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1 ORSKNINGE DAG FORSKNINGENS DAG FORSKNIN GENS DAG FORSK GENS FORSKNINGE DAG Forskningens dag den 24. april 204 Abstracts Hospitalsenhed Midt

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3 Program Forskningens dag Velkomst Foredragssession I Pause med mulighed for at se posters Foredragssession II Forskningssamarbejdet mellem HE Midt og Aarhus Universitet ved Tove Kristensen, sygeplejefaglig direktør, Hospitalsenhed Midt Præmieoverrækkelse og afslutning Session I Leif Rognås m.fl., Anæstesi- og Operationsafdelingen Can an end-tidal CO 2.33 kpa predict lack of return of spontaneous circulation during pre-hospital cardiac arrest? 2. Thomas Balslev m.fl., Børneafdelingen Improving clinical reasoning at in-patient rounds by bimodal presentation schemes and buzz groups 3. Bodil Bjørnshave Noe m.fl., Vestdansk Center for Rygmarvsskade The incidence of traumatic spinal cord injury in Denmark, : A hospital-based study 4. Pernille Endrup Jacobsen m.fl., Afdeling for Regional Specialtandpleje Prenatal exposure to antiepileptic drugs and dental agenesis 5. Linda Jeffery m.fl., Hospitalsapoteket Pharmacist identification of potential side-effects in patients with multimorbidity and polypharmacy Moderator: Ledende overlæge, dr.med. Jan Abrahamsen, Klinisk Fysiologisk Afdeling. Session II Lone Ramer Mikkelsen m.fl., Center for Planlagt Kirurgi Effect of early progressive resistance training compared to home based exercise after fast track total hip replacement. A single-blinded randomized controlled trial 2. Michael Festersen Nielsen, Kirurgisk Afdeling Increased glucose production during insulin-induced hypoglycaemia in hepatic denervated pigs evidence for a neuronal dependence of hepatic counterregulation 3. Therese Simonsen Straarup m.fl., Anæstesi- og Operationsafdelingen The effect of volatile anesthetic preconditioning on cardiac troponins during CABG surgery: A systematic review and meta-analysis 4. Marie Dahl Thomsen m.fl., Karkirurgisk Afdeling Non-attendance in a screening programme for cardiovascular diseases (CVD) and diabetes (DM) among Danish women 5. Lise Thomsen m.fl., Fertilitetsklinikken, Kvindeafdelingen The impact of male overweight on semen quality and outcome of assisted reproduction Moderator: Specialeansvarlig overlæge Henning Glerup (gastroenterologi & hepatologi), Medicinsk Afsnit, Diagnostisk Center. Hvert oplæg har en varighed af otte minutter, herefter er der afsat to minutter til diskussion. 3

4 Foredrag på Forskningens dag SESSION I:. Can an end-tidal CO 2.33 kpa predict lack of return of spontaneous circulation during pre-hospital cardiac arrest? Improving clinical reasoning at in-patient rounds by bimodal presentation schemes and buzz groups The incidence of traumatic spinal cord injury in Denmark, : A hospital-based study Prenatal exposure to antiepileptic drugs and dental agenesis Pharmacist identification of potential side-effects in patients with multimorbidity and polypharmacy... SESSION II:. Effect of early progressive resistance training compared to home based exercise after fast track total hip replacement. A single-blinded randomized controlled trial Increased glucose production during insulin-induced hypoglycaemia in hepatic denervated pigs evidence for a neuronal dependence of hepatic counterregulation The effect of volatile anesthetic preconditioning on cardiac troponins during CABG surgery: A systematic review and meta-analysis Non-attendance in a screening programme for cardiovascular diseases (CVD) and diabetes (DM) among Danish women The impact of male overweight on semen quality and outcome of assisted reproduction... 6 Øvrige indleverede abstracts til Forskningens dag. Diagnostik af jejunal diverticulitis som årsag til akut abdomen Pre-hospital advanced airway management by experienced anaesthesiologists: A prospective descriptive study Anaesthesiologist-provided prehospital airway management in patients with traumatic brain injury: An observational study Standard operating procedure changed pre-hospital critical care anaesthesiologists behaviour: A quality control study Effects of Roux-en-Y gastric bypass surgery on insulin action and glucose intolerance in morbidly obese patients Understanding the back patient. A systematic review based on thematic analysis Patient avatar identification as vicarious experience in animation video education on spinal anesthesia

5 8. Helkrops MR-skanning versus helkrops FDG-PET/CT til detektion af tumorudbredelse og fjernmetastaser ved nydiagnosticeret malign sygdom hos voksne A new point-of-care analyzer for rapid and highly precise determination of lipid profile and HbAc Ambulant 24 timers bestemmelse af pulsbølgehastighed og aorta blodtryk: Et pilot projekt The surviving sepsis campaign: Are we playing by the rules? Feasibility and effectiveness of structured hospital based nurse-led atrial fibrillation service Kvalitetssikring af 2. generations endometriablation Returning home after traumatic spinal cord injury, - patients wishes and worries Validering af OSATS (Objective Structured Assessment of Technical Skills) til diagnostik af vaginal og perinealbristning i forbindelse med vaginal fødsel Cholecystitbehandling hos gravide sent i tredje trimester Paraurethral leiomyom En casepræsentation In hospital cardiac arrest primary rhythm-analysis FAST-TRACK DIAGNOSTICS: Exploring how cancer pathways frame clinical encounters and the configuration of patient and health professional identities A prevalence study of pressure ulcers in Viborg Regional Hospital, Denmark Predicting failure of conventional disease modifying antirheumatic drugs in 230 treatment naive early rheumatoid arthritis patients: A single centre inception prognostic factor cohort study Dagens case sætter fokus på læring om det akutte barn, infektioner, neonatologi og neurologi Endometriel stromal nodulus en sjælden patologisk udfordring Modified Delphi method: A method to evaluate the clinical relevance of a pharmacist s recommendations Validation of self-obtained vaginal smears to assess the relationship between bacterial vaginosis, the vaginal microbiome and adverse outcomes in obstetrics and gynecology Experimental induction of infrarenal aortic aneurysms in a large porcine animal model Telemedicine-support in total hip replacement: Length-of-stay halved without loss of quality compared to standard fast-track procedure Graviditet efter gastric-bypass operation. Har operations-konceptionsintervallet betydning for obstetriske og neonatale komplikationer? Diagnosing and treatment of chronic exertional compartment syndrome in young active patients Multidisciplinært behandlingstilbud til overvægtige børn på Regionshospitalet Viborg Comparison of 3D ultrasound volumetric quantification and CT angiography in larger abdominal aortic aneurysms

