Laparoscopic-Assisted and Open High Anterior Resection within an ERAS Protocol

Background  

Due to potentially superior short-term outcomes compared with open colorectal surgery, laparoscopic surgery is currently being implemented in clinical practice worldwide. In parallel, enhanced recovery after surgery (ERAS) programs are shown to improve postoperative recovery in open colorectal surgery. This study reports outcomes in laparoscopic versus open surgery in conjunction with compliance to the ERAS protocol.     

Nutritional problems, overhydration and the association with quality of life in elderly dialysis patients

Purpose

The aim of this pilot study was to describe the hydration and nutritional status of a cohort of elderly dialysis patients and to explore the association between these parameters and the quality of life (QoL).

Methods

All patients over 75?years of age being in chronic dialysis by January 2008 at 3 dialysis units (n?=?34) were asked to participate in this pilot study, 24 patients were entered. Hydration status was assessed by bioimpedance spectroscopy (BIS) and nutritional status by the subjective global assessment (SGA), BIS, anthropometric measures and biochemical parameters. Based on these assessments the patients were classified as being cachectic or not according to newly defined criteria. QoL was measured using the SF-36.

Results

The results showed cachexia in 6 (25?%), 37.5?% had a body mass index below 24, whereas according to SGA 91?% were malnourished. BIS showed low lean tissue index in 46?% and overhydration in 35?% of the patients. Compared to non-cachectic and normohydrated, cachectic and overhydrated patients reported consistently poorer QoL. For cachectic patients, the differences were clinically significant for all SF-36. BIS was easily applicable when used before dialysis.

Conclusions

The high frequency of nutritional deficits in this study calls for more attention to nutritional status in elderly dialysis patients. There is a need for a general agreement on how nutritional status should be assessed and reported, both in clinics and in research.     

The structure of peritraumatic dissociation: A cross validation in clinical and nonclinical samples

Empirical data have challenged the unidimensionality of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), a widely used measure for peritraumatic dissociation. The aim of this study was to assess the factor structure of the PDEQ in 3 trauma‐exposed samples: (a) trauma‐exposed police officers (N = 219); (b) trauma‐exposed civilians (N = 158); and (c) treatment‐seeking trauma‐exposed civilians (N = 185). Confirmatory factor analyses using measurement invariance testing supported a 2‐factor structure (CFIs .96–.98; RMSEAs .07–.09), but excluded 2 of the original items. Factor 1 was termed Altered Awareness; Factor 2 was termed Derealization. Altered Awareness reflected disturbances in information processing during the traumatic event, whereas Derealization reflected distortions in perception. Hierarchical linear regression analysis showed that Derealization predicted posttraumatic stress severity at 26.5 weeks follow‐up only in the sample of police officers (R² = .45). Future longitudinal research shortly following trauma is required to elucidate causality and underlying mechanisms of peritraumatic dissociation, which may contribute to the development of more accurate screening strategies, as well as more effective strategies for prevention and early intervention.     

How do patients with exacerbated chronic obstructive pulmonary disease experience care in the intensive care unit?

The aim was to gain insight into how patients with advanced chronic obstructive pulmonary disease (COPD) experience care in the acute phase. The study has a qualitative design with a phenomenological approach. The empirics consist of qualitative in‐depth interviews with ten patients admitted to the intensive care units in two Norwegian hospitals. The interviews were carried out from November 2009 to June 2011. The data have been analysed through meaning condensation, in accordance with Amadeo Giorgi's four‐step method. Kari Martinsen's phenomenological philosophy of nursing has inspired the study. An essential structure of the patients' experiences of care in the intensive care unit by acute COPD‐exacerbation may be described as: Feelings of being trapped in a life‐threatening situation in which the care system assumes control over their lives. This experience is conditioned not only by the medical treatment, but also by the entire interaction with the caregivers. The essence of the phenomenon is presented through three themes which describe the patient's lived experience: preserving the breath of life, vulnerable interactions and opportunities for better health. Acute COPD‐exacerbation is a traumatic experience and the patients become particularly vulnerable when they depend on others for breathing support. The phenomenological analysis shows that the patients experience good care during breath of life preservation when the care is performed in a way that gives patients more insight into their illness and gives new opportunities for the future.     

