Horsens Hospital

Horsens, Denmark

Horsens Hospital

Horsens, Denmark
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Kristensen P.K.,Horsens Hospital | Kristensen P.K.,Aarhus University Hospital | Thillemann T.M.,Aarhus University Hospital | Soballe K.,Aarhus University Hospital | Johnsen A.S.P.,Aarhus University Hospital
International Journal for Quality in Health Care | Year: 2016

Objectives: To examine the association between process performance measures and clinical outcome among patients with hip fracture. Design: Nationwide, population-based follow-up study. Setting: Public Danish hospitals. Participants: A total of 25 354 patients 65 years or older who were admitted with a hip fracture in Denmark between 2010 and 2013. Intervention: The process performance measures, including systematic pain assessment, early mobilization, basic mobility assessment at arrival and at discharge, post-discharge rehabilitation program, anti-osteoporotic medication and prevention of future fall accidents measures, were analysed individually as well as an opportunity-based score defined as the proportion of all relevant performance measures fulfilled for the individual patient (0-50%, 50-75% and 75-100%). Main Outcome Measures: Thirty-day mortality, 30-day readmission after discharge and length of stay (LOS). Results: Fulfilling 75-100% of the relevant process performance measures was associated with lower 30-day mortality (22.6% vs. 8.5%, adjusted odds ratio (OR) 0.31 (95% CI: 0.28-0.35)) and lower odds for readmission (21.7% vs. 17.4%, adjusted OR 0.78 (95% CI: 0.70-0.87)). The overall opportunity score for quality of care was not associated with LOS (adjusted OR 1.00 (95% CI: 0.98- 1.04)). Mobilization within 24 h postoperatively was the process with the strongest association with lower 30-day mortality, readmission risk and shorter LOS. Conclusions: Higher quality of in-hospital care and in particular early mobilization was associated with a better clinical outcome, including lower 30-day mortality, among patients with hip fracture. © The Author 2016.

Toft B.S.,Horsens Hospital | Uhrenfeldt L.,Horsens Hospital
JBI Database of Systematic Reviews and Implementation Reports | Year: 2014

Review question/objective: The objective of this review is to identify the facilitators and barriers to physical activities (PA) experienced by morbidly obese adults in the western world. © the authors 2014. All rights reserved.

Fedder J.,Horsens Hospital | Fedder J.,University of Southern Denmark | Loft A.,Copenhagen University | Parner E.T.,University of Aarhus | And 2 more authors.
Human Reproduction | Year: 2013

