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Forskningens Dag den 23. april 2015
Abstracts
Hospitalsenhed Midt
Program ”Forskningens Dag” 2015
12.00
12.05
12.55
13.20
14.10
–
–
–
–
–
12.05
12.55
13.20
14.10
14.35
Velkomst
Foredragssession I
Pause med mulighed for at se posters
Foredragssession II
Gæstetaler: Prodekan Lise Wogensen Bach, Dekanatet Health, Aarhus
Universitet ”Ansvarlig Forskningspraksis – hvad vil det sige?”
14.35 – 15.00 Præmieoverrækkelse og afslutning
Foredrag
(se abstracts fra side 4-14)
Session I. 12.05 – 12.55
1. Andi Albertsen m.fl., Hjertemedicinsk Afdeling
En struktureret tværfaglig behandling sikrer en større andel af patienter med atrieflimren korrekt
antikoagulationsbehandling
2. Ina Qvist m.fl., Medicinsk Afsnit, Diagnostisk Center, Universitetsklinik for Innovative Patientforløb
Effectiveness of structured hospital based nurse-led atrial fibrillation clinics: A comparison of a real-world
population versus a clinical trail population
3. Rana Marbin m.fl., Karkirurgisk Afdeling
Varicose vein treatment with foam sclerotherapy – a historical cohort study
4. Brian Kloster m.fl., Karkirurgisk Afdeling
Induction of continuous expanding infrarenal aortic aneurisms in a large porcine animal model
5. Thor Haahr m.fl., Fertilitetsklinikken, Kvindeafdelingen
Gram staining, PCR or PNA FISH analysis for detection and classification of bacterial vaginosis – a
prospective study in a Danish IVF setting
Moderator: Ledende overlæge, dr.med. Jan Abrahamsen, Klinisk Fysiologisk Afdeling.
Session II. 13.20 – 14.10
1. Johan Høising Eckmann m.fl., Radiologisk Afsnit, Diagnostisk Center, Universitetsklinik for Innovative
Patientforløb
Optimeret diagnosticering af håndledsfrakturer
2. Rune Wilkens m.fl., Diagnostisk Center, Universitetsklinik for Innovative Patientforløb
Small bowel cleansing does not improve quality of wireless capsule endoscopy
3. Lene Odgaard m.fl., Universitetsklinik for Neurorehabilitering, Regionshospitalet Hammel Neurocenter
Frequency of labour market attachment after severe traumatic brain injury compared to the background
population
4. Nanna Rolving m.fl., Diagnostisk Center, Universitetsklinik for Innovative Patientforløb
Cognitive-behavioural therapy for lumbar spinal fusion patients. A clinical and economic evaluation
5. Dorte Dahl Hoffmann m.fl., Vestdansk Center for Rygmarvsskade, Neurologisk Afdeling
Prøvehandlinger som metode til ændring af rehabiliteringsindsats
Moderator: Professor, overlæge, dr.med. Jørgen Feldbæk, Hammel Neurocenter og Universitetsklinik for
Neurorehabilitering.
Hvert oplæg har en varighed af otte minutter, herefter er der afsat to minutter til
diskussion.
1
Posters
(se abstracts fra side 15-36)
1. Nørgaard KS m.fl., Diagnostisk Center, Universitetsklinik for Innovative Patientforløb
CT coronary angiography in ´real-world` patients: does sex matter?
2. Christensen MK m.fl., Kirurgisk Afdeling
Effekten af selvfikserende mesh (Progrip) på postoperativ rekonvalens efter transabdominal
præperitoneal inguinalherniekirurgi
3. Næs-Schmidt ET m.fl., Universitetsklinik for Neurorehabilitering, Regionshospitalet Hammel
Neurocenter
Microstructural changes in the brain after concussion
4. Feuerhake IL m.fl., Karkirirurgisk Afdeling
Rutinemæssig sigmoideoskopi og prædiktive faktorer for coloniskæmi efter operation for rumperet aorta
aneurisme
5. Kudsk Jensen O m.fl., RegionsRygcentret, Forskningsenheden for Sygemeldte, Diagnostisk Center,
Universitetsklinik for Innovative Patientforløb
Rygsmerter og bensmerter associerer forskelligt til MR forandringer i lænderygsøjlen og til andre
smertevariabler, herunder tegn til rodtryk: En tværsnitsundersøgelse hos 141 sygemeldte
lænderygpatienter
6. Odgaard LO m.fl., Universitetsklinik for Neurorehabilitering, Regionshospitalet Hammel Neurocenter
Surviving severe traumatic brain injury in Denmark: incidence and predictors of highly specialised
rehabilitation
7. Cleeman R m.fl., Center for Planlagte Kirurgi
Dose-responce of bone morphogenic protein 2 on a background of systemic bisphosphonate in an
unloaded canine implant model
8. Thomsen MD m.fl., Karkirurgisk Afdeling
Non-attendance in a screening programme for cardiovascular diseases and diabetes in Danish women; a
non-attendees perspective
9. Wojke P m.fl., Vestdansk Center for Rygmarvsskade, Neurologisk Afdeling
Forebyggelse af senkomplikationer gennem korrekt ernæringsscreening af mennesker med
rygmarvsskade
10. Behr-Rasmussen C m.fl., Karkirurgisk Afdeling
Pathophysiological and potential diagnostic aspects of the mural thrombus in abdominal aortic
aneurysms.
11. Riis C m.fl., Karkirurgisk Afdeling
Patienter og pårørende som partnere i Karkirurgisk Afdeling
12. Urbonaviciene G m.fl., Diagnostisk Center, Universitetsklinik for Innovative Patientforløb
High coronary artery calcium score in clinical practice: relationship with coronary revascularization and
adverse events.
13. Urbonaviciene G m.fl., Diagnostisk Center, Universitetsklinik for Innovative Patientforløb
Favourable prognosis of normal myocardial perfusion imaging in patients with suspected CAD on coronary
computed tomography angiography
14. Grøndal N m.fl., Karkirurgisk Afdeling
Iatrogene vaskulære risici ved stivgørende rygoperationer
15. Steensgaard R m.fl., Vestdansk Center for Rygmarvsskade, Neurologisk Afdeling
Styrkelse af tværfagligt samarbejde gennem kompetenceudvikling
2
16. Elbæk HO m.fl., Fertilitetsklinikken, Kvindeafdelingen
The exogenous progesterone free luteal phase in IVF: exploring a new concept
17. Grove G m.fl., Karkirurgisk Afdeling
The use of `objective structured assessment of technical skills´ as an assessment tool among Danish
vascular surgeons in training
18. Frederiksen OV m.fl., Forskningsenheden, Universitetsklinik for Neurorehabilitering, Regionshospitalet
Hammel Neurocenter
Post-traumatisk hovedpine hos unge efter en hjernerystelse
19. Vibjerg J m.fl., Vestdansk Center for Rygmarvsskade, Neurologisk Afdeling
Exercise hypotension hos cervikalt rygmarvsskadede patienter
20. Andresen SR m.fl., Vestdansk Center for Rygmarvsskade, Neurologisk Afdeling
Samlet overblik over behov, prævalens og forbrug af cannabis af rygmarvsskadede patienter i Danmark
21. Lundquist CB m.fl., Neurorehabiliteringen, Neurologisk Afdeling
Oversættelse og validering af Fugl-Meyer undersøgelse af armmotorik
3
Foredrag på ”Forskningens Dag”
SESSION I
1. En struktureret tværfaglig behandling sikrer en større andel af patienter med atrieflimren
korrekt antikoagulationsbehandling
Albertsen AE, Mogensen HM, Dahlmann G, Madsen P, Brandhof C, Saugmann P, Mønning ED, Nielsen RR,
Møller DS.
Hjertemedicinsk afdeling, Regionshospitalet Viborg.
Problemstilling: Atrieflimren (AF) er en hyppig sygdom i Danmark med en prævalens på 75-100.000
patienter. Incidensen stiger med alderen og medfører en 5 gange øget risiko for apopleksi og fordobling
af mortalitet. Selv om der findes et relativt simpelt scoresystem (CHA2DS2- VASc) til vurdering af
patientens apopleksirisiko er blot 50-80 % af AF-patienter i korrekt antikoagulationsbehandling.
Metode: Hjertemedicinsk Afdeling, Regionshospitalet Viborg etablerede den 1. maj 2012 en struktureret
tværfaglig AF-klinik.
Aktuelle studie fokuserer på antikoagulationsbehandling hos patienterne det første år (01.05.1230.04.13) i den strukturerede tværfaglige AF-klinik. Resultatet sammenlignes med en sammenlignelig
patientgruppe fra året før (01.05.11-30.04.12), hvor AF-patienter blev behandlet i konventionelle
lægespor.
Hypotesen er, at strukturerede tværfaglige patientforløb vil øge andelen af patienter, som antikoaguleres i
henhold til gældende guidelines.
Det primære endepunkt er andelen af patienter med CHA2DS2-VASc score ≥ 1 i antikoagulation.
Det sekundære endepunkt er andelen af patienter i ikke-indiceret flerstof-antitrombotisk behandling i
henhold til guidelines.
Resultater: I AF-klinikken blev 99% (170 ud af 172) af patienterne med en CHA2DS2-VASc score ≥ 1
antikoaguleret sammenlignet med 79% (143 ud af 179) af patienterne i den konventionelle gruppe
(p<0,001).
Andelen af patienter i ikke-indiceret flerstof-antitrombotisk behandling var betydelig større i den
konventionelle gruppe (23%; 34 ud af 179) sammenlignet med patienter fra AF-klinikken (1%; 1 ud af
172), (p<0,001).
Konklusion: Studiet beskriver for første gang effekten af en struktureret tværfaglig behandling af AFpatienter i Danmark. Ved etableringen af særlige AF-klinikker sikres fokus på behandling i henhold til
guidelines.
Aktuelle studie dokumenterer underbehandling af AF-patienter i konventionelle hjerteambulatorier.
Det sygeplejemæssige aspekt er værdifuldt hos disse patienter, der skal informeres om det at leve med
en kronisk sygdom (empowerment).
Et struktureret tværfagligt forløb øger andelen af AF-patienter i korrekt antikoagulation, og der er god
evidens for, at patienternes risiko for tromboemboliske komplikationer dermed reduceres.
