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Biomedical subjects

L Aabakken

Publications and source records attributed to L Aabakken.

At least 19 recordsLinked to original sources
PubMed1992

[Decision to withdraw cardiopulmonary resuscitation at Norwegian hospitals].

We present a survey on the use of do-not-resuscitate orders in Norwegian hospitals based on mailed questionnaires. 559 doctors, at least one from every somatic hospital in Norway responded. Do-not-resuscitate orders were issued by 92% of these doctors. There were large differences, however, as to who made the decision, who was involved in the decision-making, the consequences of a do-not-resuscitate order, and how the orders were documented. Formal rules for do-not-resuscitate orders are needed.

Cardiopulmonary Resuscitation↗
PubMed1992

[Use of the R-concept in a medical department].

Do-not-resuscitate orders issued in a medical department were studied by retrospective evaluation of 195 consecutive deaths in the department in 1991. No attempt at resuscitation was recorded in 171 patients. In these cases, do-not-resuscitate orders were documented in 67 only. For more than half of the orders, no reason was given in the medical record, and partial orders not to resuscitate were found in five patients only, none of whom were resuscitated. No difference was found in use of do-not-resuscitate orders between intensive-care units and regular wards, between patients above and patients below 80 years of age, or between patients with and patients without cancer. We suggest extended use of do-not-resuscitate orders in our department, and better documentation of the orders. Written guidelines have been established for this purpose.

Adult↗
PubMed1992

[Mucosal lesions associated with antiphlogistics--treatment and prevention].

Gastrointestinal side effects associated with nonsteroidal, anti-inflammatory drugs are well known, but recent data suggest that the small and large bowel are target organs in addition to the gastroduodenal mucosa, although the clinical significance of changes in permeability and of mucosal inflammation is unknown. Inhibition of prostaglandin synthesis remains the major pathogenetic hypothesis for the entire gastrointestinal tract, but additional mechanisms are probably involved. Ulcers that occur during non-steroidal anti-inflammatory drug therapy can be treated in the same way as other peptic ulcers, but the duration of treatment should be extended if the non-steroidal anti-inflammatory drug cannot be withdrawn. Prophylactic therapy with H2-antagonists or prostaglandin analogues may be justified in selected high risk individuals.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

[Development and use of a database for gastroenterologic endoscopy].

With no commercially available endoscopy database manager available, a standalone system for gastroenterological endoscopy departments has been developed since 1985 through joint efforts of gastroenterologists and dedicated programmers. The present system was implemented for daily use January 1989 and, to date, approximately 19,000 examinations have been recorded. Nurses and office assistants carry out administrative work, but the physician enters the endoscopic data, partly as free text, partly as structured data via automated menus and a mouse. In addition to the immediate printout of the result, valuable data are stored in the computer for administrative and research purposes. Mean data entering time for the physician was four minutes 17 seconds, and altogether eight minutes 40 seconds was spent on the computer system for each patient served.

Database Management Systems↗
PubMed1992

Review article: non-steroidal, anti-inflammatory drugs--the extending scope of gastrointestinal side effects.

The gastrointestinal side effects of non-steroidal, anti-inflammatory drugs extend beyond the duodenal bulb, and comprise a variety of lesions in all parts of the gut. Gastroduodenal ulceration is quantitatively dominant, although a major part of these lesions probably go unnoticed and heal spontaneously. Adaptation has been demonstrated for acetylsalicylic acid, and may be of importance for other substances as well. Non-steroidal anti-inflammatory drugs (NSAIDs) may induce relapse of inflammatory bowel disease. Permeability changes and mucosal inflammation are found in the small and large bowel in the majority of subjects taking NSAIDs, although the clinical significance is still not clear. Ulceration and perforation do, however, occur in this part of the gut as well. Treatment of NSAID-associated ulceration is similar to traditional ulcer treatment, possibly with extended treatment duration if the NSAID is continued. Prophylaxis is of some value, but is not required for every patient receiving an NSAID.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

Changes in the gastrointestinal mucosa after long-distance running.

Two groups of long-distance runners were investigated for the effect of marathon running on the gastrointestinal mucosa. In one group gastric erosions with bleeding were found in five of nine subjects, mostly localized to the corpus region. The relative gastric blood flow measured by endoscopic laser Doppler flowmetry was slightly decreased in the cardia region (from 7.0 to 5.8; p less than 0.05) but unchanged in the other parts of the stomach, including the erosive lesions. In another group (n = 8) all the subjects showed a substantial increase in the urinary excretion of 51Cr-labeled ethylenediaminetetraacetic acid after oral intake, which indicates an increase in the intestinal permeability. There is reason to suggest that long-distance running affects the integrity of the gastric and the intestinal mucosa.

