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Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature125355
Source
Scand J Trauma Resusc Emerg Med. 2012;20:28
Publication Type
Article
Date
2012
Author
Charlotte Barfod
Marlene Mauson Pankoke Lauritzen
Jakob Klim Danker
György Sölétormos
Jakob Lundager Forberg
Peter Anthony Berlac
Freddy Lippert
Lars Hyldborg Lundstrøm
Kristian Antonsen
Kai Henrik Wiborg Lange
Author Affiliation
Department of Anaesthesia and Intensive Care, Hillerød Hospital, Denmark. cbar@hih.regionh.dk
Source
Scand J Trauma Resusc Emerg Med. 2012;20:28
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Denmark
Emergency Service, Hospital - statistics & numerical data
Female
Hospital Mortality
Humans
Intensive Care Units - statistics & numerical data
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Patient Admission - statistics & numerical data
Prognosis
Prospective Studies
Regression Analysis
Triage - methods - statistics & numerical data
Vital Signs
Young Adult
Abstract
Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures.
The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, T(vitals), and presenting complaint, T(complaint). The more urgent of the two determines the final triage category, T(final). We retrieved 6279 unique adult patients admitted through the Emergency Department (ED) from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures.
The covariates, T(vitals), T(complaint) and T(final) were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO(2)), respiratory rate (RR), systolic blood pressure (BP) and Glasgow Coma Score (GCS). Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5%) and 'altered level of consciousness' (10.6%). More than half of the patients had a T(complaint) more urgent than T(vitals), the opposite was true in just 6% of the patients.
The HAPT system is valid in terms of predicting in-hospital mortality and ICU admission in the adult acute population. Abnormal vital signs are strongly associated with adverse outcome, while including the presenting complaint in the triage model may result in over-triage.
Notes
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Cites: Resuscitation. 2010 Aug;81(8):932-720637974
Cites: J Emerg Med. 2011 Jun;40(6):623-818930373
Cites: Scand J Trauma Resusc Emerg Med. 2011;19:4221718476
Cites: Ugeskr Laeger. 2011 Oct 3;173(40):2490-321975184
Cites: J Emerg Med. 2010 Jan;38(1):70-918514465
PubMed ID
22490208 View in PubMed
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Aclarubicin plus cytosine arabinoside versus daunorubicin plus cytosine arabinoside in previously untreated patients with acute myeloid leukemia: a Danish national phase III trial. The Danish Society of Hematology Study Group on AML, Denmark.

https://arctichealth.org/en/permalink/ahliterature24824
Source
Leukemia. 1991 Jun;5(6):510-6
Publication Type
Article
Date
Jun-1991
Author
O P Hansen
J. Pedersen-Bjergaard
J. Ellegaard
H. Brincker
A M Boesen
B E Christensen
A. Drivsholm
E. Hippe
H. Jans
K B Jensen
Author Affiliation
Finsen Institute-Rigshospitalet, Department of Hematology L, Copenhagen, Denmark.
Source
Leukemia. 1991 Jun;5(6):510-6
Date
Jun-1991
Language
English
Publication Type
Article
Keywords
Aclarubicin - administration & dosage
Adolescent
Adult
Aged
Amsacrine - administration & dosage
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Chi-Square Distribution
Comparative Study
Cytarabine - administration & dosage
Daunorubicin - administration & dosage
Denmark
Drug Administration Schedule
Etoposide - administration & dosage
Humans
Leukemia, Myelocytic, Acute - drug therapy - mortality
Middle Aged
Regression Analysis
Remission Induction
Survival Rate
Abstract
A regimen of aclarubicin (ACR) of 75 mg/m2 daily for 3 days plus a continuous intravenous infusion of cytosine arabinoside (ara-C) of 100 mg/m2 per day for 7 days was compared with daunorubicin (DNR) 45 mg/m2/day for 3 days plus ara-C for 7 days as first-line chemotherapy of de novo acute myeloid leukemia (AML) in a randomized, nationwide Danish study. A total of 180 patients aged between 17 and 65 years were entered onto the protocol. Patients who achieved complete remission (CR) were given five courses of intensive consolidation therapy consisting of two courses of high dose ara-C, two courses of amsacrine plus etoposide, and one course of DNR plus ara-C. Of 174 evaluable patients, 99 achieved CR. The rate of CR was significantly higher on ACR plus ara-C than on DNR plus ara-C [66% versus 50% (p = 0.043)] and decreased significantly with increasing age. The hematological toxicity was identical for the two regimens. A total of 83 patients entered consolidation therapy. At 4 years, 37% of patients with CR following ACR were still in remission compared with 33% following DNR (p = 0.48), and the total survival at 4 years was 29% versus 20% (p = 0.26). The duration of remission and total survival both decreased with increasing age. ACR plus ara-C seem at least as good or better than DNR plus ara-C as first-line chemotherapy of AML.
PubMed ID
2056774 View in PubMed
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Acute stroke care and rehabilitation: an analysis of the direct cost and its clinical and social determinants. The Copenhagen Stroke Study.

