Hospital South West Jutland

There is limited data regarding the rare and aggressive colorectal neuroendocrine carcinoma (CR-NEC). In this large prospective study, molecular-clinical characteristics and treatment outcomes following palliative chemotherapy are reported for 163 metastatic CR-NEC patients, with a comparison to a population-based prospective cohort of 263 metastatic colorectal adenocarcinoma (CR-AC) patients. Eighty-three percent of CR-NEC received first-line platinum-etoposide, while 98% of CR-AC patients received first-line fluorouracil-based chemotherapy. Disease control rate across all first-line regimens in CR-NEC and CR-AC was 43% vs. 74%, immediate progressive disease 46% vs. 15%, progression-free survival 2.4 months (m) (95% CI 2.1-3.3) vs. 7.7 m (95% CI 6.9-8.5), and overall survival 6.7 m (95% CI 5.6-8.8) vs. 16.8 m (95% CI 13.7-20.3), all, p < .001. CR-NEC more often had synchronous metastases, worse performance status, and symptom burden at treatment initiation than CR-AC (all, p < .001). Two-year survival was 9% vs. 37% in CR-NEC and CR-AC (p < .001). BRAF mutations were frequent in CR-NEC and CR-AC (26% vs. 20%, p = .153) and associated with shorter OS in CR-NEC and CR-AC (p = .025 and p = .003). KRAS mutations were less frequent in CR-NEC than CR-AC (34% vs. 45%, p = .041), but only associated with shorter OS in rectal NEC (p = .04). The frequencies of APC and TP53 mutations were similar between the cohorts and did not impact survival. Metastatic CR-NEC and CR-AC are clinically distinct, with NEC demonstrating more aggressive features, limited treatment effect, and worse prognosis. Although they share important driver mutations, the underlying reason for their marked clinical differences remains unclear.

A young woman presented with acute right flank pain, fever and thrombocytopenia. Initial evaluation suggested pyelonephritis, supported by flank tenderness, elevated C-reactive protein, and Eschericia coli in urine culture. Broad-spectrum antibiotics were initiated. Over the following 2 days, she developed progressive anaemia and severe thrombocytopenia with biochemical evidence of haemolysis. Differential diagnoses included infection-related haemolysis, atypical haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura (TTP) and drug-induced thrombotic microangiopathy (TMA). Initial imaging was inconclusive, while follow-up CT later during admission demonstrated findings consistent with pyelonephritis, but haematological deterioration was disproportionate. ADAMTS13 enzymatic activity was normal, excluding classic TTP, and a drug screen confirmed recent cocaine use. Microscopy revealed schistocytes, consistent with TMA. The patient's condition progressed rapidly with marked anaemia and thrombocytopenia by day 3. She was transferred to a tertiary specialised centre on day 4, improved with supportive care alone and achieved full recovery on day 8. This case emphasises the importance of recognising drug-induced TMA and distinguishing it from primary forms to guide appropriate management.

For Human Papillomavirus (HPV) vaccination to be delivered effectively, countries must transition from campaign-based introduction to integration within the routine immunization schedule. While existing literature provides insights into the effectiveness of HPV campaigns and barriers to initial vaccine acceptance, there is a dearth of stakeholder-informed implementation research around the transition from campaign to routine delivery. This study aimed to explore the experiences and perspectives of key stakeholders involved in the HPV vaccine campaign in Nigeria to generate stakeholder-driven recommendations for the effective and sustainable integration of the vaccine into the country’s routine immunization schedule and strengthen national capacity for introducing and sustaining future new vaccines. This study adopted a qualitative, exploratory research design. The research was conducted across nine Nigerian states, representing five of the six geopolitical zones. Participants were purposively sampled, encompassing 140 stakeholders (30 Key Informant Interviews, 110 In-depth Interviews). Data were collected using semi-structured interview guides, audio-recorded, transcribed verbatim, and thematically analysed. Stakeholder recommendations emphasize that effectively integrating the HPV vaccine into routine immunization in Nigeria demands a multi-pronged strategy. This includes comprehensive strategies for awareness, engagement, and mobilization; continuous workforce training and motivation; robust data systems and reporting; effective management of misinformation; and intensification campaign. Additionally, early and thorough planning, fostering government ownership, optimizing operational logistics, ensuring consistent funding, and maintaining vaccine availability are critical. These insights provide valuable, transferable lessons for the introduction and sustained implementation of future vaccines. The transition of the Human Papillomavirus (HPV) vaccine from a campaign-driven approach to routine immunization in Nigeria represents a critical juncture, offering both significant challenges and unparalleled opportunities to strengthen the national health system. Policy priorities should include institutionalizing periodic intensification programs, strengthening community engagement, standardizing immunization data systems, securing sustainable financing, and enhancing primary healthcare infrastructure. By addressing these priorities, Nigeria can achieve equitable HPV vaccine coverage and strengthen its capacity for future vaccine initiatives, ensuring a lasting public health impact. Not applicable.

