Forskningssymposium 2017

ABSTRACTS

Regionshospitalet Randers

Medicinsk Afdeling

DrukneulykkerLouise Nørkjær

vil forbedre livredderes færdigheder i genoplivning

for at øge overlevelsen ved drukneulykker

Kvindesygdomme og Fødsler

Clara Faurby Maarup

vil optimere behandling og

efterforløb hos kvinder med

fortykket livmoderslimhinde, så

færre får kræft eller tilbagefald

Livmoderslimhindekræft

Afdeling for Folkeundersøgelser

Kræftscreening for alle

Mette Bach Larsen

undersøger, hvordan

kræftscreening kan gøres

bedre for alle befolkningsgrupper

Medicinsk Afdeling

Optimale hjertestopholdKasper Glerup Lauridsenundersøger, hvordan man bedst organiserer hjertestopbehandling på hospitaler, så flere overlever et hjertestop

Regionshospitalet Randers

november 2017

Kære deltagere i Forskningssymposiet 2017

Velkommen til årets Forskningssymposium - en værdsat tradition på Regionshospitalet Randers.

Forskning og udvikling er en nødvendig og integreret del af hospitalets kerneydelse, hvis vi hele tiden vil levere den bedste behandling til den enkelte patient. Det kræver konstant nytænkning, afprøvning og evaluering af såvel konkret udredning og behandling som af de tilhørende processer.

Forskningen på Regionshospitalet har derfor mange facetter, hvor vi forsker i alt fra tumorbiologi og fysiologi ved tarmkræft, biomekanik ved risiko for for tidlig fødsel, genoplivning inklusiv effektiv hjertestopbehandling til screeningsadfærd og optimal medicingivning samt meget, meget mere.

Udover teoretiske forudsætninger og metodeanvendelse er forskning i høj grad afhængig af netværk i alle dele af forskningsprocessen. Vort hospital er begunstiget med erfarne forskere, som tilsammen behersker en mangfoldighed af forskellige metoder. Desuden har vi mange erfarne klinikere samt unge studerende og nyuddannede ansatte med gode ideer og enorm energi.

Et forskningssymposium er det ideelle forum, hvor forskellige aktører kan mødes, og vi sammen kan udvikle nye ideer og kvalificere de projekter, som præsenteres i dag.

Her er muligheden for at høre om dét, der foregår rundt omkring i huset samt møde fremtidige samarbejdspartnere.

Jeg håber, årets Forskningssymposium vil synliggøre den store forskningsaktivitet, som vi kan være stolte af samt inspirere til nye projekter og samarbejder på tværs af hospitalets afdelinger.

Lone Kjeld Petersen

Forskningschef

15:00 Velkomst Forskningschef Lone Kjeld Petersen

15.15 Keynote talk: Kom i gang med forskning – et par råd til et yngre jeg! Professor Bo Løfgren

15:45 Session 1: Genoplivning Moderatorer: Professor Jens Meldgaard Bruun & Overlæge Thorbjørn Grøfte

16:15 Pause 16:45 Session 2: Tarmrelateret sygdom Moderatorer: Overlæge Katrine Jøssing Emmertsen & Professor Berit Andersen

17:15 Session 3: Nye forskningsområder Moderatorer: Seniorforsker Mette Spliid Ludvigsen & Overlæge Ida Elisabeth Holm

17:45 Kort pause 18:00 Session 4: Gynækologi og obstetrik Moderatorer: Overlæge Esben Thyssen & Overlæge Pinar Bor

18:45 Afrunding Forskningschef Lone Kjeld Petersen

19:00 Middag med festtale og prisoverrækkelse

Hospitalsdirektør Jonas Dahl

Moderatorer: Professor Jens Meldgaard Bruun & Overlæge Thorbjørn Grøfte

Timing of focused cardiac ultrasound during advanced life support - a prospective clinical study

Reservelæge Rasmus Aagaard, Medicinsk og Anæstesiologisk Afdeling (abstract 1)

Poster præsentationer:

Automated external defibrillators are widely distributed in Danish hospitals but infrequently used - a nationwide study

MD ph.d.-studerende Mathilde Stærk, Medicinsk Afdeling (abstract 2)

Copeptin: the novel biomarker does not independently predict outcomes after cardioversion of atrial fibrillation

MD ph.d.-studerende Anders Sjørslev Schmidt, Medicinsk Afdeling (abstract 3)

Rapid cycle deliberate practice versus learning conversation in teaching laypersons basic life support – a randomized controlled trial

Forskningsårsstuderende Josephine Johnsen, Medicinsk Afdeling (abstract 4)

Layperson surf lifeguards deliver high-quality ventilations compared with experienced nurse anesthetists

Medicinstuderende Louise Nørkjær, Medicinsk Afdeling (abstract 5)

Major differences in advanced life support training strategies among Danish hospitals - a nationwide study

MD ph.d.-studerende Kasper Glerup Lauridsen, Medicinsk Afdeling (abstract 6)

Moderatorer: Overlæge Katrine Jøssing Emmertsen & Professor Berit Andersen

Significant improvement in the local recurrence rate after partial mesorectal excision for rectal cancer by critical evaluation of the extent and completeness of mesorectal excision on postoperative MRI Læge Peter Bondeven, Kirurgisk Afdeling K, RRA (abstract 7)

Inddragelse af ældre ortopædkirurgiske patienter forebygger post-operativ obstipation Forsker Mette Trads, Kirurgisk Center og Forskningsenheden (abstract 8)

Poster præsentationer:

Attitudes to colorectal cancer screening after diagnostic colonoscopy Seniorforsker Pia Kirkegaard, Afdeling for Folkeundersøgelser (abstract 9)

Effectiveness of the prevalence round of FIT-based colorectal cancer screening on stage of disease at time of diagnosis – a nationwide cohort study

AC-fuldmægtig Mette Bach Larsen, Afdeling for Folkeundersøgelser (abstract 10)

Moderatorer: Seniorforsker Mette Spliid Ludvigsen & Overlæge Ida Elisabeth Holm

KBU-lægers uddannelsesvejledning - en kvantitativ SWOT-analyse Uddannelseskoordinerede overlæge Anita Sørensen, Administrationen (abstract 11)

Communicating detailed information about colorectal cancer screening to citizens with lower educational attainment using an electronic decision aid: a qualitative study Ph.d.-studerende Pernille Gabel, Afdeling for Folkeundersøgelser (abstract 12)

Poster præsentationer:

Histologiske forandringer ved Central Pontin Myelinolyse Ph.d.-studerende Margarita Melnikova, Patologisk Institut (abstract 13)

Expansive learning and change of practice for nurses collaborating in transition of elderly medical patients Ph.d.-studerende Rikke Buus Bøje, Forskningsenheden (abstract 14)

An overview in preparation for development of interventions among older adults to prevent aspiration pneumonia: A scoping review protocol of the quantitative and qualitative evidence Sygeplejerske Kirstine Brask Brandt, Forskningsenheden (abstract 15)

Moderatorer: Overlæge Esben Thyssen & Overlæge Pinar Bor

New trends in lifestyle habits among Danish, pregnant women Jordemoder Tabia Volqvartz, Gynækologisk - Obstetrisk Afdeling (abstract 16)

Routine transvaginal ultrasound in women referred with pelvic organ prolapse - is it necessary?

