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Biomedical subjects

N Damsbo

Publications and source records attributed to N Damsbo.

At least 19 recordsLinked to original sources
PubMed2000

Tympanometry for diagnosis and treatment of otitis media in general practice.

OBJECTIVE: The aim of this study was to evaluate the role of tympanometry for diagnosis, treatment and follow-up of otitis media in general practice. METHODS: The results from otoscopy performed by 40 physicians in general practice in Vejle County, Denmark were combined with the clinical condition and this was recorded as the preliminary decision about diagnosis, treatment and follow-up. Subsequently, tympanometry was performed in 3176 children aged between 1 month and 16 years; a total of 6352 tympanometries. With this added knowledge, a final decision about diagnosis, treatment and follow-up was recorded. The practitioners were trained in performing tympanometry including the interpretation of the results. Simultaneously, they were involved in the establishment of guidelines for diagnosis, treatment and follow-up of otitis media in general practice. The main outcome measures were changes between preliminary and final decisions about diagnoses, treatments and follow-up regimens. RESULTS: Tympanometry was performed successfully in 87.7% of the children, and in 26.4% changes in diagnoses were found. However, tympanometry did not influence the distributions of the main outcome measures in the sample as a whole. Uncomplicated cases were checked in general practice and referrals to specialists were not increased. CONCLUSION: Tympanometry can be performed successfully in general practice after appropriate instruction. In 26.4% of children, the diagnoses were changed, which may result in more appropriate treatment and follow-up. Tympanometry is a clinically relevant supplement to the examination of a child in general practice.

Acoustic Impedance Tests↗
PubMed1999

[A screening test for depression in general practice. The COOP/WONCA chart].

Depressed patients in general practice may be difficult to identify. Questionnaires may be used for screening but some of the existing instruments are difficult to use and have only to a limited degree been introduced in general practice. In this study 798 patients' answers to the COOP/WONCA chart "Feelings" were compared to GPs' diagnosis according to ICD-10 criteria for depressive single episode (F32). At cut-off2/3 (slight/moderate problems) the chart had a sensitivity of 89% (76-100%) and specificity of 75% (72-78%). The predictive value of a positive test was not higher than 33% for any cut-off point and the predictive value of a negative test never less than 98%. A two-phased diagnostic strategy with the COOP/WONCA chart as step one is suggested as a possible and relatively simple way to optimize recognition of depressive patients in general practice.

Denmark↗
PubMed1997

[Antidepressive treatment in general practice--an interview study].

In order to elucidate potential problems concerning the use of antidepressants in general practice, 98 randomly selected antidepressant users from 12 general practices were interviewed. The primary indication for antidepressant treatment was depression (72 patients), partly regular depression (therapeutic/prophylactic treatment) (n = 39), partly depressive tendencies (n = 32) (one patient no information). Median treatment duration was three years; 25% had been in treatment for more than 10 years. The general practitioners judged the treatment problematic/unacceptable in 23 cases, largely because of uncertain indication or because other or no treatment was considered better for the patient. Side effects were modest. The patients often had a relatively high depression score and poor status according to the WONCA-scale. The use of low doses, long duration of treatment, and uncertainty about the relevance of the treatment are important features in the use of antidepressants by general practitioners. The use of antidepressants in general practice differs from the scientifically-based recommendations.

Adult↗
PubMed1996

Screening and treating depressed patients. A comparison of two controlled citalopram trials across treatment settings: hospitalized patients vs. patients treated by their family doctors. Danish University Antidepressant Group.

This study is a comparison across treatment settings of two previously published trials, namely the Danish University Antidepressant Group (DUAG) study on citalopram vs. clomipramine in hospitalized patients with major depression, and the Nordic citalopram vs. imipramine study of depressed patients treated by their family doctors. The Hamilton Depression Scale (HAM-D) had the same level of inter-rater reliability and construct validity in the two settings. Using a HAM-D score of 7 or less as the criterion for full two remission, clomipramine was superior to imipramine and citalopram. Using a reduction of the baseline HAM-D score by 50% or more as a response criterion, there were no differences between the three antidepressants after 5 or 6 weeks of treatment. Citalopram showed superior tolerability to the tricyclic antidepressants.

