Biomedical subjects

T Gjørup

Publications and source records attributed to T Gjørup.

At least 37 records · Page 2Linked to original sources

PubMed1992

Perinatal audit. Are experts biased by knowledge of outcome? A controlled study.

Perinatal audit is a method widely used for quality assurance in medicine. In clinical medicine, experiments have revealed that physicians' prior knowledge and expectations may bias their assessments. This study examined whether experts in perinatal audit were biased in their evaluation of perinatal and neonatal care when they had knowledge of the outcome. A panel of experts evaluated the quality of care in 48 infants who died in the neonatal period and 48 paired infants who survived it. The 48 pairs were randomly allocated to two groups. In the first group, the outcome of neonatal death or neonatal survival appeared in the case histories, whereas in the second group the outcome was blind. There were no differences in the assessment of quality of antenatal, delivery, and neonatal care comparing the result of the evaluation between the cases with knowledge of the outcome and the cases without knowledge of outcome. Our results indicate that the experts were not biased by the knowledge of outcome when they assessed the quality of peri- and neonatal care.

Bias↗

PubMed1991

[Clinical continuing education of younger physicians. A pedagogic trial with postgraduate clinical training using the clinical decision process].

The aim of this study was to improve the clinical training of the staff of a department of internal medicine. A total of 16 clinical pathological conferences with patient demonstrations were given. The doctor in charge of the conference motivated his choice of patient and made a critical review of the clinical decision process according to a 16 item check list. The median time used for planning of the presentation was five hours, range 2.5-8 hours. Sixteen of the participants (94%) found the training programme of very high or high quality while 1 (6%) found it less good. Fifteen (88%) of the doctors indicated higher clinical skill after than before the conferences (p less than 0.01). The registrars revealed a significantly better improvement of their clinical skills than did the senior registrars and consultants (p less than 0.05). The median educational value of the items of the check list was stated to be 1.3 (0-2). Statement of the probability of the final diagnosis of the patient, value judgement in clinical decisions and costs of diagnostic examinations were considered of highest educational value, 1.5-1.6. Postgraduate clinical pathological conferences with patient demonstrations including systematic reviews of the clinical decision process are valuable in the clinical training of doctors.

Clinical Competence↗

PubMed1991

Observer variation in the clinical assessment of the thyroid gland.

In order to evaluate the reliability of clinical assessment of the thyroid gland, two specialists in endocrinology and two younger doctors independently examined 53 patients twice, and assessed whether they had a diffuse goitre, a multinodular goitre, a solitary nodule or a normal gland. In 30% of the patients all four observers were in agreement, whereas in 47% and 23% of the patients, two and three different diagnoses were given, respectively. Inter-observer variation was determined and kappa values between -0.04 and 0.54 were found. Intra-observer variation was smaller, revealing kappa values between 0.44 and 1.00. The present study suggests that clinical assessment of the thyroid gland may lead to misclassification of the type of thyroid disease, and thereby to a less than optimal choice of therapy.

Adult↗

PubMed1991

Accuracy of the clinical assessment of thyroid size.

A number of clinical decisions regarding treatment of thyroid diseases are influenced by the evaluation of thyroid size. In order to evaluate the accuracy of clinically estimated thyroid size, two experienced specialists in endocrinology and two junior doctors independently examined 53 patients. The ultrasonically-determined size was used as standard. An average error of 39% (range 0-566%) was demonstrated, the experienced doctors being more accurate than the younger ones. No relation was found between type of gland and accuracy of clinical estimation. In conclusion, palpation of the thyroid should not be used when an accurate size evaluation is considered of importance, e.g. in the estimation of radioiodine dose.

Adult↗

PubMed1990

[Confidence intervals instead of p-values].

International scientific journals expect authors of articles to an increasing extent to calculate confidence intervals for their statistical findings. Confidence intervals are more informative than p-values in hypothesis testing as the confidence interval expresses how great the value of an investigated effect may be anticipated to be in the population. Examples of calculation of confidence intervals are presented on the basis of data frequently occurring in medical investigations.

Confidence Intervals↗

PubMed1990

Doctors' requirements for reproducibility of diagnostic information.