https://arctichealth.org/en/permalink/ahliterature11045
Source
Stroke. 1997 Jun;28(6):1138-41
Publication Type
Article
Date
Jun-1997
Author
H S Jørgensen
H. Nakayama
H O Raaschou
T S Olsen
Author Affiliation
Department of Neurology, Bispehjerg Hospital, Copenhagen, Denmark.
Source
Stroke. 1997 Jun;28(6):1138-41
Date
Jun-1997
Language
English
Publication Type
Article
Keywords
Acute Disease
Aged
Cerebrovascular Disorders - economics - rehabilitation - therapy
Comorbidity
Costs and Cost Analysis
Denmark
Female
Humans
Length of Stay - economics
Male
Regression Analysis
Research Support, Non-U.S. Gov't
Abstract
BACKGROUND AND PURPOSE: Stroke represents a major economic challenge to society. The direct cost of stroke is largely determined by the duration of hospital stay, but internationally applicable estimates of the direct cost of acute stroke care and rehabilitation on cost-efficient stroke units are not available. Information regarding social and medical factors influencing the length of hospital stay (LOHS) and thereby cost is needed to direct cost-reducing efforts. METHODS: We determined the direct cost of stroke in the prospective, consecutive, and community-based stroke population of the Copenhagen Stroke Study by measuring the total LOHS in the 1197 acute stroke patients included in the study. All patients had all their acute care and rehabilitation on a dedicated stroke unit. Neurological impairment was measured by the Scandinavian Stroke Scale. Local nonmedical factors affecting the LOHS, such as waiting time for discharge to a nursing home after completed rehabilitation, were accounted for in the analysis. The influence of social and medical factors on the LOHS was analyzed in a multiple linear regression model. RESULTS: The average LOHS was 27.1 days (SD, 44.1; range, 1 to 193), corresponding to a direct cost of $12.150 per patient including all acute care and rehabilitation. The LOHS increased with increasing stroke severity (6 days per 10-point increase in severity; P
PubMed ID
9183339 View in PubMed
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The additive nonparametric and semiparametric Aalen model as the rate function for a counting process.

https://arctichealth.org/en/permalink/ahliterature188979
Source
Lifetime Data Anal. 2002 Sep;8(3):247-62
Publication Type
Article
Date
Sep-2002
Author
Thomas H Scheike
Author Affiliation
Department of Mathematical Sciences, University of Aalborg, Fredrik Bajers Vej 7G, DK-9220 Aalborg, Denmark. ts@math.auc.dk
Source
Lifetime Data Anal. 2002 Sep;8(3):247-62
Date
Sep-2002
Language
English
Publication Type
Article
Keywords
Data Interpretation, Statistical
Denmark
Humans
Liver Diseases - drug therapy - mortality
Models, Statistical
Regression Analysis
Risk assessment
Survival Analysis
Abstract
We use the additive risk model of Aalen (Aalen, 1980) as a model for the rate of a counting process. Rather than specifying the intensity, that is the instantaneous probability of an event conditional on the entire history of the relevant covariates and counting processes, we present a model for the rate function, i.e., the instantaneous probability of an event conditional on only a selected set of covariates. When the rate function for the counting process is of Aalen form we show that the usual Aalen estimator can be used and gives almost unbiased estimates. The usual martingale based variance estimator is incorrect and an alternative estimator should be used. We also consider the semi-parametric version of the Aalen model as a rate model (McKeague and Sasieni, 1994) and show that the standard errors that are computed based on an assumption of intensities are incorrect and give a different estimator. Finally, we introduce and implement a test-statistic for the hypothesis of a time-constant effect in both the non-parametric and semi-parametric model. A small simulation study was performed to evaluate the performance of the new estimator of the standard error.
PubMed ID
12182121 View in PubMed
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Adherence to national guidelines for initiation of antiretroviral regimens in HIV patients: a Danish nationwide study.

