Regional Hospital Silkeborg

Silkeborg, Denmark

Regional Hospital Silkeborg

Silkeborg, Denmark
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Jensen C.,University of Aarhus | Jensen O.K.,Regional Hospital Silkeborg | Christiansen D.H.,University of Aarhus | Nielsen C.V.,University of Aarhus
Spine | Year: 2011

STUDY DESIGN.: Randomized clinical trial comparing two interventions in employees sick-listed 3 to 16 weeks because of low back pain (LBP). OBJECTIVE.: To compare 1-year return to work (RTW), pain, disability and physical and mental health dimensions in subjects offered a hospital-based multidisciplinary intervention or a brief intervention. SUMMARY OF BACKGROUND DATA.: Previous studies in sick-listed employees with LBP have indicated efficacy of both brief and more comprehensive multidisciplinary interventions. However, it remains unknown, which is the more effective, and which elements are instrumental in furthering RTW, and improving health. METHODS.: The brief intervention comprised clinical examination and advice offered by a rehabilitation physician and a physiotherapist. In the multidisciplinary intervention, this intervention was supplemented with the expertise of a team and the assignment of a case manager who drew up a rehabilitation plan in collaboration with the patient and the multidisciplinary team. One-year RTW was estimated by data from a comprehensive national database of social transfer payments. Questionnaires were used to obtain baseline and 1-year data on Roland Morris disability score, LBP Rating Scale, SF36, and fear-avoidance. RESULTS.: A total of 351 patients were included and randomized and 344 (98%) patients participated in all the consultations according to the study protocol. RTW was achieved by 125 (71.0%) participants in the multidisciplinary and 133 (76.0%) participants in the brief intervention group. The hazard ratio was 0.84 after adjustment for sex, age, smoking, compensation claims, disability score, and diagnosis (95% confidence interval [CI]: 0.65-1.08,P = 0.18). Multiple linear regression analysis displayed no differences in secondary outcomes, except for the mental health score (SF36), which was a little higher in the multidisciplinary intervention group than in the brief intervention group. CONCLUSION.: Hospital-based multidisciplinary intervention may be no better than brief intervention to increase RTW and improve health in sick-listed employees with low back pain. Copyright © 2011 Lippincott Williams & Wilkins.

Munch A.,Linköping University | Aust D.,University Hospital | Bohr J.,Örebro University | Bonderup O.,Regional Hospital Silkeborg | And 7 more authors.
Journal of Crohn's and Colitis | Year: 2012

Microscopic colitis (MC) is an inflammatory bowel disease presenting with chronic, non-bloody watery diarrhoea and few or no endoscopic abnormalities. The histological examination reveals mainly two subtypes of MC, lymphocytic or collagenous colitis. Despite the fact that the incidence in MC has been rising over the last decades, research has been sparse and our knowledge about MC remains limited. Specialists in the field have initiated the European Microscopic Colitis Group (EMCG) with the primary goal to create awareness on MC. The EMCG is furthermore a forum with the intention to promote clinical and basic research. In this article statements and comments are given that all members of the EMCG have considered being of importance for a better understanding of MC. The paper focuses on the newest updates in epidemiology, symptoms and diagnostic criteria, pathophysiology and highlights some unsolved problems. Moreover, a new treatment algorithm is proposed on the basis of new evidence from well-designed, randomized control trials. © 2012 European Crohn's and Colitis Organisation.

Jensen C.,University of Aarhus | Jensen O.K.,Regional Hospital Silkeborg | Nielsen C.V.,University of Aarhus
BMC Musculoskeletal Disorders | Year: 2012

