Michael Hansen-Nord

A review of endocrine changes in anorexia nervosa

Anorexia nervosa is a syndrome of unknown etiology. It is associated with multiple endocrine abnormalities. Hypothalamic monoamines (especially serotonin), neuropeptides (especially neuropeptide Y and cholecystokinin) and leptin are involved in the regulation of human appetite, and in several ways they are changed in anorexia nervosa. However, it remains to be clarified whether the altered appetite regulation is secondary or etiologic. Increased secretion of corticotropin-releasing hormone and proopiomelanocortin seems to be secondary to starvation, however, there is evidence that it may maintain and intensify anorexia, excessive physical activity and amenorrhea. Hypothalamic amenorrhea, which is a diagnostic criterion in anorexia nervosa, is not solely related to the low body weight and exercise. Growth hormone resistance with low production of insulin-like growth factor I and high growth hormone secretion reflect the nutritional deprivation. The nutritional therapy of patients with anorexia nervosa might be improved by administering an anabolic agent such as growth hormone or insulin-like growth factor I. So far none of the endocrine abnormalities have proved to be primary, however, there is increasing evidence that some of these might participate in a vicious circle.

Diurnal variation of the serum leptin concentration in patients with anorexia nervosa

In rodents, leptin is involved in regulating eating behaviour, fat storage, and reproductive function. In humans, the serum leptin concen_tration in obese and normal weight subjects correlates with body mass index, reflecting the body fat store. The serum leptin exhibit diurnal variation, however, this has been reported to be absent in normal weighted amenorrheic athletes. Anorexia nervosa is associated with multiple endocrine abnormalities. Hypothalamic amenorrhoea often precedes the weight loss and may persist after weight recovery. We hypothesized that leptin could be involved in the regulation of eating behaviour and gonadal function in anorexia nervosa.

Nurse tele-consultations with discharged COPD patients reduce early readmissions--an interventional study.

Introduction:  Exacerbations of chronic obstructive pulmonary disease (ECOPD) are the most common cause for admissions and readmissions to medical wards worldwide.

The effect of real-time teleconsultations between hospital-based nurses and patients with severe COPD discharged after an exacerbation

Summary We investigated the effect of daily real-time teleconsultations for one week between hospital-based nurses specialised in respiratory diseases and patients with severe COPD discharged after acute exacerbation. Patients admitted with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) at two hospitals were recruited at hospital discharge. They were randomly assigned to intervention or control. The telemedicine equipment consisted of a briefcase with built-in computer including a web camera, microphone and measurement equipment. The primary outcome was the mean number of total hospital readmissions within 26 weeks of discharge. A total of 266 patients (mean age 72 years) were allocated to either intervention (n = 132) or control (n = 134). There was no significant difference in the unconditional total mean number of hospital readmissions after 26 weeks: mean 1.4 (SD 2.1) in the intervention group and 1.6 (SD 2.4) in the control group. In a secondary analysis, there was no significant difference between the two groups in mortality, time to readmission, mean number of total hospital readmissions, mean number of readmissions with AECOPD, mean number of total hospital readmission days or mean number of readmission days with AECOPD calculated at 4, 8, 12 and 26 weeks. Thus the addition of one week of teleconsultations between hospital-based nurses and patients with severe COPD discharged after hospitalisation did not significantly reduce readmissions or affect mortality.

Evaluation of the optimum dose of growth hormone (GH) for restoring bone mass in adult-onset GH deficiency: results from two 12-month randomized studies.

objective To establish the optimum GH dose for restoring bone mineral density (BMD) in adult‐onset GH deficiency (GHDA).

Studies on clinical isolates of coagulase‐negative staphylococci resistant to methicillin

The in vitro susceptibility to cephalothin and cefuroxime of 195 isolates of methicillin‐resistant coagulase‐negative staphylococci was determined by the agar‐diffusion test, using 7.5% NaCl‐supplemented agar. The distribution of the inhibition zone diameters for isolates of S. epidermidis (S. biotype 1) as well as for S. haemolyticus (S. biotype 4) was trimodal. While 4% of the isolates were found susceptible to cefuroxime, 39% of the S. epidermidis/S. hominis (S. biotype 1) isolates and 34% of the S. haemolyticus (S. biotype 4) isolates were found susceptible to cephalothin by this method. Eight of these isolates (six S. epidermidis, two S. haemolyticus) were selected for susceptibility testing by the tube‐dilution method, together with four isolates (three S. haemolyticus, one S. epidermidis) found resistant to cephalothin by the agar‐diffusion test. The first‐mentioned isolates were all found susceptible to cephalothin with MICs ≤ 2 μg/1, while the last‐named all were resistant with MICs ≥ 16 μg/ml. Population analyses revealed sub‐populations of highly resistant bacteria in all methicillin‐resistant isolates of S. epidermidis (S. biotype 1), as well as in all isolates of S. haemolyticus (S. biotype 4). We thus concluded that methicillin‐resistance in isolates of coagulase‐negative staphylococci implies resistance to cephalosporins and that the difference between S. epidermidis and S. haemolyticus as regards cephalosporin‐susceptibility is quantitative and not qualitative. Eighty‐nine per cent of the 195 methicillin‐resistant isolates in this study were resistant to penicillin and at least one more antibiotic. We therefore think that resistance to penicillin and one or more non‐beta‐lactam antibiotics strongly suggests methicillin‐resistance and that such isolates should be further tested on hypertonic media.

Process driven patient tracks in FAM

Background The Danish hospital reform requires that in future all acute patients be admitted to one common emergency ward (FAM) at hospitals specially designated for receiving them. At these hospitals they will undergo instant treatment irrespective of time of admittance 24/7/365. The challenges the designated acute hospitals face is how to plan the FAM in respect to both medical and physical resources, so that instant initial treatment 24/7/ 365 can be effected, and subsequently determine all the consequences for the rest of the wards.

Tools for Process Optimizing in Emergency Departments

Overcrowding is a universal challenge in emergency departments (ED). In (re)organizing an ED, experience from other “industries” could be taken into consideration. The recommendations are to ensure standardization and focus on flow and logistics. Examples that can be taken into consideration are described. One of the most important things to focus on is to keep the patients, who are not seriously ill, in flow at all times. They are a great challenge to overcrowding, and one has to use skilled staff to deal with this particular group.