4
2. Effectiveness of structured hospital based nurse-led atrial fibrillation clinics: A comparison
of a real-world population versus a clinical trail population
Qvist I1,4, Hendriks JML2, Møller DS3,4, Albertsen AE3,4, Mogensen HM3,4, Oddershede GD3,4, Odgaard A1,4,
Mortensen LS5, Johnsen SP6, Frost L1,4.
¹Department of Medicine, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways,
Silkeborg Regional Hospital, Denmark
²Department of Cardiology, Maastricht University Medical Centre, The Netherlands
³Department of Cardiology, Viborg Regional Hospital, Denmark
4
Regional Hospital Central Jutland, Denmark
5
Spange Statistics, Lystrup, Denmark
6
Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
Aim: A randomized trial has documented that structured nurse-led Atrial Fibrillation (AF) service is
superior to conventional AF service, but there is a need for more data, confirming feasibility and outcome
in a real-world setting. We compared patient outcome in nurse-led structured hospital AF clinics between
real-world patients from Denmark (DK) and from the randomised trial on efficacy of a nurse-led AF clinic
reported from the Netherlands (NL), with respect to a composite outcome of CV hospitalization and CV
death.
Methods: Real-world data consisted of baseline and follow-up data. All patients were referred by
cardiologists. The AF nurse specialist provided patient education, risk factor control, and stimulated
empowerment and compliance in these patients. During follow-up treatment was adjusted according to
clinical guidelines, supervised by a cardiologist. Patient education was repeated and compliance was
controlled. The study size was powered as a non-inferiority study. Outcome measures were adjudicated
by same principles in both countries.
Results: 596 patients from DK and 356 patients from NL were included. There were no significant
differences between groups with respect to age, body mass index, type of AF, CHA2DS2VASc score and
co-morbidity. The composite primary end point occurred with an incidence rate of 8.0 in DK and 8.3 per
100 person years in NL, crude HR 0.83 (95% CI 0.56-1.23). Adjustment for covariates and medical
treatment did not substantially change HR.
Conclusion: Structured nurse-led hospital based AF service is feasible and effective, and patient
outcome is in real life hospital based structured AF service is as least as good as in the setting of a
randomized trial.
5
3. Varicose vein treatment with foam sclerotherapy – a historical cohort study
Rana S. Marbin1,2 Stud.med, Sigitas Urbonavicius1 MD, PhD, Carsten Behr-Rasmussen1,2 MD, Jes S.
Lindholt1,3 MD, DMSci, Jes Sandermann1 MD
1
Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark
2
Graduate School of Health, Aarhus University, Denmark
3
Department of Cardiovascular- and Thoracic Surgery T, University Hospital of Odense, Denmark
Objective: Ultrasound-guided foam sclerotherapy (UGFS) is increasing in popularity as a method to treat
varicose veins (VV) of the lower extremities. In 2008, we began using UGFS as an alternative treating
therapy. The outcomes are described in this study.
Methods:
Seven hundred nineteen legs were treated with UGFS over a 5-year period, from January 2008 to
December 2013, at Viborg Regional Hospital. The average age, sex, occlusion rates and effect of different
sclerosing agents were calculated. The outcomes were studied retrospectively. 14 days and 12 months
after treatment, the primary and secondary success rates were analyzed using Duplex Doppler.
Results: 566 (78.7%) women and 153 (21.3%) men with the average age of 52 years (20-85) where
included. The total success rates were 561 in 694 (80.84%) closed VV at 14 days, and 362 in 456
(79.4%) closed VV at 12 months. The success rate at 12 month follow-up was 52.63% (10 VV) in the
year 2008 and increased to 87.24% (171 VV) in 2013.
Twenty-eight patients had recurrent VV 12 months after the primary treatment, 20 in 27 (74%) were
closed 14 days after UGFS recurrent-treatment and 7 in 9 (78%) limbs were still closed after 12 months.
The most common side effects seen at twelve months control were hyperpigmentation (24.1%), pain
(9.5%), swelling (8.4%) and skin ulceration (1.3%). One treatment was complicated with both lung
embolism and deep vein thrombosis (DVT), which resulted in a longer hospitalization. One other leg
reported DVT alone. No strokes were reported. Median leave of absence from work was 0 days (range 05 weeks). We found no difference in the effect of the sclerosing agents.
Conclusion: The occlusion rates and post treatment complications were similar as those of other
published data. . In summary, UGFS can be easily and effectively performed in an outpatient clinical
setting.
6
4. Induction of continuous expanding infrarenal aortic aneurisms in a large porcine animal
model
Kloster B1, Lund L2, Lindholt JS 1,3
1
Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Heibergs Alle 4, 8800
Viborg Denmark. E-mail: [email protected].
2
Department of Urology, OUH Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C. E-mail:
[email protected].
3
Elitary Research Centre of Individualized Medicine in Arterial Diseases (CIMA), Department of
Cardiovascular and Thoracic Surgery, OUH Odense University Hospital, Sdr. Boulevard 29, 5000 Odense
C. E-mail: [email protected]
Background: A large animal model with a continuous expanding infrarenal aortic aneurysm gives access
to a more realistic AAA model with anatomy and physiology similar to humans, and thus allows for new
experimental research in the natural history and treatment options of the disease.
Methods: 10 pigs (group A) underwent infrarenal aortic dissection, balloon dilatation, infusion of elastase
into the lumen and placement of a stenosing cuff around the aorta. 10 control pigs (group B) underwent
a sham procedure. The subsequent 28 days the AP-diameters of the aneurysms were measured using
ultrasound, hereafter the pigs were euthanized for inspection and AAA wall sampling for histological
analysis.
Results: In group A, all pigs developed continuous expanding AAA’s with a mean increase in AP-diameter
to 16.26 ± 0.93 mm equivalent to a 57% increase. In group B the AP-diameters increased to 11.33 ±
0.13 mm equivalent to 9.3% which was significantly less than in group A (p<0.001). In group A, a
significant negative association between the preoperative weight and the resulting AP-diameters was
found. Histology shoved more or less complete resolution of the elastic tissue in the tunica media in
group A. The most frequent complication was a neurological deficit in the lower limbs.
Conclusion: In pigs it’s possible to induce continuous expanding AAA’s based upon proteolytic
degradation and pathological flow, resembling the real life dynamics of human aneurysms. Because the
lumbars are preserved, it’s also a potential model for further studies of novel endovascular devices and
their complications.
7
5. Gram staining, PCR or PNA FISH analysis for detection and classification of bacterial
vaginosis – a prospective study in a Danish IVF setting
Haahr, T1.; Thomsen LH1; Jensen JS2; Duus L; Rygaard K; Humaidan, P.1,
Faculty of Health, Aarhus University and The Fertility Clinic, Skive Regional Hospital, Skive, Denmark;
Statens Serum Institute, Denmark; 3 Regional Hospital Viborg/Herning, Clinical Microbiological
department, Denmark; 4 The Fertility Clinic, Trianglen.
1
2
Introduction: BV is a serious reproductive health issue with an incidence of approximately 19% in the
fertile population. BV often presents itself sub-clinically with a change of the vaginal microflora from
protective and acidic Lactobacilli spp. to a more heterogeneous environment dominated by anaerobic
bacteria, especially Gardnerella Vaginalis. Few studies have been conducted in infertile women, and some
have suggested a negative impact on fecundity in the presence of BV.
Study design, size, duration: A cohort of 195 asymptomatic infertile patients, primarily Caucasians,
attending two Danish fertility clinics from April 2014 – December 2014 were prospectively enrolled in the
trial.
Methods: Vaginal swabs from IVF/IUI patients were obtained from the posterior fornix. Gram stained
slides were assessed according to Nugents criteria. PCR primers were specific to four common Lactobacilli
spp., Gardnerella Vaginalis and Atopobium Vagina.
Main results: The prevalence of BV by Nugent score was 18.9% 95% CI (13.7-25.1) versus 21.3%
95% CI (15.6-27.0) by qPCR. The molecular tools revealed that 13.5 % of Nugent positives were false
positive due to the abundance of a certain Lactobacillus species called L.iners. We provide evidence that
the non-pathological L.iners cluster is morphologically indistinguishable from Gardnerella Vaginalis.
Therefore, a molecular based diagnostic tool should be used when diagnosing an abnormal vaginal flora.
Interestingly we observed that none of the patients with Gardnerella Vaginalis abundance had a
successful reproductive outcome. The full data analysis will be presented at the conference.
Conclusion and perspectives: Gardnerella Vaginalis seems to play a role in infertility, however, when
using Gram staining, there is a significant number of false positives due to the presence of nonpathological L.iners. This justifies the future use of molecular based diagnostics. If a negative correlation
between Gardnerella Vaginalis and the reproductive outcome is corroborated, we suggest that all patients
should be screened for Gardnerella Vaginalis prior to commencing fertility treatment as this intervention
might have significant socioeconomic impacts.
8
Foredrag på ”Forskningens Dag”
SESSION II
1. Optimeret diagnosticering af håndledsfrakturer
Johan Høising Eckmann1, Lau Brix1,2 & Randi Nielsen1
1
Radiologisk Afdeling, Regionshospitalet i Silkeborg
2
Indkøb & Medicoteknik, Region Midt
Baggrund: Kvinder over 50 år har nedsat knogletæthed, hvilket øger risikoen for brud i håndleddet
herunder bådbenet (os. scaphoideum) ved traumer. Brud på os. schaphoideum og håndled er vigtig at
diagnosticere, da forsinket behandling kan medføre helingsproblemer, hvilket kan lede til varigt besvær
med smerter, nedsat gribestyrke og bevægelighed samt øget risiko for udvikling af artrose i håndleddet.
Standardudredningen for mistanke om fraktur i håndleddet, er røntgenskanning. Ved manglende
påvisning af patologi og mistanke om scaphoideumbrud udføres en supplerende MR-skanning. Denne
skanning viser ofte patologi i håndleddet som ikke er synlig på røntgenbilleder.
Formålet med projektet var at undersøge hvor ofte den supplerende MR-skanning af håndleddet kunne
påvise patologi som ikke var synlig ved brug af røntgen.
Metode: Studiet inkluderede 40 kvinder i alderen over 50 år, med og uden mistanke om os.
scaphoideum-fraktur.
Resultater: I gruppen af MR-skannede kvinder blev der påvist patologi i 25 tilfælde som ikke kunne
påvises med røntgenskanning (jvf. Tabel 1).
