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Thestrup J, Hybschmann J, Madsen TW, Bork NE, Sørensen JL, Afshari A, Borgwardt L, Berntsen M, Born AP, Aunsholt L, Larsen VA, Gjærde LK. Nonpharmacological Interventions to Reduce Sedation and General Anesthesia in Pediatric MRI: A Meta-analysis. Hosp Pediatr 2023; 13:e301-e313. [PMID: 37727937 DOI: 10.1542/hpeds.2023-007289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
CONTEXT Nonpharmacological strategies are increasingly used in pediatric procedures, but in pediatric MRI, sedation and general anesthesia are still commonly required. OBJECTIVES To evaluate the effectiveness of nonpharmacological interventions in reducing use of sedation and general anesthesia in pediatric patients undergoing MRI, and to investigate effects on scan time, image quality, and anxiety. DATA SOURCES We searched Ovid Medline, CINAHL, Embase, and CENTRAL from inception through October 10, 2022. STUDY SELECTION We included randomized controlled trials and quasi-experimental designs comparing the effect of a nonpharmacological intervention with standard care on use of sedation or general anesthesia, scan time, image quality, or child and parental anxiety among infants (<2 years), children, and adolescents (2-18 years) undergoing MRI. DATA EXTRACTION Standardized instruments were used to extract data and assess study quality. RESULTS Forty-six studies were eligible for the systematic review. Limited to studies on children and adolescents, the meta-analysis included 20 studies with 33 873 patients. Intervention versus comparator analysis showed that nonpharmacological interventions were associated with reduced need for sedation and general anesthesia in the randomized control trials (risk ratio, 0.68; 95% confidence interval, 0.48-0.95; l2 = 35%) and nonrandomized studies (risk ratio, 0.58; 95% confidence interval, 0.51-0.66; l2 = 91%). The effect was largest among children aged 3 to 10 years when compared with older children and adolescents aged 11 to 18 years. LIMITATIONS There was substantial heterogeneity among nonrandomized studies. CONCLUSIONS Nonpharmacological interventions must be considered as standard procedure in infants, children, and adolescents undergoing MRI.
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Affiliation(s)
| | | | | | | | - Jette L Sørensen
- Juliane Marie Centre and Mary Elizabeth's Hospital
- Department of Clinical Medicine, Faculty of Health and Medicine Sciences
| | | | | | | | | | - Lise Aunsholt
- Neonatology
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke A Larsen
- Radiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Line K Gjærde
- Juliane Marie Centre and Mary Elizabeth's Hospital
- Pediatrics and Adolescent Medicine, Neuropaediatric Unit
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2
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Madsen TW, Sørensen MK, Cromhout PF, Sølling C, Berntsen M, Møller K, Berg SK. Temperature change in children undergoing magnetic resonance imaging-An observational cohort study. Paediatr Anaesth 2022; 32:870-879. [PMID: 35366370 PMCID: PMC9323460 DOI: 10.1111/pan.14450] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
AIM An increasing number of children undergo magnetic resonance imaging requiring anesthesia or sedation to ensure their immobility; however, magnetic resonance imaging may increase body temperature whereas sedation or anesthesia may decrease it. We investigated changes in body temperature in children who underwent sedation or anesthesia for magnetic resonance imaging. METHODS Children aged 12 weeks-12 years undergoing anesthesia and magnetic resonance imaging were included in this prospective observational study. Tympanic body temperature was measured before and after magnetic resonance imaging, and the difference between measurements was calculated. Associations between the temperature difference and patient- or procedure-related factors were evaluated with linear and logistic regression analysis. RESULTS A total of 74 children were included, of whom 5 (7%) had a temperature increase ≥0.5°C. Mean temperature difference was -0.24°C (SD 0.48) for the entire group and -0.28°C for the youngest children (0-2 years). The temperature difference correlated positively with the duration of imaging (unadjusted coefficient 0.26, 95% confidence interval (CI), (0.01; 0.52)). CONCLUSION In this study of sedated or anesthetized children undergoing magnetic resonance imaging, clinically relevant increases in body temperature above 0.5°C were only found in a few patients. However, longer imaging duration tended to be associated with increased body temperature.
