Duodecim; lääketieteellinen aikakauskirja
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Dabigatran has been introduced into the prevention of stroke in patients with atrial fibrillation. Monitoring of the effect and reversing the action of dabigatran as well as management of an emergency operation and bleeding in a patient who is using the drug is demanding. ⋯ There is no antidote for dabigatran, but its effect can possibly be partly reversed with recombinant coagulation factor VIIa and dialysis. With increasing use of dabigatran, more frequent severe bleeding complications and problems in emergency operations are to be expected.
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Referral to a specialist has a significant influence on management of the patient and costs associated with the treatments. However, development and research of the process by which patients are referred has been almost neglected. ⋯ A structured, electronic consultation letter was developed to respond this need. Functionality and interactivity are the key elements of the referral, including (1) an electronic referral letter to a specialist, (2) interactive education in clinical examination and management of shoulder disorders, and (3) an instrument of clinical examination and documentation of shoulder disorders.
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Botulism is caused by botulinum neurotoxin produced by the bacterium Clostridium botulinum. It is a flaccid paralysis in which consciousness and nociception are preserved. ⋯ In the diagnosis and treatment of botulism early suspicion is essential. Several coinciding or local clusters without a typical connecting source, or an uncommon type of toxin may indicate an intentionally caused epidemic.
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Most fractures of the distal radius are treated with closed reduction and casting. Locking plates are the most common method of fixation. In young persons and in elderly persons with functional activity above that of their age level, a <10 degrees dorsal or <20 degrees volar angle of tilt, a radial shortening of <2 mm, a radial inclination of >15 degrees and an intra-articular step-off or gap of <1 to 2 mm are regarded as an acceptable limit of position of the radius. In persons over 65 years of age the functioning of the hand can usually be restored with casting.
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Platelet inhibitors and anticoagulants are called antithrombotic drugs. New platelet inhibitors prasugrel and ticagrelor are more effective than the traditional clopidogrel, but their use is also accompanied by more frequent bleeding complications. ⋯ New anticoagulants are easier to use but clearly more expensive. The use of new anticoagulants is also accompanied by several potential problems that the clinician should be aware of.