Search

Purpose: Intensified acute in-hospital physiotherapy (IP) after hip fracture (HF) may enhance patient's ability to regain basic mobility at discharge. The primary objective was to assess the feasibility of IP. Secondary to estimate the effect of IP on regained basic mobility at discharge. Materials and methods: In a pragmatic, randomized, unblinded feasibility trial, 60 patients (mean age 79 years, 41 women) with HF and an independent pre-fracture basic mobility level were randomized (2:1) to IP with two daily sessions on weekdays focusing on functional training and weight-bearing activities (n = 40) versus usual care (UC) physiotherapy once daily (n = 20). Feasibility outcomes included physiotherapy completion rates, reasons for non-successful completion, and adverse events. The primary effect outcome was recovery of basic mobility (Cumulated Ambulation Score (CAS)). Results: Eighty-two percent of the sessions in the IP group were successfully- or partially completed versus 94% of the sessions in the UC group. No adverse events occurred. The main reason for not completing physiotherapy was fatigue. At discharge (median 7 days), 50% in the IP group had regained their pre-fracture basic mobility level (CAS = 6) versus 16% in the UC group; odds ratio = 5.33, 95%CI [1.3;21.5]. Conclusions: IP seems feasible for patients after HF surgery, and it may enhance recovery. Fatigue was the primary obstacle to completing IP. Implications for rehabilitation: Two daily physiotherapy sessions focusing on functional training and weight-bearing activities are feasible for patients after isolated hip fracture surgery, including subtrochanteric fracture, and may enhance recovery of basic mobility at discharge. During hospitalization, patient participation in intensified physiotherapy is mainly restricted by fatigue. Systematic assessment and management of fatigue may improve the completion of physiotherapy and recovery of basic mobility. [ABSTRACT FROM AUTHOR]

The early life movement patterns of long-lived, large raptors, such as the white-tailed eagle (Haliaeetus albicilla), remain largely unexplored. In this study, we have tracked 22 individuals of white-tailed eagles hatched in Denmark to investigate key parameters, including survival rates, causes of death, nest site fidelity, geographical distribution, and dispersal behaviors. Our analyses are based on approximately 340,000 GPS/GSM telemetry positions from the 22 individuals. We found that survival rates were lower in the first year of life, especially among females, but increased in subsequent years. The primary causes of death were wind turbine collisions and avian influenza. Movement analyses revealed that juvenile eagles frequented nest sites in August and September, with females showing earlier exploratory flights and dispersal. Both males and females spent most of their first calendar year near their nest sites. In the second calendar year, a significant proportion of their time was spent at well-known white-tailed eagle resting areas in Denmark, as well as visiting neighboring countries. Notably, one individual set a new distance record for a Danish GPS-tagged white-tailed eagle, venturing at least 1750 km away from its nest site to visit Sweden, Finland, Russia, and Norway. Our results, indicating that juvenile white-tailed eagles continue to utilize nest sites into September, suggest an extension of the recommended time period for nest protection zones provided by BirdLife Denmark (DOF). [ABSTRACT FROM AUTHOR]

