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Biomedical subjects

H A Holm

Publications and source records attributed to H A Holm.

At least 19 recordsLinked to original sources
PubMed1992

[Quality assurance of medical education--a prerequisite for good medical practice].

Assured quality of medical education is a prerequisite for high quality medicine. Quality assurance of medical education implies a well-planned assessment of the structure, process and outcome of education based on defined standards and objectives, and draws heavily on a thorough knowledge of how people learn. Learning in medicine shares common features at all levels, from undergraduate to continuing education. Three core elements are the context of learning, availability of information, and opportunities for elaboration (educational counselling, mentorship, interaction with peers) as a basis for linking practice and theory. A quality assurance programme must examine all these factors and suggest remedies when appropriate. The upgrading of educational research in medicine, and valuing and recognition of teaching within the profession, are important factors in promoting continuous improvement of the quality of medical education.

Education, Medical↗
PubMed1992

[Hospital training--for good and for evil. An interview study among general practitioners].

50 Norwegian doctors selected at random from the population of general practitioners who were neither recognized specialists nor enrolled in the specialist training programme, were interviewed by telephone about the need for postgraduate hospital training and the obstacles involved. Most of the doctors expressed a strong need for the education provided by such training. The most important obstacles to hospital training were personal domestic reasons, concern for the functioning of the practice and concern for the emotional problems the hospital work might cause. Strategies are suggested to make it easier, in practice and emotionally, to do hospital training.

Adult↗
PubMed1991

[Treatment of hypercholesterolemia in adults. A treatment program 1991].

A Norwegian programme for treatment of hypercholesterolemia in adults was published in 1988. In 1990 the Norwegian Medical Association appointed a group to modify this programme in the light of current knowledge, and taking into consideration the recommendations of the Consensus Conference on Cholesterol of October 1989. The present article presents this modified programme. When evaluating the risk of developing coronary heart disease a combined risk score should be calculated which also takes into account important risk factors other than cholesterol, such as family history, sex, age, smoking, hypertension, presence of diabetes etc. For those considered to be at high risk of developing coronary heart disease, the programme gives guidelines on how to intervene. With regard to treatment, special emphasis is placed on changing the diet.

Adult↗
PubMed1990

[Cholesterol measurement in general practice--Norwegian general practitioners' attitudes and estimation of their own practice].

In 1988 a group of Norwegian experts published a programme for treatment of patients with increased cholesterol. The programme recommended dietary counselling when plasma cholesterol exceeded 5 mmol/l. In the autumn 1988 the Norwegian National Health Association started a campaign on cholesterol for health personnel. In order to find out to what extent general practitioners adhered to the recommendations of the programme, a random sample of 100 general practitioners were sent a questionnaire before and after the campaign. The results showed no significant differences in the doctors' attitudes towards diagnosis and treatment of patients with increased plasma cholesterol. Both before and after the campaign the plasma cholesterol levels at which they would initiate follow-up, dietary counselling or drug therapy were 1-2 mmol/l above the levels recommended by the expert group. The attitude of the general practitioners was more conservative than the recommendations of the programme. The interval between the information meeting and the post study was only six months. It is a complicated process to change attitudes and practice routines, and the time required may be longer than six months. Furthermore, the recommendations of the programme were questioned by other doctors, which reduced its impact.

Adult↗
PubMed1990

Dose adjusted heparin treatment of deep venous thrombosis: a comparison of unfractionated and low molecular weight heparin.

Two studies have been done to establish recommendations for dosage and dose adjustment in the treatment of deep vein thrombosis (DVT) with low molecular weight heparin (LMWH). In the first, 56 patients were randomized in a double blind study to be treated either with unfractionated heparin (UFH) or LMWH s.c. every 12 h. Initial doses were given according to age and sex, disregarding bodyweight, and the dose was then adjusted when the peak plasma heparin concentration fell outside the desired range of 0.5-0.8 anti-FXa U/ml. There were fewer dose adjustments in the LMWH group. The correlation between injected dose (U/kg bodyweight) and the heparin concentration was higher in the LMWH group (r = 0.59) than in the UFH group (r = 0.38). The results suggest that, in order to obtain the desired heparin concentration, the initial dose of LMWH should be about 100 U/kg bodyweight every 12 h. In the second, open study, this dosage plan was followed in 15 patients. The peak heparin concentration on Day 2 ranged from 0.40 to 0.75 anti-FXa U/ml and adjustment was only required in 3 patients. Day to day variation in peak heparin activity in the individual patient varied little (CV 11-22%), and there was no accumulation. The results indicate that plasma heparin concentration is more predictable using LMWH than UFH, and they point to definite advantages in the use of LMWH in a bodyweight adjusted dosage.

Aged↗
PubMed1988

Group training of general practitioners: evaluation based on participants' expectations of an educational programme.

