Danish medical journal最新文献

Introduction: To combat ethnic inequalities in health, medical students should be prepared to treat all patients. Denmark has become an increasingly diverse society and therefore needs a medical curriculum that reflects the change in population composition. This study aimed to assess if the dermatology curriculum in Denmark prepared medical students to diagnose dermatological diseases in patients with skin of colour (SoC).

Methods: From 20 September to 12 October 2022, a survey was distributed to medical students and junior doctors who had completed the dermatology curriculum at one of the medical schools in Denmark between 2010-2022. The participants were recruited mainly via Facebook. The statistical data were analysed in STATA, and free-text responses were analysed using thematic analysis.

Results: A total of 592 medical students (n = 285) and junior doctors (n = 307) completed the survey. In SoC, 43.9% and 32.6% felt confident to a poor or very poor degree in diagnosing dermatological diseases versus 5.9% and 2.5% in white skin. Among others, the respondents suggested to increase visual examples in the curriculum and integrate SoC in exams to increase their confidence level when diagnosing in SoC.

Conclusion: Danish medical students and junior doctors are significantly less confident when diagnosing dermatological diseases in SoC than in white skin. Revision of the dermatology curriculum is needed to increase the students' confidence level and knowledge of SoC to prepare them to treat all patients, ultimately reducing ethnic inequalities in health.

Funding: None.

Trial registration: Not relevant.

Introduction: Development in infancy and early childhood affects mental and physical health later in life. Maternal mental health and attachment between mother and child are important for a healthy development. This qualitative study explored first-time mothers' experiences with a web-based intervention aimed at improving maternal mentalisation skills and mental health, thereby affecting child development.

Methods: Twelve first-time mothers were interviewed about their experiences using the website.

Results: During pregnancy, the mothers were positive towards using the web-intervention to find information and support for emotional challenges related to the transition to motherhood. However, the interest decreased after giving birth. The mothers requested a website that covered both physical and mental aspects of motherhood and provided a possibility for mothers to exchange experiences to normalise challenges. Moreover, they wanted the website to be easily accessible on a smartphone.

Conclusion: First-time mothers experienced a need for emotional support during their transition to motherhood and were positive towards using online solutions to obtain this support. In order to be integrated into mothers' everyday life, the intervention should be an 'all-in-one' solution, covering both physical and mental aspects of motherhood and infancy, include a chat forum and be easily accessible by smartphone app.

Funding: TRYG Foundation and KEU, Capital Region of Denmark.

Trial registration: Not relevant.

Introduction: Groin hernias in adolescents are rare and their management is associated with challenges for surgeons as some adolescents are fully grown, whereas others are not. Current groin hernia guidelines only differentiate between young children and adults; hence, no guidelines exist that may aid surgeons in handling adolescents. The aim of this study was to explore surgeons' considerations on the management of groin hernias in adolescents.

Methods: We conducted a qualitative study using pilot-tested individual semi-structured interviews. The participants were surgical specialists with experience in groin hernia repair in adolescents aged 10-17 years. Data were analysed using content analysis where essential quotes were extracted from transcripts and coded, categorised and interpreted into themes.

Results: Sixteen surgeons were included. Their considerations were reflected in four themes: 1) mesh-related concerns, 2) watchful waiting, 3) growth and 4) lack of evidence and guidelines. Surgeons performed sutured repairs on adolescents who are still growing due to concerns about mesh-related complications. A watchful waiting strategy was used by some to postpone surgery until adolescents were fully grown, thereby enabling mesh repair. Methods for evaluating growth varied and were not standardised. Finally, surgeons highlighted the need for evidence and guidelines to support their decision-making.

Conclusions: This study found a lack of consensus and uniformity on the management of groin hernias in adolescents. Increased research efforts producing clinical guidelines are needed.

Funding: This study was funded by the Michaelsen Foundation, the Aage and Johanne Louis-Hansens Foundation, Direktør Emil C. Hertz and Hustru Inger Hertz' Foundation, and the Torben and Alice Frimodts Foundation. The funders had no role in the design, conduct or reporting of the study.

Trial registration: not relevant.

Introduction: Age-related macular degeneration (AMD) causes approximately 9% of all blindness worldwide. The introduction of optical coherence tomography angiography (OCT-A) has revealed a potential for non-invasive diagnosis of neovascular AMD (nAMD), but has yet to be proven an accurate method for nAMD diagnosis. The purpose of this study was to map the clinical use of OCT-A in nAMD diagnosis and to investigate the agreement between two consultants in diagnosing nAMD.