Background We assessed the incidence, quality of in-hospital care, and mortality for hip fracture (HF) patients in Denmark before and during the coronavirus disease (COVID) pandemic. Methods We obtained data from the Danish registries in the COVID period (March 11, 2020 to January 27, 2021, overall and in 5 periods) and compared it to a pre-COVID period (March 13, 2019 to March 10, 2020). We calculated the proportion of patients (%) that have fulfilled all the relevant quality indicators (a composite score of 100%) and adjusted hazard ratios (HR) with a 95% confidence interval (CI) for 30-day mortality. Results The incidence of HF was 5.7 per 1 000 person-years both in pre-COVID and COVID periods. About 35% of patients had a composite score of 100% in the COVID period compared to 28% in the pre-COVID period (proportion ratio 1.23 [95% CI: 1.17–1.30]). Fulfillment of all individual quality indicators was similar or higher in the COVID period. 30-day mortality was 9.5% in pre-COVID period, compared to 10.8% in the COVID period (HR 1.15 [95% CI: 1.02–1.30]). HRs varied from 1.07 (95% CI: 0.89–1.29) to 1.31 (95% CI: 1.06–1.62) in 5 COVID periods. In-hospital mortality was 4% in pre-COVID versus 4.4% in COVID period. Conclusions The incidence of HF in Denmark remained unchanged. The quality of in-hospital care was higher in the COVID compared to pre-COVID period. Unfortunately, 30-day mortality was also higher, highlighting the importance of recognizing diversity of social networks, home support, and digital health intervention after discharge for outcome of HF patients. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present multicenter cohort study was to compare the rates of reoperation in elderly patients with pertrochanteric and subtrochanteric fractures that had been treated with a short or long intramedullary nail.Methods: Eleven orthopaedic departments across Denmark delivered data that had been obtained from the Danish Multidisciplinary Hip Fracture Registry (DMHFR) and a review of health-care records. With use of surgical procedure codes for pertrochanteric and subtrochanteric fractures that had been treated with an intramedullary nail, the DMRHF was searched to identify patients who had been ≥65 years of age between 2008 and 2013. The health-care records for patients who had had major reoperations, defined as any reoperation with the exclusion of simple hardware removal, were retrieved from the DMHFR, were reviewed for the type of intramedullary nail and missed reoperations, including peri-implant fractures, within 2 years of follow-up. Crude logistic regression analysis with adjustment for age, sex, and comorbidity was performed, yielding odds ratios (ORs) with 95% confidence intervals (CIs).Results: Of 2,245 pertrochanteric fractures, 1,867 were treated with a short intramedullary nail and 378 were treated with a long intramedullary nail. The rate of major reoperations was 4.0% in the short intramedullary nail group and 6.3% in the long intramedullary nail group. This yielded a crude OR of 1.61 (1.01 to 2.60) and an adjusted OR of 1.67 (1.04 to 2.70). Of 909 subtrochanteric fractures, 308 were treated with a short intramedullary nail and 601 were treated with a long intramedullary nail. The rate of major reoperations was 8.4% in the short intramedullary nail group and 4.0% in the long intramedullary nail group, yielding a crude OR of 0.45 (0.25 to 0.80) and an adjusted OR of 0.45 (0.25 to 0.81).Conclusions: This is the first study confirming the theory that, for subtrochanteric fractures, a long intramedullary nail has a lower rate of major reoperations compared with a short intramedullary nail. In contrast, a short intramedullary nail has a lower rate of major reoperations compared with a long intramedullary nail for pertrochanteric fractures but with a lower absolute risk reduction compared with the results for subtrochanteric intramedullary nailing. There is a need for validation of these results in other large studies, especially for pertrochanteric fractures.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

We calculated the relative habitat use (RHU) of birds in Denmark to study the use of nine different habitats as well as trends of habitat use between 1975 and 2021. We found that during the breeding season, habitat specialists were declining in all natural habitats. In contrast, most habitat categories showed positive trends in winter, which might arise from increasing numbers of winter guests that due to climate warming are able to spend the mild winters in Denmark. [ABSTRACT FROM AUTHOR]

Purpose: To present a metropolitan cohort, Bispebjerg acute cohort (BAC), and compare patient characteristics and outcomes with patients from urban and rural hospitals in Denmark. Patients and Methods: We linked data from seven Danish nationwide registries and included all acute contacts to non-psychiatric hospitals in the years 2016– 2018. Acute hospital contacts to Bispebjerg and Frederiksberg Hospital constituted BAC, representing a solely metropolitan/urban catchment area. Patient characteristics and outcomes were compared to the rest of Denmark in an urban cohort (UrC) and a rural cohort (RuC), stratified by visit and hospitalization contact types. Results: We identified 4,063,420 acute hospital contacts in Denmark and BAC constituted 8.4% (n=343,200) of them. BAC had a higher proportion of visits (65.1%) compared with UrC (52.1%) and RuC (45.3%). Patients in BAC more often lived alone (visits: BAC: 34.8%, UrC: 30.6%, RuC: 29.2%; hospitalizations: BAC: 50.8%, UrC: 36.7%, RuC: 37.2%) and had temporary CPR number (visits: BAC: 4.4%, UrC: 1.9%, RuC: 1.6%; hospitalizations: BAC: 1.5%, UrC: 0.9%, RuC: 0.8%). Visit patients in BAC were younger (BAC: 36, UrC: 42, RuC: 45 years, median), more often students (BAC: 18.0%, UrC: 14.0%, RuC: 12.5%), and had more contacts due to infectious diseases (BAC: 19.8%, UrC: 14.1%, RuC: 6.2%) but less due to injuries (BAC: 40.0%, UrC: 43.8%, RuC: 60.7%). Hospitalized patients in BAC had higher median age (BAC: 64, UrC: 61, RuC: 64 years) and fewer were in employment than in UrC (BAC: 26.1%, UrC: 32.1%, RuC: 28.1%). BAC Hospitalizations had a lower death rate within 30 days than in RuC (BAC: 3.0% [2.9– 3.1%], UrC: 3.1% [3.0– 3.1%], RuC: 3.4% [3.3– 3.4%]), but a higher readmission-rate (BAC: 20.5% [20.3– 20.8%], UrC: 17.3% [17.2– 17.4%], RuC: 17.5% [17.5– 17.6%]). Conclusion: Significant differences between BAC, urban, and rural cohorts may be explained by differences in healthcare structure and sociodemographics of the catchment areas. [ABSTRACT FROM AUTHOR]

