Rosenstock S.J.,Copenhagen University |
Moller M.H.,Copenhagen University |
Larsson H.,Aarhus University Hospital |
Johnsen So.P.,Aarhus University Hospital |
And 13 more authors.
American Journal of Gastroenterology | Year: 2013
OBJECTIVES:The treatment of peptic ulcer bleeding (PUB) is complex, and mortality remains high. We present results from a nationwide initiative to monitor and improve the quality of care (QOC) in PUB.METHODS:All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered demographic, clinical, and prognostic data. QOC was evaluated using eight process and outcome indicators, including time to initial endoscopy, hemostasis obtainment, proportion undergoing surgery, rebleeding risks, and 30-day mortality.RESULTS:A total of 13,498 PUB patients (median age 74 years) were included, of which one-quarter were in-hospital bleeders. Preadmission use of anticoagulants, multiple coexisting diseases, and the American Society of Anesthesiologists scores increased between 2004 and 2011. Considerable improvements were observed for most QOC indicators over time. Endoscopic treatment was successful with primary hemostasis achieved in more patients (94% in 2010-2011 vs. 89% in 2004-2006, relative risk (RR) 1.06 (95% confidence intervals 1.04-1.08)), endoscopy delay for hemodynamically unstable patients decreased during this period (43% vs. 34% had endoscopy within 6 h, RR 1.33 (1.10-1.61)), and fewer patients underwent open surgery (4% vs. 6%, RR 0.72 (0.59-0.87)). After controlling for time changes in prognostic factors, rebleeding rates improved (13% vs. 18%, adjusted RR 0.77 (0.66-0.91)). Crude 30-day mortality was unchanged (11% vs. 11%), whereas adjusted mortality decreased nonsignificantly over time (adjusted RR 0.89 (0.78-1.00)).CONCLUSIONS: QOC in PUB has improved substantially in Denmark, but the 30-day mortality remains high. Future initiatives to improve outcomes may include earlier endoscopy, having fully trained endoscopists on call, and increased focus on managing coexisting disease. © 2013 by the American College of Gastroenterology.
Bonderup O.K.,Aarhus University Hospital |
Wigh T.,Regional Hospital Randers |
Nielsen G.L.,University of Aalborg |
Pedersen L.,Aarhus University Hospital |
And 2 more authors.
Scandinavian Journal of Gastroenterology | Year: 2015
Objective. Microscopic colitis (MC) includes two main types: collagenous colitis (CC) and lymphocytic colitis (LC). Previous studies have indicated an increasing incidence, but these have mainly been based on regional databases. We found it important to study the epidemiology based on a comprehensive nationwide cohort. Material and methods. We studied the epidemiological data of MC in Denmark from 2002 to 2011. The cohort consisted of all patients with a recorded diagnosis of either CC or LC in the Danish Pathology Register during the study period. Data on all patients with a registered colon biopsy were also included. Results. A total of 7777 patients, 4749 (61%) with CC and 3028 (39%) with LC, were identified. Over the study period, the annual incidence of diagnosed cases of CC increased from 2.9/105 to 14.9/105 and of LC from 1.7/105 to 9.8/105. In 2011, the incidence of MC was 24.7/105 inhabitants. The age-specific incidence showed that the risk of both CC and LC increased with age. The female/male ratio, distribution of the type of colitis and mean age at diagnosis were relatively stable during the study period. The annual number of registered colon biopsies in the pathology register increased from 21.583 in 2002 to 39.733 in 2011, indicating an increased diagnostic activity. Conclusion. In a nationwide cohort study, the incidence of CC and LC continued to increase from 2002 to 2011. An increased diagnostic activity could in part explain the increase in the number of diagnosed cases. © Informa Healthcare
Bonderup O.K.,University of Aarhus |
Fenger-Gron M.,University of Aarhus |
Fenger-Gron M.,Aarhus University Hospital |
Wigh T.,Regional Hospital Randers |
And 3 more authors.
