FORSKNINGENS DAG
FORSKNIN
- GENS DAG
FORSKNINGENS DAG FORSKNINGENS DAG
FORSKNIN - GENS DAG FORSKNIN
- GENS DAG
Hospitalsenhed Midt
Forskerdysten på HE Midt den 4. maj 2017
Abstracts
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Program ”Forskerdysten på HE Midt” 2017
12.00 – 12.05 Velkomst
12.05 – 12.55 Foredragssession I
12.55 – 13.20 Pause med mulighed for at se posters 13.20 – 14.10 Foredragssession II
14.10 – 14.35 Gæstetaler: Professor Andreas Roepstorff fra Institut for Kultur og Samfund, Interacting Minds Center (IMC), samt Institut for Klinisk Medicin, Aarhus Universitet
”Interdisciplinær Forskning".
14.35 – 15.00 Præmieoverrækkelse og afslutning
Foredrag
(se abstracts fra side 4 - 13) Session I. 12.05 – 12.551. Thomas Baslev m.fl., Børn og Unge
Medicinsk uddannelse: Hvor tit bruges humor ved morgenkonference?
2. Michael Moesmann Madsen m.fl., Universitetsklinik for Innovative Patientforløb, Diagnostisk Center Optimering af kvalitetsindikatorer for lipid behandling af type 2 diabetes patienter
3. Simon Toftgaard Skov m.fl., Forskningsenheden, Center for Planlagt Kirurgi
Injectable Collagenase vs. Percutaneous needle fasciotomy for Dupuytren contracture in proximal interphalangeal joints: A randomized controlled trial
4. Gine Lovring Glargaard m.fl., Kardiovaskulært Forskningscenter, Karkirurgisk Afdeling Bedside measurements of toe pressures in a department of vascular surgery
5. Hanne Pallesen m.fl., Hammel Neurocenter, Universitetsklinik for Neurorehabilitering Cognitive effects of aerobic exercise after stroke?: A pilot randomized controlled trial
Moderator: Overlæge dr.med. Lars Frost, Kardiovaskulært Forskningscenter, Diagnostisk Center Session II. 13.20 – 14.10
1. Lena Aadal m.fl., Hammel Neurocenter, Universitetsklinik for Neurorehabilitering
Nursing roles and functions addressing relatives during in-hospital rehabilitation following stroke.
Care needs and involvement
2. Amanda Marie Somer Christensen m.fl., Universitetsklinik for Innovative Patientforløb, Diagnostisk Center
Geographical variation in use of oral anticoagulation in patients with atrial fibrillation in Denmark: A nationwide cohort study
3. Nicklas Vinter, Kardiovaskulært Forskningscenter, Diagnostisk Center
Coronary artery calcium score and the long-term risk of atrial fibrillation in patients undergoing non- contrast cardiac computed tomography for suspected coronary artery disease
4. Rehne Lessmann Hansen, Center for Planlagt Kirurgi
Open surgery versus ultrasound-guided corticosteroid injection for trigger finger: A randomised controlled trial with one year follow-up
5. Marie Dahl, Kardiovaskulært Forskningscenter, Karkirurgisk Afdeling; Center for Forskning i Klinisk Sygepleje
Prevalence of cardiovascular diseases and diabetes in Danish postmenopausal women.
Moderator: Professor Peter Vedsted, Universitetsklinik for Innovative Patientforløb, Diagnostisk Center.
Hvert oplæg har en varighed af otte minutter, herefter er der afsat to minutter til diskussion.
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Posters
(se abstracts fra side 14 - 46)1. Arguissain FG m.fl., Hammel Neurocenter, Universitetsklinik for Neurorehabiltering Neural correlates of visual feedback processing during motor learning: Preliminary results 2. Knudsen L m.fl., Vestdansk Center for Rygmarvsskade, Neurologisk Afdeling
The influence of coping-oriented hypnotic suggestions on chronic pain in patients with spinal cord injury (SCI)
3. Glargaard G m.fl., Sårcentret, Karkirurgisk Afdeling
Telemedicine – a treatment supplement for the most diseased diabetics with foot ulcers 4. Damgaard R m.fl., Universitetsklinik for Innovative Patientforløb, Diagnostisk Center
Influence of seaweed and rapeseed compounds in immunological diseases:
A randomized controlled trial.
5. Kristensen CG m.fl., Fysiologisk Klinik
Sammenligning af automatisk og manuel analyse ved dual energy X-ray absorptiometry
6. Przemyslaw AG, m.fl., Akutafdelingen
Raised INR – does treatment of VKA always have to be adjusted in hospital?
7. Andersen AB m.fl., Medicinsk Afdeling; Hjertemedicinsk Afdeling; Center for Forskning i Klinisk Sygepleje
The Influence of a policy document in the practice of intersectorial collaboration in Danish health care: A critical discourse analysis
8. Odgaard L m.fl., Hammel Neurocenter, Universitetsklinik for Neurorehabiltering
Labour Market attachment after severe traumatic brain injury is low in Denmark – A Nationwide follow-up study
9. Møller AD m.fl., Universitetsklinik for Innovative Patientforløb, Diagnostisk Center
24/7 hospital access for ambulatory patients with chronic diseases: A controlled historical cohort study of healthcare utilization and cost-effectiveness
10. Hansen D, Hammel Neurocenter, Universitetsklinik for Neurorehabiltering
Strategies used by SLTs in introducing parents to home-based language activities with their child 11. Stabel HH m.fl., Hammel Neurocenter, Universitetsklinik for Neurorehabiltering
Rupture of a non-traumatic anterior communicating artery aneurysm: Does location of aneurysm associate with functional independence after neurorehabilitation?
12. Grove G Ll m.fl., Karkirurgisk Afdeling
Chronic foot ulcers: Revascularization of diabetic and non-diabetic patients 13. Shathmigha K m.fl., Fertilitetsklinikken, Kvindesygdomme og Fødsler
Does protein supply taken in relation to workout impact sperm quality?
14.Andersen JW m.fl., Kardiovaskulært Forskningscenter, Karkirurgisk Afdeling
Prævalensen af diabetes mellitus blandt 67 årige deltagere i et kardiovaskulært screeningsprogram i Viborg kommune.
15. Dashnaw B m.fl., Sårcentret, Karkirurgisk Afdeling
Kan sårheling i kroniske sår speedes op ved brug af patientens eget blod som behandlingsmiddel?
