Danish medical journal最新文献_第10页

Geriatric assessment may prevent readmission in frail medical inpatients. 老年评估可防止体弱住院病人再入院。

IF 1.6 4区医学

Danish medical journal Pub Date : 2023-05-23

Astrid Heath, Seham Shahla, Sofie Ran Lindhardt Bossen, Bo Løfgren, Merete Gregersen, Troels Kjærskov Hansen

{"title":"Geriatric assessment may prevent readmission in frail medical inpatients.","authors":"Astrid Heath, Seham Shahla, Sofie Ran Lindhardt Bossen, Bo Løfgren, Merete Gregersen, Troels Kjærskov Hansen","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: Frailty is common in older adults. Many approaches exist to care of hospitalised older medical inpatients. The objectives of this study were to 1) describe frailty occurrence and 2) explore associations between frailty, type of care, 30-day readmission and 90-day mortality.Methods: In a cohort of 75+-year-old medical inpatients with daily homecare or moderate comorbidity, frailty was graded as moderate or severe using the record-based Multidimensional Prognostic Index. The emergency department (ED), internal medicine (IM) and geriatric medicine (GM) were compared. Estimates of relative risk (RR) and hazard ratios were calculated in binary regression and Cox regression models.Results: Analyses included 522 patients (61%) with moderate frailty and 333 (39%) with severe frailty. A total of 54% were females, and the median age was 84 years (interquartile range: 79-89). In GM, the distribution of frailty grade differed significantly from that of the ED (p less-than 0.001) and IM (p less-than 0.001). GM had the highest occurrence of severely frail patients and the lowest readmission rate. Compared with GM, the adjusted RR for readmission in ED was 1.58 (1.04-2.41), p = 0.032; and in IM: 1.42 (0.97-2.07), p = 0.069. Between the three specialities, no differences were seen in 90-day mortality hazard.Conclusion: In a regional hospital, frail older patients were discharged from all medical specialities. Admission to geriatric medicine was associated with a lower readmission risk and no increase in mortality. Comprehensive Geriatric Assessment may explain the observed differences in readmission risk.Funding: None.Trial registration: Not relevant.","PeriodicalId":11119,"journal":{"name":"Danish medical journal","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9665104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Change in orthopaedic surgeon behaviour by implementing evidence-based practice. 通过实施循证实践改变骨科医生行为。

IF 1.6 4区医学

Danish medical journal Pub Date : 2023-05-16

Jens-Christian Vedel, Dennis Winge Hallager, Jeanette Østergaard Penny, Tommy Henning Jensen, Thomas Juul Sørensen, Stig Brorson

{"title":"Change in orthopaedic surgeon behaviour by implementing evidence-based practice.","authors":"Jens-Christian Vedel, Dennis Winge Hallager, Jeanette Østergaard Penny, Tommy Henning Jensen, Thomas Juul Sørensen, Stig Brorson","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: Orthopaedic practice is not always aligned with new evidence which may result in an evidence-practice gap. Our aim was to present and report the use of a new model for implementation of evidence-based practice using treatment of distal radius fractures (DRF) as an example.Methods: A new implementation model from the Centre for Evidence-Based Orthopaedics (CEBO) was applied. It comprises four phases: 1) baseline practice is held up against best available evidence, and barriers to change are assessed. 2) A symposium involving all stakeholders discussing best evidence is held, and agreement on a new local guideline is obtained. 3) The new guideline based on the decisions at the symposium is prepared and implemented into daily clinical practice. 4) Changes in clinical practice are recorded. We applied the model on the clinical question of whether to use open reduction and internal fixation with a locked volar plate (VLP) or closed reduction and percutaneous pinning (CRPP) in adults with DRF.Results: Prior to application of the CEBO model, only VLP was used in the department. Based on best evidence, the symposium found that a change in practice was justified. A local guideline stating CRPP as first surgical choice was implemented. If acceptable reduction could not be obtained, the procedure was converted to VLP. A year after implementation of the guideline, the rate of VLP had declined from 100% to 44%.Conclusion: It is feasible to change surgeons' practice according to best evidence using the CEBO model.Funding: None.Trial registration: Not relevant.","PeriodicalId":11119,"journal":{"name":"Danish medical journal","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9671371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Decision support to general practice in choice of chest imaging for patients with pulmonary symptoms. 对有肺部症状患者选择胸部影像学的全科实践的决策支持。

