Ugeskrift for laeger
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Intensive care contributes to a substantial part of health care expenses. Admission to intensive care units is associated with a high mortality rate and a high risk of long-term disability. ⋯ Lack of knowledge regarding the use of intensive care and long-term outcome as well as the effectiveness and adverse effects of intensive care impede a systematic and evidence-based development and quality improvement. An initiative to establish a Danish national clinical database for intensive care has been launched.
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SIRS, sepsis, severe sepsis, and septic shock are complex syndromes ranging from early signs of infection to multiple organ dysfunction and shock. The reported incidence of sepsis is as high as 35% with mortality rates from 27% to 54% in sepsis and septic shock, respectively. Though aetiology and pathogenesis can vary significantly between septic patients, emphasis has been made to preserve sepsis as a clinical diagnosis ensuring high sensitivity. Since 2001 several new treatment strategies have been implemented, but early diagnosis, optimization of haemodynamics, rapid identification of pathogen and adequate antibiotic treatment are still of the highest importance.
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It is now documented that intensive care units do consider whether treatments promote "the good" and serve patients best. Uncritical use of technology to prolong the dying process must be avoided, and palliative principles worked out. ⋯ However, there are major differences as to how the law is acted upon. Guidelines for futile intensive care treatment should therefore be worked out, and uncritical referral of patients to the ICU avoided.
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Ugeskrift for laeger · Feb 2007
Comparative Study[Post-specialty training program in intensive care medicine. Nordic and European aspects].
Intensive care medicine has become technically and conceptually more demanding in recent years and this has created a need for improved training and education in this field. In Scandinavia a successful post-specialty training program in intensive care medicine was established in 1998 and so far about 200 physicians have passed the two-year program. This program has contributed to an increased interest in and a development of intensive care medicine - both clinically and scientifically - in the five Scandinavian countries (Denmark, Norway, Sweden, Iceland and Finland).
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Intensive care costs are a challenge to the health care system. Because of a political strategy aiming at competition as well as the documentation of treatment quality, cost-effectiveness evaluations are important in order to clarify the association between quality and the costs of treating critically-ill patients. ⋯ The treatment of critically-ill patients aims at improved health. Cost-effectiveness analyses should therefore include quality variables in that the healthcare system is an integral and inseparable part of society.