[A single physician or a group of specialists in a surgical ward. II. Impact on the continuity and patient satisfaction].
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Continuity of Patient Care↗
Biomedical subjects
J Kjaergaard
Publications and source records attributed to J Kjaergaard.
Infiltration patterns of short- and long-term cultured A-NK and T-LAK cells following adoptive immunotherapy.
Direct contact between lymphokine-activated killer (LAK) cells and tumour cells is believed to be imperative for initiating tumour cell lysis in vitro as well as in vivo. In order to optimize adoptive immunotherapy (AIT) it is therefore desirable to identify the LAK cell subtype, which ensures maximal infiltration of tumours as well as a substantial cytotoxic reactivity. In this report we have compared short- and long-term cultured murine adherent natural killer (A-NK) cells and mitogen-stimulated, lymphokine-activated T-killer (T-LAK) cells with respect to their proliferative potential, cytotoxicity, requirement for interleukin-2 (IL-2) and ability to infiltrate B16 pulmonary metastases following adoptive transfer. We found that short-term (5 days) cultured A-NK and T-LAK cells both showed a substantial accumulation of tumour tissues. However, A-NK cells gradually lost this ability during in vitro culture whereas T-LAK cells cultured for as long as 20 days retained their ability to infiltrate metastases as efficiently as their short-term cultured counterparts. Moreover, the low requirement of IL-2 by T-LAK cells to achieve maximal infiltration of tumours sharply contrasted with the excessive doses necessary to ensure maximal infiltration by A-NK cells. In conclusion, these data demonstrate that short-term cultured LAK cells of both NK- and T-cell origin are able to infiltrate B16 pulmonary metastases effectively. Importantly, the T cells retain this ability for a considerably longer time and require much less IL-2 support than do A-NK cells, making T-LAK cells attractive for AIT.
Animals↗
[Patient in the communication gap between primary and secondary health sectors].
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Communication↗
[Malignant mesothelioma: incidence, survival and relative risks in selected municipalities 1943-1992].
The development in incidence rates and survival in Denmark, and the rate-ratio in selected municipalities that had industries utilizing asbestos was studied in 1865 cases of malignant mesothelioma identified in the Danish Cancer Registry 1943-1992. For men a steady increase in the incidence to 1.6 per 100,000 personyears in 1992 was found, while the rate for women decreased to 0.28 per 100,000 personyears. Age-specific incidence rates were highest for the older age-groups. An unexplained difference in the distribution of pleural and peritoneal cancers was seen between men and women. The average survival was 6.9 months for men and 7.8 for women and had not changed during the period of observation. The average rate-ratio for the selected municipalities was 1.97 (95% confidence intervals: 1.73-2.24) for men and 1.35 (1.08-1.69) for women. Improvements in working conditions in terms of minimizing asbestos exposure were introduced in 1980. Considering the latency period from exposure to diagnosis of 25-30 years, the impact of this measure on the rate of incidence cannot be expected before the year 2000.
Adult↗
[Junior physicians educate themselves. Educational value of trainees' work at a department of surgery].
UNLABELLED: In order to investigate the educational value of trainee surgeons' work, all work done by trainees at a Department of Surgery was recorded in a prospective and consecutive way for four weeks. It was recorded as fixed categories divided into intervals of 15 minutes. The work could be classified in three dimensions: Character, educational value and geography. The youngest trainees performed routine work without educational value. They had some practical jobs which could be done by other personnel. The work did not fulfil the educational claims for a trainee surgeon in phase I. The second group of trainees performed much routine work without educational value. They had no practical jobs that could have been performed by non-doctors. They had some work with educational value but not enough to fulfil the goals of a trainee surgeon in phase II. CONCLUSION: Doctors' clinical education could be improved by giving them work with educational value and supervision. Supervision should be performed by specialists who should also contribute to the routine work without educational value.
Denmark↗
[Colorectal cancer in Denmark 1943-1988].
