39 results on '"Olesen, M."'
Search Results
2. THE C¹²(C¹², α)Ne²⁰ REACTION
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Bromley, D. A., primary, Borggreen, J., additional, Elbek, B., additional, Leachmann, R. B., additional, Olesen, M. C., additional, and Poulsen, N. O. R., additional
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- 2023
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3. Effects of long-term continuous screening for atrial fibrillation on heart failure events - results from the randomized LOOP Study
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Xing, L Y, primary, Hojberg, S, additional, Krieger, D W, additional, Graff, C, additional, Olesen, M S, additional, Healey, J S, additional, Mcintyre, W F, additional, Brandes, A, additional, Kober, L, additional, Haugan, K J, additional, Svendsen, J H, additional, and Diederichsen, S Z, additional
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- 2024
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4. Development and Validation of a Nordic Multimorbidity Index Based on Hospital Diagnoses and Filled Prescriptions
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Kristensen KB, Lund LC, Jensen PB, Broe A, Rotbain E, Damkier P, Pottegård A, Andersen JH, Højlund M, Olesen M, Rasmussen L, Hansen MR, Ernst MT, Wesselhoeft R, Henriksen DP, Reilev M, Bliddal M, and Hallas J
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multimorbidity ,comorbidity ,pharmacoepidemiology ,prognosis ,risk score ,Infectious and parasitic diseases ,RC109-216 - Abstract
Kasper Bruun Kristensen,1 Lars Christian Lund,1 Peter Bjødstrup Jensen,1 Anne Broe,1 Emelie Rotbain,2 Per Damkier,1,3,4 Anton Pottegård,1 Jacob Harbo Andersen,1 Mikkel Højlund,1,5 Morten Olesen,1 Lotte Rasmussen,1 Morten Rix Hansen,1,3,4 Martin Thomsen Ernst,1 Rikke Wesselhoeft,1,6 Daniel Pilsgaard Henriksen,3 Mette Reilev,1 Mette Bliddal,1,7 Jesper Hallas1 1Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark; 2Department of Hematology, Odense University Hospital, Odense, Denmark; 3Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark; 4Department of Clinical Research, University of Southern Denmark, Odense, Denmark; 5Department of Psychiatry Aabenraa, Mental Health Services in the Region of Southern Denmark, Aabenraa, Denmark; 6Child and Adolescent Psychiatry Odense, Mental Health Services in the Region of Southern Denmark, Odense, Denmark; 7Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, DenmarkCorrespondence: Jesper Hallas, Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 19, 2, Odense, 5000, Denmark, Tel +4565503010, Email jhallas@health.sdu.dkPurpose: To develop the Nordic Multimorbidity Index (NMI), a multimorbidity measure specifically suited to the Nordic health and administrative registry data based on current diagnosis, treatment, and coding practices.Methods: The NMI was developed to predict 5-year mortality in a population-based cohort of randomly sampled Danish residents aged ≥ 40 years (n = 425,087) followed from 2013 to 2018. Included predictors were selected from hospital diagnoses and filled drug prescriptions based on a combination of subject matter knowledge and a data-driven approach using backwards elimination. The performance of the NMI was assessed in a temporal validation cohort of Danish residents followed from 2007 to 2012 and in six cohorts of new users of selected drugs. The discriminative performance of the NMI, Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) was assessed using the c-statistic from logistic regression models with 5-year mortality as dependent variable and the multimorbidity index score, age, and sex as independent variables.Results: The NMI included 50 predictors. In the temporal validation cohort, the c-statistic of the NMI (0.887, 95% CI 0.883– 0.890) exceeded that of the CCI (0.871, 95% CI 0.868– 0.874) and ECI (0.866, 95% CI 0.863– 0.870). In all new user cohorts, the NMI outperformed the other indices with c-statistics ranging from 0.781 (95% CI 0.779– 0.784) to 0.838 (95% CI 0.834– 0.842).Conclusion: The NMI predicted 5-year mortality in a general Danish population and six cohorts of new users of selected drugs and was superior to the CCI and ECI. The NMI could be preferred over these indices to quantify the level of multimorbidity for, eg, descriptive purposes or confounding control. The NMI should be validated in other patient populations and other Nordic countries.Keywords: multimorbidity, comorbidity, pharmacoepidemiology, prognosis, risk score
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- 2022
5. Genome-wide association study of amidoarone-induced hypothyroidism
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Rand, S, primary, Olesen, M S, additional, Ostrowski, S R, additional, Sorensen, E, additional, Pedersen, O B, additional, Bundgaard, H, additional, and Ghouse, J, additional
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- 2023
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6. Anticoagulation-associated bleeding in patients randomised to screening for atrial fibrillation or usual care
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Kongebro, E, primary, Diederichsen, S, additional, Xing, L, additional, Haugan, K, additional, Graff, C, additional, Hoejberg, S, additional, Olesen, M, additional, Brandes, A, additional, Koeber, L, additional, and Svendsen, J, additional
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- 2023
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7. Heterogeneity after harmonisation: A retrospective cohort study of bleeding and stroke risk after the introduction of direct oral anticoagulants in four Western European countries
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Komen, J. J., primary, Hunt, N. B., additional, Pottegård, A., additional, Hjemdahl, P., additional, Wettermark, B., additional, Olesen, M., additional, Bennie, M., additional, Mueller, T., additional, Carragher, R., additional, Karlstad, Ø., additional, Kjerpeseth, L. J., additional, Klungel, O. H., additional, and Forslund, T., additional
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- 2023
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8. EPS6.03 Pulmonary pathogen prevalence 12 months after elexacaftor/tezacaftor/ivacaftor introduction: results from the Danish National Cystic Fibrosis Cohort
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Jeppesen, M., primary, Jensen-Fangel, S., additional, Jensen, C. Bjørn, additional, Katzenstein, T., additional, Wang, M., additional, Olesen, M. Frahm, additional, Pressler, T., additional, Skov, M., additional, Olesen, H. Vebert, additional, and Qvist, T., additional
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- 2023
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9. Electrocardiographic markers of subclinical atrial fibrillation detected by implantable loop recorder
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Xing, L Y, primary, Diederichsen, S Z, additional, Hojberg, S, additional, Krieger, D W, additional, Graff, C, additional, Olesen, M S, additional, Nielsen, J B, additional, Brandes, A, additional, Kober, L, additional, Haugan, K J, additional, and Svendsen, J H, additional
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- 2023
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10. Morphology-Voltage-P-wave-duration (MVP) score to select patients for continuous atrial fibrillation screening to prevent stroke
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Xing, L Y, primary, Diederichsen, S Z, additional, Hojberg, S, additional, Krieger, D W, additional, Graff, C, additional, Olesen, M S, additional, Nielsen, J B, additional, Brandes, A, additional, Kober, L, additional, Haugan, K J, additional, and Svendsen, J H, additional
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- 2023
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11. Heterogeneity after harmonisation: a retrospective cohort study of bleeding and stroke risk after the introduction of direct oral anticoagulants in four Western European countries
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Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, PECP - Centre for Pharmacoepidemiology, Komen, J. J., Hunt, N. B., Pottegård, A., Hjemdahl, P., Wettermark, B., Olesen, M., Bennie, M., Mueller, T., Carragher, R., Karlstad, Ø., Kjerpeseth, L. J., Klungel, O. H., Forslund, T., Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, PECP - Centre for Pharmacoepidemiology, Komen, J. J., Hunt, N. B., Pottegård, A., Hjemdahl, P., Wettermark, B., Olesen, M., Bennie, M., Mueller, T., Carragher, R., Karlstad, Ø., Kjerpeseth, L. J., Klungel, O. H., and Forslund, T.