KBU-læge Lone Pedersen, Gynækologisk - Obstetrisk Afdeling (abstract 17)

Poster præsentationer:

Easy access to transvaginal ultrasound from general practice for earlier diagnosis of ovarian cancer

Ph.d.-studerende Marie-Louise Ladegaard Baun, Forskningsenheden for Almen Praksis, Aarhus Universitet (abstract 18)

The use of medicine, caffeine, nicotine and illicit drugs during first trimester in Danish pregnant women (a research year study)

Tidl. forskningsårsstuderende Sissel Kramer Aagaard, Gynækologisk - Obstetrisk Afdeling (abstract 19)

Cervical Dysplasia – how can we improve the diagnostics? Ph.d.-studerende Berit Bargum Booth, Gynækologisk - Obstetrisk Afdeling (abstract 20)

Vitamin D deficiency in pregnancy - special emphasize on pre-eclampsia and the interactions with other xenobiotic exposures (planned PhD project)

Medicinstuderende Anna Louise Vestergaard, Gynækologisk - Obstetrisk Afdeling (abstract 21)

Conisation in women under the age of 30 Medicinstuderende Pernille Toxvig, Gynækologisk - Obstetrisk Afdeling (abstract 22)

The potential risk of endometrial cancer in women with endometrial hyperplasia - a long term follow-up

Forskningsårsstuderende Clara Faurby Maarup, Gynækologisk - Obstetrisk Afdeling (abstract 23)

New principles for quantitative elastography of the human uterine cervix Ph.d.-studerende Christine Rohr Thomsen, Gynækologisk - Obstetrisk Afdeling (abstract 24)

Timing of focused cardiac ultrasound during advanced life support - a prospective clinical study Aagaard R, Medicinsk Afdeling, Regionshospitalet Randers & Center for Akutforskning, Aarhus Universitetshospital Løfgren B, Medicinsk Afdeling, Regionshospitalet Randers & Center for Akutforskning, Aarhus Universitetshospital Grøfte T, Anæstesiologisk Afdeling, Regionshospitalet Randers Sloth E, Operation og Intensiv, Aarhus Universitetshospital Nielsen RR, Hjertesygdomme, Aarhus Universitetshospital, Frederiksen CA, Hjertesygdomme, Aarhus Universitetshospital Granfeldt A, Operation og Intensiv, Aarhus Universitetshospital Bøtker MT, Operation og Intensiv, Aarhus Universitetshospital

Background: Focused cardiac ultrasound can potentially identify reversible causes of cardiac arrest during advanced life support (ALS), but data on the timing of image acquisition are lacking. This study aimed to compare the quality of images obtained during rhythm analysis, bag-mask ventilations, and chest compressions. Methods: Adult patients in cardiac arrest were prospectively included during 23 months at a Danish community hospital. Physicians who had completed basic ultrasound training performed subcostal focused cardiac ultrasound during rhythm analysis, bag-mask ventilations, and chest compressions. Image quality was categorized as either useful for interpretation or not. Two echocardiography experts rated images useful for interpretation if all the following characteristics could be determined: 1) right ventricle larger than left ventricle, 2) pericardial fluid, and 3) collapsing ventricles. Results: Images were obtained from 60 of 104 patients undergoing ALS. A higher proportion of the images obtained during rhythm analysis and bag-mask ventilations were useful for interpretation when compared with chest compressions (rhythm analysis vs. chest compressions: OR 2.2 (95%CI 1.3-3.8), P=0.005; bag mask ventilations vs. chest compressions: OR 2.0 (95%CI 1.1-3.7), P=0.03). There was no difference between images obtained during rhythm analysis and bag-mask ventilations (OR 1.1 (95%CI 0.6-2.0), P=0.74). Conclusion: The quality of focused cardiac ultrasound images obtained during rhythm analysis and bag-mask ventilations was superior to that of images obtained during chest compressions. There was no difference in the quality of images obtained during rhythm analysis and bag-mask ventilations. Bag-mask ventilations may constitute an overlooked opportunity for image acquisition during ALS.

Automated external defibrillators are widely distributed in Danish hospitals but infrequently used - a nationwide study Stærk M, Research Unit, Randers Regional Hospital; Department of Internal Medicine, Randers Regional Hospital & Research Center for Emergency Medicine, Aarhus University Hospital Lauridsen KG, Research Unit, Randers Regional Hospital; Department of Internal Medicine, Randers Regional Hospital & Research Center for Emergency Medicine, Aarhus University Hospital Krogh K, Department of Anesthesia and Intensive Care, Aarhus University Hospital & Centre for Health Sciences Education, Aarhus University Kirkegaard H, Research Center for Emergency Medicine, Aarhus University Hospital & Prehospital Research Unit, Central Region Denmark Løfgren B, Department of Internal Medicine, Randers Regional Hospital; Research Center for Emergency Medicine, Aarhus University Hospital & Department of Clinical Medicine, Aarhus University

Background: Use of automated external defibrillators (AEDs) increase survival after out-of-hospital cardiac arrest. In contrast, data on the effect of in-hospital use of AEDs are conflicting which may be due to suboptimal use and differences in distribution of AEDs. Aim: To investigate and compare the distribution and use of AEDs and manual defibrillators in Danish hospitals. Methods: All public, somatic hospitals in Denmark with a cardiac arrest team were included. Hospitals treating outpatients only were excluded. A questionnaire was sent to the hospitals’ medico-technical departments inquiring about 1) AED and manual defibrillator distribution, 2) usage of AEDs and manual defibrillators, and 3) model of AEDs and manual defibrillators. Results: In total, 46 hospitals replied (response rate 100%). All hospitals had either AEDs (93%) and/or manual defibrillators (93%). The median number of AEDs was 10 (Q1;Q3: 5;24), and for manual defibrillators 11 (7;20) (p=0.74). During the past year, AEDs were used less (median 2 times per hospital (0;10)) compared with manual defibrillators (median 15 times per hospital (2;50)) (p=0.001) equal to each AED has been used 0.7 times and each manual defibrillator 2.7 times. Only 33% of hospitals had compatible AEDs and manual defibrillators i.e. AED electrodes could be directly connected to a manual defibrillator and 55% of hospitals required an adaptor. Conclusion: AEDs and manual defibrillators are widely distributed at Danish hospitals. AEDs are infrequently used compared with manual defibrillators. Only one third of hospitals have compatible AEDs and manual defibrillators regarding defibrillation electrodes.

Copeptin: the novel biomarker does not independently predict outcomes after cardioversion of atrial fibrillation Schmidt AS, Medicinsk Afdeling, Regionshospitalet Randers Lauridsen KG, Medicinsk Afdeling, Regionshospitalet Randers Torp P, Medicinsk Afdeling, Regionshospitalet Randers Bach LF, Anæstesiologisk Afdeling, Regionshospitalet Randers Hornung N, Klinisk Biokemisk Afdeling, Regionshospitalet Randers Rickers H, Medicinsk Afdeling, Regionshospitalet Randers Løfgren B, Medicinsk Afdeling, Regionshospitalet Randers

Background: Atrial fibrillation is associated with increased mortality, a substantial risk of heart failure and stroke. Copeptin is a novel biomarker independently predicting cardiovascular mortality in heart failure. However the value of copeptin regarding atrial fibrillation burden and persistency has not been investigated. We aim to investigate if copeptin levels can predict cardioversion success and sinus rhythm at 90-days follow-up in patients with atrial fibrillation. Methods: This study investigated 116 patients undergoing elective cardioversion of atrial fibrillation. The level of copeptin was determined before cardioversion and at 90-days follow-up. Copeptin levels were measured with a limit of quantification of 0.9 pmol/L. Results: Mean age ± standard deviation was 66 ± 9 years, and 85 (73%) were men. At baseline, 91 (78%) had hypertension; 28 (24%) had heart failure, and 10 (9%) had a history of previous stroke or transient ischemic attack. The patients had a median (1st quartile; 3rd quartile) history of atrial fibrillation of 3.5 months (1.6; 19) months; a median N-terminal pro-brain natriuretic peptide level of 837 pg/mL (624.75; 1359.25), and a mean indexed left atrial volume of 43 ± 12 mL/m2. Baseline characteristics were not statistically significantly different between the groups. The 83 (72%) patients with a successful cardioversion outcome had a mean copeptin level of 6.3 ± 2.0 pmol/L compared with 5.9 ± 1.9 for patients in atrial fibrillation (ratio 1.0 (0.8-1.1), p = 0.64). At follow up, 58 (50%) of patient, who remained in sinus rhythm, had a mean copeptin level of 5.8 ± 2.0 compared with 6.5 ± 2.1 in patient with recurrent atrial fibrillation (ratio 1.1 (0.9-1.2), p=0.44). Conclusion: Copeptin did not independently predict outcomes after cardioversion and 90-days follow-up in patients with atrial fibrillation. Future investigations may assess the role of copeptin in combination with other biomarkers and clinical history.

