Danish medical journal最新文献

Introduction: Inter-hospital variation in the management of small bowel obstruction (SBO) has been described in other countries, but the extent to which similar variations exist in Denmark remains unknown. This study aimed to compare the management of SBO between hospitals in Denmark and identify potential areas for improvement METHODS. This was a multicentre prospective study performed at six emergency hospitals. Patients aged ≥ 18 years with a diagnosis of SBO were eligible for inclusion. The primary study endpoints were the proportion of patients undergoing operative versus non-operative management, laparoscopic surgery versus open surgery and the success rate of non-operative management.

Results: A total of 316 patients were included. No differences were noted in diagnostic pathways or operative versus non-operative management. However, variations were noted in compliance with peri-operative care bundles, ranging from 63.2% to 95.8%. The surgical approach also varied, with the use of laparoscopic surgery ranging from 20.7% to 71.0% (p less-than 0.001). Variations were also noted in duration of surgery (63-124 minutes, p less-than 0.001), time to re-introduction of normal diet and length of hospital stay (3-8.5 days, p less-than 0.001). No differences were observed in 30-day or 90-day mortality rates.

Conclusion: The management of SBO in Denmark is relatively standardised. Future efforts should focus on improving adherence to multidisciplinary peri-operative protocols, optimising patient selection for laparoscopic surgery and standardising nutritional therapy.

Funding: None.

Trial registration: NCT04750811.

Introduction: The objective of this study was to describe and evaluate the management of patients with renal trauma and their complications at the Department of Urology at Aarhus University Hospital (AUH), Denmark.

Methods: All patients diagnosed with renal injury due to trauma and with contact to the Department of Urology at the AUH, Denmark, between March 2016 and March 2021 were included. Patients were identified by the International Classification of Diseases, Tenth version, code and data obtained from electronic patient records.

Results: A total of 58 patients were identified. The median age was 33 years (7-95 years) and the median length of hospitalisation was five days (range: 0-52 days). All patients were evaluated with a multiphase computed tomography upon admission. Injuries to the kidney were graded using the American Association for the Surgery of Trauma kidney injury scale. Twelve percent had grade I injury, 26% had grade II injury, 26% had grade III injury, 36% had grade IV injury and 3% had grade V injury. In the acute phase, all patients were managed non-operatively. Early complications were found in 24% of patients. Pulmonary embolism was diagnosed in 7%. Furthermore, 7% had an infection as a late complication and all of these patients had also had an early infection. A total of 60% were followed up with a renal-scintigraphy three months after their renal trauma. This examination had no consequence for any of the patients.

Conclusions: No patients died due to the renal trauma. However, many experienced complications in terms of infections and pulmonary embolisms. These data support earlier findings and suggest that a renal scintigraphy after renal traumas may be obsolete.

Funding: None.

Trial registration: Not relevant.

Introduction: Increasing complexity in healthcare makes it necessary to strengthen leadership training in postgraduate medical education (PGME). Multi-source feedback (MSF) is an acknowledged formative assessment method widely implemented in PGME. The present study examined how MSF may support junior doctors' awareness of the need to achieve and train leadership skills in clinical practice.

Methods: Semi-structured interviews were conducted with 30 junior doctors late in PGME after they had completed a leadership-focused MSF process. Written personal development plans were collected. Data were analysed using thematic analysis.

Results: The majority of the junior doctors found that the MSF process was intense, rewarding and helpful for understanding the many facets of clinical leadership. The personal feedback dialogue and the development plan were highlighted as the most beneficial elements of the process. The MSF process identified new learning objectives for leadership development such as task delegation, independent decision-making, becoming a role model and giving and seeking feedback.

Conclusions: Junior doctors found that a leadership-focused MSF process increased their attention to and awareness of leadership in daily clinical practice and provided deep insights into and specific tools to develop leadership skills. Thus, a leadership-focused MSF process may contribute to and increase junior doctors' leadership skills.

Funding: The study was supported financially by the Central and North Denmark Region.

Trial registration: Registered with the Central Denmark Region: 1-16-02-315-20.

Introduction: Instrumented lumbar fusion has been used as surgical treatment for severe disability with associated low back pain. The overall effect and risks of the most commonly used instrumented lumbar fusion techniques are controversial. The objective of the study was to describe clinical and patient-reported outcomes in patients undergoing single-level instrumented interbody fusion surgery with either posterior or transforaminal lumbar interbody fusion.

