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Jessica Wihl,1– 3 Linn Rosell,1,2 Kirsten Frederiksen,4 Sara Kinhult,1,3 Gert Lindell,5 Mef Nilbert1,4,6 1Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden; 2Regional Cancer Centre South, Region Skåne, Lund, Sweden; 3Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden; 4Danish Cancer Society Research Centre, Copenhagen, Denmark; 5Department of Surgery, Skåne University Hospital, Lund, Sweden; 6Clinical Research Centre, Hvidovre University Hospital and Copenhagen University, Copenhagen, DenmarkCorrespondence: Jessica WihlDepartment of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Scheelev. 2, Lund, 223 63, SwedenEmail jessica.wihl@med.lu.sePurpose: Multidisciplinary team (MDT) meetings integrate complex information and base recommendations for clinical management on interdisciplinary and multiprofessional decision-making. To support high-quality decision-making and define key performance indicators, we aimed to determine completeness of case information and contributions to MDT case discussions in cancer care.Methods: In a prospective observational study design, based on three MDTs, we applied the Metric for Observation of Decision-Making (MODe) tool to assess the quality of case presentation and team members’ contributions to case discussions. The MDTs handled patients with brain tumors, soft tissue sarcomas and hepatobiliary cancers. The results were correlated to patient and team characteristics and to MDT leadership skills.Results: Data were collected from 349 case discussions during 32 MDT meetings. Information on radiology received the highest scores, followed by case history and information on histopathology. Patient-related information was less frequently mentioned and generally received low scores. Contributions to the case discussions were predominantly by the chair, surgeons, and oncologists with limited contributions from nurses. Leadership skills showed a positive correlation with case presentations scores and failure to reach a treatment recommendation correlated with lower case discussion scores.Conclusion: Considerable resources are spent on MDT meetings in cancer care, which motivate initiatives to ensure high-quality and efficient decision-making processes. We identify unbalanced contributions from team members during MDT meetings, demonstrate limited provision of patient-related information and show that leadership skills may positively influence the quality of the case presentations. We suggest that MDTs should consider and develop these aspects to ensure high-quality MDT-based case management and decision-making.Keywords: tumor board, cancer conference, decision-making, patient-centred, comorbidity

Louise T Thomsen,1 Susanne K Kjær,1,2 Christian Munk,1 Kirsten Frederiksen,3 Dorthe Ørnskov,4 Marianne Waldstrøm4,5 1Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; 2Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; 3Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark; 4Department of Pathology, Vejle Hospital, Lillebaelt Hospital, Region of Southern Denmark, Vejle, Denmark; 5Institute of Regional Health Research, University of Southern Denmark, Odense, DenmarkCorrespondence: Louise T ThomsenUnit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen DK-2100, DenmarkTel +45 35257927Email ltt@cancer.dkBackground: Human papillomavirus (HPV) testing is increasingly used as the primary cervical cancer screening test. In a large pilot implementation, we compared participation, referrals and detection of high-grade cervical intraepithelial neoplasia (CIN) in HPV- versus cytology-based cervical cancer screening.Methods: The implementation was embedded into the routine screening program at Lillebaelt Hospital, Department of Pathology, Vejle, Denmark. Based on the area of residence, women aged 30– 59 years were screened by either HPV testing (with HPV16/18 genotyping and cytology triage) or cytology (with HPV triage for minor abnormalities). Our analysis includes women invited or screened during May 2017–May 2018 (invited: n=35,081; screened: n=28,352) with 6 months of follow-up. Information on screening results and sociodemographic characteristics were obtained from registers. Using logistic regression, we estimated odds ratios (ORs) with 95% confidence intervals (CIs) of participation, referral and CIN3+-detection in HPV- versus cytology-based screening, adjusting for sociodemographic characteristics.Results: Participation was virtually identical in the HPV- and cytology group (58.4% vs 58.8%; ORadjusted=0.97, 95% CI, 0.93– 1.01). Referral to colposcopy was more common in the HPV- than cytology group (3.8% vs 2.1%; ORadjusted=1.88, 95% CI, 1.63– 2.17). More cases of CIN3+ were detected in the HPV- than cytology group (1.0% vs 0.7%, ORadjusted=1.47; 95% CI, 1.13– 1.91).Conclusion: Participation did not differ between HPV- and cytology-based screening. HPV-based screening detected more cases of CIN3+, but in this initial screening round also led to more colposcopies than cytology-based screening.Keywords: human papillomavirus, cervical cancer, cervical intraepithelial neoplasia, screening, HPV testing, cytology, secondary prevention

