cross-sectional study was conducted on all patients aged 15-30 years with a seizure diagnosis admitted to the ED at Aarhus University Hospital from 1 January 2021 to 31 December 2022. Data were retrieved from a retrospective medical records review.

Results: We identified 232 unique patients with 352 seizure admissions; 41 patients (17.7%) (38 male (92%)) with 62 admissions secondary to TIS. The mean (± standard deviation) age of persons with TIS was 20.34 years (± 3.19) compared to 21.88 years (± 4.45) for those with other seizure aetiologies (p = 0.00947). The median tramadol dose was 200 mg (range: 50-1,200 mg, IQR: 50-300 mg). A subgroup of 12 patients accounted for 33/62 (53%) of total TIS admissions. Concomitant cannabis use was common and was reported in 40% of TIS admissions. Among the 62 TIS admissions, only two patients had a prescription for tramadol. The mean time spent in the ED was 5.74 hours (± 5.12). A CT of the brain was performed in 33/62 (53%) of TIS admissions. A total of 31 ambulatory follow-up neurological evaluations were conducted.

Conclusions: Tramadol is a frequent cause of seizures among young adults admitted to the ED. Targeted interventions to reduce recreational use among young adults are urgently needed.

Funding: None.

Trial registration: Not relevant.

Introduction: It is standard clinical practice to postpone frozen embryo transfer (FET) for at least one menstrual cycle after a failed fresh embryo transfer or a freeze-all cycle. Delaying FET has been hypothesised to minimise the negative effect of controlled ovarian stimulation. However, this practice may be associated with increased psychological distress and delayed time to pregnancy. In this clinical study, we aim to investigate whether immediate SC- or PC-FET is non-inferior to postponed SC- and PC-FET in terms of live birth rate (LBR).

Methods: The study is designed as a multicentre, randomised controlled, non-blinded, non-inferiority trial. A total of 484 women aged 18-45 years who are set to undergo SC- or PC-FET will be included in the trial. Participants will be randomised 1:1 to FET in the first cycle after a failed fresh transfer or freeze all (FET immediate) or to FET in a subsequent cycle (FET postponed). The main outcome will be LBR.

Conclusions: If immediate FET proves to be as efficient and safe as postponed FET, immediate FET offers various advantages, such as a shorter time to pregnancy for couples who did not conceive in the fresh cycle and lower expenses due to a shorter freezing time.

Funding: This work was supported by a research grant from Merck Denmark. Merck Denmark was in no way involved in the design of the study and will not be involved in the analysis or interpretation of results.

Trial registration:

Clinicaltrials: gov (NCT06304792).

Introduction: It would be advantageous if patients could self-report ankle range of motion (ROM). This study aimed to develop the Copenhagen Ankle Range of Motion Scale (CARS).

Methods: After input from healthcare professionals and patients, a pictorial questionnaire was developed to report ankle dorsiflexion with a straight knee and a flexed knee and ankle plantiflexion. CARS outcomes were compared to goniometer measurements made by a nurse and a doctor. Reliability, interclass correlation coefficients (ICC), agreements and correlations were calculated.

Results: A total of 102 patients were enrolled. ICCs for goniometer measurements by a nurse and a doctor were 0.66-0.77. There was good agreement between the pictorial choices made by doctors and nurses, with a weighted kappa between 0.63 and 0.71. Agreement between CARS measures and the mean of goniometer measures by the two observers showed a weighted kappa of 0.32-0.5, and Pearson correlation coefficients between patient selections and the mean goniometer measurement were 0.53-0.56.

Conclusions: CARS can be used to obtain an indication of ankle ROM without the patient's physical attendance and can standardise estimates of ankle ROM in clinical practice. It was not possible to calculate the tool's sensitivity, specificity and positive/negative predictive values. Further development with patient involvement may improve the validity of CARS version 2.0.

Funding: None.

Trial registration: Not relevant.

