Ugeskrift for laeger
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Management of perioperative treatment with anticoagulants and antiplatelet drugs is a complex medical problem. Careful preoperative evaluation of the risk of bleeding and thromboembolism with and without of antithrombotic therapy is the key prerequisite to secure safe outcome of elective, invasive procedures performed on patients treated with antithrombotic agents. In emergency cases, knowledge of the pharmacokinetics and pharmacodynamics of antithrombotic drugs and of the effect of antidotes and blood-derived, recombinant, and other haemostatic products is important.
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Cardiac patients lack compensatory capacity during bleeding, pain, and infection with an increased risk of perioperative cardiac complications. The mortality following serious postoperative cardiac events is 1400 patients per year in Denmark. ⋯ Information about the patient's heart disease should be available and treatment optimated before surgery and anaesthesia. Evidence-based preoperative risk assessment and perioperative patient care for patients with heart disease and hypertension are summarised.
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Major surgical procedures are still beset with morbidity and hospitalisation. This short survey discusses different pathogenic factors that may contribute to morbidity, with an emphasis on surgical stress responses, pain relief and all-over perioperative care in accordance with the principles of fast-track surgery. It is emphasized that further advances require a multi-disciplinary approach with a focus on process organization and where sufficient quantity is available to secure anaesthesiological, surgical and nursing care expertise.
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Anaesthesia to obese patients is a challenge due to specific changes in respiratory and circulatory functions. Obese patients have a higher risk of acquiring nosocomial infections, including wound sepsis. ⋯ The risk induced from anaesthesia and surgery correlates with comorbidity rather than BMI. Obese patients should not be discriminated against when considering a surgical option.
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Ugeskrift for laeger · Nov 2006
[The quality of diagnosis and procedure coding in Orthopaedic surgery Northern Jutland].
When the aim is for high quality, efficiency and a balanced allocation of resources in health services, there is a constant demand for optimisation of the quality of registration regarding diagnosis, treatment and DRG-values (DRG = Diagnosis Related Groups). Since the mid-nineties the DRG-system has been used to shed light on productivity in Danish hospitals. This study investigates the quality of registrations after the introduction of an organization for registrations in the county of Northern Jutland. ⋯ Locally, there is a need for continuous instruction of both doctors and secretaries regarding correct registration of diagnosis and treatment as well as an improvement of the registration facilities. On a national basis more precise recommendations are required within the medical specialist areas in order to secure an unambiguous registration.