95 results on '"Ljungqvist, Olle"'
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2. The international declaration on the human right to nutritional care: A global commitment to recognize nutritional care as a human right.
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Cardenas, Diana, Correia, M. Isabel T.D., Hardy, Gil, Gramlich, Leah, Cederholm, Tommy, Van Ginkel-Res, Annemieke, Remijnse, Wineke, Barrocas, Albert, Ochoa Gautier, Juan B., Ljungqvist, Olle, Ungpinitpong, Winnai, and Barazzoni, Rocco
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Access to nutritional care is frequently limited or denied to patients with disease-related malnutrition (DRM), to those with the inability to adequately feed themselves or to maintain their optimal healthy nutritional status which goes against the fundamental human right to food and health care. That is why the International Working Group for Patient's Right to nutritional care is committed to promote a human rights based approach (HRBA) in the field of clinical nutrition. Our group proposed to unite efforts by launching a global call to action against disease-related malnutrition through The International Declaration on the Human Right to Nutritional Care signed in the city of Vienna during the 44th ESPEN congress on September 5th 2022. The Vienna Declaration is a non-legally binding document that sets a shared vision and five principles for implementation of actions that would promote the access to nutritional care. Implementation programs of the Vienna Declaration should be promoted, based on international normative frameworks as The United Nations (UN) 2030 Agenda for Sustainable Development, the Rome Declaration of the Second International Conference on Nutrition and the Working Plan of the Decade of Action on Nutrition 2016–2025. In this paper, we present the general background of the Vienna Declaration, we set out an international normative framework for implementation programs, and shed a light on the progress made by some clinical nutrition societies. Through the Vienna Declaration, the global clinical nutrition network is highly motivated to appeal to public authorities, international governmental and non-governmental organizations and other scientific healthcare societies on the importance of optimal nutritional care for all patients. [ABSTRACT FROM AUTHOR]
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- 2023
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3. Perioperative care in open aortic vascular surgery: A consensus statement by the Enhanced Recovery After Surgery (ERAS) Society and Society for Vascular Surgery.
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McGinigle, Katharine L., Spangler, Emily L., Pichel, Adam C., Ayyash, Katie, Arya, Shipra, Settembrini, Alberto M., Garg, Joy, Thomas, Merin M., Dell, Kate E., Swiderski, Iris J., Lindo, Fae, Davies, Mark G., Setacci, Carlo, Urman, Richard D., Howell, Simon J., Ljungqvist, Olle, and de Boer, Hans D.
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The Society for Vascular Surgery and the Enhanced Recovery After Surgery Society formally collaborated and elected an international, multidisciplinary panel of experts to review the literature and provide evidence-based recommendations related to all the health care received in the perioperative period for patients undergoing open abdominal aortic operations (both transabdominal and retroperitoneal approaches, including supraceliac, suprarenal, and infrarenal clamp sites) for aortic aneurysm and aortoiliac occlusive disease. Structured around the Enhanced Recovery After Surgery core elements, 36 recommendations were made and organized into preadmission, preoperative, intraoperative, and postoperative recommendations. [ABSTRACT FROM AUTHOR]
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- 2022
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4. The effect of glucose control in liver surgery on glucose kinetics and insulin resistance.
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Blixt, Christina, Larsson, Mirjam, Isaksson, Bengt, Ljungqvist, Olle, and Rooyackers, Olav
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Clinical outcome is negatively correlated to postoperative insulin resistance and hyperglycemia. The magnitude of insulin resistance can be modulated by glucose control, preoperative nutrition, adequate pain management and minimal invasive surgery. Effects of glucose control on perioperative glucose kinetics in liver surgery is less studied. 18 patients scheduled for open hepatectomy were studied per protocol in this prospective, randomized study. In the treatment group (n = 9), insulin was administered intravenously to keep arterial blood glucose between 6 and 8 mmol/l during surgery. The control group (n = 9) received insulin if blood glucose >11.5 mmol/l. Insulin sensitivity was measured by an insulin clamp on the day before surgery and immediately postoperatively. Glucose kinetics were assessed during the clamp and surgery. Mean intraoperative glucose was 7.0 mM (SD 0.7) vs 9.1 mM (SD 1.9) in the insulin and control group respectively (p < 0.001; ANOVA). Insulin sensitivity decreased in both groups but significantly (p = 0.03, ANOVA) more in the control group (M value: 4.6 (4.4–6.8) to 2.1 (1.2–2.6) and 4.6 (4.1–5.0) to 0.6 (0.1–1.8) mg/kg/min in the treatment and control group respectively). Endogenous glucose production (EGP) increased and glucose disposal (WGD) decreased significantly between the pre- and post-operative clamps in both groups, with no significant difference between the groups. Intraoperative kinetics demonstrated that glucose control decreased EGP (p = 0.02) while WGD remained unchanged (p = 0.67). Glucose control reduces postoperative insulin resistance in liver surgery. EGP increases and WGD is diminished immediately postoperatively. Insulin seems to modulate both reactions, but mostly the WGD is affected. Intraoperative EGP decreased while WGD remained unaltered. ANZCTR 12614000278639. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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5. ESPEN practical guideline: Clinical nutrition in surgery.
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Weimann, Arved, Braga, Marco, Carli, Franco, Higashiguchi, Takashi, Hübner, Martin, Klek, Stanislaw, Laviano, Alessandro, Ljungqvist, Olle, Lobo, Dileep N., Martindale, Robert G., Waitzberg, Dan, Bischoff, Stephan C., and Singer, Pierre
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Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover both nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include the integration of nutrition into the overall management of the patient, avoidance of long periods of preoperative fasting, re-establishment of oral feeding as early as possible after surgery, the start of nutritional therapy immediately if a nutritional risk becomes apparent, metabolic control e.g. of blood glucose, reduction of factors which exacerbate stress-related catabolism or impaired gastrointestinal function, minimized time on paralytic agents for ventilator management in the postoperative period, and early mobilization to facilitate protein synthesis and muscle function. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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6. No association between preoperative impaired glucose control and postoperative adverse events following hip fracture surgery – A single-centre observational cohort study.