Citalopram↗
PubMed1995

Antidepressant treatment in general practice--an interview study.

OBJECTIVE: To elucidate potential problems concerning the use of antidepressants (AD) in general practice. DESIGN: Cross-sectional, descriptive interview study. SETTING: General practices, Odense, Denmark. SUBJECTS: Random sample consisting of 98 AD users from 12 general practices. MAIN OUTCOME MEASURES: Indication for AD treatment, justification of the treatment, duration of AD treatment, daily dose of AD, side effects, Hamilton depression rating, WONCA score. RESULTS: The primary indication for AD treatment was depression (72 patients), partly regular depression (therapeutic/prophylactic treatment) (n = 39), partly depressive tendencies (n = 32) (1 unknown). Median treatment duration was 3 years; 25% had been in treatment for more than 10 years. The general practitioners judged the treatment problematic/unacceptable in 23 cases, largely because of uncertain indication or because other or no treatment was considered better for the patient. The daily doses of AD were generally low. Side effects were modest. The patients often had a relatively high depression score and poor status according to the WONCA-scale. CONCLUSIONS: The use of low doses, long duration of treatment, and uncertainty about the relevance of the treatment are important features of the use of AD by general practitioners. There seems to be a discrepancy between the use of AD in general practice and the scientifically-based recommendations.

Adult↗
PubMed1994

[Budesonide in the treatment of mild asthma. A placebo-controlled multicenter study in general practice].

Fifty patients with mild asthma were randomized in a double-blind, parallel group design; 13 were protocol violators. Of the remaining 37, 20 patients were treated with budesonide, 17 with placebo. The Peak Expiratory Flow rate (PEF) was the main variable. In a diary, patients recorded PEF morning and evening, score of asthma symptoms and use of inhaled beta 2-agonist. Peak-flow and Goldberg's General Health Questionnaire were obtained at clinic visits. Parametric and non-parametric tests were used. All tests were two-tailed with a significance level of 0.05. The study proved that changes in the patients' PEF happened in the early phase of the treatment period. The increase in both morning and evening PEF and physical activity in the budesonide group were statistically significantly better than in the placebo group. There was no statistical difference between the two groups concerning the patients' general well-being as evaluated by Goldberg's General Health Questionnaire. No serious adverse events occurred. The conclusion is that patients with mild asthma had statistically significant effect on their morning and evening PEF and physical activity from treatment with a daily dose of 400 microgrammes budesonide given via Turbuhaler compared to treatment with placebo.

Administration, Inhalation↗
PubMed1994

Citalopram and imipramine in the treatment of depressive patients in general practice. A Nordic multicentre clinical study.

Two dose levels of citalopram, 10-30 mg and 20-60 mg, were compared with imipramine, 50-150 mg, in depressed patients treated in general practice. This was a multicentre study carried out in Denmark, Sweden, Norway, and Finland. The duration of treatment was 6 weeks with an optional continuation phase of a further 16 weeks. The patients were assessed by means of the Hamilton Rating Scale for Depression (HAMD), Clinical Global Impressions (CGI), and a visual analogue self-rating scale for depression. Observed and spontaneously reported adverse events were recorded. A total of 472 patients were entered into the study and 400 patients completed the 6 week trial period. A total of 297 patients completed the optional 22 week double-blind period. A clear reduction of the HAMD total scores was seen in all three treatment groups with no significant differences between groups. A reduction of the HAMD anxiety factor and sleep factor scores was also seen with no significant differences between treatments. The imipramine-treated patients showed a higher frequency of adverse events, especially the anticholinergic type, than citalopram-treated patients. Most patients entered into the continuation phase remained well.

