38 results on '"Nielsen MV"'
Search Results
2. ESRA19-0402 Block performance time of the ultrasound-guided bilateral transmuscular quadratus lumborum block – a local mini survey
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Tanggaard, K, primary, Bernhoff, C, additional, Nielsen, MV, additional, and Børglum, J, additional
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- 2019
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Catalog
3. ESRA19-0237 The ultrasound-guided multiple-injection costotransverse block for postoperative pain management with major breast cancer surgery: case reports
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Nielsen, MV, primary, Tanggaard, K, additional, and Børglum, J, additional
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- 2019
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4. Growth and chemical composition of the toxic dinoflagellate Gymnodinium galatheanum in relation to irradiance, temperature and salinity
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Nielsen Mv
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Photoinhibition ,Ecology ,biology ,Phosphorus ,Dinoflagellate ,Irradiance ,Temperature salinity diagrams ,chemistry.chemical_element ,Aquatic Science ,biology.organism_classification ,Photosynthesis ,Salinity ,Horticulture ,chemistry ,Botany ,Growth rate ,Ecology, Evolution, Behavior and Systematics - Abstract
Gymnodiniurn galatheanurn Braarud shows optimum growth (0.57 d-l) at 20 to 24"C and 24%0 S, within a temperature/salinity range of 7 to 24OC and 10 to 3 4 % S, respectively. The growth rate is significantly affected by temperature and salinity, but no temperature-salinity interaction is found. No photoinhibition is found below 500 pm01 photons m-' S ' Optimum irradiance for growth is -120 pm01 m-' S ' , while the optimum for the growth-relevant chl a-normalized C fixation rate is >500 pm01 m-2 S-' This difference in optimum irradiance for the growth and photosynthetic rate is related to a decrease in the cellular chl a/carbon ratio with increasing irradiance. Carbon, nitrogen and phosphorus contents per cell are significantly affected by temperature, salinity and irradiance. The high and low P/C and N/P ratios, respectively, for nutrient saturated cells indicate that G. galatheanurn has a large storage capacity for phosphorus. more...
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- 1996
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5. Toxic effect of the marine dinoflagellate Gymnodinium galatheanum on juvenile cod Gadus morhua
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Nielsen, MV, primary
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- 1993
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6. Selective Feeding and Epipsammic Browsing by the Deposit-Feeding Amphipod Corophium volutator
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Nielsen, MV, primary and Kofoed, LH, additional
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- 1982
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7. Non-inferiority: egregious infractions or conclusion confused?
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Nielsen MV, Hansen CK, and Børglum J
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- 2025
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8. Anterior quadratus lumborum blocks for postoperative pain treatment following intra-abdominal surgery: A systematic review with meta-analyses and trial sequential analyses.
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Tanggaard K, Gronlund C, Nielsen MV, la Cour K, Tvarnø CD, Børglum J, Maagaard M, and Mathiesen O
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- Humans, Analgesics, Opioid therapeutic use, Analgesics, Opioid administration & dosage, Randomized Controlled Trials as Topic, Pain, Postoperative drug therapy, Pain, Postoperative prevention & control, Nerve Block methods, Abdomen surgery, Abdominal Muscles innervation
- Abstract
Background: The anterior quadratus lumborum (QL) block may be used for postoperative pain management for intra-abdominal surgeries, but the evidence is uncertain. We aimed to investigate the benefit and harm of the anterior QL block compared to placebo/no block for intra-abdominal surgery., Methods: We searched Medline, Embase, and CENTRAL for randomized controlled trials investigating anterior QL block for postoperative pain management for adult patients undergoing any intra-abdominal surgery. The two co-primary outcomes were cumulative 24-h opioid consumption and serious adverse events. We performed meta-analysis, trial sequential analysis (TSA), assessed the risk of bias, and present the certainty of evidence with the Grading of Recommendations, Assessment, Development and Evaluation approach., Results: Thirty-five trials randomizing 2418 patients were included in the meta-analyses. Anterior QL block may reduce cumulative 24-h intravenous opioid consumption compared to placebo/no block (MD -10.42 mg, 96.7% CI -14.83 to -6.01, TSA-adjusted CI -17.03 to -3.82, p < .01). Two trials reported on SAEs. Anterior QL block may have little to no effect on the number of serious adverse events compared to placebo (RR 1.49, 96.7% CI 0.19 to 11.47, p = .68), but the evidence is very uncertain. All trial results were assessed as being high risk of bias., Conclusions: The anterior QL block may reduce cumulative 24-h opioid consumption. Reported serious adverse events were few and the anterior QL block may have little to no effect on the number of SAEs, but the evidence was very uncertain., (© 2024 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.) more...
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- 2025
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9. Education and training programs for health professionals' competence in virtual consultations: a scoping review protocol.
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Mathiesen LMW, Bagger B, Høgsgaard D, Nielsen MV, Gjedsig SS, and Hägi-Pedersen MB
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- Humans, Scoping Reviews As Topic, Clinical Competence, Health Personnel education, Remote Consultation
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Objective: The objective of this scoping review is to explore, report, and map the evidence on education and training programs for current and future health professionals' competence in virtual consultations., Introduction: Digital solutions, telemedicine, and technologies are increasingly becoming a part of the health system, requiring current and future health professionals to master skills in these domains., Inclusion Criteria: This review will consider any studies on education and training programs designed to optimize current and future health professionals' competence in virtual consultations in any setting, such as faculties, universities, university colleges, hospitals, or community locations., Methods: This review will be guided by the JBI methodology for scoping reviews. Published and unpublished sources of information will be searched for in MEDLINE (PubMed), CINAHL Complete (EBSCOhost), and Scopus. Studies written in English, German, Danish, Swedish, and Norwegian will be considered, with no geographical or cultural limitations. Two independent reviewers will screen retrieved papers, and a standardized tool will be used to extract data from each included source. The results of the extracted data will be presented in tabular format, together with a narrative summary of the evidence., Review Registration: Open Science Framework https://osf.io/bsmuy., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on Behalf of JBI.) more...
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- 2024
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10. Efficacy of the intertransverse process block: single or multiple injection? A randomized, non-inferiority, blinded, cross-over trial in healthy volunteers.
