Opio M.O.,Kitovu Hospital |
Kellett J.,Hospital of South West Jutland
American Journal of Medicine | Year: 2017
Background: Although taking a radial pulse is considered to be an essential clinical skill, there have been few reports on how well it is measured in clinical practice, and how its accuracy and precision are influenced by rate, rhythm, and blood pressure. Methods: This study is a retrospective quality audit carried out as part of a larger ongoing prospective observational trial. The radial pulse rates recorded by 2 research nurses were compared with the electrocardiogram (ECG) heart rates measured on acutely ill medical patients during their admission to a resource-poor hospital in sub-Saharan Africa. Results: There were 619 ECGs performed on 231 patients while they were in the hospital. The median interval between measuring the vital signs and obtaining an ECG was 12.6 minutes (mean 62.3, SD 104.3 minutes). The correlation coefficient between the pulse rate recorded and ECG heart rate was 0.54. The bias between the pulse rate and the ECG heart rate was 1.34, SD 13.51 beats per minute (ie, limits of agreement 26.5 beats per minute). Bias and variance were not influenced by blood and pulse pressure. However, tachycardia increased the variance and was the only independent predictor of a pulse deficit (odds ratio 2.32; 95% confidence interval, 1.53-3.51; chi-squared 17.21; P < .0001). Conclusion: Practice-based evidence shows that in acutely ill patients, there is a poor correlation between the radial pulse and the ECG heart rate, and that tachycardia increases the variance and is the only independent predictor of a pulse deficit. © 2017 Elsevier Inc.
Stolberg C.R.,Hospital of South West Jutland |
Hepp N.,Hospital of South West Jutland |
Hepp N.,Copenhagen University |
Juhl A.J.A.,University of Aarhus |
Juhl C.B.,Hospital of South West Jutland
Surgery for Obesity and Related Diseases | Year: 2017
Background: Bariatric surgery is the most effective treatment for severe obesity. It results in significant and sustained weight loss and reduces obesity-related co-morbidities. Despite an increasing prevalence of severe obesity, the number of bariatric operations performed in Denmark has decreased during the past years. This is only partly explained by changes in the national guidelines for bariatric surgery. The purpose of the cross-sectional study is to investigate referral patterns and possible reservations regarding bariatric surgery among Danish primary care physicians (PCPs). Setting: Primary care physicians in Denmark. Methods: A total of 300 Danish PCPs were invited to participate in a questionnaire survey regarding experiences with bariatric surgery, reservations about bariatric surgery, attitudes to specific patient cases, and the future treatment of severe obesity. Most questions required a response on a 5-point Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree) and frequency distributions were calculated. Results: 133 completed questionnaires (44%) were returned. Most physicians found that they had good knowledge about the national referral criteria for bariatric surgery. With respect to the specific patient cases, a remarkably smaller part of physicians would refer patients on their own initiative, compared with the patient's initiative. Fear of postoperative surgical complications and medical complications both influenced markedly the decision to refer patients for surgery. Only 9% of the respondents indicated that bariatric surgery should be the primary treatment option for severe obesity in the future. Conclusion: Danish PCPs express severe concerns about surgical and medical complications following bariatric surgery. This might, in part, result in a low rate of referral to bariatric surgery. © 2017 American Society for Bariatric Surgery.
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
Hansen A.-L.S.,StenoDiabetesCenter A S |
Carstensen B.,StenoDiabetesCenter A S |
Helge J.W.,Copenhagen University |
Johansen N.B.,StenoDiabetesCenter A S |
And 7 more authors.
Diabetes Care | Year: 2013
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 PAand glucose homeostasis,we examined the association of objectivelymeasured PA energy expenditure (PAEE) with detailed measures of glucose homeostasis. RESEARCH DESIGN AND METHODSdIn 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 froma 3-point oral glucose tolerance test in addition tomeasures of long-term glycemia (glycated hemoglobin A1c and advanced glycation end products). Associations of PAEE with glucose homeostasis markers were examined using linear regression models. RESULTSdMedian age (IQR) was 66.6 years (62.1-71.6) (54%men) with amedian 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). CONCLUSIONSdEven in an elderly populationwith 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 evenwithout 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. © 2013 by the American Diabetes Association.
