PubMed Health⌕ Search

Biomedical subjects

E Hein

Publications and source records attributed to E Hein.

11 recordsLinked to original sources
PubMed1993

[Attitudes of Danish physicians to consumer charges in the health care system].

Consumer charges in connection with visits to a doctor are common in a number of countries often used for comparison but are not employed in Denmark. The Danish Medical Association is opposed to consumer charges in health care and a test sample out of 1,000 of the Medical Association chosen at random showed a definite majority opposed to consumer charges. A minority of the profession was in favour of a nominal fee of less than 70 Danish crowns (approximately 7 pounds) for visits to a doctor while scarcely 4% considered that the fee should be more than 100 Danish crowns (approximately 10 pounds). 40% of the participants considered that the consumer charge would have to exceed 100 Danish crowns before it was of any consequences for the health of the patient. In addition, this study revealed that female doctors were more opposed to consumer charges than their male colleagues. At present, more women than men commence the medical curriculum in Denmark and it must therefore be anticipated that the percentage of women in the Danish Medical Association will soon exceed the present 30%. The resistance os the Danish Medical Association to consumer charges in health care will, therefore, probably be retained.

Attitude of Health Personnel↗
PubMed1993

[Attitude of Danish physicians to the health care services].

In recent years, Danish society has focused on the service and the information available for patients in health care. A test sample out of 1,000 members of the Danish Medical Association selected at random revealed that the majority had positive attitudes to service and information in health care. The study also indicated that doctors do not consider that any particular dress code is particularly appropriate but consider that personal appearance and the way patients are addressed are individual matters. This individualistic attitude which is consistent with Mintzberg's sociological structural theory does not invariably seem appropriate.

Attitude of Health Personnel↗
PubMed1989

Interobserver agreement and accuracy of bedside estimation of right and left ventricular ejection fraction in acute myocardial infarction.

Ninety-eight patients with acute myocardial infarction were examined by 3 clinicians who, independently of each other, gave an estimate of left ventricular (LV) and right ventricular (RV) ejection fraction (EF) in each patient. Their estimates were based on physical examination, chest x-ray, electrocardiogram, patient history and clinical course during admission. Ejection fractions were estimated as belonging to 1 of 4 categories: normal (LVEF greater than or equal to 0.53, RVEF greater than or equal to 0.57), mildly reduced (LVEF 0.40 to 0.52, RVEF 0.45 to 0.56), moderately reduced (LVEF 0.30 to 0.39, RVEF 0.35 to 0.44) or severely reduced (LVEF less than 0.30, RVEF less than 0.35). Radionuclide ventriculography was carried out immediately after the physical examination. LVEF was correctly estimated in 43% of all examinations, deviated from radionuclide LVEF by 1 LVEF category in 45% and by 2 LVEF categories in 12%. The 3 clinicians agreed on estimated LVEF in only 32% of the patients. RVEF was correctly estimated in 67% of the examinations, but none of the clinicians identified greater than 43% of the relatively few patients with reduced radionuclide RVEF and they greatly disagreed as to who among the patients had a reduced RVEF. Previous myocardial infarction, electrocardiographic infarct location, Killip class, physical signs of left- and right-sided heart failure, radiographic pulmonary congestion and cardiomegaly were analyzed to determine which were the most helpful in predicting LVEF and RVEF. The results disclosed that several variables, traditionally believed to be reliable indexes of reduced ventricular function, were surprisingly poor predictors of LVEF and RVEF.

Adult↗
PubMed1989

Symptoms and signs of heart failure in patients with myocardial infarction: reproducibility and relationship to chest X-ray, radionuclide ventriculography and right heart catheterization.