Background and purpose: Dementia is one of the most common disorders and is associated with increased morbidity, mortality and decreased quality of life. The present guideline addresses important medical management issues including systematic medical follow‐up, vascular risk factors in dementia, pain in dementia, use of antipsychotics in dementia and epilepsy in dementia. Methods: A systematic review of the literature was carried out. Based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework, we developed a guideline. Where recommendations based on GRADE were not possible, a good practice statement was formulated. Results: Systematic management of vascular risk factors should be performed in patients with mild to moderate dementia as prevention of cerebrovascular pathology may impact on the progression of dementia (Good Practice statement). Individuals with dementia (without previous stroke) and atrial fibrillation should be treated with anticoagulants (weak recommendation). Discontinuation of opioids should be considered in certain individuals with dementia (e.g. for whom there are no signs or symptoms of pain or no clear indication, or suspicion of side effects; Good Practice statement). Behavioral symptoms in persons with dementia should not be treated with mild analgesics (weak recommendation). In all patients with dementia treated with opioids, assessment of the individual risk–benefit ratio should be performed at regular intervals. Regular, preplanned medical follow‐up should be offered to all patients with dementia. The setting will depend on the organization of local health services and should, as a minimum, include general practitioners with easy access to dementia specialists (Good Practice statement). Individuals with dementia and agitation and/or aggression should be treated with atypical antipsychotics only after all non‐pharmacological measures have been proven to be without benefit or in the case of severe self‐harm or harm to others (weak recommendation). Antipsychotics should be discontinued after cessation of behavioral disturbances and in patients in whom there are side effects (Good Practice statement). For treatment of epilepsy in individuals with dementia, newer anticonvulsants should be considered as first‐line therapy (Good Practice statement). Conclusion: This GRADE‐based guideline offers recommendations on several important medical issues in patients with dementia, and thus adds important guidance for clinicians. For some issues, very little or no evidence was identified, highlighting the importance of further studies within these areas. [ABSTRACT FROM AUTHOR]

Background:We assessed the development in the number of new base of tongue squamous-cell carcinoma (BSCC) cases per year in eastern Denmark from 2000 to 2010 and whether HPV may explain any observable increased incidence.Methods:We performed HPV DNA PCR and p16 immunohistochemistry analysis for all (n=210) BSCCs registered in the Danish Head and Neck Cancer Group (DAHANCA) and the Danish Pathology Data Bank, and genotyped all HPV-positive specimens with amplicon-based next-generation sequencing.Results:The overall crude incidence of BSCCs increased significantly (5.4% per year) during the study period. This was explained by a significant increase in the number of HPV-positive BSCCs (8.1% per year), whereas the number of HPV-negative BSCCs did not increase significantly. The overall HPV prevalence was 51%, with HPV16 as the predominant HPV type.Conclusions:The increased number of HPV-positive BSCCs may explain the increasing incidence of BSCCs in eastern Denmark, 2000-2010. [ABSTRACT FROM AUTHOR]

Background:In an attempt to decrease social disparities in cancer survival, it is important to consider the mechanisms by which socioeconomic position influences cancer prognosis. We aimed to investigate whether any associations between socioeconomic factors and survival after cervical cancer could be explained by socioeconomic differences in cancer stage, comorbidity, lifestyle factors or treatment.Methods:We identified 1961 cases of cervical cancer diagnosed between 2005 and 2010 in the Danish Gynaecological Cancer database, with information on prognostic factors, treatment and lifestyle. Age, vital status, comorbidity and socioeconomic data were obtained from nationwide administrative registers. Associations between socioeconomic indicators (education, income and cohabitation status) and mortality by all causes were analysed in Cox regression models with inclusion of possible mediators. Median follow-up time was 3.0 years (0.01-7.0).Results:All cause mortality was higher in women with shorter rather than longer education (hazard ratio (HR), 1.46; 1.20-1.77), among those with lower rather than higher income (HR, 1.32; 1.07-1.63) and among women aged<60 years without a partner rather than those who cohabited (HR, 1.60; 1.29-1.98). Socioeconomic differences in survival were partly explained by cancer stage and less by comorbidity or smoking (stage- and comorbidty- adjusted HRs being 1.07; 0.96-1.19 for education and 1.15; 0.86-1.52 for income).Conclusion:Socioeconomic disparities in survival after cervical cancer were partly explained by socioeconomic differences in cancer stage. The results point to the importance of further investigations into reducing diagnosis delay among disadvantaged groups. [ABSTRACT FROM AUTHOR]

