Danish medical journal
-
This thesis is comprised of three studies focusing on severe postpartum haemorrhage (PPH). PPH is a major cause of maternal morbidity and mortality worldwide. Risk factors include retained placenta, prolonged duration of the third stage of labour, previous caesarean section, and operative vaginal delivery. ⋯ There was a difference in distribution of causes depending on the cut-off used, with atony playing a decreasing role and a retained placenta an increasing role the higher the cut-off used. In a multivariate linear regression model retained placenta was identified as a strong predictor of quantity of blood loss. The duration of the third stage of labour was a very weak predictor after adjusting for the influence of a retained placenta. In conclusion, an improved diagnosis of the causes of PPH especially retained placenta, together with an early recognition and treatment of coagulopathy, seem to be important in reducing severe PPH in an aim to minimize associated maternal morbidity.
-
Danish medical journal · Mar 2018
ReviewFrom acute to chronic postsurgical pain: the significance of the acute pain response.
The thesis comprises an overview and four papers, all published or submitted for publication in international peer-reviewed scientific journals. Chronic pain after surgery is a common and debilitating complication after many types of surgery. The cause and pathology behind is still mainly uncovered, though several risk factors have been proposed. One of the strongest risk factors for persistent postsurgical pain is the intensity of the acute pain response though the mechanisms involved remain unsettled. ⋯ Absolute and relative risk reductions were 44% (95% CI 22-67%) and 65% (95% CI 41-80%), respectively. No major complications, including respiratory compromise, were observed. Subsequent treatment with a nerve catheter was effective during the first 36 hours after surgery, but because of loss of nerve catheter or early submission of patients, data concerning pain the following days and after 3 months were inconclusive.
-
Danish medical journal · Mar 2018
ReviewPulmonary artery perfusion versus no pulmonary per-fusion during cardiopulmonary bypass.
During conventional cardiopulmonary bypass (CPB) there is no active perfusion of the pulmonary circulation and the mechanical ventilation is ceased leaving the lungs exposed to warm ischemia. Pulmonary dysfunction is seen in varying degrees after major surgery, but more severe in cardiac surgery patients probably due to the effects of CPB. The evidence for effect and safety are limited, but active pulmonary artery perfusion during CPB could be beneficial for the patients' postoperative oxygenation. Our aim was in a randomised clinical trial to assess primarily the effect of pulmonary artery perfusion during CPB on postoperative oxygenation in patients diagnosed with chronic obstructive pulmonary disease (COPD), secondarily to assess other possible benefits and harms. Furthermore, we wanted in a systematic review with meta-analyses of all randomised clinical trials to investigate the pooled effects of pulmonary artery perfusion during CPB. We planned and conducted a randomised, partly blinded, clinical trial assigning cardiac surgery patients diagnosed with COPD to receive pulmonary artery perfusion with oxygenated blood or histidine-tryptophan-ketoglutarate (HTK) solution compared to no pulmonary perfusion during CPB. ⋯ Pulmonary artery perfusion with HTK solution did not result in an improved oxygenation. In line with this, the systematic review including data from additional trials showed a possible association between pulmonary artery perfusion with blood and improved oxygenation, but no significant associations with mortality, serious adverse events or intubation time. However, all data are too sparse to be conclusive.
-
Danish medical journal · Feb 2018
ReviewEarly warning score challenges and opportunities in the care of deteriorating patients .
Clinical deterioration of patients hospitalized on general wards is often preceded by worsening vital signs. If identified early and acted upon quickly, it is conjectured that further deterioration can be prevented. To this means the early warning score (EWS) was implemented in all hospitals in the Capital Region of Denmark in 2013. ⋯ Of 3185 patients screened for eligibility, 1346 patients were included to the trial, and data from 544 patients were available for final analysis. Of these 49 % percent were allocated to the 8h group and 51% to the 12h group; of these, 23% and 20% had an elevated EWS≥2 at 24h, respectively (p=0.456), OR 1.17 (0.78-1.76). There were no significant differences in regard to the secondary outcomes: cardiac arrests, ICU admissions, review by MET, length of hospital stay, mortality, or elevated EWS at 48h.
-
Background Keeping up with the evidence and implementing it into the daily care for patients are fundamental prerequisites for delivering a high quality of care in general practice. However, despite many years of research into dissemination and implementation of evidence-based recommendations, significant challenges remain. In recent years, organisational factors have become widely acknowledged as vitally important for ensuring successful implementation. ⋯ This variation should be taken into consideration when developing quality improvement initiatives or interventions. Thus, knowledge of which approaches are used in specific practice settings could prove essential when deciding where to put the focus and support. Finally, the study indicates that important factors to be considered in that respect are the presence of formalised implementation activities in the practices as some degree of formalisation appears to contribute to sustaining a high quality of care by supporting implementation of evidence-based recommendations.