Scandinavian journal of clinical and laboratory investigation. Supplementum
Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Jo... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Journal of Hypertension. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but ...
1 The activity of the Na+/K+‐pump in rat peritoneal mast cells was measured at various time inter... more 1 The activity of the Na+/K+‐pump in rat peritoneal mast cells was measured at various time intervals after induction of cellular histamine release by compound 48/80 or by the antigen‐antibody reaction. The Na+/K+‐pump activity was assessed as the ouabain‐sensitive potassium uptake of the cells using 86Rb+ as a tracer for potassium (K+(86Rb+)‐uptake). 2 Stimulation of the cells with compound 48/80 induced a time and concentration dependent increase of the Na+/K+‐pump activity. The pump activity was maximal 2 min after stimulation of the cells. Then, the activity gradually decreased and reached a level not significantly different from the controls after 2 h of incubation. 3 When the cells were stimulated by the antigen‐antibody reaction, there was also a rapid (within 5 min) stimulation of the Na+/K+‐pump. In contrast to the stimulation with compound 48/80, the pump activity returned to the control level after 60 min of incubation with antigen. 4 The ouabain‐resistant potassium uptak...
A 46-year-old woman presented with classic symptoms. Computed tomography-angiography and duplex u... more A 46-year-old woman presented with classic symptoms. Computed tomography-angiography and duplex ultrasonography showed stenosis of the aa. mesenteria superior et inferior. The patient was moved to a university hospital and a percutaneous transluminal angioplasty with insertion of stents was performed. She was discharged shortly after feeling well.
Most existing risk stratification systems predicting mortality in emergency departments or admiss... more Most existing risk stratification systems predicting mortality in emergency departments or admission units are complex in clinical use or have not been validated to a level where use is considered appropriate. We aimed to develop and validate a simple system that predicts seven-day mortality of acutely admitted medical patients using routinely collected variables obtained within the first minutes after arrival. This observational prospective cohort study used three independent cohorts at the medical admission units at a regional teaching hospital and a tertiary university hospital and included all adult (≥15 years) patients. Multivariable logistic regression analysis was used to identify the clinical variables that best predicted the endpoint. From this, we developed a simplified model that can be calculated without specialized tools or loss of predictive ability. The outcome was defined as seven-day all-cause mortality. 76 patients (2.5%) met the endpoint in the development cohort,...
Political initiatives promoting a more efficient emergency admission process have triggered a reo... more Political initiatives promoting a more efficient emergency admission process have triggered a reorganisation of the Danish health system with a view to creating fewer and larger admission units counting more experienced physicians. At our hospital, a medical admission unit (MAU) was established. We present the effect of this on the length of hospital stay, mortality rates and the number of readmissions for the last year with the previous structure and the first year of the new MAU structure. We retrospectively extracted data from the hospital databases on two periods: one year before and the first year after establishment of the MAU. After establishment of the MAU, the overall average length of hospital stay was reduced from 4.1 to 3.8 days (p < 0.01). No increase in mortality either in-house or within 30 days after discharge was seen. A substantial reduction (26%) in the overall number of readmissions within 30 days after discharge was observed. The establishment of the MAU impr...
We have all tried it: it is pouring down with rain, we reach for the keys, and choose the wrong o... more We have all tried it: it is pouring down with rain, we reach for the keys, and choose the wrong one. The mathematical probability for choosing the correct key - out of two - is 50%. During the 1990s, candy.scient. Jarle Gundersson (JG) proposed a mathematically unexplainable factor of uncertainty. He used the above example with the keys and concluded that the real, or observed, probability for choosing the correct key was 5-10%. The discrepancy between the mathematical and real probability was, according to JG, caused by The Awfulness of Being Concept. In this article, we present the results from a study and demonstrate the difference between the mathematical and the observed probability of success in two different scenarios (winning a coin toss and choosing the correct key in the first attempt). Questionnaire survey performed at the Regional Hospital of Esbjerg 18-19 September 2009 using staff as questionnaire respondents. We found a discrepancy between the mathematical and observe...