Social support is known to be essential to cope with the physical and psychological aftermath following coronary heart disease treatment. Consequently, patients experiencing loneliness may be placed in a vulnerable situation. The aim of this study was to provide insight into the nuances and complexity of loneliness and its impact on health behaviour in the early rehabilitation period following treatment. The study used a hermeneutic philosophical approach. Patients classified as lonely were interviewed in either a focus group (n = 7) or in an individual interview (n = 10). We analysed the empirical material using inductive content analysis. The analysis illuminated various dimensions of patients' perceived loneliness; 'Loneliness as an emotional pain', 'A changed, but unmet need for social support' and 'Striving for symmetry in relationships'. Loneliness negatively influenced patients' ability to adapt to the critical event and manage health behaviour changes. Insight into the mechanisms that aggravate loneliness may inform future social support interventions. Social støtte er beskrevet som essentiel i forbindelse med håndteringen af de fysiske og psykiske følger af iskæmisk hjertesygdom. Derfor kan patienter som oplever ensomhed være i en særlig sårbar situation. Formålet med dette kvalitative studie var at opnå en nuanceret indsigt i patients oplevelse af ensomhed, samt hvordan ensomhed influerer på sundhedsadfærd i den tidlige rehabiliteringsperiode efter behandlingen for iskæmisk hjertesygdom. I studiet havde vi en hermeneutisk filosofisk tilgang. Patienter klassificeret som ensomme blev interviewet enten individuelt (n = 10) eller i fokusgruppe (n = 7). Vi analyserede det empiriske materiale med induktiv indholdsanalyse. Analysen tydeliggjorde forskellige dimensioner af patienternes oplevede ensomhed: "Ensomhed som en emotionel smerte", "Et ændret, men ikke imødekommet behov for social støtte", Stræben efter symmetri i relationer". Ensomhed havde en negativ indflydelse på patienternes mulighed for at håndtere den kritiske hændelse og på sundhedsadfærd. En øget indsigt i de mekanismer som forværrer ensomhed, har relevans ved udarbejdelsen af fremtidige sociale støtteinterventioner. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of benzodiazepines and antidepressants on the risk of hospitalization and hip fracture in patients with dementia initiating antipsychotic drug treatment. Methods: A register‐based retrospective cohort study using data on all incident dementia cases (≥65 years) initiating antipsychotic treatment as monotherapy or in combination with benzodiazepines and/or antidepressants in Denmark from 2000 to 2015. The outcomes of interest were all‐cause hospitalization and hip fracture. Cox proportional hazards models with adjustment for multiple variables were used to investigate risk of hospitalization and hip fracture within 180 days. Results: The risk of all‐cause hospitalization during 180‐days follow‐up was significantly increased by 55% (adjusted HR: 1.55, 95% CI: 1.29–1.86, p < 0.0001), when antipsychotic use was combined with benzodiazepines, when compared to antipsychotic monotherapy. The association between the combination of antipsychotics and benzodiazepines with the risk of hip fracture did not reach statistical significance (adjusted HR: 1.50, 95% CI: 0.99–2.26, p = 0.0534). Conclusions: The observed increased risk of all‐cause hospitalization and hip fracture may indicate increased drug‐related adverse events. Thus, careful and regular monitoring is needed to assess response to treatment and decrease the risk of adverse events, when antipsychotics are combined with BZDs, albeit confounding cannot be fully excluded within the current design. Key Points: Psychotropic drugs are widely used to treat neuropsychiatric symptoms in patients with dementia.Treatment with benzodiazepines in combination with antipsychotics was associated with a 55% increased risk of hospitalization and a trend for increased risk of hip fracture.The combination of antidepressants with antipsychotics was associated with a trend for increased risk of hospitalization, but not for hip fracture.Clinicians need to be aware of the potential increased risk of hospitalization and hip fracture for patients with dementia when planning psychopharmacological treatments. [ABSTRACT FROM AUTHOR]

Introduction: Surgical treatment of hip fractures within 24-48 hours decreases morbidity and mortality, but goals for early surgery have not been widely achieved so far. The primary aim of this study was to investigate the feasibility of implementation of a hip call, and the secondary aim was to investigate the effect of the hip call on time for pre-operative preparation and surgery compared to a historical control cohort.Materials and Methods: From March 4, 2019 until June 30, 2019, admission of patients at Copenhagen University Hospital, Bispebjerg, Denmark, with a suspected hip fracture triggered an acute hip call. Key personnel are summoned to secure rapid pre-operative preparation and surgery. The implementation was defined feasible, if ≥ 75% of the patients were ready for surgery within 4 hours and had surgery initiated within 24 hours of hospital arrival. The historical control cohort was patients with hip fractures in the same period in 2018.Results: A total of 128 patients were included in 2019, and 99 in 2018. After implementation of hip call, 83% of patients were ready for surgery within 4 hours. After vs before hip call, 88% vs 51% were operated within 24 hours and 96% vs 79% within 36 hours. Time from admission to surgery (hh:mm) was reduced by mean 10:33 (CI 07:46-13:20), P < .001.Conclusion: The implementation of a hip call was feasible with 83% of patients being ready for surgery within 4 hours, and 88% being operated within 24 hours. Future large-scale studies should clarify potential benefits on clinical outcome. [ABSTRACT FROM AUTHOR]

