Esbjerg, Denmark
Esbjerg, Denmark

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Ikander P.,Hospital South West Jutland | Drejoe J.B.,Rigshospitalet | Lumholt P.,Herlev Hospital | Sjostrand H.,Roskilde Hospital | And 6 more authors.
Danish Medical Journal | Year: 2014

Introduction: The indication for breast reduction in a public welfare or an insurance paid setting depends on the severity of the subjective symptoms and the clinical evalu-ation. The purpose of this study was to evaluate the use of breast volume as an objective criterion to establish the in-dication for breast reduction surgery, thus establishing a standard decision basis that can be shared by surgeons and departments to secure patients fair and equal treatment opportunities. Material and methods: A total of 427 patients who were referred to three Danish public hospitals with breast hypertrophy in the period from January 2007 to March 2011 were included prospectively in the study. The patient's subjective complaints, height, weight and standard breast measurements were registered as well as the decision for or against surgery. Breast volume was measured using transparent plastic cups. Results: Cut-off values for breast volume were calculated based on whether or not the patients were offered reduction surgery. Most patients (93%) with a breast volume below 800 cc were not offered surgery, while most with a volume exceeding 900 cc were offered surgery (94%). In the grey zone between 800 and 900 cc, the indication seemed to be less clear-cut, and additional parameters need to be included. Conclusion: Breast volume can be used as an objective criterion in addition to the presently used criteria. Breast volume can easily be measured and has become appreci-ated by plastic surgeons dealing with patients with breast hypertrophy as a tool which facilitates their decision-making and patients' acceptance of the decisions made.

Kjeldsen L.J.,Hospital Pharmacy | Birkholm T.,Region Zealand Hospital Pharmacy | Fischer H.,Hospital Pharmacy | Graabaek T.,Hospital South West Jutland | And 4 more authors.
International Journal of Clinical Pharmacy | Year: 2014

Background: A drug related problems database (DRP-database) was developed on request by clinical pharmacists. The information from the DRP-database has only been used locally e.g. to identify focus areas and to communicate identified DRPs to the hospital wards. Hence the quality of the data at the national level is unknown, which may compromise national analyses for benchmarking and identification of national focus areas. Objective: The aim of the study was to evaluate the use in practice, reliability and reproducibility of the DRPs documented in the Danish drug related problems database. Setting: Danish hospital pharmacies. Methods: Practice use of the DRP-database was explored by an electronic questionnaire distributed to hospital pharmacies, and consisted of questions regarding current and previous use of the DRP-database. The reliability was evaluated by comparing the categorization of 24 cases by clinical pharmacists with categorization performed by the project group. Reproducibility was explored by re-categorization of a sample of existing records in the DRP-database by two project group members individually. Main outcome measures: Observed proportion of agreement and Fleiss' kappa as measures of inter-rater reliability and reproducibility. Results: The practice use study of 12 hospital pharmacy locations revealed that when implementing the DRP-database, the majority of identified DRPs are documented in the DRP-database, however, some variations throughout the country exist. The interrater reliability study of 34 clinical pharmacists showed high inter-rater reliability with the project group (Fleiss' kappa = 0.79 with 95 % CI (0.70; 0.88)), and the reproducibility study also documented high inter-rater reliability of a sample of 379 records from the DRP-database re-categorized by two project group members (Fleiss' kappa = 0.81 with 95 % CI (0.78; 0.85)). Conclusion: The study showed high reliability and reproducibility of the DRP-database, however, some local variation in the use of the DRP-database throughout the country existed affecting the overall quality. These findings indicate that data in the DRP-database may be pooled, and national analyses may be conducted to explore development areas for common interest. © 2014 Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie.