6 32. Use of coronary computed tomography angiogram in patients with ischemic heart disease: Insight from a large single-center registry Combination of myocardial perfusion imaging and coronary CT scanning in patients considered for revascularization: Pre-study results Det er bare en overgang. En undersøgelse af patientovergange på operationsafsnittet Ambulatory blood pressure monitoring in spinal cord injury Spinal cord injury, Cystatin-C and lean body mass is there a correlation? Measuring psychological outcomes following spinal cord injury Heterotopic ossification in spinal cord injury The effect of Normast (PEA) in neuropathic pain in spinal cord injury The effect of Sativex in neuropathic pain and spasticity in spinal cord injury SCI-databasen. En klinisk rygmarvsskade database, der giver gode forskningsdata og styrker patient-empowerment Effekt af hypertonisk saltvandsinhalation på indlæggelsesvarigheden ved infektion med respiratorisk syncytial virus Coherence and patient empowerment in the rehabilitation process

7 Foredrag på Forskningens dag SESSION I. Can an end-tidal CO 2.33 kpa predict lack of return of spontaneous circulation during pre-hospital cardiac arrest? Rognås L,2,3,4, Hansen TM 3,4, Kirkegaard H 5, Tønnesen E 6 Department of research and development, Norwegian Air Ambulance Foundation 2 Pre-hospital Critical Care Service, Department of Anaesthesiology, Viborg Regional Hospital 3 Pre-hospital Critical Care Service, Aarhus University Hospital 4 Department of Pre-hospital Medical Services, Central Denmark Region 5 Centre for Emergency Medicine Research, Aarhus University Hospital 6 Department of Anaesthesiology, Aarhus University Hospital Background: Several authors have suggested that measuring end-tidal carbon dioxide (ETCO 2 ) may be useful for optimising CPR quality and as an aid for prognostication during CPR. Kolar et al. [] from the emergency medical system in Maribor, Slovenia found that among 086 non-traumatic adult cardiac arrest patients none of the patients with an initial ETCO 2 below.33 kpa achieved return of spontaneous circulation. The authors suggest using an ETCO 2 of.33 kpa as a cut-off value for whether return of spontaneous circulation following pre-hospital cardiac arrest is achievable. Aim: The aim of this study was to investigate if an initial ETCO 2 value at or below.3 kpa should be used as a cut-off value for whether return of spontaneous circulation during pre-hospital cardio-pulmonary resuscitation is achievable or not. Materials and methods: As part of a larger study [2], we prospectively registered data according to the Utstein-style template [3] for reporting data from pre-hospital advanced airway management from February st 20 to October 3 st 202. Included were consecutive patients at all ages with pre-hospital cardiac arrest treated by eight anaesthesiologist-staffed pre-hospital critical care teams in the Central Denmark Region. Results: We registered data from 595 cardiac arrest patients; in 60.2% (n = 358) of these cases the pre-hospital critical care teams performed pre-hospital advanced airway management beyond bag-mask ventilation. An initial ETCO 2 measurement following pre-hospital advanced airway management were available in 75.7% (n = 27) of these 358 cases. We identified 22 patients, who had an initial ETCO 2 at or below.3 kpa. Four of these patients achieved return of spontaneous circulation. [4] Conclusion: Our results indicates that an initial ETCO 2 at or below.3 kpa during pre-hospital CPR should not be used as a cut-off value for the achievability of return of spontaneous circulation. References:. Kolar M, Krizmaric M, Klemen P, Grmec S. Partial pressure of end-tidal carbon dioxide successful predicts cardiopulmonary resuscitation in the field: a prospective observational study. Critical care 2008;2:R5. 2. Rognås L, Hansen TM, Kirkegaard H, Tønnesen E. Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Scandinavian journal of trauma, resuscitation and emergency medicine 203;2():58 3. Sollid SJ, Lockey D, Lossius HM. A consensus-based template for uniform reporting of data from pre-hospital advanced airway management. Scandinavian journal of trauma, resuscitation and emergency medicine 2009;7:58 4. Rognås L, Hansen TM, Kirkegaard H, Tønnesen E: Predicting the lack of ROSC during pre-hospital CPR: should an end-tidal CO 2 below.3 kpa be used as a cut-off value? Resuscitation 203 Dec 9. 7

