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1 Forskningens dag den 9. april 0 Abstracts Hospitalsenhed Midt

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3 Program Forskningens dag Velkomst Foredragssession I Pause med mulighed for at se posters Foredragssession II Gæstetaler: Regionsdirektør Bo Johansen, Region Midtjylland Styrket forskning på regionshospitalerne - Nyt aftalekompleks mellem Region Midtjylland og Aarhus Universitet Præsentation af forskningspublikation for Præmieoverrækkelse og afslutning Session I Ole Kudsk Jensen m.fl., Diagnostisk Center Pain-intensity in non-specific low back pain versus radiculopathy: Posthoc analyses of baseline data from a randomised controlled trial.. Lene Søndergaard Larsen m.fl., Center for Sygeplejeforskning An ambiguous relationship a qualitative meta synthesis of hospitalized patients experience of interaction with fellow patients. 3. Annette Høgh m.fl., Karkirurgisk Afdeling Use of angiotensin-converting-enzyme inhibitors and cardiovascular outcomes following primary vascular surgery: A nationwide propensity score matched follow-up study. 4. Christian Høyer m.fl., Klinisk Fysiologisk Afdeling Randomised diagnostic accuracy study of a fully automated portable device for diagnosis of peripheral arterial disease by measurement of toe pressures. 5. Dorthe Dahl Hoffmann m.fl., Vestdansk Center for Rygmarvsskade Tilbage til arbejde/uddannelse efter en traumatisk rygmarvsskade. Moderator: Overlæge, lektor, dr.med. Lars Frost, Diagnostisk Center Session II Troels K Hansen m.fl., Diagnostisk Center Varigheden af kontakten til diabetesambulatorium, risikostratificering og ressourceforbrug for type diabetes patienter henvist fra almen praksis.. Helle Zacho m.fl., Klinisk Fysiologisk Afdeling Den diagnostiske værdi af knoglescintigrafi i en nordisk population uden PSA-screening: Et prospektivt studie af konsekutive patienter med nydiagnosticeret prostatacancer. 3. Mette Herly m.fl., Diagnostisk Center Patient s global assessment of general health by VAS at baseline predicts ACR/EULAR remission after 3, 6 and month s of efficient treatment in DMARD- and steroid naïve early rheumatoid arthritis patients. The Danish Cimestra-Study. 4. Jes Lindholt m.fl., Forskningssektionen, Karkirurgisk Afdeling The Scandinavian Propaten trial two year results from a randomised clinical controlled multi-centre trial. An Achilles heel exposed? 5. Pernille Endrup Jacobsen m.fl., Regional Specialtandpleje Enamel disturbances in children prenatally exposed to anti-epileptic drugs. Moderator: Professor, overlæge, dr.med. Lars Jelstrup Petersen, Klinisk Fysiologisk Afdeling Hvert oplæg har en varighed af otte minutter, herefter er der afsat to minutter til diskussion. 3

4 Foredrag på Forskningens dag Session I:. Pain-intensity in non-specific low back pain versus radiculopathy: Posthoc analyses of baseline data from a randomised controlled trial...6. An ambiguous relationship a qualitative meta synthesis of hospitalized patients experience of interaction with fellow patients Use of angiotensin-converting-enzyme inhibitors and cardiovascular outcomes following primary vascular surgery: A nationwide propensity score matched follow-up study Randomised diagnostic accuracy study of a fully automated portable device for diagnosis of peripheral arterial disease by measurement of toe pressures Tilbage til arbejde/uddannelse efter en traumatisk rygmarvsskade...0 SESSION II:. Varigheden af kontakten til diabetesambulatorium, risikostratificering og ressourceforbrug for type diabetes patienter henvist fra almen praksis.... Den diagnostiske værdi af knoglescintigrafi i en nordisk population uden PSA-screening: Et prospektivt studie af konsekutive patienter med nydiagnosticeret prostatacancer Patient s global assessment of general health by VAS at baseline predicts ACR/EULAR remission after 3, 6 and month s of efficient treatment in DMARD- and steroid naïve early rheumatoid arthritis patients. The Danish Cimestra-Study The Scandinavian Propaten trial two year results from a randomised clinical controlled multi-centre trial. An Achilles heel exposed? Enamel disturbances in children prenatally exposed to anti-epileptic drugs...5 Øvrige indleverede abstracts til Forskningens dag. Tolerability of month long Combination Therapy of Moxifloxacin and Rifamycin in treatment of Prosthetic Joint Infections due to Staphylococcus Aureus...6. Constraint Induced Language Therapy in Sub-Acute Aphasia Clinical routine rehabilitation (CRR) of patients with Chronic Obstructive Pulmonary Disease (COPD) - A follow-up study of completers and non-completers of rehabilitation Vurdering af børns smerter Comparative effectiveness of injection therapies in Lateral Epicondylitis: A systematic review and network meta-analysis of randomized control trials...0 4

