Hjollund N.H.,Regional Hospital West Jutland |
Hjollund N.H.,Aarhus University Hospital |
Frydenberg M.,University of Aarhus
Clinical Epidemiology | Year: 2015
Objective: Missing data is a ubiquitous problem in studies using patient-reported measures, decreasing sample sizes and causing possible bias. In longitudinal studies, special problems relate to attrition and death during follow-up. We describe a methodological approach for the use of multiple imputation (MI) to meet these challenges.Methods: In a cohort of patients treated with percutaneous coronary intervention followed with use of repetitive questionnaires and information from national registers over 3 years, only 417 out of 1,726 patients had complete data on all measure points and covariates. We suggest strategies for use of MI and different methods for dealing with death along with sensitivity analysis of deviations from the assumption of missing at random, all with the use of standard statistical software. The Mental Component Summary from Short Form 12-item survey was used as an example.Conclusion: Ignoring missing data may cause bias of unknown size and direction in longitudinal studies. We have illustrated that MI is a feasible method to try to deal with bias due to missing data in longitudinal studies, including attrition and nonresponse, and should be considered in combination with analysis of sensitivity in longitudinal studies. How to handle dropout due to death is still open for debate. © 2015 Biering et al.
Glassou E.N.,Regional Hospital West Jutland |
Glassou E.N.,Aarhus University Hospital |
Pedersen A.B.,Aarhus University Hospital |
Hansen T.B.,Regional Hospital West Jutland |
Hansen T.B.,University of Aarhus
Acta Orthopaedica | Year: 2014
Purpose-To compare the risks of re-admission, reoperation, and mortality within 90 days of surgery in orthopedic departments with well-documented fast-track arthroplasty programs with those in all other orthopedic departments in Denmark from 2005 to 2011. Methods-We used the Danish hip and knee arthroplasty registers to identify patients with primary total hip arthroplasty or total knee arthroplasty. Information about re-admission, reoperation, and mortality within 90 days of surgery was obtained from administrative databases. The fast-track cohort consisted of 6 departments. The national comparison cohort consisted of all other orthopedic departments. Regression methods were used to calculate relative risk (RR) of adverse events, adjusting for age, sex, type of fixation, and comorbidity. Cohorts were divided into 3 time periods: 2005-2007, 2008-2009, and 2010-2011. Results-79,098 arthroplasties were included: 17,284 in the fast-track cohort and 61,814 in the national cohort. Median length of stay (LOS) was less for the fast-track cohort in all 3 time periods (4, 3, and 3 days as opposed to 6, 4, and 3 days). RR of re-admission due to infection was higher in the fast-track cohort in 2005-2007 (1.3, 95% CI: 1.1-1.6) than in the national cohort in the same time period. This was mainly due to urinary tract infections. RR of re-admission due to a thromboembolic event was lower in the fast-track cohort in 2010-2011 (0.7, CI: 0.6-0.9) than in the national cohort in the same time period. No differences were seen in the risk of reoperation and mortality between the 2 cohorts during any time period. Interpretation-The general reduction in LOS indicates that fast-track arthroplasty programs have been widely implemented in Denmark. At the same time, it appears that dedicated fasttrack departments have been able to optimize the fast-track program further without any rise in re-admission, reoperation, and mortality rates.