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- 2023
12. Heterogeneity after harmonisation : A retrospective cohort study of bleeding and stroke risk after the introduction of direct oral anticoagulants in four Western European countries
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Komen, J. J., Hunt, N. B., Pottegård, A., Hjemdahl, P., Wettermark, Björn, Olesen, M., Bennie, M., Mueller, T., Carragher, R., Karlstad, Ø., Kjerpeseth, L. J., Klungel, O. H., Forslund, T., Komen, J. J., Hunt, N. B., Pottegård, A., Hjemdahl, P., Wettermark, Björn, Olesen, M., Bennie, M., Mueller, T., Carragher, R., Karlstad, Ø., Kjerpeseth, L. J., Klungel, O. H., and Forslund, T.
- Abstract
Purpose: Database heterogeneity can impact effect estimates. Harmonisation provided by common protocols and common data models (CDMs) can increase the validity of pharmacoepidemiologic research. In a case study measuring the changes in the safety and effectiveness of stroke prevention therapy after the introduction of direct oral anticoagulants (DOACs), we performed an international comparison. Methods: Using data from Stockholm, Denmark, Scotland and Norway, harmonised with a common protocol and CDM, two calendar-based cohorts were created: 2012 and 2017. Patients with a diagnosis code of atrial fibrillation 5 years preceding the 1-year cohort window were included. DOAC, vitamin K antagonist and aspirin treat-ment were assessed in the 6 months prior to the start of each year while strokes and bleeds were assessed during the year. A Poisson regression generated incidence rate ratios (IRRs) to compare outcomes from 2017 to 2012 adjusted for changes in individual-level baseline characteristics. Results: In 280 359 patients in the 2012 cohort and 356 779 in the 2017 cohort, treatment with OACs increased on average from 45% to 65%, while treatment with aspirin decreased from 30% to 10%. In all countries except Scotland, there were decreases in the risk of stroke and no changes in bleeding risk, after adjustment for changes in baseline characteristics. In Scotland, major bleeding (IRR 1.09, 95% confidence interval [CI] [1.00; 1.18]) and intracranial haemorrhage (IRR 1.31, 95% CI [1.13; 1.52]) increased from 2012 to 2017. Conclusions: Stroke prevention therapy improved from 2012 to 2017 with a corre-sponding reduction in stroke risk without increasing the risk of bleeding in all countries, except Scotland. The heterogeneity that remains after methodological harmonisation can be informative of the underlying population and database.
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- 2023
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13. The rs13376333 risk allele mimics the effect of atrial fibrillation on SK-current density and afterdepolarizations in human atrial myocytes
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Jiménez-Sábado, Verónica, Tarifa, Carmen, Casabella, Sergi, Montiel, José, Rodriguez-Font, E., Olesen, M. S., and Hove-Madsen, Leif
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Cardiology and Cardiovascular Medicine - Abstract
Trabajo presentado en el European Society of Cardiology Congress, celebrado en Barcelona (España), del 26 al 29 de agosto de 2022, Background: Various genome wide association studies have associated the single nucleotide polymorphism (SNP) rs13376333 with increased risk of atrial fibrillation. This SNP is intronic to the KCNN3 gene that codes for the small conductance calcium-activated potassium channel type 3 (SK3), but functional electrophysiological effects of the risk variant are not known. Purpose: This study aimed to study the effects of atrial fibrillation and the rs13376333 risk SNP on the apamine sensitive SK-current and on afterdepolarizations in human atrial myocytes. Methods: Myocytes were isolated from human right atrial samples, and subjected to perforated patch-clamp technique to measure the apamine (100 nM) sensitive SK-current elicited by a voltage-ramp protocol, spontaneous transient inward Na-Ca exchange currents (ITI) or afterdepolarizations at rest. To assess the impact of the rs13376333 risk variant, patients without atrial fibrillation were genotyped and divided into risk and control groups according to the genotype at rs13376333. Results: At membrane potentials above ¿40 mV, the SK-current density increased with increasing membrane potentials. At +20mV the density was significantly smaller (0.18±0.04 pA/pF) in 5 patients with atrial fibrillation than in 24 patients without this arrhythmia (0.65±0.12 pA/pF, p
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- 2022
14. High prevalence of deleterious variants in cardiomyopathy genes in patients with early onset atrial fibrillation
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Vad, O B, primary, Ahlberg, G, additional, Paludan-Muller, C, additional, Refsgaard, L, additional, Sajadieh, A, additional, Haunsoe, S, additional, Bundgaard, H, additional, Svendsen, J H, additional, and Olesen, M S, additional
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- 2022
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15. Genome-wide association study on cerebral white-matter hyperintensities in 36,577 individuals
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Jespersen, J, primary, Ahlberg, G, additional, Andreasen, L, additional, Ghouse, J, additional, Frederiksen, K S, additional, Haunsoe, S, additional, Svendsen, J H, additional, Frikke-Schmidt, R, additional, Olesen, M S, additional, and Bundgaard, H, additional
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- 2022
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16. Genome-wide multi-trait analysis on cardioembolic stroke identifies 47 novel loci
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Meseguer Monfort, L, primary, Ahlberg, G, additional, Andreasen, L, additional, Ghouse, J, additional, Haunso, S, additional, Bundgaard, H, additional, Svendsen, J H, additional, and Olesen, M S, additional
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- 2022
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17. Loss-of-function variants in founder population highlight atrial myopathy as susceptibility to atrial fibrillation
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Paludan-Muller, C, primary, Vad, O B, additional, Kahnert, K, additional, Ahlberg, G, additional, Monfort, L M, additional, Rand, S A, additional, Trudsoe, L C, additional, Andreasen, L, additional, Christensen, A H, additional, Bundgaard, H, additional, Lundby, A, additional, Svendsen, J H, additional, and Olesen, M S, additional