Diagnose
Fractura radii
Antal
A
B
12
Fractura carpal bones
3
Bone bruise
4
Scaphoideum
3
Anden patologi
3
Intet patologisk
15
Samlet antal patienter
40
Tabel 1. Tabellen viser fordelingen af de
forskellige patologiske fund. Anden patologi
dækker over skader på discus triangularis
og ligamentskader
Figur 1. A. Røntgenbillede af et håndled obs fraktur som er beskrevet som IA. B.
MR-skanning af samme håndled, som viser en fraktur i distale radius (røde pile).
Diskussion: Standardundersøgelsen, med røntgen til udredning af patienter med formodet
håndledsfraktur, er hurtig, billig og kan i mange tilfælde generere brugbare billeder selv hos urolige
patienter med mange smerter. Dette studie viser, at i tilfælde hvor røntgenundersøgelsen er negativ, kan
en supplerende MR-skanning i mange tilfælde påvise patologi som er usynlig for røntgen. Ud over en
9
mere præcis diagnosticering, kan MR-teknikken påvise bone bruise og bløddels-patologi hvilket ikke er
muligt med røntgen. Udfordringen med MR er at det er en dyr teknik og den kræver at patienterne kan
sidde stille igennem længere tid.
Dette studie viser, at man med fordel kan supplere standard røntgenundersøgelsen med MR i de tilfælde
hvor patologien ikke er synlig for derved at kunne øge den diagnostiske kvalitet ved mistanke om
håndledstraume hos kvinder i alderen over 50. Samt at der er et stort potentiale til at anvende MR inden
for traumeradiologi i fremtiden.
10
2. Small bowel cleansing does not improve quality of wireless capsule endoscopy
Wilkens R.*1,2, Langholz E.3, Glerup H,1
1Regional Hospital Silkeborg, University Research Clinic for Innovative Patient Pathways, Diagnostic
Center, Division of Gastroenterology, Silkeborg, Denmark,
2Aarhus University Hospital, Department of Hepatology and Gastroenterology, Aarhus, Denmark
2Gentofte Hospital, Department of Medical Gastroenterology, Copenhagen, Denmark,
Background: Wireless capsule endoscopy (WCE) is the most important tool for investigating obscure
gastrointestinal bleeding in the small bowel, superior to cross sectional imaging in detecting early and
subtle inflammation of the small intestine in Crohn's Disease (CD). [1] With increasing demand of early
diagnosis, WCE becomes more important. However, a drawback is the limited visualization of the mucosa
in patients with poor cleansing quality. The aim of our study was to determine the benefit of preparation
with Picoprep prior to examination with WCE and evaluate two different methods for cleansing quality.
Methods: This prospective cluster trial examined all patients from two Danish centers, who underwent
WCE from August 2013 to July 2014. Both Centers used the same instructions for preparation. Site A, in
addition to Site B, instructed patients to ingest one sachet of Picoprep powder, at 9 pm the day before
examination, followed by 1.5 litres of liquid diet. Patients were matched between centers based on
indication, sex and age. Cleansing quality was assessed by two different methods described by Park et al.
2010 [2] with a 3 grade subjective assessment every 5 minutes and Weyenberg et al. 2011 [3] with
computer assessed cleansing utilizing the capsule reading software colour bar. Mean overall score
between groups were compared using students ttest.
Results: We enrolled 135 consecutive patients allowing matching of 92 patients, mean age of 45 years
(16-83), 67 % women. CD was the indication in 69.6 %. Both scoring systems correlated well (rho =
0.80). Both scoring systems revealed significantly decreased cleansing quality throughout the small
bowel comparing each third individually, p < 0.01. There was no overall difference in quality between
groups.
Conclusions: Small bowel cleansing prior to WCE does not improve mucosal visualization of the small
bowel in patients with suspected CD or obscure bleeding.
References:
[1] Mustafa BF, Samaan M, Langmead L, Khasraw M, (2013), Small bowel video capsule endoscopy: an
overview, Expert review of gastroenterology & hepatology, 323-329
[2] Park SC, Keum B, Hyun JJ et al., (2010), A novel cleansing score system for capsule endoscopy,
World Journal of Gastroenterology, 875-880
[3] Van Weynberg SJB, De Leest HTJI, Mulder CJJ, (2011), Description of a novel grading system to
assess the quality of bowel preparation in video capsule endoscopy., Endoscopy, 406-411
11
3. Frequency of labour market attachment after severe traumatic brain injury compared to the
background population
Lene Odgaard1, Søren Paaske Johnsen2, Asger Roer Pedersen1, Jørgen Feldbæk Nielsen1
1
Hammel Neurorehabilitation Center and University Research Clinic, Aarhus University, Denmark
2
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Purpose: Estimates of labor market attachment (LMA) depend on stakeholder perspectives and on the
time-point of measurement. We aim to estimate frequencies of LMA after severe traumatic brain injury
(TBI), and to compare it to LMA in the background population using three different stakeholder
perspectives at different time-points of measurement.
Patients and methods: A national population of patients with severe TBI (n=637) and their matched
controls (n=2497) are followed in a Danish national register of transfer payments up to five years after
index. Frequencies of LMA are estimated for three stakeholder perspectives ie being selfsupporting; being
eligible for open market work; and being productive. We calculate frequencies in the following ways: 1)
cumulative incidence proportions of LMA after TBI; 2) weekly frequencies of LMA for patients with TBI
and for their matched controls; and 3) annual frequency of LMA for patients with TBI who returned to
work and for their matched controls. We use graphical plots and regression analyses depending on data
distribution to analyze differences and trends.
Results: Results are in progress and will be presented.
Conclusion: Results provide prognostic information on labor market attachment after severe TBI.
12
4. Cognitive-behavioural therapy for lumbar spinal fusion patients. A clinical and economic
evaluation
Rolving N1, 2, Nielsen CV3, Christensen FB4, Holm R5, Bünger CE4, Oestergaard LG2
Diagnostic Centre, Regional Hospital Silkeborg
2
Dep. of Physiotherapy and Occupational Therapy, Aarhus University Hospital
3
Centre of Public Health and Quality Improvement, Central Denmark Region
4
Dep. of Orthopaedic Surgery, Aarhus University Hospital
5
Elective Surgery Center, Regional Hospital Silkeborg
1
Background: The Western World has seen a significant increase in lumbar spinal fusion (LSF) rates due
to degenerative spinal disorders. Few published studies have looked at the potential of rehabilitation
interventions to improve the surgical outcome. Rehabilitation programmes using cognitive-behavioural
therapy (CBT) are recommended.
Aim: 1) To examine the effect of a preoperative CBT intervention on disability, pain coping, pain and
return to work and 2) To examine the cost-effectiveness from a societal perspective.
Materials and methods: 90 patients undergoing LSF due to degenerative diseases were randomly
allocated to a control group (surgery and standard rehabilitation) or a CBT group (usual care and a
preoperative CBT intervention). Questionnaires on patient-reported outcomes were completed at
baseline, and 3 months, 6 months and 1 year after surgery. Additional data was gathered from national
registers and medical records. A health economic evaluation was conducted alongside the trial.
Results: 1) The CBT group reported a significantly larger disability reduction compared to the control
group in the early recovery phase. At 1-year follow-up this difference was no longer significant due to
improvements in the control group. Pain intensity, pain coping and return to work was similar between
groups. 2) The two groups had equal costs in terms of health care utilisation and production loss, but the
CBT group achieved superior clinical outcomes compared to the control group, leading to a 70%
probability of preoperative CBT being cost-effective over usual care, at a threshold of willingness-to-pay
of €40,000 per additional QALY. For an additional gain of 15 ODI points the corresponding probability was
90%.
Conclusion: Our findings support the use of a preoperative CBT intervention for patients undergoing
LSF, as we found patients to achieve faster recovery of function and increased quality of life at limited
extra costs.
13
5. Dorte Dahl Hoffmann m.fl., Vestdansk Center for Rygmarvsskade, Neurologisk Afdeling
Prøvehandlinger som metode til ændring af rehabiliteringsindsats
Hoffmann DD1, Steensgaard R1
1
Vestdansk Center for Rygmarvskade, Neurologisk Afd., Hospitalsenhed Midt, Viborg
Introduktion og formål: Et projekt på Vestdansk Center for Rygmarvsskade havde til formål gennem
en sammenhængende og velkoordineret indsats at inddrage den enkelte patient i et målrettet,
systematisk og individuelt tilpasset rehabiliteringsforløb. Ændringerne er indført gennem prøvehandlinger,
inspireret af MidtLab og Scharmer´s Teori U. Prøvehandlingerne bestod af 8 afgrænsede indsatser, der i
2014 blev afprøvet på mindre udsnit af centeret i en begrænset periode med efterfølgende evaluering og
justering, inden implementering på hele rehabiliteringscentret.
Materiale og metode: Indholdet af hver prøvehandling er evalueret med spørgeskema af involveret
personale og af patienter, hvor det var relevant. Prøvehandlinger som metode er evalueret gennem
semistrukturerede interviews af fire fagpersoner før og efter projektet, fokusgruppeinterview af
mellemledere og spørgeskemaundersøgelse blandt deltagende personale. (N=83)
Resultater: Med en svarprocent på 90 i spørgeskemaundersøgelsen mente 62%, at der havde været et
behov for ændrede arbejdsgange. 32% ikke var ansat i tiden inden prøvehandlingerne. 81% svarede, at
prøvehandlinger er en god eller meget god måde at ændre arbejdsgange. 92% mente, at
prøvehandlinger fortsat skal anvendes, mens 3% ikke mente, metoden skal anvendes fremover. 48%
mente, at prøvehandlingerne blev afviklet for hurtigt efter hinanden. 60% fandt, at prøvehandlinger var
en god metode til at afklare, hvad der ikke virker i hverdagen, og 56% fremhævede det positive i at
afprøve ændringer i en lille gruppe inden justering og implementering på hele centeret. 48% gav udtryk
for at have haft tilpas indflydelse på processen, mens 24% ønskede mere indflydelse.
Konklusion: Prøvehandlinger er en brugbar metode i forhold til at ændre tværfaglige arbejdsgange i
rehabiliteringsindsatsen. Det er vigtigt at være opmærksom på, hvordan personalet påvirkes af at
arbejde i forandring, og at give implicerede fagpersoner høj grad af indflydelse på processen.
