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M Madsen

Publications and source records attributed to M Madsen.

At least 163 records · Page 9Linked to original sources
PubMed1989

[Regional differences in the use of cholecystectomy in Denmark during the period 1977-1985].

In a register-based study of all cholecystectomized patients in Denmark during the period from 1977-85 (37,048 patients) an account is given of the regional variations observed in connection with the intervention. The cholecystectomy operation is sub-divided into four types of operation dependent on whether the intervention is merely a matter of cholecystectomy or it involves the choledocus, the duodenum, the small intestine or other organs. The variation analysis is based on a division of the country into 75 areas, each primarily served by a single hospital. The method highly reflects the differences in clinical treatment strategies. The summarized rate of cholecystectomy for this period of time was 8.2 per 10,000 persons. In areas with the highest and the lowest rates of operation the figures were 12.3 per 10,000 and 5.1 per 10,000, respectively. In 18 areas, the rates of operation were significantly higher than average and in 18 other areas significantly higher than average and in 18 other areas significantly below average. SCV-score (X100) 2.19. There is no systematic correlation between the degree of specialisation in the operating department and the frequency in employing the operation. Areas with an operation index significantly above average had the same rate of more complicated operations than simple cholecystectomy as the other areas. Possible causes of national as well as international variations in the use of cholecystectomy are discussed, and the need for a radical evaluation of this kind of treatment is emphasized.

Adult↗
PubMed1989

A quasi-experimental design based on regional variations: discussion of a method for evaluating outcomes of medical practice.

A large proportion of common medical practices are subject to substantial regional variation resulting in numerous natural experiments. Opportunities are thereby provided for outcome evaluation through quasi-experimental design. If patients treated in different regions were comparable a natural experiment involving alternative treatments could be regarded as 'pseudo randomised', but empirical investigations are needed to verify this prerequisite. This paper discusses the role of quasi-experimental designs in assessment of medical care with evaluation of outcomes after hysterectomy in Denmark as an example. The design is developed and the comparability of selected groups of patients is elucidated from administrative data, while the outcome results are not presented in this context. One indication for hysterectomy is carcinoma in situ of the cervix uteri which may be treated with either hysterectomy, or conisation. A study group of patients was selected from departments where hysterectomy was the treatment of choice for this indication while the reference group was drawn from departments in which conisation was generally preferred. The comparability of the populations, effects and information for the two groups are elicited from administrative data. We conclude that it is possible to establish a quasi-experimental design based on regional variations and that the comparability of the groups included may be assessed through registry data. The importance of technology diffusion for the prospects of performing quasi randomised studies is emphasised. In this attempt to evaluate hysterectomy, it was not possible to identify groups of patients, which were sufficiently comparable to justify a study of soft outcomes.

Adult↗
PubMed1989

Intravenous vancomycin usage in a tertiary care hospital.

Intravenous vancomycin usage at our institution was examined by a five-month retrospective chart review. Cardiovascular surgery, neurosurgery, and intensive care units accounted for the most use. Sixty courses in 48 patients were reviewed; 42 percent was considered inappropriate, which extrapolated to an annual drug acquisition cost of $51,338. Inappropriate use was categorized as mainly due to documented infection with a beta-lactam sensitive organism in a patient with no history of an allergy (40 percent of inappropriate use) and excessive duration of empiric therapy (28 percent of inappropriate use). Concurrent monitoring by pharmacy staff was felt to be the approach most likely to be effective in modifying this problem.

Alberta↗
PubMed1989

Studies on microaerophilic cocci (Stuart-Schwan cocci) isolated from summer mastitis and other pyogenic infections of cattle.