Background/Objectives: Intracranial hemorrhage (ICH) is a life-threatening condition that can be rapidly detected by non-contrast head computed tomography (NCCT). RAPID ICH is a deep learning (DL) tool for automatic ICH identification using NCCT. Our aim was to assess the real-world performance of RAPID ICH compared to that of a first-year radiology resident on consecutively acquired NCCTs from patients referred from the Emergency Department. Methods: This single-center retrospective cohort study included NCCTs acquired on the same CT scanner over three months. Exclusion criteria were motion or metallic artifacts that substantially degraded the NCCT quality and incomplete NCCTs. Two senior neuroradiologists conducted ground-truth labeling of the NCCTs regarding ICH presence in a binary manner. The first-year radiology resident assessed NCCTs for ICH presence and was blinded to the ground-truth labeling. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed for the RAPID ICH identifications and for the first-year radiology resident’s ICH identifications. Results: After applying exclusion criteria, 844 NCCTs remained. Ground-truth labeling found ICH in 63 NCCTs. RAPID ICH showed 87.3% sensitivity, 74% specificity, 21.3% PPV, and 98.6% NPV, while the first-year radiology resident achieved 95.2% sensitivity, 90.8% specificity, 45.5% PPV, and 99.6% NPV. There were 8 false-negative and 203 false-positive RAPID ICH identifications. Conclusions: RAPID ICH’s sensitivity and specificity were lower than in prior studies performed using RAPID ICH, and there was a high number of false-positive RAPID ICH identifications, limiting the generalizability of the assessed version of this DL tool. Testing DL tools by comparing them with radiologists of varying experience can provide valuable insights into their performance.

Background and AimChronic headache disorders substantially impair quality of life, daily functioning, and social participation. Acceptance and Commitment Therapy (ACT), a third-wave cognitive-behavioral approach, has shown promise in chronic pain management, but little is known about patients’ lived experiences with ACT-based group treatment. This study explored how individuals with chronic headache experienced participation in The Headache School, a multidisciplinary ACT-informed program delivered at a specialized Danish headache clinic, with focus on knowledge gains, daily life changes, and the impact of the group setting.MethodsA qualitative design was applied using focus group interviews. Participants were purposively sampled among patients who had completed at least nine of eleven sessions of The Headache School between 2019 and 2024. Data from nine focus groups with 36 participants were analyzed using reflexive thematic analysis following Braun and Clarke.ResultsThree overarching themes were identified: (1) Knowledge and recognition that it is a real illness, (2) Accepting that the illness will always be part of my life, and (3) Belonging – I did not have to explain, apologize or defend myself. Patients described increased self-understanding, greater acceptance of their condition, and improved ability to communicate needs and limitations. The programme supported value-based life choices and prioritization of well-being despite ongoing symptoms. The group format fostered community, reduced isolation, and offered long-term peer support.ConclusionParticipation in The Headache School was experienced as meaningful and supportive, facilitating acceptance, psychological flexibility, and empowerment. Patients reported enhanced capacity to live functional, value-driven lives despite persistent headache. The group format played a central role in reducing isolation and fostering lasting connections. These findings highlight the potential of ACT-informed, multidisciplinary group interventions in chronic headache care and emphasize the importance of incorporating patient perspectives into treatment development and evaluation.Trial RegistrationRegistered with the Region of Southern Denmark (24/32787).

For centuries, amethyst has been celebrated as a crystal capable of restoring balance and even preventing intoxication. In modern alternative medicine, it continues to be promoted as a simple path to health and harmony. Given the annual struggle to recover from the excesses of December, we tested whether carrying an amethyst could improve lifestyle factors (KRAM-S: diet, smoking, alcohol, exercise, sleep) and overall health among healthcare professionals in January. In a randomised, double-blinded, placebo-controlled trial, 38 healthcare professionals at Esbjerg Hospital were assigned to carry either an amethyst or a visually similar stone in sealed cloth bags for four weeks. Participants completed baseline and follow-up questionnaires covering KRAM-S factors and self-rated health. Standard statistical tests were applied. Participants were already remarkably healthy. Almost all ate fruit and vegetables daily, none smoked, alcohol use was modest, and exercise was common. Unsurprisingly, neither amethyst nor placebo produced measurable changes in lifestyle or perceived health. Belief in alternative medicine (reported by 52%) did not modify outcomes. Drop-out was 18%, and eight participants misplaced their stone. The amethyst, despite its reputation as a protector against excess, did not improve lifestyle factors post-Christmas in healthcare professionals. Its contribution appears symbolic rather than physiological. Funding None. Not applicable.

