This study was performed to investigate whether an intravenous (IV) strategy based on newgeneration midline catheters is an efficacious alternative to a conventional IV strategy consisting of peripheral venous catheters and central venous catheters, for patients needing IV therapy exceeding 5 days. Methods: This was a prospective, randomized, controlled study. Patients requiring more than 5 days of IV treatment were randomized to either a midline catheter-based IV strategy or a conventional strategy. The primary endpoint was the composite of the insertion of a central venous catheter (CVC) or the need for four or more peripheral venous catheter (PVC) insertions. The secondary outcomes included catheter dwell times and reasons for premature removal. Results: One hundred and twenty patients were included. The fraction of patients receiving four or more PVCs or having a CVC inserted was 12/58 (21%) in the midline group versus 38/58 (66%) in the conventional group (p < 0.001); the number needed to treat was 2.2. The median overall catheter dwell time was 7 days (range 0-60 days) in the midline group and 4 days (range 0-84 days) in the conventional group (p = 0.002). Conclusion:In patients requiring more than 5 days of IV therapy, a midline catheter strategy reduced the need for insertion of a CVC or four or more PVCs.

Background/Objective: Fracture risk is increased in patients with type 1 diabetes.We aimed to evaluate bone mineral density (BMD) and to identify risk factors associated to lower BMD in Danish children and adolescents with type 1 diabetes. Methods:In this cross-sectional study BMD Z-score were determined by dual-energy X-ray absorptiometry (DXA) from a cohort of otherwise healthy children and adolescents with type 1 diabetes. Puberty Tanner stage, hemoglobin A1c (HbA1c), disease duration, and age at diabetes onset were investigated for associations to DXA results. Results:We included 85 patients, 39 girls, 46 boys, with a median (range) age of 13.2 (6-17) years; disease duration 4.2 (0.4-15.9) years; HbA1c of the last year 61.8 (41-106) mmol/mol. Our patients were taller and heavier than the background population. When adjusted for increased height SD and body mass index SD, no overall difference in BMD Z-score was found. When stratified by sex, boys had significantly increased adjusted mean BMD Z-score, 0.38 (95% confidence interval [CI]: 0.13;0.62), girls; −0.27 (95% CI: −0.53;0.00). For the whole cohort, a negative correlation between mean latest year HbA1c and BMD Z-score was found, adjusted ß −0.019 (95%CI: −0.034;−0.004, P = 0.01). Poor glycemic control (HbA1c > 58 mmol/mol [7.5%]) within the latest year was likewise negatively correlated with BMD Z-score, adjusted ß −0.35 (95%CI: −0.69;−0.014, P = 0.04). Conclusions:Our study suggests that elevated blood glucose has a negative effect on the bones already before adulthood in patients with type 1 diabetes, although no signs of osteoporosis were identified by DXA. K E Y W O R D S adolescent, bone density, child, diabetes mellitusglycated hemoglobin A, type 1

Side 4Forord DHR's styregruppe praesenterer hermed årsrapporten for 2016. Der er nu i perioden 1995-2015 i alt indberettet ca. 150.000 primaere og 23.400 revisioner til DHR. DHR har laenge levet op til de gaeldende krav for indrapportering.Dette års komplethedsgrad på 97,5 % for primaere THA er meget tilfredsstillende, mens kompletheden for revisions THA er på 90,3 % og såfremt at der fratraekkes revision af hemialloplastik stiger det til 94,4%. Da standarden er 95% er det ikke tilfredsstillende. Der skal lyde en stor tak fra styregruppen til alle laeger, sekretaerer og andet personale, der yder et stort stykke arbejde for, at vores datakomplethed fra de fleste afdelinger er god. Også en stor tak til vores sekretariat, der sørger for den gode kontakt til afdelingerne. Årets rapportI denne rapport praesenteres 20 års follow-up af de første indrapporterede patienter til registeret. Antal indberetninger for såvel primaere som revisioner er nogenlunde uaendret de sidste 5 år. Nyheder i DHR-rapporten 2016Som diskuteret på DOS-kongressen 2015, er der foretaget en raekke aendringer af indikatorerne primaert mhp. at rapportere mere relevante data til de indberettende afdelinger. Derfor er der nu fokus på 30 og ikke 90 dages genindlaeggelse uanset årsag samt 2 års revisions rater, hvor alle reoperationer og eventuel lukket reponering indgår. Desuden er der indført en registrering af 5 års proteseoverlevelse. Standarder for de nye indikatorer vil blive justeret, når der er erfaringer med dem. Indtil videre er de pragmatisk sat til landsgennemsnittet. AEndringer i styregruppenFor Region Nordjylland erstattes Michael Ulrich Jensen af Mogens Berg Laursen. Michael takkes for et rigtig stort stykke arbejde specielt ifm. oprettelse af databasen for MoM. Han ønskes held og lykke med sin nye praksis i Århus. Hans Peder Graversen (repraesentant for dataansvarlig myndighed) er trådt ud af styregruppen og erstattes af kvalitetskonsulent Sofia Kyndesen, Region Hovedstaden. Hans Peder Graversen takkes for den tid, han har siddet i styregruppen. Optimering af den elektroniske indtastning af MoM patienterStyregruppen har arbejdet med at optimere den elektroniske indtastning af MoM patienterne, og aendringerne vil blive implementeret i løbet af 2016. Dette vil betyde, at indtastningen vil tage vaesentlig kortere tid end tidligere. Indrapportering skal sikre, at vi til enhver tid kan oplyse om, hvordan det går med patienter med MoM-hofter. Styregruppen er medvidende om, at der er en meget dårlig komplethed i MoM-databsen, hvilket der nu skal rådes bod på. Vi har derfor besluttet følgende løsning: Ved kontrol af en patient med en MoM-hofte udfyldes skema enten elektronisk eller i papir form:• Smerter og ion metal måling: Der indtastes de første og seneste man har noteret sig, og derefter indtastes alle nye prospektivt.• Billeddiagnostisk: Alle resultater fra undersøgelser indtastes.• Patologi: Alle resultater fra eventuelle reoperationer skal indtastes.Dette skulle gøre det mere lempeligt at få indrapporteret de patienter, der endnu ikke er...

