Showing papers in "Tidsskrift for Den Norske Laegeforening in 2000"

[Metformin associated lactic acidosis--case reports and literature review].

Abstract: BACKGROUND The use of metformin in the treatment of diabetes mellitus type II is increasing. The drug has several advantageous metabolic effects, and is considered safe if not used in the presence of contraindications, in particular renal failure. MATERIAL AND METHODS We present a patient with metformin associated lactic acidosis, to remind of a potentially lethal adverse reaction. We also review the literature about incidence and risk, prognosis and treatment of the disease. RESULTS Our patient was a 72 year old woman with diabetes mellitus type II treated with metformin, who presented with acute renal failure, severe metabolic acidosis and circulatory failure. Treatment with bicarbonate buffer and vasopressors did not improve her condition, only after hemodialysis was her situation stabilised. INTERPRETATION Metformin associated lactic acidosis must be considered in obscure metabolic acidosis in diabetic patients. The single most important therapeutic approach appears to be immediate hemodialysis.

Resuscitation of newborn infants with room air or oxygen

Abstract: In this article we present results from the Resair 2 study in which we tested whether room air is more efficient than 100% oxygen in newborn resuscitation. Eleven participating centres in Egypt, Estonia, India, Norway, Philippines, and Spain recruited 609 infants who needed resuscitation at birth; of these, 288 were resuscitated with room air and 321 with 100% oxygen. There were no differences between the two groups with regard to outcome. One minute Apgar scores were significantly lower in the oxygen group than in the room air group. Median time to first breath was significantly delayed with 24 seconds in the oxygen group compared with the room air group. It seems that 100% oxygen depresses ventilation in newborn infants. Room air is as safe and efficient as 100% oxygen at least in most cases of newborn resuscitation. Further studies confirming these results are needed before new resuscitation routines are implemented.

Mental impairment in nursing home residents

Abstract: BACKGROUND Nursing homes are the corner stones in long-term institutional care for frail elderly people. Expansion and strengthening of community-based services during the last decade has enabled frail elderly who earlier would have moved into a nursing home to stay in their own home or in service apartments. MATERIAL AND METHODS In a cross-sectional, anonymised study, changes in nursing homes in the city of Bergen between 1985 and 1996/97 were analysed with regard to prevalence of mentally impaired residents. The following items were assessed by nurses who were in daily contact with the residents: mental capacity by means of Clinical Dementia Rating (CDR), activities of daily living (ADL), and behaviour. The study population consisted of 1,296 residents from 21 institutions in 1985 and 1,141 residents from 16 institutions i 1996/97. RESULTS The percentage of mentally impaired residents increased significantly, from 75 to 82, and the percentage of residents who were in need of extended nursing care rose from 87 to 91. The median duration of stay did not change significantly, but was reduced for residents with slight mental impairments (CDR 1), from 871 to 721 days. INTERPRETATION Today, predominately mentally impaired and physically disabled elderly are cared for in general nursing homes. These are patients in need of continuous medical care and supervision, and do not fit into an ideology which "demedicalizes" severe medical conditions in old people. Both nursing homes and sheltered livings are needed.

How does music affect the human body

Abstract: Music therapy has developed its practice and research approaches within a qualitative framework more related to humanistic traditions than to medical science. Music medicine has therefore developed as a separate discipline, endeavouring to incorporate the legitimate therapeutic use of music within a medical framework. This paper argues that more extensive communication and collaboration between the methods developed within the music therapy community, and research based on medical science, could lead to a better understanding of the place of music as a therapeutic tool, both as regards its efficacy and its limits. Research has shown that music may influence central physiological variables like blood pressure, heart rate, respiration, EEG measurements, body temperature and galvanic skin response. Music influences immune and endocrine function. The existing research literature shows growing knowledge of how music can ameliorate pain, anxiety, nausea, fatigue and depression. There is less research done on how music, and what type of music, is utilized and administered specifically for optimum effect in specific clinical situations.