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Nielsen MV, Tanggaard K, Bojesen S, Birkebæk AF, Therkelsen AS, Sørensen H, Klementsen C, Hansen C, Vazin M, Poulsen TD, and Børglum J
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- Humans, Male, Adult, Young Adult, Thoracic Vertebrae, Ropivacaine administration & dosage, Injections, Double-Blind Method, Cross-Over Studies, Healthy Volunteers, Nerve Block methods, Anesthetics, Local administration & dosage
- Abstract
Introduction: The intertransverse process block is increasingly used to ameliorate postoperative pain following a plethora of surgical procedures involving the thoracic wall. Nevertheless, the optimal approach and cutaneous extent of the sensory block are currently unknown. We aimed to further describe the intertransverse process block, single injection versus multiple injection, and we hypothesized that the single-injection intertransverse process block is a non-inferior technique., Methods: Twelve healthy male volunteers were cross-over randomized to receive either single-injection intertransverse process block with 21 mL ropivacaine 7.5 mg/mL, including two sham injections, at the thoracic level T4/T5 or multiple-injection intertransverse process block with three injections of 7 mL ropivacaine 7.5 mg/mL at the thoracic levels T2/T3, T4/T5 and T6/T7 at the first visit. At the second visit, the other technique was applied on the contralateral hemithorax. A non-inferiority margin of 1.5 anesthetized thoracic dermatomes was chosen., Results: The mean difference (95% CI) in the number of anesthetized thoracic dermatomes was 0.82 (-0.41 to 2.05) p
non-inf <0.01 indicating non-inferiority favoring the single-injection technique.Both techniques anesthetized the ipsilateral thoracic wall and demonstrated contralateral cutaneous involvement to a variable extent. The multiple-injection intertransverse process block anesthetized a significantly larger cutaneous area on the posterior hemithorax and decreased mean arterial pressure at 30 and 60 min postblock application. Thoracic thermography showed no intermodality temperature differences yet compared with baseline temperatures both techniques showed significant differences., Conclusions: Single-injection intertransverse process block is non-inferior to multiple injection in terms of anesthetized thoracic dermatomes. Both techniques generally anesthetize the hemithoracic wall to a variable extent., Eu Clinical Trials Register: 2022-501312-34-01., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.) more...- Published
- 2024
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11. No quadriceps muscle weakness following anterior quadratus lumborum block compared with placebo: a randomized, non-inferiority, blinded, volunteer trial.
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Tanggaard K, Nielsen MV, Holm UHU, Hoffmann BM, Bernhoff C, Andersen CH, Thomassen SS, Hansen C, Dam M, Poulsen TD, Holm PM, and Børglum J
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Background and Aims: Anterior quadratus lumborum block is a truncal block, applied in close proximity to the lumbar plexus, potentially causing lower limb weakness. This trial aimed to evaluate whether a unilateral anterior quadratus lumborum block caused quadriceps muscle weakness compared with placebo., Methods: In this randomized, non-inferiority, triple-blind trial, 20 healthy volunteers received an active unilateral anterior quadratus lumborum block with 30 mL ropivacaine 0.75% and a placebo block on the contralateral side. Primary outcome was change in maximal quadriceps muscle strength from baseline to 60 min postblock compared with placebo. Secondary outcomes were change in single-leg 6 m timed hop test, change in Timed-Up and Go test, change in mean arterial pressure from baseline to 30 min postblock and dermatomal affection., Results: There was no statistically significant difference in changes in maximal quadriceps muscle strength between active and placebo block; 15.88 N (95% CI -12.19 to +43.94), p
non-inf =0.003, indicating non-inferiority. Timed-Up and Go test was performed significantly faster 60 min postblock; -0.23 s (95% CI -0.38 to -0.08, p=0.005). Mean change in mean arterial pressure from baseline to 30 min postblock was 4.25 mm Hg (95% CI 0.24 to 8.26, p=0.04). Dermatome testing revealed an affection primarily of the lower abdomen (Th10-L1) with the active block., Conclusion: In this randomized controlled trial including healthy volunteers a unilateral anterior quadratus lumborum block does not cause statistical or clinical significant motor block of the quadriceps muscle compared with placebo. When administered correctly, the block can be used for procedures where early postoperative mobilization is essential., Trial Registration Number: NCT05023343., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.) more...- Published
- 2024
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12. Radiation dose to multidisciplinary staff members during complex interventional procedures.
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Mussmann B, Larsen TR, Godballe M, Abdi AJ, Kantsø A, Jakobsen AR, Nielsen MV, and Jensen J
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- Male, Humans, Radiation Dosage, Fluoroscopy, Radiation Protection
- Abstract
Introduction: Complex interventional radiology procedures involve extensive fluoroscopy and image acquisition while staff are in-room. Monitoring occupational radiation dose is crucial in optimization. The purpose was to determine radiation doses received by staff involved in complex interventional procedures performed in a dedicated vascular or neuro intervention room., Methods: Individual real-time radiation dose for all staff involved in vascular and neuro-interventional procedures in adult patients was recorded over a one-year period using wireless electronic dosimeters attached to the apron thyroid shield. A reference dosimeter was attached to the C-arm near the tube housing to measure scattered, unshielded radiation. Radiology staff carried shoulder thermo-luminescent dosimeters with monthly read-out to monitor dose over time., Results: Occupational radiation dose was measured in 99 interventional procedures. In many cases prostate artery embolization procedures exposed radiologists to high radiation doses with a median of 15.0 μSv and a very large spread, i.e. 0.2-152.5 μSv. In all procedures except uterine fibroid embolization radiographers were exposed to lower doses than those of radiologists, with endovascular aortic repair being the procedure with highest median exposure to assisting radiographers, i.e. 2.2 μSv ranging from 0.1 to 36.1 μSv. Median radiation dose for the reference dosimeter was 670 μGy while median staff dose for all procedures combined was 3.2 μGy., Conclusion: Radiation doses for multiple staff were determined and the ratio between staff dose and reference dosimeter indicated proper use of shielding in general. Some high-dose procedures may need further optimization for certain staff members, especially those not primarily employed in radiology., Implications for Practice: The study provides benchmark doses that may be used widely in audits and in the ongoing effort to optimize radiation protection for staff in interventional radiology., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.) more...
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- 2024
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13. Anterior quadratus lumborum catheters for elective cesarean section: A double-blind, randomized, placebo-controlled trial.
