Danish medical journal
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Danish medical journal · Dec 2012
Review Comparative StudyThe influence of psychosocial factors on recovery following acute whiplash trauma.
Persistent pain and disability after whiplash trauma has become an increasingly significant problem in many industrialized countries entailing comprehensive individual as well as social costs. The dissertation includes two areas of research within whiplash trauma. The first part contains two empirical articles focusing on risk factors for poor recovery. ⋯ In conclusion, we propose that a complicated interrelationship of various factors before the collision constitutes a pre-disposing vulnerability that may be triggered by the whiplash trauma and act together with multifactorial maintaining factors after the accident in the course of developing persistent pain and disability after whiplash trauma. The findings from our study will make for further research and promote identification of patients at risk and hopefully contribute to preventive interventions and treatment that may decrease impairment in health-related quality of life and persistent symptoms and prevent the social decline that is a risk for some whiplash-exposed. This will in turn result in reduced social and economical costs not only for the individual, but also for society.
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Danish medical journal · Dec 2012
Review Comparative StudyPretherapeutic evaluation of patients with upper gastrointestinal tract cancer using endoscopic and laparoscopic ultrasonography.
A detailed and correct pretherapeutic evaluation of stage and resectability is mandatory for an optimal treatment strategy and results in patients with cancer of the esophagus, stomach or pancreas (UGIC). Curative surgery should only be attempted in patients with limited extent of their disease, patients with locally advanced disease should be allocated for neo-adjuvant therapy, while the remaining patients should be referred for palliative measures following a quick, lenient and correct pretherapeutic evaluation. This thorough evaluation and subsequent treatment assignment is also valuable in the identification of uniform patient cohorts for new treatment protocols as well as for the continuing comparison of research data. But despite the importance of accurate pretherapeutic assessment being repeatedly emphasized insufficient staging has been - and is still accepted as - leading to high rates of explorative surgery as well as heterogeneous selection of patients for new treatment trials. Based on the results from the authors PhD thesis he concluded that endoscopic ultrasonography (EUS) as a single imaging modality provided detailed information that hitherto had been inaccessible. EUS was considered a significant progress regarding the loco-regional assessment of stage and resectability, but it was also evident that EUS alone was incapable of providing all the necessary information. In addition, there were no evidence regarding the EUS safety profile, patient tolerance of the procedure and no data on the clinical impact of both EUS and EUS guided fine-needle aspiration biopsy (EUS-FNA) in UGIC patients. Therefore, the author chose to conduct additional EUS trials and to test the use of EUS-FNA, laparoscopy (LAP), laparoscopic ultrasonography (LUS) and LUS guided biopsy in order to improve the overall pretherapeutic evaluation and thus the patient selection. The aim of this thesis was to describe the sequential development, testing and clinical results of a new pretherapeutic evaluation strategy based on EUS and LUS. ⋯ With the results from the present thesis the author has defined and tested a new evaluation strategy based on the combination of EUS and LUS. This combination was supplemented by EUS and LUS guided biopsies in those situations, where a malignant biopsy would change the subsequent treatment strategy. The combination of EUS and LUS was lenient, safe and cost-effective and at the same time provided additional, important pretherapeutic information regarding possible treatment options and the prognosis. It may be speculated if the improved patient selection has had a positive impact on the prognosis of the R0 resected patients. The combined strategy may also allow a more homogenous selection of patients for future treatment trials.
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Danish medical journal · Dec 2012
Initial, successful implementation of sepsis guidelines in an emergency department.
Early screening and treatment of sepsis can reduce mortality. Region Zealand established guidelines for the diagnosis and treatment of sepsis. We assess an interdisciplinary intervention for implementation of these guidelines at the Department of Emergency Medicine at Nykøbing Falster Hospital from July 2009 to August 2010. ⋯ The intervention had a positive effect on the implementation of guidelines. This effect was reduced one year after the baseline audit, possibly due to a decline in the focus on the intervention and/or personnel turnover in the department.
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Danish medical journal · Dec 2012
Comparative StudyIncreased levels of C-reactive protein and leukocyte count are poor predictors of anastomotic leakage following laparoscopic colorectal resection.
Laparoscopic procedure and fast-track regimen with short post-operative hospital stay are gaining ground in colorectal surgery. The aim of the present study was to determine whether the levels of C-reactive protein (CRP) and white blood cell counts (WBC) have a role as early predictors of post-operative septic complications including anastomotic leakage in patients operated laparoscopically in a fast-track regimen. ⋯ The insufficient diagnostic accuracy of the levels of CRP and WBC made them weak diagnostic markers in prediction of post-operative septic complications, including anastomotic leakage, in the first three post-operative days after laparoscopic colorectal surgery.