20 results on '"Uhrenholt L"'
Search Results
2. Predicting successful biologics tapering in patients with inflammatory arthritis: Secondary analyses based on the BIOlogical Dose OPTimisation (BIODOPT) trial
- Author
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Uhrenholt, L, Duch, K, Christensen, R, Dreyer, L, Hauge, E-M, Schlemmer, A, Taylor, PC, and Kristensen, S
- Subjects
clinical trials ,arthritis ,biologicals ,drug utilization - Abstract
Aims:To evaluate predictors for successful biologic tapering among patients with inflammatory arthritis using baseline characteristics from the BIODOPT trial. Methods:Adult patients with rheumatoid arthritis, psoriatic arthritis or axial spondyloarthritis on stable biologic dose and in low disease activity ≥12 months were enrolled. Participants were randomized (2:1) to disease activity-guided biologic tapering or continuation of baseline biologic. Patients achieving successful tapering reduced their biologic dose by ≥50%, had no protocol deviations and were in low disease activity at 18 months. Modified Poisson regression with robust variance estimator was applied. Results:In total, 142 patients were randomized to tapering (n= 95) or control (n= 47). Successful tapering was achieved by 32 and 2%, respectively. Tapering group was the only statistically significant independent predictor for successful tapering, risk ratio (RR): 14.0 (95% confidence interval [CI]: 1.9 to 101.3,P= .009). However, higher Short Form Health Survey 36 mental component summary (SF-36 MCS) was observed to be a predictor of potential importance, RR: 1.06 (95% CI: 0.99 to 1.13,P= .097). When limiting the analyses to the tapering group only, none of the baseline variables were statistically significant independent predictors but SF-36 MCS was still considered to be of potential importance, RR: 1.05 (95% CI: 0.99 to 1.12,P= .098). Conclusion:Successful tapering is a reachable target for 1 in 3 patients with inflammatory arthritis who are interested in reducing their biological therapy. No statistically significant predictors (besides allocation to tapering) were identified. Future research on mental health and tapering is encouraged.
- Published
- 2023
3. Serious head and neck injury as a predictor of occupant position in fatal rollover crashes
- Author
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Freeman, M.D., Dobbertin, K., Kohles, S.S., Uhrenholt, L., and Eriksson, A.
- Published
- 2012
- Full Text
- View/download PDF
4. Agreement between patient-reported outcome measures collected via a smartphone application vs a touchscreen solution in an outpatient clinic among patients with inflammatory arthritis:a randomised, within-participant trial
- Author
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Uhrenholt, L, Christensen, R, Dreyer, L, Schlemmer, A, Hauge, E-M, Krogh, NS, Abildtoft, MK, Taylor, PC, and Kristensen, S
- Abstract
Background: Patient-reported outcome measures (PROMs) are essential to understand the patient’s perception of arthritis activity. In Demark, PROMs are registered on a touchscreen in the outpatient clinic. However, some patients find it inconvenient due to e.g. waiting in queue, lack of privacy, uncomfortable seating position, reduced upper limb strength and dexterity with seeing the touchscreen due to deformity of the cervical spine. The widespread use of smartphones makes it possible for patients to register PROMs via an application (app) on their own device.Objectives: The primary aim is to evaluate the agreement (i.e. similarity) between the two devices assessed by the Health Assessment Questionnaire Disability Index (HAQ-DI) status among patients with inflammatory arthritis.Methods: The study was a randomised, crossover, agreement trial (NCT03486613) conducted at Aalborg University Hospital, Denmark. Participants were recruited through an invitation on the touchscreen in the outpatient clinic. Patients with an established diagnosis (>= 12 months) of rheumatoid arthritis (RA), psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA) and experience with the PROM questionnaires (>= 3 previous registrations) were enrolled and randomised in ratio 1:1 (stratified by diagnosis) to PROM registration through the DANBIO app and the touchscreen in random order. Figure 1A and 1B shows the two devices.The sample size calculation was based on a prespecified equivalence margin of textpm0.11 HAQ-DI points (i.e.