Rapid cycle deliberate practice versus learning conversation in teaching laypersons basic life support – a randomized controlled trial Johnsen J, Research Unit, Randers Regional Hospital; Research Center for Emergency Medicine, Aarhus University Hospital & Department of Internal Medicine, Randers Regional Hospital Stærk M, Research Unit, Randers Regional Hospital; Research Center for Emergency Medicine, Aarhus University Hospital & Department of Internal Medicine, Randers Regional Hospital Lauridsen KG, Research Unit, Randers Regional Hospital; Research Center for Emergency Medicine, Aarhus University Hospital & Department of Internal Medicine, Randers Regional Hospital Duval-Arnould JM, Johns Hopkins Medicine Simulation Center, Johns Hopkins University School of Medicine & Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine Hansen C, Research Unit, Randers Regional Hospital; Research Center for Emergency Medicine, Aarhus University Hospital & Department of Internal Medicine, Randers Regional Hospital Krogh K, Department of Anesthesiology and Intensive Care, Aarhus University Hospital Hunt EA, Johns Hopkins Medicine Simulation Center, Johns Hopkins University School of Medicine & Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine Løfgren B, Research Unit, Randers Regional Hospital; Research Center for Emergency Medicine, Aarhus University Hospital; Department of Internal Medicine, Randers Regional Hospital & Institute of Clinical Medicine, Aarhus University Hospital

Background: Feedback is a cornerstone in skill acquisition at basic life support and automated external defibrillation (BLS/AED) courses. The learning conversation (LC) is the standard European Resuscitation Council (ERC) feedback method where the learner receives feedback after skill training. Contrary, using the novel teaching approach rapid cycle deliberate practice (RCDP), feedback is provided throughout skill training. Errors are corrected immediately as they occur and the learner is exposed to repetitive practice of skills to ensure muscle memory. We aim to investigate the effect of using RCDP compared with LC at BLS/AED courses for laypersons. We hypothesize that RCDP is superior to LC when comparing learning outcome. Methods: The study will be performed as a randomized controlled superiority trial. Laypersons will be randomized 1:1 to BLS/AED training using either RCDP or LC. They will be instructed in single-rescuer adult BLS/AED according to ERC Guidelines 2015. All participants will be tested immediately after the course and after three months to assess skill acquisition. Both training and tests will be audio and video recorded for later quality assessment. Questionnaires on self-confidence, self-evaluated BLS/AED skills and participants’ perception of teaching methods will be distributed. Perspectives: If the study demonstrates that RCDP is superior to LC, it will provide evidence that may change current teaching practice in BLS/AED courses worldwide. RCDP is a simple method that may improve learners’ learning outcome and skill acquisition from BLS/AED courses. If so, implementation of RCDP can potentially improve the quality of BLS/AED delivery and thereby ultimately increase survival from cardiac arrest.

Layperson surf lifeguards deliver high-quality ventilations compared with experienced nurse anesthetists Nørkjær L, Center for Akutforskning på Aarhus Universitetshospital Stærk M, Medicinsk Afdeling, Regionshospitalet Randers & Center for Akutforskning, AUH Lauridsen KG, Medicinsk Afdeling, Regionshospitalet Randers & Center for Akutforskning, AUH Gallacher TK, Anæstesiologisk Afdeling, Regionshospitalet Randers Løyche JB, Anæstesiologisk Afdeling, Regionshospitalet Randers Krogh K, Anæstesi og intensiv behandling, Aarhus Universitetshospital Løfgren B, Afdeling for Hjertesygdomme, Aarhus Universitetshospital; Medicinsk Afdeling, Randers Regionshospital & Center for Akutforskning, AUH

Background: Every year approximately 360,000 people die following asphyxial cardiac arrest due to drowning. Quick and effective ventilation by surf lifeguards should be initiated to improve survival. The use of a supraglottic airway (SGA) may help deliver effective ventilations. SGA is widely used by nurse anesthetists as a standard for airway management, but it is unknown whether surf lifeguards, who are often non-healthcare providers, can use SGA effectively. SGA used by nurse anesthetists may be considered as a gold standard. Aim: To compare the use of a SGA by surf lifeguards and nurse anesthetists. Methods: In a simulation study, surf lifeguards and nurse anesthetists were asked to insert a SGA (i-gelO2, size 4, Intersurgical) in a resuscitation manikin (AMBU Man ALS, AMBU) and perform ventilations. Tidal volume was analyzed via manikin software and time to ventilation was analyzed by video recording. A successful ventilation was defined as a volume of 0.5-0.6 L and an effective ventilation as a visible manikin chest rise. Results: In total, 30 surf lifeguards (70% male, median age: 24 years (Q1;Q3: 21;27), lifeguard experience: 3 years (1;6)) and 30 nurse anesthetists (16% male, median age: 43 years (39;52), clinical experience: median 7 years (2;17)) were included. Mean tidal volume was 0.55 L (SD: 0.21) for surf lifeguards and 0.31 L (0.10) for nurse anesthetists (p

Major differences in advanced life support training strategies among Danish hospitals - a nationwide study Lauridsen KG, Medicinsk Afdeling, Regionshospitalet Randers Mygind-Klausen T, Medicinsk Afdeling, Regionshospitalet Randers Stærk M, Medicinsk Afdeling, Regionshospitalet Randers Løfgren B, Medicinsk Afdeling, Regionshospitalet Randers

Background: Advanced life support (ALS) training may increase survival from in-hospital cardiac arrest. Efficient ALS training includes practice of both technical and non-technical skills in a realistic setting with frequent retraining to avoid decay in ALS skills. ALS training strategies among hospitals are currently unknown. This study aimed to investigate ALS training strategies in Danish hospitals. Methods: We included all public, somatic hospitals in Denmark with a cardiac arrest team (n=46). Online questionnaires were distributed to resuscitation officers in each hospital. Questionnaires inquired information on: A) Course duration and retraining interval, B) Training methods and setting, C) Scenario training and practicing non-technical skills. Results: In total, 44 hospitals replied (response rate: 96%). ALS training was conducted in 43 hospitals (98%). Median (range) ALS course duration was 3.5 (1-8) hours. Retraining was conducted every year (28%), every second year (49%), less frequent (19%) and 4% retrained with different intervals depending on healthcare profession. E-learning was a part of ALS training by 21%. Overall, 28% conducted ALS training in a meeting room or auditorium while 72% conducted ALS training in a simulation unit or clinical setting. Chest compressions were trained on a bed by 63%, on a stretcher or table by 27%, and no hospitals used a backboard for training. Median (range) time spent on team training was 2.0 (0.5-5) hours. Overall, 51% conducted ALS training for all cardiac arrest team members (i.e. nurses, physicians, and orderlies) and 18% performed in-situ simulated cardiac arrests in addition to regular ALS training. Termination of resuscitation was practiced in team training by 60% of hospitals. Closed-loop communication was used by all (100%), but only 56% evaluated non-technical skills during or after team training. Overall, 2% reported to practice specific team leadership skills. Conclusion: There are major differences in duration, retraining interval, and methods for ALS training in Danish hospitals. These differences call for research to support standardized hospital ALS teaching strategies that improve survival.

