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Syddansk Sundhedsvidenskabeligt

Forskningsforum

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TRINITY Hotel & Conference Centre Gl. Færgevej 30, Snoghøj, Fredericia 26. April 2017


Forskningsforum

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Program: Åben Forskerdag i Syddanmark den 26. april 2017

Kl. 8.30-9.00 Ankomst, kaffe og brød.

Workshops formiddag

Kl. 9.00-12.00 Præsentation og diskussion af Syddanske sundhedsforskningsprojekter.

Kl. 12.00-13.00 Frokost.

Supportfunktioner

På dagen er stande med eksperter fra supportfunktionerne: GCP-Enheden, Juridisk kontor/SDU Er-

hverv, OPEN, De Videnskabsetiske komiteer, Et Sundere Fyn, OUH/Direktionssekretariatet, SDU-

Forskerservice Økonomi og Biomedicinsk laboratorium.

Tema eftermiddag: Data i forskning

Kl. 13.00-14.00 Velkomst

Adm. sygehusdirektør Dorthe Gylling Crüger, Sygehus Lillebælt og In-

stitutleder Rikke Leth-Larsen, Institut for Regional Sundhedsforskning,

Syddansk Universitet.

Forskerens perspektiv: Danske registres betydning for forskning og

patientbehandling

Professor Frans Boch Waldorff, Institut for Sundhedstjenesteforskning –

Forskningsenden for Almen Praksis, Syddansk Universitet.

Borgerens perspektiv: PRO data og patienten som partner i forsk-

ningsprocessen

Professor Mogens Hørder, Institut for Sundhedstjenesteforskning – Bru-

gerperspektiver, Syddansk Universitet.

Afslutning på eftermiddagens tema.


Forskningsforum

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Forskningsforum

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Foredragene må vare mellem 10 til 12 minutter


Forskningsforum

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Lokaleoversigt

Lokale S1 – Foredagene vil blive holdt på engelsk Lokale S1 – Session 1 - kl.09.00-10.00

Chairman: Thomas Levin Andersen

Issa Farah Issa: Structural valve deterioration in the Mitroflow biological heart valve prosthesis ................................... 10

Louise S. Mose: Personality profiles, grade of disability, and physical activity level correlate with the onset of

medication-overuse headache ........................................................................................................................................... 11

Morten Sall Jensen: The associations between changes in referral options for general practitioners and the use of

magnetic resonance imaging for low back pain patients – evidence from a natural experiment using nationwide data .. 12

Ahmed Hussein Zedan: Heterogeneity of miRNA expression in localized prostate cancer with clinico-pathological

correlations ....................................................................................................................................................................... 13

Lokale S1 – Session 2 - kl.10.00-11.00

Chairman: Torben Knudsen

Afsaneh Mohammednejad: GWAS based polygenic analysis of allergic rhinitis ............................................................ 15

Birgit Debrabant: DNA methylation age and perceived age in elderly Danish twins ....................................................... 16

Dorota Kuettel: Patient-reported flares in rheumatoid arthritis patients with low disease activity: a comprehensive

clinical, biochemical and imaging characterisation .......................................................................................................... 17

Dorthe Dangvard Pedersen: Detecting tuberculosis in skeletons – association of skeletal lesions and disease diagnosis 18

Thomas Levin Andersen: Relating Cortical Bone Mechanics to Intracortical Pore Morphology, Distribution and

Remodeling History within the Fibula Diaphysis ............................................................................................................. 19


Chairwoman: Annmarie Touborg Lassen

Weilong Li: Whole-genome Bisulfited Sequencing on Discordant Identical Twins For BMI ......................................... 21

Helene B. Kristensen: A new method to identify where human hematopoietic stem and progenitor cells (HSPCs) are

positioned in human bone marrow .................................................................................................................................... 22

Silvia Regina Rogatto: Establishment and molecular characterization of penile carcinomas cell lines: models for the

identification of novel therapeutic strategies .................................................................................................................... 23

Corrie Myburgh: Health Care Encounters In Danish Chiropractic Practice From A Consumer Perspectives - A Mixed

Methods Investigation ...................................................................................................................................................... 24

Lene Kongsgaard Nielsen: Quality of life in Danish multiple myeloma patients ............................................................. 25


Forskningsforum

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Lokale S2 - Foredragene vil blive holdt på dansk


Chairman: Torben Plesner

Helle Glud Binderup: Pre-storage centrifugation conditions have significant impact on measured microRNA levels in

biobanked EDTA plasma samples .................................................................................................................................... 27

Mette Tambour: Effect of two composite treatments on breast cancer related lymphedema, a multicenter, randomized,

single-blind, equivalence trial ........................................................................................................................................... 28

Malene Roland Pedersen: Comparison of tissue stiffness using Shear Wave Elastography in men with testicular cancer

.......................................................................................................................................................................................... 29

Ann Christina Eriksen: Computer-assisted stereology and automated image analysis for quantification of tumor

infiltrating lymphocytes in colon cancer. .......................................................................................................................... 30

Cathrine Lundgaard Riis: A study in optimizing follow up for postmenopausal women with breast cancer treated with

adjuvant endocrine therapy. .............................................................................................................................................. 31


Chairwoman: Jonna Skov Madsen

Anette Kargo: Biomarker CA125: To monitor or not for relapse of ovarian cancer? Development of a decision aid to

help patients make the decision. ....................................................................................................................................... 33

Chris H. Dreyer: Effect of VEGF dose and observationtime on bone formation around titanium implants. Experimental

studies in sheep ................................................................................................................................................................. 34

Sara Elisabeth Sponheltz: Sentinel Node Mapping with Robotic Assisted Near-Infrared Imaging in Women with

Cervical and Endometrial Cancer (SENTIREC) .............................................................................................................. 35

Iben Gammelgård: Recovery with the individual placement and support intervention in Denmark ................................ 36

Signe Harder: Nausea and vomiting in patients with advanced cancer ............................................................................ 37


Chairwoman: Elsebeth Stenager

Line Espenhain Andersen: Meal-induced thrombin generation in obese women and men before and after gastric bypass

- a model of intentional weight loss .................................................................................................................................. 39

Line Riis Jølving: The association between maternal chronic inflammatory bowel disease and long-term health

outcomes in the children – a nationwide cohort study ...................................................................................................... 40

Maria Sode Rønne: Bone mass tracks into teenage years ................................................................................................. 41

Lærke Tolstrup: The use of PROs in the management of adverse events in patients with malignant melanoma receiving

immunotherapy ................................................................................................................................................................. 42

Monika Pankiewicz-Dulacz: Risk of hospitalization with severe infection among schizophrenia patients before and after

onset of the illness: Population-based nationwide cohort study. ...................................................................................... 43


Forskningsforum

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Lokale U1 - Foredragene vil blive holdt på dansk

Lokale U1 – Session 1 - kl.09.00-10.00

Chairman: Søren Rafaelsen

Helle Gerbild: Håndtering af urininkontinens hos kvinder - lægers og fysioterapeuters implementering af ny national

klinisk retningslinje. ......................................................................................................................................................... 45

Eva Hoffmann: Pårørendes kontakt med sundhedsprofessionelle på en Fælles Akut Modtagelse (FAM) ....................... 46

Christina Radl-Karimi: Samskabelse af sundhedsservice ................................................................................................. 47

Mette Løwe Netsey-Afedo: Beslutningstagning i behandlingen af mænd med fremskreden prostatakræft -

kommunikation og organisation. ...................................................................................................................................... 48

Ditte Beck Jepsen: Effekten af helkropsvibrationstræning på fald og knoglebrud - et systematisk review og meta-

analyse .............................................................................................................................................................................. 49


Chairwoman: Berit Schiøttz-Christensen

Hanne Irene Jensen: Afklaring af patienters og plejehjemsbeboeres ønsker for den sidste tid......................................... 51

Karin Yde Waidtløw: Kodning af patientklager, og udvikling af et nyt klassifikationssystem på Sygehus Lillebælt ..... 52

Lisbeth Petersen: Barrierer for et sammenhængende rygforløb........................................................................................ 53

Maiken Wolderslund: Lydoptagelse af patientsamtaler via MitForløb ............................................................................ 54

Martha Haahr: Sikkerhed og mulig virkning af injection af autologe fedderiverede stamceller hos mænd med

rejsningsbesvær efter fjernelse af prostata: en 12 måneders opfølgning........................................................................... 55


Chairwoman: Malene Grubbe

Signe Høi Rasmussen: Forbedret kognition over 20 år hos 100 årige? Sammenligning af 1895 og 1915

fødselskohorterne .............................................................................................................................................................. 57

Christina Møller Andersen: Characterization of the remodeling events contributing to trabecularization of cortical bone:

A study on human fibula diaphysis ................................................................................................................................... 58

Christina Møller Andersen: Key intracortical remodeling events leading to increased cortical porosity during aging .... 59

Siv Lykke Jørgensen: Is implementation of robotic surgery in endometrial cancer treatment beneficial? – A study of

individualized functioning assessment and survival. ........................................................................................................ 60

Mike Mikkelsen Lorenzen: Psychological aspects of body contouring surgery: A qualitative study............................... 61


Forskningsforum

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Lokale U6 - Foredragene vil blive holdt på dansk


Chairman: Egon Stenager

Mette Moustgaard Jeppesen: Detection of recurrence in early stage endometrial cancer – the role of symptoms and

routine follow-up .............................................................................................................................................................. 63

Henriette Bruun: Etiske dilemmaer behandlet i Kliniske Etiske Komite for psykiatrien i Region Syddanmark i perioden

2010- 2015: En kvalitativ tematisk analyse. ..................................................................................................................... 64

Gitte Thybo Pihl: Mødres informationsbehov i forbindelse med calmettevaccination. Et mixed method design. ........... 66

Dennis Lund Hansen: Epidemiology of chronic haemolytic anaemia .............................................................................. 67

Eivind Antonsen Segtnan: Quantification of diaschisis .................................................................................................... 68

Jakob Emiliussen: Hvordan oplever terapeuter manualiseret behandling? (forskningsprotokol) ..................................... 69

Auditoriet - Foredragene vil blive holdt på dansk

Auditoriet – Session 1 - kl.09.00-10.00

Chairwoman: Bibi Gram

Manasi Sayilekshmy: Relating Cortical Bone Mechanics to Intracortical Distribution of Nerves in Human Bone and

their Association to Bone Remodeling Events and Vascular Structures .......................................................................... 71

Simon Chang: Platelet aggregation is not increased in testosterone treatment naive Klinefelter syndrome .................... 72

Pia Lysdal Veje: Traditionelt sengebad med vand og sæbe kontra anvendelse af vaskeservietter – hvad mener

patienterne? ....................................................................................................................................................................... 73

Stine Brændegaard Winther: NORDIC9: a Nordic randomized phase II trial exploring treatment strategies of older

patients with metastatic colorectal cancer ......................................................................................................................... 74

Tina Dalager: Musculoskeletal pain among Danish surgeons .......................................................................................... 75


Chairwoman: Else Marie Pinholt

Xenia G. Borggaard: Characterizing the molecular mechanism of continuous bone resorption - an in vitro study ......... 77

Andreas Dammann Andersen: Cerebrospinal fluid biomarkers for Parkinson's disease and L-DOPA-induced dyskinesia

.......................................................................................................................................................................................... 78

Bettina Ravnborg Thude: Dual leadership og fælles ledelse i praksis – et studie af 3 danske sygehusafdelinger ............ 79

Kent Søe: The variable sensitivity of breast cancer patients to treatment against bone resorption ................................... 80

Kristina Boe Dissing: Spinal pain in Danish school children – how often and how long? The CHAMPS Study-DK ..... 81


Forskningsforum

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Chairwoman: Anna-Marie Bloch Münster

Thomas Schmidt: Interdisciplinary Mixed Methods Research: Ensuring That Everybody Wins – An Example From The

Emergency Department .................................................................................................................................................... 83

Mette Hjortkjær: BRCAness in a Danish cohort of epithelial ovarian carcinoma. ........................................................... 84

Leila Saud Abdulkadir: HVORFOR KOMMER PATIENTEN IKKE? En kvalitativ undersøgelse af udeblivelser blandt

patienter med anden etnisk baggrund end dansk .............................................................................................................. 85

Kristian Kjærgaard: Bone Formation by Sheep Stem Cells in an Ectopic Mouse Model: Comparison of Adipose and

Bone Marrow Derived Cells ............................................................................................................................................. 86

Jesper Ryg: Funktionsniveau ved indlæggelse på geriatrisk afdeling som risikofaktor for mortalitet: et landsdækkende

populationsbaseret kohorte studie ..................................................................................................................................... 87


Forskningsforum

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Forskningsforum

9

Lokale S1 – Session 1

kl.09.00-10.00


Forskningsforum

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Structural valve deterioration in the Mitroflow biological heart valve prosthesis Authors Issa Farah Issa1, Steen Hvitfeldt Poulsen2, Farhad Waziri2, Christian Torp

Pedersen3, Per Hostrup Nielsen2, Lars Riber1, Jordi S. Dahl1, Peter Søgaard3,

Martin Agge Nørgaard3, Jacob Eifer Møller1.

(1) Department of Cardiology and Cardiothoracic and Vascular Surgery, Odense University Hospital

(2) Department of Cardiology and Cardiothoracic and Vascular Surgery, Aarhus University Hospital Skejby

(3) Department of Cardiology and Cardiothoracic and Vascular Surgery, Aalborg University Hospital

Email [email protected]

Speaker Issa F. Issa

Background and

Purpose

Annually more than 200,000 patients are treated with surgical aortic valve re-

placement. Concern has been raised regarding the long-term durability of the

Mitroflow aortic valve bioprosthesis.

To assess the incidence of structural valve deterioration (SVD) for the Mitro-

flow bioprosthesis in a nationwide study.

Methods All patients alive in Denmark with a Mitroflow bioprosthesis implanted since

January 2000 were invited to participate in a cross-sectional study. 1717 pa-

tients were identified (861 deceased, 47 reoperated and 165 were operated in

a private hospital or were tourists). The remaining 644 patients were invited

and 574 accepted and were evaluated for SVD. Incidence of SVD was calcu-

lated using competing-risks regression analysis with death as competing

event.

Results With echocardiography 173 were diagnosed with SVD (64 severe and 109

moderate). Severe SVD was associated with prosthesis age and small prosthe-

sis size. OR were 4.11 [1.19-14.34], p=0.02 and 10.13 [2.08-49.25], p=0.004

for size 21 and 19 respectively. The cumulative incidence of reoperation or

severe SVD at year 9 was 12.1% [7.3-18.1] for a size 19, 8.2% [5.8-11.0] for

a size 21, and 5.9% [3.7-8.6] for a size 23-29.

Conclusion The incidence of undetected severe SVD was as high as the incidence of oper-

ated SVD. The overall risk of SVD is high for the Mitroflow bioprosthesis,

which especially is increased in small prostheses and prostheses older than 5

years. Further, the study suggests that SVD is associated with adverse left ven-

tricle remodeling, poorer functional status and neurohormonal activation

Presentation

language

English


Forskningsforum

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Personality profiles, grade of disability, and physical activity level correlate with

the onset of medication-overuse headache Authors Mose LS1, 2, Pedersen SS3, 4, Jensen RH5, Gram B2

1 Department of Neurology, Hospital South West Jutland, Esbjerg, Denmark,

2 Department of Regional Health Research, University of Southern Denmark/ Hospital South West Jutland, Esbjerg

Denmark,

3 Department of Psychology, University of Southern Denmark, Odense, Denmark,

4 Department of Cardiology, Odense University Hospital, Odense, Denmark

5 Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Denmark.


Speaker Ph.D.-student Louise S. Mose

Background and

Aim

Medication-overuse headache (MOH) is a chronification of headache with mi-

graine being the most common prior primary diagnosis. The elucidation of

psychological profiles of migraineurs developing MOH is not fully under-

stood. Furthermore, severe disability and physical inactivity are frequent

among MOH patients compared to migraineurs but their role in chronification

is yet unknown. The aims of this study are to (i) compare personality profiles,

grades of disability and physical activity level of migraine patients that have

developed MOH to migraine patients without MOH, and (ii) investigate if

personality profiles, grades of disability and physical activity level correlate

with onset of MOH.

Design, Methods

and Variables

This is a single-center observational study conducted from October 2015 to

February 2017. One-hundred-and-four migraine patients participated and com-

pleted questionnaires on personality, disabilities and physical activity. After

16 months, diagnostic codes from patients’ electronic health records confirmed

if they had developed MOH.

Personality profile using NEO Five-Factor Inventory (NEO-FFI-3) question-

naire, Self-reported grade of disability due to migraine (MIDAS), Self-re-

ported Physical activity level (PAS 2.1).

Preliminary re-

sults

The majority of the participants were women (86%). Of all patients, 11%

(n=11) developed MOH, while 89% (n=93) were migraine patients without

MOH at follow-up. The two groups were comparable on demographic charac-

teristics, but MOH patients were more likely to be unemployed or receiving

sickness benefits than migraineurs (36% vs. 22%; p<0.05). The MOH patients

had significantly more headache days as compared to the migraine patients

(54±29 days vs. 33±26 days; p<0.05). There were no differences on personal-

ity profiles or physical activity level.

Conclusion This study demonstrates that 11% of migraine patients developed MOH and

that they already as migraineurs reported significantly more headache days

than the other migraineurs. This emphasizes the need for screening tools that

can help us identify migraine patients at risk of developing MOH in clinical

practice, as this subset of patients may need additional support and follow-up.

Presentation

language

English


Forskningsforum

12

The associations between changes in referral options for general practitioners

and the use of magnetic resonance imaging for low back pain patients – evidence

from a natural experiment using nationwide data Authors Morten Sall Jensen, Center for Kvalitet; Kim Rose Olsen, COHERE SDU;

Lars Morsø, Center for Kvalitet; Jens Søndergaard, Forskningsenheden for Al-

men Praksis; Berit Schiøttz-Christensen, Rygcenter Syddanmark


Speaker Morten Sall Jensen

Objective This study investigates changes in referrals to lumbar MRI and estimates

changes in MRI rates due to policy changes in Region of Southern Denmark

(RSD) and Capitol Region (CR), where RSD in 2010 opened a Spine Centre

and direct referral access to lumbar MRI for GPs and CR allowed GPs to refer

to lumbar MRI.

Background

data and Meth-

ods

We retrieved all lumbar MRIs performed on Danish hospitals from 2007-2013

using the national registries from Statistics Denmark.

We used two difference-in-difference (DD) models using OLS regression to

analyze the changes in the MRI rate per 1,000 citizens. Both models included

dummy variables pre-post policy change and one for each year. Model 1 had

an RSD/control region dummy and Model 2 a Capitol region/control region

dummy. The referrals to MRI in RSD and CR were divided into referral modes.

Preliminary re-

sults

229,758 patients had 299,977 lumbar MRI’s from 2007 to 2013 in the five

regions. Mean MRI-rates from 2007-2009 were 5.19 for RSD, 5.03 for CR,

and 4.65 for controls. Mean MRI-rates after the policy change were 13.93 for

RSD, 8.67 for CR, and 8.55 for controls. The two DD model found higher MRI

rates in RSD 4.84 [95%CI 2.45:7.24] and an insignificant lowering of the MRI-

rate -0.26 [95%CI -2.32:1.81] in CR. The RSD direct referral option were used

in 19% (N=3,128) of all referrals in 2010 and increased by 112% accounting

for 41% of all referrals in 2013 where’s CR’s only accounted for 9-12% of

total referrals from 2010-2013.

Conclusion The policy changes in RSD and CR indicates that centralization into a spine

hospital in combination with GP direct referral access has a larger impact on

MRI usages, than having decentralized spine departments with or without im-

plementing GP direct referral access.

Presentation

language

English


Forskningsforum

13

Heterogeneity of miRNA expression in localized prostate cancer with clinico-

pathological correlations Authors Ahmed Hussein Zedan1,2,6, Søren Garm Blavnsfeldt1, Torben Frøstrup Han-

sen2, Boye Schnack Nielsen3, Niels Marcussen4, Mindaugas Pleckaitis5, Palle

Jörn Sloth Osther1,6, Flemming Brandt Sørensen5,6 1) Urological Research Center, Department of Urology, Vejle Hospital, part of Lillebaelt Hospital, Vejle, Denmark

2) Department of Oncology, Vejle Hospital, part of Lillebaelt Hospital, Vejle, Denmark

3) Bioneer A/S, Hørsholm, Denmark

4) Department of Pathology, Odense University Hospital, Odense, Denmark

5) Department of Clinical Pathology, Vejle Hospital, part of Lillebaelt Hospital, Vejle, Denmark

6) Institute of Regional Health Research, University of Southern Denmark, Denmark


Speaker Ahmed Hussein Zedan

Background In the last decade microRNAs (miRNAs) have been widely investigated in

prostate cancer (PCa) and have shown to be promising biomarkers in diagnos-

tic, prognostic and predictive settings. However, tumor heterogeneity may in-

fluence miRNA expression. The aims of this study were to assess the impact

of tumor heterogeneity, as demonstrated by a panel of selected miRNAs in

PCa, and to correlate miRNA expression with risk profile and patient outcome.

Material and

Methods

Prostatectomy specimens and matched, pre-operative needle biopsies from a

retrospective series of 49 patients, who underwent curatively intended surgery

for localized PCa, were investigated with a panel of 6 miRNAs (miRNA-21,

miRNA-34a, miRNA-125b, miRNA-126, miRNA-143 and miRNA-145), us-

ing tissue micro-array (TMA) and in situ hybridization (ISH). Inter-and intra-

patient variation was assessed using intra-class correlation (ICC).

Results Four miRNAs (miRNA-21, miRNA-34a, miRNA-125 and miRNA-126) were

significantly upregulated in PCa compared to benign prostatic hyperplasia

(BPH), and except for miRNA-21 these miRNAs documented a positive cor-

relation between the expression level in PCa cores compared to their matched

BPH cores, (r > 0.72). The ICC varied from 0.451 to 0.764, with miRNA-34a

showing an intra-tumoral heterogeneity accounting for less than 50% of the

total variation. Regarding clinico-pathological outcomes, only miRNA-143

showed potential as a prognostic marker, with a higher expression correlating

with longer relapse-free survival (p = 0.016).

