Epidemiology of classic psychedelic substances: results from a Norwegian internet convenience sample.

Objective: In recent years, there has been a renewed interest in investigating the use of classic psychedelics such as psilocybin and lysergic acid diethylamide (LSD) in the treatment of mental disorders and substance use disorders. However, knowledge about the epidemiology of classic psychedelics in the Nordic countries is limited. Methods: We recruited adult, Norwegian participants who have had a memorable experience after taking a classic psychedelic substance. They filled in an anonymous internet survey with 119 items covering matters related to recreational use of psychedelics using a secure, web-based application. Data are presented by using descriptive statistics (frequencies, means, and standard deviations). Results: We recruited 841 participants, 770 (72% male; 88% 45 years or younger) of which were included in the data analysis. The intentions behind taking the psychedelic substance were mainly recreational (46.1%) or therapeutic (42.3%). Most participants reported that their most memorable experience was with psilocybin. As in modern era clinical trials, most participants were well-prepared before, did processing during, and did integration work after the experience, whereas only a minority were supported by a therapist. Self-perceived symptoms of various mental disorders and substance use disorders were prevalent in the sample. Most subjects reported improvements in their condition. Although adverse reactions were usually mild and short-lived, 4.2% lasted for 1 year or more. Persisting flashbacks were present for a year or more among 2.9% of the participants. Conclusion: In this cross-sectional sample of Norwegian, self-selecting adults, we shed light on what characterizes the most memorable experience with a classic psychedelic substance, including short- and long-term risks and benefits. For the most part, the psychedelic experience led to improvements in self-perceived symptoms of mental disorders and substance use disorders. However, a small subset experienced persisting adverse reactions.

Through the Eyes of Patients: Understanding Treatment Burden of Intravitreal Anti-VEGF Injections for nAMD Patients in Norway.

Purpose: Patients with neovascular age-related macular degeneration (nAMD) are treated with frequent intravitreal injections to maintain vision. The treatment frequency impacts the life of patients and caregivers and poses a major capacity challenge for Norwegian ophthalmic clinics. The purpose of this survey was to document patient-reported outcomes on how the disease and the treatment impact nAMD patients in Norway. Methods: Norwegian nAMD patients voluntarily completed the survey. The patients reported the time spent on each treatment appointment, the need for caregiver support, treatment intervals, and the emotional impact of the treatment. There was no active selection of patients to the survey. Respondents had to confirm the nAMD diagnosis prior to submitting the response. All data was included in the analysis as submitted by the respondents. This survey was market research involving anonymous patient data, and no participants were identifiable. Results: In total, 130 patients responded to the survey. The majority of patients reported to receive nine or more injections per year (48.8%), and many patients needed caregiver support for every treatment appointment (37.7%). Patients reported to be anxious one day (25.4%), two days (8.5%), one week (10.8%) or more than one week (3.1%) prior to treatment. The week before the treatment, 33.1% of patients reported to be stressed and 15.4% struggled to sleep. The majority of patients reported the treatment as uncomfortable (54.6%) or as somewhat painful (26.2%). The results on yearly number of injections, time used each treatment day and need for caregiver support suggested a variation between Norwegian hospital regions. Conclusions: This survey uncovers how treatment with intravitreal injections represents a substantial burden for Norwegian patients with nAMD. Future research on how the treatment burden impacts nAMD patients may lead to more patient-centered care and help guide treatment decisions. New treatments with longer intervals between injections are likely to both reduce the treatment burden and improve capacity in ophthalmology clinics.

Assessing Agreement When Agreement Is Hard to Assess-The Agatston Score for Coronary Calcification.

