Danish medical journal最新文献

Introduction: A growing number of children and adolescents (CA) suffer from mental health problems. To provide the necessary investigation and care, collaboration between general practitioners (GPs) and the municipality is essential, but often challenging. This study aimed to identify factors influencing intersectoral collaboration between general practice and municipalities when treating CA with mental health problems and to propose improvements to this collaboration.

Methods: We conducted interviews with seven GPs and three municipal employees (MEs). The data were analysed with inspiration from thematic analysis. The results were framed within Gittell's theory of relational coordination.

Results: GPs and MEs expressed frustration and challenges encountered when working with CA due to inefficient intersectoral collaboration. Many GPs expressed a need for better communication with municipal authorities or child psychiatry departments. MEs also experienced challenges related to this collaboration. Successful collaboration appeared when dedicated individuals from both sectors actively worked for improvements. Key factors identified for enhancing collaboration included personal knowledge, regular contact, awareness of activities in the other sector and improved communication channels.

Conclusions: We propose enhanced cross-sectoral communication, routine information exchange and further development of digital tools to improve collaboration. Formalising collaboration through specific agreements is also recommended.

Funding: "PLU-fonden" and "Sara Krabbes Legat" TRIAL REGISTRATION. Not relevant.

Introduction: Anxiety among medical students is highly prevalent and may negatively impact students' future practice. Transitioning from the pre-clinical to the clinical phase often presents considerable challenges. Early clinical exposure has been identified as beneficial in easing this transition. Most medical schools in Scandinavia already include a few weeks of exposure. Even so, student distress remains high. The study aimed to assess the need for more clinical exposure during the Bachelor of Science (BSc) programme in medicine based on students' subjective needs.

Methods: This cross-sectional study employed a non-probability sampling method to include medical students enrolled in the Master of Science (MSc) programme at the University of Southern Denmark. A self-administered questionnaire was designed to explore medical students' self-reported needs and attitudes towards the BSc programme. Descriptive and inferential statistics were used to summarise and assess the data.

Results: Among the 120 students included, 90% perceived the clinical exposure during the BSc programme as insufficient. Furthermore, 68% felt inadequate in their understanding of a physician's clinical role, and 87% felt inadequacy in their understanding of the work-life balance within the profession upon completing the BSc degree. The estimated response rate was 13%.

Conclusions: The findings suggest a subjective need for more clinical exposure in the BSc programme. However, the impact of additional clinical exposure on student distress remains unclear.

Funding: The authors did not receive any funding or support.

Trial registration: Not relevant.

Introduction: Our sense of taste plays a key role in eating and drinking, guiding behaviour through warning and pleasure signalling. Taste dysfunction has severe consequences for patients. Reliable gustatory testing is relevant for researchers and clinicians, emphasising the need for reproducible measuring methods. This study aimed to provide normative data on the Taste-Drop-Test (TDT), which is already used in clinical and research settings.

Methods: The TDT was administered to 424 healthy participants and 134 patients with gustatory dysfunction. The test consisted of liquid concentrations of four basic tastes: acidic, sweet, salty and bitter. After application, a test score was calculated for each individual.

Results: In the healthy participants, a significant correlation was found between TDT score and olfactory function. Furthermore, a significant positive correlation was found for superior taste function for younger age and female sex. The cut-off value based on the tenth percentile in the healthy participants was 6.25.

Conclusions: The TDT can distinguish between normo- and hypogeusia. We recommend using the TDT to researchers and clinicians when an accurate measurement of gustatory function is warranted.

Funding: This project received no specific funding. Alexander Wieck Fjældstad is partially funded by the VELUX Foundation for other projects.

Trial registration: The Central Denmark Region Ethics Committee approved the study (42832), which was conducted in consistency with the Declaration of Helsinki Ethical Principles of Medical Research.

Introduction: Hereditary multiple osteochondromas (HMO) is a genetic skeletal disorder caused by defects in exostosin glycosyltransferase 1 (EXT1) or 2 (EXT2) genes. It develops mainly in the growth period and causes multiple osteochondromas (OC) in the physis of the long bones, leading to discomfort and deformities. This study aimed to investigate the anatomical distribution of OC, the frequency of deformities of the lower limbs, scoliosis and surgeries performed in a cohort of patients with HMO at the time of their enrolment in a regional surveillance programme.

