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Biomedical subjects

A M Møller

Publications and source records attributed to A M Møller.

At least 19 recordsLinked to original sources
PubMed2003

A study of the impact of long-term tobacco smoking on postoperative intensive care admission.

Smoking is a risk factor for intra-operative pulmonary complications and a wide range of postoperative pulmonary, cardiovascular, infection and wound-related complications. These may all lead to unplanned postoperative intensive care admission. We tested the hypothesis that smokers have an increased incidence of postoperative intensive care admission and more postoperative complications than nonsmokers in a general and orthopaedic surgical population. The following information was assessed in 6026 surgical patients: age, sex and smoking status (pack-years), history of heart and lung disease, American Society of Anesthesiologists (ASA) physical classification, intensive care admission and postoperative complications. Two thousand five hundred and twenty-six (46%) were smokers but for 620 patients (10.3%) smoking status was not confirmed. Postoperative intensive care admission was required by 319 patients (5.3%). Patients with > 50 pack-years were admitted to the intensive care more frequently than were smokers with < or = 50 pack-years history and nonsmokers (p < 0.001). Ex-smokers with > 50 pack-years history had the same risk of postoperative admission to intensive care as smokers with > 50 pack-years history. Smokers admitted to intensive care with > 50 pack-years history had a higher incidence of chronic lung disease (p < 0.005) and heavy alcohol consumption (p < 0.001). These smokers also had a higher incidence of postoperative pulmonary complications (odds ratio = 3.91, p < 0.01). The mortality rate was 37% in smokers with > 50 pack-years history and 24% in nonsmokers (odds ratio = 2.02, p = 0.08). We conclude long-term tobacco smoking (> 50 pack-years) carries a higher risk of postoperative admission to intensive care, and there seems to be a dose relationship between the amount of tobacco consumed and the risk of postoperative intensive care admission.

Adult↗
PubMed2002

Perioperative risk factors in elective pneumonectomy: the impact of excess fluid balance.

BACKGROUND AND OBJECTIVE: This study was performed to identify risk factors for complications and in-hospital mortality associated with pneumonectomy. METHODS: The influence of fluid balance during anaesthesia was evaluated, taking into account the patient's age, gender and body mass index, smoking habits, history of pulmonary or cardiac disorders, the site of pneumonectomy and duration of anaesthesia. One-hundred-and-seven patients undergoing elective pneumonectomy were included in the study. RESULTS: A total of 31 patients (29%) suffered from one or more postoperative complications, seven (22.4%) of these had severe dysrhythmias, six (19.6%) had pulmonary complications and three (9.3%) had cardiovascular complications. The overall mortality rate was 10.3%. CONCLUSIONS: Based on logistic regression analysis, our data indicate the following risk factors for postoperative complications: positive fluid balance exceeding 4000 mL during anaesthesia (pulmonary complications and mortality), body mass index < 17 or > 25 kg m(-2) (severe dysrhythmias), or history of chronic heart disease (pulmonary complications). Thirteen patients (12.4%) suffered from a fluid balance > 4000 mL during anaesthesia. Regression analysis indicated that fluid balance exceeding 4000 mL was associated with a higher risk of postoperative complications than blood loss exceeding 1000 mL and to be the strongest risk factor for postoperative pulmonary complications and in-hospital mortality. Further trials estimating the effect of restrictive fluid regimens and the use of vasopressors for blood pressure control during anaesthesia must be carried out.

Adult↗
PubMed2001

[Premedication in ambulatory surgery].

UNLABELLED: A substantive amendment to this systematic review was last made on 3 January 2000. Cochrane reviews are regularly checked and updated if necessary. OBJECTIVES: To assess the effect of anxiolytic remedication on time to discharge in adult patients undergoing day case surgery under general anaesthesia. SEARCH STRATEGY: Trials were identified by computerised searches of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, by checking the reference lists of trials and review articles, by handsearching three main anaesthesia journals and by contacting five researchers active in the field and the Product Information departments of the manufactures of five commonly used premedicants. SELECTION CRITERIA: All randomised controlled trials comparing an anxiolytic drug(s) with placebo before general anaesthesia in adult day case surgical patients. DATA COLLECTION & ANALYSIS: We collected data on anaesthetic drugs used, results of tests of psychomotor function where these were used to assess residual effect of premedication, and on times from end of anaesthesia to ability to walk unaided or readiness for discharge from hospital. Formal statistical synthesis of individual trials was not performed in view of the variety of drugs studied. MAIN RESULTS: Searching identified twenty-nine reports; fourteen studies, with data from a total of 1263 patients, were considered eligible for analysis. Only two studies specifically addressed the discharge question; both found no delay in premedicated patients. Three other studies used clinical criteria to assess fitness for discharge, though times were not given. Again, there was no difference from placebo. Four studies used both clinical measures and tests of psychomotor function as tests of recovery from anaesthesia. In none of these studies did the premedication appear to delay discharge, although performance on tests of psychomotor function was sometimes still impaired. Of the four studies which used tests of psychomotor function to assess recovery, three showed impaired recovery (after midazolam 7.5 mg, midazolam 15 mg or diazepam 15 mg) which might possibly interfere with discharge from hospital. REVIEWERS' CONCLUSIONS: We have found no evidence of a difference in time to discharge from hospital in patients who received anxiolytic premedication. However, in view of the age and variety of anaesthetic techniques used, inferences for current day-case practice should be made with caution.

