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Derby CB, Gasbjerg KS, Hägi-Pedersen D, Lunn TH, Pedersen NA, Lindholm P, Brorson S, Schrøder HM, Thybo KH, Bagger J, Lindberg-Larsen M, Overgaard S, Jakobsen JC, Mathiesen O. Prolonged effects of dexamethasone following total knee arthroplasty: A pre-planned sub-study of the DEX-2-TKA trial. Acta Anaesthesiol Scand 2024; 68:35-42. [PMID: 37709280 DOI: 10.1111/aas.14319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES The DEX-2-TKA trial demonstrated that one and two doses of 24 mg intravenous dexamethasone reduced opioid consumption and pain after total knee arthroplasty (TKA). We aimed to investigate the prolonged effects of dexamethasone after the 48-h intervention period. DESIGN This was a prospective, pre-planned questionnaire follow-up on postoperative days 3-7 of patients in the DEX-2-TKA trial that randomly received: DX1 (dexamethasone 24 mg + placebo), DX2 (dexamethasone 24 mg + dexamethasone 24 mg), and placebo (placebo + placebo) perioperatively and 24 h later. SETTING A multicenter trial performed at five Danish hospitals. PARTICIPANTS We analyzed 434 of 485 adult participants enrolled in the DEX-2-TKA trial. OUTCOME MEASURES Primary outcome was difference between groups in average of all numerical rating scale (NRS) pain scores reported in the morning, at bedtime, and the daily average pain on postoperative days 3-7. Secondary outcomes were sleep quality and patient satisfaction. RESULTS The median (interquartile range) pain intensity levels for postoperative days 3-7 were: DX2 3.2 (2.1-4.3); DX1 3.3 (2.3-4.1); and placebo 3.3 (2.5-4.7). Hodges-Lehmann median differences between groups were: 0 (95% confidence interval - 0.54 to 0.2), P = 0.38 between DX1 and placebo; 0.1 (-0.47 to 0.33), p = .87 between DX1 and DX2; and 0.1 (-0.6 to 0.13), p = .20 between DX2 and placebo. We found no relevant differences between groups on sleep quality on postoperative days 3-7 nor for patient satisfaction with the analgesic treatment. CONCLUSIONS We found that neither one nor two doses of 24 mg intravenous dexamethasone demonstrated prolonged effects on overall pain or sleep quality on postoperative days 3-7 after total knee arthroplasty. We also found that dexamethasone had no effect on patient satisfaction. TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT03506789 (main result trial).
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Affiliation(s)
- Cecilie Bauer Derby
- Centre for Anaesthesiological Research, Department of Anesthesiology, Zealand University Hospital, Køge, Denmark
| | - Kasper Smidt Gasbjerg
- Research Centre of Anaesthesiology and Intensive Care Medicine, Department of Anesthesiology, Naestved, Slagelse and Ringsted Hospitals, Naestved, Denmark
| | - Daniel Hägi-Pedersen
- Research Centre of Anaesthesiology and Intensive Care Medicine, Department of Anesthesiology, Naestved, Slagelse and Ringsted Hospitals, Naestved, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Troels Haxholdt Lunn
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter Lindholm
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Stig Brorson
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | | | - Kasper Højgaard Thybo
- Centre for Anaesthesiological Research, Department of Anesthesiology, Zealand University Hospital, Køge, Denmark
| | - Jens Bagger
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martin Lindberg-Larsen
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren Overgaard
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Janus Christian Jakobsen
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Mathiesen
- Centre for Anaesthesiological Research, Department of Anesthesiology, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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2
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Gasbjerg KS, Hägi-Pedersen D, Lunn TH, Laursen CC, Holmqvist M, Vinstrup LØ, Ammitzboell M, Jakobsen K, Jensen MS, Pallesen MJ, Bagger J, Lindholm P, Pedersen NA, Schrøder HM, Lindberg-Larsen M, Nørskov AK, Thybo KH, Brorson S, Overgaard S, Jakobsen JC, Mathiesen O. Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial. BMJ 2022; 376:e067325. [PMID: 34983775 PMCID: PMC8724786 DOI: 10.1136/bmj-2021-067325] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the effects of one and two doses of intravenous dexamethasone in patients after total knee arthroplasty. DESIGN Randomised, blinded, placebo controlled trial with follow-up at 90 days. SETTING Five Danish hospitals, September 2018 to March 2020. PARTICIPANTS 485 adult participants undergoing total knee arthroplasty. INTERVENTION A computer generated randomised sequence stratified for site was used to allocate participants to one of three groups: DX1 (dexamethasone (24 mg)+placebo); DX2 (dexamethasone (24 mg)+dexamethasone (24 mg)); or placebo (placebo+placebo). The intervention was given preoperatively and after 24 hours. Participants, investigators, and outcome assessors were blinded. All participants received paracetamol, ibuprofen, and local infiltration analgesia. MAIN OUTCOME MEASURES The primary outcome was total intravenous morphine consumption 0 to 48 hours postoperatively. Multiplicity adjusted threshold for statistical significance was P<0.017 and minimal important difference was 10 mg morphine. Secondary outcomes included postoperative pain. RESULTS 485 participants were randomised: 161 to DX1, 162 to DX2, and 162 to placebo. Data from 472 participants (97.3%) were included in the primary outcome analysis. The median (interquartile range) morphine consumptions at 0-48 hours were: DX1 37.9 mg (20.7 to 56.7); DX2 35.0 mg (20.6 to 52.0); and placebo 43.0 mg (28.7 to 64.0). Hodges-Lehmann median differences between groups were: -2.7 mg (98.3% confidence interval -9.3 to 3.7), P=0.30 between DX1 and DX2; 7.8 mg (0.7 to 14.7), P=0.008 between DX1 and placebo; and 10.7 mg (4.0 to 17.3), P<0.001 between DX2 and placebo. Postoperative pain was reduced at 24 hours with one dose, and at 48 hours with two doses, of dexamethasone. CONCLUSION Two doses of dexamethasone reduced morphine consumption during 48 hours after total knee arthroplasty and reduced postoperative pain. TRIAL REGISTRATION Clinicaltrials.gov NCT03506789.
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Affiliation(s)
- Kasper Smidt Gasbjerg
- Department of Anaesthesiology, Næstved, Slagelse and Ringsted Hospitals, Næstved, Denmark
| | - Daniel Hägi-Pedersen
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Anaesthesiology, Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
| | - Troels Haxholdt Lunn
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christina Cleveland Laursen
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Majken Holmqvist
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - Louise Ørts Vinstrup
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mette Ammitzboell
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Karina Jakobsen
- Department of Anaesthesiology, Næstved, Slagelse and Ringsted Hospitals, Næstved, Denmark
| | - Mette Skov Jensen
- Department of Anaesthesiology, Næstved, Slagelse and Ringsted Hospitals, Næstved, Denmark
| | - Marie Jøhnk Pallesen
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bagger
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Lindholm
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | | | | | - Martin Lindberg-Larsen
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Kehlet Nørskov
- Department of Anaesthesiology, Nordsjællands University Hospital, Hillerød, Denmark Anders
- Copenhagen Trial Unit Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Capital Region of Denmark, Copenhagen, Denmark
| | - Kasper Højgaard Thybo
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - Stig Brorson
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Søren Overgaard
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Janus Christian Jakobsen
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Copenhagen Trial Unit Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Capital Region of Denmark, Copenhagen, Denmark
| | - Ole Mathiesen
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
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3
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Lindberg-Larsen M, Petersen PB, Corap Y, Gromov K, Jørgensen CC, Kehlet H, Madsen F, Majeed HG, Varnum C, Solgaard S, Bagger J. Fast-track revision knee arthroplasty. Knee 2022; 34:24-33. [PMID: 34894588 DOI: 10.1016/j.knee.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/21/2021] [Accepted: 09/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Limited data exist on fast-track protocols in relation to revision knee arthroplasty. Hence, the aim of this study was to report length of stay (LOS), risk of LOS > 5 days and readmission ≤ 90 days after revision knee arthroplasty in centers with a well-established fast-track protocol in both primary and revision surgery. METHODS An observational cohort study from the Centre for Fast-track Hip and Knee Replacement and the Danish Knee Arthroplasty Register. We included elective aseptic major component revision knee arthroplasties consecutively from 6 dedicated fast-track centers from 2010 to 2018. RESULTS 1439 revision knee arthroplasties were analyzed, including 900 total revisions, 171 large partial revisions (revision of either femoral or tibia component) and 368 revisions of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA). Mean age was 65 years (SD 10.9) and 66% were females. Mean LOS was 3.7 days (SD 3.9) in the study period, but decreased to 2.4 days (SD 1.3) in 2018. Risk factors for LOS > 5 days was ≥ 1 previous revision, use of walking aid, BMI > 35, ages < 50, 70-79 and ≥ 80 years, whereas revision of UKA to TKA and large partial revision were negatively associated. The 90-day readmission and mortality risk was 9.1% and 0.5%. Cardiac disease and use of walking aid were associated with increased risk of readmission ≤ 90 days. CONCLUSION Elective aseptic major component revision knee arthroplasty using similar fast-track protocols as in primary TKA is safe with short and decreasing LOS.