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Hansen CK, Steingrimsdottir GE, Dam M, Nielsen MV, Tanggaard K, Poulsen TD, Lebech M, and Børglum J
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- Humans, Female, Pregnancy, Ropivacaine, Cesarean Section methods, Pain, Postoperative prevention & control, Pain, Postoperative drug therapy, Catheters, Double-Blind Method, Analgesics, Opioid, Anesthetics, Local
- Abstract
Background: Optimizing pain management following cesarean section is crucial for the well-being of both mother and infant. Various types of quadratus lumborum blocks have exhibited reduced opioid consumption and pain scores after cesarean section. However, duration of block effect is relatively short. The aim of this study was to investigate the analgesic efficacy of the anterior quadratus lumborum catheters for cesarean section., Methods: All 32 enrolled participants were allocated to postoperative bilateral ultrasound-guided anterior quadratus lumborum catheter placement with injection of 60 mL ropivacaine 0.375% after cesarean section. Randomization at 2 h resulted in either 60 mL ropivacaine 0.2% or 60 mL isotonic saline injected through the catheters, with subsequent 22-h infusion of either ropivacaine 0.2% or isotonic saline with an infusion rate of 4 mL h
-1 per catheter. Participants in the active group received a total of 697 mg ropivacaine during the first 24 h. All participants received the standard postoperative multimodal pain regimen, and a final bilateral injection at 24-h post-catheter placement of 60 mL ropivacaine 0.375% in total. The primary outcome was time to first opioid administration. Secondary outcomes were pain scores, time to first ambulation, nausea and vomiting, accumulated opioid consumption, and catheter displacement rates., Results: No significant intergroup differences were observed following the randomized intervention. Median time to first opioid (IQR) was (active vs. placebo) 414 (283, 597) vs. 428 (245, 552) minutes, with a median difference (CI) of -14 (-184 to 262) min, p = .32., Conclusion: Bilateral anterior quadratus lumborum catheters with continuous infusion did not prolong time to first opioid after elective cesarean section., (© 2023 Acta Anaesthesiologica Scandinavica Foundation.) more...- Published
- 2024
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14. Insignificant influence of the intertransverse process block for major breast cancer surgery: a randomized, blinded, placebo-controlled, clinical trial.
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Nielsen MV, Tanggaard K, Hansen LB, Hansen CK, Vazin M, and Børglum J
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- Humans, Female, Mastectomy adverse effects, Analgesics, Opioid, Prospective Studies, Pain, Postoperative diagnosis, Pain, Postoperative etiology, Pain, Postoperative prevention & control, Breast Neoplasms surgery
- Abstract
Introduction: The intertransverse process (ITP) block mimics the thoracic paravertebral block and allegedly ameliorates hemithoracic postoperative pain. However, concerning major reconstructive breast cancer surgery the modality has never been tested against placebo in a randomized clinical trial. We aimed to assess the efficacy of the multiple-injection ITP block and hypothesized that the blockade would reduce postoperative opioid consumption., Methods: We screened 58 patients with breast cancer scheduled for unilateral subpectoral implant-based primary breast reconstruction, involving mastectomy with complete fascial dissection of the major pectoral muscle. A randomization procedure allowed for the allocation of 36 patients to receive either unilateral multiple-injection active ITP block (0.5% ropivacaine 3×10 mL) or placebo ITP block (isotonic saline 3×10 mL) at T2, T4, T6 in a prospective, blinded, clinical trial. The primary outcome was total opioid consumption within the first 24 postoperative hours. Secondary outcomes included opioid consumption at 4-hour intervals, postoperative pain, patient satisfaction with block application, time to first opioid, ambulation and discharge, opioid-related side effects, and quality of recovery., Results: Opioid consumption within the first 24 postoperative hours showed no significant reduction when comparing the active and placebo group median (IQR): 75.0 mg (45-135) vs 62.5 mg (30-115), p=0.5, respectively. We did not find any consequential clinically relevant results of the secondary outcomes., Conclusions: Following major reconstructive breast cancer surgery, a preoperative multiple-injection ITP block neither reduces 24-hour opioid consumption postoperatively nor promotes substantial clinical positive outcomes., Trial Registration Number: EudraCT2019-001016-35., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.) more...
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- 2024
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15. Impact of letrozole co-treatment during ovarian stimulation on oocyte yield, embryo development, and live birth rate in women with normal ovarian reserve: secondary outcomes from the RIOT trial.
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Bülow NS, Warzecha AK, Nielsen MV, Andersen CY, Holt MD, Petersen MR, Sopa N, Zedeler A, Englund AL, Pinborg A, Grøndahl ML, Skouby SO, and Macklon NS
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- Female, Humans, Pregnancy, Embryonic Development, Estradiol, Fertilization in Vitro methods, Follicle Stimulating Hormone, Gonadotropins, Letrozole, Live Birth, Oocytes, Ovulation Induction methods, Pregnancy Rate, Progesterone, Birth Rate, Ovarian Reserve physiology
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Study Question: Does letrozole (LZ) co-treatment during ovarian stimulation with gonadotropins for in IVF impact follicle recruitment, oocyte number and quality, embryo quality, or live birth rate (LBR)?, Summary Answer: No impact of LZ was found in follicle recruitment, number of oocytes, quality of embryos, or LBR., What Is Known Already: Multi-follicle stimulation for IVF produces supra-physiological oestradiol levels. LZ is an aromatase inhibitor that lowers serum oestradiol thus reducing negative feedback and increasing the endogenous gonadotropins in both the follicular and the luteal phases, effectively normalizing the endocrine milieu during IVF treatment., Study Design, Size, Duration: Secondary outcomes from a randomized, double-blind placebo-controlled trial (RCT) investigating once-daily 5 mg LZ or placebo during stimulation for IVF with FSH. The RCT was conducted at four fertility clinics at University Hospitals in Denmark from August 2016 to November 2018 and pregnancy outcomes of frozen-thawed embryo transfers (FET) registered until May 2023., Participants/materials, Setting, Methods: One hundred fifty-nine women with expected normal ovarian reserve (anti-Müllerian hormone 8-32 nmol/l) were randomized to either co-treatment with LZ (n = 80) or placebo (n = 79). In total 1268 oocytes were aspirated developing into 386 embryos, and morphology and morphokinetics were assessed. One hundred twenty-nine embryos were transferred in the fresh cycle and 158 embryos in a subsequent FET cycle. The effect of LZ on cumulative clinical pregnancy rate (CPR), LBR, endometrial thickness in the fresh cycle, and total FSH consumption was reported., Main Results and the Role of Chance: The proportion of usable embryos of retrieved oocytes was similar