Disparities between objectively measured hearing loss and subjectively perceived aided hearing loss: A scoping review.

Objectives: This scoping review aims to summarize and synthesize research findings on the disparities between audiometrically diagnosed and aided hearing loss versus the individual's own experience of hearing loss. Methods: A systematic search strategy was employed across multiple databases to identify studies published between 1990 and October 2023 focusing on the experiences of hearing problems among individuals with aided hearing loss. The selected studies underwent screening based on predetermined inclusion and exclusion criteria. These criteria revolved around including papers featuring a population of adult (+18) individuals with audiometrically measured hearing loss who had undergone technological rehabilitation. Data charting was employed to provide an overview of the studies and was additionally utilized to identify key themes. Narrative analysis was used to identify subthemes within the data set. Results: A total of 11 articles met the inclusion criteria. The analysis identified five themes: "disability experience and discrepancy between measured and self-perceived hearing loss"; "listening effort"; "mental burden/psychological consequences"; "factors that alleviate the consequences of HL"; and "sociodemographic factors." Conclusions: The scoping review shows that, despite the proliferation of technological options, there is a pressing need for a more concentrated effort to identify and scrutinize the supplementary facets of hearing loss that remain inadequately addressed by current hearing technology. This includes subjective experiences associated with hearing loss that may not be effectively treated solely with hearing aids.

Nation-wide mammography screening participation in Denmark during the COVID-19 pandemic: An observational study

BackgroundIn most of the world, the mammography screening programmes were paused at the start of the pandemic, whilst mammography screening continued in Denmark. We examined the mammography screening participation during the COVID-19 pandemic in Denmark. MethodsThe study population comprised all women aged 50-69 years old invited to participate in mammography screening from 2016-2021 in Denmark based on data from the Danish Quality Database for Mammography Screening in combination with population-based registries. Using a generalised linear model, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) of mammography screening participation within 90, 180 and 365 days since invitation during the pandemic in comparison with the previous years adjusting for age, year and month of invitation. ResultsThe study comprised 1,828,791 invitations among 847,766 women. Before the pandemic, 80.2% of invitations resulted in participation in mammography screening within 90 days, 82.7% within 180 days and 83.1% within 365 days. At the start of the pandemic, the participation in screening within 90 days was reduced to 69.9% for those invited in pre-lockdown and to 76.5% for those invited in 1st lockdown. Extending the length of follow-up time to 365 days only a minor overall reduction was observed (PR=0.94; 95% CI: 0.93-0.95 in pre-lockdown and PR=0.97; 95% CI: 0.96-0.97 in 1st lockdown). A lower participation was; however, seen among immigrants and among women with a low income. ConclusionsThe short-term participation in mammography screening was reduced at the start of the pandemic, whilst only a minor reduction in the overall participation was observed with longer follow-up time indicating that women postponed screening. Some groups of women; nonetheless, had a lower participation indicating that the social inequity in screening participation was exacerbated during the pandemic.

Nation-wide participation in FIT-based colorectal cancer screening in Denmark during the COVID-19 pandemic: An observational study

BackgroundWorldwide, most colorectal cancer screening programmes were paused at the start of the COVID-19 pandemic, whilst the Danish faecal immunochemical test (FIT)-based programme continued without pausing. We examined colorectal cancer screening participation and compliance with subsequent colonoscopy in Denmark throughout the pandemic. MethodsWe used data from the Danish Colorectal Cancer Screening Database among individuals aged 50-74 years old invited to participate in colorectal cancer screening from 2018-2021 combined with population-wide registries. Using a generalised linear model, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) of colorectal cancer screening participation within 90 days since invitation and compliance with colonoscopy within 60 days since a positive FIT test during the pandemic in comparison with the previous years adjusting for age, month and year of invitation. ResultsAltogether, 3,133,947 invitations were sent out to 1,928,725 individuals and there were 94,373 positive FIT tests (in 92,848 individuals) during the study period. Before the pandemic, 60.7% participated in screening within 90 days. A minor reduction in participation was observed at the start of the pandemic (PR=0.95; 95% CI: 0.94-0.96 in pre-lockdown and PR=0.85; 95% CI: 0.85-0.86 in 1st lockdown) corresponding to a participation rate of 54.9% during pre-lockdown and 53.0% during 1st lockdown. This was followed by a 5-10% increased participation in screening corresponding to a participation rate of up to 64.9%. The largest increase in participation was observed among 55-59 year olds, individuals living alone or cohabiting and immigrants. The compliance with colonoscopy within 60 days was 89.9% before the pandemic. A slight reduction was observed during 1st lockdown (PR=0.96; 95% CI: 0.93-0.98), where after it resumed to normal levels. ConclusionsParticipation in the Danish FIT-based colorectal cancer screening programme and subsequent compliance to colonoscopy after a positive FIT result was only slightly affected by the COVID-19 pandemic. FundingThe study was funded by the Danish Cancer Society Scientific Committee (grant number R321-A17417) and the Danish regions.

