Unintended perioperative hypothermia (UPH) is a common and serious complication for patients undergoing anesthesia. The purpose of this study was to identify the incidence of UPH and evaluate the ...efficacy of a self-warming blanket on the drop in core temperature and risk of UPH in patients undergoing hip or knee arthroplasty.
A case-control study was used.
Sixty patients were included. Thirty patients received prewarming with a self-warming blanket and forced-air warming intraoperatively; thirty patients received only forced-air warming intraoperatively.
The incidence of UPH (<36°C) was identified in 13% of the patients in the prewarmed group and 43% of the patients in the control group. Mean core temperature in the prewarmed group was significantly higher and remained above 36°C in the perioperative period.
The study suggests that preoperative warming with a self-warming blanket reduces the incidence of UPH and decreases the drop in core temperature.
Rationale and objective
Family functioning plays a pivotal role in the adaptation to illness of both individuals and families, especially among elderly patients. The Brief Family Assessment Measure ...Third Edition (Brief FAM‐III) is among the most frequently used self‐report instruments that measures family functioning. However, no Danish translation or measure of its psychometric properties in a Danish population is available. The purpose of this study was to translate the Brief FAM‐III into Danish and then evaluate its psychometric properties in elderly patients.
Methods
The Brief FAM‐III was translated into Danish using the forward–backward translation procedure and examined its psychometric properties in 60 elderly patients (aged over 65) consecutively admitted to an acute medical ward. Internal consistency reliability was assessed by Cronbach's alpha coefficients, and confirmatory factor analysis was used to examine the construct validity of the Brief FAM‐III.
Results
Evaluation of the Danish version of the Brief FAM‐III confirmed the three‐factor structure (General Scale, Self‐Rating Scale and Dyadic Relationships Scale) identified in the original instrument. However, goodness‐of‐fit indicators showed a relatively poor model fit. Cronbach's alpha for the total scales of Brief FAM‐III was 0.94 suggesting good internal consistency.
Conclusions
The Danish version of the Brief FAM‐III demonstrated satisfactory validity and reliability to assess family functioning among acutely admitted elderly Danish patients. We suggest that it may also be useful for monitoring family functioning over time or determining the effects of therapeutic interventions in elderly medical patients; however, further testing is recommended.
Financial incentives for quality improvement in hospital care known as pay for performance (P4P) can be directed to either the hospital level or redistributed to the department level. Theoretically, ...performance payments distributed to lower organisational levels are more effective in increasing performance than payments directed to the hospital level, but the empirical evidence for this expectation is scarce. This paper compares the performance of hospital departments at hospitals that do and do not redistribute performance payments to the department level. We study a Danish P4P scheme to provide patients with case managers. Applying difference in differences analysis, we estimate a 5 percentage points higher performance at hospital departments that are subject to a direct financial incentive. Our results suggest that payers can improve the effectiveness of P4P payments by distributing payments to the department level rather than the hospital level.
Aims and objectives
To assess the impact of family health conversations (FamHC) as a supplement to conventional care on health‐related quality of life (HRQoL), family functioning (FFSS) and family ...hardiness or resilience (FHI) 4 and 14 weeks postoperatively among patients with glioblastoma multiforme and their family members.
Background
There is a lack of knowledge about the efficiency of FamHC among families experiencing glioblastoma multiforme.
Design
A quasi‐experimental pre‐ and post‐test design adhering to the STROBE (Strengthening the reporting of observational studies in epidemiology) guidelines for case–control studies. Patients and family members were included consecutively in the pretest period from November 2013–December 2014 for the control group (offered traditional care only), and in the post‐test period from January 2015–December 2015 for the intervention group (offered traditional care and FamHC). For both groups, 4 and 14 weeks postoperative measurement were obtained.
Methods
Differences in outcomes were assessed using a difference‐in‐difference regression analysis approach measuring difference across pre and post groups and across 4 and 14 weeks measurements.
Results
The study does not reveal significant effects of FamHC (all p‐values larger than 0.05) as measured by the three instruments WHOQOL‐BREF, FFSS and FHI.
Conclusions
The present study was not able to show significant effects of FamHC. However, it cannot be left out that the intervention might be helpful and supportive at a later state of the illness trajectory.
Relevance for clinical practice
The study adds to the growing evidence‐based knowledge on FamHC by questioning their potential use in different cultural contexts among families experiencing critical illness. Oncological nurses need to adapt this information to support their daily care for the patients and their close relatives. For future studies, it is recommended that the families themselves choose when the conversations should take place during the course of the illness.
Blood-barrier (BBB) breakdown and active inflammation are hallmarks of relapsing multiple sclerosis (RMS), but the molecular events contributing to the development of new lesions are not well ...explored. Leaky endothelial junctions are associated with increased production of endothelial-derived extracellular microvesicles (EVs) and result in the entry of circulating immune cells into the brain. MRI with intravenous gadolinium (Gd) can visualize acute blood-barrier disruption as the initial event of the evolution of new lesions.