Conclusion The present study documents significant upregulation of the expression of

miRNA-21, miRNA-34a, miRNA-125 and miRNA-126 in PCa compared to

BPH, and suggests a possible prognostic value associated with the expression

of miRNA-143. The results document, however, intra-tumoral heterogeneity

in the expression of various miRNAs, calling for caution in using these tumor-

tissue biomarkers in prognostic and predictive settings.

Presentation

language

English


Forskningsforum

14


kl.10.00-11.00


Forskningsforum

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GWAS based polygenic analysis of allergic rhinitis Authors Afsaneh Mohammadnejad1,2, Charlotte Brasch-Andersen3,4, Annette Haage-

rup5,Jørgen Vestbo6, Jan Baumbach2,7 , Qihua Tan1,3

1. Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern

Denmark, Denmark

2. Department of Mathematics and Computer Science, University of Southern Denmark, Denmark

3. Unit of Human Genetics, Department of Clinical Research, University of Southern Denmark, Denmark

4. Department of Clinical Genetics, Odense University Hospital, Denmark

5. Human Genetics, Institute of Biomedicine, Århus University

6. Division of Infection, Immunity and Respiratory Medicine, University of Manchester, UK

7. Max Planck Institute for Informatics, 66123 Saarbrücken, Germany


Speaker Afsaneh Mohammadnejad

Background Allergic Rhinitis (AR) is a complex disorder that affects many people around

the world. There is a high genetic contribution to the development of the AR,

as twins and family studies have estimated heritability of more than 33%. Due

to the complex nature of the disease, single SNP analysis has limited power in

identifying the genetic variations for AR. We combined genome-wide associ-

ation analysis (GWAS) with polygenic risk score (PRS) in exploring the ge-

netic basis underlying the disease.

Methods We collected clinical data on 631 Danish subjects with AR cases consisting of

434 sibling pairs and unrelated individuals (both males and females)and con-

trol subjects of 197 unrelated individuals(solely males). SNP genotyping was

done by Affymetrix Genome-Wide Human SNP Array 5.0. SNP imputation

was performed using IMPUTE2. Using additive effect model, GWAS was con-

ducted in a discovery sample, the genotypes and their effect sizes were used to

calculate PRS in an independent testing sample. PRS is the summation of gen-

otypes weighted by effect sizes estimated from GWAS.

Results We found 14 suggestive significant SNPs from GWAS (p<10−5). A signifi-

cant PRS (p=0.04) was defined by 379409 SNPs with imputation (P-value cut-

off <0.2) which explains 3% of the variation in AR and also a significant PRS

(p=0.02) defined by 145839 SNPs without imputation. Both imputed and gen-

otyped SNPs confirmed genetic contribution to the AR.

Presentation

language

English


Forskningsforum

16

DNA methylation age and perceived age in elderly Danish twins Authors Birgit Debrabant

Epidemiology, Biostatistics & Biodemography, Institute of Public Health,

SDU


Speaker Birgit Debrabant

Background and

Purpose

Perceived age is an easily accessible biomarker of aging and an integral part

of assessment of patients. Here, we studied its relation to DNA methylation

age (DNAm age) as introduced in (Horvath, 2013) in 180 elderly Danish twins.

Primary Varia-

bles

Perceived age, DNAm age, chronological age

Methods og Re-

sults

We found perceived age and DNAm age to be associated with chronological

age (P=0.04 resp. P=2.2e-10) when correcting for gender, but did not see an

association between perceived age and DNAm age (P=0.44). Intrapair-analy-

sis showed that the proportion of pairs where the twin with the highest per-

ceived age also had the highest DNAm age was not different from 0.5 (P=1),

and we did not see a trend when dividing pairs according to their difference

in perceived age (P=0.36). Hence, intrapair analysis did not reveal links be-

tween perceived age and DNAm age. Moreover, none of the 353 CpGs un-

derlying DNAm age was individually associated to perceived age after cor-

rection for multiple-testing (P>6e-4, FDR>0.21). Finally, when constructing

an epigenetic signature based on these CpGs to predict perceived age, we

only found a correlation of 0.18 (95%CI: -0.06-0.40) and a mean square error

of 13.6 years2 between observed and predicted values in the test dataset, indi-

cating poor predictive strength.

Conclusion Altogether, our results suggest that perceived age and DNAm age capture dif-

ferent ageing aspects.

Presentation

language

English


Forskningsforum

17

Patient-reported flares in rheumatoid arthritis patients with low disease activity:

a comprehensive clinical, biochemical and imaging characterisation Authors Kuettel D 1,2, Primdahl J1,2, Weber U1,2, Østergaard3 M, Terslev L3, Hørslev-

Petersen K1,2

1.Institute for Regional Health Research, University of Southern

Denmark, Odense

2.King Christian X's Hospital for Rheumatic Diseases, Graasten, Denmark,

3.University of Copenhagen, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Dis-

eases, Rigshospitalet- Glostrup, Glostrup, Denmark


Speaker Dorota Kuettel

Objectives and

background

Flares, episodes of worsening disease activity are recognized features of rheu-

matoid arthritis (RA). There has been little consensus on how to define flare

and different definitions have been proposed, among them the patient reported

flare (PRF). There is an unmet need to identify and characterize such episodes

because they may adversely impact outcome. Objectives: comprehensive de-

scription of PRF by a multimodal approach with patient self-report, clinical,

laboratory and imaging (MRI and ultrasound (US)) assessments; exploration

of predictors for flaring and agreement between patient- and clinician-evalua-

tion at the time of flare.

Design A prospective observational cohort of 80 RA patients with a nested case-cross-

over study of patients with a flare-up, with 1 year of follow-up.

Methods Patients will fill in serial self-assessment questionnaires every three months.

Clinical visits will be scheduled at baseline, and at month 6 and 12. Patients

with experience of a flare during the observation period will be followed by a

nested case cross-over design. Patients with flares will undergo a thorough

clinical, laboratory and imaging (MRI and US) assessment at the time of their

self-reported flare and 12 and 13 weeks post-flare.

Results Recruiting patients since August 2016

Conclusions The study may aid understand PRF and identify flare predictors to improve

outcome.

Presentation

language

English


Forskningsforum

18

Detecting tuberculosis in skeletons – association of skeletal lesions and disease

diagnosis

Authors Dorthe Dangvard Pedersen1, Hans Jørn Kolmos2, George R. Milner3 and

Jesper L. Boldsen1

1 Anthropological Unit (ADBOU), Department of Forensic Medicine, SDU.

2 Department of Clinical Microbiology, OUH.

3 Department of Anthropology, Penn State University, USA


Speaker Dorthe Dangvard Pedersen

Purpose and

Background

Tuberculosis can affect bones. Detecting tuberculosis in skeletons can

therefore provide insights into the presence of the disease in times before

historic medical records were available. To perform such paleoepidemio-

logical studies it is necessary to establish the association of assumed tu-

berculosis related bone lesions and disease diagnosis, and to estimate le-

sion sensitivity and specificity to quantify their relation to this particular

disease.

Methods

A case-control study was performed with 480 skeletons from documented

skeletal collections: 240 skeletons from individuals that died from tuber-

culosis, and 240 age and sex-matched skeletons that most likely did not

have the disease, which were included as controls. The association of 19

lesions distributed throughout the skeleton and tuberculosis was tested by

comparing lesion distributions in the people who suffered from tuberculo-

sis and controls.

Results

Six lesions were found with no significant difference in cases and controls.

Seven lesions were found with significant difference but were found with

low frequencies and not occurring in patterns of significant association

with other lesions. Six lesions were found significantly more often among

cases compared to controls, they were found in patterns of significant as-

sociation with each other and they had sensitivities greater than one minus

specificities, indicating that they occurred more often in those with disease

than in those not diagnosed with tuberculosis. These bone lesions - bone

proliferation on pleural surface of ribs, bone proliferation on ventral ver-

tebral bodies, pitting and bone proliferation on lateral iliac body, pitting

on non-articular surface of acetabulum, erosive lesions on iliac auricular

surface and pitting on ulnar olecranon process – are thus considered to be

good tuberculosis indicators.

Conclusion

Recording of the six good tuberculosis indicators are thus recommended

when performing paleoepidemiological studies of tuberculosis. With such

it is possible to get insights into the impact of tuberculosis in the past.

Presentation lan-

guage

English


Forskningsforum

19

Relating Cortical Bone Mechanics to Intracortical Pore Morphology, Distribu-

tion and Remodeling History within the Fibula Diaphysis Authors Lydia P. Bakalova1, [email protected], Christina M. Andreasen2, cmandre-

[email protected], Jesper S. Thomsen3, [email protected], Annemarie Brüel3, mb@bio-

med.au.dk, Ellen M. Hauge4, [email protected], Birgitte Jul Kiil5, [email protected],

Jean-Marie Delaisse6,[email protected], Thomas Levin Andersen6,7,

[email protected] , and Mariana E. Kersh1,7, [email protected] 1 Department of Mechanical Science and Engineering University of Illinois at Urbana-Champaign Urbana, Illinois,

USA;

2 Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, OUH ;

3 Department of Biomedicine, AU;

4 Department of Rheumatology, AUH;

5 Department of Plastic Surgery, AUH;

6 Clinical Cell Biology, Vejle Hospital – Lillebælt Hospital, IRS, SDU;

7 Co-senior authors.


Speaker Thomas Levin Andersen

Background During aging and osteoporosis the cortical bone becomes more porous, making

it more fragile and susceptible to fractures. The aim of this study was to inves-

tigate the intracortical compression-induced strain energy distribution, and ad-

dress whether the intracortical pores associated with a high strain energy den-

sity (SED) in the surrounding bone have a different morphology, distribution

and remodeling history than pores with a low SED.

Methods The study was conducted on fibula diaphysis specimens from 20 patients un-

dergoing a jaw reconstruction (age range 43-75 years, 14 men and 6 women).

Samples were plastic embedded, µCT-scanned and sectioned for histology.

The compression-induced high and low SED pores were identified using a lin-

early elastic µFinite-Element analysis.

Results Pores with high SED were larger (p<0.001), less circular (p<0.001), and were

located closer to the endosteal edge of the cortex (p<0.001) than low SED

pores. A detailed histological analysis of the remodeling event generating the

pores revealed that that the high SED pores compared to low SED pores had a

13.3-fold higher odds of being a resorptive (70%) or formative (11%) pore

rather than a completely remodeled pore (p<0.001). Compared to the low SED

pores, the resorption space associated the high SED pores had a 5.9-fold higher

odds of overlapping with the pore of a preexisting osteon (type 2 pore - 91%)

than having no overlap (type 1 pore – 9%) (p<0.001).

Conclusion Collectively, the study demonstrates a strong relationship between cortical

bone mechanics and pore morphology, distribution and remodeling history.

Presentation

language

English


Forskningsforum

20


kl.11.00-12.00


Forskningsforum

21

Whole-genome Bisulfited Sequencing on Discordant Identical Twins For BMI Authors Weilong Li1, Jan Baumbach2,3, Lene Christiansen1, Qihua Tan1,4

1. Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern

Denmark, Denmark

2. Department of Department of Mathematics and Computer Science, University of Southern Denmark, Denmark

3. Max Planck Institute for Informatics, 66123 Saarbrücken, Germany

4. Unit of Human Genetics, Department of Clinical Research, University of Southern Denmark, Denmark


Speaker Weilong Li

Background Body mass index (BMI) serves as an important measurement of obesity and

adiposity which are highly correlated with cardiometabolic disease. Many ge-

netic variants have been identified in genetic association studies but with small

proportion of BMI variation explained. As of yet we have limited knowledge

about the association of epigenetics and BMI, and few studies that focus on

BMI use whole genome bisulfite sequencing data. Taking advantage of

monozygotic twins being genetic identical, we aim to explore the association

between DNA methylation profile and BMI and seek to detangle the environ-

mental influence on BMI, using discordant twin design for controlling the ge-

netic effect.

Material Thirty Monozygotic twin pairs are included for this study with 11% minimum

and 38% maximum BMI difference. There are 15 male pairs and 15 female

pairs with age ranging from 39 to 72 years old. Methylation data from whole

blood sample is collected using reduced representation bisulfite sequencing

(RRBS). Approximately 4 million CpGs coverage in this platform means that

data processing and analysis is extremely challenging. Preliminary analysis

suggests no significant association between BMI and age or sex.

Method RRBS is a cost-effective approach for genome-wide methylation pattern pro-

filing and RRBS data require many preprocessing procedures to obtain meth-

ylation data for whole CpG sites. Reads will be mapped to reference genome

using mapping software that specialized for bisulfite sequencing. Methylation

levels for each CpG will be extracted afterwards for data analysis. We will

apply the model we previously proposed that regress intra-pair methylation

difference on phenotype with adjustment of other factors such as age and sex

on need. We will examine the whole genome for differential methylated CpGs

and report those who are significantly associated with BMI for further pathway

analysis.

Presentation

language

English


Forskningsforum

22

A new method to identify where human hematopoietic stem and progenitor cells

(HSPCs) are positioned in human bone marrow Authors Helene B. Kristensen, [email protected], Thomas L. Ander-

sen, [email protected] 1, Tanja Tvistholm Sikjaer,

[email protected] , Charlotte Ejersted, [email protected]

and Jean-Marie Delaissé, [email protected]

1 Department of Clinical Cell Biology, Lillebaelt Hospital, Vejle,

2 Institute of Clinical Medicine, Aarhus University Hospital,

3 Department of Endocrinology, Odense University Hospital


Speaker Helene B. Kristensen

Background Current knowledge regarding distribution of HSPCs in bone marrow almost

exclusively comes from mouse models. Because of the many differences be-

tween mice and humans, we have developed a new method that enabled us to

reveal where human HSPCs are positioned in human bone marrow.

Method Bone marrow biopsies from healthy individuals (n=10, females, age 36-

71years, Danish National Committee on Biomedical Research Ethics project

ID# S-20110112) was included. From each biopsy we included four adjacent

sections which were stained for: i) CD34 and CD56 by using immunohisto-

chemistry (IHC); ii) CD34, CD38 and TRAcP by using immunofluorescence

(IF); iii) CD34 and smooth muscle actin by using IHC; and iv) Masson’s tri-

chrome. Hereby we could distinguish components of the vascular system,

HSPCs, osteoblasts, osteoclasts, quiescent and remodeling bone surfaces. Pic-

tures of the Masson’s trichrome-stained sections were obtained at x2.5 magni-

fication and printed. The extent of quiescent and remodeling bone surfaces

were assessed by light microscopy and marked on the print. IHC- and IF-

stained sections were scanned using a Hamamatsu scanner. We identified two

populations of HSPCs: CD34 high/CD38neg and CD34int/low/CD38pos.

Result In total we identified 2663 cells, of these 167 were CD34 high/CD38neg. All 167

cells adhered to the following criteria: high nucleus/cytoplasm ratio; inten-

sively stained cytoplasm; not part of a vascular structure on the adjacent IHC-

stained sections. Bone surface events are known to influence bone marrow

events within a distance of 50 µm from the bone surface. We identified 30 of

the CD34 high/CD38neg within this 50 µm distance from the bone surface.

Conclusion HSPCs including the rare population of CD34high/CD38neg cells can be identi-

fied in human bone marrow biopsies. Moreover, a subpopulation of the

CD34high/CD38neg cells was identified in the zone influenced by bone surface

events.

Presentation

language

English


Forskningsforum

23

Establishment and molecular characterization of penile carcinomas cell lines:

models for the identification of novel therapeutic strategies Authors Hellen Kuasne1,2 [email protected], Sandra A Drigo3, [email protected], Fabio A

Marchi2, [email protected], Gustavo G Guimaraes2, [email protected], Ademar

Lopes2, [email protected], José C Trindade Filho3, [email protected], Cristo-

vam Scapulatempo Neto4,[email protected], Eliney F Faria4, elineyfer-

[email protected], Sebastien Carreno5, [email protected] , and

Silvia R Rogatto 1 [email protected]

1 Clinical Genetics Dept, Lillebælt Hospital, IRS, SDU;

2 AC Camargo Cancer Center, SP, Brazil;

3 Department of Urology, FMB-UNESP, Botucatu, SP, Brazil;

4 Barretos Cancer Hospital, Barretos, SP, Brazil;

5 Département de Pathologie et de Biologie Cellulaire, Université de Montréal, Montréal, Québec, Canada


Speaker Silvia Regina Rogatto

Background Penile cancer (PeCa) is a mutilating disease commonly observed in poor and

developing countries. The lack of well-characterized in vitro models of PeCa

hampers advances in the establishment of new therapeutic strategies.

Methods Five of 20 PeCa cell lines were successful cultured for more than 20 passages.

These cells were characterized in epithelial or fibroblastic by immunofluores-

cence and FACS using the epithelial markers CK10, CK14 and EpCAM. Tu-

morigenic potential was assessed by anchorage-independent growth, prolifer-

ation, migration and invasion assays, and mouse xenograft. Genomic profiles

of primary tumors and their derived cell cultures were evaluated using Cy-

toScan HD (Affymetrix). Expression levels of 304 cancer related proteins were

investigated using Reverse Phase Protein Array (RPPA). Chemosensitivity as-

say upon cisplatin and anti-EGFR inhibitor (Erbitux, Tarceva and Iressa) treat-

ments was evaluated by MTT test.

Results Two PeCa cells showed typical epithelial morphology and epithelial marker

expression (Cell lines 2 and 3) and three cancer-associated fibroblasts (CAFs)

(Cell lines 4 to 6). These cells presented cancer behavior features including

anchorage-independent growth (Cells 2-5), invasive potential (Cells 3-4), and

capability to form tumor in nude mice (Cell 3). Genomic, transcriptomic and

proteomic analysis revealed high similarities between the primary tumors and

their derived cells. The cells were sensitive to cisplatin, a chemotherapy agent

used in advanced PeCa. One cell line presenting EGFR overexpression was

sensitive to anti-EGFR drugs. These data are in agreement with recent studies

in which patients with advanced PeCa expressing EGFR had a favorable over-

all survival after treatment with EGFR-targeted therapies

Conclusion These cells are reliable in vitro models to dissect mechanisms promoting penile

carcinogenesis and to identify new therapeutic strategies.

Presentation

language

English


Forskningsforum

24

Health Care Encounters In Danish Chiropractic Practice From A Consumer

Perspectives - A Mixed Methods Investigation Authors Corrie Myburgh1, Eleanor Boyle1,2, Johanne Brinch Larsen1 and Henrik Wulff

Christensen3 CM: Associate Professor, University of Southern Denmark, Department of Sports and Clinical Biomechanics, Cam-

pusvej 55, Odense M, 5230, Denmark.

EB: Associate Professor, University of Southern Denmark, Department of Sports and Clinical Biomechanics, Cam-

pusvej 55, Odense M, 5230, Denmark.

JBL: Private practice, Rosenbæk Torv 15, st. 1, Odense C, 5000, Denmark. HWC: Director Nordic Institute of Chi-

ropractic and Clinical Biomechanics, Campusvej 55, Odense M, 5230, Denmark.


Speaker Corrie Myburgh

Background Perceived value is the key ingredient to carving and maintaining a competitive

business niche. The opportunities to interact with consumers to understand and

enhance perceived value are termed ‘touch points’. Due to the out-of-pocket

expense incurred by patients, Danish chiropractors are subject to consumer

trends and behaviors. The purpose of this investigation was to explore and de-

scribe consumer touch points relevant to perceived value through healthcare

journeys in chiropractic practices.

Methods We designed a convergent parallel, mixed methods study. Our purposive sam-

pling framework identified 11 chiropractic clinics from which we collected

observational field notes, video recordings and face-to-face interviews.

Results Data was collected between April 14th and June 26th 2014. We described the

exteriors and interiors of all participant clinics, interviewed 32 staff members,

12 new patients and 36 follow-up patients and finally video recorded 11 new

and 24 follow-up consultations. Categorization and analysis led to the emer-

gence six consumer touch point themes: ‘the internet’, ‘the physical environ-

ment’, ‘practice models’, ‘administrative staff’, ‘the consultation sequence and

timing’ and ‘a consultation that adds value’. The Internet functions as a tool

when choosing/confirming a clinic as appropriate, developing and initial im-

age and managing appointments. The administrative hub appears integral to

the shaping of positive consumer experiences outside of the consultation.

Clinic location, practice model and interior design may contribute to context

effects and thus may influence value perception during the clinical encounter.

The duration of hands-on treatment received from the chiropractor is not an

apparent consumer focus point. Rather, through a seven stage clinical proce-

dure patients value consultations with clinicians who demonstrate professional

competence by effective communication diagnosis/management and facilitat-

ing satisfactory treatment outcomes.

Conclusion At least six consumer touch points add/detract from value-related experiences

in chiropractic practices. The duration of hands-on treatment per se does not

appear to be a particular focus point. More research is required to explore this

issue.

Keywords Chiropractic, Consumer behaviour, Health care encounters

Presentation

language

English


Forskningsforum

25

Quality of life in Danish multiple myeloma patients Authors Lene Kongsgaard Nielsen1 and Niels Abildgaard1 1Quality of Life Research

Centre, Department of Haematology, Odense University Hospital.


Speaker Lene Kongsgaard Nielsen

Purpose and

Background

The aim of the study is to describe and understand longitudinal quality of life

(QoL) in the general multiple myeloma (MM) population in order to be able

to initiate and test targeted initiatives for improving QoL in the future. Mye-

loma patients report high symptom burden and reduced health-related quality

of life (HRQoL) compared to patients with other haematological malignancies

and solid cancers. Systematic longitudinal monitoring of QoL outside clinical

trials has not been performed yet, so knowledge of the elderly and frail pa-

tients´ perspective on the myeloma disease is lacking, and the time after treat-

ment is left unstudied. For clinically meaningful interpretation of longitudinal

QoL data the handling of missing data and selected patient drop-out have an

impact. Moreover for clinically meaningful interpretation an integration of the

psychological phenomenon, response shift, is necessary.