in the LZ group and the placebo group with 0.31 vs 0.36 (mean difference (MD) -0.05, 95% CI (-0.12; 0.03), P = 0.65). The size and number of aspirated follicles at oocyte retrieval were similar with 11.8 vs 10.3 follicles per patient (MD 1.5, 95% CI (-0.5; 3.1), P = 0.50), as well as the number of retrieved oocytes with 8.0 vs 7.9 oocytes (MD 0.1, 95% CI (-1.4; 1.6), P = 0.39) in the LZ and placebo groups, respectively. The chance of retrieving an oocyte from the 13 to 16 mm follicles at trigger day was 66% higher (95% CI (24%; 108%), P = 0.002) in the placebo group than in the LZ group, whilst the chance of retrieving an oocyte from the ≥17 mm follicles at trigger day was 50% higher (95% CI (2%; 98%), P = 0.04) in the LZ group than in the placebo group. The proportion of fertilized oocytes with two-pronuclei per retrieved oocytes or per metaphase II oocytes (MII) (the 2PN rates) were similar regardless of fertilization with IVF or ICSI with 0.48 vs 0.57 (MD -0.09, 95% CI (-0.24; 0.04), P = 0.51), and 0.62 vs 0.64 (MD -0.02, 95% CI (-0.13; 0.07), P = 0.78) in the LZ and placebo groups, respectively. However, the MII rate in the ICSI group was significantly lower with 0.75 vs 0.88 in the LZ vs the placebo group (MD -0.14, 95% CI (-0.22; -0.06), P = 0.03). Blastocysts on Day 5 per patient were similar with 1.5 vs 2.0, P = 0.52, as well as vitrified blastocysts per patient Day 5 with 0.8 vs 1.2 in (MD -0.4, 95% CI (-1.0; 0.2), P = 0.52) and vitrified blastocysts per patient Day 6 with 0.6 vs 0.6 (MD 0, 95% CI (-0.3; 0.3), P = 1.00) in the LZ vs placebo group, respectively. Morphologic evaluation of all usable embryos showed a similar distribution in 'Good', 'Fair', and 'Poor', in the LZ vs placebo group, with an odds ratio (OR) of 0.8 95% CI (0.5; 1.3), P = 0.68 of developing a better class embryo. Two hundred and ninety-five of the 386 embryos were cultured in an embryoscope. Morphokinetic annotations showed that the odds of having a high KIDscore™ D3 Day 3 were 1.2 times higher (CI (0.8; 1.9), P = 0.68) in the LZ group vs the placebo group. The CPR per transfer was comparable with 31% vs 39% (risk-difference of 8%, 95% CI (-25%; 11%), P = 0.65) in the LZ and placebo group, respectively, as well as CPR per transfer adjusted for day of transfer, oestradiol and progesterone levels at trigger, progesterone levels mid-luteal, and number of oocytes retrieved (adjusted OR) of 0.8 (95% CI (0.4; 1.6), P = 0.72). Comparable LBR were found per transfer 28% vs 37% (MD -9%, 95% CI (-26%; 9%), P = 0.60) and per randomized women 24% vs 30% (MD of -6%, CI (-22%; 8%), P = 0.60) in the LZ group and placebo group, respectively. Furthermore, 4.8 years since the last oocyte aspiration, a total of 287 of 386 embryos have been transferred in the fresh or a subsequently FET cycle, disclosing the cumulative CPR, which is similar with 38% vs 34% (MD 95% CI (8%; 16%), P = 0.70) in the LZ vs placebo group., Limitations, Reasons for Caution: Both cleavage stage and blastocyst transfer and vitrification were permitted in the protocol, making it necessary to categorize their quality and pool the results. The study was powered to detect hormonal variation but not embryo or pregnancy outcomes., Wider Implications of the Findings: The similar utilization rate and quality of the embryos support the use of LZ co-treatment for IVF with specific indication as fertility preservation, patients with previous cancer, or poor responders. The effect of LZ on mature oocytes from different follicle sizes and LBRs should be evaluated in a meta-analysis or a larger RCT., Study Funding/competing Interest(s): Funding was received from EU Interreg for ReproUnion, Sjaelland University Hospital, Denmark, Ferring Pharmaceuticals, and Gedeon Ricther. Roche Diagnostics contributed with assays. A.P. has received grants from Ferring, Merck Serono, and Gedeon Richter, consulting fees from Preglem, Novo Nordisk, Ferring, Gedeon Richter, Cryos, & Merck A/S, speakers fees from Gedeon Richter, Ferring, Merck A/S, Theramex, & Organon, and travel support from Gedeon Richter. The remaining authors declare that they have no competing interests in the research or publication., Trial Registration Numbers: NCT02939898 and NCT02946684., (© The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.) more...
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- 2023
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16. The intertransverse process block single- or multiple-injection? A study protocol.
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de la Fuente Birkebaek A, Tanggaard K, Bojesen S, Therkelsen AS, Klementsen CH, Hansen CK, Vazin M, Poulsen TD, Børglum J, and Nielsen MV
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- Humans, Male, Ropivacaine, Thorax, Outcome Assessment, Health Care, Anesthetics, Local, Randomized Controlled Trials as Topic, Nerve Block methods
- Abstract
Background and Aims: Intertransverse process (ITP) blocks are applied on the posterior side of the thoracic paravertebral space. The modality is described as being a paravertebral block by proxy, possibly providing a similar analgesic effect as the thoracic paravertebral block. However, systematic evidence on anaesthetised dermatomes and the extent of cutaneous sensory loss following ITP blocks is sparse. This study aims to test the single- versus the multiple-injection ITP block. The primary outcome is the number of anaesthetised thoracic dermatomes for each block type., Methods: Twelve healthy male volunteers will participate in this randomised, procedure-related, double-blinded, non-inferiority crossover trial after informed consent. Blinded participants will receive either a unilateral single-injection ITP block with 21 mL ropivacaine 7.5 mg/mL including two sham blocks or a unilateral multiple-injection ITP block with 3 × 7 mL ropivacaine 7.5 mg/mL on study Day 1, and the other modality on study Day 2. Block applicants will be blinded from outcome assessment and vice versa. Following block application sensory test by mechanical pinprick and temperature discrimination will be performed. Anterior truncal thermography will be measured three times after block application to compare skin temperature in the mid-clavicular line between the blocked and the contralateral non-blocked hemithorax. In addition, blood pressure changes are measured three times non-invasively., Discussion: The current study will provide substantial knowledge regarding the cutaneous sensory loss of the ITP block. Furthermore, the study might provide insight regarding the possible clinical usage of thermography as a reliable instrument for measuring nerve block efficacy., (© 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.) more...
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- 2023
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17. Images of the thoracic paravertebral space: a demanding dance with the devil in the details.
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Nielsen MV, Tanggaard K, Hansen CK, Børglum J, and Moriggl B
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- Humans, Pain, Postoperative, Nerve Block methods
- Abstract
Competing Interests: Competing interests: None declared.
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- 2022
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18. Ultrasound-guided multiple-injection costotransverse block for mastectomy and primary reconstructive surgery. A study protocol.
