Danish medical journal最新文献

Introduction: Parkinson's disease (PD) is a widespread neurodegenerative disorder characterised by wide range of symptoms. Freezing of gait (FoG), a transient feeling that the patient's feet are nailed to the floor, resulting in an inability to move, is a particularly distressful symptom. The assessment of FoG can be challenging. Often, clinicians are reliant on patients' subjective experiences and patient questionnaires such as the Freezing of Gait Questionnaire (FOGQ) and its updated version, the New FOGQ (NFOGQ).Until now, the NFOGQ has not been validated and piloted for use in Danish. Therefore, few attempts have been made to assess the prevalence and severity of FoG in Danish patients with PD.

Methods: This report describes a two-step process of adapting the NFOGQ into Danish and piloting its use among a cohort of patients with PD. A satisfactory translation (Danish NFOGQ) was produced and successfully piloted.

Results: The translation showed robust test-retest reliability after two weeks. Patients fully understood the questionnaire. Using the Danish NFOGQ in an online prevalence survey, we found that 35.7% of respondents had experienced FoG and that the prevalence correlated with disease duration.

Conclusion: The Danish NFOGQ appears to be appropriate for assessing FoG in Danish patients with PD in both clinical and research settings.

Funding: None.

Trial registration: Not relevant.

Introduction: The diagnosis and management of subacute thyroiditis (SAT) may be challenging, and more evidence on patient and disease characteristics is warranted.

Methods: This was a retrospective cohort study of all patients in the North Denmark Region with a SAT diagnosis in the Danish National Patient Registry, 2016-2018. The medical records and biochemical results prior to the diagnosis and during a two-year follow-up period were reviewed.

Results: A total of 71 patients with a SAT diagnosis were identified, and the diagnosis was verified in 44 (62.0%) cases with an incidence rate of 2.4/100,000/year. Patients with verified SAT were predominantly females (72.7%) with a median age of 50.7 years. Biochemical results showed thyrotoxicosis at the initial examination in 69.8% and elevated C-reactive protein in 86.5% of patients. Longitudinal biochemical assessment showed a biphasic response (median thyroid-stimulating hormone, initially: 0.02 mIU/l, at three months: 4.7 mIU/l and 2.4 mIU/l after two years). Treatment with non-steroidal anti-inflammatory drugs, beta-blockers and/or prednisolone was initiated in 23 of the 38 patients (60.5%) evaluated, and ten of 33 patients (30.3%) with follow-up data received thyroid hormone replacement therapy.

Conclusion: In the North Denmark Region, a hospital diagnosis of SAT was verified in less than two thirds of cases. Further large studies are warranted to extend the findings concerning the treatment and outcome of SAT.

Funding: None.

Trial registration: Not relevant.

Introduction: Weight-screening children in schools is an ingrained part of preventive health programmes worldwide. Even though there is no evidence that weight monitoring in the context of preventive health work prevents weight gain, evidence indicates that a focus on weight among children may negatively impact mental health. We aimed to review the existing literature on potential psychosocial consequences of routine weighing and weight feedback in school-aged children.

Methods: A comprehensive search was performed in four databases (PubMed, PsycINFO, Sociological Abstracts and CINAHL) and included all original studies investigating psychological or social consequences of routine weighing or weight feedback in school-aged children. Data extracted from all included studies were coded thematically and summarised considering the nature of the effect on psychosocial outcomes.

Results: Six studies were included in this review. They were heterogeneous regarding aim and study design. Negative consequences included decreased weight satisfaction, increased weight focus and frequency of peer weight talk, over sensitisation about weight and emotional distress and discomfort.

Conclusions: The literature in the field was sparse and heterogeneous. Even so, the literature indicated that routine weighing and weight feedback resulted in harmful psychosocial consequences for some children. Unfavourable effects primarily seemed to affect children with a high BMI, whereas children categorised as normal weight seemed to have mainly positive or neutral experiences.

Introduction: Ultrasound measures of subacromial structures are reliable in the hands of experienced sonographers, but it remains unknown if inexperienced clinicians can achieve a satisfactory level of interrater reliability. The aim was to investigate if standardised subacromial ultrasound measures are reliable in the hands of novice sonographers.