14
Posters på ”Forskningens Dag”
1. CT coronary angiography in ´real-world` patients: does sex matter?
Nørgaard KS1, Isaksen C1, Buhl JS1, Johansen JK 1, Nielsen AH2, Nørgaard A1, Urbonaviciene G2, Lindholt
JS3, Frost L2*
1
Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional
Hospital, Denmark.
2
Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional
Hospital, Denmark & Institute for Clinical Medicine, Aarhus University Hospital, Denmark.
3
Centre for Individualised Medicine in Arterial Disease, Department of Cardiothoracic and Vascular
Surgery, Odense University Hospital, Denmark.
* presenting author.
Background: In ‘real-world’ patient populations undergoing CT coronary angiography (CCTA), it is
unclear whether a correlation exists between gender, coronary artery calcium score (CAC) and
subsequent referral for invasive coronary angiography and coronary revascularisation. We therefore
investigated the relationship between gender, CAC and utilisation of subsequent invasive coronary
angiography and coronary revascularisation in a cohort of patients with chest discomfort and low to
intermediate pre-test probability of CAD who underwent a CCTA at our diagnostic centre.
Methods: This is a cohort study that included patients examined between 2010 and 2013. Data were
obtained from the Western Denmark Heart Registry. The follow-up ended March 11, 2014.
Results: A total of 3541 persons (1621 men and 1920 women) were examined by CAC. The rate of
invasive coronary angiography during follow-up was 28.5% in men versus 18.3% in women (p < 0.001).
The rate of coronary revascularisation during follow-up was 11.4% in men versus 5.1% in women (p <
0.001). The CAC-adjusted hazard ratio in women versus men for invasive coronary angiography was 0.98
(0.85-1.13) and for coronary revascularisation was 0.73 (0.57-0.93). Further adjustment for age and
other risk factors did not change these estimates.
Conclusions: CAC rather than gender determines the use of invasive coronary angiography after CCTA,
though the risk of coronary revascularisation was reduced in women, irrespective of CAC. This may
reflect a gender-specific difference in coping with chest discomfort, gender-specific referral bias for CCTA,
and/or a gender-specific difference in the balance between coronary calcification and obstructive coronary
heart disease.
15
2. Effekten af selvfikserende mesh (Progrip) på postoperativ rekonvalens efter
transabdominal præperitoneal inguinalherniekirurgi
Forfattere: Christensen MK1, Dinesen MØ2 og Nielsen MF3
1,2,3
Kirurgisk afdeling, Regionshospitalet Viborg
Introduktion: I Danmark bliver cirka 10.000 patienter opereret for lyskebrok om året. Af disse får
omkring 10 % efterfølgende kroniske lyskesmerter. Der er ikke noget godt behandlingstilbud til patienter
med kroniske smerter efter operationen, hvilket gør det interessant at reducere incidensen af de kroniske
smerter. Det er desuden af almen interesse at holde den umiddelbare postoperative periode med
smerter og andre gener så kort som mulig. Da mange af patienterne samtidig er yngre og stadig
erhvervsaktive er dette ikke mindre interessant set i et samfundsmæssigt perspektiv.
Der indsættes en mesh (net) under operationen. Det er nødvendigt for at forstærke bugvæggen og
dermed reducere antallet af recidiver. Meshen samt tacks (små skruer, der hæfter nettet fast på
bagsiden af bugvæggen) anvendt til fiksering antages at forårsage en stor del af smerterne.
Operation for lyskebrok kan gøres åbent af modum Lichtenstein eller med laparoskopisk teknik
(kikkertkirurgi). Laparoskopisk kirurgi for lyskebrok er mere omkostningstungt, men er vist at reducere
forekomsten af både akutte og kroniske smerter og formodes at give hurtigere tilbagevenden til
almindelige aktiviteter.
Formålet: med studiet er primært at undersøge om en ny selvfikserende mesh, der ikke kræver
fiksering med tacks, kan reducere incidensen af akutte og kroniske smerter uden at øge
recidivfrekvensen.
Metode: Randomisering af 500 mandlige patienter med førstegangstilfælde af lyskebrok til henholdsvis
operation med standard mesh med tacksfiksering og en selvfikserende mesh (Progrip). Alle patienter
opereres fraset meshtype med en ellers fastlagt laparoskopisk kirurgisk procedure. Patienterne er blindet
i forhold til hvilket type mesh, de får indopereret. Der følges op på forekomsten af akutte og kroniske
smerter og recidivfrekvens. Desuden opfølgning angående seksuel dysfunktion, livskvalitet og
komplikationer blandt andet blødning og væskeansamling. Opfølgningen foregår med spørgeskemaer
præoperativt og 1,3 og 7 dage efter operationen samt efter 1, 3,6 og 12 måneder.
16
3. Microstructural changes in the brain after concussion
Næss-Schmidt ET1, Blicher JU3, Eskildsen SF3, Tietze A3, Møller MT4, Rask C4, Schröder A4, Hansen B3,
Østergaard L3, Nielsen JF1
1
Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University
2
Neuroradiological department, Aarhus University Hospital, Nørrebrogade
3
Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus University Hospital
4
The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital
Background: More than 20% with concussion present persisting symptoms beyond 3 months. Postconcussion symptoms (PCS) are often diffuse and involve physical, cognitive and emotional domains. The
corpus callosum (CC), the hippocampus (HC) and the thalamus (THA) have been brain areas of interest
due to their connection to widespread domains. Diffusional Kurtosis Imaging (DKI) and Diffusional Tensor
Imaging (DTI) are sensitive tools to detect structural changes and might therefore serve as a first
indicators of pathology in specific brain areas.
Aim: It is the purpose to examine microstructural changes after mTBI with a novel scan protocol with
DKI and DTI. It is hypothesized that a group of mTBI subjects with persisting PCS will show a difference
in the microstructure of the CC, THA and HC compared to mTBI subjects with no PCS.
Method: 25 subjects with and 25 without PCS, respectively, will be scanned with a conventional MRI
protocol including DTI and DKI, 3 month after trauma. The degree of PCS is assessed by the Rivermead
post-concussion questionnaire and the cognitive performance by a standardized cognition test battery.
Results: The study can potentially reveal if subjects with PCS have structural brain changes and altered
cognitive performance compared to mTBI subjects without PCS and - if this is the case- whether they are
related.
Perspective: Sensitive biomarkers are essential to the full understanding of PCS. This study will add
further knowledge into the area.
17
4. Rutinemæssig sigmoideoskopi og prædiktive faktorer for coloniskæmi efter operation for
rumperet aorta aneurisme
Feuerhake IL1, Urbonavicius S1, Randsbæk F1, Behr-Rasmussen C1, Grøndal N1.
1
Department of Vascular Surgery, Viborg Regional Hospital
Baggrund: Coloniskæmi (CI) er en relativ hyppig og alvorlig komplikation til operation for rumperet
abdominalt aorta aneurisme (rAAA) og forbundet med høj morbiditet og mortalitet. CI kan ofte
diagnosticeres ved sigmoideoskopi (FS), men rutinemæssig brug efter operation for rAAA er
omdiskuteret. Tidligere studier har forsøgt at identificere kliniske eller parakliniske prædiktorer med
henblik på at risikoinddele og selektere patienter i særlig risiko for CI til tidlig FS.
Formål: 1) At evaluere værdien af rutinemæssig FS ved diagnosticeringen af CI hos patienter opereret for
rAAA. 2) At identificere hæmodynamiske, biokemiske og kliniske variable, som kan prædikere CI hos
patienter opereret for rAAA.
Studiedesign: Retrospektiv journalaudit ved en konsekutiv serie af patienter opereret for rAAA, hvor
rutinemæssig FS var intenderet postoperativt.
Metode: I studieperioden fra den 01.04.2011-01.02.2014 blev i alt 55 patienter opereret for rAAA på
Karkirurgisk afdeling, RH Viborg. 10 patienter døde peroperativt. Af de resterende overlevede 38
patienter mere end 24 timer og blev derfor inkluderet i studiet. Antallet af patienter, der fik lavet FS,
fund ved FS og antal patienter med CI samt behandlingen heraf registreredes. Ved journal gennemgang
samledes specifikke hæmodynamiske, biokemiske og kliniske variable, målt umiddelbart præ- og
peroperativt samt dagligt indtil og med 3. postoperative dag. Der benyttedes non-parametrisk statistik
idet data ikke var normalfordelt. Associationen mellem CI og mulige prædiktorer blev undersøgt i en
logistisk regressionsmodel.
Resultater: Rutinemæssig FS blev gennemført hos 26 patienter af de 38 patienter, der efter operationen
for rAAA overlevede mere end 24 timer (68%). 16 patienter havde CI (42%) og mortaliteten blandt disse
lå på 25%. Der var ikke statistisk signifikant forskel på de målte præ- og peroperative variabler for
patienter med- og uden CI. Med logistisk regression fandtes både hæmoglobin-niveau og log. laktat som
selvstændige risikomarkører for udvikling af CI med henholdsvis OR=0,44 (p<0,001) og OR=1,91
(p=0,007).
Konklusion: Rutinemæssig sigmoideoskopi efter operation for rAAA var kun gennemført hos 68% af de
mulige patienter og nytten heraf er derfor uklar. Set ud fra de præ- og peroperative variable, så de to
patientgrupper ud til at have nogenlunde ens udgangspunkt. Mortaliteten var ligeledes samlignelig hos
patienter med- og uden CI og kan eventuelt forklares ved den forholdsvis lille studiepopulation.
Imidlertid viste den postoperative udvikling af både laktat og hæmoglobin sig som selvstændig
risikofaktor for udviklingen af CI og bør efterprøves i en prædiktionsmodel i større prospektive
kohortestudier.
18
5. Rygsmerter og bensmerter associerer forskelligt til MR forandringer i lænderygsøjlen og til andre
smertevariabler, herunder tegn til rodtryk: En tværsnitsundersøgelse hos 141 sygemeldte
lænderygpatienter
Jensen OK1, Nielsen CV2, Sørensen JS3, Stengaard-Pedersen K4
1
RegionsRygcentret, Forskningsenheden for Sygemeldte, Diagnostisk Center, Regionshospitalet Silkeborg
2
CFK • Folkesundhed og kvalitetsudvikling, Århus Universitet
3
Associeret til forskningsafdelingen, Middelfart Rygcenter, Syddansk Universitet
4
Reumatologisk afdeling U, Århus Universitetshospital
Formål: At undersøge hvordan intensiteten af rygsmerter og bensmerter de sidste 14 dage er associeret
til degenerative forandringer på MR scanning af lænderyggen og til kliniske variable som udbredt ømhed i
kroppen og angivelse af udbredte smerter.