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Thörling, John, Ljungqvist, Olle, Sköldenberg, Olof, and Hammarqvist, Folke
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Observational studies have shown an association between hyperglycaemia and increased complications in orthopaedic patients. The aim of the study was to investigate if impaired preoperative glycaemic control, reflected by elevated HbA1c, was associated with adverse postoperative events in hip fracture patients. 160 patients (116 women and 44 men; age 80 ± 10 and BMI 24 ± 4; mean ± SD) with hip fractures were included in a prospective observational cohort study. The patients were divided into two groups, normal glycaemic control (NGC) and impaired glycaemic control (IGC) HbA1c ≥ 42 mmol/mol. The patients were also characterized according to BMI and nutritional status using MNA-SF (Minimal Nutritional Assessment Short Form). Complications within 30 days of surgery were classified according to Clavien–Dindo and 1-year mortality was compared between the groups. Out of 160 patients, 18 had diabetes and 4 more had likely occult diabetes (HbA1c ≥ 48). Impaired glycaemic control (IGC) was seen in 29 patients (18.1%) and normal glycaemic control (NGC) in 131 (81.9%). In patients with NGC and IGC, no postoperative complications (Clavien–Dindo Grade 0) were seen in 64/131 vs. 14/29 (48.9 vs. 48.3%), Grade 1-3a in 54/131 vs. 14/29 (41.2 vs. 48.3%) and Grade 3b-5 in 13/131 vs. 1/29 (9.9 vs. 3.4%) respectively, p = NS. There were no differences in 30-day complications (p = 0.55) or 1-year mortality (p = 0.35) between the groups. Elevated HbA1c at admission is not associated with increased complications or mortality after hip fracture surgery. [ABSTRACT FROM AUTHOR]
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- 2021
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7. Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery: A Review
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Ljungqvist, Olle, de Boer, Hans D., Balfour, Angie, Fawcett, William J., Lobo, Dileep N., Nelson, Gregg, Scott, Michael J., Wainwright, Thomas W., and Demartines, Nicolas
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IMPORTANCE: Enhanced Recovery After Surgery (ERAS) is a global surgical quality improvement initiative now firmly entrenched within the field of perioperative care. Although ERAS is associated with significant clinical outcome improvements and cost savings in numerous surgical specialties, several opportunities and challenges deserve further discussion. OBSERVATIONS: Uptake and implementation of ERAS Society guidelines, together with ERAS-related research, have increased exponentially since the inception of the ERAS movement. Opportunities to further improve patient outcomes include addressing frailty, optimizing nutrition, prehabilitation, correcting preoperative anemia, and improving uptake of ERAS worldwide, including in low- and middle-income countries. Challenges facing enhanced recovery today include implementation, carbohydrate loading, reversal of neuromuscular blockade, and bowel preparation. The COVID-19 pandemic poses both a challenge and an opportunity for ERAS. CONCLUSIONS AND RELEVANCE: To date, ERAS has achieved significant benefit for patients and health systems; however, improvements are still needed, particularly in the areas of patient optimization and systematic implementation. During this time of global crisis, the ERAS method of delivering care is required to take surgery and anesthesia to the next level and bring improvements in outcomes to both patients and health systems.
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- 2021
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8. Perioperative nutrition: Recommendations from the ESPEN expert group.
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Lobo, Dileep N., Gianotti, Luca, Adiamah, Alfred, Barazzoni, Rocco, Deutz, Nicolaas E.P., Dhatariya, Ketan, Greenhaff, Paul L., Hiesmayr, Michael, Hjort Jakobsen, Dorthe, Klek, Stanislaw, Krznaric, Zeljko, Ljungqvist, Olle, McMillan, Donald C., Rollins, Katie E., Panisic Sekeljic, Marina, Skipworth, Richard J.E., Stanga, Zeno, Stockley, Audrey, Stockley, Ralph, and Weimann, Arved
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Malnutrition has been recognized as a major risk factor for adverse postoperative outcomes. The ESPEN Symposium on perioperative nutrition was held in Nottingham, UK, on 14–15 October 2018 and the aims of this document were to highlight the scientific basis for the nutritional and metabolic management of surgical patients. This paper represents the opinion of experts in this multidisciplinary field and those of a patient and caregiver, based on current evidence. It highlights the current state of the art. Surgical patients may present with varying degrees of malnutrition, sarcopenia, cachexia, obesity and myosteatosis. Preoperative optimization can help improve outcomes. Perioperative fluid therapy should aim at keeping the patient in as near zero fluid and electrolyte balance as possible. Similarly, glycemic control is especially important in those patients with poorly controlled diabetes, with a stepwise increase in the risk of infectious complications and mortality per increasing HbA1c. Immobilization can induce a decline in basal energy expenditure, reduced insulin sensitivity, anabolic resistance to protein nutrition and muscle strength, all of which impair clinical outcomes. There is a role for pharmaconutrition, pre-, pro- and syn-biotics, with the evidence being stronger in those undergoing surgery for gastrointestinal cancer. Nutritional assessment of the surgical patient together with the appropriate interventions to restore the energy deficit, avoid weight loss, preserve the gut microbiome and improve functional performance are all necessary components of the nutritional, metabolic and functional conditioning of the surgical patient. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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9. Enhanced recovery programs in gastrointestinal surgery: Actions to promote optimal perioperative nutritional and metabolic care.
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Gianotti, Luca, Sandini, Marta, Romagnoli, Stefano, Carli, Franco, and Ljungqvist, Olle
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The enhanced recovery after surgery (ERAS) pathway is an evidence-based approach to the use of care elements along the patient perioperative pathway. All care elements that may impact on clinically relevant outcomes have been considered and reviewed. The combined ERAS actions allow a quicker return to bowel function, oral feeding, nutritional and metabolic equilibrium, normal activity and ultimately to achieve better outcomes. Because of the multi factorial approach and the commitment of all the professionals caring for the patient, it is necessary to have the engagement of all disciplines, such as surgery, anesthesiology, clinical nutrition, nursing, physiatry, involved. ERAS is a dynamic process and new evidence are constantly integrated into the program. The primary endpoint of this review is to give updated information on the key ERAS actions to achieve optimal perioperative nutritional and metabolic care. [ABSTRACT FROM AUTHOR]
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- 2020
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10. Towards optimal nutritional care for all: A multi-disciplinary patient centred approach to a complex challenge.
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de Man, Frank, Barazonni, Rocco, Garel, Pascal, van Ginkel-Res, Annemieke, Green, Ceri, Koltai, Tunde, Pichard, Claude, Roller-Wirnsberger, Regina, Sieber, Cornel, Smeets, Marcel, and Ljungqvist, Olle
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Ten years ago, European health care professional societies, health associations and members of the European Parliament convened in Brussels to discuss the necessary and urgent actions needed to improve access, initiation and follow up nutritional care for European citizens. As a response to this, in 2014 the Optimal Nutritional Care for All (ONCA) campaign was launched under the leadership of the European Nutritional for Health Alliance and its members. As of today this campaign has been rolled out in 18 European countries, whereby national multi-disciplinary platforms including patient groups work together to implement national nutritional care programs and develop good practices in care, research, education in order to increase awareness on malnutrition and improve nutritional care. This article describes the making of and evolution of the ONCA campaign, the outcomes and impact created, as well as opportunities to accelerate implementation of personalized nutritional care for all European citizens. [ABSTRACT FROM AUTHOR]
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- 2020
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11. β-Blockade in Rectal Cancer Surgery: A Simple Measure of Improving Outcomes.