Methods: A survey was administered to assess Danish ophthalmologists in nAMD diagnostic modalities. Furthermore, a prospective observational cohort study was conducted in which two consultants graded Triton and Heidelberg OCT-A in patients with suspected nAMD.

Results: A total of 21 ophthalmologists completed the survey. OCT-A combined with structural OCT was the first choice for the majority (81%), whereas dye-based ophthalmic angiography was used when in doubt of the diagnosis. OCT-A was used to guide treatment decisions in 64% of patients. Some ophthalmologists (48%) had no formal OCT-A training. In the second part of the study, an agreement was recorded between the two consultants in 86% of the cases with Triton OCT-A and 66% with Heidelberg OCT-A.

Conclusions: OCT-A with structural OCT has become a primary diagnostic method of nAMD, but national guidelines are lacking. Future implementation of new diagnostic technology of nAMD should include trial-based guidelines and physician training.

Funding: None.

Trial registration: Not relevant.

Introduction: About 10% of hospital inpatients are labelled with penicillin allergy in their electronic medical record (EMR). However, allergy is confirmed in less than 10% of these records. Consequently, 90% of patients are treated with broad-spectrum antibiotics, contributing to antimicrobial resistance. We aimed to explore experiences and practices of healthcare professionals that may explain incorrect labelling of penicillin allergy in Denmark and elucidate any consequences hereof.

Methods: An electronic survey was distributed to physicians and nurses in six hospital units in Copenhagen and via social media. The survey was active from 19 March to 1 May 2020. Data were assessed using descriptive statistics and by thematic analysis.

Results: The response rate was 44.6%. The survey had 369 participants; 152 physicians and 217 nurses. Half of the physicians and one in every five nurses had experienced problems treating patients with a penicillin allergy label. Physicians reported limited trust in allergy labels, and labelling practices varied. The risk that patients may be truly allergic was the main reason for not removing labels (72%), and a precautionary principle was identified related to penicillin allergy labelling.

Conclusions: The penicillin allergy label is an independent factor of medication errors. Solutions to enhance patient safety may include education of physicians in allergy labelling, decision support, standardisation of the allergy registration in the various EMR systems used, and ideally also a national drug allergy register, which is accessible from all sectors.

Funding: None.

Trial registration: Not relevant.

Introduction: In the US, opioids are commonly prescribed after arthroscopic knee surgery. We aimed to investigate opioid dispensing in relation to arthroscopic knee surgeries from 2006 to 2018 in Denmark.

Methods: In Danish registries, we identified patients (≥ 15 years old) having arthroscopic knee surgery (anterior cruciate ligament (ACL) reconstruction; meniscal surgery; cartilage resection; synovectomy and diagnostic arthroscopy) between 1 January 2006 and 31 December 2018 and opioid dispensing (oral morphine equivalents (OMEQ)) within seven days after discharge from surgery.

Results: Among 218,940 patients, 15,263 (7%) had an opioid dispensed within seven days after being discharged following surgery. The opioid dispensing incidence (per 1,000 persons/year) increased during the study period for all procedures. This trend was more pronounced for ACL reconstruction, which recorded an increase from 86 (95% confidence interval (CI): 75-99) in 2006 to 278 (95% CI: 255-301) in 2018, corresponding to 9% and 28% of ACL patients, respectively. In the same period, the average amount of opioids dispensed within the first seven days after discharge decreased (change: 70.0 OMEQ (95% CI: 12.4-127.5)). Tramadol and oxycodone were the most commonly dispensed opioids.

Conclusion: About 7% of patients had an opioid dispensed within the first seven days after discharge following arthroscopic knee surgery. The incidence of opioids dispensed increased for all investigated procedures from 2006 to 2018. In the same period, the average amount of opioids dispensed within the first seven days after discharge decreased.

Funding: None.

Trial registration: Not relevant.

Introduction: Patients with scabies are often misdiagnosed before being attended by a dermatologist. The aim of this study was to use a smartphone app to screen individuals from the general population with scabies symptoms.

Methods: Subjects who suspected that they had scabies were recruited online and downloaded a app tailored for this study. A questionnaire on symptoms was completed and photos of the skin were uploaded from within the app. Two physicians, a board-certified dermatologist and a resident dermatologist, evaluated the requests by categorising the scabies risk of each case, and categorisation triggered an auto-generated response describing the level of scabies and letting the participant know whether to contact a general practitioner or not.

Results: Within 15 days of advertisement, 228 requests were sent (71% women); mean age 24 years (standard deviation: ± 10.0). Itch was experienced by 90% (n = 208) and rash by 76% (n = 174). The rash was distributed bilaterally in 79% (n = 138). The areas of rash localisation were: arms (63%), hands (56%), legs (55%), abdomen (52%), inner thigh (45%), chest (26%), genitals (24%), head and neck (17%) and axilla (16%). 5% of all cases evaluated by either the senior or junior physician were evaluated as having a high risk of scabies.

