Bondo L.,Gentofte Hospital |
Eiken P.,Hillerod Hospital |
Abrahamsen B.,Gentofte Hospital |
Abrahamsen B.,Open Data Institute
Osteoporosis International | Year: 2013
Bisphosphonate (BP) users have decreased mortality, but this could be due to channeling bias. National healthcare data on hip fracture showed lower mortality in patients who were treated prior to fracture or began treatment after fracture. Reduced mortality after only one prescription filled points to the importance of patient factors. Introduction: Use of bisphosphonates has been found to be associated with decreased mortality even when adjusted for sex, frailty, bone mineral density and comorbidity, but BP may chiefly be initiated in patients with osteoporosis whose life expectancy is judged to be good. Our aim was to investigate the association between BP initiated before or after a hip fracture with mortality, and any modifying effects of comorbid conditions and recurrent fracture. Methods: This register-based cohort study used prescription and mortality information for Danish patients born ≤1945 experiencing a hip fracture between 1/Jan/1999 and 31/Dec/ 2002 (N = 42,076). Patients who began BP after hip fracture were compared with hip fracture patients who remained alive at the time when their matched index case began treatment. Results: Patients who used BP prior to their hip fracture (4.6 %) had significantly lower 3-month mortality (adjusted odds ratio, OR, 0.68; 0.59-0.77). Patients who began BP after the fracture (2.6 %) had significantly decreased mortality, both for patients who filled only one prescription (adjusted hazard ratio, HR 0.84; 0.73-0.95) and for patients who filled multiple prescriptions HR 0.73 (0.61-0.88). There was a significant interaction by gender with no significant risk reduction in men. Conclusion: This national dataset shows significantly and substantially improved survival in women who receive BP before or after their hip fracture. However, the observation of a reduction in mortality in patients who filled only one prescription for a BP suggests that patient factors may account for a considerable part of the survival advantage observed with BPs. © 2012 International Osteoporosis Foundation and National Osteoporosis Foundation.
Abrahamsen B.,University of Southern Denmark |
Abrahamsen B.,Copenhagen University |
Eiken P.,Hillerod Hospital |
Eastell R.,University of Sheffield
Journal of Clinical Endocrinology and Metabolism | Year: 2010
Context: Bisphosphonates are the mainstay of anti-osteoporotic treatment and are commonly used for a longer duration than in the placebo-controlled trials. A link to development of atypical subtrochanteric or diaphyseal fragility fractures of the femur has been proposed, and these fractures are currently the subject of a U.S. Food and Drug Administration review. Objective: Our objective was to examine the risk of subtrochanteric/diaphyseal femur fractures in long term users of alendronate. Design: We conducted an age- and gender-matched cohort study using national healthcare data. Patients: Patients were alendronate users, without previous hip fracture, who began treatment between January 1, 1996, and December 31, 2005 (n = 39,567) and untreated controls, (n = 158,268). Main outcome measures: Subtrochanteric or diaphyseal femur fractures were evaluated. Results: Subtrochanteric and diaphyseal fractures occurred at a rate of 13 per 10,000 patient-years in untreated women and 31 per 10,000 patient-years in women receiving alendronate [adjusted hazard ratio (HR) = 1.88; 95% confidence interval (CI) = 1.62-2.17]. Rates for men were six and 31 per 10,000 patient-years, respectively (HR = 3.98; 95% CI = 2.62-6.05). The HR for hip fracture was 1.37 (95% CI = 1.30-1.46)) in women and 2.47 (95% CI = 2.07-2.95) in men. Risks of subtrochanteric/diaphyseal fracture were similar in patients who had received 9 yr of treatment (highest quartile) and patients who had stopped therapy after the equivalent of 3 months of treatment (lowest quartile). Conclusions: Alendronate-treated patients are at higher risk of hip and subtrochanteric/diaphyseal fracture than matched control subjects. However, large cumulative doses of alendronate were not associated with a greater absolute risk of subtrochanteric/diaphyseal fractures than small cumulative doses, suggesting that these fractures could be due to osteoporosis rather than to alendronate. Copyright © 2010 by The Endocrine Society.
