Five-Year Outcomes After Coronary Computed Tomography Angiography (From 110,599 Patients in a Danish Nationwide Register-Based Follow-Up Study).

The long-term cardiovascular risk for patients examined with coronary computed tomography angiography (CCTA) to rule out coronary heart disease compared with population controls remains unexplored. A nationwide register-based study including first-time CCTA-examined patients between 2007 and 2017 in Denmark alive 180 days post-CCTA was conducted. We evaluated 5-year outcomes of myocardial infarction (MI) or revascularization and all-cause mortality in 3 distinct CCTA-groups: (1) no post-CCTA preventive pharmacotherapy use (cholesterol-lowering drugs, antiplatelets, or anticoagulants); (2) post-CCTA preventive pharmacotherapy use; and (3) revascularization or MI within 180 days post-CCTA. For each patient group, population controls were matched on age, gender, and calendar year. Absolute risks standardized to the age, gender, selected co-morbidity, and anti-anginal pharmacotherapy distributions of the specific CCTA-examined patients and respective controls were obtained from multivariable Cox regression. Of 110,599 CCTA-examined patients, (1) 48,231 patients were not prescribed preventive pharmacotherapy 180 days post-CCTA; (2) 42,798 patients were prescribed preventive pharmacotherapy within 180 days post-CCTA; and (3) 19,570 patients were diagnosed with MI or revascularized within 180 days post-CCTA. For patient groups 1 to 3 versus respective controls, 5-year MI or revascularization risks were <0.1% versus 2.0%, <0.1% versus 3.8%, and 19.0% versus 2.5%, all p<0.001. Five-year all-cause mortality were 2.8% versus 4.2%, 5.5% versus 8.8%, and 6.7% versus 8.5%, all p <0.001. In conclusion, the 5-year MI or revascularization risk can be considered very low for CCTA-examined patients without ischemic events within 180 days post-CCTA. Conversely, CCTA-examined patients with MI or revascularization events within 180 days post-CCTA have significantly elevated 5-year MI or revascularization risk.

[Cardiac myxoma--a rare cause of cerebral embolism]. / Kardialt myksom--en sjaelden årsag til iskaemisk stroke.

Cardiac myxoma is the most common benign heart tumor. We report a case with multiple brain metastases, presumably due to tumor embolization. It is important to perform transthoracic echocardiography at a very early stage to exclude structural heart disease in patients with signs of multiple brain metastases. Though myxoma is a rare cause of cerebral embolism, detection of this tumor is relatively easy and surgical resection of myxoma is usually a permanent measure to prevent subsequent stroke.

Under surveillance, yet looked after: telehomecare as viewed by patients and their spouse/partners.

INTRODUCTION: In this research project, a group of heart patients were transferred from traditional hospital settings to home hospitalisation across sectors. The project involved patients with heart failure and arrhythmia. AIM: The aim was to understand the experiences and attitudes of patients and their spouses/partners with regard to the application of telehomecare technology as an option within home hospitalisation. METHODS: A phenomenological hermeneutic approach was used to collect and interpret the findings and data. A triangulation of data collection techniques was applied using participation observation and qualitative interviews with patients and spouse/partner. Data were analysed from the perspective of the sociology of everyday life. FINDINGS: The impact of home hospitalisation on patients is described according to several themes: security, freedom, increased awareness of own symptoms, being 'looked after' but annoyed with their spouse/partner. The patients experience a seamless cross-sector patient care process. The impact on the spouse/partner includes elements of increased responsibility, nervous tension, and invasion of privacy. CONCLUSION: Patients believe that home hospitalisation speeds up the process of returning to everyday life, both physically and mentally. It is important to be aware of certain anxieties experienced by the patient's spouse/partner about home hospitalisation, and these anxieties may also affect the patient.

Telehomecare technology across sectors: claims of jurisdiction and emerging controversies.