Background:Several environmental factors have been associated with increased risks for cervical cancer. We examined whether reproductive history, contraceptive use, or sexual behaviour increase the risk for cervical intraepithelial neoplasia grade 3 or worse (CIN3+) among women with persistent human papillomavirus (HPV) infection.Methods:A population-based cohort of women participated in a personal interview and underwent a gynaecological examination at which cervical specimens were obtained for HPV DNA testing. Follow-up information (∼13 years) on cervical lesions was obtained from the Danish Pathology Data Bank. Women who had a high-risk HPV infection comprised the overall study population (n=1353). A subgroup of women with persistent high-risk HPV infection (n=312) was identified. Hazard ratios (HRs) for a diagnosis of CIN3+ and the corresponding 95% confidence intervals (CIs) were calculated.Results:Women with persistent HPV infection who had given birth had a significantly increased risk for CIN3+ (HR=1.78; 95% CI: 1.07-2.94). No association was found with pregnancy, use of intrauterine devices, or sexual behaviour. Based on small numbers, women with persistent HPV infection had a decreased risk for CIN3+ with any use of oral contraceptives (HR=0.54; 95% CI: 0.29-1.00).Conclusion:Childbirth increases the risk for subsequent CIN3+ among women with persistent HPV infection. [ABSTRACT FROM AUTHOR]

Background:Tallness has consistently been associated with an increased risk of breast cancer. We investigated the association further by decomposing height into leg length and sitting height.Methods:From the prospective Danish cohort 'Diet, Cancer and Health', 23 864 postmenopausal women enrolled during 1993-1997 were followed for a diagnosis of breast cancer in the Danish Cancer Registry through 2009.Results:The incidence rate ratios for breast cancer were 1.11 (95% CI=1.06-1.16) for each 5 cm increase in total height and 1.09 (95% CI=1.01-1.17) and 1.14 (95% CI=1.04-1.25) for each 5 cm increase in leg length and sitting height, respectively. There was no statistical significant difference between the associations for leg length and sitting height (P=0.47).Conclusion:Leg length does not seem to be more strongly associated with breast cancer among postmenopausal women than sitting height. [ABSTRACT FROM AUTHOR]

Background:The extent to which experiencing a stressful life event influences breast cancer prognosis remains unknown, as the findings of the few previous epidemiological studies are inconsistent. This large population-based study examines the association between a common major life event, loss of a partner and breast cancer recurrence and all-cause mortality.Methods:N=21 213 women diagnosed with a first primary breast cancer 1994-2006, who had a cohabiting partner in the 4 years before their breast cancer diagnosis, were followed for death and recurrence in population-based registers and clinical databases. Information on education, disposable income, comorbidity and prognostic risk factors were included in Cox regression analyses.Results:Women who had lost a partner either before diagnosis or in subsequent years were not at significantly higher risk of recurrence or dying than women who had not lost a partner.Conclusion:Our results do not support the concern that experiencing a stressful life event, the loss of a partner, negatively affects prognosis of breast cancer. [ABSTRACT FROM AUTHOR]

Based on a discourse analysis inspired by the French philosopher Michel Foucault's late work, the article compares Danish textbooks for nurses and doctors between 1870 and 1956. With the concept of a figure of thought, it is suggested that the discourses of knowledge addressed to nurses were constructed in a pattern in which intertwined arguments formed the figure of orderliness. These arguments were based on knowledge, the patient's needs, the doctor's needs and moral principles, including the needs of the profession and ethical-esthetic principles, whereas the pattern of the discourses of knowledge addressed to the doctor was based on knowledge of diseases reflecting a figure of scientific order. These patterns did not change throughout the period. In the textbooks for nurses, the nurse's relation to self was an explicit subject, whereas the doctor's relation to self was not part of the textbooks addressed to doctors. In light of Foucault's late work, it is suggested that the discourses of knowledge contribute to maintaining the prevailing order in the society; it would be of interest to investigate whether the identified pattern has changed since 1956 and whether it has influenced other areas of nursing education and practice. [ABSTRACT FROM AUTHOR]