8 2. Improving clinical reasoning at in-patient rounds by bimodal presentation schemes and buzz groups Balslev T,2, Rasmussen AB, Skajaa T, Nielsen JP, Muijtjens A 3, de Grave W 3, van Merriënboer J 3 Viborg Regional Hospital, Department of Pediatrics, Denmark 2 Aarhus University, Center of Medical Education, Denmark 3 Maastricht University, Faculty of Health Medicine and Life Sciences, Department of Educational Development and Research Background: The in-patient round is a work-based learning environment with plenty of opportunities for practice of clinical reasoning. Yet, these opportunities are often underused. Cognitive research suggests that addition of a projected written text case supplementing the verbal presentation (i.e. bimodal presentation) may help participants appreciate and process more relevant information. Buzz groups describes two participants discussing initial information in a case, and will help participants to be active. In this controlled study, we tested the effects of different stepwise presentation schemes for report of selected single paediatric emergency room patients on learning processes and outcomes. Summary of work: A total of 24 clinicians, i.e. 2 experts and 2 non-experts were randomized to four groups. In each group three experts and three non-experts discussed the same two paediatric emergency room patients. The cases were always verbally presented and according to a factorial design groups differed in their use of written cases (verbal only vs. verbal+text) and the use of buzz groups (with vs. without buzz groups). The verbal interaction was recorded and transcribed to analyse for clinical reasoning processes. Diagnostic accuracy was assessed by a 20-item multiple choice question test. Summary of results: Addition of bimodal presentation only or buzz groups only did not improve clinical reasoning. In contrast, the combined use of bimodal presentation and buzz groups increased the odds ratio for clinical reasoning to occur in the discussion to.90 (p=.03). Unfortunately, power was too low to allow for conclusions to be made about effects of bimodal presentation or buzz groups on diagnostic accuracy. Conclusion: This study shows that combined bimodal presentation and buzz group discussion of emergency cases improves participants clinical reasoning during in-patient rounds. 8

9 3. The incidence of traumatic spinal cord injury in Denmark, : A hospital-based study Hovedforfatter: Bjørnshave Noe B,2,3 Adjunkt RN, MHS, ph.d. Hospitalsenhed Midt, Enhed for Sygeplejeforskning og Institut for Folkesundhed, Sektion for Sygepleje, Aarhus Universitet; mobil , arbejde Medforfattere: Mikkelsen EM 4 seniorforsker MPH, ph.d; Hansen RM overlæge; Thygesen M,5 medicinstuderende; Hagen EM, 2, 6 lektor, overlæge, ph.d. Spinal Cord Injury Centre of Western Denmark, Viborg Denmark, 2 Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark 3 Department of Nursing Science, Faculty of Health, Aarhus University, Denmark 4 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus Denmark 5 Spinal Cord Research Center Aarhus University Hospital, Denmark 6 Department of Clinical Medicine, University of Bergen, Norway Background: Knowledge of incidence is vital for planning rehabilitation services for patients with traumatic spinal cord injury (TSCI). The last Danish incidence report on TSCI is from 990, therefor an update is of relevance. Aim: To estimate the incidence of TSCI and trends in cause of TSCI, in relation to age, gender, as well as level and completeness of injury. Methods: Consecutive patient admissions between January 990 and 3 December 202 with traumatic spinal cord injury (TSCI) at the Spinal Cord Injury Center of Western Denmark. Adjusted estimates of incidence rate ratios (IRR) of TSCI were estimated using Poisson regression models with adjustment for gender, age groups and time period. Results: A total of 69 patients were admitted (males= 8.9 %), with a median age of 35 years (range 0-83 years). The incidence of TSCI was 0.2 (9.5;.0) per million inhabitants per year. The leading cause of injury was transport related injuries (50.2%), followed by fall related injuries (22.8%). For transport the incidence was associated with decreasing age at injury. In contrast, the incidence of falls was associated with increasing age at injury. The proportion of patients, who sustained an incomplete tetraplegia had increased in most recent years and incomplete tetraplegia was associated with increasing age at injury. Conclusion: The incidence of TSCI has remained stable in Denmark in the period from 990 to 202. For incomplete tetraplegia the proportion have increased and the patients age at time of injury have increased. These findings are important to clinical practice as specifically patients with incomplete tetraplegia require extensive medical treatment, specific rehabilitation and have various needs in order to achieve optimal functioning and community reintegration. 9

10 4. Prenatal exposure to antiepileptic drugs and dental agenesis Jacobsen PE, Henriksen TB 2, Haubek D, Østergaard JR 3 Section of Pediatric Dentistry, Department of Dentistry, Health, Aarhus University, Aarhus, Denmark 2 Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus Universty Hospital, Aarhus, Denmark 3 Center for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark Objective: The aim of the study was to investigate the association between prenatal exposure to AEDs and the risk of dental agenesis and to differentiate between the possible effects of the different drugs used. Methods: Data on 24 exposed and 255 unexposed children, aged 2-8 years, were extracted from the Prescription Database of the Central Denmark Region and North Denmark Region and the Danish Medical Birth Registry. The children s dental charts were examined for the presence of dental agenesis. Results: Overall, children exposed to AED in utero had an increased risk of developing dental agenesis, but as a group, the difference was not significant (OR=.7; [95% CI: ]). The risk of developing dental agenesis was three-fold increased (OR=3.; [95% CI:.3-7.4]) in children exposed to valproate in mono- or in poly-therapy with other AEDs than carbamazepine or oxcarbazepine. The risk was further increased (OR=.2; [95% CI: ]) in children exposed to valproate and carbamazepine or oxcarbazepine in combination. Conclusions: The present study shows that dental agenesis is a potential congenital abnormality that is related to prenatal exposure to valproate, and dental agenesis may be considered a sensitive marker for the teratogenicity of valproate. 0

11 5. Pharmacist identification of potential side-effects in patients with multimorbidity and polypharmacy Jeffery L, Kruse M G Hospital Pharmacy, Central Denmark Region, Department Viborg Silkeborg, Silkeborg Regional Hospital Background: Denmark s first out-patient clinic for multimorbidity and polypharmacy opened at Silkeborg Regional Hospital in 202. The clinic treats patients with at least 2 chronic illnesses, who present with a variety of symptoms. The pharmacist is an integral member of the multidisciplinary team that sees the patient during a single visit. The team includes a nurse, medical consultant, physio- and occupational therapist, and relevant senior doctors from 9 other medical specialities, including psychiatry. Purpose: To document the impact of a pharmacist on identification of potential side effects to regular medication and on other medicine related problems (MRP) in patients at a clinic for patients with multimorbidity. Materials and methods: Before the patient sees the consultant, the pharmacist interviews the patient about all aspects of his medication history (including over the counter medicines and herbal/natural medicines) and updates the electronic prescribing system. A full medicines review is then carried out with extra focus on possible side-effects. The pharmacist presents relevant MRP to the doctor before the patient s consultation. The pharmacist is also present at the following multidisciplinary conference about the patient. MRP found are recorded in a national database (LRP database). Results: The pharmacist saw 58 patients from May 202 to September 203 and highlighted 208 MRP. The patients at the clinic have on average 2.3 (3-26) regular medications. Twenty-nine patients had potential side-effects to their regular medication (from -). Ninety-four (45%) of the pharmacist s 208 suggestions were implemented at the clinic, where 20 were related to the 70 highlighted possible side-effects. Conclusion: With special focus on side-effects to regular medication, the pharmacist highlighted potential side effects in 50% of the patients at the clinic for multimorbidity and polypharmacy. Despite the clinic being an out-patient clinic, the accept rate for the pharmacist s suggestions was surprisingly high.