16. Hoffmann DD m.fl., Vestdansk Center for Rygmarvsskade, Neurologisk Afdeling Peer mentoring in rehabiltation of spinal cord injured persons
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17.Brunner I m.fl., Hammel Neurocenter, Universitetsklinik for Neurorehabiltering
Is upper limb virtual reality training more intensive than conventional training for patients in the subacute phase after stroke? An analysis of treatment intensity and content
18. Madsen MN m.fl., Forskningsenheden, Center for Planlagt Kirurgi
Optimized referral of middle aged patients with symptoms possibly related to meniscal lesion of the knee
19.Evald L m.fl., Hammel Neurocenter, Universitetsklinik for Neurorehabiltering Kognitive og affektive følger 6 mdr. efter hjertestop
20.Pedersen AR m.fl., Hammel Neurocenter, Universitetsklinik for Neurorehabiltering Clinical guidelines for the use of FIM and EFA in patients with acquired brain injury 21. Strøm J m.fl., RegionsRygcenter, Forskningsenhed for Sygemeldt, Diagnostisk Center
Exploring factors associated with symptoms of anxiety and depression in adults undergoing spine surgery – insights from a systematic integrative review
22.Haahr T m.fl., Fertilitetsklinikken, Kvindesygdomme og Fødsler
GnRH agonist trigger and modified LH activity luteal phase (LLS) support versus hCG trigger and conventional luteal phase support in fresh embryo transfer IVF/ICSI cycles – a systematic PRISMA review and meta-analysis
23.Mikkelsen LR m.fl., Forskningsenheden, Center for Planlagt Kirurgi
Development and evaluation of a screening algorithm based on patient-reported data and radiographs to improve the referral pattern to the outpatient orthopedic knee clinic 24. Rosendahl A m.fl., Vestdansk Center for Rygmarvsskade, Neurologisk Afdeling
Central sensitization and medication in spinal cord injured in-patients. A cross-sectional clinical study 25.Pedersen CK m.fl., Hjertemedicinsk Afdeling
Accelerated rule-out of acute myocardial infarction, using Copeptin and high sensitive Troponin T – The AROMI trial
26. Eg M m.fl., Børn og Unge; Center for Forskning i Klinisk Sygepleje Familiens betydning for at unge kan fastholde vægttab
27.Paludan JPD m.fl., Fysiologisk Klinik
Optimering af ventilations-/perfusions lungescintigrafi ved forudgående C-PAP 28.McGrail R m.fl., Blodprøver og Biokemi
Food allergy testing in primary care 29. Balslev T m.fl., Børn og Unge
Selection and ranking of patient video cases for learner levels in paediatric neurology 30. Jensen SK m.fl., Vestdansk Center for Rygmarvsskade, Neurologisk Afdeling
The effects of blood-flow restricted (BFR) exercise on recovery of functional capacity and muscle mass following spinal cord injury (SCI).
31.Jensen SK m.fl., Vestdansk Center for Rygmarvsskade, Neurologisk Afdeling
The effects of systematic, repetitive transcranial magnetic stimulation (rTMS) in rehabilitation after incomplete spinal cord injury (SCI): neuromuscular adaptations and recovery of lower limb muscle strength
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Foredrag til "Forskerdysten på HE Midt"
SESSION I
1. Medicinsk uddannelse: Hvor tit bruges humor ved morgenkonference?
Balslev T1,2, Teilmann G3, Toftedal P4, Hertel T4
1 Børn og Unge, Regionshospitalet Viborg
2 CESU; Aarhus Universitet
3 Nordsjællands Hospital, Hillerød
4 Odense Universitets Hospital
Formål: Kollaborativ, arbejdsbaseret læring er væsentlig for medicinstuderende og læger.
Humor har en social funktion og kan være et effektivt virkemiddel for arbejdsbaseret læring i et fællesskab. Humor kan hjælpe med at mestre usikkerhed eller håndtere følelser. Humor er stærkt bundet til relationer og kontekst, hvilket kan gøre den vanskelig at forstå eller lære. Vi ved ikke hvor tit humor anvendes ved morgenkonference, hvem der tager initiativ, eller om frekvensen af humor-episoder er afhængig af metoden hvorpå cases fremlægges. Derfor valgte vi at gennemføre dette eksplorative pilotstudie.
Metoder: Forfatterne observerede i alt 15 morgenkonferencer ved tre børneafdelinger fordelt på de tre videreuddannelsesregioner i Danmark. Vi definerede en humor-episode som en verbal eller nonverbal ytring, som opfattes som morsom af andre. Vi registrerede
initiativtagere til humor-episoder som enten speciallæger, yngre læger eller medicinske studenter, og registrerede fordelingen på skriftligt og mundtligt fremlagt, interaktiv ”Dagens Case”, og på de traditionelt, mundtligt rapporterede cases.
Resultater: Vi registrerede 56 humor-episoder fordelt på 131 cases. Middelværdien var 3,7 (0-10) pr morgenkonference. I alt 77 % af humor-episoderne blev initieret af speciallæger.
Humor blev registreret 2,6 gang pr ”Dagens Case”, men kun 0,3 gang pr traditionel case præsentation.
Konklusion: Humor blev hyppigt anvendt ved morgenkonference og blev især initieret af speciallæger. Især ”Dagens Case”, som er udviklet for at fremme kollaborativ læring, gav relativt hyppigt anledning til humor-episoder. Pilotstudiet tyder på at humor er en
gennemgribende, fast bestanddel af morgenkonference, at den er afhængig af metoden hvorpå cases bliver fremlagt, og at speciallægerne er bærende aktører.
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2. Optimering af kvalitetsindikatorer for lipid behandling af type 2 diabetes patienter Madsen MM1, Kærsvang L2, Hansen AW1, Flink M3, Nielsen HK4, Hansen KW1
1 Diagnostisk Center, Regionhospitalet Silkeborg
2 Sundhedsplanlægning, Region Midtjylland
3 IT Medico, Århus
4 Medicinsk afdeling, Regionshospitalet Randers
Introduktion: Diabetes ambulatorier rapporterer årligt til den Danske Voksen Diabetes Database (DVDD). Kvalitetsindikatoren for lipidbehandling er: "Andelen af type 2 diabetes pt.
over 40 år med LDL kolesterol > 2,5 mmol/l, som ikke er sat i lipidsænkende behandling." Vi vil undersøge A) årsager til manglende lipidbehandling, samt B) vurdere validiteten af DVDD- indikatoren som kvalitetsmål.
Materiale og metoder: A) Ved online rapportering til DVDD i Region Midtjyllands datafangstprogram præsenteres et "pop-up" spørgeskema vedr. årsager til manglende
lipidbehandling. B) På baggrund af 2014/2015 årsrapporten sammenlignes DVDD-indikatoren med ambulatoriernes opnåede median LDL kolesterol værdi samt med en internationalt
anvendt kvalitetsindikator: ”Andelen af type 2 diabetes pt. med kolesterol værdi over en given grænse."
Resultater: A) I perioden 1/1 2013 - 28/2 2015 blev 3.491 pt. registreret. Heraf 309 (9 %) med LDL > 2,5 uden lipidsænkende behandling, 518 (15 %) med LDL > 2,5 med behandling, 332 med LDL < 2,5 uden behandling (10 %) og 2.332 (67 %) med LDL < 2,5 og behandling.
Spørgeskemaet blev besvaret for 273 (88 %). 104 pt. (38 %) var ikke i behandling enten efter eget ønske (61 pt.) eller lægens anbefaling (43 pt ). Blandt pt. med LDL > 2,5 trods
behandling fik 50 % statin præparater, der ikke omfattede atorvastatin eller rosuvastatin. B) DVDD-kvalitetsindikatoren rapporteret for 40 diabetesambulatorier viste hverken
sammenhæng med den internationale kvalitetsindikator eller med ambulatoriernes mediane LDL værdier for type 2 diabetes pt.
Konklusion: A) For over halvdelen af pt. med LDL > 2,5 mmol/l var der ikke god forklaring på den manglende behandling og halvdelen af pt. med LDL > 2,5 mmol/l var ikke i behandling med de mest effektive statin præparater. B) Den nuværende DVDD indikator er ikke et validt kvalitetsmål.
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3. Injectable collagenase vs. percutaneous needle fasciotomy for Dupuytren contracture in proximal interphalangeal joints; A randomized controlled trial
Simon T. SkovMD1,2,3, Therkel Bisgaard MD1, Per Søndergaard MD1, Jeppe Lange MD PhD1,2,4
1 Center for Planned Surgery – Regional Hospital Silkeborg Falkevej 1-3, 8600 Silkeborg, Denmark
2 Interdisciplinary Research Unit – Center for Planned Surgery – Regional Hospital Silkeborg Falkevej 1-3, 8600 Silkeborg, Denmark
3 Orthopaedic Research Lab. – Department of Orthopaedic surgery, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
4 Orthopaedic Research Unit – Department of Orthopaedic surgery, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
Background: Collagenase clostridium histolyticum injection was introduced commercially as a treatment for Dupuytren contracture following initial phase-3 investigations in 2009 with promising results. However, the efficacy of injectable collagenase has not been prospectively investigated in a direct comparison to other active treatments of Dupuytren contracture with more than 1-year follow-up, despite a wide and increasing clinical use.