Background: Simulation-based training is emerging within the orthopaedic field to alleviate the challenges that trainees face such as work-hour restrictions, limited exposure to procedures, and increasing pressures to reduce risk to patients. This training modality has grown increasingly popular over the last 2 decades. However, integration into the curriculum often fails to follow a structured educational plan. The development of simulation-based curricula should follow a structured and stepwise approach that starts with a general needs assessment. This study aimed to identify and prioritize procedures within orthopaedic surgery to be included in a simulation-based curriculum on a national basis.Methods: A national needs assessment was conducted using the Delphi method. Ninety-five experts who are involved in the training of orthopaedic surgeons from all orthopaedic departments in Denmark were selected to participate in the assessment. Round 1 was a brainstorming phase to identify technical procedures that are relevant for orthopaedic surgeons in training. Round 2 was performed on a departmental basis; it explored the frequency of procedures, the number of surgeons performing each procedure, the risk and/or discomfort to patients, and the feasibility for simulation-based training to prioritize and eliminate some of the procedures that were determined in round 1. During round 3, the experts eliminated and reprioritized procedures from round 2 to produce a final prioritized list.Results: During the first round, 194 procedures were identified. These were reduced to 62 in round 2, and the final list after round 3 consisted of 33 prioritized procedures that are relevant for simulation-based training in orthopaedic surgery. The response rates were 63 of 95 physicians for round 1, 26 of 26 departments for round 2, and 64 of 97 physicians for round 3. The highest prioritized procedures were basic surgical techniques and principles for osteosynthesis, osteosynthesis of proximal femoral fracture, and surgical exposure of the upper and lower extremities.Conclusions: The prioritized list of technical procedures in orthopaedic surgery that are suitable for simulation-based training can aid in the development of a simulation-based curriculum.Clinical Relevance: This article offers insights into needs assessment and curriculum development of simulation-based training in orthopaedic surgery and traumatology. [ABSTRACT FROM AUTHOR]

Background: A growing population is living with ischemic heart disease (IHD). Patient-reported outcomes (PROs) are reliable prognostic tools. Studies exploring PROs are needed to identify vulnerable patients and guide targeted healthcare strategies. Objectives: The aims of this study were to (i) describe PROs at hospital discharge across 3 diagnostic subgroups: (1) chronic IHD/stable angina, (2) non-ST-elevation myocardial infarction (non-STEMI)/unstable angina, and (3) ST-elevation myocardial infarction (STEMI), and (ii) examine determinants for PROs at hospital discharge in patients with IHD. Methods: This study included a national cohort with register-data linkage including 14 115 adults with IHD discharged from Danish heart centers. Eligible patients (n = 13 476) were invited to complete a questionnaire, and 7 167 (53%) responded. Questionnaires included the Medical Outcome Study Short-Form 12, the Hospital Anxiety and Depression Scale, EuroQoL, HeartQoL, the Edmonton Symptom Assessment Scale, and ancillary questions. Sociodemographic and clinical characteristics were obtained fromnational registers. Student t test, χ² test, and adjusted linear and logistic regression analyses were conducted to investigate subgroup differences, and adjusted linear and logistic regression analyses were conducted to explore determinants for PROs. Results: Statistically significant subgroup differences were found, with groups reporting worst to best scores for most of PROs being as follows: chronic IHD/stable angina, non-STEMI/unstable angina, and STEMI. Symptoms of anxiety were highly prevalent in the non-STEMI/unstable angina group, with 33.8% exceeding a Hospital Anxiety and Depression Scale--Anxiety cutoff score indicating a possible anxiety disorder. Determinants for worse PROs included female sex, lower educational level, obesity, and poor physical fitness. Conclusions: Significant differences in PROs across IHD subgroups were observed and determinants for poor outcomes suggested. Results may guide differentiated care initiatives and resource allocation for preventative strategies. [ABSTRACT FROM AUTHOR]