Study Question Does neonatal outcome including congenital malformations in children born after ICSI with epididymal and testicular sperm [testicular sperm extraction (TESE)/percutaneous epididymal sperm aspiration (PESA)/testicular sperm aspiration (TESA) (TPT)] differ from neonatal outcome in children born after ICSI with ejaculated sperm, IVF and natural conception (NC)? Summary Answer Children born after TPT have similar neonatal outcome, including total malformation rates, as have children born after ICSI and IVF with ejaculated sperm. Testing for variance over the four groups may indicate smaller differences in specific malformation rates with TPT as the highest risk group. What is Known Already Regarding neonatal outcome as well as congenital malformations in children born after TPT, studies are few, with limited sample size, heterogeneous and often performed without relevant control groups. Study Design, Size, Duration Population-based cohort study including all Danish children born after TPT and fresh embryo transfer in Denmark from 1995 to 2009. Children born after transfer of frozen-thawed embryos were excluded. Control groups of children conceived by ICSI with ejaculated sperm, IVF and NC were identified by cross-linkage of the Danish IVF Register, Medical Birth Register (MBR) and National Hospital Discharge Register (HDR).PARTICIPANTS/MATERIALS, SETTINGThe study group consisted of 466 children born after TPT, while the control groups consisted of 8967 (ICSI with ejaculated sperm), 17 592 (IVF) and 63 854 (NC) children. Neonatal outcomes and congenital malformations were analysed for singletons and twins separately. Risk estimates for low birthweight (LBW, <2500 g) and preterm birth (PTB, <37 gestational weeks) were adjusted for maternal age, parity, child gender and year of childbirth. The study group was identified from the Danish national database on children born after TPT. Control groups were obtained from the IVF register and the MBR. All information included in the study was retrieved from the national registers. Main Results AND THE ROLE OF CHANCEConsidering singletons and twins as one group, the sex ratio (♂/♀) was significantly lower for children born after TPT (0.89) compared with conventional IVF (1.11; P = 0.017) but did not differ significantly when compared with ICSI with ejaculated sperm (0.94) and NC (1.05). The mean birthweight (BW) for singletons did not differ significantly between groups when including only first-born children. The mean gestational age (GA) in the TPT singletons (279 ± 12 days) was significantly higher compared with IVF (276 ± 18 days; P = 0.02), but similar to ICSI with ejaculated sperm and NC singletons when including only first-born children (277 ± 16 days and 279 ± 14 days, respectively). Rate of stillbirths, perinatal and neonatal mortality in the group of TPT singletons did not differ significantly from any of the control groups. Comparable results were found for the TPT twin group, except for perinatal mortality, which was significantly lower in the TPT group compared with naturally conceived twins. The adjusted risk of LBW was significantly higher for TPT versus NC singletons [adjusted odds ratio (AOR) = 0.67 (0.48-0.93)]; however AOR for PTB was similar in the two groups. Regarding twins, similar adjusted risks were observed for PTB and LBW between the TPT and all three control groups. Significantly more Caesarean sections were performed after IVF (27.3% for singletons) and ICSI (25.1% for singletons) with ejaculated sperm compared with the TPT group (16.4% for singletons). The total rate of congenital malformations in the TPT group was 7.7% and did not differ significantly from any of the control groups. However, singleton TPT boys showed an increased rate of cardiac malformations (3.6%) compared with singleton boys after IVF (1.4%; P = 0.04) and NC (1.1%; P = 0.02). Considering the level of male infertility as a continuum over the four groups, tests for variance in the rate of cardiac malformations in singleton boys, and undescended testicles for singleton as well as twin boys were each significantly increased from NC to IVF to ICSI to TPT (P < 0.001). The rate of hypospadias showed the same pattern, but the TPT group did not differ significantly compared with the control groups. Limitations , Reasons for Caution One of the Limitations is that the TPT group could not be classified according to testicular or epididymal sperm, as these data were not available in the IVF register. Another limitation is that registry-based studies are encumbered with the risk of reporting or coding errors or missing data due to insufficient coding. However, the quality of data on congenital malformations in HDR has, in other studies, been validated and found acceptable for epidemiological research, and furthermore, recordings on study and control groups are performed similarly. Wider Implications of the Findings Accumulating data show that TPT treatment is equally safe as conventional ICSI and IVF treatment and as NC with regard to neonatal outcome including congenital malformation. Study Funding/Potential Competing InterestsThis study is supported by Laboratory of Reproductive Biology, Scientific Unit, Horsens Hospital. No competing interests declared. © 2012 The Author.

Jorgensen P.B.,Horsens Hospital | Kjartansdottir K.R.,Horsens Hospital | Fedder J.,Horsens Hospital | Fedder J.,Braedstrup Hospital
Fertility and Sterility | Year: 2010

Objective: To provide an evidence-based guideline for professionals working with XY women. Design: Review including patient cases from a Danish fertility clinic. Setting: University-associated scientific unit and fertility clinic. Patient(s): Three selected cases. Intervention(s): None. Main Outcome Measure(s): Evaluation of etiology, diagnosis, treatment, and associated disorders in XY women. Result(s): Many gene mutations can cause abnormal fetal development leading to androgen insensitivity syndrome or gonadal dysgenesis disorders. Females with these disorders have an XY karyotype but look like girls. They are mostly diagnosed at puberty, and the condition will often lead to serious psychological problems. Increased risk of malignancies and problems with pregnancy and infertility are other aspects that should be considered. This guideline will aid doctors in caring for XY females. Conclusion(s): A precise diagnosis is important, because the treatment possibilities (e.g., use of allogenic oocytes) depend on the subgroup to which the XY female belongs. © 2010 American Society for Reproductive Medicine.

