The Capital Region Pharmacy

The inconsistent impact of medication review on adverse clinical outcomes suggests that stratification based solely on age and number of medications, without considering disease burden, is inadequate. The aim of this study was to investigate the associations between medication use and FI-OutRef (a frailty index based on abnormal routine blood tests) with 90-day readmission or mortality and to evaluate the utility of FI-OutRef in patient stratification for medication review. This single-centre, observational, register-based cohort study included acutely admitted medical patients presenting to the emergency department (ED) of Copenhagen University Hospital Hvidovre, Denmark, who received routine blood tests (including 17 standard biomarkers) between November 2013 and March 2017. Patients <18 years old, missing ≥8 standard biomarkers or who died during hospitalization were excluded. Medications obtained within 4months prior to hospitalization were categorized based on the number of unique prescriptions: 0, 1, 2-4, 5-9 or ≥10. FI-OutRef was defined as the number of biomarkers outside reference ranges and categorized according to the following cutoffs: ≤4, 5-7 or ≥8. Among 27 873 acutely admitted medical patients (52.5% female; median age 59.3years), increasing FI-OutRef was significantly associated with increasing risk of readmission (hazard ratios [HRs] ranging from 1.36 to 2.75 across levels of medication use) and mortality (HRs 2.65 to 8.82), with the highest HRs observed in patients with lower medication use. FI-OutRef strengthens the association between medication use and risk of 90-day readmission or mortality and could be an important component in patient stratification for medication review to reduce these adverse clinical outcomes.

Early initiation of antenatal care provides timely screening, advice and support. Inequities in early care initiation exist in high-income countries, but there is scant evidence on effective interventions. The community REACH (Research for Equitable Antenatal Care and Health) trial aimed to assess the effectiveness of co-produced place-based interventions to strengthen community support for early care initiation. Matched-pair cluster randomised trial in socially disadvantaged and ethnically diverse areas in England. Electoral wards with low rates of early care initiation were matched and randomly allocated to intervention or control (usual care) (n=10 pairs). Following a 3-month co-design phase, community organisations and volunteers in intervention sites conducted targeted outreach activities over 6 months. The primary outcome was initiation of antenatal care by the 12th completed week of pregnancy. There was no evidence of a difference in the primary outcome (OR 1.07, 95% CI 0.89 to 1.28). There were also no statistically significant differences in rates of emergency caesarean, preterm birth, low birth weight, smoking or breastfeeding. There was a higher rate of care initiation by 10 weeks and fewer antenatal admissions in the intervention arm during the intervention period, although differences were not sustained after it finished. This rigorous evaluation found a limited impact of short-term place-based interventions to strengthen community support for early initiation of antenatal care. Future initiatives may benefit from embedding in integrated health and care structures to ensure sufficient time and resources for mobilisation of community assets and focusing on smaller 'hyper-local' neighbourhoods. Actions to tackle wider structural and organisational barriers are also needed. ISRCTN registry: registration number 63066975. Registered on 18 August 2015.

ADHD is a descriptive diagnosis encompassing diverse symptom profiles with unclear etiology and varying prevalence estimates. This review outlines that evidence suggests diagnostic and treatment practices differ by age and gender, with a marked increase in adult diagnoses and higher treatment rates-especially among women-than cohort studies predict. This may indicate overdiagnosis. Given the diagnostic uncertainty and risk of overtreatment, particularly with rising societal performance demands, more stringent diagnostic criteria and individualised treatment approaches are recommended.

Attention deficit hyperactivity disorder (ADHD) is increasingly diagnosed in adults. The diagnostic process is complex, emphasising the need for specialised assessments due to the disorder's intricate symptomatology and frequent comorbidities. This review presents an outline for a structured diagnostic process, as is the importance of considering comorbid conditions, as they can obscure ADHD symptoms. It is central to adhere to updated clinical guidelines to enhance diagnostic accuracy and treatment efficacy for adults with ADHD.

IntroductionThe global prevalence of people living with overweight has tripled since 1975 and more than 40% of Danish women enter pregnancy being overweight. With the increasing rates of obesity observed in children, adolescents and adults, there is an urgent need for preventive measures. Risk factors for childhood obesity include maternal overweight or obesity before conception and excessive weight gain during pregnancy. Interventions aimed at modifying maternal lifestyle during pregnancy have demonstrated minimal positive or no impact on the health of the children. The ‘healthy lifestyle before and during pregnancy to prevent childhood obesity — the PRE-STORK trial’ aims to provide insights into the effect of a lifestyle intervention initiated before conception and continued during pregnancy in women with overweight or obesity, on neonatal adiposity in their children.Methods and analysisIn this randomised, two-arm, parallel-group, controlled trial, we will include 360 women with overweight or obesity (aged 18–40; body mass index 25–44 kg/m2) and their partners. The women will be randomised to receive either standard of care or a lifestyle intervention focused on preconception body weight reduction, regular physical exercise, healthy diet and support from a mentor before and during pregnancy. The primary outcome is the difference in neonatal adiposity measured in their children at birth. Children conceived during the trial will constitute a birth cohort, monitoring the effects on their health until the age of 18 years.Ethics and disseminationThe trial has been approved by the Regional Committee on Health Research Ethics in the Capital Region of Denmark (identification number H-22011403) and will be conducted in agreement with the Declaration of Helsinki. All results, whether positive, negative and inconclusive, will be disseminated at national or international scientific meetings and in peer-reviewed scientific journals.Trial registration numberClinicalTrials.gov: NCT05578690 (October 2022).