Method: In this prospective, independent, open label, randomized controlled trial,
(Clinicaltrials.gov; NCT 01538017), percutaneous needle fasciotomy was directly compared to injectable collagenase. Fifty patients with primary isolated proximal interphalangeal joint Dupuytren contractures were enrolled and followed for 2 years. The primary outcome was clinical improvement defined as a reduction in contracture by 50% or more relative to baseline. Secondary outcomes included: change in contracture, recurrence, adverse events, complications, patient satisfaction, and Disability of Arm, Shoulder and Hand questionnaire score.
Results: Clinical improvement at 2 years was maintained in 7% of injectable collagenase patients (2 of 29) and 29% of percutaneous needle fasciotomy patients (6 of 21). Injectable collagenase led to more, mainly transient, complications, in 93% of patients vs. 24% of the patients treated with percutaneous needle fasciotomy, and lower patient satisfaction, 1 vs. 7 (0 worst, 10 best). No other differences were observed.
Conclusion: This study provides evidence that injectable collagenase is not superior to percutaneous needle fasciotomy in the treatment of isolated proximal interphalangeal joint Dupuytren contracture in regard to clinical outcome, and it led to more, mainly transient, complications and lower patient satisfaction compared with percutaneous needle fasciotomy.
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4. Bedside measurements of toe pressures in a department of vascular surgery Glargaard, G1, Høyer, C2, Høgh, A1
1 The Department of Vascular Surgery, Cardiovascular Research Center, Viborg Regional Hospital
2 The Department of Clinical Physiology, Viborg Regional Hospital
Background: Peripheral arterial disease (PAD) is caused by atherosclerosis and results in reduced distal blood pressure. As PAD progresses, the patient may develop critical limb ischemia (CLI) with a systolic toe pressure (TP) of ≤30 mmHg. Measurement of TP is an essential tool in assessing PAD, but specialised personnel currently perform these
measurements by means of the time-consuming and laborious strain-gauge plethysmography (SGP). This has lead to the desire of finding a bedside method able to deliver immediate, reliable measurements, and research of the past years[1-3] has introduced SysToe as a relevant alternative to SGP.
Aim: To investigate the reliability and accuracy of SysToe measurements of very low TP in a bedside setting in a department of vascular surgery compared to SGP.
Methods: In 2016, we conducted a prospective, single-blinded study in consideration of the Standards of Reporting of Diagnostic Accuracy Studies (STARD). 95 outpatients (mean age 70.9±9.0 years) with same day SGP measurements were included and had SysToe
measurements performed in a bedside setting.
Results: 90(95%) patients had symptomatic PAD, and 31(33%) patients had previously undergone revascularisation. The modalities agreed in the diagnostic classification of CLI in 80/95(84%) patients. For detection of CLI, the sensitivity was 93.8%, the specificity 82.3%, the positive predictive value 51.7%, and the negative predictive value 98.5%.
Conclusion: SysToe is with a high sensitivity concurrent with a high negative predictive value capable of detecting CLI. However, the low positive predictive value may result in over
diagnosis. We found broader limits of agreement compared to previous studies performed in vascular laboratories, but the larger variance may be explained by the fact that we
investigated the device in a bedside setting without specialised personnel. SysToe may function as a crude screening device identifying patients in need of further diagnostics with more accurate equipment, e.g. SGP.
References:
1. Høyer, C., Randomised Diagnostic Accuracy Study of a Fully Automated Portable Device for Diagnosing Peripheral Arterial Disease by Measuring the Toeebrachial Index. European Journal of Vascular and Endovascular Surgery, 2013. 45(1): p. 57-64.
2. Widmer, L.W., Realiability and Repeatability of Toe Pressures Measured With Laser Doppler and Portable and Stationary Photoplethysmography Devices. Annals of Vascular Surgery Inc., 2012. 26(3): p. 404-410.
3. Peréz-Martin, A., Validation of a Fully Automatic Photoplethysmographic Device for Toe Blood Pressure Measurement. European Journal of Vascular and Endovascular Surgery, 2010.
40: p. 515-520.
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5. Cognitive effects of aerobic exercise after stroke?: A pilot randomized controlled trial
Pallesen H1, Bjerk, M2, Pedersen AR1, Evald, L1 and Nielsen JF1
1 Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Denmark
2 Oslo and Akershus University College of Applied Sciences, Norway
Background: Subacute stroke survivors most commonly experience declined aerobic capacity.
Aerobic exercise is an effective treatment to improve aerobic capacity following stroke. Trials including elderly have shown that high intensity is beneficial in improving aerobic capacity and cognitive impairments. High intensity aerobic exercise might therefore also improve cognitive impairments in stroke survivors.
Purpose: The central aim was to assess the effects of aerobic exercise on cognitive impairments in subacute stroke survivors.
Methods: A pilot randomized controlled trial (RCT) on the effects of aerobic exercise on cognitive impairments in stroke patients in the subacute phase was conducted. Thirty patients with moderate cognitive impairments were included in the study and randomly assigned to either the intervention group performing high-intensity aerobic exercise or the control group performing low-intensity exercise. Patients in both groups exercised twice weekly for four weeks.
Assessments were collected before and after intervention and at three months follow-up.
Aerobic capacity: Åstrand-Rhyming cycle ergometer test and 6 Minute Walk Test (6MWT).
Neuropsychological measurements: Wechsler Adult Intelligence Scale (WAIS), Trail making test part A and B, Serial subtractions, Rey Complex Figure Test and Recognition Trial (RCFT), Rey Auditory Verbal Learning Test (RAVLT), Word Association Test, The Tower of London Test (TOL) and the Subscales Anxiety (SCL-ANX) and Emotional disorder (SCL-8) from Symptom Check List (SCL-90).
Results: The results showed that the high-intensity group, compared to the low-intensity group, achieved significant improvements on Trail Making B (primary outcome) assessing processing speed and divided attention (p=0.00190),and on Tower of London assessing executive functioning (total correct score (p=0.0377) and problem solving time (p=0.0417)).
The other tests showed improvements but no significant differences.
Conclusions: Generally cognitive impairments in subacute stroke survivors did improve but not significantly with high-intensity aerobic exercise compared to low-intensity general exercise. However we did find positive results related to processing speed and attention.
Kontakt Hanne Pallesen
Forskningsansvarlig Fysioterapeut / Head of Clinical Physiotherapy Research Cand. Scient. san., PhD
Forskningenheden, Tel. +45 78 41 90 58 Mobil. +45 23 82 13 65 Mail: hannpall@rm.dk
Regionshospitalet Hammel Neurocenter Voldbyvej 15, DK-8450 Hammel
Hospitalsenheden Viborg, Silkeborg, Hammel og Skive
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Foredrag til "Forskerdysten på HE Midt"
SESSION II
1. Nursing roles and functions addressing relatives during in-hospital rehabilitation following stroke. Care needs and involvement
Aadal L1, Angel S2, Langhorn L3, Pedersen BB4,2, Dreyer P5,2
1 Hammel Neurorehabilitation and Research Centre. University Clinic for rehabilitation.
2 Institute of Public Health, Department of Nursing Science, University of Aarhus.
3 Department of Neurosurgery, Department of Anaesthesiology and Intensive Care, Section North, Aarhus University Hospital
4 Department of Neurology, Aarhus University Hospital
5 Department of Anaesthesiology and Intensive Care, Section South, Aarhus University Hospital
Rationale: In the last decades, length of stay of in-hospital rehabilitation of patients with stroke has been significantly reduced. Health authorities expect relatives to be at disposal to convey the knowledge of every day life and to provide emotional as well as practical support in relation to the patient. Caregivers require nurse assistance, support and to be seen as an essential partner in the care giving process. However, the nurses do not perceive that teaching of relatives is a task they should routinely undertake. This might indicate an ambiguity
between the relatives' expectations and the actual contribution from nurses.
