Margrethe Herning

Long-term global and regional brain volume changes following severe traumatic brain injury: A longitudinal study with clinical correlates

Traumatic brain injury (TBI) results in neurodegenerative changes that progress for months, perhaps even years post-injury. However, there is little information on the spatial distribution and the clinical significance of this late atrophy. In 24 patients who had sustained severe TBI we acquired 3D T1-weighted MRIs about 8 weeks and 12 months post-injury. For comparison, 14 healthy controls with similar distribution of age, gender and education were scanned with a similar time interval. For each subject, longitudinal atrophy was estimated using SIENA, and atrophy occurring before the first scan time point using SIENAX. Regional distribution of atrophy was evaluated using tensor-based morphometry (TBM). At the first scan time point, brain parenchymal volume was reduced by mean 8.4% in patients as compared to controls. During the scan interval, patients exhibited continued atrophy with percent brain volume change (%BVC) ranging between -0.6% and -9.4% (mean -4.0%). %BVC correlated significantly with injury severity, functional status at both scans, and with 1-year outcome. Moreover, %BVC improved prediction of long-term functional status over and above what could be predicted using functional status at approximately 8 weeks. In patients as compared to controls, TBM (permutation test, FDR 0.05) revealed a large coherent cluster of significant atrophy in the brain stem and cerebellar peduncles extending bilaterally through the thalamus, internal and external capsules, putamen, inferior and superior longitudinal fasciculus, corpus callosum and corona radiata. This indicates that the long-term atrophy is attributable to consequences of traumatic axonal injury. Despite progressive atrophy, remarkable clinical improvement occurred in most patients.

Women's experiences and behaviour at onset of symptoms of ST segment elevation acute myocardial infarction.

Background: Minimizing time from onset of symptoms to treatment (treatment delay) is crucial for patients with ST segment elevation acute myocardial infarction (STEMI), and one of the great challenges is to reduce the delay relating to the prehospital behaviour of the patient (patient delay). Studies indicate that women delay longer than men and insights into this area could lead to improved health education programmes aimed at reducing patient delay in women with STEMI. Method: Open interviews with 14 women with STEMI were held during their hospital stay from June to September 2009. The interviews were aimed at exploring determinants of treatment delay, and were carried out and analysed within a phenomenological framework. Findings: Three themes emerged important for the delay in seeking medical assistance: (1) Knowledge and ideas of AMI symptoms and risks. (2) Ambivalence whether to call for medical assistance or to cope with the situation. (3) Actions and strategies taken after onset of symptoms. Conclusions: Three factors determined whether women showed appropriate behaviour for reduced patient delay after onset of symptoms: (1) identifying the symptoms as being of cardiac origin, (2) having a prepared action plan in case of an emergency situation, and (3) living with someone or contacting other persons.

Patient-reported outcomes at hospital discharge from Heart Centres, a national cross-sectional survey with a register-based follow-up: the DenHeart study protocol

Introduction Patient reported health status, which includes symptom burden, functional status and quality of life, is an important measure of health. Differences in health status between diagnostic groups within cardiology have only been sparsely investigated. These outcomes may predict morbidity, mortality, labour market affiliation and healthcare utilisation in various diagnostic groups. A national survey aiming to include all cardiac diagnostic groups from a total Heart Centre population has been designed as the DenHeart survey. Methods and analysis DenHeart is designed as a cross-sectional survey with a register-based follow-up. All diagnostic groups at the five national Heart Centres are included during 1 year (15 April 2013 to 15 April 2014) and asked to fill out a questionnaire at hospital discharge. The total eligible population, both responders and non-responders, will be followed in national registers. The following instruments are used: SF-12, Hospital Anxiety and Depression Scale, EQ-5D, Brief Illness Perception Questionnaire (B-IPQ), HeartQoL and Edmonton Symptom Assessment Scale. The following variables are collected from national registers: action diagnosis, procedures, comorbidity, length of hospital stay, type of hospitalisation, visits to general practitioners and other agents in primary healthcare, dispensed prescription medication, vital status and cause of death. Labour market affiliation, sick leave, early retirement pension, educational degree and income will be collected from registers. Frequency distributions and multiple logistic regression analyses will be used to describe and assess differences in patient reported outcomes at hospital discharge between diagnostic groups and in-hospital predicting factors. Cox proportional hazards regression models with age as the time scale will be used to investigate associations between patient reported outcomes at baseline and morbidity/mortality, labour market affiliation and healthcare utilisation after 1 year. Ethics and dissemination The study complies with the Declaration of Helsinki. The study has been approved by the Danish Data Protection Agency: 2007-58-0015/30-0937 and registered at ClinicalTrials.gov (NCT01926145). Study findings will be disseminated widely through peer reviewed publications and conference presentations.