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Ahl, Rebecka, Matthiessen, Peter, Xin Fang, Yang Cao, Sjolin, Gabriel, Lindgren, Rickard, Ljungqvist, Olle, and Mohseni, Shahin
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Objective: To ascertain whether regular b-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery. Background: Surgery for rectal cancer is associated with substantial morbidity and mortality. There is increasing evidence to suggest that there is a survival benefit in patients exposed to β-blockers undergoing non-cardiac surgery. Studies investigating the effects on outcomes in patients subjected to surgery for rectal cancer are lacking. Methods: All adult patients undergoing elective abdominal resection for rectal cancer over a 10-year period were recruited from the prospectively collected Swedish Colorectal Cancer Registry. Patients were subdivided according to preoperative β-blocker exposure status. Outcomes of interest were 30-day complications, 30-day cause-specific mortality, and 1-year all-cause mortality. The association between β-blocker use and outcomes were analyzed using Poisson regression model with robust standard errors for 30-day complications and cause-specific mortality. One-year survival was assessed using Cox proportional hazards regression model. Results: A total of 11,966 patients were included in the current study, of whom 3513 (29.36%) were exposed to regular preoperative b-blockers. A significant decrease in 30-day mortality was detected (incidence rate ratio = 0.06, 95% confidence interval: 0.03-0.13, P < 0.001). Deaths of cardiovascular nature, respiratory origin, sepsis, and multiorgan failure were significantly lower in β-blocker users, as were the incidences in postoperative infection and anastomotic failure. The β-blocker positive group had significantly better survival up to 1 year postoperatively with a risk reduction of 57% (hazard ratio = 0.43, 95% confidence interval: 0.37- 0.52, P < 0.001). Conclusions: Preoperative b-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer. [ABSTRACT FROM AUTHOR]
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- 2020
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12. Female sex hormones in relation to insulin resistance after hysterectomy: A pilot study.
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Wijk, Lena, Ljungqvist, Olle, and Nilsson, Kerstin
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Surgery causes development of insulin resistance. Women undergoing hysterectomy have different female sex hormonal status, ranging from premenopausal to postmenopausal. The aim of the study was to explore the relation between the female sex hormones and insulin resistance (IR%) after hysterectomy. A secondary analysis from a randomised controlled single-centre study at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Twenty women were randomised to robot-assisted laparoscopic or abdominal hysterectomy. Blood were drawn before and after surgery for measurement of oestrogens, progesterone, and gonadotropins alongside determination of insulin sensitivity using the hyperinsulinemic normolycaemic clamp. Female sex hormonal status was not correlated to insulin sensitivity before operation. Premenopausal women developed more IR% than postmenopausal women (p = 0.012). Premenopausal women also showed a significant decrease in absolute levels of oestradiol (E2) (p = 0.016), and the relative decrease in E2 from preoperative to postoperative values (E2%) was significantly higher (p = 0.001). There was a significant positive correlation in the entire study population between E2% and IR% (r = 0.72, p = 0.001, r
2 0.51) that remained when adjusted for age (p = 0.028), BMI (p = 0.001), and preoperative insulin sensitivity (p = 0.011) separately. Premenopausal women developed a higher degree of postoperative insulin resistance that was associated with a parallel relative change in oestradiol levels compared with the postmenopausal women. It remains unclear whether these are independent phenomena in the overall stress response or whether a causal relationship exists. [ABSTRACT FROM AUTHOR]- Published
- 2019
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13. Short-term outcome in robotic vs laparoscopic and open rectal tumor surgery within an ERAS protocol: a retrospective cohort study from the Swedish ERAS database
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Asklid, Daniel, Ljungqvist, Olle, Xu, Yin, and Gustafsson, Ulf O.
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Background: Advantages of robotic technique over laparoscopic technique in rectal tumor surgery have yet to be proven. Large multicenter, register-based cohort studies within an optimized perioperative care protocol are lacking. The aim of this retrospective cohort study was to compare short-term outcomes in robotic, laparoscopic and open rectal tumor resections, while also determining compliance to the enhanced recovery after surgery (ERAS)®Society Guidelines. Methods: All patients scheduled for rectal tumor resection and consecutively recorded in the Swedish part of the international ERAS® Interactive Audit System between January 1, 2010 to February 27, 2020, were included (N= 3125). Primary outcomes were postoperative complications and length of stay (LOS) and secondary outcomes compliance to the ERAS protocol, conversion to open surgery, symptoms delaying discharge and reoperations. Uni- and multivariate comparisons were used. Results: Robotic surgery (N= 827) had a similar rate of postoperative complications (Clavien–Dindo grades 1–5), 35.9% compared to open surgery (N= 1429) 40.9% (OR 1.15, 95% CI (0.93, 1.41)) and laparoscopic surgery (N= 869) 31.2% (OR 0.88, 95% CI (0.71, 1.08)). LOS was longer in the open group, median 9 days (IRR 1.35, 95% CI (1.27, 1.44)) and laparoscopic group, 7 days (IRR 1.14, 95% CI (1.07, 1.21)) compared to the robotic group, 6 days. Pre- and intraoperative compliance to the ERAS protocol were similar between groups. Conclusions: In this multicenter cohort study, robotic surgery was associated with shorter LOS compared to both laparoscopic and open surgery and had lower conversion rates vs laparoscopic surgery. The rate of complications was similar between groups.
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- 2021
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14. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update.
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Nelson, Gregg, Bakkum-Gamez, Jamie, Kalogera, Eleftheria, Glaser, Gretchen, Altman, Alon, Larissa, A Meyer, Jolyn, S Taylor, Iniesta, Maria, Lasala, Javier, Mena, Gabriel, Scott, Michael, Gillis, Chelsia, Elias, Kevin, Wijk, Lena, Huang, Jeffrey, Nygren, Jonas, Ljungqvist, Olle, Pedro, T Ramirez, and Sean, C Dowdy
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PERIOPERATIVE care ,GYNECOLOGY ,RANDOMIZED controlled trials ,INTRAOPERATIVE care - Abstract
Background: This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery. Methods: A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Results: All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. Conclusions: The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review. [ABSTRACT FROM AUTHOR]
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- 2019
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15. Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS®) programs.
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Lovely, Jenna K., Hyland, Sara Jordan, Smith, April N., Nelson, Gregg, Ljungqvist, Olle, Parrish II, Richard H., and Parrish, Richard H 2nd
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PREVENTION of surgical complications ,CONVALESCENCE ,COST control ,PERIOPERATIVE care - Abstract
One of the most durable approaches to perioperative enhanced recovery programming has culminated in the formation of perioperative organizations devoted to improvements in the quality of the surgical patient experience, such as the Enhanced Recovery After Surgery (ERAS®) Society. Members of the American College of Clinical Pharmacy (ACCP) Perioperative Care Practice and Research Network (PRN) and officials from the ERAS® Society present an opinion that: (1) identifies therapeutic options within each pharmacotherapy-intensive area of ERAS®; (2) generates applied research questions that would allow for comparative analyses of pharmacotherapy options within ERAS® programs; (3) proposes collaborative practice opportunities between key stakeholders in the surgical journey and clinical pharmacists to manage drug therapy problems and research questions; and (4) highlights examples of pharmacist-led cost savings attributed to ERAS® implementation. Clinical pharmacists, working in this manner with the perioperative team across the care continuum, have optimized pharmacotherapy towards measurable outcomes improvements, and stand ready to partner with inter-professional stakeholders and organizations to advance the care of our mutual patients. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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16. Enhanced recovery after surgery—ERAS—principles, practice and feasibility in the elderly.
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Ljungqvist, Olle and Hubner, Martin
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This is a short overview of the principles of a novel development in surgery called enhanced recovery after surgery (ERAS) programs. This is an evidence-based approach to perioperative care that has shown to reduce complications and recovery time by 30-50%. The main mechanism is reduction of the stress reactions to the operation. These principles have been shown to be particularly well suited for the compromised patient and hence very good for the elderly people who often have co-morbidities and run a higher risk of complications. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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17. nutritionDay: 10 years of growth.