Since 1985, the Norwegian Medical Association (NMA) has offered a 5-year specialist training programme in general practice. For two of these years the doctors take part in a group-based educational programme with bi-weekly meetings of 3 hours' duration. The evaluation study reported here had a dual purpose: to provide the groups with a method for exploring the group members' expectations of the programme, and to measure to what extent the programme had actually met these expectations within the first of the 2 years. Thirty-one of 38 groups, first established in spring 1986, responded on a postal inquiry where they were asked to list up to 10 features they expected to find in the educational programme. These expectations were rated by the groups on a five-point scale, where 5 denoted a fully met expectation. The four most frequent features analysed were: (1) increased comprehension of the characteristics and practice of general medicine; (2) good group collaboration; (3) facilitating the acquisition of medical knowledge; and (4) evaluation of clinical problems and patient management. Expectations for the first two of these features were nearly fully met, while the two others were met to a lesser degree. This type of evaluation seemed to be a useful tool for improving the group's way of functioning.

Attitude of Health Personnel↗
PubMed1987

Monitoring of heparin therapy: should heparin assays also reflect the patient's antithrombin concentration?

Chromogenic substrate (CS) assay of heparin may be performed with or without addition of antithrombin (AT) to the test plasma. Both types of assay are used for monitoring of heparin therapy, reflecting either heparin activity (heparin act), or heparin concentration (heparin conc) when AT is added. In plasma samples from 43 patients treated with intravenous heparin for DVT, the ratio between heparin act and heparin conc varied from 0.36 in patients with AT plasma concentration below 0.50 U/ml, to 0.85 in patients with AT above 1.00 U/ml (mean ratio 0.61). A formula expressing heparin act as a function of AT and heparin concentration in the test plasmas of the patients was used to calculate heparin act of the total material comprising 280 patients. Mean heparin act and heparin conc were both significantly correlated to clinical outcomes (bleeding complications, pulmonary embolism and phlebography score). For monitoring heparin therapy, guidelines for plasma heparin activity or concentration ("therapeutic ranges") are requested. When using a heparin act assay, the heparin dose needed in patients with low plasma AT concentration to reach a fixed therapeutic range, may imply undue risk of bleeding. On the other hand, when a heparin conc assay indicate plasma heparin conc within therapeutic range, antithrombotic activity may still be inadequate in patients with low plasma AT concentration.

Antithrombins↗
PubMed1986

Subcutaneous heparin treatment of deep venous thrombosis: a comparison of unfractionated and low molecular weight heparin.

In a double-blind study, patients with phlebographically proven deep venous thrombosis (DVT) were treated with subcutaneous injections twice a day of either unfractionated heparin (UH; n = 27) or low molecular weight heparin (LH; n = 29) for 7 days, and the dose was adjusted until therapeutic range was reached, according to a chromogenic substrate anti-Xa assay. Forty-eight percent of the LH group did not need dose adjustment as compared to 24% of the UH group. During the course of heparin administration, deviation from initial heparin activity was frequent in both groups, but mean activity did not indicate a cumulative effect in either group. There was 1 incidence of pulmonary embolism (LH) and only 1 minor bleeding episode (UH). Half of the patients in both groups were phlebographically improved. We conclude that subcutaneous heparin treatment with UH or LH appears safe and convenient.

Adult↗
PubMed1985

Heparin assays and bleeding complications in treatment of deep venous thrombosis with particular reference to retroperitoneal bleeding.

Bleeding complications occurred in 30 (11%) out of 280 patients who received continuous heparin infusion for deep venous thrombosis (DVT). 22 (8%) had minor while 8 patients (3%) had major bleeding complications (1 intrathoracic [fatal], 2 gastrointestinal and 5 retroperitoneal). Heparin activity, in daily drawn blood samples, was determined by four assays (chromogenic substrate [CS] assay, activated partial thromboplastin time [APTT], thrombin time with citrated plasma [CiTT] and thrombin time with recalcified plasma [CaTT]). The differences in median heparin activity between patients with minor bleeding and patients with no bleeding did not reach significance for any of the tests. In patients with major bleeding, the differences were significant with the CS (p = .011) and the CaTT (p = .030) assays. Patients with retroperitoneal bleeding had significantly increased median activity judged by all four assays: CS (p = .002), CaTT (p = .003), APTT (p = .010), CiTT (p = .029). The difference was most pronounced after four days of heparin treatment, but there was a considerable overlap with patients without bleeding.

Adult↗
PubMed1985

Changes in plasma antithrombin (heparin cofactor activity) during intravenous heparin therapy: observations in 198 patients with deep venous thrombosis.

Plasma antithrombin (AT) measured as heparin cofactor activity decreased 0.16 +/- 0.13 U/ml (mean +/- SD) in 198 patients who received heparin infusion during 1 wk for deep venous thrombosis (DVT). The decrease was weakly, but significantly correlated to heparin dose (r = 0.15, p = 0.02) and to heparin plasma concentration (r = 0.12, p = 0.05). In patients with subnormal AT at start of heparin treatment, AT decreased less and tended to normalize at the end of heparin infusion, suggesting increased synthetic rate. The decrease in AT was apparently unrelated to the extension or the fate of the thrombus, and also unrelated to other patient and disease characteristics apart from a significantly higher decrease in diabetics. 5 out of 9 patients with AT values below 0.60 U/ml had serious disease, and 1 died from pulmonary embolism (PE) shortly after cessation of heparin (AT 0.22 U/ml). We conclude that the main decrease in AT occurs during the initial 3 d of heparin treatment. If AT stays above 0.70 U/ml after 3 d of treatment, further AT monitoring is hardly indicated.

Adult↗