Danish medical journal
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Danish medical journal · Feb 2016
Review Pragmatic Clinical TrialBenefits and harms of red blood cell transfusions in patients with septic shock in the intensive care unit.
Transfusion of red blood cells (RBCs) is widely used for non-bleeding patients with septic shock in the intensive care unit (ICU). The evidence for effect and safety are limited showing conflicting results and transfused RBCs have the potential to harm subgroups of critically ill patients. Our aim was to assess the benefits and harms of RBC transfusion in patients with septic shock in a randomised clinical trial and to conduct an up-to-date systematic review with meta-analysis of all randomised clinical trials comparing different transfusion strategies. ⋯ The TRISS trial provided evidence for the safe use of 7 g/dl as transfusion trigger in patients with septic shock and reduced the number of units transfused with about half. In line with this, the updated systematic review including data from several recent trials showed no associations with mortality or other adverse events when comparing restrictive to liberal RBC transfusion strategies, however, restrictive transfusion strategies reduce the exposure of patients to RBC transfusions and reduce number of transfused RBC units. Given the fact that liberal transfusion strategies have not been proven beneficial, a more restrictive approach should be considered. Results from the TRISS trial together with other recent trials have the potential to alter the international guidelines for transfusing critically ill patients. Several guidelines have been updated the last years recommending the use of 7-8 g/dl as the ''universal'' trigger level. Patients with acute myocardial ischaemia and patients with acute brain injury may need special considerations.
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Danish medical journal · Feb 2016
ReviewThe road to success. Long-term prognosis for persons living with HIV in Denmark - time trends and risk factors.
The work on this thesis began in 2003 when the global HIV epidemic was out of control. A minority of persons with HIV were benefitting fully from the recently introduced highly efficacious antiretroviral therapy (ART) combinations. Among the global challenges were lack of access to good healthcare, drug toxicity, and emergence of drug-resistant virus. ⋯ This thesis attempted to map some of the many challenges on the road towards increased survival of individuals and populations with HIV up to a level, which today in many settings is close to that of the general population. The studies in this thesis have each paid their modest contribution to show how crucially important it is to be diagnosed in time, to have access to a well-functioning health system, and to keep free of co-morbidity both before and after acquiring HIV. After many years of struggle and despair, and thanks to enormous advances in prevention and treatment, we are now looking towards a promising future.
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Danish medical journal · Feb 2016
Therapeutic hypothermia after cardiac arrest in a real-life setting.
In 2002, two landmark studies concluded that therapeutic hypothermia (TH) improves survival and neurologic outcome in patients with shockable rhythms and out-of-hospital cardiac arrest (OHCA). However, the evidence on whether TH also improves the prognosis in patients with non-shockable rhythms or in-hospital cardiac arrest (IHCA) is sparse. The aim of this study was to assess the prevalence and prognosis of patients with non-shockable rhythms or IHCA after implementation of TH in a real-life setting. ⋯ none.