https://arctichealth.org/en/permalink/ahliterature137186
Source
Br J Clin Pharmacol. 2011 Jul;72(1):116-24
Publication Type
Article
Date
Jul-2011
Author
Tonny S Petersen
Stig E Andersen
January Gerstoft
Kristina Thorsteinsson
Carsten S Larsen
Gitte Pedersen
Court Pedersen
Niels Obel
Author Affiliation
Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark. tsp@person.dk
Source
Br J Clin Pharmacol. 2011 Jul;72(1):116-24
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adult
Anti-HIV Agents - administration & dosage
Antiretroviral Therapy, Highly Active - methods - standards
Cohort Studies
Denmark
Drug Administration Schedule
Female
Guideline Adherence
HIV Infections - drug therapy
Humans
Male
Patient compliance
Practice Guidelines as Topic
Regression Analysis
State Medicine
Treatment Outcome
Abstract
To determine the adherence to the national guidelines for start of highly active antiretroviral treatment (HAART) in HIV infected patients.
We used a Danish nationwide cohort of HIV infected patients to calculate the fraction of patients who in the period 1997-2006 started HAART according to the guidelines from The Danish Society of Infectious Diseases. We used Kaplan-Meier tables to estimate time from fulfilling the criteria for start of HAART to initiation of the treatment. Cox regression and logistic regression was used to identify risk factors for delayed initiation of treatment and chance of being included in clinical trials.
The study included 3223 patients, 74% of whom initiated HAART in the study period. Ninety-four% fulfilled the criteria for start of HAART, with minor differences over calendar periods. Ninety-four% initiated a recommended regimen or were included in a clinical trial. Intravenous drug use predicted initiation of a non-recommended regimen and delay in start of HAART, while non-Caucasians were less likely to be included in clinical trials.
In a Western world setting, the adherence to national guidelines for start of HAART can be high. We suggest that simplicity of the guidelines, centralization of treatment and involvement of local clinicians in the development of guidelines are of major importance for high adherence to treatment guidelines.
Notes
Cites: Stud Health Technol Inform. 2008;136:339-4418487754
Cites: Scand J Infect Dis. 2010 Dec;42(11-12):917-2320840000
Cites: Nature. 2009 Sep 17;461(7262):336-919759594
Cites: Antivir Ther. 2009;14(7):995-100019918103
Cites: Health Serv Res. 2000 Mar;34(7):1429-4810737446
Cites: Br J Clin Pharmacol. 2001 Mar;51(3):213-711298066
Cites: J Gen Intern Med. 2001 Sep;16(9):625-3311556944
Cites: Clin Infect Dis. 2003 Mar 15;36(6):803-1112627367
Cites: Med Care. 1994 Mar;32(3):202-138145598
Cites: N Engl J Med. 1994 Nov 17;331(20):1350-37935706
Cites: BMJ. 1998 Sep 26;317(7162):858-619748183
Cites: JAMA. 1999 Jun 23-30;281(24):2305-1510386555
Cites: HIV Med. 2004 Nov;5(6):415-2015544693
Cites: AIDS. 2005 May 20;19(8):815-2215867496
Cites: Scand J Infect Dis. 2005;37(5):338-4316051569
Cites: Cochrane Database Syst Rev. 2006;(2):CD00025916625533
Cites: J Acquir Immune Defic Syndr. 2007 Jan 1;44(1):20-917091020
Cites: Ann Intern Med. 2007 Jan 16;146(2):87-9517227932
Cites: Br J Clin Pharmacol. 2007 Dec;64(6):722-517953721
Cites: HIV Med. 2008 Jan;9(1):47-5618199172
Cites: Ugeskr Laeger. 2008 Feb 25;170(9):740-418307962
Cites: J Acquir Immune Defic Syndr. 2008 Mar 1;47(3):377-8318176324
Cites: JAMA. 2008 Aug 6;300(5):555-7018677028
PubMed ID
21306418 View in PubMed
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Adverse effects of psychosocial stress on gonadal function and insulin levels in middle-aged males.