Adolescent↗
PubMed1993

Drug related hospital admissions. Results from an intervention program.

As part of a high-intensity monitoring study of drug events as the cause of admission to departments of internal medicine, the effect of an educational intervention programme was studied. Two departments were included, one specialising in geriatrics and one that received patients by non-selected referral. The series consisted of 607 consecutive admissions studied before and 703 after the intervention. The drug events considered were adverse drug reactions and dose-related therapeutic failures, mainly due to non-compliance. A modest, statistically non-significant decrease in drug related hospital admissions (DRH) was seen, from 14% before to 13% after the intervention period. However, DRHs classified as definitely avoidable showed the significant decrease of 83%. There was no apparent relationship between the topics selected for the intervention programme and changes in the pattern of DRHs. No relationship between alterations in sales data and hospital admissions caused by a given drug could be demonstrated. A blinded external evaluation of case abstracts did not disclose any significant shift in the investigators' assessments. The intervention may have had an non-specific effect on avoidable DRHs.

Denmark↗
PubMed1992

Drug related admissions to medical wards: a population based survey.

1. In total 1999 consecutive admissions to six medical wards were subjected to a prospective high-intensity drug event monitoring scheme to assess the extent and pattern of admissions caused by adverse drug reactions (ADRs) or dose related therapeutic failures (TF), in a population-based design. The wards were sub-specialised in general medicine, geriatrics, endocrinology, cardiology, respiratory medicine and gastroenterology. 2. Considering definite, probable and possible drug events, the prevalence of drug related hospital admissions was 11.4% of which 8.4% were caused by ADRs and 3.0% by TFs. There were large inter-department differences. 3. The six classes of drugs most frequently involved in admissions caused by ADRs were anti-rheumatics and analgesics (27%), cardiovascular drugs (23%), psychotropic drugs (14%), anti-diabetics (12%), antibiotics (7%), and corticosteroids (5%). Noncompliance accounted for 66% of the TFs with diuretics and anti-asthmatics most frequently involved. 4. The pattern of drugs involved in ADRs was compared with the regional drug sales statistics. Drugs with a particularly high rate of ADR related admissions per unit dispensed were nitrofurantoin and insulin (617 and 182 admissions per 1,000,000 defined daily doses), while low rates were seen for diuretics and benzodiazepines (10 and 7 admissions per 1,000,000 defined daily doses). Confidence intervals were wide. 5. Patients who had their therapy prescribed by a hospital doctor had a slightly higher prevalence of drug events than those who were treated by a general practitioner (12.6% vs 11.8%). The reverse applied for drug events assessed as avoidable (3.3% vs 4.6%). Although these differences were not statistically significant, it may suggest general practitioners as the appropriate target for interventive measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Drug-related illness as a cause of admission to a department of respiratory medicine.

Three hundred and thirteen consecutive admissions to a department of respiratory medicine were evaluated in a prospective high-intensity monitoring scheme concerning adverse drug reactions or dose-related therapeutic failures as the contributing or sole cause of hospital admission. Eleven patients [3.5%, 95% confidence interval (CI) 2.0-6.2] were admitted because of adverse drug reactions. Only 3 of these patients manifested respiratory symptoms, while the remainder had various intercurrent nonpulmonary problems and were well known in the outpatient clinic, e.g. asthma or cancer patients. It is concluded that adverse drug reactions requiring admission rarely present as respiratory symptoms. Fourteen patient (4.5%, CI 2.7-7.4) were admitted because of dose-related therapeutic failures in all cases, except 2 with respiratory symptoms. Half of these were due to noncompliance. Analysis of theophylline samples taken on admission from 46 patients showed 25 (54%) to have concentrations below the therapeutic range of 55-110 microM, but contributed little to the identification of noncompliant patients. Eighty-three percent of the drug events were found to have been unavoidable. Nine patients admitted with acute asthma did not receive corticosteroids prior to admission (2.9%), all of which had therapy prescribed in general practice. The present study showed a comparatively low and hardly affectable prevalence of admissions caused by adverse drug reactions and dose-related therapeutic failure. However, therapeutic failure due to inappropriate choice of asthma medication, which was not included in this estimate, may be an important avoidable cause of admissions.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

Drug-related admissions to a department of medical gastroenterology. The role of self-medicated and prescribed drugs.