Nation-wide incidence rates are presented of colorectal cancer in Denmark from 1943 to 1988. In Denmark notification of malignant and related diseases is mandatory. The percentage of histologically confirmed tumours is now 95. The annual incidence rate of colon cancer in Denmark has been increasing among men and women combined from 684 cases in 1943-1947 to 2020 cases in 1988. In the same period the incidence of rectal cancer has increased from 762 cases in 1943-1947 to 1108 cases in 1988. We analyzed the effects of age, calender time, and birth cohort with multiplicative Poisson models. We did not find consistent period effects in the models. We suggest an etiologic distinction between carcinoma of the rectum, the left colon and the right colon.
Colonic Neoplasms↗
[Examination programs in patients with colonic symptoms].
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Colonic Diseases↗
[Knowledge about colorectal cancer among surgeons in training].
Ninety-five participants in five theoretical courses on colorectal cancers were prior to the course asked to attend a multiple choice examination about colorectal cancer. All participants were under education in general surgery. Their experience in years as doctors was registered as was the time each participant had used for preparation before this course. For thirty-six of the participants the course ended with an examination and the participants had knowledge of that before they attended the course. We found a statistically significant relation between the amount of time spent in preparation and the results obtained in the multiple choice examination. There was no relation between results obtained and experience as a doctor. Participants who knew that an examination was to be held used significantly longer time for preparation and obtained a significantly better results than participants who did not attend any examination at the end of the course. It is concluded that the reading of text books extends the knowledge on colorectal cancer and that doctors during education are more eager to prepare when they know that an examination is waiting.
Clinical Competence↗
Convalescence after inguinal herniorrhaphy.
BACKGROUND: The aim of this investigation was to evaluate factors influencing the length of convalescence after ambulant inguinal hernia repair. METHODS: One hundred and twenty-three patients were followed up to assess when they returned to work, considered that they had regained full working capacity, and resumed leisure time activities. The length of sick leave was recommended on the basis of the load of the occupation. RESULTS: Half of the patients had a longer sick leave than recommended by the surgeon. Active and heavy work showed an independent significant positive correlation to the length of sick leave. Median sick leave among these patients was 42 days, which was the time they considered that they had regained full working capacity and 1 week after they had resumed their leisure time activities. Median sick leave among patients with sedentary or moderately active work was 9 days before regaining full working capacity and 12 days before resuming leisure time activities. CONCLUSIONS: Other factors than load of work and surgeon's advice seem to play a role in the patient's decision about when to resume normal activities on the job.
Adult↗
[Hartmann's procedure in the treatment of acute obstructive left-sided colonic cancer].
This retrospective study included all patients over a five-year period who underwent the Hartmann's procedure because of a malignant left-sided large bowel obstruction. Twenty-nine patients were treated with this procedure. The cumulative operative mortality was 14%, and the five-year survival was 31%. Intestinal continuity was restored in seven patients (24%). There were no anastomotic leakages. The treatment resulted in a permanent colostomy in 62% of the patients. The Hartmann's procedure can be employed as a treatment of malignant left-sided large bowel obstruction, but will cause a high frequency of permanent colostomy.
Acute Disease↗
Colorectal cancer in Denmark 1943-1988.
Nation-wide incidence rates are presented of colorectal cancer in Denmark from 1943 to 1988. In Denmark notification of malignant and related diseases is mandatory. The percentage of histologically confirmed tumours is now 95. The annual incidence rate of colon cancer in Denmark has been increasing among men and women combined from 684 cases in 1943-47 to 2020 cases in 1988. In the same period the incidence of rectal cancer has been increasing from 762 cases in 1943-47 to 1108 cases in 1988. We analyzed the effects of age, calendar time, and birth cohort with multiplicative Poisson models. We did not find consistent period effects in the models. We suggest the trends in colorectal cancer incidence rates may be due to changes in environmental factors such as dietary habits and in physical activity. Furthermore, we suggest an etiologic distinction between carcinoma of the rectum, the left colon and the right colon.
Cohort Effect↗
[Hospitals--new charge by physicians on equally worthy leadership].
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Denmark↗
[3-layer anastomoses after resection of colorectal cancer. A prospective study of 1015 anastomoses].