Significant improvement in the local recurrence rate after partial mesorectal excision for rectal cancer by critical evaluation of the extent and completeness of mesorectal excision on postoperative MRI Bondeven P, Kirurgisk Afdeling K, Regionshospitalet Randers Laurberg S, Kirurgisk Afdeling. P, AUH Hagemann-Madsen RH, Patologisk Afdeling, Sygehus Lillebælt Ginnerup Pedersen B, Billeddiagnostisk Afdeling, AUH

Background: There have been several key advances in the optimal management of rectal cancer in the past few decades; however the optimal management of upper rectal cancer remains unclear. Partial mesorectal excision (PME) without neoadjuvant therapy is currently advocated for the majority of tumors of the upper rectum. Recently, a high rate of local recurrence and evidence of suboptimal surgery was detected in patients with cancer of the upper rectum. The aim of this study was to evaluate the effects of an initiative to improve outcomes after PME for upper rectal cancer. Methods: A total of 627 patients who underwent mesorectal excision with curative intent for rectal cancer in the period from 2007 to 2013 were included with preoperative clinical data and follow-up. Postoperative MRI of the pelvis was performed on 381 patients at app. one year after surgery. Midway in 2011, a workshop with focus on extent and completeness of surgery was held including surgeons, pathologist and radiologist involved in MDT treatment planning. A multidisciplinary team radiologist evaluated the images with regard to residual mesorectum and distal margin. Outcomes after a minimum of 3 years follow-up were compared in two cohorts from 2007-2010 and 2011-2013, respectively. Results: The 3-year actuarial local recurrence rate was 6.6% in 2007-10 and 4.6% in 2010-13 (p=0.793). Three-year actuarial local recurrence rates after PME for upper rectal decreased from 11.3% to 6.3% (p=0.028). Following the workshop fewer patients with cancer of the upper rectum were selected to have PME (86% vs. 73%, p=0.012) and in patients who underwent PME fewer had insufficient distal margins in combination with residual mesorectum (64% vs. 31%, p=0.001). Conclusion: Quality assessment of surgical practice had a major impact on the oncological outcome following surgery for upper rectal cancer.

Inddragelse af ældre ortopædkirurgiske patienter forebygger post-operativ obstipation Trads M, Kirurgisk Center, Regionshospitalet Randers Pedersen PU, Aalborg Universitet

Baggrund: Forekomsten af obstipation i befolkningen er 2 – 28 % og postoperativt mellem 50 og 79 %. Obstiperede patienter angiver symptomer som mavesmerter, oppustethed, kvalme, besvær med at komme af med afføringen og generelt ubehag. Indtagelse af laksantia er den hyppigst anvendt strategi til forebyggelse af obstipation, hvorimod livsstilændringer i form af motion, øget indtag af væske og fiberholdig mad ikke bliver opfattet som en løsning blandt ældre patienter. Det er vist, at inddragelse af patienter vha. individuel pleje og støtte hjælper dem til bedre sundhedsadfærd, så formålet med studiet var at undersøge om en sygeplejeintervention baseret på aktiv inddragelse forebygger postoperativ obstipation blandt patienter med hoftenær fraktur. Metode: Klinisk kontrolleret undersøgelse med Quasi-eksperimentelt design. Inklusionskriterier: patienter med hoftenær fraktur, der er ≥ 18 år og kan tale og forstå dansk. Eksklusionskriterier: tarmsygdom, diagnosticeret demens. 100 patienter med hoftefraktur blev inkluderet i en kontrolgruppe og 86 i en interventionsgruppe. Patienter i interventionsgruppen blev inddraget efter Salling-Larsens model, der indeholder: Indlæggelsessamtale, individuel plejeplan vedr. obstipation, daglige samtaler om forebyggelse af obstipation mellem patient og sygeplejerske og anvendelse af principper for primary nursing. Ved indlæggelse og 30 dage efter udskrivelse vurderedes, om patienterne var obstiperede og hvor meget væske og fibre de indtog. North American Nursing Diagnosis Associations definition blev anvendt og blev vurderet med Bristol Stool Scale, Rasmussens Scale og afføringsfrekvens. Resultater: Efter 30 dage var patienterne i interventionsgruppen signifikant sjældnere obstiperet end patienter i kontrolgruppen (p=.042). Indtagelse af fibre og væske var signifikant højere i interventionsgruppen end i kontrolgruppen (p=.001). Effekten af væskeindtag var statistisk signifikant (OR=1,1; 95 % CI: 1,0-1,2) ligesom effekten af fiberindtag var det (OR=0,4; 95 % CI: 0,2-0,8). Konklusion: Patienter med hoftenær fraktur, som blev aktivt involveret i egen forebyggelse af obstipation var mindre obstiperede 30 dage efter operation end patienter, der ikke blev det. Stigning i væske- og fiberindtagelse havde effekt i forhold til at reducere risikoen.

Attitudes to colorectal cancer screening after diagnostic colonoscopy Kirkegaard P, Afdeling for Folkeundersøgelser, Regionshospitalet Randers Edwards E, Afdeling for Folkeundersøgelser, Regionshospitalet Randers Andersen B, Afdeling for Folkeundersøgelser, Regionshospitalet Randers

Background: Population-based screening for colorectal cancer (CRC) using FIT (faecal immunochemical test) was rolled out in Denmark in 2014 for citizens between 50 and 74 years of age. The FIT-based screening offer has been well-received in Denmark with a participation rate of 65%. Seven percent of screening participants receive a positive FIT result and an appointment for diagnostic colonoscopy. In the vast majority of cases, positive FIT results are negative for CRC. The aim of the study was to explore attitudes to CRC screening in the future among screened participants who were negative for CRC after diagnostic colonoscopy. Methods: Sixteen screening participants who had received a negative diagnostic colonoscopy were selected for interview in their own homes, using a semi-structured interview guide. Transcribed data were analyzed thematically. Results: There was a common contentment regarding communication with healthcare professionals at the hospital on the day of the colonoscopy, especially during the examination, and many patients found the diagnostic colonoscopy less intrusive and unpleasant than the self-administered bowel preparation performed at home before the colonoscopy. All patients subsequently reported they felt assured by the result of the colonoscopy, they would participate in CRC screening again, and they would recommend others to participate in screening in the future. Conclusion: The study showed positive attitudes to the offer to get screened with FIT for CRC, even though screening implies the risk of getting a positive FIT result which is, in the vast majority of cases, a false alarm for CRC. Positive attitudes to participation among citizens who have experienced a negative outcome are important in order to maintain a high level of adherence to CRC screening in the future.

Effectiveness of the prevalence round of FIT-based colorectal cancer screening on stage of disease at time of diagnosis – a nationwide cohort study Larsen MB, Afdeling for Folkeundersøgelser, Regionshospitalet Randers Njor S, Afdeling for Folkeundersøgelser, Regionshospitalet Randers Ingeholm P, Patologisk Afdeling, Herlev Universitetshospital Andersen B, Afdeling for Folkeundersøgelser, Regionshospitalet Randers

Background: In these years, many countries are considering or implementing colorectal cancer (CRC) screening programmes based on the faecal immunochemical test (FIT) even though existing literature on the effectiveness of CRC screening based on faecal samples are based on the guaiac faecal occult blood tests. The aim of this study was to evaluate the effectiveness of the prevalence round in a FIT-based CRC screening programme on the number of incident CRC diagnoses and stage of disease at time of diagnosis among citizens randomly selected to be invited to participate in CRC screening compared to citizens not yet invited to screening. Methods: The study was designed as a register-based retrospective cohort study of cancer incidence and stage at time of diagnosis within the first 36 months of the prevalence round of a FIT-based CRC screening programme. Citizens were randomised either to be invited to CRC screening within the study period or thereafter (uninvited). Results: CRC incidence during the study period was 339.4/100,000 invited and 169.6/100,000 uninvited citizens. For both those who were invited and uninvited, CRC incidence rose with age, especially for invited men. The relative risk (RR) of an invited woman/man diagnosed compared to an uninvited woman/man at Stage I was 3.39 (95% CI: 2.61-4.39)/3.71 (2.97-4.64); at Stage II, it was 2.16 (95% CI: 1.71-2.72)/2.26 (95% CI: 1.84-2.77); at Stage III, it was 1.37 (95% CI: 1.08-1.75)/1.88 (95% CI: 1.53-2.30) and at Stage IV, it was 0.92 (95% CI: 0.68-1.23)/1.20 (95% CI: 0.95-1.52). Conclusion: The findings from this study substantiate the introduction of FIT based CRC screening in order to detect CRC in earlier stages and thereby secure better prognosis for the patients. The significant increase of CRC incidence in the prevalence round calls for awareness of treatment capacity in countries introducing FIT-based CRC screening in the future.