- Published
- 2020
5. A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity
- Author
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Côté, P., Bussières, A., Cassidy, J. D., Hartvigsen, J., Kawchuk, G. N., Leboeuf-Yde, C., Mior, S., Schneider, M., Aillet, L., Ammendolia, C., Arnbak, B., Axén, I., Baechler, M., Barbier-Cazorla, F., Barbier, G., Bergstrøm, C., Beynon, A., Blanchette, M.-A., Bolton, P. S., Breen, A., Brinch, J., Bronfort, G., Brown, B., Bruno, P., Konner, M. B., Burrell, C., Busse, J. W., Byfield, D., Campello, M., Cancelliere, C., Carroll, L., Cedraschi, C., Chéron, C., Chow, N., Christensen, H. W., Claussen, S., Corso, M., Davis, M. A., Demortier, M., De Carvalho, D., De Luca, K., de Zoete, A., Doktor, K., Downie, A., Du Rose, A., Eklund, A., Engel, R., Erwin, M., Eubanks, J. E., Evans, R., Evans, W., Fernandez, M., Field, J., Fournier, G., French, S., Fuglkjaer, S., Gagey, O., Giuriato, R., Gliedt, J. A., Goertz, C., Goncalves, G., Grondin, D., Gurden, M., Haas, M., Haldeman, S., Harsted, S., Hartvigsen, L., Hayden, J., Hincapié, C., Hébert, J. J., Hesby, B., Hestbæk, L., Hogg-Johnson, S., Hondras, M. A., Honoré, M., Howarth, S., Injeyan, H. S., Innes, S., Irgens, P. M., Jacobs, C., Jenkins, H., Jenks, A., Jensen, T. S., Johhansson, M., Kongsted, A., Kopansky-Giles, D., Kryger, R., Lardon, A., Lauridsen, H. H., Leininger, B., Lemeunier, N., Le Scanff, C., Lewis, E. A., Linaker, K., Lothe, L., Marchand, A.-A., McNaughton, D., Meyer, A.-L., Miller, P., Mølgaard, A., Moore, C., Murphy, D. R., Myburgh, C., Myhrvold, B., Newell, D., Newton, G., Nim, C., Nordin, M., Nyiro, L., O’Neill, S., Øverås, C., Pagé, I., Pasquier, M., Penza, C. W., Perle, S. M., Picchiottino, M., Piché, M., Poulsen, E., Quon, J., Raven, T., Rezai, M., Roseen, E. J., Rubinstein, S., Salmi, L.-R., Schweinhardt, P., Shearer, H. M., Sirucek, L., Sorondo, D., Stern, P. J., Stevans, J., Stochkendahl, M. J., Stuber, K., Stupar, M., Srbely, J., Swain, M., Teodorczyk-Injeyan, J., Théroux, J., Thiel, H., Uhrenholt, L., Verbeek, A., Verville, L., Vincent, K., Dan Wang, A. L., Weber, K. A., Whedon, J. M., Wong, J., Wuytack, F., Young, J., Yu, H., Ziegler, D., Côté, P., Bussières, A., Cassidy, J. D., Hartvigsen, J., Kawchuk, G. N., Leboeuf-Yde, C., Mior, S., Schneider, M., Aillet, L., Ammendolia, C., Arnbak, B., Axén, I., Baechler, M., Barbier-Cazorla, F., Barbier, G., Bergstrøm, C., Beynon, A., Blanchette, M.-A., Bolton, P. S., Breen, A., Brinch, J., Bronfort, G., Brown, B., Bruno, P., Konner, M. B., Burrell, C., Busse, J. W., Byfield, D., Campello, M., Cancelliere, C., Carroll, L., Cedraschi, C., Chéron, C., Chow, N., Christensen, H. W., Claussen, S., Corso, M., Davis, M. A., Demortier, M., De Carvalho, D., De Luca, K., de Zoete, A., Doktor, K., Downie, A., Du Rose, A., Eklund, A., Engel, R., Erwin, M., Eubanks, J. E., Evans, R., Evans, W., Fernandez, M., Field, J., Fournier, G., French, S., Fuglkjaer, S., Gagey, O., Giuriato, R., Gliedt, J. A., Goertz, C., Goncalves, G., Grondin, D., Gurden, M., Haas, M., Haldeman, S., Harsted, S., Hartvigsen, L., Hayden, J., Hincapié, C., Hébert, J. J., Hesby, B., Hestbæk, L., Hogg-Johnson, S., Hondras, M. A., Honoré, M., Howarth, S., Injeyan, H. S., Innes, S., Irgens, P. M., Jacobs, C., Jenkins, H., Jenks, A., Jensen, T. S., Johhansson, M., Kongsted, A., Kopansky-Giles, D., Kryger, R., Lardon, A., Lauridsen, H. H., Leininger, B., Lemeunier, N., Le Scanff, C., Lewis, E. A., Linaker, K., Lothe, L., Marchand, A.-A., McNaughton, D., Meyer, A.-L., Miller, P., Mølgaard, A., Moore, C., Murphy, D. R., Myburgh, C., Myhrvold, B., Newell, D., Newton, G., Nim, C., Nordin, M., Nyiro, L., O’Neill, S., Øverås, C., Pagé, I., Pasquier, M., Penza, C. W., Perle, S. M., Picchiottino, M., Piché, M., Poulsen, E., Quon, J., Raven, T., Rezai, M., Roseen, E. J., Rubinstein, S., Salmi, L.-R., Schweinhardt, P., Shearer, H. M., Sirucek, L., Sorondo, D., Stern, P. J., Stevans, J., Stochkendahl, M. J., Stuber, K., Stupar, M., Srbely, J., Swain, M., Teodorczyk-Injeyan, J., Théroux, J., Thiel, H., Uhrenholt, L., Verbeek, A., Verville, L., Vincent, K., Dan Wang, A. L., Weber, K. A., Whedon, J. M., Wong, J., Wuytack, F., Young, J., Yu, H., and Ziegler, D.