Ambulatory Surgical Procedures↗
PubMed2001

Pulse oximetry for perioperative monitoring.

BACKGROUND: Monitoring with pulse oximetry might improve patient outcome by enabling an early diagnosis and consequently, correction of perioperative events that might cause postoperative complications or even death. Only a few randomised clinical trials of pulse oximetry have been performed during anaesthesia and in the recovery room which describe perioperative hypoxaemic events, postoperative cardiopulmonary complications and cognitive dysfunction. OBJECTIVES: To study the effect of perioperative monitoring with pulse oximetry to clearly identify the adverse outcomes that might be prevented or improved by the use of pulse oximetry. SEARCH STRATEGY: Trials were identified by computerised searches of the Cochrane Library, MEDLINE, EMBASE, and by checking the reference lists of trials and review articles. SELECTION CRITERIA: All controlled trials that randomised patients to either pulse oximetry or no pulse oximetry during the perioperative period, including the operating and recovery room. DATA COLLECTION AND ANALYSIS: We collected data in relation to events detectable by pulse oximetry, any serious complications that occurred during anaesthesia or in the postoperative period, intra- or postoperative mortality, and duration of recovery or intensive care stay. Formal statistical synthesis of individual trials was not performed in view of the variety of outcomes studied. MAIN RESULTS: Searching identified six reports; four studies with data from a total of 21,773 patients were considered eligible for analysis. Only two studies specifically addressed the outcomes in question; both found no effect on the rate of postoperative complications using perioperative pulse oximetry. Two studies used hypoxaemia detectable by pulse oximetry to assess the value of perioperative monitoring, although outcomes were not given. It was found that hypoxaemia was reduced in the pulse oximetry group both in the operating theatre and in the recovery room. During observation in the recovery room, the incidence of hypoxaemia in the pulse oximetry group was 1.5-3 times less. The postoperative cognitive function using the Wechsler memory scale and continuous reaction time was independent of perioperative monitoring with pulse oximetry. The other study showed that postoperative complications occurred in 10% of the patients in the oximetry group and in 9.4% in the control group. The two groups did not differ in cardiovascular, respiratory, neurologic, or infectious complications. The duration of hospital stay was a median of 5 days in both groups, and an equal number of in-hospital deaths was registered in the two groups. REVIEWER'S CONCLUSIONS: The studies confirmed that pulse oximetry can detect hypoxaemia and related events. However, we have found no evidence that pulse oximetry affects the outcome of anaesthesia. The conflicting subjective and objective results of the studies, despite an intense, methodical collection of data from a relatively large population, indicates that the value of perioperative monitoring with pulse oximetry is questionable in relation to improved reliable outcomes, effectiveness and efficiency.

Humans↗
PubMed2001

Postoperative intensive care admittance: the role of tobacco smoking.

BACKGROUND: Smokers have been shown to have increased risk of intraoperative pulmonary complications and of a wide range of postoperative complications, but an increased risk of postoperative intensive care admittance has not yet been described. The aim of this study was to estimate the risk of pulmonary complications and postoperative intensive care admittance in smokers and non-smokers in a general and orthopaedic surgical population. METHODS: A total of 4725 surgical patients were assessed. The following information was noted: age, sex and smoking status, history of heart and lung disease, ASA classification, type of anaesthesia, intensive care admittance and postoperative pulmonary or cardiovascular complications. A logistic regression model was used to determine the probability of intensive care admittance and pulmonary complications as a function of smoking status, age, and chronic heart and lung disease. RESULTS: Of the patients, 39.9% were smokers, 45.5% were non-smokers and in 14.6% of the cases smoking status was unspecified. Postoperative intensive care admittance and pulmonary complications were found in 2.0% and 4.3% of the patients, respectively. Non-smokers were more often female (P<0.01), and smokers had a higher incidence of emergency surgical procedures (P<0.05). When applying multiple regression analysis, we found that smoking, age >65 years, and a history of chronic lung disease increased the risk of unplanned intensive care admittance (odds ratio 1.55, 12.52 and 2.73). CONCLUSION: Our results indicate a relationship between a history of tobacco smoking and postoperative intensive care admittance.