Three hundred and twenty-eight consecutive patients admitted to a department of medical gastroenterology were evaluated in a high-intensity study of drug-related hospitalizations (DRH). The drug events considered were adverse drug reaction and dose-related therapeutic failures (DTF). With regards to the 'definite' and 'probable' drug events, DRHs accounted for 26 admissions (7.9%; 95% confidence interval (CI), 5.2-11.4%), and with the additional inclusion of 'possible' drug events DRHs accounted for 39 admissions (11.9%; CI, 8.6-15.9%). Of these, five and seven admissions, respectively, were caused by DTF. Patients admitted because of drug events took significantly more drugs than others. An evaluation of the circumstances of the 26 'definite' or 'probable' DRH showed none to be 'definitely avoidable', 6 to be 'possibly avoidable', and 20 to be 'not avoidable' by efforts from the prescribing physicians. Gastroduodenal lesions causally related to non-steroidal anti-inflammatory drug (NSAID) or aspirin use accounted for 17 of the definite, probable, or possible DRHs (44%). Only 1 of the 11 cases related to NSAID use was rated as possibly avoidable by efforts from the health service personnel. In 13 cases self-medication with aspirin played a substantial role in the DRH. Self-medication was largely characterized by poor indication, uncontrolled use, polypharmacy, treatment of epigastric pain with aspirin, and the patient's unawareness of potential adverse reactions. This suggests the need for intensified information to the public concerning the adverse effects of aspirin and NSAID.

Adult↗
PubMed1991

Drug related events and drug utilization in patients admitted to a geriatric hospital department.

Two hundred ninety-four consecutive admissions to a geriatric department were evaluated for drug events as cause of admission. The drug events considered were adverse drug reactions (ADRs) and dose-related therapeutic failures. In 39 cases (13.3%), a definite, probable or possible drug event was a dominant or contributing cause of the admission (11.2% ADRs and 2.0% dose-related therapeutic failures). Five of these cases (1.7%) were judged to be due to errors in prescription and a further seven (2.4%) were found to have been avoidable by efforts exceeding the obligatory. There were no statistically significant differences between drug-related and non-drug related admissions in terms of age, sex, number of drugs taken at the admission or duration of hospitalization. ADRs in the geriatric patients are difficult to recognize and may be interpreted as senile loss of function. Sixty-seven percent of the patients took drugs with a sedative action, 68% took drugs with a hypotensive action, 67% took drugs with a potential for confusional states, 15% took drugs with a potential for depression, and 64% took drugs with a potential for constipation. A reduction of the number of drug-related hospital admissions by means of a large-scale intervention would be a difficult task for several reasons: no particular class of drugs caused the drug events, no particular mechanism dominated, no particular group of doctors were responsible for the drug events, and only a part of the drug events were judged to be avoidable.

Aged↗
PubMed1990

Drug related hospital admissions: the role of definitions and intensity of data collection, and the possibility of prevention.

Three hundred and thirty-three consecutive patients in a medical ward were evaluated in a high-intensity monitoring scheme for drug events as a cause of hospitalization. Taking into consideration only 'definite' and 'probable' drug events, we found 36 cases (10.8%) of all admissions to be drug-related hospitalizations (DRH). Of these, 8.1% were adverse drug reactions and 2.7% were therapeutic failures due to ineffective dosage. In 8 cases (2.4%) the drug event could definitely have been avoided, and a further 13 cases (3.9%) were considered to have been potentially avoidable if appropriate measures had been taken by the health service. In 19 cases (53%) the referring physician was unaware of the drug-related problem. Those patients admitted because of a drug event were taking significantly more drugs than other individuals. The avoidable drug events pointed to the primary health care physicians as the appropriate targets for preventive measures in terms of intensified drug education. The study demonstrated that a reliable estimate of the DRH rate requires active data collection by a qualified health service worker in close collaboration with the patient's family doctor in cases of suspected DRH.

