Danish medical journal
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Danish medical journal · Oct 2015
Randomized Controlled Trial Comparative StudyNeuromuscular blockade for improvement of surgical conditions during laparotomy: protocol for a randomised study.
During laparotomy, surgeons frequently experience difficult surgical conditions if the patient's abdominal wall or diaphragm is tense. This issue is particularly pertinent while closing the fascia and placing the intestines into the abdominal cavity. Establishment of a deep neuromuscular blockade (NMB), defined as a post-tetanic-count (PTC) of 0-1, paralyses the abdominal wall muscles and the diaphragm. We hypothesised that deep NMB (PTC 0-1) would improve surgical conditions during upper laparotomy as compared to standard NMB with bolus administration. ⋯ The study is funded in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp.
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Danish medical journal · Oct 2015
The effect of generic switching on concerns about medicine and non-persistence among Danish adults in a general practice setting.
Generic substitution means that one medicinal product is replaced by another product containing the same active substance. Generic substitution has existed in Denmark since 1991, and pharmacies are obliged to substitute a generic version of a medication, unless the general practitioner (GP) has explicitly stated that it should not be done, or the patient insists on having the more expensive drug. Generic prescribing, that is prescribing the substance name, is not allowed in Denmark. Some specialists and patients cast doubt on the real interchange-ability of generics, although international studies have shown that most patients have positive attitudes towards generic substitution. The severity of disease is known to be associated with patients being more concerned about generic substitution. The generic substitution scheme implies changing from one drug to another that may vary in brand-name, form, size, colour and taste. Speculations have been raised as to whether these medication changes between generic brands or from brand-name drugs to generics or vice versa may cause patient concerns. Qualitative studies have shown problems in recognising the substituted medicine and lack of confidence in the identical effect of the substitutable medicines. Several studies have focused on one specific drug group such as antihypertensive drugs. However, the influence of generic switching may affect concerns about medicine differently, depending on drug categories. Research on generic substitution often focuses on incident drug users, whose prescription is substituted at their first redemption. Most of these studies did not identify significant associations between generic substitution and non-adherence, but one study assessing the association between generic substitution and persistence showed reduced persistence. So far, studies of the effect of generic drug substitution on drug continuation have not focused on patients' overall experience of generic switches within one specific drug. ⋯ The overall results from the thesis showed that experience with earlier generic switches of a specific drug was associated with making a future generic switch and did not cause additional concerns about the index medicine. The effect of previous experience with generic substitution has been shown to be drug-specific. The third study showed that patients, who are first-time switchers of a specific drug, were at higher risk of becoming non-persistent compared to never switchers and those having experienced previous generic switching.
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Danish medical journal · Oct 2015
Clinical epidemiological studies of women undergoing surgery for urogynaecological disorders.
This PhD thesis was performed during my employment at the Center for Clinical Epidemiology, Odense University Hospital and University of Southern Denmark, 2010-2013. It comprises an overview and four papers, two published in international peer-reviewed scientific journals, one under review, and one in draft. ⋯ Due to a high completeness and data of high validity the DugaBase offers a unique possibility for continuing quality assessment of urogynaecological surgery in Denmark, as well as for future research. Surgeries for UI and POP performed in Danish women were effective in alleviating symptoms of UI and POP and improvement in quality of life based on patient reported outcome measures. Our pharmacoepidemiological studies showed that preoperative use of symptom-relieving drugs and antibiotics for UTI were strong risk factors of postoperative usage of the same drugs.
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Danish medical journal · Sep 2015
Randomized Controlled TrialIncretin hormones and maturity onset diabetes of the young--pathophysiological implications and anti-diabetic treatment potential.
Maturity onset diabetes of the young (MODY) designates monogenic forms of non-autoimmune diabetes characterised by autosomal dominant inheritance, non-insulin dependent diabetes at onset and diagnosis often before 25 years of age. MODY constitutes genetically and clinically heterogeneous forms of diabetes. More than 8 different genes are known to cause MODY, among which hepatocyte nuclear factor 1 alpha (HNF1A) (MODY3) and glucokinase (GCK) (MODY2) mutations are the most common. ⋯ This effect was greater with glimepiride, although insignificant, but at the expense of a higher risk of hypoglycaemia (predominantly mild). GLP-1RAs may have a place in treatment of patients with HNF1A-diabetes, especially when hypoglycaemia is a problem. Future studies are required to clarify this.
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Danish medical journal · Sep 2015
Arterial waveform-analysis is of limited value in daily clinical practice in the intensive care unit.
It is difficult to identify the patients who will respond to fluid therapy, but the arterial waveform-derived variables have reasonably predictive values for fluid responsiveness. However, the patient must fulfil a number of prerequisites for these variables to be valid. We assessed the proportion of intensive care unit (ICU) patients with shock who at the time of resuscitation fulfilled the prerequisites for using the arterial waveform-derived variables. ⋯ Less than a quarter of the ICU patients with shock fulfilled all the prerequisites for the use of arterial waveform-derived variables to predict fluid responsiveness. Thus, these variables may be of limited use during resuscitation in the ICU.