12 Foredrag på Forskningens dag SESSION II. Effect of early progressive resistance training compared to home based exercise after fast track total hip replacement. A single-blinded randomized controlled trial Mikkelsen LR, Mechlenburg I 2, Søballe K 2, Mikkelsen S, Bandholm T 3,4, Petersen AK 5,6 Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital 3 Department of Orthopaedic Surgery, Aarhus University Hospital 4 Physical Medicine & Rehabilitation Research Copenhagen (PMR-C) 5 Department of Physiotherapy, Department of Orthopaedic Surgery and Clinical Research Centre, Copenhagen University Hospital, Hvidovre 6 Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital 7 Centre of Research in Rehabilitation (CORIR), institute of Clinical Medicine, Aarhus University Background: After Total Hip Replacement (THR) deficits in muscle strength and physical function persist. There is lack of evidence concerning which rehabilitation strategy is most effective and the amount of rehabilitation needed after fast track THR. Purpose/Aim of Study: To investigate the effect of supervised progressive resistance training initiated early after fast track THR in improving muscle strength and functional performance. Materials and Methods: THR patients with preoperative self-assessed disability were consecutively included and randomized. The control group (CG) performed home based exercise 7 days/week and the intervention group (IG) performed home based exercise 5 days/week plus resistance training of hip and thigh muscles 2 days/week. The IG trained with relative loads of 2 to 8 repetition max from week to 0 after THR. Outcome was evaluated before surgery, 0 and 26 weeks after by; leg extension power (primary outcome), isometric muscle strength (hip abduction + flexion), sit-to-stand test, stair test, 20 meter walking speed and the hip dysfunction and osteoarthritis outcome score questionnaire (HOOS). Findings / Results: Of 73 included patients 62 completed the trial (85%). Leg extension power improved significantly in both groups, with no between group difference: IG (difference baseline to week 0): 0.28 [0.;0.3] Watt/kg, CG: 0.26 [0.0;0.5] Watt/kg (P=0.9). Maximum walking speed improved more in IG: 2.98 [.8;4.2] seconds than in CG:.58 [0.8;2.4] seconds (P=0.05). No significant differences were found in the other outcomes, yet borderline significance (P= ) was seen in favour of IG in chair rise performance and isometric muscle strength. Conclusions: 7 days/week of home based exercise was equally effective as 5 days/week of home based exercise plus 2 days/week of supervised progressive resistance training in improving leg extension power after THA. For some of the secondary functional tests, trends were in favor of resistance training. ClinicalTrials.gov Identifier: NCT Corresponding author: Lone Ramer Mikkelsen, Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital 2

13 2. Increased glucose production during insulin-induced hypoglycaemia in hepatic denervated pigs evidence for a neuronal dependence of hepatic counterregulation,2 Michael Festersen Nielsen, 4 Klaus Roelsgaard, 5 Susanne Keiding, Kathrine Brodersen, 3 Niels Møller, Hendrik Vilstrup Department of Surgery, Viborg Regional Hospital, Departments of 2 Medicine V (Hepatology and Gastroenterology) and 3 M (Endocrinology and Internal Medicine), Aarhus University Hospital, 4 Department of Medicine, Randers Regional Hospital, 5 Department of Nuclear Medicine & PET Center, Aarhus University Hospital, and Department of Pathology, Aalborg University Hospital, Denmark Background: Counterregulation to hypoglycemia has been proposed to depend on neuronal signalling from hepatic receptors to sites in the brain. Impulses originating from glucosensors located within the hepatoportal region are transferred to regulatory sites in the central nervous system from where efferent impulses via sympathoadrenal pathways results in a rise in EGP. Aim: The present experiments aimed to examine these counterregulatory signalling pathways in hepatic denervated pigs subjected to insulin-induced hypoglycaemia. Method: Two weeks prior to study, the pigs underwent either hepatic denervation (DN; n=2) or a sham procedure (control; n=2). On the study day, endogenous insulin and glucagon secretion were inhibited with somatostatin, and glucagon was replaced at basal levels. EGP and whole body glucose utilization (Rd) were determined by [3-3 H] glucose infusion. Results: Following overnight fast, glucose (4.60±0.8 vs. 5.02±0.29 mmol/l; P=0.22) and insulin (±2 vs 2±3 pmol/l; P=0.72) concentrations were equal in DN and controls pigs. Also fasting EGP (2.83±0.30 vs 3.32±0.30 mg/kg/min; P=0.26) and Rd (3.6±0.26 vs 3.±0.32 mg/kg/min; P=0.89) did not differ. Insulin infusion resulted in a comparable rise in insulin concentrations (72±06 vs 72±44 pmol/l; P=0.99) at comparable hypoglycaemic levels (3.00±0.06 vs 3.07±0.08; P=0.47). Insulin action (8.5±0.77 vs 6.70±0.65 mg/kg/min; P=0.09) and glucose uptake (7.76±0.6 vs 7.3±0.53 mg/ kg/min; P=0.44) increased comparably in the two groups, whereas EGP was higher in the controls than in the DN pigs (.3±0.48 vs 0.0±0.20 mg/kg/min; P=0.04). Conclusion: These results suggest a blunted hepatic response to hypoglycaemia following hepatic denervation and imply that impulses from hepatic receptors are decisive for the ability of the liver to increase glucose production in response to hypoglycaemia. 3

