Search

Objective: To investigate the effectiveness and impact of low‐pressure pneumoperitoneum (Pnp) on postoperative quality of recovery (QoR) and surgical workspace (SWS) in patients with prostate cancer undergoing robot‐assisted radical prostatectomy (RARP). Patients and Methods: A randomised, triple‐blinded trial was conducted in a single centre in Denmark from March 2021 to January 2022. A total of 98 patients with prostate cancer undergoing RARP were randomly assigned to either low‐pressure Pnp (7 mmHg) or standard‐pressure Pnp (12 mmHg). Co‐primary outcomes were postoperative QoR measured via the QoR‐15 questionnaire on postoperative Day 1 (POD1), POD3, POD14, and POD30, and SWS assessed intraoperatively by a blinded assessor (surgeon) via a validated SWS scale. Data analysis was performed according to the intention‐to‐treat principle. Results: Patients who underwent RARP at low Pnp pressure demonstrated better postoperative QoR on POD1 (mean difference = 10, 95% confidence interval [CI] 4.4–15.5), but no significant differences were observed in the SWS (mean difference = 0.25, 95% CI −0.02 to 0.54). Patients allocated to low‐pressure Pnp experienced statistically higher blood loss than those in the standard‐pressure Pnp group (mean difference = 67 mL, P = 0.01). Domain analysis revealed significant improvements in pain (P = 0.001), physical comfort (P = 0.007), and emotional state (P = 0.006) for patients with low‐pressure Pnp. This trial was registered at ClinicalTrials.gov, NCT04755452, on 16/02/2021. Conclusion: Performing RARP at low Pnp pressure is feasible without compromising the SWS and improves postoperative QoR, including pain, physical comfort, and emotional state, compared to the standard pressure. [ABSTRACT FROM AUTHOR]

Objective This study aimed to examine the risk of being granted a disability pension (DP) among incident cancer patients up to five years after diagnosis compared to a match control group, before and after the structural reform of the Danish Disability Pension Act in 2013. Methods All 20-60-year-old incident cancer-diagnosed individuals from 2000 to 2015 were identified in the Danish Cancer Registry. A control group, not previously diagnosed with cancer, was identified in Statistics Denmark matched by gender, age, education, and household income. Risk differences (RD) in cumulative incidence proportions of being granted a DP between cancer patients and controls were analyzed before and after the reform. Results In total, 111 773 incident cancer patients and 506 904 controls were included in the study. Before reform 10 561 cancer patients and 11 231 controls were granted DP; and 2570 cancer patients and 2646 controls were granted DP after the reform. The adjusted RD of being granted DP was significantly higher for cancer patients versus controls at all time points before the reform. The RD increased the most during the first (RD 3.6, 95% CI 3.5-3.7) and second (RD 7.2, 95% CI 7.0-7.4) follow-up year and levelled off the remaining three years. After the reform, the adjusted RD were lower for all 1-5 follow-up years compared to before the reform (RD range 2.8-7.7, 95% CI 2.6-8.1). Conclusion The 2013 reform of the Disability Pension Act reduced the risk of cancer patients being granted DP. The impact on a personal level should be further explored. [ABSTRACT FROM AUTHOR]

Objective: To study cardiometabolic risk-factor trajectories (in terms of levels and changes over time) preceding diabetic polyneuropathy (DPN) 13 years after a screen-detected diagnosis of type 2 diabetes.Research Design and Methods: We clinically diagnosed DPN in a nested case-control study of 452 people in the Danish arm of the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION). By linear regression models, we estimated preceding risk-factor trajectories during 13 years. Risk of DPN was estimated by multivariate logistic regression models of each individual's risk-factor trajectory intercept and slope adjusting for sex, age, diabetes duration, height, and trial randomization group.Results: Higher baseline levels of HbA1c (odds ratio [OR] 1.76 [95% CI 1.37; 2.27] and OR 1.68 [95% CI 1.33; 2.12] per 1% and 10 mmol/mol, respectively) and steeper increases in HbA1c over time (OR 1.66 [95% CI 1.21; 2.28] and OR 1.59 [95% CI 1.19; 2.12] per 1% and 10 mmol/mol increase during 10 years, respectively) were associated with DPN. Higher baseline levels of weight, waist circumference, and BMI were associated with DPN (OR 1.20 [95% CI 1.10; 1.31] per 5 kg, OR 1.27 [95% CI 1.13; 1.43] per 5 cm, and OR 1.24 [95% CI 1.12; 1.38] per 2 kg/m2, respectively).Conclusions: Both higher levels and slopes of HbA1c trajectories were associated with DPN after 13 years. Our findings indicate that the rate of HbA1c increase affects the development of DPN over and above the effect of the HbA1c level. Furthermore, this study supports obesity as a risk factor for DPN. [ABSTRACT FROM AUTHOR]