Two radiologists independently assessed 100 leg vein phlebograms for the presence or absence of deep venous thrombosis. In a subsequent questionnaire, 66 physicians were asked to state the level of agreement they would require to use conventional phlebography in their diagnostic decisions, and whether they would reduce their requirements if the phlebographic technique were made less painful and less expensive. The responses indicated physicians' requirements for reproducibility of a well-known routine diagnostic method may be unrealistic, and that physicians do not consider the inconvenience of an examination to the patient or its cost in setting their requirements for diagnostic precision.

Adult↗

PubMed1990

Observer variation in the scintigraphic diagnosis of solitary cold thyroid lesions.

In order to evaluate the reproducibility of the diagnosis of solitary cold thyroid lesions, two specialists in nuclear medicine and two specialists in endocrinology independently twice read 240 thyroid 99mTc pertechnetate scintigrams. No significant difference or interaction between the results obtained from the right and the left lobe was found. A solitary cold lesion was diagnosed in 100 of the 480 lobes; however, in only 30 did all four observers agree upon the diagnosis. Interobserver variation was determined by pairwise comparison of observers. The observed agreement was between 0.91 and 0.94. After adjusting for expected chance agreement, kappa values between 0.57 and 0.70 were found. Intraobserver variation was smaller than interobserver variation, revealing agreement rates of 0.93-0.96 and kappa values between 0.71 and 0.77. Agreement was related to large lesions, lesions located centrally in the lobe, and ovoid-shaped lesions. Clinicians should be aware to what extent they can rely on the information they use in their decisions. The considerable inconsistency in the evaluation of cold lesions on thyroid scintigrams should be taken into consideration, and calls in question the value of using thyroid scintigrams for deciding whether a patient should be referred for operation or biopsy.

Adolescent↗

PubMed1990

Global assessment of patients--a bedside study. II. Inter-observer variation and frequency of clinical findings.

Three physicians independently assessed 201 hospital in-patients for the presence of 10 basic physical characteristics, and made an overall assessment of whether or not the patients appeared ill. There were significant differences between the physicians in the average number of observations recorded for each patient (P less than 0.001). There was a significant difference (P less than 0.05) between the physicians regarding the number of positive diagnoses of anaemia, abnormal nutritional state, breathing difficulties and the overall assessment. Inter-observer variation was estimated by a pairwise comparison of the three physicians. Overall agreement rates ranged from 0.65 for abnormal nutritional state to 0.99 for presence of pain. After adjusting for random agreement, kappa values between 0.09 (elevated body temperature) and 0.88 (consciousness impaired) were found. No tendency towards a higher level of agreement in the overall assessment than in the basic findings was observed.

Diagnosis↗

PubMed1990

Observer variation in the assessment of scintigraphy of the thyroid gland.

In order to determine observer variation in the assessment of thyroid scintigrams two specialists in nuclear medicine and two specialists in endocrinology independently evaluated 240 thyroid pertechnetate scintigrams twice, and assessed a number of variables concerning size and isotope uptake. The observed agreement between pairs of observers for the variables ranged from 0.70 to 0.98. By the use of the kappa coefficient the observed agreement was adjusted for change agreement. Kappa can variate from -1 (total disagreement) to +1 (perfect agreement). Kappa values between 0.29 and 0.86 were found. In the intraobserver study the observed agreement ranged from 0.83 to 0.99 resulting in kappa coefficients between 0.53 and 0.96. Thus the level of agreement in the present study was "fair to substantial" for agreement in the interobserver part and "substantial to almost perfect" for agreement in the intraobserver part. No difference was found in the level of agreement between the nuclear specialists and the endocrinologists. Although the treatment of patients is based on knowledge of the case histories and clinical and laboratory findings the high degree of observer variation may lead to misclassification of a number of patients with thyroid disease and subsequently a less optimal choice of treatment.

Adolescent↗

PubMed1989

Central hemodynamic changes after ingestion of a meal in patients with coronary artery disease.

Thirty-six patients with coronary artery disease participated in a controlled trial of the influence of food intake on central hemodynamic parameters determined noninvasively by radionuclide cardiography. Stroke volume increased considerably (23%) and heart rate was slightly higher (8%) half an hour after the meal, whereas the elevated cardiac output two hours postprandially could be ascribed entirely to relative tachycardia. No significant hemodynamic changes occurred in the patients who fasted. That the left ventricular ejection fraction was increased postprandially (3% to 4%) indicated that food intake had positive inotropic as well as chronotropic effects on the ischemic heart, even in heart failure. Afterload reduction and increased sympathetic nervous activity contribute to the changes, but the primary mechanism may be a change in resistance and blood flow in the intestinal vascular bed involved in digestion.