Biering K.,Regional hospital West Jutland |
Frydenberg M.,University of Aarhus |
Hjollund N.H.,Regional hospital West Jutland |
Hjollund N.H.,Aarhus University Hospital
Clinical Epidemiology | Year: 2014
Objective: Improvements in the treatment of coronary heart disease have increased the number of patients living with a chronic heart disease. Patient-reported outcomes are required to adequately describe prognosis. We report self-rated health in a population-based cohort of patients with coronary heart disease treated with percutaneous coronary intervention (PCI). Methods: Over 3 years, we followed 1,726 patients under 65 years treated with PCI with eight repetitive questionnaires. With the use of multiple imputation, we described the course of self-rated health using the short form 12-item survey’s mental component summary (MCS) and physical component summary (PCS) and analyzed adjusted differences by sex, age, educational level, indication for PCI, and left ventricular ejection fraction along with an analysis of decrease in health status. Results: MCS scores increased during follow-up, while PCS scores were stable over time. Men rated higher in MCS and PCS than women, and older patients rated higher in MCS than younger. Other differences were negligible. Younger age was identifed as a risk factor for marked decrease in mental health over time. Conclusion: In a complete population-based cohort of PCI patients with multiple measurements, we found improvements in mental, but not physical health over time. Demographic differences in health were larger than disease-related differences. © 2014 Biering et al.
Biering K.,Regional Hospital West Jutland |
Botker H.E.,Aarhus University Hospital |
Niemann T.,Regional Hospital West Jutland |
Hjollund N.H.,Regional Hospital West Jutland |
Hjollund N.H.,Aarhus University Hospital
Clinical Epidemiology | Year: 2014
Objective: A relation may exist between self-reported health and adverse events in coronary heart disease. Previous studies have been vulnerable to possible selection bias. In the study reported here, we examined the association between self-rated health and adverse events in terms of cardiac events, cardiac readmissions, and all-cause mortality in a complete cohort of patients treated with percutaneous coronary intervention (PCI). Study design and setting: A cohort of patients with coronary heart disease treated with PCI was followed up with questionnaires 4 weeks after PCI to measure self-rated health and in registers to identify adverse events. Of 1,752 eligible patients under 67 years, 26 died during the first 4 weeks. A total of 224 patients were excluded from the analysis because they were readmitted with a cardiac diagnosis before answering the first questionnaire. We received complete SF-12 Health Survey component summaries from 984 of the remaining 1,502 patients. We used multiple imputation to establish a complete cohort, including nonrespondents. Results: During follow-up, 83 patients died, 220 patients experienced a new cardiac event, and 526 patients experienced a hospital readmission related to coronary heart disease. Poor self-rated health was related to cardiac events, cardiac readmission, and all-cause mortality. The associations were stronger for all-cause mortality than for events and readmissions. Physical health was more important than mental health, but both revealed an exposure-response pattern. Conclusion: Poor self-reported health within 4 weeks of PCI was associated with adverse outcomes during up to 5 years' follow-up. © 2014 Biering et al. This work is published by Dove Medical Press Limited.
Lykke R.,Aarhus University Hospital |
Lykke R.,Regional Hospital West Jutland |
Blaakaer J.,Aarhus University Hospital |
Ottesen B.,Rigshospitalet |
Gimbel H.,Nykobing Falster Hospital
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2013
Objective To describe conditions regarding hysterectomy for benign indications during the past 35 years in Denmark. Study design Population-based register study of 167,802 women who underwent hysterectomy for benign conditions in the period 1977-2011. Patient data regarding operative techniques, hospitalization, indications, patient age, and geography were extracted from the Danish National Patient Register. Results The overall rate of hysterectomy was around 180/100,000 woman years during the period. A rise in laparoscopic and vaginal hysterectomy was seen at the expense of abdominal hysterectomy. The indication of pelvic organ prolapse and abnormal uterine bleeding increased while the indication of fibroids decreased. The average age of women at time of hysterectomy increased from 46 years in 1977-1981 to 50 years in 2006-2011. The mean number of hospitalization days was reduced by 75%. Regional differences were detected regarding route of hysterectomy and hospitalization. Conclusions This study demonstrates a change in the pattern of indications for hysterectomy, increased age of the affected women, reduced length of stay in the hospital, and a rise in the percentage of minimal invasive surgical procedures. © 2013 Elsevier Ireland Ltd © 2013 Published by Elsevier Ireland Ltd. All rights reserved.