IF 1.6 4区医学

Danish medical journal Pub Date : 2023-05-16

Lise Bolander Malvang, Christian Trolle, Torben Riis Rasmussen, Charlotte Hyldgaard

{"title":"Decision support to general practice in choice of chest imaging for patients with pulmonary symptoms.","authors":"Lise Bolander Malvang, Christian Trolle, Torben Riis Rasmussen, Charlotte Hyldgaard","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: The choice of chest imaging for patients with respiratory problems is based on risk profile and symptoms. In 2018-2020, GPs in the catchment area of Silkeborg Regional Hospital, Denmark, were offered direct referral for either X-ray or low-dose computed tomography (LDCT) of the chest for patients with respiratory symptoms who did not meet the criteria for a contrast-enhanced CT (CECT) of the chest and upper abdomen as part of the lung cancer referral pathway. The aim of this study was 1) to estimate the percentage of patients referred for LDCT or chest X-ray who met CECT criteria based on the clinical information in the referral letters, and 2) to assess the GPs' response to standard questions regarding the active feedback provided.Methods: The study was conducted from April to October 2019. Radiographers initially assessed all referrals for X-ray or LDCT, and contacted the GPs if they assessed that symptoms and clinical characteristics justified CECT.Results: In the study period, 1,112 referrals for chest imaging from GPs were received; in 97 cases (9%), the referral information warranted CECT as part of a lung cancer referral package. In 71% (69/97) of these cases, the GP accepted the conversion to CECT; 55 of 73 LDCTs and 14 of 24 X-rays. In 15 cases, the GP adhered to the requested imaging owing to clinical assessment or their agreement with the patient, and in the remaining 13 cases no specific reason was given.Conclusion: The feedback provided was well received by GPs and the approach adopted may be a step towards structured decision support to facilitate the choice of chest imaging.Funding: None.Trial registration: Not relevant.","PeriodicalId":11119,"journal":{"name":"Danish medical journal","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9665101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Changes in Kawasaki disease incidence and phenotype during the COVID-19 pandemic. COVID-19大流行期间川崎病发病率和表型的变化

IF 1.6 4区医学

Danish medical journal Pub Date : 2023-05-15

Ayse Mine Ünlü, Mette Holm, Thomas Krusenstjerna-Hafstrøm, Mia Glarup, Jesper Bjerre, Troels Herlin

{"title":"Changes in Kawasaki disease incidence and phenotype during the COVID-19 pandemic.","authors":"Ayse Mine Ünlü, Mette Holm, Thomas Krusenstjerna-Hafstrøm, Mia Glarup, Jesper Bjerre, Troels Herlin","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: The aetiology of Kawasaki disease (KD) remains unknown. Changes in infectious exposure during the COVID-19 pandemic owing to infection prevention measures may have affected the incidence of KD, supporting the pathogenic role of an infectious trigger. The purpose of this study was to evaluate the incidence, phenotype and outcome of KD before and during the COVID-19 pandemic in Denmark.Methods: This was a retrospective cohort study based on patients diagnosed with KD at a Danish paediatric tertiary referral centre from 1 January 2008 to 1 September 2021.Results: A total of 74 patients met the KD criteria of whom ten were observed during the COVID-19 pandemic in Denmark. All of these patients were negative for SARS-CoV-2 DNA and antibodies. A high KD incidence was observed during the first six months of the pandemic, but no patients were diagnosed during the following 12 months. Clinical KD criteria were equally met in both groups. The fraction of intravenous immunoglobulin (IVIG) non-responders was higher in the pandemic group (60%) than in the in the pre-pandemic group (28.3%), although the rate of timely administered IVIG treatment was the same in both groups (≥ 80%). Coronary artery dilation was observed in 21.9% in the pre-pandemic group compared with 0% in KD patients diagnosed during the pandemic.Conclusion: Changes in KD incidence and phenotype were seen during the COVID-19 pandemic. Patients diagnosed with KD during the pandemic had complete KD, higher liver transaminases and significant IVIG resistance but no coronary artery involvement.Funding: None.Trial registration: The study was approved by the Danish Data Protection Agency (DK-634228).","PeriodicalId":11119,"journal":{"name":"Danish medical journal","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9671373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Plasma Aβ biomarker for early diagnosis and prognosis of Alzheimer's disease - a systematic review. 血浆a β生物标志物对阿尔茨海默病早期诊断和预后的系统评价

