Nordisk medicin
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The article summarises 22 recommendations for future action regarding medical education that were evolved at the conference in Edinburgh in 1993. The necessity of closer integration between the various phases of medical education was strongly emphasised at the conference.
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Upper gastrointestinal bleeding is often an emergency condition requiring immediate treatment. With the introduction of acute endoscopy, the efficacy of diagnosis and treatment in such cases has been greatly improved. General guidelines for the treatment of upper gastrointestinal bleeding are given in the article.
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Munchausen Syndrome by Proxy (MSbP) in children is a form of child abuse in which a parent (usually the mother) or other care-taker feigns or fabricates disease symptoms in the child, often to the extent of causing serious physical harm, sometimes even resulting in death. Even if the child does not suffer actual physical harm, there is great danger that his or her social and mental development may be jeopardized. Health care personnel risk becoming party to the abuse through exposing the child to unnecessary medical procedures. A case of MSbP involving two siblings is presented in the article, together with a brief summary of current knowledge of the syndrome and measures for its management, emphasising the necessity of close cooperation between paediatrician, child psychiatrist and the social services.
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Infants and even premature neonates, although immature, possess the basic pathways and nociceptors necessary for pain perception. Their responses to painful stimuli are complex, and indicate the presence of central modulating mechanisms. By definition, pain is a subjective experience, but children under the age of three years are unable to communicate their experience. ⋯ In many settings, measurement of different physiological variables are used as indices of pain experience and the effect of intervention. Although the beneficial effect of intervention is well established, it may also have an impact on the possible long-term effects in early childhood. Thorough pain assessment is a prerequisite for successful intervention, and may be improved by introduction of "pain services".