Egerod I.,Copenhagen University |
Christensen D.,Hillerod Hospital
Qualitative Health Research | Year: 2010
Intensive care survivors often suffer from memory disorders, and some go on to develop anxiety, depression, and posttraumatic stress. Since the 1980s nurses have written diaries for intensive care patients to help them understand their illness and come to terms with their experiences after discharge. The central question we posed in this study was: Why do nurses write diaries in addition to conventional charting in the medical record? To answer this question, we compared intensive care diaries and hospital charts using textual analysis and narrative theory. The aims of our study were to compare patient diaries and hospital charts to explore (a) what each documentation instrument has to offer patients in their quest to make sense of their illness, and (b) why it is worthwhile for nurses to sustain the practice of writing diaries. The study findings show that the diary is coherent, personal, and supportive, whereas the hospital chart is fragmented, impersonal, and technical. The diary tells a comprehensive story that might help the patient to construct or reconstruct his or her own illness narrative. © The Author(s) 2010.
Rahman N.,Hillerod Hospital
Danish medical journal | Year: 2012
Clinical investigations of childhood tuberculosis (TB) are challenged by the paucibacillary nature of the disease and the difficulties in obtaining specimens. We investigated the challenges in diagnosing TB in children in a low-incidence country. The data were retrieved retrospectively from the paediatric departments at Danish university hospitals from April 2004 to March 2009 using the diagnosis code A15.0-A19.9 in children below the age of 15 years. A total of 54 children were identified of whom 13 were native Danes. The remaining immigrants were from a range of countries, the majority from Somalia. In all, 44 children had pulmonary TB and the proportion of extrapulmonary TB was higher among immigrants than among Danes. The cardinal symptoms were fever, weight loss and cough. In 41 cases (76%), a combination of a positive tuberculin skin test, an abnormal chest X-ray and the clinical presentation led to initiation of treatment. TB diagnosis was confirmed later by culture in 29 cases. The median number of days from contact to the healthcare system to treatment initiation was two days for 23 children who were part of contact tracing and seven days for the remaining children. All children but one completed treatment, and three patients were retreated due to relapse. Side effects to treatment were observed in 20 cases. None of the patients died. The majority of the children affected with TB were foreign-born with a higher proportion of extrapulmonary TB. The microbiological confirmation was low. A rapid onset of treatment was closely related to known, recent exposure.
Kleif J.,Hillerod Hospital
Danish medical journal | Year: 2012
Patients with an open abdomen (OA) present a major challenge to the surgeon. High mortality and associated complication rates have been reported depending on the specific method of temporary abdominal closure, the primary disorder and any co-morbidity. Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) is a novel technique recently introduced for late fascial closure of the OA. In previous studies, the disease aetiologies were mainly vascular and visceral surgical disease and trauma. We report our results using VAWCM in a non-trauma patient population treated with an OA due to visceral surgical disease. Medical records of all patients in our department treated with VAWCM during the period from 1 August 2009 to 31 May 2011 were reviewed. All sixteen patients were non-trauma patients. The initial treatment was vacuum-assisted closure (VAC) (Abdominal Dressing System KCI, San Antonio, Texas, USA). VAWCM treatment was initiated if complete fascial closure could not be obtained with VAC. Two patients died of multiple organ failure that was not associated with the VAWCM treatment. In one patient, treatment was terminated due to a very short life expectancy. We achieved a complete fascial closure rate in seven out of 16 patients. One patient had a pancreatic fistula at discharge that was not associated with the VAWCM treatment. No enteric fistulas occurred. It seems that VAWCM can improve the rate of complete fascial closure after treatment with OA without increasing the mortality or the occurrence of enteric fistula compared with other kinds of temporary abdominal closure. not relevant. not relevant.