KBU-lægers uddannelsesvejledning - en kvantitativ SWOT-analyse Sørensen A, Regionshospitalet Randers Møller MK, Aarhus Universitetshospital Andreassen P, Center for Sundhedsvidenskabelige Uddannelser, Aarhus Universitet Malling B, Center for Sundhedsvidenskabelige Uddannelser, Aarhus Universitet

Baggrund: Uddannelsesvejledning er obligatorisk for alle læger i klinisk basisuddannelse (KBU-læger) og under speciallægeuddannelse. Formålet med studiet var at evaluere KBU-lægers formelle uddannelsesvejledning med henblik på at udpege områder for forbedring. Metoder: En spørgeskemaundersøgelse blev foretaget blandt de 129 KBU-læger, som pr. 1 marts 2017 var ansat i Region Midtjylland. Spørgeskemaet matchede Sundhedsstyrelsens krav og anbefalinger til den formelle uddannelsesvejledning. Svarprocenten var 67%. Der blev foretaget en driver-performance analyse, og data blev indlæst i et prioritetskort til belysning af, hvorvidt de enkelte delelementer kan betragtes som styrker, svagheder, muligheder eller trusler. Resultater: Alle (77/77) KBU-læger havde haft mindst én vejledningssamtale, og 86% (65/77) havde en individuel uddannelsesplan. Uddannelsesvejledningens styrker er, at KBU-lægerne får deres behov for vejledningssamtaler opfyldt, og at de samarbejder med deres hovedvejleder om at udarbejde en uddannelsesplan, som identificerer læringsmål og –strategier. Til gengæld må det betragtes som trusler, at uddannelsesplanerne ikke bliver løbende justeret, og ikke beskriver, hvornår de enkelte læringsmål skal opnås eller hvornår, af hvem og hvordan disse skal kompetencevurderes. Både vejledningssamtaler og uddannelsesplan understøtter udviklingen af KBU-lægernes kliniske kompetencer og har stor indflydelse på deres oplevede udbytte og værdi af uddannelsesvejledningen. Til gengæld ser sammenhængen mellem uddannelsesvejledningen og arbejdstilrettelæggelse, konferencer, undervisning og supervision hhv. arbejdsopgaver og KBU-kurser ud til kun at have lille indflydelse på oplevet udbytte og værdi. Konklusion: Vejledningssamtaler og uddannelsesplaner er i det store hele implementeret og har stor indflydelse på oplevet udbytte og værdi af uddannelsesvejledningen. Mulige, vigtige forbedringsområder er indholdet og den løbende justering af de individuelle uddannelsesplaner.

Communicating detailed information about colorectal cancer screening to citizens with lower educational attainment using an electronic decision aid: a qualitative study Gabel P, Afdeling for Folkeundersøgelser, Regionshospitalet Randers Larsen MB, Afdeling for Folkeundersøgelser, Regionshospitalet Randers Kirkegaard P, Afdeling for Folkeundersøgelser, Regionshospitalet Randers Edwards A, Division of Population Medicine, Cardiff University School of Medicine, UK Andersen B, Afdeling for Folkeundersøgelser, Regionshospitalet Randers

Background: Compared to average educational attainment citizens, citizens with lower educational attainment (LEA) take up colorectal cancer (CRC) screening to a lesser degree, and more seldom read and understand conventional screening information. Further, the information needs of LEA citizens are diverse, with desires ranging from a clear recommendation to elaborating information. Decision aids (DAs) have been developed supporting LEA citizens in making informed decisions about CRC screening participation, but none embracing diversion in information needs. The aim of this study was to develop such a DA tailored to LEA citizens. Methods: A prototype of the DA was developed based on previous studies about LEA citizens' information needs and the IPDAS guidelines. The DA presented information in steps, allowing citizens to read as much or as little as needed. Values clarification questions were included after each piece of information and answers summarized in a choice-barometer were featured on the last page, guiding the citizens towards a decision about screening participation. Statistics were presented in both relative and absolute numbers and in figures. Both user testing, peer review and field testing were conducted using focus group interviews, email correspondence, and telephone interviews with LEA citizens and healthcare professionals. Data was analyzed using thematic analysis. Results: The citizens found the DA easy to understand and the text of suitable length. They easily and intuitively navigated around the DA, and stated, that they felt encouraged to think about benefits and harms of CRC screening without being overloaded with information. Conclusion: This DA represents a new way of communicating detailed information about CRC screening to LEA citizens. It may be able to enhance informed choices about CRC screening participation among LEA citizens. Further, this work might serve as an inspiration when developing information material in other screening programs.

Histologiske forandringer ved Central Pontin Myelinolyse Melnikova MS, Patologisk Institut, Randers Regionshospital Frost L, Institut for Retsmedicin - Retspatologisk, Aarhus Universitetshospital Holm IE, Patologisk Institut, Randers Regionshospital

Baggrund: Central pontin myelinolyse (CPM) er en sjælden neurologisk tilstand karakteriseret ved symmetriske læsioner i pons med tab af myelin i fravær af inflammation. Klinisk manifesterer tilstanden sig ved hastigt progredierende spastisk parese, pseudobulbær parese, kramper og pupilforandringer, og mortaliteten er høj. Tilstanden ses i relation til hurtig korrektion af se-Na hos patienter med kronisk hyponatriæmi. Oftest er der tale om patienter med fejlernæring, eksempelvis som følge af kronisk alkoholisme eller kronisk pancreatitis. Patogenesen er ikke fuldstændigt klarlagt, men en hypotese er, at myelinolysen forudgåes af programmeret celledød i en population af oligodendroglia celler og at ændret ekspression af aquaporiner (vandkanaler) spiller en rolle for udvikling af tilstanden. Vi har samlet autopsimateriale fra 19 afdøde patienter med histologisk verificeret CPM, og formålet med vores undersøgelse har været at undersøge om programmeret celledød og ændret aquaporin ekspression spiller en rolle i patogenesen ved CPM. Metoder: Studiet udføres på paraffinindstøbt formalinfikseret pons materiale fra 19 CPM patienter og 5 personer uden neurodegenerative forandringer. CPM diagnose bekræftes vha. luxol fast blue farvning og demyelineserede læsioner identificeres. Både patienter og kontrol gruppe undersøges med immunhistokemiske markører for vandkanaler (AQP1, AQP4), astrocytter (GFAP), mikroglia (CD68) og induceret NO synthase. Desuden undersøges programmeret celledød ved farvning for de pro- og anti-apoptotiske markører Bcl-2 og Caspase3. Immunhistokemiske farvninger vurderes vha. semikvantitativ scoring i områder udenfor læsion, i selve læsionen og i randen af læsionen. Resultater og konklusion: Vores præliminære data viser en signifikant øget ekspression af aktiverede mikroglia i læsionerne og nedsat ekspression af AQP1 og AQP4 i læsionerne, sammenlignet med kontroller og væv udenfor læsioner. Der ses en negativ korrelation mellem mikroglia og AQP4 (r=-0,61; p=0,007). Der er ingen signifikant aktivering af astrocytter, dog hos 3 ud af 19 patienter ses tab af astrocytter i centrum af læsionerne. Ud over dette, har 3 ud af 19 patienter højere ekspression af AQP4 i randen af læsionerne. Vi har endnu ikke afsluttet undersøgelserne af apoptose (Bcl-2 og Caspase3 farvninger) ved CPM.