Coronary Disease↗

PubMed1989

Forearm oxygen uptake during maximal forearm dynamic exercise.

This study was undertaken in an attempt to determine the maximal oxygen uptake in a small muscle group by measuring directly the oxygen expenditure of the forearm. Five healthy medical students volunteered. The subjects' maximal forearm work capacity was determined on a spring-loaded hand ergometer. Exercise was continued until exhaustion by pain or fatigue. Two weeks later intra-arterial and intravenous catheters were placed in the dominant arm. Blood samples for measurement of oxygen concentration were collected via the catheters. Forearm blood flow was measured by means of the indicator dilution technique. Oxygen uptake was determined according to the Fick principle. The forearm oxygen uptake attained at maximal work loads was a mean of 201 (SD +/- 56) mumol.min-1.100 ml-1. It was impossible at maximal exercise to discern a plateau of the oxygen uptake curve in relation to work output. It is suggested that a plateau in the oxygen uptake curve is not a useful criterion for maximal oxygen uptake in a small muscle group. Skeletal muscle may have an unused capacity for oxygen consumption even at maximal exercise intensity where muscle work cannot be continued due to muscle pain and fatigue.

Adult↗

PubMed1989

The value of the left ventricular ejection fraction in the treatment of angina pectoris following acute myocardial infarction: a randomized double blind study.

Radionuclide determination of left ventricular ejection fraction was performed at hospital discharge and one month later in 60 patients who had suffered acute myocardial infarction. At the first determination, the patients were randomized into two groups. In the first group, the cardiologist who cared for the patients was provided with the result of the determination of the ejection fraction whereas, in the second group, the result was withheld. At a 'blinded' evaluation two months after hospital discharge, 7 of those patients (24%) from the group where the cardiologist knew the ejection fraction and 11 of the patients (38%) in whom this result was withheld complained of angina pectoris on exertion (ns). The medication of the patients did not differ in the two groups. No significant difference was found in the values of the ejection fraction in patients with and without angina pectoris. In this controlled study, we were not able to document a clinical effect by routinely determinating left ventricular ejection fraction in patients with acute myocardial infarction in the treatment of angina pectoris.

Adrenergic beta-Antagonists↗

PubMed1989

Reproducibility in the analysis of multigated radionuclide studies of left ventricular ejection fraction.

The authors determined the reproducibility (the standard deviation [SD]) in the analysis of multigated radionuclide studies of left ventricular ejection fraction (LVEF). Radionuclide studies from a consecutive series of 38 patients suspected of ischemic heart disease were analyzed independently by four nuclear medicine physiologists and four laboratory technicians. Each study was analyzed three times by each of the observers. Based on the analyses of the eight observers, the SD could be estimated by the use of a variance component model for LVEF determinations calculated as the average of the analyses of an arbitrary number of observers making an arbitrary number of analyses. This study presents the SDs for LVEF determinations based on the analyses of one to five observers making one to five analyses each. The SD of a LVEF determination decreased from 3.96% to 2.98% when an observer increased his number of analyses from one to five. A more pronounced decrease in the SD from 3.96% to 1.77% was obtained when the LVEF determinations were based on the average of a single analysis made by one to five observers. However, when dealing with the difference between LVEF determinations from two studies, the highest reproducibility was obtained if the LVEF determinations at both studies were based on the analyses made by the same observer. No significant difference was found in the reproducibility of analyses made by nuclear medicine physicians and laboratory technicians. Our study revealed that to increase the reproducibility of LVEF determinations, special efforts should be made to standardize the outlining of the end-systolic region interest.

Adult↗

PubMed1989

Global assessment of patients--a bedside study. I: The influence of physical findings on the global assessment.

Three physicians selected ten basic physical findings for a study of diagnostic decision making in the global assessment of patients. The physicians independently examined 201 hospital in-patients for the presence of each of the findings and concluded their assessment with a global evaluation of whether the patient appeared ill. Each of the ten findings were used by at least one of the physicians in his overall assessment of the patient. All the observers considered 'looking older than age', 'trouble with breathing', 'cyanosis', and 'anaemia' important, but disagreed in their use of the remaining findings (P less than 0.01). Agreement in the global clinical assessment is an essential prerequisite to uniformity in the approach to the patient.