In around 30-40% of patients with acute severe ulcerative colitis the disease is refractory to tr... more In around 30-40% of patients with acute severe ulcerative colitis the disease is refractory to treatment with high-dose glucocorticoids. Adding intravenous cyclosporine to the therapy in these patients has shown encouraging short-term results. Case notes of twenty-three acutely ill patients, who received intravenous cyclosporine during the period 1992 to 1998 due to failure of high-dose glucocorticoid (n = 20) or due to medical complications (n = 3) which made surgery difficult, were reviewed. Eight patients had their first episode of ulcerative colitis whereas 15 had relapse or chronic active disease. Cyclosporine (4 mg/kg/dag) was added to glucocorticoid treatment after a median of 11 days. Clinical remission was achieved in 13 patients (57%) after a median of nine days, of these five subsequently underwent surgery. Ten did not obtain remission and went to surgery. Approximately a third of acutely ill ulcerative colitis patients refractory to standard treatment with high-dose gluc...
Uptake of 86Rubidium of mononuclear leukocytes (MNL) was used as a measure of cellular sodium-pot... more Uptake of 86Rubidium of mononuclear leukocytes (MNL) was used as a measure of cellular sodium-potassium pump activity. 86Rb-uptake was determined with the pump stimulated mainly from inside the cells by sodium as well as with a combined stimulation from inside by sodium and from outside by Rb. In the first case there was an increased pump activity in MNL from borderline hypertensive offspring of hypertensive patients (BHO), and this may be related to an increased number of pump sites observed previously (10). Estimation of maximal pump activity (Vmax) of MNL suggested that Vmax of each pump site in MNL from BHO may be decreased compared to control value of MNL from healthy normotensive subjects.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2011
Interruption in chest compressions during cardiopulmonary resuscitation can be characterized as n... more Interruption in chest compressions during cardiopulmonary resuscitation can be characterized as no flow ratio (NFR) and the importance of minimizing these pauses in chest compression has been highlighted recently. Further, documentation of resuscitation performance has been reported to be insufficient and there is a lack of identification of important issues where future efforts might be beneficial. By implementing in situ simulation we created a model to evaluate resuscitation performance. The aims of the study were to evaluate the feasibility of the applied method, and to examine differences in the resuscitation performance between the first responders and the cardiac arrest team. A prospective observational study of 16 unannounced simulated cardiopulmonary arrest scenarios was conducted. The participants of the study involved all health care personel on duty who responded to a cardiac arrest. We measured NFR and time to detection of initial rhythm on defibrillator and performed a comparison between the first responders and the cardiac arrest team. Data from 13 out of 16 simulations was used to evaluate the ability of generating resuscitation performance data in simulated cardiac arrest. The defibrillator arrived after median 214 seconds (180-254) and detected initial rhythm after median 311 seconds (283-349). A significant difference in no flow ratio (NFR) was observed between the first responders, median NFR 38% (32-46), and the resuscitation teams, median NFR 25% (19-29), p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001. The difference was significant even after adjusting for pulse and rhythm check and shock delivery. The main finding of this study was a significant difference between the first responders and the cardiac arrest team with the latter performing more adequate cardiopulmonary resuscitation with regards to NFR. Future research should focus on the educational potential for in-situ simulation in terms of improving skills of hospital staff and patient outcome.
Functional dyspepsia (FD) is defined as persistent or recurrent pain/discomfort centred in the up... more Functional dyspepsia (FD) is defined as persistent or recurrent pain/discomfort centred in the upper abdomen, where no structural explanation for the symptoms is found. The role of drug treatment remains controversial. The aim in this study was to evaluate the effect of omeprazole 20 mg twice daily (b.i.d) and to test methods for symptom assessment. 197 patients fulfilling the criteria for FD were randomly allocated to double-blind treatment with omeprazole 20 mg b.i.d (n = 100) or placebo (n = 97) for 14 days. Patients with a known gastrointestinal disorder or with main symptoms indicating gastro-oesophageal reflux disease or irritable bowel syndrome were excluded. Helicobacter pylori testing and 24-h intra-oesophageal 24-h pH-metry were performed before randomization. The patients recorded dyspeptic symptoms on diary cards. A stringent endpoint, &#39;complete symptom relief on the last day of treatment&#39;, was the primary efficacy variable. For the APT cohort, this was achieved in 29.0% and 17.7% on omeprazole and placebo, respectively (95% CI of difference (11.3%): -0.4%-23.0%, P = 0.057). Similar figures in the PP cohort were 31.0% and 15.5%, respectively (95% Cl of difference (15.5%): 3.2%-27.7%, P = 0.018). The benefit of omeprazole in the PP cohort was confirmed by secondary endpoints such as, no dyspeptic symptoms on the last 2 days of treatment and overall treatment response. H. pylori status and the level of oesophageal acid exposure did not significantly influence the response to therapy. A subset of patients with FD will respond to therapy with omeprazole.