Conclusion: In a very short time, the app received a high number of requests from individuals worrying about scabies; 5% of the incoming requests were categorised as carrying a high risk of having scabies. Mobile apps are a helpful tool to screen for scabies in primary care settings.

Funding: Omhu A/S.

Trial registration: Not relevant.

Introduction: The Danish Medicines Council recommends that patients with estrogen receptor and human epidermal growth factor receptor 2-negative, programmed death-ligand 1 (PD-L1)-positive advanced breast cancer receive atezolizumab in combination with nab-paclitaxel. The approval was largely based on results from Impassion130 that showed a beneficial progression-free survival (PFS) and overall survival (OS) in PD-L1-positive patients who received atezolizumab and nab-paclitaxel.

Methods: We conducted a retrospective, population-based study that included patients who received atezolizumab for advanced breast cancer from October 2019 to September 2022. The primary endpoints were PFS and OS.

Results: This study included 74 advanced breast cancer patients. Their median age was 54.5 years, and 21 (28.4%) of the patients had de novo advanced disease. Most patients received first-line treatment with atezolizumab (83.8%). The median PFS was 6.0 months (95% confidence interval (CI): 4.7-8.4 months) and the median OS was 14.3 months (95% CI: 9.9-22.2 months). A total of 48 patients received atezolizumab and nab-paclitaxel in accordance with guidelines from the Danish Medicines Council.

Conclusions: This real-world study expectedly showed numerically lower survival outcomes than the phase III trial Impassion130, but met the standards of efficacy set by real-world studies in other countries. A need exists for increased attention to the criteria for receiving atezolizumab.

Funding: none.

Trial registration: The study was approved by the Oncological Committee of the DBCG, the Research Overview of the Capital (P-2022-828) and the Centre for Health of the Capital Region (R-22060674).

Introduction: In many emergency departments (ED), specialised teams are activated to take care of medical emergency patients (MEP). The aim of this study was to describe the organisation of the management of adult MEPs in Danish EDs. The study examined trigger team activation criteria, training and composition of trigger teams.

Methods: This was a cross-sectional descriptive study. A questionnaire was sent to the head of department and head nurse at each Danish ED. They recruited eligible personnel to answer the questionnaire. Data were obtained between 1 October and 15 December 2021.

Results: We included 23 hospitals and 19 responded (82.6%). Most EDs had a trigger call for MEP (89.5%). In 70.6% of the EDs, trigger calls for MEP were activated > 300 times annually. All EDs used red triage (Danish Emergency Process Triage) as activation criteria for MEP calls. Most respondents received simulation training (82.4%). All respondents felt adequately educated to manage MEP. The MEP trigger teams varied from three to 11 members with great variation with respect to team leaders.

Conclusion: Management of MEP varies greatly in Danish Hospitals. A systematic approach to MEP management in line with management of trauma and stroke patients may potentially serve to improve the quality of care for and outcome of this patient group, but further research is needed.

Funding: None.

Trial registration: Not relevant.

Introduction: Anthropometric data are key to evaluating infant health. This study assessed the validity of parent-reported infant weight and length, and their reliability to categorise children by BMI z-score, as compared to clinical measurements.

Methods: From a cohort of 4,262 infants, parent-reported and clinically measured anthropometric data were obtained and compared at three months and one year of age.

Results: Parent-reported and clinically measured data generally correlated well. Mean differences at three months and at one year, respectively, were 0.08 kg (95% confidence interval (CI): 0.07-0.09 kg) and 0.10 kg (95% CI: 0.08-0.12 kg) for weight, 0.8 cm (95% CI: 0.8-0.9 cm) and 1.0 cm (95% CI: 0.9-1.1 cm) for length and -0.16 kg/m2 (95% CI: -0.20--0.12 kg/m2) and -0.22 kg/m2 (95% CI: -0.27--0.18 kg/m2) for BMI. Effect sizes were negligible to small. Bland-Altman plots showed clinically insignificant bias, but 95% limits of agreement were wide enough to be significant. Comparing categorisation of BMI z-score showed only fair agreement.

Conclusion: Parents' reports of measured infant weight and length are reliable at a population level in a setting with routine preventive care. Parent-reported data should not be used for assessment of individual infants, particularly not if a health condition is suspected. BMI calculated from parent-reported anthropometrics is not reliable.

Funding: None.

Trial registration: This study was registered with www.

Clinicaltrials: gov, registration number NCT01694108.