IF 1.6 4区医学

Danish medical journal Pub Date : 2023-05-10

Svend Ubbe Ebbesen, Peter Høgh, Ivan Zibrandtsen

{"title":"Plasma Aβ biomarker for early diagnosis and prognosis of Alzheimer's disease - a systematic review.","authors":"Svend Ubbe Ebbesen, Peter Høgh, Ivan Zibrandtsen","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: Alzheimer's disease (AD) is the most common cause of dementia worldwide and a cost-effective diagnostic biomarker is needed. This systematic review provides an overview of the current research on plasma amyloid beta (Aβ) as a biomarker of AD and explores the clinical implications of this line of research.Methods: PubMed was searched using the keywords plasma Aβ and AD from 2017 to 2021. Only clinical studies involving amyloid PET (aPET) or cerebrospinal fluid (CSF) biomarker analysis (or both) were included. A meta-analysis of CSF Aβ42/40 ratio, aPET and plasma Aβ42/40 ratio was conducted when possible.Results: A total of 17 articles were identified. Plasma Aβ42/40 ratio was inversely correlated with aPET positivity r = -0.48 (95% confidence interval (CI): -0.65--0.31). In numerous studies, plasma Aβ42/40 ratio was also found to be directly correlated with CSF Aβ42 and CSF Aβ42/40 ratio r = 0.50 (95% CI: 0.30-0.69). Three studies found plasma Aβ42 to be positively associated with aPET positivity and CSF Aβ42; however, four other studies found no significant association between these variables. Seven studies reported no significant association of plasma Aβ40 with aPET or CSF Aβ40.Conclusion: Plasma Aβ42/40 ratio seems as a promising plasma biomarker as it significantly correlates inversely with aPET positivity and directly with CSF Aβ42 and CSF Aβ42/40 ratio. However, more research is warranted, including validation studies, longitudinally clinical studies, studies comparing measurement methods and studies of Aβ kinetics.","PeriodicalId":11119,"journal":{"name":"Danish medical journal","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9665099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Adrenal incidentalomas and effectiveness of patient pathway transformation. 肾上腺偶发瘤与患者途径转化的有效性。

IF 1.6 4区医学

Danish medical journal Pub Date : 2023-05-10

Christian Trolle, Karen Fjeldborg, Atul Shukla, Andreas Ebbehøj, Per Løgstrup Poulsen, Klavs Würgler Hansen

{"title":"Adrenal incidentalomas and effectiveness of patient pathway transformation.","authors":"Christian Trolle, Karen Fjeldborg, Atul Shukla, Andreas Ebbehøj, Per Løgstrup Poulsen, Klavs Würgler Hansen","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: A total of 10% of older individuals harbour adrenal incidentalomas and need dedicated adrenal CT to exclude malignancy and biochemical evaluation. These investigations tax medical resources, and diagnostic delay may cause anxiety for the patient. We implemented a no-need-to-see pathway (NNTS) in which low-risk patients only attend the clinic if adrenal CT or hormonal evaluation is abnormal.Methods: We investigated the impact of a NNTS pathway on the share of patients not requiring an attendance consultation, time to malignancy and hormonal clarification, and time to end of investigation. We prospectively registered adrenal incidentaloma cases (n = 347) and compared them with historical controls (n = 103).Results: All controls attended the clinic. A total of 63% of cases entered and 84% completed the NNTS pathway without seeing an endocrinologist; 53% of consultations were avoided. Time-to-event analysis revealed a shorter time to clarification of malignancy (28 days; 95% confidence interval (CI): 24-30 days versus 64 days; 95% CI: 47-117 days) and hormonal status (43 days; 95% CI: 38-48 days versus 56 days; 95% CI: 47-68 days) and a shorter time to end of pathway (47 days; 95% CI: 42-55 days versus 112 days; 95% CI: 84-131 days) in cases than controls (p ≤ 0.01).Conclusion: We demonstrated that NNTS pathways may be an efficient way of handling the increased burden of incidental radiological findings, avoiding 53% of attendance consultations and achieving a shorter time to end of pathway.Funding: Supported by a grant from Regional Hospital Central Denmark, Denmark. The study was approved by the institutional review boards of all participating hospitals.Trial registration: Not relevant.","PeriodicalId":11119,"journal":{"name":"Danish medical journal","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9665105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comment: Reply to editorial letter on Limited value of a patient-reported triage algorithm in an outpatient epilepsy clinic. 评论:回复关于癫痫门诊病人报告的分诊算法的有限价值的社论信。