Background early mobilization after hip fracture (HF) is an important predictor of outcome, but knowledge of the consequences of not achieving the pre-fracture basic mobility status in acute hospital recovery is sparse. Objective we examined whether the regain of pre-fracture basic mobility status evaluated with the cumulated ambulation score (CAS) at hospital discharge was associated with 30-day post-discharge mortality and readmission. Design this is a population-based cohort study. Measures using the nationwide Danish Multidisciplinary HF Database from January 2015 through December 2015, 5,147 patients 65 years or older undergoing surgery for a first-time HF were included. The pre-fracture and discharge CAS score (0–6 points with six points indicating an independent basic mobility status) were recorded. CAS was dichotomized as regained or not and entered into adjusted Cox regression overall analysis and stratified by sex, age, body mass index, Charlson comorbidity index, type of fracture, residential status and length of acute hospital stay. Outcome measures were 30-day post-discharge mortality and readmission. Results overall mortality and readmission were 8.3% (n = 425) and 17.1% (n = 882), respectively. Mortality was 3.5% (n = 71) among patients who regained their pre-fracture CAS score compared with 11.4% (n = 354) among those who did not. Adjusted hazard ratios for 30-day mortality and readmission were 2.76 (95% confidence interval [CI] = 2.01–3.78) and 1.26 (95% CI = 1.07, 1.48), respectively, for patients who did not regain their pre-fracture CAS compared with those who did. Conclusions we found that the loss of pre-fracture basic mobility level upon acute hospital discharge was associated with increased 30-day post-discharge mortality and readmission after a first time HF. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate whether surgical delay or the educational level of surgeon is associated with early mortality in patients with distal femoral fractures.Methods: 392 consecutive patients aged ≥50 years registered in the Danish Fracture Database for surgery of a non-pathological, closed, low-energy distal femoral fracture (AO33A-C) were included. Data included age, gender, American Society of Anaesthesiologists (ASA) score, type of fracture, educational level of surgeon and surgical delay. Educational level of surgeon was defined as "attending or above as surgeon", "attending or above as supervisor" or "below attending alone". Surgical delay was defined as hours (h) from radiological diagnostics until onset of surgery. Mortality data was provided by The Civil Registration System. Mortality rates were calculated using multiple logistical regression analysis.Results: Mean age was 76 years (range 50-101), 79% of patients were female and 65% had an extra articular fracture (AO33A). 8% were operated within 12h, 33% within 24h, 67% within 48h and 83% within 72h. Educational level of surgeon was "attending or above as surgeon" in 56% of all cases and "attending or above as supervisor" in 33%. Mortality was 7.1% at day 30 and 12.5% at day 90. The logistical regression analysis did not demonstrate any association between surgical delay or educational level of surgeon and mortality. Increasing age, male gender and ASA score >2 significantly increased both 30-day and 90-day mortality.Conclusion: No association between surgical delay or educational level of surgeon and mortality was found. These findings do not support the development of guidelines for decreasing surgical delay in this population. [ABSTRACT FROM AUTHOR]

Objective: The evidence for cardiac rehabilitation after valve surgery remains sparse. Current recommendations are therefore based on patients with ischaemic heart disease. The aim of this randomised clinical trial was to assess the effects of cardiac rehabilitation versus usual care after heart valve surgery.Methods: The trial was an investigator-initiated, randomised superiority trial (The CopenHeartVR trial, VR; valve replacement or repair). We randomised 147 patients after heart valve surgery 1:1 to 12 weeks of cardiac rehabilitation consisting of physical exercise and monthly psycho-educational consultations (intervention) versus usual care without structured physical exercise or psycho-educational consultations (control). Primary outcome was physical capacity measured by VO2 peak and secondary outcome was self-reported mental health measured by Short Form-36.Results: 76% were men, mean age 62 years, with aortic (62%), mitral (36%) or tricuspid/pulmonary valve surgery (2%). Cardiac rehabilitation compared with control had a beneficial effect on VO2 peak at 4 months (24.8 mL/kg/min vs 22.5 mL/kg/min, p=0.045) but did not affect Short Form-36 Mental Component Scale at 6 months (53.7 vs 55.2 points, p=0.40) or the exploratory physical and mental outcomes. Cardiac rehabilitation increased the occurrence of self-reported non-serious adverse events (11/72 vs 3/75, p=0.02).Conclusions: Cardiac rehabilitation after heart valve surgery significantly improves VO2 peak at 4 months but has no effect on mental health and other measures of exercise capacity and self-reported outcomes. Further research is needed to justify cardiac rehabilitation in this patient group.Trial Registration Number: NCT01558765, Results. [ABSTRACT FROM AUTHOR]