Methods: Two novice sonographers performed standardised ultrasound measures on patients diagnosed with subacromial pain syndrome and asymptomatic shoulders. The measures were: supraspinatus tendon thickness (SUPRA), subacromial bursa thickness (SASD), acromio-humeral distance (AHD) and dynamic impingement (DI). Reliability and agreement were evaluated by intraclass correlation coefficient (ICC (2.1)), standard error of measurement, minimal detectable change, 95% limits of agreement, Bland-Altman plots and Cohen's unweighted κ.

Results: Twenty-eight patients were recruited (28 symptomatic and 20 asymptomatic shoulders). The ICC of SUPRA ranged from 0.73 to 0.77. The ICC of SASD ranged from 0.41 to 0.88 and AHD from 0.68 to 0.72. Cohen's κ of DI in symptomatic shoulders was 0.29.

Conclusion: The interrater reliability of novice sonographers was found to be moderate to good when assessing SUPRA and AHD. For SASD and DI, the reliability ranged from poor to good. No significant differences in SUPRA and SASD thickness were found between symptomatic and asymptomatic shoulders.

Funding: None.

Trial registration: Not relevant.

Introduction: In mass casualty incidents, insufficient triage may lead to increased morbidity and mortality due to delayed evacuation and treatment of the most critically injured patients. We report current litterature findings on accuracy of primary prehospital triage systems for mass casualty incidents in full-scale live simulations and map the challenges that lie ahead for finding the most accurate triage system.

Methods: This study was registered with PROSPERO ID: CRD42018091889. We searched the databases EMBASE, MEDLINE, Central, Web of Science, Reference lists, Scopus, ClinicalTrials.gov and Google Scholar. We included primary triage systems, studies reporting accuracy or outcomes convertible to accuracy and studies performed in full-scale live simulations. We excluded studies using paediatric, chemical, biological, radiological or nuclear populations or triage systems. Bias rating was based on a modified version of the QUADAS-2.

Results: A total of 15 studies were included. Six of 41 existing triage methods were tested. The studies showed substantial heterogeneity in both study characteristics and findings. Different reference standards were applied and most were based on author-defined triage categories. All studies carried an unclear-to-high risk of bias. Therefore, no quantitative comparisons were made.

Conclusion: In general, the studies suffered from substantial heterogeneity and risk of bias. A standardised protocol for future live simulations is needed to encourage consistent and comparable data collection. We identified some of the most important topics to address in such a protocol.

Introduction: High nurse turnover at hospitals is a major societal problem. Knowledge of how to decrease the turnover rate is important. The aim of this study was to explore nurses' perception of nurse turnover and retention.

Methods: An explorative study was designed with table-top simulations involving newly graduated nurses, experienced nurses and nurse supervisors in internal medicine departments. The simulations were audio-recorded and transcribed. The participants took notes, which were transcribed. The citations were sorted into subthemes and themes by use of inductive content analysis.

Results: Fifteen workshops involving a total of 43 nurses were conducted. Four overarching themes were identified: core clinical competence, professionalism, organisation and culture. The new nurses focused on development and evaluation of core clinical competences to be able to provide safe patient care. The experienced nurses favoured influence on own work and a plan for continuous professional development. The importance of a good learning culture and of collegial and social factors was mentioned by both groups of nurses.

Conclusions: The table-top simulations with newly graduated nurses, senior nurses and nurses responsible for education provided valuable insights into the nurses´ perspectives of determinants of nurse turnover and retention in internal medicine wards.

Funding: None.

Trial registration: Not relevant.

Introduction: Patients triaged as non-urgent in the emergency department constitute a diverse group with a low mortality rate assumed to be able to wait three hours for a physician. Little is known about the causes of death of non-urgent patients who die shortly after admission. We examined whether deaths among non-urgent patients were preventable.

Method: Using data from the Copenhagen Triage Algorithm Study, we conducted a review of electronic medical records of all patients triaged as non-urgent who died within 30 days of presentation and constructed short summaries. These summaries were reviewed by two senior physicians who determined whether each death was expected or unexpected. The unexpected deaths were further assessed as unrelated or related to admission and if related as preventable or unpreventable. Any disagreements were settled by a third senior physician.