Methods: This was a registry-based cohort study on patients from the national Danish surgical spine database - DaneSpine. The primary outcome was Oswestry Disability Index (ODI) score at two-year follow-up. Secondary outcome measures were the 3-Level European Quality of Life-5 Dimensions (EQ5D-3L), a visual analogue scale (VAS) score, patient satisfaction and the rate of intraoperative complications.

Results: The cohort included 460 patients. ODI improved from 48 ± 15 preoperatively to 33 ± 20 at the two-year follow-up (p less-than 0.001). The EQ5D-3L score improved from 0.279 ± 0.311 to 0.542 ± 0.340, the VAS score for leg pain from 60 ± 28 to 40 ± 32 and back pain from 70 ± 20 to 47 ± 30. Patient satisfaction was obtained in 58%; 24% were undecided, whereas 18% were not satisfied with the treatment outcome at their two-year follow-up.

Conclusions: Patients suffering from severe back-related disability after failed conservative treatment may expect an improvement in physical function and reduced pain after instrumented lumbar interbody fusion.

Funding: None.

Trial registration: The national Danish DaneSpine registration.

Introduction: Ultra-minimally invasive ultrasound-guided carpal tunnel release is a surgical procedure for treatment of carpal tunnel syndrome that is associated with less surgery-related morbidity and faster recovery than open surgery. The objectives of this study were to describe how the surgical technique may be acquired and to report the results obtained after implementation in a clinical setting.

Methods: The study consisted of two parts: 1) description of the surgical skills needed to perform the procedure, and 2) evaluation of the procedure in the first ten consecutively operated patients after 12-month follow-up using questionnaires and magnetic resonance imaging (MRI).

Results: The procedure was performed on 29 cadaveric arms and assessed regarding surgical release success and signs of iatrogenic damage. Subsequently, the procedure was performed on ten patients with carpal tunnel syndrome. The results of the six-item Carpal Tunnel Symptoms Scale (1-5) improved from 3.3 ± 0.9 (mean ± standard deviation) preoperatively to 1.2 ± 0.3, p = 0.002, after 12 months. Quick Disabilities of the Arm, Shoulder and Hand (DASH) (0-100) results improved from 33.4 ± 14.8 to 2.3 ± 4.0, p = 0.002. There were no infections or iatrogenic damage to nerves or blood vessels.

Conclusions: This study presents a way to safely acquire the skills needed to perform the procedure and implement it in an out-patient setting. The results were comparable to previous findings regarding both effectiveness and safety. MRI documented the surgical gap in the transverse carpal ligament, release length, cross-sectional area changes in the carpal tunnel and median nerve, and reactive changes in the carpal tunnel.

Funding: None.

Trial registration: Not relevant.

Introduction: Post-operative pain following open heart surgery is a clinical challenge usually requiring significant amounts of opioids. Long-acting local infiltration anaesthesia may effectively reduce post-operative opioid consumption and improve recovery. The trial is a publicly funded, double-blinded, randomised, placebo-controlled trial evaluating the effect of long-acting local infiltration anaesthesia in open heart surgery.

Methods: Two Danish centres are planning to randomise 100 patients undergoing coronary artery bypass grafting to treatment with long-acting infiltration anaesthesia or placebo. We compare an active solution of bupivacaine, adrenaline, clonidine and dexamethasone with saline placebo. The primary outcome measure is the accumulated opioid use within the first 24 post-operative hours. Secondary outcome measures include evaluation of respiratory function, patient-reported pain scores, mobilisation, opioid-associated side effects and long-term opioid consumption.

Conclusion: This trial will define whether the use of long-acting infiltration anaesthesia during heart surgery may reduce acute and prolonged post-operative opioid consumption. Reduction of opioid-related adverse effects may improve recovery.

Funding: The trial is supported by public grants (Dansk Selskab for Anæstesiologi og Intensiv Medicin: 40,000 DKK; Regionernes Medicin og Behandlingspulje 2022: 686,000 DKK). The work of I. S. Modrau is supported by an unrestricted grant from the Health Research Foundation of the Central Denmark Region.

Trial registration: EudraCT 2021-005886-41.

Introduction: Patients from Greenland are transferred overseas for highly specialised treatment, mainly to the National University Hospital, Rigshospitalet, Denmark. We aimed to investigate the pattern of transfers from Greenland to Denmark, focusing on cardiology.