Adolescent↗
PubMed2001

Studies of genetic variability of the glucose transporter 2 promoter in patients with type 2 diabetes mellitus.

This study was performed to test the hypothesis that genetic variation in the promoter of the glucose transporter 2 (GLUT2) might predispose to prediabetic phenotypes or type 2 diabetes. A total of 1611 bp comprising the minimal promoter region of the GLUT2 gene were examined by combined single-strand conformational polymorphism and heteroduplex analysis followed by direct sequencing of identified variants on genomic DNA from 96 randomly recruited Danish type 2 diabetic patients. We identified 4 nucleotide variants, -447g-->a, -149c-->a, -122t-->c, and -44g-->a. None of the variants were positioned in known or presumed transcription factor binding sites, TATA-box, or transcriptional start site. Association studies of the -149c-->a, -122t-->c, and -44g-->a variants revealed that the variants were as prevalent in 320 type 2 diabetic patients [11.0% (95% confidence interval, 8.4-13.6), 9.8% (7.4-12.2), and 29.0% (24.4-33.6), respectively] as in 241 age-matched glucose-tolerant subjects [13.1% (9.8-16.4), 11.2% (8.3-14.1), and 33.4% (28.8-38.0), respectively]. The -447g-->a mutation was only identified in a single diabetic patient and did not show cosegregation with diabetes in the family of the proband. The three common variants showed in a primary genotype-phenotype study comprising 241 glucose-tolerant middle-aged subjects association to increased plasma glucose levels during an oral glucose tolerance test. However, this result could not be replicated in a second sample of 298 60-yr-old glucose-tolerant subjects. In conclusion, we found no evidence supporting the hypothesis that genetic variability in the minimal promoter of the GLUT2 is associated with type 2 diabetes or prediabetic phenotypes in the Danish population.

Adult↗
PubMed2000

Variability of the insulin receptor substrate-1, hepatocyte nuclear factor-1alpha (HNF-1alpha), HNF-4alpha, and HNF-6 genes and size at birth in a population-based sample of young Danish subjects.

Reduced size at birth has been proposed to be a risk factor for insulin resistance and type 2 diabetes. It is, however, not known whether this association is explained by unfavorable intrauterine environment or by specific susceptibility genotypes predisposing for both reduced fetal growth and insulin resistance and type 2 diabetes. The present study was performed to evaluate whether previously identified amino acid polymorphisms of genes that from animal models have been suggested to play important roles during fetal development are associated with alterations in size at birth. The study population comprised 380 subjects randomly recruited from a population of young Danish Caucasian individuals, aged 18-32 yr. The original data of birth length and weight for 331 of 380 subjects were obtained from the midwife records. The Gly/Arg972 of insulin receptor substrate-1 (IRS-1), the Thr/Ile130 of the hepatocyte nuclear factor-4alpha (HNF-4alpha), the Pro/Ala75 of HNF-6, and the Ile/Leu27, Ala/Val93, and Ser/Asn4s7 polymorphisms of the HNF-lalpha gene were examined for association with birth weight and length and the ponderal index. Using a generalized linear model, including gender and the genotype as fixed variables, and applying Bonferroni correction for multiple testing, we could not demonstrate any significant differences in these estimates among wild-type, heterozygous, and homozygous carriers with respect to any of the gene variants. In conclusion, common variability in the genes encoding the IRS-1, HNF-lalpha, HNF-4alpha, and HNF-6 proteins can be excluded as major factors influencing size at birth among Danish Caucasian subjects.

Adolescent↗
PubMed1999

[Smoking cessation and pregnancy].