Lieberoth S.,Bispebjerg Hospital | Backer V.,Bispebjerg Hospital | Kyvik K.O.,University of Southern Denmark | Skadhauge L.R.,Hospital South West Jutland | And 4 more authors.
Respiratory Medicine | Year: 2012

Aim: To examine the association between intake of alcohol and risk of adult-onset asthma. Methods: Using data from two multidisciplinary questionnaire surveys we prospectively studied 19,349 twins, 12-41 years of age, from the nationwide Danish Twin Registry. Results: The eight-year incidence of asthma was 4.3%. After adjustment for sex, age, BMI, physical activity, educational level and smoking, the risk of new-onset asthma was significantly related to overall alcohol intake in a U-shaped manner with the lowest risk observed in the group with a moderate weekly intake of alcohol (1-6 units/week), p = 0.006. The highest risk of asthma was observed in rare/never drinkers (<1 unit/month), OR = 1.59 (1.25-2.02), p = 0.000, whereas the risk of asthma in heavy daily drinkers (≥4 units/day) was also increased, however not statistically significant, OR = 1.13 (0.54-2.36), p = 0.747. The risk of new-onset asthma was lower for subjects with wine preference (3.3%) compared with beer preference (4.3%) or no preference (4.4%). After multivariable adjustment, wine preference was inversely related to incident asthma compared with beer preference. However, this finding was not statistically significant, OR = 0.87 (0.51-1.46), p = 0.590. Conclusion: Alcohol intake is associated with new-onset asthma in adults with a U-shaped association between amount of alcohol intake and the risk of asthma. © 2011 Elsevier Ltd. All rights reserved.

Kjeldsen L.J.,Hospital Pharmacy | Birkholm T.,Hospital Pharmacy | Fischer H.,Hospital Pharmacy | Graabaek T.,Hospital South West Jutland | And 3 more authors.
International Journal of Clinical Pharmacy | Year: 2014

Background: In 2010, a database of drug related problems (DRPs) was implemented to assist clinical pharmacy staff in documenting clinical pharmacy activities locally. A study of quality, reliability and generalisability showed that national analyses of the data could be conducted. Analyses at the national level may help identify and prevent DRPs by performing national interventions. Objective: The aim of the study was to explore the DRP characteristics as documented by clinical pharmacy staff at hospital pharmacies in the Danish DRP-database during a 3-year period. Setting: Danish hospital pharmacies. Method: Data documented in the DRP-database during the initial 3 years after implementation were analyzed retrospectively. The DRP-database contains DRPs reported at hospitals by clinical pharmacy staff. The analyses focused on DRP categories, implementation rates and drugs associated with the DRPs. Main outcome measure: Characteristics of DRPs. Results: In total, 72,044 DRPs were documented in the DRP-database during the first 3 years of implementation, and the number of documented DRPs increased every year. An overall stable implementation rate of approximately 58 % was identified. The DRPs identified were multi-facetted, however evenly distributed for each of the 3 years. The most frequently identified DRP categories were: "Dose", followed by "Nonadherence to guidelines" and "Supplement to treatment". The highest implementation rates were found for the following DRP categories: "Non-adherence to guidelines" (79 %) followed by "Therapeutic duplication" (73 %) and "Dosing time and interval" (70 %). Even though the top 25 drugs were involved in 58 % of all DRPs, multiple drugs were associated with DRPs. The drugs most frequently involved in DRPs were paracetamol (4.6 % of all DRPs), simvastatin (3.0 %), lansoprazole (2.7 %), morphine (2.6 %) and alendronic acid (2.4 %). Conclusions: The study found that a national database on DRPs contained multi-facetted DRPs, however evenly distributed for each of the 3 years. Even though the top 25 drugs were involved in 58 % of all DRPs, multiple drugs were associated with DRPs. The study emphasizes the importance of detecting and intervening for DRPs. © 2014 Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie.

