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Biomedical subjects

J Bring

Publications and source records attributed to J Bring.

At least 19 recordsLinked to original sources
PubMed2000

The use of clinical information in diagnosing chronic heart failure: a comparison between general practitioners, cardiologists, and students.

In a clinical judgement analysis study, 27 general practitioners, 22 cardiologists, and 21 medical students assessed 40 case vignettes with regard to the probability of heart failure, in order to study the weights of different kinds of information (cues) measured by the regression coefficients in a multiple regression model. The vignettes were based on actual patients. We found that diagnostic accomplishment and diagnostic strategies were surprisingly similar on the group level, but very different on the individual level. The most important cues for the participants were cardiac enlargement and pulmonary stasis. Strategies in which cardiac enlargement was the predominating cue led to a higher diagnostic accomplishment; a third of the participants used such strategies. The cues given in the vignettes could have been utilized more efficiently; cardiac enlargement seems to be more important and "classical" symptoms less important for predicting heart failure than the participants realize.

Adult↗
PubMed2000

Endotoxin release from Escherichia coli after exposure to tobramycin: dose-dependency and reduction in cefuroxime-induced endotoxin release.

OBJECTIVE: To study the release of free endotoxin from Escherichia coli exposed to varying concentrations of the penicillin-binding protein (PBP) 3-specific beta-lactam antibiotic cefuroxime, the aminoglycoside tobramycin, and a combination of the two, and to test the relationship between bacterial killing rate and endotoxin release. METHODS: A clinical isolate of Escherichia coli in logarithmic phase was exposed to 0.1, 2, 10, and 50 x minimum inhibitory concentration (MIC) of cefuroxime, tobramycin, and a combination of the two. Samples for viable counts and endotoxin analysis were drawn immediately before and after the addition of the antibiotics and at 1, 2, 4, 6, and 24 h. All experiments were performed in triplicate. For the analysis of endotoxin, a chromogenic limulus amoebocyte lysate assay was used. RESULTS: Endotoxin liberation was found to be proportional to the number of killed bacteria for each antibiotic regimen at each concentration level justifying the endotoxin-liberating potential to be expressed as release of endotoxin per killed bacterium, an expression that was independent of the inoculum size. At all concentration levels there was a statistically significant difference between the treatments, with the highest release of endotoxin per killed bacterium for cefuroxime, lower for tobramycin and the lowest for the combination of the two drugs (P < 0.001). With increasing doses, there was a significant reduction (P < 0.001) in the propensity to release endotoxin. When the bacterial killing rate was correlated to the propensity to release endotoxin in bacteria exposed to tobramycin or the combination of tobramycin and cefuroxime, a significant negative correlation was found (P < 0.01). This reduction in endotoxin release was not caused by an unspecific endotoxin binding of tobramycin. CONCLUSIONS: Addition of tobramycin reduced the cefuroxime-induced endotoxin release per killed bacterium to a level which was even lower than that of tobramycin alone in spite of an increased killing rate. Increasing concentrations of tobramycin led to reduction in endotoxin release, which may be of benefit when dosing aminoglycosides once daily.

Anti-Bacterial Agents↗
PubMed2000

Factors influencing GPs' decisions on the treatment of hypercholesterolaemic patients.

OBJECTIVE: To study factors influencing GPs' decisions to prescribe lipid-lowering drugs and how their judgements agree with the Swedish guidelines on hyperlipidaemia. DESIGN: Postal questionnaire. SETTING: Primary health care. Authentic written case descriptions of patients, all with a cholesterol value of at least 5.5 mmol/l and with variations in seven other variables (cues) in a Clinical Judgement Analysis (CJA) design. SUBJECTS: Sixty randomly selected primary health care doctors in the south-eastern Stockholm area. RESULTS: Thirty-eight doctors answered the questionnaire. Coronary heart disease had the highest influence on judgements, followed by cholesterol. The majority of doctors used two or three of the eight cues. Doctors differed markedly in their strategies. One in four did not use coronary heart disease in their judgements, even though all patients with this risk factor present (12/40) should receive pharmacological treatment, according to the guidelines. Doctors who adhered to the guidelines in this respect were younger than those who did not. The GPs' insights into their own strategies were good. CONCLUSIONS: The results indicate that doctors use very different judgement strategies for drug prescription concerning patients with hypercholesterolaemia. A fairly large subgroup of the doctors did not include coronary heart disease in their judgements, in contrast to the present guidelines.