What is burnout

Abstract: BACKGROUND Burnout is most often described as a concept with three separate dimensions: emotional exhaustion, depersonalization (lack of empathy), and reduced accomplishments at work. We wanted to study the descriptive validity of the concept, which may be measured by the Maslach Burnout Inventory. MATERIAL AND METHODS The Maslach Burnout Inventory was mailed to 1,476 members of the Norwegian Medical Association. The response rate was 73%. The dimensional structure of the instrument was examined by principal component analysis, and the identified factors correlated with validated measures of job satisfaction and depression. The dichotomized factors were combined in eight different ways, and the specificity of the resulting types was studied. RESULTS The three original dimensions were reproduced, and the internal consistency of the factors was good (Cronbach's alpha ranging from 0.91 to 0.69). There were high correlations between emotional exhaustion and both job satisfaction (r = -0.54) and depression (r = 0.72). INTERPRETATION Emotional exhaustion seems to be the least specific of the burnout dimensions. For the purpose of reasonable descriptive validity, the burnout notion should be based on both emotional exhaustion and depersonalization. With the applied dichotomization thresholds, this implies that 3% of Norwegian physicians are "burned out".

[Health care systems in the Nordic countries--more similarities than differences?].

Abstract: The aim of this paper is to explore similarities and differences of the Nordic health care systems The analysis is based on a three-part model involving patients, providers and the financing third party In all Nordic countries, about 80% of the funding come from public sources In Iceland, central government is providing most of the health care services, while the county councils are central in Denmark, Norway and Sweden In Finland, the municipalities are providing most of the health care Salary is the only payment system for general practitioners in Iceland, while it is used for some GPs in Finland, Norway and Sweden Capitation in combination with service fees is used for all Danish GPs and the majority of the Finnish, while various fee-for-service systems are used for the others All Nordic countries had global hospital budgeting in the 1980s; since then, Finland, Norway and Sweden have implemented others systems, predominantly combinations of diagnosis-related group financing and global budgets The amounts of resources devoted to health care are about the same in all five countries whether measured by the proportion of GDP devoted to health care, or by hospital beds or doctor/patient ratios In monetary terms, Denmark, Iceland and Norway spend more than Finland and Sweden Despite similar amounts of resources, they are quite differently used across the countries Differences of a factor of two or more are observed for hip operations, gal bladder operations and pharmaceuticals Danes and Finns are very satisfied with their health care system; the Swedes are not All the Nordic countries have increased patient co-payments during the 1990s Finnish patients may pay an extra free to get a one-bed room Finland also has the greatest number of private hospitals Despite all these differences, the Nordic health care systems are quite similar when seen in a global perspective

Guidelines for diagnosis and treatment of acute urinary tract problems in women

Abstract: BACKGROUND Available guidelines for the management of symptoms of lower urinary tract infections (UTI) in women give conflicting recommendations. MATERIAL AND METHODS We searched The Cochrane Library, Medline and other sources for evidence that met explicit inclusion criteria for the relevant options and outcomes identified. The validity of included studies was assessed. Draft recommendations were widely circulated and discussed in focus groups with patients and physician assistants. RESULTS The probability that a woman with dysuria or frequency has bacteriuria, is 80%. The probability of UTI given a negative result of a dipstick test is 50%. Evidence suggests that antibiotics will rapidly relieve symptoms, but there are limited data from placebo-controlled randomised trials. Population based studies show that many women do not visit physicians for symptoms of UTI. Women with symptoms of UTI can be treated with antibiotics without examination of the urine. Women with earlier episodes of UTI can be offered treatment by telephone. Antibiotics for three days is sufficient based on eradication of bacteriuria. Women should be seen by a physician if the symptoms are atypical. INTERPRETATION Implementing these guidelines could result in better service to women with UTIs. More evidence about the effects of antibiotics and other treatments is needed.

