Regional Hospital Central Jutland

Atrial fibrillation (AF) is the most common arrhythmia in older people, with an increasing prevalence of various geriatric conditions, such as multimorbidity, and frailty. A contemporary integrated approach is effective in reducing the risk of clinical adverse events, particularly when streamlined through the application of the Atrial Fibrillation Better Care (ABC) pathway, as proven in 2 non-European trials. The atrial fibrillation integrated approach in frail, multimorbid and polymedicated older people (AFFIRMO) trial, a European multicenter, open-label, cluster-randomized study, will examine whether a mobile-health integrated care approach based on the ABC pathway combined with a multidimensional Comprehensive Geriatric Assessment (CGA) can reduce the 12-month risk of unplanned all-cause hospitalizations in patients with AF ≥65 years with ≥1 concomitant chronic condition(s). The AFFIRMO trial enrolled 1,260 patients with AF (mean age 74 [SD 6] years; 44.4% female) across 6 European countries (Bulgaria, Denmark, Italy, Romania, Serbia, and Spain). At baseline, the median (IQR) CHA2DS2-VASc score was 4 (3-5), and the median (IQR) HAS-BLED score was 1 (1-2). Hypertension was reported in 992 (78.7%) patients, and diabetes mellitus in 369 (29.3%) patients. Among the enrolled patients, 507 (40.5%) were prefrail, and 171 (13.7%) were frail. Oral anticoagulants (OACs) were prescribed for 1,225 (97.2%) patients, with 1,149 (91.2%) patients receiving non-VKAs oral anticoagulants (NOACs). Follow-up is ongoing and planned to be completed in January 2026. The AFFIRMO trial will provide evidence on the efficacy of the ABC pathway in conjunction with the CGA approach in reducing the risk of unplanned all-cause hospitalizations and other clinical adverse events in older, multimorbid patients with AF. ClinicalTrials.gov identifier: NCT06775028.

In patients with obstructive coronary artery disease, early revascularization does not improve outcomes but may reduce angina symptoms. The objective of this study was to examine whether changes in health status outcomes following revascularization are explained by the extent of myocardial perfusion defects and improvement in myocardial perfusion. Two trials enrolling stable patients with new-onset chest pain suggestive of obstructive coronary artery disease, the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) and the Dan-NICAD (Danish Study of Noninvasive Testing in Coronary Artery Disease) trials, were analyzed. Patients with single-vessel coronary artery disease who underwent nuclear myocardial perfusion imaging (nMPI) were included. In the ISCHEMIA trial, patients with moderate/severe ischemia were randomized to either optimal medical therapy alone or optimal medical therapy and invasive angiography. The Dan-NICAD trial enrolled patients with suspected stenosis on coronary computed tomographic angiography undergoing nMPI. Test-guided revascularization blinded to nMPI was performed, and patients with initially abnormal nMPI were reassessed after 12 months. The primary outcome was the change in the Seattle Angina Questionnaire angina frequency score. In total, 584 patients were eligible. In patients with a summed difference score of 5≤10 (n=149 [25%]) and ≥10 (n=152 [26%]), revascularization was associated with an improved angina frequency score (mean change ±SD: 16.4±20.9 and 19.0±24.1). No improvement was demonstrated in patients with a summed difference score <5. In multivariable logistic regression analysis (n=91), an increase in hyperemic myocardial blood flow at follow-up was associated with freedom from angina (odds ratio, 2.89 [95% CI, 1.04-8.70]). In patients with single-vessel coronary artery disease, nMPI may identify patients more likely to experience improved symptoms from revascularization, potentially reflecting enhanced myocardial perfusion.

Recent studies suggest potential benefits of ketosis. However, research is lacking on its effects on renal physiology. This study aimed to investigate the renal effects of short-term exogenous ketosis in healthy adults, focusing on glomerular function and electrolyte handling. In a double-blind, placebo-controlled, randomized crossover trial, 15 healthy participants received ketone monoester (KME) or placebo three times daily for 5 days under a standardized diet, separated by a 2-week washout. On the fifth day of each intervention, participants collected a 24-h urine sample. The following day, glomerular filtration rate (GFR) was assessed with 99mTechnetium-diethylene-triamine-pentaacetate (Tc-99-DTPA) clearance, and urinary electrolyte excretion was measured. Thirteen participants completed both treatment periods. Compared with placebo, KME treatment acutely increased GFR by 6.0 mL/min (p = 0.002) and sodium excretion increased by 69 μmol/min (p < 0.0001), while potassium excretion decreased (-31 μmol/min; p < 0.0001). Electrolyte excretion measured in 24-h urine remained unchanged. In conclusion, short-term KME supplementation was associated with acute increases in measured GFR and urinary sodium excretion, while reducing urinary potassium excretion in healthy adults. No changes in electrolyte excretion were detectable in the 24-h urine, indicating that renal effects are not sustained over the full collection period.