Introduction: We aimed to investigate the prevalence of opioid and benzodiazepine use among Danish youths aged 13-26 years, and to document their knowledge of opioids, benzodiazepines and overdose prevention.

Methods: An anonymous questionnaire was distributed via email and posters at youth educational institutions, and via social media. From September 2023 to April 2024, a total of 1,222 responses were collected.

Results: In the present study, most adolescents and young adults knew of opioids and benzodiazepines (90.7% and 71.8%, respectively). Approximately one out of four had used one or the other at least once (opioids: 24.4%, benzodiazepines: 24.6%). One third of respondents with prior opioid use had their debut age using opioids between 16-18 (32.9%), and one third at an even younger age (32.6%). Only 7.1% reported gaining access to opioids through a doctor. Nearly one in four of the respondents had witnessed someone overdose (24.9%). However, less than half (41.2%) knew of the antidote that prevents opioid overdoses.

Conclusions: Although our results may be restricted to certain Danish youth groups, knowledge and use of highly addictive substances appear widespread. Among our respondents, nearly one out of four reported prior use of opioids and benzodiazepines. The majority had their debut age using opioids at a young age, between 16 and 18 years or younger. Less than half knew of the antidote that can reverse an opioid overdose.

Funding: Antidote Danmark.

Trial registration: This study was a voluntary survey and, in accordance with Danish legislation, did not require ethical approval.

Introduction: In recent years, outpatient surgical treatment for ankle fractures has been introduced for selected fracture types and patients with a low degree of comorbidity. Limited evidence is available to guide the choice between inpatient and outpatient care for ankle fractures. This randomised controlled trial aims to investigate the effect of inpatient versus outpatient surgery of ankle fractures on patient-reported outcomes at 12 weeks.

Methods: This study is a single-centre non-inferiority randomised controlled trial investigating outpatient care for surgically treated ankle fractures. A total of 86 patients will be included in the study and randomised 1:1 to either outpatient or inpatient care. The primary outcome is the Foot and Ankle Outcome Score at three months after surgery. Secondary outcomes will include patient satisfaction, pain, physical function and adverse events.

Conclusions: Conducting a randomised controlled trial investigating inpatient versus outpatient surgery for ankle fractures on both patient-reported outcomes, patient satisfaction, adverse events, pain, function and bone healing will provide evidence to guide future recommendations in the planning of surgical treatment for ankle fractures.

Funding: The study is partially funded by Helsefonden and the North Denmark Region.

Trial registration: The study was pre-registered on Clinicaltrials.gov ID: NCT05389436, 20 May 2022.

Introduction: Patients on warfarin are normally required to interrupt treatment for a fixed number of days prior to an invasive procedure. This study aimed to investigate the potential influence of the warfarin maintenance dose and the initial international normalised ratio (INR) level on the duration of the break required to achieve the planned target INR.

Methods: A total of 120 patients on self-managed warfarin treatment measured INR once daily for five days before the intervention and were guided by the anticoagulation clinic on when to discontinue warfarin. Depending on the bleeding risk of the planned intervention, the target INR on the day of the intervention was ≤ 1.4, ≤ 2.5 or ≤ 3.0.

Results: From day 1 to day 5 after interruption of warfarin, the INR ratio (INRdayX/INRday0) decreased exponentially, with wide interpatient variation in the rate of decrease. Patients with a maintenance warfarin dose less-than 25 mg/week decreased significantly less in INR during the first day after stopping warfarin than patients who received a higher maintenance dose (9% vs 15%; p less-than 0.04). The INR half-life after day 1 was 113 hours for patients receiving less-than 25 mg/week and 101 hours for patients receiving ≥ 25 mg/week.

Conclusions: The duration of pre-interventional discontinuation of warfarin can be individualised by knowing the maintenance dose, baseline INR and target INR for the planned procedure.

Funding: None.

Trial registration: Quality assessment study approved by the legal department of the Capital Region of Denmark. Approval number: p-2024-15914.