Methods: The study population included HMO patients from the Centre of Heritable and Complex Diseases (CAKS) in the Region of Southern Denmark. Information on surgical procedures and age at the time of diagnosis was obtained from medical records, while deformities were evaluated on early-onset scoliosis (EOS) scans from time of enrolment in the CAKS.

Results: A total of 54 patients were included and 44 patients (82%) had an EOS scan. All except one (98%) HMO patient had OC in the knees at the time of their EOS scan. A total of 12 patients (27%) had leg length discrepancy, 30 (68%) had genu varum or valgum and 13 (30%) had scoliosis. The HMO patients had undergone a median of 2.0 (0-14) surgeries, where a median of four (1-23) OC were removed, mostly in the lower limb (68%).

Conclusions: The majority of HMO patients in this cohort suffered from major anatomical burdens, leading to multiple surgeries and deformities. We suggest that a programme, such as the CAKS surveillance programme, may be beneficial to screening and follow-up of OC and deformities in patients with HMO.

Funding: None.

Trial registration: Not relevant.

Introduction: Pathological crying and/or laughing (pseudobulbar affect (PBA)) are socially debilitating symptoms seen in many neurological diseases, such as stroke, multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS). One method for measuring the degree of PBA is the Center for Neurologic Study-Lability Scale (CNS-LS), a seven-item questionnaire validated for quantifying symptoms and supporting PBA diagnoses in ALS and MS. The aim of this study was to provide a Danish translation of the CNS-LS inspired by international guidelines on cross-cultural translation and adaptation of self-report measurements.

Methods: Through a six-step process, the CNS-LS was translated and back-translated by four certified translators, followed by an expert committee examination. The translation was then field-tested by interviewing patients with ALS and MS after they had completed the CNS-LS. If at least 20% of participants found an item "unclear", it would be reevaluated.

Results: Twelve patients with ALS patients and 30 patients with MS were tested and interviewed. None of the questionnaire items exceeded the 20% threshold for lack of clarity.

Conclusion: We present a Danish translation of the CNS-LS to facilitate better diagnosis and quantification of PBA symptoms in Danish patients with ALS or MS.

Funding: This study received funding from the PhD fellowship grant of Neuroscience Academy Denmark.

Trial registration: Not relevant.

Introduction: Psychogenic non-epileptic seizures (PNES) is a dissociative disorder with attacks resembling epileptic seizures. Previous studies have shown that patients with PNES have distinct demographical and health-related features. No studies, however, exist that describe Danish patients with PNES. In this study, we present the clinical characteristics of patients who received inpatient cognitive behavioural psychotherapy for PNES. We also present data on the short-term effect of PNES treatment for patients with and without comorbid epilepsy.

Methods: In this retrospective study, we reviewed medical records for patients admitted for treatment of PNES at the Danish Epilepsy Centre from 2018 to 2023. We compared psychometric scores before and after admission as outcome measures.

Results: Our cohort consisted of 86.6% women with a mean age of 34.1 years at admission. 29.1% lived alone, and only 39.6% were employed or under education. The patients had a long history of PNES (mean 68.6 months), and a large proportion had comorbid epilepsy (34.1%) or psychiatric comorbidity (67.2%). We found significant improvement in all psychometric scores after admission. Comorbid epilepsy had no significant impact on this effect.

Conclusions: Danish patients receiving inpatient treatment for PNES are very similar to other published cohorts. Four weeks of psychotherapy significantly improved all psychometric scores for patients both with and without epilepsy.

Funding: This study was funded entirely by the Danish Epilepsy Centre.

Trial registration: Not relevant.

Introduction: Patients with cancer and pre-existing severe mental disorders (SMD) have higher cancer mortality rates, but research on barriers to optimal treatment is limited, particularly from the perspectives of patients and relatives. This qualitative study aimed to highlight the experiences of patients and relatives regarding their cancer trajectories in Denmark to explore barriers to optimal cancer care for this patient population.

