Dan Med Bull
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Practice Guideline
Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults.
The nationwide Danish Hernia Database, recording more than 10,000 inguinal and 400 femoral hernia repairs annually, provides a unique opportunity to present valid recommendations in the management of Danish patients with groin hernia. The cumulated data have been discussed at biannual meetings and guidelines have been approved by the Danish Surgical Society. Diagnosis of groin hernia is based on clinical examination. ⋯ In the early convalescence period there are no physical restrictions. These guidelines will also be available at the website for the Danish Hernia Database (www.herniedatabasen.dk). The guidelines will be updated when new substantial evidence becomes available.
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There is increasing evidence to support the use of intravenous lipid emulsion (ILE) in the management of local anaesthetic systemic toxicity (LAST) and non-local anaesthetic lipophilic-drug poisoning. This trend is supported by the Association of Anaesthetists of Great Britain and Ireland's latest guidelines on LAST treatment. Similar national guidelines have yet to be introduced in Denmark. The aim of the present study was to study the adoption of lipid rescue therapy in Denmark. ⋯ Patients with toxic reactions who could potentially benefit from ILE will not be offered lipid rescue therapy in 26 of 34 hospitals (76%)--either because the AA is not aware of this treatment modality, or due to absence of either guidelines or ILE. To improve the availability of lipid rescue therapy, more hospitals need to develop emergency packs containing ILE and guidelines. Introduction of national guidelines on lipid rescue therapy would probably accelerate this process.
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An increasing number of studies have shown that circadian variation in the excretion of hormones, the sleep wake circle, the core body temperature rhythm, the tone of the autonomic nervous system and the activity rhythm are important both in health and in disease processes. An increasing attention has also been directed towards the circadian variation in endogenous rhythms in relation to surgery. The attention has been directed to the question whether the circadian variation in endogenous rhythms can affect postoperative recovery, morbidity and mortality. ⋯ Correlation exists between circadian rhythm parameters and measures of postoperative sleep quality and recovery. However, oral melatonin treatment in the first three nights after surgery, cannot yet be generally recommended for improvement of sleep quality or other recovery parameters based on the available results. It may be indicated in subgroups or if other perioperative treatment algorithms were used, but this has to be investigated in future trials.
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Ph.D. project performed at Copenhagen University Hospital Herlev in the period 2007-2010. ⋯ Body coil acquisition 3T WB-MRA is technically feasible using both a blood-pool and a standard non-specific extracellular contrast agent. However, the method is limited by low sensitivities for arterial stenoses. Hybrid examination technique and use of steady-state MRA are methods of improving WB-MRA. Patient acceptance of WB-MRA is superior to that of DSA. The rationale of using WB-MRA as diagnostic method in PAD patients is shown by the high prevalence of concomitant arterial stenosis outside the peripheral arteries.
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Multicenter Study
Room for improvement in the treatment of hip fractures in Denmark.
Treatment of hip fractures has evolved since the introduction of fast-track surgical programs in the late 1990s. The aim of our study was to describe the quality of treatment and care related to fast-track hip fracture surgery in Denmark by external audit of patient records. ⋯ Although the principles for fast-track surgery have been adapted to some extent at all departments in Denmark with an annual treatment of at least 50 patients with hip fractures, no single department has implemented the whole package. Hospital stay has been reduced since the introduction of fast-track regimes, and improvements were seen in many of the quality indicators. Implications for future practice include better adherence to clinical guidelines, a more homogeneous documentation system in nursing, promotion of evidence-based standards, and improved treatment and care of the physical and psychological consequences of hospitalization.