Background: High anticholinergic burden is associated with an increased risk of hospitalisation, readmission, and mortality in geriatric patients. The objectives were to develop an updated anticholinergic burden scale for drugs registered in Denmark and to estimate the burden at admission and discharge for hospitalised patients at the Geriatric Ward of Sønderjylland Hospital. Methods: The updated scale was developed through a systematic evaluation of the anticholinergic effect for all active pharmaceutical ingredients (APIs) listed on validated burden scales. APIs registered in 2020 and 2021 were evaluated separately for possible anticholinergic effect. The anticholinergic effect of each API was scored from 1 (low) to 3 (high). The scale was applied to medical records for patients hospitalised between October 2021 and March 2022. Results: The scale comprised 87 APIs with anticholinergic effect. We applied the scale on 196 patients aged (median [IQR]) 84 (78–89) years. Of these patients, 75 (38.3%) had a high burden ( on admission. These patients had significantly higher drug use and higher risk of 30-day readmission but no relationship with length of stay. Overall, the anticholinergic burden was unchanged at discharge for 109 (55.1%) patients. Conclusion: An updated scale for estimation of the anticholinergic burden in geriatric patients was successfully developed, and a high burden among the admitted geriatric patients was found.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors can cause a reversible decline in glomerular filtration rate (GFR), which may influence dosing recommendations for renally excreted medications. In practice, GFR is typically estimated by serum creatinine concentration, but creatinine may not be a reliable indicator of GFR decline in the setting of SGLT2 inhibitor use. Alternative filtration markers such as cystatin C, β-trace protein (BTP), and β2-microglobulin (B2M) may be more appropriate, but little is known about how these markers are affected by SGLT2 inhibitor use. Therefore, we determined creatinine, cystatin C, BTP, and B2M concentration in a crossover study of 35 people with type 2 diabetes receiving 12 weeks of dapagliflozin treatment or placebo. Estimated GFR (eGFR) based on creatinine (eGFRcre), cystatin C (eGFRcys), their combination (eGFRcomb), or a panel of all four markers (eGFRpanel) was compared with measured GFR (mGFR) based on plasma clearance of chromium-51 labeled ethylenediamine tetraacetic acid (51Cr-EDTA). Dapagliflozin treatment was associated with a significant decrease in mGFR (-9 mL/min/1.73 m2, P < 0.001) but not a corresponding increase in concentration of any filtration marker. No eGFR equation accurately predicted change in mGFR between treatment periods, but eGFRcomb and eGFRpanel yielded the highest overall accuracy relative to mGFR across both treatment periods. These findings highlight the stability in performance gained by combining multiple filtration markers but suggest that eGFR in general is not an ideal metric for assessing short-term GFR decline in people initiating SGLT2 inhibitor therapy.

The prevalence of patients with chronic kidney disease (CKD) and polypharmacy is increasing and has amplified the importance of examining inappropriate prescribing (IP) in CKD. This review focuses on the latest research regarding the prevalence of IP in CKD and the related adverse clinical effects and explores new interventions against IP. A literature search was performed using PubMed, EMBASE and the Cochrane Library searching articles published between June 2016 and March 2022. Twenty-seven studies were included. An IP prevalence of 12.6% to 96% and 0.3% to 66% was reported in hospital and outpatient settings, respectively. In nonhospital settings, the prevalence of IP varied between 3.9% and 60%. IP was associated with higher risk of hospitalisation (HR 1.46, 95% CI 1.17-1.81), higher bleeding rate (HR 2.34, 95% CI 1.32 to 3.37) and higher risk of all-cause mortality (OR 1.07, 95% CI 1.02 to 1.13). Three studies reported the impact of interventions on IP. This review highlights widespread IP in CKD patients across healthcare settings, with varying prevalence rates. IP is substantially linked to adverse outcomes in patients. While limited interventions show promise, urgent research is needed to develop effective strategies addressing IP and improving CKD patient care.

Region Hovedstaden har som målsætning, at den kollektive trafik bliver første valg for flere borgere. RegionHovedstaden er medejer af den kommende Hovedstadens Letbane i Ring 3 og vil få økonomisk medansvarfor driften. Derfor har de en stor interesse i, at letbanen vil tiltrække både eksisterende brugere af kollektivtrafik i korridoren samt tiltrække nye brugere. For at gøre letbanen til et attraktivt tilvalg er det vigtigt, atstationsmiljøet og ikke mindst vejen derhen er attraktiv og tryg.Tilgangen til udviklingen bygger på forskningsresultater om, at tryghed i den kollektive transport hængersammen med den omkringliggende by. Det er afgørende at det er attraktivt at være blød trafikant, samt atet stationsområde skal ses som del af en større bykontekst. Derfor har det været oplagt at starte etsamarbejde med de kommuner, der står over for den konkrete planlægning af stationsmiljøerne, ogdermed har en unik mulighed for at indtænke tryghed i og omkring stationsmiljøet i byomdannelsen.