Expansive learning and change of practice for nurses collaborating in transition of elderly medical patients Bøje RB, Institut for Klinisk Medicin, Aarhus Universitet & Forskningsenheden Regionshospitalet Randers Sørensen D, Sygeplejerskeuddannelsen Randers, VIA University College Musaeus P, Center for Sundhedsvidenskabelige uddannelser, Aarhus Universitet Ludvigsen MS, Institut for Klinisk Medicin, Aarhus Universitet & Forskningsenheden Regionshospitalet Randers

Background: In Central Region Jutland, 2396 adverse events regarding transitions between sectors were reported in 2014. Inaccurate information, planning and coordination impact upon patient safety. Despite targeted interventions to improve transitions of elderly medical patients there is a lack of direction in how to educate health care providers to carry out the tasks. The purpose of this PhD project is to develop a theory of learning that can be applied to the practice of nursing that necessitates the transition of the elderly medical patient between healthcare sectors Methods: Change Laboratory Method is used as an overall design to develop innovative solutions for learning and change of practice. Participants are nurses and management representatives from Randers Regional Hospital and Favrskov Municipality, elderly medical patients and their relatives. Methods used are; a scoping review to identify and map existing knowledge, field-studies including participant observation, in depth qualitative interviews, focus groups, questionnaires and change lab-sessions, where the participants are actively involved in developing solutions to challenges in nursing practice. Results: Preliminary results from an on-going scoping review show that there is paucity in research literature regarding educational interventions to improve patient transitions, which adds rationale to carry out this project. The studies identified lack details in description of design, methods and theoretical foundation, which impedes repetition. Perspectives: The project will contribute usable solutions to current challenges in nursing practice regarding transitions of elderly patients between sectors that can improve and enhance patient safety. The project will contribute knowledge of how inter-organizational learning can create common knowledge and understanding of different practices. The project will contribute an educational intervention with the potential of including inter-professional education.

An overview in preparation for development of interventions among older adults to prevent aspiration pneumonia: A scoping review protocol of the quantitative and qualitative evidence Brandt KB, Medicinsk Afdeling & Forskningsenheden, Regionshospitalet Randers Ludvigsen MS, Institut for Klinisk Medicin, Aarhus Universitet & Forskningsenheden, Regionshospitalet Randers Shahlam S, Medicinsk Afdeling, Regionshospitalet Randers

Background: The incidence of community-acquired pneumonia increases with age, and aspiration pneumonia composes a growing share of pneumonia in relation to advancing age. Stroke, Parkinson and dementia are well documented to increase risk of aspiration; in addition, aspiration pneumonia may occur because of multifactorial risk factors, which is less documented both in the association to aspiration pneumonia and in the prevention hereof. The objective is within the existing literature to give an overview of interventions to prevent aspirations pneumonia among older adults. Methods: We will conduct a scoping review based on Joanna Briggs Institute’s guidelines. Included will be papers that describe the components of intervention including outcome measures, effect of intervention, prevention, profession, theories, methods of implementation, suggested practical applications and issues encountered by healthcare providers targeting older adults (> 65 years) to prevent aspirations pneumonia. The structured literature search will be conducted in CINAHL, MEDLINE, EMBASE, and Web of Science, and additionally grey literature will be considered. The extracted data will be presented in a tabular form. Results: The initial literature search demonstrates a range of different interventions to prevent aspiration pneumonia. Perspectives: The expected conclusion will be the necessity of a professional or/and an interdisciplinary approach to prevent aspiration pneumonia.

New trends in lifestyle habits among Danish, pregnant women Volqvartz T, Dept. of Obstetrics and Gynecology, Randers Regional Hospital; Dept. of Biomedicine, Pharmacology, Aarhus University Vestergaard AL, Dept. of Obstetrics and Gynecology, Randers Regional Hospital; Dept. of Biomedicine, Pharmacology, Aarhus University Aagaard SK, Dept. of Obstetrics and Gynecology, Randers Regional Hospital; Dept. of Biomedicine, Pharmacology, Aarhus University Andreasen MF, Section for Forensic Chemistry, Department of Forensic Medicine, Aarhus University Lesnikova I, Department of Pathology, Vidant Medical Center, Greenville NC, US Uldbjerg N, Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark Larsen A*, Dept. of Biomedicine, Pharmacology, Aarhus University Bor P*, Department of Obstetrics and Gynecology, Randers Regional Hospital *Shared senior authorship

Background: Life style habits is ever changing in Modern society and with the plethora of inter-net based platforms new ways of eating can spread fast. In this way, licorice has become a popular flavor in the modern Nordic kitchen both as a spice and in a still increasing number of candy products. Similarly, modern health trends like ginger have become exceedingly popular. Ginger-based herbal supplements e.g. teas, shots and tablets are used as health beneficial remedies strengthening the immune defense and generally boosting human health. In pregnancy, ginger is also perceived as a safe antiemetic to be used in the first trimester. However, the general population might not be aware that despite of the natural origin, licorice and ginger could have potential health risks. Licorice affects the renin-angiotensin-aldosterone system in the kidney, increasing the blood-pressure. Moreover, licorice has been associated with an increased risk of miscarriage, preterm birth as well as hypertension and preeclampsia. Fetal exposure to licorice has also been associated with lower intelligence quotient, poor memory and higher odds of attention deficit/hyperactivity in childhood. Despite the established use as antiemetic, literature states that ginger may interact with medical treatments through its interaction with the cytochrome P450 system, and affect the fetal testosterone metabolism, which may increase the risk of adverse fetal outcomes. In addition, recent studies indicate that ginger may increase risk of bleeding by decreasing platelet aggregation, and increase the risk of stillbirths. As the extent of ginger and licorice consumption among Danish pregnant women is currently unknown, the aim of this study was to investigate ginger and licorice consumption among a cohort of pregnant women attending prenatal care at Randers Regional Hospital in 2016. Methods: Using the Maternal Lifestyle, pregnancy outcome and children’s health, a cohort of 225 pregnant women were included at the ultrasound examination at weeks 12-14 of gestation at the Department of Obstetrics and Gynecology, Randers Regional Hospital between June and December 2016. All women completed a questionnaire regarding their lifestyle and habits including their use of herbal supplements and licorice consumption.

Results: A total of 10.7% (n=24) reported use of ginger products in the first trimester; 2.7 % (n=6) self-administered ginger to relieve symptoms of nausea and vomiting. Besides, 9.8 % (n=22) took ginger as shots, tea, tablets or oil as an herbal supplement without specifying the cause of intake. As many as 29.2% (n=7) of the women taken ginger also used over-the-counter or prescription drugs. Both women with high educational levels and women with elementary education had a high consumption of ginger supplements. Overall, the consumption of licorice in the first trimester was very common as more than a third of the women 37.8% (n=85) reported eating licorice a couple of times per week and as many as 7.1% (n=16) consumed licorice on a daily basis. Only 12.4% (n=28) reported no intake of licorice. There was a gradual decrease in mean birth weight with increasing licorice consumption, ranging from a mean birth weight of 3590g in the non-exposed group to 3362.8g in the daily exposed group (NS). Conclusion: Danish pregnant women have a high intake of ginger based products and licorice. To minimize the risk of adverse pregnancy and fetal outcomes due to maternal licorice and ginger intake during pregnancy it should be scrutinized and their interactions with other medical treatments taken into consideration in prenatal counseling to ensure a sensible intake. Therefore, healthcare professionals should be aware of popular lifestyle habits among pregnant women.