Method comparison studies comprised simple scatterplots of paired measurements, a 45-degree line as benchmark, and correlation coefficients up to the advent of Bland-Altman analysis in the 1980s. The Agatston score for coronary calcification is based on computed tomography of the heart, and it originated in 1990. A peculiarity of the Agatston score is the often-observed skewed distribution in screening populations. As the Agatston score has manifested itself in preventive cardiology, it is of interest to investigate how reproducibility of the Agatston score has been established. This review is based on literature findings indexed in MEDLINE/PubMed before 20 November 2021. Out of 503 identified articles, 49 papers were included in this review. Sample sizes were highly variable (10-9761), the main focus comprised intra- and interrater as well as intra- and interscanner variability assessments. Simple analysis tools such as scatterplots and correlation coefficients were successively supplemented by first difference, later Bland-Altman plots; however, only very few publications were capable of deriving Limits of Agreement that fit the observed data visually in a convincing way. Moreover, several attempts have been made in the recent past to improve the analysis and reporting of method comparison studies. These warrant increased attention in the future.

Organisation of emergency groin hernia surgery across Denmark.

INTRODUCTION: A laparoscopic repair is recommended for emergency groin hernias. However, due to increasing sub-specialisation, the expertise in performing a laparoscopic hernia repair may not always be present. Therefore, this study aimed to assess the organisation of Danish hospitals' surgical acute teams in regard to emergency groin hernia care. METHODS: A nationwide questionnaire study was conducted for all Danish surgical departments performing emergency groin hernia repair and completed by the departments' administrative heads via REDCap. RESULTS: A total of 18 out of 19 departments completed the questionnaire. The overall response was positive towards providing emergency laparoscopic groin hernia repairs at all times. However, this was possible only in a minority of the departments outside daytime on weekdays, and regional differences were found. Surgical proficiency at the hospital and on-call from home varied, and only 24% of the departments could page surgeons (not on-call) to perform emergency laparoscopic groin hernia repair. CONCLUSIONS: A discrepancy was found between the wish of the surgical departments to provide laparoscopic emergency groin hernia repairs and the possibilities in today's surgical acute teams. Therefore, a reorganisation should be considered to ensure the availability of laparoscopic groin hernia repair for acute procedures. FUNDING: This study was funded by The Copenhagen Medical Society and Herlev and Gentofte Hospitals' research council. The funding providers had no role in designing, conducting or analysing the results. TRIAL REGISTRATION: not relevant.

Therapeutic effects of classic serotonergic psychedelics: A systematic review of modern-era clinical studies.

OBJECTIVE: To conduct a systematic review of modern-era (post-millennium) clinical studies assessing the therapeutic effects of serotonergic psychedelics drugs for mental health conditions. Although the main focus was on efficacy and safety, study characteristics, duration of antidepressants effects across studies, and the role of the subjective drug experiences were also reviewed and presented. METHOD: A systematic literature search (1 Jan 2000 to 1 May 2020) was conducted in PubMed and PsychINFO for studies of patients undergoing treatment with a serotonergic psychedelic. RESULTS: Data from 16 papers, representing 10 independent psychedelic-assisted therapy trials (psilocybin = 7, ayahuasca = 2, LSD = 1), were extracted, presented in figures and tables, and narratively synthesized and discussed. Across these studies, a total of 188 patients suffering either cancer- or illness-related anxiety and depression disorders (C/I-RADD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD) or substance use disorder (SUD) were included. The reviewed studies established feasibility and evidence of safety, alongside promising early data of efficacy in the treatment of depression, anxiety, OCD, and tobacco and alcohol use disorders. For a majority of patients, the therapeutic effects appeared to be long-lasting (weeks-months) after only 1 to 3 treatment session(s). All studies were conducted in line with guidelines for the safe conduct of psychedelic therapy, and no severe adverse events were reported. CONCLUSION: The resurrection of clinical psychedelic research provides early evidence for treatment efficacy and safety for a range of psychiatric conditions, and constitutes an exciting new treatment avenue in a health area with major unmet needs.

Variations in open and laparoscopic repair of paediatric inguinal hernia.