Women's experiences of sexual health after first-time myocardial infarction.

AIMS AND OBJECTIVES To investigate womens experience of sexual problems after a myocardial infarction. BACKGROUND Sexual problems among female patients with ischaemic heart disease have received little study but have been found to be highly prevalent in the research. Sexual problems have been found to influence quality of life and well-being, and sexual dysfunction has been associated with anxiety and depression. International guidelines recommend that healthcare professionals address sexuality; however, this is rarely done in practice, due to multiple causes, for example ignorance, embarrassment and lack of systematic treatment. Insight into womens sexual challenges after having a myocardial infarction is much needed. DESIGN Qualitative interview study. METHODS Qualitative interviews were conducted with 11 patients representative of the population and later transcribed. The analysis was inspired by Ricoeurs theory of interpretation, which consists of three levels: naive reading, structured analysis, and critical interpretation and discussion. RESULTS The overall finding that emerged regarding the womens sexual health was an anxious resuming of sexual activity. Four themes emerged: (1) the partner, (2) support, (3) the heart diseases influence on sex and (4) the relationship. CONCLUSION The women experienced anxious resuming of sexual activity. The heart disease had influence on their sex life, and relationship with their partner could be affected. Some needed support from health professionals or their network to dare sexual activity again. RELEVANCE TO CLINICAL PRACTICE This study indicates that health professionals should focus more on identifying anxiety and exhaustion after myocardial infarction and articulating their potential influence on womens sexual lives. Whether this should be addressed in the hospital setting, in the phase 2 rehabilitation at the general practitioner level or in combination has to be considered and may be the basis for further research.

The Screen-ICD trial. Screening for anxiety and cognitive therapy intervention for patients with implanted cardioverter defibrillator (ICD): a randomised controlled trial protocol

Introduction Previous research shows that patients with an implanted cardioverter defibrillator (ICD) have a fourfold increased mortality risk when suffering from anxiety compared with ICD patients without anxiety. This research supports the screening of ICD patients for anxiety with the purpose of starting relevant intervention. Methods and analysis Screen-ICD consists of 3 parts: (1) screening of all hospitalised and outpatient patients at two university hospitals using the Hospital Anxiety and Depression Scale (HADS), scores ≥8 are invited to participate. (2) Assessment of type of anxiety by Structured Clinical Interview for DSM Disorders (SCID). (3) Investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive–behavioural therapy (CBT) performed by a cardiac nurse with CBT training, plus usual care or usual care alone. The primary outcome is HADS-A measured at 16 weeks. Secondary outcomes include Becks Anxiety Inventory, HeartQoL, Hamilton Anxiety Scale, heart rate variability, ICD shock, time to first shock and antitachycardia pacing. A total of 88 participants will be included. The primary analyses are based on the intention-to-treat principle and we use a mixed model with repeated measurements for continuous outcomes. For binary outcomes (HADS-A score <8), we use a generalised mixed model with repeated measurements. Ethics and dissemination The trial is performed in accordance with the Declaration of Helsinki. All patients must give informed consent prior to participation and the trial is initiated after approval by the Danish Data Protection Agency (RH-2015-282) and the regional ethics committee (H-16018868). Positive, neutral and negative results of the trial will be published. Trial registration number NCT02713360.

Obesity and smoking is widespread in patients with ischemia and heart failure, but not in congenital heart disease and heart transplant patients: results from the national DenHeart survey The study is funded by the heart centres and the Novo Nordisk Foundation