Metoder: Via spørgeskema blev patienterne ved første besøg udspurgt om ryg- og bensmerter de sidste
14 dage samt om udbredte smerter. På basis af symptomer og kliniske fund blev patienterne klassificeret
som uspecifikke rygsmerter eller nerverodssmerter, sidstnævnte krævede at efterfølgende MR scanning
bekræftede den kliniske mistanke om nerverodspåvirkning. Derudover blev der foretaget standardiseret
undersøgelse for udbredt ømhed i kroppen (tenderpoint undersøgelse). MR billeder blev blindet for
kliniske oplysninger og sendt til standardiseret beskrivelse af de degenerative forandringer. Ryg- og
bensmerters mulige associationer med MR forandringer i lænderygsøjlen og smertevariable blev
analyseret med lineær regression med ryg- og bensmerteintensitet som afhængige variabler.
Resultater: Nerverodspåvirkning blev fundet klinisk hos 43%. Rygsmerteintensiteten var højere hos
patienter med type 1 Modic forandringer efter korrektion for billeddiagnostisk nerverodspåvirkning, men
var ikke relateret til fund af prolaps. Der var tendens til flere rygsmerter ved billeddiagnostisk kontakt til
nerverod, men færre rygsmerter ved nerverodskompression. Bensmerteintensiteten var primært
associeret med klinisk nerverodspåvirkning, fund af prolaps og billeddiagnostisk nerverodspåvirkning.
High intensity zone (HIZ) forandringer og osteofytter var ikke associeret med rygsmerter, men med
bensmerter hos patienter med klinisk nerverodspåvirkning. Ved multivariat analyse kunne
rygsmerteintensiteten hos 15% forklares af type 1 Modic forandringer, billeddiagnostisk
nerverodspåvirkning og udbredt ømhed i kroppen (tender points), og hos 31% kunne
bensmerteintensiteten forklares af diskusprolaps med nerverodspåvirkning eller udbredte smerter hos
patienter uden kliniske tegn til nerverodspåvirkning eller højere alder.
Konklusion: Rygsmerteintensitet kunne i begrænset omfang forklares af type 1 Modic forandringer og
udbredt ømhed i kroppen, mens bensmerteintensitet hos en større andel kunne forklares af
diskusprolaps, klinisk nerverodspåvirkning, angivelse af udbredte smerter og højere alder.
19
6. Surviving severe traumatic brain injury in Denmark: incidence and predictors of highly
specialised rehabilitation
Lene Odgaard1, Ingrid Poulsen2, Lars Peter Kammersgaard2, Søren Paaske Johnsen3, Jørgen Feldbæk
Nielsen1
1
Hammel Neurorehabilitation Center and University Research Clinic, Aarhus University, Denmark
Department of Neurorehabilitation, TBI and Research Unit on Brain injury rehabilitation (RUBRIC),
Glostrup Hospital, Copenhagen University, Denmark
3
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
2
Purpose: To identify all hospitalized patients surviving severe traumatic brain injury (TBI) in Denmark
and to compare these patients to TBI patients admitted to highly specialized rehabilitation (HSrehabilitation).
Patients and methods: Patients surviving severe TBI were identified from The Danish National Patient
Registry and The Danish Head Trauma Database. Overall incidence rates of surviving severe TBI and
incidence rates of admission to HS-rehabilitation after severe TBI were estimated and compared. Patientrelated predictors of no admission to HS-rehabilitation among patients surviving severe TBI were
identified using multivariable logistic regression.
Results: The average incidence rate of surviving severe TBI was 2.3 per 100,000 person years.
Incidence rates of HS-rehabilitation were generally stable around 2.0 per 100,000 person years. Overall,
84% of all patients surviving severe TBI were admitted to HS-rehabilitation.
Female gender, older age and non-working status preinjury were independent predictors of no HSrehabilitation among patients surviving severe TBI.
Conclusion: The incidence rate of hospitalized patients surviving severe TBI was stable and the majority
of the patients were admitted to HS-rehabilitation. However, potential inequity in access to HSrehabilitation may still be present despite a health care system based on equal access for all citizens.
20
7. Dose-responce of bone morphogenic protein 2 on a background of systemic bisphosphonate
in an unloaded canine implant model
Cleemann R.1, 2, Baas J.2, Sørensen M.3, Bechtold J.4 , Søballe K.2
Silkeborg Elective Surgery Centre, Denmark
2
Orthopaedic Reseach Laboratory, Department of Orthopaedics, Aarhus University
Hospital, Denmark
3
Horsens Regional Hospital, Department of Orthopaedics, Denmark
4
Excelence Center for Bone and Joint Research and Education, Minneapolis Medical
Research Foundation, Minneapolis, USA
1
Background: A total hip arthroplasty (THA) is used to alleviate people from pain due to arthrosis of the
hip. THA is considered a safe procedure with good results based on registry data.
Prior research has shown that a quick on-growth of bone to the prosthesis surface decreases the risk for
revision. The idea behind this study, is to increase bone formation and decrease bone absorption around
the prosthesis, thus increasing the initial fixation of the prosthesis.
The optimal dose of the bone-inducing cytokine Bone Morphogenic Protein-2 (BMP-2) in relation to
implant fixation is not established, neither is the type of gap where it will exerts its greatest effect.
Aim: By stimulating osteoblasts with three different doses of BMP-2 and inhibit osteoclast activity with
systemic bisphosphonate, we hypothesize that net bone formation will increase.
Methods: In a paired randomized controlled design, 12 skeletally mature male canines had porous
coated titanium implants bilaterally inserted in the femur condyles (open gap) or proximal humerus
(grafted gap).
Observation time was 4 weeks. A single dose of bisphosphonate (Zolendronate) was administered IV 10
days after surgery (0,1 mg/kg).
The open gap implants were surrounded by a 0.75 mm empty gap and the grafted gap with a 2 mm
defect with compacted allograft. The implant coating was highly porous and soaked with 3 doses of BMP2 (1. Control 2. Low [15 µg] 3. Medium [60 µg] 4. High [240 µg]).
Evalution was done by push-out to failure of the bone implant interface. Strength, Energy to failure and
Stiffness were derived from load and deformation measures.
Results: Open gap: Low had better fixation on all 3 parameters compared to Control, Medium and High
(P= 0.0022; P=0.0186; P=0.0037).
Grafted gap: Control had better fixation on all 3 parameters compared to Low, Medium and High (P=
0.0013; P=0.0004; P=0.005).
21
8. Non-attendance in a screening programme for cardiovascular diseases and diabetes in
Danish women; a non-attendees perspective
Thomsen MD1&3, Lindholt JS1&2, Søgaard R3, Frost L4, Lorentzen V5
1
Vascular Research Unit, Viborg Hospital, 2Elitary Research Centre of Individualised Medicine in Arterial
Diseases, Odense University Hospital, 3Health, Aarhus University, 4Diagnostic Centre, Silkeborg Hospital,
5
Centre for Nursing Research -Viborg.
Background: Non-attendance in preventive screening offers is a common problem associated with
increased morbidity and mortality. Additionally, the (cost-)effectiveness of screening programmes may be
adversely affected by low attendance rates. Consequently, limiting non-attendance is relevant. Exploring
non-attendance is part of a PhD-project with the overall objective to estimate the cost-effectiveness of
population-based screening for cardiovascular diseases (CVD) and diabetes (DM) in Danish women aged
60, 65, 70 and 75.
Aim: To explore a non-attendees perspective of reasons for non-attendance in screening for CVD and DM
screening programme.
Methods: Exploring non-attendance was based on a hermeneutical approach. A semi-structured
interview guide was developed with references to the literature on non-attendance in CVD and DM
screening. Individual interviews with 10 non-attenders were conducted in September – October 2013.
The informants were selected from the four age group in the screening programme. Codes were
inductively identified, and reasons for non-attendance were categorized into themes. The interpretation
was inspired by Kvale and Brinkmann’s context of interpretation, comprising self-understanding, critical
commonsense and theoretical understanding.
Results: Three main themes were revealed: 1) Finding the screening programme personal irrelevant, 2)
Insufficient knowledge related to diseases, disease prevention and potential benefits of attending, and 3)
Attitude and prejudices against the healthcare system and screening in general.
Conclusion: Non-attendance was found to be associated with previous negative experience with the
healthcare system and distrust in health professionals and screening in general. Findings indicated that
the decision of non-attendance has been made on the basis of insufficient knowledge and prejudgment.
22
9. Forebyggelse af senkomplikationer gennem korrekt ernæringsscreening af mennesker med
rygmarvsskade
Wojke P1, Steensgaard R1, Bonne S1
1
Vestdansk Center for Rygmarvsskade, Neurologisk afdeling, Hospitalsenhed Midt
Introduktion: Overvægt og fedme er en kendt problematik for mennesker med en rygmarvsskade, som
kan medføre metaboliske forstyrrelser, hjertekarsygdom, type 2 diabetes og for tidlig død.
Ernæringsscreeningsmodeller udviklet til anvendelse i sundhedsvæsenet og tilgængelig i MidtEPJ er ikke
tilpasset rygmarvsskadede patienters lavere energibehov og kan således ikke identificere disse patienters
aktuelle ernæringsmæssige tilstand og give rette handlingsanvisninger.
Metode: Vestdansk Center for Rygmarvsskade har derfor udviklet en elektronisk
ernæringsscreeningsmodel, der i vurderingen af patientens energi- og proteinbehov tager højde for
følgende faktorer: BMI, para- og tetraplegi, stressmetabolisme efter en rygmarvsskade, om patienten er
sengeliggende, mobiliseret til manuel kørestol, el-kørestol, eller har gangfunktion.
I screeningsmodellen baseres patientens ernæringsmæssige tilstand også på en 3 døgns kost- og
væskeregistrering. Dette og førnævnte faktorer resulterer i en individuel ernæringsplan.
Den elektroniske ernæringsscreeningsmodel kan tilgås på alle Centerets computere og en kopi af
resultatet dokumenteres i MidtEPJ og er således tilgængelig i journalen.