Johnsen S.P.,Aarhus University Hospital |
Svendsen M.L.,Aarhus University Hospital |
Hansen M.L.,Copenhagen University |
Brandes A.,University of Southern Denmark |
And 2 more authors.
Stroke | Year: 2014
Background and Purpose-Preadmission oral anticoagulant treatment (OAT) has been linked with less severe stroke and a better outcome in patients with atrial fibrillation. However, the existing studies have methodological limitations and have, with one exception, not included hemorrhagic strokes. We performed a nationwide historic follow-up study using data from population-based healthcare registries to assess the effect of preadmission OAT on stroke outcomes further. Methods-We identified 11 356 patients with atrial fibrillation admitted to hospital with acute stroke (including ischemic stroke and intracerebral hemorrhage) between 2003 and 2009. Propensity score-matched analyses were used to compare stroke severity (Scandinavian Stroke Scale score) and mortality among 2175 patients with preadmission OAT and 2175 patients without preadmission OAT. Results-A total of 2492 (21.9%) patients received OAT at the time of their stroke. Preadmission OAT was associated with a lower risk of severe stroke (Scandinavian Stroke Scale score at time of admission, <30 point; propensity score-matched odds ratio, 0.74; 95% confidence interval, 0.63-0.86) and lower 30-day mortality rate (propensity score-matched adjusted odds ratio, 0.83; 95% confidence interval, 0.71-0.98). Conclusions-Only a minority of hospitalized patients with acute stroke with atrial fibrillation received OAT at the time of stroke. Preadmission OAT was associated with less severe stroke and lower 30-day mortality rate in a propensity score-matched analysis. © 2013 American Heart Association, Inc.
Jeune B.,University of Southern Denmark |
Eriksen M.L.,Regional Hospital West Jutland |
Andersen-Ranberg K.,Institute of Public Health |
Bronnum-Hansen H.,Copenhagen University
Scandinavian Journal of Public Health | Year: 2015
Aims: In Denmark life expectancy (LE) has increased since 1995 after a long period of stagnation. Healthy life expectancy (HLE) at age 65 increased more than LE during the period 1987-2005. The aim of the study was to determine the trend in HLE in Denmark at ages 50 and 65 during the period 2004-2011. Methods: The study was based on nationwide register data on mortality and data on health status from the SHARE surveys carried out in 2004/2005, 2006/2007 and 2010/2011. Expected lifetime in various health states was estimated by Sullivan's method. Changes from 2004 to 2011 were decomposed into contributions from changes in mortality and prevalence of activity limitations. Results: During the period 2004-2011 LE increased by about 1 year at both age 50 and age 65. However, the increase in expected lifetime in self-rated good health, without long-term health problems and without activity limitations was even longer in both genders and it increased by 1.5-4.0 years depending on age, gender and health indicator. Consequently, expected lifetime in an unhealthy state decreased and the proportions of lifetime in a healthy state increased. The disability effect of the health gain was stronger than the mortality effect. Conclusions:In Denmark HLE increased substantially more than LE during the period 2004-2011 for all three health indicators at both age 50 and age 65, and for both genders. Thus, the improvement in health expectancy continued in Denmark in recent years. © 2015 the Nordic Societies of Public Health.