Scandinavian journal of clinical and laboratory investigation. Supplementum
Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Jo... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Journal of Hypertension. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but ...
1 The activity of the Na+/K+‐pump in rat peritoneal mast cells was measured at various time inter... more 1 The activity of the Na+/K+‐pump in rat peritoneal mast cells was measured at various time intervals after induction of cellular histamine release by compound 48/80 or by the antigen‐antibody reaction. The Na+/K+‐pump activity was assessed as the ouabain‐sensitive potassium uptake of the cells using 86Rb+ as a tracer for potassium (K+(86Rb+)‐uptake). 2 Stimulation of the cells with compound 48/80 induced a time and concentration dependent increase of the Na+/K+‐pump activity. The pump activity was maximal 2 min after stimulation of the cells. Then, the activity gradually decreased and reached a level not significantly different from the controls after 2 h of incubation. 3 When the cells were stimulated by the antigen‐antibody reaction, there was also a rapid (within 5 min) stimulation of the Na+/K+‐pump. In contrast to the stimulation with compound 48/80, the pump activity returned to the control level after 60 min of incubation with antigen. 4 The ouabain‐resistant potassium uptak...
A 46-year-old woman presented with classic symptoms. Computed tomography-angiography and duplex u... more A 46-year-old woman presented with classic symptoms. Computed tomography-angiography and duplex ultrasonography showed stenosis of the aa. mesenteria superior et inferior. The patient was moved to a university hospital and a percutaneous transluminal angioplasty with insertion of stents was performed. She was discharged shortly after feeling well.
Most existing risk stratification systems predicting mortality in emergency departments or admiss... more Most existing risk stratification systems predicting mortality in emergency departments or admission units are complex in clinical use or have not been validated to a level where use is considered appropriate. We aimed to develop and validate a simple system that predicts seven-day mortality of acutely admitted medical patients using routinely collected variables obtained within the first minutes after arrival. This observational prospective cohort study used three independent cohorts at the medical admission units at a regional teaching hospital and a tertiary university hospital and included all adult (≥15 years) patients. Multivariable logistic regression analysis was used to identify the clinical variables that best predicted the endpoint. From this, we developed a simplified model that can be calculated without specialized tools or loss of predictive ability. The outcome was defined as seven-day all-cause mortality. 76 patients (2.5%) met the endpoint in the development cohort,...
Political initiatives promoting a more efficient emergency admission process have triggered a reo... more Political initiatives promoting a more efficient emergency admission process have triggered a reorganisation of the Danish health system with a view to creating fewer and larger admission units counting more experienced physicians. At our hospital, a medical admission unit (MAU) was established. We present the effect of this on the length of hospital stay, mortality rates and the number of readmissions for the last year with the previous structure and the first year of the new MAU structure. We retrospectively extracted data from the hospital databases on two periods: one year before and the first year after establishment of the MAU. After establishment of the MAU, the overall average length of hospital stay was reduced from 4.1 to 3.8 days (p < 0.01). No increase in mortality either in-house or within 30 days after discharge was seen. A substantial reduction (26%) in the overall number of readmissions within 30 days after discharge was observed. The establishment of the MAU impr...
We have all tried it: it is pouring down with rain, we reach for the keys, and choose the wrong o... more We have all tried it: it is pouring down with rain, we reach for the keys, and choose the wrong one. The mathematical probability for choosing the correct key - out of two - is 50%. During the 1990s, candy.scient. Jarle Gundersson (JG) proposed a mathematically unexplainable factor of uncertainty. He used the above example with the keys and concluded that the real, or observed, probability for choosing the correct key was 5-10%. The discrepancy between the mathematical and real probability was, according to JG, caused by The Awfulness of Being Concept. In this article, we present the results from a study and demonstrate the difference between the mathematical and the observed probability of success in two different scenarios (winning a coin toss and choosing the correct key in the first attempt). Questionnaire survey performed at the Regional Hospital of Esbjerg 18-19 September 2009 using staff as questionnaire respondents. We found a discrepancy between the mathematical and observe...