14 The Effect of Volatile Anesthetic Preconditioning on Cardiac Troponins During CABG Surgery: A Systematic Review and Meta-analysis 3. The effect of volatile anesthetic preconditioning on cardiac troponins arup during TS, Hausenloy CABG surgery: DJ 2 A, Larsen systematic JR, review 3 and meta-analysis artment of Anesthesia and Operations, Viborg Regional Hospital versity College Hospital and Hatter Cardiovascular Institute, London, UK itute of Straarup Clinical Medicine, TS, Hausenloy Aarhus University DJ 2, Hospital, Larsen Skejby; JR,3 Center for Elective Surgery, Silkeborg Regional Hospital Department of Anesthesia and Operations, Viborg Regional Hospital 2 University College Hospital and Hatter Cardiovascular Institute, London, UK kground: 3 Volatile anesthetics (VA) are known to mimic the cardioprotective mechanism of ischemic Institute of Clinical Medicine, Aarhus University Hospital, Skejby; Center for Elective Surgery, Silkeborg Regional Hospital onditioning. The effects are triggered by multiple pathways that are not completely understood. Clinical use of in cardiac surgery has not been systematically implemented despite the well-known cardioprotective effects found Background: Volatile anesthetics (VA) are known to mimic the cardioprotective mechanism of ischemic preconditioning. The effects are triggered by multiple pathways that are not completely understood. Clinical use of VA in cardiac surgery has not been systematically implemented despite the well-known cardioprotective effects found in experimental studies. There seems to be a discrepancy between what is found in experimental studies and relevant clinical effect. xperimental studies. There seems to be a discrepancy between what is found in experimental studies and relevant ical effect. thods: We included all randomized controlled trials of adult cardiac patients undergoing CABG, either OPCAB or, and CABG in combination with valve replacement/repair and one congenital heart surgery trial. Trials between ary 985 and January 204 were obtained. Studies that did not include both a volatile anesthetic and a nontile control group were excluded. Included studies were restricted to use of Isoflurane, Desflurane and oflurane. The study was limited to examining the postoperative release of cardiac troponins (both ctni and ctnt). Results: 40 RCT s comprising 35 patients were included in the meta-analysis: ults: 40 RCT s comprising 35 patients were included in the meta-analysis: Methods: We included all randomized controlled trials of adult cardiac patients undergoing CABG, either OPCAB or ECC, and CABG in combination with valve replacement/repair and one congenital heart surgery trial. Trials between January 985 and January 204 were obtained. Studies that did not include both a volatile anesthetic and a non-volatile control group were excluded. Included studies were restricted to use of Isoflurane, Desflurane and Sevoflurane. The study was limited to examining the postoperative release of cardiac troponins (both ctni and ctnt). Meta-analysis of the Impact of Volatile Anesthetic Preconditioning Upon Post-CABG Troponin Levels Belhomme, 999 Tomai, 999 Pouzet, 2002 De Hert (9), 2002 De Hert (8), 2003 Conzen, 2003 Julier, 2003 Wang, SCVJ 2004 Nader, 2004 De Hert (0), 2004 De Hert (), 2004 Kendall, 2004 (OPCAB) Malagon, BJA 2005 (cong heart dis) Xia, 2006 Anesth-Analg Lee, EJA 2006 Law-Koune, JCVA 2006 Kawamura, JCVA 2006 Guarracino, JCVA 2006 (OPCAB) (Des) Croomhecke, Anesth Analg 2006 Lucchinetti, Anesth 2007 Piriou, BJA 2007 Ndoko, 2007 JCVA Landoni 2007, JCVA (Des) Meco, 2007 Eur J Cardiothor Surg (Des) Tritapepe, EJA 2007 Xu, Nan Fang Yi Ke Da Xue Xue Bao 2009 (OPCAB) Fraessdorf, 2009 JCVS Yildirim, 2009 Flier, 200 BJA Tempe, JCVA 200 Amr, Semin Cardiothorac Vasc Anesth 200 Huang, 20 Clin Sci Kim, 20 A I C Hellstrøm, 20 Acta Scand Jovic, 202 Cell Physiol Biochem (AVR) Lurati Buse, 202 Circ Kottenberg, 202 Acta Scand Bignami, 202 Acta Scand (MVR) Soro, EJA Surayaprakash, 203 Ann Card Anaesth Total (fixed effects) Total (random effects) Standardized Mean Difference t for inconsistency (I 2 ) was % (95%CI: ) (Significance level P < 0.000). Test for inconsistency (I2) was % (95%CI: ) (Significance level P < 0.000). cussion: Postoperative release of cardiac troponins is significantly reduced by VA in cardiac surgery. The amounts Discussion: Postoperative release of cardiac troponins is significantly reduced by VA in cardiac surgery. The amounts of released troponins are correlated to the degree of myocardial damage, but it remains undocumented whether a 0 per cent reduction in cardiac troponins obtained in trials results in better clinical outcomes regarding complications and perioperative mortality. eleased troponins are correlated to the degree of myocardial damage, but it remains undocumented whether a 0 cent reduction in cardiac troponins obtained in trials results in better clinical outcomes regarding complications perioperative mortality. Conclusion: This meta-analysis shows a 0% reduction in postoperative release of cardiac troponins from using VA during CABG surgery. Since lower troponin levels were previously correlated to post-acute myocardial infarction survival, our results indicate that the use of VA could reduce postoperative morbidity and mortality in these patients. clusion: This meta-analysis shows a 0% reduction in postoperative release of cardiac troponins from using VA ng CABG surgery. Since lower troponin levels were previously correlated to post-acute myocardial infarction ival, our results indicate that the use of VA could reduce postoperative morbidity and mortality in these patients. 4