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Affiliation(s)
- Thurid Waagstein Madsen
- Department of Neuroanaesthesiology, RigshospitaletCopenhagen University Hospital, Copenhagen UniversityCopenhagenDenmark,Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Martin Kryspin Sørensen
- Department of Neuroanaesthesiology, RigshospitaletCopenhagen University Hospital, Copenhagen UniversityCopenhagenDenmark
| | - Pernille Fevejle Cromhout
- Department of Cardiothoracic Anesthesiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Christine Sølling
- Department of Neuroanaesthesiology, RigshospitaletCopenhagen University Hospital, Copenhagen UniversityCopenhagenDenmark
| | - Marianne Berntsen
- Department of Neuroanaesthesiology, RigshospitaletCopenhagen University Hospital, Copenhagen UniversityCopenhagenDenmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology, RigshospitaletCopenhagen University Hospital, Copenhagen UniversityCopenhagenDenmark,Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Selina Kikkenborg Berg
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Department of Cardiology, RigshospitaletCopenhagen University Hospital, Copenhagen UniversityCopenhagenDenmark
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3
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Berntsen M, Bøgevig S, Høgberg LCG, Barnung SK. [Iatrogenic botulism in therapeutic use of botulinum toxin]. Ugeskr Laeger 2022; 184:V07210574. [PMID: 35179113] [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: 06/14/2023]
Abstract
The review summarises the current knowledge of the treatment of iatrogenic botulinum toxin overdose. The symptoms may be diffuse, and suspicion should be raised based on time of symptom appearance relative to the time of exposure. Iatrogenic botulism may appear if the maximum recommended total dose of botulinum toxin has been exceeded and if the drug is spread locally from the site of injection or is redistributed to the systemic circulation. The adverse drug reactions frequency is possibly underreported. Fast initiation of the available antidote may be needed. The guideline provided on treatment of iatrogenic botulism is developed from non-iatrogenic botulism.
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Affiliation(s)
- Marianne Berntsen
- Afdelingen for Intensiv Behandling af Nerve- og Hjernesygdomme, Københavns Universitetshospital - Rigshospitalet
| | - Søren Bøgevig
- Klinisk Farmakologisk Afdeling, Københavns Universitetshospital - Bispebjerg Hospital
| | | | - Steen Krøyer Barnung
- Afdelingen for Bedøvelse, Operation og Traumecenter, HovedOrtoCentret, Københavns Universitetshospital - Rigshospitalet
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4
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Søberg S, Löfgren J, Philipsen FE, Jensen M, Hansen AE, Ahrens E, Nystrup KB, Nielsen RD, Sølling C, Wedell-Neergaard AS, Berntsen M, Loft A, Kjær A, Gerhart-Hines Z, Johannesen HH, Pedersen BK, Karstoft K, Scheele C. Altered brown fat thermoregulation and enhanced cold-induced thermogenesis in young, healthy, winter-swimming men. Cell Rep Med 2021; 2:100408. [PMID: 34755128 PMCID: PMC8561167 DOI: 10.1016/j.xcrm.2021.100408] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 07/13/2021] [Accepted: 09/17/2021] [Indexed: 12/18/2022]
Abstract
The Scandinavian winter-swimming culture combines brief dips in cold water with hot sauna sessions, with conceivable effects on body temperature. We study thermogenic brown adipose tissue (BAT) in experienced winter-swimming men performing this activity 2–3 times per week. Our data suggest a lower thermal comfort state in the winter swimmers compared with controls, with a lower core temperature and absence of BAT activity. In response to cold, we observe greater increases in cold-induced thermogenesis and supraclavicular skin temperature in the winter swimmers, whereas BAT glucose uptake and muscle activity increase similarly to those of the controls. All subjects demonstrate nocturnal reduction in supraclavicular skin temperature, whereas a distinct peak occurs at 4:30–5:30 a.m. in the winter swimmers. Our data leverage understanding of BAT in adult human thermoregulation, suggest both heat and cold acclimation in winter swimmers, and propose winter swimming as a potential strategy for increasing energy expenditure. Winter swimmers have a lower core temperature at a thermal comfort state than controls Winter swimmers had no BAT glucose uptake at a thermal comfort state Winter swimmers have higher cold-induced thermogenesis than control subjects Human supraclavicular skin temperature varies with a diurnal rhythm
