Danish medical journal
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Danish medical journal · Apr 2013
ReviewAssociations between sedation, delirium and post-traumatic stress disorder and their impact on quality of life and memories following discharge from an intensive care unit.
In the intensive care units (ICUs) sedation strategies have changed in the past decade towards less sedation and daily wake-up calls. Recent studies indicate that no sedation (after intubation) is most beneficial for patients. A smaller number of these patients have been assessed for post-traumatic stress disorder (PTSD) after ICU discharge, but none of them were assessed for delirium while in the ICU. In other studies, delirium in the ICU is described as distressing for the patients and increasing morbidity, i.e. dementia after discharge and mortality. The associations between sedation, delirium, and PTSD have not previous been described. The aim of this PhD study was to investigate: 1) how sedation is associated with delirium in the ICU, 2) the consequences of delirium in relation to PTSD, anxiety, and depression, 3) the consequences of delirium for the patients' memories from ICU and the health-related quality of life after discharge. In a prospective observation study with patients admitted a minimum of 48 hours to the ICUs in Aarhus or Hillerød, we included all patients aged > 17 years. Non-Danish-speaking, patients transferred from other ICUs and patients with brain injury that made delirium-assessment impossible were excluded. Patients were interviewed face-to-face after 1 week, and at 2 months and 6 months by telephone using six different questionnaires. Among 3,066 patients admitted to the ICUs, 942 fulfilled the inclusion criteria. Primarily due to the inability to test for delirium, 302 patients were later excluded. Of the remaining 640 patients, 65% were delirious on 1 or more days. Fluctuations in sedation levels increased the risk of delirium statistically significantly with or without adjustments for age, gender, severity of illness, surgical/medical patient, or ICU site. After 2 months vs. 6 months, 297 patients vs. 248 patients were interviewed. PTSD was found in 7% vs. 5%, anxiety in 6% vs. 4%, and depression in 10% at both interviews. Delirium had no association with any of the psychometric results. Memories of delusion and memories of feelings were statistically significantly associated with delirium and with the psychometric outcomes, whereas memories of facts had no association with the psychometric outcomes. Health-related quality of life (SF-36) was statistically significantly decreased in most of the domains if patients had PTSD, anxiety, or depression but was not associated with delirium or the type of memories. ⋯ Fluctuations in the level of sedation of patients in the ICU increased the incidence of delirium, but the delirium did not affect the risk of PTSD, anxiety, or depression. These were, however, affected by the type of memories the patients had. Health-related quality of life (SF-36) was decreased if patients had PTSD, anxiety, or depression but was unaffected by memories of the ICU and the presence of delirium while in the ICU.
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Danish medical journal · Apr 2013
Randomized Controlled Trial Comparative StudyLate group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty.
This study aimed to test whether group-based rehabilitation focusing on strength training, education and self-management is more effective than individual, supervised home-training after fast-track total knee arthroplasty (TKA). ⋯ This study was funded by Holstebro Municipality, Region of Central Jutland, and Lundbeck Centre for Fast-Track Hip and Knee Surgery.
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Danish medical journal · Apr 2013
ReviewIntracranial meningiomas, the VEGF-A pathway, and peritumoral brain oedema.
Meningiomas are the second-most common intracranial tumours in adults. They are derived from the arachnoid cells, and although approximately 90% of meningiomas are benign, more than half of all meningiomas develop peritumoral brain oedema (PTBE), which increases morbidity. The PTBE can be treated with steroid therapy, but this treatment is not specific, is not always effective, and involves long-term side-effects. ⋯ Further comparison between the two meningioma groups shows that mean VEGF-A mRNA, VEGFR-2 protein, and neuropilin-1 mRNA is significantly higher and neuropilin-1 protein is lower in the angiomatous meningiomas. We believe that the VEGF-A pathway participates in the formation of PTBE in meningiomas by inducing formation of "leaky" capillaries, resulting in secretion of VEGF-A and plasma to the peritumoural brain tissue. It may therefore be worth pursuing therapies targeted directly against VEGF-A and its receptors through drugs like bevacizumab, sorafenib, sunitifib, and cediranib.
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Danish medical journal · Apr 2013
ReviewAdvances in autologous chondrocyte implantation and related techniques for cartilage repair.
Articular cartilage is a specialized tissue exhibiting low intrinsic capabilities of regeneration or healing after injury. Autologous chondrocyte implantation (ACI) and scaffold-supported ACI are often used for treatment of larger chondral defects (> 2 cm2). These utilize open surgery re-implantation of ex vivo cultured autologous chondrocytes harvested as a biopsy arthroscopically in a prior surgery. ⋯ Lastly, we found that there was no positive effect in vivo of adding dermatan sulfate to MPEG-PLGA scaffold in osteochondral repair. We conclude that while the outcome of ACI-related treatments certainly is multifactorial it may be improved by optimizing the in vitro culture by hypoxic and 3D culture and by adjusting the chondrocyte seeding density. Our studies on biomaterials and potential system for cell tracking in vivo did not show results that justified further studies and clinical trials.