Combined Heart Rate– and Accelerometer-Assessed Physical Activity Energy Expenditure and Associations With Glucose Homeostasis Markers in a Population at High Risk of Developing Diabetes: The ADDITION-PRO study

OBJECTIVE

Regular physical activity (PA) reduces the risk of developing type 2 diabetes, and different subtypes of dysglycemia have shown different associations with PA. To better understand the associations of PA and glucose homeostasis, we examined the association of objectively measured PA energy expenditure (PAEE) with detailed measures of glucose homeostasis.

RESEARCH DESIGN AND METHODS

In 1,531 men and women, with low to high risk of developing type 2 diabetes, we measured 7 days of PAEE using a combined accelerometry and heart rate monitor (ActiHeart). Measures and indices of glucose homeostasis were derived from a 3-point oral glucose tolerance test in addition to measures of long-term glycemia (glycated hemoglobin A_1c and advanced glycation end products). Associations of PAEE with glucose homeostasis markers were examined using linear regression models.

RESULTS

Median age (IQR) was 66.6 years (62.1–71.6) (54% men) with a median ActiHeart wear time of 6.9 days (6.0–7.1) and PAEE level of 33.0 kJ/kg/day (23.5–46.1). In fully adjusted models, we found higher levels of PAEE to be positively associated with insulin sensitivity and negatively with insulin 2 h after glucose load (P < 0.05).

CONCLUSIONS

Even in an elderly population with low levels of PA, we found higher objectively measured PAEE levels to be associated with a more beneficial glucose metabolic profile. Although our findings are cross-sectional, they indicate that even without high-intensity exercise, increasing the overall level of PAEE slightly in an entire population at risk for developing type 2 diabetes may be a realistic and worthwhile goal to reach in order to achieve beneficial effect in terms of glucose metabolism.Regular physical activity (PA) reduces the risk of developing type 2 diabetes by 15–60%. In cross-sectional and prospective studies, PA of light intensity as well as moderate to vigorous intensity have been related to a better glucose homeostasis (1–3), whereas other studies have found overall PA to be the main determinant of insulin sensitivity (1,4). Although some of the current evidence linking PA with glucose homeostasis has been established in large studies with prospective designs (2,5), epidemiological studies have traditionally used PA measures obtained by self-report methods, which are subject to bias. Even though heart rate monitors and accelerometers have increased in popularity as PA measurement methods (6), both have disadvantages in the assessment of PA (7). In contrast, PA monitors combining heart rate monitoring and accelerometry have shown to give more precise estimates of PA than the subjective methods and the separately measured accelerometry and heart rate (8). Even though the use of the combined PA monitors is increasing, no studies have yet studied the association between habitual PA as measured with these monitors and detailed glucose homeostasis measures in larger population-based studies. Previous epidemiological studies have investigated the association of PA measures with glucose homeostasis based on fasting and 2-h samples of glucose and insulin (1,2,4,9). The use of more detailed indices of insulin resistance and β-cell function, based on a 3-point rather than a 2-point oral glucose tolerance test (OGTT), may lead to deeper insight into the pathophysiological derangements that precede and lead to diabetes (10). Since subtypes of dysglycemia may show different associations with PA (5), including specific indices of peripheral insulin sensitivity, hepatic insulin resistance, β-cell function, and the absolute insulin response to a glucose load may provide a more detailed picture of the association of PA and glucose homeostasis. Furthermore, glycated hemoglobin A_1c (HbA_1c), which reflects the average glucose level over a longer period of time, has been suggested to be modifiable by exercise of moderate to vigorous intensity (11). Another measure of the even longer-term load of protein glycation is the skin accumulation of advanced glycation end products (AGE_skin), which is in part affected by hyperglycemia (12). AGE_skin has, in type 2 diabetes patients, been postulated to be associated with HbA_1c in cross-sectional studies and with cardiovascular disease and cardiovascular mortality in prospective studies (13,14). It is not known whether PA affects levels of AGE_skin, or whether associations of PA with HbA_1c and AGE_skin point in the same direction.The current study tests the hypothesis that higher PA levels, as measured by a combined accelerometer and heart rate monitor, are associated with a better glucose metabolic profile. In order to better understand the pathophysiological pathways linking PA and glucose homeostasis, we described the PA levels in a population at high risk of developing diabetes and examined the association of accelerometer- and heart rate–assessed PA energy expenditure (PAEE) during everyday life with various glucose homeostasis markers and long-term glycemia in a cross-sectional design. Furthermore, we studied the course of glucose and insulin during a 3-point OGTT by different levels of PAEE.     

