Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · May 2007
[Organization of Norwegian out-of-hours primary health care services].
The organization of out-of-hours primary health care services in Norway is currently changing from municipal-based to larger inter-municipal co-operations with regular employees and improved competence. The Norwegian Medical Association and others have encouraged the establishment of larger out-of-hours primary health care units that include all municipalities and regular GPs and serve the entire population. More data are needed to study the situation for out-of-hours services in Norway. ⋯ We observed distinct variations in the organization of the out-of-hours emergency primary health services in Norway. Some of these differences are due to differences in population density and geographical factors.
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Tidsskr. Nor. Laegeforen. · May 2007
Editorial Biography Historical Article[The profit roundabout].
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Cerebral stroke caused by intracerebral hemorrhage is serious. This review presents updated knowledge about the condition. ⋯ Intracerebral hemorrhage strikes about 1,000 persons in Norway annually. Hypertension is the single most important risk factor. Cerebral CT confirms the diagnosis. Almost half of the patients die during the first month after the hemorrhage, many during the first two days. About 20% of the patients can manage without help after the first six months. Treatment includes measures against increased intracranial pressure and in selected cases surgical evacuation of the haematoma, especially in cases of bleeding into the cerebellum. Recombinant factor VIIa infused within the first three hours to stop the bleeding can play an important role in the acute phase. Patients below the age of 45, patients without hypertension, and patients with lobar haemorrhage and signs of clinical deterioration should be thoroughly investigated to disclose a potential arteriovenous malformation or an aneurysm. Neurointensive care may give better clinical results and the condition should ideally be treated in an intensive care unit.
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Subarachnoid haemorrhage (SAH) causes 3% of all strokes and is caused by a ruptured cerebral aneurysm in four of five cases. This review article presents an update of knowledge on symptoms, diagnosis and management of SAH. ⋯ The mortality of SAH is approximately 50% and one out of three survivors have permanent disabling neurological symptoms. Patients with suspected or diagnosed SAH need urgent examination and treatment. A large randomised multicentre study (International Subarachnoid Aneurysm Trial) suggests that endovascular repair with coiling may be less traumatic than microsurgery. Not all patients are suitable for endovascular treatment, despite new tools like balloon- and stent-assisted coiling. Centres that treat patients with SAH should have both methods available at all hours. The management of these patients involves advanced neuro-intensive care, and co-operation between neurosurgeons, neuroradiologists and neuroanestesiologists.