Results: Among the patients triaged as non-urgent, 335 of 14,655 (2%) died within 30 days. When comparing biomarkers and age, the non-urgent patients resembled the patients in other triage categories who died within 30 days. Most deaths were expected or not preventable (96%). The preventable deaths (n = 13, 4%) were among older patients with comorbidities. Causes of death were sudden cardiac arrest (n = 3), infection (n = 4), kidney failure (n = 1), electrolyte derangement (n = 1) and unknown (n = 4).

Conclusion: Preventable deaths among non-urgent patients were rare and no overrepresentation was observed of specialties or diseases.

Funding: Trygfonden.

Trial registration:

Clinicaltrials: gov:NCT02698319.

Introduction: The purpose of this study was to explore if and how urinary incontinence affects work capacity and work-related quality of life.

Methods: This was a cross-sectional questionnaire study using a Danish validated questionnaire. The questionnaire was distributed to Danish municipal employees.

Results: The questionnaire was completed by 3,182 municipal workers 840 of whom experience urinary incontinence, which is equivalent to 26.4% of all participating municipal employees. Among these, 18.5% worried about their urinary incontinence at work, 14.1% reported that the condition disturbed their working life in a moderate to severe degree and 22% experienced interrupted night sleep caused by urinary incontinence. Physically demanding tasks were avoided by 4.5% of the municipal employees, whereas 1.5% reported sick leave. Finally, 0.5% planned early retirement due to their urinary incontinence.

Conclusions: This study revealed a 26.4% prevalence of urinary incontinence among Danish municipal employees. We conclude that urinary incontinence affected the work-related quality of life with daily worries about accidents, odours, toilet access, fluid intake and interrupted night sleep. Furthermore, in the group reporting urinary incontinence, 1.5% had sick leave and 0.5% changed their retirement plans due to incontinence.

Funding: This project was funded by "Satspuljemidler" allocated by the Danish Health Ministry to Kontinensforeningen.

Trial registration: The project is approved by the Danish Data Agency (656336).

Introduction: Peyronie´s disease is the result of an acquired fibrotic plaque in the tunica albuginea. It remains unknown why the condition appears, but it seems to affect up to 9% of all men. It can result in a debilitating curvature of the erect penis, which has extensive impact on the quality of life for many men. Thus, the disease may result in low self-esteem, depression and impaired sexual performance.

Methods: This is a prospective pilot study investigating the feasibility and safety of stromal vascular fraction injection into the plaque of 22 men with Peyronie´s disease in the chronic phase. The stromal vascular fraction is obtained from a small liposuction of 250 ml fat in general anaesthesia and injected the same day.

Conclusion: We hope to show that injection of stromal vascular fraction is safe and effective in reducing curvature in men with Peyronie´s disease.

Funding: The study was made possible with funding from: the Region of Southern Denmark, Louis-Hansen Fund, Lizzi and Mogens Staal Fund, Karola Jørgensen Fund, Marie and Børge Kroghs Fund, the Senior Doctors Research Fund OUH, the Fund for gentle Surgery OUH and the PhD fund of the executive board of the South West Denmark Hospital. The funding sources had no influence on the trial design, data collection, analysis or publication.

Trial registration:

Clinicaltrials: gov NCT04771442, EudraCT 2020-004297-22, Danish Medicines Agency 2020090057, National Ethics Committee 74705 and Danish Data Protection Agency (record no. 1/21757).

Introduction: The epidemic increase in obesity is well documented and of intensive public health interest. Attention has almost entirely focused on a dichotomous measure of obesity such as how the prevalence of BMI ≥ 30 kg/m2 has changed over time. Less consideration has been given to how the general distribution of BMI has evolved.

Methods: We used data from the National Health and Morbidity Surveys, which are surveys of the adult Danish population (16 years or above) conducted in 1987, 2000, 2005, 2010, 2013, 2017 and 2021. Participants reported height and weight from which BMI was calculated following correction for systematic bias in self-reported data and non-response.

Results: The prevalence of obesity in Denmark increased from 6.1% in 1987 to 18.4% in 2021. A right shift in BMI distribution was observed with positive linear slopes for high and low BMI percentiles and for all socioeconomic groups, although with steeper slopes for high BMI percentiles and for short education.

Conclusions: The right shift in the distribution curve of BMI from 1987 to 2021 with gradually higher values in all BMI percentiles and in all socioeconomic strata show that the increasing obesity prevalence may, to some extent, be attributed to a generally higher BMI in the entire Danish population.

Funding: None.

Trial registration: Not relevant.