Global trends in food consumption and nutrition

Abstract: Obesity and lifestyle diseases increase all over the world, especially in developing countries. One reason is the change in diet. This nutrition transition is characterised by improvement in dietary variation, but also by increase in the content of fat and sugar. The transition seems to start at a lower level of income, compared to what occurred in the Western countries after the Second World War. The reason is that many foods are relatively cheaper, especially fat and sugar. The world market is presently flooded with cheap vegetable fat. Urbanisation leads to over-consumption by increasing market access to fatty and sugary foods, including fast foods. Globalization increases the consumption of sweet soda pops, biscuits and snacks produced by multinational companies. Western supermarkets and fast food franchises also promote these dietary changes (McDonaldization). It has been proposed that the population in developing countries is more vulnerable towards these dietary changes in regard to obesity and chronic diseases, due to undernutrition in early life (the Barker hypothesis). We may therefore expect an unprecedented increase in the prevalence of chronic diseases, especially diabetes type 2 in the developing countries. One may question if this increase will be a transient phenomenon, or if we can expect the same pattern as we have seen in the West, namely that the poor become the fat-test segment of the population, with the highest prevalence of chronic diseases.

[Pseudo-Meigs' syndrome]

Abstract: Cytologic examination of the body cavity effusions in patients with ovarian tumours is performed to differentiate between reactive processes and tumour spread. While detection of malignant cells is a marker of metastatic disease and a sign of bad prognosis, benign effusions affect neither disease stage nor the patient's prognosis. Determination of the presence or absence of tumour spread is based primarily on cellular morphology. As distinction between reactive mesothelial and cancer cells can be difficult, immunocytochemistry may be employed in equivocal cases. The case of a 42-year-old woman who presented with a large pelvic mass accompanied by ascites and hydrothorax is described. Cytomorphology of preoperative pleural fluid specimen was inconclusive. Immunocytochemical examination of cell block sections using: BerEP4, B72.3, CA 125, CD15, CEA, E-cadherin and calretinin was done. No epithelial cells were detected and diagnosis of reactive mesothelial cells was made. Laparotomy was performed and adnexal tumour removed. Borderline mucinous tumour of the ovary was diagnosed. There was no recurrence of the ascites or hydrothorax. The clinicopathologic features and terminology of pseudo-Meigs' syndrome are briefly reviewed. The role of ancillary studies in diagnosis of body cavity effusions is emphasized.

Physical activity for mental health

Abstract: Background About 50% of the population will be affected by a mental disorder during their lifetime; the most common forms are mood and anxiety disorders and abuse of or dependence on drugs or alcohol. The standard forms of therapy are medication and various forms of psychotherapy. The cost of treating disease is escalating, and the health care system will never be able to meet the need for treatment in this large group of patients. Hence, development of effective self help strategies is important. Material and methods In this paper, the scientific basis for promoting exercise as treatment for mental disorders is evaluated on the basis of a review of the literature. Results Beneficial psychological effects of exercise are best documented for mild to moderate forms of unipolar depression and chronic fatigue syndrome; in these disorders, exercise is an alternative to traditional forms of treatment. A therapeutic effect may also be achieved in panic and generalised anxiety disorder, schizophrenia, conversion and somatoform pain disorder, and alcohol abuse and dependence. Interpretation Beneficial effects of exercise are well documented. A simple and inexpensive approach like exercise is helpful and might be important for public health.

[A review of Norwegian studies--how much do we exercise during our leisure time?].

Abstract: Background Low levels of physical activity is associated with major health problems. However, no overview of the level of physical activity outside work or school in Norway has been made, which is important in order to implement targeted interventions. Material and methods Based on published as well as unpublished data, we present data on physical activity in Norway--among children and adolescents, adults and elderly people. Results Results from different studies differ markedly. However, the main findings are these: The level of physical activity increases in childhood up until about 13 years of age. Approximately 70% of adolescents are active two hours or more a week beyond school-hours. The proportion of physical active youngsters then decreases towards young adulthood. Adults and elderly people get more inactive with increasing age. Data on physical activity from the past 10-15 years suggest a slight increase in the proportion of moderately active Norwegians. Interpretation Research on physical activity is impeded by the fact that different studies have operationalized physical activity differently and used different age grouping. There is a need for surveys in representative samples with standardised and validated questions, with uniform age classification, covering the full spectre of physical activity. In addition, we need smaller studies with more comprehensive measures of physical activity in Norway.

