Ugeskrift for laeger
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In clinical trials a single dose of the N-methyl-D-aspartate (NMDA) receptor antagonist ketamine has shown a rapid antidepressant effect in patients with treatment-resistant depression and bipolar depression. The implications of glutaminergic mechanisms in depression and the rapid effect of a single dose of ketamine could open new pathways to understand the pathophysiology of depression and the development of novel rapid-acting antidepressant drugs.
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All patients with pain who are admitted to hospitals in Denmark must be assessed for levels of pain. However, it is not certain how pain should be measured. ⋯ Furthermore, other suitable methods are compared with VAS. VAS is particularly useful for clinical research, but for daily clinical practice it may be easier to use a numeric rating scale.
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Cirrhosis, ascites and renal impairment are associated with high morbidity and mortality. The hepatorenal syndrome (HRS) is a type of renal failure that affects patients with cirrhosis and ascites. This paper provides an update on evidence-based interventions in HRS. ⋯ The monitoring, prevention, early detection, and correct treatment of these are essential. Terlipressin combined with albumin is the first-line treatment of type 1 HRS. In type 2 HRS with refractory ascites, liver transplantation and TIPS should be considered.
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Ugeskrift for laeger · May 2013
Review[There is a need for further studies exploring the sleep in patients during intensive care unit admission].
We have been reviewing the literature on sleep in intensive care unit (ICU) patients, concluding that lack of normal sleep is a common problem. Polysomnography studies have demonstrated sleep deprivation and fragmentation. ⋯ Mechanically ventilated patients have traditionally been sedated, making sleep scoring unreliable. There is a need for further studies exploring the relationship between circadian rhythm disturbance, sleep disorders, delirium and sedation in ICU patients.
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Ugeskrift for laeger · May 2013
Review[Increase in working hours is an option for improving surgical education in Denmark].
Danish surgeons in training have a 37-hour workweek. These are relatively few hours compared with the hours in England and USA where surgeons have a workweek of respectively 48 and 80 hours. ⋯ Learning outcome may improve if Danish surgeons in training were allowed to work more hours. We suggest a 37 + 11-hour workweek, where 11 hours are reserved for educational purposes.