The basic reproduction number can be accurately estimated within 14 days after societal lockdown: The early stage of the COVID-19 epidemic in Denmark

ObjectiveEarly identification of the basic reproduction number (BRN) is imperative to political decision making during an epidemic. In this study, we estimated the BRN 7, 14, 21 and 28 days after societal lockdown of Denmark during the early stage of the COVID-19 epidemic. MethodWe implemented the SEIR dynamical system for disease spread without vital dynamics. The BRN was modulated using a sigmoid function. Model parameters were estimated on number of admitted patients, number of patients in intensive care and cumulative number of deaths using the simulated annealing Monte Carlo algorithm. Results are presented with 95% prediction intervals (PI). ResultsWe were unable to determine any reliable estimate of the BRN at 7 days following lockdown. The BRN had stabilised at day 14 throughout day 28, with the estimate ranging from 0.95 (95% PI: 0.92-0.98) at day 7 to 0.92 (95% PI: 0.92-0.93) at day 28. We estimated the BRN prior to lockdown to be 3.32 (95% PI: 3.31-3.33). The effect of the lockdown was occurring over a period of a few days centred at March 18th (95% PI: 17th-18th) 2020. ConclusionWe believe our model provides a valuable tool for decision makers to reliably estimate the effect of a politically determined lockdown during an epidemic.

Y-Peg-in-a-Round-Hole Closure for Immediate Periareolar Mastectomy Expander Reconstruction.

INTRODUCTION: Mastectomies closed with a linear scar can distort the resulting shape of the breast. We present our novel Y-peg-in-a-round-hole closure method of the mastectomy scar, which improves the shape of the reconstructed breast while maintaining reliable healing, implant coverage, and minimum scar size for covering by tattoo. MATERIALS AND METHODS: A retrospective review of all breast reconstruction cases performed by the senior surgeon during the period from January 2010 to January 2017 was undertaken. Data were analyzed for wound healing problems, infection rates and mastectomy skin flap necrosis. RESULTS: Data were extracted for 126 consecutive patients with 154 breast reconstructions. Twelve breasts (7.7%) experienced wound healing problems, for which 7 (4.5%) required revisionary surgery. Eighteen breasts (11.7%) developed an infection requiring antibiotics, of which 8 (5.2%) needed a further operation. Four breasts (2.6%) needed removal of the implant. No patients were lost to follow-up. CONCLUSION: After nipple resecting mastectomy, the Y-peg-in-a-round-hole scar minimizes radial size and contour deformity but allows for reliable wound healing.

Aortic regurgitation after transcatheter aortic valve implantation of the Edwards SAPIEN ™ valve.

INTRODUCTION: Transcatheter aortic valve implantation (TAVI) is established as an attractive treatment option for high-risk patients with aortic valve stenosis. One concern is the high risk of prosthetic valve regurgitation. This study aimed to examine for potential preoperative risk factors for postprocedural transcatheter heart valve regurgitation and to quantify the risk, degree, and consequences of postprocedural regurgitation. MATERIALS AND METHODS: 100 consecutive patients who underwent femoral (n = 22) or transapical (n = 78) TAVI were retrospectively reviewed. Echocardiographic valve regurgitation and clinical parameters were analyzed over the first year after TAVI. RESULTS: Seventy-five percent of all patients had prosthetic valve regurgitation. It was, however, only mild or absent in 64% of patients and did not require re-intervention in any of the patients in the series. The severity of the regurgitation appeared unchanged over the one-year follow-up period. Moderate to severe regurgitation was associated with significant yet stable dilatation of the left ventricle over one year and lesser NYHA class improvement three months after TAVI. Asymmetrical native valve calcification increased the risk of paravalvular regurgitation non-significantly. CONCLUSION: Transcatheter heart valve regurgitation seems to be mild in the majority of cases and unchanged over a 12 months follow-up period. While affecting left ventricular dimensions in moderate or severe cases, we observed no obvious undesirable consequences of the prosthetic valve regurgitation within the first year.