Kusk M.W.,Hospital of South West Jutland |
Karstoft J.,University of Southern Denmark |
Mussmann B.R.,University of Southern Denmark
Acta Radiologica | Year: 2015
Background Generation of multiplanar reformation (MPR) images has become automatic on most modern computed tomography (CT) scanners, potentially increasing the workload of the reporting radiologists. It is not always clear if this increases diagnostic performance in all clinical tasks. Purpose To assess detection performance using only coronal multiplanar reformations (MPR) when triaging patients for lung malignancies with CT compared to images in three orthogonal planes, and to evaluate performance comparison of novice and experienced readers. Material and Methods Retrospective study of 63 patients with suspicion of lung cancer, scanned on 64-slice multidetector computed tomography (MDCT) with images reconstructed in three planes. Coronal images were presented to four readers, two novice and two experienced. Readers decided whether the patients were suspicious for malignant disease, and indicated their confidence on a five-point scale. Sensitivity and specificity on per-patient basis was calculated with regards to a reference standard of histological diagnosis, and compared with the original report using McNemar's test. Receiver operating characteristic (ROC) curves were plotted to compare the performance of the four readers, using the area under the curve (AUC) as figure of merit. Results No statistically significant difference of sensitivity and specificity was found for any of the readers when compared to the original reports. ROC analysis yielded AUCs in the range of 0.92-0.93 for all readers with no significant difference. Inter-rater agreement was substantial (kappa = 0.72). Conclusion Sensitivity and specificity were comparable to diagnosis using images in three planes. No significant difference was found between experienced and novice readers. © The Foundation Acta Radiologica 2014.
Lauridsen M.M.,Hospital of South West Jutland |
Thiele M.,Copenhagen University |
Kimer N.,Copenhagen University |
Vilstrup H.,Aarhus University Hospital
Metabolic Brain Disease | Year: 2013
Existing tests for minimal/covert hepatic encephalopathy (m/cHE) are time- and expertise consuming and primarily useable for research purposes. An easy-to-use, fast and reliable diagnostic and grading tool is needed. We here report on the background, experience, and ongoing research regarding the continuous reaction times (CRT) method. The method has been in clinical use for decades in Denmark for the stated purpose. The method is a 10-minutes, computerised registration of a series of motor reaction times to an auditory stimulus, with results reported as the CRTindex (50 percentile/(90-10) percentile) as a parameter of reaction time variability. The index is a measure of alertness stability and is used to assess attention and cognition deficits. The CRTindex identifies half of patients in a Danish cohort with chronic liver disease, as having m/cHE, a normal value safely precludes HE, it has a broad outcome span reflecting the degree of brain impairment, it shows no learning effect, and it is independent on age and gender. The CRTindex is, therefore, a candidate tool for routine screening, detecting, grading, and monitoring m/cHE. Still, however, further methodological and clinical validation trials are required and are currently being conducted. © 2013 Springer Science+Business Media New York.
Hansen L.K.,Hospital of South West Jutland |
Brabrand M.,Hospital of South West Jutland
European journal of emergency medicine : official journal of the European Society for Emergency Medicine | Year: 2014
Cardiopulmonary resuscitation guidelines are constantly optimized to increase survival. Keeping hands-off time brief is vital. Our hypothesis is that rhythm recognition is time-consuming during cardiopulmonary resuscitation. A Laerdal Sim-Man simulated three shockable and four nonshockable rhythms. Rhythms were presented to physicians who identified whether they were shockable and whether they would defibrillate. We measured time to stated decision. Thirty-five doctors participated, 32 had completed advanced life support training. The mean time to make a decision on whether to defibrillate or not was 3.4 s [95% confidence interval (CI): 2.8-3.9] for shockable and 4.4 s (95% CI: 3.6-5.3) for nonshockable rhythms (P<0.05). For all rhythms, the mean time was 4.0 s (95% CI: 3.5-4.5). Of all shockable rhythms, 95.2 % were correctly diagnosed as shockable, compared with 88.6 % of nonshockable rhythms being correctly diagnosed. Our simulation study indicates that doctors are able to correctly identify shockable rhythms within 4 s.
Steffensen S.M.,Hospital of South West Jutland |
Korsgaard N.,Hospital of South West Jutland
BMJ Case Reports | Year: 2014
An 82-year-old woman presented with an asymptomatic mass, rapidly growing on her left cheek for the previous 3 months. Punch biopsy of the tumour was performed, and the pathology was compatible with Merkel cell carcinoma. A resection margin of more than 1 cm would involve left oral commissura, potentially damaging speech, eating and drinking ability. The patient had a strong wish of keeping surgery simple in order to maintain quality of life. Tumour excision was performed with 1 cm resection margin, and postoperatively the patient was referred to adjuvant radiation therapy. Sensibility of upper and lower lip remained unaffected, while motor innervation of left upper lip was impaired. Despite this, the patient's ability to talk and eat was unaffected. Surgery, with adjunctive radiation therapy, is the first-line of treatment for the primary tumour. The option for a more conservative treatment is not first choice, but can be considered upon individual assessment. Copyright 2014 BMJ Publishing Group. All rights reserved.