Background: We conducted a randomised study to investigate whether providing a self-guided Internet support group to cancer patients affected mood disturbance and adjustment to cancer.Methods: Baseline and 1-, 6- and 12-month assessments were conducted from 2004 to 2006 at a national rehabilitation centre in Denmark. A total of 58 rehabilitation course weeks including 921 survivors of various cancers were randomly assigned to a control or an intervention group by cluster randomisation. The intervention was a lecture on the use of the Internet for support and information followed by participation in an Internet support group. Outcome measures included self-reported mood disturbance, adjustment to cancer and self-rated health. Differences in scores were compared between the control group and the intervention group.Results: The effect of the intervention on mood disturbance and adjustment to cancer showed a transient difference at the 6-month follow-up, where the intervention group reported less reduction in anxious preoccupation (P=0.04), helplessness (P=0.002), confusion (P=0.001) and depression (P=0.04). Otherwise no significant effects were observed.Conclusion: We conclude that use of Internet-based support groups in cancer patients still needs to confirm long-lasting psychological effects. [ABSTRACT FROM AUTHOR]

Among 14,088 patients, with a primary diagnosis of Parkinson's disease during the period 1977-98 identified from the National Register of Patients, 1282 cancers were subsequently recorded in the Danish Cancer Registry, compared with 1464 expected, with a standardised incidence ratio (SIR) of 0.88 (95% confidence interval (CI), 0.8-0.9). Significantly reduced risks were found for smoking-related cancers, for example, cancers of the lung (SIR, 0.38), larynx (0.47) and urinary bladder (0.52), although moderate reductions in risk were also seen for several nonsmoking-related cancers. In contrast, increased risks were seen for malignant melanoma (SIR, 1.95; 95% CI, 1.4-2.6), nonmelanocytic skin cancer (1.25; 1.1-1.4) and breast cancer (1.24; 1.0-1.5). The observed cancer pattern supports the hypothesis that constituents of tobacco smoke inhibit or delay the development of Parkinson's disease, but a low smoking prevalence appears to be only part of the explanation for the decreased cancer incidence. The increased relative risks of melanoma and nonmelanoma skin cancer are not likely to be artefactual, but further investigations of potential mechanisms are warranted. [ABSTRACT FROM AUTHOR]

QT interval prolongation is the ECG correlate of prolongation of the cardiac action potential (AP). Abnormal or excessive QT interval prolongation may be associated with an increased risk of ventricular tachycardia. This association appears increasingly evident in congenital long QT syndrome and with certain classes of cardiovascular and non-cardiovascular therapeutics. Almost all drugs causing QT interval prolongation inhibit the rapid component of the delayed rectifier potassium current (I[sub Kr]), an ion channel involved in the termination of the myocardial AP. Inhibition of I[sub Kr] leads to AP and QT interval prolongation. Drugs, which do not encounter a sufficient electrophysiological counterbalance to the inhibitory effect on I[sub Kr], may thus impose a risk of ventricular tachyarrhythmia. Some non-cardiac drugs, including the antipsychotic sertindole, have inhibitory effects on I[sub Kr] but, in contrast to the drugs that are known to cause tachyarrhythmia, sertindole possesses an important electrophysiological counterbalancing profile. Sertindole inhibits α[sub 1]-adrenoceptors and blocks both sodium and calcium channels. The balanced electrophysiological profile of sertindole may well explain the low proarrhythmic potential observed in animal proarrhythmia models against positive comparators. It also supports the lack of increased cardiac mortality observed in clinical trials with sertindole and in large epidemiological studies. [ABSTRACT FROM AUTHOR]

Comments on several issues concerning medicine in Great Britain. Survival from acute leukemia in childhood; Viability of tubal grafts for possible pregnancy; Incidence of liver fluke infestation in livestock.