Methods: A total of 11 semi-structured individual interviews were conducted with eight patients with cancer and pre-existing SMD and three relatives. An eclectic theoretical framework was applied to explore the participants' and relatives' experiences.

Results: Identified barriers included mental health stigma and lack of direct communication about the patients' SMD with oncology staff. While most participants wished to undergo the recommended cancer treatment, some feared adverse psychiatric side effects and worsening of mental health symptoms. Additionally, participants reported barriers such as limited consultation time, lack of clinician continuity and social isolation, which impeded access to sufficient information and support during their cancer trajectory.

Conclusions: The study identified barriers such as mental health stigma and insufficient communication about patients' mental disorders. A patient-centred approach to cancer care, which includes formal guidelines and training for healthcare professionals, is recommended.

Funding: The work was supported by the Danish Cancer Society [grant number R283-A16499].

Trial registration: Not relevant.

Introduction: Little is known about how a tertiary foetal medicine unit creates value for its stakeholders. This study explored stakeholder perspectives to uncover nuances in value creation within a highly specialised unit.

Methods: A cross-sectional exploratory survey was conducted at the Foetal Medicine Unit at Copenhagen University Hospital (Rigshospitalet), Denmark. Participants included patients, clinicians, referring hospitals, international partners and administrators. Questionnaires were designed by specialists, and data analysed using logistic regression and descriptive statistics.

Results: The study surveyed patients (104, 64.2% response rate) and healthcare providers: internal (13/19, 63.2%), national (27/29, 93.1%), international (20/27, 74.1%) and administrators (5/11, 45.4%). Stakeholders emphasised the importance of specialised training. While patients accepted trainee involvement, most preferred certified specialists. Patients referred for pregnancy complications had significantly higher expectations of physician expertise than routine screenings (odds ratio = 2.58 (95% confidence interval: 1.13-5.88), p = 0.02). Key success metrics were patient outcomes, staff satisfaction and patient satisfaction.

Conclusions: Discrepancies were found between patients' acceptance of trainee involvement and their preference for certified specialists. Patients referred for complications had even higher expectations of physician expertise. Patient outcomes, patient satisfaction and staff satisfaction were consistently identified as the most important success indicators.

Funding: None.

Trial registration: Not relevant.

Introduction: Glucagon-like peptide-1 receptor agonists (GLP1-RAs) are increasingly used to manage type 2 diabetes (T2D) and obesity. Recently, concerns have been raised regarding perioperative GLP1-RA management due to delayed gastric emptying and the potential risk of pulmonary aspiration. However, since no prospective data are available on surgical patients, we aimed to investigate the risk of perioperative pulmonary aspiration in patients with T2D treated with a GLP1-RA undergoing fast-track hip and knee arthroplasty.

Methods: This was a prospective observational study within a multicentre fast-track hip and knee replacement collaboration in patients with T2D with receiving GLP-1 RA. Detailed data were collected from 1 October 2022 to 1 April 2024, including perioperative GLP1-RA management, type of anaesthesia, complications and postoperative length of stay (LOS).

Results: Among 426 patients with T2D, 19% had spinal anaesthesia without sedation, 53% had spinal anaesthesia with propofol sedation, and 26% had general anaesthesia. Data on perioperative management of GLP1-RAs were available in 93% of all patients, of whom 92% had continued their usual GLP1-RA regimen perioperatively, and the median LOS was one (IQR: 1-1) day. There were no cases with perioperative aspiration (0%; 95% confidence interval (CI): 0.0-0.9%) or LOS > 2 days (7%; 95% CI: 5-9%) potentially related to GLP1-RA-associated delayed gastric emptying.

Conclusion: Our results support reconsidering the arguments for prolonged withholding of GLP1-RA treatment before surgery and suggest that it may be safe to continue GLP1-RA treatment up to the day of surgery in these patients.

Funding: This study was supported financially by a grant from the NOVO NORDISK Foundation (grant number NNF21SA0073760).

Trial registration:

Clinicaltrials: gov (NCT05613439).