- Abstract
In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports.
- Published
- 2020
6. Serious head and neck injury as a predictor of occupant position in fatal rollover crashes
- Author
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Freeman, Michael, Dobbertin, K, Kohles, SS, Uhrenholt, L, Eriksson, Anders, Freeman, Michael, Dobbertin, K, Kohles, SS, Uhrenholt, L, and Eriksson, Anders
- Abstract
Serious head and neck injuries are a common finding in fatalities associated with rollover crashes. In some fatal rollover crashes, particularly when ejection occurs, the determination of which occupant was driving at the time of the crash may be uncertain. In the present investigation, we describe the analysis of rollover crash data from the National Automotive Sampling System-Crashworthiness Data System for the years 1997 through 2007 in which we examined the relationship between a serious head and neck injury in an occupant and a specified degree of roof deformation at theoccupant's seating position. We found 960 occupants who qualified for the analysis, with 142 deaths among the subjects. Using a ranked compositehead and neck injury score (the HNISS) we found a strong relationship between HNISS and the degree of roof crush. As a result of the analysis, we arrived at a predictive model, in which each additional unit increase in HNISS equated to an increased odds of roof crush as follows: for ≥8cm of roof crush compared with <8cm by 4%, for ≥15cm of roof crush compared to <8cm by 6% and for ≥30cm of roof crush compared to <8cm by 11%. We describe two hypothetical scenarios in which the model could be applied to the real world investigation of occupant position in a rollover crash-related fatality.
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- 2012
- Full Text
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7. 188 MORPHOLOGICAL DESCRIPTION OF THE ANATOMY OF CERVICAL SPINE FACET JOINTS BY FACET ORIENTATION
- Author
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Uhrenholt, L., primary, Hauge, E., additional, Vesterby Charles, A., additional, and Gregersen, M., additional
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- 2008
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8. Towards the diagnosis of osteoporosis - contributions from coincidental diagnostic imaging findings in chiropractors' practice.
- Author
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Uhrenholt L, Bakkegaard JH, Hansen K, and Doktor KK
- Subjects
- Humans, Chiropractic, Radiography, Female, Bone Density, Osteoporosis diagnostic imaging
- Abstract
Background: Osteoporosis is significantly associated with fractures and burdens the health of especially older people. Osteoporotic fractures cause pain, disability, and increased mortality. Early diagnosis of osteoporosis allows earlier initiation of treatment, thereby reducing the risk of osteoporotic fractures. Chiropractors encounter potential osteoporotic patients daily, and perform radiological evaluation of these and other patients, including evaluation of X-rays done for other purposes than osteoporosis. Therefore, chiropractors may identify vertebral fractures, vertebral deformity or osteopenia not otherwise suspected or recorded., Methods: This study examines procedures available to the chiropractor to describe conventional X-rays with the focus of osteoporosis related findings. We review the indications for radiological examination in chiropractic practice, and in the realm of osteoporosis we describe radiological methods available for examination of conventional radiographs, and the necessity of inter-disciplinary communication., Results: National guidelines are available regarding referral for X-rays in chiropractic practice. Standardized protocols ensure image acquisition of the highest quality in the chiropractors' radiological department. Conventional X-ray examination is not indicated on clinical suspicion of osteoporosis alone, as bone mineral density testing is the diagnostic test. Radiological assessment of all available X-rays of patients above the age of 50 years should include evaluation of the bone quality, and hip and vertebral fracture assessment. The Singh index, Genant Semi-Quantitative tool (GSQ), and Algorithm-Based Qualitative method (ABQ) should be used consistently during interpretation. Referral for additional imaging and evaluation should be prompt and systematic when needed., Conclusions: This article presents an overview of evidence-based radiological procedures for the purpose of promoting early diagnosis of osteoporosis. We present recommendations to the clinicians where we propose an opportunistic evaluation of X-rays, done for any reason, which include systematic evaluation of bone quality, presence of hip and vertebral fractures, and vertebral deformation of all patients above the age of 50 years. Detailed referral to healthcare professionals for further diagnostic evaluation is performed when needed. Consistent, high-quality radiological procedures in chiropractic practices could feasibly contribute to the timely diagnosis of osteoporosis, ultimately minimizing the impact of osteoporosis-related complications on patients' health., (© 2024. The Author(s).)