15 4. Non-attendance in a screening programme for cardiovascular diseases (CVD) and diabetes (DM) among Danish women Thomsen MD &3, Lindholt JS &2, Frost L, Søgaard R 3, Lorentzen V 4 Cardiovascular Research Centre, Viborg and Silkeborg Hospital, 2 Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, 3 Health, Aarhus University, 4 Centre for Nursing Research -Viborg Background: Non-attendance in preventive screening offers is a common problem associated with increased morbidity and mortality. Additionally, the (cost-)effectiveness of screening programmes may be adversely affected by low attendance rates. Consequently, limiting non-attendance is relevant. Exploring non-attendance is part of a PhD-project with the overall objective to estimate the cost-effectiveness of population-based screening for CVD and DM in Danish women aged 60, 65,70 and 75. Aim: To explore the reasons for non-attendance in screening for CVD and DM in Danish women, and to explore nonattenders perception of the screening programme. Methods: A semi-structured interview guide was developed with reference to the literature on non-attendance in CVD and DM screening. Interviews with 0 non-attenders were conducted in September October 203. Analysis and interpretation was based on a hermeneutical approach. Codes were inductively identified, and reasons for non-attendance were categorized into themes. Results: The findings revealed two main themes including underlying subthemes: ) Finding the screening programme personally irrelevant with the following underlying subthemes: a) feeling healthy, b) the women s own risk assessment, c) being under health surveillance in other settings, d) insufficient knowledge. 2) A negative attitude towards screening and the healthcare system in general with the following underlying subthemes: a) only seeking medical advice in case of severe illness, b) distrust in healthcare workers and screening, c) previous negative experience with the healthcare system, d) preferring being ignorant of health problems. More than half of the non-attenders reported having regretted non-participation or being doubtful about their decisions. Conclusion: Findings indicate that the decision of non-participation has been made on the basis of insufficient knowledge related to disease prevention, diseases and the purpose of the screening programme, highlighting the importance of addressing non-attender knowledge. Based upon our findings it is possible to increase the attendance rate. 5

16 5. The impact of male overweight on semen quality and outcome of assisted reproduction Thomsen L, Humaidan P,2, Bungum L 3 and Bungum M 4 The Fertility Clinic, Skive Regional Hospital, Denmark 2 Aarhus University, Faculty of Health, Aarhus, Denmark 3 The Fertility Clinic, Herlev Hospital, Denmark 4 Reproductive Medicine Centre (RMC), Skanes University Hospital, Sweden Abstract The average body mass index (BMI) in Denmark for both men and women is rising - in accordance with the trend seen in other Western countries and at present every third Danish 8-year-old man is overweight (BMI>25 kg/m2). It is well documented that male overweight and obesity cause endocrine disorders that might diminish the male reproductive capacity, however, reports have been conflicting regarding the influence of BMI on semen quality and the outcome of assisted reproductive technology (ART). The aim of this study was to investigate whether increased male BMI affects sperm quality and the outcome of assisted reproduction in couples with an overweight or obese man with a normal weight partner. Data was prospectively collected from 62 infertile couples undergoing ART at the fertility Clinic, Skive, Denmark during the period April 2002 December Self-reported information on paternal height and weight were recorded and BMI was calculated. The men were divided into four BMI categories: underweight BMI<20 kg/m 2, normal BMI kg/m 2, overweight BMI kg/m 2 and obese BMI>30 kg/m 2. Conventional semen analysis was performed according to the WHO guideline and sperm DNA integrity was analysed by the Sperm Chromatin Structure Assay (SCSA). No statistically significant effect of male BMI was seen on conventional semen parameters (sperm concentration, total sperm count, seminal volume and motility) or on SCSA-results. Furthermore, the outcome of ART regarding fertilisation rate, number of good quality embryos, implantation, and pregnancy outcome was not influenced by increasing male BMI. In conclusion, the results of the present study indicate that high male BMI does not have a negative impact on neither the ART outcome nor the semen quality. However, in order to draw firm conclusions, relevant for daily clinical practise, the findings should be replicated in a larger ART-cohort including a wider range of BMI levels. 6