Routine transvaginal ultrasound in women referred with pelvic organ prolapse - is it necessary? Pedersen L, Gynækologisk - Obstetrisk Afdeling, Regionshospitalet Randers Glavind-Kristensen M, Afdelingen for Kvindesygdomme og Fødsler, Aarhus Universitetshospital Bor P, Gynækologisk - Obstetrisk Afdeling, Regionshospitalet Randers

Background: Pelvic organ prolapse (POP) is a herniation of the pelvic organs into vagina, which is seen at the gynecological examination in 41-50 % of women above the age of 50 years. The diagnosis of POP is based upon a gynecological examination. However, transvaginal ultrasound screening (TVS) has become a routine examination in these women, although there are no current guidelines about ultrasound screening in asymptomatic women with POP. The aim of this study was to investigate the frequency of incidental findings on TVS in women referred with POP, and to investigate which further examinations and treatments are performed due to these findings. Methods: Retrospective study including patients referred with POP to the outpatient gynecological clinics at Randers Regional Hospital and Aarhus University Hospital in 2015. Results: 92% of the women had a TVS routinely together with the gynecological examination. 507 women only had prolapse symptoms and no specific indication for TVS. A total of 59 women out of 507 (11.6 %) had incidental findings on TVS, but all were benign. The initial investigation was changed for 32.2 % of the women with incidental findings. Two of the patients (0.39 %) had endometrial cancer detected by coincidence, and both cancers were not detected by the primary TVS. Conclusion: It seems that there is a high prevalence of incidental findings detected by TVS in asymptomatic women with POP. These findings result in unnecessary investigations and change of initial treatment. Thus, in women solely with prolapse related symptoms, TVS might be omitted from routine examination.

Easy access to transvaginal ultrasound from general practice for earlier diagnosis of ovarian cancer Baun M-L L, Research Centre for Cancer Diagnosis in Primary Care & Research Unit for General Practice, Department of Public Health, Aarhus University Petersen LK, Department of Gynaecology and Obstetrics, Randers Regional Hospital Dueholm M, Department of Gynaecology and Obstetrics, Aarhus University Hospital Nørgaard Heje, H, Lægehuset Banegårdspladsen 6, 8000 Aarhus C Vedsted P, Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health, Aarhus University

Background: Ovarian cancer (OC) is a disease with a poor prognosis. This is primarily related to late-stage diagnosis. In Denmark, 74% are diagnosed in FIGO stages III and IV with a 5-year survival of 30% and 15%, respectively, compared to 83% in FIGO stage I. Since 2008, Danish general practitioners (GPs) have been able to urgently refer patients suspected of OC to a fast-track cancer pathway, which is intended to shorten the time from clinical suspicion to treatment. The pathway is designed for women presenting alarm symptoms, and direct access to fast transvaginal ultrasound (TVU) is available to Danish GPs only through the pathway. We aim to develop a clinical training course for GPs in the latest knowledge on OC symptomatology and to explore the feasibility of direct access to fast TVU, with a view to diagnosing OC earlier. Methods: Women aged ≥ 40 years who present vague and non-specific symptoms of potential OC are eligible for inclusion. GPs in selected parts of the Central Denmark Region are offered a lecture on OC symptomatology and direct access to a yes-no investigation, i.e. fast TVU, during the one-year study period. After investigation, the TVU result (OC yes or OC no) is given directly to the GP. An algorithm based on the rules developed by the International Ovarian Tumour Analysis (IOTA) group is used for management of women referred to TVU examination. The principal investigators are trained nurses with a special interest and experience in gynecological ultrasound. Women referred to TVU will receive a questionnaire before the examination regarding experienced symptoms. The GP remains the coordinator and will be instructed in how to interpret and handle the TVU results. The GPs must still refer women to the urgent OC fast-track investigation when indicated. Results: The study has been ongoing since April 2017. Preliminary results will be presented. Perspectives: Lowering the threshold for TVU examination and at the same time creating greater awareness of OC symptomatology among GPs may have the potential to change the poor stage distribution of OC.

The use of medicine, caffeine, nicotine and illicit drugs during first trimester in Danish pregnant women (a research year study) Aagaard SK, Department of Obstetrics and Gynecology, Randers Regional Hospital; Department of Biomedicine, Aarhus University Larsen A, Department of Biomedicine, Aarhus University Andreasen MF, Section for Forensic Chemistry, Department of Forensic Medicine, Aarhus University Lesnikova I, Vidant Medical Center, Greenville NC, USA Telving R, Section for Forensic Chemistry, Department of Forensic Medicine, Aarhus University Vestergaard AL, Department of Obstetrics and Gynecology, Randers Regional Hospital; Department of Biomedicine, Aarhus University Tørring N, Department of Clinical Biochemistry, Aarhus University Hospital Uldbjerg N, Department of Obstetrics and Gynecology, Aarhus University Hospital Bor P, Department of Obstetrics and Gynecology, Randers Regional Hospital

Background: Exposure to xenobiotic substances e.g. medicine and nicotine during pregnancy can affect fetal development with the early pregnancy being a particular susceptible period. Here we investigated the use of xenobiotic substances in Danish first trimester pregnant women based on blood analysis of detectable xenobiotic content in both women unaware and aware of screening. In addition, a questionnaire on lifestyle habits was obtained from the prospective cohort. Methods: The study includes: 1) A retrospective, cross-sectional study of blood samples (week 8-13) from 436 anonymous pregnant women who attended prenatal screening (the Double test) at Randers Regional Hospital in 2014. 2) A prospective study of 225 pregnant women included at Randers Regional Hospital in week 10-14 in 2016. All women contributed with a blood sample and questionnaire and were aware of the screening. The blood samples were screened for the presence of xenobiotics using the broad targeted UPLC HR-TOFMS analysis and questionnaires were evaluated. Results: A high presence of xenobiotics (medicine, nicotine, caffeine, illicit drugs) was found in both studies i.e. 82.6% (study 1) and 87.1% (study 2). Medicine was identified in 17.9% of the samples in study 1 and 13.8% in study 2, but 61.2% of these women reported using medicine during pregnancy according to the questionnaires. As many as 76.4% (study 1) and 83.6% (study 2) had caffeine in their blood samples although only 62.1% reported the use of coffee or other tea. Illicit drugs were detected in 0.9% in both studies, but 1.3% reported using an illicit drug (study 2). Approximate 1/10 in both studies had evidence of smoking in the blood sample. Conclusion: There was a high degree of comparability between the two cohorts. In both cases a high intake of caffeine was identified, alongside a high use of over-the-counter medicine. The findings emphasize the magnitude of xenobiotics use during pregnancy and thus the need for interventions and counseling.

Cervical Dysplasia – how can we improve the diagnostics? Booth BB, Gynækologisk - Obstetrisk Afdeling, Regionshospitalet Randers Petersen LK, Gynækologisk - Obstetrisk Afdeling, Regionshospitalet Randers Kristensen CB, Gynækologisk - Obstetrisk Afdeling, Hospitalsenheden Horsens Thomsen MGF, Gynækologisk - Obstetrisk Afdeling, Regionshospitalet Randers Rasmussen BH, Gynækologisk - Obstetrisk Afdeling, Regionshospitalet Randers Blaakær J, Gynækologisk og Obstetrisk Afdeling, Odense Universitetshospital Dahl K, Gynækologisk og Obstetrisk Afdeling, Århus Universitetshospital Bor P, Gynækologisk - Obstetrisk Afdeling, Regionshospitalet Randers

Background: Worldwide, nurses, residents and consultants all perform colposcopy examinations of the uterine cervix. In Denmark, the Regional Hospital of Randers is the only hospital in which trained nurses perform this examination. Previous smaller studies show that nurses trained in the procedure are just as effective at finding cervical dysplasia as doctors. Methods: As part of an ongoing PhD project, we are examining if there are any differences in the cervical biopsies taken by nurses, residents or consultants. Approximately 3000 patients will be included in the study. Patients are examined both by conventional colposcopy (taking place at the Regional Hospital of Horsens) and by new diagnostic imaging technology, DySIS colposcopy (taking place at the Regional Hospital of Randers). This new technology aids the examiner in where to take biopsies from the cervix. Results: Patient inclusion started in February 2017. As of the 1st of October 2017, a total of 209 project patients have been included in Randers and 128 control patients in Horsens; a total of 337 patients. Nurses at the Regional Hospital in Randers have done a significant job in the inclusion process and have so far included more patients (105) than both residents (49) and consultants (55). Harboefonden has awarded the project with funds for 2 colposcopy nurses to attend the American Society for Colposcopy and Cervical Pathology (ASCCP) Comprehensive Colposcopy course to further their training. The course takes places in January 2018. Perspectives: With this we hope to be able to encourage the other hospitals in Denmark to use nurses for this examination as is routinely done internationally. The overall aim of this PhD project is to improve the diagnostic process of cervical dysplasia for each individual woman.