5 6. Treatment of Lateral Epicondylitis with injection of platelet-rich plasma or corticosteroid versus saline: A randomised, double blind, placebo-controlled trial Primary Diffuse Mesangioproliferative Glomerulonephritis Gender and 30 year renal survival In 56 biopsies from Non-Ruptured Tendinopathic Achilles Tendons, the presence of T and B Lymphocytes, Macrophages and NK cells was localized by Immunohistochemistry. The amount of B Lymphocytes and NK Cells correlated to disease duration Cardiac Cycle is a major contributor to variability in size measurements of Abdominal Aortic Aneurysms by ultrasound Inter observer-variation in the evaluation of bone scans in newly diagnosed Prostate Cancer...5. Reference values and correlation with body-composition for measurement of the total Splanchnic Blood Flow...6. Kognitiv mesterlære på børneafdelingen hvad sker der og hvor lang tid tager det? Endoscopic-assisted treatment of Chronic Exertional Compartmental Syndrome (CECS) in the lower legs and forearms Forbedring af visuel søgen i patient video cases Initiale resultater af den forebyggende kredsløbsundersøgelse af 60, 65, 70 og 75-årige kvinder i Viborg Kommune Experimental induction of Infrarenal Aortic Aneurysms in a large porcine animal model Evaluering af maksimal anbefalet alder på blodprøve inden fremstilling af udstrygningspræparat til differentialtælning Implementering af Assessment of Motor and Process Skills (AMPS) Impact of soluble TWEAK and CD63/TWEAK ratio on long-term cardiovascular mortality in patients with Peripheral Arterial Disease The prognosis of Ruptured Abdominal Aortic Aneurysms in Denmark Korrelation mellem kliniske, genetiske og neurofysiologiske resultater ved Hereditær Sensorisk Motorisk Neuropati i perioden Estimating the Glomerular Filtration Rate using Serum Cystatin C levels in patients with spinal cord injuries Panayiotopoulos Syndrom en epilepsiform, som er nem at overse. En case serie Predictive value of Serum Progesterone for spontaneous resolution of pregnancies of unknown location (PUL) Årsager til fjernelse af IUD (Intrauterine Contraceptive Device) hos kvinder i almen praksis

6 Foredrag på Forskningens dag Session I. Pain-intensity in non-specific low back pain versus radiculopathy: Posthoc analyses of baseline data from a randomised controlled trial Jensen O.K., Nielsen C.V., Stengaard-Pedersen K. 3 The Spine Center, Diagnostic Center, Region Hospital Silkeborg, Dept. of Clinical Social Medicine and Rehabilitation, Aarhus University and Central Denmark Region, 3 Dept. of Rheumatology, Aarhus University Hospital, Denmark Introduction: Leg pain and pain-intensity have been documented as risk factors for adverse outcome in sick-listed low back pain (LBP) patients. Diffuse hyperalgesia may indicate sensitization of the nociceptive system. Materials and methods: Baseline data in 36 patients participating in a randomised controlled trial were analysed by multivariate linear regression with the intensity of back+leg pain, back pain and leg pain as outcome. Baseline data comprised both questionnaire data and clinical measures, including range of motion, hyperalgesia as estimated by tender point (TP) examination, and disc degeneration estimated by disc height reductions on plain X-rays. Results: About one third of the patients had radiculopathy, verified by magnetic resonance imaging, and these patients had more leg pain, not back pain, than the remaining two thirds of the patients with non-specific LBP, of whom about one half had referred pain below the knee. Overall, back+leg pain-intensity, as well as back pain-intensity, was associated with high disability in daily activities, bodily distress, short school education and the duration of pain. In addition to disability and bodily distress, leg pain-intensity was associated with the presence of radiculopathy and restricted forward-flexion. In patients with non-specific LBP, leg pain-intensity was associated with the reporting of widespread pain during the preceding two weeks. Back pain-intensity, but not leg pain-intensity, was associated with disc degeneration when adjusted for the number of TPs, which was also associated with back pain-intensity. Discussion: Different associations were found for back vs. leg pain, but it was confirmed that radiculopathy is characterized by more leg pain and restricted forward-flexion than non-specific LBP. Conclusion: Pain-intensity was associated with both clinical and psychosocial variables. Back pain-intensity was better explained, when a measure of sensitization of the nociceptive system, i.e. TPs, was included in the analyses. 6

7 . An ambiguous relationship a qualitative meta-synthesis of hospitalized patients experience of interaction with fellow patients Larsen, LS.,, Larsen, BH., Birkelund, R. Dept. of Nursing Science, Faculty of Health Sciences, Aarhus University Centre of Nursing Science, Viborg Background: The significance of social interaction is commonly discussed and intensively studied as a substantial concept in the nursing profession. Social research conducted in hospital settings has prioritised to examine interaction between patients and doctors, patients and nurses and patients and relatives over patient-patient interaction. Exploration of patients dyads during hospitalization from the patient s perspective is rare. Aim: To provide a clear view of existing knowledge of hospitalized patients significance to fellow patients. Methods: Qualitative meta-synthesis inspired by Sandelowski & Barroso s approach. Four scientific articles, two doctoral thesis and one book chapter were included. Results: The analysis resulted in three core categories: The fellow patient as ) an enforced companion; the interaction with fellow patients was an enforced companionship. Privacy was hard to achieve but even so, patients thought of interaction with fellow patients positively. For some patients interaction was a cause to distress, sadness and hopelessness ) an expert on illness and hospital life; patients shared lived experience about this which was highly valued and appreciated by fellow patients. Too much information from fellow patients might rock patients confidence and hope for own recovery 3) a care provider; the patients community was characterized by compassion where they either received care from, or provided care to a fellow patient. Interacting with and supporting fellow patients was sometimes depressing and troublesome. Really understanding and caring for fellow patients was painful Conclusion: The patients interaction is characterized as ambiguous, because interaction between the patients holds both resources and strains. The patient as a care provider may cause curiosity among nurses especially, as nurses, in general, are perceived as primary caregivers. Nurses need to discuss a change of attitude and change traditional ways of thinking about this. 7

