Elkjaer M.,Copenhagen University |
Burisch J.,Copenhagen University |
Avnstrom S.,Amager Hospital |
Lynge E.,Institute of Public Health |
Munkholm P.,Copenhagen University
European Journal of Gastroenterology and Hepatology | Year: 2010
Background: Ulcerative colitis (UC) is a lifelong disease with increasing incidence. UC requires frequent outpatient clinic visits and continuous medical treatment. Web-based self-management in other chronic diseases influences disease course, and increases self-adherence, compliance and quality of life (QoL). Lack of easy access to inflammatory bowel disease clinics and patient education, their understanding of the importance of early treatment at relapse, poor compliance and self-adherence can be partly solved by a newly developed Web-based concept. AimS: To describe the development and validation of the Web-based 'Constant-Care' concept. Methods: A Web-based treatment program (www.constant-care.dk) and a Patient Educational Centre for UC Patients were developed. The feasibility and acceptance of the concept was validated before (group A) and 6 months after (group B) the start of a randomized controlled trial. Patients' level of disease-specific knowledge, QoL, anxiety and depression were evaluated. Results: Ten (group A) and 11 (group B) Patients fulfilling the diagnostic criteria of mild-to-moderate UC participated in the study. All Patients reported an ability to initiate self-treatment after the educational training (ET). A significant increase in knowledge from 36 to 69% (group A) and 28 to 75% (group B) was obtained. A majority of the Patients were satisfied with the ET. Patients' QoL, anxiety, depression and general well-being showed no difference after the ET. Conclusion: Patient education and training through a Web-based program (www.constant-care.dk) seems to be a feasible concept for increasing Patients' ability to self-initiate treatment and increase the level of disease-specific knowledge. Relevant adjustment of the concept was implemented. The final outcome of the 'Constant-Care' concept is pending. © 2010 Wolters Kluwer Health | Lippincott.
Bak K.,Amager Hospital |
Sorensen A.K.B.,Gentofte Hospital |
Jorgensen U.,Gentofte Hospital |
Nygaard M.,Gentofte Hospital |
And 4 more authors.
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2010
Purpose: Early repair of rotator cuff tears leads to superior results. To detect symptomatic full-thickness tears of the supraspinatus tendon at an early stage, we conducted a prospective study to evaluate the value of clinical examination with and without subacromial lidocaine within the first weeks after an acute injury to the shoulder. Methods: Of 104 patients included in a prospective investigation, 52 patients were selected to evaluate the diagnostic accuracy of clinical tests in acute full-thickness tears of the supraspinatus tendon. Clinical tests and ultrasound examination were performed at a median of 13 days (range, 3 to 49 days) after the initial injury. The study group consisted of 29 patients (median age, 56 years [range, 39 to 75 years]) who all had an acute complete tear of the supraspinatus tendon verified by ultrasound and arthroscopy. The control group consisted of 23 patients who all had an intact tendon confirmed by ultrasound (median age, 38 years [range, 19 to 73 years]). Results: The Hawkins sign (0.83) and the painful arc test (0.97) had high sensitivity but low specificity (0.23 and 0.05, respectively). The external rotation lag sign (ERLS) and the drop-arm test (DAT) had a sensitivity of 0.39 and 0.37, respectively, and specificity of 0.91 and 0.86, respectively, in diagnosing acute full-thickness tears of the rotator cuff. After a subacromial lidocaine injection, sensitivity of all lag sign tests was reduced, whereas specificity and likelihood ratios of the Jobe test, the ERLS, and the DAT improved. Active abduction was significantly reduced in the full-thickness tear group. Conclusions: A positive lag sign (ERLS or DAT) is indicative of a full-thickness supraspinatus tear, but a negative lag sign does not preclude a tear. After a subacromial injection of lidocaine, the specificity improves whereas the sensitivity is reduced. Overall, in patients with suspected acute rotator cuff tear, clinical tests cannot stand alone in the evaluation the first weeks after an acute injury. Level of Evidence: Level I, diagnostic study-testing of previously developed criteria in a series of consecutive patients (by use of arthroscopy and ultrasound as the gold standard). © 2010 Arthroscopy Association of North America.
Hansen P.,Copenhagen University |
Kovanen V.,University of Jyvaskyla |
Holmich P.,Amager Hospital |
Krogsgaard M.,Copenhagen University |
And 6 more authors.
