Does LDL-C determination method affect statin prescribing for primary prevention? A register-based study in Southern Denmark.

AIMS: Examine whether low-density lipoprotein cholesterol (LDL-C) determination method influences the rate of statin initiation for primary prevention of cardiovascular disease. METHODS AND RESULTS: We conducted a register-based retrospective study in the Region of Southern Denmark. Two hospital-based laboratories in the Region directly measure LDL-C whereas four laboratories calculate LDL-C using Friedewald's formula. Physicians do not choose which method is used. We included all statin-naïve patients ≥40 years with no history of cardiovascular disease, diabetes, or chronic kidney disease, who had their LDL-C determined during 2018-2019. There were 202,807 people who had LDL-C determined during the study period (median age 59 years, 44% women) of which 37% had a direct LDL-C measurement. The median reported LDL-C was 3.40 mmol/L (IQR 2.90 to 4.00) for those with a direct measurement versus 3.00 mmol/L (IQR 2.40 to 3.50) for those with calculated LDL-C. For those with direct measurement, re-calculated LDL-C (using Friedewald's formula) was 0.35 mmol/L lower than the reported direct LDL-C measurement. Among those with directly measured LDL-C, 3.6% initiated statins compared with 2.7% of those with a calculated LDL-C. Direct LDL-C measurement led to higher odds of having a statin initiated compared to calculated LDL-C (adjusted odds ratio 1.23, 95% CI 1.17 to 1.30); for those with triglycerides > 1.7 mmol/L the adjusted odds ratio was 1.41 (95% CI 1.30 to 1.52). CONCLUSION: Differences in the reporting of LDL-C from laboratories using different methods have a substantial influence on physician's decisions to prescribe statins.

[Christmas article. Significantly fewer acute hospital admissions on days off].

The number of acute admissions in Danish hospitals is increasing and is causing recurrent overcrowding problems. There are fewer hospitalisations on days off, like weekends, public holidays and vacations, and this phenomenon is analysed in our review with data from the period 1.1.2008-31.12.2017. There were 20-30% fewer acute admissions on days off than on the about 60% normal working days in Denmark, and apparently without compensatory increases following the days off. Our findings suggest, that 1) doctors' indications for acute admissions cannot possibly be based on strict clinical criteria alone, and 2) the problem of growing hospitalisation and overcrowding could perhaps be attenuated by increasing the number of days off in the Danish healthcare system. However, further studies are required, to ensure that the quality of patient care is not adversely affected.

[Medication reconciliation].

The purpose of medicines reconciliation (MR) is to avoid medication errors through the complete and accurate transfer of information on patients' medicines during health care sector transitions. We review the rapidly expanding literature on MR showing a need for consensus on taxonomy and research into efficient ways to implement MR. Further, we describe quality improvement initiatives on MR in Denmark and challenge the, in our view, one-sided focus on information technology in MR.

Text mining electronic health records to identify hospital adverse events.

Manual reviews of health records to identify possible adverse events are time consuming. We are developing a method based on natural language processing to quickly search electronic health records for common triggers and adverse events. Our results agree fairly well with those obtained using manual reviews, and we therefore believe that it is possible to develop automatic tools for monitoring aspects of patient safety.

[Patient deaths are not suited for monitoring quality and patient safety in hospitals]. / Dødsfald er ikke egnede til monitorering af kvalitet og patientsikkerhed i sygehusvæsenet.

Although some patient deaths in hospitals can be prevented if quality of care and patient safety are improved, it is not given that such deaths can be used to track improvements. Since preventable deaths only amount to about 5% of all deaths, a decline in that number will be a weak signal as far as mortality is concerned. The commonly used hospital standardised mortality ratio (HSMR) has a low signal-to-noise ratio and is therefore not suitable for monitoring. The same goes for structured reviews of health-care records of deceased patients. Consequently, a need to develop alternatives exists.

[Hospital standardised mortality ratios do not with certainty reflect the quality of patient care]. / Hospitalsstandardiseret mortalitetsratio kan ikke sikkert relateres til kvaliteten af patientbehandlingen.