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- 2022
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18. Dissecting genetics in hypothyroidism as an independent risk factor in atherosclerotic disease
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Rand, S, primary, Haunsoe, S, additional, Olesen, M S, additional, and Ghouse, J, additional
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- 2022
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19. Screening for atrial fibrillation to prevent stroke in elderly individuals with or without preexisting cardiovascular disease
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Xing, L Y, primary, Diederichsen, S Z, additional, Hojberg, S, additional, Krieger, D W, additional, Graff, C, additional, Olesen, M S, additional, Brandes, A, additional, Kober, L, additional, Haugan, K J, additional, and Svendsen, J H, additional
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- 2022
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20. OC-0780 Parametrization of artery delineation and nationwide implementation in the DBCG RT Nation cohort
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Skarsø, E.R., primary, Hindhede Refsgaard, L., additional, Ravkilde, T., additional, Dahl Nissen, H., additional, Berg, M., additional, Boye, K., additional, Kamby, C., additional, Jakobsen, K., additional, Olesen, M., additional, Vrou Offersen, B., additional, and Korreman, S.S., additional
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- 2022
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21. Haloperidol for the Treatment of Delirium in ICU Patients
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Andersen-Ranberg, N, Poulsen, L, Perner, A, Wetterslev, J, Estrup, S, Hästbacka, J, Morgan, M, Citerio, G, Caballero, J, Lange, T, Kjær, M, Ebdrup, B, Engstrøm, J, Olsen, M, Oxenbøll Collet, M, Mortensen, C, Weber, S, Andreasen, A, Bestle, M, Uslu, B, Scharling Pedersen, H, Gramstrup Nielsen, L, Toft Boesen, H, Jensen, J, Nebrich, L, La Cour, K, Laigaard, J, Haurum, C, Olesen, M, Overgaard-Steensen, C, Westergaard, B, Brand, B, Kingo Vesterlund, G, Thornberg Kyhnauv, P, Mikkelsen, V, Hyttel-Sørensen, S, de Haas, I, Aagaard, S, Nielsen, L, Eriksen, A, Rasmussen, B, Brix, H, Hildebrandt, T, Schønemann-Lund, M, Fjeldsøe-Nielsen, H, Kuivalainen, A, Mathiesen, O, Andersen-Ranberg, Nina C, Poulsen, Lone M, Perner, Anders, Wetterslev, Jørn, Estrup, Stine, Hästbacka, Johanna, Morgan, Matt, Citerio, Giuseppe, Caballero, Jesus, Lange, Theis, Kjær, Maj-Brit N, Ebdrup, Bjørn H, Engstrøm, Janus, Olsen, Markus H, Oxenbøll Collet, Marie, Mortensen, Camilla B, Weber, Sven-Olaf, Andreasen, A Sofie, Bestle, Morten H, Uslu, Bülent, Scharling Pedersen, Helle, Gramstrup Nielsen, Louise, Toft Boesen, Hans C, Jensen, Jacob V, Nebrich, Lars, La Cour, Kirstine, Laigaard, Jens, Haurum, Cecilie, Olesen, Marie W, Overgaard-Steensen, Christian, Westergaard, Bo, Brand, Björn, Kingo Vesterlund, Gitte, Thornberg Kyhnauv, Pernille, Mikkelsen, Vibe S, Hyttel-Sørensen, Simon, de Haas, Inge, Aagaard, Søren R, Nielsen, Line O, Eriksen, Anne S, Rasmussen, Bodil S, Brix, Helene, Hildebrandt, Thomas, Schønemann-Lund, Martin, Fjeldsøe-Nielsen, Hans, Kuivalainen, Anna-Maria, Mathiesen, Ole, Andersen-Ranberg, N, Poulsen, L, Perner, A, Wetterslev, J, Estrup, S, Hästbacka, J, Morgan, M, Citerio, G, Caballero, J, Lange, T, Kjær, M, Ebdrup, B, Engstrøm, J, Olsen, M, Oxenbøll Collet, M, Mortensen, C, Weber, S, Andreasen, A, Bestle, M, Uslu, B, Scharling Pedersen, H, Gramstrup Nielsen, L, Toft Boesen, H, Jensen, J, Nebrich, L, La Cour, K, Laigaard, J, Haurum, C, Olesen, M, Overgaard-Steensen, C, Westergaard, B, Brand, B, Kingo Vesterlund, G, Thornberg Kyhnauv, P, Mikkelsen, V, Hyttel-Sørensen, S, de Haas, I, Aagaard, S, Nielsen, L, Eriksen, A, Rasmussen, B, Brix, H, Hildebrandt, T, Schønemann-Lund, M, Fjeldsøe-Nielsen, H, Kuivalainen, A, Mathiesen, O, Andersen-Ranberg, Nina C, Poulsen, Lone M, Perner, Anders, Wetterslev, Jørn, Estrup, Stine, Hästbacka, Johanna, Morgan, Matt, Citerio, Giuseppe, Caballero, Jesus, Lange, Theis, Kjær, Maj-Brit N, Ebdrup, Bjørn H, Engstrøm, Janus, Olsen, Markus H, Oxenbøll Collet, Marie, Mortensen, Camilla B, Weber, Sven-Olaf, Andreasen, A Sofie, Bestle, Morten H, Uslu, Bülent, Scharling Pedersen, Helle, Gramstrup Nielsen, Louise, Toft Boesen, Hans C, Jensen, Jacob V, Nebrich, Lars, La Cour, Kirstine, Laigaard, Jens, Haurum, Cecilie, Olesen, Marie W, Overgaard-Steensen, Christian, Westergaard, Bo, Brand, Björn, Kingo Vesterlund, Gitte, Thornberg Kyhnauv, Pernille, Mikkelsen, Vibe S, Hyttel-Sørensen, Simon, de Haas, Inge, Aagaard, Søren R, Nielsen, Line O, Eriksen, Anne S, Rasmussen, Bodil S, Brix, Helene, Hildebrandt, Thomas, Schønemann-Lund, Martin, Fjeldsøe-Nielsen, Hans, Kuivalainen, Anna-Maria, and Mathiesen, Ole
- Abstract
Background Haloperidol is frequently used to treat delirium in patients in the intensive care unit (ICU), but evidence of its effect is limited. Methods In this multicenter, blinded, placebo-controlled trial, we randomly assigned adult patients with delirium who had been admitted to the ICU for an acute condition to receive intravenous haloperidol (2.5 mg 3 times daily plus 2.5 mg as needed up to a total maximum daily dose of 20 mg) or placebo. Haloperidol or placebo was administered in the ICU for as long as delirium continued and as needed for recurrences. The primary outcome was the number of days alive and out of the hospital at 90 days after randomization. Results A total of 1000 patients underwent randomization; 510 were assigned to the haloperidol group and 490 to the placebo group. Among these patients, 987 (98.7%) were included in the final analyses (501 in the haloperidol group and 486 in the placebo group). Primary outcome data were available for 963 patients (97.6%). At 90 days, the mean number of days alive and out of the hospital was 35.8 (95% confidence interval [CI], 32.9 to 38.6) in the haloperidol group and 32.9 (95% CI, 29.9 to 35.8) in the placebo group, with an adjusted mean difference of 2.9 days (95% CI, -1.2 to 7.0) (P=0.22). Mortality at 90 days was 36.3% in the haloperidol group and 43.3% in the placebo group (adjusted absolute difference, -6.9 percentage points [95% CI, -13.0 to -0.6]). Serious adverse reactions occurred in 11 patients in the haloperidol group and in 9 patients in the placebo group. Conclusions Among patients in the ICU with delirium, treatment with haloperidol did not lead to a significantly greater number of days alive and out of the hospital at 90 days than placebo.