Berg P.,Hillerod Hospital |
Lindhardt B.O.,Hillerod Hospital
Danish Medical Journal | Year: 2012
INTRODUCTION: Promising results in relation to severity assessment and treatment of patients with communityacquired pneumonia (CAP) have recently been presented from the study of procalcitonin (PCT) levels in these patients. METHOD: A systematic search in PubMed and the Cochrane Library was conducted. Articles in English, German and Swedish were searched to investigate the role of PCT in adults with CAP. RESULTS: The most thoroughly studied topic is the prediction of complications and death during hospital stay. PCT has predictive properties comparable to those of the Pneumonia Severity Index and the CURB65 scoring systems, and it may represent an addition to these indices. Furthermore, PCT levels may indicate aetiology as patients with typical bacterial infection have higher PCT levels than patients with atypical and viral aetiologies. The literature also indicates that PCT can distinguish CAP from asthma and acute exacerbation of chronic obstructive pulmonary disease. Several studies and a meta-analysis have shown that administration of antibiotics according to a PCT algorithm in a hospital setting reduced the use of antibiotics with no evidence of an increased risk. CONCLUSION: PCT should only be an adjunct to the clinical examination and should be regarded a prognostic rather than diagnostic factor. PCT may help to safely reduce antibiotic use, but more research is required. Limitations of the present study include the heterogeneity of the literature with regard to setup and quality, differences in biochemical methods and diagnostic criteria of CAP and, finally, the risk of publication bias.
von Plessen C.,Hillerod Hospital
The clinical respiratory journal | Year: 2011
Lung cancer is the third most common mortal disease in industrialised countries and the prognosis has been slow to improve. The largest subgroup has locally advanced or metastatic non-small cell lung cancer (NSCLC). Unfortunately, these patients can usually not be cured and the main treatment option is palliative chemotherapy. Given the palliative intention of the chemotherapy, it is clinically highly relevant to establish the optimal treatment duration. While chemotherapy prolongs survival and improves quality of life (QoL), it also has side effects and only a minority of patients achieve an objective treatment response. Clinicians need guidance on treatment duration from controlled trials to balance these aspects. Improvements of the conditions under which chemotherapy is given can increase patient and staff satisfaction and increase system performance. This is especially relevant to incurable patients who spend a lot of their limited time at oncology outpatient clinics. Staffing, infrastructure and organisation of these units are often suboptimal to serve patients with palliative needs and reports of improvement projects can inspire and guide clinicians in improving their microsystems of care. Clinicians, health care administrators and the public need knowledge about the outcomes of palliative chemotherapy in unselected patient populations. The efficacy of palliative chemotherapy for advanced NSCLC has been amply documented in controlled clinical trials. Meanwhile, the elderly and patients with higher performance status have usually been under-represented in these trials and population studies of the effectiveness of chemotherapy are needed. (i) To establish the optimal duration of platinum-based first line chemotherapy for advanced NSCLC; (ii) To improve the care processes at an oncology outpatient clinical microsystem; (iii) To describe the use of chemotherapy in a national population and investigate associations between chemotherapy use and survival; and (iv) To explore approaches to improve the system of chemotherapy from the macro perspective of a whole country. The thesis combines methods from different knowledge domains. In a randomised trial, we compared three with six courses of platinum-based chemotherapy for advanced NSCLC. In a quality improvement study, we used logistic improvement tools, qualitative and quantitative patient and staff satisfaction measurements. Finally using data from the Norwegian cancer and chemotherapy registries, we investigated temporary and geographical variations of chemotherapy use and correlations with the survival of patients with advanced NSCLC. Methods and findings from the three studies were explored to inform a national improvement strategy for the chemotherapy of advanced NSCLC. Survival and QoL were equal with three or six courses of chemotherapy for advanced NSCLC. Systematic process changes at the outpatient clinic led to increased patient and staff satisfaction. Furthermore, the study illustrates the application of established process improvement and evaluation tools in a clinical microsystem. In the registry study, we found delays of the introduction of palliative chemotherapy in Norway and significant associations between the use of chemotherapy and the survival of patients with advanced NSCLC. The general section of the thesis describes approaches to system-wide improvements and introduces a quality improvement matrix. We conclude from our randomised trial and related research that chemotherapy beyond three courses is not beneficial for patients with advanced NSCLC. The report from the oncology outpatient clinic illustrates the value of the clinical microsystem approach for quality improvement at the front line of care. Patient feedback through a focus group, simple methods of assessing and simplifying processes of care, as well as measuring results over time were effective tools in our project. The description of the experiences can serve as an example for the improvement of microsystems in settings with similar problems. Finally, in the registry study of Norwegian patients with lung cancer, we found significant geographical and temporal variations of the utilisation of chemotherapy that were related to survival. Potential areas of improvement in the system of care for lung cancer are recruitment of patients in clinical studies, standardisation of the processes of care in outpatient clinics, definition of strategic aims of quality, development of balanced quality indicators, as well as measuring and reporting of outcomes by means of a quality registry. © 2010 Blackwell Publishing Ltd.