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Background and purposeIodine-impregnated incision drapes (IIIDs) are used to prevent surgical site infection (SSI). However, there is some evidence to suggest a potential increase in SSI risk as a result of IIID use, possibly from promotion of skin recolonization. A greater number of viable bacteria in the surgical field of an arthroplasty, and surgery in general, may increase the infection risk. We investigated whether IIID use increases bacterial recolonization compared to no drape use under conditions of simulated total knee arthroplasty (TKA).Methods20 patients scheduled for TKA were recruited. Each patient had 1 knee randomized for draping with IIID, while the contralateral knee was left bare. The patients thus served as their own control. The operating room conditions and perioperative procedures of a TKA were simulated. Cylinder samples were collected from the skin of each knee prior to disinfection, and again on 2 occasions after skin preparation—75 min apart. Quantities of bacteria were estimated using a spread plate technique under aerobic conditions.ResultsWe found similar quantities of bacteria on the intervention and control knees immediately after skin disinfection and after 75 min of simulated surgery. These quantities had not increased at the end of surgery when compared to baseline, so no recolonization was detected on the draped knees or on the bare knees.InterpretationThe use of IIIDs did not increase bacterial recolonization in simulated TKA. This study does not support the hypothesis that IIIDs promote bacterial recolonization and postoperative infection risk.

IntroductionPatients with type 1 diabetes has an increased risk of fracture. We wished to evaluate estimated bone strength in children and adolescents with type 1 diabetes and assess peripheral bone geometry, volumetric bone mineral density (vBMD) and microarchitecture.Research design and methodsIn a cross-sectional study, high-resolution peripheral quantitative CT (HR-pQCT) was performed of the radius and tibia in 84 children with type 1 diabetes and 55 healthy sibling controls. Estimated bone strength was assessed using a microfinite element analysis solver. Multivariate regression analyses were performed adjusting for age, sex, height and body mass index.ResultsThe median age was 13.0 years in the diabetes group vs 11.5 years in healthy sibling controls. The median (range) diabetes duration was 4.2 (0.4−15.9) years; median (range) latest year Hb1Ac was 7.8 (5.9−11.8) % (61.8 (41−106) mmol/mol). In adjusted analyses, patients with type 1 diabetes had reduced estimated bone strength in both radius, β −390.6 (−621.2 to −159.9) N, p=0.001, and tibia, β −891.9 (−1321 to −462.9) N, p<0.001. In the radius and tibia, children with type 1 diabetes had reduced cortical area, trabecular vBMD, trabecular number and trabecular bone volume fraction and increased trabecular inhomogeneity, adjusted p<0.05 for all. Latest year HbA1c was negatively correlated with bone microarchitecture (radius and tibia), trabecular vBMD and estimated bone strength (tibia).ConclusionChildren with type 1 diabetes had reduced estimated bone strength. This reduced bone strength could partly be explained by reduced trabecular bone mineral density, adverse microarchitecture and reduced cortical area. We also found increasing latest year HbA1c to be associated with several adverse changes in bone parameters. HR-pQCT holds potential to identify early adverse bone changes and to explain the increased fracture risk in young patients with type 1 diabetes.

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