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Affiliation(s)
- Susanna Søberg
- The Center of Inflammation and Metabolism and the Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark
| | - Frederik E Philipsen
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark
| | - Michal Jensen
- The Center of Inflammation and Metabolism and the Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Adam E Hansen
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark
| | - Esben Ahrens
- Department of Neurophysiology, Rigshospitalet, Copenhagen 2100, Denmark
| | - Kristin B Nystrup
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen 2100, Denmark
| | - Rune D Nielsen
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen 2100, Denmark
| | - Christine Sølling
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen 2100, Denmark
| | - Anne-Sophie Wedell-Neergaard
- The Center of Inflammation and Metabolism and the Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Marianne Berntsen
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen 2100, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark
| | - Zachary Gerhart-Hines
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Helle H Johannesen
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark
| | - Bente K Pedersen
- The Center of Inflammation and Metabolism and the Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Kristian Karstoft
- The Center of Inflammation and Metabolism and the Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.,Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen 2400, Denmark
| | - Camilla Scheele
- The Center of Inflammation and Metabolism and the Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
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5
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Hybschmann J, Povlsen NE, Sørensen JL, Afshari A, Borgwardt L, Berntsen M, Madsen TW, Gjærde LK. Nonpharmacological interventions to reduce sedation/general anaesthesia in paediatric patients undergoing magnetic resonance imaging: A systematic review and meta-analysis protocol. Acta Anaesthesiol Scand 2021; 65:1254-1258. [PMID: 33991103 DOI: 10.1111/aas.13851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Magnetic resonance imaging is frequently used in paediatrics and requires the child/adolescent to remain still for 45 min or more. The long and narrow scanner gantry makes loud noises and may cause anxiety. To complete the procedure, children and adolescents are often sedated or receive general anaesthesia. Our primary aim is to determine whether nonpharmacological interventions designed to mentally prepare, support or distract children, and adolescents are effective in reducing the need for sedation and general anaesthesia. METHODS We will conduct a systematic review with meta-analysis by searching the following electronic databases: Ovid MEDLINE, CINAHL, Embase and CENTRAL, as well as databases for ongoing trials. Eligibility criteria are based on the participants, intervention, comparator and outcome (PICO) framework. We will include intervention studies with comparator group(s) with no restriction on date. Two reviewers will independently screen titles/abstracts, and three reviewers will assess the full texts of potentially relevant studies. Data will be extracted, and the methodological quality will be assessed using Cochrane risk of bias tools. If the data allow, we will perform a meta-analysis using a random effects model on the primary outcome, sedation/general anaesthesia. A narrative synthesis will supplement the statistical analysis. Quality of evidence for the primary outcome will be assessed using the grading of recommendations, assessment, development and evaluations (GRADE) approach. DISCUSSION Our findings will provide directions for future research and may guide clinicians in terms of which type(s) of intervention(s) to implement to reduce the use of sedation/general anaesthesia during paediatric magnetic resonance imaging.
