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Bundgaard Ringgren K, Ung V, Gerds TA, Kragholm KH, Ascanius Jacobsen P, Lyng Lindgren F, Grabmayr AJ, Christensen HC, Mills EHA, Kollander Jakobsen L, Yonis H, Hansen CM, Folke F, Lippert F, Torp-Pedersen C. Prediction model for future OHCAs based on geospatial and demographic data: An observational study. Medicine (Baltimore) 2024; 103:e38070. [PMID: 38728490 PMCID: PMC11081540 DOI: 10.1097/md.0000000000038070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
This study used demographic data in a novel prediction model to identify areas with high risk of out-of-hospital cardiac arrest (OHCA) in order to target prehospital preparedness. We combined data from the nationwide Danish Cardiac Arrest Registry with geographical- and demographic data on a hectare level. Hectares were classified in a hierarchy according to characteristics and pooled to square kilometers (km2). Historical OHCA incidence of each hectare group was supplemented with a predicted annual risk of at least 1 OHCA to ensure future applicability. We recorded 19,090 valid OHCAs during 2016 to 2019. The mean annual OHCA rate was highest in residential areas with no point of public interest and 100 to 1000 residents per hectare (9.7/year/km2) followed by pedestrian streets with multiple shops (5.8/year/km2), areas with no point of public interest and 50 to 100 residents (5.5/year/km2), and malls with a mean annual incidence per km2 of 4.6. Other high incidence areas were public transport stations, schools and areas without a point of public interest and 10 to 50 residents. These areas combined constitute 1496 km2 annually corresponding to 3.4% of the total area of Denmark and account for 65% of the OHCA incidence. Our prediction model confirms these areas to be of high risk and outperforms simple previous incidence in identifying future risk-sites. Two thirds of out-of-hospital cardiac arrests were identified in only 3.4% of the area of Denmark. This area was easily identified as having multiple residents or having airports, malls, pedestrian shopping streets or schools. This result has important implications for targeted intervention such as automatic defibrillators available to the public. Further, demographic information should be considered when implementing such interventions.
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Affiliation(s)
| | - Vilde Ung
- Department of Public Health, University of Copenhagen, København, Denmark
| | | | | | | | | | - Anne Juul Grabmayr
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
- National Clinical Registries, Frederiksberg, Denmark
| | | | | | - Harman Yonis
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Torp-Pedersen
- Department of Public Health, University of Copenhagen, København, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
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Von Knorring T, Israelsen NM, Ung V, Formann JL, Jensen M, Hædersdal M, Bang O, Fredman G, Mogensen M. Bedside Differentiation Between Benign and Malignant Pigmented Skin Tumours by Four Diagnostic Imaging Technologies - A Pilot Study. Acta Derm Venereol 2021; 102:adv00634. [PMID: 34806755 DOI: 10.2340/actadv.v101.571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fast diagnosis of suspicious pigmented skin lesions is imperative, but current bedside skin imaging technologies are either limited in penetration depth or resolution. Combining imaging methods is therefore highly relevant for skin cancer diagnostics. This pilot study evaluates the ability of optical coherence tomography, reflectance confocal microscopy, photoacoustic imaging and high-frequency ultrasound to differentiate malignant from benign pigmented skin lesions. A total of 41 pigmented skin tumours were scanned prior to excision. Morphologic features and blood vessel characteristics were analysed in reflectance confocal microscopy, optical coherence tomography, high-frequency ultrasound and photoacoustic imaging images and diagnostic accuracy assessed. Three novel photoacoustic imaging features, 7 reflectance confocal microscopy features and two optical coherence tomography features were detected with a high correlation to malignancy, diagnostic accuracy > 71%. No significant features were found in high-frequency ultrasound. Conclusively, optical coherence tomography, reflectance confocal microscopy and photoacoustic imaging in combination enables image-guided evaluation of suspicious pigmented skin tumours at the bedside. Combining these advanced techniques may help to diagnose skin cancer more efficiently.
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Affiliation(s)
- Terese Von Knorring
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 17, DK-2400 Copenhagen, Denmark.