- Published
- 2024
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9. Predicting successful biologics tapering in patients with inflammatory arthritis: Secondary analyses based on the BIOlogical Dose OPTimisation (BIODOPT) trial.
- Author
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Uhrenholt L, Duch K, Christensen R, Dreyer L, Hauge EM, Schlemmer A, Taylor PC, and Kristensen S
- Subjects
- Adult, Humans, Biological Factors therapeutic use, Antirheumatic Agents therapeutic use, Arthritis, Rheumatoid drug therapy, Biological Products therapeutic use
- Abstract
Aims: To evaluate predictors for successful biologic tapering among patients with inflammatory arthritis using baseline characteristics from the BIODOPT trial., Methods: Adult patients with rheumatoid arthritis, psoriatic arthritis or axial spondyloarthritis on stable biologic dose and in low disease activity ≥12 months were enrolled. Participants were randomized (2:1) to disease activity-guided biologic tapering or continuation of baseline biologic. Patients achieving successful tapering reduced their biologic dose by ≥50%, had no protocol deviations and were in low disease activity at 18 months. Modified Poisson regression with robust variance estimator was applied., Results: In total, 142 patients were randomized to tapering (n = 95) or control (n = 47). Successful tapering was achieved by 32 and 2%, respectively. Tapering group was the only statistically significant independent predictor for successful tapering, risk ratio (RR): 14.0 (95% confidence interval [CI]: 1.9 to 101.3, P = .009). However, higher Short Form Health Survey 36 mental component summary (SF-36 MCS) was observed to be a predictor of potential importance, RR: 1.06 (95% CI: 0.99 to 1.13, P = .097). When limiting the analyses to the tapering group only, none of the baseline variables were statistically significant independent predictors but SF-36 MCS was still considered to be of potential importance, RR: 1.05 (95% CI: 0.99 to 1.12, P = .098)., Conclusion: Successful tapering is a reachable target for 1 in 3 patients with inflammatory arthritis who are interested in reducing their biological therapy. No statistically significant predictors (besides allocation to tapering) were identified. Future research on mental health and tapering is encouraged., (© 2023 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)
- Published
- 2023
- Full Text
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10. Risk of flare after tapering or withdrawal of biologic/targeted synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis or axial spondyloarthritis: a systematic review and meta-analysis.
- Author
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Uhrenholt L, Christensen R, Dinesen WKH, Liboriussen CH, Andersen SS, Dreyer L, Schlemmer A, Hauge EM, Skrubbeltrang C, Taylor PC, and Kristensen S
- Subjects
- Humans, Antirheumatic Agents therapeutic use, Arthritis, Rheumatoid drug therapy, Axial Spondyloarthritis, Biological Products adverse effects
- Abstract
Objective: To evaluate flare risk when tapering or withdrawing biologic or targeted synthetic DMARDs (bDMARDs or tsDMARDs) compared with continuation in patients with inflammatory arthritis in sustained remission or with low disease activity., Methods: Articles were identified in the Cochrane Library, PubMed, Embase and Web of Science. Eligible trials were randomized controlled trials comparing tapering and/or withdrawal of bDMARDs and/or tsDMARDs with the standard dose in inflammatory arthritis. Random effects meta-analysis was performed with risk ratio (RR) or Peto's odds ratio (POR) for sparse events and 95% CI., Results: The meta-analysis comprised 22 trials: 11 assessed tapering and 7 addressed withdrawal (4 assessed both). Only trials with an RA or axial SpA (axSpA) population were identified. An increased flare risk was demonstrated when b-/tsDMARD tapering was compared with continuation [RR 1.45 (95% CI 1.19, 1.77), I2 = 42.5%] and potentially increased for persistent flare [POR 1.56 (95% CI 0.97, 2.52), I2 = 0%]. Comparing TNF inhibitor (TNFi) withdrawal with continuation, a highly increased flare risk [RR 2.28 (95% CI 1.78, 2.93), I2 = 78%] and increased odds of persistent flare [POR 3.41 (95% CI 1.91, 6.09), I2 = 49%] were observed. No clear difference in flare risk between RA or axSpA was observed., Conclusion: A high risk for flare and persistent flare was demonstrated for TNFi withdrawal, whereas an increased risk for flare but not for persistent flare was observed for b-/tsDMARD tapering. Thus tapering seems to be the more favourable approach., Registration: PROSPERO (CRD42019136905)., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2022
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11. Advanced magnetic resonance imaging of chronic whiplash patients: a clinical practice-based feasibility study.
