Randers, Denmark
Randers, Denmark

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Glavind J.,Aarhus University Hospital | Kindberg S.F.,Aarhus University Hospital | Uldbjerg N.,Aarhus University Hospital | Khalil M.,Kolding Hospital | And 6 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2013

Objectives To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes. Design Randomised controlled multicentre open-label trial. Setting Seven Danish tertiary hospitals from March 2009 to June 2011. Population Women with uncomplicated pregnancies, a single fetus, and a date of delivery estimated by ultrasound scheduled for delivery by elective caesarean section. Methods Perinatal outcomes after elective caesarean section scheduled at a gestational age of 38 weeks and 3 days versus 39 weeks and 3 days (in both groups ±2 days). Main outcome measures The primary outcome was neonatal intensive care unit (NICU) admission within 48 hours of birth. Secondary outcomes were neonatal depression, NICU admission within 7 days, NICU length of stay, neonatal treatment, and maternal surgical or postpartum adverse events. Results Among women scheduled for elective caesarean section at 38+3 weeks 88/635 neonates (13.9%) were admitted to the NICU, whereas in the 39+3 weeks group 76/637 neonates (11.9%) were admitted (relative risk [RR] 0.86, 95% confidence interval [95% CI] 0.65-1.15). Neonatal treatment with continuous oxygen for more than 1 day (RR 0.31; 95% CI 0.10-0.94) and maternal bleeding of more than 500 ml (RR 0.79; 95% CI 0.63-0.99) were less frequent in the 39 weeks group, but these findings were insignificant after adjustment for multiple comparisons. The risk of adverse neonatal or maternal outcomes, or a maternal composite outcome (RR 1.1; 95% CI 0.79-1.53) was similar in the two intervention groups. Conclusions This study found no significant reduction in neonatal admission rate after ECS scheduled at 39 weeks compared with 38 weeks of gestation. © 2013 RCOG.


Deakin C.D.,University of Southampton | Thomsen J.E.,University of Southampton | Thomsen J.E.,Aarhus University Hospital | Lofgren B.,Aarhus University Hospital | And 3 more authors.
Resuscitation | Year: 2015

Introduction: Safe hands-on defibrillation (HOD) will allow uninterrupted chest compression during defibrillation and may improve resuscitation success. We tested the ability of electrical insulating gloves to protect the rescuer during HOD using a 'worst case' electrical scenario. Materials and method: Leakage current flowing from the patient to the 'rescuer' during antero-lateral defibrillation of patients undergoing elective cardioversion was measured. The 'rescuer' maintained firm (20. kgf) contact with the patient during defibrillation, wearing Class 1 electrical insulating gloves while simulating an inadvertent contact with the patient, through an additional wired contact between 'rescuer' and patient. Results: Data from 61 shocks from 43 different patients were recorded. The median leakage current from all defibrillations was 20.0. μA, (range: 2.0-38.5). In total, 18 of the shocks were delivered at 360. J and had a median leakage current of 27.0. μA (range: 14.3-38.5). Conclusion: When using Class 1 electrical insulating gloves for hands-on defibrillation, rescuer leakage current is significantly below the 1. mA safe threshold, allowing safe hands-on defibrillation if the rescuer makes only one other point of contact with the patient. © 2015 Elsevier Ireland Ltd.


Jensen L.F.,University of Aarhus | Pedersen A.F.,University of Aarhus | Andersen B.,Regional Hospital of Randers | Vedsted P.,University of Aarhus
BMC Cancer | Year: 2012

Background: A population-based breast cancer screening programme was implemented in the Central Denmark Region in 2008-09. The objective of this registry-based study was to examine the association between socio-demographic characteristics and screening participation and to examine whether the group of non-participants can be regarded as a homogeneous group of women.Method: Participation status was obtained from a regional database for all women invited to the first screening round in the Central Denmark Region in 2008-2009 (n=149,234). Participation data was linked to registries containing socio-demographic information. Distance to screening site was calculated using ArcGIS. Participation was divided into 'participants' and 'non-participants', and non-participants were further stratified into 'active non-participants' and 'passive non-participants' based on whether the woman called and cancelled her participation or was a 'no-show'.Results: The screening participation rate was 78.9%. In multivariate analyses, non-participation was associated with older age, immigrant status, low OECD-adjusted household income, high and low level education compared with middle level education, unemployment, being unmarried, distance to screening site >20 km, being a tenant and no access to a vehicle. Active and passive non-participants comprised two distinct groups with different socio-demographic characteristics, with passive non-participants being more socially deprived compared with active non-participants.Conclusion: Non-participation was associated with low social status e.g. low income, unemployment, no access to vehicle and status as tenant. Non-participants were also more likely than participants to be older, single, and of non-Danish origin. Compared to active non-participants, passive non-participants were characterized by e.g. lower income and lower educational level. Different interventions might be warranted to increase participation in the two non-participant groups. © 2012 Jensen et al.; licensee BioMed Central Ltd.