Adult↗
PubMed1999

Serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) are elevated in advanced stages of non-Hodgkin's lymphomas.

The serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) were measured in 116 patients with non-Hodgkin's lymphomas (NHL) tested previously for soluble intercellular adhesion molecule-1 (sICAM-1). In contrast to Hodgkin's disease and chronic lymphocytic leukaemia, the sVCAM-1 levels in NHL patients were not significantly different from the levels of healthy controls (n = 31). However, sVCAM-1 was elevated in advanced stage disease, i.e. stages III + IV. Elevated serum levels of sVCAM-1 were associated with significantly poorer disease-free (p = 0.024) and overall (p = 0.02) survival. sVCAM-1 correlated poorly with other known prognostic variables (LDH, sTK and beta 2m) and with sICAM-1. None of the tested markers added prognostic information for disease-free survival independently of Ann Arbor stage and B-symptoms. The expression of VCAM-1 and ICAM-1 in tumour biopsies from 15 patients representing 7 different histologies were examined and compared with the serum levels of the soluble adhesion molecules. No correlation was found between the adhesion molecule expression by vascular endothelium and the corresponding serum levels.

Adult↗
PubMed1999

Cervical spine fractures in the elderly: factors influencing survival in 65 cases.

To evaluate whether a cervical spine fracture increases the death risk in elderly patients, and to define risk factors, we studied the survival of 65 patients (26 women) with a mean age of 77 (66-99) years. 8 of the patients were tetraparetic. In 35 patients, the upper cervical spine was fractured. 7 patients suffered from ankylosing spondylitis. Severe co-morbidity was present in 16. Survival status and the date of death were retrieved from the government official personal registry. The expected survival was calculated from data retrieved from the Swedish National Board of Health and Welfare. Variables having a possible relation with survival (i.e., a p-value < 0.10 when entered into a Kaplan-Meier survival analysis) were used in a Cox multiple regression survival analysis. 53 (24-105) months after injury, 25 of the 65 patients had died. The survival was significantly lower than the expected values. Severe co-morbidity (risk ratio: 5,6), neurological injury (6,4), high age (1,1), and ankylosing spondylitis (5,5) proved to be significant risk factors for death. Thus, a cervical spine fracture may lead to earlier death in a patient with a severe co-morbidity. A neurological complication constitutes a risk also for a previously healthy individual. Patients having ankylosing spondylitis (with increased death risk) run a higher than normal risk of sustaining a cervical spine fracture.

Age Distribution↗
PubMed1998

How do GPs use clinical information in their judgements of heart failure? A clinical judgement analysis study.

OBJECTIVE: To study general practitioners' (GP) clinical diagnoses of heart failure. DESIGN: A Clinical Judgement Analysis study. SETTING: Primary health care. SUBJECTS: Twenty-seven GPs from nine health centres in Stockholm County. INTERVENTION: Forty-five case vignettes, based on actual patients from two health centres in Stockholm, were presented to each GP. For each case vignette, the GPs judged the probability of heart failure. MAIN OUTCOME MEASURES: The GPs' assessments of the probability of heart failure in the case vignettes. The GPs' utilization of clinical information in their judgement strategies, as measured by the regression coefficients in a multiple regression equation, with the probability assessments as dependent and the clinical criteria as independent variables. RESULTS: The variation between the GPs' assessments of the probability of heart failure was considerable. The judgemental strategies differed between the doctors, the most important variables for most of them being lung and heart X-rays and a history of myocardial infarction. CONCLUSIONS: With new treatment recommendations, it has become increasingly important to identify patients with heart failure. This study demonstrates large differences in GPs' diagnoses of heart failure. An important source of this variation is the differences in how they make use of clinical information.