8 3. Use of angiotensin-converting-enzyme inhibitors and cardiovascular outcomes following primary vascular surgery: A nationwide propensity score matched follow-up study Annette Høgh, MD,, Jes S. Lindholt DMSci, PhD, MD, Henrik Nielsen, MSc, Leif P. Jensen, Søren P. Johnsen PhD, MD Department of Vascular Surgery, RegionshospitaletViborg, Denmark Department of Clinical Epidemiology, Aarhus University Hospital, Denmark Correspondence: Annette Høgh, Department of Vascular Surgery, Heibergs Alle 4, 8800 Viborg, RegionshospitaletViborg, Denmark. address: Objective: To examine the association between angiotensin-converting-enzyme inhibitors and angiotensin II receptor antagonists (ACE/ATII) use and clinical outcome (death, myocardial infarction, recurrent vascular surgery, stroke and/ or major amputation) after primary vascular reconstruction in a population-based propensity score matched follow-up study. Methods: All patients undergoing primary vascular surgical reconstruction in Denmark between 996 and 007 were identified in the Danish Vascular Registry. We obtained data on all filled prescriptions, clinical outcomes and confounding factors by individual-level record linkage to other population-based health care registries. For each ACE inhibitor user up to five nonusers were identified using propensity score matching followed by Cox-regression to estimate adjusted hazard ratios (Adj. HR). Use of drugs was included as time-dependent variables. Results: We included 7495 matched patients (49 ACE inhibitor users and 583 non-users) with a median follow-up period of 58 days (range 30 to 4379 days). All cause mortality was 0.4% for ACE inhibitor users and 4.9% for nonusers (adj.hr 0.88, 95% CI ). The cumulative risk of myocardial infarction was 6.% for ACE inhibitor users and 4.7% for non-users adj.hr.0, 95% CI ). Cumulative risk of recurrent vascular surgery was 4.0% for ACE inhibitor users and 3.% for non-users (adj.hr., 95% CI.3-.30). No differences were seen concerning stroke and major amputation. Conclusion: We found use of ACE inhibitors to be associated with lower all-cause mortality but also an increased longterm risk of recurrent vascular reconstruction and myocardial infarction. 8

9 4. Randomised diagnostic accuracy study of a fully automated portable device for diagnosis of peripheral arterial disease by measurement of toe pressures Høyer C,, Sandermann J 3, Pavar S, Pedersen BH, Petersen LJ, Department of Clinical Physiology, Viborg Hospital Department of Health Science and Technology, Aalborg University 3 Department of Vascular Surgery, Viborg Hospital Aim: Presence of peripheral arterial disease (PAD) is an independent predictor of cardiovascular morbidity and mortality. According to the TASC II guideline, PAD is diagnosed by an ankle brachial index <0.9 or toe brachial index <0.7. Mercury-in- silastic strain gauge pletysmography (SGP) is considered the reference test for segmental blood pressure assessment in Scandinavia. The purpose of the study was to validate a new portable, fully automated photopletysmographic device (APD) for measurement of toe pressures using SGP as reference test. Methods: We conducted a double-blinded diagnostic accuracy study in accordance with STARD, GRADE, and Cochrane DTA recommendations. 04 consecutive patients with known or suspected PAD were recruited over period of two months. Patients were randomised to toe pressure measurements by APD (SysToe, Atys Medical, France) followed by SGP or vice versa. Finally, ankle pressures were measured by SGP. The primary endpoint was diagnosis of PAD on a patient basis. Secondary endpoints were agreement in absolute toe pressures, diagnosis of severe ischemia, time, reproducibility, and patient discomfort. Results: The two methods showed agreement in diagnostic classification in 86 (9.%) of the 04 patients based on toe pressures. PAD was diagnosed in 6 (78.9%) and 5 (.3%) had normal toe pressure indices by both methods. 6 (7.8%) had PAD according to APD only, and two (.0%) had PAD according to SGP only. Compared to a full SGP examination, the APD yielded a sensitivity of 98.8% and specificity of 6.0% for detecting PAD. Correlation analysis between the two techniques showed an intraclass correlation coefficient of 0.88 (95% CI ) for right and (95% ) for left side toe pressures. Conclusions: Our data indicate that the APD is a useful, bed-side method for PAD screening. The method is observerindependent and showed a good correlation with SGP even with low toe blood pressures. 9