- Author
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Uhrenholt L, Brix L, Wichmann TO, Pedersen M, Ringgaard S, and Jensen TS
- Subjects
- Feasibility Studies, Female, Humans, Magnetic Resonance Imaging, Male, Surveys and Questionnaires, Whiplash Injuries diagnostic imaging
- Abstract
Background: Whiplash injury is common following road traffic crashes affecting millions worldwide, with up to 50% of the injured developing chronic symptoms and 15% having a reduced working capability due to ongoing disability. Many of these patients receive treatment in primary care settings based upon clinical and diagnostic imaging findings. Despite the identification of different types of injuries in the whiplash patients, clinically significant relationships between injuries and chronic symptoms remains to be fully established. This study investigated the feasibility of magnetic resonance imaging (MRI) techniques including quantitative diffusion weighted imaging and measurements of cerebrospinal fluid (CSF) flow as novel non-invasive biomarkers in a population of healthy volunteers and chronic whiplash patients recruited from a chiropractic clinic for the purpose of improving our understanding of whiplash injury., Methods: Twenty chronic whiplash patients and 18 healthy age- and gender matched control subjects were included [mean age ± SD (sex ratio; females/males), case group: 37.8 years ± 9.1 (1.22), control group: 35.1 years ± 9.2 (1.25)]. Data was collected from May 2019 to July 2020. Data from questionnaires pertaining to the car crash, acute and current symptoms were retrieved and findings from clinical examination and MRI including morphologic, diffusion weighted and phase-contrast images were recorded. The apparent diffusion coefficient and fractional anisotropy were calculated, and measurement and analysis of CSF flow was conducted. Statistical analyses included Fisher's exact test, Mann Whitney U test and analysis of variance between groups., Results: The studied population was described in detail using readily available clinical tools. No statistically significant differences were found between the groups on MRI., Conclusions: This study did not show that MRI-based measures of morphology, spinal cord and nerve root diffusion or cerebrospinal fluid flow are sensitive biomarkers to distinguish between chronic whiplash patients and healthy controls. The detailed description of the chronic whiplash patients using readily available clinical tools may be of great relevance to the clinician. In the context of feasibility, clinical practice-based advanced imaging studies with a technical setup similar to the presented can be expected to have a high likelihood of successful completion., (© 2022. The Author(s).)
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- 2022
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12. Incidence and severeness of COVID-19 hospitalization in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark.
- Author
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Cordtz R, Lindhardsen J, Soussi BG, Vela J, Uhrenholt L, Westermann R, Kristensen S, Nielsen H, Torp-Pedersen C, and Dreyer L
- Subjects
- Adult, Aged, Antirheumatic Agents therapeutic use, COVID-19 complications, Cohort Studies, Denmark epidemiology, Female, Humans, Incidence, Male, Middle Aged, Rheumatic Diseases virology, COVID-19 epidemiology, Hospitalization statistics & numerical data, Rheumatic Diseases epidemiology, SARS-CoV-2, Severity of Illness Index
- Abstract
Objectives: To estimate the incidence of COVID-19 hospitalization in patients with inflammatory rheumatic disease (IRD); in patients with RA treated with specific DMARDs; and the incidence of severe COVID-19 infection among hospitalized patients with RA., Methods: A nationwide cohort study from Denmark between 1 March and 12 August 2020. The adjusted incidence of COVID-19 hospitalization was estimated for patients with RA; spondyloarthritis including psoriatic arthritis; connective tissue disease; vasculitides; and non-IRD individuals. Further, the incidence of COVID-19 hospitalization was estimated for patients with RA treated and non-treated with TNF-inhibitors, HCQ or glucocorticoids, respectively. Lastly, the incidence of severe COVID-19 infection (intensive care, acute respiratory distress syndrome or death) among hospital-admitted patients was estimated for RA and non-IRD sp - individudals., Results: Patients with IRD (n = 58 052) had an increased partially adjusted incidence of hospitalization with COVID-19 compared with the 4.5 million people in the general population [hazard ratio (HR) 1.46, 95% CI: 1.15, 1.86] with strongest associations for patients with RA (n = 29 440, HR 1.72, 95% CI: 1.29, 2.30) and vasculitides (n = 4072, HR 1.82, 95% CI: 0.91, 3.64). There was no increased incidence of COVID-19 hospitalization associated with TNF-inhibitor, HCQ nor glucocorticoid use. COVID-19 admitted patients with RA had a HR of 1.43 (95% CI: 0.80, 2.53) for a severe outcome., Conclusion: Patients with IRD were more likely to be admitted with COVID-19 than the general population, and COVID-19 admitted patients with RA could be at higher risk of a severe outcome. Treatment with specific DMARDs did not affect the risk of hospitalization., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2021
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13. Dosage reduction and discontinuation of biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis: protocol for a pragmatic, randomised controlled trial (the BIOlogical Dose OPTimisation (BIODOPT) trial).