Sore throat (POST) and hoarseness (PH) are common complaints after endotracheal intubation (EI). The aim of this study was to investigate whether tube size impacts the experiences of POST and PH after EI in patients undergoing elective surgery, as well as to document a possible role of gender. This randomised, controlled, blinded study was conducted at Aalborg University Hospital, Thisted, Denmark or North Denmark Regional Hospital, Denmark. A total of 236 patients (53.4% female, mean age 50.9 years (SD 14.0)) were enrolled from the departments of gynaecology, parenchyma and orthopaedics. The patients were randomised to a tube size of 8.0 or 7.0 for males and 7.0 or 6.0 for females. Tube sizes were known to the anaesthesia staff but blinded for patients, researchers and staff at the postoperative care unit. POST and/or PH was reported 30–60 min before anaesthesia, at 30 min and at 2, 5, 12, 24, 48, 72 and 96 h after anaesthesia. Both female and male patients experienced significantly lower levels of POST and PH after intubation with the smallest tube size. This study demonstrates that a smaller size of tube results in a reduction in POST and PH after EI for both male and female patients. [ABSTRACT FROM AUTHOR]

In direct comparison, microdissection testicular sperm extraction (mTESE) gives a higher sperm retrieval rate than multiple needle-pass testicular sperm aspiration. Patients should be informed about the higher risk of surgical complications and potential testosterone deficiency after mTESE. Surgical extraction of testicular spermatozoa is needed in men with nonobstructive azoospermia (NOA) who wish to become biological fathers. Based on available uncontrolled studies with unspecific patient selection, microdissection testicular sperm extraction (mTESE), having a sperm retrieval rate (SRR) of 50%, is considered the most efficient sperm retrieval procedure. However, no randomized clinical trials for comparison of different sperm retrieval procedures exist. Testicular sperm aspiration (TESA) is simple and commonly used, and we hypothesized that this technique using multiple needle passes would give similar SRRs to mTESE. To compare mTESE and multiple needle-pass TESA in men with NOA. A randomized clinical trial was performed between June 2017 and April 2021, with inclusion of 100 men with NOA from four centers in Denmark and Sweden. All participants received treatment at the same institution. Participants were randomized to mTESE (n = 49) or multiple needle-pass TESA (n = 51). Patients with failed multiple needle-pass TESA proceeded directly to salvage mTESE. The primary outcome was SRR. Secondary outcomes included complications and changes in reproductive hormones after surgery. Spermatozoa were retrieved in 21/49 (43%) men after mTESE and in 11/51 (22%) men after multiple needle-pass TESA (rate difference –0.21; 95% confidence interval –0.39 to –0.03; p = 0.02). The combined SRR for multiple needle-pass TESA + salvage mTESE was 15/51 (29%). No complications occurred after multiple needle-pass TESA only, while 5/89 (6%) men having mTESE experienced a complication requiring surgical intervention. Overall, no statistically significant differences in reproductive hormones were observed between groups after 6 mo. Limitations include the low number of patients in secondary outcome data. In direct comparison, SRR was higher in mTESE than in multiple needle-pass TESA. Men with azoospermia need surgical extraction of spermatozoa to become biological fathers. In this randomized trial, we compared two surgeries (microdissection testicular sperm extraction [mTESE] and testicular sperm aspiration [TESA]) and found that mTESE gives a higher sperm retrieval rate than multiple needle-pass TESA. [ABSTRACT FROM AUTHOR]

Background: Alcohol abuse may be elicited by psychological problems and can influence physicians' health and patient safety. To act on it, we need knowledge on the prevalence of the disorder and its associations with psychological factors and physicians' well-being. The aim of this study was to explore whether burnout and alexithymia are associated with risky alcohol consumption in physicians and whether burnout mediates the association between alexithymia and risky alcohol consumption.Methods: In this cross-sectional study, 4,000 randomly selected physicians received an electronic questionnaire by email containing the Alcohol Use Disorders Identification Test (AUDIT), the Maslach Burnout Inventory Human-Services-Survey (MBI-HSS) and the Toronto Alexithymia Scale (TAS-20). A total of 1,841 physicians completed the questionnaire (46%).Results: 18.8% reached the criteria for risky alcohol consumption. The likelihood of having risky alcohol consumption was associated with high levels of alexithymia (OR=1.93, 95%CI=1.37-2.74, P<0.001). Moreover, risky alcohol consumption was associated with burnout (OR=1.86, 95%CI=1.13-3.05, P<0.014) and each individual burnout dimension: emotional exhaustion (OR=1.89, 95%CI=1.33-2.69, P<0.001), depersonalisation (OR=2.23, 95%CI=1.53-3.25, P<0.001) and low levels of personal accomplishment (OR=1.66, 95%CI=1.14-2.41, P=0.008). Mediation analysis suggested that the association between alexithymia and risky alcohol consumption was partially mediated through depersonalisation.Conclusions: The results emphasize a need for enhancing emotional self-awareness in physicians as psychological traits, work-pressure and alcohol dependence might be self-reinforcing aspects for the individual physician. As alcohol dependence and burnout may have consequences for patient safety separately, the aggregated influence of these factors has to be examined. [ABSTRACT FROM AUTHOR]