The primary objective was to quantify the effect of interventions involving voluntary walking on gait function (i.e., velocity, distance, step length, stride length, and cadence) in people with Parkinson's disease (pwPD) compared to non-active or active controls. A secondary objective was to quantify the effect of voluntary walking interventions on functional mobility, disease severity, and health-related quality of life. PubMed and EMBASE were searched for relevant studies. Eligibility criteria were: 1) randomized controlled trials (RCTs) or pilot RCTs, 2) participants diagnosed with Parkinson's disease (PD), 3) evaluation of any voluntary structured walking intervention (>3 weeks and/or >6 training sessions), and 4) pre- and post-intervention walking assessments. Post-mean data of short and long walking tests, Timed-Up and Go (TUG) test, Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale III (MDS-UPDRS III), and Parkinson's Disease Questionnaire-39 were extracted and analyzed. Fifteen studies (11 RCT, 4 pilot-RCT) were included covering 590 pwPD (mean age 65.7 (±7.5) years; 208 women). Meta-analyses showed positive effects of voluntary walking on gait speed (i.e., short walking tests, standardized mean difference ((SMD) = 0.59 [0.26; 0.93]), gait distance (i.e., long walking tests, SMD = 0.83 [0.55; 1.10]), step length (SMD = 0.72 [0.35; 1.10]), stride length (SMD = 0.57 [0.07; 1.07]), MDS-UPDRS III (SMD = -0.39 [-0.62; -0.16]), and TUG (SMD = -0.38 [-0.73; -0.04]). Voluntary walking interventions improved gait and mobility function and lowered disease severity in pwPD. These results support the use of voluntary walking in PD rehabilitation.

BackgroundTuberculous arthritis of the knee is an uncommon manifestation of extrapulmonary tuberculosis that can be misdiagnosed and lead to severe joint destruction.Case presentationWe report a rare case of a 40-year-old Buddhist male patient from Bhutan with an 18-year history of progressive knee stiffness and pain following sports-related knee injury, later diagnosed as tuberculous arthritis. After delayed diagnosis and treatment, the patient underwent successful total knee arthroplasty performed by an international surgical team.ResultPostoperatively, the patient regained 90° of flexion with full extension at 6 months, with no evidence of recurrence.ConclusionThis case highlights the importance of maintaining a high index of suspicion for tuberculous arthritis in endemic regions and illustrates how delayed but appropriate surgical intervention can restore function and quality of life.

Functional Somatic Disorders (FSDs) affect approximately 10% of the general population (1) and often lead to reduced quality of life, extensive diagnostic evaluations and increased healthcare costs. The DISTRESS (Diagnostic Intervention in Secondary care Targeting patients Referred for Evaluation of bodily Stress Symptoms) trial protocol describes a randomised clinical trial evaluating a novel FSD Diagnostic Clinic, with the aim of providing early diagnosis and thereby helping patients and clinicians bring the diagnostic odyssey to a definitive and meaningful conclusion. This pragmatic, randomised trial employs allocation concealment and blinded outcome assessment, although the randomisation allocation is unavoidably unmasked to patients and clinicians due to the nature of the intervention. Patients with suspected FSD are randomised 1:1 to either the FSD Diagnostic Clinic, where internal medicine specialists (internists) undertake the FSD diagnostic process, or to usual diagnostic assessment. The two co-primary outcomes evaluate (a) healthcare utilization and (b) costs-effectiveness, assessed alongside health-related quality of life measured by the SF-36 survey at 12months post-intervention. Secondary outcomes include relevant clinical outcomes and overall public expenses. The DISTRESS trial addresses challenges in diagnosing FSDs by evaluating a novel Diagnostic Clinic model and its impact on patient outcomes, cost-effectiveness, and healthcare utilization. Insights from separately conducted qualitative studies will complement the trial by assessing the clinic's acceptability and integration within the healthcare system. By training internists to diagnose and manage FSDs using approaches typically employed by FSD specialists, the FSD Diagnostic Clinic expands access to timely care within a stepped care model. ClinicalTrials.gov Identifier: NCT06025617.