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Schindler, Karin, Pichard, Claude, Sulz, Isabella, Volkert, Dorothee, Streicher, Melanie, Singer, Pierre, Ljungqvist, Olle, Van Gossum, Andre, Bauer, Peter, and Hiesmayr, Michael
- Abstract
Summary Background & aims Despite high prevalence at hospital admission, disease related malnutrition (DRM) remains under recognized and undertreated. DRM is associated with increased morbidity, hospital readmission rate, and burden for the healthcare system. The compelling need to increase awareness and knowledge through an international survey has triggered the launch of the nutritionDay (ND) concept. Methods ND is a worldwide annual systematic collection and analysis of data in hospital wards, intensive care units and nursing homes. ND is based on questionnaires to systematically collect and analyze the patient's characteristics, food intake and nutrition support, as well as the determinants of their environment (facility, health care personal, etc …). Questionnaires, outcome documentation sheets and step-by-step guidance are available as download in 30 languages. Results ND has described the nutritional status and behavior of over 150,000 hospitalized patients and nursing home's patients in over 56 participating countries. These data allowed a local, regional, national and international benchmarking at different levels (i.e. type of medical pathologies, care facilities, etc.) and over time. Sixteen peer-reviewed publications have already been released and picture the international scene of DRM. Conclusion This review presents the 10-year of the ND project development and shows how ND serves all health care professionals to optimize nutrition care and nutrition related structures. ND keeps progressing and is likely to become a standard tool for determining the nutritional status and behavior of hospitalized patients and nursing home's population. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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18. ESPEN guideline: Clinical nutrition in surgery.
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Weimann, Arved, Braga, Marco, Carli, Franco, Higashiguchi, Takashi, Hübner, Martin, Klek, Stanislaw, Laviano, Alessandro, Ljungqvist, Olle, Lobo, Dileep N., Martindale, Robert, Waitzberg, Dan L., Bischoff, Stephan C., and Singer, Pierre
- Abstract
Summary Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include: • integration of nutrition into the overall management of the patient • avoidance of long periods of preoperative fasting • re-establishment of oral feeding as early as possible after surgery • start of nutritional therapy early, as soon as a nutritional risk becomes apparent • metabolic control e.g. of blood glucose • reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function • minimized time on paralytic agents for ventilator management in the postoperative period • early mobilisation to facilitate protein synthesis and muscle function The guideline presents 37 recommendations for clinical practice. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
19. Enhanced recovery after surgery—ERAS—principles, practice and feasibility in the elderly
- Author
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Ljungqvist, Olle and Hubner, Martin
- Abstract
This is a short overview of the principles of a novel development in surgery called enhanced recovery after surgery (ERAS) programs. This is an evidence-based approach to perioperative care that has shown to reduce complications and recovery time by 30–50%. The main mechanism is reduction of the stress reactions to the operation. These principles have been shown to be particularly well suited for the compromised patient and hence very good for the elderly people who often have co-morbidities and run a higher risk of complications.
- Published
- 2018
- Full Text
- View/download PDF
20. Free dissociable IGF-I: Association with changes in IGFBP-3 proteolysis and insulin sensitivity after surgery.
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Bang, Peter, Thorell, Anders, Carlsson-Skwirut, Christine, Ljungqvist, Olle, Brismar, Kerstin, and Nygren, Jonas
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Summary Background Patients receiving a carbohydrate drink (CHO) before major abdominal surgery display improved insulin sensitivity postoperatively and increased proteolysis of IGFBP-3 (IGFBP-3-PA) compared to patients undergoing similar surgery after overnight fasting. Aims We hypothesized that serum IGFBP-3-PA increases bioavailability of circulating IGF-I and preserves insulin sensitivity in patients given CHO. Design Matched control study. Methods At Karolinska University Hospital, patients given CHO before major elective abdominal surgery (CHO,n = 8) were compared to patients undergoing similar surgical procedures after overnight fasting (FAST,n = 10). Results from two different techniques for determination of free-dissociable IGF-I (fdIGF-I) were compared with changes in IGFBP-3-PA and insulin sensitivity. Results Postoperatively, CHO displayed 18% improvement in insulin sensitivity (hyperinsulinemic clamp) and increased IGFBP-3-PA vs. FAST. As determined by IRMA, fdIGF-I increased by 48 ± 25% in CHO while fdIGF-I decreased by 13 ± 18% in FAST (p < 0.01 vs. CHO, when corrected for duration of surgery). However, fdIGF-I determined by ultra-filtration decreased similarly in both groups (−22 ± 8% vs. −25 ± 8%, p = 0.8) and IGFBP-1 increased similarly in both groups. Patients with less insulin resistance after surgery demonstrated larger increases in fdIGF-I by IRMA (r = 0.58, p < 0.05). Fifty-three % of the variability of the changes in fdIGF-I by IRMA could be explained by changes in IGFBP-3-PA and total IGF-I levels (p < 0.05), while IGFBP-1 did not contribute significantly. Conclusion During conditions when serum IGF-I bioavailability is regulated by IGFBP-3 proteolysis, measurements of fdIGF-I by IRMA is of physiological relevance as it correlates with the associated changes in insulin sensitivity. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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21. Early Postoperative Supplementary Parenteral Nutrition
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Ljungqvist, Olle, Gustafsson, Ulf O., and Lobo, Dileep N.
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- 2022
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22. Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines
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Beverly, Anair, Kaye, Alan D., Ljungqvist, Olle, and Urman, Richard D.
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Perioperative multimodal analgesia uses combinations of analgesic medications that act on different sites and pathways in an additive or synergistic manner to achieve pain relief with minimal or no opiate consumption. Although all medications have side effects, opiates have particularly concerning, multisystemic, long-term, and short-term side effects, which increase morbidity and prolong admissions. Enhanced recovery is a systematic process addressing each aspect affecting recovery. This article outlines the evidence base forming the current multimodal analgesia recommendations made by the Enhanced Recovery After Surgery Society (ERAS). We describe current evidence and important future directions for effective perioperative multimodal analgesia in enhanced recovery pathways.
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- 2017
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23. Consensus Review of Optimal Perioperative Care in Breast Reconstruction: Enhanced Recovery after Surgery (ERAS) Society Recommendations
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Temple-Oberle, Claire, Shea-Budgell, Melissa A., Tan, Mark, Semple, John L., Schrag, Christiaan, Barreto, Marcio, Blondeel, Phillip, Hamming, Jeremy, Dayan, Joseph, and Ljungqvist, Olle
- Published
- 2017
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24. Enhanced Recovery After Surgery: A Review
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Ljungqvist, Olle, Scott, Michael, and Fearon, Kenneth C.
