Danish medical journal
-
Danish medical journal · Jul 2016
Immunoglobulin for necrotising soft tissue infections (INSTINCT): protocol for a randomised trial.
Necrotising soft tissue infections (NSTI) are aggressive infections that can result in severe disability or death. Intravenous polyspecific immunoglobulin G (IVIG) is used as supplementary treatment for patients with NSTIs. The level of evidence is very low, but suggests that IVIG may have beneficial effects. However, IVIG may also have adverse effects. With this trial we will estimate the effects of IVIG on a patient-reported outcome and other patient-centred outcomes in patients with NSTI. ⋯ The trial is supported by CSL Behring in the form of trial medication and a € 92,182 grant for trial conduct, research, nurse salary and statistical analyses.
-
Ventral hernia repairs are among the most frequently performed surgical procedures. The variations of repair techniques are multiple and outcome has been unacceptable. Despite the high volume, it has been difficult to obtain sufficient data to provide evidence for best practice. ⋯ Based predominantly on nationwide data, the present thesis has accomplished pioneering results on outcome from ventral hernia repairs. The results have inspired to increased research and the development of other ventral hernia databases, as well as pointed out a number of risk factors for poor outcome and future challenges in ventral hernia surgery. DVHD and similar registers have a huge potential and can serve as an essential and important platform for further improvement of ventral hernia surgery in the future.
-
With long-term follow-up, the DBCG 77B trial demonstrates that oral single-agent cyclophosphamide significantly reduces the risk of recurrence and mortality as compared with no systemic therapy in pre-menopausal patients with high-risk early breast cancer. DBCG 77B is the only randomised trial assessing single-agent cyclophosphamide; and a second comparison suggests that its benefits are comparable to what may be achieved by classic CMF. The lack of benefits from adding methotrexate and fluorouracil to cyclophosphamide paved the way for combining cyclophosphamide with anthracyclines and later taxanes. ⋯ In addition to age, tumour size, nodal status, histological type and malignancy grade, the PSI also includes ER level addressed as a continuous variable in the MFP model. In the MFP model, absence of LVI was sufficient to counteract the impact of other risk factors, while that could not be achieved with a categorical multivariate model in a prior study. An evaluation of whether the addition of results from a molecular assay may improve the clinical utility of the PSI is on-going, but when used alone evidence from such assays has been insufficient.
-
Danish medical journal · May 2016
ReviewPreoperative airway assessment - experience gained from a multicentre cluster randomised trial and the Danish Anaesthesia Database.
Difficulties with airway management in relation to general anaesthesia have been a challenge for the anaesthesiologist since the birth of anaesthesia. Massive landmark improvements have been made and general anaesthesia is now regarded as a safe procedure. However, rare, difficult airway management still occurs and it prompts increased risk of morbidity and mortality - especially when not anticipated. ⋯ In a cluster randomised trial it was not possible to reduce the proportion of unanticipated difficult intubation in daily clinical practice by implementing a systematic approach for airway assessment compared with usual care. However, implementation of the SARI may increase the anticipation of intubation difficulties and it may change practice towards advanced intubation techniques. This thesis underlines the continued challenge anaesthesiologists face in predicting airway management related difficulties.
-
Danish medical journal · Apr 2016
ReviewPostoperative red blood cell transfusion strategy in frail anemic elderly with hip fracture. A randomized controlled trial.
Hip fracture in the elderly is associated with poor recovery from physical disability and mortality. Perioperative blood loss is common, and anemia might be fatal in the frail elderly. Red blood cell transfusions might increase the risk of infection. ⋯ Physical performance was improved from 30 days to one year after fracture in patients treated according to the liberal strategy and was associated with better progress of OQoL in the same period. We conclude that according to our used Hb thresholds, the liberal Hb target of 7 mmol/l (11.3 g/dl) improves survival in the frailest elderly (the nursing home residents) without impairing recovery from physical disabilities and OQoL or increasing risk of infections compared to the restrictive Hb target of 6 mmol/l (9.7 g/dl). The liberal strategy seems to improve recovery of physical performance within one year after hip fracture surgery which was associated with better overall QoL.