https://arctichealth.org/en/permalink/ahliterature11406
Source
J Intern Med. 1995 May;237(5):479-86
Publication Type
Article
Date
May-1995
Author
P M Nilsson
L. Møller
K. Solstad
Author Affiliation
Health Sciences Centre, University of Lund, Sweden.
Source
J Intern Med. 1995 May;237(5):479-86
Date
May-1995
Language
English
Publication Type
Article
Keywords
Blood Pressure - physiology
Body mass index
C-Peptide - blood
Cohort Studies
Cross-Sectional Studies
Denmark
Genitalia, Male - physiopathology
Gonadal Steroid Hormones - blood
Humans
Insulin - blood
Insulin Resistance
Male
Middle Aged
Questionnaires
Regression Analysis
Research Support, Non-U.S. Gov't
Respiratory Function Tests
Stress, Psychological - blood - physiopathology
Abstract
OBJECTIVES. To investigate the relationship between gonadal function, insulin and psychosocial stress in middle-aged men. DESIGN. A population-based, cross-sectional, observational study. SETTING. Glostrup Hospital, Copenhagen, Denmark. SUBJECTS. Four hundred and thirty-nine males, all aged 51 years. MAIN VARIABLES. Body-mass index (BMI), waist-to-hip ratio (WHR), insulin, C-peptide, free testosterone, luteinizing hormone (LH), lipids, fibrinogen, lung function tests (FVC, FEV1, PEF), blood pressure, a self-administered questionnaire with questions on psychosocial variables, lifestyle and self-rated health. RESULTS. Free testosterone correlated inversely (P
PubMed ID
7738488 View in PubMed
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Ambient air levels and the exposure of children to benzene, toluene, and xylenes in Denmark.

https://arctichealth.org/en/permalink/ahliterature34102
Source
Environ Res. 1997 Nov;75(2):149-59
Publication Type
Article
Date
Nov-1997
Author
O. Raaschou-Nielsen
C. Lohse
B L Thomsen
H. Skov
J H Olsen
Author Affiliation
Division for Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark. ole@cancer.dk
Source
Environ Res. 1997 Nov;75(2):149-59
Date
Nov-1997
Language
English
Publication Type
Article
Keywords
Air Pollutants, Environmental - analysis - toxicity
Air Pollution, Indoor - adverse effects - analysis
Benzene - analysis - toxicity
Child
Denmark
Environmental Exposure
Environmental health
Female
Humans
Male
Nitrogen Dioxide - analysis - toxicity
Regression Analysis
Reproducibility of Results
Research Support, Non-U.S. Gov't
Rural Health
Toluene - analysis - toxicity
Urban health
Xylenes - analysis - toxicity
Abstract
The aims of the study were to evaluate if the front-door concentrations of benzene, toluene, and xylenes can be used to classify the personal exposures of Danish children and to identify factors that affect their personal exposure. Average concentrations were measured over 1 week with diffusive samplers, and the personal exposures of 98 children and the concentrations outside the front doors of their homes were measured simultaneously. Time and activity patterns were noted in diaries. The front-door concentrations were significantly higher in Copenhagen than in rural areas (all P
PubMed ID
9417846 View in PubMed
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Analysis of the results of the cooperative study between the Granada and Copenhagen University Institutes of Forensic Medicine.

https://arctichealth.org/en/permalink/ahliterature55461
Source
Acta Med Leg Soc (Liege). 1989;39(1):199-202
Publication Type
Article
Date
1989

Analysis of the treatment effect on recurrent bleeding and death in patients with cirrhosis and esophageal varices: multistage competing-risks model compared to conventional methods. The Copenhagen Esophageal Varices Sclerotherapy Project.