This study included patients who underwent elective curative resection of adenocarcinoma of the large bowel with primary suture of the anastomosis. The overall incidence of clinical anastomotic leakage was 5%. The incidence of anastomotic leakage was significantly higher in men than in women after low anterior resection. The three-layer anastomosis has no advantage in large bowel surgery when compared with data from other sutured anastomoses reported in the literature.
Adenocarcinoma↗
[Can hospital specialists be independent?].
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Denmark↗
Omeprazole 20 mg three days a week and 10 mg daily in prevention of duodenal ulcer relapse. Double-blind comparative trial.
In a double-blind, parallel-group clinical trial of 195 patients with duodenal ulcers who after a short-term study had relief of pain and healed ulcers proved endoscopically, 65 were randomized to receive 20 mg omeprazole 3 days a week (once in the morning from Friday to Sunday), 64 to receive 10 mg omeprazole once daily in the morning, and 66 to receive placebo for up to 6 months. The patients underwent repeat endoscopy with biopsy of the gastric fundic mucosa (qualitative assessment of argyrophilic cell population), assessment of symptoms, and laboratory screening with measurement of basal serum gastrin concentrations at 3 and 6 months or more often if indicated by recurrence of symptoms. At 3 months, endoscopically proved ulcer relapse occurred in 16% receiving 20 mg omeprazole 3 days a week; 21% receiving 10 mg omeprazole daily; and 50% receiving placebo. At 6 months, corresponding rates were 23%, 27%, and 67% with 95% confidence intervals of difference between the placebo group and omeprazole groups of 28%-60% and 24%-56% (P less than 0.00001), respectively, and between omeprazole groups of -19%-11% (NS). No major clinical or laboratory side effects were noted. Thus both omeprazole regimens are effective and safe in preventing duodenal ulcer relapse.
Adolescent↗
[Evaluation of the discharge summary by general practitioners. A questionnaire study].
In March 1986, a questionnaire investigation was sent to 250 general practitioners chosen at random in Denmark. In this questionnaire, general practitioners were asked about their assessment of the total activity involved in letters of discharge. Out of the practitioners questioned, 188 replied to the questionnaire (75.2%). 74% of the practitioners considered that changes were necessary in discharge letters. Most dissatisfaction was expressed about late receipt of discharge letters. 34% of the practitioners found that these letters should be received 0-3 days after discharge of the patient while 61% considered that 4-7 days after discharge could be accepted. A total of 92% considered that, on an average, they received letters of discharge later than seven days after discharge of the patient. As regards the contents of the letters of discharge, 68% of the practitioners considered that these were usually satisfactory. Practitioners appreciated substantial letters with emphasis on conditions of significance for the post-hospital treatment. The most important information was considered to be: medicine on discharge, information given to the patient, reasons for possible changes in medication, information about the subsequent treatment in addition to medicine and information about patho-anatomical findings at operation or biopsy. This investigation has provided a general consumer review of the form of discharge letters, the language, content, use and time of sending.
Denmark↗
[Evaluation of the discharge summary by physicians in charge. A questionnaire study].
In September 1986, a questionnaire about letters of discharge was sent to 250 physicians-in-charge i 250 clinical hospital departments in Denmark. Out of these, 214 replied to the questionnaire (85.6%). Only 110 (51%) of the physicians-in-charge stated that there was a definite time (number of days) by which the letter of discharge should be sent after the discharge of the patient. In 99 departments (46%), the letters of discharge were, on an average, sent later than the physician-in-charge found acceptable. 50% of the physician-in-charge found that the acceptable time of sending the letter of discharge after discharge of the patient was 0-3 days. 43% of the physicians-in-charge found that 4-7 days after discharge of the patient could be accepted. Formalized teaching in writing letters of discharge only took place in 24 departments (11%). Only few physicians-in-charge stated that they often or fre quently received negative or positive feed-back from general practitioners about letters of discharge. The following concrete proposals to improve the quality of letters of discharge and to shorten the time until sending are discussed: simplifying the passage from dictation of the letter to dispatch, increased formalized teaching of house officers and generally higher priority for letters of discharge.
Denmark↗