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Holm UHU, Andersen CHS, Hansen CK, Tanggaard K, Børglum J, and Nielsen MV
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- Double-Blind Method, Female, Humans, Mastectomy, Pain, Postoperative drug therapy, Pain, Postoperative prevention & control, Prospective Studies, Ultrasonography, Interventional, Breast Neoplasms surgery, Plastic Surgery Procedures
- Abstract
Background: Post-operative pain amelioration following breast cancer surgery is inconsistent. The novel multiple-injection costotransverse block (MICB) mimics the thoracic paravertebral block by possible anaesthetising the ventral rami of the thoracic spinal nerves and the sympathetic trunk. Proof of concept has been determined in a cadaveric study and needs further clinical testing., Methods: This double-blinded, randomised and placebo-controlled study investigates the efficacy of the ultrasound-guided MICB versus placebo in 36 patients undergoing unilateral mastectomy and primary subpectoral reconstruction surgery. Oral pre-operative medicine is standardised for all patients. Active group is pre-operatively administered MICB with three injections of each 10 ml of ropivacaine (5 mg/ml). The placebo group is pre-operatively administered three injections of each 10 ml of saline (0.9%). Standard general anaesthesia is induced and 30 min before emergence 0.2 μg/kg total body weight sufentanil IV, 1 g of paracetamol IV and 4 mg of ondansetron IV (post-operative nausea and vomiting, PONV, prophylaxis) will be administered. All patients are provided with a patient-controlled analgesia pump with morphine. The primary aim is total morphine consumption in the first 24 post-operative hours. Secondary aims are pain intensity, duration of the block, patient satisfaction, side effects, time to ambulation, time to discharge, and quality of recovery., Discussion: Recruitment began in November 2019 and is expected to finish ultimo 2021. Results are expected to be published in an international peer-reviewed medical journal. The results will hopefully provide a substantial contribution to the knowledge of these new 'intertransverse process blocks' providing regional anaesthesia of the thoracic wall., (© 2022 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.) more...
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- 2022
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19. The Interface of Surgical and Anesthesiological Postoperative Analgesic Regime: Pericapsular Injection Versus Lumbar Plexus Block: Letter to the Editor.
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Hæstrup DS, Therkelsen ASN, Reisbøl S, Hansen CK, Børglum J, and Nielsen MV
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- Analgesics, Humans, Lumbosacral Plexus, Pain, Postoperative drug therapy, Pain, Postoperative prevention & control, Nerve Block
- Published
- 2021
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20. The intertransverse tissue complex: friend, foe, fallacies?
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Nielsen MV, Moriggl B, and Børglum J
- Abstract
Competing Interests: Competing interests: None declared.
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- 2021
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21. Transmuscular quadratus lumborum block for total laparoscopic hysterectomy: a double-blind, randomized, placebo-controlled trial.
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Hansen C, Dam M, Nielsen MV, Tanggaard KB, Poulsen TD, Bendtsen TF, and Børglum J
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- Abdominal Muscles diagnostic imaging, Analgesics, Opioid, Anesthetics, Local, Double-Blind Method, Female, Humans, Hysterectomy adverse effects, Pain, Postoperative diagnosis, Pain, Postoperative etiology, Pain, Postoperative prevention & control, Ropivacaine, Laparoscopy adverse effects, Nerve Block adverse effects
- Abstract
Background: The population of patients scheduled for total laparoscopic hysterectomy at our surgical center is heterogeneous concerning a multitude of demographic variables such as age, collateral surgery and malign or benign pathogenesis. A common denominator is moderate to severe postoperative pain and a substantial opioid consumption. A recent procedure specific postoperative pain management (PROSPECT) review found no gain from the regional techniques included. The transmuscular quadratus lumborum (TQL) block has shown promising results in recent trials for other types of surgery. The aim of the current study was to investigate the analgesic efficacy of the ultrasound-guided TQL block for total laparoscopic hysterectomy., Methods: We enrolled 70 patients and randomly allocated participants to preoperative bilateral ultrasound-guided TQL block with either 60 mL 0.375% ropivacaine or 60 mL isotonic saline. Preoperatively, all patients received the TQL block (active or placebo) as well as a standardized multimodal analgesic regimen consisting of oral paracetamol, ibuprofen and dexamethasone. Intraoperatively, intravenous sufentanil 0.2 µg/kg was administered 30 min prior to emergence., Primary Outcome: Opioid consumption during the first 12 postoperative hours., Secondary Outcomes: Pain scores, times to first opioid demand and first ambulation, nausea and vomiting, and total opioid consumption during the first 24 postoperative hours., Results: No significant intergroup differences were observed for any outcome. Mean (SD) oral morphine equivalent consumption the first 12 postoperative hours was 58.4 mg (48.3) vs 62.9 mg (48.5), p=0.70, for group ropivacaine versus group saline., Conclusion: Preoperative bilateral ultrasound-guided TQL block did not reduce opioid consumption after total laparoscopic hysterectomy., Trial Registration Numbers: NCT03650998, EudraCT (2017-004593-34)., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2021. No commercial re-use. See rights and permissions. Published by BMJ.) more...
- Published
- 2021
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22. Quadratus lumborum block for total hip arthroplasty: anatomical knowledge is always key for choice of blocks and execution.
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Steingrimsdottir G, Hansen CK, Dam M, Tanggaard KB, Nielsen MV, and Børglum J
- Subjects
- Humans, Pain Management, Analgesia, Arthroplasty, Replacement, Hip adverse effects, Nerve Block adverse effects
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2021
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23. New Name, No Novelty.
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Nielsen MV, Moriggl B, Hansen CK, and Borglum J
- Subjects
- Nerve Block
- Published
- 2020
24. Transmuscular quadratus lumborum block for percutaneous nephrolithotomy: Study protocol for a dose-finding trial.
- Author
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Andersen CHS, Laier GH, Nielsen MV, Dam M, Hansen CK, Tanggaard K, and Børglum J
- Subjects
- Abdominal Muscles, Adult, Anesthetics, Local administration & dosage, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Male, Treatment Outcome, Young Adult, Clinical Protocols, Nephrolithotomy, Percutaneous methods, Nerve Block methods, Pain, Postoperative drug therapy, Research Design, Ropivacaine administration & dosage
- Abstract
Background: The objective of this trial is to optimize the transmuscular quadratus lumborum (TQL) block, by investigating the minimal effective volume (MEV
90 ) of ropivacaine 0.75% for single-shot TQL block in percutaneous nephrolithotomy (PNL) patients., Methods: This double-blind, randomized and controlled dose-finding trial is based on a biased coin up-and-down sequential design, where the volume of local anaesthetic administered to each patient depends on the response from the previous one. Investigating the TQL block, the first patient recruited receives 20 ml ropivacaine 0.75% preoperatively. In case of block failure, the next patient will receive the same volume with an increment of 2 ml. Given a successful block for the first patient, the next patient will be randomized to either a lower volume (previous volume with a reduction of 2 ml), or the same volume as the previous patient. The respective probabilities being b = 0.11 for a reduced volume and 1-b = 0.89 for the same volume. Block success is defined as patient reported pain score numeric rated scale (NRS) ≤3 (0-10/10) 30 minutes after arrival in the post anaesthesia care unit (PACU). The NRS pain score is our primary and only outcome for block success. A minimum of 25 eligible patients are needed to achieve precise estimation of MEV90 with narrow 95% confidence intervals derived by bootstrapping., Discussion: Recruiting will begin June 2020 and is expected to finish November 2020. Data analysis will be performed at interims during and after the study. Results will be published in an international peer-reviewed medical journal., (© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.) more...- Published
- 2020
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25. STIL block - Anatomical misconceptions and lack of novelty.