10 5. Tilbage til arbejde/uddannelse efter en traumatisk rygmarvsskade En follow-up undersøgelse af 60 personer, der pådrog sig en rygmarvsskade i perioden Hoffmann D, Madsen E, Johannesen IL Vestdansk Center for Rygmarvsskade, Neurologisk Afd., Regionshospitalet Viborg Baggrund og formål: Hvert år får omkring 60 personer en traumatisk rygmarvsskade i Danmark. Formålet med undersøgelsen var at afdække, hvor mange af de rygmarvsskadede der kommer tilbage til arbejde eller uddannelse, og hvor lang tid der går. Metode: Undersøgelsen blev gennemført som et historisk follow-up studie med brug af retrospektive data fra de to danske spinalcentres databaser samt postomdelte spørgeskemaer. Alle traumatisk betingede rygmarvsskadede i alderen 8-64 med primær indlæggelse i perioden blev inkluderet. Resultater: Der blev udsendt 9 spørgeskemaer, og 60 blev besvaret (73 %). Respondenternes gennemsnitsalder var 4 år. Mand/kvinde ratio 5:. Ligelig fordeling mellem para- og tetraplegi. Hyppigste årsag til ulykken var transport og fald. På ulykkestidspunktet var 70 % af respondenterne i arbejde og % var under uddannelse. På undersøgelsestidspunktet var 3 % i arbejde og 8 % var under uddannelse. Der gik i gennemsnit ét år, før de påbegyndte arbejde/uddannelse. Af dem, der var i arbejde på ulykkestidspunktet, kom 4 % i arbejde igen efter ulykken og 5 % påbegyndte en uddannelse. De fleste af dem, der kom i arbejde, var yngre, havde et højere uddannelsesniveau og mindre alvorlige skader. Af dem, der kom tilbage til arbejde, vendte 69 % tilbage til deres tidligere arbejdsplads og her gik kun halvt så lang tid. Diskussion/konklusion: Undersøgelsen viser, at der med en opfølgningsperiode på op til 5 år var en beskæftigelsesandel blandt rygmarvsskadede i Danmark, der ligger i underkanten af, hvad den gør i andre vestlige lande. Dette understreger vigtigheden af, at spørgsmålet om fremtidig arbejdstilknytning eller uddannelse får en mere central plads i rehabiliteringen. 0

11 Foredrag på Forskningens dag Session II. Varigheden af kontakten til diabetesambulatorium, risikostratificering og ressourceforbrug for type diabetes patienter henvist fra almen praksis Hansen TK, Ørskov C, Brockstedt H, Hornum H, Hansen KW, Diagnostisk Center, Regionshospitalet Silkeborg Formål: At undersøge varigheden af kontakten til diabetesambulatoriet for type diabetes patienter henvist fra almen praksis, samt at foretage risikostratificering ved tilbagehenvisning. Desuden beregning af ressourceforbruget i ambulatoriet. Metode: Retrospektivt studie af 54 patienter med diabetesvarighed > år, henvist til diabetesambulatoriet i perioden Inklusionskriterier: ) Diabeteskontrol i de seneste to år før henvisningen er udelukkende varetaget i primærsektoren. ) Follow-up tid mindst måneder eller til afslutning fra ambulatoriet. Ved afslutning til almen praksis blev der udført risikostratificering efter Sundhedsstyrelsens model. Desuden er kontaktens varighed samt behandlingsudgifter efter DRG-takst opgjort. Resultater: Hovedparten af patienterne blev ved afslutningen stratificeret til højrisiko-niveau uden forskel i stratafordelingen mellem patienter fulgt i mdr. eller > mdr. før afslutning. Efter gennemsnitligt 6 ambulatoriebesøg og en mediantid på 0 måneder (spændvidde -64) var 05 patienter returneret til diabeteskontrol i almen praksis, mens 0 % fortsat var tilknyttet ambulatoriet efter 6 år. Halvdelen var afsluttet efter 8 måneder. Ud fra DRG-ydelsestakst var godtgørelsen gennemsnitligt 763 euro pr. afsluttet patient. Konklusion: Risikostratificering er ikke et brugbart værktøj til at forudsige varigheden af kontakten til diabetesambulatoriet, muligvis fordi individuelle faktorer, der ikke indgår i stratificeringen har været afgørende for, hvornår patienten blev afsluttet. Der mangler strategier til at afkorte varigheden af kontakten til diabetesambulatoriet. De henviste patienter har høj grad af diabetiske komplikationer, også ved afslutning til videre kontrol i almen praksis, hvilket understreger vigtigheden af kvalificeret opfølgning, samt en effektiv kommunikation mellem sektorerne for at nedsætte behovet for genhenvisning til specialiseret behandlingsintensivering.

