Biomedical subjects

K J Dahl

Publications and source records attributed to K J Dahl.

5 recordsLinked to original sources

PubMed2001

[Blood pressure records in general practice--expectations and reality].

BACKGROUND: The effect of antihypertensive medication on cardiovascular diseases is based on results achieved in prospective and controlled clinical studies. Comparable results in clinical practice can be achieved only when the quality of management for subjects with high blood pressure is comparable with the quality achieved in clinical studies. MATERIAL AND METHODS: This study consists of two parts; an attempt to implement an computer-based clinical decision support system for management of hypertension in primary health care in two counties in Norway, and a questionnaire survey among doctors in primary care and specialists in internal medicine in hospitals in other counties. We asked what they expected would be the result of the specific implementation strategy for the computer-based program. The objectives were to evaluate the results of the implementation strategy and to compare these results with expectations expressed in the filled-in questionnaires by doctors without any obligations to the main study. RESULTS: A total of 175 doctors were invited to implement the clinical decision support system. 85% responded; 44% of these, or 37% of the invited doctors, were willing to participate. After 12 months with recurrent visits by one of the authors, only six out of 74 doctors participating in the intervention study still used the program. The questionnaire were completed and returned by 203 doctors, who expected that 55% of the invited doctors would accept the invitation following the implementation strategy used. In general the validity of the information given by the questionnaire was poor and unreliable. INTERPRETATION: We conclude that introduction of a computer-based clinical decision support system is difficult in a busy primary care setting. Availability and simplicity are crucial requirements, and doctors would need financial compensation if they were to use such a system.

Adult↗

PubMed1999

[White coat hypertension].

The prevalence of white coat hypertension, which is defined by hypertension in the physician's office, and normotension at other times, may be as high as 30% in a hypertensive population. Since white coat hypertension is associated with a low degree of end-organ damage and, accordingly, a potential favourable prognosis, the use of ambulatory blood pressure recordings has increased with the aim of identifying hypertensive subjects who may not need medical treatment. White coat hypertension is, however, not yet clearly defined, and there seems to be evidence that such subjects may have reduced vasodilator capacity. Low arterial compliance, a feature associated with hypertension in the elderly, seems to be another characteristic. Hence, although the prognostic significance of white coat hypertension has not yet been completely defined, there is accumulating evidence that ambulatory blood pressure recordings may serve as an important tool in the risk assessment of subjects with arterial hypertension.

Age Factors↗

PubMed1998

[Mild hypertension].

The Norwegian Report on Evaluation and Treatment of Mild Hypertension and The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure were both published at the end of 1997. The prevalence of hypertension and the proportion of the total adult population on antihypertensive medication is about 20% and 10% respectively in both countries. In both reports patients are assessed and graded according to various risk factors for developing cardiovascular disease. However, in the American recommendations it seems that this will only have marginal impact on the number of persons with uncomplicated mild hypertension who will be recommended drug therapy. The Norwegian guidelines recommend drug therapy only where there is a minimum of 20% absolute risk (30% for the age group 60-69 years) of developing cardiovascular disease or of death within ten years. Drug therapy is not recommended for persons over 70 years with uncomplicated mild hypertension, whereas treatment is advised in cases of complicated mild hypertension. It is therefore estimated that drug therapy will be recommended for less than 50% of patients with uncomplicated mild hypertension, as opposed to almost 100% according to the American guidelines.

Adult↗

PubMed1996

Pharmacokinetics of transperitoneal insulin transport.

Seven type I insulin-dependent diabetic patients on continuous ambulatory peritoneal dialysis treatment were selected for this study. Each patient participated in three different 6-hour 'single-dwell' studies on 3 consecutive days. A mean dose of 33 +/- 1.3 U Insulin Actrapid Human was given intraperitoneally each day. The procedures for intraperitoneal insulin administration were: (1) with 1,000 ml Ringer lactate; (2) with 1,000 ml 3.86% glucose-containing dialysate, and (3) into an empty peritoneal cavity. The calculation of the intraperitoneal volume was done with a single injection indicator dilution technique in which 100 kBq radioiodinated serum albumin (RISA) was added into the fluid prior to instillation. Free insulin and glucose were analyzed at 16 time intervals in blood and in dialysate during each dwell. After drainage the peritoneal cavity was rinsed with 1,000 ml Ringer lactate followed by two consecutive 5-hour exchanges with 2,000 ml glucose-containing dialysate. Recovery of insulin and RISA was measured in rinsing fluid and in sampled dialysate during the 6-hour dwell. The kinetic calculations made for insulin were disappearance rate (mU/min) from the peritoneal cavity, and appearance rate in circulating blood. After drainage and rinsing, 66.0 +/- 10 and 71.8 +/- 9.8% of the insulin instilled had disappeared after 6 h from the glucose fluid and from the Ringer solution respectively and did not differ significantly. However, the estimated disappearance rate from the peritoneal cavity was significantly higher in Ringer than in glucose from the time interval 120 to 360 min. A high and peak-shaped insulin concentration in the plasma was found following insulin injection into an empty peritoneal cavity, and was significantly higher than when insulin was dissolved in a 1,000-ml fluid volume. However, a higher blood concentration was also found when Ringer was instilled than when a hyperosmolal glucose solution was instilled. A high first-pass elimination in the liver is suggested. In conclusion, fluid volume and also the osmolality of the solution in the peritoneal cavity decreases the transport rate, but not the bioavailability of insulin given intraperitoneally. Both a high peak shape and a continuous insulin appearance in blood can be achieved. It is suggested that there is a high first-pass elimination of insulin during absorption from the peritoneal cavity. However, the values are uncertain and extended investigations must be done.

Adult↗

PubMed1995

Effect of fluvastatin for safely lowering atherogenic lipids in renal transplant patients receiving cyclosporine.

The lipophilic 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors have been associated with rhabdomyolysis in cyclosporine-treated treated patients, indicating an interaction of drugs. We therefore studied the safety and efficacy of the hydrophilic HMG-CoA reductase inhibitor fluvastatin in 14 cyclosporine-treated renal transplant patients. To qualify for inclusion, total cholesterol after dietary stabilization had to be > 240 mg/dL. Prior to starting active medication, patients underwent a 4-week placebo period. Fluvastatin was given in a dose of 20 mg once daily for 12 weeks, which was increased to 20 mg twice daily for a further 8 weeks. Fluvastatin reduced total and low density lipoprotein cholesterol in all patients at both dosages whereas no effect on high density lipoprotein cholesterol was observed. Triglyceride levels were lowered at week 20. Incremental dosages of fluvastatin did not affect cyclosporine concentration and no adjustment of cyclosporine dosage was necessary. The higher doses of fluvastatin also had no effect on renal function as judged by serum creatinine levels. Creatine phosphokinase remained unchanged throughout the study. No serious side-effects were observed. In conclusion, the hydrophilic HMG-CoA reductase inhibitor fluvastatin at either 20 or 40 mg/day appears to be both safe and effective in lowering atherogenic lipids in renal transplant patients.

Adolescent↗