- Abstract
IMPORTANCE: Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings. OBSERVATIONS: Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient. The care protocol is based on published evidence. The ERAS Society, an international nonprofit professional society that promotes, develops, and implements ERAS programs, publishes updated guidelines for many operations, such as evidence-based modern care changes from overnight fasting to carbohydrate drinks 2 hours before surgery, minimally invasive approaches instead of large incisions, management of fluids to seek balance rather than large volumes of intravenous fluids, avoidance of or early removal of drains and tubes, early mobilization, and serving of drinks and food the day of the operation. Enhanced Recovery After Surgery protocols have resulted in shorter length of hospital stay by 30% to 50% and similar reductions in complications, while readmissions and costs are reduced. The elements of the protocol reduce the stress of the operation to retain anabolic homeostasis. The ERAS Society conducts structured implementation programs that are currently in use in more than 20 countries. Local ERAS teams from hospitals are trained to implement ERAS processes. Audit of process compliance and patient outcomes are important features. Enhanced Recovery After Surgery started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties. CONCLUSIONS AND RELEVANCE: Enhanced Recovery After Surgery is an evidence-based care improvement process for surgical patients. Implementation of ERAS programs results in major improvements in clinical outcomes and cost, making ERAS an important example of value-based care applied to surgery.
- Published
- 2017
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25. Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society
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Dort, Joseph C., Farwell, D. Gregory, Findlay, Merran, Huber, Gerhard F., Kerr, Paul, Shea-Budgell, Melissa A., Simon, Christian, Uppington, Jeffrey, Zygun, David, Ljungqvist, Olle, and Harris, Jeffrey
- Abstract
IMPORTANCE: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. OBJECTIVE: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. EVIDENCE REVIEW: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included “head and neck surgery,” “pharyngectomy,” “laryngectomy,” “laryngopharyngectomy,” “neck dissection,” “parotid lymphadenectomy,” “thyroidectomy,” “oral cavity resection,” “glossectomy,” and “head and neck.” The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non–head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. FINDINGS: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting. CONCLUSIONS AND RELEVANCE: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.
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- 2017
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26. Enhanced Recovery After Surgery: History, Evolution, Guidelines, and Future Directions
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Tanious, Mariah K., Ljungqvist, Olle, and Urman, Richard D.
- Published
- 2017
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27. The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection.
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Andrew Currie, Burch, Jennifer, Jenkins, John T., Faiz, Omar, Kennedy, Robin H., and Ljungqvist, Olle
- Published
- 2015
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28. Determination of insulin resistance in surgery: The choice of method is crucial.
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Baban, Bayar, Thorell, Anders, Nygren, Jonas, Bratt, Anette, and Ljungqvist, Olle
- Abstract
Summary Background & aims In elective surgery, postoperative hyperglycaemia and insulin resistance are independent risk factors for complications. Since the simpler HOMA method has been used as an alternative to the hyperinsulinemic normoglycemic clamp in studies of surgery induced insulin resistance, we compared the two methods in patients undergoing elective surgery. Methods Data from 113 non-diabetic patients undergoing elective surgery were used. Insulin sensitivity, both before and after surgery, was quantified by the clamp and HOMA. Pre- and postoperatively, the results of the clamp were compared to HOMA using regression- and correlation analysis. Degree of agreement between the methods was studied using weighted linear kappa and the Bland–Altman test. Results Both the clamp and HOMA recorded a mean relative reduction in insulin sensitivity of 39 ± 24% and 39 ± 61% respectively after surgery; with significant correlations ( p < 0.01) for pre- and post-operative measures as well as for relative changes. However r 2 values were low: 0.04, 0.07 and 0.03 respectively. The degree of agreement for the relative change in insulin sensitivity using the Bland–Altman test gave a mean of difference 0% but “limits of agreement” (±2SD) was ±125%. This poor inter-method agreement was consolidated by a weighted linear kappa value of 0.18. Conclusion While the hyperinsulinemic euglycemic clamp measures the postoperative changes in insulin sensitivity, HOMA measures something different. Data using the HOMA method must therefore be interpreted cautiously and is not interchangeable with data obtained from the clamp. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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29. Will Acupuncture Be the Next Addition to Enhanced Recovery After Surgery Protocols?
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Ljungqvist, Olle and de Boer, Hans D.
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- 2023
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30. Enhanced Recovery After Surgery and Elderly Patients
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Ljungqvist, Olle and de Boer, Hans D.
- Abstract
Enhanced recovery after surgery (ERAS) is a new way of working where evidence-based care elements are assembled to form a care pathway involving the patient’s entire journey through surgery. Many elements included in ERAS have stress-reducing effects on the body or helps avoid side effects associated with alternative treatment options. This leads to less overall stress from the injury caused by the operation and helps facilitate recovery. In old, frail patients with concomitant diseases and less physical reserves, this may help explain why the ERAS care is reported to be beneficial for this specific patient group.
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- 2023
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31. Bowel Preparation for Colorectal Surgery: Have All Questions Been Answered?
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Ljungqvist, Olle and Lobo, Dileep N.
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- 2022
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32. Perioperative Opioids—Reclaiming Lost Ground
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Fawcett, William J., Ljungqvist, Olle, and Lobo, Dileep N.
- Published
- 2021
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33. Preinjury [beta]-blockade is protective in isolated severe traumatic brain injury.
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Mohseni, Shahin, Talving, Peep, Wallin, Göran, Ljungqvist, Olle, and Riddez, Louis
- Published
- 2014
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34. Preinjury β-blockade is protective in isolated severe traumatic brain injury.
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Mohseni, Shahin, Talving, Peep, Wallin, Göran, Ljungqvist, Olle, and Riddez, Louis
- Published
- 2014
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35. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS®) society recommendations.
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Cerantola, Yannick, Valerio, Massimo, Persson, Beata, Jichlinski, Patrice, Ljungqvist, Olle, Hubner, Martin, Kassouf, Wassim, Muller, Stig, Baldini, Gabriele, Carli, Francesco, Naesheimh, Torvind, Ytrebo, Lars, Revhaug, Arthur, Lassen, Kristoffer, Knutsen, Tore, Aarsether, Erling, Wiklund, Peter, and Patel, Hitendra R.H.
- Abstract
Summary: Purpose: Enhanced recovery after surgery (ERAS) pathways have significantly reduced complications and length of hospital stay after colorectal procedures. This multimodal concept could probably be partially applied to major urological surgery. Objectives: The primary objective was to systematically assess the evidence of ERAS single items and protocols applied to cystectomy patients. The secondary objective was to address a grade of recommendation to each item, based on the evidence and, if lacking, on consensus opinion from our ERAS Society working group. Evidence acquisition: A systematic literature review was performed on ERAS for cystectomy by searching EMBASE and Medline. Relevant articles were selected and quality-assessed by two independent reviewers using the GRADE approach. If no study specific to cystectomy was available for any of the 22 given items, the authors evaluated whether colorectal guidelines could be extrapolated. Evidence synthesis: Overall, 804 articles were retrieved from electronic databases. Fifteen articles were included in the present systematic review and 7 of 22 ERAS items were studied. Bowel preparation did not improve outcomes. Early nasogastric tube removal reduced morbidity, bowel recovery time and length of hospital stay. Doppler-guided fluid administration allowed for reduced morbidity. A quicker bowel recovery was observed with a multimodal prevention of ileus, including gum chewing, prevention of PONV and minimally invasive surgery. Conclusions: ERAS has not yet been widely implemented in urology and evidence for individual interventions is limited or unavailable. The experience in other surgical disciplines encourages the development of an ERAS protocol for cystectomy. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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36. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS®) society recommendations.