Adolescent↗
PubMed1990

Drug related admissions to a cardiology department; frequency and avoidability.

Three hundred and sixty-six consecutive patients admitted to a department of cardiology were evaluated for drug events as a cause of admission. The drug events considered were adverse drug reactions (ADR) and dose-related therapeutic failures (DTF). 'Definite' or 'probable' drug events accounted for 15 admissions (4.1%, 95% confidence limits 2.3-6.7%), of which eleven were ADR and four were DTF. With the inclusion of six 'possible' drug events, the rate of drug-related hospitalizations (DRH) was 5.7%. DRHs were characterized by a preponderance of acute admissions and elderly patients. Hypokalaemia (less than 3.5 mM) was observed in 27 (16%) patients receiving diuretics, and could be related to four cases of arrhythmias (two 'probable' and two 'possible' ADR). The average serum potassium level was similar in diuretic treated patients with or without drugs to counteract hypokalaemia, irrespective of the drugs chosen. Among the 15 'definite'/'probable' DRHs, five were considered to be due to an error in prescription, and a further five cases were judged to have been avoidable had appropriate measures been taken by prescribing physicians. A DRH educational intervention programme should primarily deal with non-compliance or with prescription of diuretics or digoxin, since these problems constitute the majority of cases of DRH. No specific group of doctors could be targeted as responsible for DRH, avoidable or not.

Cardiovascular Agents↗
PubMed1989

[The suicidal patient. 1. Occurrence and relevance of contact with a general practitioner prior to the suicidal actions].

A multipractice investigation was undertaken concerning suicidal behaviour. Sixty-six patients committed suicide and 227 attempted suicide. During the month prior to the suicidal actions, 2/3 of the patients had had contact with their general practitioners. Only very few had been in contact with a psychiatric department or with a practising psychiatrist during the same period. In a few cases, the general practitioner found that the most recent consultation was relevant in cases of patients who committed suicide. 28% of the patients who committed suicide and also were seen by their general practitioners within the last month suffered from serious somatic disease. Where the cases of attempted suicide were concerned, the general practitioners considered that 40% of the most recent consultations were relevant. In order to improve attention to suicidal signals, other forms of cooperation between the primary sector and hospitals, eg in the form of district psychiatric teams, are suggested.

Denmark↗
PubMed1989

[The suicidal patient. 2. Methods of suicide, diagnoses and social conditions].

By means of a multipractice investigation in which 347 general practitioners participated, 293 schemata were collected about patients who had undertaken suicidal acts. The material consists of 66 suicides and 227 attempted suicides. By and large, the sex and age distributions correspond to those in previous investigations. The number of attempted suicides in this investigation was only half of that anticipated. This may be due to lapse, seasonal variations, underrepresentation of urban practice etc. Strikingly many patients undertook acts in this material without having psychiatric diagnoses and the psychiatric diagnosis did not appear to play any part as regards whether the suicidal act lead to suicide. The methods employed appear otherwise to reflect development in society and pharmacotherapy. Where men were concerned, it appears that suicide is relatively most common among widowers, unemployed and early retirees while, where women were concerned, divorcees and early retirees were most frequently involved. Attempted suicide is most frequently carried out by unemployed men and by divorced and early retirees of both sexes. This investigation cannot indicate any definite occupational group which involves a risk as regards suicidal acts and economical factors appear only to play a part where attempted suicide is concerned.

Adolescent↗