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Biomedical subjects

Ann M Møller

Publications and source records attributed to Ann M Møller.

14 recordsLinked to original sources
PubMed2006

[The smoking and drinking patient].

Daily smokers and heavy drinkers develop two to four times more complications after major as well as minor surgery. Increased postoperative morbidity is probably due to tobacco and alcohol-related organ dysfunctions which are, however, reversible during abstinence. Preoperative smoking cessation intervention for six to eight weeks significantly reduces postoperative complications after knee and hip replacement. Four weeks of preoperative alcohol intervention significantly improves organ functions before surgery, and reduces complications after colorectal surgery. Preoperative prevention programs are cost-effective. In conclusion, according to present evidence the smoking and drinking patient should be identified, informed, and offered preoperative prevention whenever possible.

Alcohol Drinking↗
PubMed2006

[Comparison of prophylactic infusion of ephedrine and phenylephrine during Cesarean section under spinal anaesthesia].

Spinal anaesthesia for caesarean delivery may be associated with hypotension and fetal acidosis. Prophylactic infusion of phenylephrine (PE) immediately after the induction of anaesthesia appears to be a more effective approach than administration of ephedrine to reduce the incidence, frequency and severity of hypotension. Furthermore, PE appears to be associated with better fetal acid-base status than is ephedrine.

Acidosis↗
PubMed2006

[Health economic analysis of smoking cessation prior to surgery--based on a randomised trial].

Smoking is a risk factor for postoperative complications such as pneumonia, infections and impaired wound healing. These can be reduced by preoperative stop-smoking intervention six to eight weeks before surgery. The aim of this study was to evaluate the costs and benefits of a stop-smoking intervention program by means of cost consequence analysis (CCA). A total of 120 smokers scheduled for hip or knee alloplasty were randomised to either a control group or an intervention group. The intervention group received an intensive stop-smoking intervention six to eight weeks before surgery. The focus of the economic analysis was on direct costs. Diagnosis-related group (DRG) costs were used for estimating the costs of secondary surgery. In all, 64% of the patients in the intervention group stopped smoking before surgery, as opposed to 8% in the control group. In the intervention group, 5.4% of the patients had wound complications, and 3.6% needed secondary surgery. In the control group, 30.8% had wound complications and 15.4% needed secondary surgery. The direct costs were almost the same in the two groups, whereas the overall costs in the intervention group were lower than in the control group. The economic analysis shows that a preoperative smoking intervention program is beneficial to society and the patient alike. Based on these calculations, we recommend that all patients scheduled for hip or knee alloplasty be given preoperative stop-smoking intervention.

Arthroplasty, Replacement, Hip↗
PubMed2006

Clinical relevance in anesthesia journals.

PURPOSE OF REVIEW: The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles. RECENT FINDINGS: In the last few years, more attention has been paid to evidence-based medicine in anesthesia. Several articles on the subject have focused on the need to base clinical decisions on sound research employing both methodological rigor and clinically relevant outcomes. The number of systematic reviews in anesthesia literature is increasing as well as the focus on diminishing the number of surrogate outcomes. It has been shown that the impact factor is not a valid measure of establishing the level of clinical relevance to a journal. SUMMARY: This review presents definitions of clinically relevant anesthesia articles. A clinically relevant article employs both methodological rigor and a clinically relevant outcome. The terms methodological rigor and clinical outcomes are fully discussed in the review as well as problems with journal impact factors.

Anesthesiology↗
PubMed2003

Impact of lifestyle on perioperative smoking cessation and postoperative complication rate.

OBJECTIVE: The aim was to examine to what extent lifestyle, education, social support, and comorbidity predict the ability of perioperative smoking cessation, and are associated with the development of important postoperative complications. DESIGN: The design was a randomized clinical trial. SETTING: University hospitals in Copenhagen, Denmark, were the settings. PARTICIPANTS AND METHODS: One hundred twenty patients scheduled for primary elective hip or knee arthroplasty were randomized to either smoking intervention or standard care. Tobacco and alcohol consumption, exercise and eating habits, level of education, matrimonial status, and the presence of social support were registered. The data gathered concerned smoking cessation/reduction and severe postoperative morbidity. RESULTS: Men and patients with a good social network were more likely to successfully quit smoking. Smoking intervention successfully reduced the incidence of postoperative complications, as did weekly exercise exceeding 4 h, and having a high education level. CONCLUSIONS: This study emphasizes that smoking intervention programs in health care settings are highly effective in reducing postoperative risks in hip and knee arthroplasty.

