Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Mar 2004
Review[Should patients with severe sepsis be treated with activated protein C?].
Xigris (recombinant human activated protein C) has recently been introduced as a treatment for severe sepsis following a large multicentre trial (the PROWESS trial). ⋯ Although activated protein C may have beneficial effects in some patients with severe sepsis, the effect on different subgroups of patients remains to be clarified. We conclude that there is at present insufficient documentation for a recommendation of activated protein C in patients with severe sepsis.
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Tidsskr. Nor. Laegeforen. · Mar 2004
Multicenter Study Clinical Trial[Severe sepsis treated with activated protein C].
Severe sepsis is a common cause of mortality in critically ill patients. Drotrecogin alfa (activated), synonymous with recombinant human activated protein C (rhAPC), is a new therapeutic tool with anticoagulant, anti-inflammatory and profibrinolytic properties with proven effect in reducing mortality in severe sepsis. ⋯ Treatment with rhAPC is easily carried out in an intensive care unit. Patients with severe sepsis and two or more failing vital organs should be considered for treatment with rhAPC.
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Tidsskr. Nor. Laegeforen. · Mar 2004
[The length of the patient list, waiting lists, workload and job satisfaction among general practitioners in Bergen].
A list patient system was established in Norway in June 2001. Among general practitioners (GPs) there were much concern about workload according to list length, and about uneven distribution of workload among GPs. ⋯ GPs adjust their working hours in order to cope with waiting time. Job satisfaction is lower when the GP has a waiting time of more than three weeks and a full list, factors that could indicate a heavy workload.
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Sepsis is an increasingly common cause of morbidity and mortality and the leading cause of death in intensive care units. In recent years many new therapies for sepsis have been tested in randomised clinical trials, but most of them have failed to reduce mortality. Plasmapheresis is a nonselective method by which plasma is separated from the blood and replaced with donor plasma and/or albumin. The theoretical rationale is that plasmapheresis removes the harmful mediators and replenishes the consumed plasma factors, thus restoring the homeostatic milieu. ⋯ There is not sufficient evidence to justify the use of plasmapheresis as standard treatment of patients with severe sepsis and septic shock. However, plasmapheresis should be considered for fulminant Gram-negative septic shock. If applied, it should be started urgently and repeated in unresponsive patients and when a patient's clinical condition is deteriorating.