Läkartidningen
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Randomized Controlled Trial Comparative Study Clinical Trial
[Femoral nerve block as pain relief in hip fracture. A good alternative in perioperative treatment proved by a prospective study].
Almost 25% of all patients with hip fracture experience temporary confusion pre- and directly postoperatively due to trauma, advanced age, transport between units, and the use of analgesics, 35-50% of the patients suffer temporary or chronic decubitus. Analgesics often lead to nausea. A femoral nerve block can interrupt sensory impulses from the hip joint and provide complete pain relief without affecting the CNS, thus making preoperative care easier and postoperative rehabilitation can be started earlier. 80 consecutive patients with hip fracture were randomized to femoral nerve block or pharmacological treatment only. ⋯ Femoral nerve block provides adequate pain relief, equivalent to pharmacological treatment in most patients. The time for postoperative mobilization was shorter and less temporary confusion was seen. There were no complications in this group, making nerve block a good alternative to traditional pharmacological preoperative treatment for patients with hip fractures.
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Randomized Controlled Trial Multicenter Study Clinical Trial
[Prognosis in unstable coronary artery disease. Multimarker strategy is the best basis for the therapeutic choice].
Patients with unstable coronary artery disease have a serious but variable prognosis. An early and specific prediction of risk is essential for stratification of treatment. Serum was obtained at a median of 9.5 hours from symptom onset in 7800 patients with unstable coronary artery disease included in the GUSTO-IV trial for analyses of creatinine, troponin-T, C-reactive protein (CRP) and N-terminal pro brain natriuretic peptide (NT-proBNP). ⋯ Elevation of NT-proBNP was the strongest predictor of short and long-term mortality with a continuous increase in one-year mortality in relation to the levels. Also reduced creatinine clearance, elevation of CRP, troponin-T, ST-depression and clinical factors indicating a history of cardiovascular disease provided independent prognostic information on long-term mortality. A multimarker strategy with creatinine clearance, troponin, CRP and NT-proBNP together with ischemic ECG changes and clinical background characteristics provides the best prognostic information for choice of treatment in patients with unstable coronary artery disease.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Home care for elderly cancer patients. More intensive follow-up and home services reduce the need of specialist care].
The effects of intensified primary health care were examined in the "Support-Care-Rehabilitation" project conducted in Uppsala county 1993-1997. Intensified primary health care was one part of an individual support intervention and comprised extended information about patients from the specialist clinics, and education and supervision in cancer care for GPs and home care nurses. The aim was to improve the ability of general practitioners and home care nurses to monitor and support cancer patients. ⋯ About 90% of intensified primary health care patients reported such contacts, compared to 26% of control patients. The number of days of hospitalization at the specialist clinics for elderly patients (> or = 70 yr.) randomized to the intervention group were 393 less than for elderly controls three months after diagnosis. The conclusion is that intensified primary health care constitutes a cost-effective strategy for enhancing co-operation between home care, primary health care and specialist clinics.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Spinal blockade is a good alternative in elective cesarean section].
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Randomized Controlled Trial Clinical Trial
[ISIS-2--a study of patients with myocardial infarction. A combination of streptokinase and acetylsalicylic acid diminishes mortality risk, reinfarction and stroke].