Aim: This study describes nurses’ experienced roles and functions addressing the relatives of patients with stroke during in-hospital rehabilitation.
Methodological design: A phenomenological hermeneutic approach influenced by Paul Ricoeur. Focus group interviews of 19 randomly selected nurses from three different hospital settings were interpreted in three levels. The study was conducted in accordance with the Ethical guidelines for nursing research in the Nordic countries.
Findings: The nurses expressed that they address the patient, the relatives, and support the interaction between the patient and the relatives. Four themes occurred: The changed lives of relatives; shared life after stroke; non-cooperating relatives; time for the relatives.
Conclusion: Nurses experience their roles and functions addressing relatives after stroke as crucial, challenging and multifaceted. They acknowledged care needs of the relatives in their own right by addressing the relatives’ vulnerability during in-hospital rehabilitation
characterised by an existential threat to the physical as well as the shared life. The focus on the needs of relatives considering their expected future role was experienced as conflicting with restricting time frames and a health care system focusing on the individual patient.
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2. Geographical variation in use of oral anticoagulation in patients with atrial fibrillation in Denmark: A nationwide cohort study
Christesen AMS1,2, Vinter N1,2, Mortensen LS3, Johnsen SP2,4, Frost L1,2
1 Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital
2 Department of Clinical Medicine, Aarhus University
3 Spange Statistics, Lystrup
4 Department of Clinical Epidemiology, Aarhus University Hospital
Purpose: The purpose of this study was to clarify the extent of inter-regional and inter- municipal variation in Denmark in 1) use of oral anticoagulation (OAC) in patients with atrial fibrillation (AF), 2) one-year persistence in use of OAC, and 3) temporal development in geographical variation in OAC use and persistence.
Methods: By linkage of population-based Danish health care registries, we conducted a
nationwide observational historical cohort study including patients with a first-time diagnosis of AF between 2007 and 2014 (n=127,830). For each region and municipality, we estimated cumulative incidence of OAC prescription redemption within 90 days after the AF diagnosis and after one year adjusting for death as a competing risk. We also estimated relative risk (RR) and risk difference between regions and between municipalities, and temporal trend in OAC prescription redemption.
Results: In patients with CHA2DS2-VASc≥2, use of OAC within 90 days after the AF diagnosis varied from 45.1% (95% CI 44.6-45.7) to 58.5% (95% CI 57.5-59.4) among regions (RR 1.29 (95% CI 1.27-1.32)) and from 40.7% (95% CI 37.2-44.2) to 66.7% (95% CI 55.5-77.9) among municipalities. Use of OAC increased in all regions and municipalities during the study period, particularly after 2010, however regional and municipal differences remained. In patients receiving OAC within 90 days after the AF diagnosis, the proportion of patients still receiving OAC after one year varied among regions from 71.3% (95% CI 70.5-72.0) to 76.9%
(95% CI 75.9-77.8) (RR: 1.08 (95% CI 1.06-1.10)). Variation between municipalities was of similar, or even larger magnitude.
Conclusion: Use and persistence of OAC in patients with AF increased during the study period, particularly after 2010, coinciding with ESC guidelines published in 2010 and introduction of NOAC. However, extensive differences in OAC use between regions and between municipalities exist, suggesting the need for initiatives to ensure uniform treatment quality.
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3. Coronary artery calcium score and the long-term risk of atrial fibrillation in patients undergoing non-contrast cardiac computed tomography for suspected coronary artery disease
Vinter N1,2, Christesen AMS1,2, Mortensen LS3, Urbonaviciene G1,2, Lindholt JS4, Johnsen SP2,5, Frost L1,2
1 Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
2 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
3 Spange Statistics, Lystrup, Denmark
4 Department of Cardiothoracic and Vascular Surgery, Centre for Individualized Medicine in Arterial Disease, Odense University Hospital, Odense, Denmark
5 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Objectives: In patients undergoing non-contrast cardiac computed tomography (nCCT), we examined the association between coronary artery calcium score (CACS) and risk of future atrial fibrillation (AF) and estimated the predictive accuracy of CACS for AF development.
Methods: We conducted a historical population-based cohort study of 25,787 patients suspected of having coronary artery disease and without a history of AF. The patients were identified in the Western Denmark Heart Registry, which is a validated clinical quality database covering Western Denmark. The patients had their CACSs measured using nCCT between 2010 and 2015, and they were followed for the development of AF until 2016 (median 3.0 years).
We used Cox proportional hazards models to estimate hazard ratios (HRs) with 95%
confidence intervals (95% CI), applying CACS as a categorical and as a continuous variable.
The outcome was an incident AF diagnosis. We applied a receiver operating characteristic (ROC) curve for AF to assess the predictive accuracy of CACS.
Results: Among the above-mentioned 25,787 patients, 53% had a CACS of 0, 26% of 1-99, 12% of 100-399, 6% of 400-999, and 4% of ≥1,000. AF occurred in 577 patients after nCCT, corresponding to an overall incidence rate of 7.4 (95% CI: 6.8-8.0) per 1,000 person-years. In a multivariable adjusted model, we found the following HRs (95% CI), CACS 0 as reference.
CACS 1-99: 0.98 (0.78-1.24); CACS 100-399 1.34 (1.03-1.73); CACS 400-999: 1.77 (1.31- 2.38); and CACS ≥1,000: 1.59 (1.11-2.27). An ROC curve showed an AUC of 0.67 (0.64-0.71) for the prediction of AF within one year after nCCT.
Conclusion: A high CACS is associated with a high risk of subsequent AF development and may have the potential to guide future follow-ups for AF detection after CACS measurement to identify AF patients earlier.
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4. Open surgery versus ultrasound-guided corticosteroid injection for trigger finger:
A randomised controlled trial with one year follow-up Hansen RL1,2, Søndergaard M1, Lange J1-3
1Center for Planned Surgery – Regional Hospital Silkeborg
2Orthopaedic Research Unit – Department of Orthopaedic surgery, Aarhus University Hospital,
3Interdisciplinary Research Unit – Center for Planned Surgery – Regional Hospital Silkeborg Purpose: Trigger finger is a common condition with a life-time prevalence of 2%.
Corticosteroid
injection is a treatment often considered as a first-line intervention with reported cure rates between 60-90% in observational cohorts. Open surgery nevertheless remains the most effective treatment with reported cure rates near 100%. Head-to-head trials on these
treatments are limited. We investigated the efficacy of open surgery compared to ultrasound- guided corticosteroid injections.
Methods: The study was performed as a single-centre, randomized, controlled trial with a one-year follow-up. 165 patients received either open surgery (n=81) or ultrasound-guided corticosteroid injection (n=84). Follow-up was conducted at 3 and 12 months. If the finger had normal movement or normal movement with discomfort at latest follow-up, the primary
outcome was considered a success. Secondary outcomes were post-procedural pain and complications.
Results: The groups were similar at baseline except for lower alcohol consumption in the open surgery group. At 3 months 86% and 99% were successfully treated after corticosteroid
injection and open surgery, respectively. At 12 months 49% and 99% were considered successfully treated after corticosteroid injection and open surgery, respectively. The pain score at latest follow-up was significantly higher in the corticosteroid injection group.
Complications after open surgery were more severe and included 3 superficial infections and 1 iatrogenic nerve lesion. After corticosteroid injection 11 patients experienced a steroid flare and 2 had fat necrosis at the site of injection.
Conclusion: Open surgery is clinically superior to ultrasound-guided corticosteroid injections.