OBJECTIVES: To assess the effectiveness of smoking cessation programs implemented during pregnancy and to assess the impact of these programs on the health of the fetus and infant, on the mother and on the family. SEARCH STRATEGY: Randomized and quasi-randomized controlled trials identified by the search strategy of the Cochrane Pregnancy and Childbirth Group, supplemented by the search strategy of the Cochrane Tobacco Group. SELECTION CRITERIA: Trials in which programs to increase smoking cessation were implemented during pregnancy. DATA COLLECTION AND ANALYSIS: Data were abstracted according to predetermined criteria by two observers (S Oliver + J Lumley or E Waters + J Lumley). A total of 40 trials, conducted between 1975 and 1997, comprising over 9,000 women were identified and included in the review. An additional study provided data on over 3,000 women in a cluster-randomized trial. Interventions commonly included in these programs were: the provision of information on the risks of smoking to the fetus and infant and the benefits of quitting; recommendations to quit; feedback about the fetus; teaching cognitive-behavioural strategies for quitting smoking. There was substantial variation in the intensity of the intervention and the extent of reminders and reinforcement through pregnancy. Participants were healthy pregnant women and the usual setting was a hospital or community antenatal clinic. The principal outcome measure was continued smoking in late pregnancy. Eight trials provided some information on fetal outcomes: mean birthweight, low birthweight, preterm birth and perinatal mortality. MAIN RESULTS: Pooled data from 30 trials revealed a significant reduction in the odds of continued smoking in late pregnancy in the intervention groups (odds ratio (OR) = 0.51, 95% confidence interval 0.45 to 0.58). This equates to an absolute difference in the proportion continuing to smoke of 6.6%. The findings were similar when analyses were restricted to the 17 trials with biochemical validated smoking cessation (OR = 0.49, 95% CI 0.42 to 0.58 and an absolute difference in continued smoking of 7.2%); to the 11 trials where the intervention intensity was high (OR = 0.50, 95% CI 0.42 to 0.59 and an absolute difference in continued smoking of 8.6%); and to the 12 trials with a high quality score for the intervention--rated on the theoretical basis, the intensity of the intervention, detailed description of the intervention, process evaluation, validated smoking cessation--(OR = 0.47, 95% CI 0.40 to 0.56 and an absolute difference in continued smoking of 8.9%). The six trials with validated smoking cessation, a high intensity intervention and a high quality score had a pooled OR = 0.47, 95% CI 0.38 to 0.57 and an absolute difference in continued smoking of 9.2%. The subset of trials with information on fetal outcome revealed a reduction in low birthweight (pooled OR = 0.80, 95% CI 0.67 to 0.97), a non-significant reduction in preterm birth (pooled OR = 0.82, 95% CI 0.66 to 1.01), and an increase in mean birthweight of 41 g (95% CI 16.6 to 65.5), but no differences in very low birthweight, stillbirths, neonatal deaths or total perinatal mortality. Three trials of smoking relapse prevention among women who had stopped smoking by the first antenatal visit had a pooled OR = 0.73, 95% CI 0.45 to 1.18, for smoking in late pregnancy, with an absolute difference of 5.5%. The single large cluster-randomized trial showed no evidence of a decrease in continued smoking: the adjusted OR for quitting smoking by late pregnancy was 1.0, 95% CI 0.69 to 1.6. There were no differences in adjusted mean birthweight in this trial by intervention or control clinic. Process evaluation identified some problems with the implementation of this trial. CONCLUSIONS: Smoking cessation programs implemented in pregnancy increase smoking cessation, lead to a small increase in mean birthweight and a small reduction in low birthweight and preterm birth. (ABSTRACT TRUN

Controlled Clinical Trials as Topic↗
PubMed1999

[Group therapy and smoking cessation].

OBJECTIVES: Smoking cessation programmes in which groups of smokers have the opportunity to learn behavioural techniques and benefit from mutual support for quitting are widely available. The aim of this review is to determine the effectiveness of smoking cessation programmes delivered in a group format, for helping smokers achieve long-term smoking cessation. SEARCH STRATEGY: The Tobacco Addiction Group specialised register was used to identify trials in which one or more treatment arms used behaviour therapy, group therapy or cognitive therapy. SELECTION CRITERIA: Randomised trials which compared group therapy with self-help, individual counselling, another intervention or usual care or waiting list control were selected. Trials which compared two group programmes with manipulation of the group interaction and social support components were also included. There had to be a minimum of two group meetings, and follow-up of smoking status at least six months after the start of the programme. Trials in which group therapy was provided to both active therapy and placebo arms of trials of pharmacotherapies were not included unless they had a factorial design. DATA COLLECTION AND ANALYSIS: The outcome ceasure extracted was the number of successful quitters at the maximum follow-up using the strictest definition of abstinence, with biochemical validation where possible. Participants lost to follow-up were classified as still smoking. Meta-analysis was performed using a fixed effects model. MAIN RESULTS: Ten studies compared a group programme with a self-help programme presenting the same or similar information and behavioural techniques. There was an increase in cessation with the use of a group programme (OR 2.10 (95% C.I. 1.64-2.70). The direction of effect and significance was robust whether or not trials randomizing workplaces rather than individuals, and trials carried out during campaigns with televised cessation programmes were included. There was no evidence from two trials that group therapy was more effective than a similar intensity of individual counselling, and the trend favoured individual treatment. Comparison of group therapy with advice from a physician or nurse advice found no evidence for an effect, with heterogeneity in the results. Group programmes were more effective than no intervention or minimal contract interventions (OR 1.91 (95% C.I. 1.20-3.04). There was no evidence that manipulating the social interactions between participants in a group programme had an effect on outcome. CONCLUSIONS: There is reasonable evidence that groups are better than self-help, and other less intensive interventions. There is not enough evidence on their effectiveness compared to intensive individual counselling. From the point of view of the consumer who is motivated to make a quit attempt it is probably worth joining a group if one is available--it will increase the likelihood of quitting. From the public health perspective, groups are unlikely to make a substantial impact because of the low uptake.