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Affiliation(s)
- Martin Lindberg-Larsen
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Denmark; Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.
| | | | - Yasemin Corap
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Kirill Gromov
- Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark; Department of Orthopedics, Hvidovre Hospital, Hvidovre, Denmark
| | - Christoffer Calov Jørgensen
- Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark; Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Kehlet
- Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark; Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Frank Madsen
- Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark; Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark
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4
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Abba A, Accorsi C, Agnes P, Alessi E, Amaudruz P, Annovi A, Desages FA, Back S, Badia C, Bagger J, Basile V, Batignani G, Bayo A, Bell B, Beschi M, Biagini D, Bianchi G, Bicelli S, Bishop D, Boccali T, Bombarda A, Bonfanti S, Bonivento WM, Bouchard M, Breviario M, Brice S, Brown R, Calvo-Mozota JM, Camozzi L, Camozzi M, Capra A, Caravati M, Carlini M, Ceccanti A, Celano B, Cela Ruiz JM, Charette C, Cogliati G, Constable M, Crippa C, Croci G, Cudmore S, Dahl CE, Dal Molin A, Daley M, Di Guardo C, D'Avenio G, Davignon O, Del Tutto M, De Ruiter J, Devoto A, Diaz Gomez Maqueo P, Di Francesco F, Dossi M, Druszkiewicz E, Duma C, Elliott E, Farina D, Fernandes C, Ferroni F, Finocchiaro G, Fiorillo G, Ford R, Foti G, Fournier RD, Franco D, Fricbergs C, Gabriele F, Galbiati C, Garcia Abia P, Gargantini A, Giacomelli L, Giacomini F, Giacomini F, Giarratana LS, Gillespie S, Giorgi D, Girma T, Gobui R, Goeldi D, Golf F, Gorel P, Gorini G, Gramellini E, Grosso G, Guescini F, Guetre E, Hackman G, Hadden T, Hawkins W, Hayashi K, Heavey A, Hersak G, Hessey N, Hockin G, Hudson K, Ianni A, Ienzi C, Ippolito V, James CC, Jillings C, Kendziora C, Khan S, Kim E, King M, King S, Kittmer A, Kochanek I, Kowalkowski J, Krücken R, Kushoro M, Kuula S, Laclaustra M, Leblond G, Lee L, Lennarz A, Leyton M, Li X, Liimatainen P, Lim C, Lindner T, Lomonaco T, Lu P, Lubna R, Lukhanin GA, Luzón G, MacDonald M, Magni G, Maharaj R, Manni S, Mapelli C, Margetak P, Martin L, Martin S, Martínez M, Massacret N, McClurg P, McDonald AB, Meazzi E, Migalla R, Mohayai T, Tosatti LM, Monzani G, Moretti C, Morrison B, Mountaniol M, Muraro A, Napoli P, Nati F, Natzke CR, Noble AJ, Norrick A, Olchanski K, Ortiz de Solorzano A, Padula F, Pallavicini M, Palumbo I, Panontin E, Papini N, Parmeggiano L, Parmeggiano S, Patel K, Patel A, Paterno M, Pellegrino C, Pelliccione P, Pesudo V, Pocar A, Pope A, Pordes S, Prelz F, Putignano O, Raaf JL, Ratti C, Razeti M, Razeto A, Reed D, Refsgaard J, Reilly T, Renshaw A, Retriere F, Riccobene E, Rigamonti D, Rizzi A, Rode J, Romualdez J, Russel L, Sablone D, Sala S, Salomoni D, Salvo P, Sandoval A, Sansoucy E, Santorelli R, Savarese C, Scapparone E, Schaubel T, Scorza S, Settimo M, Shaw B, Shawyer S, Sher A, Shi A, Skensved P, Slutsky A, Smith B, Smith NJT, Stenzler A, Straubel C, Stringari P, Suchenek M, Sur B, Tacchino S, Takeuchi L, Tardocchi M, Tartaglia R, Thomas E, Trask D, Tseng J, Tseng L, VanPagee L, Vedia V, Velghe B, Viel S, Visioli A, Viviani L, Vonica D, Wada M, Walter D, Wang H, Wang MHLS, Westerdale S, Wood D, Yates D, Yue S, Zambrano V. The novel Mechanical Ventilator Milano for the COVID-19 pandemic. Phys Fluids (1994) 2021; 33:037122. [PMID: 33897243 PMCID: PMC8060010 DOI: 10.1063/5.0044445] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/14/2021] [Indexed: 06/12/2023]
Abstract
This paper presents the Mechanical Ventilator Milano (MVM), a novel intensive therapy mechanical ventilator designed for rapid, large-scale, low-cost production for the COVID-19 pandemic. Free of moving mechanical parts and requiring only a source of compressed oxygen and medical air to operate, the MVM is designed to support the long-term invasive ventilation often required for COVID-19 patients and operates in pressure-regulated ventilation modes, which minimize the risk of furthering lung trauma. The MVM was extensively tested against ISO standards in the laboratory using a breathing simulator, with good agreement between input and measured breathing parameters and performing correctly in response to fault conditions and stability tests. The MVM has obtained Emergency Use Authorization by U.S. Food and Drug Administration (FDA) for use in healthcare settings during the COVID-19 pandemic and Health Canada Medical Device Authorization for Importation or Sale, under Interim Order for Use in Relation to COVID-19. Following these certifications, mass production is ongoing and distribution is under way in several countries. The MVM was designed, tested, prepared for certification, and mass produced in the space of a few months by a unique collaboration of respiratory healthcare professionals and experimental physicists, working with industrial partners, and is an excellent ventilator candidate for this pandemic anywhere in the world.
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Affiliation(s)
- A. Abba
- Nuclear Instruments S.R.L., Como 22045, Italy
| | - C. Accorsi
- Elemaster Group S.p.A., Lomagna (LC) 23871, Italy
| | - P. Agnes
- Department of Physics, University of Houston, Houston, Texas 77204, USA
| | - E. Alessi
- Istituto per la Scienza e Tecnologia dei Plasmi, ISTP-CNR, Milano 20125, Italy
| | - P. Amaudruz
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A. Annovi
- INFN Sezione di Pisa, Pisa 56127, Italy
| | - F. Ardellier Desages
- APC, Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - S. Back
- SNOLAB, Lively, Ontario P3Y 1N2, Canada
| | - C. Badia
- Gran Sasso Science Institute, L'Aquila 67100, Italy
| | - J. Bagger
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - V. Basile
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato, CNR STIIMA, Milano 20133, Italy
| | | | - A. Bayo
- LSC, Laboratorio Subterráneo de Canfranc, Canfranc-Estación 22880, Spain
| | - B. Bell
- JMP Solutions, London, Ontario N6N 1E2, Canada
| | | | - D. Biagini
- Dipartimento di Chimica e Chimica Industriale, Università di Pisa, Pisa 56124, Italy
| | - G. Bianchi
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato, CNR STIIMA, Milano 20133, Italy
| | - S. Bicelli
- Camozzi Group S.p.A., Brescia BS 25126, Italy
| | - D. Bishop
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | | | - A. Bombarda
- Dipartimento di Ingegneria Gestionale, dell'Informazione e della Produzione, Università di Bergamo, Bergamo, 24129, Italy
| | - S. Bonfanti
- Dipartimento di Ingegneria Gestionale, dell'Informazione e della Produzione, Università di Bergamo, Bergamo, 24129, Italy
| | | | - M. Bouchard
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - M. Breviario
- Elemaster Group S.p.A., Lomagna (LC) 23871, Italy
| | - S. Brice
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - R. Brown
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - J. M. Calvo-Mozota
- LSC, Laboratorio Subterráneo de Canfranc, Canfranc-Estación 22880, Spain
| | - L. Camozzi
- Camozzi Group S.p.A., Brescia BS 25126, Italy
| | - M. Camozzi
- Camozzi Group S.p.A., Brescia BS 25126, Italy
| | - A. Capra
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - M. Caravati
- INFN Sezione di Cagliari, Cagliari 09042, Italy
| | - M. Carlini
- Gran Sasso Science Institute, L'Aquila 67100, Italy
| | | | - B. Celano
- INFN Sezione di Napoli, Napoli 80126, Italy
| | - J. M. Cela Ruiz
- CIEMAT, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid 28040, Spain
| | - C. Charette
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - G. Cogliati
- Elemaster Group S.p.A., Lomagna (LC) 23871, Italy
| | - M. Constable
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - C. Crippa
- Elemaster Group S.p.A., Lomagna (LC) 23871, Italy
| | - G. Croci
- Dipartimento di Fisica, Università di Milano-Bicocca, Milano 20126, Italy
| | - S. Cudmore
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | | | - A. Dal Molin
- Dipartimento di Fisica, Università di Milano-Bicocca, Milano 20126, Italy
| | - M. Daley
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - C. Di Guardo
- Dipartimento di Scienze Economiche ed Aziendali, Università degli Studi di Cagliari, Cagliari 09042, Italy
| | - G. D'Avenio
- National Center for Innovative Technologies in Public Health, ISS (Italy National Institute of Health), Roma 00161, Italy
| | - O. Davignon
- Laboratoire Leprince Ringuet, École Polytechnique, Palaiseau, Cedex 91128, France
| | - M. Del Tutto
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J. De Ruiter
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - A. Devoto
- Dipartimento di Fisica, Università degli Studi di Cagliari, Cagliari 09042, Italy
| | | | - F. Di Francesco
- Dipartimento di Chimica e Chimica Industriale, Università di Pisa, Pisa 56124, Italy
| | - M. Dossi
- Elemaster Group S.p.A., Lomagna (LC) 23871, Italy
| | - E. Druszkiewicz
- Department of Physics and Astronomy, University of Rochester, Rochester, New York 14627, USA
| | - C. Duma
- INFN-CNAF, Bologna 40127, Italy
| | - E. Elliott
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - D. Farina
- Istituto per la Scienza e Tecnologia dei Plasmi, ISTP-CNR, Milano 20125, Italy
| | | | | | | | | | - R. Ford
- SNOLAB, Lively, Ontario P3Y 1N2, Canada
| | | | | | - D. Franco
- APC, Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | | | - F. Gabriele
- INFN Laboratori Nazionali del Gran Sasso, Assergi (AQ) 67100, Italy
| | | | - P. Garcia Abia
- CIEMAT, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid 28040, Spain
| | - A. Gargantini
- Dipartimento di Ingegneria Gestionale, dell'Informazione e della Produzione, Università di Bergamo, Bergamo, 24129, Italy
| | - L. Giacomelli
- Istituto per la Scienza e Tecnologia dei Plasmi, ISTP-CNR, Milano 20125, Italy
| | | | | | | | - S. Gillespie
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - D. Giorgi
- Camozzi Group S.p.A., Brescia BS 25126, Italy
| | - T. Girma
- VEXOS, Markham, Ontario L3R 9X6, Canada
| | - R. Gobui
- VEXOS, Markham, Ontario L3R 9X6, Canada
| | | | - F. Golf
- Department of Physics and Astronomy, University of Nebraska-Lincoln, Lincoln, Nebraska 68508, USA
| | - P. Gorel
- SNOLAB, Lively, Ontario P3Y 1N2, Canada
| | - G. Gorini
- Dipartimento di Fisica, Università di Milano-Bicocca, Milano 20126, Italy
| | - E. Gramellini
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - G. Grosso
- Istituto per la Scienza e Tecnologia dei Plasmi, ISTP-CNR, Milano 20125, Italy
| | - F. Guescini
- Max-Planck-Institut für Physik (Werner-Heisenberg-Institut), 80805 München, Germany
| | - E. Guetre
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G. Hackman
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - T. Hadden
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | | | - K. Hayashi
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A. Heavey
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - G. Hersak
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - N. Hessey
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G. Hockin
- JMP Solutions, London, Ontario N6N 1E2, Canada
| | - K. Hudson