Design The design of the study is a prospective, national, observational and primary

online survey with retrospective data collection from Danish registers.

Methods We will include 800 previously untreated and relapsed MM patients recruited

from all Danish haematological departments. By using a flexible design, the

patients will complete four validated QoL instruments (EORTC QLQ-C30,

MY20, CIPN20 and SF12v2) starting at treatment-demanding myeloma and at

12 follow-up time points over a period of 24 months. We will be using system-

atic real-time follow-up of missing data and collect reasons for patient drop-

out during follow-up.

Primary varia-

bles

Patient-reported changes in QoL over time will be analysed in relation to pa-

tient-related characteristics, type of anti-myeloma treatment, peripheral neu-

ropathy, other side effects of treatment, disease and treatment related compli-

cations and quality of response. For clinically meaningful interpretation of the

results, paralleled response shift assessment will be obtained repeatedly by

Then-tests.

Conclusion This study will provide real-life knowledge of the QoL from the general MM

patients´ perspective of the myeloma disease during anti-myeloma treatment

and the time afterwards taking patient-, disease- and treatment-related factors

into account. Identified methodologically challenges in longitudinal QoL stud-

ies will be met order to interpret longitudinal QoL data in a clinically mean-

ingful way. The results of the study will be a knowledge foundation and the

first step towards improved QoL for MM patients.

Presentation

language

English


Forskningsforum

26


kl.09.00-10.00


Forskningsforum

27

Pre-storage centrifugation conditions have significant impact on measured mi-

croRNA levels in biobanked EDTA plasma samples Authors Helle Glud Binderupa, Kim Houlindb,c, Jonna Skov Madsena,c, Claus Lohman

Brasena a Biokemi og Immunologi, Sygehus Lillebælt

b Karkirurgi, Kolding Sygehus

c Institut for Regional Sundhedsforskning, SDU


Speaker Helle Glud Binderup

Background In the past few years, an increasing number of studies have reported the poten-

tial use of microRNAs (miRNA) as circulating biomarkers for diagnosis or

prognosis of a wide variety of diseases. There is, however, a lack of reproduc-

ibility between studies. Due to the high miRNA content in platelets this may

partly be explained by residual platelets in the plasma samples used. When

collecting fresh plasma samples, it is possible to produce cell-free/platelet-poor

plasma by centrifugation. In this study, we systematically investigated whether

biobanked EDTA plasma samples could be processed to be suitable for

miRNA analysis.

Materials and

Methods

Blood samples were collected from ten healthy volunteers and centrifuged to

produce platelet-poor-plasma (PPP) and standard biobank plasma. After one

week at -80 °C the biobanked EDTA plasma was re-centrifuged by different

steps to remove residual platelets. Using RT-qPCR the levels of 14 miRNAs

in the different plasma preparations were compared to that of PPP.

Results We were able to remove residual platelets from biobanked EDTA plasma by

re-centrifugation of the thawed samples. Nevertheless, for most of the investi-

gated miRNAs, the miRNA level was significantly higher in the re-centrifuged

biobanked plasma compared to PPP, even when the platelet count was reduced

to 0–1 x 109/L.

Conclusion We found, that pre-storage centrifugation conditions have a significant impact

on the measured plasma level of miRNAs known to be present in platelets.

Even for the miRNAs found to be less effected, we showed that a 1.5 – 3 fold

change in plasma levels may possible be caused by or easily overseen due to

sample preparation and/or storage.

Presentation

language

Danish


Forskningsforum

28

Effect of two composite treatments on breast cancer related lymphedema, a mul-

ticenter, randomized, single-blind, equivalence trial Authors Mette Tambour1, Marianne Holt2, Anette Speyer3, Robin Christensen4, Bibi

Gram5. 1

Department of Physiotherapy and Occupational Therapy, Hospital of South West Jutland, Esbjerg,

2Department of Rehabilitation, Odense University Hospital,

3Department of Physiotherapy and Occupational Therapy, Lillebaelt Hospital, Vejle,

4Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen,

5Department of Regional Health Research, University of Southern Denmark/Hospital of South West Jutland, Esbjerg


Speaker Mette Tambour

Background and

Aim

Physical therapy treatment of patients with arm lymphedema after breast can-

cer surgery is based on the principles of Complete Decongestive Therapy

(CDT) and includes skin care, manual lymphatic drainage (MLD), bandaging

and exercises. The scientific evidence of the effectiveness of MLD is not con-

vincing and the question is whether MLD is dispensable in relation to CDT.

The aim of the study was to investigate whether CDT is equally effective if it

includes MLD or not in the treatment of arm lymphedema in patients with

breast cancer.

Design and

Methods

A randomized, single-blind, equivalence trial of two different composite treat-

ments on lymphedema. Patients recruited from the Hospital of South West

Jutland, Lillebaelt Hospital, and Odense University Hospital, were random-

ized into A: treatment with all 4 components of CDT or B: treatment with 3

components of CDT and without MLD. The patients received treatment 2

times per week for approximately 4 weeks. Primary endpoint: Volume re-

duction of arm lymphedema (ml and %) at follow-up (7 months) (not showed).

Secondary variables: Volume reduction of arm lymphedema (4 weeks), patient

experience of heaviness and tension (range: 0-10), Health related quality of

life.

Results and con-

clusion

Preliminary results based on interim analyses on 69 patients with lymphedema

(A: n=35, B: n=34). At baseline, the groups were identical regarding age, BMI,

relative volume of lymphedema, experience of heaviness and tension. In both

groups, the relative volume of lymphedema decreased significantly after the

intervention and the effect was unaffected by whether the treatment included

MLD or not (mean ±SE) (A:-116.0±27.3 (21.4%), B:-141.6±32.9 (24.3%))

corresponding to a statistically insignificant difference between the groups

(Δ:25.4, 95% CI, -43.7 to 94.1, p=0.47). Patients receiving MLD reported less

tension in the shoulder (p=0.02), but no statistically significant differences

were detected between the groups at other outcomes. Preliminary analyses of

this equivalence trial show that an arm lymphedema decrease equally effective

regardless of MLD is a part of the treatment.

Presentation

language

Danish


Forskningsforum

29

Comparison of tissue stiffness using Shear Wave Elastography in men with tes-

ticular cancer Authors Malene Roland Pedersen1,2,3, Henrik Møller4,5, Palle Jørn Sloth Osther2,3, Peter

Vedsted5,6, René Holst3,7 and Søren Rafael Rafaelsen1,3. 1) Department of Radiology, Clinical Cancer Centre, Vejle Hospital, Part of Lillebaelt Hospital, Denmark

2) Urological Research Centre, Vejle Hospital, Part of Lillebaelt Hospital, Denmark

3) Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark

4) Cancer Epidemiology and Population Health, King´s College London, United Kingdom

5) Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark

6) Department of Clinical Medicine, Aarhus University, Denmark

7) Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo


Speaker Malene Roland Pedersen

Aim To compare elastography measurements in men with normal testicular tissue,

testicular microlithiasis and testicular cancer.

Methods A total of 248 consecutive patients were included. All men provided written

informed consent. Testicular stiffness was assessed using shear wave elas-

tography (SWE). Three SWE velocity measurements were assessed in each

testicle. The patients were divided into three groups; men with normal testic-

ular tissue (n=130), men with testicular microlithiasis (n= 99) and men with

testicular cancer (n = 19).

Results We found a higher mean velocity in the group of patients with testicular cancer

(1.92 m/s (95% CI 1.82-2.03)) compared to both the group with normal tissue

(0.76 m/s (95% CI: 0.75-0.78)) (p<0.001) and the group with testicular micro-

lithiasis 0.79 m/s (95% CI: 0.77-0.81) (p<0.001).

Conclusion The presence of testicular microlithiasis increased stiffness slightly, but within

the range of variation in normal testicles. Increased stiffness may indicate tes-

ticular malignancy in testicular lesions. Ultrasound elastography could be a

very useful tool when investigating scrotum.

Presentation

language

Danish


Forskningsforum

30

Computer-assisted stereology and automated image analysis for quantification

of tumor infiltrating lymphocytes in colon cancer. Authors Ann Christina Eriksen (1), Johnnie Bremholm Andersen (2,3), Martin Kristens-

son (3), Flemming Brandt Sørensen (1,4). (1) Department of Pathology, Lillebaelt Hospital, (2) Department of Clinical Medicine, Stereological Research Labor-

atory, Aarhus, (3) Visiopharm, Hoersholm, Denmark, (4) Institute of Regional Health Research, University of Southern

Denmark.


Speaker Ann Christina Eriksen

Introduction In stage II colon cancer (CC), there is a need for more precise prognostic and

predictive variables, which will allow improved post-operative treatment strat-

ification. In this context, tumor infiltrating lymphocytes (TILs) have been ana-

lyzed in various settings, and several studies have shown promising results.

However, the lack of a standardized analytic technique is a major concern, and

so far none of the proposed immunohistochemically classifications has been

incorporated into routine clinical practice. Manual stereological counting is

considered the gold standard, but digital pathology with image analysis is pre-

ferred due to time efficiency. The purpose of this study was to compare manual

stereological counts of TILs with automatic counts obtained by image analysis.

Materials and

Methods

Three, paraffin embedded, tumor containing tissue blocks from 43 patients

treated for stage II CC in 2002, one of which representing the deepest invasive

tumor front, were selected. Serial sections from each of the 129 blocks were

immunohistochemically stained for CD3 and CD8, and the slides were scanned

with a NanoZoomer XR scanner (Hamatsuma, Japan).

Stereology: The stereological analysis was performed using the computer as-

sisted stereology system NewCAST. We used an integrated test system consist-

ing of a 2D unbiased counting frame for cell density estimation and a point grid

for area fraction estimation.

Image Analysis: An App-based algorithm was developed, using Visiopharm

Integrator System (VIS) software. The algorithm included two processing

steps: 1. Automatic exclusion of artifacts, including folds, fatty tissue and ne-

crosis. 2. Automatic classification of CD3+ and CD8+ cells using a Bayesian

classifier. For both methods we counted in two regions: a central and an inva-

sive area delineated manually by the observer.

Results We found an excellent correlation between the stereological method and the

App-based image analysis in both the central and invasive areas and for both

CD3 and CD8 stained sections. For the density count, Spearman’s correlation

coefficient varied from 0.9457 through 0.9638 (p<0.0001). Area fraction esti-

mates showed similar results with Spearman’s correlation coefficient varying

from 0.9400 through 0.9603 (P < 0.0001).

Discussion and

Conclusion

For histopathological quantification stereology is considered as the gold stand-

ard. In this study we found a high correlation between stereology and image

analysis, and we conclude that computer-assisted image analysis provide both

exact, objective and time efficient quantification of TILs. However, in using

the algorithm it is important to take staining variability into consideration.

Presentation

language

Danish


Forskningsforum

31

A study in optimizing follow up for postmenopausal women with breast cancer

treated with adjuvant endocrine therapy. Authors Cathrine Lundgaard Riis, MD, Department of Oncology, Vejle Hospital

Karina Dahl Steffensen, MD, PhD, Department of Oncology, Vejle Hospital

Troels Bechmann, MD, PhD, Department of Oncology, Vejle Hospital

Pernille T. Jensen,MD, PhD, Associate Professor, Odense University Hospital

Angela Coulter, BA (Hons), MSc, PhD, Adjunct Professor University of

Southern Denmark.


Speaker Cathrine Lundgaard Riis

Background Problem insight: In February 2015 the Danish Health and Medicines Authority

published new clinical guidelines describing how cancer patients should be

followed. It is pointed out that patients’ who receive specific oncological treat-

ment, like endocrine therapy, is recommended to be followed at the oncologi-

cal department who is responsible for the treatment and provide the patients

with the medication. There is no evidence that routine examinations, such as

blood tests, chest X-ray, ultrasound of the liver, CT and PET scans, improves

overall survival after breast cancer. Mammography is the only specific exam-

ination to be offered to asymptomatic women, after primary treatment for

breast cancer

Purpose We hypothesize that an individualized follow up with the introduction of PRO-

data will help the postmenopausal women regain control of their health related

self-care and encourage them for a wider participation in their follow up after

cancer treatment and thereby improve the patients’ positive experience of the

follow up program.

Design and

Methods

The study is designed as a feasibility study in which patients are randomly

assigned to the department’s standard control program or an individualized so-

lutions in the context of shared decision making, with the use of patient re-

ported outcomes (PRO-data) to evaluate the patient’ needs for consultations in

clinic by nurses, doctors, physiotherapists, social workers, psychologists or

even a coach, dietitian and/or a sexologist. In both programs the patients will

have the opportunity of calling the department to make arrangements for an

urgent appointment if needed, but only in the individualized program the pa-

tients will have the opportunity of mail consultations and the influence of how

much efforts they will spend on their follow up.

Results Currently the study population consists of 105 postmenopausal women diag-

nosed with operable, resectable and thus curative breast cancer, who by prog-

nostic factors are categorized as high risk with a 10-year recurrence of more

than 10%. These patients are candidates for 5 years adjuvant endocrine therapy

due to a positive estrogen-receptor status, regardless of other adjuvant therapy.

Randomized 1:1

Conclusion This study will provide experience and feasibility with the application of PRO-

data used as a screening tool, a decision aid and a quality assessment in aiming

for a more tailored follow up for breast cancer patients after primary treatment.

Presentation

language

Danish


Forskningsforum

32


kl.10.00-11.00


Forskningsforum

33

Biomarker CA125: To monitor or not for relapse of ovarian cancer? Develop-

ment of a decision aid to help patients make the decision. Authors Anette Stolberg Kargo, Department of Oncology, Vejle.

Angela Coulter, University of Oxford

Pernille Tine Jensen, 5Department of Gynaecology and Obstetrics, OUH.

Karina Dahl Steffensen, Department of Oncology, Vejle.


Speaker Anette Kargo

Background The majority of patients with ovarian cancer (OC) are diagnosed with ad-

vanced disease (70-80 %) and will experience disease relapse with only limited

curative potential. Early initiation of relapse treatment based on rising CA125

alone does not improve survival. Increasing CA125 can be detected months

before symptoms arise and recurrence is visible on imaging. Therefore, bio-

chemical detection of potential relapse by CA125 assessment can cause signif-

icant distress. A decision aid (DA) is a tool that provides information and de-

scribes advantages and disadvantages of a specific intervention thereby facili-

tating patient’s involvement in decision making. The present study develops

and validates a DA in decision-making on CA125 monitoring during follow-

up after OC treatment.

Methods Development of the DA was conducted in collaboration with clinicians, pa-

tients with OC, representatives from patient organisations and cancer societies.

First, a focus group of seven former OC patients was performed followed by a

quantitative rating of the DA pilot version. The DA was adapted accordingly

and then tested in 14 OC patients with recurrence using a structured interview

guide (alpha testing). A final adaptation was done and the DA is now ready for

testing on real-time patients (beta test).

Preliminary re-

sults

The alpha test showed that patients had a good understanding of the infor-

mation provided in the DA. In total, 10 of the patients indicated that the DA

helped clarifying what was important, and 12 patients agreed that the DA

prepared them to make a better decision and helped them reflecting on their

concerns regarding CA125.

Conclusion The DA was useful in decision making regarding monitoring CA125 during

follow up after OC. The majority of participants indicated that the DA was

helpful in clarifying their concerns and would be helpful in making a better

decision. The effectiveness of the DA will be tested in beta test.

Presentation

language

Danish


Forskningsforum

34

Effect of VEGF dose and observationtime on bone formation around titanium

implants. Experimental studies in sheep Authors Chris H. Dreyer, MD, PhD-student ([email protected])*1 Soeren Over-

gaard, MD, Professor ([email protected])1 Niklas Rye Joergensen,

MD, Professor ([email protected])3,4 Ling Qin, MD, Profes-

sor ([email protected]) *2 Ming Ding, MD, Professor

([email protected])*1

1: Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research,

University of Southern Denmark

2: Director of Musculoskeletal Research Laboratory, Department of Orthopaedic Surgery & Traumatology, The Chi-

nese University of Hong Kong, Shatin, N.T. Hong Kong

3: Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark

4: OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, Uni-

versity of Southern Denmark, Odense, Denmark


Speaker Chris H. Dreyer

Aim To determine the number of MSCs in a combination with 10ng/VEGF/day,

amount of hydroxyapatite in the gap and observationtime on bone formation

in a larger animal.

Design 8 mature female Texel/Gotland sheep were included.

The 8 sheep were divided in groups using 1x106, 3x106 and 5x106 MSCs in

combination with 10ng VEGF/day in 8 weeks to determine the optimal number

of MSCs, VEGF coating, amount of hydroxyapatite (HA) granules and obser-

vation period. The primary study of additional 8 sheep will consist of the opti-

mal number of MSCs combined with VEGF concentrations of 10ng/day,

100,ng/day and 500ng/day with the optimal amount of HA granules, VEGF

coating technique and observation time.

Methods A VEGF coated titanium gap implant was inserted in the medial and lateral

condyle of the femur. Inside this gap was placed HA granules with attached

autologous bone marrow MSCs.

Evaluation Blood samples were collected for measurement of bone markers and verifica-

tion of the local effect of the VEGF stimulation. Furthermore, the implants

were evaluated by histology for new bone formation.

Results This study confirmed our coating in the use of releasing VEGF over time. The

highest amount of bone formation was obtained with 3x106 MSCs.

Conclusion We had the best effect on bone formation with 3x106 MSCs. The VEGF coat-

ing had confirmed release of VEGF and showed promising effect. The obser-

vationsperiod of 8 weeks didn’t seem to be enough for optimal bone ingrowth

and we will use 12 weeks in our next study. The amount of granules will to be

doubled from 180mg to 400mg.

Presentation

language

Danish


Forskningsforum

35

Sentinel Node Mapping with Robotic Assisted Near-Infrared Imaging in Women

with Cervical and Endometrial Cancer (SENTIREC) Authors Sara Elisabeth Sponholtz1,2 ([email protected]),

Ole Mogensen1,3 ([email protected]),

Malene Grubbe Hildebrandt2,4 ([email protected]),

Doris Schledermann5 ([email protected]),

Thiusius Rajeeth Savarimuthu6 ([email protected]),

Pernille Tine Jensen1,2 ([email protected])

1 Dep. of Gynecology and Obstetrics, Odense University Hospital (OUH), Denmark

2 Institute of Clinical Research, University of Southern Denmark (SDU), Denmark

3 Dep. of Gynecology, Karolinska University Hospital, Sweden

4 Dep. of Nuclear Medicine, OUH, Denmark

5 Dep. of Clinical Pathology, OUH, Denmark

6 The Maersk McKinney Moeller Institute, SDU, Denmark


Speaker Sara Elisabeth Sponholtz

Background Sentinel node (SN) mapping is used in several cancer diseases, e.g. breast can-

cer. The so-called SN is the first lymph node to which the primary tumor me-

tastasizes. If the SN is without metastatic disease, studies show that all lymph

nodes in that region are free of cancer and complete lymph node removal is

unnecessary. Studies show that the SN technique is safe in early stages of cer-

vical and endometrial cancer with a low risk of lymph node metastases, how-

ever the technique has not yet been implemented in Denmark.

Objective Our objective is to initiate a national protocolled study on the safe implemen-

tation of SN mapping in women with early stages of cervical and endometrial

cancer, investigating advantages and possible disadvantages in low-risk pa-

tients and the safety of the technique in high-risk patients.

Design, methods

and primary

variables

Study I is a randomized controlled study with comparison of self-rated inci-

dence and severity of lymphedema in removal of SN alone versus removal of

SN followed by complete removal of the pelvic lymph nodes in women with

cervical cancer tumor size < 2 cm and low-/intermediate-risk endometrial can-

cer. Study II is a prospective observational study where women with cervical

cancer tumor size 2-4 cm and high-risk endometrial cancer will have SN re-

moved followed by systematic removal of FDG-PET/CT positive lymph nodes

and removal of all the pelvic lymph nodes to examine the negative predictive

value.

Conclusion We expect that the results from this project will have substantial significance

in changing the national treatment strategy of both cervical and endometrial

cancer patients in Denmark.

Presentation

language

Danish


Forskningsforum

36

Recovery with the individual placement and support intervention in Denmark Authors Iben Gammelgård1,2,3, Lene F Eplov4, Elsebeth Stenager 3,5,6

1 Research Unit of Mental Health, Odense,

2 Institute of Clinical Research,

3 University of Southern Denmark,

4 Mental Health Centre Copenhagen,

5 Research Unit of Mental Health, Aabenraa,

6 Institute of Regional Health Services,


Speaker Iben Gammelgård

Introduction Individual Placement and Support (IPS) is an evidence-based recovery-ori-

ented intervention where employment specialists (ES) support persons with

severe mental illness in achieving competitive employment. IPS is labelled a

recovery-oriented intervention; although, the influence of IPS on outcomes of-

ten referred to as recovery measures i.e. symptoms, level of function and self-

esteem is ambiguous.

One branch of the recovery literature distinguishes between two kinds of re-

covery. The one, personal recovery is defined by: what helps the individual

move beyond the role of being a patient with a mental illness. The other, clin-

ical recovery is defined as symptom reduction and increased level of function-

ing.

Aim To investigate how an IPS-intervention influences the personal and clinical

recovery in persons with severe mental illness.

Method A qualitative phenomenological study including interview of 12 participants

in an IPS intervention.