Troelsen T.T.,Aarhus University Hospital | Troelsen T.T.,University of Aarhus | Troelsen T.T.,Regional Hospital of Randers | Granfeldt A.,Aarhus University Hospital | And 3 more authors.
Acta Anaesthesiologica Scandinavica | Year: 2015

Background Cardiovascular dysfunction after cardiac arrest is a common finding. It is unknown whether altered endothelium-mediated vasoreactivity contributes to this dysfunction. We hypothesised that cardiac arrest and resuscitation results in impaired endothelial function. This was addressed by measurements of inflammatory and endothelial plasma markers and of endothelium-dependent vasodilatation in coronary and mesenteric arteries in rats after cardiac arrest and resuscitation. Methods Male Sprague Dawley rats underwent either asphyxia-induced cardiac arrest for 5 min and subsequent resuscitation (n = 30) or a sham procedure (control animals, n = 39). Animals were euthanised after 30 min or 2 h. Blood was analysed for TNF-α, IL-1β, IL-6, IL-10, sE-selectin, sP-selectin, sVCAM-1, ICAM-1, VEGF-α and vWF. Arterial rings of the left anterior descending coronary artery and mesenteric resistance arteries were mounted in microvascular myographs, and concentration-response curves were constructed. Results The plasma levels of the endothelial markers, sP-selectin and vWF increased following cardiac arrest at both 30 min and 2 h. Acetylcholine-induced endothelium-dependent and mainly nitric oxide (NO)-mediated vasodilatation was impaired in the coronary arteries at 30 min, but not 2 h after resuscitation. Endothelium-derived hyperpolarisation (EDH)-type vasodilatation induced by NS309 and vasodilatation induced by the NO donor sodium nitroprusside was unaltered. In parallel with systemic hypotension, mesenteric arteries exhibited a larger response to NS309 2 h after resuscitation. Conclusion The present results show marked endothelial alterations after cardiac arrest and resuscitation reflected by increased endothelial plasma markers, impaired NO-mediated coronary vasodilatation in the early post-resuscitation phase and enhanced EDH-type vasodilatation in mesenteric arteries later in the post-resuscitation phase. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.


Adelborg K.,Aarhus University Hospital | Bjornshave K.,Aarhus University Hospital | Mortensen M.B.,Aarhus University Hospital | Espeseth E.,Aarhus University Hospital | And 2 more authors.
Anaesthesia | Year: 2014

Thirty surf lifeguards (mean (SD) age: 25.1 (4.8) years; 21 male, 9 female) were randomly assigned to perform 2 × 3 min of cardiopulmonary resuscitation on a manikin using mouth-to-face-shield ventilation (AMBU ® LifeKey) and mouth-to-pocket-mask ventilation (Laerdal Pocket Mask™). Interruptions in chest compressions, effective ventilation (visible chest rise) ratio, tidal volume and inspiratory time were recorded. Interruptions in chest compressions per cycle were increased with mouth-to-face-shield ventilation (mean (SD) 8.6 (1.7) s) compared with mouth-to-pocket-mask ventilation (6.9 (1.2) s, p < 0.0001). The proportion of effective ventilations was less using mouth-to-face-shield ventilation (199/242 (82%)) compared with mouth-to-pocket-mask ventilation (239/240 (100%), p = 0.0002). Tidal volume was lower using mouth-to-face-shield ventilation (mean (SD) 0.36 (0.20) l) compared with mouth-to-pocket-mask ventilation (0.45 (0.20) l, p = 0.006). No differences in inspiratory times were observed between mouth-to-face-shield ventilation and mouth-to-pocket-mask ventilation. In conclusion, mouth-to-face-shield ventilation increases interruptions in chest compressions, reduces the proportion of effective ventilations and decreases delivered tidal volumes compared with mouth-to-pocket-mask ventilation. © 2014 The Association of Anaesthetists of Great Britain and Ireland.