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Affiliation(s)
- Jane Hybschmann
- Children's Hospital Copenhagen and Juliane Marie Centre Copenhagen University HospitalRigshospitalet Copenhagen Denmark
| | - Nanna E. Povlsen
- Faculty of Health and Medicine Sciences University of Copenhagen Copenhagen Denmark
| | - Jette L. Sørensen
- Juliane Marie Centre Copenhagen University Hospital Rigshospitalet and Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Arash Afshari
- Department of Paediatric and Obstetric Anaesthesia Copenhagen University HospitalRigshospitalet Copenhagen Denmark
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET Copenhagen University HospitalRigshospitalet Copenhagen Denmark
| | - Marianne Berntsen
- Department of Neuroanaesthesiology Neuroscience Centre Copenhagen University HospitalRigshospitalet Copenhagen Denmark
| | - Thurid W. Madsen
- Department of Neuroanaesthesiology Neuroscience Centre Copenhagen University HospitalRigshospitalet Copenhagen Denmark
| | - Line K. Gjærde
- Children's Hospital Copenhagen and Juliane Marie Centre Copenhagen University HospitalRigshospitalet Copenhagen Denmark
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6
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Nersesjan V, Amiri M, Lebech AM, Roed C, Mens H, Russell L, Fonsmark L, Berntsen M, Sigurdsson ST, Carlsen J, Langkilde AR, Martens P, Lund EL, Hansen K, Jespersen B, Folke MN, Meden P, Hejl AM, Wamberg C, Benros ME, Kondziella D. Central and peripheral nervous system complications of COVID-19: a prospective tertiary center cohort with 3-month follow-up. J Neurol 2021; 268:3086-3104. [PMID: 33438076 PMCID: PMC7803470 DOI: 10.1007/s00415-020-10380-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To systematically describe central (CNS) and peripheral (PNS) nervous system complications in hospitalized COVID-19 patients. METHODS We conducted a prospective, consecutive, observational study of adult patients from a tertiary referral center with confirmed COVID-19. All patients were screened daily for neurological and neuropsychiatric symptoms during admission and discharge. Three-month follow-up data were collected using electronic health records. We classified complications as caused by SARS-CoV-2 neurotropism, immune-mediated or critical illness-related. RESULTS From April to September 2020, we enrolled 61 consecutively admitted COVID-19 patients, 35 (57%) of whom required intensive care (ICU) management for respiratory failure. Forty-one CNS/PNS complications were identified in 28 of 61 (45.9%) patients and were more frequent in ICU compared to non-ICU patients. The most common CNS complication was encephalopathy (n = 19, 31.1%), which was severe in 13 patients (GCS ≤ 12), including 8 with akinetic mutism. Length of ICU admission was independently associated with encephalopathy (OR = 1.22). Other CNS complications included ischemic stroke, a biopsy-proven acute necrotizing encephalitis, and transverse myelitis. The most common PNS complication was critical illness polyneuromyopathy (13.1%), with prolonged ICU stay as independent predictor (OR = 1.14). Treatment-related PNS complications included meralgia paresthetica. Of 41 complications in total, 3 were para/post-infectious, 34 were secondary to critical illness or other causes, and 4 remained unresolved. Cerebrospinal fluid was negative for SARS-CoV-2 RNA in all 5 patients investigated. CONCLUSION CNS and PNS complications were common in hospitalized COVID-19 patients, particularly in the ICU, and often attributable to critical illness. When COVID-19 was the primary cause for neurological disease, no signs of viral neurotropism were detected, but laboratory changes suggested autoimmune-mediated mechanisms.