Centrally acting muscle relaxants and traffic hazards

Abstract: BACKGROUND: An increasing number of the centrally acting muscle relaxants were withdrawn from the Norwegian market during the 1988-98 period. The only drug in this group now marketed in Norway is carisoprodol. The National Institute of Forensic Toxicology in Norway analyses all blood samples from suspected drugged drivers. In later years there has been a marked increase in the number of blood samples testing positive for carisoprodol or meprobamate (the major metabolite). MATERIAL AND METHODS: 480 cases testing positive for central muscle relaxants in the years 1984-1998 were further studied. RESULTS: Compared with blood samples positive primarily for benzodiazepines, there were more women in the group (39% vs. 15%), and fewer drugs and less alcohol were detected. INTERPRETATION: The positive samples may indicate misuse or abuse due to the fact that high drug concentrations and concomitant use of benzodiazepines were frequent. This knowledge should have implications for doctors prescribing centrally acting muscle relaxants. Language: no

[Psychological, social and economic situation of women surgically treated for cancer].

Abstract: INTRODUCTION As part of an international effort, a study of the psychosocial condition of women with cancer in Norway was performed in 1997. MATERIAL AND METHODS 851 women with breast or gynaecological cancer in 27 Norwegian hospitals were asked to fill in a multi-choice questionnaire. RESULTS 76% of the breast cancers were detected by the women themselves, 19% by mammography and 11% by clinical examination. Similar numbers for gynaecological cancer were 59% by the women and 41% by the doctors (13% screening smear). 25% of the women were informed about the cancer diagnosis by telephone and 9% by letter. 87% were satisfied with treatment and care, 7% dissatisfied. 62% were satisfied with the availability of doctors, 20% not. In 47% of the breast cases, therapy alternatives were discussed with the patients. In 23% of gynaecological, 50% of breast, and 72% of gynaecological cancer, patients had no wish to participate in the decision. 94 of a total of 850 patients (11%) experienced financial problems after the diagnosis had been established. More than 90% of the women had a better or unchanged relation to their partner, family and friends after treatment. However, 30% of the breast and 14% of the gynaecological cancer patients had problems with their body image, and 16% and 15% felt they were less sexually attractive. 89% felt their partner coped well with the situation, 9% had problems and only 2% lost their partner. 32% of the patients had used alternative medicine, 44% of those with recurrence and 28% under primary treatment. INTERPRETATION Women operated for breast and gynaecological cancer face a variety of psychosocial and financial problems.

Examples of the use of music in clinical medicine

Abstract: Music has been an element in medical practice throughout history. There is growing interest in music as a therapeutic tool. Since there is no generally accepted standard for how, when and where music should be applied within a medical framework, this literature study endeavours to present an overview of central areas of application of music in medicine. It further attempts to find tentative conclusions that may be drawn from existing clinical research on the efficacy of music as a medical tool. Traditionally, music has been linked to the treatment of mental illness, and has been used successfully to treat anxiety and depression and improve function in schizophrenia and autism. In clinical medicine several studies have shown analgetic and anxiolytic properties that have been used in intensive care units, both in diagnostic procedures like gastroscopy and in larger operations, in preoperative as well as postoperative phases, reducing the need for medication in several studies. The combination of music with guided imagery and deep relaxation has shown reduction of symptoms and increased well-being in chronic pain syndromes, whether from cancer or rheumatic origin. Music has been used as support in pregnancy and gestation, in internal medicine, oncology, paediatrics and other related fields. The use of music with geriatric patients could prove to be especially fruitful, both in its receptive and its active aspect. Studies have shown that music can improve function and alleviate symptoms in stroke rehabilitation, Parkinson's disease, Alzheimer's disease and other forms of dementia. The role of music in medicine is primarily supportive and palliative. The supportive role of music has a natural field of application in palliative medicine and terminal care. Music is well tolerated, inexpensive, with good compliance and few side effects.

[Students' attitudes toward active euthanasia, assisted suicide and proposed amendments to the penal code].

