Danish medical journal
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Danish medical journal · Apr 2015
ReviewDanish national sedation strategy. Targeted therapy of discomfort associated with critical illness. Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM).
Sedation of critically ill patients undergoing mechanical ventilation should be minimized or completely avoided. Only in selected situations is sedation indicated as first line therapy (increased intracranial pressure or therapeutic hypothermia). ⋯ If sedation is used a validated sedation scale is recommended. On a daily basis sedation should be interrupted and only restarted after a thorough search for reversible causes of discomfort and stress.
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Danish medical journal · Apr 2015
Comparative StudyDiagnosis and treatment of unexplained anemia with iron deficiency without overt bleeding.
A general overview is given of the causes of anemia with iron deficiency as well as the pathogenesis of anemia and the para-clinical diagnosis of anemia. Anemia with iron deficiency but without overt GI bleeding is associated with a risk of malignant disease of the gastrointestinal tract; upper gastrointestinal cancer is 1/7 as common as colon cancer. Benign gastrointestinal causes of anemia are iron malabsorption (atrophic gastritis, celiac disease, chronic inflammation, and bariatric surgery) and chronic blood loss due to gastrointestinal ulcerations. ⋯ Oral treatment with a 100-200 mg daily dose of elemental iron is recommended (lower dose if side effects), but 3-6 months of oral iron therapy is often required to achieve therapeutic goals. Intravenous iron therapy is used if oral treatment lacks efficacy or causes side effects or in the presence of intestinal malabsorption or prolonged inflammation. Three algorithms are given for the following conditions: a) the paraclinical diagnosis of anemia with iron deficiency; b) the diagnostic work-up for unexplained anemia with iron deficiency without overt bleeding; and c) how to proceed after negative bidirectional endoscopy of the gastrointestinal tract.
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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.
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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.