- VEXOS, Markham, Ontario L3R 9X6, Canada
| | - A. Ianni
- Physics Department, Princeton University, Princeton, New Jersey 08544, USA
| | - C. Ienzi
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | | | - C. C. James
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | | | - C. Kendziora
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - S. Khan
- VEXOS, Markham, Ontario L3R 9X6, Canada
| | - E. Kim
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - M. King
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - S. King
- JMP Solutions, London, Ontario N6N 1E2, Canada
| | - A. Kittmer
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - I. Kochanek
- INFN Laboratori Nazionali del Gran Sasso, Assergi (AQ) 67100, Italy
| | - J. Kowalkowski
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | | | - M. Kushoro
- Dipartimento di Fisica, Università di Milano-Bicocca, Milano 20126, Italy
| | - S. Kuula
- SNOLAB, Lively, Ontario P3Y 1N2, Canada
| | | | - G. Leblond
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - L. Lee
- Department of APT, Faculty of Medicine, University of British Columbia, Vancouver V5Z 1M9, Canada
| | - A. Lennarz
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - M. Leyton
- INFN Sezione di Napoli, Napoli 80126, Italy
| | - X. Li
- Physics Department, Princeton University, Princeton, New Jersey 08544, USA
| | | | - C. Lim
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - T. Lindner
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - T. Lomonaco
- Dipartimento di Chimica e Chimica Industriale, Università di Pisa, Pisa 56124, Italy
| | - P. Lu
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - R. Lubna
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G. A. Lukhanin
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - G. Luzón
- CAPA (Centro de Astropartículas y Física de Altas Energías), Universidad de Zaragoza, Zaragoza 50009, Spain
| | - M. MacDonald
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - G. Magni
- Elemaster Group S.p.A., Lomagna (LC) 23871, Italy
| | - R. Maharaj
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - S. Manni
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - C. Mapelli
- Dipartimento di Meccanica, Politecnico di Milano, Milano 20156, Italy
| | - P. Margetak
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - L. Martin
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - S. Martin
- VEXOS, Markham, Ontario L3R 9X6, Canada
| | | | - N. Massacret
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - P. McClurg
- Department of Respiratory and Anaesthesia Technology, Vanier College, Montréal, Quebec H4L 3X9, Canada
| | | | - E. Meazzi
- Elemaster Group S.p.A., Lomagna (LC) 23871, Italy
| | | | - T. Mohayai
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - L. M. Tosatti
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato, CNR STIIMA, Milano 20133, Italy
| | - G. Monzani
- Elemaster Group S.p.A., Lomagna (LC) 23871, Italy
| | - C. Moretti
- Dipartimento di Pediatria, Sapienza Università di Roma, Roma 00185, Italy
| | | | | | - A. Muraro
- Istituto per la Scienza e Tecnologia dei Plasmi, ISTP-CNR, Milano 20125, Italy
| | - P. Napoli
- Elemaster Group S.p.A., Lomagna (LC) 23871, Italy
| | - F. Nati
- Dipartimento di Fisica, Università di Milano-Bicocca, Milano 20126, Italy
| | - C. R. Natzke
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | | | - A. Norrick
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - K. Olchanski
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A. Ortiz de Solorzano
- CAPA (Centro de Astropartículas y Física de Altas Energías), Universidad de Zaragoza, Zaragoza 50009, Spain
| | - F. Padula
- School of Civil and Mechanical Engineering, Curtin University, Perth (Washington), Australia
| | | | - I. Palumbo
- Azienda Ospedaliera San Gerardo, Monza 20900, Italy
| | - E. Panontin
- Dipartimento di Fisica, Università di Milano-Bicocca, Milano 20126, Italy
| | - N. Papini
- Elemaster Group S.p.A., Lomagna (LC) 23871, Italy
| | | | | | - K. Patel
- VEXOS, Markham, Ontario L3R 9X6, Canada
| | - A. Patel
- VEXOS, Markham, Ontario L3R 9X6, Canada
| | - M. Paterno
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | | | | | | | - A. Pocar
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - A. Pope
- JMP Solutions, London, Ontario N6N 1E2, Canada
| | - S. Pordes
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - F. Prelz
- INFN Sezione di Milano, Milano 20133, Italy
| | - O. Putignano
- Dipartimento di Fisica, Università di Milano-Bicocca, Milano 20126, Italy
| | - J. L. Raaf
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - C. Ratti
- Elemaster Group S.p.A., Lomagna (LC) 23871, Italy
| | - M. Razeti
- INFN Sezione di Cagliari, Cagliari 09042, Italy
| | - A. Razeto
- INFN Laboratori Nazionali del Gran Sasso, Assergi (AQ) 67100, Italy
| | - D. Reed
- Equilibar L.L.C., Fletcher, North Carolina 28732, USA
| | - J. Refsgaard
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - T. Reilly
- VEXOS, Markham, Ontario L3R 9X6, Canada
| | - A. Renshaw
- Department of Physics, University of Houston, Houston, Texas 77204, USA
| | - F. Retriere
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - E. Riccobene
- Dipartimento di Informatica, Universitá degli Studi di Milano, Milano 20122, Italy
| | - D. Rigamonti
- Istituto per la Scienza e Tecnologia dei Plasmi, ISTP-CNR, Milano 20125, Italy
| | | | | | - J. Romualdez
- Physics Department, Princeton University, Princeton, New Jersey 08544, USA
| | - L. Russel
- JMP Solutions, London, Ontario N6N 1E2, Canada
| | - D. Sablone
- INFN Laboratori Nazionali del Gran Sasso, Assergi (AQ) 67100, Italy
| | - S. Sala
- Elemaster Group S.p.A., Lomagna (LC) 23871, Italy
| | | | - P. Salvo
- Istituto di Fisiologia Clinica del CNR, IFC-CNR, Pisa 56124, Italy
| | | | - E. Sansoucy
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - R. Santorelli
- CIEMAT, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid 28040, Spain
| | - C. Savarese
- Physics Department, Princeton University, Princeton, New Jersey 08544, USA
| | | | - T. Schaubel
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - S. Scorza
- SNOLAB, Lively, Ontario P3Y 1N2, Canada
| | - M. Settimo
- SUBATECH, IMT Atlantique, Université de Nantes, CNRS-IN2P3, Nantes 44300, France
| | - B. Shaw
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - S. Shawyer
- JMP Solutions, London, Ontario N6N 1E2, Canada
| | - A. Sher
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A. Shi
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | | | - A. Slutsky
- St. Michael's Hospital, Unity Health Toronto, Ontario M5B 1W8, Canada
| | - B. Smith
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | | | - A. Stenzler
- 12th Man Technologies, Garden Grove, California 92841, USA
| | - C. Straubel
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - P. Stringari
- MINES ParisTech, PSL University, CTP-Centre of Thermodynamics of Processes, 77300 Fontainebleau, France
| | - M. Suchenek
- AstroCeNT, Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, Warsaw 00-614, Poland
| | - B. Sur
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | | | - L. Takeuchi
- Department of Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - M. Tardocchi
- Istituto per la Scienza e Tecnologia dei Plasmi, ISTP-CNR, Milano 20125, Italy
| | - R. Tartaglia
- INFN Laboratori Nazionali del Gran Sasso, Assergi (AQ) 67100, Italy
| | - E. Thomas
- Arthur B. McDonald Canadian Astroparticle Research Institute, Kingston, Ontario K7L 3N6, Canada
| | - D. Trask
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - J. Tseng
- Department of Physics, University of Oxford, The Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - L. Tseng
- VEXOS, Markham, Ontario L3R 9X6, Canada
| | - L. VanPagee
- JMP Solutions, London, Ontario N6N 1E2, Canada
| | - V. Vedia
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - B. Velghe
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | | | - A. Visioli
- Dipartimento di Ingegneria Meccanica e Industriale, Università degli Studi di Brescia, Brescia 25123, Italy
| | - L. Viviani
- Elemaster Group S.p.A., Lomagna (LC) 23871, Italy
| | - D. Vonica
- VEXOS, Markham, Ontario L3R 9X6, Canada
| | - M. Wada
- AstroCeNT, Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, Warsaw 00-614, Poland
| | - D. Walter
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - H. Wang
- Physics and Astronomy Department, University of California, Los Angeles, California 90095, USA
| | - M. H. L. S. Wang
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | | | - D. Wood
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - D. Yates
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - S. Yue
- Canadian Nuclear Laboratories, Chalk River K0J 1J0, Canada
| | - V. Zambrano
- CAPA (Centro de Astropartículas y Física de Altas Energías), Universidad de Zaragoza, Zaragoza 50009, Spain
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Gasbjerg KS, Hägi‐Pedersen D, Lunn TH, Overgaard S, Pedersen NA, Bagger J, Lindholm P, Brorson S, Schrøder HM, Thybo KH, Mathiesen O, Jakobsen JC. DEX-2-TKA - DEXamethasone twice for pain treatment after Total Knee Arthroplasty: Detailed statistical analysis plan for a randomized, blinded, three-group multicentre clinical trial. Acta Anaesthesiol Scand 2020; 64:839-846. [PMID: 32048274 DOI: 10.1111/aas.13560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Optimization of post-operative pain treatment is of upmost importance. Multimodal analgesia is the main post-operative pain treatment principle, but the evidence on optimal analgesic combinations is unclear. With the "DEXamethasone twice for pain treatment after TKA" trial, we aim to investigate the role of one or two doses of glucocorticoid for post-operative pain treatment after total knee arthroplasty. To ensure transparency and minimization of bias, we present this article with a detailed statistical analysis plan, to be published before the last participant is enrolled. METHODS "DEXamethasone twice for pain treatment after TKA" (DEX-2-TKA) is a randomized, blinded, three-group multicentre clinical trial. Participants will be randomized to one of three intervention groups: single dose of iv dexamethasone 24 mg, two consecutive doses of iv dexamethasone 24 mg or matching iv placebo. All three intervention groups will receive paracetamol, NSAID (ibuprofen) and local infiltration analgesia. Participants, treatment providers, outcome assessors, data managers, statisticians and conclusion drawers will be blinded to the allocated intervention. The primary outcome is total opioid consumption (iv morphine milligram equivalents) 0-48 hours post-operatively. Secondary outcomes are (1) visual analogue scale pain levels: (a) during active 45 degrees flexion of the knee at 24 and 48 hours post-operatively, (b) at rest at 24 and 48 hours post-operatively, and (c) during 0-24 hours (highest score) and 24-48 hours post-operatively (highest score); and (2) the proportion of participants with one or more adverse events within 48 hours post-operatively. DISCUSSION The DEX-2-TKA trial will provide high quality data regarding benefits and harms of adding one or two high-doses of dexamethasone to a multimodal analgesic regimen. TRIAL REGISTRATION EudraCT: 2018-001099-39 (08/06-18); ClinicalTrials.gov: NCT03506789 (24/04-2019).