Results IPS contributed to personal recovery in a number of ways: The ES created an

equal, acknowledging and safe relationship where participants’ needs were

taking into consideration in the search and support for employment. Both em-

ployment and the ES contributed to normalization and stabilisation of partic-

ipants’ daily lives and changed their behaviours and beliefs about personal

goals and dreams. The study found nuances in how IPS and employment were

perceived to have influenced clinical recovery. Participants suffering from

psychotic symptoms were clearly of the opinion that neither IPS nor employ-

ment influenced symptom severity. In contrast to this, participants suffering

from negative or depressive symptoms described how employment helped

them get up in the morning and structure the day. Also, fellowship with col-

leagues was found important.

Conclusion The present study indicates that IPS and employment have an impact on per-

sonal recovery and may decrease depressive and negative symptoms, but does

not seem to have an impact on psychotic symptoms.

Presentation

language

Danish


Forskningsforum

37

Nausea and vomiting in patients with advanced cancer Authors Signe Harder1, Jørn Herrstedt 1, and Mogens Grønvold2

1Department of Oncology, Odense University Hospital, Odense, Denmark.

2Department of Palliative Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.


Speaker Signe Harder

Background Nausea and vomiting (N/V) are among the worst symptoms in patients with

advanced cancer. The risk of N/V depends on several factors and is in the lit-

erature described to vary between 6-68 % in these patients. Despite continuing

progress in the treatment of chemotherapy-induced nausea and vomiting dur-

ing the last 30 years, the incidence and severity of N/V are roughly unchanged

in patients with advanced cancer receiving palliative care. Evidence regarding

the effect of antiemetic treatment for cancer patients in palliative care is sparse.

The most recently published reviews conclude that no guidelines can be estab-

lished based on the present level of evidence, and that new research is urgently

needed.

In summary, the burden of N/V is very significant, and N/V can, if untreated,

lead to rapid deterioration in this old and fragile group of patients. The evi-

dence base for treatment is minimal. Research in the treatment of N/V in pal-

liative care therefore seems highly warranted, and these studies will have the

potential to create important new knowledge.

Studies 3 multicenter studies including from 5 Danish sites:

1: Epidemiologic study to determine the prevalence of nausea and the effect of

current treatment (around 1500 pts screened).

2: A double blind, randomized, controlled trial of a NK1-receptor antagonist

vs placebo (75 pts).

3: An open label study of olanzapine 10 mg daily for 5 consecutive days (40

pts).

Outcome To our knowledge, study 2 is the first to investigate the effect of a NK1-recep-

tor antagonist in patients receiving palliative care. Hence, the results of the

study will create new and important knowledge, whatever the outcome will be.

Study 1 and 3 will greatly expand current research in a very under-researched

area of highly clinical relevance for this old and fragile group of patients.

Presentation

language

Danish


Forskningsforum

38


kl.11.00-12.00


Forskningsforum

39

Meal-induced thrombin generation in obese women and men before and after

gastric bypass - a model of intentional weight loss Authors Line Espenhain Andersen, Research Assistant, MSc, Department of Regional

Health Research, Hospital of South West Jutland

Claus Bogh Juhl ([email protected]), senior physician, associated pro-

fessor, PhD, Department of Medicine, Section of Endocrinology, Hospital of

South West Jutland

Vibeke Andersen ([email protected]), chief physician, professor,

PhD, Department of Cancer and Inflammation Research, Hospital of Southern

Denmark

Else-Marie Bladbjerg ([email protected]), associated professor, MSc,

PhD, Unit for Thrombosis Research, Department of Public Health, SDU and

Department of Clinical Biochemistry, Hospital of South West Jutland


Speaker Line Espenhain Andersen

Background and

Purpose

Recently, studies have indicated that intentional weight loss is associated with

unknown harmful effects leading to increased mortality. The link between in-

tentional weight loss and thrombotic risk is poorly investigated. One candidate

mechanism is postprandial coagulation activation following high-fat meals.

The purpose of this study is to investigate postprandial coagulation activation

in relation to intentional weight loss.

Design Randomized cross-over study

Methods Thirty obese patients admitted to gastric bypass will be included in the study.

Before weight loss, after >8 % lifestyle-induced weight loss, and 3-4 months

after gastric bypass all participants will consume a high-fat meal and a low-

fat meal randomly served on two days in each study period. The meal effects

will be investigated by measuring relevant biomarkers in blood and faeces.

Main variables Markers of coagulation activation, thrombin generation, tissue factor, inflam-

mation, leptin, and endotoxin in plasma, and the gut microbiota profile in fae-

ces.

Results and

Conclusion

Clinical trials will be initiated in 2017, and the first results are analysed in 2018

and published in 2019 and 2020. If high-fat meals increase the thrombotic risk

in obese patients during intentional weight loss, existing dietary recommenda-

tions and disease prevention strategies must be modified.

Presentation

language

Danish


Forskningsforum

40

The association between maternal chronic inflammatory bowel disease and long-

term health outcomes in the children – a nationwide cohort study Authors Jølving LR1,2, Nielsen J1,2, Beck-Nielsen S2,3, Nielsen RG2,4, Friedman S2,4,

Kesmodel US5,6, Nørgård BM1,2,4

1 Center for Clinical Epidemiology, Odense University Hospital.

2 Institute of Clinical Research, University of Southern Denmark.

3 Department of Pediatrics Kolding, a part of Hospital Lillebaelt.

4 Hans Christian Andersen Children’s Hospital, OUH,

5 Crohn’s and Colitis Center, Brigham and Women’s Hospital, Boston, Massachusetts and Harvard Medical School,

Boston.

6 Department of Obstetrics and Gynaecology, Herlev University Hospital,

7 Institute for Clinical Medicine, University of Copenhagen.


Speaker Line Riis Jølving

Objectives Very little is known about the long-term impact of maternal inflammatory

bowel disease (IBD) on the offspring’s future health. We aimed to examine

whether children born to mothers with IBD had an increased risk of long-term

morbidities.

Design In this nationwide register-based cohort study, including all children born alive

in Denmark between 1989 and 2013, we investigated the association between

maternal IBD and 15 selected disease categories of physical and mental con-

ditions in the offspring. We used multivariate regression models estimating the

hazard ratio (HR) of long-term child morbidities.

Results The cohort comprised 9,238 children born to women with IBD (exposed), and

1,371,407 born to women without IBD (unexposed). Median follow-up time

among exposed was 9.7 years [interquartile range (IQR) 4.9-15.7] and 13.8

[IQR 7.4-19.9] among unexposed. In children, who in utero had been exposed

to maternal ulcerative colitis, the HR of IBD in the offspring was 4.63 (95%

CI 3.49-6.16). For maternal Crohn’s disease the HR of IBD in the offspring

was 7.70 (95% CI 5.66-10.47). For all other diseases in the offspring we did

not find a significantly increased risk associated with maternal IBD.

Conclusion Children born to mothers with IBD are more likely to be diagnosed with IBD

themselves, compared to children born to women without IBD. Our data oth-

erwise do not provide evidence for an increased risk of any of the other exam-

ined diseases in the offspring.

Presentation

language

Danish


Forskningsforum

41

Bone mass tracks into teenage years Authors Maria Sode Rønne ([email protected])1,

Malene Heidemann ([email protected])1,

Anders Schou ([email protected])1,

Jens Ole Laursen ([email protected])2,

Niels Wedderkopp ([email protected])3,

Steffen Husby ([email protected])1,

Christian Mølgaard ([email protected])1+4

1 Hans Christian Andersen Children’s Hospital, Odense University Hospital, Clinical Institute, University of Southern

Denmark,

2 Emergency Department, Hospital of South Jutland,

3 Research in Childhood Health, Faculty of Health Sciences, University of Southern Denmark,

4 Department of Nutrition, Exercise and Sports, University of Copenhagen


Speaker Maria Sode Rønne

Purpose and

Background

Bone mass development in childhood and adolescence is crucial for peak bone

mass (PBM) and low PBM may lead to osteoporosis later in life. The stability

of bone mineral status through childhood and adolescence is known as track-

ing. The objective of this study is to determine the degree of tracking according

to bone mass from pre-puberty into puberty in healthy Danish children.

Design and

Methods

194 healthy Danish children (97 boys) with mean age 9.25 years at baseline

(2008) were followed for 7 years. Whole body DXA-scan and anthropometric

measurements were performed in 2008 and 2015.

Z-scores were calculated for bone parameters (Total Body Less Head (TBLH)

Bone Mineral Content (BMC), TBLH Bone Mineral Density (BMD) and

TBLH Bone Area (BA)) adjusted for sex and age.

Results We found the correlation between TBLH BMC Z-score at baseline and at the

last follow up to be 0.80 (CI 0.74-0.84). The correlation between Z-score

TBLH BMD and TBLH BA were comparable (BMD 0.78 (CI 0.71;0.83) and

BA 0.81 (CI 0.75;0.85)).

Dividing the participants into quintiles depending on Z-scores in 2008 respec-

tively 2015 we found that 85-87% were in the same quintile or the neighbour

quintile at follow up.

Conclusion We found a high degree of tracking in bone mass indices in children from 8-

17 years. The strong tracking may be useful in early identification of individ-

uals at risk of osteoporosis later in life.

Presentation

language

Danish


Forskningsforum

42

The use of PROs in the management of adverse events in patients with malig-

nant melanoma receiving immunotherapy Authors Lærke Tolstrup1,3,4, Helle Pappot2, Karin B. Dieperink1,3,4, Ann-Dorthe O.

Zwisler1,3,4, Lars Bastholt1,4

1) Department of Oncology, Odense University Hospital

2) Copenhagen University Hospital, Rigshospitalet,

3) REHPA – Danish Knowledge Centre for Rehabilitation and Palliative Care

4) Institute of Clinical Research, SDU, Odense


Speaker Lærke Tolstrup

Background In recent years, there has been an increasing awareness within the health care

system that patients are not sufficiently involved when it comes to treatment

and care. Moreover, evidence suggests that clinicians´ reporting of sympto-

matic adverse events lacks reliability and that clinicians tend to underreport

the incidence and severity of symptoms compared to patients´ direct response.

Furthermore, patient self-reporting is more true to the patient perspective due

to the fact that the report has not been interpreted by a clinician. This underre-

porting of symptoms may also apply to toxicity-monitoring in relation to mel-

anoma patients who receive immunotherapy for cancer treatment. One of the

ways to improve monitoring of adverse events may be to use patient reported

outcomes (PROs).

Aim Primary endpoint: To examine if melanoma patients who receive immuno-

therapy and report their adverse events by means of the electronic tool PRO-

CTCA weekly to supplement standard AE monitoring have the frequency of

grade 3 or 4 adverse events reduced by 50%. Secondary endpoints: 1)To exam-

ine if the time patients experience grade 2 or higher toxicity, differs in the two

groups 2)To examine if more symptoms are reported in the intervention group 3) To examine if there is a difference between the 2 group when it comes to

number of extra out-patient visits, days in hospital, telephone consultations and

days in prednisone therapy.

Material and

Methods

A randomized pilot study is being conducted. 140 patients who meet eligibility

criteria will be randomized in a 1:1 ratio to either the intervention arm (the use

of PRO-CTCAE) or the control arm (standard AE monitoring schedule). In

addition, patients in the intervention arm will be asked to fill out a feedback

form to further evaluate their experience and level of satisfaction with the elec-

tronic tool PRO-CTCAE.

Conclusion Recruitment was initiated in January 2017 and the trial is still ongoing. So far

20 patients have been included. Patients are completing questionnaires accord-

ing to schedule.

Presentation

language

Danish


Forskningsforum

43

Risk of hospitalization with severe infection among schizophrenia patients be-

fore and after onset of the illness: Population-based nationwide cohort study. Authors Monika Pankiewicz-Dulacz, MD; Egon Stenager, MD, Ph.d.; Ming Chen,

MD, Ph.d. Elsebeth Stenager, MD,Ph.d.

University of Southern Denmark,IRS.


Speaker Monika Pankiewicz Dulacz; Research Unit Aabenraa

Objectives Serious infections are a major concern in patients with schizophrenia as they

contribute to an increased overall premature mortality. However, to date, evi-

dence about burden of severe infections, their occurrence patterns, exact type

and predictors remains largely unknown. The overall aim of this study was to

investigate occurrence of severe infections among schizophrenia patients be-

fore and after onset of the illness to increase our knowledge on these aspects.

Method We conducted a cohort study on a Danish population based sample of individ-

uals born between 1975 and 1990. Sample comprised of 7852 subject cases

diagnosed with schizophrenia between 1993 and 2013 and 885795 controls

matched on sex, age and date of birth. Information about variables of interest

was obtained from 4 national registers: the Danish National Registry of Pa-

tients, the Danish Central Psychiatric Registry, the Danish Person Registry and

The Danish Register of Causes of Death (DRCD). Study period comprised 5

years of pre -diagnostic period and 5 years of post-diagnostic period. Incidence

rates and Incidence rates ratios were estimated using Poisson regression.

Important Vari-

ables

Schizophrenia, Comorbidity, Infection, Sex, Age, Calendar Year, Death, Mi-

gration.

Results Among 7852 patients with schizophrenia, 8009 hospitalizations with infection

occurred during 148010 persons –years. Risk of hospitalization with any in-

fection remained significant elevated in the whole period of the study, both in

the pre diagnostic and post diagnostic period (IRR= 1.63;Cl=1.58-1.68

;P=0.001). The elevated risk of infection was not related to a specific time pe-

riod and was not driven by any particular type of infection. Comorbidity in-

creased rates of serious infections with 176 % regarding both subject cases and

controls.

Conclusion Our results indicate that both, the period prior to the first episode of psychosis

and after is associated with the elevated rates of wide range of severe infec-

tions.

Presentation

language

Danish


Forskningsforum

44

Lokale U1 – Session 1

kl.09.00-10.00


Forskningsforum

45

Håndtering af urininkontinens hos kvinder - lægers og fysioterapeuters imple-

mentering af ny national klinisk retningslinje. Forfattere Helle Gerbild, Marianne Rosendal og Dorte Ejg Jarbøl, Forskningsenheden for

Almen Praksis, Institut for Sundhedstjenesteforskning, SDU,

E-mail [email protected]

Foredragsholder Helle Gerbild, PT, Cand. Scient. San, MSex, Ph.d. stud.

Formål Projektet har til formål at belyse: 1) forhold af betydning for opsporing af urin-

inkontinens (UI) hos kvinder i almen praksis, 2) praktiserende lægers og fy-

sioterapeuters aktuelle håndtering af kvinder med UI, og 3) faktorer af betyd-

ning for implementering af ny national klinisk retningslinje (NKR) om UI hos

kvinder.

Baggrund Mange kvinder generes af UI, og har en påvirket livskvalitet som følger heraf.

Der er behov for større opmærksomhed på UI hos kvinder, der kontakter almen

praksis, men vi mangler viden om hvad, der karakteriserer kvinderne. I 2016

udkom en ny NKR om UI, hvor superviseret bækkenbundstræning anbefales.

Lægers og fysioterapeuters aktuelle håndtering af kvinder med UI er sammen

med barrierer og facilitatorer for implementering af NKR om UI i primærsek-

toren dårligt belyst.

Metode Projektet benytter sig af flere metoder: 1) kvantitativ deskriptiv analyse af

symptommønster hos kvinder med UI baseret på et stort befolkningsbaseret

tværsnitsstudie. 2) En auditregistrering af praktiserende læger og fysioterapeu-

ters aktuelle håndtering af kvinder med UI. 3) Kvalitative individuelle inter-

views med læger og fysioterapeuter omhandlende barriere og facilitatorer for

implementering af NKR om UI.

Perspektiv Viden fra dette projekt vil i tråd med NKR kunne bidrage til en forbedret hånd-

tering og behandling af kvinder med UI.

Fordragssprog Dansk


Forskningsforum

46

Pårørendes kontakt med sundhedsprofessionelle på en Fælles Akut Modtagelse

(FAM) Forfatter Eva Hoffmann, Lektor, Cand. Cur., Master i Klinisk Sygepleje (MKS), Syge-

plejerske, UC SYD, Sygeplejerskeuddannelsen i Sønderborg.


Foredragsholder Eva Hoffmann

Baggrund Borgerrettede kampagner opfordrer pårørende til at stille spørgsmål til plejen

og behandlingen bl.a. for at øge patientsikkerheden. Forskning tyder på, at ikke

alle pårørende har lige let ved at skabe en god kontakt til de sundhedsprofessi-

onelle.

Formål At undersøge hvordan pårørende til patienter indlagt på FAM oplever kontak-

ten til de sundhedsprofessionelle, herunder identifikation af fremmende og

hæmmende faktorer for de pårørendes mulighed for at stille spørgsmål til ple-

jen og behandlingen.

Metode Individuelle, semistrukturerede interviews med 14 pårørende til patienter ind-

lagt på FAM. Hermeneutikken har informeret såvel videnskabsteoretisk afsæt

som analyseform.

Fund Pårørende er bevidste om deres ret til at stille spørgsmål til plejen og behand-

lingen, mens nogle føler sig forpligtede hertil. Tidspres og de sundhedsprofes-

sionelles venlighed og service spiller en vigtig rolle for pårørendes oplevelse

af kontakten til de sundhedsprofessionelle. Det har stor negativ betydning for

de pårørende, hvis de ikke kan finde rundt på sygehuset eller ikke kan gennem-

skue f.eks. organiseringen af arbejdet. Pårørende gør tilsyneladende brug af

både bevidste og ubevidste strategier i deres kontakt med de sundhedsprofes-

sionelle.

Konklusion Pårørendes oplevelser af kontakten til de sundhedsprofessionelle og deres mu-

ligheder for at stille spørgsmål til plejen og behandlingen er påvirket af både

inter- og intrapersonelle faktorer såvel som faktorer, der er relateret til kontek-

sten.

Fordragssprog Dansk


Forskningsforum

47

Samskabelse af sundhedsservice Forfattere Christina Radl-Karimi ([email protected])1, Christian von Plessen (Chris-

[email protected])1, Anne Nicolaisen ([email protected])1,

Morten Sodemann ([email protected])2, og Paul Batalden (paul.ba-

[email protected])3

1) Center for Kvalitet, Region Syddanmark

2) Indvandrermedicinsk Klinik, Odense Universitetshospital

The Dartmouth Institute for Health Policy and Clinical Practice, Geisel Medical School at Dartmouth, USA


Foredragsholder Christina Radl-Karimi

Baggrund I de seneste år er man begyndt at kigge på sundhedsydelser som en service

samskabt af patienter og sundhedsprofessionelle, snarere end at kalde det for

et ”produkt” skabt alene af sundhedsvæsenet. I denne samskabelse af sund-

hedsservice arbejder både patienter og sundhedspersonale hen imod at skabe

mest mulig værdi for patienten. Samtidig er der potentiale for at omkostnin-

gerne reduceres uden at det mindsker kvaliteten af sundhedsservice. Patienter

byder ind bl.a. med deres viden, coping-strategier og egenomsorg, hvorimod

sundhedspersonale skal - udover de sundhedsfaglige kompetencer - have de

nødvendige færdigheder til at indgå i et gensidigt partnerskab med patienten.

Vi mangler viden om, hvordan sårbare patientgrupper kan bidrage i en sam-

skabelsesproces. I en tid med en stigende antal patienter med anden etnisk bag-

grund end dansk som har komplekse sygdomsforløb, er det yderst relevant at

undersøge nye veje, der lægger op til en velfungerende samskabelsesproces

mellem (sårbare) patienter og sundhedsprofessionelle.

Formål At undersøge patient- og kontekstrelaterede aspekter af samskabelse af sund-

hedsservices for patienter med indvandrerbaggrund

Design Kvalitativ studie, på baggrund af Grounded Theory tilgangen samt antropolo-

giske metoder til at observere og følge patientforløb

Metode Indledningsvis bliver der gennemført et scoping review om patient- og kon-

tekstrelaterede faktorer, der påvirker samskabelse af sundhedsservice for ind-

vandrerpatienter. Reviewresultaterne vil danne grundlag for det kvalitativ stu-

die, bestående af semi-strukturede interview med patienter og sundhedsprofes-

sionelle på Indvandrermedicinsk Klinik (OUH). Derudover vil vi følge et antal

respondenter igennem deres forløb på klinikken for at identificere yderligere

faktorer, der påvirker deres evne til samskabelse.

Forventede re-

sultater

Denne ph.d. vil give viden om, hvordan og under hvilke omstændigheder ind-

vandrerpatienter og sundhedspersonale samskaber sundhedservices. Undersø-

gelserne vil danne grundlag for en særlig samskabelsesmodel for indvandrer-

patienter. En sådan model vil være vigtigt for at designe et sundhedsvæsen, der

bidrager til sundhed samt fremtidig forskning omkring sårbare patientgrupper.

Foredragssprog Dansk


Forskningsforum

48

Beslutningstagning i behandlingen af mænd med fremskreden prostatakræft -

kommunikation og organisation. Authors Ph.d.-studerende Mette Løwe Netsey-Afedo, Enhed for Sundhedstjeneste-

forskning, Center Sygehus Lillebælt & Institut for Regional Sundhedsforsk-

ning, Det Sundhedsvidenskabelige Fakultet, Syddansk Universitet

Professor Regner Birkelund (hovedvejleder), [email protected], En-

hed for Sundhedstjenesteforskning, Center Sygehus Lillebælt & Institut for

Regional Sundhedsforskning, Syddansk Universitet

Professor Jette Ammentorp (vejleder), [email protected], Enhed for

Sundhedstjenesteforskning, Center Sygehus Lillebælt & Institut for Regional

Sundhedsforskning, Syddansk Universitet

Professor Palle Osther (vejleder), [email protected], Urologisk

Forskningscenter, Urologisk afdeling, Vejle Sygehus, Institut for Regional

Sundhedsforskning, Syddansk Universitet


Foredragsholder Mette Løwe Netsey-Afedo

Baggrund Prostatakræft er den tredje hyppigste form for kræft hos mænd i Europa, og

med en årlig incidens på ca. 4300 er det den hyppigste blandt mænd i Danmark.

10-20% af patienterne har fremskreden prostatakræft, når diagnosen stilles.