Olesen C.,Aarhus University Hospital | Harbig P.,Aarhus University Hospital | Barat I.,Horsens Hospital | Damsgaard E.M.,Aarhus University Hospital
Pharmacoepidemiology and Drug Safety | Year: 2013

Purpose: To assess possible origins of harmful interactions in elderly patients arising from the current absence of information on over-the-counter (OTC) medicines in the Danish 'on-line prescription record'. Methods: Information on current use of prescription drugs and OTC medicinal products (non-prescription drugs, herbal medicine, dietary supplements, and others) was collected by home visit interviews. The latter OTC products were not listed in an on-line prescription record that covered the previous two years. Information on interactions between OTC medicines and between OTC products and prescription drugs was obtained from the Danish National Drug Interaction Database. Results: Of the 309 patients recruited (median age 75years, interquartile range (IQR) 70-81), 229 (74%) used 568 OTC medicines not listed in the Danish 'on-line prescription record', amongst which we identified 166 potential interactions - between OTC treatments or between OTC and prescription drugs. Fifty percent of patients taking OTC medicines were exposed to potential interactions, i.e. one to three instances per patient. Twenty-five percent of patients exposed to interactions experienced interaction listed as 'Can be used with certain precautions'. Conclusion: The absence of information on OTC products in an on-line prescription record entails a risk of overlooking interactions in elderly patients. Such products should be included in on-line medication records to prevent adverse effects from interactions. However, online medication records are not available in all countries and as inclusion of data on OTC drugs seem not to be feasible presently. Still, it is highly recommended that the patient's drug list is reviewed on a regular basis. © 2012 John Wiley & Sons, Ltd.

Olesen C.,Aarhus University Hospital | Harbig P.,Aarhus University Hospital | Barat I.,Horsens Hospital | Damsgaard E.M.,Aarhus University Hospital
Pharmacoepidemiology and Drug Safety | Year: 2013

Purpose: To investigate the association between generic substitutions and medication adherence in elderly patients with prescribed polypharmacy. Methods: Our study included 672 patients aged 65+years, living at home in the municipality of Aarhus (Denmark), who at the time of enrolment took at least five prescription drugs daily including both short-term and long-term treatment independently of kind of administration route but without assistance. In this paper, only oral drugs for long-term treatment are included in the analysis resulting in median of three drugs per patient. Adherence was assessed by pill counts. Patients with a mean adherence rate <80% across all oral drugs consumed for long-term treatment were categorised as non-adherent. The number of generic substitutions during 1year was retrieved from the National Health Insurance prescription database. Each change in either a drug's or a manufacturer's name was regarded as a substitution. The association between generic substitution and the mean adherence rate to all drugs was analysed by contingency table analyses and a trend test. Results: During 1year, at least one substitution was experienced by 83.6% of patients (n=562). Patients non-adherent to long-term oral treatment (n=46) amounted to 8% of all patients who experienced substitutions. Amongst 110 elderly patients (16.4%) who did not experience substitutions, 16% were non-adherent (odds ratio 0.46; 95% confidence interval 0.25-0.82). Conclusion: As generic substitution in elderly patients undergoing polypharmacy appears not to affect adherence to long-term drug treatment negatively, there seems to be no obvious reason for avoiding generic substitution in such patients. © 2013 John Wiley & Sons, Ltd.

Bjornholdt K.T.,Horsens Hospital | Brandsborg B.,Aarhus University Hospital | Soballe K.,Aarhus University Hospital | Nikolajsen L.,Aarhus University Hospital
Acta Orthopaedica | Year: 2015

Background and purpose - Persistent postsurgical pain is a well-recognized problem after various types of surgery such as amputation and thoracotomy. The prevalence of persistent pain, and the extent to which it involves neuropathic pain, is highly dependent on the type of surgery. We investigated the prevalence of, characteristics of, and risk factors for persistent pain 1-2 years after shoulder replacement. Patients and methods - A questionnaire was sent to patients who underwent primary shoulder replacement between April 2011 and April 2012, and whose data were recorded in the Danish Shoulder Arthroplasty Register. Patients who had undergone reoperation or bilateral replacements were excluded. Persistent pain was defined as constant or daily pain within the last month, which interfered much or very much with daily activities. Multivariate logistic regression was used to assess risk factors. Results - 538 patients were available for analysis. The prevalence of persistent pain was 22% (CI: 18-25), and the prevalence of presumed neuropathic pain was 13% (CI: 10-16). Persistent pain was more frequent in fracture patients (29%) than in osteoarthritis patients (16%), while the prevalence of neuropathic pain was similar. Severe pain during the first postoperative week increased the risk of persistent pain. Risk also increased with hemiprosthesis (as compared to total prosthesis) in osteoarthritis patients, and with previous osteosynthesis and pain elsewhere in fracture patients. Interpretation - Persistent pain after shoulder replacement is a daily burden for many patients. Further studies should address patient and prosthesis selection, postoperative pain management, and follow-up of these patients. © 2015 Informa Healthcare.