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- 2022
22. Genome-wide association study of atrial fibrillation in 114,539 Finnish individuals reveals novel locus associated with cardiac remodelling
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Paludan-Muller, C, primary, Vad, O B, additional, Svendsen, J H, additional, and Olesen, M S, additional
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- 2021
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23. Left atrial remodeling and cerebrovascular disease assessed by magnetic resonance imaging in patients undergoing continuous heart rhythm monitoring
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Bertelsen, L, primary, Diederichsen, S Z, additional, Frederiksen, K S, additional, Haugan, K J, additional, Brandes, A, additional, Graff, C, additional, Krieger, D, additional, Hoejberg, S, additional, Olesen, M S, additional, Biering-Soerensen, T, additional, Koeber, L, additional, Vejlstrup, N, additional, Hasselbalch, S G, additional, and Svendsen, J H, additional
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- 2021
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24. Integration of Scandinavian genetic data with UK biobank data implicates the RBM20 gene with atrial fibrillation pathogenesis
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Vad, O B, primary, Angeli, E, additional, Liss, M, additional, Ahlberg, G, additional, Andreasen, L, additional, Christophersen, I E, additional, Tveit, A, additional, Haunsoe, S, additional, Svendsen, J H, additional, Lundegaard, P R, additional, Gotthardt, M, additional, and Olesen, M S, additional
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- 2021
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25. Haloperidol for the Treatment of Delirium in ICU Patients
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Andersen-Ranberg, N.C., Poulsen, L.M., Perner, A., Wetterslev, J., Estrup, S., Hästbacka, J., Morgan, M., Citerio, G., Caballero, J., Lange, T., Kjær, M.-B.N., Ebdrup, B.H., Engstrøm, J., Olsen, M.H., Collet, M. Oxenbøll, Mortensen, C.B., Weber, S.-O., Andreasen, A.S., Bestle, M.H., Uslu, B., Pedersen, H. Scharling, Gramstrup Nielsen, L., Toft Boesen, H.C., Jensen, J.V., Nebrich, L., Cour, K. La, Laigaard, J., Haurum, C., Olesen, M.W., Overgaard-Steensen, C., Westergaard, B., Brand, B.A., Vesterlund, G. Kingo, Kyhnauv, P. Thornberg, Mikkelsen, V.S., Hyttel-Sørensen, S., De Haas, I., Aagaard, S.R., Nielsen, L.O., Eriksen, A.S., Rasmussen, B.S., Brix, H., Hildebrandt, T., Schønemann-Lund, M., Fjeldsøe-Nielsen, H., Kuivalainen, A.-M., Mathiesen, O., Vestergaard, Stine, Bunzel, Anne-Marie, Moulvad, Rine, Andersen-Ranberg, N, Poulsen, L, Perner, A, Wetterslev, J, Estrup, S, Hästbacka, J, Morgan, M, Citerio, G, Caballero, J, Lange, T, Kjær, M, Ebdrup, B, Engstrøm, J, Olsen, M, Oxenbøll Collet, M, Mortensen, C, Weber, S, Andreasen, A, Bestle, M, Uslu, B, Scharling Pedersen, H, Gramstrup Nielsen, L, Toft Boesen, H, Jensen, J, Nebrich, L, La Cour, K, Laigaard, J, Haurum, C, Olesen, M, Overgaard-Steensen, C, Westergaard, B, Brand, B, Kingo Vesterlund, G, Thornberg Kyhnauv, P, Mikkelsen, V, Hyttel-Sørensen, S, de Haas, I, Aagaard, S, Nielsen, L, Eriksen, A, Rasmussen, B, Brix, H, Hildebrandt, T, Schønemann-Lund, M, Fjeldsøe-Nielsen, H, Kuivalainen, A, and Mathiesen, O
- Subjects
Psychiatry ,Adult ,Psychiatry General ,INTENSIVE-CARE-UNIT ,Pulmonary/Critical Care General ,Critical Care ,MORTALITY ,Neurology/Neurosurgery ,Delirium ,Confusion/Delirium ,General Medicine ,Hospital-Based Clinical Medicine ,VALIDATION ,Pulmonary/Critical Care ,Intensive Care Units ,Double-Blind Method ,Humans ,Haloperidol ,Clinical Medicine General ,Clinical Medicine ,Antipsychotic Agents - Abstract
Background: Haloperidol is frequently used to treat delirium in patients in the intensive care unit (ICU), but evidence of its effect is limited.Methods: In this multicenter, blinded, placebo-controlled trial, we randomly assigned adult patients with delirium who had been admitted to the ICU for an acute condition to receive intravenous haloperidol (2.5 mg 3 times daily plus 2.5 mg as needed up to a total maximum daily dose of 20 mg) or placebo. Haloperidol or placebo was administered in the ICU for as long as delirium continued and as needed for recurrences. The primary outcome was the number of days alive and out of the hospital at 90 days after randomization.Results: A total of 1000 patients underwent randomization; 510 were assigned to the haloperidol group and 490 to the placebo group. Among these patients, 987 (98.7%) were included in the final analyses (501 in the haloperidol group and 486 in the placebo group). Primary outcome data were available for 963 patients (97.6%). At 90 days, the mean number of days alive and out of the hospital was 35.8 (95% confidence interval [CI], 32.9 to 38.6) in the haloperidol group and 32.9 (95% CI, 29.9 to 35.8) in the placebo group, with an adjusted mean difference of 2.9 days (95% CI, -1.2 to 7.0) (P = 0.22). Mortality at 90 days was 36.3% in the haloperidol group and 43.3% in the placebo group (adjusted absolute difference, -6.9 percentage points [95% CI, -13.0 to -0.6]). Serious adverse reactions occurred in 11 patients in the haloperidol group and in 9 patients in the placebo group.Conclusions: Among patients in the ICU with delirium, treatment with haloperidol did not lead to a significantly greater number of days alive and out of the hospital at 90 days than placebo. (Funded by Innovation Fund Denmark and others; AID-ICU ClinicalTrials.gov number, NCT03392376; EudraCT number, 2017-003829-15.).
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- 2022
26. Genetic Susceptibility to Hidradenitis Suppurativa and Predisposition to Cardiometabolic Disease.
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Nielsen VW, Bundgaard Vad O, Holgersen N, Paludan-Müller C, Meseguer Monfort L, Beyer AF, Jemec GBE, Kjærsgaard Andersen R, Egeberg A, Thyssen JP, Svendsen JH, Rosenø NAL, Hansen PR, Thomsen SF, and Salling Olesen M
- Abstract
Importance: Hidradenitis suppurativa (HS) is associated with an increased prevalence of cardiovascular diseases compared with the general population. Any association between polygenic risk for HS, risk of incident cardiometabolic outcomes, and the plasma proteome is unclear., Objective: To investigate the genetic correlation between HS and cardiometabolic disease., Design, Setting, and Participants: This cohort study used a polygenic risk score (PRS) for HS to examine the risks of coronary artery disease (CAD) and diabetes and identify changes in the plasma proteome in individuals of European ancestry from the UK Biobank. Participants were enrolled from January 1, 2006, to December 31, 2010. End of follow-up was January 1, 2023. Correlations were assessed between HS susceptibility and cardiometabolic traits using linkage disequilibrium score regression. Odds ratios were assessed in logistic regressions. The risk of incident CAD and diabetes was estimated in cause-specific survival models designed as time-to-event analyses., Exposure: The PRS for HS., Main Outcomes and Measures: Main outcomes were CAD and diabetes diagnosis measured by logistic regressions and incident disease measured by Cox proportional hazards regression models adjusted for sex, age, body mass index, and smoking status., Results: The study included 391 481 individuals (median [IQR] age, 58 [51-64] years; 209 235 [53%] female). Genetic variants for HS correlated significantly with variants associated with CAD, diabetes, and plasma levels of high-density lipoprotein cholesterol, triglycerides, and C-reactive protein. Compared with the low-risk group, a high PRS for HS (≥75th percentile) conferred odds ratios of 1.09 (95% CI, 1.06-1.12; P < .001) for CAD and 1.13 (95% CI, 1.10-1.17; P < .001) for diabetes. Estimates remained consistent when examining only incident CAD and diabetes. The PRS for HS was significantly associated with altered expression of 58 plasma proteins. Integrating this proteomic profile and the PRS for HS in a machine learning model improved prediction of CAD and diabetes compared with a reference model based on sex, age, and body mass index., Conclusions and Relevance: These findings suggest that a high genetic risk of HS is associated with increased risk of subsequent CAD and diabetes and altered composition of the plasma proteome. Additional investigation into the identified proteins and their potential roles as drug targets is warranted.