In people with multiple sclerosis (PWMS), exercise improves aerobic capacity and muscle strength which are key components of physical function and overall health status. However, the effects diminish after exercise cessation. Therefore, the present study aimed to investigate whether exercise booster sessions (EBS) could preserve the exercise-induced improvements. Multicentre RCT. Ninety-four PWMS performed 12 weeks of aerobic-training (AT) or resistance-training (RT) and were subsequently randomised to receive EBS (two sessions every fifth week) (ATboost n = 24, RTboost n = 24) or usual-care (ATuc n = 20, or RTuc n = 26) for 40 weeks. The primary outcome was physical function measured as a composite score of the six-minute walk test (6MWT) and five-time sit-to-stand test (5STS). Secondary outcomes were aerobic capacity and muscle strength. No between-group difference was observed in the composite score of 6MWT and 5STS (arbitrary unit) between ATboost and RTboost 0.00 [-0.20; 0.20]. No between-group difference was observed for aerobic capacity (mL O2/kg/min) between ATboost and ATuc 1.1 [-1.9; 4.1], although a within-group change was observed for ATboost -1.9 [-4.0; 0.1], but not for ATuc -3.0 [-5.2; -0.8]. No between-group difference was seen for muscle strength (Nm/kg) between RTboost and RTuc -0.04 [-0.36; 0.28]. Also, no within-group change was observed for neither RTboost -0.07 [-0.30; 0.14] nor RTuc -0.04 [-0.27; 0.20]. EBS had no apparent effect on preservation of physical function, aerobic capacity, or muscle strength in PWMS. Muscle strength was preserved regardless of group, whereas only ATboost preserved exercise-induced improvements in aerobic capacity.

Abstract Background Screening for atrial fibrillation (AF) may reduce stroke, but the adverse effects are largely unknown. Purpose To investigate how AF detected by screening affected health-related quality of life (HRQoL) compared with AF detected by usual care and to examine HRQoL changes related to stroke and major bleeding. Methods We used HRQoL data collected from 6004 participants randomised (1:3) to screening for AF with implantable loop recorder and treatment (n=1501) or to usual care (n=4503). HRQoL was measured annually with the EQ-5D-5L questionnaire, which produced a combined EQ-index score (worst=-0.76 best=1.00) and an EQ-VAS score (0=worst, 100=best) for each trial participant per assessment. HRQoL changes were estimated with linear mixed models from before to after incident AF, stroke, and major bleeding, and interaction analyses were performed to assess differences between the randomisation groups. HRQoL changes in event-free participants were estimated from baseline until year three. Results During three years of follow-up, 693 of 6004 (12%) participants were diagnosed with AF (Screening: 424 of 1501 (28%), usual care: 269 of 4503 (6.0%)), and 636 of these were alive at the three-year assessment. HRQoL decreased for all participants during follow-up; For participants developing AF, the EQ-5D-5L index score in the screening group decreased from 0.87 before to 0.85 (p&amp;lt;0.001) after diagnosis, while the score decreased from 0.83 before to 0.79 (p&amp;lt;0.001) after diagnosis in usual care, with less HRQoL decrease in the screening group (p=0.019)(Figure 1). For patients developing stroke, the EQ-5D-5L index score in the screening group decreased from 0.82 before to 0.78 (p&amp;lt;0.001) after diagnosis and from 0.84 before to 0.76 (p&amp;lt;0.001) after diagnosis in usual care. For participants developing major bleeding, the EQ-5D-5L index score in the screening group decreased from 0.82 before to 0.76 (p&amp;lt;0.001) after diagnosis and from 0.85 before to 0.76 (p&amp;lt;0.001) after diagnosis in usual care. The HRQoL reductions following stroke and major bleeding were similar in the two randomisation groups (p=0.50, p=0.61). In event-free participants, the EQ-5D-5L index score decreased from 0.88 to 0.84 (p&amp;lt;0.001) during three years, with no three-year difference between the randomisation groups (p=0.18) (Figure 2). All analyses of EQ-VAS yielded very similar results. Conclusion HRQoL was minimally affected by an AF diagnosis detected by screening, compared with a clinical AF diagnosis. Participants diagnosed with stroke and major bleeding had large HRQoL reductions, regardless of the randomisation group.Figure 1 Figure 2