In around 30-40% of patients with acute severe ulcerative colitis the disease is refractory to tr... more In around 30-40% of patients with acute severe ulcerative colitis the disease is refractory to treatment with high-dose glucocorticoids. Adding intravenous cyclosporine to the therapy in these patients has shown encouraging short-term results. Case notes of twenty-three acutely ill patients, who received intravenous cyclosporine during the period 1992 to 1998 due to failure of high-dose glucocorticoid (n = 20) or due to medical complications (n = 3) which made surgery difficult, were reviewed. Eight patients had their first episode of ulcerative colitis whereas 15 had relapse or chronic active disease. Cyclosporine (4 mg/kg/dag) was added to glucocorticoid treatment after a median of 11 days. Clinical remission was achieved in 13 patients (57%) after a median of nine days, of these five subsequently underwent surgery. Ten did not obtain remission and went to surgery. Approximately a third of acutely ill ulcerative colitis patients refractory to standard treatment with high-dose gluc...
Uptake of 86Rubidium of mononuclear leukocytes (MNL) was used as a measure of cellular sodium-pot... more Uptake of 86Rubidium of mononuclear leukocytes (MNL) was used as a measure of cellular sodium-potassium pump activity. 86Rb-uptake was determined with the pump stimulated mainly from inside the cells by sodium as well as with a combined stimulation from inside by sodium and from outside by Rb. In the first case there was an increased pump activity in MNL from borderline hypertensive offspring of hypertensive patients (BHO), and this may be related to an increased number of pump sites observed previously (10). Estimation of maximal pump activity (Vmax) of MNL suggested that Vmax of each pump site in MNL from BHO may be decreased compared to control value of MNL from healthy normotensive subjects.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2011
Interruption in chest compressions during cardiopulmonary resuscitation can be characterized as n... more Interruption in chest compressions during cardiopulmonary resuscitation can be characterized as no flow ratio (NFR) and the importance of minimizing these pauses in chest compression has been highlighted recently. Further, documentation of resuscitation performance has been reported to be insufficient and there is a lack of identification of important issues where future efforts might be beneficial. By implementing in situ simulation we created a model to evaluate resuscitation performance. The aims of the study were to evaluate the feasibility of the applied method, and to examine differences in the resuscitation performance between the first responders and the cardiac arrest team. A prospective observational study of 16 unannounced simulated cardiopulmonary arrest scenarios was conducted. The participants of the study involved all health care personel on duty who responded to a cardiac arrest. We measured NFR and time to detection of initial rhythm on defibrillator and performed a comparison between the first responders and the cardiac arrest team. Data from 13 out of 16 simulations was used to evaluate the ability of generating resuscitation performance data in simulated cardiac arrest. The defibrillator arrived after median 214 seconds (180-254) and detected initial rhythm after median 311 seconds (283-349). A significant difference in no flow ratio (NFR) was observed between the first responders, median NFR 38% (32-46), and the resuscitation teams, median NFR 25% (19-29), p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001. The difference was significant even after adjusting for pulse and rhythm check and shock delivery. The main finding of this study was a significant difference between the first responders and the cardiac arrest team with the latter performing more adequate cardiopulmonary resuscitation with regards to NFR. Future research should focus on the educational potential for in-situ simulation in terms of improving skills of hospital staff and patient outcome.
Functional dyspepsia (FD) is defined as persistent or recurrent pain/discomfort centred in the up... more Functional dyspepsia (FD) is defined as persistent or recurrent pain/discomfort centred in the upper abdomen, where no structural explanation for the symptoms is found. The role of drug treatment remains controversial. The aim in this study was to evaluate the effect of omeprazole 20 mg twice daily (b.i.d) and to test methods for symptom assessment. 197 patients fulfilling the criteria for FD were randomly allocated to double-blind treatment with omeprazole 20 mg b.i.d (n = 100) or placebo (n = 97) for 14 days. Patients with a known gastrointestinal disorder or with main symptoms indicating gastro-oesophageal reflux disease or irritable bowel syndrome were excluded. Helicobacter pylori testing and 24-h intra-oesophageal 24-h pH-metry were performed before randomization. The patients recorded dyspeptic symptoms on diary cards. A stringent endpoint, &#39;complete symptom relief on the last day of treatment&#39;, was the primary efficacy variable. For the APT cohort, this was achieved in 29.0% and 17.7% on omeprazole and placebo, respectively (95% CI of difference (11.3%): -0.4%-23.0%, P = 0.057). Similar figures in the PP cohort were 31.0% and 15.5%, respectively (95% Cl of difference (15.5%): 3.2%-27.7%, P = 0.018). The benefit of omeprazole in the PP cohort was confirmed by secondary endpoints such as, no dyspeptic symptoms on the last 2 days of treatment and overall treatment response. H. pylori status and the level of oesophageal acid exposure did not significantly influence the response to therapy. A subset of patients with FD will respond to therapy with omeprazole.
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Papers by Torben Knudsen