Dan Med Bull
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Although falls among the elderly carry high costs to individuals and society, the prevention of falls in later life has not received adequate attention from health care professionals. The prevalence of falls appears to involve roughly one-third of persons aged 65 and over, and the risk of falling and suffering serious injury increases substantially up to the eighth decade of life. The proportion of falls which result in fracture is low, but the absolute number of older people who suffer fractures is high and places heavy demands on health care systems. ⋯ The report underscores that the causes of falls are very different for persons of varying ages, health status, and levels of mobility. While the many risk factors for falls are not yet known, poor health status, especially chronic illness, impaired mobility and postural instability, and a history of prior falls have been associated with the risk of falling. Balance, the ability to prevent falls upon displacement, can be impaired by disease or age-related changes in a number of anatomical structures, by medications which reduce their efficient functioning, and by environmental hazards.(ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative pain relief and respiratory performance after thoracotomy: a controlled trial comparing the effect of epidural morphine and subcutaneous nicomorphine.
Twenty patients scheduled for lateral thoracotomy were randomly allocated to receive either epidural morphine at regular intervals or subcutaneous nicomorphine on demand for postoperative pain relief. The daily dose of opiate administered was greater in the group receiving subcutaneous nicomorphine than in the epidural group although four patients in the latter needed additional subcutaneous injections of opiate. ⋯ No significant difference could be demonstrated between the group;s. The conclusion is that epidural morphine may produce sufficient pain relief after thoracotomy, but compared with conventional pain treatment the benefits are limited.
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The introduction briefly describes the necessity of maintaining a good metabolic control in children with diabetes mellitus. Thereupon, the object of the study is defined, viz. the wish to elucidate glycation of hemoglobin by means of reaction and biokinetic studies and to evaluate the applicability of the glycated hemoglobin fraction HbA1c in the clinical control of children with diabetes mellitus. In the subsequent historical section the most important studies on glycated hemoglobin are reviewed, with a particular view to the formation of this hemoglobin fraction and its clinical applicability. ⋯ In addition, an account is given of the reasons for choosing isoelectric focusing for a further elucidation of the glycation of hemoglobin. Among the results of the present studies it may be mentioned that by using the method of isoelectric focusing for separation of hemoglobin it is possible to: separate HbA1d and HbA1c and to determine the rate and equilibrium constants for the formation and dissociation of these glycated hemoglobin fractions; calculate, by the use of a biokinetic model, that HbA1c reflects the mean blood glucose concentration of the preceding 4 weeks; ascertain that HbA1c is preferable to HbA1 as a parameter for assessing the glycemic control; demonstrate that in children with newly diagnosed diabetes mellitus HbA1c is a useful index for defining the start and cessation of the remission period and for predicting the length of this period; demonstrate that HbA1c in children with diabetes mellitus is positively correlated to the clinical control and negatively correlated to linear growth; demonstrate a seasonal variation in the HbA1c substance fraction which shows the lowest level in the months of June and July; demonstrate that the transport of glucose across the erythrocyte membrane in children with diabetes mellitus is not notably affected by the glycemic control. The final section deals with the possibility whether glycation of hemoglobin and of other proteins can be a contributory cause of long-term diabetic complications.
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A method of tracheal intubation facilitated by using a transtracheal guide-wire is illustrated by three selected case stories. In two cases, the patients were blindly intubated and in the third case, with epiglottitis, the aditus layngis could be identified only by use of the guidewire. Using a laryngoscope and Magill's forceps, intubation was in this case performed without complications. It is suggested that the method applied in cases of difficult intubation may reduce the rate of acute tracheostomies.