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Affiliation(s)
- Kasper S. Gasbjerg
- Department of Anaesthesiology Næstved‐Slagelse‐Ringsted Hospitals Næstved Denmark
| | - Daniel Hägi‐Pedersen
- Department of Anaesthesiology Næstved‐Slagelse‐Ringsted Hospitals Næstved Denmark
- Department of Regional Health Research The Faculty of Health Sciences University of Southern Denmark Odense Denmark
| | - Troels H. Lunn
- Department of Anaesthesiology Bispebjerg and Frederiksberg University Hospital Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences Copenhagen University Copenhagen Denmark
| | - Søren Overgaard
- Orthopedic Research Unit Department of Orthopaedic Surgery and Traumatology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | | | - Jens Bagger
- Department of Orthopaedics Bispebjerg and Frederiksberg University Hospital Copenhagen Denmark
| | - Peter Lindholm
- Department of Anaesthesiology and Intensive Care Odense University Hospital Odense Denmark
| | - Stig Brorson
- Department of Clinical Medicine Faculty of Health and Medical Sciences Copenhagen University Copenhagen Denmark
- Department of Orthopaedic Surgery Zealand University Hospital Køge Denmark
| | - Henrik M. Schrøder
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Department of Orthopaedic Surgery Næstved‐Slagelse‐Ringsted Hospitals Næstved Denmark
| | - Kasper H. Thybo
- Department of Anaesthesiology Bispebjerg and Frederiksberg University Hospital Copenhagen Denmark
| | - Ole Mathiesen
- Department of Clinical Medicine Faculty of Health and Medical Sciences Copenhagen University Copenhagen Denmark
- Centre for Anaesthesiological Research Department of Anaesthesiology Zealand University Hospital Køge Denmark
| | - Janus C. Jakobsen
- Department of Regional Health Research The Faculty of Health Sciences University of Southern Denmark Odense Denmark
- Department of Cardiology Holbæk Hospital Holbæk Denmark
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Gasbjerg KS, Hägi‐Pedersen D, Lunn TH, Jakobsen JC, Overgaard S, Pedersen NA, Bagger J, Lindholm P, Brorson S, Schrøder HM, Thybo KH, Mathiesen O. DEX-2-TKA-DEXamethasone twice for pain treatment after Total Knee Arthroplasty: A protocol for a randomized, blinded, three-group multicentre clinical trial. Acta Anaesthesiol Scand 2020; 64:267-275. [PMID: 31544230 DOI: 10.1111/aas.13481] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 09/14/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Multimodal analgesia is considered the leading principle for post-operative pain treatment, but no gold standard after total knee arthroplasty (TKA) exists. AIM To investigate the beneficial and harmful effects of one or two doses of 24 mg intravenous dexamethasone (DXM) as part of a multimodal analgesic regimen (paracetamol, NSAID and perioperative local infiltration analgesia) after TKA. We hypothesize that addition of DXM will reduce post-operative opioid consumption. METHODS DEXamethasone twice for pain treatment after TKA is a randomized, blinded, three-group multicentre clinical trial. Participants will be randomized to one of three groups: placebo, single dose of DXM or two consecutive doses of DXM. Participants, treatment providers and investigators will be blinded to the allocated intervention. The primary outcome is total opioid consumption (units of morphine equivalents) 0-48 hours post-operatively. INCLUSION CRITERIA unilateral, primary TKA; age ≥18 years; American Society of Anesthesiologists-Score 1-3; Body Mass Index ≥18 and ≤40; for women-not pregnant; and written informed consent. EXCLUSION CRITERIA allergy or contraindications against trial medication; daily use of high dose opioid and/or use of methadone/transdermal opioids; daily use of systemic glucocorticoids; dysregulated diabetes; and patients suffering from alcohol and/or drug abuse. Four-hundred-and-eighty-six eligible participants are needed to detect or discard a difference of 10 mg morphine equivalents 0-48 hours post-operatively maintaining a familywise error rate of 0.05 and a power of 90% for the three possible pairwise comparisons. DISCUSSION Recruiting is planned to commence September 2018 and expected to finish March 2020. TRIAL REGISTRATION EudraCT: 2018-001099-39 (08/06-18); ClinicalTrials.gov: NCT03506789 (24/04-2019). Editorial Comment This is the protocol for the largest randomized clinical trial investigating the effect of one or two doses of dexamethasones on pain treatment after total knee arthroplasty. Due to the pragmatic and rigerous design this study will deliver results of high quality and external validity.
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Affiliation(s)
- Kasper S. Gasbjerg
- Department of Anaesthesiology Næstved‐Slagelse‐Ringsted Hospitals Næstved Denmark
| | - Daniel Hägi‐Pedersen
- Department of Anaesthesiology Næstved‐Slagelse‐Ringsted Hospitals Næstved Denmark
- Department of Regional Health Research The Faculty of Health Sciences University of Southern Denmark Odense Denmark
| | - Troels H. Lunn
- Department of Anaesthesiology Bispebjerg and Frederiksberg University Hospital Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences Copenhagen University Copenhagen Denmark
| | - Janus C. Jakobsen
- Department of Regional Health Research The Faculty of Health Sciences University of Southern Denmark Odense Denmark
- Department of Cardiology Holbæk Hospital Holbæk Denmark
| | - Søren Overgaard
- Orthopedic Research Unit Department of Orthopaedic Surgery and Traumatology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | | | - Jens Bagger
- Department of Orthopaedics Bispebjerg and Frederiksberg University Hospital Copenhagen Denmark
| | - Peter Lindholm
- Department of Anaesthesiology and Intensive Care Odense University Hospital Odense Denmark
| | - Stig Brorson
- Department of Clinical Medicine Faculty of Health and Medical Sciences Copenhagen University Copenhagen Denmark
- Department of Orthopaedic Surgery Zealand University Hospital Køge Denmark
| | - Henrik M. Schrøder
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Department of Orthopaedic Surgery Næstved‐Slagelse‐Ringsted Hospitals Næstved Denmark
| | - Kasper H. Thybo
- Centre for Anaesthesiological Research Department of Anaesthesiology Zealand University Hospital Køge Denmark
| | - Ole Mathiesen
- Department of Clinical Medicine Faculty of Health and Medical Sciences Copenhagen University Copenhagen Denmark
- Centre for Anaesthesiological Research Department of Anaesthesiology Zealand University Hospital Køge Denmark
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Lindberg-Larsen V, Kehlet H, Bagger J, Madsbad S. Preoperative High-Dose Methylprednisolone and Glycemic Control Early After Total Hip and Knee Arthroplasty. Anesth Analg 2018; 127:906-913. [DOI: 10.1213/ane.0000000000003591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lindberg‐Larsen V, Kehlet H, Pilely K, Bagger J, Rovsing ML, Garred P. Preoperative methylprednisolone increases plasma Pentraxin 3 early after total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Clin Exp Immunol 2018; 191:356-362. [PMID: 29119559 PMCID: PMC5801497 DOI: 10.1111/cei.13071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2017] [Indexed: 11/29/2022] Open
Abstract
Preoperative glucocorticoid administration reduces the systemic inflammatory response. Pentraxin 3 (PTX3) is a novel inflammatory marker belonging to the humoral arm of innate immunity exerting a potentially protective host response. This study evaluated PTX3 and other complement marker changes after preoperative methylprednisolone (MP) early after total knee arthroplasty (TKA). Seventy patients were randomized (1 : 1) to preoperative intravenous (i.v.) MP 125 mg (group MP) or isotonic saline i.v. (group C). The outcomes included change in plasma PTX3, mannose-binding lectin (MBL), ficolins (ficolin-1, -2 and -3), complement components (C4 and C3), terminal complement complex (TCC) and C-reactive protein (CRP) concentrations. Blood samples were analysed at baseline and 2, 6, 24 and 48 h after surgery with complete sampling from 63 patients for analyses. MP resulted in an increase in circulating PTX3 compared to saline from baseline to 24 h postoperatively (P < 0·001), while MP reduced the systemic inflammatory response (CRP) 24 and 48 h postoperatively (P < 0·001). However, the small postoperative changes in MBL, ficolin-1, -2 and -3, C4, C3 and TCC concentrations did not differ between groups (P > 0·05). In conclusion, preoperative MP 125 mg increased circulating PTX3 and reduced the general inflammatory response (CRP) early after TKA, but did not affect other complement markers.