Complications after open surgery are more severe, and this must be taken into account when advising the patient which treatment to initiate.
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5. Prevalence of cardiovascular diseases and diabetes in Danish postmenopausal women
Dahl M1,2, Rikke S3, Frost L 1, Lorentzen V1,4, Klausen IC1, Lindholt JS1&5
1 Cardiovascular Research Centre, Regional Hospital Central Jutland
2 Department of Clinical Medicine, Aarhus University
3 Department of Public Health and Department of Clinical Medicine, Aarhus University
4 Centre for Research in Clinical Nursing, Regional Hospital Central Jutland/VIA University College
5 Department of Cardiothoracic and Vascular Surgery, Odense University Hospital.
Background: Reducing women’s cardiovascular risk and the economic costs associated with cardiovascular diseases (CVD) and diabetes (DM) continues to be a challenge. Whether a multifaceted CVD screening programme is beneficial as a preventive strategy in women remains uncertain. The primary uncertainty for estimating whether introduction of a
systematised screening programme for CVD and DM in women is attractive in Denmark, is the prevalence of CVD and DM in postmenopausal women.
Methods: A cross-sectional study was performed among all women born in 1936, 1941, 1946 and 1951 living in Viborg Municipality, Denmark, in October 2011. In total, 1984 were invited to screening for abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), carotid plaque (CP), hypertension (HT), atrial fibrillation (AF) and dyslipidaemia. Participants with positive tests were offered prophylactic intervention including follow-up consultations and pharmacological therapy in case of AAA, PAD, and/or CP. Participants with AAA≥50 mm were referred to specialists in vascular surgery. Women with AF or potential familial
hypercholesterolaemia (FH) were referred to cardiology work-up.
Results: Among those invited, 1,474 (74.3%) attended screening, but the attendees’ share decreased with increasing age groups (p<0.001). AAA was diagnosed in 10 (0.7%) women, PAD in 101 (6.9%) and CP in 602 (40.8%). The percentage of women with these conditions rose with increasing age group (p<0.05). Unconfirmed potential HT was observed in 94 (6.4%), potential FH in 35 (2.4%) and unknown AF in 6 (0.4%), and DM in 14 (1%). None of these findings differed across age groups.
Conclusions: This study recorded an acceptable total attendance rate, even though a
significantly lower attendance rate was observed in the eldest women. Furthermore, the study presents an argument for screening for undiagnosed diseases. However, our data do not allow us to recommend a particular preventive screening strategy.
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Posters til "Forskerdysten på HE Midt"
1. Neural correlates of visual feedback processing during motor learning: preliminary results
Arguissain FG1, Ranieri A2, Nielsen JF1, Andersen HS1,3, Andersen OK2
1 Hammel Neurorehabilitation and Research Centre, Aarhus University Hospital, Hammel, Denmark
2 Integrative Neuroscience group, SMI®, Department of Health Science and Technology, Aalborg University, Denmark.
3 Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
Background: The adaptation to a visuomotor transformation has been widely used to explore the mechanisms behind motor learning [1, 2]. However, it is not completely understood how the brain processes visual movement errors when simultaneously forgetting a previously acquired skill and learning new motor commands.
Aim: The aim of this study was to investigate the neural correlates of visual feedback during motor adaptation/deadaptation.
Method: Twelve participants performed two sessions of a visuomotor adaptation task. The task consisted of fast reaching movements to reach eight targets projected on a computer screen. The hand movement was tracked by a Kinect camera and displayed as a cursor on the screen. After 96 trials (baseline), a 30-degree visuomotor transformation was presented unexpectedly (adaptation, 152 trials) and subsequently removed (deadaptation, 144 trials). In one of the sessions, participants performed the deadaptation without visual feedback of their hand position. Performance in each trial was quantified by the angular end-point error [3], measured between the target position and the final position of the hand cursor and later averaged (mean error). Electroencephalography (EEG) was continuously recorded.
Results: showed a significant feedback × condition interaction for the mean error (RM ANOVA, F2,27.7= 8.581, p<0.0024). During deadaptation, participants experienced a greater error reduction when feedback of the hand was provided (F1, 11 = 18.781, p<0.001). Furthermore, preliminary analysis showed that the movement-related cortical potentials (MRCPs) where significantly smaller (point-by-point RM ANOVA, p<0.05) at movement onset (~-60 – 65 ms, FCZ, CZ) and shortly thereafter (~100 – 200 ms, CZ, PZ) when visual feedback was present.
1] Krakauer JW. 2009. Motor learning and consolidation: the case of visuomotor rotation. Adv Exp Med Biol. 629:405--421.
[2] Galea JM, Vazquez A, Pasricha N, Orban de Xivry J-J, Celnik P. Dissociating the Roles of the Cerebellum and Motor Cortex during Adaptive Learning: The Motor Cortex Retains What the Cerebellum Learns. Cereb Cortex. 2011 Aug 1;21(8):1761–70.
[3] Krakauer JW, Ghez C, Ghilardi MF. 2005. Adaptation to visuomotor transformations:
consolidation, interference, and forgetting. J Neurosci. 25:473--478.
Supported by Bevica Foundation Contact: fedarg@rm.dk
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2. The influence of coping-oriented hypnotic suggestions on chronic pain in patients with spinal cord injury (SCI)
Knudsen L1, Kjøgx H2, Kasch H1
1Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg Regional Hospital
2Imbue, Aarhus andDepartment of Psychiatry, Odense University Hospital
Background and aims: Coping-oriented hypnotic suggestions aimed at reducing pain
catastrophizing have been shown to reduce pain in people with chronic tension-type headache and experimental pain in healthy volunteers during hypnosis (Kjøgx et al., 2016). However, the effect on pain post-hypnosis is unknown. The aim is to investigate the effect of coping- oriented hypnotic suggestions on chronic pain post-hypnosis.
Methods: Seventy-five SCI-patients with chronic pain (>3, NRS 0-10) are randomized into one of three conditions; 1) coping-oriented hypnosis plus current treatment, 2) neutral hypnosis plus current treatment, or 3) current treatment only. The following variables are assessed before intervention and over a period of 14 days post-intervention: Pain
intensity/unpleasantness (NRS 0-10), pain impact (on mood, daily activities and sleep; NRS 0- 10), coping strategies related to pain (Coping Strategies Questionnaire), pain catastrophizing (Pain Catastrophizing Scale), anxiety and depression (Hospital Anxiety and Depression Scale).
Patients’ global impression of change and side effects of the hypnosis are also assessed for 14 days post-intervention.
Results: Preliminary results will be presented.
Conclusions: If coping-oriented hypnosis is found to reduce pain for a substantial period post- hypnosis, this form of hypnosis may provide an alternative to medication or may be used in conjunction with lower medication dosages.
References:
Kjøgx, H., Kasch, H., Zachariae, R., Svensson, P., Jensen, T.S., Vase, L. (2016). Experimental manipulations of pain catastrophizing influence pain levels in chronic pain patients and healthy volunteers. Pain 157(6), 1287-1296
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3. Telemedicine – a treatment supplement for the most diseased diabetics with foot ulcers
Glargaard, G1, Christensen, P1, Dashnaw B1, Høgh, A1
1 Viborg Wound Clinic, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark
Background: The Wound Clinic at Viborg Regional Hospital, Denmark is adopting telemedicine into the clinical everyday life.
Aim: By this study, we wish to clarify if there are differences in basic descriptive characteristics among patients with diabetic foot ulcers (DFU) regarding the use of telemedicine (+TM/-TM) as a supplement to visits in the Wound Clinic.
Methods: During 2015, 106 DFU patients were primarily referred to the Wound Clinic, Viborg Regional Hospital. Data was collected retrospectively from patient records and telemedicine data, respectively.