Here, weekly MRI with Gd was combined with proteomics, multiplex immunoassay, and endothelial stress-optimized EV array to identify early markers related to BBB disruption. Five patients with RMS with no disease-modifying treatment were monitored weekly using high-resolution 3T MRI scanning with intravenous gadolinium (Gd) for 8 weeks. Patients were then divided into three groups (low, medium, or high MRI activity) defined by the number of new, total, and maximally enhancing Gd-enhancing lesions and the number of new FLAIR lesions. Plasma samples taken at each MRI were analyzed for protein biomarkers of inflammation by quantitative proteomics, and cytokines using multiplex immunoassays. EVs were characterized with an optimized endothelial stress EV array based on exosome surface protein markers for the detection of soluble secreted EVs.
Proteomics analysis of plasma yielded quantitative information on 208 proteins at each patient time point (
= 40). We observed the highest number of unique dysregulated proteins (DEPs) and the highest functional enrichment in the low vs. high MRI activity comparison. Complement activation and complement/coagulation cascade were also strongly overrepresented in the low vs. high MRI activity comparison. Activation of the alternative complement pathway, pathways of blood coagulation, extracellular matrix organization, and the regulation of TLR and IGF transport were unique for the low vs. high MRI activity comparison as well, with these pathways being overrepresented in the patient with high MRI activity. Principal component analysis indicated the individuality of plasma profiles in patients. IL-17 was upregulated at all time points during 8 weeks in patients with high vs. low MRI activity. Hierarchical clustering of soluble markers in the plasma indicated that all four MRI outcomes clustered together with IL-17, IL-12p70, and IL-1β. MRI outcomes also showed clustering with EV markers CD62E/P, MIC A/B, ICAM-1, and CD42A. The combined cluster of these cytokines, EV markers, and MRI outcomes clustered also with IL-12p40 and IL-7. All four MRI outcomes correlated positively with levels of IL-17 (
< 0.001, respectively), and EV-ICAM-1 (
< 0.0003, respectively). IL-1β levels positively correlated with the number of new Gd-enhancing lesions (
< 0.01), new FLAIR lesions (
< 0.001), and total number of Gd-enhancing lesions (
< 0.05). IL-6 levels positively correlated with the number of new FLAIR lesions (
< 0.05). Random Forests and linear mixed models identified IL-17, CCL17/TARC, CCL3/MIP-1α, and TNF-α as composite biomarkers predicting new lesion evolution.
Combination of serial frequent MRI with proteome, neuroinflammation markers, and protein array data of EVs enabled assessment of temporal changes in inflammation and endothelial dysfunction in RMS related to the evolution of new and enhancing lesions. Particularly, the Th17 pathway and IL-1β clustered and correlated with new lesions and Gd enhancement, indicating their importance in BBB disruption and initiating acute brain inflammation in MS. In addition to the Th17 pathway, abundant protein changes between MRI activity groups suggested the role of EVs and the coagulation system along with innate immune responses including acute phase proteins, complement components, and neutrophil degranulation.
This longitudinal study examined the influence of child-specific and environmental factors on the development of English receptive vocabulary and grammar by two groups of Danish children: Early ...Starters (ES) and Late Starters (LS). Age of onset, gender, language aptitude and SES significantly predicted both outcome measures. English competence beliefs (ECB) were positively related to L2 proficiency but only for children with low foreign language classroom anxiety (FLCA), suggesting a dynamic relationship between ECB and FLCA. Extramural audiovisual viewing and reading played a differential role for ES vs. LS whereas extramural English speaking significantly interacted with gender. Finally, child-specific factors explained more of the variance in English proficiency than environmental factors. This finding, which contradicts results obtained in instructed settings (e.g., Sun, Steinkrauss, Tendeiro & de Bot, 2016) but parallels those in naturalistic settings (e.g., Paradis, 2011), supports the special status of English in countries with a high degree of informal contact with English.
It is unknown whether lockdown due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may affect both clinical outcome in kidney transplant recipients and health care economics in ...Denmark.
We compared kidney transplant data at a tertiary university hospital before and during the lockdown period from March 13, 2020 until March 31, 2021, as well as kidney transplant data from Scandiatransplant for entire Denmark. Outcome variables included fall of plasma creatinine during the first postoperative day, and graft function three months posttransplant. We calculated the quality-adjusted life-years (QALYs) and costs which were caused by the lockdown recommendations.
The portion of living donation kidney transplantation was largely reduced during the lockdown period compared to before the lockdown: AB0-incompatible living donation declined from 14% to 7% (P < 0.01), and AB0-compatible living donation declined from 34% to 20% (p < 0.01).