PubMed | University of Southern Denmark and Hospital South West Jutland
Type: | Journal: Scandinavian journal of urology | Year: 2016

The objective of this study was to evaluate outcome after hand-assisted live donor nephrectomy with a retroperitoneal approach during a 5year period.All donor nephrectomies at Odense University Hospital, Denmark, from January 2008 to December 2012 were identified retrospectively, and the medical records were examined.In total, 108 patients were enrolled: 68 females, with a median age of 50years (range 24-68years), and 40 males, with a median age of 51years (32-70years). The median body mass index (BMI) was 25kg/m (19-33kg/m) in females and 27kg/m (21-38kg/m) in males. The median intraoperative bleeding was 175ml. The median warm ischaemia time was 3.2min (1.5-6.7min). The median operative time was 230min (161-360min). The median hospital stay was 4days (2-10days). Thirty donors (28%) had 34 early complications. Six donors (6%) needed reoperation. Late complications were seen in seven (7%). Sixteen donors (15%) were obese (BMI 30kg/m), which was associated with significant complications (p<.0001). There was a significantly higher complication rate in donors who were smokers and ingested alcohol above the Danish recommended limits (p<.0001). Fifteen donors (13%) developed hypertension postoperatively within the first year. There was no mortality. A total of 104 (96%) of the recipients had a functional transplant after 1year.Hand-assisted donor nephrectomy is a safe procedure. Potential candidates should be advised to stop smoking and to avoid alcohol before surgery, especially those with a BMI of 30kg/m or higher.

PubMed | University of Southern Denmark, Hospital South West Jutland and Lillebaelt Hospital Vejle
Type: Journal Article | Journal: Seminars in thrombosis and hemostasis | Year: 2016

Pulmonary embolism (PE) is a common, ubiquitous, and potentially lethal disease. As symptoms and clinical findings are notoriously nonspecific, diagnostic imaging is essential to avoid undertreatment as well as overtreatment. Controversies remain regarding first-line imaging in suspected PE. The two main contemporary contenders are ventilation/perfusion scintigraphy with single-photon emission computed tomography (V/Q SPECT) with or without additional low-dose CT (SPECT/CT) and CT angiography (CTA). We present our results from a systematic review and meta-analysis of the diagnostic performances of these modalities: V/Q SPECT, V/Q SPECT/CT, and CTA are all viable options, but we consider V/Q SPECT/CT to be superior in most clinical settings with better overall diagnostic performance, that is, pooled sensitivities (97.6 vs. 82.0%), specificities (95.9 vs. 94.9%), positive predictive values (93.0 vs. 93.8%), negative predictive values (98.6 vs. 84.7%), and accuracies (96.5 vs. 88.6%). We further address some of the ongoing controversies regarding the various modalities, that is, radiation exposure, the issues of subsegmental PE, nondiagnostic studies, and various challenges in specific patient populations.

PubMed | Hospital South West Jutland
Type: Journal Article | Journal: Basic & clinical pharmacology & toxicology | Year: 2013

Suboptimal medication use may lead to morbidity, mortality and increased costs. To reduce unnecessary patient harm, medicines management including medication reviews can be provided by clinical pharmacists. Some recent studies have indicated a positive effect of this service, but the quality and outcomes vary among studies. Hence, there is a need for compiling the evidence within this area. The aim of this systematic MiniReview was to identify, assess and summarize the literature investigating the effect of pharmacist-led medication reviews in hospitalized patients. Five databases (MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library) were searched from their inception to 2011 in addition to citation tracking and hand search. Only original research papers published in English describing pharmacist-led medication reviews in a hospital setting including minimum 100 patients or 100 interventions were included in the final assessment. A total of 836 research papers were identified, and 31 publications were included in the study: 21 descriptive studies and 10 controlled studies, of which 6 were randomized controlled trials. The pharmacist interventions were well implemented with acceptance rates from 39% to 100%. The 10 controlled studies generally show a positive effect on medication use and costs, satisfaction with the service and positive as well as insignificant effects on health service use. Several outcomes were statistically insignificant, but these were predominantly associated with low sample sizes or low acceptance rates. Therefore, future research within this area should be designed using rigorous design, large sample sizes and includes comparable outcome measures for patient health outcomes.

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