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- 2024
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27. Within-person stability of lipoprotein(a) concentration.
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Ghouse J, Ahlberg G, Albertsen Rand S, Salling Olesen M, Vilhjalmsson B, Stender S, and Bundgaard H
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- 2024
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28. Tularemia From Veterinary Occupational Exposure.
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Marx GE, Curren E, Olesen M, Cronquist L, Schlosser L, Nichols M, Bye M, Cote A, McCormick DW, and Nelson CA
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- Humans, Animals, Dogs, Abscess, Zoonoses microbiology, Tularemia microbiology, Tularemia veterinary, Francisella tularensis, Occupational Exposure
- Abstract
Tularemia is a disease caused by Francisella tularensis, a highly infectious bacteria that can be transmitted to humans by direct contact with infected animals. Because of the potential for zoonotic transmission of F. tularensis, veterinary occupational risk is a concern. Here, we report on a human case of tularemia in a veterinarian after an accidental needlestick injury during abscess drainage in a sick dog. The veterinarian developed ulceroglandular tularemia requiring hospitalization but fully recovered after abscess drainage and a course of effective antibiotics. To systematically assess veterinary occupational transmission risk of F. tularensis, we conducted a survey of veterinary clinical staff after occupational exposure to animals with confirmed tularemia. We defined a high-risk exposure as direct contact to the infected animal's body fluids or potential aerosol inhalation without use of standard personal protective equipment (PPE). Survey data included information on 20 veterinary occupational exposures to animals with F. tularensis in 4 states. Veterinarians were the clinical staff most often exposed (40%), followed by veterinarian technicians and assistants (30% and 20%, respectively). Exposures to infected cats were most common (80%). Standard PPE was not used during 80% of exposures; a total of 7 exposures were categorized as high risk. Transmission of F. tularensis in the veterinary clinical setting is possible but overall risk is likely low. Veterinary clinical staff should use standard PPE and employ environmental precautions when handling sick animals to minimize risk of tularemia and other zoonotic infections; postexposure prophylaxis should be considered after high-risk exposures to animals with suspected or confirmed F. tularensis infection to prevent tularemia., Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.)
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- 2024
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29. Endometrial scratching in women undergoing IVF/ICSI: an individual participant data meta-analysis.
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van Hoogenhuijze NE, Lahoz Casarramona G, Lensen S, Farquhar C, Kamath MS, Kunjummen AT, Raine-Fenning N, Berntsen S, Pinborg A, Mackens S, Inal ZO, Ng EHY, Mak JSM, Narvekar SA, Martins WP, Steengaard Olesen M, Torrance HL, Mol BW, Eijkemans MJC, Wang R, and Broekmans FJM
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- Pregnancy, Female, Humans, Pregnancy Rate, Sperm Injections, Intracytoplasmic methods, Embryo Transfer methods, Birth Rate, Live Birth, Fertilization in Vitro methods, Infertility, Female therapy
- Abstract
Background: In IVF/ICSI treatment, the process of embryo implantation is the success rate-limiting step. Endometrial scratching has been suggested to improve this process, but it is unclear if this procedure increases the chance of implantation and live birth (LB) and, if so, for whom, and how the scratch should be performed., Objective and Rationale: This individual participant data meta-analysis (IPD-MA) aims to answer the question of whether endometrial scratching in women undergoing IVF/ICSI influences the chance of a LB, and whether this effect is different in specific subgroups of women. After its incidental discovery in 2000, endometrial scratching has been suggested to improve embryo implantation. Numerous randomized controlled trials (RCTs) have been conducted, showing contradicting results. Conventional meta-analyses were limited by high within- and between-study heterogeneity, small study samples, and a high risk of bias for many of the trials. Also, the data integrity of several trials have been questioned. Thus, despite numerous RCTs and a multitude of conventional meta-analyses, no conclusion on the clinical effectiveness of endometrial scratching could be drawn. An IPD-MA approach is able to overcome many of these problems because it allows for increased uniformity of outcome definitions, can filter out studies with data integrity concerns, enables a more precise estimation of the true treatment effect thanks to adjustment for participant characteristics and not having to make the assumptions necessary in conventional meta-analyses, and because it allows for subgroup analysis., Search Methods: A systematic literature search identified RCTs on endometrial scratching in women undergoing IVF/ICSI. Authors of eligible studies were invited to share original data for this IPD-MA. Studies were assessed for risk of bias (RoB) and integrity checks were performed. The primary outcome was LB, with a one-stage intention to treat (ITT) as the primary analysis. Secondary analyses included as treated (AT), and the subset of women that underwent an embryo transfer (AT+ET). Treatment-covariate interaction for specific participant characteristics was analyzed in AT+ET., Outcomes: Out of 37 published and 15 unpublished RCTs (7690 participants), 15 RCTs (14 published, one unpublished) shared data. After data integrity checks, we included 13 RCTs (12 published, one unpublished) representing 4112 participants. RoB was evaluated as 'low' for 10/13 RCTs. The one-stage ITT analysis for scratch versus no scratch/sham showed an improvement of LB rates (odds ratio (OR) 1.29 [95% CI 1.02-1.64]). AT, AT+ET, and low-RoB-sensitivity analyses yielded similar results (OR 1.22 [95% CI 0.96-1.54]; OR 1.25 [95% CI 0.99-1.57]; OR 1.26 [95% CI 1.03-1.55], respectively). Treatment-covariate interaction analysis showed no evidence of interaction with age, number of previous failed embryo transfers, treatment type, or infertility cause., Wider Implications: This is the first meta-analysis based on IPD of more than 4000 participants, and it demonstrates that endometrial scratching may improve LB rates in women undergoing IVF/ICSI. Subgroup analysis for age, number of previous failed embryo transfers, treatment type, and infertility cause could not identify subgroups in which endometrial scratching performed better or worse. The timing of endometrial scratching may play a role in its effectiveness. The use of endometrial scratching in clinical practice should be considered with caution, meaning that patients should be properly counseled on the level of evidence and the uncertainties., (© The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)
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- 2023
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30. Opioid prescriber responsibility: A Danish drug utilization study.