Adult↗
PubMed1992

Gastroduodenal lesions associated with two different piroxicam formulations. An endoscopic comparison.

This endoscopic study was performed to compare the gastroduodenal endoscopic findings after short-term treatment with plain and enteric-coated piroxicam tablets. Sixteen healthy male volunteers (mean age, 22 years; range, 19-27 years) were included in a double-blind, randomized study in which 20 mg piroxicam was given once daily for 2 weeks as plain tablets or enteric-coated tablets in a crossover fashion. The washout period was 5 weeks, and endoscopy was performed before each treatment period to ensure base-line conditions. Endoscopic evaluation of the stomach and duodenum was performed, with separate registration of the duodenum distally to the duodenal bulb. Visual analogue scales of 150 mm were used for grading the mucosal lesions, with separate registration of mucosal injection and erosive and haemorrhagic lesions. A 5-point scale (Lanza scale) was also used, to compare the two scoring systems. A significantly lower lesion score was found with the enteric-coated formulation for all endoscopic variables in both scoring regions. The sum of visual analogue scale scores in the stomach/duodenal bulb after treatment was 121 mm and 74 mm, respectively (p < 0.01), and in the middle and distal duodenum the corresponding figures were 54 mm and 23 mm (p < 0.01). The fixed-point scoring gave identical conclusions, as did the separate scoring by a different investigator evaluating the same endoscopies. Subjective symptoms were similar for the two formulations, and no carryover effects were detected. We conclude that enteric coating of piroxicam tablets may offer a means of protecting the gastroduodenal mucosa in short-term treatment of healthy subjects.

Adult↗
PubMed1992

Naproxen-associated gastroduodenal toxicity: enteric coated granules versus plain tablets.

Two naproxen formulations were compared with regard to gastroduodenal endoscopic findings. Using a dose of 500 mg bid for one week, plain tablets were compared to enteric coated granules in a gelatine capsule in a randomized, cross over, double-blind, double dummy study in 16 healthy, male volunteers. Endoscopic evaluation revealed no difference between the two formulations. Since previous studies with enteric coated naproxen tablets indicated a favourable side effect profile compared to plain tablets, the present data indicates that enteric coated formulations are not all alike, and should be studied individually.

Adult↗
PubMed1992

NSAID-associated gastrointestinal damage: methodological considerations and a review of the experience with enteric coated naproxen.

Various methods are available for investigating gastrointestinal adverse effects of NSAIDs. Upper endoscopy is regarded a gold standard for controlled studies, but the grading and categorization of the visual impression of mucosal changes is complicated. Faecal blood loss represents another aspect of the toxicity, but quantitative measurements require the cumbersome procedure of 51Cr-labelling of red blood cells. For monitoring distal gut effects, permeability tests can be applied, and combination of tracer substances may further enhance the method. Measurements of electrical potential differences over the gastric mucosa are also available to monitor functional aspects of the gastric mucosal integrity. Controlled endoscopic trials have indicated an advantage of enteric coated naproxen tablets over plain tablets. Distal transfer of the toxicity by small bowel release of the active substance, has not been confirmed by permeability tests.

Endoscopy, Gastrointestinal↗
PubMed1992

Gastrointestinal bleeding associated with the use of non-steroidal, anti-inflammatory drugs--symptomatology and clinical course.

The symptoms associated with admission for gastrointestinal haemorrhage were studied in relation to the intake of non-steroidal, anti-inflammatory drugs (NSAIDs) within fourteen days prior to admission. In a prospective, two-year study we included only those with bleeding due to gastroduodenal ulcers or haemorrhagic erosive gastritis. In 94 patients with a median age of 74 years, NSAID use was stated in 54, but the symptoms in these subjects (degree of epigastric pain, nausea or heartburn) were no different from those without previous NSAID use. Correspondingly, no difference was seen as to the clinical course of the bleeding.

Adult↗
PubMed1991

[Psychomotor physical therapy--patients' starting point and their evaluation of the therapeutic results].

Psychomotor physiotherapy is a technique which aims, through relief of muscular tension and inhibited breathing, to give the patient a better understanding of the connection between mental and somatic reactions, establish improved coping patterns. In a three-year, prospective registration of 152 patients referred to psychomotor physiotherapy the expectations of the patients were evaluated, along with the presented symptoms. After 6-12 months of treatment 75% experienced a relief of symptoms, and 50% a change in symptom profile. At follow-up of 109 patients after 2 1/2 years we found a significant improvement in symptoms as well as in parameters for everyday coping, and a marked reduction in use of drugs. There was a correlation between an academic education and response to treatment.