For at nedsætte hastigheden, hvormed sygdommen udvikler sig, får størstede-

len af disse antihormonbehandling. Behandlingen er forbundet med alvorlige

fysiske og psykiske bivirkninger, og mange patienter oplever en forringet livs-

kvalitet. På denne baggrund er det særlig relevant at inddrage patienternes præ-

ferencer, behov og ønsker i behandlingsbeslutningerne.

Studier har vist, at der er mange fordele ved at inddrage patienter i beslutnings-

tagning, herunder øget patientsikkerhed og en større grad af patienttilfredshed.

Studierne viser også, at mange patienter ønsker at deltage i fælles beslutnings-

tagning. Forskningen relateret til beslutningstagning i forhold til denne pati-

entgruppe er dog stadig begrænset både nationalt og internationalt.

Formål At undersøge de kommunikative processer mellem patienter med fremskreden

prostatakræft og de sundhedsprofessionelle med fokus på beslutningstagning

samt de organisatoriske muligheder og begrænsninger for patientinddragelse.

Design Studiet er kvalitativt og funderet i den fænomenologiske-hermeneutiske forsk-

ningstradition.

Metode Data indsamles via deltagerobservationer og kvalitative interviews af 10-15

patienter med fremskreden prostatakræft samt sundhedsprofessionelle ansat i

et urinvejskirurgisk ambulatorium

Analyse og fortolkning er baseret på Ricoeur's teori om fortolkning, dvs. naiv

fortolkning, struktur analyse og kritisk fortolkning.

Foreløbige re-

sultater

Deltagerobservationer har vist, at fælles beslutningstagning kun finder sted i

begrænset omfang. Kommunikationen, som i høj grad er præget af envejskom-

munikation, fokuserer hovedsageligt på at informere patienterne. Den enkelte

patients præferencer og behov efterspørges kun sjældent. Organisatoriske fak-

torer som korte konsultationer bidrager sandsynligvis til dette.



Forskningsforum

49

Effekten af helkropsvibrationstræning på fald og knoglebrud - et systematisk re-

view og meta-analyse Forfattere Ditte Beck Jepsen. Klinisk institut, Syddansk Universitet. Geriatrisk afdeling

Odense Universitets Hospital, Odense

Katja Thomsen, Klinisk institut, Syddansk Universitet. Geriatrisk afdeling

Odense Universitets Hospital, Svendborg

Stinus Hansen, Endokrinologisk afdeling, Sydvestjysk Sygehus

Niklas Rye Jørgensen, Diagnostisk afdeling, Rigshospitalet, OPEN, Odense

Patient data Explorative Network, Odense

Tahir Masud, Universitets Hospital/ Syddansk Universitet. Geriatrisk afdeling

Nottingham University NHS Trust

Jesper Ryg, Klinisk institut, Syddansk Universitet. Geriatrisk afdeling Odense

Universitets Hospital, Odense


Foredragsholder Ditte Beck Jepsen

Baggrund Tidligere studier har vist lovende men inkonsekvente resultater af helkropsvi-

brationstrænings (WBV) effekt på knoglemineraldensiteten (BMD), muskel-

styrke og balance.

Formål At undersøge om WBV kan nedsætte risikoen for fald og knoglebrud ved

voksne ≥50 år.

Metode En systematisk litteratursøgning efter publicerede artikler i databaserne Pub-

Med, EMBASE, og Cochrane Central Register foretaget den 4. april 2016.

Randomiserede kontrollerede studier som undersøgte WBVs effekt på risikoen

for knoglebrud ved voksne ≥50 år blev inkluderet. Primære outcome var fald

og knoglebrud. Sekundære outcome var knoglestyrkeparametre. Relative ri-

siko, fald rate ratio/person år og absolut median difference blev sammenlagt

vha. random effect modeller og heterogeniciten (I2) blev estimeret. Studiernes

kvalitet blev vurderet vha. Cochrane Collaboration’s risk of bias tool og kva-

liteten af evidencen for hvert outcome vha. GRADE.

Foreløbige re-

sultater

15 artikler (14 studier) blev inkluderet. Fire studier (n=746) viste, at WBV kan

nedsætte forekomsten af fald, fald rate ratio/ person år 0.67 (95% CI = 0.50-

0.89, p =0.0006; I2= 19%) (evidens af moderat kvalitet). Derudover viste data

fra tre studier en ikke-signifikant reduktion af risikoen for at opleve fald

(n=805) (RR= 0.76, CI= 0.48-1.20, p=0.24; I2= 24%). Kun ét studie havde

outcome data med knoglebrud med en ikke-signifikant reduktion (RR= 0.47,

CI= 0.14-1.57, p=0.22) (moderat kvalitet). Der var ikke nogen effekt på knog-

lestyrke parametrene BMD, evidens af moderat til lav kvalitet og meget få data

tilgængelige med mikroarkitektur og knogleomsætning.

Konklusion WBV kan reducere antallet af fald, men der er ikke nogen overordnet effekt på

BMD.

Større randomiserede studier er nødvendige for at belyse, om WBV kan fore-

bygge knoglebrud gennem forebyggelse af fald.



Forskningsforum

50


kl.10.00-11.00


Forskningsforum

51

Afklaring af patienters og plejehjemsbeboeres ønsker for den sidste tid Forfattere Hanne Irene Jensen, Anæstesiologiske Afdelinger, SLB/IRS: hanne.irene.jen-

[email protected]; Lone Doris Tuesen, Hæmatologisk Afdeling, SLB: lone.do-

[email protected]; Hans-Henrik Bülow, Intensivafdeling, Holbæk Sygehus:

[email protected]


Foredragsholder Hanne Irene Jensen

Formål At udvikle og afprøve et dokument, der sikrer, at patienters og plejehjemsbe-

boeres ønsker for den sidste tid er kendte, dokumenterede og retsgyldige.

Baggrund Der er i disse år fokus på at øge kvaliteten af pleje og behandling i den sidste

tid, både med en bedre palliativ (lindrende) behandling, men også med at sikre,

at patienter og plejehjemsbeboere inddrages i beslutningerne. Som beskrevet i

en nylig udtalelse fra Det Etiske Råd (December 2016) oplever både patienter

og sundhedsprofessionelle, at der ofte ikke er kendskab til patienters og pleje-

hjemsbeboeres ønsker, hvilket i akutte situationer kan resultere i uønsket be-

handling som f.eks. forsøg på genoplivning.

Metode Modelforbilledet er det amerikanske POLST (Physician Orders for Life-Susta-

ining Treatment) dokument. Det handler om ved kendte sygdomstilstande at

få taget stilling til behandlingsniveau. Et POLST dokument udfyldes efter en

samtale mellem patienten og den behandlingsansvarlige læge. Tilstand, prog-

nose, behandlingsmuligheder, behandlings-konsekvenser og patientens vær-

dier og ønsker diskuteres, og sammen nås en beslutning om, hvorvidt der ved

forværring skal gives fuld behandling, begrænset behandling eller palliativ be-

handling. En dansk POLST model skal testes på sengeafdelinger, i hjemme-

pleje/lægepraksis og på plejehjem. Patienter og plejehjemsbeboere inviteres til

at deltage i projektet, hvis det ud fra en sundhedsfaglig vurdering ikke vil være

overraskende, hvis de dør indenfor 12 måneder. Deltagende personale og pati-

enter, plejehjemsbeboere og pårørende får efterfølgende udleveret et spørge-

skema med både strukturerede spørgsmål og mulighed for at skrive kommen-

tarer. Semistrukturerede interview gennemføres med et strategisk udvalg af

deltagende personale og patienter, plejehjemsbeboere og pårørende. Alle pati-

enter og plejehjemsbeboere følges hver 3. måned til de dør, eller i to år, og der

registreres, hvor de dør, og om den aftalte behandlingsplan er fulgt i den sidste

tid.

Videre plan Der er opnået projektfinansiering fra private fonde, og ph.d. studerende begyn-

der i projektet 1.5.2017.



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52

Kodning af patientklager, og udvikling af et nyt klassifikationssystem på Syge-

hus Lillebælt Forfattere Karin Yde Waidtløw, forskningsassistent, cand.scient.san. Enhed for Sund-

hedstjenesteforskning, Sygehus Lillebælt

Email: [email protected]

Anne-Mette Honoré Grauslund, forskningsassistent, cand.scient.san.

Enhed for Sundhedstjenesteforskning, Sygehus Lillebælt


Jette Ammentorp, forskningsleder, lektor, ph.d., cand.scient.san.

Enhed for Sundhedstjenesteforskning, Sygehus Lillebælt / IRS SDU


Foredragshold-

ere

Karin Yde Waidtløw & Anne-Mette Honoré Grauslund

Formål og bag-

grund

Efter indførelsen af kommunikationskurset ”Klar Tale med Patienterne” for

alle ansatte på Sygehus Lillebælt, ønskes kursets mulige effekt på omfanget og

indholdet af kommunikationsrelaterede patientklager undersøgt.

Design Projektet tager udgangspunkt i Sygehus Lillebælts patientklager fra årene

2012-2015. Med det nuværende klassifikationssystem bliver kun 10 % af kla-

gerne kategoriseret som kommunikationsrelaterede, mens en pilottest har vist,

at antallet i virkeligheden er langt højere. Der foretages derfor en systematisk

gennemlæsning af samtlige klager mhp. at udvikle et nyt klassifikationssy-

stem.

Metoder Alle klager fra 2012 gennemlæses af to uafhængige personer, og kodes

individuelt. Der foretages en sammenligning af kodningerne, den procentvise

fordeling af klagetyperne opgøres, og der udregnes inter-rater reliabilitet.

De kommunikationsrelaterede klager gennemlæses igen uafhængigt, mhp.

identifikation af kommunikationstemaer, og de fremkomne resultater

sammenholdes, diskuteres og sammenskrives i en tema-oversigt.

Vigtigste varia-

ble

- Kvantitative: Antallet af kommunikationsrelaterede patientklager før og efter

Klar Tale-kursets indførelse.

- Kvalitative: Patienternes subjektive beskrivelser af de hændelsesforløb, der

danner grundlag for klagerne.

Foreløbige re-

sultater og

konklusioner

Efter gennemlæsning og kodning af de ca. 150 indkomne patientklager fra

2012, blev der lokaliseret 8 hovedtemaer i klagerne. 57 % af klagerne viste sig

at være kommunikationsrelaterede, hvilket underbygger hypotesen om, at det

nuværende klassifikationssystem ikke er velegnet. Der er således basis for at

udvikle et nyt klassifikationssystem, der i højere grad evner at identificere de

patientklager, som enten udspringer af- eller involverer

kommunikationsproblematikker.



Forskningsforum

53

Barrierer for et sammenhængende rygforløb Forfattere Lisbeth Petersen, Rygcenter Syddanmark, [email protected]

Anne Birgitte Christensen, Ledelsesakademiet Region Syddanmark, anne.bir-

[email protected]

Berit Schiøttz-Christensen, Rygcenter Syddanmark, Berit.Schiottz-Christen-

[email protected]


Foredragsholder Lisbeth Petersen, antropolog, forskningsassistent, Rygcenter Syddanmark

Baggrund og

formal

80 % af befolkningen oplever på et tidspunkt i deres liv lænderygsmerter. Det

kræver både samfundsmæssige og personlige ressourcer. En stor gruppe ryg-

patienter er i løbet af deres behandlingsforløb i kontakt med mange forskellige

aktører på tværs af sektorer, og patienterne havner ofte i lange forløb med gen-

tagne udredninger på hospitalet. Formålet med projektet er at belyse barrierer

for det sammenhængende forløb.

Design Semistruktureret kvalitativ interviewundersøgelse

Metoder Der er etableret samarbejde med 5 kommuner og primær sektor ved almen

praksis, fysioterapeuter og kiropraktorer.

Data er indsamlet gennem individuelt semistrukturerede interviews med 25 pa-

tienter, 10 kommunale fysioterapeuter, 10 jobkonsulenter, 10 praktiserende læ-

ger samt 5 kiropraktorer og 5 fysioterapeuter i primærsektoren. Til bearbejd-

ning af interviewmaterialet anvendes Malteruds meningskondenserende ana-

lyse, understøttet af programmet Nvivo.

Vigtigste varia-

ble

Erfaringer som/med rygpatienter, udfordringer og barrierer i patientforløbet,

samarbejde med andre behandlere/sektorer.

Foreløbige fund Den praktiserende læges måde at udfylde sin tovholderfunktion på, spiller en

stor rolle i oplevelsen af patientforløbet. Patienter har behov for tydelig kom-

munikation omkring deres behandlingsforløb. Manglende samarbejde og kom-

munikation mellem sektorer forhaler patientforløbet og den røde tråd mistes.

Manglende fælles mål for rygpatienten besværliggør bedring.

Konklusioner Dette projekt er en del af projektet Mere Hjem, Mindre Hospital, der har til

formål at styrke det sammenhængende rygforløb på tværs af sektorer. Analy-

sen vil blive brugt i den videre proces med henblik på at udvikle redskaber, der

kan støtte rygpatienters vej gennem behandlingsforløbet.



Forskningsforum

54

Lydoptagelse af patientsamtaler via MitForløb Forfattere Maiken Wolderslund, Enhed for Sundhedstjenesteforskning, Sygehus Lille-

bælt/IRS, SDU,

Jane Clemensen, Center for Innovativ Medicinsk Teknologi, OUH, Jane.Cle-

[email protected]

Jette Ammentorp, Enhed for Sundhedstjenesteforskning, Sygehus Lille-

bælt/IRS, SDU, [email protected]


Foredragsholder Maiken Wolderslund

Formål og bag-

grund

Begreber som patientinvolvering og fælles beslutningstagning står i disse år

højt på den sundhedspolitiske dagsorden. Kommunikationen mellem patient

og sundhedspersonalet er helt centralt i relation hertil, men ikke uden udfor-

dringer. Mange patienter oplever at det kan være svært at forstå og ikke

mindst huske den information der bliver givet, hvilket vanskeliggør patien-

tens muligheder for at deltage aktivt i sin behandling. Formålet med dette stu-

die er at undersøge betydningen af at tilbyde patienter lydoptagelse og mulig-

hed for at genhøre samtaler gennem hele deres hospitalsforløb.

Design Prospektivt kohortestudie, hvor genhør af konsultationen betragtes som ek-

sposition. I alt 1548 patienter inkluderes ved første besøg i ambulatorier på

SLB eller OUH og følges i 12 måneder.

Vigtigste varia-

ble

Patientoplevet sundhedskompetence, livskvalitet, beslutningskompetence, be-

kymring, patientoplevet involvering, relation til den sundhedsprofessionelle,

fælles beslutningstagning.

Foreløbige re-

sultater

Aktuelt arbejdes med udvikling af lydoptagefunktionen på baggrund af fo-

kusgrupper og workshop med patienter, pårørende og sundhedsprofessio-

nelle. Studiet baseres på resultater fra et ph.d. projekt på SLB.

Konklusioner Studiet forventes at bidrage med viden, der kan understøtte implementering

af lydoptagelse af patientsamtaler i en bred klinisk sammenhæng.



Forskningsforum

55

Sikkerhed og mulig virkning af injection af autologe fedderiverede stamceller

hos mænd med rejsningsbesvær efter fjernelse af prostata: en 12 måneders op-

følgning. Forfattere Martha Haahr1,5,6, Charlotte Jensen 2,5, Navid Toyserkani 3,5,6, Ditte Andersen

2,5,6, Per Damkier 2,6, Jens Sørensen3,5,6, Søren Sheikh 2,4,5, Lars Lund 1,5,6,

1. Department of Urology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark

2. Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology,

Odense University Hospital, Odense, Denmark

3. Department of Plastic Surgery, Odense University Hospital, Odense, Denmark

4. Institute of Molecular Medicine, University of Southern Denmark, Winsloewparken 21 3rd, 5000 Odense C, Den-

mark

5. The Danish Centre for Regenerative Medicine, Odense University Hospital, Denmark

6. Clinical Institute, University of Southern Denmark, 5000 Odense C, Denmark


Foredragsholder Martha Haahr

Formål Anvendelse af autologe friskt isolerede fedtstamceller som behandling af rejs-

ningsproblemer hos mænd efter fjernelse af prostata grundet kræft.

Baggrund Stamceller betragtes i dette tilfælde som et lægemiddel og dette var et fase 1

studie. Efter fjernelse af prostata oplever op til 80% af mænd rejsningsproble-

mer, omkring halvdelen vil have ved medicinsk behandling, men mange

mænd vil stadig ikke kunne få hjælp.

Design Åbent fase 1 studie. Primære end-point var sikkerhed, sekundære end-point

var forbedring af rejsningsevne målt ved subjektivt spørgeskemaer målt ved

inklusion, 1, 3, 6 og 12 måneder efter behandling.

Metode 21 mænd blev inkluderede i studiet. Alle havde fået fjernet prostata og erklæ-

rede raske 6-18 mdr. inden stamcelle behandlingen. Alle havde forsøgt god-

kendte behandlinger af rejsningsbesvær uden held.

Stamcellerne blev høstet ved fedtsugning af det subkutane fedt ved abdomen i

general anæstesi. Stamcellerne blev isolerede uden efterfølgende dyrkning og

tilbage transplanteret til svulmelegemerne inden for 2 timer efter fedtsugning.

Hele indgrebet foregik som en ambulant behandling.

Resultater Vi registrerede ingen alvorlige hændelser knyttet til forsøget. De fleste mænd

angav lidt hæmatom, ømhed og føleforstyrrelser ved maveskindet relateret til

fedtsugningen, ingen havde symptomer 1 måned efter behabndling.

Af de 21 inkluderede var 6 inkontinente ved inklusion -som følge af fjernelsen

af prostata- 15 var urinkontinente. 8 af de 15 kontinente mænd genvandt rejs-

ningsevnen og kunne gennemføre samleje 6 måneder efter behandling og virk-

ningen varede ved til 12 måneders opfølgningen. Ingen af de inkontinente

mænd oplevede virkning af behandlingen.

Konklusion Behandling med stamceller viste sig at være sikker og der er også tegn på at

behandlingen har en positiv virkning. Dette skal undersøges nærmere i et dob-

belblindet randomiseret kontrolleret studie.



Forskningsforum

56


kl.11.00-12.00


Forskningsforum

57

Forbedret kognition over 20 år hos 100 årige? Sammenligning af 1895 og 1915

fødselskohorterne Forfattere 1,2Signe Høi Rasmussen, 2Majken Boris Højgaard ([email protected]),

1Bernard Jeune ([email protected]) og 1,2Karen Andersen-Ranberg (ka-

[email protected])

1 Epidemiologi, Biostatistik og Biodemografi, Syddansk Universitet, Odense.

2 Geriatrisk afdeling G, Odense Universitets Hospital, Odense.


Foredragsholder Signe Høi Rasmussen

Formål og Bag-

grund

Andelen af de allerældste er hastigt stigende og alt tyder på, at stigningen vil

fortsætte.

Formålet er at sammenligne to kohorter af 100 årige født i hhv. 1895 og 1915

for at belyse, om det kognitive funktionsniveau har ændret sig gennem de sid-

ste 20 år.

Design Kohortestudier

Metode Potentielle deltagere var alle, der er fyldte 100 år i hhv. 1995 og 2015, boende

vest for Storebælt. Identifikation foretaget via CPR-registret. Data indsamlet

ved struktureret interviews. Deltagelsesprocenter var hhv. 74% (n=106) og

79% (n=238) i 1895-Vest og 1915-Vest kohorterne.

Vigtigste varia-

ble

mean MMSE-score

Foreløbige re-

sultater

Mænd: 1895-Vest: mean score 22.2 (19.9;24.5)

1915-Vest: mean score 20.6 (18.5;22.6)

Kvinder: 1895-Vest: mean score 19.6 (17.7;21.5)

1915-Vest: mean score 18.5 (17.4;19.5)

Konklusioner Uændret kognitivt funktionsniveau over de sidste 20 år trods en fordobling i

antallet af 100 årige. Dette skal ses i lyset af, at en tidligere sammenligning

mellem de to kohorter har vist en fremgang i 1915-Vest sammenlignet med

1895-Vest i ADL (selv-rapporteret). Disse resultater kan biddrage til den frem-

tidige planlægning af ældreplejen.



Forskningsforum

58

Characterization of the remodeling events contributing to trabecularization of

cortical bone: A study on human fibula diaphysis Authors Christina Møller Andreasen1,7 [email protected], Jesper Skovhus Thomsen2,7

[email protected], Lydia Peteva Bakalova3, Anne-Marie Bruel1 [email protected], Ellen

M. Hauge4 [email protected], Gete Ester Toft Eschen5 [email protected], Birgitte Jul

Kill5 [email protected], Jean-Marie Delaisse6 [email protected], Mariana Elizabeth

Kersh3 [email protected], and Thomas Levin Andersen6 [email protected] 1 Orthopaedic Research Laboratory, Department of Orthopaedic Surgery & Traumatology, OUH, ICR, SDU;

2 Department of Biomedicine, AU, Aarhus;

3 Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, IL, USA;

4 Department of Rheumatology, AUH, Aarhus;

5 Department of Plastic Surgery, AUH, Aarhus;

6 Department of Clinical Cell Biology, Vejle Hospital–Lillebaelt Hospital, IRS, SDU;

7 Shared first authorship


Speaker Christina Møller Andreasen

Aim and Intro-

duction

The trabecularization of cortical bone leads to decreased cortical thickness.

This study characterizes the intracortical remodeling events contributing to tra-

becularization of the endosteal part of cortex.

Design and

Methods

The study was performed on fibular diaphysis specimens from 20 patients (14

men, 6 women, 43–75 years) undergoing a jaw reconstruction. The specimens

were plastic embedded, µCT-scanned and sectioned along the scanning plan,

to investigate the same canals in 3D by µCT and in 2D by histology.

Results The 3D analysis by µCT showed a 3.5-fold higher porosity (p<0.001) and ca-

nals with a 3-fold larger diameter (p<0.001) at the endosteal half compared to

the periosteal half, but no difference in the canal spacing. The 2D analysis of

these canals/pores showed that pores with a diameter above 100 µm were 3.3-

fold more frequent in the endosteal half than in the periosteal half (p<0.001).

