Ugeskrift for laeger
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Ugeskrift for laeger · Jun 1997
[Prehospital emergency treatment in the county of Northern Jutland 1993].
As part of the community planning of prehospital treatment in Northern Jutland, a mixed rural and urban region with a population of 500,000 people, we estimated the prehospital treatment in connection with 1617 emergency ambulance services. The investigation included data collected by the ambulance staff, the hospital doctors and review of medical records. The frequency of use of the emergency ambulance per 1000 population was 41 annually, and rapid emergency transport using signals constitutes 65% of call-outs. ⋯ In 60% of the emergency ambulance transports the ambulance staff performed therapeutic efforts, frequently oxygen treatment (34%). In 305 transports the staff would have liked to carry out other forms of prehospital service, most often electrocardiographic-monitoring and treatment of pain. Only a few patients had need of advanced prehospital services but political consideration should be given to the possibility of advanced prehospital service in both rural and urban regions.
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Ugeskrift for laeger · May 1997
Review[Morphine metabolism--pharmacokinetics and pharmacodynamics].
With the increasing use of morphine, growing interest for the clinical implications of its metabolites, morphine-3-glucuronide (M-3-G) and morphine-6-glucuronide (M-6-G) has emerged in the literature. M-6-G binds to the opioid receptor and has analgesic properties in man. Clinical studies have not delivered strong evidence of significant correlation between the concentration of morphine and its glucuronides in plasma and cerebrospinal fluid and pharmacodynamics such as analgesia. ⋯ The role of M-3-G in morphine antagonism and development of tolerance has not yet been settled. As M-3-G and M-6-G are eliminated by the kidneys, renal insufficiency will lead to accumulation of these. Accordingly dosage should be reduced or other opioids be considered in such cases.
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Ugeskrift for laeger · Apr 1997
Comparative Study Clinical Trial Controlled Clinical Trial[Community psychiatric treatment and needs of admission of psychiatric patients. A controlled study 5 years after introduction of a community psychiatric center].
The utilization of the psychiatric in-patient services was evaluated in the intervention district and compared with a selected control district. The number of admissions and in-patient days were similar before admission to the community psychiatric service. ⋯ The findings of other recent studies follow the same pattern. The reduction in in-patient days was significant in the group of schizophrenic patients.
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Ugeskrift for laeger · Mar 1997
Randomized Controlled Trial Clinical Trial[Mask physiotherapy for prevention of pulmonary complications after heart surgery. A controlled study].
The objective of this prospective, consecutive, randomized, controlled study was to investigate the effects of mask physiotherapy on postoperative complications after heart surgery. Sixty-six low-risk male patients undergoing coronary artery by-pass graft surgery were evaluated. The patients were treated with routine chest physiotherapy alone or supplied with either positive expiratory pressure (PEP), or inspiratory resistance-positive expiratory pressure (IR-PEP). ⋯ There was an almost equal decrease and subsequent rise in spirometric and blood gas values in all three groups, but patients treated with the PEP mask had a borderline significantly higher increase in PaO2 from day three to day six compared with patients treated with no mask. There was an almost equal frequency of atelectasis in the three treatment groups. It is concluded that no significant differences in outcome were found between the three groups.
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A questionnaire survey was carried out with the aim of evaluating knowledge about and practice of cancer pain treatment in Denmark. A questionnaire was sent to a 10% random sample of Danish physicians. Of these 1411 physicians, 1068 (76%) returned the questionnaires and after the exclusion of those doctors who never treated cancer patients, 577 (54%) were analyzed. ⋯ Older physicians performed less satisfactorily than did their younger colleagues. Basic pain treatment skills have been acquired by the Danish physicians. However, in the future emphasis should be placed on the treatment of neuropathic pain with coanalgesics and the management of opioid side-effects.