Dynamic geometry of the left ventricular outflow tract of pigs with induced supravalvular aortic stenosis.

OBJECTIVES: Detailed information about the dynamic geometry of the left ventricular outflow tract (LVOT) is of great importance for transcatheter aortic valve implantation (TAVI), since these valves utilize the LVOT as a landing zone for optimum placement and fixation. The LVOT is generally considered circular in shape and stable in its conformation. However, recent studies indicate that this may not be the case. METHODS: Twenty-two 5-kg pigs (± 0.47 kg) were randomly allocated to either aortic banding (n = 14) or sham operation (n = 8). LVOT dynamic geometry was assessed using cardiovascular-magnetic resonance imaging, 9 weeks after banding of the ascending aorta. RESULTS: All the banded animals developed significant left ventricular hypertrophy (P = 0.01) compared with controls. All the animals demonstrated significant reduction in eccentricity index (P(intervention) < 0.01, P(control) < 0.05) and longest internal diameter (P(intervention) < 0.01, P(control) = 0.02) when comparing measurements from end-diastole to end-systole. No significant systolic or diastolic differences were found between the two groups. CONCLUSIONS: The main findings were: the LVOT (i) undergoes substantial geometric alterations throughout the cardiac cycle and (ii) is ellipsoid throughout the cardiac cycle, (iii) geometric changes during the cardiac cycle stems from compression of the long-axis of the LVOT and (iv) dynamic geometry did not change significantly after induction of significant LV hypertrophy. Thus, our data suggest that assumptions made in daily practice, of a circular and stable LVOT geometry, need to be revised.

Improved cardiopulmonary exercise function after modified Nuss operation for pectus excavatum.

OBJECTIVES: Patients with pectus excavatum have compromised cardiac function during exercise. We hypothesized that the Nuss technique would improve cardiopulmonary function during exercise. METHODS: We investigated 75 teenagers (49 patients and 26 controls) at rest and during bicycle exercise prior to surgery and 1 year postoperative. RESULTS: Prior to surgery, patients had a lower cardiac index 6.6 ± 1.1 l/min/m(2) when compared with controls 8.1 ± 1.0 l/min/m(2) during submaximal exercise, P = 0.0001. There was no difference in heart rate or increase in heart rate between the two groups. One year after surgery, cardiac index had significantly increased in the pectus group, P = 0.0054 although cardiac index was still significantly lower 7.2 ± 1.0 l/min/m(2) when compared with the control subjects (8.5 ± 1.6 l/min/m(2), P = 0.0008). Both the patients and the controls increased their VO(2) max during the one-year study period although the controls increased most. Right ventricular diastolic dimension increased in both groups over the one-year study period and left ventricular dimensions increased in the patients. Before operation, the patients had lower forced expiratory capacity FEV(1) 86 ± 13% when compared with controls 94 ± 10%, P = 0.009. Patients increased FEV(1)/forced vital capacity over the one-year long study course although there were no differences between groups. CONCLUSION: Patients with pectus excavatum have lower cardiac index at submaximal exercise when compared with healthy age-matched controls. Their cardiac index and FEV(1) are increased one year after the modified Nuss operation.

Transcatheter aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) was introduced experimentally in 1989, based on a newly developed heart valve prosthesis - the stentvalve. The valve was invented by a Danish cardiologist named Henning Rud Andersen. The new valve was revolutionary. It was foldable and could be inserted via a catheter through an artery in the groin, without the need for heart lung machine. This allowed for a new valve implantation technique, much less invasive than conventional surgical aortic valve replacement (SAVR). Surgical aortic valve replacement is safe and improves symptoms along with survival. However, up to 1/3 of patients with aortic valve stenosis cannot complete the procedure due to frailty. The catheter technique was hoped to provide a new treatment option for these patients. The first human case was in 2002, but more widespread clinical use did not begin until 2006-2010. Today, in 2011, more than 40,000 valves have been implanted worldwide. Initially, because of the experimental character of the procedure, TAVI was reserved for patients who could not undergo SAVR due to high risk. The results in this group of patients were promising. The procedural safety was acceptable, and the patients experienced significant improvements in their symptoms. Three of the papers in this PhD-thesis are based on the outcome of TAVI at Skejby Hospital, in this high-risk population [I, II and IV]. Along with other international publications, they support TAVI as being superior to standard medical treatment, despite a high risk of prosthetic regurgitation. These results only apply to high-risk patients, who cannot undergo SAVR. The main purpose of this PhD study has been to investigate the quality of TAVI compared to SAVR, in order to define the indications for this new procedure. The article attached [V] describes a prospective clinical randomised controlled trial, between TAVI to SAVR in surgically amenable patients over 75 years of age with isolated aortic valve stenosis. The study was terminated prematurely, as patients undergoing TAVI showed a statistically non-significant trend towards more complications than SAVR patients. Although non-significant the study was closed for ethical reasons. At present, scientific evidence supports TAVI as being superior to standard medical treatment, in patients who cannot undergo SAVR due to high- predicted risk. However, in patients who are surgically amenable, current publications suggest that TAVI using presently available devices is not competitive to SAVR, with regards to procedural safety and outcome.