A histological characterization of 948 pores revealed that these enlarged pores

preferentially are resorptive pores and the odds of being such a pore were 6-

fold higher in the enlarged pores (>100 µm diameter) than in the smaller pores

(p<0.001). The enlarged resorptive pores often resulted in coalescence of two

or more pores of preexisting parent osteons. The odds for finding these en-

larged coalescent resorptive pores were 1.9-fold higher in the endosteal half

than in the periosteal part (p<0.011), and 8-fold higher in the enlarged pores

than in the smaller pores (p<0.001).

Conclusion Both the 2D and 3D analyses showed that the trabecularization of the cortex

may in part result from the accumulation of enlarged pores/canals in the en-

dosteal part of cortex. These pores are preferentially enlarged coalescent re-

sorptive pores, suggesting that the bone formation is uncoupled from the bone

resorption in these pores.

Presentation

language

Danish


Forskningsforum

59

Key intracortical remodeling events leading to increased cortical porosity during

aging Authors Christina Møller Andreasen1,2 [email protected], Jean-Marie Delaissè2 Jean-

[email protected], Bram C. J. Van der Eerden3 [email protected], Dorie Bir-

kenhäger-Frenkel3 [email protected], Johannes P. T. M. Van Leeuwen3 j.vanleeu-

[email protected], Ming Ding1 [email protected], Thomas Levin Andersen2 thomas.le-

[email protected]

1 Orthopaedic Research Laboratory, Department of Orthopaedic Surgery & Traumatology, OUH, Institute of Clinical

Research, SDU;

2 Department of Clinical Cell Biology, Vejle Hospital/Lillebaelt Hospital, Institute of Regional Health Research,

SDU;

3 Laboratory for Calcium and Bone Metabolism, Department of Internal Medicine, Erasmus MC, Rotterdam, The

Netherlands


Speaker Christina Møller Andreasen

Aim and Intro-

duction

To maintain its strength, cortical bone is constantly remodeled through numer-

ous intracortical remodeling events. During aging, a dysregulation of these re-

modeling events leads to an increased cortical porosity. The present study in-

vestigates the histological characteristics of the key intracortical remodeling

events contributing to the increased cortical porosity during aging.

Design and

Methods

A histomorphometric analysis of 4095 intracortical remodeling events was

performed on sections from iliac bone specimens from 35 women (16-78

years) undergoing forensic examination due to a sudden unexpected death.

Results The investigated iliac cortex showed an age-dependent increase in the cortical

porosity and the mean pore diameter (p<0.05), which also correlated with each

other (p<0.001). Further, the analyses revealed the presence of two remodeling

types: type 1 reflecting the generation of new canals, and type 2 reflecting the

remodeling of preexisting canals. The contribution of type 2 remodeling events

correlated positively with age and porosity (p<0.001), while type 1 remodeling

events showed a negative correlation (p<0.001). Only the incomplete type 2

remodeling events (pores with resorption or formation) correlated positively

with age and porosity (p<0.01), which were preferentially enlarged resorption

events without bone formation (p<0.01) leading to the coalescence of several

preexisting pores (p<0.001). The remodeling balance (pore diameter) within

the completed remodeling events (osteons with quiescent surface) showed no

correlation with age.

Conclusion Collectively, this study demonstrates that the accumulation of enlarged resorp-

tive type 2 remodeling events with an uncoupled/delayed bone formation is the

main contributor to the increased cortical porosity observed during aging.

Presentation

language

Danish


Forskningsforum

60

Is implementation of robotic surgery in endometrial cancer treatment benefi-

cial? – A study of individualized functioning assessment and survival. Authors Jørgensen S.L1, Jensen P.T. ([email protected])1,2 and Mogensen

O. ([email protected])1,3.

1 University of Southern Denmark,

2 Department of Gynecology and Obstetrics Odense University Hospital, Denmark

3 Department of Women's and Children's Health Karolinska University Hospital, Sweden.


Speaker Siv Lykke Jørgensen.

Aim, hypotheses

and background

The study primarily aims to evaluate whether the introduction of Robotic As-

sisted Laparoscopic Surgery (RALS) in the treatment of early stage endome-

trial cancer is as beneficial for the patient as many surgeons believe. It is hy-

pothesized that RALS is a gentle surgical modality that enables women to re-

turn to their pre-operative functional level, both physically and mentally,

within 3 weeks after surgery. Secondly the study aims to evaluate the transition

from open towards minimally invasive surgery (MIS) and to evaluate if surgi-

cal approach was associated with changes in survival and complications. It is

hypothesized that the introduction of RALS has caused a significant change

towards performing endometrial cancer surgery with MIS, with the potential

of decreasing the complication rate and increasing survival.

Only few past studies have reported quality of life among patients with endo-

metrial cancer treated by RALS. Previous studies have shown that, in general,

minimally invasive surgery (MIS) carries a lower complication rate than open

surgery. The question remains whether this is reflected in a corresponding

faster return to the everyday life the patient had before surgery.

Design This is a prospective, longitudinal, single institutional observational cohort

study, supplemented by a comprehensive, population based, registration study

of prospectively obtained data.

Material and

methods

Patients undergoing RALS at Odense University Hospital are included and fol-

lowed for six months. The individual functional level of patients undergoing

RALS is evaluated using a newly developed and validated computer adaptive

test, EORTC-QLQ-C30-CAT. The historical data of patients receiving surgery

for early stage endometrial cancer between January 2005 through June 2015,

identified through the Danish Gynecological Cancer Database and linked to

national registries. Patients are divided into two groups; before and after the

introduction of RALS. Through regression analyses the chance of receiving

MIS are compared. The risk of complications is compared between surgical

modalities. The overall survival is estimated using Kaplan Meier and Cox-re-

gression.

Most important

variables

Quality of life measurements, surgical modality, relation to the introduction of

RALS, complications and survival time.

Results Results from the prospective RALS cohort are not yet available. Preliminary

results of the historical cohort substantiate our hypotheses.

Presentation

language

Danish


Forskningsforum

61

Psychological aspects of body contouring surgery: A qualitative study. Authors Mike Mikkelsen Lorenzena, Lotte Poulsena, Signe Poulsena, Jens Ahm Søren-

sena, Kirsten K. Roesslerb

a Department of Plastic Surgery, Odense University Hospital, Odense, Denmark

b Department of Psychology, University of Southern Denmark, Odense, Denmark


Speaker Mike Mikkelsen Lorenzen

Purpose and

Background

Body contouring surgery after massive weight loss aims to improve patients’

appearance and health-related quality of life. Psychological aspects are of great

importance in the patient journey, however, they are not always addressed

properly. As part of a development process of a patient education program for

body contouring patients, our study aims to identify influencing psychological

factors important to patients both before and after body contouring surgery.

Method and De-

sign

We took an interdisciplinary approach to capture both the healthcare profes-

sional and patient perspective. We conducted semi-structured interviews with

4 healthcare professionals (two surgeons and two nurses) and 8 patients be-

tween April and June of 2016. Healthcare professionals were interviewed in-

dividually. Patient interviews consisted of a pre- and postoperative focus group

interview. Data were analyzed using an interpretive descriptive approach and

coded line-by-line until all relevant codes were extracted.

Results We identified seven psychological themes: Our findings indicate that surgery

alone cannot improve patients’ psychological difficulties and that psychologi-

cal care and management is of high importance for providing continuity of

care.

Conclusion The psychological aspect is of great importance to patients undergoing body

contouring surgery after massive weight loss. Increased focus on the identified

psychological themes has the potential to improve quality of life for body con-

touring patients. Our findings have the potential to provide content validity in

patient education programs, to reduce discrepancies in patient expectations and

improve patient satisfaction.

Presentation

language

Danish


Forskningsforum

62


kl.09.00-10.30


Forskningsforum

63

Detection of recurrence in early stage endometrial cancer – the role of symptoms

and routine follow-up Authors Mette Moustgaard Jeppesen1,

Ole Mogensen2, [email protected]

Dorte Gilså Hansen3, [email protected]

Maria Iachina4, [email protected]

Malene Korsholm1, [email protected]

Pernille Tine Jensen1, [email protected] 1 Department of Gynaecology and Obstetrics, OUH

2 Department of Gnaecology, Karolinska University Hospital, Clinical Institute, University of Southern Denmark

3 Research Unit of General Practice, OUH

4 Research Unit of Clinical Epidemiology, OUH


Speaker Mette Moustgaard Jeppesen

Purpose and

Background

Considerable controversy remains as to the optimal organization of endome-

trial cancer follow-up. Aim: To evaluate the relationship between the way of

recurrence detection and survival after endometrial cancer. Further, to identify

characteristics associated with a pre-scheduled examination in women with

symptomatic recurrence.

Design Nation-wide population-based historical cohort

Methods All women with stage I or II endometrial cancer during 2005-2009 were in-

cluded in the cohort derived from the Danish Gynecological Cancer Database.

Women diagnosed with recurrence within three years after primary surgery

and the mode of recurrence detection were identified from hospital charts.

Essential varia-

bles

Survival of women with symptomatic and asymptomatic disease was com-

pared. Sociodemographic and disease-specific characteristics associated with

self-referral as compared to presenting symptoms at regular follow-ups were

identified using univariate analyses.

Preliminary Re-

sults and Con-

clusions

In total, 183 cases of recurrence (7%) were identified in the cohort of 2612

women. Of these, 65.5 % were symptomatic with vaginal bleeding as the most

prevalent symptom. Asymptomatic women had a significantly better 3-year

survival-rate compared to symptomatic women (80.3% vs. 54.3%, p<

0.01).This finding should be interpreted cautiously due to the risk of misclas-

sification and length-time bias. Women diagnosed

at a pre-scheduled visit due to symptoms had a higher educational level

(p=0.03) and more often high-risk disease (p=0.02) than symptomatic women

diagnosed at regular follow-up.

Presentation

language

Danish


Forskningsforum

64

Etiske dilemmaer behandlet i Kliniske Etiske Komite for psykiatrien i Region

Syddanmark i perioden 2010- 2015: En kvalitativ tematisk analyse. Forfattere Henriette Bruun1,2, Signe Lystbæk2, Elsebeth Stenager1,2, Lotte Huniche3, Rei-

dar Pedersen5. 1. Department of regional health research, University of Southern Denmark. 2. Psychiatric hospitals, the Region of

Southern Denmark. 3. User Perspectives, Department of Public Health, University of Southern Denmark. 5. Center

for medical ethics, Institute of health and society, University of Oslo.


Foredragsholder Henriette Bruun

Formål og bag-

grund

Etik er en central del af kvalitetsarbejdet i sundhedsvæsnet. Viden om etiske

udfordringers eksistens og indhold er en forudsætning for at kunne håndterer

dem bedst muligt. Den Kliniske Etiske Komite for psykiatrien i Region Syd-

danmark (KEK) tilbyder en struktureret etisk analyse (modificeret SME-mo-

del) af etiske udfordringer som sundhedsprofessionelle (SP) møder i deres ar-

bejde. Hver analyse dokumenteres skriftligt i en 5-8 sider lang sagsbeskrivelse.

I dette arbejde danner sagsbeskrivelserne udgangspunkt for en tematisk ana-

lyse, som bidrager med relevant viden til en bred vifte af psykiatriens interes-

senter: medlemmer af etiske råd, de som uddanner SP samt alle ledere og an-

satte i psykiatrien. Derudover giver arbejdet offentligheden, herunder patien-

ter, pårørende og beslutningstagere et indblik i nogle af de vigtigste og van-

skeligste etiske dilemmaer i psykiatrien.

Design and

Metoder

Sagsbeskrivelserne er udarbejdet efter en fast struktur med følgende overskrif-

ter: sagsfremstilling, det etiske spørgsmål, fakta i sagen, berørte parter, etisk

analyse (autonomi, gøre godt/undgå skade, retfærdighed), sammenfattende re-

fleksioner og besvarelse af det etiske spørgsmål med argumenter både for og

imod en konkret handling. Gennemgående for alle sagsbeskrivelserne er en

stor kompleksitet. KEK har i perioden analyseret 66 sager. I studiet indgå 55

sagsbeskrivelser – 11 udgår: fiktive prøvesager (6), temasager med sparsom

skriftlig dokumentation (2), sag rejst af patient (1), analysen beskrevet som

svarbrev (2). Der er udarbejdet en konventionel tematisk analyse.. For at øge

validiteten er der anvendt forskertriangulering. Alle sagerne er læst abduktivt

af første og anden forfatter, som er psykiater og filosof. De har efterfølgende

ved personligt møde haft dialog om samtlige sager og er kommet til konsensus

om det centrale etiske tema i hver sag.

Foreløbige re-

sultater

Sagerne inddeles overordnet i 3 hovedkategorier – med flere underkategorier i

hver gruppe: 1. Psykiatrien i samfundet (13 sager): Her opstår etiske udfor-

dringer, når SP, som primæransvarlige for patientens sundhedstilstand, møder

andre værdier og motiver for konkrete handlinger f.eks. i kommunen, hos po-

litiet eller på somatiske hospitalsafdelinger. 2. Psykiatriens organisatoriske

kontekst (23 sager): Her opstår etiske udfordringer internt i psykiatrien, når

den SP oplever modsatrettede forventninger til, hvad der er det bedste at gøre

i en konkret situation. 3. Relationen mellem behandler og patient (19 sager):

Her opstår etiske udfordringer når den SP bliver i tvivl om hvor langt ansvaret

for patientens potentielt sundhedsskadelige valg rækker og hvornår det f.eks.

er uforsvarligt ikke at anvende tvang.


Forskningsforum

65

Konklusioner Analysen og resultatet heraf har flere begrænsninger, idet data er hentet fra

sags-beskrivelser som bygger på, hvad SP oplever som vanskelige etiske situ-

ationer. Det er f.eks. uklart hvilket motiv de SP har for at indbringe en sag til

KEK. Problematikkerne er utvivlsomt vanskelige at håndtere og bidrager til at

gøre de SP´s arbejde udfordrende og svært. Øget fokus på etisk vanskelige

situationer i psykiatrien kan medvirke til reduktion af udbrændthed og ethical

distress blandt SP, som ellers er velkendte konsekvenser af at arbejde i et miljø

med ”uløselige” værdikonflikter og hvor de beslutninger der tages har konse-

kvenser for andre mennesker – patienter og pårørende i psykiatrien.



Forskningsforum

66

Mødres informationsbehov i forbindelse med calmettevaccination. Et mixed me-

thod design. Forfattere Gitte Thybo Pihl12, Jette Ammentorp1, Poul-Erik Lund Kofoed2.

1. Enhed for Sundhedstjenesteforskning, Sygehus Lillebælt.

2. Børneafdelingen, Kolding Sygehus.


Foredragsholder Gitte Thybo Pihl

Baggrund Introduktionen af vaccinationsprogrammer verden over har været en stor suc-

ces for folkesundheden. Ikke desto mindre udfordres de vestlige landes vacci-

nationsprogrammer af manglende tilslutning til vacciner på grund af forældres

bekymringer for bivirkninger. Der efterlyses derfor metoder til at informere

forældrene bedre om vacciner. I konteksten af et stort randomiseret studie af

calmettevaccinen i Danmark undersøgte vi derfor forældrenes informationsbe-

hov i forbindelse med deres beslutning om at lade sit barn calmettevaccinere.

Formål At undersøge, om den information forældrene fik, da de skulle tage beslutning

om, om deres barn skulle calmettevaccineres ved fødslen, var tilstrækkelig og

relevant set fra forældrenes synspunkt, samt at få en uddybning af mødrenes

perspektiv med henblik på i fremtiden at kunne give en forbedret rådgivning.

Design Spørgsmål om forældres informationsbehov og hvor de havde søgt informati-

oner blev gennemført i et telefoninterview, når de vaccinerede børn i Calmette-

studiet blev ca. tre måneder gamle. Herefter blev forældre i Kolding indbudt

til fokusgruppe-diskussioner. Tre af de fem fokusgrupper blev gennemført

med mødre opdelt efter uddannelseslængde.

Metode Metoderne var et miks af statistiske opgørelser af svarene fra telefon-interview

kombineret med uddybende perspektiver fra fokusgruppediskussionerne.

Resultater Tre måneder efter barnets vaccination vurderede 95 % af forældrene, at de

følte sig velinformerede, da de skulle tage beslutningen. Af de 4 %, der gav

udtryk for manglende informationer, var der signifikant flere lavt-uddannede

mødre.

I fokusgrupperne beskrev mødrene, at den individuelt tilpassede vejledning

var vigtig. Det skriftlige informationsmateriale kunne fordøjes over tid og

blev brugt som en basis for vejledning og beslutning. Vi fandt, at telefonkon-

sultationen kompenserede for lav health literacy og hjalp til at få overblik

over fordele og ulemper. Empati, ærlighed og ikke-dømmende attitude blev

beskrevet som vigtige kvaliteter ved sundhedsprofessionelle i telefonkonsul-

tationerne.

Grundig beskrivelse af bivirkninger gav tryghed og forebyggede angst for

diffuse bivirkninger.



Forskningsforum

67

Epidemiology of chronic haemolytic anaemia Authors Dennis Lund Hansen, Hæmatologisk forskningsendhed HFE-X


Speaker Dennis Lund Hansen

Introduction Haemolytic anaemia is defined as anaemia due to shortened survival of red

blood cells (RBCs). RBC destruction results in free haemoglobin, which can

activate endovascular processes and lead to an increased risk of thromboem-

bolic episodes. Further, chronic anaemia causes tissue hypoxia which may also

inflict negatively on the function of others organs. In spite of the potential for

negative health effects of the disorder, epidemiological studies of the long-

term morbidity and mortality of chronic haemolytic anaemia are scant – apart

from certain subtypes, which are rare in the western world, e.g., sickle cell

anaemia, and thalassemia.

Aim We will address the abovementioned gaps in our knowledge regarding patients

suffering from chronic haemolysis, with or without anaemia. We recently

demonstrated that identification of patients with chronic haemolytic anaemia

in the Danish National Patient Registry is feasible and the validity of the coded

diagnoses, both overall, and within specific haemolysis disorders, is suffi-

ciently high for register-based studies.

With regard to long-term morbidity we will focus on thromboembolic disor-

ders. We will also examine the risk of dementia, which, we hypothesize, may

have a major impact on the socioeconomically prognosis for this group of pa-

tients.

We intend to exploit the possibilities provided by this and other nationwide

Danish registries to conduct a series of studies in which we will describe the

epidemiology of chronic haemolytic anaemia in terms of prevalence, morbid-

ity and mortality.

The proposed studies will provide important novel insights into the health con-

sequences of chronic haemolytic anaemia, to the benefit of this patient group.

Presentation

language

Danish


Forskningsforum

68

Quantification of diaschisis Authors Eivind Antonsen Segtnan1,2, Peter Grupe1, Jens Ole Jarden3, Oke Gerke1,4,

Sofie Bæk Christlieb1, Caius Constantinescu1, John Erling Pedersen1, Sina

Houshmand5, Søren Hess1,6,7, Mojtaba Zarei8, Albert Gjedde2,9, Abass Alavi5,

Poul F. Høilund-Carlsen1,7

1 Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark, 2 University of Southern Den-

mark, Odense, Denmark, 3 Department of Neurology, Herlev University Hospital, Copenhagen, Denmark , 4 Centre

of Health Economics Research, Odense, University of Southern Denmark , 5 Division of Nuclear Medicine, Depart-

ment of Radiology, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA,

USA , 6 Department of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, Esbjerg, Denmark, 7 De-

partment of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark, 8

National Brain Mapping Centre, Shahid Beheshti University (Medical and General Campus), Tehran, Iran., 9 De-

partment of Neuroscience and Pharmacology, Panum Institute, University of Copenhagen, Copenhagen,


Speaker Eivind Antonsen Segtnan

Purpose and-

background

The clinician can quantitate the number of red blood cells in a patient, or the

flow of air out of the lungs. But, there are no diagnostic test that measure the

whole brain´s glucose metabolism. Simultaneously, patients with brain disor-

ders, has often a desperate need for more information: There are a vast portion

of these individuals, that go home from the hospital with unresolved questions:

why are they feeling worse- when the MRI or CT scan shows nothing wrong?

This Ph.D. project aims to quantitate the glucose metabolism of all the neurons

in the brain, and by this, create a method that quantify the impact of diaschisis.

Introduced in 1914 by von Monakow, the term diaschisis denotes a loss or

change of function in regions of the brain, remote from the primary brain dam-

age; due to neuronal connectivity. With the trillions of connections in the hu-

man brain, diaschisis is a complex entity that is largely unexplored. With quan-

tification of diaschisis, we might heighten precision of what is wrong in the

patient´s brains: hence the patient will be more aware of his/her own disease

process. The method can also heighten the clinician´s ability to monitor the

effect, of the cerebral treatment given. This in turn, can give handles for new

treatment strategies: That is based in each patient´s individual metabolic re-

sponse to treatment.

Design and

method

In this project we developed a novel quantitative method by analyzing FDG-

PET/CT scans in patients with aggressive brain tumors. The method will also

be tested as a diagnostic tool in dementia patients.

Results The method is already accepted for publication in the most renowned scientific

journal for nuclear medicine: ’Journal of Nuclear medicine’. Our study

showed that the more impact of diaschisis, the shorter survival time of the pa-

tients. Our method is easy to use and suitable in a clinical setting. Preliminary

results in the dementia patients show that the method have a diagnostic value

in these patients.

Conclusion The method developed allows comparison of data obtained at different insti-

tutions, and has found that diaschisis can be quantitated in both cerebrum and

cerebellum. The quantitative outcome has sown a prognostic and may have a

diagnostic value, in patients with brain tumor and dementia, respectively.


Forskningsforum

69

Hvordan oplever terapeuter manualiseret behandling? (forskningsprotokol) Forfattere Jakob Emiliussen, Enheden For Klinisk Alkoholforskning, Odense, Danmark.