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Affiliation(s)
- V. Lindberg‐Larsen
- Section for Surgical Pathophysiology, Section 7621Copenhagen University Hospital, RigshospitaletCopenhagenDenmark
- The Lundbeck Foundation Centre for Fast‐Track Hip and Knee ArthroplastyCopenhagenDenmark
| | - H. Kehlet
- Section for Surgical Pathophysiology, Section 7621Copenhagen University Hospital, RigshospitaletCopenhagenDenmark
- The Lundbeck Foundation Centre for Fast‐Track Hip and Knee ArthroplastyCopenhagenDenmark
| | - K. Pilely
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631Copenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - J. Bagger
- Department of Orthopaedic SurgeryCopenhagen University Hospital, Bispebjerg and FrederiksbergDenmark
| | - M. L. Rovsing
- Department of Anaesthesiology and Intensive Care MedicineCopenhagen University Hospital, Bispebjerg and FrederiksbergDenmark
| | - P. Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631Copenhagen University Hospital, RigshospitaletCopenhagenDenmark
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9
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Lindberg-Larsen V, Bandholm TQ, Zilmer CK, Bagger J, Hornsleth M, Kehlet H. Preoperative methylprednisolone does not reduce loss of knee-extension strength after total knee arthroplasty A randomized, double-blind, placebo-controlled trial of 61 patients. Acta Orthop 2017; 88:543-549. [PMID: 28657396 PMCID: PMC5560219 DOI: 10.1080/17453674.2017.1345236] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Patients undergoing total knee arthroplasty (TKA) face challenges related to postoperative reduction in knee-extension strength. We evaluated whether inhibition of the inflammatory response by a single preoperative dose of methylprednisolone (MP) reduces the pronounced loss of knee-extension strength at discharge after fast-track TKA. Patients and methods - 70 patients undergoing elective unilateral TKA were randomized (1:1) to preoperative intravenous (IV) MP 125 mg (group MP) or isotonic saline IV (group C). All procedures were performed under spinal anesthesia without tourniquet, and with a standardized multimodal analgesic regime. The primary outcome was change in knee-extension strength from baseline to 48 hours postoperatively. Secondary outcomes were knee joint circumference, functional performance using the Timed Up and Go (TUG) test, pain during the aforementioned tests, rescue analgesic requirements, and plasma C-reactive protein (CRP) changes. Results - 61 patients completed the follow-up. The loss in quadriceps muscle strength was similar between groups; group MP 1.04 (0.22-1.91) Nm/kg (-89%) vs. group C 1.02 (0.22-1.57) Nm/kg (-88%). Also between-group differences were similar for knee circumference, TUG test, and pain scores. MP reduced the inflammatory response (CRP) at 24 hours postoperatively; group MP 33 (IQR 21-50) mg/L vs. group C 72 (IQR 58-92) mg/L (p < 0.001), and 48 hours postoperatively; group MP 83 (IQR 56-125) mg/L vs. group C 192 (IQR 147-265) mg/L (p < 0.001), respectively. Interpretation - Preoperative systemic administration of MP 125 mg did not reduce the pronounced loss of knee-extension strength or other functional outcomes at discharge after fast-track TKA despite a reduced systemic inflammatory response.
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Affiliation(s)
- Viktoria Lindberg-Larsen
- Section for Surgical Pathophysiology, Copenhagen University Hospital;,The Lundbeck Foundation Centre for Fast-Track Hip and Knee Arthroplasty, Copenhagen;,Correspondence:
| | - Thomas Q Bandholm
- Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical Therapy, Clinical Research Centre, and Department of Orthopedic Surgery, Copenhagen University Hospital
| | | | - Jens Bagger
- Department of Orthopedic Surgery, Copenhagen University Hospital, Denmark
| | - Mette Hornsleth
- Department of Orthopedic Surgery, Copenhagen University Hospital, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology, Copenhagen University Hospital;,The Lundbeck Foundation Centre for Fast-Track Hip and Knee Arthroplasty, Copenhagen
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Abstract
BACKGROUND Revision of infected knee arthroplasties is associated with high failure rates (30-40%). An understanding of the microbiology is important to optimize treatment and outcome. We describe microbiological diagnostic practice and diagnosis in revision of infected knee arthroplasties. METHODS One hundred and two partial revisions (open debridement and exchange of tibial insert) and 213 two-stage procedures performed due to infection in 275 patients from 1 July 2011 to 30 June 2013 were included and analysed by linkage to data from a nationwide registry on microbiological test results. RESULTS 78 (24.8%) revisions were culture negative, 192 (60.9%) showed monomicrobial growth and 43 (14.3%) polymicrobial growth. Staphylococcus aureus was the most frequent isolate in mono-culture in 70 (22.2%) revisions and in polymicrobial culture in 15 revisions with a total frequency of 27.0%. Only one case (1.4%) of methicillin-resistance was registered. Coagulase-negative staphylococci (CoNS) were frequent, sole pathogen in 65 revisions and in polymicrobial cultures in 28 revisions with a total frequency of 29.5%. A pre-operative knee aspiration was performed in 50% and preoperative blood cultures were performed in 22% of cases. In 73% of the preoperative knee-aspirations bacteriological findings were fully or partially in accordance with intraoperative cultures. In 54% of the later re-revisions due to infection (treatment-failures) the cultured species differed from or was not detected at index revision surgery. CONCLUSIONS The 25% culture negative cases in combination with only 50% preoperative knee aspirations and prevailing high failure rates confirm the need for improvement of diagnostic practice and treatment of infected knee arthroplasties.
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Affiliation(s)
- Martin Lindberg-Larsen
- a Department of Orthopaedic Surgery , Odense University Hospital , Odense C , Denmark.,b The Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty , Copenhagen University Hospital Rigshospitalet , Copenhagen Ø , Denmark
| | - Frederik T Pitter
- b The Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty , Copenhagen University Hospital Rigshospitalet , Copenhagen Ø , Denmark.,c Section of Surgical Pathophysiology , Copenhagen University Hospital Rigshospitalet , Copenhagen Ø , Denmark
| | - Marianne Voldstedlund
- d Department of Infectious Disease Epidemiology , Statens Serum Institut , Copenhagen S , Denmark
| | - Henrik M Schrøder
- b The Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty , Copenhagen University Hospital Rigshospitalet , Copenhagen Ø , Denmark.,e Department of Orthopaedic Surgery , Naestved Hospital , Næstved , Denmark
| | - Jens Bagger
- b The Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty , Copenhagen University Hospital Rigshospitalet , Copenhagen Ø , Denmark.,f Department of Orthopaedic Surgery , Copenhagen University Hospital Bispebjerg , Copenhagen NV , Denmark
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Abstract
Background and purpose - The surgical treatment of periprosthetic knee infection is generally either a partial revision procedure (open debridement and exchange of the tibial insert) or a 2-stage exchange arthroplasty procedure. We describe the failure rates of these procedures on a nationwide basis. Patients and methods - 105 partial revisions (100 patients) and 215 potential 2-stage revision procedures (205 patients) performed due to infection from July 1, 2011 to June 30, 2013 were identified from the Danish Knee Arthroplasty Register (DKR). Failure was defined as surgically related death ≤ 90 days postoperatively, re-revision due to infection, or not reaching the second stage for a planned 2-stage procedure within a median follow-up period of 3.2 (2.2-4.2) years. Results - The failure rate of the partial revisions was 43%. 71 of the partial revisions (67%) were revisions of a primary prosthesis with a re-revision rate due to infection of 34%, as compared to 55% in revisions of a revision prosthesis (p = 0.05). The failure rate of the 2-stage revisions was 30%. Median time interval between stages was 84 (9-597) days. 117 (54%) of the 2-stage revisions were revisions of a primary prosthesis with a re-revision rate due to infection of 21%, as compared to 29% in revisions of a previously revised prosthesis (p = 0.1). Overall postoperative mortality was 0.6% in high-volume centers (> 30 procedures within 2 years) as opposed to 7% in the remaining centers (p = 0.003). Interpretation - The failure rates of 43% after the partial revision procedures and 30% after the 2-stage revisions in combination with the higher mortality outside high-volume centers call for centralization and reconsideration of surgical strategies.
