Moesgaard L.,Holstebro Hospital
Danish medical journal | Year: 2012
Tonsillectomy may be performed by several methods. It is continuously being discussed which method is preferable with regard to postoperative haemorrhage, pain, activity and nutrition. The present study is a prospective non-randomized study of tonsillectomy. It included 198 patients aged 14-40 years who either underwent coblation tonsillectomy or traditional "cold" tonsillectomy after random allocation to different surgeons. A total of 51 patients underwent coblation tonsillectomy and 147 patients underwent traditional tonsillectomy. We tested the hypothesis that there is no difference in postoperative pain experience between the two surgical techniques. The patients were followed for nine days postoperatively. They filled in a questionnaire on postoperative pain score, activity level and food intake. We found no statistically significant difference in pain perception between the two groups and there was no difference in their levels of activity. The intraoperative haemorrhage was significantly reduced in the coblation tonsillectomy group, but there was no difference in postoperative haemorrhage between the two groups. The overall results of this study suggest that neither coblation tonsillectomy nor traditional tonsillectomy enjoys an advantage over the other in patients aged 14-40 years. not relevant. not relevant.
Beveridge L.A.,University of Dundee |
Struthers A.D.,University of Dundee |
Khan F.,University of Dundee |
Jorde R.,University of Tromso |
And 18 more authors.
JAMA Internal Medicine | Year: 2015
IMPORTANCE Low levels of vitamin D are associated with elevated blood pressure (BP) and future cardiovascular events. Whether vitamin D supplementation reduces BP and which patient characteristics predict a response remain unclear. OBJECTIVE To systematically review whether supplementation with vitamin D or its analogues reduce BP. DATA SOURCES We searched MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, and http://www.ClinicalTrials.com augmented by a hand search of references from the included articles and previous reviews. Google was searched for gray literature (ie, material not published in recognized scientific journals). No language restrictions were applied. The search period spanned January 1, 1966, through March 31, 2014. STUDY SELECTION We included randomized placebo-controlled clinical trials that used vitamin D supplementation for a minimum of 4 weeks for any indication and reported BP data. Studies were included if they used active or inactive forms of vitamin D or vitamin D analogues. Cointerventions were permitted if identical in all treatment arms. DATA EXTRACTION AND SYNTHESIS We extracted data on baseline demographics, 25-hydroxyvitamin D levels, systolic and diastolic BP (SBP and DBP), and change in BP from baseline to the final follow-up. Individual patient data on age, sex, medication use, diabetes mellitus, baseline and follow-up BP, and 25-hydroxyvitamin D levels were requested from the authors of the included studies. For trial-level data, between-group differences in BP change were combined in a random-effects model. For individual patient data, between-group differences in BP at the final follow up, adjusted for baseline BP, were calculated before combining in a random-effects model. MAIN OUTCOMES AND MEASURES Difference in SBP and DBP measured in an office setting. RESULTS We included 46 trials (4541 participants) in the trial-levelmeta-analysis. Individual patient data were obtained for 27 trials (3092 participants). At the trial level, no effect of vitamin D supplementation was seen on SBP (effect size, 0.0 [95%CI,-0.8 to 0.8]mmHg; P =.97; I2 = 21%) or DBP (effect size,-0.1 [95%CI,-0.6 to 0.5]mmHg; P =.84; I2 = 20%). Similar results were found analyzing individual patient data for SBP (effect size,-0.5 [95%CI,-1.3 to 0.4]mmHg; P =.27; I2 = 0%) and DBP (effect size, 0.2 [95%CI,-0.3 to 0.7]mmHg; P =.38; I2 = 0%). Subgroup analysis did not reveal any baseline factor predictive of a better response to therapy. CONCLUSIONS AND RELEVANCE Vitamin D supplementation is ineffective as an agent for lowering BP and thus should not be used as an antihypertensive agent. © Copyright 2015 American Medical Association. All rights reserved.
Krenk L.,Copenhagen University |
Kehlet H.,Copenhagen University |
Kehlet H.,Lundbeck |
Hansen T.B.,Holstebro Hospital |
And 3 more authors.