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Pottegård A, Sørensen AMS, Olesen M, and Rasmussen L
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- Humans, Practice Patterns, Physicians', Morphine, Drug Utilization, Drug Prescriptions, Analgesics, Opioid therapeutic use, Oxycodone therapeutic use
- Abstract
Aims: We describe the distribution of prescribers responsible for opioid initiation and maintenance (general practice, hospital prescribers and other prescribers) in Denmark., Methods: We leveraged data on opioid fills from a 20% sample of all Danes alive during 2000-2021., Results: Overall, general practitioners were responsible for most treatment initiation (74% during 2000-2021) and maintenance treatment (92%). However, while hospital prescribers initiated ≈20% of treatments during 2001-2012, this increased to 35% in 2021. Similarly, hospital prescriber's share of maintenance treatment increased from 5.9% during 2000-2012 to 13% in 2021. This change was particularly pronounced for morphine initiation (48% hospital prescribers in 2021 up from 38% during 2000-2010) and oxycodone initiation (78% up from 41%). Regarding choice of opioids, codeine use dropped markedly, in particular among hospital prescribers. Tramadol was consistently the most common first choice opioid in general practice (33% in 2021), whereas its use among hospital prescribers decreased (54% during 2000-2015 to 15% in 2021). Conversely, the proportion of treatment initiation by hospital prescribers composed of morphine and oxycodone increased to 38% and 42% in 2021, respectively., Conclusions: General practice prescribes most opioids; however, hospital prescribers are increasingly responsible for opioid prescribing, in particular initiation of morphine and oxycodone., (© 2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)
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- 2023
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31. Antiplatelet drugs and breast cancer risk in a large nationwide Danish case-control study.
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Cairat M, Pottegård A, Olesen M, Dossus L, Fournier A, and Hicks B
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- Female, Humans, Middle Aged, Aspirin therapeutic use, Case-Control Studies, Clopidogrel, Denmark epidemiology, Dipyridamole therapeutic use, Logistic Models, Breast Neoplasms epidemiology, Breast Neoplasms drug therapy, Platelet Aggregation Inhibitors
- Abstract
Low-dose aspirin has been hypothesized to prevent cancer risk by inhibiting platelet aggregation. However, the anti-cancer effect of low-dose aspirin has recently been questioned and its effect on breast cancer development remains unclear. The impact of other antiplatelet drugs on breast cancer risk has rarely been evaluated. Thus, this study aimed to investigate the associations between breast cancer risk and antiplatelet drug use in a nationwide nested case-control study. From the Danish healthcare registries, we identified as cases all women with invasive breast cancer diagnosis between 2001 and 2018 (n = 68 852). The date of diagnosis corresponded to the index date. We matched cases to 10 population controls on age and calendar time, using risk set sampling. Controls were assigned the same index date as their matched case. We used the prescription registry to identify exposure to low-dose aspirin, clopidogrel and dipyridamole. We defined ever use of antiplatelet drugs as at least two prescriptions filled up to 1 year before the index date. We applied conditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals for breast cancer associated with the use of antiplatelet drugs, overall, by breast cancer subtype and by cumulative dose. Twelve percent of women had ever been exposed to low-dose aspirin, 2% to clopidogrel and 2% to dipyridamole. In multivariable models, breast cancer risk was not associated with ever use of low-dose aspirin (OR = 1.00 [0.97-1.03]), clopidogrel (OR = 0.93 [0.87-1.00]), and dipyridamole (OR = 1.02 [0.94-1.10]), compared with never use, and there was no evidence of a dose-response relation. However, we found an inverse association between dipyridamole use and breast cancer risk among women aged <55 years old, with suggestion of a dose-response relationship (OR per 1000 Defined Daily Doses = 0.72 [0.54-0.95]). Associations did not differ by breast cancer histological type, estrogen receptor status or clinical stage at diagnosis. Overall, the findings from this study do not support the use of antiplatelet drugs for breast cancer prevention., (© 2022 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)
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- 2023
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32. Impact of the person-centred intervention guided self-determination across healthcare settings-An integrated review.
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Linnet Olesen M and Jørgensen R
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- Female, Humans, Renal Dialysis, Delivery of Health Care, Health Personnel education
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Aim: To review the evidence of the existing literature on the impact of guided self-determination across methodologies in different healthcare settings., Methods: An integrated five-stage review., Results: Forty-five eligible papers were included. Guided self-determination was applied in full- or small-scale, or combined with another intervention or approach in different healthcare settings handling, for example diabetes, stroke survivorship, schizophrenia, attention-deficit hyperactivity disorder and medical disorder, gynaecological and breast cancer, endometriosis, persons with chronic pain, persons in haemodialysis and intensive care survivors. The included studies covered 12 randomised trials, 26 qualitative and seven papers of different methodology. A statistically significant effect was found in three trials. Six main themes describe the qualitative findings across papers on patients: (1) Guided self-determination reduces disease-related loneliness, (2) Insight enables integration of life and disease, (3) Reflection sheets-appreciated but challenging tool to prompt insights and person-specific knowledge, (4) New person-specific knowledge enables person-centred support, (5) Feeling seen and believed in a new and trusted relationship and (6) Exchange of knowledge enables the development of life skills. Four themes describe the healthcare professionals' experience: (1) Change of usual practice-a decision from above, (2) A new role-unlearning previous behaviour and need for support, (3) Reflection sheets as facilitators and barriers and (4) Discovering the benefits of changing to a person-centred approach., Conclusion: Overall, guided self-determination proved to have a great impact on patient important outcomes and was useful and well-accepted by the majority of patients and healthcare professionals. Albeit guided self-determination is not a 'one size fits all' method. Continuous training and supervision of professionals are a necessary mean when implementing guided self-determination to enhance adoption and sustainability in clinical practice., (© 2022 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)
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- 2023
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33. Oral anticoagulants in patients with atrial fibrillation at low stroke risk: a multicentre observational study.
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Komen JJ, Pottegård A, Mantel-Teeuwisse AK, Forslund T, Hjemdahl P, Wettermark B, Hallas J, Olesen M, Bennie M, Mueller T, Carragher R, Karlstad Ø, Kjerpeseth LJ, and Klungel OH
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- Administration, Oral, Anticoagulants adverse effects, Cohort Studies, Hemorrhage chemically induced, Hemorrhage complications, Hemorrhage epidemiology, Humans, Intracranial Hemorrhages chemically induced, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Brain Ischemia chemically induced, Stroke epidemiology, Stroke etiology, Stroke prevention & control
- Abstract
Aims: There is currently no consensus on whether atrial fibrillation (AF) patients at low risk for stroke (one non-sex-related CHA2DS2-VASc point) should be treated with an oral anticoagulant., Methods and Results: We conducted a multi-country cohort study in Sweden, Denmark, Norway, and Scotland. In total, 59 076 patients diagnosed with AF at low stroke risk were included. We assessed the rates of stroke or major bleeding during treatment with a non-vitamin K antagonist oral anticoagulant (NOAC), a vitamin K antagonist (VKA), or no treatment, using inverse probability of treatment weighted (IPTW) Cox regression. In untreated patients, the rate for ischaemic stroke was 0.70 per 100 person-years and the rate for a bleed was also 0.70 per 100 person-years. Comparing NOAC with no treatment, the stroke rate was lower [hazard ratio (HR) 0.72; 95% confidence interval (CI) 0.56-0.94], and the rate for intracranial haemorrhage (ICH) was not increased (HR 0.84; 95% CI 0.54-1.30). Comparing VKA with no treatment, the rate for stroke tended to be lower (HR 0.81; 95% CI 0.59-1.09), and the rate for ICH tended to be higher during VKA treatment (HR 1.37; 95% CI 0.88-2.14). Comparing NOAC with VKA treatment, the rate for stroke was similar (HR 0.92; 95% CI 0.70-1.22), but the rate for ICH was lower during NOAC treatment (HR 0.63; 95% CI 0.42-0.94)., Conclusion: These observational data suggest that NOAC treatment may be associated with a positive net clinical benefit compared with no treatment or VKA treatment in patients at low stroke risk, a question that can be tested through a randomized controlled trial., Competing Interests: Conflict of interest: J.J.K. is currently employed by Daiichi-Sankyo, but not during the conduct of this study, and reports personal fees from Boehringer Ingelheim, outside the submitted work; A.P. reports grants from Alcon, grants from Almirall, grants from Astellas, grants from Astra-Zeneca, grants from Boehringer Ingelheim, grants from Novo Nordisk, grants from Servier, grants from LEO Pharma, outside the submitted work; Ø.K. reports participation in imposed Post-Authorization Safety Studies on an antidiabetic and an anti-psoriasis drug. The studies are funded by Leo Pharma and Novo Nordisk, with funds paid to the institution where he is employed (no personal fees) and with no relation to the work reported in this paper; L.J.K. was supported by the Research Council of Norway as part of the International Pregnancy Drug Safety Studies (InPreSS, Project No. 273366) during the conduct of the study. All other authors have nothing to declare., (© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.)