12 . Den diagnostiske værdi af knoglescintigrafi i en nordisk population uden PSA-screening: Et prospektivt studie af konsekutive patienter med nydiagnosticeret prostatacancer Zacho HD, Barsi T, Mortensen JC 3, Mortensen MK 4, Bertelsen H 5, Josephsen N 6, Petersen LJ,7 Klinisk Fysiologisk Afd., Regionshospitalet Viborg Urologisk Afsnit., Regionshospitalet Viborg 3 Nuklear Medicinsk Afd., Regionshospitalet Herning 4 Urologisk Afd., Regionshospitalet Holstebro 5 Klinisk Fysiologisk Afd., Regionshospitalet Randers 6 Urologisk Afd. Regionshospitalet Randers 7 Institut for Medicin og Sundhedsteknologi, Aalborg Universitet Formål: Den danske prostatabetænkning levner plads til at undlade knoglescintigrafi i den initiale udredning af prostatacancer hos patienter med lavmalign tumor; dette effektueres sjældent i praksis. Der foreligger imidlertid ingen prospektive undersøgelser af værdien af knoglescintigrafi i en nordisk population. Knoglescintigrafi har en høj sensitivitet, men moderat specificitet for detektion af knoglemetastaser hos patienter med prostatacancer. De eksisterende retrospektive studier er uden MR/CT verifikation ved inkonklusive scintigrafier. Materiale og metode: I alt 635 konsekutive patienter med nydiagnosticeret prostatacancer fra tre urologiske afdelinger i Region Midt fik lavet knoglescintigrafi i perioden. marts 008 til. oktober 009. Knoglescintigrafi samt supplerende billeddiagnostik (MR/CT) blev gennemgået mhp. tilstedeværelse af knoglemetastaser. Knoglescintigrafisvarerne blev inddelt i 4 kategorier (: Benigne forandringer/normal, : Kan repræsentere både benign og malign sygdom; 3: Overvejende sandsynligt metastaser og 4: Multiple metastaser). Et endelig billeddiagnostisk facit blev udregnet ved brug af supplerende MR/CT. Resultater: Proportionen af grad 3+4 knoglescintigrafier var 78/635 ( %). I alt 54/635 (4 %) fik foretaget supplerende billeddiagnostik, heraf 0/67 med grad knoglescintigrafi. Det billeddiagnostiske facit påviste knoglemetastaser hos 87/635 (4%). Der kunne ikke påvises knoglemetastaser hos følgende grupper: ) PSA<0 ng/ml uanset Gleason og T-score (n=3) samt ) PSA <0 ng/ml og Gleason < 8 og T-score < T3 (n=97). En valid algoritme for verifikation af knoglemetastaser kunne ikke etableres. Diskussion: Vores data viser at patienter med lav og intermediær risiko kan undlade knoglescintigrafi ved stadieinddeling og understøtter således tidligere retrospektive studier. I denne uselekterede population vil 30/635 opfylde kriterierne for at undlade knoglescintigrafi i den initiale udredning af prostata cancer.

13 3. Patient s global assessment of general health by VAS at baseline predicts ACR/EULAR remission after 3, 6 and month s of efficient treatment in DMARD- and steroid naïve early rheumatoid arthritis patients. The Danish Cimestra-Study M. Herly,*, K. Stengaard-Pedersen, P. Vestergaard 3, J. Pødenphandt 4, M. Østergaard 4, P. Junker 5, M. L. Hetland 4, K. Hørslev-Petersen 5, T. Ellingsen Department of Rheumatology, Diagnostic Center, Region Hospital Silkeborg, Silkeborg Department of Rheumatology 3 Department of Endocrinology, Aarhus University Hospital, Aarhus 4 Department of Rheumatology, Copenhagen University Hospital, Copenhagen 5 Department of Rheumatology, University of Southern Denmark, Odense, Denmark Background: At the time of diagnosis, easy-to-use and cost-effective predictors of remission are needed in rheumatoid arthritis (RA) to improve patient care. Objectives: During one year of efficient treatment aiming for remission () in 60 DMARD- and steroid naive early RA patients we investigated at baseline how total D-vitamin plasma levels (Dtot), ACPA-status, IgM-RF, CRP, total Sharp score at baseline (TSS0), HAQ, patient s general health assessment (VAS), DAS8(CRP) at baseline, number of swollen joints (NSJ) and number of tender joints (NTJ), never smoking, age and gender could predict remission, defined by the new ACR/EULAR remission criterias () or DAS8 <.6. Methods: In a multivariate logistic regression model, using backward stepwise selection, baseline values of Dtot, AC- PA-status, IgM-RF, CRP, TSS0, HAQ, patient s general health assessment VAS, DAS8, NSJ and NTJ, age, never smoking and gender, were evaluated as possible predictors of ACR/EULAR remission and DAS8 <,6 after 3, 6 and months of treatment, p < 0.05 was considered significant. Results: At 3 months: ACR/EULAR remission was predicted by patient s general health assessment (p<0.00). DAS8 <.6 was predicted by patient s general health assessment (p=0.04), ACPA (p=0.08), IgM-RF(p=0.08), gender (p=0.08), DAS8 baseline (p<0.00) and NTJ (p=0.00). At 6 months: ACR/EULAR remission was predicted by patient s general health assessment (p=0.036) and DAS8 baseline (p=0.03). DAS8 <.6 was predicted by DAS8 baseline (p<0.00) and NSJ (p=0.036). At months: ACR/EULAR remission was predicted by patient s general health assessment (p=0.05) and TSS0 (p=0.048). DAS8 <.6 was predicted by NTJ (p=0.04). Conclusions: In DMARD- and steroid naive early RA patients, the baseline patient s general health assessment predicted ACR/EULAR remission at 3, 6 and month in a multivariate logistic regression analysis. DAS8, NTJ, ACPA, IgM- RF, gender, TSS0 and NSJ predicted remission at 3, 6 or months with less concistency. Dtot did not predict treatment response. Disclosure of Interest: None Declared. 3