Background: Sick-listed employees with low back pain had similar return to work (RTW) rates at one-year follow-up in a randomized trial comparing two interventions, but the effects were modified by specific workplace related factors. The present study addressed the sustainability of the intervention effects by performing a two-year follow-up and by using different outcome measures. Methods. A total of 351 employees sick-listed for 3-16 weeks due to LBP were recruited from their general practitioners and were randomly allocated to a hospital-based brief or multidisciplinary intervention. Outcome measures were based on sick leave registered in a national database of social and health-related benefits. RTW rates, RTW status, sick leave weeks and sick leave relapse were studied. Results: During the two-year follow-up 80.0% and 77.3% had RTW for at least four weeks continuously, and the percentages with RTW at the 104th week were 61.1% and 58.0% in the brief and multidisciplinary intervention groups, respectively. At the 104th week 16.6% and 18.8% were on sick leave in the two groups, respectively, and about 12% were employed in modified jobs or participated in job training. The number of weeks on sick leave in the first year was significantly lower in the brief intervention group (median 14 weeks) than in the multidisciplinary intervention group (median 20 weeks), but during the second year the number of weeks on sick leave were not significantly different between intervention groups. Subgroups characterised by specific work related factors modified the effect of the intervention groups on RTW rates (p=0.017). No difference in sick leave relapse was found between the intervention groups. Conclusion: The effects of the brief and multidisciplinary interventions at the two-year follow-up were in general similar to the effects at one-year follow-up. © 2012 Jensen et al.; licensee BioMed Central Ltd.

Rolving N.,Aarhus University Hospital | Nielsen C.V.,University of Aarhus | Christensen F.B.,Aarhus University Hospital | Holm R.,Regional Hospital Silkeborg | And 2 more authors.
Spine | Year: 2015

Study Design. A randomized clinical trial including 90 patients. Objective. To examine the effect of a preoperative cognitive-behavioral intervention (CBT) for patients undergoing lumbar spinal fusion (LSF) surgery. Summary of Background Data. Few published studies have looked at the potential of rehabilitation to improve outcomes after LSF. Rehabilitation programs using CBT are recommended. Furthermore, initiating interventions preoperatively seems beneficial, but only limited data exist in the field of spine surgery. Methods. Patients with degenerative disc disease or spondylolisthesis undergoing LSF were randomized to usual care (control group) or preoperative CBT and usual care (CBT group). Primary outcome was change in Oswestry Disability Index from baseline to 1-year follow-up. Secondary outcomes were catastrophizing, fear avoidance belief, work status, and back and leg pain. Results. At 1-year follow-up, there was no statistically significant difference between the CBT group and the control group in Oswestry Disability Index score (P = 0.082). However, the CBT group had achieved a significant reduction of -15 points (-26; -4) already at 3 months (between group difference P = 0.003), and this reduction was maintained throughout the year. There were no differences between groups at 1-year follow-up with regard to any of the secondary outcomes. Conclusion. Participating in a preoperative CBT intervention in addition to usual care did not produce better outcomes at 1-year follow-up for patients undergoing LSF. Although the reduction in disability was achieved much faster in the CBT group, resulting in a significant difference between groups already 3 months after surgery, it did not translate into a faster return to work. Our findings support the need for further research into the use of targeted rehabilitation interventions among patients with elevated levels of catastrophizing and fear avoidance beliefs. © 2015, Wolters Kluwer Health, Inc.

Laugesen E.,Aarhus University Hospital | Hoyem P.,Aarhus University Hospital | Stausbol-Gron B.,Aarhus University Hospital | Mikkelsen A.,Aarhus University Hospital | And 8 more authors.
Diabetes Care | Year: 2013

OBJECTIVEdPatients with type 2 diabetes have a high incidence of cardiovascular events including stroke. Increased arterial stiffness (AS) predicts cardiovascular events in the general population. Cerebralwhitematter lesions (WMLs) are associated with an increased risk of stroke. It is unknown whether AS in patients with type 2 diabetes is associated with WMLs. RESEARCH DESIGN ANDMETHODSdWe examined 89 patients recently diagnosed with type 2 diabetes (,5 years) and 89 sex-and age-matched controls. AS was assessed with carotid-femoral pulse wave velocity (PWV). WMLs were identified using magnetic resonance imaging and graded qualitatively with the Breteler scale (no/slight changes = 0, moderate changes = 1, severe changes = 2) and semiquantitatively. RESULTSdThe diabetic population had excellent glycemic control (HbA1c, 6.5% [6.2-6.8]; median [interquartile range {IQR}]) and had, compared with the controls, lower office blood pressure (BP) (127 ± 12/79 ± 8 vs. 132 ± 14/84 ± 10 mmHg) and total cholesterol (4.3[3.9-4.7] vs. 5.6 [5.1-6.4];mmol/L; median [IQR]), (P,0.01 for all). Despite this, PWVwas higher in the patients with diabetes compared with controls (9.3 ± 2.0 vs. 8.0 ± 1.6 m/s; P < 0.0001). PWV was associated with Breteler score (OR 1.36 [95% CI 1.17-1.58]; P < 0.001) and WML volume (OR 1.32 [95%CI 1.16-1.51]; P,0.001) per 1 m/s increase in PWV. These associations remained significant when adjusted for age, sex, diabetes, 24-h mean arterial BP, BMI, heart rate, and use of antihypertensives and statins (Breteler score: OR 1.28 [95% CI 1.03-1.60]; P < 0.05 and WML volume: OR 1.30 [95% CI 1.06-1.58]; P < 0.05). CONCLUSIONSdPWV was higher among patients with well-controlled type 2 diabetes compared with controls and was independently associated with WMLs. PWV may represent a clinically relevant parameter in the evaluation of cerebrovascular disease risk in type 2 diabetes. Copyright © 2013 by the American Diabetes Association.