Importance: Up to 20% of patients develop chronic pain after total knee arthroplasty (TKA), yet there is a scarcity of effective interventions for this population., Objective: To evaluate whether neuromuscular exercise and pain neuroscience education were superior to pain neuroscience education alone for patients with chronic pain after TKA., Design, Setting, and Participants: A superiority randomized clinical trial was conducted at 3 outpatient clinics at Aalborg University Hospital in Denmark. Participants with moderate-to-severe average daily pain intensity and no signs of prosthesis failure at least 1 year after primary TKA were included. Participant recruitment was initiated on April 12, 2019, and completed on October 31, 2022. The 12-month follow-up was completed on March 21, 2023., Interventions: The study included 24 sessions of supervised neuromuscular exercise (2 sessions per week for 12 weeks) and 2 total sessions of pain neuroscience education (6 weeks between each session) or the same pain neuroscience education sessions alone. The interventions were delivered in groups of 2 to 4 participants., Main Outcomes and Measures: The primary outcome was change from baseline to 12 months using the mean score of the Knee Injury and Osteoarthritis Outcome Score, covering the 4 subscales pain, symptoms, activity of daily living, and knee-related quality of life (KOOS4; scores range from 0 to 100, with higher scores indicating better outcomes). The outcome assessors and statistician were blinded. All randomized participants were included in the intention-to-treat analysis., Results: Among the 69 participants (median age, 67.2 years [IQR, 61.2-71.9 years]; 40 female [58%]) included in the study, 36 were randomly assigned to the neuromuscular exercise and pain neuroscience education group, and 33 to the pain neuroscience education-alone group. The intention-to-treat analysis showed no between-group difference in change from baseline to 12 months for the KOOS4 (7.46 [95% CI, 3.04-11.89] vs 8.65 [95% CI, 4.67-12.63] points; mean difference, -1.33 [95% CI, -7.59 to 4.92]; P = .68). Among the 46 participants who participated in the 12-month assessment in the 2 groups, 16 (34.8%) experienced a clinically important improvement (a difference of ≥10 points on the KOOS4) with no between-group difference. No serious adverse events were observed., Conclusions and Relevance: In this randomized clinical trial, the results demonstrated that neuromuscular exercises and pain neuroscience education were not superior to pain neuroscience education alone in participants with chronic pain after TKA. Approximately one-third of the participants, regardless of intervention, experienced clinically important improvements. Future studies should investigate which patient characteristics indicate a favorable response to exercises and/or pain neuroscience education., Trial Registration: ClinicalTrials.gov Identifier: NCT03886259.