14 4. The Scandinavian Propaten trial two year results from a randomised clinical controlled multi-centre trial. An Achilles heel exposed? Lindholt JS( ), Gottschalksen B( ), Johannesen N( 3 ), Jepsen J( 4 ), Ravn H( 5 ), Christensen ED( 6 ), Viddal B( 7 ), Flørness T( 8 ), Petersen G( 9 ), Christensen M( 0 ), Carstensen M( ), Grøndal N( ), Fasting H( ). Vascular Research Unit, Viborg Hospital, Denmark Department of Vascular Surgery, Slagelse Hospital, Denmark 3 Department of Vascular Surgery, Aalborg Hospital, University Hospital of Aarhus, Denmark 4 Department of Vascular Surgery, Kolding Hospital, Denmark 5 Department of Vascular Surgery, Department of Vascular Surgery, Eksjö District Hospital, Sweden 6 Department of Vascular Surgery, Aabenraa Hospital, Denmark 7 Department of Vascular Surgery, Stavanger University Hospital, Norway 8 Department of Vascular Surgery, University Hospital of Oslo, Aker, Norway 9 Department of Vascular Surgery, Haukeland University Hospital, Norway 0 Department of Vascular Surgery, Gentofte Hospital, Denmark Department of Vascular Surgery, Rigshospitalet, Denmark Objective: To compare two-year patencies of Propaten grafts with those of ordinary polytetraflourethylene PTFE grafts in a randomised multi-centre study. Materials and Methods: Eleven Scandinavian centres enrolled 569 patients with chronic lower limb ischemia scheduled to undergo femoro-femoral (fem-fem) bypass or femoro-popliteal bypass (fem-pop). The patients were randomised : and stratified by centre. Patency was assessed by duplex ultrasound scanning, and 555 (96%) completed the study with adequate follow up. Cox s regression analysis was used and adjusted for the type of bypass to determine the risk ratio for graft failure after one year. Results: In all, 454 grafts remained primarily patent during the first two years. Of the 78 implanted crude PTFE grafts, (76%) remained primarily patent, as compared to 6 out of 73 (83%) implanted Propaten grafts (HR=0.67(0.47;0.98, p=0.037). Two year primary patency of Propaten grafts used for femoropopliteal bypass was overall 75% and in critical ischemia 74%, compared to 63% and 54%, respectively, of crude PTFE grafts. Consequently, propaten femoropopliteal bypasses were significantly associated with a halving of the risk of losing primary patency (HR=0.54 (0.3;0.9), p=0.04), and in cases with critical ischemia, the propaten graft was also associated with a halving of the risk of losing primary patency (HR=0.47(0.7;0.8, p=0.07)). Concerning femorofemoral cross over bypasses no significant difference was observed concerning primary patency after two years (HR=0.94 (0.47;.87), p=0.85)). In cases with critical ischemia, use of Propaten grafts halved the risk of losing primary patency (HR=0.47 (0.0;.3), p=0.08)). However, use of Propaten grafts for intermittent claudication was associated with a significant 3.8 times higher risk of losing primary patency. Conclusion: The promising results concerning first year primary patency were sustained during the second year. After two years, the propaten graft significantly reduces the risk of losing primary patency by 33% overall, 40% in fempops, and 50% in critical ischemia. However, the overall results were not very robust due to the unexpected weak overall benefit in femoro-femoral cross over bypasses caused by a very surprising finding of increased risk in cases treated for intermittent claudication. A large validation work has begun, and a certain configuration of the graft is suspected to be the cause. 4

15 5. Enamel disturbances in children prenatally exposed to anti-epileptic drugs Ph.d. student Pernille Endrup Jacobsen, Professor Tine Brink Henriksen 3, Professor Dorte Haubek, Professor John Østergaard 4 Regional Special Dentistry, Regional Hospital Viborg Dept. of Dentistry, Aarhus University 3 Dept. of Pediatric, Skejby, Aarhus University 4 Center for Rare Diseases, Skejby, Aarhus University Aim: Genetic as well as exogenous factors have been shown to be associated with enamel defects. Previous studies have suggested that prenatal exposure to drugs, such as dioxin or tetracycline, can induce enamel abnormalities. The aim of the present study is to elucidate the association between prenatal exposure to antiepileptic drugs and the development of enamel defects. Methods: The study is conducted as a follow up study based on information from the Birth Cohort of Aarhus and the Dept. of Neurology, Viborg Region Hospital. Information on the mother s medical intake was confirmed by information from the Prescription database. Information on the mother s health condition, medication use, alcohol, or smoking habits during the pregnancy have been registered previously in The Aarhus Birth Cohort. Material: A total of 38 exposed children and 8 non-exposed children, 6-0 years of age, were enrolled in the study. The outcome measurements are hypomineralization and hypoplasia registered in the permanent as well as the primary teeth. A questionnaire survey of the medical condition, lifestyle habits and breast feeding habits of the mother under the pregnancy were conducted. Results: Preliminary results show that the exposed children have an increased prevalence of hypoplasia (% vs. 4%), diffuse opacities (8% vs. 7%) and white opacities (8% vs. 0%), in the primary dentition. In the permanent dentition, we found an increased risk in the group with more than 3 white opacities (34% vs. %) The exact odds ratio are not yet available, but will be presented at the day of the presentation. Conclusion: Preliminary results show an increased risk of developing white opacities, diffuse opacities and hypoplasia in the primary teeth in children exposed to antiepileptic drugs prenatally. 5