Clinical significance of specific spinal mobilization for patients with ankylosing spondylitis evaluated by quantitative assessments and patient interviews

Purpose.?To assess individual responses to specific spinal mobilization (SSM) in terms of spinal mobility, perceived stiffness, pain and activities of daily living (ADL) in patients with Ankylosis Spondylitis (AS), and whether and how interviews supported or supplemented the quantitative results.

Methods.?Spinal mobility was recorded by the fingertip-to-floor distance, the Modified Schober Test, myerinometer, and the chest expansion test. The measures corresponding to sites targeted by SSM was used as effect variables, and the other as control variables. Visual analogue scales assessed pain and stiffness. The Bath Ankylosing Spondylitis Functional Index assessed ADL. A single subject experimental design was applied. The patients' experiences were investigated by semi-structured qualitative interviews.

Results.?Six patients completed 12 sessions of SSM. In five patients spinal mobility improved by 6-38%, and perceived stiffness reduced by 6 – 82%. Further improvements were found after three months. Improvements were not seen in the control variables. The interviews revealed that to become less stiff had various meanings for the patients, the SSM helped to get control of motion, and the conversations with the therapists enabled them to cope with the situation.

Conclusions.?The findings suggest that SSM can diminish spinal stiffness, but this had different meanings for the patients. What were important were what they experienced and learnt during the therapy process.     

Relationships between neuromuscular functioning,disability and pain in fibromyalgia

Purpose.?Fibromyalgia (FM) is associated with pain and alterations in neuromuscular properties and function. A common belief is that these neuromuscular changes are a major cause of limitations in activities or restrictions in participation. The paper aims at examining the basis for such an understanding. Another aim is to investigate how pain is modified or is a modifier of neuromuscular properties and functions.

Method.?Based on a simplified model to analyze the relationship between pain, neuromuscular properties and function, and activities/participation.

Results.?It is argued that the changes in neuromuscular properties and functions seen in FM may simply be an adaptation to lowered physical activity level, rather than being a primary feature of the FM. Furthermore, it is shown that chronic pain and acute contraction-induced pain relates differently to functioning.

Conclusion.?The analyses indicates that in clinical work and research it is important to distinguish between chronic pain and pain induced by physical activity. Furthermore, the deviations reported for FM in muscular properties and functions such as endurance and strength, are probably not reflecting pathology. Hence, physical activity and improvement of muscular functions are hardly sufficient as treatment of FM.     

Safety of gadodiamide injection in two different age groups

A meta-analyses was performed to evaluate the safety of gadodiamide injection (OMNISCAN®) for magnetic resonance imaging in two different age groups (< 65 years; ≥ 65 years). Data on vital signs, clinical laboratory parameters, and subjectively experienced adverse events were reviewed for 734 patients included in 19 European Phase II and III trials with gadodiamide injection (0.1 mmol/kg body weight or 0.3 mmol/kg body weight) used in magnetic resonance imaging. One hundred sixty-four patients were 65 years of age or older. No statistically significant differences were shown between this population and the population younger than 65 years of age with respect to vital signs or clinical laboratory parameters. A total of 48 adverse events, discomfort excluded, were reported, with no significant difference in frequency between the two age groups. Injection-associated discomfort was significantly (P=.0025) more frequent in the younger (9.2%) than in the older group (2.5%). Gadodiamide injection is in conclusion a safe contrast medium in older as well as in younger patients.     

Whole blood gene expression in infants with respiratory syncytial virus bronchiolitis

Background  

Respiratory syncytial virus (RSV) is a major cause of viral bronchiolitis in infants worldwide, and environmental, viral and host factors are all of importance for disease susceptibility and severity. To study the systemic host response to this disease we used the microarray technology to measure mRNA gene expression levels in whole blood of five male infants hospitalised with acute RSV, subtype B, bronchiolitis versus five one year old male controls exposed to RSV during infancy without bronchiolitis. The gene expression levels were further evaluated in a new experiment using quantitative real-time polymerase chain reaction (QRT-PCR) both in the five infants selected for microarray and in 13 other infants hospitalised with the same disease.