Introduction: The slim and muscular body ideals are well-established, and adolescence is a phase sensitive to developing negative body image. This study aimed to identify the BMI at which most adolescents 1) perceive themselves as being the right size and 2) experience high body satisfaction.

Methods: Data from the Danish National Youth Study included 64,451 adolescents aged 15-19 years. Multilevel logistic regression using restricted cubic splines modelled associations between BMI, body size perception and body satisfaction.

Results: The highest ORs for perceiving oneself as "about right size" and experiencing high body satisfaction were at BMIs of 19.0 kg/m2 and 15.9 kg/m2 in females, corresponding to the 21st and second percentiles of the BMI distribution. In males, the highest ORs were at BMIs of 22.2 kg/m2 and 21.9 kg/m2, near the male median of 21.6 kg/m2. Significant variations in ORs for both body size perception and body satisfaction were observed across the entire BMI range, even within the healthy weight range of 18.5-24.9 kg/m2.

Conclusions: Among females, the perception of being "about right size" and experiencing high body satisfaction was most prevalent at BMIs well below the median, whereas for males, these perceptions were most common around the median. These findings strongly confirm that gender-specific body ideals are highly internalized, placing many adolescents at risk of developing a negative body image. TRIAL REGISTRATION not relevant.

Funding: This work was supported by Centre for Childhood Health, Denmark (ID: 2024_F_001).

Introduction: Multimorbidity and polypharmacy present significant challenges for the healthcare system. In Denmark, general practitioners (GPs) play a key role in coordinating patient care, while also relying on specialist support for complex cases. This study reports on the development and implementation of the Telepharmacological Outpatient Clinic (TPOC) (Danish: Telefarmakologisk Ambulatorium), a virtual cross-sectional polypharmacy counselling service.

Methods: The intervention was developed adopting an interdisciplinary approach. The service provided virtual consultations to GPs in the Region of Southern Denmark, offering multidisciplinary specialist counselling for patients with polypharmacy. The process included referral, medication review, video conference and follow-up. Data were collected on referrals, demographics and service utilisation.

Results: A total of 364 patients (median age 74 years, 61.0% female) were referred to the TPOC from March 2019 to February 2024. Referrals increased from a median of 3.5 per month in 2019-2020 to nine per month in 2023-2024. GPs from 21 of 22 municipalities referred patients. The service was well received by GPs and recognised by national authorities as a valuable model for managing multimorbidity.

Conclusions: The TPOC was shown to be a successful model for providing specialist support to GPs. Its growing utilisation and positive reception indicate relevance in addressing multimorbidity and polypharmacy challenges.

Funding: The TPOC is funded by the Region of Southern Denmark.

Trial registration: Not relevant.

Introduction: Early rehabilitation is recommended after cardiac surgery to enhance recovery. However, due to precautions of sternum healing, the initiation of cardiac rehabilitation is often postponed for 6-8 weeks after surgery, leaving patients to face physical and emotional barriers on their own. This study aims to investigate whether early remote cardiac rehabilitation can enhance physical function and reduce the emotional challenges that older patients face after discharge.

Methods: In this bi-entre, randomised controlled trial, 120 patients older than 65 years of age undergoing open heart surgery are assigned to individualised exercise training and step counting supported by a mobile health app and weekly calls with a physiotherapist as an adjunct to standard care (intervention group), or standard care alone (control group) for six weeks after discharge. Outcomes are assessed at baseline, a six-week follow-up and a six-month follow-up. The primary outcome is change in the 30-second Chair Stand Test. Secondary outcomes include health-related quality of life, cost-effectiveness and prevalence of sarcopenia.

Conclusions: This trial will determine if early remote rehabilitation after cardiac surgery can accelerate recovery and alleviate emotional distress, advocating for early post-discharge interventions through digitally delivered care.

Funding: This trial is supported by external funds: the Novo Nordisk Foundation, the Health Foundation and the Eva and Henry Frænkels Memorial Fund.

Trial registration:

Clinicaltrials: gov NCT06370611.