17 Øvrige indleverede abstracts til Forskningens dag. Diagnostik af jejunal diverticulitis som årsag til akut abdomen Ivan Arsic, 2 Pedja Cuk, Enas Basim, Abd Al Karim & 2 Michael F Nielsen Radiologisk og 2 Kirurgisk Afdeling, Regionshospitalet Viborg Baggrund: Jejunum- og ileumdivertikler henregnes blandt de mest sjældne divertikler i gastrointestinalkanalen. Incidensen er 0,02-%. Der skelnes mellem»sande«divertikler, der indeholder alle tarmens lag, og»falske«divertikler, der ikke indeholder muscularis mucosa og adventitia. Jejuno-ileale divertikler er asymptomatiske i ca. 80% af tilfældene. Symptomatiske divertikler giver typisk symptomer i form af flatulens, dyspepsi, epigastrielle smerter og postprandialt ubehag. De kliniske symptomer ved jejunal divertikulitis kan ligne symptomerne ved akut appendicitis, akut kolecystitis, perforeret ulcus eller diverticulitis coli. Perforation af jejunumdivertikler er en sjælden komplikation med uspecifikke og uforklarlige centrale mavesmerter, hvilket kan gøre det differentialdiagnostisk vanskeligt ved akut abdomen. Kompliceret divertikulitis kan være svær at diagnosticere. Forsinket initiering af behandling kan have alvorlige konsekvenser. Sygdommen bør altid overvejes ved uforklaret akut abdomen, specielt hos ældre patienter. Nærværende abstrakt præsenter to patientforløb med jejunal diverticulitis. Sygehistorier: Case I. En 48-årig kvinde blev indlagt med ti timer varende venstresidige abdominalsmerter. Abdomen var fladt og blødt fraset i venstre fossa, hvor hun var udtalt palpationsøm og diskret peritoneal. Hun var febril med en temperatur på 38,5 C og et niveau af C-reaktivt protein (CRP) på 76 mg/l. CT viste en 5 4 cm stor afrundet, tykvægget kavitet beliggende i krøset i venstre fossa og indeholdt lidt væske samt grumset udseende tykt materiale, luft og perimesenteriel fedtvævsinflammation. UL-skanning viste et betydeligt inflammeret og ødematøst tyndtarmssegment med peristaltik og luft i lumen. Kranielt for dette tyndtarmssegment sås en luftholdig forandring og en ganske tynd forbindelse med luft mellem tyndtarmssegmentet og den påviste ansamling samt ødem i tarmvæggen. Forandringen blev diagnosticeret som et tyndtarmsdivertikel med inflammation. Patienten blev med god effekt behandlet konservativt med antibiotika. Case II. En 67-årig mand havde gennem et år haft tendens til mavesmerter ved fødeindtagelse samt uregelmæssig afføring og tre tilfælde af frisk blødning per rectum. Ved sidste tilfælde blev han indlagt akut og koloskoperet uden tegn på patologi bortset fra udpræget divertikulose i colon sigmoideum. Efter to måneder blev han indlagt igen med diffuse mavesmerter, opkastninger og dårlig appetit. Han var febril med en temperatur på 38,5 C og havde forhøjede infektiontal: CRP-niveau 25 mg/l og leukocytniveau 20,6 09/l. En CT viste svær vægfortykkelse i jejunum med perimesenteriel fedtvævsinflammation, som gav mistanke om jejunal divertikulitis. En undersøgelse af tyndtarmspassage (TTP) viste multiple divertikler i jejunum, hvor den største målte 3 cm i diameter. Den iværksatte konservative behandling med antibiotika havde god effekt. Diskussion: Diagnosen jejunal divertikulitis blev i ovennævnte patientcases stillet ud fra den kliniske anamnese støttet af CT, UL og TTP. Ved abdominal CT med dobbelt oral og intravenøs kontrast kan diagnosen stilles på baggrund af følgende kendetegn: koncentrerede bobler af ekstraluminal luft i nærheden af tarmvæggen, asymmetrisk fortykkelse af tarmvæggen og ødem af det omkringliggende fedtvæv. Hvis man finder en enkelt divertikel er det tilstrækkeligt at foretage tangentiel divertikelresektion. Til gengæld er det nødvendigt at foretage segmentresektion med primær anastomose ved perforeret divertikulitis. Oftest er der affektion af et kort tyndtarmssegment med adskillige divertikler. Behandlingen af perforeret divertikulitis uden peritonitis er antibiotika. Hos vore patienter viste CT suppleret med UL og TTP jejunal divertikulitis uden fri luft intraperitonealt. Begge patienter blev konservativt behandlet, da det kliniske billede sammenholdt med de radiologiske undersøgelser ikke indicerede kirurgisk behandling. 7

18 2. Pre-hospital advanced airway management by experienced anaesthesiologists: A prospective descriptive study Rognås L,2,3,4, Hansen TM 3,4, Kirkegaard H 5, Tønnesen E 6 Department of research and development, Norwegian Air Ambulance Foundation 2 Pre-hospital Critical Care Service, Department of Anaesthesiology, Viborg Regional Hospital 3 Pre-hospital Critical Care Service, Aarhus University Hospital 4 Department of Pre-hospital Medical Services, Central Denmark Region 5 Centre for Emergency Medicine Research, Aarhus University Hospital 6 Department of Anaesthesiology, Aarhus University Hospital Introduction: Airway management is a vital skill for pre-hospital critical care practitioners. We report data from the first Utstein-style [] study of physician-provided pre-hospital advanced airway management. Objectives: To estimate the incidences of failed / difficult pre-hospital endotracheal intubation and complications related to pre-hospital advanced airway management. To describe the critical decision-making process associated with these procedures. Materials and methods: Prospectively gathered data from consecutive patients treated by eight anaesthesiologiststaffed pre-hospital critical care teams in the Central Denmark Region during 2 months (20-202). Results: We included 08 patients where pre-hospital advanced airway management were performed or considered. The overall incidence of successful pre-hospital endotracheal intubation among 636 intubation attempts was 99.7%; in 22.4% of the cases more than one intubation attempt where needed. The overall complication rate was 7.9%. No airway management related deaths occurred. Following rapid sequence intubation, first pass success rate was 85.8%; the overall incidence of complications was 22.0%, the incidence of hypotension 7.3% and that of hypoxia 5.3%. Multiple endotracheal intubation attempts were associated with an increased incidence of complications [2]. The pre-hospital critical care anaesthesiologists waived pre-hospital advanced airway management in 32. % of the cases, most commonly because of the patient s condition or co-morbidity. The most frequently used alternative treatment was bag-mask ventilation. Immediate complications related to the decision of not performing pre-hospital advanced airway management were rare (0.6%) [3]. Discussion: The overall incidence of successful pre-hospital endotracheal intubations compares to those found in other physician-staffed pre-hospital systems. First pass success rate is surprisingly low. The incidence following prehospital rapid sequence intubation compares to those found in UK emergency departments. Conclusion: An improved first pass success rate during pre-hospital endotracheal intubation in our service may further reduce the incidences of immediate airway management related complications. Pre-hospital advanced airway management requires advanced critical decision-making. References:. Sollid SJ, Lockey D, Lossius HM. A consensus-based template for uniform reporting of data from pre-hospital advanced airway management. Scandinavian journal of trauma, resuscitation and emergency medicine 2009;7. 2. Rognås L, Hansen TM, Kirkegaard H, Tønnesen E: Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Scandinavian journal of trauma, resuscitation and emergency medicine 203, 2: Rognås L, Hansen TM, Kirkegaard H, Tønnesen E: Refraining from pre-hospital advanced airway management: a prospective observational study in an anaesthesiologist-staffed pre-hospital critical care service. Scandinavian journal of trauma, resuscitation and emergency medicine 203, 2:75. 8

