Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Mar 2001
Review[Abbreviated surgical stay programs--a professional and administrative challenge].
Accelerated surgical stay programs represent a multi-modal, multi-disciplinary concept to reduce postoperative morbidity, hospitalisation and convalescence based upon recent advantages in surgical pathophysiology and pain treatment. Preliminary data from a variety of surgical procedures suggest major improvements in quality of surgical care and cost reduction and call for further controlled or large-size multicenter studies.
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Neuromuscular complications are common in patients treated for sepsis and multiple organ dysfunction in critical care units. Failure to wean from the ventilator, due to involvement of the respiratory system, and severe muscular weakness are typical symptoms. Electrophysiological examination demonstrates fibrillation potentials and reduction of compound muscular action potential amplitudes. ⋯ Critical illness polyneuropathy and myopathy--either as separate or combined entities--are common causes of muscular weakness during treatment of critical illness. These disorders are often difficult to distinguish from each other, as the clinical and electrophysiological findings may overlap. Sepsis and multiple organ dysfunction are the main aetiological factors, but certain drugs may contribute in the pathogenesis. No specific treatment exists. In the most severe cases long-lasting physiotherapy and rehabilitation is needed.
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Tidsskr. Nor. Laegeforen. · Feb 2001
[Organization and management of Norwegian intensive care units].
A survey of organisational and managerial aspects in Norwegian intensive care units (ICU) was made six months after Standards for Intensive Care, a document setting out guidelines for the organisation and management of intensive care units, had been issued by the Norwegian Medical Association to Norwegian hospitals. ⋯ Standards of Intensive Care is poorly known and read by less than half of the respondents. Only a few have started to implement them. Some uncertainty about patient responsibility may exist particularly in secondary and tertiary care hospitals. There seems to be a need for better role clarification and definitions of responsibility for all participants in intensive care, with more focus on organisational and managerial aspects.
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Tidsskr. Nor. Laegeforen. · Feb 2001
[Activities and staffing in intensive care units in Norway--still need of better registration].
Standards in Intensive Care Medicine were approved by the Board of the Norwegian Medical Association in 1997. Their purpose is to clarify issues of responsibility, accountability and management in intensive care units. It also gives recommendations on management, staffing, education and resources. ⋯ It is concluded that staffing and work load in intensive care units are still insufficiently defined and monitored. The training environment for specialists is not optimal.
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Tidsskr. Nor. Laegeforen. · Feb 2001
Review Historical Article[Auscultation of the lungs--still a useful examination?].
Auscultation of the lungs has been a central element in clinical examination since the early part of the nineteenth century. However, the role of the stethoscope in our diagnostic work-up has more and more been challenged by newer diagnostic equipment. ⋯ Electronic stethoscopes and computer-based analysis of digital lung sounds are now available. Lungs auscultation findings should be interpreted with caution and be related to the case history and other clinical findings.