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Nielsen MV, Moriggl B, Bendtsen TF, and Børglum J
- Subjects
- Humans, Intracellular Signaling Peptides and Proteins, Ultrasonography, Ultrasonography, Interventional, Nerve Block
- Abstract
Competing Interests: Declaration of competing interest Departmental funding only. The authors declare no conflicts of interest.
- Published
- 2020
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26. Ultrasound-guided transmuscular quadratus lumborum block catheter technique.
- Author
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Andersen EB, Tanggaard K, Nielsen MV, Hansen CK, Dam M, Poulsen TD, Børglum J, and Wolmarans M
- Subjects
- Abdominal Muscles, Ultrasonography, Analgesia, Nerve Block
- Published
- 2020
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27. Reply to: Ultrasound-guided erector spinae plane block versus oblique subcostal transversus abdominis plane block for postoperative analgesia of adult patients undergoing laparoscopic cholecystectomy: Randomized controlled trial.
- Author
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Kristensen M, Nielsen MV, and Børglum J
- Subjects
- Abdominal Muscles, Adult, Humans, Pain, Postoperative, Ultrasonography, Interventional, Analgesia, Cholecystectomy, Laparoscopic, Nerve Block
- Published
- 2020
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28. Are single-injection erector spinae plane block and multiple-injection costotransverse block equivalent to thoracic paravertebral block?
- Author
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Nielsen MV, Moriggl B, Hoermann R, Nielsen TD, Bendtsen TF, and Børglum J
- Subjects
- Aged, Aged, 80 and over, Cadaver, Dissection, Epidural Space diagnostic imaging, Female, Humans, Male, Middle Aged, Thorax anatomy & histology, Thorax diagnostic imaging, Ultrasonography, Interventional, Nerve Block methods, Spine diagnostic imaging, Thoracic Vertebrae diagnostic imaging
- Abstract
Background: Thoracic paravertebral block (TPVB) is considered the gold standard for hemithoracic regional anaesthesia. Erector spinae plane block (ESPB) is a new posterior thoracic wall block. Multiple-injection costotransverse block (MICB) mimics TPVB but with injection points within the thoracic intertransverse tissue complex and posterior to the superior costotransverse ligament. We aimed to compare the spread of injectate into the thoracic paravertebral space (TPVS) resulting from single-injection ESPB and MICB, respectively, with TPVB., Methods: Ten soft-embalmed cadavers were utilised. In five cadavers, the right hemithorax was randomly allocated either to ultrasound-guided single-injection ESPB or single-injection TPVB; vice versa on the other side. In another five cadavers, the right hemithorax was randomly allocated either to ultrasound-guided MICB or multiple-injection TPVB. About 20 mL of dye was injected in each hemithorax with all techniques., Results: With TPVB, the dye was consistently present in the TPVS with concomitant epidural spread in the majority of cases. The injectate spread into the TPVS with ESPB (60%) and MICB (100%). MICB consistently stained the ventral rami (T1-7), communicating rami and thoracic sympathetic trunk without epidural spread. Dissection after MICB revealed dye spread into the TPVS via the costotransverse foramina and along the dorsal branches of the posterior intercostal veins., Conclusions: Consistent spread of dye into the TPVS colouring the ventral rami, the communicating rami, and the sympathetic trunk was observed with MICB; in this respect equivalent to TPVB. ESPB exhibited only partial success and was not equivalent to TPVB. No epidural spread was found with neither MICB nor ESPB., (© 2019 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.) more...
- Published
- 2019
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29. Reply to: Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study.
- Author
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Nielsen MV, Moriggl B, Bendtsen TF, and Børglum J
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2019
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30. Shamrock sign: inadvertently inverted.
- Author
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Nielsen MV, Bendtsen TF, and Børglum J
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2019
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31. The Shamrock sign: comprehending the trefoil may refine block execution.
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Nielsen MV, Nielsen TD, Bendtsen TF, and Børglum J
- Subjects
- Lumbosacral Plexus, Ultrasonography, Anesthesia, Conduction, Lotus, Nerve Block
- Published
- 2018
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32. Superiority of ultrasound-guided Shamrock lumbar plexus block.
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Nielsen MV, Bendtsen TF, and Børglum J
- Subjects
- Humans, Lumbosacral Plexus, Ultrasonography, Interventional, Nerve Block methods
- Abstract
Ultrasound-guided lumbar plexus block (LPB) performed with the Shamrock approach has received much interest since the technique was first described in 2013. The technique is believed to be faster and easier to perform and possibly safer in regards to potential complications compared with other LPBs. In order to outline some favorable characteristics of the Shamrock LPB, we performed an exhaustive search of the current literature; even though it is rather limited. We have related the evidence to our own clinical experience about the block execution. We present a narrative review of the alleged superiority of the ultrasound-guided Shamrock LPB. Our aim was to assess some of the characteristics that we believe differentiate the Shamrock technique from other ultrasound-guided LPB techniques. We present graphical directions about how to carry out the Shamrock block, and we present novel magnetic resonance images illustrating the injectate spread around the lumbar plexus within the intrapsoas compartment after Shamrock guided injection of contrast enhanced local anesthetic. The Shamrock approach is easier, faster and better to visualise the LPB compared to other LPB techniques. The needle trajectory and needle tip location just lateral to the lumbar plexus probably reduces the risk of adverse effects and complications. Ultrasound guided lumbar plexus blockade is an expert technique. The Shamrock technique improves but does not eliminate all the challenges of ultrasound-guided LPB technique. more...
- Published
- 2018
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33. Air Medical Evacuations From the German North Sea Wind Farm Bard Offshore 1: Traumatic Injuries, Acute Diseases, and Rescue Process Times (2011-2013).
- Author
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Dethleff D, Weinrich N, Kowald B, Hory D, Franz R, Nielsen MV, Seide K, Jürgens C, and Stuhr M
- Subjects
- Acute Disease, Craniocerebral Trauma epidemiology, Germany epidemiology, Hand Injuries epidemiology, Humans, North Sea, Retrospective Studies, Seasons, Time Factors, Wind, Air Ambulances, Cardiovascular Diseases epidemiology, Gastrointestinal Diseases epidemiology, Occupational Injuries epidemiology, Transportation of Patients statistics & numerical data, Wounds and Injuries epidemiology
- Abstract
Objective: Our purpose was 2-fold: 1) to show emergency-related traumatic injury and acute disease patterns and 2) to evaluate air rescue process times in a remotely located German offshore wind farm. Optimally, this will support methodologies to reduce offshore help time (time from the incoming emergency call until offshore arrival of the helicopter)., Methods: The type and severity of traumatic injuries and acute diseases were retrospectively analyzed for 39 air medevacs from August 2011 to December 2013, and the process times of air rescue missions were evaluated in detail., Results: Forty-nine percent of the medevacs were related to traumatic injuries, whereas 41% were associated with acute diseases and 10% remained unclear. Cardiovascular and gastrointestinal disorders accounted for 90% of internal medical cases. About 69% of the trauma was related to contusions, lacerations, and cuts. The main body regions injured were limbs (∼59%) and head (∼32%). The total rescue time until arrival at the destination facility averaged 175.3 minutes (standard deviation = 54.4 minutes). The mean helicopter offshore arrival time was 106.9 minutes (standard deviation = 57.4 minutes) after the incoming emergency call. In 64% of the medevacs, the helicopter arrived on scene within a help time of 90 minutes., Conclusion: A reduction of help time (≤ 60 minutes) for time-critical severe trauma and acute diseases may be anticipated through rapid and focused medical and logistic decision-making processes by the onshore dispatch center combined with professional, qualified, and well-trained flight and rescue personnel., (Copyright © 2016 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.) more...