- Author
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Uhrenholt L, Schlemmer A, Hauge EM, Christensen R, Dreyer L, Suarez-Almazor ME, and Kristensen S
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- Humans, Dose-Response Relationship, Drug, Spondylarthropathies drug therapy, Pragmatic Clinical Trials as Topic, Equivalence Trials as Topic, Antirheumatic Agents administration & dosage, Arthritis, Psoriatic drug therapy, Arthritis, Rheumatoid drug therapy, Biological Products administration & dosage, Deprescriptions, Spondylitis, Ankylosing drug therapy
- Abstract
Introduction: The The BIOlogical Dose OPTimisation (BIODOPT) trial is a pragmatic, multicentre, randomised controlled, open-label, parallel-group, equivalence study designed to evaluate tapering of biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) in sustained clinical remission or low disease activity (LDA). Traditionally, these patients maintain standard dosage of bDMARD lifelong; however, recent studies indicate that a significant proportion of patients in sustained remission or LDA can taper their bDMARD and maintain stable disease activity. Thus, this trial aims to evaluate whether a disease activity-guided tapering strategy for bDMARDs will enable a significant dosage reduction while maintaining disease activity compared with usual care. From the individual patient's standpoint as well as from a societal perspective, it would be advantageous if bDMARDs could be reduced or even discontinued while maintaining disease activity., Methods and Analysis: A total of 180 patients with RA, PsA or axSpA treated with bDMARDs and in clinical remission/LDA during the past 12 months will be enrolled from four centres in Denmark. Patients will be randomised in a ratio of 2:1 to either disease activity-guided tapering of bDMARDs (intervention group) or continuation of bDMARDs as usual care (control group).The primary objective is the difference between the two groups in the proportion of patients who have reduced their inclusion dosage of bDMARDs to 50% or less while maintaining stable disease activity at 18 months follow-up., Ethics and Dissemination: The study is approved by the ethics committee of Northern Jutland, Denmark (N-20170073) and by the Danish Medicine Agency. Patient research partner KHH contributed to refinement of the protocol and approved the final manuscript. Results will be disseminated through publication in international peer-reviewed journals., Trial Registration Number: 2017-001970-41; Pre-results., Competing Interests: Competing interests: LU has received speaker honoraria from Abbvie, Eli Lilly and Novartis (not related to the submitted work). SK has received speaker honoraria from Novartis and Eli Lilly (not related to the submitted work). AS has received speaker honoraria from MSD and Eli Lilly (not related to the submitted work). LD has received speaker honoraria from UCB, MSD, Eli Lilly and Janssen Pharmaceutica (not related to the submitted work)., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
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14. Serious bicycle crash injury in chiropractic practice - a case report of delayed diagnosis.
- Author
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Uhrenholt L
- Abstract
Background: Bicyclists are vulnerable road users and are at risk of serious spinal injury if involved in traffic crashes. In Denmark approximately 25 bicyclists are killed each year and some 20.000 bicycle related casualties are registered in the National Patient Registry each year. In addition to these figures, a large number of casualties remain unregistered despite injury. Many of the casualties will consult chiropractors in primary practice with or without preceding evaluation in the established emergency care facilities. Therefore, chiropractors are expected to be able to proficiently evaluate these patients clinically and radiologically in order to ensure the best possible patient care., Case Presentation: This report involves a middle-aged female who consulted several physicians following a collision with a motor vehicle while riding a bike. Despite clinical symptoms and consequent examinations she suffered from inadequate diagnostic evaluation until a radiological examination was performed 18 days following the injurious crash identifying unstable cervical spine fractures., Conclusions: The presented case is an example of the serious spinal injuries bicyclists may suffer when involved in high-energy traffic crashes despite wearing a bicycle helmet. The case report highlights the need for relevant clinical (including radiological) decision strategies when dealing with trauma patients in chiropractic practice. This involves the direct access to radiological procedures with no unnecessary delay when indicated as in most trauma cases. Furthermore, clearly defined and easy accessible referral schemes from primary care settings to emergency departments must be available to the chiropractic physician. Chiropractors are clinically competent to examine and diagnose, including radiologically evaluate, patients who have been injured in traffic crashes. Hence, chiropractors may contribute to the diagnosis, management and rehabilitation of spinal injured patients following many types of crashes and accident, including bicycle crashes.
- Published
- 2016
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15. Diffusion tensor imaging of peripheral nerves in non-fixed post-mortem subjects.