IF 1.6 4区医学

Danish medical journal Pub Date : 2023-05-08

Eva Myrdal, Tatiana Viktoria Danielsen, Tobias Sejbaek

引用次数: 0

The national implementation of a triage algorithm based on patient-reported outcome measures in outpatients with epilepsy. 在全国范围内实施基于患者报告的癫痫门诊患者预后措施的分诊算法。

IF 1.6 4区医学

Danish medical journal Pub Date : 2023-05-08

Niels Henrik Hjollund, Birgith Engelst Grove, Louise Pape Larsen, Jacob Christensen, Liv Marit Valen Schougaard

引用次数: 0

Acute kidney injury after gynaecological surgery - a systematic review and meta-analysis. 妇科手术后急性肾损伤——系统回顾和荟萃分析。

IF 1.6 4区医学

Danish medical journal Pub Date : 2023-05-03

Cani Reza, Niels Klarskov, Ilda Amirian

{"title":"Acute kidney injury after gynaecological surgery - a systematic review and meta-analysis.","authors":"Cani Reza, Niels Klarskov, Ilda Amirian","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: Acute kidney injury (AKI) is an abruptly occurring loss of renal function, which includes both kidney injury and kidney impairment. It is associated with mortality and morbidity due to the increased risk of developing chronic kidney disease. The aim of this systematic review and meta-analysis was to determine the incidence of post-operative AKI in gynaecological patients without pre-existing kidney injury.Methods: Systematic searches were made for studies examining the association between AKI and gynaecological surgery published between 2004 and March 2021. The primary outcome was to compare two subgroups of studies; a screening group where AKI was diagnosed by systematic clinical screening and a non-screening group where AKI was diagnosed randomly.Results: Among the 1,410 records screened, 23 studies met the inclusion criteria, reporting AKI in 224,713 patients. The pooled incidence for post-operative AKI after gynaecological surgery in the screening subgroup was 7% (95% confidence interval (CI): 0.04-0.12). The overall pooled result for post-operative AKI after gynaecological surgery in the non-screening subgroup was 0% (95% CI: 0.00-0.01).Conclusion: We found a 7% overall risk of post-operative AKI after gynaecological surgery. We found a higher incidence of AKI in the studies screening for kidney injury, illustrating that the condition is underdiagnosed when not screened for. An important risk exists of healthy women developing severe renal damage as AKI is a common post-operative complication with a potentially severe outcome that may be prevented in early diagnosis.","PeriodicalId":11119,"journal":{"name":"Danish medical journal","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9665109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Insufficient training in colposcopy and loop electrosurgical excision procedure among residents. 住院医师对阴道镜和环电切术的培训不足。

IF 1.6 4区医学

Danish medical journal Pub Date : 2023-04-24

Louise Krog, Kathrine Dyhr Lycke, Anne Gamst Christiansen, Anne Hammer

{"title":"Insufficient training in colposcopy and loop electrosurgical excision procedure among residents.","authors":"Louise Krog, Kathrine Dyhr Lycke, Anne Gamst Christiansen, Anne Hammer","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: Colposcopy is an important tool in the diagnostic work-up of women with an abnormal cervical smear. Unlike in other countries where colposcopy is mostly performed by certified colposcopists, in Denmark, colposcopy may be performed by residents in obstetrics and gynaecology (OB/Gyn). We aimed to evaluate training in colposcopy and loop electrosurgical excision procedure (LEEP) among Danish OB/Gyn residents.Methods: Two questionnaires were developed: one for OB/Gyn residents who are required to learn colposcopy and LEEP during their residency, and one for chief physicians who are responsible for providing their training. Questionnaires were distributed by e-mails and via social media from November to December 2021.Results: Among 120 eligible residents, 93 completed the questionnaire. The median age was 36 (interquartile range: 34-39) years. Most received training in colposcopy (84.9%), but the majority considered training to be insufficient (76.3%) and had low self-efficacy in performing colposcopy (72.0%). With respect to LEEP, most received training (84.9%), but nearly half considered that their training had been insufficient (43.0%) and had low self-efficacy in performing LEEP (49.5%).Conclusions: Most Danish OB/Gyn residents receive insufficient training in colposcopy and LEEP, which demonstrates a need for a formal training programme for residents and their supervisors to ensure an appropriate level of training and adequate patient care.Funding: Danish Association of Younger Gynaecologists and Obstetricians (FYGO).Trial registration: Not relevant.","PeriodicalId":11119,"journal":{"name":"Danish medical journal","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9400168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0