- Published
- 2016
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34. Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery: a qualitative sub-study of the Incare trial.
- Author
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Thomsen T, Vester-Andersen M, Nielsen MV, Waldau T, Møller AM, Rosenberg J, Møller MH, Nystrup KB, and Esbensen BA
- Subjects
- Aged, Aged, 80 and over, Female, Hermeneutics, Hospitals, Humans, Male, Middle Aged, Postoperative Period, Recovery Room, Abdomen surgery, Critical Care, Patient Satisfaction, Postoperative Care methods
- Abstract
Aims and Objectives: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery., Background: Emergency abdominal surgery is common, but little is known about how patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating postoperative intermediate care after emergency abdominal surgery, the InCare trial., Design: A qualitative study with individual semi-structured interviews., Methods: We analysed interviews using Systematic Text Condensation., Results: Eighteen patients (nine intervention/nine controls) were strategically sampled from the InCare trial. Data analysis resulted in three distinct descriptions of intermediate care; two of standard surgical ward care. Intermediate care was described as 'luxury service' or 'a life saver.' The latter description was prevalent among patients with a perceived complicated disease course. Intermediate care patients felt constrained by continuous monitoring of vital signs as they recovered from surgery. Standard surgical ward care was described as either 'ok - no more, no less' or 'suboptimal'. Experiencing suboptimal care was related to patient perceptions of heavy staff workloads, lack of staff availability and subsequent concerns about the quality of care., Conclusion: Postoperative intermediate care enhanced perceptions of quality of care, specifically in patients with a perceived complicated disease course. Patients were eager to contribute actively to their recovery; however, intermediate care patients felt hindered in doing so by continuous monitoring of vital signs., Relevance to Clinical Practice: Intermediate care may increase patient perceptions of quality and safety of care., (© 2014 John Wiley & Sons Ltd.) more...
- Published
- 2015
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35. Clinical indicators for bacterial co-infection in Ghanaian children with P. falciparum infection.
- Author
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Nielsen MV, Amemasor S, Agyekum A, Loag W, Marks F, Sarpong N, Dekker D, Adu-Sarkodie Y, and May J
- Subjects
- Adolescent, Anthropometry, Bacteremia pathology, Child, Child, Preschool, Coinfection microbiology, Cough pathology, Dehydration pathology, Ghana, Humans, Odds Ratio, Predictive Value of Tests, Prevalence, Regression Analysis, Rural Population, Salmonella Infections pathology, Sensitivity and Specificity, Socioeconomic Factors, Splenomegaly pathology, Streptococcal Infections pathology, Bacteremia epidemiology, Coinfection epidemiology, Malaria, Falciparum epidemiology, Malaria, Falciparum microbiology, Salmonella Infections epidemiology, Streptococcal Infections epidemiology
- Abstract
Differentiation of infectious causes in severely ill children is essential but challenging in sub- Saharan Africa. The aim of the study was to determine clinical indicators that are able to identify bacterial co-infections in P. falciparum infected children in rural Ghana. In total, 1,915 severely ill children below the age of 15 years were recruited at Agogo Presbyterian Hospital in Ghana between May 2007 and February 2011. In 771 (40%) of the children malaria parasites were detected. This group was analyzed for indicators of bacterial co-infections using bivariate and multivariate regression analyses with 24 socio-economic variables, 16 terms describing medical history and anthropometrical information and 68 variables describing clinical symptoms. The variables were tested for sensitivity, specificity, positive predictive value and negative predictive value. In 46 (6.0%) of the children with malaria infection, bacterial co-infection was detected. The most frequent pathogens were non-typhoid salmonellae (45.7%), followed by Streptococcus spp. (13.0%). Coughing, dehydration, splenomegaly, severe anemia and leukocytosis were positively associated with bacteremia. Domestic hygiene and exclusive breastfeeding is negatively associated with bacteremia. In cases of high parasitemia (>10,000/μl), a significant association with bacteremia was found for splenomegaly (OR 8.8; CI 1.6-48.9), dehydration (OR 18.2; CI 2.0-166.0) and coughing (OR 9.0; CI 0.7-118.6). In children with low parasitemia, associations with bacteremia were found for vomiting (OR 4.7; CI 1.4-15.8), severe anemia (OR 3.3; CI 1.0-11.1) and leukocytosis (OR 6.8 CI 1.9-24.2). Clinical signs of impaired microcirculation were negatively associated with bacteremia. Ceftriaxone achieved best coverage of isolated pathogens. The results demonstrate the limitation of clinical symptoms to determine bacterial co-infections in P. falciparum infected children. Best clinical indicators are dependent on the parasitemia level. Even with a moderate sensitivity of >60%, only low positive predictive values can be obtained due to low prevalence of bacteremia. Rapid testing for distinguishing parasitemia and bacteremia is essential. more...
- Published
- 2015
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36. Brain microabscesses in a porcine model of Staphylococcus aureus sepsis.
- Author
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Astrup LB, Nielsen MV, Iburg TM, Leifsson PS, Jensen HE, Nielsen OL, and Agerholm JS
- Subjects
- Animals, Brain Abscess complications, Brain Abscess microbiology, Brain Abscess pathology, Female, Sepsis complications, Sepsis microbiology, Sepsis pathology, Specific Pathogen-Free Organisms, Staphylococcal Infections complications, Staphylococcal Infections microbiology, Staphylococcal Infections pathology, Swine, Swine Diseases etiology, Swine Diseases pathology, Brain Abscess veterinary, Sepsis veterinary, Staphylococcal Infections veterinary, Staphylococcus aureus, Swine Diseases microbiology
- Abstract
Background: Sepsis caused by Staphylococcus aureus often leads to brain microabscesses in humans. Animal models of haematogenous brain abscesses would be useful to study this condition in detail. Recently, we developed a model of S. aureus sepsis in pigs and here we report that brain microabscesses develop in pigs with such induced S. aureus sepsis.Twelve pigs were divided into three groups. Nine pigs received an intravenous inoculation of S. aureus once at time 0 h (group 1) or twice at time 0 h and 12 h (groups 2 and 3). In each group the fourth pig served as control. The pigs were euthanized at time 12 h (Group 1), 24 h (Group 2) and 48 h (Group 3) after the first inoculation. The brains were collected and examined histopathologically., Results: All inoculated pigs developed sepsis and seven out of nine pigs developed brain microabscesses. The microabscesses contained S. aureus and were located in the prosencephalon and mesencephalon. Chorioditis and meningitis occurred from 12 h after inoculation., Conclusions: Pigs with experimental S. aureus sepsis often develop brain microabscesses. The porcine brain pathology mirrors the findings in human sepsis patients. We therefore suggest the pig as a useful animal model of the development of brain microabscesses caused by S. aureus sepsis. more...