Inflammatory Bowel Diseases | Year: 2014
Background: Previous small studies have indicated that commonly prescribed drugs may be associated with microscopic colitis (MC). With an increasing incidence of MC, it is important to explore the association between exposure to proton pump inhibitors (PPIs), nonsteroidal anti-inflammatory drugs, statins, and selective serotonin reuptake inhibitors and MC in a larger setting. Methods: Case-control study based on nationwide Danish registries. The study included all patients with MC diagnosis during the period 2005 to 2011. One hundred sex- and age-matched controls per case were randomly selected among the Danish population. Prescriptions were recorded in a Prescription Register in the year before the first recorded MC diagnosis. Effect measure is the adjusted odds ratio (OR) of collagenous colitis (CC) and lymphocytic colitis (LC) according to prescriptions of PPIs, nonsteroidal anti-inflammatory drugs, statins, and selective serotonin reuptake inhibitors. Within the control group, we identified a subgroup with MC-free colonic biopsies. Results: We identified 3474 patients with CC and 2277 with LC and found a positive association between redemption of prescriptions for PPIs and both CC (OR = 7.04; 95% confidence interval, 6.55-7.56) and LC (OR = 3.37; 95% confidence interval, 3.08-3.69). Among patients with MC-free colon biopsies in the control group, the association between PPIs and CC was strongly positive (OR = 3.47; 95% confidence interval, 3.08-3.89). Adding this parameter to the model attenuated all of the associations, but they remained positive for PPIs versus CC and selective serotonin reuptake inhibitors versus LC. Conclusions: We found positive associations between exposure to all 4 medication classes and MC. Variations in endoscopic frequency by drug category indicate a potential impact of bias. Copyright © 2014 Crohn's & Colitis Foundation of America, Inc.
PubMed | Regional Hospital Silkeborg, Responce A S Denmark, Central Denmark Region Emergency Medical Services, Regional Hospital Randers and 6 more.
Type: | Journal: European heart journal. Acute cardiovascular care | Year: 2016
The 2015 European Society of Cardiology non-ST-elevation myocardial infarction (NSTEMI) guidelines recommend angiography within 24 h in high-risk patients with NSTEMI. An organized STEMI-like approach with pre-hospital or immediate in-hospital triage for acute coronary angiography (CAG) may be of therapeutic benefit but it remains unknown whether the patients can be properly diagnosed in the pre-hospital setting. We aim to evaluate whether it is feasible to diagnose patients with NSTEMI in the pre-hospital phase or immediately upon admission.We randomized 250 patients to either acute or subacute CAG (i.e. <72 h of admission). Pre-hospital electrocardiogram acquisition and point-of-care troponin-T measurement ensured that 148 (59%) patients were identified already in the ambulance, whereas the remaining 102 (41%) patients were identified immediately after hospital admission. An acute coronary syndrome was verified in 215 (86%) and NSTEMI in 159 (64%) patients. The CAG rate was significantly higher in the acute CAG group (98% vs. 87%, p<0.001). A culprit lesion was identified in 74% and 64% of the patients underwent coronary revascularization: acute CAG group: 53% percutaneous coronary intervention, 5% hybrid, 7% coronary artery bypass grafting; conventional treatment: 48% percutaneous coronary intervention, 2% hybrid, 14% coronary artery bypass grafting, p=0.32. In patients randomized to acute CAG, time from randomization to CAG was 1.1 h; in patients randomized to subacute CAG it was two days. Time from randomization to initial revascularization was 1.3 h versus 2.4 days, and the median hospital stay was 4.0 days versus 4.5 days. Among patients randomized to subacute CAG, 17% crossed over to acute CAG and 5% developed STEMI before catheterization.Diagnosing NSTEMI patients in the pre-hospital phase or immediately upon hospital admission is feasible. Acute CAG may impact the mode of revascularization and is associated with earlier revascularization and shorter hospital stay. The clinical benefit of acute CAG in NSTEMI patients remains to be clarified.
Christiansen T.,Aarhus University Hospital |
Bruun J.M.,Aarhus University Hospital |
Bruun J.M.,Regional Hospital Randers |
Paulsen S.K.,Aarhus University Hospital |
And 4 more authors.