Adult↗
PubMed1991

The SADE system: an endoscopic database manager.

The development of the SADE database manager was commenced in 1985 since no commercially available systems were suited for the needs of a large endoscopy unit. Over a period of five years, this database was programmed, revised and enhanced through the joint efforts of gastroenterologists and programmers, the SADE system being implemented for daily use on 1 January 1989. The patient administration and medical record modules are fully implemented and functional, while the statistical module has only recently been finished. The present features of the system are described, and the limitations discussed. Instant report generation and direct access to previous medical data are the most immediate benefits of the system. The initial intention to have structured anamnestic data had to be modified to suit the need for flexibility and ease of free text input by the users.

Computer Systems↗
PubMed1991

SADE database for endoscopic procedures: aspects of clinical use.

The time aspects of daily use of a clinical database system in an endoscopy department were studied. The SADE database system for endoscopic procedures was introduced for daily use at Ullevål Hospital on 1 January 1989. The average weekly programme of the endoscopy unit includes 57 gastroduodenoscopies, 23 colonoscopies and 12 ERCP/EPTs. During three consecutive weeks of the study the mean physician input time was 4 min 17 sec per patient (range 57 sec to 15 min), individual variation depending mainly on the extent of the report. Assistants spent a mean time of 4 min 23 sec for each patient. Thus, a total of 8 min 40 sec was spent for every patient seen. Endoscopic units should analyze their routines and needs before introducing an electronic data base manager.

Database Management Systems↗
PubMed1991

Gastrointestinal bleeding: dyspeptic symptoms and clinical course in relation to use of non-steroidal antiinflammatory drugs.

To study the symptoms of NSAID-associated gastroduodenal bleeding, 94 patients (median age 71 years, range 19-90), were included in a prospective, clinical trial where hematemesis or melena from gastroduodenal ulceration or haemorrhagic/erosive gastritis were the inclusion criteria. NSAID use within one month was studied in relation to subjective symptoms prior to admission and to clinical course of the episode. Significantly fewer of the NSAID users (n = 54) than the non-users (n = 40) had experienced prior peptic ulceration or dyspeptic symptoms. Otherwise, no differences were seen between users and non-users, as regards pre-admission epigastric pain, heartburn or nausea. Also, the clinical course was similar in the two groups. We also found sporadic and regular NSAID use to be similar in this respect. These data do not support the alleged masking of ulcer symptoms by NSAIDs in bleeding ulcers.

Adult↗
PubMed1990

NSAID-associated gastroduodenal damage: does famotidine protection extend into the mid- and distal duodenum?

Eighteen healthy volunteers were included in a cross-over, double-blind study where 500 mg naproxen b.d. was given for 1 week with 20 mg famotidine b.d., 40 mg nocte or placebo. Endoscopic evaluation of the gastroduodenal mucosa was performed before and after each treatment period, with separate evaluation of the mid- and distal duodenum. 51Cr-EDTA-permeability tests were done to study effects on the mid- and distal gut, and, in addition, symptom registration was performed. The mucosal damage was significant in all treatment periods, and a statistically significant reduction was seen with 20 mg famotidine b.d. for erosive lesions in the stomach/duodenal bulb region as well as for the sum of damage score in the mid- and distal duodenum. The reduction was considerable in a few subjects with extensive duodenal damage. The reduction was considerable in a few subjects with extensive duodenal damage. Intestinal permeation increased significantly in all periods, and was not reduced by famotidine. Symptoms were modest and equal in all periods.

Adult↗
PubMed1990

51Cr-ethylenediaminetetraacetic acid absorption test. Effects of naproxen, a non-steroidal, antiinflammatory drug.

Eighty volunteers were studied to determine the effects of 750 or 1000 mg naproxen daily for a week on intestinal permeability, by means of the 51Cr-ethylenediaminetetraacetic acid (EDTA) absorption test. With 750 mg naproxen (n = 42) the median urinary excretion increased from 2.44% to 3.51% (p less than 0.01), and with 1000 mg (n = 38) from 2.26% to 3.39% (p less than 0.01). When the individual pretreatment absorption was included in the analysis, a statistically significant difference was found between the two doses (19% and 68% median increase as a percentage of base line, respectively (p = 0.04)). Similar results were found in 27 subjects who were given both doses of naproxen. Intraduodenal instillation of the test dose in 18 subjects showed that gastric absorption was negligible, and no correlation was found with upper endoscopy findings, changes in orocoecal transit time, or reported symptoms.

Adult↗