Anesthesia and Analgesia | Year: 2014
BACKGROUND: Postoperative cognitive dysfunction (POCD) is reported to occur after major surgery in as many as 20% of patients, elderly patients may especially experience problems in the weeks and months after surgery. Recent studies vary greatly in methods of evaluation and diagnosis of POCD, and the pathogenic mechanisms are still unclear. We evaluated a large uniform cohort of elderly patients in a standardized approach, after major joint replacement surgery (total hip and knee replacement). Patients were in an optimized perioperative approach (fast track) with multimodal opioid-sparing analgesia, early mobilization, and short length of stay (LOS ≤3 days) and discharged to home. METHODS: In a prospective multicenter study, we included 225 patients aged ≥60 years undergoing well-defined fast-track total hip or total knee replacement. Patients had neuropsychological testing preoperatively and 1 to 2 weeks and 3 months postoperatively. LOS, pain, opioid use, inflammatory response, and sleep quality were recorded. The practice effect of repeated cognitive testing was gauged using data from a healthy community-dwelling control group (n = 161). RESULTS: Median LOS was 2 days (interquartile range 2-3). The incidence of POCD at 1 to 2 weeks was 9.1% (95% confidence interval [CI], 5.4%-13.1%) and 8.0% (95% CI, 4.5%-12.0%) at 3 months. There was no statistically significant difference between patients with and without early POCD, regarding pain, opioid use, sleep quality, or C-reactive protein response, although the CIs were wide. Patients with early POCD had a higher Mini Mental State Examination score preoperatively (difference in medians 0.5 [95% CI, -1.0% to 0.0%]; P = 0.034). If there was an association between early POCD and late POCD, the sample size was unfortunately too small to verify this (23.6% of patients with early POCD had late onset vs 6.7% in non-POCD group; risk difference 16.9 (95% CI, -2.1% to 41.1%; P = 0.089). CONCLUSIONS: The incidence of POCD early after total hip and knee replacement seems to be lower after a fast-track approach than rates previously reported for these procedures, but late POCD occurred with an incidence similar to that in previous studies of major noncardiac elective surgery. No association between early and late POCD could be verified. Copyright © 2014 International Anesthesia Research Society.
Kancir A.S.P.,Aarhus University Hospital |
Johansen J.K.,Holstebro Hospital |
Ekeloef N.P.,Holstebro Hospital |
Pedersen E.B.,Aarhus University Hospital
Anesthesia and Analgesia | Year: 2015
BACKGROUND: Although hydroxyethyl starch (HES) is commonly used as an intravascular volume expander in surgical patients, recent studies suggest that it may increase the risk of renal failure in critically ill patients. We hypothesized that patients undergoing radical prostatectomy and receiving HES would be more likely to develop markers of renal failure, such as increasing urinary neutrophil gelatinase-associated lipocalin (u-NGAL), creatinine clearance (Ccrea), and decreasing urine output (UO). METHODS: In a randomized, double-blinded, placebo-controlled study, 40 patients referred for radical prostatectomy received either 6% HES 130/0.4 or saline 0.9%; 7.5 mL/kg during the first hour of surgery and 5 mL/kg in the following hours; u-NGAL, urine albumin, Ccrea, UO, arterial blood pressure, and plasma concentrations of creatinine, renin, angiotensin II, aldosterone, and vasopressin were measured before, during, and after surgery. RESULTS: Thirty-six patients completed the study. u-NGAL, Ccrea, UO, plasma neutrophil gelatinase-associated lipocalin, p-creatinine, urine albumin, and arterial blood pressure were the same in both groups. Blood loss was higher in the HES group (HES 1250 vs saline 750 mL), while p-albumin was reduced to a significantly lower level. P-renin and p-angiotensin-II increased in both groups, whereas p-aldosterone and p-vasopressin increased significantly in the saline group. CONCLUSIONS: We found no evidence of nephrotoxicity after infusion of 6% HES 130/0.4 in patients undergoing prostatectomy with normal preoperative renal function. Hemodynamic stability and infused fluid volume were the same in both groups. We observed an increased blood loss in the group given 6% HES 130/0.4. © 2015 International Anesthesia Research Society.
Madsen L.B.,Holstebro Hospital |
Christiansen T.,University of Southern Denmark |
Kirkegaard P.,Section of General Practitioners |
Pedersen E.B.,Holstebro Hospital
Blood Pressure | Year: 2011
Aims. The purpose of the present study was to compare the costs of home blood pressure (BP) telemonitoring (HBPM) with the costs of conventional office BP monitoring. In a randomized controlled trial, 105 hypertensive patients performed HBPM and 118 patients received usual care with conventional office BP monitoring during 6 months. Costs were quantified from the healthcare perspective. Non-parametric simulations were performed to quantify the uncertainty around the mean estimates and cost-effectiveness acceptability curves were made. Major findings. Systolic and diastolic daytime and night-time ambulatory BP (ABP) were reduced in both groups. The uncertainty around the incremental cost effectiveness ratio point estimates was considerable for both systolic and diastolic ABP. For systolic ABP, the difference in cost effectiveness ratio between the two groups was 256 Danish kroner (DKK)/mmHg [95% uncertainty interval, UI -860 to 4544]. For diastolic ABP, the difference in cost effectiveness ratio between the two groups was 655 DKK/mmHg [95% UI -674 to 69315]. Medication and consultation costs were lowest in the intervention group, but were offset by the cost of the telemonitoring equipment. Conclusions. Cost-effectiveness analysis showed that telemonitoring of home BP was more costly compared with usual monitoring of office BP. The cost-effectiveness result is surrounded with considerable uncertainty. © 2011 Scandinavian Foundation for Cardiovascular Research.