Background/Aims: Prior studies have shown that patients with dementia are at risk of receiving insufficient treatment for pain after a hip fracture. We therefore hypothesized that elderly hip fracture patients with dementia received less postoperative pain treatment than those without dementia. Method: All patients (age ≥ 65 years) who had been operated on for a hip fracture in the Copenhagen University Hospital region in 2009 were included. Data about analgesic use for the first 72 h after surgery were acquired from the hospitals' electronic medication system and linked with information about dementia, comorbidity, and prior drug use. Results: A total of 1,507 patients were included, of which 296 (19.6%) suffered from dementia. Both groups were equally likely to receive paracetamol and opioids. Patients with dementia received lower doses of oral morphine equivalents during the first [dementia vs. no dementia: 29.0 (26.4-31.8) vs. 34.7 (33.1-36.4) mg, p = 0.001] and second [27.8 (25.4-30.5) vs. 31.2 (29.9-32.4) mg, p = 0.019] but not on the third postoperative day (p = 0.10). Conclusion: The lower doses of opioids may reflect uncertainty about how to treat pain patients with dementia. Further guidance is needed, as inadequate treatment of pain may have adverse consequences. [ABSTRACT FROM AUTHOR]

Introduction: Evaluation of the long-term performance of implants used in trauma surgery relies on post-marked clinical studies since no registry based implant assessment exists. The purpose of this study was to evaluate the evidence of performance of implants currently used for treating proximal femoral fractures (PFF) in Denmark.Method: PubMed was searched for clinical studies on primary PFF with follow-up ≥12 months, reporting implant-related failure and evaluating one of following: DHS, CHS, HipLoc, Gamma3, IMHS, InterTan, PFN, PFNA or PTN.Limits: English language and publication date after 1st of January 1990.Results: All studies were evidence level II or III. 30 publications for SHS were found: 13 of CHS, 15 of DHS and 2 of HipLoc. In total CHS was evaluated in 1110 patients (900 prospectively), DHS in 2486 (567 prospectively) and HipLoc in 251 (all prospectively). Fifty-four publications for nails were found: 13 of Gamma3, 7 of IMHS, 5 of InterTan, 10 of PFN, 24 of PFNA and 0 of PTN. In total Gamma3 was evaluated in 1088 patients (829 prospectively), IMHS in 1543 (210 prospectively), InterTan in 595 (585 prospectively), PFN in 716 (557 prospectively), PFNA in 1762 (1018 prospectively) and PTN in 0.Conclusions: The clinical evidence behind the current implants used for proximal femoral fractures is weak considering the number of implants used worldwide. Sporadic evaluation is not sufficient to identify long term problems. A systematic post market surveillance of implants used for fracture treatment, preferable by a national register, is necessary in the future. [ABSTRACT FROM AUTHOR]

Background. To determine use and investigate factors associated with use of hypnotics the first year after a diagnosis with breast cancer. Material and methods. A retrospective registry based cohort study linking clinical data from the Danish Breast Cancer Group with the National Prescription Drug Database and other health and administrative registries. We included 26 082 women diagnosed with early breast cancer as first time primary cancer during 1996-2006. Use of hypnotics was measured as redeemed prescriptions in the first year after diagnosis of early breast cancer. Prior use of hypnotics was defined as one or more prescriptions of hypnotics 13 months to 1 month before diagnosis, and chronic use was defined as four or more prescriptions. Hazard ratios (HRs) for clinical variables, treatment-related factors and sociodemographic factors were calculated. Results. Among women with no prior history of hypnotic use, 17% became new users with 4% on a chronic level. Among prior users, 82% continued their use with one or more prescriptions of hypnotics and 15% increased their use to a chronic level. Significantly increased hazard ratios for use of hypnotics were seen with increasing age [age 50-59 years: HR 1.43 (95% CI 1.31-1.57), age 60-69: HR 1.57 (95% CI 1.44-1.71)], increasing number of tumor positive lymph nodes [1-3 lymph nodes: HR 1.12 (95% CI 1.05-1.09), 4-9 lymph nodes: HR 1.11 (95% CI 1.02-1.29)], chemotherapy [HR 1.25 (95% CI 1.12-1.39)], somatic comorbidity [HR 1.31 (95% CI 1.21-1.42)] and use of antidepressants the year before breast cancer diagnosis [HR 1.97 (95% CI 1.85-2.10)]. Conclusion. This study detected a group of patients at great risk for initiating and increasing use of hypnotics and preventive and prophylactic mechanism should be investigated and initiated when this group of patients is seen in the clinical setting. [ABSTRACT FROM AUTHOR]