Jakobsen F.,Regional Hospital West Jutland |
Hansen J.,Regional Hospital West Jutland
Journal of Interprofessional Care | Year: 2014
In a Danish Interprofessional Training Unit (ITU), the clinical tutors have succeeded in developing a safe learning environment combined with challenging the students by giving them responsibility for the patient's care and rehabilitation. In the ITU, students improved their uniprofessional and interprofessional knowledge and capability while strengthening their professional identity. It was, therefore, decided to make an attempt to transfer these interprofessional learning and teaching methods to another setting. The aims of this study were to evaluate whether the students learned about interprofessional collaboration and strengthened their professional identity and whether the clinical tutors could create a safe and challenging learning environment. Clinical tutors from the professions occupational therapy, physiotherapy, and nursing together planned the pedagogical approach and practical organization of two pilot studies in an orthopedic ward. After the intervention, focus group interviews of students and clinical tutors were performed and analyzed. The findings indicated that a one-week interprofessional clinical placement can contribute to students learning about interprofessional collaboration and to their development of professional identity. The data from the clinical tutors indicated that they needed to create a safe and challenging learning environment but emphasized that a thorough planning and continuous monitoring and adjusting of the clinical placement is necessary for success. The study documents that it is possible to create successful interprofessional learning opportunities in a normal ward environment in a restricted time frame. This knowledge can be applied to other ward settings where interprofessional clinical training is a natural possibility. © 2014 Informa UK Ltd.
Nielsen S.Y.,Regional Hospital West Jutland
Euro surveillance : bulletin Européen sur les maladies transmissibles = European communicable disease bulletin | Year: 2013
Q fever is a zoonotic infection which can pose a danger to pregnant women. To our knowledge, Denmark has never experienced a clinically verified Q fever outbreak. We aimed to quantify risk of infection in pregnant women occupationally and environmentally exposed to Coxiella burnetii. The Danish National Birth Cohort collected blood samples from 100,418 pregnant women in the period 1996 to 2002. We sampled 195 women with occupational exposure to livestock (veterinarians and female farmers), 202 women with domestic exposure (dairy cattle and/or sheep) and a random sample of 459 unexposed women. Samples were screened for antibodies against C. burnetii by commercial enzyme-linked immunosorbent assay. Positive samples were confirmed by immunofluorescence (cut-off titre ≥1:128). The proportion of seropositive women was higher in the occupationally exposed (47.2% seropositive; relative risk (RR): 9.8; 95% confidence interval (CI): 6.4-15.2) and the domestically exposed population (32.2% seropositive; RR: 6.7; 95% CI: 4.3-10.6) than in unexposed women (4.8% seropositive). We found a high prevalence of antibodies to C. burnetii among pregnant women with occupational or domestic exposure to cattle and/or sheep compared with unexposed pregnant women. Our findings suggest that contact to livestock is a risk factor for C. burnetii infection in Denmark.
Eriksen J.,Regional Hospital West Jutland |
Sneftrup S.B.,Regional Hospital West Jutland
European Journal of Clinical Nutrition | Year: 2013
Background/objective:Information on weight loss is used in screening and assessment tools. It is essential that the data are correct. Anamnestic data of weight changes were compared with records for hospitalized patients and outpatients.Subjects/methods:For hospitalized patients, anamnestic and recorded weight data were obtained. For outpatients, data of weight changes since last visit were obtained.Results:Of 34 hospitalized patients, 21 stated change of weight (15 lost, 6 gained). Weight loss in 9 and weight gain in 12 patients were recorded. Ten patients stated no change of weight. Weight loss in 4 and weight gain in 3 patients were recorded. Of 15 patients who stated weight loss, it was correct for 9 patients. Six of 21 patients stated weight changes opposite the records. Of 43 patients, 14 stated weight changes before admission; only 9 could indicate the time span. Ten patients stated 'Do not know' to the question of weight changes. For 156 outpatients, 86 stated change of weight (39 lost, 47 gained). Weight loss in 42 and weight gain in 47 patients were recorded. Fifty-eight patients stated no change of weight. Weight loss in 26 and weight gain in 29 patients were recorded. Of 38 patients who stated weight loss, it was correct for 31. Seventeen of 85 patients stated weight changes opposite the records.Conclusions:Recollection of weight changes is poor for a large percentage of patients. In patients who stated weight loss it was only correct for 75%, and for patients who stated unchanged weight 25% have lost more than 1 kg. Thus, incorrect weight loss data can cause over- and underestimation of nutritional risk. © 2013 Macmillan Publishers Limited All rights reserved.