Resultater: Udvikling og implementering af en model der er tilpasset patientgruppen giver et reelt og
brugbart resultat som har ført til at flere patienter ernæringsscreenes.
Konklusion: Udviklingen af en elektronisk ernæringsscreeningsmodel der er tilpasset patientgruppen
sikre mere korrekt screening og kan derfor anvendes til langt hurtigere at detektere patienter der er
overvægtige eller er i risiko for udvikling af overvægt eller fedme. Forebyggende tiltag kan hurtigere,
mere præcist og målrettet iværksættes under indlæggelsen på VCR.
23
10. Pathophysiological and potential diagnostic aspects of the mural thrombus in abdominal
aortic aneurysms. – a Ph.d. projekt.
C. Behr-Rasmussen1 , S. Urbonavicius1 , L. Melholt Rasmussen2 ,J. Frystyk4 , J. S. Lindholt1,3
1 Vascular Research Unit, Dept. of Vascular Surgery, Viborg Hospital, and Department of Clinical
Medicine, Aarhus Universty
2 Dept. of Clinical Biochemistry, Odense University Hospital
3 Dept. of Heart, Lung and Vascular Surgery (T), Odense University Hospital,
4 Med Research Lab, Aarhus Sygehus, Aarhus University Hospital
Background: Rupture of the abdominal aortic aneurysm (AAA) is the 10th most leading cause of death
in men above 65 years of age and the prevalence ranges from 1-8.8%. Increased size is directly related
to increased annual risk of rupture. It has been and still is being discussed if
the presence of an ILT decreases or increases the risk of a growth. It is thought that the porosity of the
ILT negates biological active substances, such as proteases, to infiltrate the aortic wall destabilising the
matrix. The active substances present at the luminal surface could be found in the
peripheral blood stream. Presence of an ILT is, according to recent research, more likely to mean bigger
risk of growth and rupture.
Aims:
1. To describe the possible association between the mural thrombus
and growth of the AAA
2. To identify components in the luminal part of the
thrombus which are many-fold Increased compared to the circulation and
3. To test the validity of these identified components together with key
markers of coagulation as:
a. Screening tool to detect AAA and
b. Potential diagnostic tool for endoleak by comparing the change in the circulation after repair with size
matched controls not having repair.
4. Investigate possible morphological traits compared with growth rate.
Planned studies:
1. Observational study of the role of the mural thrombus in the VIVA* AAA cohort - Finished and
published.
2. Paired protein analysis of luminal mural thrombus and plasma.
3. MRI evaluation of 50 patients from VIVA* - a morphological approach
* VIVA: Large screening trial to detect AAA in 65-74 year old men living in the Central Denmark Region
24
11. Patienter og pårørende som partnere i Karkirurgisk Afdeling
Riis, C, Sandermann, J, Gaarn-Larsen, K, Laursen, M
Karkirurgisk Afdeling, Regionshospitalet Viborg
D. 4. februar 2015 holdt Karkirurgisk Afdeling et PPsP-møde (Patienter og Pårørende som Partnere) med
patienter opereret for udposning på hovedpulsåren og deres pårørende.
Formålet med mødet var: At opnå kvalitativ viden om patienter og pårørendes oplevelser, behov og
vurderinger af deres gennemlevede forløb.
At anvende denne viden i tilrettelæggelsen og udviklingen af behandlingsforløb i Karkirurgisk Afdeling.
Antal deltagere: På mødet deltog 7 patienter og 7 pårørende.
Fra Karkirurgisk Afdeling deltog to interviewere og et tværfagligt reflekterende team på fire personer,
heriblandt afdelings- og afsnitsledelsen.
Metode: Mødet blev gennemført som et semi-struktureret gruppeinterview, hvor patienter og pårørende
levende kunne fortælle om deres oplevelser af deres gennemlevede forløb ud fra en række åbne
spørgsmål. Patienter og pårørende var placeret rundt om et bord sammen med mødets to interviewere.
Bagved var det reflekterende team placeret.
Det reflekterende teams vigtigste opgave var at lytte og på et tidspunkt fortælle, hvad der var
tankevækkende, overraskende eller lærerigt at høre, og sætte det i forhold til afdelingens praksis. Først
ved mødets afslutning blev der åbnet op for direkte kommunikation mellem alle deltagere, hvor der var
mulighed for at få deltagernes svar yderligere belyst, udforske andre områder mm.
Resultater: Afdelingen fik mange positive tilbagemeldinger om yderst velfungerende forløb, varm
velkomst og god stemning i afdelingen, kompetent personale hele vejen rundt, overvejende god mundtlig
og skriftlig information, særdeles god smertebehandling, tryghed ved udskrivelse og fokus på både
patient og pårørende.
Patienterne og deres pårørende fortalte også om oplevelser, der kalder på forbedringer.
Særligt vil Karkirurgisk Afdeling arbejde med at strømline patientforløbene i forbindelse med
forberedelsen, at udarbejde skriftligt informationsmateriale til de pårørende, at sikre, at vigtig
information gives på rette tidspunkt og af rette vedkommende, og at alle patienter ringes op to gange
efter udskrivelsen.
25
12. High coronary artery calcium score in clinical practice: relationship with coronary
revascularization and adverse events.
Grazina Urbonaviciene,1,2, Christin Isaksen1, Jane Kirk Johansen1, Jørgen Selmer Buhl1, Henrik Vase3,
Kirsten Schou Nørgaard1, Aage Nørgaard1, Jes Lindholt4, Lars Frost1,2.
1
Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital
2
Institute for Clinical Medicine, Aarhus University Hospital
3
Department of Cardiology, Aarhus University Hospital – Skejby
4
Department of Vascular Surgery, Odense University Hospital
Background: We aimed to investigate the association between coronary artery calcium score (CACS)
and subsequent rates of revascularization and adverse events in patients with high CACS.
Methods and Results: We reviewed 464 symptomatic patients (63 % male, mean age of 67±7.9 years)
with CACS>/=400. The patients were followed up for CCTA guided invasive coronary angiography (ICA),
and for adverse events during follow-up to a medium period of 30 ((IQR) 22; 41) months. Logistic and
Cox regression, Kaplan Meier survival analysis were used to assess the role of CACS in predicting
revascularization and adverse events.
The CCTA guided ICA and revascularization rates were 72% and 28% in patients with a CACS of 400999, vs. 89% and 41% in patients with a CACS>/=1000. The crude and adjusted OR (95% CI) of CACS
>/=1000 for revascularization were 1.79 (1.20–2.67) and 1.87 (1.24–2.83), but AUC was poor at 0.60
(95% CI: 0.55-0.66).
During follow-up a total of 49 (10.5%) adverse events were observed. There were 33 MACE and 28 allcause deaths. The MACE rate was 6.4 % and 8.2% (p=0.46), and the death rate was 3.7% and 10%
(p=0.008) comparing the patients with CACS of 400-999 and CACS >/=1000. Kaplan-Meier survival
analysis showed significantly different cumulative event-free survival rates between patients with a CACS
of 400-999 and CACS>/=1000 for all-cause death (p= 0.007), but not for MACE (p=0.684). The risk for
all-cause death increased with a crude HR of 2.71 (95%CI 1.27-5.78), and an adjusted HR of 2.39 (95%
CI 1.09-5.23) in the patients with CACS >/=1000, but the AUC was found poor at 0.67 (95%CI 0.560.78).
Conclusions: CACS was associated with coronary revascularization; however, its accuracy in identifying
patients who require revascularization was limited. Increasing CACS had a predictive value for all-cause
death but not for MACE in patients with CACS>/=400.
26
13. Favourable prognosis of normal myocardial perfusion imaging in patients with suspected
CAD on coronary computed tomography angiography
Grazina Urbonaviciene1,2, Christin Isaksen1, Lisbet Poulsen1, Jane Kirk Johansen1,
Signe Holm Larsen3, Lars Frost1, 2
1
Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital
2
Institute for Clinical Medicine, Aarhus University Hospital
3
Department of Cardiology, Aarhus University Hospital – Skejby
Background: A normal myocardial perfusion imaging is associated with a low cardiac event rate. The
aim of the present study was to investigate the prognosis of a normal magnetic resonance perfusion
imaging (MRPI) in the patient with a low-intermediate probability of coronary artery disease (CAD) and
positive findings on coronary computed tomography angiography (CCTA).
Methods and Results: A total of 144 patients with suspected CAD on CCTA underwent MRPI in
Diagnostic Centre of Silkeborg. We analyzed retrospectively 73 (60% male; mean age 61 ± 8.7 years)
consecutive patients with normal MRPI and positive findings on CCTA.There were 9 patients with
extremely high coronary artery calcium score (>1000), 11 patients with significant stenosis, and 53
patients with intermediate stenosis on CCTA. The patients were examined with a 1.5 T MRI scanner
(Siemens, Erlangen), with a first pass of 0.10 mmol/kg gadolinium chelate, during adenosine
vasodilatation (140 µg/kg/min for 3 min), and at rest. Inconclusive MRPI results were excluded from the
study. Minimum clinical follow-up was 6 months.
Fifty-nine (81%) patients were discharged without a need for further examination after a normal MRPI.
Fourteen patients (19%) with suspect angina pectoris were referred for invasive coronary angiography
(ICA) despite normal MRPI. In 4 patients ICA detected 3-vessel disease (VD), and there were 1-VD in 3
patients. Six patients underwent coronary artery revascularization, and 1 patient refused further
treatment. There were 3 PCI and 3 CABG. Seven patients were considered to treat medically after ICA.
During the follow-up period, none of the patients suffered a cardiac event. Three patients had episodes of
chest pain and underwent ICA with no need for revascularization.
Conclusion: Patients with positive findings on CCTA and normal MRPI had a favorable prognosis.
However, in patients with normal MRPI, referral for ICA remains dependent on the severity of symptoms,
especially, for patients with suspected multi-vessel coronary disease.
27
14. Iatrogene vaskulære risici ved stivgørende rygoperationer
Nikolaj Grøndal
Karkirurgisk afdeling, Regionshospitalet Viborg
Baggrund: I forbindelse med stivgørende rygoperationer eller fjernelse af disci ses iatrogene vaskulære
følgeskader i 1-5 tilfælde ud af 10.000 operationer. På trods af at det individuelt derfor er en sjælden
komplikation, ses det alligevel jævnligt grundet et stort antal samlede rygoperationer. Fatale følger af
vaskulære skader ses i op mod 40 % af tilfældene. Ved akut blødning fra legemsårene i maven er
diagnostik og karkirurgisk behandling derfor uopsættelig og altafgørende.