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Affiliation(s)
- Martin Lindberg-Larsen
- The Lundbeck Center for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital, Rigshospitalet, Copenhagen, ,Department of Orthopedic Surgery, Copenhagen University Hospital, Bispebjerg, Copenhagen, ,Correspondence:
| | - Christoffer C Jørgensen
- The Lundbeck Center for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital, Rigshospitalet, Copenhagen, ,Surgical Pathophysiology Section, Copenhagen University Hospital Rigshospitalet, Copenhagen,
| | - Jens Bagger
- The Lundbeck Center for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital, Rigshospitalet, Copenhagen, ,Department of Orthopedic Surgery, Copenhagen University Hospital, Bispebjerg, Copenhagen,
| | - Henrik M Schrøder
- The Lundbeck Center for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital, Rigshospitalet, Copenhagen, ,Department of Orthopedic Surgery, Naestved Hospital, Naestved, Denmark
| | - Henrik Kehlet
- The Lundbeck Center for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital, Rigshospitalet, Copenhagen, ,Surgical Pathophysiology Section, Copenhagen University Hospital Rigshospitalet, Copenhagen,
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Walnum C, Nielsen M, Husted K, Bagger J, Andersen J. SUN-PP033: The Effect of Maltodextrin after Training in the Early Postoperative Stage after Total Knee or Hip Arthroplasty - a Blinded, Randomized, Placebo Controlled Intervention Study. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Moortgat-Pick G, Baer H, Battaglia M, Belanger G, Fujii K, Kalinowski J, Heinemeyer S, Kiyo Y, Olive K, Simon F, Uwer P, Wackeroth D, Zerwas PM, Arbey A, Asano M, Bagger J, Bechtle P, Bharucha A, Brau J, Brümmer F, Choi SY, Denner A, Desch K, Dittmaier S, Ellwanger U, Englert C, Freitas A, Ginzburg I, Godfrey S, Greiner N, Grojean C, Grünewald M, Heisig J, Höcker A, Kanemura S, Kawagoe K, Kogler R, Krawczyk M, Kronfeld AS, Kroseberg J, Liebler S, List J, Mahmoudi F, Mambrini Y, Matsumoto S, Mnich J, Mönig K, Mühlleitner MM, Pöschl R, Porod W, Porto S, Rolbiecki K, Schmitt M, Serpico P, Stanitzki M, Stål O, Stefaniak T, Stöckinger D, Weiglein G, Wilson GW, Zeune L, Moortgat F, Xella S, Bagger J, Brau J, Ellis J, Kawagoe K, Komamiya S, Kronfeld AS, Mnich J, Peskin M, Schlatter D, Wagner A, Yamamoto H. Physics at the [Formula: see text] linear collider. Eur Phys J C Part Fields 2015; 75:371. [PMID: 26300691 PMCID: PMC4537698 DOI: 10.1140/epjc/s10052-015-3511-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/09/2015] [Indexed: 06/04/2023]
Abstract
A comprehensive review of physics at an [Formula: see text] linear collider in the energy range of [Formula: see text] GeV-3 TeV is presented in view of recent and expected LHC results, experiments from low-energy as well as astroparticle physics. The report focusses in particular on Higgs-boson, top-quark and electroweak precision physics, but also discusses several models of beyond the standard model physics such as supersymmetry, little Higgs models and extra gauge bosons. The connection to cosmology has been analysed as well.
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Affiliation(s)
- G. Moortgat-Pick
- />II. Institute of Theoretical Physics, University of Hamburg, 22761 Hamburg, Germany
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - H. Baer
- />Department of Physics and Astronomy, University of Oklahoma, Norman, OK 73019 USA
| | - M. Battaglia
- />Santa Cruz Institute for Particle Physics, University of California Santa Cruz, Santa Cruz, CA USA
| | - G. Belanger
- />Laboratoire de Physique Theorique (LAPTh), Université Savoie Mont Blanc, CNRS, B.P.110, 74941 Annecy-le-Vieux, France
| | - K. Fujii
- />High Energy Accelerator Research Organisation (KEK), Tsukuba, Japan
| | - J. Kalinowski
- />Faculty of Physics, University of Warsaw, 02093 Warsaw, Poland
| | - S. Heinemeyer
- />Instituto de Física de Cantabria (CSIC-UC), 39005 Santander, Spain
| | - Y. Kiyo
- />Department of Physics, Juntendo University, Inzai, Chiba 270-1695 Japan
| | - K. Olive
- />William I. Fine Theoretical Physics Institute, School of Physics and Astronomy, University of Minnesota, Minneapolis, MN 55455 USA
| | - F. Simon
- />Max-Planck-Institut für Physik, 80805 Munich, Germany
| | - P. Uwer
- />Humboldt-Universität zu Berlin, Institut für Physik, 12489 Berlin, Germany
| | - D. Wackeroth
- />Department of Physics, SUNY at Buffalo, Buffalo, NY 14260-1500 USA
| | - P. M. Zerwas
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - A. Arbey
- />Université de Lyon, Université Lyon 1, 69622 Villeurbonne Cedex, France
- />Centre de Recherche Astrophysique de Lyon, CNRS, UMR 5574, 69561 Saint-Genis Laval Cedex, France
- />Ecole Normale Supérieure de Lyon, Lyon, France
| | - M. Asano
- />Physikalisches Institut and Bethe Center for Theoretical Physics, Universität Bonn, 53115 Bonn, Germany
| | - J. Bagger
- />Department of Physics and Astronomy, Johns Hopkins University, Baltimore, MD 21218 USA
- />TRIUMF, Vancouver, BC V6T 2A3 Canada
| | - P. Bechtle
- />Physikalisches Institut, University of Bonn, Bonn, Germany
| | - A. Bharucha
- />Physik Department T31, Technische Universität München, 85748 Garching, Germany
- />CNRS, Aix Marseille U., U. de Toulon, CPT, 13288 Marseille, France
| | - J. Brau
- />Department of Physics, University of Oregon, Eugene, OR 97403 USA
| | - F. Brümmer
- />LUPM, UMR 5299, Université de Montpellier II et CNRS, 34095 Montpellier, France
| | - S. Y. Choi
- />Department of Physics, Chonbuk National University, Jeonju, 561-756 Republic of Korea
| | - A. Denner
- />Universität Würzburg, Institut für Theoretische Physik und Astrophysik, 97074 Würzburg, Germany
| | - K. Desch
- />Physikalisches Institut, University of Bonn, Bonn, Germany
| | - S. Dittmaier
- />Physikalisches Institut, Albert–Ludwigs–Universität Freiburg, 79104 Freiburg, Germany
| | - U. Ellwanger
- />Laboratoire de Physique, UMR 8627, CNRS, Universite de Paris-Sud, 91405 Orsay, France
| | - C. Englert
- />SUPA, School of Physics and Astronomy, University of Glasgow, Glasgow, G12 8QQ UK
| | - A. Freitas
- />PITT PACC, Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, PA 15260 USA
| | - I. Ginzburg
- />Sobolev Institute of Mathematics and Novosibirsk State University, Novosibirsk, 630090 Russia
| | - S. Godfrey
- />Ottawa-Carleton Institute for Physics, Department of Physics, Carleton University, Ottawa, K1S 5B6 Canada
| | - N. Greiner
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
- />Max-Planck-Institut für Physik, 80805 Munich, Germany
| | - C. Grojean
- />ICREA at IFAE, Universitat Autonoma de Barcelona, 08193 Bellaterra, Spain
| | | | - J. Heisig
- />Institute for Theoretical Particle Physics and Cosmology, RWTH Aachen University, 52056 Aachen, Germany
| | | | - S. Kanemura
- />Department of Physics, University of Toyama, 3190 Gofuku, Toyama, 930-8555 Japan
| | - K. Kawagoe
- />Department of Physics, Kyushu University, 6-10-1 Hakozaki, Higashi-ku, Fukuoka, 812-8581 Japan
| | - R. Kogler
- />University of Hamburg, Hamburg, Germany
| | - M. Krawczyk
- />Faculty of Physics, University of Warsaw, 02093 Warsaw, Poland
| | - A. S. Kronfeld
- />Theoretical Physics Department, Fermi National Accelerator Laboratory, Batavia, IL USA
- />Institute for Advanced Study, Technische Universität München, 85748 Garching, Germany
| | - J. Kroseberg
- />Physikalisches Institut, University of Bonn, Bonn, Germany
| | - S. Liebler
- />II. Institute of Theoretical Physics, University of Hamburg, 22761 Hamburg, Germany
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - J. List
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - F. Mahmoudi
- />Université de Lyon, Université Lyon 1, 69622 Villeurbonne Cedex, France
- />Centre de Recherche Astrophysique de Lyon, CNRS, UMR 5574, 69561 Saint-Genis Laval Cedex, France
- />Ecole Normale Supérieure de Lyon, Lyon, France
| | - Y. Mambrini
- />Laboratoire de Physique, UMR 8627, CNRS, Universite de Paris-Sud, 91405 Orsay, France
| | - S. Matsumoto
- />Kavli IPMU (WPI), The University of Tokyo, Kashiwa, Chiba 277-8583 Japan
| | - J. Mnich
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - K. Mönig
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - M. M. Mühlleitner
- />Institute for Theoretical Physics, Karlsruhe Institute of Technology, 76128 Karlsruhe, Germany
| | - R. Pöschl
- />Laboratoire de L’accelerateur Lineaire (LAL), CNRS/IN2P3, Orsay, France
| | - W. Porod
- />Universität Würzburg, Institut für Theoretische Physik und Astrophysik, 97074 Würzburg, Germany
| | - S. Porto
- />II. Institute of Theoretical Physics, University of Hamburg, 22761 Hamburg, Germany
| | - K. Rolbiecki
- />Faculty of Physics, University of Warsaw, 02093 Warsaw, Poland
- />Instituto de Fisica Teorica, IFT-UAM/CSIC, Universidad Autonoma de Madrid, Cantoblanco, 28049 Madrid, Spain
| | - M. Schmitt
- />Department of Physics and Astronomy, Northwestern University, Evanston, IL 60091 USA
| | - P. Serpico
- />Laboratoire de Physique Theorique (LAPTh), Université Savoie Mont Blanc, CNRS, B.P.110, 74941 Annecy-le-Vieux, France
| | - M. Stanitzki
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - O. Stål
- />The Oskar Klein Centre, Department of Physics, Stockholm University, 106 91 Stockholm, Sweden
| | - T. Stefaniak
- />Santa Cruz Institute for Particle Physics, University of California Santa Cruz, Santa Cruz, CA USA
| | - D. Stöckinger
- />Institut für Kern- und Teilchenphysik, TU Dresden, 01069 Dresden, Germany
| | - G. Weiglein
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - G. W. Wilson
- />Department of Physics and Astronomy, University of Kansas, Lawrence, KS 66045 USA
| | - L. Zeune
- />ITFA, University of Amsterdam, Science Park 904, 1018 XE Amsterdam, The Netherlands
| | | | - S. Xella
- />Niels Bohr Institute, University of Copenhagen, Kobenhavn, Denmark
| | - J. Bagger
- />Department of Physics and Astronomy, Johns Hopkins University, Baltimore, MD 21218 USA
- />TRIUMF, Vancouver, BC V6T 2A3 Canada
