Biomedical subjects

D Holm

Publications and source records attributed to D Holm.

9 recordsLinked to original sources

PubMed2003

[Manipulation of blood pressure self-monitoring protocol values: a randomized controlled study].

Treatment monitoring of hypertensive patients can be achieved using data from blood pressure measurements obtained in follow-up visits, from sporadic 24 hours ambulatory blood pressure monitoring (ABPM) and from patients' self-measurements. Blood pressure self-measurement values seem to be the easiest to obtain. A disadvantage is the uncertainty about the accuracy with which patients report these values. In this randomised clinical trial with 48 hypertensive outpatients we compared reported self-measurements with the stored values in the devices. One group was unaware of the storing capacity of the device. All patients measured their blood pressure twice in the morning and twice in the evening over a period of 14 days. Endpoints of our analysis were the comparison of the number of measurements performed and the missing and manipulated values between the two groups. The non-informed group measured blood-pressure more frequently than the informed group (76.1 vs. 58.8 measurements; p = 0.0005). Compared to the informed group, the number of agreements between stored and reported values was smaller in the non-informed group (95.7% vs. 87.5%; p = 0.026) whereas reporting of fictional data only occurred in the non-informed group (0 vs. 55; p = 0.002). Our data show, that use of blood-pressure devices with a memory function increases the accuracy of reported self-measured values and can lead to better treatment monitoring.

Adult↗

PubMed2001

[Comparison and reproducibility of 3 indirect methods for measuring blood pressure].

It is rare to find systematic comparisons of various methods for measuring blood pressure. This study aimed to compare blood pressure measurements performed by the doctor, by the patient and on a 24-hour basis with regard to their reliability and reproducibility. A total of 84 patients were included in the study. All patients had their blood pressure measured at the doctor's office twice on day 1 and 10, by themselves and with a 24-h blood pressure measuring unit. The doctors obtained the highest means. The mean systolic and diastolic value taken on the day 1 was higher by 13 mmHg and 8 mmHg than the ABPM value or the measurement obtained by the patient at home, respectively. This difference was still present at the end of the study (7 mmHg and 5 mmHg compared to ABPM and 9 mmHg and 6 mmHg compared to the patient's measurements, respectively). The values obtained by 24-h measurement and the patients themselves showed a better reproducibility than the doctor's measurements. Both methods are thus suitably good for use in diagnostics and therapy monitoring. Compared to the patient's own measurements, the 24-hour blood pressure measurement is less dependent on the patient's reliability.

Adult↗

PubMed2000

DEMS - a second generation diabetes electronic management system.

Diabetes electronic management system (DEMS) is a component-based client/server application, written in Visual C++ and Visual Basic, with the database server running Sybase System 11. DEMS is built entirely with a combination of dynamic link libraries (DLLs) and ActiveX components - the only exception is the DEMS.exe. DEMS is a chronic disease management system for patients with diabetes. It is used at the point of care by all members of the diabetes team including physicians, nurses, dieticians, clinical assistants and educators. The system is designed for maximum clinical efficiency and facilitates appropriately supervised delegation of care. Dispersed clinical sites may be supervised from a central location. The system is designed for ease of navigation; immediate provision of many types of automatically generated reports; quality audits; aids to compliance with good care guidelines; and alerts, advisories, prompts, and warnings that guide the care provider. The system now contains data on over 34000 patients and is in daily use at multiple sites.

Diabetes Mellitus↗

PubMed1999

[24-hour blood pressure monitoring in diagnosis and therapy of arterial hypertension].

UNLABELLED: In a prospective open multicentric study two groups (A and B) of patients with essential hypertension used different methods for blood pressure measurements under treatment with the calcium channel blocker nifidipine GITS 30 and 60 mg. Fifty-one patients were followed for 6 weeks. Results of 24 hour blood pressure monitoring at visits after 2, 4 and 6 weeks were only known to physicians of group A. In this group the patients took their blood pressure twice per day. RESULTS: Both methods for measurement showed an overall decrease of blood pressure in the course of therapy. The mean values at the medical visits were always higher than the average measurements by 24 hour monitoring or the self assessment of blood pressure. The latter two blood pressure values tended to agree favorably. The differences between measurements during medical visits and measurements taken at home or during normal activity show that measurements in the doctor's office may lead to overestimation of hypertension. Without the results from blood pressure monitoring 4 (22%) of the patients in group B were treated without reason. Nifedipine GITS was well tolerated. Nine patients (16%) had undesired drug effects leading to a premature halt of treatment in 3 of them.

Adult↗

PubMed1995

[Circadian profile of blood pressure and heart rate in geriatric patients with and without dementia].