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- 2022
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34. Who prescribes quetiapine in Denmark?
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Højlund M, Rasmussen L, Olesen M, Munk-Olsen T, and Pottegård A
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- Adult, Denmark, Humans, Practice Patterns, Physicians', Quetiapine Fumarate adverse effects, Antipsychotic Agents adverse effects, General Practitioners
- Abstract
The second-generation antipsychotic quetiapine is commonly used off-label for its anxiolytic and hypnotic properties. However, quetiapine is associated with problematic side-effects. We used Danish Medicinal Product Statistics and a 20% random sample of the Danish population's prescription fills (2001-2020) to describe the utilization of quetiapine and proportion of various prescriber types (general practitioner [GP], specialist in private practice, hospital physician and other prescribers) both in connection to first-time and subsequent prescriptions. In 2020, 92% of all quetiapine was dispensed outside hospitals and the average daily dispensed quantity of quetiapine per user corresponded to 100 mg/user/d. A GP issued 53% of first-time prescriptions and 75% of subsequent prescriptions for quetiapine in 2020. The proportion of quetiapine prescriptions issued by GPs varied by age group-from 14% among 0-17-year-olds to 93% among the ≥80-year-olds. Future initiatives on the rational use of quetiapine and related drugs, especially among adults, should target GPs., (© 2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)
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- 2022
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35. Changing characteristics over time of individuals receiving COVID-19 vaccines in Denmark: A population-based descriptive study of vaccine uptake.
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Reilev M, Olesen M, Kildegaard H, Støvring H, Andersen JH, Hallas J, Lund LC, Ladebo L, Ernst MT, Damkier P, Jensen PB, Pottegård A, and Rasmussen L
- Subjects
- Aged, BNT162 Vaccine, Denmark epidemiology, Humans, Middle Aged, Vaccination, COVID-19 epidemiology, COVID-19 prevention & control, COVID-19 Vaccines
- Abstract
Aims: The Danish authorities implemented a differential rollout of the COVID-19 vaccines where individuals at high risk of COVID-19 were prioritized. We describe the temporal uptake and characteristics of COVID-19 vaccine recipients in Denmark., Methods: Using nationwide healthcare registries, we identified all Danish residents ⩾5 years of age who received at least one dose of a COVID-19 vaccine from 27 December 2020-29 January 2022. We charted the daily number of newly vaccinated individuals and the cumulative vaccine coverage over time, stratified by vaccine type, age groups and vaccination priority groups, and described characteristics of vaccine recipients during two-month-intervals and in vaccination priority groups., Results: By 29 January 2022, 88%, 86% and 64% of Danish residents ⩾5 years ( n =5,562,008) had received a first, second and third dose, respectively, of a COVID-19 vaccine, most commonly the BNT162b2 vaccine (84%). Uptake ranged from 48% in 5-11-year-olds to 98% in 65-74-year-olds. Individuals vaccinated before June 2021 were older (median age 61-70 years vs 10-35 years in later periods) and had more comorbidities such as hypertension (22-28% vs 0.77-2.8% in later periods), chronic lung disease (9.4-15% vs 3.7-4.6% in later periods) and diabetes (9.3-12% vs 0.91-2.4% in later periods)., Conclusions: We document substantial changes over time in, for example, age, sex and medical history of COVID-19 vaccine recipients. Though these results are related to the differential vaccine rollout in Denmark, similar findings are probable in other countries and should be considered when designing and interpreting studies on the effectiveness and safety of COVID-19 vaccines.
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- 2022
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36. Restriction of Intravenous Fluid in ICU Patients with Septic Shock.
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Meyhoff TS, Hjortrup PB, Wetterslev J, Sivapalan P, Laake JH, Cronhjort M, Jakob SM, Cecconi M, Nalos M, Ostermann M, Malbrain M, Pettilä V, Møller MH, Kjær MN, Lange T, Overgaard-Steensen C, Brand BA, Winther-Olesen M, White JO, Quist L, Westergaard B, Jonsson AB, Hjortsø CJS, Meier N, Jensen TS, Engstrøm J, Nebrich L, Andersen-Ranberg NC, Jensen JV, Joseph NA, Poulsen LM, Herløv LS, Sølling CG, Pedersen SK, Knudsen KK, Straarup TS, Vang ML, Bundgaard H, Rasmussen BS, Aagaard SR, Hildebrandt T, Russell L, Bestle MH, Schønemann-Lund M, Brøchner AC, Elvander CF, Hoffmann SKL, Rasmussen ML, Martin YK, Friberg FF, Seter H, Aslam TN, Ådnøy S, Seidel P, Strand K, Johnstad B, Joelsson-Alm E, Christensen J, Ahlstedt C, Pfortmueller CA, Siegemund M, Greco M, Raděj J, Kříž M, Gould DW, Rowan KM, Mouncey PR, and Perner A
- Subjects
- Administration, Intravenous, Adult, Critical Care methods, Humans, Intensive Care Units, Fluid Therapy adverse effects, Fluid Therapy methods, Shock, Septic mortality, Shock, Septic therapy
- Abstract
Background: Intravenous fluids are recommended for the treatment of patients who are in septic shock, but higher fluid volumes have been associated with harm in patients who are in the intensive care unit (ICU)., Methods: In this international, randomized trial, we assigned patients with septic shock in the ICU who had received at least 1 liter of intravenous fluid to receive restricted intravenous fluid or standard intravenous fluid therapy; patients were included if the onset of shock had been within 12 hours before screening. The primary outcome was death from any cause within 90 days after randomization., Results: We enrolled 1554 patients; 770 were assigned to the restrictive-fluid group and 784 to the standard-fluid group. Primary outcome data were available for 1545 patients (99.4%). In the ICU, the restrictive-fluid group received a median of 1798 ml of intravenous fluid (interquartile range, 500 to 4366); the standard-fluid group received a median of 3811 ml (interquartile range, 1861 to 6762). At 90 days, death had occurred in 323 of 764 patients (42.3%) in the restrictive-fluid group, as compared with 329 of 781 patients (42.1%) in the standard-fluid group (adjusted absolute difference, 0.1 percentage points; 95% confidence interval [CI], -4.7 to 4.9; P = 0.96). In the ICU, serious adverse events occurred at least once in 221 of 751 patients (29.4%) in the restrictive-fluid group and in 238 of 772 patients (30.8%) in the standard-fluid group (adjusted absolute difference, -1.7 percentage points; 99% CI, -7.7 to 4.3). At 90 days after randomization, the numbers of days alive without life support and days alive and out of the hospital were similar in the two groups., Conclusions: Among adult patients with septic shock in the ICU, intravenous fluid restriction did not result in fewer deaths at 90 days than standard intravenous fluid therapy. (Funded by the Novo Nordisk Foundation and others; CLASSIC ClinicalTrials.gov number, NCT03668236.)., (Copyright © 2022 Massachusetts Medical Society.)