Behavior Therapy↗
PubMed1999

[The effect of tobacco smoking on risks in connection in anesthesia and surgery. Development of complications and the preventive effect of smoking cessation].

About one third of the patients presenting for surgery are smokers. Smoking has acute and chronic effects on the cardiovascular, respiratory and immune systems, microcirculatory function and drug metabolism. Smoking is related to a wide range of per- and postoperative complications. Short term smoking cessation will probably reduce the disadvantageous acute effects of nicotine and carbon monoxide on the cardiovascular system, while the changes in lung function take about eight weeks to improve. Whether the rate of postoperative complications can be reduced by preoperative smoking cessation is unknown. The preoperative period might be a beneficial time for a greater smoking cessation intervention by an interdisciplinary hospital staff team.

Anesthesia↗
PubMed1999

[Tobacco smoking among surgical patients. Smoking habits and information to smokers in Danish departments of anesthesiology].

Smoking is related to a wide range of intra- and post-operative complications. In relation to the idea of health promoting hospitals, we investigated how Danish departments of anaesthesia dealt with tobacco smoking and the surgical patient. We sent a questionnaire to 44 Danish departments of anaesthesia with seven questions about practical management of tobacco related problems in anaesthetic practice, the information of patients and the state of preventive initiatives. At about half of the departments patients are not asked about their smoking habits and at only seven departments is the patient given oral information about their increased intra- and postoperative risks. Half of the departments advocate smoking abstinence in the six fasting hours. Two departments offer assistance to preoperative smoking cessation within a scientific preventive project. In conclusion, the idea of prevention of intra- and postoperative complications by means of preoperative smoking cessation has not gained interest at Danish departments of anaesthesia so far.

Anesthesia Department, Hospital↗
PubMed1999

Hepatocyte nuclear factor-6: associations between genetic variability and type II diabetes and between genetic variability and estimates of insulin secretion.

AIMS/HYPOTHESIS: The transcription factor hepatocyte nuclear factor (HNF)-6 is an upstream regulator of several genes involved in the pathogenesis of maturity-onset diabetes of the young. We therefore tested the hypothesis that variability in the HNF-6 gene is associated with subsets of Type II (non-insulin-dependent) diabetes mellitus and estimates of insulin secretion in glucose tolerant subjects. METHODS: We cloned the coding region as well as the intron-exon boundaries of the HNF-6 gene. We then examined them on genomic DNA in six MODY probands without mutations in the MODY1, MODY3 and MODY4 genes and in 54 patients with late-onset Type II diabetes by combined single strand conformational polymorphism-heteroduplex analysis followed by direct sequencing of identified variants. An identified missense variant was examined in association studies and genotype-phenotype studies. RESULTS: We identified two silent and one missense (Pro75 Ala) variant. In an association study the allelic frequency of the Pro75Ala polymorphism was 3.2% (95% confidence interval, 1.9-4.5) in 330 patients with Type II diabetes mellitus compared with 4.2% (2.4-6.0) in 238 age-matched glucose tolerant control subjects. Moreover, in studies of 238 middle-aged glucose tolerant subjects, of 226 glucose tolerant offspring of Type II diabetic patients and of 367 young healthy subjects, the carriers of the polymorphism did not differ from non-carriers in glucose induced serum insulin or C-peptide responses. CONCLUSION/INTERPRETATION: Mutations in the coding region of the HNF-6 gene are not associated with Type II diabetes or with changes in insulin responses to glucose among the Caucasians examined.

Adult↗