Adolescent↗

PubMed1989

Plasma concentrations of adrenaline, noradrenaline and dopamine during forearm dynamic exercise.

In six healthy volunteers plasma concentrations of adrenaline, noradrenaline and dopamine were measured at rest and during dynamic forearm exercise at submaximal and maximal intensities. Arterial and venous concentrations of adrenaline and noradrenaline increased with forearm exercise at all workloads. Dopamine concentrations did not change. The increases in adrenaline and noradrenaline were almost linearly related to the increase in heart rate with no levelling off at maximal exercise intensities. It is concluded that dynamic exercise with the forearm muscle group causes a small but significant activation of the sympatho-adrenal system as reflected by increases in plasma concentrations of adrenaline and noradrenaline.

Adult↗

PubMed1988

Cardiac function at rest and during exercise in early and late alcohol intoxication.

Seven healthy men, aged 21 to 30 years, were investigated by radionuclide cardiography at rest and during submaximal exercise at heavy (early) and during declining (late) alcohol intoxication. Control studies, in which alcohol was substituted by an isocaloric, isovolumic drink, were performed on a different day. The left ventricular ejection fraction at rest decreased from 59 to 56% during early intoxication (serum ethanol 35 +/- 6 mmol/l), whereas no change was observed in the ejection fraction during exercise. No significant change was recorded in stroke volume after alcohol consumption as opposed to a small increase after ingestion of the caloric drink. Plasma noradrenaline concentrations were elevated during exercise and early intoxication. During late intoxication (serum ethanol 21 +/- 5 mmol/l) the left ventricular ejection fraction at rest was increased by 7% compared with the baseline value. At rest the heart rate was increased from 68 +/- 7 to 84 +/- 15 beats/min, whereas cardiac output had reverted to the baseline value. Plasma noradrenaline at late intoxication was increased both at rest and during exercise compared with the baseline values. Apart from tachycardia and a reduction in left ventricular volumes during late intoxication no alcohol induced hemodynamic changes occurred during exercise.

Adult↗

PubMed1988

Diagnostic strategy in suspected duodenal ulcer disease. A questionnaire study.

In a questionnaire study of 89 Danish gastroenterologists the current diagnostic strategy in patients suspected of having duodenal ulcer disease was elucidated. A case summary concerning a patient with upper abdominal pain was presented. It was assumed that the patient had had a double-contrast barium meal examination or an upper gastrointestinal endoscopy performed. If the X-ray had revealed a deformity of the duodenal bulb, 30% of the gastroenterologists would offer the patient specific medical treatment (H2-blocking agent etc.), but a significantly higher number of gastroenterologists, 45%, (p less than 0.05) would offer specific medical treatment if a deformity was revealed at endoscopy. There was also a significant difference (p less than 0.01) between those who would offer specific treatment if X-ray (84%) or if endoscopy (100%) had revealed an ulcer. Considerable variation was found among experts in their decisions on the basis of X-ray and endoscopy in patients with suspected duodenal ulcer disease. Gastroenterologists generally rely more on endoscopic than on radiographic findings.

Barium↗

PubMed1988

Reliability of scintigraphic diagnosis of liver metastases.

Three experienced specialists in nuclear medicine independently read 52 liver scans for the presence or absence of metastases. The accuracy of the assessments was, for each of the observers and for the observers' agreed-upon assessments, determined against findings at laparotomy or autopsy. Overall accuracy, predictive values of a positive and negative test result, sensitivity, and specificity were 0.71-0.79, 0.80-0.90, 0.63-0.72, 0.63-0.77, and 0.77-0.91. The accuracy was not higher for the agreed-upon assessment than for each of the observers' assessments. The interobserver variation was calculated as overall agreement between pairs of observers and ranged from 0.85 to 0.94. After adjustment of overall agreement for chance agreement, kappa values from 0.70 to 0.88 were obtained. In the determination of intraobserver variation overall agreement rates and kappa values ranged from 0.90 to 0.94 and 0.84 to 0.88. The scintigraphic diagnosis of hepatic metastases is reliable but, to increase the reliability further, it should be examined whether observer error reflects error in the primary detection of findings in the scans or error in the overall interpretation.

Adult↗