Danish medical journal最新文献

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.

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.