Methods: This descriptive quality assurance study included all Greenlandic citizens receiving healthcare services at Rigshospitalet from 2017-2021. Unique patients and disease courses were accounted for and patients were stratified across specialties.

Results: A total of 3,201 unique patients (56% males, mean age 51.0 years, 325 were 18 years or younger) from Greenland received healthcare services at Rigshospitalet. As some patients were seen two or more times, this corresponds to almost 900 patients (approximately 1,500 disease courses) or 1.2% of the entire Greenlandic population being referred annually. The referrals increased by 52% during the period. The Centre of Head and Orthopaedics received most referrals, followed by the Heart Centre. A modest increase in referrals due to heart diseases was observed with ischaemic heart disease being the more prevalent diagnosis. Coronary artery revascularisation rates in Greenlandic citizens aged 55-74 years were at least as high as in the same age-group for all Danes.

Conclusion: During the past five years, a 52% increase has been observed in the referral rate from Greenland to Rigshospitalet for diagnostics and treatment. In cardiology, ischaemic heart disease represented the largest share with a high revascularisation rate being observed in older Greenlandic citizens.

Funding: None.

Trial registration: Not relevant.

Introduction: In recent years, the waiting time for outpatient echocardiography has been increasing. This has potential consequences for patients with de novo systolic heart failure (HF). Thus, screening methods for HF are needed. One method may be electrocardiogram (ECG). We assessed the diagnostic value of the ECG in identifying HF with reduced left ventricle ejection fraction (LVEF) in patients referred from primary care.

Methods: A 2020-2021 observational retrospective study was conducted on patients referred from primary care on suspicion of HF. All patients had ECG performed before LVEF was documented by echocardiography.

Results: In total, 248 patients (61.5%) presented with an abnormal ECG. Among these patients, 4.8% had LVEF 41-49% and 7.7% had LVEF ≤ 40%. An abnormal ECG was found to be associated with reduced LVEF. The negative predictive value of the ECG was 99%, regardless of whether the ECG was interpreted by the cardiologist or automatically. Adding the ECG to a logistic model with traditional risk factors, the ECG increased the area under curve from 0.72 to 0.79.

Conclusion: This study is the first study to assess the value of automatic ECG interpretation compared with a cardiologist's interpretation. The normal ECG can safely exclude HF with LVEF less-than 50% and may serve as a gatekeeping tool to further assist the primary care physician in identifying patients with de novo systolic HF.

Funding: None.

Trial registration: Not relevant.

Skeletal muscle is an endocrine organ that produces and secretes hundreds of myokines, allowing for crosstalk between the muscle and other organs. The discovery of myokines has contributed to laying the groundwork for exercise as medicine. Exercise activates multiple signalling pathways of importance for health. However, for the individual and society to benefit from such exercise effects, a true translational perspective on exercise as medicine is needed, ranging from molecular and physiological events to political decisions with direct implications for clinical practice and public health.

Introduction: Physical child abuse is a well-known global health problem. Considerable efforts have been devoted to identifying predictors of physical abuse.

Methods: This study included all 397 cases in the cohort of children aged 0-18 years referred to the Department of Forensic Medicine, Aarhus University, Denmark, between 2000 and 2020 on suspicion of exposure to physical abuse. The number, character and location of skin lesions were described. Bone fractures were recorded. A total of 59 cases involving weapons and sharp force violence related to attack or fighting between young people were assessed as a separate group.

Results: The annual number of cases referred increased. The male-to-female ratio in the cohort was 6:4. Bruising was the most common skin manifestation in the blunt force violence (BFV) group; 72.2% of the individuals had skin lesions on the head and neck, thus visible on a normally dressed child. Lesions on the hands and arms were present in 69.8% of the BFV cases and may partially reflect defensive reactions. One or more bone fractures were recorded in 19.5% of the BFV group. Occult fractures were observed in 40% of the children in the BFV group ≤ 2 years of age.

Conclusions: More than 70% of the children in the BFV group had lesions on the head and neck visible on a normally dressed child. Skin lesions on hands and arms, which are visible on a lightly dressed child, were just as frequent. Persons with close relation to children should be aware of this opportunity to spot non-accidental skin injuries.

Funding: none.

Trail registration: not relevant.