Forty-nine strains of microaerophilic gram-positive cocci (Stuart-Schwan cocci) isolated from summer mastitis, "pyogenes"-mastitis, other pyogenic conditions of Danish cattle and swine, and from the sheep headfly Hydrotaea irritans were biochemically characterized with the API 50 CH and API ZYM test kit systems, and screened for production of a variety of extracellular enzymes by agar plate methods. For comparison 4 strains isolated from Swedish cases of heifer and dry cow mastitis were included in the study. Similarity calculations indicated a high degree of homogeneity within the strains studied (similarity level 92%; group mean similarity 87%). The strains probably represent one species, although the taxonomic position of the organism remains unclear. The biochemical feature of the strains studied were very similar for strains isolated from cases of summer mastitis and strains from other sources of origin. It is suggested that the Stuart-Schwan coccus occurs as a natural cohabitant to Actinomyces pyogenes, Peptostreptococcus indolicus and the anaerobic organism characteristic of the bacterial complex isolated from summer mastitis and similar pyogenic conditions in ruminants and swine.

Animals↗
PubMed1989

Outcome from intensive care. II. A 5-year study of 1308 patients: short-term outcome.

All patients (n = 1308) admitted to a multidisciplinary intensive care unit (ICU) during a 5-year period (1979-83) were followed prospectively. The in-unit mortality was 18% and the in-hospital mortality (mortality during ICU-stay plus mortality during the ensuing hospital stay) was 29%. Increasing age was associated with increasing in-hospital mortality, up to 40% mortality rate in patients aged 80 years and older. Using multiple logistic regression analyses, prognostic factors for mortality were identified. Risk factors for death in the ICU included age, cardiovascular diseases, sepsis, adult respiratory distress syndrome and acute renal failure. Cancer did not appear as a risk factor. The mortality during the ensuing hospital stay, however, was significantly influenced by cancer as well as the aforementioned risk factors. When controlled for severity of illness, expressed by the level of organ system failure after 48 h of ICU treatment, only sex, sepsis and severity of illness showed significant influence on the mortality in the ICU, and only sex and severity of illness significantly influenced mortality during the ensuing hospital stay after discharge from the ICU.

Adult↗
PubMed1988

Planar and SPECT Tc-99m red blood cell imaging in hepatic cavernous hemangiomas and other hepatic lesions.

The utility of Tc-99m RBC imaging in the diagnosis of hepatic cavernous hemangiomas has been established. Of the 25 patients with various focal hepatic lesions evaluated, 16 were diagnosed as having hemangiomas: eight proven by surgery, two proven by angiography, and six proven by maintaining a stable clinical course ranging from 6 to 12 months with normal follow-up liver function tests. Although fourteen of these were detected by planar imaging, two were detected by SPECT only. Two patients with large hemangiomas had false-negative scans, whereas the remaining seven patients had other liver lesions.

Adult↗
PubMed1988

Disturbed relationship between urinary prostaglandin E2 excretion, plasma arginine vasopressin and renal water excretion after oral water loading in early hepatic cirrhosis.

An oral water load of 20 ml kg-1 body weight was given to 11 patients with early hepatic cirrhosis and to 16 healthy control subjects. Urinary output (V), free water clearance (CH2O), urinary excretion of prostaglandin E2 (PGE2) and F2 alpha (PGF2 alpha), and plasma concentration of arginine vasopressin (AVP) were determined before and during the first 4 h after loading. During basal conditions, PGE2 excretion was the same in patients (75 pg min-1, median, range 15-569) and controls (78 pg min-1, range 22-262), but during the first hour after water loading, PGE2 increased to a significantly higher level in cirrhotic patients (423 pg min-1, median) than in control subjects (162 pg min-1) (P less than 0.05). No difference in PGF2 alpha excretion was found between the two groups. Urinary output and CH2O were significantly lower after water loading in patients than in controls. Arginine vasopressin before water loading did not differ between patients and control subjects, but after loading it was unchanged in the patients, whereas a significant reduction (1.9 to 1.4 pmol l-1, P less than 0.01) was found in the control subjects. In controls, but not in patients, PGE2 was significantly positively correlated to V and CH2O, and negatively correlated to AVP after water loading. Thus, renal PGE2 excretion is increased and CH2O is decreased after water loading in patients with early hepatic cirrhosis, and a disturbed relationship seems to exist between PGE2 on the one hand, and AVP and renal water excretion, on the other, in these patients after water loading.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