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Affiliation(s)
- Vardan Nersesjan
- Departments of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Moshgan Amiri
- Departments of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Casper Roed
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helene Mens
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene Russell
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lise Fonsmark
- Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Berntsen
- Department of Neuroanesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sigurdur Thor Sigurdsson
- Department of Neuroanesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jonathan Carlsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Pernille Martens
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Løbner Lund
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Klaus Hansen
- Departments of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bo Jespersen
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marie Norsker Folke
- Department of Neurology, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Meden
- Department of Neurology, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Mette Hejl
- Department of Neurology, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Wamberg
- Department of Anesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael E Benros
- Copenhagen Research Centre for Mental Health, CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Daniel Kondziella
- Departments of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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7
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Engberg M, Bonde J, Sigurdsson ST, Møller K, Nayahangan LJ, Berntsen M, Eschen CT, Haase N, Bache S, Konge L, Russell L. Training non-intensivist doctors to work with COVID-19 patients in intensive care units. Acta Anaesthesiol Scand 2021; 65:664-673. [PMID: 33529356 PMCID: PMC8013477 DOI: 10.1111/aas.13789] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/22/2022]
Abstract
Background Due to an expected surge of COVID‐19 patients in need of mechanical ventilation, the intensive care capacity was doubled at Rigshospitalet, Copenhagen, in March 2020. This resulted in an urgent need for doctors with competence in working with critically ill COVID‐19 patients. A training course and a theoretical test for non‐intensivist doctors were developed. The aims of this study were to gather validity evidence for the theoretical test and explore the effects of the course. Methods The 1‐day course was comprised of theoretical sessions and hands‐on training in ventilator use, hemodynamic monitoring, vascular access, and use of personal protective equipment. Validity evidence was gathered for the test by comparing answers from novices and experts in intensive care. Doctors who participated in the course completed the test before (pretest), after (posttest), and again within 8 weeks following the course (retention test). Results Fifty‐four non‐intensivist doctors from 15 different specialties with a wide range in clinical experience level completed the course. The test consisted of 23 questions and demonstrated a credible pass–fail standard at 16 points. Mean pretest score was 11.9 (SD 3.0), mean posttest score 20.6 (1.8), and mean retention test score 17.4 (2.2). All doctors passed the posttest. Conclusion Non‐intensivist doctors, irrespective of experience level, can acquire relevant knowledge for working in the ICU through a focused 1‐day evidence‐based course. This knowledge was largely retained as shown by a multiple‐choice test supported by validity evidence. The test is available in appendix and online.
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Affiliation(s)
- Morten Engberg
- Copenhagen Academy for Medical Education and Simulation Centre for Human Resources and Education Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
| | - Jan Bonde
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
| | - Sigurdur T. Sigurdsson
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
- Department of Neuroanaesthesiology Neuroscience Centre, Rigshospitalet Copenhagen Denmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology Neuroscience Centre, Rigshospitalet Copenhagen Denmark
| | - Leizl J. Nayahangan
- Copenhagen Academy for Medical Education and Simulation Centre for Human Resources and Education Copenhagen Denmark
| | - Marianne Berntsen
- Department of Neuroanaesthesiology Neuroscience Centre, Rigshospitalet Copenhagen Denmark
| | - Camilla T. Eschen
- Department of Cardiothoracic Anaesthesiology University of Copenhagen Copenhagen Denmark
| | - Nicolai Haase
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
| | - Søren Bache
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation Centre for Human Resources and Education Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
| | - Lene Russell
- Copenhagen Academy for Medical Education and Simulation Centre for Human Resources and Education Copenhagen Denmark
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