no: 166 Flowchart Abstracts S33 ! 2016 European Journal of Preventive Cardiology Framingham Risk Score and the PRECARD Scale. Statistical analysis involved uniand multivariate linear regression and logistic regression. Results: The CREP program enrolled 139 patients participation (45%). Included 56.8% men and 43.2% women. Smoking was associated with lower chance to participate compared to non-smokers (OR = 0.42, 95%CI = 0.16 0.88). There was small but signification difference between men and women in change in risk assessment according to the Framingham Risk Score (0.69%). Participation in supervised physical exercise program increased the effectiveness of the program assessment by SPE (0.22 points per each session). There was a strong correlation between the effectiveness of the program after 1 year and the result of evaluation directly after CREP completion. The better was the direct effect of the program the lower risk after 1 year. Conclusions: Cigarette smoking was associated with twofold lower participation in the CREP. Participation in supervised physical exercise program was associated with significantly greater effectiveness of the program. Additionally, male sex and older age had a negative effect on risk change according to the Framingham Risk Score. Significant correlation between the effectiveness of CREP after its completion and its distant consequences were reported. 168 Impact of cardiac rehabilitation on dietary habits and aerobic exercise after an acute coronary syndrome E Elio Venturini, C Sansoni, V Venturini, L Lo Conte, M Siragusa, N Bosio, R Testa Department of Cardiology Civic Hospital , Cecina (LI), Italy, University of Pisa, Department of Veterinary Sciences, Pisa, Italy Topic: Cardiac rehabilitation Purpose: aerobic exercise and the dietary habits, if maintained overtime, can be useful tools not only to attenuate the progression of coronary artery disease but also to induce a regression of the plaque. We evaluated the effect of a cardiology rehabilitation outpatient program (CR OP) on diet and physical activity in patients after acute coronary syndrome (ACS). Methods: we studied 50 P (67% men, mean age 67.3 10 y) enrolled in a CR OP duration 2 months, 24 sessions) after an ACS. The Mediterranean Diet (MD) was assessed with a translated version of the Med Diet Score which provides 0-8 points (the larger the value, the better adherence to diet). The International Physical Activity Questionnaire, in the short version, was used to assess the level of physical activity (PA): less than 700 METs /week subject inactive, 700-2519 sufficiently active, more than 2520 very active. Both questionnaires were administered before and after 1 year of the end of the program. It was provided a motivational telephone call, operated by nurses, at 3 and 6 months after the end of the CR OP. Results: the results are reported in the table below. The level of physical activity, too low at the beginning of the OP, was increased by CR; but above all, the good results persisted even a year later. Regarding the MD was observed a not significant improvement of the score going, however, by a category of sufficient adherence to MD (4-5: A good start, but you can do better), to the next still better (6-7: You’re doing well) Conclusions: a healthy lifestyle is a cornerstone for reducing cardiovascular mortality and morbidity. A comprehensive CR OP, when the training sessions are associated with educational intervention, can improve, permanently, the level of PA after ACS. Since the atherosclerosis is a process that develops over the years improvements in lifestyle can have a positive impact only if sustained. The minor impact on dietary habits could be explained by the already good adherence to the MD at the beginning of the OP, and for the absence, in the CR team, of the dietitian. A program of CR with a limited follow-up is an effective and low cost tool to promote a healthy lifestyle after an ACS.

Health related quality of life, anxiety and depression differs significantly between cardiac diagnostic groups at hospital discharge: results from denheart, a large scale national survey

Background: Heart failure is a common chronic condition that affects patients’ life situation and puts high demands on self-care and patient participation. Patients often need advanced care due to ...

DenHeart - A national cardiac health survey with register based follow-up

Associations between fatigue, symptom experiences and sleep quality after myocardial infarction

47 Oral Women's Experiences at Onset of Symptoms of ST Segment Elevation Acute Myocardial Infarction

74.8% male, roughly one quarter were over 75 years old, and 47.6% had had an anterior STEMI. There were no gemder differences in time from symptom onset to first medical contact (p = 0.52), and there was no significant interaction between gender and pre-hospital ECG programme status in this variable (p = 0.61). The time from first medical contact to first ECG was significantly longer in women than in men (p = 0.006), and this held true both before and after pre-hospital ECG programme implementation. Conclusions: Although there are some limitations, these findings suggest that there may not be significant differences between men and women in time to seek treatment for ACS. However, significantly longer times for women than men in acquisition of the first ECG is concerning. Possible explanations include women having more and therefore possibly vaguer symptoms, leading to uncertainty about possible etiology of presenting symptoms. Also, age, comorbidities and other factors may be significant co-variates, which has not been explored in this analysis. Further research of these hypotheses is warranted.

Unilateral Ocular Duplication

Purpose: To present a boy with unilateral duplication of the eye. Method: The case history is described from the first visit at birth to the age of 14 years. Results: A review of the literature shows that this malformation is compatible with life although malformations of the brain and epilepsy have been reported in all cases where a paediatric exam was described. We show that the malformation can appear as a synophthalmic eye in a single orbit or as two separate unilateral eyes in a separate orbit. Conclusion: We find the denomination, triophthalmia insufficient to differentiate between the two types and suggest a differentiation between unilateral synophthalmia and ipsilateral ocular duplication.