INTRODUCTION: No recent guidelines exist for surgical treatment of paediatric inguinal hernias. Internationally, there is disagreement about both the preferred approach and the details of the surgical procedure. The aim of this nationwide survey study was to assess variations in Danish surgeons' technique when repairing inguinal hernias in children. METHODS: A questionnaire was sent to all surgeons in Denmark performing paediatric inguinal hernia repair, including questions about demographic details, choice of open or laparoscopic repair, and technical details of the chosen surgical approach. In the questionnaire, each item was repeated for children aged les than 2, 2-12, and 13-18 years of age. RESULTS: In total, 48 of 59 surgeons responded (81%). For children 12 years of age, the majority of surgeons only performed open repair, whereas none performed laparoscopic repair only. For children aged 13-18 years of age, two thirds of the surgeons performed open repair only, 6% performed laparoscopic repair only and the rest used both methods. We found considerable variations in the execution of both open and laparoscopic repair. The variations regarded incision of the external fascia, nerve identification, division of the cremaster muscle, and exploration of the contralateral groin and repair of an asymptomatic hernia. CONCLUSIONS: This study found considerable variation in the execution of both open and laparoscopic repair of inguinal hernias in children of different age groups. Research into inguinal hernia repair in children is needed to rationalise and update guidelines in order to improve quality and facilitate research. FUNDING: none. TRIAL REGISTRATION: not relevant.

Timing of inguinal hernia repair in children varies greatly among hernia surgeons.

INTRODUCTION: Due to disagreement on optimal timing of inguinal hernia repair in children, we explored how Danish surgeons plan repair in children at different ages and with different symptoms. METHODS: A validated questionnaire on timing of inguinal hernia repair in children was sent to all surgeons performing paediatric hernia repair in Denmark. The surgeons were asked how they plan repair of asymptomatic reducible, symptomatic reducible, incarcerated, and strangulated hernias in children aged less than 2, 2-12 and 13-18 years. RESULTS: Forty-eight surgeons (81%) completed the questionnaire. Answers concerning the timing of repair of reducible and incarcerated hernias varied greatly for all age groups. For reducible hernias, the answers ranged from repairing within one week to considering watchful waiting. For incarcerated hernias, the answers ranged from repair within 12 hours to three months. There was broad agreement on the need for acute repair of strangulated hernias. CONCLUSIONS: Timing of paediatric inguinal hernia repair was inconsistent for children of all age groups and in particular for those with reducible hernias. The results call for a new guideline to ensure consistent and optimal treatment as well as an educational effort about the pros and cons of early and delayed repair. FUNDING: none. TRIAL REGISTRATION: not relevant.

Pervasive assistive technology for people with dementia: a UCD case.

Smart mobile and wearable technology offers exciting opportunities to support people with dementia (PwD). Its ubiquity and popularity could even benefit user adoption - a great challenge for assistive technology (AT) for PwD that calls for user-centred design (UCD) methods. This study describes a user-centred approach to developing and testing AT based on off-the-shelf pervasive technologies. A prototype is created by combining a smartphone, smartwatch and various applications to offer six support features. This is tested among five end-users (PwD) and their caregivers. Controlled usability testing was followed by field testing in a real-world context. Data is gathered from video recordings, interaction logs, system usability scale questionnaires, logbooks, application usage logs and interviews structured on the unified theory of acceptance and use of technology model. The data is analysed to evaluate usability, usefulness and user acceptance. Results show some promise for user adoption, but highlight challenges to be overcome, emphasising personalisation and familiarity as key considerations. The complete findings regarding usability issues, usefulness of support features and four identified adoption profiles are used to provide a set of recommendations for practitioners and further research. These contribute toward UCD practices for improved smart, pervasive AT for dementia.

Hamstring muscle fatigue and central motor output during a simulated soccer match.