Aged↗
PubMed1998

Serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) are elevated in advanced stages of non-Hodgkin's lymphomas.

The serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) were measured in 116 patients with non-Hodgkin's lymphomas (NHL) tested previously for soluble intercellular adhesion molecule-1 (sICAM-1). In contrast to Hodgkin's disease and chronic lymphocytic leukaemia, the sVCAM-1 levels in NHL patients were not significantly different from the levels of healthy controls (n=31). However, sVCAM-1 was elevated in advanced stage disease, i.e. stages III+IV. Elevated serum levels of sVCAM-1 were associated with significantly poorer disease-free (p = 0.024) and overall (p = 0.02) survival. sVCAM-1 correlated poorly with other known prognostic variables (LDH, sTK and beta2m) and with sICAM-1. None of the tested markers added prognostic information for disease-free survival independently of Ann Arbor stage and B-symptoms. The expression of VCAM-1 and ICAM-1 in tumour biopsies from 15 patients representing 7 different histologies were examined and compared with the serum levels of the soluble adhesion molecules. No correlation was found between the adhesion molecule expression by vascular endothelium and the corresponding serum levels.

Adult↗
PubMed1997

[Interim analyses--a scientific dilemma].

Interim analyses are nowadays an important part of clinical trials. Unfortunately, there is no consensus about when and how to conduct these analyses. In the field of statistics different schools promote different statistical methods. Since the choice of method can have a major impact on the results it is essential to be well informed about the problems, associated with interim analyses. One such problem concerns communication between statisticians and physicians. Close collaboration is required to facilitate good clinical trials. This paper highlights some of the statistical difficulties and relates these to the problem of collaboration between statisticians and physicians.

Clinical Trials as Topic↗
PubMed1997

Survival and daily physical activity in patients treated for advanced midgut carcinoid tumors.

BACKGROUND: Prospects for survival and quality of life ought to influence treatment strategies in patients with midgut carcinoids. METHODS: A total of 121 patients with midgut carcinoid received a combined medical and surgical treatment from 1980 to 1993. In all, 158 operations were undertaken for removal of mesentericointestinal lesions and occasional liver metastases or as repeat intervention for abdominal complications. Survival was analyzed together with estimates of daily physical activity during follow-up. RESULTS: Cause of death (63 patients) included carcinoid heart disease (41%) and cachexia (mesentericointestinal entrapment, 35%). Median survival was 11 years in patients with irresectable mesenteric metastases, 7 years with liver metastases, and 1 year with extraabdominal spread. Extensive liver metastases or substantial weight loss (9 kg or greater) reduced survival to a median of 4 to 5.5 years, and surgically treated intestinal ischemia reduced survival to a median of 8 years. Patients with carcinoid syndrome survived a median 7 years, those with 5-hydroxyindoleacetic acid values greater than 500 mumol/24 hr or a valvular heart disease survived a median of 5 years, those with heart failure a median of 2.5 years. Most patients retained an acceptable daily physical activity; impairment occurred in cases of malnutrition, high 5-hydroxyindoleacetic acid values, or heart valve fibrosis, and activity was markedly reduced in the presence of extraabdominal metastases or overt heart disease. CONCLUSIONS: Favorable survival statistics and the maintenance of daily physical activity support active medical and surgical management in patients with advanced midgut carcinoids.

Activities of Daily Living↗
PubMed1997

What is the long term value of multiphasic health screening and the initial judgement of benefit?