Results: 80(75%) had +TM in addition to Wound Clinic visits, whereas 26(25%) only had Wound Clinic visits (see table 1).
In general at baseline, +TM was characterized by a higher prevalence of co-morbidities and received a more advanced diabetes treatment.
+TM had more Wound Clinic visits and more hospital admissions compared to the -TM group.
Furthermore, more minor amputations were observed among +TM, while no difference was seen regarding major amputation.
10(13%) +TM died compared to 5(19%) -TM.
Conclusion: We suggest that telemedicine provides a treatment security for all patients with DFU. This study shows that the +TM cohort represents the most exposed group in a known high-risk population. Telemedicine is an effective monitoring tool when in combination with Wound Clinic visits.
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Table 1: Patient demographics and clinical characteristics.
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4. Influence of seaweed and rapeseed compounds in immunological diseases.
A randomized controlled trial
Damgaard R1, Villadsen J2, Glerup H3, Vedsted P4
1 Diagnostic Center, Silkeborg Regional Hospital and Faculty of Health, Aarhus University.
2 Department of Rheumatology, Diagnostic Center, Silkeborg Regional Hospital.
3 Department of Gastroenterology, Diagnostic Center, Silkeborg Regional Hospital.
4 Faculty of Health, Aarhus University and Diagnostic Center, Silkeborg Regional Hospital.
Objectives: A dysbiotic microbiome and disrupted immune system are central features in chronic inflammatory bowel disease (IBD) and -rheumatological diseases (IRD). Thus, new treatment strategies focus on modulating the microbiome and immune system towards a normobiotic state. Recent studies show, that adjuvant diet with fermented seaweed rape compounds (FSR) significantly reduces intestinal problems and overall morbidity within animal models. Theoretically, FSR constitutes natural compounds of pro-and prebiotics, antioxidants, beta-glucans among others health beneficial components, and especially seaweed have anti- bacterial, anti-viral and anti-inflammatory activity. Since FSR target main pathological features in IBD and IRD it is highly relevant in a treatment perspective. No prior study has ever
examined the influence of FSR in relation to human immunological diseases.
Aim: The current study seeks to examine the influence of FSR in relation to the microbiome composition, immune system levels, patient symptoms and other disease related markers within IBD and/or IRD patients.
Methods: The study population includes 90 patients randomly selected from the out-patient clinical database at the department of Gastroenterology and Rheumatology, Silkeborg Regional Hospital. The study is designed as a double-blinded randomized controlled cross-over trial. At baseline participants will be randomized for either the FSR or placebo intervention group, and followed 3 months within each of the groups. To reduce any carry over effects, 1 months wash-out period is planned between cross-over. Follow-up finishes at 7 months. At baseline and during follow-up, blood-and fecal samples, patient reported outcomes and/or intestinal biopsies are collected. Primary outcome: Alterations in the microbiome composition during follow-up.
Perspectives: The results derived from this study, are highly relevant for IBD and IRD patients, but the results might additionally set the foundation for interdisciplinary studies, since dysbiosis is also found within diabetes mellitus 2, cancer, autism, multiple sclerosis, obesity etc.
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5. Sammenligning af automatisk og manuel analyse ved Dual Energy X-ray Absorptiometry
Kristensen CG, Østergaard CV, Dalsgaard JB og Susan Pandrun S Fysiologisk Klinik, Regionshospitalet Viborg
Introduktion: Osteoporose er et globalt sundhedsproblem, som berører mere end 75 millioner. Den medfører forøget risiko for frakturer, og som følge af disse frakturer, en
overdødelighed. Der findes flere metoder, der kan påvise osteoporose, men den mest udbredte er Dual Energy X-ray Absorptiometry (DEXA), da denne både har høj reproducerbarhed, et hurtigt resultat og kan forudsige frakturrisikoen. Flere aspekter af DEXA-scanningsforløbet er veldokumenteret, men ikke hvordan scanningsbilledet korrigeres efterfølgende, for at opnå det mest korrekte resultat. For at belyse dette sammenlignede vi scanningsresultater, opnået med den automatiske analyse, med scanningsresultater opnået ved manuelkorrektion, for at afgøre hvorvidt den automatiske analysevar i stand til at diagnosticere osteoporose korrekt, med den manuelle analyse som guldstandard.
Metode: 300 sæt scanningsbilleder blev analyseret med begge metoder. Den automatiske analyse blev udført af APEX softwaren og derefter generede denne en BMD, T-score og Z- score. Den manuelle analyse, foregik ved at korrigere både outer Regions Of Interest (ROI), vertebral lines og bone map. Der blev udarbejdet Bland-Altman plots over de fundne T- scorer og derefter foretaget en t-test. Derudover blev det undersøgt, hvor stor en andel af de automatisk analyserede billeder, der ændrede diagnose, defineret som; osteoporose/ikke- osteoporose og foretaget en visuel analyse af de automatiskanalyserede scanningsbilleder.
Resultat: Alle Bland-Altman plots viste en forskel mellem automatisk og manuel analyse. T- testen viste, at denne forskel var statistisk signifikant. Der blev også påvist diagnostisk relevante forskelle imellem de to metoder. Den visuelle analyse fandt også forskelle imellem de 2 metoder, dette afspejlede sig ligeledes, når den visuelle analyseblev sammenholdt med de fundne T-scorer.
Konklusion: Den automatiske analyse var ikke i stand til at diagnosticere osteoporose korrekt sammenlignet med den manuelle analyse.
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6. Raised INR – does treatment of VKA always have to be adjusted in hospital?
Przemyslaw Artur Gozdzialski, MD1, Margrethe Smidth, MSc, PhD1,2
1 Emergency Department, Viborg Regional Hospital
2 Department of Clinical Medicine, Aarhus University
Background: As doctors in the Emergency Department we had the presumption that
knowledge of the National Guideline from the Danish Society of Cardiology could be improved and hereby encourage general practitioners to not habitual admitting patients in VKA
treatment and with raised InternationalNormalizedRatio(INR) to hospital. Lack of knowledge of the guideline cause unnecessary admissions that use human and economic resources as well as block beds that could be used for patients who need the specialist hospital treatment.
The aim of this study was to illustrate this problem by identifying the patients with raised INR who could have avoided admission to the Emergency Department in 2015.
Methods: A retrospective registry study with data from the Clinical Biochemical Department and EPJ. Patients’ symptoms at admission and further treatment throughout the hospital system was investigated.
Results: Between 1.1.2015 and 31.12.2015 175 patients were admitted with INR >4.0. Of these 64(38%) patients were admitted with raised INR as main diagnosis, 50(78%) had dysregulated VKA treatment with INR>4.0 and no symptoms of bleeding at time of admission.
Treatment in this group was none (n=3), pausing VKA (n=22), Vitamin K (n=25). The 14(22%) patients with raised INR and symptoms had: brusing (n=1), gastro-intestinal bleeding (n=12). There was observed one case of critical bleeding – intracerebral bleeding.
Treatment in this group was pausing VKA (n=2), pausing VKA+Vitamin K + FFP (n=11), pausing VKA+Octapex (n=1).
Conclusion and perspectives: The result supported our presumption that many of the admissions of patients with raised INR were unnecessary possible due to lack of knowledge or of what to do. To avoid this the Emergency Department initiated a collaborative effort together with the general practitioners and the Department of Cardiology to develop a local guideline, which will be actively implemented together with the National Treatment Guideline from the Danish Society of Cardiology.
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7. The influence of a policy document in the practice of intersectorial collaboration in Danish health care: A critical discourse analysis
Andersen, AB1,2,3, Beedholm, K1, Kolbæk, R3, Frederiksen, K1
1 Department of Public Health, Section for Nursing, Aarhus University
2 Medical Department and Department of Cardiology, Viborg Regional Hospital
3 Center for Clinical Research inNursing, Viborg Regional Hospital
Background: Policy documents are powerful actors in health care, and they play a significant role because they produce certain discursive and non-discursive conditions for intersectorial collaboration.