16 Øvrige indleverede abstracts til Forskningens dag. Tolerability of month long combination therapy of moxifloxacin and rifamycin in treatment of prosthetic joint infections due to Staphylococcus aureus Leitz C, Jöhnk M.L, Prag J, Søndergaard J Department of Clinical Microbiology and Orthopedics, Viborg Hospital, Heibergs Allé 4, DK Viborg, Denmark Key words: long-term treatment, tolerability, moxifloxacin, rifamycin, prosthetic joint infection, Staphylococcus aureus Objective: To describe tolerability of long-term combination therapy of moxifloxaxin and rifamycin in patients with prosthetic joint infections due to Staphylococcus aureus (S.aureus). The MICs of moxifloxacin are 8-0 times lower than these of ciprofloxacin. Therefore combination therapy with moxifloxacin and rifamycin appears promising for the treatment of prosthetic joint infections due to S. aureus. Material and Methods: A retrospective study, analysing clinical data from patients admitted to Department of Ortopedics, Viborg Hospital (005-0) with a prosthetic joint infection due to S. aureus and who received long-term treatment of moxifloxacin and rifamycin. Adverse effects, both paraclinical and subjective symptoms, were recorded. Results: The median age of the patients included was 7 years (range from 54 to 87 years). Five were males. Five patients had a two-stage prosthetic exchange, six had debridement with prosthesis retention and in one case the prothesis was sacrificed, and the patient had a permanent Girdlestone status. Most of the patients had comorbidities related to the cardiovascular system. No serious adverse reactions were observed in 0 of the patients. Two of the patients discontinued their treatment due to anaemia and abnormal liver enzymes. In both cases rifamycin was discontinued and they continued moxifloxacin alone without further problems. The adverse reactions disappeared within a short period of time. Conclusion: We found that long-term combination therapy of moxifloxacin and rifamycin was well tolerated even in older patients with comorbidities. Although our data are limited by small number, the results are encouraging and should be confirmed in further studies. 6

17 . Constraint Induced Language Therapy in Sub-Acute Aphasia Kristensen, L. F.; Steensig, I.; Pedersen, A.D.; Pedersen, A.R.; Nielsen, J.F. Hammel Neurorehabilitation and Research Center, DK Background: Constraint induced language therapy (CILT) is an intensive, short term therapy founded on the principles of prevention of compensatory communication (constraint), shaping (induced), and massed practise. Previous research indicates that CILT can lead to substantial and lasting improvements in language functions in chronic aphasia. Recovery after stroke is most profound in the first months after insult, but the applicability and the effect of CILT in the sub-acute phase of recovery have only been sparsely investigated. Aim: The aim of the current study is to investigate the applicability and the effect of CILT in stroke patients in the sub acute phase of recovery (< 6 months post onset) in the frame of an inpatient multidisciplinary neurorehabilitation program. Method: Participants: Stroke patients with sub acute aphasia. Treatment: Two consecutive periods: A and B; Period A: Two weeks of standard rehabilitation including non-specific speech and language therapy. Period B: Two weeks with 30 hours of CILT in ten weekdays, three hours a day. CILT is conducted by two experienced speech and language therapists (SLTs) and performed in small groups with two to three participants. Language functions are assessed by other SLTs with standardized language tests (WAB and MAST). The amount and quality of communication are assessed by relatives and staff with a standardized questionnaire (CETI). All assessments are carried out at four time points: pre-period A, pre- and post-period B, and at three-month follow-up. Estimation of depression and neuropsychological assessment is performed immediately before CILT. Results: Data from stroke patients will be presented. 7

18 3. Clinical Routine Rehabilitation (CRR) of patients with Chronic Obstructive Pulmonary Disease (COPD) - A follow-up study of completers and non-completers of rehabilitation Bjørnshave Noe B, Korsgaard J, Jensen C 3, Vinther Nielsen C 3 Institute of Public Health and Clinical Medicine, Aarhus University and Department of Spinal Cord Injury, Viborg Regional Hospital Moelholm Private Hospital Vejle 3 Centre of Public Health and Quality, Marselisborg Centre, Central Denmark Region and Department of Social Medicine and Rehabilitation, Institute of Public Health, Aarhus University The effect of COPD-rehabilitation has been amply documented in randomized controlled trials (RCTs). A Cochrane review and international guidelines recommend rehabilitation as an important part of the care for COPD patients. Danish COPD-rehabilitation programs have been implemented based on these recommendations. Knowledge of completion rates and effects are important, and therefore we aimed to characterize a COPD-cohort treated at Horsens Regional Hospital and to study changes in rehabilitation outcomes; walk-distance (6MWD), quality of life (QoL), and dyspnoea (MRC score). We hypothesized that completers of CRR would improve these outcomes and that their basic characteristics would predict completion. Materials and methods: Participants were in- and outpatients with COPD. Changes in MRC, 6MWD, and QoL (SF36) from baseline to follow-up at 3, 6, and months were compared between completers and non-completers. Result: From the source population of 5 patients, 48 participated in follow-up. The patients were in their late sixties, short educated, half of the patients current smokers approx. half of the patients tested positive for depression. More than 80 had at one or more co-morbidities with no differences between completers of CCR and non-completers and their characteristics did not predict completion. Completers did not improve in 6MWD from baseline to the end of rehabilitation and had declined at the -month follow-up. MRC and QoL did not improve. There were no significant differences among completers and non-completers. Completers` attitudes toward rehabilitation were positive: 75% felt better or much better after rehabilitation. Conclusion: Completers of CRR did not improve in core rehabilitation outcomes. The explanations are that completers in CRR differ from the study-populations in RCTs. The CRR offered may not match the RCTs in terms of the quality of its contents and methods. More knowledge is needed on the effects of CRR targeting broad COPD populations. 8