Lowenstein E.,Hillerod Hospital |
Ottesen B.,Hillerod Hospital |
Gimbel H.,Hillerod Hospital
International urogynecology journal | Year: 2015
INTRODUCTION AND HYPOTHESIS: The purpose of the study was to describe the incidence of pelvic organ prolapse (POP) surgeries in Denmark during the last 30 years, age distribution over time, and the lifetime risk of undergoing POP surgery.METHODS: We carried out a population-based registry study. The setting was the Danish National Patient Registry. The sample consisted of Danish women of all ages undergoing prolapse surgery during the period 1977-2009. Data were retrieved from the Danish National Patient Registry. Prolapse surgery included surgery for any type of genital prolapse including hysterectomy due to prolapse. The main outcome measures were incidence of POP, age distribution over time, and lifetime risk of undergoing POP surgery.RESULTS: Surgical interventions for POP decreased by 47 % from 1977 (288 procedures/100,000 women) to 1999 (153 procedures/100,000 women). Subsequently, they increased to 75 % of the original incidence rate; in 2008, the incidence of total POP procedures was 201 out of 100,000 women and the incidence of women undergoing POP surgery was 139 out of 100,000 women. During the study period, the age-specific incidence of POP surgeries increased for women over the age of 65-69 years and decreased for women below that age. In 2008, the lifetime risk for an 80-year-old woman of undergoing at least one POP surgery was 18.7 %.CONCLUSIONS: The incidence of POP surgery varied up to 50 % during the study period. The age distribution changed so that more elderly and less young women had surgery in 2008 compared with 1978. Finally, we found that the lifetime risk of undergoing POP surgery for an 80-year-old was 26.9 % in 1978, 20.5 % in 1988, 17.2 % in 1998, and 18.7 % in 2008.
Bjeldbak-Olesen M.,Hillerod Hospital
Danish medical journal | Year: 2013
The objective of this study was to compare medication reconciliation and medication review based on number, type and severity of discrepancies and drug-related problems (DRPs), denoted errors. This was a retrospective study conducted at the Department of Cardiology, Hillerød Hospital. Medication reconciliation compared the prescriptions in patient records, an electronic medication system (EMS) and in discharge summaries (DS). The medication review was based on the EMS. The two methods were performed on the same data material. To assess the clinical importance of the errors, a four-point scale was applied. A total of 75 patient records were included. In all, 198 discrepancies were identified by medication reconciliation, 2.6 per patient. The most frequent discrepancies were omission of a drug in the DS and discrepancy between the drugs noted in the patient record and the EMS. 15% of the discrepancies were potentially serious or fatal, 62% were potentially significant and 23% were potentially non-significant. A total of 129 DRPs were identified by medication review, 1.7 per patient. The most frequent DRPs were sub therapeutic dosage, inappropriate dosage regimen and untreated medical condition. 35% of the DRPs were potentially serious or fatal, 29% were potentially significant and 36% were potentially non-significant. Medication reconciliation identified a higher number of errors than medication review, but the number of serious errors identified by medication review was higher than that identified by medication reconciliation. The two methods identified different types of errors and should be used concurrently to supplement each other. not relevant. not relevant.
Hoyrup S.,Hillerod Hospital
Danish medical journal | Year: 2012
The aim of the present study was to explore the current use of supervision groups and the value of such groups for today's Danish general practitioners (GPs). The present study is a prospective cohort study comprising ten patients with abdominal wall defects treated with BM. At reconstructive surgery with BM, six patients had stomas, four had wounds complicated by intestinal fistulas and three had both. In five cases, the abdominal wall was closed without complications. The remaining five patients had unsuccessful primary healing of the skin, but all subsequently healed by granulation on the mesh. In two cases, BM was implanted directly on exposed bowel with inaccessible fistulas still present. Patients were discharged a median of 15 days (6-35 days) after insertion of the BM. The median follow-up was 11 months (1.5-18.5 months). Only one patient developed a hernia. BM can be used in contaminated defects, even when primary skin closure is not achieved, or with fistulas still present causing continuous contamination of the surgical site and mesh. BM facilitates early closure of the abdomen. not relevant. not relevant.