Fedder J.,Horsens Hospital
Danish medical bulletin | Year: 2011

As we found no recent published reports on the amount and kind of research published from Danish hospitals without university affiliation, we have found it relevant to conduct a bibliometric survey disclosing these research activities. We retrieved all scientific papers published in the period 2000-2009 emanating from all seven Danish non-university hospitals in two regions, comprising 1.8 million inhabitants, and which were registered in a minimum of one of the three databases: PubMed MEDLINE, Thomson Reuters Web of Science and Elsevier's Scopus. In 878 of 1,252 papers, the first and/or last author was affiliated to a non-university hospital. Original papers made up 69% of these publications versus 86% of publications with university affiliation on first or last place. Case reports and reviews most frequently had authors from regional hospitals as first and/or last authors. The total number of publications from regional hospitals increased by 48% over the 10-year period. Publications were cited more often if the first or last author was from a university hospital and even more so if they were affiliated to foreign institutions. Cardiology, gynaecology and obstetrics, and environmental medicine were the three specialities with the largest number of regional hospital publications. A substantial number of scientific publications originate from non-university hospitals. Almost two thirds of the publications were original research published in international journals. Variations between specialities may reflect local conditions. not relevant. not relevant.

Zinther N.B.,Horsens Hospital | Fedder J.,Horsens Hospital | Friis-Andersen H.,Horsens Hospital
Surgical Endoscopy and Other Interventional Techniques | Year: 2010

Background: Adhesions are a well-known and very common complication to surgery. Their extent and severity varies according to type and number of surgeries, use of intraabdominal mesh, and presence of peritonitis. Adhesions cause increased morbidity and mortality, with subsequent socioeconomic consequences. This review aimed to identify existing literature on noninvasive radiologic techniques for identification of intraabdominal adhesions. Methods: A structured literature search of medical databases was conducted. English literature published until September 2009 and relevant references were included and assessed. Results: The search identified transabdominal ultrasonography (TAU) and cine magnetic resonance imaging (cine MRI) as relevant tools matching the search criteria. In all, 12 publications concerning TAU and 4 publications concerning cine MRI were identified. All but one of these publications had the methodologic limitation of not being blinded, which influenced the final sensitivity, specificity, and accuracy. Conclusion: Both TAU and cine MRI seem able to identify intraabdominal adhesions using visceral slide with accuracy of 76% to 92%. Unfortunately, the studies are biased by being nonblinded. Accordingly, a need exists for a systematic well-conducted double-blinded comparative study to validate these radiologic techniques. © 2010 Springer Science+Business Media, LLC.

Reiter E.,Horsens Hospital | Reiter E.,Roskilde University | Nielsen K.A.,Roskilde University | Fedder J.,Horsens Hospital
Acta Obstetricia et Gynecologica Scandinavica | Year: 2012

Background. The transvaginal ultrasonographic cervix scan has partly replaced digital examination for diagnosing preterm birth; conflicting results are reported about their respective contribution to birth prediction. Objective. To review the predictive value of digital examination and transvaginal scan in low-risk asymptomatic and symptomatic women before treatment. Methods. A literature search of PubMed, Web of Science and Cochrane Databases from 1994 to 2010 and selected reference lists was carried out. Randomized controlled trials, retrospective and prospective cohort studies, outcome research and studies of clinical decision rules were included. Results. The studies showed that methods for the estimation of cervical ripening are not unequivocal nor is the nomenclature for digital examination. Evidence for routine screening for premature cervical ripening in asymptomatic low-risk women is insufficient. Knowledge of ultrasonographic cervical length in symptomatic women was not associated with a significantly improved outcome in symptomatic women, but may help to reduce length of hospitalization. In women selected by the Bishop Score, a transvaginal scan may reduce the number of false-positive results. Conclusions. Clarification on the methods for performing cervical assessment is needed. The evidence that transvaginal scanning of the cervix improves outcome in symptomatic women is insufficient. The methods for assessing cervical change should be regarded as complementary. © 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

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