American Journal of Sports Medicine | Year: 2013
Background: The Achilles tendon is one of the strongest tendons in the human body, and yet it frequently ruptures, which is a substantial clinical problem. However, the cause of ruptures remains elusive. Hypothesis: Ruptured human Achilles tendon displays inferior biomechanical properties and altered collagen composition compared with noninjured tendon. Study Design: Controlled laboratory study. Methods: Biopsy specimens were obtained at the rupture site and the noninjured part of the tendon (internal controls) in 17 patients with acute Achilles tendon rupture. Age- and weight-matched human cadaveric Achilles tendons (external controls) were also obtained. Tendon samples were tested micromechanically and biochemically. Results: The mean Young modulus was lower (P<.01) in ruptured (256.7 ± 100.8 MPa) and internal control tendon (262.4 ± 111.5 MPa) compared with external control tendon (512.9 ± 209. ± MPa; P<.01), whereas failure strength did not display similar differences (P = .06-.16). Collagen content, lysyl pyridinoline (LP), hydroxylysyl pyridinoline (HP), and pentosidine (PENT) did not display regional differences between ruptured and noninjured tendon. However, collagen content was less in ruptured (0.457 ± 0.093 mg/mg) and noninjured tendon (0.476 ± 0.072 mg/mg) compared with external control tendon (0.585 ± 0.044 mg/mg, P<.001). Pentosidine was similar in all tendon samples and was positively related to age in all samples (r2 = 0.44-0.72, P< .05). Collagen content was positively related to failure stress but only in ruptured samples (r2= 0.36; P<.05). HP, LP, and PENT content were unrelated to failure stress and Young modulus in ruptured, noninjured, and cadaveric tendon. Conclusion: These data imply that there may be a mechanical weakening of the tendon and that a reduced collagen content may be related to the pathophysiological characteristics of Achilles tendon rupture. Clinical Relevance: Earlier studies have demonstrated that specific training regimens to treat tendon injury can improve tendon composition and mechanical properties. This study supports the notion that treatment measures should aim to increase tendon collagen content and improve micromechanical quality of the tendon matrix. © 2012 The Author(s).
Jakobsdottir G.,Lund University |
Bjerregaard J.H.,Glostrup Hospital |
Skovbjerg H.,Amager Hospital |
Nyman M.,Lund University
Scandinavian Journal of Gastroenterology | Year: 2013
Background. Short-chain fatty acids (SCFAs), particularly propionic and butyric acids, have been shown to have many positive health effects. The amount and type of SCFAs formed from dietary fibre by the colonic microbiota depends on the substrate available and is reflected in blood. The total intake and type of dietary fibre in people with gastrointestinal diseases differs considerably from healthy subjects. Objective. To compare fasting SCFA concentrations in subjects with microscopic colitis (MC), celiac disease and controls without these diseases. SCFAs were also analysed over 6.5 h in young healthy subjects, who had eaten a fibre-rich breakfast, to identify a possible peak concentration of SCFAs after a meal. Methods. SCFAs in serum were pre-concentrated using hollow fibre-supported liquid membrane extraction and gas chromatography. Results. The MC group had a higher concentration of valeric acid than the control group (p < 0.01). No significant differences in other SCFA concentrations were seen between groups, but the control group tended to have higher concentration of acetic acid (p = 0.1). Furthermore, males had higher concentrations of SCFAs (with the exception of valeric acid) than females (p < 0.05), which were independent of groups. The peaks for acetic, propionic and butyric acids came approximately 5 h, 6.5 h and 2-3 h, respectively, after breakfast. Conclusion. The fasting concentrations of SCFAs were quite similar, although the fibre intake had probably been quite different for a long time. The results might have been different if SCFAs had been recorded over a longer period. © 2013 Informa Healthcare.
Qvist J.F.,Herlev Hospital |
Sorensen P.H.,Amager Hospital |
Dixen U.,Hvidovre Hospital
Danish Medical Journal | Year: 2014
Introduction: Atrial fibrillation (AF) is a cardiac epidemic. In this study, we aimed to describe the causes of hospital-isa-tion in an AF population over time and to study how different AF treatment strategies affected hospitalization. Material and methods: This was an observational study in which long-term follow-up data were collected from hospital records, discharge papers and diagnostic codes. The study population (n = 156) was observed over a total period of ten years which was divided into two successive observation periods (OP), OP1 and OP2. Fourteen endpoints of cardiovascular hospitalisations were evaluated. Results: The causes of hospitalisation shifted over time. We observed a lower proportion of admissions due to AF in OP2 (63%) than in OP1 (87%) and a higher proportion of admissions due to congestive heart failure (16% versus 3%) and of days of inpatient care due to ischaemic stroke (25% versus 7%). Persistent AF where sinus rhythm was pursued was associated with a four-fold increase in the risk of hos-pitalisation (multivariate Poisson analysis, rate ratio 3.97, 95% confidence interval 2.73-5.76, p < 0.0001) compared with accepted permanent AF. Conclusion: Over time, the causes of hospitalisation in an AF population shifted from AF relapse to the most frequent complications of AF, ischaemic stroke and congestive heart failure. In this observational study, patients treated with rhythm control were more frequently hospitalised than patients treated with rate control.