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Mogensen M, Hendel K, Ung V, Wenande E, Togsverd-Bo K, Forman JL, Haedersdal M. Assessing Light and Energy-Based Therapy by Optical Coherence Tomography and Reflectance Confocal Microscopy: A Randomized Trial of Photoaged Skin. Dermatology 2021; 238:422-429. [PMID: 34515098 DOI: 10.1159/000517960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Image-guided quantitative and semi-quantitative assessment of skin can potentially evaluate treatment efficacy. Optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) are ideal for this purpose. This study assessed clinically relevant statistical changes in RCM and OCT features in photoaged skin after light and energy-based therapy. METHODS Novel statistical analyses were performed using OCT and RCM data collected during a previously published trial: a 12-week study of female décolleté skin randomized to four areas treated with thulium laser (L), photodynamic therapy (PDT), combined L-PDT, and control. Eight semi-quantitative RCM scores of photodamage and OCT measurements of skin roughness, blood flow, and epidermal thickness (ET) were evaluated and compared to dermoscopy and clinical skin scores. In statistical analysis, estimated treatment difference (ETD) was calculated. RESULTS Twelve women with moderate to severe photodamage were included. RCM and OCT data demonstrated a trend towards rejuvenation of epidermis with increased ET, changes in skin surface, and improved honeycomb pattern in RCM. In angiographic OCT, non-significant changes towards more regular capillary meshes were shown, which matched a decline in appearance of gross telangiectasias in dermoscopy. Improved skin tone after laser and L-PDT was identified in RCM, showing less edged papillae in 36% and 45%, and lentigo number declined in 55% of patients after treatments in dermoscopy. Based on clinical scores, L-PDT provided the greatest clinical improvement, which corresponded to superior ETD outcomes in ET and edged papillae shown in OCT and RCM, respectively. CONCLUSION Objective OCT and RCM assessment of skin rejuvenation was demonstrated in this study. Importantly, image-based improvements corresponded to favorable clinical skin scores and fewer photoaging characteristics in dermoscopy. Importantly, most changes did not reach statistical significance, prompting further studies and emphasizing the modest value of non-randomized, non-blinded anti-aging trials.
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Affiliation(s)
- Mette Mogensen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kristoffer Hendel
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Vilde Ung
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Emily Wenande
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Katrine Togsverd-Bo
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Julie L Forman
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Berteloot L, Marcy O, Nguyen B, Ung V, Tejiokem M, Nacro B, Goyet S, Dim B, Blanche S, Borand L, Msellati P, Delacourt C. Value of chest X-ray in TB diagnosis in HIV-infected children living in resource-limited countries: the ANRS 12229-PAANTHER 01 study. Int J Tuberc Lung Dis 2019; 22:844-850. [PMID: 29991391 DOI: 10.5588/ijtld.18.0122] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate inter-reader agreement and diagnostic accuracy of chest radiography (CXR) in the diagnosis of tuberculosis (TB) in children with human immunodeficiency virus (HIV) infection. DESIGN HIV-infected children with clinically suspected TB were enrolled in a prospective study conducted in Burkina Faso, Cambodia, Cameroon and Viet Nam from April 2010 to December 2014. Three readers-a local radiologist, a paediatric pulmonologist and a paediatric radiologist-independently reviewed the CXRs. Inter-reader agreement was then assessed using the κ coefficient. Diagnostic accuracy of CXR was assessed in culture-confirmed cases and controls. RESULTS A total of 403 children (median age 7.3 years, interquartile range 3.5-9.7; 49.6% males) were enrolled. Inter-reader agreement was as follows: between local radiologist and paediatric pulmonologist, κ = 0.36 (95%CI 0.27-0.45); local radiologist and paediatric radiologist, κ = 0.16 (95%CI 0.08-0.24); and paediatric pulmonologist and paediatric radiologist, κ = 0.30 (95%CI 0.21-0.40). Among 51 cases and 151 controls, after a consensus, CXR had a sensitivity of 71.4% (95%CI 58.8-84.1) and a specificity of 50.0% (95%CI 41.9-58.1). Alveolar opacities and enlarged lymph nodes on CXR had limited specificity for TB (64.7% and 70.2%, respectively). Miliary and/or nodular opacities patterns on CXR were more specific to TB (specificity 94.3%). CONCLUSION CXR showed poor-to-fair inter-reader agreement and limited diagnostic accuracy for TB in HIV-infected children, likely due to comorbidities. Radiological criteria for this specific population require further investigation.
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Affiliation(s)
- L Berteloot
- Service de Radiologie Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - O Marcy
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia, Centre Institut national de la santé et de la recherche médicale Unité 1219, Université de Bordeaux, Bordeaux Population Health, Bordeaux, France
| | - B Nguyen
- Department of Radiology, Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | - V Ung
- TB/HIV Department, National Paediatric Hospital, Phnom Penh, University of Health Sciences, Phnom Penh, Cambodia
| | - M Tejiokem
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaounde, Cameroon
| | - B Nacro
- Service de Pédiatrie, Centre Hospitalier Universitaire Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - S Goyet
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - B Dim
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - S Blanche
- Unité d'Immunologie, Hématologie et Rhumatologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Paris
| | - L Borand
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - P Msellati
- Unité mixte internationale 233, Unité 1175 Recherches Translationnelles sur le VIH et les Maladies Infectieuses, Institut de recherche pour le développement, Université de Montpellier
| | - C Delacourt
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, Paris, France
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