https://arctichealth.org/en/permalink/ahliterature206043
Source
J Hepatol. 1998 Jan;28(1):107-14
Publication Type
Article
Date
Jan-1998
Author
B L Thomsen
T I Sørensen
Author Affiliation
Department of Biostatistics, Faculty of Health Sciences, University of Copenhagen, Denmark.
Source
J Hepatol. 1998 Jan;28(1):107-14
Date
Jan-1998
Language
English
Publication Type
Article
Keywords
Denmark
Esophageal and Gastric Varices - mortality - physiopathology - therapy
Follow-Up Studies
Gastrointestinal Hemorrhage - epidemiology - etiology - mortality
Humans
Liver Cirrhosis - complications - mortality
Models, Statistical
Recurrence
Regression Analysis
Risk factors
Sclerotherapy
Time Factors
Abstract
Multiple recurrences of bleeding with high mortality in cirrhosis with esophageal varices have been inadequately analyzed in previous trials. We propose analysis by the multistage competing-risks model, specifying the effect on overall mortality as an effect on mortality during bleeding, rate of cessation of bleeding, mortality rate without bleeding, and rate of rebleeding.
The Copenhagen Esophageal Varices Project enrolled patients after first bleeding and randomized 94 to usual treatment and 93 to sclerotherapy as supplement. During 9-52 months of follow-up, rebleeding occurred in 49 and 42, and death in 68 and 60 patients, respectively. The proportional hazards regression model (Cox model) was used for reanalysis both by the multistage competing-risks model and by conventional analysis for overall mortality and rate of first rebleeding. In the multistage model, time zero was at entry to any new disease stage, of which the first four were analyzed - two bleeding stages and two bleeding-free stages.
The conventional analysis showed a reduction of overall mortality rate in the sclerotherapy group of borderline significance, but no effect on rate of rebleeding. The multistage model indicated that sclerotherapy reduced the rate of rebleeding late in the disease course, and particularly after the first rebleeding. Rate of cessation of bleeding and mortality rates during bleeding and without bleeding were not affected by sclerotherapy.
Conventional analysis may give misleading conclusions, which might be avoided by applying the multistage model. The effect of sclerotherapy on overall mortality may be ascribed entirely to the reduced rate of rebleeding.
PubMed ID
9537847 View in PubMed
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Associated response in bone and lipids during hormone replacement therapy.

https://arctichealth.org/en/permalink/ahliterature182171
Source
Maturitas. 2004 Jan 20;47(1):39-45
Publication Type
Article
Date
Jan-20-2004
Author
Anne Bloch Thomsen
Sandra Silvestri
Jens Haarbo
Claus Christiansen
Nina H Bjarnason
Author Affiliation
Center of Clinical Basic Research, Ballerup Byvej 222, 2750 Ballerup, Denmark. abt@ccbr.dk
Source
Maturitas. 2004 Jan 20;47(1):39-45
Date
Jan-20-2004
Language
English
Publication Type
Article
Keywords
Biological Markers - blood - urine
Bone Density - drug effects
Cholesterol, LDL - drug effects
Denmark
Double-Blind Method
Estradiol - pharmacokinetics - therapeutic use
Estrogen Replacement Therapy - methods
Female
Follow-Up Studies
Humans
Middle Aged
Norpregnenes - pharmacokinetics - therapeutic use
Osteoporosis, Postmenopausal - drug therapy - prevention & control
Progestins - pharmacokinetics - therapeutic use
Prospective Studies
Regression Analysis
Treatment Outcome
Abstract
In postmenopausal women, we investigated if the response in bone mineral density (BMD) was associated with the response in the atherogenic lipid profile during hormone replacement therapy.
We performed an exploratory, post-hoc analysis of data from a prospective double-blind placebo-controlled trial. Healthy postmenopausal women were randomised into five groups, each receiving different combinations of 17 beta-estradiol and gestodene or placebo. A total of 133 women completed the study. The study period was 3 years. The response in bone mass was expressed as the percentage change in BMD from baseline calculated by linear regression from semi-annual measurements. The change in lipid profile was evaluated as the average of three mid-cycle and end-cycle values in percentage from baseline in order to account for cyclic changes during sequential hormone therapy.
A significant correlation between the increase in BMD of the spine and hip and forearm with the decrease in serum low density lipoprotein (LDL) and cholesterol was found. Additionally, the decrease in atherogenic lipids correlated significantly with the response in biochemical bone markers for resorption and formation.
In conclusion, our study shows that it is the same women who have a favourable response in BMD as in the lipid-profile during hormone replacement therapy (HRT). The association is most likely driven by a common response in FSH to exogenous estradiol therapy. This indicates that common denominators for the response to HRT exist. Further studies are needed to explore and identify such predictors.
PubMed ID
14706764 View in PubMed
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244 records – page 1 of 25.