Background and purpose Treatment of hip fracture patients is controversial. We implemented a new operative and supervision algorithm (the Hvidovre algorithm) for surgical treatment of all hip fractures, primarily based on own previously published results. Methods 2,000 consecutive patients over 50 years of age who were admitted and operated on because of a hip fracture were prospectively included. 1,000 of these patients were included after implementation of the algorithm. Demographic parameters, hospital treatment, and reoperations within the first postoperative year were assessed from patient records. Results 931 of 1,000 operative procedures were performed according to the algorithm, as compared to only 726 of 1,000 prior to its introduction (p < 0.001). After implementation of the algorithm, junior registrars still performed half of the operations, but unsupervised procedures declined from 192 of 1,000 to 105 of 1,000 (p < 0.001). The rate of reoperations declined from 18% to 12% (p < 0.001 in a multiple Cox regression analysis), with a decline of 24% to 18% for intracapsular fractures and a decline of 13% to 7% for extracapsular fractures. The proportion of bed-days caused by reoperations was reduced from 24% of total hospitalization before the algorithm was introduced to 18% after it was introduced. Interpretation It is possible to implement an algorithm for treatment of all hip fracture patients in a large teaching hospital. In our case, the Hvidovre algorithm both raised the rate of supervision and reduced the rate of reoperations. The reduced reoperation rate saved many hospital bed-days. [ABSTRACT FROM AUTHOR]

Background and purpose In recent years, intramedullary nails (INs) for the treatment of pertrochanteric hip fractures have gained prominence relative to conventional, sliding hip screws (SHSs). There is little empirical background for this development, however. A previous series of ours suggested that the use of SHS was not adequate in situations with fragile or fractured lateral femoral walls, where it often led to lack of healing in a maximally telescoped position. We hypothesized that INs would be the superior implant in these specific circumstances. Methods We retrospectively examined 311 consecutive patients treated in our department between 2002 and 2008, with either an IN (n == 158) or an SHS (n == 153) mounted on a 4-hole side-plate, for an AO/OTA type 31A1--2 pertrochanteric fracture with a detached greater trochanter. The status of the lesser trochanter was assessed preoperatively and the integrity of the lateral femoral wall, fracture reduction, and position of the implants were assessed postoperatively. Reoperations due to technical failure were recorded for one year postoperatively. Results Multivariate logistic regression analysis showed that the groups were similar regarding demographic and biomechanical parameters. The lateral femoral wall was more frequently fractured during SHS implantation (42 patients) than in the IN group (9 patients) (p < 0.001). 6 (4%) of the 158 patients operated with IN had to be reoperated, as compared to 22 (14%) in the SHS group of 153 patients (p == 0.001). Interpretation IN had a lower reoperation rate than SHS in these pertrochanteric hip fractures with a detached greater trochanter. IN left more lateral femoral walls intact. [ABSTRACT FROM AUTHOR]

Introduction. The purpose of this register-based study was to identify factors related to disease, treatment, sociodemographics and comorbidity associated with taking early retirement among women treated for breast cancer, and to evaluate the risk for taking early retirement among breast cancer survivors who attended a six-day rehabilitation course. Material and methods. The study population consisted of 856 women who attended the rehabilitation course and a comparison group of 1 805 women who did not attend the course identified through the Danish Breast Cancer Cooperative Group. We obtained information on receipt of unemployment benefits, sickness benefits and early retirement pension for each of the years 1996-2007. Multivariate cox-regression models were used to analyze disease-specific, treatment-related, comorbidity and sociodemographics factors associated with early retirement after breast cancer and to evaluate the effect of attending a rehabilitation course on taking early retirement. Results. The rate of retirement was higher for women with somatic comorbidity (hazard ratio [HR], 1.91; 95% CI, 1.3; 2.9 for score 1, and HR 1.42; 95% CI, 0.7; 2.7 for score ≥2), previous depression (HR, 2.29; 95% CI, 1.7; 3.2) or having received sickness benefits in the year before their breast cancer diagnosis (HR, 3.75; 95% CI, 1.8; 7.8). Living with a partner was associated with a reduced hazard ratio for taking early retirement (HR, 0.70; 95% CI, 0.5-0.9). Having received chemotherapy, alone or in combination with anti-hormone treatment, reduced the hazard ratio (HR, 0.49; 95% CI, 0.3; 0.8 and HR, 0.5; 95% CI, 0.3; 0.8, respectively). The rate of retirement was higher for women the year after attending the rehabilitation course but returned to unity by three years. Discussion. The results of this study contribute to the identification of at-risk women and point to the need for tailored rehabilitation to avoid unnecessary marginalization of breast cancer survivors due to permanent labor market withdrawal. [ABSTRACT FROM AUTHOR]