PURPOSE: To examine changes in hamstring muscle fatigue and central motor output during a 90-minute simulated soccer match, and the concomitant changes in hamstring maximal torque and rate of torque development. METHOD: Eight amateur male soccer players performed a 90-minute simulated soccer match, with measures performed at the start of and every 15-minutes during each half. Maximal torque (Nm) and rate of torque development (RTD; Nm.s-1) were calculated from maximal isometric knee flexor contractions performed at 10° of flexion. Hamstring peripheral fatigue was assessed from changes in the size and shape of the resting twitch (RT). Hamstring central motor output was quantified from voluntary activation (%) and normalized biceps femoris (BF) and medial hamstrings (MH) electromyographic amplitudes (EMG/M). RESULTS: Maximal torque was reduced at 45-minutes by 7.6±9.4% (p<0.05). RTD in time intervals of 0-25, 0-50, and 0-75 ms post-contraction onset were reduced after 15-minutes in the first-half between 29.6 to 46.2% (p<0.05), and were further reduced at the end of the second-half (p<0.05). Maximal EMG/M was reduced for biceps femoris only concomitant to the time-course of reductions in maximal torque (p = 0.007). The rate of EMG rise for BF and MH was reduced in early time periods (0-75 ms) post-contraction onset (p<0.05). No changes were observed for the size and shape of the RT, indicating no hamstring peripheral fatigue. CONCLUSION: Centrally mediated reductions in maximal torque and rate of torque development provide insight into factors that may explain hamstring injury risk during soccer. Of particular interest were early reductions during the first-half of hamstring rate of torque development, and the decline in maximal EMG/M of biceps femoris in the latter stages of the half. These are important findings that may help explain why the hamstrings are particularly vulnerable to strain injury during soccer.

Experimental realization of a new type of crystalline undulator.

A new scheme of making crystalline undulators was recently proposed and investigated theoretically by Andriy Kostyuk, concluding that a new type of crystalline undulator would be not only viable, but better than the previous scheme. This article describes the first experimental measurement of such a crystalline undulator, produced by using Si(1-x)Ge(x)-graded composition and measured at the Mainzer Microtron facility at beam energies of 600 and 855 MeV. We also present theoretical models developed to compare with the experimental data.

Direct measurement of the formation length of photons.

We report the first observation of a shoulder in the radiation spectrum from GeV electrons in a structured target consisting of two thin and closely spaced foils. The position of the shoulder depends on the target spacing and is directly connected to the finite formation length of a low-energy photon emitted by an ultrarelativistic electron. With the present setup it is possible to control the separation of the foils on a µm scale and hence measure interference effects caused by the macroscopic dimensions of the formation length. Several theoretical groups have predicted this effect using different methods. Our observations have a preference for the modified theory by Blankenbecler but disagree with the results of Baier and Katkov.

Prevalence of gastroparesis-related symptoms in an unselected cohort of patients with Type 1 diabetes.

BACKGROUND: The prevalence of diabetic gastroparesis is not well defined because of discrepancy between objective measurements, i.e. gastric emptying time, and symptoms experienced by patients. Furthermore most studies have been performed on small selected cohorts. OBJECTIVE: To determine the prevalence of clinical symptoms of diabetic gastroparesis in a large unselected cohort of out-patients with Type 1 diabetes. METHODS: 1028 patients with Type 1 diabetes attending a specialized diabetes clinic were mailed a validated questionnaire; "patient assessment of upper gastrointestinal disorders-symptom severity index", in which a subset of questions measures symptoms of gastroparesis (GCSI; Gastroparesis Cardinal Symptom Index). Response rate was 74.4% (n=765). All patients were classified according to presence or absence of late diabetic complications and clinical and paraclinical data were obtained. RESULTS: A GCSI Total Score ≥1.90 signified definite symptoms of gastroparesis (n=102) and patient charts were investigated for concomitant illness and/or medication influencing gastric emptying. In 30 patients an alternative etiology was revealed, leaving 72 (9.8%) patients with symptoms related to diabetic gastroparesis. Only 8 patients were previously diagnosed. HbA(1c) levels were significantly higher in patients with diabetic gastroparesis (8.4±1.3 vs. 8.2±1.2 respectively, p=0.02). Furthermore, patients with diabetic gastroparesis had more retinopathy (p=0.006) and peripheral polyneuropathy (16.7% vs. 6.7%, p<0.001) and there was a trend for diabetic nephropathy being more common (p=0.08). CONCLUSIONS: Symptoms of diabetic gastroparesis affect approximately 10% of patients with Type 1 diabetes in a specialized diabetes clinic and are associated with poor glycemic control and other late diabetic complications.

