Ugeskrift for laeger
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High-quality scientific evidence may be inadequate to support real world decision-making. Assessment of applicability and generalizability of medical scientific evidence is needed for the practitioner. ⋯ We present the difference between efficacy and effectiveness in connection with trial design and encourage critical evaluation of external validity. Pragmatic design of trials can be considered a preferred choice to limit the prevailing gap between current evidence and practice.
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Ugeskrift for laeger · Jul 2015
Review[The use of an inspiratory impedance valve during cardiopulmonary resuscitation does not improve long-term survival or neurologic outcome].
The impedance threshold device (ITD) works by increasing negative intrathoracic pressure, venous return and cardiac output during cardiopulmonary resuscitation. Although animal studies have shown promising results on haemodynamics, randomized studies and metaanalyses in humans have not shown better long-term survival or neurologic outcome. No studies have been done on the use of the ITD during in-hospital cardiac arrest. The ITD combined with active compression-decompression cardiopulmonary resuscitation may result in a better outcome.
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Ugeskrift for laeger · Jul 2015
Case Reports[The Masquelet procedure used after an open femur fracture with infection and osteomyelitis].
The treatment of patients with larger bone defects due to infections, trauma or tumours is a challenge in orthopaedic surgery. In 1986 Alain Charles Masquelet introduced a new technique using a two-step procedure, in which cement and bone-graft is used to reconstruct the defect. The Masquelet procedure is an effective alternative to methods formerly used in Denmark, but is still rarely used and unknown by many. In this case report we present a young woman with a large bone defect due to infection after an open femur fracture, who was successfully treated using this method.
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Ugeskrift for laeger · Jul 2015
Review[Challenges when improving surgical conditions by use of neuromuscular blockade].
Neuromuscular blockade (NMB) may pose a clinical dilemma between surgeons' requirements of muscle relaxation and the risk of residual blockade. This review has aimed at describing the challenges when using NMB for optimizing surgical conditions and reasons for inadequate relaxation despite use of NMB. Interdisciplinary collaboration, proper neuromuscular monitoring, knowledge on differences in pharmacodynamics and pharmacokinetics of NMB are essential factors when optimizing surgical conditions by use of NMB.