Transatrial stent-valve implantation in a stenotic tricuspid valve bioprosthesis.

A 69-year-old man presented with symptoms of right heart failure due to stenosis of a tricuspid valve bioprosthesis. Echocardiography revealed right atrial dilatation and an estimated tricuspid valve area of 0.4 cm2. Because of advanced poor general condition and comorbidities, he was found unfit for conventional reoperation. Instead, transcatheter transatrial stent-valve implantation through a right thoracotomy was scheduled. The procedure resulted in a markedly improved clinical condition and an increased valve area measured to 2.5 cm2. In conclusion, transcatheter transatrial stent-valve implantation in stenotic valves is technically feasible and may lead to substantial improvement of the clinical condition.

Single center experience with transcatheter aortic valve implantation using the Edwards SAPIEN™ Valve.

OBJECTIVES: The use of transcatheter aortic valve implantation (TAVI) for high-risk patients was introduced in the early 2000s for treatment of aortic valve stenosis patients with too high surgical risk. During the last years, there has been a dramatic increase in TAVI procedures. TAVI programs are implemented in numerous cardiac centers. This paper describes a single center experience with its first 100 TAVI procedures. METHODS: This study included the first 100 patients who were scheduled for either transfemoral (F-TAVI) or transapical (A-TAVI) aortic valve implantation at Aarhus University Hospital, Skejby, using the Edwards SAPIEN™ valve. The indication for TAVI was unacceptable high predicted risk associated with conventional surgery. Patients with adequate diameter of iliac arteries were scheduled for F-TAVI, otherwise A-TAVI was preferred. RESULTS: The patients were treated between February 2006 and June 2010. Of these were 44% males and 56% females with a mean (S.D.) age of 81 (7.0). Thirty-days mortality rate was 8%, and decreased from 12% among the first 50 patients to 4% for the last 50 patients. Successful implantation was achieved in 92% patients. Major non-fatal complications were seen in 5% of 76 A-TAVI and in 0% of 24 F-TAVI patients. Mean (S.D.) EuroSCORE in the F-TAVI and A-TAVI groups was 15.9 (9.4) and 21.5 (14), respectively (p = 0.06). Post-procedural leakage of cardiac biomarkers was significantly higher in the A-TAVI group as compared to in the F-TAVI group. Mean (S.D.) NYHA class improved from 2.9 (0.6) to 1.8 (0.7) p < 0.001, with no significant difference between A-TAVI and F-TAVI patients. CONCLUSION: In surgically non-amenable patients, TAVI can be performed with acceptable mortality and morbidity and results in marked functional improvement. A decrease in 30-day mortality over time indicated a learning curve when implementing this treatment.

[Catheter-based aortic valve substitution. Initial experiences with stent valve implantation]. / Kateterbaseret aortaklapsubstitution. Initiale erfaringer med implantation af stentklap.