Central documents in Denmark are the Health Agreements. These policy documents set out the premises for collaboration between hospitals, municipalities, and general practitioners in the five regions. This area is traditionally contested, and the intention of the Health
Agreements is to be a guideline for the allocation of tasks and responsibilities within the collaboration.
Aim:
• To exemplify and discuss how linguistic features and wordings in the Health Agreement for Central Denmark Region produce a certain understanding of intersectorial collaboration in the health care system.
• To show how a critical discourse analysis (CDA) can provide health care professionals and researchers with a tool to critically assess a policy document.
Method: A CDA based on a three-dimensional model for discourse analysis.
Findings: Our analysis showed how wordings and grammatical features create and maintain certain perceptions or common-sense understandings of actors, responsibilities, and tasks in health care.
The linguistic analysis of grammatical features present in the document enabled us to demonstrate how the authors of Health Agreements apply governing technologies to control the delivery of intersectorial health care in Denmark.
Furthermore, the findings showed how this policy document, through its use of language, constructs the actors in intersectorial collaboration within the framework of a market-economy understanding, the goal being to increase productivity and efficiency in health care delivery.
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8. Labour market attachment after severe traumatic brain injury is low in Denmark – A nationwide follow-up study
Lene Odgaard1, Søren Paaske Johnsen2, Asger Roer Pedersen1, Jørgen Feldbæk Nielsen1
1 Research Department, Hammel Neurorehabilitation Center and University Research Clinic, Aarhus University, Denmark
2 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Objectives: To describe the chance of labor market attachment (LMA) after severe traumatic brain injury (TBI) in Denmark and to compare with the general population.
Methods: Matched cohort study. Persons aged 18 to 64 years who received highly specialized neurorehabilitation after severe TBI between 2004 and 2012 (n = 637) were matched to general population controls on age, sex, pre-injury employment status, educational level, and residence (n = 2497).
Three definitions of LMA were considered by defining different public assistance benefits as LMA. Within each LMA-definition we calculated: 1) the proportion of people with a first instance of return to work (RTW), 2) the proportion achieving stable LMA defined as weeks with LMA of 75% or more first year after RTW, 3) the weekly prevalence of LMA.
Patients/controls were compared using multivariable conditional logistic regression.
Results: Up to 52% attempted to RTW and up to 31% achieved stable LMA within 2 years post-injury. The maximal LMA prevalence decreased from 33% to 30% from years 2–5.
Adjusted odds ratios were 0.05 and 0.06 for years 1 and 2, and 0.07 for stable LMA in patients compared to general population controls.
Conclusion: The chance of gaining LMA following severe TBI was low in Denmark when compared with the general population and with other countries.
Keywords: return to work, rehabilitation, prognosis
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9. 24/7 hospital access for ambulatory patients with chronic diseases:
A controlled historical cohort study of healthcare utilization and cost-effectiveness Møller AD1, Christiansen DH2, Fredberg U1, Vedsted P1,3
1 The Diagnostic Centre – University Research Clinic for Innovative Patient Pathways, Regional Hospital Silkeborg, Aarhus University.
2 Department of Occupational Medicine, Regional Hospital West Jutland – University Research Clinic.
3 Research Unit for General Practice. Aarhus University.
Introduction: The quantity and complexity of patients with chronic diseases is significant and there is a demand for innovative solutions in future healthcare to accommodate the challenge.
The Diagnostic Centre, Regional Hospital Silkeborg has developed the Flexible Admission Patient Pathway. This allows patients, relatives, general practitioners and municipal healthcare staff to contact the hospital round the clock if the patient experiences an acute exacerbation.
A one-year before-after study has shown reductions in healthcare utilization of the included patients. However, this study design has obvious limitations, thus there is a need to
investigate the intervention in a controlled study.
Aim: To investigate whether the flexible admission patient pathway reduces healthcare utilization and is cost-effective.
Study population: The intervention group consists of ambulatory patients residing in the municipality of Silkeborg with at least one of the diagnoses: chronic obstructive pulmonary disease, inflammatory bowel disease, liver cirrhosis, cardiac fibrillation and congestive heart failure. A control group is established by 1:n propensity score matching in a Danish population.
Matches will be located at municipalities and hospitals with characteristics similar to the intervention patients.
Outcome measures: The primary outcome measure is hospital bed days. Secondary
outcomes are: 30-days mortality after hospitalization, admissions and bed hours in intensive care units. The follow-up period is two years. Data is retrieved from Danish registers.
Statistical analysis: The effect is investigated by difference-in-difference (DID) analysis which is robust against unobserved fixed differences between groups and time varying differences that equally affects both the intervention and control group. Mixed models
regression analysis is used to accommodate the clustered structure of data. For the analysis of cost-effectiveness, a societal perspective is applied. The incremental cost effectiveness ratio per reduced bed-day is calculated by a two-part logistic and gamma regression model. 95 % confidence intervals are calculated by bootstrapping technique.
Kontaktoplysninger:
Anders Damgaard Møller, ph.d. studerende Diagnostisk Center
tlf: 784 17822
Email: anders.moeller@midt.rm.dk
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10. Strategies used by SLTs in introducing parents to home-based language activities with their child
Hansen D
Hammel Neurorehabilitation Centre and University Research Clinic.
Background/aim: Parent participation in the intervention for children with speech, language and communication needs is an established component of many speech and language
therapists’ (SLTs) practice. Yet, little is known about how parents are introduced to home activities. The literature points out needs for studies of the interaction between SLTs and parents in order to give insights into real-life practices of SLTs involving parents in the intervention process. Therefore, the aim of the present study is to scrutinize encounters between SLTs and parents in order to uncover real-life practices of SLTs when involving parents in home training activities. The focus is on different ways in which the SLTs introduce the parents to the activities.
Methods: Employing ethnomethodological conversation analysis (EMCA), the present study analyses actual interactions involving SLTs, parents and children. Data consist of video recordings of clinical encounters between two different SLTs and parents of children with speech/language disorders. Prior to analysis, data was transcribed according to EMCA principles.
Results: The analysis revealed different strategies used by the SLTs to introduce parents to home activities. One strategy was to show the parents how to carry out an activity with the child. Another strategy was first to show the activity and then let the parents perform it with the child while observed and instructed by the SLT. The analysis indicated that activation of the parent can give the SLT a better insight into the parent’s understanding of the instruction.
Conclusion/further directions: The identification of two different strategies used by two different SLTs suggests that more strategies may be identified when looking into other real-life encounters with parents. However, it is suggested that the strategies identified in the study should be considered as a starting point for SLTs’ reflection on their own practices when introducing parents to home activities.
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11. Rupture of a non-traumatic anterior communicating artery aneurysm:
Does location of aneurysm associate with functional independence after neurorehabilitation?
Stabel HH1, Pedersen AR1, Johnsen SP2, Nielsen JF1
1 Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Denmark
2 Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
Objective: Patients with non-traumatic rupture of an aneurysm located at the anterior
communicating artery (ACoA) often confabulate, show apathy and experience disabilities within memory, executive functions and social behavior. It is unknown whether location of aneurysm also affects the possibility for improvement in functional independence compared to patients with an aneurysmal subarachnoid hemorrhage (a-SAH) located elsewhere. The aim of this study is to explore the association between location of aneurysm (ACoA versus other) and level of functional independence, measured by Functional Independence Measure (FIM), at
discharge from rehabilitation. Additionally, age and FIM at admission were explored.