| | - J. Brau
- />Department of Physics, University of Oregon, Eugene, OR 97403 USA
| | - J. Ellis
- />CERN, Geneva, Switzerland
- />Theoretical Particle Physics and Cosmology Group, Department of Physics, King’s College London, Strand, London WC2R 2LS UK
| | - K. Kawagoe
- />Department of Physics, Kyushu University, 6-10-1 Hakozaki, Higashi-ku, Fukuoka, 812-8581 Japan
| | - S. Komamiya
- />Department of Physics, Graduate School of Science, and International Center for Elementary Particle Physics, The University of Tokyo, Tokyo, 113-0033 Japan
| | - A. S. Kronfeld
- />Theoretical Physics Department, Fermi National Accelerator Laboratory, Batavia, IL USA
- />Institute for Advanced Study, Technische Universität München, 85748 Garching, Germany
| | - J. Mnich
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
| | - M. Peskin
- />SLAC, Stanford University, Menlo Park, CA, 94025 USA
| | | | - A. Wagner
- />Deutsches Elektronen Synchrotron (DESY), Hamburg und Zeuthen, 22603 Hamburg, Germany
- />University of Hamburg, Hamburg, Germany
| | - H. Yamamoto
- />Department of Physics, Tohoku University, Sendai, Miyagi Japan
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Stege H, Bagger J, Nielsen J, Ersbøll A. Effect of breeding strategy and feeding system on the within-herd variation of lean meat percents in Danish slaughter pigs. Prev Vet Med 2011; 101:73-8. [DOI: 10.1016/j.prevetmed.2011.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 04/26/2011] [Accepted: 05/03/2011] [Indexed: 12/01/2022]
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Brorson S, Bagger J, Sylvest A, Hrobjartsson A. Diagnosing displaced four-part fractures of the proximal humerus: a review of observer studies. Int Orthop 2008; 33:323-7. [PMID: 18536918 DOI: 10.1007/s00264-008-0591-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 04/15/2008] [Accepted: 04/15/2008] [Indexed: 11/30/2022]
Abstract
Displaced four-part fractures comprise 2-10 % of all proximal humeral fractures. The optimal treatment is unclear and randomised trials are needed. The conduct and interpretation of such trials is facilitated by a reproducible fracture classification. We aimed at quantifying observer agreement on the classification of displaced four-part fractures according to the Neer system. Published and unpublished data from five observer studies were reviewed. Observers agreed less on displaced four-part fractures than on the overall Neer classification. Mean kappa values for interobserver agreement ranged from 0.16 to 0.48. Specialists agreed slightly more than fellows and residents. Advanced imaging modalities (CT and 3D CT) seemed to contribute more to classification of displaced four-part patterns than in less complex fracture patterns. Low observer agreement may challenge the clinical approach to displaced four-part fractures and poses a problem for the interpretation and generalisation of results from future randomised trials.
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Affiliation(s)
- Stig Brorson
- Department of Orthopaedic Surgery, Herlev University Hospital, Herlev, Denmark.
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Mygind A, Norredam M, Nielsen AS, Bagger J, Krasnik A. The effect of patient origin and relevance of contact on patient and caregiver satisfaction in the emergency room. Scand J Public Health 2008; 36:76-83. [PMID: 17852971 DOI: 10.1177/1403494807085302] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS This study examined (1) whether patient and caregiver satisfaction in the emergency room (ER) varies according to patient origin, and (2) whether relevance of visit can explain any variation. METHODS Data were obtained from a questionnaire survey of walk-in patients and their caregivers at four ERs in Copenhagen. The patient questionnaire was available in nine languages, and addressed patient satisfaction. The caregiver questionnaire addressed caregiver satisfaction and relevance of the patient contact in the ER. A total of 3,809 patients and 3,905 caregivers responded. The response rate among patients was 54%. Only data with both patient and caregiver responses and with patient country of birth were included in the analyses (n=3,426). The effect of patient origin was examined using bivariate, stratified analyses and tested for independence. RESULTS Patients and caregivers had lower satisfaction rates when patients were of Middle Eastern compared with Danish origin. Satisfaction of both groups was associated with the relevance of the visit as assessed by the caregiver. Visits by patients of Middle Eastern origin were less often assessed as being relevant, but caregivers were less satisfied with visits by these patients even after controlling for relevance. Differences in patient satisfaction by patient origin were no longer significant when stratifying by relevance. CONCLUSIONS Patient and caregiver satisfaction among patients of foreign origin can be improved by lowering the number of irrelevant visits among patients of foreign origin, e.g. by improving access to general practitioners. Training of caregivers in dealing with patients of different origins might reduce differences in caregiver satisfaction according to patient origin.
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Affiliation(s)
- Anna Mygind
- Department of Health Services Research, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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Tvedeskov H, Bagger J. [Work distribution between nurses and physicians]. Ugeskr Laeger 2007; 169:787. [PMID: 17355840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Norredam M, Mygind A, Nielsen AS, Bagger J, Krasnik A. Motivation and relevance of emergency room visits among immigrants and patients of Danish origin. Eur J Public Health 2007; 17:497-502. [PMID: 17259659 DOI: 10.1093/eurpub/ckl268] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We investigated the extent to which immigrants and patients of Danish origin have different motivations for seeking emergency room (ER) treatment, and differences in the relevance of their claims. METHODS Data were obtained from a questionnaire survey of walk-in patients and their caregivers at four Copenhagen ERs. The patient survey was available in nine languages, and addressed patient-identified reasons for using the ER. Caregivers were asked if the claim was appropriate to the ER. 3809 patients and 3905 caregivers responded. The response rate among patients was 54%. Only questionnaires in which both patient and caregiver had responded, and in which data on the patient's nationality were available, were included in the analyses (n = 3426). The effect of region of origin was examined using bivariate, stratified analyses and tested for independence. RESULTS More among immigrant patients than among patients of Danish origin had considered contacting a primary caregiver before visiting the ER, and more immigrants reported going to the ER because they could not contact a general practitioner, or could not explain their problem on the telephone. Compared to immigrants, more patients of Danish origin explained that the ER was most relevant to their need. A higher proportion of claims among immigrants were seen by caregivers as not being appropriate to the ER. CONCLUSION Migrants have more irrelevant ER claims, presumably because of barriers in access to primary care. Access to primary care should be facilitated for these groups. Alternatively, ERs could include primary care activities as part of their services.
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Affiliation(s)
- Marie Norredam
- Department of Health Services Research, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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Boes J, Alban L, Bagger J, Møgelmose V, Baggesen DL, Olsen JE. Survival of Escherichia coli and Salmonella Typhimurium in slurry applied to clay soil on a Danish swine farm. Prev Vet Med 2005; 69:213-28. [PMID: 15907571 DOI: 10.1016/j.prevetmed.2005.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2004] [Revised: 12/30/2004] [Accepted: 02/07/2005] [Indexed: 10/25/2022]
Abstract
A pilot study was carried out on a Danish swine farm infected with multi-resistant Salmonella Typhimurium DT104 (MRDT104). We aimed to (1) investigate to which degree the decline of Escherichia coli and Salmonella in swine slurry applied to farmland depended on the application method; (2) estimate the survival times of E. coli and Salmonella in the soil surface following deposition of naturally contaminated pig slurry; and (3) simulate survival of Salmonella in different infection levels using E. coli data as input estimates. Slurry was deposited by four different methods: (1) hose applicator on black soil followed by ploughing and harrowing; (2) hose applicator on black soil followed only by harrowing; (3) hose applicator on a field with winter-wheat seedlings without further soil treatment; (4) slurry injector on a field with winter-wheat seedlings without further soil treatment. E. coli and Salmonella could not be detected at all in soil following treatment 1. Following the other treatments, E. coli was not detected in soil samples after day 21 and Salmonella was no longer detected after day 7. Simulation results showed that clinical (4 log CFU g(-1)) and sub-clinical Salmonella levels (2500 CFU g(-1)) would fall below the detection limit within 10 or 5 days, respectively. Analysis of samples from 62 Danish MRDT104-infected swineherds showed that nearly 75% of these herds had low levels of MRDT104 (< 10 CFU g(-1)) in their slurry. Our results show that ploughing and harrowing of soil amended with contaminated pig slurry was an effective means to reduce environmental exposure to E. coli and Salmonella on this clay-soil farm.
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Affiliation(s)
- J Boes
- The National Committee for Pig Production, Danish Bacon and Meat Council, Axeltorv 3, DK-1609 Copenhagen V, Denmark.