Lange J.,Aarhus University Hospital | Lange J.,Regional Hospital Silkeborg
Journal of Hand Surgery: European Volume | Year: 2013

This study evaluates the diagnostic value of ultrasound as a first-line exam in carpal tunnel syndrome. In 16 patients with carpal tunnel syndrome and 32 matched controls, evaluation of the median nerve was performed by the cross-sectional area at wrist level and wrist-forearm ratio. This study found statistically significant differences between patients and controls by both methods, and both showed high specificity and positive predictive values. Optimal cut-off values were identified at a 14 mm2 cross-sectional area and a 1.6 wrist-forearm ratio. This study implies that ultrasound evaluation of the median nerve is a valuable tool as a first-line diagnostic test used by the surgeon for examination of patients with presumed carpal tunnel syndrome. Owing to the high positive predictive value of ultrasound, the need for referral to nerve conduction study may be limited. © The Author(s) 2012.

Krogh T.P.,Regional Hospital Silkeborg | Ellingsen T.,Regional Hospital Silkeborg | Ellingsen T.,University of Southern Denmark | Christensen R.,Statistics Denmark | And 2 more authors.
American Journal of Sports Medicine | Year: 2016

Background: Achilles tendinopathy (AT) is a common and difficult to treat musculoskeletal disorder. Purpose: To examine whether 1 injection of platelet-rich plasma (PRP) would improve outcomes more effectively than placebo (saline) after 3 months in patients with AT. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 24 patients with chronic AT (median disease duration, 33 months) were randomized (1:1) to receive either a blinded injection of PRP (n = 12) or saline (n = 12). The primary endpoint was improvement in Victorian Institute of Sports Assessment-Achilles (VISA-A) score at 3 months. Secondary outcomes were pain at rest, pain while walking, pain when tendon was squeezed, ultrasonographic changes in tendon thickness, and color Doppler activity. Patients were informed that they could drop out after 3 months if they were dissatisfied with the treatment. Results: After 3 months, all 24 patients were reassessed (no dropouts). No difference between the PRP and the saline group could be observed with regard to the primary outcome (VISA-A score: mean difference [MD], -1.3; 95% CI, -17.8 to 15.2; P =.868). Secondary outcomes were pain at rest (MD, 1.6; 95% CI, -0.5 to 3.7; P =.137), pain while walking (MD, 0.8; 95% CI, -1.8 to 3.3; P =.544), pain when tendon was squeezed (MD, 0.3; 95% CI, -0.2 to 0.9; P =.208), color Doppler activity (MD, 0.3; 95% CI, -0.2 to 0.8; P =.260), and tendon thickness (MD, 0.8 mm; 95% CI, 0.1 to 1.6 mm; P =.030). After the 3-month follow-up, a large dropout was observed: 75% of patients in the PRP group and 33% in the saline group. Conclusion: PRP injection did not result in an improved VISA-A score over a 3-month period in patients with chronic AT compared with placebo. The only secondary outcome demonstrating a statistically significant difference between the groups was change in tendon thickness; this difference indicates that a PRP injection could increase tendon thickness compared with saline injection. The conclusions are limited to the 3 months after treatment owing to the large dropout rate. © American Orthopaedic Society for Sports Medicine.