Abstract: BACKGROUND: Attitude surveys in the Norwegian population show a majority supporting active euthanasia for patients with terminal disease, while among physicians, only a minority do so. MATERIAL AND METHODS: Attitudes towards active euthanasia, assisted suicide and proposed alteration of section 235 (to no penalty for manslaughter on compassionate grounds) and repeal of section 236 (assisted suicide) were surveyed among students of medicine, law and psychology at the University of Oslo (n = 520, response rate 59%). The issue was a patient suffering from a painful, incurable and fatal or non-fatal disease, asking for help to die. RESULTS: 61% of the law students, 59% of the psychology students and 24% of the medical students supported active euthanasia in cases of terminal disease. For assisted suicide, the corresponding percentages were 69%, 64% and 35%, respectively. For alteration of section 235, 72%, 57% and 35% agreed; for repeal of section 236, 52%, 46% and 28%. Among students with a Christian faith, 30% supported active euthanasia in terminal disease and 39% did so for assisted suicide. For students of another faith or without a definable faith, the corresponding percentages were 57% and 65%, respectively. No significant gender difference was observed. Compared to a similar student survey made three years earlier, the results showed a significant decrease in support of active euthanasia of ten percentage points among students of medicine and law, but no change for students of psychology. INTERPRETATION: The study indicates stable and differentiated attitudes towards euthanasia with significantly greater (nearly ten percentage points) support of assisted suicide compared to active euthanasia for both terminal and non-terminal disease. This probably reflects a view of the patient's own right to participate in making decisions in a critical situation.

Giant urinary bladder stone

Abstract: We report a 660 gram stone in the urinary bladder of an otherwise healthy 69 year old male. The stone gave rise to only minor subjective symptoms, but urograms revealed dilatation of both the ureters. The stone was removed by open cystolithotomy. Giant bladder stones are rare in modern urologic practice. In earlier centuries, however, bladder stone formation was a common urinary tract disease with need for surgery. A brief survey of historical lithotomy methods is given.

Outbreak of multiresistant Acinetobacter baumannii infection

Abstract: BACKGROUND Nosocomial infections caused by multiresistant gram-negative bacteria represent an increasing problem, especially among intensive care patients. A serious outbreak of infection caused by multi-resistant Acinetobacter baumannii occurred in four burn patients. Acinetobacter is a gram-negative coccibacilli which is widespread in nature, and has been reported as an increasing problem in critically ill patients. MATERIALS AND METHODS The outbreak strain was introduced from Alicante, Spain, by a transferred patient. This strain was resistant to all commonly available systemic antibiotics (including the karbapenems and all aminoglycosides), and sensitive only to polymyxin B. Two patients were critically ill, one of them died in septic shock. RESULTS The ward was closed for admission of new patients and hygiene precautions were strengthened. Extensive testing of staff and equipment revealed multi-resistant A baumannii on a shower trolley shared by several patients. The outbreak strain was also identified by restriction endonuclease analysis. The patients were kept strictly isolated until their burn wounds were sufficiently healed to allow them to be discharged to their homes. INTERPRETATION Following discharge of the last patient and extensive cleaning and disinfection of the entire ward, the particularly resistant strain has not reoccurred. Still, this experience may warrant screening for multiresistant gram-negative rods in patients transferred from regions where broad resistance to antibiotics is a common problem.

Fysisk aktivitet for sinnets helse

Abstract: Om lag halvparten av befolkningen vil i løpet av livet få en behandlingstrengende psykisk lidelse, som oftest i form av depresjoner, angstlidelser og misbruk eller avhengighet av rusmidler. De vanligst anvendte behandlingsformene er ulike former for samtaleterapi og medikamenter. Kostnadene til behandling øker, og omfanget av lidelsene gjør at helsevesenet aldri kan dekke behandlingsbehovet i befolkningen. Virksomme selvhjelpsstrategier vil derfor være viktige.

[Cancer and religiosity--a follow up of patients with Hodgkin's disease].