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Brorson S, Bagger J, Sylvest A, Hróbjartsson A. Low agreement among 24 doctors using the Neer-classification; only moderate agreement on displacement, even between specialists. Int Orthop 2002; 26:271-3. [PMID: 12378351 PMCID: PMC3620992 DOI: 10.1007/s00264-002-0369-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/23/2002] [Indexed: 10/27/2022]
Abstract
Twenty-four orthopaedic surgeons classified 42 pairs of radiographs according to the Neer system for proximal humeral fractures. Mean kappa value for inter-observer agreement was 0.27 (95% CI 0.26-0.28) with no clinically significant difference between orthopaedic residents ( n=9), fellows ( n=6) and specialists ( n=9). Mean kappa for agreement of displacement versus non-displacement was 0.41 (95% CI 0.39-0.43) overall, and 0.50 (95% CI 0.45-0.56) within the specialist group. The agreement found in our study is unsatisfactory from a clinical perspective.
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Affiliation(s)
- S Brorson
- Department of Medical Philosophy and Clinical Theory, University of Copenhagen, Panum Institute, Blegdamsvej 3, 2200 Copenhagen N, Denmark.
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Brorson S, Bagger J, Sylvest A, Hrøbjartsson A, Høbjartsson A. Improved interobserver variation after training of doctors in the Neer system. A randomised trial. J Bone Joint Surg Br 2002; 84:950-4. [PMID: 12358384 DOI: 10.1302/0301-620x.84b7.13010] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated whether training doctors to classify proximal fractures of the humerus according to the Neer system could improve interobserver agreement. Fourteen doctors were randomised to two training sessions, or to no training, and asked to categorise 42 unselected pairs of plain radiographs of fractures of the proximal humerus according to the Neer system. The mean kappa difference between the training and control groups was 0.30 (95% CI 0.10 to 0.50, p = 0.006). In the training group the mean kappa value for interobserver variation improved from 0.27 (95% CI 0.24 to 0.31) to 0.62 (95% CI 0.57 to 0.67). The improvement was particularly notable for specialists in whom kappa increased from 0.30 (95% CI 0.23 to 0.37) to 0.79 (95% CI 0.70 to 0.88). These results suggest that formal training in the Neer system is a prerequisite for its use in clinical practice and research.
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Affiliation(s)
- S Brorson
- Bispebjerg University Hospital, Copenhagen, Denmark
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Abstract
We investigated whether training doctors to classify proximal fractures of the humerus according to the Neer system could improve interobserver agreement. Fourteen doctors were randomised to two training sessions, or to no training, and asked to categorise 42 unselected pairs of plain radiographs of fractures of the proximal humerus according to the Neer system. The mean kappa difference between the training and control groups was 0.30 (95% CI 0.10 to 0.50, p = 0.006). In the training group the mean kappa value for interobserver variation improved from 0.27 (95% CI 0.24 to 0.31) to 0.62 (95% CI 0.57 to 0.67). The improvement was particularly notable for specialists in whom kappa increased from 0.30 (95% CI 0.23 to 0.37) to 0.79 (95% CI 0.70 to 0.88). These results suggest that formal training in the Neer system is a prerequisite for its use in clinical practice and research.
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Affiliation(s)
- S. Brorson
- Department of Medical Philosophy and Clinical Theory, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200 Copenhagen NV, Denmark
| | - J. Bagger
- Department of Orthopaedic Surgery, Bispebjerg University Hospital, DK-2400 Copenhagen NV, Denmark
| | - A. Sylvest
- Department of Orthopaedic Surgery, Bispebjerg University Hospital, DK-2400 Copenhagen NV, Denmark
| | - A. Høbjartsson
- Department of Medical Philosophy and Clinical Theory, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200 Copenhagen NV, Denmark
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Nielsen B, Alban L, Stege H, Sørensen LL, Møgelmose V, Bagger J, Dahl J, Baggesen DL. A new Salmonella surveillance and control programme in Danish pig herds and slaughterhouses. Berl Munch Tierarztl Wochenschr 2001; 114:323-6. [PMID: 11570168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The Danish Salmonella Surveillance and Control Programme for pigs operates at all stages of the production chain and has been applied nationally since 1995. Due to the program the level of Salmonella in Danish pork has declined from 3.5% in 1993 to 0.7% in the year 2000. Simultaneously, the number of human cases with salmonellosis due to pork has declined from approximately 1,144 in 1993 to 166 in 2000. In year 2001, the programme has been improved at a number of stages. A new classification scheme for the serological surveillance of finisher herds has been developed. The individual test cut-off in the mix-ELISA has been reduced to 20 OD%. Only herds producing more than 200 finishers/year are sampled. Based on the serological result from the last 3 months a new weighted salmonella index is calculated: The Danish Bacon and Meat Council has agreed on a new stricter penalty system. Level 2 and 3 herds get a penalty of 2% and 4% of the value per slaughter carcass, respectively. A new method of Salmonella testing on carcasses has been introduced; 5 carcasses per slaughter day are swabbed at 3 defined areas at 100 cm2 for each sample. This method is more sensitive than the one used previously. Herds infected with multiresistant Salmonella Typhimurium DT104 have to follow special restrictions. These include a requirement for a herd intervention plan, restriction on livestock trade, and a requirement for special slurry handling. Carcasses from DT 104 herds must be heat-treated or decontaminated with hot water.
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Affiliation(s)
- B Nielsen
- Veterinary and Food Advisory Service, Danish Bacon and Meat Council, Axeltorv 3, DK-1609 Copenhagen, Denmark.
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Lykke J, Kirstein A, Bagger J. [Spread of methicillin-resistant Staphylococcus aureus. Are our hygienic precautions sufficient?]. Ugeskr Laeger 1998; 160:6357-8. [PMID: 9810243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A patient was transferred from Pakistan to a Danish orthopaedic ward. In Denmark he was tested MRSA-positive. Two months after he was discharged, similar MRSA strains were found in another patient. The two patients had been on the same ward for one week. All hygienic precautions had been taken. Staff and other patients on the ward at the relevant time all tested MRSA-negative.
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Affiliation(s)
- J Lykke
- Ortopaedkirurgisk afdeling, Amtssygehuset i Glostrup
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Bagger J, Barger V, Cheung K, Gunion J, Han T, Ladinsky GA, Rosenfeld R, Yuan C. CERN LHC analysis of the strongly interacting WW system: Gold-plated modes. Phys Rev D Part Fields 1995; 52:3878-3889. [PMID: 10019615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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27
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Bagger J, Barger V, Cheung K, Gunion J, Han T, Ladinsky GA, Rosenfeld R, Yuan C. Strongly interacting WW system: Gold-plated modes. Phys Rev D Part Fields 1994; 49:1246-1264. [PMID: 10017096 DOI: 10.1103/physrevd.49.1246] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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28
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Bagger J, Ravn J, Lavard P, Blyme P, Sorensen C. Effect of functional bracing, quadriceps and hamstrings on anterior tibial translation in anterior cruciate ligament insufficiency: a preliminary study. J Rehabil Res Dev 1992; 29:9-12. [PMID: 1740779 DOI: 10.1682/jrrd.1992.01.0009] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Anterior tibial translation was measured in six patients with anterior cruciate ligament insufficiency. The tests were done in 15, 45, and 90 degrees of knee flexion, partly with activated quadriceps or hamstrings, and partly with subjects wearing a 4-point functional DonJoy brace. The translation was evaluated with a computerized electrogoniometer (Acufex KSS). The anterior tibial translation was significantly reduced by use of the hamstrings in all three degrees of knee flexion. The effect of the 4-point brace was only significant in 15 and 45 degrees of flexion. The quadriceps did not reduce the anterior tibial translation.
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Affiliation(s)
- J Bagger
- Department of Orthopaedics T, Gentofte Hospital, Copenhagen, Denmark
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Bagger J, Dawson S, Valencia G. Testing electroweak symmetry breaking through gluon fusion at pp colliders. Phys Rev Lett 1991; 67:2256-2259. [PMID: 10044380 DOI: 10.1103/physrevlett.67.2256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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34
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Bagger J, Baandrup U, Rasmussen K, Møller M, Nielsen TV. [The occurrence of cardiomyopathy in the western belt in Denmark]. Ugeskr Laeger 1985; 147:3236-40. [PMID: 4082306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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35
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36
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Bagger J, Skjødt H. [Surgical treatment of hip arthrosis with hemi-arthroplasty]. Ugeskr Laeger 1985; 147:1997-9. [PMID: 4024353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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38
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Bagger J, Goldstein W, Soldate M. Static solutions in the vacuum sector of the Skyrme model. Phys Rev D Part Fields 1985; 31:2600-2604. [PMID: 9955561 DOI: 10.1103/physrevd.31.2600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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40
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Bagger J, Skjødt H. [The Monk metal cap hemiarthroplasty in the treatment of medical fractures of the femoral neck]. Ugeskr Laeger 1985; 147:704-5. [PMID: 3984071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Bagger J, Duun S. [Cavernous hemangioma originating from a tendon sheath at the wrist]. Ugeskr Laeger 1985; 147:527. [PMID: 3976066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Bagger J, Jensen BS. [The compartment syndrome in fractures of the leg]. Ugeskr Laeger 1983; 145:327-9. [PMID: 6845495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
A long term follow-up study of 518 patients with hip fractures was undertaken 2.5 years after the operation. The total mortality was 35 per cent (180/518). The risk of social deterioration for patients admitted from home was 47 per cent (132/281). A statistical analysis showed this risk to be determined primarily by the age of the patient and secondarily by the placement of the patient on discharge from hospital. A thorough description of these factors is presented.
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Rasmussen SN, Bagger J, Wagner F, Pedersen JF, Kristensen JK. Ultrasonic scanning for focal liver lesions. Dan Med Bull 1977; 24:151-3. [PMID: 923296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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