Ugeskrift for laeger
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The purpose of the paper is to study methods for costing hospital services specifically in relation to multi-unit studies of activity, case-mix, severity-of-illness, outcome, and resource use in adult intensive care units. The article reviews 20 published cost studies of adult intensive care units. The studies are all published in English and are both European and American. ⋯ In addition, the costing methodology applied in the majority of the studies has been wrongly specified in relation to the purpose and the viewpoint of the studies. The article concludes that the methodologies for costing intensive care unit therapy are flawed and fail to provide correct answers. In addition, the study question is in most studies not adequately specified and the cost concept used in the studies is not tailored to the purposes of the studies.
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Ugeskrift for laeger · Jun 1996
Review[Acute respiratory distress syndrome. Pathogenesis and therapy of acute pulmonary failure].
Adult respiratory distress syndrome (ARDS) is the pulmonary response to systemic inflammation precipitated by local or systemic tissue hypoxia, or ischaemia and reperfusion. ARDS is a dynamic, pathological process with a multifactorial etiology. The main clinical manifestations of ARDS are dyspnoea, non-cardiogenic pulmonary oedema, and hypoxia due to increased pulmonary capillary permeability, pulmonary vasoconstriction and diminished pulmonary vascular reactivity. ⋯ For treatment of pulmonary hypertension nitric oxide is useful. Change of position and inhalation with beta2-agonists are therapeutic possibilities. Steroids may be of benefit in the late proliferative phase of ARDS.
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Postoperative pain management in children has been subject to increasing interest during the last decade, but is still insufficient. A survey is presented concerning postoperative pain management in children. The value of monitoring the pain as well as the opioid side effects in children is stressed, and such methods are presented. ⋯ It is concluded that the present insufficient management of postoperative pain in children is not due to the lack of methods and techniques, but rather to lack of sufficient utilization and comprehension of the possibilities. Moreover, pain management in children should be individualised. It is also necessary to be more aware of side effects of the pharmacological treatment.
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Multiple endocrine neoplasia type 2a and 2b (MEN 2a and 2b) are rare diseases, inherited as autosomal dominant traits. The neoplasias in MEN 2a are medullary thyroid carcinoma, pheochromocytoma and hyperparathyroidism. ⋯ This is important as the diseases are inherited and occur in young individuals. In this review, epidemiology, clinical features, diagnosis and treatment are discussed.
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Ugeskrift for laeger · Jan 1996
Review[Invasive ventilation. Classification, technique and clinical experiences with BiPAP/APRV (Biphasic Positive Airway Pressure/Airway Pressure Release Ventilation)].
BiPAP (bilevel or biphasic positive airway pressure) and APRV (airway pressure release ventilation) are new, and from a technical viewpoint closely related techniques recently introduced to the field of invasive ventilatory support. BiPAP/APRV can be described as a pressure controlled continuous high flow positive airway pressure system with a time-cycled change between a high inspiratory pressure level and a lower expiratory pressure level. ⋯ APRV has primarily been investigated in conditions of moderate to severe acute lung injury and it seems that APRV is associated with less detrimental effects on the cardiopulmonary system compared to conventional ventilatory strategies. Apart from a review of the literature the article gives a classification and a technical description of the systems and focuses on the practical approach to BiPAP/APRV, e.g. the initiation and adjustment of respiratory support and the weaning from ventilatory support when applying these techniques.