- Author
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Cerantola, Yannick, Valerio, Massimo, Persson, Beata, Jichlinski, Patrice, Ljungqvist, Olle, Hubner, Martin, Kassouf, Wassim, Muller, Stig, Baldini, Gabriele, Carli, Francesco, Naesheimh, Torvind, Ytrebo, Lars, Revhaug, Arthur, Lassen, Kristoffer, Knutsen, Tore, Aarsether, Erling, Wiklund, Peter, and Patel, Hitendra R.H.
- Abstract
Summary: Purpose: Enhanced recovery after surgery (ERAS) pathways have significantly reduced complications and length of hospital stay after colorectal procedures. This multimodal concept could probably be partially applied to major urological surgery. Objectives: The primary objective was to systematically assess the evidence of ERAS single items and protocols applied to cystectomy patients. The secondary objective was to address a grade of recommendation to each item, based on the evidence and, if lacking, on consensus opinion from our ERAS Society working group. Evidence acquisition: A systematic literature review was performed on ERAS for cystectomy by searching EMBASE and Medline. Relevant articles were selected and quality-assessed by two independent reviewers using the GRADE approach. If no study specific to cystectomy was available for any of the 22 given items, the authors evaluated whether colorectal guidelines could be extrapolated. Evidence synthesis: Overall, 804 articles were retrieved from electronic databases. Fifteen articles were included in the present systematic review and 7 of 22 ERAS items were studied. Bowel preparation did not improve outcomes. Early nasogastric tube removal reduced morbidity, bowel recovery time and length of hospital stay. Doppler-guided fluid administration allowed for reduced morbidity. A quicker bowel recovery was observed with a multimodal prevention of ileus, including gum chewing, prevention of PONV and minimally invasive surgery. Conclusions: ERAS has not yet been widely implemented in urology and evidence for individual interventions is limited or unavailable. The experience in other surgical disciplines encourages the development of an ERAS protocol for cystectomy. [Copyright &y& Elsevier]
- Published
- 2013
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37. Preoperative oral carbohydrate therapy
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Nygren, Jonas, Thorell, Anders, and Ljungqvist, Olle
- Published
- 2015
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38. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery.
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Awad, Sherif, Varadhan, Krishna K., Ljungqvist, Olle, and Lobo, Dileep N.
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Summary: Background & aims: Whilst preoperative carbohydrate treatment (PCT) results in beneficial physiological effects, the effects on postoperative clinical outcomes remain unclear and were studied in this meta-analysis. Methods: Prospective studies that randomised adult non-diabetic patients to either PCT (≥50 g oral carbohydrates 2–4 h pre-anaesthesia) or control (fasted/placebo) were included. The primary outcome was length of hospital stay. Secondary outcomes included development of postoperative insulin resistance, complications, nausea and vomiting. Methodological quality was assessed using GRADEpro
® software. Results: Twenty-one randomised studies of 1685 patients (733 PCT: 952 control) were included. No overall difference in length of stay was noted for analysis of all studies or subgroups of patients undergoing surgery with an expected hospital stay ≤2 days or orthopaedic procedures. However, patients undergoing major abdominal surgery following PCT had reduced length of stay [mean difference, 95% confidence interval: −1.08 (−1.87 to −0.29); I2 = 60%, p = 0.007]. PCT reduced postoperative insulin resistance with no effects on in-hospital complications over control (risk ratio, 95% confidence interval, 0.88 (0.50–1.53), I2 = 41%; p = 0.640). There was significant heterogeneity amongst studies and, therefore, quality of evidence was low to moderate. Conclusions: PCT may be associated with reduced length of stay in patients undergoing major abdominal surgery, however, the included studies were of low to moderate quality. [Copyright &y& Elsevier]- Published
- 2013
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39. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations.
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Lassen, Kristoffer, Coolsen, Marielle M.E., Slim, Karem, Carli, Francesco, de Aguilar-Nascimento, José E., Schäfer, Markus, Parks, Rowan W., Fearon, Kenneth C.H., Lobo, Dileep N., Demartines, Nicolas, Braga, Marco, Ljungqvist, Olle, and Dejong, Cornelis H.C.
- Abstract
Summary: Background & aims: Protocols for enhanced recovery provide comprehensive and evidence-based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length-of-stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy. Methods: An international working group constructed within the Enhanced Recovery After Surgery (ERAS
® ) Society constructed a comprehensive and evidence-based framework for best perioperative care for pancreaticoduodenectomy patients. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group. The quality of evidence was rated “high”, “moderate”, “low” or “very low”. Recommendations were graded as “strong” or “weak”. Results: Comprehensive guidelines are presented. Available evidence is summarised and recommendations given for 27 care items. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations. Conclusions: The present evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy. A unified protocol allows for comparison between centres and across national borders. It facilitates multi-institutional prospective cohort registries and adequately powered randomised trials. [ABSTRACT FROM AUTHOR]- Published
- 2012
- Full Text
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40. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations.
- Author
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Lassen, Kristoffer, Coolsen, Marielle M.E., Slim, Karem, Carli, Francesco, de Aguilar-Nascimento, José E., Schäfer, Markus, Parks, Rowan W., Fearon, Kenneth C.H., Lobo, Dileep N., Demartines, Nicolas, Braga, Marco, Ljungqvist, Olle, and Dejong, Cornelis H.C.
- Abstract
Summary: Background & aims: Protocols for enhanced recovery provide comprehensive and evidence-based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length-of-stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy. Methods: An international working group constructed within the Enhanced Recovery After Surgery (ERAS
® ) Society constructed a comprehensive and evidence-based framework for best perioperative care for pancreaticoduodenectomy patients. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group. The quality of evidence was rated “high”, “moderate”, “low” or “very low”. Recommendations were graded as “strong” or “weak”. Results: Comprehensive guidelines are presented. Available evidence is summarised and recommendations given for 27 care items. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations. Conclusions: The present evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy. A unified protocol allows for comparison between centres and across national borders. It facilitates multi-institutional prospective cohort registries and adequately powered randomised trials. [Copyright &y& Elsevier]- Published
- 2012
- Full Text
- View/download PDF
41. The effect of perioperative glucose control on postoperative insulin resistance.
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Blixt, Christina, Ahlstedt, Christian, Ljungqvist, Olle, Isaksson, Bengt, Kalman, Sigridur, and Rooyackers, Olav
- Abstract
Summary: Background & aims: Postoperative insulin resistance and the consequent hyperglycemia affects clinical outcome. Insulin sensitivity may be modulated by preoperative nutrition, adequate pain management and minimal invasive surgery. This study aims to disclose the impact of perioperative glucose control on postoperative insulin resistance. Methods: Twenty patients scheduled for elective open hepatectomy were enrolled in this prospective, randomized study. In the treatment group (n = 9) insulin was administered intravenously to keep blood glucose between 6 and 8 mmol/l during surgery. The control group (n = 8) received insulin if blood glucose >14 mmol/l. Insulin sensitivity was measured by a hyperinsulinemic normoglycemic clamp (0.8 mU/kg/min), performed on all patients both on the day before surgery and immediately postoperatively. Plasma cortisol, insulin and C-peptide were measured. Results: There was a significant difference in mean glucose value during surgery. In the control group 8.8 mmol/l (SD 1.5) vs. 6.9 mmol/l (SD 0.4) in the treated group, p = 0.003. In the control group insulin sensitivity decreased to 21.9% ± 16.2% of the preoperative value and in the insulin treated group to 46.8 ± 15.5%, p < 0.005. Insulin levels were significantly higher in the treatment group as well as consequently lower C-peptide levels. Conclusions: This trial revealed a significant difference in postoperative insulin resistance in the group treated with insulin during surgery. [Copyright &y& Elsevier]
- Published
- 2012
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42. Health economic impact of managing patients following a community-based diagnosis of malnutrition in the UK.