- Published
- 2013
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37. Incidence and characteristics of bacteremia among children in rural Ghana.
- Author
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Nielsen MV, Sarpong N, Krumkamp R, Dekker D, Loag W, Amemasor S, Agyekum A, Marks F, Huenger F, Krefis AC, Hagen RM, Adu-Sarkodie Y, May J, and Schwarz NG
- Subjects
- Anthropometry, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Anti-Infective Agents pharmacology, Anti-Infective Agents therapeutic use, Bacteremia drug therapy, Bacteremia microbiology, Bacteria drug effects, Bacteria isolation & purification, Catchment Area, Health, Child, Preschool, Female, Ghana epidemiology, Hospitals statistics & numerical data, Humans, Incidence, Infant, Male, Microbial Sensitivity Tests, Patient Discharge statistics & numerical data, Treatment Outcome, Bacteremia epidemiology, Rural Population statistics & numerical data
- Abstract
The objective of the study was to describe systemic bacterial infections occurring in acutely ill and hospitalized children in a rural region in Ghana, regarding frequency, incidence, antimicrobial susceptibility patterns and associations with anthropometrical data.Blood cultures were performed in all children below the age of five years, who were admitted to Agogo Presbyterian Hospital (APH), Asante Region, Ghana, between September 2007 and July 2009. Medical history and anthropometrical data were assessed using a standardized questionnaire at admission. Incidences were calculated after considering the coverage population adjusted for village-dependent health-seeking behavior.Among 1,196 hospitalized children, 19.9% (n = 238) were blood culture positive. The four most frequent isolated pathogens were nontyphoidal salmonellae (NTS) (53.3%; n = 129), Staphylococcus aureus (13.2%; n = 32), Streptococcus pneumoniae (9.1%; n = 22) and Salmonella ser. Typhi (7.0%; n = 17). Yearly cumulative incidence of bacteremia was 46.6 cases/1,000 (CI 40.9-52.2). Yearly cumulative incidences per 1,000 of the four most frequent isolates were 25.2 (CI 21.1-29.4) for NTS, 6.3 (CI 4.1-8.4) for S. aureus, 4.3 (CI 2.5-6.1) for S. pneumoniae and 3.3 (CI 1.8-4.9) for Salmonella ser. Typhi. Wasting was positively associated with bacteremia and systemic NTS bloodstream infection. Children older than three months had more often NTS bacteremia than younger children. Ninety-eight percent of NTS and 100% of Salmonella ser. Typhi isolates were susceptible to ciprofloxacin, whereas both tested 100% susceptible to ceftriaxone. Seventy-seven percent of NTS and 65% of Salmonella ser. Typhi isolates were multi-drug resistant (MDR). Systemic bacterial infections in nearly 20% of hospitalized children underline the need for microbiological diagnostics, to guide targeted antimicrobial treatment and prevention of bacteremia. If microbiological diagnostics are lacking, calculated antimicrobial treatment of severely ill children in malaria-endemic areas should be considered. more...
- Published
- 2012
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38. A randomized trial on effectiveness of artemether-lumefantrine versus artesunate plus amodiaquine for unsupervised treatment of uncomplicated Plasmodium falciparum malaria in Ghanaian children.
- Author
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Kobbe R, Klein P, Adjei S, Amemasor S, Thompson WN, Heidemann H, Nielsen MV, Vohwinkel J, Hogan B, Kreuels B, Bührlen M, Loag W, Ansong D, and May J
- Subjects
- Amodiaquine adverse effects, Animals, Artemether, Lumefantrine Drug Combination, Artemisinins adverse effects, Child, Preschool, Drug Combinations, Ethanolamines adverse effects, Fluorenes adverse effects, Ghana, Humans, Infant, Patient Acceptance of Health Care statistics & numerical data, Plasmodium falciparum classification, Plasmodium falciparum drug effects, Plasmodium falciparum genetics, Treatment Outcome, Amodiaquine therapeutic use, Artemisinins therapeutic use, Ethanolamines therapeutic use, Fluorenes therapeutic use, Malaria, Falciparum drug therapy
- Abstract
Background: Numerous trials have demonstrated high efficacy and safety of artemisinin-based combination therapy (ACT) under supervised treatment. In contrast, effectiveness studies comparing different types of ACT applied unsupervised are scarce. The aim of this study was to compare effectiveness, tolerability and acceptance of artesunate plus amodiaquine (ASAQ) against that of artemether-lumefantrine (AL) in Ghanaian children with uncomplicated Plasmodium falciparum malaria., Methods: A randomized open-label trial was conducted at two district hospitals in the Ashanti region, Ghana, an area of intense malaria transmission. A total of 246 children under five years of age were randomly assigned to either ASAQ (Arsucam) or AL (Coartem). Study participants received their first weight-adjusted dose under supervision. After the parent/guardian was advised of times and mode of administration the respective three-day treatment course was completed unobserved at home. Follow-up visits were performed on days 3, 7, 14 and 28 to evaluate clinical and parasitological outcomes, adverse events, and haematological recovery. Length polymorphisms of variable regions of msp1 and msp2 were determined to differentiate recrudescences from reinfections. Acceptance levels of both treatment regimens were assessed by means of standardized interviews., Results: Adequate clinical and parasitological responses after AL and ASAQ treatment were similar (88.3% and 91.7%, respectively). Interestingly, more late clinical failures until day 28 occurred in AL-treated children than in those who received ASAQ (17.5% and 7.3%, respectively; Hazard Ratio 2.41, 95% CI 1.00-5.79, p < 0.05).Haematological recovery and drug tolerability were not found to be significantly different in both study arms. The acceptance of treatment with ASAQ was higher than that with AL (rank-scores 10.6 and 10.3, respectively; p < 0.05)., Conclusion: Unobserved AL and ASAQ treatment showed high adequate clinical and parasitological responses, though AL was inferior in preventing late clinical failures. more...
- Published
- 2008
- Full Text
- View/download PDF
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