There appears to be a substantial variation in the use of radiographs in chiropractic clinics, but the reasons for this variation are not well understood. This study examined the use of radiography over a one-year period in Danish chiropractic clinics and explored its associations with clinic- and chiropractor-level characteristics. Data on the number of unique patients consulting a chiropractor and those receiving radiography between 1 January 2022 and 31 December 2022 were obtained from a Danish national registry. Information on clinics including the number of chiropractors, geographical region, multidisciplinary status, and types of other healthcare professionals employed, as well as chiropractor characteristics (age, gender, seniority, and country of education) was collected from clinic websites and a national register of Danish healthcare professionals. The proportion of patients undergoing radiography was calculated for each clinic. Associations with clinic and chiropractic characteristics were tested using chi-square or t-tests, as appropriate. Characteristics were also compared between clinics with and without in-house radiographic imaging facilities. A total of 237 chiropractic clinics and 657 chiropractors were included. The mean age of chiropractors was 47years (SD 12.8), 53% were women and 61.8% were educated in Denmark. Clinics with radiographic facilities (n = 161, 68%) tended to be larger and more likely to be multidisciplinary than clinics without (n = 76, 32%). Among clinics with radiographic facilities, the proportion of patients receiving radiography was 9.5% (95% CI 8.4-10.6%), ranging from 0 to 39%. No associations were found between radiography use in clinics with in-house radiographic facilities and clinic or chiropractic characteristics. In clinics without radiographic facilities, only 1.1% of patients were referred for radiography via chiropractic service codes, although this is likely an underestimation, as referrals to public hospitals were not captured. Although considerable variation in radiography use was observed across Danish chiropractic clinics with radiographic facilities, this was not explained by measured clinic or chiropractic characteristics. The true extent of radiography use in clinics without in-house facilities remains uncertain. Further research into clinical decision-making is needed to support evidence-based, transparent and consistent practice, potentially using qualitative methods to better understand the reasons behind the observed variation.

Fentanyl is an opioid used for acute pain relief, but its slow elimination may lead to prolonged respiratory depression and sedation. As fatty tissue serves as fentanyl storage and prolongs its elimination, fentanyl should be dosed based on estimated ideal body weight. High-risk patients include those who are overweight, have lung disease and are exposed to other sedative drugs. The risk of severe side effects increases in sleep; delayed side effects may present several hours after administration. This review finds that there is a need for clinical guidelines on the monitoring of patients after treatment with fentanyl.

Individuals with type 1 diabetes are at high risk of cardiovascular disease (CVD) and chronic kidney disease (CKD) even with optimal glycaemic control. The Steno 1 study will test a strategy of intensified care based on multifactorial intervention (MFI) including treatment with semaglutide, sotagliflozin and finerenone in high-risk individuals with type 1 diabetes. We hypothesize that this strategy will reduce major adverse cardiovascular endpoints (MACE), hospitalization for heart failure (HHF), progression of CKD and mortality. The study is a prospective, cluster-randomized, open study with blinded endpoint evaluation. We will enrol 2000 high-risk individuals with type 1 diabetes of >10 years duration. All five Steno Diabetes Centres and 11 partner hospitals in Denmark will participate, with the addition of the Steno Diabetes Centres in Greenland and the Faroe Islands. Sites will be randomized either to receive guideline-recommended standard-of-care, or to receive the MFI. Eligible individuals with type 1 diabetes (≥40 years of age with presence of either CKD, CVD, HF, obesity or a >10% 5-year CVD risk determined by the Steno T1 Risk Engine) will be included. For the MFI group, the intervention will comprise more ambitious treatment targets for blood pressure and lipid levels, and in addition, participants will be allocated to semaglutide, sotagliflozin and/or finerenone based on phenotype. The Steno 1 study will determine whether MFI is superior to standard care with respect to MACE, HHF progression of CKD, and mortality in individuals with type 1 diabetes and high risk of CVD.

This study aimed to translate and culturally adapt the DE-STRESS (Emergency Department Stress, Coping, and Intention to Leave Survey) to the Danish emergency context. Clinicians (nurses, nurse assistants, and physicians) in an emergency department (ED) undertake psychologically demanding work, and the high-pressure environment combined with occupational stressors has made retention of ED clinicians a major issue. A suitable measure of stress and coping would contribute to the development of practices to support clinicians working in these high-stress environments. The translation process was undertaken using the ISPOR principles of good practice for the translation and cultural adaptation of patient-reported outcomes, including forward translation, back translation, and cognitive debriefing through individual interviews with ED clinicians (n=5). The study took place in a large teaching hospital in Southern Denmark and involved three forward translators, two backward translators, a key in-country person from both Australia and Denmark, and a project lead. The translation and cultural adaptation process was successfully conducted. Some concepts were difficult to translate, such as the terms ED and organization and the role of an ED supervisor. It was necessary to omit some demographic questions to ensure respondent anonymity, so the final Danish version has 123 questions versus the original 133 questions. The ED clinicians found the survey relevant and comprehensive as it addressed key factors in their work. We concluded that the Danish version of DE-STRESS is appropriate for use; however, a future study employing confirmatory factor analysis and assessing internal reliability is necessary to further investigate its psychometric properties.