In entire Denmark during the lockdown period 78 living donor kidney transplants out of 268 kidney transplants (29%) were performed, whereas there were 878 living donor kidney transplants out of 2218 kidney transplants (39%) before the lockdown (P = 0.01).
The observed reduction of living donor kidney transplants and consecutive reduction of graft survival will cause a loss of 5.04 QALYs.
The additional costs in kidney transplant recipients who received a kidney transplant during the lockdown period will be 277,298 EUR.
SARS-CoV-2 lockdown period largely reduced living donation kidney transplants which will lead to reduced QALY as well as higher costs in kidney transplant recipients.
SARS-Cov-2; Lockdown; Kidney transplantation; Kidney allograft function; QALY.
Intravenous lidocaine has been shown to have analgesic effects leading to a reduced post-operative opiate need, but this effect is still debated in various surgical populations. We investigated ...whether this effect could be demonstrated in robot-assisted colorectal surgery.
A total of 60 adult patients undergoing robot-assisted colorectal surgery were randomly assigned to two groups in this prospective, double-blinded trial. The lidocaine group was treated with intravenous lidocaine. Treatment was initiated before induction of anaesthesia with a bolus of 1.5 mg/kg and immediately followed by infusion of 1.5 mg/kg/h continued until 2 h after end of surgery. The control group received placebo treatment with an equal volume and a dosing of 0.9% saline. The follow-up period was 72 h.
No significant difference between groups in the median cumulated morphine consumption at 24 and 72 h was observed. Nor were there any differences in pain score, use of antiemetics, time until flatus and/or defecation or length of hospital stay.
In this randomised, double-blinded, prospective study using intravenous lidocaine versus 0.9% saline in robot-assisted colorectal surgery, we found no significant difference in post-operative cumulated morphine consumption at 24 or at 72 h.
The study received funding from DASAIMs Forskningsinitiativ (2016) and DASAIMs Smerteforskningspris (2016).
The trial is registered with EudraCT (2014-003466-25) and ClinicalTrials.gov (ID: NCT03044808).
A three-dimensional (3D) X-ray tomogram evaluation gives a full view of the bone distribution around an entire implant in contrast to the often-used two-dimensional (2D) histological methods. ...High-resolution X-ray absorption tomography was used to evaluate the 3D bone growth around dental implants in an experimental goat mandible reconstruction model. The tomograms allowed for the construction of virtual histological cross-sections that could be used to evaluate the statistical uncertainty of the histological methods, which was the purpose of this paper. The virtual 2D histological results showed a significantly higher uncertainty within the same sample than did the full 3D volume results.
Goal-directed therapy (GDT) is increasingly used in abdominal surgery. Whether crystalloids can exert the same effect as colloid, and how this may affect perfusion, is still unclear. The effect of ...GDT on the systemic oxygen delivery index (sDO2I) and the mesenteric oxygen delivery index (mDO2I) can be quantified by measuring cardiac index and flow in the superior mesenteric artery, respectively.
The aim of this study was to test the hypothesis that intra-operative GDT with bolus human albumin 5% is superior to GDT with bolus ringer acetate in maintaining sDO2I and mDO2I in elective major upper gastrointestinal cancer surgery.
Randomised controlled double blinded trial.
Odense University Hospital, Denmark, from May 2014 to June 2015.
A total of 89 adults scheduled for elective major upper gastrointestinal cancer surgery were randomised and data from 60 were analysed.
contraindications for using the LiDCOplus system, known allergy to albumin, pre-operative renal failure, pancreatic cancer and pre-operative down staging using chemotherapy and/or radiation therapy, pregnancy.
Patients were randomised to intra-operative GDT with either bolus human albumin or ringer acetate 250 ml, guided by pulse pressure variation and stroke volume.
Changes in sDO2I and mDO2I. Secondary outcomes were changes in other haemodynamic variables, fluid balance, blood transfusions, fluid-related complications and length of stay (LOS) in ICU and hospital.
Median IQR sDO2I was 522 420 to 665 ml min m in the ringer acetate group and 490 363 to 676 ml min m in the human albumin group, P = 0.36. Median IQR mDO2I was 12.1 5.8 to 28.7 ml min m in the ringer acetate group and 17.0 7.6 to 27.5 ml min m in the human albumin group, P = 0.17. Other haemodynamic comparisons did not differ significantly. More trial fluid was administered in the ringer acetate group. We found no significant difference in transfusions, complications or LOS.
Bolus human albumin 5% was not superior to bolus ringer acetate in maintaining systemic or mesenteric oxygen delivery in elective major upper gastrointestinal cancer surgery, despite the administration of larger volumes of trial fluid in the ringer acetate group. No significant difference was seen in fluid-related complications or LOS.
https://eudract.ema.europa.eu/ Identifier: 2013-002217-36.
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