- Author
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Haakma W, Pedersen M, Froeling M, Uhrenholt L, Leemans A, and Boel LWT
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Reproducibility of Results, Temperature, Diffusion Tensor Imaging, Lumbosacral Plexus diagnostic imaging
- Abstract
Purpose: While standard magnetic resonance imaging (MRI) sequences are increasingly employed in post-mortem (PM) examinations, more advanced techniques such as diffusion tensor imaging (DTI) remain unexplored in forensic sciences. Therefore, we studied the temporal stability and reproducibility of DTI and fiber tractography (FT) in non-fixed PM subjects. In addition, we investigated the lumbosacral nerves with PMDTI and compared their tissue characteristics to in vivo findings., Methods: MRI data were acquired on a 1.5T MRI scanner in seven PM subjects, consisting of six non-trauma deaths and one chronic trauma death, and in six living subjects. Inter-scan (within one session) and inter-session (between days) reproducibility of diffusion parameters, fractional anisotropy (FA), and mean diffusivity (MD), were evaluated for the lumbosacral nerves using Bland-Altman and Jones plots. Diffusion parameters in nerves L3-S2 were compared to living subjects using the non-parametric Mann-Whitney U test., Results: Reproducibility of diffusion values of inter-scan 95% limits of agreement ranged from -0.058 to 0.062 for FA, and (-0.037 to 0.052)×10(-3)mm(2)/s for MD. For the inter-session this was -0.0423 to 0.0423, and (-0.0442 to 0.0442)×10(-3)mm(2)/s for FA, and MD, respectively. Although PM subjects showed approximately four-fold lower diffusivity values compared to living subjects, FT results were comparable. The chronic trauma case showed disorganization and asymmetry of the nerves., Conclusion: We demonstrated that DTI was reproducible in characterizing nervous tissue properties and FT in reconstructing the architecture of lumbosacral nerves in PM subjects. We showed differences in diffusion values between PM and in vivo and showed the ability of PMDTI and FT to reconstruct nerve lesions in a chronic trauma case. We expect that PMDTI and FT may become valuable in identification and documentation of PM nerve trauma or pathologies in forensic sciences., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2016
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16. Letter to the editor regarding "do X-ray-occult fractures play a role in chronic pain following a whiplash injury?" by Hertzum-Larsen R, Petersen H, Kasch H, Bendix T. Eur Spine J. 2014; DOI 10.1007/s00586-014-3362-3.
- Author
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Uhrenholt L, Webb A, and Freeman M
- Subjects
- Female, Humans, Male, Radiography, Accidents, Traffic, Chronic Pain diagnostic imaging, Fractures, Closed diagnostic imaging, Pain Measurement, Whiplash Injuries diagnostic imaging
- Published
- 2014
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17. Inside out: modern imaging techniques to reveal animal anatomy.
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Lauridsen H, Hansen K, Wang T, Agger P, Andersen JL, Knudsen PS, Rasmussen AS, Uhrenholt L, and Pedersen M
- Subjects
- Animals, Anatomy, Magnetic Resonance Imaging methods, Tomography, X-Ray Computed methods
- Abstract
Animal anatomy has traditionally relied on detailed dissections to produce anatomical illustrations, but modern imaging modalities, such as MRI and CT, now represent an enormous resource that allows for fast non-invasive visualizations of animal anatomy in living animals. These modalities also allow for creation of three-dimensional representations that can be of considerable value in the dissemination of anatomical studies. In this methodological review, we present our experiences using MRI, CT and μCT to create advanced representation of animal anatomy, including bones, inner organs and blood vessels in a variety of animals, including fish, amphibians, reptiles, mammals, and spiders. The images have a similar quality to most traditional anatomical drawings and are presented together with interactive movies of the anatomical structures, where the object can be viewed from different angles. Given that clinical scanners found in the majority of larger hospitals are fully suitable for these purposes, we encourage biologists to take advantage of these imaging techniques in creation of three-dimensional graphical representations of internal structures.
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- 2011
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18. Esophageal injury in fatal rear-impact collisions.