Vitamin D deficiency in pregnancy - special emphasize on pre-eclampsia and the interactions with other xenobiotic exposures (planned PhD project) Vestergaard AL, Gynækologisk-Obstetrisk Afdeling, Regionshopitalet Randers & Farmakologisk Afdeling, Institut for Biomedicin Aarhus Universitet Larsen A, Farmakologisk Afdeling, Institut for Biomedicin, Aarhus Universitet Andreasen MF, Retskemisk Afdeling, Institut for Retsmedicin, Aarhus Universitet Bor P, Gynækologisk - Obstetrisk Afdeling, Regionshopitalet Randers

Background: During pregnancy, lifestyle factors such as nutrition, smoking and medication can affect placental function, pregnancy outcome and postnatal health. The prevalence of insufficient vitamin D status among pregnant women ranges from 18 to 84%. It has been associated with impaired calcium metabolism, reduced fetal growth, gestational diabetes and pre-eclampsia. The aim of this project is to investigate the potential association between exposure to xenobiotic substances and the level of vitamin D related to placental function and thereby maternal and fetal outcomes. Furthermore, we want to investigate if an extra vitamin D supplement influences the placental function and pregnancy outcomes. Methods: Double blinded randomized study. Characterization of exposure to xenobiotic substances, micronutrients and maternal blood levelsof vitamin D will be investigated in pregnant women (n=1600) seeking prenatal care at Randers Regional Hospital. The women will be randomized to receiving placebo or a moderate dosage (35 microgram/day) vitamin D. Study materials include maternal blood samples from inclusion and at 6 months of pregnancy, questionnaires describing life-style habits, placental tissue and umbilical cord blood. Information on maternal and fetal outcomes will be collected from medical records. Results: With this PhD project we expect to: Characterize the level of vitamin D and the co-exposure of potentially harmful xenobiotic substances in the blood of pregnant women. Find an association between these xenobiotic substances and the transport and metabolism of active vitamin D in the placenta. Present how maternal vitamin D deficiency affects placental function, fetal development and pregnancy outcome. Perspectives: We expect to improve national and international standard guidelines regarding the use of vitamin D supplement in pregnancy. Some maternal and neonatal adverse outcomes might be prevented if the optimal dosage of vitamin D-supplement is used during pregnancy.

Conisation in women under the age of 30 Toxvig PT, Gynækologisk - Obstetrisk Afdeling, Regionshospitalet Randers Petersen LK, Gynækologisk - Obstetrisk Afdeling, Regionshospitalet Randers

Background: The Danish guidelines recommend conisation in all women with CIN3. In case of CIN2, women with pregnancy desire are recommended monitoring with colposcopy and biopsy. If changes are still present after two years, conisation is recommended. Multiple studies have demonstrated an increased risk of preterm delivery after conisation. Especially an increasing conus height and multiple conisations are risk factors. Methods: The study is a retrospective cohort study, including all women under the age of 30, who has undergone conisation between 2012 and 2016 in Randers hospital. We identified 307 patients. Information was obtained from Patient files and the Patobank regarding: age, conus height, indication, postoperative histology and HPV status, margins, parity, previous conisation and duration of the current dysplasia. Results: Indication was CIN3 in 84%, CIN2 in 8% and diagnostic in 2 %. Postoperative pathology showed CIN3 in 79%, CIN2 in 11 % and Micro Invasive Carcinoma in 1 %. 13% had a discrepancy between pre- and post-operative pathology. 10% had a lower grading after the procedure. 66 % had no previous deliveries. 25% of the cones had a height >17 mm. Only 3% had a previous conisation. The mean duration of the current dysplasia was 10.8 months and 36% was operated within the first 3 months. Conclusion: Correct use of LEEP and awareness of the issue are important to minimize the number of high cones and thereby the risk of preterm delivery in young women. CIN should be considered a possibly reversible condition and a hesitant approach is important in case of moderate dysplasia, especially in young women. 84% of indications were CIN3 and the monitoring period was considerably longer in the CIN2 and diagnostic groups compared to the CIN3 group. This indicates a hesitant approach, in agreement with the current guidelines.

The potential risk of endometrial cancer in women with endometrial hyperplasia - a long term follow-up Maarup CF, Department of Gynecology and Obstetrics, Regional Hospital of Randers Petersen LK, Department of Gynecology and Obstetrics, Regional Hospital of Randers Stentebjerg M, Department of Gynecology and Obstetrics, Regional Hospital of Randers Bor P, Department of Gynecology and Obstetrics, Regional Hospital of Randers

Background: Endometrial hyperplasia (EH) is a precancerous lesion characterized by excessive proliferation of the endometrium and is strongly related to the development of endometrial cancer. The existing guidelines for clinical follow-up of women diagnosed with EH are sparse and there are no studies including long-time follow-up in Danish women initially diagnosed with EH investigating the risk of recurrence of EH or endometrial cancer. The aim of this study is to investigate the long-term prevalence of recurrence of EH or endometrial cancer in Danish women initially diagnosed with EH. Methods: All women diagnosed with EH at the Regional Hospital of Randers between 2000 and 2015 are included. The women who did not receive a hysterectomy as initial treatment for EH are invited to gynecological examination with ultrasound and endometrial biopsies taken using mini-hysteroscopy. Patient interviews, questionnaires and medical records are used to collect further data. Results: Data will be collected from winter 2017 to summer 2018. The outcome measured are the prevalence of recurrence and endometrial cancer after initial diagnosis with EH along with the correlation between treatment method and recurrence and endometrium cancer. Perspectives: The study can contribute to the goal of being able to identify women with EH who has a high risk of progression to cancer. Furthermore, data can be used to evaluate the need for long-term follow-up after the initial diagnosis with EH and help revise the existing guidelines on clinical follow-up of these women.

New principles for quantitative elastography of the human uterine cervix Rohr Thomsen C, Department of Obstetrics and Gynecology, Randers Regional Hospital Bor P, Department of Obstetrics and Gynecology, Randers Regional Hospital Uldbjerg N, Department of Obstetrics and Gynecology, Aarhus University Hospital Sandager P, Department of Obstetrics and Gynecology, Aarhus University Hospital Hinge M, Department of Engineering, Aarhus University.

Background: Preterm birth is a leading cause of neonatal morbidity as well as mortality. Very often softening of the uterine cervix precedes preterm birth. Today, the methods for evaluating the biomechanical properties of the human uterine cervix are inconsistent. In a recently finished PhD project, we have shown that vaginal ultrasound scanning combined with elastography software constitutes a promising tool for evaluation of the cervix. In collaboration with engineers at Aarhus University and MIT, we have developed promising improvements of the technique. The overall aim of this PhD project is to develop a new principle for identification of pregnant women at risk of preterm birth. The principle is based on the ultrasound technique termed elastography combined with either 1) reference caps developed at Aarhus University, interposed between the ultrasound transducer and the cervix or 2) a force measurement device, developed in collaboration with Massachusetts Institute of Technology, USA. Methods: We will refine the two methods at both phantoms and pregnant women concerning the optimal force, analysis of the recording, evaluation of the heterogeneity of the cervix, intra- and inter-observer variability, physiological changes during pregnancy, association between our biomechanical assessment and the cause of labor induction. Perspectives: The perspective is better identification and treatment of pregnant women at risk of preterm delivery. In addition, the methods could be used to plan induction of labor for post-term pregnancy.

11 2017 Abstracts forskningssymposiumAbstractbog_indhold