Danish medical journal
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Danish medical journal · Mar 2014
Comparative Study Observational StudyNon-invasive ventilation is less efficient in pneumonia than in chronic obstructive pulmonary disease exacerbation.
Non-invasive ventilation (NIV) is especially valid for acute exacerbation in chronic obstructive pulmonary disease (COPD), but the trend has been to use it for all types of patients with acute respiratory failure (ARF). Recent data suggest that treatment failure occurs more often in patients with ARF from pneumonia than from COPD. ⋯ not relevant.
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Danish medical journal · Feb 2014
Randomized Controlled Trial Multicenter StudyIntracoronary and systemic melatonin to patients with acute myocardial infarction: protocol for the IMPACT trial.
Ischaemia-reperfusion injury following acute myocardial infarctions (AMI) is an unavoidable consequence of the primary percutaneous coronary intervention (pPCI) procedure. A pivotal mechanism in ischaemia-reperfusion injury is the production of reactive oxygen species following reperfusion. The endogenous hormone, melatonin, works as an antioxidant and could potentially minimise the ischaemia-reperfusion injury. Given intracoronarily, it enables melatonin to work directly at the site of reperfusion. We wish to test if melatonin, as an antioxidant, can minimise the reperfusion injury following pPCI in patients with AMI. ⋯ This study received no financial support from the industry.
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Danish medical journal · Feb 2014
Randomized Controlled TrialAcute rhinosinusitis (ARS). Diagnosis and treatment of adults in general practice.
The idea behind this thesis is to present how ARS and especially acute maxillary sinusitis in adults is diagnosed and treated in general practice. The study extends over many years, beginning with the first survey in 1991. Based on doctors' answers, we then investigated the diagnostic values of the symptoms, signs and examinations which the doctors reported using. ⋯ The recommended treatment is therefore starting with penicillin V, and at treatment failure switching to amoxicillin with or without clavulanate. It is well known that URTI's can exacerbate a chronic pulmonary disease - like asthma - in allergic patients, but this influence is also demonstrated as described in article 6 where ARS in adults without any sign of chronic lung disease or allergy is accompanied by a temporary reduction lung function. Future research should focus on the use of CRP in general practice, analysing cost-effectiveness of the use of CRP patient outcome in relation to antibiotic treatment, clarification of ARS as a female disease, and a detailed exploration of the relationship between URTI's and impaired lung function in lung-healthy patients.
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Danish medical journal · Feb 2014
Randomized Controlled TrialTreatment and prognosis in peptic ulcer bleeding.
Peptic ulcer bleeding is a frequent cause of admission. Despite several advances in treatment the 30-day mortality seems unchanged at a level around 11%. Use of risk scoring systems is shown to be advantageous in the primary assessment of patients presenting with symptoms of peptic ulcer bleeding. ⋯ These findings are, however, questioned as the studies were based on life-table analysis, unmatched control groups, or did not perform adequate adjustment for comorbidity. Treatment with blood transfusion is, among patients undergoing cardiac bypass surgery, shown to increase the long-term mortality. Despite frequent use of blood transfusion in treatment of peptic ulcer bleeding a possible adverse effect of on long-term survival has not been examined in these patients.
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Danish medical journal · Jan 2014
Randomized Controlled Trial Multicenter Study Comparative StudyHydroxyethyl starch in sepsis.
Hydroxyethyl starch (HES) is a colloid that has been widely used for fluid resuscitation for decades. The newest generation of HES, tetrastarch, was believed to provide an efficient volume expansion without causing the side effects observed with former HES solutions. However, this belief was based on physiological models and small studies rather than on firm clinical evidence. Our aim was to assess the safety and efficacy of tetrastarch in a randomised clinical trial and in a systematic review. ⋯ Our randomised clinical trial is one of several high-quality trials in critically ill patients with and without sepsis that now provide evidence that the use of tetrastarch impairs kidney function and haemostasis and may even increase mortality. Whether the results can be extrapolated to other types of patients is unclear, but so far no group of patients with an overall benefit of HES beyond surrogate markers has been identified. In line with this, the European Medicines Agency's Pharmacovigilance Risk Assessment Committee now recommends that the marketing authorisations of all HES solutions are suspended in the European Union.