Søren Harnow Klausen, Institut for Kulturvidenskaber, Odense, Danmark.

Joanne Neale, National Addiction Centre, London, England.

Anette Søgaard Nielsen, Enheden For Klinisk Alkoholforskning, Odense,

Danmark.


Foredragsholder Jakob Emiliussen

Baggrund Manualiseret, ensartet behandling har været et fokusområde for psykiatrien i

de sidste 3-5 år. Det betyder at der er blevet introduceret stadig flere standar-

diserede og manualiserede metoder i den psykiatriske behandling. Men, forstår

vi hvordan den enkelte praktiker oplever denne drejning mod standardiserin-

gen, og forstår vi hvordan de oplever at skulle oversætte mellem manualiserede

tiltag og en klinisk hverdag?

Via et kvalitativt design, søger dette studie at belyse hvordan praktikere ople-

ver at udfører manualiseret behandling og hvordan de forvalter manualer og

retningslinjer i forbindelse med strukturerede indsatser overfor specifikke li-

delser. Særligt har studiet fokus på den manualiserede ’Motivational Intervie-

wing’ som er blevet meget udbredt, især i behandlingen af mennesker med

stof og alkoholproblemer.

Studiet vil øge forståelsen for hvordan vi kan hjælpe praktikere til at udfører

manualiseret behandling mere præcist og effektivt, hvilket i sidste ende kan

sænke omkostningerne forbundet med manualiseret behandlingen. Samtidig

kan vi få en indsigt i, hvordan forskellige praktikere oversætter ensartede ma-

nualer, hvilket også kan lede til effektiviseringer og besparelser.

Denne præsentation er en præsentation af studiets protokol og baggrund. Der

søges for indeværende midler til studiet ved psykiatriens forskningsfond.

Studiet er et samarbejde mellem National Addiction Centre, King’s College –

London og Enheden for Klinisk Alkoholforskning, SDU - Odense.



Forskningsforum

70

Auditoriet – Session 1

kl.09.00-10.00


Forskningsforum

71

Relating Cortical Bone Mechanics to Intracortical Distribution of Nerves in Hu-

man Bone and their Association to Bone Remodeling Events and Vascular

Structures Authors Manasi Sayilekshmy1([email protected]), Rikke Rie Hansen1(rikkerie.han-

[email protected]), Jean-Marie Delaisse2([email protected]), Lars Rolighed3(lars-

[email protected]), Anne-Marie Heegaard1,4([email protected]), Thomas Levin Ander-

sen2, 4([email protected])

1 Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark;

2 Department of Clinical Cell Biology, Vejle Hospital – Lillebaelt Hospital, Institute of Regional Health Research,

University of Southern Denmark, Vejle, Denmark;

3 Department of Otorhinolaryngology, Aarhus University Hospital, Aarhus, Denmark;

4 Shared co-senior authors


Speaker Manasi Sayilekshmy

Background Recent years, the concept that the central nervous system plays a role in the

regulation of bone remodeling has become well established and several studies

have now shown that the bone resorption and formation in animal models may

be directly regulated by nerves within the bone. However, little is known about

local distribution of nerves in the human bone. The aim of this study is to in-

vestigate the local distribution of nerves in human bone and their association

to both vascular structures and bone remodeling events on the bone surface.

Methods The analysis of the local distribution of nerves was conducted on transiliac

bone biopsies from 16 primary hyperparathyroidism patients. Serial sections

from the biopsies were immunostained with antibodies for PGP9.5 (protein

gene product 9.5), a pan-neuronal marker, and TH (tyrosine hydroxylase), a

marker for sympathetic nerve fibers, and CD34, an endothelial marker, as three

double-immunostainings.

Results Overall, the density of PGP9.5+ nerve profiles was more than 8-fold higher in

the intracortical pores than in the bone marrow or periosteum. In the intracor-

tical pores, the TH+ nerve profiles were twice as abundant as TH- nerve pro-

files. In all three compartments nearly all the nerve profiles were associated

with vascular structures, which in the bone marrow were preferentially identi-

fied as large and small arterioles. In the bone marrow, both the PGP9.5+ and

TH+ nerve profiles were denser within a 100µm distance to the bone surfaces

than in the more distant bone marrow. In the bone marrow within 100µm of

the bone surface the PGP9.5+ and TH+ nerves profiles were denser above re-

modeling surfaces than quiescent surfaces, and the PGP9.5+ nerve profiles

were denser above resorptive surfaces than formative surfaces.

Conclusion Collectively, this study demonstrates that the nerves in the human bone are

highly associated with vascular structures and that the density of nerves is ex-

ceptionally high in the pores of the cortical bone. Moreover, the study shows

that the nerve density in the bone marrow is higher close to the bone surface,

and even higher above remodeling events.

Presentation

language


Forskningsforum

72

Platelet aggregation is not increased in testosterone treatment naive Klinefelter

syndrome Authors Simon Chang1, Ole Halfdan Larsen2, Anne Skakkebæk3-5, Anders Bojesen4,

Claus H. Gravholt3,5, Vakur Bor1, Anna-Marie Bloch Münster1

1 Department of Clinical Biochemistry and Unit for Trombosis Research, Hospital of South West Jutland and Depart-

ment of Public Health, University of Southern Denmark, Esbjerg, Denmark,

2 Department of Clinical Biochemistry, Aarhus University Hospital, Centre for Haemophilia and Thrombosis, Aarhus,

Denmark,

3 Department of Endocrinology and Internal Medicine , Aarhus University Hospital, Aarhus, Denmark,

4 Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark,

5 Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.


Speaker Simon Chang

Background In Klinefelter syndrome (KS) the incidence of thrombotic disorders is in-

creased 8 fold. Recently, increased platelet aggregation was proposed as a pos-

sible risk factor in testosterone treated KS. We wanted to examine platelet ag-

gregation in a cohort of testosterone treatment naive men with KS. This would

allow distinguishing karyotypic and treatment related effects on the prothrom-

botic phenotype in KS. Preliminary results are presented here.

Methods So far 12 of 20 testosterone treatment naive men with KS have been included.

Whole blood was collected in hirudin tubes. Platelet aggregation was evaluated

by Multiplate® in response to either adenosine-5’-diphosphate (ADP), arachi-

donic acid (ASPI) or thrombin receptor activating peptide (TRAP) and ex-

pressed as area under the aggregation curve (AUC) (aggregation units*min).

Also, platelet count and sex hormone levels were evaluated.

Results AUC (mean ± SD) was 687 ± 112 for ADP, 1048 ± 83 for TRAP and 765 ±

260 for ASPI. For all agonists platelet aggregation was decreased in KS com-

pared with in-house reference data from healthy individuals (Student’s t-test

p≤0.01 for all). Platelet aggregation and total or free testosterone were neither

correlated directly (Spearman rho [-0.54;-0.29] for all agonists) nor after ad-

justing for age and platelet count.

Conclusion These preliminary results do not support a KS karyotype specific effect leading

to increased platelet aggregation. Also, in KS no correlation was found be-

tween platelet aggregation and neither total nor free testosterone. We will be

evaluating platelet aggregation in the same individuals after testosterone treat-

ment has been initiated to further elucidate possible effects of testosterone

treatment on platelet function.

Presentation

language

Danish


Forskningsforum

73

Traditionelt sengebad med vand og sæbe kontra anvendelse af vaskeservietter –

hvad mener patienterne? Forfattere Pia Lysdal Veje1,2 Ming Chen2,3, Christian Stab Jensen4, Jan Sørensen5og Jette

Primdahl 2,6

1 UCSYD, Region Syddanmark,

2 SDU, Institut for Regional Sundhedsforskning,

3 Mikrobiologisk Klinik, Sygehus Sønderjylland,

4 Central Enhed for Infektionshygiejne, Statens Serum Institut,

5 COHERE, Center for Sundhedsforskning, SDU,

6 Kong Christian X`s Gigthospital, Gråsten og Sygehus Sønderjylland

E-mail [email protected].

Foredragsholder Pia Lysdal Veje, Sygeplejerske, Ph.d.-studerende

Baggrund At blive vasket har afgørende betydning for patienters livskvalitet, sociale

selvopfattelse og velvære. Ud over at føle sig ren og frisk, kan fjernelse af

synligt snavs og reduktion af antallet af potentielt patogene mikroorganismer

på huden, muligvis medvirke til at forebygge hospitalserhvervede infektioner.

Immobile, svækkede og sengeliggende patienter tilbydes ofte sengebade, hvil-

ket tidligere primært har været udført med vand og sæbe. Nu anvendes i sti-

gende grad præimprægnerede vaskeservietter. På trods af et stigende forbrug

af vaskeservietter, savnes bl.a. viden om patienters præferencer ved sengebad.

Formål At undersøge indlagte patienters præferencer i forhold til at blive vasket med

vaskeservietter eller vand og sæbe.

Design Der er valgt et kvalitativt eksplorerende forskningsdesign.

Metode Individuelle semistrukturerede kvalitative interviews med 15-20 indlagte pati-

enter fra tre afdelinger. Interviewene struktureres i NVivo og analyseres inden-

for en fænomenologisk-hermeneutisk referenceramme.

Vigtigste vari-

able, Resultater

og Konklusioner

Interviewene forventes afsluttet sommeren 2017. Design, demografiske data,

og foreløbige fund præsenteres.



Forskningsforum

74

NORDIC9: a Nordic randomized phase II trial exploring treatment strategies of

older patients with metastatic colorectal cancer Authors Stine Brændegaard Winther1, Jesper Ryg2, Camilla Qvortrup1, Per Pfeiffer1

– on behalf of the NORDIC9 committee 1 Department of Oncology, Odense University Hospital, Institute of Clinical Research, University of Southern Den-

mark

2 Department of Geriatric Medicine, Odense University Hospital, Institute of Clinical Research, University of South-

ern Denmark


Speaker Stine Brændegaard Winther

Background More than half of the patients diagnosed with metastatic colorectal cancer

(mCRC) are older (≥ 70 years). Older patients are underrepresented in clinical

trials, and it is uncertain whether full- or reduced dose chemotherapy is the

optimal treatment strategy in patients, who are not candidates for standard full-

dose combination therapy. The oral prodrug S-1 (Teysuno®) is well tolerated

and could potentially be an ideal drug for older patients, however data to pre-

dict toxicity and efficacy is lacking.

Aim The aim is to add knowledge on how to select and tailor the optimal treatment

strategy for older mCRC patients who are not candidates for standard full-dose

combination therapy.

Design and

Methods

NORDIC9 is a Nordic randomized phase II trial exploring two treatment strat-

egies in older mCRC patients, who are not candidates to full-dose combination

therapy:

full dose monotherapy (S-1 30 mg/m2 twice daily days 1-14 every 3

weeks, followed by second line irinotecan 250-350 mg/m2 iv day 1

every 3 weeks) - or

reduced dose (80%) combination therapy regimen (S-1 20 mg/m2 days

1-14 + oxaliplatin 100 mg/m2 iv day 1 every 3 weeks, followed by sec-

ond line S-1 20 mg/m2 days 1-14 + irinotecan 180 mg/m2 day 1 every

3 week).

Bevacizumab (7.5 mg/kg) may be added at the discretion of the treating clini-

cian. Geriatric screening tools (G-8, Vulnerable Elderly Survey 13, Timed-Up-

and-Go, hand grip strength), Charlson Comorbidity Index, and Quality of Life

(EORTC QLQ-C30) will be evaluated at baseline.

Important vari-

ables

Primary endpoint is progression-free survival. Secondary endpoints are time-

to-failure of strategy, overall survival, response rate, toxicity, and correlations

between biomarkers, pre-treatment characteristics, and geriatric screening

tools.

Preliminary re-

sults

A safety analysis was performed when 50 pts had received 3 cycles. The safety

committee recommends to continue the trial without dose adjustments accord-

ing to the original design.

Conclusion The trial is still on-going. Currently 141/150 patients have been included since

March 2015.

Presentation

language

Danish


Forskningsforum

75

Musculoskeletal pain among Danish surgeons Authors Tina Dalager, Dep. of Sports Science and Clinical Biomechanics, SDU,

[email protected]. Eleanor Boyle, Dep. of Sports Science and Clinical

Biomechanics, SDU, [email protected]. Pernille Tine Jensen, Dep. of Gy-

naecology and Obstetrics, OUH, [email protected]. Ole Mo-

gensen, Dep. of Gynaecology and Obstetrics, Karolinska University Hospital

& Dep. of Clinical Research, SDU, [email protected]. Karen

Søgaard, Dep. of Sports Science and Clinical Biomechanics, SDU,

[email protected]


Speaker Tina Dalager

Purpose/Back-

ground

To investigate the prevalence and intensity of musculoskeletal pain, and the

risk factors associated with reporting pain in two or more body sites.

Design A cross-sectional study of 822 Danish surgeons within gynaecology, gastroen-

terology, and urology.

Method/most

important varia-

bles

The questionnaire collected information on sociodemographics, work experi-

ence, work demands, health status, and musculoskeletal complaints. Physical

work demands was rated on a scale from 0 (no demands) to 10 (extremely

demanding). Workability and productivity were rated on a scale from 0 to 10

(best workability/productivity) and dichotomised into ‘<10 ‘or ‘10’. Preva-

lence of the past three months for musculoskeletal complaints in hands, el-

bows, neck, shoulders, upper back and low back were reported. Pain intensity

was scaled from 0-10, with 10 being worst possible pain. A backwards logistic

regression was performed with p-value to remove set at 0.10 to determine the

risk factors associated with pain at more than one body site.

Results In total, 284 replied to all questions and were analysed. Average age was 57

years and 38% were female. The most prevalent pain sites were neck (63%)

and low back (60%) while elbows (<15%) were the least prevalent pain sites.

Pain intensity (mean±SD) was 4.0±2.2 for the neck and 3.8±2.2 for the low

back. Of 284 respondents, 76% reported to have pain in two or more body

sites. We found that being a female surgeon (OR: 3.4, 95%CI: 1.5-7.4), higher

physical work demands (OR: 1.5, 95%CI: 1.2-1.7), reporting <10 in workabil-

ity (OR: 3.4, 95%CI: 1.6-7.1), and having a sense of heaviness/headache (OR:

4.8, 95%CI: 2.0-11.5) were significantly associated with an increased odds of

reporting pain in more than one body site.

Conclusions Surgeons are a highly educated and specialised job group. The high pain in-

tensities found may compromise the surgeons’ workability and work perfor-

mance, which may lead to shortening their productive working years. The high

odds ratios in this study, especially for women, should be explored and there

is a need for developing rehabilitating and preventive strategies. An appropri-

ate next step would be a thorough exposure assessment to accurately assess the

working conditions.

Presentation

language

Danish


Forskningsforum

76


kl.10.00-11.00


Forskningsforum

77

Characterizing the molecular mechanism of continuous bone resorption - an in

vitro study Authors Xenia G Borggaard, Jean-Marie Delaissé and Kent Søe

Klinisk Cellebiologisk afd., Vejle Sygehus


Speaker Xenia G Borggaard

Background Osteoclasts (OCs) degrade bone and are in healthy individuals strictly con-

trolled by the microenvironment of the bone. With age the balance between

bone-resorption and bone-formation can change - resulting in osteoporosis.

Different pathological conditions such as cancer induced bone disease and os-

teopetrosis also affect this balance, resulting in increased or decreased bone

resorption.

In order to develop effective treatment against bone pathologies and the age-

related changes in bone resorption a molecular understanding of the OCs is

crucial, since the present treatments of osteoporosis and cancer induced bone

diseases are less effective than anticipated. We have shown that OCs can re-

sorb bone in two different ways - pit-mode (intermittent) and trench-mode

(continuous). So far previous studies have only described pit-mode.

Purpose We want to make a molecular characterization of the trench-resorption in com-

parison to pit-resorption.

Methods We will use human monocytes (purified from buffy coats of healthy blood do-

nors) and differentiated into OCs. The matured OCs are seeded on bovine cor-

tical bone slices and incubated for 3 days in presence or absence of different

specific inhibitors. After incubation OCs are either fixed for IF-staining and

evaluated using confocal microscopy or the bone slices are cleaned, stained

and evaluated in proportion to eroded surface and resorption patterns using

light microscope. Time-lapse recordings of matured OCs seeded on bovine

cortical bone slices (72 h) are used to evaluate the mobility of OCs before and

after treatment with specific inhibitors.

Preliminary re-

sults

Trench-formation is 3.1 fold (n=3) more sensitive to chloroquine (a drug that

raises the pH in lysosomes) than pit-formation. Time-lapse recordings in pres-

ence of chloroquine show an unaffected resorption speed and transition from

pit- to trench-mode in both resorption-modes, but a premature termination of

trench-resorption possibly due to intracellular accumulation of collagen. Time-

lapse recordings with lysosome tracker and collagen labelling showed appear-

ance of large lysosomes at the resorptive site of OCs in trench-mode coinciding

with labelled collagen uptake and their subsequent transport to the rear of the

OC. These large lysosomes were not observed in pit-mode.

Conclusion An efficient extra- as well as intra-cellular collagen breakdown is a prerequi-

site for trench-mode and distinguishes it from pit-mode.

Presentation

language

Danish


Forskningsforum

78

Cerebrospinal fluid biomarkers for Parkinson's disease and L-DOPA-induced

dyskinesia Forfattere Andreas Dammann Andersen1,2,3,4,5, Michael Binzer2,3, Morten Blaabjerg7,8,9,

Jan Bert Gramsbergen5, Egon Stenager1,2,4,6

1) Neurologisk afdeling, Sygehus Sønderjylland, Sønderborg 2) Institut for Regional Sundhedsforskning, Center Søn-

derjylland, Syddansk Universitet (SDU), Aabenraa 3) Odense Patient data Exploratory Network (OPEN), Odense

Universitetshospital 4) Fokuseret Forskningsenhed i Neurologi, Sygehus Sønderjylland, Aabenraa 5) Institut for Mo-

lekylær Medicin, Neurobiologisk forskning, SDU, Odense 6) Sydjysk Skleroseklinik (Sønderborg, Esbjerg, Kolding)

7) Neurologisk afdeling, OUH 8) Neurologisk afdeling, Roskilde, Universitetshospital Sjælland 9) Klinisk Institut,

SDU, Odense


Foredragsholder Andreas Dammann Andersen, reservelæge, PhD-studerende, Neurologisk Af-

deling, Sønderborg.

Baggrund Parkinson’s sygdom (PD) er den næsthyppigste fremadskridende nervesyg-

dom i Danmark, som rammer ca.1% af alle over 60 år. Sygdommen kan ikke

bremses med nutidens medicin og den mest virksomme behandling med stoffet

levodopa (L-DOPA) mister gradvist sin effekt . Derudover vil bivirkninger

pga. L-DOPA i stigende grad plage patienterne, heriblandt potentielt invalide-

rende ufrivillige bevægelser kaldet L-DOPA-inducerede dyskinesier (LID).

Sygdomsprocessen kan starte op til 20 år før patienterne udvikler de klassiske

symptomer på PD, og symptomerne forud for det er mere uspecifikke. Ved

hjælp af biomarkører er det potentielt muligt at stille diagnosen tidligere, iden-

tificere patienter med risiko for at udvikle LID samt få en bedre forståelse for

de sygdomsprocesser, som giver PD.

Design Case-control studie

Metoder I alt 26 PD-patienter og 16 kontroller fik udtaget rygmarvsvæske (CSF) og

blod til analyse. PD-patienterne blev klinisk vurderet ved hjælp af internatio-

nalt benyttede skalaer som vurderer deres sygdoms sværhedsgrad, forekom-

sten af LID samt deres kognitive formåen.

CSF og blod blev analyseret for diverse signalstoffer, proteiner og enzymer,

som kan være relateret til Parkinson’s sygdom.

Vigtigeste varia-

ble

Score af sygdommens sværhedsgrad (UPDRS), af LID (UDysRS), CSF-pro-

tein, monoaminer, alpha-synuclein, tryptofan-metabolitter, analyse af oligo-

mere proteiner (Trol), glucocerebrosidase-aktivitet.

Foreløbige re-

sultater

I CSF har PD-patienter i forhold til kontroller signifikante ændringer koncen-

trationen af monoaminer, oligomere proteiner samt ændret enzymaktivitet. I

blodet ses også ændringer i koncentrationen af oligomere proteiner.

PD-patienter med LID har signifikante ændringer i sammensætningen af mo-

noaminer og tryptofan-metabolitter i forhold til andre PD-patienter og kontrol-

ler.

Konklusioner I dette studie har vi fundet nye biomarkør-kandidater til diagnosticering af PD

og LID. Dette kan potentielt benyttes til tidligere diagnostik af PD patienter

samt til at identificere patienter med risiko for at udvikle LID.



Forskningsforum

79

Dual leadership og fælles ledelse i praksis – et studie af 3 danske sygehusafdelin-

ger Forfattere Bettina Ravnborg Thude, Ph.d. studerende Center for Kvalitet, Region Syd-

danmark og Lærings- og forskningshuset, Sygehus Sønderjylland.

Hovedvejleder, Professor Erik Hollnagel, Center for Kvalitet, Region Syddan-

mark, [email protected]

Medvejleder, Professor Egon Stenager, Forskningsleder Sygehus Sønderjyl-

land, [email protected]

Medvejleder, ekstern lektor Svend Erik Thomsen, CBS, [email protected]


Foredragsholder Bettina Ravnborg Thude

Formål Formålet med projektet er at undersøge, hvordan ledelse på sygehusene funge-

rer, når der er to eller flere ledere, der har et fælles ansvar, her betegnet som

dual leadership. Vi har belyst 3 forskellige ledelses set-up fra 3 forskellige sy-

gehuse, for at vurdere, om der er forskel på, hvordan disse set-up påvirker

tværfagligt samarbejde, afdelingens resultater og ledernes legitimitet.