European Journal of Applied Physiology | Year: 2013
The primary aim of the present study was to investigate if overweight and obese compared to lean individuals displayed differences in levels of inflammatory markers in circulation, skeletal muscle (SM) and adipose tissue (AT) after acute exercise. Fifteen lean (BMI: 22.4 ± 2 kg/m2) and 16 overweight or obese (BMI 31.8 ± 3 kg/m2) individuals were included in the study. They completed 120 min of ergometer bicycling at 55-60 % of maximal heart rate. Blood samples were obtained at baseline (T = 0), after 60 (T = 60) and 120 min of exercise (T = 120), and analyzed using an ELISA method. SM and AT biopsies were obtained at T0 and T120, and mRNA expression was investigated using a Real-time RT-PCR method. Circulating IL-6, TNF-α, IL-8, and IL-15 all increased at T = 120 min (p < 0.01). Circulating IL-6 and IL-15 increased in all subjects at T = 120 min (p < 0.01), but only the increase of IL-6 was significantly higher in overweight and obese subjects (p < 0.05), and was positively correlated with body fat percentage (p < 0.01). Circulating IL-8 and TNF-α were increased in overweight and obese (p < 0.05) but not in lean subjects. Acute exercise induced an increase in IL-6 mRNA expression in SM biopsies (p < 0.05). IL-6 as well as adiponectin mRNA expression was increased in AT biopsies (p < 0.05); however, no effect of body weight was found. The findings suggest that the systemic inflammatory response to acute exercise is different in lean compared to overweight and obese subjects, with a more pronounced increase in inflammatory markers (e.g., IL-6, IL-8, and TNF-α) in overweight and obese individuals. © 2013 Springer-Verlag Berlin Heidelberg.
Andersen P.,Aarhus University Hospital |
Andersen L.M.,Regional Hospital Randers |
Iversen L.H.,Aarhus University Hospital
Surgical Endoscopy and Other Interventional Techniques | Year: 2015
Background: Iatrogenic ureteral injury is a rare complication in colorectal surgery. We aimed to investigate the risk of ureteral injury among patients with colorectal cancer operated on with curative intent in Denmark with laparoscopic and open technique. Method: The study was based on the Danish National Colorectal Cancer database (DCCG) and included patients treated with intended curative resection for colorectal cancer between 2005 and 2011. From the DCCG database, we extracted data on intraoperative urinary tract injuries. To identify urinary tract injuries not recognized at the time of surgery but within 30 days after surgery, we cross-linked data with the National Patient Registry. All ureteral injuries were confirmed by medical record review. Data were analyzed separately for colon and rectal cancer. Results: A total of 18,474 patients had a resection for colorectal cancer. Eighty-two ureteral injuries were related to colorectal surgery. The rate of ureteral injuries in the entire cohort was 0.44 %, with 37 (0.59 %) injuries in the laparoscopic group (n = 6,291) and 45 (0.37 %) injuries in the open group (n = 12,183), (P = 0.03). No difference in ureteral injury was found in relation to surgical approach in colon cancer patients. In rectum cancer patients (n = 5,959), the laparoscopic approach was used in 1,899 patients, and 19 (1.00 %) had ureteral injuries, whereas 17 (0.42 %) of 4,060 patients who underwent an open resection had a ureteral injury. In multivariate analysis adjusted for age, gender, ASA score, BMI, tumor stage, preoperative chemo-radiation, calendar year, and specialty of the surgeon, the laparoscopic approach was associated with an increased risk of ureteral injury, OR = 2.67; 95 % CI 1.26–5.65. Conclusion: In this nationwide study laparoscopic surgery for rectal cancer with curative intent was associated with a significantly increased risk of iatrogenic ureteral injury compared to open surgery. © 2014, Springer Science+Business Media New York.
Kulenovic I.,Aarhus University Hospital |
Mortensen M.B.,Aarhus University Hospital |
Bertelsen J.,Regional Hospital Randers |
May O.,Regional Hospital Herning |
And 3 more authors.
Preventive Medicine | Year: 2016
Objectives: Guidelines recommend initiating primary prevention with statins to those at highest cardiovascular risk. We assessed the gender-specific implementation and effectiveness of this risk-guided approach. Methods: We identified 1399 consecutive patients without known cardiovascular disease or diabetes hospitalized with a first myocardial infarction (MI) in Denmark. Statin use before MI was assessed, and cardiovascular risk was calculated using SCORE (Systematic COronary Risk Evaluation). Results: Among patients with first MI, 36% were women. Compared with men, they were older (mean 72 vs. 65 years) but had a lower estimated risk (median 3.4% vs. 6.7%, SCORE high-risk model in the statin-naïve patients). Statin therapy had been initiated in 12% of women and 10% of men prior to MI. After adding 1.5 m mol/L to the total cholesterol concentration of those already on statins, the estimated pre-treatment risk was much lower in women than men (median 3.8% vs. 9.2%, SCORE high-risk model), and only 29% of women would have passed the risk-based treatment threshold defined by the European guidelines (SCORE ≥. 5%). Estimated risk and statin use correlated directly in men but not in women. Only ~ 5% of first MI are prevented by the current use of statins in people without diabetes. Conclusion: In people destined for a first MI, statin therapy is uncommon and prevents few events. Lower-risk women receive as much statins as higher risk men. This gender disparity and inefficient targeting of statins to those at highest risk indicate that risk scoring is not widely used in routine clinical practice in Denmark. © 2015 Elsevier Inc.