19 4. Vurdering af børns smerter Eg, M., Jensen, L.B. udviklingssygeplejerske, Thorsteinsson, K. klinisk oversygeplejerske 3, Andsager, A. kvalitets- og udviklingssygeplejerske 4 Børneafdelingen, Regionshospitalet Viborg, Hospitalsenhed Midt Børneafdelingen, Aalborg Universitetshospital 3 Børneafdelingen, Hvidovre Hospital 4 Børneafdelingen, Sygehus Sønderjylland Vejledning/metodebistand: Annette de Thurah, adjunkt, MPH, ph.d. Institut for Folkesundhed, Aarhus Universitet Beskrivelse af projektet: Ubehandlet smerte kan have en skadelig effekt på børn og er samtidig noget af det, børn frygter mest under en indlæggelse. Hvis smerter ikke opdages og behandles, kan det forlænge indlæggelsestiden. En præcis og veldokumenteret smertevurdering er en forudsætning for en effektiv smertebehandling. Ved gennemgang af landets børnesmerteinstrukser i 009 viste der sig stor variation i, hvilke smertescoringsredskaber der anvendtes, og med hvilken systematik de anvendtes. Det viste sig, at sundhedspersonalet var inkonsistente i vurderingen og behandlingen af smerter, og der rapporteres stadig, at børn oplever smerte, som ikke bliver opdaget under indlæggelse på børneafdelinger. En arbejdsgruppe bestående af fire sygeplejersker, der var repræsenteret nationalt, blev udpeget til at udarbejde en klinisk retningslinje, hvis formål var: - at kunne anbefale hvilke smertescoringsredskaber, der bør anvendes i daglig klinisk praksis med henblik på at opnå den mest akkurate og præcise smertevurdering af hospitalsindlagte børn (8 dage til 8 år). Metode: Der er søgt i følgende relevante elektroniske databaser: Pub Med, EMBASE, CINAHL, Psycinfo samt Cochrane) for afdækning af, hvilket smertescoringsredskab der mest validt og reliabelt vurderer og evaluerer smerter hos indlagte børn. Der fremkom 78 artikler. Efter sortering og ud fra Bland & Altman analyse fremkom 8 egnede studier, som udgør baggrund for anbefalingerne. Resultat: Der er udarbejdet en klinisk retningslinje Smertevurdering hos indlagte børn (8 dage 8 år), som indsendes til bedømmelse ved Center for Kliniske Retningslinjer Nationalt Clearinghouse for Sygepleje i marts 0. Resultaterne vil blive fremlagt på Forskningens Dag. 9

20 5. Comparative effectiveness of injection therapies in Lateral Epicondylitis: A systematic review and network meta-analysis of randomized control trials T. Krogh, E. M. Bartels, T. Ellingsen, K. Stengaard-Pedersen 3, R. Buchbinder 4, U. Fredberg, H. Bliddal, R. Christensen Diagnostic Center, Regional Hospital Silkeborg, Silkeborg The Parker Institute, Musculoskeletal Statistics Unit, Copenhagen University Hospital, Frederiksberg, Copenhagen 3 Dep. of Rheumatology, Aarhus University Hospital, Aarhus, Denmark 4 Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Australia Objective: To assess the comparative effectiveness of the increasing number of different injection therapies used for pain reduction in lateral epicondylitis (tennis elbow) using a systematic review and network meta-analysis. Methods. Structured literature searches were conducted. Selected studies were randomized controlled trials comparing different injection therapies and/or placebo injections. Risk of bias was assessed in each trial. Outcome measures were change in pain intensity and adverse events. Network (random effects) meta-analysis was applied to combine direct and indirect evidence within and across trial data. Following the arm-based network meta-analysis standardized mean differences (SMDs) were used as the effect size based on differences between means divided by the pooled standard deviation. Results: Seventeen trials (38 patients) allocating individuals to injection with eight different treatments, glucocorticoid, botulinum toxin, platelet-rich plasma, autologous blood, hyaluronic acid, prolotherapy, polidocanol, glycosaminoglycan polysulfate, and/or placebo, fulfilled the inclusion criteria. Pooled results showed that glucocorticoid injection was no more effective than placebo with respect to improvement in pain (SMD [95% CI to 0.35]); Botulinum toxin was statistically significant but clinically only marginally more effective than placebo (-0.50 [-0.9 to -0.08]); whereas autologous blood (-.43 [-.5 to -0.7]) and platelet-rich plasma (-.3 [-.77 to -0.49]) were both clearly more efficacious than placebo. Neither polidocanol (0.39 [-0.4 to.0]) nor glycosaminoglycan polysulfate (-0.3 [-.0 to 0.38]) were found to be superior to placebo, while prolotherapy (-.7 [-4.60 to -0.8]) and hyaluronic acid (-5.58 [-6.35 to -4.8]) were both much more efficacious than placebo. Conclusion: Our study found that most trials that have assessed the value of injection therapy for lateral epicondylitis are at high risk of bias and that their results therefore need to be interpreted with caution. 0

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