Metode Projektet er et kvalitativt og bygger på semistrukturerede interviews med le-

dere og medarbejdere på tre forskellige sygehuse i landet. Der er i alt inter-

viewet ca. 20 ledere og 20 medarbejdere fordelt på en afdeling fra hvert af de

tre sygehuse. Afdelingerne er alle inden for samme lægefaglige speciale.

Afdelingernes resultater er belyst ud fra eksisterende data, nemlig LUP og må-

linger af den kliniske kvalitet.

Konklusioner og

foreløbige re-

sultater

Magt balance, gode personlige relationer og enighed om beslutningsproces er

vigte faktorer bør være til stede, for at dual leadership fungerer efter hensigten.

Ifølge litteraturen er der flere årsager til at vælge dual leadership, da det kan

skabe bedre resultater for den enkelte afdeling og virksomhed men også at det

giver mulighed for at lederne har legitimitet i medarbejderkredsen. Pt arbejder

vi på at undersøge hvordan disse årsager udspiller sig i praksis.



Forskningsforum

80

The variable sensitivity of breast cancer patients to treatment against bone re-

sorption Authors Anaïs MJ Møllera, Jean-Marie Delaisséa, Troels Bechmannb, Erik H. Jakob-

senb, Jonna S. Madsenc, Kent Søea

a Kl. Cellebiologisk Afd., Vejle Sygehus; b Onkologisk Afd., Vejle Sygehus; c Kl. Biokemisk og Imm. Afd., Vejle

Sygehus.


Speaker Kent Søe

Background Breast cancer (BC) cells frequently metastasize to bone tissue. When arriving

in the bone marrow they initiate a “vicious cycle” involving the bone resorbing

osteoclasts. This results in local bone loss, increased fracture risk, pain and

reduced quality of life. Standard treatment is bisphosphonates or denosumab,

both targeting osteoclasts. Unfortunately, up to 50% of BC patients receiving

monthly bisphosphonates develop new skeletal related events (SRE) within 1

year of treatment and up to 65% within 2 years. Similar observations are made

with the novel drug, denosumab. The reasons for this incomplete suppression

are unknown.

Purpose Can differences in sensitivity to bisphosphonates be due to intrinsic differences

between osteoclasts from different individuals?

Design Inclusion criteria: 1) 50 (at present 14) female BC patients with newly identi-

fied bone metastases (80 years or younger); 2) 50 (at present 25) healthy fe-

male blood donors between 40 and 67 years of age. Exclusion criteria: 1) re-

cent/existing non-pathological fracture; 2) prior bisphosphonate treatment.

Methods BC patients: Consecutive measurements of bone markers (CTX: bone resorp-

tion; P1NP: bone formation). Blood donors: Baseline measurement of bone

markers. In addition, the sensitivity of OCs (generated from cells isolated from

peripheral blood from the blood donors) to bisphosphonate is analyzed.

Results So far, our results, as expected, show increased levels of both CTX (p=0.0588)

and P1NP (p=0.0003) in BC patients compared to controls. In addition, an im-

balance of bone resorption and formation is observed in BC patients

(p=0.0001) compared to controls. When comparing BC patients’ response to

anti-resorptive treatment, we generally observe that CTX (bone resorption) and

P1NP (bone formation) decreases following a single treatment (pCTX=0.0009,

pP1NP=0.0161). But the level of inhibition after one treatment varies by 7.86-

fold (CTX) and the absolute level of CTX at that stage varied by 13.12-fold,

indicating differences in sensitivity. Large studies in the literature document

that the least sensitive patients have a 2 to 3-fold increased risk of death com-

pared to those that are more sensitive. In our in vitro experiments, we observed

that there is up to a 100-fold difference in sensitivity between the osteoclasts

generated from different donors to treatment with zoledronic acid. In support

of the credibility of the in vitro approach we observed a positive linear corre-

lation (r2=0.3793, p=0.0038) between the age of the donors and the resorptive

activity of their in vitro generated osteoclasts.

Conclusion Variation in sensitivity to bisphosphonates may be due to intrinsic differences

between osteoclasts from different individuals.


Forskningsforum

81

Spinal pain in Danish school children – how often and how long? The CHAMPS

Study-DK Authors First author: Kristina Boe Dissing1 Last author: Lise Hestbæk1,2 Co-authors:

Jan Hartvigsen1,2, Christopher Williams3,4, Steven Kamper5, Eleanor Boyle1,

Niels Wedderkopp6,7

1 Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Den-

mark, Campusvej 55, DK-5230 Odense M, Denmark

2 Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, DK-5230 Odense M, Denmark

3 Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Callaghan,

NSW Australia.

4 Hunter New England Population Health, Hunter New England Local Health District, Longworth Ave, Wallsend,

NSW Australia.

5 The George Institute for Global Health, Level 3, 50 Bridge St, Sydney NSW 2000 Australia

6 Institute of Regional Health Services Research, University of Southern Denmark, Winsloewparken 193, DK-5000

Odense C, Denmark

7 Sports Medicine Clinic, Orthopaedic Department Hospital of Lillebaelt, Østre Hougvej 55, DK-5500 Middelfart,

Denmark


Speaker Kristina Boe Dissing

Objectives The overall aim of this study was to describe the prevalence of spinal pain in

9-15 year-old Danish schoolchildren, over a three-year period. Specifically de-

termining the characteristics of spinal pain in terms of frequency and duration.

Methods A three-year prospective longitudinal cohort study following a cohort of 1400

school children. Parents received weekly text messages (SMS) inquiring about

the child´s musculoskeletal pain.

Results The results were presented separately for each study year (year 1, 2 and 3). The

prevalence was 29%, 33% and 31% for year 1, 2 and 3 respectively, and in-

creased with age, especially for lumbopelvic pain. Most children had few and

short episodes with spinal pain, but 21%, 20% and 25% had three or more

episodes during a study year and 16%, 17% and 17% of all episodes lasted for

more than four weeks for year 1, 2 and 3 respectively.

Conclusion This study confirms the relatively high prevalence of spinal pain in young peo-

ple. Most episodes are brief, but there is a substantial group of children with

frequent and long-lasting episodes of spinal pain indicating a need for action.

Presentation

language

Danish


Forskningsforum

82


kl.11.00-12.00


Forskningsforum

83

Interdisciplinary Mixed Methods Research: Ensuring That Everybody Wins –

An Example From The Emergency Department Authors Thomas Schmidt, Mærsk Mc-Kinney Møller Instituttet, Syddansk Universitet


Speaker Thomas Schmidt

Purpose and

Background

Projects rooted in action research often tend to favor the background of the

initiating party. Thus putting the entire endeavor at risk, as expectations are

not met. In this work, I describe an approach to development of a novel clinical

decision support system for monitoring of patients. The project’s objective is

to establish a way for clinicians to spot patients at risk of deterioration in due

time, and was conducted in a way that delivered insight and value to an inter-

disciplinary team of technical, and clinical researchers, and practitioners.

Study Design Multi-staged design, implementation, and evaluation of a novel patient moni-

toring platform. Incrementally developed through feasibility, cohort, and clus-

ter randomized sub-studies together with Odense University Hospital, Hospital

of South Western Jutland, and the Mærsk Mc-Kinney Møller Institute at the

University of Southern Denmark.

Methods The overall project is designed as a Mixed Methods study by utilizing a user

centered approach with a hint of participatory design – coupled with findings

and insight from exploratory and statistical analysis of prospectively collected

patient monitor data and access to retrospective health registry data.

Essential varia-

bles

Clinically: Vital signs, severity, admission characteristics; outcomes:

Heart/Respiratory failure, transfer to Intensive Care, mortality. Technical:

technology acceptance and utility. Economically: cost reduction and opera-

tional expenses.

Results The Mixed Methods approach has potential to deliver insight and value usable

across all involved disciplines. In this project a novel patient monitoring plat-

form was developed using insights from quantitative and qualitative research

instruments. Validation of effects are planned for 2018.

Conclusions Including diverse types of data supports the nature of interdisciplinary projects

in a manner that provide benefit to all participants.

Presentation

language

Danish


Forskningsforum

84

BRCAness in a Danish cohort of epithelial ovarian carcinoma. Authors Mette Hjortkjær1,4,5, Mads Jørgensen2, Marianne Waldstrøm3,4, Erik Søgaard-

Andersen5, Anders Jakobsen1,4, Karina Dahl Steffensen1,4. Departments of 1 Oncology, 2Clinical Genetics and 3Pathology, Vejle Hospital, Denmark, 4Institute of Regional Health

Research, University of Southern Denmark, 5Department of Gynaecology and Obstetrics, Aalborg University Hospital,

Denmark.


Speaker Mette Hjortkjær

Aim and

Background

The tumour suppressor genes breast cancer early onset 1 and 2 (BRCA1/2) are

essential to proper repair of DNA double strand breaks by the mechanism ho-

mologous recombination (HR). Pharmacological inhibition of the enzyme poly-

(adenosine-diphosphate-ribose) polymerase (PARP) exploits deficient HR in

BRCA1/2 mutated cancer cells by inducing synthetic lethality. The BRCAness

phenomenon describes a tumour phenotype with homologous recombination

deficiency without a germline BRCA1/2 mutation, and could be caused by so-

matic mutations in BRCA1/2 genes, silencing of BRCA1 by hypermethylation

of its promotor region, or mutations in other genes involved in the homologous

recombination repair pathway. Pharmacological PARP inhibition has been ap-

proved internationally as monotherapy of relapsed epithelial ovarian carcinoma

(EOC) harbouring germline or somatic BRCA1/2 mutations. The BRCAness

phenomenon could potentially identify a greater fraction of patients sensitive to

PARP inhibition. Germline mutations in BRCA1/2 genes are present in 5-15 %

of EOCs. We hypothesize that approximately 50 % of EOCs show BRCAness

phenotype with a better overall survival compared to BRCA1/2 wildtype pa-

tients.

Design and

Methods

This was a retrospective, population based study cohort study. DNA derived

from formalin-fixed-paraffin-embedded tumour and normal tissue, collected at

primary debulking surgery, from a population based cohort of 512 Danish

women diagnosed with EOC in 2005, was sequenced by next generation se-

quencing (NGS) and analysed for pathogenic mutations in BRCA1/2 and 20

other HR genes. Of those, 393 samples were above tumour DNA cut-off at 20

% and included in further analyses. NGS on DNA from paired normal tissue

was performed on mutation-positive samples. Suspected somatic mutations

(positive in tumour DNA only) would be verified by pyrosequencing. Tumour

tissue was stained immunohistochemically with BRCA1 antibodies and semi-

quantitative analyses performed to determine loss of, equivocal and retained

BRCA1 protein expression.

Results According to preliminary data analyses, 59 % of the patients had a pathogenic

or likely pathogenic mutation. Of those, 24 % had BRCA1/2 mutations and 35

% had other HR mutations. DNA derived from normal tissue has been se-

quenced and immunohistochemical analyses performed. Correlation of data and

overall survival analyses are currently in process.

Conclusions Next generation sequencing on tumour derived DNA is a potentially valid

method of identifying germline and somatic BRCA1/2 mutations and

BRCAness tumours in EOC. This study suggests a substantially larger propor-

tion of BRCA deficient tumours in EOC than previous population based studies.


Forskningsforum

85

HVORFOR KOMMER PATIENTEN IKKE? En kvalitativ undersøgelse af ude-

blivelser blandt patienter med anden etnisk baggrund end dansk Forfattere Leila Saud Abdulkadir1, Ida Nygaard Mottelson2 & Dorthe Nielsen2,3

1 Stud.scient.san., Syddansk Universitet, 2 Indvandrermedicinsk Klinik,

Odense Universitetshospital 3Lektor, Syddansk Universitet


Foredragsholder Leila Saud Abdulkadir

Formål og bag-

grund

I sundhedsvæsenet er der stort fokus på effektivitet samt udnyttelse af

samfundets tilgængelige ressourcer. Udeblivelser kan have væsentlige konse-

kvenser for både patienten og sundhedsvæsenet. Hvis en patient udebliver

kan det have kliniske følger og samtidig forhindre andre patienter i at komme

til tidligere. Derudover har det store samfundsøkonomiske konsekvenser for

sundhedsvæsenet i form af ressourcespild. Internationale studier viser, at der

er en større andel af patienter med anden etnisk herkomst, der udebliver,

sammenlignet med etniske patienter. På trods af denne tendens, er dette fæ-

nomen undersøgt i begrænset omfang. Derfor har dette studie til formål at re-

gistrere udeblivelser samt afdække årsagerne til patienters udeblivelser ud fra

et patient- og sundhedsprofessionelt perspektiv.

Design Mixed methods pilotstudie. Kvantitativ registrering af udeblevne patienter via

spørgeskema. Med afsæt i denne samt eksisterende litteratur er der foretaget et

kvalitativt studie med seks semistrukturerede interviews med tre udeblevne pa-

tienter og tre sundhedsprofessionelle fra Indvandrermedicinsk Klinik.

Foreløbige re-

sultater

Spørgeskemaundersøgelsen viste, at 12 % udeblev. Analyse af den indsamlede

empiri resulterede i følgende temaer: ”At være sårbar patient”, ”At have fysi-

ske og psykiske udfordringer”, ”At mestre hverdagens udfordringer” og ”At

tilpasse behandlingen ud fra patientens behov”.

Konklusioner Patienterne og de sundhedsprofessionelle angiver, at årsagerne til patienternes

udeblivelser primært skyldes deres fysiske og psykiske tilstand.



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Bone Formation by Sheep Stem Cells in an Ectopic Mouse Model: Comparison

of Adipose and Bone Marrow Derived Cells Authors Kristian Kjærgaard1, Chris H. Dreyer1 ([email protected]), Nicholas

Ditzel2 ([email protected]), Christina M. Andreasen1

([email protected]), Li Chen2 ([email protected]),

Søren P. Sheikh3 ([email protected]), Søren Overgaard1

([email protected]), and Ming Ding1 ([email protected])

1 Orthopaedic Research Laboratory, Department of Orthopaedic Surgery and Traumatology, OUH

2 Department of Endocrinology and Metabolism, Molecular Endocrinology Laboratory (KMEB), OUH

3 Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, OUH


Speaker Kristian Kjærgaard

Purpose and

Background

Scaffolds for bone tissue engineering can be loaded with stem and progenitor

cells (SPC) from different sources to improve osteogenesis. SPC can be found

in bone marrow, adipose tissue, and other tissues. This study compares in vivo

osteogenic capacity between adipose derived cells and bone marrow derived

cells.

Design Experimental animal study.

Methods Adipose derived cells and bone marrow derived cells were isolated from five

female sheep and seeded on hydroxyapatite granules prior to subcutaneous im-

plantation in immunodeficient mice. The doses of cells in the implants were

0.5×106, 1.0×106, or 1.5×106 adipose derived cells and 0.5×106 bone marrow

derived cells, respectively. After eight weeks, bone volume versus total vol-

ume (BV/TV) was quantified using histomorphometry. Origin of new bone

was assessed using human vimentin (HVIM) antibody staining.

Essential varia-

bles

Type and number of cells implanted.

Results bone marrow derived cells yielded significantly higher BV/TV than any adi-

pose derived cell group, while differences between adipose derived cell groups

were not statistically significant. HVIM antibody stain was successfully used

to identify sheep cells in this model.

Conclusion Adipose derived cells and bone marrow derived cells were capable of forming

bone, and bone marrow derived cells yielded significantly higher BV/TV than

any adipose derived cell group.

Presentation

language

Danish


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87

Funktionsniveau ved indlæggelse på geriatrisk afdeling som risikofaktor for

mortalitet: et landsdækkende populationsbaseret kohorte studie Forfattere Jesper Ryg1 ; Henriette Engberg2 ([email protected]); Pavithra Mari-

adas2 ([email protected]); Solvejg Gram Henneberg Pedersen3 (shp@dadl-

net.dk); Martin Jørgensen4 ([email protected]); Kirsten Laila Vinding5 (kir-

[email protected]); Karen Andersen-Ranberg1 (karan-

[email protected]) 1 Geriatric Dept., Odense University Hosp.,2 Center For Clinical Epidemiology, Odense University Hosp.,3 Medical

Dept., Holbæk Hosp.,4 Geriatric Dept., Aalborg University Hosp.,5 Medical Dept., Kolding Hosp., DK


Foredragsholder Jesper Ryg

Baggrund Begrebet funktionsevne (Activities of Daily Living (ADL)) anvendes som en

karakteristik af personers evne til at klare daglige aktiviteter og således som

mål for evt. aftagende almen tilstand, hvilket er en vigtig klinisk information

ved indlæggelse. Barthel Index (BI) er et anerkendt scoringsinstrument for må-

ling af ADL via en sum-score fra 0-100, hvor 0 point angiver ingen selvstændig

ADL funktion og 100 point angiver selvstændig ADL funktion. Formålet med

dette studie var at undersøge BI som risikofaktor for efterfølgende mortalitet

hos patienter indlagt på geriatriske afdelinger i Danmark.

Design Registerbaseret prospektivt kohorte studie.

Materiale og

metoder

Studiet anvendte oplysninger fra en af de danske kliniske kvalitetsdatabaser:

Landsdækkende database for Geriatri (GER) og indhentede supplerende data

fra tre forskellige danske nationale sundhedsregistre: Central person registret

(CPR), Landspatientregistret (LPR) og Dansk Receptdatabase. Studiet inklu-

derede alle patienter ≥65 år med deres første registrering i GER i perioden 1.

januar 2005 til 31. december 2014 (indeks indlæggelse). Patienterne blev fulgt

på registerniveau fra indeksindlæggelse indtil et af følgende førstkommende

udfald: død, emigration eller slut på follow-up d. 31. december 2015. Nume-

risk data for BI ved indlæggelse blev indhentet fra GER og kategoriseret i fire

standard kategorier (0-24, 25-49, 50-79, 80-100). Multivariabel Cox regres-

sion blev anvendt til at analysere BI som prædiktor for mortalitet, og der blev

justeret for følgende konfoundere: indlæggelsesår, alder, civil stand, Body

Mass Index (BMI) identificeret i GER, antal hospitals indlæggelser før base-

line identificeret via LPR, Charlson Comorbidity Index (CCI) beregnet ud fra

sygdomsspecifikke LPR koder samt antal recepter på forskellig medicin ind-

løst ≤120 dage før indeks indlæggelsen. Alle analyser udføres separat for kvin-

der og mænd.

Vigtigste varia-

ble

BI (0-100 point) (exposure), dato for død (outcome) via CPR, alder, køn, civil

stand, BMI, antal hospitals indlæggelser før indeks indlæggelse, CCI, medicin

forbrug ved indeks indlæggelse.

Resultater I alt 74.603 patienter (63% kvinder) blev inkluderet. Kvinder var signifikant

ældre end mænd (84[79-89] (median [IQR]) vs 81[76-86] år) og havde højere

BI (55[(30-77] vs 52[26-77]). Den mediane (95% CI) overlevelse (antal år)

var signifikant forskellige i de fire BI kategorier: 4.9(4.7-5.0) og 3.6(3.4-3.7)

(BI=80-100), 3.5(3.4-3.6) og 2.3(2.2-2.4) (BI=50-79), 2.7(2.6-2.8) og


Forskningsforum

88

1.7(1.6-1.8) (BI=25-49) samt 1.3(1.2-1.4) og 0.9(0.8-0.9) (BI=0-24) for hen-

holdsvis kvinder og mænd. Justerede mortalitets hazard ratioer (95% CI) for

BI=0-24 sammenlignet med BI=80-100 som reference var 2,42(2,32-2,52)

for kvinder og 2,07(1,97-2,18) for mænd. Den justerede model med BI anvendt

som numerisk variabel viste en signifikant øget mortalitets risiko på 1,1% for

kvinder og 0,9% for mænd svarende til hvert enkelt point scoret mindre end

100 på BI.

Konklusion Funktionsniveau ved indlæggelse på hospitalet angivet i form af BI er en selv-

stændig risikofaktor for mortalitet hos geriatriske patienter. BI har en potentiel

rolle som medhjælpende prognostisk faktor i den kliniske hverdag ved behand-

lingen af skrøbelige ældre.



Forskningsforum

89

SERVICE til FORSKNING Mød os i receptionsområdet!

GCP-Enheden

Vejledning om Good Clinical Practice.

Kvalitetskontrol af lægemiddelforsøg og

forsøg med medicinsk udstyr.

Juridisk Kontor –

SDU Erhverv

Juridisk rådgivning og støtte ved udarbej-

delse og legalisering af kontrakter. SDU

Erhverv/Viden og teknologiudveksling

hjælper med at nyttiggøre forskningsresul-

tater.

Forskningsinfrastruktur: Hjælp til forskere

ved etablering af biobank, databaser, elek-

troniske spørgeskemaer, randomisering, re-

gisterforskning og forskningsrådgivning.

De Videnskabsetiske

Komitéer

Godkendelse af sundhedsvidenskabelige

forskningsprojekter, hvori der indgår inter-

vention på mennesker eller anvendes men-

neskeligt biologisk materiale.

Et Sundere Fyn

Pilotprojekt i samarbejde mellem SDU,

OUH og TV2/Fyn. Projektet engagerer og

involverer borgerne i forskning og lader

fynboerne udvælge det forskningsprojekt,

som flest ønsker at prioritere.

OUH, Direktionsse-

kretariatet

Juridisk rådgivning ifm. Anmeldelse af

sundhedsvidenskabelig forskning – hvor-

dan får du adgang til data – hvordan må du

behandle og opbevare data, når du har dem

SDU-Forskerservice

Økonomi

Kvalitetssikring og kontrol af budgetter i

forbindelse med projektansøgninger og ved

modtaget bevilling ydes assistance vedrø-

rende økonomiske forhold.

Biomedicinsk

Laboratorium

Biomedicinsk Laboratorium er den centrale

dyreforsøgsfacilitet for Det Sundhedsvi-

denskabelige Fakultet, Det Naturvidenska-

belige Fakultet og Odense Universitetsho-

spital

Åben Forskerdag 2017

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