Hospital standardised mortality ratios (HSMRs) are presumed to reflect an overall quality of patient care in hospitals. Figures for all Danish hospitals are being published quarterly on the Internet, and aggregated values are used to set goals for both regional and nationwide efforts to improve quality of care and patient safety. We have analysed the available data from 2007 through 2011 and cannot reconcile the quite substantial and often sudden changes in HSMRs with changes in quality of care, but believe that they are due to inherent noise in calculating HSMRs, e.g. owing to variable quality of the diagnostic coding.

First-time urea breath tests performed at home by 36,629 patients: a study of Helicobacter pylori prevalence in primary care.

BACKGROUND: The aim of the current study was (1) to describe the use of a (13) C-urea breath test (UBT) that was performed by patients at their homes as a part of a test-and-treat strategy in primary care and (2) to investigate the prevalence of Helicobacter pylori in patients taking a first-time UBT. MATERIAL AND METHODS: The patients performed UBTs at home based on the discretion of the general practitioner and mailed the breath bags to a central laboratory for analysis. Each patient was identified by a unique civil registration number. The study was population-based, and the background population was approximately 700,000 people. RESULTS: From 2003 to 2009, 44,487 UBTs were performed. Of these, 36,629 were first-time UBTs. In total, 726 of 45,213 breath bags received (1.6%) were unable to be analyzed because of errors with the bags. For both women and men who were ≤ 45 years of age, positive H. pylori declined over the time course of the study (women: 19.6% in 2003 to 17.6% in 2009, p < .01; men: 20.7% in 2003 to 16.9% in 2009, p < .001). Patients who were older than 45 years had significantly higher positive H. pylori results than younger patients. CONCLUSIONS: A test-and-treat system was possible to implement that allowed patients to perform UBTs at their homes. The results of the first-time UBTs demonstrated that approximately one of five patients who presented with dyspepsia in the clinical setting of Danish primary care was infected with H. pylori.

[Uniform reference intervals and harmonised results in clinical biochemistry in Scandinavia--light ahead]. / Ens referenceintervaller og harmoniserede resultater inden for klinisk biokemi i de nordiske lande--der er lys forude.

Danish laboratories are introducing identical reference intervals for a number of biochemical components in accordance with a Nordic agreement and recommendations during 2007. Danish doctors will consequently experience both changes in reference interval limits as well as adjustments of patients' levels of reported results for some components.

The common polymorphism of apolipoprotein E: geographical aspects and new pathophysiological relations.

Apolipoprotein E (apoE) has important functions in systemic and local lipid transport, but also has other functions. The gene (APOE) shows a common polymorphism with three alleles--APOE*2, APOE*3, and APOE*4. Their frequencies vary substantially around the world, but APOE*3 is the most common almost everywhere and is often considered to be the ancestral or "wild-type" allele for that reason. However, there are several arguments for APOE*4 being the ancestral allele. But then, why has APOE*3 become so frequent? And why has APOE*4 not become extinct? The proportion of APOE*4 carriers increases from only 10-15% in southern Europe to 40-50% in the north. The gradient may be a trace of the demic expansion of agriculture that began about 10,000 years ago, but it may also reflect the possibility that APOE*4 carriers are less likely to develop vitamin D deficiency. The common APOE polymorphism is associated with varying risk of cardiovascular disease and Alzheimer's disease, but other interesting aspects may emerge in the future.

Twelve single nucleotide polymorphisms on chromosome 19q13.2-13.3: linkage disequilibria and associations with basal cell carcinoma in Danish psoriatic patients.

The genetic susceptibility to basal cell carcinoma (BCC) among Danish psoriatic patients was investigated in association studies with 12 single nucleotide polymorphisms on chromosome 19q13.2-3. The results show a significant association between BCC and the A-allele of a polymorphism in ERCCI exon4 (Odds ratio 12;95% Confidence Interval 1.17-124; p(chi2, two-side) = 0.019) and to a lesser extent with XPD exon6 (p = 0.06). This is in accordance with recent studies of a different group of BCC cases (Rockenbauer et al. (in press) Carcinogenesis; Yin et al. (manuscript submitted for publication). Cancer Epidemiol. Biomarkers Prev), which places two highly influential markers between these two genes. The analysis also confirmed that considerable linkage disequilibrium exists between SNPs both within genes and between genes in this region. The combined studies suggest that genetic variation in nucleotide excision repair is of importance for the development of BCC.