Background: Although the clinical consequences of femoroacetabular impingement have been well described, little is known about the prevalence of the anatomical malformations associated with this condition in the general population, the natural history of the condition, and the risk estimates for the development of osteoarthritis. Methods: The study material was derived from a cross-sectional population-based radiographic and questionnaire database of 4151 individuals from the Copenhagen Osteoarthritis Substudy cohort between 1991 and 1994. The subjects were primarily white, and all were from the county of østerbro, Copenhagen, Denmark. The inclusion criteria for this study were met by 1332 men and 2288 women. On the basis of radiographic criteria, the hips were categorized as being without malformations or as having an abnormality consisting of a deep acetabular socket, a pistol grip deformity, or a combination of a deep acetabular socket and a pistol grip deformity. Hip osteoarthritis was defined radiographically as a minimum joint-space width of ⩽2 mm. Results: The male and female prevalences of hip joint malformations in the 3620 study subjects were 4.3% and 3.6%, respectively, for acetabular dysplasia;15.2% and 19.4% for a deep acetabular socket; 19.6% and 5.2% for a pistol grip deformity; and 2.9% and 0.9% for a combination of a deep acetabular socket and pistol grip deformity. The male and female prevalences of a normal acetabular roof were 80.5% and 77.0%. We found no significantly increased prevalence of groin pain in subjects whose radiographs showed these hip joint malformations (all p > 0.13). A deep acetabular socket was a significant risk factor for the development of osteoarthritis (risk ratio, 2.4), as was a pistol grip deformity (risk ratio, 2.2). Acetabular dysplasia and the subject's sex were not found to be significant risk factors for the development of hip osteoarthritis (p = 0.053 and p = 0.063, respectively). The prevalence of hip osteoarthritis was 9.5% in men and 11.2% in women. The prevalence of concomitant malformations was 71.0% in men with hip osteoarthritis and 36.6% in women with hip osteoarthritis. Conclusions: In our study population, a deep acetabular socket and a pistol grip deformity were common radiographic findings and were associated with an increased risk of hip osteoarthritis. The high prevalence of osteoarthritis in association with malformations of the hip joint suggests that an increased focus on early identification of malformations should be considered. [ABSTRACT FROM AUTHOR]

Introduction: Sustaining a hip fracture is a life changing event for many elderlies. While doctors and researchers tend to be preoccupied with mortality and complication rates, patients are more concerned by other aspects e.g. loss of independence and ability to remain in their own home. This study aimed to i) determine age-stratified one-year event rates of admission to nursing home after discharge, and ii) identify risk factors associated with nursing home admission.Methods: Community dwelling patients aged 60-100 years undergoing their first hip fracture surgery in 2005 - 2015 were identified in nationwide administrative registries. Outcome was admission to nursing home within one year of discharge. To assess risk factors, we performed age-stratified cumulative incidence curves and multivariate cause specific cox regression models adjusted for age, sex, social factors, and comorbidities.Results: A total of 53,157 patients were included. One-year risk increased with advancing age from 3.2% of patients aged 60 to 69, up to 22.4% in the eldest group aged 90-100 years. Living alone and dementia were strong risk factors HR 9.22 [95% CI 5.60-15.18, p = <0.0001] and HR 6.73 [95% CI 4.80- 9.44, p = 0.0001] respectively for patients aged 60 to 69 years, the effect decreased with higher age down to HR 2.75 [95% CI 2.12- 3.57, p = <0.0001] and HR 2.15 [95% CI 1.88- 2.46, p = <0.0001] for patients ≥ 90 years. Other important risk factors were pre-injury home care, Parkinson's disease and depression. Surprisingly, physical comorbidities i.e. kidney disease, chronic obstructive pulmonary disease, diabetes and cancer did not increase the risk of nursing home admission.Conclusion: Future initiatives aimed to reduce loss of independence and nursing home admission, among patients with first time hip fracture, should devote attention to living settings and cognitive impairment rather than physical comorbidity. [ABSTRACT FROM AUTHOR]

The effect of the GlycoPEGylation process used for prolonging the half-life of recombinant factor IX (rFIX) has no impact on the primary and higher order structure of activated factor IX. Characterisation work performed on recombinant factor IX and on the GlycoPEGylated form of rFIX (N9-GP), confirm that the primary structure as well as the post translational modifications (PTMs) (disulphide bonds, γ-carboxylation, β-hydroxylation, sulphation and O- and N-linked glycan structures) were comparable for rFIX and N9-GP. Three O-linked glycan sites were identified in the activation peptide (Thr159, Thr163 and Thr169), where Thr163 has not been reported previously. For N9-GP, the mono GlycoPEGylation is directed toward one of the two N-linked glycans present at Asn157 and Asn167 in the activation peptide in a one to one ratio. Spectroscopic techniques, such as far and near UV Circular Dichroism studies show comparable secondary and tertiary structures of rFIX and N9-GP. The thermally induced unfolding of rFIX and N9-GP shows that the unfolding temperature is approximately 1 °C higher for N9-GP than that of the rFIX. Furthermore, the pH dependent degradation was reduced due to the GlycoPEGylation of rFIX. GlycoPEGylated rFIX (N9-GP) is used for the manufacturing of Refixia® (nonacog beta pegol, Rebinyn®, Novo Nordisk A/S, Bagsvaerd, Denmark). [ABSTRACT FROM AUTHOR]