The long term effects of multiphasic health screening (MHS) are rarely studied. In 1964 a random sample of 546 women and 544 men born 1899, 1904, 1909, 1914 or 1919 equally distributed on cohorts from the Swedish town Eskilstuna were invited to examination. For several reasons 167 persons (15%) did not participate in the study. In 1969 the whole sample was invited to a second MHS together with a control group that had not been exposed to MHS. Furthermore, 79 of those alive 1989 born 1899 or 1904 and examined 1964 and 1969 were reexamined. Over all survival rate 1989 for those examined 1964 was for males 18% and for females 35%. Screening instruments 1964 and 1969 were questionnaires, laboratory tests, antropometric measurements, ECG, measurement of blood pressure, chest radiography, peak expiratory flow (PEF), tonometry and fundoscopy of the eyes, audiometric screening, dental, gynecological and general clinical examination. Systolic hypertension for both sexes, low PEF and smoking, low cholesterol in women were negatively related to survival. Of 18 diabetics only one was alive at follow-up. No association was found between BMI and mortality for men, but some (1964 p < 0.01; 1969 p < 0.05) for women. Altogether 87 individuals were 1969 judged to have had some benefit of the MHS in 1964, 40 of them substantial. This was, however, not statistically significantly associated with improved survival. Of the reexamined survivors 86% reported to be generally satisfied with their life situation. The prognostic value of graded benefit was analysed in some detail. The survival to age 85 in the group allotted any benefit was somewhat less good (37%) than in the group with no benefit (44%). The difference did not reach statistical significance.

Aged↗
PubMed1996

Outcome after limited posterior surgery for thoracic and lumbar spine metastases.

The efficacy of 'limited posterior surgery' for metastases in the thoracic and lumbar spine was studied prospectively in 51 patients (32 men and 19 women, mean age 64 years). The most common primary tumors were prostate, breast, and renal carcinoma, 37 patients had metastases in the thoracic spine and 14 in the lumbar spine. Indications for surgery were severe pain or neurologic deficit. Of the 46 patients with neurologic symptoms, 25 were unable to walk. Surgery was confined to direct or indirect decompression and stabilization with a pedicle screw fixator over few segments as possible. Pain, as well as a variety of functional performance parameters and residential status were registered preoperatively and after surgery at 3, 6, 9, and 12 months, and at 6-monthly intervals thereafter. Pain was rated by the patient on a Visual Analog Scale, and functional performance was assessed with the Eastern Co-operative Oncology Group (ECOG) Performance Status Scale. We had no perioperative neurologic deterioration or death. Nineteen of the 25 nonambulatory patients regained their walking ability. Postoperative pain relief was significant and lasting over time. Nearly half of the patients attained improvement in functional performance. The median survival was 8 months. Older age and intact postoperative walking ability were positive factors for survival.

Bone Screws↗
PubMed1996

Spinal fractures in patients with ankylosing spondylitis.

Thirty-one consecutive patients with ankylosing spondylitis and spinal fractures were reviewed. There were 6 women and 25 men with a mean age of 60 +/- 11 years; 19 had cervical and 12 had thoracolumbar injuries. Of the patients with cervical fracture, two had an additional cervical fracture and one had an additional thoracic fracture. Three trauma mechanisms were identified: high-energy trauma in 13 patients, low-energy trauma in 13 and insufficiency fracture in 5. One-third of the patients suffered immediate neurological impairment, a further one-third developed neurological impairment before coming for treatment and only one-third remained intact. Two patients with thoracolumbar fractures had deteriorated neurologically due to displacements during surgery at other hospitals. All patients were treated operatively except the two patients with two-level cervical fractures, who were managed in halo vests. In the cervical spine both anterior and posterior approaches were employed. In the thoracolumbar spine the majority of the patients were initially treated using a posterior approach only. Complications were common. Of the 27 patients with neurological compromise, 10 had remained unchanged; 12 had improved one Frankel grade; 4 had improved by two Frankel grades; 1 had improved by four Frankel grades. We conclude that even minor trauma can cause fracture in an ankylosed spine. A high proportion of patients with spinal fractures and ankylosing spondylitis have neurological damage. The risk of late neurological deterioration is substantial. As the condition is very rare and the treatment is demanding and associated with a very high risk of complications, the treatment of these patients should be centralised in special spinal trauma units. A combined approach that stabilises the spine from both sides is probably beneficial.

Cervical Vertebrae↗