Danish medical journal
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Danish medical journal · Mar 2015
Blood pressure and arterial stiffness in obese children and adolescents.
Obesity, elevated blood pressure (BP) and arterial stiffness are risk factors for cardiovascular disease. A strong relationship exists between obesity and elevated BP in both children and adults. Obesity and elevated BP in childhood track into adult life increasing the risk of cardiovascular disease in adulthood. ⋯ In perspective, it is reassuring that weight changes are accompanied with a change in 24-hour BP as ambulatory BP is the most precise measure to evaluate the BP burden, and it emphasises the use of 24-hour ambulatory BP measurements in children and adolescents. It is important to recognise, that obese children who recover their normal weight before adulthood will have a similar cardiovascular risk as those who were never obese. Hence, early treatment and prevention of childhood obesity is important because it may prevent irreversible damage to the cardiovascular system.
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Danish medical journal · Mar 2015
Randomized Controlled Trial Multicenter StudyLegislation hampers medical research in acute situations.
Informed consent in incapacitated adults is permitted in the form of proxy consent by both the patients' closest relative (next of kin, NOK) and general practitioner (GP). In research in acute situations not involving pharmaceuticals, Danish legislation allows for randomisation and subsequent proxy consent, as soon as possible. The aim of this study was to describe the delay associated with obtaining consent and to assess whether consent from NOK or GP/Danish Health and Medicines Authority is obtained with delays beyond the intervention. ⋯ This work was supported by the European Regional Development Fund through the Interreg IV A OKS programme (NYPS ID: 167157) with regards to authors JHT, CH, NN and JK.
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Danish medical journal · Mar 2015
Randomized Controlled TrialThe effect of direct referral for fast CT scan in early lung cancer detection in general practice. A clinical, cluster-randomised trial.
This PhD thesis is based on the project "The effect of direct referral for fast CT scan in early lung cancer detection in general practice. A clinical, cluster-randomised trial", performed in Denmark in 2010-2013. The thesis includes four papers and focuses on early lung cancer diagnostics in general practice. ⋯ This thesis contributes to the knowledge of the early diagnosis of lung cancer in Denmark. General practice was found to play an important role, but only a small part of Danish lung cancer patients were diagnosed from general practice through the fast-track pathway. This together with the fact that a high proportion of patients had two or more radiographs within the 90 days preceding the diagnosis indicate that other diagnostic strategies should be tested in an attempt to provide GPs with the best opportunity for early diagnosis. This thesis provides evidence that GPs are, indeed, able to refer patients straight-to-test in the fast-track pathway. This knowledge may be used when organising other fast tracks. Furthermore, GPs participating in education about early lung cancer diagnosis were willing to refer patients direct to low-dose CT (LDCT) from primary care. Half of the patients needed further diagnostic work-up, and 2.3% of all patients referred were diagnosed with lung cancer. In addition, many lung diseases were diagnosed by LDCT. No effect on time to diagnosis or stage at diagnosis was found when patients from intervention GPs were compared with patients from control GPs. The effect of combining direct access to LDCT with referral to the existing fast-track pathway should be analysed as it may ensure earlier and faster lung cancer detection in primary care. Direct access to LDCT scan may also be an alternative to lung cancer screening. Furthermore, if a LDCT screening program is going to be implemented, it should be considered to supplement the program with access to CT directly from primary care for the symptomatic, not-screened patients.
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Danish medical journal · Mar 2015
Faecal retention: a common cause in functional bowel disorders, appendicitis and haemorrhoids--with medical and surgical therapy.
The present studies explored whether faecal retention in the colon is a causative factor in functional bowel disease, appendicitis, and haemorrhoids. Faecal retention was characterized by colon transit time (CTT) after radio-opaque marker ingestion and estimation of faecal loading on abdominal radiographs at 48 h and 96 h. Specific hypotheses were tested in patients (n = 251 plus 281) and in healthy random controls (n = 44). ⋯ A diet rich in fibre and regular physical activity have a therapeutic and preventive effect on colorectal diseases associated with faecal retention. A “common cause” was earlier proposed for constipation, colon diverticula, cancer, appendicitis, and haemorrhoids. The actual results of the present studies support this unifying theory for these diet-related diseases, in which the functional retention of faeces maybe the common cause.
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Danish medical journal · Mar 2015
Practice GuidelineDanish Guidelines 2015 for percutaneous dilatational tracheostomy in the intensive care unit.
Percutaneous dilatational tracheostomy is a common procedure in intensive care. This updated Danish national guideline describes indications, contraindications and complications, and gives recommendations for timing, anaesthesia, and technique, use of fibre bronchoscopy and ultrasound guidance, as well as decannulation strategy, training, and education.