Danish medical journal
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Danish medical journal · May 2012
Practice GuidelineDanish national guidelines for treatment of diverticular disease.
In order to elaborate evidence-based, national Danish guidelines for the treatment of diverticular disease the literature was reviewed concerning the epidemiology, staging, diagnosis and treatment of diverticular disease in all its aspects. The presence of colonic diverticula, which is considered to be a mucosal herniation through the intestinal muscle wall, is inversely correlated to the intake of dietary fibre. Other factors in the genesis of diverticular disease may be physical inactivity, obesity, and use of NSAIDs or acetaminophen. ⋯ When malignancy is ruled out preoperatively, a sigmoid resection with preservation of the inferior mesenteric artery, oral division of colon in soft compliant tissue and anastomosis to upper rectum is recommended. Fistulae to bladder or vagina, or stenosis of the colon may be dealt with according to symptoms and comorbidity. Resection of the diseased segment of colon is preferred when possible and safe; alternatively, a diverting stoma can be the best solution.
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This thesis has reported survival among Danish colorectal cancer patients over the past decades and it has explored different aspects of the inferior short-term and long-term survival of Danish patients in relation to (i) patient factors: old age and comorbidity; (ii) disease factors: prognostic factors for early death after emergency surgery; (iii) diagnostic factors: impact of diagnostic delay; (iv) treatment factors: seasonal variation in postoperative mortality and the benefit of a new approach for management of obstructive cancer; and (v) structural factors: hospital volume and surgeon characteristics. Short-term survival. For colonic cancer, the 30-day relative survival rose from 86% in 1977-1982 to 90% in 1995-1999, and for rectal cancer it rose from 90% to 94% (I). ⋯ Emergency surgery for colonic cancer is associated with an inferior long-term survival. The 5-year survival after acute curative surgery in Denmark is 39% (16). However, the use of SEMS as bridge to elective curative surgery makes it possible to achieve 3-year survival rates similar to those of 75% seen after elective curative surgery for colonic cancer (IX) - despite an unexpectedly high perforation rate.
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Danish medical journal · Apr 2012
Comparative StudyDetection of risk factors for difficult tracheal intubation.
Several studies have identified difficult airway management including a difficult tracheal intubation of patients undergoing general anaesthesia as a major cause of anaesthesia-related morbidity and mortality. Therefore it is presumed that a difficult tracheal intubation is a surrogate marker for morbidity and mortality, and by reducing the prevalence of difficult tracheal intubation then morbidity and mortality will be reduced as well. From the Danish Anaesthesia Database (DAD), we retrieved a cohort of consecutive patients planned and attempted for tracheal intubation by direct laryngoscopy. ⋯ Therefore it seems rational to focus on the development, testing and modification of multivariate models from large scale cohort studies, hereby making the prognostication operational in everyday clinical practice. From there the challenge may be to test the effectiveness of the use of such a model in order to evaluate whether it actually has the capability to reduce difficult tracheal intubation, complications, and mortality. It seems that such a trial should and could be conducted as a cluster randomized trial of anaesthesia departments within the framework of the DAD.
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A cross-sectional study was performed at Rigshospitalet, Copenhagen, a Danish tertiary university hospital, to describe current postoperative pain and nausea treatment with a view to identifying areas with improvement potential. ⋯ not relevant.
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Danish medical journal · Apr 2012
Low confidence among general practitioners in end-of-life care and subcutaneous administration of medicine.
Most terminally ill patients prefer to die at home, and the general practitioner (GP) is central in making this possible. However, knowledge is needed about the GP's level of confidence in assuming this task and with subcutaneous (SC) administration of medicine in end-of-life care. The aim of this study was to determine if GPs used SC needle and medication in end-of-life care, if they felt confident about being principally responsible for palliative trajectories and whether such confidence was associated with GP characteristics. ⋯ Danish General Practitioners' Educational and Development Fund.