Iatrogene fremmedlegemer i forbindelse med rygoperation er i litteraturen kun beskrevet i få kasuistiske
tilfælde og relaterer sig hovedsageligt til afbrækkede efterladte knivsblade. Grundet svære
adgangsforhold er operativ fjernelse oftest yderst vanskeliggjort og derfor en risikoafvejning hos hver
enkelte patient.
Sygehistorie: En 48-årig iøvrigt rask mand er henvist fra ortopæd kirurgisk afdeling.
Patienten er et par år tidligere opereret med stivgørende operation i lumbosakrale columna (L5-S1),
hvorved et knivsblad knækkede. I den mellemliggende periode havde patienten udviklet smerter i nakken
og mistanken rettede sig nu imod forandringer i cervikale columna. Under udredning for dette, ønskedes
en MR-skanning til afklaring af forholdene. Grundet det efterladte knivsblad blev undersøgelsen
konverteret til en CT-skanning. Denne viste en efterladt ca. 1 cm lang spids af knivsbladet beliggende på
forsiden af columnas anteriore logitudinale ligament, og indkilet ved den venstre vena iliaka communis.
Dette gav naturligt anledning til stor bekymring, og samtidig henvisning til karkirurgisk afdeling med
henblik på mulig operativ fjernelse.
Konklusion: Ved litteratursøgning (PubMed/UpToDate/Embase) findes kun 2 beskrevne tilfælde med
efterladt knækket skalpelblad efter rygoperation. I begge tilfælde migrerede dette fremmedlegeme
gennem vena iliaka til henholdsvis højre pulmonal arterie og højre atrium og der blev ligeledes i begge
tilfælde foretaget akut åbent thoraxkirurgisk indgreb med succesfuld fjernelse.
For den beskrevne sygehistorie blev det vurderet, at risici ved fjernelse af knivsbladet ned mod det lille
bækken ville indebære forholdsvis store risici for komplikationer i forhold til konservativ observation. Til
vores kendskab findes der ingen fortilfælde, hvor der blev valgt en ekspekterende holdning, men sådanne
godartede forløb kan i sagens natur være underrapporteret.
28
15. Styrkelse af tværfagligt samarbejde gennem kompetenceudvikling
Steensgaard R1, Hoffmann DD1
1
Vestdansk Center for Rygmarvskade, Neurologisk Afd., Hospitalsenhed Midt
Introduktion og formål: Et projekt på Vestdansk Center for Rygmarvsskade (VCR) havde til formål
gennem en sammenhængende og velkoordineret indsats at inddrage den enkelte patient i et målrettet,
systematisk og individuelt tilpasset rehabiliteringsforløb. Som en del af projektet blev der gennemført et
omfattende tværfagligt undervisningsforløb med temadage og dialogmøder for alle ansatte på VCR.
Formålet var at øge personalets viden om og kompetencer til tværfagligt samarbejde.
Materiale og metode: Alle ansatte på VCR (N=104) blev inviteret til at deltage i undervisningsrækken
og der blev arbejdet på at tilrettelægge driften på en sådan måde, at flest muligt kunne deltage.
Undervisningen omfattede emner som ”Samarbejde og kommunikation”, ”Rehabilitering – patienten i
centrum”, ”Teamsamarbejde”, ”Kend din kerneopgave” samt ”Relationel koordinering”.
Undervisningsrækken blev evalueret med elektronisk spørgeskema til deltagende personale (N=83).
Resultater: Med en svarprocent på 90 mente 57%, at de havde fået en anden forståelse af begreberne
”rehabilitering” og ”tværfaglighed” efter undervisningsrækken, mens 36% forstod det på samme måde
som før. 55% gav udtryk for, at de nu arbejder anderledes og at undervisningen har været medvirkende
til ændringen. 15% mener, at de arbejder på samme måde som før. Gennem kommentarer blev der givet
udtryk for, at den tværfaglige undervisning har gjort det lettere at arbejde med tværfagligheden gennem
den fælles forståelse for begreberne, og at faggrupperne er kommet tættere på hinanden med større
indblik i hinandens faglige kompetencer.
Konklusion: Med en omfattende og lærerig undervisningsrække er der blevet arbejdet intensivt med den
tværfaglige kompetenceudvikling på VCR. Undervisningsrækken har faciliteret en tværfaglig
udviklingsproces og forudsætningen for at skabe velkoordinerede patientforløb er blevet understøttet.
29
16. The exogenous progesterone free luteal phase in IVF: exploring a new concept
Elbaek H.O 1, Alsbjerg B 1, Lauersen R 1, Povlsen B.B 1, Mikkelsen A.T1, Andersen CY 2,
Humaidan P 1,3
1
The Fertility Clinic, Skive Regional Hospital, Denmark.
2
Laboratory of Reproductive Biology Section 5712, University Hospital of Copenhagen, Denmark.
3
Faculty of Health Aarhus University and Faculty of health University of Southern Denmark
Introduction: Luteal phase support remains mandatory after all controlled ovarian stimulation due to
the luteal insufficiency caused by supraphysiological steroid levels. Luteal Progesterone (P) support
continues until at least confirmation of pregnancy, but in many cases until 10th week of gestation.
Vaginal P support is associated with inconvenient discharge and intramuscular P injections with pain. We
report for the first time the use of a small daily dose of r-hCG for luteal phase support in IVF patients who
received no additional luteal exogenous P.
Objective: To explore whether the luteal phase can be supported with small daily boluses of hCG without
the administration of exogenous P, while maintaining good reproductive outcomes.
Methods: A RCT was performed in a university affiliated Danish IVF unit. A total of 93 IVF normoresponder patients co-treated with a GnRH antagonist were randomized between February 2012 and
January 2014 to three different stimulation and luteal phase regimens, resulting in two study groups and
one control group, with 31 patients in each group.
Group I and II were randomized to stimulation with r-FSH and r-hCG and group III (control) to r-FSH
stimulation. Ovulation was induced with a bolus of GnRH agonist ( I + II ) or r-hCG ( III ). In I and II
the luteal phase consisted of 125 IU r-hCG daily, whereas III received a standard support consisting of
micronized vaginal P.
Results:
Pregnancy, implantation and early pregnancy loss rates
Group I
27/31 (87,1)
Group II
28/30 (93,3)
Group III
29/31 (90,6)
P-value
Embryos
transferred
1,08 ± 0,05
1,21 ±0,08
1,10 ± 0,06
>0,1
Clinical
pregnancies per
ET, n (%)
Implantation Rate,
n (%)
10/27 (37)
11/28 (39,3)
12/29 (41,4)
-
12/29 (41,4)
12/34 (35,3)
13/34 (38,2)
-
Early pregnancy
loss, n (%)
2/12 (16,6)
2/13
3/15 (20,0)
-
ET n (%)
(15,4)
30
Demografi
Age
Group I
30,60±0,81
Group II
32,40±0,80
Group III
30,84±0,76
P-value
>0,1
BMI
23,83±0,56
25,16±0,73
24,58±0,64
>0,1
Basal FSH
6,68±0,31
6,60±0,45
6,30±0,32
>0,1
Days of
stimulation
9,07±0,24
8,72±0,25
9,30±0,24
>0,1
Oocytes
Group I
7,93±0,87
Group II
8,07±0,55
Group III
9,31±0,74
P-value
>0,1
Fert. 2PN
4,78±0,63
4,79±0,41
3,77±0,56
>0,1
Embryos grade 0
or 1 n %
3,96±0,56
3,86±0,37
2,83±0,44
>0,1
Embryos
cryopreserved
2,70±0,53
2,53±0,28
4,44±0,42
>0,1
Oocyte quality
* All values are shown in mean ± SEM
Conclusion: Excellent ongoing pregnancy rates can be obtained by administration of small daily doses of
hCG (125 IU/day) in the luteal phase, thus boosting the endogenous P production – without any
exogenous P administration.
31
17. The use of `objective structured assessment of technical skills´ as an assessment tool
among Danish vascular surgeons in training
Grove G1, Høgh A1, Nielsen J2, Sandermann J1
1
Department of Vascular Surgery, Viborg District Hospital, Heibergs Allé 4, 8800 Viborg, Denmark
2
Section of Vascular Surgery, Department of Heart, Lung and Vascular Surgery, University Hospital of
Odense, Sdr. Boulevard 29, 5000 Odense C, Denmark
Objective The concept of the Objective Structured Assessment of Technical Skills (OSATS) is to quantify
surgical skills in an objective way and, thereby, produce an additional procedure-specific assessment tool.
Since 2005, a two-day practical course for upcoming specialist registrars in vascular surgery has been
obligatory.
The aim of this study is to describe the results from a tailored OSATS test as a tool for the evaluation of
practical skills during an intensive training session in a simple simulator box for vascular anastomoses.
Method: Between 2005 and 2013, we registered the OSATS scores of all course participants. The
following data were collected from the questionnaires: years as a candidate, months in vascular surgery
or in another type of surgery and the number of vascular anastomoses performed before the course.
The assessment of surgical skills was conducted with an OSATS score template specifically made for this
purpose. It consists of a 12-item table with a 5-point grading scale. OSATS score (points) and time for
the procedure (OSATS time in minutes) were registered at baseline (OSATS I) and at the end of the
course (OSATS II).
Results: OSATS scores were given in both OSATS I and OSATS II for the 83 trainees, and the mean
difference was 8.1 points (95% CI: 6.7; 9.5), P<0.001). OSATS time was given for 69 trainees, and the
mean difference was 2.8 minutes (95% CI: 1.4; 4.2), P<0.001). We found no relationship between years
since graduation, months in any surgical specialty or the experience with vascular anastomoses and
outcomes.
Conclusion: OSATS is a valuable tool for evaluating the advancement of technical skills during an
intensive practical course in performing vascular anastomoses.
