Massive transfusion: changing practice in a single Norwegian centre 2002-2015.

OBJECTIVES: To describe the change in massive transfusion (MT) practice in a single Norwegian centre throughout the period 2002-2015. BACKGROUND: MT support for traumatic haemorrhage has changed since the mid-2000s. However, life-threatening haemorrhage may occur in other clinical specialties. In 2007, Haukeland University Hospital (HUS) introduced a universal MT programme including education, Acute Transfusion Packages (ATPs) and thromboelastography. METHODS/MATERIALS: A retrospective review was performed of all MT episodes defined as ≥10 red cell concentrates (RCC) in 24 h. Episodes were identified using the laboratory information system. Patient records were reviewed manually for demographics, transfusion indication, haemostatic drugs and mortality. The ATPs contained six units RCC, six units Octaplas and two platelet concentrates (four buffy coats/apheresis in platelet additive solution (PAS)). RESULTS: A total of 410 episodes were identified in 410 patients. The mean patient age was 60 years (9-94), with a male predominance (64%); 87·1% of MT episodes were in support of surgery (cardiac services 42·7%; trauma 17·6%), and 29·8% of MTs involved platelet inhibitors, with 82·6% of these undergoing cardiac procedures. MT accounted for 2·8% of all RCCs and 3·4% of platelets issued. The mean ratio of blood components RCC: plasma: platelets changed from 1·0 : 0·37 : 0·39 in 2002-2006 (n = 149) to 1·0 : 0·79 : 0·85 in 2008-2015 (n = 241, P < 0·001). A sub-analysis showed that cardiac specialities used proportionally more plasma and platelets. CONCLUSION: The MT programme changed transfusion practice, resulting in greater use of plasma and platelets. MT was primarily used in major surgery. The practice in cardiac surgery may reflect changes in antiplatelet medication.

Near-normalization of glycaemic control with glucagon-like peptide-1 receptor agonist treatment combined with exercise in patients with type 2 diabetes.

AIMS: To investigate the effects of exercise in combination with a glucagon-like peptide-1 receptor agonist (GLP-1RA), liraglutide, or placebo for the treatment of type 2 diabetes. METHODS: Thirty-three overweight, dysregulated and sedentary patients with type 2 diabetes were randomly allocated to 16 weeks of either exercise and liraglutide or exercise and placebo. Both groups had three supervised 60-minute training sessions per week including spinning and resistance training. RESULTS: Glycated haemoglobin (HbA1c) levels dropped by a mean ± standard deviation of 2.0% ± 1.2% (from 8.2% ± 1.4%) in the exercise plus liraglutide group vs 0.3% ± 0.9% (from 8.0% ± 1.2%) in the exercise plus placebo group ( P < .001), and body weight was reduced more with liraglutide (-3.4 ± 2.9 kg vs -1.6 ± 2.3 kg; P < .001). Compared with baseline, similar reductions were seen in body fat (exercise plus liraglutide: -2.5% ± 1.4% [ P < .001]; exercise plus placebo: -2.2% ± 1.9% [ P < .001]) and similar increases were observed in maximum oxygen uptake (exercise plus liraglutide: 0.5 ± 0.5 L O2 /min [ P < .001]; exercise plus placebo: 0.4 ± 0.4 L O2 /min [ P = .002]). Greater reductions in fasting plasma glucose (-3.4 ± 2.3 mM vs -0.3 ± 2.6 mM, P < .001) and systolic blood pressure (-5.4 ± 7.4 mm Hg vs -0.6 ± 11.1 mm Hg, P < .01) were seen with exercise plus liraglutide vs exercise plus placebo. The two groups experienced similar increases in quality of life during the intervention. CONCLUSIONS: In obese patients with type 2 diabetes, exercise combined with GLP-1RA treatment near-normalized HbA1c levels and caused a robust weight loss when compared with placebo. These results suggest that a combination of exercise and GLP-1RA treatment is effective in type 2 diabetes.

Follow-up three years after intervention to relieve unmet medical and social needs of old people.

A follow-up study was conducted 3 years after a socio-medical intervention had been performed as part of an epidemiological study of 75-, 80- and 85-year-old citizens of Copenhagen. The intervention was aimed at relieving unmet medical and social needs of this group of citizens. The main recipients of social services were the oldest, single persons and women. A preponderance of the oldest had unmet social needs, but the need for health intervention did not vary according to age or sex. Although a fifth of the participants displayed unmet health needs and a third unmet social needs, no difference could be demonstrated at follow-up between participants and controls with regard to mortality, hospitalization, and institutionalization. Nor could any difference be found regarding subjective health and economy, loneliness, quality of life and functional ability. This is in contrast to the findings of another recent Danish intervention study. On the basis of the present study and other Scandinavian intervention studies, the authors conclude that in countries with a well-developed social system, efforts to improve the living conditions of the elderly should be concentrated to those who are at particular risk. Also for ethical reasons individualized intervention is greatly preferable to general intervention. It is conceivable, however, that not all risk factors, perhaps not even the most important, can be eliminated by intervention.