Ugeskrift for laeger最新文献

Diabetic retinopathy (DR) is the most common complication in patients with diabetes, and screening for sight-threatening end-stages is indicated to avoid severe visual loss. Screening of DR is nationally implemented in Denmark according to evidence-based national guidelines, which includes the use of individualised screening intervals. Treatment is indicated for proliferative DR and diabetic macular oedema, and treatment modalities include retinal laser therapy, intravitreal angiostatic therapy, and vitrectomy. In this review, we summarise the current guidelines for screening and treatment of DR in Denmark.

The Danish healthcare system is currently undergoing a transformation towards increased use of virtual healthcare services. In this review, we propose a structured risk-stratified model to delineate the differences between homecare, homemonitoring, and hospital-at-home, while discussing their current status and addressing barriers hindering the widespread adoption and scaling of home-based care incl. technological limitations, regulatory complexities, and cultural considerations. We advocate for establishing a national central support function to expedite the shift towards home-based care.

This review describes that a core outcome set (COS) represents a consensus-based minimum set of outcomes to be collected and reported in clinical trials involving a particular disease or population. A COS serves as a guideline for global consensus on which outcome domains should be collected in all clinical trials. After defining what to measure, it becomes crucial to reach consensus on how to measure it. This includes the selection of appropriate outcome measurement instruments with credible measurement properties and interpretable thresholds of meaning.

We present a rare case of an 84-year-old woman with a left atrial chorda. She was admitted with heart failure and echocardiography revealed severe mitral valve insufficiency due to chordal rupture and prolapse of the posterior leaflet. In addition, a left atrial chorda was diagnosed, attached to the anterior leaflet, restricting the valve and contributing to the insufficiency. The patient underwent surgery with the removal of the atrial chorda and insertion of two neochordae and mitral annuloplasty with a ring. Postoperative echocardiography showed a well-functioning valvuloplasty.

Recently, semi-synthetic cannabinoids have entered the illegal market and are produced to mimic the psychoactive effects of tetrahydrocannabinol (THC). This is a case report of a 19-year-old man, who was hospitalized due to severe sedation, hypotension and tachy- and bradycardia after ingestion of the semi-synthetic cannabinoids hexahydrocannabinol (HHC) and hexahydrocannabiphorol (HHC-P) mixed in food. HHC-P, HHC and metabolites were identified in blood samples. The amount of semi-synthetic cannabinoids in illegal products can be high, which can explain the described prolonged clinical effects.

Cervical spondylotic myelopathy (CSM) is a progressive degenerative condition of the cervical spine and the most common cause of spinal cord injury in adults >55 years of age. Degenerative changes in the spine lead to spinal cord compression, resulting in symptoms such as gait instability, loss of dexterity in the hands, weakness, and sensory deficits. Diagnosis is delayed by 2,2-6,3 years and includes clinical examination and imaging such as MRI. Management of CSM is primarily surgical treatment. This review highligths the importance of early recognition and appropriate treatment in optimising patient outcomes.

Sales of over-the-counter decongestant nasal sprays in Denmark from 2011 to 2023 have doubled. This article highlights the potential risks associated with prolonged use of decongestant nasal sprays, such as rhinitis medicamentosa. We conclude that there is an urgent need for increased patient education on proper use and possible side effects of over-the-counter decongestant nasal sprays, as well as a need for more substantial data on side effects related to decongestant nasal sprays to guide health authorities in future regulation.

Psychotic and negative symptoms are core features of schizophrenia but knowledge on the long-term course of these symptoms is lacking. While antipsychotics improve psychotic symptoms, they have limited effect on negative symptoms. Specialized early interventions like OPUS show great effects while ongoing but long-term follow-up indicates no lasting disease-modifying effects. 18% of patients achieved clinical recovery, and 40% obtained symptom remission after 20 years, but high mortality rates and continuous negative symptoms constitute an unmet treatment need, as argued in this review.

Preoperative virtual surgical planning and the use of 3D-printed patient-specific models and cutting guides are increasingly being used in the reconstruction of mandibular defects with a free bone flap. This technology offers several advantages over conventional surgery, such as reduced operating time, reduced bone flap ischaemia time, and the ability to perform more complex and precise reconstructions. This review presents the evidence supporting 3D-assisted surgery for mandibular defect reconstruction and discusses the utilisation of commercial vendors versus in-house 3D-printing solutions.