BOtker M.T.,Regional Hospital of Randers | BOtker M.T.,Aarhus University Hospital | Vang M.L.,Regional Hospital of Randers | GrOfte T.,Regional Hospital of Randers | And 2 more authors.
Acta Anaesthesiologica Scandinavica | Year: 2014

Background Unexpected cardiopulmonary complications are well described during surgery and anesthesia. Pre-operative evaluation by focused cardiopulmonary ultrasonography may prevent such mishaps. The aim of this study was to determine the frequency of unexpected cardiopulmonary pathology with focused ultrasonography in patients undergoing urgent surgical procedures. Methods We performed pre-operative focused cardiopulmonary ultrasonography in patients aged 18 years or above undergoing urgent surgical procedures at pre-defined study days. Known and unexpected cardiopulmonary pathology was recorded, and subsequent changes in the anesthesia technique or supportive actions were registered. Results A total of 112 patients scheduled for urgent surgical procedures were included. Their mean age (standard deviation) was 62 (21) years. Of these patients, 24% were American Society of Anesthesiologists (ASA) class 1, 39% were ASA class 2, 32% were ASA class 3, and 4% were ASA class 4. Unexpected cardiopulmonary pathology was disclosed in 27% [95% confidence interval (CI) 19-36] of the patients and led to a change in anesthesia technique or supportive actions in 43% (95% CI 25-63) of these. Unexpected pathology leading to changes in anesthesia technique or supportive actions was only disclosed in a group of patients above the age of 60 years and/or in ASA class ≥3. Conclusion Focused cardiopulmonary ultrasonography disclosed unexpected pathology in patients undergoing urgent surgical procedures and induced changes in the anesthesia technique or supportive actions. Pre-operative focused ultrasonography seems feasible in patients above 60 year and/or with physical limitations but not in young, healthy individuals. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.


Glavind J.,Regional Hospital of Randers | Uldbjerg N.,Aarhus University Hospital
Current Opinion in Obstetrics and Gynecology | Year: 2015

Purpose of review The purpose of this article is to critically review the existing literature with regard to neonatal and maternal outcomes after elective cesarean delivery at 38 completed weeks versus 39 completed weeks of gestation. Recent findings Recent observational studies have consolidated previous findings of an increased risk of neonatal composite morbidity, respiratory morbidity, and neonatal admission with elective cesarean delivery at 38 compared with 39 weeks of gestation. In opposition, results from the first randomized trial were recently reported in which there was no significant difference in the risk of neonatal admission with elective cesarean delivery at the two gestational weeks. In the mothers, the risk of adverse outcomes is similar with elective cesarean delivery at 38 or 39 weeks. Though evidence of long-term adverse effects of early-term delivery (primarily spontaneous and vaginally) is accumulating, no data exist to elucidate whether these findings apply to children electively delivered by cesarean section. Summary Neonatal but not maternal adverse events are more frequent with elective cesarean delivery performed at 38 than 39 weeks' gestation. The difference, however, may be significantly smaller than previously anticipated. Further prospective studies, including investigations with focus on the impact of labor onset prior to cesarean delivery, are warranted. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Jensen M.S.,Regional Hospital of Randers
Epidemiology | Year: 2014

BACKGROUND:: Prenatal exposure to phthalates may pose a threat to human male reproduction. However, additional knowledge about the in vivo effect in humans is needed, and reported associations with genital abnormalities are inconclusive. We aimed to study prenatal di(2-ethylhexyl) phthalate (DEHP) and diisononyl phthalate (DiNP) exposure in relation to cryptorchidism, hypospadias, and human fetal Leydig cell function.METHODS:: We studied 270 cryptorchidism cases, 75 hypospadias cases, and 300 controls. Second-trimester amniotic fluid samples were available from a Danish pregnancy-screening biobank (n = 25,105) covering 1980–1996. We assayed metabolites of DEHP and DiNP (n = 645) and steroid hormones (n = 545) by mass spectrometry. We assayed insulin-like factor 3 by immunoassay (n = 475) and analyzed data using linear or logistic regression.RESULTS:: Mono(2-ethyl-5-carboxypentyl) phthalate (5cx-MEPP, DEHP metabolite) was not consistently associated with cryptorchidism or hypospadias. However, we observed an 18% higher (95% confidence interval [CI] = 5%–33%) testosterone level, and a 41% lower (−56% to −21%) insulin-like factor 3 level in the highest 5cx-MEPP tertile compared with the lowest. Mono(4-methyl-7-carboxyheptyl) phthalate (7cx-MMeHP, DiNP metabolite) showed elevated odds ratio point estimates for having cryptorchidism (odds ratio = 1.28 [95% CI = 0.80 to 2.01]) and hypospadias (1.69 [0.78 to 3.67]), but was not consistently associated with the steroid hormones or insulin-like factor 3.CONCLUSIONS:: Data on the DEHP metabolite indicate possible interference with human male fetal gonadal function. Considering the DiNP metabolite, we cannot exclude (nor statistically confirm) an association with hypospadias and, less strongly, with cryptorchidism. © 2014 by Lippincott Williams & Wilkins, Inc