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Guest, Julian F., Panca, Monica, Baeyens, Jean-Pierre, de Man, Frank, Ljungqvist, Olle, Pichard, Claude, Wait, Suzanne, and Wilson, Lisa
- Abstract
Summary: Background & aims: To examine the effect of malnutrition on clinical outcomes and healthcare resource use from initial diagnosis by a general practitioner (GP) in the UK. Methods: 1000 records of malnourished patients were randomly selected from The Health Improvement Network database and matched with a sample of 996 patients’ records with no previous history of malnutrition. Patients’ outcomes and resource use were quantified for six months following diagnosis. Results: Malnourished patients utilised significantly more healthcare resources (e.g. 18.90 versus 9.12 GP consultations; p < 0.001, and 13% versus 5% were hospitalised; p < 0.05). The six-monthly cost of managing the malnourished and non-malnourished group was £1753 and £750 per patient respectively, generating an incremental cost of care following a diagnosis of malnutrition of £1003 per patient. Thirteen percent and 2% of patients died in the malnourished and non-malnourished group respectively (p < 0.001). Independent predictors of mortality were: malnutrition (OR: 7.70); age (per 10 years) (OR: 10.46); and the Charlson Comorbidity Index Score (per unit score) (OR: 1.24). Conclusion: The healthcare cost of managing malnourished patients was more than twice that of managing non-malnourished patients, due to increased use of healthcare resources. After adjusting for age and comorbidity, malnutrition remained an independent predictor of mortality. [Copyright &y& Elsevier]
- Published
- 2011
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43. How nutritional risk is assessed and managed in European hospitals: A survey of 21,007 patients findings from the 2007–2008 cross-sectional nutritionDay survey.
- Author
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Schindler, Karin, Pernicka, Elisabeth, Laviano, Alessandro, Howard, Pat, Schütz, Tatjana, Bauer, Peter, Grecu, Irina, Jonkers, Cora, Kondrup, Jens, Ljungqvist, Olle, Mouhieddine, Mohamed, Pichard, Claude, Singer, Pierre, Schneider, Stéphane, Schuh, Christian, and Hiesmayr, Michael
- Abstract
Summary: Background & aims: Recognition and treatment of undernutrition in hospitalized patients are not often a priority in clinical practice. Objectives: We investigated how the nutritional risk of patients is determined and whether such assessment influences daily nutritional care across Europe and in Israeli hospitals. Methods: 1217 units from 325 hospitals in 25 countries with 21,007 patients participated in a longitudinal survey “nutritionDay” 2007/2008 undertaken in Europe and Israel. Screening practice, the type of tools used and whether energy requirements and intake are assessed and monitored were surveyed using standardized questionnaires. Results: Fifty-two percent (range 21–73%) of the units in the different regions reported a screening routine which was most often performed with locally developed methods and less often with national tools, the Nutrition Risk Screening-2002, or the Malnutrition Universal Screening Tool. Twenty-seven percent of the patients were subjectively classified as being “at nutritional risk”, with substantial differences existing between regions. Independent factors influencing the classification of nutritional risk included age, BMI <18.5 kg/m
2 , unintentional weight loss, reduced food intake in the previous week and on nutritionDay (for all parameters, p < 0.0001). The energy goal was defined as >=1500 kcal in 76% of the patients, but 43% of patients did not reach this goal. Conclusions: The process of nutrition risk assessment varied between units and countries. Additionally, energy goals were frequently not met. More effort is needed to implement current guidelines within daily clinical practice. [Copyright &y& Elsevier]- Published
- 2010
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44. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: A meta-analysis of randomized controlled trials.
- Author
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Varadhan, Krishna K., Neal, Keith R., Dejong, Cornelius H.C., Fearon, Kenneth C.H., Ljungqvist, Olle, and Lobo, Dileep N.
- Abstract
Summary: Background & aims: The aim of the Enhanced Recovery After Surgery (ERAS) pathway is to attenuate the stress response to surgery and enable rapid recovery. The objective of this meta-analysis was to study the differences in outcomes in patients undergoing major elective open colorectal surgery within an ERAS pathway and those treated with conventional perioperative care. Methods: Medline, Embase and Cochrane database searches were performed for relevant studies published between January 1966 and November 2009. All randomized controlled trials comparing ERAS with conventional perioperative care were selected. The outcome measures studied were length of hospital stay, complication rates, readmission rates and mortality. Results: Six randomized controlled trials with 452 patients were included. The number of individual ERAS elements used ranged from 4 to 12, with a mean of 9. The length of hospital stay [weighted mean difference (95% confidence interval): −2.55 (−3.24, −1.85)] and complication rates [relative risk (95% confidence interval): 0.53 (0.44, 0.64)] were significantly reduced in the enhanced recovery group. There was no statistically significant difference in readmission and mortality rates. Conclusion: ERAS pathways appear to reduce the length of stay and complication rates after major elective open colorectal surgery without compromising patient safety. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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45. Modulating postoperative insulin resistance by preoperative carbohydrate loading.
- Author
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Ljungqvist, Olle
- Subjects
POSTOPERATIVE care ,INSULIN resistance ,CARBOHYDRATE metabolism ,GUIDELINES ,PREPROCEDURAL fasting ,ELECTIVE surgery ,GLUCOSE - Abstract
The concept of preoperative overnight fasting was challenged and proved to have no benefits over allowing patients to drink clear fluids up until 2 h before surgery. This led to changes in the guidelines for preoperative fasting in many countries around the world. This concept has more recently been developed further. Mounting evidence indicates that instead of being operated in the traditional overnight fasted state, undergoing surgery in the carbohydrate-fed state has many clinical benefits. Many of these clinical effects can be related to reduced postoperative insulin resistance by preoperative carbohydrate loading. This article summarises the present understanding of the mechanisms behind the positive clinical effects and gives an overview of the information available regarding the clinical effects of this treatment. Finally, the article summarises the most recently published national guidelines on preoperative fasting routines where preoperative carbohydrates are recommended for use before a major surgery. These are to be considered for all patients allowed to drink clear fluids and undergoing elective surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2009
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46. Increased expression of inflammatory pathway genes in skeletal muscle during surgery.