- Author
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Uhrenholt L, Freeman MD, Jurik AG, Jensen LL, Gregersen M, Boel LW, Kohles SS, and Thomsen AH
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- Aged, 80 and over, Chest Pain etiology, Esophageal Perforation diagnosis, Fatal Outcome, Female, Forensic Pathology, Humans, Mediastinitis pathology, Neck Pain etiology, Pulmonary Atelectasis etiology, Pulmonary Atelectasis pathology, Radiography, Sepsis etiology, Spinal Fractures complications, Spinal Fractures diagnostic imaging, Spinal Fractures etiology, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae injuries, Accidents, Traffic, Esophageal Perforation etiology, Whiplash Injuries complications
- Abstract
Neck injuries resulting from motor vehicle collisions (MVC), often referred to as whiplash trauma and injury, often demonstrate little or no evidence of significant tissue damage. In rare instances, however, serious injury to the anterior neck organ injuries can result from such trauma. The present study describes esophageal injury associated with rear-impact collisions, based on a unique case report, review of the scientific literature and a query in the National Automotive Sampling System (NASS) database of the US National Highway Traffic Safety Administration. The Medline search and present case study totaled five cases of rear-impact collision-related serious esophageal injury (laceration or rupture). In the four published cases all patients survived, whereas in the presented case study, the patient died due to mediastinitis and sepsis. The NASS query revealed an additional three cases out of a total of 55,926 investigated crashes. All three cases were associated with fatalities. Although no anatomical or bioengineering studies have presented data on the behavior of the esophagus during rear-impact whiplash loading, sudden tensile and/or compressive forces is the likely explanation of injury, often in combination with a local fracture of a vertebral body. In these 8 cases significant esophageal injury carried a substantial (50%) risk of mortality. Clinicians should be aware of the potential for significant complications in the whiplash trauma-exposed patient who complains of chest pain, mid-thoracic pain, discomfort in the neck and throat, respiratory distress, or hoarseness. For those forensic specialists involved in whiplash cases these study results highlight the need to consider esophageal injuries as a rare but potential consequence of whiplash trauma., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)
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- 2011
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19. High-resolution ex vivo magnetic resonance angiography: a feasibility study on biological and medical tissues.
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Rasmussen AS, Lauridsen H, Laustsen C, Jensen BG, Pedersen SF, Uhrenholt L, Boel LW, Uldbjerg N, Wang T, and Pedersen M
- Subjects
- Animals, Contrast Media, Coronary Angiography, Female, Heart, Humans, Image Processing, Computer-Assisted, Microscopy, Electron, Scanning, Placenta, Pregnancy, Swine, Magnetic Resonance Angiography methods
- Abstract
Background: In biomedical sciences, ex vivo angiography is a practical mean to elucidate vascular structures three-dimensionally with simultaneous estimation of intravascular volume. The objectives of this study were to develop a magnetic resonance (MR) method for ex vivo angiography and to compare the findings with computed tomography (CT). To demonstrate the usefulness of this method, examples are provided from four different tissues and species: the human placenta, a rice field eel, a porcine heart and a turtle., Results: The optimal solution for ex vivo MR angiography (MRA) was a compound containing gelatine (0.05 g/mL), the CT contrast agent barium sulphate (0.43 mol/L) and the MR contrast agent gadoteric acid (2.5 mmol/L). It was possible to perform angiography on all specimens. We found that ex vivo MRA could only be performed on fresh tissue because formalin fixation makes the blood vessels permeable to the MR contrast agent., Conclusions: Ex vivo MRA provides high-resolution images of fresh tissue and delineates fine structures that we were unable to visualise by CT. We found that MRA provided detailed information similar to or better than conventional CTA in its ability to visualize vessel configuration while avoiding interfering signals from adjacent bones. Interestingly, we found that vascular tissue becomes leaky when formalin-fixed, leading to increased permeability and extravascular leakage of MR contrast agent.
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- 2010
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20. An alternative approach to computerized tomography (CT) in forensic pathology.
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Thomsen AH, Jurik AG, Uhrenholt L, and Vesterby A
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- Embolism, Air diagnostic imaging, Female, Forensic Pathology, Humans, Interprofessional Relations, Male, Pneumothorax diagnostic imaging, Autopsy, Tomography, X-Ray Computed, Wounds and Injuries diagnostic imaging, Wounds and Injuries pathology
- Abstract
Computerized Tomography (CT) is used by some forensic pathology departments as a supplement to the forensic autopsy. Departments with a limited number of autopsies may find it relatively expensive to acquire and operate a CT-scanner. Furthermore, it requires a great deal of training and experience to interpret the radiological data. We are currently evaluating CT in order to decide whether the benefits match the efforts. In selected death-investigations the Department of Radiology at Aarhus University Hospital performs CT of the body on behalf of the Institute of Forensic Medicine at Aarhus University and a skilled radiologist interprets the data. We present our radiological findings in the 20 cases where we have used CT and compare them to the autopsy findings. The cases include fatalities from beatings, stabbings, gunshots, fires and traffic accidents. CT is an excellent tool for documenting and illustrating certain lesions, such as gunshot wounds and bone fractures, where we can obtain information that possibly would have been missed at the autopsy. We believe, however, that further research is required before we can recommend CT as a part of a standard forensic autopsy. The cooperation between forensic and radiological departments is a good approach for smaller forensic departments that insures a skilled interpretation without having to divert a lot of resources to equipment and training.
- Published
- 2009
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