Bor P.,Regional Hospital of Randers | Ledertoug S.,Regional Hospital of Randers | Boie S.,Regional Hospital of Randers | Knoblauch N.O.,Regional Hospital of Randers | Stornes I.,Regional Hospital of Randers
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2016

Objective To investigate whether discontinuation of oxytocin infusion increases the duration of the active phase of labour and reduces maternal and neonatal complications. Design Randomised controlled trial. Setting Department of Obstetrics and Gynaecology, Regional Hospital of Randers, Denmark. Population Women with singleton pregnancy in the vertex position undergoing labour induction or augmentation. Methods Two hundred women were randomised when cervical dilation was ≤4 cm to either continue or discontinue oxytocin infusion when cervical dilation reached 5 cm. Main outcome measures The primary outcome was duration of the active phase of labour, defined as the time period from 5 cm of cervical dilation until delivery. Secondary outcomes were mode of delivery, uterine tachysystole, hyperstimulation, abnormalities in fetal heart rate, postpartum haemorrhage rate, perineal tears, and neonatal outcomes. Results The active phase of labour was longer by 41 minutes (95% confidence interval 11-75 minutes) in the discontinued group (median 125 minutes in 85 women who had reached the active phase and delivered vaginally) versus the continued group (median 88 minutes in 78 women). The incidence of fetal heart rate abnormalities (51 versus 20%) and uterine hyperstimulation (12 versus 2%) was significantly greater in the continued than the discontinued oxytocin group. The incidence of tachysystole, caesarean deliveries, postpartum haemorrhage, third degree perineal tears and adverse neonatal outcomes was higher in the continued group, but did not reach significance. Conclusions Discontinuation of oxytocin infusion in the active phase of labour may improve some labour outcomes but has the disadvantage of increasing the duration of the active phase of labour. Tweetable abstract Stopping oxytocin in the active phase seems to make labour less complicated but lengthens duration. Tweetable abstract Stopping oxytocin in the active phase seems to make labour less complicated but lengthens duration. © 2015 Royal College of Obstetricians and Gynaecologists.


Jensen M.S.,Regional Hospital of Randers | Anand-Ivell R.,Regional Hospital of Randers | Norgaard-Pedersen B.,Regional Hospital of Randers | Jonsson B.A.,Regional Hospital of Randers | And 6 more authors.
Epidemiology (Cambridge, Mass.) | Year: 2015

BACKGROUND: Prenatal exposure to phthalates may pose a threat to human male reproduction. However, additional knowledge about the in vivo effect in humans is needed, and reported associations with genital abnormalities are inconclusive. We aimed to study prenatal di(2-ethylhexyl) phthalate (DEHP) and diisononyl phthalate (DiNP) exposure in relation to cryptorchidism, hypospadias, and human fetal Leydig cell function.METHODS: We studied 270 cryptorchidism cases, 75 hypospadias cases, and 300 controls. Second-trimester amniotic fluid samples were available from a Danish pregnancy-screening biobank (n = 25,105) covering 1980-1996. We assayed metabolites of DEHP and DiNP (n = 645) and steroid hormones (n = 545) by mass spectrometry. We assayed insulin-like factor 3 by immunoassay (n = 475) and analyzed data using linear or logistic regression.RESULTS: Mono(2-ethyl-5-carboxypentyl) phthalate (5cx-MEPP, DEHP metabolite) was not consistently associated with cryptorchidism or hypospadias. However, we observed an 18% higher (95% confidence interval [CI] = 5%-33%) testosterone level, and a 41% lower (-56% to -21%) insulin-like factor 3 level in the highest 5cx-MEPP tertile compared with the lowest. Mono(4-methyl-7-carboxyheptyl) phthalate (7cx-MMeHP, DiNP metabolite) showed elevated odds ratio point estimates for having cryptorchidism (odds ratio = 1.28 [95% CI = 0.80 to 2.01]) and hypospadias (1.69 [0.78 to 3.67]), but was not consistently associated with the steroid hormones or insulin-like factor 3.CONCLUSIONS: Data on the DEHP metabolite indicate possible interference with human male fetal gonadal function. Considering the DiNP metabolite, we cannot exclude (nor statistically confirm) an association with hypospadias and, less strongly, with cryptorchidism.

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