What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark.

INTRODUCTION: The goal of this study was (1) to identify logistical and clinical areas of importance for length of stay (LOS) by identifying departments with short and long LOS and to evaluate their set-up; and (2) to evaluate patient satisfaction in relation to LOS. MATERIALS AND METHODS: Based on the National Register on Patients in 2004 on LOS following total hip and knee arthroplasty (THA and TKA), departments with short and long LOS were identified. The three departments with the shortest and the three departments with the longest postoperative hospital stay were chosen for evaluation. The logistic setup and the clinical treatment/pathway were examined with on-location focus interviews to identify logistic and clinical factors acting as improvement or barriers for early rehabilitation and subsequent discharge. Also, the patients from these departments answered a questionnaire regarding satisfaction with components of their stay, co-morbidity, sex and age. RESULTS: Mean LOS was 7.4 and 8.0 days after THA and TKA, respectively staying from 4.5 to 12 days. Departments with short hospital stay were characterised by both logistical (homogenous entities, regular staff, high continuity, using more time on and up to date information including expectations on a short stay, functional discharge criteria) and clinical features (multimodal opioid-sparing analgesia, early mobilisation and discharge when criteria were met) facilitating quick rehabilitation and discharge. Patient demographics from departments with the shortest stay were similar co-morbidities than patients from departments with longer stays, but were either as satisfied-or more satisfied-with all parts of their stay. There was no difference in staffing (nurses/physiotherapists) between the two types of departments. CONCLUSION: Nationwide implementation of fast-track THA and TKA would result in a significant decrease in the needed number of hospital beds with similar or better outcome for the patients. Implementation of updated logistical and clinical features is expected to increase rehabilitation and reduce LOS with similar or improved patient satisfaction. These results support the implementation of fast-track total hip- and knee arthroplasty.

[Length of stay in total hip and knee arthroplasty in Danmark I: volume, morbidity, mortality and resource utilization. A national survey in orthopaedic departments in Denmark]. / Indlaeggelsesvarighed efter operation med hofte- og knaealloplastik i Danmark. I: volumen, morbiditet, mortalitet og resurseforbrug. En landsdaekkende undersøgelse på ortopaedkirurgiske afdelinger i Danmark.

INTRODUCTION: The goal of this study was to evaluate hospital stays for patients operated on with primary total hip- and knee-arthroplasty (THA and TKA) in Denmark in order to focus on the relationship between duration of hospital stay, surgical volume, morbidity and mortality and resources. MATERIALS AND METHODS: According to the National Register on Patients in 2004 concerning postoperative length of hospital stay, readmissions (30 days) and mortality (30 and 90 days), departments with short and long hospital stay were compared and potential economical savings were estimated if all departments reduced their stays to match the departments with the shortest hospital stay. RESULTS: Postoperative hospital stay varied between departments from 4.5 to 12 days. Two-thirds of the departments had stays of more than seven days. A high surgical volume tended to correlate with short hospital stay and reduced mortality. A nation-wide reduction of hospital stay after THA and TKA to five days would free 28,000 hospital beds and produce economic savings of approx. 13 million Euro. CONCLUSION: Nation-wide implementation of fast-track THA and TKA would result in a significant decrease in the needed number of hospital beds and generate economic savings with similar or better outcome.

[Accelerated versus conventional hospital stay in total hip and knee arthroplasty II: organizational and clinical differences]. / Kort vs. lang hospitalisering efter hofte- og knaealloplastik. II: organisatoriske og faglige forskelle.