Haidl F.,Lillebaelt Hospital |
Brabrand M.,Hospital of South West Jutland |
Henriksen D.P.,University of Southern Denmark |
Lassen A.T.,University of Southern Denmark
European Journal of Emergency Medicine | Year: 2015
An increased lactate level is related to increased mortality in subpopulations of critically ill patients. The aim of this study was to investigate whether lactate was related to mortality in an emergency department (ED) setting of undifferentiated medical patients. All adult patients admitted from March 2009 to August 2011 to a medical ED with lactate measured within 6 h after arrival were studied. Lactate was stratified into 1-mmol/l intervals and analysed in a multivariate logistic regression analysis. A total of 5317 patients were included, 46.9% men, median age 71 years (5-95% percentiles 25-90 years). The median lactate level was 1.2 mmol/l (5-95% percentiles 0.6-3.8 mmol/l, range 0.2-22 mmol/l). Lactate was associated with 10-day mortality independent of age, comorbidity and presence of hypotension, with an odds ratio of 1.54 (95% confidence interval 1.44-1.63) per 1 mmol/l increase. Lactate is an independent predictor of 10-day mortality among patients admitted to a medical ED. © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Muus Steffensen S.,Hospital of South West Jutland
BMJ case reports | Year: 2014
An 82-year-old woman presented with an asymptomatic mass, rapidly growing on her left cheek for the previous 3 months. Punch biopsy of the tumour was performed, and the pathology was compatible with Merkel cell carcinoma. A resection margin of more than 1 cm would involve left oral commissura, potentially damaging speech, eating and drinking ability. The patient had a strong wish of keeping surgery simple in order to maintain quality of life. Tumour excision was performed with 1 cm resection margin, and postoperatively the patient was referred to adjuvant radiation therapy. Sensibility of upper and lower lip remained unaffected, while motor innervation of left upper lip was impaired. Despite this, the patient's ability to talk and eat was unaffected. Surgery, with adjunctive radiation therapy, is the first-line of treatment for the primary tumour. The option for a more conservative treatment is not first choice, but can be considered upon individual assessment.
Lauridsen M.M.,Hospital of South West Jutland |
Lauridsen M.M.,University of Southern Denmark |
Schaffalitzky de Muckadell O.B.,University of Southern Denmark |
Vilstrup H.,Aarhus University Hospital
Metabolic Brain Disease | Year: 2015
Minimal hepatic encephalopathy (MHE) is a frequent complication to liver cirrhosis that causes poor quality of life, a great burden to caregivers, and can be treated. For diagnosis and grading the international guidelines recommend the use of psychometric tests of different modalities (computer based vs. paper and pencil). To compare results of the Continuous Reaction time (CRT) and the Portosystemic Encephalopathy (PSE) tests in a large unselected cohort of cirrhosis patients without clinically detectable brain impairment and to clinically characterize the patients according to their test results. The CRT method is a 10–minute computerized test of a patient’s motor reaction time stability (CRTindex) to 150 auditory stimuli. The PSE test is a 20–minute paper-pencil test evaluating psychomotor speed. Both tests were performed at the same occasion in 129 patients. Both tests were normal in only 36 % (n = 46) of the patients and this group had the best quality of life, a normal CRP, a low risk of subsequent overt HE, and a low short term mortality. Either the CRT or the PSE test was abnormal in a total of 64 % of the patients (n = 83), the CRT in 53 % (n = 69) and the PSE in 34 % (n = 44). All these patients had a poorer quality of life, low-grade CRP elevation, moderate risk for subsequent overt HE, and a higher than 20 % short term mortality. Both tests were abnormal in 23 % (n = 30) of the patients and this group had more advanced cirrhosis and a 40 % short-term mortality. One of the tests was abnormal in the majority of the patients but concordant in only 60 %. Most cirrhosis patients seem to have impairments of different cognitive domains and more domains with advancing disease. Two abnormal tests identified patients with an increased risk of overt HE and death. © 2015, Springer Science+Business Media New York.