INTRODUCTION: Recent years have seen the introduction of catheter-based aortic valve substitution with stent valves to treat aortic valve stenosis in patients who were deemed inoperable via conventional open heart surgery. We here report our initial experience. MATERIAL AND METHODS: Register-based study with prospective registration of prespecified parameters. A total of 26 patients were treated with an aortic stent valve, 12 via transfemoral (TFA-AVI) and 14 via transapical (TAP-AVI) access. In the TFA-AVI group, 75% were women and the average age was 85 4.5 years; in the TAP-AVI group, 71% were women and the average age was 79 8.4 years. RESULTS: In the TFA-AVI group, successful stent valve implantation was performed in 9/12 (75%) and TAP-AVI in 13/14 (93%) patients. Mortality after 30 days was 25% in the TFA-AVI and 7% in the TAP-AVI group. The aortic valve area increased from 0.6 0.13 cm(2) to 1.6 0.39 (2) in the TFA-AVI group and from 0.7 0.2 (2) to 1.6 0.37 (2) in the TAP-AVI group. 91% of patients showed clinical improvement after treatment. CONCLUSION: Transcatheter aortic valve implantation of conventional unresectable patients requires close cooperation between different specialities. The treatment seems to be a realistic alternative to medical treatment for inoperable patients and may even be used in operable high-risk patients.

The epidemiology and survival of extrapulmonary small cell carcinoma in South East England, 1970-2004.

BACKGROUND: Extrapulmonary small cell carcinoma (EPSCC) is a rare cancer and few studies describe its epidemiology. Our objectives were to compare the incidence and survival of EPSCC in South East England with small cell carcinoma of the lung (SCLC), to determine the most common anatomical presenting sites for EPSCC and to compare survival in EPSCC by disease stage and site of diagnosis. METHODS: We used data from the Thames Cancer Registry database for South East England between 1970 and 2004 to determine the incidence, most common anatomical sites, and survival by site, and stage of EPSCC. 1618 patients registered with EPSCC were identified. We calculated the age-standardised incidence rate for EPSCC using the European standard population and compared this to that for SCLC. We calculated survival using the Kaplan-Meier method for EPSCC and SCLC, and reported 3-year survival for different EPSCC anatomical sites and disease stages. RESULTS: The incidence of EPSCC was much lower than for SCLC, similar in males and females, and stable throughout the study period, with incidence rates of 0.45 per 100,000 in males and 0.37 in females during 2000-2004. In general, patients with EPSCC had a better 3-year survival (19%) than SCLC (5%). The most common anatomical sites for EPSCC were oesophagus (18%), other gastrointestinal (15%), genitourinary (20%), head and neck (11%), and breast (10%). Breast EPSCC had the best 3-year survival (60%) and gastrointestinal EPSCC the worst (7%). CONCLUSION: This study suggests that EPSCC has a stable incidence and confirms that it presents widely, but most commonly in the oesophagus and breast. Site and extent of disease influence survival, with breast EPSCC having the best prognosis. Further studies using standardised diagnosis, prospective case registers for uncommon diseases and European cancer registries are needed to understand this disease.

Ultrasound research scanner for real-time synthetic aperture data acquisition.

Conventional ultrasound systems acquire ultrasound data sequentially one image line at a time. The architecture of these systems is therefore also sequential in nature and processes most of the data in a sequential pipeline. This often makes it difficult to implement radically different imaging strategies on the platforms and makes the scanners less accessible for research purposes. A system designed for imaging research flexibility is the prime concern. The possibility of sending out arbitrary signals and the storage of data from all transducer elements for 5 to 10 seconds allows clinical evaluation of synthetic aperture and 3D imaging. This paper describes a real-time system specifically designed for research purposes. The system can acquire multichannel data in real-time from multi-element ultrasound transducers, and can perform some real-time processing on the acquired data. The system is capable of performing real-time beamforming for conventional imaging methods using linear, phased, and convex arrays. Image acquisition modes can be intermixed, and this makes it possible to perform initial trials in a clinical environment with new imaging modalities for synthetic aperture imaging, 2D and 3D B-mode, and velocity imaging using advanced coded emissions. The system can be used with 128-element transducers and can excite 128 transducer elements and receive and sample data from 64 channels simultaneously at 40 MHz with 12-bit precision. Two-to-one multiplexing in receive can be used to cover 128 receive channels. Data can be beamformed in real time using the system's 80 signal processing units, or it can be stored directly in RAM. The system has 16 Gbytes RAM and can, thus, store more than 3.4 seconds of multichannel data. It is fully software programmable and its signal processing units can also be reconfigured under software control. The control of the system is done over a 100-Mbits/s Ethernet using C and Matlab. Programs for doing, e.g., B-mode imaging can be written directly in Matlab and executed on the system over the net from any workstation running Matlab. The overall system concept is presented along with its implementation and examples of B-mode and in vivo synthetic aperture flow imaging.