Abstract: In this study of religiosity among cancer patients and the relationship between religiosity and illness, a questionnaire was sent to 183 survivors of Hodgkin's disease in November 1995, all of them patients treated at the Norwegian Radium Hospital between 1988 and 1994. 107 patients (58%) gave replies to 45 questions relating to religion and belief, view of life, quality of life, and the relationship between religiosity and illness. The patients' attitude to religion differed little from that of the Norwegian population at large. 15% of the patients defined themselves as atheists, 14% as agnostics, 23% believed in God as an impersonal supreme power, and 48% in a personal God. 40 patients (38%) had changed their religious belief, 33 of them becoming more religious. 58% had prayed to God (or a supreme power) for cure. Half of the respondents felt that their religious belief had been a support during their illness. 52 (49%) were not satisfied with the pastoral services during hospitalisation. The study indicates that cancer disease activates religiosity, and that religiosity may help patients cope with their disease.

Should people with epilepsy exercise

Abstract: Many people with epilepsy, especially those with uncontrolled seizures, live a sedentary life and have low physical fitness. Regular physical exercise may have a moderate seizure preventive effect in 30-40% of the patient population, while in about 10%, strenuous exercise may provoke seizures. Among those prone to exercise-induced seizures there is a preponderance of patients with very poor physical fitness and symptomatic epilepsy. The underlying mechanisms of interaction between epilepsy and physical exercise are mainly unknown. As a general rule, people with epilepsy should be stimulated to participate in recreational and athletic activities. However, as this patient group is highly heterogeneous, counselling on this topic should be individualised and take into account both seizure type and frequency. A distinction may be drawn between three categories: activities with no restrictions, activities with some restrictions, and activities that are not advisable.

Incidence of cancer in individuals with Down syndrome

Abstract: Individuals with Down syndrome have an increased risk of leukaemia, but reliable estimates of the age-specific risk of leukaemia are lacking and very little is known about the risk of solid tumours. We identified 2814 individuals with Down syndrome from the Danish Cytogenetic Register, and linked the data to the Danish Cancer Registry. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated on the basis of age- and sex-specific cancer rates in the general population. Sixty cases of cancer were observed, with 49.8 expected (SIR = 1.20; CI: 0.92-1.55). Leukaemia constituted 60% of the malignancies overall and 97% of the malignancies in children. The SIR for leukaemia varied considerably with age, being 56 (CI: 38-81) at age 0-4 years and 10 (CI: 4-20) at 5-29 years. No cases of leukaemia were observed after age 29. The cumulative risk of leukaemia by the age of 5 years was 2.1% and that by 30 years was 2.7%. Only 24 solid tumours were observed with 47.8 expected (SIR = 0.50; CI: 0.32-0.75). No cases of breast cancer were observed, with 7.3 expected (p = 0.0007). Increased risks of testicular cancer, ovarian cancer, and retinoblastoma were observed but were not statistically significant. The occurrence of cancer in Down syndrome is unique with a high risk of leukaemia in children and a decreased risk of solid tumours in all age groups. The distinctive pattern of malignancies may provide clues in the search for leukaemogenic genes and tumour suppressor genes on chromosome 21.

[UV-B comb versus betamethasone solution in scalp psoriasis].

Abstract: BACKGROUND: The aim of the study was to assess the effectiveness of a UV-B-comb on scalp psoriasis versus betamethasone valerate solution. MATERIAL AND METHODS: Of 44 adult patients with scalp psoriasis, 22 were treated with a dermalight 80 psoracomb and 22 with betamethasone valerate solution, five times a week for three weeks. RESULTS: No difference in effect was found at the end of treatment. Two weeks after end of treatment a higher proportion of patients treated with UV-B-comb (7/22) had remained in remission than those treated with betamethasone valerate solution (3/22; p < 0.05). INTERPRETATION: Treatment with a UV-B-comb offers a good alternative to topical corticosteroids for patients with scalp psoriasis.

Guidelines for diagnosis and treatment of sore throat

Abstract: Background Available guidelines for the diagnosis and treatment of sore throat give conflicting recommendations. Our aim was to develop evidence-based guidelines. Material and methods We searched The Cochrane Library, Medline and other sources for systematic reviews and other evidence that met explicit inclusion criteria for all of the relevant options and outcomes we identified. The validity of included studies was assessed. Draft recommendations based on assessment of this evidence were widely circulated and discussed in focus groups with patients and physician assistants. Results Throat infections are self-limiting and complications rare. Penicillin shortens the duration of symptoms in tonsillitis caused by beta-haemolytic streptococci and reduces the risk of complications. Penicillin has adverse effects and increases the risk of reinfections. Patients with sore throat should usually be treated without antibiotics. Visiting a physician is normally unnecessary. Antibiotics should be considered in serious cases or if the patient prefers this, but should only be prescribed for throat infections caused by beta-haemolytic streptococci. The diagnosis should be based on clinical criteria and a rapid antigen test in cases of doubt. Interpretation Benefits of antibiotics must be weighed against harms. Patients should be given good information and involved in decision-making if they want antibiotics.

