Ugeskrift for laeger
-
Ugeskrift for laeger · Sep 1994
Review[Nosocomial pneumonias. The effect of selective intestinal and ventricular decontamination in respirator-treated intensive care patients].
Nosocomial infections, especially pneumonias, are a common problem in Intensive Care Units (ICU) and are a major cause of morbidity and mortality. During the past ten years a new regime, selective decontamination of the digestive tract (SDD) has been introduced to prevent these infections which are often preceded by colonization with aerobic potentially pathogenic microorganisms. Topical antibiotics are applied both orally and by nasogastric tube to prevent secondary endogeneous infections with Gram-negative enteric rods, Staphylococcus aureus and yeasts, in combination with parenteral antibiotics for the treatment of early primarily exogeneous and endogeneous infections. ⋯ This article reviews 11 published randomized trials of SDD in ICU among intubated and artificially ventilated adult patients aged more than 15 years. Of the eleven available controlled studies, eight showed a significant reduction of nosocomial pneumonias among patients who received selective decontamination. Only two studies demonstrated a reduction in infection related mortality rates.
-
Ugeskrift for laeger · Sep 1994
[Anterior lumbar intercorporal spondylodesis. Radiological and functional therapeutic results].
The purpose of this investigation was to identify risk factors in relation to non-union following lumbar intercorporal spondylodesis and to correlate this result with the functional outcome as assessed by the Dallas Pain Questionnaire (DPQ). This comprises questions concerning daily activities, work-leisure activities, anxiety-depression and social interest, measured on visual analog scales. During the period 1979-87 a total of 132 patients were operated with spondylodesis, diagnosed as suffering from spondylolisthesis or disc degeneration. ⋯ In conclusion this investigation demonstrates a success rate of 70% for anterior lumbar interbody fusion. There is a tendency to poorer prognosis for patients with previous spine surgery and age above 45 years. The Dallas Pain Questionnaire correlates significantly to X-ray analysis and seems to be a useful tool for the description of individual biopsychosocial changes following spine surgery.
-
Ugeskrift for laeger · Sep 1994
Multicenter Study Clinical Trial[Pneumonia among patients admitted to intensive care units. An epidemiological multicenter study of APACHE II score, incidence and course].
Pneumonia in patients in intensive care units (ICU) is associated with several diagnostic difficulties and high mortality. This study was conducted to describe the diagnostic procedures and clinical characteristics of the pneumonic and critically ill patient in relation to APACHE II score. The material consisted of 193 patients admitted to seven Danish ICUs and is also included in a European epidemiologic survey (EURO. ⋯ The techniques used to diagnose pneumonia were mainly conventional and did not or only seldom include protected brush, bronchoalveolar lavage or pulmonary biosy. The predominant pathogens isolated in tracheal aspirate were Gram-negative bacilli (50%). The APACHE II scoring system was found to stratify patients with respect to mortality, duration of stay and pneumonia diagnosed in ICU.
-
Ugeskrift for laeger · Aug 1994
Comparative Study[Quality development at an emergency unit--an intervention study based on consumer satisfaction].
A study among the users of an emergency department was carried out to assess user satisfaction, based upon a questionnaire. The study was split into two periods, before and after a change in procedure in the emergency department, namely that a nurse was to give information about waiting time, make coordinations and fix an order of priority of patients (triage) in the waiting room. ⋯ There were no difference between the two groups concerning opinions on information about diagnosis, treatment and outcome, whether there was enough time for examination, treatment and information, whether the staff were obliging or whether their expectations had been fulfilled. It is concluded that such changes in procedure in the emergency department are to be recommended.