Introduction: Following surgical management of patella fractures, patients commonly report pain; difficulties with weight-bearing tasks such as walking, running and climbing stairs; and restrictions in quality of life. Recently, a locking plate system for surgical management of patella fractures has been introduced. To date, no studies have compared standard treatment with tension band wiring with locking plate fixation in a randomised study design. We aim to compare the one-year patient-reported Knee Injury and Osteoarthritis Outcome subscale scores (KOOS5-subscales) after standard care tension band fixation with locking plate fixation for patients with patella fractures., Methods: This is a multicentre randomised and prospective clinical trial. A total of 122 patients will be included in the study, and the primary outcome will be the KOOS subscales at 12 months after surgery., Conclusions: Findings from the present study are expected to advance our understanding of outcome following surgical treatment of patella fractures., Funding: This study is funded, in part, by the Novo Nordisk Foundation, Denmark., Clinicaltrials: gov ID: NCT04891549., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Background: Premature atrial complexes (PACs) meet increased attention as a potential intermediary between sinus rhythm and atrial fibrillation (AF). Patients with even high numbers of PACs do not fulfill current guidelines for oral anticoagulation treatment though an associated stroke risk is suspected., Objective: We aimed to determine whether a high number of PACs or runs of AF less than 30 seconds in 2-day continuous electrocardiogram (ECG) recording was associated with risk of recurrent ischemic stroke/transient ischemic attack (TIA) or death in a large cohort of patients with acute ischemic stroke or TIA and no prior AF., Methods: We performed 48 hours continuous ECG recording within 1 week after ischemic stroke/TIA. PACs were reported as mean number of PACs per hour. Patients were followed in Danish Stroke Registry, Danish Civil Registration System, and Danish National Patient Registry. Cox Regression analysis was used to calculate hazard ratios., Results: We included 1507 patients with TIA (40%) or ischemic stroke (60%), of which 98.7% had mild to moderate strokes. Mean age was 72.9 (7.8) years, 43.4% were females. Follow-up was 2.3 (1.3) years. Hazard ratio for recurrent stroke/TIA or death did not differ between quartiles of PAC burden, nor did any of the 2 components of this composite endpoint. Nonsustained AF less than 30 seconds was not associated with higher risk of recurrent stroke/TIA or death., Conclusions: In a large cohort of patients with recent ischemic stroke or TIA, burden of PACs or nonsustained AF less than 30 seconds were not associated to higher risk of recurrent stroke/TIA or death., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: Global prevalence of risk factors for cardiovascular disease (CVD) and all-cause mortality is increasing. Treatments are available but can only be implemented if individuals at risk are identified. General health checks have been suggested to facilitate this process., Objectives: To examine the long-term effect of population-based general health checks on CVD and all-cause mortality., Design and Setting: The Ebeltoft Health Promotion Project (EHPP) is a parallel randomised controlled trial in a Danish primary care setting., Participants: The EHPP enrolled individuals registered in the Civil Registration System as (1) inhabitants of Ebeltoft municipality, (2) registered with a general practitioner (GP) participating in the study and (3) aged 30-49 on 1 January 1991. A total of 3464 individuals were randomised as invitees (n=2000) or non-invitees (n=1464). Of the invitees, 493 declined. As an external control group, we included 1 511 498 Danes living outside the municipality of Ebeltoft., Interventions: Invitees were offered a general health check and, if test-results were abnormal, recommended a 15-45 min consultation with their GP. Non-invitees in Ebeltoft received a questionnaire at baseline and were offered a general health check at year 5. The external control group, that is, the remaining Danish population, received routine care only., Outcome Measures: HRs for CVD and all-cause mortality., Results: Every individual randomised was analysed. When comparing invitees to non-invitees within the municipality of Ebeltoft, we found no significant effect of general health checks on CVD (HR=1.11 (0.88; 1.41)) or all-cause mortality (HR=0.93 (0.75; 1.16)). When comparing invitees to the remaining Danish population, we found similar results for CVD (adjusted HR=0.99 (0.86; 1.13)) and all-cause mortality (adjusted HR=0.96 (0.85; 1.09))., Conclusion: We found no effect of general health checks offered to the general population on CVD or all-cause mortality., Trial Registration Number: NCT00145782; 2015-57-0002; 62908, 187., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The aims of this study were to describe Danish physicians' use of alcohol and drugs, their self-reported assessment of their use of alcohol and drugs, and their management of colleagues with substance use disorder in physician workplaces., Methods: During the spring of 2014, a nationwide cross-sectional study was conducted as an anonymous, electronic survey among a randomly weighted sample of 1) consultants and practicing specialists, 2) younger physicians (trainees) and 3) general practitioners in Denmark. A total of 4,000 physicians (approx. 1,333 from each group) were sampled and 1,943 responded (49%). The survey included the Alcohol Use Disorders Identification Test on alcohol use and the Drug Use Disorders Identification Test on drug use and related questions on health and psychological issues., Results: The three groups had an almost equal share of risky alcohol use (comprising hazardous, harmful and dependent use) of 17.2-20.3%. The highest proportion (24%) of risky alcohol use was found for both internal medicine and emergency medicine and the lowest for general practice (16%). Significantly more male physicians (25.1%) than female physicians (14.4%) reported risky alcohol use. Among physicians with risky substance use, 23.1% recognised their risky use., Conclusion: The proportion of physicians with a risky use of alcohol and drugs was 19% and 3.0%, respectively. Significantly more male than female physicians reported risky alcohol use. Among physicians with a risky substance use, only one in four recognised this as problematic.

Objectives: To investigate the course of low back pain (LBP) in a general population over 5 years., Design: Prospective population-based survey by postal questionnaires in 1991, 1992, and 1996., Setting: The municipal of Ebeltoft, Denmark., Subjects: Two thousand people aged 30 to 50 years, representative of the Danish population. Main outcome measure Number of days with low back pain during the past year., Results: One thousand three hundred seventy were recruited of whom 813 (59%) were followed to 5 years. The responders could be divided into 3 groups with regard to LBP: no pain, short-term pain, and long-lasting/recurring pain. More than one third of people who experienced LBP in the previous year did so for >30 days. Forty percent of people with LBP >30 days at baseline remained in that group 1 and 5 years later, and 9% with LBP >30 days in year 0 were pain free in year 5. People with LBP in year 0 were 4 times more likely to have LBP in year 1, and 2 times more likely to be affected in year 5., Conclusions: Low back pain should not be considered transient and therefore neglected, since the condition rarely seems to be self-limiting but merely presents with periodic attacks and temporary remissions. On the other hand, chronicity as defined solely by the duration of symptoms should not be considered chronic.