19 3. Anaesthesiologist-provided prehospital airway management in patients with traumatic brain injury: An observational study Rognås L,2,3,4, Hansen TM 3,4, Kirkegaard H 5, Tønnesen E 6 Department of research and development, Norwegian Air Ambulance Foundation 2 Pre-hospital Critical Care Service, Department of Anaesthesiology, Viborg Regional Hospital 3 Pre-hospital Critical Care Service, Aarhus University Hospital 4 Department of Pre-hospital Medical Services, Central Denmark Region 5 Centre for Emergency Medicine Research, Aarhus University Hospital 6 Department of Anaesthesiology, Aarhus University Hospital Background: Guidelines recommend that brain trauma patients with a Glasgow Coma Scale (GCS) score of less than 9 should have an airway established []. Hypoxia, hypotension and hypertension as well as hypoventilation and hyperventilation may worsen outcome in these patients []. Objectives: The objectives were to investigate guideline adherence, reasons for non-adherence and the incidences of complications related to pre-hospital advanced airway management in patients with traumatic brain injury. Materials and methods: We prospectively collected data from eight anaesthesiologist-staffed pre-hospital critical care teams in the Central Denmark Region according to the Utstein-style template [2]. Results: Among 08 consecutive pre-hospital advanced airway management patients, we identified 54 with a traumatic brain injury and an initial GCS score of less than 9. Guideline adherence in terms of airway management was 92.6%. The reasons for non-adherence were factors concerning the patient s condition, anticipated difficult airway management and short distance to the emergency department. Following rapid sequence intubation (RSI),.4% developed oxygen saturation below 90%, 9.% had a first post-rsi systolic blood pressure below 90 mmhg and 48.9% had a first post-rsi systolic blood pressure below 20 mmhg. The incidence of hypertension following pre-hospital RSI was 4.5%. The incidence of post-endotracheal intubation hyperventilation was as high as 7.%. [3] Conclusion: The guideline adherence was high. The incidences of post-rsi hypoxia and systolic blood pressure below 90 mmhg compare with the results reported from other physician-staffed pre-hospital services. The incidence of systolic blood pressure below 20, as well as that of hyperventilation following pre-hospital endotracheal intubation in traumatic brain injury patients call for a change in our current clinical practice. References:. Badjatia N, Carney N, Crocco TJ, et al. Guidelines for prehospital management of traumatic brain injury 2nd edition. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors 2008;2 Suppl :S Sollid SJ, Lockey D, Lossius HM. A consensus-based template for uniform reporting of data from pre-hospital advanced airway management. Scandinavian journal of trauma, resuscitation and emergency medicine 2009;7. 3. Rognås L, Hansen TM, Kirkegaard H, Tønnesen E: Anaesthesiologist-provided pre-hospital airway management in patients with traumatic brain injury: an observational study. European Journal of Emergency Medicine 203 Dec 2. [Epub ahead of print]. 9

20 4. Standard operating procedure changed pre-hospital critical care anaesthesiologists behaviour: A quality control study Rognås L,2,3,4, Hansen TM 3,4, Kirkegaard H 5, Tønnesen E 6 Department of research and development, Norwegian Air Ambulance Foundation 2 Pre-hospital Critical Care Service, Department of Anaesthesiology, Viborg Regional Hospital 3 Pre-hospital Critical Care Service, Aarhus University Hospital 4 Department of Pre-hospital Medical Services, Central Denmark Region 5 Centre for Emergency Medicine Research, Aarhus University Hospital 6 Department of Anaesthesiology, Aarhus University Hospital Introduction: The ability of standard operating procedures (SOPs) to improve pre-hospital critical care by changing pre-hospital physician behaviour is uncertain. We report data from a prospective quality control study of the effect of implementing an SOP for pre-hospital controlled ventilation on pre-hospital critical care anaesthesiologists behaviour. Objective: To evaluate whether the development and implementation of an SOP for controlled ventilation during transport could change pre-hospital critical care anaesthesiologists behaviour and thereby increase the use of automated ventilators in these patients. Materials and methods: Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region prospectively registered pre-hospital advanced airway-management data [] according to the Utstein-style template [2]. We collected pre-intervention data from February st 20 to January 3 st 202, implemented the SOP on February st 202 and collected post intervention data from February st 202 until October 3 st 202. We included transported patients of all ages in need of controlled ventilation treated with pre-hospital endotracheal intubation or the insertion of a supraglottic airways device. Results: The implementation of an SOP increased the overall prevalence of automated ventilator use in transported patients in need of controlled ventilation from 0.40 ( ) to 0.74 ( ) with a prevalence ratio of.85 ( ) (p = 0.00). The prevalence of automated ventilator use in transported traumatic brain injury patients in need of controlled ventilation increased from 0.44 ( ) to 0.85 ( ) with a prevalence ratio of.94 ( ) (p = ). The prevalence of automated ventilator use in patients transported after return of spontaneous circulation following pre-hospital cardiac arrest increased from 0.39 ( ) to 0.69 ( ) with a prevalence ratio of.79 ( ) (p = 0.00) [3]. Conclusion: We have shown that the implementation of an SOP for pre-hospital controlled ventilation can significantly change pre-hospital critical care anaesthesiologists behaviour. References:. Rognås L, Hansen TM, Kirkegaard H, Tønnesen E. Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Scandinavian journal of trauma, resuscitation and emergency medicine 203;2(): Sollid SJ, Lockey D, Lossius HM. A consensus-based template for uniform reporting of data from pre-hospital advanced airway management. Scandinavian journal of trauma, resuscitation and emergency medicine 2009;7: Rognås L, Hansen TM, Kirkegaard H, Tønnesen E. Standard operating procedure changed pre-hospital critical care anaesthesiologists behaviour: a quality control study. Scandinavian journal of trauma, resuscitation and emergency medicine 203, 2:84. 20

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