INTRODUCTION: The goal of this study was to evaluate hospital stays for patients operated on with primary total hip- and knee-arthroplasty (THA and TKA) in order to identify important logistical and clinical areas for the duration of the hospital stay. MATERIALS AND METHODS: According to the National Register on Patients, the three departments with the shortest and the three departments with the longest postoperative hospital stay at the end of 2003 were chosen for evaluation. This took place from late 2004 to mid 2005, and all written material and 25 journals from each department were evaluated, and interviews with the heads of the departments as well as the staff were conducted. The logistical set-up and the clinical treatment/pathway were examined in an attempt to identify logistical and clinical factors acting as improvements or barriers for quick rehabilitation and subsequent discharge. RESULTS: Departments with short hospital stay were characterised by both logistical (homogenous entities, regular staff, high continuity, using more time on and up-to-date information including expectations of a short stay, functional discharge criteria) and clinical features (multi-modal pain treatment, early mobilization and discharge when criteria were met) facilitating quick rehabilitation and discharge. CONCLUSION: Implementation of logistical and clinical features, as shown in this study in all departments, are expected to increase rehabilitation and reduce the length of hospital stay.

[Accelerated versus conventional hospital stay in total hip and knee arthroplasty III: patient satisfaction]. / Patienttilfredshed efter hofte- og knaealloplastik med kort vs. lang indlaeggelse. III: patienttilfredshed.

INTRODUCTION: The goal of this study was to evaluate patient satisfaction with the hospital stay in relation to the length of stay for patients operated on with primary total hip- and knee-arthroplasty (THA and TKA). MATERIALS AND METHODS: According to the National Register on Patients, the three departments with the shortest and the three departments with the longest postoperative hospital stay at the end of 2003 were chosen for evaluation. The patients, operated on with THA or TKA from September 2004 to April 2005, from the selected departments answered a questionnaire regarding satisfaction with elected parts of their stay, co-morbidity, sex and age. RESULTS: The patients from the departments with the shortest stay were not younger nor had they less co-morbidities than patients from departments with longer stays. Apart from staying a significantly shorter time, they were either as satisfied--or sometimes more satisfied--with all parts of their stay compared to patients from the departments with longer hospital stay. CONCLUSION: Patients in accelerated stays are not less satisfied with their hospital stay (or any part of it) compared to patients with longer and more conventional hospital stays. These results support the implementation of fast-track total hip- and knee arthroplasty.

[Length of stay after primary total hip and knee arthroplasty in Denmark, 2001-2003]. / Indlaeggelsesvarighed ved primaer total hofte- og knaealloplastik i Danmark 2001-2003.

INTRODUCTION: We studied length of stay (LOS) after operation with total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Denmark from 2001 to 2003 to determine whether experiences from published accelerated tracks had been implemented in Denmark, resulting in reduced LOS. MATERIALS AND METHODS: Through the National Patient Registry (Landspatientregistret) we obtained information on numbers, sex, age and LOS for each year during the period 2001-2003, inclusive. RESULTS: In 2003 the male-female sex ratios for THA and TKA were 1:1.4 and 1:1.7, respectively. In 2003, the mean age at operation with THA was 66.0 years for men and 69.9 years for women; 66.9 years for men and 69.0 years for women operated on with TKA. During the period studied, LOS was reduced for both operations: 16% for THA, to a mean of 8.1 days, and 17% for TKA, to a mean of 8.6 days, in 2003. LOS increased with age for both THA and TKA. Men had shorter LOS than women. DISCUSSION: The LOS shows that accelerated tracks - with accompanying shorter LOS in the area of 4 to 6 days - have not been implemented on a nationwide basis, and we find a need to review the principles for rehabilitation after operation with THA and TKA in the direction of accelerated tracks. This could be expected not only to generate large savings in LOS but also to reduce the need for rehabilitation and possibly reduce morbidity.