Aged↗
PubMed2003

Pulse oximetry for perioperative monitoring: systematic review of randomized, controlled trials.

Monitoring with pulse oximetry might improve patient outcome by enabling an early diagnosis and, consequently, correction of perioperative events that might otherwise cause postoperative complications or even death. The aim of the study was to clarify the effect of perioperative monitoring with pulse oximetry and to identify the adverse outcomes that might be prevented or improved by its use. Trials were identified by computerized searches of the Cochrane Library, MEDLINE, EMBASE, and by checking the reference lists of trials and review articles. All controlled trials that randomized patients to either pulse oximetry or no pulse oximetry during the perioperative period, including in the operating and recovery room, were included in the study. The search identified six reports. Of these 6 reports, 4 studies with data from 21,773 patients were considered eligible for analysis. Two studies specifically addressed the outcomes in question; both found no effect on the rate of postoperative complications using perioperative pulse oximetry. Hypoxemia was reduced in the pulse oximetry group both in the operating room and in the recovery room. During observation in the recovery room, the incidence of hypoxemia in the pulse oximetry group was 1.5-3 times less. There were postoperative complications in 10% of the patients in the oximetry group and in 9.4% in the control group. 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 both groups. The studies confirmed that pulse oximetry could detect hypoxemia and related events. However, given the relatively small number of patients studied and the rare events being sought, the studies were not able to show an improvement in various outcomes.

Blood Gas Analysis↗
PubMed2003

Effect of smoking on early complications after elective orthopaedic surgery.

Smoking is an important risk factor for the development of postoperative pulmonary complications after major surgical procedures. We studied 811 consecutive patients who had undergone hip or knee arthroplasty, recording current smoking and drinking habits, any history of chronic disease and such intraoperative factors as the type of anaesthesia and the type and duration of surgery. We recorded any postoperative complications occurring before discharge from hospital. There were 232 smokers (28.6%) and 579 non-smokers. We found that smoking was the single most important risk factor for the development of postoperative complications, particularly those relating to wound healing, cardiopulmonary complications, and the requirement of postoperative intensive care. A delay in discharge from hospital was usual for those suffering a complication. In those patients requiring prolonged hospitalisation (>15 days) the proportion of smokers with wound complications was twice that of non-smokers.

Adolescent↗
PubMed2002

Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial.

BACKGROUND: Smokers are at higher risk of cardiopulmonary and wound-related postoperative complications than non-smokers. Our aim was to investigate the effect of preoperative smoking intervention on the frequency of postoperative complications in patients undergoing hip and knee replacement. METHODS: We did a randomised trial in three hospitals in Denmark. 120 patients were randomly assigned 6-8 weeks before scheduled surgery to either the control (n=60) or smoking intervention (60) group. Smoking intervention was counselling and nicotine replacement therapy, and either smoking cessation or at least 50% smoking reduction. An assessor, who was masked to the intervention, registered the occurrence of cardiopulmonary, renal, neurological, or surgical complications and duration of hospital admittance. The main analysis was by intention to treat. FINDINGS: Eight controls and four patients from the intervention group were excluded from the final analysis because their operations were either postponed or cancelled. Thus, 52 and 56 patients, respectively, were analysed for outcome. The overall complication rate was 18% in the smoking intervention group and 52% in controls (p=0.0003). The most significant effects of intervention were seen for wound-related complications (5% vs 31%, p=0.001), cardiovascular complications (0% vs 10%, p=0.08), and secondary surgery (4% vs 15%, p=0.07). The median length of stay was 11 days (range 7-55) in the intervention group and 13 days (8-65) in the control group. INTERPRETATION: An effective smoking intervention programme 6-8 weeks before surgery reduces postoperative morbidity, and we recommend, on the basis of our results, this programme be adopted.

Adult↗
PubMed2002

The mission of the cochrane anesthesia review group: preparing and disseminating systematic reviews of the effect of health care in anesthesiology.

IMPLICATIONS: This article illustrates the basic principles of evidence-based medicine and the work within the Cochrane Collaboration and the Cochrane Anesthesia Review Group. It describes how important randomized controlled trials and systematic reviews are in providing the best evidence to answer clinically relevant questions.

Anesthesiology↗