PURPOSE: The purpose of this study was to explore and identify inter-organisational and inter-professional controversies that emerge when telehomecare technology is implemented across healthcare sectors. THEORY: A combined inter-organisational and inter-professional perspective constitutes the conceptual framework for this study. METHODS: The case study approach was applied as the overall methodology of the study. A triangulation of data collection techniques was used in order to provide multiple sources of evidence for exploring and identifying controversies (documents, participant observation, qualitative interviews, focus group interviews). FINDINGS: During the design and implementation phases of a telehomecare system, several types of controversies emerged as part of the inter-organisational and inter-professional agenda. These controversies involved competing claims of jurisdiction, controversies over knowledge technologies, or differences in network visions and network architecture. DISCUSSION AND CONCLUSIONS: The identification of such controversies and differences in the design and implementation process of the concept of home hospitalisation for heart patients by means of telehomecare technology can contribute to the uncovering of new knowledge. These issues should be taken into account when initiating a telehomecare project and implementing telehomecare technology. Technology in a network and across inter-professional relations poses a challenge to this new field. There is a particular need to precisely define the claims of jurisdiction, and the accompanying controversies that can arise related to knowledge technologies, network visions and network architecture.

Implementation of the concept of home hospitalisation for heart patients by means of telehomecare technology: integration of clinical tasks.

PURPOSE: To explore how the implementation of the concept 'Home hospitalisation of heart patients' by means of telehomecare technology influences the integration of clinical tasks across healthcare sectors. THEORY: Inter-organisational theory. METHODS: The case study approach was applied. Triangulations of data collection techniques were used: documentary materials, participant observation, qualitative and focus group interviews. RESULTS: The clinical decision-making and task solving became multidisciplinary and integrated with the implementation of telehomecare and, therefore, complex in terms of the prescription and adjustment of patient medicine. Workflows between healthcare professionals across sectors changed from sequential to collective client flows. Pre-existing procedures for patient care, treatment, and responsibility were challenged. In addition, the number of tasks for the district nurses increased. Integration in the clinical task-solving area increases fragmentation in the knowledge technologies in a network perspective. CONCLUSIONS: Implementing the concept of 'Home hospitalisation of heart patients' by means of telehomecare technology will result in a more integrated clinical task-solving process that involves healthcare professionals from various sectors. Overall, the integration of clinical tasks between hospital and district nursing will result in a direct benefit for the heart patients.

[Deep venous thrombosis--epidemiology, diagnosis and treatment]. / Dyb venøs trombose--epidemiologi, diagnose og behandling.

The pathogenesis of deep vein thrombosis (DVT) involves vascular changes or injury, stasis and alterations in the blood composition. The risk increases with age; however, important risk factors are cancer, surgery, immobilisation and hormone therapy. DVT most often appears in the crural veins. The diagnosis is based on ultrasound, d-dimer and clinical examination. Correct treatment requires gradient compression hosiery, low-molecular heparins and anticoagulant therapy. Duration of treatment depends on the individual risk of recurrence.

[Outpatient treatment of deep-vein thrombosis]. / Ambulant behandling af dyb venetrombose.

INTRODUCTION: The treatment of deep-vein thrombosis (DVT) is increasingly managed in an outpatient setting. This is the first retrospective study of an outpatient treatment program for DVT patients in a Danish hospital. MATERIALS AND METHODS: Case records from all DVT patients treated at Frederikshavn Hospital between 1997 and 2003 were studied to analyse patient characteristics and the risk of pulmonary embolism, bleeding and recurrence. Questionnaires about the use of outpatient treatment programs were sent to all Danish hospitals. RESULTS: A total of 265 patients were registered, of whom 141 (53.2%) were treated in an inpatient setting, 120 (45.3%) were treated only in an outpatient setting and 4 (1.5%) underwent initial inpatient treatment for less than 24 hours followed by outpatient treatment. The percentage of patients in ambulatory care increased during the study period. Outpatient treatment proved to be as safe as treatment during hospitalisation. Most hospitals reported that the majority of DVT patients are still managed in primary hospitalisation. CONCLUSION: The organisation used by Frederikshavn is recommended to hospitals that plan to utilise an outpatient treatment program for DVT patients. A certain delay must be expected in the transition from an inpatient to an outpatient setting. International studies have documented the cost-effectiveness as well as patient benefits and preferences from such programs.