Miehlke S.,Center for Digestive Diseases | Hansen J.B.,Aalborg Hospital | Madisch A.,Siloah Hospital | Schwarz F.,University Hospital | And 6 more authors.
Inflammatory Bowel Diseases | Year: 2013

Background: Oral budesonide has been proven effective in short- and long-term treatment of collagenous colitis; however, symptom relapse frequently occurs after drug withdrawal. The aim of this study was to identify the risk factors for symptom relapse in patients with collagenous colitis after withdrawal of short-term budesonide therapy. Methods: One hundred twenty-three patients from 4 randomized controlled studies who achieved clinical remission after short-term treatment with budesonide (9 mg/d) were analyzed, including 40 patients receiving subsequent budesonide maintenance therapy (6 mg/d) for 6 months and 83 patients without active maintenance treatment. Variables available for analysis were age, sex, baseline stool frequency, duration of diarrhea, collagenous band thickness, and lamina propria inflammation. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were calculated by Cox proportional hazard model. Results: The overall symptom relapse rate was 61%. By multivariate analysis, a baseline stool frequency >5 per day (HR, 3.95; 95% CI, 1.08-14.39), history of diarrhea >12 months (HR, 1.77; 95% CI, 1.04-3.03), and the absence of budesonide maintenance therapy (HR, 2.71; 95% CI, 1.37-5.38) were associated with symptom relapse. The time to relapse was shorter in patients with a baseline stool frequency >5 per day (56 versus 199 d, P = 0.024), as in those with history of diarrhea >12 months (56 versus 220 d, P = 0.009). Budesonide maintenance therapy delayed the time to relapse (56 versus 207 d, P = 0.005). Conclusions: Our data demonstrate that a high stool frequency at baseline and a long duration of diarrhea are risk factors for symptom relapse in collagenous colitis, whereas budesonide maintenance therapy is a protective factor against symptom relapse. Copyright © 2013 Crohn's & Colitis Foundation of America, Inc.

Trigger fingers have been reported in the literature for over a century; yet, the lack of trials comparing open surgery to corticosteroid injection is pronounced. At the initiation of the present study in 2010, no randomized controlled trials could be found comparing open surgery to corticosteroid injection. In the present randomized controlled trial, we plan to compare the efficacy of a single ultrasound-guided corticosteroid injection with conventional open surgery in terms of ability to correct the trigger finger. The study is performed as an open-label single-centre, randomised controlled trial with a one-year follow-up. Patients are randomly assigned to either ultrasound-guided corticosteroid injection (n = 83) or to open surgical release of A1-pulley (n = 83). Follow-up is conducted at 12 weeks and one year after treatment. The affected finger will be assessed using a trigger finger score. Furthermore, any treatment complications, absence from work or sport and use of related medical services or additional treatment are also recorded. The present study will be the first to compare treatment of trigger finger by conventional open surgery with ultrasound-guided corticosteroid injection in a randomized controlled trial. The results will contribute to evidence-based recommendations for the treatment of trigger finger patients. not relevant. Danish Data Protection Agency (1-16-02-119-11). The Central Denmark Region Committees on Biomedical Research Ethics (M-20110157). NCT 01486420.

Knudsen S.T.,Regional Hospital Silkeborg
Danish medical bulletin | Year: 2010

Diabetic vascular complications constitute leading causes of blindness, renal failure, and cardiovascular morbidity and mortality world-wide. We studied haemodynamic and structural abnormalities associated with the development of microvascular complications and evaluated the effect of intervention with antihypertensive agents on these risk factors and complications in type 2 diabetic patients (T2DM). Retinal thickness, urinary albumin excretion rate, and transcapillary escape rate of albumin were strongly associated in T2DM patients with maculopathy, suggesting that macular oedema is a marker of generalised vascular hyperpermeability in T2DM. Plasma from T2DM patients with maculopathy stimulated the expression of E-selectin in cultured endothelial cells. Reduced nocturnal blood pressure decline ("non-dipping") and elevated pulse pressure (PP) were associated with micro- and macrovascular complications and predicted progression of nephropathy in T2DM subjects. Non-dipping and elevated PP were associated with increased plasma levels of markers of endothelial activation in T2DM patients, suggesting that endothelial perturbation could represent a pathophysiological link between these haemodynamic risk factors and the development of vascular complications in T2DM. 4 months treatment with losartan 50 mg o.d. did not ameliorate macular oedema in T2DM patients with maculopathy. 12 months dual blockade of the renin-angiotensin system with candesartan and lisinopril reduced ambulatory PP levels compared with high-dose lisinopril monotherapy in hypertensive T2DM subjects.

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