- Author
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Witasp, Anna, Nordfors, Louise, Schalling, Martin, Nygren, Jonas, Ljungqvist, Olle, and Thorell, Anders
- Abstract
Summary: Background & aims: Postoperative insulin resistance, resulting in hyperglycemia, is strongly associated to morbidity and mortality in surgical patients but the underlying mechanisms are unclear. As increasing data suggests a link between inflammation and insulin resistance, we aimed to evaluate if the expression of inflammatory and insulin signaling genes is regulated in skeletal muscle during surgery. Methods: Eight patients (4 females, 63 [46–69] years, body mass index 25.5 [16.5–29.8]kg/m
2 ) undergoing major abdominal surgery were included. Biopsies from m. rectus abdominis were obtained at the beginning and at the end of the operation. mRNA levels of 45 genes were analyzed. Results: The time elapsed between the two biopsies was 224 (198–310)min. An increased (p <0.05) expression was noted for genes encoding both inflammatory mediators, such as interleukin 6, tumor necrosis factor, and nuclear factor of kappa light polypeptide gene enhancer in B cells, and metabolic regulators, such as peroxisome proliferator-activated receptor delta, while the analysis did not detect significant expression changes of the insulin signaling pathway genes. Conclusions: The observed gene expression changes in skeletal muscle during surgery occurred mainly in inflammatory pathways, suggesting a possible role for inflammation in the development of postoperative insulin resistance. [Copyright &y& Elsevier]- Published
- 2009
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47. Modern preoperative fasting guidelines: a summary of the present recommendations and remaining questions.
- Author
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Søreide, Eldar, Ljungqvist, Olle, and Søreide, Eldar
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FASTING ,GASTROINTESTINAL system ,ASPIRATION pneumonia ,MEDICAL care ,MEDICAL research ,ANESTHESIOLOGY ,MEDICAL protocols ,NURSE-physician relationships ,PHYSICIANS ,PREOPERATIVE care ,OCCUPATIONAL roles - Abstract
This chapter is complementary to the others in this volume focusing on preoperative fasting routines. In it we discuss some of the issues in need of more research to define best practice. One of these is the role of fasting in emergency patients. Modern preoperative fasting recommendations almost exclusively deal with elective patients. In emergency patients preoperative fasting cannot secure gastric emptying to reduce the risk of pulmonary aspiration. Hence, surgery should be timed according to the urgency of the situation, and the patient should always be treated as if the stomach was full. More data are needed to better define what is going on in the gastrointestinal tract during the perioperative period in these patients. In certain patient groups – such as patients with diabetes, gastro-oesophageal reflux disease and/or obesity – the data are insufficient to give complete guidance to best practice. Preoperative fasting guidelines also affect fluid balance and perioperative fluid management, a topic of debate in recent years. In addition, carbohydrate-enriched fluids for oral use in the preoperative phase have been shown to have a positive effect on postoperative metabolism. Recent studies also suggest that the immune system would be less affected by surgery with such preparations. Last but not least, new scientific evidence alone is not enough to change daily practice. Active implementation of new evidence is also needed. To improve perioperative care, anaesthesiologists, surgeons and the nursing staff must work together. [Copyright &y& Elsevier]
- Published
- 2006
- Full Text
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48. A comparison in five European Centres of case mix, clinical management and outcomes following either conventional or fast-track perioperative care in colorectal surgery.
- Author
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Nygren, Jonas, Hausel, Jonatan, Kehlet, Henrik, Revhaug, Arthur, Lassen, Kristoffer, Dejong, Cornelius, Andersen, Jens, von Meyenfeldt, Maarten, Ljungqvist, Olle, and Fearon, Kenneth Christopher
- Abstract
Summary: Background & aims: This study reviewed the case mix, clinical management, and clinical outcomes of patients undergoing colorectal resection in five European centres performing different forms of conventional or ‘fast-track’ perioperative care. Methods: The perioperative care programme and surgical practice in each centre was defined. Patient data were collected by case-note review on an internet-based audit system. Case mix was determined using ASA classification and the P-POSSUM scoring system. Results: A total of 451 consecutive patients from units practicing either conventional (Sweden, ; UK, ; Netherlands, , Norway, ) or fast-track surgery (Denmark, ), were studied between 1998 and 2001. Elements of perioperative practice varied widely both between units practicing ‘traditional’ care and the reference ‘fast-track’ unit (Denmark). Based on the P-POSSUM scores, the case mix was similar between centres. There were no differences in morbidity or 30-day mortality between the different centres. The median length of stay was 2 days in Denmark and 7–9 days in the other centres (). The readmission rate was 22% in Denmark and 2–16% in the other centres (). Conclusion: Compared with traditional care, fast-track perioperative care results in a reduced length of hospital stay but may be associated with a higher readmission rate. Morbidity and mortality appears to be similar with either approach. Prospective evaluation of the potential benefits of the fast-track approach in different European centres is merited. [Copyright &y& Elsevier]
- Published
- 2005
- Full Text
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49. Functional and Physiologic Assessment of the Colonic Reservoir or Side-to-End Anastomosis After Low Anterior Resection for Rectal Cancer: A Two-Year Follow-Up.
- Author
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Machado, Mikael, Nygren, Jonas, Goldman, Sven, and Ljungqvist, Olle
- Abstract
PURPOSE: Functional disturbances are common after anterior resection for rectal cancer. This study was designed to compare functional and physiologic outcome after low anterior resection and total mesorectal excision with a colonic J-pouch or a side-to-end anastomosis. METHODS: Functional and physiologic variables were analyzed in patients randomized to a J-pouch (n = 36) or side-to-end anastomosis (n = 35). Postoperative functional outcome was investigated with questionnaires. Anorectal manometry was performed preoperatively and at six months, one year, and two years postoperatively. RESULTS: There was no statistical difference in functional outcome between groups at two years. Maximum neorectal volume increased in both groups but was approximately 40 percent greater at two years in pouches compared with the side-to-end anastomosis. Anal sphincter pressures volumes were halved postoperatively and did not recover during follow-up of two years. Male gender, low anastomotic level, pelvic sepsis, and the post- operative decrease of sphincter pressures were independent factors for more incontinence symptoms. CONCLUSIONS: Colonic J-pouch and side-to-end anastomosis gives comparable functional results two years after low anterior resection. Neorectal volume had no detectable influence on function. There was a pronounced and sustained postop- erative decrease in sphincter pressures. [ABSTRACT FROM AUTHOR]
- Published
- 2005
- Full Text
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50. Microdialysis methods for measuring human metabolism.
- Author
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Rooyackers, Olav, Thorell, Anders, Nygren, Jonas, and Ljungqvist, Olle
- Abstract
Purpose Of Review: To discuss the advantages and limitations of the microdialysis technique as a diagnostic and research tool using recent findings on human metabolism.Recent Findings: Results from several studies have supported the potential of microdialysis as a diagnostic tool for metabolic monitoring in difficult accessible tissues (brain, liver, intestine). However, despite promising results, no clear diagnostic measures have yet emerged. Several studies combining microdialysis with stable isotope tracers have shown that this approach has great potential for studying human metabolism non-invasively in specific tissue beds in a more dynamic way.Summary: Bearing in mind the limitations and assumptions, the microdialysis technique is a useful tool in investigations of human metabolism. Its main advantages are that it can be used safely with low-grade invasiveness in humans, and thereby allows continuous sampling over prolonged periods of time from specific tissues without taking any biopsies. At present, microdialysis would seem to be useful as a diagnostic tool when integrated in the total clinical, physiological and pharmacological evaluation. Within human metabolic research, microdialysis has been and will be a very useful technique. [ABSTRACT FROM AUTHOR]- Published
- 2004
- Full Text
- View/download PDF
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