102 patients with myocardial infarction (MI) were examined by three clinicians, who independently recorded the following symptoms and signs: dyspnoea, a displaced apex beat, S3-gallop, rales, neck vein distension, hepatomegaly, and dependent oedema. Chest X-ray, radionuclide ventriculography, and (in 40 patients) right heart catheterization were carried out immediately after the physical examination. The clinicians frequently disagreed as to the presence of physical signs of heart failure in individuals. Moreover, these signs were of limited value in identifying patients with pulmonary vascular congestion on chest X-ray, reduced left or right radionuclide ventricular ejection fractions, enlarged ventricular volumes or haemodynamic evidence of ventricular dysfunction. We conclude that clinicians frequently disagree in the recognition of physical signs of heart failure, and that these signs have an unpredictable relationship to radiographic, radionuclide and haemodynamic measures of ventricular performance in patients with MI. Nevertheless, physical signs are useful in identifying patients with high risk of cardiac death.

Adult↗
PubMed1989

Acute hemodynamic response to intravenous enoximone: an animal study and preliminary report in infants after cardiac surgery.

In light of previous studies in adults, we considered that enoximone could be useful in treating children with therapy-resistant cardiovascular insufficiency. Prior to clinical administration, we investigated the cardiovascular properties of enoximone in anesthetized and ventilated piglets characterized by small stroke volume and high heart rate. Enoximone was administered intravenously in increasing doses (0.25, 0.5, and 1 mg/kg). The animals were monitored with heart rate, systemic and pulmonary arterial pressures, and continuous electromagnetic flow. Enoximone induced a dose-dependent flow increase, whereby heart rate and systemic arterial pressure changed only slightly. With regard to persistent pulmonary hypertension in newborns, enoximone was also used in piglets to investigate the effects on endotoxin-induced, dopamine-resistant pulmonary hypertension. Enoximone (1 mg/kg i.v.) was given immediately after E. coli endotoxin (1.5 micrograms/kg i.v.) and inhibited the endotoxin-induced, eicosanoid-mediated pulmonary hypertension, whereas during infusion of dopamine (2 mg/kg/h), no drop in systemic blood pressure could be observed. In the clinical study, six infants with post-cardiac surgery low output syndrome despite maximal catecholamine inotropic support were given enoximone (i.v. bolus of 0.2, 0.5, or 1 mg/kg followed by continuous infusion of 7.5-10 micrograms/kg/min). Continuously measured mixed-venous oxygen saturation increased in a dose-related manner. Cardiac output increased significantly by 28%, accompanied by a decrease of arteriovenous oxygen content difference and O2 utilization ratio. The preliminary results show that intravenous enoximone produces acute useful hemodynamic effects in infants, in particular allowing a weaning of vasoactive amines.

Animals↗
PubMed1984

Evaluation of intravenous radionuclide angiography in detection of occlusive disease of the iliac arteries.

Radionuclide angiography (angioscintigraphy) of the iliac arteries was performed in 173 patients consecutively referred for arterial insufficiency of the legs. In 83 of the patients femoral angiography was also performed. The interobserver variation was evaluated by the agreement indices, kappa (K) and weighted kappa (Kw). For angiography the interobserver agreement was high (K and Kw 0.65 and 0.77 respectively). For angioscintigraphy the agreement between observers was fair (K = 0.52, Kw = 0.68), and equal to the intraobserver agreement (K = 0.55, Kw = 0.65). The comparison between angioscintigraphy and angiography gave K-values of 0.22-0.31 and Kw-values of 0.37-0.48. The nosographic sensitivity of angioscintigraphy was 61%, the nosographic specificity was 93%, and the predictive value for both a positive and a negative test was 83%. The prevalence of occlusion or severe stenosis was 34%. Inguinal pulse palpation detected 48% of iliac occlusions. It is concluded that the reliability of angioscintigraphy in the diagnosis of iliac arterial occlusive disease is acceptable for a non-invasive, rapid, inexpensive and widely available screening procedure. Although anatomical details are not visualized the information obtained is useful for the detailed planning and choice of subsequent diagnostic and therapeutic procedures. The method is well suited for repeat studies and may be modified to include the femoral arteries.

Adult↗
PubMed1981

Conflict.

Explore the source record for details and available documents.

Communication↗