In this report, investigations on circadian blood pressure fluctuations in geriatric patients with or without senile dementia are reported. 24 patients of a nursing home in Zurich have been included in the study. In senile patients without dementia, persistence of circadian blood pressure rhythm, including a nocturnal decrease of blood pressure, could be demonstrated. In very old patients, however, reduced day-night amplitudes or loss of day-night rhythm, respectively, were observed. In the group of demented patients and in a subgroup including only patients with Alzheimer's disease, loss of circadian blood pressure rhythm and a lacking drop of nocturnal blood pressure values were found, while diurnal rhythmicity of the heart rate remained unchanged. Furthermore, our results demonstrate that there was no circadian blood pressure rhythm detectable in the five patients with Parkinson's syndrome (with or without dementia). The results of this study suggest that degenerative processes of the central nervous system interfere with circadian blood pressure rhythm.

Age Factors↗

PubMed1995

[Nutritional knowledge of patients in the hypertension clinic. An evaluation using the "Nutrition IQ'].

In this study the nutritional knowledge of 117 patients attending a hypertension clinic was evaluated with the use of the 'Nutrition IQ' questionnaire developed by the National Heart Lung, and Blood Institute. Overweight was identified as a risk factor for hypertension by 98% of the subjects, but more than 10% of the subjects did not identify weight reduction as an important therapeutic tool in the control of hypertension. Around 30% of the patients misjudged the importance of weight reduction in the treatment of hypertension as compared to a low salt diet. 25% believed that a salt reduction will always normalise hypertension. Only 5% of the subjects failed to identify exercise and caloric restriction as the major strategies for weight control. More than two thirds of the patients believed that skipping meals is the best way to reduce energy intake. Carbohydrates were wrongly identified as the major factor for weight gain by 50% of the subjects. The same patients did not recognize reduction in fat intake as the major nutritional tool to maintain or reduce weight. Only 25% of the subjects knew that polyunsaturated fatty acids do have the same caloric content per weight as saturated fatty acids. The nutrition IQ questionnaire can be used as an easy and quick screening method of the nutritional knowledge of patients in a hypertension clinic. The data confirm that there is still a large gap between the knowledge of a certain nutritional (risk) factor and its implementation in daily life, and suggest that patient education should be targeted more on life-style issues.

Adult↗

PubMed1994

Morning versus evening administration of nifedipine gastrointestinal therapeutic system in the management of essential hypertension.

The nifedipine gastrointestinal therapeutic system (GITS) is a recently developed controlled-release formulation for once-a-day dosing. We evaluated the influence of morning versus evening administration of the drug in a randomized double-blind cross-over study including 15 essential hypertensives. Five patients had to be excluded from blood pressure analysis because of noncompliance (three cases) or intolerable side effects (two cases). To assess the exact duration of the antihypertensive efficacy noninvasive automatic ambulatory blood pressure monitoring was performed. After a placebo period patients were given 30 mg nifedipine GITS either at 1000 or 2200 hours. Twenty-four-hours systolic and diastolic blood pressure profiles documented a sustained antihypertensive effect of both nifedipine regimens throughout the whole period without affecting the circadian rhythm. Statistical analysis revealed no significant difference between morning and evening administration. Two patients stopped their medication because of intolerable side effects (fatigue and muscle cramps, respectively). Two more cases suffered from mild reversible headache which provoked no discontinuation of the drug. In conclusion our results document a sustained antihypertensive efficacy of 30 mg nifedipine GITS in patients with moderate essential hypertension. Time of administration has no impact on day- and nighttime blood pressure control.

Aged↗

PubMed1992

[Acceptance of 24-hour blood pressure determination].

In interviews with 247 patients acceptance and behaviour during 24-hour-ambulatory blood-pressure recording were studied. In contrast to previous assumptions it was shown that the blood-pressure profile was not recorded during normal activities for a great part of patients. Very often the patients reduced their activity over the day. Our results show that for wider distribution and applications of this procedure the measuring devices have to be improved. A substantial part of patients experienced the ambulatory blood-pressure recording as an comfortable, such that one of eight patients declined a further recording and 20% of the patients complained about disturbed sleep.

Activities of Daily Living↗

PubMed1979

Bile duct diameter and diagnostic reliability at cholangiography.

Cases of exploratory choledochotomy with widened bile duct as the indication have been assessed with respect to missed bile duct concretion in a retrospective study covering a period of five years. During this period 2,000 cholecystectomies were performed. The 110 cases, in which (a) pre-exploratory cholangiography was completely normal apart from a diameter of more than 10 mm, (b) exploratory choledochotomy was performed, and (c) secondary cholangiography had been carried out, were studied in detail. No calculi were demonstrable either at exploratory surgery or secondary cholangiography. With a good radiographic technique it does not seem likely that bile duct concretions would be missed in widened ducts at otherwise normal operative cholangiography--at any rate not with bile duct diameters up to 20 mm.

Cholangiography↗