Mogensen T.H.,Aarhus University Hospital |
Christiansen J.J.,Regional Hospital Randers |
Eivindson M.V.,Regional Hospital Randers |
Larsen C.S.,Aarhus University Hospital |
Tottrup A.,Aarhus University Hospital
Scandinavian Journal of Infectious Diseases | Year: 2014
We present a case of amoebic colitis, misdiagnosed as inflammatory bowel disease and treated with corticosteroids, leading to severe necrotizing enterocolitis. We review the literature on the epidemiology, pathogenesis, diagnosis, and treatment of amoebic dysentery, with special emphasis on the association between immunosuppressive treatment and the development of severe invasive amoebiasis. © 2014 Informa Healthcare.
Malham M.,Aarhus University Hospital |
Peter Jorgensen S.,Aarhus University Hospital |
Lauridsen A.L.,Regional Hospital Randers |
Lauridsen A.L.,Regional Hospital Silkeborg |
And 3 more authors.
European Journal of Gastroenterology and Hepatology | Year: 2012
Objective: The goal of this study was to examine the effects of a single oral dose of 300 000 international units of either ergocalciferol (D 2) or cholecalciferol (D 3) on the plasma levels of 25-hydroxyvitamin D in patients with alcoholic liver cirrhosis. Methods: Inclusion criteria for this study were diagnosis of alcoholic liver cirrhosis and plasma levels of 25-hydroxyvitamin D less than 25 nmol/l. At baseline, patients were divided into Child-Pugh groups A, B, or C and were given one oral dose of 300 000 international units of ergocalciferol (D 2 group, N=23) or cholecalciferol (D 3 group, N=13). Plasma concentrations of 25(OH) vitamin D and vitamin D-binding protein were measured on days 0, 7, 30, and 90. Results: On days 7 and 30, patients from the D 3 group had higher vitamin D levels than patients from the D 2 group (P<0.05). On day 7, vitamin D levels were found to correlate with Child-Pugh scores from patients in the D 3 group. For patients in the D 2 group, there was a positive correlation between vitamin D and vitamin D-binding protein as indicated by the area under the concentration versus time curves (Spearmen's ρ=0.64 P<0.001). Conclusion: In patients with alcoholic liver cirrhosis, a single oral megadose of cholecalciferol was more effective than ergocalciferol in the treatment of vitamin D deficiency. Severe liver disease and low levels of vitamin D-binding protein were predictors for poor treatment outcomes. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Pristed R.,Regional Hospital Randers |
Hojgaard A.,Regional Hospital Randers
Sexologies | Year: 2010
There are two public sexological clinics in Denmark. The aim of the paper is to describe treatment methods, medical evaluation performed according to diagnosis at referral and the distribution of sexual dysfunctions presented at the only public sexological clinic in Denmark placed in a somatic hospital. The uptake population is three million people. The clinic was founded in 2006 as a unit of a regional gynaecological obstetrical department. Only patients who are not in a concomitant therapy and who are without abuse of alcohol or drugs and without major psychiatric illness or borderline disturbances are admitted. A review of the journals from 2006-2008 has showed the following distribution: the diagnoses among female patients were: hypoactive sexual desire 39.4%, vaginism 21.9%, dyspareunia 12.1%, anorgasmia 3.9%, partner-performance problems 18.8%, other problems 3.9%. The distributions of dysfunctions among male patients were: erectile dysfunction 16.8%, premature ejaculation 7.6%, anejaculation/delayed ejaculation 3.8%, hypoactive sexual disorder 8.8%, hypersexuality 0.8%, partner-performance problems 59.7%, and other problems 2.5%. Treatment is undertaken by a team of consultant gynecologists, nurses and a psychologist. A detailed description of our diagnostic and treatment setup is offered in this paper. The multidisciplinary approach makes a true biopsychosocial approach possible. Thus, hormone replacement therapy, Phosphodiestase type 5 inhibitor (PDE-5) inhibitor treatment and use of antidepressants are combined with intensive therapy. Sensate focus training forms the sexological backbone of the therapy being used as sound in the patients' sexual issues and problem solving abilities. © 2010 Elsevier Masson SAS.