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- 2022
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37. Characteristics of New Users of Aclidinium Bromide, Aclidinium/Formoterol, and Other COPD Medications in the United Kingdom, Denmark, and Germany.
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Rivero-Ferrer E, Olesen M, Plana E, Aguado J, Saigí-Morgui N, Rubino A, Daoud SZ, Lei A, Perez-Gutthann S, Schink T, Kristiansen NS, Hallas J, Pottegård A, and Rebordosa C
- Subjects
- Administration, Inhalation, Adult, Bronchodilator Agents, Denmark, Formoterol Fumarate, Humans, Muscarinic Antagonists therapeutic use, Tropanes adverse effects, Tropanes therapeutic use, United Kingdom epidemiology, Adrenergic beta-2 Receptor Agonists therapeutic use, Pulmonary Disease, Chronic Obstructive diagnosis, Pulmonary Disease, Chronic Obstructive drug therapy, Pulmonary Disease, Chronic Obstructive epidemiology
- Abstract
Background and Objectives: Aclidinium bromide was approved in the European Union for the treatment of chronic obstructive pulmonary disease (COPD) in adult patients in 2012 and in a fixed-dose combination with formoterol in 2014. We characterised new users of aclidinium, aclidinium/formoterol and other COPD medications and evaluated off-label prescribing of these medications in three European populations., Methods: We described demographic characteristics, comorbidities, comedications, COPD severity and off-label prescribing of new users of aclidinium, aclidinium/formoterol and other COPD medications in patients with COPD aged ≥ 40 years in the Clinical Practice Research Datalink (CPRD, UK), Danish National Health Databases, and German Pharmacoepidemiological Research Database (GePaRD) between 2015 and 2017., Results: We included 17,668 new users of aclidinium (CPRD, 4871; Denmark, 2836; GePaRD, 9961) and 14,808 new users of aclidinium/formoterol (CPRD, 2153; Denmark, 2586; GePaRD, 10,069). Study patients were of similar age, except in GePaRD, where users of long-acting beta2-agonists (LABA)/inhaled corticosteroids were younger. Patients had multiple comorbidities and used multiple comedications-most frequently hypertension (50-79%) and short-acting beta2-agonists (26-84%). Aclidinium users in CPRD and long-acting anticholinergics/LABA users in Denmark and GePaRD had the highest frequency of severe/very severe COPD. Off-label prescribing of aclidinium (5.0% [CPRD]-8.9% [Denmark]) and aclidinium/formoterol (2.6% [GePaRD]-3.2% [CPRD]) was low, and the main reason was asthma without a COPD diagnosis., Conclusions: Aclidinium and aclidinium/formoterol were mostly prescribed according to label, with preference given to older patients with more severe COPD and to patients with a high prevalence of comorbidities and comedication use., (© 2022. The Author(s).)
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- 2022
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38. The patient's agenda: nurses' experience of learning and using guided self-determination.
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Dehn P, Strømberg C, and Linnet Olesen M
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- Communication, Humans, Personal Autonomy, Qualitative Research, Learning, Nurses
- Abstract
Objectives: Health care has seen a shift towards person-centred care to encompass the entirety of a person's needs and preferences, but research is sparse on healthcare professionals learning and using person-centred care., Aim: To investigate nurses' experiences of learning and using the person-centred method guided self-determination (GSD) in three different gynaecological settings and to determine whether, and potentially, how new tasks introduced by the GSD method influence their professional identity., Design: A qualitative interview study conducted between January 2019 and January 2020., Method: We conducted 16 semi-structured interviews with nurses educated in using GSD. Applying inductive and deductive reasoning, we analysed the interviews using thematic analysis. The study was registered with the Danish Data Protection Agency (file no.: VD-2018-445, I-Suite no.: 6700)., Results: The analysis generated three main themes with two subthemes each: (a) prerequisites and barriers to learning and using GSD in terms of personal factors and organisational and method-related factors; (b) new knowledge and understanding of illness with the subthemes expanded understanding of illness and a different relationship; and (c) nursing undergoing change with the subthemes, a new role and a professional self shaped through interaction with other professions., Conclusions: Although other professionals may have either supported or challenged the use of GSD, most nurses indicated that it supplemented their professional role and identity as they gained new knowledge about person-centred challenges and felt more confident. When introducing GSD in nursing, the organisation must not only consider individual characteristics, multidisciplinary collaboration and communication but also plan individual education and supervision. This is necessary because all these factors affect how a new professional role is constructed and adopted, not to mention how it influences the nurses' perception of their professional identity and use of GSD. Establishing a helpful person-centred environment must also be considered., (© 2021 Nordic College of Caring Science.)
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- 2022
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39. Persistence and adherence to non-vitamin K antagonist oral anticoagulant treatment in patients with atrial fibrillation across five Western European countries.
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Komen JJ, Pottegård A, Mantel-Teeuwisse AK, Forslund T, Hjemdahl P, Wettermark B, Hellfritzsch M, Hallas J, Olesen M, Bennie M, Mueller T, Voss A, Schink T, Haug U, Kollhorst B, Karlstad Ø, Kjerpeseth LJ, and Klungel OH
- Subjects
- Administration, Oral, Anticoagulants, Dabigatran, Humans, Pyridones, Rivaroxaban, Warfarin, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy, Atrial Fibrillation epidemiology, Stroke epidemiology, Stroke etiology, Stroke prevention & control
- Abstract
Aims: To assess persistence and adherence to non-vitamin K antagonist oral anticoagulant (NOAC) treatment in patients with atrial fibrillation (AF) in five Western European healthcare settings., Methods and Results: We conducted a multi-country observational cohort study, including 559 445 AF patients initiating NOAC therapy from Stockholm (Sweden), Denmark, Scotland, Norway, and Germany between 2011 and 2018. Patients were followed from their first prescription until they switched to a vitamin K antagonist, emigrated, died, or the end of follow-up. We measured persistence and adherence over time and defined adequate adherence as medication possession rate ≥90% among persistent patients only., Results: Overall, persistence declined to 82% after 1 year and to 63% after 5 years. When including restarters of NOAC treatment, 85% of the patients were treated with NOACs after 5 years. The proportion of patients with adequate adherence remained above 80% throughout follow-up. Persistence and adherence were similar between countries and was higher in patients starting treatment in later years. Both first year persistence and adherence were lower with dabigatran (persistence: 77%, adherence: 65%) compared with apixaban (86% and 75%) and rivaroxaban (83% and 75%) and were statistically lower after adjusting for patient characteristics. Adherence and persistence with dabigatran remained lower throughout follow-up., Conclusion: Persistence and adherence were high among NOAC users in five Western European healthcare settings and increased in later years. Dabigatran use was associated with slightly lower persistence and adherence compared with apixaban and rivaroxaban., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2021
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