Method: Historical cohort study among 107 patients with a-SAH based on data from a clinical database and a population-based register. Data was analyzed using multivariable logistic regression.
Results: Patients with ACoA were admitted with poorer cognitive FIM (FIMcog median 6 (IQR 5- 14) compared to patients with aneurysms located elsewhere (FIMcog median 12 (IQR 6-23); no difference at discharge. No association between aneurysm location and functional
independence was observed. Older age was associated with poorer outcome in bowel
management OR 0.59 (95%CI 0.35-0.98), bladder management OR 0.54 (95%CI 0.31-0.92), comprehension OR 0.53 (95%CI 0.30-0.94) and memory OR 0.48 (95%CI 0.25-0.93). Overall, total FIM at admission was associated with the level of functional independence at discharge with the exception of stair walking OR 7.0 (95%CI 0.72-66.78) and bladder management OR 6.3 (95%CI 0.62-64.6).
Conclusion: Rupture of an aneurysm located at ACoA was not associated with poorer level of functional independence at discharge compared to patients with a a-SAH located elsewhere.
Older age was associated with poorer outcome in continence, comprehension and memory.
Overall, total FIM at admission was associated with level of functional independence at discharge.
Corresponding author:
Henriette Holm Stabel
Mail: henriette.holm.stabel@midt.rm.dk Direct phone number: 78419041
Occupational therapist and PhD student at Hammel Neurorehabilitation Centre and University Research Clinic
26 12. Chronic Foot Ulcers:
Revascularization of diabetic and non-diabetic patients Grove G Ll1, Urbonavicius S1, Høgh A1,2
1 Department of Vascular Surgery, Viborg Regional Hospital, Denmark
2 Center of Wound Healing, Viborg Regional Hospital, Denmark
Objective: Patients requiring vascular reconstruction form a high-risk population for developing chronic foot ulcers; a sizeable part of these patients are diabetic.
We aimed towards descriptive characteristics of patients revascularized on the basis of chronic ischemic foot ulcers, comparing the diabetic patients (+DM) to the non-diabetic (–DM).
Method: A retrospective observational study of all patients with chronic ischemic foot ulcers submitted to vascular reconstruction at the Department of Vascular Surgery, Viborg Regional Hospital (June 2013–November 2014).
Data was collected from patient records; follow-up on major amputation and mortality was up to 1 year after revascularization.
Results: A total of 702 patients required vascular reconstruction; 228 (32.5%) had chronic foot ulcers as indication for surgery, of which 98 (43.0%) were diabetic.
Table I. Patient characteristics stratified by diabetes (+/–DM), n=228
+DM (n=98) –DM (n=130) P-value
Male gender 59(60.2%) 64(49.2%) 0.10
Mean age (range) 73.3(49.8–97.8) 75.8(23.6–92.0) 0.07 Mean BMI (range) 26.3(15.6–42.4) 22.8(13.2–35.2) 0.00 Operation level
Central
Peripheral 22(22.4%)
76(77.6%) 46(35.4%)
84(64.6%) 0.04
Operation type Endovascular procedure Open surgery
69(70.4%)
29(29.6 %) 72(55.4%)
58(44.6%) 0.02
Within the 1st postoperative year, 16 (16.3%) died and 31 (31.6%) had a major amputation in the +DM group versus 20 (15.4%) and 32 (24.6 %) in the –DM group, respectively (p>0.05).
Conclusion: The amount of patients with chronic foot ulceration as indication for vascular reconstruction is considerable, and diabetics are highly represented within this population.
Of significance, both the proportion of peripheral and endovascular procedures were greater within the +DM group. We found no significant differences between +DM and –DM patients regarding mortality nor major amputation.
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13. Does protein supply taken in relation to workout impact sperm quality
?
Shathmigha K1,2; Haahr T1,2; Povlsen BB1; Laursen R1; Alsbjerg B1; Elbaek HO1; Humaidan P1,2
1 The Fertility Clinic, Skive Regional Hospital, 7800 Skive, Denmark
2 Faculty of Health, Aarhus University, 8000 Aarhus C, Denmark
Introduction: The market for dietary supplements is growing. Recently, it was shown that 23/24 selected dietary supplements from fitness equipment shops contained anabolic steroids.
These so-called pro-androgenic supplements are presumably not the same as the more commonly used whey and soy protein supplements. Importantly, protein supplies are not medical drugs, but dietary supplements. Thus, they are not tested like medical drugs, they do not necessarily list all contents and might contain known and unknown active mediators that impact reproductive health.
Aims: To investigate how termination of intake of protein supplements taken in relation to workout affect sperm concentration.
Materials and Methods: Case-series. A total of 11 men attending a tertiary fertility clinic were prospectively enrolled. Sperm concentration had to be below 15million/mL at time of enrollment. After 2 months abstinence from dietary supplements a new semen analysis was made according to WHO criteria.
Results: The median difference in sperm concentration was 1.6 million/mL (Interquartile range: 0-5.1) higher at the follow-up 2 months later compared to baseline. A total of four patients did not need donor back up following the dietary abstinence which was otherwise indicated from their baseline sample. Furthermore, one couple changed from IVF to IUI treatment and one couple got spontaneously pregnant. Only one patient had a slightly lower sperm concentration following protein abstinence.
Conclusions: As there is no health benefit from protein supplies for young and healthy men, we suggest fertility doctors to advice for caution in the use of protein supplies while
undergoing fertility treatment. Further research is urgently needed.
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14. Prævalensen af diabetes mellitus blandt 67 årige deltagere i et kardiovaskulært screeningsprogram i Viborg kommune
Andersen JW1, Dahl M1, Høgh A1.
1 KardioVaskulært forskningsCenter, Hospitalsenhed Midt
Mål: Ved hjælp af Hæmoglobin A1C (HbA1C), sigter dette studie efter at identificerer prævalensen af udiagnosticeret diabetes mellitus (DM) blandt 67 årige borgere i Viborg
kommune. Vi søger også at afdækket prævalensen af muligvis ikke velbehandlede borger med kendt DM
Metode: Studiet er et retrospektivt populationsstudie, baseret på et års resultatet af Viborg inter-sectorial Screening Program (VISP) kohorten. VISP inviterer alle 67 årige i Viborg
kommune til at udfylde et spørgeskema og deltage i en klinisk undersøgelse omhandlende DM og kardiovaskulær sygdom.
Programmet startede i august 2014 og kører stadig. Vi stratificerede for perioden september 2014 til september 2016 de deltagende borgere i grupper. Grupperne er baseret på borgerne selvrapporterede DM status og kliniske HbA1C målinger, som vist i fig.1.
Resultater: 1849 borgere blev inviteret til at deltage, af disse responderede 1510 og en responderende blev ekskluderet på baggrund af manglende HbA1C værdi resulterende i 1509 deltagere (81,6%). Af disse havde 184 (12,2%) ikke angivet deres DM status, hvilket gav 1325 personer til videre analyser.
Blandt de der angav sig ikke diabetiske havde 3,5% (42 personer) en HbA1C værdi over 48 mmol/mol. I samme gruppe fandt vi 17,8% (205 personer) med en HbA1C værdi mellem 42-48 mmol/mol. Blandt de med selvrapporteret DM havde 30,1% (40 personer) en HbA1C værdi over 58 mmol/mol, hvilket indikerer at de muligvis ikke er tilstrækkeligt behandlet for deres diabetes.
Konklusion: Blandt 67 årige borger i Viborg kommune, var der hos de der angav sig diabetes fri 3,5 % med udiagnosticeret DM, og 17,8% med prediabetisk HbA1C. Blandt de med kendt DM havde 30,1% en HbA1C der indikerede at de muligvis ikke var tilstrækkeligt behandlede.
Figur 1 Stratificering af deltagere baseret på DM status og HbA1C værdi