32
18. Post-traumatisk hovedpine hos unge efter en hjernerystelse
Frederiksen OV1, Feldbæk JN1, Kasch H2, Møller HJ3
1
Regionshospitalet Hammel Neurocenter, Universitetsklinik for neurorehabilitering
2
Neurologisk afdeling F, Aarhus Universitetshospital
3
Klinisk Biokemisk afdeling, Aarhus Universitetshospital
Baggrund: Der anslås det at mere end 25.000 danskere årligt slår hovedet i en sådan grad at det fører
til kontakt med sundhedsvæsenet. Selvom det initiale traume oftest et let, angives det at 5-15 %
udvikler mere vedvarende symptomer på en hjernerystelse i et miks af fysiske, kognitive og emotionelle
symptomer associeret til hjernerystelse / mTBI (mild traumatic brain injury).
Formål:
(1) At se på ændringer i hyppighed og type af post-traumatiske hovedpine 3, 6, 9 og 18 måneder efter
hovedtraume sammenlignet med hyppighed af hovedpine før traumet, ved hjælp af et spørgeskema om
hovedpine .
(2) Effekt på post-traumatiske hovedpine af aktiv behandling vurderet 6, 9 og 18 måneder efter
hovedtraumet sammenlignet med standardbehandling .
(3) At undersøge hvorvidt markører for neuroinflammation hos patienter med post-traumatisk hovedpine
3 måneder efter hovedtraumet er forhøjet i forhold til laboratoriets referenceværdier samt hvorvidt der 9
måneder efter traumet er forskel mellem den aktivt behandlede gruppe sammenlignet med
standardbehandling.
Materialer og metoder:
Projektet knytter sig til en større epidemiologisk prospektiv kohorteundersøgelse af unge (15-30 år) med
hjernerystelse i Region Midtjylland samt projektet ”Tidlig behandling af langvarige følger efter
hjernerystelse hos unge”. I det sidstnævnte RCT-behandlingsstudie (n=100) randomiseres
projektdeltagerne til enten behandling i den aktive arm i form af en gruppebaseret ambulant behandling
baseret på kognitiv adfærdsterapi og gradueret fysisk træning eller standardbehandling som består af
oplysning og eventuel behandling via praktiserende læge.
Resumé: I resumé identificeres patienterne og der udsendes et spørgeskema (Rivermead Post
Concussion Symptoms Questionnary) ca. 2 måneder efter hovedtraumet, hvorved unge med vedvarende
symptomer efter mTBI identificeres (symptomscore ≥ 20). Disse patienter tilbydes en vurdering ved en
neurolog og børne-ungdomspsykiater ca. 3 måneder efter hovedtraumet og hvis inklusionskriterierne er
opfyldt tilbydes de deltagelse i det ovennævnte RCT-studie og i aktuelle hovedpineprojekt.
33
19. Exercise hypotension hos cervikalt rygmarvsskadede patienter
Vibjerg J1Hansen RM1.
1
Vestdansk Center for Rygmarvsskade, Neurologisk afd., Regionshospitalet Viborg.
Indledning og formål: Cervikale rygmarvsskader påvirker ofte det autonome nervesystem, der kan føre
til forstyrret kardiovaskulær homeostase. Dette viser sig som store udsving i blodtrykket (BP) med
episoder af høje og lave BP. Denne undersøgelses formål er, at viser hvordan en non-invasiv
blodtryksmåling (med Finometer Midi), anvendt i klinisk praksis, objektivt identificerer forstyrrelser i
blodtrykket under og efter fysisk træning.
Baggrund og metode: En 29-årig mand med en traumatisk rygmarvsskade med neurologisk niveau C6,
AIS A (ASIA impairment Scale), rehabiliteret på Vestdansk Center for Rygmarvsskade (VCR) kommer til
kontrol på VCR, 6 år efter skaden. Han er begyndt at dyrke handicapidræt på højt plan og oplever ind
imellem svimmelhed og kvalme og almen utilpashed, under fysisk udfoldelse. Han bekymrer sig derfor en
del om træningen af frygt for at blive utilpas og besvime. Hans normale blodtryk i hvile er 90/50.
Patienten bliver monitoreret med kontinuerlig non-invasivt arteriel BP-udstyr under test på
håndergometer (Lode Angio). Han kører med mellem 65 og 70 omgange pr minut(RPM), modstanden på
ergometeret bliver øget med 10 W hver 2 minut. Hans blodtryk stiger fra 90/50 til 110/70, mens pulsen
forbliver mellem 80-95. Da patienten rammer 17 på Borgs skala for anstrengelse (meget anstrengende),
falder blodtrykket pludseligt til 70/35 og han oplever svimmelhed og utilpashed og bliver observeret bleg.
Patientens blodtryk stiger hurtigt ved ophør af test til 90/50. Proceduren gentages og nøjagtig samme
autonome reaktion observeres.
Resultater: Det konkluderes at patienten har Exercise induced hypotension. Han bliver
efterfølgende rådet til ikke at træne med en intensitet på over 15 (anstrengende) på Borgs skala for
anstrengelse.
34
20. Samlet overblik over behov, prævalens og forbrug af cannabis af rygmarvsskadede
patienter i Danmark
Andresen SR1, Biering-Sørensen F2, Hagen EM1,3,4,8, Nielsen JF4,6, Bach F5, Finnerup NB4,7
1
Vestdansk Center for Rygmarvsskade, Neurologisk afdeling, Regionshospitalet Viborg, Denmark
2
Afdeling for Rygmarvsskader i Hornbæk, Glostrup Hospital, Denmark
3
Afdeling for Klinisk Medicin, Bergen Universitet, Norge
4
Afdeling for Klinisk Medicin, Aarhus Universitet, Danmark
5
Neurologisk afdeling, Aalborg Universitetssygehus, Danmark
6
Hammel Neuro- og forskningscenter, Hammel, Danmark
7
Dansk Smerteforskningscenter, Afdeling for Klinisk Medicin, Danmark
8
The Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square,
University College London, Storbritannien
Baggrund: Behandling af neuropatiske smerter og spasticitet hos rygmarvsskadede er fortsat en meget
kompliceret opgave, som vi fortsat ikke har fundet en endelig løsning på. Taget i betragtning at 50-60%
udvikler neuropatiske smerter og 70% spasticitet i de første 12 måneder efter deres rygmarvsskade, er
der fortsat mange med ikke sufficient behandling af deres symptomer og manglende effekt på den
tilgængelige og rekommanderede medicinske behandling. Vi har derfor, igennem vores praksis, oplevet
flere og flere gå alternative veje for at lindre deres smerter og spasticitet. Da forbrugsmønstre af
cannabis er mangelfuld, ønsker vi med vores spørgeskema at tilegne os en større viden og bedre
forståelse for patienters behandling, smerter og spasticitet. Vi vil også der igennem få en ide om, hvem
der har størst sandsynlighed for at afprøve cannabis for at afhjælpe deres symptomer, samt om årsag til
forbrug, effekt og evt. bivirkninger.
Formål: Der ønskes et overblik over hvor mange, der bruger cannabis, samt effekt og evt.
bivirkningsprofil.
Metode: Alle inkluderede patienter skal mindst være 18 år, have pådraget sig en traumatisk
rygmarvsskade og været i kontakt med Vestdansk Center for Rygmarvsskade (VCR) i Viborg eller
Afdeling for Rygmarvsskader (ARS) i Hornbæk. Kontaktperiode er fra 1990 til 2012. Studiepopulationen
er på cirka 1400 patienter. Spørgeskemaet er så vidt muligt bygget op på spørgsmål og svarmuligheder
fra tidligere offentliggjorte standarder og artikler, så det er muligt at sammenligne vores med tidligere
resultater. Tilladelse fra Datatilsynet og Sundhedsstyrelsen foreligger. Spørgeskemaundersøgelsen er
anonym, og patienterne vil få mulighed for at svare enten elektronisk (Survey-xact.dk) eller i papirform.
Foreløbig status: 750 patienter tilhørende ARS har fået spørgeskemaet tilsendt, og svar modtages nu
løbende. Der afventes tillæg til tilladelsen fra Datatilsynet pga. lokale forhold før 650 patienter tilhørende
VCR i Viborg får tilsendt spørgeskemaet. Yderligere resultater vil blive præsenteret på Forskningens Dag.
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21. Oversættelse og validering af Fugl-Meyer undersøgelse af armmotorik
Lundquist CB1, Maribo T2
1
Neurorehabiliteringen, regionshospitalet Skive
2
Marselisborg Centret, Aarhus
Baggrund: Fugl-Meyer undersøgelse af armmotorik (FM)er et af de mest anvendte måleredskaber til
vurdering af funktionsnedsættelse i arm og hånd efter en apopleksi. De psykometriske egenskaber ved
FM er velundersøgte, men afhænger af det land og den population hvor redskabet anvendes.
Formål: oversætte FM til dansk og undersøge følsomhed, mindste kliniske relevante forskel samt validitet
af FM hos apopleksipatienter i den akutte til sub-akutte fase.
Metode: Studiet foregik på Neurorehabiliteringen, Regionshospitalet Skive i perioden maj 2014 til
februar 2015. Oversættelsen foregik med udgangspunkt i principperne fra ISPOR Task Force og var
overordnet set oversættelse med tilbageoversættelse til originalsproget. Studiedesignet til at undersøge
de psykometriske egenskaber var et prospektivt kohortestudie. Følsomhed blev undersøgt med receiver
operating characteristic (ROC) kurve statistik. Ændringen i FM score blev anvendt til at undersøge
sensitivitet og specificitet i forhold til korrekt at klassificere patienterne som enten bedrede eller
uændrede. Areal under kurven (AUC) og mindste kliniske relevante forskel blev udledt fra ROC kurven.
Samstemmende validitet til Motor AssessmentScale blev undersøgt med Spearman Rank Korrelation.
Resultater: Halvtreds patienter blev inkluderet. AUC var 0.87 med en sensitivitetpå 77%, specificitetpå
89% og en mindste kliniske relevante forskel på≥ 4, svarende til en ændring på 6.1% af total scoren.
Samstemmendevaliditetvar god, med r= 0.94- 0.95.
Konklusion: FM blev oversat til dansk og den danske version var valid og følsom for ændring i funktion i
arm og hånd. En mindste kliniske relevante forskel på ≥ 4 blev fundet og kan bruges af klinikere til at
opstille mål for behandlingen og til at fortolke den motoriske fremgang. Den kan hjælpe forskere til at
fastslå hvilken ændring i funktion, målt på FM, der ikke blot er statistik signifikant men også klinisk
relevant.
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Se abstracts her: www.hospitalsenhedmidt.dk/forskningensdag