Læknablađiđ
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Multicenter Study Comparative Study
[Old people in the Emergency Department; Icelandic results from the InterRAI multinational ED study].
Old people attend emergency departments (ED´s) in increasing numbers. Old people have age related changes in all organ systems and tend to have multiple chronic diseases, be on multiple medications and often have physical and cognitive functional impairments. Hence, they have complex health and social service needs. The purpose of this study was to describe function and geriatric syndromes of old people who present at Landspitali Emergency Department, Iceland, with comparison to ED´s in six other countries. ⋯ Geriatric syndromes and functional impairment afflicted majority of old people who attended the Landspitali ED. These observations should be taken into account in ED design and care planning for old people to maximize efficiency, safety and quality.
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Due to potential risk of blood transfusions, clinical guidelines emphasize restrictive use of blood components. However, numerous studies indicate that adherence to guidelines is often less than optimal. Furthermore, information regarding use of blood transfusion in intensive care units (ICUs) and compliance to clinical guidelines is lacking. We studied the use of blood components in two adult ICUs in Iceland and the compliance to clinical guidelines. ⋯ One third of patients received blood components during their ICU stay, most commonly RBCs. At least 6% of RBCs, 14% of FFPs and 33% of platelets were not transfused according to recent guidelines at Landspítali. Although our results are in line with findings of other studies it appears that the use of blood components in Icelandic ICUs can be improved. Key words: Blood transfusion, intensive care unit, red blood cells, fresh frozen plasma, platelets, transfusion clinical guidelines.
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Acute kidney injury (AKI) is a common problem in hospitalized patients, requiring extensive treatment and carries a high mortality rate. This study was designed to assess the epidemiology of AKI, and risk factors and outcome of patients with severe AKI in a tertiary care university hospital in Iceland. ⋯ Acute kidney injury is common in Iceland and the prognosis of those with severe AKI is dismal. Majority of those patients were taking drugs that increase risk of AKI, providing a target for preventive measures.
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Cognitive behavioral therapy (CBT) and SSRI/SNRI antidepressants have proven to be effective treatments for anxiety and depression. The gain from combined CBT and antidepressant therapy has in some studies been greater than from monotherapy. Benzodiazepines may interfere with the efficacy of individual CBT-treatment. We examined the effects of SSRI/SNRI antidepressants and the effects of benzodiazepines/z-drugs on the efficacy of group CBT (gCBT) in primary care. ⋯ Group CBT significantly improved symptoms of anxiety and depression in primary care. The improvement was not reduced by concomitant use of SSRI/SNRI antidepressants nor of benzodiazepines/z-hypnotics. The use of such medication is therefore not contraindicated for gCBT participants, at least not short term. Adding SSRIs or SNRIs to gCBT led to greater efficacy in reducing depressive symptom though the efficacy of such combined treatment was less for those who were also prescribed benzodiazepines and/or z-hypnotics.