Prehospital ECG reduces the delay of thrombolysis in acute myocardial infarction

Abstract: BACKGROUND Thrombolytic treatment substantially reduces mortality and morbidity in acute myocardial infarction. This survival benefit rapidly declines when thrombolysis is delayed. In our department this delay has previously been measured to be 40 (10-360) minutes. It is important to reduce this time loss. MATERIAL AND METHODS From two ambulances, 168 patients ECGs were recorded and transmitted to the coronary care unit (CCU) where they were interpreted by a cardiologist or an internist. Patients with an ECG diagnostic of acute myocardial infarction were taken directly to the CCU by-passing the emergency room. In the CCU the nurses were ready to start thrombolytic treatment once consent was given. RESULTS All 168 ECGs were of excellent quality. 16 of the ECGs transmitted were diagnostic of an acute myocardial infarction. In 15 patients the diagnosis of acute myocardial infarction could be verified on arrival. These were thrombolized at median 15 (8-32) minutes after their arrival at the hospital entrance. INTERPRETATION Pre-hospital recording and interpreting of ECGs can markedly reduce the time delay between the arrival at the hospital and the starting of thrombolysis in patients with ECGs diagnostic of acute myocardial infarction.

Is terminal sedation active euthanasia

Abstract: In order to be able to discuss the issue of whether or not terminal sedation is, or may be conceived of as, a form of help in dying, one needs to be very clear as to the meaning of the terms "help in dying" and "terminal sedation". In this article, we suggest what we take to be detailed and precise definitions of the two forms of voluntary help in dying--euthanasia and physician-assisted suicide. Our definitions (interpretations) basically draw on the Dutch experience and understanding. The Dutch approach implies that acts of abstention, i.e., withholding and withdrawing treatment, and pain and symptom treatment with possible life-shortening effect, including terminal sedation, are to be considered "normal medical practice". Furthermore, death is seen by almost all parties as having natural causes in all of these acts. We also suggest that "palliative sedation" should substitute the expression "terminal sedation". Furthermore, we discuss on what grounds this treatment strategy may be induced, including a presentation of criteria and guidelines that must be met; the issue of documentation of the strategy; palliative sedation in the light of the ethical principle of double effect; and in what way euthanasia could be concealed as palliative sedation. In closing, we comment briefly on the phenomenon of large differences between published cohorts with regard to the frequency of use of palliative sedation. This treatment strategy is open to be challenged both clinically and ethically, and all parties would benefit from a continuous debate over the legitimacy of, and the clinical need for, palliative sedation.

[Hallway patients--consequences or the quality of care and patient integrity].

Abstract: BACKGROUND: Because of the limited capacity in Norwegian hospitals, many patient beds are located in corridors. Does this affect quality of care and patient integrity? MATERIAL AND METHODS: The National Board of Health sent a questionnaire to all Norwegian hospitals with departments of internal medicine (n = 62). The questionnaire had statements on how corridor patients affect quality of care and patient integrity. We asked the head doctor and head nurse to fill in the questionnaire together. 60 questionnaires (97%) were returned. RESULTS: There was 88%-100% agreement to the following statements: Corridor patients reduce quality of care and increase risk of mistakes and accidents. The risk of infections increases. Time spent per patient by doctor and nurse is reduced. These drawbacks affect all patients, but corridor patients the most. The quality of professional and personal conversation is reduced. Some corridor patients do all their personal hygiene in the corridor. Corridor patients' diagnosis can be recognised by passing persons. INTERPRETATION: The results document that having in-patients in corridors has a negative effect on quality of care and patient integrity.