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Berntsen M, Johannsen ML, Muhamad A. Displaced gag diagnosed on MRI. Intensive Care Med 2019; 45:700-701. [PMID: 30159698 PMCID: PMC6483955 DOI: 10.1007/s00134-018-5352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Marianne Berntsen
- Department of Neuroanaesthesiology, Neuroscience Centre, University of Copenhagen, Rigshospitalet, Denmark
| | - Malene Laegdsgaard Johannsen
- Department of Neuroanaesthesiology, Centre of Head and Orthopedics, University of Copenhagen, Rigshospitalet, Denmark
| | - Ali Muhamad
- Department of Radiology, University of Copenhagen, Rigshospitalet, Denmark
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Wikkelsø A, Edwards H, Afshari A, Stensballe J, Langhoff-Roos J, Albrechtsen C, Ekelund K, Hanke G, Secher E, Sharif H, Pedersen L, Troelstrup A, Lauenborg J, Mitchell A, Fuhrmann L, Svare J, Madsen M, Bødker B, Møller A, Wikkelsø A, Edwards H, Afshari A, Stensballe J, Langhoff-Roos J, Møller AM, Albrechtsen C, Ekelund K, Hanke G, Sharif HF, Secher EL, Christensen M, Ramsing BU, Jensen-Gadegaard P, Engskov A, Wulff C, Berntsen M, Andersen KJ, Classen V, Opstrup P, Lundstrøm LH, Flindt MS, Lunde J, Pedersen LM, Troelstrup A, Lauenborg J, Lassen B, Andersson M, Winther-Olsen M, Hougaard S, Andersen C, Petersen M, Mitchell A, Fuhrmann L, Svare J, Nielsen CV, Lefort Sønderskov M, Winkel R, Johansen M, Søgaard M, Madsen MG, Bødker B, Okkels C, Berthelsen R, Elisabeth Linnet K, Stendall L, Darfeld I, Madsen M, Pedersen L. Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial †. Br J Anaesth 2015; 114:623-33. [DOI: 10.1093/bja/aeu444] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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10
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Berntsen M, Bork K, Sørensen CH. [Hyoid bone tumour]. Ugeskr Laeger 2012; 174:2085. [PMID: 22944330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Berntsen M, Fode M, Mikines KJ, Sønksen J. [Recurrence of varicocele caused by renal tumour]. Ugeskr Laeger 2009; 171:3429-3430. [PMID: 19925728] [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: 05/28/2023]
Abstract
A 31-year-old man referred with six to seven years' history of a left-side WHO grade III varicocele and normal palpatory abdominal findings underwent microsurgical subinguinal varicocelectomy. At 3-month follow-up there was complete remission. The varicocele recurred after one year and abdominal ultrasound demonstrated a solid mass in the left kidney. A radical nephrectomy was performed and histology demonstrated renal cell carcinoma pT2. We recommend performing an abdominal ultrasound in adults if recurrence of a varicocele is detected following microsurgical subinguinal varicocelectomy.
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Abstract
Work on deck on eight oil product tankers was examined. The purpose was to evaluate the need for improvement of the working environment to reduce the risk of occupational cancer. Benzene, polyaromatic hydrocarbons (PAHs) and organic lead compounds were sampled, and the crew answered a questionnaire on acute health effects. By area monitoring, benzene was generally found to be in the range from the detection limit, of 0.01 ppm, up to 1.15 ppm, but one tanker which loaded gasoline with the hatches open had levels up to 55 ppm. Personal monitoring showed exposure levels in the range 0.01-1.15 ppm. The PAH-levels and the levels of organic lead were low. No seamen were observed using respiratory protective equipment. Central nervous system symptoms were reported by the crew with the highest exposures to benzene although benzene may not be the only cause. The exposure to benzene and other hydrocarbons on the deck of oil product tankers ought to be reduced.
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Affiliation(s)
- B E Moen
- Institute of Occupational Medicine, University of Bergen, Haukeland Hospital, Norway
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13
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Abstract
Occupational exposure to carcinogenic agents on the decks on six Norwegian crude oil tankers was examined in five harbors. The purpose of the study was to evaluate the need for improving the working environment on deck on these tankers. Technical arrangements and the work itself on the deck were observed during loading or unloading. Occupational monitoring was performed by active sampling of benzene, polyaromatic hydrocarbons, and some aldehydes. The crew answered a questionnaire concerning their work, use of protective equipment, and occurrence of acute symptoms. The levels of air-borne carcinogenic agents were low, probably due to closed loading systems on all tankers. However, the seamen reported discomfort during the work that may be related to other chemical agents in the cargo. The seamen were frequently painting with lead chromate paint without using personal protective equipment. This type of chemical exposure should be evaluated.
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Affiliation(s)
- B E Moen
- Institute of Occupational Medicine, University of Bergen, Norway
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